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Skeletal System
LEARNING OBJECTIVES
1.Recognize and use terms related to the anatomy and physiology of the skeletal system.
2.Recognize and use terms related to the pathology of the skeletal system.
3.Recognize and use terms related to the procedures for the skeletal system.
4.List and describe five functions of the skeletal system.
5.Explain the difference between compact and spongy bone.
6.Classify bones according to size and shape.
7.Identify the general features of a long bone.
8.Explain the process by which long bones grow in length.
9.Explain the difference between the axial and appendicular skeletons.
10.Identify the bones of the skull.
11.Identify the structural features of vertebrae.
12.List and describe the divisions of the vertebral column.
13.Describe the structural features of the sternum and ribs.
14.Identify the parts of the pectoral girdle.
15.Identify the bones of the upper extremities.
16.Identify the parts of the pelvic girdle.
17.Identify the bones of the lower extremities.
18.List and describe the different types of joints.
19.Describe ways in which the aging of an individual affects the skeletal system.
20.Identify pathology related to the skeletal system.
CHAPTER OUTLINE
Bones of the Appendicular Skeleton
INTRODUCTION TO THE SKELETAL SYSTEM
Overview of the Skeletal System
Pectoral Girdle
Upper Extremity
Pelvic Girdle
Lower Extremity
Functions of the Skeletal System
Structure of Bone Tissue
Classification of Bones
General Features of a Long Bone
Bone Markings
Bone Development and Growth
Bone Growth in Length
Divisions of the Skeleton
Ligaments and Bursae
Diarthroses
Aging of the Skeletal System
Trauma
Fractures
Sprain/Strain and Dislocation/Subluxation
Setting Fractures
SKELETAL SYSTEM REVIEW
Bones of the Axial Skeleton
Skull
Hyoid Bone
Vertebral Column
Thoracic Cage
1
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2
CHAPTER 1 Skeletal System
CHAPTER AT A GLANCE
Use this list of key word parts and terms to assess your knowledge. Check off the ones you have mastered.
Anatomy and Physiology
 appendicular skeleton
 articulation
 axial skeleton
 depression
 process
 bursa
 cartilage
 diaphysis
 epiphysis
 epiphyseal plate
 ligament
 osteoblast
 osteoclast
 osteocyte
 osteon
 synarthrosis
 vertebrae
SUFFIXES
COMBINING FORMS
 herniated intervertebral disk
 osteoarthritis (OA)
 osteoclasis
 osteomalacia
 osteomyelitis
 osteoporosis
 pathologic fractures
 polydactyly
 rheumatoid arthritis (RA)
 spinal stenosis
 spondylosis
 spondylolisthesis
 subluxation
 syndactyly
Key Word Parts
PREFIXES
 dia dys endo-, end epi inter peri poly
 syn-
 -al
 -centesis
 -clasis
 -desis
 -ectomy
 -graphy
 -itis
 -listhesis
 -malacia
 -osis
 -pexy
 -plasty
 -sarcoma
 -scopy
 -y
 arthr/o
 burs/o
 chondr/o
 cost/o
 dactyl/o
 myel/o
 oste/o
 prosthes/o
 spondyl/o
 syndesm/o
 vertebr/o
Key Terms
 arthrocentesis
 arthrodesis
 arthroplasty
 arthroscopy
 bursitis
 carpal tunnel syndrome (CTS)
 chondrosarcoma
 costochondritis
INTRODUCTION TO THE
SKELETAL SYSTEM
The skeletal system consists of the bones and the cartilage,
ligaments, and tendons associated with the bones. It
accounts for about 20% of the body weight. Bones are rigid
structures that form the framework for the body. People
often think of bones as dead, dry, inert pipes and plates
because that is how they are seen in the laboratory. In reality,
the living bones in our bodies contain active tissues that
consume nutrients, require a blood supply, use oxygen and
discharge waste products in metabolism, and change shape
or remodel in response to variations in mechanical stress.
The skeletal system is strong but lightweight. It is well
adapted for the functions it must perform. It is a masterpiece of design.
Module_B_2622_Chapter 1_main.indd 2
OVERVIEW OF THE
SKELETAL SYSTEM
Functions of the Skeletal System
The skeletal system gives form and shape to the body.
Without the skeletal components, we would appear as big
“blobs” inefficiently “oozing” around on the ground. Besides
contributing to shape and form, our bones perform
several other functions and play an important role in
homeostasis.
Support
Bones provide a rigid framework that supports the soft
organs of the body. Bones support the body against the pull
of gravity, and the large bones of the lower limbs support
the trunk when standing.
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CHAPTER 1 Skeletal System
Protection
The skeleton protects the soft body parts. The fused bones
of the cranium surround the brain to make it less vulnerable
to injury. The vertebrae surround and protect the spinal
cord. The bones of the rib cage help protect the heart and
lungs in the thorax.
Movement
Bones provide sites for muscle attachment. Bones and
muscles work together as simple mechanical lever systems
to produce body movement.
Storage
The intercellular matrix of bone contains large amounts of
calcium salts, the most important being calcium phosphate.
Calcium is necessary for vital metabolic processes. When
blood calcium levels decrease below normal, calcium is
released from the bones so that there will be an adequate
supply for metabolic needs. When blood calcium levels are
increased, the excess calcium is stored in the bone matrix.
Storage and release are dynamic processes that go on almost
continually.
Blood Cell Formation
Blood cell formation, called hematopoiesis (hee-mat-oh-poyEE-sis), takes place mostly in the red marrow of bones. Red
marrow is found in the cavities of most bones in an infant.
With age, it is largely replaced by yellow marrow for fat
storage. In the adult, red marrow is limited to the spongy
bone in the skull, ribs, sternum, clavicles, vertebrae, and
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pelvis. Red marrow functions in the formation of red blood
cells, white blood cells, and blood platelets.
Structure of Bone Tissue
There are two types of bone tissue: compact and spongy. As
the names imply, the two types differ in density, or how
tightly the tissue is packed together. Three types of cells
contribute to bone homeostasis: osteoblasts, osteoclasts, and
osteocytes. Osteoblasts are bone-forming cells, osteoclasts
resorb or break down bone, and osteocytes are mature bone
cells. An equilibrium between osteoblasts and osteoclasts
maintains bone tissue.
Compact Bone
The microscopic unit of compact bone is known as the
osteon (haversian system). The osteon consists of a central
canal called the osteonic (haversian) canal, which is surrounded by concentric rings (lamellae) of hard, calcified
matrix. Between the rings of matrix, the bone cells (osteocytes) are located in spaces called lacunae. Small channels
(canaliculi) radiate from the lacunae to the osteonic (haversian) canal to provide passageways through the hard matrix.
In compact bone the haversian systems are packed tightly
together to form what appears to be a solid mass. The
osteonic canals contain blood vessels that are parallel to the
long axis of the bone. These blood vessels interconnect, by
way of perforating (Volkmann) canals, with vessels on the
surface of the bone. The microscopic structure of compact
bone is illustrated in Figure 1-1.
Canaliculi
Lacuna
Osteocyte
Lamellae of
an osteon
Trabeculae of
spongy bone
Figure 1-1 Structure of compact and spongy
bone. Note the osteons packed together for
compact bone and trabeculae of spongy bone.
Osteon
Periosteum
Haversian canal
Volkmann’s canal
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CHAPTER 1 Skeletal System
Highlight on the Skeletal System
Osteoporosis: Osteoporosis is a bone disorder caused by
decreased osteoblast activity. It is characterized by loss of the
organic matrix, collagenous fibers, and minerals in the bone
tissue. People with osteoporosis are susceptible to deformities
of the vertebral column and fractures because the bones are
too weak to support the weight of the body. Osteoporosis
occurs most frequently in postmenopausal Caucasian women.
Factors that influence its occurrence are aging, malnutrition,
lack of exercise, and hormone imbalance. Supplemental estrogen after menopause may be of benefit, and exercise is always
important in maintaining bone strength.
Epiphyseal plate: The epiphyseal plates of specific long bones
ossify at predictable times. Radiologists frequently can determine a young person’s age by examining the epiphyseal plates
to see whether they have ossified. A difference between bone
age and chronologic age may indicate some type of metabolic
dysfunction.
Mastoiditis: The mastoid air cells are separated from the cranial
cavity by only a thin partition of bone. A middle ear infection
that spreads to the mastoid air cells (mastoiditis) is serious
because there is danger that the infection will spread from the
air cells to the membranes around the brain.
Sinus problems: The bones with paranasal sinuses are the
frontal, the sphenoid, the ethmoid, and the two maxillae. The
sinuses are lined with mucous membranes that are continuous
with the nasal cavity. Allergies and infections cause inflammation of the membranes, which results in sinusitis. The swollen
membranes may reduce drainage from the sinuses so that
pressure within the cavities increases, resulting in sinus
headaches.
Soft spots: The bones in the skull of a newborn are not completely
joined together but are separated by fibrous membranes. The
six large areas of membranes are called fontanels, or soft
spots. The anterior fontanel is on the top of the head, at the
junction of the frontal and parietal bones. The posterior fontanel
is at the junction of the occipital and parietal bones. On each
side of the head there is a mastoid (posterolateral) fontanel near
the mastoid region of the temporal bone and a sphenoid
(anterolateral) fontanel just superior to the sphenoid bone.
Abnormal spinal curvatures: An abnormally exaggerated
lumbar curvature is called lordosis, or swayback. This is often
seen in pregnant women as they adjust to their changing center
of gravity. An increased roundness of the thoracic curvature is
kyphosis, or hunchback. This is frequently seen in elderly
people. Abnormal side-to-side curvature is scoliosis. Abnormal
curvatures may interfere with breathing and other vital
functions.
Yes and no: The atlas holds up the skull and permits you to nod
“yes.” The axis allows you to rotate your head from side to side
to indicate “no.”
Marrow biopsy: The sternum is frequently used for a red marrow
biopsy because it is accessible. The sample for biopsy is
Module_B_2622_Chapter 1_main.indd 4
obtained by performing a sternal puncture, in which a large
needle is inserted into the sternum to remove a sample of red
bone marrow.
Fractured clavicle: The clavicle is the most frequently fractured
bone in the body because it transmits forces from the arm to
the trunk. The force from falling on the shoulder or outstretched
arm is often sufficient to fracture the clavicle.
Tennis elbow: Tennis elbow is an inflammation of the tissues
surrounding the lateral epicondyle of the humerus. Six muscles
that control movement of the hand attach in this region,
and repeated contraction of these muscles irritates the
attachments. The medical term for tennis elbow is lateral
epicondylitis.
Pelvic outlet and childbirth: The female pelvis is shaped to
accommodate childbearing. Because the fetus must pass
through the pelvic outlet, the physician carefully measures this
opening to make sure there is enough room. The distance
between the two ischial spines is a good indication of the size
of the pelvic outlet. If the opening is too small, a cesarean
delivery is indicated.
Broken hip: Elderly people, particularly those with osteoporosis,
are susceptible to “breaking a hip.” The femur is a weightbearing bone, and when it is weakened, it cannot support the
weight of the body and the neck of the femur fractures under
the stress. Instead of saying, “Grandma fell and broke her hip,”
often it is more appropriate to say, “Grandma broke her hip,
then fell.”
Bunion: Poorly fitted shoes may compress the toes so that there
is a lateral deviation of the big toe toward the second toe. When
this occurs, a bursa and callus form at the joint between the
first metatarsal and proximal phalanx. This creates a bunion.
Gout: Gout was commonly known as the disease of the kings
because it was believed to be caused by a rich diet and fine
wines. Gout is an equal-opportunity disease, however, and
occurs across the entire population. A rich diet and fine wines
may contribute to the disease, but they are not the definitive
cause. Gout is caused by the excessive accumulation of uric
acid that forms needle-like crystals within the joint, producing
pain and inflammation. The great toe is the most commonly
affected joint. The disorder is diagnosed by aspirating joint fluid
and observing the crystals under the microscope. Although
there is no cure for gout, it can be effectively controlled with
antiinflammatory drugs and dietary measures.
Knee problems: The term torn cartilage refers to a damaged
meniscus, usually the medial, in the knee. Frequently this can
be repaired with relatively minor arthroscopic surgery. A torn
ligament in the knee usually involves one of the cruciate ligaments. The surgical procedure to repair this damage is quite
involved, and recovery of function may require months of rehabilitative therapy. n
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CHAPTER 1 Skeletal System
Spongy (Cancellous) Bone
Spongy (cancellous) bone is lighter and less dense than
compact bone (see Figure 1-1). Spongy bone consists of
plates and bars of bone adjacent to small, irregular cavities
that contain red bone marrow. The plates of bone are called
trabeculae (trah-BEK-yoo-lee). The canaliculi, instead of
connecting to a central haversian canal, connect to the
adjacent cavities to receive their blood supply. It may appear
that the trabeculae are arranged in a haphazard manner, but
they are organized to provide maximum strength in the
same way that braces are used to support a building. The
trabeculae of spongy bone follow the lines of stress and can
realign if the direction of stress changes.
Articular cartilage
Epiphysis
General Features of a Long Bone
Most long bones have the same general features, which are
illustrated in Figure 1-2.
Diaphysis: The shaft of a long bone is called the dia­
physis (dye-AF-ih-sis). It is formed from relatively
thick compact bone that surrounds a hollow space
called the medullary (MED-yoo-lair-ee) cavity.
Medullary cavity: In adults the medullary cavity contains
yellow bone marrow, so it is sometimes called the
yellow marrow cavity.
Epiphysis: At each end of the diaphysis, there is an
expanded portion called the epiphysis (ee-PIF-ih-sis).
