Anatomy

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Anatomy PhysiologyThe Skeletal System The
FrameworkCH 6
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206 bones

• This is the complete framework in the skeletal
  system

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Functions of bone

• Framework
• Provides support

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Functions of bone

• Protects
• Underlying organs

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Functions of bone

• Serves as levers
• Levers are simple machines
• The bones serve as levers, allowing the body to
  work efficiently

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Functions of bone

• Stores Calcium
• To be used to maintain appropriate calcium level
• Two Hormones maintain calcium balance

Calcium
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Functions of bone

• Produces Red Blood Cells
• In the Red bone Marrow
• Red blood cell production is controlled by the
  hormone Erythropoietin

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SHAPES SIZES

• BONES COME IN MANY SHAPES AND SIZES
• FLAT
• IRREGULAR
• CUBOIDAL
• LONG

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There are 2 types of osseous tissue in bone

• Compact bone hard and dense, makes up the main
  shaft of a long bone and the outer layers of
  other bones
• Spongy bone this is made up of a meshwork of
  small, bony plates filled with red marrow and is
  found at the ends of long bones and at the center
  of other bones

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Cartilage

• In the womb, the fetus is not made up of
  bones.its cartilage in the 1st month of
  embryonic life
• Bone formation begins the 2nd and 3rd months of
  embryonic life

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Ossification

• Otherwise known as bone formation

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Bone Marrow

• 2 Types-
• Red
• Yellow

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BONE MARROW

• Red marrow found at the ends of the long bones
  and at the center of other bones. RED MARROW
  MAUNFACTURES BLOOD CELLS
• FYI in infants children, all bones contain
  red marrow. As the body ages, much of the red
  marrow is transformed into yellow marrow.
• In an adult, the main bones that contain red
  marrow are the chest, spinal column, skull base,
  upper arm, and thigh

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Yellow Marrow

• Yellow marrow found in the central cavities of
  long bones and is composed largely of fat.
• If a bone breaks, possibility of yellow marrow
  coming out and traveling around the blood stream
  causing an embolism. Pt will immediately become
  S.O.B./resp. distress

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Bone Marrow Transplant

• Invented in the
• 1960s-1970
• Bone marrow transplant (or hematopoietic stem
  cell transplantation) is a very complicated and
  risky process, and therefore applied only to
  patients with life-threatening diseases (who are
  resistant to chemotherapy).

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Bone Marrow Transplant
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BONE GROWTH REPAIR
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Dont be fooledBones are living cells

• Types
• Osteoblasts
• Osteocytes
• Osteoclasts

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• OSTEOBLASTS
• They manufacture intercellular material which is
  the protein framework that hold calcium deposits.

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Bone Ingredients
Calcium
Phosphorus
Vitamin D Sun, Dairy Products
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OsteocytesBaby bone cells matured and hardened.

• Mature osteoblasts that have hardened the
  intercellular material and calcium surrounding
  them.

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OsteoclastsThe Remodelers

• Responsible for resorption of bone-Causes
  reshaping
• of bone as growth occurs.

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Bones, Calcium and Hormones

• When we look at the relationship of calcium and
  bone development you have to look at two main
  hormones related to the maintenance of Calcium
  Levels in the blood.

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Parathyroid Hormone Raises the Blood Calcium level
Calcitonin Lowers the Blood calcium level
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• Calcitonin comes from the thyroid gland
• Parathyroid hormone (PTH) released from the
  parathyroif gland

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CALCITONIN

• Is produced by the thyroid gland and acts
  directly on osteoclasts
• The osteoclasts shrink and stop bone resorption.

