Module 6 Skeletal System PDF

12/10/2024 Skin Module 6: The Skeletal Because System: learning changes everything. ®...

12/10/2024 Skin Module 6: The Skeletal Because System: learning changes everything. ® Because learning changes everything.® Bones and Joints Skeletal System 6.1 Components of the Skeletal System 6.2 Functions of the Skeletal System 6.3 Bone Anatomy 6.4 Bone Histology 6.5 Bone Development 6.6 Bone Growth 6.7 Bone Remodeling 6.7 Bone Repair 6.8 Calcium Homeostasis 6.9 Gross Anatomy of Skeletal System 6.9 Joints and Movements 1 2 Skin Because learning changes everything. ® Structural Components of Because the Skeletal System: learning changes everything. ® Learning Outcomes At the end of the module, the learners shall be able to: 6.1 Name the components of the skeletal system; 6.2 Explain the functions of the skeletal system; 6.3 Describe the anatomy of bone; 6.4 Describe the histology of bone; 6.5 Understand the process of bone development and growth; 6.6 Understand the process of bone remodeling and repair; 6.7 Relate the mechanism of calcium metabolism to the integrity of bone; 6.8 Name some disorders associated with the skeletal system; 6.9 Classify the anatomic division of the skeletal system, joints, and movements. 3 4 Structural Components of Skeletal Because System: learning changes everything. ® Because learning changes everything.® Bone - rigid connective tissue with mineralized extracellular components; provide shape and structure, protect major organs, muscle attachment, store minerals, and produce blood cells Cartilage - strong, flexible connective tissue; protects joints and bones; acts as a shock absorber throughout the body Ligaments - a fibrous connective tissue that attaches bone to bone Tendons - a cord of strong, flexible connective tissue, Major Bones of the Skeletal System. similar to a rope; connects muscles to bones The skeleton is made up of a total of 206 bones. The major bones are Joints - where two or more bones meet to allow movement shown in this figure. 5 6 1  12/10/2024 Functions of the Skeletal System: Because learning changes everything. ® Because learning changes everything.® Extracellular Matrix characteristics of the skeletal system are largely determined by the composition of their bone matrix contains organic (collagen, proteoglycans) and inorganic (calcium phosphate) materials collagen and mineral components are responsible for the major functional characteristics of bone Collagen (koila, glue + -gen, producing) - a tough, ropelike protein Proteoglycans (proteo, protein + glycan, polysaccharide) - large molecules consisting of many polysaccharides attaching to and encircling core proteins 7 8 Anatomy of Bone Extracellular Matrix Classification based on their shape: bone - contains collagen and minerals (calcium and phosphate) cartilage - contains collagen and proteoglycans tendons and ligaments - contains large amounts of collagen fibers, making these structures very tough, like ropes or cables Copyright 2022 © McGraw Hill LLC. All rights reserved. No reproduction or distribution without the prior written consent of McGraw Hill LLC. 9 Copyright 2022 © McGraw Hill LLC. All rights reserved. No reproduction or distribution without the prior written consent of McGraw Hill LLC. 10  flat bones - thin, flat;  long bones - longer than provide a strong barrier wide; shape enhances around soft organs their function in (brain and heart); movement of ex., certain skull bones, appendages; ex., bones ribs, scapulae (shoulder of the upper and lower blades), sternum limbs  irregular bones - shapes do not fit readily into the  short bones - as wide as they are long; help transfer other three categories; provide protection while force between long bones; ex., bones of the wrist allowing bending and flexing of certain body regions and ankle such as the spine; vertebrae and facial bones; Copyright 2022 © McGraw Hill LLC. All rights reserved. No reproduction or distribution without the prior written consent of McGraw Hill LLC. 11 Copyright 2022 © McGraw Hill LLC. All rights reserved. No reproduction or distribution without the prior written consent of McGraw Hill LLC. 12 2  12/10/2024 Structure of a Long Bone: Structure of a Long Bone:  long bones consist of a diaphysis (shaft), epiphyses (ends), and epiphyseal (growth) plates  diaphysis contains a medullary cavity, which is filled with marrow Structure of a Long Bone. (a) Young long bone (the femur) showing the  end of the epiphysis is epiphysis, epiphyseal plates, and covered by articular diaphysis. cartilage (a) Adult long