Anatomy and Physiology of the Skeletal System Introduction • The skeletal system provides a rigid framework to support and protect the body. Bones function closely with the muscular system to permit movement. • In this lecture, we will discuss the functions and structure of bones and how they are formed. • We will also learn the names of the major bones and where they are located. • In order to be effective in working with orthopedic patients, the medical assistant must have an understanding of the diseases and conditions that affect the skeletal system. • Since bones play a major role in body movement and support, injuries may seriously alter the activities of daily living. • Therefore, we will discuss diseases and injuries of the bones and joints along with procedures used in diagnosis and treatment. Skeletal System • Function – Support • Provides the framework to support the body’s fat, muscle, and skin. – Protection • Protects the body’s vital organs. – Leverage • Serves as a point of attachment for skeletal muscles responsible for movement. – Storage • Stores most of the body’s calcium supply. – Blood cell production • Forms red and white blood cell and platelets. – Form • Gives shape to the body. Skeletal System (cont'd) • Bone Structure – Composition • 20% water • 2/3 inorganic materials • 1/3 organic materials Skeletal System (cont'd) • Bone the Organ – Parts: – Compact—hard; dense; found near the surface where strength is required. (Tissue) – Spongy (cancellous)—mesh-like; found in ends of long bones and center of flat bones. (Tissue) – Marrow—loose connective tissue that fills cavities of bone. • Red—produces formed elements of blood. • Yellow—made up of fatty tissue—has no blood production function. – Periosteum—connective tissue around a bone. – Endosteum—inner lining of bones. – Haversian canal—duct in bone that contains blood vessels. – Osteocytes— mature bone cells that maintain the bone – Osteoblasts- immature bone cells that lay the bone matrix – Osteoclasts- bone cells that reabsorb damaged or old bone tissue. Long Bone Features Skeletal System (cont'd) • Four General Shapes – – – – Long Short Flat Irregular Skeletal System (cont'd) • Growth and Development – – – – Bone formation (ossification) begins six weeks after fertilization. Continues through adolescence (some parts do not stop growing until ages 18 to 25). Bone growth increases at puberty with the increase of the sex hormone. While the bone lengthens, it also grows in diameter due to the formation of cell layers on the outer surface of bone, and the erosion of the cell layers beneath. • 2 types of ossification = endochondral and intramembranous – Bones become thinner and weaker as a normal process of aging. – Reduction in bone mass begins to occur between ages 30 and 40. – Once bone mass reduction begins: • Females lose approximately 8% of bone mass every decade. • Males lose approximately 3% of bone mass every decade. • Osteoporosis results from bones becoming so thin they can no longer withstand normal stress. Skeletal System (cont'd) • Number of Bones – 270 at birth – 206 at adulthood – Difference between number at birth and adulthood due to fusion of bones Skeletal System (cont'd) • Divisions of the Skeletal System – Axial skeleton • Spinal column • Skull • Rib cage – Appendicular • • • • • • Arms Hands Legs Feet Shoulders Pelvis Cranial and Facial Bones Identification of Bones (cont'd) • Skull – Cranium • Protects the brain from injury. • Fontanels – Unossified space or “soft spot” located between cranial bones. – Allows for molding of skull during childbirth and for enlargement of skull as growth occurs. • Found in newborn and infancy; closed by age two. – Composed of the fusion of eight cranial bones: » Frontal—1 » Parietal—2 » Temporal—2 » Occipital—1 » Sphenoid—1 » Ethmoid—1 Identification of Bones (cont'd) • Skull (con’t) – Facial • • • • • • • • Nasal—2 Zygoma—2 Maxilla Mandible Palate—2 Concha—2 Vomer—1 Hyoid—1 Identification of Bones (cont'd) • Skull (con’t) – Ear bones (ossicles) smallest bones in the body: • Malleus (hammer)—2 • Incus (anvil)—2 • Stapes (stirrup)—2 Identification of Bones (cont'd) • Rib Cage – Twelve pairs of long slender bones attached to vertebrae. • True ribs—first seven pairs—attached directly to sternum and spine. • False ribs—last 5 pairs—attached to cartilage of rib above or have only anterior attachment. • Last 2 pairs of false ribs; referred to as floating