The epiphysis is spongy bone covered by a thin layer
of compact bone. The end of the epiphysis, where it
meets another bone, is covered by hyaline cartilage,
called the articular cartilage. This provides smooth
surfaces for movement in the joints. In growing
bones, there is an epiphyseal (ep-ih-FIZ-ee-al) plate
of hyaline cartilage between the diaphysis and
epiphysis. Bones grow in length at the epiphyseal
Module_B_2622_Chapter 1_main.indd 5
Epiphyseal line
Spongy bone
Compact bone
Medullary cavity
Nutrient foramen
Diaphysis
Endosteum
Periosteum
Classification of Bones
Bones come in a variety of sizes and shapes. Bones that are
longer than they are wide are called long bones. They consist
of a long shaft with two bulky ends or extremities. They are
primarily compact bone but may have a large amount of
spongy bone at the ends. Examples of long bones are those
in the thigh, leg, arm, and forearm.
Short bones are roughly cube-shaped with vertical and
horizontal dimensions approximately equal. They consist
primarily of spongy bone, which is covered by a thin layer
of compact bone. Examples of short bones include the
bones of the wrist and ankle.
Flat bones are thin, flattened, and often curved. They are
usually arranged like a sandwich with a middle layer of
spongy bone called the diploë (DIP-loh-ee). The diploë is
covered on each side by a layer of compact bone; these layers
are called the inner and outer tables. Most of the bones of
the cranium are flat bones.
Bones that are not in any of the previously mentioned
three categories are classified as irregular bones. They are
primarily spongy bone that is covered with a thin layer of
compact bone. The vertebrae and some of the bones in the
skull are irregular bones.
5
Epiphysis
Articular cartilage
Figure 1-2 General features of long bones.
plate. Growth ceases when the cartilaginous epiphyseal
plate is replaced by a bony epiphyseal line.
Periosteum: Except in the region of the articular cartilage,
the outer surface of long bones is covered by a tough,
fibrous connective tissue called the periosteum. The
periosteum is richly supplied with nerve fibers,
lymphatic vessels, blood vessels, and osteoblasts.
Nutrient foramina: Blood vessels enter the diaphysis of the
bone through small openings called nutrient foramina.
Endosteum: The surface of the medullary cavity is lined
with a thinner connective tissue membrane, the
endosteum, which contains osteoclasts.
In addition to the general features that are present in
most long bones, all bones have surface markings and characteristics that make a specific bone unique. Bones have
holes, depressions, smooth facets, lines, projections, and
other markings. These usually represent passageways for
vessels and nerves, points of articulation with other bones,
or points of attachment for tendons and ligaments.
Bone Markings
Each bone has characteristic protrusions and/or indentations that function as attachments for ligaments and muscles
and access for blood vessels and nerves. These bone markings are called processes and depressions. By taking the
time to study their names and characteristics, learning the
names of muscles, ligaments, and joints will be much easier.
A table of the most common bone depressions and processes
is provided below.
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6
CHAPTER 1 Skeletal System
Bone Depressions
Depression
Combining Form
Meaning/Function
Example
fissure
foramen
fissur/o
foramin/o
Fairly deep cleft or groove
Opening or hole
fossa
foss/o
Hollow or depression, especially on the surface
of the end of a bone
Small pit or depression
Sphenoidal fissure
Foramen magnum,
mental foramina
Olecranal fossa
fovea
sinus/antrum
sulcus
sinus/o, sin/o, antr/o
sulc/o
Cavity or channel lined with a membrane
General term that refers to a groove or
depression in an anatomic structure, not as
deep as a fissure
Fovea capitis of
humerus
Paranasal sinuses
Intertubercular sulcus
of humerus
Bone Processes
Process
Combining Form
Meaning/Function
Example
condyle
condyl/o
Medial condyle of the
femur
crest
epicondyle
epicondyl/o
Rounded projection at the end of a bone
that anchors the ligaments and
articulates with adjacent bones
Narrow elongated elevation
Projection on the surface of the bone
above the condyle
Small, smooth flat articular surface
Rounded, usually proximal portion of
some long bones
Narrowed area distal to a bone head
Branchlike extension
Thornlike projection
facet
head (capitis)
neck
ramus
spine
spin/o
trochanter
trochanter/o
tubercle
tuberosity
tubercul/o
One of two bony projections on the
proximal ends of the femurs that serve
as points of attachment for muscles
Nodule or small raised area
Elevation or protruberance; larger than a
tubercle
Iliac crest
Lateral epicondyle of
the humerus
Vertebral facets
Femoral head,
humeral head
Femoral neck
Mandibular ramus
Spinous process of
vertebra
Greater trochanter
Costal tubercle
Ischial tuberosity
EXERCISE 1: Bone Basics
Match the bone word parts with their meanings.
____
____
____
____
____
____
____
____
1.
2.
3.
4.
5.
6.
7.
8.
myel/o
-physis
pericondyl/o
spin/o
sin/o
foramin/o
-um
____ 9.
____ 10.
____ 11.
____ 12.
____ 13.
____ 14.
____ 15.
-blast
epifoss/o
endooste/o
-cyte
-clast
A. bone
B. foramen, hole
C. above, upon
D. cell
E. bone marrow
F. surrounding, around
. embryonic
G
H. spine
I. breaking down
J. growth, nature
K. hollow, depression
L. condyle, knob
. within
M
N. sinus, cavity
. structure
O
Fill in the blank.
16. Osteoblasts _______________ bone, whereas osteoclasts _______________ bone.
17. The shaft of a long bone is called the _______________; the ends of a long bone are called _______________ (plural!).
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CHAPTER 1 Skeletal System
7
18. The outer covering of bone is the _______________, whereas the inner lining is the _______________.
19. A foramen, a sinus, and a fossa are examples of bone _______________. A condyle, a trochanter, and a tuberosity are
examples of bone _______________.
20. A synonym for a sinus is a/an _______________.
GUIDELINE ALERT
B4.5 Procedures performed on tendons, ligaments, bursae, and fascia supporting a joint are coded
to the body part in the respective body system that is the focus of the procedure. Procedures performed
on joint structures themselves are coded to the body part in the joint body systems.
Example: Repair of the anterior cruciate ligament of the knee is coded to the knee bursae and ligament body part in the bursae and ligaments body system. Knee arthroscopy with shaving of articular
cartilage is coded to the knee joint body part in the Lower Joints body system.
GUIDELINE ALERT
B4.6. If a procedure is performed on the skin, subcutaneous tissue, or fascia overlying a joint, the
procedure is coded to the following body part:
• Shoulder is coded to Upper Arm
• Elbow is coded to Lower arm
• Wrist is coded to Lower arm
• Hip is coded to Upper leg
• Knee is coded to Lower Leg
• Ankle is coded to Foot
Bone Development and Growth
The terms osteogenesis and ossification are often used synonymously to indicate the process of bone formation. Parts of
the skeleton form during the first few weeks after conception. By the end of the eighth week after conception, the
skeletal pattern is formed in cartilage and connective tissue
membranes and ossification begins. Bone development continues throughout adulthood. Even after adult stature is
attained, bone development continues for repair of fractures
and for remodeling to meet changing lifestyles. Three types
of cells are involved in the development, growth, and
remodeling of bones. Osteoblasts are bone-forming cells;
osteocytes are mature bone cells; and osteoclasts break
down and reabsorb bone.
in length. Bone growth occurs under the influence of
growth hormone from the anterior pituitary gland and sex
hormones from the ovaries and testes.
Even though bones stop growing in length in early adulthood, they can continue to increase in thickness or diameter
throughout life in response to stress from increased muscle
activity or to weight gain. The increase in diameter is called
appositional (ap-poh-ZISH-un-al) growth. Osteoblasts in
the periosteum form compact bone around the external
bone surface. At the same time, osteoclasts in the endosteum break down bone on the internal bone surface, around
the medullary cavity. These two processes together increase
the diameter of the bone and at the same time keep the
bone from becoming excessively heavy and bulky.
Bone Growth in Length
Divisions of the Skeleton
Bones grow in length at the epiphyseal plate located between
the diaphysis and epiphysis of a long bone. The hyaline
cartilage in the region of the epiphyseal plate next to the
epiphysis continues to grow by mitosis. The chondrocytes
in the region next to the diaphysis age and degenerate.
Osteoblasts move in and ossify the matrix to form bone.
This process continues throughout childhood and adolescence until the cartilage growth slows and finally stops.
When cartilage growth ceases, usually in the early 20s, the
epiphyseal plate completely ossifies so that only a thin
epiphyseal line remains and the bones can no longer grow
The typical adult human skeleton consists of 206 named
bones. For convenience, the bones of the skeleton are
grouped in two divisions, as illustrated in Figure 1-3. The
80 bones of the axial skeleton form the vertical axis of the
body. They include the bones of the head, vertebral column,
ribs, and breastbone or sternum. The appendicular skele­
ton consists of 126 bones and includes the free appendages
and their attachments to the axial skeleton. The free appendages are the upper and lower extremities, or limbs, and their
attachments are called girdles. Table 1-1 lists the named
bones of the body by category.
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8
CHAPTER 1 Skeletal System
Skull
Vertebral column
Cervical vertebrae
Clavicle
Scapula
Sternum
Thoracic vertebrae
Humerus
Ribs
Lumbar vertebrae
Radius
Os coxae
Ulna
Sacrum
Carpals
Coccyx
Metacarpals
Phalanges
Femur
Patella
Tibia
Fibula
Tarsals
Metatarsals
Phalanges
Figure 1-3 Divisions of the skeleton with major bones identified. Yellow = axial skeleton. Blue = appendicular skeleton.
BONES OF THE AXIAL SKELETON
The axial skeleton, with 80 bones, is divided into the skull,
hyoid, vertebral column, and rib cage.
Skull
The skull has 28 bones, as illustrated in Figures 1-4 and
1-5. The eight bones of the cranium are interlocked to
enclose the brain. The anterior aspect of the skull, the face,
consists of 14 bones. The remaining six bones are the auditory ossicles, tiny bones in the middle ear cavity. With the
exception of the lower jaw, or mandible, and the auditory
ossicles, the bones in the skull are tightly interlocked along
irregular lines called sutures. Some of the bones in the skull
contain sinuses, which are air-filled cavities lined with
mucous membranes. The sinuses help to reduce the weight
of the skull. The paranasal sinuses are arranged around the
nasal cavity and drain into it.
Module_B_2622_Chapter 1_main.indd 8
Cranium
Frontal Bone
The frontal bone forms the anterior portion of the skull
above the eyes (forehead). The paranasal frontal sinuses are
cavities in the frontal bone.
Parietal Bones
The two parietal (pah-RYE-eh-tal) bones form most of the
superolateral aspect of the skull.
Occipital Bone
The single occipital (ahk-SIP-ih-tal) bone forms most of the
posterior part of the skull. The foramen magnum is a large
opening on the lower surface of the occipital bone. The
spinal cord passes through this opening. Occipital condyles
are rounded processes on each side of the foramen magnum.
They articulate with the first cervical vertebra.
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CHAPTER 1 Skeletal System
Table 1-1 Names of Bones of the Body Listed
by Category
Bones
Axial Skeleton (80 Bones)
Skull (28 bones)
Cranial bones
Parietal (2)
Temporal (2)
Frontal (1)
Occipital (1)
Ethmoid (1)
Sphenoid (1)
Facial bones
Maxilla (2)
Zygomatic (2)
Mandible (1)
Nasal (2)
Palatine (2)
Inferior nasal concha (2)
Lacrimal (2)
Vomer (1)
Auditory ossicles
Malleus (2)
Incus (2)
Stapes (2)
Hyoid
Vertebral column
Cervical vertebrae (7)
Thoracic vertebrae (12)
Lumbar vertebrae (5)
Sacrum (1)
Coccyx (1)
Thoracic cage
Sternum (1)
Ribs (24)
Number
8
14
6
1
26
25
Appendicular Skeleton (126 Bones)
Pectoral girdles
Clavicle (2)
Scapula (2)
Upper extremity
Humerus (2)
Radius (2)
Ulna (2)
Carpals (16)
Metacarpals (10)
Phalanges (28)
Pelvic girdle
Coxal, innominate, or hip bones (2)
Lower extremity
Femur (2)
Tibia (2)
Fibula (2)
Patella (2)
Tarsals (14)
Metatarsals (10)
Phalanges (28)
4
60
2
60
From Applegate E: The anatomy and physiology learning system, ed 4, St Louis,
2011, Saunders.
Module_B_2622_Chapter 1_main.indd 9
9
Temporal Bones
The two temporal bones, one on each side of the head, form
parts of the sides and base of the cranium. Near the inferior
margin of the temporal bone, there is an opening, the external auditory meatus, which is a canal that leads to the middle
ear. Just anterior to the external auditory meatus, the temporal bone articulates with the mandible to form the temporomandibular joint (TMJ). Posterior and inferior to each
external auditory meatus, there is a rough protuberance, the
mastoid process. The mastoid process contains air cells that
drain into the middle ear cavity.
Sphenoid Bone
The sphenoid (SFEE-noyd) bone is an irregularly shaped
bone that spans the entire width of the cranial floor. It is
wedged between other bones in the anterior portion of the
cranium. The sphenoid bone contains paranasal sphenoid
sinuses.
Ethmoid Bone
The ethmoid (ETH-moyd) bone is located anterior to the
sphenoid bone and forms most of the bony area between
the nasal cavity and the orbits. The ethmoid bone contains
many small, paranasal ethmoidal sinuses.
Facial Bones
The 14 facial bones form the basic framework and shape of
the face. They also provide attachments for the muscles that
control facial expression and move the jaw for chewing. All
facial bones except the vomer and mandible are paired. Facial
bones are illustrated in Figures 1-4 and 1-5.
Maxillary Bones
The maxillary bones, or maxillae (maks-ILL-ee), form the
upper jaw and the anterior part of the hard palate or roof
of the mouth. Each maxilla has a large paranasal maxillary
sinus. These are the largest of all the paranasal sinuses.
