Embryology Introduction I.

We as physical therapists need to have an understanding of where structures originate and how the body comes to be organized. Goals: 1. Describe the stages of embryo development 2. Describe the origin of the major tissue types 3. Describe the development and differentiation of the somites 4. Describe the development of the spinal column 5. Describe limb bud formation, differentiation and rotation of the upper and lower extremities 6. Describe the innervations of the limb buds and dermatomes II. Early stages of embryology a. Germ cells (ovum and sperm) fuse as fertilization occurs b. Immediately following fertilization the newly formed cell begins a series of divisions. c. Gastrulation week 3 - As the cell divides it gives rise to a three-layered disc, the Trilaminar Disc. i. Trilaminar disc composed of 3 distinct tissue types 1. ectoderm-give rise to: central and peripheral nervous systems, epidermis, subcutaneous glands, dental enamel. 2. mesoderm gives rise to: connective tissue, smooth and striated muscle, cartilage and bone, cardiovascular and urogenital systems. 3. endoderm give s rise to: thymus and thyroid, GI sytem, and liver and pancreas. ii. Formation of Notochord (Neurulation) serves as axis for development of the skeletal system 1. Cells invaginate area of the primitive pit and begin cephalic migration 2. Eventually these cells form a tube-like structure called the notochordal process 3. With further development cells of the notochordal process proliferate and form the solid tube of the definitive notochord 4. Eventually the notochord separates from ectoderm and sinks into the mesoderm. a. Notochord is inductor for development of the nervous system b. Separation stage is PIVOTAL for development of axial skeleton and spinal column

Bogduk and Twomey, Clincial Anatomy of the Lumbar Spine, 1987. III. Development of the somites a. Paraxial mesoderm-develops into muscle etc. i. Mesodermal cells near the midline (notochord) proliferate and form thickened plates of tissue ii. A block of tissue forms on both sides of the notochord. These blocks of tissue develop in the head region then proliferate b. Lateral mesoderm i. Somatic (parietal) mesoderm forms the anterior and lateral body walls. ii. Splanchnic mesoderm forms the wall of the gut c. Intermediate mesoderm connects the paraxial and lateral mesoderm an eventually contributes to the development of the collecting ducts of the urinary system d. Cardiogenic plate- most cranial section of embryonic mesoderm forms the cardiac musculature

e. Appearance of segments i. At approx 3 weeks paraxial mesoderm becomes organized into segments. Appear first in the cephalic region then formation proceeds caudally. ii. In the head region the segments contribute the majority of the head mesenchyme iii. From the occipital region to the caudal region the segments become more organized and form somites iv. 1st somite appears cervically approx the 20th day v. Approximately 3 somites develop per day in a cephalo/caudal direction. f. Somites i. 4 occipital ii. 8 cervical iii. 12 thoracic iv. 5 lumbar v. 5 sacral vi. 8-10 coccygeal IV. Differentiation of the somites a. Somites shift position and surround the notochord b. Somites differentiate into 3 portions i. Ventral/medial layer = Sclerotome, becomes cartilage and bone of the trunk and limbs, vertebral column derives from sclerotome ii. Middle layer = Myotome, becomes segmental musculature of the body iii. Dorsal/ Lateral layer = Dermatome, becomes dermis and subcutaneous tissue of the body.

Bogduk and Twomey, Clincial Anatomy of the Lumbar Spine, 1987.

