SKELETAL & JOINT SYSTEM

Skeleton includes bones and cartilages. It forms the main supporting framework of the body,
and is primarily designed for a more effective production of movements by the attached
muscles. Bones provide the structure for our bodies. The adult human skeleton is made up of
206 bones. These include the bones of the skull, spine (vertebrae), ribs, arms and legs.
Bones are made of connective tissue reinforced with calcium and specialized bone cells. Most
bones also contain bone marrow, where blood cells are made.

Bones work with muscles and joints to hold our body together and support freedom of
movement. This is called the musculoskeletal system. The skeleton supports and shapes the
body and protects delicate internal organs such as the brain, heart and lungs.

Bones contain most of our body’s calcium supply. The body is constantly building up and
breaking down bone tissue as required. Healthy bone needs a balanced diet, regular weight-
bearing exercise and the right levels of various hormones.

The skeleton
The human skeleton is made up of 206 bones, including bones of the:

• Skull – including the jaw bone

• Spine – cervical, thoracic and lumbar vertebrae, sacrum and tailbone (coccyx)
• Chest – ribs and breastbone (sternum)
• Arms – shoulder blade (scapula), collar bone (clavicle), humerus, radius and ulna
• Hands – wrist bones (carpals), metacarpals and phalanges
• Pelvis – hip bones
• Legs – thigh bone (femur), kneecap (patella), shin bone (tibia) and fibula
• Feet – tarsals, metatarsals and phalanges.
 Divisions of the Skeletal System (Fig. 2.1)

Regions of the Skeleton Number of Bones Cranial and facial

bones:
AXIAL SKELETON (mnemonic is A-Z)
Skull
Cranium 8 A-D -
Face 14 Ethmoid 1
Hyoid 1 Frontal 1
Auditory ossicles (3 in each ear): 6 G-H -
(Malleus, incus, stapes) Inferior nasal
Vertebral column 26 Choncha 2
Thorax J-K -
Sternum 1 Lacrimal 2
Ribs 24 Maxilla 2
APPENDICULAR SKELETON Mandible 1
Pectoral (shoulder) girdles Nasal 2
Clavicle 2 Occipital 1
Scapula 2 Parietal 2
Upper extremities Palatine 2
Humerus 2 Q-R -
Ulna 2 Sphenoid 1
Radius 2 Temporal 2
Carpals 16 U -
Metacarpals 10 Varner 1
Phalanges 28 W-Y -
Pelvic (hip) girdle Zygomatic 2
Pelvic, or hip bone 2
Lower extremities
Femur 2
Fibula 2
Tibia 2
Patella 2
Tarsals 14
Metatarsals 10
Phalanges 28

Total 206
BONES
• Definition
Bone is one-third connective tissue. It is impregnated with calcium salts which
constitute two-thirds part. The inorganic calcium salts (mainly calcium phosphate,
partly calcium carbonate, and traces of other salts) make it hard and rigid, which
can afford resistance to compressive forces of weight-bearing and impact forces of
jumping. The organic connective tissue (collagen fibres) makes it tough and
resilient (flexible), which can afford resistance to tensile forces. In strength, bone
is comparable to iron and steel.
Despite its hardness and high calcium content the bone is very much a living
tissue. It is highly vascular, with a constant tum-over of its calcium content. It
shows a characteristic pattern of growth. It is subjected to disease and heals after
a fracture. It has greater regenerative power than any other tissue of the body,
except blood. It can mould itself according to changes in stress and strain it bears.
It shows disuse atrophy and overuse hypertrophy.

• Functions
1. Bones give shape and support to the body, and resist any forms of stress.
2. These provide surface for the attachment of muscles, tendons, ligaments,
etc.
3. These serve as levers for muscular actions.
4. The skull, vertebral column and thoracic cage protect brain, spinal cord and
thoracic viscera, respectively.
5. Bone marrow manufactures blood cells.
6. Bones store 97% of the body calcium and phosphorus.
7. Bone marrow contains reticulo-endothelial cells which are phagocytic in
nature and take part in immune responses of the body.
8. The larger paranasal air sinuses affect the timber of the voice.
 Phalanges

(a) (b)

Human skeleton: (a) Anterior view, (b) Posterior view

• Types of bones:

A. According to Shape
I. Long bones: Each long bone has an elongated shaft (diaphysis) and two
expanded ends (epiphyses) which are smooth and articular. The shaft
typically has 3 surfaces separated by 3 borders, a central medullary cavity,
and a nutrient foramen directed away from the growing end. Examples:
(a) typical long bones like humerus, radius, ulna, femur, tibia and
fibula;
(b) miniature long bones have only one epiphysis like
metacarpals, metatarsals and phalanges; and
 (c) modified long bones have no medullary cavity like clavicle (Fig. 2.2).
2.Short bones: Their shape is usually cuboid, cuneiform, trape- zoid, or
scaphoid. Examples: tarsal and carpal bones (Fig. 2.3).
3. Flat bones resemble shallow plates and form boundaries of certain body
cavities. Examples: bones in the vault of the skull, ribs, sternum and
scapula (Fig. 2.4).
4. Irregular bones: Examples: vertebra, hip bone, and bones in the base of
the skull (Fig. 2.5).
5. Pneumatic bones: Certain irregular bones contain large air spaces lined
by epithelium Examples: maxilla, sphenoid, ethmoid, etc. They make the
skull light in weight, help in resonance of voice, and act as air
conditioning chambers for the inspired air.
6.Sesamoid bones: These are bony nodules found embedded in the
tendons or joint capsules. They have no periosteum and ossify after birth.
They are related to an articular or nonarticular bony surface, and the
surfaces of contact are covered with hyaline cartilage and lubricated by
a bursa or synovial membrane. Examples: patella, pisiform, fabella, etc.
Functions of the sesamoid bones are:
(a) to resist pressure;
(b) to minimise friction;
(c) to alter the direction of pull of the muscle; and
(d) to maintain the local circulation.

B. Developmental Classification

1. • Membrane (dermal) bones ossify in membrane

(intramembranous or mesenchymal ossification), and are thus
derived from mesenchymal condensations. Examples: bones
of the vault of skull and facial bones.
• Cartilaginous bones ossify in cartilage (intracartilaginous or
endochondral ossification), and are thus derived from
 preformed cartilaginous models. Examples: bones of limbs,
vertebral column and thoracic cage.
• Membrano-cartilaginous bones ossify partly in membrane
and partly in cartilage. Examples: clavicle, mandible, occipital,
temporal, sphenoid.
2. • Somatic bones: Most of the bones are somatic.
• Visceral bones: These develop from pharyngeal arches.
Examples are hyoid bones, part of mandible and ear ossicles.

C. Regional Classification

1. Axial skeleton includes skull, vertebral column, and thoracic cage.

2. Appendicular skeleton includes bones of the limbs.
 • GROSS STRUCTURE OF AN ADULT LONG BONE
Naked eye examination of the longitudinal and transverse sections of a long
bone shows the following features.
1. Shaft: From without inwards, it is composed of periosteum, cortex and
medullary cavity.

a) Periosteum is a thick fibrous membrane covering the surface of the

bone. It is made up of an outer fibrous layer, and an inner cellular layer
which is osteogenic in nature. Periosteum is united to the underlying
bone by Sharpey's fibres, and theunion is particularly strong over the
attachments of tendons, and ligaments. At the articular margin the
periosteum is continuous with the capsule of the joint. The abundant
periosteal arteries nourish the outer part of the underlying cortex also.
Periosteum has a rich nerve supply which makes it the most sensitive part
of the bone.
b) Cortex is made up of a compact bone which gives it the desired
strength to withstand all possible mechanical strains.

c)Medullary cavity is filled with red or yellow bone marrow. At birth the
marrow is red everywhere with widespread active haemopoiesis. As the age
advances, the red marrow at many places atrophies and is replaced by
yellow, fatty marrow, with no power of haemopoiesis. Red marrow persists
in the cancellous ends of long bones. In the sternum ribs, iliac crest,
vertebrae and skull bones the red marrow is found throughout life.

2. The two ends of a long bone are made up of cancellous bone covered with
hyaline (articular) cartilage .
Naked eye structure of an adult long bone in longitudinal section
Gross Anatomy of development of Bones

A long bone has two main regions: the diaphysis and the epiphysis . The diaphysis is
the hollow, tubular shaft that runs between the proximal and distal ends of the
bone. Inside the diaphysis is the medullary cavity, which is filled with yellow bone
marrow in an adult. The outer walls of the diaphysis (cortex, cortical bone) are
composed of dense and hard compact bone, a form of osseous tissue.

A typical long bone showing gross anatomical features.

