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Clinical terms • Dwarfism – Achondroplasia • Abnormal projection from a bone due to bony overgrowth – Bony spur • Pain in bone – Ostealgia • Bone inflammation – Osteitis • Inflammation of bone and bone marrow caused by pus-forming bacteria – Osteomyalitis • Bone cancer in a long bone of limb – Osteosarcoma • Fracture in diseased bone involving slight (coughing or quick turn) – Pathological fracture • Placing sustained tension on a body region to keep fractured bone in alignment – Traction 1 Epiphyseal Zones • Name the 5 zones Resting cartilage Proliferation Hypertrophy Erosion (Calcification) Diaphysis (ossification) 2 • Identify characteristics of this zone 1. 2. 3. 4. 5. • Resting Cartilage Chondro’s resting in Lacunae Not mitotically dividing Not actively contributing to bone growth Near epiphysis Scattered chondro’s What is the Role of this zone? 1. To anchor the rest of the epiphyseal plate to the epiphysis 3 Proliferation Zone • Identify characteristics 1. 2. 3. 4. Chondro’s proliferating and dividing Supplying new chondro’s to replace those lost to lengthening of bone Proliferating cells stick up into narrow cells Cells resemble stack of coins 4 Hypertrophy (Maturing) Zone • Identify characteristics 1. 2. 3. 4. Cellular breakdown Chondro’s begin to break down and produce alkaline phosphatase Enzyme facilitates calcification of extra cellular matrix Large chondro’s arranged in columns 5 Erosion Zone (calcification) • Identify 1. 2. 3. 4. 5. 6. Calcium salts deposited in cartilage matrix by osteoids Osteogenesis, osteoblasts laying down the matrix Only a few cells thick Dead cells because the matrix around them became calcified Calcified matrix destroyed by osteoclasts (acids and enzymes), then invaded by osteoblasts and capillaries from diaphysis Diaphyseal border of the plate firmly cemented to the bone of the diaphysis 6 Diaphysis Zone (ossification) • Identify 1. Long spiracles (tuberculae) that form spongy bone produced 7 Articulations - Appendicular • Clavicle: – Medially with sternum manubrium – Laterally acromium of scapula • Scapula: – Lateral with head of humerus at glenoid cavity – Distally, medial ulnar notch of radius to ulna and carpals • Ulna: (little finger side) – Proximal – trochlea of humerus – Distal – medial with radius at radioulnar joint • Humerus – Proximal with scapula – Distal with radius and ulna • Radius: (lateral thumb side) – Proximal with capitulum of humerus – Medial with radial notch of ulna 8 Osteological Terms - Processes • A rounded articulating process – Condyle • Any bony projection – Process • A projection located above a condyle – Epicondyle • A large rounded or irregular process – Tuberosity • A small rounded process – Tubercle • A very large, often blunt process – trochanter • A sharp, slender process – Spine • A hook-shaped process – Hamulus • A very slight ridge of bone – Line • A prominent ridge of bone – Crest • A smooth flattened articulating surface – Facet 9 Osteological terms - Fosae • A hole in a bone through which nerves and blood pass – Foramen • A tunnel-like passage through a bone – Meatus or canal • A cavity within a bone – Sinus • A furrow on a bone’s surface – Sulcus or Groove • A slit-like opening in a bone – Fissure • A shallow depression – Fovea 10 Identify parts of the bone • Tubular shaft of the long bone – Diaphysis • Part of long bone where growth occurs – Epiphysis • Irregularly arranged lamellae and osteocytes interconnected by canaliculi – Spongy bone (Cancellous, Trabeculae bone) • Marrow cavity in the shaft of long bone – Medullary cavity • Hematopoietic tissue found within trabecular cavities of spongy bone – Red marrow • Fat that fills cavities of bones – Yellow marrow • Membrane covering internal bone surfaces – Endosteum • Highly vascularized membrane covering the exterior of the diaphysis – Periosteum • Disc of hyaline cartilage that grows during childhood to lengthen the bone – Epiphyseal plate 11 Name functions of Skeleton System • • Support • Bones support the body and organs Protection – • Protect vital organs: skull, sternum, vertebrae, ribs Movement – • Skeletal muscle contraction causes movement Mineral storage – • Calcium and other minerals stored in bone can be released into the bloodstream when needed (hormonal control) Formation of blood cells – Hematopoiesis occurs in blood marrow resulting in the production of red and white blood cells and platelets 12 What are the 2 types of Osseous Tissue • Compact bone – Smooth, compact, with little air space – Haversian systems • Spongy bone (cancellous, trabecular) – Small pieces of bone surrounded by open spaces filled with red or yellow marrow 13 Name the 4 types of bone • Long bone – Shaft with a wide portion at both ends – Primarily compact bone with spongy at the widened areas – Humerus, radius, ulna, femur, tibia, fibula, phalanges • Short bones – Cube shaped, mostly cancellous bone – Wrist, ankle – Sesamoid – short bones embedded within tendon (patella) • Flat bone – Thin and flat – 2 layers of compact with spongy between – Sternum, ribs, skull • Irregular bone – Spongy with odd shape – Vertebrae and hip 14 • • • • • • • • • • Composed of? – Osteons or Haversion systems Interspersed with? – Blood, lymphatic vessels and nerves Concentric rings of compact bone called ____________ surround hollow passageways called ____________________ – Lamella, Haversion canals What connects Haversion canals? – Volkman’s canals Canals are lined with what tissue? – Endosteum Where do osteocytes reside? – Lacunae What connects the lacunae? – Canaliculi What are the canaliculi’s function? – Permit nutrients and oxygen to pass between osteocytes – Remove wastes What are interstitial lamellae? – Layers of bone that fill gaps between osteons What are circumferential lamellae? – Large rings of bone extending around the entire shaft of the bone Compact bone 15 Compact bone structure 16 Chemical Composition of bone • What are the organic components of bone? – Osteocytes, osteoblasts, osteoclasts – osteoid • What is the Osteoid comprised of? – Collagen fibers, proteoglycans, and glycoproteins • What is its function? – Flexibility and tensile strength on bone • What are the inorganic components? – Hydroxyapatites (mineral salts) which are mostly calcium phosphates (tiny crystals from the blood stream deposited among collagen fibers) • What are they responsible for? – Hardness of the bone • What are bone markings? – Bulges, depressions, rough spots, holes on the exterior surface of the bone – Most are muscle or ligament attachment sights 17 Name the 2 types of bone formation • Intramembranous ossification • Endochondrial Ossification 18 • What is it? – • Intramembranous Ossification? The process of bone developing from a fibrous tissue What bones are formed this way? – • Flat bones such as the skull and clavicles Explain the process: – Fibrous connective tissue in developing fetus become? – – Osteoid is? – – plates of bone. Eventually these plates of woven bone are replaced by? – – woven bone. Trabeculae thickens until they become? – – woven bone. The periosteum forms around the? – – small networks of collagen fibers called trabeculae. This early bone formation is called? – – then mineralized and osteoblasts become osteocytes Osteoid accumulates in? – – scattered with osteoblasts that begin secreting organic matrix. compact bone. Spongy bone remains in the center of the bone and the vascular tissue within it? – differentiates into red marrow (formation of diploe) 19 Intramembranous Ossification 1 20 Intramembranous 2 21 Intramembranous 3 22 Intramembranous 4 23 • What is it? – • Endochondrial Ossification? The process of bone formation where hyaline cartilage is used as the model for constructing bone. Most bones are formed this way Explain the process: – The perichondrium surrounding the hyaline cartilage bone model becomes infiltrated with? – – Osteoblasts in the periosteum secrete? – – medullary cavity in the center of the shaft Secondary ossification centers form shortly before or after? – – deposit osteoid, forming trabeculae of bone (early spongy bone) Osteoclasts break down new spongy bone and open a? – – the internal cavity of the forming bone. Osteoblasts from the periosteal bud begin to? – – deteriorate A periosteal bud containing arteries, veins, nerves and lymph vessels invades? – – osteoid externally onto the shaft of the hyaline bone The matrix deep within the shaft of the cartilage begins to? – – blood vessels, converting it into periosteum. birth in the epiphyses of the bone. Spongy bone is eventually formed with hyaline cartilage remaining only at the? – epiphyseal plate and the articular cartilages 24 Endochondral