Arthrosis of the costovertebral joints - characteristics and treatment

The costovertebral joints (CRJs) include two groups of synovial joints that connect the proximal ends of the ribs to their corresponding thoracic vertebrae, thus forming the rib cage posteriorly.

The connection of the ribs to the vertebrae occurs in two places:

Head (rib head joint). The two convex faces of the rib head articulate with the costal fossae of the bodies of two adjacent vertebrae, forming a synovial joint, which is strengthened by the ligament of the rib head, the radiate ligament of the rib head and the intercapital ligament.
Tubercle of the rib (costotransverse joint). This articulation is formed by the articular surface of the tubercle of the rib and the transverse costal fossa of the transverse process of the vertebra. This articulation is strengthened by the costotransverse ligaments.

Characteristics of arthrosis of costovertebral joints

The costotransverse and costovertebral joints make up the rotator cuff joint. Cartilage in this area, as in other joints, is subject to wear and destructive changes, destruction and deformation. Most often they affect the joints of the spine and the ninth-tenth ribs, less often – the third-fifth (other varieties are practically not found). As a result of the lesion, cartilage and bone tissue are destroyed, limiting mobility and causing severe pain.

Often this type of arthrosis affects elderly patients, people with slow metabolism and damage to the joint capsule.

Possible complications

Any disease without treatment is fraught with the development of serious complications, costovertebral arthrosis is no exception. When faced with an illness, people rarely turn to specialists for help. Instead, they are treated with folk remedies, which is not always justified.

If inflammation of the costotransverse and vertebral joints is not treated, their condition can worsen significantly. Complications include:

limitation of mobility and functionality of joints;
compression of nerve fibers, blood vessels supplying tissues with oxygen and nutrients;
development of chronic diseases of the spine, joint deformities, formation of osteophytes;
the appearance of pathologies in internal organs.

Based on the symptoms of costovertebral pathologies, the doctor can diagnose lung or heart diseases - the clinical picture of these pathologies is quite similar. This is the insidiousness of the disease. Incorrect diagnosis or incorrectly prescribed treatment are additional reasons for the development of complications in the patient.

Classification

There are two main forms of arthrosis of the costovertebral joints:

Primary. Typical for elderly patients. A diagnosis associated with the primary form of arthrosis is made if the causes and prerequisites for the development of the disease are not identified. As a rule, in such cases, the lesion affects not only the specified group of joints, but also all joints of the skeleton.
Secondary. It can occur in people of any age due to the presence of mechanical damage to the joints, progression of inflammatory processes, and infectious infection of the body.

The progression of pathology can go through three stages:

Latent. As a rule, destruction makes itself felt only during physical activity. The only sign of a disorder is mild pain that goes away at rest.
Second. Pain during physical activity gradually intensifies and limits the mobility of the spine. There may be difficulty breathing.
Third. The pain syndrome becomes permanent and practically cannot be relieved with conventional analgesics. In this case, there is a significant restriction of mobility up to constant bed rest, as well as difficulties with breathing and conducting usual activities.

Manifestations

Various forms of osteoarthritis, including spinal-costal pathology, are largely similar to each other. The main symptom is pain of varying severity, intensifying with physical activity and stress on the back. When you are at rest, there is usually no discomfort. A characteristic sign of pathology is the so-called starting pain, which appears at the beginning of movement, then fades away, and after some time during physical activity makes itself felt again.

There may not be morning stiffness in the joints. Other symptoms include moderate swelling and hyperemia of the affected area. However, this manifestation does not occur in everyone. The progression of the disease is accompanied by an increase in symptoms. The pain becomes more intense, and joint mobility noticeably deteriorates.

Rib arthrosis can have different manifestations depending on which joints are affected.

Destruction of the osteochondral structures between the vertebrae and ribs is characterized by the following features:

pain predominantly in the chest and upper back;
unpleasant sensations intensify when inhaling and moving;
there may be swelling and tenderness of the tissue at the site of the damaged joint;
back muscle spasm;
decreased mobility in the joints, resulting in pain even with breathing movements;
stiffness in the joints does not last long;
crunching sound when turning the body or bending over.

