1. Clinical terms Dwarfism – Achondroplasia Abnormal projection from a bone due to bony overgrowth – Bony spur Pain in bone – Ostealgia Bone inflammation – Osteitis Inflammation of bone and bone marrow caused by pus-forming bacteria – Osteomyalitis Bone cancer in a long bone of limb – Osteosarcoma Fracture in diseased bone involving slight (coughing or quick turn) – Pathological fracture Placing sustained tension on a body region to keep fractured bone in alignment – Traction 1

2. Epiphyseal Zones Name the 5 zones 2 Resting cartilage Proliferation Hypertrophy Erosion (Calcification) Diaphysis (ossification)

3. Resting Cartilage Identify characteristics of this zone 1.Chondro’s resting in Lacunae 2.Not mitotically dividing 3.Not actively contributing to bone growth 4.Near epiphysis 5.Scattered chondro’s What is the Role of this zone? 1.To anchor the rest of the epiphyseal plate to the epiphysis 3

4. Proliferation Zone Identify characteristics 1.Chondro’s proliferating and dividing 2.Supplying new chondro’s to replace those lost to lengthening of bone 3.Proliferating cells stick up into narrow cells 4.Cells resemble stack of coins 4

5. Hypertrophy (Maturing) Zone Identify characteristics 1.Cellular breakdown 2.Chondro’s begin to break down and produce alkaline phosphatase 3.Enzyme facilitates calcification of extra cellular matrix 4.Large chondro’s arranged in columns 5

6. Erosion Zone (calcification) Identify 1.Calcium salts deposited in cartilage matrix by osteoids 2.Osteogenesis, osteoblasts laying down the matrix 3.Only a few cells thick 4.Dead cells because the matrix around them became calcified 5.Calcified matrix destroyed by osteoclasts (acids and enzymes), then invaded by osteoblasts and capillaries from diaphysis 6.Diaphyseal border of the plate firmly cemented to the bone of the diaphysis 6

7. Diaphysis Zone (ossification) Identify 1.Long spiracles (tuberculae) that form spongy bone produced 7

8. Articulations - Appendicular Clavicle: – Medially with sternum manubrium – Laterally acromium of scapula Scapula: – Lateral with head of humerus at glenoid cavity Humerus – Proximal with scapula – Distal with radius and ulna Radius: (lateral thumb side) – Proximal with capitulum of humerus – Medial with radial notch of ulna – Distally, medial ulnar notch of radius to ulna and carpals Ulna: (little finger side) – Proximal – trochlea of humerus – Distal – medial with radius at radioulnar joint 8

9. Osteological Terms - Processes A rounded articulating process – Condyle Any bony projection – Process A projection located above a condyle – Epicondyle A large rounded or irregular process – Tuberosity A small rounded process – Tubercle A very large, often blunt process – trochanter A sharp, slender process – Spine A hook-shaped process – Hamulus A very slight ridge of bone – Line A prominent ridge of bone – Crest A smooth flattened articulating surface – Facet 9

10. Osteological terms - Fosae A hole in a bone through which nerves and blood pass – Foramen A tunnel-like passage through a bone – Meatus or canal A cavity within a bone – Sinus A furrow on a bone’s surface – Sulcus or Groove A slit-like opening in a bone – Fissure A shallow depression – Fovea 10

11. Identify parts of the bone Tubular shaft of the long bone – Diaphysis Part of long bone where growth occurs – Epiphysis Irregularly arranged lamellae and osteocytes interconnected by canaliculi – Spongy bone (Cancellous, Trabeculae bone) Marrow cavity in the shaft of long bone – Medullary cavity Hematopoietic tissue found within trabecular cavities of spongy bone – Red marrow Fat that fills cavities of bones – Yellow marrow Membrane covering internal bone surfaces – Endosteum Highly vascularized membrane covering the exterior of the diaphysis – Periosteum Disc of hyaline cartilage that grows during childhood to lengthen the bone – Epiphyseal plate 11

12. Name functions of Skeleton System Support Bones support the body and organs Protection – Protect vital organs: skull, sternum, vertebrae, ribs Movement – Skeletal muscle contraction causes movement Mineral storage – Calcium and other minerals stored in bone can be released into the bloodstream when needed (hormonal control) Formation of blood cells – Hematopoiesis occurs in blood marrow resulting in the production of red and white blood cells and platelets 12

13. What are the 2 types of Osseous Tissue Compact bone – Smooth, compact, with little air space – Haversian systems Spongy bone (cancellous, trabecular) – Small pieces of bone surrounded by open spaces filled with red or yellow marrow 13

14. Name the 4 types of bone Long bone – Shaft with a wide portion at both ends – Primarily compact bone with spongy at the widened areas – Humerus, radius, ulna, femur, tibia, fibula, phalanges Short bones – Cube shaped, mostly cancellous bone – Wrist, ankle – Sesamoid – short bones embedded within tendon (patella) Flat bone – Thin and flat – 2 layers of compact with spongy between – Sternum, ribs, skull Irregular bone – Spongy with odd shape – Vertebrae and hip 14

15. Compact bone Composed of? – Osteons or Haversion systems Interspersed with? – Blood, lymphatic vessels and nerves Concentric rings of compact bone called ____________ surround hollow passageways called ____________________ – Lamella, Haversion canals What connects Haversion canals? – Volkman’s canals Canals are lined with what tissue? – Endosteum Where do osteocytes reside? – Lacunae What connects the lacunae? – Canaliculi What are the canaliculi’s function? – Permit nutrients and oxygen to pass between osteocytes – Remove wastes What are interstitial lamellae? – Layers of bone that fill gaps between osteons What are circumferential lamellae? – Large rings of bone extending around the entire shaft of the bone 15

16. Compact bone structure 16

17. Chemical Composition of bone What are the organic components of bone? – Osteocytes, osteoblasts, osteoclasts – osteoid What is the Osteoid comprised of? – Collagen fibers, proteoglycans, and glycoproteins What is its function? – Flexibility and tensile strength on bone What are the inorganic components? – Hydroxyapatites (mineral salts) which are mostly calcium phosphates (tiny crystals from the blood stream deposited among collagen fibers) What are they responsible for? – Hardness of the bone What are bone markings? – Bulges, depressions, rough spots, holes on the exterior surface of the bone – Most are muscle or ligament attachment sights 17

18. Name the 2 types of bone formation Intramembranous ossification Endochondrial Ossification 18

19. Intramembranous Ossification? What is it? – The process of bone developing from a fibrous tissue What bones are formed this way? – Flat bones such as the skull and clavicles Explain the process: –Fibrous connective tissue in developing fetus become? – scattered with osteoblasts that begin secreting organic matrix. –Osteoid is? – then mineralized and osteoblasts become osteocytes –Osteoid accumulates in? – small networks of collagen fibers called trabeculae. –This early bone formation is called? – woven bone. –The periosteum forms around the? – woven bone. –Trabeculae thickens until they become? – plates of bone. –Eventually these plates of woven bone are replaced by? – compact bone. –Spongy bone remains in the center of the bone and the vascular tissue within it? – differentiates into red marrow (formation of diploe) 19

20. Intramembranous Ossification 1 20

21. Intramembranous 2 21

22. Intramembranous 3 22

23. Intramembranous 4 23

24. Endochondrial Ossification? What is it? – The process of bone formation where hyaline cartilage is used as the model for constructing bone. Most bones are formed this way Explain the process: –The perichondrium surrounding the hyaline cartilage bone model becomes infiltrated with? – blood vessels, converting it into periosteum. –Osteoblasts in the periosteum secrete? – osteoid externally onto the shaft of the hyaline bone –The matrix deep within the shaft of the cartilage begins to? – deteriorate –A periosteal bud containing arteries, veins, nerves and lymph vessels invades? – the internal cavity of the forming bone. –Osteoblasts from the periosteal bud begin to? – deposit osteoid, forming trabeculae of bone (early spongy bone) –Osteoclasts break down new spongy bone and open a? – medullary cavity in the center of the shaft –Secondary ossification centers form shortly before or after? – birth in the epiphyses of the bone. –Spongy bone is eventually formed with hyaline cartilage remaining only at the? – epiphyseal plate and the articular cartilages 24

25. Endochondral Ossification 25 Formation of bone collar around hyaline cartilage model. Cavitation of the hyaline cartilage within the cartilage model. Invasion of internal cavities by the periosteal bud and spongy bone formation. Ossification of the epiphyses; when completed, hyaline cartilage remains only in the epiphyseal plates and articular cartilages Formation of the medullary cavity as ossification continues; appearance of secondary ossification centers in the epiphyses in preparation for stage 5. Hyaline cartilage Primary ossification center Bone collar Deteriorating cartilage matrix Spongy bone formation Blood vessel of periosteal bud Secondary ossification center Epiphyseal blood vessel Medullary cavity Epiphyseal plate cartilage Spongy bone Articular cartilage

