DOCSLIB.ORG

MOVEMENTS of the FIRST RIB by R

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
MOVEMENTS of the FIRST RIB by R [ 94 ] MOVEMENTS OF THE FIRST RIB By R. WHEELER HAINES, Department of Anatomy, St Thomas's Hospital Medical School INTRODUCTION though less so than those of the succeeding ribs. The most varied opinions as to the movements of Henke (1863, p. 79) described the axis as passing the first ribs have been held by various workers, and outwards and at the same time upwards and back- are still to be found in modern text-books. In the wards, but Landerer (1881) could not confirm this, cadaver the first rib undoubtedly moves with the for he found the axis directed horizontally outwards rest when the lungs are inflated or the sternum and backwards, with no upward component. drawn upwards, and Magendie (1831,. p. 378) Estimations of the degree of obliquity of the axis described this rib as moving more than other (the angle between the axis and a line drawn hori- members of the series. Sibson (1846) in a careful zontally outwards) are also inconsistent. Henke study of the dissected cadaver found that when the and Meissner gave high figures (42 and 360, tables thorax was artificially inflated the first rib moved of Fick, 1911, p. 143), Trendelenburg, Volkmann with the others, keeping parallel to them, towards (same tables), Landerer and Fick low figures (9-16'). a more horizontal position, and Thane's (1892, Later authors have followed Braune (1888) in fig. 187) figure shows the sternum rising as a whole stating that the axis of the first rib is nearly trans- and the first rib moving with the others. But verse. Further, the shortness of the first costal Haller (1758) had found that for a moderate in- cartilages seems to preclude any movement similar spiration the lower end of the sternum moved to the lateral displacement of the lower ribs, so that forwards more than the upper end, and this was even those authors who, like Weber (1936), are taken by later writers to indicate that the manu- prepared to allow the first rib a considerable range brium, and so the ribs attached to it, could move of movement usually restrict that movement to a very little under any circumstances. Reid (1852, simple lid-like raising and lowering of the thoracic p. 834), for instance, mentions Magendie's conclusion inlet as a whole. Thane's (1892, p. 161) statement only to contradict it, and Allen Thomson (1876, that 'in the first rib the axis is nearly transverse, p. 812), though he admitted that 'on the prepared and thus while a considerable degree of elevation is skeleton, by raising and depressing the sternum the permitted the eversion is but slight', and Blair's ribs may be moved upwards and downwards nearly (1943, p. 341) that 'in the upper ribs, where the parallel to one another; the first rib moving as axis is almost transverse, the lateral movement is freely as the others', suggested that 'during life slight or absent' are fair samples of anatomical several causes combine to make the first rib more opinion. fixed than those that follow: as for example, the Yet a cursory examination of a preparation of the weight of the upper extremity, and the strain of the first rib in situ is sufficient to show that the move- intercostal muscles and the ribs beneath'. ment is not lid-like and the axis is not transverse. This uncertainty as to the amount of movement Each rib is seen to move round an oblique axis, in of the first rib has persisted in spite of the demon- inspiration the lateral border moves further from stration of considerable movement of the manu- the midline, and the directions in which the surfaces brium sterni in deep inspiration by outline tracings of the rib face are remarkably altered. This paper is (Hutchinson, 1852), photographic records (Hasse, concerned with a detailed study of the mechanisms 1901), radiographs (Macklin, 1925), and kymo- involved in the cadaver and in the living subject. graphs (Weber, 1936) and figures illustrating the movement (Keith, 1909, fig. 2), and is reflected for instance in Blair's (1943, p. 341) statement that in ANATOMICAL PREPARATIONS inspiration 'the upper border of the sternum is only Axis of movement. In a wet preparation of the slightly raised and is carried forward hardly at all'. first costal ring, from a man about 60 years of age, The mechanism of the first rib is still less under- a steel knitting needle was fixed to the rib by plasti- stood. Sibson's (1846) figures, made with the aid of cine and its position adjusted till it pointed the same a drawing machine, showed it quite clearly