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The Coimbra Method: An Entheseal Scoring Workshop at the University of Sheffield, 28th January 2015

18 Jan

The University of Sheffield is playing host to a day-long workshop on the Coimbra method of scoring enthesophytes on the Wednesday 28th of January 2014.  It is a first come first served basis as attendance (at £10 and £5 concessions) is limited, though there are still some places available – you can find out more information and book here.  Dr Charlotte Henderson from the University of Coimbra, is one of the developers of the Coimbra method of recording enthesophytes in human skeletal remains and will be helping to lead the workshop.  The workshop welcomes anyone who works with the skeletal remains of past populations, although it would be particularly suitable for researchers and students involved in biological anthropology or osteoarchaeology.

Enthesophytes, also known as musculoskeletal markers (often abbreviated to MSM), are observable indicators of activity-induced stress on bone, often appearing as bony projections.  They are present on the origin and insertion of muscle on bone in the form of the ossification of the tendon and ligament attachments that help anchor the body of a muscle to the bone itself.  They are often the product of repetitive movements or of a demanding physical lifestyle and, when scored and recorded at a population level with the correct controls in place, can be used to infer as Markers of Occupational Stress (MOS).  This is partly why it is important to become familiar with musculoskeletal anatomy as a human osteologist because the two systems are so entwined in their action.

It should be mentioned here that enthesopathies are distinct from osteophyte formation on, or around, the joints (and not at muscle origins or insertions) which also look like bony projections.  There can also be a presumption in the palaeopathological literature to use the evidence of osteoarthritis alone in skeletal remains as an indicator of a physically demanding lifestyle; this should only be considered when used in conjunction with the observation and the recording of differences in the size of the left and right-side bones, size and location of any enthesophytes present, other pathological lesions, and certain non-metric traits in the individual (Roberts & Connell 2004: 38).

Although well-studied within the osteoarchaeological literature, there are still gaps in the knowledge of the cause of enthesopathies.  Further to this is the fact that rarely are musculoskeletal markers recorded in detail during the initial osteological analysis of archaeological remains. There is also, for instance, ongoing debate regarding the action of disease processes in the forming, or influencing, of both fibrous entheses and fibrocartilaginous entheses, as well as the difference in left and right side prevalence, and the effect of life course changes on enthesophytes (Hawkey 1998, Villotte & Knüsel 2013).  However, there has been a deepening of the understanding of the cause, development and implication of enthesophytes in the human body in the recent osteoarchaeological literature (Villotte et al. 2010).  Particularly regarding the likely multi-factorial influence in the aetiology, or cause, of these physical alterations (Villotte & Knüsel 2013).  New technology, such as 3D photogrammetry, is also helping to produce large databases of comparative material, as well as clearer macro and micro visual images of the anatomical changes present in enthesophytes.

The data scored and documented on individuals can, when analysed at the population level, lead to observations on the physical repetitive movements needed to produce the musculoskeletal markers.  The Coimbra method has started to become a standard within the recording of enthesophytes, although I personally will have to wait until the workshop to learn about this in detail.  Interpretations can thus be made, and hypotheses tested, on the ability in identifying past-activity patterns of archaeological populations.  They can also be used to hypothesize the actual range of active movement during the life of an individual.  Hawkey (1998), for instance, has demonstrated the ability to reproduce possible movement patterns available to a severely disabled individual in a Pre-Colombian context in New Mexico.  Hawkey & Merbs (2005) later used MSM’s to highlight subsistence change within the Hudson Bay Eskimos, noting that different activities could be differentiated via the skeletal anatomy and related changes to stress.

Although this entry is possible a tad late, I will be attending the 1 day long course and will endeavor to produce a blog entry detailing what I learnt during the workshop itself.  As always with this blog, if you or your department are hosting a workshop or a short course in human osteology, biological anthropology or osteoarchaeology, and want to let others know about it, then please feel free to contact me and I’ll help spread the word.

Further Information

  • Details of the 1 day long Coimbra method workshop at the University of Sheffield can be found here.  The university has a well-developed osteology laboratory and Masters program at the Department of Archaeology – you can learn more about the osteoarchaeological research carried out at the University of Sheffield here.
  • The University of Coimbra’s Department of Anthropology hosted an international workshop back in July 2009, titled Musculoskeletal Stress Markers (MSM): Limitations and Achievements in the Reconstruction of Past Activity Patterns, that has proved instrumental in rejuvenating the scientific study of MSM’s.  A full workshop abstract booklet can be found here and Prof. Charlotte Robert’s thought-provoking perspective on 25 years worth of study on MSM’s can be found here.
  • If you have either academic access or subscribe to the International Journal of Osteoarchaeology journal, it helpfully released a special edition in 2013 (Vol 23 (3): 127-251) titled Entheseal Changes and Occupation: Technical and Theoretical Advances and their Applications, which details and summaries the importance of the many recent approaches to MSM’s and OSM’s.  Read it here.


Hawkey, D. E. 1998. Disability, Compassion and the Skeletal Record: using Musculoskeletal Stress Markers (MSM) to Construct an Osteobiography from Early New Mexico. International Journal of Osteoarchaeology. 8 (5): 326-340.

Hawkey, D. E. & Merbs, C. F. 2005. Activity-induced Musculoskeletal Stress markers (MSM) and Subsistence Strategy Changes among Ancient Hudson Bay EskimosInternational Journal of Osteoarchaeology. 5 (4): 324-338.

Roberts, C. & Connell, B. 2004. Guidance on Recording Palaeopathology. In: Brickley, M & McKinley, J. I. (eds.). Guidelines to the Standards for Recording Human Remains. IFA Paper No. 7.  IFA & BABAO. pp 34-39. (Open Access).

Villotte, S., Castex, D., Couallier, V., Dutour, O., Knüsel, C. J. & Henry-Gambier, D. 2010. Enthesopathies as Occupational Stress Markers: Evidence from the Upper Limb. American Journal of Physical Anthropology. 142 (2): 224-234.

Villote, S. & Knüsel, C. J. 2013. Understanding Entheseal Changes: Definition and Life Course Changes. International Journal of Osteoarchaeology. 23 (2): 135-146.

Dental Delights and Disability in Archaeology

26 Mar

I’ve recently had the joy of a dealing with a dental abscess affecting the left hand side of my mandible, and whilst I’m thankful for modern medicine I can only imagine the pain and frustration for pre-modern populations suffering with such an infection, especially those who didn’t have access to antibiotics and strong painkillers.  As such I haven’t posted properly for a while, and it might be a bit longer before I do.  Having had surgery to relieve the effect of the swelling and to drain the infection and remove two pesky teeth (with added complications courtesy of Fibrous Dysplasia), I’m once again learning how to chew (farewell 1st and 3rd left mandibular molars!).  It has also given me the time to think about the role of disability in the archaeological record and how it is approached by modern-day researchers.  What follows below is a very quick and brief overview of the main points of how disability has been approached in the archaeological sector and the changes therein.  Articles of interest are noted in the bibliography.

Dettwyler famously wrote a paper entitled ‘Can paleopathology provide evidence for compassion‘ (1991: 375-384, PDF embedded) that rightly questioned the interpretations of archaeologists and osteologists on the inferred aspects of care and compassion that disabled individuals from the archaeological record may or may not have received during their lifetimes.  The author cautioned that archaeologists and researchers are not ‘justified in drawing conclusions either about quality of life for disabled individuals in the past or attitudes of the rest of the community from skeletal impairment of physical impairment’ (Dettwyler 1991: 375).  This was a much-needed wake up call, and rightly raised questions in the realms of archaeology and palaopathology regarding how we viewed individuals, and how we analysed them.

