Seeley−Stephens−Tate: II. Support and Movement 7.

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Sixth Edition

Skeletal
System
Gross Anatomy

C H A P T E R

Colorized SEM of bone trabeculae.

7 If the body had no skeleton, it may
look somewhat like a poorly stuffed
rag doll. Without a skeletal system,
we would have no framework to help
maintain shape and we wouldn’t be able
to move much either. Most muscles act on
bone to produce movement, often pulling on
the bones with considerable force. So without
the skeleton, muscles wouldn’t make the body move.
Human bones are very strong and can resist tremendous bending and com-
pression forces without breaking. Nonetheless, each year nearly 2 million
Americans manage to break a bone.
The skeletal system includes the bones, cartilage, ligaments, and ten-
dons. To study skeletal gross anatomy, however, dried, prepared bones are
Part 2 Support and Movement

used. This allows the major features of individual bones to be seen clearly
without being obstructed by associated soft tissues, such as muscles, tendons,
ligaments, cartilage, nerves, and blood vessels. As a consequence, however,
it’s easy to ignore the important relationships among bones and soft tissues
and the fact that living bones have soft tissue, such as the periosteum (see
chapter 6).
This chapter includes a discussion of general considerations (198). It
then proceeds to discuss the two catagories of the named bones: the axial
skeleton (200), which includes the skull, hyoid bone, vertebral column, and
thoracic (rib) cage, and the appendicular skeleton (225), consisting of the limbs
and their girdles.
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198 Part 2 Support and Movement

General Considerations ber of bones varies from person to person and decreases with age
as some bones become fused.
Objective
Many of the anatomic features of bones are listed in
■ List the bones of the body.
table 7.2. Most of these features are based on the relationship
■ Define the general anatomic terms that describe the
between the bones and associated soft tissues. If a bone possesses
features of bone.
a tubercle (too⬘ber-kl; lump) or process (projection), such
The average adult skeleton has 206 bones (figure 7.1 and structures usually exist because a ligament or tendon was at-
table 7.1). Although this is the traditional number, the actual num- tached to that tubercle or process during life. If a bone has a

Table 7.1 Number of Named Bones Listed by Category

Bones Number Bones Number
Axial Skeleton Appendicular Skeleton
Skull (cranium) Pectoral Girdle
Neurocranium (braincase) Scapula 2
Paired Parietal 2 Clavicle 2
Temporal 2 Upper Limb
Unpaired Frontal 1 Humerus 2
Sphenoid 1 Ulna 2
Occipital 1 Radius 2
Ethmoid 1 Carpals 16
Viscerocranium (face) Metacarpals 10
Paired Maxilla 2 Phalanges 28
Zygomatic 2 Total Upper Limb and Girdle 64
Palatine 2 Pelvic Girdle
Lacrimal 2 Coxa 2
Nasal 2 Lower Limb
Inferior nasal concha 2 Femur 2
Unpaired Mandible 1 Tibia 2
Vomer 1 Fibula 2
Total Skull 22 Patella 2
Bones Associated with the Skull Tarsals 14
Auditory ossicles Metatarsals 10
Malleus 2 Phalanges 28
Incus 2 Total Lower Limb and Girdle 62
Stapes 2 Total Appendicular Skeleton 126
Hyoid 1
Total Associated 7 Total Axial Skeleton 80
Vertebral Column Total Appendicular Skeleton 126
Cervical vertebrae 7 Total Bones 206
Thoracic vertebrae 12
Lumbar vertebrae 5
Sacrum 1
Coccyx 1
Total Vertebral Column 26
Thoracic Cage (rib cage)
Ribs 24
Sternum 1
Total Thoracic Cage 25
Total Axial Skeleton 80
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Chapter 7 Skeletal System: Gross Anatomy 199

Axial Skeleton Appendicular Skeleton Axial Skeleton

Skull Skull

Mandible Mandible

Clavicle

Scapula

Sternum

Ribs Humerus Ribs

Vertebral
column Vertebral
column
Ulna
Radius
Sacrum Sacrum

Carpals
Metacarpals

Phalanges
Coxa Coccyx

Femur

Patella

Tibia

Fibula

Tarsals
Metatarsals
Phalanges

Anterior Posterior

Figure 7.1 The Complete Skeleton

(The skeleton is not shown in the anatomical position.)

smooth, articular surface, that surface was part of a joint and Some bones contain mucous membrane-lined air spaces called
was covered with articular cartilage. If the bone has a foramen sinuses. These bones are composed of paper-thin, translucent
(fō-rā⬘men; pl. foramina; f ō-ram⬘i-nă; a hole) in it, that fora- compact bone only and have little or no cancellous center (see
men was occupied by something such as a nerve or blood vessel. chapter 6).
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200 Part 2 Support and Movement

Table 7.2 General Anatomic Terms Skull

for Various Features of Bones Objectives
■ Describe the major features of the skull as seen from various
Term Description views.
Body Main part ■ List and describe the bones of the neurocranium and
Head Enlarged (often rounded) end viscerocranium.
Neck Constriction between head and body
The skull, or cranium (krā⬘nē-ŭm) protects the brain; sup-
ports the organs of vision, hearing, smell, and taste; and provides a
Margin or border Edge
foundation for the structures that take air, food, and water into the
Angle Bend
body. When the skull is disassembled, the mandible is easily sepa-
Ramus Branch off the body (beyond the angle)
rated from the rest of the skull, which remains intact. Special effort
Condyle Smooth, rounded articular surface is needed to separate the other bones. For this reason, it’s conve-
Facet Small, flattened articular surface nient to think of the skull, except for the mandible, as a single unit.
Ridges The top of the skull is usually cut off to reveal its interior. The
Line or linea Low ridge exterior and interior of the skull have ridges, lines, processes, and
Crest or crista Prominent ridge plates. These structures are important for the attachment of mus-
Spine Very high ridge
cles or for articulations between the bones of the skull. Selected
features of the intact skull are listed in table 7.3.
Projections
Process Prominent projection
Superior View of the Skull
Tubercle Small, rounded bump
The skull appears quite simple when viewed from above. Only four
Tuberosity or tuber Knob; larger than a tubercle
bones are seen from this view: the frontal bone, two parietal bones,
Trochanter Tuberosities on the proximal femur
and a small part of the occipital bone. The paired parietal bones are
Epicondyle Near or above a condyle joined at the midline by the sagittal suture, and the parietal bones
Lingula Flat, tongue-shaped process are connected to the frontal bone by the coronal suture (figure 7.2).
Hamulus Hook-shaped process
Cornu Horn-shaped process Posterior View of the Skull
Openings The parietal and occipital bones are the major structures seen from
Foramen Hole the posterior view (figure 7.3). The parietal bones are joined to the
Canal or meatus Tunnel occipital bone by the lambdoid (lam⬘doyd; the shape resembles the
Fissure Cleft Greek letter lambda) suture. Occasionally, extra small bones called
Sinus or labyrinth Cavity sutural (soo⬘choor-ăl) bones form along the lambdoid suture.
Depressions P R E D I C T
Fossa General term for a depression Explain the basis for the names sagittal and coronal sutures.
Notch Depression in the margin of a bone
Fovea Little pit Inca Bone
Sutural bones are usually small and bilateral and in many cases are
Groove or sulcus Deeper, narrow depression
apparently genetically determined. A large midline bone, called an Inca
bone, may form at the junction of the lambdoid and sagittal sutures. The
bone was common in the skulls of Incas and is still present in their
Andean descendants.

1. How many bones are there in an average adult skeleton? An external occipital protuberance is present on the pos-
2. How are lumps, projections, and openings in bones related terior surface of the occipital bone (see figure 7.3). It can be felt
to soft tissues? through the scalp at the base of the head and varies considerably
in size from person to person. The external occipital protuber-
ance is the site of attachment of the ligamentum nuchae
Axial Skeleton (noo⬘kē; nape of neck), an elastic ligament that extends down the
The axial skeleton is divided into the skull, hyoid bone, vertebral neck and helps keep the head erect by pulling on the occipital re-
column, and thoracic cage, or rib cage. The axial skeleton forms the gion of the skull. Nuchal lines are a set of small ridges that
upright axis of the body. It also protects the brain, the spinal cord, extend laterally from the protuberance and are the points of at-
and the vital organs housed within the thorax. tachment for several neck muscles.
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Chapter 7 Skeletal System: Gross Anatomy 201

Table 7.3 Processes and Other Features of the Skull

Bone on Which
Feature Feature Is Found Description
External Features
Alveolar process Mandible, maxilla Ridges on the mandible and maxilla containing the teeth
Angle Mandible The posterior, inferior corner of the mandible
Coronoid process Mandible Attachment point for the temporalis muscle
Genu Mandible Chin (resembles a bent knee)
Horizontal plate Palatine Posterior third of the hard palate
Mandibular condyle Mandible Region where the mandible articulates with the skull
Mandibular fossa Temporal Depression where the mandible articulates with the skull
Mastoid process Temporal Enlargement posterior to the ear; attachment site for several muscles that move the head
Nuchal lines Occipital Attachment points for several posterior neck muscles
Occipital condyle Occipital Point of articulation between the skull and the vertebral column
Palatine process Maxilla Anterior two-thirds of the hard palate
Pterygoid hamulus Sphenoid Hooked process on the inferior end of the medial pterygoid plate, around which the tendon of one
palatine muscle passes; an important dental landmark
Pterygoid plates Sphenoid Bony plates on the inferior aspect of the sphenoid bone; the lateral pterygoid plate is the site of
(medial and lateral) attachment for two muscles of mastication (chewing)
Ramus Mandible Portion of the mandible superior to the angle
Styloid process Temporal Attachment site for three muscles (to the tongue, pharynx, and hyoid bone) and some ligaments
Temporal lines Parietal Where the temporalis muscle, which closes the jaw, attaches
Internal Features
Crista galli Ethmoid Process in the anterior part of the cranial vault to which one of the connective tissue coverings of the
brain (dura mater) connects
Petrous portion Temporal Thick, interior part of temporal bone containing the middle and inner ears and the auditory ossicles
Sella turcica Sphenoid Bony structure resembling a saddle in which the pituitary gland is located

Frontal bone

Parietal bone
Coronal suture

Inferior temporal line

Superior temporal line

Sagittal suture

Parietal eminence

Lambdoid suture
Occipital bone

Figure 7.2 Skull as Seen from the Superior View

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202 Part 2 Support and Movement

Sagittal suture

Parietal bone

Occipital bone Lambdoid suture

External occipital
protuberance

Superior
Temporal bone nuchal line
Inferior
Mastoid process nuchal line

Zygomatic arch Occipital condyle

Lateral pterygoid plate Styloid process

Medial pterygoid plate

Nasal septum
Pterygoid hamulus

Horizontal plate
Hard of palatine bone
palate
Palatine process
of maxillary bone

Figure 7.3 Skull as Seen from the Posterior View

Nuchal Lines these bones. A prominent feature of the temporal bone is a large
The ligamentum nuchae and neck muscles in humans are not as strong hole, the external auditory meatus (mē-ā⬘tŭs; passageway or
as comparable structures in other animals; therefore, the human bony tunnel), which transmits sound waves toward the eardrum. The
prominence and lines of the posterior skull are not as well developed as external ear, or auricle, surrounds the meatus. Just posterior and
they are in those animals. The location of the human foramen magnum inferior to the external auditory meatus is a large inferior projec-
allows the skull to balance above the vertebral column and allows for an tion, the mastoid (mas⬘toyd; resembling a breast) process. The
upright posture. Thus human skulls require less ligamental and muscular process can be seen and felt as a prominent lump just posterior to
effort to balance the head on the spinal column than do the skulls of the ear. The process is not solid bone but is filled with cavities
other animals, including other primates, such as chimpanzees, whose called the mastoid air cells, which are connected to the middle
skulls are not balanced over the vertebral column. The presence of small ear. Important neck muscles involved in rotation of the head at-
nuchal lines in hominids (i.e., animals with an upright stance like tach to the mastoid process. The superior and inferior temporal
humans) reflects this decreased musculature and is one way used by lines, which are attachment points of the temporalis muscle, one
paleontologists to establish probable upright posture in hominids. of the major muscles of mastication, arch across the lateral sur-
face of the parietal bone.

Lateral View of the Skull Temporal Lines

The temporal lines are important to anthropologists because a heavy
The parietal bone and the squamous part of the temporal bone
temporal line suggests a strong temporalis muscle supporting a heavy
form a large part of the side of the head (figure 7.4). The term
jaw. In a male gorilla, the temporalis muscles are so large that the
temporal means related to time, and the temporal bone is so
temporal lines meet in the midline of the skull to form a heavy sagittal
named because the hair of the temples is often the first to turn
crest. The temporal lines are much smaller in humans.
white, indicating the passage of time. The squamous suture joins
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Chapter 7 Skeletal System: Gross Anatomy 203

Coronal suture

Superior temporal line Frontal bone

Inferior temporal line

Parietal bone
Supraorbital foramen
Squamous suture
Supraorbital margin
Temporal bone
Sphenoid bone (greater wing)
Nasal bone
Occipital bone Lacrimal bone
Nasolacrimal canal
Lambdoid suture
Infraorbital foramen
Mandibular condyle Zygomatic bone
External auditory meatus Coronoid process
of mandible
Mastoid process Maxilla
Styloid process
Zygomatic process
of temporal bone Mandibular ramus
Zygomatic arch
Temporal process
of zygomatic bone
Mental foramen
Angle of mandible
Mandible
Genu

Figure 7.4 Lateral View of the Skull as Seen from the Right Side

The lateral surface of the greater wing of the sphenoid bone that extends completely across the skull. Anterior to the sphe-
(sfē⬘noyd; wedge-shaped) bone is immediately anterior to the tem- noid bone is the zygomatic (zı̄⬘gō-mat⬘ik; a bar or yoke) bone, or
poral bone (see figure 7.4). Although appearing to be two bones, cheekbone, which can be easily seen and felt on the face (figure 7.5).
one on each side of the skull, the sphenoid bone is actually a single The zygomatic arch, which consists of joined processes
from the temporal and zygomatic bones, forms a bridge across the
side of the skull (see figure 7.4). The zygomatic arch is easily felt on
Frontal bone the side of the face, and the muscles on either side of the arch can
be felt as the jaws are opened and closed (see figure 7.5).
Supraorbital margin The maxilla (mak-sil⬘ă; upper jaw) is anterior and inferior
Zygomatic arch to the zygomatic bone to which it is joined. The mandible (lower
jaw) is inferior to the maxilla and articulates posteriorly with the
Nasal bone
temporal bone (see figure 7.4). The mandible consists of two main
Zygomatic bone portions: the body, which extends anteroposteriorly, and the ra-
Maxilla
mus (branch), which extends superiorly from the body toward the
temporal bone. The superior end of the ramus has a mandibular
Mastoid process condyle, which articulates with the mandibular fossa of the tem-
poral bone, and the coronoid (kōr⬘ŏ-noyd; shaped like a crow’s
Genu of mandible
beak) process to which the powerful temporalis muscle, one of the
Mandible
chewing muscles, attaches. The alveolar process of the maxilla con-
Angle of mandible tains the superior set of teeth, and the alveolar process of the
mandible contains the inferior teeth.

