TA Session #4

Question 1

which statement BEST describes the vascular supply of the intervertebral disc?

-the entire disc is avascular + depends solely on diffusion through the endplate
-the nucleus pulposus + annulus fibrosus receive the most blood supply from adjacent capillaries
-only the outermost fibers of the annulus receives blood supply from small blood vessels that penetrate from the vertebral bodies + surrounding ligaments
-the nucleus pulposus has a rich capillary network supplies by the spinal arteries

Answer 1

only the outermost fibers of the annulus receives blood supply from small blood vessels that penetrate from the vertebral bodies + surrounding ligaments

-EXPLANATION: the outermost annulus receives blood supply from small capillaries that branch from vessels in the periosteum; this is the only vascular region of the disc

Question 2

a soccer player plants their right foot + kicks a ball across their body with the left leg. in the transverse plane, the kicking motion primarily involves which osteokinematic movement at the left hip?

-abduction
-external rotation
-adduction
-internal rotation

Answer 2

internal rotation

-EXPLANATION: when the soccer player kicks the ball across their body, the femur rotates inward toward the midline as the leg crosses the body to strike the ball, which is hip internal rotation at the left hip

Question 3

a patient presents with left gluteus medius weakness. during gait, what pelvic motion is most likely to occur when the patient is standing on the left leg?

-pelvic hike on the right
-pelvic drop on the right
-pelvic drop on the left
-pelvic rotation to the right

Answer 3

pelvic drop on the right

-EXPLANATION: if the left gluteus medius is weak + the person stands on the left leg, the abductors can’t counteract gravity’s pull on the right side. as a result, the pelvis drops on the right side, known as a Trendelenburg sign

Question 4

during right hip hiking, what happens at the hips osteokinematically?

-adduction of the R hip, abduction of the L hip
-abduction of the R hip, adduction of the L hip
-external rotation of the R hip, internal rotation of the L hip
-internal rotation of the R hip, external rotation of the L hip

Answer 4

adduction of the R hip, abduction of the L hip

-EXPLANATION: abduction of the hip = the shaft of the femur is moving further away from the pubic symphysis
-adduction of the hip = the shaft of the femur is moving closer to the pubic symphysis

Question 5

which if the following images shows coxa valga?

-1st image- normal angle of inclination
-2nd image- decreased angle of inclination
-3rd image- increased angle of inclination

Answer 5

3rd image; increased angle of inclination

-EXPLANATION: angle of inclination is between the femoral neck + the shaft of the femur
-a normal angle of inclination is about 120 degrees
-decreased angle of inclination = coxa vara
-increased angle of inclination = coxa valga

Question 6

what are the implications of a small center edge angle of the hip?

-predisposition to hip abduction contracture
-predisposition to hip flexion contracture
-predisposition to hip dislocation
-predisposition to rheumatoid arthritis

Answer 6

predisposition to hip dislocation

-EXPLANATION: center edge angle is the angle between the vertical line extending from the center of the femoral head + the line extending from that same point to the edge of the bony acetabulum
-if this angle is smaller, that means there is less bony congruence between the femur + the acetabulum, thus increasing risk of hip dislocation

Question 7

you are bending over to pick something up off of the floor. as you bend, trunk flexion is occurring at your spine. in which portion of your intervertebral discs is COMPRESSION primarily occurring as you perform this movement?

-anteriorly
-posteriorly
-laterally
-centrally

Answer 7

anteriorly

-EXPLANATION: during flexion, the anterior fibers of the annulus fibrosus are compressed between the 2 vertebrae
-distraction is occurring at the posterior fibers

Question 8

mr. smith presents with a left sided hip drop due to potential gluteus medius weakness. what side of his body should he place the cane to assist abductors in producting torque?

-right
-left
-he doesn’t need a cane
-a walker should be recommended

Answer 8

left side

-EXPLANATION: a left hip drop = right gluteus medius is weak
-by placing the cane in the contralateral (opposite) hand, it allows the cane to press into the ground during stance on the weak right leg to create an upward torque that’ll level the right abductor

Question 9

what is the area of less reinforcement in the femoral neck that is the cause for greater potential for injury?

-angle of inclination
-femoral triangle
-zone of weakness
-trabecular notch

Answer 9

zone of weakness

Question 10

in an anterior pelvic tilt, what is happening at the hip + back?

