1. Chapter 5: The Skeletal System

2. Introduction
Postural and movement assessments are significant for many manual therapists
Bone landmarks provide important reference points for evaluation
Skeletal structures work together to support, protect, and allow freedom of movement
Recognizing structural imbalances are important

3. Functions of the Skeletal System
Framework and support
Protection of internal organs
Levers and fulcrums for movement
Mineral storage in bones
Blood cell production in bone marrow

4. Divisions of the Skeleton
Axial skeleton
Appendicular skeleton
See Figure 5-1 and Table 5-1

5. Bones of the Axial Skeleton
8 cranial and 14 facial bones
Hyoid bone in anterior neck
3 ossicles inside each ear
33 vertebrae in spinal column
Rib cage consisting of the sternum and 12 pairs of costal (rib) bones

6. Bones of the Appendicular Skeleton
Pectoral girdle: the clavicle (collar bone) and scapula (shoulder blade)
Upper extremity: humerus, radius and ulna, 8 carpals (wrist bones), 5 metacarpals, and 14 phalanges (finger bones)
Pelvic girdle: 2 os coxae (coxal or hip bones), each comprised of ilium, ischium, and pubis
Lower extremity: femur, tibia and fibula, patella, 7 tarsals (ankle bones), 5 metatarsals, and 14 phalanges

7. Bone Tissue and Structure
Bones undergo cycles of self-destruction and reformation (remodeling):
Bone resorption: breakdown of bone tissue
Deposition: building up of new bone tissue
Homeostatic mechanism to balance calcium and phosphorus
Osteoporosis: brittle bones caused by too much resorption

8. Bone Tissue Osseous tissue made of cells, fibers, and ground substance
4 types of bone cells:
Osteoblasts build up bone
Osteoclasts break down bone
Osteocytes carry out nutrient–waste exchange
Osteogenic cells capable of mitosis

9. Bone Tissue (cont’d) Compact (dense, or cortical) bone
Forms shaft of long bones and outer layers of all bones
Composed of osteons
Spongy (cancellous) bone
Found in ends of long bones and throughout flat bones
Composed of lattice of trabeculae
Osteocytes reside in both types of bone tissue

10. Bone Classifications by Shape
Long bones: found in appendicular skeleton: femur, tibia, fibula, humerus, ulna, radius, metatarsals, metacarpals, and phalanges
Short (cuboid) bones: carpals and tarsals
Flat bones: skull, pelvic girdle, sternum, ribs, and scapula
Irregular bones: vertebrae, some facial bones, patella

11. Bone Shapes

12. Anatomy of a Long Bone Epiphysis: end of bone; contains red marrow
Diaphysis: shaft
Epiphyseal plate: cartilaginous region between epiphyses and diaphysis where bone growth occurs
Medullary cavity: cavity in middle of shaft; contains yellow marrow
Articular or hyaline cartilage: covers articular surfaces
Periosteum: outer connective tissue covering
Endosteum: lining of medullary cavity

13. Bone Landmarks
Distinctive lines, grooves, bumps, and projections make each bone unique (see Table 5-2)
Landmarks serve as attachment points for muscles or passageways for blood vessels and nerves
Some landmarks can be felt when palpating superficial tissue
Important to manual therapists because they help locate internal structures

14. Cranial Bones Frontal Parietal Temporal Occipital Sphenoid Ethmoid
See Figures 5-6 to 5-8

15. Sinuses of the Skull

16. Facial Bones Lacrimal Nasal Nasal concha Vomer Palatine Zygomatic
Maxilla
Mandible

17. Anterior View of Cranial and Facial Bones

18. Spinal Column 33 vertebrae divided into 5 regions:
Cervical region: 7 vertebrae (C1 to C7)
Thoracic region: 12 vertebrae (T1 to T12)
Lumbar region: 5 vertebrae (L1 to L5)
Sacral: 5 vertebrae (S1 through S5)
Coccygeal: 3 or 4 vertebrae (Co1 to Co4)

19. Normal Curves of Spinal Column

20. Spinal Deviations

21. Landmarks of Thorax Sternum Manubrium Xiphoid process
23 pairs of costals (see Figure 5-14)
True ribs
False ribs
Floating ribs

22. Landmarks of Pectoral Girdle
Clavicle
Clavicular notch
Sternoclavicular (SC) joint
Acromioclavicular (AC) joint
Scapula (see Figure 5-15)
Superior and inferior angles
Axillary and vertebral borders
Fossae and processes

23. Landmarks of Upper Extremity
Glenohumeral (shoulder) joint
Humerus, radius, and ulna
Wrist and hand
See Figures 5-16 to 5-18

24. Landmarks of Pelvic Girdle
Sacrum and os coxae (ilium, ischium, pubis)
Acetabulum
Obturator foramen
Pelvic inlet
Anterior and posterior superior iliac spines
Iliac fossa
Ischial tuberosity
See Figure 5-19

25. Landmarks of Lower Extremity
Hip joint
Femur, tibia, fibula, patella
Ankle and foot
See Figures 5-20 to 5-22

26. Surface Anatomy for Manual Therapists
Upper body anterior view

27. Surface Anatomy for Manual Therapists
Upper body posterior view

28. Surface Anatomy for Manual Therapists
Lower body anterior view

29. Surface Anatomy for Manual Therapists
Lower body posterior view

30. Joints Joint or articulation: where two bones meet
Skeletal bones: rigid levers for movement
Joints: fulcrums or points where movement occurs
Joints classified by structure or function

31. Joint Classifications
Structural
Functional
Examples
Fibrous
Synarthrotic (immovable)
Sutures of the skull
Tibiofibular articulations
Cartilaginous
Amphiarthrotic (slightly movable)
Pubic symphysis
Intervertebral joints
Synovial
Diarthrotic (freely movable)
Elbow (humeroulnar joint)
Knee (tibiofemoral joint)
Hip (iliofemoral joint)

32. Fibrous Joints
Cranial bones held together at sutures by dense fibrous connective tissue
Proximal and distal tibiofibular articulations allow slight shifting

33. Cartilaginous Joints
Fibrocartilage pad between bone surfaces allows partial movement at joint
All cartilaginous joints are amphiarthrotic
Examples:
Joint between pubic bones (pubic symphysis)
Intervertebral joints between vertebrae where intervertebral discs lie

34. Synovial Joints
All are diarthrotic and have 4 common structural features:
Articular (or hyaline) cartilage protects bone ends
Stabilizing fibrous joint capsule
Synovial membrane that secretes synovial fluid
Stabilizing ligaments inside or outside joint capsule
See Figure 5-24

35. Types of Synovial Joints

36. Basic Movements of Synovial Joints

37. Special Movement Terms
Inversion, eversion
Dorsiflexion, plantar flexion
Lateral flexion
Elevation, depression
Protraction, retraction
See Table 5-4

38. Special Movement Terms (cont’d)
Rotation of scapula: upward, downward
Rotation: medial or internal, lateral or external
Supination, pronation
Radial deviation, ulnar deviation
See Table 5-4

39. Pathology Alert: Arthritis
Osteoarthritis (degenerative joint disease):
Caused by wear and tear due to injury, normal activities, or age
Most common in weight-bearing joints
Rheumatoid arthritis
Autoimmune condition
Particularly affects hands and feet
Gout

40. Aging and the Skeletal System
Common changes related to aging:
Decreased density of bone tissue matrix (bone loss)
Wearing away of articular cartilage
Decreased range of motion
Increased joint pain
Decreased production of blood cells
Manual therapists should take extra precautions