axial skeleton osteology and arthrology dr. michael p. gillespie
TRANSCRIPT
AXIAL SKELETONOSTEOLOGY AND ARTHROLOGYDr. Michael P. Gillespie
HUMAN SKELETON: ANTERIOR VIEW
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HUMAN SKELETON: POSTERIOR VIEW
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RELATIVE LOCATION OR REGION WITHIN THE AXIAL SKELETON
Term Synonym Definition
Posterior Dorsal Back of the body
Anterior Ventral Front of the body
Medial None Midline of the body
Lateral None Away from the midline of the body
Superior Cranial Head or top of the body
Inferior Caudal Tail, or the bottom of the body
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The definitions assume a person is in the anatomic position.
COMPONENTS OF THE AXIAL SKELETON
Cranium Vertebrae Ribs Sternum
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CRANIUM
The cranium encases and protects the brain. It houses several sensory organs.
Eyes, ears, nose and vestibular system. Only the temporal and occipital bones are
relevant to our study of kinesiology.
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OSTEOLOGIC FEATURES OF THE CRANIUM
Temporal Bone Mastoid process
Occipital Bone External occipital protruberance Superior nuchal line Inferior nuchal line Foramen magnum Occipital condyles Basilar part
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TEMPORAL BONES
The two temporal bones form part of the lateral external surface of the skull immediately surrounding and including the external acoustic meatus.
The mastoid process is just posterior to the ear and serves as an attachment point to many muscles (i.e. sternocleidomastoid and longissimus).
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OCCIPITAL BONE The occipital bone forms the posterior base of the skull. The external occipital protruberance (EOP) is a palpable
midline point. It is an attachment point for the ligamentum nuchae and the medial part of the upper trapezius muscle.
The superior nuchal line extends laterally from the EOP to the base of the mastoid process of the temporal bone. This line serves as the attachment point for several muscles of the neck (i.e. trapezius and splenius capitis).
The inferior nuchal line marks the anterior edge of the attachment of the semispinalis muscle capitis muscle.
The foramen magnum is a large circular hole at the base of the occipital bone. It serves as a passageway for the spinal cord.
Occipital condyles project from the anterior-lateral margins of the foramen magnum forming the convex component of the atlanto-occipital joint.
The basilar part of the occipital bone lies just anterior to the anterior rim of the foramen magnum.
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LATERAL VIEW OF THE SKULL
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INFERIOR VIEW OF THE OCCIPITAL AND TEMPORAL BONES
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VERTEBRAE
The vertebrae provide stability throughout the trunk and neck. They protect the spinal cord, ventral and dorsal roots, and exiting spinal nerve roots.
3 sections of the vertebra Vertebral body (anterior) Transverse and spinous processes (posterior) –
posterior elements (neural arch, vertebral arch) Pedicles – bridges that connect the body with the
posterior elements – transfer muscle forces applied to the posterior elements forward across the vertebral body and intervertebral discs.
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MAJOR PARTS OF A MIDTHORACIC VERTEBRA
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Table 9-2 Major parts of a Midthoracic Vertebra Chapter 9 Page 311
ESSENTIAL CHARACTERISTICS OF A VERTEBRA
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ESSENTIAL CHARACTERISTICS OF A VERTEBRA
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RIBS
Twelve pairs of ribs enclose the thoracic cavity forming a protective cage for the cardiopulmonary organs.
The rib head and tubercle articulate with the thoracic vertebrae forming two synovial joints: Costocorporeal (costovertebral) Costotransverse
These joints anchor the posterior end of a rib to its corresponding vertebra.
The anterior end of a rib consists of flattened hyaline cartilage.
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TYPICAL RIB
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STERNUM
Three parts Manubrium (Latin – handle) Body Xiphoid process (Greek – sword)
The manubrium fuses with the body of the sternum at the manubriosternal joint (a cartilaginous joint that often ossifies later in life).
The xiphoid process is connected to the sternum by fibrocartilage at the xiphisternal joint that often fuses by 40 years of age.
Sternoclavicular joints. Sternocostal joints.
