Download skeletal system

SKELETAL SYSTEM
Science Olympida
Anatomy and Physiology
2009-2010
Kathy Tripepi-Bova MSN, RN, CCNS, CCRN
http://www.personal.psu.edu/faculty/j/a/
jas43/skel/skeletal.htm
Functions
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Support & shape to body
Protect internal organs
Allow for movement in union with muscles
Storage of minerals (calcium,
phosphorus) & lipids
• Blood cell production
Skeletal sections
• • 206 Bones
• Axial skeleton: (80 bones) in
skull, vertebrae, ribs, sternum,
hyoid bone
• Appendicular Skeleton: (126
bones)- upper & lower extremities
plus two girdles
• Half of bones in hands & feet
Radiography
X-ray of arm
CT
MRI
Types of Bones:
Classification by shape
• Sesamoid bones: short bones within tendons
(e.g.: patella)
• Flat bones: thin, flat & often curved (e.g.: sternum,
scapulae, ribs & most skull bones)
• Irregular bones: odd shapes; don't fit into other
classes (e.g.: hip bones & vertebrae
• Long bones – longer than they are wide (e.g.,
humerus)
• Short bones- cube shaped bones of the wrist and
ankle
• Wormian bones: tiny bones in between major
skull bones
Vertebrae (33)
• Cervical (7)- transverse foramina, bifid
spinous processes, vertebral prominens
• Atlas- 1st; supports head
• Axis- 2nd; pivots to turn head
• Thoracic (12)- long spinous processes,
rib facets
• Lumbar (5)- large bodies thick, short
spinous processes
• Sacrum (5 fused)-five vertebrae fused at
faint grooves called transverse lines
• Coccyx (4 fused)-”tail bone”
Articulating joint
• Articular capsule: a fibrous sac at a
synovial joint that contains synovial fluid
• Articular capsule
• External layer is a tough fibrous capsule
that is an extension of the periosea of the
articulating bones
• The inner layer is the synovial membrane
• Covers all internal joint surface s that are
not hyaline cartilage
• Synovial fluid
• Synovial fluid is a thick, stringy fluid found
in the cavities of synovial joints.
• synovial fluid reduces friction between the
and other tissues in joints to lubricate and
cushion them during movement.
• Found within the articular cartilage
Synovial joint
Types of Synovial Joints
(synovial fluid)*
guy
• Ball & Socket - allows for complete
range of motion Example: shoulder, hip
• Pivot – one bone pivots in the arch of
another Example: Axis/Atlas, and
proximal radioulnar joint
• Saddle – two directional movement
between thumb and trapezium carpel
Types of Synovial Joints
• Hinge – like door hinge – bending &
extending Example: elbow, knee, finger joints
• Ellipsoid (Condyloid) – side to side and
back & forth. Example – radius end into
carpal bones
• Plane or Gliding – least moveable – side to
side only Examples: intercarpal & intertarsal
joints; between vertebrae
Types of cells constituting the
bone
• Osteoblasts
• bone forming cells synthesize and secrete
unmineralized ground substance and are found in
areas of high metabolism within the bone
• do not have the ability to divide by mitosis
• Osteocytes
• mature bone cells made from osteoblasts that
have made bone tissue around themselves.
• maintain healthy bone tissue by secreting
enzymes and controlling the bone mineral content;
• they also control the calcium release from the
bone tissue to the blood.
• do not undergo mitosis
Types of cells constituting the
bone
• Osteoclasts –
• bone absorbing cell –
• large cells that break down bone tissue
• important to growth, healing, remodeling
• Bone lining cells
• essentially inactive osteoblasts
• Bone-lining cells- thought to regulate the
movement of calcium and phosphate into and out
of the bone
Microscopic Structure of bone
*TBB DK
Compact bone
• The hard outer layer of
bones
• Composed of dense
bone tissue, due to its
minimal gaps and
spaces.
• Gives bones their
smooth, white, and solid
appearance,
• Accounts for 80% of the
total bone mass of
an adult skeleton.
• Also referred to as
dense bone or cortical
bone.
Spongy bone (cancellous
bone)
• Interior of the bone
• Composed of a network of
rod- and plate-like
elements (Trabeculae) that
make the overall organ
lighter and allowing room
for blood vessels and
marrow.
• Accounts for the
remaining 20% of total
bone mass
• Has nearly ten times the
surface area of compact
bone
• Some spongy bone
contains red marrow.
