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ANP1106 Final Notes

Human Anatomy and Physiology II (University of Ottawa)

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 Table of Contents

Section 1: Superficial Layers

Anatomical Terms …………………………………………………………………………Page 1

Integumentary System……………………………………………………………………...Page 5

Section 2: Support of the Body

Anatomy of the Skeletal System ………………………………………………………….. Page 22

Physiology of the Skeletal System ……………………………………………………….. Page 38

Anatomy and Physiology of Joints………………………………………………………… Page 71

Section 3: Movement

Anatomy of the Muscular System…………………………………………………………. Page

Section 4: Communication

Anatomy of the Nervous System…………………………………………………………... Page

Physiology of the Nervous System………………………………………………………… Page

Anatomical terms: Pages 12-20

Integumentary System: Chapter 5

DISCLAIMER: All credit goes to Pearson Textbook and Dr. Jacquelin Carnegie for content and information. I
merely organized, highlighted and put together the content for this note booklet.

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 Anatomical Terminology
Orientation and Directional Terms
- Allow observers to explain where one body structure is in relation to another.
- Anatomical terms make words less ambiguous.
• Superior (cranial) → Towards the head end or upper part of a structure/body; above.
• Inferior (caudal) → Away from head to a lower part; below
• Anterior (ventral) → Toward the front; in front of.
• Posterior (dorsal) → Toward the back; behind.
• Medial → Towards the midline; on the inner side of.
• Lateral → Away from the midline; on the outer side of.
• Intermediate → Between a more medial and lateral structure.
• Proximal → Closer to the origin of the body part or point of attachment of a
limb to the body trunk.
• Distal → Farther from the origin of a body part or the point of attachment of a
limb to the body trunk.
• Superficial (external) → Towards or at the body surface.
• Deep (internal) → Away from the body surface; internal.

Regional Terms
• The two fundamental divisions of the human body:
• Axial parts;
• Appendicular parts.
• Axial part consists of:
• Head;
• Neck;
• Trunk.
- Appendicular consists of the appendages or limbs.

Body Planes and Sections

- The most frequently used body planes are sagittal, frontal, and transverse planes.
- They lie at right angles to one another.
- A section is named for the plane along which it is cut.
- I.e. A Sagittal plane produces a sagittal section.
• Sagittal plane: A vertical plane that divides the body into right and left parts.
○ A sagittal exactly along the midline is the Median Plane (midsagittal).
○ All other sagittal planes, offset from the midline, are called Parasagittal Planes.
• Frontal plane: Divide the body into anterior and posterior parts (also called the coronal plane).
• Transverse (Horizontal Plane): Runs horizontally from right to left, dividing the body into superior and
inferior parts.
○ Many transverse planes exist at all possible levels from head to toe.
○ A transverse section can also be called a cross section.
• Oblique sections: Cuts made diagonally between the horizontal and vertical planes.

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 ○ Seldom used due to difficulty of interpretation.

(a) Median (midsagittal) plane (b) Frontal (coronal) plane (c) Transverse plane

Body Cavities
- The internal body cavities (dorsal and ventral) are closed to the outside and provide varying degrees of
protections to the organs within them.
- The two cavities differ in their mode of embryonic development and lying.
• Dorsal Body Cavity: Protects the fragile nervous system organs, having two subdivisions.
○ Cranial cavity → In the skull, encases the brain.
○ Vertebral (spinal) cavity → Runs within the bony vertebral column, enclosing the spinal cord (a
continuation of the brain).
■ The cranial and spinal cavities are continuous with one another.
■ Both the brain and spinal cord are covered by membranes called the meninges.
■ Ventral Body Cavity: Anterior and larger of the body cavities, containing two subdivisions.
○ Thoracic cavity → Surrounded by the ribs and muscles of the chest, which is divided into the
lateral pleural cavities (each enveloping a lung) and the medial mediastinum.
■ The mediastinum contains the central pericardial cavity, enclosing the heart and
surrounding the remaining thoracic organs (esophagus, trachea etc…).
■ The diaphragm (dome-shaped muscle important in breathing) separates the thoracic
cavity from its inferior abdominopelvic cavity.
○ Abdominopelvic cavity → Contains the superior portion, abdominal cavity containing the stomach,
intestines, spleen, and liver (etc).
■ The inferior portion, the pelvic cavity, lies in the bony pelvis containing the urinary
bladder, reproductive organs and rectum.
■ The abdominal and pelvic cavities are not aligned and the pelvis tips away from
the perpendicular abdominal cavity.
■ No membrane separates the pelvic cavity from the abdominal cavity.
■ The abdominal cavity is the least protected of the cavities.

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Abdominopelvic Regions and Quadrants
- The abdominopelvic cavity is large and contains several organs so we use schemes to remember it.
- The scheme uses a transverse and median plane passing through the umbilicus at right angles.
- Four quadrants are named according to their positions from the subject’s viewpoint:
• Right upper quadrant (RUQ);
• Left upper quadrant (LUQ);
• Right lower quadrant (RLQ);
• Left lower quadrant (LLQ).
• Another division method uses the two transverse and two
parasagittal planes dividing the abdominal cavity into
nine regions:
• Umbilical region → The centermost region
deep to and surrounding the umbilicus (navel).
• Epigastric region → Located superiorly to the
umbilical region.
• Pubic (hypogastric) region → Located inferior
to the umbilical region.
• Right and left inguinal (iliac) regions → Are
located lateral to the hypogastric region.
• Right and left lateral (lumbar) regions → Lie
lateral to the umbilical region.
• Right and left hypochondriac regions → Lie
lateral to the epigastric region and deep to the
ribs.
- Other body cavities are smaller, mostly found in the head
and are open to the body exterior:
• Oral and digestive cavities → The mouth, teeth and tongue.
○ Continuous with the cavity of the digestive organs, opens to the body exterior at the anus.
• Nasal cavity → Within and posterior to the nose, part of the respiratory system.
• Orbital cavities → In the skull house the eyes and present them in an anterior position.
• Middle ear cavities → Cavities in the skull lie just medial to the eardrum and contain bones that
transmit sound vibrations.
• Synovial cavities → Joint cavities that are enclosed within fibrous capsules that surround freely
moveable joints of the body (elbow and knee joints).
○ Membranes lining synovial cavities secrete a lubricating fluid that reduces friction as the
bones move across one another.

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 Ascending colon of large intestine Small intestine

Liver Diaphragm
Spleen
Gallbladder Stomach

Transverse colon of
large intestine
Descending colon
of large intestine
Cecum
Initial part of

Appendix sigmoid colon

Urinary bladder

(a) Nine regions delineated by four planes (b| Anterior view of the nine regions showing the superficial organ

Back to Top

The Integumentary System

Two Layers of Skin
- The Integumentary system consists of skin and its derivatives (sweat & oil glands, hair, nails).
- It takes constant punishment from an external agent.
- Without skin, the body would fall prey to bacteria and perish from water and heat loss.
- The skin is composed of two distinct layers:
• Epidermis → Composed of epithelial cells, the outermost protective shield of the body.
• Dermis → The bulk of the skin, tough, leathery layer composed of dense connective tissue which
is vascularized.
○ Nutrients reach the epidermis by diffusing through the tissue fluid from blood vessels in the

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 dermis.
- The skin also contains:
• Subcutaneous tissue: → Lies deep to the skin, superficial to the connective tissue layered over the
skeletal muscles.
○ Also known as the hypodermis or superficial fascia.
○ Not part of the skin, but shares protective functions.
○ Contains mostly adipose tissue with some areolar connective tissue.
■ Stores fat acting as a shock absorber and insulator.

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 Anchors the skin to underlying structures (muscle).
○ Skin slides over the structure, protecting us from glancing blows.

Sweat pore

Epldermts-
Epidermal
ridge
Dermal papilla

Arrector pili muscle

Sebaceous (oil) g'and

Dennis - Sweat glard duct

Merocrine sweat gland

Vein
Artery

Subcutaneous-
layer

tissue

Hair Sensory Areolar Sensory

foiiicte receptors connective tissue nerve fiber
Eotoon; httpiy/ www.Bccesamettitioe.coin
Copyright @ The McGraw-Hill Com pa nj as, Inc. All rights reserved.

The Epidermis
- The Epidermis consists of four distinct cell types (four or five layers):
• Keratinocytes → Produce keratin, the fibrous protein that helps give the epidermis its protective
properties.
○ Tied together by desmosomes for strength and tight junctions to hinder movement of water
between cells.
○ Arise in the Stratum Basale (deepest part of the epidermis).
■ Undergo continuous mitosis in response to epidermal growth factor (peptide
produced by cells throughout the body).
■ Pushed upward by the mitosis, filling with keratin.
○ Keratinocytes are dead at the skin surface, flat sacs of keratin (keratinized).
• Melanocytes → Spider-shaped epithelial cells synthesizing melanin in the deepest layers of the
epidermis (stratum basale).
○ Melanin is made in membrane-bound granules (melanosomes) and transferred through
the cell processes to nearby keratinocytes.
○ Basal keratinocytes contain more melanin than melanocytes themselves.

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 ○ Melanin clusters of the superficial side of the keratinocyte nuclear forming a shield
protecting the nucleus against ultraviolet (UV) radiation.
• Dendritic Cells (Langerhans cells) → Star shaped cells that arise from bone marrow and migrate
to the epidermis.
○ Macrophages that ingest foreign substances and activate the immune system.
○ Processes extend among the keratinocytes, forming a continuous network.
• Tactile Epithelial Cells (Merkel cells) → Present at the epidermal-dermal junction ○ Spiky
hemispheres that are intimately associated with sensory nerve endings. ○ Functions as a
sensory receptor for touch.

Fig. 5.2: Four major epidermal

layers of “thin” skin

-Stratum corneum-----------------------------------------
Most superficial layer; 20-30 layers of dead cells,
essentially flat membranous sacs filled with keratin.
Glycolipids in extracellular space.

- stratum granuiosum---------------------------------------------
Typically five layers of flattened cells, organelles _
deteriorating; c^oplasm full of lamellar granules — (release
Iipids) and keratohyaline granules.
-Stratum spinosum------------------------------------------------
Several layers of keratinocytes unified by desmosomes.
Ceils contain thick bundles of intermediate filaments made
of pre-keratin.
-Stratum basale-----------------------------------------------------
Deepest epidermal layer; one row of actively mitotic stem
cells; some newly formed cells become part of the more
superficial layers. See occasional melanocytes and
dendritic cells.

Dermis

DesmosomesMelanocyte Dendritic—i
cell
(bt

Epidermal Layers
- Epidermal thickness is determined if skin is thick or thin.
- Thick skin (areas of abrasion) cover the palms, fingertips, and soles of the feet.
- The epidermis consists of five layers.
- The only skin with STRATUM LUCIDUM.
- Thin skin (remainder of the body), the stratum lucidum appears to be absent.
- Epidermal Stratum (deep-to-superficial):
• Stratum Basale/Germinativum (Basal/Germinating Layer) → The deepest epidermal layer
consisting of a single row of stem cells (young keratinocytes).
○ The mitotic nuclei layer reflects the rapid division of cells.

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 ■ Daughter cells are pushed into the cell layer above (apical upward) to begin
specialization into mature keratinocytes.
■ Other daughter cells remain in the basal layer to produce new cells.
• Stratum Spinosum (Prickly Layer) → Several cell layers thick, named according to the spinelike
extensions of keratinocytes (not living cells).
○ The extensions are artifacts created during tissue preparations, the cells shrink while holding
onto desmosomes.
○ Contains thick bundles of intermediate filaments (tension-resisting proteins) called pre-
keratin.
■ Resist tension in the cell and are anchored to desmosomes.
○ This cell layer contains dendritic cells.
• Stratum Granulosum (Granular Layer) → The thin stratum granulosum consists of five cell
layers of keratinocyte appearance changes through keratinization.
○ The cells flatten, their nuclei and organelles disintegrate, and they accumulate two types of
granules:
■ Keratohyalin granules: Help to form keratin in upper layers.
■ Lamellar granules: Contain water-resistant glycolipids that are secreted into the
extracellular space.
• With tight junctions, the glycolipid helps slow water loss across the
epidermis.
○ Proteins within the keratinocyte and lipids deposited outside make the cells tough and water
resistant.
■ Like all epithelia, the epidermis relies on capillaries in the underlying connective
tissue (basement membrane – diffusion – or dermis – vascularized).
• Stratum Lucidum (Clear Layer) → Found only in thick skin, the stratum lucidum is visible as a
thin translucent band of cells above the granular layer.
○ Consists of a row of flat, dead keratinocytes.
○ The cells are identical to those at the bottom of the stratum corneum.
• Stratum Corneum (Horny Layer) → A layer of flattened anucleate cells, the outermost
epidermal layer consisting of 20-30 cell layers, ¾ of the epidermal thickness.
○ Keratin: consists of the pre-keratin intermediate filaments embedded in the
keratohyalin granules.
■ Keratin and proteins accumulate inside the plasma membrane of the cells,
protecting the skin against abrasion and penetration.

The Dermis
- Dermis → Made up of strong, flexible connective tissue.
- Contains:
• Macrophages;
• Fibroblasts;
• Mast cells;
• White blood cells.
- The dermis is a semifluid matrix, embedded with fibers that bind the body together.

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- The dermis has two layers: Papillary dermis and Reticular dermis.

• Papillary Dermis: The thin superficial dermis is areolar connective tissue in which fine interlacing collagen
and elastic fibers form a loosely woven mat with small blood vessels.
○ The looseness allows phagocytes and WBCs to wander the area for bacteria that have penetrated
the skin.
○ Dermal papillae → Projections from the dermis surface that overlay the epidermis.
• Many contain capillary loops.
• Others house free nerve endings (nociceptors) and touch receptors (tactile corpuscles –
Meissner’s corpuscles).
• In thick skin, papillae lie atop mounds called dermal ridges.
• Dermal ridges cause the overlying epidermis to form epidermal ridges.
○ Friction ridges → The collective term for epidermal and dermal ridges that may enhance our ability
to grip different surfaces.
■ Contribute to the sense of touch by enhancing vibrations detected by lamellar corpuscles
(receptors) in the dermis.
■ Friction ridge patterns are genetically determined and unique.
• Sweat pores open along their crests, leaving identifying film of sweat called
fingerprints.
• Reticular Dermis: The deeper dermis accounts for 80% of thickness of the dermis consisting of dense
irregular connective tissue.
○ Blood vessels nourish this layer (the dermal vascular plexus), lie between this layer and the
subcutaneous tissue.
■ Extracellular matrix of reticular dermis contains thick bundles of interlacing collagen
fibers.
■ The reticular dermis named for its network of collagen fibers, there is no special
abundance of reticular fibers
○ Collagen fibers run in various planes parallel to the skin surface.
■ Separations between the collagen bundles form cleavage (tension) lines.
■ Lines tend to run longitudinally in the skin of the limbs and in circular patterns.
■ Incisions made parallel to the cleavage lines heal faster.
■ Collagen fibers give skin strength and resilience to prevent minor jabs from penetrating
the skin.
○ Flexure lines → Dermal folds that occur at or near joints, where the dermis is tightly secured to
deeper structures.
■ The skin cannot slide to accommodate joint movement, so the dermis folds and deep skin
creases form.
○ Stretch marks: Extreme stretching of the skin (breaking collagen fibers) that tear the dermis,
leaving silvery white scars (striae).
○ Blister: Short-term but acute trauma (burn or friction) causes a fluid-filled pocket that separates the
epidermal and dermal layers.

