Appendicular Skeleton

Table 6.1 Bone Markings (1 of 2)

Table 6.1 Bone Markings (2 of 2)
Pectoral girdle
• Consists of the scapulae and clavicles connected to the manubrium
• Connects the upper limb to the axial skeleton (sternoclavicular joint)
Clavicle (collar bone)
• It is located at the superior part of the anterior thorax (chest).
• Parts:
• Sternal end (triangular where it articulates with the manubrium)
• Acromial end (flat; articulates with acromion)
• Shaft
• Medial 2/3 rounded and convex forwards
• Lateral 1/3 is flat and curves back to the scapula
• Upper surface = smooth
• inferior surface = rough
• Groove for subclavius (middle 1/3)
• Conoid process (acromial end) for the attachment of conoid ligament
Clavicle
• Function
• Serves as a moveable, crane-like strut (rigid support) from which the
scapula and free limb are suspended, keeping them away from the
trunk so that the limb has maximum freedom of motion
• Transmits shocks (traumatic impacts) from the upper limb to the axial
skeleton.
Clavicle landmarks
• Acromial end

• Sternal end

• Conoid tubercle

• Costoclavicular tuberosity
The clavicle
 Scapula (Shoulder Blade)

• Lies on the posteriolateral part of shoulder

• Thin triangular flat bone that forms the bulk of the

shoulder

• Related to the 2nd -7th rib

• Articulates with the humerus of the arm at the glenoid

fossa
• Posterior surface
• Convex
• Divided unevenly by the spine
• Supraspinous fossa
• Infraspinous fossa
• Costal (anterior surface)
• Concave
• Has subscapular fossa
• The continues laterally as the acromion
• Superolaterally, the lateral surface has a glenoid cavity
• Has three borders
• Medial
• Lateral
• superior (has the suprascapular notch)
• Three angles
• Superior (2nd rib)
• Inferior
th
Arm bone - Humerus
• Longest and strongest bone of the upper limb
• Nerves related to the bone
• Surgical neck – axillary nerve
• Shaft – radial nerve
• Medial epicondyle – ulnar
• Supracondylar - median
• Articulates with the scapula (glenoid cavity) at the
shoulder and the radius and ulna at the elbow
Structures of the Humerus of the Right Arm
Coronoid Humerus
Humerus Olecranon
fossa fossa

Capitulum Medial
Olecranon
epicondyle
process
Lateral
epicondyle
Medial
Head of Trochlea epicondyle
radius
Coronoid
Radial process of Head
tuberosity ulna
Neck
Radial notch
Radius Ulna Ulna Radius

(c) Anterior view at the elbow region (d) Posterior view of extended elbow
Forearm bones
• Radius and ulna
• Radius is lateral and the ulna is medial
• An interosseous membrane connects radius and ulna bones
• Both articulate with each other at the proximal and distal radioulnar
joints
• Proximal ends articulate with the humerus
• Radius only articulate with carpal bones (scaphoid and lunate) - When
radius moves, the hand moves with it
• Ulna is the main bone responsible for forming the elbow joint with the
humerus
• Radius is the weight bearing bone of the forearm
Forearm bones
• Colle’s fracture
• Distal end of radius – is displaced backwards and
upwards. Check Smith’s fracture

• Chauffer’s fracture or Hutchinson fracture or or

backfire fracture
• Radial styloid process
Carpus
• Are arranged in two irregular rows
• Proximal row from lateral to medial
• Scaphoid, lunate, triquetral, and pisiform
• Distal row from lateral to medial
• Trapezium, trapezoid, capitate, and hamate
• A mnemonic to help remember carpals
• Some Lovers Try Positions, That They Can't Handle
• So Luke Took Peter, To The Church Hall
• She Looks Too Pretty, Try To Catch Her
 She Likes To Play
Lunate
Scaphoid In the moonlight
A boat
Triquetrum
The third T Bone