Red and Yellow Bone
Marrow
• The formation of blood cells, hematopoiesis,
takes place mainly in the red marrow of the
bones.
• In infants, red marrow is found in the bone
cavities. With age, it is largely replaced by
yellow marrow for fat storage.
• In adults, red marrow is limited to the spongy
bone in the skull, ribs, sternum, clavicles,
vertebrae and pelvis
• Red marrow functions in the formation of red
blood cells, white blood cells and blood
platelets.
Cellular Structure of compact
bone
Osteon (Haversian system)- the
structural unit of compact bone
Components of the Osteon
• Perforating (Volkmann’s)
canals• channels from the periosteum
that carry nutrients, arteries,
veins and nerves through
compact bone to the Haversian
canals
• Central (Haversian) canals• canals that run lengthwise
through the bone
• channels lying at right angles
to the central canal,
• connect blood vessels and
nerve supply of periosteum to
the Haversian canal
Components of the osteon
• Lamellae• rings of hard, calcified
matrix around the central
canals.
• weight-bearing, column-like
matrix tubes composed
mainly of collagen
• Lamella are added from the
outside(nearest the
cementing line) toward the
inside of each osteon
• Most osteons are only made
of 4 to 20 lamellae
• Lacunae- small spaces between the
lamellae that contain osteocytes
• Canaliculi• minute canals that
project outward in all
directions from the
lacunae.
• forms system of
interconnected
canals for nutrients
and oxygen to reach
osteocytes
Bone lining
• Periosteum is a membrane that lines
the outer surface of all bones except at
the joints of long bones
• Endosteum is a thin layer of connective
tissue which lines the surface of the
bony tissue that forms the medullary
cavity of long bones
Osteogenesis and
ossification
• The process of bone tissue
formation which leads to:
• The formation of the bony skeleton
in embryos
• Bone growth until early adulthood
• Bone thickness, remodeling, and
repair
Formation of the Bony
Skeleton
• The formation of bone during the
fetal stage of development occurs by
two processes: intramembranous
ossification and endochondral
ossification
• Begins at week 8 of embryo
development
Intramembranous Ossificationinitiation of bone development
• Fibrous connective tissue
membranes are formed by
mesenchymal cells
• An ossification center appears in fibrous
connective tissue membrane
• Bone matrix is secreted within the fibrous
membrane
• Woven bone and periosteum form
• Bone collar of compact bone forms, and
red marrow appears
Endochondral Ossification
• Begins in the second month of
development
• occurs in long bones, such as limbs;
• Uses hyaline cartilage "bones" as
models for bone construction
• Requires breakdown of hyaline
cartilage prior to ossification
Stages of Endochondral
Ossification
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Development of
cartilage model
Growth of cartilage
model
Development of the
primary ossification
center
Development of the
secondary ossification
center
Formation of articular
cartilage and epiphyseal
plate
Endochondral
ossification
Postnatal Bone Growth
• Bone Growth in length
*TBB DK
• Epiphyseal plate or cartilage
growth plate
• cartilage cells are produced by
mitosis on epiphyseal side of plate
• cartilage cells are destroyed and
replaced by bone on diaphyseal side
of plate
• Between ages 18 to 25,
epiphyseal plates close.