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 Epidermal ridges

Dermal papillae

Blood vessels

The spatial relationship between epidermal ridges and

dermal papillae

Epidermis

Epidermal ridge
Dermal papilla Dermis
(c) Flexure lines of the hand
Substances and Pigment of the Skin
- Melanin → A polymer made of an
amino acid called tyrosine forms a
range in color from reddish yellow to brownish black.

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 - Melanin synthesis depends on an enzyme in melanocytes called tyrosinase.
- Melanin is transported from melanocytes to the basal keratinocytes.
- Lysosomes break down the melanosomes, so melanin pigment is found only in the deeper layers
of the epidermis.
- Dark skin is found in persons closer to the equator where greater protection from the sun
is needed.
- All humans have the same relative number of melanocytes, differences in skin colour reflect the
kind and amount of melanin made and retained.
- Melanocytes of black individuals produce more and darker melanosomes than those of
fair-skinned individuals.
- The keratinocytes also retain melanin longer.
- Freckles and moles are local accumulations of melanin.
- Keratinocytes secrete chemicals to stimulate melanocytes.
- Sun exposure causes a substantial melanin buildup (TAN), which protects the DNA of
skin cells from UV radiation by absorbing the rays.
- The initial signal for speeding up melanin synthesis seems to be a faster repair rate of
DNA suffering photodamage.
- In all but the darkest-skinned people, the defensive responses result in visibly
darker skin (tanning).
- Excessive sun exposure:
• Damages skin causing elastic fibers to clump resulting in leathery skin;
• Temporarily depresses the immune system;
• Can alter DNA of skin cells leading to skin cancer.
○ Basal cell and squamous cell cancers occur in all skin types.
- Carotene → A yellow to orange pigment found in carrots that accumulates in the stratum corneum and in
the fat of the subcutaneous tissue.
- Can be converted to vitamin A, which is essential for vision and epidermal health.
- Hemoglobin → Contributes to the pinkish hue of fair skin reflecting the crimson colour of the oxygenated
hemoglobin as RBCs circulate through dermal capillaries.
- Light-skinned individuals have smaller amounts of melanin, the epidermis is nearly transparent and
allows hemoglobin’s color to show through.
- Skin appendages that all derive from epithelial cells extending into the dermis include:
• Hair and hair follicles;
• Nail and nail beds;
• Sweat glands and sebaceous (oil) glands.
Skin Colour and Health
• Blueness (cyanosis) → When hemoglobin is poorly oxygenated, the skin takes on a bluish-gray tint,
especially in mucous membranes and nail bed.
○ A sign of respiratory or cardiovascular problems.
• Pallor → Blood may be diverted from the skin to internal organs.
○ Low blood pressure and anemia (decreased ability of blood to carry oxygen) may also cause pallor in
addition to emotional stress.
• Redness (erythema) → Reddened skin may indicate embarrassment (blushing), fever, inflammation, or

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 allergy.
• Yellowness → When yellow pigment from the liver (bilirubin) accumulates due to liver deterioration,
results in yellow discoloration most obvious in the sclera of the eyes.
• Red/purple/green/yellow marks → Bruises, ecchymoses, or hematomas, occur when blood vessels are
damaged and leak blood into the surrounding tissue.
○ As the body breaks down the blood, the colour changes.
○ The size, color and shape of ecchymoses is important.
• Brown or black <necklace= bruises → Dark areas of the axillae and around the neck are usually
hyperpigmentation which may be a sign of insulin resistance or elevated blood glucose.

Hair and its Components.

• The main function of hair consists of:
- Sensing insects on the skin before they bite or sting;
- Guards against physical head trauma, heat loss, and sunlight.
- Eyelashes shield the eyes;
- Nose hairs filter large particles.
- Hairs (pili) → Are flexible strands produced by hair follicles and consist largely of dead, keratinized cells
full of hard keratin.
- Its advantages include:
1) It is tougher and more durable;
2) Its individual cells do not flake off.

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The hair follicle is composed of:
• Root → The part embedded in the skin.
• Shaft → The part that projects above the skin’s surface.
○ If the shaft is flat and ribbonlike in cross section, the hair is kinky.
○ If the shelf is oval, the hair is silky and wavy.
○ If the shaft is perfectly round, the hair is straight and tends to be coarse.
Hair has three concentric layers of keratinized cells:
• The medulla: The central core, consisting of large cells and air spaces.
FOLLICLE
○ The only part of the hair containing soft keratin, absent SHAPE DETERMINES
in fine hairs.
• The cortex: A bulky layer surrounding the medulla, consists of severalHAIR layers ofTEXTURE
flattened cells.
• The cuticle: A single layer of cells overlapping one another like shingles.
○ Helps separate neighboring hairs so the hair does not mat.
○ The cuticle is heavily keratinized, providing strength and keeping the inner layers
compacted. STRAIGHT WAW CURLY SPIRAL COILED
○ The cuticle tends to wear away at the tip of the hair shaft causing split ends.
Hair pigment is made by melanocytes at the base of the follicle and transferred to cortical cells.
FOLLICLE SIZE DETERMINES
- Different concentrations of melanin produce hair color from blond to black.
- Red hair is colored by a pigment called pheomelanin. HAIR THICKNESS
- When melanin production decreases and air bubbles replace melanin in the hair shaft, hair
turns gray or white.

THICK THIN THICK THIN

What are split ends?

Healthy Cuticle Layer Raised Cuticle Layer Damaged Cuticle Layer Missing Scales

IVftaf happens when hair is turning gray or white?

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Structure of a Hair Follicle
- Hair follicle → Fold down from the epidermal surface into the dermis (and sometimes the subcutaneous
tissue).
- The end of the follicle expands to form a hair bulb.
- Hair follicle receptor (root hair plexus) → A knot of sensory nerve endings wrapping around each hair
bulb.
- Bending the hair stimulates the endings.
- Our hairs act as sensitive touch receptors.
- Papilla of a hair follicle (hair papilla) → A dermal papilla that protrudes into the hair bulb.
- Inside it contains a knot of capillaries that supplies nutrients to the growing hair and signals it
to grow.
- If hair papilla is destroyed by trauma, the follicle stops producing hair permanently.
• From external to internal, the wall of the hair follicle is composed of:
• Peripheral connective tissue sheath (fibrous sheath): Connective tissue sheath derived from the
dermis forms the external layer of the follicle.
• Glassy membrane: At the junction of the fibrous sheath and epithelial root sheath, it is the
basement membrane of the follicle epithelium.
• Epithelial root sheath: Derived from the epidermis, it contains the:
○ External root sheath (continuation of the epidermis);
○ Internal root sheath (derived from the matrix cells).
- The hair matrix is made up of dividing cells that lie immediately adjacent to the hair papilla.
- The matrix produces new hair cells, older parts of the hair are pushed upwards.
- Fused cells become keratinized and die.
- Hair matrix cells are replenished by stem cells that migrate down to the bulb from a
region closer to the skin’s surface (the hair bulge).
- Arrector pili muscle → Associated with each hair follicle is a bundle of smooth muscle which approaches
the follicle at a slight angel.
- Its contraction pulls the hair follicle upright and dimples the skin’s surface.
- The arrector pili contractions force sebum out of the hair follicles to the surface of the skin where
it acts as a skin lubricant.

Hair shaft

Arrector pili
Sebaceous Fig. 5.6C
gland
Hair root—
Hair bulb— Follicle wall
• Connective tissue root sheath
• Glassy membrane
• External epithelial root sheath
• Internal epithelial root sheath
Hair root
• Cuticle
• Cortex
• Medulla
Hair matrix
Hair papilla
Melanocyte

Subcutaneous adipose tissue

(c) Diagram of a longitudinal view of the expanded hair bulb of the follicle,
which encloses the matrix

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Hair Growth and Loss
- Hair is classified as either vellus or terminal:
- Vellus hair: Body hair of children and adult females is pale and fine.
- Terminal hair: Coarser, longer hair of the eyebrows, eyelashes and scalp.
- Terminal hairs appear in the axillary and pubic regions of both sexes during puberty.
- Terminal hairs grow in response to stimulating effects of androgens (like testosterone).
- Hirsutism: When a woman develops coarse terminal hairs in a masculine distribution that could
signal an underlying medical issue
- In polycystic ovary syndrome, the ovaries secrete large amounts of androgens,
stimulating hair growth.
- Hair grows about 2 mm per week, varying with body regions, sex, and age.
- It is affected by nutrition and hormones.
- The follicles go through growth cycles:
- An active growth phase is followed by a resting phase (the follicle shrinks).
- During the active phase: Newly growing hair pushes out the old hair, which is shed
and no longer elongates.
- In the scalp: Follicles stay active for an average of four years.
- In the eyebrows: Follicles are active for a few months so the eyebrows don’t grow long.
- Cycles of adjacent hair follicles are not synchronized.
- Baldness → When hair is no longer replaced as quickly as they shed, the hair thins.
- Coarse terminal hairs are replaced by vellus hairs and hair becomes wispy.
- Male pattern baldness → Gender-influenced condition that changes the response of the hair follicles to
androgens making them respond with shorter growth cycles.
- The cycles become so short that hairs never even emerge from the follicles.
- Drugs used to treat MPB either inhibit production of androgens or increase blood flow.
- Alopecia → Patchy baldness that may signal an autoimmune disorder.
Nails and Disorders
- Nails → Scale-like modifications of the epidermis containing hard keratin.
- Components of a nail:
• Proximal root (embedded in the skin);
• Nail plate or body/nail folds (visible attached portion);
• Free edge (hanging off the end).
• The nail apparatus consists of a dead product, the nail plate, and four specialized epithelia:
• The nail matrix → Thickened proximal portion of the nail bed responsible for nail growth and elongation.
○ Nail cells produced by the matrix become heavily keratinized.
○ The nail slides distally over the nail bed.
• The nail bed → The bed of epidermis upon which the nail rests.
○ Contains only the deeper layers of the epidermis, because the nail corresponds to the superficial
keratinized layers.
• Proximal nail fold → Proximal and lateral borders of the nail overlapped by skin folds.
○ The proximal nail fold projects onto the nail body as the cuticle or eponychium.
• Hyponychium → The thickened region beneath the free edge of the nail where dirt and debris accumulate.
○ Secures the free edge of the nail plate at the tip of the finger/toe.
- Lunula (Lunule) → The crescent shaped part of your nail matrix, the tissue just beneath your nail, containing nerves,
lymph, and blood vessels.
- Nail appearance helps diagnose conditions:
• Yellow-tinged nails → Fungal infections, respiratory disorder, thyroid gland disorder.
• Thickened and Yellow-tinged → A fungal infection.
• Spoon nails → Possible iron deficiency.
• Beau’s lines → Severe illness like diabetes, heart attack, cancer chemotherapy, or malnutrition (sporadic
stoppage of matrix growth).

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 Proximal nail told Lunula

Source: Wolff K, Goldsmith LA, Katz SI, Qilchrest BA, Paller AS, Leffell DJ:
F/izp^irickDermato/ogy ir> Generaf , 7th Edition: http://www.accessmedicine.com
Copyright ® The McGraw-Hill Companies, Inc. All rights reserved.

Types of Epithelial Glands

- Sweat glands (sudoriferous glands) → Distributed over the entire skin surface except the nipples and parts of the
external genitalia, composed of eccrine and apocrine glands.
- The secretory cells are associated with myoepithelial cells that contract when stimulated by the nervous
system.
- Contraction forces sweat into and through the gland’s duct system.
- Sweat is regulated by the autonomic nervous system.
- Eccrine Sweat Glands → Also called merocrine sweat glands, are numerous and abundant on palms, feet, and
forehead (3 million per person).
- Simple coiled, tubular glands.
- Secretory part lies coiled in the dermis, and the duct extends to open in the funnel-shaped pore at the skin’s
surface.
- Eccrine gland secretion is a hypotonic filtrate of the blood that paasses through the secretory cells
of the sweat glands and is released by exocytosis.

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 - Eccrine sweat glands contain (acidic at pH between 4 and 6):
• 99% water with salts (NaCl, vitamin C, antibodies);
• Traces of metabolic wastes (urea, uric acid, ammonia);
• Microbe-killing peptide (dermcidin).
- Heat-induced sweating begins on the forehead and spreads
inferiorly.
- Emotionally induced sweating begins on the palms, soles, and
axillae.
Apocrine Sweat Glands → largely confined to the axillary (armpits) and
anogenital areas (merocrine glands – release by exocytosis like eccrine
glands).
- Larger than eccrine glands and lie deeper in the dermis or
subcutaneous tissue, their ducts empty into hair follicles.
- Secretion contains:
• Basic components of true sweat;
• Fatty substances and proteins.
- Secretion is viscous, milky and yellowish (generally odorless, but sticky when bacteria
on the skin decompose its organic molecules).
- Apocrine glands begin functioning during puberty because of androgens and play
little role in maintaining constant body temperature.
- Apocrine glands may play a role in sexual scent, and may act as pheromones.
- Activated by the Somatic Nervous System in times of stress.
Ceruminous Glands → Modified apocrine glands found in the lining of the ear canal.
- Secretions mix with sebum produced by sebaceous glands to form earwax (cerumen).
- Deters insects and blocks entry of foreign materials into the external ear canal.
Mammary glands → Specialized apocrine gland that secretes milk.
Sebaceous Glands → Oil glands that are branched alveolar glands found all over the body except in thick skin
of the palms and feet.
- Secrete an oily substance called sebum.
- The central cells accumulate oily lipids until they become so engorged that they burst (holocrine
glands).
- Accumulated lipids and cell fragments constitute sebum, the oily secretion.
- Sebaceous glands develop as outgrowths of hair follicles and ma/or
fjiuscie
secrete into the hair follicle or pore on the skin surface.
- Arrector pili contractions aid with forcing the sebum Pectoral fat pad
Suspensory
out on the surface. ligaments

- Sebum softens and lubricates the hair and skin to prevent Lobules of two
lobes of the
water loss, brittleness, and bacterial infections (bactericidal). mammary glands
Lactiferous duct
- Increase in activity during puberty.
Areola
Hippie

Lactiferous sinus

□ The mammary glands of the left breast

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 Table 5.1 Summary of Cutaneous Glands
ECCRINE SWEAT GLANDS APOCRINE SWEAT GLANDS SEBACEOUS GLANDS

■ Lubricate skin and hair

Functions
• Temperature control May act as sexual scent glands
■ Help prevent water loss
> Some antibacterial ■ Antibacterial properties
properties
Filtrate of blood plasma with added proteins
Type of Hypotonic filtrate of blood plasma Sebum (an oily secretion)
Secretion arid fatty substances
Method of
Secretion Merocrine (exocytosis) Merocrine (exocytosis) Holocrine

Skin surface Usually upper part of hair follicle; rarely, Usually upper part of hair follicle;
Secretion
skin surface sometimes, skin surface
Exits Duct At
Everywhere, but especially palms, soles,
Body Location Mostly axillary and anogenital regions Everywhere except palms and soles
forehead
e 7019 PBOfson Gducahon, Inc

Functions of the Skin:

The Skin is a Barrier
■ Protection → The skin is an organ system exposed to microorganisms, abrasions, temperature and constitutes at
least three types of barriers:
○ Chemical Barriers → Includes skin secretions and melanin.
■ The low pH of skin secretions (acid mantle) retards bacteria multiplication.
■ Dermcidin in sweat and bactericidal substances in sebum kill bacteria.
■ Skin secretes antibiotics called defensins.
■ Wounded skin releases cathelicidins that prevent infection by group A streptococcus bacteria.
■ Melanin provides a chemical pigment shield against UV damage.
○ Physical Barriers → Barrier to trauma and bacterial infection with keratinized cells and the acidic mantle
warding off bacterial invasion.
■ The water-resistant glycolipids of the epidermis block diffusion of water and
water-soluble substances between cells, preventing water loss and entry.
■ Permeable to: lipid-soluble substances, oleoresins (poison ivy/oak), organic
solvents (acetone), heavy metals (lead), drugs, and penetration enhancers.

