Chapter 19 The Skeleton Copyright 2011 Wolters Kluwer

Chapter Objectives § § § § Axial skeleton and appendicular skeleton. Formation of bone

Key Terms Normal Structure and Function acetabulum The bony socket in the hip bone

Key Terms Normal Structure and Function (cont’d) diarthrosis A freely movable joint; also called

Key Terms Normal Structure and Function (cont’d) ossification The formation of bone tissue (from

Key Terms Normal Structure and Function (cont’d) skeleton The bony framework of the body,

Key Terms Disorders ankylosing spondylitis A chronic, progressive inflammatory disease involving the joints of

Key Terms Disorders (cont’d) gout A form of acute arthritis, usually beginning in the

Key Terms Disorders (cont’d) osteomyelitis Inflammation of bone and bone marrow caused by infection,

Key Terms Disorders (cont’d) rheumatoid factor A group of antibodies found in the blood

Key Terms Treatment alkaline phosphatase An enzyme needed in the formation of bone; serum

Key Terms Drugs antiinflammatory agent Drug that reduces inflammation; includes steroids, such as cortisone,

Supplementary Terms Normal Structure and Function annulus fibrosus The outer ringlike portion of an

Supplementary Terms Normal Structure and Function (cont’d) malleolus The projection of the tibia or

Supplementary Terms Symptoms and Conditions achondroplasia Decreased growth of cartilage in the growth plate

Supplementary Terms Symptoms and Conditions (cont’d) Ewing tumor A bone tumor that usually appears

Supplementary Terms Symptoms and Conditions (cont’d) Heberden nodes Small, hard nodules formed in the

Supplementary Terms Symptoms and Conditions (cont’d) osteochondrosis Disease of a bone's growth center in

Supplementary Terms Symptoms and Conditions (cont’d) sprain Trauma to a joint involving the ligaments

Supplementary Terms Diagnosis and Treatment allograft Graft of tissue between individuals of the same

Supplementary Terms Diagnosis and Treatment (cont’d) goniometer A device used to measure joint angles

Abbreviations ACL Anterior cruciate ligament AE Above the elbow AK Above the knee ASF

Abbreviations (cont’d) DEXA Dual-energy x-ray absorptiometry (scan) DIP Distal interphalangeal (joint) DJD Degenerative joint

Abbreviations (cont’d) NSAID(s) Nonsteroidal antiinflammatory drug(s) OA Osteoarthritis OI Osteogenesis imperfecta ORIF Open reduction

Abbreviations (cont’d) RA Rheumatoid arthritis S Sacrum; sacral SERM Selective estrogen receptor modulator T

The Skeletal System Axial Skeleton Appendicular skeleton Skull Shoulder girdle Spinal column Arms Thorax

Axial Skeleton • Consists of: – Skull • Cranial bones (8) • Facial bones

Axial Skeleton (cont’d) – Thorax • Ribs (12 pair) • True ribs (pairs 1

Appendicular Skeleton • Attached to axial skeleton • Consists of: – Shoulder girdle •

Appendicular Skeleton (cont’d) – Arm bones • Humerus • Radius • Ulna • Carpals

Appendicular Skeleton (cont’d) – Pelvis • 2 pelvic bones • Formed of 3 fused

Appendicular Skeleton (cont’d) – Leg bones • Femur • Patella • Tibia • Fibula

Skeleton Illustrated Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Skull Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Vertebral Column Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Pelvic Bones Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Roots for the Skeleton Root crani/o Meaning skull, cranium Example craniometry Definition of Example

Roots for the Skeleton (cont’d) Root sacr/o Meaning sacrum Example presacral Definition of Example

Bone Formation • Bones formed from cartilage • Ossification begins at birth and continues

Structure of Long Bone • Diaphysis = shaft of compact bone tissue – Yellow

Structure of Long Bone (cont’d) • Metaphysis = region between diaphysis and epiphysis –

Structure of a Long Bone Copyright © 2011 Wolters Kluwer Health | Lippincott Williams

Roots for Bones and Joints Root oste/o Meaning bone Example osteopenia Definition of Example

