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The framework of bones and cartilage that protects organs and allows movement is called the skeletal system. Since the skeletal system forms the framework of the body, a familiarity with the names, shapes, and positions of individual bones will help you understand some of the other organ systems. For example, the radial artery, the site where pulse is usually taken, is named for its proximity to the radius, the lateral bone of the forearm.
Types of Bones
Almost all the bones of the body may be classified into four principal types on the basis of shape: long, short, flat, and irregular. Long bones have greater length than width. Examples of long bones include those in the thigh (femur), leg (tibia and fibula), foot bones (metatarsals), toes (phalanges), arm (humerus), forearm (radius and ulna), hand bones (metacarpals), fingers (phalanges), and collarbones (clavicles). Short bones are somewhat cube-shaped and nearly equal in length and width. Examples of short bones include the wrist (carpal) and ankle (tarsal) bones. Flat bones are generally thin and composed of two nearly parallel plates of bone. Examples of flat bones include the cranial bones, the breastbone (sternum), ribs, shoulder blades (scapulas), and hip bones (iliums). Irregular bones have complex shapes and cannot be grouped into any of the three categories just described. Examples of irregular bones include the backbones (vertebrae) and certain facial bones. An additional type of bone, called a sesamoid bone, is not included in the classification by shape but instead is classified by location. Sesamoid bones are small bones that are embedded in tendons where considerable pressure develops. Examples of sesamoid bones include the bones found in the tendons of muscles leading to the thumb and big toe. These are variable in number. Some sesamoid bones, the kneecaps (patellae), are present in everyone. The patella is the largest sesamoid bone in your body.
Structure of a Typical Bone
A typical long bone has enlarged areas on the ends called the epiphysis, which articulate with other bones. The shaft of the bone between the ends is the diaphysis. The end surface of the bone is covered with a layer of hyaline cartilage called articular cartilage. The articular cartilage provides a smooth shock-absorbing surface where two bones meet to form a joint. The periosteum is the fibrous membrane that covers the shaft of the bone. It protects the bone and provides an attachment for tendons and ligaments. It also contains an abundance of nerves, blood and lymph vessels, and is essential to bone nutrition and repair. Beneath the periosteum, the walls of the diaphysis are composed of compact bone tissue. Compact bone tissue forms the hard bone found in the shafts of long bones and the plates of bone that surround short, flat, and irregular bones. This type of bone tissue is strong and rigid. It provides protection and support by resisting the stresses placed upon them by the body and gravity. The inner portion of the bone is made up mostly of spongy bone, which consists of irregularly shaped spaces defined by thin, bony plates. This provides a lightweight yet surprisingly strong interior structure to the bones. The spongy bone tissue in the flat bones and epiphysis of long bones is filled with red bone marrow and is the site of production for
blood cells. The medullary cavity is the name of the hollow chamber formed in the shaft of long bones that is filled with the red bone marrow. Marrow is the connective tissue that fills the spaces inside the spongy bone tissue. Its function is largely concerned with the formation of red and white blood cells in a process called hematopoiesis. There are two types of bone marrow, red and yellow marrow. Red bone marrow functions in the production of red and white blood cells and platelets. It occupies nearly all the bone cavities of the newborn; however, in the adult, it is found in the bone spaces of the skull, ribs, sternum, vertebrae, and pelvis. Yellow bone marrow is the result of inactive blood-producing cells filling with fatty material and is located in various parts of the medullary cavities in long bones.
Bone Growth and Development
Bone receives its nourishment through a highly organized system of blood vessels called capillaries that make their way through the periosteum into the interior of bones. Bone marrow also aids in the nutrition of bone. For proper growth and hardening of bony structures, the diet should contain an adequate amount of calcium, phosphorous, and vitamin D. Vitamin D plays important roles in both bone absorption and bone deposition. There are two types of bone cells responsible for the growth and maintenance of bones. Osteoblasts are the cells that build bone tissue. Osteoclasts are the cells that breakdown and reabsorb bone tissue. The substances liberated by the breakdown of the bone tissue are recycled by the body and are usually reused to form new bone tissue. Within limits, bone has the ability to alter its strength in response to mechanical stress. When placed under such stress, bone tissue becomes stronger with time, through increased deposition of mineral salts and production of collagen fibers. Removal of mechanical stress weakens bone through demineralization (loss of bone minerals) and reduction in the number of collagen fibers. The main mechanical stresses on bone are those that result from the pull of skeletal muscles and the pull of gravity. If a person is bedridden or has a fractured bone in a cast, the strength of the unstressed bone decreases. Astronauts subjected to the weightlessness of space also lose bone mass. Bones of athletes, which are repetitively and highly stressed, become notably thicker than those of nonathletes. Weight-bearing activities, such as walking or moderate weight lifting, help build and retain bone mass.
