The Skeletal

System:
Structure, Function, and
Diseases
of the bones and joints
 Objectives
• Classify bones according to their shape
• Classify joints according to their function
• Correlate basic function of skeletal system with diagnostic
conditions.
• Identify the major pathologies associated with the skeletal system
• Define the different types of pathology that are associated with
inflammatory, degenerative, traumatic, neoplastic, and
congenital/hereditary disease processes –
• Identify, generally and radiographically, the pathology that is
associated with each of the disease processes as it relates to the
skeletal system
• Demonstrate knowledge of differing fracture types and their
radiographic representation
The Skeletal System
· Parts of the skeletal system
· Bones (skeleton)
· Joints
· Cartilages
· Ligaments (bone to bone)(tendon=bone to
muscle)
· Divided into two divisions
· Axial skeleton- skull, spinal column
· Appendicular skeleton – limbs and girdle
 Function of the Bones
• The adult human skeleton is
composed of 206 primary bones.
Ligaments unite the bones of the
skeleton. Bones provide the
following:
– Attachment for muscles
– Mechanical basis for
movement
– Protection of internal organs
– A frame to support the body
– Storage for calcium,
phosphorus, and other salts
– Production of red and white
blood cells
4
TYPES OF BONE TISSUE
· The skeleton has 206 bones
· Two basic types of bone tissue
· Compact bone
· Homogeneous
· Spongy bone
· Small needle-like
pieces of bone
· Many open spaces Figure 5.2b
 Types of Bone Cells
· Osteocytes
· Mature bone cells
· Osteoblasts
· Bone-forming cells
· Osteoclasts
· Bone-destroying cells
· Break down bone matrix for
remodeling and release of
calcium
· Bone remodeling is a process
by both osteoblasts and
osteoclasts
BONE DEVELOPMENT
 Bone Development
• Intermembranous
ossification
– Bones that develop from fibrous
membrane in the embryo
produce the flat bones such as
those of the skull , clavicles,
mandible, and sternum.
• Endochondral ossification.
– develop from hyaline cartilage in
the embryo and produce the
short, irregular, and long bones.
– Occurs from two distinct centers
of development called the
primary and secondary centers
of ossification.
9
Changes in the Human Skeleton
· In embryos, the skeleton is primarily
hyaline cartilage
· During development, much of this cartilage
is replaced by bone
· Cartilage remains in isolated areas
· Bridge of the nose
· Parts of ribs
· Joints
DISTINCT CENTERS OF DEVELOPMENT
 Primary Ossification
• Begins before birth and
forms the entire bulk of
the short and irregular
bones.
• This process forms the
long central shaft in long
diaphysi
bones.
• During development only,
the long shaft of the bone
is called the diaphysis

12
 Secondary Ossification
• Occurs after birth when a
separate bone begins to
develop at both ends of
every long bone.
• Each end is called the
epiphysis the diaphysis and
epiphysis are distinctly
separate.
• As growth occurs, a plate
of cartilage called the
epiphyseal plate develops
between the two areas.
13
 Epiphyseal Plate
• Seen on the long-bone
radiographs of all pediatric
patients important
radiographically because it is a
common site of fractures in
pediatric patients
• Near the age of 21, full
ossification occur and the two
areas become completely joined;
only a moderately visible
epiphyseal line appears on the
bone

14
FACTORS THAT AFFECT BONE
GROWTH AND MAINTENANCE
 Heredity

• a maximum height, with genes

inherited from both parents.
• enzymes involved in cartilage and
bone production,
 Nutrition
• Vitamin D is needed for the efficient
absorption of calcium and phosphorus by
the small intestine.
• Vitamins A and C do not become part of
bone but are necessary for the process of
bone matrix formation (ossification).
 Hormones
• Important contributions to bone growth and
maintenance.
• growth hormone, thyroxine, parathyroid
hormone, and insulin, which help regulate cell
division, protein synthesis, calcium metabolism,
and energy production.
• sex hormones estrogen or testosterone help
bring about the cessation of bone growth.
HORMONES INVOLVED IN BONE
GROWTH AND MAINTENANCE
 Exercise or “stress”

• exercise means bearing weight,

which is just what bones are
specialized to do.
• Without stress bones will lose
calcium faster than it is replaced.
• simple as walking in everyday
activities.
 Axial skeleton
• Supports and protects organs of
head, neck and trunk
• Skull
– (cranium and facial bones)
• Hyoid bone
– (anchors tongue and muscles
associated with swallowing)
• Vertebral column
– (vertebrae and disks)
• Bony thorax
– (ribs and sternum)
 Skull (cranium)
Neurocranium
(braincase)

Paired Parietal 2
Temporal 2

Unpaired Frontal 1
Sphenoid 1
Occipital 1

Ethmoid 1
 Skull (cranium)

Viscerocranium (face)
Paired Maxilla 2
Zygomatic 2
Palatine 2
Lacrimal 2
Nasal 2
Inferior nasal concha 2

Unpaired Mandible 1
Vomer 1

Total Skull 22
Bones Associated with the Skull
Auditory ossicles

Malleus 2

Incus 2

Stapes 2

Hyoid 1

Total Associated 7
Spinal
Vertebral Column

Cervical vertebrae 7 7

Thoracic vertebrae 12 12

Lumbar vertebrae 5 5

Sacrum 1 1

Coccyx 1

Total Vertebral Column 26

Chest
Thoracic Cage (rib cage)