Joints • Known as articulations • Classified by amount of movement they allow –

Joints (cont’d) • Synovial fluid contained within diarthrotic cavity – Protects joint by cushioning

Clinical Aspects of the Skeleton • Orthopedics = study of diseases of skeletal and

Clinical Aspects of the Skeleton (cont’d) • Infections – Osteomyelitis = inflammation of bone

Clinical Aspects of the Skeleton (cont’d) • Fractures – Break in bone • Usually

Types of Fractures Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

$Fracture Treatment • Reduction of fracture – Realignment of broken bone – Closed -$

Metabolic Bone Diseases • Osteoporosis = loss of bone mass – Weakens bones –

Metabolic Bone Diseases (cont’d) • Osteomalacia = softening of bone tissue – Possible causes:

Metabolic Bone Diseases (cont’d) • Paget disease (osteitis deformans) – Disorder of aging –

Neoplasms • Osteogenic sarcoma = highly malignant tumor – Most commonly occurs in growing

Arthritis • Joint inflammation – Most common form is osteoarthritis • Joint cavity narrows

Rheumatoid Arthritis • Systemic inflammatory disease of joints – Cause may involve immunologic reactions

Gout • Increased uric acid in blood causes salt deposits in joints • May

Joint Repair • Arthroscopy = examination of joint interior and perform surgical repairs •

Disorders of the Spine • Ankylosing spondylitis – Disease of spine mainly in males

Disorders of the Spine (cont’d) • Spondylolisthesis – Forward sliding of vertebrae over vertebrae

Herniated Disk • Central mass of intervertebral disk protrudes into spinal column • Commonly

Herniated Disk Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Curvatures of the Spine • Kyphosis = exaggerated curve in thoracic region, “hunchback” •

Pretest 1. The root oste/o means: (a) cartilage (b) fat (c) bone (d) heart

Pretest 2. The root myel/o refers to the spinal cord. Used in reference to

Pretest 3. A bone of the spinal column is a: (a) cortex (b) ventricle

Pretest 4. The large, flared superior bone of the pelvis is the: (a) duodenum

Pretest 5. The bones of the wrist are the: (a) ribs (b) cervices (c)

Pretest 6. The bone of the thigh is the: (a) patella (b) umbilicus (c)

Pretest 7. A general term for inflammation of a joint is: (a) arthritis (b)

Pretest 8. Chondrosarcoma is a tumor that originates in: (a) adipose tissue (b) bone

