ANATOMY AND PHYSIOLOGY SKELETAL SYSTEM STUDY GUIDE

CLASSIFY BONES WITH EXAMPLE

The 206 bones that compose the adult skeleton are divided into five categories based on their
shapes (Figure 6.6). Their shapes and their functions are related such that each categorical
shape of bone has a distinct function.

Long Bones

A long bone is one that is cylindrical in shape, being longer than it is wide. Keep in mind,
however, that the term describes the shape of a bone, not its size. Long bones are found in the
arms (humerus, ulna, radius) and legs (femur, tibia, fibula), as well as in the fingers
(metacarpals, phalanges) and toes (metatarsals, phalanges). Long bones function as levers;
they move when muscles contract.

Short Bones

A short bone is one that is cube-like in shape, being approximately equal in length, width,
and thickness. The only short bones in the human skeleton are in the carpals of the wrists and
the tarsals of the ankles. Short bones provide stability and support as well as some limited
motion.

Flat Bones

The term “flat bone” is somewhat of a misnomer because, although a flat bone is typically
thin, it is also often curved. Examples include the cranial (skull) bones, the scapulae
(shoulder blades), the sternum (breastbone), and the ribs. Flat bones serve as points of
attachment for muscles and often protect internal organs.

Irregular Bones

An irregular bone is one that does not have any easily characterized shape and therefore does
not fit any other classification. These bones tend to have more complex shapes, like the
vertebrae that support the spinal cord and protect it from compressive forces. Many facial
bones, particularly the ones containing sinuses, are classified as irregular bones.

Sesamoid Bones

A sesamoid bone is a small, round bone that, as the name suggests, is shaped like a sesame
seed. These bones form in tendons (the sheaths of tissue that connect bones to muscles)
where a great deal of pressure is generated in a joint. The sesamoid bones protect tendons by
helping them overcome compressive forces. Sesamoid bones vary in number and placement
from person to person but are typically found in tendons associated with the feet, hands, and
knees. The patellae (singular = patella) are the only sesamoid bones found in common with
every person. Table 6.1 reviews bone classifications with their associated features, functions,
and examples.
 Bone Classifications

Bone
Features Function(s) Examples
classification

Femur, tibia, fibula,

Cylinder-like shape, metatarsals,
Long longer than it is Leverage humerus, ulna,
wide radius, metacarpals,
phalanges

Cube-like shape, Provide stability,

approximately equal support, while
Short Carpals, tarsals
in length, width, and allowing for some
thickness motion

Points of
attachment for Sternum, ribs,
Flat Thin and curved muscles; scapulae, cranial
protectors of bones
internal organs

Protect internal Vertebrae, facial

Irregular Complex shape
organs bones

Small and round; Protect tendons

Sesamoid embedded in from compressive Patellae
tendons forces

Types on the basis of development:

1. Membranous bones,
2. Cartilaginous bones,
3. Membro-cartilaginous bones.
C. Types on the basis of region:
1. Bones of Axial skeleton,
2. Bones of Appendicular skeleton.
D. Types on the basis of structure:
1. According to Macroscopic approach
: a. Compact bone,
b. Spongy bone.
2. According to Microscopic approach:
a. Fibrous bone,
b. Lamellar bone.
c. Woven bone.
d. Dentine and Cement.
HISTOLOGY OF COMPACT BONE

 Bone is a specialised form of connective tissue that consists of cells and intercellular
material.
 Osteoblasts, osteocytes and osteoclasts make up the cells of the bone, while the inter-
cellular material is made of organic and inorganic material.
 By dry weight, bone comprises of 33% organic matrix, with 28% representing type I
collagen, and non-collagenous proteins like bone sialoprotein, osteocalcin,
osteopontin, osteonectin and proteoglycans making up 5%.
 The organic matrix is mineralized by hydroxyapatite (inorganic material), which
comprises the rest of the 67% of bone by dry weight.

Let’s have a look at the histology of bone with the mandible as an example.

 The mandible has a rigid outer cortical bone or cortex forming an outer shell

surrounding a medullary cavity or a marrow cavity.
 The medullary cavity apart from housing the bone marrow is interrupted by a network
of numerous bony spicules or trabeculae called the cancellous bone or the spongy
bone.
 The cortical and cancellous bones are histologically identical in that, they are made
of concentric sheets of collagen called lamellae.

Compact bone histology

Histologically three types of lamellae can be identified in the compact bone, them
being circumferential, concentric and interstitial lamellae.

 Bulk of the compact bone is made of concentric lamellae that are actually bony
layers wrapped around a central cylindrical tunnel or canal. The central canal is
called the Haversian canal and houses blood vessels and nerves.
 The Haversian canal and the concentric lamellae together form the Haversian
system. The concentric lamellae or the Haversian system form the basic metabolic
unit of bone called the osteon.
 Circumferential lamellae surround the outer most and the inner most layers of the
compact bone.
 Lamellae found in between the concentric lamellae are called the interstitial
lamellae. The interstitial lamellae actually represent concentric lamellae that have
been partly resorbed and remodelled and no longer surround a Haversian canal.

Osteoblasts, Osteocytes and Lacunae

 During bone formation when the organic matrix is laid down by osteoblasts, they
often get buried within the lamellae and are housed in small cavities called
lacunae.
 Osteoblasts housed in lacunae are called osteocytes and they have delicate
cytoplasmic processes radiating out that are housed in micro canals called canaliculi.
 These canaliculi are interconnecting and help osteocytes contact adjacent osteocytes
as well as the osteoblasts lining the bone surface.
Perioteum and Nutrition

 The outer most layer of the compact bone is surrounded by a periosteum having two
layers; an outer fibrous layer and an inner layer facing the bone, having precursor
bone cells and a rich blood supply.
 The Haversian canals communicate with each other as well as the periosteum and the
marrow space via canals called Volkmann canals.
 Volkmann canals like Haversion canals also contain blood vessels.
 This system of interconnected Haversian and Volkmann canals, supplies nutrients
and nourishes the bone.

CLASSIFY SYNOVIAL JOINTS

Synovial joints are further classified into six different categories on the basis of the shape and
structure of the joint. The shape of the joint affects the type of movement permitted by the
joint. These joints can be described as planar, hinge, pivot, condyloid, saddle, or ball-and-
socket joints.

Planar Joints

Planar joints have bones with articulating surfaces that are flat or slightly curved. These joints
allow for gliding movements; therefore, the joints are sometimes referred to as gliding joints.
The range of motion is limited and does not involve rotation. Planar joints are found in the
carpal bones in the hand and the tarsal bones of the foot, as well as between vertebrae.

Hinge Joints

In hinge joints, the slightly-rounded end of one bone fits into the slightly-hollow end of the
other bone. In this way, one bone moves while the other remains stationary, similar to the
hinge of a door. The elbow is an example of a hinge joint. The knee is sometimes classified
as a modified hinge joint.

Pivot Joints

Pivot joints consist of the rounded end of one bone fitting into a ring formed by the other
bone. This structure allows rotational movement, as the rounded bone moves around its own
axis. An example of a pivot joint is the joint of the first and second vertebrae of the neck that
allows the head to move back and forth. The joint of the wrist that allows the palm of the
hand to be turned up and down is also a pivot joint.

Condyloid Joints

Condyloid joints consist of an oval-shaped end of one bone fitting into a similarly oval-
shaped hollow of another bone. This is also sometimes called an ellipsoidal joint. This type of
joint allows angular movement along two axes, as seen in the joints of the wrist and fingers,
which can move both side to side and up and down.

Saddle Joints

Each bone in a saddle joint resembles a saddle, with concave and convex portions that fit
together. Saddle joints allow angular movements similar to condyloid joints, but with a
greater range of motion. An example of a saddle joint is the thumb joint, which can move
back and forth and up and down; it can move more freely than the wrist or fingers.

Ball-and-Socket Joints

Ball-and-socket joints possess a rounded, ball-like end of one bone fitting into a cup-like
socket of another bone. This organization allows the greatest range of motion, as all
movement types are possible in all directions. Examples of ball-and-socket joints are the
shoulder and hip joints.
 Types of synovial joints: The six types of synovial joints allow the body to move in a
variety of ways. (a) Pivot joints allow for rotation around an axis, such as between the first
and second cervical vertebrae, which allows for side-to-side rotation of the head. (b) The
hinge joint of the elbow works like a door hinge. (c) The articulation between the trapezium
carpal bone and the first metacarpal bone at the base of the thumb is a saddle joint. (d) Planar
(or plane) joints, such as those between the tarsal bones of the foot, allow for limited gliding
movements between bones. (e) The radiocarpal joint of the wrist is a condyloid joint. (f) The
hip and shoulder joints are the only ball-and-socket joints of the body.
  Condyloid: The metacarpophalangeal joints in the
finger are examples of condyloid joints.
CLASSIFY JOINTS WITH EXAMPLES
Structural classification of joints categorizes them based on the type of tissue involved in
formation. There are three structural classifications of joints: fibrous, cartilaginous, and
synovial.
Fibrous Joints
Fibrous joints are connected by dense, tough connective tissue that is rich in collagen fibers.
These fixed or immovable joints are typically interlocked with irregular edges. There are
three types of fibrous joints.
Sutures are the types of joint found in the cranium (skull). The bones are connected by
Sharpey’s fibres. The nature of cranial sutures allows for some movement in the fetus.
However, they become mostly immovable as the individual ages, although very slight
movement allows some necessary cranial elasticity. These rigid joints are referred to as
synarthrodial.
Syndesmoses are found between long bones of the body, such as the radio-ulnar and tibio-
fibular joints. These moveable fibrous joints are also termed amphiarthrodial. They have a
lesser range of movement than synovial joints.
Gomphosis is a type of joint found at the articulation between teeth and the sockets of the
maxilla or mandible (dental-alveolar joint). The fibrous tissue that connects the tooth and
socket is called the periodontal ligament.
Cartilaginous Joints
Cartilaginous joints are connected by fibrocartilage or hyaline cartilage. They allow more
movement than fibrous joints but less than that of synovial joints. These types of joints are
further subdivided into primary (synchondroses) and secondary (symphyses) cartilaginous
joints. The epiphyseal (growth) plates are examples of synchondroses. Symphyses are found
between the manubrium and sternum (manubriosternal joint), intervertebral discs, and the
pubic symphysis.

