BONES AND JOINTS OF

THORAX
VERTEBRAL COLUMN

The vertebral column is also called the spine, the spinal column, or
backbone.

It is a central axis of the body.

It supports the body weight and transmits it to the ground through

the lower limbs.

The vertebral column is made up of 33 vertebra -7 cervical, 12

Thoracic, 5 lumbar ,5 sacral and four coccygeal.
 VERTEBRAL COLUMN
• There are eight nerves.
• The upper seven lying above the
Cervical region. corresponding vertebra and the 8 th below
the 7th vertebra.

Thoracic, lumbar, • Number of vertebra corresponds to the

number of spinal nerves.
and sacral • Each nerve lying below the corresponding
regions. vertebra.

• There’s only one Coccygeal nerve.

Coccygeal region.
VERTEBRAL COLUMN

Sometimes the vertebra also grouped

according to their mobility.
Movable our true vertebra include the 7 cervical, 12 thoracic and 5 lumbar
vertebra, making a total of 24 vertebra. 12 thoracic vertebra have ribs
attached to them.

The fixed vertebrae include those of the sacrum and coccyx.

 VERTEBRAL COLUMN

The length of the spine is
about 70 centimeter
males and about 60
centimeter in females.
As a result of variation in
The intervertebral disc
width of the vertebrae, the
contributed 1/5 of the
vertebrae column can be
length of the vertebral
said to made up of four
column.
pyramids.

This arrangement has a

functional bearing. The is partly compensated by
narrowing of the the transmission of weight
vertebral column at the to the lower thoracic
level of disc between 4th region through the ribs
thoracic and 5th thoracic and.
vertebra
Curvatures
Sagittal plane.
• Primary curves are present at birth due
to the shape of the vertebral bodies .
• Thoracic and sacral, both of which are
concave forwards.
• Secondary curves are postural and are
mainly due to the shape of the
intervertebral disc.
• Cervical and lumbar both of which are
convex forward.
• Cervical curve appeared during four to
five months after birth when the infant
start supporting its head.
• The lumbar curve appears during 12 to
18 months when the child assumes upright
posture
Coronal plane
• There is slight lateral Curve in the
thoracic region with its concavity towards
the left.
• It is possible due to the greater use of the
right upper limb and the pressure of the
aorta.
• The curvatures add to the elasticity of
spine and the number of curves gives it a
higher resistance to weight than would be
afforded by a single curve.
 Parts of a Typical Vertebra
Body Pedicles Lamina

• Lies anteriorly. • Right and left, are short • Each pedicle is

• It is shaped like a short
cylinder, being
rounded from side-to-
side and having flat
upper and lower
surfaces that are
attached to those of
adjoining vertebrae by
intervertebral discs
rounded bars that continuous,
project backwards, posteromedially with a
and somewhat laterally, vertical plate of bone
from the posterior called the lamina.
aspect of the body. • The laminae of the two
sides pass backwards
and medially to meet in
the midline.
• The pedicles and
laminae together
constitute the
vertebral or neural
arch.
 Parts of a Typical Vertebra
Vertebral foramen
• Bounded anteriorly by the
posterior aspect of the
body, on the sides by the
pedicles, and behind by the
lamina.
• Each vertebral foramen
forms a short segment of
the vertebral canal that
runs through the whole
length of the vertebral
column and lodges the
spinal cord.
Spinous process
• Passing backwards and
usually downwards from the
junction of the two
laminae, there is the spine
or spinous process
Transverse process
• Passing laterally and usually
somewhat downwards from the
junction of each pedicle and the
corresponding lamina, there is a
transverse process.
• The spinous and transverse
processes serve as levers for
muscles acting on the vertebral
column.
• From a morphological point of
view, the transverse processes
are made up of two elements—
the transverse element and the
costal element.
• In the thoracic region, the two
elements remain separate, and
the costal elements form the ribs.
• In the rest of the vertebral
column, the derivatives of costal
element are different from those
derived from transverse element.
 Transverse Process

Costal Element
Thoracic :
Forms a descriptive Forms that Rib.
transverse process.
Transverse
Element

1.Anterior Wall of foramen transversarium.

Cervical :
2.Anterior tubercle.
Fuses with the coastal element and 3.Costotransverse bar.
forms the medial part of the posterior 4.Posterior tubercle.
wall of the foramen Transversarium. 5.Lateral part of the posterior wall of the foramen.

Lumbar:
Form their real transverse process.
From the accessory process.