• cartilage cells stop dividing and
bone replaces the cartilage
(epiphyseal line)
• Growth in length stops at age 25
Four zones of growth in
epiphyseal plate
*TBB DK
• Zone of resting cartilage
•
anchors growth plate to bone
• Zone of proliferating cartilage
• rapid cell division (stacked coins)
• Zone of hypertrophic cartilage
• cells enlarged & remain in columns
• Zone of calcified cartilage:
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thin zone,
cells mostly dead since matrix calcified
osteoclasts removing matrix;
osteoblasts & capillaries move in to create
bone over calcified cartilage
End of a Long Bone
• a articular (hyaline)
cartilage on end of
bone
• b bone trabeculae of
spongy bone
• c red marrow cavity
• d epiphyseal plate
(hyaline cartilage)
Long Bone Growth*
TBB DK
• Interstitial growth is growth
in the length of bone
• Appositional growth:
increase in bone width
• Remodeling - bone is
reabsorbed and added
Hormonal Regulation of
Bone Growth During Youth
• During infancy and childhood, epiphyseal plate
activity is stimulated by growth hormone
• During puberty, testosterone and estrogens:
• Initially promote adolescent growth spurts
• Causes masculinization and feminization of specific
parts of the skeleton
• Later induce epiphyseal plate closure, ending
longitudinal bone growth
Hormonal Control of
Remodeling
• Activity of parathyroid hormone
and calcitonin is the mechanism
to maintain blood calcium
homeostasis, and balances
Bone Fractures
Typical Bone Fractures
• Pain when fractures
occur, the pain is
carried to the brain by
nerves running through
the periosteum
Fracture repair
1. Hematoma formation
• Torn blood vessels hemorrhage
• A mass of clotted blood
(hematoma) forms at the fracture
site
• Site becomes swollen, painful,
and inflamed
2. Fibrocartilaginous callus
• soft callus forms
• Capillaries grow into the tissue and phagocytic
cells begin cleaning debris
• Osteoblasts & fibroblasts migrate to fracture &
begin reconstructing bone
• Fibroblasts secrete collagen fibers that
connect broken bone ends
• Osteoblasts begin forming spongy bone
• Osteoblasts furthest from capillaries secrete a
matrix externally bulging cartilaginous matrix
that later calcifies
3. Bony callus formation
• New bone trabeculae appear in the
fibrocartilaginous callus
• Fibrocartilaginous callus converts into a
bony (hard) callus
• Bone callus begins 3-4 weeks after
injury, and continues until firm union is
formed 2-3 months later
• Bone remodeling
• Excess material on the bone shaft
exterior and in the medullary canal is
removed
• Compact bone is laid down to
reconstruct shaft walls
• May take several months
Salter-Harris fracture classification system
• Fractures through a growth plate
• Unique to pediatric patients
Type I
• A type 1 fracture is a transverse
fracture through the hypertrophic
zone of the physis. In this injury, the
width of the physis is increased. The
growing zone of the physis usually is
not injured, and growth disturbance
is uncommon.
Salter-Harris fracture type I
Salter-Harris Type 1 fracture of
the distal radius
Type II
• A type II fracture is a fracture through the
physis and the metaphysis, but the
epiphysis is not involved in the injury.
• These fractures may cause minimal
shortening; however, the injuries rarely
result in functional limitations.
• Type II is the most common type of SalterHarris fracture.
Salter-Harris fracture type II
Type III
• A type III fracture is a fracture through the
physis and the epiphysis. This fracture
passes through the hypertrophic layer of
the physis and extends to split the
epiphysis, inevitably damaging the
reproductive layer of the physis.
• This type of fracture is prone to chronic
disability because by crossing the
physis, the fracture extends into the
articular surface of the bone.
• The treatment for this fracture is often
surgical
Salter-Harris fracture type III
Type IV
• A Type IV fracture involves all 3 elements
of the bone: The fracture passes through
the epiphysis, physis, and metaphysis.
• Similar to a type III fracture, a type IV
fracture is an intra-articular fracture; thus,
it can result in chronic disability.
• By interfering with the growing layer of
cartilage cells, these fractures can cause
premature focal fusion of the involved
bone.
• These injuries can cause deformity of the
joint.
Salter-Harris fracture type IV
Type V
• A type V injury is a compression or
crush injury of the epiphyseal plate
with no associated epiphyseal or
metaphyseal fracture.
• This fracture is associated with
growth disturbances at the physis.
These injuries have a poor functional
prognosis.
Salter-Harris fracture type V
• The classification can be remembered
by a modified spelling of the word
'Salter' as follows:
• S = I = Separation
• A = II = Above
• L = III = Lower
• T = IV = Through
• R = V = Reduction
Cartilage –
Characteristics and Types
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Mostly water; no blood vessels or nerve
Tough, resilient
New cartilage forms from chondroblasts
Heals poorly
Hyaline Cartilages:
• fine collagen fiber matrix- most
abundant type- found in articular
(movable joint)
cartilages, costal cartilages (connect
ribs tosternum), respiratory cartilages
(in larynx & upper respiratory
passageways) & nasal cartilages
• Elastic Cartilages:
• similar to hyaline cartilage, more elastic
fibers (very flexible) – found in external
ear
& epiglottis (larynx covering
Fibrocartilage:
• rows of chondrocytes with thick collagen
fibers; highly compressible with great
tensile strength
• found in meniscus of the knee,
intervertebral discs & pubic symphysis
Bone Markings are bulges,
depressions, and holes
that serve as:
• Joint surfaces
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Fossa - shallow, basinlike depression
condyle- rounded articular projection
Epicondyle - raised area above a condyle
Head -bony expansion on a narrow neck
Bone Markings are bulges,
depressions, and holes that
serve as:
• Muscle & ligament attachment
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Trochanter- large, blunt, irregular surface
Tuberodsity- rounded projection
Process- any bony prominence
Crest- narrow, prominent ridge of bone
Line - narrow ridge of bone
Fovea - small pit like indent
Tubercle - small rounded projection
Ramus - armlike bar of bone
Spine - sharp, slender projection
Bone Markings are bulges,
depressions, and holes that
serve as:
• Passageways for vessels, etc.
