I.

SKELETAL SYSTEM: BONES AND JOINTS

TERMINLOGY
rigid framework to support the soft tissues
help joints and levers to move
functions include sitting, standing, taking a breath, walking
consists of bones, and their connective tissues (cartilage, tendons, ligaments)
skeleton derived from a Greek word that means dried (but in fact the skeleton is far from
being dry)
consists of dynamic, living tissues that are able to grow, detect pain stimuli, adapt to stress,
and undergo repair after injuries
other functions:
1. Support the skeletal system is the major supporting tissue of the body
Cartilage provide firm yet flexible support (nose, external ear,
thoracic cage, trachea)
Ligaments strong bands of fibrous connective tissue that attach to
bones and hold them together. *Ligaments allow movement between
bones, put prevent excessive movement
Joints (or articulation) place where two bones come together. Most
joints are movable, although some allow only minimal movement; a
few allow none. The structure of a joint is directly correlated to its
degree of movement. *Joints allow movement between bones
2. Protection bones are hard; they protect the organ it surrounds
3. Movement skeletal muscles attach to bones through tendons (strong bands
of connective tissue)
contraction of the skeletal muscle moves the bones, producing
movements
4. Storage calcium and phosphorous are stored in the bone, adipose tissue is
stored in the bone cavities.
5. Blood cell production bones contain cavities filled with red bone marrow
which produce blood cells and platelets.
EXTRACELLULAR MATRIX
characteristics of the bone, cartilage, tendons, ligaments are determined by the
composition of their extracellular matrix
the matrix contains collagen, ground substance, and other organic molecules, water,
and minerals

Collagen tough, ropelike protein

Proteoglycans large molecules consisting polysaccharides attached to core
proteins
form large aggregates
can attract and retain large amounts of water between their
polysaccharide needles
Extracellular matrix of tendons and ligaments contains large amounts of collagen
fibers, making them very tough as ropes and cables
Extracellular matrix of contains collagen and proteoglycans (collagen makes it
tough, water-filled proteoglycans make it smooth and resilient). Which makes the
cartilage rigid, but it springs back to its original shape after being bent or
compressed. The cartilage is also an excellent shock absorber.
Extracellular matrix of bones contain collagen and minerals (ropelike collagen
fibers lend flexible strength to bones, minerals gives the bone compression or

weight-bearing strength). Most minerals in the bone is in the form of calcium

phosphate crystals called hydroxyapatite.
GENERAL FEATURES OF BONES
Four categories of bones based on shape:
1. Long longer than wide; most bones of the upper and lower limbs are long
bones
2. Short approximately as wide as they are long; bones of the wrist and ankle
are short bones
3. Flat have a thin, flattened shape; skull bones, ribs, scapulae, and sternum
are flat bones
4. Irregular include vertebrae and facial bones; shapes do not readily fit into
other three categories mentioned above
Long Bone
serves as a useful model for illustrating the parts of a typical bone
parts:
diaphysis central shaft
epiphysis two ends
articular cartilage covers the ends of the epiphyses where the bone
joins with other bones
epiphyseal plate (growth plate) only for a long bone that is still growing;
in length. This is composed of cartilage between each epiphysis and the
diaphysis. When bone growth stops, cartilage of each epiphyseal plate is
replaced by bone and becomes an epiphyseal line
periosteum dense connective tissue that covers most of the outer
surface of bone; it consists of two layers and contains blood vessels and
nerves
endosteum thin connective tissue membrane that lines the medullary
cavity
cavities:
medullary cavity large cavity in the diaphysis and smaller cavities of the
epiphyses
marrow soft tissue that fills empty spaces
yellow marrow mostly adipose tissue
red marrow blood-forming cells; only site of blood formation in adults
childrens bones have more red marrow than adults; as you age, red
marrow is being replaced by yellow marrow
in adults, red marrow is confined to the bones in the central axis of the
body and in the most proximal epiphyses of the limbs
Histology of Bone
Osteoblasts formation of bone; repair and remodeling of bone
Osteocytes when osteoblasts become surrounded with matrix
Osteoclasts also contribute to repair and remodeling of bone, by removing
existing bone
Lamellae thin sheets of extracellular matrix where bone is formed
Lacunae spaces in the lamellae where osteocytes are located
Canaliculi tiny canals

