chapter 6 the skeletal system: the framework

Anatomy, Physiology, & Disease

Anatomy, Physiology, & Disease

An Interactive Journey for Health Professionals

Copyright ©2009 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458

All rights reserved.

Anatomy, Physiology, and Disease: An Interactive Journey for Health ProfessionalsBruce J. Colbert, Jeff E. Ankney, and Karen T. Lee

Chapter 6The Skeletal System:

The Framework




Multimedia DirectoryMultimedia Directory

Slide 40 Joint Classification AnimationSlide 41 Joint Movement AnimationSlide 45 Ankle Dorsiflexion/Extension AnimationSlide 46 Ankle Inversion/Eversion AnimationSlide 47 Elbow Pronation/Supination AnimationSlide 48 Elbow Flexion/Extension AnimationSlide 49 Hand Opposition AnimationSlide 50 Humerus Adduction/Abduction AnimationSlide 51 Humerus Circumduction AnimationSlide 52 Humerus Rotation AnimationSlide 53 Wrist Circumduction AnimationSlide 54 Wrist Flexion/Extension Animation




Multimedia Directory Multimedia Directory (cont’d)(cont’d)

Slide 60 Skeletal System ExerciseSlide 61 Skull Bones ExerciseSlide 92 Bone Healing AnimationSlide 97 Osteoporosis VideoSlide 98 Arthritis VideoSlide 123 Radiologic Technology Video




IntroductionIntroduction

•Skeletal system provides support and allows us to move

•Bones (also called osseous tissue) that make up skeleton protects soft body parts, produces blood cells, and acts as storage unit for minerals and fat

•There are 206 bones in adult skeleton, along with cartilage, ligaments, and joints




Learning ObjectivesLearning Objectives

•Describe the functions of the skeletal system

•Identify and describe the anatomy and physiology of bone

•Locate and describe the various bones within the body




Learning Objectives Learning Objectives (cont’d)(cont’d)

•Differentiate between bone, cartilage, ligaments, and tendons

•Locate and describe the various joints and types of movement of the body

•Explain common diseases and disorders of the skeletal system




Pronunciation GuidePronunciation Guide

Appendicular skeleton

Arthritis

Articulation

Axial skeleton

Cancellous bone

Diaphysis

Epiphyseal plate

Epiphysis

Hemopoiesis

Medullary cavity

(app en DIK yoo lahr SKELL eh ton)

(ahr THRYE tiss)

(AHR tick you lay shun)

(AK see al SKELL eh ton)

(CAN cell us)

(dye AFF ih siss)

(eh piff ih SEE al)

(eh PIFF ih siss)

(HEME ah poy ee sus)

(MED uh lair ee)

Click on the megaphone icon before each item to hear the pronunciation.




Pronunciation Guide Pronunciation Guide (cont’d)(cont’d)

Osseous tissue

Ossification

Osteoarthritis

Osteocytes

Osteons

Periosteum

Synovial fluid

Trabeculae

Vertebrae

(OSS see us)

(OSS siff ih cay shun)

(OSS tee oh ahr THRYE tiss)

(OSS tee oh site)

(OSS tee ons)

(pair ee OSS tee um)

(sin OH vee al)

(tra BECK you la)

(VER the bray)

Click on the megaphone icon before each item to hear the pronunciation.




BonesBones

•Are primary components of skeleton

•Although composed of non-living minerals such as calcium and phosphorous, bones are very much alive, constantly building and repairing themselves

•Word ‘bone’ comes from Greek meaning “dried up body”




General Bone ClassificationsGeneral Bone Classifications

•Classified according to their shape–Long bones: longer than they are wide and

can be found in arms and legs–Short bones: fairly equal in width and length

and found mostly in wrists and ankles–Flat bones: thinner and can be either flat or

curved; can be plate-like in nature and would include skull, ribs, and sternum (breast bone)

–Irregular bones: like parts of jigsaw puzzle, odd in shape, and include hip bone and vertebrae




Figure 6-1 Various bone shapes.




