UNIT 4: SKELETAL SYSTEM

4.1 PHYSIOLOGY OF THE SKELETAL SYSTEM

JOINTS: formed when two or more bones meet
A. FIBROUS JOINTS: fibrous tissue between I. MINERAL DEPOSITION
i. SUTURE
- Fibrous membrane until it closes  OSTEOBLAST
- Connecting cranial bones together - Produce the collagen fibers
- Immovable - Allow hydroxyapatite to deposit but do not
ii. GOMPHOSES produce it
- Fibrous ligaments
- Produce chemical: allows dissolved
- Holds tooth in socket
- Immovable calcium phosphate to crystalize
iii. SYNDESMOSES
- Formed by interosseous membrane *CALCIUM PHOSPHATE
- dissolves in body fluids and blood
- Between radius and ulna; tibia and fibula
- If highly concentrated: settles out and form crystals
- Partly movable - other tissues prevents it to crystallize, such as muscles, liver, and eyes
B. CARTILAGINOUS: cartilage between
i. SYMPHSIS  POSITIVE FEEDBACK MECHANISM
- Fibrocartilage - More and more crystals continue to form
- Between vertebrae; pubic bones (symphis) (until out of the osteoblasts’ range)
- Elastic and slightly movable during birth process
II. BONE DEVELOPMENT
 OSSIFICATION: process of bone formation
ii. SYNCHONDROSIS  OSTEOCLAST: an osteoblast that is surrounded by bone matrix
- long bones of children
- Hyaline cartilage
- Partly movable: ribs and sternum
A. INTRAMEMBRANOUS OSSIFICATION
- Immovable: bet epiphysis and diaphysis - Formation of the flat bones of the skull