Two major types of bone tissue based on histological structure

1. Compact bone mostly solid matrix and cells
2. Spongy bone (or cancellous bone) lacy networks of bone with many small,
marrow-filled spaces

 Compact Bone
forms most of the diaphysis of a long bone and thinner surfaces of all other bones
Osteons predictable pattern of repeating units
Each osteon consists of concentric ring and lamellae
surrounding a central canal (aka Haversian canal)
Central canal (or Haversian canal) location of blood vessels that run
parallel to the long axis of the bone
CONCEPTS:
Osteocytes are located in lacunae between the lamellae of each osteon
Osteocytes are connected to one another by cell processes in canaliculi
Canaliculi give the osteon the appearance of having tiny cracks within the
lamellae
Nutrients leave the blood vessels of the central canals and diffuse to
osteocytes through the canaliculi
Waste products diffuse in the opposite direction
Blood vessels in the central canals are connected to blood vessels in the
periosteum and endosteum
Spongy Bone
located in the epiphyses of long bones
forms the interior of all bones
Trabeculae delicate interconnecting rods or plates of the bone; add
strength to a bone
CONCEPTS:
spaces between the trabeculae are filled with marrow
each trabecula consists of several lamellae with osteocytes between them
no blood vessels penetrate the trabeculae
trabeculae have no central canals
nutrients exit vessels in the marrow and pass by diffusion through canaliculi
to the osteocytes of the trabeculae
Bone ossification
ossification is the formation of bone by osteoblasts
after an osteoblast become completely surrounded by bone matrix, it matures to
become an osteocyte
in fetus, bones develop by two processes; formation of bone matrix or preexisting
connective tissue
Intramembranous ossification bone formation that occurs within the membrane; when
osteoblasts begin to produce bone in connective tissue membranes; occurs mostly in
skull bones; osteoblasts line up on the surface of connective tissue fibers and deposit
bone matrix to form trabeculae
Ossification centers where the process takes place
two or more exist in a skull; skull bones are produced by
fusion of these centers

Endochondral ossification bone formation that occurs inside cartilage; bones at the
base of skull and remaining skeletal system develops through this process
Chondrocytes cartilage cells that increase in number and size, then die
Primary ossification center center part of diaphysis, where bone first appears
Secondary ossification center forms at late part of bone production

Bone growth
occurs by deposition of new bone lamellae onto existing bone or connective tissue

Appositional growth osteoblasts deposit new bone matrix on the surface of bones
between the periosteum and existing bone matrix; bone increases in width and diameter
Growth in the length of a bone (major source of increased height in people) occurs in the
epiphyseal plate; occurs through endochondral ossification

Bone remodeling
removal of existing bone by osteoclasts and deposition of new bones by osteoblasts
occurs in all bone
maintain blood calcium levels
Bone repair
blood vessels in bone are also damaged when a bone is broken; vessels bleed and a
clot (hematoma) forms in the area
two to three days after injury, vessels and cells invade the clot; some form a network of
connective tissue which hold bone fragments together and fill the gaps, some produce islets of
cartilage.
Callus network of fibers and islets of cartilage between two bone fragments
osteoblasts enter callus, begin formation of spongy bone and completes repair in 4-6
weeks.
immobilization of bone is very critical during early stages of bone healing (not good for
the bone, muscles and joints)
if a bone is immobilized for 2 weeks, muscles may lose half their strength
BONE AND CALCIUM HOMEOSTASIS
when osteoblast and osteoclast activity is balanced, movements of calcium into and out of bone
is equal
osteoclast activity increases when blood calcium levels are too low; they release calcium from
bone into blood, then blood calcium levels increase
osteoblasts remove calcium from blood to produce new bone, then blood calcium levels
decrease
calcium homeostasis is maintained by three hormones:
1. Parathyroid hormone (PTH) from parathyroid glands
2. Vitamin D from skin and diet
3. Calcitonin from thyroid gland
PTH and vit. D are secreted when blood calcium levels are too low; while calcitonin is
secreted when BCL are too high
Calcitonin decreases BCL by inhibiting osteoclast activity
PTH increases blood calcium levels through three mechanisms:
1. Indirect stimulation of osteoclasts to break down bone; releases stored calcium to
blood
2. Stimulation of kidney to take up calcium from urine and return in to blood
3. Stimulation of formation of active vit. D; promotes increased calcium absorption from
small intestine
GENERAL CONSIDERATIONS OF BONE ANATOMY
206 bones (average); may vary from person to person and decreases with age as some
bones fuse
foramen hole in a bone; a nerve or vessel passes through this point
canal (or meatus) elongated hole with a tunnel-like passage through the bone
fossa depression in a bone
tubercle lump in a bone
process projection in a bone
condyle smooth, rounded end of a bone where joint formation occurs