Ribs 24

Sternum 1

Total Thoracic Cage 25

Total Axial Skeleton 80

 The Axial Skeleton
· Forms the longitudinal
part of the body
· Divided into three parts
· Skull
· Vertebral Column
· Rib Cage

Slide
Skull
OBJECTIVES
■ DESCRIBE THE MAJOR FEATURES OF THE SKULL AS SEEN FROM VARIOUS
VIEWS.
■ LIST AND DESCRIBE THE BONES OF THE NEUROCRANIUM AND
VISCEROCRANIUM.
Skull or cranium
Superior View of the Skull

Frontal
bone
Coronal suture

Parietal bone

Sagittal suture
Posterior View of the Skull

Parietal bone

Lambdoid suture
Occipital bone
Posterior View of the Skull

EOP nuchal line

Lateral View of the Skull

Parietal bone

Squamous suture
Squamous
Lateral View of the Skull as Seen
from the Right Side

Temporal
bone

Mastoid
process
EAM
Lateral View of the Skull

Sphenoid bone (greater wing)

Lateral View of the Skull

Zygomatic bone
Lateral View of the Skull

Maxilla
Lateral View of the Skull

Condyle

Ramus

Mandible
Frontal View of the Skull
Frontal View of the Skull

Orbits
Frontal View of the Skull
Frontal View of the Skull

Optic foramen
Superior orbital fissure

Inferior orbital fissure

 Frontal View of the Skull

Nasal
septum

Perpendicular plate
of ethmoid bone

Vomer
 Frontal View of the Skull

Nasal
conchae

Middle nasal concha

Inferior nasal concha

 Bones of the Nasal Cavity

Frontal sinus

Sphenoidal sinus

Perpendicular plate
of ethmoid bone

Nasal
septum Vomer
Interior of the Cranial Cavity
Interior of the Cranial Cavity

Crista galli
Ethmoid bone
Cribriform plate
Interior of the Cranial Cavity

Sella turcica

Foramen magnum
Inferior View of the Skull

Occipital condyle
Inferior View of the Skull

Foramen lacerum
Carotid canal

Jugular foramen

Foramen magnum
Inferior View of the Skull

Mandibular fossa
Styloid process
Inferior View of the Skull

Lateral pterygoid plate

Vomer

Medial pterygoid plate

Inferior View of the Skull

Hard
palate
 Appendicular skeleton
• Includes bones of limbs and
• Bones that anchor them to the
axial skeleton
• Pectoral girdle
– (clavicle, scapula)
• Upper limbs
– (arms)
• Pelvic girdle
– (sacrum, coccyx)
• Lower limbs
– (legs)
 Long Bones
• Found only in the limbs
• Consist primarily of a long
cylindrical shaft
– body and
– two enlarged, rounded ends
• that contain a smooth, slippery
articular surface.
• A primary function of long
bones is to provide support.
• The femur and Humerus are
typical long bones.
• The phalanges of the fingers
and toes are also considered
long bones.
55
 Short Bones
• Consist mainly of cancellous • They are varied in shape and
bone allow minimum flexibility of
– containing red marrow motion in a short distance.
– a thin outer layer of compact bone.
• Example of Short bones
– carpal bones of the wrist
– tarsal bones of the ankles are the
only short bones.

56
 Flat Bones
• Consist largely of two table of • Examples of flat Bones
compact bone. – Cranium
• Diploe – Sternum
– The narrow pace between the – Scapula
inner and outer table contain • The flat surfaces of these bone
cancellous bone and red marrow. provide protection, and their
broad surface allow muscle
attachment.

57
 Irregular bones
• Peculiar shape and variety of
forms
• Examples of Irregular bones
– Vertebrae
– Bones of the pelvis
– Bones of the face
• Like other bone, they have
compact bone on the exterior
& cancellous bone
containing red marrow in the
interior.
• Shape -serves many function
– Attachment for muscles,
tendon, and ligament,
– Attach to other bone to create
joints.
58
 Sesamoid bones
• Very small and oval.
• They develop inside and beside
tendon.
• Their function is to protect the
tendon from excessive wear.
• The largest sesamoid bone is
the patella, or the kneecap.
• Other sesamoids are located
beneath the first metatarsal of the
foot and adjacent to the
metacarpals of the hand.
• 2 small but prominent sesamoids
are located beneath the base of
the large toe. Like all other
bones, they can be fractured.
59
BONE MARKINGS AND FEATURES
PROCESSES OR PROJECTIONS
 Condyle
• Rounded process
at an articular
extremity
 coracoid or coronoid
• Beaklike or crown
like process
 Crest
• Ridge like process
 Epicondyle
• Projection above a
condyle
 Facet
• Small, smooth-
surfaced process
for articulation
 Hamulus
• Hook-shaped
process
 Head
• Expanded end of a
long bone
 Horn
• Hornlike process
on a bone
 Line
• Less prominent
ridge than a crest;
a linear elevation
 Malleolus
• Club-shaped
process
 Protuberance
• Projecting part or
prominence
 Spine
• Sharp process
 Styloid
• Long, pointed
process
 Trochanter
• Either of two large,
rounded, and
elevated processes
(greater or major
and lesser or
minor) located at
junction of neck
and shaft of femur
 Tubercle
• Small, rounded,
and elevated
process
 Tuberosity
• Large, rounded,
and elevated
process
 DEPRESSIONS

