Chapter 7 The Skeleton

I. Skull A. General 1. Rests on the superior end of the vertebral column 2. Contains 22 bones a. cranial bones 8 bones enclose and protect the brain * frontal bone, parietal bones (2), temporal bones (2), Occipital bone, sphenoid bone & ethmoid bone b. facial bones 14 bones * nasal bones (2), maxillae (2), zygomatic bones (2), mandible, lacrimal bone (2), palatine bones (2), inferior nasal conchae (2), and vomer B. Sutures means seam or stitch; immovable joint found only between skull bones; little connective tissue 1. Four prominent ones a. coronal suture between the frontal bone & two parietals b. sagittal suture between the parietal bones c. lambdoidal suture between the parietals and the occipital bones 2. Other sutures names descriptive (e.g. frontonasal suture) 3. Note: review figures C. Fontanels membrane-filled spaces between cranial bones at birth (soft spots); 1. General a. areas of dense connective tissue where intramembranous ossification will occur b. functions * enable fetal skull to compress as it passes through the birth canal * permit rapid brain growth during infancy * facilitate determination of degree of brain development by their state of closure * serve as landmarks (anterior fontanel) for withdrawal of blood from the superior sagittal sinus * aid in determining the position of the fetal head prior to birth 2. Six major fontanels a. anterior (frontal) fontanel between angles of the two parietal bones and frontal bone * diamond shaped & largest * closes in 18 to 24 months b. posterior (occipital) fontanel between parietal bones occipital * diamond shaped & smaller * closes in about two months c. anterolateral ( sphenoidal) fontanels at junction frontal, parietal, temporal, and sphenoid bones * paired, small, and irregular in shape * close in about three months d. posterolateral (mastoid) fontanels at junction of parietal, occipital, and temporal bones * paired, small, and irregular * close in 12 months D. Cranial bones 1. Frontal bone forms forehead, roofs of the orbits, and most of the anterior part of the cranial floor a. supraorbital margin thickening of the frontal bone the forms the roof of the orbit * supraorbital foramen (notch) medial to the orbits midpoint; carries the supraorbital nerve & artery b. frontal sinuses mucus- lined cavities that serve as sound chambers for voice resonance 2. Parietal bones form much of the sides and roof of cranial cavity a. internal surface contains many eminences and depressions for blood vessels to meninx (dura mater) 3. Temporal bones - inferior to parietals & meet them at squamous sutures s a. form inferolateral aspects of skull & parts of cranial floor b. word comes from Latin word temporum in reference to time because gray hair usually appears here first c. complicated shape with four major regions * squamous region upper side # includes zygomatic process of arch (cheekbone) # mandibular fossa articulates with condyle of mandible --temporomandibular joint * tympanic region lower side # surrounds the external auditory meatus # styloid process provides neck muscle attachment site

* mastoid region back, lower side # mastoid process neck muscle attachment # stylomastoid foramen facial nerve exit # mastoid sinuses near inner ear; subject to infection; separated from brain by only thin bone plate * petrous region inferior most area; a bony wedge between sphenoid & occipital # together with sphenoid, form the middle cranial fossa for temporal lobes of brain # also includes the middle & inner ear cavities # many foramina including: -- jugular foramen which allows passage of internal jugular vein & three cranial nerves -- carotid canal just anterior to jugular foramen; transmits internal carotid artery; provides 80% of blood to cerebral hemispheres & passes close to inner ear cavities -- foramen lacerum not important but may see between temporal & sphenoid -- internal auditory meatus superolateral to jugular foramen; transmits the internal auditory artery and cranial nerves VII & VIII 4. Sphenoid bone spans width of cranial floor & a keystone bone (articulates with all other bones) a. a body & three processes: greater wings, lesser wings & pterygoid processes * body # sphenoid sinuses # sella turcica supports pituitary * greater wings # form