Regional Anatomy Flashcards
1
Q
2 main joints in the knee
A
- Tibiofemoral joint
2. Patellofemoral joint
2
Q
When in flexion, the patella stays_____.
A
The patella stays still but the tibial condyles move
3
Q
There is ____ change in the distance between the tibial tuberosity and the patella/ But the _____ moves and the ______ unfolds.
A
- No
- Femur
- Suprapatella pouch (synovial)
4
Q
Attachments of the capsule (knee)
A
- Edges of the tibial condyle
- Margins of the patella
5
Q
Are cruciate ligaments intra-synovial or extra-synovial?
A
Extra-synovial
6
Q
Are cruciate ligaments intra-capsular or extra-capsulare?
A
Intra-capsular
7
Q
An infrapatella fat (fat pad) is highly innervated/sensitive and is a good space filler. True or false.
A
True
8
Q
Tibiofemoral joint is __axial
A
Uniaxial
9
Q
What are the two articular surfaces that make up the tibifemoral joint?
A
- Femoral condyles
- Tibial plateau
10
Q
What are the main movements of the tibiofemoral joint?
A
- Flexion-extension in a sagittal plane around a coronal axis
- Some rotation (IR and ER) around vertical axis
11
Q
What allows for the rotation around a vertical axis of the tibiofemoral joint?
A
- Longer articular surface on medial femoral condyle (from A to P)
- Screw-home mechanism
12
Q
What is the screw home mechanism’s function?
A
Allows for extra stability as it locks the knee into extension
13
Q
What is the screw-home mechanism?
A
The discrepancy between the length of surfaces of condyles
14
Q
How does the screw-home mechanism work in extension?
A
EXTENSION + MEDIAL ROTATION
Due to the longer medial condyle from anterior to posterior, when knee is extended, there is medial rotation of the femur on a fixed tibia (eg. sit –> stand)
So most stable as locked in extension
15
Q
How does the screw-home mechanism unscrew in flexion?
A
Need to unlock to get into flexion
Popliteus will pull lateral condyles –> laterally rotate femur –> unlocks knee –> femur and tibia in sagittal plane –> flex
O: latera femoral epicondyle
I: tibia
16
Q
What is the normal frontal plane alignment of the knee?
A
5 degrees anatomical genu valgus
17
Q
What does genu valgus mean?
A
- Medial femoral condyle extends further distally
- Shaft of femur inclined laterally
- Femoral condyles in same transverse alignment
18
Q
What is the benefit of 5 degrees genu valgus?
A
Brings feet closer to midline for bipedal gait
19
Q
What is something that can be determined by the alignment of the femoral condyles in the transverse plane?
A
Orientation of the flexion/extension axis of the knees
- Relative torsion of distal condyles in relation to proximal condyles
Femur torsion= medially rotated
20
Q
The distal portion of the femoral condyle is ___ flat. Anterior and posterior portions are ____ flat. Why?
A
More flat = larger radius of curvature
When in extension (standing), the flat portion articulates with the tibial plateau = more stable
When in fexion, the curve part articulate with the plateau = less stable
21
Q
What is the medial and lateral tibial slope? What is P-line? What is line A-B?
A
Angle between the line P and line A-B
Line P: line perpendicular to long axis of tibial diaphysis
Line A-B: line from anterior tibial peak to posterior tibial peak.
22
Q
What is the function of the meniscus?
A
- Increase congruency (contact area betwene the femoral condyles and the tibial plateau)
- Decreases stress
- Protects articular cartilage
23
Q
What shape is the tibiofemoral meniscus?
A
- Semi-lunar shaped (superior view)
- Wedge-shaped (anterior view)
24
Q
What was the difference between the medial and lateral menisci?
A
- Thinner longer medially and less mobile = less able to move out of way = covers more tibia plateau = has more tibia plateau to cover (cause longer)
- Thicker laterally (to fill condyle space) and more mobile
25
What is meniscus made of? Why?
Fibrocartilage
- Able to withstand shear force
- Protects underlying hyaline cartilage (which withstand compression but not shearing)
26
What are the 5 ligaments of the tibiofemoral joint?
1. Tibia collateral (capsular)
2. Fibular collateral (extracapsular)
3. Anterolateral
4. Anterior cruciate
5. Posterior cruciate
27
What is the function of the tibial collateral ligament (TCL)?
Resist valgus
Superficial (longer and stronger) resist valgus throughout flexion
Deep (shorter) reists anterior translation of tibia too
28
What is the function of the fibular collateral ligament? (FCL)
Resists varus
29
What is the function of the anerolateral ligament (ALL)?
- Resists tibia IR in 30 degrees flexion
| - Anterolateral stability
30
Where does the fibular collateral ligament (FCL) attach?
Femoral lateral epicondyle --> head of fibula
31
Where does the anterolateral ligament (ALL) attach?
Lateral femur --> anterolateral tubercle (Gerdy's tubercle)
32
When does the anterolateral ligament (ALL) tighten?
In flexion and internal rotation of tibia
33
Where does the anterior cruciate ligament (ACL) attach?
Attach to anterior tibia
34
What are the 2 bands of the ACL?
1. Posterolateral band (PLB)- largest, tighest in extension
| 2. Anteromedial band (AMB)- tightens in flexion
35
What does the Anterior cruciate ligament (ACL) resist?
- Anterior translation of tibia on femur
- Posterior translation of femur on tibia
- Rotation stability
- Valgus
- End of range extension
36
What does the Anterior cruciate ligament (ACL) allow?
10 degrees internal and external rotation in 30 degrees flexion
37
What are some injuries of the ACL?
- Often non contact
- Large valgus moment and tibia ER
- Adolescence
- pivoting sports
- females 3-5 x
38
The slope of the tibial plateau has a direct relationship with anterior tibial translation during the transition from non-weightbearing to weightbearing conditions. Why?
Increase tibial slope = increase shear force
ACL prevents tibia from translating anteriorly and femur from translating posteriorly.
39
What does the posterior cruciate ligament (PCL) resist?
- Posterior translation of tibia on femur
40
What are some common injuries of the PCL?
- Dashboard (eg. car injury- knee hits dashboard)
| - Hyperflexion or hyperextension
41
What is a PCL sag test?
PCL deficiency = posterior shift of tibia on femur at 90 degrees flexion
42
What is the patellofemoral joint? Articulations?
Patella --> patella surface of the distal femur
43
In extension, is there contact between the patella and femur?
Little contact
44
In flexion, is there contact between the patella and femur?
Femur moves underneath patella --> Patella and patellar surface come in contact (intercondylar area)
45
Which way does the patella usually dislocate? Why?
Laterally due to the pull of the quadriceps (moves proximally and increases contact)
More flat = more dislocations
46
Translations of the patella in 0-30 degrees flexion
Glides medially
47
Translations of the patella in 30-90 degrees flexion
Glides laterally
48
Rotations of the patella in knee flexion
Tilts laterally
49
How is the line of action and moment arm of the quadriceps group changed with the presence of a patella?