Depressions are hollow or depressed area

 Fissure
• Cleft or deep
groove
 Foramen
• Hole in a bone for
transmission of
blood vessels and
nerves
 Fossa
• Pit, fovea, or
hollow space
Groove
 Meatus
• Tube-like
passageway
running within a
bone
 Notch
• Indentation into the
border of a bone
 Sinus
• Recess, groove, cavity, or
hollow pace such as
– a recess or groove in
bone, a used to designate
a channel for venous
blood on inner surface of
cranium,
– an air cavity in bone or a
hollow space in other
tissue (used to designate
a hollow pace within a
bone as in paranasal
sinuses), or
– a fistula or suppurating
channel in soft tissues
 Sulcus
• Furrow, trench, or
fissure like
depression
A fracture is a break in the bone. Fractures are classified
according to the nature of the break

FRACTURES
 Fracture General Terms
• closed Fracture that does not
break through the skin
• open Serious fracture in which
the broken bone or bones
project through the kin
• Nondisplaced Fracture in
which the bone retain its
normal alignment
• Displaced More serious
fracture in which the bones are
not in anatomic alignment
Displaced Fx
 Incomplete Fracture
• occurs when the fracture does
not traverse the bone
completely i.e. some of the
bone remains intact.
• Greenstick fractures provide a
common example of
incomplete fractures. Adults
can also experience
incomplete fractures
 Greenstick Fracture
• Commonly seen in
children's long bones.
 Comminuted Fx
•  Is one in which there
are multiple bone
fragments. 

• This is a comminuted
fracture of the
calcaneum caused by a
fall from a height (so-
called lover's fracture or
Don Juan fracture)
 Spiral Fracture
• Spiral fractures are
caused by a rotational
or torsion force.
• A typical mechanism
would be if your foot is
caught and you rotate
your leg, you are at risk
of spiral fracture of the
tibia.
 Impacted Fx
• a bone break in which t
he adjacent fragmented
 ends of the fractured b
one are wedged togeth
er
 Compound Fracture
• Is one in which the
patient's skin has
been punctured or
torn and the skin
breach is
associated with the
fracture.
 Avulsion Fx
• Tend to be small bone
fragments.
• Often at the ends of
long bones and tend
to be adjacent to
joints.
• Anywhere that there
is a tendon or
ligament attachment
is a potential site for
an avulsion fracture.
 Butterfly Fracture
• A fracture in which
the center fragment
is triangular
shaped.
 Crush Fracture
• is a fracture type associated
with a crushing injury.
• Long bone crush fractures
are usually comminuted.
• The term crush fracture is
commonly used to refer to
crushing injuries of the
digits and spine, but could
refer to a crushing injury of
any bone
 Depressed Fracture
• is one in which a
fragment or group
of fragments is
'pushed in'. These
fractures are most
frequently
associated with the
skull.
 Diastasis
• abnormal separation
of two anatomical
structures that are
normally located
together.
 Fracture-Dislocation
• This is a term which is
used to refer to an injury
that includes a fracture
and a dislocation.
• The image shown is a
Galeazzi fracture
characterized as a
fracture of the distal third
of the radius and a
dislocation of the distal
radio-ulnar joint (DRUJ)
 Pathological Fracture
• Occurs at a site
where the bone is
weakened by a
pathological
process.
 Stellate fractures
• commonly associated with the
patella.
• The term stellate refers to the
fracture being star-shaped with the
fracture lines radiating outwards
from a central point.
• Stellate fractures could occur when
any plate-like bony structure
receives a sufficiently large
(localised) blow.
– Other anatomical regions that can
demonstrate stellate fractures are
the skull and acetabulum.
 Wedge fractures
• Commonly seen in
the vertebral
bodies.
APPENDICULAR
SKELETON
 UPPER LIMB BONES

Upper limb bones are

made of 4 groups:
1. Hand and wrist.
2. Forearm.
3. Humerus.
4. Shoulder Girdle.
 Hand and Wrist

• Each hand and wrist is

made of 27 bones as
follows:

• 14 phalanges (in fingers

and thumb),
• 5 metacarpals (in the
palm)
• 8 carpals (in the wrist).
 Fingers/Phalange

• Each finger (digit) consists of 2 or

more small phalanges. The digits
are named:
1. Thumb (first digit).
2. Index (second) digit.
3. Middle (third) digit.
4. Ring (fourth) digit.
5. Little (fifth) digit.
• Each of the 5 digits (fingers),
except the thumb, is made of three
phalanges:
• proximal
• middle
• distal
• The thumb is made of only two
phalanges:
• Proximal
• distal.
 Metacarpals

Are five making up

the palm. Like the
phalanges, each has a
head, body, and a base.
JOINTS OF THE HANDS
 Joints of the Thumb

1. Interphalangeal joint (IPJ)

• between the two
phalanges.
2. 1st Metacarpophalangeal
Joint (MPJ)
• between1st MC and
proximal phalanx of
the thumb.
 Joints of the Fingers (2nd-5th)

Same as above, distal IPJ,

followed by the proximal
IPJ, and most proximally,
the MPJ.
 Joints of the Metacarpals

1. Metacarpophalangeal (MPJ)
at their distal ends.
2. Carpometacarpal (CMJ) at the
proximal ends of
metacarpals with carpals.
NB/ All joints of the upper
limb are classified as
synovial, therefore, freely
movable.
 Carpal (Wrist)

Eight bones made of a proximal and

distal rows:
(1) Proximal row (starting from the
lateral): the
scaphoid (navicular bone),
lunate, (semilunar)
triquetrum, (traingular/cuneoform)
pisiform.

