This presentation is about the anatomy of the skeleton, bones, joints and anatomical terminology, thanks for your review

1. Anatomy, Bones &
Joints
By:
Hossein Khorrami PhD.
khorrami4@yahoo.com
http://www.scribd.com/khorrami4

3. Anatomical position
 most widely used &
accurate for all aspects
of the body
 standing in an upright
posture, facing straight
ahead, feet parallel and
close, & palms facing
forward

4. Anatomical planes
 Median
 Frontal (coronal)
 Transverse

5. Body Planes and
Sections
 Coronal (frontal) plane - Lies vertically and divides
body into anterior (front) and posterior (back) parts
 Sagittal plane – lies vertically and divides the body into
left and right sides.
 Median (midsagittal) plane - Specific sagittal plane that
lies vertically in the midline
 Transverse plane - runs horizontally and divides body
into superior (up) and inferior (down) parts

6. Anatomical directional terms
• Anterior
 in front or in the front part
 Anteroinferior
 in front & below
 Anterosuperior
 in front & above
 Posterior
 behind, in back, or in the rear
 Posteroinferior
 behind & below; in back &
below
 Posterolateral
 behind & to one side,
specifically to the outside

7. Orientation and Directional Terms

8. Orientation and Directional Terms

9. Orientation and Directional Terms

10. Regional Terms

11. Regional Terms

12. Body Cavities and Membranes
 Dorsal body cavity
 Cranial cavity
 Cranial cavity
houses the brain
 Vertebral cavity
 Vertebral cavity
runs through the
vertebral column
and encloses the
spinal cord

13. Body Cavities and Membranes
 Ventral body cavity
 Thoracic cavity
 Two lateral parts each
containing a lung
surrounded by a
pleural cavity
 Mediastinum –
contains the heart
surrounded by the
pericardial sac

14. Body Cavities and Membranes
 Ventral body cavity
 Abdominopelvic
cavity
 Abdominal cavity –
contains the liver,
stomach, kidneys, and
other organs
 Pelvic cavity –
contains the bladder,
some reproductive
organs, and rectum

15. Body Cavities and Membranes
 Serous cavities – a slit-like space lined by a
serous membrane
 Pleura, pericardium, and peritoneum
 Parietal serosa – outer wall of the cavity
 Visceral serosa covers the visceral organs

16. Body Cavities and Membranes

17. Other Body Cavities
 Oral cavity
 Nasal cavity
 Orbital cavities
 Middle ear cavities
 Synovial cavities

18. Abdominal Regions and Quadrants
 Abdominal regions divide the abdomen into nine
regions

19. Abdominal Quadrants
 Abdominal quadrants divide the abdomen into four
quadrants
 Right upper and left upper quadrants
 Right lower and left lower quadrants

21. Bone functions
 Supportive
 Protection of brain & Sp.cord
 Movement
 Storage, minerals, fat
 Hematopoiesis

22. Bone growth
 Prenatal, after wk 8, starts mineralization
 Postnatal, longitudinal and diameter

23. Classification of Bones
Long bones
Typically longer than wide
Have a shaft with heads at both ends
Contain mostly compact bone
 Examples: Femur, humerus
 Short bones
 Generally cube-shape
 Contain mostly spongy bone
 Examples: Carpals, tarsals

24. Classification of Bones, cont.
 Flat bones
Thin and flattened, usually curved
Thin layers of compact bone around a layer of
spongy bone
 Examples: Skull, ribs, sternum
 Irregular bones
 Irregular in shape
 Do not fit into other bone classification categories
 Example: Vertebrae

26. Bones
The adult skeleton has 206 bones
Two basic types of bone tissue
 Compact bone
 Homogeneous
 Spongy bone
 Small needle-like
pieces of bone
 Many open spaces

27. Long Bone
Diaphysis
 Shaft
 Composed of compact bone
Epiphysis
 Ends of the bone
 Composed mostly of spongy
bone
 Hematopoiesis

29. Structures of a Long Bone
Periosteum
 Outside covering of the
diaphysis
 Fibrous connective tissue
membrane
Sharpey’s fibers
 Secure periosteum to
underlying bone
Arteries
 Supply bone cells with
nutrients

31. Structures of a Long Bone
Articular cartilage
 Covers the external
surface of the epiphyses
 Made of hyaline cartilage
 Decreases friction at joint
surfaces
Figure 5.2a

