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The A to Z of Bones, Joints, Ligaments & the Back

Dr A. L. Neill
BSc MSc MBBS PhD FACBS medicalamanda@gmail.com

The A to Z of Bones, Joints, Ligaments & the Back

Introduction
This book is particularly useful when used with the A to Z of Peripheral Nerves and The A to Z of Skeletal Muscles, parts of the material is also covered in the A to Z of the Head & Neck bones & muscles but all the A to Zs are cross-referenced and together are forming a set covering the all structural elements of the human body. Now as an adjunct to this book the first in the series of the new The A to Z offailure books is the The A to Z of Bone and Joint Failure, which builds upon the knowledge of the material in this book. Eventually there will be a companion book to each of the current and future A to Zs - the sick and the well. So... If there is a structure / subject you want to see in the A to Zs let us know, as the feedback often determines the order of the new books. The A to Zs may be viewed on 2 sites www.amandasatoz.com and http://www.aspenpharma.com.au/atlas/student.htm

Acknowledgement

Thank you Aspenpharmacare Australia for your support and assistance in this valuable project, particularly Mr. Greg Lan and Rob Koster. Thank you also Ante Mihaljevic and everyone who provided valuable feedback.

Dedication

To aging healthily if not necessarily gracefully!!

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How to use this book


The first section consists of the basic anatomical concepts, movement planes, classification and definitions of all terms discussed in this book. Additional images of articulated bones are included to help with regionalization, and colour tags added to the base of each page to remind the reader where the bone or joint is located. Bones, Joints and Ligaments are then listed alphabetically and cross referenced with their common names (e.g. the SHOULDER
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The A to Z of Bones, Joints, Ligaments & the Back

JOINT is the GLENOHUMERAL JOINT and the COLLAR BONE is the CLAVICLE). Each bone and joint is shown from at least 2 aspects. Throughout the book, bones or groups of bones are also shown in situ, or as an overview to relate them to the whole body structure, in other words as they lay in body or cavity anatomically. For example the RIBS together form the RIB CAGE and anatomically this bony structure is the way the ribs function. There is a separate section at the back to discuss the BACK! And even the back cover has been modified so that there is an additional fold over which serves as a means of identifying the book on the shelf (i.e. the fold over has the title down the spine). Books can now be placed on the shelf and still identified. The fold over is also a fold in if not used as a book mark it can be folded in on itself and lays flat on the cover.

Thank you A. L. Neill


BSc MSc MBBS PhD FACBS medicalamanda@gmail.com ISBN 978-1-921-930-19-5

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The A to Z of Bones, Joints, Ligaments & the Back

Table of contents
INTRODUCTION ACKNOWLEDGEMENT DEDICATION HOW TO USE THIS BOOK ABBREVIATIONS COMMON TERMS USED IN OSTEOLOGY / SKELETAL ANATOMY ANATOMY Anatomical planes & relations Joint movements Neck Back Shoulder & Upper Limb Hips & Lower Limb Structure of bone tissue BONES in situ UPPER BONES in situ LOWER Classification of bones Structure of a Long Bone Regional Skeletons & Disarticulated Bones Classification and Summary of Joints Synovial joint Classification and Summary of Ligaments Bones, Joints & Ligaments index alphabetical listing Common pathologies of Bones benign bone lesions malignant bone lesions 3 3 3 3 7 8

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20 21 22 24 26 28 30 32 34 36 38 39 40 42 46

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OVERVIEWS to be found in this book


carpus / wrist overview (including hand bones) chest overview ear bones overview fingers overview foot, toes overview hand, wrist, fingers overview pectoral girdle / overview of the shoulders pelvic girdle / overview of the hips sinuses overview skull overviews teeth overview vertebral column overview vertebrae overview cervical spine overview 62 68 86 98 100 106 160 162

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Abbreviations
A aa adj. aka ALL alt. ant. art. AS b/n BM BS BV C co c.f. CNS collat. CSF CT D E e.g. EC ext. GC Gk. IC IP IT jt(s) L LB LL Lt. lig. M MC med Met MT NS NT OC P = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = actions /movements of a joint anastomosis or anastomoses adjective also known as anterior longitudinal ligament alternative anterior articulation (joint w/o the additional support structures) Alternative Spelling, generally referring to the diff. b/n British & American spelling between bone marrow blood supply blood vessel carpal / carpo cortex compared to central nervous system collateral Cerebrospinal fluid connective tissue diaphysis epiphysis example extracellular (outside the cell) extensor (as in muscle to extend across a joint) giant cells Greek intercarpal / intercarpo interphalangeal intertarsal / intertarso joints = articulations Left / Lumbar long bones lower limb aka leg Latin ligament metaphysis metacarpal / metacarpo medial / medula metastasis metatarsal / metatarso nervous system / nerve supply nervous tissue osteoclast phalangeal / phalanges / phalango pl. PLL post. proc prox PS R ROM sing. SC SN SP TP UL V VB VC w/n w/o & = = = = = = = = = = = = = = = = = = = = plural posterior longitudinal ligament posterior process proximinal public symphysis Right range of movement singular spinal cord spinal nerve spinous process transverse process upper limb aka arm vertebra(e) / vein vertebral body vertebral column within without and

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The A to Z of Bones, Joints, Ligaments & the Back

Common terms in Osteology and Skeletal Anatomy


Ablation The removal of part of the body, generally a bony part, most commonly the teeth. Acral in the extremities - bones at the apex or end of limbs. Acromegaly A continuation of growth of the ends of cartilage covered bone (after fusion of the long bones) hence a gross change in the features (most noticeable in the jaw and digits) without growth in height, due mainly to the over activity of the pituitary gland. Ala A wing, hence a wing-like process as in the Ethmoid bone pl. - alae. Alveolus Air filled bone - tooth socket adj. - alveolar (as in air filled bone in the maxilla) - coalescence of alveoli helps in the formation of the sinuses. This device also lightens the weight of the bone particularly the skull. Ankle Bend = angle usually referring to the bend just above the foot, hence the ankle is the joint b/n the foot and the lower leg. Annulus fibrosis The peripheral fibrous ring around the intervertebral disc. Aperture An opening or space between bones or within a bone. Appendicular Refers to the appendices of the axial i.e. in the skeleton, the limbs upper and lower which hang from the axial skeleton, this also includes the pectoral and pelvic girdles but not the sacrum. Areola Small, open spaces as in the areolar part of the Maxilla may lead or develop into sinuses. ArthTo do with joints hence Arthritis Inflammation of a joint.

early disease loss of cartilage inflammation of jt laxity of lig & permanent damage Diseases of the joints. Joint types. Joint, description of the bone surfaces joining w/o the supporting structures = point of contact b/n 2 opposing bones hence the articulation of humerus and scapula is the articulation of the shoulder joint. Attrition Tooth wear and tear. Auditory Pertaining to hearing, hence, pertaining to the ear. (Auditory exostosis = a bony growth on the walls of the External Auditory Meatus). Avulsion Forceable tearing away of a structure or part of a structure as in an avulsed fracture where a fragment bone is torn away from the main bone. Axial Refers to the head and trunk (vertebrae, ribs and sternum) of the body. Ball and Socket Generally referring to a joint which resembles a ball sitting tightly in a socket - very stable, limited range of movement e.g. hip joint. Basilar Relating to the base or bottom of structures. Basiocranium Bones of the base of the skull. A smooth round broad eminence - mainly in the frontal bone female > male. Boss Arthropathy Arthrosis Articulation

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Common terms in Osteology and Skeletal Anatomy See Vargus. Refers to a junction of more than 2 bones in a joint as in the Bregma of the skull, junction between the coronal and sagittal sutures which in the infant is not closed and can be felt pulsating site of the anterior fontanelle. Buccal Pertaining to the cheek. Callus Hard tissue formed in the osteogenic layer of the periosteum as a fracture repair tissue it is replaced over time with compact bone. Calotte The calotte consists of the calvaria from which the base has been removed Calvaria The calvaria refers to the cranium without the facial bones attached. Canal Tunnel / extended foramen as in the carotid canal at the base of the skull adj.- canular (canicular - small canal). Cancellous bone = Trabecular bone A spongy porous bone with spicules (trabeculae) of compact bone. It is found at the ends of long bones and in the bones of the axial skeleton. Red BM is found b/n the spicules. Caput / Kaput The head or of a head, adj.- capitate = having a head (c.f. decapitate) Carotid To put to sleep; compression of the common or internal carotid artery causes coma. This refers to bony points related to the Carotid vessels. Carpo Wrist. Cavity An open area or sinus within a bone or formed by two or more bones (adj.- cavernous), may be used interchangeably with fossa. Cavity tends to be more enclosed, fossa a shallower bowl-like space (Orbital fossa-Orbital cavity). Cavum A cave. Cephalic Pertaining to the head. Cervico Pertaining to the Neck. Clinoid Like a bed-post, part of a four poster bed so that clinoid processes look like bed posts eg. in the Sphenoid bone. Clivus A slope hence in the anterior cranial fossa referring to a slope on the base of the cavity. Cochlea A snail, hence snail-like shape relating to the Organ of Corti in the ear. Compact bone = Cortical bone = Dense bone Bone found in the shafts and on external bone surfaces. Highly structured in concentric circles or Haversian systems. It is constantly changing and remodeling depending upon the lines of force. Concha A shell shaped bone as in the ear or nose (pl. conchae adj.-. chonchoid) old term for this turbinate. Condyle A rounded enlargement or process possessing an articulating surface. Cornu A horn (as in the Hyoid). Corona A crown. adj.- coronary, coronoid or coronal; hence a coronal plane is parallel to the main arch of a crown which passes from ear to ear (c.f. coronal suture). Costa / Costo Pertaining to the ribs. Cranium The cranium of the skull comprises all of the bones of the skull except for the mandible. Crest Prominent sharp thin ridge of bone formed by the attachment of muscles particularly powerful ones eg Temporalis/Sagittal crest. Cribiform A sieve or bone with small sieve-like holes. Ethmoid. Bow-legged Bregma

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The A to Z of Bones, Joints, Ligaments & the Back Cuneate/Cuneus A wedge / wedge-shaped. Dens A tooth hence dentine and dental relating to teeth, denticulate having tooth-like projections adj.- dentate See also odontoid. Depression A concavity on a surface. Detrition Wearing away of the tooth surfaces of OA. Detritus The material left after the wearing away or rubbing. Diaphysis The shaft or body of a long bone. In the young this is the region b/n the growth plates and is composed of compact bone. pl.- diaphyses adj.- diaphyseal. Diplo The cancellous bone between the inner and outer tables of the skull, adj.- diploic. Edentulous Without teeth. Elbow Any angular bend often in the arm, usually referring to the joint b/n the arm and the forearm. Eminence A smooth projection or elevation on a bone as in iliopubic eminence. Endocranium Refers to the interior of the braincase adj.- endocranial divided into the 3 major fossae anterior (for the Frontal lobes) middle (containing Temporal lobes) and posterior (for the containment of the Cerebellum). Endostium A mesodermal CT which lines the inner surface of all bones and is the conduit for the NS and BS of the bone llifting of the endostium causes cancellous bone to be laid down to fill the gap b/n the bone and the cellular layer and this device may be used to encourage bone growth/repair. See periosteum. Epiphysis The end of a long bone beyond the growth plate or epiphyseal plate. = Metaphysis Generally develops as a secondary ossification centre. There are 2 epiphyses to each long bone. In a long bone the shafts are generally compact bone and the ends = epiphyses are trabecular bone pl.= epiphyses adj.- epiphyseal. Ethmoid = Cribiform. External Auditory Ear hole. Meatus Exostosis A bony outgrowth from a bony surface, often due to irritation (as in Swimmers ear) and may involve ossification of surrounding tissues such as muscles or ligaments. Facet A face, a small bony surface (occlusal facet on the chewing surfaces of the teeth) seen in planar joints. Falciform Relating to shapes that are in a sickle shape so falciform ligaments curve around and end in a sharp point. Fissure A narrow slit or gap from cleft. Fontanelle A fountain, associated with the palpable pulsation of the brain as in the anterior fontanelle of an infant. These soft spots on the skull are cartilagenous CT covering joints which allow for skull cranial expansion and then become the mould for the bone development and shape joining along the sutural lines, later becoming the Bregma. Foramen A natural hole in a bone usually for the transmission of BS and/or nerves. pl. foramina. Fornix An arch. Fossa A pit, depression, or concavity, on a bone, or formed from several bones as in temporomandibular fossa. Shallower and more like a

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Common terms in Osteology and Skeletal Anatomy bowl than a cavity. pl. fossae. A small pit (usually smaller than a fossa)- as in the fovea of the occlusal surface of the molar tooth. Fracture = break hence Avulsed fracture - bone break due to a tearing away of part of a bone under stress. Complete fracture - complete break b/n 1 or more bones. Compound fracture - break of a bone where the bone is exposed to the air. Incomplete = Greenstick fracture - where there is an incomplete break along with bending or changing of the bone shape: it is generally seen in in young bones. Pathological fracture - a break which has to do with a disease, generally thinning of the bone for example in osteoporosis or weakening due to a tumour as in osteosarcoma or from other causes as in osteomalacia (Paget's disease) and causes the bone to break with little or no force. Fovea

Normal

Avulsed

Comminuted

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Greenstick = Incomplete Segmental

Longitudinal

Oblique

Pathologic

Spiral

Torsion Torsus

Transverse

Gallus / Galli Genu / genio Gigantism Gomphosis Groove Growth plate A. L. Neill

A cock, hence, crista galli, the cocks comb (i.e. possessive form of gallus). Knee adj.- referring to the knee. Overgrowth of the length of the long bones due to excess growth hormone before the fusion of the long bones (if this occurs after fusion it is acromegaly). Joint b/n the roots of the teeth and the jaw bones pl.- gomphoses. Long pit or furrow. A plate of cartilage b/n the diaphysis and epiphysis to allow growth of 11

The A to Z of Bones, Joints, Ligaments & the Back a long bone. The plate disappears, converting to bone, upon attainment of the full height/length of the bone. Hallux The big toe = the first toe. Hamus A hook hence the term used for bones which hook around other bones or where other structures are able to attach by hooking hamulus = a small hook. Harris lines Lines of increased bone density due to assault. They may occur across the growth plate and arrest growth of the length of the long bone. Haversian canals = secondary osteons = lamellar bone. The system of concentric circles of bone matrix and osteocytes, which continually forms and reforms, during the life of the bone. Hinge joint Joint with movement in one plane e.g. elbow or knee. Hydroxyapetite A dense organic filling; the second component of bone. Hyoid U-shaped. Hyperostosis Abnormal bone growth generally overgrowth or ectopic growth. Incisura A notch. Inter Between. Intra Within. Introitus An orifice or point of entry to a cavity or space. Joint = Articulation + supporting structures. Jugum A bridge between 2 halves of a bone pl. juga as in Sphenoid. Knock-knees See Valgus. Kyphosis Collapse of vertebral body(ies) causing sharp convexity of the spine. Lacerum Something lacerated, mangled or torn e.g. foramen lacerum a small sharp hole at the base of the skull. This often tears tissues. Lacrimal Related to tears and tear drops. (noun lacrima). Lambda From the Greek letter a capital L and written as an inverted V. (adj.lambdoid) and used to name the point of connection b/n the 3 skull bones Occipital and Temporals. Lamellar bone = Haversian system. Bone with sheets of concentric collagen fibres around Haversian canals in compact bone. Lamina A plate as in the lamina of the vertebra, a plate of bone connecting the vertical and transverse spines (pl. laminae). Ligament A band of tissue which connects bones (articular ligaments) or viscera - organs (visceral ligaments). A Ligament is a tie or a connection. L Originally sing. ligamentum pl. ligamenta from ligate or to tie up is generally composed of collagen fibres. See classification of ligaments. Linea A line as in the Nuchal lines of the Occiput/Occipital bone. Lingual Pertaining to the tongue. Lipping Bone projecting over the usual margin, excessive production generally pathological as in osteoarthritis, may interfere with joint movement. Locus A place (c.f. location, locate, dislocate). Lordosis Increased cervical and/ or lumbar curve also called sway back.