26. Bone growth in long bones How do long bones grow in children? – Entirely by interstitial growth of the epiphyseal plates How do bones grow in thickness? – By appositional growth The widening of bones 26

27. Epiphyseal bone growth The top layer (epi side) of hyaline cartilage plate contains actively dividing chondrocytes that are pushed towards the ________________? Diaphysis What does this do? Causes the entire bone to lengthen What happens to the chondrocytes as they get closer to the shaft? They enlarge and eventually die What occurs at the junction of the epiphysis and the diaphysis? Osteoblasts begin to secrete bone matrix and form small spicules of bone What promotes the adolescent growth spurt and eventually leads to the closure of epiphyseal plate? Sex hormones What happens as adolescence ends? The epiphyseal plate becomes smaller and is entirely replaced by bone tissue What is the result of this occurring? Bone growth ends 27

28. Long bone growth 28

29. Structure of long bone 29

30. What is appositional growth The process used to? – Widen bones _____________ beneath the _____________ form new ______________ systems on the outer surface of the bone – Osteoblasts, periosteum, Haversian ________________ on the ________________ break down bone to enlarge the ______________ cavity. – Osteoclasts, endosteum, medullary 30

31. Appositional growth 31 Osteoblasts beneath the periosteum secrete bone matrix, forming ridges that follow the course of periosteal blood vessels. As the bony ridges enlarge and meet, the groove containing the blood vessel becomes a tunnel. The periosteum lining the tunnel is transformed into an endosteum and the osteoblasts just deep to the tunnel endosteum secrete bone matrix, narrowing the canal. As the osteoblasts beneath the endosteum form new lamellae, a new osteon is created. Meanwhile new circumferential lamellae are elaborated beneath the periosteum and the process is repeated, continuing to enlarge bone diameter. Artery Periosteum Penetrating canal Central canal of osteon Periosteal ridge 1 2 3 4

32. Bone Remodeling What is bone remodeling? – Process where bone is resorbed and deposited at periosteal or endosteal surfaces What should the rate of bone resorption be in healthy adults? – The same rate as deposition so the total mass remains constant What is bone deposit? – Osteoblasts laying down new osteoid which is later mineralized into bone How is bone resorption carried out? – by osteoclasts secreting enzymes onto the bone that digest organic matrix. The osteoclasts also secrete acids that help to make the calcium salts more soluble What is PTH? – Parathyroid hormone – Hormone produced by the parathyroid gland in response to low blood calcium levels. – It stimulates bone resorption so that calcium is released and put back into the blood What is Calcitonin? – A protein produced by specialized “C” cells in the thyroid and secreted when blood calcium levels rise – Inhibits bone resorption and enhances calcium deposit in the bone matrix 32

33. Bone remodeling How much of our bone mass is recycled every week? – 5 to 7% How often is spongy bone replaced? Compact bone – Every 3 to 4 years – Every 10 years What are remodeling units? – Packets of adjacent osteoblasts and osteoclasts that coordinate bone remodeling What is bone deposit? – Added bone for injured or strength of bone What is an osteoid seam? – The marking of new matrix deposits by osteocytes (band of gauzy looking bone matrix) What helps trigger calcification? – Calcium and phosphate ions 33

34. Bone remodeling (cont) What happens when calcium and phosphate mix reach a certain level? – Tiny crystals of hydroxyapatite form and catalyze further crystallization of calcium salts in the area What are other factors involved? – Matrix proteins binding and concentrating calcium – Alkaline phosphatase mineralizing When the conditions are met, what happens? – Calcium salts are deposited all at once and with great precision throughout the mature matrix 34

35. Bone resorption What accomplishes this? – Osteoclasts As they move along the bone surface what do they do? – Dig grooves called resorption bays and break down bony matrix How does the area of bone destruction seal off? – By osteoclasts that touch the bone forming a ruffled membrane that clings to the bone, sealing it off What does the ruffled border secrete and what does this do? – Lysosomal enzymes – digest organic matrix – Hydrocholoric acid – converts calcium salts into soluble forms in order to make them pass easily into solution What happens to these products? – They are endocytosed and then released into the blood What cells are important in this process? – T cells 35

36. Remodeling control What regulates remodeling? – 2 control loops: Negative feedback that maintains Ca 2 Homeostasis in the blood Gravitational forces acting on skeleton Why is calcium so important for the body? – Nerve impulses – Muscle contractions – Blood coagulation – Gland and nerve cell secretions – Cell division Where is 99% of calcium in the body? – Bone minerals What range does the hormonal loop keep calcium? – 9-11 mg per 100 ml of blood Where is calcium absorbed from? – Intestine 36

37. Hormonal Mechanism What does the hormonal mechanism involve? – PTH – parathyroid hormone – parathyroid gland – Calcitonin – produced by parafollicular cells (C-cells) of thyroid gland When is PTH released? – When calcium levels decline What does it do? – Stimulates osteoclasts to resorb bone, release calcium into blood What happens? – Osteoclasts break down old and new matrix What escaped digestion and why? – Osteoid – Because it lacks calcium salts When does the stimulus for PTH end? – When blood concentrations of calcium rise 37

38. Hormonal mechanisms (cont) What is secreted when calcium levels rise? – Calcitonin What is its function? – Inhibit resorption, encourage deposition – Reduce blood calcium What happens when blood calcium levels fall? – Calcitonin release wanes Are these responses to preserve bone strength? – No. They are for maintaining blood calcium homeostasis What happens if levels are low for a long time? – Bones demineralize and develop large, punched out holes 38

39. Bone Remodeling 39

40. Mechanical Stress What is Wolff’s law? – Bones grow and remodel in response to the demands placed on it? What are other observations of Wolff’s law? – Long bones thickest midway along diaphysis (where stress is greatest) – Curved bones thickest where most likely to buckle – Trabeculae form trusses along lines of compression – Large bony projections occur where active heavy muscles attach How do forces communicate with remodeling cells? – Electrical signaling What are hormonal loops function in remodeling? – Whether and when remodeling occur What are mechanical stresses functions? – Where remodeling will occur 40

41. Fracture Classification Location of bone after fracture: – Non-displaced – normal end positions – Displaced – out of normal alignment Completeness of break: – Complete – all the way through – Incomplete – not all the way Orientation: – Linear – parallel of long axis – Transverse – perpendicular to axis Skin penetration: – Open – penetrates the skin – Closed – skin not penetrated 41

42. Bone Repair 1.Hematoma formation: 1.Clotted blood forms at site 2.Bone cells die, tissue becomes inflamed 2.Fibrocartilaginous callus formation: 1.Capillaries grow into hematoma 2.Phagocytes begin cleaning debris 3.Fibros and osteos begin reconstructing bone 4.Fibros repair collagen, chondros repair cartilage 5.Osteos form spongy bone secrete bulging cartilage matrix that later calcifies 6.Fibrocartilaginous callus splints broken bone 3.Bony Callus formed: 1.Trabeculae appear in callus, convert it to bony callus 4.Bone remodeling: 1.Bony callus remodeled 42

43. Common Fractures Comminuted: – Fragments into 3 or more pieces (aged, brittle boned) Compression: – Crushed Spiral: – Ragged break, excessive twisting (sports) Epiphyseal: – Epiphysis separated from diaphysis Depressed: – Broken inward Greenstick: – Incomplete break on one side, other side bends 43

44. Clinical advances in bone repair What does electrical stimulation do to a fracture? – Dramatically increases healing time What is the piezo electric effect? – Minute electrical currents are produced when minerals are stressed What happens in regions of negative electrical charge? Positive? – Negative – bone deposited – Positive – bone resorbed What effect does ultrasound treatment produce on fractures? – Reduce healing times 35 to 45% What is VEGF? Function? – Vascular endothelial growth factor – Stimulates blood vessel growth 44

45. Bone Imbalances - Osteoporosis What is osteoporosis? – Group of diseases in which bone resorption occurs more than bone deposit What are the results of the disease? – Reduced bone mass Which bones are most susceptible? – Vertebrae, neck of the femur Who is most likely to have this disease? – Postmenopausal women Why? – Estrogen loss What are some contributors? – Insufficient exercise – Poor calcium intake – Vitamin D or Calcitonin metabolism problems – Smoking, drinking – Immobility 45

46. Bone Imbalances - Osteomalacia What is it? – Inadequate bone mineralization – Osteoid deposited but calcium salts are not Weight bearing bones? – Fracture, bend, deform What are Rickets? – Bowing of the legs and deformed pelvis What causes this? – Insufficient calcium or vitamin D intake 46