32. Structures of a Long Bone
Medullary cavity
 Cavity of the shaft
 Contains yellow marrow
(mostly fat) in adults
 Contains red marrow (for
blood cell formation) in
infants
Figure 5.2a

33. Microscopic Anatomy of Bone
Osteon (Haversian System)
A unit of bone
Central (Haversian) canal
Carries blood vessels
and nerves
Perforating (Volkman’s)
canal
Canal perpendicular to
the central canal
Carries blood vessels
and nerves

34. Bone Markings
 Surface features of bones
 Projections and processes – grow out from the bone surface
 Depressions or cavities – indentations
 Sites of attachments for
muscles, tendons, and
ligaments
 Passages for nerves and
blood vessels

35. Changes in the Human
Skeleton
In embryos, the skeleton is primarily hyaline cartilage
During development, much of this cartilage is
replaced by bone
Cartilage remains in isolated areas
 Bridge of the nose
 Parts of ribs
 Joints

36. Bone Growth
Epiphyseal plates allow for growth of long bone
during childhood
 New cartilage is continuously formed
 Older cartilage becomes ossified
 Cartilage is broken down
 Bone replaces cartilage

37. Bone Growth
Bones are remodeled and lengthened until
growth stops
 Bones change shape somewhat
 Bones grow in width

38. Long Bone Formation and
Growth

39. Types of Bone Cells
Osteocytes
 Mature bone cells
Osteoblasts
 Bone-forming cells
Osteoclasts
 Bone-destroying cells
 Break down bone matrix for remodeling and release of
calcium
Bone remodeling is a process by both osteoblasts
and osteoclasts

40. COMPOSITION OF BONE:
Bone
33% organic
28% collagen
5% non
collagenous
proteins
67% inorganic Hydroxyapatite

41. Composition of Bone…
Inorganic component:
 Hydroxyapatite crystals with carbonate content
Organic component:
- Osteoid
 Type I collagen (95%)
 type V collagen (<5%)
Non collagenous proteins
 Osteocalcin,
 Osteopontin,
 Bone sialoprotein,
 Osteonectin.(SPARC)- Cell adhesion ,proliferation,
modulation of cytokine activity.

42. OSTEOCYTES:
Nerve cells
Sense the change in environment and send signals that affect
response of other cells involved in bone remodelling
Maintains balance between
resorption and remodelling
 Bone that forms more rapidly
shows more osteocytes

43. Osteocytic lacunae
Canaliculi- narrow extension of lacunae, permits
diffusion of gases and nutrients
Maintains bone integrity and vitality
Failure of inter connecting system between osteocytes
and osteoblasts leads to sclerosis and death of bone

44. Osteoblasts :
Derived from osteoprogenitor cells
Periosteum serves as important reservoir .
Morphology :
 basophilic
 cuboidal or slightly elongated cells
contain prominent bundles of actin, myosin
BONE CELLS:

46. Osteoblast, Functions
 New bone formation
 Controls bone mineralization at 3 levels
1. In its initial phase, by production of matrix vesicle
2. At a later stage, by controlling the ongoing process of
mineralization
3. By regulating the number of ions available
 Regulation of bone remodeling and mineral metabolism

47. Osteoblasts Functions
 Secrete type I collagen, small amount of type V collagen,
osteonectin, osteopontin, RANKL, osteoprotegerin,
Proteoglycans, latent proteases and growth factors
including bone morphogenic proteins
 Exhibit high levels of alkaline phosphatase -cytochemical
marker

48. BONE LINING CELLS:
Osteoblasts flatten, when bone is not forming and extend
along the bone surface and hence the name
They are present on periosteal as well as endosteal surfaces

49. BONE RESORPTION: Osteoclasts
Sequence of events of bone resorption: Involves 3 phases
First phase -
formation of osteoclast
Second phase-
activation of osteoclast
Third phase -
resorption of bone

50.  Alterations in the osteoclast
 Removal of hydroxyapatite
acidic environment by proton pump
 Degradation of organic matrix
acid phosphatase, cathepsin B
 Removal of degradation products from lacunae
endocytosis
 Translocation of degraded products and extracellular release

52. Removal of hydroxyapatite:
The initial phase involves the dissolution of the mineral phase –
HCl
The protons for the acid arise from the activity of cytoplasmic
carbonic anhydrase II, which is synthesized in osteoclast.
The protons are then released across the ruffled border into the
resorption zone by an ATP consuming proton pump.
 This leads to a fall in pH to 2.5 to 3.0 in the osteoclast resorption
space.