Functions of Bones
1. 2. 3. 4. 5. To offer a framework that supports body structures and gives shape to the body. To protect delicate internal organs and tissues. To act as levers in conjunction with muscles to produce movement. To manufacture blood cells in the red bone marrow. To store minerals such as calcium phosphate, calcium carbonate, and magnesium.
Organization of the Skeleton
The skeleton is divided into two main parts: the axial skeleton and the appendicular skeleton. The bones of the cranium, face, inner ear, hyoid, vertebrae, and the thoracic cage comprise the axial skeleton. The appendicular skeleton is made up of the bones of the shoulder, upper extremities, hips, and lower extremities. The name appendicular identifies these parts as appendages or extensions of the axis or axial skeleton. In the adult human, the skeleton consists of 206 named bones, distributed as follows:
The Axial Skeleton
Cranium (8) frontal (1) parietal (2) occipital (1) temporal (2) sphenoid (1) ethmoid (1) Forms a protective structure for the brain.
Face (14) Forms the structure of the eyes, nose, cheeks, mouth, and jaw. maxilla (2) palatine (2) zygomatic (2) lacrimal (2) nasal (2) vomer (1) interior nasal concha (2) mandible (1) Inner Ear bones(6) malleus (2) incus (2) stapes (2) Hyoid bone (1) Vertebrae (26) cervical vertebrae (7) thoracic vertebrae (12) lumbar vertebrae (5) sacrum (1) coccyx (1) Thoracic cage (25) ribs (24) sternum (1) Forms a protective cage for the lungs and heart. Serves as an attachment for the ribs at the front of the chest. Forms the internal structure of the ears.
Supports the base of the tongue. Forms the spinal column which supports the head and trunk and protects the spinal cord.
The Appendicular Skeleton
Upper Extremities scapula (2) clavicle (2) humerus (2) radius (2) ulna (2) carpals (16) metacarpals (10) phalanges (28) Lower Extremities hip bones (2) femur (2) patella (2) tibia (2) fibula (2) tarsals (14) metatarsals (10) phalanges (28)
Types of Joints
The bones of the skeleton are connected at different parts of their surfaces. Such connections are called joints or articulations. Joints are classified into three major groups according to the amount of motion they permit.
1. 2. 3.
Synarthrosis: an immovable joint, such as those in the skull. Amphiarthrosis: a slightly movable joint, such as the sacroiliac joints. Diarthrosis: a freely movable joint, such as the hip or shoulder.
Diarthrotic joints are freely movable. The articulating ends of the bones that meet at these joints are covered with hyaline cartilage called articular cartilage. A strong fibrous joint capsule surrounds the joint and is firmly attached to both bones. The outside of the capsule is constructed of ligaments that attach the bones, while the inner surface or the lining of the capsule consists of synovial membrane, which secretes synovial fluid that lubricates the joint surfaces. The major types of freely movable joints are classified as follows: Pivot joints have an extension on one bone that rotates in relation to the bone it articulates with, such as in the neck between the first and second cervical vertebrae (atlas and axis) and the proximal radio-ulnar joint.
Hinge joints allow for flexion and extension. They move through one plane such as in the elbow, knees, and two distal joints of the fingers.
Ball and socket joints permit the greatest range of movement including flexion and extension, abduction and adduction, internal and external rotation, and circumduction. A bone with a ball-shaped head articulates in a socket shaped depression such as in the hips and shoulders.
Gliding joints have nearly flat surfaces that glide across one another, such as in the spine, wrists and ankles, or hands and feet.
Saddle joints involve bones with concave articulating surfaces such as the joint that is found at the base of the thumb and the sternoclavicular joint.
