CHAPTER 7: SKELETAL SYSTEM

Classification of Bone Skeleton

 Axial skeleton – skull, vertebral column, and thoracic cage

 Appendicular skeleton - upper and lower limbs and the girdles (shoulder and hip
bones)
Classification of Bones Based on Shape

 Flat bones - resemble plates with broad surfaces; e.g ribs, sternum or breastbone,
scapulae or shoulder blades, and most skull bones
 Irregular bones – different and complex shapes; e.g. facial bones, pelvis, vertebrae in
the spine
 Short bones - Small and often cube-shaped; e.g. carpal (wrist) bones and tarsal (ankle)
bones
 Long bones - elongated shape; e.g. all bones in the limbs
 Sutural bones - Wormian bones, these are the small, flat, and irregular bones; between
flat bones in the skull
 Sesamoid bones - flat bones resembling sesame seeds; e.g. patellae
Gross Anatomy

 External layer – compact bone;

 Internal layer – spongy bone
o Made up of trabeculae (flat or needle-like pieces)
o Has open struts or plates covered by thin cortex (cortical bone)
 The plates are covered by connective tissue membranes (the periosteum outside and
the endosteum inside).
 The spongy bone in flat bones is called the diploe.
 The shaft is known as the diaphysis.
o Contains the medullary cavity (called yellow marrow cavity (having fat) in
adults)
 The bone ends are called epiphyses.
 Between the diaphysis and each epiphysis of long bones is an epiphyseal line, which is
a leftover remnant of the epiphyseal plate.
 The external surface covering of a bone – periosteum
o Shiny, white, double layer
o Membrane richly supplied with blood vessels and nerve fibers
 Dense irregular connective tissue makes up the outer fibrous layer.
 Osteogenic layer inside touches the bone surface and is made up mostly of
osteogenic cells (form bone cells except for bone destruction)
 Nutrient foramina – openings entering marrow cavity by blood vessels and nerve fibers
 Perforating fibers or Sharpey’s fibers – group of collagen fibers; from fibrous layer
and bind periosteum.
 Metaphyseal vessels supply blood to the diaphyseal surface of the epiphyseal
cartilages, where they are replacing bone.
 Periosteal vessels provide blood to the superficial osteons of the bone shafts.
  Internal bone surface covering – endosteum
o Delicate connective tissue membrane
o Covers trabeculae of spongy bone
o Contains osteogenic cells
 Newborn – red bone marrow located in medullary cavity of diaphysis and spongy bone
 Adult – yellow bone marrow (contains fat) in the medullary cavity
 Red blood cell production (hematopoietic activity) – heads of femur and humerus; diploe
of flat bones (skull and sternum) and irregular bones (hip bones)
Bone Markings

 Bone markings are where ligaments, muscles, and tendons attach or they may occur at
joint surfaces.
 Depressions and openings – passage for nerves and blood vessels:
o Fissures – narrow, slit-like openings
o Foramina – oval or round opening
o Grooves – shallow depressions
o Notches – indentations at the edge of structure
o Fossae - shallow depressions
o Meatuses – canal-like passageways
o Sinuses – cavity or hollow space with air; lined mucous membranes

 Bone projections that are attachment sites for muscles and ligaments:
o Crests - Narrow, prominent ridges of bone
o Epicondyle – Above condyles
o Lines – Narrow, less prominent ridges than crests
o Process – Bony prominences or any bony extension
o Spines - Pointed, sharp, or slender projections
o Trochanters – Extremely large/Massive processes only in the femur
o Tubercles - Small rounded projections or processes
o Tuberosity - Large rounded projections that may be rough

 Bone projections for the formation of joints:

o Condyles – Rounded articular projections
o Facets – Smooth, almost flat articular surfaces
o Heads - Bony expansions that are carried on narrow necks
o Rami - Arm-like bars of bone