Patella = more strength in quads
It deflects the quads = increased moment arm = more effective = more strength
50
What are 10 structures found in anterior thigh compartment
1. Sartorius
2. Quadriceps femoris
3. Rectus femoris (RF)
4. Vastus lateralis (VL)
5. Vastus intermedius (VI)
6. Vastus medialis longus (VML)
7. Vastus medialis obliquus (VMO)
8. Quadriceps tendon
9. Patella tendon
10. Tibial tuberosity
51
All the quads attach inferiorly on the______?
Tibial tuberosity
52
Rectus femoris has ________ fibres
Bipennate
53
Vastus intermedius has a _____ line of action.
Vertical
54
Action of vastus lateralis
Lateral pull
55
Action of vastus medialis obliquus
Horizontal action
- Only muscle that can offset the lateral pull of the pther quad muscles
- if knee problems exist, work on VMO as an active component to stabilise patella in medial direction
56
Tibial tuberosity IS OR ISN'T quite vulnerable to 2nd ossification (before being ossified)
IS
57
What are 4 structures found in the posterior thigh compartment?
1. Semimebranosus
2. Semitendionsus
3. Biceps femoris long head
4. Biceps femoris short head
58
Action of biceps femoris long head
Hip extension
Knee flexion
Tibial ER
59
Action of bicpes femoris short head
Knee flexion
| Tibial ER
60
Action of semimebranosus and semitendinosus
Hip extension
Knee flexion
Tibial IR
61
What are 2 structures of the posterior leg?
1. Gastrocnemius
| 2. Plantaris
62
Action of gastrocnemius. Insertion?
Crosses knee joint = knee flexion
| Inserts on femoral condyles
63
Function of popliteus
Screw home mechanism is medial rotation of femur on tibia.
Popliteus will laterally rotate femur on tibia to unlcok the extended knee.
64
Where does popliteus attach?
Medial tibia --> Lateral femoral condyle
65
Which structures are found in the medial thigh knee? What 3 muscles does it consist of?
Pes anserinus:
1. Sartorius
2. Gracilis
3. Semitendinosus
66
What are 4 structures that are found in the lateral thigh and knee?
1. Tensor fascia latae
2. Iliotibial band
3. Biceps femoris long head
4. Biceps femoris short head
67
What is the Iliotibial band (ITB)?
Thickening of TFL (ligament/tendon)
68
What is tensor fascia latae (TFL)?
Small muscle which attaches inferiorly to the long thick strip of fascia, known as the iliotibial band (ITB).
69
Where does the ITB attachment inferiorly?
Gerdy's tubercle
70
What is the function of the ITB?
Resists varus forces
71
In standing, the anterior tibia is under tension or compression?
Tension
72
In standing, the posterior tibia is under tension or compression? Why?
Compression.
| - The posterior muscle bulk is greater
73
What is a tibial stress fracture? How does it occur?
Repeated loading with insufficient time for recovery
74
Where do 90% of tibial stress fractures occur? Why?
Posteriomedial
- The junction between the proximal 2/3 and the distal 1/3
- It is the narrowest part of bone
75
Where is another common area for a tibia stress fracture other than posteromedial tibia? Better or worse?
Anterior cortex
Worse and can have serious consequences
- poor blood supply.
- bone responds to compression force to stimulate bone to produce bone cells
so when bone breaks = less compression stimulus = less ability to heal
76
What is the degree of external tibial torsion?
20-40 degrees
77
What is external tibial torsion?
The distal parts are laterally rotated with respect to condyles
78
How many tarsals, metatarsals, phalanges?
7 tarsals
5 metatarsals
5 phalanges
79
Explain a heel strike?
When walking,
Land on lateral heel but weight is medially --> Foot pronates --> weight goes to 1st/2n MTP and hallux
80
What 2 bones make up the hindfoot?
1. Calcaneus
| 2. Talus
81
What bones make up the midfoot?
All tarsal bones except calcaneus and talus
82
What bones make up the forefoot?
Metatarsals and tarsals
83
What bones make up the 1st ray?
1st MT and medial cuneiform
84
What bones make up the 2nd ray?
2nd MT and intermediate cuneiform
85
What bones make up the 3rd ray?
3rd MT and lateral cuneiform
86
What bone make up the 4th ray?
4th MT
87
What bone makes up the 5th ray?
5th MT
88
Why is a navicular stress fracture not ideal?
Central zone of hypovascularity
89
How does a navicular stress fracture occur?
Medial and lateral compressive forces though 1st and 2nd ray (both sides of the navicular)
90
What are the 3 functions of the arches of the foot?
1. Shock absorption (weight bearing)
2. Energy return wen locomotion (spring back)
3. Protection for neurovascular structure and intrinsic foot muscles (4 layers)- won't be compressed
91
What bones does the medial longitudinal arch consist of?
- Talus
- Calcaneus
- Navicular
- Medial cuneiform
- 1st MT
92
Which bones does the lateral longitudinal arch consist of?
- Calcaneus
- Cuboid
- 5th MT
93
What bones does the transverse arch consist of?
From medial to lateral
- Head of talus
- Cuneiforms
- Cuboid
94
Which longitudinal arch is longer? Medial or lateral?
Medial
95
What are 4 passive structures that support the arches of the foot?
1. Plantar aponeurosis (Medial calcaneal tuberosity to metatarsal phalangeal joints, thickening of the fascia)
2. Long plantar ligament
3. Short plantar ligament
4. Spring ligament (support the head of talus)
96
How is calcaneus specialised for weight bearing?
- Thin cortical shell around sparse trabecular bone
- Trabecular bone --> shock absorption. Bone marrow and blood --> Hydrodynamic shock absorber
- Calcaneal fat pad returns 70% energy into locomotion
97
What are 3 extrinsic active structures that support the arches of the foot? Attachments?
1. Tibialis anterior (coming down over the medial aspect will attach to medial cuneiform and base of first metatarsal. On medial inferior aspect)
2. Tibialis posterior (coming down under the foot, most of the insertion on navicular and medial cuneiform so many connections widely spread)
3. Fibularis longus
(comes down on the lateral malleolus, under the cuboid and crosses the sole of the foot on plantar aspect and insert onto the same bones as tibialis anterior)
98
What is 1 intrinsic active strcuture that supports the arches of the foot?
Abductor hallucis longus
99
How many bones articulate with the tibia distally?
2 bones
1. Fibula
2. Talus
100
What ligament resists the talus when it is forced down medially?
Spring ligament
101
What is the plantar fascia?
1Plantar fascia is a very specialised structure. Very tough structure, twice the tensile strength of other plantar ligaments very rich in proprioception.
Arises: Medial calcaneal tuberosity
Inserts: Onto capsules of all MTP joints
102
What tenses the plantar fascia?
When you go into MTP extension and when gastrocnemius and soleus pull superiorly on calcaneus, plantar flexing it.
Plantar fascia functions to hold the foot rigid for push off
103
What is the ankle joint also known as?
Talocrural joint
104
What articulates in the talocrural joint?
Talus + tibia/fibula
1 tarsal bone articulates with 2 bones of leg
105
What kind of joint is the talocrural joint? What movement does it produce?
Synovial hinge joint
| Dorsiflexion and plantarflexion
106
Pronation of the foot is a combination of____?
Dorsiflexion
Eversion
Abduction
"flat feet"
The tarsal bones are more mobile = good = usually unsure surface
107
Supination of the foot is a combination of ___?
