ANATOMY
Lecture 1-12-99
Aristotle – “A change in the state of the soul results in a change in the state of the body and a change in the state of the
body results in a change in the state of the soul.”
Science is the systematic observation of natural events for the purpose of determining the cause of natural events.
Classification of Man:
Homo sapiens means “man the intelligent”
Man is of the Phylum chordata. We have a notochord ( =flexible rod of tissue )  nucleus propulsus and a dorsal
hollow nerve tube that contains the brain and spinal chord. Man also at one time had pharyngeal pouches, the remnants
of which are the Eustachian tubes.
Man belongs in the Class Mammalia, characterized by hair, mammary glands, 3 auditory ossicles, teeth, diaphragm, and
an 4 chambered heart.
Man is of the Order Primate, along with limas, monkeys, and the great apes.
The Family Hominidae is the family of man ( people ).
Medical terminology
Suffixes:
-dyne – pain
-oid – resembling
-penia – few, small
-trophy – nourishment
Prefixes:
Dys – painful
READ MEDICAL TERMS –SUFFIX, PREFIX, THEN WORD ROOT
Structural levels of the body:
1. Atoms and molecules
2. Cellular level – 60-100 trillion cells / body
3. Tissue level – epithelial, connective, muscle, nervous tissue – layers of cells of common function.
4. Organ level – 2 or more organs that perform common function
5. System level – 2 or more organs that perform common function, integumentary, endocrine, CV, Urinary…
Planes of reference
Sagittal
Frontal
Transverse
Longitudinal – parallel to long axis
Directional terms
Rostral – toward the nose
Body regions
Head
Neck
Trunk
Thorax
Abdomen ( regions and quadrants )
Pelvic region – pubic, perineum, lumbar, sacral, gluteal.
Upper extremity – shoulder, brachium, cubital, antebrachium, carpus, Manus
Lower extremity – hip, thigh, patellar, popliteal, crural region( leg ), pes
Body membranes
Mucous membranes line body cavities open to the exterior.
Serous membranes line body cavities NOT open to the exterior.
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Terms for the day:
-oma – denoting a tumor or neoplasm
iatrogenic - denoting an unfavorable response to medical or surgical treatment, induced by the treatment itself
dysplasia – abnormal tissue develoment
hyperplasia – quantitative hypertrophy;an increase in number of cells in a tissue or organ, excluding tumor formation,
whereby the bulk of the part or organ may be increased. See also hypertrophy.
hypertrophy – general increase in bulk of a part or organ, not due to tumor formation.
cyanosis – A dark bluish or purplish coloration of the skin and mucous membrane due to deficient oxygenation of the
blood
etiology – The science and study of the causes of disease and their mode of operation.
idiopathic – denoting a primary disease of unknown cause
prognosis – A forecast of the probable course and/or outcome of a disease.
neuropathy - A classical term for any disorder affecting any segment of the nervous system
Terms related to movement of the body
1. Flexion - decrease in joint angle, if thigh or shoulder it means bringing it anteriorly
a. lateral flexion - bending of a joint, decrease of a joint angle
2. Extension - increase in joint angle
In anatomic position most joints are in extension
3. Abduction - away from the main axis
4. Adduction - toward the main axis
5. Rotation - movement of a body part around its own axis
a) medial rotation - internal rotation
b) lateral rotation - external rotation
c) supination of the forearm – anatomical position
d) pronation - rotation of the forearm so that the palm is rotated in a medial and posterior direction
or rotation of the radius on the ulna
6. Circumduction - circular movement of a body part
7. Inversion of the foot - ( sometimes called supination ) turning the sole of the foot inward
8. Eversion of the foot – ( sometimes called eversion ) turning the sole of the foot outward/laterally
9. Protraction - movement of the body part anteriorly
10. Retraction - movement of the body part posteriorly
11. Elevation - movement which raises a body part
12. Depression - lowering of a body part
Select topics relating to anatomy
1. Homeostasis - equilibrium - balance within the body. Disease results from a disruption of homeostasis
2. Fluids of the body
a) Extracellular fluids
1) plasma
2) interstitial fluid - intercellular fluid
3) synovial fluid
4) cerebrospinal fluid
b) Intracellular fluids
1) cytoplasm - cytosol
2) nucleus – nucleoplasm
There is a constant exchange between extracellular and intracellular fluids in the body.
3. Stress - reactions to disturbance in homeostasis, things that disturb the homeostasis of the body.
4. Disease - inappropriate response to stress, the body’s inappropriate response to stress
a) Signs - objective evaluation made by a trained person
b) Symptoms – subjective: “I don’t feel good”
c) Etiology - cause of disease, cause of disease
d) Diagnosis
Diagnosis
S – subjective – complaint of the patient
O – objective – clinical findings
A – assessment – put it all together
P – plan – what to do given the above information
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D – degenerative
A – anomalies or auto-immune
M – metabolic
N – Neoplasm
I – infectious
T – trauma or toxic
Eponyms, pros and cons – an eponym is the use of a person’s name to describe anything scientific, it doesn’t tell you
anything!
Different Approaches to the Healing Arts
1. Allopathic Medicine - create conditions antagonistic to the causative factor
2. Homeopathic Medicine - like treats like, medicines which evoke similar symptoms ( eg. Extract of jalapeno to treat
hemorrhoids.)
3. Chiropractic - maintain neurological and musculoskeletal balance
4. Medicine - treatment and prevention of disease using nonsurgical means
The Metric System
Deciliter = 100 ml
mg% = mg/100ml
1 cup = 8 oz. = 1/2 pint
1 meter = 100 centimeters = 1000 mm = 3.28 ft.
1 grain = 64.8 mg.
Organization of the skeletal system
1. The Axial Skeleton
Skull – cranial and facial bones
Auditory ossicles – 3 bones total per side
Hyoid bone – below the larynx
Vertebral column – 26 bones in the adult
Rib cage/sternum 2. The Appendicular Skeleton
 Pectoral Girdle - scapula & clavicles - cingulum membri superioris - girdle - articulates with sternum & vertebral
column
 Upper Extremities - humerus, radius, ulna, carpal bones, metacarpals and phalanges
 Pelvic Girdle - 2 ossa coxae, cingulum membri inferioris - articulates with sacrum
 Lower Extremities - femur, tibia, fibula, tarsal bones, metatarsals and phalanges
Functions of the skeletal system
1. Support – it is an internal rigid framework to our structure
2. Protection – of internal organs
3. Body movement – levers for muscles to pull against
4. Provide an anchoring point of muscles
5. Calcium/phosphorus storage and metabolism
6. Hematopoiesis
Terminology
1. Condyle – a large rounded projection or a knob usually on the end of a long bone. Provides smooth articulation point
2. Facet – a flattened or shallow articulating surface – ribs, vertebrae
3. Head – a prominent rounded articulating bone end
4. Alveolus – deep pit or a socket – teeth
5. Foramen – a hole or rounded opening
6. Fissure – a narrow, slit-like opening
7. Sinus – a cavity or a hollow space in a bone
8. Sulcus – a groove
9. Crest – a narrow, ridgelike projection
10. Epicondyle – a projection located superior to a condyle
11. Process – any bony protuberance
12. Spine – a sharp, slender process – scapula
13. Trochanter – a massive, big process, only on the femur: greater, lesser, and gluteal tuberosity
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14. Tubercle – a small rounded process
15. Tuberosity – a small roughened process
16. Fossa – a flattened or shallow surface, depression
Shapes of bones
1. Long bones – are longer than wide – femur
2. Short bones – somewhat cube shaped – wrist
3. Flat bones – cranial bones, ribs, scapula
