Medical Terminology A WordBuilding Approach Jane Rice RN

Medical Terminology A Word-Building Approach Jane Rice, RN, CMA-C Chapter 6 Skeletal System

Figure 6. 1 The anterior and posterior human skeleton. Medical Terminology, 6 e By

Anatomy and Physiology Overview • The skeletal system consists of cartilage, ligaments, tendons, and 206 bones. • Together these structures make up the framework or skeleton of the body. • The skeleton is divided into the axial skeleton (consisting of 80 bones, the principal bones being the skull, spine, ribs, and sternum) and the appendicular skeleton (consisting of 126 bones, the primary bones being the shoulder girdle, arms, hands, pelvic girdle, legs, and feet).

Bones • The primary organs of the skeletal system. • Bones are 50% water and 50% osseous tissue.

Bones • Classification of bones – Flat – Long – Short – Irregular – Sesmoid – Sutural or wormian

Figure 6. 2 Classification of bones by shape. Medical Terminology, 6 e By Jane

Medical Terminology, 6 e By Jane Rice Copyright © 2008 by Pearson Education, Inc.

Bones • Functions of bones – Provide protection for internal organs. – Provide shape, support, and framework of the body. – Serve as a storage place for mineral salts, calcium, and phosphorus. – Play an important role in the formation of blood cells (hematopoiesis) which takes place in the bone marrow. – Provide areas for the attachment of skeletal muscles. – Help to make movement possible through articulation.

Figure 6. 3 The features found in a long bone. Medical Terminology, 6 e

Bones • Structure of a Long Bone – Epiphysis • Ends of a developing bone. – Diaphysis • Shaft of a long bone. – Periosteum • Membrane that covers bone except at their articular surfaces. – Compact • Dense, hard layer of bone.

Bones • Structure of a Long Bone – Medullary canal • Narrow cavity throughout the length of the diaphysis. – Endosteum • Membrane that lines the medullary canal and contains bone marrow. – Cancellous or spongy bone • Reticular tissue that makes up most of the volume of bone.

Bones • Bone Markings – Common terms used to describe bone structure and their role in joining bones together, providing areas for muscle attachments, and serving as passageways for blood vessels, ligaments, and nerves.

CONDYLE

CREST

FISSURE

FORAMEN

FOSSA

HEAD

MEATUS

PROCESS

SINUS

SULCUS

3) Tubercle: Small rounded projection 4) Tuberosity: large rounded or roughened projection 5) Trochanter: very large, blunt projection (only on femur) Proximal Tibia

Joints and Movement • Also known as an articulation, the place where two bones connect. • Joints are classified as follows: – Synarthrosis • Does not permit movement. – Amphiarthrosis • Permits very slight movement. – Diarthrosis • Allows free movement in a variety of directions.

Joints and Movement • Types of body movement that occur at the diarthrotic joints: – Abduction • Moving a body part away from the middle. – Adduction • Moving a body part toward the middle. – Circumduction • Moving a body part in a circular motion. – Dorsiflexion • Bending a body part backward.

Figure 6. 4 Knee joint. Medical Terminology, 6 e By Jane Rice Copyright ©

Figure 6. 5 Types of body movements. Medical Terminology, 6 e By Jane Rice

Classification of Joints Animation Click here to view an animation showing the classification of joints. Back to Directory

Movement of Joints Animation Click here to view an animation showing joint movement. Back to Directory

Adduction Animation Click here to view an animation of adduction. Back to Directory

Extension Animation Click here to view an animation of extension. Back to Directory

Circumduction Animation Click here to view an animation of circumduction. Back to Directory

Dorsiflexion Animation Click here to view an animation of dorsiflexion. Back to Directory

Joints and Movement • Types of body movement that occur at the diarthrotic joints: – Eversion • Turning outward. – Extension • Straightening a flexed limb. – Flexion • Bending a limb. – Inversion • Turning inward.

Opposition Animation Click here to view an animation of hand opposition. Back to Directory

Flexion Animation Click here to view an animation of flexion. Back to Directory

Inversion Animation Click here to view an animation of inversion. Back to Directory

Pronation Animation Click here to view an animation of pronation Back to Directory

Joints and Movement • Types of body movement that occur at the diarthrotic joints: – Pronation • Lying prone or face downward. – Protraction • Moving a body part forward. – Retraction • Moving a body part backward.

