Exercise 11 The Skeletal System: The Appendicular Skeleton

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<ul><li><p>Exercise 11The Skeletal System: The Appendicular Skeleton</p><p>Copyright 2009 John Wiley &amp; Sons, Inc.</p></li><li><p>Appendicular SkeletonThe primary function is movementIt includes bones of the upper and lower limbsGirdles attach the limbs to the axial skeleton</p><p>Copyright 2009 John Wiley &amp; Sons, Inc.</p></li><li><p>Skeleton of the Upper LimbEach upper limb has 32 bonesTwo separate regions1. The pectoral (shoulder) girdle (2 bones)2. The free part (30 bones)</p><p>Copyright 2009 John Wiley &amp; Sons, Inc.</p></li><li><p>The Pectoral (or Shoulder) Girdle Figure 8.1</p><p>Copyright 2009 John Wiley &amp; Sons, Inc.</p></li><li><p>Upper LimbThe pectoral girdle consists of two bones, the scapula and the clavicleThe free part has 30 bones1 humerus (arm)1 ulna (forearm)1 radius (forearm)8 carpals (wrist)19 metacarpal and phalanges (hand)</p><p>Copyright 2009 John Wiley &amp; Sons, Inc.</p></li><li><p>Pectoral Girdle - ClavicleThe clavicle is S shapedThe medial end articulates with the manubrium of the sternum forming the sternoclavicular jointThe lateral end articulates with the acromion forming the acromioclavicular joint</p><p>Copyright 2009 John Wiley &amp; Sons, Inc.</p></li><li><p>The Clavicle Figure 8.2</p><p>Copyright 2009 John Wiley &amp; Sons, Inc.</p></li><li><p>Pectoral Girdle - ClavicleThe clavicle is convex in shape anteriorly near the sternal junctionThe clavicle is concave anteriorly on its lateral edge near the acromion</p><p>Copyright 2009 John Wiley &amp; Sons, Inc.</p></li><li><p>Clinical Connection - Fractured ClavicleA fall on an outstretched arm (F.O.O.S.H.) injury can lead to a fractured clavicleThe clavicle is weakest at the junction of the two curvesForces are generated through the upper limb to the trunk during a fallTherefore, most breaks occur approximately in the middle of the clavicle</p><p>Copyright 2009 John Wiley &amp; Sons, Inc.</p></li><li><p>Pectoral Girdle - ScapulaAlso called the shoulder bladeTriangular in shapeMost notable features include the spine, acromion, coracoid process and the glenoid cavity</p><p>Copyright 2009 John Wiley &amp; Sons, Inc.</p></li><li><p>Features on the ScapulaSpine - a large process on the posterior of the scapula that ends laterally as the acromion Acromion - the flattened lateral portion of the spine of the scapulaCoracoid process - a protruding projection on the anterior surface just inferior to the lateral aspect of the clavicleGlenoid cavity - shallow concavity that articulates with the head of the humerus</p><p>Copyright 2009 John Wiley &amp; Sons, Inc.</p></li><li><p>Scapula Figure 8.3</p><p>Copyright 2009 John Wiley &amp; Sons, Inc.</p></li><li><p>Scapula Figure 8.3</p><p>Copyright 2009 John Wiley &amp; Sons, Inc.</p></li><li><p>Scapula - FeaturesThe medial (vertebral) border - closest to the vertebral spineLateral border - closest to the armSuperior border - superior edgeInferior angle - where medial and lateral borders meet inferiorlySuperior angle - uppermost aspect of scapula where medial border meets superior border</p><p>Copyright 2009 John Wiley &amp; Sons, Inc.</p></li><li><p>Scapula - FeaturesSubscapular fossa - anterior concavity where the subscapularis muscle attachesSupraspinous fossa - posterior concavity superior to the scapular spine, attachment site for supraspinatus muscleInfraspinous fossa - posterior concavity inferior to the scapular spine, site of infraspinatus muscle</p><p>Copyright 2009 John Wiley &amp; Sons, Inc.