47. Bone Imbalances – Paget’s Disease What is Paget’s Disease? – Excessive, abnormal bone formation and resorption What causes this? – High ratio of woven bone to compact bone and bone mineralization reduction What is the result? – Soft, weak bones 47

48. Skeleton What % of body mass is the skeleton? – 20% How many bones? – 206 What are ligaments? – Fibrous tissue that connect bones at joints 48

49. What are the 2 groups of skeleton? Axial: How many bones? – 80 Which bones make up axial? – Skull, vertebrae, rib cage Appendicular: How many bones? – 126 Which make up appendicular? – Upper, lower limbs, shoulders, hips 49

50. Skull How many bones? – 22 including cranial and facial What kind, how do they articulate? – Flat, sutures What is the top, lateral and posterior of skull called? – The Calvaria What are the 3 base regions? – Anterior, middle, posterior cranial fossae What are the 4 pair of cavities called and what are they? – Paranasal sinuses - Sphenoid, Ethmoid, Maxillary, Frontal – Lighten the skull and give resonance to the voice What is each cavity lined with? – Mucous membranes that form the mucus that drains into the nasal cavity What are Orbits? – Eye cavities – Surrounded by fatty tissue – Formed by 7 bones 50

51. Skull (cont) What is the Nasal cavity composed of? – Bone and hyaline cartilage What is the roof, superior/lateral walls and superior nasal septum formed by? – Ethmoid bone What is the floor formed by? – Anteriorly – maxilla – Posteriorly – palatine bones What is the cavity divided by? – Nasal septum What is the Nasal septum formed by? – Perpendicular plate of ethmoid, vomer, and septal cartilage Where is the nasal concha and what does it do? – Lateral walls – Increase turbulence of air to help trap particles in mucus 51

52. Skull (cont) What are the conchae and septum lined with and what does it do? – Mucosa – Helps lighten air and secrete mucus What is the Cribriform plate and what does it do? – Part of ethmoid bone in roof of nasal cavity – Has small openings for olefactor (smell) nerves to pass through on their way to the brain 52

53. Vertebral column How many vertebrae? – 33, some fused in adults What separates them? – Fibrocartilage called intervertebral disc – Inner portion of disc contain jelly-like sub for elasticity What is a herniated disc? – Jelly-like sub is pushed out by pressure putting pressure on spinal nerve What are the curvatures of the vertebrae? – Thoracic – bow out – Lumbar – curve in 53

54. Appendicular Skeleton What makes up the appendicular skeleton? – Pectoral and pelvic girdle – Upper and lower limbs What is the only attachment of arms to body? – Scapula Does the fibula articulate with the femur? – No. Only with the Tibia What do both the fibula and tibia articulate with distally? – Talus bone to form the ankle 54

55. Axial Skeleton Skull, Vertebral Column, Bony Thorax 55

56. Skull What is body’s most complex structure? – Skull What bones form it? How many? – Cranial and facial bones – 22 What are the functions of the facial bones? – Form framework for face – Contain cavities for sense organs for sight, taste, smell – Air and food passageways – Secure teeth – Anchor expression muscles What kind of bones are found in the skull? – Flat (except mandible) What unites these bones? – Interlocking sutures What are the major sutures? – Coronal – Sagittal – Squamous – Lambdoid 56

57. Skull (cont) What is the cranial vault? – The Calvaria – The superior, lateral and posterior aspects of the head including the forehead What is the cranial base or floor? – Inferior aspects of skull What are the 3 internal fossae of the base of the skull? – Anterior, middle and posterior cranial fossae What sits in these fossae? – The brain What are the smaller cavities of the skull? – Middle, inner ear – Nasal – Orbits How many openings are in the skull? – 85 What are their functions? – Spinal cord passage – Blood vessels – nerves 57

58. Cranium How many bones? –8–8 Name them: – Parietal (pair) – Frontal – Occipital – Sphenoid – Ethmoid – Temporal (pair) What do these bones form? – The helmet around brain 58

59. Frontal bone What is medical term for forehead? – Frontal squama What are the supraorbital margins? – Thick, margin under eyebrows What does the anterior cranial fossa support? – Lobes of the brain What allows the supraorbital artery and nerve to pass to the forehead? – Supraorbital foramen What is the smooth portion between the eyes called? – Glabella What are the nasal sutures called? – Frontonasal sutures What is riddled around the glabella? – Frontal sinuses 59

60. Parietal bones Where are these bones? – Superior and lateral skull They form the bulk of the cranial ________? – Vault What occurs where the parietal bones articulate with other cranial bones? – The four largest sutures 60

61. Main Sutures Where parietal meets frontal anteriorly? – Coronal Where parietal meets superiorly at cranial midline? – Sagittal Where parietal meets occipital? – Lambdoid Where parietal meets temporal? – squamous 61

62. Mandible What is it? – Lower jaw What does it consist of? – Body, ramus, mandibular notch, condyles, coronoid process What does the mandibular body do? – Anchors the lower teeth What is the alveolar margin for? – Contains the sockets where teeth are embedded What does the mandibular symphysis indicate? – Where the 2 mandible bones fused during infancy What are the nerve entrances called? – Mandibular foramina 62

63. Mandible functions Coronoid – Insertion for temporalis muscle Condyles – Articulate with temporal bones for movement of jaw Symphysis – Fusion point of mandible Alveoli – Teeth sockets Foramina – Admit inferior alveolar nerve Mental foramen – Blood vessel and nerves to chin and lower lip 63

64. Maxillary bones What area of face? – Upper jaw, central portion What articulates with it? – All facial bones except mandible Why is it keystone of face? – All bones articulate with it. (- mandible) What part of maxilla carry upper teeth? – Alveolar margin What is the function of incisive fossa? – Passage for blood vessels, nerves What articulates with the maxilla laterally? – Zygomatic process What forms the bony roof of the mouth? – Palatine processes What is at the junction of maxilla and greater wing of the sphenoid? – Inferior orbital fissure 64

65. Maxilla functions Alveoli – Tooth socket Zygomatic processes – Form zygo arch Palatine – Form anterior hard palate Frontal – Form lateral part of nose bridge Incisive fossa – Admit blood vessels, nerves through hard palate Inferior orbital fissure – Admit maxillary branch of cranial nerve V, zygo nerve, blood vessels Infraorbital foramen – Nerve to skin of face 65

66. Articulation of other face bones Zygomatic: Articulation: – Zygomatic processes of temporal posteriorly – Zygomatic processes of frontal superiorly – Zygomatic processes of maxilla anteriorly Nasal bones: Articulation: – Frontal bone superiorly – Maxilla laterally – Perpendicular plate posteriorly – Inferiorly to cartilage that form external nose Lacrimal bones: Articulation: – Frontal superiorly – Ethmoid posteriorly – Maxilla anteriorly 66

67. Articulation of other face bones Palatine bones Articulation: What are the important plates? – Horizontal, perpendicular What are the 3 processes? – Pyramidal – Sphenoidal – Orbital 67

68. Orbits 68 Supraorbital foramen Superior Orbital fissure Optic canal Medial wall: Sphenoid body Orbital plate of ethmoid Frontal process of maxilla Lacrimal Nasal bone Floor of orbit: Orbital process of palantine Orbital surface of maxillary Zygomatic boneInfraorbital foramen Zygomatic bone Infraorbital groove Infraorbital fissure Orbital surface of zygo Greater wing of sphenoid Zygo process of frontal Orbital plate of frontal Lesser wing of sphenoid

69. Nasal Cavity What is it constructed of? – Bone and hyaline cartilage What is the roof formed by? – Cribriform plate of ethmoid What shapes the lateral walls? – Superior, middle conchae of ethmoid, perpendicular of palatine What are the depressions under the conchae? – Superior, middle, inferior meatus What is the floor formed by? – Palatine processes of maxillae and palatine bones What divides the nasal cavity? – Septum What is the bony part of septum? – Vomer What cartilage completes the septum anteriorly? – Septal cartilage 69

70. Nasal Cavity 70 Frontal sinus Superior nasal concha Middle nasal concha Inferior nasal concha Nasal bone Anterior nasal spine Maxillary bone (Palatine process) Palatine bone horizontal Palatine bone Perpendicular Pterygoid process Sphenoid sinus Superior, middle, and Inferior meatus

71. Paranasal sinuses 71

72. Hyoid bone Where? – Just inferior to mandible in the neck What is unique about this bone? – Does not articulate directly with any other bone What is anchored by? – Stylohyoid ligaments To What? – Styloid processes of temporal What is its function? – Move tongue – Attach muscles that raise/lower larynx for speech, swallowing 72

