Exam 3- Arthrology of the Vertebral Column Flashcards
(183 cards)
1
Q
What is the Latin term for joint?
A
arthron
2
Q
What is the study of joints called?
A
arthrology
3
Q
What is the Latin term for a “tightly bonded together condition”?
A
syndesmosis
4
Q
What material was responsible for the “tightly bonded together condition” in the joint?
A
dense fibrous connective tissue, a ligament
5
Q
What is the study of ligaments called?
A
syndesmology
6
Q
What protein fiber is the dense connective primarily composed of?
A
collagen fibers which give it a whitish color
7
Q
Besides collagen, what other proteins are ligaments composed of?
A
elastin fibers which can give a yellowish tinge to the ligament
8
Q
What are the examples of the typical syndesmosis from the vertebral column?
A
most of the ligamentous joints of the vertebral column and the ligamentous sacro-iliac joints
9
Q
What are the characteristics of an (amphiarthrosis) symphysis?
A
limited motion, medial plane location, support ligaments both anterior and posterior to the joint, more permanent in longevity than synchondrosis and they occur between bones developing by endochondral ossification
10
Q
What are the four consistent features of synovial (diarthrosis) joints?
A
articular or fibrous capsule, synovial membrane, articular cartilage and synovial fluid
11
Q
What are examples of intracapsular and extracapsular ligaments?
A
Intracapsular ligaments: cruciate ligaments of the knee
Extracapsular ligaments: collateral ligaments of the knee
12
Q
What is the generic function of ligaments?
A
stimulate reflex contraction of muscles around the joint
13
Q
What are the common characteristics of type I articular receptors?
A
located in the superficial layer of the fibrous capsule, resemble Ruffini endings, most numerous in cervical zygapophyses and they monitor the joint “at rest”
14
Q
What are the characteristics of type II articular receptors?
A
located in deeper strate of the fibrous capsule, resemble Pacinian corpuscles, most numerous in the cervical spine and monitor the joint during normal range of motion
15
Q
What is the location of type III articular receptors?
A
collateral and intrinsic ligaments of many joints, they were not thought to be present along vertebral column
16
Q
What is the function of type III articular receptors?
A
they monitor the joint during extreme motion or beyond normal range of motion
17
Q
What are the characteristics of type III articular receptors?
A
present in collateral and intrinsic ligaments, resemble Golgi tendon organs, not initially observed along the vertebral column and monitor extreme joint motion
18
Q
What is the function of type IV articular receptors?
A
nociceptive, they monitor pain
19
Q
Type IVa articular receptors would be present in what locations?
A
fibrous capsule, articular fat pads or adventitia of blood vessels
20
Q
Type IVb articular receptors would be present in what locations?
A
accessory ligaments in general, dense in the posterior longitudinal ligament of the spine
21
Q
Type IV articular receptors are absent in what part(s) of the synovial (diarthrosis) joint?
A
synovial membrane, articular cartilage and synovial menisci or intra-articular discs
22
Q
Articular fat pads are most numerous in what location along the vertebral column?
A
lumbar zygapophyses
23
Q
Condensed fibrous connective tissue or fibrocartilage projections of the synovial membrane are called?
A
synovial menisic or intra-articular discs
24
Q
Intra-articular discs are a feature of what joints examples?
A
temporomandibular, sternoclavicular, acromioclavicular and radio-ulnar joints
25
Synovial, menisci are a feature of what joint examples?
femur-tibia articulation, cervical zygapophyses and lumbar zygapophyses
26
What are the specific functions of type A synovial cells?
are phagocytic
27
What is the specific function of type B synovial cells?
secrete proteinaceous substances and hyaluronic acid
28
What is the primary function of bound glycosaminoglycans in articular cartilage?
form a network for water retention
29
Cartilage is able to change shape due to compression, a characteristic known as
deformation
30
What is implied when cartilage is said to have elastic properties?
cartilage can deform and returns to original volume rapidly, a time independent property
31
What is implied when cartilage is said to have viscoelastic properties?
cartilage can deform but returns to original volume slowly, a time dependent property
32
What are the properties of synovial fluid?
it is yellow-white, viscous, slightly alkaline and tastes salty
33
Synovial fluid consist of what specific chemical groups?
fats, salts, albumins, and hyaluronate
34
Which substance in synovial fluid was first thought to be responsible for its viscosity and lubricating behavior?
hyaluronate
35
What substance of synovial fluid has been proposed to be responsible for its viscosity and lubricating behavior?
lubricin
36
What are examples of synovial plane (diarthrosis arthrodial) joints?
