Anatomy of the trunk I.

Bones and joints.

Prof. Dr. Mihly, Andrs

30 September 2014

VERTEBRAE DEVELOP FROM THE SOMITE MESODERM

Neural tube

Neural crest
Lateral mesoderm

Ectoderm

Intermediate mesoderm

Somite:
dermomyotom

Somite:
sclerotom
Body cavity

Endoderm

Chorda dorsalis

Columna vertebralis:
1. Vertebrae cervicales
2. Vertebrae thoracicae
3. Vertebrae lumbales
4. Os sacrum
5. Os coccygis

Skeleton thoracis:
1. Costae
2. Sternum
3. Vertebrae thoracicae
4

Canalis vertebralis:
spinal cord protection

Cavitas thoracis
Apertura thoracis superior
Apertura thoracis inferior
Spatium intercostale
Arcus costalis
Angulus infrasternalis

Curvatures of the spine:

1. Lordosis colli
2. Kyphosis thoracica
3. Lordosis lumbalis
4. Kyphosis sacralis
5. Scoliosis

Anatomy of the vertebra

Corpus vertebrae
Arcus vertebrae
Incisura vertebralis superior
Incisura vertebralis inferior
Foramen vertebrale
Processus spinosus
Processus transversus
Processus articularis superior
Processus articularis inferior
7

Lamina arcus
vertebrae

Processus spinosus

Processus articularis
Foramen vertebrale
Processus transversus

Pediculus arcus
vertebrae

CORPUS
8

First cervical vertebra: atlas

Massa lateralis: facies articularis
superior, inferior.
Arcus anterior atlantis: fovea dentis,
tuberculum anterius.
Arcus posterior atlantis: sulcus arteriae
vertebralis, tuberculum posterius.
Processus transversus
Foramen transversarium
9

THE ANATOMY OF
THE ATLAS I.

10

THE INFERIOR SURFACE OF THE ATLAS

11

Second cervical vertebra: axis

Dens axis: apex, facies articularis anterior,
posterior.
Corpus vertebrae
Processus transversus: foramen
transversarium
Processus spinosus (bifid)
Processus articularis superior
Processus articularis inferior
Arcus vertebrae
12

THE SUPERIOR SURFACE OF THE AXIS

13

AXIS: ANTERIOR SURFACE

14

ATLAS AND AXIS CUT IN THE MIDLINE

15

C6: carotid tubercle. The tubercle

of the transverse process is used
when palpating the carotis pulse
on the neck.

FIFTH CERVICAL VERTEBRA

16

The uncinate process is the edge

of the rim of the vertebral body.

VERTEBRA PROMINENS
Anatomy of the seventh cervical vertebra (vertebra prominens). The
spinous process is long and palpable under the skin, therefore is used
for the counting of the vertebrae. The spinous process has a thickened
tuberculous tip, helping the palpation in living patient.
17

Th VI

Th XII
18

Thoracic vertebrae: body is having two pairs of small, costal articular surfaces.
Vertebral foramen is narrow, surrounded by a strong arcus (arch). Strong
transverse processes are directed posterolaterally, possessing another
articular surface for the rib tubercle. The processus spinosus is long and
directed obliquely down. Upper articular processes and lower articular
Processes have plain articular surfaces in the frontal plane (almost frontal).
The 10th, 11th and 12th: only one costal facet on the body.
The 11th and 12th: no costal facet on the transverse process.
19

LUMBAR VERTEBRA (L4)

20

Five sacral vertebrae form the

single bone: the sacrum

21

Sacrum develops from

the fusion of five
sacral vertebrae. The
vertebral fusion lines
are visible on the
pelvic surface as
transverse lines.

22

Large articular surface

on the lateral part for
articulation with the hip
bone (os ilium).

