Skeletal System Dr. Nichols Coronado HS

Foot phalangies metatarsals tarsals tarsals metatarsals phalangies

Bone cells that aid in remodeling Osteoblast Builds new bone Mature bone cell Osteocyte OsteoblastsOsteoblasts are responsible for building new bone and lie at the centre of bone physiology. Their functions include the synthesis of collagen and the control of mineralisation. OsteoclastsOsteoclasts are specialised cells that resorb bone. They work by sealing off an area of bone surface then, when activated, they pump out hydrogen ions to produce a very acid environment, which dissolves the hydroxyapatite. OsteocytesBone adapts to applied forces by growing stronger in order to withstand them; it is known that exercise can help to improve bone strength. Osteocytes are thought to be part of the cellular feed-back mechanism which directs bone to form in the places where it is most needed. They lie within mineralised bone and it is thought that they may detect mechanical deformation and mediate the response of the osteoblasts. Osteoclast Eats bone

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Fetal Skull

Immovable Joints (synarthrosis) Fibrous Joints Immovable Joints (synarthrosis) suture pubis symphisis

Slightly Movable Joint (ampharthrosis) Cartilagenous Joints Slightly Movable Joint (ampharthrosis)

(diarthrosis)- freely moveable Synovial Joints (diarthrosis)- freely moveable pelvis ligaments femur

Synovial Joints joint capsule pelvis hyaline cartilage synovial cavity femur

Knee Joint

Synovial Joint Movement Extension Rotation Flexion Adduction Abduction

275 bones 12 weeks (6-9 inches long) Fetal Skeleton 275 bones 12 weeks (6-9 inches long)

Fetal Skull

bone cartilage calcified cartilage epiphyseal line epiphyseal plate Fetus: 1st 2 months Endochondral Ossification 2o ossification center bone cartilage calcified cartilage Just before birth epiphyseal line epiphyseal plate Childhood Adult

Bone cells that aid in remodeling Osteoblast Builds new bone Mature bone cell Osteocyte OsteoblastsOsteoblasts are responsible for building new bone and lie at the centre of bone physiology. Their functions include the synthesis of collagen and the control of mineralisation. OsteoclastsOsteoclasts are specialised cells that resorb bone. They work by sealing off an area of bone surface then, when activated, they pump out hydrogen ions to produce a very acid environment, which dissolves the hydroxyapatite. OsteocytesBone adapts to applied forces by growing stronger in order to withstand them; it is known that exercise can help to improve bone strength. Osteocytes are thought to be part of the cellular feed-back mechanism which directs bone to form in the places where it is most needed. They lie within mineralised bone and it is thought that they may detect mechanical deformation and mediate the response of the osteoblasts. Osteoclast Eats bone

Bone Repair: 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

Repair of Fractures hematoma callus bony callus bone remodeling

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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

Types of Bones 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

Bone Classification

Anatomy of a Long Bone spongy bone Proximal compact bone epiphysis Endosteum diaphysis epiphyseal line yellow marrow Sharpey’s fibers Distal epiphysis periosteum hyaline cartilage

Axial Skeleton

Appendicular Skeleton

Axial Skeleton

Axial Skeleton

Axial Skeleton Posterior View

Sinal Cavities 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) Axial Skeleton The Vertebral Column Cervical Vertebrae (7) Thoracic Vertebrae (12) Lumbar Vertberae (5) Sacrum Coccyx

Cervical Vertebrae

The Thoracic Cage Sternum True Ribs (7) False Ribs (3) Axial Skeleton The Thoracic Cage Sternum True Ribs (7) False Ribs (3) Floating Ribs (2)

Axial Skeleton Sacrum & Coccyx

Bones of the Pectoral Girdle Appendicular Skeleton Bones of the Pectoral Girdle

Appendicular Skeleton Humerus Ulna Radius 8 Carpals 5 Metacarpals 14 Phalanges

Humorus

Ulna & Radius

Hand Bones

Appendicular Skeleton Pelvis

Appendicular Skeleton Pelvis (lateral view) Ilium Acetabulum Obturator foramen Pubis Ischium Ischium

Male vs Female Pelvis                                                   Female Pelvic Girdle Male Pelvic Girdle

Appendicular Skeleton The Lower Limb (Legs) Femur Patella Tibia Fibula 7 Tarsals 5 Metatarsals 14 Phalanges

Femur

Patella

Tibia & Fibula

Disorder of the Day 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.

Causes 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.

Symptoms 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.’

Bisphosphonates: Didronel (200-400mg), Fosamax (40mg once daily) Treatments Paget’s Disease: Goal of treatment is to relieve bone pain and prevent progression of disease. Bisphosphonates: Didronel (200-400mg), Fosamax (40mg once daily)

Cases

Disorder 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: Ibuprofen, 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

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:

Disorder 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.

Disorder of the Day 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.

Symptoms -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

Treatments -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.

Disorder 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.

Causes 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.

Symptoms -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

Symptoms -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

Treatment 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

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