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• • • • • • • The Skeletal System How will knowing and understanding the bones of the body help me to be a better chiropractor? Allow you to read and understand radiographs Allow you to understand the attachment of muscles Allow you to understand the relationship of how the body’s parts coordinate during movement: biomechanics Allow you to understand boney relationships: of subluxations Allow you to understand boney contact points for adjustments Allow you to understand osseous pathology; fractures Allow you to visualize osseous (vertebral) listings What you need to know • • • • • • Difference in axial and appendicular skeleton and components of each Functions of the skeletal system Osseous terminology Shapes of bones Structure of a typical long bone and bone cells Physiology of bone and calcium metabolism Organization of the Skeletal System The Axial Skeleton • • • • • The Skull - cranial and facial bones Auditory Ossicles - 6 total bones Hyoid Bone - located above the larynx Vertebral Column - 26 bones in the adult Rib Cage/Sternum The Appendicular Skeleton • • • • • • • • • • • • • • • • Pectoral Girdle - scapula and clavicles – cingulum membri superioris - girdle - articulates with sternum and vertebral column Upper Extremities - humerus, radius, ulna, carpal bones, metacarpals and phalanges Pelvic Girdle - 2 ossa coxae, cingulum membri inferioris - articulates with sacrum Lower Extremities - femur, tibia, fibula, tarsal bones, metatarsals and phalanges Functions of the Skeletal System 1) Support - rigid framework 2) Protection 3) Body Movement - levers 4) Provide an Anchoring Point for Muscles 5) Calcium/Phosphorus metabolism 6) Hematopoiesis Osseous Terminology Condyle - a large rounded projection or knob Epicondyle - a projection located superior to a condyle Tubercle - a small rounded process Head - a prominent rounded articulating bone end Sulcus - a groove Crest - a narrow ridge like projection • Facet - a flattened or shallow articulating surface • Tuberosity - a large roughened process Terminology, cont. • • • • • • • • Alveolus - a deep pit or socket Foramen - a hole or rounded opening Fissure - a narrow slit like opening Sinus - a cavity or hollow space in a bone Spine - a sharp slender process Fossa - a flattened or shallow surface, depression Process - any boney protuberance Trochanter - a massive process, on the femur Shapes of Bones • • • • • • Long Bones - longer than wide Short Bones - somewhat cube shaped Flat Bones - cranial bones, ribs, scapula Irregular Bones - vertebrae and certain bones of the skull Accessory Bones - extra bones Wormian Bones - sutural bones Structure of a Typical Long Bone • • • • • • • • • • Shaft - Diaphysis – a) Periosteum - dense regular connective tissue • 1) Sharpey’s fibers - connect periosteum to bone Epiphysis - spongy bone on each end of the diaphysis – a) Epiphyseal plate - growth center – b) Articular cartilage - hyaline cartilage – c) Red Marrow - hematopoiesis Medullary cavity - central cavity within the diaphysis - lined with endosteum and filled with fat (yellow marrow) Bone Cells Osteogenic cells - in periosteum and endosteum, can become blast or clasts Osteoblasts - lay down osteoid Osteocytes - mature bone cells, reside in lacunae, regulate calcium release into blood stream Osteoclasts - break down bone Bone-Lining cells - derived from osteoblasts along the surface of most bones, reg. Ca/P movement Spongy and Compact Bone Spongy Bone - trabecular bones, located deep to compact bone. Compact Bone - forms external portion of bone, very dense, composed of cylindrical columns of bone. – Haversian System - osteon • Lamellae - concentric rings of bone • Central Canal - contains artery, vein and lymphatics • Lacunae - spaces where osteocytes reside • Canaliculi - small channels which connect lacunae • Perforating canals - Volkmann’s canals Bone Growth • • Endochondral Ossification - long bones, etc. Intramembranous Ossification - flat bones Homeostasis and Physiologic Function of Bone • Hematopoiesis • Calcium Storage and Release – Function of Calcium • Blood clotting • Nerve transmission • Muscle contraction – Control of Calcium Levels in the Blood • Bone • Kidney • Parathyroid Glands • Diet/GIT Disorders of Calcium Metabolism • • • • Hypocalcemia - tetany pH is proportional to HCO3/CO2 Hypercalcemia