</p></li><li><p>Skeleton of the Arm - HumerusLongest and largest bone of the free part of the upper limbThe proximal ball-shaped end articulates with the glenoid cavity of the scapulaThe distal end articulates at the elbow with the radius and ulna</p><p>Copyright 2009 John Wiley &amp; Sons, Inc.</p></li><li><p>Humerus - Surface FeaturesThe head of the humerus has two unequal-sized projectionsThe greater tubercle lies more laterallyThe lesser tubercle lies more anteriorlyBetween the tubercles lies the intertubercular groove or sulcus (bicipital groove) where the long head of the biceps brachii tendon is located</p><p>Copyright 2009 John Wiley &amp; Sons, Inc.</p></li><li><p>Humerus - Surface FeaturesJust distal to the head is the anatomical neckThe surgical neck is where the tubular shaft begins and is a common area of fractureAbout mid-shaft on the lateral aspect is a roughened area, the deltoid tuberosity where the deltoid tendon attachesCapitulum - a round knob-like process on the lateral distal humerusTrochlea - medial to the capitulum, is a spool-shaped projection on the distal humerus</p><p>Copyright 2009 John Wiley &amp; Sons, Inc.</p></li><li><p>Humerus - Surface FeaturesCoronoid fossa - anterior depression that receives the coronoid process of the ulna during forearm flexionOlecranon fossa - posterior depression that receives the olecranon of the ulna during forearm extensionThe medial and lateral epicondyles are bony projections to which the forearm muscles attach</p><p>Copyright 2009 John Wiley &amp; Sons, Inc.</p></li><li><p>Humerus and Glenohumeral JointFigure 8.4</p><p>Copyright 2009 John Wiley &amp; Sons, Inc.</p></li><li><p>Skeleton of the Forearm - UlnaThe longer of the two forearm bonesLocated medial to the radiusOlecranon - the large, prominent proximal end, the tip of your elbowCoronoid process - the anterior lip of the proximal ulnaTrochlear notch - the deep fossa that receives the trochlea of the humerus during elbow flexionStyloid process - the thin cylindrical projection on the posterior side of the ulnas head</p><p>Copyright 2009 John Wiley &amp; Sons, Inc.</p></li><li><p>Right humerus in relation to scapula, ulna, and radius-- Figure 8.5</p><p>Copyright 2009 John Wiley &amp; Sons, Inc.</p></li><li><p>RadiusLies lateral to the ulna (thumb side of the forearm)The head (disc-shaped) and neck are at the proximal endThe head articulates with the capitulum of the humerus and the radial notch of the ulnaRadial tuberosity - medial and inferior to neck, attachment site for biceps brachii muscleStyloid process - large distal projection on lateral side of radius</p><p>Copyright 2009 John Wiley &amp; Sons, Inc.</p></li><li><p>Ulna and RadiusThe shaft of these bones are connected by an interosseus membraneThere is a proximal radioulnar joint and a distal radioulnar jointProximally, the head of the radius articulates with the radial notch of the ulnaDistally, the head of the ulna articulates with the ulnar notch of the radius</p><p>Copyright 2009 John Wiley &amp; Sons, Inc.</p></li><li><p>Right ulna and radius in relation to the humerus and carpals -- Figure 8.6</p><p>Copyright 2009 John Wiley &amp; Sons, Inc.</p></li><li><p>Skeleton of the HandThe carpus (wrist) consists of 8 small bones (carpals)Two rows of carpal bonesProximal row - scaphoid, lunate, triquetrum, pisiformDistal row - trapezium, trapezoid, capitate, hamateScaphoid - most commonly fracturedCarpal tunnel - space between carpal bones and flexor retinaculum</p><p>Copyright 2009 John Wiley &amp; Sons, Inc.</p></li><li><p>Articulations formed by the ulna and radius -- Figure 8.7</p><p>Copyright 2009 John Wiley &amp; Sons, Inc.