You are on page 1of 79

Skull Joints

Joints of the Skull


8 sutured bones in cranium
14 Facial bones: 13 sutured bones
1 mandible
Sagittal suture

Parietal
bone
Sutural
bone

Lambdoid
suture

Occipital bone

Superior nuchal line

External
occipital Mastoid
protuberance process
Inferior
Occipitomastoid nuchal
External Occipital
suture line
occipital condyle
(b) Posterior view crest
Figure 7.4b
TMJ
The Temporomandibular Joint

Union of mandible and skull

Condyloid process + temporal bone (mandibular


fossa)

Articulating area also includes the articular eminence


(anterior to the fossa) and the post-glenoid process
(posterior to the fossa)

Condyle of the mandible articulates directly at the


head of the condyle = articulating surface
The Temporomandibular Joint (TMJ)
TMJ: Joint Capsule
TMJ is a ball & socket joint
diathrotic joint = freely movable
synovial joint surrounded by a fibrous capsule

Capsule of fibrous connective tissue surrounds the


head and neck of the condyloid process
superior border wraps around the articular eminence and
fossa
inferior border wraps around the condyle (neck)
TMJ: Articular Disc
Between the articulating
bones = joint disc or
articular disc
(fibrocartilage disc =
meniscus)

Disc can degenerate


with age or trauma or
mechanical stress can
also become dislocated
TMJ: Articular Disc
Disc divides the joint cavity into two regions
1. superior synovial cavity
2. inferior synovial cavity
the disc attaches to:
the mandibular condyle
the temporal bone anterior attachment is NOT a direct
attachment
the temporal bone posteriorly
TMJ: Ligaments

Three major ligaments:

1. Stylomandibular ligament
2. Sphenomandibular ligament
3. TMJ ligament or lateral ligament
TMJ: Ligaments

1. Stylomandibular
ligament

styloid process to the


angle of the mandible

tightens with
protrusion
TMJ: Ligaments
2. Sphenomandibular
ligament
NOT a part of the TMJ
runs from the spine of the
sphenoid to the ramus of the
mandible (lingula of the
mandibular foramen)
a vestige of the embryonic
lower jaw

tightens with protraction of


mandible
landmark for local anesthesia
TMJ: Ligaments

3. TMJ ligament or lateral ligament


reinforces the inferior portion of the capsule
prevents excessive retraction of mandible
runs from tubercle of the zygomatic pr. to the neck of
the mandible
TMJ: Muscles
the four muscles of mastication:
Temporalis contraction of both retracts the mandible and produces a gliding motion
in the upper synovial cavity
O: Temporal Bone
I: Coronoid process & ramus of mandible
A: elevates & retracts
N: mandibular division of cranial nerve V
Masseter strongest of the four muscles
O: maxilla & zygomatic arch
I: angle & ramus of mandible
A: elevates
N: mandibular division of cranial nerve V
Medial Pterygoid
O: lateral pterygoid process of sphenoid
I: angle and ramus
A: elevates, protracts and lateral movements
N: mandibular division of cranial nerve V
Lateral Pterygoid
O: lateral pterygoid process of sphenoid
I: condyle of mandible
A: depresses, retracts and lateral movements
N: mandibular division of cranial nerve V
TMJ: Movements
ball & socket
structure allows
for movement
in more the one
plane = multi-
axial joint
The Temporomandibular Joint (TMJ)
Cervical Spine Quick Review

One of the most adaptable areas in the body


Functions:
Supports the skull
For neurological and vascular protection
Provides attachment site for muscles
Neuromuscular feedback
Shock absorber for the brain/skull (lordodic curve)
Stability while maintaining mobility
Cervical Spine

The Neck can be broken down into 2 segments:

1. The OA and the AA joints (upper C-Spine)


2. C3-C7 (the lower C-Spine)
Cervical Spine
Superior Articular Process
Face superior and posterior
Start to arch back as they descend
Start to arch back as they descend

Inferior Articular Process


Face inferior and anterior
Forms an articular pillar with the Sup. Art. Process
Vertebral Foramen
Large and triangular for mobility
Increased need for room due to the plexuses (Cervical and
Brachial)
Typical Cervical Vertebrae

