Practical Exam - Ligaments Flashcards Preview

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Flashcards in Practical Exam - Ligaments Deck (21):
1

Anterior Longitudinal Ligament

Bony Reference:

Description:

A1: 

A2:

Fibre Direction:

Stress:

Function:

Relationships:

Anterior Longitudinal Ligament

Bony Reference: N/A

Description: 3 layers: Superficial (3 to 4 vertebrae - weakest), intermediate (2 or 3 vertebrae), deep (one body to next - strongest)

Belt like

Broader caudually, thinner cranially

A1: Front of Sacrum - Anterior surface of vertebral bodies, IVD, hyaline cartilage

A2: C2 (replaced by atlantooccipital membrane) - Anterior surface of vertebral bodies, IVD, hyaline cartilage

Fibres blend with subadjacent periosteum, perichondrium and peripher of the annulus fibrosis

Fibre Direction: Vertical (superior / inferior)

Stress: Taught in extension but can't in reality stress it

Function: Resists extension, prevents anterior translation, force attenuation by transmitting force through the entire spine.

Relationships:

Continuous with anteromedial aspect of SIJ at the sacrum

Lateral borders of the ALL merge with attachment sites for Psoas - implication is a tight psoas can put stress on the anterior longitudinal ligament and thus the vertebrae. Vice versa if there is no movement or disfunction is present in the lumbar spine it can impact the psoas

Crura shares attachemnt - R. side L1-L3 L. side L1-L2. Every time you breath the crura is pulling on L1-L3

 

2

Posterior Longitudinal Ligament

Bony Reference:

Description:

A1: 

A2:

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Stress:

Function:

Relationships:

Posterior Longitudinal Ligament

Bony Reference: N/A

Description: Belt like

3 layers: superficial (3 to 4 vertebrae), intermediate (2 to 3 vertebrae), deep (extends to adjacent vertebrae)

Strongest attachments to outer layer of annulus fibrosis weakest attachments to vertebral bodies 

A1: C1/C2 (replaced by membrane tectorium) - posterior surface of vertebral bodies, IVD, hyaline cartilage

A2: Sacrum - posterior surface of vertebral bodies, IVD, hyaline cartilage

Fibre Direction: vertical (superior / inferior)

Stress: Taut in flexion

Function: resist posterior translation, flexion

Relationships:

Affected by anything in the vertebral canal such as meningitis or disc herniation

Attachment for the dura

3

Ligamentum Flavum:

Bony Reference:

Description:

A1: 

A2:

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Ligamentum Flavum

Bony Reference: N/A

Description: Made up of 80% elastin (yellow - unique to this ligament)

Short

A1: Inferior aspect of one lamina (inside vertebral canal posterior to spinal cord)

A2: Superior aspect of another (inside vertebral canal posterior to spinal cord) 

Fibre Direction: Vertical (perpendicular fibres)

Stress: Flexion

Function: restrics flexion and lends rebound tension to go back into extension

Force attenuation - transmitted between supraspinous, interspinous as well as up and down the spine

Helps to protect the contents of the vertebral foramen by helping to form the roof over top

Relationships:

Lateral fibres attach to facet joint capsule

Medial fibres fuse with interspinous ligament

If buckes as it comes into neutral or extension it could push into the vertebral foramen and you could be in trouble - it merges with the interspinous ligament which pulls it back out disallowing it to buckle

Forms roof of the vertebral canal

With age calcification occurs, decreasing elasticity and leading to spinal stenosis

 

4

Supraspinous Ligament

Bony reference:

Description:

A1: 

A2:

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Stress:

Function:

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Supraspinous Ligament

Bony Reference: SP

Description: Superficial fibres (3 to 4 segments), intemediate (2 to 3), deep (segment to segment)

A1: C7 (replaced by ligamentum nuchae) - Spinous process

A2: Sacrum (may cease at L5) - Spinous process

Fibre Direction: Vertical (superior / inferior)

Stress: Flexion

Function: Resist flexion

Relationships:

Most superficial ligament in the spine

Thicker in L-spine

Binds to the interspinous ligament

Blends with neighbouring fascia - thus act as force transducer - transmitting force develpoed in the extremities and torso into the lumbar vertebral column