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Resorption

• Removal by absorption
• In bone resorption, older bone sort of
  disintegrates and gets reabsorbed, then the new
  osteoblasts mature into osteocytes becoming
  stronger, this process takes place during the
  stage when osteoclasts re-mould the bone
• (Boniva and Fosamax)

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Bone Shapes(Not all information at this site
needs to be memorized, but bone shapes, Spongy vs
Compact tissue, Bone marrow, periosteum, and
endosteum.)
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Long Bone
Epiphysis Contains red bone marrow which produces
Red Blood Cells, spongy bone
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Long Bone
Epiphyseal Ring (Growth Plate) This is where bone
grows and remodels itself until adolescence when
growth will stop.
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Long Bone
Diaphysis Contains Yellow bone marrow which is
made of fat.
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PERIOSTEUM

• Membrane that covers the outside of the bone
• The inner layer of the periosteum contains
  osteoblasts that are important in bone formation
  and also in the repair of fractures
• Blood and lymphatic vessels in the periosteum
  help nourish the bone tissue. Nerves are also in
  the periosteum ouch

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ENDOSTEUM

• A thin membrane that lines the marrow cavity of
  bone and contains cells that help in the growth
  and repair of bone tissue
• Endo means through or from within

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Endosteum
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FORMATION OF A LONG BONE

• The changing of cartilage to hard bone begins at
  the center of the shaft
• At a later time, other bone forming centers
  develop across the ends of the bones
• The long bones cont. to grow in length at these
  centers from childhood late teens

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FORMATION OF A LONG BONE CONTD

• Each bone forming region hardens
• As a bone grows in length, the shaft is remodeled
  so it grows wider and the central marrow cavity
  increases in size
• This process conts. throughout life, more
  actively in some parts of the bone than in others
  due to wear and tear or injuries

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SOFT BONES

• Children have softer bones than do adults due to
  the cartilage and bone still being in the
  growing process

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ELDERLY BONES

• The contd growth and reformation of bones
  throughout life starts to slow down and the
  elderly persons bones are weaker and more
  fragile
• Elderly have a decreased ability to form the
  protein framework on which ca salts are
  deposited - injury occurs

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BONE MARKINGS

• Head rounded knob-like end, separated from the
  rest of the bone by a slender region called the
  neck, like on the femur bone

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• Process a large projection of a bone such as in
  the upper part of the ulna in the forearm that
  creates the elbow

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BONE MARKINGS

• Crest - a distinct border or ridge often rough
  such as in over the top of the hip bone

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• Spine - a sharp projection from the surface of a
  bone such as in the spine of the scapula or
  shoulder bone

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Depressions or holes in bones

• Foramen - a hole that allows a nerve or blood
  vessel to pass through
• or between bones

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• Sinus an air space found in some bones

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• Fossa a depression on a bone surface

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• Meatus a short channel or passageway such as
  the channel in the temporal bone of the skull
  that leads to the inner ear

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Review of Bone Structure
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• We are NOT learning every bone in the body
• Remember that there are approx. 206 bones in total

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Divisions of the Skeleton

• The skeleton is divided into 2 main groups of
  bones
• 1. AXIAL SKELETON- head trunk
• 2. APPENDICULAR SKELETON- shoulder arms, pelvis
  legs

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AXIAL SKELETON

• Consists of 80 bones
• Includes the bony framework of the head and trunk
• The bony framework of the head is the SKULL

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SUTURES

• The line of union in an immovable part, as those
  between the skull bones
• Sutures from in adulthood, these are the old
  fontanels

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OSSICLES

• 3 tiny bones in each middle ear
• These bones transmit sound waves in the inner ear

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Infant skull

• Has many areas in which the bone formation is
  incomplete leaving soft spots called fontanels

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ANTERIOR FONTANEL

• This is the largest fontanel of all
• Its near the front of the skull at the junction
  of the 2 parietal bones and the frontal bone
• This fontanel does not close until the child is
  about 18 months old

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Anterior Fontanel

• Can indicate if child is dehydrated or has
  swelling in brain
• Fontanel will either sink in or bulge out

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Sunken fontanel
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FRAMEWORK OF THE TRUNK

• Bones of trunk include
• Spine and vertebral column
• Thorax (chest and bones)

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Vertebrae

• Protects the spinal cord
• Is made up of 33 bony segments that serve as
  weight-bearing part of the frame
• Disks of cartilage between the vertebra serve as
  shock absorbers and provide flexibility

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FORAMEN

• In the center of each vertebra is a large hole
• All vertebra are linked together by strong
  connective tissue bands called ligaments
• The space the vertebra and
• tissue bands leave, forms
• the spinal canal to help
• protect the spinal cord