The lines of fusion are

visible on the midline
section of the sacrum
(visible on X-ray, too)

23

RUDIMENTARY VERTEBRAE: COCCYX

JOINS TO THE APEX OF THE SACRUM IN A SMALL SYMPHYSIS

24

ARTICULATIONS OF THE VERTEBRAL

COLUMN (A: articulation)

A. atlantooccipitalis
A. atlantoaxialis mediana
A. atlantoaxialis lateralis
A. zygapophysialis (the articular processes)
A. lumbosacralis: between L5 and sacrum
(the articular processes)
A. sacrococcygea: sacrum & coccyx
(symphysis)
Symphysis intervertebralis (disc)
25

LIGAMENTOUS CONNECTIONS
Lig: ligamentum; ligg: ligamenta

Lig. longitudinale anterius

Lig. longitudinale posterius
Lig. nuchae
Lig. supraspinale
Ligg. flava
Ligg. interspinalia
Ligg. intertransversaria
Lig. iliolumbale
Membrana atlantoocipitalis anterior et posterior
Lig. cruciforme atlantis
Lig. apicis dentis
Ligg. alaria
26

THE INTERVERTEBRAL DISC (LUMBAR)

27

28
JOINT OF THE DENS AXIS: MEDIAN ATLANTOAXIAL JOINT

LATERAL VIEW OF THE MEDIAN ATLANTOAXIAL JOINT

29

LIG. LONGITUDINALE ANTERIUS ET POSTERIUS

30

FUNCTIONAL MOVEMENT UNIT ON THE NECK: THE INTERVERTEBRAL

DISC, THE ZYGAPOPHYSIAL JOINT, THE LIGAMENTS PARTICIPATE IN
THE MOVEMENTS.

31

FUNCTIONAL MOVEMENT UNIT IN THE LUMBAR REGION: THE

32
INTERVERTEBRAL DISC, ZYGAPOPHYSIAL JOINT AND LIGAMENTS

ZYGAPOPHYSIAL JOINT

THE ZYGAPOPHYSIAL JOINT IS THE FULCRUM OF THE MOVEMENTS:

THE ELASTICITY OF THE DISC AND THE LIGAMENT SUPPORT THE
33
MOVEMENTS (RED ARROWS)

THE JOINTS OF THE

LUMBOSACRAL REGION
Lumbosacral joint: the articular processes of
the L5 and the sacrum form a synovial joint.
The intervertebral disc forms a symphysis.
Ligament: iliolumbar ligament.
Sacrococcygeal joint: symphysis. Small
ligaments are around.
Sacroiliac joint: between the auricular
surfaces of the ilium and sacrum
(fibrocartilage). Anterior-, posterior- and
interosseous sacroiliac ligaments. Very
strong joint without movements.
34

Blood supply of the vertebral

column
From arteries close to the vertebrae: a.
vertebralis, aa. intercostales, aa. lumbales, a.
sacralis lateralis (rami spinales).
Veins: plexus venosus vertebralis internus
anterior et posterior; plexus venosus
vertebralis externus anterior et posterior.
Venae basivertebrales: large veins exiting
from the vertebral body towards the vertebral
canal (regularly 1 per vertebra).
35

The posterior intercostal arteries supply the thoracic part of the

vertebral column. They also supply the deep muscles of the back
and the spinal cord (a. medullaris segmentalis).

36

VEINS AND VENOUS

PLEXUSES OF THE
VERTEBRAL COLUMN

Venous blood is drained by:

1. Plexus venosus vertebralis
externus anterior et posterior
2. Plexus venosus vertebralis
internus anterior et posterior
3. Venae basivertebrales
These plexi are discharging
into segmental veins (e.g.:
posterior intercostal veins)
37

Movements of the vertebral column

The vertebral column consists of separate vertebrae accurately positioned one on

the other and separated by intervertebral discs. The vertebrae are held in position
relative to one another by strong ligaments that limit the degree of movement
possible. Nevertheless, the summation of all these small movements gives the
vertebral column as a whole a remarkable degree of mobility.
FLEXION is a forward movement and EXTENSION is a backward movement. Both
are extensive in the cervical and lumbar regions but restricted in the thoracic region.
LATERAL FLEXION is the bending of the body to one or the other side. It is
extensive in the cervical and lumbar regions but restricted in the thoracic region.
ROTATION is the twisting of the vertebral column. This is least extensive in the
lumbar region (lumbar region is very stable).
CIRCUMDUCTION is the combination of the above movements.
The type and range of the movements depend on the thickness of the intervertebral
discs and the shape and direction of the articular processes. In the thoracic region
the ribs, the costal cartilages and the sternum restrict the range of movement.
The ATLANTO-OCCIPITAL JOINTS permit extensive flexion and extension of the
head.
The ATLANTOAXIAL JOINTS allow a wide range of rotation of the atlas and thus of
the head on the axis.
38