Lamina
Long and narrow with a thin
upper border

Pedicle
Project dorsolaterally (The
position of the pedicles will
dictate the shape of the
foramen)
Cervical Spine
Spinous Process
Short and bifid to allow for ligamentum nuchae to be
separated into left and right
Easily palpable
Transverse Process
Lateral extending from the body of the vertebrae
2 tubercles (anterior and posterior)
In between tubercles is a groove where the spinal nerve exits
In the middle is the foramen
Transverse Foramen
Occupied by the vertebral artery that ascends through all the
cervical vertebrae and into the cranium
Table 7.2
Table 7.2
Atypical Cervical Vertebrae

C1 (atlas) and C2 (axis) have unique features


Atlas (C1)
Supports the globe of the head (the occiput)
No body, therefore no disc between C0/C1/C2
C2 acts as a disc between C1 and C3; No absorption properties
The body is replaced by the dens of C2
Has no true spinous process
Consists of anterior and posterior arches and two lateral
masses
Superior facets on the superior surfaces of lateral masses
articulate with the occipital condyles
C1 Posterior Posterior
Posterior Posterior
Posterior arch tubercle
tubercle
Posterior arch Inferior
Lateral Transverse articular
masses Lateral
Transverse process facet
masses
foramen

Superior
articular Transverse Anterior
Anterior arch Anterior facet foramen arch
tubercle Facet for dens Anterior tubercle
(a) Superior view of atlas (C1) (b) Inferior view of atlas (C1)
Cervical Vertebrae

Axis (C2)
Is an axis of rotation for the atlas and head around its
strong dens
Dens projects superiorly into the anterior arch of the
atlas
The dens has a small articular facet on the anterior side
that forms a synovial joint with the reciprocal facet on
the back of the anterior atlantal arch
Dens has a facet on the posterior side that articulates
with the transverse ligament
Posterior
C2
Spinous process
Inferior Lamina
articular
process
Pedicle

Superior
Transverse articular
process facet
Dens Body
(c) Superior view of axis (C2)
The Axis
Anterior View Posterosuperior View
Joints of the Cervical Spine

Atlantaloccipital Joint
The joint between the occiput and the atlas
Synovial, Ellipsoidal
Occipital facets articulate with the reciprocally curved
atlantal facets
Fibrous capsule surrounds
Permits flexion/extension (chin tuck) and slight
side bending
Joints of the Cervical Spine

1. Atlantaloccipital Joint
2. Atlantal Axial Joint
3. Zygoapophyseal Joint (Facet)
Joints of the Cervical Spine

Atlantaloccipital Joint
The joint between the occiput and the atlas
Synovial, Ellipsoidal
Occipital facets articulate with the reciprocally curved
atlantal facets
Fibrous capsule surrounds
Permits flexion/extension (chin tuck) and slight
side bending
Joints of the Cervical Spine
Atlantal Axial Joint
Joint between the Atlas and the Axis
3 synovial articulations:
A pair between the inferior articulating facets of the atlas and
the superior articulating facets of the axis
One median complex between the dens and the anterior
atlantal arch
Movements of the AA joint; atlantal rotation on the
axis
Weak, loose fibrous capsule
Lined with a synovial membrane
Joints of the Cervical Spine

Zygoapophyseal Joint (Facet)


Facet joints join each vertebrae above and below via the
superior and inferior articulating processes
Simple and loosest in the Cervical spine
Resists forward sliding and twisting
Surrounded by a thin and loose fibrous capsule
Ligaments of the Cervical Spine (Ant to Post)
1. Transverse Ligament
2. Alar Ligaments
3. Apical Ligament
4. Anterior Longitudinal Ligament
5. Anterior Atlantooccipital Membrane
6. Posterior Longitudinal Ligament
7. Membrane Tectoria
8. Ligamentum Flavum
9. Ligamentum Nuchae
10. Supraspinous Ligament
11. Interspinous Ligament
12. Intertransverse Ligament
Ligaments of the Cervical Spine
Transverse Ligament:
A thick strong band across the atlantal ring
Divides the ring into unequal parts; the larger
posterior part which surrounds the spinal cord and
meninges and the anterior part which contains the dens
Holds the dens against the anterior arch, without it C1 &
C2 would translate
Attached to a small, medial tubercle on each atlantal
lateral mass
Is broader centrally and bears an anterior thin layer of
articular cartilage
Forms the transverse part of the atlantal cruciform
ligament
Ligaments of the Cervical Spine

