Skeletal System PDF

(006) SKELETAL SYSTEM DR. ERNESTO TAGORDA| 10/21/2020 ▪ Vertebral Column...

(006) SKELETAL SYSTEM DR. ERNESTO TAGORDA| 10/21/2020 ▪ Vertebral Column ▪ Thoracic Cage OUTLINE o Appendicular – forms the appendages or I. SKELETON structures where they are attached to ▪ Upper Limbs (Arms) II. SKULL ▪ Lower Limbs (Legs) A. CRANIUM ▪ Pectoral Girdle (shoulder) ▪ B. FACIAL BONES Pelvic Girdle III. HYOID BONE II. THE SKULL IV. VERTEBRAL COLUMN A. SPINAL CURVATURES A. The Cranium (Cranial Bones) B. STRUCTURES OF THE VERTEBRAE Vault – also known as “calvaria” = skull cap, upper part C. CERVICAL VERTEBRAE o Forms superior, lateral, and posterior aspects of the D. THORACIC VERTEBRAE Skull and Forehead E. LUMBAR VERTEBRAE Base or Floor: Inferior Part o Prominent bony ridges divide cranial base into 3 V. THORACIC CAGE fossae (steps) – Anterior, Middle, and Posterior A. STERNUM AND RIBS VI. DISORDERS OF THE AXIAL SKELETON VII. FONTANELS VIII. APPENDICULAR SKELETON IX. PECTORAL GIRDLE X. UPPER EXTREMITIES A. ARM B. FOREARM C. HAND XI. PELVIC GIRDLE A. ILIUM B. ISCHIUM C. PUBIS XII. LOWER EXTREMITIES A. THIGH B. LEG C. FOOT XIII. TEST YOURSELF XIV. REFERENCES Figure 1. This figure shows the three fossae in the skull. XV. APPENDIX ⮚ Cranial Bones Frontal Bone I. THE SKELETON Parietal Bones (paired) Occipital Bone Consist of: Temporal Bones (paired) – houses the External o Bones (206) Acoustic/Auditory Meatus/ External Ear; contains o Cartilages the Zygomatic Process which becomes continuous o Joints/ Articulations – junctions between skeletal with the Zygomatic Arch or cheekbone muscles Sphenoid Bone – can be seen from the base of the o Ligaments – fibrous tissue that connects bone to skull; has a body, a Greater Wing, and a Lesser another bone Wing; butterfly-shaped; 3 Processes (Greater Wing, Divided into: o Axial – forms the long axis of the body Lesser Wing, Ptyregoid Process); Sella Turcica – a ▪ Skull depression in the body of the Sphenoid Bone where Cranial Bones (Cranium) the Pituitary Gland lies. Facial Bones (Anterior Aspect of Ethmoid Bone – found above the nose; the spaces the Skull) are called Ethmoid Sinuses (when infected = PREPARED AND EDITED BY: LIMBAUAN, J., LIVED, R., LOCQUIAO, C., LOPEZ, F., PADILLA, A., PADOLINA, J., PALAGANAS, B., PANG-AG, L  (006) SKELETAL SYSTEM DR. ERNESTO TAGORDA| 10/21/2020 Sinusitis); consist the Middle Nasal Concha; the perpendicular plate and Nasal Concha is part of the Ethmoid Bone while the Inferior Nasal Concha is a part of the Facial Bone. The Sphenoid and the Ethmoid Bone are NOT very visible because they are located inside. Figure 2. This figure shows the lateral view of the skull along the bones found in the Cranium. Figure 3. This figure shows the posterior part of the Cranium. Figure 4. (Upper Picture) Sphenoid bone in anterior, posterior and superior view. (Lower Picture) Ethmoid Bone ⮚ Sutures Immovable, interlocking joints of flat bones of the skull PREPARED AND EDITED BY: LIMBAUAN, J., LIVED, R., LOCQUIAO, C., LOPEZ, F., PADILLA, A., PADOLINA, J., PALAGANAS, B., PANG-AG, L  (006) SKELETAL SYSTEM DR. ERNESTO TAGORDA| 10/21/2020 Irregular, saw-toothed appearance Largest 4 Skull Sutures (area where bones articulate with parietal bones) o Coronal – junction between the Frontal Bone and Parietal Bone o Sagittal – joint between the 2 parietal bones o Squamous – junction between the Parietal Bone and Temporal Bone o Lambdoid – junction between the Parietal Bone and the Occipital Bone The Skull consists of the following: 1. Cranial Cavity – houses the brain 2. Other smaller cavities a. Auditory Cavity – houses the middle ear b. Nasal Cavity – houses organ for smell and turbinates c. Orbital Cavity – houses the orbits/eyes d. Nasal Cavity – houses the Sinuses 3. Openings (Foramina, Canals, Fissures) for a. Spinal Cord b. Blood Vessels c. 12 Cranial Nerves B. Facial Bones (Anterior Aspect of the Skull) consists of: 1. Mandible – also called the lower jaw 2. Vomer 3. Maxillae (paired) – also called the upper jaw 4. Zygomatics (paired) 5. Nasal (paired) 6. Lacrimals (paired) 7. Palatines (paired) – part of the hard palate (consist of the Palatine Process of the Maxilla and Palatine Bones) 8. Inferior Nasal Conchae (paired) Figure 5. Facial bones and their descriptions Figure 6. This figure shows the Anterior view of the Skull along with the Facial Bones PREPARED AND EDITED BY: LIMBAUAN, J., LIVED, R., LOCQUIAO, C., LOPEZ, F., PADILLA, A., PADOLINA, J., PALAGANAS, B., PANG-AG, L  (006) SKELETAL SYSTEM DR. ERNESTO TAGORDA| 10/21/2020 Figure 8. This figure shows the lateral view of the skull along with the Facial Bones Lateral View of the Skull Parietal bones – form the sides and roof of the cranium and articulate with each other in the midline at the sagittal suture. Figure 7. This figure also shows the Anterior view of the skull along with the Facial They articulate with the occipital bone behind, at the lambdoid Bones. suture. Part of the temporal bone: Anterior View of the Skull o Squamous Frontal Bone – forehead bone, curves downward to make the o Tympanic upper margins of the orbits. o Mastoid Process o