3. Anatomical position
most widely used &
accurate for all aspects
of the body
standing in an upright
posture, facing straight
ahead, feet parallel and
close, & palms facing
forward
5. Body Planes and
Sections
Coronal (frontal) plane - Lies vertically and divides
body into anterior (front) and posterior (back) parts
Sagittal plane – lies vertically and divides the body into
left and right sides.
Median (midsagittal) plane - Specific sagittal plane that
lies vertically in the midline
Transverse plane - runs horizontally and divides body
into superior (up) and inferior (down) parts
7. Anatomical directional terms
• Anterior
in front or in the front part
Anteroinferior
in front & below
Anterosuperior
in front & above
Posterior
behind, in back, or in the rear
Posteroinferior
behind & below; in back &
below
Posterolateral
behind & to one side,
specifically to the outside
12. Body Cavities and Membranes
Dorsal body cavity
Cranial cavity
Cranial cavity
houses the brain
Vertebral cavity
Vertebral cavity
runs through the
vertebral column
and encloses the
spinal cord
13. Body Cavities and Membranes
Ventral body cavity
Thoracic cavity
Two lateral parts each
containing a lung
surrounded by a
pleural cavity
Mediastinum –
contains the heart
surrounded by the
pericardial sac
14. Body Cavities and Membranes
Ventral body cavity
Abdominopelvic
cavity
Abdominal cavity –
contains the liver,
stomach, kidneys, and
other organs
Pelvic cavity –
contains the bladder,
some reproductive
organs, and rectum
15. Body Cavities and Membranes
Serous cavities – a slit-like space lined by a
serous membrane
Pleura, pericardium, and peritoneum
Parietal serosa – outer wall of the cavity
Visceral serosa covers the visceral organs
17. Other Body Cavities
Oral cavity
Nasal cavity
Orbital cavities
Middle ear cavities
Synovial cavities
18. Abdominal Regions and Quadrants
Abdominal regions divide the abdomen into nine
regions
19. Abdominal Quadrants
Abdominal quadrants divide the abdomen into four
quadrants
Right upper and left upper quadrants
Right lower and left lower quadrants
22. Bone growth
Prenatal, after wk 8, starts mineralization
Postnatal, longitudinal and diameter
23. Classification of Bones
Long bones
Typically longer than wide
Have a shaft with heads at both ends
Contain mostly compact bone
Examples: Femur, humerus
Short bones
Generally cube-shape
Contain mostly spongy bone
Examples: Carpals, tarsals
24. Classification of Bones, cont.
Flat bones
Thin and flattened, usually curved
Thin layers of compact bone around a layer of
spongy bone
Examples: Skull, ribs, sternum
Irregular bones
Irregular in shape
Do not fit into other bone classification categories
Example: Vertebrae
25.
26. Bones
The adult skeleton has 206 bones
Two basic types of bone tissue
Compact bone
Homogeneous
Spongy bone
Small needle-like
pieces of bone
Many open spaces
27. Long Bone
Diaphysis
Shaft
Composed of compact bone
Epiphysis
Ends of the bone
Composed mostly of spongy
bone
Hematopoiesis
28.
29. Structures of a Long Bone
Periosteum
Outside covering of the
diaphysis
Fibrous connective tissue
membrane
Sharpey’s fibers
Secure periosteum to
underlying bone
Arteries
Supply bone cells with
nutrients
30.
