Skeletal System :

Bones and Joints

Ronald G. Daroya, M.D.
Bone Tissue And Homeostasis
 Bone Tissue is continuously growing,
remodeling and repairing itself.
 It contributes to Homeostasis of the
body by providing support and
protection, producing blood cells, and
storing minerals and triglycerides.
Skeletal System
 BONE
 CARTILAGE
 TENDONS
 LIGAMENTS
Human Skeleton
Major Functions
 1. Support = serves as structural framework
for supporting soft tissue & providing
attachment points for tendons of most
skeletal muscles.
 Ex. rigid strong bone suited for bearing
weight & major supporting tissue of the body.
 Cartilage firm yet flexible support nose,
external ear, thoracic cage & trachea.
 Ligaments are strong band of fibrous CT
attach bone & hold them together.
Major Functions
 2. Protection = bone is hard & protect organs from
injury.
 Ex. Skull (brain), Vertebrae (SC), Rib cage (heart,
lungs & other organs of thorax).
 3. Movement = Skeletal m. attach to bones by
tendons which are strong band of CT. Contraction of
skeletal m. moves bones, producing body
movement. Joints, where 2 or more bones come
together , allow movement between bones.
Ligaments allow some movement between bone but
prevent excessive movement.
Major Functions
 4. Storage and release =minerals in blood (Calcium and
Phosphorus) stored in bone.
 5. Blood cell production = many bones contain cavities
filled with RBM, produces blood cells & platelets,
process called “Hemopoiesis”. RBM consists of
developing blood cells, adipocytes, fibroblast &
macrophages within a network of reticular fibers. Found
in developing bones of fetus & adult bones (hip, pelvic
bones, ribs, sternum, vertebrae, skull, & end of humerus
& femur.
Major Functions
 Newborn, all Bone Marrow is red and
involved in Hemopoiesis with increasing
age, much of BM changes from red to
yellow.
 6. Triglyceride = YBM consist mainly of
adipose cells, which store triglycerides &
are potential energy reserve.
Extracellular Matrix
 Bone, Cartilage, Tendons & Ligaments of SS are
all CT.
 Their characteristics largely determined by the
composition of their ECM.
 Matrix always contain collagen, ground subs., &
other organic molecules as well as water & minerals.
But types & quantities differ in @ type of CT.
 Collagen = is a tough, ropelike protein.
 Proteoglycan = are large molecules consisting of
polysaccharide attached to core protein (like
needles of pine tree are attached to the tree’s
branches)
Extracellular Matrix
 ECM of Tendons & Ligaments contains large
amount of collagen fibers, making structure very
tough, like ropes or cables.
 ECM Cartilage = contain collagen and
proteoglycan. Collagen make cartilage tough &
water-filled proteoglycan make it smooth and
resilient. Cartilage is relatively rigid, easily bent or
slightly compressed. It’s an excellent shock
absorber.
Extracellular Matrix
 ECM Bone = contains collagen & mineral
(Ca++& PO4 ). Ropelike collagen fibers, like
reinforcing steel bars in concrete, lend flexible
strength to the bone. Mineral component , like
concrete itself, gives the bone compression (wt.
bearing) strength. Most mineral in bone is in the
form of calcium phosphate crystals called
Hydroxyapatite.
General Features of Bone
 Four categories based on their shape :
 1. Long B. = longer than they are wide
 Ex. U & L limbs
 2. Short B. = approximately as wide as they are
long.
 Ex. Wrist & Ankle
 3. Flat B. = thin, flattened shape
 Ex. Skull , Ribs, Scapulae & Sternum
 4. Irregular B. = have shapes that do not fit readily
into the 3 categories
 Ex. Vertebrae & Facial bones
General Features of Bone
SESAMOID BONES = are small,
rounded bones resembling a grain of
sesame in shapes. Found near joints,
& they inc. the efficiency of muscles
near a particular joint. Ex. Kneecap
(largest)
LONG BONE
 Serves as useful model for typical bone & consists :
 1. Diaphysis = central shaft
 2. Epiphyses = 2 ends (growing upon)
 3. Metaphyses = regions between diaphysis and
epiphyses.
 4. Articular cartilage = thin layer , covers the ends
of Epiphyses where the bone articulates (joins) with
other bone. AC reduces friction & absorbs shock at
freely movable joints. Because AC lacks a
perichondrium & lacks blood vessels, repair of
damage is limited.
LONG BONE
 Epiphyseal plate or Growth plate = if long
bone still growing ; composed of cartilage
between @ epiphysis & diaphysis. EP where
bone grows in length. When bone growth
stops, cartilage of @ EP is replaced by bone
& becomes Epiphyseal line.
Long Bone
Long bone
LONG BONE
 Bones contain cavities, large medullary cavity in
Diaphysis & smaller cavities in Epiphyses of long bones
& in the interior of other bones.
 Spaces filled with soft tissue called Marrow
 1. YM = mostly adipose tissue
 2. RM = consists of blood forming cells & site of blood
formation in adult.