Pisiform
Pea-shaped

Hamate
A hambone
With a hook
Trapezium:
“It’s by the thumb”
Capitate
Trapezoid
“Is by its side”

Try To Catch Her

 Carpus
• Scaphoid – boat-shaped, tubercle, most commonly fractured
carpal bone
• Lunate – Most commonly dislocated carpal bone
• Pisiform – pea-shaped, sesamoid bone (flexor carpi ulnaris
tendon)
• Hamate – wedged-shaped, hook
• Trapezoid – shoe-shaped
• Trapezium – pyramidal shape, tubercle
• Capitate- largest, first carpal bone to ossify

Carpal tunnel syndrome

Metacarpus and Phalanges
• Metacarpus
• Numbered 1–5, beginning with the pollex (thumb)
• Each has a head, shaft and base
• Articulate proximally with the distal row of carpals
• Articulate distally with the proximal phalange
• Phalanges
• Numbered 1–5, beginning with the pollex (thumb)
• Except for the thumb, each finger has three phalanges proximal,
middle, and distal
• Each has a head, shaft and base

• Bennet’s fracture – Base of metacarpal I

• Boxer’s fracture – Neck of metacarpal, esp. V
Bones of the Hand
Bones of the Hand
The Appendicular Skeleton
• Lower extremity
• Pelvic (hip) girdle
• Consists of paired hip bones (coxal bones,
innominate bones)

• Lower Limbs
• Bones of thigh, leg, foot
• Carries the entire weight of the erect body
• Bones are thicker and stronger than those of
upper limb
Hip bones (coxal bones or os coxae or innominate bones)

 Each hip bone consists of three parts:

ilium, ischium and pubis. They fuse
to form a fossa called acetabulum. ilium

 The 3 parts are separate bones in

childhood

 The 2 hip bones articulate posteriorly

Pubis
with the sacrum, and joins anteriorly ischium
by pubic symphysis.

 Attaches the lower limbs to the trunk.

Lateral and Medial Views of the Hip Bone
Bony Pelvis

PLAY Pelvis
Bony Pelvis
 Consists of
 2 hip bones
 1 Sacrum
 1 Coccyx
 Functions?

In anatomical position, the upper margins of pubic symphysis and anterior superior
iliac spines lies in the same coronal plane
Bony Pelvis
• Bones are united by 4 joints
• 2 sacroiliac joints
(posterosuperolaterally)

• 2 fibrocartilaginous joints
• pubic symphysis
(anteroinferiorly)
• sacrococcygeal joint
(posteroinferiorly)

 In pregnancy, the hormones relaxin, progesterone and oestrogen

affect the joints and ligaments, enabling some movements of
the joints to facilitate birth
Bony Pelvis

PLAY Pelvis

Copyright © 2008 Pearson Education, Inc.,

publishing as Benjamin Cummings Figure 8.8a
True and False Pelves
• The pelvis is divided into two parts: greater pelvis and lesser
pelvis by the pelvic inlet (superior pelvic aperture or pelvic
brim)

• True (lesser) pelvis

• part inferior to pelvic brim
• enclosed by sacrum and lower parts of the two hip bones
• divided into 3 regions: brim, cavity and outlet

• False (greater) pelvis

• part superior to the pelvic brim and is formed by two iliac
fossae
Pelvic brim
• Boundaries: pubis symphysis, pubic crest, pectineal line or pecten
pubis, arcuate line, sacroiliac joint, ala of sacrum, sacral
promontory
• iliopectineal line?
• Linea terminalis or innominate line ?
Pelvic outlet/ inferior pelvic aperture
• Diamond-shaped.
• Anatomical boundaries: lower margin of the pubic
symphysis, ischiopubic rami, ischial tuberosities,
sacrotuberous ligament, tip of coccyx
Pelvimetry
• Measurement of the dimensions of the inlet and outlet
of the pelvis.
• The dimensions of the inlet, cavity and outlet affect the
passage of the fetus
Pelvimetry- Pelvic inlet