Synovial Joints
This is the most common and movable joint type in the body. These joints (also called
diarthroses) have a synovial cavity. Their bones are connected by dense irregular connective
tissue that forms an articular capsule surrounding the bones’ articulating surfaces.
A synovial joint connects bones with a fibrous joint capsule that is continuous with the
bones’ periosteum. This joint capsule constitutes the outer boundary of a synovial cavity and
surrounds the bones’ articulating surfaces.
Synovial cavities are filled with synovial fluid. The knees and elbows are examples of
synovial joints.
  Functional classification of joints.
Functional classification of joints is based on the type and degree of movement permitted.
Based on the type and degree of movement permitted. There are six types of freely movable
joint and are mentioned below with the examples:
Ball and Socket Joints
Here, one bone is hooked into the hollow space of another bone. This type of joint helps in
rotatory movement. An example ball and socket joint are the shoulders.
Pivotal Joints
In this type of joint, one bone has tapped into the other in such a way that full rotation is not
possible. This joint aid in sideways and back-forth movement. An example of a pivotal joint
in the neck.
Hinge Joints
Hinge joints are like door hinges, where only back and forth movement is possible. Example
of hinge joints is the ankle, elbows, and knee joints.
Saddle Joints
Saddle joint is the biaxial joint that allows the movement on two planes–flexion/extension
and abduction/adduction. For example, the thumb is the only bone in the human body having
a saddle joint.
Condyloid Joints
Condyloid joints are the joints with two axes which permit up-down and side-to-side motions.
The condyloid joints can be found at the base of the index finger, carpals of the wrist, elbow
and the wrist joints. This joint is also known as a condylar, or ellipsoid joint.
Gliding Joints
Gliding joints are a common type of synovial joint. It is also known as a plane or planar joint.
This joint permit two or more round or flat bones to move freely together without any
rubbing or crushing of bones. This joint is mainly found in those regions where the two bones
meet and glide on one another in any of the directions. The lower leg to the ankle joint and
the forearm to wrist joint are the two main examples of gliding joints.
Three Categories of Functional Joints
 Synarthrosis: These types of joints are immobile or allow limited mobility. This
category includes fibrous joints such as suture joints (found in the cranium) and
gomphosis joints (found between teeth and sockets of the maxilla and
mandible).
 Amphiarthrosis: These joints allow a small amount of mobility. Most joints in
this category
include cartilaginous joints such as those found between vertebrae and the
pubic symphysis.
  Diarthrosis: These are the freely-movable synovial joints. Synovial joints are
further classified based on the different types of movement they provide,
including:
o Plane joint
o Ball and socket joint
o Hinge joint
o Pivot joint
o Condyloid joint
o Saddle joint
Joints can also be classified by the number of axes of movement they permit:
 Nonaxial (gliding): Found between the proximal ends of the ulna and radius.
 Monoaxial (uniaxial): Movement occurs in one plane. An example is the elbow
joint.
 Biaxial: Movement can occur in two planes. An example is the wrist.
 Multiaxial: Includes the ball and socket joints. An example is the hip joint.
HUMERUS
The humerus is a long bone forming the skeleton of the upper arm. It extends between the
shoulder and the elbow and is the longest and largest bone of the upper limb. he humerus is
connected with the scapula at one end, and with both forearm bones (radius and ulna) on the
other end. The proximal end of the humerus articulates with the glenoid cavity of the scapula
at the glenohumeral joint. At the distal end, the humerus articulates with the head of the
radius and the trochlear notch of the ulna, forming the elbow joint.

Like other long bones, the humerus has three main parts - a proximal end, a shaft, and a distal
end. All of these parts have important anatomical landmarks.

Proximal end of humerus

The proximal end or extremity of the humerus consists of the head, an anatomical neck, and
the greater and lesser tubercles.

The head of the humerus has a hemispherical shape and has a smooth articular surface, which
is covered by hyaline cartilage. In the anatomical position, the head faces in a medial,
superior, and posterior direction, where it articulates with the glenoid cavity of the scapula.

The anatomical neck of the humerus is a narrowing below the articular surface of the head.
The joint capsule of the shoulder joint attaches here.

The greater tubercle is the most lateral part of the proximal end of the humerus. Three
impressions mark it at the upper posterior aspect, all of which serve for the attachment of
muscles. From superior to inferior, the muscles that attach at these impressions are three of
the rotator cuff muscles:

 supraspinatus,
 infraspinatus, and
 teres minor.
The lateral aspect of the greater tubercle is covered by the deltoid muscle, which gives the
shoulder its usual rounded shape. Multiple vascular foramina also mark the lateral aspect of
the greater tubercle.

The lesser tubercle is found anterior to the anatomical neck and has a smooth, palpable
muscular impression. The lateral aspect of this tubercle forms the medial margin of the
intertubercular sulcus. The lesser tubercle of the humerus gives attachment to the
subscapularis muscle. Also, the transverse ligament of the shoulder attaches here.

There is a deep groove separating the two tubercles, which is called the intertubercular
sulcus. It is also known as the bicipital groove. The long tendon of the biceps brachii and a
branch of the ascending circumflex humeral artery lie within the intertubercular sulcus. A
lateral lip and a medial lip form the intertubercular sulcus. The lateral lip is also known as the
crest of the greater tubercle, and it gives attachment to the tendon of the pectoralis
major muscle. The medial lip serves as the attachment site for the teres major muscle. Also,
the tendon of the latissimus dorsi muscle attaches to its posterior aspect.

There is also a slight narrowing below the tubercles, which is known as the surgical neck of
the humerus. It is a common fracture site. The axillary nerve and the posterior circumflex
humeral artery lie close to the bone here. Here, the proximal extremity ends and continues as
the shaft of the humerus.

Shaft of humerus

The shaft or body is the middle part of the humerus, and it gives attachment to several
muscles. Cross-section views reveal that the proximal half of the shaft is circular, while its
distal half is triangular and flattened. The shaft of the humerus has three borders and three
surfaces.

The borders of the shaft:

 the anterior border extends from the greater tubercle downward almost to the end of
the humerus, and its proximal end is continuous with the lateral lip of the
intertubercular sulcus;
 the lateral border begins distal to the greater tubercle, and it gets ticker distally to
form the lateral supracondylar ridge, its middle portion is adjacent to the rough “V”
shaped area called the deltoid tuberosity;
 the medial border forms the medial supracondylar ridge distally, and it is interrupted
in its medial third by the radial groove, where the radial nerve and the deep brachial
artery are situated.

The surfaces of the shaft:

 the anterolateral surface is the area between the anterior and lateral borders of the
shaft, its proximal surface is smooth and is mostly covered by the deltoid muscle; the
deltoid inserts into the deltoid tuberosity, which is located around the middle of this
surface; the lateral part of the brachialis originates from the distal portion of the
 anterolateral surface, as well as from the proximal two-thirds of the lateral
supracondylar ridge;
 the anteromedial surface is the area between the anterior and medial borders;
the coracobrachialis muscle attaches approximately in the mid-portion of this
surface, while the distal half of the anteromedial surface is mostly covered by the
medial portion of the brachialis muscle;
 the posterior surface is located between the medial and lateral borders of the shaft.
Most of it is covered by the medial head of the triceps brachii muscle, while a ridge
on its proximal-third also gives attachment to the lateral head of the triceps brachii.

Distal end of humerus

The distal end or extremity of the humerus has both articular and non-articular parts.
The articular part is a modified condyle, which consists of a medial trochlea and a lateral
capitulum, separated by a faint groove. This part of the humerus articulates with both ulna
and radius. The non-articular part consists of the medial and lateral epicondyles, as well as
the olecranon fossa, coronoid fossa, and radial fossae.

The trochlea is a projection that is shaped like a pulley and located medially, extending onto
the posterior aspect of the humerus. It articulates with the ulna at the trochlear notch.

Lateral to the trochlea is the capitulum, which is a rounded and convex projection on the
distal end of the humerus. It articulates with the head of the radius.

The medial epicondyle is a blunt projection that forms the end of the medial border of the
humerus. It is located superomedially to the medial condyle. The ulnar nerve passes in a
groove on the posterior aspect of the medial epicondyle. The anterior surface of the medial
epicondyle provides origin sites for the following superficial muscles of the anterior
compartment of the forearm:

 flexor carpi ulnaris,

 palmaris longus,
 flexor carpi radialis,
 pronator teres.

The lateral epicondyle is smaller than the medial, and it is where the lateral border of the
humerus ends. It is marked by an impression where seven superficial muscles of the lateral
and posterior compartments of the upper limb, which include the following muscles:

 brachioradialis,
 extensor carpi radialis longus,
 extensor carpi radialis brevis,
 extensor digitorum,
 extensor digiti minimi,
 extensor carpi ulnaris,
 anconeus.
The olecranon fossa is a deep depression on the posterior surface of the distal end, superior
to the trochlea. During the extension of the elbow, the tip of the ulnar olecranon process
lodges into this fossa.

The coronoid fossa is a smaller depression that is also located superior to the trochlea but on
the anterior surface of the humerus. Upon elbow flexion, the coronoid process of the ulna
lodges into this fossa.

Lateral to the coronoid fossa and superior to the capitulum of the humerus is another hallow
area called the radial fossa—the margin of the head of the radius lodges into this fossa upon
full elbow flexion.

KNEE JOINT
The knee joint is a synovial joint that connects three bones; the femur, tibia and patella. It is a
complex hinge joint composed of two articulations; the tibiofemoral joint and patellofemoral
joint. The tibiofemoral joint is an articulation between the tibia and the femur, while the
patellofemoral joint is an articulation between the patella and the femur.
The knee joint is the largest and arguably the most stressed joint in the body. The arrangement
of the bones in the joint provides a fulcrum that translates the actions of the flexor and extensor
muscles of the knee. The arrangement of the extracapsular and intracapsular and ligaments, as
well as extensions of muscles that cross the joint, provide the much needed stability that
counters the considerable biomechanical stress brought upon the joint. As a hinged joint, the
knee joint mostly allows movement along one axis in terms of flexion and extension of the
knee in the sagittal plane. It also allows slight medial rotation during flexion and the last stage
of extension of the knee, as well as lateral rotation when “unlocking” the knee.