Sacral :
Fuses with the coastal element to Form the anterior part of the lateral
form the posterior part of the lateral mass.
mass.
Parts of a Typical Vertebra
Articular Vertebral Intervertebra
facets. notch. l foramina.

Projecting upwards from The pedicle is much The superior and

the junction of the narrow in vertical inferior notches of
pedicle and lamina a diameter than the body adjoining vertebrae join
superior articular and is attached near its to form the
process present on either upper border. intervertebral
side. foramen.

Projecting downwards, As a result, there is a

large, inferior vertebral Which give passage to the
there is an inferior dorsal and ventral rami
articular process. notch below the pedicle.
of the spinal nerve
emerging from the spinal
cord.

Each process bears a

smooth articular facet :
the superior facet of one Above the pedicle, there is
vertebra articulates with a much shallower superior
inferior facet of the vertebral notch.
vertebra above it.
Thoracic Vertebrae - Identification

The thoracic vertebrae are identified by the presence

of costal facets on the side of the vertebral bodies.

The costal facets, maybe two or only one on each

side.

There are 12 thoracic vertebra out of each 2th to 8th

are typical, and the remaining five are atypical.
Typical Thoracic Vertebrae
• The body is heart shaped, with roughly the same measurement from side
to side and anterior posteriorly.

Body. • On each side, it bears 2 costal Demi facets.

Costal
• The superior Coastal Navy fested is larger and placing the upper border of
the body near the pedicle it articulates with the head of the numerically
corresponding rim. The.

Demifacet.
• The inferior coastal Democrat is smaller employers on the lower border in
front of the inferior vertebral and notch. It articulates with the next lower
rib

Vertebral
• The Vertebral foramen is comparatively smaller and circular.

Foramen
 Typical Thoracic Vertebrae
The Pedicles are directed straight The superior vertebral notches while the inferior vertebral
downwards. shallow, notches deep and conspicuous.

The laminae overlap each other

from above.
Vertebral

The superior articular process

The articular facets are flat This direction permits rotatory
project upwards from the
enough directed backwards. movement of the spine.
arc

junction of pedicle and lamina.

The inferior articular process are Their articular facets are

fused to the lamella. directed downwards.

The transverse processes are The anterior surface of each In the upper 6 vertebra, the In lower 4, the facet of are and
large and are directed laterally process bears a facet near its tip costal facets on the transverse face upwards,laterally and slightly
backwards from the junction of for articulation with the tubercle process are concave and face forward. In the last two vertebral
the pedicles and lamina. of the corresponding rib. forward and laterally articular facets are absent.

The 5th to 9th Spine are the

The spine is long and is directed The upper and lower spine are
longest, more vertical and
downwards and backwards. less oblique in direction.
overlap each other.
Attachments.
• No upper and lower body for the body give attachment in front and behind respectively to the anterior and posterior
longitudinal ligament.
Borders.

• The upper borders and lower parts of the anterior surface of the lamina provide attachment to the ligament of flower.

Lamina

• Lateral costotransverse ligament at the tip.

• Superior costotransverse ligament along the lower border.
Transverse • Inferior poster transfer ligament along the anterior surface.
process. • Levator costae on the posterior surface.

• Give attachment to the supraspinous and interspinous ligament.

• They also give attachment to the several muscles included and including the trapezius, rhomboids, latissimus dorsi, serratus
Spines posterior superior, and the serratus posterior inferior and the many deep muscles of the back.
Atypical thoracic Vertebra.
A first thoracic vertebra. The body of this vertebra resembles that of a cervical vertebra.
• It is broad and not heart shaped.
• It’s upper surface is lifted laterally and beveled anteriorly.
• The superior coaster facet on the body is complete. It articulates with the head of the first rib.
• The inferior coastal facet is a demifacet for the second rib.
• The spine is thick, long, and nearly horizontal.
The superior vertebral notches are well marked as in cervical vertebra.
• Facet on transfers process is concave on T1 to T6 vertebra.
The ninth thoracic vertebrae resembles a typical thoracic vertebra except that the body has only the
9 thoracic vertebra. superior coastal dam facet.
• The inferior coastal facets are absent.
• Facet on transverse process is flat on T7 to T10 vertebra.

The 10th thoracic vertebra resembles a typical thoracic vertebra, except that the body is a single,
10 . Thoracic vertebra.
th
complete superior coastal facet on each side, exceeding onto the root of the pedicle.

