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SISTEM SISTEM SKELETAL SKELETAL TULANGTULANG & & SENDISENDI

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Functions of the Bones

1. Support (penyokong)

2. Protection (pelindung)

3. Movement (gerakan)

4. Storage (deposit)

5. Hematopoiesis

2 Jenis Tulang

Tulang keras (Compacta)

Tulang berongga (Spongy )

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KLASIFIKASI TULANG

•• Menurut strukturnya:Menurut strukturnya:

1. compact = masa solid; padat & keras

= membentuk lapisan luar struktur tulang

= unit fungsionil --- Sistem Havers

2. cancellous or spongy = berongga

pada tulang bersumsum

= incomplete Sistem Havers

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CLASSIFICATION of BONES

•• Menurut BentukMenurut Bentuk

1.1. Tulang panjang Tulang panjang = = ukuran panjang lebih besar ukuran panjang lebih besar dibanding lebarnyadibanding lebarnya

= = Terdiri Terdiri ((diaphysisdiaphysis) & (epiphysis)) & (epiphysis)

diaphysisdiaphysis = = terisi sumsum kuningterisi sumsum kuning

= = cylindrical, large space or canal at the cylindrical, large space or canal at the centercenter

= = periosteumperiosteum

epiphysis epiphysis = = dibangun oleh jaringan dibangun oleh jaringan cancellouscancellous

e.g.: femur, e.g.: femur, humerushumerus, tibia, fibula, radius, ulna, phalanges, tibia, fibula, radius, ulna, phalanges

MembranesMembranes: : 1. 1. periosteumperiosteum

2. 2. endosteumendosteum

cont’n.

•• Menurut BentuknyaMenurut Bentuknya

2. 2. Tulang pendek Tulang pendek = = bentuk kuboidbentuk kuboid

= = tulang tulang spongy spongy dengan sedikit lapisan tulang dengan sedikit lapisan tulang

keraskeras

= = tulang tulang sesamoidsesamoid ---- tulangnya pendek melekat di tulangnya pendek melekat di

tendotendo e.g.: patellae.g.: patella

e.g.: carpals (wrist), tarsal (ankle) bonese.g.: carpals (wrist), tarsal (ankle) bones

3. 3. Tulang pipih Tulang pipih = = lebarlebar or or pipih panjangpipih panjang

= = proteksi proteksi & & perlekatan ototperlekatan otot

Komposisi Komposisi : 2 : 2 lapisan tipis tulang keras membungkus lapisan tipis tulang keras membungkus

tulang tulang spongyspongy

e.g.: bones of the skull, sternum, ribs, scapulae.g.: bones of the skull, sternum, ribs, scapula

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cont’n.

•• Menurut bentukMenurut bentuk

4. 4. TulangTulangIrregular Irregular = = Yang tidak termasuk 3 Yang tidak termasuk 3

klasifikasi tulang sebelumnyaklasifikasi tulang sebelumnya

e.g.: e.g.: vertebraevertebrae

pelvic bones pelvic bones

bones of the base of the skullbones of the base of the skull

KLASIFIKASI TULANG cont’n.

•• Menurut perkembangannya:Menurut perkembangannya:

1. MembraMembraosaosa = = seperti membran seperti membran fibrofibrosasa,,

calcium gradually deposited until structure calcium gradually deposited until structure

becomes ossified becomes ossified �� intramembranousintramembranous ossificationossification

e.g.: bones of the skull, mandiblee.g.: bones of the skull, mandible

2. 2. CartilagenoCartilagenosasa = starts as cartilage, gradually ossified= starts as cartilage, gradually ossified

enchondralenchondral or or intracartilagenousintracartilagenous ossification.ossification.

e.g.: long bonese.g.: long bones

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CLASSIFICATION of BONES cont’n.

•• Menurut Lokasinya: Menurut Lokasinya:

A X I A LA X I A Lskullskull 2222

hyoidhyoid 11

ossiclesossicles 66

vertebraevertebrae 2626

ribs & sternum ribs & sternum 25_25_

8080

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cont’n.