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Chapter Objectives § § § § Axial skeleton and appendicular skeleton. Formation of bone tissue. The structure of a long bone. Suture, symphysis and synovial joint. Roots pertaining to the skeleton. Main disorders that affect the skeleton and joints. Common methods to diagnose & treat disorders of the skeleton. Abbreviations used in relation to the skeleton. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Key Terms Normal Structure and Function acetabulum The bony socket in the hip bone that holds the head of the femur (from the Latin word for vinegar because it resembles the base of a vinegar cruet) articulation A joint (adjective: articular) atlas The first cervical vertebra (root: atlant/o) axis The second cervical vertebra bone A calcified form of dense connective tissue; osseous tissue; also an individual unit of the skeleton made of such tissue (root: oste/o) bone marrow The soft material that fills the cavities of bones. Yellow marrow fills the central cavity of the long bones; blood cells are formed in red bone marrow, which is located in spongy bone tissue (root: myel/o) bursa A fluid-filled sac that reduces friction near a joint (root: burs/o) cartilage A type of dense connective tissue that is found in the skeleton, larynx, trachea, and bronchi. It is the precursor to most bone tissue (root: chondr/o) Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Key Terms Normal Structure and Function (cont’d) diarthrosis A freely movable joint; also called a synovial join; adjective: diarthrotic diaphysis The shaft of a long bone epiphyseal plate The growth region of a long bone; located in the metaphysis, between the diaphysis and epiphysis. When bone growth ceases, this area appears as the epiphyseal line epiphysis The irregularly shaped end of a long bone ilium The large, flared, superior portion of the pelvic bone; adjective: iliac; (root: ili/o) joint The junction between two bones; articulation (root: arthr/o) ligament A strong band of connective tissue that joins one bone to another metaphysis The region of a long bone between the diaphysis (shaft) and epiphysis (end); during development, the growing region of a long bone Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Key Terms Normal Structure and Function (cont’d) ossification The formation of bone tissue (from Latin os, meaning “bone”) osteoblast A cell that produces bone tissue osteoclast A cell that destroys bone tissue osteocyte A mature bone cell that nourishes and maintains bone tissue pelvis The large ring of bone at the inferior trunk. Formed of the two hip bones (os coxae) joined to the sacrum and coccyx (plural: pelves). Each os coxae is formed of three bones, the superior, flared ilium (IL-ē-um), ischium (IS-kē-um), and pubis (PŪ-bis). periosteum The fibrous membrane that covers the surface of a bone resorption Removal of bone by breakdown and absorption into the circulation Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Key Terms Normal Structure and Function (cont’d) skeleton The bony framework of the body, consisting of 206 bones. The axial portion (80 bones) is composed of the skull, spinal column, ribs, and sternum. The appendicular skeleton (126 bones) contains the bones of the arms and legs, shoulder girdle, and pelvis. suture An immovable joint, such as the joints between the skull bones symphysis A slightly movable joint synovial fluids The fluid contained in a freely movable (diarthrotic) joint; synovia (root: synov/i) synovial joint A freely movable joint; has a joint cavity containing synovial fluid; a diarthrosis tendon A fibrous band of connective tissue that attaches a muscle to a bone thorax The upper part of the trunk between the neck and the abdomen; formed by the 12 pairs of ribs and sternum Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Key Terms Disorders ankylosing spondylitis A chronic, progressive inflammatory disease involving the joints of the spine and surrounding soft tissue, most common in young males; also called rheumatoid spondylitis ankylosis Immobility and fixation of a joint arthritis Inflammation of a joint chondrosarcoma A malignant tumor of cartilage curvature of the spine An exaggerated spinal curve, such as scoliosis, lordosis, or kyphosis degenerative joint disease (DJD) Osteoarthritis fracture A break in a bone. In a closed or simple fracture, the broken bone does not penetrate the skin; in an open fracture, there is an accompanying wound in the skin Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Key Terms Disorders (cont’d) gout A form of acute arthritis, usually beginning in the knee or foot, caused by deposit of uric acid salts in the joints herniated disk Protrusion of the center (nucleus pulposus) of an intervertebral disk into the spinal canal; ruptured or “slipped” disk kyphosis An exaggerated curve of the spine in the thoracic region; hunchback, humpback lordosis An exaggerated curve of the spine in the lumbar region; swayback osteoarthritis (OA) Progressive deterioration of joint cartilage with growth of new bone and soft tissue in and around the joint; the most common form of arthritis; results from wear and tear, injury, or disease; also called degenerative joint disease (DJD) osteogenic sarcoma A malignant bone tumor; osteosarcoma osteomalacia A softening and weakening of the bones due to vitamin D deficiency or other disease Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Key Terms Disorders (cont’d) osteomyelitis Inflammation of bone and bone marrow caused by infection, usually bacterial osteopenia A lower-than-average bone density, which may foreshadow osteoporosis A condition characterized by reduction in