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!ecture010Anatom" and Human Skeleton

Shoulder Girdle
T$e $u&an upper ar&! t$e s$oulder 'oint is co&posed o( t$ree bones% the clavicle
(collarbone), the scapula (shoulder blade), and the humerus (upper arm bone). T)o
'oints (acilitate s$oulder &o*e&ent. T$e acro&iocla*icular +"C, 'oint is located bet)een t$e
acro&ion +part o( t$e scapula t$at (or&s t$e $i-$est point o( t$e s$oulder, and t$e cla*icle. T$e
-leno$u&eral 'oint! to )$ic$ t$e -eneric ter& .s$oulder 'oint. usuall/ re(ers! is a ball0and0soc1et
'oint t$at allo)s t$e ar& to rotate in a circular (as$ion or to $in-e out and up a)a/ (ro& t$e
bod/. +T$e .ball. is t$e top! rounded portion o( t$e upper ar& bone or $u&erus2 t$e .soc1et!. or
-lenoid! is a dis$0s$aped part o( t$e outer ed-e o( t$e scapula into )$ic$ t$e ball (its., "r&
&o*e&ent is (urt$er (acilitated b/ t$e abilit/ o( t$e scapula to slide bot$ laterall/ and *erticall/
alon- t$e rib ca-e. T$e capsule is a so(t tissue en*elope t$at encircles t$e -leno$u&eral 'oint. 3t
is lined b/ a t$in! s&oot$ s/no*ial &e&brane.
T$e bones o( t$e s$oulder are $eld in place b/ &uscles! tendons! and li-a&ents. Tendons are
tou-$ cords o( tissue t$at attac$ t$e s$oulder &uscles to bone and assist t$e &uscles in &o*in-
t$e s$oulder. Li-a&ents attac$ s$oulder bones to eac$ ot$er! pro*idin- stabilit/. 4or e5a&ple!

t$e (ront o( t$e 'oint capsule is anc$ored b/ t$ree -leno$u&eral li-a&ents.
T$e rotator cu(( is a structure co&posed o( tendons t$at! )it$ associated &uscles! $olds t$e ball
at t$e top o( t$e $u&erus in t$e -lenoid soc1et and pro*ides &obilit/ and stren-t$ to t$e
s$oulder 'oint.
T)o (il&/ sac0li1e structures called bursae per&it s&oot$ -lidin- bet)een bone! &uscle! and
tendon. T$e/ cus$ion and protect t$e rotator cu(( (ro& t$e bon/ arc$ o( t$e acro&ion.

RIBCAGE
T$e $u&an rib ca-e. 3n anato&/! ribs +Latin costae, are t$e lon- cur*ed bones! )$ic$ (or& t$e
rib ca-e. Ribs surround t$e c$est +Latin t$ora5, o( land *ertebrates! and protect t$e lun-s! $eart!
and ot$er internal or-ans o( t$e t$oracic ca*it/.

Fi2 #ib cae Anatom"
T"pes of #ibs
T$e $u&an s1eleton $as 24 ribs! 12 on eac$ side. +" s&all proportion &a/ $a*e one pair &ore
or (e)er., T$e/ are attac$ed be$ind t$e *ertebral colu&n. T$e (irst se*en pairs are connected to
t$e sternu& in (ront and are 1no)n as true ribs +costae *erae! 30V33,. T$e ei-$t$! nint$! and
tent$ are attac$ed in (ront to t$e cartila-inous portion o( t$e ne5t rib abo*e and are 1no)n as
(alse ribs +costae spuriae! V33306,. T$e lo)er t)o! t$at is t$e ele*ent$ and t)el(t$! are not
attac$ed in (ront and are called (loatin- ribs +costae (luitantes! 630633,. T$e spaces bet)een t$e
ribs are 1no)n as intercostal spaces2 t$e/ contain t$e intercostal &uscles! ner*es! and arteries.
T$e rib ca-e allo)s (or breat$in- due to its elasticit/. 3n so&e $u&ans! t$e rib re&nant o( t$e
7t$ nec1 *ertebra on one or bot$ sides is replaced b/ a (ree e5tra rib called a cer*ical rib! )$ic$
can cause trouble (or t$e ner*es -oin- to t$e ar&.