• Foreamen- round or oval opening through
a bone
• Fissure - narrow, slit like opening
• Meatus - canal-like passageway
• Space within a bone -sinus
Sinuses
• Named for the bone
they are near
• They lighten the weight
of the skull
• They give resonance to
your voice.
• They filter and moisten
the air that we breathe.
Skull
1.
Frontal Bone
2.
Supra-Orbital Foramen
3.
Orbit (Orbital Cavity)
4.
Superior Orbital Fissure
5.
Inferior Orbital Fissure
6.
Zygomatic Bone
7.
Infra-Orbital Foramen
8.
Maxilla
9.
Mandible
10.
Mental Foramen
11.
Incisive Fossa
12.
Symphysis
13.
Vomer
14.
Inferior Nasal Concha
15.
Middle Nasal Concha
16.
Perpendicular Plate of Ethmoid
17.
Nasal Bone
18.
Lacrimal
Anterior View
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1.Parietal Bone
2. Coronal Suture
3. Frontal Bone
4. Nasal Bone
5.Vomer
6. Lacrimal Bone
7. Orbital Part of Ethmoid
8. Zygomatic Bone
9. Maxilla
10. Body of Mandible
11. Ramus of Mandible
12.Coronoid Process
13.Mandibular Condyle
14.Mental Foramen
15.Styloid Process
16. External Acoustic Meatus
17. Mastoid Process
18. Zygomatic Process
19.Temporal Bone
20. Greater Wing of Sphenoid
21.Inferior Temporal Line
22. Superior Temporal Line
23.Squamosal Suture
24.Lambdoidal Suture
25.Occipital Bone
Lateral View
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1.Parietal Bone
2. Sagittal Suture
3. Lambdoid Suture
4. Occipital Bone
5.External Occipital
Protruberance
• 6. Superior Nuchal Line
• 7. Inferior Nuchal Line
Superior view
1.
Occipital Bone
2.
Lambdoidal Suture
3.
Parietal Bone
4.
Sagittal Suture
5.
Coronal Suture
6.
Frontal Bone
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1.Anterior Palatine Foramen
2. Palatine Process of Maxilla
3. Palatine
4. Greater Palatine Foramen
5.Lesser Palatine Foramen
6. Pterygoid Processes of Sphenoid
7.Zygomatic Process
8. Squamous Part of Temporal Bone
9. Mandibular Fossa
10. Styloid Process
11.Stylomastoid Foramen
12. Mastoid Process
13.Mastoid Foramen
14. Superior Nuchal Line
15. External Occipital Protruberance
16.Median Nuchal Line
17. Inferior Nuchal Line
18.Foramen Magnum
19. Condyloid Cana
20.Occipital Condyle
21.Hypoglossal Canal
22.Jugular Foramen
23.Carotid Canal
24.Foramen Spinosum
25.Foramen Ovale
26.Foramen Lacerum
27.Vomer
28.Transverse Palatine Suture
29.Median Palatine Suture
Inferior View
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1.Frontal Sinus
2. Foramen Cecum
3. Crista Galli
4. Cribriform Plate
5.Anterior Cranial Fossa
6. Lesser Wing of Sphenoid
7.Chiasmatic Groove
8. Hypophyseal Fossa
9. Dorsum Sella
0. Optic Canal
1.Anterior Clinoid Process
12. Foramen Rotundum
13.Foramen Ovale
14. Foramen Spinosum
15. Squamous Part of Temporal
16.Petrous Part of Temporal
17. Groove for Transverse Sinus
18.Posterior Cranial Fossa
19. Foramen Magnum
20.Hypoglossal Canal
21.Jugular Foramen
22.Internal Acoustic Meatus
23.Posterior Clinoid Process
24.Foramen Lacerum
25.Superior Orbital Fissure
Internal View
Nationals-foramina of the skull
• Table
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1.Mandibular Condyle
2. Mandibular Notch
3. Coronoid Process
4. Ramus
5.Angle
6. Oblique Line
7.Body
8. Alveolar Process
9. Mental Foramen
10. Mylohyoid Line
11.Mandibular Foramen
Mandible
• helps to support the
tongue and serves as
an attachment point
for several muscles
that help to elevate
the larynx during
swallowing and
speech.
