1. The Skeletal System Lesson 2: The Pathology of the Skeletal System23
The Skeletal System
Lesson 2:
The Pathology of the Skeletal System

2. Lesson Objectives
Upon completion of this lesson, students should be able to …
Define and spell the terms to learn for this chapter.
List and explain common disorders of the skeletal system.
Identify abnormal curvatures of the spine.
Identify various types of fractures.

3. Abnormal Spinal Curvatures3

4. Scoliosis Often diagnosed early in toddlers, children and adolescents
Lateral curvature of the spine
Many times, a scoliatic spine appears to have an S or C shape
Those afflicted with scoliosis may often appear as if either their shoulders or legs are uneven
Treatment includes:
Orthopedic braces to reduce the progression of the abnormal spinal curvature
Surgical treatment for severe cases

5. Lordosis Often called swayback
An exaggerated curvature of the lumbar spine
When diagnosed in adults, may be commonly found in those who are overweight and in pregnant women
When diagnosed in children, the most common symptom is a prominently protruding abdomen and/or buttocks

6. Lordosis
Treatment depends on the patient’s overall health, age, and severity of the condition. Overall goal of treatment is to stop the curvature and prevent spinal deformity.

7. Kyphosis Most often known as humpback
An exaggeration of the thoracic curvature
Normal thoracic curvature may become exaggerated due to:
A congenital defect
Disease process compression fracture
Faulty posture, osteoarthritis
Rheumatoid arthritis, rickets, osteoporosis, or other conditions

8. Signs, Symptoms, and Treatments of Kyphosis
Signs and symptoms include:
Rounded back appearance
Tiredness, mild back pain, and either a tender or stiff feeling within the spine
In severe cases, shortness of breath may be apparent
Treatment depends on the overall health and age of the patient as well as the cause or source of the patient’s disease

9. Critical Thinking Question
Why might an individual develop arthritis?

10. Arthritis Inflammation of one or more joints
Causes include joint injury, autoimmune disorders, and normal to excessive wear and tear on the joints
Can occur at any age; however most commonly develops in older adults

11. Arthritis Signs and symptoms: Vary with every patient
Classic signs and symptoms include joint pain and swelling, morning stiffness, warmth and redness around a joint, and decreased ability to move the joint

12. Treatment for Arthritis
Dependent upon the age, occupation and activities of the patient, the cause and severity of the disease, and the joint affected
A modification to daily activities and low-impact aerobic exercise (such as swimming) is helpful in treatment
Medications to reduce joint pain and swelling, application of heat or cold, joint protection, and surgery may be used in treating various levels of arthritis

13. Osteoarthritis
Most common type of arthritis resulting from years of wear and tear on joints
Most frequently occurs in the hips, knees, and finger joints of elderly patients
Obesity, a history of trauma, and various genetic and metabolic diseases increase the risk of osteoarthritis

14. Signs, Symptoms, and Treatment of Osteoarthritis
Signs and symptoms:
In addition to pain, symptoms include swelling and fluid accumulation around the joints
Aching pain that is association with changes in the weather
Permanent joint deformity may occur in some cases

15. Signs, Symptoms, and Treatment of Osteoarthritis
The use of nonsteroidal anti-inflammatory drugs (NSAIDs)
Steroid injections to the affected joint
In severe cases, joint replacement

16. Rheumatoid Arthritis
An autoimmune disorder causing joints to at times become deformed due to inflammation. In addition to inflammation, there is an increased growth of both cartilage and bone associated with this autoimmune disorder. 16

17. Signs, Symptoms, and Treatments of Rheumatoid Arthritis
Signs and symptoms:
Marked by inflammation, joint swelling, and joint deformity
Morning joint stiffness
Fatigue and loss of appetite

18. Signs, Symptoms, and Treatments of Rheumatoid Arthritis
No cure; however, early detection, diagnosis, and treatment may deter pain and joint decay
In addition to rest, eating a balanced diet, and taking corticosteroids, disease-modifying antirheumatic drugs are helpful in decreasing joint deformation

19. Bursitis
An inflammation of the bursa (a small sac of fluid that cushions and lubricates an area where joint-related tissues rub against one another)