4. Irregular bones – vertebrae and certain bones of the skull
5. Accessory bones – extra bones
6. Wormian bones – after Olas W. – sutural bones in the skull, extra bones
Structure of a typical long bone
Shaft – diaphysis – long tubular
1. periosteum – dense regular CT
a. Sharpey’s fibers – perforating fibers that connect periosteum to bone
2. Epiphysis – spongy bone on each end of the diaphysis
a. Epiphyseal plate – the growth center of the bone, covered with hyaline cartilage
b. Articular cartilage – hyaline cartilage
c. Red marrow – hematopoiesis/hemopoiesis
3. Medullary cavity – a central cavity within the diaphysis
a. endosteum – lines the medullary cavity
b. yellow marrow – fills it
Bone cells
1. Osteogenic cells – in periosteum and endosteum,  osteoblasts or  osteoclasts
2. Osteoblasts – lay down the osteoid, make bone
3. Osteocytes – mature bone cells, reside in the lacunae, regulate calcium release into the blood stream maintain
bone
4. Osteoclasts – break down bone
5. Bone lining cells – derived from osteoblasts along the surface of most bones, regulate Ca/P movement
Spongy and Compact Bone
1. Spongy bone – lacy network of trabeculae (= supporting bundles of fibers), located deep to compact bone
2. Compact bone – very dense, forms external portion of bone composed of cylindrical columns of bone.
Haversian system – osteon
a. lamellae – concentric rings of bone
b. central canal – contains artery, vein, and lymphatics
c. lacunae – spaces where osteocytes reside
d. canaliculi – small channels which connect lacunae
e. perforating channels – Volkmann’s canal
Bone Growth
1. Endochondral ossification – long bones, etc. preexisting, most bone is made like this
2. Intramembranous ossification – flat bones, within a membrane
Homeostasis and Physiologic function of bone
1. Hematopoiesis – in the bone marrow, RBCs, WBCs, Platelets (thrombocytes)
2. Calcium storage and release
a. Function of calcium in the body
1) blood clotting
2) nerve transmission
3) muscle contraction
b. Control of calcium levels in the blood
1) bone
2) kidney
3) parathyroid glands
c. diet/GIT Disorders of calcium metabolism
1) hypocalcemia – tetany, spasm/seizures of muscles
2) pH is proportional to HCO3/CO2 ( story about his wife in labor- hypocalcemic – paperbag over her mouth )
3) hypercalcemia
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d. Essential nutrients for normal bone development and function
1) Calcium, phosphorus, magnesium
2) Vitamin D – absorption of calcium
3) Vitamin A – osteoblast function
4) Vitamin C – necessary for osteoid synthesis
5) Protein
The Axial Skeleton
Skull
Divisions of the skull
1. Cranial bones – 8 bones in all
a. Cranial cavity – where the brain is
1) Calvaria – roof of the cranial vault
2) Cranial fossa – floor of the cranial cavity
b. Facial bones – 14 bones are not in contact with the brain. All are paired except the vomer and mandible
Fontanels – means literally fountain
1. Anterior fontanel – bregmatic fontanel closes by 18-24months  bregma
2. Posterior or occipital fontanel – closes by 2 months  lambda
3. Anterolateral or sphenoidal fontanel – closes by 3 months of age  pterion ( 4 bones come together here )
4. Posterolateral or mastoid fontanel – closes by 12 months  asterion
Sutures – means seam
1. Sagittal suture – separates parietal bones, bregma  lambda
2. Coronal suture – anterolateral fontanel  bregma  anterolateral fontanel
3. Lambdoid suture – posterolateral to posterolateral fontanel, asterion to lambda
4. Squamous suture - anterolateral posterolateral fontanel, pterion  asterion
5. Metopic suture – bregma  intranasal sutures, anterior fontanel rostrally to glabella, closes by age 6
Foramen
Carotid canal foramen
FORAMINA OF THE SKULL
Location Netters plate #
Structures that pass through it
Petrous temporal bone 7
Internal carotid artery
Internal carotid nerve plexus
Greater palatine foramen
palatine bone 5
greater palatine nerve
Hypoglossal canal
superior and anterolateral
to the occipital condyles 5, 7
hypoglossal nerve XII
Incisive foramen
anterior region of palatine
process of maxilla 5
e
Inferior orbital fissure
btwn maxilla & greater wing
of sphenoid bone 2
maxillary division of trigeminal nerve V2,
zygomatic nerve
Infraorbital foramen
inferior to the orbit 1
infraorbital nerve
Jugular foramen
btwn the petrous portion of
temporal & occipital b. posterior
to carotid canal 5, 7
Foramen lacerum
btwn petrous portion of the
loop of the internal carotid artery -does not go thru
Temporal bone and sphenoid 5
Foramen magnum
occipital bone
Mandibular foramen
medial surface of ramus of
mandible 10
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5, 7
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nasopalatine nerve
sigmoid sinus, Glossopharyngeal IX,
Vagus X,
Spinal accessory nerve XI
spinal cord, vertebral arteries, spinal accessory
nerve roots XI, meninges
V3 inferior alveolar nerve ( once it goes thru here)
Anatomy TRI 1
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Mental foramen
inferior to first molar on
Lateral side of mandible 2
Inf. Alveolar  mental nerve ( once it goes thru here)
Nasolacrimal foramenbony canal lacrimal bone 44
nasolacrimal (tear) duct
Cribriform plate or
Olfactory foramina
cribriform plate of the ethmoid
bone 7
olfactory nerve I
Optic canal
sphenoid bone 7
optic nerve II
Foramen ovale
sphenoid bone 5, 7
mandibular division of trigeminal nerve V3,
Foramen rotundum
sphenoid bone 5, 7
maxillary division of the trigeminal nerve V2
Foramen spinosum
sphenoid bone 5, 7
middle meningeal vessels ( a and v ),
Stylomastoid foramen
btwn styloid and mastoid
process of temporal bone 5
facial nerve VII
Superior orbital fissure
btwn greater and lesser wings
of the sphenoid bone 1
oculomotor III, trochlear IV, ophthalmic division of
trigeminal nerve V1, Abducens VI
Supraorbital notch (foramen)
supraorbital arch of frontal b. 1 supraorbital nerve
Zygomaticofacial foramen
anterolateral surface of the
zygomatic bone 1
zygomaticofacial nerve
Internal acoustic meatus
temporal bone 7
Facial VII, Vestibulocochlear VII (does not exit!)
1-19-99
Terms for the day
cytology - the study of the anatomy, physiology, pathology, and chemistry of the cell.
Fibrous tissue - a tissue composed of bundles of collagenous white fibers between which are rows of connective tissue
cells; the tendons, ligaments
Erythro- - Combining forms meaning red or denoting relationship to redness
Chromo- - Combining form meaning color
Hyper- - Prefix denoting excessive or above the normal;
Hypo- - Prefix denoting deficient or below the normal;
Meta- - a prefix denoting the concept of after, subsequent to, behind, or hindmost; corresponds to L. post-.
Prefix denoting joint, action sharing.
Dia- - Prefix meaning through, throughout, completely
Dys- - Prefix meaning bad or difficult.
Genetic - Relating to 1) genetics; 2) ontogeny.
-coid – like
-osis – denotes primarily any production or increase, physiologic or pathologic, and secondarily an invasion, and increase
within the organism, of parasites;
-plasia - Suffix meaning formation.
-stasis - Stagnation of the blood or other fluids.
Words of the day 1-26-99
Petechiae- minute hemorrhagic spots, of pinpoint to pinhead size, in the skin, which are not blanched by pressure.
Pallor , jaundice, rhinorrhea, vesicle, alopecia, hypoxia,
Cicatrix – scar
Hypercapnia – increased arterial CO2
Anodyne – compound less potent than a narcotic, but capable of relieving pain.
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Ligaments of the Spine
1/26/99
Anterior Longitudinal Ligament
–
anterior aspect of vertebral bodies and IVD
–
axis to first sacral segment
Posterior Longitudinal Ligament
–
attaches axis (continuous with the Tectorial membrane) to the first sacral segment
–
inside of the neural canal
–
attaches body to body and IVD’s
Interspinous Ligament
–
connects adjacent spinous processes
Supraspinous Ligament