Articular surfaces
The tibiofemoral joint
The tibiofemoral joint is an articulation between the lateral and medial condyles of the distal
end of the femur and the tibial plateaus, both of which are covered by a thick layer of hyaline
cartilage.
The lateral and medial condyles are two bony projections located at the distal end of the femur,
which have a smooth convex surface, and are separated posteriorly by a deep groove known as
the intercondylar fossa. The medial condyle is larger, more narrow and further projected than
its lateral counterpart, which accounts for the angle between the femur and the tibia. The
roughened outer surfaces of the medial and lateral condyles are defined as medial and lateral
epicondyles, respectively. Along the posterior aspect of the distal femur, there are paired rough
elevations above the medial and lateral epicondyles known as the medial and
lateral supracondylar ridges.
The tibial plateaus are the two slightly concave superior surfaces of the condyles located at the
proximal end of the tibia, and are separated by a bony protuberance known as the intercondylar
eminence. The medial tibial articular surface is somewhat oval shaped along its anteroposterior
length, while the lateral articular surface is more circular in shape
The articular surfaces of the tibiofemoral joint are generally incongruent, so compatibility is
provided by the medial and lateral meniscus. These are crescent-shaped fibrocartilaginous
structures that allow a more even distribution of the femoral pressure on the tibia.
The patellofemoral joint
The patellofemoral joint is a saddle joint formed by the articulation of the patellar surface of
femur (also known as the trochlear groove of femur) and the posterior surface of patella. The
patellar surface of femur is a groove on the anterior side of the distal femur, which extends
posteriorly into the intercondylar fossa.
The patella is a triangular shaped bone, with a curved proximal base and a pointed distal apex.
Its articular surface is defined by medial and lateral facets which are concave articular surfaces
covered with a thick layer of hyaline cartilage and separated by a vertical ridge. Medial to the
medial facet is a third minor facet, known as the ‘odd’ facet which lacks hyaline cartilage.
Being a sesamoid bone, the patella is tightly embedded and held in place by the tendon of
the quadriceps femoris muscle. On the distal part of the patella, an extension of the quadriceps
femoris tendon forms a central band called the patellar ligament. It is a strong, thick ligament
that extends from the patellar apex to the superior area of the tibial tuberosity.

Blood supply
The knee joint has a rich vascularization stemming from the genicular anastomosis formed by
several arterial blood vessels. There are approximately ten arteries involved in the formation of
the genicular anastomosis:

 Descending branches: Descending branch of the lateral circumflex femoral artery,

descending genicular branch of the femoral artery.
 Ascending branches: circumflex fibular branch of the posterior tibial artery, anterior
and posterior tibial recurrent branches of the anterior tibial artery.
 Branches of the popliteal artery: lateral superior and inferior genicular arteries, the
medial superior and inferior genicular arteries, and the middle genicular arteries.
In recent years however, a study by Sabalbal et al. has rejected the traditional textbook
representation of the genicular anastomosis described above. During their study of ten cadaver
lower limbs, they found that “robust direct communications between branches of the femoral
and popliteal arteries did not exist”, and that vasculature of this region was subject to a
interindividual variation.

Movements
Being a hinge joint, the main movements in the knee joint are flexion and extension of the knee
in the sagittal plane. It also allows limited medial rotation in a flexed position and in the last
stage of extension, as well as lateral rotation when “unlocking” and flexing the knee. Unlike the
elbow joint, the knee joint is not a true hinge since it has a rotational component, an accessory
motion that accompanies flexion and extension, hence it is termed as a modified hinge joint.
The degree of possible knee flexion depends on the position of the hip joint and whether the
movement is active or passive. When the hip is flexed, a maximum degree of flexion of 140° is
achievable in the knee joint, whereas an extended hip allows for only 120°. This is due to the
fact that the hamstrings are both extensors of the hip and flexors of the knee, so they lose some
of their efficiency to flex the knee if the hip is extended, and vice versa. In addition, a wider
range of motion in the knee joint is achieved with passive flexion of the knee, increasing it to
160°. The contact of the posterior leg (calf) with the thigh is the major limiting factor of flexion
of the knee. In addition, the capsular pattern of the knee joint, in terms of most restriction, is
flexion and extension to a lesser degree.
During movement of the knee from flexion to extension, the femoral condyles roll and
glide posteriorly over the tibial plateaus owing to their greater articular surface area. The
posterior gliding motion is important because without it, the femur would simply roll off the
tibia before full extension is complete. Additionally, as the articular surface of the lateral
femoral condyle is less than its medial counterpart, the posterior gliding of the medial condyle
during the last degrees of extension results in medial rotation of the femur on the tibia.
During the last few degrees of extension, the femoral condyle rotates medially on the tibial
plateau “locking” the knee. This is called the the “screw-home mechanism”, which allows for
prolonged weight-bearing without the help from the muscles of the knee. The full extension of
the knee along with the medial rotation of the femoral condyle put the knee in a so called “close
packed position”, in which there are no additional movements possible. In order to flex the
knee again, the knee must be “unlocked” by the contraction of the popliteus, which
causes lateral rotation of the femur on the tibia. The flexion of the knee puts it in the “open
packed position”, which is less stable and has more laxity than the “close packed position”.
In the patellofemoral joint, the main motion is gliding of the posterior surface of the patella
over the patellar surface of the femur as far as the intercondylar notch. The main function of the
patella is to provide a larger moment arm for the quadriceps femoris muscle, which is the
distance between the axis of the muscle and the center of the joint. It does so by acting like a
pulley for the quadriceps femoris, increasing its mechanical advantage and providing greater
angular force.
Some accessory movements in the knee joint are possible, but depend on the position of the
knee. For example, adduction and abduction is prevented by the interlocking of the femoral and
tibial condyles, as well as collateral ligaments and cruciate ligaments when the knee is fully
extended. On the other hand, when the knee is slightly flexed, limited adduction and abduction
are possible. Motions in the longitudinal axis, as in medial and lateral rotation, are similarly
affected by the amount of joint flexion, and are possible if the knee joint is slightly flexed.
PATELLA AND ITS IMPORTANCE
The patella, most commonly referred to as the kneecap, is the largest sesamoid bone in the
body. A sesamoid bone is one that is embedded in a tendon and, in the patella’s case, it exists
within the quadriceps tendon. This tendon helps hold the patella in place along with other
muscles found in and near the quadriceps so it can do its most important job, protect the knee
joint.
Anatomy
The patella bone goes through the process of ossifying (turning into bone) between the ages
of three and six years old.
In its whole, complete form the patella is a flat, triangular-shaped bone that is fairly dense.
The apex, or point, of the patella points downward towards the shin while the base of the
bone sits upward towards the thigh. The base is also what attaches to the quadriceps tendon.
The back of the patella forms a joint with the femur, otherwise known as the thighbone. This
makes the femur become a joint facet, as it also connects with a medial and lateral condyle of
the femur. The patella is also attached by the vastus lateralis and medialis, which are muscles
in the thigh.
From the apex of the patella comes the patellar ligament, which connects to the front of
the tibia (shin bone). The middle of the patella consists of openings for arteries to supply
blood to the kneecap. Muscles in the thigh, parts of the femur, and a tendon in the knee,
referred to as medial patellar retinaculum and that crosses the knee joint in the middle of the
patella, all work together to keep the patella stabilized.
Location
The patella sits between the femur and tibia, not only protecting the knee joint but connecting
muscles in the front of the femur to the tibia. Under the patella and the at the end of the femur
is articular cartilage, which makes it possible for the patella and femur bones to move
alongside each other. This cartilage offers protection on top of added mobility with any knee
movements.
Function

The main job of the patella is to help with knee extension and movement, while offering
protection for the knee joint.
In the case of knee extension, this movement happens by the patella offering leverage that the
quadriceps tendons it's attached to can put on the femur. In terms of protection, the patella
gives the front of the knee joint support during activities like exercise or even from daily
wear and tear from walking and stepping.
CARPAL BONES

Wrist Bones (Carpal Bones) Names in Order

 The carpal bones are arranged in two rows. The first row is proximal to the radius and ulna
and the second row lies close to the metacarpal bones of the hand.
Proximal Row (radial to ulnar)
 Scaphoid (boat-shaped): It is the most commonly fractured carpal bone
 Lunate (moon-shaped)
 Triquetral (pyramid-shaped)
 Pisiform (pea-shaped): It is the smallest carpal bone
Distal row (radial to ulnar):
 Trapezium (Table-shaped with one side parallel)
 Trapezoid (Table-shaped with no sides parallel): It is the smallest carpal bone in the
distal row
 Capitate (head-shaped): It is the largest carpal bone
 Hamate (having hook/hamulus)
BONES FORMING SHOULDER JOINT
The most flexible joint in the entire human body, our shoulder joint is formed by the union of the
humerus, the scapula (or shoulder blade), and the clavicle (or collarbone). Commonly thought of as a
single joint, the shoulder is actually made up of two separate joints - the glenohumeral and
acromioclavicular joints. These two joints work together to allow the arm both to circumduct in a
large circle and to rotate around its axis at the shoulder.
NAME OF TARSAL BONES
There are seven bones within the tarsal bones group:
 Talus (ankle bone)
 Calcaneus (heel bone)
 Navicular
 Cuboid - The cuboid provides stability for the foot and helps with the movement of
the toes
 Medial cuneiform - This bone anchors several of the ligaments in the foot
 Intermediate cuneiform - The intermediate cuneiform if very important in the
flexibility of the foot
 Lateral cuneiform
The calcaneus is the largest of the tarsal bones and is the largest bone in the entire foot.
NAME OF CRANIAL BONES
The 8 cranial bones are the:

 Frontal bone
 Parietal bone (x 2)
 Temporal bone (x 2)
 Occipital bone
 Sphenoid bone
 Ethmoid bone

HIP JOINT
The hip joint is a ball and socket synovial joint, formed by an articulation between the pelvic
acetabulum and the head of the femur.
It forms a connection from the lower limb to the pelvic girdle, and thus is designed for
stability and weight-bearing – rather than a large range of movement.
In this article, we shall look at the anatomy of the hip joint – its articulating surfaces,
ligaments and neurovascular supply.
Articulating Surfaces
The hip joint consists of an articulation between the head of femur and acetabulum of the
pelvis.
The acetabulum is a cup-like depression located on the inferolateral aspect of the pelvis. Its
cavity is deepened by the presence of a fibrocartilaginous collar – the acetabular labrum.
The head of femur is hemispherical, and fits completely into the concavity of the acetabulum.
Both the acetabulum and head of femur are covered in articular cartilage, which is thicker at
the places of weight bearing.
The capsule of the hip joint attaches to the edge of the acetabulum proximally. Distally, it
attaches to the intertrochanteric line anteriorly and the femoral neck posteriorly.
Neurovascular Supply
The arterial supply to the hip joint is largely via the medial and lateral circumflex femoral
arteries – branches of the profunda femoris artery (deep femoral artery). They anastomose at
the base of the femoral neck to form a ring, from which smaller arteries arise to supply the
hip joint itself.