53. As age increases resorption exceeds
Cortical bone turnover-5% per year
 Trabecular and endosteal surface – 15% per year
Coupling
The processes of bone synthesis and bone breakdown go on
simultaneously and the status of the bone represents the net result
of a balance between the two processes. This phenomenon is
called coupling.

54. Hormones and coupling
With the exception of calcitonin, all the hormones, cytokines, and
growth factors that act on bone, as an organ, mediate their activity
through osteoblasts
Resorbing hormones act directly on osteoblasts, which then
produce other factors that regulate osteoclast activity
This results in both bone formation and bone resorption being
coupled

55. To prevent accumulation of damaged bone by regenerating
new bone
Allowing to respond to the changes in mechanical forces
Mineral homeostasis
Functions of remodeling

56. Sequence of events in bone remodelling:

57. MEDIATORS OF BONE REMODELLING:
 Parathyroid hormone
 Calcitonin
 Vitamin D metabolites i.e., 1, 25-dihydroxycholecalciferol
 Cytokines
 Prostaglandins
 Growth factors
 Corticosteroids
 Mechanical factors
 Bacterial products

58. Pathologies caused due to improper control of remodelling are:
•Osteoporosis
•Osteopetrosis*
•Malignant bone tumors
•Inflammatory joint diseases
*Osteopetrosis is a bone disease that makes bones abnormally
dense and prone to fracture
Autosomal Dominant Osteopetrosis(ADO)

60. Bone remodeling

61. Bone formation
 Piezoelectric effect
 GH
 Insulin
 Estrogen
 Androgen
 Vitamin D
 TGF-beta
 PDGF
 Calcitonin
 PTH

62. Hormonal Control of Blood CaPTH;
calcitonin
secreted
Calcitonin
stimulates
calcium salt
deposit
in bone
Parathyroid
glands release
parathyroid
hormone (PTH)
Thyroid
gland
Thyroid
gland
Parathyroid
glands
Osteoclasts
degrade bone
matrix and release
Ca2+ into blood
Falling blood
Ca2+ levels
Rising blood
Ca2+ levels
Calcium homeostasis of blood: 9–11 mg/100 ml
PTH

63. Response to Mechanical Stress
 Trabeculae form along lines of stress
 Large, bony projections occur where heavy, active
muscles attach

64. Response to Mechanical Stress
 Wolff’s law: a bone grows or remodels in response to the
forces or demands placed upon it
 Observations supporting Wolff’s law include
 Long bones are thickest midway along the shaft
(where bending stress is greatest)
 Curved bones are thickest where they are most
likely to buckle

65. Response to Mechanical Stress

66. The Skeletal System

67. Bones
 270-300 bones at birth
 206 in adults
 Skull: 8
 Facial bones: 14
 Middle ear: 6
 Hyoid
 Upper limbs: 64 ( 10+54)
 Pelvic girdle: 3
 Lower limb: 60 (8+52)
 Vertebrae: 33(7+12+5+5+4)
 Ribs: 24
 Sternum

68. Joint definition
 Joints connect the components of the skeletal
system together
 They give the skeletal system flexibility, and allow
muscles to direct movements by moving bones in
different directions

69. Joints
Articulations of bones
Functions of joints
 Hold bones together
 Allow for mobility
Ways joints are classified
 Functionally
 Structurally

70. Functional Classification of
Joints
Synarthrosis –
immovable joints
Amphiarthrosis – slightly
moveable joints
Diarthrosis – freely
moveable joints

71. Synarthrosis

72. Functional classification,
187 joints in body
 Synarthrosis are immovable joints; these joints are
common where protection of delicate internal structures
 Skull, mandible
 Amphiarthrosis are slightly movable joints; connected
by broad flattened disks of fibrocartilage, of a more or
less complex structure, which adhere to the ends of
each bone
 Vertebrae, pubic symphysis, sternocostal joint
 Diarthrosis are freely movable joints; these joints
dominate in the limbs and areas of the body where
movement is important

