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vertebral column > Facet joints > Flashcards

Facet joints Flashcards

1
Q

what is a facet joint?

A

synovial plane joint

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2
Q

what is a facet joint also known as?

A

a zygapophyseal, or apophyseal, joint

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3
Q

what does a facet joint contain?

A

Contains joint capsule and membrane which helps produce synovial fluid which aids in facet joint movement

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4
Q

how many facets are there at each spinal level?

A

2 facets

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5
Q

where are the facet joints?

A

Between the inferior articular process from vertebra above and the superior articular process form vertebra below
Located in posterior portion of individual vertebra

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6
Q

what do the facet joints contribute to?

A

the motion segment of the spine, along with the intervertebral disc, which helps protect, stabilise and limit movement of the spine.

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7
Q

facet joints help what?

A

help guide movement of the segment and help transmit spinal loads

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8
Q

what are the facet joints covered in?

A

hyaline cartilage

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9
Q

each facet is enclosed in what?

A

within a thin fibrous capsule lined with a synovial membrane – this capsule can aid or limit movements within different vertebral levels

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10
Q

what allows stretching without injury in relation to the joint capsule?

A

crimped collagen fibres

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11
Q

shape of the articular processes help determine what?

A

the movement each facet joint will allow – differs at each vertebral level

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12
Q

the joint capsule prevents what?

A

friction during movement

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13
Q

what does the literature say about joint capsules?

A

capsule is innervated by fine nerve fibres which may produce nociceptive and proprioceptive sensations

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14
Q

the capsular ligaments helps reinforce what?

A

ligament helps reinforce the facet capsule and helps to limit motions of the facet joint

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15
Q

what is the capsular ligaments composed of?

A

collagen fibres which extend between the vertebrae and connect to the ligamentum flavum

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16
Q

capsular ligament encloses what?

A

the joint

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17
Q

what are meniscoids?

A

Invaginations of synovial membrane that can vary in shape

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18
Q

where are the meniscoids attached to?

A

Attached to the joint capsule peripherally, at dorsal and ventral poles, and extend towards the centre of the joint

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19
Q

what are meniscoids made up of?

A

Composition of adipose tissue, loose and connective tissue with collagen fibres that extend through the structure

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20
Q

meniscoids are hypothesised to do what?

A

to distribute heavy loads over a larger surface area, allowing smoother gliding motions during joint movement

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21
Q

Facet joints are innervated by what?

A

medial branches of the dorsal rami – much research has been performed on how to eliminate pain from the facet joints using these medial branches – nerve blocks, injections etc….

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22
Q

what are the arteries involved with the vertebrae?

A

Cervical- vertebral and ascending cervical arteries
Thoracic- costocervical and posterior intercostal arteries
Lumbar- lumbar and iliolumbar arteries
Sacral- lateral sacral arteries

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23
Q

what are the veins involved with the vertebrae?

A

Intervertebral veins which form plexuses

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24
Q

what is the structure of the superior facets of the atlas?

A

upward and medial, concave, anterior ends nearest midline

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25
Q

what is the structure of the inferior facets of the atlas?

A

concave but looks flat, oval

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26
Q

the concavity of the atlas does what?

A

prevents ‘no’ movement

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27
Q

what are the variations of the atlas?

A

Concavity
Unsymmetrical
Constrictions (45% of 200 vertebrae)

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28
Q

what is the structure of the superior facet of the axis?

A

oval, inclined obliquely downwards posteriorly, face laterally

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29
Q

what is the structure of the inferior facet of the axis?

A

face more anteriorly to articulate with C3

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30
Q

‘no’ movement at the atlantoaxial joint of the axis is permitted by what?

A

permitted by relatively flat and tilted facets

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31
Q

what is the structure of the superior facet of the lower cervical (C3-7)?

A

flat, face posteromedially

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32
Q

what is the structure of the inferior facet of the lower cervical (C3-7)?

A

face anterolaterally

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33
Q

facets in the lower cervical region allow what?

A

for greater range of movement in this region – flexion, extension, rotation, lateral bending
Oblique- 45’ from the horizontal plane

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34
Q

what is the structure of the capsule in the lower cervical region?

