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Mr. Nichols PHHS Paget’s Disease: Is a chronic disorder that can result in enlarged and misshapen bones. The excessive breakdown and formation of bone tissue causes affected bone to weaken, resulting in pain, misshapen bones, fractures, and arthritis in the joints near the affected bones. Paget’s Disease: Paget's disease may be caused by a slow virus infection (measles association, Canine distemper virus) present for many years before symptoms appear. Paget’s Disease: Many patients do not know they have Paget's disease because they have a mild case and have no symptoms, characterized by ‘spotty bone pain.’ Paget’s Disease: Goal of treatment is to relieve bone pain and prevent progression of disease. Bisphosphonates: Didronel (200400mg), Fosamax (40mg once daily) phalangies metatarsals tarsals tarsals metatarsals phalangies Osteoblast Builds new bone Mature bone cell Osteocyte Osteoclast Eats bone Osteoporosis 29 40 84 92 Immovable Joints (synarthrosis) suture pubis symphisis Slightly Movable Joint (ampharthrosis) (diarthrosis)- freely moveable pelvis ligaments femur joint capsule pelvis hyaline cartilage synovial cavity femur Synovial Joint Movement Extension Flexion Rotation Adduction Abduction 275 bones 12 weeks (6-9 inches long) Fetus: 1st 2 months Endochondral Ossification 2o ossification center bone cartilage calcified cartilage Just before birth epiphyseal line epiphyseal plate Childhood Adult Osteoblast Builds new bone Mature bone cell Osteocyte Osteoclast Eats bone Bone Repair: 1. Electrical stimulation of the fracture site: • Increases speed and completeness of healing • The e- stimulation inhibits PTH and slow osteoclasts down from reabsorbing bone 2. Ultrasound treatment: • Daily treatments reduce healing time of broken bones by 25-35% 3. Free vascular fibular graft technique: • Transplant fibula in arm • Gives good blood supply not available in other treatments 4. Bone substitutes: • Crushed bone from cadaver- but risk of HIV and hepatitis • Sea bone- coral • Artificial bone- ceramic hematoma callus bony callus bone remodeling Osteoporosis 29 40 84 92 Diseases of the Skeletal System: Rickets- vitamin D deficiency Osteomalacia- soft bones, inadequate mineralization in bones, lack of vitamin D Pagets Disease- spotty weakening in the bones, excessive and abnormal bone remodeling Rheumatoid arthritis- autoimmune reaction Cartoons of the Day • Avascular Necrosis • Is a disease that results from the temporary or permanent loss of blood supply to the bone. • When blood supply is cut off, the bone tissue dies and the bone collapses. If avascular necrosis occurs near a joint, collapse of the joint surface may occur. Symptoms minimal early joint pain increased joint pain as bone and joint begin to collapse limited range of motion due to pain Treatments Medications: Ibuprofin, Aleve to relieve pain. Osteotomy - a surgical procedure to reshape the bone and reduce stress on the affected area. Bone graft - a surgical procedure in which healthy bone is transplanted from another part of the patient's body into the affected area. Arthroplasty (total joint replacement) - a surgical procedure to remove and replace an arthritic or damaged joint with an artificial; may be considered only after other treatment options have failed to provide adequate relief from pain and/or disability Up Close Cartoon of the Day Cartoon of the Day Cartoon of the Day Cartoon of the Day Chondrosarcoma Is a type of cancer that develops in cartilage cells. Cartilage is the specialized, connective tissue that is present in adults and the tissue from which most bones develop. Cartilage plays an important role in the growth process. Chondrosarcoma is the second most common type of primary bone cancer. A primary bone cancer is one that originates from bone, as opposed to starting in another organ and then spreading to the bone. This type of cancer rarely affects individuals under age 20 and continues to rise until age 75. The incidence between males and females is equal. -Large mass on the affected bone (tumor) -Feeling of pressure around the mass -Pain that is usually worse at night and may be relieved by taking anti-inflammatory medications such as ibuprofen -Pain that is not usually relieved through rest -Pain that may be present for years but increases gradually over time -Surgery to remove the tumor -Physical therapy to regain strength and use of the affected area after surgery -Chemotherapy, although not the primary treatment, may be required if the cancer