31. Structures of a Long Bone
Articular cartilage
Covers the external
surface of the epiphyses
Made of hyaline cartilage
Decreases friction at joint
surfaces
Figure 5.2a
32. Structures of a Long Bone
Medullary cavity
Cavity of the shaft
Contains yellow marrow
(mostly fat) in adults
Contains red marrow (for
blood cell formation) in
infants
Figure 5.2a
33. Microscopic Anatomy of Bone
Osteon (Haversian System)
A unit of bone
Central (Haversian) canal
Carries blood vessels
and nerves
Perforating (Volkman’s)
canal
Canal perpendicular to
the central canal
Carries blood vessels
and nerves
34. Bone Markings
Surface features of bones
Projections and processes – grow out from the bone surface
Depressions or cavities – indentations
Sites of attachments for
muscles, tendons, and
ligaments
Passages for nerves and
blood vessels
35. Changes in the Human
Skeleton
In embryos, the skeleton is primarily hyaline cartilage
During development, much of this cartilage is
replaced by bone
Cartilage remains in isolated areas
Bridge of the nose
Parts of ribs
Joints
36. Bone Growth
Epiphyseal plates allow for growth of long bone
during childhood
New cartilage is continuously formed
Older cartilage becomes ossified
Cartilage is broken down
Bone replaces cartilage
37. Bone Growth
Bones are remodeled and lengthened until
growth stops
Bones change shape somewhat
Bones grow in width
39. Types of Bone Cells
Osteocytes
Mature bone cells
Osteoblasts
Bone-forming cells
Osteoclasts
Bone-destroying cells
Break down bone matrix for remodeling and release of
calcium
Bone remodeling is a process by both osteoblasts
and osteoclasts
41. Composition of Bone…
Inorganic component:
Hydroxyapatite crystals with carbonate content
Organic component:
- Osteoid
Type I collagen (95%)
type V collagen (<5%)
Non collagenous proteins
Osteocalcin,
Osteopontin,
Bone sialoprotein,
Osteonectin.(SPARC)- Cell adhesion ,proliferation,
modulation of cytokine activity.
42. OSTEOCYTES:
Nerve cells
Sense the change in environment and send signals that affect
response of other cells involved in bone remodelling
Maintains balance between
resorption and remodelling
Bone that forms more rapidly
shows more osteocytes
43. Osteocytic lacunae
Canaliculi- narrow extension of lacunae, permits
diffusion of gases and nutrients
Maintains bone integrity and vitality
Failure of inter connecting system between osteocytes
and osteoblasts leads to sclerosis and death of bone
44. Osteoblasts :
Derived from osteoprogenitor cells
Periosteum serves as important reservoir .
Morphology :
basophilic
cuboidal or slightly elongated cells
contain prominent bundles of actin, myosin
BONE CELLS:
45.
46. Osteoblast, Functions
New bone formation
Controls bone mineralization at 3 levels
1. In its initial phase, by production of matrix vesicle
2. At a later stage, by controlling the ongoing process of
mineralization
3. By regulating the number of ions available
Regulation of bone remodeling and mineral metabolism
47. Osteoblasts Functions
Secrete type I collagen, small amount of type V collagen,
osteonectin, osteopontin, RANKL, osteoprotegerin,
Proteoglycans, latent proteases and growth factors
including bone morphogenic proteins
Exhibit high levels of alkaline phosphatase -cytochemical
marker
48. BONE LINING CELLS:
Osteoblasts flatten, when bone is not forming and extend
along the bone surface and hence the name
They are present on periosteal as well as endosteal surfaces
49. BONE RESORPTION: Osteoclasts
Sequence of events of bone resorption: Involves 3 phases
First phase -
formation of osteoclast
Second phase-
activation of osteoclast
Third phase -
resorption of bone
50. Alterations in the osteoclast
Removal of hydroxyapatite
acidic environment by proton pump
Degradation of organic matrix
acid phosphatase, cathepsin B
Removal of degradation products from lacunae
endocytosis
Translocation of degraded products and extracellular release
51.
52. Removal of hydroxyapatite:
The initial phase involves the dissolution of the mineral phase –
HCl
The protons for the acid arise from the activity of cytoplasmic
carbonic anhydrase II, which is synthesized in osteoclast.
The protons are then released across the ruffled border into the
resorption zone by an ATP consuming proton pump.
This leads to a fall in pH to 2.5 to 3.0 in the osteoclast resorption
space.
