Download The Skeletal System

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The Skeletal System
How will knowing and understanding the bones of the body help me to be a better chiropractor?
Allow you to read and understand radiographs
Allow you to understand the attachment of muscles
Allow you to understand the relationship of how the body’s parts coordinate during movement:
biomechanics
Allow you to understand boney relationships: of subluxations
Allow you to understand boney contact points for adjustments
Allow you to understand osseous pathology; fractures
Allow you to visualize osseous (vertebral) listings
What you need to know
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Difference in axial and appendicular skeleton and components of each
Functions of the skeletal system
Osseous terminology
Shapes of bones
Structure of a typical long bone and bone cells
Physiology of bone and calcium metabolism
Organization of the Skeletal System
The Axial Skeleton
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The Skull - cranial and facial bones
Auditory Ossicles - 6 total bones
Hyoid Bone - located above the larynx
Vertebral Column - 26 bones in the adult
Rib Cage/Sternum
The Appendicular Skeleton
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Pectoral Girdle - scapula and clavicles
– cingulum membri superioris - girdle - articulates with sternum and vertebral column
Upper Extremities - humerus, radius, ulna, carpal bones, metacarpals and phalanges
Pelvic Girdle - 2 ossa coxae, cingulum membri inferioris - articulates with sacrum
Lower Extremities - femur, tibia, fibula, tarsal bones, metatarsals and phalanges
Functions of the Skeletal System
1) Support - rigid framework
2) Protection
3) Body Movement - levers
4) Provide an Anchoring Point for Muscles
5) Calcium/Phosphorus metabolism
6) Hematopoiesis
Osseous Terminology
Condyle - a large rounded projection or knob
Epicondyle - a projection located superior to a condyle
Tubercle - a small rounded process
Head - a prominent rounded articulating bone end
Sulcus - a groove
Crest - a narrow ridge like projection
• Facet - a flattened or shallow articulating surface
• Tuberosity - a large roughened process
Terminology, cont.
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Alveolus - a deep pit or socket
Foramen - a hole or rounded opening
Fissure - a narrow slit like opening
Sinus - a cavity or hollow space in a bone
Spine - a sharp slender process
Fossa - a flattened or shallow surface, depression
Process - any boney protuberance
Trochanter - a massive process, on the femur
Shapes of Bones
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Long Bones - longer than wide
Short Bones - somewhat cube shaped
Flat Bones - cranial bones, ribs, scapula
Irregular Bones - vertebrae and certain bones of the skull
Accessory Bones - extra bones
Wormian Bones - sutural bones
Structure of a Typical Long Bone
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Shaft - Diaphysis
– a) Periosteum - dense regular connective tissue
• 1) Sharpey’s fibers - connect periosteum to bone
Epiphysis - spongy bone on each end of the diaphysis
– a) Epiphyseal plate - growth center
– b) Articular cartilage - hyaline cartilage
– c) Red Marrow - hematopoiesis
Medullary cavity - central cavity within the diaphysis - lined with endosteum and filled with fat (yellow
marrow)
Bone Cells
Osteogenic cells - in periosteum and endosteum, can become blast or clasts
Osteoblasts - lay down osteoid
Osteocytes - mature bone cells, reside in lacunae, regulate calcium release into blood stream
Osteoclasts - break down bone
Bone-Lining cells - derived from osteoblasts along the surface of most bones, reg. Ca/P movement
Spongy and Compact Bone
Spongy Bone - trabecular bones, located deep to compact bone.
Compact Bone - forms external portion of bone, very dense, composed of cylindrical columns of bone.
– Haversian System - osteon
• Lamellae - concentric rings of bone
• Central Canal - contains artery, vein and lymphatics
• Lacunae - spaces where osteocytes reside
• Canaliculi - small channels which connect lacunae
• Perforating canals - Volkmann’s canals
Bone Growth
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Endochondral Ossification - long bones, etc.
