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The Skeletal System serves many important functions; it provides the shape and
form for our bodies in addition to supporting, protecting, allowing bodily
movement, producing blood for the body, and storing minerals.
Functions
Its 206 bones form a rigid framework to which the softer tissues and organs of
the body are attached.
Vital organs are protected by the skeletal system. The brain is protected by the
surrounding skull as the heart and lungs are encased by the sternum and rib cage.
Bodily movement is carried out by the interaction of the muscular and skeletal
systems. For this reason, they are often grouped together as the musculo-skeletal
system. Muscles are connected to bones by tendons. Bones are connected to each
other by ligaments. Where bones meet one another is typically called a joint.
Muscles which cause movement of a joint are connected to two different bones
and contract to pull them together. An example would be the contraction of the
biceps and a relaxation of the triceps. This produces a bend at the elbow. The
contraction of the triceps and relaxation of the biceps produces the effect of
straightening the arm. Blood cells are produced by the marrow located in some
bones. An average of 2.6 million red blood cells are produced each second by the
bone marrow to replace those worn out and destroyed by the liver. Bones serve as
a storage area for minerals such as calcium and phosphorus. When an excess is
present in the blood, buildup will occur within the bones. When the supply of
these minerals within the blood is low, it will be withdrawn from the bones to
replenish the supply.
Types of Bone give the bone strength, and collagenous
fibers and ground substance to give the
The bones of the body fall into bone flexibility.
four general categories: long
bones, short bones, flat bones, Bone remodeling
and irregular bones. Long
bones are longer than they are Bone remodeling is a life long process
wide and work as levers. The where old bone is removed from the
bones of the upper and lower skeleton (a sub-process called bone
extremities (ex. humerus, tibia, resorption) and new bone is added (a sub-
femur, ulna, metacarpals, etc.) process called bone formation). These
are of this type. Short bones are processes also control the reshaping or
short, cube-shaped, and found replacement of bone during growth and
in the wrists and ankles. Flat following injuries. Remodeling responds
bones have broad surfaces for to functional demands and muscle
protection of organs and attachments. As a result bone is added
attachment of muscles (ex. ribs, where needed and removed where it is not
cranial bones, bones of required.
shoulder girdle). Irregular
bones are all others that do not In the first year of life, almost 100% of
fall into the previous the skeleton is replaced. In adults,
categories. They have varied remodeling proceeds at about 10% per
shapes, sizes, and surfaces year.
features and include the bones
of the vertebrae and a few in An imbalance in the regulation of bone
the skull. remodeling's two sub-processes, bone
resorption and bone formation, results in
Bone Composition many metabolic bone diseases, such as
osteoporosis.
Bones are composed of tissue
that may take one of two forms.
Compact, or dense bone, and
spongy, or cancellous, bone.
Most bones contain both types.
Compact bone is dense, hard,
and forms the protective
exterior portion of all bones.
Spongy bone is inside the
compact bone and is very
porous (full of tiny holes).
Spongy bone occurs in most
Bone Repair
bones. The bone tissue is
composed of several types of
bone cells embedded in a web
of inorganic salts (mostly
calcium and phosphorus) to
Skeletal Diseases symptoms include: Delayed puberty,
Double vision or difficulty with side
Growth & Developmental (peripheral) vision, Frontal bossing and a
Disorders prominent jaw, Headache, Increased
sweating, Irregular periods
(menstruation), Large hands and feet with
Gigantism - is abnormally
thick fingers and toes, Release of breast
large growth due to an excess
milk, Thickening of the facial features
of growth hormone during
and Weakness.
childhood, before the bone
growth plates have closed.
Diagnosis
• CT or MRI scan of the head
showing pituitary tumor
• Failure to suppress serum growth
hormone (GH) levels after an oral
glucose challenge (maximum 75g)
• High prolactin levels
• Increased insulin growth factor-I
(IGF-I) levels
Treatment
In pituitary tumors with well-defined
borders, surgery is the treatment of choice
and can cure many cases.
