1. SKELETAL DISORDERS

2. Objectives: Copyright 2003 by Mosby, Inc. All rights reserved.

3. Assessment Techniques Bone x-rays Bone marrow aspiration Bone marrow biopsy Radionuclide bone scan Computed axial tomography (CAT) Magnetic resonance imaging (MRI) Bone densitometry

4. 4 Bone Scan Radioactive tracer is given intravenously Amount of uptake is related to amount of blood flow to the bone “Hot spots” are areas of increased metabolic activity that may indicate cancer, abnormal healing or growth “Cold spots” indicate decreased metabolism of decalcified bone, fracture or bone infection

5. 5 Hormonal Abnormalities/Imbalances Oversecretion of hGH during childhood produces giantism Undersecretion of hGH or thyroid hormone during childhood produces short stature Both men or women that lack estrogen receptors on cells grow taller than normal –estrogen is responsible for closure of growth plate

6. Copyright 2003 by Mosby, Inc. All rights reserved. Disorders of the Skeletal System Ankylosing spondylitis –A hereditary chronic spinal disease Arthritis –A group of disorders evidenced by inflammation of a joint, pain and stiffness during movement Avulsion fracture –Occurs when a ligament or tendon pulls off part of a bone during an injury Bursitis –Inflammation of the sac around a joint that is caused by trauma or irritation

7. Copyright 2003 by Mosby, Inc. All rights reserved. Disorders of the Skeletal System (continued) Caries –Also called cavities, it is the major cause of tooth loss Carpal tunnel syndrome –A disorder caused by pressure on the median nerve of the wrist due to repetitive use or trauma Degenerative joint disease –Also called osteoarthritis, usually associated with aging; it is the most common form of arthritis

8. Copyright 2003 by Mosby, Inc. All rights reserved. Disorders of the Skeletal System (continued) Dislocation –When bones move out of their proper location, usually in the shoulder or hip Fracture –A broken bone caused by trauma Gout –A painful swelling of a joint that results from the buildup of uric acid crystals, most commonly in the great toe

9. Copyright 2003 by Mosby, Inc. All rights reserved. Disorders of the Skeletal System (continued) Herniated disk –A ruptured or “slipped” disk between vertebrae Kyphosis –Also called “hunchback” or “humpback,” is an abnormal curvature of the thoracic part of the spine Lordosis –Also called “swayback,” is an abnormal curvature of the lumbar spine

10. Copyright 2003 by Mosby, Inc. All rights reserved. Disorders of the Skeletal System (continued) Meningomyelocele –Also called spina bifida, is a congenital condition of the spinal column Osteoma –A bone tumor Osteomalacia –Also called rickets in children, is a softening of the bones caused by vitamin D and calcium deficiency

11. Copyright 2003 by Mosby, Inc. All rights reserved. Disorders of the Skeletal System (continued) Osteomyelitis –A bacterial infection of the bone Osteoporosis –A weakening of the bones Paget’s disease –Also called osteitis deformans, is due to excessive destruction of bone cells

12. Copyright 2003 by Mosby, Inc. All rights reserved. Disorders of the Skeletal System (continued) Periodontitis –An inflammation of the tissues that keep teeth in place Rheumatoid arthritis –Pain and stiffness in the joints caused by thickening of the synovial membrane Rickets –A painless deformity at the epiphysis of the bones caused by insufficient vitamin D

13. Copyright 2003 by Mosby, Inc. All rights reserved. Disorders of the Skeletal System (continued) Scoliosis –An abnormal lateral spinal curvature Subluxation –A partial dislocation of a joint, such as in the neck in a “whiplash” injury Talipes –A congenital deformity involving the foot and ankle

14. Osteoporosis- cont. Osteoporosis –Group of diseases in which bone reabsorption outpaces bone deposit –Spongy bone of the spine is most vulnerable –Occurs most often in postmenopausal women –Bones become so fragile that sneezing or stepping off a curb can cause fractures