Palatine Bones
The palatine (PAL-ah-tyne) bones are behind, or posterior
to, the maxillae and form the posterior portion of the hard
palate.
Nasal Bones
The two nasal bones are small rectangular bones that form
the bridge of the nose.
Lacrimal Bones
The small, thin lacrimal (LACK-rih-mal) bones are located
in the medial walls of the orbits, between the ethmoid bone
and the maxilla. Each one has a small lacrimal groove that
is a pathway for a tube that carries tears from the eyes to
the nasal cavity.
Zygomatic Bones
The zygomatic (zye-goh-MAT-ik) bones, also called malar
bones, form the prominences of the cheeks.
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10
CHAPTER 1 Skeletal System
FRONTAL BONE
PARIETAL BONE
SPHENOID BONE
TEMPORAL BONE
NASAL BONE
ETHMOID BONE
LACRIMAL BONE
SPHENOID BONE
ZYGOMATIC BONE
VOMER BONE
MAXILLA
INFERIOR NASAL
CONCHA
MANDIBLE
Figure 1-4 Skull, anterior view.
PARIETAL BONE
FRONTAL BONE
SPHENOID BONE
NASAL BONE
LACRIMAL BONE
OCCIPITAL BONE
TEMPORAL BONE
ZYGOMATIC BONE
MAXILLA
External
auditory meatus
Mastoid process
MANDIBLE
Figure 1-5 Skull, lateral view.
Module_B_2622_Chapter 1_main.indd 10
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Inferior Nasal Conchae
The inferior nasal conchae (KONG-kee) are thin, curved
bones that are attached to the lateral walls of the nasal cavity
and project into the nasal cavity.
CHAPTER 1 Skeletal System
Cervical curve
Vomer
The thin, flat vomer (VOH-mer) is in the inferior portion
of the midline in the nasal cavity. It forms part of the nasal
septum.
Mandible
The mandible (MAN-dih-bul) is the lower jaw. It articulates
with the temporal bone to form the temporomandibular
(tem-por-oh-man-DIB-yoo-lar) joint.
C1 Cervical vertebrae
2
3
4
5
6
7
T1 Thoracic vertebrae
2
3
4
5
6
Thoracic curve
7
8
9
Auditory Ossicles
Three tiny bones form a chain in each middle ear cavity in
the temporal bone. These are the malleus, incus, and stapes.
These bones transmit sound waves from the tympanic
membrane, or eardrum, to the inner ear, where the sound
receptors are located.
10
11
12
L1 Lumbar vertebrae
2
Hyoid Bone
The hyoid bone is not really part of the skull, so it is
listed separately. It is a U-shaped bone in the neck, suspended under the mandible. It is unique because it is the
only bone in the body that does not articulate directly
with another bone. It functions as a base for the tongue
and as an attachment for several muscles associated with
swallowing.
Vertebral Column
The vertebral column extends from the skull to the pelvis
and contains 26 bones called vertebrae (singular, vertebra).
The bones are separated by pads of fibrocartilage called
intervertebral discs. The discs act as shock absorbers and
allow the column to bend. Normally there are four curvatures, illustrated in Figure 1-6, that increase the strength
and resilience of the column. They are named according
to the region in which they are located. The thoracic
and sacral curvatures are concave anteriorly and are
present at birth. The cervical curvature develops when an
infant begins to hold his or her head erect. The lumbar
curvature develops when an infant begins to stand and
walk. Both the cervical and lumbar curvatures are convex
anteriorly.
General Structure of Vertebrae
All vertebrae have a common structural pattern, illustrated
in Figure 1-7, although there are variations among them.
The thick anterior, weight-bearing portion is the body or
centrum. The posterior curved portion is the vertebral arch.
The vertebral arch and body surround a central large
opening, the vertebral foramen. When all the vertebrae are
stacked together in a column, the vertebral foramina make
a canal that contains the spinal cord. Transverse processes
project laterally from the vertebral arch, and in the posterior
Module_B_2622_Chapter 1_main.indd 11
11
Lumbar curve
3
4
5
Sacrum
Sacral curve
Coccygeal vertebrae
Figure 1-6 Curvatures of the vertebral column. The thoracic and
sacral curvatures are concave anteriorly, and the cervical and lumbar
curvatures are convex anteriorly.
Body (centrum)
Vertebral foramen
Transverse process
Vertebral arch
Spinous process
Figure 1-7 General features of vertebrae, viewed from above.
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12
CHAPTER 1 Skeletal System
1st thoracic vertebra (T1)
1
2
3
Jugular notch
TRUE
RIBS
4
Figure 1-8 Thoracic cage.
STERNUM
5
6
7
8
9
Costal cartilage
12th
midline there is a spinous process. These processes are places
for muscle attachment. The spinous processes can be felt as
bony projections along the midline of the back.
Composition of the Vertebral Column
The seven cervical vertebrae are designated C1 through C7.
The 12 thoracic vertebrae are designated T1 through T12.
Five lumbar vertebrae, designated L1 through L5, make up
the part of the vertebral column in the small of the back.
The lumbar vertebrae have large, heavy bodies because they
support most of the body weight and have many back
muscles attached to them.
The sacrum is a triangular bone just below the lumbar
vertebrae. In the child there are five separate bones, but
these fuse to form a single bone in the adult. The sacrum
articulates with the pelvic girdle laterally, at the sacroiliac
(say-kro-ILL-ee-ak) joint, and forms the posterior wall of
the pelvic cavity.
The coccyx (KOK-siks), or tailbone, is the last part of the
vertebral column (see Figure 1-8). A child has four (the
number varies from three to five) separate small bones, but
these fuse to form a single bone in the adult.
Thoracic Cage
The thoracic cage, or bony thorax, protects the heart, lungs,
and great vessels. It also supports the bones of the shoulder
girdle and plays a role in breathing. The components of the
thoracic cage are the thoracic vertebrae dorsally, the ribs
laterally, and the sternum and costal cartilage anteriorly.
Sternum
The sternum, or breastbone, is in the anterior midline
(Figure 1-8). An important anatomic landmark, the jugular
(suprasternal) notch is an easily palpable, central indentation
Module_B_2622_Chapter 1_main.indd 12
thoracic vertebra (T12)
10
12
FALSE
RIBS
11
in the superior margin of the sternum. The superior portion
of the sternum articulates with the clavicles and the first two
pairs of ribs. The body of the sternum has notches along
the sides where it attaches to the cartilage of the third
through seventh ribs.
Ribs
Twelve pairs of ribs, illustrated in Figure 1-8, form the
curved, lateral margins of the thoracic cage. One pair is
attached to each of the 12 thoracic vertebrae. The upper
seven pairs of ribs are called true, or vertebrosternal (verTEE-broh-stir-nal), ribs because they attach to the sternum
directly by their individual costal cartilage. The lower five
pairs of ribs are called false ribs because their costal cartilage
does not reach the sternum directly. The first three pairs of
false ribs reach the sternum indirectly by joining with the
cartilage of the ribs above. These are called vertebrochondral
(ver-TEE-broh-kahn-dral) ribs. The bottom two rib pairs
have no anterior attachment and are called vertebral ribs or
floating ribs.
BONES OF THE APPENDICULAR
SKELETON
The 126 bones of the appendicular skeleton are suspended
from two yokes or girdles that are anchored to the axial
skeleton. They are additions or appendages to the axis of
the body. The appendicular skeleton is designed for movement. If a portion is immobilized for a period of time, life
without appendicular movement can be awkward.
Pectoral Girdle
Each half of the pectoral girdle, or shoulder girdle, consists of
two bones: an anterior clavicle (KLAV-ih-kul) and a
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CHAPTER 1 Skeletal System
13
CLAVICLE
Acromion process
of scapula
CLAVICLE (right, superior view)
Acromion process
HUMERUS
Glenoid
cavity (fossa)
Glenoid
cavity
SCAPULA
SCAPULA (right, posterior view)
Figure 1-9 Components of the pectoral girdle: clavicle and scapula.
posterior scapula (SKAP-yoo-lah). The bones of the pectoral
girdle, illustrated in Figure 1-9, form the connection
between the upper extremities and the axial skeleton. The
clavicles and scapulae, with their associated muscles, also
form the shoulder.
The clavicle is commonly called the collarbone. It is an
elongated, S-shaped bone that articulates proximally with
the manubrium of the sternum. The distal end articulates
with the scapula.
The scapula, commonly called the shoulder blade, is a
thin, flat triangular bone on the posterior surface of the
thoracic wall. It articulates with the clavicle and the
humerus. The acromion process of the scapula forms the
point of the shoulder. On the lateral margin of the scapula
there is a shallow depression, the glenoid cavity (fossa),
where the head of the humerus connects to the scapula.
The clavicle and scapula provide attachments for numerous muscles.
Head
Upper Extremity
The upper extremity (limb) consists of the bones of the arm,
forearm, and hand.
Arm
The arm, or brachium, is the region between the shoulder
and the elbow. It contains a single long bone, the humerus,
illustrated in Figure 1-10. The head is the large, smooth,
rounded end that fits into the scapula. The deltoid muscle
attaches to the humerus along the shaft of the humerus. At
the distal end, on the posterior surface, there is a depression,
the olecranon fossa, where the ulna fits with the humerus to
form the hinged elbow joint. Two smooth, rounded projections are evident on the distal end of the humerus. The
capitulum is on the lateral side and articulates with the
Module_B_2622_Chapter 1_main.indd 13
Olecranon
fossa
Capitulum
A
Trochlea
B
Trochlea
Figure 1-10 Humerus. A, Anterior view. B, Posterior view.
radius of the forearm. The trochlea is on the medial side
and articulates with the ulna of the forearm.
Forearm
The forearm is the region between the elbow and wrist. It
is formed by the radius on the lateral side and the ulna on
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14
CHAPTER 1 Skeletal System
Olecranon
process
Trochlear notch
ULNA
RADIUS
Head
of radius
CARPALS
Proximal
phalanx
of thumb
RADIUS
1
2
3
4
5
METACARPALS
ULNA
Distal
phalanx
of thumb
Proximal phalanx
PHALANGES
Middle phalanx
Styloid
process
Head
of ulna
Styloid
process
Figure 1-11 Radius and ulna, anterior view. The radius is on the
lateral side, and the ulna is the medial bone.
the medial side when the forearm is in anatomic position.
When the hand is turned so that the palm faces backward,
the radius crosses over the ulna. The radius and ulna are
illustrated in Figure 1-11.
The radius has a circular, disclike head on the proximal
end. This articulates with the capitulum of the humerus.
On the distal end, the prominent marking is the styloid
process, a pointed projection on the lateral side.
The proximal end of the ulna has a wrenchlike shape,
with the opening of the wrench being the trochlear notch,
or semilunar notch. The projection at the upper end of the
notch is the olecranon process, which fits into the olecranon
fossa of the humerus and forms the bony point of the elbow.
The head is at the distal end, and on the medial side of the
head the pointed styloid process serves as an attachment point
for ligaments of the wrist.
Hand
The hand, illustrated in Figure 1-12, is composed of the
wrist, palm, and five fingers. The wrist, or carpus, contains
eight small carpal bones, tightly bound by ligaments. The
palm of the hand, or metacarpus, contains five metacarpal
bones, one in line with each finger. These bones are not
named but are numbered one through five starting on the
thumb side. The 14 bones of the fingers are called phalanges
(fah-LAN-jeez). Some people refer to these as digits. Three
phalanges are in each finger (a proximal, middle, and distal
phalanx) except the thumb, or pollex, which has two. The
thumb lacks a middle phalanx. The proximal phalanges
articulate with the metacarpals.
Module_B_2622_Chapter 1_main.indd 14
Distal phalanx
Hand (right, palmar aspect)
Figure 1-12 Hand. The carpals form the wrist, the metacarpals form
the palm, and the phalanges form the fingers.
Pelvic Girdle
The pelvic girdle, or hip girdle, attaches the lower extremities
to the axial skeleton and provides a strong support for the
weight of the body. It also provides support and protection
for the urinary bladder, a portion of the large intestine, and
the internal reproductive organs, which are located in the
pelvic cavity.
The pelvic girdle consists of two coxal (hip) bones, illustrated in Figure 1-13. The coxal bones are also called the
ossa coxae, or innominate bones. Anteriorly, the two bones
articulate with each other at the symphysis pubis; posteriorly,
they articulate with the sacrum at the iliosacral joints.
During childhood, each coxal bone consists of three separate parts: the ilium, ischium, and pubis. In the adult, these
bones are firmly fused to form a single bone. Where the
three bones meet, there is a large depression, the acetabulum
(as-seh-TAB-yoo-lum), which holds the head of the femur.
The obturator foramen is a large opening between the pubis
and ischium that functions as a passageway for blood vessels,
nerves, and muscle tendons.
Together, the sacrum, coccyx, and pelvic girdle form the
basin-shaped pelvis. The false pelvis (greater pelvis) is surrounded by the flared portions of the ilium bones and the
lumbar vertebrae. The true pelvis (lesser pelvis) is smaller
and inferior to the false pelvis. It is the region below the
pelvic brim, or pelvic inlet, and it is encircled by bone. The
large opening at the bottom of this region is the pelvic outlet.
The dimensions of the true pelvis are especially important
in childbirth.
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CHAPTER 1 Skeletal System
15
Iliosacral articulation
ILIUM
Acetabulum
Acetabulum
PUBIS
Obturator foramen
ISCHIUM
Pubic symphysis
PELVIC GIRDLE (anterior view)
OS COXAE (right, lateral view)
Figure 1-13 Bones of the pelvic girdle. The right and left ossa coxae form the pelvic girdle. Posteriorly, the two bones are separated by the sacrum.
Anteriorly, they meet at the symphysis pubis.