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Spinous process

• These are bony protrusions that encircle the
  spinal cord and can be felt just under the skin
  of the back

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Bones of the vertebral column

• Cervical vertebrae there are 7 and they are
  located in the neck
• ATLAS is the very 1st vertebrae it supports the
  head. When one nods the head, the skull rocks on
  the atlas at the occipital bone

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Cervical Vertebrae

• AXIS is the 2nd vertebrae, it serves as a
  pivot when the head is turned from side to side

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THORACIC VERTEBRAE

• There are 12 vertebrae
• Located in the chest area (from the front), but
  are posterior
• The posterior ends of the 12 pairs of ribs are
  attached to these vertebrae

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LUMBAR VERTEBRAE

• There are 5 vertebrae
• Located in the small of the back, L1-5 usually
  herniates, due to all of the stress
• These are the larger and heavier vertebrae to
  support more weight

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SACRAL VERTEBRAE

• There are 5 separate bones in the child
• They fuse to form the sacrum in the adult

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COCCYX

• A.K.A. tailbone
• Consists of 4-5 bones in the child
• These fuse to become one single bone in the adult

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THORAX (front view)

• Sternum (or breast bone) attaches the 12 pairs of
  ribs
• These bones protect the heart and lungs and other
  organs of the thorax

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STERNUM

• Top portion is T-shaped, it joins at the top on
  each side with the clavicle (collarbone) and
  joins with the 1st pair of ribs
• Body of the sternum is long and blade-like, it
  joins along each side with ribs 2-7

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XIPHOID PROCESS

• Lower end of the sternum, consists of a small tip
  made of cartilage as a child, then forms to bone
  in adult
• IT IS USED AS A LANDMARK FOR CPR TO LOCATE THE
  REGION FOR CHEST COMPRESSIONS

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Ribs

• TRUE RIBS the first 7 pairs, these attach
  directly to the sternum by means of the costal
  cartilage
• FALSE RIBS the remaining 5 pairs. Of these,
  8th, 9th and 10th attach to the cartilage of the
  rib above
• FLOATING RIBS the last 2 pairs of ribs, have no
  attachment

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Intercostal Spaces

• These are the spaces between the ribs, they
  contain muscle, blood vessels and nerves

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Appendicular Skeleton

• Upper division shoulder
• girdle upper extremity
• Lower Division - pelvic
• bones lower extremity

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Shoulder girdle

• Consists of 2 bones clavicle and scapula

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Clavicle

• A.K.A. collarbone
• It helps to support the shoulder
• Often receives the full force of falls when arms
  are outstretched or from blows to the shoulder,
  MOST FREQUENTLY BROKEN BONE

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Scapula

• A.K.A. shoulder blade
• Muscles that move the arm, attach to the fossa
  above and below the scapular spine

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Upper Extremity

• A.K.A. the arm
• Includes the humerus, long upper arm bone
• Olecranon process forms the point of the elbow
• Ulna is the forearm bone which lies on the medial
  side in line with the pinky finger
• Radius is on the thumb side, radius rotates
  around the ulna if the hand goes from palm up to
  palm down

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Humerus Ulna and Radius
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WRIST BONE

• A.K.A carpal bone
• Metacarpal bones form the knuckles
• Phalanges are known as the finger bones

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Lower Division of the Appendicular skeleton

• Os coxae A.K.A. the hip bone
• Made up of the
• ilium
• Ischium
• pubis

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ILIUM

• Forms the upper flared portion of the hip bone
• Iliac crest is the curved rim along the upper
  border of the ilium

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ileum
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ISCHIUM

• Lowest and strongest part of the hip
• The ischial spine at the back of the pelvic
  outlet is used as a reference during child birth
  to indicate the progress of the presenting part,
  usually the head

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Ischium
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Pubis
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Pelvic Ring
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Acetabulum

• Is the deep socket that holds the head of the
  femur
• The ilium, ischium and pubis help form the bones
  of the acetabulum

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The lower limb

• Femur is the longest and strongest bone in the
  body
• Has a large ball shaped head

