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Lesson 2

We will review how to: Define the key terms of this chapter and state the meanings of the word origins of this chapter. Describe the relationship between cranial suture joints and childbirth. List the major muscles of mastication and describe their role in mastication. Explain the possible relationship between TMJ dysfunction and the muscular system. Describe the structure and function of the spine. Define the curves of the spine and describe their development. 2

1. Suture joints 2. Temporomandibular joints (TMJs) 3. Atlanto-occipital and atlantoaxial joints 4. Cervical spinal joints 5. Thoracic spinal joints a. Rib joints 6. Lumbar spinal joints 3

Structure Classification: Fibrous joint Suture joint Function Classification: Synarthrotic Major Motions Allowed: Nonaxial 4

Structure Classification: Synovial joint Modified hinge Function Classification: Diarthrotic Uniaxial Major Motions Allowed: Elevation and depression Protraction and retraction Left and right lateral deviation 5

1 2 depression elevation protraction retraction 3 Left lateral deviation Right lateral deviation 6

Major Ligaments of the TMJ: Fibrous joint capsule Temporomandibular ligament Stylomandibular ligament Sphenomandibular ligament 7

Major Muscles of the TMJ: Lateral pterygoid Medial pterygoid Temporalis Masseter Causes of TMJ Dysfunction: Tightness/imbalance of muscles that cross the TMJ Forward-head posture 8

Elements of the Spine: Cervical spine Thoracic spine Lumbar spine Sacrococcygeal spine Shape of the Adult Spine Primary spinal curves Thoracic curve Sacrococcygeal curve Secondary spinal curves Cervical curve Lumbar curve 9

Development of the Spinal Curves: - Born with one kyphotic curve - Develops a cervical lordosis - Develops a lumbar lordosis 10

Functions of the Spine: Provides structural support Allows movement Protects the spinal cord Provides shock absorption 11

1. Suture joints 2. Temporomandibular joints (TMJs) 3. Atlanto-occipital and atlantoaxial joints 4. Cervical spinal joints 5. Thoracic spinal joints Rib joints 6. Lumbar spinal joints 12

Segmental Structure: One median joint Two lateral joints Types of Spinal Joints: Intervertebral disc joints (disc joints) Vertebral facet joints (facet joints) 13

Structure Classification: Cartilaginous joint Symphysis Function Classification: Amphiarthrotic Functions of a Disc Joint: Determines amount of movement Absorbs shock Bears the weight of the body Maintains opening for spinal nerves 14

B Structure Classification: Synovial joint Plane Function Classification: Diarthrotic Function of a Facet Joint: Guides movement Motion Freely Allowed by the Facet Joints: Cervical facets - Right and left rotation in transverse plane - Right and left lateral flexion in frontal plane 15

B Motion Freely Allowed by the Facet Joints Thoracic facets Right and left lateral flexion in frontal plane C Motion Freely Allowed by the Facet Joints Lumbar facets Flexion and extension in sagittal plane 16

1. Flexion and Extension: Sagittal plane Mediolateral axis 1. 2. 2. Right and Left Lateral Flexion: Frontal plane Anteroposterior axis 3. 3. Right and Left Rotation: Transverse plane Vertical axis 17

Gliding Translational Movements: Right-side and left-side translation Anterior and posterior translation Superior and inferior translation 18

Major Ligaments of the Spinal Joints: Fibrous capsules of the facet joints Annulus fibrosus of the disc joints Anterior longitudinal ligament Posterior longitudinal ligament Ligamentum flava Interspinous ligaments Supraspinous ligament Intertransverse ligaments Nuchal ligament 20

Major Muscles of the Spinal Joints: Spinal extensors What are some examples of muscles Spinal flexors that belong to these groups of muscles? Lateral flexors The erector spinae group, the Rotators transversospinalis group, and other muscles of the posterior neck and trunk are examples of spinal extensor muscles. Muscles of the anterior abdominal wall and muscles in the anterior neck are examples of spinal flexors. Most flexors and extensors are also lateral flexors. All lateral flexors are ipsilateral lateral flexors. Prominent rotators of the trunk include the external and internal abdominal obliques and the transversospinalis group muscles. 22

Structure Classification: Synovial joint Condyloid Function Classification: Diarthrotic Triaxial Major Motions Allowed: Flexion and extension Right and left lateral flexion Right and left lateral rotation 23

Flexion/extension Right lateral flexion and left lateral flexion Right rotation and left rotation 24

This bump is the odontoid process, often called the dens. The atlantoaxial joint (AAJ) is a cervical joint that is located between the atlas (C1) and the axis (C2). The AAJ allows the atlas to move on the axis. 25