N 146
attach the tips of the spinous processes, C7 to S1
Ligamentum Nuchae



N14/16
superior continuation of the supraspinous ligament
triangular in shape
attaches to the EOP and the median nuchal line, posterior tubercle of the atlas, and spinous processes of
the cervical vertebrae
Ligamentum Flavum

connects adjacent lamina, one on each side, elastic ligament
Supraspinous Ligament

attach the tips of the spinous processes, C7 to S1
Ligamentum Nuchae

superior continuation of the supraspinous ligament

triangular in shape, attaches to the EOP and the median nuchal line, posterior tubercle of the atlas, and spinous
processes of the cervical vertebrae
Ligamentum Flavum

connects adjacent lamina, one on each side, elastic ligament
The Rib Cage
Sternum – “dagger”


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N 171
Manubrium – superior portion
 Jugular notch
 clavicular notch – where the clavicle articulates
 costal notch
 manubriosternal joint - sternal angle, Angle of Louis ( can see it when you look laterally )- heart
just deep to this
Body of the Sternum
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 6 Costal notches
 Xiphoid Process – starts out cartilaginous
 7 ribs total attach to the sternum
Sternum has
articulations
ribs
Manubrium
7
4
Body
14
12
Xiphoid
1
0

Costal Margin - fusion of cartilage of ribs 8,9,10 ( vertebrochondral ribs )

Costal Angle - formed by the 2 costal margins
Ribs
N 170

12 pairs of ribs

Ribs 1 thru 7 - Vertebrosternal ( True ) ribs

Ribs 8 thru 10 - Vertebrochondral ( False ) ribs – these do not attach directly to the sternum, but through a
cartilaginous attachment.