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OSTEOLOGIC FEATURES OF THE STERNUM
Osteologic Features of the Sternum Manubrium Jugular notch Clavicular facets for sternoclavicular joints Body Costal facets for sternocostal joints Xiphoid process
Intrasternal Joints Manubriosternal joint Xiphosternal joint
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STERNUM
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VERTEBRAL COLUMN
33 vertebral bony segments divided into five regions. Cervical Thoracic Lumbar Sacral Coccygeal
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CURVATURES WITHIN THE VERTEBRAL COLUMN When viewed from the side, the vertebral column
shows four slight bends called normal curves. Relative to the anterior aspect of the body, the
cervical and lumbar curves are convex (bulging out), whereas the thoracic and sacral curves are concave (cupping in).
The curves in the vertebral column increases its strength, help maintain balance in the upright position, absorb shocks during walking, and help to protect the vertebrae from fracture.
Various conditions may exaggerate the normal curves of the vertebral column, or the column may acquire a lateral bend, resulting in abnormal curves.
The abnormal curves are kyphosis, lordosis, and scoliosis. 23
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VERTEBRAL COLUMN
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INCORRECT LABELING OF THE NORMAL CURVES
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EXTENSION AND FLEXION OF THE VERTEBRAL COLUMN
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LINE OF GRAVITY The line of gravity acting on a person with ideal
posture passes near the mastoid process of the temporal bone, anterior to the second sacral vertebra, just posterior to the hip, and anterior to the knee and ankle.
In the vertebral column, the line of gravity typically falls just to the concave side of the apex of each region’s curvature.
Ideal posture allows gravity to produce a torque that helps maintain the optimal shape of the spinal curvatures.
The external torque attributed to gravity is the greatest at the apex of each region: C4 and C5, T6, and L3. 27
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LINE OF GRAVITY
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COMMON POSTURAL DEVIATIONS
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LIGAMENTOUS SUPPORT OF THE VERTEBRAL COLUMN
The vertebral column has extensive ligament support.
These ligaments limit motion, help maintain natural spinal curvatures, stabilize the spine, and protect the spinal cord and nerve roots.
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LIGAMENTS: LATERAL VIEW
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LIGAMENTS: ANTERIOR VIEW
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LIGAMENTS: POSTERIOR VIEW
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MAJOR LIGAMENTS OF THE VERTEBRAL COLUMN
Name Attachments Function Comment
Ligamentum Flavum
Between the anterior surface of one lamina and the posterior surface of the lamina below.
Limits flexion High in elastinPosterior to the spinal cord
Supraspinous and interspinous ligaments
Between adjacent spinous processes from C7 to sacrum
Limits flexion Ligamentum nuchae is the cervical and cranial extension of the supraspinous ligaments
Intertransverse ligaments
Between adjacent transverse processes
Limits contralateral flexion and forward flexion
Few fibers in cervical and thoracic, thin in lumbar
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MAJOR LIGAMENTS OF THE VERTEBRAL COLUMN
Name Attachments Function Comment
Anterior longitudinal ligaments
Between occipital bone and anterior vertebral bodies including sacrum
Limits extensionReinforces anterior aspect of IVDs
Most developed in lumbar spineTwice the tensile strength of PLL
Posterior longitudinal ligaments
Posterior surfaces of all vertebral bodies between C2 and sacrum
Limits flexionReinforces posterior sides of IVDs
Lies within vertebral canal just anterior to spinal cord
Capsules of the apophyseal joints
Margin of each apophyseal joint
Strengthen the apophyseal joint
Loose in the neutral position, but become taut in the extremes of other positions
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STRESS STRAIN CURVE LIGAMENTUM FLAVUM
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PROMINENT LIGAMENTUM FLAVUM
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CERVICAL REGION
Smallest and most mobile of the vertebrae, which facilitates the large range of motion of the head.
Transverse foramina are located in the transverse processes of the cervical spine through which the vertebral artery travels.
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CERVICAL VERTEBRA: SUPERIOR VIEW
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CERVICAL VERTEBRA: ANTERIOR VIEW
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TYPICAL CERVICAL VERTEBRAE (C3 TO C6) Small rectangular bodies. The superior surfaces are concave side to
side, with raised lateral hooks called uncinate processes (uncus means “hook”).
These form the uncovertebral joints (a.k.a. “joints of Luschka”).
Osteophytes can form around the margins of these joints which can reduce the size of the intervertebral foramen (IVF) and impinge upon exiting nerve roots.