20. Signs, Symptoms, and Treatments of Bursitis
Signs and symptoms:
Joint pain, limited joint mobility, swelling, and tenderness surrounding the joint
Treatment:
Rest, pain medication, steroid injections, aspiration of excess fluid from the bursa, and antibiotics
Physical therapy may be utilized to increase and promote joint movement

21. Carpal Tunnel Syndrome
Becomes present when pressure is placed on the median nerve
Signs and symptoms:
When pressure is placed on this median nerve, pain is produced along with numbness and hand weakness
Certain conditions increase the risk of carpal tunnel syndrome, including obesity, diabetes, and rheumatoid arthritis

22. Treatment of Carpal Tunnel Syndrome
Application of wrist splints at night for several weeks
Hot and cold compresses may be used
Proper ergonomics related to typing and other activities can be useful in preventing this syndrome
Medications such as the use of NSAIDs such as ibuprofen or naproxen
Injections of corticosteroids
A surgical procedure that decreases the pressure on the median nerve

23. Types of Fractures Closed Fracture
A fracture in which there is no open skin wound. Also called a simple fracture. 23

24. Types of Fractures Open Fracture
A fracture in which the skin has been broken through to the fracture. Also called a compound fracture. 24

25. Types of Fractures Comminuted Fracture
A fracture in which the bone is shattered, splintered, or crushed into many small pieces or fragments. 25

26. Types of Fractures Colles’ Fracture
Frequently the result of reaching forward to stop or cushion a fall. Exemplified by a break in the distal portion of the radius. Most frequently seen in children and the elderly. 26

27. A fracture in which the vertebrae are compressed together.
Types of Fractures
Compression Fracture
A fracture in which the vertebrae are compressed together. 27

28. Epiphyseal Plate Fracture
Types of Fractures
Epiphyseal Plate Fracture
A fracture in which the break occurs at the epiphysieal plate. 28

29. Other Types of Fractures
Transverse – Break of the shaft of the bone across its longitudinal access.
Greenstick – Usually occurs in young children. Only one side of the shaft is broken; the other side is bent, similar to breaking a green plant stick.
Spiral – Spread along the length of a bone. Produced by twisting stresses.
Pott’s – Occur in the ankle and affect both bones of the lower leg (the tibia and fibula).

30. Treatment for Fractures
Generally casted by a physician
At times, in severe fractures, surgical intervention must be performed
Common that both pins and metal plating are used to stabilize joints and bones during surgery
Pain and anti-inflammatory medications are often prescribed for patient comfort

31. Dislocations Usually occur following a blow, fall, or other trauma
Means that the bones are no longer in their normal position
Usually the joint capsule and ligaments tear when a joint becomes dislocated, and often the nerves are injured

32. Treatments for Dislocations
Signs and symptoms:
Dislocated joints may be visibly out of place, discolored, misshapen, limited in movement, bruised or swollen, and intensely painful
Generally very difficult to move the affected joint
Treatment:
Seek emergency department treatment
Reduction is used to align and reposition the joint
Pain relievers and anti-inflammatory medications

33. Osteoporosis
Characterized by the progression of loss of bone density and the thinning of bone tissue
Affects more than 25 million Americans, mostly women ages 50 to 70 years old
Individuals with osteoporosis are subject to increased fracture potential, especially in the hips, vertebrae, and wrists

34. Critical Thinking Question
Why might an individual be more at risk for developing osteoporosis?

35. Individuals at Higher Risk for Osteoporosis
Those with a family history of osteoporosis
Those who lack weight-bearing exercise as part of their lifestyle
Caucasian women who have never been pregnant and experience early menopause
Individuals with a history of frequent corticosteroid use

36. Individuals at Higher Risk for Osteoporosis
Individuals who excessively smoke, drink alcohol, and consume diets high in salt, fat, and caffeine
Individuals who have an insufficient intake of calcium or vitamin D

37. Signs, Symptoms, and Treatments of Osteoporosis
Signs and symptoms:
Most common sign is decreased height and a stooped posture
Additional signs and symptoms include back pain and frequent fractures
Treatment includes:
Calcium and vitamin D supplementation
Medications to help preserve calcium
Hormone replacement
Exercise

