SKELETAL SYSTEM ▪ Short bones

p 160, 164, 170, 171, 174, 175, 185, 187, 192 ▪ Cube shaped
Intro ▪ Contain mostly spongy bone
• Skeleton: dried up body ▪ Bones of wrist and ankle
• For protection and motion ▪ Patella
• Axial skeleton: longitudinal axis of the body ▪ Sesamoid bones: form tendons
• Appendicular skeleton: bones of the limbs and girdles are appended (attached) to axial skeleton ▪ Flat bones
• Includes joints, cartilages, ligaments ▪ Thin, flatted, and usually curved
• Joints give body flexibility ▪ Two thin layers of compact bone sandwiching a layer of spongy bone
Bones: Overview ▪ Skull (cranium), scapula, sternum
▪ Irregular bones
• Functions
o Support ▪ Do not fit any of the categories
▪ Form internal framework that supports body and cradles organs ▪ Vertebrae, which make up the spinal column
▪ Bones of legs support body runk ▪ Pelvis
▪ Rib cage supports thoracic wall ▪ Sacrum, mandible, facial bones, rib bones
o Protection • Structure of Bone
▪ Protect soft body organs o Long bone or diaphysis or shaft makes up most of bone’s length and is composed of compact bone
▪ Fused skull bones provide snug enclosure for the brain ▪ Covered by fibrous connective tissue membrane or periosteum
▪ Vertebrae surrounds spinal cord ▪ Perforating or Sharpey’s fiber secure periosteum to the underlying bone
▪ Rib cage protects organs of thorax o Epiphyses are the ends of the long bones
o Movement ▪ Consists of a thin layer of compact bone enclosing an area filled with spongy bone. Mostly
▪ Skeletal muscles are attached to bones by tendons spongy bone.
▪ Bones are used as lever to move body ▪ Articular cartilage covers external surface of epiphyses (permanent)
o Storage ▪ It is glassy hyaline cartilage
▪ Fat is stored in internal (marrow) cavities of bones. ▪ Provides smooth slippery surface
▪ Storehouse for minerals (Ca and P) ▪ decrease friction at joint surface (between bones)
▪ Most of body’s Ca is stored as Ca2+ ▪ Epipyseal line (permanent) is a remnant of the epipyseal plate (flat hyaline cartilage) in
▪ Must be present in blood for the nervous system to transmit messages for muscles young, growing bone
to contract ▪ The plates cause lengthwise growth of a long bone
o Blood cell formation ▪ By the end of puberty, when hormones inhibit long bone growth, epiphysel plates
▪ Hematopoiesis occurs within the cavities of certain bones have been completely replaced by bone, leaving only the epiphyseal lines
o Endosteum covers inner bony surafce of the shaft
• Classification of bones
o Adult skeleton is composed of 206 bones ▪ Delicate connective tissue lining
o Pisiform bone: size and shape of a pea ▪ Shaft is a storage area of adipose tissue
o Femur/thigh bone: 2 ft long and has a large, ball-shaped head ▪ Called the yellow marrow or medullary cavity— where hematopoeisis occurs
o Osseous ▪ Cavity inside the shaft
▪ Compact bone (cortical) ▪ In infants, this forms RBCs and red marrow is found here
▪ Dense, smooth, homogenous ▪ In adults, red marrow is confined to cavities in the spongy bone of flat bones and
▪ Spongy bone (cancellous, trabecular) epiphysis of some long bones
▪ Composed of small needlelike pieces of bone and open spaces o Bone markings
▪ Long bones ▪ Bone surfaces are not smooth
▪ Longer than they are wide ▪ Scarred with bumps, holes, and ridges
▪ Have a shaft with heads at both ends ▪ Reveal where musles, tendons, and ligaments wereattached
▪ Mostly compact bone ▪ Where blood vessels and nerves passed
▪ All bones of the limbs (except patella, wrist, and ankle bones) are long bones ▪ Projections/processes: grow out from bone surface
▪ Humerus, femur, tibia, fibula, radius, ulna, clavicle, metatarsals, metacarpals, ▪ Terms often begin in T
phallenges ▪ Depressions/cavities: indentations in the bones
▪ Necessary weight bearing ▪ Terms often begin with F
 ▪ Microscopic Anatomy
▪ Spongy bone: spiky, open appearance
▪ Compact bone: dense
▪ Osteocytes: mature bone cells. Found within the matrix in lacunae
▪ Lacunae: tiny cavities. Aranged in cocentric circles called lamellae around
central (Harvesian) canals.
▪ Osteon/ Harvesian system: each complex consisting of central canal and matrix
ring. Run lengthwise through bony matrix. Carry blood vessels and nerves to all
areas of the bone
▪ Canaliculi: tiny canals. Radiate outward from central canal to all lacunae. Form a
transportation system that connects all the bone cells to nutrient supply through
hard bone matrix.
▪ Bone cells are well noursihed in spite of hardness of matrix
▪ Bone injuries heal quickly and well
▪ The communication pathway from outside of the bone to its interior is completed
by perforating (Volkmann’s) canals which run in the compact bone at right
angles to the shaft
o Bone is one of the hardest materials in the body
o It is relatively light but has a remarkable ability to resist tension and other forces acting on it
o The calcium salts deposited in the matrix give bone its hardness, which resist compression
o The organic parts (collagen fibers) provide for bone;s flexibility and great tensile strength
• Bone Formation, Growth, and Remodeling
o Bone Formation and Growth
▪ The skeleton is formed from cartilage and bone, the strongest and most supportive tissues in
the body.
▪ In embryos, the skeleton is made of hyaline cartilage. Replaced by bone in the young child.
▪ Occurs on hyaline cartilage models or fibrous membranes
▪ Cartilage remians in bridge of nose, parts of ribs, joints.
▪ Except for flats bones, which form on fibrous membranes, most bones develop using hyaline
cartilage structures as their models.