Superior articular facets face posterior and superior, whereas the inferior articular facets face anterior and inferior. 41
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CERVICAL VERTEBRA: POSTERIOR-LATERAL VIEW
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CERVICAL VERTEBRAL COLUMN: LATERAL VIEW
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ATYPICAL CERVICAL VERTEBRAE (C1, C2, & C7)
Atlas (C1) Axis (C2) “Vertebra Prominens” (C7)
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ATLAS (C1)
The primary function is to support the head. The atlas has large, palpable transverse
processes, usually the most prominent of the cervical vertebrae.
The transverse processes serve as attachment points for muscles that move the cranium.
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ATLAS
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ATLAS (C1)
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AXIS (C2)
The axis has an upwardly projecting dens (odontoid process) which provides a vertical axis of rotation for the atlas and head.
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AXIS (C2)
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AXIS (C2)
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ATLANTO-AXIAL ARTICULATION
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“VERTEBRA PROMINENS” (C7)
C7 is the largest of all cervical vertebrae and has many characteristics of thoracic vertebrae.
This vertebra has a large spinous process, characteristic of thoracic vertebrae.
The hypertrophic anterior tubercle may sprout an extra cervical rib, which may impinge on the brachial plexus.
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THORACIC REGION
Typical Thoracic Vertebrae (T2 to T9) The heads of ribs 2 – 9 typically articulate with a
pair of costal demifacets. Atypical Thoracic Vertebrae (T1 and T10 to
T12) T1 has a full costal facet the accepts the entire
head of the first rib. The spinous process of T1 is elongated and often
as prominent as C7. The bodies of T10 – T12 may have a single full
costal facet. These segments usually lack costotransverse joints.
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TYPICAL THORACIC VERTEBRAE
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LUMBAR REGION
Massive wide bodies for supporting the entire superimposed weight of the head, trunk, and arms.
The spinous processes are broad and rectangular projecting horizontally (as opposed to the slant n the thoracic region).
Short mammillary processes project from the posterior surface of each superior articular facet for attachment of the multifidi muscles.
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LUMBAR VERTEBRAE: SUPERIOR VIEW
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LUMBAR VERTEBRA: LATERAL-POSTERIOR VIEW
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SACRUM Triangular bone with the base facing superiorly and
apex inferiorly. Transmits weight of the vertebral column to the pelvis. In childhood, each of the five separate sacral
vertebrae is joined by a cartilaginous membrane. By adulthood they fuse into a single bone. Four paired ventral (pelvic) sacral foramina transmit
the ventral rami of spinal nerve roots that form the sacral plexus.
Four paired dorsal sacral foramina transmit the dorsal rami of sacral spinal nerve roots.
The sacral canal houses and protects the cauda equina.
A large auricular surface articulates with the ilium, forming the sacroiliac joint.
The apex articulates with the coccyx.
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LUMBOSACRAL REGION: ANTERIOR VIEW
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LUMBOSACRAL REGION: POSTERIOR-LATERAL VIEW
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SACRUM: SUPERIOR VIEW
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COCCYX
Small triangular bone consisting of four fused vertebrae.
Base of coccyx joins the apex of the sacrum at the sacrococcygeal joint (which usually fuses late in life).
The joint has a fibrocartilaginous disc.
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CAUDA EQUINA At birth the spinal cord and vertebral column are nearly
the same length. The vertebral column grows slightly faster than the
spinal cord. The spinal cord terminates at around the level of L1 or
L2. The lumbosacral spinal nerve roots must travel a great
distance caudally before reaching their corresponding intervertebral foramina.
The elongated nerves represent a horse’s tail, hence the term cauda equina.
Severe fracture or trauma to the lumbosacral region can damage the cauda equina but spare the spinal cord.
Damage to the cauda equina can result in muscle paralysis, atrophy, altered sensation, and reduced reflexes.
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TYPICAL INTERVERTEBRAL JUNCTION
Three functional components: 1. Transverse and spinous processes
Levers that increase the mechanical leverage of muscles and ligaments.
2. Apophyseal joints Guiding intervertebral motion (like railroad tracks for a
train). 3. Interbody joints
Connect an intervertebral disc with a pair of vertebral bodies.
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TYPICAL INTERVERTEBRAL JUNCTION
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MOVEMENT IN THE VERTEBRAL COLUMN
With a few exceptions, movement within any given intervertebral joint is relatively small.
When added across the entire vertebral column, however, these small movements can yield considerable angular rotation.
