Chapter 5 The Skeletal System

5
Function Preview
◗ The skeletal system provides
an internal framework for
the body, protects organs
by enclosure, and anchors
skeletal muscles so that
muscle contraction can
cause movement.
The Skeletal
System
Although the word skeleton comes from the skeleton, the bones of the limbs and girdles that
Greek word meaning “dried-up body,” our inter- are “appended” (attached) to the axial skeleton. In
nal framework is so beautifully designed and en- addition to bones, the skeletal system includes
gineered that it puts any modern skyscraper to joints, cartilages, and ligaments (fibrous cords that
shame. Strong yet light, it is perfectly adapted bind the bones together at joints). The joints give
for its functions of body protection and motion. the body flexibility and allow movement to occur.
No other animal has such relatively long legs
(compared to the arms or forelimbs) or such a
strange foot, and few have such remarkable grasp- Bones: An Overview
ing hands. Even though the infant’s backbone is 5-1 Identify the subdivisions of the skeleton as axial or
like an arch, it soon changes to the swayback, or appendicular.
S-shaped, structure that is required for the upright 5-2 List at least three functions of the skeletal system.
posture.
5-3 Name the four main classifications of bones.
The skeleton is subdivided into two divisions:
the axial skeleton, the bones that form the lon- At one time or another, all of us have heard the
gitudinal axis of the body, and the appendicular expressions “bone tired,” “dry as a bone,” or “bag of
Chapter 5: The Skeletal System 159
bones”—pretty unflattering and inaccurate images

of some of our most phenomenal organs. Our
brains, not our bones, convey feelings of fatigue,
and bones are far from dry. As for “bag of bones,”
they are indeed more obvious in some of us, but
without bones to form our internal skeleton, we
would creep along the ground like slugs, lacking
any definite shape or form. Let’s examine how our
bones contribute to overall body homeostasis.
Functions of the Bones

Besides contributing to body shape and form, our
bones perform several important body functions:
5
1. Support. Bones, the “steel girders” and “rein-
forced concrete” of the body, form the internal Spongy
framework that supports the body and cradles bone
its soft organs. The bones of the legs act as pil-
lars to support the body trunk when we stand, Compact
and the rib cage supports the thoracic wall. bone
2. Protection. Bones protect soft body organs. Figure 5.1 Flat bones consist of a layer of
For example, the fused bones of the skull pro- spongy bone sandwiched between two thin
vide a snug enclosure for the brain, allowing layers of compact bone.
someone to head a soccer ball without worry-
ing about injuring the brain. The vertebrae sur- Explore human cadaver
round the spinal cord, and the rib cage helps >Study Area>
protect the vital organs of the thorax.
3. Movement. Skeletal muscles, attached to
bones by tendons, use the bones as levers to too much. Hormones control the movement of
move the body and its parts. As a result, we calcium to and from the bones and blood accord-
can walk, swim, throw a ball, and breathe. ing to the needs of the body. Indeed, “deposits”
Before continuing, take a moment to imagine and “withdrawals” of calcium (and other miner-
that your bones have turned to putty. What als) to and from bones go on almost all the time.
if you were running when this change took 5. Blood cell formation. Blood cell formation,
place? Now imagine your bones forming a rigid or hematopoiesis (hem″ah-to-poi-e′sis), occurs
metal framework inside your body, somewhat within the marrow cavities of certain bones.
like a system of plumbing pipes. What prob-
lems could you envision with this arrangement? Classification of Bones
These images should help you understand how The adult skeleton is composed of 206 bones.
well our skeletal system provides support and There are two basic types of osseous, or bone, tis-
protection while allowing movement. sue: Compact bone is dense and looks smooth
4. Storage. Fat is stored in the internal (marrow) and homogeneous (Figure 5.1). Spongy bone is
cavities of bones. Bone itself serves as a store- composed of small needlelike pieces of bone and
house for minerals, the most important of which lots of open space.
are calcium and phosphorus. Most of the body’s Additionally, bones come in many sizes and
calcium is deposited in the bones as calcium shapes. For example, the tiny pisiform bone of
salts, but a small amount of calcium in its ion the wrist is the size and shape of a pea, whereas
form (Ca2+) must be present in the blood at all the femur, or thigh bone, is nearly 2 feet long and
times for the nervous system to transmit mes- has a large, ball-shaped head. The unique shape
sages, for muscles to contract, and for blood to of each bone fulfills a particular need. Bones are
clot. Problems occur not only when there is too classified according to shape into four groups:
little calcium in the blood, but also when there is long, short, flat, and irregular (Figure 5.2, p. 160).
160 Essentials of Human Anatomy and Physiology
(c) Flat bone (sternum)
(a) Long bone (humerus)
(b) Irregular bone (vertebra),

right lateral view (d) Short bone (talus)
Figure 5.2 Classification of bones on the basis of shape.
As their name suggests, long bones are typi- (see Figure 5.1). Most bones of the skull, the ribs,
cally longer than they are wide. As a rule, they and the sternum (breastbone) are flat bones.
have a shaft with heads at both ends. Long bones Bones that do not fit one of the preceding
are mostly compact bone. All the bones of the categories are called irregular bones. The verte-
limbs, except the patella (kneecap) and the wrist brae, which make up the spinal column, and the
and ankle bones, are long bones. hip bones fall into this group.
Short bones are generally cube-shaped and con-
tain mostly spongy bone. The bones of the wrist and Did You Get It?
ankle are short bones. Sesamoid (ses′ah-moyd) bones,
1. What is the relationship between muscle function
which form within tendons, are a special type of short and bones?
bone. The best-known example is the patella.
2. What are two functions of a bone’s marrow cavities?
Flat bones are thin, flattened, and usually
curved. They have two thin layers of compact bone 3. Where are most long bones found in the body?
sandwiching a layer of spongy bone between them (For answers, see Appendix D.)
Structure of Bone marrow is found there. In adult bones, red mar-

row is confined to cavities in the spongy bone of
5-4 Identify the major anatomical areas of a long bone.
flat bones and the epiphysis of some long bones.
5-5 Describe the microscopic structure of compact Even when looking casually at bones, you
bone.
can see that their surfaces are not smooth but
5-6 Explain the role of bone salts and the organic scarred with bumps, holes, and ridges. These
matrix in making bone both hard and flexible.
bone markings (described and illustrated in
Table 5.1 on p. 164) reveal where muscles, ten-
Gross Anatomy of a Long Bone
dons, and ligaments were attached and where
blood vessels and nerves passed. There are two
As we learn about the structure and
categories of bone markings: (a) projections, or pro-
organization of bones, remember the levels of
cesses, which grow out from the bone surface, and
structural organization (Figure 1.1, p. 27).
(b) depressions, or cavities, which are indentations 5
Bones are organs, and so they contain not
in the bone. You do not have to learn these terms
only osseous tissue, but also several other
now, but they can help you remember some of the
connective tissues: fibrous tissue, cartilage,
specific markings on bones that we will introduce
adipose tissue, and blood.
later in this chapter.
There is a little trick for remembering some of
In a long bone, the diaphysis (di-af′ı̆-sis), or shaft, the bone markings listed in the table: All the terms
makes up most of the bone’s length and is com- beginning with T are projections. The terms be-
posed of compact bone (Figure 5.3, p. 162). The ginning with F (except facet) are depressions.
diaphysis is covered and protected by a fibrous
connective tissue membrane, the periosteum (per- Microscopic Anatomy
e-ŏs′te-um). Hundreds of connective tissue fibers, To the naked eye, spongy bone has a spiky, open
called perforating, or Sharpey’s, fibers, secure appearance, whereas compact bone appears to
the periosteum to the underlying bone. be very dense. Looking at compact bone tissue
The epiphyses (ĕ-pif′ı̆-sēz) are the ends of through a microscope, however, you can see that
the long bone. Each epiphysis consists of a thin it has a complex structure (Figure 5.4, p. 163).
layer of compact bone enclosing an area filled It is riddled with passageways carrying nerves,
with spongy bone. Articular cartilage, instead of blood vessels, and the like, which provide the
a periosteum, covers its external surface. Because living bone cells with nutrients and a route for
the articular cartilage is glassy hyaline cartilage, it waste disposal. The mature bone cells, osteocytes
provides a smooth, slippery surface that decreases (os′te-o-sı̄tz″ ), are found within the matrix in tiny
friction at joint surfaces. cavities called lacunae (lah-ku′ne). The lacunae
In adult bones, there is a thin line of bony tis- are arranged in concentric circles called lamellae
sue spanning the epiphysis that looks a bit different (lah-mel′e) around central (Haversian) canals.
from the rest of the bone in that area. This is the Each complex consisting of central canal and matrix
epiphyseal line. The epiphyseal line is a remnant rings is called an osteon, or Haversian system.
of the epiphyseal plate (a flat plate of hyaline car- Central canals run lengthwise through the bony
tilage) seen in a young, growing bone. Epiphyseal matrix, carrying blood vessels and nerves to
plates cause the lengthwise growth of a long bone. all areas of the bone. Tiny canals, canaliculi
By the end of puberty, when hormones inhibit long (kan″ah-lik′u-li), radiate outward from the central
bone growth, epiphyseal plates have been com- canals to all lacunae. The canaliculi form a trans-
pletely replaced by bone, leaving only the epiphy- portation system that connects all the bone cells
seal lines to mark their previous location. to the nutrient supply through the hard bone
The inner bony surface of the shaft is covered matrix. Because of this elaborate network of ca-
by endosteum, a delicate connective tissue lining. nals, bone cells are well nourished in spite of the
In adults, the cavity of the shaft is primarily a stor- hardness of the matrix, and bone injuries heal
age area for adipose (fat) tissue. It is called the quickly and well. The communication pathway
yellow marrow, or medullary, cavity. However, from the outside of the bone to its interior (and
in infants this area forms blood cells, and red the central canals) is completed by perforating
Articular
cartilage
Compact bone
Proximal
epiphysis
Spongy bone
Epiphyseal
line
Periosteum
Compact bone
Medullary
cavity (lined
by endosteum) (b)
Diaphysis Endosteum
Yellow
bone marrow
Compact bone
Periosteum
Distal Perforating
epiphysis (Sharpey’s)
fibers
(a)
Nutrient
arteries
(c)
Figure 5.3 The structure of a long bone (humerus of arm). (a) Anterior Practice art labeling
view with longitudinal section cut away. (b) Pie-shaped, three-dimensional >Study Area>Chapter 5
view of spongy bone and compact bone of the epiphysis. (c) Cross section of
the shaft (diaphysis). Note that the external surface of the diaphysis is covered
by a periosteum, but the articular surface of the epiphysis (see a and b) is
covered with hyaline cartilage.
(Volkmann’s) canals, which run in the compact crude) supporting system without giving up mo-
bone at right angles to the shaft. bility. The calcium salts deposited in the matrix
Bone is one of the hardest materials in the give bone its hardness, which resists compres-
body, and although relatively light in weight, it sion. The organic parts (especially the collagen
has a remarkable ability to resist tension and fibers) provide for bone’s flexibility and great
other forces acting on it. Nature has given us an tensile strength (ability to be stretched without
extremely strong and exceptionally simple (almost breaking).
Spongy
bone
Osteon
(Haversian Perforating
5
system) (Volkmann’s)
canal
Lamellae Blood vessel continues
into medullary cavity
containing marrow
Blood vessel
Compact bone
Central (Haversian) canal

Perforating (Sharpey’s)
fibers
Periosteum
Periosteal
blood vessel
(a)
Lamella Osteon
Osteocyte
Interstitial
lamellae
Canaliculus
Lacuna
Central
(Haversian) canal
(b) (c)
Figure 5.4 Microscopic structure of compact bone. (a) Diagram of a View histology slides
pie-shaped segment of compact bone illustrating its structural units (osteons). >Study Area>
(b) Higher magnification view of part of one osteon. Notice the position of
osteocytes in lacunae (cavities in the matrix). (c) Photo of a cross-sectional view
of an osteon.
Table 5.1 Bone Markings
Name of bone marking Description Illustration
Projections that are sites of muscle and ligament attachment

Tuberosity Large, rounded projection; Intertrochanteric
Trochanter
may be roughened line
Iliac
Crest Narrow ridge of bone; crest
usually prominent
Trochanter (tro-kan’ter) Very large, blunt,

irregularly shaped Ischial
process (the only spine Adductor
tubercle
examples are on the
Hip Femur
femur) Ischial of Medial
bone tuberosity epicondyle
Line Narrow ridge of bone; thigh
less prominent than a crest Condyle
Tubercle (too’ber-kl) Small, rounded projection or process

Vertebra
Epicondyle Raised area on or above a condyle
Spine Sharp, slender, often pointed projection Facet

Spinous
Process Any bony prominence process
Projections that help to form joints

Head Bony expansion carried on a
Head
narrow neck Condyle
Facet Smooth, nearly flat articular surface Ramus
Facets
Condyle (kon’dı̄l) Rounded articular projection
Rib Mandible
Ramus (ra’mus) Armlike bar of bone
Depressions and openings

For passage of blood vessels and nerves
Meatus
Groove Furrow Sinus
Fissure Narrow, slitlike opening
Fossa
Foramen (fo-ra’men) Round or oval opening through a bone Notch

Groove
Notch Indentation at the edge of a structure
Others
Meatus (me-a’tus) Canal-like passageway