Plantarflexion
Inversion
Adduction
108
What plane is DF/PF in?
Sagittal plane
109
What plane is adduction/abduction of the foot in?
Transverse plane
110
What plane is inversion/eversion of the foot in?
Coronal plane
111
Tarsal bones are more mobile in supination or pronation? Why?
Pronation.
Used on unsteady surface
112
Explain the movements of the foot in gait (Landing --> pushing off)
Land on posterolateral heel --> pronate foot to transfer weight to the anterior/medial side for shock absorption (adaptation of --> midstance --> supination --> ridged --> push off
113
Is the distal tibiofibular joint a synovial joint or not?
No- is a syndesmosis
114
Is the distal radioulnar joint a synovial joint or not?
Yes- synovial gliding joint
115
Distal tibiofibular joint is supported by what ligaments? Why is the stability of this joint so important?
- Anterior tibiofibular ligament
- Posterior tibiofibular ligament
- Interosseous membrane
Forms the superior part of the talocrual joint (dome of the talus + tibia and fibula)
116
The dome of the talus is widest anteriorly. What could that mean?
So when you are in planter flexion --> narrowest part articulating with tibia and fibula
When you are is dorsiflexion --> widest part articulating with tibia and fibula
Therefore, dorsiflexion --> closed pack.
117
What type of movement is pronation and supination of the foot?
Triplanar
118
What is the subtalar joint?
Talus and calcaneus
Separates vertical leg & talus with rest of the foot at 90 degrees = links movement
119
How many articulations are there in the subtalar joint? What/where are they?
3 articulations
1. Anterior
2. Middle
3. Posterior
120
What movements does the subtalar joint allow?
Supination and pronation
121
What is function of the subtalar joint?
Translates movements from foot to the leg (vice versa)
122
When a foot pronates, does it IR or ER the tibia?
Tibial IR
123
When a foot supinates, does it IR or ER the tibia?
Tibial ER
124
When a foot supinates, does it IR or ER the tibia?
Tibial ER
125
What is the transverse tarsal?
Talonavicular + calcaneocuboid
The joint between the rearfoot and the midfoot
126
What are some joints of the foot? Starting from intertarsal --> DIP.
```
Intertarsal
TMT
MTP
PIP
DIP
```
127
The joint capsule is continuous with the ______ and _____ subtalar joint capsule.
Anterior & middle
128
Talocalanonavicular joints surrounded by ____ large capsule
1
129
Name 16 ligaments in the foot
1. Anterior talofibular (ATFL)
2. Calcaneofibular (CFL)
3. Posterior talofibular (PTFL)
4. Talocalcaneal interosseous
5. Dorsal calcaneonavicular (Bifurcate)
6. Dorsal calcaneocuboid (Bifurcate)
7. Cervical
8. Deltoid
9. Posterior tibiofibular
10. Spring
11. Anterior tibiotalar
12. Posterior tibiotalar
13. Tibiocalcaneal
14. Tibionavicular
15. Short plantar
16. Long plantar
130
What is a closed-pack position?
Both articular surfaces are at maximal congruency = max. stability and energy transfer
131
When are the tarsal joints in a closed-packed position?
Full supination (inversion)
132
When are the metatarsaophalangeal joints in a closed-packed position?
Extension
133
When are the interphalangeal joints in a closed-packed position?
Extension
134
What muscle groups are found in the anterior compartment (foot/leg)?
Dorsiflexors
| Invertors
135
What muscle groups are found in the posterior compartment (foot/leg)?
Plantar flexors
| Evertors
136
What muscle group is found in the lateral compartment (foot/leg)?
Evertors
137
What nerve innervates the anterior compartment (foot/leg)?
Deep fibular nerve L4,L5, S1
138
What nerve innervates the posterior compartment (foot/leg)?
Tibial nerve L4,L5,S1,S2
139
What nerve innervates the lateral compartment (foot/leg)?
Superficial fibular nerve L4,L5,S1
140
Action of tibialis anterior
```
Strong dorsiflexor (forward of axis- agonist)
Inversion (midfoot)
```
141
Action of tibialis posterior
```
Inversion (large moment arm- agonist)
Weak plantarflexor (posterior to axis)
```
142
Action of fibularis tertius
Plantarflexion
| Eversion
143
Action of fibularis longus/brevis
```
Strong evertor (agonist)
Plantarflexion (small contribution)
```
144
Which 2 muscles are in Triceps Surae? Action?
1. Gastrocnemius (2 heads)
2. Soleus
```
Strong plantarflexor (agonist)
Some inversion (line of action is slightly to midline)
```
145
Attachments of fibularis longus
Crosses plantar aspect of the foot to insert onto the medial cuneiform and base of 1st MT
- Stabilises lateral longitudinal arch
- Stabilises 1st ray durin 1st toe extension and push off
146
What is one pathway into the foot? Where?
Tarsal tunnel
| Area behind medial malleolus
147
Which two tendons cross (foot/leg)?
Flexor digitorum longus & tibialis posterior
Eg. when palpating the posteromedial area of the tibia, usually palpate the origin of FDL not tib. posterior
Usually tib. posterior = deep = some discomfort
148
What are 4 intrinsic muscles of the foot?
1. Extensor hallucis brevis
2. Extensor digitorum brevis
3. 3 PAD
4. 4 DAB
149
How many layers of intrinsic muscles are there in the foot?
4 layers
150
How many vertebrae do we have?
24
151
How many vertebral discs do we have?
23
Because don't have one between C1 and C2. They are between vertebral bodies and C1 has no vertebral body
152
What are the 3 functions of the vertebral column?
1. Protection (Spinal cords, nerves, vertebral artery, protection of viscera by attaching the ribs, forming part of the pelvis by sacrum fusing: Protection of pelvic organs)
2. Weightbearing
3. Mobility
153
Lordosis = mobility or stability?
Mobility
154
Kyphosis = mobility or stability?
Stability
155
The ______ vertebrae moves on the ______ vertebrae.
Superior
| Inferior
156
The vertebral column motion segment includes:
- 2 vertebrae
- 1 intervertebral disc
- 3 joints (interbody joint and 2 z-joints)
- ligaments
- muscles
- nerves
157
What are the gross movements of the vertebral body?
- Flexion
- Extension
- Lateral flexion
- Axial rotation **** (Do not write lateral rotation!!!)
158
What are 3 translations of the vertebral column?
1. Left /right
2. Superior/inferior
3. Anterior/posterior
159
What are the 3 rotations of the vertebral column?
1. Lateral flexion (tilt of vertebrae)
2. Axial rotation
3. Flexion/extension
160
What is a ring apophysis?
Apophysis --> Secondary ossification centre: site where annulus fibrosis attaches.
161
What is a vertebral end plate?
Hyaline cartilage that fills in the ring apophysis
Vertebral end plate is more firmly attached to intervertebral disc than the vertebral body. So, if pulled, end plate will remain with the disc.