For situations in which surgery cannot
completely remove the tumor, medication
Robert Wadlow at the middle w/ is the treatment of choice. The most
gigantism
effective medications are somatostatin
Causes
analogs (such as octreotide or long-acting
The most common cause of too
lanreotide), which reduce growth
much growth hormone release
hormone release.
is a non-cancerous (benign)
Dopamine agonists (bromocriptine
tumor of the pituitary gland.
mesylate, cabergoline) have also been
Other causes include: Carney
used to reduce growth hormone secretion,
complex, McCune-Albright
but these are generally less effective. A
syndrome (MAS), Multiple
medication that blocks the effect of
endocrine neoplasia type 1
growth hormone, pegvisomant, has
(MEN-1), and
recently become available.
Neurofibromatosis.
Radiation therapy has also been used
to bring growth hormone levels to
Symptoms
normal. However, it can take 5-10 years
The child will grow in height,
for the full effects to be seen and almost
as well as in the muscles and
always leads to low levels of other
organs. This excessive growth
pituitary hormones.
makes the child extremely
Most experts will use radiation only if
large for his or her age. Other
surgery and medication fail.
Dwarfism - refers to a Diagnosis
condition in individual plants Unusually short stature for a child's age is
or animals characterized by usually what brings the child to medical
extreme small size. In older attention. Skeletal dysplasia ("dwarfism")
popular and medical usage, any is usually suspected because of obvious
type of marked human physical features (e.g., unusual
smallness could also be termed configuration of face or shape of skull),
dwarfism. The term as related because of an obviously affected parent,
to human beings (the major or because body measurements (arm span,
subject of this article) is often upper to lower segment ratio) indicate
used to refer specifically to disproportion. Bone x-rays are often the
those forms of extreme key to diagnosis of a specific skeletal
shortness characterized by dysplasia, but they are not the key
disproportion of body parts, diagnosis.
typically due to an inheritable
disorder in bone or cartilage Treatments
development. Most dwarfism treatments don't increase
stature but may alleviate problems caused
by complications.
Causes
Staphylococcus aureus is the
organism most commonly
isolated from all forms of
osteomyelitis.
Osteomyelitis of the tibia of a young child.
Symptoms Numerous abscesses in the bone show as
Signs and symptoms of radiolucency.
osteomyelitis depend on Diagnostic
whether the condition is acute, The process of diagnosing a spinal
lasting several months or less, infection usually starts with an x-ray. X-
or chronic, lasting several rays will usually be normal in the first 2
months to years. to 4 weeks after the infection starts. For
changes to show up on an x-ray, 50% to
Signs and symptoms of acute 60% of the bone in the vertebral body
osteomyelitis include: needs to be destroyed. If the disc space is
• Fever that may be abrupt involved (discitis), the disc space may
• Irritability or lethargy in narrow and destruction of the endplates
young children around the disc may be seen on the x-ray.
• Pain in the area of the
infection The most sensitive and specific imaging
• Swelling, warmth and study for spinal infection is a MRI scan
redness over the area of with enhancement with an intravenous
the infection dye (Gadolinium). The infection will
cause an increase in blood flow to the
Signs and symptoms of chronic vertebral body, and this will be picked up
osteomyelitis include: by the Gadolinium, which will enhance
• Warmth, swelling and the MRI signal in areas of increased
redness over the area of blood flow.
the infection
• Pain or tenderness in the
affected area
painless mass. Some bone tumors may
Treatment weaken the structure of the bone, causing
Osteomyelitis often requires pathologic fractures.
prolonged antibiotic therapy,
with a course lasting a matter
of weeks or-months. A PICC
line or central venous catheter
is often placed for this purpose.
Osteomyelitis also may require
surgical debridement. Severe
cases may lead to the loss of a
limb. Initial first line antibiotic
choice is determined by the
patient's history and regional
differences in common
infective organisms.
