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Arthrology CH. 8, p. 192 - 225 How will knowing and understanding the joints of the body help me to be a better chiropractor? • If you understand joint anatomy you can explain joint injuries to patients • Allows you to understand biomechanics and motion of the body • Allows you to determine and understand subluxations • Allows you to understand rehab procedures • Allows you to prescribe therapeutic regimens to patients with joint injuries What do you need to know • The way joints are classified • The definition of terms as they related to the various joint classifications • The anatomic differences in the ways bones are held together at a joint • The different examples of each type of classification • The different classifications of synovial joints based on movement, types of movement and anatomical shape of the joint surfaces • The major joints of the body and the joint classifications that apply to each • The ligaments assoc. with the major joints of the body Success principle #7 To heal (remove “quality nerve interference”), remove “doubt” in both doctor and patient and instill “faith” in both doctor and patient. Joints • Definition of a joint – a place where two or more bones come together. – does there have to be movement here? • Articulation – a joint • Kinesiology – the study of the mechanics of motion, biomechanics, study of the movement of joints Classification of Joints Many ways to classify joints. According to the type of material that holds the bones together and the method used to unite the boney components. Fibrous joints • Synarthrosis - joined by fibrous connective tissue • 3 types: 1) suture - found only in the skull • serrate suture - sawlike interlocking articulations • squamous - edges overlap • plane - edges are smooth and do not overlap 2) syndesmosis - joined by a ligament • interosseous ligament - FCT sheet between two bones – between the radius and ulna – interspinous ligament – between tibia and fibula 3) gomphoses • between root of tooth and alveolar socket Fibrous joints Fibrous Articulations Cartilaginous Joint 2 Types: 1) Primary Cartilaginous Joint - synchondrosis – epiphyseal plates – costochondral articulation of first rib and manubrium – these joints typically become a synostosis 2) Secondary Cartilaginous Joint - symphysis, or amphiarthrosis – symphysis pubis – intervertebral joint* – manubriosternal joint Primary cartilaginous joints Synchondrosis Secondary cartilaginous joints Amphiarthrosis, Symphysis Cartilaginous Articulations Diarthrosis Synovial Joints Structure of a Synovial joint • • • • • Joint capsule Synovial membrane Synovial Fluid Articular cartilage Joint cavity Structure of a Synovial joint Range of Motion • Is determined by: The anatomic shape of the articular surfaces of the ends of the bones forming the joint The laxity or tightness of the joint capsule • • • • The presence of adjacent anatomical structures Planes of Movement Uniaxial – movement in one plane – three types - hinge, pivot and plane (gliding) Biaxial – movement in two planes – two types - condyloid and saddle Multiaxial – movement in three planes – basically one type - ball and socket Associated Structures Ligaments – Intrinsic – Extrinsic • Bursae Associated Structures • Tendon sheath Kinds of Synovial Joints Uniaxial joints Movement in one plane • Hinge - ginglymus – flexion and extension • resembles a door hinge – Humeroulnar - cubital joint – Interphalangeal joint • • Pivot - trochoid (means to resemble a pivot or pulley) Rotation • One component is shaped like a ring and the other is shaped so that it can rotate within the ring – Proximal radioulnar joint – Atlantoaxial joint • Gliding Joints - plane • Flat planer surfaces (some joints may demonstrate limited rotation) – Zygapophyseal joints – Intercarpal and intertarsal joints – Sternocostal joints – Sacroiliac joint – acromioclavicular joint Biaxial joints Movement in two planes • • • Condyloid - ellipsoidal joint flexion-extension, abduction-adduction • An oval convex surface fits into a concave depressed surface; flexion and extension and abduction and adduction – Radiocarpal joint – Metacarpophalangeal joint – Knee joint (double condyloid) • Saddle - sellar joint • flexion-extension • abduction-adduction • Each joint surface is both convex in one plane and concave in the other – Carpometacarpal joint of the thumb • trapezium and first metacarpal bone – Sternoclavicular joint Multiaxial joints Movement in three planes • • • Ball and socket joints - spheroid – flexion-extension – abduction-adduction – rotation hip - coxofemoral joint shoulder joint - glenohumeral joint • • Synovial Articulations How to classify synovial joints If it is synovial then it is diarthrodial or freely moveable. • Plane of movement – unaxial, biaxial or multiaxial. • Type of movement – hinge, pivot, etc. Shape of articular surfaces – ball and socket, sellar, etc. • Many joints fit several classifications. Specific Joints of the Body NOTE: many joints fit into one or more classifications. It is rare to find a joint that fits perfectly into one specific category This is the reason joints can be so confusing Typically we try to use the classifications which most appropriately apply. Atlanto-occipital Joint • Synovial, diarthrodial • Ginglymus and condyloid - the condyles of the occiput rest on the superior articular facets of the atlas (condyloid portion); the condyles converge anteriorally and allow motion in one plane (flexion and extension - hinge portion), nodding the head, “yes” joint. • There is limited side ways tilting of the head and limited rotation. Atlanto-occipital Joint • Anterior atlanto-occipital membrane - anterior arch of atlas to anterior margin of foramen magnum, direct continuation of the anterior longitudinal ligament • Posterior atlanto-occipital membrane - posterior arch of atlas to posterior margin of foramen magnum Atlanto-occipital Joint • Lateral Atlanto-occipital membrane - (Anterior Oblique Ligament), these two ligaments connect TP of atlas to jugular process of occiput • Articular Capsule (capsular ligament) - these ligaments enclose the articular surfaces and are lined with a synovial membrane • • Atlanto-occipital Joint Occipito-Axial Complex The axis is NOT in direct articulation with the occiput so it is called a complex NOT a joint Ligaments attach the axis to the occiput Occipito-Axial Complex • • • • • • • Membrana-tectoria - occipito-axial ligament, tectorial membrane - continuation of the posterior longitudinal ligament; attaches on the occipital bone medial to the hypoglossal canal; closely adherent to the cranial dura once inside the cranial vault Alar Ligaments - check ligament, odontoid ligament; one on each side, apex of dens to medial surface of occipital condyles, serve to limit or check the degree of rotation of the axis Occipito-Axial Complex Occipito-Axial Complex Occipito-Axial Complex Apical ligament (suspensory ligament) - single ligament, tip of dens to anterior margin of foramen magnum; may be remains of embryonic notochord as there is no disc here Cruciate ligament - “cross shaped”, AKA cruciform lig. – transverse ligament of the atlas - lateral mass over posterior aspect of dens to lateral mass – cranial crus (SLB) - attaches central portion of the transverse ligament to ant. margin of FM – caudal crus (ILB) - attaches central portion of the transverse ligament to posterior body of axis Occipito-Axial Complex Occipito-Axial Complex Atlantoaxial Joints 2 separate joints here: both are synovial, diarthrodial First joint: bilateral joints between the inferior articular facets of the atlas and the superior articular facets of the axis; these zygapophyseal joints are plane, gliding joints Second joint: the articulation between the dens and anterior arch of the atlas and the dens and the transverse ligament of the atlas - trochoid, pivot joint Atlantoaxial Joints Ligaments associated with the Atlanto-axial joint Anterior atlanto-axial ligament - anterior surface of body of axis to anterior arch of atlas Posterior atlanto-axial ligament - from the laminae of the axis to the posterior arch of the atlas Accessory Ligaments - runs from the medial surface of the lateral masses of atlas down to the posterior surface of the body at the base of dens - part of tectorial memb. Atlantoaxial Joints Atlantoaxial Joints Atlantoaxial Joints` Atlantoaxial Joints, cont. Transverse Ligament of the Atlas - runs from lateral mass across the neural ring over the