UNIT 2 (Skeletal System)

Arbaminch College of Health Sciences
Department of Clinical Nursing

Unit Two
Skeletal system
2.1 Introduction to skeletal system
The word skeleton comes from the Greek word skeleton meaning “dried up”. It is strong yet
light, adapted for its function of body protection and motion. The skeletal system includes
bones, joints, cartilages and ligaments. The joints give the body flexibility and allow
movement to occur. From the structural point of view, the human skeletal system consists of
two main types of supportive connective tissue, bones and cartilages.
Osteology – is a science which study about bones or the skeletal system in general.
2.2.Functions of the skeletal system
The skeleton serves six major functions.

1. Support
The skeleton provides the framework which supports the body and maintains its shape. For
instance, without the ribs, costal cartilages, and the intercostal muscles the lungs would
collapse.
2. Movement
The joints between bones permit movements. Movement is powered by skeletal muscles,
which are attached to the skeleton at various sites on bones. Muscles, bones, and joints
provide the principal mechanics for movement, all coordinated by the nervous system.
3. Protection
The skeleton protects many vital organs:
 The skull protects the brain, the eyes, and the middle and inner ears.
 The vertebrae protects the spinal cord.
 The rib cage, spine, and sternum protect the lungs, heart and major blood vessels.
 The clavicle and scapula protect the shoulder.
 The ilium and spine protect the digestive and urogenital systems and the hip.
4. Blood cell production
The skeleton is the site of haematopoiesis (blood cell production), which takes place in red
bone marrow. Marrow is found in the center of long bones.
5. Storage
Bone matrix can store calcium and is involved in calcium metabolism, and bone marrow can
store iron in ferritin and is involved in iron metabolism. Fat is also stored in the internal
cavities of bones.
6. Endocrine regulation
Bone cells release a hormone called osteocalcin, which contributes to the regulation of
blood sugar (glucose) and fat deposition. Osteocalcin increases both the insulin secretion
and sensitivity, in addition to boosting the number of insulin-producing cells and reducing
stores of fat.
2.3. Introduction to bone
Bone tissue is a type of highly specialized dense connective tissue. Because bones come
in a variety of shapes and have a complex internal and external structure they are
lightweight, yet strong and hard, in addition to fulfilling their many other functions. One of
the types of tissue that makes up bone is the mineralized osseous tissue, also called bone
tissue, that gives it rigidity and a honeycomb-like three-dimensional internal structure.
Other types of tissue found in bones include marrow, endosteum and periosteum, nerves,
blood vessels and cartilage. There are 206 bones in the adult human body and 270 in an
infant.
Prepared by: Mesfin Beyene (PHO) 12

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The biggest bone in the human body is the femur in the thigh & the smallest is the stapes
bone in the middle ear. All bones consist of living and dead cells embedded in the
mineralized organic matrix that makes up the osseous tissue.
2.3.1. Types of bones by shape and size

 The bones of the skeleton are classified in to five principal types based on shape
1. Long bones
o Their length is greater than their width
o Are tubular
E.g. Most lower limb bones (eg. femur) and upper limb bones (eg. Humerus)
2. Short bones
o Are about equal in length, width and thickness and are some what cube like shaped.
They occur in Wrists (Carpals) and ankles (Tarsals).
3. Flat bones
o Are thin and have broad dense surface for muscle attachment and protection
E.g. Bones of the cranium (parietal bone) ribs, sternum, scapulae
4. Irregular bones
o Have varied shapes and many surface markings for muscle attachment
o Do not fit nearly into any of the above other category
E.g. vertebral, facial and hip bones.
5. Sesamoid (round) bones
Are usually small and nodular, embedded with in tendons adjacent to joints, where the
tendons are compressed. The typical examples are Patella (knee cap) and Pisiform (carpal
bone).
2.3.2. Types of bones by cell arrangement
 Based on the relative amount of solid matter, the number and size of the space
A) Compact (Cortical) bone
 Compact bone tissue is the very hard and dense part which forms the outer
sheet of a bone.
 Contains cylinders of calcified bone known as osteons (Haversion system),
which are made up of a seemingly arranged concentric layers called
Lamellae. The house of osteocytes(bone cells) known as Lucunae /little
space/ are contained here.
 Osteons contain a central canal (Haversion canal), which are a longitudinal
canals that contains blood vessels, nerves & lymphatic vessels. Central
canals usually have horizontal branches called perforating (Valkmann’s)
canal extending the system of nerves & vessels outward to the periosteum &
endosteum.
 Compact bone provides strength and resistant to bending
B) Spongy (cancellous) bones
 Spongy (cancellous) bone tissue, also named as Trabecular bone tissue is in the
form of an open interlaced pattern which is composed of a network of rod- and plate-
like elements that make the overall organ lighter and allow room for blood vessels
and marrow.
 The microscopic difference between compact and cancellous bone is that compact
bone consists of haversian sites and osteons, while cancellous bones do not. Also,
bone surrounds blood in the compact bone, while blood surrounds bone in the
cancellous bone.

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Gross anatomy of typical long bones
 Figure showing parts of a long bone
End of long
Outer most layer bone
of the bone
Hard layer of bone tissue under

periosteum Shaft of long bones
Epiphysis
 Is a roughly spherical end of the bone
 At each end are cornered with a reticular cartilage and articulate with other bones
 It is wider than the shaft
 Is secondary ossification center
Metaphysis
 Is the part separating the diaphysis from the epiphysis
 Broader than diaphysis
 It is made up of epiphyseal plates and adjacent bony trabeculae of spongy
(cancellous) bone tissue
Diaphysis
 Is the middle of the bone
 Is the tubular shaft, a hollow cylinder with walls of compact bone tissue
 The center of the cylinder is the modularly cavity with is filled with marrow
 Is primary ossification center
Epiphyseal plate
 Is a thick plate of hyaline cartilage, which provides the frame work of synthesis of the
spongy (cancellous) bone tissue with in metaphysics.
 The medullary cavity running through the length of the diaphysis contains yellow
marrow
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 The porous lattice work of the spongy epiphysis is filled with red bone marrow. The
red marrow also known as myeloid tissue.
 Endosteum is the lining of the medullary cavity consisting of compact bone fissure and
covering the trabeculae of spongy bone tissue
 Periosteum is the covering of the outer surface of the bone, It is absent at joints and
replaced by articular cartilage
2.3.3. Bone cells