 5. Periosteum = covering the outer surface of bone with
dense CT, consist of 2 layers & contains blood vessels
and nerves.
 6. Medullary Cavity (Marrow Cavity) = is a hollow,
cylindrical space within the diaphysis that contains fatty
YBM & numerous blood vessels in adults.
 7. Endosteum = lined the surface of medullary cavity
with thinner CT membrane.
Divisions of a long bone &
interior structure
Cont.
 1. Diaphysis
 2. Epiphysis
 3. Epiphyseal line or plate
 4. Metaphysis
 5. Periosteum
 6. Articular cartilage
 7. Compact bone
 8. Haversian canal
 9. Medullary cavity
 10. Cancellous bone
Long Bone
 Bone or Osseous Tissue contains an
abundant EC matrix that surrounds widely
separated cells.
 The ECM is about 15% water; 30% collagen
fibers; & 55% crystallized mineral salts.
 The most abundant mineral salt is Calcium
Phosphate [Ca3(PO4)2].
 It combines with another mineral salt,
Calcium Hydroxide [Ca(OH)2], to form
crystals of hydroxyapatite [
Ca10(PO4)6(OH)2]
Histology of Bone Tissue
 As the crystal form, they combine with still
other mineral salts, such as Calcium
Carbonate (CaCO3), & ions such as
magnesium, fluoride, potassium, & sulfate.
 As these mineral salts are deposited in the
framework formed by the collagen fibers of
the EC matrix, they crystallize and the tissue
hardens, process called “Calcification”, is
initiated by bone-building cells called
Osteoblasts.
Histology of Bone Tissue
 The combination of crystalized salts and
collagen fibers is responsible for the
characteristics of bone.
 Although a bone’s hardness depends on the
crystallized inorganic mineral salts, a bone’s
flexibility depends on its collagen fibers.
 There are 4 types of cells present in Bone
Tissue : osteogenic cells, osteoblasts,
osteocytes, and osteoclasts.
Histology of Bone Tissue
 1. Osteogenic cells = are unspecialized bone
stem cells derived from mesenchyme, the tissue
from which almost all CT are formed. They are
the only bone cells to undergo cell division. OC
are found along the inner portion of the
periosteum, endosteum, & in the canals within
bone that contain blood vessels.
 2. Osteoblasts = are bone-building cells. They
synthesize & secrete collagen fibers & other
organic components needed to build the EC
matrix of bone tissue & they initiate calcification.
Histology of Bone Tissue
 3. Osteocytes = mature bone cells, are the
main cells in bone tissue & maintain its daily
metabolism, such as exchange of nutrients &
waste with the blood. Like osteoblasts,
osteocytes do not undergo cell division.
 4. Osteoclasts = are huge cells derived from
the fusion of as many as 50 monocytes
(WBC) & are concentrated in the endosteum.
This breakdown of bone ECM termed
resorption, is part of the normal
development, maintenance, & repair of bone.
Histology of Bone Tissue
 A mnemonic that will help you
remember the difference between the
function of Osteoblasts and
Osteoclasts is as follows :
osteoBlasts Build bone, while
osteoClasts Carve out bone.
Histology of Bone
 Periosteum & Endosteum = contain osteoblast
(bone forming cells) formation of bone, repair &
remodeling.
 When osteoblasts surrounded by matrix, referred to
as osteocytes (bone cell) . Osteoclasts (bone eating
cells) also present & contribute to bone repair &
remodeling by removing existing bone.
 Bone formed in thin sheets of ECM called Lamellae
(plates) with osteocytes located between the
lamellae within spaces called Lacunae (hollows).
 Cell processes extend from osteocytes across ECM
of the lamellae within tiny canals called Canaliculi
Histology of Bone
 Bone found throughout skeleton is divided into 2
major types; based on histological structure .
 1. Compact B. = mostly solid matrix & cells
 2. Spongy B. (Cancellous) = consist of lacy
network of bone with many small, marrow-filled
spaces.
 Compact B. = forms most of diaphysis & thinner
surfaces of all other bones. Has predictable patterns
of repeating units called Osteons. @ osteon
consists of concentric ring of lamellae surrounding
“Central Canal” or “Haversian Canal”.
Histology of Bone
 Spongy B. = located mainly in epiphysis of long bone.
Consists of delicate interconnecting rods or plates of
bone called “Trabeculae”, which resemble the beams or
scaffolding of a building. Like scaffolding Trabeculae add
strength to a bone without added weight if bone were
solid mineralized matrix.
 Spaces between the Trabeculae are filled with marrow.
@ Trabculae consist of several lamellae with osteocytes
between them. Usually no blood vessels penetrates the
Trabeculae & have no central canal.
Bone Ossification
 Formation of bone by osteoblast
 2 types of Bone formation :
 1. Intramembranous O. = bone formation that occurs
within CT membrane.
 2. Endochondral O. = bone formation that occurs inside
cartilage.
 Primary Ossification Center = center part of Diaphysis
where bone first begins to appear.
 Secondary Ossification Center = later form in the
Epiphysis.