The medial circumflex femoral artery is responsible for the majority of the arterial

supply (the lateral circumflex femoral artery has to penetrate through the thick iliofemoral
ligament). Damage to the medial circumflex femoral artery can result in avascular
necrosis of the femoral head.
The artery to head of femur and the superior/inferior gluteal arteries provide some
additional supply.
The hip joint is innervated primarily by the sciatic, femoral and obturator nerves. These
same nerves innervate the knee, which explains why pain can be referred to the knee from the
hip and vice versa.

PARTS OF STERNUM
The word sternum originates from the ancient Greek word ‘sternon’, meaning chest. The
sternum is also known as the breastbone. It is a flat bone that articulates with the clavicle and
the costal cartilages of the upper 7 ribs (true ribs), while the 8th, 9th and 10th ribs (false ribs)
are indirectly attached with sternum via costal cartilage of the ribs above. The bone is divided
into three parts:

1. The manubrium.
2. The body of the sternum (mesosternum).
3. The xiphoid process (xiphisternum).
The manubrium is a large quadrangular shaped bone that lies above the body of the sternum.
The lower border is narrower, is quite rough, and articulates with the body with a thin layer of
cartilage in between. At the superior border of the bone is the jugular notch or suprasternal
notch, fibres of interclavicular ligaments are attached here. The clavicular notches for the
articulation of clavicles are projected upward and laterally on both sides of jugular notch. The
costal cartilages of the first rib and part of the second rib also articulate with the manubrium,
and they fit into facets on its lateral border.
The body of the bone (also known as the gladiolus) is a long flat structure, with a convex
anterior surface, and a concave posterior surface. It has facets on its each lateral border for
articulation with the costal cartilage of the 3rd to 7th ribs along with the part of second costal
cartilage. The sternocostal head of the pectoralis major muscle attaches the sternum, on the
lateral sides of its anterior surface. The posterior surface of the body gives rise to
the transversus thoracis muscle (innervated by intercostal nerves). The lower part of the bone is
narrower and articulates with the xiphoid process.
The xiphoid process is a small projection of bone which is usually pointed. It possesses
demifacets for part of seventh costal cartilage at its superolateral angle. The fibres of rectus
abdominis and aponeurosis of internal and external obliques are attached to its anterior surface.
Posterior surface gives rise to the inferior sternopericardial ligament. It also is the site of
insertion of part of the thoracic diaphragm. Blood supply to the sternum arises from the internal
thoracic artery.

TYPES OF SKELETONS
Human Axial Skeleton

The axial skeleton forms the central axis of the human body and includes the bones of the
skull, the ossicles of the middle ear, the hyoid bone of the throat, the vertebral column, and
the thoracic cage (ribcage). The function of the axial skeleton is to provide support and
protection for the brain, spinal cord, and organs in the ventral body cavity. It also provides a
surface for the attachment of muscles that move the head, neck, and trunk; performs
respiratory movements; and stabilizes parts of the appendicular skeleton, which will be
discussed later.

Human Appendicular Skeleton

The human appendicular skeleton is composed of the bones of the upper limbs (which
function to grasp and manipulate objects) and the lower limbs (which permit locomotion). It
also includes the pectoral (or shoulder) girdle and the pelvic girdle, which attach the upper
and lower limbs to the body, respectively

DIFFERENCES BETWEEN ADULT AND FETAL SKULL

the calvarium of the adult scull is fused, in the foetus the bones making up the skull are not
fused (not joined together), also they’re actually quite a lot of space around the bones - called
fontanelles or "soft spots" on a baby's head that you can feel on the back of the head in many
babies until 6-9 months or so and on the front of many babies until 15-18 months or so.
2-The foetus and children's skull is flexible the "fontanels are soft to help mom in
birth while adult skull is rigid and hard not flexible but it is breakable.
3-The foetus and children's skull is smaller thinner and composed of deformable bones while
adult's skull is bigger thicker and not deformable usually after age 18-25.

CLAVICLE
The clavicle (also collarbone, Latin: clavicula) is a paired long bone extending between
the sternum and the scapula. The clavicle can be palpated along its length, and can is visible
under the skin in a thin person.
The clavicle is slender bone with two curves, giving it an “S” shape. When facing forward, its
medial part is convex, while its lateral aspect is concave. The clavicle is situated directly
above the first rib. Its medial end articulates with the manubrium of the sternum at
the sternoclavicular joint. The lateral end of the clavicle articulates with the acromion of the
scapula at the acromioclavicular joint.

Interestingly, the clavicle is the only long bone that lies horizontally in the human body. The
clavicle acts as a strut that keeps the scapula in place so that the upper limb can hang freely.

The main functions of the clavicle include:

 participates in attaching the upper limb to the trunk, by being a part of the shoulder
girdle;
 protects neurovascular structures underneath that supply the upper limb;
 transmits force from the upper limb to the axial skeleton.
The clavicle can be divided into three parts: a sternal (medial) end, a shaft, and an acromial
(lateral) end.

Sternal end of clavicle

The sternal or medial end of the clavicle has a large triangular facet for articulation with the
clavicular notch on the manubrium of the sternum. This articulation forms the
sternoclavicular joint.

The inferior aspect of the medial end is marked by a rough oval depression for the attachment
of the costoclavicular ligament. It is a ligament of the sternoclavicular joint.

The medial end also gives attachment to the following structures: 

 all-around - a fibrous joint capsule;

 superoposteriorly - an articular disc;
 superiorly - the interclavicular ligament.

Shaft of clavicle

The shaft (or diaphysis, or body) refers to the middle part of any long bone. The shaft of the
clavicle serves as an origin site for several muscles, including the deltoid, trapezius,
subclavius, pectoralis major, and sternohyoid.

Acromial end of clavicle

The acromial or lateral end of the clavicle has an oval facet for articulation with the acromion
of the scapula to form the acromioclavicular joint. The area surrounding the joint gives
attachment to the fibrous joint capsule.

The lateral end of the clavicle has landmarks that serve as the attachment sites for the
coracoclavicular ligament:

 conoid tubercle - attachment site of the conoid ligament, which is the medial part of
the coracoclavicular ligament;
 trapezoid line - attachment site of the trapezoid ligament, which is the lateral part of
the coracoclavicular ligament.

The coracoclavicular ligament is a very strong ligament that connects the clavicle with the
coracoid process of the scapula. It suspends the weight of the upper limb from the clavicle.
BONES OF THE LOWER LIMB

 Femur
 Patella
 Tibia
 Fibula
 Tarsal Bones
 Metatarsal Bones
 Phalanges
 Arches of the Foot

Like the upper limb, the lower limb is divided into three regions. The thigh is that portion of
the lower limb located between the hip joint and knee joint. The leg is specifically the region
between the knee joint and the ankle joint. Distal to the ankle is the foot. The lower limb
contains 30 bones. These are the femur, patella, tibia, fibula, tarsal bones, metatarsal bones,
and phalanges (see Figure 6.51). The femur is the single bone of the thigh. The patella is the
kneecap and articulates with the distal femur. The tibia is the larger, weight-bearing bone
located on the medial side of the leg, and the fibula is the thin bone of the lateral leg. The
bones of the foot are divided into three groups. The posterior portion of the foot is formed by
a group of seven bones, each of which is known as a tarsal bone, whereas the mid-foot
contains five elongated bones, each of which is a metatarsal bone. The toes contain 14 small
bones, each of which is a phalanx bone of the foot.

Femur
The femur, or thigh bone, is the single bone of the thigh region (Figure 6.51). It is the longest
and strongest bone of the body, and accounts for approximately one-quarter of a person’s
total height. The rounded, proximal end is the head of the femur, which articulates with the
acetabulum of the hip bone to form the hip joint.

Patella

The patella (kneecap) is largest sesamoid bone of the body (see Figure 6.51). A sesamoid
bone is a bone that is incorporated into the tendon of a muscle where that tendon crosses a
joint. The sesamoid bone articulates with the underlying bones to prevent damage to the
muscle tendon due to rubbing against the bones during movements of the joint. The patella is
found in the tendon of the quadriceps femoris muscle, the large muscle of the anterior thigh
that passes across the anterior knee to attach to the tibia. The patella articulates with the
patellar surface of the femur and thus prevents rubbing of the muscle tendon against the distal
femur. The patella also lifts the tendon away from the knee joint, which increases the
leverage power of the quadriceps femoris muscle as it acts across the knee. The patella does
not articulate with the tibia.

Tibia

The tibia (shin bone) is the medial bone of the leg and is larger than the fibula, with which it
is paired (Figure 6.52). The tibia is the main weight-bearing bone of the lower leg and the
second longest bone of the body, after the femur. The medial side of the tibia is located
immediately under the skin, allowing it to be easily palpated down the entire length of the
medial leg.

Fibula

The fibula is the slender bone located on the lateral side of the leg (see Figure 6.52). The
fibula does not bear weight. It serves primarily for muscle attachments and thus is largely
surrounded by muscles. Only the proximal and distal ends of the fibula can be palpated.
The head of the fibula is the small, knob-like, proximal end of the fibula. It articulates with
the inferior aspect of the lateral tibial condyle, forming the proximal tibiofibular joint. The
distal end of the fibula forms the lateral malleolus, which forms the easily palpated bony
bump on the lateral side of the ankle. The deep (medial) side of the lateral malleolus
articulates with the talus bone of the foot as part of the ankle joint. The distal fibula also
articulates with the fibular notch of the tibia.

Tarsal Bones
The posterior half of the foot is formed by seven tarsal bones (Figure 6.53). The most
superior bone is the talus. This has a relatively square-shaped, upper surface that articulates
with the tibia and fibula to form the ankle joint. Inferiorly, the talus articulates with
the calcaneus (heel bone), the largest bone of the foot, which forms the heel. Body weight is
transferred from the tibia to the talus to the calcaneus, which rests on the ground. The medial
calcaneus has a prominent bony extension called the sustentaculum tali (“support for the
talus”) that supports the medial side of the talus bone.

Metatarsal Bones
The anterior half of the foot is formed by the five metatarsal bones, which are located
between the tarsal bones of the posterior foot and the phalanges of the toes (see Figure 6.53).
These elongated bones are numbered 1–5, starting with the medial side of the foot.

Phalanges
The toes contain a total of 14 phalanx bones (phalanges), arranged in a similar manner as the
phalanges of the fingers (see Figure 6.53). The toes are numbered 1–5, starting with the big
toe (hallux). The big toe has two phalanx bones, the proximal and distal phalanges. The
remaining toes all have proximal, middle, and distal phalanges. A joint between adjacent
phalanx bones is called an interphalangeal joint.
LABELLED DIAGRAM OF SYNOVIAL JOINT

PARTS OF HIP BONE

Composition of the Hip Bone
The hip bone is comprised of the three parts; the ilium, pubis and ischium. Prior to
puberty, the triradiate cartilage separates these parts – and fusion only begins at the age of
15-17.

