SPINAL CORD  Meninges – envelops the brain to the

entire spinal cord

- elongated extension of the brain
 DURAL SAC – covering up until S2
- ovoid-shaped dorsa-laterally
- 18in (male adults) Vertebrae – longer; bony structure
17in (female adults)
Spinal Cord – shorter; tissue
- presence of:
Grey Matter - has 5 levels
White Matter - 31 pairs of spinal nerves (2 per each
- presence of axons segment)
1. Sensory axons
2. Motor axons - 8 Cervical – 18mm
- 12 Thoracic – 6.4mm
- found at the Lateral
- 5 Lumbar
Funiculus and Posterior
- 5 Sacral – largest nerves
Funiculus
- 1 Coccygeal – smallest nerves
- came from the medulla oblongata as it
exits through the foramen magnum Enlargements:
extending and inserts to the vertebral 1. Cervical Enlargement
canal and terminates to the CONUS - C3-T2 spinal cord segment
MEDULLARIS and will end to the - Innervates the upper limbs
PHYLUM TERMINALE 2. Lumbosacral Enlargement
- L1-S3 spinal cord segment
FUNCTIONS:
- Innervates the lower limbs
1. Transmission of nerve signals from both
ends
2. Center of coordination for many
reflexes
3. Location of grooves of spinal
interneurons which is responsible for
controlling motor functions for
rhythmic movements such as walking

 CONUS MEDULLARIS
- located at the level of L1
- 2/3 of L1 vertebrae
- L1-S2 (where the CSF is
found; spinal tap/lumbar tap Transverse Section: not of the same sizes
is done)

enclosed by:

 Vertebrae – bony structure where the

spinal cord is enclosed

 Anterior Horns
- Anterior motor roots
 Posterior Horns
- Posterior sensory roots
- Will give rise to the sensory rootlets
Spinal Nerves = Anterior Motor Roots +
Posterior Sensory Roots
Brachial Plexus – combination of all nerves
 Pain input (any sensations)
- Ascends to the brain and stops at the
PRIMARY SOMATOSENSORY CORTEX in
the POST-CENTRAL GYRUS
 Reaction
- PRIMARY MOTOR CORTEX descends to
the affected part
Grey Matter
 REXED LAMINA (10 Zones)
Posterior Funiculus
- Medial Fasciculus Gracilis
- Lateral Fasciculus Cuneatus
2 Somato-Sensory Pathways
1. Anterolateral Pathways
- Conveys the pain, temperature
and crude touch
2. Posterior Column Medial Lemniscal
Pathway
- Convey the fine touch or
discriminative touch, vibration and
conscious proprioception
Sensory Pathways will transmit sensation to 3
neurons
Descending Tracts
1. Voluntary Movements
2. Postural Movement
3. Coordination of head, neck and eyes
2 Motor Neurons
1. Upper Motor Neurons
- Cerebral Cortex and Brainstem
2. Lower Motor Neurons
- Grey Matter
2 Motor Systems
1. Lateral Motor System
 Latero-Cortico-Spinal Tract
- found at the lateral column
- the most important because it
serves the movement of the
limbs
 Rubro-Spinal Tract
- Red nucleus
2. Medial Motor System
- Maintains posture, balance and
gate
 Anterior Cortico-Spinal Tract
 Vestibulo-Spinal Tract
 Resticulo-Spinal Tract
 Tecto-Spinal Tract
Arterial Supply – Spinal Arteries
 1 Anterior Spinal Arteries
 2 Posterior Spinal Arteries
8-10 segmental medullary arteries that supply
the spinal cord per segment
- Largest Medullary Artery
- Lower Thoracic / Upper Lumbar Region
at the left side
JOINTS  Bicondylar (knee joint)
 Condylar (wrist)
2 Classes of Joints
 Saddle (wrist)
1. Synovial Joint  Ball and Socket (hip, shoulder)
- Covering of skeletal
Based on Movement
- Freely movable
2. Solid Joint  Uniaxial – elbow (up-down) (left-right)
- No cavity  Biaxial
- Held together by connective  Multiaxial – ball and socket, hip joint
tissues
- Limited movements Not all synovial joints have:
 Fibrous - Articular disc – absorbs compression
- Sutures forces
- Gomphoses - Fat pads
- Syndesmosis - Tendons
 Cartilaginous
- Synchondrosis / ; but are present in the TMJ
Primary (head/growth Specific types of Synovial Joints
plates of long bones)
- Symphyses/ Secondary 1. Plane Joints- Allow sliding or gliding
movements when one bone moves
Fibrous Membrane across the surface of another
- Formed by dense connective tissue 2. Hinge joints- Allow movement around
- Surrounds and stabilizes the joint one axis that passes transversely
- Parts of the fibrous membranes may through the joint; Permit flexion and
thicken to form ligaments, which extension
further stabilizes the joint 3. Pivot joints- Allow movement around
one axis that passes longitudinal along
- Ligaments outside the capsule usually the shaft of the bone, Permit rotation
provide additional reinforcement 4. Bicondylar Joints- Allow movements
mostly in one axis with limited rotation
Synovial around a second axis formed by two
- Joint capsule (synovial fluid) convex condyles that articulate with
- Outer fibrous membrane concave or flat surface
- Inner synovial membrane 5. Condylar ( Ellipsoid) Joints- Allow
- Lubricant of the joint to avoid friction movement around two axes that are at
right angles to each other; Permit
Description of Synovial Joints flexion, Extension, abduction, adduction
and circum- duction
Based on Shape
6. Saddle Joint- Allow movement around
- Shape of their articular surface plane two axes that are at right angles to each
 Plane other; The articular surfaces are
 Hinge (elbow) saddled shaped; Permit flexion,
 Pivot (neck – side-to-side)
 extension, abduction, adduction and
circumduction
7. Ball and Socket joints- Allow movement
around multiple axes; permit flexion;
extension, abduction, adduction,
circumduction and rotation
BURSAE
- Often intervene between structures,
such as tendons and bone, tendon and
joints; or skin and bone
- Reduce the friction of one structure
moving over the other
TENDON SHEATHS
- Surround tendons
- Also reduce friction
ARTICULAR DISC
- Not all joints have articular disc
- Soft tissues in between bones to
lessen/avoid impact and provides
cushion
- Present in Temporomandibular Joint
- Can be described according to
movement and shape
Temporomandibular Joint
- Joint capsule
- Articular cavity
- Articular disc
 Head of the mandible (condyle)
 Articular / glenoid / mandibular
fossa
 Articular tubercle of temporal
bone
Articular Disc
1. Anterior
2. Intermediate
3. Posterior
- 13-25mm (no movement)
- 25mm (protrusion)
(condyle and articular disc)
Bilaminar Zone
- Attaches the articular disc to the
posterior part of the glenoid fossa
 Upper Lamina
 Lower Lamina
- Depression
- Elevation
- Protrusion
- Retrusion
2 features that participate in forming the TMJ
on the inferior aspect of the root of the
zygomatic process are:
1. Articular tubercle or articular eminence
2. Mandibular fossa or glenoid fossa
Articular Disc
- Divides the joint into 2 spaces or
synovial cavity
 Superior (disco-temporal) space –
filled with synovial fluid
 Central Part (avascular)
 Inferior (disco-mandibular) space –
filled with synovial fluid
Joint Cavity of the TMJ is divided into two parts
by an intra-articular disc of fibrocartilage.
1. Concavo-convex above
2. Concave below
In sagittal section, the disc has three distinct
parts:
1. Anterior Band
2. Thinner Intermediate Zone
3. Posterior Band
The temporomandibular joints, one on each
side, allow:
 The opening and closing of the mouth
 Complex chewing or side to side
movements of the lower jaw
Principal Articulating Surfaces of the TMJ
1. Anterior and superior surfaces of the
mandibular condyle
2. Articular eminence
3. Preglenoid plane of the squamous
temporal bone
The normal range of maximum mouth opening
measured between upper and lower incisor tips
is 35-50mm.
- The first 15-25mm: due to hinging of
condyle
- The remainder: due to condylar
translation
- Lateral excursions of the chin can
normally achieve 8-12mm of movement
at the lower incisors
At the limit of normal opening, the condyle has
translated on to the peak or just beyond the
peak of the articular eminence. Translation
beyond this results in:
1. Subluxation
2. Dislocation of the joint
3. Displacement of the disc
anteromedially (most common)
The adult range of movements is reached at
around:
1. 10 years in females
2. 15 years in males
With the teeth in occlusion:
- The condyle is in the glenoid fossa
- The intra-articular disc sits on the
condylar head
- Its posterior band at the 12 o’clock
position from the center of the condyle
head in the sagittal plane
FOR PRINCIPLE OF MUSCLES OF MASTICATION;
1. Medial Pterygoid
2. Lateral Pterygoid
3. Temporalis
4. Masseter
 Their action produces movements of
the mandible at the
temporomandibular joint
MOVEMENT OF THE TEMPOROMANDIBULAR
JOINT
1. Protrusion- Lateral Pterygoid assisted
by Medial Pterygoid
2. Retraction- Posterior fibers of
temporalis, deep part of masseter and
geniohyoid and digastric
3. Elevation- Temporalis, Masseter,
Medial Pterygoid
4. Depression- Gravity, Digastric,
Geniohyoid and mylohyoid muscles
MASSETER
- Elevates the mandible to occlude the
teeth in mastication
- Has a small effect in side to side
movements, Protraction and Retraction
- Its electrical activity in the resting
portion of the mandible is minimal
TEMPORALIS
- Elevates the mandible and so closes the
mouth and approximates the teeth
- This movements requires both the
upward pull of the anterior fibers and
the backward pull of the posterior
fibers, Because the head of the
mandibular condyle rests on the
articular eminence when the mouth is
open
- Also contributes to side to side grinding
movements
- The posterior fibers retract the
mandible after it has been protruded
 - The posterior fibers of the temporalis, - The nerve supply to the
which are almost horizontal, Are the temporomandibular joint is from the
only source of mandibular retrusion mandibular division of the trigeminal
- Most of the power clenching force is nerve, mostly through the
due to contraction of masseter and auriculotemporal branch, Along with
temporalis branches from the masseteric and deep
- The associated backward pull of temporal nerves.
temporalis is greater than the -
associated forward pull of
( Superficial) masseter, and so their
combined jaw-closing action potentially
pulls the condyle backwards.
Protraction is mainly achieved by the;
- Lateral Pterygoid muscle, with some
assistance by medial pterygoid
- When the lateral and medial pterygoids
contract on the one side, the chin
moves to opposite side. When opposite
movements at the two
temporomandibular joints are
coordinated, a chewing movement
result.

LATERAL PTERYGOID

- Has assumed a specialized role in

mandibular opening that is mediated by
its horizontally oriented fibers
- When left and right muscles contract
together, Condyle is pulled forwards
and slightly downwards. This Protrusive
movement alone has little or no
function except to assist in opening of
the jaw

VASCULAR SUPPLY AND INNERVATION

- The articular tissues and the dense part

of the articular disk have no nerve
supply
- The joint derives its arterial supply from
the “superficial temporal artery
laterally and the maxillary artery
medially”
- Penetrating vessels that supply lateral
pterygoid may also supply the condyle