Movements of Diarthrotic (Freely Movable) Joints
Movement Flexion Extension Hyperextension Abduction Adduction Description This movement involves a decrease in the angle between the surfaces of the articulating bones. Examples include bending the knee or elbow. This movement involves an increase in the angle between the surfaces of the articulating bones. Examples include straightening the knee or elbow. This movement involves a continuation of extension beyond the anatomical position. Examples include leaning excessively backwards. This involves movement of a bone away from midline. Examples include moving the arm or leg upward away from midline. This involves movement of a bone toward the midline. Examples
Internal rotation External rotation Circumduction Protraction Retraction Plantarflexion Dorsiflexion Pronation Supination Inversion Eversion
include returning the arm or leg to the body’s side. This movement involves moving a limb or body part around its longitudinal axis towards the midline. It is also known as medial rotation. This movement involves moving a limb or body part around its longitudinal axis away from the midline. It is also known as lateral rotation. This movement involves a combination of flexion / extension and abduction / adduction in succession with the distal portion of the limb moving in a circle. Examples include moving the arm or leg in a circle. This movement involves moving a part of the body such as the mandible or shoulder girdle forward on a plane parallel to the ground. This movement involves moving a part of the body such as the mandible or shoulder girdle backward on a plane parallel to the ground. This movement involves the movement of the foot down towards the plantar surface of the foot such as when walking on the toes. This movement involves the movement of the foot up towards the dorsal surface of the foot such as when walking on the heels. This movement involves movement of the forearm in which the palm is turned posteriorly and inferiorly. This movement involves movement of the forearm in which the palm is turned anteriorly and superiorly such as when one twists a doorknob to open a door. This movement involves moving the sole of the foot inward, thus stretching the lateral aspect of the ankle. This most common type of ankle injury is due to excessive ankle inversion. This movement involves moving the sole of the foot outward, thus stretching the medial aspect of the ankle. This type of ankle movement is limited by bony structures.
Skeletal and Joint Disorders
A fracture is a break or rupture in a bone. There are five types of fractures classified according to the severity of the injury:
Simple: This type of fracture is described as being a clean break through the entire bone with no splintering or fragmentation. Since there is no communication with the overlying skin surface, this type of fracture is also known as a closed fracture. Compound: This type of fracture is described as being a distorted break through the entire bone with splintering or fragmentation as well as communication with the overlying skin surface; therefore, it is also known as an open fracture. This type of fracture is the most dangerous due to the strong possibility of infection. Greenstick: This type of fracture is described as being an incomplete break through the bone with no clear division. There is also splintering present.
Comminuted: This type of fracture is described as having multiple bone fragments with clear separation. The multiple fragments make healing difficult and operative intervention is usually necessary. Spiral: This type of fracture is described as having an extensive break line that travels an extensive length of the bone in a corkscrew manner.
A dislocation occurs when a bone is displaced within a joint. This is usually due to a traumatic injury that stretches or tears the ligaments around the joint and requires reduction, realigning the bones, and rest while the ligaments heal. A sprain is an injury to a joint that results in the stretching or tearing of the ligaments but is not severe enough to cause a dislocation. All classes of sprains cause swelling and require rest and support while the tissues heal. Sprains are classified according to their severity into three classes: Class I Sprain: There is a stretch in the ligament, some discomfort, and minimal loss of function. Class II Sprain: The ligament is torn with some loss of function. There may or may not be a discoloration due to tissue damage and bleeding. Class III Sprain: This is the most severe type of sprain. The ligaments are torn and there is internal bleeding and severe loss of function. Bursitis is an inflammation of the small fluid-filled sacs lined with synovial membrane known as bursae located near the joints that reduce the friction of overlying structures during movement. Bursitis is a painful condition that results from repeated irritation or trauma. The most common site of bursitis is the subdeltoid bursae of the shoulder, but it can develop at any joint. Pain from an acute case of bursitis drastically limits joint mobility. After the inflammation subsides, mobility remains limited because of pain and contracted muscles. Mild exercise, range of motion, and massage are very effective for restoring mobility. Arthritis is an inflammatory condition of the joints often accompanied by pain and changes in bone structure. There are many kinds of arthritis; the most common types are osteoarthritis, rheumatoid arthritis, and gouty arthritis. Osteoarthritis is a chronic disease that accompanies aging. It usually affects joints that have experienced a great deal of wear and tear or trauma. The knees, hips, and spine are common sites for this degenerative disease, which erodes the articular cartilage and results in abnormal bone thickening and progressive joint immobility. There is no cure for osteoarthritis, but medication, exercise, and massage help relieve pain and maintain mobility. Surgery is sometimes indicated to remove spurs or replace affected joints. Rheumatoid arthritis is a chronic inflammatory disease and is the most serious and crippling form of arthritis. It is a systemic disease, often affecting a number of joints, that first affects the synovial membrane that lines the joints. The joints become swollen, hot, and red. The inflammation causes the articular cartilage to erode and the joints to calcify and eventually become immovable. Its cause is unknown, but treatments are available to slow the progress and reduce the discomfort. Gouty arthritis, also referred to as gout, usually affects the feet, especially the metatarsophalangeal joint of the big toe. High levels of uric acid in the blood produce uric
acid crystals that deposit in the joint of the big toe resulting in pain and inflammation, and making walking difficult. Osteoporosis literally means increased porosity of the bones. Increased reabsorption of calcium into the blood stream causes a thinning of bone tissue, leaving it more fragile and prone to fracture. When severe osteoporosis is present, the massage therapist must be very cautious to prevent injury.