bone with epiphyseal lines. Structure of a Long Bone. (c) Internal features of a portion of the diaphysis in (a). Copyright 2022 © McGraw Hill LLC. All rights reserved. No reproduction or distribution without the prior written consent of McGraw Hill LLC. 13 Copyright 2022 © McGraw Hill LLC. All rights reserved. No reproduction or distribution without the prior written consent of McGraw Hill LLC. 14 Histology of Bone Bone is formed in thin sheets of extracellular matrix called cell processes extend from Types of Bone Cells: lamellae (plates), with the osteocytes across the osteocytes located between extracellular matrix of the Osteoblasts – bone-building cells; produce collagen and lamellae within tiny canals proteoglycans; secrete high concentrations of calcium the lamellae within spaces called lacunae called canaliculi phosphate ions Structure of Bone Tissue: Ossification – formation of new bone by osteoblasts (a) Photomicrograph of compact bone. (b) Fine structure of compact bone. Osteocytes – bone cells located between thin sheets of extracellular matrix called lamellae; osteoblasts become osteocytes once osteoblasts have secreted sufficient bone matrix; account for 90-95% of bone cells Osteoclasts – bone-destroying cells; break down bone known as bone reabsorption; massive, multinucleated cells; develop from red marrow cells that differentiate into specialized white blood cells Copyright 2022 © McGraw Hill LLC. All rights reserved. No reproduction or distribution without the prior written consent of McGraw Hill LLC. 15 Copyright 2022 © McGraw Hill LLC. All rights reserved. No reproduction or distribution without the prior written consent of McGraw Hill LLC. 16 Types of bone tissue based on histological structure: Structure of Bone Tissue: 1. Compact bone or cortical bone (a) Photomicrograph of compact bone. (b) Fine structure of compact bone. consists of osteons with concentric rings of lamellae around a central canal forms the perimeter of the diaphysis of a long bone and the thinner surfaces of all other bones mostly solid matrix and cells, fewer pores than spongy bone Structure of Bone Tissue: (a) Photomicrograph of compact bone. (b) Fine structure of compact bone. Copyright 2022 © McGraw Hill LLC. All rights reserved. No reproduction or distribution without the prior written consent of McGraw Hill LLC. 17 Copyright 2022 © McGraw Hill LLC. All rights reserved. No reproduction or distribution without the prior written consent of McGraw Hill LLC. 18 3  12/10/2024 Types of bone tissue based on histological structure: Bone Ossification 2. Spongy bone Ossification (os, bone + facio, to make) located in the epiphyses of is the formation of bone by osteoblasts long bones and lines the after an osteoblast becomes completely medullary cavity of long surrounded by bone matrix, it becomes bones a mature bone cell, or osteocyte less bone matrix and more In the fetus, bones develop by two open space than compact Structure of Bone Tissue: processes, each involving the formation of bone matrix on preexisting bone (a) Photomicrograph of compact bone. (b) Fine structure of compact bone. connective tissue consists of delicate intramembranous ossification - bone interconnecting rods or formation that occurs within connective Bone Formation in a Fetus: plates of bone called tissue membranes Intramembranous ossification occurs trabeculae (beams), which in a 12-week-old fetus at ossification resemble the beams or endochondral ossification - bone centers in the flat bones of the skull scaffolding of a building formation that occurs inside hyaline (yellow). Spongy Bone. cartilage lacy network of bone with (a) Beams of bone, the trabeculae, surround spaces in Endochondral ossification occurs in many small, marrow-filled the bone. In life, the spaces are filled with red or both types of bone formation result in the bones forming the inferior part of yellow bone marrow and with blood vessels. the skull (blue). spaces (b) Transverse section of a trabecula. compact and spongy bone Copyright 2022 © McGraw Hill LLC. All rights reserved. No reproduction or distribution without the prior written consent of McGraw Hill LLC. 19 Copyright 2022 © McGraw Hill LLC. All rights reserved. No reproduction or distribution without the prior written consent of McGraw Hill LLC. 20 Bone Ossification 2. Endochondral ossification 1. Intramembranous ossification occurs when osteoblasts begin to produce bone within connective tissue membranes in the bones of skull osteoblasts line up on the surface of connective tissue Bone Formation in a Fetus: 1. A