•• Menurut lokasinya :Menurut lokasinya :

APPENDICULARAPPENDICULARUpper ExtremitiesUpper Extremities Lower ExtremitiesLower Extremities

clavicleclavicle 22 hip bonehip bone 22

scapulaescapulae 22 femurfemur 22

humerushumerus 22 patellapatella 22

radiusradius 22 tibiatibia 22

ulnaulna 22 fibulafibula 22

carpalscarpals 1616 tarsalstarsals 1414

metacarpals 10metacarpals 10 metatarsals metatarsals 1010

phalanges phalanges 28__28__ phalanges phalanges 28__28__

6464 6262

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Fig. 6.10

Table. 6.1

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Table. 6.2

KERANGKA AKSIAL

I.I. TENGKORAKTENGKORAK

= skeleton = skeleton ------ kepalakepala & & wajahwajah

= = pipihpipih & irregular& irregular

= = gabungan berbagai sendigabungan berbagai sendi by joints (sutures)by joints (sutures)

cranium cranium ---- tengkorak non mandibularetengkorak non mandibulare

calvariumcalvarium ---- tengkorak termasuk tulang wajahtengkorak termasuk tulang wajah

cavities:cavities: a. Cranial a. Cranial -- berisi otakberisi otak

b. Orbital b. Orbital -- berisi bola mataberisi bola mata

& organ& organ asesorisasesoris

c. nasalc. nasal

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Fig. 6.11

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Fig. 6.14

Fig. 6.15

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PEMBAGIAN TULANG TENGKORAK

a.a. Cerebral / cranial bones / brain case (8 bones)Cerebral / cranial bones / brain case (8 bones)

unpaired (4)unpaired (4) paired (4)paired (4)

1. occipital1. occipital 1. parietal1. parietal

2. frontal2. frontal 2. temporal2. temporal

3. sphenoid3. sphenoid

4. 4. ethmoidethmoid

b.b. Facial or visceral craniumFacial or visceral cranium

paired (12)paired (12) unpaired (2)unpaired (2)

a. Nasala. Nasal a. a. VomerVomer

b. b. LacrimalLacrimal b. Mandibleb. Mandible

c. Maxillac. Maxilla

d. d. ZygomaticZygomatic / / malarmalar / cheek bones/ cheek bones

e. Palatinee. Palatine

f. Inferior nasal f. Inferior nasal conchaconcha or turbinateor turbinate

The uppermost portion of the human respiratory system, the nose is a The uppermost portion of the human respiratory system, the nose is a The uppermost portion of the human respiratory system, the nose is a The uppermost portion of the human respiratory system, the nose is a hollow air passage that functions in breathing and in the sense of hollow air passage that functions in breathing and in the sense of hollow air passage that functions in breathing and in the sense of hollow air passage that functions in breathing and in the sense of smell. The nasal cavity moistens and warms incoming air, while small smell. The nasal cavity moistens and warms incoming air, while small smell. The nasal cavity moistens and warms incoming air, while small smell. The nasal cavity moistens and warms incoming air, while small hairs and mucus filter out harmful particles and microhairs and mucus filter out harmful particles and microhairs and mucus filter out harmful particles and microhairs and mucus filter out harmful particles and micro----organisms. This organisms. This organisms. This organisms. This illustration depicts the interior of the human nose.illustration depicts the interior of the human nose.illustration depicts the interior of the human nose.illustration depicts the interior of the human nose.

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Fig. 6.13

Fontanelle

= = membran yang mengandung ruangmembran yang mengandung ruang terang untuk terang untuk

newborn infantsnewborn infants

e.g.:e.g.: 1. 1. anterior anterior = largest= largest

2. 2. posterior posterior

3. 3. anterolateralanterolateral ((sphenoidalsphenoidal))

4. 4. posterolateralposterolateral (mastoid)(mastoid)

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Fig. 6.37

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KERANGKA AXIAL

I.I. HYOID BONE HYOID BONE

= = berbentuk Uberbentuk U; ; terletak di bagian depan leherterletak di bagian depan leher

= = perlekatan dasar lidahperlekatan dasar lidah

= = ada diantara ada diantara mandibmandibuullaa & & kartilago kartilago thyroid thyroid

II. II. OSSICLESOSSICLES

= = tulang pada telingantulang pada telingan

a. Stapes (stirrup)a. Stapes (stirrup) 22

b. b. IncusIncus (anvil)(anvil) 22

c. c. MalleusMalleus (hammer)(hammer) 22

Fig. 6.16

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AXIAL SKELETON

I.I. VERTEBRAL COLUMNVERTEBRAL COLUMN

= = panjangpanjang, , kurvekurve, , gerakan sedikitgerakan sedikit

= = persatuan oleh persatuan oleh cartilage & ligamentscartilage & ligaments

= = panjang panjang 71 71 –– 75 cm.75 cm.