Frontal View of the Skull

The major structures seen from the frontal view are the frontal
bone (forehead), the zygomatic bones (cheekbones), the maxillae,
Figure 7.5 Lateral View of Bony Landmarks on the Face and the mandible (figure 7.6). The teeth, which are very prominent
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Frontal bone

Parietal bone
Coronal suture
Supraorbital foramen
Glabella

Orbital plate of frontal bone

Supraorbital margin
Sphenoid bone (greater wing)
Temporal bone
Superior orbital fissure
Nasal bone

Infraorbital margin Lacrimal bone

Zygomatic bone
Infraorbital foramen

Perpendicular plate Middle nasal concha

Nasal of ethmoid bone
septum Inferior nasal concha
Vomer
Nasal cavity Anterior nasal spine

Maxilla Oblique line of mandible

Alveolar processes

Body of mandible
Mental foramen Mandibular symphysis
Genu

Figure 7.6 Skull as Seen from the Frontal View

in this view, are discussed in chapter 24. Many bones of the face can fossae. The bones of the orbits provide both protection for the eyes
be easily felt through the skin of the face (figure 7.7). and attachment points for the muscles that move the eyes. The
From this view the most prominent openings into the skull major portion of each eyeball is within the orbit, and the portion of
are the orbits and the nasal cavity. The orbits are cone-shaped fos- the eye visible from the outside is relatively small. Each orbit con-
sae with their apices directed posteriorly (see figures 7.6 and 7.8). tains blood vessels, nerves, and fat, as well as the eyeball and the
They are called orbits because of the rotation of the eyes within the muscles that move it. The bones forming the orbit are listed in
table 7.4.

Orbit Weak Point

The superolateral corner of the orbit, where the zygomatic and frontal
bones join, is a weak point in the skull that is easily fractured by a blow
Glabella Frontal bone
to that region of the head. The bone tends to collapse into the orbit,
Supraorbital resulting in an injury that is difficult to repair.
margin
Zygomatic The orbit has several openings through which structures
bone
communicate between it and other cavities. The nasolacrimal duct
passes from the orbit into the nasal cavity through the naso-
Maxilla lacrimal canal and carries tears from the eyes to the nasal cavity.
Genu of mandible The optic nerve for the sense of vision passes from the eye through
the optic foramen at the posterior apex of the orbit and enters the
cranial cavity. Superior and inferior fissures in the posterior region
of the orbit provide openings through which nerves and blood ves-
Figure 7.7 Anterior View of Bony Landmarks on the Face sels communicate with structures in the orbit or pass to the face.
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Supraorbital foramen

Lesser wing of sphenoid bone Frontal bone

Optic foramen
Superior orbital fissure
Posterior and anterior
ethmoid foramina

Ethmoid bone
Greater wing of
sphenoid bone Lacrimal bone
Palatine bone Opening to
nasolacrimal canal
Zygomatic
bone Maxilla

Inferior orbital fissure

Infraorbital foramen
Infraorbital groove

Figure 7.8 Bones of the Right Orbit

Table 7.4 Bones Forming the Orbit Table 7.5 Bones Forming the Nasal Cavity
(see figures 7.6 and 7.8) (see figures 7.6 and 7.9)
Bone Part of Orbit Bone Part of Nasal Cavity
Frontal Roof Frontal Roof
Sphenoid Roof and lateral wall Nasal Roof
Zygomatic Lateral wall Sphenoid Roof
Maxilla Floor Ethmoid Roof, septum, and lateral wall
Lacrimal Medial wall Inferior nasal concha Lateral wall
Ethmoid Medial wall Lacrimal Lateral wall
Palatine Medial wall Maxilla Floor
Palatine Floor and lateral wall
Vomer Septum

The nasal cavity (table 7.5 and figure 7.9; see figure 7.6) has
a pear-shaped opening anteriorly and is divided into right and left
The external part of the nose, formed mostly of hyaline car-
halves by a nasal septum (sep⬘tŭm; wall). The bony part of the
tilage, is almost entirely absent in the dried skeleton and is repre-
nasal septum consists primarily of the vomer and the perpendicu-
sented mainly by the nasal bones and the frontal processes of the
lar plate of the ethmoid bone. Hyaline cartilage forms the anterior
maxillary bones, which form the bridge of the nose.
part of the nasal septum.
P R E D I C T
Deviated Nasal Septum A direct blow to the nose may result in a “broken nose.” List at least
The nasal septum usually is located in the midsagittal plane until a three bones that may be broken.
person is 7 years old. Thereafter it tends to deviate, or bulge slightly to
The lateral wall of the nasal cavity has three bony shelves,
one side or the other. The septum can also deviate abnormally at birth
the nasal conchae (kon⬘kē; resembling a conch shell), which are
or, more commonly, as a result of injury. Deviations can be severe
directed inferiorly (see figure 7.9). The inferior nasal concha is a
enough to block one side of the nasal passage, and interfere with normal
separate bone, and the middle and superior nasal conchae are
breathing. Repair of severe deviations requires surgery.
projections from the ethmoid bone. The conchae function to
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206 Part 2 Support and Movement

Frontal bone Crista galli

Frontal sinus Cribriform plate
Olfactory foramina
Nasal bone
Sphenoidal sinus
Perpendicular plate
of ethmoid bone Sphenoid bone
Nasal
septum Septal cartilage
Vomer
Greater alar cartilage
Anterior Horizontal plate
nasal spine of palatine bone
Palatine process
of maxilla
Incisive canal
(a) Central incisor

Frontal bone
Lacrimal bone
Olfactory recess
Frontal sinus
Superior nasal concha Part of
Middle nasal concha ethmoid bone
Nasal bone

Sphenoidal sinus
Maxillary bone
Sphenoid bone
Lateral nasal cartilage Vertical plate of palatine bone

Greater alar cartilage Inferior nasal concha

Medial pterygoid plate
Horizontal plate of palatine bone

Palatine process of maxilla

(b) Lateral incisor

Figure 7.9 Bones of the Nasal Cavity

(a) Nasal septum as seen from the left nasal cavity. (b) Right lateral nasal wall as seen from inside the nasal cavity (nasal septum removed).

increase the surface area in the nasal cavity, thereby facilitating Interior of the Cranial Cavity
moistening, removal of particles, and warming of the air inhaled The cranial cavity is the cavity in the skull occupied by the
through the nose. brain. The cranial cavity can be exposed by cutting away the
Several of the bones associated with the nasal cavity have calvaria (kal-vā⬘rē-ă), the upper dome-like portion of the
large cavities within them called the paranasal sinuses, which skull. With the calvaria removed, the floor of the cranial cavity
open into the nasal cavity (figure 7.10). The sinuses decrease the can be seen (figure 7.11). That floor can be divided roughly
weight of the skull and act as resonating chambers during voice into anterior, middle, and posterior fossae, which are formed
production. Compare the normal voice to the voice of a person as the developing neurocranium conforms to the shape of
who has a cold and whose sinuses are “stopped up.” The sinuses are the brain.
named for the bones in which they are located and include the A prominent ridge, the crista galli (kris⬘tă găl⬘ē; rooster’s
frontal, maxillary, ethmoidal, and sphenoidal sinuses. comb), is located in the center of the anterior fossa. The crista galli
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Chapter 7 Skeletal System: Gross Anatomy 207

Frontal sinus

Ethmoidal sinus Frontal sinus

Sphenoidal sinus
Ethmoidal sinus

Sphenoidal sinus

Maxillary sinus

Maxillary sinus

(a) (b)

Frontal sinus

Figure 7.10 Paranasal Sinuses

(a) Viewed from the side. (b) Viewed from in front. (c) False-color x ray of the
(c) frontal sinus.

is a point of attachment for one of the meninges (mĕ-nin⬘jēz), a Fracture of the Cribriform Plate
thick connective tissue membrane that supports and protects The cribriform plate may be fractured in an automobile accident
the brain (see chapter 13). On either side of the crista galli is an involving a car without air bags, if the driver’s nose strikes the steering
olfactory fossa. An olfactory bulb rests in each fossa and receives wheel. Cerebrospinal (ser⬘ĕ-brō-spı¯-nă l, sĕ-rē⬘brō-spı̄-năl) fluid from the
the olfactory nerves for the sense of smell. The cribriform cranial cavity may leak through the fracture into the nose. This leakage is
(krib⬘ri-fōrm; sievelike) plate of the ethmoid bone forms the floor a dangerous sign and requires immediate medical attention because risk
of each olfactory fossa. The olfactory nerves extend from the cra- of infection is very high.
nial cavity into the roof of the nasal cavity through sievelike perfo-
rations in the cribriform plate called olfactory foramina (see The body of the sphenoid bone forms a central prominence
figure 7.9a and chapter 15). located within the floor of the cranial cavity. This prominence is
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208 Part 2 Support and Movement

Frontal sinuses

Anterior cranial fossa Crista galli

Ethmoid bone
Cribriform plate
Olfactory fossa
Frontal bone

Lesser wing
Sphenoid bone Optic foramen
Greater wing
Foramen rotundum Sella turcica
Foramen ovale
Foramen lacerum Foramen spinosum
Carotid canal
Middle cranial fossa Squamous portion
Temporal bone
Internal auditory meatus Petrous portion

Foramen magnum Jugular foramen

Hypoglossal canal

Posterior cranial fossa

Parietal bone
Occipital bone

Figure 7.11 Floor of the Cranial Cavity

The roof of the skull has been removed, and the floor is viewed from above.

modified into a structure resembling a saddle, the sella turcica separates the carotid canal from the middle ear, therefore, making
(sel⬘ă tŭr⬘si-kă; Turkish saddle), which is occupied by the pituitary it possible for a person to hear his or her own heartbeat, for exam-
gland. The petrous (rocky) part of the temporal bone is on each ple, when frightened or after running. Most blood leaves the brain
side of and slightly posterior to the sella turcica. This thick bony through the internal jugular veins, which exit through the jugular
ridge is hollow and contains the middle and inner ears. (jŭg⬘ū-lar; throat) foramina located lateral to the occipital
The prominent foramen magnum, through which the condyles.
spinal cord and brain are connected, is located in the posterior Two long, pointed styloid (stı̄⬘loyd; stylus- or pen-shaped)
fossa. The other foramina of the skull and the structures passing processes project from the floor of the temporal bone (see figures
through them are listed in table 7.6. 7.4 and 7.12). Three muscles involved in movement of the tongue,
hyoid bone, and pharynx attach to each process. The mandibular
Inferior View of the Skull fossa, where the mandible articulates with the rest of the skull, is
Seen from below with the mandible removed, the base of the skull is anterior to the mastoid process at the base of the zygomatic arch.
complex, with a number of foramina and specialized surfaces The posterior opening of the nasal cavity is bounded on each
(figure 7.12). The foramen magnum passes through the occipital side by the vertical bony plates of the sphenoid bone: the medial
bone just slightly posterior to the center of the skull base. Occipital pterygoid (ter⬘i-goyd; wing-shaped) plate and the lateral pterygoid
condyles, the smooth points of articulation between the skull and plate. The medial and lateral pterygoid muscles, which help move the
the vertebral column, are located on the lateral and anterior mar- mandible, attach to the lateral plate (see chapter 10). The vomer
gins of the foramen magnum. forms the posterior portion of the nasal septum and can be seen be-
The major entry and exit points for blood vessels that supply tween the medial pterygoid plates in the center of the nasal cavity.
the brain can be seen from this view. Blood reaches the brain The hard palate, or bony palate, forms the floor of the nasal
through the internal carotid arteries, which pass through the cavity. Sutures join four bones to form the hard palate; the palatine
carotid (ka-rot⬘id; put to sleep) canals, and the vertebral arteries, processes of the two maxillary bones form the anterior two-thirds
which pass through the foramen magnum. Immediately after the of the palate, and the horizontal plates of the two palatine bones
internal carotid artery enters the carotid canal, it turns medially al- form the posterior one-third of the palate. The tissues of the soft
most 90 degrees, continues through the carotid canal, again turns palate extend posteriorly from the hard palate. The hard and soft
almost 90 degrees, and enters the cranial cavity through the supe- palates separate the nasal cavity from the mouth and enable hu-
rior part of the foramen lacerum (lă-ser⬘um). A thin plate of bone mans to eat and breathe at the same time.
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Chapter 7 Skeletal System: Gross Anatomy 209

