Clinical terms Dwarfism –Achondroplasia Abnormal projection from a bone due to bony overgrowth –Bony spur Pain in bone –Ostealgia Bone inflammation –Osteitis.

Clinical terms• Dwarfism

– Achondroplasia• Abnormal projection from a bone due to bony overgrowth

– Bony spur• Pain in bone

– Ostealgia• Bone inflammation

– Osteitis• Inflammation of bone and bone marrow caused by pus-forming

bacteria– Osteomyalitis

• Bone cancer in a long bone of limb– Osteosarcoma

• Fracture in diseased bone involving slight (coughing or quick turn)– Pathological fracture

• Placing sustained tension on a body region to keep fractured bone in alignment– Traction 1

Epiphyseal Zones• Name the 5 zones

2

Resting cartilage

Proliferation

Hypertrophy

Erosion (Calcification)

Diaphysis (ossification)

Resting Cartilage• Identify characteristics of this zone

1. Chondro’s resting in Lacunae

2. Not mitotically dividing

3. Not actively contributing to bone growth

4. Near epiphysis5. Scattered chondro’s

• What is the Role of this zone?

1. To anchor the rest of the epiphyseal plate to the epiphysis

3

Proliferation Zone• Identify

characteristics1. Chondro’s

proliferating and dividing

2. Supplying new chondro’s to replace those lost to lengthening of bone

3. Proliferating cells stick up into narrow cells

4. Cells resemble stack of coins

4

Hypertrophy (Maturing) Zone• Identify

characteristics1. Cellular breakdown

2. Chondro’s begin to break down and produce alkaline phosphatase

3. Enzyme facilitates calcification of extra cellular matrix

4. Large chondro’s arranged in columns

5

Erosion Zone (calcification)

• Identify1. Calcium salts deposited

in cartilage matrix by osteoids

2. Osteogenesis, osteoblasts laying down the matrix

3. Only a few cells thick4. Dead cells because the

matrix around them became calcified

5. Calcified matrix destroyed by osteoclasts (acids and enzymes), then invaded by osteoblasts and capillaries from diaphysis

6. Diaphyseal border of the plate firmly cemented to the bone of the diaphysis

6

Diaphysis Zone (ossification)

• Identify1. Long

spiracles (tuberculae) that form spongy bone produced

7

Articulations - Appendicular• Clavicle:

– Medially with sternum manubrium

– Laterally acromium of scapula

• Scapula:– Lateral with head of

humerus at glenoid cavity

• Humerus– Proximal with scapula– Distal with radius and ulna

• Radius: (lateral thumb side)– Proximal with capitulum of

humerus– Medial with radial notch of

ulna

– Distally, medial ulnar notch of radius to ulna and carpals

• Ulna: (little finger side)– Proximal – trochlea of

humerus– Distal – medial with radius at

radioulnar joint

8

Osteological Terms - Processes• A rounded articulating

process– Condyle

• Any bony projection– Process

• A projection located above a condyle– Epicondyle

• A large rounded or irregular process– Tuberosity

• A small rounded process– Tubercle

• A very large, often blunt process– trochanter

• A sharp, slender process– Spine

• A hook-shaped process– Hamulus

• A very slight ridge of bone– Line

• A prominent ridge of bone– Crest

• A smooth flattened articulating surface– Facet

9

Osteological terms - Fosae• A hole in a bone through which nerves and blood pass

– Foramen• A tunnel-like passage through a bone

– Meatus or canal• A cavity within a bone

– Sinus• A furrow on a bone’s surface

– Sulcus or Groove• A slit-like opening in a bone

– Fissure• A shallow depression

– Fovea

10

Identify parts of the bone

• Tubular shaft of the long bone– Diaphysis

• Part of long bone where growth occurs– Epiphysis

• Irregularly arranged lamellae and osteocytes interconnected by canaliculi– Spongy bone (Cancellous,

Trabeculae bone)• Marrow cavity in the shaft of

long bone– Medullary cavity

• Hematopoietic tissue found within trabecular cavities of spongy bone– Red marrow

• Fat that fills cavities of bones– Yellow marrow

• Membrane covering internal bone surfaces– Endosteum

• Highly vascularized membrane covering the exterior of the diaphysis– Periosteum

• Disc of hyaline cartilage that grows during childhood to lengthen the bone– Epiphyseal plate 11

Name functions of Skeleton System

• Support• Bones support the body and organs

• Protection– Protect vital organs: skull, sternum, vertebrae, ribs

• Movement– Skeletal muscle contraction causes movement

• Mineral storage– Calcium and other minerals stored in bone can be released

into the bloodstream when needed (hormonal control)

• Formation of blood cells– Hematopoiesis occurs in blood marrow resulting in the

production of red and white blood cells and platelets

12

What are the 2 types of Osseous Tissue

• Compact bone– Smooth, compact, with little air space– Haversian systems

• Spongy bone (cancellous, trabecular)– Small pieces of bone surrounded by open spaces

filled with red or yellow marrow

13

Name the 4 types of bone• Long bone

– Shaft with a wide portion at both ends– Primarily compact bone with spongy at the widened areas– Humerus, radius, ulna, femur, tibia, fibula, phalanges

• Short bones– Cube shaped, mostly cancellous bone– Wrist, ankle– Sesamoid – short bones embedded within tendon (patella)

• Flat bone– Thin and flat– 2 layers of compact with spongy between– Sternum, ribs, skull

• Irregular bone– Spongy with odd shape– Vertebrae and hip

14

Compact bone• Composed of?

– Osteons or Haversion systems• Interspersed with?

– Blood, lymphatic vessels and nerves• Concentric rings of compact bone called ____________ surround hollow

passageways called ____________________– Lamella, Haversion canals

• What connects Haversion canals?– Volkman’s canals

• Canals are lined with what tissue?– Endosteum

• Where do osteocytes reside?– Lacunae

• What connects the lacunae?– Canaliculi

• What are the canaliculi’s function?– Permit nutrients and oxygen to pass between osteocytes– Remove wastes

• What are interstitial lamellae?– Layers of bone that fill gaps between osteons

• What are circumferential lamellae?– Large rings of bone extending around the entire shaft of the bone

15

Compact bone structure

16

Chemical Composition of bone• What are the organic components of bone?

– Osteocytes, osteoblasts, osteoclasts– osteoid

• What is the Osteoid comprised of?– Collagen fibers, proteoglycans, and glycoproteins

• What is its function?– Flexibility and tensile strength on bone

• What are the inorganic components?– Hydroxyapatites (mineral salts) which are mostly calcium phosphates

(tiny crystals from the blood stream deposited among collagen fibers)• What are they responsible for?

– Hardness of the bone• What are bone markings?

– Bulges, depressions, rough spots, holes on the exterior surface of the bone

– Most are muscle or ligament attachment sights

17

Name the 2 types of bone formation

• Intramembranous ossification

• Endochondrial Ossification

18

Intramembranous Ossification?• What is it?– The process of bone developing from a fibrous tissue

• What bones are formed this way?– Flat bones such as the skull and clavicles

• Explain the process:– Fibrous connective tissue in developing fetus become?

– scattered with osteoblasts that begin secreting organic matrix. – Osteoid is?

– then mineralized and osteoblasts become osteocytes– Osteoid accumulates in?

– small networks of collagen fibers called trabeculae. – This early bone formation is called?

– woven bone. – The periosteum forms around the?

– woven bone.– Trabeculae thickens until they become?

– plates of bone. – Eventually these plates of woven bone are replaced by?

– compact bone. – Spongy bone remains in the center of the bone and the vascular

tissue within it?– differentiates into red marrow (formation of diploe)

19

Intramembranous Ossification 1

20

Intramembranous 2

21

Intramembranous 3

22

Intramembranous 4

23

Endochondrial Ossification?• What is it?

– The process of bone formation where hyaline cartilage is used as the model for constructing bone. Most bones are formed this way

• Explain the process:– The perichondrium surrounding the hyaline cartilage bone model

becomes infiltrated with?– blood vessels, converting it into periosteum.

– Osteoblasts in the periosteum secrete?– osteoid externally onto the shaft of the hyaline bone

– The matrix deep within the shaft of the cartilage begins to?– deteriorate

– A periosteal bud containing arteries, veins, nerves and lymph vessels invades?

– the internal cavity of the forming bone. – Osteoblasts from the periosteal bud begin to?

– deposit osteoid, forming trabeculae of bone (early spongy bone)– Osteoclasts break down new spongy bone and open a?

– medullary cavity in the center of the shaft– Secondary ossification centers form shortly before or after?

– birth in the epiphyses of the bone. – Spongy bone is eventually formed with hyaline cartilage remaining

only at the?– epiphyseal plate and the articular cartilages

24

Endochondral Ossification

25

Formation of bone collar around hyaline cartilage model.

Cavitation of the hyaline cartilage within the cartilage model.

Invasion of internal cavities by the periosteal bud and spongy bone formation.