Bone AnatomyBone Anatomy

•Periosteum–Tough and fibrous connective tissue covering

bone–Contains blood vessels which transport blood

and nutrients to nurture bone cells –Also contains lymph vessels and nerves–Acts as anchor point for ligaments and

tendons




Bone Anatomy Bone Anatomy (cont’d)(cont’d)

•Epiphysis and diaphysis –Epiphysis: formed by increase in size of both

ends of long bone–Diaphysis: region running between two

epiphyses; hollow area called medullary cavity acts as storage area for bone marrow

•Bone marrow–Yellow marrow: has high fat content; can

convert to red marrow in an emergency–Red marrow: produces red blood cells




Figure 6-2 Basic bone anatomy.




Bone TissueBone Tissue

•Compact bone–Dense, hard tissue that composes shafts of

long bones and forms outer layer of other bone types

–Tightly packed material within tissue makes for dense and strong structure

–Material forms microscopic, cylindrical shaped units called osteons, or Haversian systems




Bone Tissue Bone Tissue (cont’d)(cont’d)

•Each units has mature bone cells (osteocytes) forming concentric circles around blood vessels

•Area around osteocyte is filled with protein fibers, calcium, and other minerals

•Osteons run parallel to each other with blood vessels literally connecting with them to ensure sufficient oxygen and nutrients for bone cell




Bone Tissue Bone Tissue (cont’d)(cont’d)

•Spongy (cancellous) bone–Arranged in bars and plates called trabeculae–Irregular holes between trabeculae make bone

lighter in weight and provide space for red bone marrow, which produces red blood cells

–Holes give bone spongy appearance




Figure 6-3 Comparison of compact and spongy bone.




Surface Structure of BonesSurface Structure of Bones

•Bone is not perfectly smooth; has variety of projections, bumps, and depressions–Projections act as points of attachment for

muscles, ligaments, or tendons–Grooves and depressions act as pathways for

nerves and blood vessels

•Projecting structures and depressions can work together as joining or articulation points to form joints such as ball and socket joint in hip




Table 6-1 Bone Features




Bone Growth and RepairBone Growth and Repair

•Ossification: describes formation of bone in body

•Bones grow longitudinally to develop height and horizontally (wider and thicker) so they can more efficiently support body weight and any other weight we support




Bone Growth and Repair Bone Growth and Repair (cont’d)(cont’d)

•Cell types involved in bone formation and growth–Osteoprogenitor cells–Osteoblasts–Osteocytes–Osteoclasts





•Osteoprogenitor cells: non-specialized cells found in periosteum, endosteum, and central canal of compact bones; can turn into other types of cells as needed

•Osteoblasts: cells that actually form bones; arise from non-specialized osteoprogenitor cells and are cells that secrete a matrix of calcium with other minerals that give bone its typical characteristics





•Osteocytes: considered mature bone cells that started as osteoblasts; osteoblasts surround themselves with matrix to then become mature osteocytes

•Osteoclasts: believed to originate from type of white blood cell called monocyte found in red bone marrow; job is to tear down bone material and help move calcium and phosphate into blood





•Bone development begins when we are embryos through intramembranous and endochondral ossification

•Intramembranous ossification occurs when bone develops between two sheets composed of fibrous connective tissue





•Cells from connective tissue turn into osteoblasts and form matrix while other osteoblasts create compact bone over surface of spongy bone; once matrix surrounds osteoblasts they become osteocytes, which is how bones of skull develop





•Majority of bones form through endochondral ossification–Shaped cartilage replaced by bone–Periosteum surrounds diaphysis of cartilage

bone as cartilage itself begins to break down

•Osteoblasts come into region and create spongy bone in area that is then referred to as primary ossification center





•Other osteoblasts begin to form compact bone under periosteum; osteoclasts break down spongy bone of diaphysis to create medullary cavity





•Epiphyseal plate (growth plate)–After we are born, epiphysis on long bones

continues to grow–Plate is thin band of cartilage formed between

primary and secondary ossification centers –Plate exists as long as bones need to

lengthen and widen; controlled by hormones, plate will eventually ossify and stop growth process




Figure 6-4 Endochondral ossification of long bone.




