Angie Guggino, MS, ATC, LAT

 What is the structure and function of the skeletal system?  What are the common diseases and injuries effecting the skeletal system?

Evaluate the anatomy, physiology, and basic pathophysiology of the muscular and skeletal systems, and perform technical skills related to the systems.  6.2 Analyze the basic structures and functions of the skeletal system, including locating and identifying the bones of the skeletal system and hemopoiesis.  6.4 Identify and explain medical terms related to the muscular and skeletal systems, and utilize when documenting in the electronic medical record.  6.5 Research common diseases, disorders, and emerging disorders of the muscular and skeletal systems including pathophysiology, prevention, diagnosis and treatment that might be utilized.  6.6 Differentiate between the axial and appendicular skeletons.  6.7 Describe the development of the skeletal system.  6.8 Locate and identify the types of joints in the skeletal system.  6.12 Demonstrate proper techniques for ambulation with assistive devices (crutches, cane, walker); and identify limitations and abnormalities.

 How many bones in the human body?  206  What is a joint?  Place where two bones meet.  What is the name for the connective tissue that attaches bone to bone?  ligaments  What are the two segments of the skeleton?  Appendicular skeleton  Axial skeleton

 Support  Protection  Movement  Storage  Blood cell formation

 Osteocytes  Mature bone cells  Osteoblasts  Bone-forming cells  Osteoclasts  Bone-destroying cells  Break down bone matrix for remodeling and release of calcium

COMPACTCANCELLOUS (TRABECULAR)  Dense  Compact  High mineral content  Strong  Spongy  Porous with honeycomb structure

 Short bones  Generally cube-shape  Contain mostly spongy bone  Examples: Carpals, tarsals  Long bones  Typically longer than wide  Have a shaft with heads at both ends  Contain mostly compact bone  Examples: Femur, humerus

 Flat bones  Thin, flattened and usually curved  Thin layers of compact bone around a layer of spongy bone  Examples: Skull, ribs, sternum  Irregular bones  Irregular shape  Do not fit into other bone classification categories  Example: Vertebrae

 Diaphysis  Shaft  Composed of compact bone  Epiphysis  Ends of the bone  Composed mostly of spongy bone

 Periosteum  Outside covering of the diaphysis  Fibrous connective tissue membrane  Sharpey’s fibers  Secure periosteum to underlying bone  Arteries  Supply bone cells with nutrients

 Articular cartilage  Covers the external surface of the epiphyses  Made of hyaline cartilage  Decreases friction at joint surfaces  Medullary cavity  Cavity of the shaft  Contains yellow marrow (mostly fat) in adults  Contains red marrow (for blood cell formation) in infants

 Ossification  In embryos, the skeleton is primarily hyaline cartilage  During development, much of this cartilage is replaced by bone  Cartilage remains in isolated areas  Bridge of the nose  Parts of ribs  Joints

 Epiphyseal plates allow for growth of long bone during childhood  New cartilage is continuously formed  Older cartilage becomes ossified  Cartilage is broken down  Bone replaces cartilage  Bones are remodeled and lengthened until growth stops

 Bone mineral peaks  Women age  Men age  Remodeling  Process through which adult bone can change in density, strength, and sometimes shape  When bone is subjected to high force it tends to increase density  Bone only accounts for about 15% of body weight

 Astronauts can experience a dramatic decrease in bone density while in a weightless environment. Explain how this happens and suggest a way to slow the loss of bone tissue.

 Articulations of bones  Functions of joints  Hold bones together  Allow for mobility  Ways joints are classified  Functionally  Structurally

 Synarthroses  immovable joints  Amphiarthroses  slightly moveable joints  Diarthroses  freely moveable joints

 Fibrous joints  Generally immovable  Cartilaginous joints  Immovable or slightly moveable  Synovial joints  Freely moveable

 Articulating bones are separated by a joint cavity  Synovial fluid is found in the joint cavity  Articular cartilage (hyaline cartilage) covers the ends of bones  Joint surfaces are enclosed by a fibrous articular capsule  Ligaments reinforce the joint

 Bursae – flattened fibrous sacs  Lined with synovial membranes  Filled with synovial fluid  Not actually part of the joint  Tendon sheath  Elongated bursa that wraps around a tendon

 Gliding (plane)  Hinge  Pivot  Condyloid  Saddle  Ball-and- Socket

The Skeletal System

 Dislocations  One of the articulating bones is displaced  Shoulder, patella, fingers, elbow, jaw  Subluxation  Partial dislocation  Bursitis  Inflammation of the bursa  Sprains  Overstretching or tearing of a ligament  Fractures  Broken bone

 Extremities most common  Statistics:  men up to 45 years of age  women over 45 years of age  Before 75 years wrist fractures most common  75 years hip fractures most common

 Magnitude and direction of force  Closed – Bone fragments do not pierce skin  Open/compound – Bone fragments pierce skin  Displaced or non-displaced

 Usually caused by directly applied force to fracture site

 Caused by violence transmitted through the distal limb  twisting movement

 Occurs in children  Bones soft and bend without fracturing completely

 Traction  Bony fragment usually torn off by a tendon or ligament

 Abnormal stress on normal bone  Fatigue fracture  Normal stress on abnormal bone  Insufficiency fracture

 Two or more bone pieces  High energy trauma  Can require serious hardware to repair

 Splinting  Red Cross Videos

 Reduction  Open reduction (surgery)  very accurate  risk of infection  Usually when internal fixation is needed  Manipulation  Usually with anesthesia  Traction  pulling

 4-12 weeks  External fixation  Internal fixation  Frame fixation

 Used for fractures that are too unstable for a cast.  Can shower and use the hand gently with the external fixator in place.

 Allows correction of deformities by moving the pins in relation to the frame.

“Homedepot Method”  Rods  Screws  Pins  Plates

1. Fracture hematoma 2. Fibrocartilaginous callus 3. Bony callus 4. Bone Remodeling

 blood from broken vessels forms a clot.  6-8 hours after injury  swelling and inflammation to dead bone cells at fracture site

 About 3 weeks  New capillaries organize fracture hematoma into granulation tissue called a procallus  Fibroblasts and osteogenic cells invade procallus.  Make collagen fibers which connect ends together  Chondroblasts begin to produce fibrocartilage

 After 3 weeks  Lasts about 3-4 months  Osteoblasts make woven bone.

 Osteoclasts remodel woven bone into compact bone and spongy bone  Often no trace of fracture on X-ray  Several months

1. What is the definition of arthritis? 2. Approximately how many different varieties of arthritis have been identified? 3. How do young or middle-aged adults usually experience the disease? 4. Describe the four functional classifications of arthritis. 5. How are nerves affected with arthritis? 6. What are the general goals of arthritis therapy? 7. How does heat therapy help with arthritis? 8. What are NSAIDS? 9. Why should heat modalities not be used in acute cases of arthritis? 10. What is the benefit of the COX-2 inhibitor vs. the COX-1 inhibitor?