Table 7.6 Skull Foramina, Fissures, and Canals (see figures 7.11 and 7.12)
Opening Bone Containing the Opening Structures Passing Through Openings
Carotid canal Temporal Carotid artery and carotid sympathetic nerve plexus
Ethmoid foramina, anterior and Between frontal and ethmoid Anterior and posterior ethmoid nerves
posterior
External auditory meatus Temporal Sound waves enroute to the eardrum
Foramen lacerum Between temporal, occipital, The foramen is filled with cartilage during life; the carotid canal and
and sphenoid pterygoid canal cross its superior part but do not actually pass
through it
Foramen magnum Occipital Spinal cord, accessory nerves, and vertebral arteries
Foramen ovale Sphenoid Mandibular division of trigeminal nerve
Foramen rotundum Sphenoid Maxillary division of trigeminal nerve
Foramen spinosum Sphenoid Middle meningeal artery
Hypoglossal canal Occipital Hypoglossal nerve
Incisive foramen (canal) Between maxillae Incisive nerve
Inferior orbital fissure Between sphenoid and maxilla Infraorbital nerve and blood vessels and zygomatic nerve
Infraorbital foramen Maxilla Infraorbital nerve
Internal auditory meatus Temporal Facial nerve and vestibulocochlear nerve
Jugular foramen Between temporal and occipital Internal jugular vein, glossopharyngeal nerve, vagus nerve, and
accessory nerve
Mandibular foramen Mandible Inferior alveolar nerve to the mandibular teeth
Mental foramen Mandible Mental nerve
Nasolacrimal canal Between lacrimal and maxilla Nasolacrimal (tear) duct
Olfactory foramina Ethmoid Olfactory nerves
Optic foramen Sphenoid Optic nerve and ophthalmic artery
Palatine foramina, anterior Palatine Palatine nerves
and posterior
Pterygoid canal Sphenoid Sympathetic and parasympathetic nerves to the face
Sphenopalatine foramen Between palatine and sphenoid Nasopalatine nerve and sphenopalatine blood vessels
Stylomastoid foramen Temporal Facial nerve
Superior orbital fissures Sphenoid Oculomotor nerve, trochlear nerve, ophthalmic division of trigeminal
nerve, abducens nerve, and ophthalmic veins
Supraorbital foramen or notch Frontal Supraorbital nerve and vessels
Zygomaticofacial foramen Zygomatic Zygomaticofacial nerve
Zygomaticotemporal foramen Zygomatic Zygomaticotemporal nerve

3. List the parts of the axial skeleton and its functions.

Cleft Lip or Palate
4. List the seven bones that form the orbit of the eye.
During development, the facial bones sometimes fail to fuse with one
5. Describe the bones and cartilage found in the nasal septum.
another. A cleft lip results if the maxillae don’t form normally, and a cleft
6. What is a sinus? What are the functions of sinuses? Give the
palate occurs when the palatine processes of the maxillae don’t fuse
location of the paranasal sinuses.
with one another. A cleft palate produces an opening between the nasal
7. Name the bones that form the hard palate. What is the
and oral cavities, making it difficult to eat or drink or to speak distinctly.
function of the hard palate?
An artificial palate may be inserted into a newborn’s mouth until the
8. Through what foramen does the brainstem connect to the
palate can be repaired. A cleft lip occurs approximately once in every
spinal cord? Name the foramina that contain nerves for the
1000 births and is more common in males than in females. A cleft palate
senses of vision (optic nerve), smell (olfactory nerves), and
occurs approximately once in every 2500 births and is more common in
hearing (vestibulocochlear nerve)?
females than in males. A cleft lip and cleft palate may also occur in the
9. Name the foramina through which the major blood vessels
same person.
enter and exit the skull.
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210 Part 2 Support and Movement

Incisive fossa
Maxilla

Palatine process of maxillary bone Hard

Zygomatic bone
Horizontal plate of palatine bone palate

Anterior palatine foramen Pterygoid hamulus

Posterior palatine foramen
Temporal process
Inferior orbital fissure
of zygomatic bone
Lateral pterygoid plate Zygomatic arch
Sphenoid Zygomatic process
bone Greater wing of temporal bone
Medial pterygoid plate Vomer
Foramen ovale
Foramen lacerum
Foramen spinosum Styloid process
Mandibular fossa
External auditory meatus Carotid canal
Jugular foramen Stylomastoid foramen
Occipital condyle Mastoid process

Foramen magnum Temporal bone

Occipital bone
Inferior nuchal line

External occipital protuberance Superior nuchal line

Figure 7.12 Inferior View of the Skull

10. List the places where these muscles attach to the skull: neck poral bones and the unpaired frontal, occipital, sphenoid, and
muscles, throat muscles, muscles of mastication, muscles ethmoid bones.
of facial expression, and muscles that move the eyeballs. The 14 bones of the viscerocranium, or facial bones, form
11. Name the bones of the neurocranium and the structure of the face in the anterior skull. They are the maxilla
viscerocranium. What functions are accomplished by (two), zygomatic (two), palatine (two), lacrimal (two), nasal
each group? (two), inferior nasal concha (two), mandible (one), and vomer
(one) bones. The frontal and ethmoid bones, which are part of
Bones of the Skull the neurocranium, also contribute to the face. The mandible is
The skull, or cranium, is composed of 22 separate bones (see table often listed as a facial bone, even though it is not part of the in-
7.1 and figure 7.13). In addition, the skull contains six auditory tact skull.
ossicles, which function in hearing (see chapter 15). Each tempo- The facial bones protect the major sensory organs located in
ral bone holds one set of auditory ossicles, which consists of the the face: the eyes, nose, and tongue. The bones of the face also
malleus, incus, and stapes. These bones cannot be observed unless provide attachment points for muscles involved in mastication
the temporal bones are cut open. (mas-ti-kā⬘shŭn; chewing), facial expression, and eye movement.
The 22 bones of the skull are divided into two portions: the The jaws (mandible and maxillae) possess alveolar (al-vē⬘ō-lăr)
neurocranium and the viscerocranium. The neurocranium, or processes with sockets for the attachment of the teeth. The bones
braincase, consists of eight bones that immediately surround of the face and their associated soft tissues determine the unique
and protect the brain. They include the paired parietal and tem- facial features of each individual.
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Chapter 7 Skeletal System: Gross Anatomy 211

Landmarks seen on this figure:

Superior and inferior temporal lines: attachment point
for temporalis muscle.
Parietal Parietal eminence: the widest part of the head is from
eminence one parietal eminence to the other.
Special feature: Forms lateral wall of skull.
Superior
temporal line
Inferior temporal
line

(a) Right parietal bone

(viewed from the lateral side)
Landmarks seen on this figure:
External auditory meatus: external canal of the ear;
carries sound to the ear.
Mandibular fossa: articulation point between the mandible and skull.
Squamous Mastoid process: attachment point for muscles moving
portion the head and for a hyoid muscle.
Squamous portion: flat, lateral portion of the temporal bone.
Zygomatic Styloid process: attachment for muscles of the tongue, throat,
process and hyoid bone.
Mandibular fossa Zygomatic process: helps form the bony bridge from the cheek to just
Mastoid anterior to the ear; attachment for a muscle moving the mandible.
External auditory Landmarks seen in other figures:
process meatus Carotid canal: canal through which the internal carotid
Styloid process artery enters the cranial cavity (figures 7.11 and 7.12).
Internal auditory meatus: opening through which the facial (cranial
nerve VII) and vestibulocochlear (cranial nerve VIII) nerves enter the
Right temporal bone
petrous portion of the temporal bone (figure 7.11).
(viewed from the lateral side)
Jugular foramen: foramen through which the internal
jugular vein exits the cranial cavity (figures 7.11 and 7.12).
Middle cranial fossa: depression in the floor of the cranial
cavity formed by the temporal lobes of the brain (figure 7.11).
Petrous portion: thick, "rocky" portion of the temporal bone (figure 7.11).
Stylomastoid foramen: foramen through which the facial
nerve (cranial nerve VII) exits the skull (figure 7.12).
Special features: Contains the middle and inner ear, and the mastoid air
cells; place where the mandible articulates with the rest of the skull.
(b)

Landmarks seen on this figure:

Glabella: area between the supraorbital margins.
Nasal spine: superior part of the nasal bridge.
Orbital plate: roof of the orbit.
Supraorbital foramen: opening through which nerves
and vessels exit the skull to the skin of the forehead.
Supraorbital margin: ridge forming the anterior superior
border of the orbit.
Zygomatic process: connects to the zygomatic bone; helps
form the lateral margin of the orbit.
Special features: Forms the forehead and roof of the orbit;
Glabella contains the frontal sinus.
Supraorbital Supraorbital
foramen margin
Orbital plate Zygomatic
process

Nasal spine

(c) Frontal bone

(viewed from in front and slightly above)

Figure 7.13 Skull Bones

(a) Right parietal bone viewed from the lateral side. (b) Right temporal bone viewed from the lateral side. (c) Frontal bone viewed from in front and slightly above.
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212 Part 2 Support and Movement

Optic Landmarks seen on this figure:

foramen Body: thickest part of the bone.
Superior Foramen ovale: opening through which a branch of the
Lesser orbital trigeminal nerve (cranial nerve V) exits the cranial cavity.
wing fissure Foramen rotundum: opening through which a branch of the
trigeminal nerve (cranial nerve V) exits the cranial cavity.
Greater Foramen spinosum: opening through which a major artery
wing to the meninges (membranes around the brain) enters the
Sella
turcica cranial cavity.
Foramen rotundum Greater wing: forms the floor of the middle cranial fossa;
several foramina pass through this wing.
Foramen ovale Lateral pterygoid plate: attachment point for muscles
Foramen spinosum Groove of of mastication (chewing).
carotid canal Lesser wing: superior border of the superior orbital fissure.
(superior view) Medial pterygoid plate: posterolateral walls of the nasal
cavity.
Optic foramen: opening through which the optic nerve
(cranial nerve II) passes from the orbit to the cranial cavity.
Pterygoid canal: opening through which nerves and vessels
exit the cranial cavity.
Lesser Superior Pterygoid hamulus: process around which the tendon from
wing orbital a muscle to the soft palate passes.
Greater fissure Sella turcica: fossa containing the pituitary gland.
wing Body Superior orbital fissure: opening through which nerves and
vessels enter the orbit from the cranial cavity.
Special feature: Contains the sphenoidal sinus.

Foramen rotundum
Pterygoid canal Lateral
pterygoid
plate
Pterygoid hamulus Medial
pterygoid
(posterior view) plate

(d) Sphenoid bone

Anterior Landmarks seen on this figure:

Condyle: articulation point between the skull and first vertebra.
External occipital protuberance: attachment point for a strong
ligament (nuchal ligament) in back of the neck.
Foramen magnum: opening around the point where the brain and
Condyle spinal cord connect.
Inferior nuchal line: attachment point for neck muscles.
Superior nuchal line: attachment point for neck muscles.
Foramen magnum Landmarks seen in other figures:
Hypoglossal canal: opening through which the hypoglossal nerve
(cranial nerve XII) passes (figure 7.11).
Posterior cranial fossa: depression in the posterior of the cranial cavity
formed by the cerebellum (figure 7.11).
Inferior
Special features: Forms the base of the skull.
nuchal line
Superior
nuchal line

External occipital
protuberance
Posterior
(e) Occipital bone
(viewed from below)

Figure 7.13 (continued )

(d ) Sphenoid bone, superior and posterior views. (e) Occipital bone viewed from below.
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Chapter 7 Skeletal System: Gross Anatomy 213

Anterior Crista galli

Perpendicular
plate
Orbital plate
Ethmoidal Superior
Ethmoidal sinus sinus nasal concha
Crista galli
Middle
Perpendicular nasal concha
Cribriform plate
plate

Orbital plate
(anterior view)

Landmarks seen on this figure:

Cribriform plate: contains numerous openings through which
branches of the olfactory nerve (cranial nerve I) enter the
Posterior
cranial cavity from the nasal cavity.
(superior view) Crista galli: attachment for meninges (membrane around brain).
Ethmoidal sinus: spaces in the bone; help lighten the skull.
Middle nasal concha: ridge extending into the nasal cavity;
increases surface area, helps warm and moisten air in the
Crista galli cavity.
Orbital plate: forms the medial wall of the orbit.
Perpendicular plate: forms part of the nasal septum.
Ethmoidal sinus Superior nasal concha: ridge extending into the nasal cavity;
Orbital increases surface area, helps warm and moisten air in the
plate cavity.
Landmarks seen in other figures:
Ethmoid foramina: openings through which nerves and vessels
Posterior Anterior pass from the orbit to the nasal cavity (figure 7.8).
Special features: Forms part of the nasal septum and part of the
lateral walls and roof of the nasal cavity; contains the ethmoidal
Middle nasal Perpendicular sinus, or ethmoidal air cells.
concha plate

(lateral view)

(f) Ethmoid bone

Landmarks seen on this figure:

Frontal Frontal process: connection to the frontal bone; helps form the
process lateral margin of the orbit.
Infraorbital margin: ridge forming the inferior border of the
orbit.
Temporal process: helps form the bony bridge from the cheek
to just anterior to the ear.
Zygomaticofacial Zygomaticofacial foramen: opening through which a nerve
foramen and vessels exit the orbit to the face.
Temporal Special features: Forms the prominence of the cheek; forms the
process anterolateral wall of the orbit.
Infraorbital
margin

Right zygomatic bone

(g) (lateral view)

Figure 7.13 (continued )

( f ) Ethmoid bone, superior, lateral, and anterior views. (g) Right zygomatic bone, lateral view.
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214 Part 2 Support and Movement

Frontal process Frontal

Notch for
process
lacrimal bone

Maxillary sinus
Orbital
surface
Infraorbital
foramen

Zygomatic Anterior
Palatine process process nasal spine

Tuberosity
Incisive canal Alveolar
Alveolar process process

Molars
Incisors
Premolars
Canine Canine
Incisors Premolars

(medial view) Molars

(h)
(lateral view)
Right maxilla

Landmarks seen on this figure:

Alveolar process: ridge containing the teeth.
Anterior nasal spine: forms part of the nasal septum.
Frontal process: forms the sides of the nasal bridge.
Incisive canal: opening through which a nerve exits
the nasal cavity to the roof of the oral cavity.
Infraorbital foramen: opening through which a nerve
and vessels exit the orbit to the face.
Maxillary sinus: cavity in the bone, which helps lighten the skull.
Orbital surface: forms the floor of the orbit.
Palatine process: forms the anterior two-thirds of the hard palate.
Tuberosity: lump posterior to the last maxillary molar tooth.
Zygomatic process: connection to the zygomatic bone; helps
form the interior margin of the orbit.
Special feature: Contains the maxillary sinus and maxillary teeth.

Landmarks seen on this figure:

Vertical plate Horizontal plate: forms the posterior one-third of
Vertical plate the hard palate.
Vertical plate: forms part of the lateral nasal wall.
Special features: Helps form part of the hard palate
and a small part of the wall of the orbit.

Horizontal plate Horizontal plate

(medial view) (anterior view)

(i) Right palatine bone

Figure 7.13 (continued )

(h) Right maxilla, medial and lateral views. (i ) Right palatine bone, medial and anterior views.
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Chapter 7 Skeletal System: Gross Anatomy 215

Special feature: Forms a small portion of the

orbital wall.