73. Amphiarthrosis

74. Diarthrosis

75. Structural classification
 Fibrous joints allow very little movement, and are composed of fibrous (dense)
connective tissue
 skull sutures, tibia and fibula
 Cartilaginous joints allow very little or no movement, and are characterized by
a connection between adjoining bones made of cartilage, no joint cavity
 1. Fibrocarlilage
 2. Hyaline cartilage
 The pubic symphysis, intervertebral joints and connection between the first rib and
sternum are slightly movable cartilaginous joints. The epiphyseal plate of growing
bones is an immovable cartilaginous joint.
 Synovial joints are the most complex of the joint types. They are characterized
by articular (hyaline) cartilage covering the ends of bones, a fibrous articular
capsule (composed of fibrous connective tissue) lined with synovial membrane,
a joint cavity containing synovial fluid and reinforcing ligaments to hold the
bones together
 Between the bones of the limbs.
 Bursae: flattened fibrous sacs lined with synovial membrane that develop in areas of
friction
 Tendon sheaths are special bursae that wrap around tendons in areas of friction

76. Fibrous Joints
Bones united by fibrous
tissue
Examples
 Sutures
 Syndesmoses
 Allows more
movement than
sutures
 Example: distal
end of tibia and
fibula

77. Cartilaginous Joints
Bones connected by cartilage
Examples
 Pubic
symphysis
 Intervertebral
joints

78. Synovial Joints
Articulating bones are
separated by a joint
cavity
Synovial fluid is found in
the joint cavity

79. Features of Synovial Joints
Articular cartilage (hyaline cartilage) covers the ends
of bones
Joint surfaces are enclosed by a fibrous articular
capsule
Have a joint cavity filled with synovial fluid
Ligaments reinforce the joint

80. Structures Associated with the Synovial
Joint
Bursae – flattened fibrous sacs
 Lined with synovial membranes
 Filled with synovial fluid
 Not actually part of the joint
Tendon sheath
 Elongated bursa that wraps around a tendon

81. Synovial joints
 Some synovial joints such as knee and hip have
fatty pads between the fibrous capsule and the
bone
 Some have discs or wedges of fibrocartilage
separating the articular surface of bones (menisci of
knee)
 Some synovial joints have bursa which is a fluid
filled sac containing the synovial fluid to decrease
the friction

82. The Synovial Joint

83. Synovial joints
 Joint cavity
 Articular cavity
 Articular capsule
 Synovial fluid
 Reinforcing ligaments
 Nerve & blood vessels

84. Synovial joint

85. Types of Synovial Joints Based on
Shape

86. Types of Synovial Joints Based on
Shape

87. Synovial joints classification
 Nonaxial(plane): carpal bones
 Uniaxial joint: one degree of freedom
 Hinge: elbow
 Pivot: Atlas & Axis
 Biaxial joint:
 Saddle: thumb carpal-metacarpal
 Condyloid: MCP in fingers
 Triaxial joint(multiaxial joint)
 Ball & socket: humeroscapular

88. • Plane joints connect two flat surfaces of bone to one another, and only allow
side-to-side movement with no rotation, so called nonaxial joints. Flat wrist
bones
• Hinge joints connect a cylindrical bone end to a concave portion of another
bone. Rotation can occur in only one plane (like a door hinge), so called uniaxial
joints. Elbow and ankle
• Pivot joints connect the rounded end of one bone to a ring or sheath formed by
another bone, so are uniaxial joints. Radius & ulna, atlas & axis
• Condyloid joints fit the rounded convex articular surface of one bone into the
rounded concave surface of another bone. Allow side to side and forwards-
backwards movements, but no rotation, similarly to saddle joints, so are biaxial
joints. Knuckles
• Saddle joints are characterized by concave and convex surfaces on both
articular surfaces. Allow side to side and forwards-backwards movements, but no
rotation, so are biaxial joints. Carpal & metacarpal of the thumb
• Ball-and-socket joints join the spherical end of one bone to the concave,
rounded socket of another bone. Allow movement in all axes and rotation, and
are therefore multiaxial joints. shoulder and hip

91. Motion depends on:
 Joints
 Muscle and tendon
 Ligaments
 Capsule
 Skin
 Other soft tissues such as vessels, adipose tissue,
nerves & etc.