73. Anterior Skull 1.Frontal Bone 2.Supra-Orbital Foramen 3.Orbit (Orbital Cavity) 4.Superior Orbital Fissure 5.Inferior Orbital Fissure 6.Zygomatic Bone 7.Infra-Orbital Foramen 8.Maxilla 9.Mandible 10.Mental Foramen 11.Incisive Fossa 12.Symphysis 13.Vomer 14.Inferior Nasal Concha 15.Middle Nasal Concha 16.Perpendicular Plate of Ethmoid 17.Nasal Bone 18.Lacrimal Bone 73

74. Skull - Lateral 1.Parietal Bone 2.Coronal Suture 3.Frontal Bone 4.Nasal Bone 5.Vomer 6.Lacrimal Bone 7.Orbital Part of Ethmoid 8.Zygomatic Bone 9.Maxilla 10.Body of Mandible 11.Ramus of Mandible 12.Coronoid Process 13.Mandibular Condyle 14.Mental Foramen 15.Styloid Process 16.External Acoustic Meatus 17.Mastoid Process 18.Zygomatic Process 19.Temporal Bone 20.Greater Wing of Sphenoid 21.Inferior Temporal Line 22.Superior Temporal Line 23.Squamosal Suture 24.Lambdoidal Suture 25.Occipital Bone 74

75. Skull Posterior 1.Parietal Bone 2.Sagittal Suture 3.Lambdoid Suture 4.Occipital Bone 5.External Occipital Protruberance 6.Superior Nuchal Line 7.Inferior Nuchal Line 75

76. Occipital bone Where is this bone? – Posterior wall and base of skull What sutures connect it to the temporal and parietal bones? – Lambdoid – Occipitomastoid What does the internal walls of occipital form? – Posterior cranial fossa What foramen is at the base of occipital? – Foramen magnum What are the occipital condyles? – Rocker like condyles that articulate with c1 and allow nodding of head What does the external occipital crest secure? – Ligamente nuchae What do nuchal lines and bony regions do? – Anchor many back muscles 76

77. Occipital Parts functions Foramen magnum – Spinal cord passage from brain stem to vertebral canal Hypoglossal canal – Passage of hypoglossal nerve (cranial nerve XII) Occipital condyles – Atlas articulation External protuberence/nuchal lines – Muscle attachments External Crest – Ligamente nuchae 77

78. Skull - superior 1.Occipital Bone 2.Lambdoidal Suture 3.Parietal Bone 4.Sagittal Suture 5.Coronal Suture 6.Frontal Bone 78

79. Superior Skull 1.Frontal Sinus 2.Foramen Cecum 3.Crista Galli 4.Cribriform Plate 5.Anterior Cranial Fossa 6.Lesser Wing of Sphenoid 7.Chiasmatic Groove 8.Hypophyseal Fossa 9.Dorsum Sella 10.Optic Canal 11.Anterior Clinoid Process 12.Foramen Rotundum 13.Foramen Ovale 14.Foramen Spinosum 15.Squamous Part of Temporal 16.Petrous Part of Temporal 17.Groove for Transverse Sinus 18.Posterior Cranial Fossa 19.Foramen Magnum 20.Hypoglossal Canal 21.Jugular Foramen 22.Internal Acoustic Meatus 23.Posterior Clinoid Process 24.Foramen Lacerum 25.Superior Orbital Fissure 79

80. Mandible 1.Mandibular Condyle 2.Mandibular Notch 3.Coronoid Process 4.Ramus 5.Angle 6.Oblique Line 7.Body 8.Alveolar Process 9.Mental Foramen 10.Mylohyoid Line 11.Mandibular Foramen 80

81. Anterior skull 81 Frontal squama Of frontal bone Nasal bone Sphenoid Parietal bone Temporal Ethmoid Lacrimal Zygomatic Infraorbital foramen Maxilla Mandible Mental Foramen Mandibular Symphysis Frontal Glabella Frontonasal suture Supraorbital foramen Supraorbital margin Superior Orbital fissure Optic Canal Inferior orbital fissure Middle nasal concha Perpendicular plate Inferior nasal concha Vomer

82. Lateral Skull 82 Frontal bone Sphenoid bone Ethmoid bone Lacrimal bone Lacrimal fossa Nasal bone Zygomatic bone Maxilla Alveolar margins Mandible Mental foramen Coronoid Process Mandibular angle Mandibular ramus Mandibular notch Mandibular condyle Styloid process Mastoid process External auditory meatus Occipitomastoid suture Zygomatic process Occipital bone Squamous suture Lambdoid suture Temporal bone Parietal bone Coronal suture

83. Posterior Skull 83 Sagittal suture Parietal bone Mastoid process Inferior Nuchal line Occipital condyle External Occipital crest Occipitomastoid suture External Occipital protuberance Superior nuchal line Occipital bone Lambdoid suture Wormian bone

84. Midsagittal Internal left side of skull 84 Coronal suture Frontal bone Sphenoid bone Frontal sinus Crista galli Nasal bone Sphenoid sinus Ethmoid bone Vomer bone Incisive fossa Maxilla Alveolar margins Mandible Palatine process Palatine bone Mandibular foramen Pterygoid Process of Sphenoid Sella Turcica of sphenoid Internal acoustic meatus External occipital Pro- tuberence Occipitomastoid suture Occipital bone Lambdoid suture Temporal bone Squamous suture Parietal bone

85. Inferior skull 85 Incisive fossa Medial palantine suture Infraorbital foramen Maxilla Sphenoid bone Foramen ovale Foramen lacerum Carotid canal External acoustic meatus Stylomastoid foramen Jugular foramen Occipital condyle Inferior nuchal line Superior nuchal line Foramen magnum External Occipital protuberence External Occipital Crest Parietal bone Pharyngeal Tubercle of basoccipital Temporal bone Mastoid process Styloid process Mandibular fossa Vomer Temporal bone Zygomatic bone Palatine bone Maxilla

86. Temporal bone 86 Squamous region Zygomatic process Mandibular fossa Tympanic region Styloid process Mastoid process Mastoid region External Acoustic meatus

87. Temporal bones How many? Where are they on skull? – 2 (One on each side - inferior to parietal bones) What are the temporal’s four major regions? – Squamous,Tympanic, Mastoid, Petrous Functions of parts? Zygomatic process – – helps form prominence of cheek External acoustic meatus – – for hearing Styloid process – – attach hyoid and neck muscles Mastoid process – – attach neck and tongue muscles Carotid canal – – passage of internal carotid artery Jugular foramen – – passage of internal jugular vein and cranial nerves IX, X, XI 87

88. Superior sphenoid 88 Optic canal Chiasmatic groove Lesser wing Greater wing Anterior clinoid process Foramen rotundum Foramen ovale Foramen spinosum Dorsum Sellae Body of sphenoid Posterior clinoid process Hypophyseal Fossa of sella turcica Greater wing

89. Posterior sphenoid 89 Body of sphenoid Posterior clinoid process Superior orbital fissure Foramen rotundum Pterygoid process Pterygoid plates Greater wing

90. Sphenoid Where? – Spans the middle cranial fossa Why is it considered the keystone of cranium? – Because it forms a central wedge that articulates with all other cranial bones What does it consist of? – Central body, 3 pairs of wings – Greater, lesser, pterygoid processes What is the sella turcica? – Area where pituitary gland is located What is the function of the anterior clinoid processes? – Anchor the brain to the skull What are the pterygoid processes functions? – Anchor pyterygoid muscles used for chewing What are the optic canals for? – They allow optic nerves to pass to the eyes What is the superior orbital fissure’s function? – It allows cranial nerves that control eye movements to enter the orbit 90

91. Sphenoid parts functions Sella turcica – Seat of pituitary gland Optic canal – Passage of cranial nerve II, opthamolic arteries Superior Orbital fissures – Cranial nerves III, IV, part of V, opthamolic vein Foramen rotundum – Passage of maxillary division of cranial nerve V Ovale – Pass mandibular division of nerve V Spinosum – Pass middle meningeal artery 91

92. Ethmoid Where? – Between sphenoid and nasal bones (between nasal and orbits) What forms roof of nasal cavity and floor of anterior cranial fossa? – Cribriform plate What are the tiny holes in cribriform that allow smell nerves to pass to the brain? – Olfactory foramina What is the crista galli’s function? – Attach falx cerbri What are some other parts of the ethmoid? – Inferior, middle nasal concha – Perpendicular plate – Orbital plates 92

93. Ethmoid 93 Crista galli Cribriform plate Left lateral mass Middle nasal concha Perpendicular plate Ethmoid sinuses Orbital plate Olfactory foramina