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TERMINOLOGY DESCRIBING MOVEMENT
Osteokinematics Rotations within the three cardinal planes. Each plane, or degree of freedom, is associated
with one axis of rotation. Movement is described in a cranial-to-caudal
fashion. Arthrokinematics
Describes the relative movement between articular facet surfaces within the apophyseal joints.
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OSTEOKINEMATICS OF THE VERTEBRAL COLUMN
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APOPHYSEAL JOINTS 24 pairs of apophyseal joints. Each apophyseal joint is formed between
opposing articular facet surfaces. Lined with articular cartilage and enclosed by a
synovial-lined, well innervated capsule. The articular surfaces of most apophyseal joints
are flat. Apophysis means “outgrowth” which emphasizes
the protruding nature of the articular process. The facets act as barricades. They permit certain
movements, but block other movements. The near vertical orientation of the apophyseal
joints in the lower thoracic, lumbar, and lumbosacral regions block excessive anterior translation of one vertebra on another. 69
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ARTHROKINEMATICS APOPHYSEAL JOINTS
Terminology Definition Functional Example
Approximation of joint surfaces
An articular facet surface tends to move closer to its partner facet. Usually caused by a compression force.
Axial rotation between L1 and L2 causes approximation (compression) of the contralateral apophyseal joint.
Separation (gapping) between joint surfaces
An articular facet tends to move away from its partner facet. Usually caused by a distraction force.
Therapeutic traction is a way to decompress or separate the apophyseal joints.
Sliding (gliding) between joint surfaces
An articular facet translates in a linear or curvilinear direction relative to another articular facet. Sliding between joint surfaces is caused by a force directed tangential to the joint surfaces.
Flexion-extension of the mid to lower cervical spine.
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APOPHYSEAL JOINT (OPENED)
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INTERBODY JOINTS
From C2-3 to L5-S1, 23 interbody joints are present in the spinal column.
Each interbody joint contains an intervertebral disc, vertebral endplates, and adjacent vertebral bodies.
The joint is a cartilaginous synarthrosis.
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INTERVERTEBRAL DISCS Central nucleus pulposus surrounded by an
annulus fibrosus. The nucleus pulposus is a pulplike gel in the mid to
posterior part of the disc. In youth, the lumbar discs consist of 70% - 90%
water. The discs act as a hydraulic shock absorption
system, dissipating and transferring loads across vertebrae.
The annulus fibrosus consists of 15 to 25 concentric layers or rings of collagen fibers.
Abundant elastin protein is also interspersed conferring circumferential elasticity to the annulus fibrosus.
If the disc is dehydrated and thin, a disproportionate amount of compressive force is placed on the apophyseal joints.
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INTERVERTEBRAL DISC
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ANNULUS FIBROSIS
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VERTEBRAL ENDPLATES
The vertebral endplates are relatively thin cartilaginous caps of connective tissue that cover most of the superior and inferior surfaces of the vertebral bodies.
At birth they are thick, accounting for approximately 50% of the height of each intervertebral space.
During childhood, the endplates function as growth plates for the vertebrae.
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VERTEBRAL ENDPLATE
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INTERVERTEBRAL DISC AS A HYDROSTATIC PRESSURE DISTRIBUTER
The intervertebral discs act as shock absorbers to protect the bone from excessive pressure.
Compressive forces push the endplates inward and toward the nucleus pulposus.
The nucleus pulposus deforms radially and outwardly against the annulus fibrosus.
When the compressive force is removed from the endplates, the stretched elastin and collagen fibers return to their original preload length.
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FORCE TRANSMISSION THROUGH DISC
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INTRADISCAL PRESSURE DURING COMMON POSTURES AND ACTIVITIES
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DIURNAL FLUCTUATIONS IN WATER CONTENT WITHIN THE INTERVERTEBRAL DISCS
When a healthy spine is unloaded (i.e. bed rest) the pressure within the nucleus pulposus is relatively low.
This low pressure attracts water to the disc and the disc swells slightly while sleeping.
When we are awake and upright, weight bearing produces compressive forces that push water out of the disc.
The water retaining capacity of the disc declines with age.
With less water and a lower hydrostatic pressure, the disc can bulge outward when compressed (like a flat tire). 81
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SPINAL COUPLING
Movement performed within any given plane throughout the vertebral column is coupled with automatic and usually imperceptible movement in another plane.