Styloid Process Superciliary arches and supraorbital notch or foramen – o Zygomatic Process can be seen near the frontal bone o Greater wing of the sphenoid Orbital margins – bounded by the frontal bone superiorly, the zygomatic bone laterally, the maxilla inferiorly and the Note the position of the external auditory meatus. processes of the maxilla and frontal bone medially. The ramus and the body of the mandible lie inferiorly. Frontal air sinuses – above the orbital margins; two hollow spaces lined with mucous membrane Pterion – thinnest part of the lateral wall of the skull where the anteroinferior corner of the parietal bone articulates with the Nasal bones – paired; form the bridge of the nose. Lower greater wing of the sphenoid. Clinically, an important area borders with the maxillae make the anterior nasal aperture. because it overlies the anterior division of the middle Zygomatic bone – forms the prominence of the cheek and meningeal artery and vein. part of the lateral wall and floor of the orbital cavity. Medially, Superior and Inferior Temporal Lines – begin as a single it articulates with the maxilla and laterally it articulates with the line from the posterior margin of the zygomatic process of the zygomatic process of the temporal bone to form the zygomatic frontal bone and diverge as they arch backward arch. Perforated by two foramina for the zygomaticofacial and Temporal Fossa – lies below the inferior temporal line zygomaticotemporal nerves. Infratemporal Fossa – lies below the infratemporal crest on the greater wing of the sphenoid. Pterygomaxillary Fissure – a vertical fissure that lies within the fossa between the pterygoid process of the sphenoid bone and back of the maxilla. It leads medially into the pterygopalatine fossa. Inferior Orbital Fissure – horizontal fissure between the greater wing of the sphenoid bone and the maxilla. It leads forward into the orbit. Pterygopalatine Fossa – small space behind and below the orbital cavity. It communicates laterally with the infratemporal fossa through the sphenopalatine foramen, superiorly with the skull through the foramen rotundum, and anteriorly with the orbit through the inferior orbital fissure. PREPARED AND EDITED BY: LIMBAUAN, J., LIVED, R., LOCQUIAO, C., LOPEZ, F., PADILLA, A., PADOLINA, J., PALAGANAS, B., PANG-AG, L  (006) SKELETAL SYSTEM DR. ERNESTO TAGORDA| 10/21/2020 Posterior View of the Skull External occipital protuberance – midline of the occipital bone; gives attachment to muscles and ligamentum nuchae. Superior nuchal lines – extend laterally toward the temporal bone. Figure 9. This figure shows the Palatine Bone. Foramen magnum – occupies the central area of the floor and transmits the medulla oblongata and its surrounding meninges, the ascending spinal parts of the accessory nerves, and two vertebral arteries. FIGURE 11. Parts of the inner surface of the skull Mandible – or lower jaw, consists of a horizontal horseshoe-shaped body and two vertical rami; part of the anterior view of the skull. o Body of the mandible – external surface in the midline; has a faint ridge indicating the line of fusion of the two halves during the development at the symphysis menti. o Mental foramen – can be seen below the second premolar tooth; transmits the terminal branches of the inferior alveolar nerve and vessels o Mental spines – seen on the medial surface of the body of the mandible in the median plane; gives origin to the genioglossus muscles above the geniohyoid muscles. o Mylohyoid line – oblique ridge that runs backward and laterally from the area of the mental spines to an area below and behind the third molar tooth. o Submandibular fossa – superficial part of the submandibular salivary gland; lies below the posterior part of the mylohyoid line. o Sublingual fossa – for the sublingual gland; lie above the anterior part of the mylohyoid line. Figure 10. This figure shows the Foramen Magnum which is an opening to the Spinal o Alveolar part – upper border of the body of the mandible (in cord. adult contains 16 sockets for the roots of the teeth) o Base – lower border of the body of the mandible PREPARED AND EDITED BY: LIMBAUAN, J., LIVED, R., LOCQUIAO, C., LOPEZ, F., PADILLA, A., PADOLINA, J., PALAGANAS, B., PANG-AG, L  (006) SKELETAL SYSTEM DR. ERNESTO TAGORDA| 10/21/2020 o Digastric fossa – small, roughened depression on the base, on either side of the symphysis menti; fossae that the anterior bellies of the digastric muscles are attached. o Ramus of the mandible – vertically placed and has an anterior coronoid process and posterior condyloid process or head o Mandibular notch – separates coronoid process and condyloid process. o Mandibular foramen – seen on the medial surface; for the inferior alveolar nerve and vessels o Lingula – projection of bone, in front of the foramen, for the attachment of the sphenomandibular ligament. o Mandibular canal – opens on the lateral surface of the body of the mandible at the mental foramen. o Incisive canal – continuation forward of the mandibular canal beyond the mental foramen and below the incisor teeth. Figure 13. This figure shows the parts