○ Biological Barriers → Include dendritic cells of the epidermis and macrophages.

■ Dendritic cells: Part of the immune system, they engulf foregin materials that have penetrated
the epidermis.
• Once they capture prey, they migrate to the nearest lymph node and present to the
immune cells, triggering the immune response.

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 ■ Dermal macrophages: Dispose of viruses and bacteria that penetrate the epidermis, they can
initiate an immune response.

Body Temperature Regulation

- Under resting conditions (environmental temperature below 31-32ºC), sweat glands secrete 500 mL or 0.5 L of
sweat daily.
- 0.5 L of sweat is insensible perspiration (unnoticed).
- As body temperature rises, the nervous system dilates dermal blood vessels and the sweat glands go into
vigorous secretory activity.
- Sweat can account for a loss of up to 12 L of body water daily.
- Sensible perspiration often evaporates and dissipates body heat to efficiently cool the body,
preventing overheating.
- When the external environment is cold, dermal blood vessels constrict causing the warm blood to bypass the
skin temporarily and allow skin temperature to drop.
- Constriction slows passive heat loss, conserving body heat.

Cutaneous Sensation
- The skin is innervated with cutaneous sensory receptors called exteroceptors.
- They respond to stimuli arising outside of the body:
• Tactile (Meissner’s corpuscles), in the dermal papillae, and the tactile epithelial cells with
sensory nerve endings.
○ Allow us to become aware of a caress and feel our clothing against our skin (tactile
information).
• Lamellar (Pacinian) corpuscles, deep in the dermis/subcutaneous: Alert us to bumps or
contacts involving deep pressure.
• Hair follicle receptors: Report on wind blowing through our hair and tugs.
• Free nerve endings: Sense painful stimuli like irritating chemicals, extreme heat or cold, and
many other sensations.

Metabolic Functions
- Modified cholesterol molecules are converted to vitamin D precursor when sunlight hits skin.
- The precursor is transported via blood to other body areas and converted to vitamin D.
- Vitamin D is required in calcium metabolism, calcium cannot be absorbed without it.
- The epidermis makes chemical conversions that supplement those of the liver.
- Keratinocyte enzymes can:
• <Disarm= cancer-causing chemicals that penetrate the epidermis.
• Activate steroid hormones, transport cortisone to hydrocortisone.
- Skin cells also make important proteins like collagenase, aids in natural turnover of collagen.

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Blood Reservoir
- Dermal vascular supply holds about 5% of the body’s entire blood volume.
- When other organs need a greater supply of blood, the nervous system constricts the dermal blood vessels.
- Constriction of dermal blood vessels shunts blood into the general circulation.
- The blood becomes available to muscles and other organs.

Excretion
- Sweat eliminates a limited amount of nitrogen-containing wastes (ammonia, urea, uric acid).
- Most are excreted through urine.
- Profuse sweating is an important avenue for water and salt loss.

Burns and their Consequences

- Burns → Tissue damage inflicted by intense heat, electricity, radiation, chemicals, which kill cells in the affected
area.
- Immediate threat to life resulting from severe burns is catastrophic loss of bodily fluids containing proteins
and electrolytes.
- Dehydration and electrolyte imbalance lead to renal failure and circulatory shock.
- The lost fluids must be replaced by administering intravenous fluids.
- Partial thickness burns:
- First-degree burns → Only the epidermis is damaged, there is localized redness, swelling and pain but tends
to heal in two to three days.
- Second-degree burns → Injure the epidermis and upper region of the dermis, blisters appear between the
epidermis and dermis.
- The burned area is red and painful, but skin regeneration occurs with little or no scarring within three
to four weeks.
- Full thickness burns:
- Third-degree burns → Involving the entire thickness of the skin, the burned area appears gray-white, cherry
red, or blackened.
- There is little or no edema.
- The burned area is not painful because the nerve endings are damaged.
- Skin grafting is advised.
Burns are considered critical if any of the following conditions exist:
Over 25% of the body has second-degree burns.
Over 10% of the body has third degree burns.

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 Third-degree burns of the face, hands, or
feet (Burned respiratory passageways can 41/2%, Rule of Nines
swell and cause suffocation). Totals
Anterior end posterior head
and neck, 9% Anterior and
The percentage of the body surface is estimated using the t.
posterior

rule of nines. 41/2% trunk, ) 41/2% ‘jpper limbs, 18%

I 1 ne/ I I Anterior and posterior
- The method divides the body into 11 areas

iiiitk
1 trunk, 36%

accounting for 9% of total body area.

- The rule of nines is only approximate.
9% 9% (Perineum, 1%)

Anterior and posterior lower

limbs, 36%
1OO%

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Treating Burns
- Patients with severe burns need thousands of extra food calories to replace lost proteins and allow tissue repair.
- Burn patients are supplemented with nutrients through gastric tubes and IV lines.
- Replacing lost fluid by IV hydration is critical.
- After the crisis, infection becomes the main threat and sepsis (bacterial infection) is the leading cause of death in
burn victims.
- Bacteria, fungi, and pathogens easily invade areas where skin is destroyed.
- They multiply rapidly in the nutrient-rich environment of dead tissue.
- Antibiotics play an important role in burn treatment.
- Long-term treatment of full-thickness burns usually involves skin grafting.
- Burn skin is debrided (remove), healthy skin is transplanted on the burn site.
- Scar tissue often forms regardless, limiting joint mobility.

Back to Top

Anatomy of the Skeletal System

Cartilage that forms the Skeleton
- Skeletal cartilage → Made of cartilage tissue, it is sculpted to fit its body location and function.
- Cartilage is primarily water (80%), it is resilient; contains no nerves or blood vessels.
- Ground substance contains lots of the glycosaminoglycans (GAGs), chondroitin sulfate & hyaluronic acid
- also chondronectin (adhesive protein).
- Perichondrium → A layer of dense irregular connective tissue surrounding cartilage.
- The perichondrium acts as reinforcement to resist outward expansion when cartilage is compressed.
- The perichondrium contains blood vessels that nourish the cartilage cells.
- Thickness of cartilage is limited by the distance nutrients can diffuse through the matrix to reach
the cells.
- In damaged areas, perichondrium can form scar tissue because poorly vascularized cartilage repairs
badly.
- Ossification of cartilage occurs with aging.
- Chondroblasts → Immature cartilage cells which actively form the cartilage matrix.
- Chondrocytes → Mature cartilage cells that maintain the cartilage.
- Lacunae → Localized clusters of chondrocytes in cartilage which divide and secrete new matrix, expanding
cartilage from within.
- The three types of cartilage (hyaline, elastic, and fibrocartilage) are composed of chondrocytes (enclosed in small
cavities – lacunae) within an extracellular matrix, ground substance.

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 - Hyaline Cartilage → Looks like frosted glass, provides flexibility and resilience.
- The most abundant skeletal cartilages, their chondrocytes are spherical.
- The only fiber type in the matrix are fine collagen fibers.
- Skeletal cartilages include:
• Articular cartilages: Covers the ends of most bones at movable joints.
• Costal cartilages: Connects the ribs to the sternum.
• Respiratory cartilages: Form the skeleton of the larynx and reinforces other respiratory
passageways.
• Nasal cartilages: Supports the external nose.
- Elastic Cartilage → Contain stretchy elastic fibers and are able to stand up to repeated bending.
- Found in the external ear and the epiglottis.
- Fibrocartilage → Highly compressible with great tensile strength, consists roughly parallel rows of chondrocytes,
alternating with thick collagen fibers.
- Occur at sites subject to pressure and stretch: Menisci of the knee and discs of vertebrae.

Growth of Cartilage
- Cartilage has a flexible matrix that can accommodate mitosis.
- It is the ideal tissue to use to rapidly lay down the embryonic skeleton and to provide for new skeletal growth.
- Cartilage grows in two ways:
• Appositional growth – Cartilage-forming cells in the surrounding perichondrium secrete new matrix
against the external face of the existing cartilage tissue.
• Interstitial growth – The lacunae-bound chondrocytes divide and secrete new matrix, expanding the
cartilage from within.
○ Cartilage growth ends during adolescence when the skeleton stops growing.
• During normal bone growth (youth and old age) cartilage can become calcified (hardened due to deposit of calcium
salt).

epiglottis

Cartilage in Thyroid
Cartilages in
external ear cartilage
Cricoid
Articular cartilage
cartilage
of a joint
Costa
Cartilage tn cartilage
Intervertebral

Respiratory
tube cartilages
in neck and thorax

Pubic symphysis Bones of skeleton

H Axial skeleton
Meniscus (padliKe rn Appendicular skeleton
cartilage in
knee joint) Cartilages
n Hyaline cartilages
Articular cartilage
of a joint Pj Elastic cartilages

Fl brocartilages

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Bones performing functions
• Support → Bones provide a framework that supports the body and cradles soft organs.
○ Bones of lower limbs act as pillars to support the body trunk when we stand, and the rib cage supports the
thoracic wall.
• Protection → The fused bones of the skull protect the brain, the vertebrae surround the spinal cord, and the rib
cage protects the vital organs of the thorax.
• Anchorage → Skeletal muscles, which attach to bones by tendons, use bones as levers to move the body and its
parts.
○ The design of joints determines the types of movement possible.
• Mineral storage → Bone is a reservoir for minerals (calcium and phosphate) which are released into the
bloodstream in their ionic form as needed for distribution.
○ Deposits and withdrawals of minerals to and from bones is continuous.
• Blood cell formation → Hematopoiesis, occurs in red bone marrow of certain bones.
• Triglyceride (fat) storage → Fat is stored as yellow marrow in cavities of long bones.
• Hormone production → Bones produce osteocalcin, a hormone regulating insulin secretion, glucose homeostasis
and energy expenditure.

Classifying Bones by Location

• The 206 bones of the body are classified as:
• Axial skeleton → forms the long axis of the body and includes the bones of the skull, vertebral column,
and rib cage.
• Appendicular skeleton → consists of the bones of the upper and lower limbs and the girdles (shoulder
and hip bones) that attach the limbs to the axial skeleton.
- Bones are classified by their shape as long, short, flat, or irregular:
Long bones → Considerably longer than they are wide, a long bone has a shelf and two ends which are
often expanded.
○ All limb bones except the patella, wrist and ankle bones are long bones.
○ The bones are named for their elongated shape, not the overall size.
Short bones → Roughly cuboidal in shape, sesamoid bones are a special type of short bone that form in a
tendon (patella) that vary in size and number in individuals.
○ Some sesamoid bones act to alter the direction of pull of a tendon.
○ Other sesamoid bones reduce friction
and modify pressure on tendons.
Flat bones → Thin, flattened, and usually a bit curved
comprising the sternum, scapulae, ribs, and most cranial
bones of the skull.
Irregular bones → Complicated in shape and fit none
of the preceding classes (vertebrae and hip bones). Flat bone
(sternum)
(a) Long ban«
(humerus)

6.2

(b) Irregular bone

Short bone
(vertebra), right
(talus)
lateral view

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Gross Anatomy
- Compact bone → The external dense outer layer that looks smooth and solid.
- Spongy bone → The internal layer (trabecular bone), a honeycomb of small needle-like or flat pieces called
trabeculae.
- In living bones, the open spaces between trabeculae are filled with red or bone marrow.

Structure of Short, Irregular, and Flat Bones

- The three bone types share a simple pattern:
• Thin plates of spongy bone (diploë) → Spongy bone on the inside of the bone, sandwiched between two
compact bone covers.
○ Contain bone marrow between trabeculae, no well defined marrow cavity.
• Compact bone covers → On either side of the spongy bones is covered by connective tissue membranes
(periosteum and endosteum).
○ The bones are not cylindrical and so they have no shaft or expanded ends.
○ Where they form movable joints, hyaline cartilage covers their surfaces.

Structure of a Long Bone

- Long bones have the same general structure (shaft, bone end, membranes):
• Diaphysis → A tubular diaphysis (shaft) that forms the long axis of the bone with a thick collar of
compact bone surrounding the central medullary cavity.
○ The medullary cavity contains no bone tissue.
○ It contains yellow marrow in adults, the yellow marrow cavity.
○ Between the marrow and the compact bone is a thin layer of spongy bone.
• Epiphyses (singular: epiphysis) → The bone ends, an outer shell of compact bone forms the epiphysis
exterior and interior which contains spongy bone.
○ A thin layer of articular (hyaline) cartilage covers the joint surface, cushioning the opposing bone
ends during movement and absorbing stress.

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• Epiphyseal line → Between the diaphysis and each epiphysis is the epiphyseal line, a remnant of the
epiphyseal plate.
○ Commonly called the growth plate, it is a disc of hyaline cartilage that grows during childhood to
lengthen the bone
• Membranes of the bone → A glistening white, double-layered membrane called the periosteum covers
the external surface the entire bone except joint surfaces.
○ Outer fibrous layer: Dense irregular connective tissue of the periosteum.
■ Provides anchoring points for tendons and ligaments.
○ Osteogenic layer (osteoprogenitor cells): Next to the bone surface containing primitive stem cells
(osteoprogenitors) that give rise to most bones.
■ It also contains:
• Osteoclasts: Bone-destroying cells.
• Osteoblasts: Bone-forming
○ Perforating fibers: Bundles of collagen fibers that extend into the bone matrix – securing the
periosteum to the underlying bone.
■ Exceptionally dense fibers.
○ Endosteum: A delicate connective tissue membrane covering internal bone surfaces.
■ It covers the trabeculae of spongy bone and lines the canals that pass through compact
bone.
• Blood vessels and nerves → Bones are well vascularized with the main vessels serving the diaphysis as a
nutrient artery and a nutrient vein.
○ Nutrient foramen: A hole in the wall of the diaphysis.
○ The artery runs inward to supply the bone marrow and spongy bone.
○ Several epiphyseal arteries and veins serve each epiphysis the same way.
■ Nerves accompany blood vessels through the nutrient foramen.
• Hematopoietic tissue in bones → Red bone marrow is found in different locations in infants and adults.
○ In infants, the medullary cavity of the diaphysis and the spongy bone contain red bone marrow.
○ In adults, much of the red bone marrow is replaced by the fat-containing yellow bone marrow
extending into the epiphysis.
■ Little red marrow marrow is present in spongy bone cavities.
○ Red bone marrow is only found in the cavities between trabeculae of spongy bone in the skull,
sternum, ribs, clavicles, hips, scapulae, vertebrae, femur, and humerus of the arm.
■ Red bone marrow in spongy bone of flat bones is more active in hematopoiesis.
■ Yellow bone marrow can revert to redbone marrow when in need.