Ribs 11 and 12 - Floating ribs – no attachment on one side
NOTE: all 12 ribs articulate directly with the body of the sternum ( via their costal cartilage )

Components of a typical rib








Head
Body – main portion
Tubercle
Costal groove – posterior inferior surface of rib, distinguishes L from R rib
vein, artery, and nerve.
Neck
Intercostal space
Angle
Costochondral joint
, houses intercostal
The Appendicular Skeleton
CH. 7, p. 169 - 188
The Pectoral Girdle
p. 169 - 172
The Clavicle - Collar Bone – superior surface is smooth

Acromial Extremity - lateral end – articulates with the acromion of the scapula


Coronoid Tubercle - coracoclavicular ligament
Sternal Extremity – medial end, large round, knob like


Costal Tuberosity - costoclavicular ligament
Groove for the Subclavius muscle
N 391
The Scapula

Spine of the scapula


acromion - lateral end of spine is enlarged – separates the 2 fossa below
Fossae of the Scapula


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supraspinous fossa - supraspinatus m.
infraspinous fossa - infraspinatus m.
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

subscapular fossa – anterior surface – subscapularis muscle originates here
Glenoid cavity



N 392
Articulates with head of humerus to make the shoulder joint
supraglenoid tubercle - long head of biceps brachii m.
infraglenoid tubercle - long head of triceps brachii m.

Coracoid process - 3 muscles attach here

Margins (borders) of the scapula




N 393
lateral border (axillary margin)
medial border (vertebral margin)
superior border
 suprascapular notch - scapular notch - suprascapular nerve
Angles of the Scapula



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inferior angle
medial angle
superior angle
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Neck
The Humerus

Head

Anatomic neck ( where the joint capsule attaches ) vs. surgical neck ( humerus would be removed here )

Greater tubercle

Lesser Tubercle

Intertubercular groove – bicipital groove

Deltoid Tuberosity – midshaft on the anterior surface – deltoid muscle inserts here.

Radial groove - spiral groove - musculospiral groove - radial nerve – located below the deltoid tuberosity. A
midshaft break of the humerus oftentimes is along this groove, and the radial nerve can be damaged.

Medial epicondyle - flexors of carpus and digits

Lateral epicondyle - extensor muscles of the carpus and digits originate here

Medial and lateral supracondylar crests

Trochlea – “pulley” – articulates with the ulna

Capitulum –articulates with the radius – trochlea and capitulum together make up the
distal condyle

Coronoid fossa – anterior distal aspect of the trochlea

Olecranon fossa – posterior aspect of the trochlea.
To tell a L bone from a R, orient it in 3 planes, proximal/distal; medial/lateral; anterior/ posterior.
The Ulna

Olecranon process - elbow

Semilunar notch - trochlear notch – hinge joint

Coronoid process – sits in olecranon fossa when arm is extended

Ulnar tuberosity – distal to coronoid process on the anterior surface.

Radial notch - on lateral surface, where the head articulates with the radius (L/R distinguishing factor!)

Styloid process

Interosseous margin – membrane or ligament attaches here.

Posterior border of ulna - separates forearm into flexor and extensor compartment
The Radius

Head

Radial tuberosity

Styloid process - distal
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N 409

Ulnar notch – distal – where the ulna articulates

Grooves on the posterior surface




groove for ECRL (Extensor carpi radius longus ) and ECRB mm.
dorsal tubercle
groove for the Ex Pollicis Longus m.
groove for the Ex Dig. And Ex. Indicis mm
The Carpus

Proximal Row of Carpal Bones - medial to lateral





N 422
Pisiform - sesamoid bone in the tendon of Flexor Carpi Ulnaris m.
Triquetral - triangular bone
Lunate - articulates with radius
Scaphoid bone - navicular bone, articulates with radius
Distal Row - medial to lateral
 Hamate bone - hamulus – “hammer” – has a hook on it
 Capitate - Os Magnum – largest bone of the carpi
 Trapezoid - Lesser multangular
 Trapezium - Greater multangular
Mnemonic how to remember the carpal bones from proximal medial to distal lateral
Please
Take
Larry Shopping
– He
Came
Pisiform
Triquetral
Lunate Scaphoid
– Hamate
Capitate
X-rays of carpals are difficult to interpret
To
Trapezoid
Metacarpal Bones and Phalanges

Metacarpal bones




Base
Body
Head
Phalanges


Proximal, middle and distal phalanx on 4 digits, but not the thumb.
Digits are numbers form lateral to medial, 1-5
The Pelvic Girdle

Formed by two Ossa Coxae - hip bones

Greater pelvis (false) - superior to pelvic brim

Lesser (true) pelvis - inferior to brim of pelvis

Pelvic Brim - sink

Pelvic Inlet – hole through the brim
Bones of the Pelvis
p. 177 - 180
Ilium

External surface

Iliac crest - ( holds up the bikini! )


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anterior superior iliac spine and anterior inferior iliac spine
posterior superior iliac spine ( locate dimples!) and posterior inferior iliac spine
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Town
Trapezium

Gluteal Lines - lateral aspect of ilium, “glutes” attaches here.

Iliac Fossa - medial

Greater Sciatic Notch - posterior

Auricular Surface for the sacrum – medial articulation with auricular surface of sacrum

Iliac tuberosity

Inguinal ligament - pubic tubercle to ASIS
Ischium
N 453

Spine of the Ischium

Ischiatic tuberosity – sitting on it! Hamstring muscle originates here.

Lesser Sciatic Notch

Body

Ramus (“bridge ) of the Ischium – connects body to pubic bone
Pubis

Superior Pubic Ramus



pubic tubercle
pecten pubis – line
obturator groove

Inferior Pubic Ramus

Symphysis

Obturator Foramen –in life, this hole is covered by membrane

Acetabulum – “cup of vinegar”




N 453
acetabular notch – inferior surface
acetabular fossa
lunate surface – moon like rim around the surface
Sex related differences in the pelvis
Page 332 – pelvic differences
Male pelvis
Narrow, straight
Heavy
Rough
Heart shaped
Deep
Pubic symph angle <=90
female pelvis
broad, flared out
light
smooth
oval to round
relatively shallow
>90 degrees
Larger pelvic outlet
Wider inlet
The Femur

N 455
Head –large, prominent

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fovea capitis
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
Neck