most zygapophyses of the vertebral column:
intercarpal, carpometacarpal and intermetacarpal joints of the hand; intercuneiform, tarsometatarsal and intermetatarsal joints of the foot
37
What are examples of synovial hinge (diarthrosis ginglymus) joints?
humero-ulnar joint of the elbow and interphalangeal joints of the fingers and toes; temporomandibular joint
38
Diarthrosis ginglymus joints are commonly called ____ joints based on action.
synovial hinge
39
Diarthrosis trochoid joints are commonly called ____ joints based on action
synovial pivot
40
What are the examples of synovial pivot (diarthrosis trochoid) jonts?
median atlanto-axial joint and proximal radio-ulnar joint
41
What is shared morphological characteristic of diarthrosis trochoid joints?
an osseous pivot point and an osteo-ligamentous ring
42
What is a common name for the diarthrosis sellar joint?
synovial saddle joint
43
What are examples of synovial saddle (diarthrosis sellar) joints?
carpometacarpal joint of the thumb, talocrural joint of the ankle and the calcaneocuboid joint of the foot
44
What is an example of a modified synovial saddle/diarthrosis sellar joint?
the joint of Luschka in the cervical spine
45
What are examples of diarthrosis condylar joints?
temporomandibular joint and femur-tibia joint of the knee
46
What are examples of diarthrosis ellipsoidal joints?
radiocarpal joint of the wrist metacarpo-phalangeal joints of the hand, metatarsal-phalangeal joints of the foot and the atlanto-occipital joint of the vertebral column
47
Which synovial joint classifications are now often interchanged in textbooks?
ellipsoidal and condylar synovial joints
48
What are the common ligaments of the vertebral column?
those ligaments commonly found between vertebral couples from C2/C3 to L4/L5
49
Identify the common ligaments of teh vertebral column
anterior longitudinal ligament, intervertebral disc, posterior longitudinal ligament, ligamentum flavum, capsular ligament, interspinous ligament, ligamentum nuchae, supraspinous ligament and intertransverse ligament
50
What is the maximum number of common ligaments identified with a vertebral couple?
eight
51
What is the number of true intervertebral discs identified in the adult?
twenty-three
52
In the adult, which vertebral levels will demonstrate a true intervertebral disc?
those between C2 and S1 inclusive
53
What is the cervical nucleus pulposus composed of?
fibrocartilage
54
What is the consequence of non-aggregated glycosaminoglycans in the lumbar nucleus pulposus?
the nucleus pulposus will lose water under deformation conditions
55
What cell is associated with the nucleus pulposus until about age eleven?
notochord cells
56
Which type of collagen is dominant in the nucleus pulposus?
collagen type II
57
What is the organizational pattern for collagen fibers in the nucleus pulposus?
they are irregularly oriented and randomly scattered
58
What is unusual about the cervical annulus fibrosus?
it lacks any lamellar or layered organization
59
What is the appearance of the cervical annulus fibrosus?
a horse-shoe with the anterior margin thick and the lateral margins tapering to the uncinate processes; the posterior margin is thin
60
What compensates for the thinness of the posterior part of the cervical annulus fibrosus?
posterior longitudinal ligament
61
What is the organization of the lumbar annulus fibrosus?
it has 12-14 concentric cylindrical lamellae
62
Why is the posterior part of the lumbar annulus fibrosis more susceptible to rupture, herniation, prolapse, or protrusion?
the posterior margin of each lamellus is thin and the posterior longitudinal ligament is also less developed
63
What is the consequence of aggregated glycosaminoglycans in the lumbar annulus fibrosus?
the annulus fibrosus will retain water under deformation conditions
64
Which type of collagen is dominant in the annulus fibrosus?
collagen type I
65
What is the organizational pattern for collagen fibers in the annulus fibrosus?
they are parallel with one another in a single lamellus and angled
66
What is the organization of collagen fibers between lamellae?
collagen fibers will be angled in the opposite direction such that a spiral- counterspiral organization is observed
67
What is the average angle of collagen fibers within the annulus fibrosis?
they average 50 to 60 degrees
68
What cell type is associated with the annulus fibrosus?
fibroblast and fibrocyte
69
What is the thickest part of the cartilage end plate?
around the periphery
70
What is the thinnest part of the cartilage end plate?
the central part, over the nucleus pulposus
71
What is the principal type of collagen fiber within the cartilage end plate?
the type II collagen fiber
72
What is the direction of collagen fibers within the cartilage end plate?
collagen fibers are aligned anterior to posterior
73
What is the earliest indicator of intervertebral disc pathology or degeneration?