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Bone Markings
- The external surface of a bone has distinct bone markings providing information about how that bone, its muscles,
and ligaments, work together.
- Bone marking fit into three categories:
1) Projections – sites of muscle and ligament attachment.
2) Surfaces – that form joints.
3) Depressions and openings – for blood vessels and nerves.

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 Very large, blunt, irregularly shaped process (the only examples are on the

Narrow ridge of bone; less prominent

NAME OF ROME
MARKING DESCRIPTION

Proiectons That Are Sites of Muscle and Lwamerit Attachment

Tuberosity Large rounded projection, may be

(toob^rosJ'tej roughened

Narrow ridge of bone; usually prominent

Trochanter
(tfo-kan'terj
femur)

than a crest

Tubercle Small rounded projection or process

(too ber*kl]
tuberosity — Adductdr
Epicondyle Raised area on or above a condyle tubercle
(ep i’kon dri)

Sharp, slender, often pointed projection Medial

eptcondyle
Any bony prominence
Condyle

Spinous
process

on

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Table 6.2 Bone Markings
NAME OF BONE MARKING DESCRIPTION ILLUSTRATIONS

Surfaces That Help to Form Joints

Head Bony expansion carried on a narrow neck

Facet Smooth, nearly flat articular (joint) surface

Condyle (kon'dll) Rounded articular projection; often articulates

with a corresponding fossa

Depressions and Openings

For passage of Blood Vessels and Nerves

Groove Furrow
Fissure Narrow, slitlike opening
Foramen Round or oval opening through a bone
(fo-ra'men)
Notch Indentation at the edge of a structure
Others
Meatus Canal-like passageway
(me-a'tus)
Sinus Cavity within a bone, filled with air and
lined with mucous membrane
Fossa Shallow, basinlike depression in a bone,
(fos'ah) often serving as an articular surface

Cells of Bone Tissue

- All major cell types except for the osteoclasts, originate from embryonic connective tissue cells.
- The presence of bone cells is what makes bone a dynamic living tissue because these cells continuously
resorb (breakdown) and deposit bone via remodelling.
• Osteoprogenitor Cells → Mitotically active stem cells found in the membranous periosteum and endosteum, they
are flattened or squamous cells in growing bones.
○ When stimulated, they differentiate into osteoblasts and others persist as osteoprogenitors.
• Osteoblasts → Bone-forming cells that secrete the bone matrix.
○ Like fibroblasts and chondroblasts, they are actively mitotic.
○ The unmineralized bone matrix they secrete include collagen (90% of bone protein) and calcium-binding
proteins making up unmineralized bone, the osteoid.
■ They play a role in matrix calcification.
■ When actively depositing matrix, osteoblasts are cube shaped.
■ When inactive, they resemble flattened osteoprogenitor cells or may differentiate into bone lining
cells.
○ When osteoblasts are completely surrounded by matrix, they become osteocytes.
• Osteocytes → Mature bone cells that occupy spaces (lacunae) that conform to their shape.
○ They monitor and maintain the bone matrix and also act as stress or strain sensors and respond to mechanical
stimuli (bone loading, bone deformation, weightlessness).
○ Osteocytes communicate with cells to initiate bone remodelling in response to stressors or to maintain
calcium homeostasis.

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• Bone lining cells – Cells on the surface of bone where remodelling does not go on; like osteocytes, they maintain
the matrix.
• Osteoclasts → Giant multinucleate cells located at sites of bone resorption that are derived from the same WBC
lineage as macrophages.
○ Osteoclasts lie in shallow depressions they carve out when resorbing bone.
○ They have a ruffled border that directly contacts the bone.
■ The plasma membrane infoldings of the ruffled border increase surface area for
enzymatically degrading the bones and sealing off the area from the matrix.
BONE calcium salts give hardness & strength for support/protection of softer tissues;
cavities for fat storage & synthesis of blood cells

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 ta) Osteogenic cell |b) Osteoblast (c) Osteocyte (d) Osteoclast
Stem cell Matrix-synthesizing Mature bone cell that Bone-resorbing cell
cell responsible for monitors and maintains
bone growth the mineralized
bone matrix

Microscopic Anatomy of Compact Bone

- Compact bone has passageways that serve as conduits for nerves and blood vessels.
• Osteon → The structural unit of compact bone, the Haversian system.
○ Each osteon is an elongated cylinder oriented parallel to the long axis of the bone.
○ Osteons are tiny weight bearing pillars.
■ A group of hollow tubes of bone matrix, one placed outside the next.
• Lamella → Each individual matrix tube in the osteon is composed of one lamella; compact bone is often called
lamellar bone.
○ All the collagen fibers run in a single direction.
○ Collagen fibers in adjacent lamellae run in different directions.
■ Helps reduce and withstand torsional stresses (TWISTER RESISTOR).
○ Bone salts align between the collagen fibers and alternate their direction in adjacent lamellae.
• Central canal (Haversian canal) → A central canal runs through the core of each osteon containing small blood
vessels and nerve fibers serving osteon cells.
• Perforating canals (Volkmann’s canals) → Lie at right angles to the long axis of the bone and connect the blood
and nerve supply of the medullary cavity to the central canals.
○ Not surrounded by concentric lamellae, these canals are lined with endosteum.
• Lacunae → The location in which spider shaped osteocytes occupy.
• Canaliculi → Hairlike canals that radiate from lacunae connecting them to each other and the central canal.
○ As bone forms, osteoblasts maintain contact with one another by gap junctions.
○ Osteoblasts secrete bone matrix and are trapped within it as it hardens becoming osteocytes.
○ The canaliculi filled with tissue fluid contains the osteocyte extensions.
○ Canaliculi tie osteocytes together allowing them to communicate, permitting nutrients and wastes to be
relayed to the next through the osteon.
○ The canaliculi and gap junctions allow bone cells to be well nourished.
• Interstitial lamellae → Either fill the gaps between forming osteons or are remnants of osteons that have been cut
through by bone remodelling.
• Circumferential lamellae → Located deep to the periosteum and superficial to the endosteum, extend around the
entire circumference of the diaphysis resisting twisting of the long bone.
• Spongy bone construction → Trabeculae in spongy bone align precisely along lines of stress and help the bone
resist stress.
○ The struts are carefully positioned.
○ Trabeculae contain irregularly arranged lamellae and osteocytes interconnected by canaliculi; no osteons.
○ Nutrients reach the osteocytes by diffusing through the canaliculi from capillaries in the endosteum
surrounding the trabeculae.

bone Spongy bone

See Figure 6,3b. c for details

Medullary
cavity

Interstitial External Concentric

Perioslecm-------- lamellae Osteocyte
circumferential ’amellae lamellae

Trabeculae

Periosteal vein

Periosteal artery
Periosteum:
Outer fibrous layer Inner
osteogenic layer

Osteonic canal
Interosteonic (Volkmann’s
or perforating) canal
Perforating
{Sharpey's} libers

(a) Osteons
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document systems)
is available free of in compact
charge Q studocu
on bone and trabeculae in spongy bone
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 Internal circumferential lamellae
Chemical Composition of Bone
- Bone contains organic and inorganic substances in proportions that make the bone extremely strong and durable
without being brittle.
• Organic components – bone cells and osteoid – allow it to resist tension (stretch).
○ Osteoprogenitor cells, osteoblasts, osteocytes, bone lining cells, and osteoid make up the organic
part of the matrix.
○ Osteoid includes ground substance and collagen fibers secreted by osteoblasts.
■ Collagen contributes to bone structure, flexibility, and tensile strength.
■ Collagen allows it to resist stretch and twisting.
○ Bone’s resilience comes from sacrificial bonds in or between collagen molecules.
■ The bonds stretch and break on impact, dissipating energy to prevent the force from
rising to a fracture value.
■ Most sacrificial bonds re-form.
• Inorganic components – mineral salts – allow it to resist compression.
○ The balance of bone tissue (65% by mass) consists of inorganic hydroxyapatites, mineral salts,
calcium phosphate present as tiny needle-like crystals in and around collagen fiber (extracellular
matrix).
■ Crystals account for the exceptional hardness of the bone which allows it to resist
compression.
○ Mineral salts allow bones to last long after death.
- A healthy bone is half as strong steel in resisting compression and fully as strong as steel in resisting tension.

Formation of Bone
- Ossification and osteogenesis are names for the process of bone tissue formation.
- Bones are capable of growing thicker throughout life.
- Ossification in adults is mainly for bone remodeling and repair.
- The embryonic skeleton consists only of fibrous connective tissue membranes and hyaline cartilage before week 8.
- Bone tissue develops at this time and replaces most of the existing fibrous cartilage structures in the
embryo.
• Endochondral ossification → Bone develops by replacing hyaline cartilage.
○ Resulting bone is called an endochondral bone.
• Intramembranous ossification → Bone develops from a fibrous membrane.
○ Resulting bone is called membranous bone.

Intramembranous ossification

• Forms the cranial bones of the skull, frontal, parietal, occipital, and temporal bones, and clavicles.
• Most bones formed by this process are flat bones.
- Ossification begins within fibrous connective tissue formed by mesenchymal cells.
- Begins around 8 weeks.

Endochondral Ossification
- All bones (except clavicles) below the base of the skull form by endochondral ossification.
- This process uses hyaline cartilage formed earlier as models for construction.
- Endochondral ossification is more complex than intramembranous ossification because the hyaline cartilage
must be broken down as ossification proceeds.
- The process (6th month of development):
1) A bone collar forms around the diaphysis of the hyaline cartilage model.
• The cartilage model is surrounded by a perichondrium.
• Ossification begins when the underlying mesenchymal cells of the deep layer of perichondrium
specialize into osteoblasts.
○ Perichondrium becomes the periosteum.
• Osteoblasts of the converted periosteum secrete osteoid against the hyaline cartilage diaphysis,
encasing it in a collar of bone.
• Primary Ossification → Chondrocytes within the shaft hypertrophy (enlarge).
2) Cartilage calcifies in the center of the diaphysis and then develops cavities.
• Hypertrophic chondrocytes calcify the surrounding cartilage matrix.
• Because the cartilage matrix becomes impermeable to nutrients, chondrocytes die and the matrix
deteriorates.
• The deterioration opens up cavities, but the bone collar stabilizes the cartilage.
○ The cartilage remains healthy elsewhere and continues to grow brisky, causing the
cartilage model to elongate.
3) The periosteal bud invades the internal cavities and spongy bone forms.
• Month 3: the forming cavities are invaded by a collection of elements called the periosteal bud
containing –
○ Nutrient artery and vein;
○ Nerve fibers;
○ Red marrow elements;
○ Osteoprogenitor cells;
○ Osteoclasts.
• The osteoclasts partially erode the calcified cartilage matrix.
• The osteoprogenitor cells become osteoblasts that secrete osteoid around the remaining calcified
fragments of cartilage.
4) The diaphysis elongates and a medullary cavity forms.
• As the primary ossification center enlarges, osteoclasts break down nearly formed spongy bone
and open the medullary cavity in the center.
○ The rapidly growing epiphysis consists only of cartilage at week 9 until birth and the
hyaline cartilage continues to elongate by division.
• Ossification removes cartilage formation along the length of the shaft as cartilage calcifies,
erodes, and is replaced by bony spikes on the epiphyseal surfaces.
5) The epiphyses ossifies.
• Secondary ossification reproduces almost exactly the events of primary ossification, except the
spongy bone in the interior is retained.
• No medullary cavity forms in the epiphyses.

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 - Secondary ossification is complete, hyaline cartilage remains only at two places in the long bone:
• On the epiphyseal surfaces, as the articular cartilages.
• At the junction of the diaphysis and epiphysis, where it forms the epiphyseal plates.

Weeks -> Month 3 ♦-Birth Childhood to adolescence

(T) Bone collar forms @ Cartilage in the center @The periosteal bud (^The diaphysis elongates C^The epiphyses ossify.
around the diaphysis of of the diaphysis calcifies invades the internal and a medullary cavity When completed, hyaline
the hyaline cartilage and then develops cavities and spongy forms. Secondary cartilage remains only in the
model. cavities. bone forms. ossification centers appear epiphyseal plates and
in the epiphyses. articular cartilages.

Fig. 6.10 - Endochondral ossification in a long bone

Postnatal Bone Growth

- During infancy and youth, long bones lengthen entirely by interstitial growth of the epiphyseal plate cartilage and
all bones grow in thickness by appositional growth.
- Most bones stop growing during adolescence.
- Facial bones (nose and lower jaw) grow imperceptible throughout life.
- Longitudinal bone growth (lengthening) mimics the events of endochondral ossification, depending on the
presence of epiphyseal cartilage.
- Resting Zone → Region of the epiphyseal plate facing epiphysis where cartilage is relatively inactive.

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- Components of longitudinal growth:
1) Proliferation zone → Cartilage cells undergo rapid mitosis on the epiphysis face pushing the epiphysis away
from the diaphysis, lengthening the bone.
2) Hypertrophic zone → Older chondrocytes closer to the diaphysis, hypertrophy and the lacunae erode and
enlarge leaving large interconnected spaces.
3) Calcification zone → The surrounding matrix calcifies, chondrocytes die, and the matrix deteriorates allowing
blood vessels to invade.
• Long, slender spicules of calcified cartilage at the epiphysis-diaphysis junctions are left behind.
4) Ossification zone → Calcified spicules are invaded by marrow elements of the medullary cavity.
• Osteoclasts partly erode the cartilage spicules.
• Osteoblasts cover the cartilage spicules with new bone.
• Spongy bone replaces the cartilage, and as osteoclasts digest the spicule tips, the medullary cavity also
lengthens.
- The epiphyseal plate maintains a constant thickness because the rate of cartilage growth on its
epiphysis-facing side is balanced by its replacement with bony tissue on the diaphysis-side.
- Longitudinal growth is accompanied by remodeling of the epiphyseal ends to maintain proportion between
the diaphysis and epiphysis.
- Bone remodelling involves new bone formation and bone resorption.
- At the end of adolescence, chondroblasts of the epiphyseal plates divide less.
- The plate becomes thinner until they are entirely replaced by bone tissue.
- Longitudinal bone growth ends when the bone of the epiphysis and diaphysis fuses.
- Epiphyseal plate closure → Only the articular cartilage remains in bones.
- An adult bone can still widen by appositional growth if stressed by excessive muscle activity or body weight.

■ig. 6.12: Growth in length of a long bone at the epiphyseal plate

— Resting zone

— ® Proliferation-----------
zone
Cartilage cells
undergo mitosis.

— ® Hypertrophic —
zone
Older cartilage cells
enlarge.

(a) X-ray image of right knee, anterior — © Calcification'----------

view. Proximal epiphyseal plate of the zone
tibia enlarged in part (b). Matrix becomes .
calcified; cartilage ceils
die; matrix begins
Calcified deteriorating.
cartilage
spicule
Osseous
— @ Ossification-----------
tissue
zone
New bone is forming.

(b) Photomicrograph of (c) Diagram of the zones

cartilage in the epiphyseal within the epiphyseal
plate (125xJ. plate.

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Growth in Width (Thickness)
- Growing bones widen as they lengthen.
- As with cartilage, bones increase in thickness or diameter by appositional growth.
1) Osteoblasts in the periosteum secrete bone matrix on the external bone surface.
2) Osteoclasts on the endosteal surface of the diaphysis remove bone.
- There is slightly more building up than breaking down.
- The unequal process produces thicker, stronger bones but prevents it from becoming heavy.