(2) Distal row:

Trapezium, (Gr. Multangular)
Trapezoid, (L. Multangular)
Capitate, (Os magnum/Capitatum)
Hamate. (unciform)
* The scaphoid is the largest of all and is
frequently fractured.
 8 carpals (short bones)
– Scaphoid
• navicular
– Lunate
• semilunar
– Triquetrum
• triquetral,
• cuneiform,
• triangular
– Pisiform
– Trapezium
• G. multangular
– Trapezoid
• L. multangular
– Capitate
• os magnum
• capitatum
– Hamate
• unciform

119
 Carpal Characteristics
• Beginning the proximal row of carpals on the
lateral side
• The scaphoid, • The triquetrum
– the largest bone in the ▫ Roughly pyramidal
proximal carpal row, ▫ Articulates anteriorly w/
– has a tubercle on the the hamate.
anterior and lateral • The pisiform
aspect ▫ Pea-shaped bone
• for muscle attachment
▫ Situated anterior to the
– palpable near the base
triquetrum
of the thumb.
▫ Easily palpated.
• The lunate
– Articulates with the
radius proximally
– Crescent shape. 120
 Carpal Characteristics
• Beginning the distal row of carpals on the lateral side

• Trapezium
▫ has a tubercle and
groove on the anterior
surface.
 The tubercles of the
trapezium and scaphoid
comprise the lateral
margin of the carpal
groove.
• Trapezoid
▫ has a smaller surface
anteriorly than posteriorly.
• Capitate
▫ Articulates w/the base of the
3rd metacarpal
▫ Largest and most centrally
located carpal.
• Hamate
▫ wedge-shaped
▫ exhibits the prominent hook
▫ located on the anterior surface.
▫ The hamate and the
pisiform form the medial
margin of the carpal groove.
121
 Carpal Sulcus(Tunnel)

• Is formed by the concave

anterior aspect of the carpals.
• Major nerves and tendons,
particularly the median nerve,
pass through the sulcus.
• A very common pathological
condition of this part is the
carpal tunnel syndrome in which
the median nerve is involved.
 Forearm (Radius & Ulna)

• Both bones articulate with each

other at the proximal radioulnar
joint and distal radioulnar joint.
• At the wrist joint, both of the
radius and ulna have styloid
processes.
• The radial styloid extends more
distally than the ulnar styloid
 Forearm (Radius & Ulna)
Head of ulna is near the wrist at
the distal end if the ulna.
• Head of radius is at the proximal
end of the radius near the elbow
joint.
• body (shaft), long middle part of
both ulna and radius
• Radius is the shorter of the two
bones and the only one that is
involved in the wrist joint.
• Head and neck of radius are found
at the proximal radius.
• The radial tuberosity is located just
below the round radial head.
 Proximal Ulna
• It is the longer of the bones of
the forearm and is involved in
the wrist joint.
• It consists of an olecranon and a
coronoid processes, a radial notch
and a trochlear notch.
• The trochlear notch is a depression
for articulating with distal
humerus.
• The radial notch (small
depression) is on the lateral
aspect of proximal ulna where
the head of radius articulates
with the ulna.
 Distal Humerus
• The long mid center of the
humerus is the body (shaft)
• The humeral condyle is its
expanded distal end.
• Articular part of the humeral
condyle is made of the trochlear
and the capitulum.
• Trochlear is more medially and
articulates with the ulna.
• Capitulum is more lateral and
will articulate with head of
radius.
 Distal Humerus
• Lateral epicondyle is a small
projection on lateral aspect of
distal humerus.
• Medial epicondyle (larger and
more prominent) is located on
medial edge of distal humerus.
• Anterior depressions: Coronoid
fossa and radial fossa.
• Posterior depression: is the
olecranon fossa.
• Lateral view of elbow shows
proximal radius and ulna with
radial head and neck and radial
tuberosity.
RADIOGRAPHIC ANATOMY

A. Medial epicondyle.
B. Trochlea (medial aspect).
C. Coronoid tubercle.
D. Radial head.
E. Capitulum.
F. Lateral epicondyle.
RADIOGRAPHIC ANATOMY

(G) Superimposed
epicondyles.
(H) Olecranon process.
(I) Trochlear sulcus.
(J) Trochlear notch.
(K) Outer ridges of
capitulum
And trochlea.
(L ) Coronoid process of
ulna.
(M) Radial head.
(N) Radial neck.
(O) Radial tuberosity.
 Anatomical
neck
Greater tubercle Head
Intertubercular Anatomical
(bicipital) groove neck

Surgical neck

Deltoid tuberosity

Lateral
supracondylar
ridge AP Medial supracondylar ridge PA
Radial fossa Olecranon fossa
Lateral epicondyle Coronoid
fossa
Medial epicondyle Lateral epicondyle
Capitulum
1
3
0
Trochlea Trochlea
Anterior Aspect of the Shoulder Girdle

The girdle attaches to the humerus and manubrium of

the sternum. 131
 Acromion process

Acromion process
Coracoid process
Coracoid process
Superior angle
Supraglenoid tubercle Scapular notch
Superior border
Scapular notch
Glenoid cavity
Glenoid cavity (fossa)
Supraspinous
fossa
Lateral angle
Spine Infraglenoid tubercle