MRI images of cervical, thoracic and lumbosacral

regions
Vertebral bodies, spinous processes, vertebral canal, intervertebral discs are
visible. The spinal cord, spinal dural sac and subarachnoid space, and some of the
nucleus pulposus are visible, too. The vertebrae of the sacrum are separated by
cartilages (young subject).

Atlas
Axis

L5

Sacrum
39

The anatomy of the thoracic cage

Superior and inferior thoracic apertures, costal arch, infrasternal
angle, intercostal spaces. Pectus: latin term for the anterior thoracic
surface. Radiology is an important investigation procedure.

40

Thorax: ribs and sternum

Ribs (12): costae verae; true ribs (1-7), costae
spuriae; false ribs (8-12), costae fluctuantes;
floating ribs (11-12).
Caput costae (facies articularis), collum
costae, tuberculum costae (facies articularis),
corpus costae, cartilago costalis.
The costal angle: angulus costae. Inferior
surface of the corpus: sulcus costae.
Anterior: costal cartilage (cartilago costalis;
hyaline cartilage, which may ossify in elderly,
decreasing the flexibility of the chest).

41

THE STERNUM (BREAST BONE)

IMPORTANCE OF THE STERNAL ANGLE (ANGLE OF LOUIS)

42

Infrasternal angle
Costal arch

PROJECTION OF THORAX ON THE ANTERIOR BODY WALL

43

JOINTS OF THORAX
Articulationes costovertebrales: articulatio
capitis costae + articulatio costotransversaria
Articulationes sternocostales: small sliding
movements
Synchondrosis costae primae: no movement
Articulationes costochondrales: no movement
Articulationes interchondrales: small sliding
movements
Symphysis xiphosternalis: ossification is
frequent
Symphysis manubriosternalis: true symphysis
This forms the sternal angle (angle of Louis)
44

Articulatio capitis costae (joint of head of rib costovertebral

45
joint); Articulatio costotransversaria (costotransverse joint).

COSTOVERTEBRAL JOINTS (RIB HEADS)

AXIS OF TROCHOID MOVEMENT

RIB HEAD

THE RIB ARTICULATES TO TWO VERTEBRAL BODIES AND TO THE TRANSVERSE

PROCESS OF THE UPPER VERTEBRA. THE COSTOVERTEBRAL JOINT IS THE
JOINT OF THE RIB HEAD, THE COSTOTRANSVERSE JOINT IS THAT OF THE46RIB
TUBERCLE. THE TWO JOINTS MOVE AS A PIVOT JOINT.

STERNAL JOINTS

Jugular notch

Sternocostal joints and

manubriosternal symphysis

47

Articulatio sternoclavicularis

48

THE MOVEMENTS OF THE THORAX AND THE

DIAPHRAGM IN INSPIRATION AND IN EXPIRATION

49

CERVICAL RIB
(MAY CAUSE COMPRESSION
OF SUBCLAVIAN VESSELS
AND/OR BRACHIAL PLEXUS)

Hemivertebra

DEVELOPMENTAL PROBLEMS OF RIBS AND VERTEBRAE

50

Pictures:
Gilroy-MacPherson-Ross: Atlas of Anatomy.
Thieme, 2008.
Tillmann BN: Atlas der Anatomie des
Menschen. Springer, 2005.
Moore-Persaud-Torchia: Before we are born.
Elsevier, 2013.
Scientific illustrations owned by the
Department of Anatomy, Szeged, Hungary.
51