▪ Bone formation or ossification involves two major phases
▪ Osteoblast
▪ The hyaline cartilage model in covered with bone matrix (bone collar) by
osteoblasts, bone forming cells.
▪ The fetus has cartilage bones encodlosed the bony bones
▪ The enclosed hyaline cartilage model is digested away, opening up a medullary
cavity within the newly formed bone
▪ By birth, most hyaline cartilage models have been converted to bone except for
the articular cartilages (cover bone ends) and epiphyseal plates
▪ New cartilage is formed continuously on the external face of the articular cartilage
and on the epiphyseal plate surface that faces the bone end (is farther away from
the medullary cavity).
▪ Enclosed hyaline cartilage is digested, opening up a medullary cavity
▪ The old cartilage abutting the internal face of the articular cartilage and the
medullary cavity is broken down and replaced by bony matrix
▪ Growing bones also widen as they lengthen
▪ Osteoblasts in the periosteum add bone tissue to the external face of
the diaphysis
▪ cells called osteoclasts in the endosteum remove bones from inner face
of diaphysis wall
▪ These processes occur simuntaneously, ensuring that the
circumference of the long bone expands and widens
▪ Appositional growth: process by which bones grow in diameter.
Controlled by hormones—growth hormone (anterior pituitary
gland) and sex hormones. Ends during adolescence, when epiphyseal
plated are completely converted to bone.
▪ Bone growth and remodeling happen alternatively
▪ Epiphyseal plates are converted to bone during adolescence
▪ Growth in length ends
o Bone Remodeling
▪ Regulate bone marow in producing RBC
▪ Bone is an active and dynamic tissue
▪ Bones are remodelled in response to changes in:
▪ Ca levels in the blood
▪ When blood Ca levels drop, the parathyroid galnds are stimulated to
release parathyroid hormone (PTH) into the blood.
▪ PTH activates osteoclasts, bone-destroying cells, to break down bone
matrix and release Ca ions into blood
▪ When blood Ca levels are too high (hypercalcemia) Ca is deposited in
bone matrix as hard Ca salts
▪ Pull of gravity and muscles on the skeleton
▪ Essential if bones are to retain normal proportions and strength during long-bone growth
▪ Accounts for the fact that bones become thicker and form large projections to increase their
strength in areas where bulky muscles are attached.
▪ At such sites, osteoblasts lay down new matrix and become trapped within
it. (Once they are trapped, they become osteocytes, or mature bone cells.)
▪ In contrast, the bones of bedridden or physically inactive people tend to lose mass and to
atrophy because they are no longer subjected to stress.
▪ Ca uptake and release and bone remodeling work together
▪ PTH determines when bone is to be broken down or formed in response to the Ca
levels in blood
▪ The stresses of muscle pull and gravity determine where bone matrix is to be
broken down or fomed
▪ Ensures that skeleton can remain as strong and vital as possible
▪ Rickets: disease of children which the bones fail to calcify. Bones dogten and weight-bearing
bones of legs show definite bowing. Due to lack of Ca or vit. D. Milk, bread, and vit. D rich
food to avoid. Can happen to infants nursed by mothers who are vit. D deficient.
• Bone Fractures
o Low mass but strong
o Susceptible to fractures
▪ During youth, most fractures results from exceptional trauma that twists or smashes the
bones. In old age, bones thin and weaken, and fractures occur more often.
▪ Closed/simple fracture: when the bone breaks cleanly but does not penetrate skin.
▪ Open/compoud fracture: when the broken bone ends penetrate through the skin.
o A fracture is treated by reduction, the realignment of the broken bone ends
▪ Closed reduction: bone ends are coaxed back into their normal position by physician’s hands.
Non-invasive.
▪ Open reduction: surgery is performed. Bone ends are secured together with pins or wires.
Invasive.
 ▪ After broken bone is reduced, it is immobilized by cast or traction to allow healing process to
begin
▪ 6-8 weeks
▪ Longer for large bones and bones of older people (poor circulation)
o A fracture may also be treated with immobilization
o Hematoma forms
▪ Blood vessels are ruptured
▪ Bloodfilled swelling (hematoma) forms
▪ Bone cells deprived of nutrition die
o Fibrocartilage callus forms
▪ Early event of tissue repair—growth of new capillaries (granulation tissue) inro clotted blood
at damage site and disposal of dead tissue by phagoctes
▪ Connective tissue cells form a masee of repair tissue, fibrocartilage callous
▪ Contains cartilage matrix, bony matrix, collagen fibers
▪ Splints the broken bone, closing the gap
o Bony callus forms
▪ More osteoblasts and osteoclasts migrate into area and multiply
▪ Fibrocartilage callus is gradually replaced by bony callus made of spongy bone
o Bone remodeling occurs
▪ Bony callus is remodeled in response to the mechanical stresses placed on it
▪ It forms a strong permanent patch at the fracture site
Axial Skeleton (80)
• Skull
o Formed by two sets of bones
o Cranium encloses and protects brain
▪ Composed of 8 large flat bones. Except for two paired bone (parietal and temporal), they are
all single bones
▪ Frontal bone: forms the forehead, the bony projections under the eyebrows, and superior
part of each eye’s orbit
▪ Parietal bones: paired. Form most of superior and lateral walls of cranium. Meet in midline of
skull at sagittal suture and form coronal suture, where they meet the frontal bone
▪ Temporal bones: lie inferior to the parietal bones; join them at squamous sutures
▪ External acoustic meatus: canal that leads to the eardrum and the middle ear.
Route by which sound enters ear
▪ Styloid process: sharp, needlelike projection, inferior to external auditory meatus.
Used by many neck muscles as an attachment point.
▪ Zygomatic process: thin bridge of bone that joins with the cheekbone
(zygomatic bone) anteriorly.