Tumors
Fractures
A fracture is commonly referred to as a broken bone. Fractures are common; the
average person has two during a lifetime. They occur when the physical force
exerted on the bone is stronger than the bone itself. Your risk of fracture depends,
in part, on your age. Broken bones are very common in childhood, though
children's fractures are generally less complicated than fractures in adults. Older
people, whose bones are more brittle, are more likely to suffer fractures from
falls that would not affect younger people.
There are many types of fractures, but the main categories are complete,
incomplete, compound and simple. Complete and incomplete fractures refer to
the way the bone breaks: In a complete fracture, the bone snaps into two or more
parts; in an incomplete fracture, the bone cracks but does not break all the way
through. In a compound fracture, also called an open fracture, the bone breaks
through the skin; it may then recede back into the wound and not be visible
through the skin. In a simple fracture, also called a closed fracture, the bone
breaks but there is no open wound in the skin.
Simple fractures include:
Comminuted fracture
Greenstick Fracture.
Comminuted fracture: a fracture in
Greenstick fracture: an which the bone fragments into several
incomplete fracture in which pieces.
the bone is bent. This type
occurs most often in children.
Transverse fracture
Transverse fracture: a
fracture at a right angle to the Buckle fracture of the distal radius. Arrows indicate
location of fracture.
bone's axis.
Impacted fracture: is one whose ends
are driven into each other. This is
commonly seen in arm fractures in
children and is sometimes known as a
buckle fracture. Other types of fracture
Oblique fracture are pathologic fracture, caused by a
disease that weakens the bones, and stress
Oblique fracture: a fracture in fracture, a hairline crack.
which the break slopes.
Other types of fracture: are pathologic
fracture, caused by a disease that weakens
the bones, and stress fracture, a hairline
crack.
Joint
A joint is the location at which two or
more bones make contact. They are
constructed to allow movement and
provide mechanical support, and are
classified structurally and functionally.
Classification
Joints are mainly classified structurally
and functionally. Structural classification
is determined by how the bones connect
to each other, while functional
classification is determined by the
degree of movement between the
articulating bones. In practice, there is
significant overlap between the seven types of classifications.
Terms ending in the suffix -sis are singular and refer to just one joint, while -ses
is the suffix for pluralization.
Functional classification
Joints can also be classified
functionally, by the degree of
mobility they allow:
• synarthrosis - permits
little or no mobility.
Joint Disorders weight can lead to arthritis. This is
especially true of the hips and knees that
Arthritis can be worn quickly in heavier patients.
Previous Injury
Arthritis (from Greek arthro-,
joint + -itis, inflammation;
Joint damage can cause irregularities in
plural: arthritides) is a group of
the normal smooth joint surface. Previous
conditions involving damage to
major injuries can be part of the cause of
the joints of the body. Arthritis
arthritis. An example of an injury leading
is the leading cause of
to arthritis is a tibial plateau fracture,
disability in people older than
where the broken area of bone enters the
fifty-five years.
cartilage of the knee joint.
Cause
Occupational Hazards
Determining the cause of
arthritis can be difficult,
Workers in some specific occupations
because often several factors
seem to have a higher risk of developing
contribute to an individual
arthritis than other jobs. These are
developing this common
primarily high demand jobs such as
problem. Some of the risk
assembly line workers and heavy
factors that can cause arthritis
construction.
include:
Some High-Level Sports
Genetics
It is difficult to determine how much
Exactly how much heredity or
sports participation contributes to
genetics contributes to the
development of arthritis. Certainly, sports
cause of arthritis is not well
participation can lead to joint injury and
understood. However, there are
subsequent arthritis. However, the
likely genetic variations that
benefits of activity likely outweigh any
can contribute to the cause of
risk of arthritis.
arthritis.
Illness or Infection
Age
People who experience a joint infection
Cartilage becomes more brittle
(septic joint), multiple episodes of gout,
with age and has less of a
or other medical conditions, can develop
capacity to repair itself. As
arthritis of the joint.
people grow older they are
more likely to develop arthritis.