AXIAL SKELETON
composed of brain, skull, vertebral column, and thoracic cage
1. Skull 22 bones; divided in the braincase and face
Braincase encloses cranial cavity; consists of 8 bones that surround and
protect the brain
Facial bones forms face structure; consists of 14 bones
13 facial bones are solidly connected; 1 (the mandible) is
movable; there are also 3 auditory ossicles in each middle ear (total
of 6)
i.

Lateral view
Parietal and temporal bones forms a large portion in the head
Squamous suture joint uniting bones of the skull; where parietal and temporal
bones join
Coronal suture where parietal bone and frontal bone join anteriorly
Lambdoid suture where parietal and occipital bone join posteriorly
External auditory canal large opening that enables sound waves to reach
eardrum
Mastoid process seen and felt as a lump posterior to the ear
Sphenoid bone single bone that extends completely across the skull
(resembles a butterfly); seen immediately anterior to the temporal bone
Zygomatic bone anterior to sphenoid; cheekbone; easily felt
Zygomatic arch joined processes of temporal and zygomatic bones; forms a
bridge at the side of the face; major attachment site for moving the mandible
Maxilla forms the upper jaw; sutures to the temporal bone; contains superior
set of the teeth
Mandible forms the lower jaw; contains inferior set of teeth

ii.

Frontal view view where major structures (frontal bone, zygomatic bones, maxillae,
and mandible) can be seen; teeth are very prominent in this view
Orbits most prominent openings into the skull; eyes rotate within them; coneshaped fossae
Superior and inferior orbital fissures largest openings of the orbit where nerves
and vessels communicate
Optic foramen where optic nerve passes to enter the cranial cavity
Nasolacrimal canal passes from the orbit to nasal cavity; has a duct that carries
tears from eyes to nasal cavity
Nasal septum divides nasal cavity into right and left halves
Vomer bony part of the nasal septum (inferiorly)
Perpendicular plate of ethmoid bone bony part of the nasal septum (superiorly)
Nasal bones form nose bridge
Nasal conchae three bony shelves of the nasal cavity walls
Paranasal sinuses large cavities which open into nasal cavity; acts as
resonating chambers during voice production
Mastoid air cells inside the mastoid processes of the temporal bone

iii.

Inferior of the cranial cavity

Foramen magnum large; where spinal cord joins the brain; location: posterior
fossa
Sella turcica saddle-like structure which contains the pituitary gland; central
region of sphenoid bone

iv.

Base of skull viewed from below

Occipital condyles- smooth points of articulation between the skull and
vertebral column; location: foramen magnum
Styloid processes two, long, pointed; project from interior surface of
temporal bone; where the muscles involved in moving the tongue, hyoid
bone, and pharynx orginate
Mandibular fossa where mandible articulates with temporal bone; anterior
to mastoid process
Hard palate forms floor of nasal cavity and roof of mouth; 2/3 of this is
formed by maxillae; 1/3 is formed by palatine bones
Soft palate made up of connective tissue and muscles; extends posteriorly
from hard palate
Hard and soft palates separate the nasal cavity and nasopharynx from mouth
thus enabling us to chew and breathe at the same time

v.

