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

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

Dr A. L. Neill BSc MSc MBBS PhD FACBS [email protected] Front cover

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

Introduction This book is particularly useful when used with the A to Z of Peripheral Nerves and The A to Z of Skeletal Muscles, parts of the material is also covered in the A to Z of the Head & Neck bones & muscles but all the A to Zs are cross-referenced and together are forming a set covering the all structural elements of the human body. Now as an adjunct to this book – the first in the series of the new The A to Z of…failure books is the The A to Z of Bone and Joint Failure, which builds upon the knowledge of the material in this book. Eventually there will be a companion book to each of the current and future A to Zs - the sick and the well.

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So... If there is a structure / subject you want to see in the A to Zs let us know, as the feedback often determines the order of the new books. The A to Zs may be viewed on 2 sites – www.amandasatoz.com and http://www.aspenpharma.com.au/atlas/student.htm

Acknowledgement

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

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Dedication

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To aging “healthily” – if not necessarily gracefully!!

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

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

JOINT is the GLENOHUMERAL JOINT and the COLLAR BONE is the CLAVICLE). Each bone and joint is shown from at least 2 aspects. Throughout the book, bones or groups of bones are also shown “in situ”, or as an “overview” to relate them to the whole body structure, in other words as they lay in body or cavity anatomically. For example the RIBS together form the RIB CAGE and anatomically this bony structure is the way the ribs function. There is a separate section at the back to discuss the BACK!

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And even the back cover has been modified so that there is an additional fold over which serves as a means of identifying the book on the shelf (i.e. the fold over has the title down the “spine”). Books can now be placed on the shelf and still identified. The fold over is also a fold in if not used as a book mark it can be folded in on itself and lays flat on the cover.

Thank you A. L. Neill BSc MSc MBBS PhD FACBS [email protected]

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ISBN 978-1-921-930-19-5

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

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

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OVERVIEWS to be found in this book carpus / wrist overview (including hand bones) chest overview ear bones overview fingers overview foot, toes overview hand, wrist, fingers overview pectoral girdle / overview of the shoulders pelvic girdle / overview of the hips sinuses overview skull overviews teeth overview vertebral column overview vertebrae overview cervical spine overview

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

Abbreviations A aa adj. aka ALL alt. ant. art.

= = = = = = = =

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b/n BM BS BV C co c.f. CNS collat. CSF CT D E e.g. EC ext.

= = = = = = = = = = = = = = = =

GC Gk. IC IP IT jt(s) L LB LL Lt. lig. M MC med Met MT NS NT OC P

= = = = = = = = = = = = = = = = = = = =

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actions /movements of a joint anastomosis or anastomoses adjective also known as anterior longitudinal ligament alternative anterior articulation (joint w/o the additional support structures) Alternative Spelling, generally referring to the diff. b/n British & American spelling between bone marrow blood supply blood vessel carpal / carpo cortex compared to central nervous system collateral Cerebrospinal fluid connective tissue diaphysis epiphysis example extracellular (outside the cell) extensor (as in muscle to extend across a joint) giant cells Greek intercarpal / intercarpo interphalangeal intertarsal / intertarso joints = articulations Left / Lumbar long bones lower limb aka leg Latin ligament metaphysis metacarpal / metacarpo medial / medula metastasis metatarsal / metatarso nervous system / nerve supply nervous tissue osteoclast phalangeal / phalanges / phalango

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pl. PLL post. proc prox PS R ROM sing. SC SN SP TP UL V VB VC w/n w/o &

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plural posterior longitudinal ligament posterior process proximinal public symphysis Right range of movement singular spinal cord spinal nerve spinous process transverse process upper limb aka arm vertebra(e) / vein vertebral body vertebral column within without and

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Common terms in Osteology and Skeletal Anatomy Ablation

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

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

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Common terms in Osteology and Skeletal Anatomy Bow-legged Bregma

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

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

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

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Avulsed

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

Simple

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Compound

Greenstick = Incomplete

Oblique

Pathologic

Segmental

Torsion Torsus

Transverse

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

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

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Common terms in Osteology and Skeletal Anatomy Magnum Malleus Mandible Mastoid Maxilla Meatus

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

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Tumour of the bone tissue. Disease of softening of the bones / Paget’s disease. 13

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

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

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Common terms in Osteology and Skeletal Anatomy Rickets Ridge Rotundum Sagittal

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

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The A to Z of Bones, Joints, Ligaments & the Back Temporal Tendon Tentorium Torus Trabecula Trephination Trochanter Trochlea Tubercle Tuberculum Tuberosity Turbinate Tympanum Ulna Uncus Valgus-Vargus