cartilage model, with 2. The chondrocytes enlarge, and fibers and begin depositing the general shape of the (a) Intramembranous ossification occurs in a cartilage is calcified. A bone collar bone matrix to form trabeculae; 12-week-old fetus at ossification centers in the mature bone, is produced is produced, and the perichondrium begin in areas called flat bones of the skull (yellow). Endochondral by chondrocytes. A of the diaphysis becomes the ossification centers; ossification occurs in the bones forming the perichondrium surrounds periosteum. trabeculae radiate out from the inferior part of the skull (blue). most of the cartilage model. centers Endochondral Ossification of a Long Bone. two or more ossification centers mature skull bones result from A long bone forms from a hyaline cartilage precursor. The cartilage is exist in each flat skull bone fusion of these centers as they removed and new bone is formed by osteoblasts—first in the diaphysis, enlarge then in the epiphyses. Copyright 2022 © McGraw Hill LLC. All rights reserved. No reproduction or distribution without the prior written consent of McGraw Hill LLC. 21 Copyright 2022 © McGraw Hill LLC. All rights reserved. No reproduction or distribution without the prior written consent of McGraw Hill LLC. 22 Bone Ossification Radiograph of an 18-week-old fetus, showing intramembranous and endochondral ossification. Intramembranous ossification occurs at ossification centers in the 3. A primary ossification center forms flat bones of the skull. as blood vessels and osteoblasts 4. Secondary ossification invade the calcified cartilage. The centers form in the Endochondral ossification has osteoblasts lay down bone matrix, epiphyses of long bones. formed bones in the diaphyses of forming trabeculae. long bones. The epiphyses are still cartilage at this stage of Endochondral Ossification of a Long Bone. development. A long bone forms from a hyaline cartilage precursor. The cartilage is removed and new bone is formed by osteoblasts—first in the diaphysis, then in the epiphyses. Copyright 2022 © McGraw Hill LLC. All rights reserved. No reproduction or distribution without the prior written consent of McGraw Hill LLC. 23 Copyright 2022 © McGraw Hill LLC. All rights reserved. No reproduction or distribution without the prior written consent of McGraw Hill LLC. 24 4  12/10/2024 Endochondral Bone Growth. Bone Growth  bone elongation occurs at the epiphyseal plate as chondrocytes proliferate, enlarge, die, and are (a) Location of the epiphyseal replaced by bone 1.New cartilage is plate in a long bone, the tibia. produced on the epiphyseal side of the plate as the chondrocytes divide and form stacks of cells. 1. New cartilage is produced on 2.Condrocytes the epiphyseal side of the plate mature and enlarge. as the chondrocytes divide and 3.Matrix is calcified, and chondrocytes die. form stacks of cells. 4.The cartilage on the diaphyseal side 2. Chondrocytes mature and of the plate is replaced by bone. enlarge. Endochondral Bone Growth 3. Matrix is calcified, and a. Location of the epiphyseal plate in a long bone, the tibia. chondrocytes die. b. As the chondrocytes of the epiphyseal plate divide and align in columns, the cartilage expands toward the epiphysis, and the bone elongates. At the same time, the older cartilage is calcified and then replaced 4. The cartilage on the diaphyseal by bone, which is remodeled, resulting in expansion of the medullary cavity of the diaphysis. The net result side of the plate is replaced by is an epiphyseal plate that remains uniform in thickness through time but is constantly moving toward the epiphysis, resulting in elongation of the bone. bone. Epiphyseal plate remains uniform in thickness but is constantly c. Photomicrograph of an epiphyseal plate, demonstrating chondrocyte division and enlargement and the areas of calcification and ossification moving toward the epiphysis, resulting in elongation of the bone Copyright 2022 © McGraw Hill LLC. All rights reserved. No reproduction or distribution without the prior written consent of McGraw Hill LLC. 25 Copyright 2022 © McGraw Hill LLC. All rights reserved. No reproduction or distribution without the prior written consent of McGraw Hill LLC. 26 Endochondral Bone Growth. Bone Remodeling 1. New cartilage is produced on the shape and composition of bones are constantly changing epiphyseal side of through bone remodeling the plate as the chondrocytes divide removal of existing bone by osteoclasts and deposition of and form stacks of new bone by osteoblasts cells. (c) Photomicrograph 