53. As age increases resorption exceeds
Cortical bone turnover -5% per year
Trabecular and endosteal surface – 15% per year
Coupling
The processes of bone synthesis and bone breakdown go on
simultaneously and the status of the bone represents the net result
of a balance between the two processes
54. Hormones and coupling
With the exception of calcitonin, all the hormones, cytokines, and
growth factors that act on bone, as an organ, mediate their activity
through osteoblasts
Resorbing hormones act directly on osteoblasts, which then
produce other factors that regulate osteoclast activity
This results in both bone formation and bone resorption being
coupled
55. To prevent accumulation of damaged bone by regenerating
new bone
Allowing to respond to the changes in mechanical forces
Mineral homeostasis
Functions of remodeling
60. Hormonal Control of Blood Ca
PTH;
calcitonin
secreted
Calcitonin
stimulates
calcium salt
deposit
in bone
Parathyroid
glands release
parathyroid
hormone (PTH)
Thyroid
gland
Thyroid
gland
Parathyroid
glands
Osteoclasts
degrade bone
matrix and release
Ca2+ into blood
Falling blood
Ca2+ levels
Rising blood
Ca2+ levels
Calcium homeostasis of blood: 9–11 mg/100 ml
PTH
62. Pathologies caused due to improper control of remodelling are:
•Osteoporosis
•Osteopetrosis*
•Malignant bone tumors
•Inflammatory joint diseases
*Osteopetrosis is a bone disease that makes bones abnormally
dense and prone to fracture
Autosomal Dominant Osteopetrosis(ADO)
63. Response to Mechanical Stress
Trabeculae form along lines of stress
Large, bony projections occur where heavy, active
muscles attach
64. Response to Mechanical Stress
Wolff’s law: a bone grows or remodels in response to the
forces or demands placed upon it
Observations supporting Wolff’s law include
Long bones are thickest midway along the shaft
(where bending stress is greatest)
Curved bones are thickest where they are most
likely to buckle
68. •Cranial and Facial Bones (22):
•frontal bone
•parietal bone (2)
•temporal bone (2)
•occipital bone
•sphenoid bone
•ethmoid bone
•mandible
•maxilla (2)
•palatine bone (2)
•zygomatic bone (2)
•nasal bone (2)
•lacrimal bone (2)
•vomer
•inferior nasal conchae (2)
70. Joint definition
Joints connect the components of the skeletal
system together
They give the skeletal system flexibility, and allow
muscles to direct movements by moving bones in
different directions
74. Functional classification,
187 joints in body
Synarthrosis are almost immovable joints; these joints
are common where protection of delicate internal
structures
Skull, mandible
Amphiarthrosis are slightly movable joints; connected
by broad flattened disks of fibrocartilage, of a more or
less complex structure, which adhere to the ends of
each bone
Vertebrae, pubic symphysis, sternocostal joint
Diarthrosis are freely movable joints; these joints
dominate in the limbs and areas of the body where
movement is important
77. Structural classification
Fibrous joints allow very little movement, and are composed of fibrous (dense)
connective tissue
skull sutures, tibia and fibula
Cartilaginous joints allow very little or no movement, and are characterized by
a connection between adjoining bones made of cartilage, no joint cavity
1. Fibrocarlilage: epiphyseal plate of growing bones is an immovable cartilaginous
joint
2. Hyaline cartilage: pubic symphysis, intervertebral joints and connection between
the first rib and sternum are slightly movable cartilaginous joints
Synovial joints are the most complex of the joint types
Characterized by articular (hyaline) cartilage covering the ends of bones, a fibrous
articular capsule (composed of fibrous connective tissue) lined with synovial
membrane, a joint cavity containing synovial fluid and reinforcing ligaments to hold the
bones together
Between the bones of the limbs
Bursae: flattened fibrous sacs lined with synovial membrane that develop in areas of
friction
Tendon sheaths are special bursae that wrap around tendons in areas of friction
78.
79. Fibrous Joints
Bones united by fibrous
tissue
Examples
Sutures
Syndesmoses
Allows more
movement than
sutures
Example: distal
end of tibia and
fibula
83. Synovial joints
Some synovial joints such as knee and hip have
fatty pads between the fibrous capsule and the
bone
Some have discs or wedges of fibrocartilage
separating the articular surface of bones (menisci of
knee)
Some synovial joints have bursa which is a fluid
filled sac containing the synovial fluid to decrease
the friction
84. Features of Synovial Joints
Articular cartilage (hyaline cartilage) covers the ends
of bones
Joint surfaces are enclosed by a fibrous articular
capsule
Have a joint cavity filled with synovial fluid
Ligaments reinforce the joint
85. Structures Associated with the Synovial
Joint
Bursae – flattened fibrous sacs
Lined with synovial membranes
Filled with synovial fluid
Not actually part of the joint
Tendon sheath
Elongated bursa that wraps around a tendon
91. • Plane joints connect two flat surfaces of bone to one another, and only allow
side-to-side movement with no rotation, so called nonaxial joints. Flat wrist
bones, Acromioclavicular joint(ACJ)
• Hinge joints connect a cylindrical bone end to a concave portion of another
bone. Rotation can occur in only one plane (like a door hinge), so called uniaxial
joints. Elbow and ankle, PIP, DIP
• Pivot joints connect the rounded end of one bone to a ring or sheath formed by
another bone, so are uniaxial joints. Radius & ulna, atlas & axis
• Condyloid joints fit the rounded convex articular surface of one bone into the
rounded concave surface of another bone. Allow side to side and forwards-
backwards movements, similarly to saddle joints, so are biaxial joints.