C. SYNOVIAL JOINTS 1. Osteoblasts deposits bone in the skull

- Bones capped with cartilage articulate within a
fluid-filled cavity
- Have a joint cavity (joint space)
- JOINT CAPSULE: rounds and seals the joint space;
fibrous CT continuous with periosteum
- SYNOVIAL MEMBRANE: lining of the joint space;
produces SYNOVIAL FLUID
-lubricates; reducing heat of friction
-removes waste from articular cartilage
- ARTICULAR CARTILAGE: covers the bones’
surfaces in the joint space 2.
- BURSA: a pocket formed from the extension of
the synovial membrane (cushion for rubbing
tendons against bones)
3.
EXAMPLES:
1. Knee- unstable joint formed by femur, tibia and patella
2. Hip- more stable joint (head of femur fits with acetabulum)
Ligaments that support the knee:
a. COLLATERAL LIGAMENTS: medial and lateral B.
- Attach epicondyles of femur to the tibia and fibula
- Prevent side-to-side movement
b. CRUCIATE LIGAMENTS: anterior and posterior
- Attach femur to tibia
- Cross to form X between condyles
- Prevent femur from sliding forward or backward relative
to tibia 1.
c. PATELLAR LIGAMENT: patellar tendon 2.
- Attaches patella to the tibia
- Attaches quadriceps to tibia at tibial tuberosity
- Both tendon and a ligament
*Menisci: two C-shaped fibrocartilage pads 3.
- between femur and tibia 4.
- acts as a shock absorber for a femoral condyle
- prevents condyle in the femur to slide from side to side
i. HINGE: movable in one direction; elbow 5.
ii. BALL AND SOCKET: ball fits into a socket of other; very
movable in all directions; hip
iii. SADDLE: concave surfaces articulate with one another; all 6.
movements are possible; rotation is limited; carpometacarpal 7.
joint of the thumb
iv. GLIDING: flat surfaces glide past one another; up-and-down
movement; carpal bones
v. ELLIPSOID: reduced ball and socket; side-to-side; 8. CHONDROCYTES: more cartilage to expand
metacarpophalangeal joints; fingers to be spread
vi. PIVOT: ring of bone articulates with a post of bone; atlas on
the odontoid; enables rotation
membrane (connective tissue membrane)
- Site of ossification: center of the parietal,
frontal and occipital bone
- Deposition: outward; until the bones fuse
*Spongy bone at the beginning;
compact bone at the top of the spongy
 FONTANELLES: membranous areas
-baby’s soft spot
The membrane continues to grow as bone is
being deposited
- Allows the skull to get bigger
Sutures are completely closed
- Development stops
 SUTURE: joint formed when cranial bones
fused together
ENDOCHRONDAL OSSIFICATION
- Formation of the long bones, vertebrae,
ribs, sternum, scapula, and pelvic bones
- Happens inside cartilage
Starts with small hyaline cartilage
Primary Ossification in the diaphysis
-Osteoblasts begin depositing bone around the
diaphysis (formation of bony collar)
- Blocks the chondrocytes’ blood supply: cell death
Lacunae merge to form the marrow cavity
Blood vessel penetrates and establishes stem
cells in the marrow cavity
- Creates red bone marrow
Secondary ossification in the epiphysis
- BV penetrates again to establish stem cells of red bone
marrow between the trabeculae
Osteoblast deposit bone in all directions
Chondrocytes continue to produce cartilage
to extend the length of the bone
 EPIPHYSEAL PLATE: zone of cartilage
OSTEOBALSTS: more bone deposits in the plate
until all long bone growth is finished
 III. BONE GROWTH
A. ENDOCHRONDRAL GROWTH
- race between osteoblasts and
chondrocytes (until puberty)
 HORMONES (ESTROGEN AND TESTOTERONE)
SPEED UP THE OSTEOBLAST
- Causing it to deposit more bones
- Epiphyseal plate closes;
epiphyseal line will remain
 EPIPHYSEAL LINE:
indicating where the plate was located
- Chondrocytes stops on expanding the
bone (long bones will not get any longer)
- Endochondral growth will stop
B. APPOSITIONAL GROWTH
- Occurs in all types of bones
- Makes the bone more massive
 OSTEOBLASTS OF THE PERIOSTEUM (diaphysis)
- Deposit on the shaft
 OSTEOBLASTS OF THE TRABECULAR (epiphysis)
- Deposit along the bone’s lines of stress
1. When muscles develop, will cause more stress
on her bones at the epicondyles
2. As more stress is applied, the bones will
continue to enlarge through AG
- Eg: tubercles, trochanters, epicondyles,
spines and processes of other bones
ON ADULTS: AG may continue as long as
1. Supplies osteoblasts with sufficient calcium
2. Continue to put stress on her bones (exercise)
IV. BONE REMODELING
- Removal of existing bone by osteoclasts
and deposition of new bone by osteoblast
- Negative Feedback Mechanism