Essential Nutrients for Bone Development – calcium, phosphorus, magnesium – Vit D - absorption of Ca – Vit. A - osteoblast function – Vit C - necessary for osteoid synthesis – protein The Axial Skeleton What you need to know • • • • • • • The divisions of the skull and the bones of each The relationship of the fontanelles (and their adult counterparts) to the sutures of the skull The bones of the skull and their relationship to each other The anatomic structures found on each bone of the skull The openings in the skull and what structures pass through each Bones that form the orbit Branches of the trigeminal nerve and openings its branches pass through The Skull • • • • • Divisions of the Skull – a) Cranial Bones - 8 bones in all • 1) Cranial Cavity - where the brain is – a) Calvaria - roof of the cranial vault – b) Cranial fossa - floor of the cranial cavity – b) Facial bones - 14 bones are not in contact with the brain. All paired except for vomer and mandible Fontanels Anterior - Frontal - closes by 18-24 months, becomes the bregma Posterior - Occipital, closes by 2 months - becomes the lambda Anterolateral - Sphenoidal - closes by 3 months of age, becomes the pterion Posterolateral - Mastoid - closes by 1 year of age, becomes the asterion Fontanels Fontanels Sutures • • • • • Sagittal Suture Coronal Suture Lambdoidal Suture Squamous Suture Metopic Suture - extends from anterior fontanel rostrally to the glabella, closes by age 6 years Sutures Sutures The Cranial Bones Frontal Bone Frontal Squama - flattened portion of the forehead Supraorbital Margin - arch, ridge Supraorbital foramen - supraorbital nerve Roof of the orbit Supracilliary Ridge - deep to eyebrow Glabella - most forward projecting part of head, AKA mesophryon, antinion, intercilium Metopic Suture Bregma Frontal Sinus Frontal Squama - flattened portion of the forehead Supraorbital Margin - arch Supraorbital foramen - supraorbital nerve Roof of the orbit Supracilliary Ridge - deep to eyebrow Glabella - most prominent point in the midsagittal plane between the eyebrows, AKA mesophryon, antinion, intercilium, means smooth, hairless. Metopic Suture Bregma Frontal Sinus Parietal Bones • • • • Coronal Suture Sagittal Suture Parietal Foramina - emissary veins Temporal Lines - origin of temporalis m. Coronal Suture Sagittal Suture Parietal Foramina - emissary veins Temporal Lines - origin of temporalis m. Temporal Bones • Squamous Suture • • Squamous Portion – a) zygomatic process – b) mandibular fossa – c) groove for the middle temporal artery Tympanic Portion – a) external acoustic meatus - ear canal – b) styloid process Temporal bone Temporal bones, cont. • Mastoid Portion – a) Mastoid process – b) Mastoid foramen – c) Stylomastoid foramen - CN VII – d) Mastoid sinus • Petrous portion – a) Groove for the Sigmoid Sinus – b) Carotid canal - internal carotid artery – c) Bones of the middle ear - malleus, incus, stapes – d) internal acoustic meatus - CN VII and VIII – e) Jugular foramen - CN IX, X, XI, internal jugular v. Temporal bone Temporal bone Temporal portion Occipital Bone • • • • • • • • • • Lambdoid Suture Foramen magnum - SC, CN XI, Vertebral aa., meninges Occipital condyles Hypoglossal canal - CN XII Condyloid canal - emissary veins External occipital protuberance - inion Nuchal lines Clivus - from dorsum sellae to foramen magnum Pharyngeal Tubercle Groove for the Transverse Sinus Occipital bone - lambdoidal suture Occipital bone Occipital bone Occipital bone Sphenoid Bone - the wedge • Greater wing – Groove for the middle meningeal artery • Lesser wing – Anterior clinoid process • Body – sphenoidal sinus – jugum – Chiasmatic groove – Groove for the internal Carotid a. Greater wing Lesser wing Body of the sphenoid bone Sphenoid Bone, cont., The Sella Turcica Sphenoid Bone, con’t. • • • • • • Pterygoid Plates - lateral wall of nasal cavity Optic canal - CN II Superior Orbital Fissure - CN III, IV, VI and V1 (ophthalmic division of CN V) Foramen Rotundum - V2 - maxillary div. Foramen Ovale - V3 - mandibular div. Foramen Spinosum - middle meningeal a. Pterygoid processes Sphenoid bone, cont. Sphenoid bone Ethmoid Bone • • • • • Perpendicular plate Ethmoidal air cells - ethmoid sinus Crista Galli - anterior attachment for falx cerebri Superior and Middle Nasal Conchae - AKA turbinates Cribriform Plate - CN I Ethmoid bone Ethmoid