Microscopic Anatomy

 Five major types of bone cells:

o osteogenic cells – also called osteoprogenitor cells; mitotically active
squamous stem cells in periosteum and endosteum; differentiate into osteoblasts
or bone lining cells, or remain osteogenic cells.
o osteoblasts – bone matrix producing cells; secretes unmineralized bone matrix
such as collagen (major bone protein) and calcium-binding proteins to form
 osteoid (original unmineralized bone); cuboidal when active and squamous
when inactive; differentiate also into bone lining cells;
o osteocytes – mature osteoblasts surrounded/embedded by bone matrix; occupy
and conform to the shape of lacunae (small cavities) in the bone; resorption
occurs when osteocytes die; respond to stress and stimuli
o bone lining cells – flat cells on bone surfaces that help maintain bone matrix
 periosteal cells – on external bone surfaces
 endosteal cells – on internal bone surfaces
o osteoclasts – also known as osteophages; large, multinucleated bone cells
found at sites of bone resorption (osteolysis); form from hematopoietic stem cells
(transformed into macrophages)
Compact Bone

 Canaliculi – passageway for communication of osteocytes to other cells

 Hydroxyapatite – formed crystals in the bone through calcium phosphate – calcium
hydroxide interaction
 Haversian systems - cylinder-shaped osteons in the compact bone which central canal
helps in its formation
 Osteons – parallel to the bone’s long axis; structural units of compact bone
 Each osteon – group of hollow tubes of bone matrix
 Each lamella (matrix tube) – lamellar bone
 Each central canal - nerve fibers, blood vessels, and the surrounding connective tissue
 Volkmann’s canals – where central canal is connected; contains large nerves and
blood vessels; lies right angle to the bone’s long axis
 Interstitial lamellae – between osteons either fill gaps or leftover structures of previous
osteons for bone remodeling
 Circumferential lamellae – deep to periosteum, superficial to the endosteum; help long
bone to resist twisting
Spongy Bone

 The cells in spongy bone lie inside the trabeculae (supporting structures of dense tissue)
 Trabeculae have irregular lamellae and osteocytes, interconnected by canaliculi, and no
osteons are present.
 Nutrients reach spongy bone osteocytes via diffusion through the canaliculi from
capillaries in the endosteum.
Chemical Composition of Bone

 Organic Components
o Osteogenic cells, osteoblasts, bone lining cells, osteocytes, osteoclasts, and
osteoid
o Nearly one-third of the matrix is made up of the osteoid.
 Osteoid includes proteoglycans and glycoproteins (making up its
ground substance) and collagen fibers.
 Collagen is the greater contributor to the structure of bones and to their
flexibility and tensile strength.
  Sacrificial bonds inside or between collagen molecules appear to aid in
bone resilience.

 Inorganic Components
o Hydroxyapatites or mineral salts, which make up 65% of the bone mass.
o Mostly made of calcium phosphates, responsible for hardness and compression
resistance
Bone Growth and Development

 Ossification - The process of replacing other tissues with bone, which involves the
deposition of calcium salts.
 Osteogenesis - defined as the formation of bone.
 Endochondral ossification results in the production of long bones.
o Cartilage is also referred to as endochondral bone.
o Periosteal bone collar - collar-like structure that encloses the bone collar
formed around the diaphysis of the hyaline cartilage
o Periosteal bud – elements which invades the cavities of the cartilage; includes
the nutrient artery and vein, red marrow elements, nerve fibers, osteoclasts, and
osteogenic cells.
o Primary ossification center – is the shaft (diaphysis) where ossification starts.
o Secondary ossification centers - develop in one or both epiphyses just before
or just after birth.
 Intramembranous ossification results in the development of flat bones.
o Flat bones develop from fibrous connective tissue membranes (formed by
mesenchymal cells) that are replaced by spongy bone, and then compact bone.
o The produced bones are also referred to as membrane bones.
o Examples of flat bones formed via intramembranous ossification include the
frontal, parietal, occipital, and temporal bones of the skull and the
clavicles.
 Epiphyseal plate – a structure where the diaphyses meet the epiphyses.
o Four cartilage layers:
 reserve cartilage
 proliferating (hyperplastic) cartilage
 hypertrophic cartilage
 calcified matrix
 Once the epiphyseal plate experiences closure, the long bones can no longer grow.
 Growth hormone from the anterior pituitary gland determines epiphyseal plate growth
activity.
 Calcitriol, synthesized from another steroid called cholecalciferol (vitamin D3) is made
by the kidneys.
o Essential for normal phosphate and calcium ion absorption in the digestive tract
 Vitamin C for important enzyme reactions in collagen synthesis; simulate osteoblast
differentiation.
 Vitamin A stimulate osteoblast activity.
 Vitamins C, K, and B12 for synthesis of normal bone proteins.
  Male and female sex hormones stimulate ossification of epiphyseal plates.

