Skeletal - Appendicular (235 #8)

Question 1

Pectoral/Shoulder Girdle

Answer 1

Attach the bones of the upper limbs to the axial skeleton. Do not articulate with the vertebra – are held in place & stabilized with muscles that extend from vertebrae and ribs to scapula.

1) clavicle – anterior bone articulates with the manubrium of the sternum
2) scapula – posterior bone articulates with the clavicle at the acromioclavicular joint and with the humerus at the glenohumeral joint.

Question 2

Clavicle

Answer 2

S-shaped bone, rougher and more curved in males. Transmits mechanical force from the upper limb to the trunk. One of the most frequently broken bones.

1) sternal end – articulates with manubrium
2) acromial end – articulates with acromium of scapula
3) conoid tubercle – inferior surface of lateral end, for attaching conoid ligament btwn scapula and clavicle.
4) Impression for costoclavicular ligament – attaches clavicle to first rib.

Question 3

Scapula

Answer 3

Large triangular flat bone in superior posterior thorax btwn R2-R7.

1) spine – prominent ridge across posterior, lateral flattened expanded process is ACROMION – high point of shoulder (acromioclavicular joint)
2) Glenoid cavity – shallow depression inferior to acromion, accepts head of humerus (glenohumeral joint)
3) Inferior angle – point at bottom of scapula
4) Superior angle – along the superior border.
5) Scapular notch – prominent indentation in superior border for suprascapular nerve
6) Coracoid process – tendons of muscles (pectoralis minor, coracobrachialis and biceps brachii) and ligaments (coracoacromial, conoid, trapezoid) attach.
7) Supraspinous Fossa & Infraspinous Fossa – superior and inferior to spine, for same name muscle attachment.
8) Subscapular Fossa – on anterior of scapula for subscapularis muscle.

Question 4

Upper Limb (Extremity)

Answer 4

30 bones in 3 locations

1) humerus
2) ulna and radius
3) 8 carpals in wrist, 5 metacarpals in the metacarpus (palm) and 14 phalanges

Question 5

Humerus - Proximal

Answer 5

Longest and largest bone of the upper limb

1) head – proximal end that articulates with glenoid cavity of scapula
2) anatomical neck – distal to head, visible as oblique groove. Former site of epiphyseal plate
3) greater tubercle – lateral projection distal to neck, most laterally palpable bony landmark
4) lesser tubercle – projects anteriorly. Btwn two tubercles is intertubercular sulcus.
5) Surgical neck – constriction in shaft just distal to tubercles, where fractures often occur
6) Shaft – starts cylindrical, ends up triangular, flattened and broad.
7) Deltoid tuberosity – middle of shaft, roughened V-shape

Question 6

Humerus - Distal

Answer 6

8) Radial groove – contains radial nerve
9) Capitulum – rounded knob that articulates with radius
10) Radial fossa – anterior depression above the capitulum that articulates with the head of the radius when the forearm is bent.
11) Trochlea – medial to the capitulum, spool-shaped that articulates with trochlear notch of the ulna
12) coronoid fossa – receives coronoid process of ulna when forearm is flexed
13) olecranon fossa – receives olecranonon of ulna when forearm is straight
14) Medial & lateral epicondyle – rough projections for tendon attachment
15) ulnar nerve – can be palpated over medial condyle – FUNNY BONE

Question 7

ULNA – Proximal to Distal

Answer 7

Located on the medial aspect (little finger side) of the forearm and is longer than the radius. P.U. = Pinky is on the Ulna side

1) olecranon – forms the prominence of the elbow
2) coronoid process – articulates with the trochlea of the humerus – the trochlear notch is the curved area between olecranon and coronoid process that forms part of the elbow joint
3) radial notch – articulates with the head of the radius
4) ulnar tuberosity – where the biceps brachii tendon attaches
5) head (distal) – separated from the wrist by layer of fibrocartilage
6) styloid process – attachment for the ulnar collateral ligament to the wrist

Question 8

Radius – Proximal to Distal

Answer 8

Smaller bone of the forearm, narrow at it’s proximal end and widens at the distal end.
1) head – disc-shaped, articulates with capitulum of humerus and radial notch of ulna
2) neck – constricted, inferior to head
3) radial tuberosity – roughened area for attachment of biceps brachii
4) styloid process – can be felt proximal to the thumb, attachment for brachioradialis and radial collateral ligament to the wrist.
Fracture of the distal end of the radius is the most common fracture in +50yr olds

Question 9

Interosseus Membrane

Answer 9

Joins the shaft of the radius & ulna – broad flat connective tissue. Site of attachment for some tendons of deep skeletal muscles of the forearm.