bone density, most common in white women past menopause; predisposing factors include poor diet, inactivity, and low estrogen levels Paget disease Skeletal disease of the elderly characterized by bone thickening and distortion with bowing of long bones; osteitis deformans Pott disease Inflammation of the vertebrae, usually caused by tuberculosis rheumatoid arthritis A chronic autoimmune disease of unknown origin resulting in inflammation of peripheral joints and related structures; more common in women than in men Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Key Terms Disorders (cont’d) rheumatoid factor A group of antibodies found in the blood in cases of rheumatoid arthritis and other systemic diseases rickets Faulty bone formation in children, usually caused by a deficiency of vitamin D sciatica Severe pain in the leg along the course of the sciatic nerve, usually related to spinal nerve root irritation scoliosis A sideways curvature of the spine in any region spondylolisthesis A forward displacement of one vertebra over another (-listhesis means “a slipping”) spondylolysis Degeneration of the articulating portions of a vertebra allowing for spinal distortion, specifically in the lumbar region Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Key Terms Treatment alkaline phosphatase An enzyme needed in the formation of bone; serum activity of this enzyme is useful in diagnosis arthrocentesis Aspiration of fluid from a joint by needle puncture arthrodesis Surgical immobilization (fusion) of a joint; artificial ankylosis arthroplasty Partial or total replacement of a joint with a prosthesis arthroscopy Use of an endoscope to examine the interior of a joint or to perform surgery on the joint; the instrument used is an arthroscope diskectomy Surgical removal of a herniated intervertebral disk; also spelled discectomy orthopedics The study and treatment of disorders of the skeleton, muscles, and associated structures; literally “straight” (ortho) “child” (ped); also spelled orthopaedics reduction of a fracture Return of a fractured bone to a normal position; may be closed (not requiring surgery) or open (requiring surgery) traction The process of drawing or pulling, such as traction of the head in the treatment of injuries to the cervical vertebrae Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Key Terms Drugs antiinflammatory agent Drug that reduces inflammation; includes steroids, such as cortisone, and nonsteroidal antiinflammatory drugs (NSAIDs) bisphonate Agent used to prevent and treat osteoporosis; increases bone mass by decreasing bone turnover. Examples are alendronate (Fosamax) and risedronate (Actonel) nonsteroidal antiinflammatory drug (NSAID) Drug that reduces inflammation but is not a steroid; examples include aspirin and ibuprofen and other inhibitors of prostaglandins, naturally produced substances that promote inflammation selective estrogen receptor modulator (SERM) Drug that acts on estrogen receptors. Raloxifene (Avista) is used to prevent bone loss after menopause. Other SERMs are used to prevent and treat estrogen-sensitive breast cancer Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Supplementary Terms Normal Structure and Function annulus fibrosus The outer ringlike portion of an intervertebral disk calvaria The domelike upper portion of the skull coxa Hip cruciate ligaments Ligaments that cross in the knee joint to connect the tibia and fibula. They are the anterior cruciate ligament (ACL) and the posterior cruciate ligament (PCL). Cruciate means “shaped like a cross” genu The knee glenoid cavity The bony socket in the scapula that articulates with the head of the humerus hallux The great toe Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Supplementary Terms Normal Structure and Function (cont’d) malleolus The projection of the tibia or fibula on either side of the ankle meniscus Crescent-shaped disk of cartilage found in certain joints, such as the knee joint. In the knee, the medial meniscus and the lateral meniscus separate the tibia and femur. (plural: menisci (me-NISkī); meniscus means “crescent”) olecranon The process of the ulna that forms the elbow os Bone (plural: ossa) osseous Pertaining to bone symphysis pubis The anterior pelvic joint, formed by the union of the two pubic bones; also called pubic symphysis Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Supplementary Terms Symptoms and Conditions achondroplasia Decreased growth of cartilage in the growth plate of long bones resulting in dwarfism; a genetic disorder Baker cyst Mass formed at the knee joint by distention of a bursa with excess synovial fluid resulting from chronic irritation bunion Inflammation and enlargement of the metatarsal joint of the great toe, usually with displacement of the great toe toward the other toes bursitis Inflammation of a bursa, a small fluid-filled sac near a joint; causes include injury, irritation, and joint disease; the shoulder, hip, elbow, and knee are common sites carpal tunnel syndrome Numbness and weakness of the hand caused by pressure on the median nerve as it passes through a tunnel formed by carpal bones chondroma A benign tumor of cartilage Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Supplementary Terms Symptoms and Conditions (cont’d) Ewing tumor A bone tumor that usually appears in children 5 to 15 years of age. It begins in the shaft of a bone and spreads readily to other bones. It may respond to radiation therapy, but then returns. Also called Ewing sarcoma exostosis A bony outgrowth from the surface of a bone giant cell tumor A bone tumor that usually appears in children and young adults. The ends of the bones are destroyed, commonly at the