Lower Extremity
The lower extremity (limb) consists of the bones of the
thigh, leg, foot, and patella, or kneecap. The lower extremities support the entire weight of the body when we are erect,
and they are exposed to tremendous forces when we walk,
run, and jump. With this in mind, it is not surprising that
the bones of the lower extremity are larger and stronger than
those in the upper extremity.
Thigh
The thigh is the region from the hip to the knee. It contains
a single long bone, the femur, illustrated in Figure 1-14. It
is the largest, longest, and strongest bone in the body.
The large, smooth, ball-like head of the femur has a small
depression called the fovea capitis. A ligament attaches here.
Prominent projections at the proximal end, the greater and
lesser trochanters, are major sites for muscle attachment. The
neck is between the head and the trochanters. The distal end
is marked by two large, rounded surfaces, the lateral and
medial condyles. These form joints with the bones of the leg.
The intercondylar notch is a depression between the condyles
that contains ligaments associated with the knee joint. On
the anterior surface, between the condyles, a smooth patellar
surface marks the area for the kneecap.
Leg
The leg is the region between the knee and the ankle. It is
formed by the slender fibula (FIB-yoo-lah) on the lateral
side and the larger, weight-bearing tibia (TIB-ee-ah), or
shin bone, on the medial side. The tibia articulates with the
femur to form the knee joint and with the talus (one of the
foot bones) to allow flexion and extension at the ankle.
Module_B_2622_Chapter 1_main.indd 15
Neck
Greater
trochanter
Head
Fovea capitis
Lesser
trochanter
Intercondylar
notch
Patellar
surface
Lateral condyle
PATELLA
Medial condyle
FEMUR and PATELLA (right)
Figure 1-14 Femur and patella (right). A, Anterior view. B, Posterior
view.
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16
CHAPTER 1 Skeletal System
The proximal end of the fibula is the head, and the projection at the distal end is the lateral malleolus, which forms
the lateral bulge of the ankle. The superior surface of the
tibia is flattened and smooth, with two slightly concave
regions called the lateral and medial condyles. The condyles
of the femur fit into these regions. The anterior crest is a
sharp ridge on the anterior surface and forms the shin. On
the medial side of the distal end, the medial malleolus forms
the medial bulge of the ankle. Figure 1-15 illustrates the
tibia and fibula.
Foot
The foot, illustrated in Figure 1-16, is composed of the
ankle, instep, and five toes. The ankle, or tarsus, contains
seven tarsal bones. These correspond to the carpals in the
wrist. The largest tarsal bone is the calcaneus (kal-KAY-neeus), or heel bone. The talus, another tarsal bone, rests on
top of the calcaneus and articulates with the tibia. The
instep of the foot, or metatarsus, contains five metatarsal
bones, one in line with each toe. The distal ends of these
bones form the ball of the foot. These bones are not named
but are numbered one through five starting on the medial
side. The tarsals and metatarsals, together with strong
tendons and ligaments, form the arches of the foot. The 14
bones of the toes are called phalanges. Three phalanges are
in each toe (a proximal, middle, and distal phalanx), except
in the great (or big) toe, or hallux, which has only two. The
great toe lacks a middle phalanx. The proximal phalanges
articulate with the metatarsals.
Patella
The patella, or kneecap, is a flat, triangular bone enclosed
within the major tendon that anchors the anterior thigh
muscle to the tibia. It provides a smooth surface for the
tendon as it turns the corner between the thigh and leg
when the knee is flexed. It also protects the knee joint
anteriorly.
Lateral condyle
Medial condyle
Head
FIBULA
TIBIA
Anterior crest
Medial malleolus
Lateral malleolus
Anterior view (right)
Figure 1-15 Tibia and fibula, anterior view (right). The fibula is on the
lateral side of the leg, and the tibia is on the medial side.
Calcaneus
Tarsals
Talus
5
Metatarsals
Phalanges
A
4
Proximal
Middle
Distal
Talus
3
2
1
Distal
phalanx
Proximal
phalanx
First
metatarsal
Calcaneus
B
Figure 1-16 Bones of the foot. A, Superior view. B, Lateral view.
Module_B_2622_Chapter 1_main.indd 16
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CHAPTER 1 Skeletal System
17
LIGAMENTS AND BURSAE
Ligaments are strong bands of white fibrous connective tissue that connect one bone to
another at the joints.
Bursae are the sacs that appear in some synovial joints with the function of providing
additional cushioning. The sacs are lined with a synovial membrane and filled with synovial
fluid, a clear, viscous lubricating liquid. The term synovial is derived from its similar appearance to egg white.
The names of the bursae and ligaments echo the names of their associated bones and
joints. If you have been working in sequence, the combining forms should help you recognize
the location of many of these structures.
ligament = ligament/o,
syndesm/o
bursa = burs/o
synovial = synovi/o
GUIDELINE ALERT
NOTE
B4.3 Bilateral body part values are available for a limited number of body parts. If the identical
procedure is performed on the contralateral body parts, and a bilateral body part value exists for that
body part, a single procedure is coded using the bilateral body part value. If no bilateral body part
value exists, code each procedure separately using the appropriate body part value.
While most ligaments connect bones around a joint, there are other ligaments that are not the
expected elastic bands of connective tissue. Instead, these ligaments are folds of peritoneal
tissue (the lining of the abdominopelvic cavity) that hold the abdominopelvic cavity viscera
(organs) in place. These are not considered organs of the musculoskeletal system, but are
referenced in the digestive and urogenital systems.
Diarthroses
Most joints in the adult body are diarthroses (dye-ahr-THROH-seez) or freely movable
joints. The singular form is diarthrosis. In this type of joint, the ends of the opposing bones
are covered with hyaline cartilage, the articular cartilage, and they are separated by a space
called the joint cavity. The components of the joints are enclosed in a dense fibrous joint
capsule (Figure 1-17).
The outer layer of the capsule consists of the ligaments that hold the bones together. The
inner layer is the synovial membrane, which secretes synovial fluid into the joint cavity for
lubrication. Because all of these joints have a synovial membrane, they are sometimes called
synovial joints.
Synovial
membrane
Articular
cartilage
Joint cavity
filled with
synovial fluid
Module_B_2622_Chapter 1_main.indd 17
Ligaments
Figure 1-17 Generalized structure of a synovial joint.
Fibrous joint
capsule
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18
CHAPTER 1 Skeletal System
Some diarthroses have pads and cushions associated with them. The knee has fibrocartilaginous pads, called semilunar cartilages or the lateral meniscus (meh-NIS-kus) and medial
meniscus, which rest on the lateral and medial condyles of the tibia. The pads help stabilize
the joint and act as shock absorbers. Bursae are fluid-filled sacs that act as cushions and help
reduce friction. Bursae are lined with a synovial membrane that secretes synovial fluid into
the sac. They are commonly located between the skin and underlying bone or between
tendons and ligaments. Inflammation of a bursa is called bursitis.
There are six types of diarthrotic or freely movable joints based on the shapes of their parts
and the types of movement they allow. These are described and illustrated in Figure 1-18.
Pivot joint
Rounded or conical
surface of one bone
fits into ring of bone
or tendon. Permits
rotation. Examples
are the joint between
atlas and axis and
the proximal
radioulnar joint.
Ball and socket joint
Ball shaped end of
one bone fits into cupshaped socket of
another. Permits the
widest range of
movement in all planes,
including rotation.
Examples are
shoulder and hip.
Saddle joint
Articulating surfaces
of both bones have
concave and convex
regions; shapes of two
bones complement
each other. Permits
wide range of
movement. The carpometacarpal joint of
thumb is the only
saddle joint in the body.
Hinge joint
Convex projection
of one bone fits into
concave depression
in another. Permits
flexion and extension
only. Examples are the
elbow and knee joints.
Condyloid (ellipsoidal) joint
Oval-shaped condyle fits into
elliptical cavity of another.
Permits angular motion but not
rotation. Examples are the
occipital condyles with atlas;
metacarpals and metatarsals
with phalanges.
Gliding joint
Flat or slightly curved
surfaces moving against
each other. Permits sliding
or twisting without circular
movement. Examples are
joints between carpals in
wrist and between tarsals
in ankle.
Figure 1-18 Types of freely movable joints.
Module_B_2622_Chapter 1_main.indd 18
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CHAPTER 1 Skeletal System
AGING OF THE SKELETAL SYSTEM
The major age-related change in the skeletal system is the
loss of calcium from the bones. Calcium loss occurs in
both men and women, but it starts at an earlier age and
is more severe in women. The exact reasons for the loss
are unknown and possibly involve a combination of
several factors. These may include an imbalance between
osteoblast and osteoclast activity, imbalance between calcitonin and parathormone levels, reduced absorption of
calcium and/or vitamin D from the digestive tract, poor
diet, and lack of exercise. Whatever the cause, there is no
sure way of preventing the loss, but adequate calcium and
vitamin D in the diet may help reduce the effects.
Another change with age is a decrease in the rate of collagen synthesis. This means that the bones have less strength
19
and are more brittle. Bones fracture more readily in elderly
individuals, and the healing process may be slow or incomplete. Tendons and ligaments become less flexible because
of the changes in collagen.
The articular cartilage at the ends of bones tends to
become thinner and deteriorates with age. This causes joint
disorders that are commonly found in older individuals.
People also appear to get shorter as they get older. This is
caused partially by loss of bone mass and partially by compression of the intervertebral discs.
Age-related changes in the skeletal system cannot be
prevented. An active and healthy lifestyle with appropriate
exercise and an adequate diet help reduce the effect of the
changes in the skeletal system.
Highlight on Conditions Affecting the Skeletal System
Ankylosing spondylitis (ANG-kih-loh-sing spahn-dih-LYE-tis)
Inflammation of the spine that is characterized by stiffening of
the spinal joints and ligaments so that movement becomes
increasingly painful and difficult; also called rheumatoid
spondylitis
Arthritis (ahr-THRYE-tis) Inflammation of a joint
Bunion (BUN-yun) Abnormal swelling of the joint between the big
toe and the first metatarsal bone, resulting from a buildup of
soft tissues and bone caused by chronic irritation from ill-fitting
shoes
Carpal tunnel syndrome (KAHR-pull TUH-nul SIN-drohm) Condition characterized by pain and burning sensations in the fingers
and hand, caused by compression of the median nerve as it
passes between a wrist ligament and the bones and tendons
of the wrist
Dislocation (dis-loh-KAY-shun) Displacement of a bone from its
joint with tearing of ligaments, tendons, and articular capsule;
also called luxation
Gout (GOWT) A form of acute arthritis in which uric acid crystals
develop within a joint and irritate the cartilage, causing acute
inflammation, swelling, and pain; most commonly occurs in
middle-aged and older men
Lyme disease (LYME dih-ZEEZ) A bacterial disease transmitted
to humans by deer ticks; characterized by joint stiffness, headache, fever and chills, nausea, and back pain; complications
include severe arthritis and cardiac problems; early stages of
the disease respond well to antibiotics
Osteoarthritis (ahs-tee-oh-ahr-THRYE-tis) A noninflammatory
disease of the joints that is characterized by degeneration of
the articular cartilage and changes in the synovial membrane;
also called degenerative joint disease (DJD)
Module_B_2622_Chapter 1_main.indd 19
Osteomalacia (ahs-tee-oh-mah-LAY-shee-ah) Softening of bone
because of inadequate amounts of calcium and phosphorus;
bones bend easily and become deformed; in childhood this is
called rickets
Osteomyelitis (ahs-tee-oh-my-eh-LYE-tis) Inflammation of the
bone marrow caused by bacteria
Osteoporosis (ahs-tee-oh-por-OH-sis) Decrease in bone density
and mass; commonly occurs in postmenopausal women as a
result of increased osteoclast activity caused by diminished
estrogen levels; bones fracture easily
Osteosarcoma (ahs-tee-oh-sahr-KOH-mah) Malignant tumor
derived from bone; also called osteogenic sarcoma; osteoblasts
multiply without control and form large tumors in bone
Rheumatoid arthritis (ROO-mah-toyd ahr-THRYE-tis) A chronic
systemic disease with changes occurring in the connective
tissues of the body, especially the joints; in contrast to osteoarthritis, the symptoms are usually more generalized and
severe; evidence indicates it may be an autoimmune
disease
Spina bifida (SPY-nah BIFF-ih-dah) A developmental anomaly in
which the vertebral laminae do not close around the spinal
cord, leaving an opening through which the cord and meninges
may or may not protrude
Sprain (SPRAYN) Twisting of a joint with pain, swelling, and injury
to ligaments, tendons, muscles, blood vessels, and nerves;
most often occurs in the ankle; more serious than a strain,
which is the overstretching of the muscles associated with a
joint
Talipes (TAL-ih-peez) Congenital deformity of the foot in which
the patient cannot stand with the sole of the foot flat on the
ground; also called clubfoot n
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20
CHAPTER 1 Skeletal System
Combining Forms for the Anatomy of the Musculoskeletal System
Meaning
Combining Form
Meaning
Combining Form
acromion
bone marrow
bone
bursa
calcaneus (heel bone)
carpus (wrist)
cartilage
chin
clavicle (collarbone)
coccyx (tailbone)
condyle
elbow (olecranon)
epicondyle
ethmoid
femur (thigh bone)
fibula (lower lateral leg
bone)
finger, toe (whole), digitus
foramen
frontal bone
glenoid
hallux
humerus (upper arm
bone)
ilium
ischium
jaw (entire)
joint (articulation)
lacrima
lamina
ligament
lower back
mandible (lower jaw bone)
maxilla (upper jaw bone)
meniscus
acromi/o
myel/o
oste/o, osse/o, oss/i
burs/o
calcane/o
carp/o
chondr/o, cartilag/o
ment/o, geni/o
clavicul/o, cleid/o
coccyg/o
condyl/o
olecran/o
epicondyl/o
ethmoid/o
femor/o
fibul/o, perone/o
metacarpus (hand bone)
metatarsus (foot bone)
muscle
neck
occiput
olecranon
palatine bone
parietal bone
patella (kneecap)
pelvis
phalanx (one of the bones
of the fingers or toes)
pubis (pubic bone)
radius (lower lateral arm
bone)
rib (costa)
sacrum
scapula (shoulder blade)
sinus
skeleton
skull (cranium)
sphenoid
spinal column, spine
sternum, breastbone
tarsus (anklebone)
temporal bone
tendon
metacarp/o
metatars/o
my/o, myos/o, muscul/o
cervic/o
occipit/o
olecran/o
palat/o
pariet/o
patell/o, patell/a
pelv/i, pelv/o
phalang/o
dactyl/o, digit/o
foramin/o
front/o
glen/o
halluc/o
humer/o
ili/o
ischi/o
gnath/o
arthr/o, articul/o
lacrim/o
lamin/o
ligament/o, syndesm/o
lumb/o
mandibul/o
maxill/o
menisc/o
thorax (chest)
tibia (shinbone)
ulna
vertebra (backbone)
vomer
xiphoid process
zygoma (cheekbone)
pub/o
radi/o
cost/o
sacr/o
scapul/o
sin/o, sinus/o, antr/o
skelet/o
crani/o
sphenoid/o
spin/o, rachi/o, vertebr/o
stern/o
tars/o
tempor/o
tendin/o, tendon/o, ten/o,
tend/o
thorac/o
tibi/o
uln/o
vertebr/o, spondyl/o
vomer/o
xiph/o
zygomat/o
Prefixes for the Anatomy of the Musculoskeletal System
Prefix
Meaning
Prefix
Meaning
amphidiaendo-, endepi-
both
through, complete
within
above, upon
interintraperisyn-
between
within
surrounding, around
together, joined
Suffixes for the Anatomy of the Musculoskeletal System
Suffixes
Meaning
Suffixes
Meaning
-ar, -al, -ic, -ous, -eal
-blast
-clast
-cyte
-genesis
pertaining to
embryonic
breaking down
cell
production, origin
-oid
-physis
-poiesis
-sis
-um
resembling, like
growth
formation
condition
structure
Module_B_2622_Chapter 1_main.indd 20
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CHAPTER 1 Skeletal System
21
KOLDMANN, DYLAN M. - 507940 Opened by Bradley Oppenheimer, MD
Task
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As Of 16:10
Age: 7 years
DOB: 1/27/2004
KOLDMANN, DYLAN M.