162
Name 5 characteristics of a cervical vertebrae
1. Large vertebral foramen
2. Transverse foramen present
3. Bifid spinous process
4. Anterior and posterior tubercle on the transverse foramen (NEW)
5. Articular facet 45 degrees to transverse plane
163
Name 4 characteristics of a thoracic vertebrae
1. Articular demifacets on body articulate with ribs
2. Long, downward spinous process
3. Relatively small and round vertebral foramen
4. Articular facet almost in coronal plane
164
Name 5 characteristics of a lumbar vertebrae
1. Large vertebral body
2. Small triangular vertebral foramen
3. Mammillary process
4. Accessory process
5. Articular facet almost in sagittal plane
165
What degree is the cervical articular facet at?
45 degrees
166
What degree is the thoracic articular facet at?
60 degrees
167
What degree is the lumbar articular facet at?
90 degrees
168
What is the main function of the vertebral body? How does the structure support this function?
Weight bearing and withstanding compression
- Vertical and horizontal trabeculae + bone marrow and blood (hydrodynamic shock absorber)
- Vertical struts are the thickest and you have smaller horizontal struts that support them.
169
While it can withstand compressive forces, which 2 forces can the vertebral body not resist?
1. Translational forces
| 2. Rotational forces
170
Describe the fibre direction of annulus fibrosis (4 characteristics)
1. 10-20 concentric layers
2. All fibres in 1 layer = same orientation and
3. Each layer is opposite to adjacent layers
4. 65 degrees angel to the vertical
171
What type of collagen is the annular fibrosis? Why
Collagen type I
It is good at withstanding tension
172
Where does the annular fibrosis attach?
Annulus fibrosis attaches to ring apophysis for secure attachment.
173
What is annulus fibrosis in the lumbar region like? What would this predispose you to?
Round anteriorly but indented posteriorly and may have some incomplete layers in posterolateral corners
Hence an area of weakness.
174
What is the consistency of nucleus pulposus? What is this due to?
Gel like, 90% water incompressible. Dissolved proteoglycans and collagen makes it viscous and slows down the movement.
175
Nucleus pulposus is enclosed by ______ and ________.
Annulus fibrosis and vertebral end plate.
176
What is the role of intervertebral disc in weight bearing? Describe the force transmission in 4 steps
1. Nucleus pulpous cannot be compressed (decreased vertical height = NP will expand radially= pressure on annular fibres)
2. Annular fibres will resist the tension = exert the pressure back onto Nucleus Pulposus = resist bulge
3. Nucleus Pulposus and annular fibres share the forces = pressure onto vertebral endplates
4. Transmit force to the inferior vertebrae
177
What is the function of intervertebral disk in movement?
- Allows compression forces to go through
| - Provides more room for the superior vertebrae to tilt (Permits rocking of the superior vertebra)
178
The intervertebral disc can ______ and _______ the movement as well.
Provide
| Limit
179
Are the articular surfaces of intervertebral bodies curved or flat? Why? Why is there an intervertebral disc.
Flat
This is because it permits rocking of the superior vertebrae = stability and mobility
- With the disc, there is more room for tilt before impact of the bones - mobility
- Without disc, the flat surfaces are stable under compressive forces but limit the rolling/tilting movement
They are NOT CURVED
While it could facilitate rolling, it would also increase instability under compressive loads
180
Greater the height of intervertebral disc (as compared to the vertebral body), the _______ movement you will get.
More
181
Describe the forces on each side of the vertebrae in lateral flexion. What %?
Compression and tension
(50% each)
Only so much compression before resist
Only so much tension before resist
182
Left axial rotation is when the superior moves ______ in relation to the inferior.
Left
183
The nucleus pulposus is made of _____ cartilage
Fibrocartilage
184
Explain the action of flexion (vertebral column)
Compresses anterior AF --> NP moves posteriorly --> tensions posterior AF --> tensions z joints --> tensions posterior ligaments --> tensions posterior muscles
185
Explain the action of extension (vertebral column)
Compresses posterior AF--> NP moves anteriorly --> tensions anterior AF --> tensions z joints --> tensions anterior ligaments --> tensions anterior muscles
186
Explain the action or axial rotation (vertebral column)
When rotate, will tension 50% fibres and 50% (opposite direction) will go slack
Same with translation
187
In cervical vertebrae, annulus fibrosis is divided in an "A" direction posteriorly. This is called "B" and it develops at "C" years of age. So, the superior part of the annulus fibrosis can move against the inferior part of annulus fibrosis, facilitating movement, particularly axial rotation, posteriorly. Thick D fibrosis acts as a pivot for rotation. Therefore, these structures together facilitate great range of movement that is available at the cervical spine.
A- transverse
B- posterolateral uncovertebral cleft
C- 9 years of age
D- anterior annular
188
What makes up a zygapophyseal joint? Are they the same for all vertebral regions? What characteristics will affect its resistance on forward sliding and/or rotation of the upper vertebrae
Superior articular process of the vertebral below hooks onto inferior articular process of the vertebrae above.
Alignment of the zygapophyseal joint is different in different regions, affecting stability and mobility.
Depend on:
- Orientation of articular facets
- Height of the superior articular process
189
3 characteristics of the cervical z-joints
1. Aligned in coronal plane, 45 deg
2. Almost coronal orientation
3. Superior articular process not very tall = doesn’t block the inferior vertebrae.
190
What movements does the cervical z-joints allow?
All movements
MOST MOBILE
191
What movements does the thoracic z-joints allow?
If you have superior articular processes aligned tall and vertically in the coronal plane (Straight down the ears), anterior translation will be difficult = Superior articular process of the vertebrae below will run into the inferior articular process of the vertebrae above.
Blocks flexion/extension but allows rotation and lateral flexion
192
3 characteristics of the thoracic z-joints
1. Almost coronal orientation
2. 'Tall" superior articular processes
3. 60-80 deg. to transverse (more vertical than Cx)
193
2 characteristics of the lumbar z-joints
1. Sagittal plane orientation
| 2. Vertical
194
What movement does the lumbar z-joints allow?
Flexion-extension
Blocks axial rotation and lateral flexion
195
What do you need to consider when explaining structural reason for the degree of movement available at a vertebral column?
- Orientation and alignment of zygapophyseal joints
- Intervertebral discs
- Height of the superior articular process
- Ribs
196
Majority of the force should go through ______ elements but you’ll get some weight bearing through the posterior elements ESPECIALLY IN _______! Some weight bearing through posterior elements in extension.
Anterior
| Extension
197
What is pars interarticularis?
“Part between the two articular processes”
| Neck of the dog
198
What is a common mechanism of injury of the pars interarticularis? What is this called?
Repetitive extension in weight bearing
Collar stress fracture
199
A pars interarticularis fracture/ collar fracture is most common in?
- Gymnastics
- Divers
- Ballet dancers
- Cricket fast bowlers
200
Why is it important to have strong pedicles? How do you know pedicles are strong?
So that muscles can move the vertebral body (which are attached)...
Pedicles transmit bending and sharing forces from the muscles through to the vertebral body..
Fan shaped trabeculae spans between the vertebral body and the posterior elements to help transmit the force
So that you don’t get break down...
You know your pedicles are strong becauseAs a result of the compression and the pull, you will get increased density of compact bone near the base of the pedicles.
201
When vertebral column flexes anything posterior to the COR, it will tighten. If we go into extension, anterior longitudinal ligament will tighten. What ligament limits flexion the most and why?