bone Ethmoid bone Success principle #4 The way to get an ambition, desire, or love to become part of your Mission, Talent or Destiny (MTD) in life is thought + action = feeling. Innate always executes, or carries out, your FEELINGS. This is an INFALLIBLE LAW!!!! Facial Bones Maxilla • Alveolar Process - area around alveolus • Palatine Process - Horizontal Plate - Hard Palate • Median Palatine Suture • Incisive Foramen - Nasopalatine nerve • Infraorbital Foramen - branch of V2 • Maxillary Sinus • Frontal Process • Zygomatic Process • Intermaxillary suture (closure) • Inferior Orbital Fissure - V2 Maxillary bones Maxillary bones, cont. Palatine Bones • Horizontal Plate - posterior 1/3 of hard palate • • Greater Palatine Foramen Lesser Palatine Foramen Palatine bones Zygomatic Bones • Temporal Process • Zygomaticofacial Foramen - Zygomatic n. Zygomatic bones, cont. Lacrimal Bones • Lacrimal Sulcus • Nasolacrimal Canal Lacrimal bones Facial bones, cont. • • • Nasal Bones – Internasal Suture Inferior Nasal Conchae Vomer Bone – Inferior portion of the nasal septum – Does not touch the occipital bone Nasal Bones Inferior Nasal Conchae Vomer Bone Mandible • • • Jawbone - to chew - only movable bone in the Body – symphysis menti - fuses at 1-2 years of age – mental (chin) protuberance – mental tubercle – mental foramen - mental nerve - branch of V3 Angle of the mandible skull Mandible, cont. Mandible, con’t. • Ramus – condylar process • head • neck • pterygoid fossa – Coronoid (crow’s beak) process – Mandibular notch – Mandibular foramen - inferior alveolar nerve – Lingula Mandible, cont. Hyoid Bone • • • Body Greater Cornu (Horn) Lesser Cornu - stylohyoid ligament Hyoid bone, cont. Last Time we talked about • The bones of the skull – The fontanels – The sutures of the skull – The bones of the cranial vault – The bones of the face Bones Which Form the Orbit • • • • • • • • • • • • • • • • • Frontal Bone Ethmoid Bone Sphenoid Bone Maxillary Bone Lacrimal Bone Zygomatic bone Palatine Bone Bones Which Form the Orbit Auditory Ossicles Three small paired bones within the middle ear cavity of the petrous portion of the temporal bone malleus - hammer - touches the tympanic membrane incus - anvil stapes - stirrup Bones Which Enclose the Nasal Cavity Ethmoid Bone Frontal Bone Maxilla Palatine Bone Nasal Bone Sphenoid bone Bones which do not touch the sphenoid bone • There are 13 of them and they are……….. • Hint - they are all paired except one (this list does not include the hyoid bone) Holes in the Skull • • • • • • Supraorbital foramen - supraorbital nerve Cribriform plate - Olfactory nerve (CN I) Optic canal - Optic nerve (CN II) Superior orbital fissure - CN III, IV, VI and V1 Foramen rotundum - Maxillary nerve (V2) Foramen ovale - Mandibular nerve (V3) • • Foramen spinosum - middle meningeal vessels Foramen lacerum - loop of internal carotid artery Holes in Skull, cont. • • • • • • Carotid canal - internal carotid artery Internal acoustic meatus - CN VII and CN VIII Stylomastoid foramen - CN VII Jugular foramen - CN IX, X and XI, and sigmoid sinus Hypoglossal canal - CN XII Foramen magnum - Spinal cord, meninges, vertebral arteries, spinal roots of CN XI Holes in Skull, cont. • • • • • • • • • • • • • • • • • • Greater palatine - greater palatine nerve Incisive foramen - nasopalatine nerve Inferior orbital fissure - maxillary div. of CN V Mandibular foramen - inferior alveolar nerve Mental foramen - mental nerve Nasolacrimal canal - nasolacrimal (tear) duct Zygomaticofacial foramen - zygomaticofacial n. Branches of the trigeminal nerve V1 - ophthalmic division - superior orbital fissure - supraorbital foramen (supraorbital n.); (supratrochlear, infratrochlear, external nasal, lacrimal nn.) V2 - maxillary division - foramen rotundum - infraorbital fissure - zygomaticofacial foramen (n.); infraorbital foramen (n.); greater and lesser palatine foramen (nn.).; incisive foramen (nasopalatine n.) V3 - mandibular division - foramen ovale - mandibular foramen (inferior alveolar n.) - mental foramen ( mental n.); (auriculotemporal, buccal nn.) The Vertebral Column What you need to know The vertebral formula The curves of the spinal column Anatomic structures of a typical vertebra Anatomic structures of cervical, thoracic, lumbar and sacral vertebra and their location on the vertebra and the unique characteristics of each