Trunk

Question 1

Desc ribe the different function of the spine.

Answer 1

Skeleton of the trunk
Supports the body and participated in the thoracic and pelvic cavity
Provides attachments for the ribs and strong muscles
Protects thoracic and pelvic viscera
Protects the spinal cord
Provides “stable” mobility

Question 2

Explain why C1 is defined an atypical vertebra

Answer 2

No body, spinous process, lamina and pedicles
Two large lateral masses joined by anterior and posterior arches
Has large, palpable transverse processes
Different orientation of the facet joints, that allow specialised movements

Question 3

A patient has pain when rotating his head at the middle of the movement.
What does this suggest?

Answer 3

The dysfunction lies within the mid cervical spine

Question 4

A patient has pain when rotating his head at the end of the movement.
What structures of the neck are most probably involved?

Answer 4

Compression of the facet joints and narrowing of the intervertebral foramina which increase pressure on the nerve root

Question 5

A patient presents hyper mobility of the A-A joint. What does this suggest?

Answer 5

Rotation at AA joint is predominantly limited by the contralateral alar ligament. Damage to these ligaments may permit rotational hypermobility of the A-A joint and
subsequently threaten closely associated structures such as the vertebral arteries and spi

Question 6

Synthesise the four phases of the hydrostatic pressure distribution of an intervertebral disc

Answer 6

1. nucleus filled of water and therefore incompressible, when loaded responds by slowly deforming against the annulus fibrosus
2. radial deformation is resisted by the tension created on rings of collagen and elastin of the annulus fibrosus
3. pressure within the entire disc is thus uniformly elevated and transmitted
4. when force removed from the endplates, return to their original preloaded length

Question 7

Explain the movements of the ribs at the different levels

Answer 7

• Movement of the upper ribs (first 7):
  Anterior ends raise with the body of the sternum
  The body of the sternum is lifted upwards and outwards
  Increase of the anteroposterior diameter of the thorax
  Looks like a movement of a handle of a pump when drawing water from a well
  PUMP-HANDLE MOVEMENT
• Movement of the lower ribs (8 to 10):
  Anterior ends moves outward and upward
  Lateral excursion of the ribs and costal cartilages
  Increase in transverse diameter of the thorax
  Flat costotransverse joints induces a rotation and gliding of one bone against the other
  Upward and outward movement of the shaft of the rib looks like raising the handle from the side of a bucket
  BUCKET-HANDLE MOVEMENT
• Movement of the 11th and 12th ribs:
  Not attached anteriorly
  Have little influence on increasing the diameter of the thorax
  Give attachment to some fibers of the diaphragm
  With quadratus lumborum, provides a firm attachment to the diaphragm

Question 8

Name the different forces applied on the IVD

Answer 8

Shear force
Compressive force
Tensile

Question 9

At the zygapophyseal joint level, what is the common spinal coupling pattern?

Answer 9

Ipsilateral

Question 10

What is the difference in terms of limitation of the movement during rotation at the Atlanto-axial level and the rest of the cervical spine?

Answer 10

At A-A level: Rotation at this level therefore is predominantly limited by ligamentous structures, in particular the contralateral alar ligament

Lower: Rotation in the sub-axial spine is limited by the IVD disc and articular facets.

Question 11

How many degrees of rotation are present between C1 and C2 and for the rest of the cervical?

Answer 11

C1-C2:45°
Cervical: 35°

Question 12

Name TWO structures that limits neck flexion

Answer 12

The posterior longitudinal ligament
Zygapophyseal joint capsule
Ligamentum flavum
Ligamentum nuchae
Posterior vertebral muscles

Question 13

How many degrees of flexion and extension are present at the thoracic level?

Answer 13

Flexion (30-40°)
Extension (15-20°)

Question 14

Name and explain the movement of the macro-iliac joint

Answer 14

Nutation: relative anterior tilt of the base (top) of the sacrum relative to the ilium
Counternutation: reverse motion: relative posterior tilt of the base of the sacrum relative to the ilium

Question 15

Explain the role of the abdominal muscles

Answer 15

Protect the viscera
Stabilization of the spinal column
Help in expiration
Raise the intra-abdominal pressure (sneezing, coughing, micturating, defecating, lifting)
Maintain erect posture

Question 16

Explain what is happening during a posterior tilt of the pelvis at the lumbar level

Answer 16

Flexion of the lumbar spine
Decreases the lumbar lordosis

Question 17

Briefly describe the lumbopelvic rhythm during extension from forward bending

Answer 17

Early phase is dominated by greater hip extension and associated activation of the hip extensor muscles
Significant activation of the lumbar extensor muscles is typically delayed slightly until the middle phase