Symptoms
Joint pain and progressive stiffness
Weight
without noticeable swelling, chills, or
fever during normal activities probably
Because joint damage is partly
indicate the gradual onset of
dependent on the load the joint
osteoarthritis.
has to support, excess body
Diagnosis targeted at the disease process causing the
Arthritis diagnosis information, arthritis). Arthroplasty (joint replacement
blood tests, and other surgery) may be required in eroding
diagnostic tests. Physical forms of arthritis.
examination and diagnostic In general, studies have shown that
tests, along with a patient's physical exercising of the affected joint
clinical picture, help to can have noticeable improvement in
formulate an accurate terms of long-term pain relief.
diagnosis. Furthermore, exercising of the arthritic
Arthrography - is an imaging joint is encouraged to maintain the health
technique that utilizes contrast of the particular joint and the overall body
dye so that certain structures of of the person.
the joints that aren't readily Another form of non-drug treatment that
seen on traditional X-rays can does have a body of proper research to
be seen. Arthrography helps support its efficacy is marine oil, from
detect joint damage and both fish and the New Zealand green-
problems with surrounding lipped mussel (Perna canaliculus). Diets
structures. high in marine oils from cold-water fish
Arthritis is a complicated such as salmon, mackerel, and tuna have
disease with many different been shown to reduce the inflammation of
types. To accurately diagnose joint conditions such as arthritis. Massage
arthritis, a medical history, on joints with neem oil has reported
physical examination, improvement in chronic and acute cases
laboratory tests, and medical
imaging are involved.
Rheumatoid arthritis (RA) is a
chronic, systemic autoimmune disorder
that causes the immune system to attack
the joints, where it causes inflammation
(arthritis) and destruction. It can also
damage some organs, such as the lungs
and skin. It can be a disabling and painful
condition, which can lead to substantial
loss of functioning and mobility.
Cause
Patient hands X-ray-Arthritis The cause of rheumatoid arthritis is a very
active area of worldwide research. Some
Treatment scientists believe that the tendency to
Treatment options vary develop rheumatoid arthritis may be
depending on the type of genetically inherited. It is suspected that
arthritis and include physical certain infections or factors in the
and occupational therapy, environment might trigger the immune
lifestyle changes (including system to attack the body's own tissues,
exercise and weight control), resulting in inflammation in various
medications and dietary organs of the body such as the lungs or
supplements (symptomatic or eyes.
Regardless of the exact Diagnosis
trigger, the result is an It is diagnosed with blood tests
immune system that is geared (especially a test called rheumatoid
up to promote inflammation in factor) and X-rays. Diagnosis and long-
the joints and occasionally term management are typically performed
other tissues of the body. by a rheumatologist, an expert in the
Immune cells, called diseases of joints and connective tissues.
lymphocytes, are activated and
chemical messengers
(cytokines, such as tumor
necrosis factor/TNF and
interleukin-1/IL-1) are
expressed in the inflamed
areas.
Environmental factors also
seem to play some role in
causing rheumatoid arthritis.
Recently, scientists have
reported that smoking tobacco
increases the risk of If one metacarpal phalangeal joint (MCP) is involved with
rheumatoid arthritis, then typically all of the joints are
developing rheumatoid involved. In this image we see that every MCP joint is affected.
arthritis. The DIP (distal interphalangeal) joints are relatively spared.
This patient has also developed ligamentous abnormalities due
to RA. A radial deviation of the carpus and ulnar deviation of
Symptoms the digits give the hands a characteristic zig-zag pattern.
Treatment
Generally speaking, the process of
clinically detectable osteoarthritis is
irreversible, and typical treatment consists
of medication or other interventions that
can reduce the pain of OA and thereby
improve the function of the joint.
Conservative care
Diagnosis
Causes
People with certain foot types are more
likely to develop bunions. If you have flat
Radiograph of Elbow w/ Bursitis feet, or low arches, your chance of getting
bunions is increased.
