BAYELSA MEDICAL UNIVERSITY

FACULTY OF HEALTH SCIENCES

DEPARTMENT OF PHYSIOTHERAPY

CLINICAL PHYSIOLOGY FOR

PHYSIOTHERAPY (PST 303)

THE SKELETAL SYSTEM

COURSE CO-ORDINATOR: ONYENAUCHEYA CHIDI

 Outline
Introduction
Function of the skeletal system
Structure of Bone Tissue
Division of the Skeleton
Bone Diseases and Injuries
Role of Physiotherapy in Bone Diseases
and Injuries
Conclusion
Reference
 Introduction
The human skeletal system consists of
bones, cartilage, ligaments and tendons
It accounts for about 20 percent of the
body weight
Living bones use oxygen and give off
waste products in metabolism.
They contain active tissues that consume
nutrients.
They require a blood supply.
They remodel in response to variations in
Functions of the Skeletal System
The skeleton supports the body against the
pull of gravity.
a. E.g. the large bones of the lower limbs
support the trunk when standing.

The skeleton also protects the soft body

parts.
a. E.g. the cranium protects the brain.
b. the vertebrae protect the spinal cord.
c. bones of the rib cage protect the heart and
Functions of the Skeletal System (Cont’d)
Bones together with muscles produce body
movement.

The storage of calcium salts (especially,

calcium phosphate) in the bone in the bone
matrix calcium is vital in the maintenance
of blood calcium level.

Hematopoiesis, the formation of blood

cells, mostly takes place in the red marrow
 Structure of Bone Tissue

Two types of bone tissue:

a. compact bone.
b. Spongy bone.

Three types of cells that contribute to bone

homeostasis.
a. Osteoblasts are bone-forming cell.
b. Osteoclasts resorb or break down bone.
c. Osteocytes are mature bone cells.

An equilibrium between osteoblasts and

 Compact Bone
Compact bone consists of closely packed
osteons or haversian systems.
Osteons are the cylindrical, functional
units of bone.
The osteon consists of a central canal
(the osteonic or haversian canal), which
is surrounded by lamella.
Lamellae are concentric rings of matrix.
Between the rings of matrix, the bone
cells (osteocytes) are located in spaces
 Compact Bone (Cont’d)
Small channels (canaliculi) radiate from the
lacunae to the osteonic canal to provide
passageways through the hard matrix.
In compact bone, the haversian systems are
packed tightly together to form what
appears to be a solid mass.
The osteonic canals contain blood vessels
that are parallel to the long axis of the bone.
These blood vessels interconnect, by way of
perforating canals, with vessels on the
surface of the bone.
Spongy (Cancellous) Bone

Spongy bone is lighter and less dense than

compact bone.
It consists of plates (trabeculae) and bars of
bone adjacent to small, irregular cavities that
contain red bone marrow.
Their canaliculi connect to the adjacent
cavities to receive their blood supply.
Their trabeculae though haphazard in
appearance, are organized to provide
maximum strength.
The trabeculae follow the lines of stress and
Classification of Bones
Long bones

Short bones

Flat bones

Irregular bones
 Long Bones

Bones that are longer than they are wide

are called long bones.
They consist of a long shaft with two
bulky ends or extremities.
They are primarily compact bone
They may have a large amount of spongy
bone at the ends or extremities.
Examples include bones of the femur,
tibia, fibula, humerus, ulna, and radius.
 Short Bones
Short bones are roughly cube shaped.

Their vertical and horizontal dimensions are

approximately equal.

They consist primarily of spongy bone.

They are covered by a thin layer of compact

bone.

Examples include the bones of the wrist and

 Flat Bones

Flat bones are thin, flattened, and

usually curved.

Most of the bones of the cranium are flat

bones.

Examples are: the temporal bones,

frontal bone, occipital bone, parietal
bone, etc.
 Irregular Bones
Bones that are not in any of the above
three categories are classified as
irregular bones.

They are primarily spongy bone that is

covered with a thin layer of compact
bone.

Examples include the vertebrae and

some of the bones in the skull.
 Divisions of the Skeleton

Adult human skeleton usually consists of

over 200 bones.

These bones can be grouped in two

divisions:

Axial skeleton

Appendicular skeleton.
 Axial Skeleton

There are over 80 bones of the axial

skeleton

They form the vertical axis of the body.

They are the cranial bones, facial bones,

vertebral column bones, ribs and sternum
(breastbone).
 Cranial bones

Parietal (2)
Temporal (2)
Frontal (1)
Occipital (1)
Ethmoid (1)
Sphenoid (1)
Facial Bones

Maxilla (2)
Zygomatic (2)
Mandible (1)
Nasal (2)
Platine (2)
Inferior nasal
concha (2)
Lacrimal (2)
Vomer (1)
 Auditory Bones
Malleus (2)
Incus (2)
Stapes (2)
Hyoid Bone
Hyoid (1)
 Vertebral Column

Cervical
vertebrae (7)
Thoracic
vertebrae (12)
Lumbar
vertebrae (5)
Sacrum (5)
Coccyx (4)
 Thoracic Cage

Sternum (1)
Ribs (24)
 Appendicular skeleton
The appendicular skeleton consists of
over 120 bones

It includes the free appendages and their

attachments to the axial skeleton.