part of middle cranial fossa # form laterodorsal walls of orbits # form part of external wall of cranium * lesser wings # form part of the anterior fossa of the cranial floor # form part of the medial wall of orbits b. have several important foramina * optic foramen anterior to sella turcica # transmits optic nerve & ophthalmic nerve * superior orbital fissure # transmits cranial nerves that control eye movements * foramen rotundum (base of greater wings) & foramen ovale (posterior to foramen rotundum) transmit branches of cranial nerve V 5. Ethmoid bone complex shape; between sphenoid & nasals a. forms most of bony area between nasal cavity & orbit * horizontal plate superior surface # crista galli projection that anchors brain # cribriform plates has many tiny olfactory foramina which allow nerves to nasal cavity * perpendicular plate inferior part; forms superior part of nasal cavity * perpendicular plate inferior part; forms superior part of nasal septum * lateral masses riddled with ethmoid sinuses # laterally form part or orbit # medially have coiled superior & middle nasal conchae (turbinates) E. Facial Bones- 14 with only the mandible & vomer unpaired; more elongate in men 1. Mandible lower jaw a. body & two upright rami * mandibular angle where body & ramus meet * coronoid process anterior part of ramus where temporalis inserts * mandibular condyle articulates with mandibular fossa of the temporal bone (temporomandibular joint) * alveolar margin of body superior & has alveoli ( sockets) * mandibular symphysis fusion point * mandibular foramina medial surface of each ramus; transmits nerves for tooth sensation # where dentists inject novacaine for lower jaw work * mental foramina lateral aspects of body; transmit nerves to chin 2. Maxillary bones upper jaw; keystone bones since all facial bones except mandible articulate with them a. alveolar margins for upper teeth

b. palatine processes form part of hard palate c. frontal processes form lateral part of nose d. maxillary sinuses largest of paranasal sinuses; from orbits to upper teeth e. articulate laterally with zygomatic bones via zygomatic processes f. inferior orbital fissure transmits cranial nerve V, zygomatic nerve & blood vessels to maxillary and zygomatic regions of face g. infraorbital foramen infraorbital nerve & artery 3. Zygomatic bones (malar) cheek bones and inferolateral margins of orbits a. between temporal & maxillae 4. Nasal bones bridge of nose a. between frontals, maxillae, & perpendicular plate of ethmoid 5. Lacrimal bones minor bones that form part of medial walls of orbits a. lacrimal sulcus transmits tears from eye into nasal cavity 6. Palatine bones hard part of palate posteriorly; small part of orbit and a part of posterolateral wall of nasal cavity 7. Vomer plow-shaped bone in nasal cavity; forms part of nasal septum (discussed more later) 8. Inferior nasal conchae thin, curved bones from lateral wall of nasal cavity below the middle conchae of the ethmoid bone; largest of the 3 pairs of conchae II. Orbits eye sockets A. sockets for eyeball & associated structures B. formed by seven bones of skull: frontal & sphenoid (roof), zygomatic & sphenoid ( lateral wall), maxilla, zygomatic & palatine (floor), and maxilla, lacrimal, ethmoid, & sphenoid (medial wall) B. principle openings: optic foramen (junction of roof & medial wall), superior orbital fissure, inferior orbital fissure, supraorbital foramen, canal for naso lacrimal duct (in nasal bone) III. Hyoid Bone single u shaped bone that is suspended from styloid process of temporal bone A. only axial bone the is free ( doesnt articulate directly with other bones) B. supports the tongue & some of its muscles C. provides attachment points for some muscles of neck & pharynx D. composed of body & two pairs of paired projections, the lesser cornu & greater cornu E. often breaks during strangulation murders IV. Vertebral Column spine A. General 1. along with sternum and ribs forms the trunk of body 2. makes up 2/5 of body height 3. composed of series of bones (vertebrae) & intervertebral discs 4. 