Anatomy: Skeletal System

1
Anatomy Skeletal System

• functions, names and numbers of bones, problems

2
Skeletal System Functions

• Bones are living structures with 5 functions
• protect internal organs
• support the body
• make blood cells
• store minerals
• provide for muscle attachment

3
Classification of bones

• Long bones
• Short bones
• Flat bones
• Irregular bones
• Sesamoid bones

4
Classification of bones

• The femur is an example of a long bone

5
Classification of bones

• These are short bones

6
Classification of bones

• These are considered flat bones

7
Classification of bones

• Vertebrae are irregular bones

8
Classification of bones

• kneecap (patella) is a sesamoid bone

9
Review of bone tissue

• Osteocyte
• Canaliculi
• Matrix
• Haversian (central) canal
• Lamella
• 6. Haversian system (osteon)

10
Parts of a bone

• Diaphysis - shaft of bone
• Epiphyses - ends of bone
• Articular cartilage - covers epiphysis at a joint
  
• Periosteum - membrane covers outer bone surface
• Endosteum - lines medullary cavity
•  
•  www.bmb.psu.edu/courses/ bisci004a/bone/bone.htm
  
•                            

11
Parts of a bone

• 1.
• 2.
• 3.
• 4.
• 5.

12
WHY WE NEED CALCIUM

• You may know that calcium plays an important
  role in building healthy teeth and bones. What
  you may not know is that calcium is vital to
  every cell of the body for muscle function, nerve
  transmission, blood clotting and many other uses.
  When you don't get enough calcium in your diet,
  the calcium stored in your bones is "stolen" to
  supply the rest of your body. Hence, your bones
  suffer the consequences of a low-calcium diet.
  This is why the bones become more susceptible to
  fractures.

13
Where bones meet

• A point where two or more bones connect is
  called a joint. There are two different types of
  joints in the body
• Movable joints (like ball-and-socket, hinge,
  gliding and pivot joints)
• Immovable joints (like the bones of the skull and
  pelvis) which allow little or no movement

14
There are approximately 206 bones in the body.
How many of them can you identify on this
skeleton?
15
Account for 206

• 8 cranium (1 Occipital, 2 Parietal, 1Frontal, 2
  Temporal, 1 Sphenoid, 1 Ethmoid)
• 14 face (2 Nasal, 2 Maxillæ, 2 Lacrimal, 2
  Zygomatic, 2 Palatine, 2 Inferior Nasal Conchæ, 1
  Vomer, 1 Mandible)
• 6 ears
• 1 hyoid
• 26 Vertebral column-7 cervical, 12 thoracic, 5
  lumbar, (1)5 sacral, (1) 4 coccygeal
• 25 Sternum and ribs
• 64 Upper extremities
• 62 Lower extremities

16
Skull

• The skull is made up of 22 bones (8 paired and
  6 unpaired) joined by tight sutures
• 8 bones to cranium
• 14 bones in the face
• Other bones in the area
• 6 bones (3 each) ears
• 1 hyoid

17
In the lateral view above label the following
bones

• Cranium
• Frontal 1
• Parietal 2
• Temporal 2
• Occipital 1
• Sphenoid 1
• Ethmoid 1

18
In the lateral view above label the following
bones
Face Maxilla 2 Zygomatic 2 Lacrimal 2 Nasal
2 Vomer 1 NS Palatine 2 NS Inferior nasal concha
2 NS Mandible 1
19
Hyoid bone
20
Bones of the ear

• each ear
• malleus
• incus
• stapes

21
Vertebral column

• Your back is made up of a series of bones
  called vertebrae." Together they form a flexible
  column. (left)  There are a total of thirty-three
  vertebrae and they are grouped under the names
  cervical, thoracic, lumbar, sacral, and
  coccygeal.  There are 7 cervical region, 12
  thoracic, 5 lumbar, 5 sacral, and 4 coccygeal

22
Lumbar vertebrae

• fibrocartilage intervertebral disc

23
Name the vertebrae

• 1.
• 2.
• 3.
• 4.
• 5.

24
Scapula

• Compare the shoulder joint (glenoid) with the hip
  joint (acetabulum)
• Note the spine, acromion process coracoid
  process.

25
Scapula and clavicle
26
Clavicle

• Pectoral girdle for the humerus

27
Sternum and ribs

• Notice the parts manubrium, blade (gladiolus)
  and xiphoid process
• The ribs enclose the thoracic cavity. What are
  true ribs, false ribs floating ribs?

28
Upper limb

• scapula
• clavicle
• humerus
• radius
• ulna

29
Shoulder joint

• The shoulder joint is the joint with greatest
  ROM (range of motion) of any joint. But the wide
  range of motion is at the expense of stability. A
  lack of stability results in a joint that is
  loose with a tendency to dislocate (come out of
  its socket). The joint and the tendons about the
  joint are subjected to considerable wear and tear
  leading to degeneration of the joint surface
  giving rise to arthritis and tears in the
  supporting tendons .