Spinal-costal arthrosis can occur hidden for several years. Pathology is often discovered by chance - for example, during routine medical examinations. At an early stage, the symptoms are mild, but as the pathological process progresses, the clinical manifestations intensify. Patients experience the greatest discomfort in the evening - the result of overexertion during the day. Inflammation most often affects the lower part of the chest.

The disease is often accompanied by chest pain

Damage to the sternocostal joints is rare. This is usually caused by chest contusions (and other injuries), infectious processes and multisystem diseases. Costotransverse osteoarthritis is manifested by the following symptoms:

discomfort occurring at the edges of the sternum;
severe pain during forced inhalation;
the severity of inflammation of the sternocostal joints is low;
palpation of tissue pastiness is noted;
there is no reflex muscle spasm;
joint stiffness lasts longer than with other forms of the disease.

The act of breathing may not be accompanied by constant pain; serious deformations of the osteoarticular apparatus rarely occur. The prognosis for this form is more favorable than for spinal-costal osteoarthritis. Any type of arthrosis has a bad effect on posture. When sitting and moving, patients develop a stoop, their shoulders drop and protrude forward.

In the absence of treatment at the initial stage, destructive processes continue to gain momentum, and then patients are forced to resort to surgical intervention. Serious damage to osteochondral structures significantly reduces the quality of life of patients and can lead to disability.

Causes and risk factors for development

Among the most common and probable causes of the development of arthrosis of the costovertebral joints of the thoracic region are:

Vertebral injuries;
Genetic disorders;
Endocrine pathologies;
Congenital spinal deformities;
Poor posture;
Wear and tear of joints associated with constant physical activity and age-related changes;
Dystrophy of tissues of joints and vertebrae;
Scoliosis and other spinal diseases;
Development of infectious diseases.

There are also factors that increase the likelihood of costovertebral arthrosis against the background of existing disorders:

Decreased metabolic activity;
Flat feet;
Excess body weight;
Episodic physical activity (carrying out activities related to physical labor with a sedentary lifestyle).

Forms of the disease

Arthrosis of the lumbar, cervical, and thoracic spine is conventionally divided into two groups:

primary;
secondary.

If the disease has developed due to age-related changes, and its root cause has not been established, they speak of primary arthrosis. The development mechanism is associated with degenerative-destructive processes in cartilage tissue, wear of joints and dysfunction of various body systems. If the disorder was preceded by fractures, injuries, acute infectious diseases, hormonal imbalances, osteoarthritis takes a secondary form.

Often the cause of the disease is the inflammatory process occurring in the joint. In some patients, the cartilage located in the sternocostal joints is affected. This disorder is called “Tietze syndrome” and has the character of aseptic inflammation. Tuberculosis can provoke spinal-costal arthrosis. Scientists also note the role of genetic disorders and congenital joint dysplasia.

Diagram of the connection of the ribs with the spinal column and sternum

Symptoms and signs

The most typical symptom for arthrosis of the costovertebral joints is acute pain localized in the spine, chest and ribs. Along with this, aching muscle pain is also possible. Pain is caused by movement and breathing. Stooping helps patients reduce its manifestation in arthrosis. The development of the disease is also accompanied by the following phenomena:

Stiffness in the morning;
Swelling and swelling in the affected area;
Local increase in body temperature;
Crunching and clicking noises during physical activity.

Diagnostic methods

For the most accurate diagnosis, it is possible to involve specialists:

Surgeon;
Neurologist;
Traumatologist;
Orthopedist.

The diagnosis itself is carried out in three stages. At the first stage, basic information and anamnesis are collected. Here the doctor needs to find out the following:

The nature and intensity of the pain syndrome;
Possible causes of the lesion (in the future they need to be confirmed or refuted);
Possible presence of concomitant symptoms;
Chronic and past diseases, injuries;
Features of lifestyle;
Duration of pathological phenomena.

The second stage involves an external inspection. With its help, it is possible to determine the scale of the deformation, and palpation allows us to identify the presence of swelling and spasms of the muscles, as well as the level of joint mobility.

The final stage plays a decisive role in diagnosis. The examination includes standard procedures:

X-ray of the chest and spine to identify the nature and extent of damage and deformities;
Computed tomography and magnetic tomography to visualize soft tissues around bones and joints to identify inflammatory and destructive processes;
Arthroscopy to visualize the inside of the joint using a microcamera.