Treatment
The treatment of any form of Most bunions develop as a result of
bursitis depends on whether or wearing shoes that do not fit properly.
not it involves infection. Women get bunions more often than men
Bursitis that is not infected because they tend to wear tight, pointed,
(from injury or underlying or high-heeled shoes. High heels push
rheumatic disease) can be most of your body weight onto the front
treated with ice compresses, of your foot, placing a great strain on the
rest, and antiinflammatory and toe joints. Women also tend to have
pain medications. Occasionally, looser ligaments than men, which make
them more prone to getting family has had bunions, or if you have
bunions. injured your foot in any way.
If your shoes are tight, they
will rub against the big toe An X-ray may sometimes be necessary to
joint. This can thicken the skin see how severe the bunion is and to check
and tissues and form a bunion. the alignment of your toes.
Continuing to wear badly
fitting shoes will make your
bunions worse.
Bunions can also be caused, or
made worse, by arthritis.
Arthritis is a condition where
the protective cartilage
covering the joints becomes
diseased or damaged. As the
joints are stiff, and hard to
move, it can be difficult to
straighten out your toes to
prevent them rubbing against
your shoes.
Symptoms
The symptoms of bunions
include irritated skin around Hallux valgus .
the bunion, joint redness and
pain, and possible shift of the Treatment
big toe toward the other toes. Bunions may be treated conservatively
with changes in shoe gear, different
Diagnosis orthotics (accommodative padding and
Bunions cause a visible shielding), rest, ice, and medications.
swelling at the base of the big These sorts of treatments address
toe. Your GP will therefore be symptoms more than they correct the
able to identify a bunion just by actual deformity. Surgery, by a Podiatrist,
looking at your foot. You may may be necessary if discomfort is severe
be asked to move your big toe enough or when correction of the
up and down to see if your deformity is desired.
range of movement is limited.
Your GP will also check for
redness and swelling and ask
you about pain.
You may also be asked about
the types of shoes that you
wear and how frequently you
wear them. You should tell
your GP if anyone in your
Divisions of the Skeleton
The axial skeleton consists of bones that form the axis of the body and support
and protect the organs of the head, neck, and trunk.
• The Skull
• The Sternum
• The Ribs
• The Vertebral Column
SKULL
Frontal view.
Side view.
The skull
is the bony framework of the head. It is comprised of the eight cranial and
fourteen facial bones.
Cranial Bones
The joints between bones of the the posterior portion of the roof of
skull are immovable and called the mouth.
sutures. The parietal bones are • The left and right zygomatic are
joined by the sagittal suture. the cheek bones. They form
Where the parietal bones meet portions of the orbits as well.
the frontal is referred to as the • The left and right nasal form the
coronal suture. The parietals superior portion of the bridge of
and the occipital meet at the the nose.
lambdoidal suture. The suture • The left and right lacrimal help to
between the parietals and the form the orbits.
temporal bone is referred to as
• The vomer forms part of the nasal
the squamous suture. These
septum (the divider between the
sites are the common location
nostrils).
of fontanelles or "soft spots"
The left and right inferior turbinate
on a baby’s head.
forms the lateral walls of the nose and
increase the surface area of the nasal
Facial Bones
cavity.
The facial bones makeup the
upper and lower jaw and other
facial structures.
Zygomatic process bones bordering the temporal and maxilla bones have
zygomatic bone areas next to the zygomatic bone.
The Sternum the bottom of the sternum. It is often
cartilaginous (cartilage), but does become
bony in later years.
The Ribs
The sternum is a flat, dagger
shaped bone located in the
middle of the chest. Along with
the ribs, the sternum forms the
rib cage that protects the heart,
lungs, and major blood vessels
from damage.
