Living in a Stress-Filled Body What Can We Do? the Structural Panic Pattern
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Part 1 the Thorax ECA1 7/18/06 6:30 PM Page 2 ECA1 7/18/06 6:30 PM Page 3
ECA1 7/18/06 6:30 PM Page 1 Part 1 The Thorax ECA1 7/18/06 6:30 PM Page 2 ECA1 7/18/06 6:30 PM Page 3 Surface anatomy and surface markings The experienced clinician spends much of his working life relating the surface anatomy of his patients to their deep structures (Fig. 1; see also Figs. 11 and 22). The following bony prominences can usually be palpated in the living subject (corresponding vertebral levels are given in brackets): •◊◊superior angle of the scapula (T2); •◊◊upper border of the manubrium sterni, the suprasternal notch (T2/3); •◊◊spine of the scapula (T3); •◊◊sternal angle (of Louis) — the transverse ridge at the manubrio-sternal junction (T4/5); •◊◊inferior angle of scapula (T8); •◊◊xiphisternal joint (T9); •◊◊lowest part of costal margin—10th rib (the subcostal line passes through L3). Note from Fig. 1 that the manubrium corresponds to the 3rd and 4th thoracic vertebrae and overlies the aortic arch, and that the sternum corre- sponds to the 5th to 8th vertebrae and neatly overlies the heart. Since the 1st and 12th ribs are difficult to feel, the ribs should be enu- merated from the 2nd costal cartilage, which articulates with the sternum at the angle of Louis. The spinous processes of all the thoracic vertebrae can be palpated in the midline posteriorly, but it should be remembered that the first spinous process that can be felt is that of C7 (the vertebra prominens). The position of the nipple varies considerably in the female, but in the male it usually lies in the 4th intercostal space about 4in (10cm) from the midline. -
Skeletal System? Skeletal System Chapters 6 & 7 Skeletal System = Bones, Joints, Cartilages, Ligaments
Warm-Up Activity • Fill in the names of the bones in the skeleton diagram. Warm-Up 1. What are the 4 types of bones? Give an example of each. 2. Give 3 ways you can tell a female skeleton from a male skeleton. 3. What hormones are involved in the skeletal system? Skeletal System Chapters 6 & 7 Skeletal System = bones, joints, cartilages, ligaments • Axial skeleton: long axis (skull, vertebral column, rib cage) • Appendicular skeleton: limbs and girdles Appendicular Axial Skeleton Skeleton • Cranium (skull) • Clavicle (collarbone) • Mandible (jaw) • Scapula (shoulder blade) • Vertebral column (spine) • Coxal (pelvic girdle) ▫ Cervical vertebrae • Humerus (arm) ▫ Thoracic vertebrae • Radius, ulna (forearm) ▫ Lumbar vertebrae • Carpals (wrist) • Metacarpals (hand) ▫ Sacrum • Phalanges (fingers, toes) ▫ Coccyx • Femur (thigh) • Sternum (breastbone) • Tibia, fibula (leg) • Ribs • Tarsal, metatarsals (foot) • Calcaneus (heel) • Patella (knee) Functions of the Bones • Support body and cradle soft organs • Protect vital organs • Movement: muscles move bones • Storage of minerals (calcium, phosphorus) & growth factors • Blood cell formation in bone marrow • Triglyceride (fat) storage Classification of Bones 1. Long bones ▫ Longer than they are wide (eg. femur, metacarpels) 2. Short bones ▫ Cube-shaped bones (eg. wrist and ankle) ▫ Sesamoid bones (within tendons – eg. patella) 3. Flat bones ▫ Thin, flat, slightly curved (eg. sternum, skull) 4. Irregular bones ▫ Complicated shapes (eg. vertebrae, hips) Figure 6.2 • Adult = 206 bones • Types of bone -
Costochondritis
Department of Rehabilitation Services Physical Therapy Standard of Care: Costochondritis Case Type / Diagnosis: Costochondritis ICD-9: 756.3 (rib-sternum anomaly) 727.2 (unspecified disorder of synovium) Costochondritis (CC) is a benign inflammatory condition of the costochondral or costosternal joints that causes localized pain. 1 The onset is insidious, though patient may note particular activity that exacerbates it. The etiology is not clear, but it is most likely related to repetitive trauma. Symptoms include intermittent pain at costosternal joints and tenderness to palpation. It most frequently occurs unilaterally at ribs 2-5, but can occur at other levels as well. Symptoms can be exacerbated by trunk movement and deep breathing, but will decrease with quiet breathing and rest. 2 CC usually responds to conservative treatment, including non-steroidal anti-inflammatory medication. A review of the relevant anatomy may be helpful in understanding the pathology. The chest wall is made up of the ribs, which connect the vertebrae posteriorly with the sternum anteriorly. Posteriorly, the twelve ribs articulate with the spine through both the costovertebral and costotransverse joints forming the most hypomobile region of the spine. Anteriorly, ribs 1-7 articulate with the costocartilages at the costochondral joints, which are synchondroses without ligamentous support. The costocartilage then attaches directly to the sternum as the costosternal joints, which are synovial joints having a capsule and ligamentous support. Ribs 8-10 attach to the sternum via the cartilage at the rib above, while ribs 11 and 12 are floating ribs, without an anterior articulation. 