Refers to time and the fact that grey hair (marking the passage of time) often appears first at the site of the temporal bone. T A tie or cord of collagen fibres connecting muscle with bone (as opposed to articular ligaments which connect bone with bone). A tent. Protruberance pl. tori. A “little” beam i.e. supporting structure or strut pl. trabeculae = spicule. The practice of making an artificial hole in the cranium practiced in many ancient religions used to relieve cranial pressure. Pertaining to a small wheel or disc. In the femur it is a large disc = shaped tuberosity. A pulley that part of the bone or ligamentous attachment that pulls the bone in another direction as in the elbow or the ankle (adj.- Trochlear). A small process or bump, an eminence. A very small prominence, process or bump. A large rounded process or eminence, a swelling or large rough prominence often associated with a tendon or ligament attachment. A child’s spinning top, hence shaped like a top. An old term for the nasal conchae. A drum pl. tympani. = Elbow or arm (adj.- ulnar) A hook adj.- uncinate.

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Normal Volar Wormian bone Zygoma

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

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

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Notes...

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

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Anatomical relations

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The Back

Joint movements of the Neck

neck flexion

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neck extension/hyper-extension

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The Back

Joint movements of the Back

flexion of the VC

extension of the VC

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rotation of the VC 21

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Joint movements of the Shoulder

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

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shoulder/scapula movements in the horizontal plane

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

Joint Movements of the Upper Limb & Shoulder

arm extension in sagittal plane / shoulder movement

shoulder extension in the sagittal plane

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

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shoulder abduction in the coronal plane (with elbow flexion)

wrist extension wrist flexion

shoulder elevation - reverse movement shoulder depression shoulder movement © A. L. Neill

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

Joint Movements of the Hip & Lower Limb

Hip flexion

Hip extension

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Hip lateral and medial rotation

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Hip adduction

Hip circumduction

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

Joint Movements of the Feet & Hands

Foot dorsiflexion

Foot plantar flexion

Foot inversion

Foot normal position

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Fingers extension

Forearm pronation

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Fingers flexion

Forearm supination

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Foot eversion

Hand deviation radial/laterally ulna/medially

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

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

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

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

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BONES in situ – UPPER 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

Frontalis - forehead Zygoma Maxilla –upper jaw Mandible – lower jaw Clavicle – collar bone Humerus – arm Manubrium Sternum breastbone Xiphoid process Temporalis Parietalis Occipitalis Atlas - C1 Axis – C2 Vertebrae – cervical (7) – neck Vertebrae – thoracic (12) – thorax Shoulder joint Elbow joint Scapularis – shoulder blade 10th Rib (24 ribs- 12 each side)

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Anterior 1

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7 8 9

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Posterior 11 12 13

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

BONES in situ – LOWER 21 22 23 24 25 26 27 28 29 30 31 32 36 37 38 39 40 41 42 43

Radius Ulna Femur – thigh bone Patella – kneecap Fibula Tibia – shin Cuniform bones (3 each foot) Metatasal bones – foot bones (5 each foot) Phalanges = digits (14 each foot) Toes / joints Tarsal bones - foot bones (7 each foot) Ankle joint 33 Knee joint 34 Wrist joint 35 Hip joint Os Coxae - Hip bone Sacrum Carpal bones – wrist bones (8 each hands) Ischium (part of the hip bone) Navicula – ankle bone Talus – heel bone Metacarpal bones - hand bones (5 each hand) Coccygeal bones (3-5)

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Anterior

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

Classification of Bones Flat bones

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

Irregular bones Various shapes not easily classified Sphenoid, Vertebrae, Hip, Ear Bones irregular growth centres. Long bones

These bones are long with a shaft = diaphysis and 2 ends epiphyses. They have growth centres at each end and grow lengthwise over years via their growth plates at the metaphyses, e.g.: most limb bones: Femur, Fibula Humerus, Radius, Tibia, Ulna, & digits Phalanges. See diagram.

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

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Sesamoid bones are completely surrounded by soft tissue w/o joints e.g. Hyoid. small bones around the thumb and big toe. Short bones

Roughly cubic in shape. Most wrist Carpal and ankle Tarsal bones; many of the bones at the base of the skull.

Sutural bones

= “Wormian” bones are small bones which occur w/in the skull sutures. They are sometimes called extra-sutural if the main part f the bone is outside of the suture. They are unnamed, except the Incus - the largest extra-sutural bone.

There are:

There are between 600 and 620 bones in the body including the various sesamoid and Wormian bones and other areas where there may be separate or ossified joints. 22 paired skull bones including the ear ossicles / not including the teeth. 5 single bones mainly on the base of the skull. 1 mandible. 1 hyoid. variable sutural & extra-sutural bones (generally between 3-5).

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56 digit bones or Phalanges plus an additional 3 to 4 small sesamoid bones in the foot over the big toe and the thumb.

