Ahmad ata 1 - Fisiokinesiterapia · Ahmad ata 3 Objectives Distinguish between the axial and appendicular skeleton. Identify the types of fractures Identify the clinical condition

Ahmad ata Ahmad ata 11


Objectives Objectives List and discuss the 6 functions of bone tissue.List and discuss the 6 functions of bone tissue.

Illustrate the major features of a long bong including the Illustrate the major features of a long bong including the following: diaphysis, epiphyses, following: diaphysis, epiphyses, epiphysealepiphyseal line, line, periosteumperiosteum, endosteum, , endosteum, medullarymedullary cavity, nutrient cavity, nutrient foramen and note the locations of spongy bone, foramen and note the locations of spongy bone, compact bone, yellow marrow, red marrow and articular compact bone, yellow marrow, red marrow and articular cartilage.cartilage.

Compare and contrast the organic and inorganic Compare and contrast the organic and inorganic components of bone matrix, in terms of structure and components of bone matrix, in terms of structure and function. function.

Discuss the different types of bone cells in terms of Discuss the different types of bone cells in terms of origin, location and functionorigin, location and function


ObjectivesObjectives

Distinguish between the axial and Distinguish between the axial and appendicularappendicularskeleton.skeleton.Identify the types of fracturesIdentify the types of fracturesIdentify the clinical condition of bone disease Identify the clinical condition of bone disease Discuss the Discuss the HaversianHaversian System as the structural System as the structural unit of compact bone using the following terms: unit of compact bone using the following terms: osteocytesosteocytes, lacunae, lamellae, , lacunae, lamellae, HaversianHaversian canal, canal, blood vessels, bone matrix, and blood vessels, bone matrix, and canaliculicanaliculi..


THE SKELETAL SYSTEM: THE SKELETAL SYSTEM: OVERVIEWOVERVIEW

I.I. INTRODUCTIONINTRODUCTIONThe organs of the skeletal system include The organs of the skeletal system include the bones and the structures that connect the bones and the structures that connect bones to other structures, including bones to other structures, including ligaments, tendons, and cartilages.ligaments, tendons, and cartilages.The adult skeleton is composed of 206 The adult skeleton is composed of 206 separate bones.separate bones.


Division of skeleton Division of skeleton

–– Axial skeletonAxial skeletonIncludes the bones of:Includes the bones of:skull, vertebral column, and rib cage.skull, vertebral column, and rib cage.

These bones are involved in protection, support, These bones are involved in protection, support, and carrying other body parts.and carrying other body parts.

–– Appendicular skeletonAppendicular skeletonBones of upper & lower limbs and the girdles Bones of upper & lower limbs and the girdles (shoulder bones and hip bones) that attach them (shoulder bones and hip bones) that attach them to the axial skeleton.to the axial skeleton.Involved in locomotion and manipulation of the Involved in locomotion and manipulation of the environment.environment.


AXIAL SKELETONAXIAL SKELETON

AppendicularAppendicularSKELETONSKELETON



1) Skull: 28 irregular shaped bones from 1) Skull: 28 irregular shaped bones from the skull.the skull.The skull consists of two major division:The skull consists of two major division:

a)a) Cranium is formed by eight bones.Cranium is formed by eight bones.b)b) Face is formed by fourteen bones.Face is formed by fourteen bones.



2) VERTEBRAL 2) VERTEBRAL COLUMNCOLUMN

Divided into 5 main Divided into 5 main regionsregions

1.1. Cervical spine (7)Cervical spine (7)2.2. Thoracic spine (12)Thoracic spine (12)3.3. Lumbar spine (5) Lumbar spine (5) 4.4. Sacrum (5)Sacrum (5)5.5. Coccyx (4)Coccyx (4)


Cervical, Thoracic, Lumbar, Sacrum Cervical, Thoracic, Lumbar, Sacrum and Coccyxand Coccyx



THORAXTHORAX12 pairs of ribs12 pairs of ribsJoined to thoracic Joined to thoracic vertebraevertebraeTop 10 ribs joined to Top 10 ribs joined to sternumsternumRemaining two have Remaining two have ““freefree”” ends ends –– ‘‘floatingfloating’’