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Common terms in Osteology and Skeletal Anatomy Magnum Malleus Mandible Mastoid Maxilla Meatus Large pl. magna. Hammer (as in the ear ossicle). From the verb to chew, hence, the movable lower jaw; adj.- mandibular. A breast or teat shape - mastoid process of the Temporal bone. The jaw-bone; now used only for the upper jaw; adj.- maxillary. A short passage; adj.- meatal as in external acoustic meatus connecting the outer ear with the middle ear. Meniscus Gk. crescent. Mental Relating to the chin (mentum = chin, not mens = mind). Meta An extension of: cf. metacarpal = extension of the wrist. Metaphysis = Epiphysis The slightly expanded end of the shaft of a bone. (pl. metaphysis). Neurocranium The neurocranium refers only to the braincase of the skull. Notch An indentation in the margin of a structure. Nucha The nape or back of the neck adj.- nuchal. Occiput The prominent convexity of the back of the head Occipitum = Occipital bone adj.- occipital. Occulus An eye. Odontoid Relating to teeth, toothlike. See Dens. Ontogeny The development of an individual growth pattern. Orbit A circle; the name given to the bony socket in which the eyeball rotates; adj.- orbital. Orifice An opening. Os A bone or pertaining to bones adj.- osseus. Ossicle A small bone as in the ear ossicles: stapes (stirrup), incus (anvil) and malleus (hammer). Ossification The process of turning something into bone, i.e. from one tissue to another as in cartilagenous ossification from cartilage into bone. Two other forms are primary ossification (in the shaft of the long bone where the bone forms from CT and secondary ossification where the bone has formed and secondary centres develop as at the ends of the long bones). Osteitis Inflammation of the bone. Osteoblasts Bone cells capable of dividing and laying down matrix - baby osteocytes Osteochondroma Bone & cartilagenous tumour benign often arising in the ephyseal plate or line & protrude at right angles, common & asymptomatic. Osteoclasts Multinuclear cells which resorb or phagocytose bone = resorption of bone = Giant cells. Osteocytes Bone cells incapable of dividing but maintain the extracelluar matrix of the bone. Osteogenesis Formation and growth of bone. Osteoclasts Osteocytes

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Osteoma Osteomalacia A. L. Neill

Tumour of the bone tissue. Disease of softening of the bones / Pagets disease. 13

The A to Z of Bones, Joints, Ligaments & the Back Inflammatory disease of the bone due to infection. A thinning of the bones which can result in bone weakness & fracture. Osteosarcoma Malignant tumour of bone tissue. Ostium A door, an opening, an orifice. Otic Pertaining to the ear. Ovale Oval shaped. Palate A roof adj.- palatal or platatine. Parietal Pertaining to the outer wall of a cavity from paries, a wall. Parotid Pertaining to a region beside or near the ear (par - otic) Pars A part of / nearby (adj.- para) Pecten A comb. Perikymata Transverse ridges and the grooves on the surfaces of teeth Periosteum Layer of fascial tissue (connective tissue) on the outside of compact bone not present on articular (joint) surfaces. See endostium. Periostitis Inflammation on the outer surface of the bone. Periostosis Abnormal growth of long bones on their outer surfaces. Petrous Pertaining to a rock / rocky / stoney adj.- petrosal. Phalanx Pertaining to flanks of soldiers - phalanges a row of soldiers used for a row of fingers or toes. Planar joints Joints which allow for sliding across the joint as in the wrist, foot and ribs movement in one plan. Pneumatic Air filled see Classification of Bones. Pollex Thumb. Process A general term describing any marked projection or prominence as in the mandibular process. Prominens A projection. Pseudoarthrosis False or new joint due to the nonhealing of a fracture. Pterion A wing; the region where the tip of the greater wing of the sphenoid meets or is close to the parietal, separating the frontal from the squamous region of the temporal bone. (TERY-on) Alternatively the region where these 4 bones meet. Pterygoid Wing shaped. Pubis Hairy, that part of the hip bone with hair over the surface adj.- pubic pl. pubes. Ramus Branch as in the superior pubic ramus the superior or higher branch of the pubic bone (Pubis). Recess A secluded area or pocket; a small cavity set apart from a main cavity. Rectus Straight - erect. Re-modelling The forming and reforming of bone in its normal growth cycle with the normal bone cells involved: osteoclasts to resorb the old bone to move under the covering layer of fascial cells - osteum: osteoblasts to move into the new cavity: divide and spread out: osteocytes to lay down the matrix in the new bone & give it its strength Retinaculum A device to hold structures in place - generally composed of CT - such as the flexor retinaculum. See Classification of Ligaments. Osteomyelitis Osteoporosis

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Common terms in Osteology and Skeletal Anatomy Form of osteomalacia or bone softening due to Vitamin D deficiency. Elevated bony growth often roughened. Round. An arrow, the sagittal suture is notched posteriorly, making it look like lightning arrows. Scoliosis A deviation from the vertical plane of the Vertebral column laterally (as opposed to exaggeration of vertical curves in kyphosis and lordosis). Sella A saddle; adj.- sellar, sella turcica = Turkish saddle. Sesamoid Grainlike. Sigmoid S-shaped, from the letter Sigma which is S in Greek. Sinus A space usually within a bone, lined with mucous membrane, such as the frontal and maxillary sinuses in the head. A modified BV usually vein, with an enlarged lumen for blood storage & containing no or little muscle in its wall. Sinuses may contain air, venous or arterial blood, lymph or serous fluid depending upon location & health of the subject adj.- sinusoid. Skull The skull refers to all of the bones that comprise the head. SphenoA wedge i.e. the Sphenoid is the bone which wedges in the base of the skull between the unpaired frontal & occipital bones adj.- sphenoid. Spine A thorn adj.- spinous descriptive of a sharp, slender process/protrusion. Splanchocranium The splanchocranium refers to the facial bones of the skull. Stylos An instrument for writing hence adj.- styloid a pencil-like structure. Sulcus Long wide groove often due to a BV indentation. Sustenaculum A supportive structure as in the sustenaculum tali = a structure which supports the Talus in the foot. Suture The saw-like edge of a cranial bone that serves as joint b/n bones of the skull. Symphysis A cartilagenous joint or a growth with bone-cartilage-bone. See Classification of Joints. SynTogether i.e... the close proximity of or fusion of 2 structures. Tight inflexible joints b/n 2 bones little to no movement. Many axial joints Syndesmosis are of this type. Synostosis Fusion of any joints. Synovial joints Any moveable joint with synovial fluid b/n the 2 opposing bones most moving joints are synovial. Talus Ankle (Gk. bend). Ball & Socket Condyloid Hinge Tarsus Pertaining to any bones joining the foot with the leg adj.- tarsal (Gk wickerwork referring to the basketlike structure of the os Pivot Plane Saddle tarsus with its ligaments). Tectum A roof. Tegmen A covering. Rickets Ridge Rotundum Sagittal

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The A to Z of Bones, Joints, Ligaments & the Back Temporal Tendon Tentorium Torus Trabecula Trephination Trochanter Trochlea Tubercle Tuberculum Tuberosity Turbinate Tympanum Ulna Uncus Valgus-Vargus Refers to time and the fact that grey hair (marking the passage of time) often appears first at the site of the temporal bone. T A tie or cord of collagen fibres connecting muscle with bone (as opposed to articular ligaments which connect bone with bone). A tent. Protruberance pl. tori. A little beam i.e. supporting structure or strut pl. trabeculae = spicule. The practice of making an artificial hole in the cranium practiced in many ancient religions used to relieve cranial pressure. Pertaining to a small wheel or disc. In the femur it is a large disc = shaped tuberosity. A pulley that part of the bone or ligamentous attachment that pulls the bone in another direction as in the elbow or the ankle (adj.- Trochlear). A small process or bump, an eminence. A very small prominence, process or bump. A large rounded process or eminence, a swelling or large rough prominence often associated with a tendon or ligament attachment. A childs spinning top, hence shaped like a top. An old term for the nasal conchae. A drum pl. tympani. = Elbow or arm (adj.- ulnar) A hook adj.- uncinate.

Normal Volar Wormian bone Zygoma

For more medical terms in this or other areas see the A to Z of Medical terms.

Pertaining to the palm (hand) or the sole (foot). Extrasutural bone in the skull. A yoke, hence, the bone joining the maxillary, frontal, temporal & sphenoid bones adj.- zygomatic.

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Notes...

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Anatomical position and Anatomical planes


This is the anatomical position.
A = Anterior Aspect from the front, Posterior Aspect from the back, used interchangeably with ventral and dorsal respectively. B = Lateral Aspect from either side C = Transverse / Horizontal plane D = Midsagittal plane = Median plane; trunk moving away from this plane = lateral flexion or lateral movement moving into this plane medial movement; limbs moving away from this direction = abduction; limbs moving closer to this plane = adduction E = Coronal plane F = Median

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Anatomical relations

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The Back

Joint movements of the Neck

neck flexion

neck extension/hyper-extension

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lateral rotation

note: extension of the neck is in the normal anatomical position


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The Back

Joint movements of the Back

flexion of the VC

extension of the VC

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lateral flexion
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rotation of the VC
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Joint movements of the Shoulder

arm/shoulder movements in the coronal plane commencing from adduction abduction to extension

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shoulder/scapula movements in the horizontal plane

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Joint Movements of the Upper Limb & Shoulder

arm extension in sagittal plane / shoulder movement

arm abduction - away from median plane / adduction - towards the median plane -shoulder movement

shoulder extension in the sagittal plane

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shoulder abduction in the coronal plane (with elbow flexion)

wrist extension wrist flexion

shoulder elevation - reverse movement shoulder depression shoulder movement


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Joint Movements of the Hip & Lower Limb

Hip flexion

Hip extension

Hip abduction

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Hip lateral and medial rotation

Hip circumduction

Knee flexion
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Knee extension
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Joint Movements of the Feet & Hands

Foot dorsiflexion

Foot plantar flexion

Foot inversion

Foot eversion

Foot normal position

Fingers extension

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Forearm pronation

Forearm supination

Hand deviation radial/laterally ulna/medially

Fingers abduction Fingers adduction


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Thumb opposition
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Structure of Bone Tissue


Bone is a tissue. It contains osteocytes (mature bone cells -1), osteoblasts (new bone cells -2), osteoclasts (resident monocytes) which may combine to form GIANT cells (3) to remodel bone which occurs constantly. The tissue may be packaged as COMPACT bone = dense bone for major weight-bearing areas as in the Long bones or as CANCELLOUS bone = spongy bone = trabechular bone, which is present in the axial skeleton and at the heads of most Long bones. The density of bone is changing all the time. It is one of the most dynamic tissues in the body constantly forming and reforming its structure. Its repair capacity is extensive, but changes in body demands, diet and disease states will affect its integrity. Loss of bone = Osteoporosis Excess deposition of bone = Osteopetrosis Deposition of bone in ectopic sites = Ossification

COMPACT BONE - A

It is surrounded by an outer fascial layer Periosteum (4) and an inner fascial layer Endostium (5) and has a central cavity filled with Bone Marrow (BM) either filled with fat cells YELLOW BM or haemopoietic tissue (cells related to forming the blood and its component cells) RED BM. The bone is laid down in circular layers or lamellae (6L) with a central core (6c) for the BS, called HAVERSION systems (7).

CANCELLOUS BONE - B
This consists of long trabeculae or spicules of bone laid along pressure lines surrounded by haemopoietic tissue RED BM (8). It is highly mobile; the first to be mobilized for mineral needs or changing body function, and gives support to the compact bone.

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BONES in situ UPPER


1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Frontalis - forehead Zygoma Maxilla upper jaw Mandible lower jaw Clavicle collar bone Humerus arm Manubrium Sternum breastbone Xiphoid process Temporalis Parietalis Occipitalis Atlas - C1 Axis C2 Vertebrae cervical (7) neck Vertebrae thoracic (12) thorax Shoulder joint Elbow joint Scapularis shoulder blade 10th Rib (24 ribs- 12 each side)

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Anterior
1 2 3 4 5 7 8 9

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BONES in situ LOWER


21 22 23 24 25 26 27 28 29 30 31 32 36 37 38 39 40 41 42 43 Radius Ulna Femur thigh bone Patella kneecap Fibula Tibia shin Cuniform bones (3 each foot) Metatasal bones foot bones (5 each foot) Phalanges = digits (14 each foot) Toes / joints Tarsal bones - foot bones (7 each foot) Ankle joint 33 Knee joint 34 Wrist joint 35 Hip joint Os Coxae - Hip bone Sacrum Carpal bones wrist bones (8 each hands) Ischium (part of the hip bone) Navicula ankle bone Talus heel bone Metacarpal bones - hand bones (5 each hand) Coccygeal bones (3-5)

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37 43 42

Anterior

3b 38

39

35

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Classification of Bones
Flat bones Thin flattened and usually curved bones: most Skull bones, Scapula, Manubrium generally surrounded by a layer of compact bone with cancellous or spongy bone in b/n.

Irregular bones Various shapes not easily classified Sphenoid, Vertebrae, Hip, Ear Bones irregular growth centres. Long bones These bones are long with a shaft = diaphysis and 2 ends epiphyses. They have growth centres at each end and grow lengthwise over years via their growth plates at the metaphyses, e.g.: most limb bones: Femur, Fibula Humerus, Radius, Tibia, Ulna, & digits Phalanges. See diagram.

Pneumatic bone/Alveolar bones Bones filled with air to lighten their weight Maxilla, Frontal, Mandible, Ethmoid and bones with sinuses.

Sesamoid bones are completely surrounded by soft tissue w/o joints e.g. Hyoid. small bones around the thumb and big toe. Short bones Sutural bones Roughly cubic in shape. Most wrist Carpal and ankle Tarsal bones; many of the bones at the base of the skull. = Wormian bones are small bones which occur w/in the skull sutures. They are sometimes called extra-sutural if the main part f the bone is outside of the suture. They are unnamed, except the Incus - the largest extra-sutural bone.

There are:

There are:

There are between 600 and 620 bones in the body including the various sesamoid and Wormian bones and other areas where there may be separate or ossified joints. 22 paired skull bones including the ear ossicles / not including the teeth. 5 single bones mainly on the base of the skull. 1 mandible. 1 hyoid. variable sutural & extra-sutural bones (generally between 3-5). 56 digit bones or Phalanges plus an additional 3 to 4 small sesamoid bones in the foot over the big toe and the thumb.

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Each limb has a single long bone proximally (arm and thigh), a hinge joint and 2 bones distally (the forearm and shin) joined by an interosseous upper membrane ligament. Each pair of limbs is supported by a GIRDLE of supporting bones the PECTORAL GIRDLE and the lower PELVIC GIRDLE.

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Structure of a Long Bone


1 2 3 4 5 6 7 8 9 10 11 12 13 joint surface = articular surface = hyaline cartilage joint space joint capsule + periosteum compact bone endosteum BM red & yellow epiphysis head of the bone metaphysis widest part of the shaft BVs entering bone through nutrient foramen neurovascular bundle travelling in 3 diaphysis shaft of the bone cancellous bone bone spicules ossification of growth plate fusion of spicules

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Regional Skeletons
The colours on these skeletons are placed as colour tags at the bottom of the Bone & Joint pages, and indicate their position on the skeleton. green shoulders, upper limbs & hands yellow axial skeleton pink thorax and rib cage blue hips, lower limbs and feet

Anterior

Posterior

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Disarticulated Bones

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Classification and Summary of Joints


definition: joint = any BONE something BONE B+?+B i.e whenever 2 or more bones meet
TYPE OF JOINT GOMPHOSIS STRUCTURE BONE FIBRES TOOTH SYNARTHROSES = BONE FIBROUS JOINT FIBRES BONE eg SUTURE BONE (short fibrous FIBRES connection b/n bones) BONE eg SYNDESMOSIS BONE (longer fibres more FIBRES cartilage) BONE SYNCHONDROSIS = BONE 1 CARTILAGENOUS HYALINEJOINT CARTILAGE (Amphiarthrosis) BONE SYMPHYSIS BONE (20 cartilagenous joint) FIBROCARTILAGE BONE SYNOVIAL (Diarthrosis) MOVEMENT nil EXAMPLES teeth / jaw bone

little / nil

nil

joints in the Skull

little

joints b/n flat bones Tibiofibula joint Radioulna joint

due to the elasticity of the CARTILAGE

eg PLANE eg HINGE eg PIVOT

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BONE HYALINE CARTILAGE SYNOVIAL FLUID HYALINE CARTILAGE BONE

little in all directions may be influenced by HORMONES Full movement type depends upon the shape of the bony surfaces

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1st costal cartilage to the Manubrium rib cartilage Manubriosternum MOST joints in axial skeleton eg b/n VERTEBRAL BODIES b/n Pubic bones MOST joints in the appendicular skeleton, upper limb, lower limb, feet and hand joints

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gliding / sliding one directional

eg CONDYLOID eg BALL & SOCKET

eg SADDLE 38

movement around an axis movement in 2 directions movement in many directions - common hip / shoulder centre movement in 2 planes thumb C-MC joint

costovertebral zygapophyseal elbow / knee / finger / toe atlanto-axial medial joint wrist / ankle

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Classification and Summary of Joints

Synovial Joint
Upper part shows a section through the bone in the joint NORMAL- A Lower part shows an opening onto the joint surface ABNORMAL- arthritic -B

1 2 3 4 5 6 7 8 9 10 11 12

BM red & yellow ligament (bone to bone) bursa bone compact & cancellous skeletal muscle tendon (bone to muscle) attachment fibres (Sharpeys fibres) shaft of long bone joint capsule + periosteum articular (joint) surface / d defect in the surface jt space synovium / h-overgrowth inflammatory reaction 4

A
12 11

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Classification and Summary of Ligaments


definition: a band of tissue connecting bones, viscera or other body structures, may be distinct fibrous bands or fascial folds or nonfunctional remnants of foetal structures