The healthy adult spine has a double S curve. The cervical and lumbar portions of the spine are concave and have a normal lordotic curve. The thoracic and sacral portion of the spine is convex and has a normal kyphotic curve. These curvatures provide flexibility, strength, shock absorption, and balance. Sometimes abnormal curvatures develop in the spine. Scoliosis is a lateral deviation of the spine. Lordosis is an exaggerated concave curve most commonly found in the lumbar spine. Kyphosis is an abnormally exaggerated convex curve of the thoracic spine. Occasionally, the cervical spine will have a kyphotic curve. These abnormal curves may develop because of a congenital defect, habitually poor body mechanics, or aging. Regardless of their origin, these abnormal conditions cause tremendous biomechanical stress on the body. Massage and exercise, while not offering a cure for these conditions, are very effective in counteracting the stress and pain associated with these abnormalities.
Surface Anatomy of Skeletal Structures
Term Condyle Crest Foramen Fossa Head Linea Meatus Process Sulcus Trochanter Tubercule Tuberosity Meaning A rounded knuckle-like prominence, usually at a point of articulation A ridge A hole A depression or hollow A rounded articulating process at the end of a bone A less prominent ridge of a bone A tube-like passage A boney prominence or projection A ditch like groove in a bone where tendons slide A large process of bone found only on the femurs where muscles attach A small, rounded process A large, rounded, usually roughened process
Important Joints of the Skeletal System
The atlantoaxial joint is found at the top of the spine. This joint is formed by the first and second cervical vertebra (atlas and axis). It is a pivot joint that allows for rotation.
The sternoclavicular joint is found on the anterior surface of the chest. This joint is formed by the sternum and the proximal portion of the clavicle. It is a saddle joint that allows for elevation / depression and protraction / retraction. The acromioclavicular joint is found on the superior aspect of the shoulder. This joint is formed by the acromion process of the scapula and the distal end of the clavicle. It is a gliding joint that allows for back and forth and side to side movement. The glenohumeral joint is the proper name for the “shoulder joint.” This joint is formed by the glenoid fossa of the scapula and the proximal humeral head. It is a ball and socket joint that allows for flexion / extension, abduction / adduction, internal and external rotation, and circumduction. The elbow joint is formed by the distal humerus and the proximal radius and ulna. It is a hinge joint that allows for flexion and extension. The coxafemoral joint is the technical name for the “hip joint.” This joint is formed by the acetabulum of the hip and the proximal femoral head. It is a ball and socket joint that allows for flexion / extension, abduction / adduction, internal and external rotation, and circumduction. The knee joint is formed by the patella, distal femur, and the proximal tibia. The knee joint does not include the fibula. It is a hinge joint that allows for flexion and extension. The ankle joint is formed by the medial malleolus of the tibia, lateral malleolus of the fibula, and the talus bone. It is a special type of saddle joint that allows for plantarflexion / dorsiflexion and inversion / eversion.
Questions for Discussion and Review: “The Skeletal System”
1. What are some of the functions of the skeletal system? 2. What are the four basic types of bones? 3. What is a long bone? 4. Name some examples of long bones. 5. What is a short bone? 6. Name some examples of short bones. 7. What is a flat bone? 8. Name some examples of flat bones. 9. What is an irregular bone? 10. Name some examples of irregular bones. 11. What is a sesamoid bone? 12. What is the largest sesamoid bone in the body? 13. What is the epiphysis? 14. What is the diaphysis? 15. What is articular cartilage? 16. What is an articulation? 17. What is periosteum? 18. What is compact bone tissue? 19. What is spongy bone tissue? 20. What is the medullary cavity? 21. What is bone marrow? 22. What is red bone marrow? 23. What is yellow bone marrow? 24. What is an osteoblast?