This is referred to as spinal coupling.
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NORMAL SAGITTAL PLANE CURVATURES ACROSS REGIONS OF THE SPINAL COLUMN
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CONNECTIVE TISSUES THAT MAY LIMIT MOTIONS OF THE VERTEBRAL COLUMN
Motion of the Vertebral Column
Connective Tissues
Flexion Ligamentum nuchaeInterspinous and supraspinous ligamentsLigamentum flavaApophyseal jointsPosterior annulus fibrosisPosterior longitudinal ligament
Beyond neutral extension Apophyseal jointsCervical viscera (esophagus and trachea)Anterior annulus fibrosisAnterior longitudinal ligament
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CONNECTIVE TISSUES THAT MAY LIMIT MOTIONS OF THE VERTEBRAL COLUMN
Motion of the Vertebral Column
Connective Tissues
Axial rotation Annulus fibrosisApophyseal jointsAlar ligaments
Lateral flexion Intertransverse ligamentsContralateral annulus fibrosusApophyseal joints
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CRANIOCERVICAL REGION
“Craniocervical region” and “neck” are used interchangeably.
Three articulations Atlanto-occipital joint Atlanto-axial joint complex Intracervical apophyseal joints (C2 to C7)
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ATLANTO-OCCIPITAL JOINTS
The atlanto-occipital joints provide independent movement of the cranium relative to the atlas.
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ATLANTO-OCCIPITAL JOINTS: POSTERIOR - EXPOSED
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ATLANTO-OCCIPITAL JOINTS: ANTERIOR
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ATLANTO-OCCIPITAL JOINTS: POSTERIOR
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ATLANTO-AXIAL JOINT COMPLEX The atlanto-axial joint complex has two articular
components: a median joint and a pair of laterally positioned apophyseal joints.
The median joint is formed by the dens of the axis (C2) projecting through an osseous-ligamentous ring created by the anterior arch of the atlas and the transverse ligament.
The transverse ligament of the atlas stabilizes the atlanto-axial articulation and prevents anterior slippage.
The two apophyseal joints are formed by the articulation of the inferior areticular facets of the atlast with the superior articular facets of the axis.
Two degrees of freedom are allowed by this joint complex: horizontal plane rotation and flexion-extension.
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ATLANTO-AXIAL JOINT COMPLEX: SUPERIOR
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ATLANTO-AXIAL JOINT COMPLEX: POSTERIOR
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INTRACERVICAL APOPHYSEAL JOINTS (C2 TO C7)
The facet surfaces within the apophyseal joints of C2 to C7 are oriented like shingles on a 45-degree sloped roof.
This orientation enhances the freedom of movement in all three planes.
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APPROXIMATE ROM FOR THE THREE PLANES OF MOVEMENT CRANIOCERVICAL
Joint or Region
Flexion & Extension (Sagittal Plane, Degrees)
Axial Rotation (Horizontal Plane, Degrees)
Lateral Flexion (Frontal Plane, Degrees)
Atlanto-occipital joint
Flexion: 5Extension: 10Total: 15
Negligible About 5
Atlanto-axial joint complex
Flexion: 5Extension: 10Total: 15
35-40 Negligible
Intracervical region (C2-C7)
Flexion: 35-40Extension: 55-60Total: 90-100
30-35 30-35
Total across craniocervical region
Flexion: 45-50Extension: 75-80Total: 120-130
65-70 35-4095
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KINEMATICS OF CRANIOCERVICAL EXTENSION
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KINEMATICS OF CRANIOCERVICAL FLEXION
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PROTRACTION AND RETRACTION OF THE CRANIUM
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KINEMATICS OF CRANIOCERVICAL AXIAL ROTATION
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KINEMATICS OF CRANIOCERVICAL LATERAL FLEXION
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THORACIC REGION
The thorax consists of a relatively rigid rib cage, formed by ribs, thoracic vertebrae, and sternum.
The rigidity provides a stable base for muscles to control the craniocervical region, protection for intrathoracic organs, and a mechanical bellows for breathing.