ribs; only attach to vertebrae. • Sternum (breast bone)—1 Identification of Bones • Spinal Column – Supports the head, keeps trunk erect, protects spinal cord. – Sections: • • • • • • Cervical—first 7 neck vertebrae (C1–C7) Thoracic—12 chest vertebrae (T1–T12) Lumbar—5 back vertebrae (L1–L5) Sacral—1 large vertebra fused from five original bones Coccyx (tailbone)—1 vertebra fused from four original bones Cartilage disks separate the vertebrae to absorb shock and allow flexibility. Bones of the Rib Cage Identification of Bones (cont'd) • Upper Extremities – – – – – – – – Clavicle (collar bone)—1 Scapula (shoulder blade)—2 Humerus (arm) 2 Ulna—2 Radius—2 Carpals (wrist) eight in each wrist Metacarpals (palm) 5 in each palm Phalanges (fingers) each finger has 3 bones, each thumb has 2, 14 in each hand Identification of Bones (cont'd) • Pelvic Girdle— – Differences between male and female: female must accommodate pregnancy and childbirth • Ilium—upper wedge called iliac crest; wider in females—2 • Ischium—2 • Pubis—2 The Male Pelvis The Female Pelvis Identification of Bones (cont'd) • Lower Extremities – – – – – – – Femur (thigh) strongest bone in body—2 Patella (kneecap)—2 Tibia (shinbone)—2 Fibula—2 Tarsal (ankle) 7 in each ankle Metatarsals (instep) 5 in each instep Phalanges (toes) 14 in each foot Joints • A place where any two or more bony parts join together; also called an articulation. • Held together by bands of connective tissue called ligaments. Joints Joints (cont'd) • Joint Classifications – Diarthrosis • • • • Moveable Knee, elbow, which has action of a hinge Shoulder or hip, which has action like that of ball and socket Most joints are diarthrotic and contain: – Articular cartilage – Bursa, sack-like capsules for cushioning – Synovial cavity, filled with synovial fluid for lubrication – Synovial membrane around and between tendons to lubricate and reduce friction Joints (cont'd) • Joint Classifications (cont'd) – Amphiarthrosis/cartilaginous • Partly moveable • Vertebrae – Synarthrosis/fibrous • Immovable • Cranial sutures Joints (cont'd) • Types of Joints – Gliding joints • Found at the end of clavicles, between carpals and tarsals—slight movement. – Hinge joint • Angular movement in a single plane—knee, elbow. – Pivot joint • Permit rotation only—joint between C1 and C2 allows the head to rotate to either side. – Ball and socket • Round head of one bone rests within the cup-like depression in another—shoulder, hip. Joints (cont'd) • Types of Movement – Flexion • Movement that reduces the angle between articulating joints. – Extension • Movement that increases the angle between articulating joints. – Abduction • Movement away from the longitudinal axis of the body. – Adduction • Movement towards the longitudinal axis of the body. – Rotation • Turning around the longitudinal axis of the body or limb. Diagnostic Examinations • Athroscopy – • Computer Tomography (CT scan) – • Visual inspection of a joint with an endoscope. An x-ray which allows three dimensional views. Magnetic Resonance Imaging (MRI) – Process uses strong magnets and radio waves to construct a three dimensional image. • Advantages over CT scan: – No radiation used. – Soft tissues seen in more detail. • Disadvantages: – More expensive. – Patients put in tube; obesity or claustrophobia could be a problem for some patients. • X-ray – Image produced by ionizing radiation. Fractures • Types of Fractures: – – – – – – – – Greenstick—bone cracks but does not break, common in children. Simple or closed—complete break, does not break skin. Compound or open—complete break, bone protrudes through skin. Impacted—broken ends are jammed into each other. Comminuted—more than one fracture, bone fragments. Depressed—broken pieces of skull driven inward. Spiral—break winds around bone, common in sports accidents. Colles—fracture of distal end of radius and/or ulna. Examples of Fracture Types Fractures (cont'd) • Treatment – – – – – Immobilization of the affected part. Prevention of shock. Elevate. Cold pack or ice. Reducing the fracture: • Alignment of the bones. • Splint or cast keeps bone immobilized. – Open reduction is a surgical procedure to achieve alignment of the bone and repair tissues and skin. Fractures (cont'd) • Healing Process – When a fracture occurs, a collection of blood forms at site. – This begins the inflammatory reaction which begins the healing process. – A fibrous bridge formed between