Lacrimal bone
Nasolacrimal canal

Right lacrimal bone

(j) (anterolateral view)

Special feature: Forms the bridge of the nose.

Nasal bone

Coronoid
Right nasal bone process
(k) (anterolateral view)
Mandibular
notch Landmarks seen on this figure:
Molars Alveolar process: ridge containing
Mandibular the teeth.
Premolars condyle Angle: corner between the body and
Canine Condylar ramus.
Incisors process Body: major, horizontal portion of the
Ramus bone.
Condylar process: extension
Mandibular
containing the mandibular condyle.
foramen
Coronoid process: attachment for a
Alveolar muscle of mastication.
process Mandibular condyle: point of
articulation between the mandible
and the rest of the skull.
Angle Mandibular foramen: opening
through which nerves and vessels
Body to the mandibular teeth enter the
(medial view) bone.
Mandibular notch: depression
between the condylar process and
the coronoid process.
Mandibular Mental foramen: opening through
Coronoid which a nerve and vessels exit the
notch
process mandible to the skin of the chin.
Mandibular Ramus: major, nearly vertical portion
Molars
condyle of the bone.
Premolars Special features: The only bone in
Condylar
process Canine this figure that is freely movable
relative to the rest of the skull bones;
Incisors holds the lower teeth.

Ramus
Alveolar
process
Body
Mental
Angle foramen

(lateral view)

(l) Right half of the mandible

Figure 7.13 (continued )

( j ) Right lacrimal bone, lateral view. (k) Right nasal bone, lateral view. ( l) Right half of the mandible, medial and lateral views.
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216 Part 2 Support and Movement

Ala Landmarks seen on this figure:

Ala: attachment point between the vomer
and sphenoid.
Ala Vertical plate: forms part of the nasal
septum.
Special feature: Forms most of the
Vertical posterior nasal septum.
Vertical plate
plate

(anterior view) (lateral view)

(m) Vomer

Figure 7.13 (continued )

(m) Vomer, anterior and lateral views.

Greater Landmarks seen on this figure:

cornu Body: major portion of the bone.
Greater cornu: attachment point for
muscles and ligaments.
Lesser cornu: attachment point for
Lesser muscles and ligaments.
cornu Special features: One of the few
bones of the body that does not
Body articulate with another bone; it is
attached to the skull by muscles
and ligaments.

(anterior view)

Lesser
cornu
Greater
cornu

Body

(lateral view)
(from the left side)

Hyoid bone

Figure 7.14 Hyoid Bone

Anterior and lateral views, from the left side.

Hyoid to the skull and the hyoid “floats” in the superior aspect of the
neck just below the mandible. The hyoid bone provides an attach-
The hyoid bone (figure 7.14), which is unpaired, is often listed as
ment for some tongue muscles, and it’s also an attachment point
part of the viscerocranium because it has a common developmen-
for important neck muscles that elevate the larynx during speech
tal origin with the bones of the face. It is not, however, part of the
or swallowing.
adult skull (see table 7.1). The hyoid bone has no direct bony at-
tachment to the skull but, rather, muscles and ligaments attach it 12. Where is the hyoid bone located and what does it do?
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Chapter 7 Skeletal System: Gross Anatomy 217

Vertebral Column First cervical vertebra

(atlas)
Objectives Second cervical vertebra
■ Describe the development of the four major curvatures of Cervical (axis)
the vertebral column. region
(curved
■ List the features that characterize the vertebrae of the anteriorly)
cervical, thoracic, lumbar, and sacral regions.

The vertebral column usually consists of 26 bones, which Seventh cervical vertebra
can be divided into five regions (figure 7.15). Seven cervical verte- First thoracic vertebra
brae (ver⬘tĕ-brē), 12 thoracic vertebrae, five lumbar vertebrae,
one sacral bone, and one coccygeal (kok-sij⬘ē-ăl) bone make up
the vertebral column. The developing embryo has about 34 verte-
brae, but the five sacral vertebrae fuse to form one bone, and the
four or five coccygeal bones usually fuse to form one bone.
The five regions of the adult vertebral column have four ma- Thoracic
jor curvatures (see figure 7.15). Two of the curves appear during region
(curved
embryonic development and reflect the C-shaped curve of the em- posteriorly)
bryo and fetus within the uterus. When the infant raises its head in
the first few months after birth, a secondary curve, which is convex
anteriorly, develops in the neck. Later, when the infant learns to sit
and then walk, the lumbar portion of the column also becomes
convex anteriorly. Thus in the adult vertebral column, the cervical
region is convex anteriorly, the thoracic region is concave anteri-
orly, the lumbar region is convex anteriorly, and the sacral and coc- Intervertebral disk
cygeal regions are, together, concave anteriorly. Twelfth thoracic vertebra

Abnormal Spinal Curvatures

Lordosis (lōr-dō ⬘sis; hollow back) is an exaggeration of the convex Intervertebral foramina
curve of the lumbar region. Kyphosis (kı̄-fō⬘sis; hump back) is an First lumbar vertebra
exaggeration of the concave curve of the thoracic region. Scoliosis
(skō⬘lē-ō⬘sis) is an abnormal bending of the spine to the side, which is Body
often accompanied by secondary abnormal curvatures, such as Lumbar
kyphosis (figure 7.16). region
(curved Transverse process
anteriorly)
Spinous process

Fifth lumbar vertebra

Sacral promontory

Sacral and Sacrum

coccygeal
regions
(curved
posteriorly)

Coccyx

Figure 7.15 Vertebral Column

Complete column viewed from the left side.
Figure 7.16 Scoliosis
Scoliosis is an abnormal lateral curvature of the spine. The abnormality is
indicated by the arrows.
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218 Part 2 Support and Movement

Intervertebral Disks (pŭl-pō⬘sŭs; pulp). The disk becomes more compressed with in-
During life, intervertebral disks of fibrocartilage, which are lo- creasing age so that the distance between vertebrae and therefore
cated between the bodies of adjacent vertebrae (see figures 7.15 the overall height of the individual decreases. The annulus fibro-
and 7.17), provide additional support and prevent the vertebral sus also becomes weaker with age and more susceptible to
bodies from rubbing against each other. The intervertebral disks herniation.
consist of an external annulus fibrosus (an⬘ū-lŭs f ı̄-brō⬘sŭs;
fibrous ring) and an internal gelatinous nucleus pulposus General Plan of the Vertebrae
The vertebral column performs five major functions: (1) it sup-
ports the weight of the head and trunk, (2) it protects the spinal
cord, (3) it allows spinal nerves to exit the spinal cord, (4) it pro-
vides a site for muscle attachment, and (5) it permits movement of
Vertebral body the head and trunk. The general structure of a vertebra is outlined
Annulus in table 7.7. Each vertebra consists of a body, an arch, and various
Intervertebral fibrosus
processes (figure 7.19). The weight-bearing portion of the vertebra
disk Nucleus
pulposus
is a bony disk called the body.
The vertebral arch projects posteriorly from the body.
Intervertebral
foramen
The arch is divided into left and right halves, and each half has
two parts: the pedicle (ped⬘i-kl; foot), which is attached to the
body, and the lamina (lam⬘i-na; thin plate), which joins the
lamina from the opposite half of the arch. The vertebral arch and
Figure 7.17 Intervertebral Disk the posterior part of the body surround a large opening called
the vertebral foramen. The vertebral foramina of adjacent
vertebrae combine to form the vertebral canal, which contains
the spinal cord. The vertebral arches and bodies protect the
spinal cord.
Herniated or Ruptured Intervertebral Disk
A herniated, or ruptured, disk results from the breakage or ballooning of the
annulus fibrosus with a partial or complete release of the nucleus pulposus
(figure 7.18). The herniated part of the disk may push against the spinal
cord or spinal nerves, compromising their normal function and producing Laminectomy and Spina Bifida
pain. Herniation of the inferior lumbar intervertebral disks is most common, In some surgical procedures, such as removal of an intervertebral disk,
but herniation of the inferior cervical disks is almost as common. the vertebrae are in the way and prevent access to the intervertebral
Herniated or ruptured disks can be repaired in one of several ways. disk. This problem can be solved by removing a lamina, a procedure
One procedure uses prolonged bed rest and is based on the tendency for called a laminectomy.
the herniated part of the disk to recede and the annulus fibrosus to repair Sometimes vertebral laminae may partly or completely fail to fuse
itself. In many cases, however, surgery is required, and the damaged disk (or even fail to form) during fetal development, resulting in a condition
is removed. To enhance the stability of the vertebral column, a piece of called spina bifida (spı̄⬘nă bif⬘i-dă; split spine). This defect is most
hipbone is sometimes inserted into the space previously occupied by the common in the lumbar region. If the defect is severe and involves the
disk, and the adjacent vertebrae become fused by bone across the gap. spinal cord (figure 7.20), it may interfere with normal nerve function
below the point of the defect.
Spinous process
Dura mater Skin of back
Transverse process
Enlarged fluid-filled space
Compressed
Spinal cord spinal nerve root in
in vertebral intervertebral foramen Back
canal muscles
Herniated
portion of disk Spinal cord
Incomplete
Nucleus pulposus Intervertebral Cauda equina vertebral arch
Annulus fibrosus disk Body of first
lumbar vertebra

Figure 7.18 Herniated Disk

Part of the annulus fibrosus has been removed to reveal the nucleus pulposus Figure 7.20 Spina Bifida
in the center of the disk. This developmental malformation occurs when two vertebral laminae fail to fuse.
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Chapter 7 Skeletal System: Gross Anatomy 219

Table 7.7 General Structure of a Vertebra (see figure 7.19 b and c)

Feature Description
Body Disk-shaped; usually the largest part with flat surfaces directed superiorly and inferiorly; forms the anterior wall of the
vertebral foramen; intervertebral disks are located between the bodies
Vertebral foramen Hole in each vertebra through which the spinal cord passes; adjacent vertebral foramina form the vertebral canal
Vertebral arch Forms the lateral and posterior walls of the vertebral foramen; possesses several processes and articular surfaces
Pedicle Foot of the arch with one on each side; forms the lateral walls of the vertebral foramen
Lamina Posterior part of the arch; forms the posterior wall of the vertebral foramen
Transverse process Process projecting laterally from the junction of the lamina and pedicle; a site of muscle attachment
Spinous process Process projecting posteriorly at the point where the two laminae join; a site of muscle attachment; strengthens the
vertebral column and allows for movement
Articular processes Superior and inferior projections containing articular facets where vertebrae articulate with each other; strengthen the
vertebral column and allow for movement
Intervertebral foramen Lateral opening between two adjacent vertebrae through which spinal nerves exit the vertebral canal

Posterior
Anterior Posterior
Spinous process Transverse process
Inferior intervertebral
Superior notch of superior vertebra
articular process
Lamina Space for intervertebral disk
Transverse Vertebral Intervertebral foramen
process arch Inferior articular process
Pedicle of superior vertebra
Vertebral Superior articular
foramen process of inferior vertebra

Body Spinous processes

Superior intervertebral
notch of inferior vertebra
(a) Anterior Bodies
(c)

Superior articular process

Superior Superior articular facet

intervertebral notch Pedicle
Superior articular Transverse process
facet for rib head
Articular facet for
tubercle of rib
Anterior Body Lamina Posterior

Inferior articular process

Inferior articular
facet for rib head
Spinous process

Inferior intervertebral
(b) notch

Figure 7.19 Vertebra

(a) Superior view. (b) Lateral view of a thoracic vertebra. (c) Photograph of two stacked thoracic vertebrae from a lateral view. The relationship between the inferior
articular process of one vertebra and the superior articular process of the next inferior vertebra can be seen. The intervertebral foramen and the space for the
intervertebral disk also can be seen.
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220 Part 2 Support and Movement

A transverse process extends laterally from each side of Posterior arch

Transverse
the arch between the lamina and pedicle, and a single spinous process Vertebral foramen
process is present at the point of junction between the two lami-
nae. The spinous processes can be seen and felt as a series of Superior articular
lumps down the midline of the back (figure 7.21). Much vertebral facet (articulates
with occipital condyle)
movement is accomplished by the contraction of skeletal muscles
Facet for dens
that are attached to the transverse and spinous processes (see
Transverse Anterior arch
chapter 10). (a) foramen

Spinous process
(bifid)
Spinous process of
seventh cervical vertebra
Transverse Posterior arch
Superior border
process
of scapula Vertebral foramen
Medial border Transverse
Body
of scapula foramen Superior articular
facet
Scapula
Dens
Inferior angle (b)
of scapula
Lumbar spinous
processes Spinous process
(bifid)
Lamina

Figure 7.21 A Person’s Back Showing the Scapula and Pedicle

Vertebral Spinous Processes Vertebral foramen
Transverse
foramen Superior articular
Transverse facet
process Body
Spinal nerves exit the spinal cord through the inter-
(c)
vertebral foramina (see figures 7.15 and 7.19c). Each interverte-
bral foramen is formed by notches in the pedicles of adjacent
vertebrae.
Movement and additional support of the vertebral column
are made possible by the vertebral processes. Each vertebra has a
superior and an inferior articular process, with the superior
process of one vertebra articulating with the inferior process of the
C1 Spinous
next superior vertebra. Overlap of these processes increases the Dens process
rigidity of the vertebral column. The region of overlap and
C2
articulation between the superior and inferior articular processes
creates a smooth articular facet (fas⬘et, little face), on each articu-
lar process. C3

Regional Differences in Vertebrae C4

The vertebrae of each region of the vertebral column have specific Body C5
characteristics that tend to blend at the boundaries between Transverse
regions. The cervical vertebrae (see figures 7.15 and 7.22a–d) C6 process
have very small bodies, partly bifid (bı̄⬘fid; split) spinous C7
Transverse
processes, and a transverse foramen in each transverse process foramen
through which the vertebral arteries extend toward the head. Only
cervical vertebrae have transverse foramina.
The first cervical vertebra is called the atlas (see figure (d)
7.22a) because it holds up the head, just as Atlas in classical Figure 7.22 Cervical Vertebrae
(a) Atlas (first cervical vertebra), superior view. (b) Axis (second cervical
vertebra), slightly posterior and superior view. (c) Fifth cervical vertebra,
superior view. (d ) Cervical vertebrae together from a lateral view.
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Chapter 7 Skeletal System: Gross Anatomy 221

mythology held up the world. The atlas vertebra has no body

and no spinous process, but it has large superior articular facets,
where it joins the occipital condyles on the base of the skull. This
joint allows the head to move in a yes motion or to tilt from side
to side. The second cervical vertebra is called the axis (figure
7.22b) because a considerable amount of rotation occurs at this Spinous process
vertebra to produce a no motion of the head. The axis has a Lamina
Vertebral foramen
highly modified process on the superior side of its small body Transverse
process Articular facet
called the dens, or odontoid (ō-don⬘toyd; tooth-shaped) for tubercle of rib
process (both dens and odontoid mean tooth-shaped). The dens Superior articular
Superior articular
fits into the enlarged vertebral foramen of the atlas, and the lat- process
facet
ter rotates around this process. The spinous process of the sev- Pedicle
Superior articular
enth cervical vertebra, which is not bifid, is quite pronounced facet for rib head
and often can be seen and felt as a lump between the shoulders Body
(see figure 7.21). The most prominent spinous process in this
area is called the vertebral prominens. This is usually the spi-
(a)
nous process of the seventh cervical vertebra, but may be that of
the sixth cervical vertebra or even the first thoracic.

