Chapter 1: Functional Anatomy and Biomechanics - Spine and TMJ

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Chapter 1: Functional Anatomy and Biomechanics - Spine and TMJ
2015-03-08 19:20:38
Spine TMJ
NPTE: Chapter 1
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  1. General Function of Vertebral Column
    • Support for head and internal organs
    • Stable attachment for all soft tissues, extremities, rib cage, and pelvis
    • Protection of internal organs and spinal cord
    • Attenuates forces from above and below
  2. Components of Vertebral Column
    • 24 freely moveable and 9 fused bones
    • 5 distinct regions (cervical, thoracic, lumbar, sacral, and coccygeal)
  3. Cervical Regional Variations
    • 2 atypical (atlas and axis) allow for increased AROM in rotation without compressing SC
    • Uncinate Joints/Processes (Joints of Von Lushka): found at C3-C7, limit lateral cervical movement
    • Transverse forament
  4. Thoracic Regional Variations
    • Costotransverse articulations: between rib and TP
    • Costovertebral articulations: between rib and vertebral body
  5. Rule of Threes
    • SP of T1-T3 even with TP of same level vertebra
    • T4-T6 SP found 1/2 level below TP of same level
    • T7-T9 SP 1 full level below TP of same level
    • T10 full level below
    • T11 1/2 level below
    • T12 is level
  6. Atlanto-Occipital Joint
    • Synovial articulation between occiput and C1
    • "Yes joint" = much of head nodding motion comes from this articulation
  7. Atlanto-Axial Joint
    • Nonsynovial articulation between dens of C2 and ant arch of C1
    • "No joint" = much of head rotation comes from this articulation
  8. Apophyseal/Facet Joints
    • Guide movement of the spine
    • Synovial/diarthrodial 
    • Capsule and synovial membrane 
    • Composed of superior and inferior articulatory processes of adjacent vertebrae
    • Surfaces flat or curved in lumbar region, flat in cervical and thoracic regions
  9. Intervertebral Joints
    • Between intervertebral disc and adjacent superior and inferior vertebral bodies
    • Allow movement between vertebral bodies
    • Transmit loads from one vertebral segment to another
  10. Sacroiliac Joint
    • Composed of auricular-shaped joint surfaces of sacrum and ilium
    • Diarthrosis/synarthrosis (syndesmosis) combination 
    • Ilial articulation convex and covered with thin layer of fibrocartilage
    • Sacral articulation concave and covered with hyaline cartilage 
    • Attenuates forces from trunk and LE's
  11. Fibroadipose Meniscoid
    • Structure composed of dense connective tissue and adipose tissue
    • Found at superior and inferior aspects of facet joints
    • Protects cartilage of facet surface during extremes in motion
  12. Annulus Fibrosis
    • Concentric layers (lamellae) 
    • Composed of collagen (type II) and fibrocartilage
    • 65% water
    • Outer 1/3 innervated by branches of sinuvertebral nerve 
    • Function: sustain compressive, torsional, shearing, and distraction loads
  13. Nucleus Pulposis
    • Gel with imbibing capabilities 
    • Composed of water and proteoglycans with minimal amount of collagen (type I)
    • 70-90% water
    • Avascular and aneural  
    • Makes up 20-33% heath of vertebral column
    • Functions: sustain compressive, torsional, shearing, and distraction loads
  14. Vertebral Endplate
    • Continuous with annulus and nucleus
    • Sits inside ring apophysis of vertebral body
    • Composed of proteoglycans, collagen, and water 
    • Also fibrocartilage (on side closest to disc) and hyaline cartilage (side closest to vertebral body)
    • Function: provide passive diffusion of nutrients
  15. Facet Joint Capsule
    • Assist ligaments in providing limitation of motion and stability of spine
    • Strongest in throacolumbar and cervicothoracic regions
  16. Thoracolumbar Fascia
    • Provides stability of vertebral column when forces is applied
    • Acts as corset when tension is creed by contraction of abdominals, gluteals, and lumbar muscles
  17. Dorsal and Ventral Roots
    • Dorsal roots: transmit sensory fibers to spinal cord
    • Ventral roots: transmit motor fibers from spinal cord to spinal nerves
  18. Spinal Nerves
    • Connected centrally to SC by a dorsal and ventral root - join to become spinal nerve in the intervertebral foramen
    • Divide into dorsal and ventral rami
    • Cervical: spinal nerves come out at the level above its associated vertebra 
    • Thoracic/Lumbar: spinal nerves come out at the level below its associated vertebra 
    • SC terminates approximately L1-L2 level
  19. Dorsal Rami
    Innervate structures on posterior trunk
  20. Ventral Rami
    • Cervical ventral rami from cervical and brachial plexuses
    • Thoracic ventral rami innervate anterior structures of trunk within thoracic region
    • Lumbar ventral rami form lumbar and lumbosacral plexuses
  21. Spinal Arthrokinematics
    • Flexion: upper facets glide anteroproximally and tilt forward 
    • Extension: upper facets move downward, slightly posterior, and tilt backward
    • Sidebending: SB to the R = upper facet moves down and slightly ant, L facet moves upward and slightly post, both facets move to the L
    • Rotation:
    • --> Cervical causes facets on R to glide down and back, causing approximation of facet joints on the R
    • --> Lumbar/thoracic = very little but motion causes separation and approximation of facet joints (i.e. L3 rotates R = separation at R L3-L4 and approximation at L L3-L4 joint)
  22. Cervical Spine: Coupled Motions
    • Sidebending and rotation occur in the same direction from C2-C7
    • When occiput side bends, C1 rotates in opposite direction
  23. Lumbar/Thoracic Spine Coupled Motions
    • Neutral/extension: lumbar segments will side bend and rotate in opposite directions (SB R results in segment rotating L) 
    • Flex: lumbar segments will side bend and rotate in the same direction
    • Significant variations exist
  24. Lumbopelvic Rhythm
    • During flexion, spine (primarily lumbar) goes through 60-70 degrees of motion --> then pelvis will rotate anteriorly --> eventually followed by flexion of hips 
    • During extension (coming from flexed position), hips extend, pelvis rotates posteriorly, then spine begins to extend
  25. SIJ Osteokinematics
    • Motion limited but during gait, movements take place in multiple plains 
    • Nutation and counternutation: coupling movement that occurs between sacrum and ilium during gait
  26. Nutation
    Involves flexion of sacrum and posterior rotation of ilium
  27. Counternutation
    Involves extension of sacrum and anterior rotation of ilium
  28. TMJ Functional Anatomy
    A bilateral articulation between mandible and cranium (craniomandibular joint)
  29. TMJ Arthrology
    • Synovial joint 
    • Articular surfaces covered by dense fibrous connective tissue
    • Articular disc without blood vessels or nerves in pressure bearing areas
    • Discal ligaments function to restrict movement in sagittal plane
    • Superior retrodiscal lamina (superior stratum): composed of elastic tissue, counteracts forward pull of sup lat pteryoid muscle on articular disc
    • Retrodiscal pad: consists of loose neurovascular connective tissue
  30. TMJ Movement
    • Combination of hinge axis rotation in disc condyle complex and sliding movement of upper joint
    • Functional range of opening = 40 mm with 25 mm of rotation and 15 mm of translators glide