changed in the histology of the cartilage end plate
74
What part of the intervertebral disc is innervated?
the outer lamellae of the annulus fibrosus
75
What are the types of receptor endings in the intervertebral disc?
nociceptors and proprioceptors
76
What is the relationship between size of the intervertebral disc and receptor endings?
the larger the disc, the greater the variety of receptor endings
77
What is the proposed function of receptor ending density in the anterior part of the intervertebral disc?
they provide feedback during extension
78
What are the sources of innervation of the intervertebral disc?
the sinu-vertebral nerve (sinus vertebral nerve, recurrent meningeal nerve), fibers from the ventral primary ramus, fibers from the white ramus communicans, fibers from the paradiscal ramus communicans, fibers from the gray ramus communicans
79
What is innervated by the recurrent meningeal/sinu-vertebral/sinus vertebral nerve?
the outer lamellae of the annulus fibrosus at the posterior part of the intervertebral disc, the posterior longitudinal ligament and dura mater plus vessels and connective tissue of the epidural space
80
What innervates the annulus fibrosus at the lateral part of the intervertebral disc?
fibers from the ventral primary ramus, fibers from the white ramus communicans, fibers from the paradiscal ramus communicans, fibers from the gray ramus communicans
81
What is the name given to the white ramus communicans which becomes embedded within the annulus fibrosus of the intervertebral disc?
the paradiscal ramus communicans
82
How does the intervertebral disc help shape the spine?
the anterior height is greater than the posterior height tin the cervical and lumbar region this creating a lordotic or anterior curve
83
What is the popular theory of intra-abdominal cavity pressure and intervertebral disc response to weight bearing?
increasing the intra-abdominal cavity pressure will diminish the amount of resistance the intervertebral disc needs to generate by up to 50%
84
What vertebral levels will the anterior longitudinal ligament attach to?
those between occiput and S3 inclusive and traditionally indicated
85
What is the lowest extent of the anterior longitudinal ligament based on recent studies?
L3
86
What is the function of the anterior longitudinal ligament?
it brakes or limits dorsi-flexion or hyperextension of the vertebral column
87
What was ossification of the anterior longitudinal ligament in the lumbar region identified as?
Forestier's Disease
88
Anterior longitudinal ligament ossification in the lumbar region is now identified as _____?
Diffuse Idiopathic Skeletal Hyperstosis or DISH
89
What vertebral levels will the posterior longitudinal ligament attach to?
those between C2 and S3 inclusive are traditionally indicated
90
What is the function of the posterior longitudinal ligament?
it brakes or limits flexion of the vertebral column
91
Where is ossification of the posterior longitudinal ligament most commonly identified?
the cervical spine with an 80% incidence
92
What is the clinical sign of posterior longitudinal ligament ossification in the cervical spine?
a loss of hand and finger dexterity
93
What is the incidence of posterior longitudinal ligament ossification in the thoracic and lumbar spine?
about 10% at the thoracic and 10% at the lumbar spine
94
What is the clinical sign of posterior longitudinal ligament ossification in the lumbar spine?
faltering gait
95
What is the gender, age, and ethnic bias associated with ossification of the posterior longitudinal ligament?
it is greater in males over 50 and has a higher incidence in the Japanese
96
What is the acronym for ossification of the posterior longitudinal ligament?
OPLL
97
At one time ossification of the posterior longitudinal ligament was an example of what condition?
Diffuse Idiopathic Skeletal Hyperostosis or DISH
98
What vertebral levels will the ligamentum flavum be attached to?
those between C2 and S1 inclusive are traditionally indicated
99
What is the histology of the ligamentum flavum?
it is formed primarily with elastic fibers, which are yellow in appearance
100
What is the name given to the ligamentum flavum based on appearance and histology?
it is a yellow elastic ligament
101
What is the function of the ligamentum flavum?
it brakes or limits flexion of the vertebral column
102
What is now thought to be a major function of the ligamentum flavum?
it is an early prime factor in extension of the vertebral column
103
Where is ossification of the ligamentum flavum most commonly identified?
the thoracic spine or thoracolumbar transition zone
104
What is the acronym for ossification of the ligamentum flavum?