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Greater trochanter

• Used as a landmark for injections

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Knee cap

• Patella

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Lower leg

• Tibia A.K.A shin bone, is a long weight bearing
  bone
• The flat part of the tibia can be stuck with an
  IV called and interosseous needle
• Fibula, smaller bone next to the tibia, not for
  wt bearing

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Interosseous needle

• Into the tibial bone

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Interosseous Needle
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Calcaneous

• Is the heel bone, it helps to support the weight
  of the body

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TOES

• Tarsals are at the crease of the foot/ankle, many
  small bones there
• Metatarsals are midway down on the top of the
  flat part of the foot to the base of each toe
• Phalanges are the actual toes themselves all the
  way to the tip of the toes where the toe nail is

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BONE DISORDERS

• Osteomyelitis inflammation of a bone caused by
  bacteria
• Rickets rare childhood disease, lack of Vit D
  prevents absorption of calcium and phosphorus
• Cleft palate congenital deformity in which
  there is an opening in the roof of the mouth,
  there is a faulty union of the maxillary bones

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Osteomyelitis
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Rickets
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• Pagets disease-bones undergo periods of Ca loss
  followed by periods of excessive deposits of Ca,
  bones get lumpy bumpy (Dr. G.)
• Osteoporosis lack of Ca salt deposits and a
  decrease in bone protein, there is increase
  breakdown of bone tissue but no deposit of new
  osteoblasts

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Pagets
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Osteoporosis
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Curvatures of the spine(scoliosis)

• Kyphosis curvature of the thoracic spine
  (hunchback)
• Lordosis- curvature of the lumbar spine
  (swayback)
• Scoliosis a lateral curve of the vertebral
  column
• Scoliosis is most seen in growth periods of teen
  years, more in girls than boys, surgery is tx

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Kyphosis, Lordosis, Scoliosis
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FRACTURES (see sheet)

• Closed simple fx with no open wound
• Open fracture broken bone pokes out of skin
• Greenstick one side of bone is broken and the
  other side is bent
• Impacted broken ends of the bone are jammed
  into each other
• Comminuted more than 1 fx and bone is splintered
  or crushed
• Spiral bone is twisted, abused children or
  skiing

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What does the skin look like when a broken bone
occurs?

• Skin around area can be reddened, ecchymotic and
  edematous
• Ecchymosis a skin discoloration consisting of
  large, irregularly formed hemorrhagic areas. The
  color is blue-black and changes in time to green
  or brown
• This is a bruise

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Ecchymosis after a broken bone
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Crepitus

• A grating sound heard on movement of ends of a
  broken bone
• Found under the skin with a compound fracture,
  between the bones
• Sounds like you are popping the bubbles in a
  sheet of bubble wrap

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Broken Nose Black Eyes
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First Aid for broken bones
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What to do when someone breaks a bone

• Elevate extremity but you must watch for changes
  in circulation. If changes occur, lower
  extremity
• Place ice around edematous limb to curb edema
  which pain
• NEVER USE HEAT at this time

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How to use an ace wrap

• When the Dr. orders you to place an ace wrap on
  the lower extremity of a pt, you must
• 1. BEGIN applying the wrap at the metatarsals
  (this is the ball of the foot from the underside)
  
• 2. Toes are left uncovered to asses circulation
• 3. To relieve swelling, wrap distally to
  proximal which means from the toes up the calf to
  alleviate swelling

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Wrap distal to proximal
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When to re-wrap an injured limb

• Pts must remove and re-wrap bandages daily (for
  bathing and air)
• Pt is instructed to re-wrap the bandage anytime
  the toes appear swollen. Rewrapping the
  extremity may restore or improve circulation

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What to do if toes look swollen once the wrap has
been applied?

• REMOVE WRAP IMMEDIATELY.
• If circulation is impaired due to a tightly
  applied wrap, toes may become blue and pt may c/o
  numbness

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Check the wrapped limb for circulation
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In what pattern do you wrap an ankle?