Greater and lesser trochanter

Shaft – diaphysis, bows anteriorly

Linea aspera – pectineal line

Gluteal tuberosity - third trochanter

Epicondyles

Adductor tubercle – adductor m. attaches here

Condyles – point posteriorly

Intercondylar fossa

Popliteal fossa

Patellar surface
The Tibia – shin bone

Medial Condyle - proximal

Lateral Condyle


N 478
Gerdy’s tubercle – on the anterior lateral aspect of tibia - insertion of the iliotibial tract
Tibial Plateau

Intercondylar eminence
 Medial and lateral intercondylar tubercle – menisci attach here

Tibial Tuberosity – Quadriceps femoris attaches here

Shaft

Interosseous crest - lateral

Medial Malleolus – distal medial aspect – ankle bone

Inferior Articular surface – articulates with tarsus

Fibular notch
The Fibula

Head

Interosseous border - medially

Lateral Malleolus – distally, little fossa on it, posterior medial aspect (L/R distinguishing factor!)
The Tarsal Bones ( 7 )

Talus - pulley shaped, articulates with distal tibia and fibula


posterior process
 groove for the FHL m.
 medial and lateral tubercles
Calcaneus - heel bone

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
sustentaculum tali – “balcony”, supportive to talus, points medially (L/R distinguishing factor!)

groove for the FHL m.

Navicular

Cuboid - groove for the peroneus longus m.

Cuneiform bones – 3 – they make an arch
Metatarsals and Phalanges

Metatarsals - numbered from medial to lateral [ carpals lateral to medial!!!]



N 488
base, body, head
Mt 5 has a tuberosity on its base
Phalanges


proximal, middle and distal
Hallux has only two phalanges
Arches of the Foot

Longitudinal Arch – toes to heel


medial portion is more elevated than lateral portion. The talus is the keystone of the medial portion and
the cuboid is keystone for the lateral portion.
Transverse Arch –from medial to lateral

extends across the width of the foot. Formed by the calcaneus, navicular, cuboid and all 5 Metatarsal’s.
Terms for 1-28-99
Tracheostomy – Formation of an opening into the trachea
Tracheotomy – The operation of opening into the trachea
Cystocenthesis – puncture of a cyst, or bladder
Pneumoconiosis – inflammation commonly leading to fibrosis of the lungs caused by the inhalation of dust
Apnea – absence of breath
Rhinoplasty – nose job
Atelectasis –Absence of gas from a part or the whole of the lungs, due to failure of expansion or resorption of gas from the
alveoli.
Epistaxis – nose bleed
Embolism – Obstruction or occlusion of a vessel by an embolus
Aphonia – loss of the voice as a result of disease or injury of the organ of speech
Arthrology
CH. 8, p. 192 – 225
Terms for this section
Symphysis – grown together, fused
Synostosis - osseous union between the bones forming a joint.
Synchondrosis - a union between two bones formed either by hyaline cartilage or fibrocartilage.
Synarthrosis – a joint that does not permit movement between the articulating elements
Amphiarthrosis – symphysis
Diarthrotic – relating to 2 joints
Arthrology – study of joints
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Joints ( SAVE THESE NOTES FOR BOARDS IN UPPER TRIs!)

Definition of a joint – AKA articulation, arthrosis: a place where two or more bones come together. There may
or may not be movement there. A joint’s primary purpose is movement, but it doesn’t have to be.

Kinesiology - the study of the mechanics of motion, biomechanics, study of the movement of joints. The motion
present is largely determined by the structure of the articular surfaces.
Classification of Joints
According to the type of material that holds the bones together and the method used to unite the boney components.
What holds the bones together, what method is used to hold them together?
Synarthrosis – ( “to join”)
1. Fibrous joints - joined by fibrous connective tissue – no joint cavity
A. suture - found only in the skull – there are over 30 in the skull – they are classified by how they overlap
{bone-fibrous tissue-bone}
 serrate suture - most common - sawlike interlocking articulations
 squamous - edges overlap – pterion/asterion
 plane - edges are smooth and do not overlap – maxilla/palatine – often disappear later in life by
fusing  bony fusion = synostosis
B. syndesmosis – “joined by a ligament”
a ligament is a CT structure that connects bone to bone
C. single ligament or interosseous ligament - FCT sheet between two bones
D. ( tympanostapedial )
E. between the radius and ulna
F. interspinous ligament – between the spines of the vertebrae
G. between tibia and fibula
C. gomphoses – between the teeth, where the tooth fits into the alveolar process, like a peg in a hole.
2. Cartilaginous Joint – 2 ends of bone are joined by either hyaline cart., fibrocartilage, or both. { bone-cartilage-bone}
A. Primary Cartilaginous Joint - synchondrosis – no movement
 synostosis – often temporary
epiphyseal plates – located between diaphysis and epiphysis, separates the end of the
bone from the shaft of the bone, where growth occurs. These epiphyseal plates
close under the influence of testosterone/estrogen.
 costochondral articulations – between the ribs and the sternum – costal cartilage
B. Secondary Cartilaginous Joint - symphysis – limited movement – not a synarthrosis but a
amphiarthrosis, secondary because there is a second kind of cartilage { bone-hyaline-fibro-hyaline-bone}


symphysis pubis – between the pubic bones – Elastin is a hormone of pregnancy that relaxes this
joint for partition so that the 2 pubic bones can spread to deliver the baby
intervertebral joint –between 2 vertebral bodies
There is no joint in the body with just fibrocartilage
Diarthrosis
Synovial Joints – are freely movable . There is no cartilage or connective tissue directly connecting the ends of the
bones. The 2 bones slide freely on each other. A synovial joint consists of:
1. Joint capsule – outer lining stratum fibrosum made of dense CT attached to the periosteum. This has poor
blood supply but is well innervated (pain, motion, tension, vibration )
2. Synovial membrane or stratum synovium – inner lining, very vascular, but poorly innervated
3. Synovial fluid – is very slick to lubricate the joint. It contains synoviocytes which secrete this synovial fluid.
4. Articular cartilage – The articular ends of the bone are not covered with periosteum, but hyaline cartilage.
All joints (except one ) are lined with hyaline cartilage!
Joint cavity – is a space between the bones, and exists only in synovial joints.
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Range of Motion – is determined by 3 features
B. Anatomic shape of the articular surfaces
C. Joint capsule – how tight and how strong it is
D. Presence of adjacent structures
Types of Movement
1. Uniaxial - one plane - flexion /extension
a. Hinge
b. Pivot
2. Biaxial - two planes - capable of flexion/extension and adduction/abduction.
a. Condyloid
b. Saddle
3. Multiaxial or polyaxial or triaxial - three planes capable of flexion/extension, adduction/abduction, int/ext. rotation
a. Ball and Socket
b. Plane
Associated Structures – anatomic structures
1. Ligaments – CT structure that connects bone to bone , “bandage”


