Spine/Pelvis Flashcards
The intervertebral discs are responsible for ~1/4 of the length of the vertebral column.
True
After the 3rd decade, the intervertebral discs become avascular.
True
The effect of increased intra-abdominal and intra-thoracic pressures is to decrease the load on the lumbar discs.
True
The transverse and oblique abdominal muscles are primarily responsible for increases intraabdominal pressure and giving additional support to the lumbar vertebral disc during weight lifting.
True– The rectus abdominal muscles are NOT primarily responsible.
At which position is intra-disc pressure at L3-L4 maximal?
Sitting
Lumbar intervertebral disc pressure is HIGHER with unsupported sitting than upright standing.
True
Isometric abdominal muscle exercises are less dangerous than flexion/extension in terms of load on the spine.
True
A defect a whigh ligament is responsible for high incidence of lumbar disc herniation?
PLL
The greatest sensitivity to pain is found where?
PLL
Anomalies of the spine associated with LBP?
- unusually long transverse process of L5
- Tropism of articular facets
- transitional lumbosacral vertebra
Most lumbar flexion occurs where?
at the L5-S1 interface (75%)
Pelvic rotation: without pelvic rotation, you could only reach halfway to the floor.
True
Intervertebral discs receive nutrition from?
the colloid inhibition pump
Piriformis muscle
Originates from the pelvic surface of the sacrum, inserts on the greater trochanter
Action: external rotation, abduction (very similar to the movement produced by the posterior fibers of gluteus medium
Relationship of the sciatic nerve and the piriformis
The sciatic nerve usually exists the pelvis by going through the sciatic foramen and UNDER the piriformis; There are anatomic variations
Piriformis myofascial syndrome
- LMP with extension down the leg
- c/o pain in the hip region, tailbone, and buttocks
- painful ambulation (ipsilateral to the WB side)
- ipsilateral pain on sitting
Physical exam of piriformis myofascial syndrome
- +SLR when leg is internally rotated
- tenderness on palpation inferior and lateral to S1 joint (palpating through gluteus maximus)
- focal tenderness on rectal/pelvis
Facet joints
- Synovial lined!
- Innervation from multilevel posterior rami
Facet planes
Thoracic: facet are in horizontal plane–> allow lateral flexion & rotation; do not allow flexion/extension
Lumbar: facets are in vertical saggital plane–> allow flexion/extension; do not allow lateral bending or rotation
As the disc space narrows, it adds pressure on the facet joints.
True
Iliolumbar Syndrome
- LBP with focal area in posterior portion of iliac crest frequently
- PE: pain on later bending AWAY from the painful side–> bc you stretch the muscle
- Dx: confirm with lidocaine injection
Episacroiliac lipoma
Exam: palpable nodule in sacroiliac area; palpation triggers shooting pain down lateral thigh
Dx: relief of pain with local anesthesia
LaBan Phenomenon
- Posterior rami findings out of proportion to anterior rami findings
- 1st not much in the legs, 2nd prominent findings when you go to the paraspinals
- Cancer metastasis to the paraspinals until proven otherwise!
Inferior gluteal neuropathy (gluteus maximus +/- posterior femoral cutaneous nerve (back of thigh)
Worry about recurrent colorectal carcinoma
