Anatomy Quiz: L5-S1 Junction

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Questions and Answers

Which of the following structures is NOT directly involved in resisting the anterior shearing force at the L5-S1 junction?

  • Intervertebral disc
  • Posterior longitudinal ligament (correct)
  • Capsule of apophyseal joints
  • Anterior longitudinal ligament

Which of the following scenarios would MOST likely increase the risk of anterior spondylolisthesis at L5-S1?

  • Strengthening the iliolumbar ligament
  • Reducing the force vector of the erector spinae muscle
  • Decreasing lumbar lordosis
  • Increasing the sacrohorizontal angle (correct)

What is the main function of the iliolumbar ligament in relation to the L5-S1 junction?

  • To facilitate the extension of the lumbar spine
  • To restrict lateral movement of the L5 vertebra
  • To increase the flexibility of the L5-S1 joint
  • To provide a firm anchor between the transverse processes of L5 and the ilium/sacrum (correct)

What is the most likely cause of anterior spondylolisthesis?

<p>Excessive extension of the lumbar spine (B)</p> Signup and view all the answers

A herniation of the nucleus pulposus can lead to which of the following conditions?

<p>Compression of the spinal cord or cauda equina (D)</p> Signup and view all the answers

What is the typical scarohorizontal angle that produces an anterior shear force at the L5-S1 junction equal to 64% of the superimposed body weight?

<p>40 degrees (A)</p> Signup and view all the answers

What is the most common location for anterior spondylolisthesis to occur?

<p>L5-S1 (B)</p> Signup and view all the answers

Which of the following is NOT a potential consequence of severe anterior spondylolisthesis?

<p>Increased range of motion in the lumbar spine (D)</p> Signup and view all the answers

Which of the following statements accurately describes the orientation of lumbar apophyseal joints in the sagittal plane?

<p>The concave superior articular facets are oriented closer to the sagittal plane in the upper lumbar spine, while the concave superior articular facets are oriented closer to the frontal plane in the mid to lower lumbar spine. (B)</p> Signup and view all the answers

What is the primary function of the mamillary processes in the lumbar spine?

<p>To increase the surface area for muscle attachment, enhancing lumbar stability. (A)</p> Signup and view all the answers

How does the orientation of the L5-S1 apophyseal joint differ from other lumbar apophyseal joints, and what is the significance of this difference?

<p>It is oriented closer to the frontal plane, providing greater stability to the lumbosacral junction. (C)</p> Signup and view all the answers

What is the primary reason for the change in orientation of lumbar apophyseal joints from a more frontal plane orientation at birth to a more sagittal plane orientation by the age of 12?

<p>The development of the upright posture and the demands placed on certain muscles like the multifidi. (C)</p> Signup and view all the answers

Which of the following factors can contribute to bilateral asymmetry in lumbar apophyseal joints?

<p>Natural variations in development during childhood and the different rates of ossification. (C)</p> Signup and view all the answers

What is a potential consequence of extreme bilateral asymmetry in lumbar apophyseal joints?

<p>Premature degeneration and osteoarthritis in the apophyseal joints. (A)</p> Signup and view all the answers

Why does the spinal cord become relatively shorter compared to the vertebral column after birth?

<p>The spinal cord grows at a slower rate than the vertebral column after birth. (B)</p> Signup and view all the answers

What anatomical feature is responsible for the lumbar spine's increased ability to absorb shock compared to other regions of the vertebral column?

<p>The lordotic curvature of the lumbar spine. (C)</p> Signup and view all the answers

What is the primary action of the transverse abdominis (TrA) in relation to lumbopelvic stability?

<p>Increasing fascial tension and compressing the SI/SymPub (A)</p> Signup and view all the answers

How should patients be instructed to engage the transverse abdominis?

<p>Draw the belly button towards the spine (A)</p> Signup and view all the answers

Which muscle's activation is essential alongside the transverse abdominis for effective contraction?

<p>Diaphragm (A)</p> Signup and view all the answers

In the context of lifting, what does IMA stand for?

<p>Internal Moment Arm (D)</p> Signup and view all the answers

What is a potential drawback of using the Valsalva maneuver during lifting?

<p>It may raise blood pressure and pose risks for certain individuals (B)</p> Signup and view all the answers

Which lifting technique involves extending the hips and lumbar region while keeping the knees slightly flexed?

<p>Stoop lift (D)</p> Signup and view all the answers

What is the role of the thoracolumbar fascia during movement?

<p>It stabilizes the spine through contraction of certain muscles (D)</p> Signup and view all the answers

What is a significant risk associated with lifting as mentioned?