Joints and Movement • Types of body movement that occur at the diarthrotic joints: – Rotation • Moving a body part around a central axis. – Supination • Lying supine or face upward.

Rotation Animation Click here to view an animation of rotation. Back to Directory

Vertebral Column • Composed of a series of bones called vertebrae. They are connected in such a way as to form four spinal curves.

Vertebral Column • These curves consist of the: – Cervical • The first 7 vertebrae. – Thoracic • The next 12 vertebrae. – Lumbar • The next 5 vertebrae. – Sacral • Consists of the sacrum and coccyx (tailbone).

Figure 6. 6 Vertebral (spinal) column. Medical Terminology, 6 e By Jane Rice Copyright

Figure 6. 7 Normal development of posture and spinal curves. (A) Infant 2– 3 months: Holds head erect when held upright; thoracic kyphosis when sitting. (B) 6– 8 months: Sits without support; spine is straight. (C) 10– 15 months: Walks independently; straight spine. (D) Toddler: Protruding abdomen; lumbar lordosis. (E) School-age child: Height of shoulders and hips is level; balanced thoracic convex and lumbar concave curves.

The Male and Female Pelvis • The pelvis is the lower portion of the trunk of the body. • It is bound anteriorly and laterally by the hip bones (ilium, pubis, and ischium) and posteriorly by the sacrum and coccyx.

The Male and Female Pelvis • The Male Pelvis – Shaped like a funnel; forms a narrower outlet than the female. – Is heavier and stronger than the female pelvis, making it suitable for lifting and running.

Figure 6. 8(a) The male pelvis (android) is shaped like a funnel, forming a narrower outlet than the female. Medical Terminology, 6 e By Jane Rice Copyright © 2008 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ 07458

Male Pelvis Animation Click here to view an animation of the male pelvis. Back to Directory

The Male and Female Pelvis • The Female Pelvis – Shaped like a basin; may be oval to round, and is wider than the male pelvis. – It is constructed to accommodate the fetus during pregnancy and to facilitate its downward passage through the pelvic cavity in childbirth. – It is broader and lighter than the male pelvis.

Figure 6. 8(b) The female pelvis (gynecoid) is shaped like a basin. Medical Terminology,

Female Pelvis Animation Click here to view an animation of the female pelvis. Back to Directory

Life Span Considerations: The Child • Bones begin to develop during the second month of fetal life as cartilage cells enlarge, break down, disappear, and are replaced by bone-forming cells called osteoblasts. • This is known as endochondral ossification. • Bone cells deposit organic substances in the spaces vacated by cartilage to form bone matrix.

Life Span Considerations: The Child • As the process proceeds, blood vessels form within the bone and deposit salts that serve to harden the developing bone. • The bones of children tend to bend before breaking, but when they break, they heal more quickly. • This occurs because there is a rich blood supply to the bones, their periosteum is thick, and osteogenic activity is high.

Life Span Considerations: The Child • A high calcium content is critical to the strength of bones. • The portions of developing bones are as follows: – Epiphyseal plate • The center for longitudinal bone growth in children. – Epiphyses • The ends of the long bones. – Diaphysis • The shaft of long bones.

Figure 6. 9 Epiphyseal plate (arrows). (Courtesy of Teresa Resch) Medical Terminology, 6 e

Life Span Considerations: The Older Adult • Women build bones until about the age of 35, then begin to lose about 1% of bone mass annually. Men start losing bone mass 10 to 20 years later. • Most of the changes in the skeletal system associated with age occur in the connective tissue.

Life Span Considerations: The Older Adult • Loss of bone mass and strength is due to the loss of bone mineral content during later life. Calcium salts may be deposited in the matrix and cartilage becomes hard and brittle. • Age-related osteoporosis, loss of bone mass, is often seen in older women and men.

Life Span Considerations: The Older Adult • Low levels of calcium can: – Make older people susceptible to osteoporosis and stress fractures. – Result in slower, impaired bone healing due to osteoblasts being less able to use calcium to restructure bone tissue.

Building Your Medical Vocabulary • Medical Words and Definitions with Word Parts • These terms (shown in black in the Building Your Medical Vocabulary feature) can be analyzed and defined by dividing them into component parts. 1. 2. 3. 4. Prefixes (P) Roots (R) Combining Forms (CF) Suffixes (S)

Building Your Medical Vocabulary • • Medical Words and Definitions without Word Parts These terms (shown in pink in the Building Your Medical Vocabulary feature) are not usually analyzed and defined by dividing them into component parts.