• only bone of the body
that does not
articulate with any
other bone.
• suspended above the
larynx where it is
anchored by
ligaments to the
styloid processes of
the temporal bones of
the skull
Hyoid bone
• 1.Future Coronal Suture
• 2. Anterior Fontanel
• 3. Anterolateral
Fontanel
• 4. Future Squamosal
Suture
• 5.Posterolateral
Fontanel
• 6. Future Lamdoidal
Suture
• 7.External Acoustic
Meatus
• 8. Future Sagittal
Suture
• 9. Posterior Fontanel
Fetal Skull
Vertebral column
Atlas (C1)
• 1.Superior Articular
Surface
• 2. Transverse Foramen
• 3. Transverse Process
• 4. Odontoid (Dens)
Facet
• 5.Vertebral Foramen
• 6. Inferior Articular
Surface
Axis (C2)
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1.Spinous Process
2. Lamina
3. Transverse Process
4. Pedicle
5.Superior Articular
Surface
6. Odontoid Process
(Dens)
7.Body
8.Vertebral Foramen
9. Inferior Articular
Surface
Cervical (C3 - C7)
• 1.Spinous Process
• 2. Lamina
• 3. Superior Articular
Surface
• 4. Transverse Foramen
• 5.Transverse Process
• 6. Body
• 7.Pedicle
Thoracic
1.Spinous Process
2. Lamina
3. Superior Articular
Surface
4. Transverse Foramen
5.Pedicle
6. Body
7.Vertebral Foramen
8.Articular Facet for Rib
9.Inferior Articular Surface
Lumbar
1.
Spinous Process
2.
Lamina
3.
Superior Articular Surface
4.
Transverse Foramen
5.
Pedicle
6.
Body
7.
Vertebral Foramen
8.
Inferior Articular Surface
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1.Promontory
2. Transverse Ridges
3. Coccyx
4. Body of Sacrum
5.Sacral Canal
6. Superior Articular
Surface
7.Median Sacral Crest
8.Sacrum to Ilium
Articular Surface
9.Dorsal Sacral
Foramina
10.Sacral Hiatus
Sacrum
Thoracic Bones
Rib & Vertebra Articulated
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1. Articular Facet of Rib
2. Interarticular Crest
3. Neck
4. Articular Portion of
Tubercle
5. Nonarticular Portion
of Tubercle
6. Angle of Rib
7. Costal Groove
8. Body of Rib
9. Articular Facet of
Transverse Process
10.Transverse Process
11. Spinous Process
12. Lamina
13. Vertebral Foramen
Sternum
1.
Jugular Notch
2.
Manubrium
3.
Sternal Angle
4.
Body (Gladiolus)
5.
Xiphoid Process
Upper Limb Bones
Left Scapula (Posterior Aspect)
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1.Coracoid Process
2. Scapular Notch
3. Superior Margin
4. Supraspinatus Fossa
5.Superior Angle
6. Scapular Spine
7.Vertebral Margin
.Infraspinatus Fossa
.Inferior Angle
10.Axillary Margin
11.Glenoid Cavity Margin
12.Acromion Process
Aspect) Left Scapula (Lateral
1.
Coracoid Process
2.
Glenoid Cavity
3.
Scapular Spine
4.
Acromion Process
5.
Infraspinatus Fossa
6.
Inferior Angle
7.
Axillary Margin
Right Humerus - Proximal End
(Anterior Aspect)
1.
Head
2.
Anatomical Neck
3.
Lesser Tubercle
4.
Intertubercular Groove
5.
Greater Tubercle
6.
Surgical Neck
7.
Deltoid Tuberosity
Right Humerus - Distal End
1.
Radial Fossa
2.
Lateral Epicondyle
3.
Capitulum
4.
Trochlea
5.
Medial Epicondyle
6.
Coronoid Fossa
7.
Olecranon Fossa
Right Ulna - Proximal & Distal End (Anterior Aspect)
1.