Subscapular
fossa
Lateral border
(axillary)
Infraspinous fossa

Medial border
(vertebral)

Lateral border

Inferior angle

Anterior view
Posterior view
132
Lateral Aspect of Scapula

133
 The foot
• Consist of 26 bones
• Subdivided into 3 parts
• Tarsus (hind foot/bones of the
ankle)
– Talus- astragalus
– Calcaneus – os calcis
• Midfoot (bones of the instep)
– Cuneiforms
– Navicular
– Cuboid bones
• Forefoot
– Metatarsal
– Phalanges (toes)

134
 Arches of the Foot
• Longitudinal arch • Transverse arch
•• functions
The bone ofasthe foot are absorber
a shock shaped
• runs from side to side &
and joined together to form a
to distribute the weight of the assist in supporting the
series of arches
body in all directions, which
longitudinal arch.
permits smooth walking

135
 The foot
• 14 phalanges
– 2 great toe
– 3 in each of the other toes
• 5 Metatarsal
– Begins at the medial
– Consist of a body or a shaft
– The head is at distal (from the
ball of the foot)
– The 1st is the shortest & thickest
– 2nd is the longest
– 5th presents a prominent
tuberosity at lateral side on its
base

136
 The foot
• 7 Tarsals
• Calcaneus (os calcis)
– Largest of the tarsus
– Cuboidal in shape
– Projects posteriorly & medially at the distal posterior part
– Inferiorly , the long axis forms 30o with the sole of the
foot
• Talus
– Irregular in form
– Occupying the highest position
– Second largest bone of the tarsus
• Cuboid
– Lies on the lateral side of the foot
– Between the 4th & 5th metatarsal
• Scaphoid (navicular)
– Lies on the medial side of the foot
– between the talus &the 3 cuneiforms
• Cuneiforms
– Lies at the central & medial side of the foot
– Between navicular & the 1st,2nd & 3rd metatarsal
– The medial (1st) is the largest
– The second is the smallest
137
 Bones of the Right Calcaneus
Foot
Talus

Cuboid Tarsals

Navicular
Medial cuneiform

Metatarsals
Intermediate cuneiform
Lateral cuneiform

Proximal phalanx
Digits Middle phalanx
Distal phalanx Proximal phalanx
of great toe

Distal phalanx
orsal view. of great toe

138
 Bones of the Right Foot
Navicular Talus
Intermediate cuneiform Fibula
Medial cuneiform Tibia

Talus

Cuboid Calcaneus

Phalanges
Metatarsals Tarsals
Medial view.
139
 Ankle Joint
• The ankle joint or
“talocrural joint” is a
synovial hinge joint
that is made up of the
articulation of 3
bones.
• The 3 bones are the
T
tibia, the fibula and F Talus
the talus.
• The articulations are
between the talus and
the tibia and the talus
and the fibula.
 Leg
• The leg has two bones: the
tibia and fibula.
• The tibia, the second largest
bone in the body, is situated on
the medial side of the leg.
• Slightly posterior to the tibia on
the lateral side of the leg is the
fibula.
 TIBIA
• Larger of the two bones of the leg and consists of
one body and two expanded extremities.
• The proximal end of the tibia has two prominent
processes-the medial and Lateral condyles
• The superior surfaces of the condyles form smooth
facets for articulation with the condyles of the
femur, called the tibial plateaus,
• Between the two articular surfaces is a sharp
projection, the intercondyLar eminence,
• which terminates in two peak like processes called
the medial and Lateral intercondyLar tubercles.
• The lateral condyle has a facet at its distal
posterior surface for articulation with the head of
the fibula. On the anterior surface of the tibia, just
below the condyles, is a prominent process called
the tibial tuberosity, to which the ligamentum
patellae attaches.
 Fibula
• Slender in comparison to its length and
consists of one body and two articular
extremities.
• The proximal end of the fibula is expanded
into a head, which articulates with the
lateral condyle of the tibia.
• At the lateroposterior aspect of the head is
a conical projection called the apex.
• The enlarged distal end of the fibula is the
lateral malleolus.
• The lateral malleolus is pyramidal and
marked by several depressions at its
inferior and posterior surfaces.
 Femur
• The femur is the longest, strongest, and
heaviest bone in the body
• This bone consists of one body and two
articular extremities .
• The body is cylindrical, slightly convex
anteriorly, and slants medially The extent
of medial inclination depends on the
breadth of the pelvic girdle. When the
femur is vertical, the medial condyle is
lower than the lateral condyle
• The superior portion of the femur
articulates with the acetabulum of the hip
joint
 Distal end of the femur
• Is broadened and has two large
eminences: the larger medial condyle
and the smaller lateral condyle.
• Anteriorly the condyles are separated
by the patellar surface, a shallow,
triangular depression.
The triangular area superior to the
• Posteriorly the condyles are
intercondylar fossa on the posterior
separated by a deep depression
femur is the popliteal surface, over
called the intercondylar fossa.
which the popliteal blood vessels and
• A slight prominence above and within
nerves pass.
the curve of each condyle forms the
medial and lateral epicondyles.
• The medial condyle contains the
adductor tubercle, which is located on
the posterolateral aspect.
 Patella
• knee cap
• Largest and most constant
sesamoid bone in the body
• Flat, triangular bone situated at the
distal anterior surface of the femur.
• Develops in the tendon of the
quadriceps femoris muscle
between the ages of 3 and 5 years.
• The apex, or tip, is directed
inferiorly, lies ½ inch (1.3 cm)
above the joint space of the knee,
and is attached to the tuberosity of
the tibia by the patellar ligament.
• The superior border of the patella is
called the base.
 5th lumbar
vertebra
Iliac
fossa