-lumbar extension, hip flexion
-lumbar flexion, hip extension
-lumbar extension, hip extension
-lumbar flexion, hip flexion

Answer 10

lumbar extension, hip flexion

-EXPLANATION: the pelvis tilts forward (ASIS will move anterior + inferior relative to PSIS) + cause hip to flex, + in turn, back has to do the opposite motion + extend

Question 11

what is the typical curvature presentation of the spine (superior to inferior)?

-lordotic (c-spine), kyphotic (t-spine), kyphotic (l-spine), lordotic (sacral)
-lordotic (c-spine), kyphotic (t-spine), lordotic (l-spine), kyphotic (sacral)
-kyphotic (c-spine), lordotic (t-spine), kyphotic (l-spine), lordotic (sacral)
-kyphotic (c-spine), kyphotic (t-spine), lordotic (l-spine), kyphotic (sacral)

Answer 11

lordotic (c-spine), kyphotic (t-spine), lordotic (l-spine), kyphotic (sacral)

Question 12

what forces are occurring at the orange + white arrows in this diagram, respectively?

-compression; distraction
-distraction; compression
-shearing; distraction
-compression, shearing

Answer 12

distraction; compression

-EXPLANATION: distraction occurs when the annulus resists tensile loading (think of it like a stretch)
-compression occurs when annulus pushes back in all directions (evenly distributing load)
-distraction forces can happen symmetrically or with movement of the spine
-compression is occurring on the right (white) but distraction is occurring at the left (orange)
-slides 3-5 of VC general function lecture

Question 13

which of the following are the main functions of the annulus fibrosus (select all that apply)
1. resists tensile stress
2. produces synovial fluid for joint lubrication
3. restricts + regulates movement
4. stores + releases calcium for bone metabolism

-1 + 2
-2 + 4
-1 + 3
-all are correct

Answer 13

1 + 3

-EXPLANATION: the main functions of the annulus fibrosus include resistance of tensile stress as well as restriction + regulation of movement
-the annulus fibrosus is composed of fibrocartilage + is part of a symphysis joint
-production of synovial fluid occurs in a synovial joint, + calcium storage + release occurs mainly in bone tissue
-slide 2 of vc general soft tissue lecture

Question 14

which of the following is considered a normal angle of inclination?

-90 degrees
-150 degrees
-110 degrees
-120 degrees

Answer 14

120 degrees

-EXPLANATION: angle of inclination is between the femoral neck + the shaft of the femur
-a normal angle of inclination is about 120 degrees
-answers A + B would be considered coxa vara (decreased angle of inclination) + answer C would be considered coxa valga (increased angle of inclination)

Question 15

during an anterior pelvic tilt, the pelvis rotates forward, altering the alignment of the hip joint. which of the following best describes how this motion influences functional activities such as sitting down or climbing stairs?

-the hip joint flexes as the pelvis tilts anteriorly, allowing controlled lowering into a chair or lifting the leg during stair climbing
-the hip joint remains neutral, with no effect on movements like sitting or stair climbing
-the hip joint extends as the pelvis tilts anteriorly, helping to straighten the trunk when standing
-the hip adductors initiate anterior pelvis tilt to stabilize the pelvis during movement

Answer 15

the hip joint flexes as the pelvis tilts anteriorly, allowing controlled lowering into a chair or lifting the leg during stair climbing

-EXPLANATION: anterior pelvic tilt results in flexion of the hip, while posterior pelvic tilt results in extension of the hip
-this motion at the pelvis is needed during this activities where flexion of the hip is required
-slide 14 of hip biomechanics lecture

Question 16

you just finished running the race 4 rehab 5k + your right hip is super tight. dr. hodges finishes right after you + suggests doing a figure 4 stretch. of course, he quizzes you + asks what position of the hip you’re in while performing this stretch, what do you tell him?

-close-packed position, extension, adduction, internal rotation
-loose-packed position, flexion, adduction, external rotation
-loose-packed position, flexion, abduction, external rotation
-close-packed position, extension, abduction, internal rotation

Answer 16

loose-packed position, flexion, abduction, external rotation

-EXPLANATION: in a figure 4 stretch, the hip is flexed, abducted, + ER which is the loose-packed position of the hip, where the ligaments are most lax
-unlike most other joints however, this is also the position of most joint congruency

Question 17

you’re finishing up your SDV at kinetix physical therapy + your CI asks you to help a patient with a supine exercise in which they flatten their lower back against the treatment table. what motion is occurring at the pelvis?