▪ Mastoid process: full of air cavities (mastoid sinuses). Rough projection
posterior and inferior to external acoustic meatus. Provides attachment site to
some muscles of neck. Close to middle ear (high risk infection spot) that they may
become infected too. The infection of the mastoid process isa called mastoiditis.
Since this area is close to the brain, mastoiditis may spread there.
▪ Jugular foramen: at junction of occiptal and temporal bones. Allows passage of
the jugular vein, larget vein of the head, which drains brain.
▪ Internal acoustic meatus: anterior to jugular foramen in cranial cavity. Transmits
cranila nerves VII and VIII (facial and vestibulocochlear).
▪ Carotid canal: anterior to jugular foramen on skull’s inferior aspect. Through
which internal carotid artery runs, supplying blood to brain.
▪ Occipital bone: most posterior bone of cranium. Forms base and back wall of skull. Joind
parietal bones anteriorly ate lambdoid suture.
▪ Foramen magnum: large opening at base. Surrounds the lower part of brain.
Allows spinal cord to coonect with brain
▪ Occipital condyles: lateral to foramen magnum. Rest on first vertebra of spinal
column.
▪ Sphenoid bone: butterfly-shaped. Spans width of skull and forms part of the floor of cranial
cavity.
▪ Sella turcica/Turk’s saddle: small depression in midline of sphenoid bone. Forms
snug enclosure for the pituitary gland.
▪ Foramen ovale: large oval opening in line with posterior end of sella turcica.
Allows fibers of cranila nerve V (trigeminal) to pass the chewing muscles of lower
jaw (mandible). Openings:
▪ Optic canal: allows the optic nerve to pass to eye
▪ Superior orbital fissure: slitlike. Through which the cranial nerves
controlling eye movement (III, IV, VI) pass.
▪ Spenoidal sinuses: air cavities in central part of sphenoid bone.
▪ Ethmoid bone: irregularly shaped. Lies anterior to sphenoid. Forms roof of nasal cavity and
part of medial walls of orbits.
▪ Crista galli: projects from its superior surface. “Cock;s comb”. Outermost covering
of brain attaches to this projection.
▪ Cribriform plates: small holes on each side of crista galli. Allow nerve fibers
carrying impulses from the olfactory receptors of nose to reach brain.
▪ Superior and middle nasal conchae: extensions of ethmoid bone. Form lateral
walls of nasal cavity. Increase turbelence of air flowing through nasal passages.
o Facial bones hold the eyes in an anterior position and allow facial muscles to show feelings. 12 are
paired; only the mandible and vomer are single.
▪ Maxillae: maxillary bones fuse to form upper jaw. All facial bones (except mandible) join
maxillae; they are the keystone bones of face. Carry upper teeth in alveolar process.
▪ Palatine processes: extension. Form anterior part of hard palate.
▪ Sinuses: drain into nasal passages.
▪ Paranasal sinuses: surrounds nasal cavity. Lighten skull bones and amplify
speaking sounds.
▪ Sinusitis: mucosa lining sinuses is continuous with that in the nose and
thorat. Infections in these areas migrate into sinuses. A headache or
upper jaw pain is the usual result.
▪ Palatine bones: posterior to the palatine processes of the maxillae. Form the posterior part
of the hard palate.
▪ Cleft palate: failure of these or the palatine processes to fuse medially.
▪ Zygomatic bones: cheekbones. Form portion of lateral walls of the orbits, or eyesockets.
▪ Lacrimal bones: fingernail-sized. Forming part of medial walls of each orbit. Each bone has
a groove that serves as passageway for tears.
▪ Nasal bones: small rectangular bones forming nose bridge. Lower part of nose skeleton is
cartilage.
▪ Vomer bone: single bone in median line of nasal cavity. “Plow”. Forms most of bony nasal
spetum
▪ Mandible: lower jaw. Largest and strongest bone of face. Joins temporal bones on each side
of face, forming only freely movable joints in skull.
▪ Body: horizontal part. Forms chin.
 ▪ Rami: upright bars of bone. Exten from body to connect mandible with temporal
bone.
▪ Alveoli (sockets) in alveolar process: where lower teeth lie. At superior edge of
mandibular body.
o Sutures are interlocking, immovable joints
o Only the mandible is attached to the rest of the skull by a freely movable joint
o Hyoid bone o Common features of vertebrae
▪ not part of skull.
▪ Closely related to mandible and temporal bones. Only bone of body that does not articulate
directly with any other bone.
▪ Suspended in midneck region about cm above larynx. Horseshow shaped.
▪ With body, two pairs of horns, or cornua.
▪ Serves as movable base for tongue and attachment point for neck muscles that raise and
lower larynx when we swallow and speak.
o Fetal Skull
▪ Skull is large compared to infant’s total body length
▪ Adult skull is on one-eight of total body length, whereas that of a newborn infant is 1/4 as
long. o Cervical vertebrae
▪ When a baby is born, his/her skeleton is still unfinished.
▪ Some areas of hyaline cartilage still remains to be ossified (converted to bone)
▪ Fontanels: Skull has fibrous regions/membranes. Rhythm of baby’s pulse can be felt in these
soft spots. Allow fetal skull to be compressed slightly during birth. Allows infant’s brain to
grow during later part of pregnancy and early infancy. Gradually converted to bone during
early part of infancy. Can no longer be felt by 22-24 months after birth.
▪ Anterior fontanel: largest fontanel. Diamond shaped.
• Vertebral column (spine)
o Axial support of body
o Extends from skull to pelvis, where it transmits the weight of the body to the lower limbs.
o Formed from 26 irregular bones connected and reinforced by ligaments
▪ Flexible, curved structure
o Spinal cord: runs through central cavity of vertebral column. Surrounded and protected by vertebral o Thoracic Vertebrae
column.
o Before birth, there are 33 separate bones called vertebrae
▪ 9 fuse to from two composite bones, the sacrum and coccyx. These construct the inferior
vertebral column.