Causes
Fibrous dysplasia is very rare; not much
is known about it, and there is no known
cure. However, it is known that it is
Radiograph of bone spur caused by a genetic mutation that occurs
sometime during fetal development, and
Treatments is not hereditary. There are two types of
fibrous dysplasia: 1. Monostotic
There's no specific treatment (Involving a single bone), and 2.
for bone spurs. Polystotic (Involving many bones). The
most severe form of
If your bone spurs don't cause polystotic fibrous dysplasia is known as
you any pain or if they don't Albright Syndrome.
limit any range of motion in
your joints, then you likely Symptoms
won't need treatment. If you Fibrous dysplasia can affect any bone in
need treatment, it's typically your body. Most people with the disorder
directed at the underlying have only one affected bone — a form
problem to prevent further joint called monostotic fibrous dysplasia —
damage. and develop no signs or symptoms. When
the condition affects more than one bone,
Medications it's known as polyostotic fibrous
dysplasia. Bones most commonly affected
If your bone spurs are causing are:
pain, your doctor may
recommend nonsteroidal anti- • Thighbone (femur)
inflammatory drugs (NSAIDs) • Shinbone (tibia)
to ease the pain. • Pelvic bones
• Ribs
Surgery • Skull
• Facial bones
Bone spurs that limit your
range of motion or cause other • Upper arm bone (humerus)
problems that limit your ability
to go about your day may Fibrous dysplasia may cause few or no
require surgery. What surgical signs and symptoms, particularly if the
options you have will depend condition is mild. Signs and symptoms
may develop during childhood,
adolescence or adulthood. If take up the tracers and emit
you have the polyostotic form, radiation that's captured by a
you're more likely to develop special camera, which
signs and symptoms, usually by • produces a picture of your skeleton.
age 10. More severe fibrous Your doctor may order a bone scan
dysplasia may cause: to determine whether your fibrous
dysplasia is monostotic or
• Bone pain polyostotic.
• Difficulty walking
• Bone deformities • Bone biopsy. Surgically removing a
• Fractures sample of affected bone for
examination under a microscope is
Diagnosis necessary only if your doctor
If you have monostotic fibrous suspects cancer. During a biopsy, a
dysplasia, you may not know it surgeon removes a small piece of
until it's discovered your affected bone for analysis in a
incidentally on an X-ray for laboratory.
another condition. If you have
signs and symptoms, your
doctor will perform a physical
examination and order X-rays
of the affected bones. On X-
ray, fibrous dysplasia appears
as an abnormal section of bone
(lesion) that has the hazy
appearance of ground glass.
• Imaging tests.
Computerized
tomography (CT) or
magnetic resonance
imaging (MRI) scans
may be used to
determine how
extensively your bones
are affected. Fibrous Dysplasia-MRI.
• Bone scan. This test uses
radioactive tracers,
which are injected into
your body. Your bones
Treatment generally well tolerated, but may irritate
If you have mild fibrous your gastrointestinal tract. Some
dysplasia that's discovered bisphosphonates aren't available as oral
incidentally and you have no medications, and you must receive them
signs or symptoms, your risk of through a vein (intravenously). The drug
developing deformity or tends to work faster when you receive it
fracturing your bone is low. through a vein than if you take it orally,
Your doctor can monitor your and intravenous administration provides
condition with follow-up X- an option when you can't tolerate or
rays every six months. If there's otherwise aren't a candidate for oral
no progression, you don't need bisphosphonates. You can't take
treatment. bisphosphonates if you have serious
If you develop signs and kidney disease or low blood calcium
symptoms, treatment may levels.
include medications or surgery.
Surgery
Medications
Your doctor may recommend
Medications called surgery in order to:
bisphosphonates, including
pamidronate (Aredia) and • Correct a deformity
alendronate (Fosamax), are • Fix a fracture
used to inhibit bone • Remove an affected area of bone
breakdown, preserve bone (lesion) that's causing you difficulty
mass and even increase bone
• Relieve pressure on a nerve,
density in your spine and hip,
particularly if the lesion is in your
reducing the risk of fractures.
skull or face
Doctors use these medications
primarily for adults to treat
Surgery may involve removing the bone
osteoporosis and increase bone
lesion and replacing it with bone from
density, but bisphosphonates
another part of your body. Your surgeon
may also reduce bone pain
may insert metal plates, rods or screws to
associated with fibrous
stabilize the bone and the graft. Risks
dysplasia, and, in some cases,
include infection, blood clots and
improve bone formation.
bleeding. In addition, a bone graft may
not last.
