Bony Anatomy of Lumbar Spine and Pelvis

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Questions and Answers

Which muscle runs longitudinally between the xiphoid and the pubic crest?

Rectus abdominus (correct)

Transverse abdominis

Piriformis

External obliques

What is the correct method to locate the transverse abdominis?

Palpate above the xiphoid process

Palpate 1 inch caudal and medial from the ASIS (correct)

Palpate 1 inch lateral from the ASIS

Palpate directly over the pubic crest

Which anatomical landmark is used to begin palpation of the piriformis muscle?

PSIS (posterior superior iliac spine) (correct)

Greater trochanter of the femur

Lateral edge of the rib cage

Anterior aspect of the femur

What movement is suggested to effectively palpate the piriformis during the examination?

Bent leg hip external rotation Signup and view all the answers

How is the oblique fibers of the external obliques positioned relative to the rectus abdominis?

Laterally from the rectus abdominis Signup and view all the answers

What is the significance of palpating the PSIS in relation to identifying the S2 level?

It connects to the PSIS for localizing the lumbar spine anatomy. Signup and view all the answers

Which method is used to confirm the identification of the L5 spinous process?

Palpating and blocking L5 while mobilizing the ilium. Signup and view all the answers

What should be noted about the feel of L5 compared to S2 during palpation?

L5 is firmer than S2 upon palpation. Signup and view all the answers

When palpating the iliac crest, how should the hands be positioned?

Cranial hand stabilizes while caudal hand analyzes movement. Signup and view all the answers

What is meant by 'drawing a dashed helper’s line' during the palpation process?

It serves as a reference line for anatomical landmarks. Signup and view all the answers

What anatomical structure is palpated after L5 during the assessment of the lumbar spine?

L4 spinous process. Signup and view all the answers

What change is observed when palpating the iliac crest and moving posteriorly towards the PSIS?

The hand must switch from finger tips to thumb. Signup and view all the answers

What conclusion can be drawn if the stabilizing hand and the pelvis move in the same direction during examination?

The examiner is on the S1 spinous process. Signup and view all the answers

Which of the following statements accurately describes the characteristics of the spinous processes in the lumbar region compared to the thoracic region?

The spinous process of L5 is smaller and rounded compared to the longer processes of L1-L4. Signup and view all the answers

What anatomical landmark can be utilized to identify the location of the T12 spinous process?

The relevant attachment point of the 12th rib at T12. Signup and view all the answers

Which method is used to palpate the ischial tuberosity?

Walking the palm of the hand up from the proximal hamstring into the glutes. Signup and view all the answers

In which position should a patient lie to effectively palpate the erector spinae group?

Prone with legs extended. Signup and view all the answers

While palpating the ASIS, what action should you take to find this anatomical structure?

Walk from the posterior lateral side along the iliac crest to its anterior medial edge. Signup and view all the answers

What is the purpose of asking the patient to alternate the extension of their lower limbs during palpation of the erector spinae group?

To create tension that can be felt under the palpating fingers. Signup and view all the answers

When palpating the pubic crest, which method is recommended?

Walking the heel of the hand from the umbilicus towards the pubis. Signup and view all the answers

Which muscle group runs from the sacrum to the occiput along the posterior vertebral column?

Erector spinae group. Signup and view all the answers

Study Notes

Bony Anatomy of the Lumbar Spine and Pelvis

PSIS/S2: Palpate the iliac crest laterally and a bit cranially, moving inferiorly to identify the iliac crest. Palpate bilaterally along the superior aspect of the iliac crest, moving from the lateral to the posterior medial side. Feel the bone widening and switch from using your fingertips to your thumb. The iliac crest curves downward ending in a bony step, the Posterior Superior Iliac Spine (PSIS). Use your thumb perpendicular to the underside of the PSIS; draw a dashed helper line connecting the PSIS to the S2, which helps locate the level of the S2.The size and location of the S2 spinous process is variable.
L5 SP: Measure two thumb widths cranially from the S2 spinous process to locate the L5 spinous process. Confirm this by standing to the side of the patient; use one hand (cranial side) to palpate and block the L5 spinous process. Your caudal hand reaches across, and grabs the opposite anterior and lateral portion of the ilium. Stabilize L5, moving the ilium towards the center; if L5 does not move, you are on S1, not S2. Apply a mobilizing rotational force to the pelvis (lifting it towards you while stabilizing L5). If the pelvis moves against the stabilizing hand, you confirm you are on L5's spinous process. Repeat this to confirm or rule out locations of previous processes.
SP of L1-L4: Palpate the remaining lumbar spinous processes cranially. Also, palpate the sides and interspinous spaces.

Muscles of the Lumbar Spine and Abdomen

Erector Spinae: The patient lies prone. Palpate the large muscle group, the erector spinae (Spinalis, Longissimus, Iliocostalis) located on the lateral side of the lumbar vertebrae. These muscles run from the sacrum to the occiput, along the posterior vertebral column and are difficult to individually palpate. The patient can perform alternate extensions of the lower limbs to help feel these muscles under the palpating fingers, moving from the sacrum cranially towards the thoracic spine. The patient can raise their head and chest off the table for greater palpation.
Ischial Tuberosity: To locate the ischial tuberosity, use the palm of your hand, progressing upward from the proximal hamstring into the glutes.

Other Structures

ASIS: Palpate the Anterior Superior Iliac Spine (ASIS). Starting from the iliac crest, move from the posterior lateral side to the anterior medial portion to the ASIS, which forms a prominent bony edge.
Pubic Crest: Walk the heel of the hand from the umbilicus towards the pubis. Your fingers will contact the firm ridge of the pubic crest.
Pubic Tubercles: Palpate the prominent forward-projecting tubercle on the superior border of the medial portion of the superior ramus of the pubis. The inguinal ligament attaches to the pubic tubercle.
Rectus Abdominis: Ask the patient to raise their head and chest off the table, activating the rectus abdominis, which runs from the xiphoid to the pubic crest.
External Obliques: The patient raises their head and chest, bringing the shoulder toward the opposite ASIS. Palpate for the oblique fibers.
Transverse Abdominis: Locate the anterior superior iliac spines (ASIS). Palpate an inch caudal (lower) and medial (toward the midline) to the ASIS. Ask the patient to take a deep breath, then hold their breath, drawing their umbilicus toward their spine; tension should be palpable.
Piriformis: Locate the PSIS (lower part). Find the lateral edge of the sacrum, then move laterally towards the coccyx. The piriformis, creating a "T" shape, attaches to the anterior aspect of the sacrum and inserts at the greater trochanter. Rotate the patient's leg to find and palpate the piriformis for external rotation.

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Description

This quiz focuses on the bony anatomy of the lumbar spine and pelvis, specifically the identification and palpation of key landmarks such as the iliac crest, PSIS, and L5 spinous process. Test your understanding of the anatomical relationships and palpation techniques used in assessing lumbar spine structures.