NAME accessory = collateral

DESCRIPTION any helping lig. supporting/strengthening the primary lig. generally used where there are many short bones in a crowded area any circular lig. binding enclosing lig. any curved lig. description of any lig. in front of the named structure (also used to describe those fibres in front of a structure) lig. with 2 insertions

EXAMPLES the: palm (palmar), sole (plantar), phalanges (volar) temporomandibular joint (Henle), humerus and wrist annulus fibrosis annular lig. of the Radius

SHOWN IN hand overview, foot overview, TMJ views, shoulder joint, wrist overview

annular also see retinaculum arcuate anterior

arcuate pubic ligament pelvic girdle overview ANTERIOR LONGITUDINAL LIGAMENT = ALL

bifurcate

collateral = accessory

any helping lig. supporting/strengthening the primary lig. generally used with outer ligs over bigger joints ligaments which cross over

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vertebro-vertebral joints elbow

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craniovertebral jts thoracic cage vertebro-vertebral jts

calcaneocuboid + calcaneonavicular pisio-hamate + pisio-metacarpal radial collat. . lig.

ankle joint-subtalar dorsum of the hand

elbow, knee jts wrist

cruciform

CRUCIATE LIGAMENTS knee jt (of the knee) cruciate ligs of the atlanto-axial jt odontoid jt craniovertebral jts ankle jt

deltoid

ligs which fan out as a D DELTOID LIGAMENT

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The ligaments included in this book are those associated with the musculoskeletal system, bones and skeletal muscles. Tendons which join muscle to bone are not discussed nor are other ligamentous structures such as the aponeuroses or ligaments of organs such as the Hepatic ligaments.
NAME flava DESCRIPTION ligs with large amounts of elastic fibres hence yellow in colour EXAMPLES LIGAMENTUM FLAVA SHOWN IN vertebra-vertebro jts

interarticular ligs which enter the (may also be synovium and are inside called synovial) the joint inter-osseous ligs which span across 2 bones for a considerable length - deep ligs acting as a surface for muscle attachment

long head of Biceps shoulder jt cruciate ligs of the knee knee jts acetabular lig. hip jt

inter-spinous

long ligs which attach 2 bones interspinous over long distances acting as an extended surface for muscle attachment - more supf than the inter- ligs

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ligs which are b/n 2 spines INTERSPINOUS deep ligs acting as a LIGAMENTS surface for muscle attachment.

an

interosseous membrane forearm radioulna jts lower leg tibiofibular jts of the forearm interosseous membrane of the lower leg OBTURATOR LIG. pelvic overview

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SUPRASPINOUS LIGAMENTUM NUCHAE SACROSPINOUS SACROTUBEROUS INGUINAL LIG

vertebro-vertebral jts craniovertebral jts pelvic girdle overview sacrum pelvic girdle vertebro-vertebral jts

description of any lig. POSTERIOR behind the named structure LONGITUDINAL (also used to describe LIGAMENT = PLL those fibres of a lig. behind a structure) lig. which fans out (smaller radiate lig. of the rib deltoid shape)

radiate synovial = interarticular

thoracic cage, costovertebral jts

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The Bones, Joints and Ligaments


This is the order of the illustrations in the book. When beside the name of a structure there is a listing - (see XYZ) it will be listed at the site XYZ, which may also refer to its alternative name; when beside a structure there is a listing - (also see XYZ) further information about that structure will be at the site for XYZ, but it will be present in the order listed site as well; this includes structures listed in the BACK section. Bones are listed in BLACK; Joints are listed in DARK YELLOW & ligaments when referred to separately are listed in ORANGE. Generally ligaments will be referred to in joint diagrams and not listed or demonstrated in separate diagrams. Overviews of regions are listed in MAROON (DARK RED). Acetabular joint (see HIP JOINT) Acromioclavicular articulation & joint ANKLE BONE (see Talus - (biggest of the Tarsal bones aka Tarsus)) ANKLE JOINT = Talocrural joint = Talus + Tibia + Fibula = Subtalar joints = Talus + Calcaneus + Os Tarsus ARM = Upper limb = Humerus + Radius + Ulna (see Humerus) Atlas (C1 ) - (Vertebra - cervical) also see the Back Atlanto-Axial joints (C1/C2) Atlanto-Occipital joint (see Craniovertebral joint) Axial-Occipital joint (see Craniovertebral joint) Auditory Ossicles (see EAR BONES overview) Axis (C2) - (Vertebra - cervical) also see the Back BACK See end of this section the Back = Vertebral Column. BREAST BONE (see Manubriosternum) Calcaneus (aka HEEL) Capitate (see Carpus disarticulated, also Hand & Wrist overview) Carpus - carpal bones wrist (Os Carpus = Wrist bones) articulated see Hand & Wrist overview individual bones 1st row - Trapezium, Scaphoid, Lunate, Triquetral, Pisiform, 2nd row - Trapezoid, Capitate, Hamate Carpus - disarticulated Carpo-Metacarpal joints (see HAND and WRIST joints) CHEEK BONES (see Zygoma) CHIN (see Mandible) CHEST OVERVIEW (Thoracic cavity) (also see Pectoral Girdle) Clavicle (aka COLLAR BONE) Coccyx -Os coccygis (also see Sacrum) Collar bone (see Clavicle)

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Costovertebral articulations & joints (RIB & SPINAL joints) Costovertebral articulations of atypical ribs 1 & 2 (see Ribs Atypical) Cranial Fossae (see Skull internal views) Craniovertebral joints (HEAD/SPINE joints aka Atlanto-Occipital joints & Axial-Occipital joints) also see the Back Cuboid (ankle) Cuneiforms (foot) 1st - medial cuniform, 2nd intermediate cuniform, 3rd lateral cuniform EAR BONES overview ELBOW - articulation, joint (humero-ulnar) Ethmoid bone Femur (upper leg bone) aka THIGH bone aka LEG bone Fibula (lower leg lateral bone part of the SHIN) FINGERS articulation overview ((see Hand and Wrist bones overview) FINGER JOINTS = interphalangeal joints + MCP joints FOREARM (see Radius, Ulna) FOREHEAD (see Frontal bone) FOOT BONES (tarsal + metatarsal + phalanges) overview (see also Metatarsals) FOOT JOINTS - aka Intertarsal joints Frontal bone (aka FOREHEAD) Glenohumeral joint (see SHOULDER JOINT) Hamate (see Carpus disarticulated, also Hand & Wrist) HAND (and WRIST bones) overview Carpal, Metacarpal bones and Phalanges - articulations HAND BONES (see Metacarpals disarticulated) HAND JOINTS intercarpal joints = IC joints Carpometacarpal, intercarpal joints = C-MC, IC joints HANGING joint (see Atlanto-Axial median joint) also see the Back HEAD/SPINE JOINTS (see Craniovertebral joints) also see the Back HEEL (see Calcaneus) Hip (aka Os Coxae - Innominate) HIP ISCHIUM, ILIUM, PUBIS overview HIP joint (also see PELVIC GIRDLE Sacrum) HIPS (also see PELVIC GIRDLE) Humeroulnar joint (see ELBOW joint) Humerus = ARM bone (upper arm bone) Hyoid Inferior Nasal Concha (also see Nasal Bones & Cavity) Innominate (see HIP) Interphalangeal joints of the Foot = TOES Interphalangeal joints of the Hand (see FINGER joints) Interphalangeal joints = TOES (see FOOT joints)

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Ischium (see HIP) JAW (see Mandible) Knee articulations KNEE CAP (see Knee articulations) aka Patella KNEE JOINTS (Tibiofemoral + [Tibiofibular]+ Femoropatellar + Tibiopatellar) Lacrimal (see inf Nasal Concha) Larynx overview (aka VOICEBOX) LEG = Lower limb = Femur + Patella +Tibia + Fibula Lunate (see Carpus disarticulated, also hand & wrist) Mandible (aka JAW aka CHIN) Mandibular joint (see Temporomandibular joint) Manubriocostal joints (see Sternocostal joints) Manubriosternum = Manubrium + Sternum + Xiphoid process aka BREAST BONE Manubrium (see Manubriosternum) Maxilla (aka UPPER JAW) Metacarpals aka HAND BONES (see Hand & Wrist overview) Metacarpal Individual views - disarticulated 1st - the thumb / 2nd - the index / 3rd - the middle 4th - the ring / 5th - to the little finger Metatarsals (bones b/n the ankle & the toes) aka FOOT BONES see overview Metatarsals (individual views) disarticulated 1st (bone to the big toe) / 2nd (bone to the second toe) 3rd / 4th / 5th (bone to the little toe) Nasal bones and cavity = NOSE Navicular (ankle) NOSE (see Nasal Bones & Cavity) Occipital bone / Occiput Odontoid Joint (see Atlanto-Axial median joint) Os Coxae (see HIP bone) Palantine bones / Palate Parietal bone Patella = aka KNEE CAP (see Knee articulations) Pectoral girdle = articulations PELVIS = HIPS (see Pelvic girdle) Pelvic girdle = HIPS (also see Hip) Phalanges = FINGERS / TOES (see Hand and Foot overviews) Pisiform (see Carpus disarticulated, also Hand & Wrist bones overview) Pubic Symphysis = Pubic joint (also see Pelvic girdle) Pubis (see HIP) Radiocarpal joint see WRIST JOINT

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Radioulnar joints (also see ELBOW) Radius (aka FOREARM) RIB CAGE overview (see Chest overview) RIB JOINT (see costo-vertebral joints) Rib atypical - ribs 1, 2 Ribs typical - ribs 3 - 10 Sacroiliac joint also see the Back Sacrum (lower BACK BONE) also see the Back Scaphoid (see Carpus disarticulated, also Hand & Wrist) Scapula (aka SHOULDER BLADE) SHIN (see Tibia) SHOULDER JOINT (aka Glenohumeral joint) Sinus overview (see Skull Internal views - coronal) Skull External Views and Internal Views Sphenoid SPINE overview see the Back SPINAL JOINTS see the Back Sternoclavicular joints Sternocostal joints Sternum (see Manubriosternum) Talus (aka Tarsus aka ANKLE) Teeth overview Temporal bone (aka TEMPLE) Temporomandibular joint (aka TMJ) Thoracic cavity (see CHEST overview) Tibia (aka lower leg bone aka SHIN - shin bone)) Tibiofemoral joint (see KNEE which includes this joint) Tibiofibula joints TOES = digits = phalanges (see Foot bones overview) Trapezium (see Carpus disarticulated, also Hand & Wrist overview) Trapezoid (see Carpus disarticulated, also Hand & Wrist overview) Triquetral (see Carpus disarticulated, also Hand & Wrist overview) Ulna (aka FOREARM - also funny bone) Vertebrae, Vertebral Column and Vertebral joints see the Back VOICE BOX (see Larynx) Vomer Wrist bones (see Carpal bones disarticulated also Hand & Wrist overview / Metacarpal bones) Wrist joint (aka radiocarpal joint) Xiphoid (see Manubriosternum) Zygapophyseal joints see the Back Zygoma (aka CHEEK BONES) see the Back

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Lesion
well delimited, areas of rarefaction; painful extreme cellularity & variability, polyhedral cells, GC, glycogen, reticulin begins in the cavity of diaphysis of a LB expands & thins cortex mature lobules of cartilage hypocellular lobules with intersecting bands spindle cells, OC mature fibroblasts, abundant collagen

age M:F range Microscopic features

features / Bones in order of frequency greatest to least site in the bone tissue X-ray appearance

dense mature lamellar bone sharply delineated centre: osteoid lined by plump osteoblasts, w/o inflammation sharply delineated centre: osteoid lined by plump osteoblasts, w/o inflammation cap of cartilage covered by a membrane continuous with the periosteum

Chondroblastoma

10-25

2:1

Femur, Humerus, Tibia, Feet, Pelvis, Scapula heads of these bones

Hands & Feet, Ribs, Femur, Humerus medulla of LBs sharply defined, may be large

Chondroma

10-40

1:1

Chondromyxoid fibroma lytic / honeycombed

10-25

1:1

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Haemangioma

20-50

1:1

Skull, VBs, Mandible medulla

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Osteoma lucent centre <15mm peripheral sclerotic reaction; painful

40-50

2:1

skull & facial bones

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Desmoplastic fibroma

20-30

1:1

Humerus, Tibia, Pelvis, Mandible, mur, Scapula ends of shafts of LBs

sunburst trabeculation 2 to periosteal levation thick walled lattice pattern of cavernous spaces

may protrude inside a paranasal sinus

Osteoid osteoma

10-30

2:1

femur, tibia, humerus, hands & feet, vertebrae, fibula cortex of LB

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Osteoblastoma

10-30

2:1

VBs, Tibia, Femur, Humerus, Pelvis, Ribs medulla of LBs

larger centre, absent reactive bone; not painful

Osteochondroma thin cortex

10-30

1:1

Femur, Tibia, Humerus, Pelvis cortex of LBs

grows out opposite to adjacent joint

BENIGN BONE LESIONS

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Solitary bone cyst

10-20

3:1

Humerus, Femur


Microscopic features
as per lymphoma elsewhere range of differentiation: cartilaginous matrix, lack of direct bone formation cords and lobules; physaliferous cells 22-50%
low 78% mod 53% high 22%

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Lesion
bone production & destruction over a wide area

features / age M Bones in order of frequency range :F greatest to least site in the bone tissue X-ray appearance

Behaviour 5yr survival

acute & chronic lymphomas osteolytic with splotchy calcification

30-60 1: Femur, Pelvis, VBs, Tibia, Humerus, Mandible, 1 Skull, Ribs medulla of shafts of LBs

Chondrosarcoma 30-60 3: Pelvis, Ribs, Femur, Humerus, VBs cortex 1 of LBs medulla of central axial bones osteolytic, rarely osteoblastic

MALIGNANT BONE LESIONS

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Chordoma

40-60 2: Sacrococcygeal, Spheno-occipital, 1 cervical VBs

malignant, 48% Mets 20-30% 28% 50% recur, 10% Met

Ewings sarcoma/PNET

5-20

1: Femur, Pelvis, Tibia, Humerus, Ribs, 2 Fibula; Mets to lung, pleura, other bones medulla of shafts of LBs

cortical thickening with widening sheets of cells with fibrous strands, of the medullary canal; reactive pseudorosettes, glycogen periosteum as per soft tissue, no tumour osteoid stromal cells, GCs

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Fibrosarcoma

20-60 1: Femur, Tibia, Mandible, Humerus 1 medulla in LBs

osteolytic soap-bubble

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Giant cell tumour lytic expansile lesion w/o sclerosis or a periosteal reaction

20-40 4: Femur, Tibia, Radius heads of these 5 bones

lytic expansile lesion w/o sclerosis or a periosteal reaction

20-60 1: Ribs, Skull, Mandible, VBs, Pelvis, soft Mesenchymal chondrosarcoma 1 tissues shafts of LBs

dimorphic: well-differentiated cartilage with v poor Px undifferentiated stroma

Osteosarcoma

10-25 3: Femur, Tibia, Humerus, Pelvis, Jaw, 2 Fibula medulla of LBs

Codmans triangle; metastasizes osteoid produced by tumour cells w/o to: lung, bone, pleura, heart intervening cartilage

20%

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Plasma cell myeloma

40-60 2: VBs, Pelvis, Ribs, Sternum, Skull 1 medulla of LBs

diffuse always fatal

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A Acromio-Clavicular articulation & joint =

part of the pectoral girdle


anterior (ribs cut away) BS suprascapular artery, thoracoacromial artery NS suprascapular, lat. pectoral Ns (C5-C6)

Movements associated with scapula: elevation / depression, protraction/retraction, rotation 1 2 Acromion Coracoid process of Scapula

1A Aromio-Clavicular lig. 2A Coraco-Acromial lig.

2B Coraco-Clavicular lig.- Trapezoid part 2C Coraco-Clavicular lig. - conoid part 3 4 5 6 supra-scapula notch 3A supra-scapular lig.

Clavicle - sternal end

Clavicle - acromial end

Acromio-Clavicular art.

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A ANKLE JOINT = Talocrural joint


medial / lateral / posterior BS ant. tibial & peroneal arteries NS deep peroneal (=ant. tibial), tibial (L4-S2) A dorsiflexion plantarflexion 1D Tibio-Calcaneal (deep) lig. 2D Tibio-Navicular lig. 3D Tibio-Calcaneal lig. 4D Tibio-Talar (deep) lig. 5 6 7 8 9 ant. Talo-Fibular lig. Tibio-Talar lig. Tibio-Fibular lig. post. Talo-Fibular lig.

Talo-Fibular lig. - tibial fibres

10 Calcaneo-Fibular lig. 11 Talonavicular lig.

*D = all parts of the DELTOID lig. -from TIBIA to ankle bones in a D shape

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3D 8 5 2D

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A ANKLE JOINTS lower = SUBTALAR joints


lateral / medial BS* anastomotic network around jts from ant. post. tibial arteries, dorsalis pedis, peroneal arteries NS medial lateral plantar Ns (L4-S3) A inversion eversion (foot) gliding and rotation (subtalar joints individually) 1 2 3 interosseous Talo-Calcaneal lig. cervical lig. Talo-Navicular lig.

4B* lat. Calcaneo-Navicular lig. 5B* med. Calcaneo-Cuboidal lig. 6 7 8 9 long plantar lig. lat. Talo-Calcaneal lig. subtalar jt

med. Talo-Calcaneal lig.

10 Talo-Calcaneo-Navicular jt

11 Spring lig. / plantar Calcaneo-cuboidal lig. 12 short plantar lig. B* = BIFURCATED lig. (2 heads) also called Bifurcate lig.

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A Atlas = C1 = First Cervical Vertebra


anterior / superior
(Atlas - Gk demigod who held up the world on his shoulders).

Articulations: Atlanto-Axial jts (3) Atlanto-Occipital jts (2) Special features no vertebral body no spinous process no articular discs

C1-C2 C1-Occiput (Base of the skull) special anterior facet for dens (odontoid process)

1 Facet for odontoid / dens process 2 Ant. tubercle 3 Superior articular facet 4 Inferior articular facet 5 Posterior tubercle 6 Posterior arch

7 Groove for vertebral BVs & suboccipital N 8 Foramen transversarium = transverse foramen 9 TP

10 Lat. mass 11 Vertebral foramen 12 Ant. arch

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A Atlanto - Axial joint - median =

ODONTOID JOINT aka hanging joint


BS spinal branches of vertebral art. NS spinal Ns dorsal rami (C1-2) A rotation, circumduction

Atlanto-Axial joints - lateral = zygapophyseal joints of C1/C2


BS spinal branches of vertebral art. NS spinal Ns dorsal rami (C1-2) A 1 2 3 4 5 6 7 8 9 10 11 12 flexion, extension, lateral flexion, rotation

Dens = odontoid process (C2) Transverse lig of axis (C2) Transverse foramen of atlas C1 Medial tubercle of atlas (C1) Tranverse foramen of axis (C2) Post arch and tubercle of atlas (C1) Lamina and spine of axis (C2) Body of axis (C2) Superior articular facet of atlanto-occipital jt Ant. arch of atlas (C1) Facet for dens (C2) Ant. tubercle of atlas (C1)

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Atlanto-Occipital joint (see Craniovertebral joint)

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A Axis = C2 = Second Cervical Vertebra


anterior / superior
(Axis - pivot for movement of the head, all movements but nodding)

Articulations: Atlanto-Axial jts (3) vertebro-axial Axial jts (2) (Base of the skull) Special no vertebral body features dens/odontoid process no articular discs 1 2 3 4 5 6 7 8 9 10 11 12 13

C1-C2 C1-Occiput Dens acts as an AXIS for rotation at C1

Dens = odontoid process (tooth) Attachment of alar ligament Groove for transverse ligament Pedicle Body Vertebral foramen Spinous process Lamina Inferior articular process Transverse process Transverse notch / foramen (if closed) Superior articular facet Facet for odontoid / dens process

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CHEEK BONES (see Zygoma) CHIN (see Mandible)

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Calcaneus = Os Calcis = Heel bone


lateral / medial / inferior / superior

(Calcaneus - large quadrangular bone at the back of the Talus - largest of the Tarsal bones/Os Tarsus i.e. foot bones)

Articulations: 3 articular surfaces Calcaneo-navicular for the Os Tarsus Calcaneo-talus (tarsal bones) Calcaneo-cuboid 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Sulcus Calcanei = Calcaneal sulcus middle articulation surface with foot bones / Os Talus anterior articulation surface with foot bones / Os Tarsus peroneal trochlea attachment for the calcaneofibular ligament posterior surface posterior part of the joint surface for the Talus groove for Flexor Hallicus Longus Sustenaculum Tali articular surface for Cuboid medial process Calcaneal tuberosity lateral process Peroneal tubercle

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Carpus = Carpal Bones = WRIST BONES & Metacarpus - Metacarpals - HANDBONES C Overview - ARTICULATED
dorsal / palmar
(Carpus = Os Carpus = wrist bones = 2 rows of bones between the fingers and the forearm)

1st row 2nd row trapezium, scaphoid, lunate, trapezoid, capitate hamate triquetral, pisiform, 1 2 3 4 5 6 7 8 9 10 11 12 13 Triquetral Capitate Lunate Trapezoid Scaphoid Trapezium Metacarpals = MC head of 5th MC shaft of 5th MC base of 5th MC Hamate Pisiform Hook of Hamate

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Carpus = Carpal Bones = WRIST BONES Overview - DISARTICULATED


C Capitate / Hamate / Lunate / Pisiform / Scaphoid dorsal / palmar
These bones allow for small gliding movements in the hand in several directions to increase the mobility of the fingers

Capitate = Os Capitus Hamate

A B

small cap-like bone in the wrist - consists mainly of articulating facets bone in the shape of a hammer with hook process which attaches to the flexor retinaculum

Lunate = Os Lunatus Scaphoid

small moonshaped bone of the wrist consists mainly of articulating facets boat shaped bone, most lateral and proximal in the Carpus large pivotal bone similar to the Navicular in the foot - forms part of the attachment of the flexor retinaculum

Pisiform - smallest carpal bone - sesamoid bone


attaches to the flexor retinaculum

1 2 3 4 5 6 7 8 9

articulation surface for Lunate palmar surface facet for 3rd MC facet for 4th MC articulation surface for Hamate articulation surface for Scaphoid facet for Trapezoid facet for 2nd MC dorsal surface

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10 facet for Triquetral 11 Hamulus - hook of the Hamate 12 articulation surface for Capitate 13 facet for the 5th MC 14 facet for Radius 15 facet for Trapezium 16 tubercle

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Carpus = Carpal Bones = WRIST BONES Overview - DISARTICULATED


C Trapezium / Trapezoid / Triquetral
dorsal / palmar
These bones allow for small gliding movements in the hand in several directions to increase the mobility of the fingers

Trapezium = Os Trapezius (Lt - greater multi-angular) F


medium-sized irregular bone with large saddleshape articulation for the thumb often broken in trauma

Trapezoid (Lt lesser multi-angular)


2nd smallest carpal bone - irregular bone

Triquetral
irregular bone of the wrist articulates with the Pisiform

1 2 3 4 5 6 7 8 9 10 11

articulation surface for Lunate articulation surface for Pisiform articulation surface for Hamate tubercle facet for 1st MC articulation surface for Scaphoid articulation surface for Trapezoid facet for 2nd MC articulation surface for Capitate dorsal surface palmar surface

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CHEST - overview
C ARTICULATIONS
anterior synovial joints
RIB 1 with Manubrium see STERNO-COSTAL jt RIB 2 with the Manubrium & Sternum see STERNO-COSTAL jt RIBS 3-6 (true ribs) with the Sternum directly

Thoracic cavity

cartilagenous joints

RIBS 7-10 (false ribs) with Sternum via costocartilagenous ridge RIBS 11-12 (floating ribs) do not articulate anteriorly

20 fibrocartilagenous joints - ossify with age


Manubrium with Sternum Sternum with Xiphisternum

posterior planar synovial joints

EACH RIB with the same VB and the one above medially + with the TP of the VB laterally

SPECIAL FEATURES

UPPER 6 ribs - pump movement -up & down LOWER 4 ribs - bucket handle movement -up and out & down and in LOWEST 2 ribs - DO NOT MOVE with respiration - anchor the DIAPHRAGM upper border = thoracic inlet = 1st rib + clavicle +manubrium + VB lower border = thoracic outlet = Xiphisternum + 12th rib + VB

1 2 3 4 5

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1st rib Clavicle acromion (Scapula) Humerus 5th rib

Manubrium Sternum Xiphoid process 12th rib L1 VB

See also Pectoral Girdle

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Clavicle = COLLAR BONE


C
inferior / anterior Articulations: with Manubrium with acromion proximally (Scapula) distally sterno-clavicular jt acromio-clavicular jt 1 2 3 4 5 6 7 8 9 Sternal end of Clavicle facet for first costal cartilage groove for subclavian artery conoid tubercle acromial end of Clavicle trapezoid line (oblique ridge) impression for costoclavicular lig superior surface anterior surface

Coccyx = Os Coccygis
anterior / posterior

(Coccyx = Small tail bones at the base of the spine - functions as an anchor for many regional muscles and ligaments = the vestigial tail looks like a cuckoo's bill)

Articulations: with each other 3-5 bones with the sacrum superiorly Special less features inferiorly after features: S1 no pedicles, laminae or spinous processes Variable Shape/Morphology

1 2 3 4

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S1-3/5 average 4 sacro-coccygeal may fuse with sacrum late in life


looks like the bill of the cuckoo

rudimentary superior articular surface = cornua body of coccyx (Co1) fused bodies (Co3-5) - intervertebral discs TP

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Costovertebral joints = RIB/SPINE joints


articulations-superior / joints-superior

(Costovertebral joints = 3 joints in each typical rib, 2 with the bodies of the vertebrae, 1 with the transverse process of the respective thoracic vertebra)

BS posterior intercostals - spinal branches of the thoracic Aorta NS posterior intercostals Ns spinal branches (C8,T1-12) A gliding in inspiration upper 6 elevation (pump handle) lower 4 eversion (bucket handle) lowest 2 no movement

Articulations: with VB 2 demi-joints eg RIB 3 articulates with T2,T3 VB with the TP of the equivalent vertebra eg RIB 3 with T3 1 2 3 4 5 6 7 8 9 10 11 12 13 14

articular facet for the (TP) transverse process tubercle of rib articular part of rib neck of rib facet on the head of the rib superior demi-facet on the base of the VB articular capsule of the costotransverse jt costotransverse lig. joint capsule intervertebral disc inner - nucleus pulposis intervertebral disc outer - annulus fibrosis intra-articular lig. superior costotransverse lig. lat. costotransverse lig.

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demifacets on the bodies of 2 adjacent vertebrae & their connecting disc transverse costovertebral jt = costotransverse jt

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Costovertebral joints = RIB/SPINE joints


articulations, joints / lateral

(Costovertebral joints = 3 joints in each typical rib, 2 with the bodies of the vertebrae, 1 with the TP of the respective thoracic vertebra)

BS posterior intercostals - spinal branches of the thoracic Aorta NS posterior intercostals Ns spinal branches (C8,T1-12) A gliding in inspiration upper 6 elevation (pump handle) lower 4 eversion (bucket handle) lowest 2 no movement Articulations: with VB 2 demi-joints eg RIB 3 articulates with T2,T3 VB with the TP of the equivalent vertebra eg RIB 3 with T3 1 2 3 4 5 6 7 8 9 10 11 12 13

articular facet for TP superior demi-facet on the base of the VB VB = vertebral body radiate lig. ALL = anterior longitudinal lig. intervertebral disc intra-articular lig. head of rib angle and shaft of rib paired synovial joints planar with demi-facets superior costotranverse lig. spine of thoracic vertebra superior costo-demi-facet on inferior aspect of VB

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Craniovertebral joints = HEAD/SPINE joints


anterior - looking onto the anterior surface of the cervical spine

(made up of median and lateral Atlanto-Occipital (C1/head) and AxialOccipital joints (C2/head) joints)

BS vertebral arteries NS medial branches of dorsal rami, recurrent laryngeal spinal branches of ventral rami (C1-3) A 1 2 3 4 5 6 7 8 9 10 11 flexion/extension, lateral flexion, rotation

basilar of Occiput - cut through jugular foramen (TF of the base of the skull) mastoid process TP of C1 ALL = anterior longitudinal lig. attached to tubercle of C1 intervertebral disc C2/C3 ALL C2/C3 zygapophyseal joint (L) capsule of the lat. atlanto-occipital joint capsule of the lat. atlanto-axial joint ant. atlanto-occipital membrane

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Craniovertebral joints = HEAD/SPINE joints


lateral

(made up of median and lateral Atlanto-Occipital (C1/head) and AxialOccipital joints (C2/head) joints)

BS vertebral arteries NS medial branches of dorsal rami, recurrent laryngeal spinal branches of ventral rami (C1-3) A 1 2 3 3A 4 5 6 7 7A 8 9 10 11 12 13 14 flexion/extension, lateral flexion, rotation

basilar of Occiput tectorial membrane ant. atlanto-occipital membrane leads to 3A ALL ALL apical lig. of Dens ant. arch of Atlas C1 Dens of C2

15 16 17 17A
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longitudinal band of cruciform lig. superior (becomes 7A) longitudinal band of cruciform lig. inferior C2/C3 intervertebral disc body of C3 PLL lamina of C2 transverse lig. of atlas (C1) post. atlanto-axial lig. post. arch of C1

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Craniovertebral joints = HEAD/SPINE joints


posterior internal - looking into the back of the vertebral canal

(made up of median and lateral Atlanto-Occipital (C1/head) and AxialOccipital joints (C2/head) joints)

BS vertebral arteries NS medial branches of dorsal rami, recurrent laryngeal spinal branches of ventral rami (C1-3) A 1 2 3 4 5 6 7 8 flexion/extension, lateral flexion, rotation jugular foramen transverse process of Atlas tectoral membrane capsule of zygapophyseal joints C2/C3 intervertebral disc

3A PLL

longitudinal band of cruciform lig. inferior capsule of lat. joint of C1 C2 transverse band of cruciform lig. over the deeper stronger transverse lig. of the Atlas (C1) alar lig.*

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10 capsule of lat. atlanto-occipital jt 11 longitudinal band of cruciform lig. superior


*broken in hanging

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Cuboid = part of Os Tarsus / bones of the foot


C lateral / medial
(Cuboid = large cubic bone of the tarsal bones b/n calcaneus and the 4th and 5th metatarsals, has a tuberosity and groove to support the passage of peroneus longus tendon of the foot)

Articulations: with Calcaneus posteriorly with 4th and 5th MTs anteriorly Special cuboid shape with features large tuberosity on the inferolateral surface 1 2 3 4 5 6 7 8 9

cubo-calcaneal cubo-metatarsal joints underneath and to the side

facet for lateral cuniform facet for Navicular facet for Calcaneus facet for 4th MT dorsal surface lateral surface facet for 5th MT groove for peroneus longus tendon facet on tuberosity for sesamoid bone in the tendon

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Cuneiform bones - wedgeshaped


C
1 Medial Cuneiform = 1st Cuneiform 2 Intermediate Cuneiform = 2nd Cuneiform 3 Lateral Cuneiform = 3rd Cuneiform part of Os Tarsus / bones of the foot Lateral / Medial
There are 3 + 1 bones in the middle layer of the foot, broadening the sole from the heel for better weightbearing and balance. The Cuboid is the biggest and most lateral of the Cuneiform bones and spans across 2 layers.

Medial / 1st = the largest Cuneiform, kidney shaped at the base for the 1st MT

Intermediate / 2nd = the smallest Cuneiform - articulates with Cuneiforms on both sides

Lateral / 3rd

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EAR BONES = Auditory Ossicles


in situ
middle ear / INCUS, MALLEUS & STAPES

1 2 3 4 5 6 7 8 9 10 11 12 13

Head of malleus Body of incus Short process of incus Ant. malleolar process Post. crus of stapes Base of stapes Ant. crus of stapes Long. process of stapes Lenticular process of incus Handle of malleus Ant. process of malleus Neck of malleus Lateral malleolar process

cochlea / labyrinth

21 Ant. semicircular canal 22 Ant. bony ampulla 23 Elliptical recess 24 Spherical recess 25 Cochlea 26 Cupola of cochlea 27 Base of cochlea 28 Oval window - fenestra vestibuli 29 Post. bony ampulla 30 Round window - fenestra cochlea 31 Lat. semicircular canal 32 Post. semicircular canal 33 Lat. bony ampulla

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ELBOW joint / humero-ulnar


articulation, anterior / posterior
Extended (Elbow joint - hinge joint b/n the Ulna and the Humerus only one dimensional movement)

E BS anastomoses around jt from brachial, profunda


brachii, radial & ulnar arteries NS musculocutaneous, radial, ulnar & median Ns (C5-7) A flexion and extension - elbow supination pronation proximal & distal radioulnar jts at the wrist

Articulations: hinge jt Ulna hinge jt and Humerus inferior is the proximal pivot jt radio-ulnar joint 1 2 3 4 5 6 7 Humerus Radius Ulna head of Radius neck of Radius Trochlea of Humerus Olecranon of Ulna

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ELBOW joint / humero-ulnar


joint, lateral / medial
Flexed (Elbow joint - hinge joint b/n the Ulna & the Humerus only one directional movement)

E BS anastomoses around jt from brachial, profunda


brachii, radial & ulnar arteries NS musculocutaneous, radial, ulnar & median Ns (C5-7) A flexion and extension - elbow supination pronation proximal & distal radioulnar jts at the wrist hinge jt pivot jt

Articulations: hinge jt Ulna & Humerus inf. is the proximal radio-ulnar jt 1 2 3 4 5 6 7 8 9 10 11 12 13

radial collateral lig. annular lig. (covering the head of the Radius) radial tuberosity interosseous membrane oblique cord supinator crest of Ulna articular capsule lat. epicondyle of Humerus ant. band of ulnar collateral lig. medial epicondyle post. band of ulnar collateral lig. Olecranon of ulna oblique band of ulnar collateral lig.

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Ethmoid bone
anterior / lateral / medial / superior
(Ethmoid = sieve light spongy cubic bone sitting b/n the 2 orbital cavities).

Ethmoidal labyrinth containing air cells (part of the Ethmoid sinus) continuous with the Sphenoid sinus 2 Crista Galli 3 Orbital plate of Ethmoid bone (part of the Orbital cavity) 4 Middle Nasal concha 5 Jugum of Sphenoid - Jugum Sphenoidale (Bridge connecting the 2 wings of the Sphenoid bone) 6 Perpendicular plate of the Palatine bone 7 Uncinate process 8 Ala (of Crista Galli) 9 Anterior groove (on the Ethmoid) 10 Posterior groove (on the Ethmoid) 11 Cribiform plate (entrance for the Olfactory nerve) 12 Vomer

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anterior

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Femur = Thigh bone aka LEG BONE


anterior / posterior
(Femur = is the longest, heaviest and strongest bone in the body)

Articulations: with acetabulum with the hip superiorly / proximally with patella and tibia with the knee distally and only 1 bone of the lower leg 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 greater trochanter fovea on the head head of the femur neck of the femur intertrochanteric line lesser trochanter shaft of the femur adductor tubercle medial epicondyle medial condyle lateral condyle lateral epicondyle patella surface of the femur trochanteric fossa intertrochanteric crest spiral line linea aspera medial supracondylar line intertrochanteric fossa popliteal surface lateral supracondylar line quadrate tubercle gluteal tuberosity

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Fibula = lower leg bone aka part of the SHIN


anterior / posterior
(Fibula = is a long thin lateral bone of the lower leg incidental at the knee joint pivotal at the ankle)

Articulations: with Tibia superiorly Tibiofibular jt not the knee with Talus distally Talofibular jt lateral lateral malleolus side 1 2 3 4 5 6 7 8 9 10 11 12 styloid process articular facet for Tibia head of Fibula lateral surface lateral border anterior border posterior surface interosseus border medial surface Tubercle between articulations fossa for lateral malleolus fossa for Tibia (distal)

Fingers = Digits - see Hand and Wrist bones overview

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FINGER joints = Interphalangeal joints (IP jts) + metacarpophalangeal joints (MCP jts)
Bones of the Hand = Carpals (C), Metacarpals (MCs) & Fingers (Phalanges - P) + Sesamoid bones encased in tendons = 27 bones (foot 26).

The MCs are shorter than the foot Metatarsals (MTs) and the fingers much longer, as the functional emphasis is for gripping and fine motor skills rather than weightbearing. Each finger has a proximal, middle and distal phalanx, except the thumb (Pollux), which only has 2.

BS princes pollicis, radialis indicis, palmer & dorsal digital art. NO ANASTOMOSES ACROSS THE FINGERS hence blocking both sides of the finger will result in tissue death eg wearing a tight ring NS median N for medial nerve for the thumb, index and middle finger, ulnar N for the little and ring fingers (C7-T1) A IP extension / flexion MCP flexion/extension, rotation, adduction/abduction circumduction 1 2 3 4 5 6

palmer lig. of IP joints collat. ligs of IP joints collat. ligs of MCP joints capsule for MCP of the thumb deep transverse MC ligs. palmer ligs grooved for flexor tendons

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FOOT BONES overview


dorsal / plantar
Bones of the Foot = Tarsal (T), Metatarsals (MTs) & Toes (Phalanges P) + Sesamoid bones encased in tendons = 26 bones (hand 27). The MTs are longer than the hand Metacarpals (MCs) and the toes are shorter than the fingers, as the functional emphasis goes from gripping to weightbearing & shock absorbing. Each toe has a proximal, middle and distal (terminal) phalanx, except the big toe (Hallux) which only has 2.

Articulations: foot with Tibia -Talo-Fibular jt = lateral Malleoli foot with Fibula -Talo-Fibular = medial malleoli w/n the foot T-MT jts + MT-P jts = the arch of the foot IP jts = ball of the foot 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 lateral tubercle of Talus medial tubercle of Talus trochlea of Talus neck of Talus head of Talus Navicular lat. Cuneiform intermed. Cuneiform medial Cuneiform proximal P of Hallux (big toe) distal P of Hallux (big toe) middle P of 2nd toe distal P of 2nd toe proximal P of 2nd toe metatarsals = MTs Cuboid facet for medial malleolus Calcaneus middle P of 4th toe middle P of 3rd toe Sustenaculum Tali of Calcaneus

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FOOT joints = Intertarsal joints (IT jts)


dorsal / plantar
Bones of the Foot = Tarsal (T), Metatarsals (MTs) & Toes (Phalanges - P) + Sesamoid bones encased in tendons = 26 bones (hand 27). The MTs are longer than the hand Metacarpals (MCs) and the toes are shorter than the fingers, as the functional emphasis goes from gripping to weightbearing & shock absorbing.

As with the Hand - IP joints hinge joints - flexion and extension only IT joints planar joints - slight gliding + rotation MT joints gliding and planar - slight gliding + rotation

BS branches of dorsalis pedis, medial & lat. plantar arteries. NS deep peroneal medial & lat. plantar Ns (S1-2) A

the actions of the foot joints are much more limited than the hand and are primarily to assist with inversion / eversion of the foot and weight dispersal 1 2 3 4 5 6 7 8 dorsal intercuneiform ligs. dorsal cuneonavicular lig. dorsal cuboidenonavicular lig. dorsal cuneocuboid lig. plantar intercuneiform ligs. plantar cuneonavicular lig. plantar cuboidenonavicular lig. plantar cuneocuboid lig.

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Frontal bone
anterior / lateral / inferior
(Unpaired largest and very robust anterior bone forming the forehead horizontal section forming the roof of the orbit.)

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Frontal tuberosity - Frontal bossing Superciliary arch Supraorbital margin and notch Nasal spine Superior and inferior temporal lines Superior Orbital plate - pars orbitalis Frontal & Ethmoid air cells - Frontal sinus Posterior Ethmoidal foramen Anterior Ethmoidal foramen Zygomatic process Supra-Orbital notch or foramen Lacrimal fossa Metopic suture - frontal suture, Glabella Frontal squama Ethmoidal notch

Hammate see Carpus - disarticulated

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HAND & WRIST bones overview


dorsal Bones of the Hand + Wrist = Carpals (C), Metacarpals (MCs) & Fingers (Phalanges - P) + Sesamoid bones encased in tendons = 27 bones (foot 26).
The MCs are shorter than the foot Metatarsals (MTs) and the fingers much longer, as the functional emphasis is for gripping and fine motor skills rather than weightbearing. Each finger has a proximal, middle and distal phalanx, except the thumb (Pollux), which does not have a middle phalanx.

1 2 3 4 5 6 7 8 9 10 11 12 13 14

distal ends of forearm bones carpus or wrist bones in 2 layers MCs phalanx / phalanges, P = finger bones Ulna, distal end Radius, distal end Scaphoid (part of os carpus/wrist) 1st MC proximal P of thumb (pollux) distal P of thumb middle P of 2nd finger (index finger) distal P of index finger distal P of 3rd finger (middle finger) distal P of 4th finger (ring finger)

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HAND & WRIST bones overview


palmar Bones of the Hand + Wrist = Carpals (C), Metacarpals (MCs) & Fingers (Phalanges - P) + Sesamoid bones encased in tendons = 27 bones (foot 26).
The MCs are shorter than the foot Metatarsals (MTs) and the fingers much longer, as the functional emphasis is for gripping and fine motor skills rather than weightbearing. Each finger has a proximal, middle and distal phalanx, except the thumb (Pollux), which only has 2.

1 2 3 4 5 6 7 8 9 10 11 12 13 14

distal ends of forearm bones carpus or wrist bones in 2 layers MCs phalanx / phalanges, P = finger bones Ulna, distal end Radius, distal end Scaphoid (part of os carpus/wrist) 1st MC proximal P of thumb (pollux) distal P of thumb middle P of 2nd finger (index finger) distal P of index finger distal P of 3rd finger (middle finger) distal P of 4th finger (ring finger)

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Hand - Intercarpal joints = IC joints b/n the wrist and the fingers
dorsal / palmar Articulations: main levels forearm with wrist wrist with hand hand with fingers sublevel within the wrist along the fingers Special thumb/pollux only has features 2 phalanges proximal & distal all other fingers have 3 (middle) radiocarpal / radioulnar C-MC MC-P IC IP MC-P jt in the thumb = saddle jt - hence additional mobility

BS anterior interosseus C & MC branches of radial & ulnar art. and deep palmar arch rich aa NS ant. post. interosseus Ns (C6-8) A

sliding and gliding to allow increased wrist range of movement, radial and ulna deviation 1 palmar C-MC ligs. 2 radial collat. . ligs. 3 palmer radiate C lig. 4 proximal IC lig. 5* pisiohamate lig. 6* pisio-MC lig. 7 distal dorsal IC ligs. 8 radial collat. ligs. 9 dorsal radiate ligs. 10 dorsal C-MC ligs. * Bifurcate ligament

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HAND JOINTS - Carpo-metacarpaI and Intercarpal joints = C-MC IC joints b/n the forearm and the fingers
dorsal / palmar Articulations: main levels forearm with wrist wrist with hand hand with fingers sublevel within the wrist along the fingers Special thumb/pollux only has features 2 phalanges proximal & distal all other fingers have 3 (middle) radiocarpal / radioulnar C-MC MC-P IC IP MC-P jt in the thumb = saddle jt - hence additional mobility

BS anterior interosseus, carpal and metacarpal branches of radial and ulnar arteries and deep palmar arch rich aa NS ant. & post. interosseus Ns (C6-8) A 1 2 3 4 5 6 7 8 sliding and gliding to allow for the fingers and thumb to increase range of movements

interosseous MC lig. dorsal lig. of the thumb lateral lig. of the thumb dorsal C-MC lig. dorsal MC-MC ligs. (inter MC) palmar MC-MC lig. (interMC) palmar lig. of the thumb palmar C-MC ligs.

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Hip bone = Innominate bone (unnamed bone) = Os Coxae


lateral
(Hip bone - unnamed because it does not resemble anything)

Articulations/Special features - see Pelvic Girdle 1 2 3 4 5 6 7 8 9 10 11 12 13 13A 14 15 16 17 18 19 ASIS = anterior superior iliac spine Iliac fossa Iliac crest Iliac tuberosity PSIS = posterior superior iliac spine Auricular surface / articular surface of Ilium with sacrum PIIS = posterior inferior iliac spine greater sciatic notch (enclosed with a ligament in life) ischial spine lesser sciatic notch ischial body ischial tuberosity ischiopubic junction ischiopubic ramus pubic symphysis pubic crest pubic tubercle superior ramus of Pubis iliopubic eminence AIIS = anterior inferior iliac spine

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Hip bone = Innominate bone (unnamed bone) = Os Coxae


sagittal plane - (looking into the joint through the femur)
(Hip bone - unnamed because it does not resemble anything)

made up of 3 bones ILIUM, ISCHIUM, PUBIS which meet in the Acetabulum - lunate surface

1 ASIS = anterior superior iliac spine 2 iliac fossa 3, 4 iliac crest, iliac tuberosity 5 PSIS = posterior superior iliac spine 7 PIIS = posterior inferior iliac spine 8 greater sciatic notch (+ lig. - greater sciatic foramen) 9 ischial spine 10 lesser sciatic notch (+ lig. lesser sciatic foramen) 11 ischial body 12 ischial tuberosity 13/13A ischiopubic junction / ramus 15 pubic crest 18 iliopubic eminence 19 AIIS = anterior inferior iliac spine 20 post. gluteal line / superior gluteal line 21 ant. gluteal line 22 inf. gluteal line 23 Rim of Acetabulum n 24 Obturator groove 25 Obturator foramen

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Hip joint
anterior / posterior BS articular branches of: obturator, medial circumflex femoral, superior and inferior gluteal arteries NS gluteal, obturator Ns (L2-4) A flexion / extension, adduction / abduction / circumduction, rotation 1 2 3 4 5 6 iliofemoral lig. pubofemoral lig. medial band of iliofemoral lig. central band of iliofemoral lig lateral band of iliofemoral lig ischiofemoral lig

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Hip joint
sagittal plane - (looking into the joint from inside of the pelvis) BS articular branches of: obturator, medial circumflex femoral, superior and inferior gluteal arteries NS gluteal, obturator Ns (L2-4) A flexion / extension, adduction / abduction / circumduction, rotation 1 2 3 4 5 6 7 8 9 10 iliofemoral lig. pubofemoral lig. ischeal ramus pubic ramus femur acetebulum - edge ligament of femoral head ischeal spine transverse ligament head of femur in acetabulum - cavity

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Humerus = ARM bone (upper arm bone)


anterior / posterior
(Humerus = largest bone in the upper limb)

Articulations proximal/upper end arm with scapula distal/lower end elbow Special ossifies from 8 features centres 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18

glenohumeral joint = shoulder joint elbow = humerus + ulna + radius shaft, head, 2 tubercles, capitulum, trochlea, 2 epicondyles

head of Humerus / epiphysis anatomical neck surgical neck medial lip of intertubercular sulcus shaft of Humerus / diaphysis and nutrient foramen medial supracondylar ridge coronoid fossa medial epicondyle trochlea capitulum lateral epicondyle radial fossa lateral supracondylar ridge deltoid tuberosity lesser tubercle greater tubercle sulcus for radial N olecranon fossa

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Hyoid
Description - Small U-shaped bone. Attached to the styloid processes via ligaments. This bone has no articulations - the only bone in the body - and is not normally broken in trauma, protected by the mandible / CHIN. It may be broken in hanging and strangulation.

Articulations: nil Special of interest in Forensic investigation rarely features broken unless specific pressure on this bone because of its site, acts to shape the jawline by supporting and bending the strap muscles 1 2 3 body of hyoid greater horn (cornu) lesser horn (cornu) MUSCLE ATTACHMENTS 4 Genioglossus 5 Geniohyoid 6 Middle Pharyngeal Constrictor 7 Hypoglossus 8 Stylohyoid 9 Thyrohyoid 10 Omohyoid 11 Sternohyoid 12 Mylohyoid

Incus see Ear bones overview

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Inferior Nasal Concha = Inferior Nasal Turbinate


Lateral Description small long thin areolar bone covered in mucosal epithelium

Articulations: with maxilla laterally All 2 with ethmoid posteriorly fibrocartilagenous & laterally joints with lacrimal superiorly Special Features the only nasal concha bone other conchae which is an independent are formations of the Maxilla

1 Lacrimal process 2 Ethmoidal process 3 Maxillary process

L Lacrimal

Description - Small cone-shaped bone.

Articulations: with ethmoid laterally with frontal superiorly with inferior nasal concha inferiorly with maxilla medially 1 2 3 4 5 6

Apex articulates with frontal Lacrimal crest and groove Hammulus Descending process Inferior edge Medial edge

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JAW see Mandible Malleus see Ear Bones overview

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KNEE articulations
anterior / posterior
The knee is the most unstable peripheral joint in the body and is actually 2 seerate jts with 4 bones and many intra-articular structures.

BS genicular branches of the following: femoral, ant. tibial and peroneal NS obturator, femoral, tibial, common peroneal Ns A 1 2 3 4 5 6 7 8 9 10 hinge joint - flexion/extension slight lateral and medial rotation for locking and unlocking Femur Patella Tibia 1 Fibula Tibial tuberosity styloid process of Fibula soleal line lateral condyle of Femur tibio-fibular jt (superior) 2 Patello-tibio-femoro artic. = knee artic

KNEE cap = Patella

anterior / posterior 1 base 2 apex 3 femur articulation in flexion 4 femur articulation - lateral condyle 5 femur articulation in extension 6 area for infra-patella fat pad 7 femur articulation - medial condyle

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KNEE JOINT
ant. flexed / superior view of the Tibia
(the knee is the most unstable peripheral joint in the body)

BS genicular branches of the following: femoral, ant. tibial and peroneal NS obturator, femoral, tibial, common peroneal Ns A hinge joint - flexion/extension slight lateral and medial rotation for locking and unlocking (key for this passage and the next) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 ant. cruciate lig. post. meniscofemoral lig. tibial collat. lig. medial meniscus tendon of semimembranosis oblique popliteal lig. post. cruciate lig. popliteal muscle arcuate lig. fibular collat. lig. tendon of popliteal lateral meniscus suprapatellar bursa tendon of quadratus patella subcutaneous prepatella bursa infrapatella fat pad patella lig. deep infrapatella bursa synovial cavity fibrous capsule transverse lig. of the knee coronary lig. ant. ligs. of the proximal tibiofibular joint

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KNEE JOINT
posterior / lateral
(the knee is the most unstable peripheral joint in the body genu = knee)

BS genicular branches of the following: femoral, ant. tibial and peroneal NS obturator, femoral, tibial, common peroneal Ns A hinge joint - flexion/extension slight lateral and medial rotation for locking and unlocking

intra-articular MENISCI, CRUCIATE LIGAMENTS, structures 1 ant. cruciate lig. 2 post. meniscofemoral lig. 3 tibial collat. lig. 4 medial meniscus 5 tendon of semimembranosis 6 oblique popliteal lig. 7 post. cruciate lig. 8 popliteal muscle 9 arcuate lig. 10 fibular collat. lig. 11 tendon of popliteal 12 lateral meniscus 13 suprapatellar bursa 14 tendon of quadratus 15 patella 16 subcutaneous prepatella bursa 17 infrapatella fat pad 18 patella lig. 19 deep infrapatella bursa 20 synovial cavity 21 fibrous capsule

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Larynx overview
Cartilages articulated and disarticulated

1 2 3 4 4A/B 5 6 7 8 9 10 11 12

Hyoid bone Epiglottis Thyroid membrane Thyroid cartilage Thyroid cartilage - superior horn - inferior horn Medial cricothyroid ligament Cricoid cartilage Arytenoid cartilages Tracheal rings Corniculate ligaments Attachment for Transverse Arytenoid Muscular process (for arytenoids) Attachment for vocal cords

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Mandible = JAW
lateral / posterior
(Mandible - lower jaw bone joins the skull via the condyles and a cartilagenous articular plate in the Temporal fossa. Primary function - mastication, houses all the bottom teeth).

Articulations with the Temporal TMJ = temporofossa - this shallow mandibular joint fossa makes it easy to dislocate this joint 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 Mandibular notch Pterygoid fovea Head of Mandible - condylar process Neck of Mandible Post. border of ramus of Mandible Ramus - vertical ramus Angle of mandible Oblique line Inferior border Body - horizontal ramus Base Mental foramen Mental tubercle - Gnathion Mental protuberance Alveolar bone surrounding teeth Anterior border of ramus Coronoid process - endocoronial ridge Mandibular foramen Lingula Superior & inferior mental spines Digastric fossa Mylohyoid line Mylohyoid groove

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Manubriosternum = BREAST BONE


(Combination of 3 bones = Manubrium + Sternum + Xiphoid)

Articulations Manubrium + Sternum Manubrium + 1st rib; 2nd rib Manubrium + Clavicle Sternum with all costal cartilages except the 1st Xiphoid with Sternum Xiphoid with 7th rib Special 6 ossification centres features Xiphoid bone bizarre patterns of ossification 1 2 3 4 5 6 7 8 9 10 11 12 13 14

manubriosternal costomanubrial manubrioclavicular costosternal xiphisternal

Manubrium clavicular notch notch for 1st costal cartilage (rib) notch for 2nd costal cartilage (cartilaginous part of the rib) sternal angle / manubriosternal joint - fibrous notch for 3rd costal cartilage notch for 4th costal cartilage notch for 5th costal cartilage notch for 6th costal cartilage notch for 7th costal cartilage xiphoid process Xiphisternal joint Sternum Jugular notch

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Maxilla / Maxillae Bones


anterior / lateral / medial
(The Maxillae are 2 paired bones which form the dominant portion of the face and hold the upper teeth. The overgrowth of the Maxilla is often the reason for orthodontic treatment.)

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18

Frontal process Medial orbital surface Infra-orbital margin Zygomatic process Infra-orbital foramen Nasal notch Nasal crest Anterior nasal spine Alveolar bone around teeth Tuberosity / alveolar process Infra-temporal surface Orbital surface Palatine process Ethmoid crest Canine jugun Conchal crest Naso-lacriminal process

Incisive canal supported by the canine jugun 19 Greater palatine canal - groove 20 Articulating surface with palatine bones 21 Maxillary hiatus continues with the sinus 22 Nasal lacrimal groove 23 alveolus - bone containing tooth root 24 canine jugun 25 inferior meatus

premaxillary suture is here - fuses with complete jaw growth

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Metacarpals = HAND BONES


(metacarpals = bones between the wrist and the fingers)

Articulations

Special features

proximal - 2nd row of carpal bones (wrist bones) metacarpals either side distal - proximal end of the approp. proximal phalanx these are long bones

View of the 1ST MC lateral / medial rounded articulation at the HEAD for the proximal phalanx of the THUMB indented facet at the BASE for TRAPEZIUM groove at the HEAD for tendons of FLEXOR POLLICUS BREVIS & LONGUS

View of the 2ND MC lateral / medial rounded articulation at the HEAD for - proximal phalanx of the INDEX finger indented facet at the BASE for TRAPEZIUM + TRAPEZOID +CAPITATE lateral facets for articulations with 3rd MC

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Metacarpals = HAND BONES


(metacarpals = bones between the wrist and the fingers)

Articulations

Special features

proximal - 2nd row of carpal bones (wrist bones) metacarpals either side distal - proximal end of the approp. proximal phalanx these are long bones

View of the 3RD MC lateral / medial rounded articulation at the HEAD for proximal phalanx of the MIDDLE finger indented facet at the BASE for CAPITATE next to STYLOID process lateral facets for articulations with 2nd MC and 4th MC

View of the 4TH MC lateral / medial rounded articulation at the HEAD for proximal phalanx of the RING finger indented facet at the BASE for HAMATE lateral facets for articulations with 3rd MC and 5th MC

View of the 5TH MC lateral / medial rounded articulation at the HEAD for proximal phalanx of the LITTLE finger indented facet at the BASE for HAMATE lateral facets for articulations with 4TH MC

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Metatarsals = FOOT BONES (not ankle)


disarticulated
(metatarsals = bones between the ankle and the toes)

Articulations proximal - tarsal bones cuneiforms + cuboid lat/medial - adjacent metatarsals distal - proximal end of proximal phalanx Special these are long bones features View of the 1ST MT lateral / medial rounded articulation at the HEAD for the proximal phalanx of the BIG TOE indented facet at the BASE for the MEDIAL CUNEIFORM lateral facet 2nd MT

M View of the 2ND MT

lateral / medial rounded articulation at the HEAD for the proximal phalanx of the 2nd TOE indented facets at the BASE for the LATERAL & MEDIAL CUNEIFORMS lateral facet for 3rd MT

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Metatarsals (MTs) = FOOT BONES


disarticulated
(metatarsals = bones between the ankle and the toes)

Articulations proximal - tarsal bones (ankle bones) metatarsals either side distal - proximal end of the appropriate proximal phalanx Special these are long bones features

View of the 3RD MT lateral / medial rounded articulation at the HEAD for the proximal phalanx of the MIDDLE TOE indented facets at the BASE for the LATERAL CUNEIFORMS lateral/medial facets for 2nd & 4th MT View of the 4TH MT lateral / medial rounded articulation at the HEAD for the proximal phalanx of the 4th TOE indented facets at the BASE for the LATERAL CUNEIFORMS & CUBOID lateral/medial facets for 3rd & 5th MT View of the 5TH MT lateral / medial rounded articulation at the HEAD for the proximal phalanx of the LITTLE TOE indented facets at the BASE for the CUBOID medial facet for 4th MT

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Nasal Bones and Cavity = NOSE


BONES external / internal / paired - posterior
Looking onto the medial wall of the nasal cavaty - onto the lateral wall The NOSE consists of: - 2 small thin rectangular bones below the Glabella, the NASAL BONES; 2 lateral walls which house the 3 PAIRED TURBINATES or CONCHAE; the MEDIAL SEPTUM - made up of the VOMER and the ETHMOID bones and the many cartilages which determine the length and shape of the nose and nasal nares (nostrils). The cavity is surrounded by sinuses which open into it and superiorly by the Ethmoid plate allowing the OLFACTORY nerves to drop processes into the cavity. More details in the A-Z of Surface Anatomy.

Articulations: with Frontal superiorly All 2 with Lacrimal laterally fibrocartilagenous joints with itself medially with Ethmoid inferiorly articulates with nasal BS in septum does SPECIAL FEATURES cartilages anteriorly not extend to cartilage superior & parts of the Ethmoid middle nasal bone conchae inferior nasal 2 small snail like bones lying conchae on top of Palantine bones 1 2 2A 3 3A 4 5 6 6A Frontal sinus Nasal spine of frontal bone Articulation with frontal bone Nasal bone - external surface Nasal bone internal surface Perpendicular plate of ethmoid Ant. nasal spine Maxilla Articulation b/n Nasal bones & Maxilla 7 Sphenoid bone(pterygoid plates) 8 Vomer

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Sphenoidal sinus Crista Galli Foramen for nasal vein Notch for external nasal N Articulation with other nasal bone Lacrimal bone Inferior concha & meatus Palantine bone - perpendicular plate & incisive fossa Sphenopalantine meatus Superior concha & meatus Middle concha & meatus
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2A 2 2A external 11 12 1 2 3 4 3 6A 6A

paired posterior 13 internal 21 1 10 medial

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Navicular = part of Os Tarsus / bones of the foot


distal / proximal Articulations with all the cuneiforms distally with Talus proximally 1 2 3 4 5 tuberosity facet for medial cuneiform facet for intermediate cuneiform facet for lateral cuneiform facet for head of Talus

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Occipital bone
external / internal Articulations with Sphenoid anteriorly with VC inferiorly with C1, C2 laterally Special large bowl like bone with a features hole at the infero-posterior portion of the skull 1 Superior angle 2 Highest nuchal line 3 Superior nuchal line 4 Inferior nuchal line 5 Mastoid margin 6 Jugular process 7 Condylar fossa 8 Occipital condyle 9 Foramen magnum 10 Hypoglossal canal 11 Condylar canal 12 Lateral surface 13 Lateral angle 14 Occipital crest (internal) 15 Squamous surface 16 Occipital protuberance (internal) 17 Lambdoid margin 18 Groove for superior sagittal sinus 19 Posterior cerebral fossa / occipital fossa 20 Groove for transverse sinus 21 Attachment for tentorium cerebelli 22 Groove for sigmoid sinus 23 Jugluar notch 24 Jugular tubercle 25 Attachments for falx cerebri 26 Opisthion 27 Basion 28 Occipital sulcus - sagittal sinus

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Palatine bones (Left)


lateral / medial / anterior / posterior Articulations mainly with the 2o upper jaw (Maxilla) fibrocartilagenous and the Sphenoid joints Special L-shaped bones features forms the floor of the Nasal cavity 1 2 3 4 5 6 6A 7 perpendicular plate - vertical plate Palato-Maxillary suture Maxilla Orbital process Spheno-Palatine notch Sphenoidal process Pterygo-Palatine canal horizontal plane

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Parietal bone (Left)


external / internal Articulations with the Frontal - anterior with the Temporal - inferiorly with the Occipital - posteriorly with itself medially Special large square bone - largest of features the cranial vault - even thickness all 4 corners made up the basis of the fontanelles in the infant 1 2 3 4 All 2o fibrocartilagenous joints

Superior temporal line Parietal eminence Articulation with the occipital bone (lambdoid suture) Articulation with the temporal bone (mastoid) parieto-mastoid suture 5 Articulation with the temporal (squamous) temporo-parietal suture 6 Articulation with the sphenoid (greater wing) spheno-parietal suture 7 Articulation with the frontal bone coronal suture 8 Inferior temporal line 9 Articulation between parietal bones sagittal suture 10 Frontal angle 11 Sphenoidal angle 12 Groove for frontal branch of middle meningeal vessels 13 Groove for parietal branch of middle meningeal vessels 14 Mastoid angle 15 Groove for sigmoid sinus 16 Occipital angle 17 Groove for superior sagittal sinus

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PECTORAL GIRDLE = SHOULDERS


anterior / superior / posterior
SPECIAL FEATURES to support the upper limb to act as accessory structure in respiration

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

first rib Clavicle Acromion of Scapula Humerus glenoid fossa of Scapula coracoid process of Scapula Manubrium (part of the Manubriosternum) Sternum (part of the Manubriosternum) Xiphisternum vertebral body of T12 rib 11 rib 12 spine of Scapula medial border of Scapula transverse processes spine of vertebrae

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Pelvic Girdle - articulations Articulariae Coxea


anterior Articulations Pubis to Pubis defining the mid-Sagittal plane Femur with Acetabulum Pubic symphysis 2o cartilagenous

hip joint synovial / diarthrosis ball and socket Ilium with Sacrum Iliosacral joint synarthrosis Sacrum with VB of L5 lumbosacral 2o cartilagenous fused segments of the Sacrum Intrasacral joints synarthroses partial fusion with fibrous inserts vestigial discs Sacrum with Coccyx may completely fuse later in life Special features 3 component bones of the HIP bone = PUBIS/pubic bone + ILIUM + ISCHIUM with separate ossification centres completely fuse in adolescence - ceases to be a joint highly modified for bipedal walking and weight bearing hip+sacrum+hip = pelvic girdle (PG) 1 2 3 4 5 6
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intervertebral disc L5/S1 Iliosacral joint Femoro-acetabular joint - hip jt Pubic symphysis ala of the Ilium ala of the Sacrum
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PELVIC GIRDLE = HIPS LIGAMENTS


antero-superior
SPECIAL FEATURES to support the body weight to support the pelvic organs and contents to balance weight across the lower limbs

1 anterior longitudinal lig. = ALL 2 iliolumbar lig. superior band 3 iliolumbar lig. inferior band 4 ant. sacroiliac lig. 5 iliac fossa 6 iliac crest 7 greater sciatic foramen 8/8A spine of Ischium / Sacrospinal lig. 9 lesser sciatic foramen 10 pectoneal lig. = Coopers lig. 11/11A tuberosity of Ischium / Sacrotuberous lig. 12 superior pubic lig. 13 interpubic disc 14 iliopectoneal eminence 15 ant. inferior iliac spine = AIIS 16 ant. superior iliac spine = ASIS 17 sacroiliac joint 18/18A base of Sacrum / sacral canal 19 inguinal lig. 19A reflected inguinal lig. (cut to demonstrate deeper lig.) 20 aponeurosis of the external oblique muscle 21 lacuna lig. 22 supf. inguinal ring 22A/22B medial crus / lateral crus

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PELVIC GIRDLE = HIPS ARTICULATION & LIGAMENTS


Posterior
SPECIAL FEATURES to support the body weight to support the pelvic organs and contents to balance weight across the lower limbs

1 anterior longitudinal lig. = ALL 2 iliolumbar lig. superior band 3 iliolumbar lig. inferior band 4 ant. sacroiliac lig. 5 iliac fossa 6 iliac crest 7 greater sciatic foramen 8/8A spine of Ischium / Sacrospinal lig. 9 lesser sciatic foramen 10 pectoneal lig. = Coopers lig. 11/11A tuberosity of Ischium / Sacrotuberous lig. 12 superior pubic lig. 13 interpubic disc 14 iliopectoneal eminence 15 ant. inferior iliac spine = AIIS 16 ant. superior iliac spine = ASIS 17 sacroiliac joint 18/18A base of Sacrum / sacral canal 19 inguinal lig. 19A reflected inguinal lig. (cut to demonstrate deeper lig.) 20 aponeurosis of the external oblique muscle 21 lacuna lig. 22 supf. inguinal ring 22A/22B medial crus / lateral crus

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Pubic Symphysis = Pubic joint


anterior
(Pubic symphysis is a secondary fibrocartilagenous joint)

BS internal pudendal NS internal pudendal Ns perineal branch (S2-4) A nil - except under hormonal influence eg childbirth 1/1A 2 3 4 5 6 7 8 9 inguinal lig. / thickened central portion acetabular labrium pectineal lig. transverse acetabular lig. lacuna lig. arcuate pubic lig. interpubic disc of fibrocartilage superior pubic lig. hyaline cartilage

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Radio-Ulnar joints proximal (below the elbow) distal (above the wrist)
anterior
(pivot joint b/n the Ulna and the Radius allowing turning one bone over the other)

BS aa around jt from brachial, profunda brachii, radial & ulnar arteries NS radial & median Ns (C7-8) A supination / pronation

Articulations superior is the elbow joint hinge joint inferior is the wrist joint 1 2 3 4 5 6 7 annular lig. oblique cord gap for the posterior interosseous vessels interosseous membrane gap for the posterior interosseous vessels styloid process sacciform recess of the capsule of distal radioulnar joint

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Radius
anterior / posterior Articulations with Ulna proximally & distally with first row of carpal bones distally 1 2 3 4 5 6 7 8 9 a-f a b c d e f mid radio-ulnar joint = interosseous scaphoid, lunate, triquetral

head neck radial tuberosity shaft interosseous border ulnar notch styloid process dorsal tubercle posterior border grooves for the tendons crossing the Radius ext. digitorum ext. indicis ext. carpi radialis brevis ext. carpi radialis longus ext. pollicus brevis ext. pollicus longus

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Ribs - atypical 1, 2
Articulations superior view Bones superior view 1/1A 2/2A 3 3A T1 - RIB 1 T2 RIB 2 costovertebral joints demi-facets on head of Rib 2 b/n T1 and T2 crest in b/n single facet on head of Rib 1 for T1 4 spine of T1 + TP 5 costal tubercles 6 shafts 7A/7V groove for subclavian artery and N and vein 8 scalene tubercle 9 attachment of costovertebral lig. 10 attachment of lig. of Serratus Anterior

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Ribs - typical 3 -10


inferior / posterior Articulations with VC -transverse process (TP) posteriolaterally with VB posteriorly synovial joints at the same level eg RIB 3 = T3 artic.

Special features 1 2 3 4 5 6 7 8 9 10 11

at the same level and above eg RIB 3 = T2/3 artic. with Sternum directly cartilagenous joints or through costal bone cartilage bone cartilage ridge each rib has a costal groove which protects the segmental BS & NS

head neck tubercle facet tubercle angle shaft / body costal groove costal end demi-facet for vertebra interarticular crest demi-facet for vertebra

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Sacroiliac joint (part of the Pelvic girdle)


anterior / posterior BS aa round jt: superior gluteal, iliolumbar & sacral arteries NS superior gluteal, sacral plexus (L4, 5 S1) A 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 slight AP rotation anterior longitudinal lig. = ALL lubosacral lig. iliolumbar lig. ant. sacroiliac lig. sacrospinous lig. inguinal lig. pectineal lig. sacrotuberous lig. ant. sacrococcygeal lig. lateral sacrococcygeal lig. (ant. aspect) lumbosacral lig. short dorsal sacroiliac lig. long dorsal sacroiliac lig. lateral sacrococcygeal lig. (post. aspect) intercornu lig. supf. dorsal sacrococcygeal lig. falciform process lesser sciatic foramen greater sciatic foramen superior pubic lig.

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anterior right 3 4 2

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Sacrum (+ Coccyx) = part of the PELVIC GIRDLE


anterior / lateral / posterior Articulations laterally with Ilium Iliosacral joint synarthrosis superiorly with VB of L5 lumbosacral 2o cartilagenous this may change and fusion of 5 sacral vertebrae deteriorate with age, disease or nutrition and contribute to lower back pathology

Special features

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

superior articular process body ala articular surface fusion b/n 2 VB inferior lateral angle sacral canal hiatus sacral cornu dorsal sacral foramen lateral crest & tubercles lamina TP median sacral crest & spinous process(es) Coccyx Coccygeal Cornu

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Scapula = part of the PECTORAL GIRDLE


anterior / posterior / lateral 1 superior angle 2 medial edge 3 superior border 4 suprascapula notch 5 acromion 6 coracoid process 7 glenoid fossa 8 subscapula fossa 9 lateral axillary border 10 inferior angle 11 body all but the spine 12 acromial angle 13 infraspinous fossa 14 supraspinous fossa 15 spinoglenoid notch 16 spine of scapula

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SHOULDER JOINT = Glenohumeral joint


(Articulation b/n the Glenoid fossa of the Scapula and the head of the Humerus - Ball and Socket joint of ill fitting bony surfaces great mobility inferior instability)

BS posterior circumflex, humeral and suprascapular arteries NS posterior cord of the Brachial Plexus suprascapular, axillary & lateral pectoral Ns (C5-6) A 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 flexion/extension, abduction/adduction, lateral/medial rotation, circumduction superior glenohumeral lig. middle glenohumeral lig. inferior glenohumeral lig. Latissimus Dorsi tendon of long head of Biceps Pectoralis Major (cut) transverse lig. of Humerus coracohumeral lig. Supraspinatus tendon articular capsule Subscapularis bursa edge of the articular capsule glenoid labrium glenoid cavity Subscapularis tendon

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Skull External Views


anterior 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 Frontal bone Fronto-Nasal suture Inter-Nasal suture Nasal bone, Lacrimal bone Supra-Orbital foramen Spheno-Parietal suture Spheno-Frontal suture Spheno-Squamosal suture Zygoma Zygomatico-Maxillary suture Infra-orbital foramen Middle Nasal concha - turbinate (from Ethmoid bone) Inferior nasal concha - turbinate (from Ethmoid bone) Vomer Mandible Mental foramen Inter-Maxillary suture Maxilla Ethmoid bone (Orbital plate) Inferior Orbital fissure Temporo-Zygomatic suture Superior Orbital suture Fronto-Zygomatic suture Greater wing of the Sphenoid Coronal suture - Fronto-Parietal suture Lesser wing of the Sphenoid Optic foramen

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Skull External Views


inferior base of skull 1 Incisive fossa - Alveolare 2 Medial Pterygoid plate and Hamulus (Ethmoid) 3 Posterior Nasal aperture 4 Pterygoid plate (ethmoid) 5 Lateral Pterygoid plate (Ethmoid) 6 Zygomatic arch 7 Mandibular fossa 8 External Auditory meatus 9 Styloid process 10 Mastoid process 11 Parieto-Mastoid suture 12 Occipito-Mastoid suture 13 Foramen magnum 14 External Occipital proturberance 15 Sagittal suture - Parieto-Parieto suture 16 Lambda 17 Lambda suture 18 Superior nuchal line (Occipital) 19 Inferior nuchal line (Occipital) 20 Occipital condyle 21 Jugular foramen (fossa) 22 Stylo-Mastoid foramen 23 Carotid foramen - Carotid canal 24 Foramen spinosum 25 Foramen lacerum - Basilar suture 26 Greater Palatine foramen 27 Horizontal plate of Palatine 28 Palatine process of the Maxilla

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Skull External Views


lateral 1 Frontal bone - temporal ridges for attachment of Temporalis (aka temporal lines) 2 Parietal bone 3 Occipital bone 4 Mastoid process 5 Temporal bone 6 Zygomatic arch 7 Mandible 8 Body of mandible 9 Maxilla 10 Zygoma 11 Nasal bone 12 Lacrimal bone 13 Frontal bone 14 Greater wing of the sphenoid

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Skull External Views


posterior 1 sagittal suture 2 Parietal foramen 3 lambda Pareito-Occipital suture 4 Occipital bone 5 lambdoid suture 6 inf. nuchal groove 7 Occipital bone 7A external Occitipal protruberance 8 superior nuchal groove 9 sutural bones - Inca 10 Parietal bone

Skull External Views

superior 3 lambda 5 lambdoid suture - Occipito-Parieto suture 7 Occipital bone 10 Parietal bone 11 Parietal eminence - Euryon 12 Frontal bone 13 Bregma 14 coronal suture

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Skull External Views


Postero-inferior rear view with tilt Mandible attached rear view of the TMJ 1 Sutural bones = Inca = Wormian bones enclosed in the skull sutures 2 Parietal bones 3 Nuchal lines i = inferior s = superior 4 Foramen magnum 5 Mastoid process 6 Sphenoid bone s = spine of 7 Pterygoid plate L = lateral m = medial 8 Incisive fossa = alveolare= ant. palatine fossa 9 Digastric fossa = attachment for geniohyoid 10 Mental spines inf. & superior (muscle attachments) 11 Mandible 12 Hard palate 13 Greater palatine foramen 14 Hypoglossal canal 15 Nasal turbinates = conchae sup., middle & inf. 16 Styloid process (temporal bone) 17 Zygomatic arch 18 Temporal bone 19 Occipitum

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Skull Internal Views


inferior Skull cap 1 Lambda 2 Lambdoid suture 3 Parietal foramen 4 Diploe 5 Bregma 6 Coronal suture 7 Frontal crest 8 Frontal bone 9 Depressions for arachnoid granulations 10 Grooves for middle meningeal vessels 11 Parietal bone 12 Sagittal suture 13 Groove for superior sagittal sinus 14 Occipital bone

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Skull Internal Views


lateral - looking out to the sides of the skull from the inside 1 groove for the middle meningeal artery 2 Frontal sinus 3 superior nasal concha 4 middle nasal concha 5 inferior nasal concha 6 hard palate 7 mandible 8 lateral pterygoid plate 9 medial pterygoid plate 10 styloid process 11 mastoid process 12 sphenoid sinus

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Skull Internal Views


superior internal base - cranial fossae 1 Cribiform plate 2 Frontal sinus 3 Crista Galli 4 Orbital plate of Frontal bone 5 Jugum of Sphenoid 6 Optic canal 7 Lesser wing of the Sphenoid bone 8 Anterior Clinoid process 9 Foramen rotundum 10 Foramen lacerum 11 Foramen ovale 12 Foramen spinosum 13 Dorsum sellae 14 Internal acoustic meatus 15 Jugular foramen 16 Foramen magnum A B C ANTERIOR FOSSA MIDDLE FOSSA POSTERIOR FOSSA

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Paranasal sinuses = Sinuses


Coronal
The paranasal sinuses are generally the sinuses referred to when discussing sinus pain etc - they are the air filled spaces which empty into the nasal cavity. They may swell, become infected and fill with fluid, causing pain and pathology. A number of bones contribute to this space, as indicated.

1 Cranial vault (ACF at this point) 2 Ethmoid air cells 3 Maxillary sinus 4 Nasal cavity 5 Boney palate = hard palate 6 Inferior meatus (opening) 6A Inferior concha (turbinate) 7 Middle meatus 7A Middle concha (turbinate) 8 Superior meatus 8A Superior concha (turbinate) 9 Orbit / orbital fossa Contribution of the frontal bone Contribution of the zygoma Contribution of the maxilla Contribution of the ethmoid bone Inferior nasal concha (is its own bone) Vomer

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Sphenoid
anterior / posterior / schema - development
A single wedge-shaped bone consisting of four parts: the central body; the lateral greater wings, the medial lesser wings and the lower ptergoid plates. The bone looks like a bat in flight and is the centre piece of the skull.

1 Articulation with L temporal bone 2 Orbital surface 3 Infratemporal crest 4 Body of the sphenoid 5 Openings for sphenoidal sinuses 6 Lesser wing (come across and meet to form jugum) 7 Squamosal suture - articulation with R Temporal bone 8 Superior orbital fissure 9 Foramen rotundum 10 Pterygoid canal 11 Rostrum 12 Vaginal process 13 Medial pterygoid plate 14 Pterygoid hamulus 15 Pterygoid notch 16 Lateral pterygoid plate 17 Pterygoid process 18 Sphenoid spine 19 Greater wing 19A Cerebral surface of the greater wing 20 Anterior clinoid process 21 Posterior clinoid process 22 Dorsum sellae 23 Articulation with occiput

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Sterno-Clavicular joints Sterno-Costal joints


anterior
(joints b/n the Manubriosternum and the Clavicle = SYNOVIAL JOINTS and these joints have INTRA-ARTICULAR DISCs joints b/n the Manubriosternum and RIBS 3-9 = planar SYNOVIAL JOINTS joints b/n Manubriosternum and RIBS 6-10 = 10 CARTILAGENOUS JOINTS - SYNCHONDROSIS - they have elasticity due to the cartilage but little to no actual mobility)

BS internal thoracic artery

NS ant. supraclavicular & N to subclavius ant. cutaneous branches of intercostal Ns (C8-T1-12) A 1 2 3 4 5 6 7 8 9 10 11 12 13

elevation / depression, retraction / protraction, rotation interclavicular lig. fibrocartilage artic surface articular disc - the disc is inside the joint cavity costoclavicular lig. double synovial joint cavity RIB 2 with intra-articular lig. sternocostal / manubriocostal joints manubriosternal symphysis (20 cartilagenous) ant. sternoclavicular lig. costoclavicular lig. sternocostal lig. sternocostal joints (R3-9) PLANE synovial joints interchondral cavities (R6-10) synchondrosis interchondral ligs. syndesmosis costochondral junction

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Talus = ANKLE BONE


superior / posterior medial / lateral
(Talus biggest of the Tarsal bones in the foot - irregular bone)

Articulations with Tibia superiomedially with Calcaneus inferiorly with Navicular anteriorly with Fibula laterally 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 trochlea surface for Tibia facet for lateral Malleous neck groove for ant. lig. of ankle artic. surface for Navicular sulcus Tali lat. process post. calcaneal facet plantar surface facet for medial Malleous medial tubercle roughened surface for Deltoid lig. groove for Hallucis longus medial tubercle ant. surface for Calcaneus middle calcaneal surface plantar calcaneonavicular lig

Tibiotalar joint Talocrural joint Subtalar joint Talofibular

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Teeth overview
There are many different methods used to name teeth, define their positions and dentitions and describe their surfaces. This overview shows the 1o & 2 o dentitions, describes their positions and tooth types using some of the better known methods. Teeth are labeled XY on the Left and Right - X is the quadrant of the teeth and dentition type - adult or child - Y is the tooth type (devised by the Federation Dentaire Internationale)

1 2 3 4 5 6 7 8 1 2 3 4 5 6 7 8 A B C D E F

Maxillary upper right quadrant - adult Maxillary upper left quadrant - adult Mandibular lower left quadrant - adult Mandibular lower right quadrant - adult Maxillary upper right quadrant - child Maxillary upper left quadrant - child Mandibular lower left quadrant - child Mandibular lower right quadrant - child Central Incisor Lateral Incisor Canine First Pre-molar Second Pre-molar First Molar Second Molar Third Molar

Palatal Buccal Mesial Distal Lingual Occlusal -

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upper tooth surface facing the inside of the mouth any tooth surface facing the cheek any tooth more anterior than the 1st molar all teeth behind the 1st molar lower tooth surface facing the tongue any tooth surface which abuts with another tooth-bite surface (shown surface) - any tooth surface facing the lips

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Temporal bone (Left) external / inferior / internal


Temporal = TIME. This bone shows first signs of aging - grey hair. It is involved in both the wall & the base of the skull. Temporal bones contain the auditory ossicles/ear bones & form the only joint with the mandible.

1 Suprameatal triangle 2 Groove for middle temporal artery 3 Parietal notch 4 Squamo-mastoid suture 5 Mastoid area 6 Mastoid process 7 Sheath of styloid process 8 Styloid process 9 Tympanic part l 10 External acoustic meatus / anterior border (bony ear hole) 11 Tympanosquamosal (squamotympanic) fissure 12 Mandibular fossa 13 Zygomatic process 14 Articular tubercle 15 Postglenoid tubercle 16 Squamous part - squama 17 Stylomastoid foramen 18 Mastoid notch - digastric groove 19 Occipital groove 20 Jugular surface 21 Jugular fossa 22 Canaliculus (opening) for tympanic nerve 23 Petrous part 24 Carotid canal 25 Edge of tegmen tympani 26 Groove for the middle meningeal vessels 27 Groove for the superior petrosal sinus 28 Articulation with the greater wing of the sphenoid spheno-temporal suture 29 Zygomatic process 30 Groove for the middle meningeal vessels 31 Internal acoustic meatus 32 Articulates with the occipital bone 33 Aqueduct of the vestibule 34 Mastoid foramen 35 Groove for sigmoid sinus - sigmoid sulcus 36 Arcuate eminence 37 Articulates with the parietal bone temporoparietal suture

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Temporo-Mandibular joint = TMJ


closed - lateral / medial open - sagittal
(only SYNOVIAL joint in the skull).

BS superficial temporal & maxillary arteries NS auriculotemporal & masseteric branches of mandibular branch of Trigeminal N (CN5) A 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 depression/elevation, protrusion/retraction, lateral movements Fibrous capsule Lateral TMJ lig Stylomandibular lig Mandible Ant. Temporal attachment of meniscus Meniscus Ant. mandibular attachment Condyle of mandible Posterior attachment Sphenomandibular lig Posterior temporal attachment Lower joint compartment Temporal bone Upper compartment Ext. auditory meatus

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Tibia
anterior / posterior Articulations with Fibula laterally syndesmosis distally and proximally with Talus inferiorly synovial- condyloid 1 2 3 4 5 6 7 8 9 10 11 12 13 interosseous border medial malleolus tibial tuberosity posterior border anterior border fibular notch articular facet for Fibula lateral condyle soleal line medial condyle attachment of iliotibial tract tubercles of intercondylar eminence medial surface

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Tibio-Fibula
posterior
(3 joints distal, proximal and along the shafts via the interosseous membrane)

BS proximal - ant. tibial artery distal - ant. & post. tibial arteries NS proximal - tibal N (S2-3) distal - deep peroneal and tibial Ns (L5, S1-3) A lateral rotation with dorsiflexion of foot distal as above 1 2 3 4 5 proximal post. Tibiofibular lig. opening for ant. tibial vessels interosseous membrane opening for peroneal artery distal post. Tibiofibular lig.

TOES = digits = Phalanges. See Foot bones overview Trapezium, Trapezoid / Triquetral bones = Carpal bones see Carpus disarticulated, also Hand & Wrist.

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Ulna
anterior / posterior Articulations with Radius proximally pivot joint and distally with Humerus proximally hinge jt ELBOW 1 2 3 4 5 6 7 8 9 10 11 12 radial notch olecranon trochlea notch coronoid process interosseous border head styloid process subcutaneous area of olecranon crest for supinator medial surface posterior border / surface groove for ext. carpi ulnaris

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Vertebrae Vertebral Column and Vertebral joints including Zygapophyseal joints removed to BACK - see index

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Vomer
lateral / posterior / in situ
A single small narrow frail plough-shaped midline bone. It is the deviation of this bone which may obstruct the nasal airways.

1 2 3 4 5 6 7 8 9 10 11 12 13 14

Ala (Alae) Articulation with Maxillae and Palatine Maxillovomer suture / palatinovomer suture Groove for the nasopalatine nerves and vessels articulation with nasal cartilages articulation with Sphenoid bone articulation with the Ethmoid plate Perpendicular plate of the Ethmoid Body of Vomer Maxillae areolar bone Medial pterygoid plate Frontal bone Sphenoid sinus anterior of nasal bones Frontal sinus

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WRIST JOINT = Radiocarpal joints


palmar / dorsal BS anterior interosseous, ant. post. carpal branches of the radial and ulan art. NS ant. post. interosseous Ns (C6-8) A flexion / extension ulna and radial deviation circumduction 1 2 3 4 5 6 7 meniscus ulna collateral lig. articular disc palmar ulnocarpal lig. palmar radio-carpal lig. radial collateral lig. dorsal radio-carpal ligs.

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Zygoma = CHEEK BONES


antero-lateral / postero-medial
These bones form the prominent corners of the face under the orbital rim.

1 2 3 4 5 6 7 8 9 10

Frontal process Zygomatico-facial formina Articulation with the frontal bone Articulation with the sphenoid Zygomatico-orbital foramina Articulation with maxilla Zyomatico-temporal foramina Temporal process Maxillary process Orbital surface

Z
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The Back
The Back generally refers to as the lumbar region of the VC and its muscles. This section also includes: the cervical, thoracic and lumbar regions of the VC and associated bony structures. The primary function of the VC is to house and protect the SC, allow exit and entrance of the SNs and act as an axis for the bodys skeleton. ALL THINGS HANG FROM THE BACK. As the Back is more than just the bony components of the VC, pathology includes muscle spasm as well as bone demineralization and failure OSTEOPOROSIS and a consideration of the consequences of mal-alignment of its individual bony units, the Vertebrae. These consequences include: damage to the SNs, which is also dealt with in the A to Z of Peripheral Nerves and changes which may occur with malalignment or changes in the musculature of the VC examined also in the A to Z of Skeletal Muscles.

The VC has 5 segments at the top of which is the Skull. Vertebrae fuse at the Sacrum which also acts as part of the pelvic girdle
1 The cervical VC consists of the 7 cervical vertebrae. The special vertebrae - the Atlas (C1) and Axis (C2) & their associated joints craniovertebral & atlanto-axial, are listed in the main section of this book. 2 The thoracic VC consists of the 12 thoracic vertebrae (T1-12). The costovertebral joints (rib joints) are listed in the main section of the BJL and overviewed in Chest overview. 3 The lumbar VC consists of the 5 lumbar vertebrae (L1-5). The Sacrum, Iliosacral joints & the Pelvic girdle are also listed in the main section. 4 The Sacrum consists of 5 fused vertebrae & acts as a major component of the Pelvic girdle as such it is listed in the main section of this book. 5 The Coccyx consists of 3-5 small vestigial vertebrae which in other animals goes on to form the Tail but has little to no function in the human. Typical VB of each region, their joints & associated ligaments are listed in order in this section of the book. Anatomical movements of the back are listed along with other anatomical movements in the front, but testing and examination of the component parts are in this section.

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The Back
This is the order of illustrations of this section of the book - note if beside the title there is a listing to see ...it will be found at that site. The BJL means the main section where the bones joints & ligaments of the body are listed.
THE BACK VC overview Common Postures & Abnormal Curves of the Spinal Column Movements of the Back see Anatomical movements (in the front) VERTEBRAE overview typical cervical thoracic & lumbar vertebrae Typical vertebro-vertebral articulations : cervical, thoracic & lumbar Vertebro-vertebral joints cervico-occiput (Skull C1/C2) lumbar joints Typical vertebral BS Typical vertebral NS CERVICAL SPINE:- Overview Examination of the cervical spine THORACIC SPINE : - Overview see Chest overview, and Costovertebral joints in the BJL 66, 70 LUMBAR SPINE : - Overview Examination of the lumbar spine 230 232 23

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242

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B I Anterior AP

Back - VC overview

II Lateral III Posterior / in situ CERVICAL CURVE (7 cervical vertebrae) THORACIC CURVE (12 thoracic vertebrae) LUMBAR CURVE (5 lumbar vertebrae) SACRUM (5 fused sacral vertebrae)

Spinal curves develop with the adoption of the upright posture.

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Common Postures and Abnormal Curves of the Spinal Column 1


C 1 Normal Posture - note presence of
cephalic thoracic and lumbar curves (see image to the right) 2 poor posture Rounded Shoulders may lead to Dowager hump (4) or Thoracic Kyphosis (5) 3 Forward Head posture - reducing thoracic curve by exaggerating head tilt may lead to flat back (6) associated with back pain Note awareness of these postures allows for corrections in the early stages, particularly the rounded shoulders and forward head postures. They should be first looked for in adolescence.

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Common Postures and Abnormal Curves of the Spinal Column continued


C 1 Normal Posture - note presence of
cephalic thoracic and lumbar curves (see image to the right) 4 Dowagers hump - commonly seen in older women - permanent change in bones and may be a sign of developing osteoporosis. 5 exaggerated AP thoracic curve Thoracic Kyphosis may develop into the Dowager hump deformity with age 6 Flat back - commonly associated with back pain, reduced shock absorption also the result of poor lifetime posture

7 Sway Back - commonly seen in adolescent girls exaggerated AP lumbar curve - Lumbar Lordosis

Note awareness of these postures allows for corrections in the early stages, particularly the rounded shoulders and forward head postures. They should be first looked for in adolescence.

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Common Postures and Abnormal Curves of the Spinal Column continued


C 8 Thoracic scoliosis abnormal lateral curve in thoracic region
9 Lumbar scoliosis abnormal lateral curve in lumbar region Note awareness of these postures allows for corrections in the early stages. They should be first looked for in adolescence. If not detected changes may become permanent and exaggerated.

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Vertebrae Overview superior


Typical Cervical Vertebrae - C3-7 atypical C1 - Atlas / C2 Axis see the BJL Typical Thoracic vertebrae - T2-9 atypical T1 attaches fixed first rib / T10-12 see the BJL ribs atypical Typical Lumbar Vertebrae - L1-5 Articulations with vertebrae above and below for typical VB-VB jts - symphysis single vertebrae SP-SP jts - syndesmosis via lig. single zygapophyseal jts planar synovial paired TP-TP jts syndesmosis via lig. paired Thoracic with rib + VB 2 demifacets on superior & inferior only lips of the VB and disc in b/n for artic. with rib above and below - planar synovial paired with rib+TP costal facet on TP - planar synovial - paired 1 2 superior facet articular pillar zygapophysis 3 vertebral body 4 transverse foramen (cervical) 5 inferior facet 6 transverse process 7 anterior tubercle 8 posterior tubercle 9 uncinate process 10 lamina 11 zygapophyseal joint 12 spinal canal vertical 13 spinous process 13a superior border 13b lateral border 13c tip 14 inferior facet

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15 pedicle 16 intervertebral foramen (separate - notches) 16i inferior vertebal notch 16s superior vertebral notch 17 intervertebral disc 18i inferior demifacet (thoracic) 18s superior demifacet (thoracic) 19 costal facet (for rib tubercle - thoracic) 20 head of rib 21 neck of rib 22 costotransverse junction (thoracic) 23 body of rib 24 mammillary process (lumbar)
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13 10 12 6 4

CERVICAL

4 1 13 15 13c 13b 3 10 7

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Vertebral - Vertebral articulations CERVICAL


lateral / posterior / anterolateral view 1 superior facet 2 articular pillar zygapophysis 3 VB 4 transverse foramen (cervical) 5 inf. facet 6 TP 7 ant. tubercle 8 post. tubercle 9 uncinate process 10 lamina 11 zygapophyseal joint 12 spinal canal - vertical 13 SP 13a sup. border 13b lat. border 13c tip 14 inf. facet 15 pedicle 16a intervertebral foramen from 2 separate notches 16i inf.vertebal notch 16s sup. vertebral notch 17 intervertebral disc 18i inf. demifacet (thoracic) 18s sup. demifacet (thoracic) 19 costal facet (for rib tubercle - thoracic) 20 head of rib 21 neck of rib 22 costotransverse junction (thoracic) 23 body of rib 24 mammillary process (body) (lumbar) 1 2 3 4 5 6 7 8

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THORACIC
1,2 15 3 16 17 11 18i,s 6 19 5 13 1,2 6 10 13a

LUMBAR
1,2 15 3 16a 17 11 13 24 6 14 1,2 6 10 13 14 11 24 8 1 12 24 6 17 14 11 1 10 13

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Vertebral - Vertebral joints - external views CERVICAL Occiput/C1/2


external posterior view* 1 external occipital protuberance 2 mastoid process 3 TP 4 posterior tubercle (C1) 5 TP outer edge 6 transverse foramina 7 spinous process (C2) 8 lamina 9 outer capsule of PLL supf. to cruciate ligs. deep to the ligamentum nuchae (not shown) 10 vertebral artery 11 capsule of lateral VV jts 12 capsule of lateral Head/Spine jts

LUMBAR

posterior view 1 TP 2 inferior artic. pillar of zygapophysis 3 supraspinous lig. 4 lamina 5 intervertebral disc - deep to the vertebral foramen 6 intertransverse lig. 7 capsular lig. 8 intervertebral disc capsule

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Typical vertebral BS
superior arteries: supplied via segmental spinal branches from the aorta and iliacs
veins: supplied via segmental branches from the azygous vessels

medial venous plexi drain to the azygous vessels


note the vertebrae are richly innervated and vascularized with multiple aas allowing for movement and for repair. Branches travel in the pia-arachnoid mater to supply the SC. VBs have red BM and supply new blood elements in the adult

1 2 3 4 5 6A 6V 7 8A 8V 9 10 11 12

SP TP vertebral foramen VB pedicle spinal artery intravertebral vein intercostal artery /vein segmental artery intervertebral vein basivertebral vein venous plexus of vertebral body anterior venous plexus posterior venous plexus

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Typical vertebral NS
superior thoracic - superior lumbar nerves - thoracic region: the SP, TP and laminae supplied via segmental spinal branches from the dorsal rami.
VB supplied by segmental branches of the ventral rami Note the sympathetic chain in this region and the solid SC nerves - lumbar region: the SP, TP and laminae supplied via segmental spinal branches from the dorsal rami.

VB supplied by segmental branches of the ventral rami these bodies are very large in this region and require extensive innervations. They are very sensitive to pain. Note the SC has finished in this region - the corda equina travels in the CSF fluid

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SP TP vertebral foramen VB pedicle rib sympathetic ganglion N to vertebral body ad ALL grey and white rami doral ramus ventral ramus recurrent meningeal nerve parspinal sympathetic ganglion dorsal root ganglion cauda equina lumbar sacral roots

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Cervical Spine - overview


note vertebra prominens - the most prominent SP on palpation is either on C7 or T1 1 Atlas = C1 2 Axis = C2 3 C3 4 C4 5 C5 6 C6 7 C7 8 T1 9 1st rib 10 clavicle 11 Occiput cut surface 12 Transverse foraminae - canal for the vertebral artery often misses C6-7 13 cervical curve - concave 14 intervertebral disc

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Examination of the cervical spine

examination of C1 / Atlas

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examination of C2 / Axis

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examination of ligamentum nuchae

examination of the mastoid process

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distraction of the cervical spine

examination of the vertebral artery

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examination for cervical irritability and mobility

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Examination of the lumbar spine - bony features and ligaments

examination of SP

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examination of mobility of SP

examination of mobility of the TP

note with any N irritability cease as compressing the intervertebral space will aggravate any N pathology
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Examination of the lumbar spine - bony features and ligaments continued

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examination of the ischeal tuberosities

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examination of the supraspinous lig


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Examination of the lumbar spine - mobility


These examinations of the bones and ligaments of the cervical and lumbar spines and associated joints are not complete and do not cover any neurological considerations which are dealt with in the A to Z of the Head and Neck and the A to Z of the Peripheral Nerves. They will be further examined in the A to Z of Clinical Examination and Assessment.

examination of back and hip extension lumbar and SI joint mobility

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lumbar distraction and extension for lumbar and SI mobility

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The A to Z of Bones, Joints, Ligaments & the Back

Examination of the lumbar spine - mobility continued


Lumbar verterbra + disc

examination of lumbar mobility AP

examination of lumbar mobility with hip and leg rotation and lateral flexion

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examination of lumbar mobility with hip and leg flexion


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The A to Z of Hair, Nails & Skin


ISBN 978-1-921930-027 The structure of the biggest & most visible organ in the body THE SKIN, is described in detail along with its associated structures. The book has 3 distinct sections each listed in the A to Z way, with clear colourful diagrams. A large Common Terms section explains & illustrates terminology on the subject. With over 230 pages & 280 illustrations it still fits in your pocket for convenience.

The A to Z of Peripheral Nerves


ISBN 978-1-921930-05-8

The origins, pathways, branches and functions of all the Peripheral nerves are listed alphabetically and illustrated individually. The main content includes neurological testing techniques, basic structural components of the nervous system and overviews of the major nerve plexi. It begins with a comprehensive glossary of all terms, and illustrations of basic anatomical principles. With over 230 pages and 290 illustrations this strong little book still fits in your pocket.

The A to Z of Skeletal Muscles

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ISBN 978-1-921930-188

The origins, insertions, blood & nerve supply for all muscles are listed alphabetically with separate illustrations. All the major muscle groups, their common names their functions, along with cross-referencing and regional tagging are included. Basic structural components of the skeletal muscle system are included with a comprehensive glossary of all terms used in the field. With over 230 pages and 290 illustrations this strong little book still fits in your pocket

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The A to Z of Bones, Joints, Ligaments & the BACK


ISBN 978-1-921930-19-5 All the bones, joints and ligaments of the body including teeth are listed alphabetically. At least 2 views of each bone and joint are illustrated. The Range of movement and basic structure of all the skeletal components are categorized and illustrated. There is a separate section on the back Vertebral Column where it is discussed as a functioning unit. Over 260 pages and 300 illustrations make this little pocket book invaluable.

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The A to Z of Bones and Joint Failure


ISBN 978-1-921930-04-1 All the bones, joints and ligaments of the body have been covered in the A to Z book on these tissues so this is the follow-up book on their pathology analysing their failures due to various causes. It goes into the microstructure, development, control and formation and how these tissues interact and change under stress and with age. There are over 280 pages and 350 illustrations in this concise pocket book reference.

The A to Z of the Heart


ISBN 978-0-9806840-6-3

The heart is comprehensively illustrated along with the great vessels. This book also includes illustrations of all the major vascular structures and describes the circulation of the major organs and systems. The clinical section contains examination and testing of the heart and blood vessel flow. Arteries, veins, capillaries and lymphatics their pathways and special features are present in this book of over 240 pages and 300 illustrations.

The A to Z of the Digestive Tract

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ISBN 978-1-921930-00-3

The Digestive tract is one long tunnel from food to faeces its components are individually illustrated, colour tagged and listed alphabetically along with many of its adjunct organs. Their structure and functions are also clearly described along with sectional overviews. In particular detailed descriptions of the intricacies of the oral cavity, the processes of swallowing are included in this book of 240 pages and 300 illustrations.

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The A to Z of the Head and Neck Muscles & Bones


ISBN 978-1-921930-12-6 interactions between the many muscular layers of this area, listing alphabetically and illustrating each muscle individually in one section then examining the individual bones and teeth in the same manner. The skull is also illustrated as a unit, in this book of 280 pages and 300 illustrations.

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The A to Z of Surface Anatomy


ISBN 978-1-921930-17-1 The surface anatomy of all anatomical regions and structures are illustrated at several levels form superficial to deep. Methods of locating structures deep in the body using common landmarks are illustrated cross referenced and listed alphabetically. Proportions and relations between limb and regional sizes are charted extensively. Photographs as well as detailed graphics are used extensively, in this book of 240 pages and 300 illustrations.

The A to Z of the Brain & Cranial Nerves


ISBN 978-0-9806840-2-5

The brain as an entity and the individual structures within it are illustrated and then listed with their functions alphabetically sections on the testing and pathways and interactions of cranial nerves are also included in a separate clinical section in this book of 240 pages and 300 illustrations.

The A to Z of Medical Terms


ISBN 978-1-921930-01-0

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This book is invaluable as a medical terminology reference initially designed for the derivation of the anatomical terms; it has expanded to include tables of medical, pathological and other specialist terms; tables of prefixes and suffixes which allow interpretation of terms and lists of abbreviations commonly in use. It also includes forms of address, titles, major medical associations and other useful material. These colour-coded illustrated sections are clear and concise. Special rates for students and libraries.

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The A to Z of Bones, Joints, Ligaments & the Back

The A to Zs Dr. A. L. NEILL BSc MSc MBBS PhD FACBS medicalamanda@gmail.com www.amandasatoz.com