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Anatomy: Skeletal System functions, names and numbers of bones, problems Skeletal System: Functions Bones are living structures with 5 functions: • protect internal organs • support the body • make blood cells • store minerals • provide for muscle attachment Classification of bones • • • • Long bones Short bones Flat bones Irregular bones • Sesamoid bones Classification of bones The femur is an example of a long bone Classification of bones These are short bones Classification of bones These are considered flat bones Classification of bones Vertebrae are irregular bones Classification of bones kneecap (patella) is a sesamoid bone Review of bone tissue 1. 2. 3. 4. Osteocyte Canaliculi Matrix Haversian (central) canal 5. Lamella 6. Haversian system (osteon) Parts of a bone •Diaphysis - shaft of bone •Epiphyses - ends of bone •Articular cartilage - covers epiphysis at a joint •Periosteum - membrane covers outer bone surface •Endosteum - lines medullary cavity www.bmb.psu.edu/courses/ bisci004a/bone/bone.htm Parts of a bone 1. 2. 3. 4. 5. WHY WE NEED CALCIUM You may know that calcium plays an important role in building healthy teeth and bones. What you may not know is that calcium is vital to every cell of the body for muscle function, nerve transmission, blood clotting and many other uses. When you don't get enough calcium in your diet, the calcium stored in your bones is "stolen" to supply the rest of your body. Hence, your bones suffer the consequences of a low-calcium diet. This is why the bones become more susceptible to fractures. Where bones meet A point where two or more bones connect is called a joint. There are two different types of joints in the body: • Movable joints (like ball-and-socket, hinge, gliding and pivot joints) • Immovable joints (like the bones of the skull and pelvis) which allow little or no movement There are approximately 206 bones in the body. How many of them can you identify on this skeleton? Account for 206 • • • • • • • • 8 cranium (1 Occipital, 2 Parietal, 1Frontal, 2 Temporal, 1 Sphenoid, 1 Ethmoid) 14 face (2 Nasal, 2 Maxillæ, 2 Lacrimal, 2 Zygomatic, 2 Palatine, 2 Inferior Nasal Conchæ, 1 Vomer, 1 Mandible) 6 ears 1 hyoid 26 Vertebral column-7 cervical, 12 thoracic, 5 lumbar, (1)5 sacral, (1) 4 coccygeal 25 Sternum and ribs 64 Upper extremities 62 Lower extremities Skull The skull is made up of 22 bones (8 paired and 6 unpaired) joined by tight sutures • 8 bones to cranium • 14 bones in the face Other bones in the area: • 6 bones (3 each) ears • 1 hyoid In the lateral view above label the following bones: Cranium •Frontal 1 •Parietal 2 •Temporal 2 •Occipital 1 •Sphenoid 1 •Ethmoid 1 In the lateral view above label the following bones: Face Maxilla 2 Zygomatic 2 Lacrimal 2 Nasal 2 Vomer 1 NS Palatine 2 NS Inferior nasal concha 2 NS Mandible 1 Hyoid bone Bones of the ear each ear malleus incus stapes Vertebral column Your back is made up of a series of bones called “vertebrae." Together they form a flexible column. (left) There are a total of thirtythree vertebrae and they are grouped under the names cervical, thoracic, lumbar, sacral, and coccygeal. There are 7 cervical region, 12 thoracic, 5 lumbar, 5 sacral, and 4 coccygeal Lumbar vertebrae fibrocartilage intervertebral disc Name the vertebrae 1. 2. 3. 4. 5. Scapula Compare the shoulder joint (glenoid) with the hip joint (acetabulum) Note the spine, acromion process & coracoid process. Scapula and clavicle Clavicle Pectoral girdle for the humerus Sternum and ribs Notice the parts: manubrium, blade (gladiolus) and xiphoid process The ribs enclose the thoracic cavity. What are true ribs, false ribs & floating ribs? Upper limb scapula clavicle humerus radius ulna Shoulder joint The shoulder joint is the joint with greatest ROM (range of motion) of any joint. But the wide range of motion is at the expense of stability. A lack of stability results in a joint that is loose with a tendency to dislocate (come out of its socket). The joint and the tendons about the joint are subjected to considerable wear and tear leading to degeneration of the joint surface giving rise to arthritis and tears in the supporting tendons . Anatomy of shoulder The shoulder is made up of three bones, the scapula, clavicle and humerus. Torn rotator cuff MRI of a torn rotator cuff. The supraspinatus tendon normally extends over the head of the