Pathology Connection: Osteoporosis Pathology Connection: Osteoporosis

•As we age breakdown of bone becomes greater than formation of new bone (causing bone mass to gradually decrease)

•Bones become lighter and weaker, with holes in spongy bone becoming more prominent; weakened bones more prone to breakage; condition of decreasing bone density called osteoporosis




Pathology Connection: Osteoporosis Pathology Connection: Osteoporosis (cont’d)(cont’d)

•Loss of bone mass can be slowed down by–Increasing calcium (forms matrix of bone),

fluoride, and vitamin D (helps body absorb ingested calcium from digestive tract) in diet, particularly in formative years

–Eliminating smoking and decreasing caffeine consumption (both aid in calcium depletion)

–Engaging in weight-bearing exercise–Taking medications to increase bone mass (such

as alendronate)




CartilageCartilage

•Special form of dense connective tissue that can withstand fair amount of flexing, tension, and pressure

•Flexible part of nose and ears are cartilage

•Also makes flexible connection between bones, as between ribs and sternum, allowing chest flexion during deep breathing




Cartilage Cartilage (cont’d)(cont’d)

•Acts as cushion between bones; articular cartilage located on ends of bones and acts as shock absorber, preventing ends from grinding together when you move

•In this location, small sacs, called bursa, secrete lubricant called synovial fluid

•Joints can still wear out and become inflamed despite all this protection, resulting in arthritis or osteoarthritis




Figure 6-5 Articular cartilage and synovial joint.




Joints and LigamentsJoints and Ligaments

•When two or more bones join together they form a joint or articulation

•Articulating joints held together, yet still movable; accomplished by special connective tissue called ligaments

• Ligaments: tough, whitish bands that connect from bone to bone and can withstand heavy stress

•Tendons: cord-like structures that attach muscle to bone




Joints and Ligaments Joints and Ligaments (cont’d)(cont’d)

•Types of synovial joints –Pivot joint: turnstile movement in neck and

forearm–Ball and socket joint: hip and shoulder; all

forms of movement, including rotation–Hinge joint: allow opening and closing

movement in knees and elbows–Gliding joint: wrists and ankles; provides

sliding back and forth movement




Joints and Ligaments Joints and Ligaments (cont’d)(cont’d)

•Types of synovial joints –Saddle joint: shaped like saddle, found in

thumb; can rock up and down or side to side–Condyloid joint: oval shaped bone end fitting

into elliptical cavity in other bone so there is movement from one plane to another but no rotation as found in fingers and toes

–Ellipsoidal joint: provide two axes of movement through same bone like joint formed at wrist with radius and ulna




Figure 6-6 Types of joints.




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Joint Classification AnimationJoint Classification Animation




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Joint Movement AnimationJoint Movement Animation




Movement ClassificationsMovement Classifications

•Flexion: bending a joint and decreasing angle between involved bones

•Extension: straightening a joint

•Plantar flexion: pointing toes down

•Dorsiflexion: bending foot up toward body

•Abduction: moving away from body’s midline

•Adduction: moving toward midline of body




Movement Classifications Movement Classifications (cont’d)(cont’d)

•Inversion: turning foot inward toward other foot

•Eversion: turning foot outward away from opposing foot

•Supination: turning hand palm up

•Pronation: turning hand palm down

•Circumduction: circular arm movement of a pitcher




Figure 6-7 Classification of joint movements.