OLF
105
What is the relationship between the capsular ligament and mobility?
the more lax/loose the capsular ligament is, the greater the motion of the joint
106
What regions of the vertebral column demonstrate the greatest laxity of capsular ligaments?
the cervical and lumbar regions
107
The capsular ligament may blend with which other ligament?
the ligamentum flavum
108
What muscle will blend with the capsular ligament posteriorly?
the multifidus
109
What is the pattern of innervation for the zygapophysis capsular ligament?
it is typically innervated by 3 spinal nerves
110
If the zygapophyseal capsular ligament is not significantly involved in restricting motion what is its' function?
it is probably involved in proprioceptive feedback to the muscles stabilizing the vertebral couple during movement
111
What vertebral levels will the interspinous ligament be attached to?
those between C2 and S1 inclusive are traditionally indicated
112
What is the status of the human interspinous ligament compared with other common ligaments?
they are poorly developed as ligaments although collagen fibers are present
113
What is the status of the cervical interspinous ligament?
it is lacking, poorly developed, or simply considered the deep anterior part of the ligamentum nuchae
114
What is the status of the thoracic interspinous ligament?
it is narrow and elongated reflecting the shape of the spinous process
115
What is the status of the lumbar interspinous ligament?
it is broad and thick with three layers identified from anterior to posterior
116
What is the classic function of the interspinous ligament?
it brakes or limits flexion of the vertebral column
117
What is now though to be a major function of the interspinous ligament?
it is more likely a proprioceptive transducer for the spinal reflex
118
What is the name given to the superficial layer of the ligamentum nuchae?
the funicular layer or part
119
What is the name given to the deep layer of the ligamentum nuchae?
the lamellar layer or part
120
What are the attachment sites for the superficial layer of the ligamentum nuchae?
the external occipital protuberance, external occipital crest, and spinous tubercle of C7
121
What are the attachment sites for the deep layer of the ligamentum nuchae?
the posterior tubercle of the posterior arch of C1, and spinous tubercles between C2 and C6 inclusive
122
What is the histological make-up of the ligamentum nuchae in quadrupeds?
it is a yellow elastic ligament
123
What is the histological make-up of the human ligamentum nuchae?
it is a yellow elastic ligament, but has more collagen fibers than in quadrupeds
124
What is the primary yellow elastic or elastic ligament of the spine?
the ligamentum flavum
125
What is the classic function of the human ligamentum nuchae?
it brakes or limits flexion of the cervical spine
126
What will the supraspinous ligament be attached to?
the spinous tubercles along the vertebral column from C7 to sacrum
127
What is the termination level inferiorly for the supraspinous ligament according to current literature?
primarily at L4 (73%); between L4 and L5 (5%)
128
Where is the supraspinous ligament said to be best developed?
in the lumbar spine
129
What is the classic function of the human supraspinous ligament?
it brakes or limits flexion of the spine
130
What is now thought to be a major function of the supraspinous ligament?
it is a proprioceptive transducer for the spinal reflex
131
What is the status of the cervical intertransverse ligament?
is it said to be paired with an anterior and a posterior intertransverse ligament present
132
What is the status of the thoracic intertransverse ligament?
it is said to blend with muscles of the deep back; a separate ligament may not exist
133
Where in the vertebral column is the intertransverse ligament best developed?
in the lumbar spine
134
What part of the lumbar intertransverse ligament covers the intervertebral foramen?
the ventral slip
135
What part of the intertransverse ligament in the lumbar spine divides the body wall into an anterior muscular compartment and a posterior muscular compartment?
the dorsal slip
136
What is the classic function of the anterior atlanto-occipital ligament?
it brakes or limits "extension" of the skull over the cervical spine
137
What is the classic function of the posterior atlanto-occipital ligament?
it brakes or limits axial rotation, flexion and perhaps lateral bending of the skull on atlas
138
What amount of flexion - extension is accommodated by the atlanto-occipital joint?
about twenty-five degrees
139
What amount of axial rotation is accommodated by the atlanto-occipital joint?
about three to eight degrees one side axial rotation
140
What amount of lateral bending is accommodated by the atlanto-occipital joint?
about five degrees
141
Which motion is best accommodated by the atlanto-occipital joint?
flexion-extension
142
What is the function of the transverse atlantal ligament?
it is the primary stabilizer of the atlanto-axial joint restricting the distance of C2 from the anterior arch of C1
143
What movements are facilitated at the median atlanto-axial joint?
flexion-extension, rotation and telescoping (superior-inferior gliding)
144
What is the ADI?
the Atlanto-Dental Interspace, a radiographic distance between the surfaces of the anterior bursa of the median atlanto-axial joint
145
The ADI is observed between which surfaces?
the fovea dentis of C1 and the facet for fovea dentis of C2
146
What is the ADI of children compared with that of adults?
about 4.5 mm in children; a range of 2-3 mm or about 2.5 mm in adults
147
What are the characteristics of the capsular ligament of the lateral atlanto-axial joint?