Supraspinous ligament because it is the furthest from axis, vertical.
Joins tips of spinous processes
202
What does ligamentum flavum do?
Majority are elastin fibres --> not so much about resisting the movement. Its more aligning in the posterior part of the vertebral canal and it blends with the anterior part of the zygapophyseal joint capsule. When you move it deforms and does not buckle up and take up space.
Interspinous --> the multidirectional arrangement of fibres
Ligamentum flavum --> paired, thick, segmental, elastic ligaments
203
What does the ligamentum flavum form?
- Posterior wall of the vertebral canal
- Anterior capsule of z-joints
Joins adjacent lamina
204
Name 5 ligaments found in the vertebral column
1. Supraspinous Ligament
2. Interspinous ligament
3. Ligamentum flavum
4. Posterior longitudinal ligament
5. Anterior longitudinal ligament
205
Interspinous ligament has oblique direction of fibres. What is the significance of that?
Fibres go anteriorly and inferiorly
This is important during flexion:
- combines anterior rotation with anterior translation, keeping the zygapophyseal joints in contact.
- It also resists posterior shear of the superior vertebrae
206
Cervical spine can be divided into two components. What is that?
Upper cervical spine
| Lower cervical spine
207
Name 7 characteristics of C1- ATLAS
1. Shaped like a ring
2. Does not have a vertebral body --> therefore no intervertebral disc between c1 and c2.
3. Anterior and posterior arches
- Two lateral masses weight transfer
4. 2 large kidney shaped concave superior articular facets (articular facet on superior and inferior surface of the lateral mass) --> Cradle occiput
5. Large transverse process --> muscle attachment and leverage
6. Large vertebral foramen --> protect vertebral artery.
7. Deep sockets (concave superior zygapophyseal facets and the convex occipital condyle) makes rotation and lateral flexion minimal
208
Name 4 characteristics of C2 (AXIS) and state the functions.
1. DOES have a vertebral body.
2. Superiorly from the vertebral body is the dens occiput and C1 stay together and rotate around the dens.
3. Zygapophyseal joints and vertebral body weight transfer Combined load of head and C1
4. Odontoid process provides axis for axial rotation for head and C1 on C2.
209
Describe the joint C0/1. The _____ occipital condyles articulate with _____ articular facet of C1 located on top of lateral mass. This is where you get the _____ motion.
convex
concave
nodding (yes)
*minimal rotation and lateral flexion due to deep sockets
210
What is the convex-concave rule? (C0/1)
Roll of the condyles
Glide occur in opposite direction
Eg. When you are flexing, your occipital condyles are moving forward but will glide posterilrly. Will keep the convex surface of occipital condyle in the centre of concave surface of C1.
211
What are the 3 joints at C1, C2?
1. Median atlanto-axial joint
| 2. 2 x Lateral atlanto-axis joint
212
The lateral atlanto-axial joints is composed of________ and ______.
- Convex inferior articular facets of C1
- Conves superior articular facts of C2.
*plane joint
213
The median atlanto-axial joint is composed of _____ and ________.
- Odondoid process
| - Osseoligamentous ring
214
What does osseoligamentous ring composed of?
- Anterior arch of C1
| - Transverse ligament of atlas.
215
C1/2 joint contributes to ______% of cervical rotation
50%
216
What does the transverse ligament resist and what structure does it protect? What is the fibre that makes up this ligament? Where does it arise from?
Fibre --> predominantly collagen fibres (strong ligament, no elastic fibres)
Resist anterior translation of C1 on C2.
Protects the cervical spinal cord (prevents the posterior arch from going over the vertebral canal)
Arise from inner surface of each lateral mass
217
Alar ligaments. What is the direction of travel? Where does it arise? Where does it attach to? What movement does it resist? What does it NOT have in terms of fibres?
Direction of travel: Posterior and superior
Arises from posterior odontoid process
Attaches to margins of foramen magnum
Resists:
- occiput and C1 moving anteriorly.
- Lateral flexion
- Axial rotation (since it arises posteriorly from the dens, when you rotate, it will WIND around the dens, limiting rotation)
- Flexion
- Main limit for axial rotation of the head & C1 on C2
No elastic fibres
218
Which ligament limits axial rotation of head (C1/C2) the most?
Alar ligament
219
What is the possible consequence of strong rotation of head and C1 on C2?
You can stretch and tear contralateral vertebral artery.
220
State 2 functions of lower cervical spine.
1. Transmit load
| 2. Mobility and stability
221
Explain the pathway of the vertebral artery.
Arise from the subclavian artery --> enters C6 transverse foramen (misses C7) --> ascends to C2 --> exits C2 foramen -> C1 foramen (wide- sharp turn) --> runs along the groove above C1 --> foramen magnum --> meet vertebral from other side
222
What are the movements available at lower cervical spine? What morphology is responsible for this?
- Flexion- Extension
- Rotation and lateral flexion (coupled and ipsilateral)
MORPHOLOGY:
- Interbody joint
- Zygapophyseal joint
223
What are uncinate processes?
Bony prominences, projecting edges on the posterolateral margins of the superior end plates of C3-C7.
224
What do uncinate processes allow and limit?
Allows flexion/extension
Limit transverse or sliding motion of superior vertebrae LATERAL FLEXION AND AXIAL ROTATION, TRANSVERSE GLIDING (guide rails)
225
What does uncinate processes protect?
Vertebral artery and Spinal nerve.
Start --> vertebral artery takes up most of the vertebral foramen and then the spinal nerve will be exiting just posterior…
Protects from distorted disc material.
226
Where do you not have annulus fibrosis?
Where uncinate processes are present
227
What is the characteristics of the intervertebral disc in the cervical region?
- Thick annulus fibrosis
- Fibrocartilaginous disc (consistency of soap)
- Posteriorly, annulus fibrosis is thin, narrow bands of vertical fibres
*Cervical intervertebral disc is innervated by both somatic and autonomic nervous system potential area of pain.
228
__________ joints are the MAIN reason why axial rotation and lateral flexion is coupled. (cannot isolate and do just one movement), explain why?
*Coupled movement= primary movement in one plane accompanied by an automatic movement in another plane.
Zygapophyseal joints
For axial rotation you will need: Transverse plane and vertical axis.
For lateral flexion you will need: frontal plane and sagittal axis
But axis of lower cervical rotation is: 45 degrees to the transverse plane.
Ipsilateral "coupled" rotation/lateral flexion
229
Do uncinate processes allow or limit movement?
Limit (bony block)
230
Do uncovertebral clefts allow or limit movement?
Allow
231
Name 4 ligaments (with subparts specified) found in the cervical spine?
1. Anterior longitudinal ligament (ALL)
2. Posterior longitudinal ligament (PLL)
3. Ligamentum flavum
4. Ligamentum nuchae (replaces supraspinous ligament)- dorsal raphne & midline septum)
232
Do uncovertebral clefts allow or limit movement?
Allow
233
What are the 2 parts of the ligamentum nuchae? What are they?
Dorsal raphne
(occipital protuberance --> C6/7 spinous processes)
- interlacing tendons of: trapezius, splenius capitis, rhomboid minor
```
Midline septum
(fascia from ventral aspect of dorsal raphne --> cervical spinous processes & occiput)
```
234
In the cervical region, what is the supraspinous ligament replaced with?