Little is known about the use of
bisphosphonates for children
and adolescents, but some
studies indicate they may help
relieve pain in children and
adolescents with severe fibrous
dysplasia.
Oral bisphosphonates are
Osteopenia is a condition training, which would result in lower
where bone mineral density is calcium absorption than other groups.
lower than normal. It is
considered by many Symptoms
doctors to be a precursor to There are no symptoms associated with
osteoporosis. However, not the early stages of osteopenia. As such,
every person diagnosed with osteopenia is a silent risk factor for
osteopenia will develop fractures. Symptoms occurring during
osteoporosis. More specifically, later stages include fractures of the
osteopenia is defined as a bone vertebrae, wrists or hips (usually the first
mineral density T score indication); low back pain; neck pain;
between -1.0 and -2.5. bone pain and tenderness; loss of height
over time; and a stooped posture.
Causes
Like osteoporosis, osteopenia Diagnosis
occurs more frequently in post- The pharmaceutical company Merck,
menopausal women as a result which sells the anti-bone-loss drug
of the loss of estrogen. It can Fosamax, estimated in 2003, from its own
also be exacerbated by lifestyle market research, that about 8 million
factors such as lack of exercise, women had been found to have
excess consumption of alcohol, osteopenia and about a third of them were
smoking or prolonged use of taking an osteoporosis drug. Scans of
glucocorticoid medications bones anywhere in the body can be done
such as those prescribed for with X-rays, known as Dexa (Dual energy
asthma. X-ray absorptiometry). Scans can also be
done with portable scanners using
The condition can occur in ultrasound, and portable X-ray machines
young women who are athletes. can measure density in the heel. A study
It is associated with female paid for by Merck found that the extent to
athlete triad syndrome as one which osteopenia was diagnosed varied
of the three components, the from 28 to 45 percent, depending on the
other two being amenorrhea type of machine.
and disordered eating. Female
athletes tend to have lower
body weight, lower fat
percentage, and higher
incidence of asthma than their
less active peers. The low
estrogen levels (stored in body
fat) and / or use of
corticosteroids to treat asthma
can significantly weaken bone
over long periods of time. radiograph of knees shows periarticular osteopenia,
Distance runners in particular prominent tibial spines, and interosseous cysts (arrows)
are also discouraged from
consuming milk products when
Paget's disease, otherwise cases, the diagnosis is made only after
known as osteitis deformans, is complications have developed. Symptoms
a chronic disorder that typically can include:
results in enlarged and
deformed bones. It is named • Bone pain is the most common
after Sir James Paget, the symptom. Bone pain can occur in
British surgeon who first any bone affected by Paget's
described this disease. The disease. It often localizes to areas
excessive breakdown and adjacent to the joints.
formation of bone tissue that • Headaches and hearing loss may
occurs with Paget's disease can occur when Paget's disease affects
cause bone to weaken, resulting the skull.
in bone pain, arthritis, • Pressure on nerves may occur when
deformities, and fractures. Paget's disease affects the skull or
spine.
Cause • Somnolence (drowsiness) due to
Although the exact cause of vascular steal syndrome of the
Paget's disease is unknown, it skull.
appears to run in families. Up • Paralysis due to vascular steal
to 30 % of people with the syndrome of the vertebrae.
disease have other family
• Increased head size, bowing of
members who also have it.
limb, or curvature of spine may
Some researches believe that a
occur in advanced cases.
virus may be involved, but a
specific virus has not been • Hip pain may occur when Paget's
identified. disease affects the pelvis or
Whatever the cause, Paget's thighbone.
disease results in abnormal • Damage to joint cartilage may lead
bone remodeling (the normal to arthritis.
process of bone breakdown and • Teeth may spread intraorally.
rebuilding). In Paget's disease, • Chalkstick fractures.
when bone is broken down, it is
replaced with soft bone. The Diagnosis
bone is weak and can bend Paget's disease may be diagnosed using
easily. As bones rebuild, they one or more of the following tests:
can also become larger than
before. • Pagetic bone has a characteristic
appearance on x-rays. A skeletal
Symptoms survey is therefore indicated.
