The Axial Joints

.Figure 1A – The temporomandibular (T. M) joint

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.Figure 1B – Ligaments of the temporomandibular (T. M) joint

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Temporomandibular (T. M) Joint (fig. 1)
 Is a synovial joint of the ellipsoid type, between head
of mandible and mandibular fossa of temporal bone.
 It is surrounded by a fibrous capsule, which is
attached above to the circumference of mandibular
fossa, articular tubercle and squamotympanic fissure,
and below to neck of the mandible.
 The capsule is lined by synovial membrane.
 The joint cavity is divided by an articular disc into
upper and lower part.
 The articular surfaces are covered with fibrocartilage
and not hyaline cartilage.
 The capsule presents a lateral thickening, the lateral
temporomandibular ligament.
 The other ligaments are the sphenomandibular and
stylomandibular ligaments, which lie outside the joint,
 The joint is supplied by auriculotemporal nerve and the
masseteric branches of mandibular nerve.

Relations:
 Anteriorly, to the masseteric artery and nerve.
 Posteriorly, to the tympanic plate of temporal bone and parotid
gland.
 Medially, to maxillary vessels and auriculotemporal nerve.
 Laterally to parotid gland.
a. Lateral temporomandibular ligament:
 It is attached above to the tubercle on the root of zygomatic
process of temporal bone, and below to neck of the mandible.
 The great strength of this ligament prevents the head of the
mandible from passing backward and fracturing the tympanic plate
when a severe blow falls on the chin
b. Sphenomandibular ligament:
 Lies on medial side of the joint, but completely separated from it.
 It is attached above to the spine of sphenoid, and below to the
lingual of the mandibular foramen. 4
c. Stylomandibular ligament:
It is a thickened part of the deep cervical fascia, which stretches
from apex of styloid process to posterior border of mandible
just above the angle.

Joints of the Vertebral Column

Atlantooccipital Joints (fig 2, 3, 4, and 5)
 These two joints are synovial of the ellipsoid type.
 The articulations are between the facets on the superior
articular processes of the lateral masses of atlas below and the
occipital condyles of occipital bone.
 Each joint is enclosed by a fibrous capsule, which is thickened
posteriorly and laterally.
 The bones are connected by the anterior and posterior atlanto-
occipital membranes.
The anterior atlantooccipital membrane (fig. 4):
 Connects the anterior arch of atlas to anterior margin of
foramen magnum.
• It is strengthened in the median plane by anterior
longitudinal ligament.
The posterior atlantooccipital membrane (fig. 4):
Connects the posterior arch of atlas to posterior margin of
foramen magnum.
Movements and muscle producing:
• Flexion (nodding of the head): Produced by rectus capitis
anterior.
• Extension (nodding of the head): Produced by rectus capitis
posterior minor and major, obliquus capitis superior,
splenius capitis, semispinalis capitis, and upper fibers of
trapezius.
• Slight lateral flexion (bending the head to one or other side):
Produced by rectus capitis lateralis, splenius capitis,
semispinalis capitis, sternocleidomastoid, and upper fibers
of trapezius.

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Figure 2 – The upper part of vertebral canal. The spinous
processes and parts of the posterior vertebral arches
removed to expose ligaments on posterior aspect of the
vertebral bodies (posterior view).

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Figure 3 – The principal part of the tectorial membrane
removed to expose deeper ligaments (posterior view).

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Figure 4 – Atlantoocciptal and atlantoaxial joints (anterior
.and posterior view)

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Atlantoaxial Joints (fig. 3 and 4)
The atlas articulates with axis by three synovial joints:
a. The median atlantoaxial joint (fig. 5):
Is of the pivot type, between odontoid process (dens) of axis
and the ring formed by the anterior arch of atlas and the
transverse ligament of atlas.
b. The two lateral atlantoaxial joints (fig. 2, 4, 5, and 6): Are
synovial of the plane type, between the facets on inferior
articular processes of atlas and the facets on superior
articular processes of axis.
 Each joint is enclosed by a capsule.
 The bones are connected by three ligaments and membrane
tectoria.
The median apical ligament (fig. 5):
Connects the apex of the odontoid process to anterior margin
of foramen magnum. 10
.Figure 5 – The median atlantoaxial joint

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.Figure 6 – Atlantoaxial joints

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The lateral alar ligaments (fig. 5, and 6)):
 They are placed on each side of the apical ligament.
 They connect the odontoid process to the medial side of the occipital
condyles.