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Ankle Dorsiflexion/Extension Ankle Dorsiflexion/Extension AnimationAnimation




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Ankle Inversion/Eversion Ankle Inversion/Eversion AnimationAnimation




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Elbow Pronation/Supination Elbow Pronation/Supination AnimationAnimation




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Elbow Flexion/Extension Elbow Flexion/Extension AnimationAnimation




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Hand Opposition AnimationHand Opposition Animation




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Humerus Adduction/Abduction Humerus Adduction/Abduction AnimationAnimation




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Humerus Circumduction Humerus Circumduction AnimationAnimation




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Humerus Rotation AnimationHumerus Rotation Animation




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Wrist Circumduction AnimationWrist Circumduction Animation




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Wrist Flexion/Extension Wrist Flexion/Extension AnimationAnimation




Pathology Connection: Pathology Connection: Common Joint Disorders Common Joint Disorders

•Types of Arthritis –Osteoarthritis: when a joint “wears out;” risk

factors include sports injury, trauma, repetitive motion, obesity, and aging

–Rheumatoid arthritis: autoimmune disease affecting joints

–Septic arthritis: infection in a joint–Gout: metabolic disorder where uric acid

crystals deposit in connective tissues and synovial fluid




Pathology Connection: Pathology Connection: Common Joint Disorders Common Joint Disorders (cont’d)(cont’d)

•Inflammation can also develop in other structures near joint–Bursitis: inflammation of a bursa (due to

infection or repetitive motion)–Tendonitis (tendonitis): inflammation of a

tendon (usually due to repetitive movement)

•Treatments: rest, analgesics, application of cold and heat, and sometimes steroid injections




Pathology Connection: Pathology Connection: Common Joint Disorders Common Joint Disorders (cont’d)(cont’d)

•Rotator cuff tear–Rotator cuff is group of muscles that hold

head of humerus in shoulder socket–Activities that stress shoulder can cause

tendons attaching rotator cuff to tear–Treatment often involves surgery




The SkeletonThe Skeleton

•Two main sections–Axial skeleton: bones of bony thorax, spinal

column, hyoid bone, bones of middle ear, and skull; protect body organs and total 80 bones

–Appendicular skeleton: bones of arms, legs, hips, and shoulders and total 126 bones

–Half of bones in body found in hands and feet




Figure 6-8 The anterior and posterior human skeleton.




Click here to view an interactive labeling exercise of the skeletal system. Back to Directory

Skeletal System ExerciseSkeletal System Exercise




Click here to view an interactive labeling exercise of the bones of the skull.

Skull Bones ExerciseSkull Bones Exercise

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The Human SkullThe Human Skull

•Protects and houses brain; has openings needed for sensory organs such as eyes, nose, and ears

•Forms mouth, common passageway for both respiratory and digestive systems

•Fibrous cartilage allows for some flexibility of bones surrounding brain




Figure 6-9 Bones of the skull.




Figure 6-9 (continued) Bones of the skull.




The Bony ThoraxThe Bony Thorax

•Bones of chest form thoracic cage that provides support and protection for heart, lungs, and great blood vessels

•Cage is flexible due to cartilaginous connections that allow for movement during breathing

•Sternum is location for conducting chest compressions during CPR, compressing heart between sternum and bones of vertebrae




Figure 6-10 The bony thorax.




The Spinal ColumnThe Spinal Column

•Also called vertebral column; is superhighway for information traveling to and from central nervous system




The Spinal ColumnThe Spinal Column

•Individual bones, or vertebrae, are numbered and classified according to body region where they are located–7 cervical vertebrae in neck area–12 thoracic vertebrae in chest area–5 lumbar vertebrae in waist area–5 sacral vertebrae below waist–3 - 5 small fused bones at very tail-end that

form coccyx




Figure 6-11 The spinal column.