:Bone contains five types of cells
a. Ostegenic (osteoprogenitor) cells

 A small spindle shaped cells found in periosteum and endosteum
 They have high mitotic potential and can be transformed in to bone forming
cells ( osteoblasts)
b. Osteoblasts
 Found in the growing portion of a bone which synthesize and secrete osteoids
(are protein mixtures which later mineralized to be a bone).
c. Osteocytes
 Mature cells derived from osteoblasts
 Their functions include to varying degrees: formation of bone, matrix
maintenance and calcium homeostasis. They have also been shown to act as
mechano-sensory receptors — regulating the bone's response to stress and
mechanical load. They are mature bone cells..
d. Osteoclasts
 are the cells responsible for bone resorption (remodeling of bone to reduce its
volume). Osteoclasts are large, multinucleated cells located on bone surfaces
derived from white blood cells called monocytes. Because the osteoclasts are
derived from a monocyte stem-cell lineage, they are equipped with phagocytic-
like mechanisms similar to circulating macrophages. Osteoclasts mature and/or
migrate to discrete bone surfaces.
e. Bone - lining cells
 Found on the surface of most bones, which derived from osteoblasts that ceased
their physiological activity.
 They cover all of the available bone surface and function as a barrier for certain
ions.
2.3.4. Bone formation (Osteogenesis)
The formation of bone during the fetal stage of development occurs by two processes:
Intramembranous ossification and endochondral ossification.
1.Intramembranous ossification
Intramembranous ossification mainly occurs during formation of the flat bones of the skull
but also the mandible, maxilla, and clavicles; the bone is formed from connective tissue
such as mesenchyme tissue rather than from cartilage. The steps in intramembranous
ossification are:
1. Development of ossification center
2. Calcification
3. Formation of trabeculae
4. Development of periosteum

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2. Endochondral ossification
Endochondral ossification, on the other hand, occurs in long bones and most of the rest of
the bones in the body; it involves an initial hyaline cartilage which continues to grow. The
steps in endochondral ossification are:
1. Development of cartilage model
2. Growth of cartilage model
3. Development of the primary ossification center
4. Development of the secondary ossification center
5. Formation of articular cartilage and epiphyseal plate
Endochondral ossification begins with points in the cartilage called "primary ossification
centers." They mostly appear during fetal development, though a few short bones begin
their primary ossification after birth. They are responsible for the formation of the diaphyses
of long bones, short bones and certain parts of irregular bones. Secondary ossification
occurs after birth, and forms the epiphyses of long bones and the extremities of irregular
and flat bones. The diaphysis and both epiphyses of a long bone are separated by a
growing zone of cartilage (the epiphyseal plate). When the child reaches skeletal maturity
(18 to 25 years of age), all of the cartilage is replaced by bone, fusing the diaphysis and
both epiphyses together (epiphyseal closure).
 Factors affecting bone development, growth and repair
 Nutrition
 Exposure to sunlight
 Hormonal secretions
 Physical exercise
- Insufficient secretion of pituitary growth hormone may result in dwarfism, excessive
secretion may result in gigantism, or acromegally
- Deficiency of thyroid hormones delays bone growth
- Male and female sex hormones promote bone formation and stimulate ossification of
epiphyseal discs
- Deficiency of vit - A,C, or D result in abnormal bone development
- Vit D is necessary for proper absorption of calcium in the small intestine. Without this
vitamin, calcium is poorly absorbed the inorganic salt portion of the bone matrix lacks
calcium and bones are deformed. In children, this condition is called rickets, and in
adults it is called ostemoalacia
2.3.5. Functions of Bone:

1. Mechanical
 Protection
 Shape :-Bones provide a frame to keep the body supported.
 Movement :-
 Sound transduction:- Bones are important in the mechanical aspect of overshadowed
hearing.
2. Synthetic
 Blood cell production —
3. Metabolic
 Mineral storage — Bones act as reserves of minerals important for the body, most notably calcium
and phosphorus.
 Growth factor storage — Mineralized bone matrix stores important growth factors such as insulin.
 Fat Storage - The yellow bone marrow acts as a storage reserve of fatty acids.
 Acid-base balance -Bone buffers the blood against excessive pH changes by absorbing or
releasing alkaline salts.
 Endocrine organ – as discussed earlier bones secrete a hormone known as Osteocalcin.

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2.4. The Skeleton
The human skeleton consists of both fused and individual bones supported and supplemented by
ligaments, tendons, muscles and cartilage. In an adult, the skeleton comprises around 30-40% of the
total body weight, and half of this weight is water.
Fused bones include those of the pelvis and the cranium. Not all bones are interconnected directly:
there are three bones in each middle ear called the ossicles that articulate only with each other. The
hyoid bone, which is located in the neck and serves as the point of attachment for the tongue, does
not articulate with any other bones in the body, being supported by muscles and ligaments.An adult
human skeleton have 206 named bones that are grouped in to two principal parts: Axial and
Appendicular skeletons.
2.4.1. Axial skeleton
The axial skeleton (80 bones) is formed from bones that lies along the axis of the body by including
the vertebral column (26), the thoracic cage (12 pairs of ribs and the sternum), and the skull (22
bones and 7 associated bones).
The axial skeleton transmits the weight from the head, the trunk, and the upper extremities down to
the lower extremities at the hip joints, and is therefore responsible for the upright position of the
human body. Most of the body weight is located in back of the spinal column which therefore have the
erectors spinae muscles and a large amount of ligaments attached to it resulting in the curved shape
of the spine. The 366 skeletal muscles acting on the axial skeleton position the spine, allowing for big
movements in the thoracic cage for breathing, and the head.
2.4.2 Appendicular skeleton
The appendicular skeleton (126 bones) is formed by the pectoral girdles (4), the upper limbs (60), the
pelvic girdle (2), and the lower limbs (60). Their functions are to make locomotion possible and to
protect the major organs of locomotion, digestion, excretion, and reproduction.
Table 2.4.3.: Bones included in axial and appendicular skeleton
Axial skeleton Appendicular skeleton