-pelvic translocation
-anterior pelvic glide
-posterior pelvic tilt
-anterior pelvic tilt

Answer 17

posterior pelvic tilt

-EXPLANATION: posterior pelvic tilt helpss to reduce excessive lumbar lordosis

Question 18

a patient presents with limited ROM in flexion + extension of their lumbar spine. you tell your patient “oh, I just watched dr. hayes’ lecture on the vertebral column, you might have a limitation in your lumbar zygapophyseal joints”. dumbfounded, your patient reluctantly asks to explain what those are. what do you tell them?

-they’re the joints between the inferior surface of the superior transverse process + the superior surface of the inferior transverse process
-they’re the joints between the inferior surface of the superior articular process + the superior surface of the inferior articular process
-they’re the joints between the inferior surface of the superior vertebral disc + the superior surface of the inferior vertebral disc
-your CI yells at you before you can get a word out because none of this is patient friendly language

Answer 18

they’re the joints between the inferior surface of the superior articular process + the superior surface of the inferior articular process

Question 19

it’s NFL sunday + unfortunately the left tackle of your favorite team gets hurt + enters the blue medical tent. you noticed on the play the left tackle experienced a lot of spinal hyperextension. if the injury is ligamentous, what ligament do you suspect is most at risk for injury?

-intertransverse ligament
-supraspinous ligament
-posterior longitudinal ligament
-anterior longitudinal ligament

Answer 19

anterior longitudinal ligament

-EXPLANATION: the anterior longitudinal ligament limits excessive extension of the spine, making hyperextension a susceptible motion to cause injury to this ligament

Question 20

a patient presents to you in the clinic with chronic low back pain + states that they are afraid to move their back as they believe it will hurt them further. what should your education include for the patient?

-do the same exact thing that hurt your back, it will be better this time I promise
-it is a good idea to keep moving around, the loading + unloading of the discs is actually healthy + is what pumps fluid around the discs
-do not move + continue to lie down until the issue completely resolves

Answer 20

it is a good idea to keep moving around, the loading + unloading of the discs is actually healthy + is what pumps fluid around the discs

-EXPLANATION: as we know loading + unloading the discs is what pushed fluid around; that fluid contains nutrients that will continue to heal + keep the disc healthy while also pushing out waste from the site
-if we don’t move, the joints + muscles might get stiff + reduce the amount of fluid that is circulating

Question 21

T/F- unlike distraction + other forces of the discs, torsion only uses half of the set of fiber rings inside of your annulus

Answer 21

true

-EXPLANATION: unlike distraction or any other tensile force, all the fibers of the annulus are resisting that movement of force. however, with torsion only half of the fiber rings are responsible for resisting torsion + thus are more prone to injury especially when combining it with flexion

Question 22

a patient presents to you in the clinic with his toes facing inwards + the doctor makes a note on the referral that the patient has “squinting patella”. what is the doctor trying to tell you?

-patient’s patellae are elevated due to tight quadriceps tendon
-patient’s patellae are facing laterally due to a pathological decrease in torsion angle (femoral retrotorsion)
-patient’s patellae are positioned inferiorly due to patellar baja
-patient’s patellae are facing medially due to a pathological increase in torsion angle (femoral antetorsion)

Answer 22

patient’s patellae are facing medially due to a pathological increase in torsion angle (femoral antetorsion)

-EXPLANATION: “squinting patella” refers to a pathological increase in femoral torsion angle; this will result in the patellae of the individual pointing towards the midline of the body
-this is often a result of anteversion of the femur which results in the femur rotating inwards + as a result making it so the individuals toes point inwards as well

Question 23

for those who do not have enough torque in their abductors to offset gravity when in single leg stance, what is one compensation that we will commonly see in these individuals?

-the opposite hip drops down
-the trunk leans toward the stance leg
-the trunk leans away from the stance leg
-the lower back arches more

Answer 23

the trunk leans toward the stance leg

-EXPLANATION: when an individual has weak hip abductors they do not have sufficient torque to keep the hips level when they are in single leg stance
-to compensate for this, these individuals will lean their body towards the stance leg to increase the COM that way thus putting less stress on the weak abductors