Bone Growth
 Bone elongation occurs at the
epiphyseal plate as chondrocytes
proliferate, enlarge, die & are
replaced by bone.
Bone Remodeling
 Consists of removal of existing bone by
osteoclasts & deposition of new bone
osteoblasts.
 Bone is the major storage site for Ca++ in the
body, bone remodeling is important to
maintain blood Ca++ level within normal limits.
 Ca++ is removed from bones when blood Ca++
level decrease, & it is deposited when dietary
Ca++ is adequate. This removal & deposition
is under Hormonal control.
Bone Remodeling
 If too much bone is deposited = bones
become thick or develop abnormal spur or
lumps that can interfere with normal
function.
 If too little bone formation or too much
bone removal = occurs in osteoporosis,
weakens the bone & make them
susceptible to Fracture.
Bone Repair
 Sometimes bone is broken & needs to be repaired.
 During bone repair, cells move into damaged area &
form a callus, which is replaced by bone (spongy
bone formation in the Callus is usually complete 4-6
weeks after injury. Subsequently, spongy bone is
slowly remodeled to form compact & spongy bone &
repair is complete).
 Callus = network of fibers & islet of cartilage
between 2 fragments.
Bone & Calcium Homeostasis
 Bone is the major storage site for Calcium in the
body, & movement of calcium into & out of bone
helps determine blood calcium level, which is critical
for normal muscle & NS functions.
 Osteoclasts remove Ca++ from bone, causing blood
Ca++ level to increase.
 Osteoblasts deposit Ca++ into bone, causing blood
Ca++ level to decrease.
Bone & Calcium Homeostasis
 Calcium homeostasis is maintained by 3 Hormones :
 1. Parathyroid H (PTH) = Parathyroid gland
 2. Vit. D = skin or diet
 3. Calcitonin = Thyroid gland
 PTH & Vit. D = are secreted when blood Ca++ level
are too low
 Calcitonin is secreted when blood Ca++ level are
too high
Bone & Calcium Homeostasis
 PTH works through 3 simultaneous mechanism to increase
blood Ca++ level :
 1. PTH indirectly stimulate osteoclast to break down
bone, which releases stored Ca++ into the blood.
 2. PTH stimulate the kidney to take up Ca++ from the
urine & return it to the blood.
 3. PTH stimulate the formation of active Vit. D ,
which in turn, promotes increased Ca++ absorption
from the SI.
Bone & Calcium Homeostasis
 PTH & Vit. D therefore cause blood Ca++ level to
increase, maintaining homeostatic levels
 Decrease blood Ca++ level stimulate PTH secretion.
 Calcitonin decrease blood Ca++ level by inhibiting
osteoclast activity.
 PTH increases bone breakdown , whereas
Calcitonin decreases bone breakdown
 In summary, PTH, Vit. D & Calcitonin work together
to keep blood Ca++ level within homeostatic range.
General Consideration of Bone
Anatomy
 There are 206 bones in ave. adult skeleton although
actual no. varies from person to person & decrease
with age as some bone fuse.
 Anatomist use sev. common terms to describe
features of bones :
 Ex. Foramen = hole in a bone (nerve or blood v.
pass)
 Canal or Meatus =hole is elongated into a tunnel-
like passage.
General Consideration of Bone
Anatomy
 Tubercle / Tuberosity = lump on a bone ( for
muscle attachment).
 Process = projection from a bone
 Condyle = smooth, rounded end of a bone, where it
forms a joint with another bone.
 Bones of the skeleton are divided into AXIAL and
APPENDICULAR.
STRUCTURE
 There are 206 bones of various types in the body.
 Regional Classification of Bones:

Region of Skeleton No. of Bones

Axial skeleton
Skull
cranium 8
face 14
auditory ossicles 6
STRUCTURE
Hyoid 1
Vertebrae 26
Sternum 1
Ribs 24
Appendicular skeleton
Shoulder girdles
clavicle 2
scapula 2
Upper extremities
Humerus 2
Radius 2
STRUCTURE
Ulna 2
Carpals 16
Metacarpals 10
Phalanges 28
Pelvic girdle
Hip bone 2
Lower extremities
Femur 2
Patella 2
Fibula 2
Tibia 2
STRUCTURE
Tarsals 14
metatarsals 10
phalanges 28
206
Axial Skeleton
 Composed of Skull, Vertebral Column & Thoracic Cage.

 Skull :
 Consist of 22 bones : 8 braincase & 14 facial bones, hyoid bone
& 6 auditory ossicles associated with skull
 Lateral view : parietal, temporal & sphenoid bones
 Frontal view : orbits & nasal cavity, as well as asstd. bones &
structure such as Frontal b., Zygomatic b., Maxilla & Mandible.
 The interior of cranial cavity contains 3 fossae with several
foramina.
Axial Skeleton
 Seen from below : the base of skull reveals
numerous foramina & other structure such as
processes for muscle attachment.

 Vertebral Column :
 Contains : Cervical = 7 Thoracic = 12
 Lumbar = 5 Sacral = 1
 Coccyx = 1 Total = 26
Axial Skeleton
 @ vertebra consists of body, an arch and
processes.