Question 10

Elbow

Answer 10

1) head of radius with capitulum of humerus

2) trochlear notch of ulna articulates with the trochlea of the humerus

Question 11

Proximal Radioulnar Joint

Answer 11

Head of radius articulates with ulna’s radial notch

Question 12

Distal Radioulnar Joint

Answer 12

Head of ulna articulates with radius’s ulnar notch

Question 13

Head of ulna articulates with radius’s ulnar notch

Answer 13

Distal end of radius articulates with three bones of the wrist = lunate, scaphoid and triquetrum.

Question 14

Carpus/Wrist

Answer 14

Consists of 8 carpals joined by intercarpal joints = two traverse rows of 4 bones
Proximal, lateral to medial
1) scaphoid = boatlike, 70% of carpal fractures
2) lunate = moon-shaped
3) triquetrum = three-cornered
4) pisiform = pea-shaped
Distal, lateral to medial
5) Trapezium = 4-sided figure
6) Trapezoid = 4-sided, 2 sides parallel
7) Capitate = head-shaped, largest carpal bone
8) Hamate = hooked projection on anterior surface
Stop Letting Those People Touch The Cadaver’s Hand
Carpal Tunnel = formed by pisiform and hamate, scaphoid and trapezium with roof of flexor retinaculum.

Question 15

Metacarpus/Palm

Answer 15

Intermediate region of the hand, consists of 5 (I-V) metacarpals.
1) Proximal = base, carpometacarpal joins
2) Shaft
3) Distal = head (knuckles), metacarpophalangeal joints
Thumb = I, Pinky = V

Question 16

Phalanges - Hand

Answer 16

14 phalanges with interphalangeal joints. (I-V) = proximal, middle and distal rows
Thumb (pollex) has no middle row.

Question 17

Pelvic Girdle

Answer 17

Consists of two hip bones (coxal or os coxa or pelvic bones), united by the pubic symphysis and sacrum, forming the bony pelvis. Provides a strong and stable support for the vertebral column and pelvic and lower abdominal organs, and connects the bones of the lower limbs to the axial skeleton.

Question 18

Hip Bone

Answer 18

The hip bone is made up of three fused bones, which converge and ossify at the acetabulum = the socket for the femur.

1) Illium
2) Ischium
3) Pubis
4) Acetabulum – functions as the socket that accepts the rounded head of the femur (coxal joint). On the inferior side is the acetabular notch, which forms a foramen for the blood vessels and nerves and allows attachment of femur ligaments (the ligament of the head of the femur).

Question 19

Illium

Answer 19

Largest of the three components of the hip bone.
1) ala – superior wing
2) body – inferior, one of the components of the acetabulum
3) iliac crest – superior border, ends anteriorly in a blunt anterior superior iliac spine.
4) Posterior superior iliac spine below it
5) Greater sciatic notch = where the sciatic nerve passes through (longest nerve in the body
6) Iliac fossa – medial surface, attachment of iliacus muscle
7) Iliac tuberosity – posterior to fossa, attachment of sacroiliac ligament
8) Auricular surface – articulates with sacrum at sacroiliac joint
9) Auricuate line – ridge that projects inferiorly and anteriorly from auricular surface
10) Anterior, Inferior and Posterior Gluteal Lines – gluteal muscle attachments on lateral surface
Hip Pointer = bruising of anterior superior iliac spine

Question 20

Ischium

Answer 20

Inferior, posterior part of the hip bone

1) body – fuses with both pubis and illium
2) ramus – fuses with the pubis
3) ischial spine – prominent projection
4) lesser sciatic notch – below the spine
5) ischial tuberosity – roughened, thickened (sits bones)
6) obturator foramen – largest foramen in the skeleton, formed by the ramus of the ischium and the pubis. Blood vessels and nerves pass through, but it is almost completely closed by the obturator membrane.