• Figure 8
• This is done by overlapping the roller bandage in
  an alternately ascending and descending oblique
  pattern around a joint.
• This is the method most used for a sprained ankle
  and for a stump

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Figure 8 ankle/stump
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Other wraps

• Spiral reverse used to bandage a cone-shaped
  body part like the thigh or leg
• Recurrent turn used to cover the tip of a body
  part such as the stump of an amputated limb.
• Spica turn similar to the figure-8, used to
  wrap around an adjacent body part such as the
  thumb and hand or thigh and hip

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Aging bones

• Loss of Ca salts
• Decrease amt of protein formed in bone tissue
• Increase in collagen making bones and joints
  stiff
• Thinning of vertebral column loss of ht

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JOINTS
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JOINTS

• Is an area of junction or union between 2 or more
  bones
• Some joints have fibrous connective tissue
• Some joints have no movable parts
• Some joints are connected by cartilage

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Synovial Joint

• The bones in this joint have a potential space
  between them which contains fluid called synovial
  fluid, it lubricated the joint cavity
• Synovial joints are free moving

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Most joints are synovial joints

• The bones in freely moving joints are held
  together by ligaments
• Each joint is surrounded by a joint capsule made
  of connective tissue to protect that joint

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JOINTS
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Movement of a joint

• A motion that decreases the angle between the
  bone at a joint is known as
• Flexion

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BURSAE

• Near some joints are small sacs of synovial fluid
  known as bursae
• These lie in areas where lots of stress to the
  joint is occurring, it helps that joint move
  better
• Bursae can become inflamed called bursitis

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Bursae

• Bursae are fluid-filled cavities located at
  tissue sites where tendons or muscles pass over
  bony prominences near joints. Their function is
  to facilitate movement and reduce friction
  between moving parts. When a bursa becomes
  infected, traumatized, or injured it is referred
  to as bursitis

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Disorders of Joints

• Dislocation a derangement of the parts of the
  joint such as dislocating the shoulder or the
  ball of the hip
• Shoulder joint is the most frequently dislocated
  joint in the body
• If shoulder becomes dislocated, it may hang
  longer than the other

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Disorders of joints

• Sprain the wrenching of a joint with rupture or
  tearing of the ligaments.
• Arthritis inflammation
• of the joints.

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Osteoarthritis

• In osteoarthritis, the cushioning (cartilage)
  between the bones wears away in the joints. As
  osteoarthritis gets worse, the cartilage
  disappears and bone rubs on bone. Bony spurs or
  growths usually form around the joint. The
  ligaments and muscles around the joint loosen and
  become weaker.
• Often, the cause of OA is unknown. It is mainly
  related to aging, but other factors can also lead
  to OA.
• Osteoarthritis tends to run in families
• Being overweight increases the risk
• Fractures or other joint injuries can lead to
  osteoarthritis later in life
• Long-term overuse at work or in sports can lead
  to osteoarthritis

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Osteoarthritis
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Osteoarthritis Pain

• These pts will c/o pain at the end of the day
  because they have rested all night, worked all
  day and now they have pain

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Rheumatoid Arthritis

• (RA) is a long-term disease that leads to
  inflammation of the joints and surrounding
  tissues. It can also affect other organs.
• The cause of RA is unknown. It is considered an
  autoimmune disease. The body's immune system
  normally fights off foreign substances, like
  viruses. But in an autoimmune disease, the immune
  system confuses healthy tissue for foreign
  substances. As a result, the body attacks itself.
• RA can occur at any age. Women are affected more
  often than men.
• RA usually affects joints on both sides of the
  body equally. Wrists, fingers, knees, feet, and
  ankles are the most commonly affected. The course
  and the severity of the illness can vary
  considerably. Infection, genes, and hormones may
  contribute to the disease d/t inflammation and
  over growth of the synovial membranes and joint
  tissue. Pt may see 1st signs during young
  adulthood

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R.A.
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R.A. Pain

• These pts are stiff and in pain upon awakening
  d/t laying all night.
• Most often c/o pain upon awakening and once they
  get moving

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Septic Arthritis

• Septic arthritis develops when bacteria spread
  through the bloodstream to a joint. It may also
  occur when the joint is directly infected with
  bacteria by an injury or during surgery.
• The most common sites for this type of infection
  are the knee and hip.
• Most cases of acute septic arthritis are caused
  by organisms such as staphylococcus or
  streptococcus