posterior aspect of the dens to hold the dens firmly against the fovea dentalis of the atlas, does not attach to the dens, small synovial pocket between the two Atlantoaxial Joints Joint of Luschka • Uncovertebral joint • Diarthrosis, synovial • Between the uncinate processes and a small indentation found on the inferior surface of the vertebra it articulates with, from C3-C6 • located at the lateral and posterolateral margins of the IVD’s • typically undergo degeneration with resulting bony outgrowth which may encroach on neighboring structures such as the vertebral artery and the exiting spinal nerves Intervertebral Joints • • • • • • Secondary cartilaginous, symphysis, amphiarthrotic Designed for weight bearing and strength Articular surfaces of adjacent vertebra connected by IV discs and ligament No disc between C1 and C2 Intervertebral joint Intervertebral Disc - classified as a ligament by some authors 23 total from C2,3 to L5,S1 25% of the height of the vertebral column Lordotic curve areas - the disks are thicker (top to bottom) anteriorally Form inferior half of anterior wall of IVF Adherent to thin layers of hyaline cartilage which cover the surfaces of the vertebral bodies Attach to the anterior and posterior longitudinal ligaments and to the heads of ribs 2 - 9 Intervertebral Joints, cont. Components – Annulus fibrosus - peripheral portion, concentric rings of fibrocartilage, thicker anteriorally – Nucleus pulposus - 88% H2O at birth, 70% at age 70; more posterior placed; avascular Intervertebral Joints • • • • • • • • • • • Zygapophyseal Joints AKA Z-joint, facet joints, interlaminar joints, apophyseal joints Synovial, diarthrodial, plane (shape of the articular surfaces), gliding (surfaces glide on each other), uniaxial formed by the prezygapophysis (superior articular facets) and the postzygapophysis (inferior articular facets) of two adjacent vertebra. Paired Capsular ligaments - joint capsule Zygapophyseal Joints joint capsule is posterolateral anterior and medial aspect of the joint is covered by the ligamentum flavum presence of synovial folds in the joint which are pain sensitive – if these synovial folds become entrapped between articular facets, back pain could result Zygapophyseal Joints Movement of the “Z” joint Translation (linear) motion - movement of an object in a straight line Rotatory (angular) motion - movement of an object around a fixed axis in a curved path “Z” joint is capable of both depending on which vertebral segment is being considered. Spinous Process Articulation Syndesmosis of the spine Interspinous ligament - between spinous processes • • • • • • • Supraspinous ligament - connects tips of spinous processes from C7 - S1 (first sacral tubercle) Ligamentum nuchae - direct continuation of the supraspinous ligament, from EOP and median nuchal crest to C7 What about the ligamentum flavum, Anterior longitudinal ligament and the Posterior longitudinal ligament of the spine? Spinous Process Articulation Spinous Process Articulation Sacroiliac Joint Synovial, diarthrodial, gliding, plane, multiaxial Auricular surface of the sacrum (formed by the fused portions of the first 3 sacral vertebra) and the auricular surfaces of the ilium Articular cartilage on the iliac side is fibrocartilage Articular cartilage on the sacral side is hyaline cartilage In childhood the joint is multiaxial Sacroiliac joint, cont. After puberty the joint surfaces change their configuration and motion is restricted to anterior and posterior movement – becomes uniaxial Flexion (rotation) and extension (counter rotation) Sacroiliac joint, cont. • • • • • • • • • Ligaments: iliolumbar ligaments - TP’s of L4,5 to iliac crest sacroiliac ligaments - iliac crest to tuberosity of S1-4 sacrospinous ligaments - ischial spines to lateral border of sacrum and coccyx, forms inferior border of greater sciatic notch *sacrotuberous ligaments - ischial tuberosity to sacrum and coccyx, forms inferior border of lesser sciatic notch Temporomandibular Joint Synovial, diarthrodial, hinge, gliding, multiaxial, condyloid Components - articular disc fibrocartilage Articular surfaces lined with fibrocartilage Movement – depression and elevation - hinge – protraction and retraction - gliding – lateral rotation Ligaments – lateral ligament - prevents posterior displacement – stylomandibular - styloid process to ramus of mandible – sphenomandibular ligament - sphenoid bone to lingula Articular discs When two or move joint surfaces are incongruent, there is frequently an accessory joint structure that contributes to the overall contact of the two surfaces. These discs are made of fibrocartilage Present in the TMJ, Sternoclavicular joint, Knee and sometimes the acromioclavicular joint Temporomandibular Joint, lateral view Temporomandibular Joint, lateral view • • • • • • • • • Sternoclavicular Joint Only structural attachment of the scapula to the axial skeleton Synovial, diarthrodial, sellar, multiaxial Articular surfaces are flat to saddle shaped and covered with fibrocartilage and it acts like a ball and socket joint Movements: – elevation and depression of the clavicle – protraction and retraction of the clavicle – rotation of the clavicle There is an articular disc made of fibrocartilage that separates the joint into two compartments Sternoclavicular Joint Ligaments – provide strength so dislocations are rare Anterior sternoclavicular ligament - covers anterior aspect of the joint Posterior sternoclavicular ligament - covers posterior aspect of the joint Interclavicular ligament - attaches the two sternal ends Costoclavicular ligament - costal cartilage of the first rib to the costal tubercle Sternoclavicular Joint, anterior view Costochondral Joints and Costosternal Joints Ribs 2-7 articulate with costal cartilages (costochondral joints) and the cartilages articulate with the manubrium and the sternum (costosternal joints) Costosternal joints of ribs 2-7 - synovial joints, usually obliterate with aging. Rib one attachment to the manubrium - primary cartilaginous - synchondrosis - no synovial joint here Costovertebral joints • Synovial, diarthrodial, plane (capable of rotation and gliding), uniaxial • formed by the head of a rib and two demifacets of the adjacent vertebra, also includes a small portion with the interposed IVD • the 1st, 10th, 11th and 12th ribs articulate with one vertebral body only Costovertebral joints, cont. • Ligaments: – Radiate (stellate) ligament • 3 bands - superior and inferior that attach to the vertebral bodies and the intermediate which attaches to the IVD – Intra-articular ligament • on ribs 2-10 • head of rib to annulus between demifacets • divides synovial joint into two cavities Costotransverse joints • • • • • Synovial, diarthrodial, plane, uniaxial tubercle of rib and transverse costal facet allows for some rotation and gliding last 2 ribs have neither articular tubercles or form CT joints. Costotransverse ligaments – superior – medial and lateral Manubriosternal and Xiphisternal joints • Manubriosternal joint - symphysis – very similar to the symphysis pubis, sometimes called the “symphysis sterni” – ossification occurs in 10% of older adults – 33% of older women have a synovial lined cavity that exists secondary to resorption of the central portion of the fibrocartilaginous disc • Xiphisternal joint - synchrondosis – ossifies at 40-50 years of age Rule of Life If you think you can or can’t, you’re right! Glenohumeral Joint • Synovial, diarthrodial, ball and socket, spheroid, multiaxial • Components – head of the humerus and the glenoid fossa of the scapula, most freely moveable joint in the body • Ligaments coracohumeral ligament - coracoid process to greater tubercle of humerus glenohumeral ligament - thickenings of joint capsule transverse humeral retinaculum - from greater tubercle to lesser tubercle of humerus, holds bicipital tendon in place Glenohumeral Joint, anterior view Glenohumeral Joint, coronal section Glenohumeral joint, cont. • Protected from trauma from above by: – acromion, coracoid process, lateral aspect of the clavicle • Bursae – subdeltoid bursa - between deltoid m and joint capsule – subacromial bursa - between acromion and joint capsule • Rotator cuff muscles - musculotendinous cuff Supraspinatus m. - support from above Infraspinatus m. - support from posterior Teres minor m. - support from posterior Subscapularis m. - support from anterior Glenohumeral Joint, anterior view Muscles of the Rotator cuff Muscles that move the shoulder joint • Flexors: pectoralis