Together, the ilium, pubis and ischium form a cup-shaped socket known as
the acetabulum (literal meaning in Latin is ‘vinegar cup‘). The head of the femur articulates
with the acetabulum to form the hip joint.

The Ilium
The ilium is the widest and largest of the three parts of the hip bone, and is located
superiorly. The body of the ilium forms the superior part of the acetabulum (acetabular roof).
Immediately above the acetabulum, the ilium expands to form the wing (or ala).

The wing of the ilium has two surfaces:

 Inner surface – has a concave shape, which produces the iliac fossa (site of origin of
the iliacus muscle).
  External surface (gluteal surface) – has a convex shape and provides attachments to
the gluteal muscles.

The superior margin of the wing is thickened, forming the iliac crest. It extends from the
anterior superior iliac spine (ASIS) to the posterior superior iliac spine (PSIS).

On the posterior aspect of the ilium there is an indentation known as the greater sciatic
notch.

PUBIS
The pubis is the most anterior portion of the hip bone. It consists of a body, superior ramus
and inferior ramus (ramus = branch).

 Pubic body – located medially, it articulates with the opposite pubic body at the
pubic symphysis. Its superior aspect is marked by a rounded thickening (the pubic
crest), which extends laterally as the pubic tubercle.
 Superior pubic ramus – extends laterally from the body to form part of the
acetabulum.
 Inferior pubic ramus – projects towards the ischium.

The Ischium
The ischium forms the posteroinferior part of the hip bone. Much like the pubis, it is
composed of a body, an inferior ramus and superior ramus.

The inferior ischial ramus combines with the inferior pubic ramus forming the ischiopubic
ramus, which encloses part of the obturator foramen. The posterorinferior aspect of the
ischium forms the ischial tuberosities and when sitting, it is these tuberosities on which our
body weight falls.

Near the junction of the superior ramus and body is a posteromedial projection of bone;
the ischial spine.

PARTS OF A DEVELOPING LONG BONE

A typical long bone consists of the following parts:
1. The diaphysis (growing between) is the shaft of a long bone — the long,
cylindrical, main portion of the bone.
2. The epiphyses (growing over; singular is epiphysis) are the proximal
and distal ends of the bone.
3. The metaphyses (between; singular is metaphysis) are the regions
between the diaphysis and the epiphyses. In a growing bone, each
metaphysis contains an epiphyseal (growth) plate, a layer of hyaline
cartilage that allows the diaphysis of the bone to grow in length. When a
bone ceases to grow in length at about ages 14–24, the cartilage in the
epiphyseal plate is replaced by bone; the resulting bony structure is known
as the epiphyseal line.
4. The articular cartilage is a thin layer of hyaline cartilage covering the part
of the epiphysis where the bone forms an articulation (joint) with another
bone. Articular cartilage reduces friction and absorbs shock at freely
movable joints. Because articular cartilage lacks a perichondrium and lacks
blood vessels, repair of damage is limited.
5. The periosteum is a tough connective tissue sheath and its associated blood
supply that surrounds the bone surface wherever it is not covered by
articular cartilage. It is composed of an outer fibrous layer of dense irregular
connective tissue and an inner osteogenic layer that consists of cells. Some
of the cells enable bone to grow in thickness, but not in length. The
periosteum also protects the bone, assists in fracture repair, helps nourish
bone tissue, and serves as an attachment point for ligaments and tendons.
The periosteum is attached to the underlying bone by perforating fibers or
Sharpey’s fibers, thick bundles of collagen that extend from the periosteum
into the bone extracellular matrix.
6. The medullary cavity (medulla- = marrow), or marrow cavity, is a
hollow, cylindrical space within the diaphysis that contains fatty yellow
bone marrow and numerous blood vessels in adults. This cavity minimizes
the weight of the bone by reducing the dense bony material where it is least
needed. The long bones’ tubular design provides maximum strength with
minimum weight.
7. The endosteum (endo- = within) is a thin membrane that lines the
medullary cavity. It contains a single layer of bone-forming cells and a
small amount of connective tissue.
BONES OF UPPER LIMB
The upper limb is divided into three regions. These consist of the arm, located between the
shoulder and elbow joints; the forearm, which is between the elbow and wrist joints; and
the hand, which is located distal to the wrist. There are 30 bones in each upper limb.
The humerus is the single bone of the upper arm, and the ulna (medially) and
the radius (laterally) are the paired bones of the forearm. The base of the hand contains eight
bones, each called a carpal bone, and the palm of the hand is formed by five bones, each
called a metacarpal bone. The fingers and thumb contain a total of 14 bones, each of which
is a phalanx bone of the hand.

Humerus

See anatomy of humerus

Radius

The radius runs parallel to the ulna, on the lateral (thumb) side of the forearm (see Figure 2).
The head of the radius is a disc-shaped structure that forms the proximal end. The small
depression on the surface of the head articulates with the capitulum of the humerus as part of
the elbow joint, whereas the smooth, outer margin of the head articulates with the radial
notch of the ulna at the proximal radioulnar joint.

Carpal Bones

The wrist and base of the hand are formed by a series of eight small carpal bones
(see Figure 3). The carpal bones are arranged in two rows, forming a proximal row of four
carpal bones and a distal row of four carpal bones. The bones in the proximal row, running
from the lateral (thumb) side to the medial side, are the scaphoid (“boat-
shaped”), lunate (“moon-shaped”), triquetrum (“three-cornered”), and pisiform (“pea-
shaped”) bones. The small, rounded pisiform bone articulates with the anterior surface of the
triquetrum bone. The pisiform thus projects anteriorly, where it forms the bony bump that can
be felt at the medial base of your hand. The distal bones (lateral to medial) are
the trapezium (“table”), trapezoid (“resembles a table”), capitate (“head-shaped”),
and hamate (“hooked bone”) bones. The hamate bone is characterized by a prominent bony
extension on its anterior side called the hook of the hamate bone.

Metacarpal Bones

The palm of the hand contains five elongated metacarpal bones. These bones lie between the
carpal bones of the wrist and the bones of the fingers and thumb (see Figure 3). The proximal
end of each metacarpal bone articulates with one of the distal carpal bones. Each of these
articulations is a carpometacarpal joint (see Figure 4). The expanded distal end of each
metacarpal bone articulates at the metacarpophalangeal joint with the proximal phalanx
bone of the thumb or one of the fingers. The distal end also forms the knuckles of the hand, at
the base of the fingers. The metacarpal bones are numbered 1–5, beginning at the thumb.

Phalanx Bones

The fingers and thumb contain 14 bones, each of which is called a phalanx bone (plural
= phalanges), named after the ancient Greek phalanx (a rectangular block of soldiers). The
thumb (pollex) is digit number 1 and has two phalanges, a proximal phalanx, and a distal
phalanx bone (see Figure 3). Digits 2 (index finger) through 5 (little finger) have three
phalanges each, called the proximal, middle, and distal phalanx bones. An interphalangeal
joint is one of the articulations between adjacent phalanges of the digits (see Figure 4).