The cruciate ligament (fig. 3, and 6):

It has two parts, vertical and transverse:
a. The transverse part: Is firmly attached on each side to the medial
aspect of lateral mass of atlas and binds the odontoid process to anterior
arch of atlas.

b. The vertical part: As the transverse part crosses the dens, it presents
an upwards and downwards prolongation to form the vertical part, which
connects the posterior surface of the body of axis to upper surface of
basilar part of occipital bone between the apical ligament of the dens and
the membrane tectoria.

The membrane tectoria (fig. 2, 3, and 6):

 It is an upward continuation of the posterior longitudinal ligament.
 Superiorly, the membrane passes through the foramen magnum to be
attached to basilar part of occipital bone.
Movements and muscles producing:
Rotation of atlas upon axis is the only possible movement,
and is produced by obliquus capitis inferior, rectus capitis
posterior major, and splenius capitis of one side, acting with
opposite sternocleidomastoid.

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Joints Between Vertebral Bodies (fig. 8, and 10)
 The vertebral bodies of each two adjacent vertebrae from
the Axis vertebra to the S1 are united by a secondary
cartilaginous joint.
 In these joints, the upper and lower surfaces of the bodies
of the vertebrae are covered by thin plates of hyaline
cartilage.
 Sandwiched between the plates of hyaline cartilage is a
thick plate of fibrocartilage, known as the intervertebral disc.
 The collagen fibers of the disc strongly connect the bodies
of the two adjacent vertebrae.
 The intervertebral discs are supported by two longitudinal
bands, the anterior and posterior longitudinal ligaments,
which form accessory ligaments.

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.Figure 7 – The intervertebral disc

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The intervertebral disc (fig. 7)
 This fibrocartilage consists of many concentric layers of
strong collagenous fibrous tissue, called the annulus fibrosus.
 These fibers run between the cartilage layers which cover the
superior and inferior surfaces of the bodies.
 The alternate layers of collagen run at an angle to each other,
and together they surround an internal mass of gelatinous
material known as the nucleus pulposus.
 The discs are thickest in the lumbar region and thinnest in the
thoracic region where the range of movement is necessarily
limited.

The anterior longitudinal ligament (fig. 4, 8, 1o, 13, and 14):

 Superiorly the ligament is attached to basilar part of occipital
bone in front of foramen magnum, from which it extends to
anterior tubercle of the anterior arch of atlas.
 The ligament then descends from anterior tubercle of atlas
vertebra over anterior surfaces of the vertebrae as far as the
upper part of sacrum.
Figure 8 – Joints between vertebral bodies.

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 It is firmly attached to anterior surfaces of the intervertebral
discs and the adjacent margins of the vertebral bodies.
The posterior longitudinal ligament (fig. 6, 8, and 10):
 Lies within the vertebral canal on the posterior surfaces of
the bodies of the vertebrae.
 It is much narrower than the anterior, and stretches from
the body of the axis to the sacrum.
 Its upper end extends upwards as a wide membrane, the
membrane tectoria.
 It is attached to the intervertebral disc and adjacent margins
of vertebral bodies.
 Between these attachments, the ligament is separated from
the vertebral bodies by the basivertebral veins.

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Figure 9 – Lateral view of
vertebral column.

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Figure 10A – Lateral view of partially sectioned vertebral
column in median plane, showing the vertebral ligaments.

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Figure 10B – Lateral view of partially sectioned vertebral
column in median plane, showing the vertebral ligaments.

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.Figure 11 – Posterior vertebral segments (anterior view)

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Joints Between Vertebral arches
 The vertebral arches are held together by ligamentum flava,
ligamentum nuchae, supraspinous ligament, intertransverse
ligaments, and interspinous ligament.
 The joints between the articular processes of adjacent
vertebrae (zygapophysial joints) are synovial.
 Each joint is surrounded by an articular capsule, which is
attached to margins of the articular processes
The ligamentum flava (fig. 4, 11, and 15):
Connect the laminae of adjacent vertebrae.
The supraspinous ligaments (fig. 9, 10, and 15):
Connect the apices of the spines from C7 vertebra to sacrum.
The interspinous ligaments (fig. 10):
Connect the spines of adjacent vertebrae.