Reference Text Browser
Orders
Last 48 Hours
Form Browser
ED
Lab
ED Record
Loc: ARH
FIN: 3506004
Medication Profile
Radiology
Assessments
…
Flowsheet: ED
Navigator
Sex: Male
MRN: 507940
Surgery
Clinical Notes
Level: ED Record
Pt. Info
Pt. Schedule
Table
Task List
Group
I & O MAR
List
7-year-old sustained injury to right hand when fell off bike. Pain over thenar eminence. Able to
bend at his wrist and flex at his DIP and PIP joints and every digit of the hand with exception of
first digit.
Exam of right hand is significant for mild protrusion but no ecchymosis and minimal edema
overlying thenar eminence of the right hand. Good wrist mobility. X-ray significant for what
appears to be a Salter-Harris fracture of the first metacarpal. Immobile and follow-up tomorrow
with Ortho for possible cast.
o
o,
PROD MAHAFC
26 March 2011
16:10
EXERCISE 2: Emergency Room Report
Use the emergency room record above to answer the following questions.
1. Dylan’s injury is to the fleshy area of the palm near the thumb, the “thenar eminence.” Explain the difference between a DIP
(distal interphalangeal joint) and a PIP (proximal interphalangeal) joint.
und
2. Not being able to “flex” a body part means one is unable to .
3. “First digit, R hand” means .
4. The first metacarpal is a bone of the .
like
Module_B_2622_Chapter 1_main.indd 21
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22
CHAPTER 1 Skeletal System
Figure 1-20 Syndactyly.
Figure 1-19 Polydactyly.
PATHOLOGY
TERMINOLOGY REVIEW
Terms Related to Congenital Conditions (QØØ-Q99)
Term
Word Origin
Definition
achondroplasia
a- no, not, without
chondr/o cartilage
-plasia condition of formation
poly- many, much
dactyl/o fingers, toes
-y process of
spin/o spine
bi- two
-fida to split
occulta hidden
syn- joined, together
dactyl/o fingers, toes
-y process of
Disorder of the development of cartilage at the epiphyses of
the long bones and skull, resulting in dwarfism.
polydactyly
spina bifida occulta
syndactyly
Condition of more than five fingers or toes on each hand or
foot (Figure 1-19).
Congenital malformation of the bony spinal canal without
involvement of the spinal cord.
Condition of the joining of the fingers or toes, giving them a
webbed appearance (Figure 1-20).
EXERCISE 3: Congenital Disorders
Build the terms.
1. Process of joined fingers/toes 2. Condition of formation without cartilage 3. Process of many fingers/toes Module_B_2622_Chapter 1_main.indd 22
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CHAPTER 1 Skeletal System
23
TERMINOLOGY REVIEW
Terms Related to Arthropathies (MØØ-M25) and Dentofacial Anomalies (M26-M27)
Term
Word Origin
Definition
arthrosis
arthr/o joint
-osis abnormal condition
bunion/o bunion
Abnormal condition of a joint; may be hemarthrosis, hydrarthrosis, or
pyarthrosis (blood, fluid, or pus respectively, in a joint cavity).
Fairly common, painful enlargement and inflammation of the first
metatarsophalangeal joint (the base of the great toe). Also called
hallux valgus.
Chronic fixation of a joint in flexion (such as a finger) caused by
atrophy and shortening of muscle fibers after a long period of
disuse.
Crackling sound heard in joints.
bunion
contracture
con- together
tract/o pulling
-ure condition
crepit/o crackling
-us thing
crepitus
gout
osteoarthritis (OA)
oste/o bone
arthr/o joint
-itis inflammation
osteophytosis
oste/o bone
phyt/o growth, nature
-osis abnormal condition
rheumat/o watery flow
-oid resembling, like
arthr/o joint
-itis inflammation
tempor/o temporal bone
mandibul/o lower jaw
-ar pertaining to
rheumatoid arthritis (RA)
temporomandibular joint
disorder (TMJ)
Type of arthritis due to excessive uric acid that causes crystals to
form. The joints then become swollen and inflamed.
Joint disease characterized by degenerative articular cartilage and a
wearing down of the bones’ edges at a joint; considered a “wear
and tear” disorder. Also called degenerative joint disease (DJD)
(Figure 1-21).
Abnormal bone growth in a joint. Bouchard nodes are osteophytes of
the proximal interphalangeal joints in rheumatoid arthritis (Figure
1-22).
Inflammatory joint disease believed to be autoimmune in nature;
occurs in a much younger population (ages 20 to 45) than OA (see
Figure 1-22). Diagnosed with a rheumatoid factor test.
Dysfunctional temporomandibular joint, accompanied by gnathalgia
(jaw pain).
Cervical vertebrae
Lower lumbar vertebrae
Hip
First carpometacarpal
Distal interphalangeal
Knee
First metatarsophalangeal
A
Figure 1-21 Joints most frequently involved in
osteoarthritis.
Module_B_2622_Chapter 1_main.indd 23
B
Figure 1-22 A, Bouchard’s nodes seen in rheumatoid arthritis of the hands. Moderate involvement. B, Arthrogram of wrist showing RA and resultant osteophytosis.
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24
CHAPTER 1 Skeletal System
TERMINOLOGY REVIEW
Terms Related to Systemic Connective Tissue Disorders (M3Ø-M36) and Deforming Dorsopathies (M4Ø-M54)
Term
Word Origin
Definition
ankylosing spondylitis
ankyl/o stiffening
spondyl/o vertebra
-itis inflammation
inter- between
vertebr/o vertebra
-al pertaining to
kyph/o round back
-osis abnormal condition
lord/o swayback
-osis abnormal condition
Chronic inflammatory disease of idiopathic origin,
which causes a fusion of the spine.
herniated intervertebral disk
kyphosis
lordosis
sciatica
scoliosis
scoli/o curvature
-osis abnormal condition
spinal stenosis
spin/o spine
-al pertaining to
stenosis abnormal condition of narrowing
spondyl/o vertebra
-listhesis slipping
spondylolisthesis
spondylosis
A
spondyl/o vertebra
-osis abnormal condition
B
Protrusion of the central part of the disk that lies
between the vertebrae, resulting in compression
of the nerve root and pain.
Extreme posterior curvature of the thoracic area of
the spine (Figure 1-23, A).
Swayback; exaggerated anterior curve of the
lumbar vertebrae (lower back) (Figure 1-23, B ).
Inflammation of the sciatic nerve. Symptoms
include pain and tenderness along the path of
the nerve through the thigh and leg.
Lateral S curve of the spine that can cause an
individual to lose inches in height (Figure
1-23, C ).
Abnormal condition of narrowing of the spinal
canal with attendant pain, sometimes caused by
osteoarthritis or spondylolisthesis (Figure 1-24).
Condition resulting from the partial forward
dislocation of one vertebra over the one
beneath it.
An abnormal condition characterized by stiffening
of the vertebral joints.
C
Vertebral body
Spinal nerves
Transverse
process
Spinal cord
Kyphosis
Lordosis
Scoliosis
Figure 1-23 A, Kyphosis, B, Lordosis, C, Scoliosis.
Module_B_2622_Chapter 1_main.indd 24
Spinous process
Lamina
Figure 1-24 Spinal stenosis. Bony overgrowth has narrowed
the spinal canal and pinched the spinal nerves.
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CHAPTER 1 Skeletal System
25
EXERCISE 4: Arthropathies and Dentofacial Anomalies; Systemic Connective Tissue Disorders
and Dorsopathies
Fill in the blanks using the terms from the list below.
rheumatoid arthritis, crepitus, bunion, TMJ, osteophytosis, ankylosing spondylitis, spinal stenosis, herniated intervertebral
disk, contracture, lordosis, arthrosis, gout
1. An abnormal condition of a joint is called .
2. A painful enlargement and inflammation of the great toe is .
3. Chronic fixation of a joint in flexion is called .
4. _______________ is a crackling sound heard in joints.
5. A type of arthritis due to excessive uric acid that causes crystals to form is .
6. Abnormal bone growth in a joint is called .
7. _______________ is an autoimmune inflammatory joint disease.
8. _______________ is a dysfunctional temporomandibular joint, accompanied by gnathalgia.
9. A chronic inflammatory disease that causes fusion of the spine .
10. A protrusion of the central part of the disk that lies between the vertebrae is called .
11. Another word for swayback is .
12. An abnormal, painful narrowing of the spinal canal is called .
Build the terms.
13. inflammation of a bone and joint 14. condition of slipping of the vertebrae 15. abnormal condition of vertebra 16. abnormal condition of curvature 17. abnormal condition of round back TERMINOLOGY REVIEW
Terms Related to Soft Tissue Disorders (M6Ø-M79)
Term
Word Origin
Definition
bursitis
burs/o bursa
-itis inflammation
Inflammation of a bursa.
Module_B_2622_Chapter 1_main.indd 25
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26
CHAPTER 1 Skeletal System
B
A
Figure 1-25 A, The hallmark of osteoporosis: the dowager hump. Affected persons lose height, have a bent spine, and appear to sink into their hips.
B, X-ray demonstrating a compression fracture of T12 and L1 subsequent to osteoporosis.
TERMINOLOGY REVIEW
Terms Related to Osteopathies and Chondropathies (M8Ø-M94)
Term
Word Origin
Definition
chondromalacia
chondr/o cartilage
-malacia softening
cost/o rib
chondr/o cartilage
-itis inflammation
oste/o bone
-itis inflammation
deformans misshapen
oste/o bone
-malacia softening
Softening of the cartilage.
costochondritis
osteitis deformans
osteomalacia
osteomyelitis
osteoporosis
oste/o bone
myel/o bone marrow
-itis inflammation
oste/o bone
por/o passage
-osis abnormal condition
Inflammation of the cartilage of the ribs.
Misshaped bone resulting from inflammation. Also known as Paget’s
disease of the bone.
Softening of bone caused by loss of minerals from the bony matrix as
a result of vitamin D deficiency. When osteomalacia occurs in
childhood, it is called rickets.
Inflammation of the bone and bone marrow.
Loss of bone mass, which results in the bones being fragile and at
risk for fractures (Figure 1-25). Osteopenia refers to a less severe
bone mass loss.
EXERCISE 5: Soft Tissue Disorders; Osteopathies and Chondropathies
Fill in the blanks using the terms from the list below.
bursitis, costochondritis, osteitis deformans, osteomalacia, osteomyelitis
1. Inflammation of the cartilage of the ribs is called .
2. Inflammation of a bursa is called .
3. Paget’s disease of the bone is also known as .
Module_B_2622_Chapter 1_main.indd 26
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CHAPTER 1 Skeletal System
4. Softening of the bone is called .
5. Inflammation of the bone and bone marrow is called .
27
Decode the terms.
6. chondromalacia 7. osteoporosis Trauma
Fractures
Put simply, a fracture (fx, #) is a broken bone. However, there are a number of types of
breaks, each with its own name. Most fractures occur as a result of trauma, but some can
result from an underlying disease, such as osteoporosis or cancer; these pathologic fractures
are also sometimes called spontaneous fractures. All fractures may be classified into simple
(closed) or compound (open) fractures. Fractures are additionally characterized as nondis­
placed fractures, meaning that the broken bones are still in alignment, or displaced frac­
tures, meaning that the ends of the fractured bones are not in alignment (Figure 1-26). The
break in a simple fracture does not rupture the skin, but a compound fracture splits open
the skin, which allows more opportunity for infection to take place. See the table in Terminology Review for different types of fractures.