 Regional differences in vertebrae are as follows :
 1. cervical v. = have transverse foramina.
 2. thoracic v. = have long spinous processes &
attachment site for ribs.
 3. lumbar v. = have rectangular transverse &
spinous process & the position of their facets limits
rotation.
 4. sacrum = is a single fused bone.
 5. coccyx = is 4 or fewer fused vertebrae.
Axial Skeleton
 Thoracic cage :
 Rib cage : Ribs & sternum
 Ribs : 12 pairs
 1-7 True ribs = attach directly to sternum by means
of costal cartilage.
 8-12 False ribs = do not attach directly to sternum.
 8-10 = attach to the sternum by common cartilage.
 11-12 = do not attach at all to the sternum & are
called “Floating Ribs”
Thoracic Cage
 Rib cage
Axial Skeleton
 Sternum (breastbone) = 3 parts : manubrium, body
& xiphoid process.
 Resemble a sword (manubrium = handle, body =
blade, xiphoid process = tip).
 Superior end of sternum, depression (Jugular Notch)
 Sternal angle = slight elevation ,felt at the junction of
the manubrium & body of sternum.
 Land mark : identifies 2nd rib, able to locate apex of the
heart between 5th – 6th ribs.
 Xiphoid process = impt. landmark esp. CPR impt. to
place the hand over body of sternum not in XP (liver).
Appendicular Skeleton
 Consists of the bones of the UL, LL, & their GIRDLES
 1. Pectoral Girdle = Scapulae & Clavicles
 2. UL = arm (humerus), forearm (ulna & radius)
 wrist (8 carpal) & hand (5 metacarpal)
 3 phalanges in @ finger & 2 in thumb.
 3. Pelvic Girdle = 2 coxal bones @ coxal bone
consists of ilium, ischium & pubis
 4. LL = thigh (femur), leg (tibia & fibula), ankle (7
tarsal) & foot (metatarsal) & phalanges same as hand.
JOINTS
 Or ARTICULATION is a place where 2 bones come
together.
 Is usually considered movable, but that is not always
the case.
 One method of classifying joints is a “Functional
Classification”,based on the degree of motion.
 1. Synarthrosis = non-movable joint ex. Suture of the
skull
 2. Amphiarthrosis = sl. movable joint ex. Superior
Tibiofibular joint
 3. Diarthrosis = freely movable joint ex. Shoulder joint
JOINTS
 Function : classification somewhat restrictive & is not
used instead we use structural classification whereby
joints are classified according to the type of CT that
binds the bone together & where there is fluid-filled joint
capsule.
 3 Major Structural Classes of Joints:
 1. Fibrous joints
 2. Cartilaginous joints
 3. Synovial joints
JOINTS
 Fibrous Joints :
 Consists of 2 bones united by fibrous CT & allow
little or no movement.
 Further subdivision on the basis of structure as :
Suture, Syndesmoses or Gomphoses.
 A) Suture = fibrous joint between the bones of the
skull.
 * Fontanels = soft spot (Ant. & Post.), little
fountains, allow flexibility in the skull during birth
process as well as growth of head after birth.
JOINTS
 B) Syndesmoses = fibrous joint in which
bones are separated by some distance &
held together by ligaments. Ex. Fibrous
membrane connecting most distal parts of
Radius & Ulna
 C) Gomphoses = consists of pegs fitted into
skull & held in place by ligaments. Ex. Joint
between a tooth & its socket.
JOINTS
 Cartilaginous joints :
 Consists of 2 bones united by cartilage & exhibit sl.
movement .
 Ex. Cartilage in epiphyseal plates of growing long bone.
Cartilage between Ribs & Sternum
 * Fibrocartilage = cartilage forms joint
 Ex. Intervertebral disks
 Synovial Joints :
 Freely movable joint that contain fluid in a cavity
surrounding the ends of articulating bones.
JOINTS
 Most joints that unite the bones of the appendicular
skeleton are SJ but axial skeleton are not.
 Several features of SJ are important to their function :
 Articular cartilage = covered articular surface of bones
with SJ. Thin layer which provide smooth surface
where bones meet.
 Joint cavity = filled with fluid.
 Joint capsule = enclosed the cavity which help hold
the bones together & allows movement.
 SJ consists of articular cartilage over the uniting
bones,
JOINTS
 A joint cavity lined by a synovial membrane and
containing fluid & a joint capsule.
 They are highly movable joints
 SJ can be classified according to shape of adjoining
articular surfaces :
 1. Plane J. (gliding j.) = consists of 2 opposed flat
surfaces that glide over @ other. Ex. Articular facets
between vertebrae
 2. Saddle J. = consists of 2 saddle-shaped
articulating surfaces oriented at rt. angle to @ other.
Ex. Joint bet. metacarpal & carpal bone (trapezium)
of the thumb.