<p>Back and shoulder injuries accounting for missed work time (B)</p> Signup and view all the answers

Which muscles play a primary role in SI joint force closure?

<p>Gluteus Maximus, Biceps Femoris, Erector Spinae, Latissimus Dorsi (A)</p> Signup and view all the answers

What type of movement is described as nutation?

<p>The base of the sacrum moving anteriorly (C)</p> Signup and view all the answers

Which statement best describes the role of tension in the thoracolumbar fascia (TLF) regarding SI joint stability?

<p>It aids in creating stability through muscle contractions. (B)</p> Signup and view all the answers

What is the recommended approach to diagnose SI joint dysfunction?

<p>A minimum of six positive special tests are required. (C)</p> Signup and view all the answers

Which of the following statements about SI joint kinematics is true?

<p>Nutation includes anterior movement of the sacral base. (C)</p> Signup and view all the answers

What is a common misconception regarding SI joint pain?

<p>All patients with SI joint dysfunction present with bilateral pain. (C)</p> Signup and view all the answers

How is the sacrum functionally linked with the lumbar spine?

<p>By altering the lumbar lordosis during hip extension. (A)</p> Signup and view all the answers

Which group of muscles is primarily responsible for feed-forward activation regarding the SI joint?

<p>Transverse Abdominis, Internal Oblique, Multifidus, Piriformis (B)</p> Signup and view all the answers

What is the clinical significance of the genitofemoral nerve regarding pain during specific activities?

<p>Pain increases during External/Internal rotation and walking. (B)</p> Signup and view all the answers

Which condition is least likely to be associated with entrapment of the lateral femoral cutaneous nerve?

<p>Ankle sprain (C)</p> Signup and view all the answers

What is the primary function of the obturator nerve?

<p>Controls adductor muscle movements. (D)</p> Signup and view all the answers

Which statement correctly differentiates a peripheral nerve field from a dermatome?

<p>Dermatomes are specific to one nerve root, while peripheral nerve fields involve multiple roots. (A)</p> Signup and view all the answers

What type of sensations does the femoral nerve primarily provide?

<p>Sensory information to the anterior medial thigh. (B)</p> Signup and view all the answers

Which explanation best reflects the role of the lumbar sacral trunk?

<p>It contributes to the sacral plexus from the anterior rami of L4 and L5. (C)</p> Signup and view all the answers

Which condition is NOT commonly related to the femoral nerve?

<p>Obturator injury (C)</p> Signup and view all the answers

In the context of hip extension, which peripheral nerve is primarily affected?

<p>Genitofemoral nerve (A)</p> Signup and view all the answers

Which of the following correctly describes the relationship between the intervertebral disc and the intervertebral foramen during lumbar flexion?

<p>Flexion increases the diameter of the intervertebral foramen, potentially alleviating nerve root impingement. (C)</p> Signup and view all the answers

Which of the following is NOT a function of the annulus fibrosis?

<p>Providing direct blood supply to the nucleus pulposus. (A)</p> Signup and view all the answers

Why is the posterior location of the nucleus pulposus in the lumbar spine clinically significant?

<p>It makes herniations more likely to occur anteriorly. (B)</p> Signup and view all the answers

What is the primary function of the linea alba?

<p>To provide attachment for the rectus abdominus muscle. (B)</p> Signup and view all the answers

Why is lumbar extension not recommended for patients with a fully herniated disc at L5/S1?

<p>It can increase the lordosis, further compressing the S1 nerve root. (B)</p> Signup and view all the answers

Which of the following is NOT a function of the abdominal muscles?

<p>Providing direct support to the vertebral column. (B)</p> Signup and view all the answers

Which of the following correctly identifies the movement of the superior articular facet during lumbar extension at L3-L4?

<p>Slides inferiorly and slightly posteriorly. (B)</p> Signup and view all the answers

What is the primary mechanism of nutrition for the nucleus pulposus?

<p>Imbibing of fluids from surrounding tissues. (D)</p> Signup and view all the answers

What is the role of the rectus sheath?

<p>It merges with other abdominal muscle structures, blending into anterior and posterior connective tissue sheets. (C)</p> Signup and view all the answers

What is the relationship between lumbar flexion, intervertebral foramen diameter, and potential nerve root impingement?

<p>Flexion increases the foramen opening, and the larger opening can potentially relieve nerve root impingement. (B)</p> Signup and view all the answers

Flashcards

Functions of Lumbar Skeleton

Supports body weight, protects spinal cord, and absorbs shock.