of the Maxilla. ⮚ Nasal Cavity Roof is Ethmoid’s Cribriform Plate Floor formed by the Palatine Processes of the 2 Maxillae and the Horizontal Plates of the Palatine Bones. o These nasal floor structures forms the roof of the mouth called the Hard Palate Divided into two by the bony nasal septum (called Vomer): - Superior Conchae - Middle Conchae Figure 12. This figure shows the lateral view of the Mandible. Mandibular Condyle is the part of the Mandible that is in contact with the Temporal Bone. They are shelves of bone that project into the nasal cavity from the ethmoid bone on each side; the inferior conchae are Maxilla – two (2) maxilla forms the upper jaw; anterior part of the hard separate bones. palate, part of the lateral walls of the nasal cavities, and part of the floors of the orbital cavities; part of the anterior view of the skull. ⮚ Orbital Cavity Cone-shaped bony cavity housing the eyes, muscles that Intermaxillary suture – the midline where two bones meet; moves the eye, fat and tear-producing glands form the lower margin of the nasal aperture Infraorbital foramen – below the orbit; perforates the maxilla Alveolar process – projects downward together with the alveolar arch Alveolar arch – carries the upper teeth Maxillary sinus – large pyramid shaped lined with mucous membrane; communicates with the nasal cavity and serves as a voice resonator PREPARED AND EDITED BY: LIMBAUAN, J., LIVED, R., LOCQUIAO, C., LOPEZ, F., PADILLA, A., PADOLINA, J., PALAGANAS, B., PANG-AG, L  (006) SKELETAL SYSTEM DR. ERNESTO TAGORDA| 10/21/2020 Figure 14. This figure shows the Orbital Cavity. Take note of the Optic Canal where the Optic Nerve passes. Figure 15. Muscle attachments, nerve, and vessels entering the orbit The bones contributing to the orbit include the following: - Frontal (orbital surface) - Maxillary (orbital surface) Figure 16. This figure shows the location of the different Paranasal Sinuses. - Zygomatic (Orbital surface) - Sphenoid - Palatine (orbital plate) - Ethmoid (orbital plate) - Lacrimal The back of the orbit has three (3) large openings that include the following: - Superior orbital fissure: CN III, IV, VI and V1 (Ophthalmic) (frontal, lacrimal, and nasociliary nerves) pass through the fissure along with the ophthalmic vein - Inferior orbital fissure: CN V2 (Maxillary) and the ophthalmic artery pass through this canal. - Optic canal: CN II and the ophthalmic artery pass through this canal. ⮚ Paranasal Sinuses Air filled sacs in the bone Figure 17. Paranasal sinuses and their site of drainage into the nose Called “Paranasal” because they cluster near and connect to the Nasal Cavity III. HYOID BONE When infected = Sinusitis Only bone that does NOT articulate with any other bone Free bone and it is not part of the skull or vertebral column Movable base for the tongue Point of attachment for neck muscles that raises and lowers the Larynx during swallowing Part of the Axial Skeleton PREPARED AND EDITED BY: LIMBAUAN, J., LIVED, R., LOCQUIAO, C., LOPEZ, F., PADILLA, A., PADOLINA, J., PALAGANAS, B., PANG-AG, L  (006) SKELETAL SYSTEM DR. ERNESTO TAGORDA| 10/21/2020 Figure 18. This figure shows the parts of the Hyoid Bone. IV. VERTEBRAL COLUMN Fetus and infants have 33 separate bones on vertebrae Adult have 24 + 2 = 26 vertebrae, the Inferior 9 have fused forming the Sacrum (5 bones fused into sacrum) and Coccyx (4 bones fused into Coccyx) 7 Cervical; 12 Thoracic; 5 Lumbar; Sacrum (5 fused into 1); Coccyx (4 fused into 1); Total = 26 A. Spinal Curvatures Cervical and Lumbar are concave posteriorly Thoracic and Sacral are convex posteriorly Abnormal o When viewed from the side too much curvature i. Kyphosis – abnormal curvature of the Thoracic Spine ii. Lordosis – abnormal curvature of the Lumbar Spine) o When viewed from Antero-posterior i. Scoliosis – more than 10 degrees of Lateral Curvature ii. Levoscoliosis – Scoliosis on the Left Side iii. Dextroscoliosis – Scoliosis on the right side) Non-bony parts of the Vertebral Column o Intervertebral Discs - area between the body of the Figure 19. This figure shows the Non-bony parts of the Vertebral Column vertebrae o Anterior Longitudinal Ligament – found anterior to B. Structures of a typical Vertebrae the body of the spine; wide and strong and attaches Body to the vertebrae as well as discs; prevents Vertebral Foramen hyperextension Spinous Process o Posterior Longitudinal Ligament - found posterior Transverse Process to the body of the spine; narrow and relatively weak Pedicle – found between the body and the Transverse attaching only to the disks Process o Ligamentum flavum - found between the spines Lamina – bone between the Spinous Process and Transverse o Intervertebral Foramen – opening within the Process Ligamentum flavum where the spinal nerves passes C. Cervical Vertebrae (C1-C7) Smallest, lightest, most flexible Triangular vertebral foramen Transverse Process have Foramina (Transverse Foramen) PREPARED AND EDITED BY: LIMBAUAN, J., LIVED, R., LOCQUIAO, C., LOPEZ, F., PADILLA, A., PADOLINA, J., PALAGANAS, B., PANG-AG, L  (006) SKELETAL SYSTEM DR. ERNESTO TAGORDA| 10/21/2020 Spinous process