Skull (29 bones)
Cranium ……………………………..8 Upper extremities (64 bones)
Parietal (2) Pectoral (shoulder ) girdle…..4
Temporal (2) - Clavicle (2)
Frontal (1) - Scapula (2)
Ethmoid (1) Arm………………………….2
Sphenoid (1) - Humerus (2)
Occipital (1) Fore arm ……………………….4
Face……………………………………….14 - Ulna (2)
Maxillary (2) - Radius (2)
Zygomatic (molar) (2) Wrist …………………………….16
Lacrimal (2) - Carpals (16)
Nasal (2) Hand and fingers ……………….38
Interior nasal conchii (2) - Mefacarpals (10)
Palatine (2) - Phalanges (28)
Mandible (1)
Vomer (1) Lower extremities (62 bones)
Ossicles of ear………………………6
Malleus (hammer) (2) Pelvic girdle (fused ileum ischium, pubis) -2
Incas (anvil) (2) Tigh ………………………………..4
Stapes (stirrup) (2) - Femur (2)
Hyoid …………………………………1 - Patella (2)
Vertebral column (26 bones) Leg …………………………………..4
Cervical vertebrae …………………..7 - Tibia (2)
Thoracic “ …………………..12 - Fibula (2)
Lumbar “ ……………………5 Ankle ………………………………..14
Sacrum (5fused bone) ………………1 - Tarsals (14)
Coccyx (3-5) fused bones ……………1 Foot and toes …………………….38
Thorax (25 bones) - metatarsals (10)
Ribs ……………………………………24 - Phalanges (28)
Sternum ………………………………..1
Total axial bones = 80 Total appendicular bones = 126

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2.4.4. Bones of axial skeleton
2.4.4.1. Skull bones

 Consist cranial and facial bones
 Posses sinuses (frontal, maxillary, ethmoidal and sphenoidal)
- Helps to reduce weight of skull and give resonance to voice
 Have foramina to permit passage of blood vessels, nerves and other structures
 Foramen magnum is the largest of all which allows part of brain, spinal cord and
vertebral vessels
A). Cranial bones(Calvaria)(Braincase)
- Protects brain
- Composed of 8 flat bones (fibrous joints in adults and fontanels in new born connect
or located in b/n the bones)
- Cranium root vault calvaria/ skull cap
Is made from frontal bone
 Parietal bones
 Occipital bone
Floor /base
Is made from sphenoid
 Ethmoid
 Occipital
Frontal bone (1) :- Anterior & superior parts of cranium, forehead and brow areas.
Parietal bones (2):- Forms superior sides and roof of cranium, b/n frontal & occipital bones.
- Coronal suture separates it from frontal bone & lambdoidal suture from occipital bone
Occipital bone (1):- Forms back (posterior part) and much of the base of the skull
Temporal bones (2):- Forms the lower sides of the cranium
- It made from four parts
a. Squamous part
- Flattened plate at the side of the skull
b. Tympanic part
- contains external acoustic meatus and styloid process
c. mastoid part
- The part on which mastoid process projects
d. Petrous part
- Houses the structures of middle and inner ear
Sphenoid bone (1):- Forms base of cranium, located anterior to occipital and temporal bones
- Key stone bone (all other bones articulate with it)
- Shaped like bat with out stretched wings with its 3parts: body, greater & lesser wings
- Houses pituitary gland (in the depression called the sella turcica); contains foramina(holes)
for cranial nerves, meningeal artery &veins.
Ethmoid bone (1):- Forms base of cranium, lies anterior to body of spheniod
- Forms orbits and root of nasal cavity and nasal septum
Features of cranial bones

Sutures
 Meaning to stitch, sutures are immovable joints found between skull bones except
the mandible contact with the cranium
 Are fibrous joints where cranial bones meet
There are four main sutures in the skull
A. Coronal suture :- B/n the frontal and the two parietal bones
B. Sagital suture :- B/n the two parietal bones
C. Lambdoidal suture :- B/n two parietal bones and occipital bone
D. Squamosal suture :- B/n parietal bones and temporal bones

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 Anatomy of fetal skull

- Fontanels
- The skeleton of a newly formed embryo consists of cartilage or fibrous membrane
structures, which are gradually replaced by bone through the process called ossification. At
birth, the cranial bones are connected by areas of fibrous connective tissue. These
connections are quite flexible, and the skull can be distorted without damage. Such
distortion normally occurs during delivery & eases the passage of the infant through the birth
canal. At birth, the membrane filled spaces on the skull are called Fontanels, are areas
where sutures meet.
- Function of fontanels
 They enable the skull of the fetus to compress as it passes through the birth
canal (permit molding during birth)
 Permit the rapid growth of a brain during infancy
 Serves as a land mark (anterior fontanel) for withdrawal of blood from the
superior sagital sinus
 Aid in determination of fetal position prior to birth
In the skull of the fetus there are six prominent fontanels
a. Anterior (frontal) fontanel
 Is b/n the angle of two parietal bones and the segment of the frontal bone
 It is diamond shaped and is the largest fontanel
 It closes 18 to 24 months after birth
b. Posterior (occipital) fontanel

 Is b/n parietal and occipital bones
 Smaller than the anterior fontanel
 It closes 2 months after birth
c. Anterolateral (sphenoidal) fontanels

 Are a pair, one on each side
 They are found at the junction of frontal, parietal, temporal and sphenoidal
bones
 Small and irregular in shape
 Close of the third (3rd ) month after birth
d, Posterolateral (mastoid) fontanels
 Are paired, one on each side
 Found at the junction of parietal, occipital and temporal bones
 Irregular in shape
 Begin to close at 1 or 2 months after birth and completely by 12 months
B). Facial bones(Viscero cranium):