Ligamentum nuchae
235
What are 4 characteristics of small, deep muscles?
1. Fine tuning
2. Rich in muscle spindles
3. Proprioceptive role
4. Segmental control
236
What are 3 characteristics of large, superficial muscles?
1. Greater PCSA
2. Greater moment arm
3. Prime movers
237
Attachments of upper trapzius
O: occiput
I: lateral 3rd of clavicle
238
Unilateral and bilateral action of levator scapulae
Unilateral:
Ipsilateral lateral flexion
Ipsilateral axial rotation
(scapular fixed)
Bilateral:
Cervical extension
239
Attachments of levator scapulae
O: C1-4 transverse processes
I: Superior medial border/angle of scapula
240
Unilateral and bilateral of sternocleidomastoid
Unilateral:
Ipsilateral lateral flexion
Contralateral axial rotation
Bilateral:
Upper cervical extension
Lower cervical flexion
241
What are the prime movers for right head rotation? (be specific)
Left SCM
| Right splenius
242
Where is the centre of gravity of your head in relation to occipital condyles?
Centre of gravity is anterior
Need to keep head up (all day)
243
Name all the 4 muscles in the anterior cervical compartment
1. Rectus capitis anterior
2. Rectus capitis lateralis
3. Longus capitis
4. Longus cervicis (colli)
244
Name all the 3 muscles in lateral cervical compartment
1. Anterior scalene
2. Middle scalene
3. Posterior scalene
245
What innervates the anterior and middle cervical muscles?
Ventral rami cervical nerves
246
Action of longus capitis VS longus cervicis
Capitis
Flex head and upper cervical spine
Cervicis
Cervical flexion
247
What are the 5 major groups of intrinsic muscles in the posterior compartment of the back?
1. Suboccipital
2. Segmental
3. Transversospinales
4. Erector spinae
5. Spinotransverse
248
What are 4 intrinsic muscles in the suboccipital group?
1. Rectus capitis posterior major
2. Rectus capitis posterior minor
3. Obliquus capitis superior
4. Obliquus capitis inferior
249
What are 2 intrinsic muscles in the segmental group?
1. Interspinales
| 2. Intertransversales (medial not lateral)
250
What are the 3 intrinsic muscles in the transversospinales group?
1. Rotatores
2. Multifidus
3. Semispinalis
251
What is the 1 intrinsic muscles in the spinotransverse group?
1. Splenius
252
What is the innervation of the suboccipital group?
Suboccipital nerve (dorsal ramus of C1)
253
Unilateral and bilateral of the suboccipital group?
Unilateral:
Ipsilateral axial rotation/lateral flexion
Bilateral:
Head/C1 extension on C2
254
Attachments of rectus capitis posterior minor
C1 --> occiput
255
Attachments of rectus capitis posterior major
C2 spinous process --> occiput
256
Attachments of obliquus capitis superior
C1 transverse process --> occiput
257
Attachments of obliquus capitis inferior
C2 spinous process --> C1 transverse process
258
Longus cervicis has _____ parts
3 parts (upper, middle, lower)
259
Where do middle and posterior scalenes attach?
C2-6 cervical processes --> first rib (anterior: anterior first rib, middle: lateral: first rib and posterior: posterolateral second rib)
260
What is the purpose of scalenes?
Stabilise cervical spine
Stabilise the contralateral cervical spine when carrying heavy weight
261
What are the posterior back muscles innervated by?
Dorsal rami
262
Why is it a problem if there is tightening..etc on the anterior and middle scalenes? What are they? (2)
Brachial plexus and subclavian artery travel between anterior and middle scalenes.
So any tightness..etc will affect these structures (crush them)
263
Which subocciptal muscle will be the main one to do rotation? Why?
Obliqus capitis inferior- due to its alignment.
264
2 characteristics of segmental muscles
1. Small PCSA
2. Small moment arm
= small force production
265
2 characteristics of rotatores
(brevis/longus)
1. Most developed in throacic region
2. Very small PCSA
266
2 characteristics of multifidus
1. Most developed in lumbar spine
2. Most oblique alignment in thoracic region = Better line of action for segmental rotation and lateral flexion tham in lumbar region
267
2 characteristics of semispinalis
1. Most developed in cervical and capitis regions = main cervical extensors
2. Semispinalis thoracics spinous attachments C4-T4
268
Which is deeper? Semispinalis capitis or cervicis? Why?
******help check
column 2 p.15
Semispinalis cervicis is deep to semispinalis capitis.
Because...inferior attachment is transverse process and superior attachment is spinous process
269
Attachments of spinalis
Superior and inferior attachments on spinous processes
270
Name 4 erector spinae muscles of the cervical region
1. Iliocostalis cervicis
2. Longissimus cervicis
3. Spinalis cervicis
4. Spinalis capitis
3 & 4 blends with semispinalis cervicis and capitis
271
Unilateral and bilateral action of splenius capitis and cervicis (spinotransverse group)
Unilateral:
Ipsilateral axial rotation/lateral flexion
Bilateral:
Head and neck extension
272
What curve is in the thoracic region? Kyphosis or lordosis?
Kyphosis
273
What is 1 reason why there is a kyphosis curve in the thoracic region?
1. Wedge-shaped vertebral body = Anterior height is less than posterior height (vertebral body)
274
What are 4 reasons why there is less mobility and movement in the thoracic region?
1. 12 pairs of ribs = less mobility
2. Lowest IVD to body height ration = less tilt of superior vertebrae = less mobility
3. Superior articular process are tall and vertical (coronal) = more block for anterior translation = less mobility (FLEXION)
4. Long, downward spinous processes and inferior articular processes impact on lamina/superior articular processes below = less mobility (EXTENSION)
275
Explain the coupled movement in upper thoracic spine
When you laterally flex, you ipsilaterally rotate as well.
Due to the 45 degree to the transverse plane alignment of the articular processes (at cervical spine).
When the inferior articular process of the superior vertebrae slides inferiorly it also moves
posteriorly (like mid & lower Csp)
276
Articular process in the lumbar region align in the _________ plane.
Sagittal
277
Why are there more processes in the lumbar vertebrae? Name the 2 processes.
For muscle attachments (smaller, deeper lumbar muscles)
1. Mammillary process
2. Accessory process
278
Where is the mammillary process located on the lumbar vertebrae?
On superior articular process
279
Where is the accessory processes located on the lumbar vertebrae?
On dorsal, medial aspect of the transverse process
280
What are 3 characteristics of L1-4 vertebrae?
1. Flat superior and inferior ends of vertebral bodies (not wedge-shaped)
2. Almost sagittal orientation of z-joints
3. Anteriorly curved
281
What is the main characteristic of L5 vertebrae?
Wedge-shaped (taller anteriorly)
282
Generally we say that the superior articular process of the lumber region has a ________ alignment. Anterior part of the articular process is curved to limit _______ transition. But when you start to come down to L4, 5 the majority of superior articular process is in the ________ plane. This makes sense to prevent ______________.
Sagittal
Anterior
Coronal
Forward slipping of L5 on S1 (therefore sacrum is anteriorly tilted)
283
What are 5 causes for lumbar lordosis?