#ib Anatom"
T"pical ribs
T$e t$ird t$rou-$ nint$ ribs are .t/pical ribs. since t$e/ s$are t$e sa&e structure. T$e/ eac$
$a*e a $ead t$at $as t)o (acets separated b/ a crest. 8ne $ead articulates )it$ t$e rib9s
correspondin- *ertebra and one $ead articulates )it$ t$e *ertebra superior +abo*e, to it. T$e/
$a*e a nec1 t$at connects t$e $ead )it$ t$e s$a(t. T$e nec1 &eets t$e s$a(t at a tubercle. T$e
s$a(t is t$in! (lat! and cur*ed. T$e cur*e is &ost pro&inent at t$e costal an-le. T$e conca*e
+inside, sur(ace $as a -roo*e to protect t$e intercostal ner*e and *essels.
At"pical ribs
T$e at/pical ribs are t$e 1st! 2nd! and 10t$ to 12t$.
T$e (irst rib $as a s$a(t t$at is )ide and nearl/ $ori:ontal! and $as t$e s$arpest cur*e o( t$e
se*en true ribs. 3ts $ead $as a sin-le (acet to articulate )it$ t$e (irst t$oracic *ertebra +T1,. 3t
also $as t)o -roo*es (or t$e subcla*ian *essels! )$ic$ are separated b/ t$e scalene tubercle.
T$e second rib is t$inner! less cur*ed! and lon-er t$an t$e (irst rib. 3t $as t)o (acets to articulate
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)it$ T2 and T1! and a tubercle (or &uscles to attac$ to.
T$e 10t$ to 12t$ ribs $a*e onl/ one (acet on t$eir $ead! and t$e 11t$ and 12t$ ribs are s$ort
)it$ no nec1s or tubercles.
#ib Fractures and Associated 3n4uries
T$e (irst rib is rarel/ (ractured because o( its protected position be$ind t$e cla*icle +collarbone,.
;o)e*er! i( it is bro1en serious da&a-e can occur to t$e brac$ial ple5us o( ner*es and t$e
subcla*ian *essels.
T$e &iddle ribs are t$e ones &ost co&&onl/ (ractured. 4ractures usuall/ occur (ro& direct blo)s
or (ro& indirect crus$in- in'uries. T$e )ea1est part o( a rib is 'ust anterior to its an-le! but a
(racture can occur an/)$ere.
" lo)er rib (racture $as t$e co&plication o( potentiall/ in'urin- t$e diap$ra-&! )$ic$ could result
in a diap$ra-&atic $ernia.
Rib (ractures are pain(ul because t$e ribs $a*e to &o*e (or inspiration and e5piration o( air. Rib
pain &a/ also be associated )it$ &etastasis o( cancer! especiall/ (ro& t$e breast or prostate.
5ifid rib6 bifurcated rib
" <i(id rib or bi(urcated rib is a con-enital abnor&alit/ occurrin- in about 1= o( t$e population.
T$e sternal end o( t$e rib is clea*ed into t)o. 3t is usuall/ unilateral. >((ects o( t$is neuros1eletal
ano&al/ can include respirator/ di((iculties! neurolo-ical di((iculties! li&itations! and li&ited
ener-/ (ro& t$e stress o( needin- to co&pensate (or t$e neurop$/siolo-ical di((iculties.


Vertebral Column
T$e *ertebral colu&n +bac1bone or spine, is a colu&n o( *ertebrae situated in t$e dorsal aspect
o( t$e abdo&en. 3t $ouses t$e spinal cord in its spinal canal.

Fi2 Vertebral Column
Curves
Vie)ed laterall/ t$e *ertebral colu&n presents se*eral cur*es! )$ic$ correspond to t$e di((erent
re-ions o( t$e colu&n! and are called cervical6 t+oracic6 lumbar6 and pelvic.