The majority of disability studies before the Dettwyler (1991) article focused on disabled individuals as case studies, reported in journals and rarely integrated or investigated as part of the society or cemetery population they may belonged to.  Mays (2012) rightly investigated the impact of the relative value of individual case studies compared to quantitative and problem orientated population studies, and found that although the publishing gap had lessened between the two types, singular case studies still predominated.  Mays (2012) main contention is that individual case studies do little to further the advance of palaeopathology, something which Larsen (1997) effectively demonstrates throughout his book and review (2002), in the consideration of how palaeopathology can indicate society or cultural wide rituals, actions or lifestyles.

Since the publication of the Dettwyler paper there has been a slew of articles, journals and books dedicated to researching disability as evidenced from the skeletal and archaeological record, both from a bioarchaeological perspective and from a theory perspective (Battles 2011, Brothwell 2010, Hawkey 1998, Kleinman 1972, Vilos 2011, Wood et al. 1992).  Indeed the study of disability and the implications for affected individuals, their communities and societies, has moved on considerably since the descriptive days of Calvin Wells, especially in the consideration of the theory of ‘compassion’ as an evolutionary force in the primate family (Hublin 2009, Stewart et al. 2012), or as evidenced in other mammals (Fashing & Nyuyen 2011).

This is in accordance with the rise and debate of disability theory and studies in numerous other disciplines.  This has had real life applications in many areas of modern-day life, where multi-agented approaches to understanding,  recognising and implementing programs that are designed to raise awareness or life quality for disabled individuals.  Two prominent examples from the UK are the 2005 Disability Discrimination Act and the 2010 Equality Law where disability itself is given a legal definition, and here we come to a prominent problem in the archaeological and palaeopathological record itself.

Disability, as we would recognise it today, can mean both a physical and/or a mental impairment that can be substantial and lifelong, and it is worth noting some problems inherent in the archaeological record.  Firstly, in the archaeological record, we can only recognise physical disability when it has affected the skeletal remains of individuals, normally at a late and severe stage in the disease progression (Aufderheide & Rodriquez 1998, Waldron 2009, Wood et al. 1992).  As such, a large number of individuals with diseases or traumatic injuries that only affected the flesh will go unknown, and as such are unstudied.  Secondly, there is no universal or standard definition of disability that archaeologists and researchers use, it is solely up to the person/persons to define clearly and openly which definition they are using at the outset of their research (and there are a lot of definitions and models depending on which source you base your definition on).  Thirdly, the usage of terminology itself, such as the very word disability, can have vastly different connotations or implications for different populations and cultures (Battles 2011).

There may have been distinct differences as to who was considered disabled or not in historic and prehistoric cultures, and we should, as researchers, always be aware of observer bias ourselves (Dettwyler 1991).  As such researchers should always be clear who they are addressing, and the possible differences highlighted, where evidence is available, as to how a disabled person was treated within their culture when archaeological or cultural evidence is available.

To complicate the matter further is the ‘osteological paradox‘, as highlighted by Larsen (1997), Woods et al. (1992) and Wright & Yoder (2003) amongst others, which heavily influences the health status of skeletal remains that survive and that are then studied.  Therefore it should always be understood that no skeletal sample is entirely representative of their population, that there are many caveats (Hahn 1995, Roberts 2000).

Battles (2011) highlighted the need to move towards a more holistic approach to disability, to take advantage of different fields (including physical anthropology, sociocultural anthropology, experimental studies and archaeology itself) to understand disability at archaeological sites and affected individuals, to a model that integrates the data and insight of the various fields.  In particular Battles (2011) makes the salient point of noting the individuals  (largely females and sub-adults) that historically have been under-studied in archaeological and population analyses.

An important methodological update has been the advancement of a ‘Bioarchaeology of Care‘, as espoused by Tilley & Oxenham (2011), where a four stage assessment of an individual produces an assessment of the care needed for the disabled individual found in a Neolithic Vietnam community.  The stages are: (1) describing,  diagnosing and documenting the individual and site, (2) identify the clinical/functional impacts of disease or trauma, and determine if care was needed, (3) produce a model of care, and finally (4) interpret the implications for the individual and society, as well as possible indications for the identity and nature of both (Tilly & Oxenham 2011: 36).  It could be argued that other researchers have espoused the same sentiments (Roberts & Manchester 2010, Vilos 2011), but it is the clear initiation of the applying the model to individuals who fit the criteria that will hopefully produce further studies and elicit meaningful result which highlight this recent study as one to watch.  The Tilley & Oxenham (2011) model is particularly useful for prehistoric cases where there are no written or documentary sources.

Hawkey’s (1998) study of musculoskeletal markers (MSM’s) of a disabled individual from a New Mexico Pueblo culture highlighted the worth of applying existing osteological techniques to disabled individuals in order to assess the quality of bodily movement.  The modelling of the movement capable for this individual suggested that bodily manipulation, feeding, and the cleaning of this person was likely carried out by members of his culture (possibly family relatives, although this is conjecture) due to the severity of his disability (Hawkey 1998: 330).  Craig & Craig (2011) make extensive use of modern medical imaging to diagnosis a specific disease (fibrous dysplasia) in the case of a sub-adult from an English Anglo-Saxon site.  The striking bone expansion in the mandible is discussed within the social sphere of the community that the individual belonged.  The implications, via the the inference of position of the body within the grave, grave goods and grave location, and studies into Anglo-Saxon culture and social stratification give rise to the theory that the individual was not treated any differently due to his disability, although it is unknown if the disease led to the early demise of the individual (Craig & Craig 2011: 3).

Craig & Craig’s (2011) case study, and the above studies, highlight the use of modern medical literature and imaging technology in establishing a likely disease diagnosis, yet Brothwell (2010) rightly highlights the dangers of the differential diagnosis of diseases in skeletal remains at a macroscopic level.  Waldron’s (2009) palaeopathology handbook presents an ideal source on how to identify diseases that can lead to disability, but highlights the value of the differential diagnosis when the osteologist cannot be exactly sure of the disease.

The battery of scientific techniques used in archaeological investigations, including aDNA analysis, trace chemical analysis, and isotopic analysis amongst others, have become significantly refined within the past two decades, and are now allowing for a more nuanced understanding of individual and population dynamics (Brown & Brown 2011).  This includes the ability to analysis the movement of a person in a landscape within their lifetime (Marstellar et al. 2011), and to understand the changes in diet and the effects of diet on the body (Larsen 1997, Roberts 2000, Roberts & Manchester 2010). It also includes the ability to indicate the likely exposure of populations to various chemicals and diseases (Barnes et al. 2011), and exploration of how social structure (Bentley et al. 2012), and hence the role of the population or of the individual, changed through time.

Perhaps what the above studies cannot show, especially in prehistoric societies, are the actions of the disabled individuals themselves.  It is most likely that we will never know if they took an active interest in their society, if they took part, or how they felt as disabled individuals, or even if they saw themselves as disabled (Battles 2011, Hahn 1995).  Compassion  itself cannot be excavated (Dettwyler 1991), but with careful examination of the available evidence results can be produced that suggest that severely disabled individuals did survive past natural limitations.

The progress continually being made in the hard sciences and in the humanities continues to advance our knowledge of past populations via their skeletal remains and their cultural context.  The understanding of disability within an archaeological and osteological context provides the opportunity to investigate of how individual’s survived, and whether care was a key component (Hawkey 1998, Kleinman 1978, Tilley & Oxenham 2011).  This is a burgeoning area of bioarchological research, and when combined with a multidisciplinary approach, it opens up a wide range of interesting and diverse approaches and avenues.