JOINTS
 3. Hinge J. = permit movement in 1 plane only. Consist
of a convex cylinder of one bone applied to a
corresponding concavity of the other bone. Ex. Elbow &
knee joints
 The flat condylar surface of the knee joint is modified into
a concave surface by shock-absorbing fibrocartilage
pads called Menisci
 4. Pivot J. = restrict movement to rotation around a
single axis. @ PJ consist of cylindrical bony process that
rotates within a ring composed partly of bone and partly
ligaments. Ex. Rotation occurs bet. Axis & Atlas when
shaking the head “no”/ articulation bet. proximal end of
ulna and radius.
JOINTS
 Atlas = C1 (named after the mythological Atlas who
supported the world on his shoulder)
 Axis = C2
 5. Ball-and-Socket J. = consist of a ball (head) at the
end of one bone & a socket in an adjacent bone into
which a portion of the ball fits. Allows movement in
almost any direction.
 Ex. Shoulder & Hip joints
 Ellipsoid J. or Condyloid J. = are elongated Ball-and-
Socket J. Ex. Joints bet. Occipital condyles of skull &
atlas of the vertebral column & joints bet. metacarpal
bones & phalanges.
Types of Movement
 The types of movement occurring at a joint are related to the
structure of that joint.
 All movements are described relative to the anatomical position
because most movements are accompanied by movements in
the opposite direction, they are often illustrated in pairs.
 Major types of movements are :
 1. Flexion/Extension 6. Protraction/Retraction
 2. Abduction/Adduction 7. Elevation/Depression
 3. Pronation/Supination 8. Excursion & Opposition/
 4. Eversion/Inversion Reposition
 5. Rotation/Circumduction
Types of Movement
 Flexion & Extension = are common opposing
movements. Bend (flex) Straighten (extend)
 Flexion = occurs when the bone of particular joint are
moved closer together. Ex. Person flexes forearm to
“make a muscle”
 Extension = occurs when the bones of forearm to “make
a muscle” farther apart, such that bone are now
arranged somewhat end to end.
 * Plantar Flexion = foot toward plantar surface (sole),
standing on toes.
 * Dorsiflexion = foot toward the shin, as when walking
on the heels.
Types of Movement
 Abduction (to take away) = movement away from
median or midsagittal plane.
 Adduction (to bring together) = movement toward
median plane.
 Pronation = rotation of forearm so palm is down.
 Supination = rotation of forearm so palm faces up.
 Eversion = turning foot so plantar surfaces faces
laterally.
 Inversion = turning foot so plantar surface faces
medially.
Types of Movement
 Rotation = turning a structure around its long axis,
as in shaking the head “no”. Rotation of arm best
demonstrated with the elbow flexed (fig. 6.41e)
medial rotation/lateral rotation
 Circumduction = occurs at freely movable joint. Ex.
Shoulder
 = is the combination in sequence of the movements
of flexion, extension, abduction & adduction.
 Protraction = movement in which a structure, such
as mandible, glides anteriorly (to move forward)
Types of Movement
 Retraction = structure glides posteriorly ( to move
backward).
 Elevation = movement of structure in superior direction.
Ex. Closing mouth
 Depression = movement of structure in an inferior
direction. Ex. Open mouth
 Excursion = movement of structure to one side, as in
moving the mandible from side to side.
 Opposition = movement unique to thumb and little
finger. Ex. Tips of the thumb & little finger are brought
toward @ other across the palm of the hand. The thumb
can also oppose the other digits.
Types of Movement
 Reposition = returns the digits to anatomical
position.
 Hyperextension = an abnormal forced extension of
a joint beyond its normal range of motion.
 SPRAINS = when the bones of a joint are forcefully
pulled apart & the ligaments around the joints are
pulled or torn.
 SEPARATION = exists when bones remain apart
after injury to a joint.
 DISLOCATION = when end of one bone is pulled
out of the socket in a Ball-and-Socket, ellipsoid or
pivot joint.
Effects of Aging on the
Skeletal System & Joints
 1. Bone matrix become more brittle & decrease in
total amount during aging. (decrease collagen
production results in more mineral & less collagen
fibers).
 Bone mass highest at age 30, Men have denser
bones than Women due to Testosterone & greater
body weight.
 Race & ethnicity = also affect bone mass.
 African-American & Latinos = have higher bone
masses than Caucasian & Asians.
Effects of Aging on the
Skeletal System & Joints
 After age 35, both Men & Women loss bone 0.3 – 0.5%
a year
 Loss increase 10-fold in women after menopause (lose
bone mass 3-5% a year for 5-7 years.
 Loss of bone increase bone fracture, which can cause
deformity, loss of ht., pain & stiffness.
 Loss of bone from Jaws can lead to tooth loss
 2. Joints lose articular cartilage & become less flexible
with age.
 3. Prevention measures include Exercise, Calcium & Vit.
D supplements. Intensive exercise can reverse loss of
bone matrix.
Kinds of Bone Problems
 1. Osteoporosis
 2. Osteogenesis imperfecta
 3. Paget’s disease of bone
 4. Fractured bone
 5. Bone cancer
 6. Other bone disease are caused by poor nutrition,
genetic factors or problems with rate of bone growth
or rebuilding
PATHOLOGICAL CONDITIONS &
FRACTURE
 Ewing Sarcoma = malignant bone tumor.