</p></li><li><p>Metacarpals and PhalangesFive metacarpals - numbered I-V, lateral to medial14 phalanges - two in the thumb (pollex) and three in each of the other fingersEach phalanx has a base, shaft, and headJoints - carpometacarpal, metacarpophalangeal, interphalangeal </p><p>Copyright 2009 John Wiley &amp; Sons, Inc.</p></li><li><p>Right wrist and hand in relation to ulna and radius -- Figure 8.8</p><p>Copyright 2009 John Wiley &amp; Sons, Inc.</p></li><li><p>Skeleton of the Lower LimbSkeleton of the Lower LimbTwo separate regions1. A single pelvic girdle (2 bones)2. The free part (30 bones)</p><p>Copyright 2009 John Wiley &amp; Sons, Inc.</p></li><li><p>Pelvic (Hip) GirdleEach coxal (hip) bone consists of three bones that fuse together: ilium, pubis, and ischiumThe two coxal bones are joined anteriorly by the pubic symphysis (fibrocartilage)Joined posteriorly by the sacrum forming the sacroiliac joints (Fig 8.9)</p><p>Copyright 2009 John Wiley &amp; Sons, Inc.</p></li><li><p>Bony Pelvis </p><p>Copyright 2009 John Wiley &amp; Sons, Inc.</p></li><li><p>The IliumLargest of the three hip bonesIlium is the superior part of the hip boneConsists of a superior ala and inferior body which forms the acetabulum (the socket for the head of the femur)Superior border - iliac crestHip pointer - occurs at anterior superior iliac spineGreater sciatic notch - allows passage of sciatic nerve</p><p>Copyright 2009 John Wiley &amp; Sons, Inc.</p></li><li><p>Ischium and PubisIschium - inferior and posterior part of the hip boneMost prominent feature is the ischial tuberosity, it is the part that meets the chair when you are sittingPubis - inferior and anterior part of the hip boneSuperior and inferior rami and body</p><p>Copyright 2009 John Wiley &amp; Sons, Inc.</p></li><li><p>Right Hip Bone Figure 8.10</p><p>Copyright 2009 John Wiley &amp; Sons, Inc.</p></li><li><p>False and True PelvesPelvic brim - a line from the sacral promontory to the upper part of the pubic symphysisFalse pelvis - lies above this line (Fig 8.9b)Contains no pelvic organs except urinary bladder (when full) and uterus during pregnancyTrue pelvis - the bony pelvis inferior to the pelvic brim, has an inlet, an outlet and a cavityPelvic axis - path of baby during birth</p><p>Copyright 2009 John Wiley &amp; Sons, Inc.</p></li><li><p>True and False Pelves Figure 8.11</p><p>Copyright 2009 John Wiley &amp; Sons, Inc.</p></li><li><p>Comparing Male and Female PelvesMales - bone are larger and heavierPelvic inlet is smaller and heart shapedPubic arch is less the 90Female - wider and shallower Pubic arch is greater than 90More space in the true pelvis (Table 8.1)</p><p>Copyright 2009 John Wiley &amp; Sons, Inc.</p></li><li><p>Comparing Male and Female PelvesTable 8.1</p><p>Copyright 2009 John Wiley &amp; Sons, Inc.</p></li><li><p>Comparing Male and Female PelvesTable 8.1</p><p>Copyright 2009 John Wiley &amp; Sons, Inc.</p></li><li><p>Right Lower LimbFigure 8.12</p><p>Copyright 2009 John Wiley &amp; Sons, Inc.</p></li><li><p>Skeleton of the Thigh - Femur and PatellaFemur - longest, heaviest, and strongest bone in the bodyProximally, the head articulates with the acetabulum of the hip bone forming the hip (coxal) jointNeck - distal to head, common site of fractureDistally, the medial and lateral condyles articulate with the condyles of the tibia forming the knee jointAlso articulates with patella</p><p>Copyright 2009 John Wiley &amp; Sons, Inc.</p></li><li><p>FemurGreater and lesser trochanters are projections where large muscles attachGluteal tuberosity and linea aspera - attachment sites for the large hip musclesIntercondylar fossa - depression between the condylesMedial and lateral epicondyles - muscle site attachments for the knee muscles</p><p>Copyright 2009 John Wiley &amp; Sons, Inc.