The median plane is the midline longitudinal plane dividing the head and torso into right and

left
halves. The presence of the sectioned midline of the vertebral column and spinal cord is char- acter-
istic of this plane. Planes parallel to the median plane are sagittal. Watch out! “Medial” is not a
plane.

The sagittal plane is a longitudinal plane dividing the body (head, torso, limbs) or its parts into left
and right parts (not halves). It is parallel to the median plane.

The coronal or frontal plane is a longitudinal plane dividing the body or its parts into front and
back halves or parts. These planes are perpendicular to the median and sagittal planes.

The transverse or cross plane divides the body into upper and lower halves or parts (cross sec-
tions). This plane is perpendicular to the longitudinal planes. Transverse planes are horizontal
planes of the body in the anatomical position.

Terms of position and direction describe the relationship of one structure on/in the body to an-
other with reference to the anatomical position: body standing erect, limbs extended, palms of the
hands forward, thumbs directed outwardly.

Cranial and superior refer to a structure being closer to the top of the head than another structure
in the head, neck, or torso (excluding limbs).

Anterior refers to a structure being more in front than another struc- ture in the body. Ventral
refers to the abdominal side; in bipeds, it is synonymous with anterior. Rostral refers to a beak-like
structure in the front of the head or brain that projects forward.

Posterior and dorsal refer to a structure being more in back than another structure in the body.
Dorsal is synonymous with posterior (the preferred term) except in quadrupeds.

Medial refers to a structure that is closer to the median plane than another structure in the body.

Lateral refers to a structure that is farther away from the median plane than another structure in the
body.

Employed only with reference to the limbs, proximal refers to a structure being closer to the me-
dian plane or root of the limb than another structure in the limb.

Employed only with reference to the limbs, distal refers to a struc- ture being farther away from the
median plane or the root of the limb than another structure in the limb.

Caudal and inferior refer to a structure being closer to the feet or the lower part of the body than
another structure in the body. These terms are not used with respect to the limbs. In quadru- peds,
caudal means closer to the tail.

The term superficial is synonymous with external, the term deep with internal. Related to the ref-
erence point on the chest wall, a structure closer to the surface of the body is superficial; a structure
farther away from the surface is deep.

Ipsilateral means “on the same side” (in this case, as the reference point); contralateral means “on
the opposite side” (of the reference point).
Bones are connected at joints (articulations). All bones move at joints. Joints are functionally
classified as immovable (synarthroses), partly movable (amphiarthroses), or freely movable (di-
arthroses). Structural classification of freely movable joints can be seen below.

Fibrous joints (synarthroses) are those in which the articulat- ing bones are connected by fibrous
tissue. Sutures of the skull are essentially immovable fibrous joints, especially after having ossified
with age. Teeth in their sockets are fixed fibrous joints (gomphoses). Syndesmoses are partly mov-
able fibrous joints, such as the interosseous ligaments between bones of the fore- arm or the bones
of the leg.

Cartilaginous joints (synchondroses) are essentially immovable joints seen during growth, such
as growth (epiphyseal) plates, and the joint between the first rib and the sternum. Fibrocartilaginous
joints (amphiarthroses) are partly movable (e.g., the intervertebral disc, and a part of the sacroiliac
joint). Symphyses also are partly movable fibrocarlilagious joints, such as between the pubic bones
(symphysis pubis) and the manubrium and the body of the sternum (sternal angle).

Synovial joints (diarthroses) are freely movable within ligamen- tous limits and the bony architec-
ture. They are characterized
by articulating bones whose ends are capped with articular cartilage and are enclosed in a liga-
ment-reinforced, sensitive, fibrous (joint) capsule lined internally with a vascular synovial mem-
brane that secretes a lubricating fluid within the cavity. The synovial membrane does not cover ar-
ticular cartilage.

Synovial or serous fluid-secreting membranes line fibrous tissue pockets (bursa(e) that exist
throughout the body wherever there are areas of frictional contact between two adjacent structures).
These sacs facilitate irritation-free movement. Often associated with synovial joints, several are as-
sociated with the hip, shoulder, and knee joints, to mention but a few.

Ball-and-socket joints are best seen at the hip and shoulder. Movements in all direction are permit-
ted: flexion, extension, adduc- tion, abduction, internal and external rotation, and circumduction.

A hinge joint permits movement in only one plane: flexion/ extension. The ankle, interphalangeal,
and elbow (humeroulnar) joints are hinge joints.

A saddle (sellar) joint (e.g., carpometacarpal joint at the base of the thumb) has two concave articu-
lating surfaces, permitting all motions but rotation.

The ellipsoid (condyloid, condylar) joint is a reduced ball- and-socket configuration in which sig-
nificant rotation is largely excluded (e.g., the bicondylar knee, temporomandibular, and radiocarpal
(wrist) joints).