Whiplash
Whiplash is a traumatic hyperextension of the cervical vertebrae. The
head is a heavy object at the end of a flexible column, and it may Articular
T1 facets for
become hyperextended when the head “snaps back” as a result of a
rib head
sudden acceleration of the body. This commonly occurs in “rear-end”
automobile accidents, or athletic injuries, in which the body is quickly T2
forced forward while the head remains stationary. Common injuries Articular
facet for
resulting from whiplash are fracture of the spinous processes of the T3 tubercle of rib
cervical vertebrae and herniated disks, with an anterior tear of the
Transverse
annulus fibrosus. These injuries can cause posterior pressure on the Body T4 process
spinal cord or spinal nerves and strained or torn muscles, tendons, and
ligaments. Spinous
T5 process
Space for
intervertebral
The thoracic vertebrae (see figures 7.15 and 7.23) possess disk
long, thin spinous processes, which are directed inferiorly, and T6
Intervertebral
they have relatively long transverse processes. The first 10 tho- foramen
racic vertebrae have articular facets on their transverse T7
processes, where they articulate with the tubercles of the ribs.
Additional articular facets are on the superior and inferior mar-
gins of the body where the heads of the ribs articulate. The head (b)
of most ribs articulates with the inferior articular facet of one
vertebra and the superior articular facet for the rib head on the Figure 7.23 Thoracic Vertebrae
next vertebra down. (a) Thoracic vertebra, superior view. (b) Thoracic vertebrae together from a
lateral view.
The lumbar vertebrae (see figures 7.15 and 7.24) have large,
thick bodies and heavy, rectangular transverse and spinous
processes. The superior articular processes face medially, and the
inferior articular processes face laterally. When the superior articu-
The sacral (sā⬘krăl) vertebrae (see figures 7.15 and 7.25) are
lar surface of one lumbar vertebra joins the inferior articulating
highly modified compared to the others. These five vertebrae are
surface of another lumbar vertebra, the resulting arrangement
fused into a single bone called the sacrum (sā⬘krŭm).
adds strength to the inferior portion of the vertebral column and
limits rotation of the lumbar vertebrae.
Variation in Lumbar Vertebrae
P R E D I C T The fifth lumbar vertebra or first coccygeal vertebra may become fused
Why are the lumbar vertebrae more massive than the cervical into the sacrum. Conversely, the first sacral vertebra may fail to fuse with
vertebrae? the rest of the sacrum, resulting in six lumbar vertebrae.
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The transverse processes of the sacral vertebrae fuse to form a landmark that separates the abdominal cavity from the pelvic
the alae (ā⬘lē; wings), which join the sacrum to the pelvic bones. cavity. The sacral promontory can be felt during a vaginal exami-
The spinous processes of the first four sacral vertebrae partially nation, and it’s used as a reference point during measurement of
fuse to form projections, called the median sacral crest, along the the pelvic inlet.
dorsal surface of the sacrum. The spinous process of the fifth ver- The coccyx (kok⬘siks; shaped like a cuckoo’s bill; see figures
tebra does not form, thereby leaving a sacral hiatus (hı̄-ā⬘tŭs) at 7.15 and 7.25), or tailbone, is the most inferior portion of the ver-
the inferior end of the sacrum, which is often the site of anesthetic tebral column and usually consists of three to five more-or-less
injections. The intervertebral foramina are divided into dorsal fused vertebrae that form a triangle, with the apex directed inferi-
and ventral foramina, called the sacral foramina, which are lat- orly. The coccygeal vertebrae are greatly reduced in size relative to
eral to the midline. The anterior edge of the body of the first sacral the other vertebrae and have neither vertebral foramina nor well-
vertebra bulges to form the sacral promontory (see figure 7.15), developed processes.

Spinous process
Ala
Lamina
Sacral
promontory
Transverse Superior articular
process facet Sacral
foramina
Pedicle Vertebral foramen

Body

(a)

Coccyx

(a)
Superior
articular facet
(articulates
Intervertebral Ala
with fifth
L1 foramen Sacral canal lumbar
Space for
vertebra)
intervertebral
disk Spinous Articular
process surface Median sacral
L2 crest
(point of
articulation
Transverse with coxa)
process
L3
Body
Sacral
foramina

L4
Sacral hiatus

L5

Coccyx
(b)
(b)
Figure 7.24 Lumbar Vertebrae
(a) Lumbar vertebra, superior view. (b) Lumbar vertebrae together from a Figure 7.25 Sacrum
lateral view. (a) Anterior view. (b) Posterior view.
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Chapter 7 Skeletal System: Gross Anatomy 223

Seventh cervical vertebra

Clavicle First thoracic vertebra
Jugular notch
1

2
Sternal
angle
3
True ribs
4
Costal
cartilage Manubrium
5
Body Sternum
6
Xiphoid process
7

8 11
T12
False ribs
(8–12) 9
12 L1
Floating ribs
10

(a)

Articular facets for

Head body of vertebrae
Neck Articular facet for
transverse process
Tubercle of vertebra
Angle
Sternal end
(b) Body

Head of rib set

against the inferior
articular facet
of the superior
vertebra and
the superior
articular facet
of the inferior
vertebra

Tubercle of rib
set against the
articular facet
on the transverse
process of the
inferior vertebra

Angle of rib

Body of rib

(c)

Figure 7.26 Thoracic Cage

(a) Entire thoracic cage as seen from in front. (b) Typical rib. (c) Photograph of two thoracic vertebrae and the proximal end of a rib, as seen from the left side,
showing the relationship between the vertebra and the head and tubercle of the rib.
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224 Part 2 Support and Movement

Vertebral Column Injuries Rib Defects

Because the cervical vertebrae are rather delicate and have small A separated rib is a dislocation between a rib and its costal cartilage. As
bodies, dislocations and fractures are more common in this area than in a result of the dislocation, the rib can move, override adjacent ribs, and
other regions of the column. Because the lumbar vertebrae have massive cause pain. Separation of the tenth rib is the most common.
bodies and carry a large amount of weight, fractures are less common, The angle is the weakest part of the rib and may be fractured in a
but ruptured intervertebral disks are more common in this area than in crushing accident, such as an automobile accident.
other regions of the column. The coccyx is easily broken in a fall in which The transverse processes of the seventh cervical vertebra may
a person sits down hard on a solid surface. form separate bones called cervical ribs. These ribs may be just tiny
pieces of bone or may be long enough to reach the sternum. The first
13. Describe the four major curvatures of the vertebral column, lumbar vertebra may develop lumbar ribs.
explain what causes them, and when they develop. Define
the terms scoliosis, kyphosis, and lordosis. Sternum
14. Describe the structures forming the vertebral foramen. The sternum, or breastbone, has been described as being sword-
Where do spinal nerves exit the vertebral column? shaped and has three parts (see figure 7.26a). The manubrium
15. Describe how superior and inferior articular processes (mă-noo⬘brē-ŭm; handle) is the sword handle, the body is the
help support and allow movement of the vertebral blade, and the xiphoid (zi⬘foyd; sword) process is the sword tip.
column. The superior margin of the manubrium has a jugular (neck)
16. Name and give the number of each type of vertebra. notch in the midline, which can be easily felt at the anterior base of
Describe the characteristics that distinguish the different the neck (figure 7.27). The first rib and the clavicle articulate with
types of vertebrae. the manubrium. The point at which the manubrium joins the body
of the sternum can be felt as a prominence on the anterior thorax
Thoracic Cage called the sternal angle (see figure 7.26). The cartilage of the sec-
ond rib attaches to the sternum at the sternal angle, the third
Objectives
through seventh ribs attach to the body of the sternum, and no ribs
■ Describe the parts of the thoracic (rib) cage, and explain
their function.
attach to the xiphoid process.

The thoracic cage, or rib cage, protects the vital organs Sternal Angle and Thoracic Landmarks
within the thorax and forms a semi-rigid chamber that can in- The sternal angle is important clinically because the second rib is found
crease and decrease in volume during respiration. It consists of the lateral to it and can be used as a starting point for counting the other
thoracic vertebrae, the ribs with their associated costal (rib) carti- ribs. Counting ribs is important because they are landmarks used to
lages, and the sternum (figure 7.26a). locate structures in the thorax, such as areas of the heart. The sternum
often is used as a site for taking red bone marrow samples because it is
Ribs and Costal Cartilages readily accessible. Because the xiphoid process of the sternum is
The 12 pairs of ribs are classified as either true or false ribs. The su- attached only at its superior end, it may be broken during
perior seven pairs are called true ribs, or vertebrosternal cardiopulmonary resuscitation (CPR) and then may lacerate the liver.
(ver⬘tĕ⬘brō-ster⬘năl) ribs, and articulate with the thoracic vertebrae
and attach directly through their costal cartilages to the sternum. 17. What is the function of the thoracic (rib) cage? Distinguish
The inferior five pairs, or false ribs, articulate with the thoracic ver- between true, false, and floating ribs, and give the number
tebrae but do not attach directly to the sternum. The false ribs con- of each type.
sist of two groups. The eighth, ninth, and tenth ribs, the 18. Describe the articulation of the ribs with thoracic vertebrae.
vertebrochondral (ver⬘tĕ-brō-kon⬘drăl) ribs, are joined by a com- 19. Describe the different parts of the sternum. Name the
mon cartilage to the costal cartilage of the seventh rib, which, in structures that attach to, or articulate with, the sternum.
turn, is attached to the sternum. Two of the false ribs, the eleventh
and twelfth ribs, are also called floating, or vertebral, ribs because
they do not attach to the sternum. The costal cartilages are flexible
and permit the thoracic cage to expand during respiration. Acromion process
Jugular notch
Most ribs have two points of articulation with the thoracic
vertebrae (figure 7.26b and c). First, the head articulates with the
bodies of two adjacent vertebrae and the intervertebral disk be- Clavicle
tween them. The head of each rib articulates with the inferior ar-
ticular facet of the superior vertebra and the superior articular
facet of the inferior vertebra. Second, the tubercle articulates with
Sternum
the transverse process of one vertebra. The neck is between the
head and tubercle, and the body, or shaft, is the main part of the
rib. The angle of the rib is located just lateral to the tubercle and is Figure 7.27 Surface Anatomy Showing Bones of the Upper
the point of greatest curvature. Thorax
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Chapter 7 Skeletal System: Gross Anatomy 225

Appendicular Skeleton Clavicle

Objectives
■ Name and describe the bones of the pectoral girdle and Scapula
upper limb.
■ Name the major features of these bones and describe their
functions.
■ Name and describe the bones of the pelvic girdle and lower
limb. Humerus
■ Name the major features of these bones and describe their
functions.

The appendicular skeleton (see figure 7.1) consists of the

bones of the upper and lower limbs and the girdles by which they
are attached to the body. The term girdle means a belt or a zone and
refers to the two zones, pectoral and pelvic, where the limbs are at-
tached to the body.
Ulna
Pectoral Girdle and Upper Limb
The human upper limb (figure 7.28) is extremely mobile. It is
Radius
capable of a wide range of movements, including lifting, grasping,
pulling, and touching. Many structural characteristics of the upper
limb reflect these functions. The upper limb and its girdle are at-
tached rather loosely by muscles to the rest of the body, an arrange- Carpals
ment that allows considerable freedom of movement of this Metatcarpals
extremity. This freedom of movement allows placement of the
hand in a wide range of positions to accomplish its functions.
Phalanges
Pectoral Girdle
The pectoral (pek⬘tŏ-răl), or shoulder, girdle consists of two pairs
Figure 7.28 Bones of the Pectoral Girdle and Right Upper
of bones that attach the upper limb to the body: each pair is com- Limb
posed of a scapula (skap⬘ū-lă), or shoulder blade (figure 7.29), and
a clavicle (klav⬘i-kl), or collarbone (see figures 7.26, 7.28, and
7.29c). The scapula is a flat, triangular bone that can easily be seen ial skeleton. Because the clavicle holds the upper limb away from
and felt in a living person (see figure 7.21). The base of the triangle, the body it facilitates the mobility of the limb.
the superior border, faces superiorly; and the apex, the inferior 20. Name the bones that make up the pectoral girdle. Describe
angle, is directed inferiorly. their functions.
The large acromion (ă-krō⬘mē-on; shoulder tip) process of 21. What are the functions of the acromion process and the
the scapula, which can be felt at the tip of the shoulder, has three coracoid process of the scapula?
functions: (1) to form a protective cover for the shoulder joint, (2) to
form the attachment site for the clavicle, and (3) to provide attach- P R E D I C T
ment points for some of the shoulder muscles. The scapular spine A broken clavicle changes the position of the upper limb in what way?
extends from the acromion process across the posterior surface of
the scapula and divides that surface into a small supraspinous fossa Arm
superior to the spine and a larger infraspinous fossa inferior to the The arm, the part of the upper limb from the shoulder to the el-
spine. The deep, anterior surface of the scapula constitutes the sub- bow, contains only one bone, the humerus (figure 7.30). The
scapular fossa. The smaller coracoid (meaning shaped like a crow’s humeral head articulates with the glenoid cavity of the scapula.
beak) process provides attachments for some shoulder and arm The anatomical neck, immediately distal to the head, is almost
muscles. A glenoid (glē⬘noyd, glen⬘oyd) cavity, located in the supe- nonexistent; thus a surgical neck has been designated. The surgi-
rior lateral portion of the bone, articulates with the head of the cal neck is so named because it’s a common fracture site that of-
humerus. ten requires surgical repair. If it becomes necessary to remove the
The clavicle (see figures 7.26, 7.28, and 7.29c) is a long bone humeral head because of disease or injury, it’s removed down to
with a slight sigmoid (S-shaped) curve and is easily seen and felt in the surgical neck. The greater tubercle is located on the lateral
the living human (see figure 7.27). The lateral end of the clavicle surface and the lesser tubercle is located on the anterior surface
articulates with the acromion process, and its medial end articu- of the proximal end of the humerus, where they function as sites
lates with the manubrium of the sternum. These articulations form of muscle attachment. The groove between the two tubercles con-
the only bony connections between the pectoral girdle and the ax- tains one tendon of the biceps brachii muscle and is called the
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226 Part 2 Support and Movement

