JOINTS OF THE SKULL, SPINE & PELVIS

1. JOINTS OF THE SKULL, SPINE & PELVIS • Kaan Yücel M.D., Ph.D. • 24.02.2014 Monday

2. JOINTS OF THE CRANIUM

3. SUTURAE – SUTURES(S)

4. SUTURAE form of articulation margins of bones united by a thin layer of fibrous tissue CORONAL suture Frontalbones Parietalbones sagIttAL suture Parietalbones Lambdoid suture Parietalbones Occipitalbones

5. TEMPOROMANDIBULAR JOINT a modified hinge type of synovial joint Movements • gliding (translation) • small degree of rotation (pivoting) • flexion (elevation) • extension (depression)

6. TEMPOROMANDIBULAR JOINT • mandibular fossa &articular tubercle of temporal bone • head of the mandible • articular disc of the TMJ

7. JOINTS OF THE VERTEBRAL COLUMN Spineby Sara Young

8. JOINTS OF THE VERTEBRAL COLUMN Symphysesbetweenvertebralbodiesn=2 1 above, 1 below Synovialjoinsbetweenarticularprocessesn=4 2 above, 2 below a total of 6 jointsbetweentwovertebrae 1) Craniovertebral(atlanto-axial and atlanto-occipital) joints 2) Costovertebraljoints 3) Sacroiliac joints

9. JOINTS OF THE VERTEBRAL BODIES Jointtype: symphyses (secondary cartilaginous joints) designed for weight-bearing and strength A layer of hyalinecartilageon eachvertebral body An intervertebraldiscbetweentheselayers an outer anulusfibrosussurrounds a central nucleus pulposus.

10. Anulusfibrosus • an outer ring of collagen surrounding • a wider zone of fibrocartilage arranged in a lamellar configuration.

11. Nucleuspulposus L. pulpa, fleshy • core of the intervertebral disc • fills the center of the intervertebral disc • gelatinous • absorbs compression forces between vertebrae. semifluid natureresponsible for much of the flexibility & resilience of the intervertebral disc and of the vertebral column as a whole

12. INTERVERTEBRAL DISCS • Providestrong attachments between the vertebral bodies • Unitevertebralbodiesinto a continuous semirigid column • Formthe inferior ½ of anterior border of the intervertebral foramen. • 20-25% of the length (height) of the vertebral column.

13. INTERVERTEBRAL DISCS Thicknessof the discs vertebral column descends The range (amount) of movement relativethicknessto body greatest @ cervical &lumbar regions, movements of vertebral column greatestthickness most uniform in the thoracic region L4 L5

14. FUNCTIONS OF INTERVERTEBRAL DISCS Thankstothesemifluidnature Onevertebrarockforwardorbackward on anotherduringflexion & extension

15. JOINTS OF THE VERTEBRAL ARCHES Zygapophysial joints, FACET JOINTS plane synovial joints between superior &inferior articular processes of adjacent vertebrae. @ cervicalregionarticularcapsuleespeciallythin wide range of movement

16. JOINTS OF THE VERTEBRAL ARCHES Zygapophysial joints, FACET JOINTS • permit gliding movements between articular processes • shape &disposition of the articular surfaces determine the types of movement possible. • Accessory ligaments unite the laminae, transverse processes, and spinous processes and help stabilize the joints.

17. LIGAMENTS OF THE VERTEBRAL COLUMN Joints between vertebrae reinforced &supported by numerous ligaments pass between vertebral bodies interconnect components of vertebral arches.

18. LIGAMENTS OF THE VERTEBRAL COLUMN Anterior & posterior longitudinal ligaments Ligamentaflava Supraspinousligament & ligamentumnuchae Interspinous ligaments betweentwolaminae

19. Posteriorlongitudinal ligament Anteriorlongitudinal ligament Tectorialmembrane Posteriorlongitudinalligamentconnectingaxistobase of theskull • Frombase of the skull to anterior surface of sacrum • Along its length attached to vertebral bodies and intervertebral discs

20. Ligamentaflava/Ligamentumflavum • Between • posterior surface of the lamina on the vertebra below • anterior surface of the lamina of the vertebra above • resist separation of the laminae in flexion. • assist in extension back to the anatomical position.

21. Supraspinous ligament connects tips of thespinous processes from vertebra C7 to the sacrum From vertebra C7 to the skullbecomes structurally distinct ligamentumnuchae

22. Ligamentumnuchae triangular, sheet-like structure in the median sagittal plane Externaloccipitalprotuberancetomagnum tip of spinousprocess of C7 deep side attached to posterior tubercle of vertebra C1 & spinousprocesses of other cervical vertebrae.

23. Ligamentumnuchae • supports the head. • resists flexion . • facilitates returning the head to the anatomical position. • provide attachment for adjacent musclesbroad lateral surfaces & posterior edge

24. Interspinousligaments between adjacent vertebral spinousprocesses from base to apex of each spinous process

25. CRANIOVERTEBRAL JOINTS atlanto-occipital joints between atlas (C1) & occipital (condyle) bone atlanto-axialjoints between atlas (C1) & axis (C2) Synovialjointswithnointervertebraldiscs a wider range of movement than in the rest of the vertebral column.

26. ATLANTO-OCCIPITAL JOINTS Superiorarticularsurfaces of lateralmassesOccipitalcondyles nodding of the head, “yes” movement also sideways tilting of the head. Mainmovement flexion, with a little lateral flexion and rotation.