94. Capsular joint
 Joint mobilization
 Capsular excess
 Joint play

95. The Axial Skeleton
Forms the longitudinal part of the body
Divided into three parts
 Skull
 Vertebral column
 Bony thorax

96. The Axial Skeleton

97. The Vertebral
Column
Vertebrae separated by
intervertebral discs
The spine has a normal
curvature
Each vertebrae is given a
name according to its
location

99. Structure of a Typical
Vertebrae

100. Cervical vertebrae
 Unlike the other parts of the spine, the cervical
spine has TRANSVERSE FORAMINA in each vertebra
for the vertebral arteries
 Classify to upper and lower parts

101. Cervical, Upper part
 The upper cervical spine consists of the atlas (C1) and
the axis (C2)
 These first 2 vertebrae are quite different from the rest of
the cervical spine
 The atlas articulates superiorly with the occiput (the
atlanto-occipital joint) and inferiorly with the axis (the
atlantoaxial joint)
 The atlantoaxial joint is responsible for 50% of all
cervical rotation; the atlanto-occipital joint is responsible
for 50% of flexion and extension
 The unique features of C2 anatomy and its articulations
complicate assessment of its pathology

102. Atlas & Axis
Zygapophyseal Joint

103. Steel’s Rule of Thirds
 At the level of the atlas, the odontoid process, the
subarachnoid space, and spinal cord each occupy
one third of the area of the spinal canal

104. Axis
 The axis is composed of a vertebral body, heavy
pedicles, laminae, and transverse processes, which
serve as attachment points for muscles
 The axis articulates with the atlas via its superior
articular facets, which are convex and face upward and
outward

106. Axis
 At birth, a vestigial cartilaginous disc space called the
neurocentral synchondrosis separates the odontoid process
from the body of C2
 The synchondrosis is seen in virtually all children aged 3 years
and is absent in those aged 6 years
 The apical portion of the dens ossifies by age 3-5 years and
fuses with the rest of the structure around age 12 years
 This synchondrosis should not be confused with a fracture

107. Lower Cervical Spine

108. Joint of Luschka

109. Joint of Luschka
 The joint believed to be
the result of degenerative
changes in the annulus,
which lead to fissuring in
the annulus and the
creation of the joint
 Can develop osteophytic
spurs, which can narrow
the intervertebral foramina

110. Facet Joints
 The facet joints in the cervical spine are diarthrodial
synovial joints with fibrous capsules
 The joint capsules are more lax in the lower cervical
spine than in other areas of the spine to allow
gliding movements of the facets
 The joints are inclined at an angle of 45° from the
horizontal plane and 85° from the sagittal plane
 This alignment helps prevent
excessive anterior translation and is
important in weight-bearing

111. Intervertebral Discs
 These disks are composed of 4 parts: the nucleus
pulposus in the middle, the annulus fibrosis surrounding
the nucleus, and 2 end plates that are attached to the
adjacent vertebral bodies
 They serve as force dissipators, transmitting compressive
loads throughout a range of motion
 The disks are thicker anteriorly and therefore contribute to
normal cervical lordosis

116. Cervical

118. Rule of Threes

119. Regional
Characteristics of
Vertebrae

120. Facet Joints*
 To guide and limit mvmts in vertebral segments
 Cartilage
 Synovial fluid
 Nerve & blood vessels
 Ligaments
 *Zygapophyseal(Z-joint)

121. Facet Joint Orientation, Cervical
 Cervical Region: 45 degrees; frontal plane; all
movements are possible such as flexion, extension,
lateral flexion, and rotation
 The articulating facets in the cervical vertebrae face
45o to the transverse plane and lie parallel to the
frontal plane, with the superior articulating process
facing posterior and up and the inferior articulating
processes facing anteriorly and down

122. Facet Joint Orientation, Thoracic
 Thoracic Region: 60 degrees;
frontal plane; lateral flexion and
rotation; no flexion/extension
 The facet joints between
adjacent thoracic vertebrae are
angled at 60° to the transverse
plane and 20° to the frontal
plane, with the superior facets
facing posterior and a little up
and laterally and the inferior
facets facing anteriorly, down,
and medially

124. Costovertebral Joints

127. Ribs

128. Facet Joint Orientation, Lumbar
 Lumbar Region: 90 degrees; sagittal
plane; only flexion and extension
 The facet joints in the lumbar region lie
in the sagittal plane; the articulating
facets are at right angles to the
transverse plane and 45° to the frontal
plane
 The superior facets face medially, and
the inferior facets face laterally, this
changes at the lumbosacral junction,
where the apophyseal joint moves into
the frontal plane and the inferior facet
on L5 faces front
 This change in orientation keeps the
vertebral column from sliding forward on
the sacrum