Structure Classification: Synovial joints Atlanto-odontoid joint: Pivot joint Lateral facet joints: Plane joints Function Classification: Diarthrotic Biaxial Major Motions Allowed: Right and left rotation Flexion and extension Right and left lateral flexion Major Muscles of the Occipito- Atlantoaxial Region: Suboccipital group Rectus capitis anterior Rectus capitis lateralis 26

Special Vertebrae of the Cervical Spine: C1 atlas C2 axis C7 vertebral prominens 27

Special Characteristics of the Cervical Vertebrae: Transverse foramina Bifid spinous processes Bifid transverse processes Uncinate Processes Uncovertebral joint 28

Functions of the Cervical Spine: Bears the weight of the head Allows movement in all three planes Major Motions Allowed: Flexion and extension Right and left lateral flexion Right and left rotation Gliding translational movements in all three directions 29

List the joints at which rib motion occurs; explain how the movement of a bucket handle is used to describe how rib motion occurs. Describe the roles of the muscles of respiration. Explain the mechanism of thoracic breathing versus abdominal breathing. Describe the general structure and function of the cervical spine, thoracic spine, and lumbar spine. Describe the structure and function of the thoracolumbar fascia and abdominal aponeurosis. 30

Suture joints Temporomandibular joints (TMJs) Atlanto-occipital and atlantoaxial joints Cervical spinal joints Thoracic spinal joints Rib joints Lumbar spinal joints 31

Costospinal Joints of the Thoracic Spine: Costospinal articulations Costovertebral joint Costotransverse joint Structure classification Synovial joints 32

Costospinal Joints of the Thoracic Spine: Function classification Nonaxial Functions Stabilize ribs Allow ribs to move relative to the spine Spinal Joints of the Thoracic Spine: Major motions allowed Flexion and extension Right and left lateral flexion Right and left rotation Gliding translational movements 33

Costospinal Joints Sternocostal Joints Intrasternal Joints 34

Types of Costospinal Joints: Costovertebral joint Costotransverse joint 35

Structure of the Thoracic Spine: Two costal hemifacets per vertebra Intervertebral disc Ligaments of a Costovertebral Joint: Fibrous joint capsule Radiate ligament Structure of the Thoracic Spine: One full costal facet per vertebra Ligaments of a Costotransverse Joint: Fibrous joint capsule Costotransverse ligament Lateral costotransverse ligament Superior costotransverse ligament 36

Types of Ribs: True ribs False ribs Floating ribs Structure Classification: Cartilaginous joint Synchondrosis Function Classification: Amphiarthrotic Gliding 37

Types of Intrasternal Joints: Manubriosternal joint Sternoxiphoid joint Ligaments of the Intrasternal Joints: Manubriosternal ligament Sternoxiphoid ligament Both of the intrasternal joints are fibrocartilaginous amphiarthrotic joints. 38

Inspiration and Expiration Roles of Muscles of Respiration: Inspiration Elevate the ribs Expand the thoracic cavity downward Expiration Depress the ribs Expand the abdominal cavity upward 39

Abdominal Breathing: Contraction of the diaphragm Expanding thoracic cavity downward Thoracic Breathing: Further contraction of the diaphragm Elevating the lower ribs Roles of Muscles of Respiration: Inspiration Elevate the ribs Expand the thoracic cavity downward Expiration Depress the ribs Expand the abdominal cavity upward 40

Functions of the Lumbar Spine: Bears the weight of the body Allows movement Major Motions Allowed: Flexion and extension Right and left lateral flexion Right and left rotation Gliding translational movements in all three directions 41

Special Characteristics: a. Lumbosacral joint Allows the pelvis to move relative to the trunk b. Sacral base angle Determines the curvature of the spine 42

Major Motions Allowed: Flexion and extension Right and left lateral flexion Right and left rotation Flexion/extension Right/left lateral flexion Right/left rotation 43

Structure: Layer of fascia located in thoracic and lumbar regions Located posteriorly in the trunk Divided into three layers Functions: Provides attachment sites for muscles Adds to the stability of the trunk 44

Abdominal Aponeurosis Structure: Layers of fibrous connective tissue located in the abdominal region Located anteriorly in the trunk Left and right aponeuroses Functions: Provides attachment sites for muscles Adds to the stability of the trunk 45

Define the key terms of this chapter and state the meanings of the word origins of this chapter. Describe the structure of the pelvis and explain the difference between intrapelvic motion and motion of the pelvis relative to an adjacent body part. Describe the sacral movements of nutation and counternutation. Describe and compare movements of the pelvis at the lumbosacral and hip joints. Explain the reverse action relationships between pelvic movements and movements of the trunk and thighs. 46

