A Skeletal System - Appendicular Skeleton

Musculoskeletal System
Appendicular Skeleton
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 It is divided into: a). Axial skeleton composed
of skull/cranium, vertebral column, sternum
and ribs, hyoid bone, mandible
b). Appendicular skeleton composed of the
upper limbs & shoulder girdle, lower limbs &
pelvic girdle.

Human Skeleton and Arthrology.
Classification of Bones.
 Based on Region: Axial skeleton- ribs & sternum,
cranium, mandible, vertebral column (cervical-7,

thoracic- 12, lumbar -5, sacral -4 fused, coccyx -3
fused, hyoid bone).
 Appendicular skeleton: clavicle, humerus, scapula,
radius, ulna, carpal bones (distal row- trapezium,

trapezoid, capitate, hamate; proximal row-
scaphoid, lunate, triquetral, pisiform), metacarpals 1
-5, phalanges. (Scare Lunatics Take Position That
They Cannot Handle)
 Lower limbs, hip bones (ischium, ilium, & pubic
bone), femur, patella, tibia, fibula, calcaneous, tarsal

bones (cuboid, navicular, cuneiform), metatarsals 1-
5, phalanges.
 Based on Shape- Long bones e.g. bones of
the limbs (tibia, femur, radius, ulna) they
have long shafts and two distinct ends.
 Short bones e.g. carpal bones, tarsal bones,
sessamoid bones.
 Flat bones e.g. scapula, sternum, ribs, and
skull bones.
 Irregular bones e.g. hip bones, vertebrae
bones.
 Based on structure (osseous tissue).
Compact bones.
Spongy bones (bone marrow)

Parts of a Long Bone

Gross Anatomy
 Landmarks on a typical long bone
◦ Diaphysis
◦ Epiphysis
◦ Membranes
 Membranes
◦ Periosteum
◦ Endosteum

Diaphysis
Long tubular diaphysis is the shaft of the bone.
Collar of compact bone surrounds a central
medullary or marrow cavity. In adults, cavity
contains fat
 Medullary cavity
The interior of all bones consists largely of
spongy bone. The very center of the bone is
an open cavity or marrow cavity. The cavity is
filled with yellow bone marrow.
 Membranes
Periosteum covers outer bone surface. Consists

of dense irregular connective tissue &
osteoblasts . Contain nerve fiber blood and
lymph vessels secured by Sharpey’s fibers.
Endosteum covers internal bone surfaces

Short, Irregular and Flat Bones
 Bones consist of thin layers of compact
bones over spongy bone. No shaft,
epiphysis or marrow cavity. Spongy area
between is a diploe. Flat sandwich of bone

BONE SURFACE MARKING
 Bones have characteristic surface markings,
structural features adapted for specific
functions.
 Most are not present at birth but develop in
response to certain forces and are most

prominent in the adult skeleton.
 In response to tension on a bone surface from
tendons, ligaments, aponeuroses, and fasciae,

new bone is deposited, resulting in raised or
roughened areas.
BONE SURFACE MARKING…
 Conversely, compression on a bone surface
results in a depression.
 There are two major types of surface markings:
(1) Depressions and openings, which allow the

passage of soft tissues or form joints
(2) Processes, projections or outgrowths that
either help form joints or serve as attachment
points for connective tissue (such as ligaments
and tendons).
MARKING DESCRIPTION EXAMPLE
Fissure Narrow slit between Superior orbital

adjacent parts of bones fissure of the
through which blood sphenoid bone
vessels or nerves pass.
Foramen Opening through which Optic foramen of the
blood vessels nerves, or sphenoid bone
ligaments pass
Fossa Shallow depression. Coronoid fossa of the
humerus
Sulcus Furrow along a bone Intertubercular

surface that sulcus of the
accommodatedates a humerus
blood vessel, nerve, or
tendon.
Meatus Tube-like opening. External auditory
meatus of the
temporal bone
PROCESSES THAT FORM JOINTS
Condyle Large, round protuberance Lateral condyle of

at the end of a bone. the femur
Facet Smooth flat articular Superior articular

surface. facet of a vertebra
Head Rounded articular Head of the femur
projection supported on
the neck (constricted
portion) of a bone.
BONE SURFACE MARKING-PROCESSES THAT FORM
ATTACHMENT POINTS FOR CONNECTIVE TISSUE
Crest Prominent ridge or Iliac crest of the hip