it is lax or loose and demonstrates a meniscoidal fold within the joint cavity
148
What are the attachment sites for the accessory atlanto-axial ligament?
the base of the odontoid process and vertebral body of axis to teh tubercle for the transverse atlantal ligament on the lateral mass of C1; a superior continuation may attach on the occipital bone just behind that of the alar ligament
149
What are the degrees of movement facilitated at the atlanto-axial joint?
about 20 degrees flexion - extension, 40 degrees one side axial rotation, and 5 degrees of lateral bending
150
The occiput-C1-C2 joint complex accounts for what percent of all cervical axial rotation?
about 60%
151
Embryologically, what forms the apical ligament of the dens or the apical dental ligament?
the notochord
152
What ligament attaches to the posterolateral part of the odontoid process of C2 and to surfaces on the medial border of the occipital condyle or as far anterior as the anterolateral margin of the foramen magnum?
the alar ligament
153
What is the function of the alar ligament?
together they function to resist axial rotation
154
For the cervical spine below C2, what is the range of flexion - extension?
about 90 degrees or about 18 degrees per couple
155
For the cervical spine below C2, what is the range of one side lateral bending?
about 50 degrees or about 10 degrees per couple
156
For the cervical spine below C2, what is the range of one side axial rotation?
about 33 degrees or about six degrees per couple
157
For the cervical spine below C2, what is the range of motion allowed for each type of joint motion identified?
90 degrees flexion-extension, 50 degrees one side lateral bending and 33 degrees one side axial rotation
158
Based on current literature, what common ligaments are absent at the lumbosacral joint?
ligamentum nuchae, interspinous ligament and supraspinous ligament
159
Which ligaments replace the intertransverse ligament at the lumbosacral joint?
the iliolumbar ligament and lumbosacral ligament
160
What are the attachment sites for the lumbosacral ligament?
the sacral ala and ventrolateral surface of sacrum attach to the transverse process of L5
161
What are the attachment sites for the iliolumbar ligament?
the iliac crest is attached to the transverse process of L5
162
What muscle is intimately attached to the superior iliolumbar ligament?
quadratus lumborum
163
Which vertebral couple of the lumbar spine has the greatest range of motion?
L5/S1
164
Which range of motion is greatest for all lumbar vertebral couples?
flexion-extension
165
Which range of motion is least for L1-L5 vertebral couples?
one side axial rotation
166
Which range of motion is least for the L5/S1 vertebral couple?
one side lateral bending
167
What are the attaching sites for the anterior sacrococcygeal ligament?
the vertebral bodies from about S3 to Co2-Co3
168
List, in order, from cranial to caudal the ligaments forming the anterior boundary of the spinal column
anterior atlanto-occipital ligament, anterior atlanto-axial ligament, anterior longitudinal ligament, and the anterior sacrococcygeal ligament
169
What are the attaching sites for the deep posterior sacrococcygeal ligament?
the vertebral bodies from about S3 to Co1
170
Which gender has greater unevenness of the auricular surface of the sacro-iliac joint?
males
171
What pathological or age-related modifications of the sacro-iliac joint may occur?
degenerative arthrosis and ankylosis
172
What does degenerative arthrosis mean?
a condition of degeneration of the joint, sometimes referred to as degenerative joint disease (DJD)
173
What does ankylosis mean?
a condition of fibrous adhesion occurs within the joint
174
What is the age and surface bias associated with degenerative arthrosis of the sacro-iliac joint?
age 40, the iliac auricular surface
175
What is the age and gender bias associated with ankylosis of the sacro-iliac joint?
age 50 and male bias particularly in African American males
176
What age and gender bias is associated with ossification of the anterior sacro-iliac ligament?
age 40 and male bias
177
Which is the strongest of the sacro-iliac ligaments?
the interosseous sacro-iliac ligament
178
What are the attachment sites of the interosseous sacro-iliac ligament?
at the sacral tuberosity and the iliac sulcus
179
What passes between the layers of the interosseous sacro-iliac ligament?
dorsal rami from the sacral spinal nerves
180
What ligament blends with the lateral border of the long posterior sacro-iliac ligament?
the sacrotuberous ligament
181
What is formed by the continuation of the sacrotuberous ligament along the ischial ramus?
the falciform process
182
What separates the greater sciatic and lesser sciatic foramina?
the sacrospinous ligament
183
What is the function of the sacrospinous and sacrotuberous ligament?
they oppose the upward tilt of the sacral apex and resist the rotation of sacrum between the innominate bones