94. Superior cranial cavity 94 Frontal bone Cribform plate Crista galli Ethmoid Optic canal Anterior clinoid process Foramen rotundum Foramen ovale Foramen spinosum Foramen lacerum Jugular foramen Hypoglossal canal Foramen magnum Occipital bone Parietal bone Posterior Cranial fossa Internal acoustic meatus Temporal bone Middle cranial fossa Posterior clinoid process Dorsum sellae Hypophyseal fossa Tuberculum sellae Greater wing Lesser wing Anterior cranial fossa Olfactory foramina

95. Vertebrae How many bones? What kind of bones? – 26, irregular Name some functions of vertebrae? – Transmits weight of trunk to lower limbs – Surround, protect spinal cord – Attachment site for ribs and muscles of back and neck How many in fetus? – 33 separate bones How many eventually fuse and what do they become? –9–9 – Sacrum, coccyx What are the divisions? How many bones in each? – Cervical – 7 – Thoracic – 12 – Lumbar – 5 – Sacrum – Coccyx 95

96. Vertebrae (cont) What are the four curvatures? – Cervical, lumbar – concave posteriorly – Thoracic, sacrum – convex posteriorly What are some abnormal curvature disorders? – Scoliosis – Thoracic twisted – Kyphosis – hunchback What are ligaments? – Bands of fibrous tissue that connect and support bones What are the ligs of the vertebrae? – Anterior, posterior longitudinal ligaments What are the intervertebral discs functions? – Shock absorbers during walking, jumping and running 96

97. General structure of Vertebrae What is the common structure of all vertebrae? – Body anteriorly – Vertebral arch posteriorly – Vertebral foramen for vertebral canal (spinal cord) What forms vertebral arch? – Pedicles, laminae What are pedicles? – Short, bony pillars that form side of arch (project posteriorly) What are laminae? – Flat plates that fuse in median plane (posterior) How many processes project from vertebral arch? –7–7 What are they? – Spinous – median, at junction of 2 laminae – Transverse – lateral from each side of arch – Superior, inferior articular processes – smooth joints called facets (covered with hyaline cartilage) form movable joints with processes of vertebrae below and above them 97 Facet (Thoracic Only) Demifacet (Thoracic Only

98. Vertebrae structure 98

99. 99 Cervical ThoracicLumbar

100. 100

101. 101

102. Cervical Vertebrae Characteristics: – Smallest, lightest – First 2 unusual – Oval body – Wide – Spinous short (except for C7) – Large foramen – Transverse foramen – C7 is the vertebrae prominens C1 and C2 have – no disc between – Atlas – no body, spinous Superior articular receive occipital condyle of skull Inferior joins axis – Axis – Has dens (odontoid) process superiorly from body Dens allow side to side movement 102

103. Thoracic Vertebrae Characteristics: – All articulate with ribs – First looks like C7, last four look like Lumbar – Increase in size from 1 st to last – Heart shape body – Demifacets on each side (superior and inferior) (T 10 to T 12 have single facet) – Demifacets receive ribs – Foramen circular – Long, pointed spinous – Superior and inferior facets lie mainly in frontal plane 103

104. Lumbar vertebrae Characteristics: – Most stress – Massive, kidney shaped body – Pedicles and laminae shorter and thicker than other verts – Short, flat, hatchet shaped spinous (project backward) – Triangle foramen – Facets orientated different than other vertebrae 104

105. Differences in Vertebrae Body: – C – small wide – T – Larger than C, heart shaped – L – Massive body Spinous process: – C – short, has V notch – T – Long sharp, projects inferiorly – L – Short blunt, projects posteriorly Foramen: – C – large triangle shaped – T- small oval – L – small triangular shape Transverse processes: – C- contain foramen – T- Have facets for ribs – L – thin,tapered 105 Cervical Lumbar Thoracic

106. C1 Atlas Superior view 1.Anterior tubercle 2.Anterior arch 3.Facet for dens 4.Transverse process 5.Foramen transversarium or transverse foramen 6.Superior articular facet on lateral mass 7.Posterior arch 8.Posterior tubercle 9.Vertebral foramen 106

107. Cervical, Thoracic, Lumbar, Sacrum 1.Body 2.Vertebral foramen 3.Anterior tubercle 4.Posterior tubercle 5.Foramen transversarium or transverse foramen 6.Demifacet for head of rib 7.Superior articular process 8.Pedicle 9.Lamina 10.Transverse process 11.Spinous process or spine 12.Lateral mass 13.Posterior sacral foramina 14.Coccyx 15.Sacral hiatus 107

108. Cervical, Thoracic, Lumbar, sacrum 1.Body 2.Facet for head of rib 3.Superior articular process 4.Superior vertebral notch 5.Pedicle 6.Transverse process 7.Inferior vertebral notch 8.Inferior articular process 9.Spinous process or spine 108

109. Cervical Vertebrae 1.C1 or atlas 2.C2 or axis 3.C3 4.C4 5.C5 6.C6 7.C7 8.Body 9.Vertebral foramen 10.Bifid spinous process or spine 11.Transverse process 12.Foramen transversarium or transverse foramen 13.Superior articular facet 109

110. Vertebrae - Atlas 1.Superior Articular Surface 2.Transverse Foramen 3.Transverse Process 4.Odontoid (Dens) Facet 5.Vertebral Foramen 6.Inferior Articular Surface 110

111. Axis 1.Spinous Process 2.Lamina 3.Transverse Process 4.Pedicle 5.Superior Articular Surface 6.Odontoid Process (Dens) 7.Body 8.Vertebral Foramen 9.Inferior Articular Surface 111

112. Cervical Vertebrae 1.Spinous Process 2.Lamina 3.Superior Articular Surface 4.Transverse Foramen 5.Transverse Process 6.Body 7.Pedicle 8.Vertebral Foramen 112

113. Thoracic 1.Spinous Process 2.Lamina 3.Superior Articular Surface 4.Transverse Process 5.Pedicle 6.Body 7.Vertebral Foramen 8.Articular Facet for Rib 9.Inferior Articular Surface 113

114. Lumbar 1.Spinous Process 2.Lamina 3.Superior Articular Surface 4.Transverse Process 5.Pedicle 6.Body 7.Vertebral Foramen 8.Inferior Articular Surface 114

115. Sacrum Characteristics: – Formed by 5 fused verts – Articulates superiorly with L 5 – inferiorly with coccyx, laterally with hip bone (sacroiliac joint) – Sacral promontory anterosuperior – Four ridges: The transverse lines cross concave anterior aspect, marking lines of fusion of sacral vertebrae – Ventral sacral foramina penetrate sacrum at lateral ends of transverse lines to transmit blood vessels and nerves – Lateral to these and expanding superior are the alae – Dorsal midline – median sacral crest – Dorsal sacral foramina – Lateral sacral crests – Vertebral canal – sacral canal – Sacral hiatus – opening where vert failed to fuse 115

116. Sacrum 1.Promontory 2.Transverse Ridges (lines) 3.Coccyx 4.Body of Sacrum 5.Sacral Canal 6.Superior Articular Surface 7.Median Sacral Crest 8.Sacrum to Ilium Articular Surface 9.Dorsal Sacral Foramina 10.Sacral Hiatus 116 alae Lateral sacral crest Ventral Sacral foramina

117. Rib and Vertebrae 1.Articular Facet of Rib 2.Interarticular Crest 3.Neck 4.Articular Portion of Tubercle 5.Nonarticular Portion of Tubercle 6.Angle of Rib 7.Costal Groove 8.Body (shaft) of Rib 9.Articular Facet of Transverse Process 10.Transverse Process 11.Spinous Process 12.Lamina 13.Vertebral Foramen 117 Sternal edge

118. Sternum 1.Jugular Notch 2.Manubrium 3.Sternal Angle 4.Body (Gladiolus) 5.Xiphoid Process 118 Clavicular Notch Costal facet

119. Bony Thorax 119

120. Bony Thorax What is included in bony thorax? – Thoracic vertebrae dorsally, ribs laterally, sternum and costal cartilage anteriorly How many ribs? – 12 pairs What do they articulate with? – Posteriorly – thoracic vertebrae – Anteriorly – superior 7 rib pairs – directly to sternum (true) – 5 (false) – indirectly to sternum or no sternal – Ribs 8-10 connect to cartilage joining to rib above – Ribs 11-12 – floating – no anterior attachment – Characteristics of ribs: – Bowed flat bone – Superior smooth, inferior sharp and thin – Costal groove – lodges nerves and blood vessels – Head and tubercle – join to the body and transverse process of vert – Tubercle is posterior and superior 120