71 cm mean in males; 61 cm mean in females 5. functions a. enclose and protect spinal cord b. support head c. points of attachments for ribs & muscles of back d. outlets for nerves via intervertebral foramina B. vertebral types 33 prior to fusion of two groups 1. cervical vertebrae (7) in neck region 2. thoracic vertebrae 12 posterior to thoracic cavity 3. lumbar vertebrae 5 in lower back 4. sacral vertebrae 5 fused to form sacrum in adults 5. coccygeal vertebrae 4 fused to form coccyx C. intervertebral discs between vertebrae 1. annulus fibrosus outer fibrous ring of fibrocartilage 2. nucleus pulposus inner soft pulp, highly elastic 3. functions a. form strong joints b. permit movements c. absorb vertical shock D. Normal curves two convex & two concave (see figure in your textbook) 1. increase strength 2. fetus has only single anteriorly concave curve posteriorly convex 3. development of others a. cervical curve 3rd postnatal month when infant begins to hold head erect (concave posteriorly) b. lumbar curve when child sits up, stands & walks (concave)

c. thoracic & sacral curves primary curves retaining the fetal anterior concavity. (convex) E. Typical Vertebra 1. body (centrum) thick disc-shaped anterior portion a. superior & inferior surfaces roughened foe disc attachment b. anterior & lateral surfaces with nutrient foramina for blood vessels 2. vertebral (neural) arch posterior from body a. with body surrounds spinal cord b. formed by two short, thick pedicles c. pedicles meet laminae which are flat posterior d. space between vertebral arch and body is vertebral foramen which together with other vertebral foramina form the vertebral (spinal) canal e. superior and inferior notched help form intervertebral foramina 3. processes arise from vertebral arch a. transverse process lateral on each side b. spinous process single, posterior to inferior projection c. these first three form muscle attachment points d. next four form joints e. superior articular processes articulate with next superior vertebra f. inferior articular processes articulate with next inferior vertebra g. facets articular surfaces F. Vertebral characteristics (by region) 1. Cervical region a. bodies small but vertebral arches large b. transverse foramina in addition to vertebral foramen * transmits vertebral artery and vein & nerves c. spinous process often bifid d. first cervical vertebra (C1) atlas * supports head, lacks body & is ring of bone #anterior and posterior arches #lateral masses * superior articular facets articulate with axis * inferior lateral facets articulate with axis e. second cervical vertebra (C2) axis * dens peg like process that projects up through the ring of the altus # forms pivot for rotation of head # whiplash injuries that are due from this process can be fatal (damage medulla) f. C3 through C6 typical but C7 ( the vertebra prominens) has large, nonbifid spinous process (feel it at base of neck) 2. Thoracic Region vertebrae are larger & stronger than in cervical region a. spinous process is laterally flattened & pointed inferiorly b. transverse processes longer & heavier * except for T11 & T12, there are facets that articulate with tubercles of ribs * facets or demifacets articulate with heads of ribs # specifics vary among T vertebrae 3. Lumbar region largest & strongest in vertebral column a. projections are short & thick b. inferior processes are directed laterally c. spinous process is quadrilateral & nearly straight 4. Sacrum & Coccyx a. sacrum (= holy bone) formed from fusion of S1-S5 * begins 16 18 years of age; completed by mid 20s * posterior portion of the pelvic cavity between coxal bone * transverse lines anterior side is concave & has 4 lines that mark vertebral joinings * anterior sacral (pelvic) foramina at ends of transverse lines * ala (=wing) formed by transverse process of S1 * posterior surface # median sacral crest spinous processes # lateral sacral crests transverse processes # posterior (dorsal) foramina go to ventral # sacral canal continuous with vertebral canal