A

The capsule is particularly lax in the cervical region to allow gliding of vertebrae

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35
Q

what degree of flexion can occur in the lower cervical region and what occurs to the facets?

A

(25’)- superior facets slide up and tilt forward (capsule widens posteriorly, no bony limitations- subluxation)

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36
Q

what degree of extension can occur in the lower cervical region and what occurs to the facets?

A

(85’)- superior facets tilt and slides posteriorly, IV space closes, gap opens anteriorly

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37
Q

what degree of lax flexion can occur in the lower cervical region and what occurs to the facets?

A

(40’)- gliding up and down but also back and forward due to orientation of facets, so always accompanied by rotation

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38
Q

what degree of rotation can occur in the lower cervical region and what occurs to the facets?

A

(50o)- occurs with lateral flexion, prevented by grinding of opposite facets together, opens capsule in direction of head rotation

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39
Q

what is the structure of the articular processes in the thoracic region?

A

thin, triangular

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40
Q

where do the superior articular facets face in the thoracic region?

A

posterolateral

41
Q

where do the inferior articular facets face in the thoracic region?

A

anteromedial

42
Q

where do the facets sit in the thoracic region in relation to the horizontal and axial plane?

A

60’ horizontal abd 20’ axial

43
Q

what kind of arrangement are the facets in the thoracic region?

A

circumferential

44
Q

what degree of flexion can occur in the thoracic region and what occurs to the facets?

A

freer in lower T region because they’re more flexible (longer cartilage and floating ribs), limited by ribs and ligaments

45
Q

what degree of extension can occur in the thoracic region and what occurs to the facets?

A

limited by impact of articular processes

46
Q

what degree of lat flexion can occur in the thoracic region and what occurs to the facets?

A

20-25o)- freer lower half, contralateral facet moves like flexion and other moves like extension, limited by articular processes, also rotate (1o for 1o)

47
Q

what degree of rotation can occur in the thoracic region and what occurs to the facets?

A

(35o)- articulations made for rotation, articular processes slide away from other processes, lost when fully extended- important during walking to keep head facing forward (T7/8 no rotation but above and below have the most)

48
Q

what is the structure of the articular processes in the lumbar region?

A

strong

49
Q

what is the structure of the superior facets in the lumbar region?

A

concave, medially and backward facing

50
Q

what is the structure of the inferior facets in the lumbar region?

A

convex, forward facing and slightly lateral

51
Q

Literature suggests that the joint capsules in the lumbar regions are what?

A

more taut and smaller in comparison to the cervical region which helps limit rotational movements in the spine

52
Q

what movement can occur in the lumbar region?

A

Flexion, extension, lateral flexion, no rotation

53
Q

what degree of flexion can occur in the lumbar region ?

A

(55’)- inferior facets glide upwards and forwards on superior facets

54
Q

what degree of extension can occur in the lumbar region ?

A

(30’)- superior facets glide down into the inferior facets and tilt backwards,

55
Q

what degree of lateral bending can occur in the lumbar region ?

A

(20’-30’, 60’ in children)- very little lateral bending and therefore no rotation, one side becomes close packed and the other separates and gap forms

56
Q

shape of surfaces in the lumbar regions restrict what?

A

restrict rotation (couple of degrees)- increases with flexion and decreases with extension. Small gaps between facets become obliterated with rotation and prevents any more rotation

57
Q

are there facets between the sacral bones?

A

no as they are fused together

58
Q

where are the lumbosacral facet joints?

A

Between inferior facets of L5 and sacrum

59
Q

the L5 facets face where?

A

anteromedially

60
Q

the sacrum facets face where?

A

posteriomedially

61
Q

Iliolumbar ligaments attach where?

A

attach from the transverse processes of L5 to the ilia

62
Q

main movements of the sacral facets are what?

A

flexion and extension

63
Q

total range of movement of the sacral facets is what?

A

18’

64
Q

what is movement of the sacral facets limited by?

A

iliolumbar ligaments

65
Q

in relation to the sacral facet lateral flexion decreases from what to what?

A

decreases from 7’ in children to 1’ in adults

66
Q

Orientation of facets and ligaments prevent what?