humerus. Courtesy S. Sadiq, M.D. x-ray of elbow Lower arm • radius • ulna Bones of the wrist and hand Label: phalanges metacarpals carpals – – – – – – – – Hamate Capitate Trapezoid Trapezium Triangular Lunate Scaphoid Pisiform (not shown in this posterior view) Male pelvis, hip, os coxa • ilium • ischium • pubis Female pelvis The pelvic girdle is formed from 2 pelvic bones joined to the sacrum (base of spinal cord). In front the pelvic bones are held together by the pubic symphysis joint. This joint allows only slight bending movement, but it softens and becomes more flexible in a female giving birth. Acetabulum This is a view of the right pelvic bone. It is formed from 3 fused bones: the ilium (green), ischium (yellow) and pubis (red). The 3 bones meet in the acetabulum (hip socket) at point A. Leg bones • • • • Femur Tibia Fibula Patella X-ray of knee knee surgery post-op 48 hours Basically, the ACL runs in a left to right direction and provides support for pivoting motions. In most cases people can live with an ACL tear they just have to be careful and potentially limit certain activities Bones of the foot • phalanges • metatarsals • tarsals: Talus, Calcaneus, Navicular, Cuboid, Lateral cuneiform, Intermediate cuneiform, Medial cuneiform Trauma Fracture Definition - a break in the continuity of a bone or cartilage. Classification • Closed fracture (simple) - no communication with the outside environment. • Open fracture (compound) communication with the outside environment. Bone fractures Comminuted Fracture This is a plain film of the left forearm and wrist which has at least five fragments of bone. Bone fractures A skeletally immature person suffered an ankle injury, resulting in a Salter-Harris Type III fracture. Note that the lateral aspect of the distal physis of the left tibia is separated with extension of the fracture line into the epiphyseal component of the distal tibia. Bone fractures Open fractures have contacted the environment. They are most commonly seen in vehicular or motorcycle accients and they are at high risk for infection or osteomyelitis. Bone fractures This is an image of a spiral fracture. Note the wavy appearance of the fracture due to torque through the bone. You often see spiral fractures in children when they twist an ankle or knee. This can be extremely alarming because a spiral fracture in children who are not yet walking can be due to child abuse. Bone fractures This is an image of a greenstick fracture. Due to the pliability of pediatric bone, the bone does not completely fracture. The medial side of the radius is open where as the lateral cortex has simply buckled. Bone fractures This is an example of a stress fracture of the tibia (arrows). Stress fractures are a common result of overuse or stress on the bone. It is desirable to catch them before they become complete fractures because they are non-displaced and in perfect anatomic alignment so they tend to heal well with appropriate treatment. Bone fractures This is a radiograph of the anterior superior illiac spine of the pelvis of a high school sprinter. Note the bony fragment that has dissociated from the pelvis (arrow). The patient pulled the bone fragment off the pelvis at the point of the Sartorious muscle attachment and subject to possible fracture at times of intense stress. Bone fractures This is an image of a both bone forearm fracture. The callus or fracture fragments have caused the bone to ossify between the radius and ulna fusing the forearm and preventing pronation or supination. Dislocation of the elbow Osteomyelitis (bone infection) This is an advanced case of osteomyelitis that had been developing for approximately 3 to 4 months at the time of the plain film. Note the mixed lytic and sclerotic processes that are occurring in the bone. Degenerative Joint Disease (DJD or osteoarthritis) • Primary osteoarthritis - most common in the older age group as the result of wear and tear on articular cartilage over time. • Secondary osteoarthritis - results from a previous process that damaged cartilage such as trauma, inflammatory arthritis. • The most commonly involved joints in primary osteoarthritis are: – Distal interphalangeal joints – First carpometacarpal joint – Weight bearing joints: spine, hips, knees Inflammatory Arthritis • An inflammatory process with the target organ being the synovial membrane leading to pannus formation (inflammatory exudate