major m., deltoid m. coracobrachialis m. biceps brachii m. • Extensors: latissimus dorsi m., triceps brachii m. • Abductors: deltoid m., supraspinatus m. • Adductors: pectoralis major m., latissimus dorsi m. • Medial rotators: subscapularis m., deltoid m. • Lateral rotators: infraspinatus m., teres minor m., deltoid m. Acromioclavicular joint • Synovial, diarthrodial, plane, gliding, uniaxial • Sometimes an intraarticular disc is present • Articular surfaces are covered with fibrocartilage • Movements – – – – very limited movement protraction and retraction elevation and depression primary function is to maintain the relationship of the clavicle and the scapula in the early stages of elevation of the upper limb The Elbow Joint • • • • • • • • • • • • • Humeroulnar and humeroradial joint Cubital joint - trochlea of humerus and trochlear notch of ulna and the capitulum of the humerus and the head of the radius Synovial, diarthrodial, ginglymus, hinge, uniaxial Ligaments – Radial (lateral) collateral ligament – Ulnar (medial) collateral ligament – Annular ligament - encircles the head of the radius Olecranon bursa - on posterior side of elbow The Elbow Joint The Elbow Joint, anterior view The Elbow Joint, lateral view Proximal Radioulnar Joint Formed by the head of the radius and the radial notch of the ulna Synovial Diarthrodial Trochoid, pivot Uniaxial Annular Ligament Proximal Radioulnar Joint, anterior view Metacarpophalangeal Joints Synovial, diarthrodial, biaxial Condyloid Interphalangeal Joints • • • • • Synovial, diarthrodial, uniaxial Hinge Joints of the hand, anterior view Symphysis Pubis Secondary cartilaginous, symphysis, amphiarthrosis Ends of pubic bones are covered with hyaline cartilage and separated by a disc of fibrocartilage Ligaments – superior pubic ligament - attaches pubic tubercles – inferior pubic ligament - inferior ramus – posterior ligament • • • • • • • • • • • • • The Coxal (Hip) Joint Formed by the head of the femur and the acetabulum of the os coxae Bears weight of the body Synovial, diarthrodial, ball and socket, spheroid, multiaxial Acetabular labrum - fibrocartilage The Coxal (Hip) Joint Ligaments of the hip Iliofemoral ligament - “Y” ligament of Bigelow • AIIS to intertrochanteric line, prevents hyperextension Pubofemoral ligament • pubis to intertrochanteric line, limits hyperextension and abduction Ischiofemoral ligament • ischium to greater trochanter, limits hyperextension Ligaments of the hip, cont. Round ligament - ligamentum teres - ligament of the head of the femur - ligamentum fovea capitis • intrinsic ligament, fovea capitis of femur to transverse acetabular ligament Transverse acetabular ligament • crosses the acetabular notch, connects joint capsule to ligamentum capitis femoris The Coxal (Hip) Joint, anterior view The Coxal (Hip) Joint, posterior view The Coxal (Hip) Joint, lateral view The Coxal (Hip) Joint, coronal section Tibiofemoral - Stifle Joint Largest and most complex joint of body, Synovial, diarthrodial, “modified hinge”, biaxial Classified as a double condyloid joint, capable of flexion, extension and medial and lateral rotation Hyperextension of knee foot on ground - medial rotation of femur foot not on the ground - lateral rotation of the tibia Tibiofemoral Joint, anterior view Ligaments of the knee Function: control excessive knee extension control abduction and adduction stresses control anterior and posterior displacement of tibia on femur control medial and lateral rotation of tibia beneath femur give rotatory stabilization Ligaments of the knee, cont. Lateral and medial patellar retinacula - tendinous insertion of quadriceps femoris m. Gives anterior stability. Attaches to patella and tibial tuberosity Ligaments of the knee, cont. Oblique popliteal ligament - posterior aspect of joint capsule, its is a tendinous expansion of the semimembranous m., provides posterior stability and limits hyperextension. Ligaments of the knee, cont. • Arcuate popliteal ligament - head of fibula over tendon of popliteus m. to intercondylar area of tibia and lateral epicondyle of femur. Limits hyperextension of knee. • Collateral Ligaments - provide medial and lateral stability – Medial (tibial) collateral ligament – Lateral (fibular) collateral ligament