Inferior

orbital
Sinus Cavity within a bone, filled with air and fissure

lined with mucous membrane Foramen
Fossa (fos’ah) Shallow, basinlike depression in a bone,
often serving as an articular surface
Skull
Articular
cartilage
Hyaline Spongy
cartilage bone
New center of
bone growth New bone
Epiphyseal forming
plate
cartilage Growth
Medullary in bone
cavity width
Bone starting
to replace
Invading
Growth blood
5
cartilage in bone vessels
length
New bone
Bone collar forming
Hyaline Epiphyseal
cartilage plate cartilage
model
In an embryo In a fetus In a child
Figure 5.5 Stages of long-bone formation in an embryo, fetus,
and young child.
Did You Get It? Except for flat bones, which form on fibrous
membranes, most bones develop using hyaline car-
4. What is the anatomical name for the shaft of a long
bone? For its ends? tilage structures as their “models.” Most simply, this
process of bone formation, or ossification (os″ı̆-fı̆-
5. How does the structure of compact bone differ
ka′shun), involves two major phases (Figure 5.5).
from the structure of spongy bone when viewed
with the naked eye? First, the hyaline cartilage model is completely cov-
ered with bone matrix (a bone “collar”) by bone-
6. What is the importance of canaliculi?
forming cells called osteoblasts. So, for a short
(For answers, see Appendix D.) period, the fetus has cartilage “bones” enclosed by
“bony” bones. Then, the enclosed hyaline carti-
Bone Formation, Growth, lage model is digested away, opening up a medul-
and Remodeling lary cavity within the newly formed bone.
5-7 Describe briefly the process of bone formation By birth or shortly after, most hyaline cartilage
in the fetus, and summarize the events of bone models have been converted to bone except for
remodeling throughout life. two regions—the articular cartilages (that cover
the bone ends) and the epiphyseal plates. New
Bone Formation and Growth cartilage is formed continuously on the external
The skeleton is formed from two of the strongest face of the articular cartilage and on the epiphy-
and most supportive tissues in the body—cartilage seal plate surface that faces the bone end (is far-
and bone. In embryos, the skeleton is primarily ther away from the medullary cavity). At the same
made of hyaline cartilage, but in the young child, time, the old cartilage abutting the internal face
most of the cartilage has been replaced by bone. of the articular cartilage and the medullary cav-
Cartilage remains only in isolated areas such as ity is broken down and replaced by bony matrix
the bridge of the nose, parts of the ribs, and the (Figure 5.6, p. 166).
joints.
Bone growth Bone remodeling

Bone grows in Growing shaft is
length because: remodeled as:
1 Cartilage Articular cartilage

grows here.
Epiphyseal plate
2 Cartilage
is replaced 1 Bone is
by bone here. resorbed here.
3 Cartilage 2 Bone is added
grows here. by appositional
growth here.
4 Cartilage
is replaced by 3 Bone is
bone here. resorbed here.
Figure 5.6 Growth and articular cartilages and epiphyseal growth during long-bone
remodeling of long bones. The plates as the bone grows in length. growth to maintain proper bone
events at the left depict the process The events at the right show bone proportions.
of ossification that occurs at the remodeling and appositional
Growing bones also must widen as they hormone (PTH) into the blood. PTH activates
lengthen. How do they widen? Simply, osteoblasts osteoclasts, giant bone-destroying cells in bones,
in the periosteum add bone tissue to the external to break down bone matrix and release calcium
face of the diaphysis as cells called osteoclasts in ions into the blood. When blood calcium levels
the endosteum remove bone from the inner face are too high (hypercalcemia [hi″per-kal-se′me-ah]),
of the diaphysis wall (see Figure 5.6). Because calcium is deposited in bone matrix as hard cal-
these two processes occur at about the same rate, cium salts.
the circumference of the long bone expands and Bone remodeling is essential if bones are
the bone widens. This process by which bones to retain normal proportions and strength during
increase in diameter is called appositional growth. long-bone growth as the body increases in size
This process of long-bone growth is controlled by and weight. It also accounts for the fact that bones
hormones, the most important of which are growth become thicker and form large projections to in-
hormone and, during puberty, the sex hormones. It crease their strength in areas where bulky muscles
ends during adolescence, when the epiphyseal are attached. At such sites, osteoblasts lay down
plates are completely converted to bone. new matrix and become trapped within it. (Once
they are trapped, they become osteocytes, or ma-
Bone Remodeling ture bone cells.) In contrast, the bones of bedrid-
Many people mistakenly think that bones are life- den or physically inactive people tend to lose
less structures that never change once long-bone mass and to atrophy because they are no longer
growth has ended. Nothing could be further from subjected to stress.
the truth; bone is a dynamic and active tissue. These two controlling mechanisms—calcium
Bones are remodeled continually in response to uptake and release and bone remodeling—work
changes in two factors: (1) calcium levels in the together. PTH determines when (or if ) bone is
blood and (2) the pull of gravity and muscles on to be broken down or formed in response to the
the skeleton. We outline how these factors influ- need for more or fewer calcium ions in the blood.
ence bones next. The stresses of muscle pull and gravity acting on
When blood calcium levels drop below ho- the skeleton determine where bone matrix is to be
meostatic levels, the parathyroid glands (located broken down or formed so that the skeleton can
in the throat) are stimulated to release parathyroid remain as strong and vital as possible.
Focus on cAREERs
Radiologic Technologist
Radiologic technologists supply constantly moving from here to
critical information that allows there, from surgery to the neonatal
doctors to make accurate intensive care unit and so on.”
diagnoses. As you might guess, radiologic
technologists, especially in hospitals,
“You never know what’s going
must be prepared to spend a lot
to walk in the door, really,” says
of time on their feet and to think
Maggie Regalado, a radiologic
quickly. Regalado described one
technologist at Dell Children’s
case when a two-car accident sent
Hospital in Austin, Texas. “In an
five children to the trauma unit. The
emergency room, you see kids
radiologic technologists had to work
who swallowed something, car
quickly to help the doctors see what
accident victims, all kinds of things.”
injuries the children suffered—and
Regalado and her coworkers
equally important, to make sure not
operate X-ray equipment and must
to mix up anyone’s X-ray exams.
be ready to do everything from
“You don’t want to make errors,
preparing patients for chest X-ray
because one thing you do wrong
exams to MRIs.
could cost this patient his or her
Fortunately for Regalado,
life.” she says. “Even though
anatomy was her favorite class,
radiology can get emotional, you
because it’s an important one for
have to stay technical with your job.”
radiologic technologists. After
“We can’t see your bones with
getting her associate’s degree in
our bare eyes, so we have to make
diagnostic imaging, she completed
sure we position you correctly. Then
both state and national certification. day, and often are required to be on-
also, if you say, ‘It hurts here,’ I’ll call
To keep her certification current, call in addition to their regular shifts.
the doctor and see if he wants to do
she must complete 24 hours of Technologists who work in clinics
a different type of X-ray exam.”
continuing education every 2 years. usually have a more traditional
Regalado enjoys working with the
9-to-5 schedule. Depending on
patients at Dell. Getting children to
the clinic, these technologists
remain perfectly still and positioned
You don’t want correctly is a challenge, but the
may also specialize in areas such
as ultrasound, mammography,
imaging department has toys and
to make errors, televisions to distract them. For
magnetic resonance imaging (MRI),
or computed tomography (CT).
babies who cannot easily hold still or
because one thing understand why they need to, there For more information, contact:
are various devices to position them
you do wrong could appropriately.
American Society of Radiologic
Technologists
“We have a lot of interaction
cost this patient his with the patients, with the patient’s
15000 Central Ave. SE
Albuquerque, NM 87123-3909
family, we try to joke around and
or her life. make them happy,” she say. “When
(800) 444-2778
http://www.asrt.org
we make the child happy, then the
parents are happy.” For additional information on this
“I didn’t realize how big a field it In a hospital setting, radiologic career and others, click the Focus on
was,” she says. “With X rays you’re technologists are needed 24 hours a Careers link at .
167
Table 5.2 Common Types of Fractures
Fracture type Illustration Description Comment
Comminuted Bone breaks into many Particularly common in older

fragments people, whose bones are more
brittle
Compression Bone is crushed Common in porous bones (i.e.,

osteoporotic bones of older
people)
Depressed Broken bone portion is Typical of skull fracture

pressed inward
Impacted Broken bone ends are Commonly occurs when

forced into each other someone attempts to break a
fall with outstretched arms
Spiral Ragged break occurs when Common sports fracture

excessive twisting forces
are applied to a bone
Greenstick Bone breaks incompletely, Common in children, whose

much in the way a green bones are more flexible than
twig breaks those of adults
Homeostatic Imbalance 5.1 foods are fortified with vitamin D, and most children
Rickets is a disease of children in which the bones drink enough calcium-rich milk. However, it can hap-
fail to calcify. As a result, the bones soften, and the pen in infants nursed by mothers who become vita-
weight-bearing bones of the legs show a definite min D-deficient over the course of a long gray winter,
bowing. Rickets is usually due to a lack of calcium in and it remains a problem in some other parts of the
the diet or lack of vitamin D, which is needed to ab- world. ....................................................................................✚
sorb calcium into the bloodstream. Rickets is not seen
very often in the United States. Milk, bread, and other Did You Get It?
7. Bones don’t begin as bones. What do they begin as?
8. Which stimulus—PTH (a hormone) or mechanical
forces acting on the skeleton—is more important
in maintaining blood calcium levels than in
maintaining bone strength?
9. If osteoclasts in a long bone are more active than
osteoblasts, what change in bone mass is likely to occur?
(For answers, see Appendix D.)
Bone Fractures
5-8 Name and describe the various types of
fractures.
Homeostatic Imbalance 5.2

For their relatively low mass, bones are amazingly
strong. Consider, for example, the forces endured
This child suffering from rickets is a member of the el-Molo
tribe in Kenya, whose diet consists primarily of fish. in touch football and professional hockey. Despite
Hematoma
External Bony
callus callus of
spongy
bone
New
Internal blood
callus vessels Healed
(fibrous fracture
tissue and Spongy
cartilage) bone
trabecula
5
1 Hematoma 2 Fibrocartilage 3 Bony callus 4 Bone remodeling
forms. callus forms. forms. occurs.
Figure 5.7 Stages in the healing of a bone fracture.
their remarkable strength, bones are susceptible blood-filled swelling called a hematoma (he-
to fractures, or breaks, all through life. During mah-to′mah) forms. Bone cells deprived of
youth, most fractures result from exceptional nutrition die.
trauma that twists or smashes the bones. Sports ac- 2 A fibrocartilage callus forms. An early
tivities such as football, skating, and skiing jeopar- event of tissue repair—and bone repair is no
dize the bones, and automobile accidents certainly exception—is the growth of new capillaries
take their toll. In old age, bones thin and weaken, (granulation tissue) into the clotted blood at
and fractures occur more often. the site of the damage and disposal of dead
A fracture in which the bone breaks cleanly tissue by phagocytes (recall what you learned
but does not penetrate the skin is a closed (or in Chapter 3). As this goes on, connective tis-
simple) fracture. When the broken bone ends sue cells of various types form a mass of re-
penetrate through the skin, the fracture is open pair tissue, the fibrocartilage callus (kal′us),
(or compound). (Some of the many common that contains several elements—some cartilage
types of fractures are illustrated and described in matrix, some bony matrix, and collagen fibers—
Table 5.2). .................................................................✚ and acts to “splint” the broken bone, closing
A fracture is treated by reduction, which is the the gap.
realignment of the broken bone ends. In closed re- 3 The bony callus forms. As more osteoblasts
duction, the bone ends are coaxed back into their and osteoclasts migrate into the area and multi-
normal position by the physician’s hands. In open ply, the fibrocartilage callus is gradually replaced
reductions, surgery is performed, and the bone by the bony callus made of spongy bone.
ends are secured together with pins or wires. After 4 Bone remodeling occurs. Over the next few
the broken bone is reduced, it is immobilized by a weeks to months, depending on the bone’s
cast or traction to allow the healing process to be- size and site of the break, the bony callus is
gin. The healing time for a simple fracture is 6 to remodeled in response to the mechanical
8 weeks, but it is much longer for large bones and stresses placed on it, so that it forms a strong,
for the bones of older people (because of their permanent “patch” at the fracture site.
poorer circulation).
The repair of bone fractures involves four ma- Did You Get It?
jor events (Figure 5.7):
10. What is a fracture? What two fracture types are
1 A hematoma forms. Blood vessels are rup- particularly common in older people?
tured when the bone breaks. As a result, a
Cranium
Skull
Facial bones
Bones of
pectoral
Clavicle
girdle
Thoracic cage Scapula
(ribs and
sternum) Sternum Upper
limb
Rib
Humerus
Vertebra
Vertebral
column Radius Bones
Ulna of
pelvic
Sacrum girdle
Carpals
Phalanges
Metacarpals
Femur
Patella
Lower
limb
Tibia
Fibula
Tarsals
Metatarsals
Phalanges
(a) Anterior view (b) Posterior view

Figure 5.8 The human skeleton. The bones of the axial skeleton are colored
green. Bones of the appendicular skeleton are gold.
Axial Skeleton (it is shown as the green portion of Figure 5.8). It

can be divided into three parts—the skull, the verte-
As noted earlier, the skeleton is divided into two bral column, and the thoracic cage.
parts, the axial and appendicular skeletons. The ax-
ial skeleton forms the longitudinal axis of the body
Coronal suture Frontal bone
Parietal bone
Sphenoid bone
Temporal bone Ethmoid bone
Lambdoid Lacrimal bone

suture
Squamous suture
Nasal bone
Occipital bone
Zygomatic bone
5
Zygomatic process
Maxilla
External acoustic meatus
Mastoid process
Alveolar processes
Styloid process
Mandible (body)
Mental foramen
Mandibular ramus
Figure 5.9 Human skull, lateral view. Practice art labeling