APPENDICULAR SKELETONAPPENDICULAR SKELETON

Forms mainly the Forms mainly the extremities of the body extremities of the body and their connections to and their connections to the axial skeletonthe axial skeleton

Consists ofConsists of-- limbs (arms & legs)limbs (arms & legs)-- shoulder and pelvic shoulder and pelvic

girdlesgirdles


Bone ClassificationBone Classification

4 types of bones:4 types of bones:–– Long Bones Long Bones

Much longer than they are Much longer than they are wide.wide.All bones of the limbs All bones of the limbs except for the patella except for the patella (kneecap), (kneecap), and the bones and the bones of the wrist and ankle.of the wrist and ankle.Consists of a shaft plus 2 Consists of a shaft plus 2 expanded ends.expanded ends.

–– Short BonesShort BonesRoughly cube shaped.Roughly cube shaped.Bones of the wrist and the Bones of the wrist and the ankle.ankle.

Femur

Carpal Bones


Bone ClassificationBone Classification

Types of bones:Types of bones:–– Flat BonesFlat Bones

Thin, flattened, and usually Thin, flattened, and usually a bit curved.a bit curved.Scapulae, sternum, Scapulae, sternum, (shoulder blades), ribs and (shoulder blades), ribs and most bones of the skull.most bones of the skull.

–– Irregular BonesIrregular BonesHave weird shapes that fit Have weird shapes that fit none of the 3 previous none of the 3 previous classes.classes.Vertebrae, hip bones, 2 Vertebrae, hip bones, 2 skull bones ( sphenoid skull bones ( sphenoid and the ethmoid bones).and the ethmoid bones).

Sternum

Sphenoid Bone


Parts of long bone Parts of long bone

1) diaphysis: main shaft like structure, its 1) diaphysis: main shaft like structure, its hollow cylindrical shape, its functions of hollow cylindrical shape, its functions of providing strong support bone.providing strong support bone.

2) epiphysis: both end of long bone, 2) epiphysis: both end of long bone, epiphysis have a bulbous shape that epiphysis have a bulbous shape that provide generous space near joint. provide generous space near joint. For muscle attachment and give stability For muscle attachment and give stability of joint.of joint.


Parts of long boneParts of long bone

3) articular cartilage thin layer of hyaline 3) articular cartilage thin layer of hyaline cartilage that covers joint surface.cartilage that covers joint surface.

4) Periosteum: dense white fibrous 4) Periosteum: dense white fibrous membrane that cover bone except at joint membrane that cover bone except at joint surface and anchoring bone to muscles.surface and anchoring bone to muscles.

5) Marrow cavity: a 5) Marrow cavity: a tubeliketubelike hollow space in hollow space in the diaphysis of long bone.the diaphysis of long bone.

6) endosteum: a thin epithelial membrane 6) endosteum: a thin epithelial membrane that line the medullry cavity.that line the medullry cavity.


Long Bone Long Bone StructureStructure


Composition of bone matrix Composition of bone matrix

1)1) Inorganic saltsInorganic salts: the hardness of bone result : the hardness of bone result from the deposition of high specialized from the deposition of high specialized chemical crystal of calcium and phosphorous chemical crystal of calcium and phosphorous called hydroxyapatite, the process called called hydroxyapatite, the process called calcification in addition to mg, Na, sulphate calcification in addition to mg, Na, sulphate and fluoride.and fluoride.

2)2) Organic substance:Organic substance: collagenous fiber and collagenous fiber and mixture protein and poly saccarids called mixture protein and poly saccarids called ground substance, provide support and ground substance, provide support and adhesion between cellular and adhesion between cellular and fiberousfiberous..Chondroitin and Chondroitin and glucosamineglucosamine are required for are required for repair and maintenance of bone and cartilage.repair and maintenance of bone and cartilage.