 Consists of about 14 bones.
 Provide the basic shape of the face.
 All are paired except vomer and mandible.
Lacrimal(2): - medial wall of orbit, contains depression for lacrimal sacs & nasolacrimal tear duct
Inferior nasal conchii(2): - lateral walls of nasal cavities, which is a thin, cancellous & shaped
like curved leaves
Mandible(lower jaw)(1): - is the largest & strongest facial bone. Forms lower jaw, part of the
temporomandibular joint; site of attachment for muscles
Maxillae(upper jaw)(2): - Forms upper jaw, front of hard palate & part of eye sockets.
Nasal(2): - upper bridge of nose, attached to nasal cartilage
Palatine(2): - posterior part of hard palate, floor of nasal cavity & orbit; posterior to maxillae.
Vomer(1): - forms posterior & inferior nasal septum dividing nasal cavities
Zygomatic(molar)(2): - cheekbones, below and lateral to orbits of the eye.

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2.4.4.2. Ossicles of ear (Auditory Ossicles)

 Three auditory ossicles in the middle ear of each ear; Malleus(hammer), Incus(anvil) &
Stapes(stirrup).
 Inside cavity of petrous portion of temporal bones.
 Helps to transmit sound impulses from ear drum to oval window.
2.4.4.3. Hyoid bone:
 Located below root of tongue, above (superior) to larynx.
 U- Shaped & is site of attachment for muscles used in speaking and swallowing.
 Does not articulate with any other bone.
2.4.4.4. Vertebral column:

 It is also called spinal(back)column and it extends from skull to pelvis
 Composed of a total of 26 vertebral bones, but during early development they were
33 bones.
 If composes 2/5th of the height of the body and has an average length in males of 71
cms, and in females 61 cm.
 The cervical, thoracic & lumbar vertebras are movable, but the sacral & coccygeal
are immovable.
 It is strong and flexible in either direction and rotates on it self.
Have four normal curvatures in adults:
 Cervical, thoracic and lumbar curves are identified by type of vertebrae they contain and
pelvic (sacral) curve is formed by the shape of sacrum and coccyx.
 In the fetus the vertebral column is C-shaped with the concavity facing anteriorly. There is
only a single anterior curve (concave).
 After birth at an approximately the 3rd post natal month, when the child begins to hold its
head erect, the cervical curve develops.
 Later when the child sits up, stands and walks (the legs starts weight bearing) the lumbar
curve develops.
 The cervical and lumbar curves are anteriorly convex and b/c they are modifications of the
fetal positions, they are called secondary curves.
 The thoracic and pelvic (sacral) curves are anteriorly concave and since they retain the
anterior concavity of the fetal curve they are refereed to as primary curves.
The curves function in :-
- increasing the strength
- helps in maintaining balance in the upright position
- absorbs shock during walking & running
- Protection of vertebral column from fracture.
Abnormal curvatures include:-
- Scoliosis ( abnormal lateral curvatures)
- Kaposi’s (abnormal posterior curvature – hunch back)
- Lordosis (abnormal anterior curvature – sway back)
Functions of the vertebral column.
- Supports head, trunk and upper extremities.
- Allowing movement by rotating and moving forward, backward & sideways.
- Protects spinal cord and nerves.
- Provide attachment for muscles, ribs and vertebral structures.
Intervertebral Discs:-
- Between adjacent vertebrae from 2nd cervical to sacrum there are intervertebral discs
which are composed of fibro cartilage.
- Each disc is composed of an outer fibrous ring consisting of fibro-cartilage called
annulus fibrosis.
- The inner soft, pulpy highly elastic structure called nucleus pulpous.

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Cervical vertebrae(7)
- The 1st cervical vertebrea is called Atlas
o Atlas supports head, permits “Yes” motion of head at joint b/n skull and Atlas.
- The 2nd C.V is called Axis.
o Permits “No” Motion in at joint b/n Axis and Atlas.
Thoracic vertebrae(12)
- Are relatively larger & stronger than cervical vertebras & articulate with ribs.
- Allow limited mov’t of spine in thoracic area, due to their attachment to the sternum.
Lumbar vertebrae(5)
- Largest and strongest vertebrae
- Support back muscles by their distinct short & thick projections.
- Allow forward and back ward bending of spine.
Sacrum (1)
- Triangular shaped bone located b/n hip bones posterior to lumbar vertebrae
- It has 5(five) fused bones and decreases in size down.
- Support vertebral column & serves as a strong foundation for pelvic girdle
Coccyx (1)
- It is a small triangular tail bone formed by fusion of 4 coccygeal vertebrae which
usually occurs b/n age of 20-30 years.
- Vestige of an embryonic tail.
2.4.4.5. Thorax
- Superior part of the trunk, it is b/n the neck & abdomen.
- The thorax refers to the chest & the skeletal portion of it is known as thoracic cage; i.e.
formed by the sternum (breast bone), costal cartilage, ribs and bodies of the thoracic
vertebra.
- The thoracic cage encloses & protects the organs in the thoracic cavity & the upper
abdominal cavity. It also provides support for the bones of shoulder girdle & upper
limb
i. sternum (breast bone)
_ Is a flat bone, located in the median line of the anterior thoracic wall.
 Has 3 fused bones: manubrium (superior portion), body (middle & largest portion), and xiphoid
process (inferior & smallest portion).
 On its side it has costal and clavicular notches and superiorly jugular notch.
 The junction b/n the manubrium & the body forms the sternal angle, which is the major surface
landmark used by clinicians in performing physical examination of the thorax.
_ The mabubrium on its superior portion has a depression called the jugular (supra sternal) notch.
 On each side of the jugular notch are clavicular notches that articulate with the medial end of the
clavicle.
- The manubrium also articulates with the 1st and 2nd ribs.
- The body of the sternum articulates directly or indirectly with the 2 nd to 10th ribs.
- Xiphoid process consists of hyaline cartilage during infancy & childhood and does not ossify
completely until age of 40years.
ii. Ribs:
- 12 pairs
- Connect directly to corresponding thoracic vertebrae in the back (posteriorly).
 Ribs increase in length from the 1st through to the 7th and decrease in length through the 12th.
- The space b/n ribs, called intercostal spaces, are occupied by intercostals muscles, blood
vessels and nerves.
 Types of Ribs:
= By attachment with sternum
1. True ribs (vertebro –sternal ribs)
- Ribs 1st -7th
- Attach to sternum via their own costal cartilage
- Anteriorly the 1st seven ribs have direct attachment to the sternum by costal cartilages hence
they are called true ribs.
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2. False ribs (vertebro –chondral ribs)
- Ribs 8th -10th
- Their costal cartilage joins the superior rib costal cartilage
 Sternal connection is indirect
 Their cartilages attach one on other and then attach to the cartilage of the 7 th rib
3.Floating ribs
- Ribs 11th and 12th
- Don’t connect with the sternum or other costal cartilage
- End at abdominal musculature
- Their anterior part doesn’t attach even indirectly to the sternum
= By shapes and parts (head, neck, Tubercles, shaft)
1. Typical ribs
- ribs 3rd to 9th
2. Atypical ribs
- 1st, 2nd, 10th to 12th
- are dissimilar
2.4.5 . Bones of the Appendicular skeleton