bifid/forked except for C7 C1 Vertebrae (The Atlas) – 1st cervical vertebra - Does not possess a body or a spinous process. It has an anterior and posterior arch. It has a lateral mass on each side with articular surfaces on its upper surface for articulation with the occipital condyles (atlanto-occipital joints) and articular surfaces on its inferior surface for articulation with the axis (atlantoaxial joints) C2 Vertebrae (The Axis) – 2nd Cervical Vertebra - Has a peg-like odontoid process (dens) that projects from the superior surface of the body (representing the body of the atlas that has fused with the body of the axis). C7 – most prominent when back of the neck is palpated - 7th cervical vertebrae or vertebra prominens; named because it has the longest spinous process and the process is not bifid. The transverse process is large, but Figure 21. This figure shows the different structures found in the Thoracic Vertebra. the foramen transversarium is small and transmits the vertebral veins. E. Lumbar Vertebra (L1-L5) Massive block-like bodies Short, thick, hatchet-shaped Spinous process Limited mobility Kidney-shaped vertebral body Figure 20. This figure shows the difference of the C1 (Atlas) and C2 (Axis) as well as the structures found in them. D. Thoracic Vertebra (T1-T12) Heart-shaped vertebral body Has additional costal facets Figure 22. This figure shows the Lumbar Vertebra and the structures found in it. Round or oval vertebral foramen Forms the posterior part of the rib cage PREPARED AND EDITED BY: LIMBAUAN, J., LIVED, R., LOCQUIAO, C., LOPEZ, F., PADILLA, A., PADOLINA, J., PALAGANAS, B., PANG-AG, L  (006) SKELETAL SYSTEM DR. ERNESTO TAGORDA| 10/21/2020 Figure 25. This figure shows the Sacrum and Coccyx. V. THORACIC CAGE Figure 23. This figure shows the difference between the different Vertebrae A. Sternum and Ribs F. Sacrum Manubrium corresponds to the True Ribs (1-7) – they are Shapes the posterior wall of the Pelvis called True Ribs because their Costal Cartilages are directly Composite bone of 5 fused vertebrae attached to the Manubrium and Body of the Sternum Sacral Foramina allows passage of vessels and nerves Body corresponds to the False Ribs (8-12) – they are called G. Coccyx False Ribs because their Costal Cartilages are NOT directly The Tail Bone attached to the Sternum but rather to the Costal Cartilage of the 7th rib Xiphoid Process corresponds to the Floating Ribs (11-12) – they are called as Floating Ribs because their Costal Cartilages are NOT attached to any part of the Sternum The ribs are attached posteriorly on the Vertebral column and attached anteriorly to the Sternum via the Costal Cartilage. Figure 24. This figure shows the Sacrum and Coccyx. PREPARED AND EDITED BY: LIMBAUAN, J., LIVED, R., LOCQUIAO, C., LOPEZ, F., PADILLA, A., PADOLINA, J., PALAGANAS, B., PANG-AG, L  (006) SKELETAL SYSTEM DR. ERNESTO TAGORDA| 10/21/2020 Figure 28. This figure also shows the parts of a typical Rib. VI. DISORDERS OF THE AXIAL SKELETON Scoliosis - more than 10 degrees of Lateral Curvature; o Levoscoliosis – Scoliosis on the Left Side o Dextroscoliosis – Scoliosis on the right side Kyphosis - abnormal curvature of the Thoracic Spine Lordosis - abnormal curvature of the Lumbar Spine Figure 26. This figure shows the Sternum and its parts. Vertebral Compression Fractures – occurs secondary to trauma Spinal Stenosis – narrowing of the Spinal Canal which causes compression of the Spinal Cord VII. FONTANELS Unossified remnants of membranes Present at birth Anterior Fontanel – largest Called “Soft Spots” Ossify by 1 ½ to 2 years Continue to ossify during adulthood and becomes Sutures and can become fused in old age abnormalities (early fusion of the Sutures - Craniosynostosis) Metopic Synostosis and Trigonocephaly Sagittal Synostosis and Scaphocephaly – the most common suture to fuse is the middle or Sagittal Suture. Often the back or front of the skull will be worse but the overall shape is a long skull with a shortened distance from ear to ear VIII. APPENDICULAR SKELETON It has 2 pairs of limbs and 2 pairs of girdles 2 GIRDLES: 1. PECTORAL (shoulder) girdle- attaches upper limbs 2. PELVIC (hip) girdle- secures lower limbs Figure 27. This figure shows the parts of a typical Rib. 2 PAIRS OF LIMBS: 1. Three segmented Upper limb (Arms) a. Arm (Upper portion) PREPARED AND EDITED BY: LIMBAUAN, J., LIVED, R., LOCQUIAO, C., LOPEZ, F., PADILLA, A., PADOLINA, J., PALAGANAS, B., PANG-AG, L  (006) SKELETAL SYSTEM DR. ERNESTO TAGORDA| 10/21/2020 b. Forearm (Middle portion) articulates with the clavicular notch of the sternum c. Hand (Lower portion) through a compound synovial joint containing an 2. Three segmented Lower limb (Legs) articular disc a. Thigh (Upper portion) o Acromial Extremity b. Leg (Middle portion) flattened distal end of the clavicle c. Foot (Lower portion) articulates with the acromion process of the scapula o Conoid Tubercle IX. PECTORAL GIRDLE small, roughened elevation on the inferior surface, near the acromial end Shoulder girdle attachment area for the conoid ligament part of the coracoclavicular ligament SCAPULA – posterior: Shoulder