OSTEOBLAST
Bones in the human body are constantly remodelled. In fact, during fetal development, your
bones were just cartilage moulds, into which bone material was laid. With changes in age,
exercise, lifestyle, and eating habits, there are changes in the strength and shape of your
bones. There are three types of cells in your body that bring about changes in our bones:
osteoblasts, osteocytes, and osteoclasts. In this lesson, we're going to discuss osteoblasts.
Osteoblasts are bone forming cells. Of the three types of bone cells, they are the ones that
produce the matrix that makes up bone. The matrix, or organic material, includes molecules
such as collagen protein fibres, which give bone its flexibility, and calcium (Ca2+) and
phosphate (PO4-) ions, which give bone its rigidity. Osteoblasts make and package the matrix
molecules for release into the extracellular environment. Once released, the molecules in the
matrix react with each other to form a rigid yet flexible bone tissue called osteoid that
eventually hardens to form bone.
Osteoblasts are typically found on top of or next to existing bone. The matrix they produce
becomes a new layer of bone tissue, making the existing bone stronger and thicker. Think of
osteoblasts as a child making a snowman. In order to make the snowman stronger, the child
packs more snow on the outside of the snowman in specific places. However, in the case of
bones, osteoblasts eventually become encased in the matrix that they themselves produce.
Once this happens, we call the cells osteocytes. One osteoblast cannot make a bone all by
itself. Instead, groups of osteoblasts work together in communities called osteons.
FUNCTION OF OSTEOCLASTS
As we grow taller and stronger (and perhaps even wider), the shape and strength of our bones
change. There are two types of cells that work together to alter your bones in response to
many environmental factors: osteoblasts and osteoclasts. Bone is a hardened matrix
composed mainly of the mineral calcium phosphate and the protein collagen. This matrix is
produced and secreted by osteoblasts. Osteoblasts make bone in response to growth factors
and mechanical stress on the bone.
Counteracting the osteoblast activity are osteoclasts - the bone reabsorbing
cells. Osteoclasts make and secrete digestive enzymes that break up or dissolve the bone
tissue. Osteoclasts then take up or 'absorb' the bone debris and further break it down inside
the cell. The collagen is broken down into amino acids, which are recycled to build other
proteins, while the calcium and phosphate are released to be used elsewhere in the body.
You can think of osteoclasts as a collection of miniature demolition machines. A wrecking
ball and jack hammer break up the side of a building; a front loader scoops up the debris and
loads it into a dump truck, which takes it to a recycling center where the material is further
processed. All of this is done by osteoclasts!
Osteoclasts are found on top of or next to existing bone tissue, sometimes in close proximity
to osteoblasts. There is on-going race between the two cell types; osteoblasts make bone
tissue while osteoclasts reabsorb it. To recall the difference, remember osteo-B-lasts B-uild
bone, while osteo-C-lasts C-ollapse bone.
FUNCTIONS OF A BONE
The functions of the bones in the human body are abundant and crucial – far above and
beyond provision of rigidity.
1. Mechanical Functions
 Protection. Bones are vital for protecting the most important and fragile organs in
the body. The chest for example protects the heart, while the skull keeps the brain
safe from harm.
 Structure. Without bones, the body would have no frame and essentially be an
immobile mass of flesh and tissue.
 Movement. The bones pair up with the joints, ligaments, tendons and muscles to
enable the body to move as it does.
  Sound Transduction. Bones are also important for conduction vibrations which
allow us to hear.
2. Synthetic Functions
 Blood Production. Bone marrow, which is found in the central cavity of the
body’s longer bones, is crucial for producing both red and white blood cells.
3. Metabolic Functions
 Mineral Storage. With phosphorus and calcium being the two most prevalent
examples, the bones of the body store the most important minerals the body needs
to function.
 Fat Storage. Fatty acids are stored in yellow bone marrow to be called upon as
energy reserves when needed.
 Growth Factor Storage. Crucial growth factors are stored in mineralized bone
matrix.
 Acid-base Balance. Bone is extremely affective when it comes to both releasing
and absorbing alkaline salts, which in turn helps preserve the pH balance of the
body.
 Detoxification. The tissue of human bones is capable of removing heavy metal
and other toxins from the blood, so as to be stored safely away from the organs
and slowly released to be expelled from the body in excretions.
 Endocrine Organ. Bones release fibroblast growth factor which controls
phosphate metabolism. Fat deposition and blood sugar levels are also controlled
by the bones through the release of osteocalcin hormone, which is known to
increase insulin production and help reduce excessive fat storage.
FUNCTION OF VERTEBRAL COLUMN
In humans the structure and function of the vertebral column can be affected by certain
diseases, disorders, or injuries. Examples include scoliosis, lordosis, and kyphosis, which are
deviations from the normal spinal curvature; degenerative diseases, such as osteoarthritis and
Baastrup disease (kissing spine syndrome); and tuberculosis of the spine (Pott disease),
which is caused by infection of the vertebral column by Mycobacterium tuberculosis.
CALLUS
Callus, also spelled callous, in osteology, bony and cartilaginous material forming a
connecting bridge across a bone fracture during repair. Within one to two weeks after injury,
a provisional callus forms, enveloping the fracture site. Osteoblasts, bone-forming cells in
the periosteum (the bone layer where new bone is produced), proliferate rapidly, forming
collars around the ends of the fracture, which grow toward each other to unite the fragments.
The definitive callus forms slowly as the cartilage is resorbed and replaced by bone tissue.
Two to three weeks after injury, strong bony extensions join the fractured bone ends, and the
organized aspect of bone gradually recurs. The callus is resorbed over a period of months to
years.
FACTORS THAT DELAY BONE HEALING
Numerous factors are known to retard or inhibit bone repair. Glucocorticoid excess, for
example, can lead to severe osteopenia, imperilling fracture healing; juvenile diabetes has the
same potential effect. A deficiency of gonadal steroids in either men or women can also result
in profound osteopenia, which slows the regenerative response after a fracture. Severe
anaemia can alter oxygen tensions at the fracture site. Deficiencies of vitamin D or its
metabolites cause abnormal mineralization of the fracture callus, delaying fracture healing or
causing non-union.
The regenerative response is interrupted by large bone gaps due to the interposition of soft
tissue and by devitalization of bone by irradiation, vascular loss, injury, loss of soft tissue, or
denervation. Infections and neoplasm can retard fracture healing by some unknown
mechanisms. The regenerative response can also be interrupted by components in the
synovial fluid bathing the fragments of an intra-articular fracture, resulting in delayed union
or non-union. Severe osteoporosis from any cause, as well as metabolic diseases such as
hyperparathyroidism, osteocalcin, Paget disease of bone, or fibrous dysplasia, can retard the
regenerative response to a fracture.
Fractures heal more slowly in older persons than in children and young adults. Poor
general nutrition and lack of vitamin C can have a direct inhibitory effect on the production
of extracellular matrix, which can disrupt the formation of both soft and hard callus.
Although movement can stimulate fracture healing, too little or too much movement disrupts
endochondral callus formation, which may have important implications for fracture healing.
Cigarette smoke has a negative effect on bone healing and increases the risk of non-union.
Nonsteroidal anti-inflammatory drugs have a negative impact on bone healing and should be
avoided if possible, during fracture healing as well.
TYPES OF SYNOVIAL JOINT MOVEMENT
The wide range of movement allowed by synovial joints produces different types of
movements. The movement of synovial joints can be classified as one of four different types:
gliding, angular, rotational, or special movement.
Gliding Movement
Gliding movements occur as relatively flat bone surfaces move past each other. Gliding
movements produce very little rotation or angular movement of the bones. The joints of the
carpal and tarsal bones are examples of joints that produce gliding movements.
Angular Movement
Angular movements are produced when the angle between the bones of a joint changes.
There are several different types of angular movements, including flexion, extension,
hyperextension, abduction, adduction, and circumduction. Flexion, or bending, occurs when
the angle between the bones decreases. Moving the forearm upward at the elbow or moving
the wrist to move the hand toward the forearm are examples of flexion. Extension is the
opposite of flexion in that the angle between the bones of a joint increases. Straightening a
limb after flexion is an example of extension. Extension past the regular anatomical position
is referred to as hyperextension. This includes moving the neck back to look upward, or
bending the wrist so that the hand moves away from the forearm.
Abduction occurs when a bone moves away from the midline of the body. Examples of
abduction are moving the arms or legs laterally to lift them straight out to the
side. Adduction is the movement of a bone toward the midline of the body. Movement of the
limbs inward after abduction is an example of adduction. Circumduction is the movement of
a limb in a circular motion, as in moving the arm in a circular motion.
Rotational Movement
Rotational movement is the movement of a bone as it rotates around its longitudinal axis.
Rotation can be toward the midline of the body, which is referred to as medial rotation, or
away from the midline of the body, which is referred to as lateral rotation. Movement of the
head from side to side is an example of rotation.
Special Movements
Some movements that cannot be classified as gliding, angular, or rotational are called special
movements. Inversion involves the soles of the feet moving inward, toward the midline of
the body. Eversion is the opposite of inversion, movement of the sole of the foot outward,
away from the midline of the body. Protraction is the anterior movement of a bone in the
horizontal plane. Retraction occurs as a joint moves back into position after protraction.
Protraction and retraction can be seen in the movement of the mandible as the jaw is thrust
outwards and then back inwards. Elevation is the movement of a bone upward, such as when
the shoulders are shrugged, lifting the scapulae. Depression is the opposite of elevation—
movement downward of a bone, such as after the shoulders are shrugged and the scapulae
return to their normal position from an elevated position. Dorsiflexion is a bending at the
ankle such that the toes are lifted toward the knee. Plantar flexion is a bending at the ankle
when the heel is lifted, such as when standing on the toes. Supination is the movement of the
radius and ulna bones of the forearm so that the palm faces forward. Pronation is the
opposite movement, in which the palm faces backward. Opposition is the movement of the
thumb toward the fingers of the same hand, making it possible to grasp and hold objects.
OSTEOPOROSIS
Osteoporosis causes bones to become weak and brittle — so brittle that a fall or even mild
stresses such as bending over or coughing can cause a fracture. Osteoporosis-related fractures
most commonly occur in the hip, wrist or spine.
Bone is living tissue that is constantly being broken down and replaced. Osteoporosis occurs
when the creation of new bone doesn't keep up with the loss of old bone.
Osteoporosis affects men and women of all races. But white and Asian women — especially
older women who are past menopause — are at highest risk. Medications, healthy diet and
weight-bearing exercise can help prevent bone loss or strengthen already weak bones.
Symptoms
There typically are no symptoms in the early stages of bone loss. But once your bones have
been weakened by osteoporosis, you might have signs and symptoms that include:

 Back pain, caused by a fractured or collapsed vertebra

 Loss of height over time
 A stooped posture
 A bone that breaks much more easily than expected
Causes
Your bones are in a constant state of renewal — new bone is made and old bone is broken
down. When you're young, your body makes new bone faster than it breaks down old bone
and your bone mass increases. After the early 20s this process slows, and most people reach
their peak bone mass by age 30. As people age, bone mass is lost faster than it's created.
How likely you are to develop osteoporosis depends partly on how much bone mass you
attained in your youth. Peak bone mass is somewhat inherited and varies also by ethnic
group. The higher your peak bone mass, the more bone you have "in the bank" and the less
likely you are to develop osteoporosis as you age.
RICKETS
Rickets is a childhood disorder of the bones where the bones become soft and prone to
fractures. Bones tend to become weak due to an inadequate supply of nutrients, Vitamin D3
in particular. It is also caused due to lack of calcium and phosphate in the body. Weak bones
can lead to bone deformities. Vitamin D largely comes from exposing the skin to sunlight.
Other good sources of Vitamin D are fatty fish (such as tuna and salmon) and egg yolks.
It is a commonly occurring disorder in children, especially ones with darker skin due to lack
of exposure to sunlight, is also seen in premature infants. This condition of rickets in adults is
called osteomalacia which is usually characterized by soft bones. Diagnosis of rickets is
normally done through blood tests and X-rays. Blood tests indicate the condition through
alarmingly low levels of calcium and phosphorous and higher levels of a phosphatase that is
alkaline in nature. Through X-rays, it is indicated by the change in the shape of bones. Bone
biopsies also help in their diagnosis.

Symptoms Of Rickets
The symptoms of rickets are as follows:
  Reduced growth and short height
 Fractures in bones
 Softening of bones
 Pain in the bones of arms, legs, pelvis, and spine
 Deformities in teeth
 Deformities in the skeleton like bowlegs, and protruding breastbone.

Causes of Rickets
Vitamin D is required to absorb calcium from food. Lack of calcium and vitamin D or
inability to absorb the same causes rickets.
Vitamin D is obtained through sunlight and food. Vitamin D is produced when the skin is
exposed to sunlight. Use of sunscreen blocks the rays and hence the production of Vitamin D
by the skin is reduced.
Fish oil and fat and the egg yolk are highly rich in Vitamin D. In addition, some cereals, milk
and fruit juices also contain Vitamin D.
Sometimes, Rickets can be inherited as it is a genetic disorder. It commonly occurs in
children since bones grow rapidly in them, more so in children with the following attributes:

 Darker complexion – excess melanin pigment

 Inadequate supply of foods rich in calcium, phosphorous
 Lack of sunlight exposure
 When infants are breastfed without Vitamin D supplements
 Possessing diseases which inhibit the absorption of Vitamin D
OSTEOMALACIA
Osteomalacia refers to a marked softening of your bones, most often caused by severe
vitamin D deficiency. The softened bones of children and young adults with osteomalacia can
lead to bowing during growth, especially in weight-bearing bones of the legs. Osteomalacia
in older adults can lead to fractures.
Treatment for osteomalacia involves providing enough vitamin D and calcium, both required
to harden and strengthen bones, and treating disorders that might cause the condition.
Symptoms
When osteomalacia is in its early stages, you might not have symptoms, although signs of
osteomalacia might show on an X-ray or other diagnostic tests. As osteomalacia progresses,
you might develop bone pain and muscle weakness.
The dull, aching pain associated with osteomalacia most commonly affects the lower back,
pelvis, hips, legs and ribs. The pain might be worse at night or when you put pressure on the
bones. The pain is rarely relieved completely by rest.
Decreased muscle tone and leg weakness can cause a waddling gait and make walking slower
and more difficult.
Causes
Osteomalacia results from a defect in the bone-maturing process. Your body uses the
minerals calcium and phosphate to help build strong bones. You might develop osteomalacia
if you don't get enough of these minerals in your diet or if your body doesn't absorb them
properly. These problems can be caused by:
 Vitamin D deficiency. Sunlight produces vitamin D in your skin. Dietary
vitamin D is usually from foods to which the vitamin has been added, such as
cow's milk.
 People who live in areas where sunlight is limited, get little exposure to sunlight
or eat a diet low in vitamin D can develop osteomalacia. Vitamin D deficiency is
the most common cause of osteomalacia worldwide.

