As Seen on TV: Activity Markers on Bones S1E1

bones_s1e1_group_minus_boothAs a scholar of anthropology, I am frequently questioned about the plausibility of science on tv shows. This is especially true for the show Bones. Typically I’m asked if some forensic method or another Dr. Brennan employs is realistic. The answers range from “Yes kind of” to “Maybe in certain circumstances” to “Definitely not”. One of the “Maybe in certain circumstances” situations occurs in the Pilot of the series. As the Pilot, this episode serves to establish the working relationship between Dr. Temperance Brennan and FBI Special Agent Seeley Booth. Booth is bringing Brennan in on a case in which a body was found at the bottom of a lake at Arlington Cemetery. The scene plays out like this:

Bones S1E1: Brennan, Booth, and Zach observe the skeletal remains of a young woman

Booth: (joining Brennan and Zach at the body) What can you tell me?

Temperance: Not much. She was a young woman, probably between 18 and  22.

Booth: (sarcastically) That’s all?

Temperance: Tennis player.

Booth: How do you get a pretty tennis player out of that guck?

Zach: Epiphyseal fusion gives age, pelvic bone shape gives sex…

Temperance: Bursitis in the shoulder, somebody this young, must be an athletic injury.

Bones S1E1: Brennan and the tennis player

In a later scene when Booth is explaining Brennan’s expertise to his boss, Deputy Director Cullen, Booth says that she provided age, sex, and favorite sport from the skeleton. “Impressive,” remarks Cullen. Impressive? Yes. Possible from actual skeletal analysis? Umm…maybe not.

Many people may only think of the skeleton as a rigid hard tissue structure that provides our bodies with its framework and support. And while that is true, it can be easy to forgot that your bones are dynamic – they respond to pressure/stress and remodel accordingly during our lifetimes. When physical anthropologists examine bones, we are looking at the result of a lifetime (however long it was) of those processes.

Anterior (front) view of the shoulder girdle

Brennan identifies the young women as a tennis player based on the bursitis in her shoulder. Bursitis is an inflammation of the bursa, a fluid filled sac that acts as a cushion in your joints (Mayo Clinic). The condition is found in joints that see a lot of repetitive movement – the shoulder, elbow, and knee. Unfortunately, there are many bursae (plural of bursa) in the shoulder, described by their relation to the muscles. The most significant bursae include the subacromial bursa, subdeltoid bursa, subscapularis bursa, and the coracobrachialis bursa, though there are six other minor bursa (Milano & Grasso 2013). With so many bursae, it is difficult to know how Dr. Brennan exactly observed bursitis in the shoulder girdle (scapula, clavicle, and humeral head) of the this tennis player. However, she is most likely observing arthritis in the shoulder which can be connected to bursitis.

A case of likely rheumatoid arthritis. From Identification of Pathological Conditions in Human Skeletal Remains, Donald J. Ortner.

According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases, “Rheumatoid arthritis also can inflame the rotator cuff and result in tendinitis and bursitis” since any can lead to inflammation of the joint and limited mobility. Of the two types of joint diseases, proliferative (bone growth) and erosive (bone depletion), rheumatoid arthritis is the most characteristic of the erosive diseases. To the right you can see an example of rheumatoid arthritis on the humerus (upper arm bone) – this is presumably what Brennan saw on the young woman’s remains. And if that is true, then her assessment is correct, the appearance of a humerus in a woman that young is likely due to trauma/injury, presumably overuse, which could occur if the individual were repeatedly and aggressively using that joint – like in tennis. However, it is the movement that is important, and it is not out of the question that another sport could produce a similar appearance on the skeleton – if she had played volleyball or softball for example. Therefore, a more realistic assessment of the skeleton would include a description of the arthritis observed on the shoulder girdle and possible causes. But a proper paleopathology report does not necessarily make for compelling television.