Ossification Secondary ossification center Hyaline cartilage Deteriorating cartilage matrix Spongy bone formation Primary ossification center Bone collar Formation of bone collar around hyaline cartilage model. Epiphyseal blood vessel Articular cartilage Spongy bone Medullary cavity Epiphyseal plate cartilage Blood vessel of periosteal bud Cavitation of the hyaline cartilage within the cartilage model. Invasion of internal cavities by the periosteal bud and spongy bone formation. Formation of the medullary cavity as ossification continues; appearance of secondary ossification centers in the epiphyses in preparation for stage 5. Ossification of the epiphyses; when completed, hyaline cartilage remains only in the epiphyseal plates and articular cartilages 25 Bone growth in long bones • How do long bones grow in children? – Entirely by interstitial growth of the epiphyseal plates • How do bones grow in thickness? – By appositional growth • The widening of bones 26 Epiphyseal bone growth • • • The top layer (epi side) of hyaline cartilage plate contains actively dividing chondrocytes that are pushed towards the ________________? • Diaphysis What does this do? • Causes the entire bone to lengthen What happens to the chondrocytes as they get closer to the shaft? • • They enlarge and eventually die What occurs at the junction of the epiphysis and the diaphysis? • • Osteoblasts begin to secrete bone matrix and form small spicules of bone What promotes the adolescent growth spurt and eventually leads to the closure of epiphyseal plate? • • Sex hormones What happens as adolescence ends? • • The epiphyseal plate becomes smaller and is entirely replaced by bone tissue What is the result of this occurring? • Bone growth ends 27 Long bone growth 28 Structure of long bone 29 What is appositional growth • The process used to? – Widen bones • _____________ beneath the _____________ form new ______________ systems on the outer surface of the bone – Osteoblasts, periosteum, Haversian • ________________ on the ________________ break down bone to enlarge the ______________ cavity. – Osteoclasts, endosteum, medullary 30 Appositional growth Periosteal ridge Artery Periosteum 1 Osteoblasts beneath the periosteum secrete bone matrix, forming ridges that follow the course of periosteal blood vessels. Central canal of osteon Penetrating canal 2 As the bony ridges enlarge and meet, the groove containing the blood vessel becomes a tunnel. 3 The periosteum lining the tunnel is transformed into an endosteum and the osteoblasts just deep to the tunnel endosteum secrete bone matrix, narrowing the canal. 4 As the osteoblasts beneath the endosteum form new lamellae, a new osteon is created. Meanwhile new circumferential lamellae are elaborated beneath the periosteum and the process is repeated, continuing to enlarge bone diameter. 31 Bone Remodeling • What is bone remodeling? – Process where bone is resorbed and deposited at periosteal or endosteal surfaces • What should the rate of bone resorption be in healthy adults? – The same rate as deposition so the total mass remains constant • What is bone deposit? – Osteoblasts laying down new osteoid which is later mineralized into bone • How is bone resorption carried out? – • by osteoclasts secreting enzymes onto the bone that digest organic matrix. The osteoclasts also secrete acids that help to make the calcium salts more soluble What is PTH? – Parathyroid hormone – Hormone produced by the parathyroid gland in response to low blood calcium levels. – It stimulates bone resorption so that calcium is released and put back into the blood • What is Calcitonin? – A protein produced by specialized “C” cells in the thyroid and secreted when blood calcium levels rise – Inhibits bone resorption and enhances calcium deposit in the bone matrix 32 Bone remodeling • How much of our bone mass is recycled every week? – 5 to 7% • How often is spongy bone replaced? Compact bone – Every 3 to 4 years – Every 10 years • What are remodeling units? – Packets of adjacent osteoblasts and osteoclasts that coordinate bone remodeling • What is bone deposit? – Added bone for injured or strength of bone • What is an osteoid seam? – The marking of new matrix deposits by osteocytes (band of gauzy looking bone matrix) • What helps trigger calcification? – Calcium and phosphate ions 33 Bone remodeling (cont) • What happens when calcium and phosphate mix reach a certain level? – Tiny crystals of hydroxyapatite form and catalyze further crystallization of calcium salts in the area • What are other factors involved? – Matrix proteins binding and concentrating calcium – Alkaline phosphatase mineralizing • When the conditions are met, what happens? – Calcium salts are deposited all at once and with great precision throughout the mature matrix 34 Bone resorption • What accomplishes this? – Osteoclasts • As they move along the bone surface what do they do? – Dig grooves called resorption bays and break down bony matrix • How does the area of bone destruction seal off? – By osteoclasts that touch the bone forming a ruffled membrane that clings to the bone, sealing it off • What does the ruffled border secrete and what does this do? – Lysosomal enzymes – digest organic matrix – Hydrocholoric acid – converts calcium salts into soluble forms in order to make them pass easily into solution • What happens to these products? – They are endocytosed and then released into the blood • What cells are important in this process? – T cells 35 Remodeling control • What regulates remodeling? – 2 control loops: • Negative feedback that maintains Ca2 Homeostasis in the blood • Gravitational forces acting on skeleton • Why is calcium so important for the body? – – – – – Nerve impulses Muscle contractions Blood coagulation Gland and nerve cell secretions Cell division • Where is 99% of calcium in the body? – Bone minerals • What range does the hormonal loop keep calcium? – 9-11 mg per 100 ml of blood • Where is calcium absorbed from? – Intestine 36 Hormonal Mechanism • What does the hormonal mechanism involve? – PTH – parathyroid hormone – parathyroid gland – Calcitonin – produced by parafollicular cells (C-cells) of thyroid gland • When is PTH released? – When calcium levels decline • What does it do? – Stimulates osteoclasts to resorb bone, release calcium into blood • What happens? – Osteoclasts break down old and new matrix • What escaped digestion and why? – Osteoid – Because it lacks calcium salts • When does the stimulus for PTH end? – When blood concentrations of calcium rise 37 Hormonal mechanisms (cont) • What is secreted when calcium levels rise? – Calcitonin • What is its function? – Inhibit resorption, encourage deposition – Reduce blood calcium • What happens when blood calcium levels fall? – Calcitonin release wanes • Are these responses to preserve bone strength? – No. They are for maintaining blood calcium homeostasis • What happens if levels are low for a long time? – Bones demineralize and develop large, punched out holes 38 Bone Remodeling 39 Mechanical Stress • What is Wolff’s law? – Bones grow and remodel in response to the demands placed on it? • What are other observations of Wolff’s law? – Long bones thickest midway along diaphysis (where stress is greatest) – Curved bones thickest where most likely to buckle – Trabeculae form trusses along lines of compression – Large bony projections occur where active heavy muscles attach • How do forces communicate with remodeling cells? – Electrical signaling • What are hormonal loops function in remodeling? – Whether and when remodeling occur • What are mechanical stresses functions? – Where remodeling will occur 40 Fracture Classification • Location of bone after fracture: – Non-displaced – normal end positions – Displaced – out of normal alignment • Completeness of break: – Complete – all the way through – Incomplete – not all the way • Orientation: – Linear – parallel of long axis – Transverse – perpendicular to axis • Skin penetration: – Open – penetrates the skin – Closed – skin not penetrated 41 Bone Repair 1. Hematoma formation: 1. 2. 2. Fibrocartilaginous callus formation: 1. 2. 3. 4. 5. 6. 3. Capillaries grow into hematoma Phagocytes begin cleaning debris Fibros and osteos begin reconstructing bone Fibros repair collagen, chondros repair cartilage Osteos form spongy bone secrete bulging cartilage matrix that later calcifies Fibrocartilaginous callus splints broken bone Bony Callus formed: 1. 