Functions of Bones

 Hemopoiesis – also known as hematopoiesis

o This process which is blood cell production begins in the yolk sac of the
developing embryo and later in red bone marrow.
o As children mature into adults, much of the red bone marrow degenerates into a
fatty tissue called yellow bone marrow.

 Movement - providing attachments for skeletal muscles that pull on the bones; act as
levers.
 Support and protection - support and protect vital organs of the body (brain, spinal
cord, heart, lungs); also protect soft tissues; support trunk of the body.
 Storage of minerals and growth factor - more than 90% of the minerals—calcium and
phosphorus are stored in the bone.
 Fat storage – triglyceride in fat is an energy source stored in bone cavities.
 Hormone production - hormone osteocalcin is produced by bones.
o Osteocalcin regulates bone formation and also protects against glucose
intolerance, diabetes mellitus, and obesity.

Bone Homeostasis
 The process of self-repair of the bones, which are active and dynamic types of tissue
that undergo continual changes.
 5% – 7% bone mass is recycled every week
 500 mg calcium – may enter or leave the skeleton of adult
 10 years – replacement of compact bone
 3-4 years – replacement of spongy bone

Bone Remodeling

 Process includes bone deposit and resorption in the periosteum and endosteum
o Remodeling units - Groups of nearby osteoblasts and osteoclasts that control
bone remodeling
Bone Fracture
Classification of Bone Fracture

 Based on Positioning
o Nondisplaced - bone ends remain in their normal position
o Displaced - bones are out of their normal alignment
 Based on Completeness
o Complete - bone is broken completely
o Incomplete - bone is not broken completely
  Based on Skin Penetration
o Open or Compound Fracture - a bone penetrates the skin
o Closed or Simple Fracture – a bone doesn’t penetrate the skin
 Based on Location, External Appearance, and Manner
o Comminuted - fragmented into three or more pieces
o Compression - bone has been crushed e.g. osteoporosis
o Depressed - pressed inward, as often occurs in skull fractures
o Epiphyseal - has separated from the diaphysis along the epiphyseal plate
o Greenstick - bone breaks incompletely, with breakage occurring only on one side
of the shaft, whereas the other side bends
o Spiral - because of excessive twisting forces, a ragged bone break occurs

Treatment of Bone Fracture

 Reduction - the realignment of the broken bone ends

o Closed or external reduction - physically manipulate the bone ends into position
o Open or internal reduction - bone ends to be pulled together surgically

Bone Repair

 Hematoma formation - Blood clot forms which is called fracture hematoma.

 Fibrocartilaginous callus formation – Also known as internal callus forms in a few days.
The entire repair tissue mass is called fibrocartilaginous callus. Blood clot is invaded by
fibroblasts and other cells, forming the callus.
 Bony callus formation – Also known as external callus. Calcium is deposited in the
callus, knitting the ends together.
 Bone remodeling - The bony callus is remodeled during bony callus formation which
continues for several months. The final repaired bone structure appears nearly identical
to the original unbroken region due to response of same forms of mechanical stress.
Bone Deposition

 Osteoid seams - unmineralized sections of thin bone matrix, only 10–12 μm in width.
 Calcification front - an abrupt transition point exists between osteoid seams and older
bone
 Alkaline phosphatase - an enzyme that is lost in matrix vesicles by osteoblasts, and
which is critical for mineralization.
Bone Resorption