Intramembranous Ossification - flat bones
Homeostasis and Physiologic Function of Bone
• Hematopoiesis
• Calcium Storage and Release
– Function of Calcium
• Blood clotting
• Nerve transmission
• Muscle contraction
– Control of Calcium Levels in the Blood
• Bone
• Kidney
• Parathyroid Glands
• Diet/GIT
Disorders of Calcium Metabolism
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Hypocalcemia - tetany
pH is proportional to HCO3/CO2
Hypercalcemia
Essential Nutrients for Bone Development
– calcium, phosphorus, magnesium
– Vit D - absorption of Ca
– Vit. A - osteoblast function
– Vit C - necessary for osteoid synthesis
– protein
The Axial Skeleton
What you need to know
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The divisions of the skull and the bones of each
The relationship of the fontanelles (and their adult counterparts) to the sutures of the skull
The bones of the skull and their relationship to each other
The anatomic structures found on each bone of the skull
The openings in the skull and what structures pass through each
Bones that form the orbit
Branches of the trigeminal nerve and openings its branches pass through
The Skull
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Divisions of the Skull
– a) Cranial Bones - 8 bones in all
• 1) Cranial Cavity - where the brain is
– a) Calvaria - roof of the cranial vault
– b) Cranial fossa - floor of the cranial cavity
– b) Facial bones - 14 bones are not in contact with the brain. All paired except for vomer and mandible
Fontanels
Anterior - Frontal - closes by 18-24 months, becomes the bregma
Posterior - Occipital, closes by 2 months - becomes the lambda
Anterolateral - Sphenoidal - closes by 3 months of age, becomes the pterion
Posterolateral - Mastoid - closes by 1 year of age, becomes the asterion
Fontanels
Fontanels
Sutures
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Sagittal Suture
Coronal Suture
Lambdoidal Suture
Squamous Suture
Metopic Suture - extends from anterior fontanel
rostrally to the glabella, closes by age 6 years
Sutures
Sutures
The Cranial Bones
Frontal Bone
Frontal Squama - flattened portion of the forehead
Supraorbital Margin - arch, ridge
Supraorbital foramen - supraorbital nerve
Roof of the orbit
Supracilliary Ridge - deep to eyebrow
Glabella - most forward projecting
part of head, AKA mesophryon,
antinion, intercilium
Metopic Suture
Bregma
Frontal Sinus
Frontal Squama - flattened portion of the forehead
Supraorbital Margin - arch
Supraorbital foramen - supraorbital nerve
Roof of the orbit
Supracilliary Ridge - deep to eyebrow
Glabella - most prominent point in the midsagittal plane between the eyebrows,
AKA mesophryon, antinion, intercilium, means smooth, hairless.
Metopic Suture
Bregma
Frontal Sinus
Parietal Bones
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Coronal Suture
Sagittal Suture
Parietal Foramina - emissary veins
Temporal Lines - origin of temporalis m.
Coronal Suture
Sagittal Suture
Parietal Foramina - emissary veins
Temporal Lines - origin of temporalis m.
Temporal Bones
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Squamous Suture
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Squamous Portion
– a) zygomatic process
– b) mandibular fossa
– c) groove for the middle temporal artery
Tympanic Portion
– a) external acoustic meatus - ear canal
– b) styloid process
Temporal bone
Temporal bones, cont.
• Mastoid Portion
– a) Mastoid process
– b) Mastoid foramen
– c) Stylomastoid foramen - CN VII
– d) Mastoid sinus
• Petrous portion
– a) Groove for the Sigmoid Sinus
– b) Carotid canal - internal carotid artery
– c) Bones of the middle ear - malleus, incus, stapes
– d) internal acoustic meatus - CN VII and VIII
– e) Jugular foramen - CN IX, X, XI, internal jugular v.
Temporal bone
Temporal bone
Temporal portion
Occipital Bone
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Lambdoid Suture
Foramen magnum - SC, CN XI, Vertebral aa., meninges
Occipital condyles
Hypoglossal canal - CN XII
Condyloid canal - emissary veins
External occipital protuberance - inion
Nuchal lines
Clivus - from dorsum sellae to foramen magnum
Pharyngeal Tubercle
Groove for the Transverse Sinus
Occipital bone - lambdoidal suture
Occipital bone
Occipital bone
Occipital bone
Sphenoid Bone - the wedge
• Greater wing
– Groove for the middle meningeal artery
• Lesser wing
– Anterior clinoid process
• Body
– sphenoidal sinus
– jugum
– Chiasmatic groove
– Groove for the internal Carotid a.
Greater wing
Lesser wing
Body of the sphenoid bone
Sphenoid Bone, cont., The Sella Turcica
Sphenoid Bone, con’t.
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Pterygoid Plates - lateral wall of nasal cavity
Optic canal - CN II
Superior Orbital Fissure - CN III, IV, VI and V1 (ophthalmic division of CN V)
Foramen Rotundum - V2 - maxillary div.
Foramen Ovale - V3 - mandibular div.
Foramen Spinosum - middle meningeal a.
Pterygoid processes
Sphenoid bone, cont.