Composition of bone matrixComposition of bone matrix


This bone:

a. Has been demineralized

b. Has had its organic component removed


11. . OsteoblastsOsteoblastsBoneBone--forming cells found forming cells found in all bone surfaces in all bone surfaces BoneBone--building cells.building cells.Synthesize and secrete Synthesize and secrete collagen fibers and other collagen fibers and other organic components of organic components of bone matrix. bone matrix. serve as a framework for serve as a framework for the deposition of calcium the deposition of calcium and phosphate and phosphate calcificationcalcification The blue arrows indicate the

osteoblasts. The yellow arrows indicate the bone matrix they’ve just secreted.

Types of bone cellsTypes of bone cells



22. . OsteoclastsOsteoclastsGiant multinucleate cellsGiant multinucleate cellsResponsible for the Responsible for the active erosion of bone active erosion of bone mineralsmineralsContain large numbers Contain large numbers of mitochondria and of mitochondria and lysosomeslysosomes



3. 3. OsteocytesOsteocytes——mature, mature, nondividingnondividingosteoblastosteoblast surrounded by matrix, lying surrounded by matrix, lying within lacunae within lacunae


Bone MarrowBone Marrow

Specialized type of soft, diffuse connective Specialized type of soft, diffuse connective tissue; called tissue; called myeloid tissuemyeloid tissueSite for the production of blood cellsSite for the production of blood cellsFound in Found in medullarymedullary cavities of long bones cavities of long bones and in the spaces of spongy boneand in the spaces of spongy bone


Microscopic Structure of Compact BoneMicroscopic Structure of Compact Bone

–– Contains many cylinderContains many cylinder--shaped shaped structural units calledstructural units called osteonsosteons, , oror HaversianHaversian systemssystems

–– Four types of structures make Four types of structures make up each up each osteonosteon::

LamellaLamella——concentric, cylinderconcentric, cylinder--shaped layers of calcified shaped layers of calcified matrixmatrix

LacunaeLacunae——small spaces small spaces containing tissue fluid in containing tissue fluid in which bone cells are located which bone cells are located between hard layers of the between hard layers of the lamellalamella


Microscopic Structure of Microscopic Structure of Compact BoneCompact Bone

CanaliculiCanaliculi——ultrasmallultrasmall canals canals radiating in all directions radiating in all directions from the lacunae and from the lacunae and connecting them to each connecting them to each other and to the other and to the HaversianHaversiancanalcanalHaversianHaversian canalcanal——extends extends lengthwise through the lengthwise through the center of each center of each osteonosteon and and contains blood vessels and contains blood vessels and lymphatic vesselslymphatic vessels


Microscopic Structure of Microscopic Structure of Compact BoneCompact Bone



Two types of marrow are present during a Two types of marrow are present during a personperson’’s lifetime:s lifetime:–– Red marrowRed marrow

Found in virtually all bones in an infantFound in virtually all bones in an infant’’s or childs or child’’s bodys bodyFunctions to produce red blood cellsFunctions to produce red blood cells

–– Yellow marrowYellow marrowAs an individual ages, red marrow is replaced by yellow As an individual ages, red marrow is replaced by yellow marrowmarrowMarrow cells become saturated with fat and are no longer Marrow cells become saturated with fat and are no longer active in blood cell productionactive in blood cell production



The main bones in an adult that still The main bones in an adult that still contain red marrow include the ribs, contain red marrow include the ribs, bodies of the vertebrae, the bodies of the vertebrae, the humerushumerus, the , the pelvis, and the femurpelvis, and the femurYellow marrow can alter to red marrow Yellow marrow can alter to red marrow during times of decreased blood supply, during times of decreased blood supply, such as with anemia, exposure to such as with anemia, exposure to radiation, and certain diseasesradiation, and certain diseases


Functions of BoneFunctions of Bone

SupportSupport——bones form the framework of the body and bones form the framework of the body and contribute to the shape, alignment, and positioning of contribute to the shape, alignment, and positioning of the body partsthe body partsProtectionProtection——bony bony ““boxesboxes”” protect the delicate structures protect the delicate structures they enclosethey encloseMovementMovement——bones with their joints constitute levers that bones with their joints constitute levers that move as muscles contractmove as muscles contractMineral storageMineral storage——bones are the major reservoir for bones are the major reservoir for calcium, phosphorus, and other mineralscalcium, phosphorus, and other mineralsHematopoiesisHematopoiesis——blood cell formation is carried out by blood cell formation is carried out by myeloid tissuemyeloid tissue