Knuckles(MCP)
• Saddle joints are characterized by concave and convex surfaces on both
articular surfaces. Allow side to side and forwards-backwards movements, but no
rotation, so are biaxial joints. Carpal & metacarpal of the
thumb **SternoClavicular**(with rotational mvmnt)
• Ball-and-socket joints join the spherical end of one bone to the concave,
rounded socket of another bone. Allow movement in all axes and rotation, and
92.
93.
94.
95. Motion depends on:
Joints
Muscle and tendon
Ligaments
Capsule
Skin
Other soft tissues such as vessels, adipose tissue,
nerves & etc.
99. Sometimes these paired
bones will show the same
motions, sometimes
opposite, depending on the
pair Clinically, this means
that problems in one bone
can often be driven by its
paired bone
For instance, if a person
chronically has problems
with their C1 in the upper
neck, one should also
address problems in its pair;
the L5 in the low back
Lovett Reactor System
Postural Homeostasis
100. Spinal Coupling:
C1 should move in a similar direction as L5
C2 should move in a similar direction as L4
C3 should move in a similar direction as L3
C4 should move in the opposite direction as L2
C5 should move in the opposite direction as L1
This continues downward to T5 which moves in the opposite direction
as T6
101.
102. Pelvic-Cranial Coupling:
Sacrum should move in the opposite direction as the occiput
The ilium should move in the opposite direction to the
ipsilateral temporal bone (e.g., an anteriorly rotated left ilium
should automatically rotate the left temporal bone posteriorly)
The coccyx should move in the same direction as the
sphenoid bone
In essence, the Lovett Reactor is a description of what
occurs in the pelvis, vertebrae and cranial bones when the
Righting Reflex is working correctly
103.
104.
105. The Vertebral
Column
Vertebrae separated by
intervertebral discs
The spine has a normal
curvature
Each vertebrae is given a
name according to its location
4 Curves
Primary: Thoracic &
Sacrococcygeal
Secondary: Cervical & Lumbar
109. Cervical vertebrae
Unlike the other parts of the spine, the cervical
spine has TRANSVERSE FORAMINA in each vertebra
for the vertebral arteries
Classify to upper and lower parts
Y-shape spinous process(C3-C6)
U-shape transverse processes for cervical spinal
nerves
Transverse foramen for paravertebral artery
Larger spinous process at C7
110.
111.
112. Cervical, Upper part
The upper cervical spine consists of the atlas (C1) and
the axis (C2)
These first 2 vertebrae are quite different from the rest of
the cervical spine
The atlas articulates superiorly with the occiput (the
atlanto-occipital joint) and inferiorly with the axis (the
atlantoaxial joint), synovial joints
The atlantoaxial joint is responsible for 50% of all
cervical rotation; the atlanto-occipital joint is responsible
for 50% of flexion and extension
The unique features of C2 anatomy and its articulations
complicate assessment of its pathology
115. Steel’s Rule of Thirds
At the level of the atlas, the odontoid process, the
subarachnoid space, and spinal cord each occupy
one third of the area of the spinal canal
116. Axis
The axis is composed of a vertebral body, heavy
pedicles, laminae, and transverse processes, which
serve as attachment points for muscles
The axis articulates with the atlas via its superior
articular facets, which are convex and face upward and
outward
117.