121. Appendicular Skeleton Pectoral & Pelvic Girdle, Upper & Lower Limbs 121

122. Clavicle Where? – Across superior thorax Articulation: – Medial sternal end – to sternal manubrium – Lateral acromial end – scapula Medial 2/3’s convex anteriorly Lateral 3 rd concave anteriorly Superior surface is? – Smooth Inferior surface is? – Ridged and grooved Function – Anchor many muscles – Act as braces – Hold scapula and arms out laterally away from superior part of thorax Not very strong, easy to fracture 122

123. Clavicle 1.sternal head 2.superior surface 3.sternal head 4.inferior surface 5.groove for subclavious muscle 6.conoid tubercle 7.trapezoid line 8.acromial head Identification aspects: – Conoid tubercle always posterior/inferior – Medial surface always convex, lateral concave – Acromial - lateral 123

124. Scapula Posterior 1.Coracoid Process 2.Scapular Notch 3.Superior Border 4.Supraspinous Fossa 5.Superior Angle 6.Scapular Spine 7.Vertebral Margin 8.Infraspinous Fossa 9.Inferior Angle 10.Lateral Border 11.Glenoid Cavity Margin (lateral angle) 12.Acromion Process Identification: – Spine-posterior – Glenoid - lateral 124

125. Scapula (Ventral) 1.superior angle 2.vertebral (medial) border 3.inferior angle 4.subscapular fossa 5.infraglenoid tubercle 6.glenoid fossa 7.coracoid process 8.Acromion 9.suprascapular notch 125

126. Scapula lateral 1.Coracoid process 2.Glenoid cavity 3.Scapular spine 4.Acromion process 5.Infraspinous Fossa 6.Inferior Angle 7.Axillary Margin 126

127. Scapula Where? – Dorsal surface of rib cage, between ribs 2 and 7 What are the 3 borders? – Superior – shortest, sharpest – Medial (vertebral) – parallels vertebral column – Lateral (axillary) – abuts the armpit and ends superiorly in a small shallow fossa, the glenoid cavity Articulation – Glenoid cavity articulates with humerus of the arm What are the 3 angles? Where do they meet? – Superior scapular border meets medial border at superior angle and lateral border at the lateral angle – Medial and lateral borders join at the inferior angle 127

128. Scapula (cont) Features: Anterior surface is? – Concave and relatively featureless Posterior surface? – Prominent spine easily felt through skin – Ends laterally in enlarged, roughened triangular projection called? Acromion – Acromion articulates with? Acromial end of clavicle – Which forms the? Acromioclavicle joint Projecting anteriorly from superior scapular border is what? – Coracoid process What is the coracoid process’ function? – Helps anchor the biceps of the arm Bounded by? – Suprascapular notch medially and glenoid cavity laterally Several large fossae appear on both sides of scapula. They are? – Infraspinous and supraspinous fossae – Named for their location – Inferior and superior to the spine What is the subscapular fossa? – Shallow concavity formed by the entire anterior scapula surface 128

129. Proximal Humerus 1.Head 2.Anatomical neck 3.Lesser Tubercle 4.Intertubercular Groove 5.Greater Tubercle 6.Surgical Neck 7.Deltoid Neck (tuberosity) Identify: Head – medial Shallow, distal coronoid fossa – anterior Capitulum – anterior lateral 129

130. Humerus Distal 1.Radial Fossa 2.Lateral Epicondyle 3.Capitulum 4.Trochlea 5.Medial Epicondyle 6.Coronoid Fossa 7.Olecranon Fossa 130

131. Humerus – proximal to middle of the bone Location – Upper arm Articulation? – proximal to the scapula (glenoid cavity) – distal to the radius and ulna What is at the proximal end? – Smooth hemispherical head What does it fit into to? – Glenoid cavity What is immediately inferior to the head? – Anatomical neck What tubercles are just inferior to the neck? – Lateral greater tubercle – Medial lesser tubercle What separates these tubercles? – Intertubercular (bicipital) groove What are tubercles function? – Sites where muscles attach What is distal to tubercles? – Surgical neck What is midway down shaft laterally? – Deltoid tuberosity (roughened deltoid muscle attachment site) What runs obliquely down the posterior aspect of shaft marking the course of radial nerve? – Radial groove 131

132. Humerus - Distal What are the 2 condyles at distal end? – Medial trochlea – looks like hour glass tipped on side – Lateral capitulum – ball-like What do these articulate with? – Ulna and radius What flanks these condyles? – Medial, lateral epicondyles (muscle attachment sites) What is directly above these condyles? – Supracondyle ridges What is responsible for the tingling feeling when “funny bone” is hit?’ – Ulnar nerves that run behind the medial epicondyle Where is the coronoid fossa? – Superior to the trochlea on the anterior surface Where is the Olecranon fossa? – Posterior to the coronoid fossa 132

133. Humerus – distal What is the function of the coronoid and olecranon fossae? – They allow the corresponding processes of the ulna to move freely when the elbow is flexed and extended What receives the head of the radius when the elbow is flexed? – Radial fossa 133

134. Radius – Right/anterior 1.Head of radius 2.Neck of radius 3.Radial Tuberosity 4.Radius (Shaft) 5.Styloid Process 6.Ulnar Notch Recognition aspects: – Tuberosity – anterior/medial – Styloid – lateral – Concave surface above styloid - anterior 134 Radial Tuberosity Anterior medial Always anterior in Anatomical position

135. Forearm- antebrachium Location: – Lower arm Bones: – Radius, ulna Articulation – Proximal end with humerus – Distal end forms joints with the wrist – Radius and ulna articulate with each other both proximally and distally at small radioulnar joints What connects the radius and ulnar across their entire length? – Flexible, interosseous membrane What is the position of radius and ulna in anatomical postion? – Radius – lateral on thumb side – Ulna – medial on little finger side What happens in the prone position? – Distal end of the radius crosses over the ulna and form an “X” 135

136. Ulna -right/ proximal/distal 1.Olecranon process 2.Trochlear notch 3.Coronoid process 4.Tuberosity 5.Radial notch 6.Ulna shaft 7.Head of ulna 8.Styloid process Identification aspects: – Radial notch always lateral – Styloid process-medial 136

137. Ulna Main responsibility? – Forming elbow joint with humerus What are the 2 main processes at proximal end? – Olecranon, coronoid processes What separates these? – Trochlear notch What does the locking of the olecranon process and olecranon fossa do? – Keeps the forearm from moving posteriorly beyond the elbow joint Where does the ulna articulate with the head of the radius? – Radial notch Where is the ulnar head? – At the distal end of the bone by wrist What is medial to the ulnar head? – Styloid process What separates the ulnar from the carpals? – A disc of fibrocartilage Does it have any role in hand movement? – Little to none at all 137

138. Radius What is the superior surface of the head – convex or concave? – Concave Articulation – Head proximal with the capitulum of the humerus – Medially with the radial notch of the ulna – Distal where the radius expands, medial ulnar notch with the ulna – Carpal bones The ulna contributes heavily to? – The elbow The radius contributes to? – Wrist What happens when the radius moves? – The hand moves with it 138

139. Hand – Right Dorsal 1.Styloid process of radius 2.Navicular (Scaphoid) 3.Lunate 4.Triquetral 5.Pisiform 6.Trapezium 7.Trapezoid 8.Capitate 9.Hamate 10.Metacarpal 11.Proximal Phalange 12.Middle Phalange 13.Distal Phalange 14.Styloid Process of Ulna 139

140. Hand – Right palmar 1.Navicular (Scaphoid) 2.Lunate 3.Triquetral 4.Pisiform 5.Trapezium 6.Trapezoid 7.Capitate 8.Hamate 9.Metacarpal 10.Proximal Phalange 11.Middle Phalange 12.Distal Phalange 140

141. Carpus-Wrist What is the true wrist? The carpus. The proximal part of the hand How many bones are in the carpus? What are they called? 8 marble sized short bones Carpals How are they arranged? In 2 irregular rows of 4 bones each Which bones are in the proximal row? (lateral to medial) Scaphoid Lunate Triquetral pisiform Which bones articulate with radius? – Scaphoid, lunate What bones make up the distal row? (lat to med) – Trapezium – Trapezoid – Capitate – Hamate Sally – scaphoid Left – lunate The – triquetral Party – pisiform To- trapezium Take – trapezoid Cathy – capitate Home - hamate 141

142. Metacarpus - palm How many? What are they named? – 5, No name. They are numbered from 1 to 5 from thumb to little finger Articulation – Bases with carpals proximally – Each other medially and laterally – Heads with proximal phalanges distally What is meta #1 and why is it different from the rest? – The thumb – Does not have a middle phalanx 142