The Spinal Column The Spinal Column (cont’d)(cont’d)

•Initial curvature of back begins in newborn period; concave, like fetal position

•Curvature changes as infant learns to hold its head up, again as it begins to walk, curving in opposite direction

•From about age 2 onward, vertebral column will present with secondary curvature in neck, primary in upper back, secondary in lower back, and primary in mid buttocks and tailbone region




Pathology Connection: Pathology Connection: Spinal Column Abnormalities Spinal Column Abnormalities

•Herniated disk: when soft central portion of intervertebral disk is forced through outer covering of disk–May cause compression on nearby nerves–Commonly occurs in low back–Symptoms may include: low back pain and

radiating pain down sciatic nerve to buttock, leg, and foot on one side of body




Pathology Connection: Spinal Column Pathology Connection: Spinal Column Abnormalities Abnormalities (cont’d)(cont’d)

•Abnormal spinal curvature–Kyphosis: exaggerated “humpback;” usually in

thoracic spine–Lordosis: exaggerated “swayback;” usually in

lumbar spine–Scoliosis: abnormal sideways curve of any

portion of spine




Pathology Connection: Spinal Column Pathology Connection: Spinal Column Abnormalities Abnormalities (cont’d)(cont’d)

•Key to successful treatment is early detection; spinal corrections can be accomplished through, exercise good nutrition with weight control, bracing, corrective shoes (so legs are of equal length), or surgery




Figure 6-12 Spinal disfigurements. (A) Spinal disfigurements compared to healthy spinal curves.




Figure 6-12 (continued) Spinal disfigurements. (B) Kyphosis. (Source: Phototake NYC.)




Figure 6-12 (continued) Spinal disfigurements. (C) Scoliosis. (Source: Photo Researchers, Inc.)




Upper and Lower ExtremitiesUpper and Lower Extremities

•Appendicular region consists of arms and legs

•These areas perform most of body’s movement, making them more vulnerable to sports injuries




Upper and Lower Extremities Upper and Lower Extremities (cont’d)(cont’d)

•Pelvic girdle is different for women than men; women have greater pubic angle that facilitates childbirth and broad girdle to support weight of growing fetus; helps scientists identify skeletons as male or female




Figure 6-13 Bones of the upper and lower extremities.




Pathology Connection: Bone Fractures Pathology Connection: Bone Fractures and Healing and Healing

•Fracture is a broken bone •Types of fractures

– Simple (closed): break without puncture to skin– Compound (open): fracture in which bone has been

pushed through skin– Hairline: fine fracture that does not completely break

or displace bone (looks like hair on x-ray)– Spiral: fracture caused by severe twisting of bone– Greenstick: incomplete breaks, more common in

children– Comminuted: when bone has been fragmented or

splintered




Pathology Connection: Bone Fractures Pathology Connection: Bone Fractures and Healing and Healing (cont’d)(cont’d)

•Fracture in which bone is pushed through skin referred to as compound or open; particularly nasty because deep tissue has potential to be exposed to bacteria once bone is set into place, and, hence, chance for infection in addition to break is increased





•Bones take several weeks to heal; can only heal normally if ends of bones are touching; if bones are not touching (are poorly aligned), bone must be set (reduced)

•In first few hours after injury hematoma, or blood clot, forms around broken bone and inflammation sets in





•For next 3-4 weeks soft callus forms, replacing hematoma and bridging gap between broken ends of bone; soft callus starts as hyaline cartilage which eventually has some bone cells within it; capillaries invade site, ready to vascularize healing bone





•From week 4 to week 12 after injury, bony callus forms, replacing soft callus via endochondral ossification; usually bony callus will contain excess bone

•Remodeling necessary after bony callus formation to make repaired bone match rest of bone




Figure 6-14 (A) Femur, AP view, comminuted fracture.




Figure 6-14 (continued) (B) Tibia, simple, transverse fracture.




Figure 6-14 (continued) (C) Open fracture of the wrist.




Figure 6-14 (continued) (D) Displaced fracture of the distal radius. (Source: Charles Stewart & Associates.)




Figure 6-14 (continued) (E) X-ray of complete fracture of the radius. (Source: James Stevenson/Science Photo Library/Photo Researchers, Inc.)




