Spinal Lecture 2

Question 1

what type of joint is the symphasis pubis?

Answer 1

cartilaginous

Question 2

what is the articular surface of the symphasis pubis?

Answer 2

the pubic bodies of each hip bone have a thin hyaline cartilage covering

Question 3

the interpubic disc is strengthened anteriorly by several interlacing collagenous fibrous layers which interweave with fibres of ___ and ___ tendons of the _____

Answer 3

external oblique aponeuroses and medial tendons of the recti abdominus

Question 4

what two points does the superior pubic ligament travel between?

Answer 4

from pubic tubercle to pubic tubercle and from crest to crest

Question 5

attachment point for the arcuate pubic ligament

Answer 5

A1: interpubic disc

A2:inferior pubic rami

FD: Lateral and inferior

Question 6

what is the primary function of the sacroiliac joint?

Answer 6

firmly unite the pelvic girlde to facilitate the transmission of weight bearing forces between the upper and lower extremities

Question 7

What type of movement occurs between the ilium and sacrum?

Answer 7

Rotation (Limited)

Question 8

structurally the sacroiliac joint is _ joints consisiting of a __ joint and a __ joint.

Answer 8

2 joints consisting of a SYNOVIAL PLANE joint and a FIBROSIS joint

Question 9

what are the two articular surfaces of the sacroiliac joint?

Answer 9

ear shaped surface on the sacropelvic surface of the ilium and by a similar shaped surface on the alar (wing) of the sacrum

Question 10

what are the articular surfaces of the sacroiliac joint covered with?

Answer 10

hyaline cartilage

Question 11

what two points does the fibrous portion of the sacroiliac joint run between?

Answer 11

exists between the iliac tuberosity and the upper dorsal surface of the sacrum

Question 12

the two bones of the sacroiliac joint do not contact each other between the iliac tuberosity and the upper dorsal surface of the sacrum, consequently they form a ___ behind which the ___ projects beyond the ___

Answer 12

cleft behind which the ilium projects beyond the sacrum

Question 13

what is the cleft of the sacroiliac joint filled with?

Answer 13

a dense mass of fibres called the interosseous sacro-iliac ligament

Question 14

behind the cleft of the sacroiliac joint the fibres are known as the __

Answer 14

dorsal sacro-iliac ligament

Question 15

what is the massive ligament located posteriorly, forming the chief bond of the SI joint and filling the irregular space posterosuperior to the joint?

Answer 15

interosseous sacro-iliac ligament

Question 16

what covers the interosseous sacro-iliac ligament superficially?

Answer 16

dorsal sacroiliac ligament

Question 17

the deeper part of the interosseous sacro-iliac ligament has superior and inferior bands passing from depression posterior to ___ and to ___

Answer 17

superior and inferior bands passing from depressions posterior to sacral auricular surface to iliac tuberosity

Question 18

does the dorsal sacro-iliac ligament lie anterior or posterior to the interosseous SI ligament?

Answer 18

posterior

Question 19

the dorsal SI ligament has several weak __ connecting ___ and __ sacral crests to the ___ and internal lip of the ___

Answer 19

has several weak FASICULI connecting INTERMEDIATE and LATERAL sacral crests to the PSIS and internal lip of the ILIAC CREST

Question 20

often inferior fibres from __ and __ sacral segments ascend to ___ forming a separate long posterior sacroiliac ligament

Answer 20

inferior fibres from 3rd and 4th sacral segments ascend to PSIS forming a separate long posterior SI ligament

Question 21

What is the Posterior SI Ligament continuous with laterally? Medially?

Answer 21

laterally: sacrotuberous ligament
medially: posterior lamina of the thoracolumbar fascia

Question 22

Which ligament strengthens the ventral portion of the SI joint capsule and is most developed on the anterior inferior aspect of the joint?

Answer 22

anterior sacro-iliac ligament

Question 23

what two points do the bands of the iliolumbar ligament run between?

Answer 23

the iliac crest and the transverse process of the 5th lumbar vertebrae, consist of 5 parts

Question 24

what ligament prevents forward slippage of L5?

Answer 24

iliolumbar ligament

Question 25

what ligament limits twisting, forward, back and lateral bending of L5?

Answer 25

iliolumbar ligament

Question 26

Which points does the anterior portion of the iliolumbar ligament travel between?

Answer 26

A1: anterior inferior border of TP of L5 A2: medial body of L5

Question 27

what two points does the superior portion of the iliolumbar ligament attach to?

Answer 27

A1: anterior and posterior fascia that surrounds QL A2: anterior superior border of L5 TP

Question 28

what points does the posterior aspect of the iliolumbar ligament attach to?

Answer 28

attached to the top of the posterior border of the TP and attached to the ilium behind QL

Question 29

What points does the inferior aspect of the iliolumbar ligament attach to?

Answer 29

A1: lower border of the TP of L5 A2:SI ligament (anterior) FD: Inferior and lateral

Question 30

what two points does the vertical aspect of the iliolumbar ligament attach to?

