Skeletal system 2.1 INTRODUCTION The skeletal and muscular systems of the human body form the movement mechanism and perform other functions that are of tremend- ous importance for maintaining life. The skeletal system provides the mechanical levers whose movements are accomplished by contraction of the muscles. Movement of the body is of great interest in ergonomics. To gain an understanding of how this function is accomplished, this chapter presents an overview of the human skeletal system; the muscular system will be described in Chapter 3. Because of its importance in understanding the subject of back injuries, a special emphasis is placed on describing the structure of the spinal column and potential back injuries due to manual materials handling. 2.2 THE SKELETAL SYSTEM The skeletal system consists of all the bones, cartilages, and the joints formed by their attachments to each other by connective tissues (Fig. 2.1). This system is made of three predominant types of tissues (Anthony and Kolthoff, 1975): bone tissues; cartilage tissues; and herhopoietic tissues, which are responsible for forming blood cells. 2.2.1 BONES There are 206 bones in the human body; they are usually classified according to their shapes, as follows (Anthony and Kolthoff, 1975): e Long bones: humerus (in the upper arm), radius and ulna (in the forearm), femur (in the thigh), tibia and fibula (in the lower leg), and phalanges (finger bones, metacarpals in the palm of the hands, toe bones and metatarsals in the feet); © Short bones: carpals (wrist bones) and tarsals (ankle bones);14 Skeletal system | Clavicle - Clavicle ‘Acromion Stemum —— scaputa Humerus i Olecranon, Radius —/ Ulna Femur Patella (knee cap) Anterior view Posterior view Fig. 2.1. The human skeleton. e Flat bones: scapulae, ribs, and the skull; e Irregular bones: vertebrae, sacrum, coccyx, mandible (the lower jaw), and the hyoid bone. The hyoid bone is a single bone in the neck that does not articulate with any other bones. Its U shape can be felt between the mandible and upper part of the larynx, to which the tongue muscle is attached. 2.2.1.1 Gross skeletal structure The human skeleton consists of the following two parts: © Axial skeleton, consisting of the skull (the head, face, and ear bones), hyoid bone, vertebral bones in the spine, the ribs and sternum (breast bone), and the pelvis (Fig. 2.2a). © Appendicular skeleton, consisting of the bones attached to the axial skeleton. It includes the upper and lower extremities (Fig. 2.2b).-TheThe skeletal system 15 Fig. 2.2 The human skeleton consists of two groups: (a) axial skeleton and (b) appendicular skeleton. upper extremities consist of the clavicle and scapula in the shoulder, the humerus in the upper arm, the radius and ulna in the forearm, and the wrist and hand bones, The lower extremities consist of the femur in the thigh, the patella (the knee cap), the fibula and tibia in the lower leg, and the foot bones. 2.2.1.2 Functions of the bones: The skeletal system performs the following critical functions: © supporting the body's framework (structure), preventing the entire body from collapsing into a heap of soft tissues; © providing shells to protect vital organs; for example, the ribeage protects the heart and lungs, and the skull protects the brain; @ allowing movement of the body. The skeletal system provides the mechanical levers for certain groups of muscles whose contraction moves the body; housing bone marrow which produces red blood cells; @ storing calcium and phosphorus. The bones are the greatest calcium and phosphorus reserves of the body, constantly being drawn upon and added to. 2.2.2 CARTILAGE Cartilage is made of a transparent material formed by round cells (cartilage cells), that are embedded and bound together in a firm,16 Skeletal system gel-like, intercellular substance (Anthony and Kolthoff, 1975). Cartilage is firm, elastic, flexible and capable of rapid growth, and plays an important role in supporting the body structure so long as the load is moderate (Astrand and Rodahl, 1986). Cartilage is found between the joints of the spinal column (as intervertebral disks), at the joint surface of the limbs, and at the end of the ribs. Cartilage is avascular; that is, there is not any canal system or blood vessel penetrating the cartilage structure (Anthony and Kolthoff, 1975). Hence, nutrients and oxygen can reach the isolated cartilage cells only by diffusion. The cartilage cells, absorb these