Case Studies, Theories and Further Information:

Full articles are linked where possible, although a number hide behind Journal pay walls.

Aufderheide, A. C. & Roderiquez-Martin, C. 1998. The Cambridge Encyclopedia of Human Palaeopathology. Cambridge: Cambridge University Press.

Barnes, I., Duda, A., Pybus, O. G. & Thomas, M. G. 2011. Ancient Urbanization Predicts Genetic Resistance to Tuberculosis. Evolution. 65 (3): 842-848.

Battles, H. 2011. Toward Engagement: Exploring the Prospects for an Integrated Anthropology of Disability. Explorations in Anthropology. 11 (1): 107-124.

Bentley, R. A., Bickle, P., Fibiger, L., Nowell, G. M., Dale C. W., Hedges, R. E. M., Hamiliton,. J., Wahl, J., Francken, M., Grupe, G., Lenneis, E., Teschler-Nicola, M., Arbogast, R-M., Hofmann, D. & Whittle, A. 2012. Community Differentiation and Kinship Among Europe’s First Farmers. Proceedings of the National Academy of Sciences Early Edition. 1-5. (Early View).

Brothwell, D. 2010. On problems of Differential Diagnosis in Palaeopathology, as Illustrated by a Case from Prehistoric Indiana. International Journal of Osteoarchaeology. 20: 621-622.

Brown, T. & Brown, K. 2011. Biomolecular Archaeology: An Introduction. Chichester: Blackwell Publishing.

Churchill, S. E., Franciscus. R. G., McKean-Peraza, H. A., Daniel, J, A. & Warren, B. R. 2009. Shanidar 3 Neandertal Rib Puncture Wound and Palaeolithic Weaponry. Journal of Human Evolution. 57: 163-178.

Craig, E. & Craig, G. 2011. The Diagnosis and Context of a Facial Deformity from an Anglo-Saxon Cemetery at Spofforth, North Yorkshire. International Journal of Osteoarchaeology. (Early View doi: 10.1002/oa.1288).

Dettwyler, K. A. 1991. Can Palaeopathology Provide Evidence for “Compassion”? American Journal of Physical Anthropology. 84: 375-384.

Fashing, P. J. & Nguyen, N. 2011. Behaviour Towards the Dying, Diseased, or Disabled Among Animal and its Relevance to Palaeopathology.  International Journal of Palaeopathology. 1: 128-129. 

Hahn, R. A. 1995. Sickness and Healing: An Anthropological Perspective. New Haven: Yale University.

Hawkey, D. E. 1998. Disability, Compassion and the Skeletal Record: Using Musculoskeletal Stress Markers (MSM) to Construct an Osteobiography from Early New Mexico. International Journal of Osteoarchaeology. 8: 326-340.

Hublin, J. J. 2009. The Prehistory of Compassion. Proceedings of the National Academy of Sciences. 106 (16): 6429-6430.

Kleinman A. 1978. Concepts and a Model for the Compassion of Medical Systems as Cultural Systems. Soc Sci Med. 12: 85-93.

Knusel, C. J. 1999.  Orthopaedic Disability: Some Hard Evidence. Archaeological Review Cambridge. 15: 31-53.

Larsen, C. 1997. Bioarchaeology: Interpreting Behaviour from the Human Skeleton. Cambridge: Cambridge University Press.

Larsen, C. S. 2002. Bioarchaeology: The Lives and Lifestyles of Past Peoples. Journal of Archaeological Research. 10 (2): 119-166.

Marstellar, S. J., Torres-Rouff, C. & Knudson, K. J. 2011. Pre-Columbian Andean Sickness Ideology and the Social Experience of Leishmaniasis: A Contextualised Analysis of Bioarchaeological and Palaeopathological Data from San Pedro de Atacama, Chile. International Journal of Palaeopathology. 1 (1): 23-34.

Mays, S. 2012. The Impact of Case Reports Relative to Other Types of Publication in Palaeopathology. International Journal of Osteoarchaeology. 22: 81-85.

Roberts, C. A. 2000. ‘Did They Take Sugar? The Use of Skeletal Evidence in the Study of Disability in Past Populations’. In Hubert, J. (ed) Madness, Disability and Social Exclusion: The Archaeology and Anthropology of Difference. London: Routledge. 46-59.

Roberts, C. & Manchester, K. 2010. The Archaeology of Disease. Stroud: The History Press.

Stewart, F.A., Piel, A.K., O’Malley, R.C., 2012. Responses of Chimpanzees to a Recently Dead Community Member at Gombe National Park, Tanzania. American Journal of Primatology. 74: 1–7.

Tilley, L. & Oxenham, M. F. 2011. Survival Against the Odds: Modelling the Social Implications of Care Provision to the Seriously Disabled. International Journal of Palaeopathology. 1 (1): 35-42.

Vilos, J. D. 2011.  Bioarchaeology of Compassion: Exploring Extreme Cases of Pathology in a Bronze Age Skeletal Population from Tell Abraq, U. A. E. Master’s Dissertation. Las Vegas: University of Nevada.

Waldron, T. 2009. Palaeopathology. Cambridge: Cambridge University Press.

Wood, J. W., Milner, G.R., Harpending H. C., & Weiss, K. M. 1992.  The Osteological Paradox: Problems of Inferring Prehistoric Health from Skeletal SamplesCurrent Anthropology 33:  343-370.

Wright, L. E. & Yoder, C. J. 2003.  Recent Progress in Bioarchaeology: Approaches to the Osteological ParadoxJournal of Archaeological Research 11 (1): 43-70. (**An extensive bibliography of articles can be found in the bibliography of this article**).

Anatomy of Human Dissection: An Introspection

27 Sep

It was to be the last time that we saw his body on the table.  In the intervening weeks we had come to know his features with intimacy and respect.   Outside the wind had turned fierce, whilst the clouds, a deep shade of grey and pregnant with snow, streamed across the sky as winter proper closed in.  The Medical Teaching Unit had largely emptied over the past week, the last teaching week before the Christmas break.  Only the aspiring human osteologists and palaeoanthropologists now remained and filled the cavernous light blue coloured room.  With glistening scalpels and silver probes, the last examination of our beloved participant took place.  Pairs of nervous eyes and trembling hands ran through what we had been taught.   We touched and felt the cold body as we reeled off the list drilled into us by the 12 weeks of dissection classes.  Each muscle,  its attachment; insertion; action; nerve; blood supply; ligaments and tendons, were ticked off, one by one.  Each major actor in the human musculoskeletal system was to be identified and admired.  Just as in field archaeology, as in the body.  There are layers, superficial and deep, to be uncovered and appreciated, and then to be reflected back as we investigated further.

It had taken some getting used to at first, the chemical smell and the sights of the MTU.  The individuals who had donated their bodies were to be found wrapped up on their metallic trays, waiting with eternal patience in the centre of the room.  I couldn’t help but notice the sad fact of the bodies different lengths, from adult to child.  It was a hive of activity, bristling with groups of medical students crowding around different individuals on their cold slabs.  The medical students commandeered the central space every week, as they deconstructed the body to heal it.  Tucked away in the side of the main room, we learnt about the intricacies of the fleshed body; how movement is dictated by flexion and extension of passive and active striated skeletal muscle groups.  Each week we would start with a new aspect on our adopted individual and help uncover that week’s muscle group.

