What comprises the axial skeleton?
Skull Hyoid bone Vertebral column Sternum Ribs
What are the general functions of the vertebral column?
- Protection 2. Base of attachment 3. Structural support 4. Flexibility and mobility 5. Other basic bone functions
What are the normal vertebral curves?
Lordosic (cervical and lumbar) – anteriorly convex Kyphotic (thoracic and sacral) – anteriorly concave
What are the two joints found through the vertebral column?
Intervertebral (between adjacent vertebrae) Zygopophyseal (between articular facets of adjacent vertebrae)
Intervertebral Joints
Articulation: between bodies of adjacent vertebrae Classification: amphiarthrotic cartilaginous symphysis Movement: slight
Zygopophyseal Joints
Articulation: between articular facets of adjacent vertebrae Classification: diarthrotic synovial planar Movement: small gliding
Anterior longitudinal ligament
Extends along anterior surfaces of vertebral bodies, from C2-sacrum Thicker in thoracic than cervical and lumbar
Posterior longitudinal ligament
Within vertebral canal. Extends along posterior surface of bodies of vertebrae Continuous from C2 to sacrum Thickest in t-spine
Intertransverse ligament
In between transverse processes C-spine irregular and scattered T-spine rounded cords connected to deep muscles of back L-spine thin and membranous
Supraspinous Ligaments
Strong fibrous cord running on top of interspinous ligaments C7-sacrum Thicker and broader in L-spine
Ligamentum flavum
Connects lamina of adjacent vertebrae Axis-sacrum C-spine thin and strong T-spine thicker L-spine thickest Elasticity preserves and helps return to upright posture
Interspinous ligaments
Connect adjacent spinous processes Extend for root to apex of each process Under Supraspinous ligaments
Intervertebral discs
Fried egg. Annulus fibrosis encircling nuclear pulposis
Classification: intervertebral joints
Amphiarthrotic Cartilaginous symphysis
Classification: zygapophyseal joint
Diarthrotic Synovial gliding
Classification: Sacroiliac
ANTERIOR: Diarthrotic Synovial planar POSTERIOR Amphiarthtosis Fibrous syndesmosis
Classification: sacrococcygeal
Amphiarthrosis Cartilaginous symphysis
Classification: pubic symphysis
Amphiarthrosis Cartilaginous symphysis
FISH?
Fibrocartilage: ilium Sacrum: hyaline (In the context of the SI joint)
What ligaments are associated with the SI joint?
Anterior SI ligament Posterior SI ligament Interosseous SI ligament
What is the lumbosacral articulation?
Not a true joint. Iliolumbar ligament connects iliac crest with TVPs of L4 and 5. Forms Planar diarthrosis
Sacrum with ischium?
Not a true articulation. Sacrotuberous ligament (forms greater sciatic foramen) Sacrospinous ligament (forms lesser sciatic foramen)
What ligaments are associated with the Sacrococcygeal joint?
Anterior SC ligament Posterior SC ligament Lateral SC ligament Interarticular ligament
What ligaments are associated with the pubic symphysis?
Anterior pubic ligament Superior public ligament Posterior pubic ligament Inferior/subpubic/arcuate pubic ligament
What ligaments are associated with the joints of the vertebral column?
Anterior longitudinal ligaments Posterior longitudinal ligaments Intertransverse ligaments Interspinous ligaments Supraspinous ligaments Ligamentum flavum
Disc herniation
Usually L4-5, L5-S1 Nucleur pulposis protrudes from disc.
Sciatica
Irritation of sciatic nerve
Spondylosis
Degeneration of posterior elements, Presence of bony spurs, osteophytes etc.
Spondylysis
Defect in pars interarticularis (between superior and inferior articular facet)
Spondolysthesis
Anterior slippage of on lumbar vertebra on another due to defect in pars interarticularis.
Degenerative Joint disease/disc disease/osteoarthritis
Degeneration of the spine and loss of vertical height of the intervertebral discs due to normal aging, wear and tear, genetics and/or traumatic arthritic changes.
Costovertebral joints: classification and articular surfaces
Classification: diarthrosis; synovial planar Articular surfaces: head of rib with costal facets of T vertebrae. Typical: demi-facets, inferior vert same number. R1,10-12 articulate with only one vert.
What ligaments are associated with Costovertebral joints?
Radiate and interarticular
Radiate ligament
Connects head of the rib with vertebral bodies and IVD. (Kind of like a joint capsule)
Interarticular ligaments
Connect the interarticular crest of the rib with the IVD. Creates two distinct synovial cavities = intraarticular
Costotransverse joint: classification and articulating surfaces
Diarthrosis. Synovial planar Between costal tubercle and the TVP of the same number.
What ligaments are associated with the costotransverse joint?
Lateral costotransverse Costotransverse Superior costotransverse
Lateral costotransverse ligament
Attaches tip of TVP to tubercle of the corresponding rib
Costotransverse ligament
Connects dorsal surface of neck of the rib with anterior TVP of corresponding vertebra.
Superior costotransverse ligaments
Connect superior surface of the neck of the rib to the TVP of the vertebra above.
Costochondral joints: classification and articulating surfaces
Amphiarthrotic. Cartilaginous symphysis Between the rib and costal cartilage (bars of hyaline cartilage). Held together by periosteum.
Ligaments of the costochondral joints.
Trick question: there are none. (Held together by periosteum)
Interchondral joints: classification and articulating surfaces
RIBS 6-9: Diarthrosis. Synovial planar RIBS 9-10: Amphiarthrosis. Fibrous Syndesmosis Articulates the contiguous borders of R6-8 and sometimes 9-10
What ligaments are associated with interchondral joints?