Figure 6-14 (continued) (F) Fractured humerus. (Source: Charles Stewart & Associates.)




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Bone Healing AnimationBone Healing Animation

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Maintaining Good Bone HealthMaintaining Good Bone Health

•Bone mass loss is a natural process of aging, can be slowed by healthy lifestyle; important to consume proper amount of dietary calcium to build strong bones

•As previously discussed, exercise (especially weight-bearing forms) also plays vital role in developing and maintaining bones, so stay active




Maintaining Good Bone Health Maintaining Good Bone Health (cont’d)(cont’d)

•While osteoporosis and arthritis are big concerns, many more potential disorders of bones and joints

•Disorders generally classified by these causative agents: –Congenital –Degenerative –Nutritional –Secondary disorders

–Tumors–Trauma–Inflammation–Infection




Table 6-2 Bone Disorders




Table 6-3 Joint Disorders




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Osteoporosis VideoOsteoporosis Video

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Arthritis VideoArthritis Video

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Common Skeletal DisordersCommon Skeletal Disorders

•Arthritis: inflammation of joint/synovial membrane– Osteoarthritis

Etiology: joint cartilage “wears out” Signs and symptoms: painful inflammation;

wearing away of joint cartilage Diagnostic tests: visual exam; X-ray Treatment: rest, analgesics, anti-inflammatory

medications, steroid injections (into affected joint), surgical intervention (joint replacement, etc.)




Common Skeletal Disorders Common Skeletal Disorders (cont’d)(cont’d)

•Rheumatoid arthritis–Etiology: autoimmune disease that attacks

connective tissue; especially joints–Signs and symptoms: stiffness, swelling and

pain in multiple joints; inflammation of synovial membrane; pronounced joint deformities

–Diagnostic tests: visual exam; X-ray; antibody screening (rheumatoid factor)





•Rheumatoid arthritis–Treatment: aspirin; non-steroidal anti-

inflammatory drugs; corticosteroid medications; methotrexate; rest and range of motion exercises; surgical intervention (in extreme cases)





•Septic arthritis–Etiology: infection inside joint, usually seeded

by penetrating joint wound, or pathogen carried in blood

–Signs and symptoms: pain and swelling; filling of joint with inflammatory exudates; destruction of joint and replacement with fibrous tissue and eventually bone





•Septic arthritis–Diagnostic tests: visual exam; X-ray; fluid

culture for infective agents–Treatment: antibiotics; prevent septic arthritis

with good aseptic techniques





•Bursitis: inflammation of a bursa– Etiology: repetitive movement; strain;

congenital defect; rheumatic diseases– Signs and symptoms: pain on movement;

limited range of motion; inflammation and swelling at affected site

– Diagnostic tests: visual exam; X-ray





•Bursitis: inflammation of a bursa– Treatment: rest; moist heat/cold therapy;

analgesics; anti-inflammatory medications; corticosteroid injection at affected site; draining (of fluid) if severe; range of motion exercises once pain subsides to restore full joint function





•Cruciate ligament tears: tear in one or more of supporting ligaments of knee–Etiology: trauma that is induced when leg is

twisted, planted (weight bearing) leg receives anterior or posterior blow

–Signs and symptoms: pain in knee; instability of knee; limited mobility





•Cruciate ligament tears: tear in one or more of supporting ligaments of knee–Diagnostic tests: physical exam (especially joint

stability tests); radiologic examination (especially MRI)

–Treatment; rest; immobilization; surgical repair





•Gout–Etiology: metabolic disease where uric acid

levels become too high; causes uric acid crystals to deposit in joints (and other tissues)

–Signs and symptoms; excruciating pain in affected joint (most commonly big toe); tenderness and swelling of affected joint; inflammation with palpable heat in affected joint; advanced stages may also affect kidneys