Area for muscle, fascia and aponerutoic attachment

5

Interspinous Ligament 

Bony Reference:

Description:

A1: 

A2:

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Stress:

Function:

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Interspinous Ligament

Bony Reference: SP

Description: Thin almost membranous 

A1: Root of one spine

A2: Apex of another spine

Fibre Direction: Vertical - fan shaped allowing the ligament to expand without rupture 

Stress: Flexion

Function: Resist flexion, force dispersal 

Relationships:

Meet ligamentum flavum anteriorly 

Meet supraspinous ligament posteriorly

 - Thus dispersed force between the two

- The fibres run mostly anterior posterior to act as an anchor, transmitting the AP pull of the TLF, into which is attached the supraspinous ligament and ligamentum flavum, not allowing the later to buckle

 

6

Intertransverse Ligament 

Bony Reference:

Description:

A1: 

A2:

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Function:

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Intertransverse Ligament 

Bony Reference: TP

Description: C-Spine = few irregular fibres

T-Spine = Blended with surrounding muscles

L-Spine = thin and membranous 

A1: Superior part of one TP

A2: Inferior part of another TP

Fibre Direction: Vertical

Stress: Side bending

Function: Prevents side bending a rotation (a little)

Relationships:

Replaced with intertransverse muscle in the c-spine

7

Superior Pubic Ligament

Bony reference:

Description:

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A2:

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Function:

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Superior Pubic Ligament

Bony reference: Pubic Disc to Pubic tubercles

Description: Thin flat band

A1: Pubic Tubercle, Crest

A2: Pubic Tubercle, Crest, Superior aspect of disc

Fibre Direction: Transverse

Stress: Gap anterior pelvis

Function: Stabilize pubic symphasis

Relationships: Blends with disc

8

Arcuate Pubic Ligament

Bony reference:

Description:

A1: 

A2:

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Function:

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Arcuate Pubic Ligament

Bony Reference: N/A

Description:

A1: Inferior Pubic Rami, Interpubic Disc

A2: Inferior Pubic Rami

Fibre Direction: Lateral

Stress: Gap pubic symphasis

Function: Stabilize inferior aspect of pubic symphasis

Relationships: Blends with disc

9

Interosseus SI Ligament

Bony reference:

Description:

A1: 

A2:

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Function:

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Interosseus SI Ligament

Bony Reference: Iliac Crest to L4 to S2 to PSIS fall medial into sacral sulcus

Description: Short, strong fibres

A1: Posterior to Sacral Auricular Surface

A2: Iliac Tuberosity 

Fibre Direction: Transverse

Stress: Gap posterior in either side lying or supine position *Pain provocation only

Function: Forms cheif bond of SI joint

Relationships:

Covered superficially by Dorsal SI Ligament

10

Dorsal SI Ligament

Bony reference:

Description:

A1: 

A2:

Fibre Direction:

Stress:

Function:

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Dorsal SI Ligament

Bony Reference: Iliac crest to L4 to S1-S4 move to crests 

Description: Long and short fibres

A1: Short Dorsal: Intermediate, Lateral Sacral Crests at S1 & S2

Long Dorsal: Intermediate, Lateral Sacral Crests at S3 & S4

A2: PSIS, Internal Lip of Iliac Crest

Fibre Direction: Short = Transverse Long = Oblique

Stress: Push medially on ASIS (Gap posterior SI) *Pain Provocation only

Function: Stability of SI

Relationships:

Lies posterior to interosseus SI ligament 

Continuous laterally with the sacrotuberous ligament (Long Dorsal SI fibres)

11

Anterior SI Ligament

Bony reference:

Description:

A1: 

A2:

Fibre Direction:

Stress:

Function:

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Anterior SI Ligament

Bony reference: N/A

Description: Numerous thin bands

A1: Auricular surface of the sacrum

A2: Auricular surface of the ilium

Fibre Direction: Transverse

Stress: Push out on ASIS's (splay anteriorly) 

*Pain provocation test only

Function: Strengthens anterior portion of the capsule

Relationships: Anterior to interosseus SI

12

Iliolumbar Ligament

Bony reference:

Description:

A1: 

A2:

Fibre Direction:

Stress:

Function:

Relationships:

Iliolumbar Ligament

Bony reference: Iliac crest to L4/L5 SP and then move lateral to TP

Description: 5 bands, Strong

A1: Iliac Crest

A2: TP of L5 (L4 too depending on author)

5 Bands

Anterior:

Anterior inferior border TP of L5 & Medial body of L5

Iliac Crest

Posterior: 

Tip of posterior border TP of L5

Ilium behind QL

Superior:

Anterior Superior border TP of L5

Anterior/Posterior QL fascia

Inferior:

Inferior border TP of L5

Anterior aspect of Anterior SI Ligament

Vertical:

Anterior/Inferior border TP of L5

Iliopectineal Line

Fibre Direction: 5 directions as above

Stress: Side Bending 

patients lies on side, therapist landmarks L5, slide in to the base of the SP and push vertebrae down toward table while stabilizing the innominate with the free hand

Function:

Prevents forward slippage of L5

Limits twisting, forward, back and lateral bending of L5

Stabilizes the vertebrae (L4-L5) on the innominate bone

Relationships:

blend superiorly with the intertransverse ligaments of the lumbar vertebrae and inferiorly with the anterior and posterior aspects of the SIJ capsule

The taut bands of the iliolumbar ligament form hoods over the L4 and L5 nerve roots.  These hoods are capable of compressing the associated nerve roots

fibres of the iliolumbar ligament merge with fibres of the QL

13

Sacrospinous Ligament

Bony Reference:

Description:

A1: 

A2:

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Stress:

Function:

Relationships:

Sacrospinous Ligament

Bony reference: Lower lateral aspect of sacrum and coccyx (not palpable but can get close) 

PSIS & Ichial tuberosity, break into thirds and lower hand is ischial spine

Description: Thin traingular ligament with a broad base

A1: Lateral margin lower sacrum and coccyx

A2: Ischial Spine

Fibre Direction: Lateral

Stress: Hand on sacrum and push lower end anteriorly (*Not in notes)

Function: Converts GSN and LSN into foramen

Limit anterior rotation of the sacrum 

Relationships:

Blends with sacrotuberous ligament (lies anterior to it) and SIJ capsule

14

Sacrotuberous Ligament

Bony Reference:

Description:

A1: 

A2:

Fibre Direction:

Stress:

Function:

Relationships:

Sacrotuberous Ligament

Bony Reference: PSIS, Ischial Tuberosity, landmark PIIS using thirds and palpate sacrum

Description: Flat, Y-shaped (Fans out from its base)

A1: PSIS, PIIS, lower 1/2 of the dorsal surface of sacrum, lower ½ of lateral sacral crest, lateral margin of coccyx 

A2: Medial margin of Ischial Tuberosity

Fibre Direction: Inferior and Lateral

Stress: Hand on sacrum and push lower end anteriorly

Function: Resists rotation of the sacrum

Relationships:

Blends superiorly with the Dorsal SI ligament and posterior lamina of the thoracolumbar fascia

Blends inferiorly with Bicep Femoris via same attachment site (Ischial Tuberosity)

Posterior surface merges with lowest fibres of Glute Max

Pierced by inferior gluteal artery and perforating cutaneous nerve 

15

Costovertebral Radiate Ligament

Bony reference:

Description:

A1: 

A2:

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Stress:

Function:

Relationships:

Costovertebral Radiate Ligament 

Bony reference: N/A

Description: Superior, inferior and intermediate fibres

A1: Anterior parts of each costal head

A2: Bodies of 2 vertebrae and the IVD between them

Superior fibres to body above

Inferior fibres to body below

Intermediate fibres to disc

Fibre Direction: Radiate

Stress: Push down on costal *Not in notes

Function: Stabilize costal head on to the vertebrae *Not in notes

Relationships: Blends with IVD and bodies

Surrounds the Intra-Articular Ligament (Superficial to it) 

 

16

Intra-Articular Ligament of the head of the rib

Bony Reference:

Description:

A1: 

A2:

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Stress:

Function:

Relationships:

Intra-Articular Ligament

Bony reference: N/A

Description: Short bands

A1: IVD

A2: Crest between costal articular facets (Head of the rib)

Fibre Direction: Transverse

Stress: Push down on rib (*Not in notes)

Function: Stabilize head of rib onto vertebral disc

Relationships:

T1, T10-T12 Intra-Articular ligament is absent

Surrounded by Costovertebral Radiate ligament 

17

Costotransverse Ligament

Bony reference:

Description:

A1: 

A2:

Fibre Direction:

Stress:

Function:

Relationships:

Costotransverse Ligament

Bony reference: TP across to costal neck

Description: numerous short fibers

A1: Costal neck

A2: Corresponding TP

Fibre Direction: Transverse

Stress: 
place thumb on spinous process of vertebrae and finger just lateral to the CT joint…the movement is posterior to anterior..spinous process should move toward the test side

Function: Stabilize the costal (rib) onto the anterior aspect of the TP

Relationships:

Fills costotransverse foramen

missing in the first rib unless there’s a cervical rib (superior portion)
absent in T11 and T12

numerous short fibers extend back from the posterior rough surface on the costal neck to the anterior surface of the transverse process
 

 

18

Superior CT Ligament

Bony reference:

Description:

A1: 

A2:

Fibre Direction:

Stress:

Function:

Relationships:

Superior CT Ligament

Bony reference: Sp to TP to Costal neck then SP to TP above *Remember rule of thirds foracurate palpation

Description: Strong,  Anterior & Posterior layers 

A1: 
Anterior layer:

costal neck

lower aspect of the TP above

A2:

Posterior Layer:

Dorsally on the costal neck, the superior part of the rib 

TP above

Fibre Direction: 

Anterior Layer: passing upwards and laterally 

Posterior Layer: ascending posteromedially

Stress: Try to push inferior on rib

Function: Stabilize the rib to the TP above

Relationships:
Blends with the internal intercostal membrane and is crossed by intercostal vessels and nerve (sympathetic trunk of ANS)

missing in the first rib unless there’s a cervical rib (superior portion)

absent in T11 and T12

numerous short fibers extend back from the posterior rough surface on the costal neck to the anterior surface of the transverse process
 

19

Lateral CT Ligament

Bony reference:

Description:

A1: 

A2:

Fibre Direction:

Stress:

Function:

Description:

Relationships:

Lateral CT Ligament

Bony reference: SP to TP to neck of costal

Description: Short, thick, strong fibres

A1: Apex of TP

A2: Rough non-articular part of adjacent costal tubercle

Fibre Direction: Oblique

Stress: 
place thumb on spinous process of vertebrae and finger just lateral to the CT joint…the movement is posterior to anterior..spinous process should move toward the test side

Function: Stabilize rib onto the TP

Relationships:
lateral CT blends with the external intercostals muscle

absent in T11 and T12


 

 

20

Radiate Sternocostal Ligament

Bony reference:

Description:

A1: 

A2:

Fibre Direction:

Stress:

Function:

Relationships:

Radiate Sternocostal Ligament

Bony reference: Sternum and corresponding costal cartilages

Description: Radiates, fan shaped

A1: Front and back of sternal ends of cartilage of true ribs (1-7)

A2: Corresponding sternal surfaces

Fibre Direction: Radiates

Stress: Push downward, inferior, superior (*not in notes)

Function: Stabilize rib onto the sternum

Relationships:
superficial fibers intermingle with adjacent ligaments above and below with those of the opposite side and with tendinous fibers of pectoralis major, forming a thick fibrous membrane around the sternum, more markedly in its lower part
 

21

Costoxiphoid Ligament

Bony Reference:

Description:

A1: 

A2:

Fibre Direction:

Stress:

Function:

Relationships:

Costoxiphoid Ligament

Bony reference: Sternum to xiphoid to corresponding rib

Description: Radiates

A1: Anterior/posterior surfaces 7th costal cartilage

A2: anterior/posterior surfaces of xiphoid process

Fibre Direction: Radiate

Stress: Inferior, posterior, superior movement of the rib *not in notes

Function: Stabilize rib onto the xiphoid process and thus the sternum

Relationships: Blends with radiate ligaments above