38. Gout Also referred to as gouty arthritis
Caused by the formation and accumulation of urate crystals in the joints that result from high levels of uric acid, leading to inflammation
The most frequent joint affected is the great toe; however fingers and hands can also be affected

39. Signs, Symptoms, and Treatment of Gout
Signs and symptoms:
A gouty joint is often very warm and very sore to the touch
After joints have been persistently affected by gout they may become disfigured
Treatments:
Medication
A diet rich in colorful fruits and vegetables help to decrease the symptoms of gout
Dietary restrictions including the avoidance of caffeine, alcohol, liver and other purine-rich foods

40. Hallux Valgus Also called a bunion
The enlargement of the inner portion of the metatarsophalangeal joint at the base of the big toe
Signs and symptoms include:
Reddened skin surrounds the inflamed joint of the big toe
The joint may be filled with fluid and feel tender to the touch

41. Treatments for Hallux Valgus
Properly fitting shoes should be worn
Proper padding and cushioning of the joint should be considered
Foot surgery and pain medications may be required for severe cases
Patient may need to be fitted with special adaptive shoes made by a specialist in orthopedic shoes

42. Hammer Toe
Produced when the toe bends upward like a claw because of the abnormal flexion of the proximal interphalangeal joint
Signs and symptoms:
Pain and visible joint deformation are classic symptoms of this skeletal disorder

43. Hammer Toe Treatment includes: Analgesics Splinting
Wearing specially designed footwear
In severe cases, surgical straightening of the toe may be required

44. Osteomalacia The adult onset of rickets
Causes are deficiencies in calcium and vitamin D
Additional causes include cancers, liver disease, kidney failure and side effects associated with antiseizure medications
Symptoms include bone pain, bowling legs, and frequent fractures
Treatment is similar to treatment for rickets, including increasing vitamin and mineral intake and comfort measures to relieve symptoms

45. Rickets
An early childhood disease caused by a deficiency in calcium, vitamin D, and phosphate
Results in bone deformities, especially bowed legs
Genetics may increase the risk of developing rickets

46. Rickets Signs and symptoms include:
Pain and tenderness of the bones
An increased likelihood of bone breakage
Impaired growth and decreased height
Muscle cramps
Treatment includes increasing vitamin and mineral intake and comfort measures, including rest and heat and ice applications, to relieve the symptoms

47. Additional Disorders of the Skeletal System
Epicondylitis
Commonly referred to as tennis elbow
Characterized by elbow pain that is a result of repetitive grasping and rotating of the forearm
Osteomyelitis:
Inflammation of the bone and bone marrow due to infection
Can be difficult to treat

48. Additional Disorders of the Skeletal System
Paget’s disease:
A fairly common metabolic disease of the bone from unknown causes
Usually attacks middle-aged and elderly people
Characterized by bone destruction and deformity
Ruptured intervertebral disk:
Herniation or outpouching of a disk between two vertebrae
Also called a slipped or herniated disk

49. Additional Disorders of the Skeletal System
Spinal stenosis:
Narrowing of the spinal canal causing pressure on the cord and nerves

50. What type of fracture is this?
Try It For Yourself!
What type of fracture is this?
Greenstick Fracture
Greenstick Fracture 50

51. What type of fracture is this?
Try It For Yourself!
What type of fracture is this?
Closed or Simple Fracture
Closed Fracture 51

52. What type of fracture is this?
Try It For Yourself!
What type of fracture is this?
Open or Compound Fracture
Open Fracture 52

53. What type of fracture is this?
Try It For Yourself!
What type of fracture is this?
Compression Fracture
Compression Fracture 53

54. What type of fracture is this?
Try It For Yourself!
What type of fracture is this?
Colles’ Fracture
Colle’s Fracture 54

55. What type of fracture is this?
Try It For Yourself!
What type of fracture is this?
Comminuted Fracture
Comminuted Fracture 55

56. What type of fracture is this?
Try It For Yourself!
What type of fracture is this?
Epiphyseal Fracture
Epiphyseal Plate Fracture 56

57. Questions? 57