•Gout–Diagnostic tests; visual examination; blood

testing for excessive uric acid–Treatment: restriction of dietary protein (which

can precipitate attack); consumption of low-fat dairy products (which may help prevent attacks); rest and immobilization of joint; analgesics and anti-inflammatory medications; gout-specific medications (colchicine, probenecid, and allopurinol); monitoring of blood uric acid





•Kyphosis – a “humpback”–Etiology: osteoporosis, etc.–Signs and symptoms: exaggerated curve of

upper back (“humpback”); may lead to backache, dyspnea/pulmonary insufficiency

–Diagnostic tests: visual exam; X-ray–Treatment: depends on age and severity; may

include: exercise; bracing; surgery; electrical stimulation; weight control





•Osteomalacia – softening of bone–Etiology: decreased mineralization of bone

due to insufficient vitamin D; can be caused by poor diet, lack of sufficient sunlight, malabsorption condition

–Signs and symptoms: bone pain; loss of height; deformity of weight bearing bones

–Diagnostic tests: visual examination; bone scan

–Treatment: correct nutritional deficiency





•Osteomyelitis –Etiology: infection in bone, often seeded from

wound in skin; staphylococcus aureus a common pathogen

–Signs and symptoms: sudden pain, swelling, heat, and tenderness of affected site; high fever and chills; sometimes nausea and malaise

–Diagnostic tests: visual examination; culture for pathogen

–Treatment: antibiotics; surgical debridement





•Osteoporosis–Etiology: decreased bone mass that can be due

to aging, decreased mobility, estrogen deficient or post-menopausal women

–Signs and symptoms: decreasing bone density; pain; fractures; loss of height; kyphosis

–Diagnostic tests: X-ray, bone densitometry





•Osteoporosis–Treatment: early prevention including adequate

dietary calcium, avoiding smoking and caffeine, engaging in weight-bearing exercise, supplemental calcium, vitamin D, and/or fluoride, and if necessary, medications that increase bone mass





•Plantar fasciitis (runner’s heel)–Etiology: repetitive impact on heel, resulting in

inflammation of connective tissue on plantar surface of foot; predisposing factors include high arches, flat feet, shoes with poor support, increased body weight, and sudden increase in activity





•Plantar fasciitis (runner’s heel)–Signs and symptoms: intermittent pain–Diagnostic tests: radiology exam–Treatment: rest; application of ice; analgesic

and anti-inflammatory medications; padding heel; possible surgical intervention





•Rickets–Etiology: lack of vitamin D in childhood,

resulting in impaired calcium absorption and bone calcification

–Signs and symptoms: weak, deformed bones–Diagnostic tests: visual exam; radiology exam–Treatment: dietary correction to increase

vitamin D; vitamin D supplementation; sunlight exposure (which increases vitamin D production)





•Scoliosis: sideways curve of spine–Etiology: congenital defect, trauma, etc.–Signs and symptoms: lateral curvature of

spine; may lead to backache, fatigue, dyspnea/pulmonary insufficiency

–Diagnostic tests: visual exam, radiology exam–Treatment: depends on age and severity; may

include exercise, bracing, surgery





•Tendonitis (Tendinitis): inflammation of tendon–Etiology: repetitive movement, etc.–Signs and symptoms: inflammation of involved

tendon; pain on movement of involved area–Diagnostic tests: visual exam; radiology exam–Treatment: rest; application of moist heat/cold;

analgesics and anti-inflammatory medications; injection of affected site with corticosteroids




Pharmacology Corner Pharmacology Corner

•Analgesic creams (often contain capsaicin; applied to affected site)

•Corticosteroid injections (injected into affected site)

•Pain medications: NSAIDs (ibuprofen and naproxen) treat inflammation and pain; aspirin and acetaminophen treat pain (no anti-inflammatory affect)

•Methotrexate: treats rheumatoid arthritis





•Calcium supplements (including calcium base antacids) help maintain or improve bone density

•Alendronate: powerful medication that improves bone density





•Vitamin D: improves body’s ability to absorb calcium

•Estrogen replacement therapy: improves bone density, now considered controversial due to possible complications of treatment




