Chapter 8, Bones, PartChapter 8, Bones, Part 2: 2: The Appendicular SkeletonThe Appendicular Skeleton

Appendicular Skeleton =Appendicular Skeleton =

Everything that is not the Everything that is not the Axial Skeleton, i.e., pelvis Axial Skeleton, i.e., pelvis and limbsand limbs

Goal: Learn and locate the bones and Goal: Learn and locate the bones and markings of the appendicular skeletonmarkings of the appendicular skeleton

The GirdlesThe Girdles

Pectoral GirdlePectoral Girdle Supports the ArmsSupports the Arms Clavicle and ScapulaClavicle and Scapula

Pelvic GirdlePelvic Girdle Supports the LegsSupports the Legs PelvisPelvis

Ilium, ischium, pubic boneIlium, ischium, pubic bone

Clavicle Clavicle (collarbone)(collarbone)

Manubrium to Acromion

Frequently fractured

Scapula Scapula (shoulder blade)(shoulder blade)

Origin of biceps brachii muscle:Origin of biceps brachii muscle:Coracoid ProcessCoracoid ProcessSupraglenoid tubercleSupraglenoid tubercle

GlenoidGlenoid SpineSpine AcromionAcromion Acromioclavicular Acromioclavicular

jointjoint Inferior and Superior Inferior and Superior

AnglesAngles

The ArmThe Arm

Synonym: Upper limbSynonym: Upper limb Upper Arm = BrachiumUpper Arm = Brachium Forearm = Forearm =

AntebrachiumAntebrachium

Humerus, Radius and Humerus, Radius and UlnaUlnaCarpus (wrist)Carpus (wrist)Hand (manus)Hand (manus)

HumerusHumerusHeadHeadGreater and Lesser Greater and Lesser TuberclesTuberclesIntertubercular SulcusIntertubercular Sulcus

Biceps tendonBiceps tendon

Coronoid FossaCoronoid FossaOlecranon FossaOlecranon FossaTrochleaTrochleaMedial and Lateral Medial and Lateral EpicondylesEpicondyles

Radius UlnaRadius UlnaHead, neck, shaftHead, neck, shaftInsertion of biceps Insertion of biceps brachii:brachii: Radial TuberosityRadial TuberosityRadial Styloid Radial Styloid ProcessProcess

OlecranonOlecranonTrochlear notchTrochlear notchCoronoid ProcessCoronoid ProcessUlnar Styloid ProcessUlnar Styloid Process

Interosseous Membrane (between Interosseous Membrane (between radius and ulna)radius and ulna)

Note how the two bones can Note how the two bones can crosscross

““Funny bone”Funny bone”

Carpus = WristCarpus = WristFour ProximalFour Proximal Scaphoid, Scaphoid,

lunate, lunate, triquetrum, triquetrum, pisiformpisiform

Four DistalFour Distal Trapezium, Trapezium,

trapezoid, trapezoid, capitate, hamatecapitate, hamate

Scaphoid is frequently fractured

Hand = ManusHand = Manus

Five metacarpal bones (1-5)Five metacarpal bones (1-5)Five fingers Five fingers Labeled 1-5Labeled 1-5 Thumb = Pollex = digit 1Thumb = Pollex = digit 1

Two phalangeal bonesTwo phalangeal bones Fingers = phalanges = digits 2-5Fingers = phalanges = digits 2-5

Three phalangeal bonesThree phalangeal bones Proximal, middle, distalProximal, middle, distal

The GirdlesThe Girdles

Pectoral GirdlePectoral Girdle Supports the ArmsSupports the Arms Clavicle and ScapulaClavicle and Scapula

Pelvic GirdlePelvic Girdle Supports the LegsSupports the Legs Pelvis (os coxae)Pelvis (os coxae)

Pelvis = Pelvis = os coxae = hip bone = os coxae = hip bone = (innominate bone)(innominate bone)