blade – Triangular, paired – Lies on the posterior chest wall between the 2nd and 7th rib – Don’t connect in back – Articulates with the acromial extremity of the clavicle and the head of the humerus – Adds to thoracic flexibility o Three Borders 1. Superior border – short, thin, superior edge of scapula – Scapular notch – located on the lateral aspect of the superior border, near the base of the coracoid process 2. Medial Border – long, medial edge of the scapula, located closest to Figure 29. Pectoral Girdle. the vertebral column CLAVICLE – anterior: Collar bone 3. Lateral Border – Sternal end attaches to the manubrium medially – thickened, lateral edge of the scapula, located closest to – Acromial end articulates with the scapula laterally the axilla – Connects the upper limb to the thorax and allows the limb to move freely from the trunk o Three Angles – First bone to begin ossification 1. Superior Angle – Most commonly fractured bone in the body – junction of the superior and medial border 2. Inferior Angle – junction of the medial and lateral borders 3. Lateral Angle – junction of the superior and lateral borders – thickest and most complex part – composed mainly of the head of the scapula that is connected to the rest of the bone by the neck of the scapula – lateral Surface forms the glenoid cavity – articulates with the head of humerus ▪ Glenoid labrum – fibrocartilage ring rims the margin of the glenoid cavity and serves to broaden and deepen the joint cavity ▪ Supraglenoid tubercle – small elevation located at the apex of the glenoid cavity, near the base of the coracoid process ▪ Infraglenoid tubercle – a roughened area located immediately inferior to the glenoid cavity Figure 30. Clavicle o Sternal Extremity blunt, thickened, proximal end of the clavicle PREPARED AND EDITED BY: LIMBAUAN, J., LIVED, R., LOCQUIAO, C., LOPEZ, F., PADILLA, A., PADOLINA, J., PALAGANAS, B., PANG-AG, L  (006) SKELETAL SYSTEM DR. ERNESTO TAGORDA| 10/21/2020 Between shoulder and elbow (humerus) FOREARM OR ANTEBRACHIUM – Radius and Ulna HAND – Includes: a. Wrist (carpus) b. Palm (metacarpus) c. Fingers (phalanges) Thumb: 2 Phalanges Other Fingers: 3 Phalanges Figure 31. Scapula (anterior and posterior aspect). o Two Surfaces 1. Dorsal Surface ▪ Supraspinous fossa – smaller, trough-like area superior to the spine ▪ Infraspinous fossa – much larger area inferior to spine ▪ Spine – large, triangular ridge that runs laterally from the medial border of the scapula to merge into the acromion process Lateral border – blends into the neck of Figure 33. Parts of the Upper Extremities scapula forming spinoglenoid or greater scapular notch that connects supraspinous A. ARM fossa with the infraspinous fossa HUMERUS Acromion – articulates with clavicle the only bone in the arm; longest bone of the upper limb head of humerus (upper part) fits into glenoid cavity of scapula 2. Costal Surface Distal & Medially: Trochlea articulates with the Ulna ▪ Subscapular fossa – shallow concavity Distal & Laterally: Capitulum articulates with the Radius ▪ Coracoid process – thick, beaklike structure that projects anterolaterally from the junction of the neck and lateral end of the superior border of the scapula Figure 34. Parts of the Humerus (Anterior and Posterior) Right Humerus (Anterior and Posterior) (Appendix 1) Figure 32. Right Scapula (Lateral aspect). The three most important parts highlighted with a symbol. o Three Main Regions 4. Proximal Extremity ▪ Head – articulates with the glenoid cavity of the scapula to form the glenohumeral joint in the X. UPPER EXTREMITY shoulder joint complex ARM OR BRACHIUM – Upper arm PREPARED AND EDITED BY: LIMBAUAN, J., LIVED, R., LOCQUIAO, C., LOPEZ, F., PADILLA, A., PADOLINA, J., PALAGANAS, B., PANG-AG, L  (006) SKELETAL SYSTEM DR. ERNESTO TAGORDA| 10/21/2020 ▪ Greater tubercle – large, roughened elevation ▪ Olecranon – hinges with the humerus forming on the lateral proximal end of the humerus, the ‘point’ of the elbow lateral to the head – fits into the olecranon fossa of the humerus ▪ Lesser tubercle – small, roughened elevation ▪ Coronoid process – anterior projection forming on the anterior proximal end of the humerus, the inferior end of the hook-like proximal end of inferior to the head and medial to the greater the ulna tubercle – contributes to the formation of the trochlear ▪ Anatomical neck – slightly constricted region notch surrounding the articular surface of the head ▪ Trochlear notch – large, crescent-shaped notch – attached by the articular capsule of the on the anterior aspect of the proximal end of the glenohumeral joint ulna ▪ Surgical neck – constricted area immediately – articulates with the trochlea of the humerus inferior to the greater and lesser tubercles ▪ Radial notch – shallow, smooth notch on the ▪ Intertubercular (bicipital) groove – deep lateral aspect of the coronoid process groove on the anterior surface of the humerus ▪ Ulnar tuberosity – anterior, distal, roughened that separates the greater and lesser tubercles aspect of the coronoid process 5. Body/Shaft ▪ Body –tapers along its proximodistal length ▪ Deltoid tuberosity – roughened triangular – posterior – rounded and subcutaneous elevation on the anterolateral surface of the – distinguished by the hamulus (hook) – one of midshaft of the humerus the attachment points of the flexor retinaculum. – attachment area for the deltoid muscle ▪ Radial groove – shallow depression that spirals “Some Lovers Try Positions That They Cannot Handle” around the posterior and lateral aspects of the midshaft of the humerus Some - Scaphoid ▪ Medial supracondylar ridge – narrow ridge Lovers - Lunate running proximally from the medial epicondyle, Try -Triquetrum forming the lower medial border of the humerus Positions - Pisiform ▪ Lateral supracondylar ridge – narrow ridge That -Trapezium running proximally from the lateral epicondyle, They -Trapezoid forming the lower lateral border of the humerus. Cannot - Capitate 6. Distal Extremity Handle - Hamate ▪ Lateral epicondyle – small, roughened projection on the distal, lateral side of the METACARPAL BONES humerus, proximal to the capitulum five bones located between the carpal bones and the – attachment area for the common extensor phalanges of the hand tendon bones are identified by number (1–5), starting with the ▪ Medial epicondyle – large, knoblike projection most lateral unit on the distal, medial side of the humerus, first metacarpal bone of the thumb proximal to the trochlea shortest and most mobile ▪ Capitulum – rounded, half-spherical, articular occupies a more anterior position than the others process at the distal, lateral end of the humerus rotated medially through a right angle so that its – articulates with the head of the radius extensor surface is directed laterally rather than ▪ Trochlea – pulley-shaped articular process at posteriorly the distal, medial end of the humerus o Parts – articulates with the trochlear notch of the ulna ▪ Base – articulates with the distal row of carpal bones ▪ Coronoid fossa – depression on the distal, ▪ Body – slightly concave anteriorly and is triangular anterior end of the humerus, immediately in transverse section proximal to the trochlea ▪ Head – articulates with the proximal phalanx of the ▪ Radial fossa – shallow depression on the distal, corresponding digit and forms a knuckle of the hand anterior end of the humerus, immediately proximal to the capitulum PHALANGES ▪ Olecranon fossa – deep depression on the bones that comprise the digits of the hand distal, posterior end of the humerus, immediately thumb has 2 phalanges (proximal and distal) proximal to the trochlea each other digit has 3 phalanges (proximal, middle, distal) B. FOREARM each hand has 14 phalanges in total - Consists of 2 bones that articulates both proximally and distally - Interosseous membrane between them ULNA medial side of the forearm (antebrachium) Proximally: articulates with both the trochlea of the humerus and the head of the radius, in the elbow joint Distally: articulates with the ulnar notch of the radius o Parts PREPARED AND EDITED BY: LIMBAUAN, J., LIVED, R., LOCQUIAO, C., LOPEZ, F., PADILLA, A., PADOLINA, J., PALAGANAS, B., PANG-AG, L  (006) SKELETAL SYSTEM DR. ERNESTO TAGORDA| 10/21/2020 Forms part of the acetabulum which receives ball- shaped head of femur o Parts ▪ Auricular surface – articulation with the sacrum ▪ Iliopectineal line – serves to divide the false from the true pelvis ISCHIUM ▪ Ischial Tuberosity – sets the distance for pubic arch – determine if pregnant woman can deliver normally – pubic arch distance for normal pregnancy delivery: approximately 10-12 cm PUBIS joins medially in pubic symphysis forms “obturator foramen” (large hole/opening) with ischium part of socket Figure 35. Anterior and Posterior view of the Left hand Right Hip bone (Lateral view) (Appendix 5) Pelvic Girdle (Anterior View) (Appendix 6) Right wrist and hand, anterior (palmar) view (Appendix 4) Ligaments (Appendix 7) XI. PELVIC GIRDLE - aka “Hip girdle” - Strongly attached to the axial skeleton (Sacrum) - More stable than pectoral (shoulder) girdle - Made up of the paired Hip Bones - “Bony Pelvis” is basin-like structure - consists of Hip bones (Right and Left side) + Axial Sacrum and Coccyx - Hipbone (OS COXAE) Has 3 separate bones in childhood which fuse: a. Ilium b. Ischium c. Pubis False pelvis: above the pelvic brim - supports the abdominal contents and, after the 3rd Figure 36. Pelvic Girdle month of pregnancy, helps support the gravid uterus True pelvis: below the pelvic brim ▪ Pelvic brim – separates true pelvis from false pelvis – draw line from sacrum up to pubic crest; corresponds to pelvic inlet/pelvic opening ▪ Pelvic outlet – boundaries are the coccyx posteriorly, the ischial tuberosities laterally, and the pubic arch anteriorly PELVIS AND CHILDBEARING – diamond shaped, with the ischiopubic rami and the symphysis pubis forming the boundaries in front and the TABLE 1. Male/Female Differences sacrotuberous ligaments and the coccyx forming the MALE FEMALE boundaries behind. Large & Heavy Light & Delicate ▪ Pelvic cavity – short, curved canal, with a shallow anterior Heart shaped pelvic inlet Oval wall and a much deeper posterior wall Narrow deep true pelvis Wide and