- Lecture 1 -

HEAD, NECK
& TRUNK

Dr. A. Vorster
 I. Osteology:
• Axial skeleton
• Os coxae

Notes: p. 3-11
 Aims & Outcomes:
1. To know the osteology of the axial skeleton.
2. To know the basic structure of the skin.

Head, Neck & Trunk: Outcomes 1. - 4., 55.

(NB!! Outcomes 52-54 apply to ALL lectures!!)

 Vertebral
column

Also see: Moore p.440-463, 470-471

 Vertebral column:
= vertebrae + intervertebral discs
▪ 33 vertebrae:
✓ 7 cervical
✓ 12 thoracic
✓ 5 lumbar
✓ 5 sacral – fused → sacrum
✓ 4 coccygeal – fused → coccyx
▪ Fetus: concave anteriorly
▪ Primary curvatures: thoracic & sacral regions
▪ Secondary curvatures: cervical & lumbar regions → convex anteriorly for balance
▪ Lumbosacral angle independent
Curvatures of the vertebral column:
 Abnormal curvatures:

Scoliosis: excessive curvature to one side (laterally)

 Abnormal curvatures:
Kyphosis: excessive curvature towards posterior
→ especially thoracic region (old ladies)
Lordosis: excessive curvature towards anterior
→ especially lumbar region (pregnancy)
 Parts of
a vertebra:
• Vertebral body: weight-bearing part
• Vertebral arch: protects spinal cord
• 2 Transverse processes and a spinous process: muscle attachments
• 2 Superior and 2 inferior articulation processes (facets):
allow and limit movement between vertebrae
 Typical vertebrae:
Vertebral body:
= attached to adjacent vertebral bodies by intervertebral discs

➢ cervical region: oval-shaped

➢ thoracic region: heart-shaped
➢ lumbar region: kidney-shaped

Rib facets on either side of vertebral body - in thoracic region.

 Typical vertebrae:
Vertebral arch:
▪ Pair of pedicles projecting posteriorly
▪ Roof formed by lamina – meet in midline
▪ Tunnel formed:
anterior → vertebral body
posterior → vertebral arch
▪ Vertebral foramen → vertebral canal
(spinal cord)
▪ Vertebral foramina largest in cervical region
▪ Pedicles of adjacent vertebra → intervertebral foramina
(spinal nerves and blood vessels)
 Typical vertebrae:

Transverse processes:
→ at junction between pedicles and laminae
➢ cervical region: transverse foraminae – ant. & post. tubercles
➢ thoracic region: articulation facets for tubercles of ribs
➢ lumbar region: flattened rods
Typical vertebrae:

Spinous processes:
→ project posteriorly where laminae meet
➢ cervical region: short and bifid
➢ thoracic region: long and point inferiorly and overlap
➢ lumbar region: large, axe-shaped
 Typical vertebrae:
Superior and inferior articulation facets:
→ at the junction between the lamina and pedicle
→ between adjacent vertebrae

➢ cervical region: superior and inferior

➢ thoracic region: posterior and anterior
➢ lumbar region: medial and lateral
 Cervical
vertebrae:
 Thoracic
vertebrae:
 Lumbar
vertebrae:
 Intervertebral disc:
Annulus fibrosus: concentric rings of fibrocartilage
Nucleus pulposus: central mass of jelly-like tissue
Shock absorbers → normally under pressure
Abnormal stress: tear fibers of annulus fibrosus
→ herniation of nucleus pulposus (“slipped disc”)
Protruding mass → press on spinal cord or –nerves → pain/paralysis
Axis around which movement takes place
Movements ↑ where discs are thickest:
- cervical and lumbar regions
Herniation of intervertebral disc:
 Atypical vertebrae:
= at the beginning and end of each region
anterior arch

Atypical cervical vertebrae:

posterior arch
Atlas (C1):
▪ 2 lateral masses joined by arches
▪ Anterior arch: anterior tubercle& facet for dens of axis
▪ Lat. mass: transverse foramen & facets for occipital condyles of skull / axis
▪ Posterior arch: post. tubercle & groove for vertebral a. & C1 spinal nerve
 Atypical cervical vertebrae:
Axis (C2):
▪ Blunt tooth-like process = dens
▪ Ant. surface: articulation facet for atlas
▪ Post. surface: bursa - transverse ligament

Vertebra Prominens (C7):

▪ Long spinous process
 Atypical thoracic vertebrae:
1st, 9-12th thoracic vertebrae: Typical
whole facets on vertebral body vertebra