Hyoid bone
unpaired, U-shaped
not part of the skull
no direct attachment to skull
provides attachment for tongue muscles and important neck muscles that elevate
larynx (voicebox) during swallow or speech

2. Vertebral Column (backbone) central axis of the skeleton, extending from base of skull
to end of pelvis
26 individual bones (usually in adults) grouped into 5:
o 7 cervical vertebrae
o 12 thoracic vertebrae
o 5 lumbar vertebrae
o 1 sacral bone
o 1 coccyx bone
Sacral fuse from 5 individual bones, while coccyx from 3-4
Regions are identified by letters and numbers
o cervical vertebrae: C1-C7
o thoracic vertebrae: T1-T12
o lumbar vertebrae: L1-L5
o sacral bone: S
o coccyx bone: CO
adult vertebral column has four major curvatures:
o cervical region curves anteriorly
o thoracic region posteriorly
o lumbar anteriorly
o sacral and coccygeal posteriorly
abnormal curvatures common
o Kyphosis abnormal posterior curvature of spine; mostly in upper
thoracic region resulting in hunchback condition
o Lordosis abnormal anterior curvature of spine; mainly in lumbar region;
results in swayback condition

o Scoliosis abnormal lateral curvature of spine

Functions of vertebral column:
o Supports weight of head and trunk
o Protects spinal cord
o Allows nerves to exit spinal cord
o Provides site for muscle attachment
o Permits movement of head and trunk

i. General plan of the vertebrae

each vertebra consist of body, arch, and various processes
o body weight bearing portion
o intervertebral disks separates bodies; formed by fibrocartilage
o vertebral arch surrounds the vertebral foramen; has 2 pedicles and 2
laminae
o vertebral foramen large opening that forms the vertebral canal
o vertebral canal location of spinal cord; protects spinal cord from injury
o pedicles extend from body to transverse process
o laminae extend from transverse process to spinous process
o transverse process extends laterally from each side of the arch,
between pedicle and lamina
o spinous process projects dorsally from where the two laminae meet;
can be seen and felt as a series of lumps at the midline of the back
o intervertebral foramina formed by notches in the pedicles of adjacent
vertebrae; spinal nerves exit the spinal cord through this
o articular process where vertebrae articulate with each other
o articular facet smooth little face of articular process
ii. Four regional differences in vertebrae:
I.
Cervical vertebrae
Have very small bodies (except for atlas, which has no body)
Relatively delicate
Dislocations and fractures are more common in this area that in
other regions
Atlas first cervical vertebra; holds up the head
Axis second cervical vertebra; allows rotation of head
Dens where rotation occurs; protrudes superiorly from the axis
II.
Thoracic vertebrae
Long, thin, spinous inferior processes
Have extra articular facets in their lateral surfaces which
articulate the ribs
III.
Lumbar vertebrae
Large, thick bodies and heavy, rectangular transverse and
spinous processes
Have massive bodies; carry out a large amount of weight;
ruptured intervertebral disks are more common in this area than
in other regions
Superior articular facets face medially; inferior articular facets
laterally to lock the lumbar vertebrae to give more strength
(other regions have open articular facets, which allow rotational
movement)
IV.
Sacral vertebrae
5 sacral vertebrae are fused into a single bone called sacrum

Median sacral crest spinous process of the first 4 sacral

vertebrae
5th sacral vertebrae doesnt form, thus forming the sacral hiatus;
the usual site of caudal anesthetic injected before childbirth
Sacral promontory bulge formed by the anterior edge of body
of sacral vertebra; landmark felt during vaginal examination;
reference point to determine if pelvic is large enough to allow
normal delivery of baby
Coccyx (tailbone) consists of 4 fused vertebrae; dont have a typical
structure; easily broken