▪ 7 vertebrae of the neck are cervical vertebrae
▪ Next 12 are thoracic vertebrae
▪ The remaining 5 are the lumbar vertebrae
o Intervertebral discs: pads of fibrocartilage that separate the individual vertebrae. Cushions vertebrae.
Absorbs shock while allowing spine flexibility. o Lumbar Vertebrae
▪ In a young person, discs have high water content (90%) and are spongy and compressible
▪ But as a person ages, the water content of the discs decreases, and the discs become
harder and less compressible.
▪ Herniated disks: drying of the disks predisposes older people to herniated disks. Result when
vertebral column is subject to twisting. If the protruding disc presses on the spinal cord or o Sacrum
the spinal nerves exiting from the cord, numbness and excruciating pain can result
o The discs and S-shaped structure of vertebral column prevent shock to the head. Make the body trunk
flexible.
o Primary curvatures: spinal curvatures in thoracic and sacral regions. Present at birth.
▪ Two primary curvatures formed C-shaped spine of newborn
▪ Secondary curvatures: curvatures in cervical and lumbar regions. Develop after birth.
Cervical curvature appears with baby begins to raise his/her head. Lumbar curvature
develops when baby learns to walk. In adults, they allow us to center body weight on lower
limbs.
▪ Scoliosis, kyphosis, lordosis: abonormal spine curvatures. May be congenital or result from
disease, poor posture, or unequal muscle pull on the spine.
▪ Body/centrum: disclike, weight-bearing part of the vertebra facing anteriorly in the vertebral
column.
▪ Vertebral arch: arch formed from the joining of all posterior extensions, the laminae and
pedicles, from the vertebral body.
▪ Vertebral foramen: canal through which the spinal cord passes.
▪ Transverse processes: two lateral projections from the vertebral arch.
▪ Spinous process: single projection arising from the posterior aspect of the vertebral arch
(actually the fused laminae).
▪ Superior and inferior articular processes: paired projections lateral to the vertebral
foramen, allowing a vertebra to form joints with adjacent vertebrae.
▪ C1-C7
▪ Form neck region of spine.
▪ Atlas and axis perform functions not shared by the other cervical vertebrae
▪ Atlas (c1): no body. superior surfaces of its transverse processes contain large depressions
that receive the occipital condyles of the skull. Allows you to nod.
▪ Axis (C2): acts as pivot for rotation of atlas and skull.
▪ Dens: large upright process. Acts as pivot point.
▪ The joint between C1 and C2 allows you to rotate your head side to side
▪ C3-C7: “typical” cervical vertebrae. Smallest, lightest. Spinous processes are short and
divided into two processes
▪ Transverse processes: contain foramina (openings) through which vertebral
arterie pass to reach the brain.
▪ T1-T12
▪ All typical
▪ Larger than cervical vertebrae
▪ Only vertebrae to articulate with ribs
▪ Body has two costal facets (articulating surfaces) on each side which receive the heads of
ribs
▪ Transverse process of thoracic vertebra articulate with knoblike tubercles of ribs.
▪ Spinous process is long and hooks sharply downward
▪ L1-L5
▪ Have massive, blocklike bodies
▪ Short, hatchet-shaped spinous processes
▪ Sturdiest—most of the stress on the vertebral column occurs here
▪ Formed by fusion of 5 vertebrae
▪ Articulates with L5 superiorly
▪ Contacts wit coccyx inferiorly
▪ Alae: articulate laterally with hip bones. Forms sacroiliac joints.
▪ Forms posterior wall of pelvis
 ▪ Posterior midline surface is roughened by median sacral crest, fused spinous processes of ▪ Scapula has three borders: superior, medial (vertebral), and lateral (axillary).
sacral vertebrae. ▪ It has three angles: superior, inferior, lateral
▪ Flanked laterally by posterior sacral foramina. ▪ Glenoid cavity: shallow socket that receives head of arm bone is in the lateral angle.
▪ Vetebral canal continues inside sacrum as sacral canal. Terminates in inferior opening ▪ Shoulder girdle: is light and allows the upper limb free movement.
called sacral hiatus. ▪ Each shoulder girdle attaches to the axial skeleton at only one point—
o Coccyx the sternoclavicular joint.
▪ Formed by fusion of 3-5 tiny, irregularly shaped vertebrae ▪ The loose attachment of the scapula allows it to slide back and forth against the
▪ Human “tailbone” thorax as muscles act.
• Thoracic cage ▪ The glenoid cavity is shallow, and the shoulder joint is poorly reinforced by
o Sternum, ribs, and thoracic vertebrae make up bony thorax ligaments.
o Forms protective, cone-shaped cage of slender bones around organs of thoracic cavity (heart, lungs, ▪ However, this exceptional flexibility also has a drawback; the shoulder girdle is
major blood vessels) very easily dislocated.
o Sternum • Bones of the Upper Limbs
▪ Breastbone o 30 separate bones form skeletal framework of each upper limb
▪ Flat bone o Form foundation of arm, forearm, hand
▪ Fusion of three bones—manubrium, body, xiphoid process o Arm
▪ Jugular notch: concave upper border of manubrium. Level of T3 ▪ Formed by humerus, typical long bone.
▪ Sternal angle: results where manubrium and body meet at slight angle to each other. ▪ Rounded head at its proximal end. Fits into glenoid cavity of scapula
Transverse ridge is formed at level of 2nd ribs. Reference point for counting ribs to locate 2nd ▪ Anatomical neck: slight contriction inferior to head.
ICS. ▪ Intertubular sulcus: separates greater and lesser tubercles
▪ Xiphisternal joint: point where sternal body and xiphoid process fuse. Lies at T9. ▪ greater and lesser tubercles: anterolateral to head. Sites of muscle attachment
▪ Sternal puncture: needle is inserted into marrow of sternum. ▪ Surgical neck: distal to tubercles. Most frequently fractured part of humerus.
o Ribs ▪ Deltoid tuberosity: roughened area in midpoint of shaft. Where deltoid muscle of shoulder
▪ 12 pairs form walls of bony thorax attaches.