Before growth After growth

and remodeling and remodeling
As the bone grows in length, remodeling (resorption
and deposition) maintains the bone’s shape.
Articular and epiphyseal plate cartilage Bone was added here by appositional
grows and is replaced by bone growth.
(endochondral ossification).

Regulating Bone Growth Outline of bone

- Bone growth until young before growth
adulthood is controlled by remodeling.
hormones.
- Growth hormone →
The single most
Articular
important stimulus of cartilage
epiphyseal plate activity
released by the anterior Epiphysea Bone that
l plate was here has
pituitary gland. been
- Thyroid hormones → resorbed.
Modulate the activity of
growth hormone, ensuring the
skeleton has proper
proportions as it grows.
- Estrogen levels → Stimulate the growth spurt typical of adolescence.
- As estrogen levels increase over time, they induce epiphyseal closure, ending longitudinal bone growth.
- Excess or deficiencies of any of the hormones can result in abnormal skeletal growth.
- Hypersecretion of GH results in excessive height.
- Deficits of GH or thyroid hormone, produce types of dwarfism.
- Hypersecretion of estrogen can also prematurely end bone growth.

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Control of Remodelling
- Remodeling is regulated by two control loops serving different purposes:
• Maintaining Ca homeostasis: A hormonal negative feedback loop involving parathyroid hormone
2+

maintains Ca in the blood.

2+

• Keeping bones strong: Mechanical and gravitational forces acting on a bone drives remodeling where it is
required to strengthen that bone.

Hormonal Controls (Whether and When remodelling occurs).

- Maintaining extracellular fluid calcium levels within homeostatic levels is absolutely critical for maintaining the
resting membrane potential of all cells.
- Without normal levels of blood calcium, nerves cannot fire as needed and muscles are unable to contract.
- Hormones use the vast amount of calcium in bone as a storage bank to resorb or deposit as needed to maintain
extracellular fluid calcium.
- Calcium is absorbed from the intestine under the control of the active form of vitamin D, called
calcitriol.

1) Parathyroid hormone (PTH) → Produced by the parathyroid glands, PTH is released when blood calcium
declines, stimulating osteoclasts to resorb bone, releasing Ca into the blood.
2+

• The PTH stimulation of osteoclasts is indirect – various cells (osteoblasts) respond to PTH secretion by
producing another protein (RANK-L).
2) RANK-L → Stimulates the formation and activity of osteoclasts.
3) As blood concentrations of calcium rise, stimulation of PTH release ends, reversing the effects and causing blood
calcium levels to fall.
• When activated, osteoclasts break down both old and new matrix.
• If blood calcium levels are low for extended time, the bone becomes so demineralized that they develop
large holes.

- Calcitonin → A hormone produced by parafollicular cells of the thyroid gland regulates blood calcium levels
alongside PTH.
- Its effects on calcium homeostasis are negligible, but it does temporarily lower blood calcium levels when
administered at a high dose.
- PTH, glucocorticoids (adrenal cortex), and vitamin D stimulate osteoclast activity by increasing
the synthesis of RANK-L.
- They also decrease the
synthesis of osteoprotegerin
ig. 6.14: Parathyroid hormone (PTH) control of blood
(antithesis of RANK-L). calcium
- Sex hormones (estrogen) increase the
synthesis of osteoprotegerin, reducing
osteoclast activity and increasing bone
formation.

Response to Mechanical Stress (where remodelling

occurs)
- Wolff’s Law → Bone grows in response to the
demands placed on it.

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 - A bone is loaded whenever weight bears down on it or muscles pull on it.
- The load is usually off center and tends to bend the bone.
- Bending compresses one side and stretches the other.
- Compact bone of long bones is thickest midway along the diaphysis, where bending is greatest.
- Both compression and tension are minimal towards the center of the bone, so a bone can use spongy
bone instead of compact bone for lightness.
- Wolff’s law also explains:
• Handedness results in the bones of one upper limb being thicker than those of the less-used limb.
• Curved bones are thickest where they are most likely to buckle.
• The trabeculae of spongy bone form trusses along lines of compression.
• Large, bony projections occur where heavy, active muscles attach.
○ The bones of weight lifters have enormous thickenings at the attachment sites of the most-used
muscles.
• Unstressed bones are featureless and atrophied in bedridden people.

Fracture Key Events in Reformation

1) Formation of a hematoma: Blood vessels in the bone and periosteum are torn, hemorrhaged blood clots forming
the hematoma.
• Local bone cells are deprived of oxygen/nutrients and die causing inflammation and pain.
2) Formation of a fibrocartilaginous callus: New blood vessels invade the fracture site, bringing macrophages and
osteoclasts to break down damaged bone.
• Fibroblasts and chondroblasts produce collagen fibers and cartilaginous matrix that later calcifies that
connects the broken bone ends.
3) Conversion to bony callus: Cartilage is converted to trabecular spongy bone (2~months).
• Gradually the fibrocartilaginous callus is replaced by immature bone.
• Repeats the events of endochondral ossification.
4) Bone remodelling: Extra bony material is removed over several months and years; the outer
walls of the shaft are converted to compact bone and the bone regains its original shape.

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Osteoporosis
- Osteoporosis → Diseases in which bone resorption outpaces bone deposition.
- The bone becomes demineralized and porous.
- The spine and neck of the femur (broken hip) are the most susceptible to fracture.
- Risk factors include:
• Age-related reduction of sex hormones → Estrogens and androgens restrain osteoclasts and
promote deposit of new bone.
• Insufficient bone stress → Low body weight or weight-bearing exercise hinders new bone
deposition.
• A diet poor in calcium, vitamin D, or protein.
• Smoking → Reduces estrogen levels and calcium absorption.
• Abnormal vitamin D receptors.

Back to Top

Physiology of the Skeletal System

The Skeleton
- The skeleton is divided into axial and appendicular portions, 206 bones, 20% body weight.
- Axial skeleton → A structure of 80 bones segregated into three major portions.
- The skull;
- Vertebral column;
- Thoracic cage.
- The axial skeleton:
• Forms the longitudinal axis of the body;
• Supports the head, neck, and trunk;
• Protects the brain, spinal cord, and organs in the thorax.
- The bones of the appendicular skeleton allows us to manipulate and interact with our environment,
<appended= to the axial skeleton (bones of the lower limbs, pectoral/pelvic girdle).
The Skull
- The skull → The body’s most complex bony structure comprises 22 cranial and facial bones.
- Cranial bones (cranium) → Enclose and protect the brain and furnish the attachment sites for head
and neck muscles.
• Form the framework of the face;
• Contain cavities for special sense organs of sight, taste, and smell;
• Provide openings for air and food passage;
• Secure the teeth;
• Anchor the facial muscles of expression, which we use to show emotions.
- Most skull bones are flat bones, with exception of the mandible.
- Mandible → Connected to the rest of the skull by freely moveable joints.
- Sutures → Interlocking joints that have saw-tooth or serrated appearance, they connect cranial bones
and connect facial bones (named according to the bones they connect).
- With the lower jaw removed, the skull is lopsided, hollow, and bony.
- The facial bones form its anterior aspect, and the cranium forms the skull.
- The cranium can be divided into a vault and a base:
• Cranial vault (calvaria) → The bald part of the skull, forms the superior, lateral, and posterior aspect
of the skull, as well as the forehead.
• Cranial base → Forms the skull’s inferior aspect with prominent bony ridges dividing the base into
three distinct <steps= or fossae:
○ Anterior (highest), middle, and posterior (lowest) cranial fossa.
○ The brain sits in the cranial fossa, enclosed by the cranial vault.
- The space enclosed by the cranial vault and base is called the cranial cavity.
- The skull has many smaller cavities:
• The middle and internal ear cavities;
• Anterior nasal cavity;
• The orbits housing the eyeballs.
- The skull has 85 OPENINGS (foramina, canals, fissures, etc) for nerves, blood vessels, and spinal
cord.
- 12 pairs of cranial nerves (I-XII) that transmit information to and from the brain.
- Skull bones contain air-filled sinuses, which lighten the skull.

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Cranium
- The eight cranial bones are the paired parietal and temporal bones, unpaired frontal, occipital, sphenoid,
and ethmoid bones.
- The cranium is self-bracing due to its curvature.
- Bones can be thin but remarkably strong for its weight.
• Frontal Bone → Forms the anterior cranium and articulates (connects) posteriorly with the paired parietal
bones via the prominent coronal suture.
○ The most anterior part of the frontal bone is the vertical squamous part, forehead.
○ Supraorbital margins → The frontal squamous inferior end region, the thickened superior margins of
the orbits lie under the eyebrows.
○ Anterior cranial fossa → The superior wall of the orbits.
○ Supraorbital foramen (notch) → Allows the supraorbital artery and nerve to pass to the forehead.
○ Glabella → Smooth portion of the frontal bone between the orbits.
■ Frontonasal suture → Inferior, the frontal bone meets the nasal bone.
○ Frontal sinuses → Areas lateral to the glabella contain the sinuses.

• Parietal bones → Curved, rectangular bones that form most of the superior and lateral aspects of the skull; the
bulk of the cranial vault.
○ Four largest sutures occur where the parietal bones articulate (form a joint) with other cranial bones
(coronal, sagittal, lambdoid, squamous).
■ Coronal suture → Where the parietal bones meet the frontal bone anteriorly.
■ Sagittal suture → Where the parietal bones meet superiorly at the cranial midline.
■ Lambdoid suture → Where the parietal bones meet the occipital bone posteriorly.
■ Squamous suture → Where the parietal and temporal bone meet on the lateral aspect of the
skull.

■ Occipital bone → Most of the skull’s posterior wall and base, articulates anteriorly with the paired parietal and
paired temporal bones (lambdoid and occipitomastoid sutures).
○ The basilar part of the occipital also joints with the sphenoid bone in the cranial base.
○ Forms the walls of the posterior cranial fossa.
○ Foramen Magnum → The base of the occipital bone through which the inferior part of the brain
connects to the spinal cord.
■ Flanked by two occipital condyles → Articulates the first vertebra of the spinal column and

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 permits the nodding motion of the head.
○ Hypoglossal canal → Hidden medially and superiorly to each occipital condyle through which a cranial
nerve (XII) passes.
■ External occipital protuberance → Superior to the foramen magnum is a median protrusion.
■ External occipital crest and the superior and inferior nuchal lines → Ridges surrounding
the external occipital protuberance.

■ External occipital crest secures the ligamentum nuchae, a sheet of elastic ligament that
connects the vertebrae of the neck to the skull.
• Nuchal lines and bony regions anchor many neck and back muscles.
• Superior nuchal line marks the upper limit of the neck.

• Temporal Bones → Lateral skull surface, they lie inferior to the parietal bones and meet them at the squamous
sutures.
○ Form the inferolateral aspects of the skull and parts of the cranial base.
○ Described based on three major parts:
1) Squamous part: Ends at the squamous suture, flattened from the zygomatic process to the
cheekbone (zygomatic bone).
a) Mandibular fossa receive the mandibular condyle.
2) Tympanic part: Surrounds the external acoustic meatus, or external ear canal.
a) The eardrum at its deep end is part of the external ear.
b) On a dried skull, the eardrum is removed and part of the middle ear cavity deep to
the external meatus can also be seen.
3) Petrous part: Internal aspect of the temporal bone, houses the middle and internal ear
cavities, containing sensory receptors for hearing and balance.
a) Extends to the sphenoid anteriorly and occipital posteriorly.
i) Middle cranial fossa → The sphenoid bone and the petrous portions of the
temporal bone construct the fossa supporting the temporal lobes of the
brain.
ii) Jugular foramen → The junction of the occipital and petrous temporal
bones allowing the passage of the internal jugular vein and three cranial
nerves (IX, X, and XI).
iii) Carotid canal → Anterior to the jugular foramen, transmits the internal
carotid artery into the cranial cavity.
(1) Two internal carotid arteries transmit blood to over 80% of the
cerebral hemispheres of the brain.
iv) Foramen lacerum → Jagged opening between the petrous temporal bone
and sphenoid bone (usual covered by cartilage).
v) Internal acoustic meatus → Superolateral to the jugular foramen, transmits
cranial nerves VII and VIII.
b) Mastoid process → Anchoring site for neck muscles (behind the ear).
1) Mastoid air cells (full of air cavities – SINUSES).
(1) Close to the middle ear with a risk of infection for the ear and
throat – mastoiditis.
c) Styloid process → Attachment point for tongue and neck muscles and for a ligament
securing the hyoid bone of the neck to the skull.
d) Stylomastoid foramen → Between the styloid and mastoid processes, allows for
cranial nerve VII (facial nerve) to leave the skull.

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○ Sphenoid Bone → The bat-shaped bone spanning the width of the middle cranial fossa.
○ The keystone bone of the cranium because it forms a central wedge that ties the cranial bones together
and articulates with all other cranial bones.
○ Consists of a central body and three pairs of processes:
■ Central body:
• Sphenoidal sinuses → Within the central body cavities.
• Sella turcica → A saddle-shaped prominence.
• Hypophyseal fossa → Seat of the saddle forming a snug enclosure for the pituitary
gland (hypophysis).
■ Greater wings → Project laterally from the sphenoid body forming parts of:
1) The middle cranial fossa;
2) The posterior walls of the orbits;
3) The external wall of the skull (flag shaped), bony areas medial to the zygomatic arch.
■ Lesser wings → Form part of the floor of the anterior cranial fossa and part of the medial
walls of the orbits.
■ Pterygoid processes → Trough-shaped projection inferiorly from the junction of the body
and greater wings.
■ They anchor the pterygoid muscles, important in chewing.

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 ○ Openings in the sphenoid bone:
■ Optic canals → Anterior to the sella turcica; allow the optic nerves (cranial nerves II) to pass
to the eyes
■ On each side of the sphenoid body is a crescent-shaped row of four openings.
• Superior orbital fissure → The anteriormost fissure between the great and lesser
wings.
○ Allows cranial nerves that control eye movement (III, IV, VI) to enter the
orbit.
○ The most obvious in an anterior view of the skull.
• Foramen rotundum and foramen ovale → Provide passageways for branches of
cranial nerve V to reach the face.
○ Foramen rotundum is usually in the medial part of the greater wing, usually
an oval shape.
○ Foramen ovale is a large oval foramen posterior to the foramen rotundum,
visible in an inferior view of the skull.
• Foramen spinosum → Posterolateral to the foramen, it transmits the middle
meningeal artery, serving internal faces of some cranial bones.

(a) Superior view

○ Ethmoid Bone → Has a complex shape, lying between the sphenoid and the nasal bones of the face, most deeply
situated in the skull.
○ Forms most of the bony area between the nasal cavity and the orbits.
○ Cribriform plates → The superior surface is formed by the paired horizontal plates, helping form the roof
of the nasal cavity and floor of the anterior cranial fossa.
■ Cribriform foramina → Tiny holes punctured in the plates that allow the filaments of the
olfactory nerves to pass from the smell receptors in the nasal cavity to the brain.
○ Crista galli → The outermost covering of the brain (the dura mater) articulates to the bone and helps secure
the brain in the cranial cavity.
○ Perpendicular plate → Projects inferiorly in the median plane and forms the superior part of the nasal
septum (divides the nasal cavity into left and right halves).
■ Ethmoidal air cells → On either side of the perpendicular plate, a lateral mass with sinuses.
○ Superior and middle nasal conchae → Extend medially from the lateral masses, protrude into the nasal
cavity.
■ The lateral surfaces of the ethmoid’s lateral masses are called orbital plates because they
contribute to the medial walls of the orbits.