Regulation of Blood Calcium LevelsRegulation of Blood Calcium Levels

Skeletal system (cont.)Skeletal system (cont.)–– Homeostasis of calcium ion concentration Homeostasis of calcium ion concentration

essential for the following:essential for the following:Bone formation, remodeling, and repairBone formation, remodeling, and repairBlood clottingBlood clottingTransmission of nerve impulsesTransmission of nerve impulsesMaintenance of skeletal and cardiac muscle Maintenance of skeletal and cardiac muscle contractioncontraction


Regulation of Blood Calcium LevelsRegulation of Blood Calcium Levels

Mechanisms of calcium homeostasisMechanisms of calcium homeostasis–– Parathyroid hormoneParathyroid hormone

Primary regulator of calcium homeostasisPrimary regulator of calcium homeostasisStimulates Stimulates osteoclastsosteoclasts to initiate breakdown of to initiate breakdown of bone matrix and increase blood calcium levelsbone matrix and increase blood calcium levelsIncreases renal absorption of calcium from urineIncreases renal absorption of calcium from urineStimulates vitamin D synthesisStimulates vitamin D synthesis


Mechanisms of calcium homeostasis Mechanisms of calcium homeostasis (cont.)(cont.)–– CalcitoninCalcitonin

Protein hormone produced in the thyroid glandProtein hormone produced in the thyroid glandProduced in response to high blood calcium levelsProduced in response to high blood calcium levelsStimulates bone deposition by Stimulates bone deposition by osteoblastsosteoblastsInhibits Inhibits osteoclastosteoclast activityactivityFar less important in homeostasis of blood calcium Far less important in homeostasis of blood calcium levels than parathyroid hormonelevels than parathyroid hormone


Fracture TypesFracture Types

–– Open (compound) Open (compound) bone ends penetrate the bone ends penetrate the skin.skin.

–– Closed (simple) Closed (simple) bone ends donbone ends don’’t penetrate t penetrate the skin.the skin.

–– Spiral Spiral ragged break caused by excessive ragged break caused by excessive twisting forces. Sports injury/Injury of abusetwisting forces. Sports injury/Injury of abuse

–– Greenstick Greenstick bone breaks incompletely. One bone breaks incompletely. One side bent, one side broken. Common in side bent, one side broken. Common in children whose bone contains more collagen children whose bone contains more collagen and are and are less mineralizedless mineralized


Clinical Clinical ConditionsConditions

OsteomalaciaOsteomalacia–– Literally Literally ““soft bones.soft bones.””–– Includes many disorders in which osteoid Includes many disorders in which osteoid

is produced but inadequately is produced but inadequately mineralized.mineralized.

Causes can include insufficient Causes can include insufficient dietary calciumdietary calciumInsufficient vitamin D fortification or Insufficient vitamin D fortification or insufficient exposure to sun light.insufficient exposure to sun light.

RicketsRickets–– Children's form of osteomalaciaChildren's form of osteomalacia–– More detrimental due to the fact that More detrimental due to the fact that

their bones are still growing.their bones are still growing.–– Signs include bowed legs, and Signs include bowed legs, and

deformities of the pelvis, ribs, and skull.deformities of the pelvis, ribs, and skull.What about the above x-ray is indicative of rickets?


Clinical ConditionsClinical Conditions

OsteomyelitisOsteomyelitis–– Inflammation of bone Inflammation of bone

and bone marrow and bone marrow caused by puscaused by pus--forming forming bacteria that enter the bacteria that enter the body via a wound (e.g., body via a wound (e.g., compound fracture) or compound fracture) or migrate from a nearby migrate from a nearby infection.infection.

–– Fatal before the advent Fatal before the advent of antibiotics.of antibiotics.

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Ahmad ata 1 - Fisiokinesiterapia · Ahmad ata 3 Objectives Distinguish between the axial and appendicular skeleton. Identify the types of fractures Identify the clinical condition