3. Thoracic cage (Rib cage) protects vital organs within the thorax and prevents collapse
during respiration; consists of thoracic vertebrae, ribs with their cartilages, and sternum
Ribs and costal cartilages
o 12 pairs of ribs divided into 2: true ribs and false ribs
o True ribs: 1-7; attach directly to sternum by costal cartilages
o False ribs: 8-12; dont attach directly to sternum
o Ribs 8-10 attach to sternum by a common cartilage
o Ribs 11 and 12 dont attach; they are aka floating ribs
Sternum (breastbone)
o Divided into 3: manubrium, body, xiphoid process
o Resembles a sword with manubrium as the handle, body as the blade,
and xiphoid process is the tip
o Jugular notch depression at the ends of clavicles here they articulate
with sternum
o Sternal angle slight elevation that is felt at the junction of the
manubrium and the body of sternum; identifies location and counting of
second rib
o Xiphoid process during CPR, hands must be placed over body of
sternum rather than in here; internal bleeding can happen when pressure
is applied
APPENDICULAR SKELETON
Consists of the bones of the upper and lower limbs, and girdles which attach the
limbs to the axial skeleton
1. Pectoral girdle (shoulder girdle) consists of 4 bones, 2 scapulae, 2 clavicles which
attach the upper limb to the body
Scapula (shoulder blade) flat, triangular bone with 3 large fossae where
muscles extending to the arm are attached
Glenoid cavity 4th fossa where the head of humerus connects to the
scapula
Spine ridge that runs across the posterior surface of scapula
Acromion process projection that extends from scapular spine to form the
point of the shoulder
Clavicle (collarbone) articulates with the scapula at acromion process; frst
bone to begin ossification in the fetus, but last bone to complete the
ossification process
Coracoid process curves below the clavicle and provides attachment of
arm and chest muscles
2. Upper limb consists of bones of arm, forearm, wrist and hand
a. Arm between shoulder and elbow; contains humerus

Proximal end of humerus contains a smooth rounded head;

which attaches to the scapulas glenoid cavity
Deltoid tuberosity deltoid muscles attach here
Epicondyle provides attachment sites for forearm muscles
b. Forearm has 2 bones: ulna (medial) and radius (lateral)
Trochlear notch proximal end of ulna; attached to the end
of humerus
Olecranon process extension of ulna which can be felt at
the point of elbow
Coronoid process completes the grip of ulna to the
humerus
Styloid process articulates with the bones of the wrist
Radial tuberosity where the biceps brachii attaches
c. Wrist short region between forearm and hand; composed of 8
carpal bones: scaphoid, lunate, triquetrum, pisiform, trapezium,
trapezoid, capitate, hamate.
d. Hand formed by the 5 metacarpal bones that attach to the carpal
bones; aligned with 5 digits (thumb and fingers)
Phalanges small bones in the fingers
all fingers except the thumb have 3
(proximal, middle, distal). The thumb
only has proximal and distal.
3. Pelvic girdle where lower limbs attach to the body; formed by the joining of the left
and right coxal bones and sacrum
o Pelvis includes pelvic girdle and coccyx (but sacrum and coccyx are part of
the axial skeleton)
o Each coxal bone is formed by fusion of three bones to form a single bone:
ilium (most superior), ischium (inferior and posterior), pubis (inferior and
anterior)
o Iliac crest seen long the superior margin of each ilium
o Anterior superior iliac spine important hip landmark
o Pubic symphysis where coxal bones join each other anteriorly
o Sacroiliac joints where coxal bones join the sacrum posteriorly
o Acetabulum socket of hip joint
o Obturator foramen large hole in each coxal bone closed by muscles
o Male pelvis is larger than female pelvis
o Pelvic inlet formed by pelvic brim and sacral promontory
o Pelvic outlet bounded by ischial spines, pubic symphysis, coccyx
4. Lower limb consists of bones of thigh, leg, ankle, and foot
i. Thigh between hip and knee
o Femur single bone; head of femur is attached to the acetabulum of coxal
bone; distinguished from humerus by its long neck
o Condyles of femur articulate with tibia
o Epicondyles points of ligament attachment
o Trochanters where neck of femur is found
o Patella (kneecap) enables tendon to bend over knee
5. Leg between knee and ankle; contains two bones: tibia and fibula
i. Tibia larger; major weight-bearer of the leg; where condyles of femur attach
o Tibial tuberosity where muscles of anterior thigh attach
ii. Fibula doesnt attach to the femur; but head is attached to tibia