Acromion process
Acromion process
Coracoid process
Coracoid process Superior angle
Superior border
Supraglenoid tubercle Scapular notch Scapular notch
Glenoid cavity
Glenoid cavity Supraspinous
fossa
Infraglenoid tubercle
Spine
Subscapular
Lateral border fossa
Infraspinous fossa
Medial border

Lateral border

Inferior angle

(a) Anterior view (b) Posterior view

Body of clavicle
Spine of scapula Posterior

Supraspinous
fossa of scapula
Superior border
of scapula
Proximal end Acromion process
of scapula
Lateral (acromial)
Distal end end of clavicle

(c) Coracoid process

of scapula
(d) Body of clavicle Anterior

Figure 7.29 Right Scapula and Clavicle

(a) Right scapula, anterior view. (b) Right scapula, posterior view. (c) Right clavicle, anterior view. (d ) Photograph of the right scapula and clavicle from a superior
view, showing the relationship between the distal end of the clavicle and the acromion process of the scapula.

intertubercular, or bicipital (bı̄-sip⬘i-tăl), groove. The deltoid trochlea are the medial and lateral epicondyles, which function as
tuberosity is located on the lateral surface of the humerus a little points of muscle attachment for the muscles of the forearm.
more than a third of the way along its length and is the attachment
site for the deltoid muscle. Forearm
The articular surfaces of the distal end of the humerus ex- The forearm has two bones. The ulna is on the medial side of the
hibit unusual features where the humerus articulates with the two forearm, the side with the little finger. The radius is on the lateral,
forearm bones. The lateral portion of the articular surface is very or thumb side, of the forearm (figure 7.31).
rounded, articulates with the radius, and is called the capitulum The proximal end of the ulna has a C-shaped articular sur-
(kă-pit⬘ū-lŭm; head-shaped). The medial portion somewhat re- face, called the trochlear, or semilunar, notch that fits over the
sembles a spool or pulley, articulates with the ulna, and is called the trochlea of the humerus. The trochlear notch is bounded by two
trochlea (trok⬘lē-ă; spool). Proximal to the capitulum and the processes. The larger, posterior process is the olecranon
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Chapter 7 Skeletal System: Gross Anatomy 227

Anatomical neck
Head
Greater tubercle Lesser
tubercle Anatomical
neck

Surgical neck
Intertubercular
(bicipital) groove

Radial groove
Deltoid tuberosity

Lateral
supracondylar
ridge Medial supracondylar ridge
Olecranon fossa
Radial fossa Coronoid
fossa
Lateral epicondyle Lateral epicondyle
Medial epicondyle
Capitulum

Trochlea Trochlea
(a) (b)

Figure 7.30 Right Humerus

(a) Anterior view. (b) Posterior view.

(ō-lek⬘ră-non; the point of the elbow) process. It can easily be felt of the head constitute a smooth cylinder, where the radius rotates
and is commonly referred to as “the elbow” (see figure 7.33). Poste- against the radial notch of the ulna. As the forearm rotates
rior arm muscles attach to the olecranon process. The smaller, an- (supination and pronation; see chapter 8), the proximal end of the
terior process is the coronoid (kōr⬘ŏ-noyd; crow’s beak) process. ulna stays in place, and the radius rotates. The radial tuberosity is
the point at which a major anterior arm muscle, the biceps
P R E D I C T brachii, attaches.
Explain the function of the olecranon and coronoid fossae on the The distal end of the radius, which articulates with the ulna
distal humerus (see figure 7.30). and the carpals, is somewhat broadened, and a styloid process to
which wrist ligaments are attached is located on the lateral side of
The distal end of the ulna has a small head, which articulates
the distal radius.
with both the radius and the wrist bones (see figures 7.31 and
7.33). The head can be seen on the posterior, medial (ulnar) side of
Radius Fractures
the distal forearm. The posteromedial side of the head has a small
The radius is the most commonly fractured bone in people over 50 years
styloid (stı̄⬘loyd; shaped like a stylus or writing instrument)
old. It is often fractured as the result of a fall on an outstretched hand.
process to which ligaments of the wrist are attached.
The most common site of fracture is 2.5 cm proximal to the wrist, and the
The proximal end of the radius is the head. It is concave and
fracture is often comminuted, or impacted.
articulates with the capitulum of the humerus. The lateral surfaces
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228 Part 2 Support and Movement

Olecranon process bercle of the trapezium to the hook of the hamate to form a tunnel
Trochlear (semilunar) notch on the anterior surface of the wrist called the carpal tunnel. Ten-
Radial notch of ulna Coronoid process dons, nerves, and blood vessels pass through this tunnel to enter
Head the hand.
Neck
Carpal Tunnel Syndrome
Radial tuberosity The bones and ligaments that form the walls of the carpal tunnel do not
stretch. Edema (fluid buildup) or connective tissue deposition may occur
within the carpal tunnel as the result of trauma or some other problem.
The edema or connective tissue may apply pressure against the nerve
and vessels passing through the tunnel. This pressure causes carpal
Ulna tunnel syndrome, which consists of tingling, burning, and numbness in
the hand. Carpal tunnel syndrome occurs more frequently in people who
use their hands a lot. The number of cases has increased in recent
decades among people who perform repetitive tasks such as computer
Radius keyboarding.

Hand
Five metacarpals are attached to the carpal bones and constitute
the bony framework of the hand (see figure 7.32). The metacarpals
form a curve so that, in the resting position, the palm of the hand
is concave. The distal ends of the metacarpals help form the knuck-
les of the hand (figure 7.33). The spaces between the metacarpals
are occupied by soft tissue.
Head
The five digits of each hand include one thumb and four fin-
Styloid process
Styloid process gers. Each digit consists of small long bones called phalanges
(a)
(fă-lan⬘jēz; the singular term phalanx refers to the Greek word,
meaning a line or wedge of soldiers holding their spears, tips out-
ward, in front of them). The thumb has two phalanges, and each
Olecranon
finger has three. One or two sesamoid (ses⬘ă-moyd; resembling a
Radial notch of ulna process sesame seed) bones (not illustrated) often form near the junction
Trochlear between the proximal phalanx and the metacarpal of the thumb.
Head of radius (semilunar) Sesamoid bones are small bones located within tendons.
notch
(b) Coronoid process
P R E D I C T
Figure 7.31 Right Ulna and Radius Explain why the dried, articulated skeleton appears to have much
(a) Anterior view of right ulna and radius. (b) Proximal ends of the right ulna longer “fingers” than are seen in the hand with the soft tissue intact.
and radius.
22. Name the important sites of muscle attachment on the
humerus.
Wrist 23. Give the points of articulation between the scapula,
The wrist is a relatively short region between the forearm and hand humerus, radius, ulna, and wrist bones.
and is composed of eight carpal (kar⬘păl) bones arranged into two 24. What is the function of the radial tuberosity? Of the styloid
rows of four each (figure 7.32). The eight carpals, taken together, processes? Name the part of the ulna commonly referred to
are convex posteriorly and concave anteriorly. The anterior con- as “the elbow.”
cavity of the carpals is accentuated by the tubercle of the trapezium 25. List the eight carpal bones. What is the carpal tunnel?
at the base of the thumb and the hook of the hamate at the base of 26. What bones form the hand? The knuckles? How many
the little finger. A ligament stretches across the wrist from the tu- phalanges are in each finger and in the thumb?
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Radius
Ulna
Carpals
(distal row)
Scaphoid bone Scaphoid bone
Carpals Hamate bone Carpals
Lunate bone Lunate bone (proximal
(proximal Capitate bone
row) Triquetrum bone Triquetrum bone row)
Pisiform bone Trapezoid bone Pisiform bone
Trapezium bone

1 1
Metacarpals
5 2
4 3 2 5
3 4

Proximal
phalanx
of thumb

Distal
phalanx
of thumb

Digits Proximal
phalanx
of finger

Middle phalanx of finger

Distal phalanx of finger

(a) Posterior (b) Anterior

Figure 7.32 Bones of the Right Wrist and Hand

(a) Posterior view. (b) Anterior view.

Heads of
metacarpals Acromion
(knuckles) process

Medial border
Head of ulna
of scapula

Lateral
epicondyle Olecranon
process
Olecranon
Medial
process
epicondyle

Figure 7.33 Surface Anatomy Showing Bones of the Pectoral Girdle and Upper Limb
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230 Part 2 Support and Movement

of each coxa and is the point of articulation of the lower limb with
Pelvic Girdle and Lower Limb the girdle. The articular surface of the acetabulum is crescent-
The lower limbs support the body and are essential for normal shaped and occupies only the superior and lateral aspects of the
standing, walking, and running. The general pattern of the lower fossa. The pelvic girdle is the place of attachment for the lower
limb (figure 7.34) is very similar to that of the upper limb, except limbs, supports the weight of the body, and protects internal or-
that the pelvic girdle is attached much more firmly to the body gans. Because the pelvis is a complete bony ring, it provides more
than is the pectoral girdle, and the bones in general are thicker, stable support but less mobility than the incomplete ring of the
heavier, and longer than those of the upper limb. These structures pectoral girdle. In addition, the pelvis in a woman protects the de-
reflect the function of the lower limb in support and movement of veloping fetus and forms a passageway through which the fetus
the body. passes during delivery.
Each coxa is formed by the fusion of three bones during de-
Pelvic Girdle velopment: the ilium (il⬘ē-ŭm; groin), the ischium (is⬘kē-ŭm;
The pelvic girdle consists of the right and left coxae (kok⬘sē), or hip), and the pubis (pū⬘bis; refers to the genital hair). All three
hipbones. The coxae join each other anteriorly and with the bones join near the center of the acetabulum (figure 7.36a). The
sacrum posteriorly to form a ring of bone called the pelvis superior portion of the ilium is called the iliac crest (figure 7.36b
(pel⬘vis, basin) (figure 7.35). Each coxa consists of a large, concave and c). The crest ends anteriorly as the anterior superior iliac
bony plate superiorly, a slightly narrower region in the center, and spine and posteriorly as the posterior superior iliac spine. The
an expanded bony ring inferiorly, which surrounds a large obtura- crest and anterior spine can be felt and even seen in thin individu-
tor (ob⬘too-rā-tŏr; to occlude or close up, indicating that the fora- als (figure 7.37). The anterior superior iliac spine is an important
men is occluded by soft tissue) foramen. A fossa called the anatomic landmark that is used, for example, to find the correct lo-
acetabulum (as-ĕ-tab⬘ū-lŭm; a shallow vinegar cup—a common cation for giving injections in the hip muscle. A dimple overlies the
household item in ancient times) is located on the lateral surface posterior superior iliac spine just superior to the buttocks. The
greater ischiadic (is-kē-ad⬘ik; formerly called sciatic) notch is on
the posterior side of the ilium, just inferior to the inferior posterior
iliac spine. The ischiadic nerve passes through the greater ischiadic
notch. The articular surface of the ilium joins the sacrum to form
the sacroiliac joint (see figure 7.35). The medial side of the ilium
consists of a large depression called the iliac fossa.
Coxa
The Sacroiliac Joint
The sacroiliac joint receives most of the weight of the upper body and is
strongly supported by ligaments. Excessive strain on the joint, however,
can cause slight joint movement and can stretch connective tissue and
associated nerve endings in the area and cause pain. Thus is derived the
expression, “My aching sacroiliac!” This problem sometimes develops in
pregnant women because of the forward weight distribution of the fetus.
Femur
The ischium possesses a heavy ischial (is⬘kē-ăl) tuberosity,
where posterior thigh muscles attach and on which a person sits
(see figure 7.36b). The pubis possesses a pubic crest, where
abdominal muscles attach (see figure 7.36c). The pubic crest can be
Patella felt anteriorly. Just inferior to the pubic crest is the point of junc-
tion, the symphysis (sim⬘fi-sis; a coming together) pubis, or pu-
bic symphysis, between the two coxae (see figure 7.35).
The pelvis can be thought of as having two parts divided by
Tibia an imaginary plane passing from the sacral promontory along the
iliopectineal lines of the ilium to the pubic crest (figure 7.38). The
bony boundary of this plane is the pelvic brim. The false, or
greater, pelvis is superior to the pelvic brim and is partially sur-
Fibula
rounded by bone on the posterior and lateral sides. During life, the
abdominal muscles form the anterior wall of the false pelvis. The
true pelvis is inferior to the pelvic brim and is completely sur-
Tarsals rounded by bone. The superior opening of the true pelvis, at the
level of the pelvic brim, is the pelvic inlet. The inferior opening of
Metatarsals
the true pelvis, bordered by the inferior margin of the pubis, the is-
Phalanges
chial spines and tuberosities, and the coccyx, is the pelvic outlet
Figure 7.34 Bones of the Pelvic Girdle and Right Lower Limb (see figure 7.38c).
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Chapter 7 Skeletal System: Gross Anatomy 231

Sacrum Sacral promontory

Sacroiliac joint

Ilium
Anterior superior
iliac spine

Coxa
Pubis
Acetabulum
Symphysis pubis
Obturator Ischium
foramen

Subpubic angle

Figure 7.35 Anterior View of the Pelvis

Ilium
Figure 7.36 Coxa
(a) Right coxa of a growing child. Each coxa is formed by fusion of the
ilium, ischium, and pubis. The three bones can be seen joining near the
center of the acetabulum, separated by lines of cartilage. (b) Right coxa,
lateral view. (c) Right coxa, medial view.