The appendicular skeleton is composed of 126 bones in the human body. The word
appendicular is the adjective of the noun appendage, which itself means a part that is joined
to something larger. Functionally it is involved in locomotion (Lower limbs) of the axial
skeleton and manipulation of objects in the environment (Upper limbs).
The appendicular skeleton is divided into six major regions:
(1) Pectoral Girdles (4 bones) - Left and right Clavicle (2) and Scapula (2).
(2) Arm and Forearm (6 bones) - Left and right Humerus (2) (Arm), Ulna (2) and Radius (2)
(Fore Arm).
(3) Hands (58 bones) - Left and right Carpal (16) (wrist), Metacarpal (10), Proximal
phalanges (10), Middle phalanges (8), distal phalanges (10), and sesamoid (4).
(4) Pelvis (2 bones) - Left and right os coxae (2) (ilium).
(5) Thigh and leg (8 bones) - Femur (2) (thigh), Tibia (2), Patella (2) (knee), and Fibula (2)
(leg).
(6) Feet (56 bones) - Tarsals (14) (ankle), Metatarsals (10), Proximal phalanges (10), middle
phalanges (8), distal phalanges (10), and sesamoid (4)
2.4.5.1. The Pectoral girdle

Pectoral girdle (shoulder girdle)
 This bones are attached only anteriorly to the axial skeleton on sternum
 Connects the appendicular skeleton to the axial bones
 Functions in muscle attachment and movement of arm and fore arm
The bones of pectoral (shoulder) girdle are:-
- Clavicle and scapulae
Clavicle
 Is also named as Collar bone
 Double curved long bone (which gives it “S” shape) with rounded medial and
flattened lateral end held in place by ligaments
 The clavicle holds the upper limb(UL) away from the trunk and allows it to have a
wide range of movements in the shoulder region
 It has two curves, the lateral third being concave forward and the medial two thirds
convex forward
 The junction b/n the two curves is the weakest point and is the commonest site of
clavicular fractures
 Medially the clavicle articulates with the sternum at the sternoclavicular joint and
laterally with the acromion of the scapula at the acromioclavicular joint

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Clavicle has a no of unusual features
 It has no medullary cavity as being a long bone
 It is the 1st bone to start ossifying in the fetus (5th _ 6th wks)
 It is the only long bone which ossifies in membrane
 It is subcutaneous through out and the most commonly fractured bone in the body
The clavicle has three main functions

 Transmit shock (forces) from the UL to axial skeleton
 Support and give freedom of movement for the UL
 Protect neurovascular bundle of the UL (brachial plexus)
Scapula (shoulder blade)

 Flat triangular bone, which lies on the posteriolateral aspect of thorax
 Lies b/n 2nd and 7th ribs
 Site of attachment for muscles of arm and chest
 At its lateral angle (superiolaterally) bears a large shallow oval depression called
Glenoid cavity (socket for humeral head) and articulate with the head of the humerus
forming shoulder joint
 Scapula is rarely fractured only by direct and strong violence b/c of the strong outer
muscular coverings
Parts
 The body has two surfaces
 Anterior (costal) Smooth Subscapular fossa
 Posterior (dorsal)  Upper part gives off a large projection called the spine
 The space above the spine called supraspinous and below it infraspinous
 The body of the scapula has:
o Three angles: superior, inferior and lateral
o Three borders: medial, lateral and superior
o Three processes: the spinal, acromion and coracoid process

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2.4.5.2. Bones of the Upper Limb(UL)
ARM (BRACHIUM)
 The arm is the part b/n the shoulder and elbow

 Its bone is the humerus
Humerus
 Largest and longest bone in the UL
 Articulates with scapula at Scapulo - Humeral joint at shoulder and with radius and
ulna at Elbow
 Forms ball and socket joint with glenoid fossa of scapula
 Site of attachment for muscles of shoulder and arm
 Permitting hand to flex and extend at elbow
Parts
 Head
o Articulates with the glenoid cavity of scapula
 Anatomical neck
o Formed by the groove circumscribing the head and separating it from the greater and
lesser tubercles
o It is the former site of Epiphyseal plate
 Greater/ lesser tubercles
o Greater tubercle at the lateral margin of the humerus
o Lesser tubercle  projects anteriorly from the bone
 Inter tubercular sulcus (biceptal groove)
o Separates the tubercles & is insertion site for tendon of long head of biceps
 Surgical neck
o Common site of proximal humerus fracture
o Narrow part distal to the tubercles and the crests descending from them, flanking the
inter tubercular groove
 Deltoid tuberosity
o A roughened, V-shaped area found on the body of humerus
o Used for attachment of the deltoid muscle
 Oblique redial groove
o For radial nerve and deep artery of the arm
 Epicondyles  distal end(lateral & medial) for muscle attachment