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 Their attachments extend from the root to the apex of each
process.
The intertransverse ligaments (fig. 14, and 15):
Connect the transverse processes of adjacent vertebrae.
The ligamentum nuchae (fig. 9):
 Extends from the external occipital protuberance and crest
to the spine of C7 vertebra.
 It correspond the supraspinous and interspinous ligaments
of other level.
Movements of the Vertebral Column and Muscles Producing:
Flexion (forward bending):
 This movement is extensive in the cervical and lumbar
regions, but restricted in the thoracic region.
 The movement is produced by longus cervicis, scalene,
sternocleidomastoid, and rectus abdominis of both sides.
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Extension (backward bending):
 Similar to flexion, this movement is free in the cervical and
lumbar regions, but restricted in the thoracic region.
 The movement is produced by erector spinae, splenius
capitis, semispinalis capitis of both sides.
Lateral flexion (bending to one or other side):
 This movement is extensive in the cervical and lumbar
regions, but restricted in the thoracic region.
 The movement is produced by longissimus and iliocostalis
cervicalis components of erector spinae, internal and
external oblique muscles, and the ipsilateral flexor muscles
(flexor muscles of the side towards which lateral flexion is
occurring).
Rotation:
 Although only slight between any two vertebrae, this allows
a considerable extent of movement when it takes place along
the length of the vertebral column, the upper part being
turned to one or other side. 26
 This movement is most marked at the atlantoaxial joint.
 It occurs to a slight extent in the rest part of the cervical
region, is free in the upper part of the thoracic region and is
least in the lumbar region.
 The movement is produced by the rotators, multifidus, and
splenius cervicis.

Joints of the Thoracic Cage

Manubriosternal Joint (fig. 12B)
 It is a secondary cartilaginous joint, between the lower end
of manubrium and upper end of the body of sternum.
 The articular surfaces are coated with hyaline cartilage and
connected by a disc of fibrocartilage.
 It is strengthened by thickened, longitudinal periosteal
fibers in front and behind.
 The joint permits small amount of angular movement during
respiration, though in the elderly these become restricted
.Figure 12A – Sternocostal articulation (anterior view)

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.Figure 12B – Sternocostal articulation (anterior view)

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Xiphisternal Joint (fig. 12B)
 It is a secondary cartilaginous joint between the lower end
of the body and upper end of xiphoid process.
 The joint being ossified in middle life.

Stenocostal Joint (fig. 12)

 The costal cartilage of 1st rib articulates with manubrium sterni
at the sternoclavicular joint (saddle joint) by a primary
cartilagenous joint.
 The costal cartilages from the 2 nd – 7th articulate with the
corresponding notches on the lateral border of the body of
sternum at synovial joints of plane type.
 Each joint has a fibrous capsule which is strengthened
anteriorly and posteriorly by a radiate sternocostal ligament.
The radiate sternocostal ligaments (fig. 12B):
These are broad, thin, membranous band which radiate from the
anterior and posterior surfaces of the costal cartilages of the
true ribs to the anterior and posterior surfaces of the sternum.
The intraarticular sternocostal ligaments (fig. 12):
The cavity of the 2nd sternocostal joint is divided into two by
an intraarticular ligament, which is attached to the fibrous
disc of the manubriosternal joint.
The costoxiphoid ligament (fig. 12B):
Connect the anterior and posterior surfaces of the 7th costal
cartilage, and sometimes those of the 6th, to the anterior and
posterior surfaces of the xiphoid process.

Interchondral Joints (fig. 12)

 These are small synovial joints between the contiguous
margins of the adjacent costal cartilages from 7th to 10th and
may involve the 5th and 6th.
 Each joint is enclosed by a thin fibrous capsule, which is
strengthened by interchondral ligaments (fig. 12A).
 The joint between contiguous margins of the 9th and 10th
costal cartilages is fibrous.
Costovertebral Joints (fig. 13, 14, and 15)
 The head of a typical rib presents two articular facets, which
are separated by a ridge.
 These facets articulate with the corresponding demi facets
present on the margins of the sides of the bodies of adjacent
thoracic vertebrae.
 The upper rib facet articulates with the demi facet on the lower
margin of the vertebra above, and the lower rib facet articulates
with the demi facet on the upper margin of its own vertebra.
 The two small joints form are synovial of the plane type.
 An intra-articular ligament connects the ridge between the two
rib facets to the intervertebral disc.
 This ligament divides the joint into two distinct parts which are
enclosed by a common capsular ligament.
 The fibrous capsules connect the head of the ribs with the
margins of the intervertebral disc and the adjacent vertebrae.
 The anterior aspect of the capsule is thickened to form the
radiate ligament.
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Radiate ligament (fig. 13, 14A, and 14C) 33
 Laterally, it is attached to anterior part of the head of the rib.
 Medially, the upper fibers ascend to the body of the vertebra
above, the lower fibers descend to the body of the vertebra below,
and the middle fibers pass horizontally to the intervertebral disc.
 The head of the 1st and last three ribs, each has a single facet,
which articulates with its own vertebra.