Sprain/Strain and Dislocation/Subluxation
A sprain is a traumatic injury to a joint involving the ligaments. Swelling, pain, and discoloration of the skin may be present. The severity of the injury is measured in grades.
A bone that is completely out of its place in a joint is called a dislocation. If the bone
is partially out of the joint, it is considered to be a subluxation. This can be a congenital
or an acquired condition.
Non-displaced
fracture
Displaced
fracture
Figure 1-26 Nondisplaced and
displaced fractures.
GUIDELINE ALERT
19a. Code Extensions
Most categories in Chapter 19 have 7th character extensions that are required for each applicable
code. Most categories in this chapter have three extensions (with the exception of fractures): A, initial
encounter; D, subsequent encounter; and S, sequela.
Extension “A”, initial encounter is used while the patient is receiving active treatment for the injury.
Examples of active treatment are: surgical treatment, emergency department encounter, and evaluation and treatment by a new physician.
Extension “D” subsequent encounter is used for encounters after the patient has received active
treatment of the injury and is receiving routine care for the injury during the healing or recovery phase.
Examples of subsequent care are: cast change or removal, removal of external or internal fixation
device, medication adjustment, other aftercare and follow up visits following injury treatment.
The aftercare Z codes should not be used for aftercare for injuries. For aftercare of an injury, assign
the acute injury code with the 7th character “D” (subsequent encounter).
Extension “S”, sequela, is for use for complications or conditions that arise as a direct result of an
injury, such as scar formation after a burn. The scars are sequelae of the burn. When using extension
“S”, it is necessary to use both the injury code that precipitated the sequela and the code for the
sequela itself. The “S” is added only to the injury code, not the sequela code. The “S” extension
identifies the injury responsible for the sequela. The specific type of sequela (e.g. scar) is sequenced
first, followed by the injury code.
Module_B_2622_Chapter 1_main.indd 27
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28
CHAPTER 1 Skeletal System
GUIDELINE ALERT
Compression
NOTE
Comminuted
19.c. Coding of Traumatic Fractures
The principles of multiple coding of injuries should be followed in coding fractures. Fractures of specified sites are coded individually by site in accordance with both the provisions within specific categories
and the level of detail furnished by medical record content.
A fracture not indicated as open or closed should be coded to closed. A fracture not indicated
whether displaced or not displaced should be coded to displaced.
Colles’
Complicated
The Gastilo classification for open fractures is used to give more information about the type of
wound caused by the break. It includes information about the size of the wound, presence or
absence of contamination, and additional complications.
TERMINOLOGY REVIEW
Terms Related To Injury, Poisoning, and Certain Other Consequences of External
Causes (SØØ-T88)
Type
Impacted
Hairline
Greenstick
Salter-Harris
Avulsion fracture
Figure 1-27 Fractures.
A
Normal
B
Definition
FRACTURES (Figure 1-27)
avulsion
Part of the bone is pulled away by a tendon or ligament.
Colles’
Fracture at distal end of the radius at the epiphysis. Often occurs when
patient has attempted to break his/her fall.
comminuted
Bone is crushed and/or shattered into multiple pieces.
complicated
Bone is broken and pierces an internal organ.
compression
Fractured area of bone collapses on itself.
greenstick
Partially bent and partially broken. Relatively common in children.
hairline
Minor fracture appearing as a thin line on x-ray. May not extend through
bone.
impacted
Broken bones with ends driven into each other.
Salter-Harris
Fracture of epiphyseal plate in children.
torus
Compression injury in children in which the bone does not break, but
buckles because of its pliable nature. Also called a buckle fracture.
OTHER TRAUMA (Figures 1-28 and 1-29)
dislocation
Bone that is completely out of its joint socket.
subluxation
Partial dislocation.
sprain
Traumatic injury to ligaments of a joint, including tearing of a ligament.
Anterior
dislocation
C
Posterior
dislocation
Figure 1-28 Normal shoulder (A). Dislocated shoulder, anterior (B) and
posterior (C).
Module_B_2622_Chapter 1_main.indd 28
Sprain (ligament)
Figure 1-29 Sprain.
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CHAPTER 1 Skeletal System
29
EXERCISE 6: Fractures
Match the fractures with their definitions.
____
____
____
____
____
____
____
____
____
1. complicated
2. greenstick
3. Colles’
4. impacted
5. comminuted
6. simple/closed
7. compound/open
8. hairline
9. pathologic
A. broken bone pierces internal organ.
. broken bone pierces skin.
B
. spontaneous fracture as a result of disease.
C
. bone is partially bent and partially broken.
D
E. bone is broken, skin is closed.
F. distal end of radius is broken.
G. ends of broken bone are driven into each other.
. fracture appears as a line on the bone and fracture may not
H
be completely through bone.
I. bone is crushed.
EXERCISE 7: Other Trauma
1. A partial displacement of a bone at a joint is a _______________________________________________; full displacement
is a _______________________________________________________________________________________________________.
2. An injury that can be described in grades and involves the soft tissue of a joint is a
___________________________________________________________________________________________________________.
TERMINOLOGY REVIEW
Terms Related to Benign Neoplasms (D1Ø-D36)
Term
Word Origin
Definition
chondroma
chondr/o cartilage
-oma tumor
ex- out
oste/o bone
-osis abnormal condition
oste/o bone
-oma tumor
Benign tumor of the cartilage, usually occurring in children and
adolescents.
Abnormal condition of bony growth. Also called hyperostosis
and osteochondroma.
exostosis
osteoma
Benign bone tumor, usually of compact bone.
TERMINOLOGY REVIEW
Terms Related to Malignant Neoplasms (CØØ-C96)
Term
Word Origin
Definition
chondrosarcoma
chondr/o cartilage
-sarcoma connective tissue cancer
oste/o bone
-sarcoma connective tissue cancer
Malignant tumor of the cartilage. Occurs most
frequently in adults (Figure 1-30).
Malignant tumor of bone. Also called Ewing’s
sarcoma. Most common children’s bone cancer.
osteosarcoma
Figure 1-30 A, Chondrosarcoma of femur. B, X-ray
showing prominent dense calcification in a large neoplastic mass.
A
Module_B_2622_Chapter 1_main.indd 29
B
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30
CHAPTER 1 Skeletal System
EXERCISE 8: Neoplasms
Match the neoplasms with their definitions.
____ 1. osteosarcoma
____ 2. chondrosarcoma
A. connective tissue cancer of bone
B. connective tissue cancer of cartilage
Herold, Jean F - 12438 Opened by Landrey, Melissa, PA
Task
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As Of 09:19
Age: 54 years
DOB: 7/23/1957
Herold, Jean F
Reference Text Browser
Orders
Last 48 Hours
Form Browser
ED
Lab
History & Physical
Loc: AR-OC
FIN: 8425633
Medication Profile
Radiology Assessments Surgery
…
Flowsheet: Assessments
Navigator
Sex: Female
MRN: 12438
Clinical Notes
Pt. Info
Pt. Schedule
Table
Level: History & Physical
CHIEF COMPLAINT:
Task List
Group
List
Right shoulder pain/fracture
HISTORY OF PRESENT ILLNESS: Patient is a 54-year-old female who works as a healthcare worker. While out exercising last night, she fell on
her right shoulder. She has a comminuted fracture of the
proximal humerus involving the humeral head, extending
into the joint space. Admitted for observation and
analgesia. CT of shoulder reveals the need for a humeral
prosthesis. Some discomfort with deep inspiration.
Unclear whether this is in the shoulder or possible right
chest wall.
PAST MEDICAL HISTORY:
Cholecystectomy 1986. ORIF left forearm, fracture same
forearm, age 9. Has some dependent edema and takes
Lasix 80 mg daily for it. Does not wear compression
stockings as they make her feet feel cold. Also diagnosis
of fibromyalgia in 2008.
FAMILY HISTORY:
Mother died age 64 post surgical pulmonary embolus.
REVIEW OF SYSTEMS:
Negative.
PHYSICAL EXAM:
Pleasant, uncomfortable, overweight female appearing
her stated age and in no distress. HEENT normal, neck
supple, thyroid normal. No JVD, carotids normal. Lungs
decreased breath sounds at bases. Heart regular rate
and rhythm. Extremities: normal range of motion of lower
extremities. Motor sensory deep tendon reflexes are
normal in arm. Trace pretibial edema bilaterally without
venostasis changes. Excellent peripheral pulses. Cannot
adduct her arm and shoulder without pain. X-ray of
shoulder and CT show comminuted fracture.
ASSESSMENT:
Comminuted right proximal humeral fracture involving
humeral head.
PLAN:
Admit for analgesia, IV fluids. Has a little nausea
probably from analgesics. Won’t have surgery until
tomorrow. Preoperative labs, EKG, and chest x-ray will
be obtained before that time.
PROD MAHAFC
Module_B_2622_Chapter 1_main.indd 30
I & O MAR
22 Jan 2012
09:19
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CHAPTER 1 Skeletal System
31
Build the term.
3. Benign bone tumor 4. Benign tumor of cartilage 5. An abnormal condition of out(growth) of bone EXERCISE 9: Admission Record
Using the admission record above, answer the following questions:
1. Which bone did she break while exercising? Give the medical and English names. 2. Did she fracture the area closest to her shoulder or farther from her shoulder? Circle one.
3. Describe the type of fracture sustained. 4. What does “cannot adduct her arm and shoulder without pain” mean? NOTE
PROCEDURES
Be aware that many of the musculoskeletal procedural codes are dependent on the correct
identification of a left or right anatomical term. A little common sense (certainly there are left
and right kneecaps, but only one sacrum) and knowledge of the anatomy of that particular
system will help when checking one’s work.
GUIDELINE ALERT
B2.1b Body systems designated as upper or lower contain body parts located above or below the
diaphragm respectively.
Example: Joints are categorized as either upper or lower joints. The dividing line is the end of the
thoracic vertebrae (upper) and the beginning of the lumbar vertebrae (lower). The thoracolumbar joint
and disc are part of the upper body designation.
GUIDELINE ALERT
B4.1b If the prefix peri- is used with a body part to identify the procedure, the body part value is
defined as that body part.
Example: peripatellaplasty coded as a patellaplasty.
This is where you reap the benefits of learning the bone processes, as they are used within
the procedural part of coding to address specific parts of bones and name many muscles,
ligaments, and tendons. With the general terms for the bones, you’ll need to decide if it’s a
procedure on the head and facial bones, upper bones, or lower bones. With the more specific
terms, you’ll need to think back to where the bone is in the skeleton and how it would be
categorized.
BE CAREFUL! Geni/o means chin, while -gen means producing and gen/u means knee.
BE CAREFUL! Ment/o means both chin and mind.
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32
CHAPTER 1 Skeletal System
TERMINOLOGY REVIEW
Terms Related to Bone Procedures
Term
Word Origin
Definition
acetabuloplasty
acetabul/o acetabulum
-plasty surgically forming
alveoloplasty
alveol/o small cavity
-plasty surgically forming
Reconstruction of the acetabulum to correct hip dysplasia,
remove metastatic lesions, or as part of hip replacement
surgery.
Surgically shaping the alveolus of the jaw in preparation for
dentures.
Removal of a limb when there are no feasible options to save it.
Cutting off a bunion (Figure 1-31).
amputation
bunionectomy
carpectomy
chondrectomy
claviculectomy
condylotomy
costectomy
densitometry
discography
genioplasty
kyphoplasty
bunion/o bunion
-ectomy cutting out
carp/o carpus, wrist bone
-ectomy cutting out
chondr/o cartilage
-ectomy cutting out
clavicul/o collarbone, clavicle
-ectomy cutting out
condyl/o condyle
-tomy cutting
cost/o rib
-ectomy cutting out
densit/o density
-metry measuring
disc/o disc
-graphy recording
geni/o chin
-plasty surgically forming
kyph/o round back
-plasty surgically forming
Cutting off part or all of a wrist bone. A proximal row
carpectomy is done to reduce pain but maintain ROM.
Surgically cutting off part or all of a damaged cartilage.
Cutting off part or all of a collarbone. A partial (or distal)
claviculectomy is performed to reduce pain in the
acromioclavicular (AC) joint due to osteoarthritis.
Cutting a condyle, e.g., to treat TMJ.
Cutting out part or all of a rib. May be done as part of a
procedure to treat scoliosis.
Process of measuring bone density. An example is dual energy
x-ray absorptiometry (DEXA) (Figure 1-32).
X-ray recording of an intervertebral disc using a contrast
medium to establish a diagnosis for herniated discs.
Surgical formation to augment or reduce the size of the chin.
Also called mentoplasty.
Minimally invasive procedure designed to address the pain of
fractured vertebrae resulting from osteoporosis or cancer. A
balloon is used to inflate the area of fracture before a
cementlike substance is injected. The substance hardens
rapidly, and pain relief is immediate in most patients (Figure
1-33).
Medial eminence
of metatarsal bone
is removed
Figure 1-31 Bunionectomy.
Module_B_2622_Chapter 1_main.indd 32
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CHAPTER 1 Skeletal System
33
TERMINOLOGY REVIEW—cont’d
Terms Related to Bone Procedures
Term
Word Origin
Definition
mandibulectomy
mandibul/o mandible, lower jaw
-ectomy cutting out
metatars/o metatarsus, foot
bone
-ectomy cutting out
oste/o bone
-clasis breaking
patell/a kneecap, patella
-pexy fixation
sacr/o sacrum
-ectomy cutting out
scapul/o shoulder blade,
scapula
-pexy fixation
sequestr/o sequestrum
-ectomy cutting out
spondyl/o vertebra
syn- joined, together
-desis binding
stern/o breastbone, sternum
-tomy cutting
tars/o tarsus, ankle bone
-ectomy cutting out
Cutting off part or all of the lower jaw. May be done to treat
cancer of the jaw.