Olecranon Process
2.
Semilunar Notch
3.
Coronoid Process
4.
Tuberosity
5.
Radial Notch
6.
Ulna (Shaft)
7.
Head of Ulna
8.
Styloid Process
Right Radius - Proximal & Distal End
(Anterior Aspect)
1.
Head of Radius
2.
Neck of Radius
3.
Radial Tuberosity
4.
Radius (Shaft)
5.
Styloid Process
6.
Ulnar Notch
Bones of the Right Hand (Dorsal
Surface)
1.
Styloid Process of Radius
2.
Navicular (Scaphoid)
3.
Lunate
4.
Triquetral
5.
Pisiform
6.
Trapezium
7.
Trapezoid
8.
Capitate
9.
Hamate
10. Metacarpal
11. Proximal Phalange
12. Middle Phalange
13. Distal Phalange
14. Styloid Process of Ulna
Bones of the Right Hand
(Palmar Surface)
1.
Navicular (Scaphoid)
2.
Lunate
3.
Triquetral
4.
Pisiform
5.
Trapezium
6.
Trapezoid
7.
Capitate
8.
Hamate
9.
Metacarpal
10. Proximal Phalange
11. Middle Phalange
12. Distal Phalange
Lower Limb Bones
1.
Anterior Superior Spine
2.
Iliac Crest
3.
Posterior Superior Spine
4.
Posterior Inferior Spine
5.
Greater Sciatic Notch
6.
Body of Ilium
7.
Ischial Spine
8.
Lesser Sciatic Notch
9.
Body of Ischium
Left Os Coxa (Lateral Aspect)
10. Ischial Tuberosity
11. Obturator Foramen
12. Inferior Ramus of Ischium
13. Inferior Ramus of Pubis
14. Body of Pubis
15. Acetabulum
16. Anterior Inferior Spine
Os Coxa medial view
1.
Iliac Fossa
2.
Anterior Superior Spine
3.
Anterior Inferior Spine
4.
Arcuate Line
5.
Obturator Foramen
6.
Symphysis Pubis
Articulating Surface
7.
Ischial Tuberosity
8.
Lesser Sciatic Notch
9.
Ischial Spine
10. Greater Sciatic Notch
11. Sacrum Articulating Surface
12. Posterior Inferior Spine
13. Posterior Superior Spine
14. Iliac Crest
Left Femur - Proximal End
(Anterior & Posterior Aspects)
1.
Head
2.
Neck
3.
Greater Trochanter
4.
Intertrochanteric Line
5.
Lesser Trochanter
6.
Shaft of Femur
7.
Gluteal Tuberosity
8.
Intertrochanteric Crest
9.
Linea Aspera
Left Tibia - Proximal & Distal
End (Anterior Aspect)
1.
Intercondylar Eminence
2.
Lateral Condyle
3.
Tibial Tuberosity
4.
Anterior Crest
5.
Medial Condyle
6.
Anterior Surface
7.
Medial Malleolus
Left Fibula - Proximal & Distal
End (Anterior Aspect)
1.
Head of Fibula
2.
Neck of Fibula
3.
Anterior Crest
4.
Lateral Malleolus
Bones of the Left Foot
(Superior Aspect)
1.
Calcaneus
2.
Talus
3.
Navicular
4.
Cuboid
5.
Cuneiform, First
6.
Cuneiform, Second
7.
Cuneiform, Third
8.
Metatarsal
9.
Proximal Phalange
10. Middle Phalange
11. Distal Phalange
Bones of the Left Foot (Lateral
Aspect)
1.
Calcaneus
2.
Talus
3.
Navicular
4.
Cuboid
5.
Cuneiform, First
6.
Cuneiform, Second
7.
Cuneiform, Third
8.
Metatarsal
1.
Knee - Anterior & Posterior
Aspects
Tibial Collateral Ligament
2.
Medial Condyle of Femur
3.
Posterior Cruciate Ligament
4.
Anterior Cruciate Ligament
5.
Lateral Condyle of Femur
6.
Fibular Collateral Ligament
7.
Lateral Condyle of Tibia
8.
Lateral Meniscus
9.