>Study Area>Chapter 5
Cranium
Recall the regional body terms you have
already learned (Figure 1.5, p. 40). Many of these The boxlike cranium is composed of eight large
terms can be associated with a bone name or flat bones. Except for two paired bones (the pari-
group of bones. For example, the carpal region is etal and temporal), they are all single bones.
the location of the carpals, or wrist bones. Frontal Bone The frontal bone forms the fore-
head, the bony projections under the eyebrows, and
the superior part of each eye’s orbit (Figure 5.9).
Skull
5-9 On a skull or diagram, identify and name the Parietal Bones The paired parietal bones
bones of the skull. form most of the superior and lateral walls of the
5-10 Describe how the skull of a newborn infant (or cranium (see Figure 5.9). They meet in the midline
fetus) differs from that of an adult, and explain of the skull at the sagittal suture and form the
the function of fontanels. coronal suture, where they meet the frontal
bone.
The skull is formed by two sets of bones. The
cranium encloses and protects the fragile brain Temporal Bones The temporal bones lie in-
tissue. The facial bones hold the eyes in an ante- ferior to the parietal bones; they join them at the
rior position and allow the facial muscles to show squamous sutures. Several important bone mark-
our feelings through smiles or frowns. All but one ings appear on the temporal bone (see Figure 5.9):
of the bones of the skull are joined together by • The external acoustic meatus is a canal that
sutures, which are interlocking, immovable joints. leads to the eardrum and the middle ear. It is
Only the mandible (jawbone) is attached to the the route by which sound enters the ear.
rest of the skull by a freely movable joint. • The styloid process, a sharp, needlelike pro-
jection, is just inferior to the external auditory
Frontal bone
Cribriform plate
Ethmoid
Crista galli bone
Sphenoid
bone Optic canal
Sella turcica
Foramen ovale
Temporal bone
Jugular foramen
Internal
acoustic meatus
Parietal bone
Occipital bone
Foramen magnum Practice art labeling

Figure 5.10 Human skull, superior view (top of cranium removed).
meatus. Many neck muscles use the styloid pro- through which the internal carotid artery runs,
cess as an attachment point. supplying blood to most of the brain.
• The zygomatic (zi″go-mat′ik) process is a thin
Occipital Bone The occipital (ok-sip′ı̆-tal) bone
bridge of bone that joins with the cheekbone is the most posterior bone of the cranium (as you
(zygomatic bone) anteriorly. can see in Figures 5.9, 5.10, and 5.11). It forms the
• The mastoid (mas′toid) process, which is full base and back wall of the skull. The occipital bone
of air cavities (mastoid sinuses), is a rough joins the parietal bones anteriorly at the lambdoid
projection posterior and inferior to the external (lam′doyd) suture. In the base of the occipital
acoustic meatus. It provides an attachment site bone is a large opening, the foramen magnum
for some muscles of the neck. (literally, “large hole”). The foramen magnum sur-
The mastoid sinuses are so close to the rounds the lower part of the brain and allows the
middle ear—a high-risk spot for infections—that spinal cord to connect with the brain. Lateral to the
they may become infected too, a condition called foramen magnum on each side are the rockerlike
mastoiditis. Also, this area is so close to the brain occipital condyles (see Figure 5.11), which rest on
that mastoiditis may spread to the brain. the first vertebra of the spinal column.
• The jugular foramen, at the junction of the
Sphenoid Bone The butterfly-shaped sphenoid
occipital and temporal bones (Figure 5.10 and
(sfe′noid) bone spans the width of the skull and
Figure 5.11), allows passage of the jugular vein,
forms part of the floor of the cranial cavity (see
the largest vein of the head, which drains the
Figure 5.10). In the midline of the sphenoid is a
brain. Just anterior to it in the cranial cavity is
small depression, the sella turcica (sel′ah tur′sı̆-
the internal acoustic meatus (see Figure 5.10),
kah), or Turk’s saddle, which forms a snug enclo-
which transmits cranial nerves VII and VIII (the
sure for the pituitary gland. The foramen ovale, a
facial and vestibulocochlear nerves). Anterior
large oval opening in line with the posterior end of
to the jugular foramen on the skull’s inferior
the sella turcica (Figure 5.10), allows fibers of
aspect is the carotid canal (see Figure 5.11),
Maxilla
Hard (palatine process)
palate
Palatine bone Maxilla
Zygomatic bone
Sphenoid bone
Temporal bone (greater wing)
(zygomatic process)
Foramen ovale
Vomer
Mandibular fossa
Carotid canal 5
Styloid process
Mastoid process Jugular foramen
Temporal bone Occipital condyle
Parietal bone
Foramen magnum
Occipital bone
Figure 5.11 Human skull, inferior view (mandible removed). Practice art labeling
cranial nerve V (the trigeminal nerve) to pass to the the superior and middle nasal conchae
chewing muscles of the lower jaw (mandible). Parts (kong′ke), form part of the lateral walls of the
of the sphenoid bone, seen exteriorly forming part nasal cavity (see Figure 5.12) and increase the tur-
of the eye orbits, have two important openings, the bulence of air flowing through the nasal passages.
optic canal, which allows the optic nerve to pass
to the eye, and the slitlike superior orbital fissure, Facial Bones
through which the cranial nerves controlling eye Fourteen bones compose the face. Twelve are
movements (III, IV, and VI) pass (see Figure 5.10 paired; only the mandible and vomer are single.
and Figure 5.12, p. 174). The central part of the (Figures 5.9 and 5.12 show most of the facial bones.)
sphenoid bone is riddled with air cavities, the
sphenoidal sinuses (see Figure 5.13, p. 175). Maxillae The two maxillae (mak-si′le), or
maxillary bones, fuse to form the upper jaw. All
Ethmoid Bone The ethmoid (eth′moid) bone facial bones except the mandible join the maxillae;
is very irregularly shaped and lies anterior to the thus they are the main, or “keystone,” bones of the
sphenoid (Figure 5.12; see also Figures 5.9 and face. The maxillae carry the upper teeth in the
5.10). It forms the roof of the nasal cavity and part alveolar process.
of the medial walls of the orbits. Projecting from its Extensions of the maxillae called the palatine
superior surface is the crista galli (kris′tah gah′le), (pal′ah-tı̄n) processes form the anterior part of
literally “cock’s comb” (see Figure 5.10). The outer- the hard palate of the mouth (see Figure 5.11).
most covering of the brain attaches to this projec- Like many other facial bones, the maxillae con-
tion. On each side of the crista galli are many small tain sinuses, which drain into the nasal passages
holes. These holey areas, the cribriform (krib′rı̆- (Figure 5.13). These paranasal sinuses, whose
form) plates, allow nerve fibers carrying impulses naming reveals their position surrounding the na-
from the olfactory (smell) receptors of the nose to sal cavity, lighten the skull bones and amplify the
reach the brain. Extensions of the ethmoid bone, sounds we make as we speak.
Q: What bone articulates with every other facial bone?
Coronal suture
Frontal bone
Parietal bone
Nasal bone
Superior orbital fissure
Sphenoid bone
Optic canal
Ethmoid bone
Temporal bone
Lacrimal bone
Zygomatic bone
Middle nasal concha
of ethmoid bone
Maxilla Inferior nasal concha
Vomer
Mandible
Alveolar processes
Practice art labeling

Figure 5.12 Human skull, anterior view.
Homeostatic Imbalance 5.3 Zygomatic Bones The zygomatic bones are

The paranasal sinuses also cause many people a commonly referred to as the cheekbones. They
great deal of misery. Because the mucosa lining also form a good-sized portion of the lateral walls
these sinuses is continuous with that in the nose of the orbits, or eye sockets.
and throat, infections in these areas tend to migrate
Lacrimal Bones The lacrimal (lak′rı̆-mal) bones
into the sinuses, causing sinusitis. Depending on
are fingernail-sized bones forming part of the me-
which sinuses are infected, a headache or upper
dial walls of each orbit. Each lacrimal bone has
jaw pain is the usual result. .....................................✚
a groove that serves as a passageway for tears
Palatine Bones The paired palatine bones lie (lacrima = tear).
posterior to the palatine processes of the maxillae.
Nasal Bones The small rectangular bones form-
They form the posterior part of the hard palate
ing the bridge of the nose are the nasal bones.
(see Figure 5.11). Failure of these or the palatine
(The lower part of the skeleton of the nose is
processes to fuse medially results in cleft palate.
made up of cartilage.)
Vomer Bone The single bone in the median
A: The maxilla. line of the nasal cavity is the vomer. (Vomer means
Frontal
sinus
Ethmoid
sinus
Sphenoidal
sinus
Maxillary
sinus
Greater horn
Lesser horn
Body
5
Figure 5.14 Anatomical location and structure

of the hyoid bone. Anterior view.
(a) Anterior view
the only freely movable joints in the skull. You can

find these joints on yourself by placing your fingers
over your cheekbones and opening and closing
Frontal your mouth. The horizontal part of the mandible
sinus (the body) forms the chin. Two upright bars of
Ethmoid bone (the rami) extend from the body to connect
sinus the mandible with the temporal bone. The lower
Sphenoidal teeth lie in alveoli (sockets) in the alveolar process
sinus at the superior edge of the mandibular body.
Maxillary
sinus The Hyoid Bone
Though not really part of the skull, the hyoid
(hi′oid) bone (Figure 5.14) is closely related to the
mandible and temporal bones. The hyoid bone is
unique in that it is the only bone of the body that
does not articulate directly with any other bone.
Instead, it is suspended in the midneck region
about 2 cm (1 inch) above the larynx, where it
is anchored by ligaments to the styloid processes
(b) Medial view
of the temporal bones. Horseshoe-shaped, with a
Figure 5.13 Paranasal sinuses. body and two pairs of horns, or cornua, the hyoid
bone serves as a movable base for the tongue and
“plow,” which refers to the bone’s shape.) The vo- as an attachment point for neck muscles that raise
mer forms most of the bony nasal septum. and lower the larynx when we swallow and speak.
Inferior Nasal Conchae The inferior nasal con- Fetal Skull

chae are thin, curved bones projecting medially The skull of a fetus or newborn infant is different
from the lateral walls of the nasal cavity. (As men- in many ways from an adult skull (Figure 5.15,
tioned earlier, the superior and middle conchae are p. 176). The infant’s face is very small compared
similar but are parts of the ethmoid bone.) to the size of its cranium, but the skull as a
whole is large compared to the infant’s total body
Mandible The mandible, or lower jaw, is the
length (as you can see in Figure 5.15b). The adult
largest and strongest bone of the face. It joins the
skull represents only one-eighth of the total body
temporal bones on each side of the face, forming
Anterior flexible, they allow the infant’s brain to grow dur-

fontanel ing the later part of pregnancy and early infancy.
Frontal bone
This would not be possible if the cranial bones
were fused in sutures as in the adult skull. The
fontanels are gradually converted to bone during
the early part of infancy and can no longer be felt
Parietal by 22 to 24 months after birth.
bone
Did You Get It?
11. What are the three main parts of the axial skeleton?
Posterior fontanel
Occipital 12. Johnny was vigorously exercising the only joints in
bone the skull that are freely movable. What would you
guess he was doing?
(a) 13. Which skull bone(s) form the “keystone of the
face”?
Anterior fontanel 14. Which bone has the cribriform plate and crista
Sphenoidal galli?
Parietal bone fontanel
15. Which bones are connected by the coronal suture?
Frontal By the sagittal suture?
Posterior bone
fontanel (For answers, see Appendix D.)
Vertebral Column (Spine)

5-11 Name the parts of a typical vertebra, and explain
Occipital in general how the cervical, thoracic, and lumbar
bone vertebrae differ from one another.
Mastoid 5-12 Discuss the importance of the intervertebral discs
fontanel and spinal curvatures.
Temporal bone
5-13 Explain how the abnormal spinal curvatures
(b) (scoliosis, lordosis, and kyphosis) differ from one
another.
Figure 5.15 The fetal skull. (a) Superior view.
(b) Lateral view. Serving as the axial support of the body, the ver-
tebral column, or spine, extends from the skull,
Practice art labeling which it supports, to the pelvis, where it transmits
the weight of the body to the lower limbs. Some
people think of the vertebral column as a rigid sup-
porting rod, but that picture is inaccurate. Instead,
length, whereas that of a newborn infant is one-
the spine is formed from 26 irregular bones con-
fourth as long as its entire body. When a baby is
nected and reinforced by ligaments in such a way
born, its skeleton is still unfinished. As noted ear-
that a flexible, curved structure results (Figure 5.16).
lier, some areas of hyaline cartilage still remain to
Running through the central cavity of the vertebral
be ossified, or converted to bone. In the newborn,
column is the delicate spinal cord, which the verte-
the skull also has fibrous regions that have yet to
bral column surrounds and protects.
be converted to bone. These fibrous membranes
Before birth, the spine consists of 33 separate
connecting the cranial bones are called fontanels
bones called vertebrae, but 9 of these eventu-
(fon″tah-nelz′). The rhythm of the baby’s pulse
ally fuse to form the two composite bones, the
can be felt in these “soft spots,” which explains their
sacrum and the coccyx, that construct the inferior
name (fontanel = little fountain). The largest fonta-
portion of the vertebral column. Of the 24 single
nel is the diamond-shaped anterior fontanel. The
bones, the 7 vertebrae of the neck are cervical
fontanels allow the fetal skull to be compressed
vertebrae, the next 12 are the thoracic vertebrae,
slightly during birth. In addition, because they are
Anterior Posterior
1st cervical
vertebra (atlas)
Cervical
curvature
2nd cervical (concave)
vertebra (axis) 7 vertebrae,
C1 – C7
1st thoracic
vertebra
Transverse
5
process Figure 5.17 The C-shaped spine typical of a
newborn.
Spinous Thoracic
process curvature
(convex) and the remaining 5 supporting the lower back
12 vertebrae, are lumbar vertebrae.
T1 – T12 • Remembering common meal times, 7 a.m., 12
Intervertebral
disc noon, and 5 p.m., may help you to recall the
number of bones in these three regions of the
vertebral column.
Intervertebral
foramen The individual vertebrae are separated by pads
of flexible fibrocartilage—intervertebral discs—
that cushion the vertebrae and absorb shocks
1st lumbar while allowing the spine flexibility. In a young
vertebra person, the discs have a high water content (about
Lumbar
curvature
90 percent) and are spongy and compressible. But
(concave) as a person ages, the water content of the discs
5 vertebrae, decreases (as it does in other tissues throughout
L1 – L 5 the body), and the discs become harder and less
compressible.
Sacral
curvature Drying of the discs, along with a weakening of
(convex) the ligaments of the vertebral column, predisposes
5 fused older people to herniated (“slipped”) discs.
vertebrae However, herniation also may result when the ver-
Coccyx tebral column is subjected to exceptional twisting
4 fused forces. If the protruding disc presses on the spinal
vertebrae cord or the spinal nerves exiting from the cord,
numbness and excruciating pain can result. ........✚
Figure 5.16 The vertebral column. Thin discs
between the thoracic vertebrae allow great flexibility The discs and the S-shaped structure of the
in the thoracic region; thick discs between the lumbar vertebral column work together to prevent shock
vertebrae reduce flexibility. Notice that the terms to the head when we walk or run. They also make
convex and concave refer to the curvature of the the body trunk flexible. The spinal curvatures in
posterior aspect of the vertebral column. the thoracic and sacral regions are referred to
as primary curvatures because they are pres-
ent when we are born. Together the two pri-
mary curvatures produce the C-shaped spine of
the newborn baby (Figure 5.17). The curvatures
Posterior
Lamina Vertebral
arch
Transverse Spinous
process process
Superior
articular
process
and
facet
(a) Scoliosis (b) Kyphosis (c) Lordosis
Pedicle Vertebral
Figure 5.18 Abnormal spinal curvatures. foramen
Body
in the cervical and lumbar regions are referred to
as secondary curvatures because they develop Anterior
some time after birth. In adults, the secondary Figure 5.19 A typical vertebra, superior view.
curvatures allow us to center our body weight on (Inferior articulating surfaces are not shown.)
our lower limbs with minimum effort. The cervical
curvature appears when a baby begins to raise its Practice art labeling
head, and the lumbar curvature develops when >Study Area>Chapter 5
the baby begins to walk.
Homeostatic Imbalance 5.5 • Spinous process: single projection arising