11 thoracic vertebra. The body has a single large poster facet on each side extending onto the upper part of the pedicle.

• The transverse process is small and has no articular facet. Sometimes it is difficult to differentiate between the 10 th and 11th thoracic vertebra.

12th thoracic vertebra. The shapes of the body pedicles transverse presents fine are similar to those of a lumbar vertebra.
• However, the body beats a single poster facet on each side which lies lower on the. More on the lower part of the pedicle than on the body.
• The transfer process is small and has no façade, but has superior, inferior and lateral tubercles.
• The inferior articular facets are lumbar in type.
• These are inverted in a directed laterally, but the superior articular facet are thoracic in time.
Ossifications.

The ossification of The three primary

typical vertebra and a centers - one from the At birth, the vertebra
thoracic vertebra are centrum and one from consist of three part the
similar, it ossifies in each half of the neural centrum and two half of
cartilage from 3 primary arch, appear during 8th the neural arch.
and 5 secondary centers. to 9th week of fetal life.

The two halves of the The neural arch is joined

Boney fusion occurs here
neural arch fuse with the centrum by
during the 3rd to 6th years
posteriorly during the NeuroCentral
of life.
first year of life. Synchondrosis.
Clinical anatomy.
spina bifida
and
• Failure of fusion of two halves of the neural are results in spina bifida.
• Sometimes the body ossifies from two primary centre and if one centre fees to develop ½ right or left of
the body is missing.
• This result in a hammy vertebra and lateral bend in whatever column or scoliosis.

scoliosis
Disc
• In young adult, the discs are very strong.
• However, after the second decade of life, degenerative changes set in, result in weakness of the annulus
fibrous.
• When such a day celebrated to strain, the analysis of fibrosis may rupture, leading to prolapse of the

Prolapse
nucleus pulposus.
• This is commonly referred to as disk prolapse.
• It may occur even after a minor strain.
• In addition to prolapse of the nucleus, pulposus internal de arrangements of the days may also takes place.

• This prolapse is usually posterior lateral.

• The prolix nucleus pulposus presses upon adjacent nerve roots and gives rise to pain that radiates along the