Treatment methods

The main methods of treatment and prevention of complications are conservative therapy and physical therapy.

As a rule, it is not possible to completely eliminate the pathology, however, traditional and folk therapy can get rid of symptoms and significantly improve the quality of life of patients

Drug effects

To relieve the main symptoms, patients are prescribed:

NSAIDs in the form of tablets, injections, ointments and creams (Diclofenac, Movalis, Ibuprofen) to eliminate pain, reduce swelling, inflammation and its complications. In difficult situations, corticosteroids are prescribed instead of these drugs.
Warming agents based on natural ingredients.
Chondroprotectors (Chondroitin, Glucosamine). Helps restore and protect joint cartilage, improve metabolic processes, and relieve pain.
Muscle relaxants. Helps eliminate pain and relieve excess tension from muscles.

Physiotherapy and exercise therapy

Physiotherapy, therapeutic exercises and massage courses are not used separately as independent techniques and are an addition to the main treatment. For osteoarthritis of the costovertebral joints, the following are effective:

Electrophoresis using an analgesic to eliminate pain, inflammation and improve metabolic processes in tissues;
acupuncture;
Laser and magnetic therapy;
Ultrasound treatment to relieve pain and discomfort;
Phonophoresis;
Heat compresses to stimulate blood circulation and tissue regeneration.

The procedures have contraindications and are prescribed only after a thorough examination.

A complex of exercise therapy is compiled by the attending physician based on the individual characteristics of the patient and his illness

For arthrosis of the costosternal joints, the following typical groups are effective:

Deflections in different positions;
Turns and tilts of the head;
Raising the body from a lying position.

Treatment

Any variants of osteoarthritis require complex treatment, which includes:

anti-inflammatory and analgesic drug therapy in the form of injections, ointments, tablet forms (Diclofenac, Ibuprofen);
physiotherapy (magnetic, ultrasound, laser, etc.);
in the early stages and during the rehabilitation period - therapeutic exercises, massage, swimming;
acupuncture, reflexology;
Spa treatment;
taking general strengthening medications, mineral and vitamin complexes and agents aimed at the regeneration of cartilage tissue and the production of synovium.

All these remedies, in fact, relate to symptomatic and pathogenetic methods of treatment. Thus, analgesics are used to relieve pain, NSAIDs are used to reduce inflammation. Mineral and vitamin complexes slow down degenerative and destructive processes in the osteochondral apparatus (chondroprotectors).

Pain is treated with non-steroidal anti-inflammatory drugs

Among the promising means of pharmacotherapy for arthrosis are:

complex preparations of glucosamine and chondroitin sulfate;
diacerin;
metalloproteinase inhibitors;
agents affecting bones (calcitonin, biosphosphonates, hormone replacement therapy).

If muscle spasm is present, muscle relaxants are prescribed. They are aimed at relaxing muscles and reducing tension. Physiotherapeutic techniques and exercise therapy are used to strengthen the back muscles, especially in the area of the costovertebral and costothoracic joints, and increase endurance. In addition, physical activity is necessary for weight loss, which is necessary for osteoarthritis.

Even regular walks in the fresh air are useful, during which it is recommended to wear a support corset (or bandage). After walks and therapeutic exercises, you should do a relaxing massage. Modern physiotherapeutic procedures occupy an important place in the treatment of spinal-costal arthrosis.

Thus, laser treatment affects the area of inflammation directly. This method allows you to quickly and painlessly excise damaged tissue and stop the destructive process. After this, complex drug treatment is prescribed. Magnetic therapy is widely used in the treatment of arthrosis. A magnetic field is used as a healing factor.

During the rehabilitation period, a sanatorium-resort holiday, the program of which also includes various procedures and physical education, has a good effect. All these treatment methods are effective only in the initial stage of the disease. If there is severe deformation of the osteoarticular apparatus, surgery is performed. An uncomplicated form of arthrosis is treated by surgical removal of elements of destroyed cartilage. Next, anti-inflammatory and regenerating agents are prescribed.

During the recovery period they do therapeutic exercises

In severe cases, they resort to endoprosthetics - removal of the destroyed joint and implantation of an artificial one.

Prognosis and possible complications

In the early stages, osteoarthritis is quite easy to treat, but is rarely diagnosed due to the fact that patients do not pay attention to the symptoms.