Why do they do “spine checks” in middle school? from the posterior aspect of the vertebral arch
The answer is that they are looking for abnor- (actually the fused laminae).
mal spinal curvatures. There are several types of • Superior and inferior articular processes:
abnormal spinal curvatures. Three of these are paired projections lateral to the vertebral fora-
scoliosis (sko″le-o′sis), kyphosis (ki-fo′sis), and men, allowing a vertebra to form joints with
lordosis (lor-do′sis) (Figure 5.18). These abnor- adjacent vertebrae (see also Figure 5.20).
malities may be congenital (present at birth) or re- In addition to these common features, ver-
sult from disease, poor posture, or unequal muscle tebrae in the different regions of the spine have
pull on the spine. As you look at these photos, try very specific structural characteristics. We describe
to pinpoint how each of these conditions differs these unique regional characteristics of the verte-
from the normal healthy spine. ..............................✚ brae next.
All vertebrae have a similar structural pattern
Cervical Vertebrae
(Figure 5.19). The common features of vertebrae
include the following: The seven cervical vertebrae (identified as C1
to C7) form the neck region of the spine. The first
• Body or centrum: disclike, weight-bearing
two vertebrae (atlas and axis) are different be-
part of the vertebra facing anteriorly in the ver-
cause they perform functions not shared by the
tebral column.
other cervical vertebrae. As you can see (Figure
• Vertebral arch: arch formed from the joining 5.20a), the atlas (C1) has no body. The superior
of all posterior extensions, the laminae and surfaces of its transverse processes contain large
pedicles, from the vertebral body. depressions that receive the occipital condyles of
• Vertebral foramen: canal through which the the skull. This joint allows you to nod “yes.” The
spinal cord passes. axis (C2) acts as a pivot for the rotation of the
• Transverse processes: two lateral projections atlas (and skull) above. It has a large upright pro-
from the vertebral arch. cess, the dens, which acts as the pivot point. The
(a) ATLAS AND AXIS (b) TYPICAL CERVICAL VERTEBRAE
Facet on superior Spinous

Transverse Posterior articular process process
process arch
Vertebral
foramen
Anterior Transverse
arch process
Superior view of atlas (C1) Superior view
Spinous
Superior
Body
5
articular
Transverse process process
process
Facet on Spinous
superior process
articular Transverse
process process
Dens
Facet on inferior
Body articular process
Superior view of axis (C2) Right lateral view
(c) THORACIC VERTEBRAE (d) LUMBAR VERTEBRAE
Spinous process Spinous process

Transverse Vertebral
process foramen
Vertebral
foramen
Transverse
process
Facet Facet on
for rib superior
articular Facet on
process superior
Body articular
Body process
Superior view Superior view
Facet on Body
superior Superior Body
articular articular
process process
Facet on
transverse
process Costal facet
Spinous for rib
process Spinous Facet on inferior
process articular process
Right lateral view Right lateral view
Figure 5.20 Regional characteristics of vertebrae.

Thoracic Vertebrae
The 12 thoracic vertebrae (T1 to T12) are all typical.
They are larger than the cervical vertebrae and are
distinguished by the fact that they are the only
vertebrae to articulate with the ribs. The body is
somewhat heart-shaped and has two costal facets
(articulating surfaces) on each side, which receive
the heads of the ribs (Figure 5.20c). The two
transverse processes of each thoracic vertebra
articulate with the nearby knoblike tubercles of
the ribs. The spinous process is long and hooks
Superior Auricular sharply downward, causing the vertebra to look
articular surface like a giraffe’s head viewed from the side.
Ala Sacral
process
canal
Lumbar Vertebrae
The five lumbar vertebrae (L1 to L5) have massive,
blocklike bodies. Their short, hatchet-shaped spi-
nous processes (Figure 5.20d) make them look like a
Body moose head from the lateral aspect. Because most of
the stress on the vertebral column occurs in the lum-
bar region, these are the sturdiest of the vertebrae.
Median
Sacrum sacral
crest Sacrum
The sacrum (sa′krum) is formed by the fusion
of five vertebrae (Figure 5.21). Superiorly it ar-
ticulates with L5, and inferiorly it connects with
Posterior
the coccyx. The winglike alae articulate laterally
sacral
foramina with the hip bones, forming the sacroiliac joints.
The sacrum forms the posterior wall of the pelvis.
Sacral Its posterior midline surface is roughened by the
Coccyx hiatus median sacral crest, the fused spinous processes
of the sacral vertebrae. This is flanked laterally by
the posterior sacral foramina. The vertebral canal
Figure 5.21 Sacrum and coccyx, posterior view. continues inside the sacrum as the sacral canal
and terminates in a large inferior opening called
the sacral hiatus.
joint between C1 and C2 allows you to rotate your
head from side to side to indicate “no.” Coccyx
The “typical” cervical vertebrae are C3 through The coccyx is formed from the fusion of three to five
C7 (shown in Figure 5.20b). They are the smallest, tiny, irregularly shaped vertebrae (see Figure 5.21).
lightest vertebrae, and most often their spinous It is the human “tailbone,” a remnant of the tail that
processes are short and divided into two branches. other vertebrate animals have.
The transverse processes of the cervical vertebrae
contain foramina (openings) through which the Thoracic Cage
vertebral arteries pass on their way to the brain
5-14 Name the components of the thoracic cage.
above. Any time you see these foramina in a ver-
tebra, you should know immediately that it is a 5-15 Describe how a true rib differs from a false rib.
cervical vertebra. The sternum, ribs, and thoracic vertebrae make up
the bony thorax (Figure 5.22). The bony thorax
is routinely called the thoracic cage because it
forms a protective, cone-shaped cage of slender
T1 vertebra
Jugular notch
Clavicular notch
Manubrium
Sternal angle
Body
Xiphisternal Sternum
True joint
ribs Xiphoid
(1–7) process
5
T2 Jugular
T3 notch
T4 Sternal
angle
False
ribs
(8–12) Heart
Intercostal
spaces T9 Xiphisternal
L1 joint
Floating vertebra Costal cartilage
ribs (11, 12)
(a) (b)
Figure 5.22 The bony thorax (thoracic cage). (a) Anterior view. Explore human cadaver
(b) Midsagittal section through the thorax, showing the relationship of the key >Study Area>
parts of the sternum to the vertebral column.
bones around the organs of the thoracic cavity other, so that a transverse ridge is formed at the
(heart, lungs, and major blood vessels). level of the second ribs. It provides a handy
reference point for counting ribs to locate the
Sternum second intercostal space for listening to certain
The sternum (breastbone) is a typical flat bone heart valves.
and the result of the fusion of three bones— • The xiphisternal (zi′fe-ster″nal) joint, the
the manubrium (mah-nu′bre-um), body, and point where the sternal body and xiphoid pro-
xiphoid (zif′oid) process. It is attached to the cess fuse, lies at the level of the ninth thoracic
first seven pairs of ribs. vertebra.
The sternum has three important bony land- Palpate your sternal angle and jugular notch.
marks—the jugular notch, the sternal angle, and Because the sternum is so close to the body
the xiphisternal joint. surface, it is easy to obtain samples from it of
• The jugular notch (concave upper border blood-forming (hematopoietic) tissue for the di-
of the manubrium) can be palpated easily; agnosis of suspected blood diseases. A needle is
generally it is at the level of the third thoracic inserted into the marrow of the sternum, and the
vertebra. sample is withdrawn; this procedure is called a
• The sternal angle results where the manu- sternal puncture. Because the heart lies immedi-
brium and body meet at a slight angle to each ately posterior to the sternum, the physician must
take extreme care not to penetrate the sternum manubrium of the sternum medially (at its sternal
during this procedure. end) and to the scapula laterally, where it helps
to form the shoulder joint. The clavicle acts as
Ribs a brace to hold the arm away from the top of
Twelve pairs of ribs form the walls of the bony the thorax and helps prevent shoulder dislocation.
thorax. (Contrary to popular misconception, men When the clavicle is broken, the whole shoulder
do not have one rib fewer than women!) All the region caves in medially, which shows how important
ribs articulate with the vertebral column posteri- its bracing function is.
orly and then curve downward and toward the an- The scapulae (skap′u-le), or shoulder blades,
terior body surface. The true ribs, the first seven are triangular and are commonly called “wings”
pairs, attach directly to the sternum by costal carti- because they flare when we move our arms pos-
lages. False ribs, the next five pairs, either attach teriorly. Each scapula has a flattened body and
indirectly to the sternum or are not attached to the two important processes—the acromion (ah-
sternum at all. The last two pairs of false ribs lack kro′me-on), which is the enlarged end of the
the sternal attachments, so they are also called spine of the scapula, and the beaklike coracoid
floating ribs. (kor′ah-koid) process. The acromion connects
The intercostal spaces (spaces between the with the clavicle laterally at the acromioclavicu-
ribs) are filled with the intercostal muscles, which lar joint. The coracoid process points over the
aid in breathing. top of the shoulder and anchors some of the
muscles of the arm. Just medial to the coracoid
Did You Get It? process is the large suprascapular notch, which
serves as a nerve passageway. The scapula is not
16. What are the five major regions of the vertebral
column?
directly attached to the axial skeleton; it is loosely
held in place by trunk muscles. The scapula has
17. How can you distinguish a lumbar vertebra from a
three borders—superior, medial (vertebral), and
cervical vertebra?
lateral (axillary). It also has three angles—superior,
18. What is a true rib? A false rib? inferior, and lateral. The glenoid cavity, a shal-
19. Besides the ribs and sternum, there is a third group low socket that receives the head of the arm bone,
of bones forming the thoracic cage. What is it? is in the lateral angle.
20. What bone class do the ribs and skull bones fall into? The shoulder girdle is very light and allows the
(For answers, see Appendix D.) upper limb exceptionally free movement. This is
due to the following factors:
1. Each shoulder girdle attaches to the axial skel-
Appendicular Skeleton eton at only one point—the sternoclavicular
5-16 Identify on a skeleton or diagram the bones of joint.
the shoulder and pelvic girdles and their attached 2. The loose attachment of the scapula allows it
limbs.
to slide back and forth against the thorax as
5-17 Describe important differences between a male muscles act.
and a female pelvis.
3. The glenoid cavity is shallow, and the shoulder
The appendicular skeleton (shaded gold in Figure joint is poorly reinforced by ligaments.
5.8) is composed of 126 bones of the limbs (ap- However, this exceptional flexibility also has a
pendages) and the pectoral and pelvic girdles, drawback; the shoulder girdle is very easily dislo-
which attach the limbs to the axial skeleton. cated.
Bones of the Shoulder Girdle Bones of the Upper Limbs
Each shoulder girdle, or pectoral girdle, Thirty separate bones form the skeletal frame-
consists of two bones—a clavicle and a scapula work of each upper limb (Figure 5.24, p. 184 and
(Figure 5.23). Figure 5.25, p. 185). They form the foundations of
The clavicle (klav′ı̆-kl), or collarbone, is a the arm, forearm, and hand.
slender, doubly curved bone. It attaches to the
Posterior
Sternal (medial)
Acromio- end
clavicular Clavicle
joint
Acromial (lateral)
Anterior
end
Superior view
Acromial end
Anterior
Sternal end
5
Posterior
Scapula
Inferior view
(b) Right clavicle, superior and inferior views
Acromion
Suprascapular notch
Superior border
Coracoid
(a) Articulated right shoulder (pectoral) girdle process Superior
showing the relationship to bones of the angle
thorax and sternum
Glenoid
cavity
Coracoid process
Suprascapular notch
Superior Acromion
angle
Glenoid cavity
at lateral angle
Spine Lateral
(axillary) Medial
border (vertebral)
border
Medial Inferior angle

border
(d) Right scapula, anterior aspect
Lateral border
(c) Right scapula, posterior aspect Practice art labeling

Figure 5.23 Bones of the shoulder girdle.
Head of
Greater humerus
tubercle
Trochlear
notch
Lesser
tubercle Olecranon
Anatomical
neck Surgical Head
neck Coronoid
Intertubercular process
sulcus Neck
Radial Proximal
tuberosity radioulnar
joint
Radius
Radial
groove
Deltoid Deltoid
tuberosity tuberosity Ulna
Inter-
osseous
membrane
Radial Medial
fossa epicondyle Olecranon
fossa
Coronoid Ulnar
fossa Radial
styloid
styloid Distal process
Lateral process radioulnar
Capitulum Trochlea epicondyle joint
(a) (b) (c)

