Presentation Guide, Week Three

Musculoskeletal System (M2)

The neck, trunk and axial skeleton

Objectives Group A:
1. Be able to describe the function/primary action of each muscle listed
2. Be able to describe the attachments of each muscle listed
3. Be able to identify the innervation of each muscle listed
4. Be able to identify the ligaments of the C1/C2 joint
5. Be able to identify the hyoid bone and atlanto occipital joint
6. Be able to identify the components of the temporomadibular joint

Group A. Neck muscles

1.) Primary neck extensors
a. splenius capitus
b. splenius cervicis
c. Semi spinalis capitus
d. trapezius (cranial nerve XI)
2.) Primary neck rotator
a. Sternocleidomastoid-primary rotator (spinal accessory or cranial XI)
3.) Primary lateral neck flexor
a. scalenes-anterior primary divisions of lower cervical nerves
4.) Primary neck flexors
a. Sternocleidomastoid in conjunction (spinal accessory or cranial XI)
b. secondary flexors
1. longus colli muscle

2. longus capitis muscle

5. Special focus: C1/C2 joint-review ligaments for this synovial joint
-alar ligament
-apical ligament of dens
-cruciform ligament (Cross ligament)
6. Atlanto-Occipital joint
7. Hyoid bone
8. Temporo-mandibular joint- mandibular condyle, mandibular fossa and articular
eminence, the articular disc, the articular capsule
Clinical correlations
1. C1/C2 subluxation (rheumatoid arthritis)
2. herniated disc in the cervical spine
3. hyperextension injury of the sternocleidomastoid
4. Osteoarthritis of the cervical spine
5. Temporo-mandibular joint syndrome (TMJ)
Objectives Group B:
1. Be able to describe the function/primary action of each muscle listed
2. Be able to describe the attachments of each muscle listed
3. Be able to identify the innervation of each muscle listed
4. Be able to identify the ligaments listed

Group B:Axial/Trunk Muscles

1.) Trunk/spine Extension
a. Erector spinae group
1. spinalis
2. longissimus
3. iliocostalis

b. Transversospinalis group
1. semispinalis (extends and rotates)
2. multifidus (extends and rotates)
2). Rotation: semispinalis and multifidus as above
3.) Trunk/spine Flexion( flexor muscles are located in the cervical -as above- and
lumbar regions of the spine. There are no flexors in the thoracic spine
a. psoas muscles flex the hip and has little effect on flexing the spine
1. psoas major
2. psoas minor
b. The main lumbar spine flexors are the front muscles of the abdominal wall
1. rectus abdominis,
2. abdominal internal and external oblique muscles
c. quadratus lumborum
4. Ligaments to know:
-anterior longitudinal ligament
-ligamentum flavum
-supraspinal ligament
-posterior longitudinal ligament

Clinical Correlations
1. spondyloarthropathies (axial arthropathies and sacroiliitis)
2. osteoarthritis of the spine
3. scoliosis
4. herniated disc
5. osteoporosis of the spine

Objectives Group C
1. Be able to identify the anatomy of the cervical vertebrae
2. Be able to identify the ligaments listed
3. Be able to identify the articulations listed
4. Be able to identify the cervical intervertebral discs

Group C: Cervical Vertebrae (C1-C7) and articulations

1. Atlanto-occipital joint-50% of flexion/extension
2. Atlanto-axial joint (C1/C2) 50% of rotation
a. C1 atlas (review vertebra anatomy)
b. C2 axis-odontoid process (review vertebra anatomy)
3. Vertebral anatomy C3-C7
a. arch
b. body
c. pedicle
d. spinous process
e. transverse process
f. vertebral foramina
g. transverse foramina
h. superior processes
i. inferior articular processes
j. uncinate processes
4. Articulations:
a. facet joints
b. Joints of Lushka (uncovertebral joints)-synovial joints

These are small synovial joints formed secondarily between the lateral lips
(uncinate processes) of the superior surfaces of the bodies of the lower cervical
vertebrae (C3-C7) and the inferior surface of the superior vertebral body.
5. Ligaments
a. alar ligament (C1/2)
b. apical ligament of dens (C1/2)
c. Cruciform ligament (Cross ligament) (C1/2)
d. tectorial membrane
e. posterior longitudinal ligament
6. Cervical intervertebral discs
Clinical correlations
Subluxation in the cervical spine
Rheumatoid arthritis-joints of Lushka and C1/C2 subluxatoin
Osteoarthritis of the cervical spine

Objectives Group D
1. Be able to identify the anatomy of the thoracic vertebrae,
2. Be able to identify the ligaments listed
3. Be able to identify the articulations listed
4. Be able to identify the thoracic intervertebral discs

Group D: Thorax: thoracic vertebrae,

1. Vertebral anatomy (T1-T12)
a. arch
b. body
c. pedicle
d. Lamina

d. spinous process
e. transverse process
f. vertebral foramina
g. transverse foramina
h. superior articular processes-facet joint
i. inferior articular processes- facet joint
2. Articulations:
a. transverse costal facet
b. costovertebral joints
c. Articulation of first rib with manubrium
d. Sterno-manubrial joint
e. Articulation of the second rib with the sternomanubrial joint
f. Costochondral articulations with the sternum
g. xyphoid process fused to body of sternum with a fibrous joint
h. Facet joint
3.ligaments
a. anterior longitudinal ligament
b. ligamentum flavum
c. supraspinal ligament
d. posterior longitudinal ligament
4. Intervertebral Discs

Clinical correlations:
Scoliosis
Osteoporotic vertebral compression fractures
Spondyloarthropathies

Objectives Group E
1. Be able to identify the anatomy of the lumbar vertebrae and sacrum
2. Be able to identify the ligaments listed
3. Be able to identify the articulations listed
4. Be able to identify the lumbar intervertebral discs

Group E: Lumbar/Sacral Vertebrae and ligaments

A.Lumbar
1. Vertebral anatomy (L1-L5)
a. arch
b. body
c. pedicle
d. Lamina
d. spinous process
e. transverse process
f. vertebral foramina
g. transverse foramina
h. superior articular processes-facet joint
i. inferior articular processes- facet joint
2. Articulations
a. Facet Joints
3. ligaments
a. anterior longitudinal ligament
b. ligamentum flavum

c. supraspinal ligament
d. posterior longitudinal ligament
4. Intervertebral Discs

B Sacrum (S1-S5)
1. Sacrum anatomy
a. sacral ala
b. base and apex of the sacrum
c. lumbosacral articular promontory
d. Coccyx
2. Articulations
a. lumbosacral articular surface
b. sacral horns (superior articular process)

Clinical correlations:
Spondyloarthropathies, Spondylolisthesis, Metastasis to the lumbar spine
(pedicles), Osteoarthritis , Herniated disc, Fracture the coccyx