Cervical curve2 T$e cer*ical cur*e! con*e5 (or)ard! be-ins at t$e ape5 o( t$e odontoid +toot$0
li1e, process! and ends at t$e &iddle o( t$e second t$oracic *ertebra2 it is t$e least &ar1ed o( all
t$e cur*es.
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Fi2 Spinal Column Curvature
T+oracic curve2 T$e t$oracic cur*e! conca*e (or)ard! be-ins at t$e &iddle o( t$e second and
ends at t$e &iddle o( t$e t)el(t$ t$oracic *ertebra. 3ts &ost pro&inent point be$ind corresponds
to t$e spinous process o( t$e se*ent$ t$oracic *ertebra.
!umbar curve2 T$e lu&bar cur*e is &ore &ar1ed in t$e (e&ale t$an in t$e &ale2 it be-ins at
t$e &iddle o( t$e last t$oracic *ertebra! and ends at t$e sacro*ertebral an-le. 3t is con*e5
anteriorl/! t$e con*e5it/ o( t$e lo)er t$ree *ertebrae bein- &uc$ -reater t$an t$at o( t$e upper
t)o.
(elvic curve2 T$e pel*ic cur*e be-ins at t$e sacro*ertebral articulation! and ends at t$e point o(
t$e cocc/52 its conca*it/ is directed do)n)ard and (or)ard. T$e t$oracic and pel*ic cur*es are
ter&ed pri&ar/ cur*es! because t$e/ alone are present durin- (etal li(e. 3n t$e earl/ e&br/o! t$e
*ertebral colu&n is C0s$aped! and t$e cer*ical and lu&bar cur*atures are not /et present in a
ne)born in(ant.
T$e cer*ical and lu&bar cur*es are co&pensator/ or secondar/! and are de*eloped a(ter birt$!
t$e (or&er )$en t$e c$ild is able to $old up its $ead +at t$ree or (our &ont$s,! and to sit upri-$t
+at nine &ont$s,! t$e latter at t)el*e or ei-$teen &ont$s! )$en t$e c$ild be-ins to )al1.
T$e *ertebral colu&n also $as a sli-$t lateral cur*ature! t$e con*e5it/ o( )$ic$ is directed to)ard
t$e ri-$t side. T$is &a/ be produced b/ &uscular action! &ost persons usin- t$e ri-$t ar& in
pre(erence to t$e le(t! especiall/ in &a1in- lon-0continued e((orts! )$en t$e bod/ is cur*ed to
t$e ri-$t side. 3n support o( t$is e5planation it $as been (ound t$at in one or t)o indi*iduals )$o
)ere le(t0$anded! t$e con*e5it/ )as to t$e le(t side. T$is cur*ature is re-arded b/ ot$ers as
bein- produced b/ t$e aortic arc$ and upper part o( t$e descendin- t$oracic aorta ?@A a *ie)
)$ic$ is supported b/ t$e (act t$at in cases )$ere t$e *iscera are transposed and t$e aorta is on
t$e ri-$t side! t$e con*e5it/ o( t$e cur*e is directed to t$e le(t side.
Surfaces
Anterior surface
W$en *ie)ed (ro& in (ront! t$e )idt$ o( t$e bodies o( t$e *ertebrae is seen to increase (ro& t$e
second cer*ical to t$e (irst t$oracic2 t$ere is t$en a sli-$t di&inution in t$e ne5t t$ree *ertebrae2
belo) t$is t$ere is a-ain a -radual and pro-ressi*e increase in )idt$ as lo) as t$e sacro*ertebral
an-le. 4ro& t$is point t$ere is a rapid di&inution! to t$e ape5 o( t$e cocc/5.
(osterior surface
T$e posterior sur(ace o( t$e *ertebral colu&n presents in t$e &edian line t$e spinous processes.