The first exam had been taken some 5 weeks before, and we now stared at the second, a mere day or two away.  Our focus this time was the lower half of the body, from the pelvis down to the toes.  The almost fan-like gluteal muscles provided a staunch launching pad from which to run down the thighs, past tensor fascia latae and the iliotibial band on the lateral aspect, to curve with the sartorius on the anterior aspect, as we reached and admired the complexity of the knee joint.  As we uncovered and cleaned each section free of adipose fat, we unveiled the vastus, adductors and hamstring muscle groups.  Whilst running a discussion on what constituted the delicate femoral triangle, I couldn’t help but think of my own numerous surgeries.  Of the many times I have had a scalpel part my skin on the lateral aspect of my thighs.  That scar tissue, on my body as a permanent fixation, serves as a reminder that I too have been laid on a table, ready to be examined and explored; that ultimately, there is no difference between the living and the dead- it is just a different state of being, of matter in the universe.

We had already uncovered the startlingly array and complexicity of the upper body in previous dissection sessions.  The human body, like any living creature, is a marvelous machine developed over millions of years of evolution.  Nothing is perfect however.  Homologies from a common ancestor, ‘the same organ in different animals under every variety of form and function’, are to be found throughout the animal kingdom, and the human as a part of this, has many.  They are well documented, and I shan’t digress here.  However, it is important to note the expected variation within species and between species.  The detailed analysis of fossil hominids depends on this fundamental approach, even as new batteries of investigations are used.

And now, the week before Christmas, the main hall stood empty.  No bodies lay on their metallic tables, and there was no crowd of bustling medical students hunched over, investigating and desiccating the minutiae of life.  It was as if even the bodies had gone home for the bleak mid-winter break.  As we finished testing each other on the soleus or the gastrocnemius, we carefully de-bladed the scalpels, washed all of the tools, and placed them back inside our student dissection kits for the last time.  We silently thanked the individual’s generous bodily donation, and placed the plain cloth over the body and carefully tucked it in.  As I made my way to a nearby exit, my fellow colleagues were already outside breathing the fresh cold winter air.  As I opened the exit door I was accompanied by a lonely radio playing a mournful 1950s song.  Knowing that I would not be back in this place again, I closed it and bid the room a fond farewell.


The University of Sheffield MSc Human Osteology program is the only UK based University that offers the teaching and education of human musculoskeletal anatomy by first hand dissection.  Other UK Universities offering Osteological Masters degrees only teach musculoskeletal anatomy in the lecture theatre.  I firmly believe that my education was enhanced by this opportunity.  At all times the people who donated their bodies to the Medical Teaching Unit were respected and treated with dignity.  The staff displayed professionalism and esteem, and encouraged us all to smile and to learn about the wonders of the human body.

Related and Further Information:

  • The Chirurgeon’s Apprentice has an interesting article on vivisection in Early Modern England, and the medical advances and reactions to this method of dissection.
  •  An article in the Lancet by Lindsey Fitzharris (2012: 108-109), author of the above blog, discusses the effects of human dissection on early modern doctors and today’s medical practitioners .  
  • Guardian article citing the difficulties of obtaining skeletons for academic study, and the difficult process of donating bodies for medical and clinical science, with quotes from Dr Tim Thompson and Dr Piers D. Mitchell
  • At the Museum of London, there is a current exhibition on ‘Doctors, Dissection and Resurrection Men‘ (until April 2013) detailing the excavation of 262 burials from Royal London Hospital with extensive evidence of dissection, along with faunal remains.  The exhibition “reveals the intimate relationship between surgeons pushing forward anatomical study and the bodysnatchers who supplied them; and the shadowy practices prompted by a growing demand for corpses” (MoL 2013).


Skeletal Series Part 10: The Human Leg

15 Mar

We shall continue our look at the human skeleton with the next installment of the Skeletal Series blog posts with a consideration of the leg elements.  Previously covered was the hip and we shall now cover the femur (upper leg), patella (kneecap) and the tibia and fibula (the two lower leg elements).  The evolution of the leg mirrors that of the arm, from ancient fins to rod bearing segments, and as per the arm the leg contains a single upper bone with two lower bones making up the limb ending in the quite unique foot or Pes (White & Folkens 2005: 255).

The femur is the human body’s longest and sturdiest bone that helps to take the whole weight of the body during ambulation (Schwartz 2007: 151).  The tibia is the larger of the lower leg bones and it is easier to tell it apart from its slimmer lateral partner, the long and angular fibula.  The patella is the body’s largest sesamoid bone, safely ensconced in its muscle pouch in the anterior portion of the knee.  The human knee is particularly interesting as it ‘locks’ when stood straight up and unlocks with the aid of the popliteus muscle by laterally rotating the distal femur, which helps critically stabilise the knee.

The basic bones of the human leg (Image credit: Sheri 2012).


During excavation of the supine skeleton in-situ, the lower limb bones tend to survive well because of their structural design and bone density.  In extended burials, and dependent on burial and soil conditions, the lower limb bones are often well-preserved and relatively easy to distinguish from the rest of the body.  As always, care must be taken when excavating the soil on top of and around the lower body.  The fibula can often be found fragmented or broken due to its lateral positioning and the effect of the weight of the soil and associated tibia lying close to it (Larsen 1997).  Even in cremated or burned skeletal tissue samples, particular features and landmarks of the lower limb long bones can easily be identified, and sometimes even sided as larger fragments can sustain slightly higher temperatures and minimal warping (White & Folkens 2005).

A medieval cemetery excavation during the 2007 Brodsworth community project (Image credit: the universities of Hull & Sheffield field school).

Leg Anatomy and Elements

The lower limb in the modern human is an interestingly adapted limb to bipedal walking, and as such it has changed anatomically from our nearest cousins (the great apes) to cope with our locomotion (Jurmain et al. 2011).  In this section we’ll cover the basic gross anatomy of each bone with a more in-depth look at the knee component after.  As mentioned elsewhere (and on this blog herelong bone growth is typically through the distal metaphysis (distal border of the diaphysis of the limb) and its epiphysis through the growth plate.

Growth of the long bones in a juvenile knee joint (the femur is located proximally, with tibia distal and fibula laterally. (Image credit: Danna 2011).


The femur, as stated, is the longest limb bone with several distinctive bony elements.  It is a fairly distinct bone with a high level of robusticity and dense, compact bone due to it being the main supporting limb doing ambulation.  The head of the femur fits into the acetabulum of the hip bone (ilium, ischium and pubis bones).   Unlike the humerus and the glenoid cavity joint, it has a direct ligament attachment between femoral bone and acetabulum, the ligamentum teres, which fits it snugly from the fovea capitis depression on the femoral head into the hip joint, helping to stabilise the joint (White & Folkens 2005: 255).  It is also heavily walled with muscles, from the trunk of the torso down to the knee, with the gluteal (lateral-posterior),  adductors (medial), quadriceps (anterior) and hamstring (posterior) muscle groups acting on the bone at various points (Gosling et al. 2008).  

Main anatomical landmarks of the femur.  For further information see Hawks 2011.

The main osteological features found on the femur include the greater and lesser trochanter’s, which are found in the proximal half of the femur, just below the femoral neck.  The greater and lesser trochanter’s act as muscle attachment sites for the gluteal muscles, amongst others, and sometimes a third trochanter can been seen just distal of the lesser (White & Folkens 2005).  Directly posterior, and running down the length of the shaft of the femur, is the linea aspera, one of the main attachment points for a variety of muscles, including the vastus and adductor muscle groups.

At the proximal femoral end the linea aspera collects the spiral, pectineal and gluteal lines (White & Folkens 2005: 257).  The lateral and medial condyles mark the distal articular surface with the tibia bone of the lower limb.  Alongside the medial edge of the medial epicondyle (just above the medial condyle) lies the adductor tubercle, the insertion point for the adductor magnus muscle (Gosling et al. 2008: 260).  The femur can be easily sided as the trochanters are medial and posteriorly positioned, with the linea aspera running directly posteriorly and the adductor tubercle located medially on the medial epicondlye.  The mid-section shaft of the femur is tear shaped, with the round body in the anterior position and the top of the  ‘tear’ pointing posteriorly.