Three bones: Ilium, Ischium, Three bones: Ilium, Ischium, PubisPubisAnterior and posterior iliac Anterior and posterior iliac spines meet to form the iliac spines meet to form the iliac crestcrestGreater and Lesser Sciatic Greater and Lesser Sciatic NotchesNotchesIschial TuberosityIschial TuberosityAcetabulumAcetabulum

Acetabular fossaAcetabular fossa

Obturator ForamenObturator Foramen

More PelvisMore Pelvis

Articular Surface for Articular Surface for Articulation with SacrumArticulation with SacrumDifference between male Difference between male and femaleand femalePelvic (or pubic) Pelvic (or pubic) symphysissymphysis

FibrocartilageFibrocartilage Stretches at childbirth Stretches at childbirth

(Relaxin)(Relaxin)

The legThe leg

AKA Lower LimbAKA Lower Limb

FemurFemurPatellaPatellaTibia/fibulaTibia/fibulaTarsusTarsusFootFoot

FemurFemurHead and fovea capitusHead and fovea capitus Articulate with pelvis Articulate with pelvis

Neck (“fx pelvis”)Neck (“fx pelvis”)Greater and Lesser Greater and Lesser TrochantersTrochantersShaftShaftLateral and medial Lateral and medial condyles and condyles and epicondylesepicondylesIntercondylar fossaIntercondylar fossaPatellar SurfacePatellar Surface

Patella Patella = knee cap= knee cap

Sesamoid BoneSesamoid BoneEnclosed in the Enclosed in the tendon of the tendon of the quadriceps group of quadriceps group of musclesmuscles

“Skyline” MRI of patella

Tibia Tibia = shin bone= shin bone

Lateral and medial Lateral and medial condylescondyles Intercondylar eminenceIntercondylar eminence

Tibial tuberosityTibial tuberosityInferior articular surfaceInferior articular surfaceMedial malleolusMedial malleolus (= ankle bone)(= ankle bone)

Interosseous MembraneInterosseous Membrane

FibulaFibula

HeadHeadShaftShaftLateral malleolusLateral malleolus (= ankle bone)(= ankle bone)

Not weight bearingNot weight bearing Frequent fxFrequent fx

Interosseous MembraneInterosseous Membrane

Tarsus (7 bones)Tarsus (7 bones) Cute Tillie Never Could Cooperate Cute Tillie Never Could Cooperate

NavicularNavicularCuboidCuboidCunieform (3)Cunieform (3) CalcaneusCalcaneus

TalusTalus

FootFoot

Metatarsals (1-5)Metatarsals (1-5)Phalanges (3 per toe Phalanges (3 per toe except big toe)except big toe)Longitudinal ArchesLongitudinal Arches

Medial and lateralMedial and lateral

Transverse ArchTransverse Arch

Dancer’s fx

Cute Tillie Never Could Cooperate

Fractures Fractures (a review)(a review)

BleedingBleeding Then clotThen clot

Periosteal reactionPeriosteal reaction FibroblastsFibroblasts OsteoblastsOsteoblasts

CallusCallus New bone “collar”New bone “collar”

RemodelingRemodeling

““Hip” fractureHip” fracture““Grandma fell and broke her hip.”Grandma fell and broke her hip.”

More accurately, “Grandma broke More accurately, “Grandma broke her femoral neck and then fell.”her femoral neck and then fell.”

Sometimes the fx is at the Sometimes the fx is at the intertrochanteric lineintertrochanteric line

Diabetes, hypertension, Diabetes, hypertension, osteoporosisosteoporosis25% die from complications in first 25% die from complications in first year mostly related to immobility:year mostly related to immobility:

AnesthesiaAnesthesia Muscle AtrophyMuscle Atrophy PneumoniaPneumonia Decubitus ulcersDecubitus ulcers Depression and disorientationDepression and disorientation

Douglas IrisDouglas Iris