knee, by a large mass that does not metastasize hammertoe Change in position of the toe joints so that the toe takes on a claw-like appearance and the first joint protrudes upward, causing irritation and pain on walking hallux valgus Painful condition involving lateral displacement of the great toe at the metatarsal joint. There is also enlargement of the metatarsal head and bunion formation Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Supplementary Terms Symptoms and Conditions (cont’d) Heberden nodes Small, hard nodules formed in the cartilage of the distal joints of the fingers in osteoarthritis hemarthrosis Bleeding into a joint cavity Legg–Calvé–Perthes disease Degeneration (osteochondrosis) of the proximal growth center of the femur. The bone is eventually restored, but there may be deformity and weakness. Most common in young boys. Also called coxa plana multiple myeloma A cancer of blood-forming cells in bone marrow (see Chapter 10) neurogenic arthropathy Degenerative disease of joints caused by impaired nervous stimulation; most common cause is diabetes mellitus; Charcot arthropathy Osgood-Schlatter disease Degeneration (osteochondrosis) of the proximal growth center of the tibia causing pain and tendinitis at the knee osteochondroma A benign tumor consisting of cartilage and bone Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Supplementary Terms Symptoms and Conditions (cont’d) osteochondrosis Disease of a bone's growth center in children; degeneration of the tissue is followed by recalcification osteodystrophy Abnormal bone development osteogenesis imperfecta (OI) A hereditary disease resulting in the formation of brittle bones that fracture easily. There is faulty synthesis of collagen, the main structural protein in connective tissue. osteoma A benign bone tumor that usually remains small and localized Reiter syndrome Chronic polyarthritis that usually affects young men; occurs after a bacterial infection and is common in those infected with HIV; may also involve the eyes and genitourinary tract spondylosis Degeneration and ankylosis of the vertebrae resulting in pressure on the spinal cord and nerve roots; often applied to any degenerative lesion of the spine Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Supplementary Terms Symptoms and Conditions (cont’d) sprain Trauma to a joint involving the ligaments subluxation A partial dislocation talipes A deformity of the foot, especially one occurring congenitally; clubfoot valgus Bent outward varus Bent inward von Recklinghausen disease Loss of bone tissue caused by increased parathyroid hormone; bones become decalcified and deformed, and fracture easily Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Supplementary Terms Diagnosis and Treatment allograft Graft of tissue between individuals of the same species but different genetic makeup; homograft, allogenic graft (see autograft) arthroclasia Surgical breaking of an ankylosed joint to provide movement aspiration Removal by suction, as removal of fluid from a body cavity; also inhalation, such as accidental inhalation of material into the respiratory tract autograft Graft of tissue taken from a site on or in the body of the person receiving the graft; autologous graft (see allograft) calcitonin A hormone from the thyroid gland that decreases resorption (loss) of bone tissue; used in the treatment of Paget disease and osteoporosis; also called thyrocalcitonin chondroitin A complex polysaccharide found in connective tissue; used as a dietary supplement, usually with glucosamine, for treatment of joint pain glucosamine A dietary supplement used in the treatment of joint pain Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Supplementary Terms Diagnosis and Treatment (cont’d) goniometer A device used to measure joint angles and movements (root goni/o means “angle”) iontophoresis Introduction into the tissue by means of electric current, using the ions of a given drug; used in the treatment of musculoskeletal disorders laminectomy Excision of the posterior arch (lamina) of a vertebra meniscectomy Removal of the crescent-shaped cartilage (meniscus) of the knee joint myelogram Radiograph of the spinal canal after injection of a radiopaque dye; used to evaluate a herniated disk osteoplasty Scraping and removal of damaged bone from a joint prosthesis An artificial organ or part, such as an artificial limb Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Abbreviations ACL Anterior cruciate ligament AE Above the elbow AK Above the knee ASF Anterior spinal fusion BE Below the elbow BK Below the knee BMD Bone mineral density C Cervical vertebra; numbered C 1 to C 7 Co Coccyx; coccygeal Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Abbreviations (cont’d) DEXA Dual-energy x-ray absorptiometry (scan) DIP Distal interphalangeal (joint) DJD Degenerative joint disease Fx Fracture HNP Herniated nucleus pulposus IM Intramedullary L Lumbar vertebra; numbered L 1 to L 5 MCP Metacarpophalangeal (joint) MTP Metatarsophalangeal (joint) Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Abbreviations (cont’d) NSAID(s) Nonsteroidal antiinflammatory drug(s) OA Osteoarthritis OI Osteogenesis imperfecta ORIF Open reduction internal fixation ortho, ORTH Orthopedics PCL Posterior cruciate ligament PIP Proximal interphalangeal (joint) PSF Posterior spinal fusion Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Abbreviations (cont’d) RA Rheumatoid arthritis S Sacrum; sacral SERM Selective estrogen receptor modulator T Thoracic vertebra; numbered T 1 to T 12 THA Total hip arthroplasty TKA Total knee arthroplasty TMJ Temporomandibular joint Tx Traction Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