shallow Narrow outlet Wide Less than 90 ° pubic arch More than 90 ° HIPBONE degree - acetabulum: deep sockets - greater sciatic notch: large notch separated from the Birth canals changes shape as baby descends: Head turns 1/4 lesser sciatic notch by the spine of the ischium - Higher: Pelvic inlet (brim) - side to side largest - sciatic notches are converted into the greater and lesser - Lower: Pelvic outlet - largest AP direction sciatic foramina by the sacrotuberous and sacrospinous ligaments ILIUM possesses the iliac crest runs between the anterior and posterior superior iliac spines PREPARED AND EDITED BY: LIMBAUAN, J., LIVED, R., LOCQUIAO, C., LOPEZ, F., PADILLA, A., PADOLINA, J., PALAGANAS, B., PANG-AG, L  (006) SKELETAL SYSTEM DR. ERNESTO TAGORDA| 10/21/2020 ▪ Medial and lateral epicondyles – distal part ▪ Adductor tubercle – continuous with the medial epicondyle PATELLA largest sesamoid bone o Parts ▪ Apex – connected to the tuberosity of the tibia by the ligamentum patellae ▪ Prepatellar bursa – separates the patella from the skin Sesamoid bone - bone derived from substance of tendon; forms part of knee joint contributing to joint stability Figure 37. Bones of the Pelvic Girdle (anterior) XII. LOWER EXTREMITY/LIMB Thigh - Femur Leg - Tibia - Fibula Foot (Trisegmental) - Tarsals Figure 38. Femur anterior and posterior - Metatarsals - Phalanges Right Femur (Anterior and Posterior) (Appendix 8) A. THIGH B. LEG FEMUR TIBIA largest longest and strongest bone in the body Shin bone; bulkier than fibula o Parts o Parts ▪ Head – fits in the acetabulum ▪ Lateral and medial condyles – articulate with the – fovea capitis – small depression for the lateral and medial condyles of the femur and the attachment of the ligament of the head intervening lateral and medial menisci ▪ Neck – weakest part – lateral condyle – possesses a small circular ▪ Greater and lesser trochanters – large eminences articular facet for the head of the fibula at the junction of the neck and the shaft ▪ Anterior and posterior intercondylar areas – ▪ Intertrochanteric line – connects the trochanters separate the upper articular surfaces of the tibial anteriorly, where the iliofemoral ligament attaches condyles ▪ Intertrochanteric crest – connects the trochanters ▪ Shaft – triangular in cross section posteriorly – anterior border – prominent, forms the shin ▪ Shaft – smooth and rounded on its anterior surface – tuberosity of the tibia – receives the attachment – linea aspera – posterior ridge of the ligamentum patellae ▪ Medial margins – medial supracondylar ridge to the – lateral border – attachment area of the adductor tubercle on the medial condyle interosseous membrane ▪ Lateral margin –lateral supracondylar ridge ▪ Medial malleolus – saddle-shaped articular ▪ Gluteal tuberosity – posterior surface of the shaft surface for the talus below the greater trochanter ▪ Popliteal surface – flat, triangular area on the FIBULA posterior surface slender lateral bone of the leg ▪ Intercondylar notch – separates the lateral and o Parts medial condyles posteriorly ▪ Head – possesses a styloid process and an ▪ Articular surface for the patella – joins the anterior articular surface for articulation with the lateral surfaces of the condyles condyle of the tibia. PREPARED AND EDITED BY: LIMBAUAN, J., LIVED, R., LOCQUIAO, C., LOPEZ, F., PADILLA, A., PADOLINA, J., PALAGANAS, B., PANG-AG, L  (006) SKELETAL SYSTEM DR. ERNESTO TAGORDA| 10/21/2020 ▪ Shaft – medial border – gives attachment to the – lateral surface of body – has a triangular interosseus membrane articular facet for articulation with the lateral ▪ Lateral malleolus – lower end of the fibula malleolus of the fibula – articular facet – for articulation with the lateral – medial surface of body – has a small, comma- aspect of the talus shaped articular facet for articulation with the – malleolar fossa – depression behind the medial malleolus of the tibia articular facet – posterior surface of body – marked by two small tubercles c. Navicular – gives attachment to the main part of the tibialis posterior tendon d. Cuboid – deep groove on the inferior lodges the tendon of the fibularis longus muscle e. Cuneiform – articulate proximally with the navicular bone and distally with the first three metatarsal bones – wedge shape contributes greatly to the formation and maintenance of the transverse arch of the foot “Tiger Cub Needs MILC” Tiger - Talus Cub - Calcaneus Needs - Navicular M - Medial Cuneiform I - Intermediate Cuneiform L - Lateral Cuneiform C - Cuboid - first metatarsal bone is large and strong and plays an important role in supporting the weight of the Figure 39. Anterior and Posterior view of Tibia and Fibula body Right lower leg (Anterior and Posterior) (Appendix 9) C. FOOT TARSUS composed of 7 tarsal bones a. Calcaneum – largest bone of the foot – posterior – forms the prominence of the heel; METATARSALS (5) gives attachment to the Achilles tendon – anterior – articulates with the cuboid bone – superior – dominated by the sulcus calcanei – roughened groove – inferior – has an anterior tubercle in the midline and a large medial and a smaller