3n t$e cer*ical re-ion +)it$ t$e e5ception o( t$e second and se*ent$ *ertebrae, t$ese are s$ort
and $ori:ontal! )it$ bi(id e5tre&ities. 3n t$e upper part o( t$e t$oracic re-ion t$e/ are directed
obliBuel/ do)n)ard2 in t$e &iddle t$e/ are al&ost *ertical! and in t$e lo)er part t$e/ are nearl/
$ori:ontal. 3n t$e lu&bar re-ion t$e/ are nearl/ $ori:ontal. T$e spinous processes are separated
b/ considerable inter*als in t$e lu&bar re-ion! b/ narro)er inter*als in t$e nec1! and are closel/
appro5i&ated in t$e &iddle o( t$e t$oracic re-ion. 8ccasionall/ one o( t$ese processes de*iates a
little (ro& t$e &edian line ?@C a (act to be re&e&bered in practice! as irre-ularities o( t$is sort
are attendant also on (ractures or displace&ents o( t$e *ertebral colu&n. 8n eit$er side o( t$e
spinous processes is t$e *ertebral -roo*e (or&ed b/ t$e la&inae in t$e cer*ical and lu&bar
re-ions! )$ere it is s$allo)! and b/ t$e la&inae and trans*erse processes in t$e t$oracic re-ion!
)$ere it is deep and broad2 t$ese -roo*es lod-e t$e deep &uscles o( t$e bac1. Lateral to t$e
*ertebral -roo*es are t$e articular processes! and still &ore laterall/ t$e trans*erse processes. 3n
t$e t$oracic re-ion! t$e trans*erse processes stand bac1)ard! on a plane considerabl/ be$ind
t$at o( t$e sa&e processes in t$e cer*ical and lu&bar re-ions. 3n t$e cer*ical re-ion! t$e
trans*erse processes are placed in (ront o( t$e articular processes! lateral to t$e pedicles and
bet)een t$e inter*ertebral (ora&ina. 3n t$e t$oracic re-ion t$e/ are posterior to t$e pedicles!
inter*ertebral (ora&ina! and articular processes. 3n t$e lu&bar re-ion t$e/ are in (ront o( t$e
articular processes! but be$ind t$e inter*ertebral (ora&ina.
!ateral surfaces
T$e lateral sur(aces are separated (ro& t$e posterior sur(ace b/ t$e articular processes in t$e
cer*ical and lu&bar re-ions! and b/ t$e trans*erse processes in t$e t$oracic re-ion. T$e/
present! in (ront! t$e sides o( t$e bodies o( t$e *ertebrae! &ar1ed in t$e t$oracic re-ion b/ t$e
(acets (or articulation )it$ t$e $eads o( t$e ribs. More posteriorl/ are t$e inter*ertebral (ora&ina!
(or&ed b/ t$e 'u5taposition o( t$e *ertebral notc$es! o*al in s$ape! s&allest in t$e cer*ical and
upper part o( t$e t$oracic re-ions! and -raduall/ increasin- in si:e to t$e last lu&bar. T$e/
trans&it t$e spinal ner*es and are situated bet)een t$e trans*erse processes in t$e cer*ical
re-ion! and in (ront o( t$e& in t$e t$oracic and lu&bar re-ions.
Vertebral Canal
T$e *ertebral canal (ollo)s t$e di((erent cur*es o( t$e colu&n2 it is lar-e and trian-ular in t$ose
parts o( t$e colu&n )$ic$ en'o/ t$e -reatest (reedo& o( &o*e&ent! suc$ as t$e cer*ical and
lu&bar re-ions2 and is s&all and rounded in t$e t$oracic re-ion! )$ere &otion is &ore li&ited.
Abnormalities
8ccasionall/ t$e coalescence o( t$e la&inae is not co&pleted! and conseBuentl/ a cle(t is le(t in
t$e arc$es o( t$e *ertebrae! t$rou-$ )$ic$ a protrusion o( t$e spinal &e&branes +dura &ater
and arac$noid,! and -enerall/ o( t$e spinal cord +&edulla spinalis, itsel(! ta1es place! constitutin-
t$e &al(or&ation 1no)n as spina bi(ida. T$is condition is &ost co&&on in t$e lu&bosacral
re-ion! but it &a/ occur in t$e t$oracic or cer*ical re-ion! or t$e arc$es t$rou-$out t$e )$ole
len-t$ o( t$e canal &a/ re&ain inco&plete.