The Skeletal System Axial Skeleton Appendicular skeleton Skull Shoulder girdle Spinal column Arms Thorax Hands Pelvic girdle Legs Feet Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Axial Skeleton • Consists of: – Skull • Cranial bones (8) • Facial bones (14) – Spinal column • Cervical vertebrae (7) • Thoracic vertebrae (12) • Lumbar vertebrae (5) • Sacrum vertebrae (5 fused into 1) • Coccyx vertebrae (4 or 5 fused into 1) Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Axial Skeleton (cont’d) – Thorax • Ribs (12 pair) • True ribs (pairs 1 -7) • False ribs (pairs 8 -12) • Floating ribs (pairs 11 & 12) • Sternum Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Roots for the Skeleton Root crani/o Meaning skull, cranium Example craniometry Definition of Example measurement of the cranium spondyl/o vertebra spondylolysis vertebr/o paravertebral rachi/o vertebra, spinal column spine cost/o rib costochondral destruction and separation of a vertebra near the vertebrae or spinal column fissure (-schisis) of the spine; spina bifida pertaining to a rib and its cartilage rachisis Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Roots for the Skeleton (cont’d) Root sacr/o Meaning sacrum Example presacral Definition of Example in front of the sacrum coccy, coccyg/o coccyx coccygeal* pertaining to the coccyx pelvi/o pelviscope ili/o ilium iliopelvic endoscope for examining the pelvis pertaining to the ilium and pelvis * Note spelling. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Bone Formation • Bones formed from cartilage • Ossification begins at birth and continues through adulthood • Three types of bone cells – Osteoblasts = cells that produce bone – Osteocytes = mature bone cells – Osteoclasts = involved in breakdown of bone tissue • Resorption = process of destroying bone for absorption into circulation Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Structure of Long Bone • Diaphysis = shaft of compact bone tissue – Yellow bone marrow located inside medullary cavity • Epiphysis = ends of spongy bone tissue – Contains red bone marrow – Covered by thin layer of cartilage Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Structure of Long Bone (cont’d) • Metaphysis = region between diaphysis and epiphysis – Contains epiphyseal plate (growth region) • Periosteum = thin layer of fibrous tissue covering outside of bone – Nourishes and protects bone – Generates new bone cells for growth and repair Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Roots for Bones and Joints Root oste/o Meaning bone Example osteopenia Definition of Example deficiency of bone tissue myel/o myeloid pertaining to or resembling bone marrow chondr/o bone marrow; also, spinal cord cartilage chondroblast a cartilage-forming cell arthr/o joint arthrosis synov/i synovial fluid, joint, or membrane bursa asynovia joint; condition affecting a joint lack of synovial fluid peribursal around a burs/o Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Joints • Known as articulations • Classified by amount of movement they allow – Suture = immoveable joint • Held together by fibrous connective tissue – Symphysis = slightly moveable joint • Connected by fibrous cartilage • Synovial joint = freely moveable joint – Allow for wide range of movements Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Joints (cont’d) • Synovial fluid contained within diarthrotic cavity – Protects joint by cushioning and lubricating – Produced by synovial membrane • Ligaments connect articulating bones – Stabilize and strengthen synovial joints Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Clinical Aspects of the Skeleton • Orthopedics = study of diseases of skeletal and muscular systems • Detection: radiographs, CT, MRI, changes in blood levels of calcium and alkaline phosphatase Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Clinical Aspects of the Skeleton (cont’d) • Infections – Osteomyelitis = inflammation of bone • Caused by pus-forming bacteria – Tuberculosis • May spread to bone, especially long bones, wrist, and ankle bones • If in spine, called Pott disease Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Clinical Aspects of the Skeleton (cont’d) • Fractures – Break in bone • Usually caused by trauma – Effects depend on: • Location • Severity • Closed fracture (skin not broken) • Open fracture (accompanied by skin wound) Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