rising way whether the rib was raised or lowered (method from a more oblique to a more horizontal position of Henke, 1863 and Landerer, 1881). The fact that during inflation of the lungs, and at the same time this was possible showed that the rib was turning turning so that its outer border came to look more about a stationary axis and the movement was a laterally and less downwards. Several authors simple rotation. The axis was found to pass through whose results have been tabulated by Fick (1911, the head, along the neck and through the tubercle, p. 143) have published measurements showing that outwards, backwards and somewhat upwards, as the axis about which the first rib moves is oblique, stated by Henke (1863). It was very far from the Movements oJf the first rib 95 simple horizontal axis so often described, and the by 9 mm., but the distance between the costo- axes of opposite ribs met in the fore part of the body chondral junctions of the two sides, 85 mm., was of the first thoracic vertebra at an angle of 1100, so unchanged. that the obliquity, as defined above, was 35'. In Comparing the first rib with the others the actual the other ribs the axes pointed downwards rather displacement of its anterior end was less, for the than upwards, except for the second where the axis anterior end of the 7th rib of the same individual, was directed nearly horizontally. for example, moved through 45 mm., but owing to Range of movement. The preparation with needles the great length of the rib this displacement was fixed in the positions of the two axes could now be brought about by an angular movement of 140 mounted in a drawing frame in convenient positions, only, so that so far as angular movement was con- and accurate orthoscopic projections made with the cerned the first rib moved more than the others, ribs raised and lowered. For purposes of measure- and Magendie's (1831) statement on this point was ment direct vertical (Fig. 2), anterior (Fig. 4) and confirmed. lateral views are the most convenient, for the Trajectory. Since the axis of movement, if we vertical, lateral and anterior displacements of the ignore small displacements, remains stationary, it ribs can be read off from them directly, while a follows that each point on the rib must describe an view taken directly along the line of the axis arc of a circle about the axis as the rib turns, and a Fig. 1. Orthoscopic tracings of the first rib in inspiration and expiration in a wet preparation, taken looking directly along the axis, showing the true angular movement of the rib about the axis. (Fig. 1) gives the total movement at the costo- view along the axis will show the anterior end chondral junction and the angular movement of the moving along such an arc (Fig. 1). Other views rib about the axis. The mechanism is however show the circular trajectory projected as an ellipse, better understood from oblique views (Fig. 3), for and it is convenient to draw in the ellipse before these bring out the peculiar movements about the considering the mechanism of the rib as a whole. two axes very clearly. A wire AB (Fig. 2) is fixed so that it lies along the In the specimen illustrated the right rib turned straight line from the costo-chondral junction B to through an angle of 240. The distance from the axis the axis OAX, and meets the axis at a right angle of movement to the centre of the costo-chondral OAB. In practice since the point A is embedded in junction was 75 mm., so that the anterior end of the bone of the first thoracic vertebra the wire the rib was displaced through 31 mm., and the cannot actually reach the axis, though it can point sternum was displaced through a corresponding in its direction. A second wire AC is fixed so as to distance. When the specimen was mounted as pass from the axis at the same point as the first, and nearly as could be judged in the position it occupied again at a right angle OAC to the axis, but in the in life, the 31 mm. of total displacement was found plane in which the drawing is being made, i.e. the to be made up of 28 mm. of vertical and 14 mm. of plane of the paper. A third wire AD stands at right anterior movement. The maximum distance be- angles both to AC and to the axis, so that AO, AC tween the lateral borders of the two ribs increased and AD might lie along adjacent margins of a cube 96 R. WHEELER HAINES Fig. 2. Orthoscopic tracings taken from below looking vertically upwards, showing movement of the first ribs round the oblique axes, the forward movement of the cartilages and sternum, and the lateral displacements of the shafts of the ribs.