Iliac crest
Sacro-iliac
joint
1st sacral arches

2nd sacral arches

Anterior
superior
iliac spine
Hip joint
Neck of
femur Ischial spine
Anterior
inferior
Greater iliac spine
trochanter

Ischial
Symphysis tuberosity
pubis Superior pubic ramus
Inferior pubic ramus 147
Lesser Obturator
trochanter foramen Body of pubis
 AXIAL
SKELETON
 Bones of the Skull

Figure 5.11

Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings

 Cranium / Calvarium
• Rigidly joined together by
fibrous joints or suture

parietal 2 temporal 2
frontal 1

ethmoid 1 sphenoid 1 occipital 1

Allows for
growth
 Facial Bones

nasal 2 zygomatic arch 2

inferior nasal
conchae 2

lacrimal 2 maxillae 2

Palatine 2 mandible 1153

vomer-ploshare 1
Paranasal Sinuses
· Hollow portions of bones surrounding
the nasal cavity
 Functions
• Serve as a resonating chamber for the voice
• Decrease the weight of the skull by containing
air
• Help to warm and moisten inhaled air
• Act as shock absorbers in trauma (as air bag
do in automobiles)
• Possibly control the immune system

155
 Sinuses
• Begins to develop in early fetal life
• Maxillary well developed & aerated at birth
• by age 6 or 7 years the frontal and sphenoidal
sinuses are distinguishable from the ethmoidal
air cells.
• ethmoidal air cells develop during puberty, and
the sinuses are not completely developed until
the seventeenth or eighteenth year of life.

156
 Frontal sinuses
• Second largest sinuses
• Paired pyramidal shape
• Located between the tables
of the vertical plate of the
frontal bone.
• Approx. 2 to2.5 cm in
vertical or lateral dimension
• Occasionally they are
absent
• Drain into the middle nasal
meatus.

157
 2 ethmoidal labyrinths
• Located w/in the lateral mass of the ethmoid bone
• Composed of air cells
• anterior
– 2 – 8 cells
– Opens into middle nasal meatus
• middle
– 2 – 8 cells
– Opens into middle nasal meatus
• posterior
– 2- 6 cells
– Drain into the superior nasal meatus
158
 Maxillary Sinuses

• Largest sinuses
• Paired, located in the body of each maxilla
• Pyramidal in shape
• Adult 3.5 cm high & 2.5 – 3cm wide
• Divided by a complete septum
• Divided into sub compartments by partial septa
• Communicates w/ the middle nasal meatus at
the superior aspect of the sinus.

159
 Sphenoidal Sinuses
• Normally paired, but often one
is present
• Occupies the body of the
sphenoid bone.
• Lie below immediately the sell
turcica & extend between
dorsum sellas & the posterior
ethmoidal air cells.
• open into the
Sphenoethmoidal recess of
the nasal cavity.

160
The Hyoid Bone

· The only bone that

does not articulate
with another bone

· Serves as a
moveable base for
the tongue, and
other muscle
attachments
 Bony Thorax – functions

• Support the walls of pleural cavity

• Protects the heart and lungs
• Varies the volume of thoracic cavity during respiration
Bony Thorax - composition
• Sternum
• 12 pairs of ribs
• 12 thoracic vertebrae.
• Conical in shape
• narrower above than below,
• more wide than deep
• longer posteriorly than anteriorly.
 Sternum
• Breastbone
• Directed anteriorly and inferiorly centred over the
midline of anterior thorax narrow, flat bone
• 6 “ ( I5cm)
• 3parts:
– manubrium,
– Body
– xiphoid process.
• supports the clavicles
– at the superior manubrial angle
• provide attachment to the costal cartilages
– 1st seven pairs of ribs at the lateral borders.
Costochondral
articulations Sternoclavicular Sternum
1st sternocostal
joint
joint
Clavicle • Manubrium
– Superior & widest portion
– Quadrilateral
• Jugular notch
– palpable concavity at the
superior border of
manubrium
– anterior to the interspace
between T2 & T3
• Clavicular notch
– articulates w/ the Sternal
extremity of the clavicle
– below the Clavicular
notches, are shallow
depression for the
attachment of the cartilages
of the 1st pair of ribs.
 Sternum
• Body
– Longest part – 4”
– Joined to the manubrium at the
Sternal angle
– 5 pair of costal cartilage are
attached to the lateral border of
the body.
• Sternal Angle
– Palpable in normal thorax
– Obtuse angle that lie at the level
of the junction of 2nd costal
cartilage.
– manubrium & body contribute to
the attachment of 2nd costal
cartilage.
– lies anterior to the interspace
between the T4 & T5 in upright
 Sternum

• Xiphoid Process
– Distal & smallest part
– Cartilaginous in early life and
partially or completely
ossifies, particularly the
superior portion, in later life
– Variable in shape & often
deviates from the midline of
the body.
– Lie over T10 & serves as a
bony landmark for locating
the superior portion of the
liver & inferior border of the
heart
 Sternum
Clavicular
notch Jugular notch