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Gouty Arthritis

• Gout is a kind of arthritis that occurs when uric
  acid builds up in the joints.
• Acute gout is a painful condition that typically
  affects one joint.
• Chronic gout is repeated episodes of pain and
  inflammation, which may involve more than one
  joint.
• Gout is caused by having higher-than-normal
  levels of uric acid in your body. Your body may
  make too much uric acid, or have a hard time
  getting rid of uric acid. If too much uric acid
  builds up in the fluid around the joints
  (synovial fluid), uric acid crystals form. These
  crystals cause the joint to swell up and become
  inflamed.
• Not everyone with high uric acid levels in the
  blood has gout.
• The exact cause is unknown. Gout may run in
  families. It is more common in males,
  postmenopausal women, and people who drink
  alcohol. People who take certain medicines, such
  as hydrochlorothiazide and other water pills, may
  have higher levels of uric acid in the blood
• Pt needs a diet low in purine

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Gout or Gouty Arthritis
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Symptoms of Gout

• Extreme pain in great toe
• Bed or foot cradle is used in preventing foot or
  affected joint from being touched

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Lab Test

• Serum uric acid determines how much uric acid
  is in blood
• What is uric acid?????

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Meds to treat Gout

• Meds to give class is anti-gout
• Colchicine can be given Q 1hr upon initial
  flare up
• Allopurinal more of a maintenance drug
• With colchicine, nurse must stop the med when pt
  develops GI symptoms N/V/diarrhea/abdominal pain

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FOODS NOT TO EAT

• Avoid foods high in purine
• Alcohol anchovies sardines oils
• Herring gravies mushrooms
• organ meat (liver, kidney, and sweetbreads)
• legumes (dried beans and peas)
• Spinach asparagus cauliflower consommé,
• baking or brewer's yeast.
• Limit how much meat you eat at each meal.
• Avoid fatty foods such as salad dressings, ice
  cream, and fried foods.

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Lab Test for Arthritis

• ESR (erythrocyte sedimentation rate)
• This test indicates the presence and progress of
  an inflammatory disease

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Meds to give for arthritis

• ASA aspirin to decrease swelling and pain in
  joints
• S.E. bleeding, GI bleed

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arthrosis

• Arthro pertains to a joint
• Joint affection caused by trophic degeneration
  which really means,
• Joint disease caused by no nourishment or
  feeding of blood into the nerves which causes
  degeneration or breakdown of the joint

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2 areas that come together and form a joint. But
how does that joint move?
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SYN joined together. Sutures in the
skull Vertebrate in the spine, can
move in all directions
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Ligaments

• Remember that these connect bone to bone

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ReviewWhat things do you need for strong bone?

• Vitamin D
• Phosphorus
• Calcium

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Sources of Vitamin D

• Its a fat soluble vitamin
• Found in the sun
• Milk
• Fish
• Vitamin D aids the absorption of Ca

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Sources of Phosphorus and its function

• It helps make bone and teeth
• Aids in clotting of blood
• Aids muscle in its action
• Found in milk and cheese
• Meat
• Legumes
• nuts

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Sources of Calcium

• Found in milk and cheese
• Dark green leafy vegetables

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Moving Ca back into the bone

• Requires a person to MOVE, MOVE, MOVE
• Laying around allows Ca to exit the bones
• Wt bearing exercises keep Ca packed in the bone
  (tennis, running, aerobics)

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DECREASE IN PHOSPHORUS

• Youll have osteoporosis
• Ricketts
• Bone pain
• Soda pop causes bone disintegration d/t ? in
  phosphorus (it eats away the bone)

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DECREASE IN CALCIUM

• Youll have
• Osteoporosis
• Ricketts
• Poor tooth formation
• Tetany
• Decrease clotting

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Bone marrow aspiration

• Usually taken from a flat portion of a bone
  particularly the ilieum or pelvic (hip) bone

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Bone Marrow Aspiration

• Taken mostly from flat bones such as hip

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Test Your Knowledge

• Pg. 138 start now with your elbow partner
• CASE STUDY pg. 139
• Review Questions pg. 140, 141 Do at home

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The End