27. LIGAMENTS OF ATLANTO-OCCIPITAL JOINTS Anterior atlanto-occipital membrane(continuation of anteriorlong.lig.) connects anterior arch of the atlas to anterior margin of the foramen magnum Posterior atlanto-occipital membrane(similar to the ligamentumflavum) connects the posterior arch of the atlas to the posterior margin of the foramen magnum. help prevent excessive movement of the atlanto-occipital joints

28. ATLANTO-AXIAL JOINTS p Right & leftlateralatlantoaxialjoints betweeninf. facets of lateralmasses of C1 & superiorfacets of C2 Medianatlantoaxialjoint betweendens of axis& anteriorarch of atlas lane IVOT

29. MOVEMENTS OF ATLANTO-AXIAL JOINTS Cranium & atlas rotate on axis as a unit. • Duringrotation of thehead • Dens/pivot held in a collar • anteriorlyanteriorarch of atlas • posteriorlytransverseligament of atlas • betweentubercles on medialsides of lateralmasses of atlas Headturns from sidetoside, disapproval (“no” movement).

30. LIGAMENTS OF ATLANTO-AXIAL JOINTS • Superior and inferior longitudinal bands • Apical ligament • Alar ligaments • Cruciate ligament of the atlas • Tectorial membrane (Membranatectoria) • .

31. COSTOVERTEBRAL JOINTS • A typical rib articulates with: • bodiesof adjacent vertebraejoint with the head of the rib • transverse process of its related vertebra costotransverse joint • Necksrotatearoundtheirlongitudinalaxismainly in upperribs • Ribsascenddescdendrelativetothespinemainly in lowerribs essential for altering the volume of the thoracic cavity during breathing

32. Joint with head of rib Head of therib Twofacetsface of articulation 1- withsuperiorfacet of itsownvertebra 2- withinferiorfacet of thevertebraabove divided into two synovial compartments by an intra-articular ligament

33. Costotransversejoints Slight gliding movements

34. MOVEMENTS OF THE • VERTEBRAL COLUMN • Rangeof movement according to the region and the individual • Mobilityprimarily from compressibility & elasticity of the intervertebral discs Normalrange of movement reduced by 50% or more as a result of aging • Movements by the vertebral column • Flexion • Extension • Lateral flexion • Rotation • Circumduction

35. MOVEMENTS OF THE • VERTEBRAL COLUMN Movements in a specific region (cervical, thoracic, and lumbar) determined by shape &orientation of joint surfaces on the articular processes & on the vertebral bodies

36. JOINTS OF THE PELVIS

37. The primary joints Sacroiliac joints & pubic symphysis Sacroiliac joints link axialskeleton & inferior appendicular skeleton. Lumbosacral & sacrococcygeal joints, although joints of the axial skeleton, are directly related to the pelvic girdle. Strong ligaments support and strengthen these joints.

38. SACROILIAC JOINTS Strong, weight-bearing compound joints An anterior synovial joint between the earshaped auricular surfaces of the sacrum & ilium A posterior syndesmosis between the tuberosities of the same bones Differ from most synovial joints limited mobility is allowed, a consequence of their role in transmitting the weight of most of the body to the hip bones.

39. Weight from the axial skeleton: Sacroiliac ligaments ilia Femurs –during standing- Ischial tuberosities –during sitting- Sacrum is actually suspended between the iliac bones Firmly attached to iliac bones by posterior and interosseous sacroiliac ligaments.

42. Sacrotuberous ligament • Formed byposteriorsacroiliacligaments • Passes from posterior ilium, lateral sacrum & coccyx to ischialtuberosity • Transformsthe sciatic notch of the hip bone into a large sciatic foramen.

43. Sacrospinousligament from lateral sacrum & coccyx to ischialspine subdividessciatic foramen into greater and lesser sciatic foramina.

44. Most of the time, movement at the sacroiliac joint is limited by interlocking of the articulating bones and the sacroiliac ligaments. By allowing only slight upward movement of the inferior end of the sacrum relative to the hip bones, resilience is provided to the sacroiliac region when the vertebral column sustains sudden increases in force or weight.

45. PUBIC SYMPHYSIS Secondary cartilaginous joint A fibrocartilaginous interpubic disc & surrounding ligaments uniting the bodies of the pubic bones in the median plane. Interpubicdiscwider in women.

46. superior & inferior margins of the symphysis Superior pubic ligament connects the superior aspects of the pubic bodies and interpubic disc. Inferior (arcuate) pubic ligament connect the inferior aspects of the jointcomponents round off the subpubic angle as it forms the apex of the pubic arch. Superior & inferiorpubicligaments

47. LUMBOSACRAL JOINTS L5 & S1 articulate Anterior intervertebral (IV) joint formed by L5/S1 IV disc between their bodies & 2 posterior zygapophysial joints (facet joints) between the articular processes of these vertebrae Fan-like iliolumbar ligaments radiate from the transverse processes of the L5 vertebra to the ilia.

48. SACROCOCCYGEAL JOINT Secondary cartilaginous joint with an intervertebral disc. Fibrocartilage & ligaments join apex of the sacrum base of coccyx. Anterior & posterior sacrococcygeal ligaments long strands that reinforce the joint.