These are the upper and lower limbs,

plus the pectoral and pelvic girdles.
 Pectoral Girdles

Clavicle (2)

Scapula (2)
 Upper Limb
Humerus (2)
Radius (2)
Ulna (2)
Carpals (16)
Metacarpals
(10)
Phalanges (28)
Pelvic Girdle

Coxal, innominate, or
hip bones (2)
Lower Limb

Femur (2)
Tibia (2)
Fibula (2)
Patella (2)
Tarsals (14)
Metatarsals
(10)
Joints
A joint, or articulation, is where
two bones come together.
In terms of the amount of
movement, there are three types
of joints:
a. Immovable(synarthroses).
b. Slightly
movable(amphiarthroses).
Synarthroses

Synarthroses are immovable joints.

(singular – synarthrosis).

The bones come in very close contact.

They are separated only by a thin layer

of fibrous connective tissue.

Examples are the sutures in the skull.

Amphiarthroses

Slightly movable joints are called

amphiarthroses. (singular – amphiarthrosis).
The bones of these joints are connected by
hyaline cartilage or fibrocartilage.
Examples of amphiarthroses are:
a. The sternocostal joints which are
connected by hyaline cartilage.
b. The symphysis pubis in which there is a
fibrocartilage pad between the pubis.
c. The joints between the vertebrae and the
intervertebral discs.
 Diarthroses

Diarthroses are freely movable joints.

(singular – diarthrosis).
The ends of the opposing bones of these
joints are covered with hyaline cartilage
(the articular cartilage).
They are separated by a space called the
joint cavity.
The components of the joints are
enclosed in a dense fibrous joint capsule.
 Diarthroses

The outer layer of the capsule

consists of the ligaments that hold
the bones together.
The inner layer is the synovial
membrane that secretes synovial
fluid into the joint cavity for
lubrication.
Diarthroses are sometimes called
synovial joints because possess
Bone Disease and Injuries
Bone disease refers to any of the diseases
or injuries that affect human bones.
They are major causes of abnormalities of
the human skeletal system.
Physical injuries predispose the bone to
fracture.
Fracture is one of several common causes
of bone disease.
Bone disease on the other hand is a
common cause of fracture.
Bone Disease and Injuries (Cont’d)
Some of the bone diseases and injuries
include:
Osteoporosis
Osteopenia
Paget’s disease
Osteogenesis Imperfecta
Osteonecrosis
Osteomyelitis
Scoliosis
Bone Disease and Injuries (Cont’d)
Fibrous dysplasia
Bone cancer and tumors
Ankylosis
Osteomalacia
Rickets
Osteoarthritis
Fracture
 Osteoporosis
Osteoporosis is a disease that results in a
decrease in bone mass and mineral density.

It affects the quality and structure of the bone.

It can decrease bone strength.

It increases the risk of fracturing.

The risk of osteoporosis increases with age.

It affects people of all ethnic groups.

 Osteopenia

Osteopenia refers to a reduction in bone mineral

density below a normal level but not low enough to
classified as osteoporosis.

T-score is a measure of bone density.

A person with a T-score between -1 and -2.5 will

receive a diagnosis of osteopenia.

A T-score lower than -2.5 is classified as osteoporosis.

The prevalence of osteopenia is 4 times in females

compared with males.
 Paget’s Disease
Paget’s disease is a chronic condition that affects the
bone remodelling process.

The remodelling process refers to the breaking down of

old bone tissue and its replacement with newly
generated ones.

In Paget’s disease, the process of regenerating bones

takes place at a faster rate, resulting in an unusual bone
structure.

The bones to become either softer or larger.

Such bones are more susceptible to complications like

 Osteogenesis Imperfecta

Osteogenesis imperfecta (OI) is a disorder that

causes the bones to fracture easily.
It is also known as brittle bone disease.
The condition results from a change or
mutation in the genes that carry information for
making type I collagen.
This protein (type 1 collagen) is necessary for
strong bones.
People with a family history of OI have a higher
risk of having the disease.
There are different types of OI.
The most common and mildest type of OI is type
 Osteonecrosis
Osteonecrosis, occurs when there is a disruption to a
bone’s blood flow, leading to bone tissue death.

It is also known as avascular necrosis or aseptic necrosis.

This can cause the bone to break down and the joint to
collapse.

It commonly affects the shoulders, hips, and knees.