Figure 5.24 Bones of the right arm and forearm. (a) Humerus, anterior Practice art labeling
view. (b) Humerus, posterior view. (c) Anterior view of the bones of the >Study Area>Chapter 5
forearm: the radius and the ulna.
Arm projections separated by the intertubercular

The arm is formed by a single bone, the humerus sulcus—the greater and lesser tubercles, which
(hu′mer-us), which is a typical long bone (see are sites of muscle attachment. Just distal to the
Figure 5.24a and b). At its proximal end is a tubercles is the surgical neck, so named because
rounded head that fits into the shallow glenoid it is the most frequently fractured part of the hu-
cavity of the scapula. Immediately inferior to the merus. In the midpoint of the shaft is a roughened
head is a slight constriction called the anatomical area called the deltoid tuberosity, where the
neck. Anterolateral to the head are two bony large, fleshy deltoid muscle of the shoulder attaches.
Nearby, the radial groove runs obliquely down

the posterior aspect of the shaft. This groove
marks the course of the radial nerve, an impor-
tant nerve of the upper limb. At the distal end of
the humerus is the medial trochlea (trok′le-ah), Distal
which looks somewhat like a spool, and the lat- Middle
eral ball-like capitulum (kah-pit′u-lum). Both of Phalanges
these processes articulate with bones of the fore- (fingers)
arm. Above the trochlea anteriorly is a depression, Proximal
the coronoid fossa; on the posterior surface is
the olecranon (o-lek′rah-non) fossa. These two
depressions, which are flanked by medial and 4 3 2
lateral epicondyles, allow the corresponding Metacarpals 5 1
5
(palm)
processes of the ulna to move freely when the elbow
is bent and extended.
Hamate Trapezium
Forearm Carpals Pisiform Trapezoid
Two bones, the radius and the ulna, form the skel- (wrist) Triquetrum Scaphoid
eton of the forearm (see Figure 5.24c). When the Lunate Capitate
body is in the anatomical position, the radius is the Ulna
lateral bone; that is, it is on the thumb side of the Radius
forearm. When the hand is rotated so that the palm
Figure 5.25 Bones of the right hand,
faces backward, the distal end of the radius crosses anterior view.
over and ends up medial to the ulna. Both proxi-
mally and distally the radius and ulna articulate at Practice art labeling
small radioulnar joints, and the two bones are >Study Area>Chapter 5
connected along their entire length by the flexible
interosseous membrane. Both the ulna and the
radius have a styloid process at their distal end.
The disc-shaped head of the radius also forms The palm of the hand consists of the metacar-
a joint with the capitulum of the humerus. Just be- pals. The phalanges (fah-lan′jēz) are the bones of
low the head is the radial tuberosity, where the the fingers. The metacarpals are numbered 1 to 5
tendon of the biceps muscle attaches. from the thumb side of the hand toward the little
When the upper limb is in the anatomical po- finger. When the fist is clenched, the heads of the
sition, the ulna is the medial bone (on the little- metacarpals become obvious as the “knuckles.” Each
finger side) of the forearm. On its proximal end hand contains 14 phalanges. There are three in each
are the anterior coronoid process and the poste- finger (proximal, middle, and distal), except in the
rior olecranon, which are separated by the troch- thumb, which has only two (proximal and distal).
lear notch. Together these two processes grip the
trochlea of the humerus in a pliers-like joint. Did You Get It?
21. Contrast the general function of the axial skeleton
Hand to that of the appendicular skeleton.
The skeleton of the hand consists of the carpals, 22. What is the single point of attachment of the
the metacarpals, and the phalanges (Figure 5.25). The shoulder girdle to the axial skeleton?
eight carpal bones, arranged in two irregular 23. What bone forms the skeleton of the arm?
rows of four bones each, form the part of the hand
24. Where are the carpals found, and what type (long,
called the carpus or, more commonly, the wrist. short, irregular, or flat) of bone are they?
The carpals are bound together by ligaments that
restrict movements between them. (In case you 25. Which bones of the upper limb have a styloid
process?
need to learn their names, the individual carpal
bones are identified in Figure 5.25.) (For answers, see Appendix D.)
Bones of the Pelvic Girdle anteriorly and the ischium posteriorly forms a bar
of bone enclosing the obturator (ob′tu-ra″tor)
The pelvic girdle is formed by two coxal
foramen, an opening that allows blood vessels
(kok′sal) bones, or ossa coxae, commonly called
and nerves to pass into the anterior part of the
hip bones, and the sacrum (described on p. 180).
thigh. The pubic bones of each hip bone fuse
Together with the coccyx, the pelvic girdle forms
anteriorly to form a cartilaginous joint, the pubic
the pelvis (Figure 5.26). Note that the terms pelvic
symphysis (pu′bik sim′f ı̆-sis).
girdle and bony pelvis have slightly different mean-
The ilium, ischium, and pubis fuse at the deep
ings (pelvic girdle = 2 coxal bones and sacrum;
socket called the acetabulum (as″ĕ-tab′u-lum),
bony pelvis = 2 coxal bones, sacrum, and coccyx).
which means “vinegar cup.” The acetabulum re-
The bones of the pelvic girdle are large and
ceives the head of the thigh bone.
heavy, and they are attached securely to the axial
The bony pelvis is divided into two regions.
skeleton via the sacral attachment to the lower-
The false pelvis is superior to the true pelvis; it
most lumbar vertebra. The sockets, which receive
is the area medial to the flaring portions of the
the thigh bones, are deep and heavily reinforced
ilia. The true pelvis is surrounded by bone and
by ligaments that attach the limbs firmly to the
lies inferior to the flaring parts of the ilia and the
girdle. Bearing weight is the most important func-
pelvic brim. The dimensions of the true pelvis of a
tion of this girdle, because the total weight of the
woman are very important because they must be
upper body rests on the pelvis. The reproductive
large enough to allow the infant’s head (the largest
organs, urinary bladder, and part of the large intes-
part of the infant) to pass during childbirth. The
tine lie within and are protected by the pelvis.
dimensions of the cavity, particularly the outlet
Each hip bone is formed by the fusion of
(the inferior opening of the pelvis measured be-
three bones: the ilium, ischium, and pubis. The
tween the ischial spines) and the inlet (superior
ilium (il′e-um), which connects posteriorly with
opening between the right and left sides of the
the sacrum at the sacroiliac (sak″ro-il′e-ac) joint,
pelvic brim), are critical, and they are carefully
is a large, flaring bone that forms most of the hip
measured by the obstetrician.
bone. When you put your hands on your hips,
Of course, individual pelvic structures vary,
they are resting over the alae, or winglike por-
but there are fairly consistent differences between
tions, of the ilia. The upper edge of an ala, the
a male and a female pelvis. The following charac-
iliac crest, is an important anatomical landmark
teristics differ in the pelvis of the man and woman
that is always kept in mind by those who give
(see Figure 5.26c):
intramuscular injections. The iliac crest ends an-
teriorly in the anterior superior iliac spine and • The female inlet is larger and more circular.
posteriorly in the posterior superior iliac spine. • The female pelvis as a whole is shallower, and
Small inferior spines are located below these. the bones are lighter and thinner.
The ischium (is′ke-um) is the “sit-down • The female ilia flare more laterally.
bone,” so called because it forms the most inferior • The female sacrum is shorter and less curved.
part of the coxal bone. The ischial tuberosity is
a roughened area that receives body weight when • The female ischial spines are shorter and far-
you are sitting. The ischial spine, superior to the ther apart; thus the outlet is larger.
tuberosity, is another important anatomical land- • The female pubic arch is more rounded because
mark, particularly in the pregnant woman, because the angle of the pubic arch is greater.
it narrows the outlet of the pelvis through which
the baby must pass during birth. Another impor- Did You Get It?
tant structural feature of the ischium is the greater 26. What three bones form the hip bone? What two
sciatic notch, which allows blood vessels and the bones form each pectoral girdle?
large sciatic nerve to pass from the pelvis posteri-
27. In what three ways does the bony pelvis of a
orly into the thigh. Injections in the buttock should woman differ from that of a man?
always be given well away from this area.
The pubis (pu′bis), is the most anterior part
of a coxal bone. Fusion of the rami of the pubis
Iliac crest
Sacroiliac
joint
llium
Coxal bone
(or hip bone) Sacrum
Pelvic brim
5
Pubis Coccyx Ischial spine
Acetabulum
Ischium Pubic symphysis
Pubic arch
(a) False pelvis
Ilium Inlet of
Ala true
pelvis
Iliac crest
Posterior
superior
iIiac Anterior superior Pelvic brim
spine iliac spine
Posterior Pubic arch
inferior Anterior inferior (less than 90°)
iliac spine iliac spine
Greater sciatic False pelvis

notch Acetabulum
Ischial body
Body of pubis
Ischial spine Inlet of
Pubis true
pelvis
Ischial
tuberosity Inferior pubic Pelvic brim
ramus
Ischium
Obturator Pubic arch
Ischial ramus foramen (more than 90°)
(b) (c)
Figure 5.26 The bony pelvis. (a) Articulated pelvis. (b) Right coxal (hip) Practice art labeling
bone, showing the point of fusion of the ilium, ischium, and pubic bones. >Study Area>Chapter 5
(c) Comparison of the pelves of the male (above) and female (below).
Neck
Greater Intercondylar
Head trochanter eminence
Inter- Inter-
Lateral Medial
trochanteric trochanteric
Lesser trochanter condyle condyle
line crest
Head Tibial
Gluteal tuberosity
tuberosity
Proximal
tibiofibular
joint
Interosseous
membrane
Anterior
border
Fibula
Tibia
Intercondylar
fossa
Medial
Lateral Distal
condyle
Lateral condyle tibiofibular
condyle joint
Patellar Medial
Lateral
surface malleolus
malleolus
(a) (b) (c)
Figure 5.27 Bones of the right thigh and leg. (a) Femur (thigh bone), Practice art labeling
anterior view. (b) Femur, posterior view. (c) Tibia and fibula of the leg, >Study Area>Chapter 5
anterior view.
Bones of the Lower Limbs intertrochanteric line and posteriorly by the

intertrochanteric crest). These markings and
The lower limbs carry our total body weight when
the gluteal tuberosity, located on the shaft, all
we are erect. Hence, it is not surprising that the
serve as sites for muscle attachment. The head of
bones forming the three segments of the lower limbs
the femur articulates with the acetabulum of the
(thigh, leg, and foot) are much thicker and stronger
hip bone in a deep, secure socket. However, the
than the comparable bones of the upper limb.
neck of the femur is a common fracture site, espe-
Thigh cially in old age.
The femur slants medially as it runs downward
The femur (fe′mur), or thigh bone, is the only
to join with the leg bones; this brings the knees in
bone in the thigh (Figure 5.27a and b). It is the
line with the body’s center of gravity. The medial
heaviest, strongest bone in the body. Its proximal
course of the femur is more noticeable in women
end has a ball-like head, a neck, and greater and
because the female pelvis is typically wider than
lesser trochanters (separated anteriorly by the
Phalanges: Medial longitudinal arch

Distal Transverse arch
Middle
Proximal Lateral longitudinal
arch
Tarsals:
Medial Metatarsals
cuneiform
Tarsals:
5
Intermediate
cuneiform Lateral
cuneiform Figure 5.29 Arches of the foot.
Navicular
Cuboid
Distally, a process called the medial malleolus

(mal-le′o-lus) forms the inner bulge of the ankle.
Talus The anterior surface of the tibia is a sharp ridge, the
anterior border, that is unprotected by muscles;
thus, it is easily felt beneath the skin.
Calcaneus The fibula, which lies alongside the tibia and
forms joints with it both proximally and distally, is
thin and sticklike. The fibula has no part in form-
Figure 5.28 Bones of the right foot, ing the knee joint. Its distal end, the lateral mal-
superior view. leolus, forms the outer part of the ankle.
Practice art labeling
Foot
The foot, composed of the tarsals, metatarsals, and
phalanges, has two important functions. It sup-
that of the male. Distally on the femur are the lat- ports our body weight and serves as a lever that
eral and medial condyles, which articulate with allows us to propel our bodies forward when we
the tibia below. Posteriorly these condyles are sepa- walk and run.
rated by the deep intercondylar fossa. Anteriorly The tarsus, forming the posterior half of the
on the distal femur is the smooth patellar surface, foot, is composed of seven tarsal bones (Figure
5.28). Body weight is carried mostly by the two
which forms a joint with the patella, or kneecap.
largest tarsals, the calcaneus (kal-ka′ne-us), or heel-
Leg bone, and the talus (ta′lus; “ankle”), which lies be-
tween the tibia and the calcaneus. Five metatarsals
Connected along their length by an interosseous
form the sole, and 14 phalanges form the toes. Like
membrane, two bones, the tibia and fibula, form
the fingers of the hand, each toe has three phalan-
the skeleton of the leg (see Figure 5.27c). The tibia,
ges, except the great toe, which has two.
or shinbone, is larger and more medial. At the
The bones in the foot are arranged to form
proximal end, the medial and lateral condyles
three strong arches: two longitudinal (medial
(separated by the intercondylar eminence) ar-
and lateral) and one transverse (Figure 5.29).
ticulate with the distal end of the femur to form the
Ligaments, which bind the foot bones together,
knee joint. The patellar (kneecap) ligament, which
and tendons of the foot muscles help to hold the
encloses the patella, a sesamoid bone (see Figure
bones firmly in the arched position but still allow a
6.20c and d on p. 235) attaches to the tibial tuberos-
certain amount of give or springiness. Weak arches
ity, a roughened area on the anterior tibial surface.
are referred to as “fallen arches” or “flat feet.”
A closER look Joint Ventures
The technology for fashioning
joints in medieval suits of armor
developed over centuries. The
technology for creating the
prostheses (artificial joints) used
in medicine today developed,
in relative terms, in a flash—less
than 60 years. The history of joint
prostheses dates to the 1940s and
1950s, when World War II and the
Korean War left large numbers of
wounded who needed artificial
limbs. Today, well over a third of a
million Americans receive total joint
replacements each year, mostly
(a) A hip prosthesis. (b) X-ray image of right
because of the destructive effects of
knee showing total knee
osteoarthritis or rheumatoid arthritis.
replacement prosthesis.
To produce durable, mobile
joints requires a substance that
is strong, nontoxic, and resistant therapy of arthritic hips. His device strong and relatively problem free.
to the corrosive effects of organic consisted of a metal ball on a stem Hip prostheses were followed by
acids in blood. In 1963, Sir John and a cup-shaped polyethylene knee prostheses (see photos a and b),
Charnley, an English orthopedic plastic socket anchored to the pelvis and replacements are now available
surgeon, performed the first total by methyl methacrylate cement. This for many other joints, including
hip replacement, revolutionizing the cement proved to be exceptionally fingers, elbows, and shoulders.
Did You Get It? meet. They have two functions: They hold the
bones together securely but also give the rigid
28. What two bones form the skeleton of the leg?
skeleton mobility.
29. Bo’s longitudinal and medial arches have suffered a The graceful movements of a ballet dancer
collapse. What is the name of Bo’s condition?
and the rough-and-tumble grapplings of a foot-
30. Which bone of the lower limb has an intertrochanteric ball player illustrate the great variety of motion
line and crest and an intercondylar fossa? that joints allow. With fewer joints, we would
(For answers, see Appendix D.) move like robots. Nevertheless, the bone-binding
function of joints is just as important as their role
in mobility. The immovable joints of the skull,
Joints for instance, form a snug enclosure for our vital
5-18 Name the three major categories of joints, and brain.
compare the amount of movement allowed by Joints are classified in two ways—functionally
each. and structurally. The functional classification fo-
With one exception (the hyoid bone of the neck), cuses on the amount of movement the joint allows.
every bone in the body forms a joint with at On this basis, there are synarthroses (sin″ar-
least one other bone. Joints, also called articu- thro′sēz), or immovable joints; amphiarthroses
lations, are the sites where two or more bones (am″fe-ar-thro′sēz), or slightly movable joints; and
190
time. One solution is to and produces a program to direct
strengthen the cement the machines that shape it.
that binds the implant Equally exciting are techniques
to the bone. Another that call on the patient’s own tissues
solution currently being to regenerate, such as these three:
tested is a robotic • Osteochondral grafting: Healthy
surgeon, ROBODOC bone and cartilage are removed
(photo c), which can from one part of the body and
drill a better-fitting transplanted to the injured joint.
hole for the femoral
• Autologous chondrocyte
prosthesis in hip
implantation: Healthy chondrocytes
surgery. In cementless
are removed from the body,
(c) Physician with the ROBODOC machine prostheses, researchers
cultivated in the lab, and implanted
used to perform hip joint replacement are exploring ways to
surgery. at the damaged joint.
get the bone to grow
so that it binds strongly to the • Stem cell regeneration:
implant. Undifferentiated stem cells are
Dramatic changes are also removed from bone marrow and
Total hip and knee replacements
occurring in the way artificial joints placed in a gel, which is packed
last about 10 to 15 years in elderly
are made. CAD/CAM (computer- into an area of eroded cartilage.
patients who do not excessively
stress the joint. Most such operations aided design and computer-aided These techniques offer hope for
are done to reduce pain and restore manufacturing) techniques have younger patients because they
about 80% of original joint function. significantly reduced the time and could stave off the need for a joint
Replacement joints are not yet cost of creating individualized prosthesis for several years.
strong or durable enough for young, joints. The computer draws from Modern technology has
active people. The problem is that a database of hundreds of normal accomplished what the physicians
the prostheses work loose over joints, generates possible designs, of the 1940s never dreamed of.
diarthroses (di″ar-thro′sēz), or freely movable

joints. Freely movable joints predominate in the To understand the structural classes of
limbs, where mobility is important. Immovable and joints more clearly, recall the properties of
slightly movable joints are restricted mainly to the tissues that form the joints. Fibrous connective
axial skeleton, where firm attachments and protec- tissue contains many collagen fibers for
tion of internal organs are priorities. strength. The three types of cartilage (hyaline,
Structurally, there are fibrous, cartilaginous, fibrocartilage, elastic) provide structure with
and synovial joints. These classifications are some degree of flexibility, and fibrocartilage
based on whether fibrous tissue, cartilage, or also has the ability to absorb compressive
a joint cavity separates the bony regions at the shock (Chapter 3, pp. 117, 120).
joint. As a general rule, fibrous joints are im-
movable, and synovial joints are freely movable.
Although cartilaginous joints have both immov-
Fibrous Joints
able and slightly movable examples, most are In fibrous joints, the bones are united by fibrous
amphiarthrotic. Because the structural classifica- tissue. The best examples of this type of joint are
tion is more clear-cut, we will focus on that the sutures of the skull (Figure 5.30a). In sutures,
classification scheme here. (The joint types are the irregular edges of the bones interlock and are
shown in Figure 5.30 on p. 192, described next, bound tightly together by connective tissue fibers,
and summarized in Table 5.3 on p. 193.)
191
Cartilaginous joints Fibrous joints Synovial joints
Fibrous
connective Scapula
tissue
Articular
First rib capsule
(a) Suture
Hyaline Articular
cartilage (hyaline)
cartilage
Sternum Humerus
(c) Synchondrosis (f) Multiaxial joint

(shoulder joint)
Humerus
Vertebrae Articular
(hyaline)
cartilage
Fibrocartilage
Articular
capsule
Radius
Ulna
(d) Symphysis (g) Uniaxial joint
(elbow joint)
Ulna
Radius
Pubis Articular
capsule
Fibro-
cartilage Carpals
(e) Symphysis Tibia

(h) Biaxial joint
(intercarpal joints of hand)
Fibula
Fibrous
Figure 5.30 Types of joints. Joints to connective
the left of the skeleton are cartilaginous tissue
joints; joints above and below the
skeleton are fibrous joints; joints to the
right of the skeleton are synovial joints. (b) Syndesmosis
Table 5.3 Summary of Joint Classes
Structural class Structural characteristics Types Mobility
Fibrous Bone ends/parts united by Suture (short fibers) Immobile (synarthrosis)

collagenic fibers
Syndesmosis (longer fibers) Slightly mobile
(amphiarthrosis) and
immobile
Gomphosis (periodontal Immobile
ligament) 5
Cartilaginous Bone ends/parts united by Synchondrosis (hyaline Immobile
cartilage cartilage)
Symphysis (fibrocartilage) Slightly movable
Synovial Bone ends/parts covered Plane Condylar Freely movable
with articular cartilage and Hinge Saddle (diarthrosis; movements
enclosed within an articular Pivot Ball and depend on design of
capsule lined with synovial socket joint)
membrane
allowing essentially no movement. In syndesmoses 1. Articular cartilage. Articular (hyaline) carti-

(sin-dez-mo′sēz), the connecting fibers are longer lage covers the ends of the bones forming the
than those of sutures; thus the joint has more joint.
“give.” The joint connecting the distal ends of the 2. Articular capsule. The joint surfaces are en-
tibia and fibula is a syndesmosis (Figure 5.30b). closed by a sleeve or layer of fibrous connective
tissue, which is lined with a smooth synovial
Cartilaginous Joints membrane (the reason these joints are called
In cartilaginous joints, the bone ends are con- synovial joints).
nected by fibrocartilage. Examples of this joint 3. Joint cavity. The articular capsule encloses a
type that are slightly movable (amphiarthrotic) are cavity, called the joint cavity, which contains
the pubic symphysis of the pelvis (Figure 5.30e) lubricating synovial fluid.
and intervertebral joints of the spinal column
4. Reinforcing ligaments. The fibrous layer of
(Figure 5.30d), where the articulating bone sur-
the capsule is usually reinforced with ligaments.
faces are connected by pads (discs) of fibrocar-
tilage. The hyaline-cartilage epiphyseal plates of Bursae and tendon sheaths are not strictly part
growing long bones and the cartilaginous joints of synovial joints, but they are often found closely
between the first ribs and the sternum are immov- associated with them (see Figure 5.31). Essentially
able (synarthrotic) cartilaginous joints referred to bags of lubricant, they act like ball bearings to re-
as synchondroses (Figure 5.30c). duce friction between adjacent structures during
joint activity. Bursae (ber′se; “purses”) are flat-
Synovial Joints tened fibrous sacs lined with synovial membrane
Synovial joints are joints in which the articu- and containing a thin film of synovial fluid. They
lating bone ends are separated by a joint cavity are common where ligaments, muscles, skin, ten-
containing synovial fluid (see Figure 5.30f–h). All dons, or bones rub together. A tendon sheath
joints of the limbs are synovial joints. (also shown in Figure 5.31), is essentially an elon-
All synovial joints have four distinguishing fea- gated bursa that wraps completely around a tendon
tures (Figure 5.31, p. 194): subjected to friction, like a bun around a hot dog.
Q: How does this joint type differ structurally from cartilaginous and
fibrous joints?
Acromion of
scapula
Ligament Joint cavity

containing
Bursa synovial fluid
Ligament
Articular
(hyaline)
Tendon cartilage
sheath
Synovial membrane
Tendon of Fibrous layer of the

biceps muscle articular capsule
Humerus
Figure 5.31 General structure of a synovial joint. Practice art labeling

Homeostatic Imbalance 5.6 is, gliding does not involve rotation around any
A dislocation happens when a bone is forced out axis. The intercarpal joints of the wrist are the
of its normal position in the joint cavity. The pro- best examples of plane joints.
cess of returning the bone to its proper position, • In a hinge joint (Figure 5.32b), the cylindri-
called reduction, should be done only by a phy- cal end of one bone fits into a trough-shaped
sician. Attempts by an untrained person to “snap surface on another bone. Angular movement
the bone back into its socket” are usually more is allowed in just one plane, like a mechani-
harmful than helpful. ................................................✚ cal hinge. Examples are the elbow joint, ankle
joint, and the joints between the phalanges of
Types of Synovial Joints Based the fingers. Hinge joints are classified as uni-
on Shape axial (u″ne-aks′e-al; “one axis”); they allow
The shapes of the articulating bone surfaces de- movement around one axis only (as indicated
termine what movements are allowed at a joint. by the single magenta arrow in Figure 5.32b).
Based on such shapes, our synovial joints can be • In a pivot joint (Figure 5.32c), the rounded
classified as plane, hinge, pivot, condylar, saddle, end of one bone fits into a sleeve or ring of
and ball-and-socket joints (Figure 5.32). bone (and possibly ligaments). Because the ro-
• In a plane joint (Figure 5.32a), the articular tating bone can turn only around its long axis,
surfaces are essentially flat, and only short slip- pivot joints are also uniaxial joints (see the
ping or gliding movements are allowed. The single arrow in Figure 5.32c). The proximal
movements of plane joints are nonaxial; that radioulnar joint and the joint between the atlas
and the dens of the axis are examples.
A:
separating the articulating bones.
It has a joint cavity instead of cartilage or fibrous tissue
Nonaxial
Uniaxial
Biaxial
Multiaxial
(f)
(a) Plane joint

(b)
(c)
Humerus
Ulna
Ulna
Radius
5
(a)
(e) (b) Hinge joint (c) Pivot joint
(d)
Carpal
Metacarpal #1
Metacarpal
Phalanx
(d) Condylar joint (e) Saddle joint
Head of
humerus
Scapula
(f) Ball-and-socket joint
Figure 5.32 Types of synovial joints). (c) Pivot joint (proximal joint joint of the thumb). (f) Ball-and-
joints. (a) Plane joint (intercarpal between the radius and the ulna). socket joint (shoulder and hip
and intertarsal joints). (b) Hinge (d) Condylar joint (knuckles). joints).
joint (elbow and interphalangeal (e) Saddle joint (carpometacarpal
• In a condylar joint (kon′dı̆-ler; “knucklelike”), is the most widespread, crippling disease in the
the egg-shaped articular surface of one bone United States. All forms of arthritis have the same
fits into an oval concavity in another (Figure initial symptoms: pain, stiffness, and swelling of
5.32d). Both of these articular surfaces are the joint. Then, depending on the specific form,
oval. Condylar joints allow the moving bone certain changes in the joint structure occur.
to travel (1) from side to side and (2) back and Acute forms of arthritis usually result from
forth, but the bone cannot rotate around its bacterial invasion and are treated with antibiotic
long axis. Movement occurs around two axes, drugs. The synovial membrane thickens and fluid
hence these joints are biaxial (bi = two), as in production decreases, leading to increased friction
knuckle (metacarpophalangeal) joints. and pain. Chronic forms of arthritis include osteo-
• In saddle joints, each articular surface has arthritis, rheumatoid arthritis, and gouty arthritis,
both convex and concave areas, like a saddle which differ substantially in their later symptoms
(Figure 5.32e). These biaxial joints allow essen- and consequences. We will focus on these forms
tially the same movements as condylar joints. here.
The best examples of saddle joints are the Osteoarthritis (OA), the most common form
carpometacarpal joints in the thumb, and the of arthritis, is a chronic degenerative condition that
movements of these joints are clearly demon- typically affects the aged. Eighty-five percent of
strated by twiddling your thumbs. people in the United States develop this condition.
• In a ball-and-socket joint (Figure 5.32f), the OA, also called degenerative joint disease (DJD)
and “wear-and-tear arthritis,” affects the articular
spherical head of one bone fits into a round
cartilages. Over the years, the cartilage softens,
socket in another. These multiaxial joints allow
frays, and eventually breaks down. As the disease
movement in all axes, including rotation (see
progresses, the exposed bone thickens and extra
the four arrows in Figure 5.32f), and are the
bone tissue, called bone spurs, grows around
most freely moving synovial joints. The shoul-
the margins of the eroded cartilage and restricts
der and hip are examples.
joint movement. Patients complain of stiffness on
Because they relate to muscle activity, we dis- arising that lessens with activity, and the affected
cuss the various types of movements that occur at joints may make a crunching noise (crepitus)
synovial joints in detail in the chapter covering the when moved. The joints most commonly affected
muscular system (Chapter 6). are those of the fingers, the cervical and lumbar
joints of the spine, and the large, weight-bearing
joints of the lower limbs (knees and hips).
Few of us pay attention to our joints unless some- The course of osteoarthritis is usually slow and
thing goes wrong with them. Joint pain and in- irreversible, but it is rarely crippling. In most cases,
flammation may be caused by many things. For its symptoms are controllable with a mild analge-
example, falling on one’s knee can cause a pain- sic such as aspirin, moderate activity to maintain
ful bursitis, called “water on the knee,” due to joint mobility, and rest when the joint becomes
inflammation of bursae or synovial membrane. very painful. Some people with OA claim that rub-
Sprains and dislocations are other types of joint bing capsaicin (a hot pepper extract) on the skin
problems that result in swelling and pain. In a over painful joints provides relief. Others swear to
sprain, the ligaments or tendons reinforcing a the pain-reducing ability of glucosamine sulfate, a
joint are damaged by excessive stretching, or they nutritional supplement.
are torn away from the bone. Both tendons and Rheumatoid (roo′mah-toid) arthritis (RA) is
ligaments are cords of dense fibrous connective a chronic inflammatory disorder. Its onset is in-
tissue with a poor blood supply; thus, sprains heal sidious and usually occurs between the ages of
slowly and are extremely painful. 40 and 50, but it may occur at any age. It affects
Few inflammatory joint disorders cause more three times as many women as men. Many joints,
pain and suffering than arthritis. The term arthritis particularly those of the fingers, wrists, ankles, and
(arth = joint; itis = inflammation) describes over feet, are affected at the same time and usually in
100 different inflammatory or degenerative dis- a symmetrical manner. For example, if the right
eases that damage the joints. In all its forms, arthritis
elbow is affected, most likely the left elbow will

be affected also. The course of RA varies and is
marked by remissions and flare-ups (rheumat =
susceptible to change or flux).
RA is an autoimmune disease—a disorder in
which the body’s immune system attempts to de-
stroy its own tissues. The initial trigger for this re-
action is unknown, but some suspect that it results
from certain bacterial or viral infections.
RA begins with inflammation of the synovial
membranes. The membranes thicken and the joints
swell as synovial fluid accumulates. Inflammatory
cells (white blood cells and others) enter the joint 5
cavity from the blood and release a deluge of in-
flammatory chemicals that destroy body tissues
when released inappropriately as in RA. In time Figure 5.33 X-ray image of a hand deformed by
the inflamed synovial membrane thickens into a rheumatoid arthritis.
pannus (“rag”), an abnormal tissue that clings
to and erodes articular cartilages. As the cartilage Untreated gout can be very destructive; the
is destroyed, scar tissue forms and connects the bone ends fuse, and the joint becomes immo-
bone ends. The scar tissue eventually ossifies, and bilized. Fortunately, several drugs (colchicine,
the bone ends become firmly fused (ankylosis) ibuprofen, and others) are successful in prevent-
and often deformed (Figure 5.33). Not all cases ing acute gout attacks. Patients are advised to
of RA progress to the severely crippling ankylosis lose weight if obese, to avoid foods such as liver,
stage, but all cases involve restricted joint move- kidneys, and sardines, which are high in nucleic
ment and extreme pain. acids, and to avoid alcohol, which inhibits excre-
Current therapy for RA involves many dif- tion of uric acid by the kidneys. .......................... ✚
ferent kinds of drugs. Some, like methotrexate,
are immunosuppressants. Others, like etanercept
Did You Get It?
(Enbrel), neutralize the inflammatory chemicals
in the joint space and (hopefully) prevent joint 31. What are the functions of joints?
deformity. However, drug therapy often begins 32. What is the major difference between a fibrous joint
with aspirin, which in large doses is an effec- and a cartilaginous joint?
tive anti-inflammatory agent. Exercise is rec- 33. Where is synovial membrane found, and what is its
ommended to maintain as much joint mobility role?
as possible. Cold packs are used to relieve the 34. What two joints of the body are ball-and-socket
swelling and pain, and heat helps to relieve joints? What is the best example of a saddle joint?
morning stiffness. Replacement joints or bone (For answers, see Appendix D.)
removal are the last resort for severely crippled
RA patients.
Gouty (gow′te) arthritis, or gout, is a dis- Developmental Aspects
ease in which uric acid (a normal waste product of
nucleic acid metabolism) accumulates in the blood of the Skeleton
and may be deposited as needle-shaped crystals in 5-19 Identify some of the causes of bone and joint
the soft tissues of joints. This leads to an agoniz- problems throughout life.
ingly painful attack that typically affects a single
As we described earlier, the first “long bones” in
joint, often in the great toe. Gout is most common
the very young fetus are formed of hyaline car-
in men and rarely appears before the age of 30. It
tilage, and the earliest “flat bones” of the skull
tends to run in families, so genetic factors are defi-
are actually fibrous membranes. As the fetus de-
nitely implicated.
velops and grows, both the flat and the long bone
Parietal
bone
Frontal
bone
of skull Occipital
bone
Mandible
Clavicle
Scapula Human newborn Human adult
(a)
Radius
Ulna
Humerus
Femur
Tibia
Ribs
Vertebra Newborn 2 yrs. 5 yrs. 15 yrs. Adult

Hip bone (b)
Figure 5.35 Differences in the growth rates
Figure 5.34 Ossification centers in the skeleton for some parts of the body compared to others
of a 12-week-old fetus are indicated by the
determine body proportions. (a) Differential
darker areas. Lighter regions are still fibrous or
growth transforms the rounded, foreshortened
cartilaginous.
skull of a newborn to the sloping skull of an adult.
(b) During growth of a human, the arms and legs
grow faster than the head and trunk, as shown in this
models are converted to bone (Figure 5.34). At conceptualization of different-aged individuals all
birth, some fontanels still remain in the skull to drawn at the same height.
allow for brain growth, but these areas are usu-
ally fully ossified by 2 years of age. By the end of
adolescence, the epiphyseal plates of long bones respiratory passages expand and the permanent
that provide for longitudinal growth in child- teeth develop.
hood have become fully ossified, and long-bone The so-called primary curvatures of the verte-
growth ends. bral column are present at birth and are convex
The skeleton changes throughout life, but the posteriorly, so an infant’s spine is arched, like that
changes in childhood are most dramatic. At birth, of a four-legged animal. The secondary curvatures
the baby’s cranium is huge relative to its face are convex anteriorly and are associated with a
(Figure 5.35a). The rapid growth of the cranium child’s later development. They result from reshap-
before and after birth is related to the growth of ing of the intervertebral discs rather than from
the brain. By 2 years, the skull is three-quarters modifications of the bony vertebrae and produce
of its adult size; and, by 8 to 9 years, the skull is the S-shaped spine typical of the adult.
almost of adult size and proportions. However, Most cases of abnormal spinal curvatures, such
between the ages of 6 and 11, the head appears to as scoliosis and lordosis (see Figure 5.18), are
enlarge substantially as the face literally grows out congenital, but some can result from injuries. The
from the skull. The jaws increase in size, and the abnormal curvatures are usually treated by sur-
cheekbones and nose become more prominent as gery, braces, or casts when diagnosed. Generally
5
Age 40 Age 60 Age 70
Figure 5.37 Vertebral collapse due to
osteoporosis. Women with postmenopausal
osteoporosis are at risk for fractures in their vertebral
column as they age. Eventually these vertebrae tend
to collapse, producing spinal curvature that causes
loss of height, a tilted rib cage, a dowager’s hump,
and a protruding abdomen.
It cannot be emphasized too strongly that bones

have to be physically stressed to remain healthy.
When we remain active physically and muscles and
gravity pull on the skeleton, the bones respond by
becoming stronger. By contrast, if we are totally in-
active, they become thin and fragile. Osteoporosis
Figure 5.36 Osteoporosis. The architecture of
is a bone-thinning disease that afflicts half of women
osteoporotic bone, at top, is contrasted with that of
normal bone, below. over 65 and some 20 percent of men over the age
of 70. The ratio of bone formation to bone break-
down gets out of balance as osteoblast activity
speaking, young, healthy people have no skeletal becomes sluggish. Osteoporosis makes the bones so
problems, assuming that their diet is nutritious and fragile that even a hug or a sneeze can cause bones
they stay reasonably active. to fracture (Figure 5.36). The bones of the spine and
During youth, growth of the skeleton not the neck of the femur are particularly susceptible.
only increases overall body height and size but Vertebral collapse frequently results in a hunched-
also changes body proportions (Figure 5.35b). At over posture (kyphosis) familiarly known as dowa-
birth, the head and trunk are approximately 1½ ger’s hump (Figure 5.37).
times as long as the lower limbs. The lower limbs Estrogen helps to maintain the health and
grow more rapidly than the trunk from this time normal density of a woman’s skeleton, and the
on, and by the age of 10, the head and trunk are estrogen deficiency that occurs after a woman
approximately the same height as the lower limbs goes through menopause (“change of life,” when
and change little thereafter. During puberty, the menstruation ceases) is strongly implicated as
female pelvis broadens in preparation for child- a cause of osteoporosis. Other factors that may
bearing, and the entire male skeleton becomes contribute to osteoporosis are a diet poor in
more robust. Once adult height is reached, a calcium and protein, lack of vitamin D, smok-
healthy skeleton changes very little until late mid- ing, and insufficient weight-bearing exercise
dle age. In old age, losses in bone mass become to stress the bones. Sadly, many older people
obvious. feel that they are helping themselves by “saving
systEms In sync
Homeostatic Relationships between the

Skeletal System and Other Body Systems
Nervous System
Endocrine System • Skeletal system protects brain
and spinal cord; provides a
• Skeletal system provides some depot for calcium ions needed
bony protection for neural function
• Hormones regulate uptake and • Nerves innervate bone and
release of calcium from bone; articular capsules, providing
hormones promote long-bone for pain and joint sense
growth and maturation
Respiratory System
Lymphatic System/Immunity • Skeletal system (rib cage)
protects lungs by enclosure
• Skeletal system provides • Respiratory system provides
some protection to lymphoid oxygen; disposes of carbon
organs; lymphocytes involved dioxide
in immune response originate
in bone marrow
• Lymphatic system drains leaked
tissue fluids; immune cells Cardiovascular System
protect against pathogens
• Bone marrow cavities provide
site for blood cell formation;
matrix stores calcium needed
for cardiac muscle activity
Digestive System • Cardiovascular system delivers
• Skeletal system provides nutrients and oxygen to bones;
some bony protection to carries away wastes
intestines, pelvic
organs, and liver
• Digestive system
provides nutrients Reproductive System
needed for bone health • Skeletal system protects some
and growth reproductive organs by
enclosure
• Gonads produce hormones that
influence form of skeleton and
Urinary System epiphyseal closure
• Skeletal system protects pelvic
organs (bladder, etc.)
• Urinary system activates vitamin D;
disposes of nitrogen-containing Integumentary System
wastes • Skeletal system provides
support for body organs
including the skin
• Skin provides vitamin D
Muscular System needed for proper calcium
absorption and use
• Skeletal system provides levers
plus calcium for muscle activity
• Muscle pull on bones increases
bone strength and viability; helps Skeletal System
determine bone shape
200
their strength” and not doing anything too physi- Did You Get It?
cal. Their reward for this is pathologic fractures
35. Which spinal curvatures are present at birth?
(breaks that occur spontaneously without appar-
ent injury), which increase dramatically with age 36. How does the shape of a newborn baby’s spine
differ from that of an adult?
and are the single most common skeletal prob-
lem for this age group. 37. Ninety-year-old Mrs. Pelky is groaning in pain. Her
Advancing years also take their toll on joints. grandson has just picked her up and given her
a bear hug. What do you think might just have
Weight-bearing joints in particular begin to degen- happened to her spine, and what bone condition
erate, and osteoarthritis is common. Such degen- may she be suffering from?
erative joint changes lead to the complaint often
38. Which two regions of the skeleton grow most
heard from the aging person: “My joints are getting rapidly during childhood?
so stiff. . . .”
SUMMARY
For more chapter study tools, go to the Study Area
5. Bones form on hyaline cartilage “models,” or fi-
of MasteringA&P. There you will find: brous membranes. Eventually these initial sup-
porting structures are replaced by bone tissue.
• Essentials of Interactive Physiology
Epiphyseal plates persist to provide for longitudinal
• A&PFlix growth of long bones during childhood and be-
• Practice Anatomy Lab
come inactive when adolescence ends.
• Get Ready for A&P 6. Bones change in shape throughout life. This re-
modeling occurs in response to hormones (for ex-
• Flashcards, Quizzes, Crossword Puzzles, Art-labeling
ample, PTH, which regulates blood calcium levels)
Activities, Practice Tests, and more!
and mechanical stresses acting on the skeleton.
7. A fracture is a break in a bone. Common types of
Bones: An Overview (pp. 158–170) fractures include simple, compound, compression,
1. Bones support and protect body organs; serve as comminuted, and greenstick. Bone fractures must
levers for the muscles to pull on to cause move- be reduced to heal properly.
ment at joints; store calcium, fats, and other sub-
stances for the body; and contain red marrow, the Axial Skeleton (pp. 170–182)
site of blood cell production. 1. The skull is formed by cranial and facial bones.
2. Bones are classified into four groups—long, short, Eight cranial bones protect the brain: frontal, oc-
flat, and irregular—on the basis of their shape and cipital, ethmoid, and sphenoid bones, and the pairs
the amount of compact or spongy bone they con- of parietal and temporal bones. The 14 facial bones
tain. Bone markings are important anatomical land- are all paired (maxillae, zygomatics, palatines, na-
marks that reveal where muscles attach and where sals, lacrimals, and inferior nasal conchae), except
blood vessels and nerves pass. for the vomer and mandible. The hyoid bone, not
really a skull bone, is supported in the neck by
3. A long bone is composed of a shaft (diaphysis) ligaments.
with two ends (epiphyses). The shaft is compact
bone; its cavity contains yellow marrow. The epiph- 2. Skulls of newborns contain fontanels (membranous
yses are covered with hyaline cartilage; they con- areas), which allow brain growth. The infant’s facial
tain spongy bone (where red marrow is found). bones are very small compared to the size of the
cranium.
4. The organic parts of the matrix make bone flexible;
calcium salts deposited in the matrix make bone 3. The vertebral column is formed from 24 vertebrae,
hard. the sacrum, and the coccyx. There are 7 cervical
vertebrae, 12 thoracic vertebrae, and 5 lumbar ver- 4. Most fibrous joints are synarthrotic, and most carti-
tebrae, which have common as well as unique fea- laginous joints are amphiarthrotic. Fibrous and car-
tures. The vertebrae are separated by fibrocartilage tilaginous joints occur mainly in the axial skeleton.
discs that allow the vertebral column to be flexible.
5. Most joints of the body are synovial joints, which
The vertebral column is S-shaped to allow for upright
predominate in the limbs. In synovial joints, the
posture. Primary spinal curvatures present at birth
articulating bone surfaces are covered with articular
are the thoracic and sacral curvatures; secondary cur-
cartilage and enclosed within the joint cavity by a
vatures (cervical and lumbar) develop after birth.
fibrous capsule lined with a synovial membrane.
4. The bony thorax is formed from the sternum and All synovial joints are diarthroses.
12 pairs of ribs. All ribs attach posteriorly to tho-
6. The most common joint problem is arthritis, or
racic vertebrae. Anteriorly, the first 7 pairs attach
inflammation of the joints. Osteoarthritis, or degen-
directly to the sternum (true ribs); the last 5 pairs
erative arthritis, is a result of the “wear and tear” on
attach indirectly or not at all (false ribs). The bony
joints over many years and is a common affliction
thorax encloses the lungs, heart, and other organs
of the aged. Rheumatoid arthritis occurs in both
of the thoracic cavity.
young and older adults; it is believed to be an auto-
immune disease. Gouty arthritis, caused by the de-
Appendicular Skeleton (pp. 182–190)
posit of uric acid crystals in joints, typically affects a
1. The shoulder girdle, composed of two bones—the single joint.
scapula and the clavicle—attaches the upper limb
to the axial skeleton. It is a light, poorly reinforced Developmental Aspects
girdle that allows the upper limb a great deal of of the Skeleton (pp. 197–201)
freedom. There are two shoulder girdles.
1. Fontanels, which allow brain growth and ease birth
2. The bones of the upper limb include the humerus passage, are present in the skull at birth. Growth of
of the arm, the radius and ulna of the forearm, the cranium after birth is related to brain growth;
and the carpals, metacarpals, and phalanges of the the increase in size of the facial skeleton follows
hand. tooth development and enlargement of the respira-
tory passageways.
3. The pelvic girdle is formed by the two coxal bones,
or hip bones and the sacrum (which is actually part 2. The vertebral column is C-shaped at birth (thoracic
of the axial skeleton). Each hip bone is the result and sacral curvatures are present); the secondary
of fusion of the ilium, ischium, and pubis bones. curvatures form when the baby begins to lift its
The pelvic girdle is securely attached to the verte- head and walk.
bral column, and the socket for the thigh bone is 3. Long bones continue to grow in length until late
deep and heavily reinforced. This girdle receives adolescence. By the age of 10, the head and trunk
the weight of the upper body and transfers it to are approximately the same height as the lower
the lower limbs. The female pelvis is lighter and limbs and change little thereafter.
broader than the male’s; its inlet and outlet are
larger, reflecting the childbearing function. 4. Fractures are the most common bone problem in
elderly people. Osteoporosis, a condition of bone
4. The bones of the lower limb include the femur of wasting that results mainly from hormone deficit or
the thigh, the tibia and fibula of the leg, and the inactivity, is also common in older individuals.
tarsals, metatarsals, and phalanges of the foot.
Joints (pp. 190–197) Review QueStionS

1. Joints hold bones together and allow movement of Multiple Choice
the skeleton.
More than one choice may apply.
2. Joints fall into three functional categories: synar-
throses (immovable), amphiarthroses (slightly mov- 1. Which of the following is a list of long bones?
able), and diarthroses (freely movable). a. Humerus, ulna, sternum, cranium.
3. Joints also can be classified structurally as fibrous, b. Femur, calcaneous, vertebra, clavicle.
cartilaginous, or synovial joints depending on the c. Radius, ulna, tibia, femur.
substance separating the articulating bones. d. Sternum, vertebra, sacrum, talus.
2. The concentric layers of bone are known as 9. Which bone of the arm corresponds to the femur of
a. lacunae. c. canaliculi the leg?
b. Volkmann’s layers. d. lamellae. a. Ulna d. Tibia

b. Humerus e. Fibula
3. Which of the following would you expect to be
prominent in osteoclasts? c. Radius
a. Golgi apparatus c. Microfilaments 10. Which of the following characteristics is (are) true
b. Lysosomes d. Exocytosis of synovial joints?
a. Enclosed with an articular capsule
4. What is the correct order of the stages in embry-
onic and fetal long bone formation? b. Contain lubricating synovial fluid
a. The hyaline cartilage template calcifies in the c. Connect bones ending with fibrous cartilage
middle, the bone collar forms, the medullary cavity d. Have reinforcing ligaments 5
forms. 11. Match the types of joints to the descriptions that apply
b. The medullary cavity forms, the epiphyseal to them. (More than one description might apply.)
growth plates mature, the bone collar forms.
a. Fibrous joints
c. The bone collar forms, the bone circumferences
b. Cartilaginous joints
increase, the medullary cavity forms.
d. The hyaline template forms the medullary cavity, c. Synovial joints
the epiphyses appear, the bony matrix forms. Attachment site
1. a. Trochanter
5. Select the best description of the composition of a for muscle or b. Condyle
fibrocartilage callus. ligament
c. Foramen
a. Red blood cells, fibrin, dead osteocytes, phago- 2. Forms a joint
d. Process
cytes. surface
e. Facet
b. Phagocytes, fibroblasts, collagen fibres, osteo- 3. Passageway for
vessels or nerves f. Tuberosity
blasts.
c. Osteocytes, fibroblasts, elastin fibres, compact bone. 1. Have no joint cavity
d. Fibroblasts, collagen fibres, lamellae, compact 2. Types are sutures and syndesmoses
bone.
3. Dense connective tissue fills the space be-
6. Which humeral process articulates with the radius? tween the bones
a. Trochlea d. Capitulum 4. Almost all joints of the skull
b. Greater tubercle e. Olecranon fossa 5. Types are synchondroses and symphyses
c. Lesser tubercle 6. All are diarthroses
7. Which parts of the thoracic vertebrae articulate 7. The most common type of joint in the body
with the ribs? 8. Nearly all are synarthrotic
a. Spinous process
9. Shoulder, hip, knee, and elbow joints
b. Transverse process
12. Match the bone markings listed on the right with
c. Superior articular processes
their function listed on the left.
d. Body
e. Pedicles 1. Attachment site a. Trochanter
for muscle or b. Condyle
8. Which of the following bones or bone parts articu- ligament
late with the femur? c. Foramen
2. Forms a joint
a. Ischial tuberosity d. Fibula d. Process
surface
b. Pubis e. Tibia e. Facet
3. Passageway
c. Patella for vessels or f. Tuberosity
nerves
Short Answer essay 35. List two factors that keep bones healthy. List two factors
that can cause bones to become soft or to atrophy.
13. Name three functions of the skeletal system.
14. What is yellow marrow? How do spongy and com-
pact bone look different?
CRitiCAl thinking AnD
15. What are Sharpey’s fibres and what is their function
in bone? CliniCAl AppliCAtion
16. Describe the microscopic structure of compact bone. QueStionS
17. What type of tissue are epiphyseal plates composed
36. A 75-year-old woman and her 9-year-old grand-
of, and what is their role in growing children?
daughter were in a car accident. Both sustained
18. Identify and describe briefly the four phases of chest trauma from the force of being restrained by
fracture repair. their seatbelts in the crash. An X-ray showed that
the woman had sustained multiple rib fractures. Her
19. With one exception, all skull bones are joined by
granddaughter, however, only had mild bruising.
sutures. What is the exception?
Explain these observations by referencing known
20. What facial bone forms the chin? The cheekbone? facts about skeletal formation and physiology.
The upper jaw? The bony eyebrow ridges?
37. The pediatrician at the clinic explains to parents
21. Name two ways in which the fetal skull differs from of a newborn that their son suffers from cleft pal-
the adult skull. ate. She tells them that the normal palate fuses in
an anterior-to-posterior pattern. The child’s palatine
22. How many vertebrae are there in each of the three
processes of the maxilla have not fused. Have his
superior regions of the vertebral column?
palatine bones fused normally?
23. Diagram the normal spinal curvatures and then the
38. After having a severe cold accompanied by nasal
curvatures seen in scoliosis and lordosis.
congestion, Nicole complained that she had a fron-
24. Describe the underlying pathology that leads to tal headache and the right side of her face ached.
herniated discs. What bony structures probably became infected by
the bacteria or viruses causing the cold?
25. Name the major components of the thorax.
39. Bob, a 52-year-old man, has been experiencing
26. Is a floating rib a true or a false rib? Why are float-
excruciating pain in his feet, particularly his big
ing ribs easily broken?
toes. He is worried he may have gout. What is gout,
27. Name the bones of the shoulder girdle. and what blood marker would be elevated in this
condition?
28. Name all the bones with which the ulna articulates.
40. At work, a box fell from a shelf onto Ella’s acromial
29. What bones make up each hip bone (coxal bone)?
region. In the emergency room, the physician felt
Which of these is the largest? Which has tuberosi-
that the head of her humerus had moved into the
ties that we sit on? Which is the most anterior?
axilla. What had happened to Ella?
30. Name the bones of the lower limb from superior to
41. An X-ray image of the arm of an accident victim
inferior.
reveals a faint line curving around and down the
31. Compare the amount of movement possible in syn- shaft. What kind of fracture might this indicate?
arthrotic, amphiarthrotic, and diarthrotic joints. Relate
42. Bone X-ray studies are sometimes used to deter-
these terms to the structural classification of joints;
mine whether a person has reached his or her final
that is, to fibrous, cartilaginous, and synovial joints.
height. What are the clinicians checking out?
32. Describe the structure of a synovial joint.
43. A patient complains of pain starting in the jaw and
33. Professor Rogers pointed to the foramen magnum radiating down the neck. When he is questioned
of the skull and said, “The food passes through this further, he states that when he is under stress he
hole when you swallow.” Some students believed grinds his teeth. What joint is causing his pain?
him, but others said that this was a big mistake.
44. Dr. Davis is palpating Lauren’s vertebral column
What do you think? Support your answer.
to determine whether she is beginning to exhibit
34. Which structural parts of our vertebrae are most likely scoliosis. What part or region of her vertebrae was
to be weakened and at risk of fracture as we age? he feeling as he ran his fingers along her spine?

Chapter 5 The Skeletal System

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5

bones”—pretty unflattering and inaccurate images

Functions of the Bones

(c) Flat bone (sternum)

(a) Long bone (humerus)

(b) Irregular bone (vertebra),

Figure 5.2 Classification of bones on the basis of shape.

Structure of Bone marrow is found there. In adult bones, red mar-

Central (Haversian) canal

Table 5.1 Bone Markings

Name of bone marking Description Illustration

Projections that are sites of muscle and ligament attachment

Trochanter (tro-kan’ter) Very large, blunt,

Tubercle (too’ber-kl) Small, rounded projection or process

Spine Sharp, slender, often pointed projection Facet

Projections that help to form joints

Depressions and openings

Meatus (me-a’tus) Canal-like passageway

Bone growth Bone remodeling

1 Cartilage Articular cartilage

Table 5.2 Common Types of Fractures

Fracture type Illustration Description Comment

Comminuted Bone breaks into many Particularly common in older

Compression Bone is crushed Common in porous bones (i.e.,

Depressed Broken bone portion is Typical of skull fracture

Impacted Broken bone ends are Commonly occurs when

Spiral Ragged break occurs when Common sports fracture

Greenstick Bone breaks incompletely, Common in children, whose

Homeostatic Imbalance 5.2

(a) Anterior view (b) Posterior view

Axial Skeleton (it is shown as the green portion of Figure 5.8). It

Coronal suture Frontal bone

Temporal bone Ethmoid bone

Lambdoid Lacrimal bone

Figure 5.9 Human skull, lateral view. Practice art labeling

Foramen magnum Practice art labeling

Mastoid process Jugular foramen

Temporal bone Occipital condyle

Q: What bone articulates with every other facial bone?

Practice art labeling

Figure 5.12 Human skull, anterior view.

Homeostatic Imbalance 5.3 Zygomatic Bones The zygomatic bones are

Figure 5.14 Anatomical location and structure

the only freely movable joints in the skull. You can

Inferior Nasal Conchae The inferior nasal con- Fetal Skull

Anterior flexible, they allow the infant’s brain to grow dur-

Vertebral Column (Spine)

Homeostatic Imbalance 5.5 • Spinous process: single projection arising

(a) ATLAS AND AXIS (b) TYPICAL CERVICAL VERTEBRAE

Facet on superior Spinous

(c) THORACIC VERTEBRAE (d) LUMBAR VERTEBRAE

Spinous process Spinous process

Figure 5.20 Regional characteristics of vertebrae.

Medial Inferior angle

(c) Right scapula, posterior aspect Practice art labeling

(a) (b) (c)

Arm projections separated by the intertubercular

Nearby, the radial groove runs obliquely down

Ischium Pubic symphysis

Greater sciatic False pelvis