1st

Manubrium
Sternal extremity

Manubrium
Sternal
angle
Sternal
angle

Body

Xiphisternal jt

Xiphoid process
 Rib

• rib number corresponds to

the thoracic vertebra to
which it attaches

• long, narrow, curved bone w/ an anteriorly

attached piece of hyaline cartilage
• costal cartilage

• Costal cartilage of 8th to 10th rib is attach

to the costal cartilage of 7th rib
 Rib

•• 8The
The last
to 12 aretwo
first ribsribs
called
seven areare
false called
ribs floating
because
called ribs
theybecause
true ribs
because
do notattach
they they
attach are attached
directly
directly totothe only to the
thesternum.
sternum
vertebrae.
 Rib

• have facets on their head for articulation

• •typical
Ontubercle
some rib
also
, the
contains
ribvertebrae.
consists facet isa divided
of a head,facet forinto a
a flattened
thwith the
11 neck,
&articulation
12 a ribs
th
superior anddowith
notand
inferior
tubercle, have
the a neck
portion for orprocess
atransverse
body tubercular facet .
articulation
of the vertebra.
with demjfacet on the
vertebral bodies.
 173

The Body
• Cylindrical shape
• Compose of large cancellous tissue covered by
a layer of compact tissue
• Posterior Surface is flattened and the lateral
surfaces are concave
• In the articulated column the bodies are
separated by cartilaginous disk that consist of:
– Nucleous pulposus- central mass of soft, pulpy,
semigelatinous material
– Annulus fibrosus- surrounding outer layer
 Typical Vertebra Cervical vertebrae (C3-C6)
174

• 3 foramina
– Transverse
• Left & right
• Body • Transmission of
– small, transversely vertebral artery
located, oblong body w/ – Pedicles
slightly elongated Spinous process • Project laterally &
anteroinferior border posteriorly from the
body
• Transverse Process Vertebrol
foramen

– arise partly from the side

of the body & vertebral
– Articular processes
arch. Transverse – Posterior to transverse
foramen

– Short & wide processes

– Superior & inferior
• Spinous Process
– Zygaphophyseal facets
– Short, bifid tips
– 2nd to 7th
– Direct posteriorly, slight
– (R ) to MSP
inferiorly
– palpable – Clearly demonstrated in
Lateral Projection
 175
Atlas Cervical Vertebra

• 1st cervical vertebra, a

– Ring like structure
– No body and no spinous
process.
– Consist of anterior arch ,
posterior arch, two lateral
masses and two transverese
processes.
– The anterior portion of the ring
receives the dens of the axis
(odontoid process)
– The posterior portion transmit
the proximal spinal cord
 Cervical Vertebrae - Axis
176

• 2nd cervical
– has a strong conical process
– arising from the upper surface of
the body (dens).
• Dens
– is received into the anterior
portion of the atlantal ring
– act as pivot or body of the atlas
• Vertebral prominence- 7th
– Long prominent spinous process
that project almost horizontally to
the posterior
– It is easily palpable at the base of
the neck poteriorly
 177
Thoracic Vertebrae

• increase in size from1st to the 12th vertebra.

• From 3rd – 9th are approximately triangular in form
• Transverse process
– project obliquely laterally and posteriorly.
– With exception to the 11th and 12th pairs,
– each process has on the anterior surface of its
extremity a small concave facet for the articulation
with the tubercle of the rib.
• The spinous process
– long from the 5th to the 9th vertebrae
– project sharply inferiorly and overlap each other but
are less vertical in direction.
• The zygapophyseal joints
– except the inferior facets of the 12th vertebra, angle
anteriorly approximately 15-20 degrees.
– Anterior rotation is used to demonstrate those farther
from the film
The intervertebral foramina are clearly demonstrated
 178
Lumbar Vertebrae
• Body
– Large been-shaped
– Increases in size from the 1st to the 5th.
– Deeper anteriorly than posteriorly, and superior and
inferior surface are flattened or slightly concave.
– The transverse processes are smaller than those of
the thoracic region.
• Spinous processes
– Large , thick, blunt and project almost horizontally
posteriorly.
– 5th lumbar process is smaller and shorter and the
transverse processes are much thicker
• The zygapophyseal joints
– inclined posteriorly from the coronal plane forming
an angle , open, posteriorly of 30- 50 degrees to
the MSP of the body.
– These joints can be demonstrate radiographically
by rotating the body from the supine or prone
position.
The intervertebral foramina are situated at the right
angles to the MSP of the body, except the 5th which
turns slightly anteriorly
the superior four pairs of foramina are
demonstrated in a true lateral position. the last pair
requires a slight obliquity of the body
 Sacrum and Coccyx
179

• formed by the fusion of the five sacral

segments into a curved, triangular bone
• wedges between the iliac bones of the
pelvis.
• The body has a prominent ridge at its
upper (sacral promontory)
– On each side is a large wing like mass or ala
• The inferior surface has an oval facet for
articulation w/ the coccyx and two
processes, the sacral horns
• The coccyx
– is composed of three to five (usually four)
rudimentary vertebra that
– have a tendency to fuse into one bone in
adult.
Arthrology