Tibiofemoral - Stifle Joint, anterior view Cruciate ligaments • Anterior cruciate ligament Anterior tibia to posterior medial aspect of the lateral condyle of the femur Prevents anterior displacement of the tibia on the femur During extension of the knee the ACL is pulled taut Torn ACL = Anterior drawer sign, tibia slides anterior in relation to the femoral condyles Cruciate ligaments, cont. • Posterior cruciate ligament Posterior tibia to lateral aspect of medial condyle of femur, prevents posterior displacement of the tibia. Shorter and less oblique than ACL During flexion of the knee the PCL is pulled taut Torn PCL = Posterior drawer sign, tibia slides posterior in relation to femoral condyles Bursa of the knee Anserine bursa - deep to tendons of insertion at pes anserinus Prepatellar bursa - between patella and skin (Housemaid’s knees) Suprapatellar bursa - between quadriceps tendon and anterior femur Menisci of the knee Medial meniscus - semicircular, attached to medial collateral lig. and to semimembranosus m. Lateral meniscus - 4/5’s of a circle, attached to posterior cruciate lig. And popliteus muscle via coronary lig. and posterior joint capsule. Talocrural (ankle) Joint • Synovial, diarthrodial, hinge, uniaxial • Ligaments – Deltoid • posterior tibiotalar ligament • tibiocalcaneal ligament • tibionavicular ligament • anterior tibiotalar ligament – Lateral collateral ligaments • anterior and posterior talofibular ligament • calcenofibular ligament Talocrural (ankle) Joint Talocrural (ankle) Joint Review of Joint Classification Classify joints according to type of material that holds them together. 1) Fibrous joints - AKA synarthrosis, held together by FCT. 3 types: – suture – syndesmosis – gomphosis Review of Joint Classification 2) Cartilaginous joints, 2 types: – Primary Cartilaginous Joint - synchondrosis • epiphyseal plate • costochondral joints – Secondary Cartilaginous Joint - symphysis • symphysis pubis • intervertebral joint • manubriosternal joint Review of Joint Classification 3) Synovial joints, AKA diarthrosis – these joints have specific criteria, ie. • Joint capsule, Synovial membrane, Synovial Fluid • Articular cartilage, Joint cavity • Terms such as type of movement - uniaxial, biaxial, and multiaxial only apply to synovial joints • Terms such as hinge, ball and socket, saddle, condyloid, trochoid, plane, gliding, etc only apply to synovial joints • • • • • • • • • • • • • • • • The “syns” of joints syn - Greek for joined, with or together; union synarthrosis - two bones that form the joint are joined together synostosis - joined with bone syndesmosis - joined with a ligament synchondrosis - joined with cartilage symphysis - a growing together synovial - joined and egg (refers to the joint fluid) Terms Related to Joint Pathology Strain - stretched or pulled tendon or ligament Sprain - hyperextension, with tearing of tendons or lig. Luxation - derangement of the articulating bones that compose a joint Subluxation - partial dislocation of a joint Bursitis - inflammation of a bursa Tendonitis - inflammation of a tendon Osteoarthritis - degenerative joint disease Rheumatoid arthritis - an autoimmune disease Gouty arthritis - abnormal accumulation of uric acid 1) define amphiarthrosis and know which joints would be classified as amphiarthrotic joints 2) know the definitions of the vocabulary words given to you in class 3) what is the difference in a primary verses a secondary cartilaginous joint 4) what criteria make a fibrous joint a fibrous joint? 5) know which types of joints are uniaxial, biaxial and multiaxial; ie. hinge joints are uniaxial 6) which classification apply to the zygapophyseal joint 7) which classification apply to the intervertebral joint 8) know examples of each kind of joint discussed in class; ie. which joints would be classified as condyloid joints? 9) know the classifications that apply to each of the major joints of the body we discussed in class; for example there will be questions that say something like, “which of the following classifications apply to the atlantooccipital joint?” 10) what are the clinical signs of a dislocated glenohumeral joint? 11) know the ligaments of the cervical spine 12) what is the joint of Luschka? What classifications apply to this joint? 