Applied Anatomy, Physiology and Biomechanics for Physiotherapy Practice.
Major bony landmarks of the skeleton
This background material needs to be practiced regularly to ensure that you
are confident and competent in identifying all of the major bony landmarks
presented and their importance.
The information in this section is the starting point on which tutors will build
over the coming weeks.
As you will need to be able to describe the location of anatomical structures
you will need to be able to pronounce all of the new words you find here. It
is not unusual while learning a new language to struggle with this. If you are
having difficulties please seek out support from one of the module tutors.
Major Bony Landmarks
The pelvis
a. The iliac crest forms the distal attachment point for several major muscles
of the trunk
b. This anterior surface of the ilium is the iliac fossa which is the proximal
attachment point for iliacus one of the flexor muscles of the hip.
The posterior surface of the ilium is the proximal attachment point for all
three of the gluteal muscles.
c. Is the anterior superior iliac crest (ASIS). This is easily palpated on most
people and is the proximal attachment point of the muscle sartoruis
d. Lying below the ASIS is the anterior inferior iliac crest (AIIS) which
forms the proximal attachment point of rectus femoris one of the
quadriceps muscle group
e. Is the ischial tuberosity on the posterior aspect of the pelvis. This is the
proximal attachment point for the three muscles that make up the
hamstring group.
f.
Is the pubic tubercle
NB the symphysis pubis is the cartilaginous joint that joins the pelvis
anteriorly between the two pubic bones.
g. Is the sacrum which sits between the two ilia to form the large stable
sacroiliac joints on the posterior aspect of the pelvis
The 5 lumbar vertebra are stacked above the sacrum. The 5th (L5) has local
ligament attachments the sacrum and the ilium
Self Check The Pelvis
Bony Feature
Identification of the skeleton
Identification on a model
The iliac crest
The iliac fossa
N/A
Anterior superior iliac spine
Anterior inferior iliac spine
Ischial tuberosity
Pubic tubercle
The sacrum
The coccyx
5th lumbar vertebra
N/A
Clinical relevance
Major Bony Features of the Lower Limb 1
The Anterior Femur
a. The head of the femur Ball of the hip joint it articulates with the acetabulum of the
pelvis. It has a fossa in the middle (fovea capitis)
b. Neck of the femur
– Angled to increase the range of movement of the hip
– The angle is more acute in women
– It is a common site of osteoporosis resulting in a high risk for fracture in fall in
the elderly
– It is the distal attachment site of the hip capsule
c. Greater trochanter
a. The attachment site for the gluteal muscles (Gluteus Maximus, Medius and
minimus
d
d. Lesser trochanter
a. The attachment point for the psoas muscles and iliacus
Inter-trochanteric line passes across the anterior surface between the two
trochanters. It is the site of the distal attachment of the iliofemoral ligament of the hip
e Lateral epicondyle of the distal femur – proximal attachment of the lateral
collateral ligament of the knee
f
Medial epicondyle of the distal femur – proximal attachment of the medial
collateral ligament of the knee
g Adductor tubercle on the superior part of the medical epicondyle– the distal
attachment point of the adductor magnus muscle
Self Check: Femur
Bony Feature
Identified on the skeleton
Identified on a model
Head of the femur
N/A
Neck of the femur
N/A
Greater trochanter
Lesser trochanter
N/A
Inter trochanteric line
N/A
Lateral epicondyle of the
femur
Medial epicondyle of the femur
The adductor tubercle
Clinical relevance
The Posterior Femur
h
The gluteal tuberosity – distal attachment point for the deep
fibres of the gluteus maximus
i
The intertrochanteric crest
j
The linea aspera – this raised ridge running down the posterior
aspect of the femur is a site of attachment for several major
muscles the quadriceps muscles vastus medialis and vastus lateralis
before they wrap round the femur the adductor muscles (adductor
magnus, adductor longus and adductor brevis)
the short head of the biceps femoris one of the hamstring muscles
k
The lateral and medial supracondylar lines
l
The lateral condyle of the femur – articulates with the flattened
lateral condyle of the tibia
the medial surface of this condyle is the attachment point of the
anterior cruciate ligament of the knee
m
The medial condyle of the femur – articulates with the flattened
medical condyle of the tibia.
The lateral surface of this condyle is the attachment point of the
posterior cruciate ligament of the knee
n
The intercondylar notch
Self Check Femur cont.
