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CHAPTER 6
SKELETAL SYSTEM - BONES & JOINTS
SKELETAL SYSTEM COMPONENTS
• BONES
• OTHER CONNECTIVE TISSUE
• JOINTS
FUNCTIONS OF THE SKELETAL SYSTEM
• SUPPORT
• PROTECTION
• MOVEMENT
• STORAGE
• BLOOD CELL PRODUCTION
EXTRACELLULAR MATRIX REVIEW
• DETERMINES FUNCTION OF
CONNECTIVE TISSUES
• COLLAGEN
• PROTEOGLYCANS
• MINERALS
EXTRACELLULAR MATRIX
• TENDONS AND LIGAMENTS
• LARGE AMOUNTS OF COLLAGEN FIBERS
• CREATES TOUGH STRUCTURES, LIKE ROPE
OR CABLE
EXTRACELLULAR MATRIX
• CARTILAGE
• CONTAINS COLLAGEN AND
PROTEOGLYCANS
• COLLAGEN MAKES TOUGH
• PROTEOGLYCANS MAKE SMOOTH AND
RESILIENT
EXTRACELLULAR MATRIX
• BONES
• CONTAINS COLLAGEN AND MINERALS
(CALCIUM/PHOSPHATE)
• COLLAGEN GIVES FLEXIBLE STRENGTH
• MINERAL GIVES COMPRESSION OR
WEIGHT BEARING STRENGTH
SHAPE CATEGORIES OF BONE
• LONG
• SHORT
• IRREGULAR
• FLAT
STRUCTURE OF A LONG BONE
• DIAPHYSIS
• EPIPHYSIS
• ARTICULAR CARTILAGE
• EPIPHYSEAL PLATE
• EPIPHYSEAL LINE
STRUCTURE OF LONG BONE
STRUCTURE OF LONG BONE
STRUCTURE OF LONG BONE
• MEDULLARY CAVITY
• YELLOW MARROW VS RED MARROW
• PERIOSTEUM
• ENDOSTEUM
STRUCTURE OF LONG BONE
GENERAL HISTOLOGY OF BONE
• OSTEOBLASTS VS OSTEOCYTE
• FORMED AS LAMELLAE
• LACUNAE BETWEEN LAMELLAE
• CANALICULI
TYPES OF BONE – HISTOLOGY
• COMPACT
• SPONGY
• ONE SINGLE BONE MAY HAVE BOTH TYPES
WITHIN IT
COMPACT BONE
• FOUND IN DIAPHYSIS ON LONG BONES &
THIN SURFACES OF OTHER BONES
• MOST LAMELLAE ARE IN RINGS AROUND A
HAVERSIAN CANAL (OR CENTRAL CANAL)
COMPACT BONE
• HAVERSIAN SYSTEM (OR OSTEON)
• CANALICULI ALLOW FOR CONNECTIONS
BETWEEN OSTEOCYTES, AND PATHWAY
FOR DIFFUSION AND WASTE MOLECULES
COMPACT BONE PICTURE
SPONGY BONE
• FOUND IN EPIPHYSES OF LONG BONES &
INTERIOR OF OTHER BONES
• TRABECULAE
• MARROW IN SPACES
SPONGY BONE
• NO BLOOD VESSELS OR CENTRAL CANAL
IN TRABECULAE
• NUTRIENTS LEAVE MARROW AND
DIFFUSE THROUGH CANALICULI TO
REACH OSTEOCYTES THERE
BONE OSSIFICATION
• FORMATION OF BONE BY OSTEOBLASTS
• AFTER AN OSTEOBLAST BECOMES
SURROUNDED BY BONE MATRIX, IT
BECOMES AND OSTEOCYTE
INTRAMEMBRANOUS OSSIFICATION
• OSTEOBLASTS BEGIN TO
PRODUCE BONE IN
CONNECTIVE TISSUE
MEMBRANES
• BEGINS IN OSSIFICATION
CENTERS
ENDOCHONDRAL OSSIFICATION
• BONE STARTS AS CARTILAGE
• CHONDROCYTES INCREASE IN NUMBER,
ENLARGE AND DIE
• CARTILAGE MATRIX BECOMES CALCIFIED
• BLOOD VESSELS ACCUMULATE IN
PERICHONDRIUM
ENDOCHONDRAL OSSIFICATION
• PRESENCE OF BLOOD VESSELS CAUSES
SOME CONNECTIVE TISSUE CELLS TO
BECOME OSTEOBLASTS
• OSTEOBLASTS THEN START TO FORM BONE
AROUND THE OUTSIDE OF DIAPHYSIS
• PERICHONDRIUM BECOMES PERIOSTEUM
ENDOCHONDRAL OSSIFICATION
• BLOOD VESSELS GROW INTO DEEP PARTS OF
DIAPHYSIS BRINGING IN OSTEOBLASTS AND
STIMULATING OSSIFICATION
• OSTEOCLASTS DESTROY CALCIFIED CARTILAGE
MATRIX THAT IS NO LONGER NEEDED
• OSTEOBLASTS LINE UP ON REST OF CALCIFIED
CARTILAGE MATRIX TO START FORMING TRABECULAE
ENDOCHONDRAL OSSIFICATION
• MEDULLARY CAVITY FORMS IN CENTER OF
DIAPHYSIS
• BONE MARROW REPLACES SOME OF CALCIFIED
CARTILAGE MATRIX IN MEDULLARY CAVITY
• SECONDARY OSSIFICATION CENTERS FORM THE
EPIPHYSES
ENDOCHONDRAL OSSIFICATION
BONE GROWTH
• NEW BONE LAMELLAE IS PUT ON EXISTING
BONE/CONNECTIVE TISSUE
• APPOSITIONAL GROWTH
• INCREASES WIDTH
• INCREASE IN LENGTH OF BONE
• ENDOCHONDRAL OSSIFICATION AT
EPIPHYSEAL PLATE
BONE REMODELING
• EXISTING BONE IS REMOVED AND NEW BONE IS
MADE
• CAUSES BONE TO CHANGE SHAPE, REPAIR,
ADJUST TO STRESS, AND REGULATE CALCIUM
IONS IN BODY FLUIDS
• INVOLVED IN NEW SPONGY BONE BEING
CONVERTED TO COMPACT BONE
BONE REMODELING
BONE REMODELING
BONE REPAIR
• BONE BREAKS
• BLOOD VESSELS ARE DAMAGED
• CLOT FORMS
• BLOOD VESSELS & CELLS FROM SURROUNDING
TISSUE INVADE THE CLOT
• CALLUS FORMS
BONE REPAIR
• OSTEOBLASTS FORM SPONGY BONE IN
CALLUS
• BONE REMODELING
• IMMOBILIZATION?
BONE REPAIR
BONE & CALCIUM HOMEOSTASIS
• CALCIUM IS STORED IN BONE
• BODY MAINTAINS HOMEOSTASIS OF
CALCIUM IN BLOOD
HYPOCALCEMIA
• LOW BLOOD CA LEVELS CAUSES ↑ PARATHYROID
HORMONE (PTH) SECRETION
• CAUSES ↑ OSTEOCLAST ACTIVITY TO ↑ BLOOD
CA LEVELS
• CAUSES ↑ VITAMIN D FORMATION BY KIDNEYS
• VITAMIN D ↑ CA ABSORPTION FROM INTESTINES
• CAUSES ↑ CA ABSORPTION FROM URINE IN
KIDNEY
HYPOCALCEMIA
• HYPOPARATHYROIDISM
• VITAMIN D DEFICIENCY
• CHRONIC RENAL DISEASE
HYPERCALCEMIA
• HIGH BLOOD CA LEVELS CAUSES ↑ CALCITONIN
SECRETION
• CAUSES ↓ OSTEOCLAST ACTIVITY
• ↓ VITAMIN D PRODUCTION BY KIDNEYS
• ↓ ABSORPTION FROM THE INTESTINES
• ↑ CA EXCRETION VIA THE KIDNEYS/URINE
HYPERCALCEMIA
• KIDNEY FAILURE
• VITAMIN D DISORDERS
• PARATHYROID DISORDERS
• CANCER
• HIGH BONE TURN-OVER RATES
CALCIUM HOMEOSTASIS
OSTEOPOROSIS
• POROUS BONE
• LESS BONE MATRIX
• MORE COMMON IN ELDERLY & WOMEN
• DUE TO DECREASES IN ESTROGEN
• DUE TO DECREASES IN CALCIUM ABSORPTION
• DUE TO LACK OF EXERCISE
• DECREASES IN TESTOSTERONE DO NOT HAVE SAME EFFECT IN MALES
• CAN CAUSE VERTEBRAE TO COLLAPSE
• TREATMENTS
GENERAL CONSIDERATIONS OF BONE
ANATOMY
• FORAMEN
• CANAL/MEATUS
• FOSSA
• TUBERCLE/TUBEROSITY
• PROCESS
• CONDYLE
AXIAL SKELETON COMPONENTS
• SKULL
• VERTEBRAL COLUMN
• THORACIC CAGE
SKULL
• 22 BONES
• BRAINCASE
• 8 BONES
• FACIAL BONES
• 14 BONES
• AUDITORY OSSICLES
• 3 PER EAR
SKULL – LATERAL VIEW
• PARIETAL BONE
• EXTERNAL AUDITORY CANAL
• TEMPORAL BONE
• MASTOID PROCESS
• SQUAMOUS SUTURE
• SPHENOID BONE
• FRONTAL BONE
• ZYGOMATIC BONE
• CORONAL SUTURE
• ZYGOMATIC ARCH
• OCCIPITAL BONE
• MAXILLA
• LAMBDOID SUTURE
• MANDIBLE
SKULL – LATERAL VIEW PICTURE
SPHENOID BONE PICTURE
SKULL – FRONTAL VIEW
• FRONTAL BONE
• NASAL CAVITY
• ZYGOMATIC BONES
• NASAL SEPTUM
• MAXILLAE
• NASAL BONES
• MANDIBLE
• ORBITS
• SUPERIOR & INFERIOR
ORBITAL FISSURES
• OPTIC FORAMEN
• NASOLACRIMAL CANAL
• LACRIMAL BONE
• NASAL CONCHAE
• PARANASAL SINUSES
• MASTOID AIR CELLS
SKULL - FRONTAL VIEW PICTURE
PARANASAL SINUS PICTURE
SUPERIOR VIEW OF THE CRANIAL CAVITY
• DIVIDED INTO 3 CRANIAL FOSSAE
• ANTERIOR, MIDDLE, & POSTERIOR
• FORAMINA IN MIDDLE FOSSA ALLOW NERVES &
BLOOD VESSELS INTO SKULL
• FORAMEN MAGNUM IN POSTERIOR FOSSA
ALLOWS SPINAL CORD TO CONNECT TO BRAIN
• SELLA TURCICA CONTAINS THE PITUITARY GLAND
SUPERIOR VIEW OF THE CRANIAL CAVITY
HYOID BONE
• U-SHAPED
• NOT PART OF SKULL
• MUSCLES & LIGAMENTS
ATTACH IT TO SKULL
• PROVIDES ATTACHMENT
FOR SOME TONGUE
MUSCLES & SOME NECK
MUSCLES
VERTEBRAL COLUMN
• 7 CERVICAL VERTEBRAE
• 12 THORACIC VERTEBRAE
• 5 LUMBAR VERTEBRAE
• 1 SACRAL BONE
• 1 COCCYGEAL BONE
VERTEBRAL COLUMN ABNORMALITIES
Kyphosis
Lordosis
Scoliosis
VERTEBRAL COLUMN FUNCTIONS
• SUPPORT WEIGHT OF HEAD AND TRUNK
• PROTECT SPINAL CORD
• ALLOW SPINAL NERVES TO EXIT THE SPINAL
CORD
• PROVIDE SITES OF MUSCLE ATTACHMENT
• PERMIT MOVEMENT OF HEAD AND TRUNK
VERTEBRAL BODY ANATOMY
• 3 PARTS
• BODY
• ARCH
• PROCESSES
• VERTEBRAL FORAMEN
• INTERVERTEBRAL FORAMINA
• INTERVERTEBRAL DISKS
CERVICAL VERTEBRAE
• SMALL (OR NO BODY)
• TRANSVERSE PROCESS HAS TRANSVERSE
FORAMEN FOR VERTEBRAL ARTERIES TO
REACH BRAIN
• ATLAS
• AXIS
THORACIC VERTEBRAE
• LONG, THIN SPINOUS PROCESS
THAT POINT INFERIORLY
• EXTRA ARTICULAR FACETS ON SIDE
FOR JOINT WITH RIBS
LUMBAR VERTEBRAE
• LARGE, THICK BODY
• RECTANGULAR TRANSVERSE & SPINOUS
PROCESS
• SUPERIOR ARTICULAR FACETS FACE
MEDIALLY & INFERIOR ARTICULAR FACETS
FACE LATERALLY
SACRUM
• FORMED BY 5 FUSED VERTEBRAE
• MEDIAN SACRAL CREST
• SACRAL HIATUS
• SACRAL PROMONTORY
COCCYX
• COCCYX
• ABOUT 4 FUSED
VERTEBRAE
• REDUCED BODIES
• NO FORAMEN OR
PROCESS
THORACIC CAGE
• THORACIC VERTEBRAE
• RIBS
• CARTILAGE
• STERNUM
RIBS & COSTAL CARTILAGES
• COSTAL CARTILAGE
• TRUE RIBS
• FALSE RIBS
• FLOATING RIBS
STERNUM
• MANUBRIUM
• BODY
• XIPHOID PROCESS
• JUGULAR NOTCH
• STERNAL ANGLE
APPENDICULAR SKELETON
• UPPER LIMB
• LOWER LIMB
• GIRDLES
PECTORAL GIRDLE
• 2 SCAPULAE
• FLAT, TRIANGULAR BONE
• 3 FOSSA FOR ARM MUSCLES TO ATTACH
• GLENOID
• SPINE
• ACROMION PROCESS
• CORACOID PROCESS
PECTORAL GIRDLE
• 2 CLAVICLES
• ARTICULATES WITH SCAPULA
AT ACROMION PROCESS
• PROXIMAL END ATTACHES
TO STERNUM
UPPER LIMB
• ARM
• FOREARM
• WRIST
• HAND
ARM - HUMERUS
• HEAD
• ANATOMICAL NECK
• GREATER & LESSER
TUBERCLES
• DELTIOD TUBEROSITY
• CONDYLES
• EPICONDYLES
FOREARM
• ULNA
• TROCHLEAR NOTCH
• OLECRANON PROCESS
• CORONOID PROCESS
• STYLOID PROCESS
• RADIUS
• HEAD
• RADIAL TUBEROSITY
• STYLOID PROCESS
WRIST
• 8 CARPEL BONES
• SCAPHOID
• LUNATE
• TRIQUETRUM
• PISIFORM
• TRAPEZIUM
• TRAPEZOID
• CAPITATE
• HAMATE
HAND
• 5 METACARPAL
BONES
• 14 PHALANGES
• MAKE UP THE
DIGITS
PELVIC GIRDLE
• PLACE WHERE LOWER LIMBS ATTACH TO
BODY
• PELVIC GIRDLE
• RIGHT AND LEFT COXAL BONES (HIP
BONES) JOIN TO FORM ANTERIOR
PORTION
• SACRUM JOINS POSTERIORLY
• FORMS A RING
PELVIC GIRDLE GENDER DIFFERENCES
• MALES – LARGER
• FEMALES – BROADER & SHORTER
• WIDER INLET & OUTLET
• SACRUM POINTS MORE POSTERIORLY IN
FEMALES
• SUBPUBIC ANGLE
• LESS THAN 90° IN MALES, 90° OR MORE IN
FEMALES
PELVIC GIRDLE GENDER DIFFERENCES
PELVIS
• INCLUDES PELVIC GIRDLE AND
COCCYX
• ILIUM
• ISCHIUM
• PUBIS
• ILIAC CREST
• ANTERIOR SUPERIOR ILIAC SPINE
• PUBIC SYMPHYSIS
• SACROILIAC JOINTS
• ACETABULUM
• OBTURATOR FORAMEN
PELVIS
LOWER LIMB
• THIGH
• LEG
• ANKLE
• FOOT
THIGH
• BETWEEN HIP & KNEE
• FEMUR
• HEAD ARTICULATES WITH ACETABULUM OF COXAL
BONE
• CONDYLES ARTICULATE WITH TIBIA
• EPICONDYLES ARE FOR LIGAMENT ATTACHMENT
• TROCHANTERS ARE FOR MUSCLE ATTACHMENT
• PATELLA
• KNEECAP
LEG
• BETWEEN KNEE & ANKLE
• TIBIA
• FLAT CONDYLES ARTICULATE WITH FEMUR
• TIBIAL TUBEROSITY – MUSCLES OF ANTERIOR THIGH ATTACH
• ARTICULATES WITH TALUS OF ANKLE
• MEDIAL MALLEOLUS
• FIBULA
• HEAD IS ATTACHED TO TIBIA
• ARTICULATES WITH TALUS OF ANKLE
• LATERAL MALLEOLUS
ANKLE
• 7 TARSAL BONES
• TALUS
• CALCANEUS
• CUBOID
• NAVICULAR
• MEDIAL CUNEIFORMS
• INTERMEDIATE CUNEIFORMS
• LATERAL CUNEIFORMS
FOOT
• METATARSAL BONES
• PHALANGES
• 3 ARCHES
• 2 GO FROM HEEL TO
BALL OF FOOT
• 1 GOES TRANSVERSELY
JOINTS
• ALSO CALLED ARTICULATION
• A PLACE WHERE TWO BONES COME
TOGETHER
• MAY OR MAY NOT BE MOVEABLE
• FUNCTIONAL CLASSIFICATION – BASED
ON DEGREE OF MOVEMENT
• STRUCTURAL CLASSIFICATION – BASED ON
TYPE OF CONNECTIVE TISSUE THAT BINDS
THE BONES TOGETHER AND WHETHER
THERE IS A FLUID-FILLED JOINT CAPSULE
FIBROUS JOINTS
• BONES HELD TOGETHER BY FIBROUS
TISSUE
• USUALLY NO MOVEMENT BETWEEN
BONES
• 3 TYPES
• SUTURES
• FONTANELS
• SYNDESMOSES
• GOMPHOSES
CARTILAGINOUS JOINTS
• TWO BONES ARE JOINED BY
CARTILAGE
• ONLY SLIGHT MOVEMENT CAN
OCCUR
• EXAMPLES
• BETWEEN RIBS & STERNUM
• EPIPHYSEAL PLATES
• INTERVERTEBRAL DISKS
• FIBROCARTILAGE
SYNOVIAL JOINTS
• FLUID WILL BE IN A CAVITY THAT SURROUNDS THE
ENDS OF THE BONES
• FREELY MOVEABLE
• GENERAL PARTS
• ARTICULAR CARTILAGE
• JOINT CAVITY
• JOINT CAPSULE
• SYNOVIAL MEMBRANE
• SYNOVIAL FLUID
• BURSA
• TENDON SHEATH
TYPES OF SYNOVIAL JOINTS
• GROUPED BASED ON SHAPE OF
ADJOINING BONES
• PLANE JOINTS
• SADDLE JOINTS
• HINGE JOINTS
• PIVOT JOINTS
• BALL-AND-SOCKET JOINTS
• ELLIPSOID JOINTS
TYPES OF MOVEMENT
• FLEXION & EXTENSION
• PLANTAR FLEXION & DORSIFLEXION
•
•
•
•
•
•
•
•
•
ABDUCTION & ADDUCTION
PRONATION & SUPINATION
EVERSION & INVERSION
ROTATION
CIRCUMDUCTION
PROTRACTION & RETRACTION
ELEVATION & DEPRESSION
EXCURSION
OPPOSITION & REPOSITION
DOUBLE DREAM FEET REVIEW
• WHEN THE CLIP IS PAUSED, TELL ME THE TYPE OF MOVEMENT, BONES,
& JOINT INVOLVED
EFFECTS OF AGING ON THE SKELETAL
SYSTEM AND JOINTS
• BONE MATRIX
• BECOMES MORE BRITTLE DUE TO LESS COLLAGEN
• BECOMES LESS DENSE
• OSTEOPOROSIS
• JOINTS
• LESS ARTICULAR CARTILAGE
• LESS SYNOVIAL FLUID
• ARTHRITIS
• LIGAMENTS & TENDONS SHORTEN
TYPES OF BONE FRACTURES
• DISPLACED VS NON-DISPLACED
• COMMINUTED
• CLOSED VS OPEN
• GREENSTICK
• TRANSVERSE
• OBLIQUE
• IMPACTED
PICTURES OF BONE FRACTURES