Sciatica
distribution of the nerve.
• Such pain along the course of the sciatic nerve is for sciatica.
• Motor effects with loss of power and reflexes may follow.
• Disc prolapse occurs most frequently in the lower lumbar region.
• It is also commonly in the lower cervical region from 5 th to 7th cervical vertebra.
Joints of thorax.
Manubriosternal joint
• Manubriosternal joint is a
secondary cartilages joint
• It permits slight movements of
the body of the sternum on the
Manubrium during respiration.
Costovertebral joints Costochondral joints
• The head of a typical rib • Each Rib is continues anteriorly
articulates with its own with its cartilage to form a
vertebra and also with the body primary cartilage joint.
of the next higher vertebra to • No movements are permitted at
form two plane synovial cavity these joints.
is separated by an intra
articular ligament.
• This ligament is attached to the
Ridge on the head of the rib
and to the intervertebral disc.
• Other ligaments of the joint
include a capsular ligament and
a Triradiate ligament.
• The upper ligament is attached
to the vertebra above.
• The lower ligament is attached
to the vertebra below.
• The middle band of the
TriRadiant ligament forms the
Hypochordal bow uniting the
joints of the two sides.
Costotransverse joint.
Joint
• The tubercle of a typical articulates
with the facet on anterior surface or
transverse process of the
corresponding vertebra to form a
synovial joint.
• The capsule ligament is
strengthened by three
costotransverse ligaments.
Costotransverse ligaments
• the superior costotransverse
ligament has two lamina, which
extend from the Crest on the neck
of the rib, to the transverse process
of the vertebra above.
• The inferior posterior fossa
development password from the
posterior surface of the neck to the
transverse process of its own
vertebra.
• The latter, costo transverse
ligament, connects the lateral non
articular part of the tubal pull to
the tip of the transfer process of its
own vertebra.
Articulation
• The articular facets on the tubercles of the
upper six ribs are convex and permit rotation
of the neck of the rift for pump handle
movements.
• Rotation of rib-neck backwards causes
elevation of 2nd to 6th grade while moving
forwards and upwards of the sternum. This
increases the anterior posterior diameter of
the thorax.
• The articular surface of the 7th to 12th leaves
are flat, permitting up and down gliding
movements or bucket handle movement of
the lower and the neck of the seven to 10th
rib move upward. Backwards and medially
the results is increasing infrastructural
angle. This causes increase in transfer
diameter of three.
Joints of thorax.
• The first Chondrosternal joints is a primary cartilage is joined.
• It does not permit any movement .
• This helps in the stability of the shoulder girdle and of the upper limb.
• The 2nd to 7th coastal cartilage articulate with the sternum by synovial
Chondrosternal joints
joints.
• Each joint has a single cavity except in the second joint where the cavity
divided into two parts.
• The joints are held together by the capsular and radiate ligaments.
• The 7th to 9th coastal cartilages articulate with one another was synovial
Interchondral joints
joint. The 10th cartilage is united to the 9th by fibrous tissue.
• Adjoining vertebrae are connected to each other at three joint there is a
medium joint where the vertebral bodies and two joints on the right side
and one on the left side between the articular processes. The joints
between the articular processes are plains 9 novial joints. The joint
Intervertebral joints
between the vertebral body is a symphysis. The surface of the vertebral
bodies are lined with thin layers of highland cartilage. Between these
layers of Highland Park, there are thick plate of fibrocartilage which is
called the intervertebral disc.
Intervertebral disc.
Variation in intervertebral disc.
• These are fibrocartilaginous discs which
Intervene between the bodies of adjacent
vertebrae and bind them together.
• Their shape corresponds to that of the
vertebral bodies between which they are
placed.
• The thickness of the discs varies in
different regions of vertebral column, and
different types of the same disk
• In the cervical and lumbar region, the
disks are thicker in front and then behind.
• While in the thoracic region they are of
uniform thickness.
• The discs are thinnest in the upper
thoracic region and thickest in the lumbar
region.
Parts of intervertebral disc. Functions of intervertebral disc.
• The discs contribute about 1/5 of the • The intervertebral discs give shape to the
length of the vertebral column. vertebral column.
• The contribution is greater the cervical • They act as a remarkable series of shock
and lumbar region than in the thoracic absorbers or buffers.
region. • Because their elasticity they allow slight
• Each disc is made up of following two movement of the vertebral bodies on each
farts. other, more so in the cervical and lumbar
• The nucleus pulposus is the center part of region.
the disk. • When the slight movements at individual
• It is soft and gelatinous at birth. discs are added together they become
• It is kept under tension and act as a considerable.
hydraulic shock absorbers.
• With advancing age, the elasticity of the
discs is much reduced.
• The annulus fibrous from the peripheral
part of the disk.
• It is made up of the narrower outer zona
of Collagenous fiber and a wider inner
zone of fibrocartilage.
• The fiber form laminae that are arranged
into the form of incomplete rings.
• The rings are connected by short fibrous
band.
• The outer collagenous fibers blend with
the anterior posterior longitudinal
ligaments.
 Ligaments connecting adjacent vertebra.
Apart from the intervertebral disc in the capsule around the joint between the
articular processes, adjacent vertebra connected by several ligaments which are as
follows.

• Passes from the anterior surface of body of 1 vertebra to another.

Anterior
longitudinal • Its upper end reaches the basilar part of the occipital bone.
ligament.

• President of the posterior surface of whatever bodies within the vertebral canal.
Posterior
longitudinal • Upper and reaches the body of the axis vertebra (C2) beyond which it is continuous with the membrane tectoria.
ligament.

Intertransverse
• Connect adjacent transverse processes.
ligament.

Interspinous
• Connect adjacent spines.
ligament.

• Connect the tips of the spines of vertebra from the 7th cervical to the sacrum.
Supraspinous
ligaments.
• In the cervical region, they are replaced by ligamentum nuchae.

• Connect the lamina of adjacent vertebra.

Ligamentum
flava
• Made up of mainly of elastic tissue.
Respiratory movements.
Introduction. Lungs expand during inspiration and retract during expiration.
These movements are governed by the following two factors.

Alteration in the capacity of the thorax : brought about by

movements of the thoracic wall.

Increasing volume of the thoracic cavity creates a negative

intrathoracic pressure, which sucks air into the lungs.

Movement of the thoracic wall occur chiefly at the

Costovertebral and Manubriosternal joint.

Elastic recoil : pulmonary alveoli and end thoracic wall expels

air from the lungs during expiration.
 • Each rib may be regarded as a lever, the fulcrum of which lies just lateral to the Tubercle.
• Because of the disproportionation in the length of the two arms of the lever, the slight

Rib as a lever.
movement of the vertebral end of the are greatly magnified at the anterior end.