It is almost impossible to eliminate the manifestation of the last stages of the disease using conservative methods, therefore, in such cases, surgical intervention is used.

In addition, the progression of destruction causes the following complications:

Disturbances in the functioning of other systems and internal organs;
Deformation and compression of the chest;
Significant limitation of mobility;
Compression of capillaries and nerves.

Links[edit]

This article incorporates open access text from page 299 of the 20th edition

"Grey's Anatomy"
(1918).

^ ab Chopra, Pradeep (01/01/2009), Smith, HOWARD S. (ed.), "Chapter 26 - Chest Pain", Current Therapy in Pain
, Philadelphia: WB Saunders, pp. 194–201, ISBN 978-1-4160-4836-7, received 2021-01-04
Gradner, G. (2014-01-01), Langley-Hobbs, Sorrel J.; Demetriou, Jackie L.; Ladlow, Jane F. (ed.), "Chapter 43 - Chest Wall", Feline Soft Tissue and General Surgery
, W. B. Saunders, pp. 495–505, ISBN 978-0-7020-4336-9, received 2021-01-04

Disease prevention

Prevention of arthrosis of the costotransverse joints is important at any age, but its special need arises after forty to fifty years. In order to significantly reduce the risks of degenerative changes, it is necessary:

Create a daily diet based on the principles of proper balanced nutrition;
Maintain normal body weight;
Eliminate skeletal diseases in a timely manner;
Maintain muscle tone with moderate physical activity;
To refuse from bad habits;
From time to time use the services of a professional massage therapist;
Regularly undergo preventive examinations with an orthopedist.

Connections of the spinal column and head bones

Spinal joints
Joints and ligaments between the occipital bone and the atlas and axial vertebra
Ligaments of the spinal column
Costovertebral joints
Costosternal joints
Temporomandibular joint

Intervertebral discs (cartilage)
lie between the bodies of two adjacent vertebrae throughout the cervical, thoracic and lumbar spine.

The intervertebral disc, discus
intervertebralis,
belongs to the group of fibrous cartilage.
It distinguishes:

peripheral part - fibrous ring, anulus flbrosus;
centrally located nucleus pulposus, nucleus pulposus.
There is no intervertebral disc between the atlas and the axial vertebra. The thickness of the discs is uneven and gradually increases towards the lower part of the spinal column, and the discs of the cervical and lumbar spine are somewhat thicker in front than in the back. In the middle part of the thoracic spine, the discs are much thinner than in the higher and lower parts. The cartilaginous section makes up a quarter of the length of the entire spinal column.

The facet joint, junctura
zygapophysealis,
is formed between
the upper articular process, processus articularis superior,
of the underlying vertebra and
the lower articular process, processus articularis inferior,
of the overlying vertebra.
The articular capsule, capsula articularis,
is strengthened along the edge of the articular cartilage.

Articular cavity, cavum articulare,

is located according to the position and direction of the articular surfaces, approaching the horizontal plane in the cervical region, the frontal plane in the thoracic region, and the sagittal plane in the lumbar region.

The facet joints are classified as flat joints in the cervical and thoracic sections of the spinal column, and cylindrical joints in the lumbar spine.

The sacrococcygeal joint, junctura
sacrococcygea,
lies between the bodies of the V-sacral and I-coccygeal vertebrae;
sacrococcygeal synchondrosis contains a small cavity in the intervertebral disc. This synchondrosis is strengthened by the following ligaments.

lateral sacrococcygeal ligament, lig.
sacrococcygeum lateralis, stretches between the transverse processes of the last sacral and 1st coccygeal vertebrae and is a continuation of the lig. Intertransversaria;
ventral sacrococcygeal ligament, lig.
sacrococcygeum ventrale, is a continuation of lig. longitudinaleanterius and consists of two bundles located on the anterior surface of the sacrococcygeal joint; along the way, the fibers of these bundles intersect;
superficial dorsal sacrococcygeal ligament, lig.
sacrococcygeum dorsale superficiale, stretches between the posterior surface of the coccyx and the side walls of the entrance to the sacral canal, covering its gap. It corresponds to the yellow and supraspinous ligaments of the spinal column;
deep dorsal sacrococcygeal ligament, lig.
sacrococcygeum donate profundum, is a continuation of lig. longitudinaleposterius.