3 There are many causes of musculo-skeletal chest pain arising from the ribs and their articulations, including rib trauma, slipping rib syndrome, costovertebral arthritis and Tietze’s syndrome. -
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. -
Chapter 02: Netter's Clinical Anatomy, 2Nd Edition
Hansen: Netter's Clinical Anatomy, 2nd Edition - with Online Access 2 BACK 1. INTRODUCTION 4. MUSCLES OF THE BACK REVIEW QUESTIONS 2. SURFACE ANATOMY 5. SPINAL CORD 3. VERTEBRAL COLUMN 6. EMBRYOLOGY FINAL 1. INTRODUCTION ELSEVIERl VertebraeNOT prominens: the spinous process of the C7- vertebra, usually the most prominent The back forms the axis (central line) of the human process in the midline at the posterior base of body and consists of the vertebral column, spinal cord, the neck supporting muscles, and associated tissues (skin, OFcon- l Scapula: part of the pectoral girdle that sup- nective tissues, vasculature, and nerves). A hallmark of ports the upper limb; note its spine, inferior human anatomy is the concept of “segmentation,” and angle, and medial border the back is a prime example. Segmentation and bilat l Iliac crests: felt best when you place your eral symmetry of the back will be obvious as you hands “on your hips”; an imaginary horizontal study the vertebral column, the distribution of the line connecting the crests passes through the spinal nerves, the muscles of th back, and its vascular spinous process of the L4 vertebra and the supply. intervertebral disc of L4-L5, a useful landmark Functionally, the back is involved in three primary for a lumbar puncture or epidural block tasks: l Posterior superior iliac spines: an imaginary CONTENThorizontal line connecting these two points l Support: the vertebral column forms the axis of passes through the spinous process of S2 (second the body and is critical for our upright posture sacral segment) (standing or si ting), as a support for our head, as an PROPERTYattachment point and brace for move- 3. -
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 -
Skeleton of the Spine and the Thorax
SKELETON OF THE SPINE AND THE THORAX Pages 37- 42 and 54 - 57 Skeleton of the spine Vertebral Column . forms the basic structure of the trunk . consists of 33-34 vertebrae and intervertebral discs . 7 cervical, 12 thoracic, 5 lumbar = true vertebrae . sacrum and coccyx fused = false vertebrae Vertebra . all vertebrae have certain features in common (vertebral body, vertebral arch and seven processes) and regional differences . vertebral body . vetrebral arch pedicle lamina spinous process transverse process articular processes . vertebral foramen . vetrebral notch Cervical vertebrae . transverse foramen (foramen transversarium) in the transverse process . transverse processes of cervical vertebrae end laterally in two projection for attachment of cervical muscles anterior tubercle and posterior tubercle . bifid spinous process . C6 - tuberculum caroticum . C7 - vertebra prominens Atlas C1 . a ring-shaped bone . has neither a boby nor a spinous process . lateral masses . anterior and posterior arches . anterior and posterior tubercles . superior and inferior articular surfaces . articular facet for dens Axis C2 . serves as the pivot about which the rotation of the head occurs . odontoid process = dens . anterior articular facet Thoracic vertebrae . spinous process is long and running posteroinferiorly . superior costal facet . inferior costal facet . transverse process has an articulating facet for the tubercle of a rib = costal facet . the body is heart-shaped Lumbar vertebrae . massive bodies . accessory process - on the posterior surface of the base of each transverse process . mammilary process - on the posterior surface of the superior articular process . costal process Sacrum solid triangular bone . base . wings (alae) . apex . dorsal surface median crest intermediate crest lateral crest posterior sacral foramina superior art. processes . -
