WK9+10 Lumbopelvic

Question 1

What are the primary and secondary curvatures of the spine ?

Answer 1

1st: thoracic and sacral kyphoses that are apparent since birth
2nd: cervical and lumbar lordoses that develop in upright positions after birth

Question 2

What is the lumbosacral angle ?

Answer 2

The junction of the lumbar vertebrae at the coccyx when viewed laterally, the angle that is formed

Question 3

What are vertebral endplates ?

Answer 3

They are “plates” of hyaline cartilage which cover the superior and inferior surface of vertebral bodies
- these are surrounded by rings of smooth bony epiphyseal rims.

Question 4

Which parts of the vertebrae make up the vertebral arch ?

Answer 4

The pedicles, laminae and vertebral bodies

Question 5

Describe the regional differences between vertebrae.

Answer 5

Cervical: trans foramen, bifid spinous processes, vertebra prominens, atlas+ axis
Thoracic: costal facets for rib articulation, long downard sloping spinous processes, antero-posterior facing articular facets to accommodate rib motion
Lumbar: massive vertebral bodies, short and sturdy spinous proccesses, articular facets point at each other medially, mamillary processes

Question 6

What are some unique features of the intervertebral discs ?

Answer 6

Act as shock absorbers, mobile, cartilaginous, discs are relatively thicker in more mobile areas such as the neck and low back.

Question 7

What are some structures that help to hold the L5 vertebra on the S1 vertebra ?

Answer 7

-Iliolumbar, ant and post SI ligaments
-Orientation of facets between L5-S1, this makes it so the vertebra is locked in place

Question 8

Define the unique characteristics of the following ligaments: ALL, PLL Ligamentum flavum, supraspinous, interspinous, intertransverse

Answer 8

ALL: the only ligaments that limits ext.
PLL: has pain innervation, weaker than ALL, weakly resists hyperflexion, can help prevent posterior disc protrusions
Ligamentum Flavum: connect laminae of vertebrae, yellow, limit abrupt flexion
Supraspinous: attach the tips of spinous processes
Interspinous: attach the roots of spinous processes
Intertransverse: connect adjacent transverse ligaments

Question 9

Discuss the connections of thoracolumbar fascia to structures in the lumbar region.

Answer 9

ext obl, and IO connect to TL fascia and can help stabilize the lumbar vertebrae which are the roots of the TL fascia

Question 10

Which muscles contribute to lumbar stabilization ?

Answer 10

rectus abdominus, IO + Ext Obl, TrAb, Psoas Major, QL

Question 11

Explain the categorization of back muscles and list which muscles belong in which group.

Answer 11

Extrinsic:
—-> Superifical: trapezius, latissimus dorsi, rhomboids ( all except traps (CNXI) innervated by posterior spinal nerves )
—-> Intermediate: serratus post and inferior ( innervated by the intercostal nerves )

Intrinsic:
—-> Deep:
superfical; splenius cervicis and capitis
int; erector spinae group ( iliocostalis, longissimus, spinalis )
deep; transversospinalis ( semispinalis, multifidus, rotatores )

• All deep muscles innervate by posterior rami of spinal nerves

Question 12

Which muscles can you name that would be active for the following trunk motions ? (a) flexion ( return from an extended position ) (b) Extension ( return from flexion) (c) Side bending (d) rotation

Answer 12

(a) Psoas major, rectus Ab.
(b) erector spinae group, multifidus, semispinalis thoracis, gluteus maximus
(c) glut med, max, QL, IO and Ext Obl, serratus ant, SCM
(d) SCM, Splenius, iliocostalis and longissimus, IO and Ext Obl, Transversospinalis

Question 13

How is the vertebral column innervated ?

Answer 13

by the recurrent meningeal nerves from the mixed spinal nerves

Question 14

Where does the spinal cord end ?

Answer 14

Ends at the conus medullaris at about the level of T12-L3

Question 15

What is a spinal cord segment ?

Answer 15

the portion of the spinal cord that gives rise to rootlets and roots that form one bilateral pair of spinal nerves

Question 16

How do nerve roots get out the vertebral canal after the spinal cord ends ?

Answer 16

From the cauda equina which is a continuation of the conus medullaris

Question 17

Explain the relationship between lumbar disc bulge and which spinal nerve root is affected.

Answer 17

Compression of nerve roots by a herniated disc may reflect a dermatomal distribution, impingments could be occurring superior to where the symptoms may reflect disc bulge to be, for example and L4 disc bulge could impinge L5 spinal nerve on its path downward.

Question 18

Draw the lumbosacral dermatomes.

Answer 18

…

Question 19

Trace the major lumbosacral nerves and name their roots and what structures they innervate. Draw the lumbosacral plexus.