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■ Sutural Bones → Tiny, irregularly shaped bones or bone clusters that occur within sutures (lambdoid suture);
additional ossification centers that appeared during fetal development.
○ Not everyone has these bones, their significance is unknown.

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Facial Bones
- Two unpaired bones: Mandible and Vomer.
- Paired bones: maxillae, zygomatics, nasals, lacrimals, palatines, inferior nasal conchae.
- Mandible → Lower jawbone is the largest, strongest bone of the face with a body and two upright <rami=,
each ramus meets the body posteriorly at the mandibular angle.
○ Mandibular notch → At the superior margin of each ramus are two processes separated by the notch.
○ Coronoid process → An insertion point for the large temporalis muscle that elevates the lower jaw
when chewing.

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 ■ Articulates with the mandibular fossa of the temporal bone, forming the
temporomandibular joint.
○ Mandibular body → Anchors the lower teeth.
■ Alveolar process → The superior border which contains the sockets (dental alveoli) in which
the teeth are embedded.
• In the midline of the body is a slight ridge.
■ Mandibular symphysis → Indicating where the two mandibular bones fused during infancy.
○ Mandibular foramina → On the medial surface of each ramus, permits the nerves responsible for tooth
sensation to pass to the teeth in the lower jaw.
○ Mental foramina → Openings on the lateral aspect of the mandibular body, allowing blood vessels and
nerves to pass to the skin of the chin and lower lip.

• Maxillary (Maxillae) Bones → The maxillae are fused medially, forming the upper jaw and central portion of the
face.
○ All facial bones except the mandible articulate with the maxillae (a keystone bone of the facial
skeleton).
○ Alveolar processes → Carry the upper teeth.
■ Anterior nasal spine → Just inferior to the nose, the maxillae meet medially forming a point
at their junction.
■ Palatine processes → Projections from the maxillae posteriorly from the alveolar processes
and fuse medially.
• Form the anterior two-thirds of the hard palate, bony roof of the mouth.
○ Incisive fossa → A midline foramen leading into the incisive canal, a passageway for blood vessels and
nerves.
○ Frontal processes → Extend superiorly to the frontal bone, forming the lateral aspects of the bridge of
the nose.
■ Maxillary sinuses → Flank the nasal cavity laterally, they are the largest of the paranasal
sinuses.
• Extend from the roots of the upper teeth.
• Laterally, the maxilla articulates with the zygomatic bones via their zygomatic
processes.

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 ○ Inferior orbital fissure → Located deep within the orbit at the junction of the maxilla with the greater
wing of the sphenoid.
■ Permits the zygomatic nerve, maxillary nerve (cranial nerve V branch), and blood vessels, to
pass to the face.
○ Infraorbital foramen → Just below the eye socket on each side, allows the infraorbital nerve
(continuation of the maxillary nerve) and artery to reach the face.

body
O£O11 riniwflii Tirirjme*- hii^

• Zygomatic Bones → Cheekbones formed from irregular bones making the prominence of the cheeks and part
of the inferolateral margins of the orbits.
○ Articulate posteriorly with the zygomatic processes of the temporal bones;
○ Articulates superiorly with the zygomatic processes of the frontal bone;
○ Articulates anteriorly with the zygomatic processes of the maxillae.

• Nasal Bones → Thin rectangular bones that are fused medially forming the bridge of the nose.
○ They articulate with the frontal bone superiorly, the maxillary bones laterally, and the perpendicular
plate of the ethmoid bone posteriorly.
○ Inferiorly they attach to the cartilages that form most of the skeleton of the external nose.

• Lacrimal Bones → Fingernail-shaped bones that contribute to the medial walls of each orbit.
○ Articulate with the frontal bone superiorly, ethmoid bone posteriorly, maxillae anteriorly.
○ Lacrimal fossa → Houses the lacrimal sac, part of the passageway allowing tears to drain from the
eye surface into the nasal cavity.

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 • Palatine Bones → Formed from two bony plates, perpendicular (vertical) and horizontal plates.
○ Horizontal plates → Joined at the median palatine suture, complete the posterior portion of the hard
palate.
○ Perpendicular (vertical plates) → Superior projection forming part of the posterolateral walls of
the nasal cavity and a small part of the orbits.

• Vomer → Plow-shaped bone that lies in the nasal cavity forming part of the nasal septum.

• Inferior Nasal Conchae → Thin, curved bones that project medially from the lateral walls of the nasal
cavity, just inferiorly to the middle nasal conchae of the ethmoid bone.
○ Largest of the three pairs of conchae and form part of the lateral walls of the nasal cavity.

Superior orbital
fissure
Roof of orbit
Lesser wing of
sphenoid bone

Orbital plate of
frontal bone

Lateral wall of orbit Orbital plate of

ethmoid bone
Zygomatic process of
frontal bone
of maxilla
Greater wing of
sphenoid bone Lacrimal bone
Orbital surface of
Nasal bone
zygomatic bone

Inferior orbital fissure Floor of orbit

Infraorbital groove Orbital process of
palatine bone
Zygomatic bone —
Orbital surface of
maxillary bone
Zygomatic bone
(b) Contribution of each of the seven bones forming the right orbit

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The Hyoid Bone
- Considered to be part of the skull, though not directly connected to it.
- Lies in the anterior neck just inferior to the mandible.
- The only bone of the body that does not articulate directly with any other bone.
- Stylohyoid ligaments → Ligament that anchors the hyoid to the styloid processes of the temporal
bones.
- The hyoid bone acts as a moveable base for the tongue with a body and two pairs of horns (cornua).
- The body and greater horns are attachment points for neck muscles that raise and lower the
larynx during swallowing and speech.

The Orbits
- Orbits → Bony cavities in which the eyes are firmly encased and cushioned by fatty tissue.
- The muscles that move the eyes and the tear-producing lacrimal glands are housed in the orbits.
- The walls are formed by seven bones – the frontal, sphenoid, zygomatic, maxilla, palatine, lacrimal, and
ethmoid bones.
- The superior and inferior orbital fissures, optic canals were all described earlier.

The Nasal Cavity

- Nasal cavity → Constructed of bone and hyaline cartilage.
- Roof of the nasal cavity → Formed by cribriform plates of the ethmoid.
- Lateral walls → Shaped by the superior and middle conchae of the ethmoid bone, the
perpendicular plates of the palatine bones, and the inferior nasal conchae.
- Meatuses (superior, middle, inferior) → The depressions under cover of the conchae on
the lateral walls.
- Floor → Formed by the palatine processes of the maxillae and the palatine bones.
- The nasal cavity is divided into right and left parts by the nasal septum.
- The bony portion is formed by the vomer inferiorly and the perpendicular plate of the ethmoid
bone superiorly.
- Septal cartilage → Completes the septum anteriorly.
- The nasal conchae are covered with mucus-secreting mucosa that:
• Moistens and warms the entering air;
• Helps cleanse air of debris.
- The conchae help to:
• Increase the turbulence of air through the nasal cavity.
○ Forces more of the inhaled air into contact with the warm, damp mucosa, encouraging
trapping of airborne particles in the mucus.

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Parasinuses
- Five skull bones – frontal, sphenoid, ethmoid, and paired maxillary bones.
- They contain mucosa-line, air-filled sinuses (parasinuses) because they cluster around the nasal
cavity.
- Small openings connect the sinuses to the nasal cavity, allowing material to flow in and out.
- Air enters the sinuses from the nasal cavity, and mucus formed by the sinuses mucosae drains into
the nasal cavity.
- Mucosa helps to warm and humidify incoming air.
- The paranasal sinuses lighten the skull and enhance the resonance of the voice.

Bones Of The Nasal

Ethmoid
Frontal sinus

Nasal bone

Perpendicular plate of
ethmoid bone Septal
cartilage

Vomer
Palatine bone Alveolar margin of
Palatine process of maxilla
maxilla
(b)

The Vertebral Column

- Composed of 33 bones (70 cm long), 24 remain separate for flexibility and 9 fuse to form two
composite bones: the coccyx and the sacrum.
- There are:
- 7 cervical vertebrae (C1–C7);
- 12 thoracic vertebrae (T1-T12);
- 5 lumbar vertebrae (L1-L5);
- 5 sacral vertebrae (fused);
- 4 coccygeal vertebrae (fused).

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Function of the spine:
• Transmits the weight of the trunk to the lower limbs;
• Surrounds and protects the spinal cord;
• Provides an attachment point for the ribs and for the muscles of the back and neck.
There are five major regions, with four curvatures providing a sinusoid shape.
• Cervical and lumbar curvature → Concave posteriorly.
• Thoracic and sacral curvatures → Convex posteriorly.
Curvatures increase the resilience and flexibility of the spine, allowing it to function
as a spring rather than a rigid rod.

Ligaments → Provide cable-like supports for the vertebral column alongside muscle.
• Anterior and posterior longitudinal ligaments → Continuous bands down
the front and back surfaces of the vertebrae from neck to sacrum.
- The broad anterior ligament is attached to both the bony
vertebrae and disc.
- Prevents hyperextension of the back (bending backward).
- The posterior ligament → Is narrow and weak.
- Resists hyperflexion of the spine (bending forward).
- Attaches only to the discs.
- Ligamentum flavum → Connects adjacent vertebrae, contains elastic
connective tissue and is especially strong.
- Stretches as we bend forward and recoils to assume posture.
- Short ligaments → Connect each vertebra to those immediately above and
below

Intervertebral discs → A cushion-like pad composed of two parts.

- Nucleus pulposus → An inner gelatinous center of the disc providing
Anterior view Right lateral viei
elasticity and compressibility.
- Annulus fibrosis → Surrounding the nucleus pulposus, a strong collar composed of collagen fibers
superficially and fibrocartilage internally.
- Limits the expansion of the nucleus pulposus when the spine is compressed.
- Acts like a woven strap to bind successive vertebrae together, withstanding twisting
forces, and resisting tension in the spine.
- Discs are thickest in the lumbar and cervical regions, to enhance flexibility.

NORMAL CURVATURES
• resilience & flexibility cervical &
lumbar: concave thoracic & sacral:
convex
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- Function of vertebral discs:
• Act as shock absorbers during walking, jumping, and running;
• Allow the spine to flex, extend, and sort of bend laterally;
• At point of compression, the discs flatten and bulge out between the vertebrae.
- Discs account for 25% of the height.
- They flatten during the day and extend during the night due to compression.
- Herniated (prolapsed) disc → Severe or sudden trauma to the spine may involve the rupture of
the annulus fibrosus followed by the protrusion of the spongy nucleus through the annulus.
- The protrusion presses on the spinal cord or spinal nerves causing numbness or pain.
- Only treated surgically if other treatments fail.

Fig. 7-18 ABNORMAL SPINAL CURVATURES

(a) Scoliosis (b) Kyphosis (c) Lordosis

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Scoliosis → An abnormal rotation of the spine that results in a lateral curvature, most often in the thoracic region which is common
in late childhood.
- Treated with bracing, but more severe cases require surgery.

Kyphosis → Hunchback, a dorsally exaggerated thoracic curvature due to osteoporosis, tuberculosis of the spine, rickets, or
osteomalacia.

Lordosis → An accentuated lumbar curvature, caused by those carrying a heavy frontal load.

Structure of Vertebrae
- Vertebral body (centrum) → Anterior body of the vertebrae.
- Vertebral arch → Posterior curvature of the disc-shaped body, the weight bearing region.
- The body and vertebral arch enclose an opening, the vertebral foramen.
- Successive vertebral foramina of the articulated vertebrae form the long vertebral canal, through which the
spinal cord passes.
- Composed of two pedicles and two laminae :
• Pedicles → Short bone pillars projecting posteriorly from the vertebral body, forming the sides of the
arch.
○ Pedicles have notches on the superior and inferior border, providing lateral openings between
adjacent vertebral, intervertebral foramina.
■ Spinal nerves from the spinal cord issue from the foramina.
• Laminae → Flattened plates that fuse in the median plane, complete the arch posteriorly.
- Spinous process → A median posterior projection arising at the junction of the two laminae.
- Transverse process → Extends laterally from each side of the vertebral arch.
- Spinous and transverse processes are attachment sites for muscles that move the vertebral column and ligaments
that stabilize it.
- Superior and inferior articular processes → Protrude superiorly and inferiorly from the pedicle-lamina junctions.
- Form smooth joint surfaces of the articular processes called facets, they are covered in hyaline cartilage.
- Inferior processes of each vertebrae form movable joints with the superior processes of the vertebrae
immediately below.
- Successive vertebrae join both at the bodies and articular processes.
Postsrior

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Cervical Vertebrae
• Typical cervical vertebrae (C3–C7) have the following characteristics:
• The body is oval – wider from side to side.
• Except in C7, the spinous process is short, projects directly back, and is bifid (split at tip).
• The vertebral foramen is large and triangular.
• Each transverse process contains a transverse foramen through which the vertebral arteries pass to service the
brain.
- C7 – the spinous process is not bifid and is much larger than those of the other cervical vertebrae, palpable through the
skin.
- Called the vertebra prominens.
- C1 – The Atlas is more robust than typical cervical vertebrae with no intervertebral disc and are highly modified to
specific functions.
• No body;
• No spinous process;
• It is a ring of bone consisting of anterior and posterior arches and a lateral mass on each side of the ring.
○ Each lateral mass has articular facets on superior and inferior sides.
• The superior articular facets receive the occipital condyles of the skull.
○ The joints allow the head to nod.
• Inferior articular facets form joints with the Axis (C2).
- C2 – The Axis which has a body and the other typical vertebrae, is not as specialized as the atlas.
• Contains a knoblike dens projecting superiorly from the body.
○ The Dens → A missing body of the atlas, which fuses to the axis during embryonic development.
■ Acts as a pivot for the rotation of the atlas.
■ This joint is the one that allows you to rotate the head side-to-side.
■ It is cradled in the anterior arch of the atlas by the transverse ligament.

Posterior
Posterior tubercle
Posterior arch
Inferior
articular
Transverse facet
process
Lateral
masses

Anterior
arch
Facet for dens
Anterior tubercle
(b) Inferior view of atlas

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(c) Superior view of axis (C^)

Decs of ans
Transverse Eoament Superior
Transverse
of anas process process articular
C, (atlas]
Transverse costa
C- (SKIS] facet (for tubercle of rib]

nfenor articijlar Intervertebral d sc

process
Bifid spinous
process
Inferior costa facet
Trariaveise processes Spinous (for head of
process rib]
> Inferior articular
C, (vertebra process
prominens]

Superior
articular
process

process Intervertebral
disc

inferior articular
process
5^ Spinous

process

(cl Lumbar vertebrae

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on

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Thoracic Vertebrae
- The first thoracic vertebra looks much like C7, the last four show a progression towards lumbar vertebral
structure.
- The thoracic vertebrae increase in size from the first to the last.
- All thoracic vertebrae articulate with the ribs.
• Unique characteristics of the vertebrae include:
• The body is roughly heart shaped.
○ It bears two small facets (demifacets) on each side, one on the superior (superior costal
facet) and inferior (inferior costal facet) edge.
○ The demifacets receive the heads of the ribs.
• The vertebral foramen is circular.
• The spinous process is long and points downward.
• The transverse processes have facets, the transverse costal facets, that articulate with the
tubercles (round processes of the ribs).
○ Except for T11 and T12.
• The superior and inferior articular facets lie on the frontal plane limiting flexion and extension, but
allowing the thorax to rotate.
○ Lateral flexion is limited by the ribs.