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COSTOTRANSVERSE & COSTOCORPOREAL JOINTS: SUPERIOR-LATERAL VIEW
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COSTOTRANSVERSE & COSTOCORPOREAL JOINTS: SUPERIOR VIEW
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APPROXIMATE ROM FOR THE THREE PLANES OF MOVEMENT THORACIC REGION
Flexion & Extension (Sagittal Plane, Degrees)
Axial Rotation (Horizontal Plane, Degrees)
Lateral Flexion (Frontal Plane, Degrees)
Flexion: 30-40Extension: 20-25Total: 50-65
30-35 25-30
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KINEMATICS OF THORACOLUMBAR FLEXION
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KINEMATICS OF THORACOLUMBAR EXTENSION
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KINEMATICS OF THORACOLUMBAR AXIAL ROTATION
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KINEMATICS OF THORACOLUMBAR LATERAL FLEXION
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LUMBAR REGION
L1 to L4 The facet surfaces of most lumar apophyseal
joints are oriented nearly vertically. This orientation favors sagittal plane motion at
the expense of rotation in the horizontal plane. L5-S1
The facet surfaces of the L5-S1 apophyseal joints are usually oriented in a more frontal plane than those of other lumbar regions.
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APPROXIMATE ROM FOR THE THREE PLANES OF MOVEMENT LUMBAR REGION
Flexion & Extension (Sagittal Plane, Degrees)
Axial Rotation (Horizontal Plane, Degrees)
Lateral Flexion (Frontal Plane, Degrees)
Flexion: 40-50Extension: 15-20Total: 55-70
5-7 20
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SPONDYLOLISTHESIS
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HERNIATED NUCLEUS PULPOSUS
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LUMBOPELVIC RHYTHM DURING TRUNK FLEXION
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LUMBOPELVIC RHYTHM DURING TRUNK EXTENSION
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ANTERIOR PELVIC TILT
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POSTERIOR PELVIC TILT
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KINESIOLOGIC EFFECTS OF LUMBAR FLEXION & EXTENSION
Structure Effect of Flexion Effect of Extension
Nucleus Pulposus Deformed or pushed posteriorly
Deformed or pushed anteriorly
Annulus Fibrosus Posterior side stretched
Anterior side stretched
Apophyseal Joint Capsule stretchedArticular loading decreased
Capsule slackenedArticular loading increased
Intervertebral Foramen
Widened narrowed
Posterior longitudinal ligament
Increased tension (elongated)
Decreased tension (slackened)
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KINESIOLOGIC EFFECTS OF LUMBAR FLEXION & EXTENSION
Structure Effect of Flexion Effect of Extension
Ligamentum flavum Increased tension (elongated)
Decreased tension (slackened)
Interspinous ligament
Increased tension (elongated)
Decreased tension (slackened)
Supraspinous ligament
Increased tension (elongated)
Decreased tension (slackened)
Anterior longitudinal ligament
Decreased tension (slackened)
Increased tension (elongated)
Spinal cord Increased tension (elongated)
Decreased tension (slackened)
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SITTING POSTURE & EFFECTS ON ALIGNMENT
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SACROILIAC JOINTS
The sacroiliac joints mark the transition between the caudal end of the axial skeleton and the lower appendicular skeleton.
The tight fitting SI joint is designed for stability, ensuring effective transfer of potentially large loads between the vertebral column, the lower extremities, and ultimately the ground.
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SACROILIAC JOINTS: EXPOSED SURFACES
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LIGAMENTS OF THE SACROILIAC JOINT
Primary Anterior sacroiliac Iliolumbar Interosseous Short and long posterior sacroiliac
Secondary Sacrotuberous Sacrospinous
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LUMBOSACRAL REGION: ANTERIOR VIEW
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LUMBOSACRAL REGION: POSTERIOR VIEW
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NUTATION & COUNTERNUTATION
Nutation Nutation means to nod. Nutation is the anterior tilt of the base (top) of
the sacrum relative to the ilum. Counternutation
Counternutation is a reverse motion defined as the relative posterior tilt of the base of the sacrum relative to the ilium.
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KINEMATICS OF THE SACROILIAC JOINTS
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FUNCTIONS OF THE SACROILIAC JOINTS
Stress relief mechanism within the pelvic ring.
A stable means of load transfer between the axial skeleton and lower limbs.
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MUSCLES THAT REINFORCE AND STABILIZE THE SACROILIAC JOINT
Erector Spinae Lumbar multifidi Abdominal muscles
Rectus abdominis Obliquus abdomninis internus and externus Transversus abdominis
Hip extensor muscles Latissimus dorsi Iliacus and piriformis
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