The condition occurs most often in people aged 20–50

years.
These individuals also often have a history of trauma,
corticosteroid use, or excessive alcohol intake.
 Osteomyelitis

Osteomyelitis describes an infection or

inflammation of the bone.
The ‘myelitis’ refers to inflammation of
the fatty tissues within the bone.
Occurs when a bacterial or fungal
infection enters a bone from the
bloodstream or surrounding tissue.
It can happen at any age but is more
common in young children.
 Scoliosis
This is abnormal, side-to-side curvature
of the spine.
It results in an S- or C-shaped
appearance when seen from behind.
It's commonly diagnosed in infants or
children.
It can persist into adulthood.
It’usually associated with diseases that
presents with weakness of the trunk
muscles e.g. Muscular dystrophy.
 Fibrous Dysplasia
Fibrous dysplasia occurs when abnormal
fibrous tissue replaces healthy bone tissue.
The unusual scar-like tissue makes the bone
weaker.
This can cause the bone to change shape
and increase the risk of fractures.
Fibrous dysplasia typically occurs due to a
gene mutation that results in bone cells
producing an abnormal type of fibrous bone.
It occurs most often in the thigh bone, shin
bone, ribs, skull, humerus, and pelvis.
 Bone Cancer and Tumors

Bone cancer is an uncommon type of cancer that

begins when cells in a bone start to grow out of
control.
Any of the cells in the bone can develop into
cancer.
Primary bone cancers are cancers that start in
the bone, e.g. osteosarcoma and Ewing sarcoma.
Cancer cells can also spread to the bone from
other areas of the body (metastases).
Metastasis is the spreading of cancer cells from
one organ or tissue to another.
The most common site for bone metastases is
 Ankylosis
This refers to stiffness of a joint as the result of injury
or disease.
The rigidity may be complete or partial.
It may be due to inflammation of the tendons or
muscles around the joint or of the tissues of the joint
itself.
When the structures outside the joint are affected, it
is called false ankylosis
True ankylosis, is when the disease is within the joint.
When inflammation has caused the joint ends of the
bones to be fused together, the ankylosis is termed
osseous, or complete.
Excision of a completely ankylosed shoulder or elbow
may restore free mobility and usefulness to the limb.
Ankylosis
 Osteomalacia

Osteomalacia refers to a condition where the

bone does not harden the way it should after
forming.
It is also known as bone softening.
It is a metabolic bone disease
It occurs when there is incomplete
mineralization of the bone.
Mineralization refers to the process where
minerals coat the inner layer of the bone,
forming a hard outer shell.
The incomplete formation of this shell leaves
 Rickets
Rickets is a childhood bone condition
similar to osteomalacia, but it occurs due to
imperfect mineralization.
The bones are soft and weak bones due to
vitamin D deficiency.
Without sufficient vitamin D, the body
cannot metabolize calcium and
phosphorous, which are essential for proper
bone development and growth.
Vitamin D deficiency may result from
inadequate nutrition, lack of sun exposure,
or malabsorption.
 Fracture
A bone fracture refers to a partial or
complete break in the continuity of any bone
in the body.

It could be a simple fracture (with fracture

line) , or communited fracture with several
fragments.

Causes of bone fractures include: accidents,

falls, sports injuries, and underlying disease
conditions like osteoporosis.
 Fracture
A fracture can closed (stable) or open
(compound)

In closed fracture, the broken ends of

the bone remain aligned and are barely
out of place.

In open fracture, the broken ends of the

bone are out of place. And the fractured
ends of the bone may pierce the skin.
Fracture
 Osteoarthritis

This condition affects the body’s joints by

degrading cartilage.
It is degenerating disease of the bone.
Cartilage is the tissue that covers the surface
of joints.
Osteoarthritis is the most common form of
arthritis
It can change the shape of bones.
It most frequently affects the hands, hips, and
knees.
Spondylosis is the osteoarthritis of the
Symptoms of Osteoarthritis
Pain in joints (hand, knees, hip)

Tender and warm joints

Swelling

Limited range of movement

 Role of Physiotherapy in the
Treatment of Osteoarthritis
Relieving of pain
Increasing muscle mass/strength around
the joints
Increasing range of motion
Reducing inflammation and swelling
around the affected joint
Preventing osteoarthritis from getting
worse
Weight reduction exercises that reduces
pressure on the joints
 Conclusion
The skeletal system is a vital system of the
human body.
Students should acquaint themselves with
an indepth knowledge of the pathophysiology
of the system as this will prepare them for
further studies and management of such
cases.
Health care professionals should carry out
more studies on the system.
This will breach the knowledge gap which is
important in health education and
management of bone diseases and injuries.
References
Adam Augustyn. Ankylosis. Available from:
https://www.britannica.com/science/ankylosis(acce
ssed: 02/03/2024)
Introduction to the Skeletal System. Available from
https://training.seer.cancer.gov/anatomy/skeletal/re
view.html (assessed in March 2024)
Lisa Esposito. A Patient’s Guide to Bone and Joint
Diseases. Available from:
https://health.usnews.com/conditions/bone-and-
joint-disease (assessed in March 2024).