# sacral hiatus open laminae of S5 and sometimes S4 # sacral promontory superior border of sacrum -- auricular surface articulates with ilium # sacral tuberosity ligaments attachment to coxal (forms sacroiliac joint) b. coccyx triangular fusion of Co1-Co4 * fusion generally occurs between 20-30 years V. Thorax chest skeleton including sternum, costal cartilage, ribs, and the bodies of the thoracic vertebrae A. Function encloses and protects the organs in the thoracic cavity and upper abdominal; supports the bones of the girdle & upper appendages B. Sternum breastbone 1. flat, narrow bone ca. 15cm long 2. medial line of the anterior thoracic wall 3. three portions a. manubrium superior b. body middle and largest c. xiphoid process inferior & smallest 4. sternal angle junction of manubrium and body 5. jugular (suprasternal) notch depression on superior surface 6. clavicular notches articulate with medial ends of clavicle C. Ribs twelve pairs that make up sides of thoracic cavity 1. increase in length 1-7 then decrease 2. 1-7 articulate with cartilage (costal) to sternum a. true ribs 3. 8-12 called false ribs a. 8,9,& 10 vertebrochondral ribs whose costal cartilage attaches to the 7th rib b. 11 & 12 floating (vertebral) ribs have anterior ends that dont even attach indirectly to sternum (only to thoracic vertebrae) 4. typical structure (3-9 at least) a. head projection at posterior end of rib * has one or two facets b. neck a constricted portion just lateral to head * tubercle where neck joins head # nonarticular part ligament attachment # articular part articulates with the facet of the transverse process of the inferior of the 2 vertebrae to which it connects c. body (shaft) main part of the rib * costal groove inner surface groove that protects blood vessels 5. intercostal spaces intercostal muscles, blood vessels & nerves The Appendicular Skeleton bones of the pectoral & pelvic girdles & upper & lower extremities I. Pectoral Girdles attach bones of upper extremities to the axial skeleton A. Components two bones; clavicle & scapula 1. articulation with axial skeleton only at sternum B. Clavicle 1. anterior most bones (=collar bones) a. double curvature * medial convex anterior * distal concave anterior b. superior & anterior of thorax & horizontal 2. articulations a. sternal extremity medial rounded & art. to sternum b. acromial extremity broader, flat, lateral end that articulates with the scapula * joint- acromioclavicular joint 3. other processes for ligament attachment a. conoid tubercle inferior surface of the lateral end of bone b. costal tuberosity inferior medial end C. Scapulae (scapula is singular) shoulder blades 1. posterior large, flat , triangular bones a. between levels of 2nd & 7th ribs b. medial borders ca. 5 cm from vertebral Column

2. parts a. body * coracoid process (anterior lateral end) * subscapular fossa (posterior depression) b. spine diagonal ridge * acromion lateral end of spine # articulates with clavicle * supraspinatous fossa (superior to the spine) * infraspinatous fossa (inferior to the spine) c. glenoid cavity inferior to spine * articulates with humerus II. Upper Extremity 60 bones A. Humerus- arm bone 1. articulates with glenoid cavity & radius & ulna 2. parts of proximal end a. head b. anatomical neck (site of epiphyseal plate) c. greater tubercle lateral & distal of neck d. lesser tubercle anterior e. intertubercular sulcus between tubercles f surgical neck - distal to tubercles 3. parts of body (shaft) - cylindrical at proximal end but triangular then flattened & broad toward distal end a. deltoid tuberosity b. distal end * capitulum art. with radius * radial fossa art. / received head of radius when arm is flexed * trochlea ulnar articulation (pully-like) * coronoid fossa ant. * olecranon fossa post. * medial & lateral epicondyles B. Ulna medial bone of forearm (little finger side) 1. proximal end a. olecranon process art. with trochlea (elbow) b. coronoid process art. with trochea notch c. radial notch lateral & inferior to trochea notch 2. distal end a. head has fibro. cart. disc at end & meets wrist b. styloid medial C. Radius lateral bone of forearm 1. proximal end a. head art, with capitulum (humerus) & radial notch of ulna b. radial tuberosity medial side ( insertion of biceps brachii) 2. distal end (concave) a. styloid process lateral b. ulnar process medial c. also wrist articulation with lunate & scaphoid D. Carpals, Metacarpals & Phalanges 1. carpus (wrist) - 8 bones united by ligaments a. two transverse rows b. scaphoid & lunate articulate with distal concave end of radius # you do not have to know specific names of others 2. metacarpus 5 a. base, shaft & head (distal end) b. I V (I articulates with thumb) 3. phalanges 14 a. base, shaft & head (distal end) b. 3/digit except thumb (pollex) lacks middle c. proximal, medial & distal rows III. Pelvic (hip) girdle