 Certain surgeries. Normally, the stomach breaks down food to release calcium

and other minerals that are absorbed in the intestine. This process is disrupted if
you have surgery to remove part or all of your stomach or to bypass your small
intestine and can result in vitamin D and calcium deficiency.
 Celiac disease. In this autoimmune disorder, foods containing gluten, a protein
found in wheat, barley and rye, can damage the lining of your small intestine. A
damaged intestinal lining doesn't absorb nutrients well, and can lead to vitamin
D and calcium deficiency.
 Kidney or liver disorders. These organs are involved in activating vitamin D in
your body. Problems with your kidneys or liver can affect your body's ability to
make active vitamin D.
 Drugs. Some drugs used to treat seizures, including phenytoin (Dilantin,
Phenytek) and phenobarbital, can cause severe vitamin D deficiency and
osteomalacia.

OSTEOMYELITIS
Osteomyelitis is an infection in a bone. Infections can reach a bone by traveling through the
bloodstream or spreading from nearby tissue. Infections can also begin in the bone itself if an
injury exposes the bone to germs.
Smokers and people with chronic health conditions, such as diabetes or kidney failure, are
more at risk of developing osteomyelitis. People who have diabetes may develop
osteomyelitis in their feet if they have foot ulcers.
Although once considered incurable, osteomyelitis can now be successfully treated. Most
people need surgery to remove areas of the bone that have died. After surgery, strong
intravenous antibiotics are typically needed.
Symptoms
Signs and symptoms of osteomyelitis include:

 Fever
 Swelling, warmth and redness over the area of the infection
 Pain in the area of the infection
 Fatigue
Sometimes osteomyelitis causes no signs and symptoms or the signs and symptoms are hard
to distinguish from other problems. This may be especially true for infants, older adults and
people whose immune systems are compromised.
Causes
Most cases of osteomyelitis are caused by staphylococcus bacteria, types of germs commonly
found on the skin or in the nose of even healthy individuals.
Germs can enter a bone in a variety of ways, including:

 The bloodstream. Germs in other parts of your body — for example, in the

lungs from pneumonia or in the bladder from a urinary tract infection — can
travel through your bloodstream to a weakened spot in a bone.
 Injuries. Severe puncture wounds can carry germs deep inside your body. If
such an injury becomes infected, the germs can spread into a nearby bone.
 Germs can also enter the body if you have broken a bone so severely that part of
it is sticking out through your skin.
 Surgery. Direct contamination with germs can occur during surgeries to replace
joints or repair fractures.

LORDOSIS
Everyone’s spine curves a little in your neck, upper back, and lower back. These curves,
which create your spine’s S shape, are called the lordotic (neck and lower back) and kyphotic
(upper back). They help your body:
 absorb shock
 support the weight of the head
 align your head over your pelvis
 stabilize and maintain its structure
 move and bend flexibly
Lordosis refers to your natural lordotic curve, which is normal. But if your curve arches too
far inward, it’s called lordosis, or swayback. Lordosis can affect your lower back and neck.
This can lead to excess pressure on the spine, causing pain and discomfort. It can affect your
ability to move if it’s severe and left untreated.
Common causes of lordosis
Lordosis can affect people of any age. Certain conditions and factors can increase your risk
for lordosis. This includes:
 Spondylolisthesis: Spondylolisthesis is a spinal condition in which one of the lower
vertebras slips forward onto the bone below. It’s usually treated with therapy or
surgery. Find out more about the condition here.
 Achondroplasia: Achondroplasia is one of the most common types of
dwarfism. Learn about its causes, diagnosis, and treatment.
 Osteoporosis: Osteoporosis is a bone disease that causes a loss of bone density,
which increases your risk of fractures. Learn about its causes, symptoms, and
treatments.
 Osteosarcoma: Osteosarcoma is a bone cancer that typically develops in the
shinbone near the knee, the thighbone near the knee, or the upper arm bone near the
shoulder. Read more about symptoms, diagnosis, and treatments.
 Obesity: Obesity is an epidemic in the U.S. This condition puts people at a higher
risk for serious diseases, such as type 2 diabetes, heart disease, and cancer
What are the symptoms of lordosis?
The most common symptom of lordosis is muscle pain. When your spine curves abnormally,
your muscles get pulled in different directions, causing them to tighten or spasm. If you have
cervical lordosis, this pain may extend to your neck, shoulders, and upper back. You may
also experience limited movement in your neck or lower back.
You can check for lordosis by lying on a flat surface and checking if there’s a lot of space
between the curve of your neck and back and the floor. You may have lordosis if you can
easily slide your hand through the space.
Make an appointment with the doctor if you are experiencing other symptoms, such as:
 numbness
 tingling
 electric shock pains
 weak bladder control
 weakness
 difficulty maintaining muscle control
These may be signs of a more serious condition such as a trapped nerve.
OSTEOARTHRITIS
Osteoarthritis is the most common form of arthritis, affecting millions of people worldwide.
It occurs when the protective cartilage that cushions the ends of the bones wears down over
time.
Although osteoarthritis can damage any joint, the disorder most commonly affects joints in
your hands, knees, hips and spine.
Osteoarthritis symptoms can usually be managed, although the damage to joints can't be
reversed. Staying active, maintaining a healthy weight and receiving certain treatments might
slow progression of the disease and help improve pain and joint function.
Osteoarthritis symptoms often develop slowly and worsen over time. Signs and symptoms of
osteoarthritis include:

 Pain. Affected joints might hurt during or after movement.

 Stiffness. Joint stiffness might be most noticeable upon awakening or after
being inactive.
 Tenderness. Your joint might feel tender when you apply light pressure to or
near it.
 Loss of flexibility. You might not be able to move your joint through its full
range of motion.
 Grating sensation. You might feel a grating sensation when you use the joint,
and you might hear popping or crackling.
 Bone spurs. These extra bits of bone, which feel like hard lumps, can form
around the affected joint.
 Swelling. This might be caused by soft tissue inflammation around the joint.
Causes
Osteoarthritis occurs when the cartilage that cushions the ends of bones in your joints
gradually deteriorates. Cartilage is a firm, slippery tissue that enables nearly frictionless joint
motion.
Eventually, if the cartilage wears down completely, bone will rub on bone.
Osteoarthritis has often been referred to as a wear and tear disease. But besides the
breakdown of cartilage, osteoarthritis affects the entire joint. It causes changes in the bone
and deterioration of the connective tissues that hold the joint together and attach muscle to
bone. It also causes inflammation of the joint lining.
KYPHOSIS
Kyphosis is an exaggerated, forward rounding of the back. It can occur at any age but is most
common in older women.
Age-related kyphosis is often due to weakness in the spinal bones that causes them to
compress or crack. Other types of kyphosis can appear in infants or teens due to
malformation of the spine or wedging of the spinal bones over time.
Mild kyphosis causes few problems. Severe kyphosis can cause pain and be disfiguring.
Treatment for kyphosis depends on your age, and the cause and effects of the curvature.
Symptoms
Mild kyphosis may produce no noticeable signs or symptoms. But some people experience
back pain and stiffness in addition to an abnormally curved spine.
Causes
The individual bones (vertebrae) that make up a healthy spine look like cylinders stacked in a
column. Kyphosis occurs when the vertebrae in the upper back become more wedge shaped.
Abnormal vertebrae can be caused by:
  Fractures. Broken or crushed vertebrae (compression fractures) can result in
curvature of the spine. Mild compression fractures often don't produce
noticeable signs or symptoms.
 Osteoporosis. This bone-thinning disorder can cause spinal curvature,
especially if weakened vertebrae result in compression fractures. Osteoporosis is
most common in older women and people who have taken corticosteroids for
long periods of time.
 Disk degeneration. Soft, circular disks act as cushions between spinal
vertebrae. With age, these disks dry out and shrink, which often worsens
kyphosis.
 Scheuermann's disease. Also called Scheuermann's kyphosis, this disease
typically begins during the growth spurt that occurs before puberty. Boys are
affected more often than girls.
 Birth defects. Spinal bones that don't develop properly before birth can cause
kyphosis.
 Syndromes. Kyphosis in children can also be associated with certain
syndromes, such as Ehlers-Danlos syndrome and Marfan syndrome.
 Cancer and cancer treatments. Cancer in the spine can weaken vertebrae and
make them more prone to compression fractures, as can chemotherapy and
radiation cancer treatments.