143. Phalanges - Fingers What are other names for the phalanges? – Fingers, digits How are they numbered? – From 1 to 5 beginning with pollex (thumb) How many phalanges on each hand? – 14 What are the parts named? – Proximal – Middle – Distal Thumb no middle 143

144. Os Coxa – Left lateral 1.Anterior Superior Spine 2.Iliac Crest 3.Posterior Superior Spine 4.Posterior Inferior Spine 5.Greater Sciatic Notch 6.Body of Ilium 7.Ischial Spine 8.Lesser Sciatic Notch 9.Body of Ischium 10.Ischial Tuberosity 11.Obturator Foramen 12.Inferior Ramus of Ischium 13.Inferior Ramus of Pubis 14.Body of Pubis 15.Acetabulum 16.Anterior Inferior Spine 144

145. Os Coxa – Left,medial 1.Iliac Fossa 2.Anterior Superior Spine 3.Anterior Inferior Spine 4.Arcuate Line 5.Obturator Foramen 6.Symphysis Pubis Articulating Surface 7.Ischial Tuberosity 8.Lesser Sciatic Notch 9.Ischial Spine 10.Greater Sciatic Notch 11.Sacrum Articulating Surface 12.Posterior Inferior Spine 13.Posterior Superior Spine 14.Iliac Crest 145 Identification: Acetabulum – lateral Pubis – anterior Ischial- posterior

146. Pelvic girdle - Hip What are its functions? – Attach lower limbs to axial skeleton – Transmit upper body weight to lower limbs – Support visceral organs of the pelvis What are the hip bones named? – Os coxae Articulation – Each other anteriorly – Sacrum posteriorly What is the hip, sacrum and coccyx called? – Bony pelvis What are the 3 bones of the pelvis? – Ilium – Ischium – Pubis Are they separate? – In childhood. Fuse in adults What is the name of the deep lateral socket on the pelvis? – Acetabulum What is its function? What is the joint called? 1.Receives head of femur 2.Hip joint 146

147. Ilium Where on the coxal? – Superior region What does it consist of? – Body – Ala – wing Where is it thickest at? – Tubercle of iliac crest Where does each iliac crest end? – Anteriorly – anterior superior iliac spine – Posteriorly – posterior superior iliac spine What is below these? – Anterior, posterior inferior iliac spines What are these spines for? – Attachment points for muscles of trunk, hip, thigh Where is the greater sciatic notch? What is it for? – Inferior to posterior inferior iliac spine – Where sciatic nerve passes to enter thigh What makes up the posterolateral surface of the ilium? – Gluteal surface What 3 ridges cross it? – Posterior, Anterior, inferior gluteal lines What is the interior, concave area? – Iliac fossa What is posterior to this? – Auricular surface What does ilium join anteriorly? – Ischium, pubis 147

148. Ischium What part of hip bone? – Posteroinferior Articulation – Body – ilium – Ramus – pubis anteriorly What are the 3 major markings? – Ischial spine – medially into pelvic cavity – Lesser sciatic notch – just inferior to ischial spine – Ischial tuberosity – strongest part of hip bone. Inferior surface of ischial body What helps hold the pelvis together? – Sacrotuberous ligament – massive ligament from sacrum to ischial tuberosity 148

149. Pubis Where? – Anterior of hip bone V shaped consisting of? – Superior, inferior rami – Medial body Articulation – Medial to ischium – Inferior to ilium What does the anterior border form? – Pubic crest What is at the lateral end of pubic crest? – Pubic tubercle What is the large opening of the hip bone? – Obturator foramen What is the name of the fibrocartilage joining the 2 pubic bones? – Pubic symphysis What is the arch that differentiates male and female pelve? – Pubic arch 149

150. Pelvis - anterior 1.anterior superior iliac spine 2.superior pubic ramus 3.ischial tuberosity 4.inferior pubic ramus 5.pubic symphysis 6.pubic tubercle 7.Acetabulum 8.anterior inferior iliac spine 9.iliac fossa 150

151. Pelvis - posterior 1.iliac crest 2.greater sciatic foramen 3.ischial spine 4.ischial tuberosity 5.Coccyx 6.sacrum (dorsum) 7.posterior superior iliac spine 151

152. Pelvic structure/childbearing What is the difference between female and male pelvis? – Female wider, shallower, lighter and rounder Tilted forward What are the false and true pelvis? – False superior to the pelvic brim Bounded by alae laterally; lumbar vertebrae posteriorly Part of abdomen Does not restrict childbirth – True Inferior to pelvis brim Forms deep bowl containing pelvic organs Dimensions critical for childbirth What are the pelvic inlet and outlet? – Inlet – pelvic brim – Outlet – inferior margin of true pelvis 152

153. Femur- proximal end/left 1.Head 2.Neck 3.Greater Trochanter 4.Intertrochanteric Line 5.Lesser Trochanter 6.Shaft of Femur 7.Gluteal Tuberosity 8.Intertrochanteric Crest 9.Linea Aspera Identification: Distal Patellar Surface – anterior Intercondyle notch - posterior 153 Fovea Capitis

154. Left femur-distal 1.Medial Condyle 2.Lateral Condyle 3.Intercondylar Fossa 154 Intercondyle notch Lateral Epicondyle Medial Epicondyle Adductor tubercle

155. Femur Location – Upper leg Articulation – Proximal – hip bone/ acetabulum – Distal – tibia What is the name of the small central pit at the head? – Fovea capitis What is at the junction of the shaft and neck? – Greater and lesser trochanters What connects these trochanters? – Intertrochanteric line anteriorly – Intertrochanteric crest posteriorly What does the gluteal tuberosity blend into? – Linea aspera inferiorly What does the linea aspera diverge into? – Medial and lateral suprachondyle lines What are all of these markings? – Muscle attachment sites Distally, the femur widens into? – Lateral and medial condyles What flanks the condyles superiorly? – Medial and lateral epicondyles 155

156. Femur (cont) What is the patellar surface? – Articulation site for the patella What is the deep U-shape on the distal posterior aspect of femur? – Intercondyle notch What is superior to this? – Smooth popliteal surface What is the patella? – Triangular, sesamoid bone enclosed in quadriceps that secures anterior thigh muscles to the tibia 156

157. Left Tibia-proximal/distal/anterior 1.Intercondylar Eminence 2.Lateral Condyle 3.Tibial Tuberosity 4.Anterior Crest 5.Medial Condyle 6.Anterior Surface 7.Medial Malleolus Identify aspects: – Tibial tuberosity always anterior – Flattened side always lateral – Medial malleolus always medial 157 Proximal Tibiofibular joint Distal Tibiofibular joint

158. Tibia Location – Anterior shin bone Articulation – Proximal – femur – tibia condyles to the femur condyles – Distally – talus of the foot – Lateral to the fibula (tibiofibular joint) Parts – Broad proximal end Medial and lateral condyles Intercondyle imminence – Inferior to this Tibial tuberosity – anterior Lateral tibial condyle – proximal tibiofibular joint – Middle of bone Anterior crest – Distal end Medial malleolus Distal tibiofibular joint Articular surface 158

159. Left Fibula-proximal/distal/anterior 1.Head of Fibula 2.Neck of Fibula 3.Anterior Crest 4.Lateral Malleolus Identifying aspects: – Lateral malleolus always lateral 159

160. Fibula Location – Posterior, lateral shin Articulation – Proximal with the tibia – Distal with the tibia medially and the talus distally Name of proximal and distal ends? – Proximal – head – Distal – lateral malleolus (ankle bulge) Does the fibula bear weight? – No 160

161. Left foot superior 1.Calcaneus 2.Talus 3.Navicular 4.Cuboid 5.Cuneiform, Middle 6.Cuneiform, Intermediate 7.Cuneiform, Lateral 8.Metatarsal 9.Proximal Phalange 10.Middle Phalange 11.Distal Phalange 161

162. Tarsus How many bones? Name them? –7–7 – Calcaneus – Talus – Navicular – Cuboid – 1 st Cuneiform (Hallux), 2 nd Cuneiform, 3 rd Cuneiform What 2 tarsals carry most body weight? – Talus, calcaneus What does the Achilles tendon attach to? – Posterior surface of calcaneus What part of calcaneus touches the ground? – Tuber calcanei, calcaneal tuberosity, sustentaculum tali Name the remaining tarsals: – Lateral cuboid – Medial navicular – Intermediate, lateral cuneiform What do the cuboid and cuneiform bones articulate with? – Metatarsal bones anteriorly 162

163. Left foot lateral 1.Calcaneus 2.Talus 3.Navicular 4.Cuboid 5.Cuneiform, First 6.Cuneiform, Second 7.Cuneiform, Third 8.Metatarsal 163