Pain & swelling are common, w/ the tumor
sometimes involving the entire shaft
(medullary cavity) of a long bone. Usu.
occurs at an early age (5-15 y/o).
Radiotherapy w/ chemo. represents the best
chance for cure (60-70% of patient are cured
before metastasis occur).
Bone Cancer
 Osteosarcoma
Cont.
 Exostosis = bony growth arising from the surface of
bone (ex- means out; -ostosis means condition of
bone).
 Osteochondromas (composed of cartilage & bone)
are “exostoses” & are usu. fd. on the metaphyses of
long bone near the epiphyseal plate.
 A Bunion is a swelling of the metatarsophalangeal
joint near the base of the big toe & is accompanied
by the build-up of soft tissue & underlying bone.
Osteogenesis Imperfecta
 Also called Brittle Bone Dse. or Lobstein
syndrome
 Genetic disorder in which bone break easily.
 Sometimes bone breaks for no known reason.
 Also cause weak muscle, brittle teeth, a curved
spine & hearing loss.
 The cause is a gene defect that affects how you
make collagen, a protein that helps make bone
strong.
 Inherit the faulty gene from a parent.
OI
 Sometimes due to mutation, a random gene
change.
 Can range from mild to severe.
 Symptoms vary from person to person.
 No cure, but can manage symptoms.
 Tx: exercise, pain meds, physical therapy,
wheelchairs, braces & sx.
Osteogenesis Imperfecta
 OI = genetic bone disorder, defective CT or
w/o the ability to make it. usu. because of
defective of Type I-collagen. This def. arises
from an AA substitution of glycine to bulkier
AA in the collagen triple helix structure,
autosomal dominant.
Paget’s Disease
 Also called Osteitis deformans
 Cause your bones to grow larger & weaker than
normal.
 Break easily
 Dse. can lead to other health problems (arthritis &
hearing loss)
 Common in spine, pelvis, skull & legs.
 Common in men than women.
 Common in older people.
 Symptoms : pain, enlarged bone, broken bones
damaged cartilage in joints.
PD

 Unknown cause
 Some cases, virus might be
responsible.
 It tend to run in families

 Tx : meds. & sx

 Food diet & exercise might also

help.
PD of bone
 Paget’s Disease
Cont.
 Fracture = sudden breaking of a bone.
 A CLOSED (simple) FX = means that a bone is
broken but there is no open wound in the skin.
Whereas an OPEN (compound) FX means a bone
is broken & there is an open wound in the skin.
 PATHOLOGICAL FX = is caused by disease of the
bone or change in the tissue surrounding the bone,
making it weak.
 Note : A tumor in a bone for instance, can make a
bone weak & lead to Pathological Fx
Types of Fractures
 Bone Fractures
Cont.
 CREPITUS = is the crackling sound produced
when ends of bones rub @ other or rub against
roughened cartilage
 Some example of Fractures are :
1. Colles Fx = occurs near the wrist jt. at the lower
end of the radius.
2. Comminuted Fx = bone is splintered or crushed
into several pieces.
 A Simple Fx means that a bone breaks in only
one place & is therefore not comminuted.
Types of Fractures
 Typical Bone Fractures
Types of Fracture
 Typical Bone Fractures
Cont.
3. Compression Fx = bone is compressed; often
occurs in vertebrae.
4. Greenstick Fx = bone is partially broken & partially
bent on the opp. side, as when a greenstick breaks;
occurs in children.
5. Impacted Fx = fx in w/c are fragment is driven firmly
into the other.
 Tx of Fx involves REDUCTION, w/c is the
restoration of the bone to its (N) position.
 A Closed Reduction =is manipulative reduction w/o
a surgical incision.
Cont.
 An Open Reduction = an incision is made into the
Fx side.
 A cast (solid mold of the body part) = is applied to fx
to immobilize the injured bone.
Osteogenic Sarcoma = malignant tumor arising fr.
bone (osteosarcoma). Most common type of
malignant bone tumor. Osteoblasts multiply w/o
control & form large bony tumors, esp at the ends of
long bones (half the lesion are located just below or
just above the knee). Metastasis takes place
through the bloodstream & often occurs to the
Lungs
Cont.
Surgical resection followed by chemo
improves the survival rate .
 Malignant tumors from other parts of the body
( breast , prostate, lung & kidney) may
metastasize (spread) to bones; they are
called “metastatic bone lesions”.
Cont.
 Osteomalacia = softening of bone, w/ inadequate amt.
of mineral (calcium) in the bone. Occurs primarily as a
dse. of infancy & childhood & is then known as
RICKETS. Bones fail to receive adequate amts. of
Calcium & P & they become soft, bend easily, & become
deformed. Vit. D is usu. def. in the diet & this prevents
Calcium & P from being absorbed into bloodstream from
the intestines. Vit. D is formed by the action of sunlight
on certain cpds. (such as cholesterol) in the skin ; thus
Ricket is more common in large, smoky cities during the
winter months. Tx. most often consists of adm. of large
daily doses of Vit. D & an inc. dietary intake of Calcium &
P.