Ossification of the epiphyses; when completed, hyaline cartilage remains only in the epiphyseal plates and articular cartilages

Formation of the medullary cavity as ossification continues; appearance of secondary ossification centers in the epiphyses in preparation for stage 5.

Hyaline cartilage

Primary ossification center

Bone collar

Deteriorating cartilage matrix

Spongy bone formation

Blood vessel of periosteal bud

Secondary ossification center

Epiphyseal blood vessel

Medullary cavity

Epiphyseal plate cartilage

Spongy bone

Articular cartilage

Bone growth in long bones• How do long bones grow in children?

– Entirely by interstitial growth of the epiphyseal plates

• How do bones grow in thickness?– By appositional growth

• The widening of bones

26

Epiphyseal bone growth• The top layer (epi side) of hyaline cartilage plate contains actively

dividing chondrocytes that are pushed towards the ________________?• Diaphysis

• What does this do?• Causes the entire bone to lengthen

• What happens to the chondrocytes as they get closer to the shaft?• They enlarge and eventually die

• What occurs at the junction of the epiphysis and the diaphysis?• Osteoblasts begin to secrete bone matrix and form small spicules of bone

• What promotes the adolescent growth spurt and eventually leads to the closure of epiphyseal plate?

• Sex hormones• What happens as adolescence ends?

• The epiphyseal plate becomes smaller and is entirely replaced by bone tissue• What is the result of this occurring?

• Bone growth ends

27

Long bone growth

28

Structure of long bone

29

What is appositional growth

• The process used to?– Widen bones

• _____________ beneath the _____________ form new ______________ systems on the outer surface of the bone– Osteoblasts, periosteum, Haversian

• ________________ on the ________________ break down bone to enlarge the ______________ cavity.– Osteoclasts, endosteum, medullary

30

Appositional growth

31

Osteoblasts beneath the periosteum secrete bone matrix, forming ridges that follow the course of periosteal blood vessels.

As the bony ridges enlarge and meet, the groove containing the blood vessel becomes a tunnel.

The periosteum lining the tunnel is transformed into an endosteum and the osteoblasts just deep to the tunnel endosteum secrete bone matrix, narrowing the canal.

As the osteoblasts beneath the endosteum form new lamellae, a new osteon is created. Meanwhile new circumferential lamellae are elaborated beneath the periosteum and the process is repeated, continuing to enlarge bone diameter.

Artery Periosteum Penetrating canalCentral canal of osteonPeriosteal ridge

1 2 3 4

Bone Remodeling• What is bone remodeling?

– Process where bone is resorbed and deposited at periosteal or endosteal surfaces

• What should the rate of bone resorption be in healthy adults?– The same rate as deposition so the total mass remains constant

• What is bone deposit?– Osteoblasts laying down new osteoid which is later mineralized into bone

• How is bone resorption carried out?– by osteoclasts secreting enzymes onto the bone that digest organic matrix. The

osteoclasts also secrete acids that help to make the calcium salts more soluble• What is PTH?

– Parathyroid hormone– Hormone produced by the parathyroid gland in response to low blood calcium

levels. – It stimulates bone resorption so that calcium is released and put back into the

blood• What is Calcitonin?

– A protein produced by specialized “C” cells in the thyroid and secreted when blood calcium levels rise

– Inhibits bone resorption and enhances calcium deposit in the bone matrix

32

Bone remodeling• How much of our bone mass is recycled every week?

– 5 to 7%• How often is spongy bone replaced? Compact bone

– Every 3 to 4 years– Every 10 years

• What are remodeling units?– Packets of adjacent osteoblasts and osteoclasts that coordinate bone

remodeling• What is bone deposit?

– Added bone for injured or strength of bone• What is an osteoid seam?

– The marking of new matrix deposits by osteocytes (band of gauzy looking bone matrix)

• What helps trigger calcification?– Calcium and phosphate ions

33

Bone remodeling (cont)• What happens when calcium and phosphate mix reach a certain

level?– Tiny crystals of hydroxyapatite form and catalyze further

crystallization of calcium salts in the area• What are other factors involved?

– Matrix proteins binding and concentrating calcium– Alkaline phosphatase mineralizing

• When the conditions are met, what happens?– Calcium salts are deposited all at once and with great precision

throughout the mature matrix

34

Bone resorption• What accomplishes this?

– Osteoclasts• As they move along the bone surface what do they do?

– Dig grooves called resorption bays and break down bony matrix• How does the area of bone destruction seal off?

– By osteoclasts that touch the bone forming a ruffled membrane that clings to the bone, sealing it off

• What does the ruffled border secrete and what does this do?– Lysosomal enzymes – digest organic matrix– Hydrocholoric acid – converts calcium salts into soluble forms in

order to make them pass easily into solution• What happens to these products?

– They are endocytosed and then released into the blood• What cells are important in this process?

– T cells

35

Remodeling control• What regulates remodeling?

– 2 control loops:• Negative feedback that maintains Ca2 Homeostasis in the blood• Gravitational forces acting on skeleton

• Why is calcium so important for the body?– Nerve impulses– Muscle contractions– Blood coagulation– Gland and nerve cell secretions– Cell division

• Where is 99% of calcium in the body?– Bone minerals

• What range does the hormonal loop keep calcium?– 9-11 mg per 100 ml of blood

• Where is calcium absorbed from?– Intestine

36

Hormonal Mechanism• What does the hormonal mechanism involve?

– PTH – parathyroid hormone – parathyroid gland– Calcitonin – produced by parafollicular cells (C-cells) of thyroid

gland• When is PTH released?

– When calcium levels decline• What does it do?

– Stimulates osteoclasts to resorb bone, release calcium into blood• What happens?

– Osteoclasts break down old and new matrix• What escaped digestion and why?

– Osteoid– Because it lacks calcium salts

• When does the stimulus for PTH end?– When blood concentrations of calcium rise

37

Hormonal mechanisms (cont)• What is secreted when calcium levels rise?

– Calcitonin• What is its function?

– Inhibit resorption, encourage deposition– Reduce blood calcium

• What happens when blood calcium levels fall?– Calcitonin release wanes

• Are these responses to preserve bone strength?– No. They are for maintaining blood calcium homeostasis

• What happens if levels are low for a long time?– Bones demineralize and develop large, punched out holes

38

Bone Remodeling

39

Mechanical Stress• What is Wolff’s law?

– Bones grow and remodel in response to the demands placed on it?

• What are other observations of Wolff’s law?– Long bones thickest midway along diaphysis (where stress is

greatest)– Curved bones thickest where most likely to buckle– Trabeculae form trusses along lines of compression– Large bony projections occur where active heavy muscles

attach• How do forces communicate with remodeling cells?

– Electrical signaling• What are hormonal loops function in remodeling?

– Whether and when remodeling occur• What are mechanical stresses functions?

– Where remodeling will occur

40

Fracture Classification• Location of bone after fracture:

– Non-displaced – normal end positions– Displaced – out of normal alignment

• Completeness of break:– Complete – all the way through– Incomplete – not all the way

• Orientation:– Linear – parallel of long axis– Transverse – perpendicular to axis

• Skin penetration:– Open – penetrates the skin– Closed – skin not penetrated

41

Bone Repair1. Hematoma formation:

1. Clotted blood forms at site

2. Bone cells die, tissue becomes inflamed

2. Fibrocartilaginous callus formation:1. Capillaries grow into hematoma

2. Phagocytes begin cleaning debris

3. Fibros and osteos begin reconstructing bone

4. Fibros repair collagen, chondros repair cartilage

5. Osteos form spongy bone secrete bulging cartilage matrix that later calcifies

6. Fibrocartilaginous callus splints broken bone

3. Bony Callus formed:1. Trabeculae appear in callus, convert it to bony callus

4. Bone remodeling:1. Bony callus remodeled

42

Common Fractures• Comminuted:

– Fragments into 3 or more pieces (aged, brittle boned)

• Compression:– Crushed

• Spiral:– Ragged break, excessive twisting (sports)

• Epiphyseal:– Epiphysis separated from diaphysis

• Depressed:– Broken inward

• Greenstick:– Incomplete break on one side, other side bends

43

Clinical advances in bone repair• What does electrical stimulation do to a fracture?

– Dramatically increases healing time• What is the piezo electric effect?

– Minute electrical currents are produced when minerals are stressed• What happens in regions of negative electrical charge? Positive?

– Negative – bone deposited– Positive – bone resorbed

• What effect does ultrasound treatment produce on fractures?– Reduce healing times 35 to 45%

• What is VEGF? Function?– Vascular endothelial growth factor– Stimulates blood vessel growth

44

Bone Imbalances - Osteoporosis

• What is osteoporosis?– Group of diseases in which bone resorption occurs more than bone

deposit• What are the results of the disease?

– Reduced bone mass• Which bones are most susceptible?

– Vertebrae, neck of the femur• Who is most likely to have this disease?

– Postmenopausal women• Why?

– Estrogen loss• What are some contributors?