A pivot joint has a ring of bone around a peg; for example, the C1 vertebra rotates about the dens
of C2, a rounded humeral capitulum on which the radial head pivots (rotates).
Gliding joints
(e.g., the facet joints
of the ver- tebrae, the
acromio- clavicular,
inter- carpal, and
intertarsal joints)
generally have flat
articulat- ing sur-
faces.

Movements of bones occur at joints. Terms of movement are therefore applicable to joints, not
bones (e.g., flexing bones tends to break them!). Ranges of motion are limited by the bony archi-
tecture of a joint, related ligaments, and the muscles crossing that joint. Specific directions of move-
ment can be clearly delineated, and ranges of motion measured, by reference to the anatomical posi-
tion.
Extension of a joint generally means straightening it. In the ana- tomical position, most joints are in
relaxed extension (neutral). In relation to the anatomical position, movements of extension are di-
rected in the sagittal plane. Extreme, even abnormal extension is called hyperextension. At the ankle
and wrist joints, extension is termed dorsiflexion.

Flexion of a joint is to bend it or decrease the angle between the bones of the joint. Movements of
flexion are in the sagittal plane. At the ankle joint, flexion is also called plantar flexion.

Adduction of a joint moves a bone toward the midline of the body (or, in the case of the fingers or
toes, toward the midline of the hand or foot). In relation to the anatomical position, movements of
adduction are directed in the coronal plane.

Abduction of a joint moves a bone away from the midline of the body (or hand or foot). Move-
ments of abduction are directed in the coronal plane.

Circumduction is a circular movement, permitted at ball and socket, condylar, and saddle joints.
Circumduction is character- ized by flexion, abduction, extension, and adduction of the joint done
in sequence.

Rotation of a joint is to turn the moving bone about its axis. Rotation of a limb toward the body is
internal or medial rotation; rotation of the limb away from the body is external or lateral rotation.

Supina- tion is ex-

ternal ro- tation of
the radio- humeral
joint in which the
hand and wrist are
turned palm up.
In the foot,
supination of the
subtalar (talocal-
caneal) joint and
the trans- verse
tarsal joints
(talonav- icular and
calca- neocuboid
joints; see page 40)
moves the sole of the
foot in a medial di-
rection.

Prona- tion is in-

ternal ro- tation of
the radio- humeral
joint in which the
hand and wrist are
turned palm
down. In the foot, pronation of the subtalar and transverse tarsal joints rotates the foot in a lateral di-
rection.

Inversion turns the sole of the foot inward, elevating its medial border, as a result of supination at
the subtalar and transverse tarsal joints and adduction of the forefoot. See Glossary.

Eversion turns the sole of the foot outward, elevating its lateral border as a result of subtalar and
transverse tarsal joint pronation and forefoot abduction.

Bone is a living, vascular structure, composed of organic tissue and mineral. The organic compo-
nent (cells, fibers, extracellular matrix, vessels, nerves) makes up about 35% of a bone’s weight;
65% of the bone’s weight is mineral (calcium hydroxyapatite). Bone functions as (1) a support
structure; (2) a site of attachment for skeletal muscle, ligaments, tendons, and joint capsules; (3) a
source of calcium; and (4) a significant site of blood cell develop- ment. The femur is classified as a
long bone.

The epiphysis is the end of a long bone. The mature epiphysis is largely cancellous bone. Its articu-
lating surface is lined with 3–5 mm of hyaline (articular) cartilage.
The diaphysis is the shaft of a long bone. It has a marrow-filled medullary cavity surrounded by
compact bone that is lined externally by bone cell-forming periosteum and internally by bone-form-
ing endosteum (not shown).

Articular cartilage is smooth, slippery, porous, malleable, insen- sitive, and bloodless; it is the
only remaining evidence of an adult bone’s cartilaginous past. It is the articulating surface in freely
movable joints.

Periosteum is a fibrous, cellular, vascular, and highly sensitive life support sheath for bone, provid-
ing a source of bone cells throughout life.

Cancellous (spongy) bone consists of interwoven beams (tra- beculae) of bone in the epiphyses of
long bones, the bodies of the vertebrae, and other bones without cavities. The spaces among the tra-
beculae are filled with red or yellow marrow (see colorable arrows) and blood vessels. Cancellous
bone forms a dynamic latticed truss capable of mechanical alteration in re- sponse to the stresses of
weight, postural change, and muscle tension.

Compact bone forms the stout walls of the diaphysis and the thinner outer surface of other bones
where there is no articular cartilage (e.g., the flat bones of the skull).

The medullary cavity is the cavity of the diaphysis. It contains marrow: red in the young, turning
to yellow in many long bones in maturity. It is lined by thin connective tissue with many bone-
forming cells (endosteum).

Red marrow is a red, gelatinous substance composed of

red and white blood cells in a variety of developmental forms (hematopoietic tissue), and special-
ized capillaries (sinusoids) enmeshed in reticular tissue. In adults, red marrow is generally limited to
the sternum, vertebrae, ribs, hip bones, clavicles, long bones, and cranial bones.