Medial Meniscus
10. Medial Condyle of Tibia
11. Tibia
12. Fibula
13. Transverse Ligament
Skeletal Disorders
• Osteoarthritis
• A type of arthritis marked by progressive
cartilage deterioration in synovial joints and
vertebrae
The symptoms of osteoarthritis
include:
• Deep aching joint pain that gets worse after
exercise, or putting weight on it, and is
relieved by rest
• Grating of the joint with motion
• Joint pain in rainy weather
• Joint swelling
• Limited movement
• Morning stiffness
• No symptoms
• Medications
• Nonsteroidals
• Cox 2 inhibitors
• Antiinflammatories
• Lifestyle change’
•
•
•
•
•
Applying heat and cold
Eating a healthy balanced diet
Getting rest
Losing weight if you are overweight
Protecting the joints
Osteoarthritis-treatment
• Physical therapy
• Braces
• Surgery
• Arthroscopy
• Joint replacement
Arthritic joint x-ray
CT of joint
MRI of joint
• Osteoporosis• Loss of bone mass that occurs throughout
the skeleton.
• Bones become very fragile
Causes of osteoporosis
•
•
•
•
•
•
•
•
•
Female gender postmenopausal
Caucasian or Asian race;
Thin and small body frames;
Family history of osteoporosis (for example, having a
mother with an osteoporotic hip fracture doubles your risk
of hip fracture);
Personal history of fracture as an adult;
Cigarette smokingExcessive alcohol consumption;
Lack ofexercise;
Diet low in calcium;
Poor nutrition and poor general health;
Treatment for osteoporsis
• Bisphosphonates are — by far — the
most common medications prescribed
for osteoporosis treatment. These
include:
• Alendronate (Fosamax)
• Risedronate (Actonel)
• Ibandronate (Boniva)
• Zoledronic acid (Reclast)
• Disc HerniationRupture of the soft
tissue that
separates two
vertebral bones into
the spinal canal
Sign and symptom
•
•
•
•
Electric shock pain
Tingling and numbness
Muscle weakness
Loss of bladder control
Treatment
•
•
•
•
Exercise
Medication-NSAIDs
Steroid injection in joint
surgery
MRI
• Scoliosis• A lateral curvature of
the spine.
• Usually occurs in
puberty
• A slight curvature in
adults can get worse
Treatment
• If the curve is less than 25°, no treatment is required,
and the child can be reexamined every four to six
months.
• If the curve is more then 25° but less than 30°, a back
brace may be used for treatment.
• Curves more than 45° will need to be evaluated for
the possibility of surgical correction. Surgical
correction involves fusing vertebrae together to
correct the curvature and may require inserting rods
next to the spine to reinforce the surgery
X-ray
• ACL tear
• The anterior cruciate
ligament (ACL)
provides almost 90%
of the stability to the
knee joint
Immediate treatment
• R.I.C.E. stands for:
• Rest - The individual is advised to rest the knee from
weight-bearing activities allowing the swelling to
settle.
• Ice - Placing a cold compress or ice pack on the knee
is helpful in controlling inflammation as well as
helping to reduce pain.
• Compression - Utilizing an ace wrap for compression
around the knee is beneficial to control the swelling.
• Elevation - Lying down with the leg elevated higher
than the level of the chest is helpful in controlling and
reducing swelling.
• ACL reconstruction is a highly
successful operation. With good
rehabilitation, 90% to 95% of individuals
who undergo this surgery can expect to
return to full sports participation within
six months.
National diseases/disorders
• Spinal Stenosisnarrowing of the
spinal column
Signs and symptoms
• Low back pain
• Leg numbness and tingling
• Limitations in walking
CT diagnosis with myelogram
•
•
•
•
•
Exercise
Activity modification
Physical therapy
Epidural injections
Surgery
• Achondroplasia
(dwarfing)
• Genetic defect
(fibroclast growth
receptor gene) in the
formation of cartilage at
the epiphysis of long
bones
• Disproportionate
shortened stature
• An average-size trunk
• Short arms and legs, with particularly short upper
arms and upper legs
• Short fingers, often with a wide separation
between the middle and ring fingers
• Limited mobility at the elbows
• A disproportionately large head, with a prominent
forehead and flattened bridge of the nose
• Progressive development of bowed legs (genu
varum)
• Progressive development of swayed lower back
(lordosis)
• An adult height around 4 feet — about 122
centimeters (cm)
• Treatments for most dwarfism-related conditions
don't increase stature but may lessen
complications
• Juvenile
Rheumatoid
Arthritis-chronic
inflammatory
diseases involving
the joints or other
organs in children
under 16
• Juvenile arthritis is different from adult
arthritis in two ways:
• children with arthritis sometimes outgrow the
illness,
• tends to be difficult to diagnose because the
regular tests for arthritis are unreliable for children.