1. Sacrum is tilted anteriorly
2. L5/S1 IVD is wedge-shaped (taller anteriorly)
3. L5 vertebra similarly wedge-shaped
4. superior vertebrae incline slightly backwards
5. L1 aligned vertically over S1
284
How is a vertebral region lordosis? Is it naturally evident or does it have to be developed?
Requires active maintenance by muscles.
(Muscles pulling on posterior (eg. spinous processes) --> tilting superior vertebrae backwards (eg. lumbar multifidus)
Eg. if a child does not learn to be upright, it will not develop
285
What is the 2 function of iliolumbar ligament?
1. Resists L5 slipping anteriorly off sacrum (maintain stability)
2. Resists all direction of movement of L5 on the sacrum
286
Attachments of the iliolumbar ligament
L5 transverse processes --> ilium
287
What are 4 ligaments in the lumbar region?
1. Anterior longitudinal ligament
2. Lumbosacral ligament
3. Anterior sacro-illiac ligament
4. Iliolumbar ligament
288
What are 3 causes that limits flexion of the lumbar vertebral column?
1. Impact of articular processes = anterior curve
2. Tension in:
- Zygapophyseal joint capsules (very strong)
- Supraspinous ligament
- Interspinous ligament
- Ligamentum flavum
3. Compression of anterior annulus fibrosis (resists further movement)
289
What are 2 causes that limits extension of the lumbar vertebral column?
1. Impaction of spinous processes or inferior articular process with lamina below (when actively extending)
2. Tension in the anterior AF
290
What are 3 causes that limits axial rotation of the lumbar vertebral column?
1. Impaction of zygapophyseal joints
2. Tension in posterior ligaments (supraspinous and interspinous)
3. Tension in annulus fibrosis (oblique/diagonal fibres)
***If the superior vertebrae is rotation to the left, it is the right articular process that will limit the movement. 1
291
What are 2 (suspected) causes that limit lateral flexion of the lumbar vertebral column?
1. Ipsilateral impact in articular process
| 2. Lengthen anything ******** (AF fibres on other side)
292
What is scoliosis?
Three dimensional torsional deformity of the spine and trunk
293
What is structural scoliosis?
- Deformity arises from vertebral column itself
- Same regardless of body position
- Idiopathic = don’t know cause
= Have onsets at different times
294
What is functional scoliosis?
- Extrinsic cause
- Can be caused by leg length difference, can be caused by muscles
- Change of body position makes scoliosis go away
295
What is a cobb angle?
Angle of scoliosis
It is a scoliosis when > 10 degrees or more
30 deg. can have complications
50 deg. definite complications
296
_____________ group is superficial to the segmental muscles and from the deepest and shortest _______, to Multifidus (intermediate depth) to Semispinalis (capitis, cervices and thoracis)
Transversospinalis
Rotatores
297
It is important to note that erector spinae group are ______ muscles whereas transversospinalis which comprises of (______ , ______ and _______) are not as large as the erector spinae group.
large
rotatores, multifidus and semispinalis
298
Multifidus have 3-5 fascicles innervated by the same dorsal rami that diverge inferiorly and attach to
"A" in cervical spine
"B" in thoracic spine
"C" in lumbar spine as well as "D" and "E" (depending on the region)
```
A- Superior articular process
B- Base of transverse process
C- Mamillary process
D- Iliac crest
E- Sacrum
```
299
What does multifidus do? Action (2)
1. Vertical line of action and posterior axis laterally
Pull spinous process inferiorly, cause pure extension (maintain lumbar lordosis = compression)
No posterior translation. (not diagonal)
2. Abdominal muscles produce flexion/LF = multifidus produces extension = F and E cancel = produce LF
300
How does multifidus assist in rotation?
Abdominal muscles will want to rotate and flex you at the same time. Multifidus remain in extension
301
What muscles in the erector spinae group have pars thoracis and pars lumborum?
Longissimus thoracis and illiocostalis lumborum
302
With Longissimus thoracis and Illiocostalis lumborum, there’s pars thoracis and pars lumborum. So how do you know whether you are looking at pars thoracis or pars lumborum?
If you can see erector spinae aponeurosis you are looking at pars thoracis!
303
What is the attachments of longissimus thoracis pars thoracis?
- Lumbar vertebrae spinous process, PSIS and sacrum --> Thoracic vertebrae transverse process medial ribs
304
What are the attachments of illicostalis lumborum pars thoracis?
- Illium and sacrum --> Lower 8 rib angles
305
What is the unilateral and bilateral actions of longissimus thoracis pars thoracis and illiocostalic lumborum pars thoracis?
Unilateral:
Lateral flexion
Bilateral:
Extension
306
Why are erector spinae muscles be prime extensors of the thoracolumbar spine?
- Superficial
- Large PCSA
- Vertical alignment
307
What is the special movement of illiocostalis lumborum pars thoracis?
It can DEROTATE You
Superficial, large PCSA, doesn’t even attach to lumbar, vertical extension. Contract unilaterally --> ipsilateral lateral flexion.
Illiocostalis lumborum pars thoracis better
Illiocostalis lumborum pars thoracis can de-rotate you once your rib angles are changed.
308
How do you see pars lumborum of longissimus thoracis and illiocostalis lumborum?
Remove ESA.
From around the PSIS area, you will have fibres attaching to lumbar transverse process. Not going up to thoracic region.
309
5 tips to identify longissimus thoracis pars lumborum
1. Just lateral to lumbar multifidus
2. Prokect superiorly and anteriorly to medial transverse process from PSIS.
3. Almost cover eachother in anterior to posterior direction
4. 4 fascicles
5. Long tendon
310
4 tips to identify Illiocostalis lumborum pars lumborum
1. Medial iliac crest
2. Tips of transverse process
3. 5 fascicles
4. Just lateral to longissimus thoracis pars lumborum
311
What is the unilateral and bilateral action of longissimus thoracis pars lumborum and Iliocostalis lumborum pars lumborum?
```
Unilateral:
Lateral flexion (vertical, lateral to the axis)
```
Bilateral:
- Extension (vertical and posterior to axis)
- Component of horizontal line of action (posterior shear)
- Posteriorly translate superior vertebrae or prevent anterior translation of the vertebrae
312
Direction of force of multifidus
Vertical
- Compressive
- Maintains lordosis
313
Direction of force of pars lumborum
Diagonal
| - Resists anterior shear
314
Direction of force of pars thoracic
Vertical
- Superficial
- Minimal compression
- Maximum extension
315
Multifidus, pars lumborum, pars thoracic are all _______
Extensors
316
When you flex what is happening at your lumbar spine?
Curve is flattening
317
Vertebral structures are innervated by ______.
Dorsal rami but different branches.
318
What are the 3 branches of the dorsal rami?
1. Medial branch
2. Intermediate branch (in lumbar spine)
3. Lateral branch
319
Medial branch of the dorsal rami in the lumbar spine innervates:
- Zygapophyseal joint above and below
- All muscles attach to spinous process and lamina (interspinales, rotatores, multifidus, semispinalis, cutaneous branches in cervical and upper thoracic vertebrae)
320
Intermediate branch of the dorsal rami in the lumbar spine innervates:
Longissimus
321
Lateral branch of the dorsal rami in the lumbar spine innervates:
- Erector spinae
| - Cutaneous branches in lower thoracic and lumbar vertebrae
322
What forms the anterior plexus? (anterior to the vertebral bodies). What are some innervated structures?
