WK9+10 Lumbopelvic Flashcards
(36 cards)
What are the primary and secondary curvatures of the spine ?
1st: thoracic and sacral kyphoses that are apparent since birth
2nd: cervical and lumbar lordoses that develop in upright positions after birth
What is the lumbosacral angle ?
The junction of the lumbar vertebrae at the coccyx when viewed laterally, the angle that is formed
What are vertebral endplates ?
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.
Which parts of the vertebrae make up the vertebral arch ?
The pedicles, laminae and vertebral bodies
Describe the regional differences between vertebrae.
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
What are some unique features of the intervertebral discs ?
Act as shock absorbers, mobile, cartilaginous, discs are relatively thicker in more mobile areas such as the neck and low back.
What are some structures that help to hold the L5 vertebra on the S1 vertebra ?
-Iliolumbar, ant and post SI ligaments
-Orientation of facets between L5-S1, this makes it so the vertebra is locked in place
Define the unique characteristics of the following ligaments: ALL, PLL Ligamentum flavum, supraspinous, interspinous, intertransverse
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
Discuss the connections of thoracolumbar fascia to structures in the lumbar region.
ext obl, and IO connect to TL fascia and can help stabilize the lumbar vertebrae which are the roots of the TL fascia
Which muscles contribute to lumbar stabilization ?
rectus abdominus, IO + Ext Obl, TrAb, Psoas Major, QL
Explain the categorization of back muscles and list which muscles belong in which group.
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
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
(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
How is the vertebral column innervated ?
by the recurrent meningeal nerves from the mixed spinal nerves
Where does the spinal cord end ?
Ends at the conus medullaris at about the level of T12-L3
What is a spinal cord segment ?
the portion of the spinal cord that gives rise to rootlets and roots that form one bilateral pair of spinal nerves
How do nerve roots get out the vertebral canal after the spinal cord ends ?
From the cauda equina which is a continuation of the conus medullaris
Explain the relationship between lumbar disc bulge and which spinal nerve root is affected.
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.
Draw the lumbosacral dermatomes.
…
Trace the major lumbosacral nerves and name their roots and what structures they innervate. Draw the lumbosacral plexus.
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.
What is meralgia paresthetica ?
- Impingement of lateral femoral cutaneous nerve at inguinal lig causing paresthesia over lateral groin and thigh area
Describe arterial supply to: (a) lumbar vertebrae (b) Spinal cord
(a) supplied by equatorial and periosteal branches of lumbar arteries as well as subcostal arteries
(b) supplied by spinal branches from lumbar arteries
What is spondylolisthesis and how does it happen ?
Dislocation of adjacent vertebrae, can due to spondylosis ( a fracture of the the parts of vertebrae that connects articular processes )
What are some of the effects of aging on the lumbar vertebrae and discs ?
decreased bone density/strength, discs become convex superiorly and inferiorly, osteophytes develop at points of friction
Describe the different types of stenosis in the vertebral column ?
Spinal stenosis: narrowing of the vertebral canal
Foraminal stenosis: narrowing of IV foramen