Cutting off part or all of a foot bone to surgically treat intractable
metatarsal pain.
metatarsectomy
osteoclasis
patellapexy
sacrectomy
scapulopexy
sequestrectomy
spondylosyndesis
sternotomy
tarsectomy
Surgical fracture of a bone to correct a malformation.
Fixing the kneecap to the femur to stabilize the joint.
Cutting off part or all of the sacrum usually to remove an
attached tumor.
Fixing the shoulder blade in place to treat a protruding shoulder
blade.
Cutting out a necrosed (dead) bone fragment to prevent or
correct possible complications.
Binding the vertebrae together to stabilize the spine. Also called
spinal fusion and spondylodesis.
Cutting the sternum to allow access to the heart and thoracic
cavity.
Cutting out one of the tarsal bones. May be done to correct an
abnormally high arch of the foot.
X-ray fan
beam
Linear
scan path
A
B
Figure 1-32 Dual energy x-ray absorptiometry (DEXA). A, DEXA system.
B, Scan of lumbar vertebrae.
Module_B_2622_Chapter 1_main.indd 33
Figure 1-33 Kyphoplasty.
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34
CHAPTER 1 Skeletal System
Setting Fractures
Broken bones must be “set”—that is, aligned and immobilized; the most common method
is with a plaster cast. If a bone does not mend and realign correctly, it is said to be a mal­
union. If no healing takes place, it is a nonunion. A piece of bone that does not have a
renewed blood supply will die; this tissue then is called a sequestrum. Removal of dirt,
damaged tissue, or foreign objects from a wound is one of the first steps in repairing an open
fracture. This removal of debris is called débridement. Methods of fixation and alignment
are described as follows:
External fixation: (EF) Noninvasive reposition and stabilization of broken bones in which
no opening is made in the skin; instead, the stabilization takes place mainly through
devices external to the body that offer traction (Figure 1-34, A).
Internal fixation: (IF) Reposition and stabilization of broken bones in their correct position,
using devices such as pins, screws, plates, and so on, which are fastened to the bones to
maintain correct alignment (Figure 1-34, B).
Reduction: Alignment and immobilization of the ends of a broken bone. Also called
manipulation. Open reduction (OR) requires incision of the skin; closed reduction (CR)
does not require incision.
B
A
Figure 1-34 Fixation. A, External. B, Internal.
EXERCISE 10: Bone Procedures
Match the procedure to its definition.
____
____
____
____
____
____
____
____
____
Module_B_2622_Chapter 1_main.indd 34
1. spondylosyndesis
2. tarsectomy
3. scapulopexy
4. sternotomy
5. osteoclasis
6. costectomy
7. débridement
8. amputation
9. alveoloplasty
A. cutting out an ankle bone
B. cutting out a rib
C. cutting the breastbone
D. fixing a shoulder blade
E. binding the vertebrae together
F. surgical fracture of a bone to correct a malformation
G. surgically forming a small cavity
H. removal of a limb
I. removal of debris
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CHAPTER 1 Skeletal System
35
Build the terms.
10. cutting out dead bone 11. fixation of a kneecap 12. measuring density 13. cutting out cartilage 14. surgically forming a chin 15. breaking a bone 16. recording a disc TERMINOLOGY REVIEW
Terms Related To Joint Procedures
Term
Word Origin
Definition
acromioplasty
acromi/o acromion
-plasty surgically forming
arthr/o joint
-centesis surgical puncture
arthr/o joint
-desis binding
arthr/o joint
-graphy recording
arthr/o joint
-plasty surgically forming
arthr/o joint
-scopy viewing
arthr/o joint
-tomy cutting
Forming the acromion process to correct a defect as in rotator cuff surgery.
arthrocentesis
arthrodesis
arthrography
arthroplasty
arthroscopy
arthrotomy
Module_B_2622_Chapter 1_main.indd 35
Surgical puncture of a joint to remove fluid, pus, or blood.
Binding a joint in order to stabilize it.
X-ray recording of a joint.
Surgically forming a joint. Examples include total knee replacement (TKR)
and total hip replacement (THR) (Figure 1-35).
Internal viewing of a joint, especially the shoulder and knees to aid in the
diagnosis of ligament tears and injuries (Figure 1-36).
An incision of a joint, usually as a means of access for a surgical
procedure, such as a joint replacement. It may also be performed to
provide drainage for infection.
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36
CHAPTER 1 Skeletal System
Pelvis
Femur
A
Femur
Plastic bearing
Metal surface
Screws
B
Tibia
Fibula
Figure 1-35 A, Total hip replacement (THR) B, Total knee replacement (TKR).
TERMINOLOGY REVIEW—cont’d
Terms Related To Joint Procedures
Term
Word Origin
Definition
bursectomy
burs/o bursa
-ectomy cutting out
burs/o bursa
-centesis surgical puncture
disc/o disc
-ectomy cutting out
lamin/o lamina, thin plate
-ectomy cutting out
menisc/o meniscus
-ectomy cutting out
synov/o synovial membrane
-ectomy cutting out
Cutting out part or all of a bursa.
bursocentesis
discectomy
laminectomy
meniscectomy
synovectomy
Module_B_2622_Chapter 1_main.indd 36
Surgical puncture of a bursa to remove excess fluid.
Removal of an intervertebral disc. Also called diskectomy.
Cutting out one of the vertebral laminae to treat spinal stenosis
(Figure 1-37).
Cutting out a meniscus to treat a tear of the meniscus.
Cutting out a synovial membrane to treat severe rheumatoid arthritis or
hemarthrosis.
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CHAPTER 1 Skeletal System
37
Patella
PCL
Trochlea
Medial
condyle
ACL
Popliteus
tendon
Medial
gutter
Lateral
meniscus
Lateral
condyle
Lateral
meniscus
Lateral
condyle
Medial
condyle
Medial meniscus
Tibial plateau
Tibial
plateau
A
B
Figure 1-36 A, Arthroscopy of the knee. B, Knee structures that can be seen during arthroscopy at 6 different points (circles).
Vertebral disk
Spinal cord
Lamina
Spinous process
Figure 1-37 Laminectomy.
EXERCISE 11: Joint, Muscle and Fascia Procedures
Match the procedure to its definition.
____
____
____
____
____
____
1. arthroscopy
2. acromioplasty
3. bursectomy
4. bursocentesis
5. arthrography
6. laminectomy
A. recording a joint
B. surgically forming the acromion process
C. surgical puncture of a bursa
D. cutting out a vertebral lamina
E. cutting out a bursa
F. viewing a joint
Decode the term.
7. arthrocentesis 8. arthrodesis Module_B_2622_Chapter 1_main.indd 37
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38
CHAPTER 1 Skeletal System
RECOGNIZING SUFFIXES FOR PCS
Now that you’ve finished reading about the procedures for the musculoskeletal system, take
a look at this review of the suffixes used in their terminology. Each of these suffixes is associated with one or more root operations in the medical surgical section or one of the other
categories in PCS.
Suffixes and Root Operations for the Musculoskeletal System
Suffix
Root Operation
-clasis
-desis
-ectomy
-pexy
-plasty
-tomy
Division
Fusion
Excision, resection, extirpation
Repair, reposition
Repair, replacement, supplement, alteration
Release, division, drainage
PHARMACOLOGY
analgesics: Reduce pain. Examples include morphine (MS Contin), hydrocodone (Vicodin
or Lortab, in combination with acetaminophen), acetaminophen (Tylenol), and NSAIDs
such as naproxen (Anaprox).
antiinflammatories: Used to reduce inflammation and pain. Examples include steroidal and
nonsteroidal antiinflammatory drugs (NSAIDs). Prednisolone (Delta-Cortef ) is an
example of a steroid; ibuprofen (Advil, Motrin) and celecoxib (Celebrex) are examples of
NSAIDs.
antirheumatics: Manage symptoms of rheumatoid arthritis. Methotrexate, hydroxychloroquine (Plaquenil), and gold sodium thiomalate (Myochrysine) are common examples.
bisphosphonates: Prevent and sometimes reverse bone loss to treat diseases such as osteoporosis, Paget disease, or bone cancer. Examples include alendronate (Fosamax) and
zoledronic acid (Zometa).
disease-modifying antirheumatic drugs (DMARDs): Slow progression of rheumatoid
arthritis while also reducing signs and symptoms. Examples include leflunomide (Arava),
etanercept (Enbrel), and infliximab (Remicade).
muscle relaxants: Relieve pain caused by muscle spasms by relaxing the skeletal muscles.
Examples include cyclobenzaprine (Flexeril) and metaxalone (Skelaxin).
EXERCISE 12: Pharmacology
1. What class of drugs may prevent osteoporosis? .
2. Rheumatoid arthritis progression may be treated with .
3. NSAIDs are used to treat what kinds of symptoms? 4. are used to treat muscle spasms.
Module_B_2622_Chapter 1_main.indd 38
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CHAPTER 1 Skeletal System
39
Abbreviations
Abbreviation
Meaning
Abbreviation
Meaning
ACL
C1-C7
anterior cruciate ligament
first cervical through seventh cervical
vertebrae
closed reduction
closed reduction external fixation
dual energy x-ray absorptiometry
distal interphalangeal joint
degenerative joint disease
external fixation
fracture
internal fixation
first lumbar through fifth lumbar vertebrae
lateral collateral ligament
medial collateral ligament
MS
OA
OR
ORIF
PIP
PCL
RA
S1-S5
T1-T12
musculoskeletal
osteoarthritis
open reduction
open reduction internal fixation
proximal interphalangeal joint
posterior cruciate ligament
rheumatoid arthritis
first sacral through fifth sacral segments
first thoracic through twelfth thoracic
vertebrae
total hip replacement
total knee replacement
temporomandibular joint disorder
ulnar collateral ligament
CR
CREF
DEXA, DXA
DIP
DJD
EF
Fx, #
IF
L1-L5
LCL
MCL
THR
TKR
TMJ
UCL
Auden, Evelyn E - 29202 Opened by Chong, Mae-Li (surgeon)
Task
Edit
View
Time Scale
Options
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As Of 11:11
Age: 72 years
DOB: 9/2/1939
Auden, Evelyn E
Reference Text Browser
Orders
Last 48 Hours
Form Browser
ED
Flowsheet: Surgery
Navigator
Operative Report
Lab
Sex: Female
MRN: 29202
Loc: ARH-ANC
FIN: 8425633
Medication Profile
Radiology
Assessments Surgery
…
Clinical Notes
Level: Operative Report
Preoperative Diagnosis: Degenerative Joint
Disease, Right Knee
Postoperative Diagnosis: Degenerative Joint
Disease, Right Knee
Name of Operation: Total Knee Replacement
Pt. Info
Pt. Schedule
Table
Task List
Group
I & O MAR
List
Components: Zimmer NextGen LPS
Femur: size G
Tibia: 6
Articulating Surface: 10 mm
Patella: 38
Anesthesia: Spinal
Estimated Blood Loss: 150 cc
Antibiotics: Vancomycin 1 gm
Tourniquet: 350 mm Hg
Complications: none
Procedure
The patient was properly identified in the OR, and the leg was prepped and draped in the
routine fashion. The leg was exsanguinated, and the tourniquet inflated. A standard anterior
approach was made along with the median parapatellar arthrotomy. The patella was everted.
The fat pad was partially removed, the knee flexed, and all joint surfaces prepared in the
conventional manner to the size needed. The surfaces were prepared with pulse irrigating
system followed by antibiotic irrigation. They were then dried. All components were cemented
simultaneously. Any excess cement was removed with curettes and/or osteotomes.
The knee was placed in full extension, if not slight hyperextension, while the cement cured.
The patient tolerated the procedure well and left the operating room in stable condition.
PROD MAHAFC
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11:11
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40
CHAPTER 1 Skeletal System
EXERCISE 13: Healthcare Report
Using the operative report on the previous page, answer the following questions.
1. A synonym for the preoperative diagnosis of degenerative joint disease is .
2. An “anterior approach” to the knee would be through which part of the knee? 3. What is the patella? 4. To what does the term parapatellar refer? 5. What is an arthrotomy? 6. If the patella was everted, how would it be placed? 7. What is an osteotome? Module_B_2622_Chapter 1_main.indd 40
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CHAPTER 1 Skeletal System
41
SKELETAL SYSTEM REVIEW
Match the word parts to their definitions.
Word Part Definitions
Prefix/Suffix
-centesis
-clasis
-desis
-listhesis
-malacia
-osis
peri-physis
-plasia
syn-
Definition
1. ______________ binding
2. ______________ condition of formation
3. ______________ surgical puncture
4. ______________ together, joined
5. ______________ softening
6. ______________ slipping
7. ______________ surrounding, around
8. ______________ intentional breaking
9. ______________ growth
10. ______________ abnormal condition
Combining Form
arthr/o
carp/o
cervic/o
chondr/o
cleid/o
coccyg/o
cost/o
dactyl/o
femor/o
gnath/o
humer/o
mandibul/o
myel/o
olecran/o
oste/o
patell/a
phalang/o
scapul/o
spondyl/o
zygomat/o
Definition
11. ______________
12. ______________
13. ______________
14. ______________
15. ______________
16. ______________
17. ______________
18. ______________
19. ______________
20. ______________
21. ______________
22. ______________
23. ______________
24. ______________
25. ______________
26. ______________
27. ______________
28. ______________
29. ______________
30. ______________
collarbone
bone
jaw (entire)
upper arm bone
wrist
cheekbone
thigh bone
neck
vertebra
cartilage
spinal cord
finger/toe (whole)
finger/toe bone
rib
elbow
tailbone
kneecap
joint
lower jaw
shoulder blade
Wordshop
Prefixes
Combining Forms
Suffixes
aaninterperisyn-
arthr/o
chondr/o
dactyl/o
disc/o
geni/o
myel/o
oste/o
phyt/o
rhabdomy/o
spondyl/o
vertebr/o
-al
-desis
-graphy
-malacia
-osis
-plasia
-plasty
-um
-y
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42
CHAPTER 1 Skeletal System
Build musculoskeletal terms by combining the word parts on previous page. Some word parts may be used more than once. Some
may not be used at all. The number in parentheses indicates the number of word parts needed.