Costotransverse Joints (fig. 13, 14, and 15))

 The tubercles of the upper ten ribs, each has two parts, a medial
articular and a lateral non- articular.
 The articular part presents a facet that articulates with the facet
near the tip of the transverse process of the vertebra to which it
corresponds numerically.
 The non-articular part provides attachment to the lateral
costotransverse ligament (fig. 13 and 14).
 The last two ribs do not have tubercles and makes no
articulations with transverse processes, but are connected to the
transverse process by thin and weak costotransverse ligaments.
Figure 13 – Costovertebral joints (Lateral view).

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Figure 14A – Costovertebral joints (left lateral view).

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Figure 14B – Costovertebral joints (transverse section:
.superior view)

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Figure 14C – Costovertebral joints (right posterolateral view).

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Figure 15 – Ligaments of the vertebral arches and the
.costovertebral joints (posterior view)

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The superior costotransverse ligament (fig. 13, 14, and 15)
Connects the superior surface of the neck of the rib to the
lower aspect of the transverse process of the vertebra above.
The lateral costotransverse ligament (fig. 14, and 15)
Lies lateral to the joint and connects the non-articular part of
the tubercle of the rib to the tip of the transverse process.
The costotransverse ligament (fig. 14)
Lies medial to the joint and connects the neck of the rib to
the transverse process.

Movements of the Thoracic Cage and Producing

Muscles
 The first rib is fixed to manubrium sterni and is immobile.
 The remaining ribs move during respiration.
 Inspiration is associated with an increase in the capacity of
the thoracic cage and expiration with a decrease.
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  In quite respiration the increase in the size of the thorax is mainly
vertical and caused by contraction and descent of the diaphragm.
 The latter relaxes during expiration and moves upwards, results
in a decrease in the vertical diameter of the chest.
 During the quite respiration, the intercostal muscles do not show
any activity.
 The scalene muscles usually contract during inspiration and
either fix these ribs or elevate them to small extent.
 In deep inspiration there is a much further descend of the
diaphragm.
 In addition the walls of the thoracic cage move.
 Movement of the ribs is produced by the scalene muscles
associated by the sternocleidomastoid, which acts on the
manubrium sterni.
 The intercostals muscles contract but mainly to prevent
retraction of the rib spaces.
 Movements of the upper ribs are accompanied by movements in
both the joints of the heads and the tubercle, permitting the neck of
each rib to rotate around its own axis.
 Movements of these ribs result in an increase in the
anteroposterior and transverse diameters of the chest.
 The costotransverse joint of the lower ribs is flat so that the
neck of the rib does not rotate but move upwards and
backwards.
 As a result, there is an increase in the transverse diameter
of the chest and no increase in the anteroposterior diameter.
 In deep expiration the ribs return to their original position.
 In the quite respiration there is little or no movement of the
sternum.
 In deep respiration the sternum moves upwards about 1.5
cm and forwards about 1 cm.
 This movement is associated with a forward angulation of
the manubriosternal joint.

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 Joints Dislocation
Dislocation of the Temporomandibular Joint
 When the mandible is depressed, the head of the mandible and the
articular disc both move forward until they reach the summit of the
articular tubercle. In this position, the joint is unstable.
 Excessive contraction of the lateral pterygoid muscles, may be
sufficient to dislocate the heads of the mandible anteriorly (pass in
front of the articular tubercles).
 In this dislocation, the mandible remain depressed, and the person
may not be able to close his mouth.
 Most commonly, a sideways blow to the chin when the mouth is
open dislocate the TMJ on the side that received the blow.
 Reduction of the dislocation is easily achieved by pressing the
gloved downward on the lower molar teeth and pushing the
mandible backward. The downward pressure overcomes the tension
of the temporalis and masseter muscles, and the backward pressure
overcomes the spasm of the lateral pterygoid muscles. 42
 Rupture of the Transverse Ligament of Atlas
This rupture results in dislocation of the median atlantoaxial
joint. When complete dislocation occurs, the dense may be
driven into upper cervical region of the spinal cord, causing
quadriplegia (paralysis of fourlimbs), or into the medulla of
the brainstem, causing death.

Rupture of the Alar Ligament

This ligament is weaker than the transverse ligament of the
atlas. Consequently, combined flexion and rotation of the
head may tear on or both alar ligaments, results in an
increase of approximately 30% in the range movement to
the opposite side.
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 Dislocation of the Cervical Vertebrae
Cervical vertebra can be dislocated in the neck injuries with
less force than is required to fracture them.
Slight dislocation can occur without injury to the spinal cord.
Sever dislocation, however, damaged the spinal cord.

Dislocation of Vertebrae in the thoracolumbar

Region
Dislocation in this region Is uncommon, because of the
interlocking of their articular processes.
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