Lordotic Curve

The lumbar curve that is concave anteriorly, known as lordosis.

Orientation of Lumbar Facets

Inferior articular facets face laterally; superior facet concave.

Sagittal Plane Motion

The lumbar spine favors flexion and extension over rotation.

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Apophyseal Joint Orientation Change

At birth, lumbar joints orient towards the frontal plane; changes to sagittal plane by age 12.

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Asymmetry in Lumbar Vertebrae

Bilateral asymmetry occurs in 20-30% of adults, leading to potential degeneration.

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Development of Cauda Equina

Post-birth, the vertebral column grows faster than the spinal cord.

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Mamillary Process Function

Attachment sites for multifidi muscles in the lumbar region.

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Stress Fracture

A fracture caused by excessive stress on bone, potentially injuring the spinal cord.

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Surgical Fixation Devices

Devices implanted to immobilize and stabilize the thoracolumbar junction, prone to stress failure.

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Anterior Spondylolisthesis

Condition where one vertebra slips forward over another, usually at L5-S1 or L4-L5.

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Pars Articularis

A section of a lumbar vertebra that, when fractured, often leads to anterior spondylolisthesis.

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Cauda Equina Damage

Severe cases of anterior spondylolisthesis may injure the cauda equina, affecting nerve function.

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Lumbar Lordosis

The inward curve of the lower spine that can increase anterior shear forces at L5-S1.

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Iliolumbar Ligament

A ligament connecting L4-L5 to the ilium, preventing anterior shear forces at the L5-S1 junction.

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Herniated Nucleus Pulposus

Condition where the nucleus pulposus migrates, potentially compressing spinal nerves.

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Intertransverse ligament

A ligament connecting adjacent vertebrae that helps stabilize the spine.

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Intervertebral discs

Cartilage structures between vertebrae that act as shock absorbers and allow spinal movement.

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Nucleus pulposus

The gelatinous center of the intervertebral disc that helps distribute pressure.

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Annulus fibrosus

The tough outer layer of the intervertebral disc made of fibrocartilage.

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Herniated disc

Condition where the nucleus pulposus bulges out, often causing pain.

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Lumbar flexion

Bending of the lumbar spine that increases diameter of intervertebral foramen.

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McKenzie exercises

Therapeutic movements focusing on lumbar extension to alleviate pain from disc issues.

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Linea Alba

The fibrous structure that divides the rectus abdominis into two halves.

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Diastasis recti

Condition where the abdominal muscles separate, common post-pregnancy.

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Abdominal musculature functions

Supports organs, aids in movement, posture, and various bodily functions.

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Transverse Abdominis (TrA)

A core muscle important for lumbopelvic stability and fascial tension.

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TrA Activation in Low Back Pain

Patients with low back pain show 3x decreased TrA activation.

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Role of Diaphragm

Separates thoracic and abdominal cavities; innervated by phrenic nerve.

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Multifidus Importance

Key muscle that helps stabilize the lumbar spine and works with TrA.

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Lifting Techniques

Two techniques: Stoop lift (more back flexion) and Squat lift (less back stress).

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Intra-abdominal Pressure (IAP)

Pressure within the abdomen that assists in spinal stability during lifting.

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Lifting and Base of Support (BOS)

Foot positioning affects stability and safety during lifting.

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Internal Moment Arm (IMA) vs External Moment Arm (EMA)

For stability, IMA and EMA should be equal during lifting tasks.

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Gluteus Maximus

A major muscle involved in stabilizing the SI joint and hip extension.

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SI Joint Stability

Stability achieved through muscle contractions and tension in retroferential ligaments.

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Nutation

Anterior movement of the SI joint's base, an important motion for balance.

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Counter-nutation

The return to neutral position after nutation; important for joint mechanics.

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Force Closure

Muscle contractions that stabilize the SI joint by creating tension.

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Feed Forward Activation

The initial muscle contractions that prepare the body for movement.

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Pelvic Floor Muscles

Muscles that help stabilize the pelvis and support SI joint function.

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SI Joint Pain Sources

SI joint can cause lower back, buttock, and leg pain due to dysfunction.

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Genitofemoral Nerve

Nerve traveling through psoas, divides into genital and femoral branches affecting groin and thigh.

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Lateral Femoral Cutaneous Nerve

A sensory nerve (L2-L3) that can be entrapped leading to increased sensation and pain.

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Femoral Nerve

Nerve (L2-L4) supplying motor and sensory to the anterior thigh and knee.

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Obturator Nerve

Nerve (L2-L4) motor to adductors and sensory to small thigh area, exits via obturator foramen.