Cont.
Osteomyelitis = inflammation of the bone &
bone marrow secondary to infxn. bact. enter
the body through a wound & spread to the
bone. Children are most often affected & the
infxn. usu. Occurs in the long bones of the
legs & arms. Adults can be affected too, usu.
as the results of an open Fx.
Cont.
 The lesion begin as inflam. w/ pus collection.
Pus tends to spread down the medullary
cavity & outward to the periosteum. AB
therapy corrects the condition if the ifxn is
treated quickly. If Tx is delayed, an abscess
can form. An Abscess = is a walled-off area
of infxn that can be difficult or impossible to
penetrate w/ AB. Surgical drainage is
necessary.
Cont.
 Osteoporosis = dec. in bone density (mass);
thinning & weakening of bone. This condition is also
called Osteopenia because the interior of bone is
diminished in struc., as if the steel skeleton of a
building had rusted & been worn down. Commonly
occurs in older women as a consequence of
estrogen def. w/ menopause. Lack of estrogen
promotes excessive bone resorption (osteoclasts
activity) & less bone deposition. Weakened bones
are subj. to Fx (as in HIP) ; loss of height & kyphosis
occur
Bone Scan
Osteoporosis
 Kyphosis
 (humpback,
 hunchback)
 Posterior
curvature in
the thoracic
region
Cont.
 Scoliosis (crooked, bent) = lateral
curvature
 Spinal column is bent abnormally to
the side.
 Most common spinal deformity in
adolescent girls.
Cont.
 Lordosis (curve, swayback) = anterior
curvature in the lumbar region.
 Word lordosis derived from greek, describing
a person leaning backward in a lordly
fashion.
 An excessive, abnormal ant. curvature, or
swayback, condition known as
hyperlordosis.
Abnormal Curvature of the
Spine
 Kyphosis
 Outward curvature = humpback or hunchback
 Lordosis
 Inward curvature = swayback
 Scoliosis
 Lateral (sideward) curvature
Abnormal Curvature of the
Spine
Cont.
 as vertebra collapse. Estrogen replacement therapy
& inc. intake of Calcium may be helpful for some
patient. A wt. bearing daily exercise program is also
important. Can occur w/ atrophy caused by disuse,
as in a limb that is in a cast, in the legs of a
paraplegic or in a bedridden patient. It may also
occur in men as part of the aging process & in
patients who have given corticosteroid (hormone
made by adrenal gland & used to treat inflammatory
conditions) therapy.
Cont.
 Talipes = congenital abnormality of the hindfoot
(involving Talus). Several varities of Talipes are
known. They are thought to result from congenital
anomalies, abnormal positioning of the fetus, or both
while in womb. Most common form is Talipes
Equinovarus (equin/o means horse) or
CLUBFOOT. In this congenital deformity, the patient
cannot stand w/sole of the foot flat on the ground.
The defect can be corrected by orthopedic splitting
in the early month of infancy or if that fails, by
surgery.
Talipes
PATHOLOGICAL CONDITIONS
 ARTHRITIS = inflammation of joints.
 Some of the more common forms are:
1. Ankylosing Spondylitis = chronic, progressive
arthritis with stiffening of joints, primarily of the
spine. Bilat. sclerosis (hardening) of the sacroiliac
joints is a dxtic sign. Joints changes similar to RA.
Tx : corticosteroids & anti-inflammatory drugs.
2. Gouty Arthritis = inflammation of joints caused
by excessive UA in the body.
(N) value UA :1.5 – 7.0 mg/dl(F)/0.09-0.42 mmol/L
2.5 – 8.0 mg/dl (M)/0.15-0.48 “
Cont.
 a defect in the metab. of UA causes too much of
it to accumulate in blood (Hyperuricemia), jts. &
soft tissue near jts. The UA crystals (salts)
destroy the articular cartilage & damage the
S.memb. A jt. chiefly affected is the BIG Toe ;
hence the condition is often called PODAGRA
(pod/o means foot, -agra means excessive
pain). Tx : Allupurinol (lower UA prodn.) &
Colchicine & Indomethacin (prevent inflam.) &
special diet (Red meats, Red wine & fermented
cheese).
Cont.
 3. Osteoarthritis = progressive degenerative joint
dse. characterized by loss of articular cartilage &
hypertrophy of bone (formation of osteophytes or
bone spurs) at articular surfaces. Condition also
known as Degenerative Joint dse. occurs mainly in
Hips & Knees of older individual & it is marked by
narrowing of the joint spaces (due to loss of
cartilage) Tx: aspirin & analgesic to reduce inflam. &
pain & physical therapy to loosen impaired joints.
 End-stage OA is the most common reason for joint
replacement surgery (Total Joint Arthroplasty)
Shoulder Arthroscopy
Cont.
4. RA = a chronic disease in which joints
become inflamed & painful. It is believed
to be caused by an immune (autoimmune)
reaction against joint tissues, particularly
against the synovial memb. Dx is by blood
test that shows the presence of
Rheumatoid factor (an antibody) & X-rays
revealing changes around the affected
joints. Tx : aspirin, gold compound and
corticosteroids.