25. 26. 27. 28. 29. 30. 31. 32. 33. 34. 35. 36. 37. 38. 39. 40. 41. 42. 43. 44. 45. 46. 47. 48. 49. 50. 51. 52. 53. 54. 55. 56. 57. 58. 59. 60. 61. 62. 63. 64. 65. 66. 67. 68. 69. 70. 71. 72. 73. 74. 75. 76. 77.
What is an osteoclast? What happens to unstressed bone? What happens to bone that is highly stressed? Where does the main mechanical stress on bone come from? Name five functions of bones. What are the two main divisions of the skeletal system? What is the axial skeleton? What is the appendicular skeleton? What are the bones that form the cranium? What are the bones that form the face? Name the ear bones. What is unique about the hyoid bone? How many cervical vertebrae are there? How many thoracic vertebrae are there? How many lumbar vertebrae are there? How many ribs are there? What is the function of the sternum? What is the technical name for the shoulder blade? What is the technical name for the collarbone? What is the technical name for the arm bone? What are the technical names for the forearm bones? What is the lateral forearm bone? What is the medial forearm bone? What is the technical name for the wrist bones? What is the technical name for the palm bones? What is the technical name for the fingers? What is the technical name for the thighbone? What is the technical name for the kneecap? What are the technical names for the leg bones? What is the lateral leg bone? What is the medial leg bone? What is the technical name for the anklebones? What is the technical name for the bones found in the palm of the foot? What is the technical name for the toes? What is an articulation? What are the three different types of joints? Describe the five different types of diarthritic joints? What is flexion? What is extension? What is hyperextension? What is abduction? What is adduction? What is internal rotation? What is external rotation? What is circumduction? What is protraction? What is retraction? What is plantarflexion? What is dorsiflexion? What is pronation? What is supination? What is inversion? What is eversion?
78. What is a fracture? 79. Describe the five different types of fractures. 80. What is a dislocation? 81. What is reduction? 82. What is a sprain? 83. Describe the three different types of sprains. 84. What is a bursa? 85. What is bursitis? 86. What are the effects of bursitis? 87. What is arthritis? 88. What is osteoarthritis? 89. What is rheumatoid arthritis? 90. What is gouty arthritis? 91. What is osteoporosis? 92. Describe the shape of a healthy adult spine. 93. What are the functions of spinal curvatures? 94. What is a lordotic curve? 95. What is a kyphotic curve? 96. What is scoliosis? 97. What is lordosis? 98. What is kyphosis? 99. What are the causes of abnormal spinal curvatures? 100. What is a condyle? 101. What is a crest? 102. What is a foramen? 103. What is a fossa? 104. What is a head? 105. What is a linea? 106. What is a meatus? 107. What is a process? 108. What is a trochanter? 109. What is a tubercule? 110. What is a tuberosity? 111. Where is the atlantoaxial joint found? 112. What type of joint is the atlantoaxial joint? 113. What bones form the atlantoaxial joint? 114. What type of motion is allowed by the atlantoaxial joint? 115. Where is the sternoclavicular joint found? 116. What type of joint is the sternoclavicular joint? 117. What bones form the sternoclavicular joint? 118. What type of motion is allowed by the sternoclavicular joint? 119. Where is the acromioclavicular joint found? 120. What bones form the acromioclavicular joint? 121. What type of motion is allowed by the acromioclavicular joint? 122. What is the technical name for the shoulder joint? 123. What bones form the glenohumeral joint? 124. What type of joint is the glenohumeral joint? 125. What type of motion is allowed by the glenohumeral joint? 126. What bones form the elbow joint? 127. What type of joint is the elbow joint? 128. What type of motion is allowed by the elbow joint? 129. What is the technical name for the hip joint? 130. What bones form the hip joint?
131. 132. 133. 134. 135. 136. 137. 138.
What type of joint is the hip joint? What type of motion is allowed by the hip joint? What bones form the knee joint? What type of joint is the knee joint? What type of motion is allowed by the knee joint? What bones form the ankle joint? What type of joint is the ankle joint? What type of motion is allowed by the ankle joint?
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