The patella is the human skeletal systems largest sesamoid bone, and can be found in the anterior muscular pouch on the knee joint, anchored by the quadriceps tendon and patellar tendon on the distal anterior femoral surface (see diagram below).  It does not attach or articulated directly with any other bone.  The patella functions to ‘protect the intricate muscles and ligaments inside the knee joint, to increase area of contact between the patellar ligament and the femur, and to lengthen the lever arm of the quadricep muscles’ (White & Folkens 2005: 270).  The apex of the patella is the most distal point of the bone, and the smooth posterior articular facet rides the ligaments and muscles located anteriorly of the distal femur.

The complex knee joint and associated musculo-skeletal anatomy.  See Roberts & Manchester (2010) for palaeopathological lesions of the knee, especially osteoarthritis. (Image credit: Wikipedia 2012).


The tibia is a distinctly shaped bone with an proximal medial and lateral condyles, medial and laterally intracondylar eminence’s (set posteriorly on the superior surface), an anterior proximal tibial tuberosity, the curved ‘tri-blade’ of the body (anterior, medial and posterior crests, with the medial malleolus marking the distal extremity of the bone (White & Folkens 2005: 273-79).  The landmarks on the tibia represent muscle origin and insertion points, such as the soleal line on the posterior aspect of the proximal tibia, which represents the soleus muscle origin.  The tibia is connected to the laterally positioned fibula with a strong interosseus membrane connecting the two throughout the length of the fibula, with articulations at the proximal and distal segments of the tibia (Gosling et al. 2008: 277).  Distally, the tibia articulates with the talus, the first tarsal bone of the foot.  To easily side the tibia, the malleolus is located on the medial distal aspect of the tibia, and the tibial tuberosity represents the anterior facing proximal end of the bone.

Labelled Tibia and Fibula.

The main anatomical landmarks of the right tibia and fibula, with the anterior position on the left and the posterior on the right hand side. (Image credit: Wikipedia 2012).


The fibula is the thinner of the two lower legs bones, and does not bare any substantial weight (White & Folkens 2005).  It’s primarily importance is providing the lateral border of the ankle joint, with which it articulates with the calcaenous bone.  The head of the fibula, located superiorly, can be easily complicated with the distal malleolar articular surface, and to add to the woes of identification, the body of the fibula, without the proximal or distal segments, is nearly impossible to identify because of its irregularity.  The interosseous crest is located medially, and serves as the attachment for the interosseus membrane which spans between the length of the tibia and fibula.  To side an intact fibula quickly, use the posterior facing malleolar fossa, which can be found on the distal articular surface of the fibula.  The fibula has also been used as marker of sex (Sacragi & Ikeda 1995) and although this method is rarely used, it could be useful in a forensic or archaeological context where the skeletal remains may be limited.

Further Information

  • Although not mentioned here, please take the time to get associated with the fleshy articular pads between the femur and tibia (be aware as this is a fleshed photo).


Gosling, J. A., Harris, P. F., Humpherson, J. R., Whitmore I., & Willan P. L. T. 2008. Human Anatomy Color Atlas and Text Book. Philadelphia: Mosby Elsevier.

Hawks, J. 2011.  Femur: major landmarks and how to side it. From Accessed 2012.

Jurmain, R. Kilgore, L. & Trevathan, W.  2011. Essentials of Physical Anthropology International Edition. London: Wadworth.

Larsen, C. 1997. Bioarchaeology: Interpreting Behaviour From The Human Skeleton. Cambridge: Cambridge University Press.

Roberts, C. & Manchester, K. 2010. The Archaeology of Disease Third Edition. Stroud: The History Press.

Sacragi, A & Ikeda, T. 1995. Sex Identification From The Distal Fibula. International Journal of Osteoarchaeology. 5: 139-143. (access required).

Schwartz, J. H. 2007. Skeleton Keys: An Introduction to Human Skeletal Morphology. New York: Oxford University Press.

White, T. & Folkens, P. 2005. The Human Bone Manual. London: Elsevier Academic Press.

Skeletal Series Part 9: The Human Hip

22 Jan
In this post I shall be discussing and looking at the three main elements that make up the human pelvis (or the pelvic girdle, a homology to the shoulder girdle).  The bones that make up the pelvis are the Ischium, Ilium & the Pubis.  The Sacrum has been discussed in an earlier post on the spine.  During the development of the hip, these three elements remain singular, fusing together during adolescence to become one single unit during early maturity to become the Os Coxa (White & Folkens 2005: 246).

The main elements in the human hip, and as a whole Referred to as the Os Coxa. NB acetabulum faces laterally.

The hip is a fantastic wealth of skeletal knowledge.  The two most basic and fundamental traits of the person, the age and biological sex of the individual, can be found in articles by Brooks & Suchey (1990) and by Patriquin et al. (2005), which both use morphological features of the pelvis to estimate sex and age of the individual under study.  Many muscles also insert and attach along the borders, rims and edges of the pelvis, especially anchoring those that are key in movement during bipedal locomotion (Schwartz 2007: 147).  The hip, and its component parts, are most distinctive in shape and size.  Odd looking, hard to figure out at first, and looking like nothing else (a top heavy hourglass is one view), the Os Coxa can can be hard to identify and orientate, especially in smaller fragments.

Juvenile ilium (top), ischium (bottom right) and pubis (bottom left) (Image credit: Bone Clones 2006).

Unfortunately during excavation, the first thing that the pick ax, spade or trowel is likely to hit is the most anterior part of the hip, the pubic symphysis, as in most human burials the body lies prone and face up, in a supine burial (see Brothwell: 3 for other burial positions).  This can lead to destruction of this joint, which can lead to loss of information on age and sex of the individual.  However, during normal inhumation excavation the grave cut can be clearly distinguished, and a pattern of working from top to bottom or bottom to top can help limit the amount of damage during excavation (White & Folkens 2005).

The author excavating a Medieval skeleton in Germany in 2011. Note the damaged anterior aspect of the Pubic Symphysis, which is outlined in red.

Pelvic Anatomy and Elements:
The acetabulum  makes up the socket to receive the head of the femur (thigh), and is equally made up of a portion of the three elements of the hip which fuse during early adolescence.  This joint is necessarily much more stable then the non-weight bearing shoulder joint- it is much deeper, has the ligamentum teres (a ligament that attaches to the femoral head and the hip) and is covered by much stronger and denser musculature (White & Folkens 2005: 246).  As the main weight bearing joint, the bone is also much denser with thicker cortical bone.
The ilium is the largest of the three parts of the os coxa, and sits superiorly above the ischium and pubis, and it is often described as ‘blade like’ (Schwartz 2007: 148) as it is a thin but strong plate of curved bone.  On the lateral side of the blade, three gluteal lines (anterior, inferior & posterior) are visible which are the muscle attachment sites for the large gluteal muscles.  The main landmarks along the upper ridge is the iliac crest, which can be felt on yourself, and begins anteriorly with the anterior superior iliac spine and ends in the posterior superior iliac spine (White & Folkens 2005: 247).  The auricular surface of the medial ilium articulates with the sacrum (and is a very useful age estimator- Buckberry & Chamberlain 2002).  The greater sciatic notch is also generally a good indicator of the biological sex of the individual.

Anatomical landmarks on the right hip (Image credit: Pearson Education 2010).