Load more

Recommended publications
  • Copyrighted Material
    C01 10/31/2017 11:23:53 Page 1 1 1 The Normal Anatomy of the Neck David Bainbridge Introduction component’ of the neck is a common site of pathology, and the diverse forms of neck The neck is a common derived characteristic disease reflect the sometimes complex and of land vertebrates, not shared by their aquatic conflicting regional variations and functional ancestors. In fish, the thoracic fin girdle, the constraints so evident in this region [2]. precursor of the scapula, coracoid and clavi- Unlike the abdomen and thorax, there is no cle, is frequently fused to the caudal aspect of coelomic cavity in the neck, yet its ventral part the skull. In contrast, as vertebrates emerged is taken up by a relatively small ‘visceral on to the dry land, the forelimb separated from compartment’, containing the larynx, trachea, the head and the intervening vertebrae speci- oesophagus and many important vessels, alised to form a relatively mobile region – the nerves and endocrine glands. However, I neck – to allow the head to be freely steered in will not review these structures, as they do many directions. not represent an extension of the equine ‘back’ With the exception of the tail, the neck in the same way that the more dorsal locomo- remains the most mobile region of the spinal tor region does. column in modern-day horses. It permits a wide range of sagittal plane flexion and exten- sion to allow alternating periods of grazing Cervical Vertebrae 3–7 and predator surveillance, as well as frontal plane flexion to allow the horizon to be scan- Almost all mammals, including the horse, ned, and rotational movement to allow possess seven cervical vertebrae, C1 to C7 nuisance insects to be flicked off.
    [Show full text]
  • Evaluation and Treatment of Selected Sacral Somatic Dysfunctions
    Evaluation and Treatment of Selected Sacral Somatic Dysfunctions Using Direct and HVLA Techniques including Counterstrain and Muscle Energy AND Counterstrain Treatment of the Pelvis and Sacrum F. P. Wedel, D.O. Associate Adjunct Professor in Osteopathic Principles and Practice A.T. Still University School of Osteopathic Medicine in Arizona, and private practice in Family Medicine in Tucson, Arizona Learning Objectives HOURS 1 AND 2 Review the following diagnostic and treatment techniques related to sacral torsion Lumbosacral spring test Sacral palpation Seated flexion test HOURS 3 AND 4 Counterstrain treatments of various low back pathologies Sacral Techniques Covered : 1. Prone, direct, muscle energy, for sacral rotation on both same and opposite axes 2. HVLA treatment for sacral rotation on both same and opposite axes 3. Counterstain treatment of sacral tender points and of sacral torsion Counterstrain Multifidi and Rotatores : UP5L Gluteii – maximus: HFO-SI, HI, P 3L- P 4L ,medius, minimus Piriformis Background and Basis The 4 Osteopathic Tenets (Principles) 1. The body is a unit; the person is a unit of body, mind, and spirit. 2. Structure and function are reciprocally inter-related. 3. The body is capable of self- regulation, self-healing, and health maintenance. 4. Rational treatment is based upon an understanding of these basic principles. Somatic Dysfunction - Defined • “Impaired or altered function of related components of the somatic (body framework) system: • Skeletal, arthrodial, and myofascial structures, • And… • Related vascular, lymphatic, and neural elements” Treatment Options for Somatic Dysfunctions All somatic dysfunctions have a restrictive barrier which are considered “pathologic” This restriction inhibits movement in one direction which causes asymmetry within the joint: The goal of osteopathic treament is to eliminate the restrictive barrier thus restoring symmetry….