elongated projection bone
Epicondyle Projection above a Medial epicondyle
condyle. of the femur
Line(linea) Long, narrow ridge or Linea aspera of the
border (less prominent femur
than a crest).
Spinous Sharp, slender Spinous process of
BONE SURFACE MARKING-PROCESSES THAT FORM
ATTACHMENT POINTS FOR CONNECTIVE TISSUE
MARKINGS DESCRIPTION EXAMPLE
Trochanter Very large projection Greater trochanter

of the femur
Tubercle Small, rounded Greater tubercle of

projection. the humerus
Tuberosity Large, rounded, Ischial tuberosity of
usually roughened the hip bone
projection.
Arthrology
 Arthrology is the scientific study of joints and
articulations.
 Joint (or articulation) - the junction between two
or more bones. With the exception of the hyoid

bone, every bone in the body is connected to/ or
forms a joint. There are 230 joints in the body
 Joint Functions
Hold the skeletal bones together

Allow the skeleton some flexibility so gross
movement can occur
Make bone growth possible.

Classification of Joints
Classification based on function (functional
classification)
Depends on mobility i.e.
i). Synarthroses the immovable joints e.g.
sutures.
ii). Amphiarthroses are the slightly movable
joints, and have fibrous connections e.g.
intervertebral joints.
iii). Diarthroses are the freely movable joints
e.g. the synovial joints.
 NB: Synarthroses and amphiarthroses are
largely restricted to the axial skeleton,

diarthroses predominate in the limbs.

Classification based on Structure
Based on the material that binds the bone together and on the
presence of joint cavity.
 Fibrous joints bones are connected by fibrous tissue and have no
joint cavity e.g. joint between the skull bones (sutures),

gomphoses joint found in the bones of the mandible & tooth,
syndesimoses the joint between distal parts of tibia and fibula.
 Cartilagenous joints the bones are united by a cartilage, there is
no joint cavity.
Synchondroses- hyaline cartilage unites the bones e.g.
costochondral joints seen in ribs and sternum, epiphyseal plates
(primary cartilaginous joints).
Symphyses – fibrocartilage unites the bones e.g. seen in
symphysis pubis, intervertebral joints (secondary cartilaginous
joints).
 Synovial joints are the most movable joints in the body (has a
wide range of movement) and are filled with synovial fluid. They
have a joint cavity with synovial fluid. They are strengthened by
articular capsule, reinforcing ligaments, muscles, bursae and
tendons that cross them.
 Synovial Joints.
 Articular ends covered in hyaline cartilage
and held together by dense connective tissue.

Joint capsules made up of ligaments (outer
layer) and synovial membranes (inner layer).
Some synovial joints have shock-absorbing
pads called menisci and fluid filled sacs
called bursae.

Types of Synovial Joints
a. Plane joints (Gliding Joint) –articular surfaces
are plane and allow only gliding movements
and has nearly flat or slightly curved
articulating surfaces. This type of joint
allows sliding and twisting movements. Some
examples of this type of joint include, the
joints within the wrists and the ankles, the
joints between the articular processes of
adjacent vertebrae, the sacroiliac joints, and
the joints formed by ribs (2-7) connecting
with the sternum.
b. Hinge Joint: - the convex surface of one
bone fits into the concave surface of another.
This type of joint permits movement in one
plane only. This movement consists of
flexion and extension. Two examples are the
elbow and the phalanges.

c. Pivot Joint: - the cylindrical (rounded)
surface of one bone rotates within a ring
formed of bone and ligament. Movement is
limited to the rotation around a central axis.
Examples of this type of joint are the joints
between the proximal ends of the radius and
ulna.

d. Condyloid Joint: an oval-shape condyle of
one bone fits into an elliptical cavity of
another bone. This type of joint permits a
variety of movements in different planes.
 It however, does not permit rotational
movement.
 Examples of this type of joint would be the
joints between the metacarpals and the

phalanges.

e. Saddle joint: - forms between bones whose
articulating surfaces have both concave and
convex regions. The surface of one bone fits
the complementary surface of the other bone.
This type of joint permits a variety of
movements. An example would be the joint
between the trapezium and the metacarpal
bones of the thumb.

f. Ball & socket joint:- the spherical head of
one bone fits into the socket of the other
bone. Ball-and-Socket Joint: consists of a
bone with a ball-shaped head that attaches
with the cup-shaped cavity of another bone.
This type of joint allows for a wider range of
motion than any other kind. It permits
movement in all planes, and a rotational
movement around a central axis. Two
examples of this type of joint would be the
hip and shoulder joints.

Planes of motion in a joint
 Uniaxial- allows movement in only one axis
e.g. knee joint, elbow joint.
 Biaxial- allows movement in two axis e.g. the
subtalar joint, wrist joint.

 Multiaxial/polyaxial allows movement in
multiple planes e.g. shoulder and hip joints.

 NB: Sessamoid (seed-like) bones are found in
between tendons e.g. patella in quadriceps

tendon, pisiform in the flexor carpi ulnaris
tendon. They are associated with certain
tendons where they glide over an adjacent
bone.

 They may be fibrous, cartilaginous or bony
nodules or a mixture of all three and their
presence is variable. Patella is the largest
sessamoid bone; others are in the tendons of
adductor pollicis, flexor pollicis brevis and flexor
hallucis brevis. In the foot, they can occur in the
peroneus longus tendon over the cuboid bone
tibialis anterior tendon.
 Reasons for the presence of sessamoid bones are
uncertain, but they are thought to be concerned
with altering the line of pull of a tendon (patella
in quadriceps tendon) or with helping to prevent
friction (as in the peroneus longus tendon moving
against the cuboid bone).

Pectoral Girdle
 Bones of the pectoral/ shoulder girdle are
clavicle & scapula which connects the upper
limbs to the axial skeleton. Sternoclavicular
joint connects the girdle to the rest of the
skeleton. The two girdle bones are joined to
one another by the acromioclavicular joint

.

Muscles of the pectoral Girdle
 These are; Pectoralis minor, subclavius, trapezius,
the rhomboids, levator scapulae and serratus
anterior. Greater muscles of the axillary fold;
Pectoralis major, latissmus dorsi which moves the
pectoral girdle on the trunk.
 NB: The muscles supraspinatus, infraspinatus, teres
minor, teres major crosses the glenohumeral joint
and attaches on the humerus. The four forms an
important segment called rotator cuff muscles which
provide important stability of the shoulder joint.
 The head of humerus snugly fits into the glenoid
cavity and this makes the joint unstable thus
stabilized by the muscles crossing there.

Bony structures of the upper limb
These are the scapula, clavicle, humerus, radius, ulna,

carpal bones, metacarpal bones and phalanges.
Joints
 Sternoclavicular joint
 Acromioclavicular joint
 Scapulothoracic joint- physiological joint.
 Glenohumeral joint (these four forms the shoulder
joint complex).
 Elbow joint.
 Wrist joint
 Intercarpal joint
 Carpometacarpal joints
 Metacarpalphalangeal joints
 Interphalangeal joints

Pectoral Region
 The most important structure here is the
breast. Other structures are muscles; pectoralis
major, pectoralis minor. In non-ptotic (firm not
sagging) breasts it is located between the 2 nd
and 6th ribs, with the nipple at 4th intercostal
space. It extends laterally to mid-axillary line,
and medially lateral border of sternum.
 It has adipose tissues, ducts and ligaments
(suspensory ligaments) also called “coopers”
ligaments which provide support to the breast.
In cancer of the breast there is dimpling and
shortening giving a “ peared orange”
appearance.
 .
Pectoral Region
 Blood supply is from internal thoracic artery
and branches of anterior intercostal arteries
Lymphatic drainage is by axillary nodes (80%)
which have 5 groups; pectoral group,
posterior, central, lateral and apical. During
breast examination examine all the groups,
parasternal nodes (15%), diaphragmatic
nodes (5%), and some lymph goes to the
opposite breast.

Deltoid Region
 The main muscle is the deltoid muscle which
has three portions; anterior, lateral and
posterior. The main function of this muscle is
abduction of the shoulder joint.
 Nerve supply is from axillary nerve.
 Clinical Relevance
 Intramuscular injections can be done on the
deltoid muscle.

Axilla Region
 This is the area under the arm (armpit). Has a
pyramid shape
Boundaries: Anteriorly- anterior axillary fold
which contains muscles of pectoralis major,
pectoralis minor and subclavius.
Posteriorly- posterior axillary fold which contains
the muscles latissmus dorsi, subscapularis &
teres major.
Laterally- medial aspect of the arm
Medially- serratus anterior muscle and thoracic wall
sitting on ribs 2-6.
Floor – formed by skin and fascia.
Apex formed by the first rib.
Superior border formed by scapula and the clavicle.

The Axilla contd….
Contents
 Axillary artery – brachial artery in the arm
 Axillary vein
 Axillary lymph nodes- the five groups of nodes
(pectoral, subscapular, lateral, central & apical).

 Nerves- the cords of brachial plexus and their
branches.
 Axillary fat
Clinical Relevance
 Palpation of axillary lymphadenopathy done here.
 It is a site for inferior dislocation of the shoulder joint.
 Brachial nerve block done on either axillary region or
at the neck.
 Axillary nerve is injured in inferior dislocation of the
shoulder joint.
.
 Cubital Fossa- found in front of the elbow
and it is triangular in shape.
 Boundaries: Medially- pronator teres muscle
Laterally- brachioradialis muscle

Base- Imaginary line between the medial
& lateral epicondyle
Roof- Skin and brachial fascia
Floor- muscle brachialis

.
Contents
 Median cubital vein
 Brachial artery
 Median nerve
 Tendon of biceps brachii
 Lateral margin of radial nerve
Clinical relevance
 Intravenous access done through the median
cubital vein.
 Palpation of pulse rate done on the brachial
artery.
 Bicipital tendon reflexes done here.
 It is the site for estimation of blood pressure.

Anatomical Snuff Box
 It is found on the extensor tendons of the
thumb. Bordered laterally by two tendons

abductor pollicis brevis, extensor pollicis
brevis, medially by extensor pollicis longus,
floor made by distal radius, scaphoid and
trapezium. Roof contains the cephalic veins
and radial nerve.
 It contains the radial artery and it is the site
for palpation of the radial pulse. Tenderness

on the anatomical snuffbox after history of
fall on an outstretched hand is treated as
fracture scaphoid whether seen on x-ray or
not.
Carpal Tunnel
 The carpal tunnel is a narrow passageway found on the
anterior portion of the wrist. It serves as the entrance to

the palm for several tendons and the median nerve.
Borders.
 The carpal tunnel is formed by two layers: a deep
carpal arch and a superficial flexor retinaculum. The

deep carpal arch forms a concave surface, which is
converted into a tunnel by the overlying flexor
retinaculum.
Contents
 The carpal tunnel contains a total of 9 tendons,
surrounded by synovial sheaths, and the median nerve.

Tendons
 The tendon of flexor pollicis longus
 4 tendons of flexor digitorum profundus
 4 tendons of flexor digitorum superficialis

con

 The 8 tendons of the flexor digitorum profundus and
flexor digitorum superficialis are surrounded by a single
synovial sheath. The tendon of flexor pollicis longus is
surrounded by its own synovial sheath. These sheaths
allow free movement of the tendons.
 Sometimes the carpal tunnel contains another tendon,
the flexor carpi radialis tendon, but this is located within

the flexor retinaculum and not within the carpal tunnel
itself.
Clinical Relevance: Carpal Tunnel Syndrome
 Any form of swelling causing compression of the median
nerve within the carpal tunnel can cause carpal tunnel

syndrome (CTS). It is the most common
mononeuropathy and can be caused by thickened
ligaments and tendon sheaths. CTS can cause
weakness, paraesthesia and atrophy of the region
supplied by the median nerve (thenar muscles).

Contents

Transverse section of the carpal tunnel.

Regions in the Lower Limb
Gluteal region contains the muscle gluteaus

maximus, which do extension at the hip joint.
Also has gluteal minimus muscle which does
abduction at the hip joint.
Clinical Relevance
 Intramuscular injections are given on the
upper outer quadrant of the buttocks to avoid

injury to the neurovascular bundle specifically
the sciatic nerve.

Femoral Triangle
 It is a hollow triangle in the thigh region.
Borders
 Superior border formed by the inguinal ligaments (run
from the anterior superior iliac spine to the pubic

tubercle).
 Lateral border formed by the medial border of the
Sartorius muscle.
 Medial border formed by the medial border of the
adductor longus muscle. The rest of this muscle forms

part of the floor of the triangle.
 Roof formed by fascia lata.
 Base formed by the pectineus, iliopsoas and adductor
longus muscle.
 The inguinal ligament acts as flexor retinaculum,
supporting the contents of the femoral triangle during

flexion at the hip.
Contents (Lateral to Medial)
 Femoral nerve- which innervates the anterior
compartment of the thigh and provides

sensory branches for the leg and foot.
 Femoral artery responsible for the majority of
the arterial supply to the lower limb.