Spinous process
Superior articular--- Superior
Transverse process and facet costal facet
Vertebral process (for head
foramen Transvers
e process

Transverse
- costal
Transverse facet (for
costal facet tubercle of
(for tubercle rib)
of Inferior '—Inferior
Superior costal notch facet (for
articular head of rib)
Superior costal
process
facet (for head Spinous
and facet
of rib) process

Body Table 7.2 b

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Lumbar Vertebrae
- The lumbar receives the most stress of the vertebral column.
- The enhanced weight-bearing function of the five lumbar vertebrae (L1-L5) is reflected by their
sturdier structure.
- Characteristics include:
• Their bodies are massive and kidney shaped.
• The pedicles and laminae are shorter and thicker than those of other vertebrae.
• The spinous processes are short, flat, and hatchet shaped and are easily seen when a person
bends forward.
○ The projections are robust and project directly backward, adaptations for the attachment
of the large back muscles.
• The vertebral foramen is triangular.
• The orientation of the facets of the articular processes differ from other vertebrae types.
○ The modifications lock the lumbar vertebrae together and provide stability by preventing
rotation of the lumbar spine.
○ Flexion and extension are possible, as is lateral flexion.

(4) orientation of inferior & superior facets unique - curved; sup faces in & inf
faces out

Spinous process Transverse

Superior process
articular
Body
process

Inferior notch

Inferior articular
Spinous
process and facet
process

Vertebral canal
Sacrum
- The sacrum shapes the posterior wall of the pelvis, it is formed by five fused vertebrae (S1-S5).
- It articulates superiorly (superior articular processes) with L5 and inferiorly with the coccyx.
- Laterally, the sacrum articulates (auricular surfaces) with the two hip bones to form the sacroiliac
joints of the pelvis.
- Sacral promontory → The anterosuperior margin of the first sacral vertebra bulges anteriorly into the
pelvic cavity.
- Four ridges, the transverse ridges, cross its concave anterior aspect, marking the lines of fusion of
the sacral vertebrae.
- Anterior sacral foramina → Lateral ends of the ridges and transmit blood vessels and anterior
rami of the sacral spinal nerves.
- The regions lateral to these foramina expand superiorly like wings called alae.
- Median sacral crest → The fused spinous processes of the sacral vertebrae that is flanked laterally by the
posterior sacral foramina.
- Lateral sacral crests → Remnants of the transverse processes of S1-S5.
- Sacral canal → The continuation of the vertebral canal.
- The laminae of the fifth sacral vertebrae often fail to fuse medially, they form an enlarged external
opening called the sacral hiatus.

Coccyx
- Coccyx → A small triangular bone consisting of four (maybe three or five) vertebrae fused together, which
articulates superiorly with the sacrum.
- Except for slight support to pelvic organs, it is nearly useless.

(a) Anterior view (b) Posterior view

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The Thorax and Sternum
- The Thorax → The chest and its bony underpinnings called the thoracic cage or bony thorax.
- Includes: the thoracic vertebrae, ribs laterally, the sternum, and costal cartilages.
- The costal cartilages secure the ribs to the sternum.
- Roughly cone shaped with its broad dimensions positioned inferiorly, the bony thorax:
• Protects the vital organs (heart, lungs, blood vessels);
• Supports the shoulder girdles and upper limbs;
• Provides attachment points for many muscles of the neck, back, chest, and
shoulders.
- Intercostal spaces → Spaces between the ribs, occupied by intercostal muscles, which lift and depress the
thorax during breathing.
- Sternum → Lies in the anterior midline of the thorax, a flat bone resulting from the fusion of three bones:
• Manubrium → The superior portion of the sternum.
○ Articulates with the clavicles via the clavicular notches.
○ Articulates with the first two pairs of ribs.
• Body (midportion) → Forms the bulk of the sternum.
○ Articulates with the costal cartilages of the 2nd to 7th ribs.
• Xiphoid process → forms the inferior end of the sternum.
○ Variably shaped processes made of a plate of hyaline cartilage, begins to ossify in adults
over 40 years of age.
○ Articulates only with the sternal body.
○ Serves as an attachment point for abdominal muscles.
The sternum has three important anatomical landmarks:
Jugular (suprasternal) notch → The central indentation in the superior border of the manubrium.
○ In line with the disc between the second and third thoracic vertebrae and the point where the
left common carotid artery branches from the aorta.
Sternal angle → Felt as a horizontal ridge across the sternum, where the manubrium joins the
sternal body.
Cartilaginous joint acts as a hinge, allowing the sternal body to swing anteriorly when we
inhale.
In line with the disc between the 4th and 5th thoracic vertebrae and at the level of the 2nd
pair of ribs.
Xiphisternal joint → The point where the sternal body and
xiphoid process fuse.
It lies at the level of the ninth thoracic vertebra.
The heart lies on the diaphragm just deep to the
joint.

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Ribs
- Twelve pairs of ribs form the flaring sides of the thoracic
cage.
- All ribs attach posteriorly to the thoracic
vertebrae (bodies and transverse processes) and
curve inferiorly toward the anterior body surface.
- Vertebrosternal (true) ribs → The superior seven rib
pairs attaching directly to the sternum by individual costal

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 cartilages.
- Anatomical name gives the posterior attachment point the first name.
- False ribs → Either attach indirectly to the sternum or entirely lack a sternal attachment.
- Vertebrochondral ribs → Rib pairs 8-10 attacking to the sternum indirectly, each joining the
costal cartilage immediately above it.
- Costal margin → Formed by the costal cartilages of ribs 7-10.
- Vertebral (floating) ribs → Rb pairs 11-12 have no anterior attachments, costal cartilages lie
embedded in the muscles of the lateral body wall.
• A rib is a bowed flat bone.
• Shaft → The bulk of the rib with a smooth superior portion and sharp thin inferior border.
○ Costal groove → Loges the intercostal nerves and blood vessels.
• Head → Wedge-shape articulating with the vertebral bodies by two facets:
○ One joins the body of the same-numbered thoracic vertebra;
○ The other articulates with the body of the vertebra immediately superior.
• Neck → The constricted portion of the rib just beyond the head.
• Tubercle → The knoblike lateral button that articulates with the costal facet of the transverse
process of the same-numbered thoracic vertebra.
○ The shaft then angles sharply forward and then extends to attach to its costal cartilage
anteriorly.
- The costal cartilage provides a secure but flexible rib attachment to the sternum.
- The first pair of ribs is atypical, they are flattened superiorly to inferiorly and are quite broad
forming a table that supports the subclavian blood vessels.
- Rib 1 and Rib 10-12 – articulates with only one vertebral body.
- Rib 11-12 – Do not articulate with a vertebral transverse process.

Appendicular Skeleton
- Appendicular Skeleton → Bones of the limbs and their girdles, referred to as appendicular because they
are appended to the axial skeleton.
- Pectoral girdles → Attach the upper limbs to the body trunk.
- Pelvic girdle → Secures the lower limbs, more sturdy.
- Each limb is composed of three major segments connected by moveable joints.

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 - The appendicular skeleton enables us to carry the movement typical of our lifestyles.
- Pectoral (shoulder) girdle → Consists of the clavicle anteriorly and the scapula posteriorly.
- Girdle → A belt like structure that encircles the body with their associated muscles forming the
shoulders.
- The medial end of each clavicle joins the sternum; the distal ends of the clavicles meet the
scapulae laterally.
- The scapulae fail to complete the ring periotorly, their medial borders do not join each
other or the axial skeleton.
- Scapula → Attached to the thorax and vertebral column only by the muscles that clothe their
surfaces.
- The pectoral girdles attach the upper limbs and provide attachment points for many of the
muscles moving the upper limbs.
- The girdles are light and allow mobility not seen elsewhere in the body.
- Mobility is due to the following factors:
• Only the clavicle attaches to the axial skeleton, the scapula can move freely across the
thorax, allowing the arm to move with it.
• The socket of the shoulder joint (scapula’s glenoid cavity) is shallow and
poorly reinforced so it does not restrict the movement of the humerus.
○ Although it’s good for flexibility, it is bad for stability.
- Clavicles → Collarbones that extend horizontally across the superior thorax.
- Clavicles act as braces:
• Hold the scapulae and arms out laterally, away from the narrower superior part of the
thorax.
• Anchor muscles of the back and neck.
• Transmit compression forces from the upper limbs to the axial skeleton.
- At the medial sternal end, the clavicle attaches to the sternal manubrium and flattened at the
lateral acromial end.
- Two thirds of the clavicle is convex anteriorly.
- Superior surface is smooth; the inferior surface is rigid, but grooved by ligaments and
by the action of the muscles that attach to it.
- Trapezoid line and the conoid tubercle are anchoring points for a ligament that connects the
clavicle to the scapula.
- The clavicle is weak and likely to fracture.
- It is exceptionally sensitive to muscle pull and becomes larger and stronger in those who
perform manual labor involving arm and shoulder muscles.
- Curvature of the clavicle ensures an outward fracture away from the subclavian artery.

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 - Scapulae → Thin, triangular flat bones, which lie dorsally on the surface of the rib cage, between ribs 2 and
7, with three borders:
• Superior border → The shortest, sharpest border.
• Medial (vertebral) border → Parallels the vertebral column.
• Lateral (axillary) border → Next to the armpit and ends superiorly in the shallow fossa of the
glenoid cavity.
○ The glenoid cavity articulates with the humerus, forming the shoulder joint.
- The scapula has three corners (angles):
• Superior angle → Where the superior scapular border meets the medial border.
• Lateral angle → Where the lateral border meets the glenoid cavity.
• Inferior angle → Where the lateral and medial borders join.
- Scapular spine → Posterior surface of the scapula,projecting laterally.
- Acromion → The enlarged, roughened, lateral triangular projection of the end of the spine.
- Acromioclavicular joint → The point at which the acromion articulates with the acromial end of
the clavicle, forming a joint.
- Coracoid process → Projection anteriorly from the superior
scapular border.
- Helps anchor the bicep muscle of the arm.
• Suprascapular notch → A nerve passage that binds the
coracoid process medially and the glenoid cavity laterally.
- The fossa of the scapulae:
• Infraspinous and supraspinous fossae → Inferior and
superior to the spine.
• Subscapular fossa → The shallow concavity formed by the
entire anterior scapular; surface lying with them are muscles
with similar names.
Arm Bones
- 30 separate bones form the framework of each upper limb.
- Humerus → The sole bone of the arm (a long bone) which articulates with the scapula at the
shoulder and with the radius and ulna (forearm bones) at the elbow.
- Head → The proximal end of the humerus, which fits into the glenoid cavity of the scapula, allows
the arm to hang.
- Anatomical neck → Inferior to the head, slightly constricted.
- Greater tubercle and lesser tubercle → Lateral and medial which are separated by the
intertubercular sulcus (bicipital groove).
- The tubercles are sites of attachment for the rotator cuff muscles .
- The intertubercular sulcus guides a tendon of the biceps to the arm to the attachment point
at the rim of the glenoid cavity (supraglenoid tubercle).
- Surgical neck → Distal to the tubercles, named due to it's the most frequently fractured part of
the humerus.
- Deltoid tuberosity → V-shaped roughened attachment down the shaft on its lateral side for the
deltoid muscle of the shoulder.
- Radial groove → Runs obliquely down the posterior aspect of the shaft, marking the course of the
radial nerve.
- At the distal end of the humerus are two condyles:
• Medial trochlea → An hourglass looking shape tipped on its side.
• Capitulum → The lateral ball-like piece.
- The condyles articulate with the ulna and the radius respectively.
- The condyle pair is flanked by:
• Medial and lateral epicondyles → Muscle attachment sites.
- Directly above the epicondyles are the medial and lateral supracondylar ridges.
- Funny bone sensation → The ulnar nerve which runs behind the medial epicondyle.
- The fossa of the humerus:
- Coronoid fossa → Superior to the trochlea on the anterior surface.
- Olecranon fossa → Posterior surface, the deeper fossa.
- The two depressions allow the corresponding processes of the ulna to move freely when
the elbow is flexed and extended.

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 - When you rotate the forearm so the palm faces posteriorly (pronation), the distal end of the radius
crosses over the ulna forming and X.
- Ulna → Slightly longer than the radius, it has the main responsibility for forming the elbow joint with the
humerus.
- It bears two prominent processes, the olecranon (elbow) and the coronoid process.
- The two processes are separated by a deep concavity, the trochlear notch.
- The two processes grip the trochlea of the humerus, forming a hinge joint that allows the
forearm to be bent (flexed) or straightened (extended).
- Radial notch → The lateral side of the coronoid process, a small depression where the ulna
articulates with the head of the radius.
- Head → Distally, the ulnar shaft narrows and ends in a knob structure.
- Ulnar Styloid process → Medial to the head, from which a ligament runs to the wrist; the
head is separated from the bones of the wrist by a disk of fibrocartilage - Plays little or no role
in hand movement.
- Radius → Thin at the proximal end and wide at the distal end – opposite of the ulna.
- The head → Shaped like a nail, the superior surface is concave and articulates with the capitulum
of the humerus
- Medially, the head articulates with the radial notch of the ulna.
- Radial tuberosity → Anchors the biceps muscle of the arm.
- Ulnar notch → Articulates with the ulna where the radius is expanded.
- Radial styloid process → An anchoring site for ligaments that run to the wrist.
- The radius is concave where it articulates with the carpal bones of the wrist.
- The ulna contributes more heavily to the elbow joint, the radius contributes to the wrist joint; when
the radius moves, the hand moves with it.
- Colles’ fracture → A break at the distal end of the radius, common when a person is falling and attempts to
break the fall with outstretched hands.

Coronoid
fossa

Medial
epicondyle

Trochlea
Coronoid
process of
ulna
Radial notch
Ulna

(c) Anterior view at the elbow (d) Posterior view of extended elbow
region

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 Ulnar notch of radius
(e) Distal ends of the radius and ulna at the
wrist

The Hand
- The 27 skeleton bones of the hand includes:
• Carpus → Bones of the wrist.
• Metacarpus → Bones of the palm.
• Phalanges → Bones of the fingers.