the fracture fragments is called a callus. – As time passes this callus turns first to cartilage and then to bone. • Amputation – Loss of an extremity due to injury or disease. – Phantom limb is the sensation that the missing limb is present. – Prosthesis is an artificial limb. Common Diseases and Disorders • Arthritis – – – – Description: joint inflammation. More than 100 different types. Currently affects 40 million Americans, mostly women. Most common forms: • • • • • Osteoarthritis Rheumatoid arthritis Gout Fibromyalgia Lupus Arthritis Common Diseases and Disorders (cont'd) • Bursitis – Description: inflammation of sac located around a joint; most often occurs at hip, shoulder, or knee. – SX: pain upon movement, limited motion of joint. – Causes: usually occurs in middle age and is result of recurring trauma or inflammatory joint disease. – TX: joint rest, pain medication, steroid injection combined with anesthetic, removal of fluid by aspiration, physical therapy. Common Diseases and Disorders (cont'd) • Dislocation – – – – Description: displacement of the bones of a joint. SX: pain. Causes: congenital, trauma, disease of surrounding joint. TX: reduction, splint, cast, traction. Common Diseases and Disorders (cont'd) • Herniated Disk (ruptured disk) – Description: the soft gel-like material within an intervertebral disk has been forced through its outer surface causing pressure on a spinal nerve. – SX: severe lower back pain, frequently radiating deep into the buttocks and down the back of the leg; sensory loss from compression of nerve; motor difficulties. – Causes: severe trauma or strain, degeneration of the intervertebral joints; occurs in adults, mainly men under 45; often occurs from trauma in elderly. Common Diseases and Disorders (cont'd) • Lumbar Myositis – – – – Description: inflammation of the lumbar region muscles of the back. SX: low back pain. Causes: straining of back muscles. TX: rest, mild analgesics, and muscle relaxers. • Osteoporosis – Description: metabolic bone disorder where the bone becomes porous, brittle and prone to fracture. • Two types: Primary, which is postmenopausal and Secondary, following various abuses to the body such as steroid therapy. – SX: snapping sound followed by instant pain, spinal curvatures, fractures, loss of height. – Causes: aging, inadequate calcium, faulty metabolism, tobacco, family history. – TX: increasing exercise, estrogen supplement, calcium, vitamin D. Common Diseases and Disorders (cont'd) • Spinal Curvatures – Kyphosis • Description: bowing of the back, usually at the thoracic level. • SX: visible curving, pain, stiffness, tightening of hamstring muscles. • Causes: growth retardation, degeneration of intervertebral disks, osteoporosis. • TX: exercise, firm mattress, surgery. Common Diseases and Disorders (cont'd) • Spinal Curvatures (cont'd) – Lordosis • • • • Description: anterior convex curvature of the lumbar spine. SX: visual curvature. Causes: poor posture, wearing high heels. TX: exercise, improving posture, proper footwear. – Scoliosis • Description: lateral curvature of the spine usually in the thoracic region. • SX: uneven hemlines or unequal pants legs, one hip appearing higher than the other, one shoulder appearing higher. • Causes: congenital defects, muscular dystrophy, paralysis, transmitted trait that develops during the growing process, poor posture, uneven leg lengths. • TX: exercise, brace, surgery. SPINAL CURVATURES Common Diseases and Disorders (cont'd) • Sprain – – – – Description: complete or incomplete tear in the supporting ligament of a joint. SX: pain, swelling, black and blue discoloration; ankle most common site. Causes: twisting action. TX: follow R.I.C.E.—Rest, Ice, Compression, and Elevation; may require surgery. • Carpal Tunnel Syndrome – Cause: compression of median nerve at the wrist. – SX: numbness, pain in hand. – TX: surgery to relieve pressure. Questions – – – – – – – – – – – Name the bones and locate them on a skeleton. What is the difference between compact and spongy bone? How many phalanges are there? What is the difference between true and false ribs? Name three types of spinal curvatures and describe their physical characteristics. What is a greenstick fracture? What does the abbreviation R.I.C.E. stand for? What does open reduction mean? What is the cause of lumbar myositis? How many bones are in the human body? How many bones are there in the human body at birth?