Sphenoid bone
Ethmoid Bone
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Perpendicular plate
Ethmoidal air cells - ethmoid sinus
Crista Galli - anterior attachment for falx cerebri
Superior and Middle Nasal Conchae - AKA turbinates
Cribriform Plate - CN I
Ethmoid bone
Ethmoid bone
Ethmoid bone
Success principle #4
The way to get an ambition, desire, or love to become part of your Mission, Talent or Destiny (MTD) in life is
thought + action = feeling.
Innate always executes, or carries out, your FEELINGS. This is an INFALLIBLE LAW!!!!
Facial Bones
Maxilla
• Alveolar Process - area around alveolus
• Palatine Process - Horizontal Plate - Hard Palate
• Median Palatine Suture
• Incisive Foramen - Nasopalatine nerve
• Infraorbital Foramen - branch of V2
• Maxillary Sinus
• Frontal Process
• Zygomatic Process
• Intermaxillary suture (closure)
• Inferior Orbital Fissure - V2
Maxillary bones
Maxillary bones, cont.
Palatine Bones
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Horizontal Plate - posterior 1/3 of hard palate
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Greater Palatine Foramen
Lesser Palatine Foramen
Palatine bones
Zygomatic Bones
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Temporal Process
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Zygomaticofacial Foramen - Zygomatic n.
Zygomatic bones, cont.
Lacrimal Bones
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Lacrimal Sulcus
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Nasolacrimal Canal
Lacrimal bones
Facial bones, cont.
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Nasal Bones
– Internasal Suture
Inferior Nasal Conchae
Vomer Bone
– Inferior portion of the nasal septum
– Does not touch the occipital bone
Nasal Bones
Inferior Nasal Conchae
Vomer Bone
Mandible
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Jawbone - to chew - only movable bone in the
Body
– symphysis menti - fuses at 1-2 years of age
– mental (chin) protuberance
– mental tubercle
– mental foramen - mental nerve - branch of V3
Angle of the mandible
skull
Mandible, cont.
Mandible, con’t.
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Ramus
– condylar process
• head
• neck
• pterygoid fossa
– Coronoid (crow’s beak) process
– Mandibular notch
– Mandibular foramen - inferior alveolar nerve
– Lingula
Mandible, cont.
Hyoid Bone
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Body
Greater Cornu (Horn)
Lesser Cornu - stylohyoid ligament
Hyoid bone, cont.
Last Time we talked about
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The bones of the skull
– The fontanels
– The sutures of the skull
– The bones of the cranial vault
– The bones of the face
Bones Which Form the Orbit
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Frontal Bone
Ethmoid Bone
Sphenoid Bone
Maxillary Bone
Lacrimal Bone
Zygomatic bone
Palatine Bone
Bones Which Form the Orbit
Auditory Ossicles
Three small paired bones within the middle ear cavity of the petrous portion of the temporal bone
malleus - hammer - touches the tympanic membrane
incus - anvil
stapes - stirrup
Bones Which Enclose the Nasal Cavity
Ethmoid Bone
Frontal Bone
Maxilla
Palatine Bone
Nasal Bone
Sphenoid bone
Bones which do not touch the sphenoid bone
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There are 13 of them and they are………..
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Hint - they are all paired except one (this list does not include the hyoid bone)
Holes in the Skull
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Supraorbital foramen - supraorbital nerve
Cribriform plate - Olfactory nerve (CN I)
Optic canal - Optic nerve (CN II)
Superior orbital fissure - CN III, IV, VI and V1
Foramen rotundum - Maxillary nerve (V2)
Foramen ovale - Mandibular nerve (V3)
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Foramen spinosum - middle meningeal vessels
Foramen lacerum - loop of internal carotid artery
Holes in Skull, cont.
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Carotid canal - internal carotid artery
Internal acoustic meatus - CN VII and CN VIII
Stylomastoid foramen - CN VII
Jugular foramen - CN IX, X and XI, and sigmoid sinus
Hypoglossal canal - CN XII
Foramen magnum - Spinal cord, meninges, vertebral arteries, spinal roots of CN XI
Holes in Skull, cont.
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Greater palatine - greater palatine nerve
Incisive foramen - nasopalatine nerve
Inferior orbital fissure - maxillary div. of CN V
Mandibular foramen - inferior alveolar nerve
Mental foramen - mental nerve
Nasolacrimal canal - nasolacrimal (tear) duct
Zygomaticofacial foramen - zygomaticofacial n.
Branches of the trigeminal nerve
V1 - ophthalmic division - superior orbital fissure - supraorbital foramen (supraorbital n.); (supratrochlear,
infratrochlear, external nasal, lacrimal nn.)
