Skeletal System.SP10iicaudio

Skeletal System : 

Skeletal System Chapter 6

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Figure 6.1 The anterior and posterior human skeleton.

Anatomy and Physiology Overview : 

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 : 

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

Bones : 

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

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Figure 6.2 Classification of bones by shape.

Bones : 

Bones Classification of bones Functions of bones Structure of a long bone Bone markings

Bones : 

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.

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Figure 6.3 The features found in a long bone.

Bones : 

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 : 

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 : 

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.

Joints and Movement : 

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 : 

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.

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Figure 6.4 Knee joint.

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Figure 6.5 Types of body movements.

Joints and Movement : 

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.

Joints and Movement : 

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 : 

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.

Vertebral Column : 

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 : 

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).

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Figure 6.6 Vertebral (spinal) column.

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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 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 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.

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Figure 6.8(a) The male pelvis (android) is shaped like a funnel, forming a narrower outlet than the female.

The Male and Female Pelvis : 

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.

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Figure 6.8(b) The female pelvis (gynecoid) is shaped like a basin.

Life Span Considerations:The Child : 

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 : 

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 : 

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.

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Figure 6.9 Epiphyseal plate (arrows). (Courtesy of Teresa Resch)

Life Span Considerations:The Older Adult : 

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 : 

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 : 

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.

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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.

Drug Highlights : 

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 : 

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 : 

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 : 

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 : 

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.

Diagnostic and Lab Tests : 

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.

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Figure 6.17 Using a goniometer to measure joint ROM.

Diagnostic and Lab Tests : 

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 : 

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 : 

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 : 

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 : 

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.

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Figure 6.18(a) Abnormal curvatures of the spine: (A) kyphosis

Abnormal Curvatures of the Spine : 

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.

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Figure 6.18(b) Abnormal curvatures of the spine: (B) lordosis

Abnormal Curvatures of the Spine : 

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

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Figure 6.18(c) Abnormal curvatures of the spine: (C) scoliosis.

Arthritis : 

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 : 

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.

Carpal Tunnel Syndrome : 

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.

Slide 61: 

Cross-section of wrist showing tendons and nerves involved in carpal tunnel syndrome.

Fractures : 

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.

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Figure 6.23 Various types of fractures.

Fractures : 

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

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Figure 6.24 Open fracture of the wrist. (Source: Pearson Education/PH College)

Fractures : 

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

Osteoporosis : 

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.

Slide 68: 

Figure 6.25 Spinal changes caused by osteoporosis.