Applied Anatomy, Physiology and Biomechanics for Physiotherapy Practice.

Major bony landmarks of the skeleton

This background material needs to be practiced regularly to ensure that you are confident and competent in identifying all of the major bony landmarks presented and their importance.

The information in this section is the starting point on which tutors will build over the coming weeks.

As you will need to be able to describe the location of anatomical structures you will need to be able to pronounce all of the new words you find here. It is not unusual while learning a new language to struggle with this. If you are having difficulties please seek out support from one of the module tutors.

Major Bony Landmarks

The pelvis a. The iliac crest forms the distal attachment point for several major muscles of the trunk

b. This anterior surface of the ilium is the iliac fossa which is the proximal attachment point for iliacus one of the flexor muscles of the hip.

The posterior surface of the ilium is the proximal attachment point for all three of the gluteal muscles.

c. Is the anterior superior iliac crest (ASIS). This is easily palpated on most people and is the proximal attachment point of the muscle sartoruis

d. Lying below the ASIS is the anterior inferior iliac crest (AIIS) which forms the proximal attachment point of rectus femoris one of the quadriceps muscle group

e. Is the ischial tuberosity on the posterior aspect of the pelvis. This is the proximal attachment point for the three muscles that make up the hamstring group.

f. Is the pubic tubercle

NB the symphysis pubis is the cartilaginous joint that joins the pelvis anteriorly between the two pubic bones.

g. Is the sacrum which sits between the two ilia to form the large stable sacroiliac joints on the posterior aspect of the pelvis

The 5 lumbar vertebra are stacked above the sacrum. The 5th (L5) has local ligament attachments the sacrum and the ilium

Self Check The Pelvis

Bony Feature Identification of the skeleton Identification on a model Clinical relevance

The iliac crest

The iliac fossa N/A

Anterior superior iliac spine

Anterior inferior iliac spine N/A

Ischial tuberosity

Pubic tubercle

The sacrum

The coccyx

5th lumbar vertebra

Major Bony Features of the Lower Limb 1

The Anterior Femur a. The head of the femur Ball of the hip joint it articulates with the acetabulum of the pelvis. It has a fossa in the middle (fovea capitis)

b. Neck of the femur– Angled to increase the range of movement of the hip– The angle is more acute in women– It is a common site of osteoporosis resulting in a high risk for fracture in fall in

the elderly– It is the distal attachment site of the hip capsule

c. Greater trochantera. The attachment site for the gluteal muscles (Gluteus Maximus, Medius and

minimus

d. Lesser trochantera. The attachment point for the psoas muscles and iliacus

Inter-trochanteric line passes across the anterior surface between the two trochanters. It is the site of the distal attachment of the iliofemoral ligament of the hip

e Lateral epicondyle of the distal femur – proximal attachment of the lateral collateral ligament of the knee

f Medial epicondyle of the distal femur – proximal attachment of the medial collateral ligament of the knee

g Adductor tubercle on the superior part of the medical epicondyle– the distal attachment point of the adductor magnus muscle

d

Self Check: Femur

Bony Feature Identified on the skeleton Identified on a model Clinical relevance

Head of the femurN/A

Neck of the femur N/A

Greater trochanter

Lesser trochanter

N/A

Inter trochanteric line N/A

Lateral epicondyle of the femur

Medial epicondyle of the femur

The adductor tubercle

The Posterior Femur

h The gluteal tuberosity – distal attachment point for the deep fibres of the gluteus maximus

i The intertrochanteric crest

j The linea aspera – this raised ridge running down the posterior aspect of the femur is a site of attachment for several major muscles the quadriceps muscles vastus medialis and vastus lateralis before they wrap round the femur the adductor muscles (adductor magnus, adductor longus and adductor brevis)

the short head of the biceps femoris one of the hamstring muscles

k The lateral and medial supracondylar lines

l The lateral condyle of the femur – articulates with the flattened lateral condyle of the tibia the medial surface of this condyle is the attachment point of the anterior cruciate ligament of the knee

m The medial condyle of the femur – articulates with the flattened medical condyle of the tibia. The lateral surface of this condyle is the attachment point of the posterior cruciate ligament of the knee

n The intercondylar notch

Self Check Femur cont.Bony Feature Identified on the skeleton Identified on a model Clinical relevance

The gluteal tuberosityN/A

Intertrochanteric crest N/A

Linea aspera N/A

Lateral and medial supracondylar lines

N/A

Lateral condyle of the femur

Medial condyle of the femur

The intercondylar notch N/A

Major Bony Features of the Lower Limb 2: The Tibia and fibula

Tibia and Fibula Anterior View

A The tibial spine. The anterior part of the intercondylar ridge (this raised area divides the tibial plateau into the lateral and medial articular surfaces.