 Anteroposterior/True conjugate
 Oblique diameter: distance from sacroiliac joint to
contralateral iliopectineal line or eminence
 Anatomical transverse diameter: widest distance of
pelvic inlet, i.e widest points on iliopectineal line
Pelvimetry-Anteroposterior diameters
 A conjugate is a
measurement taken
from one point in the
pelvis to another.
 There are anatomical
(“true”) conjugate
(11cm), obstetrical
conjugate (10.5cm)
and internal (diagonal)
conjugate (12.5cm).
 The diagonal
conjugate can be
estimated at vaginal
examination
Pelvimetry-Pelvic outlet

??

anatomical

 Transverse diameter: between inner aspects of ischial

tuberosities OR between the tips of ischial spines
Caldwell-Moloy classification of pelvic types
 The shape of the pelvis affects the mechanism of labour.

 Abnormal pelvic shape is associated with problems at

delivery as the rotation of the presenting part may be
suboptimal.

 Injury, disease and dietary deficiencies can affect the growth

and shape of the pelvis

 4 types of pelvis have been described. Majority of pelves are

of mixed types
Caldwell-Moloy classification of pelvic types
 Gynecoid (42%)- Normal, Inlet is transversely
oval (TD>APD)

Android (32%)- Male type, inlet is heart-

shaped (APD>TD), pelvic cavity is funnel-shaped
with projecting iliac spines, narrow subpubic
angle <90o

 Anthropoid (25%)- ape-like type, Inlet is

compressed from side-to-side (APD>>TD),
narrow subpubic angle, long and narrow
sacrum

 Platypelloid (<5%)- flat female pelvis, TD

>>APD, wide subpubic angle
Female and Male Pelves
Female and Male Pelves
Femur (thigh bone)
• Single bone of the thigh
• Longest and strongest bone of the body
• Ball-shaped head articulates with the acetabulum of hip bone.
Distal condyle articulates with the tibia and patella
• Fracture at neck of femur is very common in the elderly due to
osteoporosis
Anterior Posterior
Patella (Knee-cap)
• Largest sesamoid bone (lies in quadriceps tendon),
protects the knee anteriorly
• As a sesamoid bone, it is devoid of periosteum, hence
when fractured bony union does not take place.
Patella (Knee-cap)
Leg
• Tibia and fibula are bones of the leg
• Interosseous membrane connects the tibia and fibula
• Tibia (shin bone)
• Second largest bone
• Lies medially,
• Transmits weight of the body from femur to the foot
• Articulates with femur (knee joint) and talus (ankle joint).
• Has a medial malleolus
Leg
• Fibula
• Long pin-like bone, lies laterally
• Does not contribute to the knee joint; helps stabilize the ankle
joint via lateral malleolus
• Articulates with the tibia and talus (ankle joint)
Structures of the Tibia and Fibula
The Foot
• Foot is composed of
• Tarsus,
• Metatarsus,
• Phalanges

• Important functions
• Supports body weight
• Acts as a lever to propel body forward when walking
• Segmentation makes foot pliable and adapted to uneven ground

PODIATRY?
Tarsus (ankle bones)
• Contains 7 bones called tarsals

• Proximal row: talus and calcaneus.

Middle row: navicular (boat-shaped).
Distal row: 3 cuneiforms (medial, intermediate, and lateral) and cuboid.

• Body weight is primarily borne by the talus (ankle bone) and calcaneus.

• The talus serves as a link between the bones of the foot and the leg, is
devoid of muscular attachment

• The calcaneus (heel bone) is the largest. It articulates with the talus
superiorly and the cuboid anteriorly.