Answer 30

the anterior and inferior border of L5 TP and descends vertically to the iliopectineal line

Question 31

What are the medial and lateral attachments of the sacrospinous ligament? FD?

Answer 31

Medial attachment: lateral margin of the lower sacrum and coccyx Lateral attachment: the spine of the ischium FD: fibres run transversely laterally

Question 32

what ligament does the sacrospinous ligament blend with?

Answer 32

the sacrotuberous ligament

Question 33

list the proximal attachments for the sacrotuberous ligament

Answer 33

PSIS, PIIS, lower 1/2 of the dorsal surface of the sacrum, lower 1/2 of the lateral sacral crest, lateral margin of the coccyx and blends partially with the dorsal sacro-iliac ligaments

Question 34

list the fibre direction and distal attachments for the sacrotuberous ligament

Answer 34

the fibres run down and laterally to attach distally to the medial margin of the ischial tuberosity

Question 35

the posterior surface of the sacrotuberous ligament attaches to the lowest fibres of which muscle

Answer 35

lowest fibres of glute max

Question 36

the lower part of the sacrotuberous ligament continues into what tendon?

Answer 36

lower part continues into biceps femoris tendon

Question 37

what pierces the sacrotuberous ligament

Answer 37

inferior gluteal artery and perforating cutaneous nerve

Question 38

What aspect of l5 – s1 tells you that it can handle lots of weight?

Answer 38

It’s width – remember structure dictates function

Question 39

Why is the SI joint a weight transferal joint?

Answer 39

It’s a plane joint that relies on the forces of the muscles to hold it together – transfers the force to the coccyxfemoral joint where the thickest cartilage is, where the strongest ligaments and muscles are

Question 40

If you have OA of the hip on only one side you need to consider…

Answer 40

the fact that it is likely disfunction that is causing the issue

Question 41

What type of joint is the symphysis pubis weight bearing or weight transferal?

Answer 41

Weight transferal

Question 42

Why is the pelvis not a full bony structure

Answer 42

The joints allow movement, and important for pregnancy so the pelvic girdle can open

Question 43

What two muscles support the symphysis pubis?

Answer 43

Aponeurosis of the external obliques Rectus abdominus

Question 44

What creates force closure in the SI joints

Answer 44

Lats Glutes

Question 45

What two movements must the SI joint allow for?

Answer 45

Side bending Rotation

Question 46

What is the bony configuration of the SI joint?

Answer 46

Essentially 2 blocks that fit together – the wedge shape of the sacrum helps to provide stability and it narrows inferiorly

Question 47

What is one of the most common muscle imbalances you will see?

Answer 47

Glutes and Hamstrings

Question 48

What will pain do to muscle in the area?

Answer 48

Turn them off – pain inhibition

Question 49

How do you test the integrity of the SI joint?

Answer 49

Gapping Splaying Keep in mind when you are gapping and splaying the SI joint that it is so strong there realistically will be little to no movement – if there is there is a big problem

Question 50

The orientation of the dorsal SI ligament is..

Answer 50

Vertical

Question 51

If there is tension on the sacrotuberous ligament it will place tension on the __ ligament

Answer 51

Dorsal SI ligament

Question 52

How do you test the anterior SI ligament? Is this test functional? What is this test called, other than gapping or splaying?

Answer 52

Pushing out on the ASIS’s – again realistically should not move at all – so think is this test functional? No, its called a pain provocation test

Question 53

How many bands does the iliolumbar ligament have?

Answer 53

5 running off of the TP of L4 and L5 – some authors say just L5

Question 54

What are the directions of the 5 bands of the iliolumbar ligament?

Answer 54

Anterior Posterior Superior Inferior Vertical

Question 55

What movement does the iliolumbar ligament prevent? What is another function/purpose of the iliolumbar ligament

Answer 55

Side bending in L4 and L5 Stabilizes the vertebrae (L4-L5) on the innominate bone

Question 56

If you have disfunction of L4-L5 what also may be in disfunction?

Answer 56

The innominate bone – clinical relevance: patient could present with a innominate bone disfunction but cause could be traces back to L4 or L5 stuck in a side bent position placing tension on the iliolumbar ligament and thus placing tension on the innominate

Question 57

The iliolumbar ligament will also help prevent ___ from sliding anteriorly (Extremely significant)

Answer 57

L4-L5

Question 58

What is the significance of the sacrospinous ligament with regard to foramen?

Answer 58

Converts the greater/lesser sciatic notch into foramen

Question 59

What does the sacrotuberous blend with superiorly?

Answer 59

Posterior (dorsal) sacroiliac ligament, also goes into the posterior lamina of the thoracolumbar fascia – significant because it disperses the force (force attenuation) so the force is not focal on any one area

Question 60

What does the sacrotuberous blend with inferiorly?

Answer 60

Ischial tuberosity – same attachment point as bicep femoris, so remember you are getting a transfer of forces all the way down the leg

Question 61

What other muscles does the sacrotuberous ligament merge with?

Answer 61

Glute max

Question 62

Answer 62

Question 63

Answer 63