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

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Classification of Bones

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Structure of a Long Bone 1 2 3 4 5 6 7 8 9 10 11 12 13

joint surface = articular surface = hyaline cartilage joint space joint capsule + periosteum compact bone endosteum BM red & yellow epiphysis – head of the bone metaphysis – widest part of the shaft BVs entering bone through nutrient foramen neurovascular bundle travelling in 3 diaphysis – shaft of the bone cancellous bone – bone spicules ossification of growth plate – fusion of spicules

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

Anterior

Posterior

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

Disarticulated Bones

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Classification and Summary of Joints definition: joint = any BONE something BONE B+?+B i.e whenever 2 or more bones meet TYPE OF JOINT GOMPHOSIS

STRUCTURE BONE FIBRES TOOTH SYNARTHROSES = BONE FIBROUS JOINT FIBRES BONE eg SUTURE BONE (short fibrous FIBRES connection b/n bones) BONE eg SYNDESMOSIS BONE (longer fibres more FIBRES cartilage) BONE SYNCHONDROSIS = BONE 1º CARTILAGENOUS HYALINEJOINT CARTILAGE (Amphiarthrosis) BONE SYMPHYSIS BONE (20 cartilagenous joint) FIBROCARTILAGE BONE

MOVEMENT nil

SYNOVIAL (Diarthrosis)

Full movement type depends upon the shape of the bony surfaces

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joints in the Skull

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joints b/n flat bones Tibiofibula joint Radioulna joint

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m rA BONE HYALINE CARTILAGE SYNOVIAL FLUID HYALINE CARTILAGE BONE

EXAMPLES teeth / jaw bone

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

eg PLANE

gliding / sliding

eg HINGE

one directional

eg PIVOT

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

eg CONDYLOID eg BALL & SOCKET

eg SADDLE 38

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

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Classification and Summary of Joints

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

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

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

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

NAME

DESCRIPTION

EXAMPLES

SHOWN IN

accessory = collateral

any “helping” lig. supporting/strengthening the primary lig. generally used where there are many short bones in a crowded area

the: palm (palmar), sole (plantar), phalanges (volar) temporomandibular joint (Henle), humerus and wrist

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

annular also see retinaculum

any circular lig.

annulus fibrosis annular lig. of the Radius

vertebro-vertebral joints elbow

binding enclosing lig.

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arcuate

any curved lig.

arcuate pubic ligament pelvic girdle overview

anterior

description of any lig. in front of the named structure (also used to describe those fibres in front of a structure)

ANTERIOR LONGITUDINAL LIGAMENT = ALL

craniovertebral jts thoracic cage vertebro-vertebral jts

bifurcate

lig. with 2 insertions

calcaneocuboid + calcaneonavicular pisio-hamate + pisio-metacarpal

ankle joint-subtalar dorsum of the hand

elbow, knee jts wrist

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collateral = accessory

any “helping” lig. supporting/strengthening the primary lig. generally used with outer ligs over bigger joints

radial collat. . lig.

cruciform

ligaments which cross over

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

deltoid

ligs which fan out as a “D” DELTOID LIGAMENT

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Classification and Summary of Ligaments

The ligaments included in this book are those associated with the musculoskeletal system, bones and skeletal muscles. Tendons which join muscle to bone are not discussed nor are other ligamentous structures such as the aponeuroses or ligaments of organs such as the Hepatic ligaments. NAME

DESCRIPTION

EXAMPLES

flava

ligs with large amounts of elastic fibres hence yellow in colour

LIGAMENTUM FLAVA

SHOWN IN vertebra-vertebro jts

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interarticular ligs which enter the (may also be synovium and are inside called synovial) the joint

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

inter-osseous

ligs which span across 2 bones for a considerable length - deep ligs acting as a surface for muscle attachment

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

inter-spinous

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

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SUPRASPINOUS LIGAMENTUM NUCHAE SACROSPINOUS SACROTUBEROUS INGUINAL LIG

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vertebral column overview

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

posterior

description of any lig. POSTERIOR behind the named structure LONGITUDINAL (also used to describe LIGAMENT = PLL those fibres of a lig. behind a structure)

vertebro-vertebral jts

radiate

lig. which fans out (smaller radiate lig. of the rib deltoid shape)

thoracic cage, costovertebral jts

synovial = interarticular

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

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

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

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

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

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10-25

10-40

10-25

20-30

20-50

40-50

10-30

10-30

10-30

10-20

Chondroblastoma

Chondroma

Chondromyxoid fibroma

Desmoplastic fibroma

Haemangioma

Osteoma

Osteoid osteoma

Osteoblastoma

Osteochondroma

Solitary bone cyst

3:1

Humerus, Femur

N

thin cortex

grows out opposite to adjacent joint

cap of cartilage covered by a membrane continuous with the periosteum

sharply delineated centre: osteoid lined by plump osteoblasts, w/o inflammation

larger centre, absent reactive bone; not painful

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

Femur, Tibia, Humerus, Pelvis cortex of LBs

sharply delineated centre: osteoid lined by plump osteoblasts, w/o inflammation

lucent centre