 Occurs because of osteoclast activities, including the creation of grooves or depressions

as bone matrix is broken down. Osteoclasts undergo apoptosis after a certain bone area
has been resorbed
Control of Bone Remodeling

 More than 99% of the body’s 1,200–1,400 g of calcium is present in the bones.
 Hormonal controls keep blood calcium ions in a range between 9 and 11 mg/dL (100
mL) of blood.
 400 – 800 mg calcium needed for children under age 10
  1,200 – 1,500 mg calcium needed for ages 11 – 24
Parathyroid Hormone

 primary hormonal controller of bone remodeling

 released by the parathyroid glands when blood levels of ionic calcium decline,
stimulating osteoclasts to resorb bone and releasing calcium into the blood
Leptin

 released by the adipose tissue which helps to regulate bone density, weight, and energy
balance
 appears to inhibit the actions of osteoblasts, via mediation by the hypothalamus,
activating sympathetic nerves that serve bones
Serotonin

 mediates the balance between bone destruction and formation and is primarily
manufactured in the intestine.
 is secreted during eating, circulating to the bones to interfere with osteoblast activity.
 Serotonin uptake inhibitors make excessive serotonin available to bone cells, resulting in
lower bone density and higher potential for fracture.\
Wolff’s law - Bones grow or remodel in response to demands.

 Curved bones are thickest at the point where they are most likely to break.
 Large increases in bone strength occur from vigorous exercise of the most-used upper
limb.
 Where heavy and active muscles attach, large and bony projections develop.
 Spongy bone trabeculae form a supportive framework along compression lines.
 When bones are not stressed, such as in a fetus or an immobilized patient, the bones
lack normal features.
Bone Homeostatic Imbalance
Rickets - disease in children that is nearly identical to osteomalacia in adults

 caused by insufficient dietary calcium or by vitamin D deficiency.

 can be cured by exposure to sunlight (which stimulates formation of vitamin D by the
body) and drinking milk that is fortified with vitamin D.
Osteomalacia - a variety of disorders involving poor bone mineralization

 bones become soft and weak

 may also result in an abnormal gait, decreased muscle tone, weakness, and immobility
Osteoporosis - a group of diseases involving bone resorption that is quicker than bone
deposition

 bone mass declines while the composition of the matrix remains the same.
 compression fractures of the vertebrae often occur as a result
  In postmenopausal women, estrogen secretion normally slows. Its deficiency greatly
contributes to osteoporosis.

Skeletal Organization
Axial Skeleton - supports and protects the head, neck, and trunk.

 Skull, hyoid bone, vertebral column, thoracic cage

Skull

 Consists of 22 bones
 Divided into cranium (8 bones) and facial bones (14 bones).
 Sutures - lines where the bones of the skull lock together
 Mandible (lower jaw) - only movable bone in the skull
 Paranasal sinuses - air-filled spaces inside the cranial bones
Cranium

 Frontal bone – anterior skull above eyes

o Having supraorbital foramen (notch)
o Two frontal sinuses – central part of eyes
o Frontal squama – forehead; provide surface area for facial muscles
o Lacrimal fossa – shallow depression marking location of the lacrimal gland
 Parietal bone – each side of the skull behind the frontal bone
CHAPTER 8: ARTICULATIONS

 Joints, also referred to as articulations, act as junctions between bones.

o Two primary functions:
 Hold the skeleton together
 Make the skeleton mobile
Classification of Joints

 Synarthrotic – immovable
 Amphiarthrotic – slightly movable
 Diarthrotic – movable
Structural Type of Joints