1 the Thoracic Wall I
AAA_C01 12/13/05 10:29 Page 8 1 The thoracic wall I Thoracic outlet (inlet) First rib Clavicle Suprasternal notch Manubrium 5 Third rib 1 2 Body of sternum Intercostal 4 space Xiphisternum Scalenus anterior Brachial Cervical Costal cartilage plexus rib Costal margin 3 Subclavian 1 Costochondral joint Floating ribs artery 2 Sternocostal joint Fig.1.3 3 Interchondral joint Bilateral cervical ribs. 4 Xiphisternal joint 5 Manubriosternal joint On the right side the brachial plexus (angle of Louis) is shown arching over the rib and stretching its lowest trunk Fig.1.1 The thoracic cage. The outlet (inlet) of the thorax is outlined Transverse process with facet for rib tubercle Demifacet for head of rib Head Neck Costovertebral T5 joint T6 Facet for Tubercle vertebral body Costotransverse joint Sternocostal joint Shaft 6th Angle rib Costochondral Subcostal groove joint Fig.1.2 Fig.1.4 A typical rib Joints of the thoracic cage 8 The thorax The thoracic wall I AAA_C01 12/13/05 10:29 Page 9 The thoracic cage Costal cartilages The thoracic cage is formed by the sternum and costal cartilages These are bars of hyaline cartilage which connect the upper in front, the vertebral column behind and the ribs and intercostal seven ribs directly to the sternum and the 8th, 9th and 10th ribs spaces laterally. to the cartilage immediately above. It is separated from the abdominal cavity by the diaphragm and communicates superiorly with the root of the neck through Joints of the thoracic cage (Figs 1.1 and 1.4) the thoracic inlet (Fig. -
Foramen in Xiphoid Process of Sternum
[Sabnis et. al., Vol.7 (Iss.12): December 2019] ISSN- 2350-0530(O), ISSN- 2394-3629(P) Index Copernicus Value (ICV 2018): 86.20 DOI: https://doi.org/10.29121/granthaalayah.v7.i12.2019.317 Science FORAMEN IN XIPHOID PROCESS OF STERNUM Dr Anjali Sabnis 1, Dr. Prakash Mane 2 1 Professor and head, Department of Anatomy, MGM Medical College, Navi Mumbai 2 Tutor, Department of Anatomy, MGM Medical College, Navi Mumbai Abstract Xiphoid process is smallest and distal component of manubrium sternum which is located in epigastrium. Variations in size and shape of xiphoid process are commonly observed. During teaching sternum to 1st M.B.B.S. students of MGM Medical College, Navi Mumbai, two small foramina in two different xiphoid processes were noticed. Though presence of foramen in xiphoid process is not uncommon, their presence should not be ignored. During assessment of injuries in autopsy, post-mortem examination and radiological reporting knowledge of xiphoid process and foramina in xiphoid process will be helpful. Keywords: Foramen; Xiphoid Process; Manubrium; Sternum; Perforation. Cite This Article: Dr Anjali Sabnis, and Dr. Prakash Mane. (2019). “FORAMEN IN XIPHOID PROCESS OF STERNUM.” International Journal of Research - Granthaalayah, 7(12), 239-242. https://doi.org/10.29121/granthaalayah.v7.i12.2019.317. 1. Introduction Sternum is a flat bone which forms anterior boundary of thoracic wall. Prosternum or manubrium, mesosternum or body and metasternum or xiphoid process are the three components of sternum. The distal and smallest component is xiphoid process which is located in epigastrium. Xiphoid process is derived from the Greek word “xiphos” means straight sword1. -
Calcification of Costal Cartilage in the Adult Rib Cage
IRC-17-106 Calcification of Costal Cartilage in the Adult Rib Cage. IRCOBI conference 2017 SA. Holcombe, S. Ejima, SC. Wang Abstract Costal cartilage bridges the sternum and the ribs and plays a key role in the biomechanics of the chest. Costal cartilage is known to calcify in local regions with age, which can substantially stiffen its overall response to loading. However, the rate of accumulation of the calcified volume is not well quantified. Current computational models of the thorax assign a homogeneous soft material to cartilage segments, yet their finite element meshes are well suited to the specification of interstitial calcification zones, should applicable data become available. This study measures volumes and extents of costal cartilage calcification from 205 live subject CT scans. Significant increases in volume calcification – both in a given cartilage segment and in the lengthwise extent of those segments that experience calcification – are seen with age (p<0.0001). Age and sex accounted for 35% of all inter‐individual population variability. Specific recommendations for introducing person‐age via regional calcification