FRACTURE
A fracture is a broken bone. It can range from a thin crack to a complete break. Bone can
fracture crosswise, lengthwise, in several places, or into many pieces. Most fractures happen
when a bone is impacted by more force or pressure than it can support.
If you suspect you have a fracture, seek medical help immediately.
What are the symptoms of a fracture?
Most fractures are accompanied by intense pain when the initial injury occurs. It may become
worse when you move or touch the injured area. In some cases, you may even pass out from
the pain. You may also feel dizzy or chilled from shock.
Other potential symptoms of a fracture include:
 a snap or grinding sound when the injury occurs
 swelling, redness, and bruising in the injured area
 difficulty supporting weight with the injured area
 visible deformity in the injured area
In some cases, you may see broken bone poking through your skin.
What causes a fracture?
You can develop a fracture when your bone is impacted with greater pressure or force than it
can support. This force usually occurs suddenly or is very intense. The strength of the force
determines the severity of the fracture.
Some common causes of fractures include:
 falls
 direct strikes to your body
 traumatic events, such as car accidents or gunshot wounds
 injuries from sports
DEFINE BONES AND JOINTS
A bone is a rigid tissue that constitutes part of the skeleton in most vertebrate animals. Bones
protect the various organs of the body, produce red and white blood cells, store minerals,
provide structure and support for the body, and enable mobility. Bones come in a variety of
shapes and sizes and have a complex internal and external structure. They are lightweight yet
strong and hard, and serve multiple functions.
Bone tissue (osseous tissue) is a hard tissue, a type of specialized connective tissue. It has
a honeycomb-like matrix internally, which helps to give the bone rigidity. Bone tissue is
made up of different types of bone cells. Osteoblasts and osteocytes are involved in the
formation and mineralization of bone; osteoclasts are involved in the resorption of bone
tissue. Modified (flattened) osteoblasts become the lining cells that form a protective layer on
the bone surface. The mineralized matrix of bone tissue has an organic component of
mainly collagen called ossein and an inorganic component of bone mineral made up of
various salts. Bone tissue is a mineralized tissue of two types, cortical bone and cancellous
bone. Other types of tissue found in bones include bone
marrow, endosteum, periosteum, nerves, blood vessels and cartilage.
A joint or articulation (or articular surface) is the connection made between bones in the
body which link the skeletal system into a functional whole.[1][2][3] They are constructed to
allow for different degrees and types of movement. Some joints, such as the knee, elbow,
and shoulder, are self-lubricating, almost frictionless, and are able to withstand compression
and maintain heavy loads while still executing smooth and precise movements.[3] Other joints
such as sutures between the bones of the skull permit very little movement (only during birth)
in order to protect the brain and the sense organs.[3] The connection between a tooth and
the jawbone is also called a joint, and is described as a fibrous joint known as a gomphosis.
Joints are classified both structurally and functionally.[4]

PROCESS OF BONE FORMATION

In the early stages of embryonic development, the embryo’s skeleton consists of fibrous
membranes and hyaline cartilage. By the sixth or seventh week of embryonic life, the actual
process of bone development, ossification (osteogenesis), begins. There are two osteogenic
pathways—intramembranous ossification and endochondral ossification—but bone is the
same regardless of the pathway that produces it.
Cartilage Templates
Bone is a replacement tissue; that is, it uses a model tissue on which to lay down its mineral
matrix. For skeletal development, the most common template is cartilage. During fetal
development, a framework is laid down that determines where bones will form. This
framework is a flexible, semi-solid matrix produced by chondroblasts and consists of
hyaluronic acid, chondroitin sulfate, collagen fibers, and water. As the matrix surrounds
and isolates chondroblasts, they are called chondrocytes. Unlike most connective tissues,
cartilage is avascular, meaning that it has no blood vessels supplying nutrients and
removing metabolic wastes. All of these functions are carried on by diffusion through the
matrix. This is why damaged cartilage does not repair itself as readily as most tissues do.
Throughout fetal development and into childhood growth and development, bone forms on
the cartilaginous matrix. By the time a fetus is born, most of the cartilage has been replaced
with bone. Some additional cartilage will be replaced throughout childhood, and some
cartilage remains in the adult skeleton.
Intramembranous Ossification
During intramembranous ossification, compact and spongy bone develops directly from
sheets of mesenchymal (undifferentiated) connective tissue. The flat bones of the face, most
of the cranial bones, and the clavicles (collarbones) are formed via intramembranous
ossification.
The process begins when mesenchymal cells in the embryonic skeleton gather together and
begin to differentiate into specialized cells ([link]a). Some of these cells will differentiate
into capillaries, while others will become osteogenic cells and then osteoblasts. Although
they will ultimately be spread out by the formation of bone tissue, early osteoblasts appear
in a cluster called an ossification center.
The osteoblasts secrete osteoid, uncalcified matrix, which calcifies (hardens) within a few
days as mineral salts are deposited on it, thereby entrapping the osteoblasts within. Once
entrapped, the osteoblasts become osteocytes ([link]b). As osteoblasts transform into
osteocytes, osteogenic cells in the surrounding connective tissue differentiate into new
osteoblasts.
Osteoid (unmineralized bone matrix) secreted around the capillaries results in a trabecular
matrix, while osteoblasts on the surface of the spongy bone become the periosteum
([link]c). The periosteum then creates a protective layer of compact bone superficial to the
trabecular bone. The trabecular bone crowds nearby blood vessels, which eventually
condense into red marrow ([link]d).
Intramembranous ossification begins in utero during fetal development and continues on
into adolescence. At birth, the skull and clavicles are not fully ossified nor are the sutures
of the skull closed. This allows the skull and shoulders to deform during passage through
the birth canal. The last bones to ossify via intramembranous ossification are the flat bones
of the face, which reach their adult size at the end of the adolescent growth spurt.
Endochondral Ossification
In endochondral ossification, bone develops by replacing hyaline cartilage. Cartilage does
not become bone. Instead, cartilage serves as a template to be completely replaced by new
bone. Endochondral ossification takes much longer than intramembranous ossification.
Bones at the base of the skull and long bones form via endochondral ossification.
In a long bone, for example, at about 6 to 8 weeks after conception, some of the
mesenchymal cells differentiate into chondrocytes (cartilage cells) that form the
cartilaginous skeletal precursor of the bones ([link]a). Soon after, the perichondrium, a
membrane that covers the cartilage, appears [link]b).
As more matrix is produced, the chondrocytes in the center of the cartilaginous model grow
in size. As the matrix calcifies, nutrients can no longer reach the chondrocytes. This results
in their death and the disintegration of the surrounding cartilage. Blood vessels invade the
resulting spaces, not only enlarging the cavities but also carrying osteogenic cells with
them, many of which will become osteoblasts. These enlarging spaces eventually combine
to become the medullary cavity.
As the cartilage grows, capillaries penetrate it. This penetration initiates the transformation
of the perichondrium into the bone-producing periosteum. Here, the osteoblasts form a
periosteal collar of compact bone around the cartilage of the diaphysis. By the second or
third month of fetal life, bone cell development and ossification ramps up and creates
the primary ossification center, a region deep in the periosteal collar where ossification
begins ([link]c).
While these deep changes are occurring, chondrocytes and cartilage continue to grow at the
ends of the bone (the future epiphyses), which increases the bone’s length at the same time
bone is replacing cartilage in the diaphyses. By the time the fetal skeleton is fully formed,
cartilage only remains at the joint surface as articular cartilage and between the diaphysis
and epiphysis as the epiphyseal plate, the latter of which is responsible for the longitudinal
growth of bones. After birth, this same sequence of events (matrix mineralization, death of
chondrocytes, invasion of blood vessels from the periosteum, and seeding with osteogenic
cells that become osteoblasts) occurs in the epiphyseal regions, and each of these centers of
activity is referred to as a secondary ossification center ([link]e).
HAVERSIAN SYSTEM
A Haversian system, also known as an osteon, is a series of concentric circles, called
lamellae, found in the compact bone of humans. Down the middle of each of these systems
is a hollow tube that holds a blood vessel. Each compact bone in the human body has many
Haversian systems that line up next to each other, creating a dense structure.
Within the lemellae of each Haversian system are a series of spaces called lacunae. The
lacunae hold the osteocytes, or bone cells. These osteocytes, along with
the collagen and calcium phosphate that make up the matrix of the lamellae, ensure that
compact bone is very strong. There are also osteoblasts in the area that become osteocytes.
The blood vessel that runs down the middle of a Haversian system provides nutrients to the
living bone tissue. Nerves and lymph vessels are also found in Haversian canals. These
accessory tissues help with immune response in the bones and also pick up signals from
various stimuli.
Compact bone is most often found in the shafts of the long bones of the human skeleton. The
epiphyses, found at the ends of long bones, are made of cancellous, or spongy, bone.
Haversian systems are not found within the cancellous bone, which is porous, less dense, and
more fragile than compact bone.
Even though this system was first observed by Anton von Leeuwenhoek in the late 1600s, it
was named after the English physician, Clopton Havers. Havers published and lectured about
the microscopic makeup of the canals he had seen in the bone. His theory about the function
of the canals was that they provided the oils necessary to harden the bone around it.
The exact function of a Haversian system is not known, and they are not present in many
vertebrate animals. Some theories as to their function are that they repair damaged bone
tissue, reduce stress on the compact bone, and give muscle a place to anchor.
Necrotic, or dying, bone tissue leaves empty lacunae in the Haversian system, and it is
believed that the Haversian canals absorb these dead or dying tissues so they can be replaced
by new osteocytes. These areas are known as resorption spaces and require the help of blood
vessels that bring nutrients to the surrounding tissues.

PIVOT JOINT
Pivot joints are joints that permit rotatory movement of bones, around a single axis. Pivot
joint is a synovial joint in which the ends of two bones connect. In this joint, a cylinder-
shaped bone rotates inside another ligament that forms a ring around the joint. The joint
between the atlas and the axis which is right under the skull, allows the turning of the head
from side to side. The rotation of the skull is possible because of pivot joints. The twisting
movement of the bones of the forearm, against the upper arm is due to pivot joints.

Implications of Pivot Joints

 The pivot joint located near the elbow, holds the two forearm bones, radius and ulna,
together.
 The two bones, radius and ulna, are also connected to each other near the wrist by
another pivot joint. These two bones twist around each other by using a pivot joint.
 The pivot joint situated at the base of the skull, connects the first vertebrae of the
spine to the second vertebrae. Thereby, allowing the side-to-side rotation of the head.
 A pivot joint permits movement of the bones in one plane, such as rotation around a
single axis.
 In the human body, the joint of the wrist that lets the palm of the hand move up and
down is possible because of pivot joints.
 Without pivot joints, the skeleton of the human body would lack flexibility and
freedom of movement thus, making the movement of the skeleton quite stiff and rigid.
SUPERIOR RADIOULNAR JOINT
The proximal radioulnar joint is located immediately distal to the elbow joint, and is
enclosed with in the same articular capsule. It is formed by an articulation between the head
of the radius and the radial notch of the ulna.

The radial head is held in place by the annular radial ligament, which forms a ‘collar’
around the joint. The annular radial ligament is lined with a synovial membrane, reducing
friction during movement.

Movement is produced by the head of the radius rotating within the annular ligament. There
are two movements possible at this joint; pronation and supination.

 Pronation: Produced by the pronator quadratus and pronator teres.

 Supination: Produced by the supinator and biceps brachii.

SEMILUNAR CARTILAGE OF KNEE JOINT

Either of the crescent-shaped menisci found between the tibia and the femur in the knee joint.