▪ All ribs articulate with vertebral column posteriorly ▪ Radial groove: runs obliquely down posterior aspect of shaft. Marks course of radial nerve.
▪ curve downward and toward anterior body surface ▪ Medial trochlea at distal end of humerus and lateral capitulum articulate with bones of
▪ True ribs: first 7. Attach directly to sternum by costal cartilages. forearm.
▪ False ribs: next 5. Attached indirectly to sternum or not attached at all. ▪ Coronoid fossa: depression above trochlea anteriorly
▪ Floating ribs: last 2. Lack sternal attachments. ▪ Olecranon fossa: on posterior surface
▪ ICS are filled with intercostal muscles, which aid in breathing ▪ Both depressions are flanked by medial and lateral epicondyles.
▪ These depressions allow the corresponding processes of the ulna to move freely when the
Appendicular Skeleton elbow is bent and extended.
• 126 bones of limbs/appendages and the pectoral and pelvic girdles, which attach limbs to axial skeleton o Forearm
• Bones of Shoulder/Pectoral Girdle ▪ Formed by radius and ulna
o Clavicle/collarbone ▪ Radius: lateral bone when body is in anatomical position. On thumb side.
▪ Slender, doubly curved bone ▪ Radioulnar joints: where radius and ulna articulates both proximally and distally.
▪ Attaches to manubrium of sternum medially and to scapula laterally ▪ Interoseeous membrane: where radius and ulna are connected along their entire length.
▪ Helps form shoulder joint ▪ Styloid process: at radius and ulna’s distal end
▪ Acts as brace to hold the arm away from top of thorax ▪ Head of radius forms joint with capitulum of humerus
▪ Helps prevent shoulder dislocation ▪ Radial tuberosity: below head. Where tendon of biceps attach
▪ When clavicle is broken, whole shoulder region caves in medially. ▪ Ulna: medial bone of forearm
o Scapulae ▪ Coronoid process and posterior olecranon: at ulna’s posterior end. Separated by
▪ “Wings” trochlear notch. Grip the trochlea of humerus in joint.
▪ Flare when arms are moved posteriorly o Hand
▪ Each scapula has flattened body and two processes ▪ Carpal bones: 8. Arrange in two irregular rows of 4 bones each. Form carpus.
▪ Acromion: enlarged end of spine of scapula. Connects with clavicle laterally at ▪ Carpus: wrist
acromioclavicular joint ▪ Carpals are bound by ligaments that restrict movement between them.
▪ Coracoid process: beaklike. Points over top of shoulder. Anchors some muscles of the arm. ▪ Palm consists of metacarpals. Numbered 1-5 from thumb to pinky.
▪ Suprascapular notch: medial to coracoid process. Nerve passageway. ▪ Phalnges: bones of fingers. Each hand has. Phalanges. 3 in each finger (proximal, middle,
▪ Scapula is not directly attached to axial skeleton; it is loosely held in place by turnk muscles. distal). 2 in thumb (proximal and distal).
• Bones of the Pelvic Girdle
o Formed by two coxal bones/ossa coxae/hip bones and sacrum
o Forms pelvis with the coccyx
o Pelvic girdle: 2 coxal bones and sacrum
o Bony pelvis: 2 coxal bones, sacrum, coccyx
o Bones are large and heavy. Attached securely to axial skeleton via sacral attachment to lowermost
lumbar vertebra
o Sockets: receive thigh bones. Deep and heavily reinforced by ligaments that attach limbs firmly to girdle.
Most impt function is bearing weight.
o Reproductive organs, bladder, part of large intestine lie within and are protected by pelvis
o Each hip bone is formed by fusion of ilium, ischium, pubis
o Ilium: connects posteriorly with sacrum at sacroiliac joint. Large, flaring bone that forms most of hip
bone.
o Alae: winglike portion of ilia
o Iliac crest: upper edge of ala. landmark for intramuscular injections.
▪ Ends posteriorly in the anterior superior iliac spine and posteriorly in the posterior
superior iliac spine.
▪ Small inferior spines are located below these.
o Ischium: sit down bone. Forms most inferior part of coxal bone.
o Ischial tuberosity: roughened area that receives body weight when you are sitting
o Ischial spine: superior to tuberosity. Landmark for pregnant women. Narrows outlet of pelvis through
which baby must pass through.
o Greater sciatic notch: allows blood vessels and large sciatic never to pass from pelvis into thigh.
Where buttock injections are given.
o Pubis: most anterior part of coxal bone.
o Obturator foramen: enclosed by fusion of rami and pubis anteriorly and ischium posteriorly. Opening
that allows blood vessels and nerves to pass into anterior part of thigh.
o Pubic bones fuse anteriorly to forms cartilaginous joint, pubic symphysis.
o Acetabulum: deep socket where ilium, ischium, and pubis fuse. “Vinegar cup”. Receives head of thigh
bone.
o False pelvis: superior to true pelvis. Medial to flaring portions of ilia
o True pelvis: surrounded by bone and lies inferior to flaring parts of the ilia and pelvic brim
o The dimensions of the true pelvis of a woman are very important because they must be large
enough to allow the infant’s head to pass during childbirth.
o The dimensions of the cavity, particularly the outlet (the inferior opening of the pelvis measured between
the ischial spines) and the inlet (superior opening between the right and left sides of the pelvic
brim), are critical, and they are carefully measured by the obstetrician.
o he following characteristics differ in the pelvis of the man and woman:
▪ The female inlet is larger and more circular.
▪ The female pelvis as a whole is shallower, and the bones are lighter and thinner.
▪ The female ilia flare more laterally.
▪ The female sacrum is shorter and less curved.
▪ The female ischial spines are shorter and farther apart; thus the outlet is larger.