118. Axis
At birth, a vestigial cartilaginous disc space called the
neurocentral synchondrosis separates the odontoid process
from the body of C2
The synchondrosis is seen in virtually all children aged 3 years
and is absent in those aged 6 years
The apical portion of the dens ossifies by age 3-5 years and
fuses with the rest of the structure around age 12 years
This synchondrosis should not be confused with a fracture
121. Joint of Luschka
Between C3-C7
The joint believed to be
the result of degenerative
changes in the annulus,
which lead to fissuring in
the annulus and the
creation of the joint
Can develop osteophytic
spurs, which can narrow
the intervertebral foramina
122. Facet Joints
The facet joints in the cervical spine are Diarthrodial
synovial joints with fibrous capsules
The joint capsules are more lax in the lower cervical
spine than in other areas of the spine to allow
gliding movements of the facets
The joints are inclined at an angle of 45° from the
horizontal plane and 85° from the sagittal plane
This alignment helps prevent
excessive anterior translation and is
important in weight-bearing
123. Intervertebral Discs
These disks are composed of 4 parts: the nucleus
pulposus in the middle, the annulus fibrosis surrounding
the nucleus, and 2 end plates that are attached to the
adjacent vertebral bodies
They serve as force dissipators, transmitting compressive
loads throughout a range of motion
The disks are thicker anteriorly and therefore contribute to
normal cervical lordosis
133. Facet Joints*
To guide and limit mvmts in vertebral segments
Cartilage
Synovial fluid
Nerve & blood vessels
Ligaments
*Zygapophyseal(Z-joint)
134. Facet Joint Orientation, Cervical
Cervical Region: 45 degrees; all movements are
possible such as flexion, extension, lateral flexion, and
rotation
The articulating facets in the cervical vertebrae face
45o to the transverse plane and lie parallel to the
frontal plane, with the superior articulating process
facing posterior and up and the inferior articulating
processes facing anteriorly and down
135. Facet Joint Orientation, Thoracic
Thoracic Region; lateral flexion
and rotation; least
flexion/extension
The facet joints between
adjacent thoracic vertebrae are
angled at 60° to the
transverse(Hor) plane and 20°
to the frontal plane, with the
superior facets facing posterior
and a little up and laterally and
the inferior facets facing
anteriorly, down, and medially
144. Atypical Ribs
Rib1
One facet on its head
Subclavian groove for art & vein
Scalene tubercle
Rib2
Two articular facet on head
Tuberosity for serratus ant
148. Facet Joint Orientation, Lumbar
Lumbar Region: 90 degrees; sagittal plane;
only flexion and extension, limited rotation,
least lat flexion
The facet joints in the lumbar region lie in
the sagittal plane; the articulating facets are
at right angles to the transverse plane and
45° to the frontal plane
The superior facets face medially, and the
inferior facets face laterally, this changes at
the lumbosacral junction, where the
apophyseal joint moves into the frontal
plane and the inferior facet on L5 faces front
This change in orientation keeps the
vertebral column from sliding forward on the
sacrum
159. Herniation Stages
1) Disc Degeneration: chemical changes
associated with aging causes discs to
weaken, but without a herniation
2) Prolapse: the form or position of the
disc changes with some slight
impingement into the spinal canal. Also
called a bulge or protrusion
3) Extrusion: the gel-like nucleus pulposes
breaks through the annulus fibrosus but
remains within the disc
4) Sequestration: nucleus pulposus
breaks through the annulus fibrosus and
lies outside the disc in the spinal canal
162. Posterior Longitudinal Ligament
From C2 to sacrum
Long and
important ligament located
immediately posterior to the
vertebral bodies (to which it
attaches loosely) and
intervertebral discs
Extends from the back of the
sacrum inferiorly and
gradually broadens as it
ascends
164. Facet Joint Syndrome
Narrowing the joint space
Friction and destroying articular cartilage and the
fluid
Wear away cartilage
Bone spurs
Compress nerve
More bone spurs extend to the spinal canal
Spinal stenosis
165. Facet Joint Symptoms
Difficulty in head rotation
Difficulty in straightening back and get up of a chair
Pain, numbness, muscle weakness,..