Many patients do not know • An elevated level of alkaline
they have Paget's disease phosphatase in the blood in
because they have a mild case combination with normal calcium,
with no symptoms. phosphate, and aminotransferase
Sometimes, symptoms may be levels in an elderly patient are
confused with those of arthritis suggestive of Paget's disease.
or other disorders. In other
• Bone scans are useful in and throat disorders) may be called
determining the extent upon to evaluate specialized
and activity of the symptoms.
condition. If a bone scan
suggests Paget's disease, the Drug therapy
affected bone(s) should be x-
rayed to confirm the diagnosis. The goal of treatment is to relieve bone
pain and prevent the progression of the
disease. The U.S. Food and Drug
Administration has approved the
following treatments for Paget's disease:
Bisphosphonates
Renal osteodystrophy is a
bone pathology, characterized
by defective mineralization,
that results from kidney
disease. Renal osteodystrophy
comes in two different forms,
high bone turnover and low
bone turnover.
Symptoms
Renal osteodystrophy may
exhibit no symptoms; if it does
show symptoms, they include: Radiograph of Fingers w/ osteodystrophy
Symptoms
Osteitis fibrosa cystica can lead
to bone pain or tenderness,
pathological fractures in the
arms, legs, or spine, and
deformities (bowing of the
bones). Being a precursor to
the disorder,
hyperparathyroidism itself may
cause kidney stones, nausea,
constipation, fatigue and
weakness. Blood tests show a This is a cross section from a femur of a
high level of serum calcium patient who suffered from
and alkaline phosphatase, and hyperparathyroidism.
low serum
Treatment juveniles. In the adult group of cases
The main treatment for trauma is thought to be the main or
hyperparathyroidism is surgery perhaps the sole factor in determining the
to remove the abnormal onset of osteochondritis dissecans. The
parathyroid gland(s). Newer trauma may be endogenous and/or
techniques use radioactive exogenous. Interestingly, the incidence of
tracers and rapid parathyroid overuse injuries in young athletes is on
hormone blood tests to make the rise and accounts for a significant
the surgery quicker and easier. number of visits to the primary care
If surgery is not possible, drugs office; this reinforces the theory that OCD
can sometimes be used to lower may be associated with increased
calcium levels. participation in sports and subsequent
trauma.
Osteochondritis
Symptoms
dissecans
The symptoms of osteochondritis
(typically abbreviated to OCD)
dissecans are pain and swelling of the
is a form of osteochondritis. It
affected joint, catching and locking on
is commonly accepted that
movement and a restriction in the range
trauma, avascular necrosis and
of movement. These symptoms
other causative factors
characterize many knee conditions and
affecting the subchondral
may have a broad range of other causes,
(below cartilage) bone can lead
making OCD relatively hard to clinically
to the loss of support for
diagnose.
adjacent cartilaginous
structures and precede the
Diagnosis
separation of an articular
To determine whether pains are
fragment from the underlying
osteochondritis dissecans, an MRI, CT
bone and formation loose
scan or X-ray can be performed to show
bodies.
necrosis of subchondral bone and/or
formation of loose fragments. In specific
Cause
cases, if caught early enough, a harmless
Although the etiology is not
dye will be injected into the blood stream
certain, possible causative
to show where calcium will accumulate.
factors include repetitive
trauma, ischemia, hereditary
Physical examination
and endocrine factors,
avascular necrosis, rapid
A special test known as the "Wilson sign"
growth, deficiencies and
has been described to locate OCD lesions
imbalances in the ratio of
of the femoral condyle. The test is
calcium to phosphorus, and
performed by slowly extending the knee
anomalies of ossification.
from 90 degrees while maintaining
Trauma, rather than avascular
internal rotation. Pain reported at 30
necrosis, is thought to be the
degrees of flexion and relief with tibial
factor which localizes and
external rotation is a positive result.
determines the development of
osteochondritis dissecans in
Non-surgical treatment