The ischium is the butt bone, literally the bone which takes the weight whilst we are sitting on a chair!  The key features of this element of the hip is that a lot of muscles attach to the posterior ischial tuberosity.  The ischial tuberosity muscle attachments include the origins of the hamstring muscles (semimembranosus, semitendinosus, adductor magnus & biceps femoris) (White & Folkens 2005).  Alongside the pubic bone, the ischium also includes the obturator foramen, a gap (in life covered by a membrane) where a number of internal gluteal muscles converge and provide stability for the hip.
The pubic bone makes up the anterior part of the hip as a whole and includes a cartilaginous joint, just above the genitalia in living individuals.  The pubic symphysis, as this joint is called, is also a good indicator of biological sex because of the shape below it (the  pubic arch) and also age because of age related changes in the bony surface of the pubic symphysis (Schwartz 2007: 230).  The pubic bone also includes a superior and inferior pubic ramus, literally the corpus of the bone, which help support numerous muscle attachments, namely the adductors (adductor brevislongus & magnus) of the medial compartment of the thigh.

The  major landmarks of the pelvic bones in anatomical position.


For the discussion on the hip we shall talk about septic arthritis (SA).  SA is mostly common in the hip and knee, and rarely presents in the elbow or shoulder.  Although it is rare in the archaeological record, it is nonetheless recorded in a number of examples (i.e. Yukon individuals in the Natural Museum of National History in Washington, US), and it pays to be able to recognise it (Roberts & Manchester 2010: 154).  The condition is fairly uncommon, and the aetiology of SA is when an infection reaches a joint, normally through one of three means- i) the haematogenous route (most common), ii) a penetrating injury or iii) its spread from metaphysis (Marsland & Kapoor 2008).  The bacteria, or germ, normally infects the synovial fluid which may be inflamed from disease or trauma, and ‘proliferation of bacteria cause an inflammatory response by the host with numerous leucocytes migrating into the joint’ (Marsland & Kapoor 2008: 136).

Main outcome of septic arthritis (Image credit:

At this point the variety of enzymes and breakdown products that are produced helps to damage the articular cartilage very quickly, and if left will produce permanent damage (Waldron 2009: 89).  The prognosis is good if treated promptly, however in the archaeological record this is quite unlikely due to the high risks of re-infection and complications such as joint destruction, avascular necrosis (mostly at the hip) & the ‘seeding of infection’ to other places (Marsland & Kapoor 2008: 137).  Again, the diagnosis of septic arthritis in the archaeological record is hindered by confusion with similarities to tuberculous infection, and difficulties in diagnosing multiple diseases that may present themselves on any one individual (Roberts & Manchester 2010: 154).  In the hip, the surface and surrounding area (lunate surface) of the acetabulum would be highly damaged, with a rough appearance and feeling as the bony lytic destruction took hold (Waldron 2009).


Brooks, S. & Suchey, J. M. 1990. Skeletal age determination based on the os pubis: a comparison of the Acsádi-Nemeskéri and Suchey-Brooks methods. Human Evolution 5– N.3: 227-238.

Brothwell, D. R. 1981. Digging Up Bones: The Excavation, Treatment and Study of Human Skeletal Remains.  Ithica: Cornell University Press.

Buckberry, J.L. & Chamberlain, A.T.  2002.  Age estimation from the auricular surface of the ilium: a revised methodAmerican Journal of Physical Anthropology 119: 231-239.

Larsen, C. 1997. Bioarchaeology: Interpreting Behaviour From The Human Skeleton. Cambridge: Cambridge University Press.

Marsland, D. & Kapoor, S. 2008. Rheumatology and Orthopaedics. London: Mosby Elsevier.

Mays, S. 1999. The Archaeology of Human Bones. Glasgow: Bell & Bain Ltd.

Patriquin, M.L., Steyn, M. & Loth, S.R. 2005.  Metric analysis of sex differences in South African black and white pelvesForensic Science International 147: 119-127.

Roberts, C. & Manchester, K. 2010. The Archaeology of Disease Third Edition. Stroud: The History Press.

Schwartz, J. H. 2007. Skeleton Keys: An Introduction to Human Skeletal Morphology. New York: Oxford University Press.

Waldron, T. 2009. Palaeopathology: Cambridge Manuals in Archaeology. Cambridge: Cambridge University Press.

White, T. & Folkens, P. 2005. The Human Bone Manual. London: Elsevier Academic Press.

Skeletal Series Part 7: The Human Arm

30 May

In this post we shall focus on the main bones located in the arm.  They are the Humerus, Radius & Ulna.  The previous post on the shoulder elements (Scapula & Clavicle) can be found here.  It should be noted that the bones discussed  in this post, known as the forelimb, are the homologs to the bones in the leg, the hind limb.

The Human Arm, And The Bones Under Discussion

Articulation of arm with the distal humerus and proximal radius and ulna making the elbow joint (Image credit: Wikipedia 2011).


As noted in previous Skeletal Series posts care should be taken with excavating human remains, and the maxim that ‘context is everything’ should be well noted with detailed plans of the in-situ remains made.  It is likely that some damage will have occurred to the smaller ulna and radius as they are more fragile then the larger and denser humerus bone.  A record of the condition of the bones should be made, alongside what contextual information is available (Mays 1999, White & Folkens 2005).

Arm Anatomy & Function

The humerus articulates proximally with the scapula and clavicle, as discussed in the last entry (See diagram below).  The distal humerus articulates with the proximal radius and ulna head.  This articulation makes up the elbow, which will be discussed in detail below.  At the distal end of the radius and ulna the carpals are located, which make up the wrist.  These, alongside the other elements in the hand, will be discussed in the next Skeletal Series post.

The individual brachium and antebrachium skeletal elements and major skeletal landmarks, as seen in articulation with the full limb (image credit: Wikipedia 2011).

The function of the forelimb is to provide a rigid limb to help hold, grab and move surfaces and objects.  The shoulder girdle and arm bones have moved away from our evolutionary history of weight-bearing limbs, and have become essential in helping humans to manipulate and move objects with astounding dexterity (Jurmain et al 2011).

Elbow Joint

The elbow joint (image credit: CK-12).

This joint in particular is important to understand as it is a key hinge joint.  The diagram below helps to mark out the distal humerus with the proximal radius and ulna in articulation.  The elbow is one of the strongest points of the body in terms of bone hitting strength.  The two main movements of the elbow are flexion and extension of the humerus and ulna, alongside the pronation of the radius and ulna in turning the arm over (White & Folkens 2005).  The joint itself has a large synovial membrane that protects the articulation points of the bone, whilst the main muscles involved are the Brachialis & Brachiaoradialus (at the anterior side) and the Triceps Brachii & Aconaeus towards the posterior side.  The lateral and medial muscles are the Supinator and Extensor muscles, alongside the Flexor muscles and Flexor Carpi Ulnaris muscles (White & Folkens 2005, but also here).

Anterior elbow joint in articulation, highlighting the major skeletal landmarks of the three bones that make up the joint. Image credit: here.

The Humerus

The humerus is the largest bone in the upper body, and ‘compromises of a proximal end with a round articular head, a shaft, an irregular distal end’ (White & Folkens 2005: 203).  It articulates with the Glenoid cavity (or fossa) of the scapula, and as mentioned, the proximal radius and ulna at the distal end.  The humerus head faces medially, whilst the surgical (or anatomical) neck is the groove that encircles the head for the attachment of the joint capsule (White & Folkens: 203-4).  Both the Greater and Lesser Tubercle are muscle attachment eminences that help move and rotate the upper arm.  On the Greater tubercle (the more posterior and large of the tubercles) rugosities for the insertion of the rotator cuff muscles are round, which help in rotation and adduction and abduction of the arm (White & Folkens 2005).