vital materials from capillaries in the fibrous covering of cartilage or, in the case of articulating cartilage, from synovial fluid. There are three types of cartilage tissues: © Hyaline cartilage tissue, that covers articular surfaces (where bones join) to cushion the joints against the impact effects of jolts. The word hyaline is a Greek term, meaning glassy. It resembles milk glass in appearance. © Fibrous cartilage tissue has the greatest rigidity and tensile strength of the three types of cartilage tissue. The ribcage is mainly made up of this type of cartilage tissue. The intervertebral disks are also fibrocartilages. © Elastic cartilage tissue has both elasticity and firmness. The cartilage that protrudes from the body is of this type (e.g., ears and nose). 2.2.3 JOINT ARTICULATIONS A joint is the junction between two or more bones. The types of joint movements are determined by bone shapes and joint structures, For example, where free movements are desirable, the bone shape and joint structure facilitate unhampered and smooth movements. Where only slight movements are required, the bones are so shaped and joints so constructed as to permit only slight movements. Based on their functions, joint articulations are divided into the following two types (Anthony and Kolthoff, 1975): © Diarthroses (or diarthrotic joints): in a diarthrotic joint a small space exists between the articulating surfaces of the two joined bones. Since no other tissues grow in this cavity, the surfaces move freely against one another. Hence, they are functionally defined as freely movable joints, Specific examples of diarthrotic joints include ball-and-socket joints (Fig. 2.3a) and hinge joints (Fig. 2.3b). Other classifications of diarthrotic joints can be found in anatomy textbooks. © Synarthroses (or synarthrotic joints): a synarthrotic joint does not have a joint cavity. Fibrous cartilage or bone tissues grow between the articulating surfaces of the two joined bones and make them unable toJoint movements 17 ) Fig: 2.3 (a) Balland-socket joint (e.g., in the shoulder); (b) hinge type of joint (e.g., in the elbow). move freely against one another. Therefore, they are functionally defined as immovable (or slightly movable) joints that do not allow free movement. Examples of synarthrotic joints are the skull joints. 2.3 JOINT MOVEMENTS The freely movable joints (diarthroses) can perform one or more of the following joint movements: flexion, extension, abduction, adduction, rotation, circumduction, pronation, and supination. These movements are described as follows: Extension and flexion: Flexion is a movement which decreases the angle between two bones. It is also referred to as bending or making an angle. Extension is a stretching or straightening movement which increases the angle between two bones. Figure 2.4 illustrates extension and flexion movements of joints. ¢ Abduction and adduction: Abduction means moving away laterally from the central axis of the body (e.g., the median plane). Adduction means moving toward the central axis of the body (e.g., the median plane). Figure 2.5 illustrates abduction and adduction movements of joints. © Circumduction is an action which involves flexion, abduction, extension, and adduction, in sequence. The moving segment describes the surface of a cone. © Rotation is a movement of a bone around its long axis, such as the rotation of the humerus in the upper arm. Figure 2.6 illustrates the rotation of the elbow in which the radius rotates around the ulna.18 Skeletal system WA OG Elbow flexion _ Elbow extension ‘Thumb flexion a extension Shoulder flexion Shoulder extension © Fig. 2.4 Flexion and extension of (a) the elbow; (b) the thumb; (c) the shoulder. ¢ Pronation and supination: Pronation is a medial rotation (or inward rotation) of a body member. For example, medial rotation of the forearm (Fig. 2.7a) brings the palm of the hand downward (facing the ground). Supination is a lateral (or outward) rotation of a body member. For example, lateral rotation of the forearm (Fig. 2.7b) brings the palm of the hand upward (facing up). 2.4 THE BACK STRUCTURE The back is a complex structure that is made of: © muscles; @ bones (vertebrae and their processes); e intervertebral disks; @ ligaments; e tendons; e blood supply; e the spinal cord and branched nerves. Figure 2.8 illustrates the structure of the spinal column, which is a stack of 33 (in some 34) vertebrae (seven cervical, 12 thoracic, five