 Femoral vein – the greater saphenous vein
drain into the femoral vein within the triangle.

 Femoral canal- a structure which contains
deep lymph nodes and vessels.

 Deep inguinal nodes.
 NB: The femoral artery, vein and canal are
contained within a fascial compartment known

as femoral sheath.
Clinical Relevance
 The femoral artery can be palpated for femoral
pulse.
 Femoral vein can also be accessed for blood
samples.
 Procedures e.g. coronary angiography can be done
through the femoral artery.

 Femoral artery can be catheterized to draw blood
for gas analysis.

 In case of femoral hernia, part of the bowel pushes
into the femoral canal, underneath the inguinal

ligament. This manifests clinically as a lump/bulge
in the area of the femoral triangle.
 Other swellings in this region may be caused by
femoral artery aneurysms, varicose veins of the

great saphenous veins.
Popliteal Fossa
 It is a diamond shaped space found at the back (posterior)
of the knee. It is the main path in which structures move

from the thigh to the leg.
Borders
 The borders are formed by the muscle in the posterior
compartment of the leg and thigh.

 Superiomedial border formed by semimembranosus.
 Superiolateral border formed by biceps femoris.
 Inferiomedial border formed by medial head of the
gastrocinemius.
 Inferiolateral border formed by the lateral head of
gastrocinemius.
 Floor formed by the posterior surface of the knee joint
capsule, and by the posterior surface of the femur.

 Roof is made up of popliteal fascia and skin (popliteal
fascia is continuous with the fascia lata of the leg).

Contents (medial to lateral)
 Popliteal artery and branches
 Popliteal vein
 Tibial nerve
 Common peroneal nerve branch of sciatic
nerve
 Saphenous vein
 Fats
 Popliteal nodes

.
Clinical Relevance
 Swelling in the popliteal fossa may be baker’s cyst
(inflammation and swelling of the semimembranosus

bursa) or aneurysm (dilatation) of the popliteal artery.
 The popliteal fascial layer is tough and non-extensible
thus an aneurysm will compress on the tibial nerve

which will present as leg anaesthesia, or loss of motor
function.
 Other rare cause of popliteal mass include deep vein
thrombosis, adventitial cyst of the popliteal artery and

neoplasms e.g. rhabdomyosarcoma, popliteal
adenopathies.
I. NB: An aneurysm of the popliteal artery can be
detected by an obvious palpation in the popliteal
fossa, with abnormal arterial sounds.
II. Do not put a needle to aspirate a swelling on the back
of the knee joint.

A Skeletal System - Appendicular Skeleton

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Musculoskeletal System

Sunday, March 31, 2024 1

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Sunday, March 31, 2024 3

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cranium, mandible, vertebral column (cervical-7,

radius, ulna, carpal bones (distal row- trapezium,

bone), femur, patella, tibia, fibula, calcaneous, tarsal

Sunday, March 31, 2024 7

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Periosteum covers outer bone surface. Consists

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Sunday, March 31, 2024 14

response to certain forces and are most

tendons, ligaments, aponeuroses, and fasciae,

(1) Depressions and openings, which allow the

Fissure Narrow slit between Superior orbital

Sulcus Furrow along a bone Intertubercular

Condyle Large, round protuberance Lateral condyle of

Facet Smooth ﬂat articular Superior articular

MARKING DESCRIPTION EXAMPLE

Crest Prominent ridge or Iliac crest of the hip

MARKINGS DESCRIPTION EXAMPLE

Trochanter Very large projection Greater trochanter

Tubercle Small, rounded Greater tubercle of

or more bones. With the exception of the hyoid

Hold the skeletal bones together

Sunday, March 31, 2024 22

largely restricted to the axial skeleton,

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joint cavity e.g. joint between the skull bones (sutures),

and held together by dense connective tissue.

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joints between the metacarpals and the

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subtalar joint, wrist joint.

multiple planes e.g. shoulder and hip joints.

between tendons e.g. patella in quadriceps

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These are the scapula, clavicle, humerus, radius, ulna,

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(pectoral, subscapular, lateral, central & apical).

Laterally- brachioradialis muscle

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thumb. Bordered laterally by two tendons

for palpation of the radial pulse. Tenderness

anterior portion of the wrist. It serves as the entrance to

carpal arch and a superficial flexor retinaculum. The

surrounded by synovial sheaths, and the median nerve.

 4 tendons of flexor digitorum profundus