The somites and the myotomal derivates that come from them according to their level - form the somatic musculature. The occipital myotomes (4, green)mainly form the pharynx (throat) and upper or anterior neck musculature, including the tongue muscles. They are also responsible for the musculature in the occipital head region. From the cervical myotomes (8,orange) the neck and shoulder musculature form. They are followed by the thoracic myotomes (12, yellow)that form the musculature of the upper extremities and breast and abdominal wall musculature. The lumbal myotomes (5, blue) are responsible for the formation of the musculature in the lower extremities. Finally follow the sacral and coccygeal myotomes (5 sacral and 4-5 coccygeal, green) that form the muscles in the lower pelvis and gluteal region. V. Skeletal muscle a. Stem from dermatomyotome of the paraxial mesoderm that extend from the primitive streak(pit). VI. Development of the spinal column a. Movement of the Sclerotome around the developing spinal cord and notochord. i. At approx the 4th week sclerotomes migrate and surround the spinal cord and notochord. ii. Sclerotomes form a segmental mesenchymal layer 1. Sclerotome blocks are separated by areas of less dense tissue 2. Less dense areas contain a segmental artery Intersegmental artery b. Formation of the pre-cartilaginous vertebral body i. The caudal portion of each segment proliferates and condenses ii. Proliferation is so extensive that the dense portion expands into the next caudal segment iii. Subsequent to this proliferation expansion and caudal migration of the dense caudal portion of one segment fuses with the less dense cranial portion of the next segment thus forming the precartilaginous vertebral body. Essentially the caudal dense segment separates from the less dense segment its attached to and fuses with the segment below. c. Formation of the intervertebral(IV) disc i. The connective tissue between the original cranial and caudal portions of a segment does not proliferate and fills the space between newly formed vertebral bodies thus contributing to the Intervertebral Disc.

d.

ii. The notochord regresses (disintegrates) in the region of the developing vertebrae but persists in the area of the IV disc and forms the Nucleus Pulposus. Other structures i. myotomes now cross segments, positioned across IV disc thus allowing the developing muscle to move the spinal column ii. Intersegmental arteries pass over the region of the vertebral bodies iii. Spinal nerves lie near the IV disc and will eventually pass through the IV foramen

VII.

Limb bud stage- limb bud appears at approximately week 4 as a condensation of mesenchyme along the ventrolateral body wall. a. Induction i. Thought that somites induce differentaiation of mesenchyme into limb bud ii. Thought that somites induce thickening of apical ectoderm over the developing limb bud = Apical Ectodrmal Ridge(AER). Continued normal development of the limb is dependent upon interactions between the developing mesenchyme and AER. b. Initial position of limb bud early stages of UE and LE development are similar i. Initially the limb bud grow ventrally out of the embryo 1. UE thumb is cranial or pre-axial 2. LE great toe is cranial or pre-axial ii. UE limb bud grows opposite at approximately C3 T2 iii. LE limb bud grows opposite at approximately L2 S2 c. Hand and foot processes distal portion of the limb buds flatten out into paddle-like processes or plates i. Plate mesenchyme condenses to form digital rays (6th week UE, 7th week LE) ii. Regions between the rays break down forming notches between the rays and eventually will disintegrate forming the fingers and toes. (programmed cell death) d. Limb rotation- 7th or 8th week i. UE rotates 90 deg laterally (externally, outward) so that the elbow is directed posteriorly ii. LE rotates 90 degrees medially ( internally, inward) so that the knee is directed anterior iii. Thus, UE extensors are posterior and LE extensors are anterior.

Week six limb bud at right angles to trunk.

Week eight , rotation has occurred. VIII. Limb musculature development- two theories a. Mesenchyme differentiates into myoblasts which become muscle b. Bits of several myotomes migrate into the limb bud the fuse to form muscle. i. A muscle develops from multiple myotomes or multiple segmental levels ii. Muscle bits are located on either side of the A/P and M/L axes 1. Bits are dorsal or ventral, cranial or caudal 2. Dorsal bits fuse to become UE extensors (dorsal innervations) 3. Ventral bits fuse to become UE flexors(ventral innervations) IX. Innervation - As soon as the limb bud forms spinal nerves corresponding to the approximate levels of formation penetrate the bud. UE C3-T2, LE L2-S2 a. Each spinal nerve has a Dorsal and Ventral portion b. Motor- as development proceeds the dorsal portions unite and innervate dorsal structures and the ventral portions unite to innervate ventral structures. c. Sensory- since the limb buds grow as extensions or evaginations of the trunk they carry segmental innervation of the trunk wall with them. i. PREaxial borders (cranial) innervated by higher segments ii. POSTaxial borders (caudal) innervated by lower segments

iii. Intervening areas are innervated by an orderly sequence of segments iv. Segments may innervate only the distal portion of the limb ( i.e. the hand or foot) Note: Generally, a structure will bring its innervation with it from its point of origin. So, each bit of muscle brings with it its own segmental innervation. These bits of segmental innervation mix together to form the major nerve trunks.