= = dibentuk oleh tulangdibentuk oleh tulang----tulangtulang vertebraevertebrae

FUNCTION:FUNCTION:

1.1. penopang badanpenopang badan

2. 2. berisiberisi & & melindungi spinal kord melindungi spinal kord & &

serabut sarafserabut saraf

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VERTEBRAL COLUMNVERTEBRAL COLUMN

Ruas vertebraRuas vertebra youngyoung adultadult

cervicalcervical 77 77

ThoracicThoracic 1212 1212

lumbarlumbar 55 55

sacralsacral 55 1 1

coccygealcoccygeal 4 4 1 1

3333 2626

Diskusb Diskusb IntervertebralIntervertebral = = pipih terdiri pipih terdiri atas atas fibrocartilagefibrocartilage terletak terletak antara permukaan badan antara permukaan badan vertebrtavertebrta

Fungsi Fungsi :: 1. 1. menyambung antar menyambung antar vertebtavertebta

2. 2. bantalan (bantalan ( shock absorbershock absorber))

3. flexibility & g3. flexibility & gerakan erakan kolumna vertebrakolumna vertebra

VERTEBRAL COLUMNVERTEBRAL COLUMN

General parts of vertebraeGeneral parts of vertebrae

1. body1. body 5. transverse process5. transverse process

2. arch2. arch 6. 6. articulararticular processprocess

3. pedicle or root3. pedicle or root 7. 7. spinousspinous processprocess

4. lamina4. lamina 8. spinal or vertebral foramen8. spinal or vertebral foramen

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CiriCiri--ciri bagian tulag vertebraciri bagian tulag vertebra

a. vertebraea. vertebrae servikalservikal (7)(7) = = membentuk kerangka lehermembentuk kerangka leher, , semua meimiliki semua meimiliki fotramenfotramen

atypical vertebraeatypical vertebrae servikalservikal: :

1. atlas 1. atlas ---- 11st st

2. axis or 2. axis or epistropheusepistropheus = 2= 2nd nd

3. 73. 7thth vertebraevertebrae servikalservikal = = spinousspinous process process sempit sempit , , foramen foramen transversus keciltransversus kecil

b. Thoracic vertebrae (12)b. Thoracic vertebrae (12) = = selubung dadaselubung dada-- perlekatan igaperlekatan iga--igaiga

= circular vertebral canal= circular vertebral canal

Special characteristics of individual vertebrae Special characteristics of individual vertebrae cont’ncont’n

c. Lumbar vertebrae (5)c. Lumbar vertebrae (5) = presence of = presence of mamillarymamillary & accessory processes& accessory processes

= triangular vertebral foramen= triangular vertebral foramen

d. Sacrumd. Sacrum = = tulang tulang triangular triangular menghubungan tulang panggulmenghubungan tulang panggul

e. e. CoccygealCoccygeal vertebrae (1)vertebrae (1) = 4 = 4 tulang tulang vertebraevertebrae inkomplit inkomplit

bersatu membentuk ekor /bersatu membentuk ekor /coccyx; triangularcoccyx; triangular

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Fig. 6.17

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Fig. 6.18

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AXIAL SKELETON

I.I. STERNUM (STERNUM (tulang dadatulang dada))

= = tulang pipihtulang pipih, , dinding anterodinding antero--posterior posterior

dinding toraksdinding toraks

= = terdiri atas 2 tulang terdiri atas 2 tulang compact compact dengan lapisan dengan lapisan

tulang tulang spongy spongy mengandung sumsum merah mengandung sumsum merah

BagianBagian--bagiannyabagiannya::

a. a. ManubriumManubrium

b. Corpus or bodyb. Corpus or body

c. c. XiphoidXiphoid processprocess

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AXIAL SKELETON

I.I. IGAIGA--IGAIGA (12 pairs)(12 pairs)