Bony Feature
Identified on the skeleton
Identified on a model
The gluteal tuberosity
N/A
Intertrochanteric crest
N/A
Linea aspera
N/A
Lateral and medial
supracondylar lines
N/A
Lateral condyle of the femur
Medial condyle of the femur
The intercondylar notch
N/A
Clinical relevance
Major Bony Features of the Lower Limb 2: The Tibia and fibula
Tibia and Fibula Anterior View
A
The tibial spine. The anterior part of the intercondylar ridge (this raised
area divides the tibial plateau into the lateral and medial articular surfaces.
This point is also the distal (anterior) attachment of the anterior cruciate
ligament
B
The lateral condyle of the tibia – distal attachment of the iliotibial band
C
The head of the fibula – distal attachment of the lateral collateral ligament
of the knee – distal attachment of the biceps femoris muscle (one of the
hamstrings)
The superior tibiofibular joint is formed between the medial side head of
the fibula and the under surface of the lateral tibial condyle. (This is a
synovial plane joint)
D
The medial condyle of the tibia – distal attachment site of the medial
collateral ligament of the knee
E
The tibial tuberosity - this is the distal attachment of the common tendon of
the quadriceps (via the patella tendon)
Tibia and Fibula Posterior View
F
The soleal line – the proximal attachment of the soleus muscle
G
The medial malleolus – proximal attachment point of the ligaments on the
medial side of the ankle (talocural) joint
H
The lateral margin of the distal tibia – forms the inferior tibiofibular
joint with the medial surface of the distal fibula. This is an example of a
fibrous joint (syndesmosis)
I
The lateral malleolus at the distal end of the fibula – the proximal
attachment point of the ligaments on the lateral side of the ankle
Self Check Tibia and Fibula
Bony Feature
Tibial Spine and intercondylar
ridge
Identified on the skeleton
Identified on a model
N/A
Lateral condyle of the tibia
Head of the fibula
Medial condyle of the tibia
Tibial tuberosity
The soleal line
N/A
The medial malleolus
N/A
Lateral margin of the distal tibia
Medial margin of the distal fibula
The lateral malleolus
Clinical relevance
Bony Features of the Lower Limb 3:
The Foot and Ankle
A. The interosseous membrane connecting the tibia and the fibula centrally. The
anterior and posterior surfaces of the interosseous membrane also provide
attachment for several muscles of the lower leg.
B. The medial malleolus on the distal end of the tibia. The proximal attachment
point of the medial (deltoid) ligament of the ankle.
C. The lateral malleolus on the distal end of the fibula. The proximal attachment
point of the lateral ligament complex of the ankle.
D. The talus the arrows indicating the dome of the talus immediately below the
tibia and the neck of the talus in front. The talus forms the ankle joint with the
tibia and fibula
E. The calcaneus is found under the talus and extends backwards to form the
heel. Its posterior surface forms the distal attachment point for the Achilles
tendon (of the calf muscles).
F. The navicular
NB the talus and the calcaneus provide the distal attachment points of the
lateral ligament complex on the lateral side and the talus calcaneus and
navicular provide the distal attachment of the deltoid ligament on the medial
side.
G. The cuboid
H. H indicates the three small bones of the midfoot the cuneiforms.
I.
Is the base of the 5th metatarsal – the distal attachment point of the peroneus
brevis muscle
Self Check Foot and Ankle
Bony Feature
The interosseous membrane
The medial malleolus
The lateral malleolus
The talus
The calcaneus
The navicular
The cuboid
The cuneiforms
5th Metatarsal
Identification of the skeleton
Identification on a model
N/A
Clinical relevance
Major Bony Features of the Upper Limb 1:
A
The clavicle the medial end of the clavicle joins with the sternum (at the
lateral side of the manubrium) to form the sternoclavicular joint the
lateral end of clavicle joints with the acromion process of the scapula to
form the acromioclavicular joint
B
The scapula. The scapula is an important site of attachment for many
muscles so it is important to know the main features. It has three fossa
(supra scapular, infra scapular and sub scapular; two borders (lateral
and medial) and two angles (superior and inferior). The muscles of the
rotator cuff of the glenohumeral joint all have their proximal attachments
onto the scapula
C
The coracoid process (of the scapula). This small prominent
bony point is an attachment point for important ligaments of the
acromioclavicular joint and for the proximal attachment of the
pectoralis minor muscle
D
The acromion process
E
The greater tuberosity of the humerus is the distal attachment
point of three of the four rotator cuff muscles
F
The lesser tuberosity of the humerus is the distal attachment of
the subscapularis muscle of the rotator cuff
G
The deltoid tuberosity of the humerus is the distal attachment point of
the powerful deltoid muscle
The Shoulder Complex
G
Between the greater and lesser tuberosity we find the interbubercular grove
sometimes called the bicipital groove as the tendon of part of the biceps passes
through the groove on its way to its proximal attachment
Self Check: Shoulder Girdle
Bony Feature
Identified on the skeleton
Identified on a model
Stenoclavicular joint
Acromioclavicular joint
Scapula fossa
Supra scapular
Infrascapular
subscapular
NA
Scapula borders (lateral, medial)
Inferior only
Scapula angles (superior, inferior)
The coracoid process
The acromion process
Greater tuberosity (tubercle)
Lesser tuberosity (tubercle)
Intertubercular (bicipital) groove
Clinical relevance
Major Bony Landmarks of the Upper Limb 2
The Elbow (Anterior View)
The elbow is formed by the distal end of the humeus and the proximal end of
the radius on the lateral side and the ulna on the medial side.