Figure 6. 10 This girl has a long leg cast, which was applied after surgery to correct her clubfoot. Medical Terminology, 6 e By Jane Rice Copyright © 2008 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ 07458

Figure 6. 11 (A) Genu valgum, or knock-knee. Note that the ankles are far apart when the knees are together. (B) Genu varum, or bowleg. The legs are bowed so that the knees are far apart as the child stands. Medical Terminology, 6 e By Jane Rice Copyright © 2008 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ 07458

Figure 6. 12 Hammertoe. Medical Terminology, 6 e By Jane Rice Copyright © 2008

Figure 6. 13 Abscess of the brain due to osteomyelitis. Medical Terminology, 6 e

Figure 6. 14 Typical hand deformities associated with rheumatoid arthritis. (Reprinted with permission of Photo Researchers, Inc. ) Medical Terminology, 6 e By Jane Rice Copyright © 2008 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ 07458

Figure 6. 15 Does this child have legs of different lengths or scoliosis? Look at the level of the iliac crests and shoulders to see if they are level. See the more prominent crease at the waist on the right side? This child could have scoliosis. Medical Terminology, 6 e By Jane Rice Copyright © 2008 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ 07458

Figure 6. 16 Traction is the application of a pulling force to maintain bone alignment during fracture healing. Different fractures require different types of traction. (A) Skin traction (also called straight traction) such as Buck’s traction shown here, is often used for hip fractures. (B) Balanced suspension traction is commonly used for fractures of the femur. (C) Skeletal traction, in which the pulling force is applied directly to the bone, may be used to treat fractures of the humerus. Medical Terminology, 6 e By Jane Rice Copyright © 2008 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ 07458

Drug Highlights • Anti-inflammatory agents are classified as steroidal (corticosteroids) and nonsteroidal. Used to relieve swelling, tenderness, redness, and pain of inflammation. • Corticosteroids – Steroid substances with potent anti-inflammatory effects. • Nonsteroidal (NSAIDs) – Agents that are used to treat arthritis and related disorders.

Drug Highlights • Disease-Modifying Antirheumatic Drugs (DMARDS) – May influence the course of the disease progression. • Cox-2 inhibitors – Cyclooxygenase (COX) is an enzyme involved in normal cellular function and also in the inflammatory response.

Drug Highlights • Antitumor Necrosis Factor Drugs (Anti-TNF) – Slows or halts the destruction of the joint by disrupting the activity of tumor necrosis factor (TNF), a substance involved in the body’s immune response. • Agents Used to Treat Gout – Acute attacks are treated with colchicines. – Once acute attack of gout is controlled, drug therapy to control hyperuricemia can be initiated.

Drug Highlights • Agents Used to Treat or Prevent Postmenopausal Osteoporosis – Medications reduce the activity of the cells that cause bone loss and increases the amount of bone in most patients. • Analgesics are agents that relieve pain without causing loss of consciousness. – They are classified as narcotic and non-narcotic.

Diagnostic and Lab Tests • Arthrography – Diagnostic examination of a joint in which air and then a radiopaque contrast medium are injected into the joint space and x-rays are taken. • Arthroscopy – Examination of internal structures of a joint via an arthroscope. Usually done after arthrography and before joint surgery.

Arthroscopy Video Click here to view a video on the topic of arthroscopy. Back to Directory

Diagnostic and Lab Tests • Goniometry – Measurement of joint movement and angles via a goniometer. • Photon Absorptiometry – Bone scan that uses a low beam of radiation to measure bone-mineral density and bone loss in the lumbar vertebrae to diagnose and monitor osteoporosis.

Figure 6. 17 Using a goniometer to measure joint ROM. Medical Terminology, 6 e

Diagnostic and Lab Tests • Thermography – Process of recording heat patterns of the body surface. • X-ray – Examination of bones by the use of an electromagnetic wave of high energy produced by the collision of a beam of electrons with a target in a vacuum tube. • Alkaline Phosphatase Blood Test – Blood test to determine the level of alkaline phosphatase.

Diagnostic and Lab Tests • Antinuclear Antibodies (ANA) – Present in a variety of immunologic diseases. • Bone Mineral Density Test (BMD) – Used to measure bone mass or bone mineral density. – Different machines measure density in different bony areas. • C-Reactive Protein Blood Test – Positive results may indicate RA, acute inflammatory changes, and widespread metastasis.