129. Discus
 Nucleus pulposus
 Annulus fibrosus

131. Discus
 Pressure on lumbar disc
 Lying or standing: 17 PSI
 Sitting or bending to lift: up to 300 PSI

133. Disc Problems
 Disc Prolapse: annulus fibrosus is intact
 Disc Protrusion: annulus fibrosus involved
 Disc Herniation: tearing annulus fibrosus & bulge
out nucleus


134. Herniation Stages
 1) Disc Degeneration: chemical changes
associated with aging causes discs to
weaken, but without a herniation
 2) Prolapse: the form or position of the
disc changes with some slight
impingement into the spinal canal. Also
called a bulge or protrusion
 3) Extrusion: the gel-like nucleus pulposes
breaks through the annulus fibrosus but
remains within the disc
 4) Sequestration: nucleus pulposus
breaks through the annulus fibrosus and
lies outside the disc in the spinal canal

135. Disc problem, Risk
Factors
 Aging
 Decrease bone density, muscle & ligament
weakness
 Improper lifting
 Smoking
 Strenuous repetitive activities
 Obesity
 Sudden pressure

136. Lumbar Area Problems
 Lordosis
 Disc problems
 Facet joints problems(dysfunction)
 Degenerative vertebrae secondary to degenerative
disc
 Spondylolisthesis

137. Posterior Longitudinal Ligament

138. Facet Joint Syndrome
 OA
 Disc degeneration
 Pressure overload
 Aging

139. Facet Joint Syndrome
 Narrowing the joint space
 Friction and destroying articular cartilage and the
fluid
 Wear away cartilage
 Bone spurs
 Compress nerve
 More bone spurs extend to the spinal canal
 Spinal stenosis

140. Facet Joint Symptoms
 Difficulty in head rotation
 Difficulty in straightening back and get up of a chair
 Pain, numbness, muscle weakness,..

141. FJS Treat
 Ice, to reduce inflammation
 Ultrasound, Electrostimulation to reduce muscle
spasm
 Massage, traction, mobilization to increase ROM
and reduce pain
 Exercise for more stability

142. Spondylolisthesis
 Birth defect
 Rapid growth during adolescence
 Football
 Weightlifting
 Wrestling
 Gymnastics
 Track and field…

143. Sternum

145. Clavicle

146. Acromioclavicular Joint
 To allow the scapula additional range of rotation on
the thorax
 Allow for adjustments of the scapula (tipping and
internal/external rotation) outside the initial plane of
the scapula in order to follow the changing shape of
the thorax as arm movement occurs
 The joint allows transmission of forces from the
upper extremity to the clavicle

147. Sternoclavicular Joint
 Plane style synovial joint
 Fibrocartilage joint disk
 Ligaments
 Anterior sternoclavicular ligament
 Posterior sternoclavicular ligament
 Costoclavicular lig
 Interclavicular lig

148. Sternoclavicular Joint

149. The Bony Thorax
Forms a cage to
protect major organs

150. The Bony Thorax
Made-up of three
parts
 Sternum
 Ribs
 Thoracic
vertebrae

151. The Appendicular Skeleton
Limbs (appendages)
Pectoral girdle
Pelvic girdle

152. The Pectoral (Shoulder) Girdle
Composed of two bones
 Clavicle – collarbone
 Scapula – shoulder blade
These bones allow the upper limb to have
exceptionally free movement

153. Bones of the Shoulder Girdle

154. Bones of the Shoulder Girdle

157. Bones of the Upper Limb
The arm is formed by a
single bone
 Humerus

158. Bones of the Upper Limb
The forearm has two bones
 Ulna
 Radius

160. Bones of the Upper Limb
The hand
 Carpals – wrist
 Metacarpals – palm
 Phalanges – fingers
So Long To Pinky, Here Comes The Thumb

161. Right Hand

162. Bones of the Pelvic Girdle
Hip bones
Composed of three pair of fused bones
 Ilium
 Ischium
 Pubic bone
The total weight of the upper body rests on the pelvis
Protects several organs
 Reproductive organs
 Urinary bladder
 Part of the large intestine