Question 21

Inferior, posterior part of the hip bone
1) body – fuses with both pubis and illium
2) ramus – fuses with the pubis
3) ischial spine – prominent projection
4) lesser sciatic notch – below the spine
5) ischial tuberosity – roughened, thickened (sits bones)
6) obturator foramen – largest foramen in the skeleton, formed by the ramus of the ischium and the pubis. Blood vessels and nerves pass through, but it is almost completely closed by the obturator membrane.
Inferior, posterior part of the hip bone
1) body – fuses with both pubis and illium
2) ramus – fuses with the pubis
3) ischial spine – prominent projection
4) lesser sciatic notch – below the spine
5) ischial tuberosity – roughened, thickened (sits bones)
6) obturator foramen – largest foramen in the skeleton, formed by the ramus of the ischium and the pubis. Blood vessels and nerves pass through, but it is almost completely closed by the obturator membrane.
Inferior, posterior part of the hip bone
1) body – fuses with both pubis and illium
2) ramus – fuses with the pubis
3) ischial spine – prominent projection
4) lesser sciatic notch – below the spine
5) ischial tuberosity – roughened, thickened (sits bones)
6) obturator foramen – largest foramen in the skeleton, formed by the ramus of the ischium and the pubis. Blood vessels and nerves pass through, but it is almost completely closed by the obturator membrane.
Pubis

Answer 21

1) superior ramus
2) inferior ramus
3) body – superior border is pubic crest, ending in pubic tubercle laterally
4) pectineal line – line running from pubic tubercle, along the superior ramus and merging with the auricuate line of the illium
5) pubic symphysis is the joint between the two pubes of the hip bones. Disc of fibrocartilage
6) pubic arch – inferior to the symphysis, inferior rami of both sides converge.

Question 22

False and True Pelves

Answer 22

Bony pelvis is separated by the PELVIC BRIM or INLET – circumference is from sacral promontory, along auricuate line, pectineal line and pubic crest to the pubic symphysis. Forms an oblique plane that is higher in back than front.

Question 23

FALSE (Greater) Pelvis

Answer 23

Superior to pelvic brim, bordered by lumbar spine, hip bones and abdominal wall. Part of the lower abdomen. Contains superior part of bladder, lower intestines, uterus, ovaries and uterine tubes.

Question 24

TRUE (Lesser) Pelvis

Answer 24

Inferior to pelvic brim. Has inlet, outlet and a cavity and is bounded by the sacrum and coccyx, inferior portions of the illium and ischium and the pubic bones. Surrounds pelvic cavity and contains rectum and urinary bladder, vagina and cervix, prostate. Superior opening bordered by pelvic brim is the INLET, inferior opening is the OUTLET. AXIS = imaginary line that curves through the true pelvis from the central point of the plane of the inlet to the outlet = route that baby’s head passes through.

Question 25

Female Pelvis

Answer 25

1) General = light and thin
2) False = shallow
3) Brim = wide and more oval
4) Acetabulum = small and faces anteriorly
5) Obturator Foramen = Oval
6) Pubic Arch = greater than 90 degrees
7) Illiac Crest = less curved
8) Illium = Less vertical
9) Greater Sciatic Notch = Wide, almost 90 degrees
10) Coccyx = more movable and curved anteriorly
11) Sacrum = shorter, wider and less curved anteriorly
12) Outlet = Wider
13) Ischial Tuberosity = shorter, farther apart and more medially projecting

Question 26

Male Pelvis

Answer 26

1) General = heavy and thick
2) False = Deep
3) Brim = narrow and heart-shaped
4) Acetabulum = large and faces laterally
5) Obturator Foramen = Round
6) Pubic Arch = less than 90 degrees
7) Illiac Crest = more curved
8) Illium = More vertical
9) Greater Sciatic Notch = Narrow, ~70 degrees
10) Coccyx = less movable and less curved anteriorly
11) Sacrum = longer, narrower and more curved anteriorly
12) Outlet = Narrower
13) Ischial Tuberosity = longer, closer together and more laterally projecting

Question 27

LOWER LIMB

Answer 27

30 bones in 4 locations

1) femur in the thigh
2) patella
3) tibia/fibula in leg
4) tarsals in tarsus, 5 metatarsals in the metatarsus ad the 14 phalanges in the toes

Question 28

FEMUR

Answer 28

Longest, heaviest and strongest bone in the body. Proximal end articulates with the acetabulum and the distal end articulates with the tibia and patella. The body angles medially and the knee joint is closer to the midline than the hip joints (angle of convergence, greater in females)

Question 29

FEMUR – Proximal

Answer 29

1) head – rounded, forms the coxal joint with the acetabulum.
2) Fovea capitis – central depression in the head that contains the ligament of the head, which attaches to the acetabulum
3) Neck – constricted region distal to the head – broken hip usually occurs here
4) Greater trochanter – projection from the junction of the neck and shaft, attachment for tendons of thigh/buttock muscles. Felt anterior to the hollow on side of hip
5) Lesser trochanter – inferior and medial to the greater trochanter
6) Intertrochanteric line – btwn greater/lesser
7) Intertrochanteric crest – between posterior surfaces.
8) Gluteal tuberosity – vertical ridge that blends into linea aspera (down the shaft)