$Fracture Treatment • Reduction of fracture – Realignment of broken bone – Closed -$

Fracture Treatment • Reduction of fracture – Realignment of broken bone – Closed - no surgery required – Open - requires surgery for proper positioning • Healing phase – Splint or cast often needed – Bone immobilized – Traction Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Metabolic Bone Diseases • Osteoporosis = loss of bone mass – Weakens bones – Most susceptible: Women over 50 – Possible prevention • Adequate calcium intake • Weight-bearing exercises – Diagnosed and monitored with DEXA scan Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Metabolic Bone Diseases (cont’d) • Osteomalacia = softening of bone tissue – Possible causes: • Deficiency of vitamin D • Renal disorders • Liver disease • Certain intestinal disorders Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Metabolic Bone Diseases (cont’d) • Paget disease (osteitis deformans) – Disorder of aging – Bones overgrown and thicker – Usually involves bones of axial skeleton Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Neoplasms • Osteogenic sarcoma = highly malignant tumor – Most commonly occurs in growing region – Often requires amputation • Chondrosarcoma = cartilage tumor – May require amputation • Signs of bone tumors – Pain – Easy fracture – Increases in serum calcium and alkaline phosphatase Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Arthritis • Joint inflammation – Most common form is osteoarthritis • Joint cavity narrows • Bone thickens • Cartilage may crack and break loose • Treatment – Analgesics – Antiinflammatory agents – Physical therapy Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Rheumatoid Arthritis • Systemic inflammatory disease of joints – Cause may involve immunologic reactions – Overgrowth of synovial membrane – Synovial fluid accumulates, causes joint swelling – Degeneration of bone eventually causes ankylosis • Treatment – Rest – Physical therapy – Analgesics – Antiinflammatory drugs Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Gout • Increased uric acid in blood causes salt deposits in joints • May result from – Metabolic disturbance – Secondary effect of another disease • Treatment – Drugs • Suppress formation of uric acid • Increase elimination of uric acid Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Joint Repair • Arthroscopy = examination of joint interior and perform surgical repairs • Arthroplasty = reconstruction or replacement of joint • Arthrodesis = fusion of joint Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Disorders of the Spine • Ankylosing spondylitis – Disease of spine mainly in males – Joint cartilage destroyed – Eventually disks between vertebrae calcify – Bones fuse – Starts “low” and progresses upward Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Disorders of the Spine (cont’d) • Spondylolisthesis – Forward sliding of vertebrae over vertebrae below • Spondylolysis = degeneration of joint structures that stabilize vertebrae Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Herniated Disk • Central mass of intervertebral disk protrudes into spinal column • Commonly occurs: – Lumbosacral region – Cervical regions • Results from injury or heavy lifting • Severe cases may require diskectomy Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Curvatures of the Spine • Kyphosis = exaggerated curve in thoracic region, “hunchback” • Lordosis = exaggerated curve in lumbar region, “swayback” • Scoliosis = lateral curvature of spine in any region Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Pretest 2. The root myel/o refers to the spinal cord. Used in reference to bones it means: (a) bone marrow (b) joint (c) bone shaft (d) membrane Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins