Spine/Pelvis

Question 1

The intervertebral discs are responsible for ~1/4 of the length of the vertebral column.

Answer 1

True

Question 2

After the 3rd decade, the intervertebral discs become avascular.

Answer 2

True

Question 3

The effect of increased intra-abdominal and intra-thoracic pressures is to decrease the load on the lumbar discs.

Answer 3

True

Question 4

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.

Answer 4

True– The rectus abdominal muscles are NOT primarily responsible.

Question 5

At which position is intra-disc pressure at L3-L4 maximal?

Answer 5

Sitting

Question 6

Lumbar intervertebral disc pressure is HIGHER with unsupported sitting than upright standing.

Answer 6

True

Question 7

Isometric abdominal muscle exercises are less dangerous than flexion/extension in terms of load on the spine.

Answer 7

True

Question 8

A defect a whigh ligament is responsible for high incidence of lumbar disc herniation?

Answer 8

PLL

Question 9

The greatest sensitivity to pain is found where?

Answer 9

PLL

Question 10

Anomalies of the spine associated with LBP?

Answer 10

• unusually long transverse process of L5
• Tropism of articular facets
• transitional lumbosacral vertebra

Question 11

Most lumbar flexion occurs where?

Answer 11

at the L5-S1 interface (75%)

Question 12

Pelvic rotation: without pelvic rotation, you could only reach halfway to the floor.

Answer 12

True

Question 13

Intervertebral discs receive nutrition from?

Answer 13

the colloid inhibition pump

Question 14

Piriformis muscle

Answer 14

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

Question 15

Relationship of the sciatic nerve and the piriformis

Answer 15

The sciatic nerve usually exists the pelvis by going through the sciatic foramen and UNDER the piriformis; There are anatomic variations

Question 16

Piriformis myofascial syndrome

Answer 16

• 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

Question 17

Physical exam of piriformis myofascial syndrome

Answer 17

• +SLR when leg is internally rotated
• tenderness on palpation inferior and lateral to S1 joint (palpating through gluteus maximus)
• focal tenderness on rectal/pelvis

Question 18

Facet joints

Answer 18

• Synovial lined!

- Innervation from multilevel posterior rami

Question 19

Facet planes

Answer 19

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

Question 20

As the disc space narrows, it adds pressure on the facet joints.

Answer 20

True

Question 21

Iliolumbar Syndrome

Answer 21

• 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

Question 22

Episacroiliac lipoma

Answer 22

Exam: palpable nodule in sacroiliac area; palpation triggers shooting pain down lateral thigh
Dx: relief of pain with local anesthesia

Question 23

LaBan Phenomenon

Answer 23

• 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!

Question 24

Inferior gluteal neuropathy (gluteus maximus +/- posterior femoral cutaneous nerve (back of thigh)

Answer 24

Worry about recurrent colorectal carcinoma