Answer 19

Subcostal: T12; ext obl, skin of anterolateral Ab wall
Iliohypogastric: L1; Ab muscles in the skin of inguinal pubic area
Ilioinguinal: L1; Ab muscles in the skin of inguinal pubic area
Genitofemoral: L1/2; genitalia and groin and upper thigh sensation
Lateral Femoral Cutaneous: L2/3; supplies sensation to anterolateral thigh region
Femoral: supplies quadriceps muscle group, runs under inguinal lig
Obturator: L2-4; supplies the hip abductor muscles
Sciatic: L2-4; articular branches to hip joint and muscular branches to knee flexors and all muscles in leg and foot
Superior gluteal: L4-S1; Servers glute med, minimus, and tensor fascia latae
Inferior gluteal: L5-S2; gluteus maximus
Nerve to Piriformis: S1-S2; piriformis muscle
Nerve to Obturator Internus: L5-S2; obturator internus and sup gemellus
Nerve to Quadratus Femoris: L4-S1; Quadratus femoris, and inf gemellus
Nerve to Levator Ani: S3-4; levator ani and coccygeus
Posterior Femoral Cutaneous: S2-3; cutaneous branches to buttocks and uppermost medial and post surfaces of thigh
Pudendal: S2-4; structures in perineum, sens. to ext genitalia; perineal muscles.

Question 20

What is meralgia paresthetica ?

Answer 20

• Impingement of lateral femoral cutaneous nerve at inguinal lig causing paresthesia over lateral groin and thigh area

Question 21

Describe arterial supply to: (a) lumbar vertebrae (b) Spinal cord

Answer 21

(a) supplied by equatorial and periosteal branches of lumbar arteries as well as subcostal arteries
(b) supplied by spinal branches from lumbar arteries

Question 22

What is spondylolisthesis and how does it happen ?

Answer 22

Dislocation of adjacent vertebrae, can due to spondylosis ( a fracture of the the parts of vertebrae that connects articular processes )

Question 23

What are some of the effects of aging on the lumbar vertebrae and discs ?

Answer 23

decreased bone density/strength, discs become convex superiorly and inferiorly, osteophytes develop at points of friction

Question 24

Describe the different types of stenosis in the vertebral column ?

Answer 24

Spinal stenosis: narrowing of the vertebral canal
Foraminal stenosis: narrowing of IV foramen

Question 25

What is a disc bulge and how does it occur ?

Answer 25

a bulge of an IV disc into spinal spaces
-can be caused by slouched postures, and forward bending
- if anular wall is compromised PT is not appropriate

Question 26

Describe the following procedures, why they are performed, and a complication of each one ? (a) laminectomy (b) lumbar fusion

Answer 26

(a) Laminectomy: the surgical excision of one or more spinous processes and adjacent laminae, typically done to relieve pressure on the spinal cord// post laminectomy syndrome can occur if scar tissue adheres to neural tissue exposed
(b)lumbar fusion: 2 or more vertebrae are fused together, bone graft adjoin them, can lead to instability above and below fusion which can lead to more back pain.

Question 27

What is the difference between a strain, sprain, and spasm.

Answer 27

Strain: tearing of muscle fibers, caused by over contraction or forceful stretch, erector spinae are susceptible
Sprain: injury to ligament or ligament attached to bone, no dislocation or fracture
Spasm: involuntary contraction

Question 28

List the innervated structures of the spine that contribute to LBP.

Answer 28

1. Fibroskeletal structures ( periosteum)
2. Meninges
3. Synovial joints ( facets )
4. Muscles
5. Nervous Tissue- percieved in dermatome

Question 29

What is spina bifida ?

Answer 29

• Neural arches fail to develop normally resulting in hernations of meninges
  -occulta and cystica

Question 30

What deficits would expect to see with spinal cord injuries at the following levels: L2-3, T10-L1, T1-9, C6-8, C4-5, C1-2

Answer 30

L2-3: some quad function, no lower leg function
T10-L1: some hip function, no quads or below
T1-9: paraplegia, no leg fxn, some trunk lost
C6-8: no hand fxn, some shoulder fxn
C4-5: quadriplegia, still can breath due to C3
C1-3: no function below head, need ventilator

Question 31

What is an innominate ?

Answer 31

• A hemi- pelvis, half of the pelvis; another word is coxa, or hip bone

Question 32

Why is the SI joint so stable ?

Answer 32

SI joints are synovial joints, with a syndesmosis on the joint tubercles which allow sacrum and pelvis to interlock, this allows little mobility
Strong antero and posterior SI ligs help to stabilize sacrum against pelvis and lumbar vertebrae along with iliolumbar, and sacrotuberous ligaments

Question 33

In visible body review the branching of arterial supply to the pelvis.

Answer 33

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Question 34

What happens to the SI joints and ligaments during late pregancy ?

Answer 34

During late pregnancy a hormone named relaxin allows ligaments to become more lax to allow greater movement, can cause dislocations

Question 35

What is sciatica and how does it occur ?

Answer 35

Radiating pain down the low back and leg, due to compression of L5-S1 by a herniated disc.

Question 36

Review structures in visible body

Answer 36

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