Ligaments and Tendons

Question 1

describe the ALL

Answer 1

vertical collagen fibres
broad band
stabilises VB
prevents hyperextension and anterior herniation

Question 2

describe the PLL

Answer 2

vertically collagen fibres
stabilises VB
prevents hyperflexion and posterior herniation

Question 3

overview PLL ossification - pathological

Answer 3

calcification
causes - genetic, metabolic, age
sx - narrowed spinal canal and subsequent compression
tx - analgesia, PT, surgical decompression

Question 4

what can cause ALL ossification

Answer 4

DISH

Question 5

what can DISH lead to

Answer 5

dyspnoea, dysphagia and dysphonia

Question 6

describe the ligamentum flavum

Answer 6

vertical elastic fibres from each lamina
midline network connection

Question 7

ligamentum flavum functions

Answer 7

connect and stabilise adjacent laminae
forms part of posterior vertebral canal
maintain smooth posterior dura capsule surface

Question 8

overview ligamentum flavum hypertrophy

Answer 8

abnormal thickening -> cord or root compression
associated w/ spinal stenosis
tx includes steroid injections or surgical decompression

Question 9

describe the nuchal ligament

Answer 9

fibroelastic fibres - lamellar and funicular portions
connect tips of cervical spinous processes
attachment site of muscles

Question 10

describe the supraspinous ligament

Answer 10

strong collagen fibrils w/ cord like structure
connects S processes and prevents their separation during flexion

Question 11

describe the interspinous ligament

Answer 11

thin membrane of collagen bundles
connect adjacent S processes

Question 12

describe the intertransverse ligament

Answer 12

cervical - scattered fibres
thoracic - fibrous cord
connects and stabilises adjacent T processes

Question 13

describe the atlanto-occipital ligament - anterior

Answer 13

densely woven fibres
supports movements
prevents hyper-extension

Question 14

describe the posterior atlanto-occipital ligament

Answer 14

weaker fibres
supports movements
prevents hyper-flexion

Question 15

describe the AA cruciate ligament

Answer 15

2 weak longitudinal bands
1 strong transverse band
supports rotation and holds dens in socket

Question 16

describe the alar ligaments

Answer 16

short, cylindrical cords
prevents anterior atlantal shift and hyper-rotation

Question 17

describe the apical ligament of the dens

Answer 17

weak, narrow band
supports other ligaments

Question 18

describe the anterior AA membrane

Answer 18

strong, flattened band
strengthened midline cord
resists posterior displacement of axis and hyper-rotation

Question 19

describe the posterior AA membrane

Answer 19

thin with vertical fibres
maintains stability

Question 20

describe the tectorial membrane

Answer 20

strong band, vertical fibres
resists flexion and axial rotation

Question 21

what are the 3 phases of ligament healing

Answer 21

inflammation
proliferation
remodelling

Question 22

describe inflammatory phase

Answer 22

blood clot at site
growth factors stimulate inflammatory cell migration
initiating matrix turnover

Question 23

describe proliferative phase (healing)

Answer 23

ECM expands w/ increased cellularity
scar tissue formation
fibroblastic deposition of type III collagen and proteins

Question 24

describe the remodelling phase of healing

Answer 24

collagen maturation over months to years
tissue matrix begins to resemble normal tissue (type I collagen) , but weaker than original ligament