Intrinsic – inside the joint w/I the joint capsule, cruciate ligament of the knee
Extrinsic – found associated w/ a joint capsule, just a thickening of the joint capsule, lateral
collateral ligament of the knee
2. Bursae – flat sac of synovial fluid membrane filled with synovial fluid, located usually where there is a
tendon or muscle across a joint. Its function is to decrease friction, subdeltoid.
3. Tendon sheath – modified bursa that surrounds a tendon and lubricates it when it moves back and
forth. Shin splints –inflammation of the anterior tibial tendon sheath.
Kinds of Synovial Joints
p. 198 - 200
Uniaxial Joints
1. “Hinge” - ginglymus – capable of flexion /extension



Humero-ulnar or cubital joint – AKA elbow joint
Distal interphalangeal joint
Knee joint – EXCEPTION – this is really a modified hinge joint, since the knee joint is biaxial.
2. Pivot - trochoid – resembles a pivot. One joint component is shaped like a ring, the other rotates around it


Proximal radioulnar joint
Atlantoaxial joint – anterior arch of the Atlas with the dens of the Axis (Epistropheus)
Biaxial Joints
1. Condyloid - ellipsoidal joint – oval convex articular surface of one bone into the concave depression of another
bone – capable of flexion/extension and adduction/abduction.



Radiocarpal joint
Metacarpophalangeal joint
Atlantooccipital joint – occipital condyles and superior articular facets of the atlas. EXCEPTION: this is only a
hinge joint, but is named condyloid because of the shape of its components.
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2. Saddle - sellar joint – looks like 2 saddles – both bones of the joint are convex in one plane, concave in the other.



carpometacarpal joint of the thumb
trapezium and first metacarpal bone
articulation between the malleus and the incus
Multiaxial Joints
1. Gliding Joints - plane – the articular surfaces are mostly flat and they glide on top of each other.





Zygapophyseal joints
Intercarpal and intertarsal joints
Sternoclavicular joint
Sternocostal joints - planar
Sacroiliac joint - planar – auricular surface of the sacrum and the ilium
2. Ball and socket joints - spheroid - one bone contributes the ball, the other the socket of the joint


hip - coxofemoral joint shoulder joint – glenohumeral joint
Circumduction is only a combination of flexion/extension and adduction/abduction (not internal/external rotation)
Specific Joints of the Body (p. 208 – 218)
Atlantooccipital Joint
N 14

Synovial, diarthrodial - freely movable

Ginglymus and condyloid – (movement and shape ) the condyles of the occiput rest on the superior articular
facets of the atlas (condyloid portion); the condyles converge anteriorly and allow motion in only one plane (flexion
and extension - hinge portion)

Anterior atlantooccipital membrane /ligament- anterior arch of atlas to anterior margin of foramen magnum, direct
continuation of the anterior longitudinal ligament

Posterior atlantooccipital membrane - posterior arch of atlas to posterior margin of foramen magnum

Lateral Atlanto-occipital membrane - (Anterior Oblique Ligament), these two ligaments connect Transverse
Process of atlas to jugular process of occiput.

Articular Capsule (capsular ligament) - these ligaments enclose the articular surfaces and are lined with a synovial
membrane
Occipito-Axial Complex
N 15

the axis is NOT in direct articulation with the occiput so it is called a complex NOT a joint

Ligaments attach the axis to the occiput

Membrana-tectoria - occipito-axial ligament, tectorial membrane – superior continuation of the posterior
longitudinal ligament; attaches on the occipital bone medial to the hypoglossal canal; closely adherent to the cranial
dura once inside the cranial vault.

Alar Ligament - check ligament, odontoid ligament; one on each side, apex of dens to medial surface of occipital
condyles, serve to limit or check the degree of rotation of the axis. ( Prevents turning your head like an owl or Linda
Blair in the exorcist!)
BOARD QUESTION!

Apical ligament (suspensory ligament) - single ligament, tip of dens to anterior margin of foramen magnum; may
be remains of embryonic notochord as there is no disc here.

Cruciate ligament - 3 components
N 15
1. transverse ligament of the atlas - lateral mass over posterior aspect of dens to lateral mass – can be torn
by whiplash.
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2. cranial crus - attaches central portion of the transverse ligament to ant. margin of foramen magnum
3. caudal crus - attaches central portion of the transverse ligament to posterior body of axis
Terms for 2-2-99
Atlantoaxial Joints

2 joints here: both are Synovial, diarthrodial
1. bilateral joints between the inferior articular facets of the atlas and the superior articular facets of the axis;
these zygapophyseal joints are plane, gliding joints
2. articulation between dens and anterior arch of the atlas and the dens and the transverse ligament of the
atlas - trochoid, pivot joint