vertebral region Components of and structures that pass through the IVF Joints of the spinal column and what forms each joint Ligaments of the spinal column, their location and attachments The Vertebral Column Functions – Support and Weight Bearing – Provide attachments for muscles – Protection of Spinal Cord – Permit passage of spinal nerves – Motion – Shock absorption Human Vertebral Formula • C7, T12, L5, S5, Cy 3-6 • Spinal Curves – Primary Curves - present at birth - kyphotic - posterior curves - thoracic and sacral – Secondary Curves - develop at 3 months of age and as baby begins to stand erect - Lordotic - anterior curves - cervical and lumbar Vertebral Column Disorders and Injuries A typical vertebra Structure of a Typical Vertebrae • • Body - weight bearing portion Neural Arch = 2 pedicles + 2 lamina – pedicles – Lamina – Pars interarticularis – Part of the lamina between the two articular processes Structure of a Typical Vertebrae Structure of a Typical Vertebrae • Intervertebral foramen - ovoid holes formed by the superior vertebral notch of one vertebra and the inferior vertebral notch of the superior vertebra. – Flexion verses extension – First pair between C2 and C3, and last one between L5 and S1 The IVF • Boundaries of the IVF: – the pedicle of the vertebra above – the vertebral body of the vertebra above – the IVD – the vertebral body of the vertebra below (in cervical region this includes the uncinate process) – the pedicle of the vertebra below forms the floor – the Z-joint forms the posterior wall Structures of the IVF The IVF • Structures that traverse the IVF – the spinal nerve – the dural root sleeve (attaches to the boundaries of the IVF and become continuous with the epineurium at the lateral border of the IVF) – lymphatic channels – the spinal ramus of a segmental artery (radicular artery) – intraforaminal venous plexus – two to four recurrent meningeal nerves Structure of a Typical Vertebrae, cont. • Vertebral foramen - neural ring – Vertebral canal - neural rings all stacked together – Boundaries • posterior portion of the vertebral body • vertebral arch Structure of a Typical Vertebrae, cont. • Shape of neural ring – cervical, lumbar and sacral regions - triangular – thoracic region - circular, smallest Structure of a Typical Vertebrae, cont. • Transverse process - from lamina-pedicle junction Structure of a Typical Vertebrae, cont. • Superior and Inferior Articular processes • Articular facets Primary Ossification centers of vertebra • Each typical vertebra has 3 primary ossification centers – Centrum – accounts for most of the body – each half of the neural arch • Neurocentral joints (see page 448) – primary cartilaginous joints – articulation between the halves of the neural arch and the centrum • Vertebral arch – cervical - fusion begins during first year – lumbar - complete by 6 years – the arch fuses to centrum 5-8 years of age Secondary Ossification centers of vertebra • 5 Secondary Ossification centers develop during puberty in each typical vertebra – tip of spinous process – tip of each transverse process – 2 annular epiphyses (ring epiphyses) - one on superior and one on inferior edge of the centrum • unite with vertebral body in early adulthood • Secondary ossification centers become fused by age 25 • Lumbar vertebra have secondary ossification centers for mammillary processes as well Ossification centers for other vertebra • • The atlas – Primary center for each lateral mass and adjacent half of the posterior arch – Primary center for the anterior arch – Fusion occurs by age 8 Ossification Center for other vertebra The Axis – 5 Primary centers • One for most of the body • One for each lateral mass • One for each half of the dens and adjacent part of the body • They fuse by three years of age – 2 Secondary centers • The tip of the dens – appears at 2 years of age – fuses by age 12 • Lower surface of the body – appears at puberty and fuses by age 25 Other Ossification centers • The Sacrum – Represents 5 fused vertebra – Many ossification centers – centrum, neural arches, etc. – Fused by age 20 Costal elements of vertebra • Parts of cervical, lumbar and sacral vertebra represent the ribs that articulate with thoracic vertebra • Cervical – anterior and posterior tubercle and costotransverse bar • Thoracic – true ribs • Lumbar – anterior portion of the transverse process • Sacral lateral portion to include the auricular surface Joints of the Spine • Zygapophyseal Joint - facet joint, a synovial joint • formed by the inferior articular facet of the superior vertebra and the superior articular facet of the inferior vertebra. Intervertebral Joint - symphysis, amphiarthrotic • IVD - intervertebral disc – 23 in total - first one between C2 and C3, last one L5 and S1 – Function • shock absorption • attach vertebral bodies together • form secondary curves to the vertebral column • form anterior wall of the IVF (intervertebral foramen) Intervertebral disc • Components - nucleus pulposus and annulus fibrosus Cervical Vertebrae Cervical vertebra • Designed to support and allow movement of the head • They are the smallest of the 24 moveable vertebrae • Their alignment is curved in an anterior direction to aid in shock absorption • Vertebral foramen is large and triangular shaped Cervical vertebra • All have a transverse foramen • Superior surface of vertebral body is concave and inferior surface is convex • 3 are considered atypical (C1, C2 and C7) • 4 are considered typical (C3,4,5,6) • All mammals have 7 cervical vertebrae except 3 The Atlas, C1 • A ring shaped bone • An atypical cervical vertebra • Lateral mass - 2 - no body The Atlas, C1 • Superior and Inferior Articular processes and facets (the facets sit on the processes) The Atlas, C1 • Anterior Arch – anterior tubercle – articular facet for the dens The Atlas, C1 • Transverse process – transverse foramen – costotransverse bar - intertubercular bar – anterior and posterior tubercles The Atlas, C1 • Posterior Arch – groove for the vertebral artery – posterior tubercle The Atlas, C1, inferior view The Atlas, C1, superior view Axis, C2, Epistropheus • • • The strongest of the cervical vertebra The skull rotates on it when a person shakes their head no Has a tooth like projection called the dens Axis, C2, Epistropheus • Odontoid process - dens – Anterior Articular Facet for the Atlas – Posterior Articular Facet for the Transverse Ligament of the Atlas – attachments for the alar ligaments on lateral aspects Axis, C2, Epistropheus • Lateral Mass Axis, C2, Epistropheus • Body - lip on anterior surface that overlaps superior surface of the body of C3 Axis, C2, Epistropheus • Bifid Spinous process - can palpate 2 inches below the EOP Axis, C2, Epistropheus, anterior view Axis, C2, Epistropheus, posterior view Facts about Cervical Vertebrae • • • • Typical Cervical Vertebrae - C3,4,5,6 – Bifid Spinous process – Transverse foramen Atypical Cervical Vertebrae - C1,2,7 First IVF - between C2 and C3 First IVD - between C2 and C3 Facts about Cervical Vertebrae • Uncinate process – hook shaped process on the lateral borders of the superior surface of the bodies of C3-C6 (T1) – prevents posterior linear movement (translation) of the vertebral bodies and limits lateral flexion Typical cervical vertebra C3,4,5,6 C7 • • • • Vertebral Prominens transverse processes do not posses a costotransverse bar the vertebral artery does not go through the transverse foramen, but the accessory vertebral vein does no anterior lip to overlap T1 C7 Success principle #5 Innate will carry out whatever you demand with faith; you prove faith by actions. Thoracic Vertebrae • • • • • • Also called Dorsal vertebrae Humans have 12; 2-8 are typical Spinous process are long and slender and directed inferiorly Costal Facets - where ribs articulate, most have 3 on each side Surfaces of the articular process are aligned on a frontal plane T1, 9, 10, 11 and 12 are atypical Thoracic Vertebrae Thoracic Vertebrae Thoracic vert., cont. • All have transverse costal facets except T11 and T12 • Bodies have whole facet or 1/2 facet called a demifacet • T1 has a whole superior facet and an inferior demifacet and articulates with the first and second rib respectively • T2-T8 have 2 demifacets on each side of their bodies. • T9 has a single superior demifacet on each side • T10, T11 and T12 have whole facets on either side of their bodies. Each articulate with only one pair of ribs Costovertebral joint Costovertebral joint Atypical thoracic vertebrae • T1 - articulates with rib 1 and 2 • T9 - may have no demifacets and articulate with rib 9, or it may have superior and inferior demifacets and • • • • • • articulate with 2 ribs T10 - has only a full pair of facets, rib 10 T11 - has only a full pair of facets, no transverse costal facets, short spinous process, articulates with rib 11 T12 - no transverse costal facets, articulates with rib 12, inferior articular facets face laterally Thoracic Vertebrae, T12 Lumbar Vertebrae Mamillary processes - on superior facets Accessory processes - on inferior base of TP Lumbar Vertebrae The surfaces of the articular facets are oblique to a sagittal plane - superior facets are concave and face posteromedial, inferior facets are convex and face anterolateral Lumbar Vertebrae • Have massive bodies • • • • • • • • • • • • Lumbar Vertebrae L5 - largest circumference but not as thick as other lumbars, atypical as it has a wedge shaped body (anterior portion of body is of greater height than the posterior region The Sacrum Auricular surface Sacroiliac joint Median Sacral Crest (fused spinous processes) Anterior and Posterior Sacral Foramina (IVF’s) Sacral Canal (neural canal) Superior articular process Sacral Tuberosity Transverse lines (where the IVD’s were) Sacral Promontory Lateral masses Complete ossification by 18-25 years of age The Sacrum, anterior view The Sacrum, posterior view Identify the vertebra Identify the vertebra Identify the vertebra Identify the vertebra Ligaments of the Spine Anterior Longitudinal Ligament • • anterior aspect of vertebral bodies and IVD axis to first sacral segment Posterior Longitudinal Ligament • attaches axis (continuous with the Tectorial membrane) to the first sacral segment • inside of the neural canal • attaches body to body and IVD’s Interspinous Ligament • connects adjacent spinous processes Supraspinous Ligament • attach the tips of the spinous processes, C7 to S1 Ligamentum Nuchae • superior continuation of the supraspinous ligament • triangular in shape • attaches to the EOP and the median nuchal line, posterior tubercle of the atlas, and spinous processes of the cervical vertebrae to C7 Ligamentum Flavum • connects adjacent lamina, one on each side, elastic ligament Rib cage and sternum What you need to know • • • • • • • • The different names for the manubriosternal joint The components of the sternum How many costal facets on the sternum How to tell an right from a left rib The different classifications of ribs The anatomic components of a rib How many ribs articulate with the various parts of the sternum How the ribs articulate with the thoracic vertebra The Rib Cage • Sternum, 3 parts – Manubrium • Jugular notch • clavicular notch • costal notch • manubriosternal joint - sternal angle, Angle of Louis – Body of the Sternum • Costal notches – Xiphoid Process Ossification Center for the sternum • Number of primary centers varies – Manubrium – usually has one or two – Body 4- 6 centers – Fusion occurs between puberty and age 25 – “Bullet Holes” in the sternum (sternal foramina) may occur with incomplete fusion Sternum • • • Manubrium – Jugular notch – Clavicular notch – Costal notch – Manubriosternal joint Body of the Sternum – Costal notches Xiphoid Process Costal Margin - fusion of cartilage of ribs 8,9,10 Costal Angle - formed by the 2 costal margins How many ribs articulate with the …... Ribs • • • • • 12 pairs of ribs Ribs 1 thru 7 - Vertebrosternal (True) ribs Ribs 8 thru 10 - Vertebrocondral (False) ribs Ribs 11 ans 12 - Floating ribs - no tubercle Components of a typical rib – Head Body Tubercle Costal groove Costochondral joint • Ribs – ossification centers – Primary ossification center for the body – Secondary center for the head and tubercle (2) – Unites by age 20 Neck Intercostal space Angle Ribs The Appendicular Skeleton What you need to know • How to tell right from left in the bones of the appendicular skeleton • The anatomic structures of the bones of the appendicular skeleton • How the bones of the appendicular skeleton relate to each other anatomically The Pectoral Girdle The Clavicle - Collar Bone • • Acromial Extremity - lateral end Sternal Extremity The Clavicle - Collar Bone • • • Acromial Extremity - lateral end – Conoid Tubercle - coracoclavicular ligament Sternal Extremity – Costal Tuberosity - costoclavicular ligament Groove for the Subclavius muscle The Scapula • Spine of the scapula – acromion - lateral end of spine • Fossae of the Scapula – supraspinous fossa - supraspinatus m. – infraspinous fossa - infraspinatus m. – subscapular fossa The Scapula • Glenoid cavity – supraglenoid tubercle - long head of biceps brachii m. – infraglenoid tubercle - long head of triceps brachii m. • Coracoid process - 3 muscles attach here The Scapula, cont. • Margins (borders) of the scapula – lateral border (axillary margin) – medial border (vertebral margin) – superior border • suprascapular notch - scapular notch - suprascapular nerve The Scapula, cont. • Angles of the Scapula – inferior angle – medial angle – superior angle • Neck • Overlies ribs 2-7, 15 muscles attach to the scapula The Humerus • • • • • Head Anatomic neck vs. surgical neck Greater tubercle Lesser Tubercle Intertubercular groove The Humerus • Deltoid Tuberosity • Radial groove - spiral groove - musculospiral groove - radial nerve • Medial epicondyle - flexors of carpus and digits, groove for the ulnar nerve on posterior surface The Humerus, cont. • • • • • Lateral epicondyle - extensor muscles of the carpus and digits Medial and lateral supracondylar crests Trochlea Capitulum Coronoid fossa The Humerus, cont. • Trochlea • Olecranon fossa The Ulna • • • • • • Semilunar notch - trochlear notch Coronoid process Ulnar tuberosity Radial notch Styloid process Interosseous margin The Ulna • • Olecranon process Posterior border of ulna The ulna, anterior view The Radius • • • • Head Radial tuberosity Styloid process - broken off in Colles fracture Ulnar notch The Radius • Grooves on the posterior surface – groove for ECRL and ECRB mm. – dorsal tubercle – groove for the Ex Pollicis Longus m. – groove for the Ex Dig. And Ex. Indicis mm. The distal end of the radius The Carpus • Proximal Row of Carpal Bones - medial to lateral – Pisiform - sesamoid bone in the tendon of FCU m. – Triquetral - triangular bone – Lunate - articulates with radius – Scaphoid bone - navicular bone, articulates with radius • Distal Row - medial to lateral – Hamate bone - hamulus – Capitate - Os Magnum – Trapezoid - Lesser multangular – Trapezium - Greater multangular The carpal bones, palmar view The carpal tunnel Metacarpal Bones and Phalanges The Pelvic Girdle • • • • • • Formed by two Ossa Coxae - hip bones Greater pelvis (false) - superior to pelvic brim Lesser (true) pelvis - inferior to brim of pelvis Pelvic Brim Pelvic Inlet Subpubic angle The Pelvis Bones of the Pelvis Ilium • External surface • Iliac crest • • • • • • – anterior superior iliac spine and anterior inferior iliac spine – posterior superior iliac spine and posterior inferior iliac spine Gluteal Lines Iliac Fossa Greater Sciatic Notch Auricular Surface for the sacrum Iliac tuberosity Inguinal ligament - pubic tubercle to ASIS The Ilium, lateral view The Ilium, medial view Pelvic Rotation Affects Leg Length Ischium • • • • • Spine of the Ischium Ischiatic tuberosity Lesser Sciatic Notch Body Ramus of the Ischium The Ischium, lateral view Success principle #6 Nature will give you what you act like you already have! To become, act as if. Pubis • • • Superior Pubic Ramus – pubic tubercle – pecten pubis – obturator groove Inferior Pubic Ramus Symphysis The pubic bone, lateral view The Pelvis, cont. • Obturator Foramen • Acetabulum – acetabular notch – acetabular fossa – lunate surface • Sex related differences in the pelvis – Female pelvic brim is more circular – male is more heart shaped – Female sacrum is wider, shorter and les curved – Female ischial spines are further apart – Subpubic angle is female is 90-120 degrees and male is 60-90 degrees The Pelvis, cont. The Femur • Head – fovea capitis • Neck • Greater and lesser trochanter • Shaft • Linea aspera • Gluteal tuberosity - third trochanter • Epicondyles • Adductor tubercle • Condyles • Intercondylar fossa • Popliteal fossa • Patellar surface The femur, anterior view The femur, posterior view The patella • • • • Apex Base Articular surface How to tell a right from a left patella The Tibia • Medial Condyle • Lateral Condyle – Gerdy’s tubercle - insertion of the iliotibial tract • Tibial Plateau – Intercondylar eminence • Medial and lateral intercondylar tubercle • Tibial Tuberosity • Shaft • Interosseous crest • Medial Malleolus • Inferior Articular surface • Fibular notch The tibia, anterior view The Fibula • • • Head Interosseous border Lateral Malleolus The fibula, posterior view Importance of the feet and normal gait • • • • • • Sacroiliac joint Pelvis tilt Spinal posture Leg length Arch An excellent book to discuss