Distal ends of tibia and fibula form a partial socket that articulates with the
ankle bone: the medial malleolus of tibia and lateral malleolus of fibula

6. Ankle has 7 tarsal bones: talus, calcaneus, cuboid, navicular, and the medial,
intermediate, and lateral cuneiforms
Talus connects with tibia and fibula to form ankle joint; calcaneus forms the
heel
7. Foot there are 3 primary arches in the foot; 2 longitudinal arches that extend from
heel to the ball of the foot; a transverse arch that extends across the foot

JOINTS (aka articulation)

Where 2 bones come together
Usually movable
Classification of joints according to functions:
1. Synarthrosis
2. Amphiarthrosis
3. Diarthrosis
According to structure:
1. Fibrous joints 2 bones united by fibrous tissue; exhibit limited or no movement
o Sutures between bones of skull
Fontanels sutures in newborns that are quite wide and are
soft spots that allow flexibility in the skull during birth process
and growth of head
o Syndesmoses bones are separated by distance and held together by
ligaments (example: connection of radius and ulna)
o Gomphoses has pegs fitted in to sockets and held in place by ligaments
(example: joint of tooth and its socket)
2. Cartilaginous joints unite 2 bones by cartilages; only slight movement can occur
o Fibrocartilage forms joints like the intervertebral disk
3. Synovial joints freely movable; contain fluid in a cavity surrounding ends of bones
Most bones of the appendicular are united by synovial joints (explains why there
is greater movement in the appendicular than axial)
o Articular cartilage smooth surface where joints meet
o Joint cavity filled with fluid
o Joint capsule encloses joint cavity
o Synovial membrane lines joint cavity everywhere
o Synovial fluid produced by synovial membrane; mixture of polysaccharides,
lipids, proteins, cells; covers the surface of the joint
o Bursa pocket or sac located in structures that rub together; reduce friction
that can damage structures
o Bursitis inflammation of bursa
o Tendon sheath
Types of synovial joints:
o Plane joints (gliding joints)

o
o

2 opposed flat surfaces that glide over each other

Saddle joints
2 saddle-shaped articulating surfaces oriented at right angles to each
other
Movements occur in 2 planes
Hinge joints
Movement in 1 plane only
Consist of a convex cylinder
Menisci shock-absorbing fibrocartilage pads
Pivot joints
Restrict movement to rotation around a single axis
Ball and socket joints
Consist of a ball (head) at the end of one bone and a socket in an
adjacent bone
Ellipsoid joints (condyloid joints) elongated ball and socket joints

Types of movement
o Flexion and extension common opposing movements; bend and straighten
o Plantar flexion movement of foot toward the plantar surface (ex: standing on
toes)
o Dorsiflexion movement of foot toward the shin (ex: walking on heels)
o Abduction movement away from median or midsagittal plane (ex: jumping
jacks)
o Adduction movement toward the median plane (ex: bringing the legs back
together)
o Pronation and supination
o Eversion turning the foot so that the bottom of the foot faces laterally
o Inversion turning the foot so the bottom faces medially
o Rotation turning of a structure around its long axis (ex: shaking the head no)
o Circumduction occurs at freely movable joints
o Protraction when a structure glides anteriorly
o Retraction structure glides posteriorly
o Elevation structure moves in a superior direction (ex: closing the mouth is
elevation of the mandible)
o Depression structure moves in an inferior direction (ex: opening the mouth is
depression of the mandible)
o Excursion movement of structure to one side (ex: moving the mandible from
side to side)
o Opposition movement unique to thumb and little finger; occurs when tips of
thumb and little finger are brought toward each other across palm of the hand
o Reposition returns digits to the anatomical position
Joint malfunction
Sprain results when bones of a joint are forcefully pulled apart causing the
ligaments around the joint to be torn
Separation exists when bones remain apart after injury to a joint
Dislocation end of one bone is pulled out of the socket
Hyperextension abnormal, forced extension of a joint beyond its normal range
of motion