Main skeletal landmarks of the humerus (click to enlarge). Image credit: Google 2011.

The Shaft of the humerus is variably triangular in section, going from more cylindrical at its proximal end to more triangular in shape towards the distal end (Larsen 1997).  The Deltoid tuberosity is an important feature located on the lateral side of the shaft.  It is the insertion site of the deltoideus muscle, and is recognised by its roughened appearance.  Towards the distal end of the humerus we have several key features that are easily identifiable in recognising this as an upper limb element.

The Olecrannon Fossa is the largest of three hollows located posteriorly at the distal end, and accommodates the olecrannon process of the ulna during forearm extension.  The Capitulum is the rounded eminence that forms the lateral portion of the distal humeral surface, and it articulates with the head of the radius (White & Folkens 2005: 211).  The Lateral and Medial Epicondyle are the non articulating projections of bone, the medial is more prominent than the lateral epicondyle.

The humerus is relatively easy to recognise by the certain features picked out above, but parts can be confused with the tibia and femur.  With the femur, the head has a distinct depression called the Fovea Capitis whilst the humerus lacks this feature (Mays 1999).  The humeral shaft is smaller and less triangular than the tibial shaft.  When siding remember that the olecrannon fossa is posterior and the medial epicondyle is larger, and the humeral head faces medially.  The deltoid tuberosity is found laterally (White & Folkens 2005: 214).

The Ulna

The Ulna is the longest and thinnest bone of the forearm, and articulates proximally with trochlea of the humerus and head of the radius.  Distally, it articulates with the ulnar notch of the radius and an articular disk that separates it from the carpals.  The Olecrannon of the ulna is located on the most proximal part of the ulna; it is the insertion point for triceps brachii muscle.  The Trochlea Notch articulates with the trochlea articular surface of the humerus.  The Coronoid Process is the ‘anterior beak shaped projection at the base of the semilunar notch’ (White & Fokens 2005: 219).  The Radial Notch  is the small articular surface for the radius, and is located along the lateral side of the coronoid process.  The Radial Articulation (Ulna Head)  is the distal, lateral round articulation that conforms to the ulna notch on the radius.  The distal and proximal ends of the ulna are fairly distinctive and indicative of the element, however as White & Folkens (2005) and May (1999) point out, the shafts could be mistaken for radial or fibular shafts.

The ulna and the radius and their associated skeletal landmarks, click to enlarge. Image credit: Wikipedia 2011.

The Radius

The radius is a relatively small bone and shortest of the three in the forelimb.  Its name was gained for the action it goes through as the ‘turning movement about the capitulum of the humerus’ (White & Folkens 2005: 214).  At the proximal end it articulates with the humerus and medially with the ulna on both proximal and distal ends, whilst also distally it articulates with two carpal bones of the wrist.

The Head is a round articular structure at the proximal end of the radius, and as stated above articulates with both the humerus and ulna.  The Neck is a slender segment between the head and the radial tuberosity.  The Radial Tuberosity is a blunt rugged structure on the anteromedial site of the proximal radius that marks the insertion for the biceps brachii muscle (Mays 1999).  The  Styloid Process is a sharp projection located on the lateral side of the distal radius whilst the Ulnar Notch is a concave articular hollow on the medial corner of the distal radius.

Discussion: Wrist Fracture

Colle’s fracture is a break at the distal end of the radius and ulna that results in a ‘dinner fork deformity‘ with dorsal angulation, and displacement of the fracture with radial angulation.  The counterpart to this is Smith’s fracture which is the same but the fracture is displaced in the opposite direction, ie palmar (Marsland & Kapoor 2008: 96).

Smiths fracture highlighting the displacement of the distal radius. Image credit: Wikipedia 2011.

These type of fractures often occur because of trips or falls onto outstretched hands, as an automatic safety device by the body.  In modern contexts they also happen in a variety of sport environments.  These types of breaks are often easy to treat with splints and plaster casts, although they sometimes require surgery to correct the breaks and/or angles.  The patients can often be left with a visible deformity, but likely without any pain whatsoever (Marsland & Kapoor 2008: 96).  In archaeological examples these type of fractures can be found in any number of contexts or cultures.  It is important to note that, as Larsen (1997) says, many human cultures’ skeletal series often exhibit these breaks, and it can shed light into pathways of differing lifestyles.  Larsen also notes that whilst there is a large osteological literature on injuries in comparison to more population based studies which would help to highlight inferences on accidents and conflict in both historic and prehistoric societies (1997: 109).

Further Information


Jurmain, R. Kilgore, L. & Trevathan, W.  2011. Essentials of Physical Anthropology International Edition. London: Wadworth.

Larsen, C. 1997. Bioarchaeology: Interpreting Behaviour From The Human Skeleton. Cambridge: Cambridge University Press.

Marsland, D. & Kapoor, S. 2008. Rheumatology and Orthopaedics. London: Mosby Elsevier.

Mays, S. 1999. The Archaeology of Human Bones. Glasgow: Bell & Bain Ltd.

Roberts, C. & Manchester, K. 2010. The Archaeology of Disease Third Edition. Stroud: The History Press.

Waldron, T. 2009. Palaeopathology: Cambridge Manuals in Archaeology. Cambridge: Cambridge University Press.

White, T. & Folkens, P. 2005. The Human Bone Manual. London: Elsevier Academic Press.

Skeletal Series Part 6: The Human Shoulder

16 May

This post will focus on the scapula and the clavicle elements of the shoulder girdle.  The scapula provides the back of the shoulder, and the clavicle articulates with the sternum (discussed in previous post) and the top of the arm (the humerus).  The humerus will be discussed in a subsequent post on the elements of the arm.


Together with previous posts on the spine and rib cage, this post makes up the ‘trunk’ of the human body.  As ever, care should be taken during excavation & examination.  Both the scapula and the clavicle are fairly tough elements and survive well.  The body and medial border of the scapula is liable to damage however as it is a thin blade of bone (Mays 1999).

On mainland Europe the study of anthropologie de terrain (the study and alignment of the body in a burial context) is often used, especially so in prehistoric sites.  Interestingly by examining the placement of the clavicle bones in burial, you can often tell whether a body has been covered in a shroud or likewise garment in the deposit of the cadaver.  The clavicles are often found near vertical in the upper chest cavity, which itself is often tightly bound.

The Shoulder Girdle Anatomy and Its Function

The shoulder girdle consists of the scapula bone, and the clavicle, which provide support and articulation for the humerus.  They also  anchor a variety of muscles which help rotate, move and flex the humerus.  The joint of the humerus and scapula is called the Glenohumeral Joint, the acromion process (see below) and clavicle is the  Acromioclavicular Joint, & the sternum and clavicle is called the Sternoclavicular Joint (Marshland & Kapoor 2008: 206).  The clavicle functions as the strut for the shoulder whilst the scapula helps provide anchor points for the larger muscles as well as the loose ranging ‘cup’ for the humeral head (White & Folkens 2005: 193).  Because of the lateral placement of the forelimb on the upper human body, we have evolved away from our nearest ancestors, as the forelimb placement gradually changed (See Afarensis article below in relation to our recent hominid brothers).  The diagram below marks out the main features of the shoulder girdle-

Anterior view of the shoulder elements, note only the clavicle and scapula are discussed in this post (Image credit: Britannic Inc 2007).

The clavicle is easy to palpate in your own body, along the length of the bone whilst the scapula spine and acromial process (see below) can be palpated just adjacent medially from the top of either arm.