~Symphysis pubis joint ~Sacroiliac joints ~Lumbosacral joint ~Hip joints ~Knee joint complex ~Tibiofibular joints ~Talocrural (ankle) joint ~Tarsal joints ~Tarsometatarsal joints ~Intermetatarsal joints ~Metatarsophalangeal (MTP) joints ~Interphalangeal (IP) joints 47

Joints Located within the Pelvis: Symphysis pubis joint Sacroiliac joints Pelvic Motion: Intrapelvic motion Motion of pelvis as a unit relative to an adjacent body part 48

Symphysis Pubis Joint: Structure: Cartilaginous joint Symphysis joint Function: Amphiarthrotic Major motions: Nonaxial gliding Major ligaments: Arcuate pubic ligament Sacroiliac Joints: Structure: Mixed synovial/fibrous joint Plane joint Function: Mixed diarthrotic/amphiarthrotic Major motions allowed: Nonaxial gliding Nutation and counternutation 49

Major ligaments of the SI joint: Sacroiliac ligaments Sacrotuberous ligament Sacrospinous ligament Iliolumbar ligament 50 Intrapelvic Motion

Posterior/anterior tilt Right rotation pelvis/left rotation pelvis Elevation right pelvis Elevation left pelvis 51

Posterior tilt anterior tilt Depression right pelvis depression left pelvis Right rotation pelvis left rotation pelvis 52

When the pelvis moves at both the lumbosacral joint and the hip joints, it changes in position relative to both the spine and the femurs. When the pelvis approaches its maximum range of movement at the lumbosacral joint, motion also occurs at the lumbar spinal joints, changing the lumbar spinal curve. 53

Sagittal plane movements Frontal plane movements Transverse plane movements 54

Muscles involved include both left-sided ipsilateral rotators of the trunk (the erector spinae group and left internal abdominal oblique) and right-sided contralateral rotators of the trunk (the right transversospinalis group and right external abdominal oblique). 56

Sagittal plane movements Frontal plane movements Transverse plane movements 57

Pelvic/thigh movement in the transverse plane results from the action of posterior and anterior groups of musculature. The posterior group is often called the lateral rotators of the hip joint. The anterior group is often called the medial rotators of the hip joint. 59

Sacral base angle Lumbopelvic rhythm Righting reflex 60

Explain the relationship between pelvic posture (and, specifically, the sacral base angle) and spinal posture. Discuss the meaning of open-chain and closed-chain activities and give examples of each. Explain the concepts of the femoral angle of inclination and femoral torsion angle, and explain the possible consequences of these femoral angulations. Describe and give an example of the concept of femoropelvic rhythm. 61

Symphysis pubis joint Sacroiliac joints Lumbosacral joint Hip joints Knee joint complex Tibiofibular joints Talocrural (ankle) joint Tarsal joints Tarsometatarsal joints Intermetatarsal joints Metatarsophalangeal (MTP) joints Interphalangeal (IP) joints 62

Structure Classification: Synovial joint Ball-and-socket Function Classification: Diarthrotic Triaxial Major Motions Allowed: Flexion and extension of thigh Abduction and adduction of thigh Medial rotation and lateral rotation of thigh Reverse Actions: Movement of pelvis 63

Open-chain activity Distal bone of joint free to move Closed-chain activity Distal bone of joint fixed Chain activities involve linked kinematic elements (such as bones). An open chain allows movement of the distal element. A closed chain does not, requiring that the proximal element move instead. 64

Major Ligaments of the Hip Joint: Fibrous joint capsule Iliofemoral ligament Pubofemoral ligament Ischiofemoral ligament Ligamentum teres Closed-Packed Position: Full extension Major Muscles of the Hip Joint: Anterior muscles Posterior muscles Medial muscles Lateral muscles 65

Femoral Angles of Inclination: The head, neck and shaft that compose the femur do not lie in a straight line. 66

There tends to be a rhythm to how the femur of the thigh and the pelvis move. When the actions of the thigh and the pelvis are coupled to allow a greater elevation of the foot in the air, this coordination of movement is known as femoropelvic rhythm. Femoropelvic motion couples right thigh extension at the hip joint with an anterior tilt of the pelvis at the left (contralateral) hip joint. 67

Tibiofemoral joint Patellofemoral joint Structure Classification: Synovial joint Modified hinge joint Function Classification: Diarthrotic Biaxial Major Motions Allowed: Flexion and extension of leg Medial rotation and lateral rotation of leg Reverse Actions: Flexion and extension of thigh Lateral rotation and medial rotation of thigh 69

Major Ligaments of the Knee Joint: Fibrous joint capsule Medial collateral ligament Lateral collateral ligament Anterior cruciate ligament Posterior cruciate ligament 70