This point is also the distal (anterior) attachment of the anterior cruciate ligament

B The lateral condyle of the tibia – distal attachment of the iliotibial band

C The head of the fibula – distal attachment of the lateral collateral ligament of the knee – distal attachment of the biceps femoris muscle (one of the hamstrings)

The superior tibiofibular joint is formed between the medial side head of the fibula and the under surface of the lateral tibial condyle. (This is a synovial plane joint)

D The medial condyle of the tibia – distal attachment site of the medial collateral ligament of the knee

E The tibial tuberosity - this is the distal attachment of the common tendon of the quadriceps (via the patella tendon)

Tibia and Fibula Posterior View

F The soleal line – the proximal attachment of the soleus muscle

G The medial malleolus – proximal attachment point of the ligaments on the medial side of the ankle (talocural) joint

H The lateral margin of the distal tibia – forms the inferior tibiofibular joint with the medial surface of the distal fibula. This is an example of a fibrous joint (syndesmosis)

I The lateral malleolus at the distal end of the fibula – the proximal attachment point of the ligaments on the lateral side of the ankle

Self Check Tibia and FibulaBony Feature Identified on the skeleton Identified on a model Clinical relevance

Tibial Spine and intercondylar ridge

N/A

Lateral condyle of the tibia

Head of the fibula

Medial condyle of the tibia

Tibial tuberosity

The soleal line N/A

The medial malleolus

Lateral margin of the distal tibia

Medial margin of the distal fibula

N/A

The lateral malleolus

Bony Features of the Lower Limb 3: The Foot and Ankle

A. The interosseous membrane connecting the tibia and the fibula centrally. The anterior and posterior surfaces of the interosseous membrane also provide attachment for several muscles of the lower leg.

B. The medial malleolus on the distal end of the tibia. The proximal attachment point of the medial (deltoid) ligament of the ankle.

C. The lateral malleolus on the distal end of the fibula. The proximal attachment point of the lateral ligament complex of the ankle.

D. The talus the arrows indicating the dome of the talus immediately below the tibia and the neck of the talus in front. The talus forms the ankle joint with the tibia and fibula

E. The calcaneus is found under the talus and extends backwards to form the heel. Its posterior surface forms the distal attachment point for the Achilles tendon (of the calf muscles).

F. The navicular

NB the talus and the calcaneus provide the distal attachment points of the lateral ligament complex on the lateral side and the talus calcaneus and navicular provide the distal attachment of the deltoid ligament on the medial side.

G. The cuboid

H. H indicates the three small bones of the midfoot the cuneiforms.

I. Is the base of the 5th metatarsal – the distal attachment point of the peroneus brevis muscle

Self Check Foot and Ankle

Bony Feature Identification of the skeleton Identification on a model Clinical relevance

The interosseous membrane N/A

The medial malleolus

The lateral malleolus

The talus

The calcaneus

The navicular

The cuboid

The cuneiforms

5th Metatarsal

Major Bony Features of the Upper Limb 1:

The Shoulder Complex

A The clavicle the medial end of the clavicle joins with the sternum (at the lateral side of the manubrium) to form the sternoclavicular joint the lateral end of clavicle joints with the acromion process of the scapula to form the acromioclavicular joint

B The scapula. The scapula is an important site of attachment for many muscles so it is important to know the main features. It has three fossa (supra scapular, infra scapular and sub scapular; two borders (lateral and medial) and two angles (superior and inferior). The muscles of the rotator cuff of the glenohumeral joint all have their proximal attachments onto the scapula

C The coracoid process (of the scapula). This small prominent bony point is an attachment point for important ligaments of the acromioclavicular joint and for the proximal attachment of the pectoralis minor muscle

D The acromion process

E The greater tuberosity of the humerus is the distal attachment point of three of the four rotator cuff muscles