has spread to other areas of the body. Key Chemo (drug)- Doxorubicin, Ifosfamide. Methotrexate, cisplatin. Cartoon of the Day Cartoon of the Day Cartoon of the Day Cartoon of the Day Cartoon of the Day • Fibrous dysplasia is a chronic disorder in which bone expands due to abnormal development of fibrous. • Any bone in the body can be affected but more commonly affects, the femur, tibia, ribs, skull, humerus, pelvis, vertebrae. • The exact cause of fibrous dysplasia is not known, but it is believed to be due to a chemical irregularity in a specific bone protein. • This bone protein abnormality may be due to a gene mutation present at birth, but it is not known to be an inherited disorder. -a waddling walk -bone pain (as a consequence of the expanding fibrous tissue in the bone) -bone deformity -bone fractures -scoliosis - a lateral, or sideways, curvature and rotation of the back bones. -uneven growth of bones -pain -brittle bones -a waddling walk -bone pain (as a consequence of the expanding fibrous tissue in the bone) -bone deformity -bone fractures -scoliosis - a lateral, or sideways, curvature and rotation of the back bones. -uneven growth of bones -pain -brittle bones Surgery, including the following: -removal of affected bone, followed by bone grafting -removal of bone wedge -placement of a rod down the shaft of the bone -Medication: (bisphosphonates) Aredia, Fosamax, preserve bone mass and even increase bone density reducing the risk of fractures. -Pain management -Physical therapy • Long Bones- metacarples, metatarsals, phelangies, humerus, ulna, radius, tibia, fibula • Short Bones- carpals, tarsals • Flat Bones- rib, scapula, skull, sternum • Irregular Bones- vertebrae, some facial bones • Sesamoid- patella spongy bone Proximal compact bone epiphysis Endosteum diaphysis epiphyseal line yellow marrow Sharpey’s fibers Distal epiphysis hyaline cartilage periosteum Posterior View Frontal Sinus Ethmoid Sinus Sphenoid Sinus Maxillary Sinus • • • Warm and moisten air Lighten the skull Enhance voice resonance The Vertebral Column Cervical Vertebrae (7) Thoracic Vertebrae (12) Lumbar Vertberae (5) Sacrum Coccyx Cervical Vertebrae Cartoons of the Day! Cartoons of the Day! Cartoons of the Day! Cartoons of the Day! Cartoons of the Day! Disorder of the Day! Osteomyelitis Is an inflammation or swelling of bone tissue that is usually the result of an infection. Osteomyelitis, or bone infection, may occur for many different reasons and can affect children or adults. Symptoms fever pain and tenderness in the affected area irritability swelling of the affected area redness in the affected area warmth in the affected area difficulty moving joints near affected area difficulty bearing weight or walking Treatment Medications: Intravenous or oral antibiotic treatment for osteomyelitis may be very extensive, lasting for many weeks. I.E (Ancef, Ceftin, Azactam) monitoring of successive x-rays and blood tests pain management bed rest or restricted movement of the affected area Surgery In some cases, surgical intervention may be necessary to drain infectious fluid, or to remove damaged tissue and bone. Osteomyelitis Cartoons of the Day! Cartoons of the Day! Cartoons of the Day! Cartoons of the Day! Cartoons of the Day! Cartoons of the Day! The Thoracic Cage Sternum True Ribs (7) False Ribs (3) Floating Ribs (2) Sacrum & Coccyx Bones of the Pectoral Girdle Humerus Ulna Radius 8 Carpals 5 Metacarpals 14 Phalanges Cartoon of the Day! 94 Cartoon of the Day! 95 Cartoon of the Day! 96 Rare Disorder of the Day: Von Hippel-Lindau (VHL) Von Hippel-Lindau disease (VHL) is said to affect one in 35,000 people. It is an extremely rare genetic condition that is characterized by the growth of tumors in different parts of the body. More Info Many of the tumors will grow within the central nervous system and are often benign. Different tumors are also known to grow on the pancreas, adrenal glands, and kidneys. If left untreated, the disease can cause strokes, heart attacks, and cardiovascular disease. Symptoms Chronic Headaches. Problems with balance and walking, dizziness. Weakness of the limbs. Vision problems (retinal detachment common) High blood pressure. Treatment Laser coagulation of retinal occlusions. Cryotherapy to reduce swelling, inflammation, also aids in removal of tumor. Symptoms Looks like: Pelvis Pelvis (lateral view) Ilium Acetabulum Obturator foramen Ischium Pubis Ischium Male Pelvic Girdle Female Pelvic Girdle The Lower Limb (Legs) Femur Patella Tibia Fibula 7 Tarsals 5 Metatarsals 14 Phalanges