11th & 12th thoracic vertebrae:

no facets on transverse processes
 Atypical
lumbar vertebrae:

5th lumbar vertebra:

➢ wedge-shaped body (lumbosacral angle)
➢ articulation facets widely apart → sacrum
The Sacrum:
 Coccyx:

✓ 4 fused coccygeal vertebrae

✓ Only the first looks like a vertebra
 The Ribs

Also see: Moore p.72-76

 The Ribs: = 12 pairs
= costal cartilages at anterior ends

Ribs 1-7:
attach to sternum by their costal cartilages
= vertebrosternal ribs (true ribs)
Ribs 8-10:
attach via costal margin to superior rib
= vertebrocostal ribs (false ribs)
Ribs 11-12:
anterior ends are free
= floating / vertebral ribs
Head:
Typical Ribs:
▪ posterior end - 2 facets and crest in between
▪ articulates with demifacets on vertebral bodies
Neck:
▪ attachment - superior & inferior costotransverse ligaments
Tubercle:
▪ posterior with 2 facets:
medial – for transverse process of vertebra
lateral – for lateral costotransverse ligament
Shaft:
▪ flat in vertical plane, curves anteriorly at angle
▪ superior border - round, inf. border – sharp, costal groove
Typical Ribs:
 Atypical ribs:
= 1st and last ribs

1st rib:
✓ short and broad, flattend in horizontal plane
✓ head has single facet for articulation with T1
✓ scalene tubercle on medial border
✓ groove anterior: subclavian vein
✓ groove posterior: subclavian a. & inf. trunk of brachial plexus
✓ m. subclavius attaches anterior to grooves
✓ m. scalenus medius attaches posterior to grooves
✓ 1st digitation of m. serratus anterior - lateral border
 Atypical ribs:
Ribs 10 – 12:
✓ single facets on heads
✓ ribs 11 and 12 have no tubercles
✓ 12th rib allows attachment for m. quadratus lumborum

Rib Elements:
➢ small % of people have cervical or lumbar ribs
➢ cervical rib may lead to neurovascular problems
➢ lumbar ribs more common than cervical ribs
 The Sternum

Also see: Moore p.76-78

 The Sternum:
= flat, elongated bone – anterior part of thoracic cage

3 parts:
Manubrium: (±T1-4)
▪ jugular/suprasternal notch superior
▪ facets for clavicles, 1st ribs
▪ rib 2 on level between manubrium and body
(manubriosternal joint - NB landmark)
Body: (T5-9)
▪ narrow & thin
▪ lateral borders have costal notches (ribs 3-6)
▪ transverse ridges
▪ 4 sternebrae which fuse: at end of puberty - 25 yrs
 The Sternum:
Xiphoid process (T10):
✓ rib 7 at level of xiphisternal joint
✓ smallest, most variable
✓ pointed / blunt / curved / deflected
✓ cartilaginous in young people
✓ ossified in adults >40yrs – elderly people

Important landmarks:
❖ Sternal angle (of Louis): manubriosternal joint
– level IV disc T4/5 and rib 2
❖ Xiphisternal joint - inferior limit central part thoracic cavity
 Os Coxae

Also see: Moore p.327-331

 The Os Coxae:
Ilium:
✓ iliac crest (ant. ⅔ convex to lateral)
✓ iliac spines
(sup. & inf. – ant. & post. (ASIS))
✓ auricular facet and tuberosity (SI joint)

Ischium:
✓ ischial tuberosity
✓ ischial spine

Pubis:
✓ pubic crest and tubercle
✓ pectineal line
 Cranium
&
Mandible

The Skull: Also see: Moore p.822-832

 The Cranium: Cranium = calvaria + facial skeleton

Sutures between bones:

✓ sagittal/frontal
✓ coronal
✓ lambdoid

Fontanelles where different bones meet:

✓ anterior (brechma): ◊ - closes at 18 months
✓ posterior (lambda): Δ - closes at 3 months
Skull:
Superior view
Skull: Anterior view
Skull: Lateral view
Skull: Inferior view
 The Mandible:
➢ two halves meet at symphysis menti
Body:
▪ foramens (mental, mandibular)
▪ oblique & mylohyoid line
▪ digastric fossa
▪ mental spine with genial tubercles
Ramus:
▪ coronoid process – anterior
▪ condylar process – articulate with skull
 Hyoid bone:

Also see: Moore p.984

Hyoid bone:
• In neck between mandible and larynx
• Suspended from styloid process
• Attachment to hyoid muscles and pharynx
NEXT LECTURE:
JOINTS OF THE AXIAL SKELETON

- Notes p. 12-17