The wider section at each end of the bone is called the epiphysis (plural = epiphyses),
which is filled internally with spongy bone, another type of osseous tissue. Red bone
marrow fills the spaces between the spongy bone in some long bones. Each epiphysis
meets the diaphysis at the metaphysis. During growth, the metaphysis contains
the epiphyseal plate, the site of long bone elongation described later in the
chapter. When the bone stops growing in early adulthood (approximately 18–21
years), the epiphyseal plate becomes an epiphyseal line seen in the figure.

Lining the inside of the bone adjacent to the medullary cavity is a layer of bone cells
called the endosteum (endo- = “inside”; osteo- = “bone”). These bone cells
(described later) cause the bone to grow, repair, and remodel throughout life. On the
outside of bones there is another layer of cells that grow, repair and remodel bone
as well. These cells are part of the outer double layered structure called
the periosteum (peri– = “around” or “surrounding”). The cellular layer is adjacent to
the cortical bone and is covered by an outer fibrous layer of dense irregular
connective tissue (see figure). The periosteum also contains blood vessels, nerves,
and lymphatic vessels that nourish compact bone. Tendons and ligaments attach to
bones at the periosteum. The periosteum covers the entire outer surface except
where the epiphyses meet other bones to form joints (figure). In this region, the
epiphyses are covered with articular cartilage, a thin layer of hyaline cartilage that
reduces friction and acts as a shock absorber.

Periosteum and Endosteum: The periosteum forms the outer surface of bone, and the
endosteum lines the medullary cavity.

Flat bones, like those of the cranium, consist of a layer of diploë (spongy bone),
covered on either side by a layer of compact bone. The two layers of compact bone
and the interior spongy bone work together to protect the internal organs. If the
outer layer of a cranial bone fractures, the brain is still protected by the intact inner
layer.

Anatomy of a Flat Bone: This cross-section of a flat bone shows the spongy bon covered on
either side by a layer of compact bone.

Blood and Nerve Supply

The spongy bone and medullary cavity receive nourishment from arteries that pass
through the compact bone. The arteries enter through the nutrient foramen (plural
= foramina), small openings in the diaphysis .The osteocytes in spongy bone are
nourished by blood vessels of the periosteum that penetrate spongy bone and blood
that circulates in the marrow cavities. As the blood passes through the marrow
cavities, it is collected by veins, which then pass out of the bone through the
foramina.

In addition to the blood vessels, nerves follow the same paths into the bone where
they tend to concentrate in the more metabolically active regions of the bone. The
nerves sense pain, and it appears the nerves also play roles in regulating blood
supplies and in bone growth, hence their concentrations in metabolically active sites
of the bone.
 Figure – Diagram of Blood and Nerve Supply to
Bone: Blood vessels and nerves enter the bone through the nutrient foramen.

DEVELOPMENT AND OSSIFICATION OF BONES

Bones are first laid down as mesodermal (connective tissue)
condensations. Conversion of mesodermal models into bone is called
intramembranous or mesenchymal ossification, and the bones are called
membrane (dermal) bones.
However, mesodermal stage may pass through cartilaginous stage
by chondrification during 2nd month of intrauterine life. Conversion
of cartilaginous model into bone is called intracartilaginous or
endochondral ossification, and such bones are called cartilaginous
bones.
Ossification takes place by centres of ossification, each one of which
is a point where laying down of lamellae (bone formation) starts by the
osteoblasts situated on the newly formed capillary loops. The centres
of ossification may be primary or secondary. The primary centres
appear before birth, usually during 8th week of intrauterine life; the
secondary centres appear after birth, with a few exceptions of lower end
of femur and upper end of tibia. Many secondary centres appear during
puberty.
A primary centre forms diaphysis, and the secondary centres form
epiphyses. Fusion of epiphyses with the diaphysis starts at puberty
and is complete by the age of 25 years, after which no more bone
growth can take place. The law of ossification states that secondary
centres of ossification which appear first are last to unite. The end of a
long bone where epiphysial fusion is delayed is called the growing
end of the bone.

GROWTH OF A LONG BONE

1. Bone grows in length by multiplication of cells in the epiphysial
plate of cartilage (Fig. 2.15).
2. Bone grows in thickness by multiplication of cells in the deeper
layer of periosteum.
3. Bones grow by deposition of new bone on the surface and at the
ends. This process of bone deposition by osteoblasts is called
appositional growth or surface accretion. However, in order to
maintain the shape the unwanted bone must be removed. This
process of bone removal by osteoblasts is called remodelling.
This is how marrow cavity increases in size.