4. Clotted blood forms at site Bone cells die, tissue becomes inflamed Trabeculae appear in callus, convert it to bony callus Bone remodeling: 1. Bony callus remodeled 42 Common Fractures • Comminuted: – Fragments into 3 or more pieces (aged, brittle boned) • Compression: – Crushed • Spiral: – Ragged break, excessive twisting (sports) • Epiphyseal: – Epiphysis separated from diaphysis • Depressed: – Broken inward • Greenstick: – Incomplete break on one side, other side bends 43 Clinical advances in bone repair • What does electrical stimulation do to a fracture? – Dramatically increases healing time • What is the piezo electric effect? – Minute electrical currents are produced when minerals are stressed • What happens in regions of negative electrical charge? Positive? – Negative – bone deposited – Positive – bone resorbed • What effect does ultrasound treatment produce on fractures? – Reduce healing times 35 to 45% • What is VEGF? Function? – Vascular endothelial growth factor – Stimulates blood vessel growth 44 Bone Imbalances - Osteoporosis • • • • • • What is osteoporosis? – Group of diseases in which bone resorption occurs more than bone deposit What are the results of the disease? – Reduced bone mass Which bones are most susceptible? – Vertebrae, neck of the femur Who is most likely to have this disease? – Postmenopausal women Why? – Estrogen loss What are some contributors? – – – – – Insufficient exercise Poor calcium intake Vitamin D or Calcitonin metabolism problems Smoking, drinking Immobility 45 Bone Imbalances - Osteomalacia • What is it? – Inadequate bone mineralization – Osteoid deposited but calcium salts are not • Weight bearing bones? – Fracture, bend, deform • What are Rickets? – Bowing of the legs and deformed pelvis • What causes this? – Insufficient calcium or vitamin D intake 46 Bone Imbalances – Paget’s Disease • What is Paget’s Disease? – Excessive, abnormal bone formation and resorption • What causes this? – High ratio of woven bone to compact bone and bone mineralization reduction • What is the result? – Soft, weak bones 47 Skeleton • What % of body mass is the skeleton? – 20% • How many bones? – 206 • What are ligaments? – Fibrous tissue that connect bones at joints 48 What are the 2 groups of skeleton? • Axial: • How many bones? – 80 • Which bones make up axial? – Skull, vertebrae, rib cage • Appendicular: • How many bones? – 126 • Which make up appendicular? – Upper, lower limbs, shoulders, hips 49 Skull • How many bones? – 22 including cranial and facial • What kind, how do they articulate? – Flat, sutures • What is the top, lateral and posterior of skull called? – The Calvaria • What are the 3 base regions? – Anterior, middle, posterior cranial fossae • What are the 4 pair of cavities called and what are they? – Paranasal sinuses - Sphenoid, Ethmoid, Maxillary, Frontal – Lighten the skull and give resonance to the voice • What is each cavity lined with? – Mucous membranes that form the mucus that drains into the nasal cavity • What are Orbits? – Eye cavities – Surrounded by fatty tissue – Formed by 7 bones 50 Skull (cont) • What is the Nasal cavity composed of? – Bone and hyaline cartilage • What is the roof, superior/lateral walls and superior nasal septum formed by? – Ethmoid bone • What is the floor formed by? – Anteriorly – maxilla – Posteriorly – palatine bones • What is the cavity divided by? – Nasal septum • What is the Nasal septum formed by? – Perpendicular plate of ethmoid, vomer, and septal cartilage • Where is the nasal concha and what does it do? – Lateral walls – Increase turbulence of air to help trap particles in mucus 51 Skull (cont) • What are the conchae and septum lined with and what does it do? – Mucosa – Helps lighten air and secrete mucus • What is the Cribriform plate and what does it do? – Part of ethmoid bone in roof of nasal cavity – Has small openings for olefactor (smell) nerves to pass through on their way to the brain 52 Vertebral column • How many vertebrae? – 33 , some fused in adults • What separates them? – Fibrocartilage called intervertebral disc – Inner portion of disc contain jelly-like sub for elasticity • What is a herniated disc? – Jelly-like sub is pushed out by pressure putting pressure on spinal nerve • What are the curvatures of the vertebrae? – Thoracic – bow out – Lumbar – curve in 53 Appendicular Skeleton • What makes up the appendicular skeleton? – Pectoral and pelvic girdle – Upper and lower limbs • What is the only attachment of arms to body? – Scapula • Does the fibula articulate with the femur? – No. Only with the Tibia • What do both the fibula and tibia articulate with distally? – Talus bone to form the ankle 54 Axial Skeleton Skull, Vertebral Column, Bony Thorax 55 • What is body’s most complex structure? – Skull • What bones form it? How many? – Cranial and facial bones – 22 • What are the functions of the facial bones? – – – – – Form framework for face Contain cavities for sense organs for sight, taste, smell Air and food passageways Secure teeth Anchor expression muscles • What kind of bones are found in the skull? – Flat (except mandible) • What unites these bones? – Interlocking sutures • What are the major sutures? – – – – Coronal Sagittal Squamous Lambdoid Skull 56 • What is the cranial vault? – The Calvaria – The superior, lateral and posterior aspects of the head including the forehead • What is the cranial base or floor? – Inferior aspects of skull • What are the 3 internal fossae of the base of the skull? – Anterior, middle and posterior cranial fossae • What sits in these fossae? – The brain • What are the smaller cavities of the skull? – Middle, inner ear – Nasal – Orbits • How many openings are in the skull? Skull (cont) – 85 • What are their functions? – Spinal cord passage – Blood vessels – nerves 57 Cranium • How many bones? –8 • Name them: – – – – – – Parietal (pair) Frontal Occipital Sphenoid Ethmoid Temporal (pair) • What do these bones form? – The helmet around brain 58 Frontal bone • What is medical term for forehead? – Frontal squama • What are the supraorbital margins? – Thick, margin under eyebrows • What does the anterior cranial fossa support? – Lobes of the brain • What allows the supraorbital artery and nerve to pass to the forehead? – Supraorbital foramen • What is the smooth portion between the eyes called? – Glabella • What are the nasal sutures called? – Frontonasal sutures • What is riddled around the glabella? – Frontal sinuses 59 Parietal bones • Where are these bones? – Superior and lateral skull • They form the bulk of the cranial ________? – Vault • What occurs where the parietal bones articulate with other cranial bones? – The four largest sutures 60 Main Sutures • Where parietal meets frontal anteriorly? – Coronal • Where parietal meets superiorly at cranial midline? – Sagittal • Where parietal meets occipital? – Lambdoid • Where parietal meets temporal? – squamous 61 Mandible • What is it? – Lower jaw • What does it consist of? – Body, ramus, mandibular notch, condyles, coronoid process • What does the mandibular body do? – Anchors the lower teeth • What is the alveolar margin for? – Contains the sockets where teeth are embedded • What does the mandibular symphysis indicate? – Where the 2 mandible bones fused during infancy • What are the nerve entrances called? – Mandibular foramina 62 Mandible functions • Coronoid – Insertion for temporalis muscle • Condyles – Articulate with temporal bones for movement of jaw • Symphysis – Fusion point of mandible • Alveoli – Teeth sockets • Foramina – Admit inferior alveolar nerve • Mental foramen – Blood vessel and nerves to chin and lower lip 63 Maxillary bones • What area of face? – Upper jaw, central portion • What articulates with it? – All facial bones except mandible • Why is it keystone of face? – All bones articulate with it. (- mandible) • What part of maxilla carry upper teeth? – Alveolar margin • What is the function of incisive fossa? – Passage for blood vessels, nerves • What articulates with the maxilla laterally? – Zygomatic process • What forms the bony roof of the mouth? – Palatine processes • What is at the junction of maxilla and greater wing of the sphenoid? – Inferior orbital fissure 64 Maxilla functions • Alveoli – Tooth socket • Zygomatic processes – Form zygo arch • Palatine – Form anterior hard palate • Frontal – Form lateral part of nose bridge • Incisive fossa – Admit blood vessels, nerves through hard palate • Inferior orbital fissure – Admit maxillary branch of cranial nerve V, zygo nerve, blood vessels • Infraorbital foramen – Nerve to skin of face 65 Articulation of other face bones • Zygomatic: • Articulation: – Zygomatic processes of temporal posteriorly – Zygomatic processes of frontal superiorly – Zygomatic processes of maxilla anteriorly • Nasal bones: • Articulation: – – – – Frontal bone superiorly Maxilla laterally Perpendicular plate posteriorly Inferiorly to cartilage that form external nose • Lacrimal bones: • Articulation: – Frontal superiorly – Ethmoid posteriorly – Maxilla anteriorly 66 Articulation of other face bones • Palatine bones • Articulation: • What are the important plates? – Horizontal, perpendicular • What are the 3 processes? – Pyramidal – Sphenoidal – Orbital 67 Orbits Supraorbital foramen Superior Orbital fissure Optic canal Lesser wing of sphenoid Medial wall: Orbital plate of frontal Sphenoid body Orbital plate of ethmoid Zygo process of frontal Frontal process of maxilla Greater wing of sphenoid Lacrimal Nasal bone Orbital surface of zygo Floor of orbit: Infraorbital fissure Infraorbital groove Zygomatic bone Orbital process of palantine Infraorbital foramen Orbital surface of maxillary Zygomatic bone 68 Nasal Cavity • What is it constructed of? – Bone and hyaline cartilage • What is the roof formed by? – Cribriform plate of ethmoid • What shapes the lateral walls? – Superior, middle conchae of ethmoid, perpendicular of palatine • What are the depressions under the conchae? – Superior, middle, inferior meatus • What is the floor formed by? – Palatine processes of maxillae and palatine bones • What divides the nasal cavity? – Septum • What is the bony part of septum? – Vomer • What cartilage completes the septum anteriorly? – Septal cartilage 69 Nasal Cavity Frontal sinus Superior, middle, and Inferior meatus Superior nasal concha Middle nasal concha Inferior nasal concha Nasal bone Anterior nasal spine Maxillary bone (Palatine process) Sphenoid sinus Pterygoid process Palatine bone Palatine bone Perpendicular horizontal 70 Paranasal sinuses 71 Hyoid bone • Where? – Just inferior to mandible in the neck • What is unique about this bone? – Does not articulate directly with any other bone • What is anchored by? – Stylohyoid ligaments • To What? – Styloid processes of temporal • What is its function? – Move tongue – Attach muscles that raise/lower larynx for speech, swallowing 72 Anterior Skull 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. Frontal Bone Supra-Orbital Foramen Orbit (Orbital Cavity) Superior Orbital Fissure Inferior Orbital Fissure Zygomatic Bone Infra-Orbital Foramen Maxilla Mandible Mental Foramen Incisive Fossa Symphysis Vomer Inferior Nasal Concha Middle Nasal Concha Perpendicular Plate of Ethmoid Nasal Bone Lacrimal Bone 73 Skull - Lateral 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. Parietal Bone Coronal Suture Frontal Bone Nasal Bone Vomer Lacrimal Bone Orbital Part of Ethmoid Zygomatic Bone Maxilla Body of Mandible Ramus of Mandible Coronoid Process Mandibular Condyle Mental Foramen Styloid Process External Acoustic Meatus Mastoid Process Zygomatic Process Temporal Bone Greater Wing of Sphenoid Inferior Temporal Line Superior Temporal Line Squamosal Suture Lambdoidal Suture Occipital Bone 74 Skull Posterior 1. 2. 3. 4. 5. 6. 7. Parietal Bone Sagittal Suture Lambdoid Suture Occipital Bone External Occipital Protruberance Superior Nuchal Line Inferior Nuchal Line 75 Occipital bone • Where is this bone? – Posterior wall and base of skull • What sutures connect it to the temporal and parietal bones? – Lambdoid – Occipitomastoid • What does the internal walls of occipital form? – Posterior cranial fossa • What foramen is at the base of occipital? – Foramen magnum • What are the occipital condyles? – Rocker like condyles that articulate with c1 and allow nodding of head • What does the external occipital crest secure? – Ligamente nuchae • What do nuchal lines and bony regions do? – Anchor many back muscles 76 Occipital Parts functions • Foramen magnum – Spinal cord passage from brain stem to vertebral canal • Hypoglossal canal – Passage of hypoglossal nerve (cranial nerve XII) • Occipital condyles – Atlas articulation • External protuberence/nuchal lines – Muscle attachments • External Crest – Ligamente nuchae 77 Skull - superior 1. 2. 3. 4. 5. 6. Occipital Bone Lambdoidal Suture Parietal Bone Sagittal Suture Coronal Suture Frontal Bone 78 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. Frontal Sinus Foramen Cecum Crista Galli Cribriform Plate Anterior Cranial Fossa Lesser Wing of Sphenoid Chiasmatic Groove Hypophyseal Fossa Dorsum Sella Optic Canal Anterior Clinoid Process Foramen Rotundum Foramen Ovale Foramen Spinosum Squamous Part of Temporal Petrous Part of Temporal Groove for Transverse Sinus Posterior Cranial Fossa Foramen Magnum Hypoglossal Canal Jugular Foramen Internal Acoustic Meatus Posterior Clinoid Process Foramen Lacerum Superior Orbital Fissure Superior Skull 79 Mandible 1. Mandibular Condyle 2. Mandibular Notch 3. Coronoid Process 4. Ramus 5. Angle 6. Oblique Line 7. Body 8. Alveolar Process 9. Mental Foramen 10. Mylohyoid Line 11. Mandibular Foramen 80 Anterior skull Parietal bone Frontal Glabella Frontal squama Of frontal bone Nasal bone Frontonasal suture Supraorbital foramen Supraorbital margin Superior Orbital fissure Sphenoid Temporal Optic Canal Ethmoid Inferior orbital fissure Lacrimal Zygomatic Middle nasal concha Perpendicular plate Inferior nasal concha Infraorbital foramen Maxilla Vomer Mandible Mental Foramen Mandibular Symphysis 81 Lateral Skull Coronal suture Frontal bone Parietal bone Sphenoid bone Temporal bone Ethmoid bone Lacrimal bone Lacrimal fossa Lambdoid suture Squamous suture Occipital bone Zygomatic process Nasal bone Zygomatic bone Occipitomastoid suture External auditory meatus Maxilla Mastoid process Styloid process Mandibular condyle Mandibular notch Mandibular ramus Alveolar margins Mandible Mental foramen Coronoid Process Mandibular angle 82 Posterior Skull Sagittal suture Parietal bone Wormian bone Lambdoid suture Occipital bone Superior nuchal line External Occipital protuberance Mastoid process Occipitomastoid suture External Occipital Occipital condyle crest Inferior Nuchal line 83 Midsagittal Internal left side of skull Coronal suture Parietal bone Squamous suture Frontal bone Sphenoid bone Temporal bone Frontal sinus Crista galli Nasal bone Sphenoid sinus Ethmoid bone Lambdoid suture Occipital bone Occipitomastoid suture Vomer bone Incisive fossa Maxilla External occipital Protuberence Internal acoustic meatus Sella Turcica of sphenoid Alveolar margins Pterygoid Process of Sphenoid Mandible Palatine bone Mandibular foramen Palatine process 84 Inferior skull Incisive fossa Medial palantine suture Infraorbital foramen Maxilla Maxilla Palatine bone Zygomatic bone Temporal bone Sphenoid bone Foramen ovale Foramen lacerum Vomer Carotid canal External acoustic meatu Stylomastoid foramen Mandibular fossa Styloid process Mastoid process Temporal bone Jugular foramen Occipital condyle Inferior nuchal line Pharyngeal Tubercle of basoccipital Parietal bone External Occipital Crest Superior nuchal line Foramen magnum External Occipital protuberence 85 Temporal bone Squamous region External Acoustic meatus Zygomatic process Mandibular fossa Mastoid region Mastoid process Styloid process Tympanic region 86 • How many? Where are they on skull? – 2 (One on each side - inferior to parietal bones) • What are the temporal’s four major regions? – Squamous,Tympanic, Mastoid, Petrous Temporal bones • Functions of parts? • Zygomatic process – – helps form prominence of cheek • External acoustic meatus – – for hearing • Styloid process – – attach hyoid and neck muscles • Mastoid process – – attach neck and tongue muscles • Carotid canal – – passage of internal carotid artery • Jugular foramen – – passage of internal jugular vein and cranial nerves IX, X, XI 87 Superior sphenoid Optic canal Chiasmatic groove Lesser wing Greater wing Anterior clinoid process Foramen rotundum Foramen ovale Greater wing Hypophyseal Fossa of sella turcica Foramen spinosum Dorsum Sellae Body of sphenoid Posterior clinoid process 88 Posterior sphenoid Body of sphenoid Greater wing Posterior clinoid process Superior orbital fissure Foramen rotundum Pterygoid process Pterygoid plates 89 Sphenoid • Where? – Spans the middle cranial fossa • Why is it considered the keystone of cranium? – Because it forms a central wedge that articulates with all other cranial bones • What does it consist of? – Central body, 3 pairs of wings – Greater, lesser, pterygoid processes • What is the sella turcica? – Area where pituitary gland is located • What is the function of the anterior clinoid processes? – Anchor the brain to the skull • What are the pterygoid processes functions? – Anchor pyterygoid muscles used for chewing • What are the optic canals for? – They allow optic nerves to pass to the eyes • What is the superior orbital fissure’s function? – It allows cranial nerves that control eye movements to enter the orbit 90 Sphenoid parts functions • Sella turcica – Seat of pituitary gland • Optic canal – Passage of cranial nerve II, opthamolic arteries • Superior Orbital fissures – Cranial nerves III, IV, part of V, opthamolic vein • Foramen rotundum – Passage of maxillary division of cranial nerve V • Ovale – Pass mandibular division of nerve V • Spinosum – Pass middle meningeal artery 91 • Where? – Between sphenoid and nasal bones (between nasal and orbits) Ethmoid • What forms roof of nasal cavity and floor of anterior cranial fossa? – Cribriform plate • What are the tiny holes in cribriform that allow smell nerves to pass to the brain? – Olfactory foramina • What is the crista galli’s function? – Attach falx cerbri • What are some other parts of the ethmoid? – Inferior, middle nasal concha – Perpendicular plate – Orbital plates 92 Ethmoid Crista galli Cribriform plate Olfactory foramina Orbital plate Left lateral mass Ethmoid sinuses Middle nasal concha Perpendicular plate 93 Superior cranial cavity Olfactory foramina Anterior cranial fossa Lesser wing Greater wing Tuberculum sellae Hypophyseal fossa Dorsum sellae Posterior clinoid process Middle cranial fossa Temporal bone Internal acoustic meatus Frontal bone Cribform plate Crista galli Ethmoid Optic canal Anterior clinoid process Foramen rotundum Foramen ovale Foramen spinosum Foramen lacerum Jugular foramen Hypoglossal canal Posterior Cranial fossa Parietal bone Occipital bone Foramen magnum 94 Vertebrae • How many bones? What kind of bones? – 26, irregular • Name some functions of vertebrae? – Transmits weight of trunk to lower limbs – Surround, protect spinal cord – Attachment site for ribs and muscles of back and neck • How many in fetus? – 33 separate bones • How many eventually fuse and what do they become? – 9 – Sacrum, coccyx • What are the divisions? How many bones in each? – – – – – Cervical – 7 Thoracic – 12 Lumbar – 5 Sacrum Coccyx 95 Vertebrae (cont) • What are the four curvatures? – Cervical, lumbar – concave posteriorly – Thoracic, sacrum – convex posteriorly • What are some abnormal curvature disorders? – Scoliosis – Thoracic twisted – Kyphosis – hunchback • What are ligaments? – Bands of fibrous tissue that connect and support bones • What are the ligs of the vertebrae? – Anterior, posterior longitudinal ligaments • What are the intervertebral discs functions? – Shock absorbers during walking, jumping and running 96 General structure of Vertebrae • What is the common structure of all vertebrae? – Body anteriorly – Vertebral arch posteriorly – Vertebral foramen for vertebral canal (spinal cord) • What forms vertebral arch? – Pedicles, laminae • What are pedicles? – Short, bony pillars that form side of arch (project posteriorly) • What are laminae? – Flat plates that fuse in median plane (posterior) • How many processes project from vertebral arch? – 7 • What are they? Demifacet (Thoracic Only Facet (Thoracic Only) – Spinous – median, at junction of 2 laminae – Transverse – lateral from each side of arch – Superior, inferior articular processes – smooth joints called facets (covered with hyaline cartilage) form movable joints with processes of vertebrae below and above them 97 Vertebrae structure 98 Cervical Thoracic Lumbar 99 100 101 Cervical Vertebrae • Characteristics: – – – – – – – – Smallest, lightest First 2 unusual Oval body Wide Spinous short (except for C7) Large foramen Transverse foramen C7 is the vertebrae prominens • C1 and C2 have – no disc between – Atlas – no body, spinous • Superior articular receive occipital condyle of skull • Inferior joins axis – Axis – • Has dens (odontoid) process superiorly from body • Dens allow side to side movement 102 Thoracic Vertebrae • Characteristics: – – – – – – – – – All articulate with ribs First looks like C7, last four look like Lumbar Increase in size from 1st to last Heart shape body Demifacets on each side (superior and inferior) (T10 to T12 have single facet) Demifacets receive ribs Foramen circular Long, pointed spinous Superior and inferior facets lie mainly in frontal plane 103 Lumbar vertebrae • Characteristics: – Most stress – Massive, kidney shaped body – Pedicles and laminae shorter and thicker than other verts – Short, flat, hatchet shaped spinous (project backward) – Triangle foramen – Facets orientated different than other vertebrae 104 Differences in Vertebrae • Body: Cervical – C – small wide – T – Larger than C, heart shaped – L – Massive body • Spinous process: – C – short, has V notch – T – Long sharp, projects inferiorly – L – Short blunt, projects posteriorly • Foramen: – C – large triangle shaped – T- small oval – L – small triangular shape Lumbar Thoracic • Transverse processes: – C- contain foramen – T- Have facets for ribs – L – thin,tapered 105 C1 Atlas Superior view 1. 2. 3. 4. 5. 6. 7. 8. 9. Anterior tubercle Anterior arch Facet for dens Transverse process Foramen transversarium or transverse foramen Superior articular facet on lateral mass Posterior arch Posterior tubercle Vertebral foramen 106 Cervical, Thoracic, Lumbar, Sacrum 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. Body Vertebral foramen Anterior tubercle Posterior tubercle Foramen transversarium or transverse foramen Demifacet for head of rib Superior articular process Pedicle Lamina Transverse process Spinous process or spine Lateral mass Posterior sacral foramina Coccyx Sacral hiatus 107 1. 2. 3. 4. 5. 6. 7. 8. 9. Body Facet for head of rib Superior articular process Superior vertebral notch Pedicle Transverse process Inferior vertebral notch Inferior articular process Spinous process or spine Cervical, Thoracic, Lumbar, sacrum 108 Cervical Vertebrae 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. C1 or atlas C2 or axis C3 C4 C5 C6 C7 Body Vertebral foramen Bifid spinous process or spine Transverse process Foramen transversarium or transverse foramen Superior articular facet 109 Vertebrae - Atlas 1. 2. 3. 4. 5. 6. Superior Articular Surface Transverse Foramen Transverse Process Odontoid (Dens) Facet Vertebral Foramen Inferior Articular Surface 110 Axis 1. 2. 3. 4. 5. 6. 7. 8. 9. Spinous Process Lamina Transverse Process Pedicle Superior Articular Surface Odontoid Process (Dens) Body Vertebral Foramen Inferior Articular Surface 111 Cervical Vertebrae 1. 2. 3. 4. 5. 6. 7. 8. Spinous Process Lamina Superior Articular Surface Transverse Foramen Transverse Process Body Pedicle Vertebral Foramen 112 Thoracic 1. 2. 3. 4. 5. 6. 7. 8. 9. Spinous Process Lamina Superior Articular Surface Transverse Process Pedicle Body Vertebral Foramen Articular Facet for Rib Inferior Articular Surface 113 Lumbar 1. 2. 3. 4. 5. 6. 7. 8. Spinous Process Lamina Superior Articular Surface Transverse Process Pedicle Body Vertebral Foramen Inferior Articular Surface 114 Sacrum • Characteristics: – Formed by 5 fused verts – Articulates superiorly with L5 – inferiorly with coccyx, laterally with hip bone (sacroiliac joint) – Sacral promontory anterosuperior – Four ridges: The transverse lines cross concave anterior aspect, marking lines of fusion of sacral vertebrae – Ventral sacral foramina penetrate sacrum at lateral ends of transverse lines to transmit blood vessels and nerves – Lateral to these and expanding superior are the alae – Dorsal midline – median sacral crest – Dorsal sacral foramina – Lateral sacral crests – Vertebral canal – sacral canal – Sacral hiatus – opening where vert failed to fuse 115 Sacrum alae 1. 2. Promontory Transverse Ridges (lines) 3. Coccyx 4. Body of Sacrum 5. Sacral Canal 6. Superior Articular Surface 7. Median Sacral Crest 8. Sacrum to Ilium Articular Surface 9. Dorsal Sacral Foramina 10. Sacral Hiatus Ventral Sacral foramina Lateral sacral crest 116 Rib and Vertebrae 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. Articular Facet of Rib Interarticular Crest Neck Articular Portion of Tubercle Nonarticular Portion of Tubercle Angle of Rib Costal Groove Body (shaft) of Rib Articular Facet of Transverse Process Transverse Process Spinous Process Lamina Vertebral Foramen Sternal edge 117 Sternum Clavicular Notch Costal facet 1. 2. 3. 4. 5. Jugular Notch Manubrium Sternal Angle Body (Gladiolus) Xiphoid Process 118 Bony Thorax 119 Bony Thorax • What is included in bony thorax? – Thoracic vertebrae dorsally, ribs laterally, sternum and costal cartilage anteriorly • How many ribs? – 12 pairs • What do they articulate with? – – – – – Posteriorly – thoracic vertebrae Anteriorly – superior 7 rib pairs – directly to sternum (true) 5 (false) – indirectly to sternum or no sternal Ribs 8-10 connect to cartilage joining to rib above Ribs 11-12 – floating – no anterior attachment – • Characteristics of ribs: – – – – – Bowed flat bone Superior smooth, inferior sharp and thin Costal groove – lodges nerves and blood vessels Head and tubercle – join to the body and transverse process of vert Tubercle is posterior and superior 120 Appendicular Skeleton Pectoral & Pelvic Girdle, Upper & Lower Limbs 121 • Where? – Across superior thorax • Articulation: – Medial sternal end – to sternal manubrium – Lateral acromial end – scapula • • • Clavicle Medial 2/3’s convex anteriorly Lateral 3rd concave anteriorly Superior surface is? – Smooth • Inferior surface is? – Ridged and grooved • Function – Anchor many muscles – Act as braces – Hold scapula and arms out laterally away from superior part of thorax • Not very strong, easy to fracture 122 1. 