 Trochlea
 Capitulum constitute the condyle of the humerus
 Fossa
o Olecranon fossa  For olecranon process of the ulna (extension )
o Coronoid fossa  for coronoid process of ulna (on flexion)
o Radial fossa  for head of radius (for fully flexed fore arm)
Condyle  Capitulum (lateral) of humerus  for alticulation with head of radius

&
Trochlea (medial) of Humerus  for articulation with trochlear notch of Ulna  Elbow joint
FORE ARM
- Located between the elbow and wrist

- Ulna + Radius

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Radius
- is lateral and shorter of the two
 Head  Proximal end
Concave, for articulation with the capitulum of humerus during flexion and
Extension of the elbow joint
 Radial tuberosity
- For insertion of biceps brachii
 Neck
- Located b/n the head and the radial tuberosity
 Ulnar notch of radius
- At its distal end
- Which accommodates the head of the ulna  Distal radio - ulnar joint (inferior)
 Styloid process of radius (radial styloid process)
- Larger than the ulnar styloid process
Ulna
- Medial and longer one of the fore arm bones
 Parts
 Olecranon process
 Located on the proximal end & fits with olecranon fossa of humerus
 Has 2 proximal projections, which projects proximally from its posterior aspect
 For insertion of 3 heads of triceps brachii (all)
 Coronoid process
 which projects anteriorly
 Trochlear notch
 Looks a pipe - wrench & it is a part which articulates with the trochlea of humerus
 Radial notch of ulna
 Found at its proximal end and on the lateral side of coronoid process
 Smooth rounded concavity
 Articulates with the head of the radius proximal (superior) radio ulnar joint
Body
 Taper to the end  disc like head
Styloid process
 At its narrow distal end
Ulnar head
 A small, conical
The hand
 Consists of the
 Wrist (carpus)
 Hand Proper (metacarpus)
 Digits (phalanges)
Carpus
 Short bones
 Composed of 8 (eight) carpal bones (in each wrist)
 Arranged in two transverse rows of 4 bones
Table 2.4.5.2.1. : The row arrangement of carpal bones of a hand
Proximal row (lateral to medial) Distal row (lateral to medial)
Scaphoid  boat shaped Trapezium  four sided

Lunate  moon shaped Trapezoid  Wedge shaped
Pisiform  small pea shaped Capitate  rounded head

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Triquetrum  Three cornered Hamate  wedge shaped, has hook
Metacarpus
o There are five metacarpals in each hand, which are groups of long bones
o Aid in opposition movement of thumb & enable in cupping of hand
o Has body(intermediate) and two ends(the base on proximal & the head on distal end)
o Aritculate with
 Proximally with carpal bones
 Distally with phalanges
Phalanges
o Are also Long bones
o Each digit has three phalanges except the 1st finger (thumb) which has only two
o Digits are numbered from lateral to medial side as 1st ,2nd ,3rd ,4th and 5th which are
called Thumb (pollex), Index or fore finger, Middle finger, Ring finger and Little finger
respectively.
o Each finger has 3 phalanges named proximal, middle and distal except the 1st
finger (thumb / pollex) has only 2 phalanges, Proximal and Distal

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2.4.5.3. Bones of the lower limb(LL)
- Lower limbs are connected to the Axial skeleton by pelvic girdle.
General function of LL
- Supports body weight
- Locomotion
- Maintain equilibrium
Four parts of LL
- Hip from iliac crest to thigh
- Thigh  b/n hip and knee
- Leg b/n knee and Ankle
- Foot distal to ankle
Pelvic girdle
- Formed by two hip bones, Joined at pubic symphysis and sacrum

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Hip bones
- Each hip bone consists of 3 separate bones
Ilim + Ischium + pubis
- Connects the lower limb with the sacrum.
- The three (3) bones fuse at age of ~ 25 yrs.
- At puberty there is “Y” shaped cartilage at acetabulum (triradiate cagtilage)
- All three contribute to the formation of acetabulum where there is a triradiate caltilage
separating the three components until 15-17 years of age. This fuses completely in
the adult.
 The bone pelvis is made up of three bones: the two hip bones and the sacrum.
 The hip bones articulate with each other infront (anteriorly) at the pubic
symphysis and with the sacrum at the back (posteriorly) through the two sacroiliac joints.
 Each hip bone has three components: the ilium, the pubis and the iscium, the three
bones fusing together in the acetabulum.
- Acetabulum
o Socket for femur
o Has acetabular notch and
o Acetabular fossa above the notch.
1. Ilium
- The largest of the three
- Forms the superior 2/3 of hipbones and superior 2/5 of acetabulum.
Parts:
- Iliac crest  Palpable
 Used as a surface marking w/n performing Lumbar Puncture (b/n L4/L5 disc.)
 Used for bone graft, bone marrow biopsy
- Ala an anterior surface & wing like process of the ilium
- Iliac tubercle (tubercle of the iliac crest)-
- Anterior superior iliac spine  palpable
- Anterior inferior iliac spine
- Iliac fossa  located on the anterior surface of iliac crest, often used for muscular
attachment
- Posterior superior iliac spine  palpable
- Posterior inferior iliac spine
- Greater sciatic notch  below posterior inferior iliac spine & above ischial spine
- Lesser sciatic notch  between ischial spine & ischial tuberiosity
2. Ischium
- Posterio inferior of the hip bone
Parts
- Body of ischium
- Ramus of ischium  join inferial ramus of pubic ischio pubic ramus.
- Obturator formen.
o Irregular triangular apperture
o Closed by thin but strong obturator membrane
o Has passage for obturator muscles, nerves and vessels (obturator canal).
- Ischial spine sharp- ended projection, located inferior to greater Sciatic notch.
is important to assess descent of the head of the fetus during labor.
- Ischial tuberosity  carries body weight on sitting position  palpable.
3. Pubis
 Anteriomedial part of the hip bone
- Two parts:
 flattened body
 two rami
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- superior pubic rami
And Join ramus of ischium
- inferior pubic rami 
Ischio pubic ramus.
- Pubic symphysis:
o Medially
o Body of the pubis joins the body of the opposite pubis.
o A fibrocartilaginous joint
- Pectin pubis (pectneal lines)  sharp raised edge.
- Pubic crest  superior
- Pubic tubercles palpable
  a very important land mark w/n inguinal hernia present which can
be palpated about 2.5 cm from the median plane.
Table 2.4.5.3.1.: Differences b/n the male and female pelvis