30
Anatomy of shoulder

• The shoulder is made up of three bones, the
  scapula, clavicle and humerus.

31
Torn rotator cuff

• MRI of a torn rotator cuff. The supraspinatus
  tendon normally extends over the head of the
  humerus. Courtesy S. Sadiq, M.D.

32
x-ray of elbow
33
Lower arm

• radius
• ulna

34
Bones of the wrist and hand

• Label
• phalanges
• metacarpals
• carpals
• Hamate
• Capitate
• Trapezoid
• Trapezium
• Triangular
• Lunate
• Scaphoid
• Pisiform (not shown in this posterior view)

35
Male pelvis, hip, os coxa

• ilium
• ischium
• pubis

36
Female pelvis

• The pelvic girdle is formed from 2 pelvic
  bones joined to the sacrum (base of spinal cord).
  In front the pelvic bones are held together by
  the pubic symphysis joint. This joint allows only
  slight bending movement, but it softens and
  becomes more flexible in a female giving birth.

37
Acetabulum

• This is a view of the right pelvic bone. It
  is formed from 3 fused bones the ilium (green),
  ischium (yellow) and pubis (red). The 3 bones
  meet in the acetabulum (hip socket) at point A.

38
Leg bones

• Femur
• Tibia
• Fibula
• Patella

39
X-ray of knee
40
knee surgery post-op 48 hours

• Basically, the ACL runs in a left to right
  direction and provides support for pivoting
  motions. In most cases people can live with an
  ACL tear they just have to be careful and
  potentially limit certain activities

41
Bones of the foot

• phalanges
• metatarsals
• tarsals Talus, Calcaneus, Navicular, Cuboid,
  Lateral cuneiform, Intermediate cuneiform, Medial
  cuneiform

42
Trauma

• Fracture Definition - a break in the continuity
  of a bone or cartilage.
• Classification
• Closed fracture (simple) - no communication with
  the outside environment.
• Open fracture (compound) - communication with the
  outside environment.

43
Bone fractures

• Comminuted Fracture
• This is a plain film of the left forearm and
  wrist which has at least five fragments of bone.

44
Bone fractures

• A skeletally immature person suffered an ankle
  injury, resulting in a Salter-Harris Type III
  fracture. Note that the lateral aspect of the
  distal physis of the left tibia is separated with
  extension of the fracture line into the
  epiphyseal component of the distal tibia.

45
Bone fractures

• Open fractures have contacted the
  environment. They are most commonly seen in
  vehicular or motorcycle accients and they are at
  high risk for infection or osteomyelitis.

46
Bone fractures

• This is an image of a spiral fracture. Note
  the wavy appearance of the fracture due to torque
  through the bone. You often see spiral fractures
  in children when they twist an ankle or knee.
  This can be extremely alarming because a spiral
  fracture in children who are not yet walking can
  be due to child abuse.

47
Bone fractures

• This is an image of a greenstick fracture. Due
  to the pliability of pediatric bone, the bone
  does not completely fracture. The medial side of
  the radius is open where as the lateral cortex
  has simply buckled.

48
Bone fractures

• This is an example of a stress fracture of
  the tibia (arrows). Stress fractures are a common
  result of overuse or stress on the bone. It is
  desirable to catch them before they become
  complete fractures because they are non-displaced
  and in perfect anatomic alignment so they tend to
  heal well with appropriate treatment.

49
Bone fractures

• This is a radiograph of the anterior superior
  illiac spine of the pelvis of a high school
  sprinter. Note the bony fragment that has
  dissociated from the pelvis (arrow). The patient
  pulled the bone fragment off the pelvis at the
  point of the Sartorious muscle attachment and
  subject to possible fracture at times of intense
  stress.

50
Bone fractures

• This is an image of a both bone forearm
  fracture. The callus or fracture fragments have
  caused the bone to ossify between the radius and
  ulna fusing the forearm and preventing pronation
  or supination.

51
Dislocation of the elbow

52
Osteomyelitis (bone infection)

• This is an advanced case of osteomyelitis that
  had been developing for approximately 3 to 4
  months at the time of the plain film. Note the
  mixed lytic and sclerotic processes that are
  occurring in the bone.

53
Degenerative Joint Disease (DJD or
osteoarthritis)

• Primary osteoarthritis - most common in the older
  age group as the result of wear and tear on
  articular cartilage over time.
• Secondary osteoarthritis - results from a
  previous process that damaged cartilage such as
  trauma, inflammatory arthritis.
• The most commonly involved joints in primary
  osteoarthritis are
• Distal interphalangeal joints
• First carpometacarpal joint
• Weight bearing joints spine, hips, knees

54
Inflammatory Arthritis

• An inflammatory process with the target organ
  being the synovial membrane leading to pannus
  formation (inflammatory exudate in the lining of
  the synovial cells).