Yellow marrow is fatty connective tissue that does not produce blood cells.

The nutrient artery is the principal artery and major supplier of oxygen and nutrients to the shaft
or body of a bone; its branches snake through the labyrinthine canals of the haversian systems and
other tubular cavities of bones.

Bone development occurs by intramembranous and/or endochondral ossification. Here we show

longitudinal sections
of developing long bone, demonstrating both forms of ossification but emphasizing endochondral
bone growth.

The endochondral process begins at about 5 weeks after fertilization with formation of cartilage
models (bone prototypes) from embryonic connective tissue. Subsequently (over the next 16–25
years), the cartilage is largely replaced by bone (views 2–8). The rate and dura- tion of this process
largely determines a person’s standing height.
Endochondral ossification begins with a hyaline cartilage model (1). As the cartilage structure
grows, its central part dehydrates.
The cartilage cells there begin to degenerate: they enlarge, die,
and calcify. At the same time, blood vessels bring bone-forming cells (osteoblasts) to the waist of
the cartilage model, and a collar
of bone (2) is formed around the cartilage shaft within the mem- branous perichondrium. This vas-
cular, cellular, fibrous membrane around the bone collar is now called periosteum. The new bone
collar (periosteal bone) becomes a supporting tubular shaft for the cartilage model with its core of
degenerating, calcifying cartilage (3).

Blood vessels from the fibrous periosteum penetrate the bone collar, enter the cartilage model via a
periosteal bud (4), and proliferate, conducting periosteal osteoblasts into the cartilage model (4).
Starting at about 8 weeks post-fertilization, these bone-forming cells line up along peninsulas of
calcified cartilage (5) at the extremes of the shaft (diaphysis) and secrete new bone (5). The calci-
fied cartilage degenerates and is absorbed into the blood. In this manner, endochondral bone re-
places calcified cartilage. The two sites of this activity are called primary centers of ossification.
The direction of growth at these sites is toward the ends of the developing bone. The calcified carti-
lage and some endochondral bone of the diaphysis are subsequently absorbed, forming the
medullary cavity (5). This cavity of the developing tubular bone shaft becomes filled with gelati-
nous red marrow in the fetus. Productive primary (diaphyseal) centers of ossification are well estab-
lished at birth.

Beginning in the first few years after birth, secondary centers of ossification begin at the epiphyses
as blood vessels penetrate the cartilage there (6). The healthy cartilage between the epiphyseal and
diaphyseal centers of ossification becomes the epiphyseal plate (7). Its growth is responsible for
bone lengthening. The grad- ual replacement of this cartilage by bone cells in the metaphysis (7)
thins this plate and ultimately permits fusion of the epiphyseal and diaphyseal ossification centers
(8), ending longitudinal bone growth (at 12–20 years of age). Dense areas of bone at the fusion site
(epiphyseal line) may remain into maturity.

ClassifiCation of Bones
Bones have a variety of shapes and defy classification by shape; yet such a classification histori-
cally exists. Long bones are clearly longer in one axis than in another; they are characterized by a
medullary cavity, a hollow diaphysis of compact bone, and at least two epiphyses (e.g., femur, pha-
lanx). Short bones are roughly cube-shaped; they are predominantly cancellous bone with a thin
cortex of compact bone and have no cavity (e.g., carpal and tarsal bones). Flat bones (cranial
bones, scapulae, ribs) are generally more flat than round. Irregular bones (vertebrae) have two or
more different shapes. Bones not specifically long or short go into this latter category.

Sesamoid bones are developed in tendons (e.g., patellar ten- don); they are mostly bone, often
mixed with fibrous tissue and cartilage. They have a cartilaginous articular surface facing an articu-
lar surface of an adjacent bone; they may be part of a synovial joint ensheathed within the fibrous
joint capsule. The structures are generally pea-sized and are most commonly found in certain ten-
dons/joint capsules in hands and feet, and occa- sionally in other articular sites of the upper and
lower limbs. The largest sesamoid bone is the patella, integrated in the tendon

of the quadriceps femoris. Sesamoid bones resist friction and compression, enhance joint move-
ment, and may assist local circulation.
The axial skeleton, the principal supportive structure of the body, is oriented along its median lon-
gitudinal axis. It includes the skull, vertebrae, sternum, ribs, and hyoid bone. Much of the mobility
of the torso is due to the multiple articulations throughout the vertebral column.

The appendicular skeleton includes the pectoral and pelvic girdles and the bones of the arms, fore-
arms, wrists, hands, thighs, legs, and feet. The joints of the appendicular skeleton make possible a
considerable degree of freedom of movement for the upper and lower limbs. Fractures and disloca-
tions are more common in this part of the skeleton, but often more serious in the axial skeleton.