Alar Ligaments
A static stabilizer that allows the dens to sit central
Strong round cords that start on each side of the apex of
the dens
They ascend laterally to rough impressions on the
medial sides of the occipital condyles
Ligaments of the Cervical Spine

Apical Ligament
Extends from the apex of the dens to the anterior margin
of the foramen magnum between the alar ligaments
Blends with the deep fibers of the anterior
atlantooccipital membrane
Ligaments of the Cervical Spine

Anterior Longitudinal Ligament


From C1 Sacrum
Connects the vertebrae in the front extends from
the anterior surfaces of the vertebral bodies
Strong wide band
Longitudinal fibers attach to the IVD, hyaline cartilage,
lamina and adjacent vertebral bodies strongly
Broader caudally and thinner cranially where at
about C1 it is replaced by the Anterior
Atlantaloccipital Membrane
Ligaments of the Cervical Spine

Anterior Atlantooccipital Membrane


Continuation of the anterior longitudinal ligament
Connects the anterior margin of the foramen magnum
to the upper border of the anterior atlantal arch
Laterally it blends with the anterior portion of the
capsule
Ligaments of the Cervical Spine

Posterior Longitudinal Ligament


Lies in the vertebral canal on the posterior surfaces
of the vertebral bodies
Continuous with the membrane tectoria at about C1/C2
Smooth and glistening fibers that allow the spinal
cord to move in relation to it
Attached to the IVD, hyaline cartilage and vertebral
bodies, reinforces the discs posteriorly
Ligaments of the Cervical Spine

Membrane Tectoria
Connects the axis and the occipital bone inside the
vertebral canal
Broad, strong band of fibers covering the dens and
its ligaments
Very smooth tissue for the spinal cord to glide along
Is a extension of the posterior longitudinal
ligament
Ligaments of the Cervical Spine

Posterior Atlantal Occipital Membrane


Broad and thin
Connects the posterior margin of the foramen
magnum to the upper border of the posterior
atlantal arch
Ligaments of the Cervical Spine

Ligamentum Flavum
Connects lamina to lamina in the vertebral canal
Descends from one lamina from the inferior surface to
the lower superior surface of the lamina below
Yellow elastic tissue to allow for mobility and recoil
Ligaments of the Cervical Spine

Ligamentum Nuchae
Bilaminar fibroelastic intermuscular septum
Separates the left and right upper trapezius
Yellow elastic tissue to allow for stability and
mobility
Extends from the external occipital protuberance to
C7
Attached to the median aspects of the bifid spines of the
C-spine
Ligaments of the Cervical Spine

Supraspinous Ligament
Strong fibrous cord
Attaches SP to SP
From C7 to the sacrum
Thicker and broader in the L-Spine
Intimately blends with neighboring fascia
Ligaments of the Cervical Spine

Interspinous Ligament
Thin almost membranous
Connects adjoining spines from the root to the apex
of each
Meets the ligamentum flavum in front (anterior)
and supraspinous ligament behind (posterior)
Narrow and elongated in the T spine, broader and
thicker in the L spine
Poorly developed in the C spine
Intervertebral
Supraspinous ligament disc
Transverse process Anterior
longitudinal
ligament
Sectioned
spinous process
Intervertebral foramen
Ligamentum flavum Posterior longitudinal
ligament
Interspinous Anulus fibrosus
ligament
Nucleus pulposus
Inferior articular process Sectioned body
of vertebra
Median section of three vertebrae, illustrating the composition
of the discs and the ligaments
Ligaments of the Cervical Spine

Intertransverse Ligament
Between transverse processes, superior part of one
below to the inferior part of one above
In C spine, few irregular fibers
In T spine, cords blended with surrounding
muscles
In L spine, thin and membranous