55
Rheumatoid arthritis

• Diagnosis usually made by plain film
• Osteopenia - a demineralization of the bone -
  is the result of increased blood flow, due to
  inflammation, which washes out the calcium.

56
Rheumatoid arthritis

• Rheumatoid arthritis affecting the hands

57
Tumor involving bone

• Primary tumors
• Benign
• Osteoid (e.g., osteoid osteoma, osteoblastoma)
• Chondroid (e.g., enchondroma)
• Fibrous (e.g., non-ossifying fibroma)
• Mixed (e.g., osteochondroma)
• Malignant
• Osteoid (e.g., osteosarcoma)
• Chondroid (e.g., chondrosarcoma)
• Fibrous (e.g., fibrosarcoma)
• Mixed (e.g. dedifferenciated chondrosarcoma)
• Metastatic tumors

58
Benign Versus Malignant Tumor

• Left image is an enchondroma in a metacarpal
  bone. It is a sharply marginated, lucent
  structure. It is a slow growing tumor.
• The right image, however, is an osteosarcoma
  in the femur. The tumor is growing beyond the
  margins of the bone and it is difficult to
  discern the full extent of the tumor. These
  features suggest it is an aggressively growing
  tumor.

59
Ankle sprain

• A sprain is a stretched or torn ligament.
  Ligaments connect one bone to another bone at a
  joint and help keep the bones from moving out of
  place. The most common site of sprains is the
  ankle

60
Ankle sprain

• Although ligament damage frequently occurs
  during athletics or exercise, ankles are just as
  often injured stepping off a curb, into a
  pothole, or onto uneven ground.

61
Ankle sprain

• Upon physical examination, the ankle will
  exhibit swelling and discoloration (black and
  blue) over the outside part of the joint.
  Touching of the area will result in a variable
  amount of discomfort. Frequently, there is
  instability notes on the drawer test as the heel
  structures are moved forward and back as the leg
  is stabilized. Range of motion (ROM) in the ankle
  can be limited due to pain and swelling, but
  strength is not usually affected. X-rays are
  essential, as the possibility of a fracture must
  be ruled out.

62
Ankle sprain-Grade I

• Mild sprain, mild pain, little swelling, and
  joint stiffness may be apparent
• Stretch and/or minor tear of the ligament without
  laxity (loosening)
• Usually affects the anterior talofibular ligament
  
• Minimum or no loss of function
• Can return to activity within a few days of the
  injury (with a brace or taping)

63
Ankle sprain-Grade II
64
Ankle sprain-Grade II

• Moderate to severe pain, swelling, and joint
  stiffness are present
• Partial tear of the lateral ligament(s)
• Moderate loss of function with difficulty on toe
  raises and walking
• Takes up to 2-3 months before regaining close to
  full strength and stability in the joint

65
Ankle sprain-Grade III

• Severe pain may be present initially, followed by
  little or no pain due to total disruption of the
  nerve fibers
• Swelling may be profuse and joint becomes stiff
  some hours after the injury
• Complete rupture of the ligaments of the lateral
  complex Usually requires some form of
  immobilization lasting several weeks
• Complete loss of function and necessity for
  crutches
• Usually managed conservatively with
  rehabilitation exercises, but a small percentage
  may require surgery
• Recovery can be as long as 4 months

66
How can ankle sprains be treated?

• Many doctors suggest using the RICE approach
• Rest
• Ice
• Compression
• Elevation

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RICE approach Rest

• Rest--You may need to rest your ankle, either
  completely or partly, depending on how serious
  your sprain is. Use crutches for as long as it
  hurts you to stand on your foot.
• Ice--Using ice packs, ice slush baths or ice
  massages can decrease the swelling, pain,
  bruising and muscle spasms. Keep using ice for up
  to 3 days after the injury.
• Compression--Wrapping your ankle may be the best
  way to avoid swelling and bruising. You'll
  probably need to keep your ankle wrapped for 1 or
  2 days after the injury and perhaps for up to a
  week or more.
• Elevation--Raising your ankle to or above the
  level of your heart will help prevent the
  swelling from getting worse and will help reduce
  bruising. Try to keep your ankle elevated for
  about 2 to 3 hours a day if possible.

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References

• The Sourcebook of Medical Illustration, edited by
  Peter Cull (Park Ridge, NJ Parthenon, 1989)
  members.aol.com/Attic21/Anatomy/skullans.html
• Virtual Hospital is the Apprentice's Assistant
  www.vh.org/.../Lectures/icmrad/
  skeletal/Parts/Compound.html
• The Nicholas Institute of Sports Medicine and
  Athletic Trauma www.nismat.org/ptcor/
  ankle_sprain/