Cartilage in
Acetabulum young pelvis
Pubis

Ischium Obturator
foramen
(a)

Iliac crest
Ilium Articular surface
(point of
Iliac fossa articulation
Anterior superior with sacrum)
iliac spine
Posterior superior
Posterior iliac spine
Anterior inferior
superior
iliac spine
iliac spine Posterior inferior
Lunate surface iliac spine
Posterior inferior Iliopectineal line Greater ischiadic
iliac spine Acetabulum (sciatic) notch
Greater ischiadic Superior pubic ramus Ischium
(sciatic) notch
Pubic crest Ischial spine
Ischial spine
Inferior pubic ramus Lesser ischiadic
(sciatic) notch
Symphysis pubis
Lesser ischiadic Acetabular notch Pubis
(sciatic) notch
Obturator foramen Ischial ramus
Ischial tuberosity Ischial ramus
(b) (c)
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232 Part 2 Support and Movement

Comparison of the Male and Female Pelvis

The male pelvis usually is more massive than the female pelvis as a
Iliac result of the greater weight and size of the male, and the female
crest
Anterior pelvis is broader and has a larger, more rounded pelvic inlet and
inferior outlet (see figure 7.38a and b), consistent with the need to allow the
iliac spine
Anterior fetus to pass through these openings in the female pelvis during
superior delivery. Table 7.8 lists additional differences between the male and
iliac
Greater spine female pelvis.
trochanter
Pelvic Outlet and Birth
A wide circular pelvic inlet and a pelvic outlet with widely spaced ischial
spines are ideal for delivery. Variation from this ideal can cause
Figure 7.37 Surface Anatomy Showing an Anterior View of
the Hipbones problems during delivery; thus the size of the pelvic inlet and outlet is
routinely measured during prenatal pelvic examinations of pregnant
women. If the pelvic outlet is too small for normal delivery, delivery can
be accomplished by cesarean section, which is the surgical removal of
the fetus through the abdominal wall.

27. Define the terms pelvic girdle and pelvis. What bones fuse
to form each coxa? Where and with what bones do the
coxae articulate?
28. Name the important sites of muscle attachment on the
pelvis.
29. Distinguish between the true pelvis and the false pelvis.
30. Describe the differences between a male and a female
pelvis.

Sacral
Pelvic promontory Ischial
inlet spine
Pelvic Pelvic
(red outlet
brim
dashed (blue
line) Coccyx
dashed
Symphysis
line)
pubis Symphysis
pubis
Subpubic angle
(a) Male (b) Female

Sacral
promontory
Figure 7.38 Comparison of the Male and Female Pelvis Pelvic
(a) Male. The pelvic inlet (red dashed line) and outlet (blue dashed line) are brim Pelvic inlet
small, and the subpubic angle is less than 90 degrees. (b) Female. The pelvic
inlet (red dashed line) and outlet (blue dashed line) are larger, and the
subpubic angle is 90 degrees or greater. (c) Midsagittal section through the Coccyx
pelvis to show the pelvic inlet (red arrow and red dashed line) and outlet (blue Pelvic outlet
arrow and blue dashed line). (c)
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Chapter 7 Skeletal System: Gross Anatomy 233

Thigh
Table 7.8 Differences Between the Male and The thigh, like the arm, contains a single bone, which is called
Female Pelvis (see figure 7.38) the femur. The femur has a prominent rounded head, where it
Area Description articulates with the acetabulum, and a well-defined neck; both
are located at an oblique angle to the shaft of the femur (figure
General The female pelvis is somewhat lighter in weight
and wider laterally but shorter superiorly
7.39). The proximal shaft exhibits two tuberosities: a greater
to inferiorly and less funnel-shaped; less trochanter (trō-kan⬘ter; runner) lateral to the neck and a
obvious muscle attachment points exist in smaller, or lesser, trochanter inferior and posterior to the neck.
females than in males Both trochanters are attachment sites for muscles that fasten the
Sacrum Broader in females with the inferior part hip to the thigh. The greater trochanter and its attached muscles
directed more posteriorly; the sacral form a bulge that can be seen as the widest part of the hips (see
promontory does not project as far
figure 7.37). The distal end of the femur has medial and lateral
anteriorly in the female
condyles, smooth, rounded surfaces that articulate with the
Pelvic inlet Heart-shaped in males; oval in females
tibia. Located proximally to the condyles are the medial and
Pelvic outlet Broader and more shallow in females
lateral epicondyles, important sites of ligament attachment.
Subpubic angle Less than 90 degrees in males; 90 degrees or
more in females P R E D I C T
Ilium More shallow and flared laterally in females Compare the following in terms of structure and function for the upper
Ischial spines Farther apart in females and lower limbs: depth of sockets, size of bones, and size of tubercles
Ischial tuberosities Turned laterally in females and medially in and trochanters. What is the significance of these differences?
males

Head
Head
Fovea
capitis Greater trochanter
Greater trochanter
Neck
Neck
Intertrochanteric line Intertrochanteric crest
Lesser trochanter

Pectineal line
Gluteal tuberosity

Linea aspera

Body (shaft) of femur

Medial
epicondyle
Lateral epicondyle

Lateral epicondyle Intercondylar fossa

Medial Lateral condyle
condyle
Patellar groove

(a) (b)

Figure 7.39 Right Femur

(a) Anterior view. (b) Posterior view.
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234 Part 2 Support and Movement

Intercondylar
eminence

Anterior Lateral Medial

surface condyle condyle
Head Tibial
tuberosity
(a)

Posterior
surface
Anterior
Medial Lateral crest
facet facet
Fibula
Tibia
(b)

Figure 7.40 Right Patella

(a) Anterior view. (b) Posterior view.

The patella, or kneecap, is a large sesamoid bone located

within the tendon of the quadriceps femoris muscle group, which
is the major muscle group of the anterior thigh (figure 7.40). The
Lateral Medial
patella articulates with the patellar groove of the femur to create a malleolus malleolus
smooth articular surface over the anterior distal end of the femur.
The patella holds the tendon away from the distal end of the femur
and therefore changes the angle of the tendon between the Figure 7.41 Right Tibia and Fibula, Anterior View
quadriceps femoris muscle and the tibia, where the tendon
attaches. This change in angle increases the force that can be Medial epicondyle of femur
applied from the muscle to the tibia. As the result of this increase
in applied force, less muscle contraction force is required to move
the tibia.
Head of fibula
Patellar Defects Patella
If the patella is severely fractured, the tendon from the quadriceps
Tibial tuberosity
femoris muscle group may be torn, resulting in a severe decrease in Calcaneus
muscle function. In extreme cases, it may be necessary to remove the Anterior crest
patella to repair the tendon. Removal of the patella results in a decrease of tibia
Lateral epicondyle
in the amount of power the quadriceps femoris muscle can generate at
of femur
the tibia.
Lateral
The patella normally tracks in the patellar groove on the anterodistal malleolus
end of the femur. Abnormal tracking of the patella can become a problem in Medial malleolus
some teenagers, especially females. As the young woman’s hips widen
during puberty, the angles at the joints between the hips and the tibia may
change considerably. As the knee becomes located more medially relative Figure 7.42 Surface Anatomy Showing Bones of the
to the hip, the patella may be forced to track more laterally than normal. Lower Limb
This lateral tracking may result in pain in the knees of some young athletes.
easily be seen and felt just inferior to the patella (figure 7.42). The
Leg anterior crest forms the shin. The proximal end of the tibia has flat
The leg is the part of the lower limb between the knee and the an- medial and lateral condyles, which articulate with the condyles of
kle. Like the forearm, it consists of two bones: the tibia (tib⬘ē-ă; or the femur. Located between the condyles is the intercondylar em-
shinbone) and the fibula (fib⬘ū-lă; resembling a clasp or buckle; inence, which is a ridge between the two articular surfaces of the
figure 7.41). The tibia is by far the larger of the two and supports proximal tibia. The distal end of the tibia is enlarged to form the
most of the weight of the leg. A tibial tuberosity, which is the at- medial malleolus (ma-lē⬘ō-lŭs; mallet-shaped), which helps form
tachment point for the quadriceps femoris muscle group, can the medial side of the ankle joint.
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Chapter 7 Skeletal System: Gross Anatomy 235

The fibula does not articulate with the femur but has a small Foot
proximal head where it articulates with the tibia. The distal end of The proximal portion of the foot consists of seven tarsal
the fibula is slightly enlarged as the lateral malleolus to create the (tar⬘să l; the sole of the foot) bones, which are depicted and
lateral wall of the ankle joint. The lateral and medial malleoli can named in figure 7.43. The talus (tā⬘lŭs; ankle bone), or ankle
be felt and seen as prominent lumps on either side of the ankle (see bone, articulates with the tibia and the fibula to form the ankle
figure 7.42). The thinnest, weakest portion of the fibula is just joint. The calcaneus (kal-kā⬘nē-us; heel) is located inferior to
proximal to the lateral malleolus. the talus and supports that bone. The calcaneus protrudes poste-
P R E D I C T
riorly where the calf muscles attach to it and where it can be eas-
Explain why modern ski boots are designed with high tops that extend ily felt as the heel of the foot. The proximal foot is relatively
partway up the leg.
much larger than the wrist.

Calcaneus

Talus
Tarsals
Cuboid

Navicular

Medial cuneiform
Intermediate cuneiform
Metatarsals
5 Lateral cuneiform
4
3 2 1

Proximal phalanx
Digits
Middle phalanx
Distal phalanx Proximal phalanx
of great toe

Distal phalanx
of great toe
(a)

Fibula

Talus Tibia
Navicular
Intermediate cuneiform
Talus
Medial cuneiform

Cuboid Calcaneus

(b) Phalanges Metatarsals Tarsals

Figure 7.43 Bones of the Right Foot

(a) Dorsal view. (b) Medial view.
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236 Part 2 Support and Movement

Distal Proximal Medial

phalynx phalanx First longitudinal
of great toe of great toe metatarsal arch Medial cuneiform Navicular Talus

Distal Middle Proximal Lateral Fifth Transverse Cuboid Calcaneus

phalynx phalynx phalynx longitudinal metatarsal arch
of fifth of fifth of fifth arch
toe toe toe

Figure 7.44 Arches (arrows) of the Right Foot

The medial longitudinal arch is formed by the calcaneus, talus, navicular, cuneiforms, and three medial metatarsals. The lateral longitudinal arch is formed by the
calcaneus, cuboid, and two lateral metatarsals. The transverse arch is formed by the cuboid and cuneiforms.

The metatarsals and phalanges of the foot are arranged in a when a person with wet, bare feet walks across a dry surface; the
manner very similar to that of the metacarpals and phalanges of print of the heel, the lateral border of the foot, and the ball of the
the hand, with the great toe analogous to the thumb (see figure foot can be seen, but the middle of the plantar surface and the me-
7.43a). Small sesamoid bones often form in the tendons of muscles dial border leave no impression. The medial side leaves no mark
attached to the great toe. The ball of the foot is the junction be- because the arches on this side of the foot are higher than those on
tween the metatarsals and phalanges. The foot as a unit is convex the lateral side. The shape of the arches is maintained by the
dorsally and concave ventrally to form the arches of the foot (de- configuration of the bones, the ligaments connecting them, and the
scribed more fully in chapter 8). muscles acting on the foot.
P R E D I C T 31. What is the function of the greater trochanter and the lesser
A decubitus ulcer is a chronic ulcer that appears in pressure areas of skin trochanter?
overlying a bony prominence in bedridden or otherwise immobilized 32. Describe the function of the patella.
patients. Where are likely sites for decubitus ulcers to occur? 33. Name the bones of the leg.
34. Give the points of articulation between the pelvis, femur,
Arches of the Foot
leg, and ankle.
The foot has three major arches that distribute the weight of the
35. What is the function of the tibial tuberosity?
body between the heel and the ball of the foot during standing and
36. Name the seven tarsal bones. Which bones form the ankle
walking (figure 7.44). As the foot is placed on the ground, weight is
joint? What bone forms the heel?
transferred from the tibia and the fibula to the talus. From there,
37. Describe the bones of the foot. How many phalanges are in
the weight is distributed first to the heel (calcaneus) and then
each toe?
through the arch system along the lateral side of the foot to the ball
of the foot (head of the metatarsals). This effect can be observed
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Chapter 7 Skeletal System: Gross Anatomy 237

S U M M A R Y

The gross anatomy of the skeletal system considers the features of bone, Hyoid
cartilage, tendons, and ligaments that can be seen without the use of a mi-
croscope. Dried, prepared bones display the major features of bone but The hyoid bone, which “floats” in the neck, is the attachment site for throat
obscure the relationship between bone and soft tissue. and tongue muscles.