arches, the feet, and spinal pelvic stabilization is: – SPS, A Practical Approach to Orthotic Application. – By John Hyland, DC, DACBR The Tarsal Bones • Talus – posterior process groove for the FHL m. medial and lateral tubercles • Navicular bone • Cuboid bone– groove for the peroneus longus m. • Cuneiform bones – lateral, intermediate and medial • • The calcaneus bone • Calcaneus – tuberosity – sustentaculum tali Metatarsals and Phalanges • • Metatarsals – base, body, head – Mt 5 has a tuberosity on its base – numbered from medial to lateral Phalanges – proximal, middle and distal – Hallux has only two phalanges The bones of the foot, dorsal view The calcaneus bone Arches of the Foot • • Longitudinal Arch – medial portion is more elevated than lateral portion. The talus is the keystone of the medial portion and the cuboid is keystone for the lateral portion. Transverse Arch – extends across the width of the foot. Formed by posteriorally by the calcaneus, navicular, cuboid and anteriorally by the bases of all 5 Mt’s. Arches of the Foot Identify the following Identify the following 1) What plane divides a part into right and left equal halves; superior and inferior parts; anterior and posterior sections? 2) Define proximal. 3) Define distal 4) Define efferent. 5) Define contralateral. 6) What does inversion of the foot mean? eversion of the foot? 7) What does flexion of a joint mean? extension of a joint? 8) Define pronation; supination. 9) Define supine; prone. 10) Define protraction; Retraction. 11) Differentiate subjective from objective findings in a patient. 12) Define etiology. 13) What are eponyms? 14) Define: foramen, meatus, alveolus, fossa, facet, tubercle, tuberosity. 15) What is the calvaria? 16) Know the closure dates for the fontanels. 17) Know the name of the intersections of the sutures, ie. bregma, lambda, pterion, asterion. 18) What structures are found on the sphenoid bone? 19) What bones of the skull do not touch the sphenoid bone? 20) What is the sella turcica? 21) List all the holes of the skull and what structures (mainly nerves) run through them. 22) List the auditory ossicles. 23) What is the temporomandibular joint? 24) What is the glenohumeral joint? 25) Know the divisions of the CN V and what they innervate and which holes or fissures of the skull they traverse. 26) Know the curves of the spinal column, when they develop. 27) Define: transverse foramen, intervertebral foramen, vertebral foramen. 28) Know the boundaries of the IVF. 29) Know the boundaries of the vertebral foramen. 30) Know the primary and the secondary ossification centers of vertebra. 31) Know which vertebra are considered typical and which ones are considered atypical and why. 32) Know how many ribs articulate with the various thoracic vertebra, how many costal facets and demi facets are on each thoracic vertebra. 33) Understand the orientation of the articular facets on thoracic vertebra verse lumbar vertebra. 34) Know the ligaments of the spine and where they attach. 35) Know how the ribs attach to the sternum. 36) Where is the deltoid tuberosity? 37) Understand the anatomic structure of the distal humerus. 38) Understand the anatomic structures of the proximal ulna. 39) Understand the anatomic structure of the distal radius. 40) Understand the anatomic arrangement of the bones of the carpus and how they articulate with the radius. 41) Understand the anatomy of the pelvis. 42) What is the adductor tubercle? 43) Understand how you tell and right from a left patella. 44) Understand the anatomic structures of the proximal tibia. 45) How do you tell and right from a left fibula? 46) What is the sustentaculum tali? 47) Understand the anatomic arrangement of the bones of the tarsus and how they articulate with one another. 48) Understand the membranes of the body. 49) How many vertebra are there in the adult? 50) Know the components of a long bone. 51) Know the components of the Haversian system and understand how compact bone is formed and the arrangement of the osteons. 52) Know the definitions of the vocabulary words I gave you in class. 53) Know the anatomic structures of the atlas and the axis vertebrae. 54) Know Dr. Jim's principles. 55) Know how many articular surfaces are present on the various vertebra. ie. C1, C2, C4, C7, T1, T3, T9, T10, T12, L1, L5. 56) Where are the various fossae located on the scapula.