▪ The female pubic arch is more rounded because the angle of the pubic arch is greater.
• Bones of the Lower Limbs
o The lower limbs carry our total body weight when we are erect.
o bones forming the three segments of the lower limbs (thigh, leg, and foot) are much thicker and
stronger than the comparable bones of the upper limb.
o Thigh
▪ Femur: thigh bone. Only bone in the thigh. The heaviest, strongest bone in the body. Its
proximal end has a ball-like head, a neck, and greater and lesser
trochanters (separated anteriorly by the intertrochanteric line and posteriorly by
the intertrochanteric crest).
▪ These markings and the gluteal tuberosity, located on the shaft, all serve as
sites for muscle attachment.
▪ Head of the femur: articulates with the acetabulum of the hip bone in a deep, secure socket.
Common fracture site, especially in old age.
▪ The femur slants medially as it runs downward to join with the leg bones; this brings the
knees in line with the body’s center of gravity.
▪ The medial course of the femur is more noticeable in women because the female pelvis is
typically wider than that of the male.
▪ lateral and medial condyles: Distally on the femur are the s, which articulate with the
tibia below. Posteriorly these condyles are separated by the deep intercondylar
fossa. Anteriorly on the distal femur is the smooth patellar surface, which forms a joint with
the patella, or kneecap.
o Leg
▪ tibia and fibula: Connected along their length by an interosseous membrane form the
skeleton of the leg
▪ Tibia: shinbone. Larger and more medial.
▪ Medial and lateral condyles: At the proximal end. Separated by the intercondylar
eminence. Articulate with the distal end of the femur to form the knee joint.
▪ Patellar (kneecap) ligament: encloses the patella, a sesamoid bone, attaches to the tibial
tuberosity
▪ Tibial tuberosity: roughened area on the anterior tibial surface.
▪ medial malleolus: process that forms the inner bulge of the ankle.
▪ The anterior surface of the tibia is a sharp ridge, the anterior border, that is unprotected by
muscles; thus, it is easily felt beneath the skin.
▪ Fibula: lies alongside the tibia and forms joints with it both proximally and distally. Thin and
sticklike. Has no part in forming the knee joint.
▪ lateral malleolus: distal end of fibula. Forms the outer part of the ankle.
o Foot
▪ tarsals, metatarsals, and phalanges
▪ It supports our body weight
▪ serves as a lever that allows us to propel our bodies forward
▪ Tarsus: forms posterior half of foot. Composed of seven tarsal bones.
▪ calcaneus (heelbone), and talus: carries most of body weight. two largest tarsals. Lies
between the tibia and the calcaneus.
▪ Five metatarsals form the sole, and 14 phalanges form the toes.
▪ Each toe has 3 phalanges, except the great toe, which has 2.
▪ The bones in the foot are arranged to form three strong arches: two longitudinal (medial and
lateral) and one transverse.
▪ Ligaments: bind the foot bones together
▪ Tendons: of the foot muscles help to hold the bones firmly in the arched position but still
allow a certain amount of give or springiness.
▪ “fallen arches” or “flat feet”: weak arches
Joints
• every bone (except hyoid bone of neck) in the body forms a joint with another bone.
• Articulations
• Sites where two or more bones meet
• Hold the bones together securely
• Gives rigid skeleton mobility ▪ Pivot
• Functional classification ▪ Rounded end of one bone fits into sleeve or ring of bone (and ligaments))
o Synarthoses: immovable joints. Restricted to axial skeleton. ▪ Uniaxial
o Amphiathroses: slightly movable joints. Restricted to axial skeleton. ▪ Rotating bone can turn around only on its long axis
o Diarthroses: freely movable joints. Predominate in the limbs. Ex: synovial joints. ▪ Ex: proximal radioulnar joint, joint between atlas and dens of the axis
• Structural classification ▪ Condylar
o Fibrous: immovable ▪ Egg shaped articular surface of one bone fits into oval concavity in another
o Cartilaginous: both immovable and movable, mostly amphiarthrotic ▪ Both articular surfaces are oval
o Synovial: movable ▪ Allow moving bone to travel from side to side and back and forth
• Fibrous Joints ▪ Biaxial: Bone cannot rotate around its long axis. Movement occurs around two
o United by fibrous tissue axes
o Sutures of skull. Irregular edges of the bones interlock and are bound tightly tigether by connective ▪ Ex: metacarpophalangeal (knuckle) joints
tissue fibers. No movement. ▪ Saddle
o Syndesmoses: connecting fibers are longer than those of sutures. Joint has more “give”. Examples are ▪ Each articular surface has convex and concave areas
joints coinnecting the distal ends of tibia and fibula. ▪ Biaxial
• Cartilaginous Joints ▪ Ex: carpometacarpal joints in thumb
o Bone ends are connected by fibrocartilage (made up of collagen fibers). ▪ Twiddling thumbs
o Examples are amphiarotic: pubic symphysis of pelvis and intervertebral joints of spinal column. ▪ Ball and socket
Articulating bone surafces are connected by pads (discs) of fibrocartilage. ▪ Spherical head of one bone fits into a round socket in a nother
o Hyaline-cartilage epiphyseal plates of long bones and cartilaginous joints between the 1st ribs and ▪ Multiaxial: allow movement in all axes, including rotation
sternum are synarthrotic cartilaginous joints referred to as synchondroses ▪ Most freely moving synovial joints
• Synovial Joint ▪ Ex: shoulder and hip
o Articulating bone ends are separated by joint cavity containing joint fluid
o All joints of the limbs Inflammatory Conditions Associated with Joints
o Articular cartilage: hyaline cartilage covers and cushions end of bones forming joint o Bursitis: falling on one’s knee. “Water on the knee” due to inflammation of bursae or synovial
o Articular capsule: joint surfaces are enclosed by sleeve of layer of fibrous connective tissue lined with membrane.