    [Show full text]
  • The Influence of the Rib Cage on the Static and Dynamic Stability
    www.nature.com/scientificreports OPEN The infuence of the rib cage on the static and dynamic stability responses of the scoliotic spine Shaowei Jia1,2, Liying Lin3, Hufei Yang2, Jie Fan2, Shunxin Zhang2 & Li Han3* The thoracic cage plays an important role in maintaining the stability of the thoracolumbar spine. In this study, the infuence of a rib cage on static and dynamic responses in normal and scoliotic spines was investigated. Four spinal fnite element (FE) models (T1–S), representing a normal spine with rib cage (N1), normal spine without rib cage (N2), a scoliotic spine with rib cage (S1) and a scoliotic spine without rib cage (S2), were established based on computed tomography (CT) images, and static, modal, and steady-state analyses were conducted. In S2, the Von Mises stress (VMS) was clearly decreased compared to S1 for four bending loadings. N2 and N1 showed a similar VMS to each other, and there was a signifcant increase in axial compression in N2 and S2 compared to N1 and S1, respectively. The U magnitude values of N2 and S2 were higher than in N1 and S1 for fve loadings, respectively. The resonant frequencies of N2 and S2 were lower than those in N1 and S1, respectively. In steady-state analysis, maximum amplitudes of vibration for N2 and S2 were signifcantly larger than N1 and S1, respectively. This study has revealed that the rib cage improves spinal stability in vibrating environments and contributes to stability in scoliotic spines under static and dynamic loadings. Scoliosis, a three-dimensional deformity, prevents healthy development.
    [Show full text]
  • Biomechanics of the Thoracic Spine - Development of a Method to Measure the Influence of the Rib Cage on Thoracic Spine Movement
    Universität Ulm Zentrum für Chirurgie Institut für Unfallchirurgische Forschung und Biomechanik Direktor: Prof. Dr. A. Ignatius Biomechanics of the Thoracic Spine - Development of a Method to Measure the Influence of the Rib Cage on Thoracic Spine Movement Dissertation zur Erlangung des Doktorgrades der Medizin der Medizinischen Fakultät der Universität Ulm vorgelegt von: Konrad Appelt geboren in: Pforzheim 2012 Amtierender Dekan: Prof. Dr. Thomas Wirth 1. Berichterstatter: Prof. Dr. H.-J. Wilke 2. Berichterstatter: Prof. Dr. Tobias Böckers Tag der Promotion: 06.06.2013 Index List of abbreviations ......................................................................................IV 1 Introduction .............................................................................................. 1 1.1 Background ............................................................................................................. 1 1.2 State of Research .................................................................................................... 4 1.3 Objectives ............................................................................................................... 6 2 Material and methods .............................................................................. 7 2.1 Testing machines and devices ................................................................................. 7 2.1.1 Spine loading simulator ................................................................................... 7 2.1.2 Vicon – MX Motion Capture System
    [Show full text]
  • Lab Manual Axial Skeleton Atla
    1 PRE-LAB EXERCISES When studying the skeletal system, the bones are often sorted into two broad categories: the axial skeleton and the appendicular skeleton. This lab focuses on the axial skeleton, which consists of the bones that form the axis of the body. The axial skeleton includes bones in the skull, vertebrae, and thoracic cage, as well as the auditory ossicles and hyoid bone. In addition to learning about all the bones of the axial skeleton, it is also important to identify some significant bone markings. Bone markings can have many shapes, including holes, round or sharp projections, and shallow or deep valleys, among others. These markings on the bones serve many purposes, including forming attachments to other bones or muscles and allowing passage of a blood vessel or nerve. It is helpful to understand the meanings of some of the more common bone marking terms. Before we get started, look up the definitions of these common bone marking terms: Canal: Condyle: Facet: Fissure: Foramen: (see Module 10.18 Foramina of Skull) Fossa: Margin: Process: Throughout this exercise, you will notice bold terms. This is meant to focus your attention on these important words. Make sure you pay attention to any bold words and know how to explain their definitions and/or where they are located. Use the following modules to guide your exploration of the axial skeleton. As you explore these bones in Visible Body’s app, also locate the bones and bone markings on any available charts, models, or specimens. You may also find it helpful to palpate bones on yourself or make drawings of the bones with the bone markings labeled.