164. Metatarsus How many? – 5 small bones Articulation – Distal – proximal phalanges of the toes – Proximal – tarsals What is the first metatarsal? – Great toe (Hallux) How are they identified? – By number laterally from big toe 164

165. Phalanges-Toes How many? – 14 3 in each digit except the? – Hallux (big toe) 165

166. Arches of foot A segmented structure can only hold weight if it is? – Arched What are the 3 arches of the foot? – Longitudinal – medial and lateral – Transverse arch What are the functions of these arches? – Strength What maintains arches? – Interlocking shape of foot bones – Strong ligaments – Tendon pull during muscle activities Which arch curves above the ground? – Medial longitudinal Which is very low? – Lateral longitudinal Where is the weight of the body distributed by these arches? – ½ to heel bones, ½ to heads of metatarsals 166

167. Knee- anterior/ posterior 1.Tibial Collateral Ligament 2.Medial Condyle of Femur 3.Posterior Cruciate Ligament 4.Anterior Cruciate Ligament 5.Lateral Condyle of Femur 6.Fibular Collateral Ligament 7.Lateral Condyle of Tibia 8.Lateral Meniscus 9.Medial Meniscus 10.Medial Condyle of Tibia 11.Tibia 12.Fibula 13.Transverse Ligament 167

168. 168

169. Basic structure, types, location What types of cartilage does skeletal cartilage contain? – Hyaline, elastic, fibro What type of hyaline cartilage is in skeletal? – Articular – covers ends at movable joints – Costal – connect ribs to sternum – Respiratory – skeleton of the larynx – Nasal – support nose What type is elastic? – External ear – Epiglottis What type is fibro? – Discs between vertebrae – knee 169

170. What are the 2 ways cartilage grows? Appositional – Cartilage-forming cells secrete new matrix against external face of existing cartilage Interstitial – Chondrocytes divide and secrete new matrix – Expand from within When does growth end? – During adolescence Is calcified cartilage bone? – No. Cartilage and bone are always distinct tissues 170

171. Classification of Bone What are the 2 groups? – Axial – Appendicular What is the axial? – Skull, vertebrae, ribs Appendicular? – Upper/lower limbs, girdles (hips,shoulders) 171

172. Structure of long bone Diaphysis – Shaft – Surrounds medullary cavity. Adults – yellow bone marrow Epiphysis – Bone ends – Interior spongy bone – Joint surface – articular cartilage – Epiphyseal line – between the diaphysis and epiphysis of adult bone; remnant of epiphyseal plate (hyaline that grows during childhood) Also called metaphysis Membranes – Glistening white outer cover? periosteum – Where do nerve, blood, lymph enter diaphysis? Nutrient foramen – Periosteum secured to bone by? Sharpey’s fibers What covers internal bone surfaces? – endosteum 172

173. Structure of short bone What design do all short, irregular and flat bones share? – Thin plates of periosteum-covered compact bone sandwiching spongy bone in the middle Short bones have no what? – Shaft or epiphysis What is the spongy bone called? – Diploe 173

174. Hemopoietic tissue-red marrow Where is it found? – Within trabecular cavities in long bone – Diploe of flat bone What are those cavities called? – Red marrow cavities Where does blood production occur in adult long bone? – Only in head of femur and humerus What sites are usually more active and used for obtaining red marrow samples? – Diploe, irregular sites of flat bones (sternum, hip bone) 174

175. Compact bone What do canaliculi do? – Tie all the osteocytes in osteon together – Permit nutrients and wastes to enter and exit – Maintain bone matrix What is interstitial lamellae? – Incomplete lamellae that fill the gaps between forming osteons What are circumferential lamellae? – Lamellae just deep to the periosteum and superficial to the endosteum, that extend around the entire circumference of the diaphysis and resist twisting of the bone 175

176. Formation of skeleton What is the skeleton of human embryo made of before week 8? – Entirely fibrous membranes and hyaline cartilage What is it called when a bone develops from fibrous membrane? – Intramembranous ossification What is the bone of this type of formation called? – Membrane bone What is it called when bone is formed by replacing hyaline cartilage? – Endochondral Ossification What is this bone called? – Cartilage or endochondral bone 176

177. Intramembranous Ossification What bones are formed this way? – Skull – Clavicle What type of bones formed this way? – Flat bones What are the 4 major steps? Step One: – What appears in the fibrous tissue? Ossification center – What do mesenchymal cells do at this stage? Cluster Differentiate into osteoblasts Form the ossification center Step Two: – What do the osteoblasts do at this stage? Secrete the osteoid – What do trapped osteoblasts become? osteocytes 177

178. Intramembranous Ossification (cont) Step 3: – What is formed in step 3? Woven bone Periosteum – What is a random network? Accumulated osteoid laid down between blood vessels – What does this form? Trabeculae (spongy bone) – What does vascularized mesenchyme condensing on the external face of woven bone become? The periosteum Step 4: – What does thickened trabeculae just deep to the periosteum form? Woven bone collar – What is this replaced by? Mature lamellar bone – What is a diploe? Compact bone sandwiching spongy bone 178

179. Endochondral Ossification What bones are formed this way? – All bones of the skeleton below the base of the skull What is the model this process uses? – Hyaline cartilage model When does the process begin? – 2 nd month of fetal development What is the primary ossification center? – The region where long bone formation usually begins What sets the stage for this process to begin? – Perichondrium infiltrated by blood vessels converting it to periosteum – Mesenchymal cells specialize into osteoblasts 179

180. Endochondral Ossification (cont) Step 1: What do the osteoblasts secretions against hyaline cartilage do? – Encase it in a bone collar Step 2: What does cartilage in the center of diaphysis do? – Calcifies, cavitates (creates cavities) What do chondrocytes do at this stage? – Hypertrophy (enlarge) – Signal matrix to calcify What happens to the chondrocytes and the matrix at this stage? – They die – Matrix deteriorates What happens to cartilage elsewhere? – Remains healthy – Grows briskly What does this cause the cartilage model to do? – Elongate 180

181. Endochondral Ossification (cont) Step 3: What is the periosteal bud? – Collection of elements Nutrient artery Vein Lymphatics Nerve fibers Red marrow elements Osteoblasts, osteoclasts When does it appear? – The 3 rd month of development What are the osteoclasts and osteoblasts doing at this stage? – Clasts – eroding calcified matrix – Blasts – secreting osteoid around remaining cartilage What is this forming? – Trabeculae (earliest version of spongy bone) 181

182. Endochondral Ossification (cont) Step 4: What forms in stage 4? – Medullary cavity 182

183. Joints 183

184. Classification of joints What are the 2 ways to classify joints? – Functional – Structural Functional: – Synarthroses Immovable (skull) – Amphiarthroses Slightly movable (intervertebral, pubic symph) – Diarthroses Freely movable (limbs, joints of limbs) Structural: – Fibrous Bones joined by fibrous tissue – no joint cavity Most immovable or slightly movable 184

185. Fibrous joints (cont) 3 types of fibrous joints: Sutures: – Rigid splices of interlocking bone – Where’s the only place they occur? Skull Syndesmoses: – Joints where bones connect by cord or sheet of fibrous tissue called a ligament Gomphoses: – Resembles peg or socket (teeth) 185

186. Cartilaginous Joints Bones connected by cartilage with no joint cavity 2 types: Synchondroses- – Plate of hyaline cartilage connects the bones – Epiphyseal plates of long bones, joint of 1 st rib and manubrium Symphyses- – Bones covered with articular hyaline cartilage fused to fibrocartilage plate. – All amphiarthritic (intervertebral, pubic symphysis) 186

187. Synovial Joints Articulating bones separated by fluid filled joint All have: – Hyaline both bony surfaces – Joint cavity – 2 layer joint capsule with outer fibrous layer – Synovial membrane lining fibrous capsule – All internal joint surfaces not covered with cartilage – Synovial fluid fills joint capsule May have: – Wedges of fibro separating – Sacs lined with synovial membrane 187

188. 6 types of synovial Plane – Flat articular surface Hinge – Similar to door hinge 188

189. Pivot joints Rotation of bone on axis Ulna atlantoaxial 189

190. Condyloid joints Oval surface of one fits into concave of other 190

191. Saddle joints Each bone has concave and convex surface Carpometacarpal of thumb 191

192. Ball and Socket Round head of one fits into concave of other Humerus femur 192

193. Joint Injuries Sprain – Overstretched, torn ligaments Cartilage – Torn or overused. Does not heal. Must remove Dislocation – Bones forced out of position Bursitis – Inflamed bursae, tendon sheath. Overuse, stress, bacterial, friction Arthritis – Diseases that damage joints. Wear, bacteria, immune 193