Ligaments associated with the Atlanto-axial joint
N 14,15,16
1. Anterior atlanto-axial ligament - anterior surface of body of axis to anterior arch of atlas
2. Posterior atlanto-axial ligament - from the laminae of the axis to the posterior arch of the atlas
3. Accessory Ligaments - runs from the medial surface of the lateral masses of atlas down to the posterior surface of
the body at the base of dens
4. Transverse Ligament of the Atlas - runs from lateral mass across the neural ring over the posterior aspect of the
dens to hold the dens firmly against the fovea dentalis of the atlas, does not attach to the dens, small synovial
pocket between the two. Articular facet = fovea dentalis
Joint of Luschka (BOARDS!)
N13
AKA Uncovertebral joint – some people wonder if this is really a joint, if it really exists.
1. Diarthrosis, synovial , gliding, planar
2. Between the uncinate processes and a small indentation found on the inferior surface of the vertebra it articulates
with.
3. typically undergo degeneration with resulting bony outgrowth ( osteophytes ) which may encroach on
neighboring structures such as the vertebral artery and the exiting spinal nerves.
4. DO NOT COUNT THE ARTICULATIONS FOR THIS JOINT AS EXTRA ARTICULATIONS FOR THE
VERTEBRAE.
Intervertebral Joints (TEST)
N 144
1. Secondary cartilaginous, symphysis, amphiarthrotic
2. Intervertebral Disc – truly classified as a ligament
1.
2.
3.
4.
5.
23 total in the adult: the most superior one between C2 and C3, the most inferior one between L5 and S1
25% of the height of the vertebral column is due to IVD’s
lordotic curve areas - disks are thicker on the anterior side than posterior
adherent to a thin layer of hyaline cartilage which covers the surfaces of the vertebral bodies
attach to the anterior and posterior longitudinal ligaments and the heads of the ribs 2-9.
3. Components
1. Annulus fibrosus - peripheral portion, fibrocartilage
2. Nucleus pulposus ( fibrocartilage in gelatinous matrix ) - 88% H2O at birth, 70% at age 70  this causes
disc collapse  shrinking in age.
Zygapophyseal Joints ( TEST )
Located between the adjacent inferior articular facets of the superior vertebra and the superior articular facets of the
inferior vertebra.
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1. Synovial
2. Diarthrodial
3. Plane
4. Gliding
5. Multiaxial
Spinous Process Articulation
( Dr. G’s notes page 26 )
1. Syndesmosis of the spine (“held together by ligament “)
N 146
a. Interspinous ligament - between spinous processes
b. Supraspinous ligament - connects tips of spinous processes from C7 - S1 (first sacral tubercle)
c. Ligamentum nuchae - direct continuation of the supraspinous ligament, from EOP and median nuchal
crest to C7 – touches the tips of all transverse processes
d. what about the ligamentum flavum, Anterior longitudinal ligament and the Posterior longitudinal ligament
of the spine? ( ligamentum flavum is the only truly elastic ligament in the body.) These are syndesmosis
as well
Temporomandibular Joint
( Dr. G’s daughter had this joint successfully adjusted by chiropractor)
N 11
1. Synovial, diarthrodial, hinge, ( but also: ) gliding ( due to the intra-articular disc ), multiaxial
2. Components - articular disc fibrocartilage
3. Articular surfaces lined with fibrocartilage ( NOT HYALINE CARTILAGE )
4. Movement 


depression and elevation - hinge
protraction and retraction - gliding
lateral rotation
5. Ligaments ( not on test ?)



lateral ligament - prevents posterior displacement
stylomandibular - styloid process to ramus of mandible
sphenomandibular ligament - sphenoid bone to lingula/ramus of mandible
Any time you have an intra-articular disc, it is made of fibrocartilage
Sternoclavicular Joint
N 391
1. Synovial, diarthrodial, gliding, multiaxial
2. There is an articular disc made of fibrocartilage
3. Ligaments ( not on test? )




Anterior sternoclavicular ligament - covers anterior aspect of the joint
Posterior sternoclavicular ligament - covers posterior aspect of the joint
Interclavicular ligament - attaches the two sternal ends
Costoclavicular ligament - costal cartilage of the first rib to the costal tubercle
Glenohumeral Joint
N 394
AKA shoulder joint
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1. Synovial, diarthrodial, ball and socket, spheroid, multiaxial
2. Components

head of the humerus and the glenoid fossa of the scapula, most freely moveable joint in the body. BUT: to get
that kind of mobility, stability had to be sacrificed. The joint is pretected on 3 sides, but not inferiorly, therefore this
is the most often dislocated joint in the body, usually inferiorly and anteriorly.
3. Ligaments
 coracohumeral ligament - coracoid process to greater tubercle of humerus
 superior and inferior glenohumeral ligaments - thickenings of joint capsule around the neck of the scapula to the
anatomic neck of the humerus
 transverse humeral retinaculum - retaining band of CT- from greater tubercle to lesser tubercle of humerus
( across intertubercular groove) , holds bicipital tendon in place, tendon attaches to supraglenoid tubercle.
Glenoid labrium - increases the surface area of the glenoid fossa.
4. Protected from trauma from above by:

acromion & coracoid process of the scapula, lateral aspect of the clavicle, BUT: no protection inferior,
therefore most dislocations inferiroly.
5. Bursae
Serve to cushion and decrease friction
 subdeltoid bursa - between deltoid m and joint capsule
 subacromial bursa - between acromion and joint capsule
\ sometimes these 2
/ can be just 1
6. Rotator cuff muscles - musculotendinous cuff – rotators of the shoulder, medial and lateral




N 396
Supraspinatus m. - support from above – small lateral abductor – most commonly torn rotator cuff muscle
Infraspinatus m. - support from posterior – lateral rotator
Teres minor m. - support from posterior – lateral rotator
Subscapularis m. - support from anterior – medial rotator ( Dr. G’s wife tore this falling down the stairs )
The Elbow Joint
N 408
AKA Humeroulnar and Humeroradial joint or
1. Cubital joint - trochlea of humerus and trochlear notch of ulna and the capitulum of the humerus and the head of the
radius ( primary between humerus and ulna)
2. Synovial, diarthrodial, hinge, uniaxial
3. Ligaments




Radial (lateral) collateral ligament – most often involved in “tennis elbow”
Ulnar (medial) collateral ligament
Anular ligament - encircles the head of the radius – provides circle for pivot joint
Olecranon bursa - on posterior side of elbow – if this bursa becomes inflammed, usually by trauma, it forms a
hygroma.
Proximal Radioulnar Joint
N 408