A

anterior gliding of the lumbar vertebrae

67
Q

the coccyx consists of what?

A

fused bones

68
Q

do the coccyx vertebrae have articular processes or facets?

A

no

69
Q

what kind of joint is in the coccyx?

A

second cartilagenous

70
Q

The facet joint aids the IV disc in what?

A

in stabilising the spine and supporting spinal motion

71
Q

Weight can bear down and transfer to the facet joints when?

A

especially when the spine is in motion to produce movements such as rotation

72
Q

With repeated weight bearing loads does what to the facet joint and can lead to what?

A

the facet joint cant deteriorate over time/ age, This can lead to facet degeneration which can lead to disorders such as facet joint syndrome and osteoarthritis

73
Q

Up to 25% of compression through facets, torsional stiffness, prevent what?

A

translation

74
Q

what is whiplash?

A

is an acceleration-deceleration mechanism of energy transfer to the neck. It may result from rear end or side impact motor vehicle collisions, but can also occur during diving or other mishaps. The impact may result in bony or soft-tissue injuries (whiplash injury), which may lead to a variety of clinical manifestations.” (Quebec Task Force)

75
Q

What causes symptoms?

A

Facet joint degeneration after injury

76
Q

what are the most common injury associated with road traffic accidents (RTA)?

A

Whiplash associated disorders (WAD)

77
Q

what movements occur during whiplash?

A

Cervical spine movements during whiplash

78
Q

WAD graded 0-4: symptoms include what?

A

neck stiffness, pain, headache, upper limb pain, paraesthesia

79
Q

Acute/ subacute- symptoms last how long?

A

< 3 months

80
Q

Chronic- symptoms last how long?

A

> 3 months (40% patients are chronic)

81
Q

what is stage 1 of whiplash?

A

cervical lordosis is lost so there is a flexion deformity of upper and lower C-spine
Force- tensile (<50ms)

82
Q

what is stage 2 of whiplash?

A

‘S’ shape forms- lower vertebrae extend while upper vertebrae flex
Force- shear, tensile and compressive (50-75ms)

83
Q

what is stage 3 of whiplash?

A

extension at both ends of the C-spine

Force- shear and tensile (75-100ms)

84
Q

what is stage 4 of whiplash?

A

hyperflexion

Force- shear and tensile (>100ms)

85
Q

when is most damage caused during whiplash?

A

stage 2, between C5/6 posteriorly

86
Q

lax ligaments allow what?

A

gliding of vertebrae

87
Q

what state are the muscles in before whiplash?

A

Usually an unexpected event so muscles are relaxed too

88
Q

Most stretch occurs where?

A

anteriorly; most compression occurs posteriorly

89
Q

During flexion there is no bony limitations in the cervical region which can lead to what?

A

can lead to dislocations

90
Q

what is synovitis?

A

Inflammation and damage to the capsule

91
Q

what is Capsule ligament stretch?

A

Mechanical stimuli causes hyperexcitability of capsular afferents
Poor healing abilities of ligaments leaves patient with chronic pain
Increased instability of facet joints could lead to further damage- facet subluxation

92
Q

what is Nerve and meniscoid impingement?

A

Articular facets collide and cause meniscoid impingement

Spinal nerves trapped in intervertebral foramen in extension phase

93
Q

what is degenerative changes?

A

Articular facets wear away from years of poor congruency

May end up with osteoarthritis

94
Q

what percentage of over 70s have FJD- ageing is a risk factor?

A

75%

95
Q

Injury to a joint increases what?

A

the likelihood of degenerative disease

96
Q

symptoms of facet joint degeneration after whiplash?

A

stiffness, pain

No correlation between symptom severity and x-ray findings

97
Q

diagnosis of facet joint degeneration after whiplash?

A

accident + symptoms
Only x-ray if there are red flags (eg neurological impairment)
X-rays show a lot of false positives in the acute phase
Can sometimes see loss of lordosis, subluxation and fractures

98
Q

management of facet joint degeneration after whiplash?

A 
Early mobilisation (in the past, collars were used)
NSAIDs
Steroid and anaesthetic facet joint injections not given on the NHS

vertebral column (10 decks)

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