    [Show full text]
  • Vertebral Column
    Vertebral Column • Backbone consists of Cervical 26 vertebrae. • Five vertebral regions – Cervical vertebrae (7) Thoracic in the neck. – Thoracic vertebrae (12) in the thorax. – Lumbar vertebrae (5) in the lower back. Lumbar – Sacrum (5, fused). – Coccyx (4, fused). Sacrum Coccyx Scoliosis Lordosis Kyphosis Atlas (C1) Posterior tubercle Vertebral foramen Tubercle for transverse ligament Superior articular facet Transverse Transverse process foramen Facet for dens Anterior tubercle • Atlas- ring of bone, superior facets for occipital condyles. – Nodding movement signifies “yes”. Axis (C2) Spinous process Lamina Vertebral foramen Transverse foramen Transverse process Superior articular facet Odontoid process (dens) •Axis- dens or odontoid process is body of atlas. – Pivotal movement signifies “no”. Typical Cervical Vertebra (C3-C7) • Smaller bodies • Larger spinal canal • Transverse processes –Shorter – Transverse foramen for vertebral artery • Spinous processes of C2 to C6 often bifid • 1st and 2nd cervical vertebrae are unique – Atlas & axis Typical Cervical Vertebra Spinous process (bifid) Lamina Vertebral foramen Inferior articular process Superior articular process Transverse foramen Pedicle Transverse process Body Thoracic Vertebrae (T1-T12) • Larger and stronger bodies • Longer transverse & spinous processes • Demifacets on body for head of rib • Facets on transverse processes (T1-T10) for tubercle of rib Thoracic Vertebra- superior view Spinous process Transverse process Facet for tubercle of rib Lamina Superior articular process
    [Show full text]
  • Fractures of the Odontoid Process of the Axis*
    Fractures of the Odontoid Process of the Axis* BY LEWIS D. ANDERSON,M.D.?, AND RICHARD T. D'ALONZO,M.D.$, MEMPHIS, TENNESSEE From the Department of Orthopaedic Surgery, University of Tennessee College of Medicine and the Campbell Foundation, Memphis ABSTRACT:Odontoid fractures were classified into three types, and, in a series of forty-nine fractures, two avulsion, thirty-two body, and fifteen basilar fractures were treated and followed for an average of twenty-two months (range, six months to nineteen years). Body fractures are most prone to non-union and surgery (spine fusion) is commonly required in this group. Fractures of the odontoid process and the body of the axis have always aroused in- terest but there is little agreement on the best method of treatment and the long-term prog- nosis of these injuries. The incidence of non-union of fractures of the odontoid process has been variously estimated to be as low as 4.8 per cent and as high as 62.8 per cent 1,2,8- lo. Osgood and Lund reviewed the relevant literature in 1928, and found only fifty-five reported cases of fracture of the odontoid process. They noted that most previous authors had found a high incidence of neurological involvement and death, but suspected that this was related to many of the reported cases being from autopsy material. However, in ten of their reported patients paralysis was not present at the time of initial injury and sub- sequently caused death after a second, trivial injury. Osgood and Lund did state that the general impression at the time of the 1928 article was that union rarely occurred.