Anteroposterior
• Anterior end of the rib is lower than the posterior end.
• Therefore, during elevation of the rib , anterior end also moves forwards.
• This occurs mostly in the vertebral sternal ribs, along with the up and down movement of the
2nd to 6th ribs.

diameter . • The movement of the sternum also moves up and down, called pump-handle movement.
• In this way, the anterior posterior diameter of the thorax is increased.

Transverse
• Middle of the shaft of the rib lies at a lower level than the plane passing through the two ends.
• Therefore, during elevation of the race, the shaft also moves outwards.
• This causes increase in the transverse diameter of the thorax.
•

diameter.
Such movement occur in the vertebrochondral ribs and are called bucket handle movement.
• The thorax resembles a corn tapering upwards. Each rib is longer than the next higher rib. On
elevation, the larger lower rib comes to occupy the position of the smaller upper rib, which
pushes sternum forward. This also increase the transfer diameter the thorax.

Vertical
• Increased by the ‘piston movement’ for the thoracoabdominal diaphragm

diameter.
Respiratory movements
Anteroposterior diameter is increased.
• Mainly by the pump and the movement of the sternum brought about by the elevation
of vertebral sternal 2nd to 6th.
• Partly by elevation of the 7 th to 10th vertebrae condolences.

Transverse diameter is increased.

• Mainly by the bucket handle movement of the seven to 10. The Vertebrocondral ribs.
• Partly by the elevation of the 2nd to 6th vertebrasternal ribs.

Vertical diameter is increased.

• By descent of the diaphragm as it contracts, this is called piston mechanism.
• During inspiration, the diaphragm contract and it comes down by 2cm.
• It is aided by relaxation of muscles of anterior abdominal wall.
• During expiration, abdominal muscle contract and diaphragm is pushed upward.
• It facilitates in inspiration of at least 400ML of air during each contraction
• In female respiration is thoracoabdominal and in male it is abdominothoracic type.
Respiratory movements – Respiratory muscles
For inspiration
• Diaphragm, external intercostal muscle and part of internal
intercostal of contralateral side
Deep inspiration
• Erector spinae, scalene muscles, pectoral muscles

For expiration – passive process

Forced expiration
• Muscles of anterior abdominal wall
Respiratory movements- Respiratory movements
during different types of breathing.
• Quiet inspiration : AP diameter increases by elevation – 2nd to 6th
ribs. 1st rib remains fixed.
• Transverse diameter increases by elevation – 7th to 10th ribs.
• Vertical diameter is increases by descent of diaphragm.
• Deep inspiration : movements increases
• 1st rib elevated by scaleni- indirectly by the sternocleidomastoid
Inspiration
• Concavity of thoracic spine is reduced by the erector spinae.
• Forced inspiration: All the movement describe are exaggerated.
• Scapula are elevated and fixed by the trapezius, levator scapula
and the rhomboids so that the serratus anterior and the
pectoralis minor muscle may act on the spine.
• Action of Erector spinae is increased.
• Quiet expiration: Mainly by the elastic recoil of the chest wall
and pulmonary alveoli, and partly by the tone of the abdominal
Expiration. muscle.
• Deep and forced expiration: Brought by strong contraction of the
abdominal muscle and of the Latissimus dorsi.
Clinical anatomy.
In Dyspnoea or difficulty in breathing, the
patients are most comfortable on sitting,
leaning forward, fixing the arms.
In sitting posture, the position of diagram
is the lowest, allowing maximum
ventilation.
extremely uncomfortable, as he/she needs
Fixation of the arm fixes the scapula so
that the serratus anterior pectoralis minor
may act on the ribs to good advantage.
Most prominent role in respiration is
played by Diaphragm.
Respiration occurs in two phases:
Inspiration - active phase of 1s
Expiration - passive phase of 3s
While sitting the patient is quite
Height of the diaphragm in the thorax is
comfortable as the effort required for
variable according to the position of the
inspiration is the least.
body and tone of the abdominal muscle.
The diaphragm is midway in position while
It is highest supine, so the patient is
standing, but the patient is too ill or
exhausted to stand so dyspnoea patient
to exert immensely inspiration.
feel comfortable while sitting.
In young children, the thoracic cavity is
Women of advanced stage of pregnancy,
almost circular. In Cross section to the
descent of diaphragm is limited, so the
scope for anteroposterior site to site
type of respiration in them is mainly
expansion is limited. The type of
thoracic.
respiration is in children is abdominal.