2. The joints of the occipital bone, atlas and axial vertebra include the following.

Atlanto-occipital joint, arliculatio atlantooccipitalis,
paired;
it is formed by the articular surface of the occipital condyles, condylioccipilales, and the superior articular fossa of the atlas, foveaarticularissuperior. The articular capsule is attached along the edge of the articular cartilage. Based on the shape of the articular surfaces, this joint belongs to the group of ellipsoidal joints, articulatioellipsoidea. In both, right and left, joints that have separate articular capsules, movements occur simultaneously, i.e. they form one combined joint; Nodding (bending forward and backward) and slight lateral movements of the head are possible. The anterior atlanto-occipital membrane, tet br apa atlantooccipitalis anterior,
stretches along the entire gap between the anterior edge of the foramen magnum and the upper edge of the anterior arch of the atlas; fused with the upper end of the lig. longitudinaleanterius.
Posterior atlanto-occipital membrane, membrana atlantooccipitalis posterior,
is located between the posterior edge of the foramen magnum and the upper edge of the posterior arch of the atlas. This membrane is a modified ligamentum flavum. When the atlas and axial vertebra articulate, three joints are formed: two paired and one unpaired:
The lateral atlantoaxial joint, articulatio atlantoaxialis lateralis, is
a paired combined joint, formed by the upper articular surfaces of the axial vertebra and the lower articular surfaces of the atlas. It belongs to the type of low-moving joints, since its articular surfaces are flat and even. In this joint, sliding occurs in all directions of the articular surfaces of the atlas in relation to the axial vertebra.
The median atlantoaxial joint, articulatio atlantoaxialis mediana,
is formed between the posterior surface of the anterior arch of the atlas
{fovea dentis)
and the tooth of the axial vertebra.
In addition, the posterior articular surface of the tooth forms a joint with the transverse atlas ligament. The joints of the tooth belong to the group of cylindrical ones and in them it is possible to rotate the atlas together with the head around the vertical axis of the tooth along the axial vertebra, i.e., rotation of the head to the right and left. The ligamentous apparatus of the two joints described includes:

covering membrane, membrana tectoria.
This membrane is called the integumentary membrane because it covers the back (from the side of the spinal canal) of the tooth, the transverse ligament of the atlas and other formations of this joint. It is considered as part of the posterior longitudinal ligament of the spinal column;
cruciate ligament of the atlas, lig.
cruciforme atlantis, consisting of longitudinal and transverse bundles.

The transverse bundle
is called
the transverse ligament of the atlas, lig.
transversum atlantis, and is a dense connective tissue cord stretched between the internal parts of the massalateralis atlantis.
It is adjacent to the posterior articular surface of the tooth of the axial vertebra and strengthens it. Longitudinal fasciculus, fasciculus iongitudinalis, consists of two legs:

the upper leg
comes from the middle part of the transverse ligament of the atlas and reaches the anterior surface of the foramen magnum;
the lower leg
also starts from the middle part of the transverse ligament, goes down and is attached to the posterior surface of the body of the axial vertebra.

Ligament of the apex of the tooth, lig.
apicis dentis, extends between the apex of the tooth of the axial vertebra and the middle part of the anterior edge of the foramen magnum. This ligament is considered a rudiment of the dorsal string, chordadorsalis.
Pterygoid ligaments, ligg.
alaria, are formed by bundles of connective tissue fibers stretched between the lateral surfaces of the tooth of the axial vertebra and the inner surfaces of the occipital condyles, condylioccipilales.

3.
The long ligaments of the spinal column include the following elements.
Anterior longitudinal ligament, lig. longitudinale anterius,

runs along the anterior and partly lateral surfaces of the vertebral bodies from the anterior tubercle of the atlas to the sacrum, where it is lost in the periosteum of the 1st and 2nd sacral vertebrae. Limits excessive extension of the spinal column. The anterior longitudinal ligament in the lower parts of the spinal column is much wider and stronger; it connects loosely with the vertebral bodies and tightly with the intervertebral cartilage, as it is woven into the perichondrium covering them; on the sides of the vertebrae it continues into their periosteum. The deep layers of the bundles of this ligament are somewhat shorter than the superficial ones, due to which they connect adjacent vertebrae with each other, and the superficial, longer bundles lie over 4-5 vertebrae.