– Insufficient exercise– Poor calcium intake– Vitamin D or Calcitonin metabolism problems– Smoking, drinking– Immobility

45

Bone Imbalances - Osteomalacia

• What is it?– Inadequate bone mineralization– Osteoid deposited but calcium salts are not

• Weight bearing bones?– Fracture, bend, deform

• What are Rickets?– Bowing of the legs and deformed pelvis

• What causes this?– Insufficient calcium or vitamin D intake

46

Bone Imbalances – Paget’s Disease• What is Paget’s Disease?

– Excessive, abnormal bone formation and resorption

• What causes this?– High ratio of woven bone to compact bone and bone

mineralization reduction

• What is the result?– Soft, weak bones

47

Skeleton• What % of body mass is the skeleton?

– 20%

• How many bones?– 206

• What are ligaments?– Fibrous tissue that connect bones at joints

48

What are the 2 groups of skeleton?• Axial: • How many bones?

– 80

• Which bones make up axial?– Skull, vertebrae, rib cage

• Appendicular:• How many bones?

– 126

• Which make up appendicular?– Upper, lower limbs, shoulders, hips

49

Skull• How many bones?

– 22 including cranial and facial• What kind, how do they articulate?

– Flat, sutures• What is the top, lateral and posterior of skull called?

– The Calvaria• What are the 3 base regions?

– Anterior, middle, posterior cranial fossae• What are the 4 pair of cavities called and what are they?

– Paranasal sinuses - Sphenoid, Ethmoid, Maxillary, Frontal– Lighten the skull and give resonance to the voice

• What is each cavity lined with?– Mucous membranes that form the mucus that drains into the nasal

cavity• What are Orbits?

– Eye cavities– Surrounded by fatty tissue– Formed by 7 bones

50

Skull (cont)• What is the Nasal cavity composed of?

– Bone and hyaline cartilage• What is the roof, superior/lateral walls and superior nasal septum

formed by?– Ethmoid bone

• What is the floor formed by?– Anteriorly – maxilla– Posteriorly – palatine bones

• What is the cavity divided by?– Nasal septum

• What is the Nasal septum formed by?– Perpendicular plate of ethmoid, vomer, and septal cartilage

• Where is the nasal concha and what does it do?– Lateral walls– Increase turbulence of air to help trap particles in mucus

51

Skull (cont)• What are the conchae and septum lined with and what

does it do?– Mucosa– Helps lighten air and secrete mucus

• What is the Cribriform plate and what does it do?– Part of ethmoid bone in roof of nasal cavity– Has small openings for olefactor (smell) nerves to pass through on

their way to the brain

52

Vertebral column• How many vertebrae?

– 33 , some fused in adults• What separates them?

– Fibrocartilage called intervertebral disc– Inner portion of disc contain jelly-like sub for elasticity

• What is a herniated disc?– Jelly-like sub is pushed out by pressure putting pressure on spinal

nerve• What are the curvatures of the vertebrae?

– Thoracic – bow out– Lumbar – curve in

53

Appendicular Skeleton• What makes up the appendicular skeleton?

– Pectoral and pelvic girdle– Upper and lower limbs

• What is the only attachment of arms to body?– Scapula

• Does the fibula articulate with the femur?– No. Only with the Tibia

• What do both the fibula and tibia articulate with distally?– Talus bone to form the ankle

54

Axial Skeleton

Skull, Vertebral Column, Bony Thorax

55

Skull

• What is body’s most complex structure?– Skull

• What bones form it? How many?– Cranial and facial bones– 22

• What are the functions of the facial bones?– Form framework for face– Contain cavities for sense organs for sight, taste, smell– Air and food passageways– Secure teeth– Anchor expression muscles

• What kind of bones are found in the skull?– Flat (except mandible)

• What unites these bones?– Interlocking sutures

• What are the major sutures?– Coronal– Sagittal– Squamous– Lambdoid

56

Skull (cont)

• What is the cranial vault?– The Calvaria– The superior, lateral and posterior aspects of the head including the

forehead• What is the cranial base or floor?

– Inferior aspects of skull• What are the 3 internal fossae of the base of the skull?

– Anterior, middle and posterior cranial fossae• What sits in these fossae?

– The brain• What are the smaller cavities of the skull?

– Middle, inner ear– Nasal– Orbits

• How many openings are in the skull?– 85

• What are their functions?– Spinal cord passage– Blood vessels– nerves 57

Cranium

• How many bones?– 8

• Name them:– Parietal (pair)– Frontal– Occipital– Sphenoid– Ethmoid– Temporal (pair)

• What do these bones form?– The helmet around brain

58

Frontal bone• What is medical term for forehead?

– Frontal squama• What are the supraorbital margins?

– Thick, margin under eyebrows• What does the anterior cranial fossa support?

– Lobes of the brain• What allows the supraorbital artery and nerve to pass to the

forehead?– Supraorbital foramen

• What is the smooth portion between the eyes called?– Glabella

• What are the nasal sutures called?– Frontonasal sutures

• What is riddled around the glabella?– Frontal sinuses

59

Parietal bones

• Where are these bones?– Superior and lateral skull

• They form the bulk of the cranial ________?– Vault

• What occurs where the parietal bones articulate with other cranial bones?– The four largest sutures

60

Main Sutures

• Where parietal meets frontal anteriorly?– Coronal

• Where parietal meets superiorly at cranial midline?– Sagittal

• Where parietal meets occipital?– Lambdoid

• Where parietal meets temporal?– squamous

61

Mandible

• What is it?– Lower jaw

• What does it consist of?– Body, ramus, mandibular notch, condyles, coronoid process

• What does the mandibular body do?– Anchors the lower teeth

• What is the alveolar margin for?– Contains the sockets where teeth are embedded

• What does the mandibular symphysis indicate?– Where the 2 mandible bones fused during infancy

• What are the nerve entrances called?– Mandibular foramina

62

Mandible functions• Coronoid

– Insertion for temporalis muscle • Condyles

– Articulate with temporal bones for movement of jaw• Symphysis

– Fusion point of mandible• Alveoli

– Teeth sockets• Foramina

– Admit inferior alveolar nerve• Mental foramen

– Blood vessel and nerves to chin and lower lip

63

Maxillary bones• What area of face?

– Upper jaw, central portion• What articulates with it?

– All facial bones except mandible• Why is it keystone of face?

– All bones articulate with it. (- mandible)• What part of maxilla carry upper teeth?

– Alveolar margin• What is the function of incisive fossa?

– Passage for blood vessels, nerves• What articulates with the maxilla laterally?

– Zygomatic process• What forms the bony roof of the mouth?

– Palatine processes• What is at the junction of maxilla and greater wing of the

sphenoid?– Inferior orbital fissure

64

Maxilla functions• Alveoli

– Tooth socket• Zygomatic processes

– Form zygo arch• Palatine

– Form anterior hard palate• Frontal

– Form lateral part of nose bridge• Incisive fossa

– Admit blood vessels, nerves through hard palate• Inferior orbital fissure

– Admit maxillary branch of cranial nerve V, zygo nerve, blood vessels• Infraorbital foramen

– Nerve to skin of face

65

Articulation of other face bones• Zygomatic:• Articulation:

– Zygomatic processes of temporal posteriorly– Zygomatic processes of frontal superiorly– Zygomatic processes of maxilla anteriorly

• Nasal bones:• Articulation:

– Frontal bone superiorly– Maxilla laterally– Perpendicular plate posteriorly– Inferiorly to cartilage that form external nose

• Lacrimal bones:• Articulation:

– Frontal superiorly– Ethmoid posteriorly– Maxilla anteriorly

66

Articulation of other face bones

• Palatine bones• Articulation:• What are the important plates?

– Horizontal, perpendicular• What are the 3 processes?

– Pyramidal– Sphenoidal– Orbital

67

Orbits

68

Supraorbital foramen

SuperiorOrbital fissure Optic canal

Medial wall:

Sphenoid body

Orbital plate of ethmoid

Frontal process of maxilla

Lacrimal

Nasal bone

Floor of orbit:

Orbital process of palantine

Orbital surface of maxillaryZygomatic boneInfraorbital foramen

Zygomatic boneInfraorbital grooveInfraorbital fissure

Orbital surface of zygo

Greater wing of sphenoid

Zygo process of frontal

Orbital plate of frontal

Lesser wing of sphenoid

Nasal Cavity• What is it constructed of?

– Bone and hyaline cartilage• What is the roof formed by?

– Cribriform plate of ethmoid• What shapes the lateral walls?

– Superior, middle conchae of ethmoid, perpendicular of palatine • What are the depressions under the conchae?

– Superior, middle, inferior meatus• What is the floor formed by?

– Palatine processes of maxillae and palatine bones• What divides the nasal cavity?

– Septum• What is the bony part of septum?

– Vomer• What cartilage completes the septum anteriorly?

– Septal cartilage

69

Nasal Cavity

70

Frontal sinus

Superior nasal concha

Middle nasal concha

Inferior nasal concha

Nasal bone

Anterior nasal spineMaxillary bone(Palatine process)

Palatine bonehorizontal

Palatine bonePerpendicular

Pterygoid process

Sphenoid sinus

Superior, middle, andInferior meatus

Paranasal sinuses

71

Hyoid bone • Where?– Just inferior to mandible

in the neck• What is unique about this

bone?– Does not articulate

directly with any other bone

• What is anchored by?– Stylohyoid ligaments

• To What?– Styloid processes of

temporal• What is its function?

– Move tongue– Attach muscles that

raise/lower larynx for speech, swallowing

72

Anterior Skull 1. Frontal Bone2. Supra-Orbital Foramen3. Orbit (Orbital Cavity)4. Superior Orbital Fissure5. Inferior Orbital Fissure6. Zygomatic Bone7. Infra-Orbital Foramen8. Maxilla9. Mandible10. Mental Foramen11. Incisive Fossa12. Symphysis13. Vomer14. Inferior Nasal Concha15. Middle Nasal Concha16. Perpendicular Plate of

Ethmoid17. Nasal Bone18. Lacrimal Bone

73

Skull - Lateral 1. Parietal Bone2. Coronal Suture3. Frontal Bone4. Nasal Bone5. Vomer6. Lacrimal Bone7. Orbital Part of Ethmoid8. Zygomatic Bone9. Maxilla10. Body of Mandible11. Ramus of Mandible12. Coronoid Process13. Mandibular Condyle14. Mental Foramen15. Styloid Process16. External Acoustic Meatus17. Mastoid Process18. Zygomatic Process19. Temporal Bone20. Greater Wing of Sphenoid21. Inferior Temporal Line22. Superior Temporal Line23. Squamosal Suture24. Lambdoidal Suture25. Occipital Bone

74

Skull Posterior

1. Parietal Bone

2. Sagittal Suture

3. Lambdoid Suture

4. Occipital Bone

5. External Occipital Protruberance

6. Superior Nuchal Line

7. Inferior Nuchal Line

75

Occipital bone• Where is this bone?

– Posterior wall and base of skull• What sutures connect it to the temporal and parietal bones?

– Lambdoid– Occipitomastoid

• What does the internal walls of occipital form?– Posterior cranial fossa

• What foramen is at the base of occipital?– Foramen magnum

• What are the occipital condyles?– Rocker like condyles that articulate with c1 and allow nodding of

head• What does the external occipital crest secure?

– Ligamente nuchae• What do nuchal lines and bony regions do?

– Anchor many back muscles

76

Occipital Parts functions

• Foramen magnum – Spinal cord passage from brain stem to vertebral canal

• Hypoglossal canal– Passage of hypoglossal nerve (cranial nerve XII)

• Occipital condyles– Atlas articulation

• External protuberence/nuchal lines– Muscle attachments

• External Crest– Ligamente nuchae

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Skull - superior

1. Occipital Bone

2. Lambdoidal Suture

3. Parietal Bone

4. Sagittal Suture

5. Coronal Suture

6. Frontal Bone

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Superior Skull1. Frontal Sinus2. Foramen Cecum3. Crista Galli4. Cribriform Plate5. Anterior Cranial Fossa6. Lesser Wing of Sphenoid7. Chiasmatic Groove8. Hypophyseal Fossa9. Dorsum Sella10. Optic Canal11. Anterior Clinoid Process12. Foramen Rotundum13. Foramen Ovale14. Foramen Spinosum15. Squamous Part of Temporal16. Petrous Part of Temporal17. Groove for Transverse Sinus18. Posterior Cranial Fossa19. Foramen Magnum20. Hypoglossal Canal21. Jugular Foramen22. Internal Acoustic Meatus23. Posterior Clinoid Process24. Foramen Lacerum25. Superior Orbital Fissure

79

Mandible1. Mandibular

Condyle

2. Mandibular Notch

3. Coronoid Process

4. Ramus

5. Angle

6. Oblique Line

7. Body

8. Alveolar Process

9. Mental Foramen

10. Mylohyoid Line

11. Mandibular Foramen

80

Anterior skull

81

Frontal squamaOf frontal bone

Nasal bone

Sphenoid

Parietal bone

Temporal

Ethmoid

LacrimalZygomatic

Infraorbital foramen

Maxilla

MandibleMentalForamen

Mandibular Symphysis

Frontal

Glabella

Frontonasal suture

Supraorbital foramenSupraorbital marginSuperior Orbital fissure

Optic Canal

Inferior orbital fissure

Middle nasal conchaPerpendicular plateInferior nasal concha

Vomer

Lateral Skull

82

Frontal bone

Sphenoid bone

Ethmoid boneLacrimal boneLacrimal fossa

Nasal bone

Zygomatic bone

Maxilla

Alveolar margins

MandibleMental foramen

Coronoid ProcessMandibular angle

Mandibular ramusMandibular notch

Mandibular condyleStyloid process

Mastoid process

External auditory meatusOccipitomastoid suture

Zygomatic processOccipital bone

Squamous suture

Lambdoid suture

Temporal bone

Parietal bone

Coronal suture

Posterior Skull

83

Sagittal suture

Parietal bone

Mastoid process

InferiorNuchal line

Occipitalcondyle

External Occipitalcrest

Occipitomastoidsuture

External Occipitalprotuberance

Superior nuchalline

Occipital bone

Lambdoidsuture

Wormian bone

Midsagittal Internal left side of skull

84

Coronal suture

Frontal bone

Sphenoid bone

Frontal sinusCrista galliNasal boneSphenoid sinusEthmoid bone

Vomer boneIncisive fossaMaxilla

Alveolar margins

Mandible

Palatine process

Palatine bone

Mandibular foramen

PterygoidProcess of Sphenoid

Sella Turcica of sphenoid

Internal acoustic meatus

External occipital Pro-tuberence

Occipitomastoid suture

Occipital bone

Lambdoid suture

Temporal bone

Squamous suture

Parietal bone

Inferior skull

85

Incisive fossaMedial palantine sutureInfraorbital foramenMaxilla

Sphenoid bone

Foramen ovaleForamen lacerum

Carotid canalExternal acoustic meatusStylomastoid foramen

Jugular foramen

Occipital condyleInferior nuchal line

Superior nuchal line

Foramen magnum

External Occipitalprotuberence

External OccipitalCrest

Parietal bone

Pharyngeal Tubercle of basoccipital

Temporal boneMastoid process

Styloid process

Mandibular fossa

Vomer

Temporal boneZygomatic bone

Palatine bone

Maxilla

Temporal bone

86

Squamous region

Zygomatic process

Mandibular fossa

Tympanic regionStyloid process

Mastoid process

Mastoid region

External Acousticmeatus

Temporal bones

• How many? Where are they on skull?– 2 (One on each side - inferior to parietal bones)

• What are the temporal’s four major regions?– Squamous,Tympanic, Mastoid, Petrous

• Functions of parts?• Zygomatic process –

– helps form prominence of cheek• External acoustic meatus –

– for hearing• Styloid process –

– attach hyoid and neck muscles• Mastoid process –

– attach neck and tongue muscles• Carotid canal –

– passage of internal carotid artery• Jugular foramen –

– passage of internal jugular vein and cranial nerves IX, X, XI

87

Superior sphenoid

88

Optic canal

Chiasmatic groove

Lesser wing

Greater wing

Anterior clinoid processForamen rotundumForamen ovale

Foramen spinosum

Dorsum Sellae

Body of sphenoid

Posterior clinoidprocess

HypophysealFossa of sella turcica

Greater wing

Posterior sphenoid

89

Body of sphenoidPosterior clinoid process

Superior orbital fissure

Foramen rotundum

Pterygoid process

Pterygoidplates

Greater wing

Sphenoid• Where?

– Spans the middle cranial fossa• Why is it considered the keystone of cranium?

– Because it forms a central wedge that articulates with all other cranial bones

• What does it consist of?– Central body, 3 pairs of wings– Greater, lesser, pterygoid processes

• What is the sella turcica?– Area where pituitary gland is located

• What is the function of the anterior clinoid processes?– Anchor the brain to the skull

• What are the pterygoid processes functions?– Anchor pyterygoid muscles used for chewing

• What are the optic canals for?– They allow optic nerves to pass to the eyes

• What is the superior orbital fissure’s function?– It allows cranial nerves that control eye movements to enter the orbit

90

Sphenoid parts functions

• Sella turcica– Seat of pituitary gland

• Optic canal– Passage of cranial nerve II, opthamolic arteries

• Superior Orbital fissures– Cranial nerves III, IV, part of V, opthamolic vein

• Foramen rotundum– Passage of maxillary division of cranial nerve V

• Ovale– Pass mandibular division of nerve V

• Spinosum– Pass middle meningeal artery

91

Ethmoid

• Where?– Between sphenoid and nasal

bones (between nasal and orbits)• What forms roof of nasal cavity

and floor of anterior cranial fossa?– Cribriform plate

• What are the tiny holes in cribriform that allow smell nerves to pass to the brain?– Olfactory foramina

• What is the crista galli’s function?– Attach falx cerbri

• What are some other parts of the ethmoid?– Inferior, middle nasal concha– Perpendicular plate– Orbital plates

92

Ethmoid

93

Crista galli

Cribriform plate

Left lateral mass

Middle nasal concha

Perpendicular plate

Ethmoid sinuses

Orbital plate

Olfactory foramina

Superior cranial cavity

94

Frontal bone

Cribform plateCrista galli Ethmoid

Optic canalAnterior clinoid processForamen rotundumForamen ovaleForamen spinosum

Foramen lacerum

Jugular foramen

Hypoglossal canal

Foramen magnum

Occipital bone

Parietal bone

Posterior Cranial fossa

Internal acoustic meatus

Temporal bone

Middle cranial fossaPosterior clinoid process

Dorsum sellae

Hypophyseal fossaTuberculum sellae

Greater wingLesser wing

Anterior cranial fossaOlfactory foramina

Vertebrae• How many bones? What kind of bones?

– 26, irregular• Name some functions of vertebrae?

– Transmits weight of trunk to lower limbs– Surround, protect spinal cord– Attachment site for ribs and muscles of back and neck

• How many in fetus?– 33 separate bones

• How many eventually fuse and what do they become?– 9– Sacrum, coccyx

• What are the divisions? How many bones in each?– Cervical – 7– Thoracic – 12– Lumbar – 5– Sacrum– Coccyx

95

Vertebrae (cont)

• What are the four curvatures?– Cervical, lumbar – concave posteriorly– Thoracic, sacrum – convex posteriorly

• What are some abnormal curvature disorders?– Scoliosis – Thoracic twisted– Kyphosis – hunchback

• What are ligaments?– Bands of fibrous tissue that connect and support bones

• What are the ligs of the vertebrae?– Anterior, posterior longitudinal ligaments

• What are the intervertebral discs functions?– Shock absorbers during walking, jumping and running

96

General structure of Vertebrae

• What is the common structure of all vertebrae?– Body anteriorly– Vertebral arch posteriorly– Vertebral foramen for vertebral canal (spinal cord)

• What forms vertebral arch?– Pedicles, laminae

• What are pedicles?– Short, bony pillars that form side of arch (project posteriorly)

• What are laminae?– Flat plates that fuse in median plane (posterior)

• How many processes project from vertebral arch?– 7

• What are they?– Spinous – median, at junction of 2 laminae– Transverse – lateral from each side of arch– Superior, inferior articular processes – smooth joints called facets (covered

with hyaline cartilage) form movable joints with processes of vertebrae below and above them

97

Facet(ThoracicOnly)

Demifacet(ThoracicOnly

Vertebrae structure

98

99

Cervical Thoracic Lumbar

100

101

Cervical Vertebrae• Characteristics:

– Smallest, lightest– First 2 unusual– Oval body– Wide– Spinous short (except for C7)– Large foramen– Transverse foramen– C7 is the vertebrae prominens

• C1 and C2 have – no disc between– Atlas – no body, spinous

• Superior articular receive occipital condyle of skull

• Inferior joins axis– Axis –

• Has dens (odontoid) process superiorly from body

• Dens allow side to side movement

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Thoracic Vertebrae

• Characteristics:– All articulate with ribs– First looks like C7, last four look like

Lumbar– Increase in size from 1st to last– Heart shape body– Demifacets on each side (superior and

inferior) (T10 to T12 have single facet)

– Demifacets receive ribs– Foramen circular– Long, pointed spinous– Superior and inferior facets lie mainly in

frontal plane

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Lumbar vertebrae• Characteristics:

– Most stress– Massive, kidney shaped body– Pedicles and laminae shorter

and thicker than other verts– Short, flat, hatchet shaped

spinous (project backward)– Triangle foramen– Facets orientated different

than other vertebrae

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Differences in Vertebrae• Body:

– C – small wide– T – Larger than C, heart shaped– L – Massive body

• Spinous process:– C – short, has V notch– T – Long sharp, projects inferiorly– L – Short blunt, projects posteriorly

• Foramen:– C – large triangle shaped– T- small oval– L – small triangular shape

• Transverse processes:– C- contain foramen– T- Have facets for ribs– L – thin,tapered

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Cervical

Lumbar Thoracic

C1 Atlas Superior view

1. Anterior tubercle

2. Anterior arch

3. Facet for dens

4. Transverse process

5. Foramen transversarium or transverse foramen

6. Superior articular facet on lateral mass

7. Posterior arch

8. Posterior tubercle

9. Vertebral foramen

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Cervical, Thoracic, Lumbar, Sacrum

1. Body 2. Vertebral foramen 3. Anterior tubercle 4. Posterior tubercle 5. Foramen

transversarium or transverse foramen

6. Demifacet for head of rib

7. Superior articular process

8. Pedicle 9. Lamina 10. Transverse process 11. Spinous process or

spine 12. Lateral mass 13. Posterior sacral

foramina 14. Coccyx 15. Sacral hiatus

107

Cervical, Thoracic, Lumbar, sacrum

1. Body

2. Facet for head of rib

3. Superior articular process

4. Superior vertebral notch

5. Pedicle

6. Transverse process

7. Inferior vertebral notch

8. Inferior articular process

9. Spinous process or spine

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Cervical Vertebrae 1. C1 or atlas 2. C2 or axis 3. C3 4. C4 5. C5 6. C6 7. C7 8. Body 9. Vertebral

foramen 10. Bifid spinous

process or spine 11. Transverse

process 12. Foramen

transversarium or transverse foramen

13. Superior articular facet

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Vertebrae - Atlas

1. Superior Articular Surface

2. Transverse Foramen

3. Transverse Process

4. Odontoid (Dens) Facet

5. Vertebral Foramen

6. Inferior Articular Surface

110

Axis1. Spinous Process

2. Lamina


4. Pedicle


6. Odontoid Process (Dens)

7. Body



111

Cervical Vertebrae

1. Spinous Process

2. Lamina


4. Transverse Foramen


6. Body

7. Pedicle


112

Thoracic

1. Spinous Process

2. Lamina



5. Pedicle

6. Body


8. Articular Facet for Rib


113

Lumbar

1. Spinous Process

2. Lamina



5. Pedicle

6. Body



114

Sacrum

• Characteristics:– Formed by 5 fused verts– Articulates superiorly with L5 – inferiorly with coccyx, laterally with

hip bone (sacroiliac joint)– Sacral promontory anterosuperior– Four ridges: The transverse lines cross concave anterior aspect,

marking lines of fusion of sacral vertebrae– Ventral sacral foramina penetrate sacrum at lateral ends of

transverse lines to transmit blood vessels and nerves– Lateral to these and expanding superior are the alae– Dorsal midline – median sacral crest– Dorsal sacral foramina– Lateral sacral crests– Vertebral canal – sacral canal– Sacral hiatus – opening where vert failed to fuse

115

Sacrum1. Promontory2. Transverse

Ridges (lines)3. Coccyx4. Body of Sacrum5. Sacral Canal6. Superior

Articular Surface

7. Median Sacral Crest

8. Sacrum to Ilium Articular Surface

9. Dorsal Sacral Foramina

10. Sacral Hiatus

116

alae

Lateral sacralcrest

Ventral Sacral foramina

Rib and Vertebrae

1. Articular Facet of Rib

2. Interarticular Crest3. Neck4. Articular Portion of

Tubercle5. Nonarticular Portion

of Tubercle6. Angle of Rib7. Costal Groove8. Body (shaft) of Rib9. Articular Facet of

Transverse Process10. Transverse Process11. Spinous Process12. Lamina13. Vertebral Foramen

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Sternal edge

Sternum

1. Jugular Notch

2. Manubrium

3. Sternal Angle

4. Body (Gladiolus)

5. Xiphoid Process

118

Clavicular Notch

Costal facet

Bony Thorax

119

Bony Thorax

• What is included in bony thorax?– Thoracic vertebrae dorsally, ribs laterally, sternum and costal

cartilage anteriorly• How many ribs?

– 12 pairs• What do they articulate with?

– Posteriorly – thoracic vertebrae– Anteriorly – superior 7 rib pairs – directly to sternum (true)– 5 (false) – indirectly to sternum or no sternal– Ribs 8-10 connect to cartilage joining to rib above– Ribs 11-12 – floating – no anterior attachment –

• Characteristics of ribs:– Bowed flat bone– Superior smooth, inferior sharp and thin– Costal groove – lodges nerves and blood vessels– Head and tubercle – join to the body and transverse process of vert– Tubercle is posterior and superior

120

Appendicular Skeleton

Pectoral & Pelvic Girdle, Upper & Lower Limbs

121

Clavicle

• Where?– Across superior thorax

• Articulation:– Medial sternal end – to sternal

manubrium– Lateral acromial end – scapula

• Medial 2/3’s convex anteriorly• Lateral 3rd concave anteriorly• Superior surface is?

– Smooth• Inferior surface is?

– Ridged and grooved• Function

– Anchor many muscles– Act as braces– Hold scapula and arms out

laterally away from superior part of thorax

• Not very strong, easy to fracture

122

Clavicle1. sternal head 2. superior surface 3. sternal head 4. inferior surface 5. groove for subclavious

muscle6. conoid tubercle7. trapezoid line8. acromial head

• Identification aspects:– Conoid tubercle always

posterior/inferior– Medial surface always

convex, lateral concave– Acromial - lateral

123

Scapula Posterior1. Coracoid Process

2. Scapular Notch

3. Superior Border

4. Supraspinous Fossa

5. Superior Angle

6. Scapular Spine

7. Vertebral Margin

8. Infraspinous Fossa

9. Inferior Angle

10. Lateral Border

11. Glenoid Cavity Margin (lateral angle)

12. Acromion Process• Identification:

– Spine-posterior– Glenoid - lateral

124

Scapula (Ventral)1. superior angle

2. vertebral (medial) border

3. inferior angle

4. subscapular fossa

5. infraglenoid tubercle

6. glenoid fossa

7. coracoid process

8. Acromion

9. suprascapular notch

125

Scapula lateral

1. Coracoid process2. Glenoid cavity3. Scapular spine4. Acromion process5. Infraspinous Fossa6. Inferior Angle7. Axillary Margin

126

Scapula • Where?

– Dorsal surface of rib cage, between ribs 2 and 7• What are the 3 borders?

– Superior – shortest, sharpest– Medial (vertebral) – parallels vertebral column– Lateral (axillary) – abuts the armpit and ends superiorly in a small

shallow fossa, the glenoid cavity • Articulation

– Glenoid cavity articulates with humerus of the arm• What are the 3 angles? Where do they meet?

– Superior scapular border meets medial border at superior angle and lateral border at the lateral angle

– Medial and lateral borders join at the inferior angle

127

Scapula (cont)• Features:• Anterior surface is?

– Concave and relatively featureless

• Posterior surface?– Prominent spine easily felt

through skin– Ends laterally in enlarged,

roughened triangular projection called?

• Acromion– Acromion articulates with?

• Acromial end of clavicle– Which forms the?

• Acromioclavicle joint• Projecting anteriorly from superior

scapular border is what?– Coracoid process

• What is the coracoid process’ function?– Helps anchor the biceps of the

arm

• Bounded by?– Suprascapular notch

medially and glenoid cavity laterally

• Several large fossae appear on both sides of scapula. They are?– Infraspinous and

supraspinous fossae– Named for their location– Inferior and superior to the

spine• What is the subscapular

fossa?– Shallow concavity formed by

the entire anterior scapula surface

128

Proximal Humerus1. Head2. Anatomical neck3. Lesser Tubercle4. Intertubercular Groove5. Greater Tubercle6. Surgical Neck7. Deltoid Neck

(tuberosity)• Identify:

• Head – medial• Shallow, distal coronoid

fossa – anterior• Capitulum – anterior

lateral

129

Humerus Distal

1. Radial Fossa

2. Lateral Epicondyle

3. Capitulum

4. Trochlea

5. Medial Epicondyle

6. Coronoid Fossa

7. Olecranon Fossa

130

Humerus – proximal to middle of the bone

• Location– Upper arm

• Articulation?– proximal to the scapula (glenoid

cavity)– distal to the radius and ulna

• What is at the proximal end?– Smooth hemispherical head

• What does it fit into to?– Glenoid cavity

• What is immediately inferior to the head?– Anatomical neck

• What tubercles are just inferior to the neck?– Lateral greater tubercle– Medial lesser tubercle

• What separates these tubercles?– Intertubercular (bicipital) groove

• What are tubercles function?– Sites where muscles attach

• What is distal to tubercles?– Surgical neck

• What is midway down shaft laterally?– Deltoid tuberosity (roughened

deltoid muscle attachment site)• What runs obliquely down the

posterior aspect of shaft marking the course of radial nerve?– Radial groove

131

Humerus - Distal• What are the 2 condyles at distal

end?– Medial trochlea – looks like hour

glass tipped on side– Lateral capitulum – ball-like

• What do these articulate with?– Ulna and radius

• What flanks these condyles?– Medial, lateral epicondyles (muscle

attachment sites)• What is directly above these

condyles?– Supracondyle ridges

• What is responsible for the tingling feeling when “funny bone” is hit?’– Ulnar nerves that run behind the

medial epicondyle• Where is the coronoid fossa?

– Superior to the trochlea on the anterior surface

• Where is the Olecranon fossa?– Posterior to the coronoid fossa

132

Humerus – distal

• What is the function of the coronoid and olecranon fossae?– They allow the corresponding processes of the ulna to

move freely when the elbow is flexed and extended

• What receives the head of the radius when the elbow is flexed?– Radial fossa

133

Radius – Right/anterior

1. Head of radius

2. Neck of radius

3. Radial Tuberosity

4. Radius (Shaft)

5. Styloid Process

6. Ulnar Notch• Recognition aspects:

– Tuberosity – anterior/medial

– Styloid – lateral– Concave surface above

styloid - anterior

134

Radial TuberosityAnterior medial

Always anterior in Anatomical position

Forearm- antebrachium• Location:

– Lower arm• Bones:

– Radius, ulna• Articulation

– Proximal end with humerus– Distal end forms joints with the wrist– Radius and ulna articulate with each other both proximally and

distally at small radioulnar joints• What connects the radius and ulnar across their entire length?

– Flexible, interosseous membrane• What is the position of radius and ulna in anatomical postion?

– Radius – lateral on thumb side– Ulna – medial on little finger side

• What happens in the prone position?– Distal end of the radius crosses over the ulna and form an “X”

135

Ulna-right/ proximal/distal 1. Olecranon process

2. Trochlear notch

3. Coronoid process

4. Tuberosity

5. Radial notch

6. Ulna shaft

7. Head of ulna

8. Styloid process

• Identification aspects:– Radial notch always

lateral– Styloid process-medial

136

Ulna• Main responsibility?

– Forming elbow joint with humerus

• What are the 2 main processes at proximal end?– Olecranon, coronoid

processes• What separates these?

– Trochlear notch• What does the locking of the

olecranon process and olecranon fossa do?– Keeps the forearm from

moving posteriorly beyond the elbow joint

• Where does the ulna articulate with the head of the radius?

– Radial notch• Where is the ulnar head?

– At the distal end of the bone by wrist

• What is medial to the ulnar head?– Styloid process

• What separates the ulnar from the carpals?– A disc of fibrocartilage

• Does it have any role in hand movement?– Little to none at all

137

Radius• What is the superior surface of the head – convex or

concave?– Concave

• Articulation– Head proximal with the capitulum of the humerus– Medially with the radial notch of the ulna– Distal where the radius expands, medial ulnar notch with the

ulna– Carpal bones

• The ulna contributes heavily to?– The elbow

• The radius contributes to?– Wrist

• What happens when the radius moves?– The hand moves with it

138

Hand – Right Dorsal

1. Styloid process of radius

2. Navicular (Scaphoid)

3. Lunate

4. Triquetral

5. Pisiform

6. Trapezium

7. Trapezoid

8. Capitate

9. Hamate

10. Metacarpal

11. Proximal Phalange

12. Middle Phalange

13. Distal Phalange

14. Styloid Process of Ulna139

Hand – Right palmar

1. Navicular (Scaphoid)

2. Lunate

3. Triquetral

4. Pisiform

5. Trapezium

6. Trapezoid

7. Capitate

8. Hamate

9. Metacarpal


11. Middle Phalange

12. Distal Phalange

140

Carpus-Wrist• What is the true wrist?

• The carpus. The proximal part of the hand

• How many bones are in the carpus? What are they called?• 8 marble sized short bones• Carpals

• How are they arranged?• In 2 irregular rows of 4

bones each• Which bones are in the

proximal row? (lateral to medial)• Scaphoid• Lunate• Triquetral• pisiform

• Which bones articulate with radius?– Scaphoid, lunate

• What bones make up the distal row? (lat to med)– Trapezium– Trapezoid– Capitate– Hamate

• Sally – scaphoid• Left – lunate• The – triquetral• Party – pisiform• To- trapezium• Take – trapezoid• Cathy – capitate• Home - hamate

141

Metacarpus - palm• How many? What are they named?

– 5, No name. They are numbered from 1 to 5 from thumb to little finger

• Articulation– Bases with carpals proximally– Each other medially and laterally– Heads with proximal phalanges distally

• What is meta #1 and why is it different from the rest?– The thumb– Does not have a middle phalanx

142

Phalanges - Fingers• What are other names for the phalanges?

– Fingers, digits• How are they numbered?

– From 1 to 5 beginning with pollex (thumb)• How many phalanges on each hand?

– 14• What are the parts named?

– Proximal– Middle– Distal

• Thumb no middle

143

Os Coxa – Left lateral

1. Anterior Superior Spine2. Iliac Crest3. Posterior Superior Spine4. Posterior Inferior Spine5. Greater Sciatic Notch6. Body of Ilium7. Ischial Spine8. Lesser Sciatic Notch9. Body of Ischium10. Ischial Tuberosity11. Obturator Foramen12. Inferior Ramus of Ischium13. Inferior Ramus of Pubis14. Body of Pubis15. Acetabulum16. Anterior Inferior Spine

144

Os Coxa – Left,medial

1. Iliac Fossa2. Anterior Superior Spine3. Anterior Inferior Spine4. Arcuate Line5. Obturator Foramen6. Symphysis Pubis

Articulating Surface7. Ischial Tuberosity8. Lesser Sciatic Notch9. Ischial Spine10. Greater Sciatic Notch11. Sacrum Articulating

Surface12. Posterior Inferior Spine13. Posterior Superior Spine14. Iliac Crest 145

Identification:• Acetabulum – lateral• Pubis – anterior• Ischial- posterior

Pelvic girdle - Hip• What are its functions?

– Attach lower limbs to axial skeleton

– Transmit upper body weight to lower limbs

– Support visceral organs of the pelvis

• What are the hip bones named?– Os coxae

• Articulation– Each other anteriorly– Sacrum posteriorly

• What is the hip, sacrum and coccyx called?– Bony pelvis

• What are the 3 bones of the pelvis?– Ilium– Ischium– Pubis

• Are they separate?– In childhood. Fuse in

adults• What is the name of

the deep lateral socket on the pelvis?– Acetabulum

• What is its function? What is the joint called?

1. Receives head of femur2. Hip joint

146

Ilium• Where on the coxal?

– Superior region• What does it consist of?

– Body– Ala – wing

• Where is it thickest at?– Tubercle of iliac crest

• Where does each iliac crest end?– Anteriorly – anterior

superior iliac spine– Posteriorly – posterior

superior iliac spine• What is below these?

– Anterior, posterior inferior iliac spines

• What are these spines for?– Attachment points for

muscles of trunk, hip, thigh

• Where is the greater sciatic notch? What is it for?– Inferior to posterior inferior

iliac spine– Where sciatic nerve passes to

enter thigh• What makes up the

posterolateral surface of the ilium?– Gluteal surface

• What 3 ridges cross it?– Posterior, Anterior, inferior

gluteal lines• What is the interior, concave

area?– Iliac fossa

• What is posterior to this?– Auricular surface

• What does ilium join anteriorly?– Ischium, pubis

147

Ischium• What part of hip bone?

– Posteroinferior• Articulation

– Body – ilium– Ramus – pubis anteriorly

• What are the 3 major markings?– Ischial spine – medially into pelvic cavity– Lesser sciatic notch – just inferior to ischial spine– Ischial tuberosity – strongest part of hip bone. Inferior surface of

ischial body• What helps hold the pelvis together?

– Sacrotuberous ligament – massive ligament from sacrum to ischial tuberosity

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Pubis• Where?

– Anterior of hip bone• V shaped consisting of?

– Superior, inferior rami– Medial body

• Articulation– Medial to ischium– Inferior to ilium

• What does the anterior border form?– Pubic crest

• What is at the lateral end of pubic crest?– Pubic tubercle

• What is the large opening of the hip bone?– Obturator foramen

• What is the name of the fibrocartilage joining the 2 pubic bones?– Pubic symphysis

• What is the arch that differentiates male and female pelve?– Pubic arch

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Pelvis - anterior 1. anterior superior iliac spine

2. superior pubic ramus

3. ischial tuberosity

4. inferior pubic ramus

5. pubic symphysis

6. pubic tubercle7. Acetabulum8. anterior

inferior iliac spine

9. iliac fossa

150

Pelvis - posterior1. iliac crest

2. greater sciatic foramen

3. ischial spine

4. ischial tuberosity

5. Coccyx

6. sacrum (dorsum)

7. posterior superior iliac spine

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Pelvic structure/childbearing• What is the difference

between female and male pelvis?– Female

• wider, shallower, lighter and rounder

• Tilted forward• What are the false and

true pelvis?– False

• superior to the pelvic brim

• Bounded by alae laterally; lumbar vertebrae posteriorly

• Part of abdomen• Does not restrict

childbirth– True

• Inferior to pelvis brim

• Forms deep bowl containing pelvic organs

• Dimensions critical for childbirth

• What are the pelvic inlet and outlet?– Inlet – pelvic brim– Outlet – inferior margin

of true pelvis

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Femur-proximal end/left1. Head2. Neck3. Greater Trochanter4. Intertrochanteric

Line5. Lesser Trochanter6. Shaft of Femur7. Gluteal Tuberosity8. Intertrochanteric

Crest9. Linea Aspera• Identification:

• Distal Patellar Surface – anterior

• Intercondyle notch - posterior

153

FoveaCapitis

Left femur-distal

1. Medial Condyle

2. Lateral Condyle

3. Intercondylar Fossa

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Intercondylenotch

Lateral Epicondyle Medial Epicondyle

Adductor tubercle

Femur• Location

– Upper leg• Articulation

– Proximal – hip bone/ acetabulum

– Distal – tibia• What is the name of the small

central pit at the head?– Fovea capitis

• What is at the junction of the shaft and neck?– Greater and lesser

trochanters• What connects these

trochanters?– Intertrochanteric line

anteriorly– Intertrochanteric crest

posteriorly

• What does the gluteal tuberosity blend into?– Linea aspera inferiorly

• What does the linea aspera diverge into?– Medial and lateral

suprachondyle lines• What are all of these

markings?– Muscle attachment sites

• Distally, the femur widens into?– Lateral and medial condyles

• What flanks the condyles superiorly?– Medial and lateral

epicondyles

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Femur (cont)

• What is the patellar surface?– Articulation site for the

patella• What is the deep U-shape

on the distal posterior aspect of femur?– Intercondyle notch

• What is superior to this?– Smooth popliteal

surface• What is the patella?

– Triangular, sesamoid bone enclosed in quadriceps that secures anterior thigh muscles to the tibia

156

Left Tibia-proximal/distal/anterior

1. Intercondylar Eminence

2. Lateral Condyle

3. Tibial Tuberosity

4. Anterior Crest

5. Medial Condyle

6. Anterior Surface

7. Medial Malleolus• Identify aspects:

– Tibial tuberosity always anterior

– Flattened side always lateral

– Medial malleolus always medial

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Proximal

Tibiofibular

joint

Distal

Tibiofibular

joint

Tibia• Location– Anterior shin bone

• Articulation– Proximal – femur – tibia condyles to the femur condyles– Distally – talus of the foot– Lateral to the fibula (tibiofibular joint)

• Parts– Broad proximal end

• Medial and lateral condyles• Intercondyle imminence

– Inferior to this• Tibial tuberosity – anterior• Lateral tibial condyle – proximal tibiofibular joint

– Middle of bone• Anterior crest

– Distal end• Medial malleolus• Distal tibiofibular joint• Articular surface

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Left Fibula-proximal/distal/anterior

1. Head of Fibula

2. Neck of Fibula

3. Anterior Crest

4. Lateral Malleolus• Identifying aspects:

– Lateral malleolus always lateral

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Fibula• Location– Posterior, lateral shin

• Articulation– Proximal with the tibia– Distal with the tibia medially and the talus distally

• Name of proximal and distal ends?– Proximal – head– Distal – lateral malleolus (ankle bulge)

• Does the fibula bear weight?– No

160

Left foot superior

1. Calcaneus

2. Talus

3. Navicular

4. Cuboid

5. Cuneiform, Middle

6. Cuneiform, Intermediate

7. Cuneiform, Lateral

8. Metatarsal


10. Middle Phalange

11. Distal Phalange

161

Tarsus• How many bones? Name them?– 7– Calcaneus– Talus– Navicular– Cuboid– 1st Cuneiform (Hallux), 2nd Cuneiform, 3rd Cuneiform

• What 2 tarsals carry most body weight?– Talus, calcaneus

• What does the Achilles tendon attach to?– Posterior surface of calcaneus

• What part of calcaneus touches the ground?– Tuber calcanei, calcaneal tuberosity, sustentaculum tali

• Name the remaining tarsals:– Lateral cuboid– Medial navicular– Intermediate, lateral cuneiform

• What do the cuboid and cuneiform bones articulate with?– Metatarsal bones anteriorly

162

Left footlateral

1. Calcaneus

2. Talus

3. Navicular

4. Cuboid

5. Cuneiform, First

6. Cuneiform, Second

7. Cuneiform, Third

8. Metatarsal

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Metatarsus• How many?

– 5 small bones• Articulation

– Distal – proximal phalanges of the toes– Proximal – tarsals

• What is the first metatarsal?– Great toe (Hallux)

• How are they identified?– By number laterally from big toe

164

Phalanges-Toes• How many?

– 14• 3 in each digit except the?

– Hallux (big toe)

165

Arches of foot• A segmented structure can only hold weight if it is?

– Arched• What are the 3 arches of the foot?

– Longitudinal – medial and lateral– Transverse arch

• What are the functions of these arches?– Strength

• What maintains arches?– Interlocking shape of foot bones– Strong ligaments– Tendon pull during muscle activities

• Which arch curves above the ground?– Medial longitudinal

• Which is very low?– Lateral longitudinal

• Where is the weight of the body distributed by these arches?– ½ to heel bones, ½ to heads of metatarsals

166

Knee-anterior/posterior

1. Tibial Collateral Ligament

2. Medial Condyle of Femur

3. Posterior Cruciate Ligament

4. Anterior Cruciate Ligament

5. Lateral Condyle of Femur

6. Fibular Collateral Ligament

7. Lateral Condyle of Tibia

8. Lateral Meniscus

9. Medial Meniscus

10. Medial Condyle of Tibia

11. Tibia

12. Fibula

13. Transverse Ligament

167

168

Basic structure, types, location

• What types of cartilage does skeletal cartilage contain?– Hyaline, elastic, fibro

• What type of hyaline cartilage is in skeletal?– Articular – covers ends at movable joints– Costal – connect ribs to sternum– Respiratory – skeleton of the larynx– Nasal – support nose

• What type is elastic?– External ear– Epiglottis

• What type is fibro?– Discs between vertebrae– knee

169

What are the 2 ways cartilage grows?

• Appositional– Cartilage-forming cells secrete new matrix against external

face of existing cartilage

• Interstitial– Chondrocytes divide and secrete new matrix– Expand from within

• When does growth end?– During adolescence

• Is calcified cartilage bone?– No. Cartilage and bone are always distinct tissues

170

Classification of Bone

• What are the 2 groups?– Axial– Appendicular

• What is the axial?– Skull, vertebrae, ribs

• Appendicular?– Upper/lower limbs, girdles (hips,shoulders)

171

Structure of long bone• Diaphysis

– Shaft– Surrounds medullary cavity. Adults – yellow bone marrow

• Epiphysis– Bone ends– Interior spongy bone– Joint surface – articular cartilage– Epiphyseal line – between the diaphysis and epiphysis of adult bone; remnant

of epiphyseal plate (hyaline that grows during childhood) Also called metaphysis

• Membranes– Glistening white outer cover?

• periosteum– Where do nerve, blood, lymph enter diaphysis?

• Nutrient foramen– Periosteum secured to bone by?

• Sharpey’s fibers

• What covers internal bone surfaces?– endosteum

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Structure of short bone

• What design do all short, irregular and flat bones share?– Thin plates of periosteum-covered compact bone

sandwiching spongy bone in the middle

• Short bones have no what?– Shaft or epiphysis

• What is the spongy bone called?– Diploe

173

Hemopoietic tissue-red marrow

• Where is it found?– Within trabecular cavities in long bone– Diploe of flat bone

• What are those cavities called?– Red marrow cavities

• Where does blood production occur in adult long bone?– Only in head of femur and humerus

• What sites are usually more active and used for obtaining red marrow samples?– Diploe, irregular sites of flat bones (sternum, hip bone)

174

Compact bone• What do canaliculi do?

– Tie all the osteocytes in osteon together– Permit nutrients and wastes to enter and exit– Maintain bone matrix

• What is interstitial lamellae?– Incomplete lamellae that fill the gaps between forming osteons

• What are circumferential lamellae?– Lamellae just deep to the periosteum and superficial to the

endosteum, that extend around the entire circumference of the diaphysis and resist twisting of the bone

175

Formation of skeleton• What is the skeleton of human embryo made of before week 8?

– Entirely fibrous membranes and hyaline cartilage• What is it called when a bone develops from fibrous membrane?

– Intramembranous ossification• What is the bone of this type of formation called?

– Membrane bone• What is it called when bone is formed by replacing hyaline

cartilage?– Endochondral Ossification

• What is this bone called?– Cartilage or endochondral bone

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Intramembranous Ossification• What bones are formed this way?

– Skull– Clavicle

• What type of bones formed this way?– Flat bones

• What are the 4 major steps?Step One:– What appears in the fibrous tissue?

• Ossification center– What do mesenchymal cells do at this stage?

• Cluster• Differentiate into osteoblasts• Form the ossification center

Step Two:– What do the osteoblasts do at this stage?

• Secrete the osteoid– What do trapped osteoblasts become?

• osteocytes

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Intramembranous Ossification (cont)Step 3:– What is formed in step 3?

• Woven bone• Periosteum

– What is a random network?• Accumulated osteoid laid down between blood vessels

– What does this form?• Trabeculae (spongy bone)

– What does vascularized mesenchyme condensing on the external face of woven bone become?

• The periosteum

Step 4:– What does thickened trabeculae just deep to the periosteum

form?• Woven bone collar

– What is this replaced by?• Mature lamellar bone

– What is a diploe?• Compact bone sandwiching spongy bone

178

Endochondral Ossification• What bones are formed this way?

– All bones of the skeleton below the base of the skull• What is the model this process uses?

– Hyaline cartilage model• When does the process begin?

– 2nd month of fetal development• What is the primary ossification center?

– The region where long bone formation usually begins• What sets the stage for this process to begin?

– Perichondrium infiltrated by blood vessels converting it to periosteum– Mesenchymal cells specialize into osteoblasts

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Endochondral Ossification (cont)Step 1:• What do the osteoblasts secretions against hyaline cartilage do?

– Encase it in a bone collar

Step 2:• What does cartilage in the center of diaphysis do?

– Calcifies, cavitates (creates cavities)• What do chondrocytes do at this stage?

– Hypertrophy (enlarge)– Signal matrix to calcify

• What happens to the chondrocytes and the matrix at this stage?– They die– Matrix deteriorates

• What happens to cartilage elsewhere?– Remains healthy– Grows briskly

• What does this cause the cartilage model to do?– Elongate

180

Endochondral Ossification (cont)

Step 3:• What is the periosteal bud?

– Collection of elements• Nutrient artery• Vein• Lymphatics• Nerve fibers• Red marrow elements• Osteoblasts, osteoclasts

• When does it appear?– The 3rd month of development

• What are the osteoclasts and osteoblasts doing at this stage?– Clasts – eroding calcified matrix– Blasts – secreting osteoid around remaining cartilage

• What is this forming?– Trabeculae (earliest version of spongy bone)

181

Endochondral Ossification (cont)• Step 4:• What forms in stage 4?

– Medullary cavity

182

Joints

183

Classification of joints

• What are the 2 ways to classify joints?– Functional– Structural

• Functional:– Synarthroses

• Immovable (skull)– Amphiarthroses

• Slightly movable (intervertebral, pubic symph)– Diarthroses

• Freely movable (limbs, joints of limbs)

• Structural:– Fibrous

• Bones joined by fibrous tissue – no joint cavity• Most immovable or slightly movable

184

Fibrous joints (cont)

• 3 types of fibrous joints:• Sutures:

– Rigid splices of interlocking bone – Where’s the only place they occur?

• Skull

• Syndesmoses:– Joints where bones connect by cord or sheet of fibrous tissue called a

ligament • Gomphoses:

– Resembles peg or socket (teeth)

185

Cartilaginous Joints

• Bones connected by cartilage with no joint cavity• 2 types:• Synchondroses-

– Plate of hyaline cartilage connects the bones– Epiphyseal plates of long bones, joint of 1st rib and manubrium

• Symphyses-– Bones covered with articular hyaline cartilage fused to

fibrocartilage plate.– All amphiarthritic (intervertebral, pubic symphysis)

186

Synovial Joints

• Articulating bones separated by fluid filled joint

• All have:– Hyaline both bony

surfaces– Joint cavity– 2 layer joint capsule with

outer fibrous layer– Synovial membrane lining

fibrous capsule– All internal joint surfaces

not covered with cartilage– Synovial fluid fills joint

capsule• May have:

– Wedges of fibro separating

– Sacs lined with synovial membrane

187

6 types of synovial• Plane

– Flat articular surface

• Hinge– Similar to door hinge

188

Pivot joints• Rotation of bone on

axis• Ulna• atlantoaxial

189

Condyloid joints

• Oval surface of one fits into concave of other

190

Saddle joints• Each bone has concave

and convex surface• Carpometacarpal of

thumb

191

Ball and Socket

• Round head of one fits into concave of other

• Humerus• femur

192

Joint Injuries• Sprain

– Overstretched, torn ligaments

• Cartilage– Torn or overused. Does not heal. Must remove

• Dislocation– Bones forced out of position

• Bursitis– Inflamed bursae, tendon sheath. Overuse, stress,

bacterial, friction

• Arthritis– Diseases that damage joints. Wear, bacteria, immune

193

Clinical terms Dwarfism –Achondroplasia Abnormal projection from a bone due to bony overgrowth –Bony spur Pain in bone –Ostealgia Bone inflammation –Osteitis.

Documents

diseased bone

fractured bone

spongy bone

bone marrow

bone sinus

bone growth

bone meatus

prominent ridge of bone