</p></li><li><p>Right Femur Figure 8.13</p><p>Copyright 2009 John Wiley &amp; Sons, Inc.</p></li><li><p>PatellaLargest sesamoid bone in the bodyForms the patellofemoral jointSuperior surface is the baseInferior, narrower surface is the apexThick articular cartilage lines the posterior surfaceIncreases the leverage of the quadriceps femoris musclePatellofemoral stress syndrome - runners knee</p><p>Copyright 2009 John Wiley &amp; Sons, Inc.</p></li><li><p>Patella Figure 8.14</p><p>Copyright 2009 John Wiley &amp; Sons, Inc.</p></li><li><p>Tibia (shin bone)The larger, medial weight-bearing bone of the legThe lateral and medial condyles at the proximal end articulate with the femurIt articulates distally with the talus and fibulaTibial tuberosity - attachment site for the patellar ligamentMedial malleolus - medial surface of distal end (medial surface of ankle joint)</p><p>Copyright 2009 John Wiley &amp; Sons, Inc.</p></li><li><p>FibulaThe smaller, laterally placed bone of the legNon-weight bearingThe head forms the proximal tibiofibular jointLateral malleolus - distal end, articulates with the tibia and the talus at the ankle</p><p>Copyright 2009 John Wiley &amp; Sons, Inc.</p></li><li><p>Tibia and Fibula Figure 8.15</p><p>Copyright 2009 John Wiley &amp; Sons, Inc.</p></li><li><p>Tibia and Fibula Figure 8.15</p><p>Copyright 2009 John Wiley &amp; Sons, Inc.</p></li><li><p>Skeleton of the Foot - Tarsals, Metatarsals, and PhalangesSeven tarsal bones - talus (articulates with tibia and fibula), calcaneus (the heel bone, the largest and strongest), navicular, cuboid and three cuneiformsFive metatarsals - (I-V) base, shaft, head14 phalanges (big toe is the hallux)Tarsus = ankle</p><p>Copyright 2009 John Wiley &amp; Sons, Inc.</p></li><li><p>Right Foot Figure 8.16</p><p>Copyright 2009 John Wiley &amp; Sons, Inc.</p></li><li><p>Arches of the Foot</p><p>Two arches support the weight of the bodyProvide spring and leverage to the foot when walkingThe arches flex when body weight appliedFlatfoot - the arches decrease or fallClawfoot - too much arch occurs due to various pathologies</p><p>Copyright 2009 John Wiley &amp; Sons, Inc.</p></li><li><p>Arches of the foot - Figure 8.17</p><p>Copyright 2009 John Wiley &amp; Sons, Inc.</p></li><li><p>Development of the Skeletal SystemMost skeletal tissue arises from mesenchymal cellsThe skull develops during the fourth week after fertilizationFontanels are the spaces between the skull bones during fetal life and infancyUpper limb buds form during the fourth week after fertilization followed by the lower limb budsDuring the sixth week, hand plates and foot plates formVertebrae and ribs are formed from sclerotomes of somitesFailure of proper development of the vertebral arches leads to spina bifida </p><p>Copyright 2009 John Wiley &amp; Sons, Inc.</p></li><li><p>Development of the skeletal system - Figure 8.18</p><p>Copyright 2009 John Wiley &amp; Sons, Inc.</p></li><li><p>Development of the skeletal system - Figure 8.18</p><p>Copyright 2009 John Wiley &amp; Sons, Inc.</p><p>Emphasize that it is important to learn the location of each bone (and its surface features) relative to the location of other bones (and their surface features) in order to understand the three-dimensional relationship between bones. </p><p>Use of directional terms (e.g., lateral, superior, etc.) while studying will facilitate this task. While progressing through a lecture, point out that many of the bones and their surface features (e.g., olecranon) may be easily palpated. </p><p>Point out that the lower limb bones are larger and stronger than the upper limb bones due to the need to support the weight of the body </p></li></ul>

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