180
 Arthrology
• Study of the joints, or articulations
between bones.
• The two classifications of joints
described in anatomy books are
– Functional
– based on the mobility of the joint
• Synarthrose : (fibrous) immovable joint
• Amphiarthroses: slightly movable ( ones are
attached by cartilage)
•
Diarthroses: freely movable
– Structural
– based on the type of tissue that unite or
bind the articulating bone
• Fibrous (fibrous) immovable joint
• Cartilaginous slightly movable
( amphiarthroses)
• Synovial freely movable, much more
movement than cartilaginous joints. Cavities
between bones are filled with synovial fluid.
This fluid helps lubricate and protect the 181
bones.
 Fibrous joints
• Do not have a joint cavity
• united by various fibrous and
connective tissues or ligaments.
• Strongest joints in the body because
they are virtually immovable.
• Syndesmosis:
– immovable joint or very slightly movable
joint united by sheets of fibrous tissue.
Ex: tibiofibular joint
• Suture:
– immovable joint occurring only in the
skull . The interlocking bone are held
tightly together by strong connective
tissues.
• Gomphosis:
– an immovable joint occurring only in the
roots of the teeth. The roots of the teeth
that lie in the alveolar sockets are held in
place by fibrous periodontal ligaments
182
 Cartilaginous joints
• Are similar to fibrous joints in two
way :
– 1 they do not have a joint cavity
– 2 they are virtually immovable.
• Hyaline cartilage or fibro-cartilage
unites these joints.
• Symphysis: a slightly movable joint.
– The bones in this joint are separated
by a pad of fibrocartilage. The ends of
the bones contain hyaline cartilage. A
symphysis joint is designed for
strength and shock absorbency. Ex:
between each vertebrae
• Synchondrosis: an immovable joint.
– This joint contains a rigid cartilage that
unites two bones. An example is the
epiphyseal plate found between the
epiphysis and diaphysis of a growing 183
long bone
SYNOVIAL JOINTS
 Synovial joints
• Freely movable
• most complex joints in the body
• Articular Capsule
– completely surrounds all synovial joints
• Fibrous Capsule
– Outer layer, connects the capsule to
periosteum of the two bones
• Synovial membrane
– Inner layer, surrounds the entire joint to create
a cavity
• Synovial fluid
– Lubricates the joint space to reduce friction
between the bones.
• Meniscus
– pad of fibrocartilage
– act as shock absorber by conforming to and
filling in the large gaps around the periphery
of the bones
• Bursae
– synovial fluid filled sacs outside the main joint 185
cavity
 Synovial joints Gliding (plane)
• Uniaxial (simplest) movement
• Simplest synovial joint
• permit very slight movement
• have flattened or slightly
curved surface
• Most glide slightly in only one
axis
• Ex: intercarpal & intertarsal
joints, acromioclavicular &
costovertebral joints

186
 Synovial joints - Hinge (ginglymus)
• Uniaxial movement.
• A hinge joint permits only flexion
and extension
• The motion is similar to that of
a door
• Examples
– Elbow
– Knee
– Ankle
– Interphalengeal jt.

187
 Synovial joints - Pivot (trochoid)
• Uniaxial movement.
• These joints allow only rotation
around a single axis.
• A rounded or pointed surface of
one bone articulates within a ring
formed partially by the other
bone.
• The atlas rotates around the
dens of the axis and allows the
head to rotate to either side
• Proximal radioulnar

188
 Synovial joints - Ellipsoid (condyloid)
• Biaxial movement
• Permits movement in two
directions at right angles to
each other.
• Ex: radiocarpal joint of the
wrist
• Flexion and extension occur
along with abduction and
adduction.
• Circumduction, a
combination of both
movements, can also occur.
– No rotation
189
 Synovial joints - Saddle (sellar)
• Biaxial movement
• Permit movement in two axes,
very similar to the ellipsoid joint.
No rotation
• The articular surface of one bone
is saddle shaped and the articular
surface of the other bone is
shaped like a rider sitting in a
saddle.
• The carpometacarpal joint
between the trapezium and the
first metacarpal is the only saddle
joint in the body.
• The opposing bones are shaped in
a manner that allows side-to- side
and up-and-down movement
190
 Synovial joints - Ball and Socket
(spheroid)
• Multi-axial movement.
• Permits movement in many
axes:
– Flexion and extension,
– Abduction and adduction,
– Circumduction, and rotation.
• In a ball-and-socket joint the
round head of one bone rests
within the cup- shaped
depression of the other bone.
• More motion distally, less
proximally
– Ex: hip shoulder

191
TYPES OF JOINTS
JOINTS
 SternoclvicularJoint
• Protraction & retraction
• Medial end of the clavicle
& manubrium sterni
• Costoclavicular ligament
 Acromioclavicular joint
• Lateral & medial rotation
• Acromion process of the
scapula w/ the lateral end of
the clavicle
• The coraclavicular ligaments
 Shoulder joint
• Provides flexion,
extension, medial &
lateral rotation of the arm.
• 600
• Head of the humerus w/
glenoid fossa of the
scapula
AP radiograph of right shoulder

Applied Radiological Anatomy

Grade I
Grade II
Grade III
 Humerus
Anatomical neck
Greater tubercle
Lesser
tubercle Surgical neck
 Humerus

Bicipital groove

Deltoid tuberosity

Lateral
Medial
Epicondyles
Epicondyles

Capitulum
Trochlea
Radius Ulna
 Radial tuberosity
Radial notch

Styloid process