2. 3. 4. 5. sternal head superior surface sternal head inferior surface groove for subclavious muscle 6. conoid tubercle 7. trapezoid line 8. acromial head • Clavicle Identification aspects: – – – Conoid tubercle always posterior/inferior Medial surface always convex, lateral concave Acromial - lateral 123 Scapula Posterior 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. Coracoid Process Scapular Notch Superior Border Supraspinous Fossa Superior Angle Scapular Spine Vertebral Margin Infraspinous Fossa Inferior Angle Lateral Border Glenoid Cavity Margin (lateral angle) 12. Acromion Process • Identification: – – Spine-posterior Glenoid - lateral 124 Scapula (Ventral) 1. superior angle 2. vertebral (medial) border 3. inferior angle 4. subscapular fossa 5. infraglenoid tubercle 6. glenoid fossa 7. coracoid process 8. Acromion 9. suprascapular notch 125 Scapula lateral 1. 2. 3. 4. 5. 6. 7. Coracoid process Glenoid cavity Scapular spine Acromion process Infraspinous Fossa Inferior Angle Axillary Margin 126 Scapula • Where? – Dorsal surface of rib cage, between ribs 2 and 7 • What are the 3 borders? – Superior – shortest, sharpest – Medial (vertebral) – parallels vertebral column – Lateral (axillary) – abuts the armpit and ends superiorly in a small shallow fossa, the glenoid cavity • Articulation – Glenoid cavity articulates with humerus of the arm • What are the 3 angles? Where do they meet? – Superior scapular border meets medial border at superior angle and lateral border at the lateral angle – Medial and lateral borders join at the inferior angle 127 Scapula (cont) • • • Features: Anterior surface is? – Concave and relatively featureless Posterior surface? – Prominent spine easily felt through skin – Ends laterally in enlarged, roughened triangular projection called? • Acromion – Acromion articulates with? • Acromial end of clavicle – Which forms the? • Acromioclavicle joint • Projecting anteriorly from superior scapular border is what? – Coracoid process • What is the coracoid process’ function? – Helps anchor the biceps of the arm • Bounded by? – Suprascapular notch medially and glenoid cavity laterally • Several large fossae appear on both sides of scapula. They are? – Infraspinous and supraspinous fossae – Named for their location – Inferior and superior to the spine • What is the subscapular fossa? – Shallow concavity formed by the entire anterior scapula surface 128 Proximal Humerus 1. 2. 3. 4. 5. 6. 7. • Head Anatomical neck Lesser Tubercle Intertubercular Groove Greater Tubercle Surgical Neck Deltoid Neck (tuberosity) Identify: • • • Head – medial Shallow, distal coronoid fossa – anterior Capitulum – anterior lateral 129 Humerus Distal 1. 2. 3. 4. 5. 6. 7. Radial Fossa Lateral Epicondyle Capitulum Trochlea Medial Epicondyle Coronoid Fossa Olecranon Fossa 130 Humerus – proximal to middle of the bone • Location – Upper arm • Articulation? – proximal to the scapula (glenoid cavity) – distal to the radius and ulna • What is at the proximal end? – Smooth hemispherical head • What does it fit into to? – Glenoid cavity • What is immediately inferior to the head? – Anatomical neck • What tubercles are just inferior to the neck? • What separates these tubercles? – Intertubercular (bicipital) groove • What are tubercles function? – Sites where muscles attach • What is distal to tubercles? – Surgical neck • What is midway down shaft laterally? – Deltoid tuberosity (roughened deltoid muscle attachment site) • What runs obliquely down the posterior aspect of shaft marking the course of radial nerve? – Radial groove – Lateral greater tubercle – Medial lesser tubercle 131 • What are the 2 condyles at distal end? Humerus - Distal – Medial trochlea – looks like hour glass tipped on side – Lateral capitulum – ball-like • What do these articulate with? – Ulna and radius • What flanks these condyles? – Medial, lateral epicondyles (muscle attachment sites) • What is directly above these condyles? – Supracondyle ridges • What is responsible for the tingling feeling when “funny bone” is hit?’ – Ulnar nerves that run behind the medial epicondyle • Where is the coronoid fossa? – Superior to the trochlea on the anterior surface • Where is the Olecranon fossa? – Posterior to the coronoid fossa 132 Humerus – distal • What is the function of the coronoid and olecranon fossae? – They allow the corresponding processes of the ulna to move freely when the elbow is flexed and extended • What receives the head of the radius when the elbow is flexed? – Radial fossa 133 1. 2. 3. 4. 5. 6. Head of radius Neck of radius Radial Tuberosity Radius (Shaft) Styloid Process Ulnar Notch • Recognition aspects: – – – Tuberosity – anterior/medial Styloid – lateral Concave surface above styloid - anterior Radius – Right/anterior Radial Tuberosity Anterior medial Always anterior in Anatomical position 134 Forearm- antebrachium • Location: – Lower arm • Bones: – Radius, ulna • Articulation – Proximal end with humerus – Distal end forms joints with the wrist – Radius and ulna articulate with each other both proximally and distally at small radioulnar joints • What connects the radius and ulnar across their entire length? – Flexible, interosseous membrane • What is the position of radius and ulna in anatomical postion? – Radius – lateral on thumb side – Ulna – medial on little finger side • What happens in the prone position? – Distal end of the radius crosses over the ulna and form an “X” 135 Ulna-right/ proximal/distal 1. 2. 3. 4. 5. 6. 7. 8. Olecranon process Trochlear notch Coronoid process Tuberosity Radial notch Ulna shaft Head of ulna Styloid process • Identification aspects: – – Radial notch always lateral Styloid process-medial 136 Ulna • Main responsibility? – Forming elbow joint with humerus • What are the 2 main processes at proximal end? – Olecranon, coronoid processes • What separates these? – Trochlear notch • What does the locking of the olecranon process and olecranon fossa do? – Keeps the forearm from moving posteriorly beyond the elbow joint • Where does the ulna articulate with the head of the radius? – Radial notch • Where is the ulnar head? – At the distal end of the bone by wrist • What is medial to the ulnar head? – Styloid process • What separates the ulnar from the carpals? – A disc of fibrocartilage • Does it have any role in hand movement? – Little to none at all 137 Radius • What is the superior surface of the head – convex or concave? – Concave • Articulation – Head proximal with the capitulum of the humerus – Medially with the radial notch of the ulna – Distal where the radius expands, medial ulnar notch with the ulna – Carpal bones • The ulna contributes heavily to? – The elbow • The radius contributes to? – Wrist • What happens when the radius moves? – The hand moves with it 138 Hand – Right Dorsal 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. Styloid process of radius Navicular (Scaphoid) Lunate Triquetral Pisiform Trapezium Trapezoid Capitate Hamate Metacarpal Proximal Phalange Middle Phalange Distal Phalange Styloid Process of Ulna 139 Hand – Right palmar 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. Navicular (Scaphoid) Lunate Triquetral Pisiform Trapezium Trapezoid Capitate Hamate Metacarpal Proximal Phalange Middle Phalange Distal Phalange 140 Carpus-Wrist • What is the true wrist? • The carpus. The proximal part of the hand • How many bones are in the carpus? What are they called? • Which bones articulate with radius? – Scaphoid, lunate • What bones make up the distal row? (lat to med) – – – – • 8 marble sized short bones • Carpals • How are they arranged? • In 2 irregular rows of 4 bones each • Which bones are in the proximal row? (lateral to medial) • • • • Scaphoid Lunate Triquetral pisiform • • • • • • • • Trapezium Trapezoid Capitate Hamate Sally – scaphoid Left – lunate The – triquetral Party – pisiform To- trapezium Take – trapezoid Cathy – capitate Home - hamate 141 • Metacarpus palm How many? What are they named? – 5, No name. They are numbered from 1 to 5 from thumb to little finger • Articulation – Bases with carpals proximally – Each other medially and laterally – Heads with proximal phalanges distally • What is meta #1 and why is it different from the rest? – The thumb – Does not have a middle phalanx 142 Phalanges - Fingers • What are other names for the phalanges? – Fingers, digits • How are they numbered? – From 1 to 5 beginning with pollex (thumb) • How many phalanges on each hand? – 14 • What are the parts named? – Proximal – Middle – Distal • Thumb no middle 143 Os Coxa – Left lateral 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. Anterior Superior Spine Iliac Crest Posterior Superior Spine Posterior Inferior Spine Greater Sciatic Notch Body of Ilium Ischial Spine Lesser Sciatic Notch Body of Ischium Ischial Tuberosity Obturator Foramen Inferior Ramus of Ischium Inferior Ramus of Pubis Body of Pubis Acetabulum Anterior Inferior Spine 144 Identification: •Acetabulum – lateral •Pubis – anterior •Ischial- posterior Os Coxa – Left,medial 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. Iliac Fossa Anterior Superior Spine Anterior Inferior Spine Arcuate Line Obturator Foramen Symphysis Pubis Articulating Surface Ischial Tuberosity Lesser Sciatic Notch Ischial Spine Greater Sciatic Notch Sacrum Articulating Surface Posterior Inferior Spine Posterior Superior Spine Iliac Crest 145 Pelvic girdle - Hip • What are its functions? – Attach lower limbs to axial skeleton – Transmit upper body weight to lower limbs – Support visceral organs of the pelvis • What are the hip bones named? – Os coxae • – – – • • • What is the hip, sacrum and coccyx called? – Bony pelvis In childhood. Fuse in adults What is the name of the deep lateral socket on the pelvis? – • Ilium Ischium Pubis Are they separate? – • Articulation – Each other anteriorly – Sacrum posteriorly What are the 3 bones of the pelvis? Acetabulum What is its function? What is the joint called? 1. 2. Receives head of femur Hip joint 146 Ilium • Where on the coxal? – Superior region • What does it consist of? – Body – Ala – wing • Where is it thickest at? – Tubercle of iliac crest • Where does each iliac crest end? – Anteriorly – anterior superior iliac spine – Posteriorly – posterior superior iliac spine • What is below these? – Anterior, posterior inferior iliac spines • What are these spines for? – Attachment points for muscles of trunk, hip, thigh • Where is the greater sciatic notch? What is it for? – Inferior to posterior inferior iliac spine – Where sciatic nerve passes to enter thigh • What makes up the posterolateral surface of the ilium? – Gluteal surface • What 3 ridges cross it? – Posterior, Anterior, inferior gluteal lines • What is the interior, concave area? – Iliac fossa • What is posterior to this? – Auricular surface • What does ilium join anteriorly? – Ischium, pubis 147 Ischium • What part of hip bone? – Posteroinferior • Articulation – Body – ilium – Ramus – pubis anteriorly • What are the 3 major markings? – Ischial spine – medially into pelvic cavity – Lesser sciatic notch – just inferior to ischial spine – Ischial tuberosity – strongest part of hip bone. Inferior surface of ischial body • What helps hold the pelvis together? – Sacrotuberous ligament – massive ligament from sacrum to ischial tuberosity 148 Pubis • Where? – Anterior of hip bone • V shaped consisting of? – Superior, inferior rami – Medial body • Articulation – Medial to ischium – Inferior to ilium • What does the anterior border form? – Pubic crest • What is at the lateral end of pubic crest? – Pubic tubercle • What is the large opening of the hip bone? – Obturator foramen • What is the name of the fibrocartilage joining the 2 pubic bones? – Pubic symphysis • What is the arch that differentiates male and female pelve? – Pubic arch 149 Pelvis - anterior 1. anterior superior iliac spine 2. superior pubic ramus 3. ischial tuberosity 4. inferior pubic ramus 5. pubic symphysis 6. pubic tubercle 7. Acetabulum 8. anterior inferior iliac spine 9. iliac fossa 150 Pelvis - posterior 1. 2. 3. 4. 5. 6. 7. iliac crest greater sciatic foramen ischial spine ischial tuberosity Coccyx sacrum (dorsum) posterior superior iliac spine 151 Pelvic structure/childbearing • What is the difference between female and male pelvis? – Female • wider, shallower, lighter and rounder • Tilted forward • What are the false and true pelvis? • Forms deep bowl containing pelvic organs • Dimensions critical for childbirth • What are the pelvic inlet and outlet? – Inlet – pelvic brim – Outlet – inferior margin of true pelvis – False • superior to the pelvic brim • Bounded by alae laterally; lumbar vertebrae posteriorly • Part of abdomen • Does not restrict childbirth – True • Inferior to pelvis brim 152 1. 2. 3. 4. 5. 6. 7. 8. 9. • Femur-proximal end/left Head Neck Greater Trochanter Intertrochanteric Line Lesser Trochanter Shaft of Femur Gluteal Tuberosity Intertrochanteric Crest Linea Aspera Identification: • • Fovea Capitis Distal Patellar Surface – anterior Intercondyle notch posterior 153 Left femur-distal 1. Medial Condyle 2. Lateral Condyle 3. Intercondylar Fossa Adductor tubercle Lateral Epicondyle Medial Epicondyle Intercondyle notch 154 Femur • Location – Upper leg • Articulation – Proximal – hip bone/ acetabulum – Distal – tibia • What is the name of the small central pit at the head? – Fovea capitis • What is at the junction of the shaft and neck? – Greater and lesser trochanters • What connects these trochanters? – Intertrochanteric line anteriorly – Intertrochanteric crest posteriorly • What does the gluteal tuberosity blend into? – Linea aspera inferiorly • What does the linea aspera diverge into? – Medial and lateral suprachondyle lines • What are all of these markings? – Muscle attachment sites • Distally, the femur widens into? – Lateral and medial condyles • What flanks the condyles superiorly? – Medial and lateral epicondyles 155 Femur (cont) • What is the patellar surface? – Articulation site for the patella • What is the deep U-shape on the distal posterior aspect of femur? – Intercondyle notch • What is superior to this? – Smooth popliteal surface • What is the patella? – Triangular, sesamoid bone enclosed in quadriceps that secures anterior thigh muscles to the tibia 156 Left Tibia-proximal/distal/anterior 1. 2. 3. 4. 5. 6. 7. • Distal Tibiofibular joint Intercondylar Eminence Lateral Condyle Tibial Tuberosity Anterior Crest Medial Condyle Anterior Surface Medial Malleolus Identify aspects: – Proximal Tibiofibular – joint – Tibial tuberosity always anterior Flattened side always lateral Medial malleolus always medial 157 • Location – Anterior shin bone Tibia • Articulation – Proximal – femur – tibia condyles to the femur condyles – Distally – talus of the foot – Lateral to the fibula (tibiofibular joint) • Parts – Broad proximal end • Medial and lateral condyles • Intercondyle imminence – Inferior to this • Tibial tuberosity – anterior • Lateral tibial condyle – proximal tibiofibular joint – Middle of bone • Anterior crest – Distal end • Medial malleolus • Distal tibiofibular joint • Articular surface 158 Left Fibula-proximal/distal/anterior 1. 2. 3. 4. • Head of Fibula Neck of Fibula Anterior Crest Lateral Malleolus Identifying aspects: – Lateral malleolus always lateral 159 • Location Fibula – Posterior, lateral shin • Articulation – Proximal with the tibia – Distal with the tibia medially and the talus distally • Name of proximal and distal ends? – Proximal – head – Distal – lateral malleolus (ankle bulge) • Does the fibula bear weight? – No 160 Left foot superior 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. Calcaneus Talus Navicular Cuboid Cuneiform, Middle Cuneiform, Intermediate Cuneiform, Lateral Metatarsal Proximal Phalange Middle Phalange Distal Phalange 161 • How many bones? Name them? – – – – – – 7 Calcaneus Talus Navicular Cuboid 1st Cuneiform (Hallux), 2nd Cuneiform, 3rd Cuneiform Tarsus • What 2 tarsals carry most body weight? – Talus, calcaneus • What does the Achilles tendon attach to? – Posterior surface of calcaneus • What part of calcaneus touches the ground? – Tuber calcanei, calcaneal tuberosity, sustentaculum tali • Name the remaining tarsals: – Lateral cuboid – Medial navicular – Intermediate, lateral cuneiform • What do the cuboid and cuneiform bones articulate with? – Metatarsal bones anteriorly 162 Left foot lateral 1. 2. 3. 4. 5. 6. 7. 8. Calcaneus Talus Navicular Cuboid Cuneiform, First Cuneiform, Second Cuneiform, Third Metatarsal 163 • How many? Metatarsus – 5 small bones • Articulation – Distal – proximal phalanges of the toes – Proximal – tarsals • What is the first metatarsal? – Great toe (Hallux) • How are they identified? – By number laterally from big toe 164 • How many? Phalanges-Toes – 14 • 3 in each digit except the? – Hallux (big toe) 165 Arches of foot • A segmented structure can only hold weight if it is? – Arched • What are the 3 arches of the foot? – Longitudinal – medial and lateral – Transverse arch • What are the functions of these arches? – Strength • What maintains arches? – Interlocking shape of foot bones – Strong ligaments – Tendon pull during muscle activities • Which arch curves above the ground? – Medial longitudinal • Which is very low? – Lateral longitudinal • Where is the weight of the body distributed by these arches? – ½ to heel bones, ½ to heads of metatarsals 166 1. 