13) know the information discussed concerning the IVD 14) what is a syndesmosis? 15) know the classifications that apply to the TMJ 16) what is an articular disc? 17) classify the sternoclavicular joint 18) what criteria must be present for a joint to be classified as a synovial joint? 19) what is the transverse humeral retinaculum? 20) what is the significance of the subacromial and subdeltoid bursae? 21) know the classifications that apply to the coxofemoral joint 22) know the ligaments, their attachments and their function of the ligaments of the coxofemoral joint 23) know the classifications that apply to the knee joint 24) know the attachments of the cruciate ligaments and their function and clinical signs of a torn ACL or a torn PCL 25) know the ligaments and retinacula of the knee of the functions of each 26) know the movements of the knee and explain rotation of the knee joint 27) be able to define the terms associated with joints, ie. snyarthrosis, synchondrosis, etc. • • • THE END STUDY EVERYDAY START MUSCLES Review for Exam 1) know your vocabulary words 2) know your prefixes and suffixes and word roots 3) What plane divides the body into right and left parts, superior and inferior parts, front and back parts? 4) Define, flexion, extension, inversion, eversion, circumduction, dorsiflexion, plantar flexion, rotation, elevation, depression, protraction, retraction. 5) What are the components of an osteon? 6) define popliteal, cubital, manus, plantar, palmar, etc. 7) Differentiate intramembranous from endochondral ossification. 8) Which fontanel closes first and which one closes last? 9) List the sutures of the skull and their location? 10) Where is the bregma, asterion, pterion, lambda? 11) What runs through the supraorbital foramen? 12) What runs through the stylomastoid foramen? 13) What runs through the optic canal? 14) What runs through the superior orbital fissure? 15) What runs through the foramen ovale? 16) What runs through the jugular foramen? 17) What runs through the foramen rotundum? 18) Where is the EOP?What else is it called? 19) Which bones do not touch the sphenoid bone? 20) What are the primary, secondary curves of the spine? 21) What are the components of the neural arch? 22) What is the falx cerebri? Where does it attach rostrally? 23) What is the sella turcica? Where is it and what are its components? 24) Where is the first IVF/ IVD? 25) List the atypical vertebra. 26) What are the boundaries for the vertebral foramen? 27) What structures are unique to cervical, thoracic, lumbar vertebra? 28) Which vertebra have transverse foramen? 29) What is the neural ring? 30) How many IVD’s are there in the adult? 31) How many articular surfaces present on C1, C2, T1, T11, L1 ? 32) Which vertebra have names? 33) What is an uncinate process? 34) How many ribs articulate with T1, T6, T12? 35) Attachments for the nuchal ligament? 36) Describe the orientation of the articular facets on thoracic vert., lumbar vert. 37) How many ribs articulate with the manubrium? 38) Describe the anterior long. lig., the post. long lig., lig flavum, interspinous lig., ligamentum nuchae. 39) List the fossae of the scapula and tell their location. 40) What is a costal groove and where is it? 41) Name the carpal bones, which ones articulate with the radius? 42) Name the bones that form the acetabulum? 43) Where is the greater tubercle of the humerus? 44) Where is the base of the patella? How to tell right from left? 45) How many phalanges are there in the hand? 46) Give examples of fibrous joints. 47) Classify the intervertebral joint and give its components. 48) Attachments for the anterior atlanto-occipital membrane. 49) Differentiate between a primary and a secondary cartilaginous joints. 50) Describe the movement of the knee. 51) List the ligaments of the hip and tell their function. 52) Describe the attachments for the cruciate ligaments. 53) Describe the cruciate ligaments of the cervical region. 54) Classify the uncovertebral joint. 55) What are the components of an IVD? 56) Describe the TMJ. 57) Define synostotic and which joints commonly become synostotic 58) Classify and describe the elbow joint. 59) What are the deltoid ligaments of the tarsus? 60) Classify and describe the shoulder joint.