General Considerations (p. 198) Vertebral Column

Bones have processes, smooth surfaces, and holes that are associated with 1. The vertebral column provides flexible support and protects the
ligaments, muscles, joints, nerves, and blood vessels. spinal cord.
2. The vertebral column has four major curvatures: cervical, thoracic,
Axial Skeleton (p. 200) lumbar, and sacral/coccygeal. Abnormal curvatures are lordosis
(lumbar), kyphosis (thoracic), and scoliosis (lateral).
The axial skeleton consists of the skull, hyoid bone, vertebral column, and 3. Adjacent bodies are separated by intervertebral disks. The disk has a
thoracic cage. fibrous outer covering (annulus fibrosus) surrounding a gelatinous
Skull interior (nucleus pulposus).
4. A typical vertebra consists of a body, a vertebral arch, and various
1. The skull, or cranium, can be thought of as a single unit. processes.
2. The parietal bones are joined at the midline by the sagittal suture; • Part of the body and the vertebral arch (pedicle and lamina) form
they are joined to the frontal bone by the coronal suture, to the the vertebral foramen, which contains and protects the spinal
occipital bone by the lambdoid suture, and to the temporal bone by cord.
the squamous suture. • Spinal nerves exit through the intervertebral foramina.
3. Nuchal lines are the points of attachment for neck muscles. • The transverse and spinous processes serve as points of muscle
4. Several skull features are seen from a lateral view. and ligament attachment.
• The external auditory meatus transmits sound waves toward the • Vertebrae articulate with one another through the superior and
eardrum. inferior articular processes.
• Important neck muscles attach to the mastoid process. 5. Several types of vertebrae can be distinguished.
• The temporal lines are attachment points of the temporalis • All seven cervical vertebrae have transverse foramina, and most
muscle. have bifid spinous processes.
• The zygomatic arch, from the temporal and zygomatic bones, • The 12 thoracic vertebrae are characterized by long, downward-
forms a bridge across the side of the skull. pointing spinous processes and demifacets.
5. Several skull features are seen from a frontal view. • The five lumbar vertebrae have thick, heavy bodies and processes.
• The orbits contain the eyes. • The sacrum consists of five fused vertebrae and attaches to the
• The nasal cavity is divided by the nasal septum, and the hard coxae to form the pelvis.
palate separates the nasal cavity from the oral cavity. • The coccyx consists of four fused vertebrae attached to the
• Sinuses within bone are air-filled cavities. The paranasal sinuses, sacrum.
which connect to the nasal cavity, are the frontal, ethmoidal,
sphenoidal, and maxillary sinuses. Thoracic Cage
• The mandible articulates with the temporal bone. 1. The thoracic cage (consisting of the ribs, their associated costal
6. Several skull features are seen inside the cranial cavity. cartilages, and the sternum) functions to protect the thoracic
• The crista galli is a point of attachment for one of the meninges. organs and changes volume during respiration.
• The olfactory nerves extend into the roof of the nasal cavity 2. Twelve pairs of ribs attach to the thoracic vertebrae. They are
through the cribriform plate. divided into seven pairs of true ribs and five pairs of false ribs. Two
• The sella turcica is occupied by the pituitary gland. pairs of false ribs are floating ribs.
• The spinal cord and brain are connected through the foramen 3. The sternum is composed of the manubrium, the body, and the
magnum. xiphoid process.
7. Several features are seen on the inferior surface of the skull.
• Occipital condyles are points of articulation between the skull and Appendicular Skeleton (p. 225)
the vertebral column.
The appendicular skeleton consists of the upper and lower limbs and the
• Blood reaches the brain through the internal carotid arteries,
girdles that attach the limbs to the body.
which pass through the carotid canals, and the vertebral arteries,
which pass through the foramen magnum. Pectoral Girdle and Upper Limb
• Most blood leaves the brain through the internal jugular veins,
which exit through the jugular foramina. 1. The upper limb is attached loosely and functions in grasping and
• Styloid processes provide attachment points for three muscles manipulation.
involved in movement of the tongue, hyoid bone, and pharynx. 2. The pectoral girdle consists of the scapulae and clavicles.
• The hard palate forms the floor of the nasal cavity. • The scapula articulates with the humerus and the clavicle. It serves
8. The skull is composed of 22 bones. as an attachment site for shoulder, back, and arm muscles.
• The auditory ossicles, which function in hearing, are located inside • The clavicle holds the shoulder away from the body, permitting
the temporal bones. free movement of the arm.
• The braincase protects the brain. 3. The arm bone is the humerus.
• The facial bones protect the sensory organs of the head and • The humerus articulates with the scapula (head), the radius
function as muscle attachment sites (mastication, facial (capitulum), and the ulna (trochlea).
expression, and eye muscles). • Sites of muscle attachment are the greater and lesser tubercles, the
• The mandible and maxillae possess alveolar processes with sockets deltoid tuberosity, and the epicondyles.
for the attachment of the teeth.
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238 Part 2 Support and Movement

4. The forearm contains the ulna and radius. 3. The thigh bone is the femur.
• The ulna and the radius articulate with each other and with the • The femur articulates with the coxa (head), the tibia (medial and
humerus and the wrist bones. lateral condyles), and the patella (patellar groove).
• The wrist ligaments attach to the styloid processes of the radius • Sites of muscle attachment are the greater and lesser trochanters.
and the ulna. • Sites of ligament attachment are the lateral and medial
5. Eight carpal, or wrist, bones are arranged in two rows. epicondyles.
6. The hand consists of five metacarpal bones. 4. The leg consists of the tibia and the fibula.
7. The phalanges are digital bones. Each finger has three phalanges, • The tibia articulates with the femur, the fibula, and the talus. The
and the thumb has two phalanges. fibula articulates with the tibia and the talus.
• Tendons from the thigh muscles attach to the tibial tuberosity.
Pelvic Girdle and Lower Limb 5. Seven tarsal bones form the proximal portion of the foot.
1. The lower limb is attached solidly to the coxa and functions in 6. The foot consists of five metatarsal bones.
support and movement. 7. The toes have three phalanges each, except for the big toe, which has
two.
2. The pelvic girdle consists of the right and left coxae. Each coxa is 8. The bony arches transfer weight from the heels to the toes and allow
formed by the fusion of the ilium, the ischium, and the pubis. the foot to conform to many different positions.
• The coxae articulate with each other (symphysis pubis) and with
the sacrum (sacroiliac joint) and the femur (acetabulum).
• Important sites of muscle attachment are the iliac crest, the iliac
spines, and the ischial tuberosity.
• The female pelvis has a larger pelvic inlet and outlet than the male
pelvis.

R E V I E W A N D C O M P R E H E N S I O N

1. Which of these is part of the appendicular skeleton? 7. The mandible articulates with the skull at the
a. cranium a. styloid process.
b. ribs b. occipital condyle.
c. clavicle c. mandibular fossa.
d. sternum d. zygomatic arch.
e. vertebra e. medial pterygoid.
2. A knoblike lump on a bone is called a 8. The nerves for the sense of smell pass through the
a. spine. a. cribriform plate.
b. facet. b. nasolacrimal canal.
c. tuberosity. c. internal auditory meatus.
d. sulcus. d. optic foramen.
e. ramus. e. orbital fissure.
3. The superior and middle nasal conchae are formed by projections of 9. The major blood supply to the brain enters through the
the a. foramen magnum.
a. sphenoid bone. b. carotid canals.
b. vomer bone. c. jugular foramina.
c. palatine process of maxillae. d. both a and b.
d. palatine bone. e. all of the above.
e. ethmoid bone. 10. The site of the sella turcica is the
4. The crista galli a. sphenoid bone.
a. separates the nasal cavity into two parts. b. maxillae.
b. attaches the hyoid bone to the skull. c. frontal bone.
c. holds the pituitary gland. d. ethmoid bone.
d. is an attachment site for the membranes that surround the brain. e. temporal bone.
e. is a passageway for blood vessels. 11. Which of these bones is not in contact with the sphenoid bone?
5. The perpendicular plate of the ethmoid and the a. maxilla
form the nasal septum. b. inferior nasal concha
a. palatine process of the maxilla c. ethmoid
b. horizontal plate of the palatine d. parietal
c. vomer e. vomer
d. nasal bone 12. Which of these statements about vertebral column curvature is not
e. lacrimal bone true?
6. Which of these bones does not contain a paranasal sinus? a. The cervical curvature develops before birth.
a. ethmoid b. The thoracic curvature becomes exaggerated in kyphosis.
b. sphenoid c. The lumbar curvature becomes exaggerated in lordosis.
c. frontal d. The sacral curvature develops before birth.
d. temporal e. The lumbar curvature develops as an infant learns to sit and walk.
e. maxilla
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Sixth Edition

Chapter 7 Skeletal System: Gross Anatomy 239

13. A herniated disk occurs when 23. Which of these parts of the upper limb are not correctly matched
a. the annulus fibrosus ruptures. with the number of bones in that part?
b. the intervertebral disk slips out of place. a. arm: 1
c. the spinal cord ruptures. b. forearm: 2
d. too much fluid builds up in the nucleus pulposus. c. wrist: 10
e. all of the above. d. palm of hand: 5
14. The weight-bearing portion of a vertebra is the e. fingers: 14
a. vertebral arch. 24. The ankle bone that the tibia rests upon is the
b. articular process. a. talus.
c. body. b. calcaneus.
d. transverse process. c. metatarsals.
e. spinous process. d. navicular.
15. Transverse foramina are found only in e. phalanges.
a. cervical vertebrae. 25. A place where nerves or blood vessels pass from the trunk to the
b. thoracic vertebrae. lower limb is the
c. lumbar vertebrae. a. obturator foramen.
d. the sacrum. b. greater ischiadic (sciatic) notch.
e. the coccyx. c. ischial tuberosity.
16. Articular facets on the bodies and transverse processes are found d. iliac crest.
only on e. pubis symphysis.
a. cervical vertebrae. 26. A projection on the pelvic girdle that is used as a landmark for
b. thoracic vertebrae. finding an injection site is the
c. lumbar vertebrae. a. ischial tuberosity.
d. the sacrum. b. iliac crest.
e. the coccyx. c. anterior superior iliac spine.
17. Medially facing, superior articular processes and laterally facing, d. posterior inferior iliac spine.
inferior articular processes are found on e. ischial spine.
a. cervical vertebrae. 27. When comparing the pectoral girdle to the pelvic girdle, which of
b. thoracic vertebrae. these statements is true?
c. lumbar vertebrae. a. The pectoral girdle has greater mass than the pelvic girdle.
d. the sacrum. b. The pelvic girdle is more firmly attached to the body than the
e. the coccyx. pectoral girdle.
18. Which of these statements concerning ribs is true? c. The pectoral girdle has the limbs more securely attached than the
a. The true ribs attach directly to the sternum with costal cartilage. pelvic girdle.
b. There are five pairs of floating ribs. d. The pelvic girdle allows greater mobility than the pectoral girdle.
c. The head of the rib attaches to the transverse process of the vertebra. 28. When comparing a male pelvis to a female pelvis, which of these
d. Vertebrochondral ribs are classified as true ribs. statements is true?
e. Floating ribs do not attach to vertebrae. a. The pelvic inlet in males is larger and more circular.
19. The point where the scapula and clavicle connect is the b. The subpubic angle in females is less than 90 degrees.
a. coracoid process. c. The ischial spines in males are closer together.
b. styloid process. d. The sacrum in males is broader and less curved.
c. glenoid fossa. 29. A site of muscle attachment on the proximal end of the femur is the
d. acromion process. a. greater trochanter.
e. capitulum. b. epicondyle.
20. The distal medial process of the humerus to which the ulna joins is the c. greater tubercle.
a. epicondyle. d. intercondylar eminence.
b. deltoid tuberosity. e. condyle.
c. malleolus. 30. A process that forms the outer ankle is the lateral
d. capitulum. a. malleolus.
e. trochlea b. condyle.
21. The depression on the anterior surface of the humerus that receives c. epicondyle.
part of the ulna when the forearm is flexed (bent) is the d. tuberosity.
a. glenoid fossa. e. tubercle.
b. capitulum.
Answers in Appendix F
c. coronoid fossa.
d. olecranon fossa.
e. radial fossa.
22. Which of these is not a point of muscle attachment on the pectoral
girdle or upper limb?
a. epicondyles
b. mastoid process
c. radial tuberosity
d. spine of scapula
e. greater tubercle
 Seeley−Stephens−Tate: II. Support and Movement 7. Skeletal System: Gross © The McGraw−Hill
Anatomy and Physiology, Anatomy Companies, 2004
Sixth Edition

240 Part 2 Support and Movement

C R I T I C A L T H I N K I N G

1. A patient has an infection in the nasal cavity. Name seven adjacent 7. A paraplegic individual develops decubitus ulcers (pressure sores)
structures to which the infection could spread. on the buttocks from sitting in a wheelchair for extended periods.
2. A patient is unconscious. Radiographic films reveal that the Name the bony protuberance responsible.
superior articular process of the atlas has been fractured. Which of 8. Why are women knock-kneed more often than men?
the following could have produced this condition: falling on the top 9. On the basis of bone structure of the lower limb, explain why it’s
of the head or being hit in the jaw with an uppercut? Explain. easier to turn the foot medially (sole of the foot facing toward the
3. If the vertebral column is forcefully rotated, what part of the midline of the body) than laterally. Why is it easier to cock the wrist
vertebra is most likely to be damaged? In what area of the vertebral medially than laterally?
column is such damage most likely? 10. Justin Time leaped from his hotel room to avoid burning to death in
4. An asymmetric weakness of the back muscles can produce which of a fire. If he landed on his heels, what bone was he likely to fracture?
the following: scoliosis, kyphosis, or lordosis? Which could result Unfortunately for Justin, a 240 lb fire fighter, Hefty Stomper, ran by
from pregnancy? Explain. and stepped heavily on the proximal part of Justin’s foot (not the
5. What might be the consequences of a broken forearm involving toes). What bones could now be broken?
both the ulna and radius when the ulna and radius fuse to each
Answers in Appendix G
other during repair of the fracture?
6. Suppose you need to compare the length of one lower limb to the
other in an individual. Using bony landmarks, suggest an easy way
to accomplish the measurements.

A N S W E R S T O P R E D I C T Q U E S T I O N S

1. The sagittal suture is so named because it is in line with the 7. The depth of the hip socket is deeper, the bone is more massive, and
midsagittal plane of the head. The coronal suture is so named the tubercles are larger than similar structures in the upper limb. All
because it is in line with the coronal plane (see chapter 1). of this correlates with the weight-bearing nature of the lower limb
2. The bones most often broken in a “broken nose” are the nasals, and the more massive muscles necessary for moving the lower limb
ethmoid, vomer, and maxillae. compared to the upper limb.
3. The lumbar vertebrae support a greater weight than the other 8. The top of modern ski boots is placed high up the leg to protect the
vertebrae. The vertebrae are more massive because of the greater weakest point of the fibula and make it less susceptible to great
weight they support. strain during a fall. Modern ski boots are also designed to reduce
ankle mobility, which increases comfort and performance.
4. The anterior support of the scapula is lost with a broken clavicle,
and the shoulder is located more inferiorly and anteriorly than 9. Decubitus ulcers form over bony prominences where the bone is
normal. In addition, since the clavicle normally holds the upper close to the overlying skin and where the body contacts the bed
limb away from the body, the upper limb moves medially and rests when lying down. Such sites are the back and front of the skull and
against the side of the body. the cheeks (over zygomatic bones), the acromion process, scapula,
olecranon process, coccyx, greater trochanter, lateral epicondyle of
5. The olecranon process moves into the olecranon fossa as the elbow femur, patella, and lateral malleolus.
is straightened. The coronoid process moves into the coronoid fossa
as the elbow is bent.
6. The dried skeleton seems to have longer “fingers” than the hand
with soft tissue intact because the soft tissue fills in the space
between the metacarpals. With the soft tissue gone, the metacarpals
seem to be an extension of the fingers, which appear to extend from
the most distal phalanx to the carpals.

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