15. 15 Osteoporosis-cont. Decreased bone mass resulting in porous bones Those at risk –white, thin menopausal, smoking, drinking female with family history –athletes who are not menstruating due to decreased body fat & decreased estrogen levels –people allergic to milk or with eating disorders whose intake of calcium is too low Prevention or decrease in severity –adequate diet, weight-bearing exercise, & estrogen replacement therapy (for menopausal women) –behavior when young may be most important factor

16. Osteoporosis: Treatment Calcium and vitamin D supplements Increased weight-bearing exercise Hormone (estrogen) replacement therapy (HRT) slows bone loss Natural progesterone cream prompts new bone growth Statins increase bone mineral density

17. Rickets cont. Rickets Risk Factors/Causes: –Bones of children are inadequately mineralized causing softened, weakened bones –Bowed legs and deformities of the pelvis, skull, and rib cage are common –Caused by insufficient calcium in the diet, or by vitamin D deficiency

18. 18 Rickets cont. Rickets Treatment: –Dietary changes –Exercise –Reversible if caught early Osteomalacia new adult bone produced during remodeling fails to ossify hip fractures are common

19. Osteomalacia cont. Osteomalacia –Bones are inadequately mineralized causing softened, weakened bones –Main symptom is pain when weight is put on the affected bone –Caused by insufficient calcium in the diet, or by vitamin D deficiency

20. Paget’s Disease cont. Characterized by excessive bone formation and breakdown Pagetic bone with an excessively high ratio of woven to compact bone is formed Pagetic bone, along with reduced mineralization, causes spotty weakening of bone Osteoclast activity wanes, but osteoblast activity continues to work

21. Paget’s Disease cont. Usually localized in the spine, pelvis, femur, and skull Unknown cause (possibly viral) Treatment includes the drugs Didronate and Fosamax

22. 22 HOMEOSTATIC IMBALANCES of Joints Lyme disease is a bacterial disease which is transmitted by deer ticks. Symptoms include joint stiffness, fevers, chills, headache, and stiff neck. Ankylosing spondylitis affects joints between the vertebrae and between the sacrum and hip bone. Its cause is unknown. Ankle Sprains and Fractures: The ankle is the most frequently injured major joint. Sprains are the most common injury to the ankle; they are treated with RICE. A fracture of the distal leg that involves both the medial and lateral malleoli is called a Pott’s fracture.

23. 23 Rheumatism and Arthritis cont. Osteoarthritis is a degenerative joint disease commonly known as “wear-and-tear” arthritis. It is characterized by deterioration of articular cartilage and bone spur formation. It is noninflammatory and primarily affects weight- bearing joints. Gouty arthritis is a condition in which sodium urate crystals are deposited in soft tissues of joints, causing inflammation, swelling, and pain. If not treated, bones at affected joints will eventually fuse, rendering the joints immobile.

24. 24 Rheumatoid Arthritis Autoimmune disorder Cartilage attacked Inflammation, swelling & pain Final step is fusion of joint

25. 25 Osteoarthritis Degenerative joint disease –aging, wear & tear Noninflammatory---no swelling –only cartilage is affected not synovial membrane Deterioration of cartilage produces bone spurs –restrict movement Pain upon awakening--disappears with movement

26. 26 Gouty Arthritis Urate crystals build up in joints---pain –waste product of DNA & RNA metabolism –builds up in blood –deposited in cartilage causing inflammation & swelling Bones fuse Middle-aged men with abnormal gene

27. Copyright 2003 by Mosby, Inc. All rights reserved. Issues and Innovations Progress in dental care – Corrective measures including bonding, bleaching, and implants Bone substitutes and repairs – Bone replacing material including organoapatites and coral – Surgical implants for cranial and joint injuries – Bone regeneration

28. 28 Hip Replacement (Innovations)

29. 29 Arthroscopy & Arthroplasty Arthroscopy = examination of joint –instrument size of pencil –remove torn knee cartilages & repair ligaments –small incision only Arthroplasty = replacement of joints –total hip replaces acetabulum & head of femur –plastic socket & metal head –knee replacement common

30. 30 Innovations for cartilage replacement In cartilage transplantation chondrocytes are removed from the patient, grown in culture, and then placed in the damaged joint. Eroded cartilage may be replaced with synthetic materials Researchers are also examining the use of stem cells to replace cartilage.