smooth synovial membrane o Sprain: ligaments or tendons reinforcing joint are damges by excessive stretching or they are torn away
o Joint cavity: cavity enclosed by articular capsule. Contains lubricating synovial fluid. from bone. Poor blood supply; heal slowly, extremely painful
o Reinforcing ligaments: in fibrous layer of capsula o Tendonitis
o Bursae and tendon sheaths are not part of snynovial joints but are associated with them. o Arthritis: joint inflammation. Degenerative disease that damages the joints. Symptoms include pain,
▪ Act like ball bearings to reduce friction between adjacent structures during joint activity stiffness, and swelling of the joint. Certain changes in joint structure occur. Acute forms result from
▪ Bursae: flattened firbous sacs lined with synovial membrane and contain thin film of synovial bacterial invasion and are treated with antibiotic drugs. Synovial membrane thicens and fluid production
fluid. Common where ligaments, muscles, skin, tendons, bones rub together. decreases, leadinge to increased friction and pain. Chronic forms include osteoarthritis, rheumatoid
▪ Tendon sheaths: slongated bursa that wraps completely around tendon subjected to friction arthritis, and gouty arthritis.
o Dislocation: when bone is forced out of normal position in joint cavity. o Osteoarthritis (OA)
o Reduction: process of returning bone to its proper position ▪ most common form of arthritis
o Types of Synovial Joints based on Shape ▪ Chronic, degenerative
▪ determine what movements are allowed at a joint ▪ Affects the aged
▪ Plane joint ▪ Degenerative joint disease
▪ Articular surfaces are flat ▪ Wear and tear arthritis
▪ Slipping/gliding movements are allowed ▪ Affects articular cartilages
▪ Nonaxial: gliding does not involve rotation ▪ cartilage softens, frays, and eventually breaks down
▪ Ex: intercarpal joints ▪ As the disease progresses, the exposed bone thickens and extra bone tissue (bone spurs)
▪ Hinge grows around the margins of the eroded cartilage and restricts joint movement.
▪ Cylindrical end of bone fits into through-shaped surface on another bone ▪ stiffness on arising that lessens with activity
▪ Angular movement is allowed in one place ▪ affected joints may make a crunching noise (crepitus) when moved.
▪ Ex: elbow joint, ankle joint, joints between phalanges ▪ Joints most commonly affected are those of the fingers, the cervical and lumbar joints of the
▪ Uniaxial: allow movement in one axis only spine, large, joints of the lower limbs (knees and hips).
▪ slow and irreversible, but it is rarely crippling.
 ▪ symptoms are controllable with a mild analgesic such as aspirin, moderate activity to maintain
joint mobility, and rest when the joint becomes very painful.
▪ Capsaicin, glucosamine sulfate
o Rheumatoid arthritis (RA)
▪ chronic inflammatory disorder
▪ insidious and usually occurs between the ages of 40 and 50, may occur at any age.
▪ Many joints, particularly those of the fingers, wrists, ankles, and feet, are affected at the same
time and usually in a symmetrical manner.
▪ marked by remissions and flare-ups
▪ autoimmune disease—a disorder in which the body’s immune system attempts to destroy its
own tissues.
▪ Results from certain bacterial or viral infections
▪ Phagocytes release enzymes that attack cartilage
▪ begins with inflammation of the synovial membranes
▪ membranes thicken and the joints swell as synovial fluid accumulates.
▪ Inflammatory cells (white blood cells and others) enter the joint cavity from the blood and
release a deluge of inflammatory chemicals that destroy body tissues when released
inappropriately as in RA
▪ In time the inflamed synovial membrane thickens into a pannus (“rag”), an abnormal tissue
that clings to and erodes articular cartilages.
▪ As the cartilage is destroyed, scar tissue forms and connects the bone ends.
▪ The scar tissue eventually ossifies, and the bone ends become firmly fused (ankylosis)
and often deformed
▪ Not all cases of RA progress to the severely crippling ankylosis
stage, but all cases involve restricted joint movement and extreme pain.
▪ Current therapy: methotrexate (immunosuppressants), etanercept (Enbrel)—neutralize the
inflammatory chemicals in the joint space and (hopefully) prevent joint deformity.
▪ Drug therapy begins with aspirin
▪ Exercise
▪ is recommended to maintain as much joint mobility as possible
▪ Cold packs are used to relieve the swelling and pain, and heat helps to relieve morning
stiffness.
▪ Replacement joints or bone removal are the last resort for severely crippled RA patients.
o Gouty arthritis
▪ gout
▪ uric acid accumulates in the blood and may be deposited as needle-shaped crystals in the
soft tissues of joints.
▪ Synovial joints are normally affected
▪ leads to an agonizingly painful attack that typically affects a single joint, often in the great
toe.
▪ most common in men and rarely appears before the age of 30.
▪ genetic factors are definitely implicated.
▪ If untreated, the bone ends fuse, and the joint becomes immobilized.
▪ Colchicine, ibuprofen, and others are successful in preventing acute gout attacks.
▪ Patients are advised to lose weight if obese, to avoid foods such as liver, kidneys, and
sardines (high in nucleic acids) and to avoid alcohol (inhibits excretion of uric acid)
Developmental Aspects of the Skeleton
• long bones in fetus are formed of hyaline cartilage
• Earliest flat bones of skull are fibrous membranes
• As fetus develops and grows, flat and long bone models are converted to bone
• At birth, fontanels still remain in skull to allow brain growth—fully ossified by 2 years
• By the end of adolescence, the epiphyseal plates of long bones have fully ossified—long bone growth growth ends
• At birth, baby’s cranium is huge relative to face
• Rapid cranium growth is related to brain growth
• By 2 years, skull is 3/4 of adult size and proportions.