Female pelvis Male pelvis
- lighter and smaller bones - heavier and longer bones
- shallow and round cavity - deep and funnel shaped cavity
- sacrum more concave - sacrum less concave
- wider angle(the angle made by the - Narrower angle (the angle made by
two pubic bones, at symphysis the two pubic bones at symphysis
pubis) pubis).
Skeleton of the lower limb

 The bones which make up the lower extremities are:
- Femur
- Patella
- Tibia and fibula
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- Tarsus
- Metatarsus
- Phalanges
Femur
- Thigh bone
- Typical long bone which is the longest, strongest & heaviest bone in our body.
- Forms the ball of a ball & socket joint with pelvic bones
- Provides articular surface for knee.
- Supports body and transmits weight to lower leg
 Have a shaft and two ends (superior & inferior)
Sup. end
 Superior end of femur (Head + Neck + Greater & Lesser Trochanters)
- Fovea capitis
- Head  superiomedial projection
 Head and neck angle 1150-1490, wide at birth and less in
F, b/c pelvis is wider, b/c of  obliquity.
- Neck
- Greater trochanter
- Inter trochanteric line  anteriorly
- Lesser trochanter
Body/shaft
- Linea aspera (M&L lips)

of femur
- Pectineal line
- Supra condylar line
- Gluteal tuberosity
 Distal end of femur

- Femoral condyles (L&M)  articulate with tibial condyles. + Femur with patella 
Knee joint.
- Inter condylar fossa (notch)
- Patelar surface
- Epicondyles (L&M)
- Adductor tubercle
N.B. Trochanters, lines, tubrcles and epicondyles are sites for muscles and ligaments
attachment.
Tibia & Fibula

- Are parts of the bones of the leg
 Tibia
- Larger long bone of leg
- Located medially
- Supports body weight
- Transmits body wt from femur to talus.
- Articulates with femur condyles (superiorly) and talus (inferiorly)
- Wide proximal end for femur condyles
Parts
- Tibial plateau  b/n medial and lateral tibial condyles.
- Intercondylar eminence  fit with intercondylar fossa on femur.
- Medial malleolus  distal end.
 Fibula
- Smaller long bone of leg
- Doesn’t transmit weight
- Mainly used for muscle attachment.
- Provide stability & strength for ankle joint.
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- Head  proximally articulates with tibia (posterio lateral part, lateral condyle of tibia)
- Lateral malleolus  more posterior and longer (1 cm) than the medial malleolus of
tibia
- Articulate with lateral surface of talus.
Ankle
Foot bones
- Tarsus (7)
- Metatarsus (5)
- Phalanges (14)
 Tarsus
- Short bones, 7 in each ankle
- Raise body wt & transmit thrust during running and walking
o Talus  The only bone which articulates with leg bones.
o Calcaneous
o Cuboid
o Navicular
o Cuneiforms(3)  the medial is the largest and the intermediate is the
smallest.
 Metatarsus
- long bones
- five in each foot
- improve stability while standing
- Can absorb shocks
- Bear wt
- Aid in locomotion.
 Phalanges
- 14 in number (in each sides)

- 1st digits (great toe) has two  proximal (base) & distal (head)
- 5th digit middle and distal phalanges off fused in elderly.
Arches of the foot

 The sole of your foot is arched for the same reason that your spine is curved.
 Besides its function of absorbing shock, it prevents nerves & blood vessels in the
sole of the foot from being crushed.
 Tarsal & metatarsal bones are arranged in longitudinal & transverse arches.
 To add weight bearing capability & resiliency
 Act as shock absorber – to support weight propelling
 Resilient of arches – makes adaptable to surface
 Weight from tibia to talus then posteriorly to calcaneus & anteriorly to head of the
2nd to 5th metatarsals & sesamoid of the 1st digit.
There are 3 arches in the foot
 Two longitudinal (medial & lateral) &
 One transverse
 Medial longitudinal arch
 Composed of :- calcaneus
- Talus
- Navicular
- 3 Cuneiforms
- Medial 3 metatarsals (1st, 2nd & 3rd)
 Lateral longitudinal arch
 Composed of:- Calcaneus
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- Cuboid
- Lateral 2 metatarsals (4th & 5th)
 Transverse arch
 Runs from foot side to side
 Composed of:- cuboid
- 3 cuneiforms
- Bases of metatarsals
2.5. JOINTS (Articulations)

Definition: place of union or junction b/n two or more bones or parts of skeleton
 The study of joints is called Arthrology (Greek- arthros = joint, logos = study)

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 Function :-
 Motion
 Support
 Force transfer
 Growth (eg. Suture, epiphysis)
2.5.1. Terms of joint movement:
 Anatomy is concerned with the living body. There fore, various terms are used to
describe d/t body movements.
Table 2.5.1.1.: Commonly used terms of joint movements:

Term Explanation of term
Flexion Bending or decreasing the angle b/n body parts
Extension Straightening or increasing the angle b/n body parts.
Abduction Moving away from the median plane
Adduction Moving towards the median plane
Rotation Moving around the long axis
Circumduction Circular movement combining flexion, extension, abduction & adduction
Eversion Moving the sole of the foot away from the median plane
Inversion Moving the sole of the foot towards the median plane
Supination Rotating forearm & hand so that palm faces anteriorly
Pronation Rotating forearm & hand so that palm faces posteriorly
Protrustion Moving anteriorly
Retrusion Moving posteriorly
2.5.2. Classification and types of joints

 Joints are classified by two methods
o By function or degree of movement
o By structure or presence of cavity
Anatomical classification of joints