F The lesser tuberosity of the humerus is the distal attachment of the subscapularis muscle of the rotator cuff

G The deltoid tuberosity of the humerus is the distal attachment point of the powerful deltoid muscle

Between the greater and lesser tuberosity we find the interbubercular grove sometimes called the bicipital groove as the tendon of part of the biceps passes through the groove on its way to its proximal attachment

G

Self Check: Shoulder GirdleBony Feature Identified on the skeleton Identified on a model Clinical relevance

Stenoclavicular joint

Acromioclavicular joint

Scapula fossaSupra scapularInfrascapular subscapular

NA

Scapula borders (lateral, medial)

Scapula angles (superior, inferior)

Inferior only

The coracoid process

The acromion process

Greater tuberosity (tubercle)

Lesser tuberosity (tubercle)

Intertubercular (bicipital) groove

Major Bony Landmarks of the Upper Limb 2 The Elbow (Anterior View) The elbow is formed by the distal end of the humeus and the proximal end of

the radius on the lateral side and the ulna on the medial side.NB To help you orientate the thumb is on the lateral side

a. The lateral epicondyle of the distal humerus. This is the proximal attachment point for a group of tendons called the common extensor origin.

b. The capitulum on the distal surface of the humerus that articulates with c the head of the radius.

c. Is the head of the radius which articulates with the capitulum above and also with the proximal ulna to form the superior radio ulnar joint. (The superior radioulnar joint is one of only two pivot joints in the body).

d. Is the radial tubercle which forms the distal attachment point of the biceps brachii muscle

e. Medial epicondyle of the distal humerus. This is the proximal attachment point of a group of tendons called the common flexor origin

f. Is the trochlea of the distal humerus. The trochlea articulates with the trochlea notch on the proximal end of the ulna.

g. If the coranoid process on the proximal anterior ulna. It is the distal attachment point of the brachialis muscle.

h. Is the coronoid fossa. When the elbow is fully flexed the coronoid process of the ulna is moved into this space.

Self Check: Elbow

Bony Feature Identified on the skeleton Identified on a model Clinical relevance

Lateral epicondyle

Capitulum of the humerus N/A

Head of the radius

Radial Tubercle N/A

Medial epicondyle

Trochlea of the humerus N/A

Coranoid process N/A

Cononoid fossa N/A

Elbow Posterior view

a. The lateral supracondylar ridge of the distal humerus

b. The medial supracondylar ridge of the distal humerus

c. Lateral epicondyle of the distal humerus

d. Medial epicondyle of the distal humerus

Indicates the position of the ulna nerve as it passes from the upper arm and in to the forearm. If you palpate into the space just below the medial epicondyle you will be able to feel the nerve. It may even make your little finger tingle.

e. Olecranon process of the proximal ulna. This is the distal attachment point of the triceps muscle group

f. The olecranon fossa on the distal humerus. In full extension of the elbow the olecranon process is moved into the olecranon fossa.

Self Check: Elbow cont.

Bony Feature Identified on the skeleton Identified on a model Clinical relevance

Lateral supra condylar ridge

Medial Supra condylar ridge

Medial epicondyle

Ulna nerve

Lateral epicondyle

Olecranon process

Olecranon fossa

Major Bony Features of the Upper limb 3:Forearm, Wrist and Hand

The forearm is made up of the radius and the ulna joined proximally by the superior radioulnar joint and distally by the inferior radioulnar joint.

Movement of these two joints occurs as a single movement. They are responsible for our ability to turn our palm upwards (supination) and downwards (pronation)

Between the shafts of both bones there is an interosseous membrane which helps to hold them together and the provide attachment for muscles.

a. Olecranon process

b. Radial tuberosity

c. Ulna styloid

d. Radial styloid

e. The bones of the proximal and distal carpal rows (known collectively as the carpus)

The curved concave surface of the distal radius and ulna forms the wrist joint with the convex surface of the proximal carpal row.

f. The metacarpals (the metacarpals provide attachment for the small muscles of the hand and thumb)

g. The phalanges (note the fingers all have three phalanx while the thumb has only two)

Self Check: Forearm and Hand

Bony Feature Identified on the skeleton Identified on a model Clinical relevance

Olecranon process

Radial tubercle N/A

Ulna styloid

Radial styloid

Carpal bones

Metacarpals

Phallanges