Posterior longitudinal ligament, lig. longitudinale posterius,

located on the posterior surface of the vertebral bodies in the spinal canal, canalis vertebralis.

The posterior longitudinal ligament, in contrast to the anterior one, is wider in the upper part of the spinal column than in the lower part.

The superficial bundles of this ligament, as in the anterior longitudinal ligament, are longer than the deep ones.

Ligamentum flavum, ligg. flaves,

fill the spaces between the vertebral arches from the axial vertebra to the sacrum. They are directed from the inner surface and lower edge of the arch of the overlying vertebra to the outer surface and upper edge of the arch of the underlying vertebra and, with their anterior edges, limit the intervertebral foramina from behind. They reach their greatest development in the lumbar region. The yellow ligaments are very elastic, consisting of vertically running elastic bundles, giving them a yellow color. When the torso is extended, they shorten and act like muscles, keeping the torso in a state of extension and reducing muscle tension. When flexed, they stretch and thereby also reduce the tension of the rectus abdominis.

There are no yellow ligaments between the arches of the atlas and the axial vertebra. The connective tissue atlanto-axial membrane is stretched here

which, with its anterior edge, limits behind the intervertebral foramen, foramenintervertebrale, through which the second cervical nerve exits.

Interspinous ligaments, ligg. interspinalia

- thin plates that fill the spaces between the spinous processes of two adjacent vertebrae. At the front they are connected to the ligg. flava; and behind, at the apex of the spinous process, they merge with the supraspinous ligament.

Supraspinous ligament, lig. supraspinale,

It is a continuous cord running along the tops of the spinous processes of the vertebrae in the lumbar and thoracic regions. Below, it is lost on the spinous processes of the sacral vertebrae, at the top, at the level of the protruding vertebra, it passes into the rudimentary nuchal ligament.

Nuchal ligament, lig. nuchae, -

a thin plate consisting of elastic and connective tissue bundles; is directed from the spinous process of the protruding vertebra along the spinous processes of the cervical vertebrae upward and, expanding slightly, is attached to the external occipital crest and external occipital protrusion (it has the shape of a triangular plate).

Intertransverse ligaments, ligg. intertransversaria,

They are thin bundles, weakly expressed in the cervical and partly thoracic regions and more developed in the lumbar region; paired ligaments connecting the tops of the transverse processes of adjacent vertebrae limit lateral movements of the spine in the opposite direction.

4. Costovertebral joints.

Joint of the rib head, articulatio capitis costae,

formed by the articular surface of the rib head and the costal fossae of the vertebral bodies.
The heads from II to the ridges are in contact with the corresponding articular fossae of the bodies of two vertebrae. The pits on the vertebral bodies are formed:

lesser and upper costal fossa, foveacostalis superior;
greater and lower costal fossa, foveacostalis inferior. Ribs I, XI and XII articulate only with the fossa of one vertebra. In the cavity of the joints of the II-X ribs lies the intra-articular ligament of the rib head, lig.
capitis costae inlraarliculare. It runs from the cristacapitis costae to the intervertebral disc and divides the joint cavity into two chambers.

The articular capsule is thin and is supported by the radiate ligament of the head of the rib, lig. capitis costae radiaturn,

which originates from the anterior surface of the rib head and is attached in a fan-shaped manner to the above and underlying vertebrae and intervertebral disc.

Costotransverse joint, articulatio costotransversaria,

is formed by the articulation of the articular surface of the tubercle of the rib, facies articularistuberculicostae, with the transverse costal fossa, foveacostalis transversalis, the transverse processes of the thoracic vertebrae.
These joints are present only in the 10 upper ribs. The joint is strengthened by numerous ligaments:

superior costotransverse ligament, lig.
costotransversarium superius, - originates from the lower surface of the transverse process and attaches to the crest of the neck of the underlying rib;
lateral costotransverse ligament, lig.
costotransversarium laterale, - stretches between the bases of the transverse and spinous processes and the posterior surface of the neck of the underlying rib;
costotransverse ligament, lig.
costotransversarium - lies between the posterior surface of the rib neck and the anterior surface of the transverse process of the corresponding vertebra.
The joints of the head and tubercle of the rib
are combined (cylindrical or rotational) joints, since they are functionally connected: movements during the act of breathing occur simultaneously in both joints.