Diagnostic and Lab Tests • Calcium (Ca) Blood Test – An increase in calcium levels in the blood may indicate metastatic bone cancer, acute osteoporosis, prolonged immobilization, and the healing of fractures. Levels may be decreased in osteomalacia and rickets. • Phosphorus (P) Blood Test – Levels of phosphorus in blood may increase in osteoporosis and fracture healing.

Diagnostic and Lab Tests • Serum Rheumatoid Factor (RF) – An immunoglobulin present in the serum of 50 – 95% of adults with RA. • Uric Acid Blood Test – Uric acid is increased in gout, arthritis, multiple myeloma, and rheumatism.

Abnormal Curvatures of the Spine • Kyphosis – Normal thoracic curvature becomes exaggerated, producing a humpback appearance, which may be caused by a congenital defect, a disease process, a malignancy, compression fracture, faulty posture, etc.

Figure 6. 18(a) Abnormal curvatures of the spine: (A) kyphosis Medical Terminology, 6 e

Abnormal Curvatures of the Spine • Lordosis – An abnormal anterior curvature of the spine. – The condition may be referred to as swayback, as the abdomen and buttocks protrude due to an exaggerated lumbar curvature.

Figure 6. 18(b) Abnormal curvatures of the spine: (B) lordosis Medical Terminology, 6 e

Abnormal Curvatures of the Spine • Scoliosis – An abnormal lateral curvature of the spine, which usually appears in adolescence, during a period of rapid growth.

Figure 6. 18(c) Abnormal curvatures of the spine: (C) scoliosis. Medical Terminology, 6 e

Arthritis • Inflammation of one or more joints. • Treatment varies and is aimed at reducing pain and discomfort along with preventing disabilities. • Medications, exercise, activity modifications, and surgery are included.

Arthritis • Types of arthritis include: – Osteoarthritis • The most common form of arthritis in the U. S. , resulting from years of accumulated wear and tear of weight-bearing joints and those of the fingers. – Gout • A hereditary metabolic disease seen most often in men over the age of forty. – Rheumatoid arthritis • An autoimmune disorder that affects both males and females of all ages.

Arthritis Video Click here to view a video on the topic of arthritis. Back to Directory

Figure 6. 19 X-ray showing typical joint changes associated with osteoarthritis. (Source: Getty Images/Stone Allstock. ) Medical Terminology, 6 e By Jane Rice Copyright © 2008 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ 07458

Figure 6. 20 Gout of the finger joint. (Source: Reprinted from the Clinical Slide Collection on the Rheumatic Diseases, © 1991, 1995. Used by permission of the American College of Rheumatology. ) Medical Terminology, 6 e By Jane Rice Copyright © 2008 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ 07458

Figure 6. 21 Multisystem effects of rheumatoid arthritis. Medical Terminology, 6 e By Jane

Carpal Tunnel Syndrome • Results from pressure on the median nerve, resulting in numbness, pain, and eventually, hand weakness. • Occurs because of repetitive movement of the wrist. • Treatment includes night splints, modifying the work area, medications, and surgery.

Figure 6. 22 Cross-section of wrist showing tendons and nerves involved in carpal tunnel syndrome. Medical Terminology, 6 e By Jane Rice Copyright © 2008 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ 07458

Carpal Tunnel Syndrome Video Click here to view a video on the topic of carpal tunnel syndrome. Back to Directory

Fractures • Fractures are classified according to their external appearance, the site of the fracture, and the nature of the crack or break in the bone.

$Figure 6. 23 Various types of fractures. Medical Terminology, 6 e By Jane Rice$

Fractures • Classification of Fractures: – Closed or simple – Open or compound – Comminuted – Transverse – Greenstick

$Figure 6. 24 Open fracture of the wrist. (Source: Pearson Education/PH College) Medical Terminology,$

Figure 6. 24 Open fracture of the wrist. (Source: Pearson Education/PH College) Medical Terminology, 6 e By Jane Rice Copyright © 2008 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ 07458

Fractures • Classification of Fractures: – Spiral – Colles’ – Pott’s – Compression – Epiphyseal

Bone Healing Animation Click here to view an animation of bone healing. Back to Directory

Osteoporosis • Condition characterized by the progressive loss of bone density and thinning of bone tissue. • Occurs when the body fails to form enough new bone, or when too much old bone is reabsorbed by the body, or both.