V2 - maxillary division - foramen rotundum - infraorbital fissure - zygomaticofacial foramen (n.);
infraorbital foramen (n.); greater and lesser palatine foramen (nn.).; incisive foramen (nasopalatine n.)
V3 - mandibular division - foramen ovale - mandibular foramen (inferior alveolar n.) - mental foramen (
mental n.); (auriculotemporal, buccal nn.)
The Vertebral Column
What you need to know
The vertebral formula
The curves of the spinal column
Anatomic structures of a typical vertebra
Anatomic structures of cervical, thoracic, lumbar and sacral vertebra and their location on the vertebra and
the unique characteristics of each vertebral region
Components of and structures that pass through the IVF
Joints of the spinal column and what forms each joint
Ligaments of the spinal column, their location and attachments
The Vertebral Column
Functions
– Support and Weight Bearing
– Provide attachments for muscles
– Protection of Spinal Cord
– Permit passage of spinal nerves
– Motion
– Shock absorption
Human Vertebral Formula
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C7, T12, L5, S5, Cy 3-6
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Spinal Curves
– Primary Curves - present at birth - kyphotic - posterior curves - thoracic and sacral
– Secondary Curves - develop at 3 months of age and as baby begins to stand erect - Lordotic - anterior
curves - cervical and lumbar
Vertebral Column
Disorders and Injuries
A typical vertebra
Structure of a Typical Vertebrae
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Body - weight bearing portion
Neural Arch = 2 pedicles + 2 lamina
– pedicles
– Lamina
– Pars interarticularis
– Part of the lamina
between the two articular processes
Structure of a Typical Vertebrae
Structure of a Typical Vertebrae
• Intervertebral foramen - ovoid holes formed by the superior vertebral notch of one vertebra and the inferior
vertebral notch of the superior vertebra.
– Flexion verses extension
– First pair between C2 and C3, and last one between L5 and S1
The IVF
• Boundaries of the IVF:
– the pedicle of the vertebra above
– the vertebral body of the vertebra above
– the IVD
– the vertebral body of the vertebra below (in cervical region this includes the uncinate process)
– the pedicle of the vertebra below forms the floor
– the Z-joint forms the posterior wall
Structures of the IVF
The IVF
• Structures that traverse the IVF
– the spinal nerve
– the dural root sleeve (attaches to the boundaries of the IVF and become continuous with the epineurium at
the lateral border of the IVF)
– lymphatic channels
– the spinal ramus of a segmental artery (radicular artery)
– intraforaminal venous plexus
– two to four recurrent meningeal nerves
Structure of a Typical Vertebrae, cont.
• Vertebral foramen - neural ring
– Vertebral canal - neural rings all stacked together
– Boundaries
• posterior portion of the vertebral body
• vertebral arch
Structure of a Typical Vertebrae, cont.
• Shape of neural ring
– cervical, lumbar and sacral regions - triangular
– thoracic region - circular, smallest
Structure of a Typical Vertebrae, cont.
• Transverse process - from lamina-pedicle junction
Structure of a Typical Vertebrae, cont.
• Superior and Inferior Articular processes
• Articular facets
Primary Ossification centers of vertebra
• Each typical vertebra has 3 primary ossification centers
– Centrum – accounts for most of the body
– each half of the neural arch
• Neurocentral joints (see page 448)
– primary cartilaginous joints
– articulation between the halves of the neural arch and the centrum
• Vertebral arch
– cervical - fusion begins during first year
– lumbar - complete by 6 years
– the arch fuses to centrum 5-8 years of age
Secondary Ossification centers of vertebra
• 5 Secondary Ossification centers develop during puberty in each typical vertebra
– tip of spinous process
– tip of each transverse process
– 2 annular epiphyses (ring epiphyses) - one on superior and one on inferior edge of the centrum
• unite with vertebral body in early adulthood
• Secondary ossification centers become fused by age 25
• Lumbar vertebra have secondary ossification centers for mammillary processes as well
Ossification centers for other vertebra
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The atlas
– Primary center for each lateral mass and adjacent half of the posterior arch
– Primary center for the anterior arch
– Fusion occurs by age 8
Ossification Center for other vertebra
The Axis
– 5 Primary centers
• One for most of the body
• One for each lateral mass
• One for each half of the dens and adjacent part of the body
• They fuse by three years of age
– 2 Secondary centers
• The tip of the dens – appears at 2 years of age – fuses by age 12
• Lower surface of the body – appears at puberty and fuses by age 25
Other Ossification centers
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The Sacrum
– Represents 5 fused vertebra
– Many ossification centers – centrum, neural arches, etc.
– Fused by age 20
Costal elements of vertebra
• Parts of cervical, lumbar and sacral vertebra represent the ribs that articulate with thoracic vertebra
• Cervical – anterior and posterior tubercle and costotransverse bar
• Thoracic – true ribs
• Lumbar – anterior portion of the transverse process
• Sacral lateral portion to include the auricular surface
Joints of the Spine
• Zygapophyseal Joint - facet joint, a synovial joint
• formed by the inferior articular facet of the superior vertebra and the superior articular facet of the inferior
vertebra.
Intervertebral Joint - symphysis, amphiarthrotic
• IVD - intervertebral disc
– 23 in total - first one between C2 and C3, last one L5 and S1
– Function
• shock absorption
• attach vertebral bodies together
• form secondary curves to the vertebral column
• form anterior wall of the IVF (intervertebral foramen)
Intervertebral disc
• Components - nucleus pulposus and annulus fibrosus
Cervical Vertebrae
Cervical vertebra
• Designed to support and allow movement of the head
• They are the smallest of the 24 moveable vertebrae
• Their alignment is curved in an anterior direction to aid in shock absorption
• Vertebral foramen is large and triangular shaped
Cervical vertebra
• All have a transverse foramen
• Superior surface of vertebral body is concave and inferior surface is convex
• 3 are considered atypical (C1, C2 and C7)
• 4 are considered typical (C3,4,5,6)
• All mammals have 7 cervical vertebrae except 3
The Atlas, C1
• A ring shaped bone
• An atypical cervical vertebra
• Lateral mass - 2 - no body
The Atlas, C1
• Superior and Inferior Articular processes and facets (the facets sit on the processes)
The Atlas, C1
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Anterior Arch
– anterior tubercle
– articular facet for the dens
The Atlas, C1
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Transverse process
– transverse foramen
– costotransverse bar - intertubercular bar
– anterior and posterior tubercles
The Atlas, C1
• Posterior Arch
– groove for the vertebral artery
– posterior tubercle
The Atlas, C1, inferior view
The Atlas, C1, superior view
Axis, C2, Epistropheus
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The strongest of the cervical vertebra
The skull rotates on it when a person shakes their head no
Has a tooth like projection called the dens
Axis, C2, Epistropheus
• Odontoid process - dens
– Anterior Articular Facet for the Atlas
– Posterior Articular Facet for the Transverse Ligament of the Atlas
– attachments for the alar ligaments on lateral aspects
Axis, C2, Epistropheus
• Lateral Mass
Axis, C2, Epistropheus
• Body - lip on anterior surface that overlaps superior surface of the body of C3
Axis, C2, Epistropheus
• Bifid Spinous process - can palpate 2 inches below the EOP
Axis, C2, Epistropheus, anterior view
Axis, C2, Epistropheus, posterior view
Facts about Cervical Vertebrae
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Typical Cervical Vertebrae - C3,4,5,6
– Bifid Spinous process
– Transverse foramen
Atypical Cervical Vertebrae - C1,2,7
First IVF - between C2 and C3
First IVD - between C2 and C3
Facts about Cervical Vertebrae
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Uncinate process
– hook shaped process on the lateral borders of the superior surface of the bodies of C3-C6 (T1)
– prevents posterior linear movement (translation) of the vertebral bodies and limits lateral flexion
Typical cervical vertebra C3,4,5,6
C7
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Vertebral Prominens
transverse processes do not posses a costotransverse bar
the vertebral artery does not go through the transverse foramen, but the accessory vertebral vein does
no anterior lip to overlap T1
C7
Success principle #5
Innate will carry out whatever you demand with faith; you prove faith by actions.
Thoracic Vertebrae
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Also called Dorsal vertebrae
Humans have 12; 2-8 are typical
Spinous process are long and slender and directed inferiorly
Costal Facets - where ribs articulate, most have 3 on each side
Surfaces of the articular process are aligned on a frontal plane
T1, 9, 10, 11 and 12 are atypical
Thoracic Vertebrae
Thoracic Vertebrae
Thoracic vert., cont.
• All have transverse costal facets except T11 and T12
• Bodies have whole facet or 1/2 facet called a demifacet
• T1 has a whole superior facet and an inferior demifacet and articulates with the first and second rib
respectively
• T2-T8 have 2 demifacets on each side of their bodies.
• T9 has a single superior demifacet on each side
• T10, T11 and T12 have whole facets on either side of their bodies. Each articulate with only one pair of ribs
Costovertebral joint
Costovertebral joint
Atypical thoracic vertebrae
• T1 - articulates with rib 1 and 2
• T9 - may have no demifacets and articulate with rib 9, or it may have superior and inferior demifacets and
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articulate with 2 ribs
T10 - has only a full pair of facets, rib 10
T11 - has only a full pair of facets, no transverse costal facets, short spinous process, articulates with rib 11
T12 - no transverse costal facets, articulates with rib 12, inferior articular facets face laterally
Thoracic Vertebrae, T12
Lumbar Vertebrae
Mamillary processes - on superior facets
Accessory processes - on inferior base of TP
Lumbar Vertebrae
The surfaces of the articular facets are oblique to a sagittal plane - superior facets are concave and face
posteromedial, inferior facets are convex and face anterolateral
Lumbar Vertebrae
• Have massive bodies
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Lumbar Vertebrae
L5 - largest circumference but not as thick as other lumbars, atypical as it has a wedge shaped body (anterior
portion of body is of greater height than the posterior region
The Sacrum
Auricular surface
Sacroiliac joint
Median Sacral Crest (fused spinous processes)
Anterior and Posterior Sacral Foramina (IVF’s)
Sacral Canal (neural canal)
Superior articular process
Sacral Tuberosity
Transverse lines (where the IVD’s were)
Sacral Promontory
Lateral masses
Complete ossification by 18-25 years of age
The Sacrum, anterior view
The Sacrum, posterior view
Identify the vertebra
Identify the vertebra
Identify the vertebra
Identify the vertebra
Ligaments of the Spine
Anterior Longitudinal Ligament
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anterior aspect of vertebral bodies and IVD
axis to first sacral segment
Posterior Longitudinal Ligament
• attaches axis (continuous with the Tectorial membrane) to the first sacral segment
• inside of the neural canal
• attaches body to body and IVD’s
Interspinous Ligament
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connects adjacent spinous processes
Supraspinous Ligament
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attach the tips of the spinous processes, C7 to S1
Ligamentum Nuchae
• superior continuation of the supraspinous ligament
• triangular in shape
• attaches to the EOP and the median nuchal line, posterior tubercle of the atlas, and spinous processes of the
cervical vertebrae to C7
Ligamentum Flavum
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connects adjacent lamina, one on each side, elastic ligament
Rib cage and sternum
What you need to know
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The different names for the manubriosternal joint
The components of the sternum
How many costal facets on the sternum
How to tell an right from a left rib
The different classifications of ribs
The anatomic components of a rib
How many ribs articulate with the various parts of the sternum
How the ribs articulate with the thoracic vertebra
The Rib Cage
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Sternum, 3 parts
– Manubrium
• Jugular notch
• clavicular notch
• costal notch
• manubriosternal joint - sternal angle, Angle of Louis
– Body of the Sternum
• Costal notches
– Xiphoid Process
Ossification Center for the sternum
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Number of primary centers varies
– Manubrium – usually has one or two
– Body 4- 6 centers
– Fusion occurs between puberty and age 25
– “Bullet Holes” in the sternum (sternal foramina) may occur with incomplete fusion
Sternum
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Manubrium
– Jugular notch
– Clavicular notch
– Costal notch
– Manubriosternal joint
Body of the Sternum
– Costal notches
Xiphoid Process
Costal Margin - fusion of cartilage of ribs 8,9,10
Costal Angle - formed by the 2 costal margins
How many ribs articulate with the …...
Ribs
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12 pairs of ribs
Ribs 1 thru 7 - Vertebrosternal (True) ribs
Ribs 8 thru 10 - Vertebrocondral (False) ribs
Ribs 11 ans 12 - Floating ribs - no tubercle
Components of a typical rib
– Head Body Tubercle
Costal groove
Costochondral joint
• Ribs – ossification centers
– Primary ossification center for the body
– Secondary center for the head and tubercle (2)
– Unites by age 20
Neck Intercostal space
Angle
Ribs
The Appendicular Skeleton
What you need to know
• How to tell right from left in the bones of the appendicular skeleton
• The anatomic structures of the bones of the appendicular skeleton
• How the bones of the appendicular skeleton relate to each other anatomically
The Pectoral Girdle
The Clavicle - Collar Bone
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Acromial Extremity - lateral end
Sternal Extremity
The Clavicle - Collar Bone
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Acromial Extremity - lateral end
– Conoid Tubercle - coracoclavicular ligament
Sternal Extremity
– Costal Tuberosity - costoclavicular ligament
Groove for the Subclavius muscle
The Scapula
• Spine of the scapula
– acromion - lateral end of spine
• Fossae of the Scapula
– supraspinous fossa - supraspinatus m.
– infraspinous fossa - infraspinatus m.
– subscapular fossa
The Scapula
• Glenoid cavity
– supraglenoid tubercle - long head of biceps brachii m.
– infraglenoid tubercle - long head of triceps brachii m.
• Coracoid process - 3 muscles attach here
The Scapula, cont.
• Margins (borders) of the scapula
– lateral border (axillary margin)
– medial border (vertebral margin)
– superior border
• suprascapular notch - scapular notch - suprascapular nerve
The Scapula, cont.
• Angles of the Scapula
– inferior angle
– medial angle
– superior angle
• Neck
• Overlies ribs 2-7, 15 muscles attach to the scapula
The Humerus
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Head
Anatomic neck vs. surgical neck
Greater tubercle
Lesser Tubercle
Intertubercular groove
The Humerus
• Deltoid Tuberosity
• Radial groove - spiral groove - musculospiral groove - radial nerve
• Medial epicondyle - flexors of carpus and digits, groove for the ulnar nerve on posterior surface
The Humerus, cont.
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Lateral epicondyle - extensor muscles of the carpus and digits
Medial and lateral supracondylar crests
Trochlea
Capitulum
Coronoid fossa
The Humerus, cont.
• Trochlea
• Olecranon fossa
The Ulna
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Semilunar notch - trochlear notch
Coronoid process
Ulnar tuberosity
Radial notch
Styloid process
Interosseous margin
The Ulna
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Olecranon process
Posterior border of ulna
The ulna, anterior view
The Radius
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Head
Radial tuberosity
Styloid process - broken off in Colles fracture
Ulnar notch
The Radius
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Grooves on the posterior surface
– groove for ECRL and ECRB mm.
– dorsal tubercle
– groove for the Ex Pollicis Longus m.
– groove for the Ex Dig. And Ex. Indicis mm.
The distal end of the radius
The Carpus
• Proximal Row of Carpal Bones - medial to lateral
– Pisiform - sesamoid bone in the tendon of FCU m.
– Triquetral - triangular bone
– Lunate - articulates with radius
– Scaphoid bone - navicular bone, articulates with radius
• Distal Row - medial to lateral
– Hamate bone - hamulus
– Capitate - Os Magnum
– Trapezoid - Lesser multangular
– Trapezium - Greater multangular
The carpal bones, palmar view
The carpal tunnel
Metacarpal Bones and Phalanges
The Pelvic Girdle
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Formed by two Ossa Coxae - hip bones
Greater pelvis (false) - superior to pelvic brim
Lesser (true) pelvis - inferior to brim of pelvis
Pelvic Brim
Pelvic Inlet
Subpubic angle
The Pelvis
Bones of the Pelvis
Ilium
• External surface
• Iliac crest
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– anterior superior iliac spine and anterior inferior iliac spine
– posterior superior iliac spine and posterior inferior iliac spine
Gluteal Lines
Iliac Fossa
Greater Sciatic Notch
Auricular Surface for the sacrum
Iliac tuberosity
Inguinal ligament - pubic tubercle to ASIS
The Ilium, lateral view
The Ilium, medial view
Pelvic Rotation Affects
Leg Length
Ischium
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Spine of the Ischium
Ischiatic tuberosity
Lesser Sciatic Notch
Body
Ramus of the Ischium
The Ischium, lateral view
Success principle #6
Nature will give you what you act like you already have! To become, act as if.
Pubis
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Superior Pubic Ramus
– pubic tubercle
– pecten pubis
– obturator groove
Inferior Pubic Ramus
Symphysis
The pubic bone, lateral view
The Pelvis, cont.
• Obturator Foramen
• Acetabulum
– acetabular notch
– acetabular fossa
– lunate surface
• Sex related differences in the pelvis
– Female pelvic brim is more circular – male is more heart shaped
– Female sacrum is wider, shorter and les curved
– Female ischial spines are further apart
– Subpubic angle is female is 90-120 degrees and male is 60-90 degrees
The Pelvis, cont.
The Femur
• Head
– fovea capitis
• Neck
• Greater and lesser trochanter
• Shaft
• Linea aspera
• Gluteal tuberosity - third trochanter
• Epicondyles
• Adductor tubercle
• Condyles
• Intercondylar fossa
• Popliteal fossa
• Patellar surface
The femur, anterior view
The femur, posterior view
The patella
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Apex
Base
Articular surface
How to tell a right from a left patella
The Tibia
• Medial Condyle
• Lateral Condyle
– Gerdy’s tubercle - insertion of the iliotibial tract
• Tibial Plateau
– Intercondylar eminence
• Medial and lateral intercondylar tubercle
• Tibial Tuberosity
• Shaft
• Interosseous crest
• Medial Malleolus
• Inferior Articular surface
• Fibular notch
The tibia, anterior view
The Fibula
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Head
Interosseous border
Lateral Malleolus
The fibula, posterior view
Importance of the feet and normal gait
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Sacroiliac joint
Pelvis tilt
Spinal posture
Leg length
Arch
An excellent book to discuss arches, the feet, and spinal pelvic stabilization is:
– SPS, A Practical Approach to Orthotic Application.
– By John Hyland, DC, DACBR
The Tarsal Bones
• Talus
– posterior process
groove for the FHL m.
medial and lateral tubercles
• Navicular bone
• Cuboid bone– groove for the peroneus longus m.
• Cuneiform bones – lateral, intermediate and medial
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The calcaneus bone
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Calcaneus
– tuberosity
– sustentaculum tali
Metatarsals and Phalanges
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Metatarsals
– base, body, head
– Mt 5 has a tuberosity on its base
– numbered from medial to lateral
Phalanges
– proximal, middle and distal
– Hallux has only two phalanges
The bones of the foot, dorsal view
The calcaneus bone
Arches of the Foot
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Longitudinal Arch
– medial portion is more elevated than lateral portion. The talus is the keystone of the medial portion and
the cuboid is keystone for the lateral portion.
Transverse Arch
– extends across the width of the foot. Formed by posteriorally by the calcaneus, navicular, cuboid and
anteriorally by the bases of all 5 Mt’s.
Arches of the Foot
Identify the following
Identify the following
1) What plane divides a part into right and left equal halves; superior and inferior parts; anterior and posterior
sections?
2) Define proximal.
3) Define distal
4) Define efferent.
5) Define contralateral.
6) What does inversion of the foot mean? eversion of the foot?
7) What does flexion of a joint mean? extension of a joint?
8) Define pronation; supination.
9) Define supine; prone.
10) Define protraction; Retraction.
11) Differentiate subjective from objective findings in a patient.
12) Define etiology.
13) What are eponyms?
14) Define: foramen, meatus, alveolus, fossa, facet, tubercle, tuberosity.
15) What is the calvaria?
16) Know the closure dates for the fontanels.
17) Know the name of the intersections of the sutures, ie. bregma, lambda, pterion, asterion.
18) What structures are found on the sphenoid bone?
19) What bones of the skull do not touch the sphenoid bone?
20) What is the sella turcica?
21) List all the holes of the skull and what structures (mainly nerves) run through them.
22) List the auditory ossicles.
23) What is the temporomandibular joint?
24) What is the glenohumeral joint?
25) Know the divisions of the CN V and what they innervate and which holes or fissures of the skull they
traverse.
26) Know the curves of the spinal column, when they develop.
27) Define: transverse foramen, intervertebral foramen, vertebral foramen.
28) Know the boundaries of the IVF.
29) Know the boundaries of the vertebral foramen.
30) Know the primary and the secondary ossification centers of vertebra.
31) Know which vertebra are considered typical and which ones are considered atypical and why.
32) Know how many ribs articulate with the various thoracic vertebra, how many costal facets and demi facets
are on each thoracic vertebra.
33) Understand the orientation of the articular facets on thoracic vertebra verse lumbar vertebra.
34) Know the ligaments of the spine and where they attach.
35) Know how the ribs attach to the sternum.
36) Where is the deltoid tuberosity?
37) Understand the anatomic structure of the distal humerus.
38) Understand the anatomic structures of the proximal ulna.
39) Understand the anatomic structure of the distal radius.
40) Understand the anatomic arrangement of the bones of the carpus and how they articulate with the radius.
41) Understand the anatomy of the pelvis.
42) What is the adductor tubercle?
43) Understand how you tell and right from a left patella.
44) Understand the anatomic structures of the proximal tibia.
45) How do you tell and right from a left fibula?
46) What is the sustentaculum tali?
47) Understand the anatomic arrangement of the bones of the tarsus and how they articulate with one another.
48) Understand the membranes of the body.
49) How many vertebra are there in the adult?
50) Know the components of a long bone.
51) Know the components of the Haversian system and understand how compact bone is formed and the
arrangement of the osteons.
52) Know the definitions of the vocabulary words I gave you in class.
53) Know the anatomic structures of the atlas and the axis vertebrae.
54) Know Dr. Jim's principles.
55) Know how many articular surfaces are present on the various vertebra.
ie. C1, C2, C4, C7, T1, T3, T9, T10, T12, L1, L5.
56) Where are the various fossae located on the scapula.