Responsible for:
-changes in bone shape
-bone repair
-adjustment of bone to stress
-calcium ion regulation
USE OF CALCIUM
 Muscle contraction
 For blood to clot
 SUFFICIENT CALCIUM IN THE BLOOD
- bone will be maintained
 EXCESS CALCIUM IN THE BLOOD
- Appositional growth will take place
 INSUFFICIENT CALCIUM IN THE BLOOD
- Calcium will be taken from the bone
 OSTEOCLASTS:
- Reabsorb calcium by producing
hydrochloric acid
*HYDROCHLORIC ACID
- dissolves the calcium and
phosphate ions to return to the blood
A. DEPOSITION
- Putting calcium phosphate crystals into the bone
B. ABSORPTION
- Putting calcium into the blood for the first time
C. REABSORPTION
- Putting calcium into the blood again (dissolving
from the bone)
V. BONE REPAIR
1. Blood clot: HEMATOMA
- because of broken blood vessels
2. Formation of SOFT CALLUS
- Formed by deposited collagen and
fibrocartilage in the break
- Thicker than the original bone
3. Osteoblast deposit bone in the soft callus,
forming a HARD CALLUS
- Extends into the marrow cavity
4. Osteoblast: forms compact bone
Osteoclast: remodels to establish marrow cavity
*remnant of hard callus: thickening of the bone
 FRACTURE: break in a bone
- Result from injury or trauma, or disease
process (weakened bone)
- Simple crack, dent, or shattered
TYPES OF FRACTURES:
 CLOSED: simple; doesn’t cause break in the skin
 OPEN: compound; breaks through the skin
 COMPLETE: two or more pieces
 DISPLACED: no longer in proper alignment
 HAIRLINE: crack
 GREENSTICK: broken on one side, not
completely on the other
 DEPRESSED: dented (cancellous bone)
- Skull fracture
 TRANSVERSE: broken perpendicular to its length
 OBLIQUE: at an angle
 SPIRAL: spirals up; twisting the bone
 EPIPHYSEAL: occurs in epiphyseal plate
 COMMINUTED: shattered; three or more pieces
 COMPRESSION: compressed cancellous bone
- May occur in the vertebrae
4.2 NUTRITIONAL REQUIREMENT OF THE SKELETAL SYSTEM
 VITAMIN D (CALCITRIOL)
- Required for the small intestine to absorb
calcium from the diet
 While CALCIUM requires Vitamin D to be absorbed,
PHOSPHORUS does not and is readily absorbed
4.3 HORMONAL REGULATION OF BONE DEPOSITION
 ESTROGEN AND TESTOSTERONE
- Locks calcium on bone
- More difficult for osteoclast to reabsorb
*TESTOSTERONE has less effect than estrogen in
speeding up osteoblasts
 CALCITONIN (THRYOID GLAND)
- Blood calcium levels: high
- Tells osteoblast to deposit calcium in the
bone; prevents osteoclast from
reabsorbing
- Net effect: bone deposition
 PARATHYROID HORMONE OR PTH
(PARATHYROID GLANDS)
- Blood calcium levels: low
- Directs osteoclast to reabsorb
- Kidney: reabsorb calcium from urine
-doesn’t increase blood calcium, helps maintain
calcium levels on the body
- SMALL INTESTINE: absorb any calcium
present from digestion
 4.4 DIAGNOSTIC TESTS FOR SKELETAL SYSTEM
4.4 FUNCTIONS OF THE SKELETAL SYSTEM
1. SUPPORT 1. DEXA (Dual-energy X-ray absorptiometry)
- Spinal column: support weight - use of low-dose radiation
-lumbar: more massive - measure bone density in the hip & vertebrae
- Massive femurs and tibias through AG
2. MOVEMENT 2. X-RAY
- Arrangement of bones and joints allows a - Use of electromagnetic radiation
range of movements - Sends photons through the body to create
3. PROTECTION visual image of dense structures
- cranial bones: brain
- ribs and sternum: lungs and heart 3. COMPUTED TOMOGRAPHY (CT scans)
- central vertebral foramen: spinal cord - Used in staging cancer (if it has already
- sella turcica: pituitary gland spread to other organs)
4. ACID-BASE BALANCE - Shows the lymph nodes and distant organs
- Maintaining normal blood pH (7.35 – 7.45) - Used to guide a biopsy needle into a tumor
- ACIDOSIS: blood pH too low (CT- GUIDED NEEDLE BIOPSY)
-excess hydrogen ions
- phosphate ions bind to excess hydrogen 4. MAGNETIC RESONANCE IMAGING (MRI scans)
ions to normalize pH - Outlining a bone tumor
- phosphate ion as a buffer, resisting change - Looking at the brain and spinal cord
5. ELECTROLYTE BALANCE
- Bones as reservoir for calcium 5. NEEDLE BIOPSY
- Calcium deposition and reabsorption FINE NEEDLE ASPIRATION
6. BLOOD FORMATION - Thin needle and a syringe
- RBC, WBC, and platelets are produced by - take out small amount of fluid and
stem cells in the red bone marrow cells
*HEMATOPOIETIC TISSUE
CORE NEEDLE BIOPSY
- tissue that makes blood cells - Larger needle
- NEWBORNS: loc is red marrow - Remove small cylinder of tissue
- ADULTS: red replaced with yellow (in epiphyses) (1/16 in diameter; ½ long)