2. Chondrocytes responsible for changes in bone shape, the adjustment of of an epiphyseal mature and enlarge. bone to stress, bone repair, and calcium ion plate, demonstrating regulation in the body fluids 3. Matrix is calcified, and chondrocytes chondrocyte division die. and enlargement also involved in bone growth when newly formed spongy 4. The cartilage on the and the areas of bone in the epiphyseal plate forms compact bone diaphyseal side of calcification and important to maintain blood calcium levels within normal the plate is replaced by bone. ossification. limits Copyright 2022 © McGraw Hill LLC. All rights reserved. No reproduction or distribution without the prior written consent of McGraw Hill LLC. 27 Copyright 2022 © McGraw Hill LLC. All rights reserved. No reproduction or distribution without the prior written consent of McGraw Hill LLC. 28 Complete fracture - bone Bone Fractures is broken into at least two Bone Repair fragments Incomplete fracture - does not extend completely across the bone Comminuted fracture - a X-ray of a fractured humerus complete fracture in which the bone breaks into more (top panel). than two pieces - usually two major fragments and a Types of Bone Fractures smaller fragment Impacted fracture - one X-ray of the same humerus a Open fracture (compound fracture) - occurs when an open wound fragment is driven into the few weeks later with callus extends to the site of the fracture or spongy portion of the other (bottom panel). when a fragment of bone protrudes fragment through the skin Linear fracture - runs parallel to the length Closed fracture (simple fracture) of the bone Transverse fractures - at right angles to - skin is not perforated the length of the bone. Copyright 2022 © McGraw Hill LLC. All rights reserved. No reproduction or distribution without the prior written consent of McGraw Hill LLC. 29 Copyright 2022 © McGraw Hill LLC. All rights reserved. No reproduction or distribution without the prior written consent of McGraw Hill LLC. 30 5  12/10/2024 Bone Repair Bone and Calcium Homeostasis  Bone - major storage site for calcium in the body  movement of calcium into and out of bone helps determine blood calcium levels, which is critical for normal muscle and nervous system function  Calcium (Ca2+) moves into bone as osteoblasts build new bone and out of bone as osteoclasts break down bone (figure 6.10) Bone fractures are initially stabilized by a hematoma (1), which is replaced by a cartilaginous callus (2), a network of fibers and islets of cartilage between the two bone fragments. Osteoblasts enter the callus and begin  when osteoblast and osteoclast activity is balanced, forming spongy bone (3). The spongy bone is slowly remodeled to form the movements of calcium into and out of a bone compact bone, internal callus is removed, medullary cavity is restored, and are equal the repair is complete (4). Copyright 2022 © McGraw Hill LLC. All rights reserved. No reproduction or distribution without the prior written consent of McGraw Hill LLC. 31 Copyright 2022 © McGraw Hill LLC. All rights reserved. No reproduction or distribution without the prior written consent of McGraw Hill LLC. 32 Bone and Calcium Homeostasis Bone and Calcium Homeostasis  Calcium homeostasis is maintained by three hormones:  When blood calcium levels are too low, osteoclast activity increases, osteoclasts release calcium Parathyroid hormone (PTH) - from the parathyroid glands; from bone into the blood, and blood calcium secreted when blood calcium levels are too low; cause blood levels increase. calcium levels to increase, maintaining homeostatic levels  If blood calcium levels are too high, osteoclast activity Vitamin D - from the skin or diet; secreted when blood calcium levels are too low; cause blood calcium levels to increase, decreases, osteoblasts remove calcium from the maintaining homeostatic levels blood to produce new bone, and blood calcium levels decrease Calcitonin - from the thyroid gland; secreted when blood calcium levels are too high Copyright 2022 © McGraw Hill LLC. All rights reserved. No reproduction or distribution without the prior written consent of McGraw Hill LLC. 33 Copyright 2022 © McGraw Hill LLC. All rights reserved. No reproduction or distribution without the prior written consent of McGraw Hill LLC. 34 Bone and Calcium Homeostasis BONE ANATOMY 1. Osteoclasts remove calcium from bone, causing blood calcium levels to divided into increase. axial and 2. Osteoblasts appendicular deposit calcium portions into bone, causing blood calcium levels to decrease. 3. Parathyroid hormone increases bone breakdown, whereas calcitonin Calcium Homeostasis. decreases bone Three hormones work to maintain blood Ca2+ levels at their breakdown. set point. PTH and Vitamin D raise blood Ca2+ levels, whereas calcitonin lowers blood Ca2+ levels. Copyright 2022 © McGraw Hill LLC. All rights reserved. No reproduction or distribution without the prior written consent of McGraw Hill LLC. 35 Copyright 2022 © McGraw Hill LLC. All rights reserved. No reproduction or distribution without the prior written consent of McGraw Hill LLC. 36 6  12/10/2024 Axial Skeleton includes the skull, Complete Skeleton. vertebral column, and Bones of the axial skeleton are listed in the columns on each thoracic cage side of the figure; bones of the appendicular skeleton are Skull as Seen from the Right Side (The names of bones listed in the center of the two Skull are in bold.) Lateral view. skeleton views. (The skeleton is not shown in the anatomical consists of 22 bones: position.) 8 forming the brain- case and 14 facial bones; hyoid bone and 6 auditory ossicles are associated with the Skull and Face (The names of bones are in bold.) skull (a)Frontal view of the skull. (b)Bony landmarks of the face. Copyright 2022 © McGraw Hill LLC. All rights reserved. No reproduction or distribution without the prior written consent of McGraw Hill LLC. 37 Copyright 2022 © McGraw Hill LLC. All rights reserved. No reproduction or distribution without the prior written consent of McGraw Hill LLC. 38 Axial Skeleton Axial Skeleton Thoracic or Rib Cage Vertebral Column protects the vital organs also called spine; within the thorax and central axis of the prevents the collapse of skeleton, extending the thorax during from the base of the respiration skull to slightly past consists of the thoracic the end of the pelvis; Vertebra. vertebrae, the ribs with in adults, it usually Superior view of a their associated consists of 26 generalized vertebra cartilages, and the individual bones, sternum grouped into five Rib Cage. 12 pairs of ribs: 7 true Anterior view of the ribs and costal cartilage and 5 false (2 of the attachments to the sternum. false ribs are also called floating ribs) Vertebral Column. Complete column viewed from the left side. Copyright 2022 © McGraw Hill LLC. All rights reserved. No reproduction or distribution without the prior written consent of McGraw Hill LLC. 39 Copyright 2022 © McGraw Hill LLC. All rights reserved. No reproduction or distribution without the prior written consent of McGraw Hill LLC. 40 Appendicular Skeleton Appendicular Skeleton consists of the bones of the upper and lower limbs and their girdles Pectoral Girdle Pelvic Girdle includes the scapulae and 2 hip bone clavicles Lower Limb Upper Limb includes the thigh (femur), consists of the arm (humerus), leg (tibia and fibula), ankle forearm (ulna and radius), wrist (8 carpal bones), and hand (5 (7 tarsal bones), and foot metacarpal bones, 3 phalanges (metatarsal bones and in each finger, and 2 phalanges phalanges, similar to the in the thumb) bones in the hand) Bones of the Pelvic Girdle and Right Lower Limb. Bones of the Pectoral Girdle and Right Upper Limb. Anterior view of the bones of the pelvic girdle and Anterior view of the bones of the pectoral girdle and upper limb. right lower limb. Copyright 2022 © McGraw Hill LLC. All rights reserved. No reproduction or distribution without the prior written consent of McGraw Hill LLC. 41 Copyright 2022 © McGraw Hill LLC. All rights reserved. No reproduction or distribution without the prior written consent of McGraw Hill LLC. 42 7  12/10/2024 Joints Fibrous Joints  or articulations; a place where bones come together consist of bones united by fibrous connective tissue;  classified based on structure and type of movement no cavity or space between bones; allow little or no movement; sutures, syndesmoses, and Fibrous Joints gomphoses consist of bones united by fibrous connective tissue; allow little or no movement Cartilaginous Joints consist of bones united by cartilage; exhibit slight movement Synovial Joints consist of articular cartilage over the uniting bones, a joint cavity lined by a synovial membrane and containing synovial fluid, and a joint capsule; highly movable joints classified as plane, saddle, hinge, pivot, ball-and-socket, or ellipsoid Copyright 2022 © McGraw Hill LLC. All rights reserved. No reproduction or distribution without the prior written consent of McGraw Hill LLC. 43 Copyright 2022 © McGraw Hill LLC. All rights reserved. No reproduction or distribution without the prior written consent of McGraw