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Radiologic Technology VideoRadiologic Technology Video

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Snapshots from the JourneySnapshots from the Journey

•Skeleton provides support and protection, produces blood cells, and acts as storage unit for minerals and fats

•206 bones of skeleton classified according to shape: long bones, short bones, flat bones, and irregular bones

•Bone covered with periosteum, tough fibrous connective tissue




Snapshots from the JourneySnapshots from the Journey

•In long bones, each end called an epiphysis, shaft is diaphysis, and hollow region in diaphysis called medullary cavity and stores yellow marrow




Snapshots from the Journey Snapshots from the Journey (cont’d)(cont’d)

•Compact bone is dense, hard tissue that normally composes shafts of long bones or found as outer layer of other bone types

•Spongy bone contains irregular holes, making it lighter in weight and providing space for red bone marrow which produces red blood cells





•Ossification is term for bone formation

•Osteoprogenitor cells are non-specialized cells that can turn into osteoblasts that form bones

•Osteocytes are mature bone cells





•Osteoclasts originate from type of white blood cell called monocyte and tear down bone material, moving calcium and phosphate into blood

•Thin band of cartilage forms epiphyseal plate, called growth plate, and allows bone to lengthen and widen as long as it exists





•Cartilage is special form of dense connective tissue that can withstand fair amount of flexing, tension, and pressure, making flexible connection and cushion between bones

•Various types of joints join two or more bones and provide various types of movement; point where bones join called articulation





•Ligaments are tough, whitish bands that connect bone to bone and hold joints together; can withstand heavy stress

•With exception of osteoporosis, most chronic diseases of skeleton involve joints





•Skeleton can be divided into two main sections: axial skeleton (thorax, spinal column, hyoid bone, bones of the middle ear, and skull) and appendicular skeleton (arms, legs, hips, and shoulder girdle)





•Although different diseases, bursitis and tendonitis have similar treatment regimens including rest of affected joint(s), analgesics, and application of cold and moist heat; injection of corticosteroids into affected joint may be beneficial in reducing inflammation





•Chemical composition of cartilage changes with age, becoming more brittle; articular cartilage aging or injury can lead to arthritis, inflammatory process of joint or joints





•Bone mass also decreases with age, beginning in 50s, and can lead to osteoporosis if not slowed by healthy lifestyle





•General guidelines for when to see a doctor: obvious bone deformity or misalignment of a joint, pain for more than10 days, injury that does not improve after 5-7 days, continued swelling and/or inflammation of joint or injury, signs of infection such as fever, pus, red streaks, or swelling of lymph glands, and of course, common sense




Case StudyCase Study

•A somewhat frail 76-year-old female visits her physician’s office for an annual check-up. Her social history shows she smokes a pack of cigarettes a day and she is a heavy coffee drinker




Case Study Case Study (cont’d)(cont’d)

•She has had several fractured bones in the last five years that required medical attention. During initial examination, measurements show that the patient has lost approximately an inch of height over the past year. She has also lost several pounds but states she still wears the same size clothes




Case Study Case Study (cont’d)(cont’d)

•What possible bone disease do you think she is exhibiting?

•Describe the bone changes in this condition on a macro and cellular level

•What treatments/life style changes would you suggest?




Case Study: Ray’s StoryCase Study: Ray’s Story

•You are a member of the discharge planning team responsible for developing a home care plan for our quadriplegic, Ray. Thinking back to Ray’s condition, remember that he can breathe only with mechanical assistance, cannot move himself without help from others, needs assistance eating, and spends most of his time lying in a bed




Case Study: Ray’s Story Case Study: Ray’s Story (cont’d)(cont’d)

•What suggestions would you make for his skeletal, bone, and joint health?

•Which profession(s) should be involved in maintaining or improving his “skeletal health”?

chapter 6 the skeletal system: the framework

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