• The trochlea of talus articulates with the tibia and fibula at the ankle joint.
The head of the talus articulates with the navicular bone
Bones of the Foot

Phalanges
Distal
Middle
Proximal

1 2 3 4
Metatarsals
Medial 5
cuneiform
Intermediate Lateral
cuneiform cuneiform
Navicular Cuboid
Tarsals
Talus
Trochlea
of talus
Calcaneus

(a) Superior view

Bones of the Foot
Hindfoot
 Talus and Calcaneus

Midfoot
 Navicular, Cuneiforms
& Cuboid

Forefoot
 metatarsals &
phalanges
Bones of the Foot

Sustentaculum tali or talar shelf

Arches of the Foot
• Foot has 3 important arches.

• The arches enable the foot to support the weight of the body,
provide an ideal distribution of body weight over the soft and hard
tissues of the foot, and provide leverage while walking.
• The arches are not rigid; they yield as weight is applied
and spring back when the weight is lifted, thus storing energy for
the next step and helping to absorb shocks.
• Fully developed by age 12 or 13.
• Concavity of the arches protects the nerves and vessels of the sole
• Arches are maintained by Interlocking shapes of tarsals, ligaments
and tendons
Arches of the Foot - Types
• Medial longitudinal arch
• formed by the calcaneus, talus, navicular, three cuneiforms, and
medial three metatarsals. Involved in propulsion during locomotion.
The talus is the keystone of this arch.

• Lateral longitudinal arch

• formed by the calcaneus, cuboid and lateral two metatarsals,
• characteristically low and almost touches the ground.
• involved in receiving and supporting the body weight during walking
and running.
• The cuboid is the keystone of this arch

• Transverse arch
• Formed by the cuboid, three cuneiforms, and the
bases of the five metatarsals
Arches of the Foot

Copyright © 2008 Pearson Education, Inc.,

publishing as Benjamin Cummings
Pes planus (Flat foot)
• commonest of all foot problems.
•
• occurs due to the collapse of medial longitudinal arch

• causes include excessive weight, postural abnormalities, weakened

supporting tissues, and genetic predisposition.

• effects of the flat foot are:

• person usually has clumsy shuffling gait due to the loss of spring in the foot.
• makes the foot more liable to trauma due to loss of the shock absorbing
function.
• compression of the nerves and vessels of the sole is due to the loss of
concavity of the sole
• Fallen arches may lead to inflammation of the fascia of the sole (plantar
fasciitis), Achilles tendinitis, shin splints, stress fractures, bunions, and
calluses
Pes cavus (Claw foot)
 Foot morphology characterized by high arch (unusually
high medial longitudinal arch) of the foot that does not
flatten with weightbearing.
 Deformity can be located in the forefoot, the midfoot,
the hindfoot, or a combination of these sites.
 It can bee a sign of an underlying neurologic disorder
Talipes -Clubfoot
 Talipes equinus (horse like):
foot is plantar flexed and
person walks on the toes with
heel raised.

 Talipes calcaneus: the person

walks on the heel with
forefoot raised.

 Talipes varus: the foot is

inverted and adducted. The
person walks on the outer
border of the foot.

 Talipes valgus: the foot is

everted and abducted. The
person walks on the inner
border of his foot.
 Talipes equinovarus: commonest deformity of the
foot. The foot is inverted, adducted, and plantar
flexed.
Disorders of the Appendicular Skeleton
Disorders of the Appendicular Skeleton

• Genu valgum (genu-knee; valgum -bent outward)

A deformity in which the knees are abnormally close together and the
space between the ankles is increased due to a lateral angulation of
the tibia in relation to the femur. Also called knock-knee. The opposite
occurrence is genu varum, otherwise known as "bowleggedness".
Disorders of the Appendicular Skeleton

Genu valgum

Genu varus
Disorders of the Appendicular
Skeleton
• Hallux valgus (hallux-great
toe)
• Angulation of the great toe
away from the midline of the
body, typically caused by
wearing tightly fitting shoes.
When the great toe angles
toward the next toe, there is a
bony protrusion at the base of
the great toe. Also called a
bunion.