    [Show full text]
  • I. Axial Vs Appendicular Axial Skeleton Forms Long Axis of Body: Skull
    Anatomy Lecture Notes Chapters 7 and 8 I. axial vs appendicular axial skeleton forms long axis of body: skull, vertebral column, rib cage appendicular - bones of upper and lower limbs including girdles that attach limbs to axial skeleton II. bone markings A. functions attachment joint surfaces tunnels for blood vessels and nerves B. general meanings 1. projection = something that sticks out from the surface of the bone 2. depression = something that dips in from the surface of the bone 3. opening = tunnel that goes into or through a bone C. confusing terms: 1. tuberosity trochanter tubercle 2. condyle epicondyle 3. crest line spine 4. meatus foramen fissure 5. fossa groove Strong/Fall 2008 page 1 Anatomy Lecture Notes Chapters 7 and 8 III. axial skeleton A. skull = cranium + facial bones 1. cranium = bones that enclose brain frontal parietal temporal occipital sphenoid ethmoid 2. suture = interlocking, fused joint between flat bones coronal - frontal and parietal sagittal - left and right parietal squamous - parietal and temporal lambdoidal - parietal and occipital sutural bones = small bones within sutures, no always present 3. paranasal sinuses = cavities inside bones located in frontal, maxillary, sphenoid, and ethmoid bones filled with air lined by mucous membrane open into nasal cavity condition incoming air (increase surface area of mucosa), voice resonance, decrease skull bone mass 4. fontanel - un-ossified fibrous membranes of skull allow compression of skull during delivery allow continued cranial growth after birth eventually close: anterior posterior mastoid sphenoidal Strong/Fall 2008 page 2 Anatomy Lecture Notes Chapters 7 and 8 B. spinal column 1. vertebra/vertebrae body (anterior) arch (posterior) lamina pedicle vertebral foramen processes spinous transverse superior articular inferior articular 2.
    [Show full text]
  • Coccygeal Pits
    Coccygeal Pits Bradley E. Weprin, MD*‡§, and W. Jerry Oakes, MDʈ¶ ABSTRACT. Background. Congenital dermal sinuses ABBREVIATION. OSD, occult spinal dysraphism. represent cutaneous depressions or tracts that are lined by stratified squamous epithelium. They communicate between the surface of the skin and deeper structures utaneous abnormalities of the back may rep- and may occur anywhere along the craniospinal axis. resent underlying malformations of the spine. These sinuses are thought to result from abnormal sep- One such anomaly, the congenital dermal si- aration of the cutaneous and neural ectoderm between C nus, is a superficial depression or tract in the skin the third and fifth week of intrauterine life. They may be that is lined by stratified squamous epithelium. Its often accompanied by other cutaneous stigmata, various appearance can signify the presence of an abnormal dysraphic abnormalities, or intraspinal tumors. In the sacrococcygeal area, cutaneous congenital abnor- connection between the skin surface and subarach- malities are relatively common. It is estimated that 2% to noid space and/or an occult dysraphic state. This 4% of children harbor intergluteal dorsal dermal sinuses. potential communication places the child at addi- These intergluteal sinuses in the perianal region are fre- tional neurologic risk from meningitis, which can quently referred to as pits or dimples. Their cause is sometimes be recurrent. These congenital dermal si- considered similar to other congenital dermal sinuses nuses are frequently associated with other cutaneous and appears unrelated to acquired pilonidal conditions signatures, occult dysraphic lesions, or intraspinal observed in adults. They may become susceptible to local tumors. The natural history of such occult spinal recurrent infection from trauma or hirsutism.
    [Show full text]
  • Emergency Ultrasound
    >> EEMERGENCYMERGENCY Phillips Perera, MD, RDMS, FACEP Thomas Mailhot, MD, RDMS UULTRASOUNDLTRASOUND Diku Mandavia, MD, FACEP, FRCPC Rapid Ultrasound in SHock: The RUSH Protocol EVALUATION OF THE PUMP: THE PARASTERNAL CARDIAC VIEWS Last month, we presented an overview of a unified ultrasound protocol for evalua- tion of the critical patient (Rapid Ultrasound in SHock, or RUSH). The RUSH exam employs bedside ultrasound to rapidly evaluate both the anatomy and physiology of a patient in shock, allowing the emergency physician to better identify the type of shock state and to formulate optimal therapy. The three main components of the exam were introduced: bedside ultrasonography to evaluate the “pump” (ie, cardiac echocardiogra- phy assessing for left ventricular contractility, pericardial effusion, and right ventricular strain), the “tank” (assessing the core vascular volume and Figure 1. Evaluation of identifying “fullness” or “leakiness” in the tank), and the the Pump “pipes” (assessing for thoracic or abdominal aortic aneu- rysm or dissection and deep vein thrombosis). This month, we emphasize the first component of the RUSH exam: the evaluation of the heart using bedside echo- cardiography. Focused echocardiography is best performed with a small footprint phased-array probe at a frequency of about 3 MHz. The heart is traditionally examined from four views on the anterior chest wall: the parasternal long- and short-axis, subxiphoid, and apical planes (Figure 1). In this article, the parasternal long- and short-axis planes will be examined in more detail. It is important for the emergency physician to learn and practice visualizing the parasternal views of the heart, as they often allow for a detailed cardiac examination and pro- vide important information about the patient’s physiologi- A.
    [Show full text]
  • Rib Movement in Health, Kyphoscoliosis, and Ankylosing Spondylitis
    Thorax: first published as 10.1136/thx.24.4.407 on 1 July 1969. Downloaded from Thorax (1969), 24, 407. Rib movement in health, kyphoscoliosis, and ankylosing spondylitis J. JORDANOGLOU1 From the Pulmonary Research Unit, Kitng's College Hospital Medical School, London, S.E.5 Costal movement was defined on living subjects by determining the spatial vectors along the ribs that are produced during inspiration. The determination of these vectors was achieved with an instrument specially designed for this purpose. Rib movement was studied on 61 ribs in 10 normal subjects and on 35 ribs in six patients suffering from kyphoscoliosis and ankylosing spondylitis. In normal subjects during smooth inspiration all the ribs studied, which ranged from the 2nd to the 9th, rotated round a single axis. The direction of the inspiratory movement of the ribs was oblique, upward, outward, and forward, and symmetrical in both hemithoraces. This direction is compatible with rotation around the rib-neck axis but not with other axes that have been postu- lated. In ankylosing spondylitis and in kyphoscoliosis the magnitude of rib movement was reduced but movement still took place solely around the rib-neck axis. In the patients with kyphoscoliosis the direction of this movement was altered due to a change in the position of the rib neck. Hitherto research workers have not agreed about inspiratory (Zi) position of any costal point repre- the manner in which ribs move. Some authors sents the spatial vector S (Fig. IA). These spatial consider that there is mono-axial movement of vectors show the amount as welil as the direction the rib round the rib-neck axis (Agostoni, 1964; of the inspiratory excursion of each point along http://thorax.bmj.com/ Ganong, 1965).
    [Show full text]
  • On Fusion of the Atlas and Axis Vertebrae by A
    ON FUSION OF THE ATLAS AND AXIS VERTEBRAE BY A. J. E. CAVE, M.B. Senior Demonstrator in Anatomy, University of Leeds INTRODUCTORY THE condition of true, non-pathological fusion of the atlas and axis vertebrae constitutes an extremely rare anomaly-perhaps the rarest of all the many and varied manifestations of irregular segmentation affecting the vertebral axis. But few cases occur in the whole of the literature, a fact which is not very surprising when one considers the functional importance of the atlanto- axial articulation, and the disability necessarily consequent upon any grave developmental disturbance of that mechanism. Additional examples may have been overlooked in the past, since the older anatomists (e.g. Macalister(1)) dis- missed all such fusions as entirely the result of pathological change; and although Dwight(2) had in 1901 figured and briefly mentioned an undoubted specimen of complete atlanto-axial fusion, it was not until Elliot Smith(3) in 1907-9 described what must be regarded as the classical case that the correct nature and interpretation of this most interesting vertebral variation was finally established. In this paper attention is drawn, without apology, to further, if somewhat incomplete, cases. TYPES OF ATLANTO-AXIAL FUSION If merely descriptive terminology be employed, the following classification covers all known cases of fusion of the first pair of cervical vertebrae: Group 1. Fusion of the separated odontoid process with the ventral atlantal arch. Group 2. Complete (= bilateral) fusion of atlas and axis with or without attempted assimilation of the first vertebra by the second. Group 3. Incomplete (= unilateral) fusion, one-half of the atlas retaining its independence, with or without some degree of assimilation.
    [Show full text]