to models of the costal cartilage are that (1) calcification volume within a segment should increase at the rate of 0.9 mm (for an equivalent cube edge length) per decade, and (2) should involve an increasing lengthwise extent of the cartilage segment at a rate of at least 7% per decade. Keywords age, calcification, cartilage, costal cartilage calcification, rib. I. INTRODUCTION The chest plays a major role in mitigating the forces that the body experiences during motor vehicle crash events. Costal cartilage is a key structural component of the chest, contributing to its rigidity and reinforcing the chest wall by bridging the space between the sternum and the ribs. -
Coccygodynia: Evaluation and Management
Coccygodynia: Evaluation and Management Guy R. Fogel, MD, Paul Y. Cunningham III, MD, and Stephen I. Esses, MD Abstract Coccygodynia is pain in the region of the coccyx. In most cases, abnormal mobility incidence of fusions between seg- is seen on dynamic standing and seated radiographs, although the cause of pain is ments.4 Symptomatic patients have a unknown in other patients. Bone scans and magnetic resonance imaging may show slightly higher incidence of sacral coc- inflammation and edema, but neither technique is as accurate as dynamic radiog- cygeal fusion and a more angular sag- raphy. Treatment for patients with severe pain should begin with injection of local ittal alignment of the coccyx than anesthetic and corticosteroid into the painful segment. Coccygeal massage and stretch- asymptomatic patients.4 No pathologic ing of the levator ani muscle can help. Coccygectomy is done only when nonsur- findings have been noted in the id- gical treatment fails, which is infrequent. Coccygectomy usually is successful in care- iopathic or hypermobile segments in fully selected patients, with the best results in those with radiographically demonstrated patients with coccygodynia. The ab- abnormalities of coccygeal mobility. normal subluxation and hypermobil- J Am Acad Orthop Surg 2004;12:49-54 ity appear to cause pain, but coccy- godynia can occur with an immobile coccyx. Only occasionally have post- traumatic nonunion, arthritis, or Coccygodynia, pain in the region of Anatomy malunion been found in surgical spec- the coccyx, typically is triggered by imens. or occurs while sitting. The intensity Five fused sacral and three or four of the pain varies and sometimes is fused coccygeal vertebrae form the ter- aggravated by arising from a seated minal end of the spinal column. -
Compact Bone Spongy Bone
Spongy bone Compact bone © 2018 Pearson Education, Inc. 1 (b) Flat bone (sternum) (a) Long bone (humerus) (d) Irregular bone (vertebra), right lateral view (c) Short bone (talus) © 2018 Pearson Education, Inc. 2 Articular cartilage Proximal epiphysis Spongy bone Epiphyseal line Periosteum Compact bone Medullary cavity (lined by endosteum) Diaphysis Distal epiphysis (a) © 2018 Pearson Education, Inc. 3 Trabeculae of spongy bone Osteon (Haversian Perforating system) (Volkmann’s) canal Blood vessel continues into medullary cavity containing marrow Blood vessel Lamellae Compact bone Central (Haversian) canal Perforating (Sharpey’s) fibers Periosteum Periosteal blood vessel (a) © 2018 Pearson Education, Inc. 4 Lamella Osteocyte Canaliculus Lacuna Central Bone matrix (Haversian) canal (b) © 2018 Pearson Education, Inc. 5 Osteon Interstitial lamellae Lacuna Central (Haversian) canal (c) © 2018 Pearson Education, Inc. 6 Articular cartilage Hyaline Spongy cartilage bone New center of bone growth New bone Epiphyseal forming plate cartilage Growth Medullary in bone cavity width Bone starting Invading to replace Growth blood cartilage in bone vessels length New bone Bone collar forming Hyaline Epiphyseal cartilage plate cartilage model In an embryo In a fetus In a child © 2018 Pearson Education, Inc. 7 Bone growth Bone grows in length because: Articular cartilage 1 Cartilage grows here. Epiphyseal plate 2 Cartilage is replaced by bone here. 3 Cartilage grows here. © 2018 Pearson Education, Inc. 8 Bone remodeling Growing shaft is remodeled as: Articular cartilage Epiphyseal plate 1 Bone is resorbed by osteoclasts here. 2 Bone is added (appositional growth) by osteoblasts here. 3 Bone is resorbed by osteoclasts here. © 2018 Pearson Education, Inc. 9 Hematoma External Bony callus callus of spongy bone New Internal blood callus vessels Healed (fibrous fracture tissue and Spongy cartilage) bone trabecula 1 Hematoma 2 Fibrocartilage 3 Bony callus 4 Bone remodeling forms.