Closed-Packed Position: Full extension Major Muscles of the Knee Joint: Anterior muscles Posterior muscles Medial muscles Lateral muscles Menisci Medial meniscus Lateral meniscus Major bursae Sub patellar Screw-home mechanism The patellofemoral joint is formed by the articulation between the patella and the femur and located within the capsule of the knee joint along with the tibiofemoral joint. However, the tibia is not directly involved in the movement of the patella. The intercondylar groove shown in the figure indicates the path along which the patella tracks the femur during its nonaxial gliding movement. P a t e ll o f e m o r a l j o i n t 72

Structure of the Patella: Medial facet Lateral facet Articular cartilage Major Motions Allowed: Superior and inferior gliding (nonaxial) movements Closed-Packed Position: Flexion (of the knee joint) Functions of the Patella: Acts as an anatomic pulley Reduces friction Protects the femoral condyles 73

Angulations of the Knee Joint Knock-Knees Bowleg Q-Angle: 74

Tibiofibular Joints: Proximal tibiofibular joint Middle tibiofibular joint Distal tibiofibular joint Interosseus membrane Two purposes Tibial torsion Lateral twist of shaft of tibia The interosseus membrane that unites the shafts of the tibia and fibula allows the joined bones to grip the talus of the ankle joint between them, making the middle tibiofibular joint vital to the stability of the ankle joint. It also transfers the force of muscles pulling on the fibula to the tibia, moving the leg at the knee joint. 75

Symphysis pubis joint Sacroiliac joints Lumbosacral joint Hip joints Knee joint complex Tibiofibular joints 76

Functions of the Foot: Provides stability Bears weight of body Absorbs shock from motion Propels body through space Provides flexibility Adapts to uneven ground Evaluating the Arches of the Foot: Pes cavus (excessive arch) Pes planus (decreased arch) The joints of the lower extremity include the talocrural (ankle) joint, the tarsal joints, the tarsometatarsal joints, the intermetatarsal joints, the metatarsophalangeal joints, and the interphalangeal joints. How are the names for the metatarsophalangeal and interphalangeal joints often abbreviated? The metatarsophalangeal joints are often referred to as the MTP joints, and the interphalangeal joints are often referred to as the IP joints. 77

Plantar Fascia: Superficial layer Deep layer The foot has a thick layer of dense fibrous tissue on the plantar side known as the plantar fascia, whose purpose is to maintain and stabilize the longitudinal arches of the foot. There are two layers of plantar fascia: The superficial layer, located in the dermis of the skin of the foot, and the deep layer, which attaches to the calcaneal tuberosity posteriorly and the plantar plates of the MTP joints and adjacent flexor tendons of the toes anteriorly. Plantar fascitis is an inflammation that can tighten the muscles attaching to the fascia, placing tension on the fascia s calcaneal attachment, which can cause a heel spur. The condition often responds well to soft-tissue work. 78

Structure Classification: Synovial joint Hinge joint Function Classification: Diarthrotic Uniaxial Major Motions Allowed: Dorsiflexion and plantarflexion of foot Reverse Actions: Dorsiflexion and plantarflexion of leg 79

The terms dorsiflexion and plantarflexion are used to avoid confusion regarding which ankle joint motion is flexion and which is extension. Technically, flexion is plantarflexion because that is the direction of flexion from the knee joint and further distal. What movement is possible at the ankle joint if the foot is fixed in place? Moving the ankle joint with the foot fixed produces a reverse action: in this case, dorsiflexion and plantarflexion of the leg in the sagittal plane at the talocrural joint. 80

Figure above shows most of the bursae, retinacula, and tendon sheaths of the ankle joint region. The retinacula hold down the tendons that cross the ankle joint, preventing the tendon action called bowstringing. Why are tendon sheaths important to the talocrural joint? Tendon sheaths, found around most tendons that cross the ankle joint, minimize friction between the tendons and the underlying bony structures. 81

Subtalar Tarsal Joint (cont d.) Structure Classification: Synovial joint(s) Function Classification: Diarthrotic Uniaxial Major Motions Allowed: Pronation and supination of foot Reverse Actions: Medial rotation and lateral rotation of leg Closed-Packed Position: Supination Three separate talocalcaneal articulations compose the subtalar joint. Each is a facet articulation either slightly concave/convex or flat in shape. The dashed lines in the Figure indicate how the facets line up with each other. Where is the largest of these articulations? The largest articulation is between the posterior facets of the talus and calcaneus. 82

Component Cardinal Plane Actions: Pronation Eversion Dorsiflexion Abduction Supination Inversion Plantarflexion Adduction 83

The interphalangeal joints pedis are located between the head of the more proximal phalanx and the base of the more distal phalanx of the toes. The big toe has only one IP joint, but toes #2-5 each have two IP joints (a proximal interphalangeal [PIP] joint and a distal interphalangeal [DIP] joint). 85