Question 30

FEMUR – Distal

Answer 30

1) medial condyle – articulates with medial condyle of tibia
2) lateral condyle – articulates with lateral condyle of tibia
3) medial & lateral epicondyles – superior to condyles, attachment for knee ligaments
4) intercondylar fossa – depression between condyles
5) patellar surface – between condyles on anterior surface
6) adductor tubercle – roughened projection for adductor magnus

Question 31

Patella

Answer 31

Increases the leverage of the tendon of the quadriceps femoris, maintains the position of the tendon when flexed, and protects the knee joint. Small triangular bone anterior to knee joint. Develops in tendon of the quadriceps femoris.
1) base - Broad proximal end
2) apex - pointed distal end
3) articular facets – for lateral and medial condyles of femur
Patellofemoral joint is intermediate component of the tibiofemoral (knee) joint.

Question 32

Patellofemoral Stress Syndrome

Answer 32

Incorrect tracking of patella in the groove between the condyles of the femur (tracking laterally as well as superiorly & inferiorly). Runner’s Knee

Question 33

Tibia

Answer 33

Shin bone, larger medial weight-bearing bone of the leg.
Proximal to distal:
1) lateral and medial condyles – articulate with condyles of femur at tibiofemoral joint. Inferior surface of lateral articulates with head of fibula.
2) Intercondylar eminence – upward projection btwn slightly concave condyles.
3) Tibial tuberosity – anterior surface, attachment for patellar ligament
4) Anterior border/crest – shin. Continuous with the tibial tuberosity, can be felt as a sharp ridge
5) Medial malleolus – distal articulation with the talus of the ankle, felt as prominence
6) Fibular notch – distal articulation with fibula, distal tibiofibular joint.
Most frequently fractured of all long bones, typically open (compound) fracture.

Question 34

Fibula

Answer 34

Parallel and lateral to the tibia, but considerably smaller (the fibuLA is LAteral). Doesn’t articulate with femur, but stabilizes ankle joint.
1) head – articulates with inferior surface of lateral condyle of tibia – proximal tibiofibular joint
2) lateral malleolus – articulates with talus of the ankle, forms prominence.
3) Distal tibiofibular joint – articulates with fibular notch of tibia.
Popular site for removing bone for bone grafting, since you can sill move regularly with a piece of the bone missing!

Question 35

Tarsus – Ankle

Answer 35

Proximal region of the foot
Tall Centres Never Take Shots From Corners
1) talus – articulates with fibula and tibia = talocrural joint
2) calcaneus – heel, strongest and largest bone, takes 50% of weight during walking
3) navicular – little boat
4) third cuneiform – lateral
5) Second cuneiform
6) First cuneiform – medial
7) Cuboid
Joints between are intertarsal joints.

Question 36

Metatarsus

Answer 36

Five metatarsal bones (I-V) from medial to lateral – base, shaft & head. Articulate with cuneiform 1-3 and cuboid to form tarsometatarsal joints. Distally with phalanges for metatarsophalangeal joints. First is thickest, bears most weight. Often fractured with heavy object falls or in dancing.

Question 37

Phalanges - Foot

Answer 37

14 phalanges  with interphalangeal joints.  (I-V) = proximal, middle and distal rows
Big toe (hallux) has no middle row.

Question 38

Arches of the Foot

Answer 38

Two arches held in position by ligaments and tendons – enable the foot to support the body weight, provide an ideal dist of body weight of soft and hard tissues, provide leverage while walking. Absorb shocks – yield when weight is applied and spring back when weight is lifted. Developed by 12 or 13. 60% heel, 40% ball of foot.

Question 39

Longitudinal Arch

Answer 39

Anterior to posterior of foot. Medial part originates at calcaneus, rises to talus and descends through navicular, three cuneiforms and the heads of the 3 medial metatarsals. Lateral part begins at calcaneus, rises at cuboid and descends at heads of two lateral metatarsals. Ball-heel of foot doesn’t touch ground due to medial part.

Question 40

Transverse Arch

Answer 40

Medial to lateral – formed by navicular, three cuneiforms and bases of the metatarsals.

Question 41

Arch Deformities

Answer 41

Flatfoot – ligaments and tendons are weakened and height of medial longitudinal arch decreases.
Clawfoot – medial longitudinal arch is abnormally elevated – caused by muscle deformities.