The following abnormal curvatures may occur in some people:
7"p+osis is an e5a--erated posterior cur*ature in t$e t$oracic re-ion. T$is produces t$e so0
called .$u&pbac1..
!ordosis is an e5a--erated anterior cur*ature o( t$e lu&bar re-ion! .s)a/bac1.. Te&porar/
lordosis is co&&on a&on- pre-nant )o&en.
Scoliosis! lateral cur*ature! is t$e &ost co&&on abnor&al cur*ature! occurrin- in 0.5= o( t$e
population. 3t is &ore co&&on a&on- (e&ales and &a/ result (ro& uneBual -ro)t$ o( t$e t)o
sides o( one or &ore *ertebrae.

Arm
3n anato&/! t$e ar& is t$e upper li&b o( a bipedal &a&&al! speci(icall/ t$e se-&ent bet)een
t$e s$oulder and t$e elbo). "r& can also re(er to an/ analo-ous structure! suc$ as one o( t$e
paired (oreli&bs o( a Buadruped! or an/ &uscular $/drostat si&ilar to a tentacle! as seen on
so&e cep$alopods! suc$ as octopuses.
T$e ter& ar& also re(ers to t$e entire upper li&b in an or-anis&. "nato&icall/! t$e se-&ent
bet)een t$e elbo) and )rist is properl/ called t$e (orear&.
3n pri&ates t$e ar&s are ric$l/ adapted (or bot$ cli&bin- and (or &ore s1illed! &anipulati*e
tas1s. T$e ball and soc1et s$oulder 'oint allo)s (or &o*e&ent o( t$e ar&s in a )ide circular
plane! )$ile t$e presence o( t)o (orear& bones )$ic$ can rotate around eac$ ot$er allo)s (or
additional ran-e o( &otion at t$is le*el.
Anatom" of t+e +uman arm
T$e $u&an ar& contains bones! 'oints! &uscles! ner*es and blood *essels. Man/ o( t$ese
&uscles are used (or e*er/da/ tas1s. T$ere are clinical uses (or t$e ar&! includin- *enepuncture
and perip$eral *enous cannulation in t$e cubital (ossa.
5on" structure and 4oints
T$e $u&erus is t$e +upper, ar& bone. 3t articulates )it$ t$e scapula abo*e at t$e -leno$u&eral
'oint +s$oulder, and )it$ t$e ulna and radius belo) as t$e elbo) 'oint.
S+oulder 4oint
T$e s$oulder is t$e ball0and0soc1et 'oint bet)een t$e pro5i&al end o( t$e $u&erus and t$e
cla*icle and scapula.
*lbow 4oint
T$e elbo) 'oint is t$e $in-e 'oint bet)een t$e distal end o( t$e $u&erus and t$e pro5i&al ends
o( t$e radius and ulna.
Osteofascial compartments
T$e ar& is di*ided b/ a (ascial la/er +1no)n as lateral and &edical inter&uscular septa,
separatin- t$e &uscles into an anterior and posterior osteo(ascial co&part&ents. T$e (ascia
&er-es )it$ t$e periosteu& +outer bone la/er, o( t$e $u&erus. T$e co&part&ents contain
&uscles )$ic$ are inner*ated b/ t$e sa&e ner*e and per(or& t$e sa&e action.
T$e anterior co&part&ent is 1no)n as t$e .(le5or co&part&ent. as (le5ion is its &ain action. T$e
&uscles contained t$erein are%
<iceps brac$ii
<rac$ialis
Coracobrac$ialis
T$e/ are all supplied b/ t$e musculocutaneous nerve! )$ic$ $as ner*ous ori-ins o( C5! C! C7
+see brac$ial ple5us,.
T$e deltoid &uscle is considered to $a*e part o( its bod/ in t$e anterior co&part&ent. T$is $u-e
&uscle is t$e &ain adductor o( t$e upper li&b and e5tends o*er t$e s$oulder.
T$e brac$ioradialis &uscle ori-inates in t$e ar& but inserts into t$e (orear&. T$is &uscle is
responsible (or supination.