Cont.
 BUNION = abnormal swelling of the medial aspect
of the joints bet. the big toe & the first metatarsal
bone.
* a bursa often develops over the site & chronic
irritation from ill-fitting shoes can cause a build-up of
tissue & underlying bone.
* Bunionectomy may be indicated if other measures
(changing shoes & use of anti-inflammatory agents)
fail.
Cont.
 CARPAL TUNNEL SYNDROME (CTS) = compression (by a
wrist ligament) of the median nerve as it passes bet. the ligament
& the bones & tendons of the wrist (the carpal tunnel).
= this condition most often affects middle-aged women, & pain &
burning sensations occur in the fingers & hand, sometimes
extending to the elbow.
= symptoms most often affect the index (2nd) and long fingers,
although the thumb and radial half of the ring (4th) finger may
also be symptomatic. Excessive wrist movement, arthritis,
hypertrophy of bone, & swelling of the wrist can produce CTS.
= Tx is splinting the wrist to immobilize it, use of anti-inflam. & inj.
of cortisone into carpal tunnel. If these measures fail, surgical
release of the carpal ligament can be helpful.
Cont.
 DISLOCATION = displacement of a bone from
its joint.
= dislocated bones do not articulate w/ @ other.
Most common cause of dislocation is TRAUMA.
= some example of dislocation are :
1. Acromioclavicular disloc. = disruption of the
articulation bet. acromion & clavicle. Also known
as “shoulder separation”.
2. Shoulder disloc. = disruption of articulation
bet. the head of the humerus & the glenoid
fossa of the scapula.
Cont.

3. Hip disloc. = disruption of articulation bet. the

head of the femur & the acetabulum of the pelvis.
= Tx of dislocation involves REDUCTION which is
restoration of the bones to their normal position. A
SUBLUXATION is a partial or incomplete
dislocation.
GANGLION = a fluid-filled cyst arising from the jt.
capsule or tendon in the wrist.
Cont.
 Herniation of an intervertebral disc (disk) = abnormal
protrusion of a fibrocartilaginous intervertebral disc into
the neural canal or spinal nerves.
= commonly referred to as SLIPPED DISC. Pain is
experienced as the protruded disc presses on spinal
nerves or on the spinal cord.
= low-back pain and sciatica (pain radiating down the
legs) are symptoms when the disc protrudes in the
lumbar spine.
= neck pain & burning pain radiating down an arm are
characteristic of a herniated disc in the cervical spine.
Cont.
= bed rest, physical therapy & drug for pain help in initial tx.
in patient w/ chronic or recurrent disc herniation,
LAMINECTOMY (surgical removal of a portion of the
vertebral arch to allow visualization of the protruded disc)
and dissection (removal of all or part of the protruding
disc) may be advised. Spinal fusion of the 2 vertebrae
may be necessary as well.
= endoscopic discectomy is a new technique of
removing the disc by inserting a tube through the skin &
aspirating the disc through the tube. Chemonucleolysis
is injection of a disc-dissolving enzyme (such as
chymopapain) into the center of a herniated disc in an
effort to relieve pressure on the compressed nerve or
spinal cord.
Cont.
 LYME DSE. = a recurrent disorder marked by
severe arthritis, myalgia, malaise, neurologic
and cardiac symptoms.
= also known as LYME ARTHRITIS, the
cause of the condition is a spirochete
(Borrelia burgdorferi) that is carried by a tick.
It was first reported in Old Lyme, Connecticut,
& is now found throughout the eastern coast
of the US. It is treated w/ AB.
Cont.
 SPRAIN = trauma to a joint with pain, swelling, and
injury to ligaments.
= may also involve damage to blood vessels,
muscles, tendons, & nerves.
= A STRAIN is a less serious injury involving the
overstretching of muscle.
= application of ice, elevation of the joint, &
application of a gentle compressive wrap are
immediate measures to relieve pain & minimize
swelling due to sprains.
Arm cast from a wrist Fx
Arm/Forearm cast
Leg cast
Plaster of Paris Bandage
Plaster of Paris
Cont.
 SYSTEMIC LUPUS ERYTHEMATOSUS (SLE) =
chronic inflammatory disease involving joints, skin,
kidneys, NS, heart & lungs.
= condition affects CT (specifically a protein
component called COLLAGEN) in tendon, ligament,
bones & cartilage all over the body.
= typically, there’s a red, scaly rash on the face over
the nose & cheeks.
= patient usually women experience joint pain
(polyarthralgia) pyrexia & malaise.
Cont.

SLE believed to be autoimmune disease that can be

diagnosed by the presence of abnormal Ab’s in the
bloodstream & characteristic WBC called LE cells.
= Tx : corticosteroids, hormones made by adrenal
gland that are used to treat inflammatory conditions.
= the Lupus (wolf) has been used since 13th century
because MD thought the shape & color of the skin
lesions resembled the bite of a wolf.
Questions ?