5. Costosternal joints.

The anterior ends of the ribs end in costal cartilages.

The costal cartilage of the first rib
fuses with the sternum
(synchondrosis).
The costal cartilages of the II - VII ribs
articulate with the costal notches of the sternum, forming
the sternocostal joints, articulationes sternocostales.
The cavity of these joints is a narrow, vertically located gap, which in the cavity of the joint of the 2nd costal cartilage has
an intra-articular sternocostal ligament, lig.
sternocostale intraarticulare. It goes from the costal cartilage of the second rib to the junction of the manubrium and the body of the sternum.
The articular capsules of these joints, formed by the perichondrium of the costal cartilages, are strengthened by the radiate sternocostal ligaments, ligg.
sternocostalia radiata, the anterior ones are stronger than the posterior ones.
These ligaments run radially from the end of the costal cartilage to the anterior and posterior surfaces of the sternum, forming crosses and interlaces with the ligaments of the same name on the opposite side, as well as with the overlying and underlying ligaments. As a result, a strong fibrous layer is formed covering the sternum - the sternum membrane, membrana stemi.
The bundles of fibers that run from the anterior surface of the VI-VII costal cartilages obliquely downwards and medially to the xiphoid process form
the costoxiphoid ligaments, ligg. costoxiphoidea.
The costal cartilages from the V to the IX ribs
are connected to each other through dense fibrous tissue and
intercartilaginous joints, articulationes interchondrales.
The tenth rib is connected by fibrous tissue to the cartilage of the IX rib, and the cartilages of the XI and XII ribs
end freely between the abdominal muscles.

6.
The temporomandibular joint, articulatio temporomandibula-ris,
paired,
is formed:

head of the lower jaw, caput mandibulae;
mandibular fossa, fossa mandibularis;
articular tubercle, tuberculum articulare,
scaly part of the temporal bone.

Heads of the mandible

have a roller shape; their long converging axes, as their continuation, converge at an obtuse angle at the anterior edge of the foramen magnum.

Mandibular fossa of the temporal bone

is not completely included in the cavity of the temporomandibular joint.

It has two parts:

extracapsular part of the mandibular fossa,

which lies behind the fissurapetrotympanica;

intracapsular part of the mandibular fossa

anterior to it - this part is contained in a capsule, which extends to the articular tubercle, reaching its anterior edge.
The articular surfaces are covered with connective tissue cartilage. In the joint cavity lies a biconcave oval-shaped fibrous cartilaginous plate - articular disc, discus articularis.
Located in a horizontal plane, the disc with its upper surface is adjacent to the tuberculumarticulare, and its lower surface is adjacent to the caputmandibulae. It fuses along the circumference with the articular capsule and divides the joint cavity into two sections that do not communicate with each other: upper and lower.

of the lateral pterygoid muscle, i.e. pterygoideus lateraiis, is attached to the inner edge of the disc Articular capsule, capsula articularis.

attached to the edge of the articular cartilage;
fixed on the temporal bone:

in front - along the anterior slope of the tuberculumarticulare;
behind - along the anterior edge of the fissurapetrotympanica;
laterally - at the base of the processuszygomaticus;
medially reaches spinaossissphenoidalis;

on the lower jaw it covers its neck, attaching to it at the back somewhat lower than at the front.

The ligaments of the temporomandibular joint are divided into three groups:

intracapsular ligaments -

. meniscotemporal ligaments,
anterior and posterior;
menisco-maxillary ligaments,
internal and external;

extracapsular ligament - lateral, lig.
laterale, in which two parts are distinguished -

anterior (or external);
rear (or internal);

ligaments related to the temporomandibular joint, but not connected to the joint capsule:

sphenomandibular ligament, lig. sphenomandibulare stylomandibular ligament, tig. stylomandibulare.

Temporomandibular joint

belongs to the type of block joints, ginglymus.

The right and left temporomandibular joints together form one combined articulation - movement in the joints is possible.

lowering and raising the lower jaw;
moving it forward, backward and to the side (right or left).

In the latter case, in the joint of one side there is a slight rotation around the vertical axis, and on the other side the articular disc is displaced in the direction of movement of the head of the mandible.