A. components two coxal bones support lower extremities & connect to sacrum B. pelvis general formed of sacrum, coccyx & coxal 1. brim of pelvis circumference of plane from sacral promontory to symphysis pubis 2. greater (false) pelvis superior expanded area * note anterior part has no bone 3. lesser ( true) pelvis inferior & posterior of brim a. formed by inferior portion of ilia & sacrum, the coccyx & pubis b. pelvic inlet superior opening c. pelvic outlet inferior opening d. pelvimetry measurement C. pelvis bones, etc. 1. coxal bones ilium, ischium & pubis a. unfused in babies; fused in adults b. acetabulum point of fusion where it articulates with femur (2/5 ilium, 2/5 ischium, 1/5 pub) 2. ilium a. iliac crest * anterior superior iliac spine * posterior superior Iliac spine * abductor. muscles attachment to spine b. greater sciatic notch inferior to the post. Sup. Iliac spine c. iliac fossa d. auricular surface 3. ischium inferior posterior portion a. ischial spine b. lesser sciatic notches below spines c. ischial tuberosity inferior d. ramus partly around obturator foramen 4. pubis anterior & inferior a. superior & inferior rami b. body to symphysis pubis c. symphysis pubis fibrocartilage pad & joint IV. Lower Extremeties 60 bones A. Femur thighbone longest & heaviest bone in body 1. proximal end a. head art. acetabulun b. neck c. greater trochanter lateral d. lesser trochanter medial posterior 2. body a. linea aspera - vertical ridge on posterior surface - muscle attachment 3. distal a. medial condyle artic. with tibia b. lateral condyle artic. with tibia c. medial epicondyle & lateral epicondyle d. patellar surface between condyles on anterior surface B. Patella 1. broad superior end (base) 2. pointed inferior (apex) 3. posterior surface (two articular facets) that articulate with condyles C. Tibia & Fibula 1. Tibia larger a. proximal * lateral condyle & medial condyle * intercondylar eminence rise between condyles * tibial tuberosity anterior surface for attachment of patellar ligament * distal # medial malleolus art. with talus bone # fibular notch articulates with fibula 2. Fibula lateral to tibia & smaller a. proximal end * head art. with inferior surface of lateral condyle of femur

b. distal end * lateral malleolus articulates with talus bone. D. Tarsals, Metatarsals & Phalanges 1. tarsus 7 bones (know the following two by name) a. talus articulates with fibula & tibia * medial malleolus of tibia * lateral malleolus of fibula b. calcaneus heel bone 2. metatarsus I-V a. connecters with a base (proximal end), shaft, head (distal end) 3. phalanges 3 per toe except hallux 4. arches a. longitudinal arch * medial part (flatfoot) # Calcaneus through talus (keystone) to through other tarsals through 3 medial metatarsals * lateral part # Calcaneus through cuboidal through 2 lateral metatarsals (bunions) b. transverse arch V. Homeostatic Imbalances of the Skeleton in General A. Herniated (Slipped) Disc 1. rupture of fibrocartilage allowing nucleus pulposus to become herniated 2. often slips posteriorly toward spinal cord & nerves a. can cause acute pain b. if sciatic nerve is involved pain can extend down leg 3. treatment a. traction & bed rest b. surgical decompression or removal followed by bone graft and fusion c. percutaneous laser disc decompression (an out patient treatment) B. Abnormal curves 1. scoliosis lateral bending often congenital a. can result in malformation, chronic sciatica, paralysis of back muscles, poor posture, one shorter leg 2. kyphosis exaggeration of the thoracic curve. Causes include: a. intervertebral disc degeneration b. rickets c. bad posture 3. Lordosis exaggeration of lumbar curve. Causes include: a. obesity b. poor posture c. rickets d. pregnancy C. Spinabifida congenital defect where laminae fail to unite 1. 50% in lumbar region 2. mild cases affect urinary problems minor 3. serious cases meninges protrusion occurs paralysis, loss of urinary control 4. prenatal diagnosis mothers blood, sonography, amniocentesis D. Fractures often of T5, T6, T9 L2 E. Various problems require marrow biopsy 1. Marrow aspiration by sternal puncture is a common method