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- Functions:
• Attaches the lower limbs to the axial skeleton;
• Transmits the full weight of the upper body to the lower limbs;
• Supports the visceral organs of the pelvis.
- The hip bones are secured to the axial skeleton by some strong ligaments.
- The sockets of the pelvic girdle are deep and cuplike, firmly securing the head of the femur in
place.
- The pelvic girdle lacks the mobility of the pectoral girdle, but is far more stable.
- Irregularly shaped hip bones consist of three separate bones during childhood:
• Ilium → A large bone of the superior region of the hip consisting of a body and a winglike portion
called the ala.
○ Iliac crests → Superior margins of the alae to which muscles attach, each crest ends
anteriorly in the:
■ Blunt anterior superior iliac spine → Pointed projection.
■ Sharp posterior superior iliac spine → A sharp pointed projection.
○ Below the anterior superior iliac spines:
■ Anterior inferior iliac spines.
■ Posterior inferior iliac spines.
○ The spines are attachment points for the muscles of the trunk, hip and thigh.
■ Greater sciatic notch → Inferior to the posterior inferior iliac spine, the ilium
indents deeply through which the thick sciatic nerve passes to enter the thigh.
■ Gluteal surface → The broad posterolateral surface of the ilium crossed by the
three ridges:
• Posterior, anterior, and inferior gluteal lines: The gluteal (buttock)
muscles attach.
○ Fossa of the iliac alae:
■ Iliac fossa → Medial surface of the iliac ala exhibiting a concavity.
■ Auricular surface → Articulates with the same named surface of the sacrum,
forming the sacroiliac joint.
• The weight of the body is transmitted from the spine to the pelvis
through these joints.
■ Arcuate line → Robust ridge running inferiorly and anteriorly from the auricular
surface.
• Helps define the pelvic brim, the superior margin of the true pelvis.
• The body of the ilium joins the pubis; inferiorly it joins the ischium.
• Ischium → Posteroinferior part of the hip bone.
○ Superior body joining the ilium;
○ Inferior thinner part joining the ramus (a branch of bone).
○ Ischial tuberosity → The inferior surface of the ischial body, when we sit our weight is
borne by the tuberosity.
■ The tuberosity is the strongest part of the hip bones.
• Pubis → Anterior part of the ox cosa which unite at the pubic symphysis joint.
○ It lies nearly horizontally, the urinary bladder rests upon it.
○ Pubic crest → The anterior border of the pubis is thickened, upon which is the pubic

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 tubercle, one of the attachments for the inguinal ligament.
○ Obturator foramen → The two rami of the pubis join with the body and ramus
of the ischium, a large opening through which blood vessels and nerves pass.
■ The obturator foramen is nearly closed by a fibrous membrane.
○ Pubic arch (subpubic angle) → The V-shaped formation that helps differentiate between
male and female pelves.
- In adults, these bones are firmly fused and boundaries indistinguishable.
- Acetabulum → The point of fusion of the ilium, ischium, and pubis, a deep hemispherical
socket; on the lateral surface of the pelvis.
- Receives the head of the femur.

Iliac crest
Sacroiliac joint
Anterior
superior iliac
spine

Sacral promontory
Hip bone
(coxal bone Anterior inferior
or os coxae) iliac spine Pelvic
brim

Acetabulum
Pubic tubercle
Pubic crest Pubic
symphysis

- False pelvis → The portion of the pelvic brim that is bounded by the alae of the ilia laterally and the
lumbar posteriorly.
- Part of the abdomen and helps support abdominal viscera, it doesn’t restrict childbirth.
- True pelvis → The region inferior to the pelvic brim that is almost entirely surrounded by bone; it forms a
deep bowl containing the pelvic organs.

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The Thigh
- The lower limbs carry the entire weight of the erect body and are subjected to exceptional force.
- The three segments of the lower limb:
• The thigh → made up of the femur, the single bone of the thigh which is the largest, longest,
strongest bone in the body.
○ The femur is surrounded by muscle, it articulates with the hip bones and then courses
medially as it descends towards the knee.
■ Allows the knee joint to be closer to the body’s center of gravity and provides for
better balance.
■ The medial course is more pronounced in women because of the wider pelvis, a
situation contributing to greater knee problem incidence.
○ Head → The proximal part of the femur containing a central pit, the fovea capitis, which
secures the femur with the short ligament of the head of the femur.
■ The ligament runs from the pit to the acetabulum
○ The head is carried on the neck that angles laterally to join the shaft.
■ Reflects the fact that the femur articulates with the lateral aspect of the pelvis
(rather than inferior region).
■ WEAKEST part of the femur and is often fractured: called a broken hip.
○ Greater and Lesser Trochanters → Serve as attachment sites for thigh and buttock
muscles
○ Gluteal tuberosity → Blends into a long vertical ridge, the linea aspera from the
intertrochanteric crest.
○ Lateral and medial condyles → Articulate with the tibia of the leg.
○ Medial and lateral epicondyles → Sites of muscle attachment, which flank the condyles
superiorly.
■ Patellar surface → Between the condyles on the anterior femoral
surface, articulates with the patella (knee cap).
■ Patella → Triangular sesamoid
bone enclosed in the quadriceps
tendon that secures the anterior
thigh muscle to the tibia.
The leg → Two parallel bones, the tibia and fibula,
form the skeleton of the leg and the region between
the knee and ankle.
○ The bones are connected by an interosseous
membrane and articulate with each other
Anterior Patella
proximally and distally.
■ The tibiofibular joints allow Facet for lateral
essentially no movement. condyle of femur
○ Tibia → Transfers weight from femur to
foot, next largest and strongest.
■ Forms the knee joint, with medial
and lateral condyles.
■ Anterior border → The sharp
border of the medial surface
which is not covered by muscle.

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 ■ Tibial tuberosity → The tibia’s anterior surface that is rough, to which the
patellar ligament attaches.
○ Fibula → articulates with the tibia proximally, distally with the lateral aspects.
■ Does not bear weight.
■ Muscles originate from it.
○ Medial malleolus → Forms the medial bulge of the ankle.
○ Lateral malleolus → Forms the lateral ankle bulge and articulates with the talus.
• The foot → A total of 26 bones including:
○ Tarsus (ankle bone) → 7 bones called the tarsus.
■ Calcaneus (heel bone) → The largest bone.
■ Talus (ankle bone) → Second largest bone, part of the ankle joint.
○ Metatarsus → 5 small long bones, numbered I to V beginning on the medial (great toe) side
of the foot.
■ The big toe plays an important role in supporting body weight, is short and thick.
■ The metatarsals articulate with the proximal phalanges of the toes, the enlarged
head of the first metatarsal forms the ball of the foot.
○ Phalanges → The 14 phalanges of the toes are smaller than those of the finger and are less
nimble.
■ Big toe is referred to as the HALLUX, it has the proximal and distal phalanx.
■ The other toes have the proximal, middle, and distal phalanx.

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 Back to Top

Anatomy and Physiology of Joints

Classification of Joints
- Joints are a site where 2 or more bones meet.
- Classified by their structure (the material binding bones together and whether there’s a joint cavity)
as well as function (the amount of movement allowed).
- Structure:
• Fibrous → Immovable joints.
• Cartilaginous → Both rigid and slightly movable.
• Synovial → The only joint class that has a joint cavity, it is freely moveable.
- Function:
• Synarthroses → Immovable joints.
• Amphiarthrosis → Slightly movable joints.
○ Largely restricted to the axial skeleton.
• Diarthroses → Freely movable joints.
○ Predominant in the appendicular skeleton.
- The less movable the joint, the more stable it is likely to be.
- Arthro prefix indicates that it is a JOINT.

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 Fibrous Joints
- Bones are joined by the collagen fibers of connective tissue.
- There is no joint cavity present, the amount of movement depends on the length of the connective tissue
fibers.
- Some allow for slight movement, most are immovable.
• Sutures (Synostoses) → Includes the sutures, the junction is completely filled by short connective tissue
fibers continuous with the periosteum.
○ Allow the skull to expand.
○ The fibrous tissues slowly ossify and skull bones fuse together.
■ Closed sutures are called synostoses.
○ Immovable structures.
• Syndesmoses → Bones are connected by ligaments, cords, or bands of fibrous tissue.
○ The amount of movement depends on the length of the fibers.
■ Short fibers have minimal movement like in those of the distal ends of the tibia.
■ If fibers are long (interosseous membrane of the radius and ulna), a large amount of
movement is possible.
• Gomphoses → The only example is the articulation of a tooth with its bony alveolar socket.
○ The fibrous connection in this case is a short periodontal ligament.

Suture Syndesmosis

Joint held together with very short, Joint held together by a ligament. Fibrous “Peg in socket” fibrous joint. Periodontal ligament
interconnecting fibers, and bone edges interlock. tissue can vary in length, but is longer than in holds tooth in socket.
Found only in the skull. sutures.

fibrous
connective
tissue ligament

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Cartilaginous Joints
- Cartilaginous joints → The articulating bones are united by cartilage.
- They lack a joint cavity and are not highly moveable.
- Two types of cartilaginous joints:
• Synchondroses → a bar or plate of hyaline cartilage that unites bones, they are all synarthrotic
(immovable).
○ Ex. Epiphyseal plates in long bones.
■ Temporary joints that eventually become synostoses.
○ Ex. Costal cartilage of the first rib and manubrium.
■ An immovable joint.
• Symphyses → A joint where fibrocartilage unites the bones, it is compressible and resilient, acting as
a shock absorber and permitting limited movement.
○ Hyaline cartilage is also present in the form of articular cartilages on the bony surfaces.
○ Symphyses are amphiarthrotic joints designed for strength and mobility.
■ Ex. Intervertebral joints and the pubic symphysis.

(a) Synchondroses
Bones united by hyaline cartilage

Sternum
(manubrium)
Epiphyseal plate
(temporary Joint between first
hyaline cartilage rib and sternum
joint) (immovable)

{b} Symphyses
Bones united by fibrocartilage

Body of vertebra

Fibrocartilaginous
intervertebral disc
(sandwiched between Pubic symphysis
hyaline cartilage)

Synovial Joints
- Synovial Joints → Articulate bones that are separated by a fluid-containing joint cavity.
- Permits freedom of movement, diarthroses.
- Most joints of the body are in this class.
- General structure:
• Articular cartilage → Covers opposing bone surfaces, cushioning that absorbs compression
placed on the joint, preventing bone crushing.
• Joint (articular) cavity → Contains a small amount of synovial fluid, a potential space because it

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 is normally nonexistent, can expand if fluid accumulates (inflammation).
• Articular capsule → Two-layered capsule consisting of:
○ Fibrous layer → dense irregular connective tissue, continuous with the periostea of the
articulating bones (strengthen bones).
○ Synovial membrane → Secretes synovial fluid and is composed of loose connective tissue.
■ It covers all internal joint surfaces that are not hyaline cartilage.
• Synovial fluid → Slippery fluid that occupies free spaces within the joint capsule, largely derived
from filtered blood through capillaries in the synovial membrane.
○ Reduces friction between cartilages.
○ Also contains phagocytic cells that rid the joint cavity of microbes and cellular debris.
• Reinforcing ligaments → Restrict the movement of joints and reinforce them.
○ Some synovial joints have fatty pads for cushioning (hip and knee) or articular discs to
improve fit (knee/jaw joints) between the fibrous layer and synovial membrane or bone.
• Nerves and blood vessels → Richly supplied with sensory fibers that innervate the capsule.
○ Blood vessels supply the synovial membrane.

ig. 8.3: General structure of a synovial joint

Bursae and Tendon Sheaths
- Not strictly part of synovial joints, but often found closely associated.
• Bursae → Flattened fibrous bags of lubricant that reduce friction between adjacent structures during
joint activity.
- They are lined with synovial membrane and contain a film of synovial fluid.
- Found where ligaments, muscles, skin, tendons, or bones, rub together.
• Tendon sheath → An elongated bursa that wraps completely around a tendon subjected to friction.
- Common where several tendons are crowded together (wrist).
- A bunion → An enlarged bursa at the base of the big toe that may misalign the toes.

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Factors that Influence Stability of Synovial Joints
- Synovial joints allow for lots of movement.
- They are the weakest parts of the skeleton, and not as stable as fibrous or cartilaginous joints;
nonetheless, they undergo compression.
- Joints must be stabilized or they will dislocate.
- Stability is dependent on:
• Articular surface shape → Play a minor role in joint stability; when articular surfaces are large
and fit together (deep ball and socket joints) , stability is improved.
• The number and positioning of ligaments → Capsules and ligaments prevent excessive motion;
the more ligaments, the stronger the joint.
○ Stretched ligaments stay stretched; they can only stretch 6% of its length before snapping.
○ When ligaments are the major means of bracing, the joint is not stable.

• Muscle tone → The muscle tendons crossing joints are an important stabilizing factor.
○ Tendons are kept under tension by tone of the muscles.
■ The low levels of contractile activity in related muscles that keep muscles healthy
and ready to react to stimulation.
○ Muscle tone reinforces the shoulder, knee joints, and arches of the foot.

Joint Injuries
- Cartilage injuries → Usually the knee – cartilage has no blood supply and self-repairs very slowly; pieces
break off and interfere with joint function.
- Requires arthroscopic surgery.
- Dislocations → Bones are forced out of their normal positions at a joint.
- Need to be reduced; repeat dislocations are common because joint capsules and ligaments get
stretched with each injury.

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 - Sprains → Partially torn ligaments that repair slowly due to poor vascularization.
- Completely torn ligaments require surgery.

Movement of Joints
- Origin → The muscle’s attachment to the immovable (or less movable) bone.
- Insertion → Attached to the movable bone.
- Body movement occurs when muscles contract across joints and their insertion moves toward the
origin.
- Movements are described relative to lines or axes:
- Transverse plane;
- Frontal (coronal) plane;
- Sagittal plane.
- Nonaxial movement → Gliding movements only.
- Uniaxial movement → Movement in one plane.
- Biaxial movement → Movement in two planes.
- Multiaxial → Movement in or around all three planes of space and axes.
- Three types of movements:
• Gliding movement → Occurs when on flat bone surface glides or slips over another without
appreciable angulation or rotation (intercarpal joints).
• Angular movement → Increase or decrease the angle between two bones (any plane of the body)
including:
○ Flexion → Bending movement, usually along the sagittal plane that decreases the angle of
the joint and brings bones closer together.
○ Extension → Reverse of flexion, moves along the sagittal plane increasing the angle
between articulating bones; straightens the bones.
■ Hyperextension → Movement beyond anatomical position.
○ Abduction → Movement away from the midline along the frontal plane.
■ Not referring to lateral bending of the trunk called lateral flexion.
○ Adduction → Movement of a limb toward the body midline.
○ Circumduction → Moving a limb so it describes a cone in space.
■ Limb moves in a circle, like a pitcher winding up to throw a ball.

• Rotation → The turning of a bone around its own axis.

○ Only movement allowed between the first two cervical vertebrae and common at the hip and
shoulder joints.
■ May be directed towards the midline or away.
■ Medial rotation of the high.
■ Lateral rotation is the opposite movement.
• Special Movements → Movements that do not fit into the categories above and only occur at a few
joints.
○ Supination and Pronation → Movement of the radius around the ulna.
■ Supination → The radius and ulna are parallel (palm upward).
■ Pronation → Radius rotates over ulna crossing over (palm down).
○ Dorsiflexion and Plantar flexion → movement of the foot up (dorsiflexion)
– wrist extension, and down (plantar flexion) – wrist flexion.

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○ Inversion and Eversion → Sole of the foot turns medially (inversion) and sole of the
foot faces laterally (eversion).
○ Protraction and Retraction → Non-angular anterior and posterior movements in a
transverse plane.
■ The mandible is protracted when you just out the jaw.
■ The mandible is retracted when you bring it back.
○ Elevation and Depression → Lifting the body part superiorly or inferiorly (the mandible
moves inferiorly and superiorly).
○ Opposition → The saddle joint between metacarpal I and the trapezium allows the thumb
to touch the tips of other fingers.

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 Special
movements.

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Types of Joints
1) Plane joint (nonaxial movement)
2) Hinge joint (uniaxial movement)
3) Pivot joint (uniaxial movement)
4) Condyle joint (biaxial movement)
5) Saddle joint (biaxial movement)
6) Ball-and-socket joint (multiaxial movement)

REFER TO PAGE 262-263 FOR IMAGES OF THE ABOVE JOINT TYPES

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