163. The Pelvis

164. The Pelvis: Right Coxal Bone

165. Gender Differences of the
Pelvis

166. Lower Limbs
The thigh has one
bone
 Femur – thigh bone

167. Lower Limbs, distal
The leg has two bones
 Tibia
 Fibula

168. Foot
The foot
 Tarsus – ankle
 Metatarsals – sole
 Phalanges – toes

169. Arches of the Foot
Bones of the foot are
arranged to form three
strong arches
 Two longitudinal
 One transverse

172. Assessment
 Manual muscle test (MMT)
 Range Of Motion (ROM)

173. ROM benefits
 To determine presence of impairment
 Establishing a diagnosis
 Evaluation of progress
 Modify the treatment
 Motivate the patient
 Research

174. Definitions
 Power: work produced /time
 For more power: more repetition
 Strength: contract against external load
 Endurance: perform activities over prolonged
period
 Flexibility: ability to move a single joint or series of
joints smoothly & easily through an unrestricted
pain-free ROM
 Plasticity: property of skeletal muscle that allow for
a new & greater length after a stretch that has been
applied

175. Manual Muscle Testing(MMT)
Grade Result
0 No contraction, no movement
1 Visible contraction, a little
2 Visible contraction, full ROM in elimination of gravity
3 Visible contraction, full ROM against gravity
4 Full ROM with moderate resistance
5 Full ROM with max resistance

176. Joint improvement
 Passive range of motion
 Active range of motion
 Active assistive range of motion
 Strengthening
 Isometric
 Isotonic
 Concentric
 Eccentric
 Stretching

177. Benefits of exercises
 Increase & maintain muscle strength
 Increase endurance
 Improve & maintain ROM
 Increase circulation
 Increase flexibility
 Improve balance & coordination
 Increase CV fitness
 Improve sense of wellbeing

178. Stretching, indications
 Adhesion, contracture, scar tissue
 Decreased ROM(may lead deformity)
 Part of a fitness program to prevent injury
 Warm-up & cool-down exercise

179. Stretching, contra-indications
 Recent fracture, incomplete bony union
 Muscle ossification
 Acute inflammation, infection
 Sharp pain
 Hematoma in muscle or area
 Hypermobility

180. Characters of stretching
 Intensity
 Duration: 30sec
 Frequency: 5-7/day
 Speed: slowly

181. Inflammatory Conditions Associated with
Joints
Bursitis – inflammation of a bursa usually caused by a
blow or friction
Tendonitis – inflammation of tendon sheaths
Arthritis – inflammatory or degenerative diseases of joints
 Over 100 different types
 The most widespread crippling disease in the United
States

182. Clinical Forms of Arthritis
Osteoarthritis
 Most common chronic arthritis
 Probably related to normal aging processes
Rheumatoid arthritis
 An autoimmune disease – the immune system attacks
the joints
 Symptoms begin with bilateral inflammation of certain
joints
 Often leads to deformities

183. Clinical Forms of Arthritis
Gouty Arthritis
 Inflammation of joints is caused by a deposition of
urate crystals from the blood
 Can usually be controlled with diet

184. Developmental Aspects of the Skeletal
System
At birth, the skull bones are incomplete
Bones are joined by fibrous membranes – fontanelles
Fontanelles are completely replaced with bone within two
years after birth

185. The Skull
Two sets of bones
 Cranium
 Facial bones
Bones are joined by sutures
Only the mandible is attached by a freely movable
joint

186. The Skull

188. Human Skull, Superior View

189. Human Skull, Inferior View

190. Paranasal Sinuses
Hollow portions of bones surrounding the nasal
cavity

191. Paranasal Sinuses
Functions of paranasal sinuses
 Lighten the skull
 Give resonance and amplification to voice

192. The Hyoid Bone
The only bone that does
not articulate with another
bone
Serves as a moveable base
for the tongue

193. The Fetal Skull
The fetal skull is large
compared to the infants
total body length

194. The Fetal Skull
Fontanelles – fibrous
membranes connecting the
cranial bones
 Allow the brain
to grow
 Convert to bone within 24
months after birth

195. Thank you

196. Bone Fractures
A break in a bone
Types of bone fractures
 Closed (simple) fracture – break that does not
penetrate the skin
 Open (compound) fracture – broken bone penetrates
through the skin
Bone fractures are treated by reduction and
immobilization
 Realignment of the bone

197. Common Types of Fractures

198. Repair of Bone Fractures
Hematoma (blood-filled swelling) is formed
Break is splinted by fibrocartilage to form a callus
Fibrocartilage callus is replaced by a bony callus
Bony callus is remodeled to form a permanent patch

199. Stages in the Healing of a
Bone Fracture