Arthritis is a disease of the joints, but there is another place in the skeleton that bioarchaeologists examine in an attempt to recreate the activity of an individual.  These stress markers are places in which muscles, tendons, or ligaments attach to bone. Musculoskeletal stress markers (MSM) are assumed to be linked to activity related stress, i.e. frequent, regular movement that causes enough stress on the musculoskeletal system to warrant a response. Certain MSMs, or enthesopathies, however, may also be associated with disease so the degree to which they can successfully reconstruct activity or occupation is an ongoing question in bioarchaeology. These entheses, sometimes known as muscle attachment sites, also change with age. When Cardoso and Henderson (2010) examined enthesopathies for different occupations (manual and non-manual laborers) for a skeletal population in Peru, they found that age was the single most significant factor for humeral enthesopathy formation – there was no significant association with occupation/activity.

Muscle attachment sites on the humerus (a, b, f), and the radius (c, d, e). Pictures a & c are normal entheses while b, c, d, e, and f represent enthesopathies. From Villotte et al. 2010.

One of the challenges in identifying enthesopathies (changes to these attachment sites) involves classifying entheses that are morphologically normal so changes can be assessed. With normal variation and changes due to age and health factors, the creation of such a method is challenging. In order to hopefully eliminate the complication of age related changes, researchers in the Czech Republic only studied individuals less than 50 years of age (Havelkova et al. 2011). They utilized a new method of enthesopathy identification developed in 2006 by Sebastien Villotte, a French biological anthropologist, which used current anatomical and medical data and was reliably reproducible. They compared two populations from the Early Medieval – individuals from the castle and individuals from the surrounding hinterland. Presumably, the two groups led different lifestyles so the authors tested the hypothesis that different socio-economic conditions would be reflected in differences at the muscle attachment sites. The authors found no statistically significant difference between the two populations, although there was a higher number of recorded enthesopathies in the hinterland population. When considering sex, females in the castle had a higher prevalence of enthesopathies, mostly in the lower limb, while males in the hinterland displayed greater numbers of upper limb enthesopathies. Ultimately, reconstructing activity from the joints or muscle attachment sites of a skeleton is a challenging endeavor, with many factors to consider. It is an important area of skeletal analysis to continue to explore, however, so we may increase the potential and understand the limitations of examining a skeleton for its life’s activity.

While I applaud media that sparks an interest in science and especially anthropology, we must always keep in mind that tv shows like Bones do not depict the reality of how science is employed in forensic investigations. In some cases it’s not even close. But these shows can make for compelling television, especially when they are based on real methodologies or possible future methodologies. If you’re ever in doubt, however, please ask your friendly neighborhood anthropologist for clarification – so if you think of a method or procedure you’ve seen employed by your favorite prime time crime fighters, fell free to comment below and I will work it into a future post!


Bones. Season 1 Episode 1: “Pilot”. Fox Broadcasting Company. Original air date: September 13, 2005.

Cardoso, F. A., & Henderson, C. y. (2010). Enthesopathy formation in the humerus: Data from known age-at-death and known occupation skeletal collections. American Journal of Physical Anthropology, 141(4), 550–560.

Havelková, P., Villotte, S., Velemínský, P., Poláček, L., & Dobisíková, M. (2011). Enthesopathies and activity patterns in the Early Medieval Great Moravian population: Evidence of division of labour. International Journal of Osteoarchaeology, 21(4), 487–504.

Milano, G., & Grasso, A. (2013). Shoulder Arthroscopy: Principles and Practice. Springer Science & Business Media.

ORTNER, D. J. (2003). Identification of Pathological Conditions in Human Skeletal Remains (Second Edition) San Diego: Academic Press.

Rich Clark, O. of C. and P. L. (n.d.). Fast Facts About Bursitis and Tendinitis. Retrieved January 18, 2017, from

Villotte, S. (2006). Connaissances médicales actuelles, cotation des enthésopathies : nouvelle méthode. Bulletins et mémoires de la Société d’Anthropologie de Paris, (18 (1-2)), 65–85.

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.

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