 Based on the type of material uniting or binding the articulating bones: joints can
b classified as:-
1. Fibrous joints
 Bones are united by fibrous connective tissue
 This type of joint includes:
o Sutures:- held by strong connective tissue & common in skull
o Syndesmoses:- bones are united by sheet of fibrous tissue
Eg. Interosseus membrane or ligament connecting tibia – fibula and
radius – ulna.
o Gomphosis:- unique joint b/n a tooth & its socket (periodental
ligament)

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2. Cartilagenous joints
 Bones are united by either hyaline cartilage or fiblo cartilage
 This joint also includes two types of joints
o Synchondroses (10 cartilagenous joint)
 Bones unite by hyaline cartilage
 Permit slight bending during early life
Eg. b/n epiphysis & diaphysis
o Symphysis (20 cartilagenous joint)
 Bones are united by a pad of fibrocartilage
 Are strong slightly movable joints
Eg. b/n vertebral bodies, pubic symphysis
3. Synovial joints
 The most common & important one, united by articular capsule
 Provide free movement inmost parts
 Has lubricating fluid (synovial fluid) lined with synovial membrane (produce the
synovial fluid)
 Has three unique features
1. Joint cavity (filled with synovia fluid)
2. Articular cartilage (avascular)
3. Joint capsule with membrane

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Types of synonial joints

 There are six major types of synovial joints (based on shape of articular surfaces
&/or the type of movement they permit)
1. Plane joints (uniaxial joint)
 Allow gliding or sliding movement (mov’t in one plane hence uniaxial jt)
Eg. Intercarpal joint, intertarsal jt, sternoclavicular jt and joint b/n articular
surface of adjacent vertebrae.
2. Hing joints (uniaxial joint)
 Permit flexion and extension only
Eg. Knee jt, Elbow jt and b/n phalanges
3. Condyloid joints (biaxial joint)
 Allow movement in two directions
Eg. Radiocalpal joint of the wrist
4. Saddle joints (biaxial joint)
 Opposing surfaces of bones are like a saddle
Eg. Trapezium of carpal bone with 1st metatarsal bone
 Mov’t – Flexion & extension
- Adduction & Abduction  circumduction
5. Ball & socket joints (multiaxial)
 Allow multidirectional movement
Eg. Hip & shoulder joints
 Mov’t – flexion & extension
 Adduction & abduction  circumduction
 Medial & lateral rotation
6. Pivot joints (uniaxial joint)
 Allwo rotation only
Eg. Attlantoaxial joint (Atlas(C1) in odontoid process of axis (C2))
 Proximal radioulnar joint (proximal articulation of radius & ulna)

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 According to functional classification
o Immovable joints (synartherosis) – fiblous or fixed joints eg. sutures
o Slightly movable joints (Amphiartherosis) – cartilaginous its eg. –
manubrium & body of sternum
- Body of vertebrae.
o Freely movable (diarthrosis)  synovial joints

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UNIT 2 (Skeletal System)

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UNIT 2 (Skeletal System)

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Arbaminch College of Health Sciences

Department of Clinical Nursing

2.2.Functions of the skeletal system

The skeleton serves six major functions.

Prepared by: Mesfin Beyene (PHO) 12

2.3.1. Types of bones by shape and size

Prepared by: Mesfin Beyene (PHO) 13

Hard layer of bone tissue under

2.3.3. Bone cells

a. Ostegenic (osteoprogenitor) cells

Prepared by: Mesfin Beyene (PHO) 15

2.3.5. Functions of Bone:

Prepared by: Mesfin Beyene (PHO) 16

Table 2.4.3.: Bones included in axial and appendicular skeleton

Axial skeleton Appendicular skeleton

Total axial bones = 80 Total appendicular bones = 126

Prepared by: Mesfin Beyene (PHO) 17

2.4.4.1. Skull bones

Features of cranial bones

Prepared by: Mesfin Beyene (PHO) 18

 Anatomy of fetal skull

b. Posterior (occipital) fontanel

c. Anterolateral (sphenoidal) fontanels

B). Facial bones(Viscero cranium):

Prepared by: Mesfin Beyene (PHO) 19

2.4.4.2. Ossicles of ear (Auditory Ossicles)

2.4.4.4. Vertebral column:

Prepared by: Mesfin Beyene (PHO) 20

= By shapes and parts (head, neck, Tubercles, shaft)

2.4.5 . Bones of the Appendicular skeleton

2.4.5.1. The Pectoral girdle

Prepared by: Mesfin Beyene (PHO) 22

The clavicle has three main functions

Scapula (shoulder blade)

Prepared by: Mesfin Beyene (PHO) 23

Prepared by: Mesfin Beyene (PHO) 24

2.4.5.2. Bones of the Upper Limb(UL)

 The arm is the part b/n the shoulder and elbow

 Epicondyles  distal end(lateral & medial) for muscle attachment

Condyle  Capitulum (lateral) of humerus  for alticulation with head of radius

- Located between the elbow and wrist

Prepared by: Mesfin Beyene (PHO) 25

Scaphoid  boat shaped Trapezium  four sided

Prepared by: Mesfin Beyene (PHO) 26

Prepared by: Mesfin Beyene (PHO) 27

2.4.5.3. Bones of the lower limb(LL)

- Lower limbs are connected to the Axial skeleton by pelvic girdle.

Prepared by: Mesfin Beyene (PHO) 28

Table 2.4.5.3.1.: Differences b/n the male and female pelvis

Skeleton of the lower limb

 Superior end of femur (Head + Neck + Greater & Lesser Trochanters)

- Linea aspera (M&L lips)

 Distal end of femur

Tibia & Fibula

- 14 in number (in each sides)

Arches of the foot

2.5. JOINTS (Articulations)

Prepared by: Mesfin Beyene (PHO) 33

Table 2.5.1.1.: Commonly used terms of joint movements:

2.5.2. Classification and types of joints

Anatomical classification of joints

Prepared by: Mesfin Beyene (PHO) 34

Prepared by: Mesfin Beyene (PHO) 35