T$e posterior co&part&ent contains &uscles! )$ic$ are all supplied b/ t$e radial ner*e. T$is
co&part&ent is also 1no)n as t$e .e5tensor co&part&ent.! e5tension bein- its &ain action.
Muscles o( t$is co&part&ent are%
Triceps brac$ii! a $u-e &uscle )$ic$ contains t$ree $eads! t$e lateral! &edial and &iddle.
"nconeus! a tin/ &uscle! )$ic$ so&e e&br/olo-ists su--est &a/ be t$e (ourt$ $ead o( t$e
triceps brac$ii &uscle. T$is &uscle stabili:es t$e elbo) 'oint durin- &o*e&ents. "s t$e upper
and lo)er li&bs $a*e si&ilar e&br/olo-ical ori-ins and t$e lo)er li&b contains t$e Buadriceps
(e&oris &uscle +t$e lo)er li&b eBui*alent o( t$e triceps,! )$ic$ $as (our $eads! t$is )ould see&
to &a1e sense.
Cubital fossa
T$is i&portant area is clinicall/ i&portant (or *enepuncture and (or blood pressure &easure&ent.
3t is an i&a-inar/ trian-le )it$ borders bein-%
Laterall/! t$e &edial border o( brac$ioradialis &uscle.
Mediall/! t$e lateral border o( pronator teres &uscle.
Superiorl/! t$e intercond/lar line! an i&a-inar/ line bet)een t$e t)o cond/les o( t$e $u&erus
T$e (loor is t$e brac$ialis &uscle
T$e roo( is t$e s1in and (ascia o( t$e ar& and (orear&
T$e structures! )$ic$ pass t$rou-$ t$e cubital (ossa! are *ital. T$e order (ro& )$ic$ t$e/ pass
into t$e (orear& are as (ollo)s! (ro& &edial to lateral%
1. Median ner*e! )$ic$ starts to branc$
2. <rac$ial arter/
3. Tendon o( t$e biceps brac$ii &uscle
4. Radial ner*e
5. Median cubital *ein 0 t$is i&portant *ein is )$ere *enepuncture occurs. 3t connects t$e
basilic and cep$alic *eins.
. L/&p$ nodes
8ervous suppl"
3&portant ner*es related to ar&s%
1. Musculocutaneous ner*e
2. Radial ner*e
3. Median ner*e
4. Dlnar ner*e
5lood suppl" and venous drainae
T$e &ain arter/ in t$e ar& is t$e brac$ial arter/. T$is arter/ is a continuation o( t$e a5illar/
arter/. T$e point at )$ic$ t$e a5illar/ beco&es t$e brac$ial is distal to t$e lo)er border o( teres
&a'or. T$e brac$ial arter/ -i*es o(( an i&portant brac$! t$e pro(unda brac$ii +deep arter/ o( t$e
ar&,. T$is branc$in- occurs 'ust belo) t$e lo)er border o( teres &a'or.
T$e pro(unda brac$ii tra*els t$rou-$ t$e lo)er trian-ular space )it$ t$e radial ner*e. 4ro& $ere
on)ards it $as an inti&ate relations$ip )it$ t$e radial ner*e.
T$e *eins o( t$e ar& carr/ blood (ro& t$e e5tre&ities o( t$e li&b! as )ell as drain t$e ar& itsel(.
T$e t)o &ain *eins are t$e basilic and t$e cep$alic *eins. T$ere is a connectin- *ein bet)een t$e
t)o! t$e &edian cubital *ein! )$ic$ passes t$rou-$ t$e cubital (ossa and is clinicall/ i&portant
(or *enepuncture +)it$dra)in- blood,. T$e basilic tra*els on t$e &edial side o( t$e ar& and
ter&inates at t$e le*el o( t$e 7t$ rib. T$e cep$alic tra*els on t$e lateral side o( t$e ar& and
ter&inates as t$e a5illar/ *ein. 3t passes t$rou-$ t$e deltopectoral trian-le! a space bet)een t$e
deltoid and t$e pectoralis &a'or &uscles.


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