Hill LLC. 44 Synovial Joints Cartilaginous Joints consist of articular cartilage over the uniting bones,  bones are connected by cartilage; exhibit slight a joint cavity lined by a synovial membrane movement and containing synovial fluid, and a joint  Synchondroses - bones are joined by hyaline capsule; highly movable joints cartilage; found in the epiphyseal plates of growing bones in children synovial fluid lubricates the joint, reducing friction  Symphyses - hyaline cartilage covers the end of between the bones and allowing for greater the bone, connection between bones occurs movement through fibrocartilage; found at the joints between vertebrae and between the pubic bones classified as plane, saddle, hinge, pivot, ball-and- socket, or ellipsoid Copyright 2022 © McGraw Hill LLC. All rights reserved. No reproduction or distribution without the prior written consent of McGraw Hill LLC. 45 Copyright 2022 © McGraw Hill LLC. All rights reserved. No reproduction or distribution without the prior written consent of McGraw Hill LLC. 46 Structure of a Synovial Joint Types of Synovial Joints 1 TABLE 6.4 Synovial Joints Class and Example Bones Joined Movement of Joint Plane Intervertebral Between articular processes of Uniaxial; slight adjacent vertebrae Acromioclavicular Acromion process of scapula and Uniaxial; slight Carpometacarpal clavicle Uniaxial; slight Costovertebral Carpals and metacarpals 2–5 Uniaxial; slight Intercarpal Ribs and vertebrae Uniaxial; slight Intermetatarsal Between carpal bones Uniaxial; slight Intertarsal Between metatarsal bones Uniaxial; slight Sacroiliac Between tarsal bones Uniaxial; slight Plane Intervertebral Between sacrum and hip bone (complex joint with several planes and Tarsometatarsal synchondroses) Uniaxial; slight Tarsal bones and metatarsal bones Saddle Carpometacarpal pollicis Carpal and metacarpal of thumb Biaxial Sternoclavicular Manubrium of sternum and clavicle Multiaxial; slight Saddle Carpometacarpal Hinge Cubital (elbow) Humerus, ulna, and radius Uniaxial Knee Femur and tibia Uniaxial Interphalangeal Between phalanges Uniaxial Talocrural (ankle) Talus, tibia, and fibula Multiaxial; one Figure 6.37 Hinge Cubital predominates Access the text alternative for slide images. Copyright 2022 © McGraw Hill LLC. All rights reserved. No reproduction or distribution without the prior written consent of McGraw Hill LLC. 47 Copyright 2022 © McGraw Hill LLC. All rights reserved. No reproduction or distribution without the prior written consent of McGraw Hill LLC. 48 8  12/10/2024 Types of Synovial Joints 2 TABLE 6.4 Synovial Joints Class and Example Bones Joined Movement of Joint Pivot Atlantoaxial Atlas and axis Uniaxial rotation Proximal radioulnar Radius and ulna Uniaxial rotation Distal radioulnar Radius and ulna Uniaxial rotation Pivot Proximal radioulnar Ball-and-Socket Glenohumeral (shoulder) Scapula and humerus Multiaxial Hip Hip bone and femur Multiaxial Ball-and-socket Glenohumeral Ellipsoid Atlantooccipital Atlas and occipital bone Biaxial Metacarpophalangeal (knuckles) Metacarpal bones and phalanges Biaxial Metatarsophalangeal (ball of foot) Metatarsal bones and phalanges Biaxial Radiocarpal (wrist) Radius and carpal bones Multiaxial Ellipsoid Atlantooccipital Temporomandibular Mandible and temporal bone Multiaxial; one predominates Copyright 2022 © McGraw Hill LLC. All rights reserved. No reproduction or distribution without the prior written consent of McGraw Hill LLC. 49 Copyright 2022 © McGraw Hill LLC. All rights reserved. No reproduction or distribution without the prior written consent of McGraw Hill LLC. 50 Types of Movement: Types of Movement : Types of Movement: (a) Flexion and extension of the elbow. Flexion: bending (b) Flexion and extension of Extension: straightening the neck. (c) Abduction and adduction Abduction: movement away from midline of the fingers. Adduction: movement toward the midline (d) Pronation and supination of the hand. Pronation: rotation of the forearm with palms down (e) Medial and lateral rotation of the arm Supination: rotation of the forearm with palms up Rotation: movement of a structure about the long axis Copyright 2022 © McGraw Hill LLC. All rights reserved. No reproduction or distribution without the prior written consent of McGraw Hill LLC. 51 Copyright 2022 © McGraw Hill LLC. All rights reserved. No reproduction or distribution without the prior written consent of McGraw Hill LLC. 52 Copyright 2022 © McGraw Hill LLC. All rights reserved. No reproduction or distribution without the prior written consent of McGraw Hill LLC. 53 9