in the lining of the synovial cells). Rheumatoid arthritis Diagnosis usually made by plain film Osteopenia - a demineralization of the bone - is the result of increased blood flow, due to inflammation, which washes out the calcium. Rheumatoid arthritis Rheumatoid arthritis affecting the hands Tumor involving bone • Primary tumors Benign – Osteoid (e.g., osteoid osteoma, osteoblastoma) – Chondroid (e.g., enchondroma) – Fibrous (e.g., non-ossifying fibroma) – Mixed (e.g., osteochondroma) Malignant – Osteoid (e.g., osteosarcoma) – Chondroid (e.g., chondrosarcoma) – Fibrous (e.g., fibrosarcoma) – Mixed (e.g. dedifferenciated chondrosarcoma) – Metastatic tumors Benign Versus Malignant Tumor Left image is an enchondroma in a metacarpal bone. It is a sharply marginated, lucent structure. It is a slow growing tumor. • The right image, however, is an osteosarcoma in the femur. The tumor is growing beyond the margins of the bone and it is difficult to discern the full extent of the tumor. These features suggest it is an aggressively growing tumor. • Ankle sprain A sprain is a stretched or torn ligament. Ligaments connect one bone to another bone at a joint and help keep the bones from moving out of place. The most common site of sprains is the ankle Ankle sprain Although ligament damage frequently occurs during athletics or exercise, ankles are just as often injured stepping off a curb, into a pothole, or onto uneven ground. Ankle sprain Upon physical examination, the ankle will exhibit swelling and discoloration (black and blue) over the outside part of the joint. Touching of the area will result in a variable amount of discomfort. Frequently, there is instability notes on the drawer test as the heel structures are moved forward and back as the leg is stabilized. Range of motion (ROM) in the ankle can be limited due to pain and swelling, but strength is not usually affected. X-rays are essential, as the possibility of a fracture must be ruled out. Ankle sprain-Grade I • Mild sprain, mild pain, little swelling, and joint stiffness may be apparent • Stretch and/or minor tear of the ligament without laxity (loosening) • Usually affects the anterior talofibular ligament • Minimum or no loss of function • Can return to activity within a few days of the injury (with a brace or taping) Ankle sprain-Grade II Ankle sprain-Grade II • Moderate to severe pain, swelling, and joint stiffness are present • Partial tear of the lateral ligament(s) • Moderate loss of function with difficulty on toe raises and walking • Takes up to 2-3 months before regaining close to full strength and stability in the joint Ankle sprain-Grade III • Severe pain may be present initially, followed by little or no pain due to total disruption of the nerve fibers • Swelling may be profuse and joint becomes stiff some hours after the injury • Complete rupture of the ligaments of the lateral complex Usually requires some form of immobilization lasting several weeks • Complete loss of function and necessity for crutches • Usually managed conservatively with rehabilitation exercises, but a small percentage may require surgery • Recovery can be as long as 4 months How can ankle sprains be treated? Many doctors suggest using the RICE approach— Rest Ice Compression Elevation RICE approach Rest • Rest--You may need to rest your ankle, either completely or partly, depending on how serious your sprain is. Use crutches for as long as it hurts you to stand on your foot. • Ice--Using ice packs, ice slush baths or ice massages can decrease the swelling, pain, bruising and muscle spasms. Keep using ice for up to 3 days after the injury. • Compression--Wrapping your ankle may be the best way to avoid swelling and bruising. You'll probably need to keep your ankle wrapped for 1 or 2 days after the injury and perhaps for up to a week or more. • Elevation--Raising your ankle to or above the level of your heart will help prevent the swelling from getting worse and will help reduce bruising. Try to keep your ankle elevated for about 2 to 3 hours a day if possible. References The Sourcebook of Medical Illustration, edited by Peter Cull (Park Ridge, NJ: Parthenon, 1989) members.aol.com/Attic21/Anatomy/skullans.html Virtual Hospital ® is the Apprentice's Assistant www.vh.org/.../Lectures/icmrad/ skeletal/Parts/Compound.html The Nicholas Institute of Sports Medicine and Athletic Trauma www.nismat.org/ptcor/ ankle_sprain/