2. Kneeanterior/ posterior 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. Tibial Collateral Ligament Medial Condyle of Femur Posterior Cruciate Ligament Anterior Cruciate Ligament Lateral Condyle of Femur Fibular Collateral Ligament Lateral Condyle of Tibia Lateral Meniscus Medial Meniscus Medial Condyle of Tibia Tibia Fibula Transverse Ligament 167 168 Basic structure, types, location • What types of cartilage does skeletal cartilage contain? – Hyaline, elastic, fibro • What type of hyaline cartilage is in skeletal? – – – – Articular – covers ends at movable joints Costal – connect ribs to sternum Respiratory – skeleton of the larynx Nasal – support nose • What type is elastic? – External ear – Epiglottis • What type is fibro? – Discs between vertebrae – knee 169 What are the 2 ways cartilage grows? • Appositional – Cartilage-forming cells secrete new matrix against external face of existing cartilage • Interstitial – Chondrocytes divide and secrete new matrix – Expand from within • When does growth end? – During adolescence • Is calcified cartilage bone? – No. Cartilage and bone are always distinct tissues 170 Classification of Bone • What are the 2 groups? – Axial – Appendicular • What is the axial? – Skull, vertebrae, ribs • Appendicular? – Upper/lower limbs, girdles (hips,shoulders) 171 Structure of long bone • Diaphysis – Shaft – Surrounds medullary cavity. Adults – yellow bone marrow • Epiphysis – – – – • Bone ends Interior spongy bone Joint surface – articular cartilage Epiphyseal line – between the diaphysis and epiphysis of adult bone; remnant of epiphyseal plate (hyaline that grows during childhood) Also called metaphysis Membranes – Glistening white outer cover? • periosteum – Where do nerve, blood, lymph enter diaphysis? • Nutrient foramen – Periosteum secured to bone by? • Sharpey’s fibers • What covers internal bone surfaces? – endosteum 172 Structure of short bone • What design do all short, irregular and flat bones share? – Thin plates of periosteum-covered compact bone sandwiching spongy bone in the middle • Short bones have no what? – Shaft or epiphysis • What is the spongy bone called? – Diploe 173 Hemopoietic tissue-red marrow • Where is it found? – Within trabecular cavities in long bone – Diploe of flat bone • What are those cavities called? – Red marrow cavities • Where does blood production occur in adult long bone? – Only in head of femur and humerus • What sites are usually more active and used for obtaining red marrow samples? – Diploe, irregular sites of flat bones (sternum, hip bone) 174 Compact bone • What do canaliculi do? – Tie all the osteocytes in osteon together – Permit nutrients and wastes to enter and exit – Maintain bone matrix • What is interstitial lamellae? – Incomplete lamellae that fill the gaps between forming osteons • What are circumferential lamellae? – Lamellae just deep to the periosteum and superficial to the endosteum, that extend around the entire circumference of the diaphysis and resist twisting of the bone 175 Formation of skeleton • What is the skeleton of human embryo made of before week 8? – Entirely fibrous membranes and hyaline cartilage • What is it called when a bone develops from fibrous membrane? – Intramembranous ossification • What is the bone of this type of formation called? – Membrane bone • What is it called when bone is formed by replacing hyaline cartilage? – Endochondral Ossification • What is this bone called? – Cartilage or endochondral bone 176 Intramembranous Ossification • What bones are formed this way? – – • Skull Clavicle What type of bones formed this way? – • Flat bones What are the 4 major steps? Step One: – What appears in the fibrous tissue? • – Ossification center What do mesenchymal cells do at this stage? • • • Cluster Differentiate into osteoblasts Form the ossification center Step Two: – What do the osteoblasts do at this stage? • – Secrete the osteoid What do trapped osteoblasts become? • osteocytes 177 Intramembranous Ossification (cont) Step 3: – What is formed in step 3? • Woven bone • Periosteum – What is a random network? • Accumulated osteoid laid down between blood vessels – What does this form? • Trabeculae (spongy bone) – What does vascularized mesenchyme condensing on the external face of woven bone become? • The periosteum Step 4: – What does thickened trabeculae just deep to the periosteum form? • Woven bone collar – What is this replaced by? • Mature lamellar bone – What is a diploe? • Compact bone sandwiching spongy bone 178 Endochondral Ossification • What bones are formed this way? – All bones of the skeleton below the base of the skull • What is the model this process uses? – Hyaline cartilage model • When does the process begin? – 2nd month of fetal development • What is the primary ossification center? – The region where long bone formation usually begins • What sets the stage for this process to begin? – Perichondrium infiltrated by blood vessels converting it to periosteum – Mesenchymal cells specialize into osteoblasts 179 Endochondral Ossification (cont) Step 1: • What do the osteoblasts secretions against hyaline cartilage do? – Encase it in a bone collar Step 2: • What does cartilage in the center of diaphysis do? – Calcifies, cavitates (creates cavities) • What do chondrocytes do at this stage? – Hypertrophy (enlarge) – Signal matrix to calcify • What happens to the chondrocytes and the matrix at this stage? – They die – Matrix deteriorates • What happens to cartilage elsewhere? – Remains healthy – Grows briskly • What does this cause the cartilage model to do? – Elongate 180 Endochondral Ossification (cont) Step 3: • What is the periosteal bud? – Collection of elements • • • • • • Nutrient artery Vein Lymphatics Nerve fibers Red marrow elements Osteoblasts, osteoclasts • When does it appear? – The 3rd month of development • What are the osteoclasts and osteoblasts doing at this stage? – Clasts – eroding calcified matrix – Blasts – secreting osteoid around remaining cartilage • What is this forming? – Trabeculae (earliest version of spongy bone) 181 Endochondral Ossification (cont) • Step 4: • What forms in stage 4? – Medullary cavity 182 Joints 183 Classification of joints • What are the 2 ways to classify joints? – Functional – Structural • Functional: – Synarthroses • Immovable (skull) – Amphiarthroses • Slightly movable (intervertebral, pubic symph) – Diarthroses • Freely movable (limbs, joints of limbs) • Structural: – Fibrous • Bones joined by fibrous tissue – no joint cavity • Most immovable or slightly movable 184 Fibrous joints (cont) • 3 types of fibrous joints: • Sutures: – Rigid splices of interlocking bone – Where’s the only place they occur? • Skull • Syndesmoses: – Joints where bones connect by cord or sheet of fibrous tissue called a ligament • Gomphoses: – Resembles peg or socket (teeth) 185 Cartilaginous Joints • Bones connected by cartilage with no joint cavity • 2 types: • Synchondroses– Plate of hyaline cartilage connects the bones – Epiphyseal plates of long bones, joint of 1st rib and manubrium • Symphyses– Bones covered with articular hyaline cartilage fused to fibrocartilage plate. – All amphiarthritic (intervertebral, pubic symphysis) 186 • Articulating bones separated by fluid filled joint • All have: – Hyaline both bony surfaces – Joint cavity – 2 layer joint capsule with outer fibrous layer – Synovial membrane lining fibrous capsule – All internal joint surfaces not covered with cartilage – Synovial fluid fills joint capsule Synovial Joints • May have: – Wedges of fibro separating – Sacs lined with synovial membrane 187 6 types of synovial • Plane – Flat articular surface • Hinge – Similar to door hinge 188 Pivot joints • Rotation of bone on axis • Ulna • atlantoaxial 189 Condyloid joints • Oval surface of one fits into concave of other 190 Saddle joints • Each bone has concave and convex surface • Carpometacarpal of thumb 191 Ball and Socket • Round head of one fits into concave of other • Humerus • femur 192 Joint Injuries • Sprain – Overstretched, torn ligaments • Cartilage – Torn or overused. Does not heal. Must remove • Dislocation – Bones forced out of position • Bursitis – Inflamed bursae, tendon sheath. Overuse, stress, bacterial, friction • Arthritis – Diseases that damage joints. Wear, bacteria, immune 193