As for any shoulder element, there are two clavicles present in the human skeleton.  As demonstrated by the above and below diagram, the clavicle is a tubular S shaped bone that sits anteriorly in the shoulder joint and is easily palpated.  The clavicle is oval to circular in cross section (White & Folkens 2005: 193).   The main anatomical landmarks are featured in the diagram below.

Landmark features and muscle attachment sites for clavicle (click to enlargen). Image credit: Wikipedia.

The costal impression is a broad rough surface that anchors the costoclavicular ligament, which strengthens the joint.  The lateral side of the clavicle has two major attachment muscle sites for the trapezuis & deltoideus muscles (White & Folkens 2005: 193).  The clavicle articulates with the acromial process of the scapula at the lateral end, whilst at the medial end it articulates with the clavicular notch of the manubrium.  The clavicle is often broken during a trip or a fall as the bone is so close to the skin, and acts as a supporting strut (Marsland & Kapoor 2008).

There are a few main points to consider when siding a clavicle.  The medial end is rounded whilst the lateral side is flattened.  Most irregularities are roughenings are on the inferior edge of the bone, whilst the bone itself ‘bows anteriorly from the medial end, curves posteriorly at the midshaft and sweeps anteriorly again at the lateral flat end’ (White & Folkens 2005: 195).


The scapula is a ‘large, flat, triangular bone with two basic surfaces; the posterior (dorsal) and costal (anterior, or ventral)’ (White & Folkens 2005: 195).  The bone articulates with the humerus at the glenoid cavity (or fossa), and the distal clavicle on a small facet on the acromion process (see below diagram).  The ‘coracoid process just anteriorly and superlaterally from the superior border of the scapula’ whilst the acromion process is the lateral projection of the scapula spine.  Both of these projection points provide anchoring points for a number of key muscle abductors, rotators and flexors, amongst others (White & Folkens 2005: 200).  The glenoid cavity provides the humeral head with great mobility because of how shallow the fossa is; however the arm can be easier to dislocate then the leg bones (Marshland & Kapoor 2008).  The scapular spine provides an anchor point for the acromion process, and it key in distinguishing the posterior aspect of the body.

Distinctive landmark features on the scapula (anterior view, lateral view and posterior view). Image credit: Wikipedia.

Interestingly scapula fractures are rare in the archaeology record, but when evident they are usually located in the blade of the bone.  They are usually marks indicative of interpersonal violence due to the posterior position and location (Roberts & Manchester 2010: 104).  However as pointed out above the blade is usually damaged before or during excavation due to its delicate nature.

Another feature to be aware of is the lack of fusion that can take place at the acromion epiphysis (growing plate).  The most famous case concerning the lack of fused acromional points in a  skeletal series are from the remains of individuals from the Tudor ship The Mary Rose.  Of the skeletons studied, 13.6% of their number had unfused acromions (see diagram above/below).  The reason suggested was that they represented the archers aboard the ship, and had practised since childhood which had prevented any fusion of the element because of the constant stress, strain and movement needed to be a top bowman (Roberts & Manchester 2010: 105).

Posterior shoulder anatomy showing the major muscle (supra and inferspinatus muscles). Image credit: source.

When siding and investigating a piece of suspected scapula bone, it should be noted that it is mostly a thin bone, and unlike the pelvis, there is no spongy bone sandwiched between the cortices.  The following is taken from (yes that’s right!) White & Folkens 2005, page 202, with some modification.

  • The glenoid cavity is teardrop-shaped, with the blunt end inferior.
  • An isolated acromion is concave on its inferior surface.  The clavicular facet is anteriormedially relative to the tip.
  • For an isolated coracoid element the smooth surface is inferior whilst the rough superior.  The anterior body is longer and thee hollow on the inferior surface faces the glenoid area.
  • The spine thins medially whilst it thickens towards the acromion.  The inferior border has a tubercle that points inferiorly, as seen in the above diagram.
  • On the posterior body there are several transverse muscle attachment sites.  These are usually quite prominent, and are key indicators in helping to visualise the orientation of the scapula.

Range Of Movement

Lateral view of the rotation of the shoulder joint. Image credit: Wikipedia.

Anterior view of the rotation of the shoulder joint. Image credit: Wikipedia.

An Arctic Case Study

There is a perception, garnered from the earlier descriptions of the Arctic aboriginal groups, that the native Eskimo groups were passive, of ‘quiet repose and lived in a state of non-violence’ (Larsen 1997: 131).  New bioarchaeological investigations are helping to provide data that is slowly leading to a revision in the review of those perceptions.

A Saunaktuk site, dated to the late 14th Century AD, located east of the Mackenzie Delta in the Canadian Northwest Territories has provided compelling evidence of violent confrontation between native groups (Larsen 1997).  As Larsen (1997: 132) discusses the skeletal remains of 35 Inuit Eskimo Villages represented at the site, it becomes clear that there is evidence for violent death and body treatment, which is indicated by extensive perimortem skeletal modifications.  A large percentage of the whole group are adolescents (68.6%), whilst all of individuals represented had not been purposefully buried.  It is suggested that the group represents a targeted selection whilst other adults where away from the site (Melbye & Fairgrieve 1994).

Studying the bones in anatomical position. Image credit: Google.

On the skeletons themselves, hundreds of knife cuts were evidenced.  These ranged from around the articular joints and neck vertebrae, which is indicative of decapitation and dismemberment (Larsen 1997).  As well as this there are numerous cuts on the facial bones on many of the victims, with cuts also present on the clavicles and scapulae as well (Melbye & Fairgrieve 1994).  Many of these cuts reflect an overall pattern associated with dismemberment, removal of muscle and other soft tissues as well as intentional mutilation.  There is the distinct possibility of cannibalism having been carried out at this site.

In particular, unique to this Saunaktuk skeletal series, is the ‘presence of gauges at the ends of long bones’ (Larsen 1997: 132).  The modifications of the gauges on the adult distal femora are consistent with oral tradition describing a type of torture where the victims knees were pierced and the individual dragged around the village by a cord passed through these perforations’ (Larsen 1997: 132).

We have to understand that there is a vast rich historical record that does help to provide a context for this group to group violence as recognised by the skeletal and oral records.  Violent interactions at this locality occurred between the groups, and intergroup violence has been recorded by many explorers for the Hudson Bay Company in the 18th century (Melbye & Fairgrieve 1994).  Other pre-contact sites such as Kodiak Island in Alaska, alongside the sites of Uyak Bay, Crag Point & Koniag Island there is also evidence of culturally modified human bone.  However, we must remember the context in which these actions had taken place.  There are a small selection of the overall number of ore-contact Arctic sites in this area.  Please refer back to previous posts by my guest blogger Kate Brown on the pre conditions and difficulties of diagnosing cannibalism.

Further Online Sources


Larsen, C. 1997. Bioarchaeology: Interpreting Behaviour From The Human Skeleton. Cambridge: Cambridge University Press.

Marsland, D. & Kapoor, S. 2008. Rheumatology and Orthopaedics. London: Mosby Elsevier.

Mays, S. 1999. The Archaeology of Human Bones. Glasgow: Bell & Bain Ltd.

Melbye, J. & S. I. 1994. ‘A Massacre And Possible Cannibalism In The Canadian Arctic: New Evidence From The Saunatuk Site (NgTn-1)’. Arctic Anthropology. Vol 31. No 2. PP 57-77. Wisconsin: University of Wisconsin.

Roberts, C. & Manchester, K. 2010. The Archaeology of Disease Third Edition. Stroud: The History Press.

Waldron, T. 2009. Palaeopathology: Cambridge Manuals in Archaeology. Cambridge: Cambridge University Press.

White, T. & Folkens, P. 2005. The Human Bone Manual. London: Elsevier Academic Press.