= = tulang pipih dengan lengkung dan 2 ujungtulang pipih dengan lengkung dan 2 ujung

1. vertebral 1. vertebral -- posterior; posterior; perlekatan perlekatan toratoraksks

2. 2. sternalsternal -- anterior; anterior; perlekatan perlekatan costal costal cartilagescartilages

Classification of ribs:Classification of ribs:

a. a. SternalSternal or true ribs (1or true ribs (1stst to 7to 7thth))

-- ribs whose costal cartilages are directly ribs whose costal cartilages are directly

attached to sternumattached to sternum

b. b. AsternalAsternal or false ribs (8or false ribs (8thth to 12to 12thth))

-- ribs whose costal cartilages are not attached ribs whose costal cartilages are not attached

directly to the sternum but to 7directly to the sternum but to 7thth

subdivisions:subdivisions: 1. false rib proper 1. false rib proper -- 88thth, 9, 9thth, 10, 10thth ribsribs

2. floating or hanging ribs 2. floating or hanging ribs –– 1111thth & 12& 12thth

Fig. 6.21

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APPENDICULAR SKELETON

BONES of the UPPER BONES of the UPPER

EXTREMITY (UEEXTREMITY (UE))

11.. Clavicle (collar bone)Clavicle (collar bone)

2.2. Scapula (shoulder Scapula (shoulder

blade) blade) –– articulates with articulates with

humerushumerus & clavicle& clavicle

3.3. HumerusHumerus (arm bone) (arm bone) --

longest & largest longest & largest

bone of UEbone of UE

articulates with articulates with

scapula (above)scapula (above)

radius & ulna radius & ulna

(below)(below)

4.4. Radius Radius -- lateral lateral

bone of the bone of the

forearm; cupforearm; cup--

shaped headshaped head

5.5. Ulna Ulna -- principal principal

bone of the bone of the

forearm; forearm;

longer & larger longer & larger

than radiusthan radius

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APPENDICULAR SKELETON

BONES of the UPPER EXTREMITY BONES of the UPPER EXTREMITY

(UE)(UE) cont’ncont’n

6. 6. Carpals (wrist bone) Carpals (wrist bone) -- 8 8

bones arranged into 2 rowsbones arranged into 2 rows

-- proximal & distal rows proximal & distal rows

7. 7. Metacarpals (bones of the Metacarpals (bones of the

hand) hand) -- 5 long bones 5 long bones

placed between carpals & placed between carpals &

phalangesphalanges

-- numbered from lateral numbered from lateral

to medialto medial

8. 8. Phalanges Phalanges (bones of the (bones of the

fingers) = 14 long bones of fingers) = 14 long bones of

the fingers the fingers ---- 3 bones except 3 bones except

thumb thumb -- 2 bones2 bones

Fig. 6.22

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APPENDICULAR

SKELETON

BONES of the LOWER BONES of the LOWER

EXTREMITY (LE)EXTREMITY (LE)

1. 1. Tulang PANGGULTulang PANGGUL ((innominateinnominate

bone)bone)

Tulang panggul kanan & kiri Tulang panggul kanan & kiri

+ sacrum = + sacrum = lingkar panggullingkar panggul

3 3 bones: bones: 11. . iliumilium**

22. . ischiumischium**

33. pubis*. pubis*

Fig. 6.30

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Male Pelvic Girdle Female Pelvic Girdle

Fig. 6.31

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Fig. 6.32

2. Femur (2. Femur (pahapaha) = ) = paling paling

panjangpanjang, , kuatkuat, , terbesarterbesar

3. Tibia (3. Tibia (tulang keringtulang kering) = ) =

tulang panjangtulang panjang; ;

anterior, medial, & anterior, medial, &

lebih besar dari fibulalebih besar dari fibula

4. Fibula (4. Fibula (peronealperoneal bone) = bone) =

panjang ramping sejajar panjang ramping sejajar

tibia tibia ttp agakttp agak laterallateral

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Fig. 6.34

KERANGKA APPENDICULARTULANG EKSATREMITAS TULANG EKSATREMITAS

BAWAH BAWAH cont’ncont’n

5. 5. TarsalsTarsals (ankle bone) = (ankle bone) =

tulang pendektulang pendek; ;