lateral tubercle at the junction of the inferior and posterior surfaces – medial – has sustentaculum tali – assists in the support of talus – lateral – has peroneal tubercle – separates the tendons of the fibularis longus and brevis muscles b. Talus – articulates above at the ankle joint with the tibia and fibula, below with the calcaneum, and in front with the navicular bone – head – has an oval convex articular surface for Figure 40. Lateral view of the Foot articulation with the navicular bone – upper neck surface – roughened and gives attachment to ligaments - fifth metatarsal has a prominent tubercle on its base that can – lower neck surface – has sulcus tali – deep be easily palpated along the lateral border of the foot groove – superior surface of body – articulates with the PHALANGES (14) distal end of the tibia - great toe is Hallux - Great toe: 2 Phalanges Others: 3 Phalanges PREPARED AND EDITED BY: LIMBAUAN, J., LIVED, R., LOCQUIAO, C., LOPEZ, F., PADILLA, A., PADOLINA, J., PALAGANAS, B., PANG-AG, L  (006) SKELETAL SYSTEM DR. ERNESTO TAGORDA| 10/21/2020 - Head is grooved on its inferior aspect by the medial 8. Among the borders of the scapula, which of the following is and lateral sesamoid bones in the tendons of the short and thin? flexor hallucis brevis. a. Superior border - Superior (Dorsal) and Inferior (Plantar) view of b. Medial Border the Right Foot c. Lateral Border - Lateral and Medial views of the Right Foot. (Appendix 10) 9. It is the narrow ridge running proximally from the medial epicondyle, forming the lower medial border of the humerus a. Medial supracondylar ridge XIII. TEST YOURSELF b. Lateral supracondylar ridge c. Inferior supracondylar ridge d. Superior supracondylar ridge 1. The following are parts of the temporal bone except: a. Squamous 10. This vertebrae is most prominent when the back is palpated b. Ethmoid Bone a. C1 c. Mastoid Process b. C3 d. Styloid Process c. C5 e. Zygomatic Process d. C7 2. This is the largest bone of the foot. a. Talus b. Calcaneum ANSWERS: 1.B 2. B 3. E 4. B 5. D 6. D 7. B 8. A 9. A 10. D c. Navicular d. Cuboid e. Cuneiform 3. It is the anterior, distal, roughened aspect of the coronoid XIV. REFERENCES process a. Olecranon Agur, A. and Moore, K. (2014). Clinically Oriented Anatomy. b. Coronoid process Lippincott Williams and Wilkins c. Trochlear notch d. Radial notch Snell, R. (2012). Clinical Anatomy by Regions. Lippincott e. Ulnar tuberosity Williams & Wilkins, a Wolters Kluwer business. 4. It lies below the inferior temporal line. a. PterionSuperior and Inferior Temporal Lines b. Temporal Fossa c. Infratemporal Fossa d. Pterygomaxillary Fissure e. Inferior Orbital Fissure 5. The bones contributing to the orbit surface includes the following, except: a. Frontal b. Maxillary c. Zygomatic Sphenoid d. Palatine 6. Among the 4 largest skull sutures, which of the following is located at the junction between the parietal and occipital bone? a. Coronal b. Sagittal c. Squamous d. Lambdoid 7. This is the abnormal curvature of the lumbar spine. a. Kyphosis b. Lordosis c. Scoliosis d. Levoscoliosis e. Dextroscoliosis PREPARED AND EDITED BY: LIMBAUAN, J., LIVED, R., LOCQUIAO, C., LOPEZ, F., PADILLA, A., PADOLINA, J., PALAGANAS, B., PANG-AG, L  (006) THE SKELETAL SYSTEM DR. ERNESTO TAGORDA JR. | 10/21/2020 XV. APPENDIX Appendix 1 PREPARED AND EDITED BY: LIMBAUAN, J., LIVED, R., LOCQUIAO, C., LOPEZ, F., PADILLA, A., PADOLINA, J., PALAGANAS, B., PANG-AG, L  (006) THE SKELETAL SYSTEM DR. ERNESTO TAGORDA JR. | 10/21/2020 Appendix 2 Appendix 3 PREPARED AND EDITED BY: LIMBAUAN, J., LIVED, R., LOCQUIAO, C., LOPEZ, F., PADILLA, A., PADOLINA, J., PALAGANAS, B., PANG-AG, L  (006) THE SKELETAL SYSTEM DR. ERNESTO TAGORDA JR. | 10/21/2020 Appendix 4 Appendix 5 PREPARED AND EDITED BY: LIMBAUAN, J., LIVED, R., LOCQUIAO, C., LOPEZ, F., PADILLA, A., PADOLINA, J., PALAGANAS, B., PANG-AG, L  (006) THE SKELETAL SYSTEM DR. ERNESTO TAGORDA JR. | 10/21/2020 Appendix 6 Appendix 7 PREPARED AND EDITED BY: LIMBAUAN, J., LIVED, R., LOCQUIAO, C., LOPEZ, F., PADILLA, A., PADOLINA, J., PALAGANAS, B., PANG-AG, L  (006) THE SKELETAL SYSTEM DR. ERNESTO TAGORDA JR. | 10/21/2020 Appendix 8 Appendix 9 PREPARED AND EDITED BY: LIMBAUAN, J., LIVED, R., LOCQUIAO, C., LOPEZ, F., PADILLA, A., PADOLINA, J., PALAGANAS, B., PANG-AG, L  (006) THE SKELETAL SYSTEM DR. ERNESTO TAGORDA JR. | 10/21/2020 Appendix 10 Appendix 11 PREPARED AND EDITED BY: LIMBAUAN, J., LIVED, R., LOCQUIAO, C., LOPEZ, F., PADILLA, A., PADOLINA, J., PALAGANAS, B., PANG-AG, L  (006) THE SKELETAL SYSTEM DR. ERNESTO TAGORDA JR. | 10/21/2020 Appendix 12 PREPARED AND EDITED BY: LIMBAUAN, J., LIVED, R., LOCQUIAO, C., LOPEZ, F., PADILLA, A., PADOLINA, J., PALAGANAS, B., PANG-AG, L  (006) THE SKELETAL SYSTEM DR. ERNESTO TAGORDA JR. | 10/21/2020 Appendix 13 Appendix 14 PREPARED AND EDITED BY: LIMBAUAN, J., LIVED, R., LOCQUIAO, C., LOPEZ, F., PADILLA, A., PADOLINA, J., PALAGANAS, B., PANG-AG, L  (006) THE SKELETAL SYSTEM DR. ERNESTO TAGORDA JR. | 10/21/2020 Appendix 15 PREPARED AND EDITED BY: LIMBAUAN, J., LIVED, R., LOCQUIAO, C., LOPEZ, F., PADILLA, A., PADOLINA, J., PALAGANAS, B., PANG-AG, L