Formed by the head of the radius and the radial notch of the ulna, allows for supination and pronation

Synovial

Diarthrodial

Trochoid or pivot

Uniaxial

Anular Ligament – encircles head of radius and holds it tight into the radial notch
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Metacarpophalangeal Joints
N 427
AKA knuckle
 Synovial, diarthrodial, biaxial
 Condyloid – because of the shape of the surface
Interphalangeal Joints
 Synovial, diarthrodial, uniaxial
 Hinge
The Coxal (Hip) Joint
N 454

Formed by the head of the femur and the acetabulum of the os coxae

Bears weight of the body - stable

Synovial, diarthrodial, spheroid, multiaxial

Acetabular labrum – fibrocartilage - rim
1. Ligaments of the hip
Iliofemoral ligament - “Y” ligament of Bigelow - anterior
 AIIS to intertrochanteric line, prevents hyperextension
 Pubofemoral ligament – triangular in shape
 pubis to intertrochanteric line, limits hyperextension and abduction
 Ischiofemoral ligament – spiral in shape
 ischium to greater trochanter, limits hyperextension
 Round ligament - ligamentum teres - intrinsic ligament ( w/I joint capsule), from fovea capitis of femur to
transverse acetabular ligament, bridges the gap formed by the acetabular notch
 Transverse acetabular ligament - crosses the acetabular notch, connects joint capsule to ligamentum capitis
femoris
There is a small artery, the acetabular branch of the obturator artery that goes into the head of the femur. When this little
artery ruptures, it leads to avascular necrosis of the head of the femur, and a hip replacement may be necessary ( Bo
Jackson ).

Tibiofemoral - Stifle Joint
N 458, 476

Largest and most complex joint of body

Synovial, diarthrodial, “modified hinge”- but also biaxial ( there is some rotation )

Classified as a double condyloid joint, capable of flexion, extension and medial and lateral rotation

Hyperextension of knee - foot firmly on the ground, locking of the knee medial rotation of femur
Foot in the air like in kicking  lateral rotation of the tibia

Ligaments

Primary function ( keep femur and tibia together and aligned, allow for bending of the knee
 control excessive knee extension
 control abduction and adduction stresses
 control anterior and posterior displacement of tibia on femur, so that the tibia doesn’t slide
 control medial and lateral rotation of tibia beneath femur, so the tibia doesn’t twist off
 give rotatory stabilization to the knee
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
Lateral and medial patellar retinacula – broad, flat band, tendinous insertion of quadriceps femoris m. Gives
anterior stability. Attaches to patella and tibial tuberosity, gives anterior stability to the knee, this reinforces the joint
since there is no anterior joint capsule.

Oblique popliteal ligament - posterior aspect of joint capsule, provides posterior stability and limits hyperextension.

Arcuate popliteal ligament – Extends from the head of fibula over tendon of popliteus muscle to insert to
intercondylar area of tibia and lateral epicondyle of femur. Since this is on the posterior aspect of the knee, it limits
hyperextension of knee.

Collateral Ligaments - provide medial and lateral stability



N 473
Medial (tibial) collateral ligament – attaches to tibia
Lateral (fibular) collateral ligament – attaches to fibula
Cruciate ligaments
N 476
1. Anterior cruciate ligament ( ACL )
 Anterior tibia to posterior medial aspect of the lateral condyle of the femur (support post. lateral)
 Prevents anterior displacement of the tibia on the femur
 During extension of the knee the ACL is pulled taut, PCL is lax  most ACL injuries occur when the knee is
extended
 Torn ACL = Anterior drawer sign ( flex knee  knee will slide anteriorly)
2. Posterior cruciate ligament ( PCL )
 Posterior tibia to lateral aspect of medial condyle of femur, prevents posterior displacement of the tibia with
relationship to the femur.
 Shorter and less oblique than ACL – more straight up and down
 During flexion of the knee the PCL is pulled taut, the ACL is lax  most PCL injuries occur when the knee is
flexed.
 Torn PCL = Posterior drawer sign ( push tibia posteriorly )
Injuries to the ACL or PCL heal very slowly.
Bursa
1. Popliteal bursa - between tendon of popliteus m. and lateral condyle of femur
2. Prepatellar bursa - between patella and skin, more commonly damaged. This is why carpet layers etc. wear knee
pads.
3. Suprapatellar bursa - between quadriceps tendon and anterior femur
Menisci
1. Medial meniscus – 2 fibrocartilaginous pads, semicircular, attached to medial collateral ligament and to
semimembranosus muscle’s tendon of insertion. The anterior horn of this meniscus is the most commonly injured
since it is thinner. Firm attachment.
2. Lateral meniscus - 4/5’s of a circle, attached to posterior cruciate lig. And popliteus muscle via coronary lig. And
posterior joint capsule. This meniscus is thicker, has more give, loose attachment. Its function is to distribute and
absorb the weight of the femur of the tibia. The compressive forces are 5-6 times the body weight when walking.
The lateral meniscus is C shaped, thick in the periphery, thin centrally, forms a cup. The horns attach to the
intercondylar tubercles of the intercondylar eminence.
Talocrural (ankle) Joint ( not on tests )
N 491
1. Synovial, diarthrodial, hinge, uniaxial – no rotation – straight hinge
2. Ligaments

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Deltoid
 posterior tibiotalar ligament
 tibiocalcaneal ligament
 tibionavicular ligament
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
 anterior tibiotalar ligament
Lateral collateral ligaments
 anterior and posterior talofibular ligament
 calcenofibular ligament
Terms Related to Joint Pathology
1. Strain - stretched or pulled tendon or ligament
2. Sprain - hyperextension, with tearing of tendons or lig. Luxation - derangement of the articulating bones that compose
a joint
3. Subluxation - partial dislocation of a joint
4. Bursitis - inflammation of a bursa
5. Tendonitis - inflammation of a tendon
6. Osteoarthritis - degenerative joint disease
7. Rheumatoid arthritis - autoimmune disease
8. Gouty arthritis - abnormal accumulation of uric acid
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