2 2 barisbaris: : internal internal

& & externalexternal

6. Metatarsals (bones of 6. Metatarsals (bones of

foot) = 5 foot) = 5 tulang tulang

panjang panjang

dihitung dari dihitung dari

medial medial to lateralto lateral

7. Phalanges (bones of 7. Phalanges (bones of

toes) = toes) = tulang jaritulang jari--jarijari

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Fig. 6.35

Common Fracturesgreenstickgreenstickgreenstickgreenstick fracturefracturefracturefracture= the bone does not break = the bone does not break = the bone does not break = the bone does not break all of the way through. all of the way through. all of the way through. all of the way through.

simple,simple,simple,simple, or or or or closedclosedclosedclosed= = = = when the bone breaks but when the bone breaks but when the bone breaks but when the bone breaks but the skin does not. the skin does not. the skin does not. the skin does not.

compound,compound,compound,compound, or or or or open open open open = when the broken bone = when the broken bone = when the broken bone = when the broken bone tears through the skin, tears through the skin, tears through the skin, tears through the skin, introducing the dangerous introducing the dangerous introducing the dangerous introducing the dangerous possibility of infection. possibility of infection. possibility of infection. possibility of infection.

The area around a break The area around a break The area around a break The area around a break swells and discolors, but swells and discolors, but swells and discolors, but swells and discolors, but some fractures can be some fractures can be some fractures can be some fractures can be detected only by Xdetected only by Xdetected only by Xdetected only by X----ray. ray. ray. ray.

The weakened bones of the The weakened bones of the The weakened bones of the The weakened bones of the elderly are especially elderly are especially elderly are especially elderly are especially susceptible to fractures.susceptible to fractures.susceptible to fractures.susceptible to fractures.

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Fig. 6B

Fig. 6C

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Bone Deformation

RicketsRicketsRicketsRickets can result from can result from can result from can result from

insufficient vitamin D in the diet insufficient vitamin D in the diet insufficient vitamin D in the diet insufficient vitamin D in the diet

or from insufficient amounts of or from insufficient amounts of or from insufficient amounts of or from insufficient amounts of

ultraviolet radiation from the ultraviolet radiation from the ultraviolet radiation from the ultraviolet radiation from the

sun. sun. sun. sun.

It can lead to skeletal It can lead to skeletal It can lead to skeletal It can lead to skeletal

deformation, such as vertebral deformation, such as vertebral deformation, such as vertebral deformation, such as vertebral

or leg curvature. or leg curvature. or leg curvature. or leg curvature.

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Sendi

• Persambungan/ artikulasio :pertemuan antara dua atau lebihdari tulang rangka.

• Artrologi: ilmu yang mempelajaripersendian.

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3 Jenis Sendi Berdasarkanstrukturnya

• Fibrosa: hubungan antar sendi oleh jaringan fibrosa

• Kartilago/tulang rawan: ruang antar sendinya berikatandengan tulang rawan.

• Sinovial/sinovial joint: ada ruang sendi dan ligament untukmempertahankan persendian.

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Sendi berdasarkan jenispersambungannya

SinartrosisSendi yang terdapat kesinambungan krn di antara

kedua ujung tulang yang bersendi tdp suatujaringan

DiartrosisSendi terdapat ketidak-sinambungan karena di antara

tulang yg bersendi terdapat rongga (cavumarticulare)

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Sinartrosis

1. Syndesmosis: jaringan penghubungnya mrpjaringan ikata. Sutura: tepi-tepi tulang dihubungkan olehjaringan ikat yg tipis. Cth: di antara tulang-tulang tengkorak

b. Schindylesis: lempeng pd tulang yg satuterjepit di dlm celah pada tulang lain. Cthantara rostrum sphenoid & vomer

c. Ghomphosis: tulang yg 1 berbentuk kerucutmasuk ke dalam lekuk yg sesuai dgn bentukitu pd tlng lain.Cth: antara gigi dg rahang

d. Syndesmosis elastica: jar ikatpenghubungnyamrp jar ikat elastin. Cth: di antara arc. Vertebra oleh lig.flavum

e. Syndesmosis fibrosa: jar ikatpenghubungnyamrp serat kolagen. Cth: antara ulna & radius oleh membran interossa antebrachii