- Branches from the sympathetic trunks
- Grey rami
- Anterior outer annulus fibrosis
- ALL
- Anterior vertebral periosteum and vertebrae
- Blood vessels
323
What forms the posterior plexus? What are some innervated structures?
- Branches from sinuvertebral nerve
- Posterior out annulus fibrosis
- PLL
- Anterior and ventral/lateral dura and nerve root sleeves
- Posterior vertebral periosteum and vertebrae
- Blood vessels
324
```
Abdominopelvic cavity is enclosed by?
Superiorly
Inferiorly
Posteriorly
Anterolaterally
Anteriorly
```
Superiorly: Diaphragm
Inferiorly: Pelvic floor
Posteriorly : Psoas major and Quadratus lumborus
Anterolaterally: External oblique, internal oblique, transversus abdominis
Anteriorly: Rectus abdominis
325
What are the attachments of diaphragm?
Superiorly ---> central tendon
| Inferiorly ---> L1,2,3, lower 6 costal cartilages and ribs.
326
What are the three openings of the diaphragm? At what thoracic vertebral level does it correspond?
Inferior vena cava ---> T8
Oesophagus ---> T10
Descending aorta ---> T12
327
What innervates the diaphragm?
Phrenic nerve, C3,4,5,alive!
328
What are the 2 muscles of the pelvic floor?
1. Levator ani
| 2. Coccygeus
329
Psoas major has two bodies posterior and anterior. Where does it arise from?
Posterior body: from transverse processes
Anterior body: from vertebral bodies
***You see lumbar plexus coming out between the bodies!!!
330
What does psoas major do to the lumbar spine?
Vertical line of action and close to the joint
- Compress
- Flexion (small moment arm)
When it exerts as hip flexor it will compress the lumbar vertebral column.
331
What are the attachments of quadratus lumborum?
- 12th rib
- Iliac crest
- Transverse processes
***Posteriorly quadratus lumborum is lateral to pars lumborum fibres and ventrally, it is lateral to psoas major
332
What movements can quadratus lumborum produce?
Flexion/extension of vertebral column (limited: small moment arm) However, active during flexion and extension, meaning it doesn’t do flexion or extension as you can't do flexion and extension.
Providing STABILITY for vertebral column
Lateral flexion- significant moment arm for lateral flexion good lateral flexor.
333
What innervates quadratus lumborum?
Thoracolumbar ventral rami
334
What are the three layers of the abdominal wall?
1. External oblique
2. Internal oblique
3. Transversus abdominis
335
What are the attachments for external oblique abdominal?
Posterosuperior attachment:
- Posterolateral aspect of the ribs
Inferior attachment:
- Anterolateral iliac crest
- Linea alba via aponeurosis
336
What is the innervation of external oblique?
T7-12 ventral rami
337
What is the uniaxial and biaxial movement of external oblique abdominal?
Uniaxial:
Contralateral rotation and ipsilateral lateral flexion
Biaxial:
Trunk flexion, increase intra-abdominal pressure
338
What are the attachments of internal abdominal oblique?
Posterior:
- Thoracolumbar fascia
Inferior:
- Anterolateral iliac crest
- Inguinal ligament
Superior:
- Inner surfaces of lower 4 ribs and cartilages
Anterior attachment
- Linea alba via aponeurosis
***
Fibre above ASIS superior line of action
Fibre below ASIS transverse/inferior line of action
339
What is unilateral and bilateral action of the internal oblique?
Uniaxial:
- Ipsilateral rotation
- Lateral flexion
Biaxial:
- Trunk flexion
- Increase intra-abdominal pressure (not as effective as external onliques)
340
If you want to have axial rotation of your trunk to your left, which muscles will you contract?
- Right external oblique abdominal
| - Left internal oblique abdominal
341
If you want axial rotation, what muscles will be activated along with abdominal muscles?
Multifidus to keep you in extension.
Abdominal muscles produce flexion with rotation so need to activate lumbar multifidus for extension
342
What are the attachments of Transversus abdominis?
Posterior:
- Thoracolumbar fascia
Superior:
- Internal aspect of the lower ribs and cartilages
Inferior:
- Iliac crest
- Inguinal ligament
Insertion:
- Linea alba
- Pubic crest
343
What are the actions of transversus abdominis?
Since the fibres are TRANSVERSE, it cannot be a flexor or rotator…. (NO VERTICAL LINE OF ACTION)
Increase intrabdominal pressure, no movements associated with them.
344
What is the innervation of transversus abdominis?
T7-L1 ventral rami
345
What are the attachments of rectus abdominis?
Superior attachment:
- Xyphoid process
- Adjacent rib cartilages
Inferior attachment:
- Pubic crest and symphysis
346
What are the movements of rectus abdominis?
Since fibres are purely vertical flexion. Very good moment arm as well. The tendinous intersections of rectus abdominis exists so that:
- Muscle can fold onto each other
- Gives it strength (when external and internal oblique attach, give muscle fibre some strength, so internal and external oblique can’t just pull the rectus abdominis apart)
347
What is the innervation of rectus abdominis?
T7-L1 ventral rami
348
What is the rectus sheath?
The rectus sheath is formed by the aponeuroses of the transverse abdominal and the external and internal oblique muscles. Can be divided into anterior and posterior portions
349
What 2 muscles make up the upper anterior rectus sheath?
Aponeurosis of
1. External oblique abdominal
2. 1/2 of internal oblique abdominal
350
What 2 muscles make up the upper posterior rectus sheath?
Aponeurosis of
1. Internal oblique abdominal
2. 1/2 of transverse abdominis
351
What is the function of rectus sheath?
- Re-directing the line of action of external and internal oblique
- Enhanced line of action of flexion
352
Thoracolumbar fascia is a 3 layered structure. What are the three layers?
Anterior and middle layer:
- Attach to lumbar transverse processes
- Envelope quadratus lumborum
- Anterior and middle layer fuse laterally and attach to transversus abdominis and Internal oblique (NOT EXTERNAL OBLIQUE)
Posterior layer:
- Attach to spinous processes
- Enclose erector spinae
- Attach to the middle layer laterally.
353
Thoracolumbar fascia blends with...? (3)
1. Erector spinae aponeurosis
2. Latissimus dorsi
3. Gluteus max.
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What is stability?
Control of the motion segment
355
What controls the motion segment?
- Bony
- Ligamentous
- Muscular (vertical line of action, compression)
- Muscular (counteracting movements, eg pars lumborum)
- Intra-abodominal pressure
356
Muscles can provide stability by attaching onto ________
Thoracolumbar fascia
Muscle attach to TLF attach spinous and transverse processes
TLF function: vertebral stability and muscle attachment.
357
If you are sitting and waving your arms around (displacing centre of mass) you diaphragm will begin to _____ only until it reaches 80% relaxation. Keep the stability by ______ intra-abdominal pressure
If you ______ available oxygen, it will start 100% relaxing because air is ___ important than postural stability.
relax
increasing
decrease
more