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Dermatome

Area of skin supplied by a single nerve root, indicating neurological conditions.

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Peripheral Nerve Field (PNF)

Combined area of skin served by multiple nerve roots, different from dermatome.

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Clinical Relevance

Understanding nerve involvement in conditions like hernia or neuropathy for diagnosis.

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Lumbosacral Trunk

Anterior rami of L4 and L5, part of the sacral plexus contributing to lower limb nerves.

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Study Notes

Lumbar Skeleton

  • Functions include sustaining the spine, anchoring muscles and ligaments, protecting the spinal cord, and absorbing shock
  • Lumbar curve is lordotic
  • Ligaments are sparse between L4 and L5
  • Facet/apophyseal/zygoapophyseal orientation in the thoracic and lumbar spine differs
  • Lumbar spine's orientation (90 degrees) in the sagittal plane favours sagittal plane movement more than rotation
  • Mamillary processes are attachment points for multifidi muscles

Special Focus 9.2: Development Abnormalities of Lumbar Apophyseal Joints

  • At birth, lumbar apophyseal joint surfaces are more oriented towards the frontal plane similar to thoracic spine.
  • Between birth and 12 years old, the orientation changes to the sagittal plane in most lumbar apophyseal joints.
  • This change is influenced by upright posture development and the demands on lumbar multifidi muscles
  • Natural variations in development of lumbar apophyseal joints, can persist into adulthood.
  • Bilateral asymmetry exists in 20-30% of adult lumbar vertebrae. This can increase the risk of premature degeneration.

Special Focus 9.3: Cauda Equina

  • At birth, the spinal cord and vertebral column are the same length,
  • The vertebral column grows faster after birth than the spinal cord.
  • In adults, the caudal end of the spinal cord ends adjacent to the L1 vertebrae.
  • The lumbosacral spinal nerve roots go a long distance before reaching their foramina.
  • This group of elongated nerves resembles a horse's tail and is known as the cauda equina.
  • Damage to the cauda equina can lead to muscle paralysis, atrophy, and altered sensation. However this does not involve a damaged spinal cord.
  • Since cauda equina is part of the peripheral nervous system, there is a potential for nerve regeneration.

Special Focus 9.4: Intra-articular Structures Located Within Apophyseal Joints

  • Lumbar spine has two main accessory structures: subcapsular fat pads and fibroadipose meniscoids
  • Subcapsular fat pads fill crevices between the capsule and synovial membrane. They can extend outside the joint.
  • Fibro-adipose meniscoids are connective tissue structures found at the periphery of apophyseal joints. They can range from thickenings of cartilage to folds of synovium that include fat pads, collagen fibres and blood vessels.

Special Focus 9.6: Clinical Implications Regarding the Thoracolumbar Junction

  • The abrupt change from thoracic to lumbar spine’s orientation can create sagittal plane hypermobility and mechanical instability in this region,
  • Chronic flexion can lead to an increase in posterior disc herniation risk,
  • Mechanical damage and high impact can result in traumatic paraplegia or cauda equina injury.

Special Focus 9.7: Anterior Spondylolisthesis at L5-S1

  • Anterior spondylolisthesis occurs when one vertebra slips anteriorly relative to the next, commonly at L5-S1.
  • It can occur either congenitally or due to excessive stress or pathology.
  • Often associated a fracture of pars articularis.
  • High instances of AS can lead to injuries to the cauda equina.

Special Focus 9.8: More about the Herniated Nucleus Pulposus

  • Herniations involve the posterior-lateral or posterior migration of the nucleus pulposus towards sensitive neural tissues.
  • Herniation can include fragments of dislodged vertebral endplates (sequestration).
  • The material of herniated could be lodged in the epidural space (extrusion/sequestration).

Special Focus 9.9: Using Knowledge of Kinesiology to Help Guide Treatment of Chronic Low Back Pain

  • Knowledge of kinesiology helps to guide treatment of chronic low back pain. These treatments include flexion and extension exercises, surgery, dry needling, heat therapy, electrical stimulation, soft tissue manipulation etc.

Lumbosacral Spine

  • Mobility of the lumbar spine involves flexion, extension, and rotation.
  • Facet joints and interspinal spaces allow for the movement associated with the lumbar regions.
  • Spinal facets take more weight higher on the spine.
  • Lumbosacral junction (including lumbar facet and SI joint) has significant biomechanical functions.
  • L5-S1 is oriented close to frontal plane.
  • Lumbar spine facets have large range of motion but are not weightbearing.

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