4.4 EFFECTS OF AGING ON THE SKELETAL SYSTEM 6. SURGICAL BONE BIOPSY

- levels of estrogen and testosterone decrease w/ age
- much easier for osteoclast to reabsorb
 Decreased collagen production
 Loss of bone density
 Degenerative changes
-surgeon cuts through the skin to reach tumor
-INCISIONAL: remove a small piece of tissue
-EXCISIONAL: entire tumor is removed
4.5 SKELETAL SYSTEM DISORDERS

D>R birth to age Increase in density and mass BONE SOFTENING:

D=R 25 to 45 Maintains density and mass A. OSTEOPOROSIS
D<R 45 and over Decrease in density and mass - Severe lack of bone density
D: deposition; R: reabsorption - Affects all but more evident in cancellous
- May not be apparent until fracture occurs
Effects of decreased bone mass and density:
- Oftentimes, related with kyphosis
1. Vertebrae become thinner
- Spinal column becomes more curved and MAJOR CAUSES:
compressed  Diet deficient in calcium and Vit D
- Shorter trunk
 Lack of exercise
- Stooped posture
- Tilted neck  Diminished estrogen and testosterone
* Intervertebral disk become thinner (bc of gravity) (aging)

2. Change in posture affects gait and balance B. OSTEOMALACIA

- Adults are prone to falls - Softening of the bones
3. Long bones lose mass but not length - Due to reabsorption of calcium
4. Scapulae becomes thin and more porous - Mostly associated with pregnancy
5. Joints stiffen and become less flexible (fetus gets calcium on the mother’s bloodstream)
- Osteoarthritis; synovial fluid decrease (articular
cartilage erodes) C. RICKETS
6. Minerals may deposit in joints - Childhood disorder
7. Phalangeal joints lose cartilage
- Inadequate amount of mineral crystals is
deposited in the bone
- May not be able to completely support the
weight
- Legs become bowed and deformed

BRITTLE BONES
A. OSTEOGENESIS IMPERFECTA
- Congenital defect
- Bones lack collagen fibers
*may appear to be victims of abuse
 INFECTION:
ABNORMAL SPINAL CURVATURES: A. MASTOIDITIS
A. SCOLIOSIS - Infection of the mastoid process
- Lateral curvature - Caused by untreated middle-ear infection
- Often in thoracic region - Symptoms: pain, fever, redness, tenderness
B. KYPHOSIS and swelling near the process
- Hunchback - May have pus or discharge from the ear
- curvature of the thoracic - TREATMENT: antibiotics intravenously
- Associated w/ aging and osteoporosis Surgery (to drain pus)
C. LORDOSIS
- Swayback B. OSTEOMYELITIS
- Curvature of the lumbar - Bone infection that can reach the bone
- Associated with obesity and pregnancy from the blood, tissues, or trauma
- Exposes the bone to a pathogen
JOINT INFLAMMATION: pain, redness, tenderness bacterium or fungus)
A. BURSITIS - Open fracture; break in the shin’s skin
- Inflammation of the bursa *anterior surface or tibia is very superficial
-pocket in the synovial membrane; acts as a cushion - TREATMENT: antibiotics or surgery
- Caused by trauma or repetitive movement
(tennis player and baseball pitchers)
CANCERS:
- Commonly affected:
A. OSTEOSARCOMA
knees, elbow, shoulder, hip
- Malignant bone tumor
- TREATMENT: rest, nonsteroidal anti-
- Occur in immature bone
inflammatory drugs, immobilization
- Common in ages of 10-25
- Near the knee or other long bones
B. GOUT
- TREATMENT: chemo and surgery
- Deposit of monosodium urate crystals
- May caused by HPYERURICEMIA
B. CHONDROSARCOMAS
- Excess uric acid in the blood
* decrease in UA secretion of kidneys
- Cancerous tumors
* increase in production of urate - Occur in cartilage
* increase in intake of high-protein foods - Primary tumors (originate in cartilage, not
- can cause acute or chronic arthritis from a tumor located in another organ)
called GOUTY ARTHRITIS - May also occur in patients with
- TREATMENT: anti-inflammatory drugs, osteosarcoma
cholchicine - TREATMENT: surgical removal

C. OSTEOARTHRITIS OTHER DISORDERS:

- Most common form of arthritis A. CLEFT PALATE
- Normal wear & tear if a joint as articular - Craniofacial congenital defect
cartilage wears with age - Failure of the hard or soft palate, or both,
- CREPITUS: creaking sound to fuse during gestation
- Commonly affected: fingers, hips, knees - FACTORS: environmental or genetic
and vertebrae - Increase risks: use of alcohol and tobacco
- Decrease risks: intake of folic acid
D. RHEUMATOID ARTHRITIS - May affect lips, ability to feed, speech,
- Autoimmune disease (at any age) increase instance of ear infection
- Children: Juvenile RA - TREATMENT: surgical repair
- antibodies mistakenly attack a joint’s
synovial membrane B. HERNIATED DISK
- synovial membrane thickens: - Ruptured or slipped disk
-enzymes produced by inflammatory cells - Pressure of extra weight
erode the articular cartilage - Intervertebral disk bulges out laterally
- articular cartilage: eaten away or fused - Bulge may allow the softer matrix to ooze
with one another (ANKYLOSIS) out
- periods of remission
- joint damage is progressive C. FLAT FEET OR FALLEN ARCHES
- Caused by congenital weakness, obesity,
JOINT REPLACEMENT SURGERY or repetitive stress
- option for badly damaged joints - Foot ligaments to stretch
- articulating bone surfaces: replaced with - Foot’s entire plantar surface comes in
metal alloy contact with the ground
- joint sockets: lined with plastics - Less tolerant to prolonged standing and
- porous surfaces on the metal allow walking
osteoblasts to deposit bone into the
component surface (ensure tight bond)