166. FJS Treat
Ice, to reduce inflammation
Ultrasound, Electrostimulation to reduce muscle
spasm
Massage, traction, mobilization to increase ROM
and reduce pain
Exercise for more stability
167. Spondylolisthesis
Birth defect
Rapid growth during adolescence
Football
Weightlifting
Wrestling
Gymnastics
Track and field…
175. The Pectoral (Shoulder) Girdle
Composed of two bones
Clavicle – collarbone
Scapula – shoulder blade
These bones allow the upper limb to have
exceptionally free movement
177. Acromioclavicular Joint
To allow the scapula additional range of rotation on
the thorax
Allow for adjustments of the scapula (tipping and
internal/external rotation) outside the initial plane of
the scapula in order to follow the changing shape of
the thorax as arm movement occurs
The joint allows transmission of forces from the
upper extremity to the clavicle
188. Bones of the Upper Limb
The hand
Carpals – wrist
Metacarpals – palm
Phalanges – fingers
So Long To Pinky, Here Comes The Thumb
189. Bones of the Pelvic Girdle
Hip bones
Composed of three pair of fused bones
Ilium
Ischium
Pubic bone
The total weight of the upper body rests on the pelvis
Protects several organs
Reproductive organs
Urinary bladder
Part of the large intestine
200. ROM benefits
To determine presence of impairment
Establishing a diagnosis
Evaluation of progress
Modify the treatment
Motivate the patient
Research
201. Definitions
Power: work produced /time
For more power: more repetition
Strength: contract against external load
Endurance: perform activities over prolonged
period
Flexibility: ability to move a single joint or series of
joints smoothly & easily through an unrestricted
pain-free ROM
Plasticity: property of skeletal muscle that allow for
a new & greater length after a stretch that has been
applied
202. Manual Muscle Testing(MMT)
Grade Result
0 No contraction, no movement
1 Visible contraction, a little
2 Visible contraction, full ROM in elimination of gravity
3 Visible contraction, full ROM against gravity
4 Full ROM with moderate resistance
5 Full ROM with max resistance
203. Joint improvement
Passive range of motion
Active range of motion
Active assistive range of motion
Strengthening
Isometric
Isotonic
Concentric
Eccentric
Stretching
204. Benefits of exercises
Increase & maintain muscle strength
Increase endurance
Improve & maintain ROM
Increase circulation
Increase flexibility
Improve balance & coordination
Increase CV fitness
Improve sense of wellbeing
205. Stretching, indications
Adhesion, contracture, scar tissue
Decreased ROM(may lead deformity)
Part of a fitness program to prevent injury
Warm-up & cool-down exercise
206. Stretching, contra-indications
Recent fracture, incomplete bony union
Muscle ossification
Acute inflammation, infection
Sharp pain
Hematoma in muscle or area
Hypermobility
208. Inflammatory Conditions Associated with
Joints
Bursitis – inflammation of a bursa usually caused by a
blow or friction
Tendonitis – inflammation of tendon sheaths
Arthritis – inflammatory or degenerative diseases of joints
Over 100 different types
The most widespread crippling disease in the United
States
209. Clinical Forms of Arthritis
Osteoarthritis
Most common chronic arthritis
Probably related to normal aging processes
Rheumatoid arthritis
An autoimmune disease – the immune system attacks
the joints
Symptoms begin with bilateral inflammation of certain
joints
Often leads to deformities
210. Clinical Forms of Arthritis
Gouty Arthritis
Inflammation of joints is caused by a deposition of
urate crystals from the blood
Can usually be controlled with diet
211. Developmental Aspects of the Skeletal
System
At birth, the skull bones are incomplete
Bones are joined by fibrous membranes – fontanelles
Fontanelles are completely replaced with bone within two
years after birth
212. The Skull
Two sets of bones
Cranium
Facial bones
Bones are joined by sutures
Only the mandible is attached by a freely movable
joint
219. The Hyoid Bone
The only bone that does
not articulate with another
bone
Serves as a moveable base
for the tongue
220. The Fetal Skull
The fetal skull is large
compared to the infants
total body length
221. The Fetal Skull
Fontanelles – fibrous
membranes connecting the
cranial bones
Allow the brain
to grow
Convert to bone within 24
months after birth
223. Bone Fractures
A break in a bone
Types of bone fractures
Closed (simple) fracture – break that does not
penetrate the skin
Open (compound) fracture – broken bone penetrates
through the skin
Bone fractures are treated by reduction and
immobilization
Realignment of the bone
225. Repair of Bone Fractures
Hematoma (blood-filled swelling) is formed
Break is splinted by fibrocartilage to form a callus
Fibrocartilage callus is replaced by a bony callus
Bony callus is remodeled to form a permanent patch