 Fibrous Joints
o Bones close contact with each other
o Thin, dense connective tissue
o Three Types of Fibrous Joints
 Sutures (Synarthrotic) – seams between the bones of the skull
 Synostoses – closed sutures during brain growth
 Syndesmoses (Amphiarthrotic) – ligaments connect the bones
 Between the distal tibia and fibula
 Gomphoses (Synarthrotic) - fibrous joints with a peg-in-socket structure
 Between teeth and jaws; binding the teeth to their bony sockets
 Cartilaginous Joints
o Connected by hyaline cartilage or fibrocartilage
o Two Types of Cartilaginous Joints
 Synchondroses (Synarthrotic) - plates or bars of hyaline cartilage uniting
the bones.
 Epiphyseal cartilages, vertebrosternal ribs, and the sternum
 Symphyses (Amphiarthrotic) - fibrocartilage unites bones
 Between the two pubic bones of pelvis (pubic symphysis)
 Synovial Joints
o allow free movement and are referred to as diarthrotic.
o Have outer layers (joint capsules) and inner linings of synovial membrane for
synovial fluid (lubricating fluid) secretion
 o Some have shock-absorbing fibrocartilage pads (menisci), also have fluid-filled
sacs (bursae)
o Six Characteristics of Synovial Joints
 Articular cartilage – smooth hyaline cartilage
 Articular cavity - potential space containing a small amount of synovial
fluid
 Articular capsule - two-layered structure that encloses the joint cavity
 Each joint capsule inner layer is called synovial membrane.
 Synovial Fluid - slippery liquid found in all free spaces inside the joint
capsule
 Weeping lubrication – When there’s a compression, fluid forced
out of the cartilages, and flows back to cartilages if pressure is
relieved.
 Reinforcing ligaments - band-like accessory structures that reinforce
and strengthen synovial joints.
 capsular ligaments - thicker parts of the fibrous layer
o extracapsular ligament – outside of the capsule
o intracapsular ligament – remains deep in the capsule
 double-jointed – term for loose joint capsules and ligaments; more
flexible than the average
 Nerves and Blood vessels
 Bursae and Tendon Sheaths
o Bursae – flat fibrous sacs that have synovial membrane
o Tendon sheath - lengthened bursae wrapping totally around a tendon
 Types of Synovial Joints
o Gliding joints – nonaxial movement involves linear gliding (e.g intercarpal joints)
o Hinge joints – uniaxial movement involves flexion and extension (e.g. elbow joint)
o Pivot joints – uniaxial movement involves rotation (radioulnar joints)
o Ellipsoidal joints – biaxial movement involves adduction and abduction (wrist joint
o Saddle joints – biaxial movement involves flexion and extension (joints in thumb)
o Ball-and-Socket – multiaxial movement involves rotation, adduction, abduction,
flexion, and extension (shoulder and hip joints)
 Shoulder Joints
o Most freely movable but lack stability
o Shoulder separation is an injury involving partial or complete dislocation of the
acromioclavicular joint.
o The superior coracohumeral ligament is the thickest area of the capsule.
o The front of the capsule is only slightly strengthened by three glenohumeral
ligaments.
o Rotator cuff – encircles the shoulder joint
 Associated muscles (the subscapularis, infraspinatus, supraspinatus, and
teres minor) and a total of four other tendons

 Elbow Joints
o Extends inferiorly from humerus to radius and ulna and to the annular ligament
(surrounds the head of the radius)
 o Two strong capsular ligaments restrict horizontal movements:
 Medial ulnar collateral ligament
 Triangular radial collateral ligament
o Radius has less activity in the elbow movements.
 But rotates its head during pronation and supination of the forearm
 Hip Joints
o Also known as coxal joints (ball-and-socket-joints)
o Acetabular labrum - a circular rim of fibrocartilage; increase depth of acetabulum
o Capsule is reinforced by:
 iliofemoral ligament – lies anteriorly, V-shaped, very strong
 pubofemoral ligament – triangular thickening of the inferior area of the
capsule
 ischiofemoral ligament – spirals posteriorly.
o ligamentum teres – ligament of the femur head
 flattened intracapsular band connecting the femur head to the
acetabulum’s lower edge

 Hip Joints
o Tibiofemoral joints – collective term for intermediate joint between the patella and
lower femur and lateral and medial joints
o