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Sinartrosis

2. Synchondrosis: jaringan penghubungnyajaringan tulang rawan. Cth:antara epifisis & diafisis sebelum penulangan selesai, antarakedua ossa pubica

3. Synostosis: jaringan penghubungnyajaringan tulang. Cth: antara epifisis & diafisissetelah penulangan selesai, antara os ilium, os pubis, dan os ischium

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Diartrosis

Pada diartrosis tdp bgn2 sbb:

1. Ujung-ujung tulang yg bersendi: kepala sendi (caput articulare) & lekuk sendi (cavitas glenoidalis)

2. Simpai sendi (capsula articularis): stratum fibrosum (bgn luar) & stratum synoviale(bgn dlm)

3. Rongga sendi (cavum articulare) berisicairan synovial

4. Alat-alat khusus:- tendon: membatasi gerak sendi & sbgpenyokongmekanik- kartilago & bantalan lemak (fat pads): discus & meniscus articulares sbg alat menerimatumbukan, penyangga, & untuk mengurangidiskongruen- kandung sega (bursae mucosae) untukmemudahkangerakan sendi- ligament (accessories, extracapsular, & intracapsularligaments)

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Diartrosis bdskn kemungkinan gerak

1. Sendi kejur (amphiartrosis): kemampuan gerak sangat sedikit-Symphysis; dihubungkan oleh fibrokartilago. Cth: intervertebraldisc, pubic symphysis

2. Articulationes: kemampuan gerak luasa. Sendi sumbu 1(1) sendi engsel/ hinge joint (ginglymus): sumbu gerak tegak lurus

pd arah panjang tulang. Cth: art.interphalangeae, humero-ulnaris

(2) sendi kisar/ pivot joint (art trochoidea): sumbu gerak kira-kirasesuai dgn arah panjang tulang. Cth:

art.radioulnaris,atlantodentalis

b. Sendi sumbu 2: kedua sumbu gerak berpotongan tegak lurus(1) Sendi telur/ ellipsoidal joint (art. Ellipsoidea): kepala sendi

cekungberbentuk ellipsoid dg sumbu panjang & sumbu pendek. Cth: art.radiocarpae

(2) Sendi pelana/saddle joint (art.sellaris): permukaan sendiberbentuk

pelana; arah sumbu yg 1 permukaannya cembung & arah sumbu yg lain cembung. Cth: art.carpo-metacarpea

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Diartrosis bdskn kemungkinan gerak

c. Sendi sumbu 3 (arthroida): kemampuan gerak paling luas; kepala sendi berbentuk bola(1) Sendi peluru/ ball & socket joint (art. Globoidea): lekuk sendi mencakup kurang dari setengah kepala sendi. Cth: art.humeri

(2) Sendi buahpala (enarthrosis spheroidea): lekuk sendi mencakup lebih dari setengah kepala sendi. Cth: art coxae

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Penstabil sendi1. Jaringan kolagen kapsula sendi & ligamen.

2. Bentuk permukaan sendi→menentukan gerakan spesifik sendi

3. Adanya tulang lain, otot rangka, & bantalan lemak pd sendi

4. Tegangan pd tendon yg menempel pd tulang yang bersendi

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Gerakan Sendi

1. Gerakan lurus (linear motion) - gliding

2. Gerakan sudut (angular motion) * fleksi-ekstensi-hiperekstensi* abduksi-adduksi* sirkumduksi

3. Gerakan putar (rotation)* rotasi kanan-kiri* rotasi medial-lateral* pronasi-supinasi

4. Gerakan khusus* inversi-eversi* dorsofleksi-plantar fleksi* opposisi* protraksi-retraksi* elevasi-depresi* fleksi lateral

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Fig. 6.41abcde

Fig. 6.41f

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Goodluck!