NB To help you orientate the thumb is on the lateral side
a. The lateral epicondyle of the distal humerus. This is the proximal
attachment point for a group of tendons called the common extensor
origin.
b. The capitulum on the distal surface of the humerus that articulates with
c the head of the radius.
c. Is the head of the radius which articulates with the capitulum above
and also with the proximal ulna to form the superior radio ulnar joint.
(The superior radioulnar joint is one of only two pivot joints in the body).
d. Is the radial tubercle which forms the distal attachment point of the
biceps brachii muscle
e. Medial epicondyle of the distal humerus. This is the proximal
attachment point of a group of tendons called the common flexor origin
f.
Is the trochlea of the distal humerus. The trochlea articulates with the
trochlea notch on the proximal end of the ulna.
g. If the coranoid process on the proximal anterior ulna. It is the distal
attachment point of the brachialis muscle.
h. Is the coronoid fossa. When the elbow is fully flexed the coronoid
process of the ulna is moved into this space.
Self Check: Elbow
Bony Feature
Identified on the skeleton
Identified on a model
Lateral epicondyle
Capitulum of the humerus
N/A
Head of the radius
Radial Tubercle
N/A
Medial epicondyle
Trochlea of the humerus
N/A
Coranoid process
N/A
Cononoid fossa
N/A
Clinical relevance
Elbow Posterior view
a. The lateral supracondylar ridge of the distal
humerus
b. The medial supracondylar ridge of the distal
humerus
c. Lateral epicondyle of the distal humerus
d. Medial epicondyle of the distal humerus
Indicates the position of the ulna nerve as it passes
from the upper arm and in to the forearm. If you
palpate into the space just below the medial
epicondyle you will be able to feel the nerve. It may
even make your little finger tingle.
e. Olecranon process of the proximal ulna. This is the
distal attachment point of the triceps muscle group
f. The olecranon fossa on the distal humerus. In full
extension of the elbow the olecranon process is moved
into the olecranon fossa.
Self Check: Elbow cont.
Bony Feature
Lateral supra condylar ridge
Medial Supra condylar ridge
Medial epicondyle
Ulna nerve
Lateral epicondyle
Olecranon process
Olecranon fossa
Identified on the skeleton
Identified on a model
Clinical relevance
Major Bony Features of the Upper limb 3:
Forearm, Wrist and Hand
The forearm is made up of the radius and the ulna joined proximally
by the superior radioulnar joint and distally by the inferior radioulnar
joint.
Movement of these two joints occurs as a single movement. They
are responsible for our ability to turn our palm upwards (supination)
and downwards (pronation)
Between the shafts of both bones there is an interosseous
membrane which helps to hold them together and the provide
attachment for muscles.
a. Olecranon process
b. Radial tuberosity
c. Ulna styloid
d. Radial styloid
e. The bones of the proximal and distal carpal rows (known
collectively as the carpus)
The curved concave surface of the distal radius and ulna forms the
wrist joint with the convex surface of the proximal carpal row.
f.
The metacarpals (the metacarpals provide attachment for
the small muscles of the hand and thumb)
g. The phalanges (note the fingers all have three phalanx while
the thumb has only two)
Self Check: Forearm and Hand
Bony Feature
Identified on the skeleton
Identified on a model
Olecranon process
Radial tubercle
Ulna styloid
Radial styloid
Carpal bones
Metacarpals
Phallanges
N/A
Clinical relevance