Interchondral ligaments
Interchondral ligaments
From one costal cartilage to another. Between r6-9, maybe 9-10
Sternalcostal joints: classification and articulating surfaces
RIB 1: Synarthrosis. Cartilaginous synchondrosis R2-7 Diarthrosis. Synovial planar. Articulates between costal cartilages to facets on lateral margin of sternum.
What ligaments are associated with the sternocostal joints?
Radiate sternocostal ligaments.
Radiate sternocostal ligaments
Connect costal cartilage to superior/lateral/inferior margins of the sternum
Manubrosternal joint: classification and articulating surfaces
Amphiarthrosis. Cartilaginous symphysis Between manubrium and body of sternum.
What ligaments are associated with the manubriosternal joint?
Radiate sternocostal of R2 Intraarticular sternocostal of R2
Radiate Sternocostal ligament of R2
At manubriosternal joint. Little round ligament between sternum and costal cartilage.
Interarticular Sternocostal of the R2
Between articular facets of head of rib and intervertebral fibrocartilage. At Manubriosternal joint.
Xiphesternal joint: classification and articulating surfaces
Amphiarthrotic. Cartilaginous symphysis Between xyphoid process and body of sternum
What are the ligaments associated with the xiphisternal joint?
Radiate Sternocostal ligament of R6 & 7 Costoxiphoid ligament
Costoxiphoid ligament
Connect anterior/posterior of 7th costal cartilage (and maybe 6th) to anterior/posterior xiphisternal process.
What are the movements of the thoracic spine?
R1-6. Up and forward. (Ant/post) R7-10 up and back (lateral) R11-12 away from midline (lateral)
Sternoclavicular joint: classification and articular surfaces
Diarthrotic. Synovial saddle-like Sternal end of clavicle with upper/lateral manubrium, and cartilage if first rib
What are the ligaments associated with the sternoclavicular joint?
Anterior sternoclavicular Posterior sternoclavicular Interclavicular Costoclavicular Articular disc
Anterior sternoclavicular ligament
Connects above to ant/superior sternal end of clavicle to anterior upper manubrium.
Posterior sternoclavicular ligament
Superior posterior sternal end of clavicle to posterior upper manubrium
Interclavicular ligament
Attaches sternal ends of the clavicles yo each other, and also upper part of manubrium.
Costoclavicular ligament
First costal cartilage to costal tuberosity of clavicle
Pectus carinatum
Pigeon chest
Pectus excavatum
Funnel chest
Median atlantoaxial joint: classification, movement and articulating surfaces
Diarthrotic. Synovial pivot Shaking head (rotation) Fovea dentalis of C1 with anterior articulating facet of dens of C2
What makes the c-spine unique?
1 uncovertebral joints 2 ligamentum nuchae
Apical ligament
Median and lateral atlantoaxial joint Tip of dens to anterior foramen magnum
What are the ligaments associated with the median and lateral atlantoaxial joints?
Apical Alar Cruciform/cruciate Tectorial membrane
Alar ligament
Median and lateral atlantoaxial joints From superolateral dens to anterolateral foramen magnum
Cruciform/cruciate ligaments
Transverse ligament of atlas: connects lateral masses of atlas; keeps odontoid process in place. Superior longitudinal and inferior longitudinal bisect it running superior/inferior. Together connect foramen magnum to body of C2
Tectorial membrane
From body of atlas to anterior half of foramen magnum. Continuous with PLL.
Lateral Atlantoaxial joint: classification and articular surfaces
Diarthrosis. Synovial Planar. Inferior articulating facet of lateral masses of the atlas/C1 to superior articulating facet of axis/C2.
Atlanto-occipital articulation: classification, movement and articulating surfaces.
Diarthrotic. Synovial, condyloid/ellipsoid. Flexion/extension; lateral flexion Condyles of the occiput with superior articulating facts of lateral masses of atlas/C1.
What are the ligaments associated with the atlanto-occipital articulation?
Anterior atlanto-occipital membrane Posterior atlanto-occipital membrane Lateral ligaments
What is the blood supply for the cervical spine?
Vertebral artery, common carotid, subclavian, branches of external carotid.
What innervates the cervical spine?
Branches of cervical plexus; segmental spinal nerves.
Anterior atlanto-occipital membrane
Pass between the anterior margin of the foramen magnum and the anterior arch of the atlas/C1
Posterior atlanto-occipital membrane
Connects posterior margin of foramen magnum to upper border of posterior arch of atlas/C1
Lateral ligaments
Jugular processes of occiput to base of TVP of atlas/C1
Thoracic outlet syndrome (TOS)
Compression ofthe neurovascular bundle that emerges from the level of RI
What portion of the C-spine does DJD/osteoarthritis affect most frequently?
C5-6 and C4-5 (because that’s where the greatest flexion/extension occurs)
What supplies blood to the thoracic cage and mediasternum?
Internal thoracic, superior and posterior intercostals
Nerve supply to chest wall and sternum
Name the three Atlantoaxial joints and their classification
A: inferior articular process
B: superior articular process
C: inferior vertebral noch
D: superior vertebral noch
E: intervertebral disc
F: zygapophysial joint
G: intervertebral foramen
A: anulus fibrosus
B: nucleus pulposus
C: hyaline cartilage
1: anterior longitudinal ligament
2: posterior longitudinal ligament
3: ligamentum flavum
4: interspinous ligament
5: supraspinous ligament
This is the ligamentum nuchae. It replaces the supraspinous and interspinous ligaments in the cervical region. Runs from the external occipital protuberance of the skull to the spinous process of the vertebra prominent (C7).