• Systemic onset type begins with very high
fevers, frequently as a skin rash and shows
evidence of inflammation in many internal
organ systems as well as the joints
Symptoms:
• Arthritis symptoms:
•
•
•
•
•
•
Joint stiffness on arising in the morning
`Limited range of motion
Slow rate of growth or uneven arm or leg growth
Hot, swollen, painful joints
A child may stop using an affected limb
Back pain
• Systemic JRA symptoms:
• Fever, usually high fevers every day
• Rash that comes and goes with the fever
• Swollen lymph nodes (glands)
• JRA can also cause eye inflammation. These symptoms include:
•
•
•
•
Red eyes
Eye pain
Photophobia (increased pain when looking at a light)
Visual changes
Diagnosis
• Lab tests
• X-ray
• history
Treatment
•
•
•
•
•
•
•
•
Medicines used to treat this condition may include:
Nonsteroidal anti-inflammatory drugs (NSAIDs)
Corticosteroids
An antimalaria medicine called hydroxychloroquine, which helps
reduce inflammation related to JRA
Disease-modifying anti-rheumatic drugs (DMARDs), including
methotrexate
Biologic drugs, such as such as etanercept and infliximab, which
block high levels of inflammatory proteins
Note: Talk to your health care provider before giving aspirin or
NSAIDs to children.
Physical therapy and exercise programs may be recommended.
Surgery may be needed in some cases, including joint
replacement
• Ankylosing
spondylitis• inflammation and
immobility of a
joints in the spine
• A form of arthritis
• Genetics plays a role
in the disease, but
the cause of AS is
still unknown
• Eventually, the whole back may become
curved and inflexible if the bones fuse (this is
known as "bamboo spine"). AS is a systemic
disorder that may involve multiple organs,
such as the:
•
•
•
•
•
eye (causing an inflammation of the iris, or iritis)
heart (causing aortic valve disease)
Lungs
skin (causing a scaly skin condition, or psoriasis)
gastrointestinal tract (causing inflammation within
the small intestine, called ileitis, or inflammation of
the large intestine, called colitis)
Diagnosis
• Diagnosis is by signs and symptoms
Treatment
• Physical therapy
• NSAIDS and antiinflammatory therapy
• Bracing
• Osteosarcomamalignant tumor of the
bone
• Osteosarcoma is the
most common type of
bone cancer in children
and adolescents.
• It occurs most often in
the bones on either side
of the knee and in the
upper arm. It most
commonly arises from
the metaphysis (the
wider part) of the bone
Incidence
• Each year in the United States,
osteosarcoma is diagnosed in approximately
400 children and adolescents younger than
20 years.
• The peak incidence of osteosarcoma is in
the second decade of life, during the
adolescent growth spurt. It is extremely rare
in children before the age of 5 years.
• Osteosarcoma is somewhat more likely to
affect males than females.
• The incidence in black children is higher than
that in whites.
•
• The cause of osteosarcoma is
unknown; however, irradiation and
genetic influences have been implicated
in its development
• Patients usually present with pain,
swelling, and sometimes decreased
joint motion.
• Occasionally, a patient may present with
a fracture at the tumor site
• The work up of a patient with suspected
osteosarcoma typically includes blood tests,
plain x-rays and magnetic resonance imaging
(MRI) of the affected bone, computerized
tomography (CT) scan of the chest and a
radionuclide bone scan.
• A biopsy is always required to make the
diagnosis. It is preferable to have the biopsy
done by the surgeon who will ultimately
perform the definitive surgical treatment.
• Treatment of osteosarcoma includes surgery
and chemotherapy.
• Surgical removal of all gross and microscopic
tumor is required to prevent local tumor
recurrence. Before the 1970s, amputation
was the only surgical approach. Currently, 95
percent of patients with localized
osteosarcoma of the extremity can be
considered for limb-salvage surgery.
Survival Rates
• Currently, the estimated 5-year survival for
patients with osteosarcoma is 65 percent
compared with 15 percent in the early 1960s.
• The presence of metastasis at diagnosis has
a major impact on patient survival. The
estimated survival rate for patients with
localized osteosarcoma is about 75 percent
compared to 30 percent for patients with
metastatic disease