Definition
Term
1. structure surrounding bone (3)
2. pertaining to between vertebrae (3)
3. softening of cartilage (2)
4. process of many fingers or toes (3)
5. abnormal condition of bone growth (3)
6. binding of a joint (2)
7. process of joined fingers or toes (3)
8. recording a disc (2)
9. binding together of vertebrae (3)
10. surgical puncture of a bursa (2)
11. condition of formation of no cartilage (3)
12. surgical repair of the chin (2)
Sort the terms into the correct categories.
Term Sorting
Anatomy and Physiology
Pathology
Procedures
achondroplasia
amputation
arthrocentesis
arthrodesis
arthrography
arthrosis
arthrotomy
articulation
bunion
bursitis
carpectomy
cartilage
contracture
costa
densitometry
diaphysis
digitus
endosteum
genioplasty
humerus
lamellae
laminectomy
ligament
meniscectomy
osteoclasis
osteogenesis
osteomyelitis
osteoporosis
osteosarcoma
patellapexy
perichondrium
radius
sacrectomy
scapula
scapulopexy
spondylolisthesis
sternum
syndactyly
TMJ
ulna
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CHAPTER 1 Skeletal System
43
Replace the boldface text with the correct terms.
Translations
1. Ms. Alston was diagnosed with softening of the cartilage of
her knee and a cyst of synovial fluid in the popliteal area of
her leg.
2. The patient had surgical puncture of a joint to treat his
abnormal condition of blood in the joint of the left knee.
3. Dr. Matthews performed an alignment and immobilization of
the right collarbone of 5-year-old Caitlin, who had fallen while
jumping on her bed.
4. Sarah Henderson had abnormal bone growths in the joints
between the bones of her fingers.
5. The patient had an extreme posterior curvature of the
thoracic area of the spine that was a result of her loss of
bone mass.
6. The patient was admitted for an inflammation of the bone and
bone marrow of his lower lateral arm bone.
7. The patient complained of inflammation of the fascia on the
sole of the foot and inflammation of a tendon.
8. A procedure that records the electrical activity of muscles
was used to confirm Mr. Travis’ chronic, idiopathic
inflammation of many muscles.
9. An x-ray revealed a partially bent and partially broken fracture
of the child’s right upper arm bone.
10. The baby was born with condition of more than five fingers
on her hand and condition of the joining of the toes.
11. Mrs. Anderhub had a removal of a bunion to correct her
painful enlargement and inflammation of the first
metatarsophalangeal joint.
12. The patient underwent a removal of an intervertebral disc to
treat his protrusion of the central part of vertebral disk.
13. The baby was diagnosed with congenital malformation of the
spinal canal without spinal cord involvement.
TERMINOLOGY REVIEW
Medical Term
Word Parts
Definition
Amphiarthrosis
arthr/o: joint
-osis: condition of
dia-: through
arthr/o: joint
-osis: condition of
epi-: above, upon, on
-phys: to grow
epi-: above, upon, on
oste/o: bone
-blast: immature cell
oste/o: bone
-clast: to break
oste/o: bone
-cyte: cell
oste/o: bone
syn-: together
arthr-: joint
-osis: condition of
A slightly movable joint; plural, amphiarthroses.
Diaphysis
Diarthrosis
Epiphyseal plate
Epiphysis
Osteoblast
Osteoclast
Osteocyte
Osteon
Synarthrosis
Module_B_2622_Chapter 1_main.indd 43
The long straight shaft of a long bone.
Freely movable joint characterized by a joint cavity; also called a synovial joint;
plural, diarthroses.
The cartilaginous plate between the epiphysis and diaphysis of a bone; responsible
for the lengthwise growth of a long bone.
The end of a long bone.
Bone-forming cell; immature bone cell.
Cell that destroys, breaks down, or resorbs bone tissue.
Mature bone cell.
Structural unit of bone; haversian system.
An immovable joint; plural, synarthroses.
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44
CHAPTER 1 Skeletal System
ON THE WEB
For information on the skeletal system:
Loyola University Medical Education Network: Pick a Bone: www.meddean.luc.edu/lumen/MedEd/GrossAnatomy/
learnem/bones/main_bone.htm
Merck Manual: Bone, Joint, and Muscle Disorders: www.merck.com/mmhe (Click on “Bone, Joint, and Muscle
Disorders”)
National Osteoporosis Foundation: www.nof.org
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CHAPTER 1 Skeletal System
45
CHAPTER REVIEW
Name ____________________________________________________________
Date __________________________________
PRETEST
True or False
_____ 1. The skeletal system provides a rigid framework for the body.
_____ 2. Blood cell formation takes place in the spleen.
_____ 3. Vertebrae are made up of flat bones.
_____ 4. Articular cartilage covers the ends of long bones.
_____ 5. Long bones grow in length at the epiphyseal line.
_____ 6. The maxillary bones form the upper jaw.
_____ 7. The sacrum makes up the small of the back.
_____ 8. The shoulder is an example of a hinge joint.
_____ 9. The patella is the kneecap.
_____ 10. The humerus makes up the thigh.
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46
CHAPTER 1 Skeletal System
Notes
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CHAPTER 1 Skeletal System
47
KEY TERM ASSESSMENT
A. Definitions
Directions: Match each medical term with its definition.
_____ 1.
_____ 2.
_____ 3.
_____ 4.
_____ 5.
_____ 6.
_____ 7.
_____ 8.
_____ 9.
_____10.
Amphiarthrosis
Diaphysis
Diarthrosis
Epiphyseal plate
Epiphysis
Osteoblast
Osteoclast
Osteocyte
Osteon
Synarthrosis
A. A slightly movable joint
B. An immovable joint
C. Bone-forming cell
D. Cell that destroys or resorbs bone tissue
E. Freely movable joint characterized by a joint cavity; also called a synovial
joint
F. Mature bone cell
. Structural unit of bone; haversian system
G
H. The cartilaginous plate between the epiphysis and diaphysis of a bone;
responsible for the lengthwise growth of a long bone
I. The end of a long bone
J. The long, straight shaft of a long bone
B. Word Parts
Directions: Indicate the meaning of each word part in the space provided. List as many medical terms as possible that incorporate the
word part in the space provided.
Word Part
Meaning of Word Part
Medical Terms That Incorporate Word Part
1. arthr/o
2. -osis
3. dia 4. epi 5. -physis
6. oste/o
7. -blast
8. -clast
9. -cyte
10. syn-
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48
CHAPTER 1 Skeletal System
EVALUATION OF LEARNING
Directions: Fill in each blank with the correct answer.
1. What structures make up the skeletal system?
2. What are the five functions of the skeletal system?
3. How is the blood calcium level maintained in the body?
4. What is the function of red bone marrow?
5. Where is red bone marrow found in the adult?
6. What is an osteon?
7. Describe the following structures that make up an osteon:
a. Osteonic canal (haversian canal): b. Lamella: c. Osteocytes: d. Lacunae: e. Canaliculi: Module_B_2622_Chapter 1_main.indd 48
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CHAPTER 1 Skeletal System
49
8. What is the difference between spongy bone and compact bone?
9. List examples of each of the following classifications of bone:
a. Long bones: b. Short bones: c. Flat bones: d. Irregular bones: 10. Describe each of the following structures that make up a long bone:
a. Diaphysis: b. Medullary cavity: c. Epiphysis: d. Articular cartilage: e. Periosteum: f. Nutrient foramina: g. Endosteum: 11. What is ossification?
12. What is the function of each of the following types of bone cells?
a. Osteoblast: b. Osteocyte: c. Osteoclast: 13. Where is the epiphyseal plate located in a long bone?
14. What type of cartilage is found in the epiphyseal plate?
15. How do long bones grow in length?
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50
CHAPTER 1 Skeletal System
16. When does an individual stop growing in length?
17. What happens to the epiphyseal plate when long bones stop growing?
18. What influences bone growth in the body?
19. How many bones make up the skeleton of an adult?
20. What are the two divisions of the skeleton? What structures are included in each division?
21. How many bones make up the skull?
22. What is the function of the cranium?
23. What are sinuses and what is their function?
24. What bones make up the cranium?
25. What is the function of the facial bones?
26. What are the names of the three small bones located in the middle ear?
27. What is the function of the hyoid bone?
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CHAPTER 1 Skeletal System
51
28. How many vertebrae make up the vertebral column?
29. What are the functions of the intervertebral disks?
30. What structures make up the vertebrae?
31. How many vertebrae are included in each of the following divisions of the vertebral column?
a. Cervical: b. Thoracic: c. Lumbar: 32. Describe the following:
a. Sacrum: b. Coccyx: 33. What are the functions of the thoracic cage?
34. What is the name of the central indentation in the superior margin of the sternum?
35. How many pairs of ribs are present in the human skeleton?
36. What is the difference between true ribs and false ribs?
37. What are floating ribs?
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52
CHAPTER 1 Skeletal System
38. What is the function of the appendicular skeleton?
39. What two bones make up the pectoral girdle?
40. What is another name for the clavicle?
41. What is the name of the shallow depression on the scapula where the head of the humerus connects to the scapula?
42. What bone is located in the upper arm?
43. What bones are located in the forearm?
44. State the location of the following bones making up the hand:
a. Carpal bones: b. Metacarpal bones: c. Phalanges: 45. What are the functions of the pelvic girdle?
46. What three bones fuse to form a coxal bone?
47. What is the symphysis pubis?
48. What bone is located in the thigh?
49. What is the patella?
50. What is the function of the patella?
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CHAPTER 1 Skeletal System
53
51. What bones are located in the leg?
52. What does the lateral malleolus do?
53. Describe the location of the following bones making up the foot:
a. Tarsal bones: b. Calcaneus bone: c. Metatarsal bones: d. Phalanges: 54. What is an articulation?
55. What is a synarthrosis?
56. What is an example of a synarthrosis?
57. What is an amphiarthrosis?
58. What is an example of an amphiarthrosis?
59. What is a diarthrosis?
60. Describe the following parts of a diarthrosis:
a. Articular cartilage: b. Joint cavity: c. Joint capsule: d. Synovial membrane: e. Synovial fluid: 61. What is the function of fibrocartilaginous pads located in the knee?
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54
CHAPTER 1 Skeletal System
62. What are bursae?
63. What are the functions of bursae?
64. List examples of the following types of joints. What range of movement is possible with each of the following joints?
Joint
Examples
Range of Movement
a.Ball-and-socket
b.Condyloid
c.Saddle
d.Pivot
e.Hinge
f. Gliding
CRITICAL THINKING ACTIVITIES
A. Long Bone
Using Figure 1-2 in your textbook as a reference, label each of the parts of a long bone on the following diagram.
(Modified from Applegate E: The anatomy and physiology learning system, ed 4, St. Louis, 2011, Saunders.)
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CHAPTER 1 Skeletal System
55
B. Synovial Joint
Using Figure 1-17 in your textbook as a reference, label each of the parts of a synovial joint on the following diagram.
(Modified from Applegate E: The anatomy and physiology learning system, ed 4, St. Louis, 2011, Saunders.)
C. Inquiring Patients Want to Know
You are working in a general practice medical office. Your patients ask you the following questions. In the space provided, indicate
how you would respond to each question in terms the patient would understand. Use your textbook and Internet resources to develop
your responses.
1. What causes osteoporosis?
2. What causes my sinus headaches?
3. How does a baby get through the bones of the pelvis during childbirth?
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56
CHAPTER 1 Skeletal System
4. What causes older people to break their hips?
5. What causes gout?
6. Why do people get shorter when they get older?
7. Why do babies have “soft spots” on their heads?
8. What is the difference between osteoarthritis and rheumatoid arthritis?
9. What happens when someone cracks his or her knuckles?
10. What is the difference between a strain and a sprain?
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CHAPTER 1 Skeletal System
57
D. Crossword Puzzle: Skeletal System
Directions: Complete the crossword puzzle using the clues provided.
1
2
3
4
5
6
7
9
8
10
11
12
13
14
15
16
17
18
19
20
Across
1 Abnormal side-to-side spinal curvature
2 Bones that protect brain
4 Freely movable joint
6 Upper arm bone
7 Shaft of a long bone
9 Softening of bones
11 Collarbone
14 Bone cell
15 Air-filled cavity in the skull
17 Shoulder blade
18 Spinal cord passes through this part of the skull
19 Bones of the upper jaw
20 Lower jaw bones
Module_B_2622_Chapter 1_main.indd 57
Down
1 Immovable joint
3 Tailbone
5 Ankle
8 Finger bones
10 Where bones grow in length
12 Breastbone
13 Outer surface of a long bone
14 Process of bone formation
16 Kneecap
18 Thigh bone
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CHAPTER 1 Skeletal System
Notes
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CHAPTER 1 Skeletal System
Name ____________________________________________________________
59
Date __________________________________
POSTTEST
True or False
_____ 1. The formation of blood cells is known as hemogenesis.
_____ 2. Osteons are the microscopic units of compact bone.
_____ 3. Calcium is located in an osteonic canal.
_____ 4. The shaft of a long bone is the diaphysis.
_____ 5. The endosteum is the tough fibrous connective tissue that covers a long bone.
_____ 6. A mature bone cell is an osteoblast.
_____ 7. The central indentation of the sternum is the jugular (suprasternal) notch.
_____ 8. The clavicle and scapula make up the pelvic girdle.
_____ 9. The ileum, ischium, and pubis make up the coxal bones.
_____ 10. The ulna is located on the lateral side of the forearm.
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CHAPTER 1 Skeletal System
Notes
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