• Between 6-11, head enlarges as face grows out from skull
o Jaws increase in size
o Cheekbones and nose become more prominent
o Respiratory passages expand and permanent teeth develop
o Primary curvature of vertebral column are present at birth and are convex posteriorly
▪ infant’s spine is arched
• Secondary curvatures are convex anteriorly, associated with child’s later development
o resulting from reshaping of intervertebral discs
o produce S shaped spine of adult
• Scoliosis and lordosis: abnormal spine curvatures. Congenital or may result from ijuries. Treated by surgery,
braces, casts.
• During youth, skeletal growth increases body height, size, and proportions
• At birth, head and trunk are 1 1/2 times as long as lower limbs
o Lower limbs grow more rapidly than trunk
• By the age of 10, head and trunk are same height as lower limbs and change little
• During puberty, female pelvis broadens in preparation for child bearing. Entire male skeleton becomes more robust
• Once adult height is reached, healthy skeleton changes very little until middle age
• In old age, losses in bone mass become evident
• Bones have to be hysically stressed to remain healthy
o When we remain active physically and muscles and gravity pull on the skeleton, the bones respond by
becoming stronger.
o If we are totally inactive, they become thin and fragile.
• Osteoporosis: bone thinning disease that affects 50% of women over 65 and 20% of men over 70.
o Ratio of bone formation to breakdown gets out of balance as osteroblast activity becomes sluggish.
Makes the bone fragile. Bones of spine and neck of femur are susceptible.
o Vertebral collapse results in kyphosis (hunched posture) or dowager’s hump
o Estrogen helps maintain health and normal density of woman’s skeleton. After menopause, estrogen
deficiency is a cause of osteoporosis.
o Causes: diet poor in Ca and protein, lack of Vit. D, smoking and insufficient weight bearing exercise to
stress the bone
• Pathologic fractures: breaks that occur spontaneously without apparent injury. Decrease dramatically with age.
Most common skeletal problem for this age group
• Osteoarthritis: weight bearing joints begin to degenerate in older people.
KALAT NOTES • Minerals are removed from bone: softer
• Collagen is removed: brittle
• you can aspirate bone marrow from sternum, ribs, iliac o Osteogenesis imperfecta: bones have not completely developed, brittle bones
• Body of neonates is made up of hyaline cartilage • Appositional growth: widening of bones. Does not cease when epiphyseal plate closes (prevents longitudinal
o Converted into bone growth).
• Mineralization of bones results to hardening of bones o To accommodate muscle weight, weight bearing
• Pontanelles • Bone Components
o Anterior o Organic parts of the matrix make bone flexible
▪ Diamond shaped o Calcium slats deposited in the matrix make bone hard
▪ Closes/disappears at the age of 2
o Soft softs in skull of new born infant
o Will undergo go ossification/osteogenesis
▪ Cartillage to bone
▪ Intramembranous ossification
▪ Caput susc: elongation of baby’s skull
• Minerals (Ca, F, P, Mg) for compressional strength
• Babies have 305-602 bones in neonates
• Osteoclastic activity
o In elderly
o Osteoclast: bone resorption
▪ Ca goes into bloodstream
▪ Ca levels are maintained by PTH and Calcitonin
▪ PTH
▪ Released if hypocalcemia
▪ Ca (9-11 mg/ 1L): normal
▪ Activates osteoclast
▪ Calcitonin

▪ Released if hypercalcemia in serum (in blood)

• Hormones secreted by thymus
o T2: Calcitonin
▪ Osteoblasting activity
o T3: trioo
o T4: Thyroxine
• Osteoblast: bone building cells. For bone maintanance. For bone rmeodelling and resorption
• Osteoclast: bone break down. Bone resorption cells
• Osteocyte: mature bone cells
• Appendicular
o Limbs
o Girdles
▪ Pelvic
▪ Gynecoid
▪ Pectoral
▪ Clavicle
▪ Scapula
Bone Disorders • Degenerative Bone disorders
• Bone and cartilage deterioration is a natural process as we age o Osteoporosis
• Skeletal cartilage: bluish-flexible skeletal cartilage becomes yellowish brittle cartilage with age due to calcification ▪ Decrease in bone density due to natural aging and unhealthy living
• Articular cartilage: becomes brittle and does not function as a shock absorber in the joints, resulting in arthritis ▪ Men lose less than 25% of their bone density with aging
• Bone: osteoclasts start breaking down bone faster than osteoblast build it up after we turn 50 ▪ Women lose ~35% of their bone density with aging
▪ Men and women lose bone density differently due to the reduction of estrogen
levels following menopause
Slowing Down the Natural Loss of Bone Density ▪ Osteoclast mediated bone resorption medication: alendronate
• Healthy Living • Bone Infection
o Weight bearing excercise o Osteomyelitis
o Sufficient intake of dietary Ca ▪ Infection of bone or bone marrow in children
o Sufficient intake of Vit. D ▪ Affects long bones
▪ Allows the body to absorb the dietary Ca ▪ In adults, vertebrae and pelvis are most commonly affected
▪ Provide compressional strength to bone ▪ Microorganisms move to bone
▪ Collagen and ground substances give bone tensile strength ▪ Via blood stream
• Things to avoid ▪ Spread to bone from local areas of infection, such as cellulitis be introduced by
o Caffeine (>2 cups of coffee/day penetrating trauma such as joint replacements, fractures, or root canalled teeth
o Cigarette smoking ▪ Treatment involves prolonged IV antibiotics over weeks or months
▪ 8% higher loss in bone density than non-smokers ▪ Can result to necrotic bone tissue
▪ Alcohol use • Bone Disorders Due to Nutritional Deficiencies
▪ Inactivity o Vit. D deficiency
• Congenital Bone Disorders ▪ Rickets (in children), Osteomalacia (in adults)
o Abnormal Bone Disorders ▪ Softening of bones due to Ca deficiency
▪ Kyphosis ▪ Leads to greenstick fractures and deformity
▪ Lordosis ▪ Vit. D is required for proper Ca absorption from gut. W/o Vit. D, dietray Ca is not
▪ Scoliosis absorbed properly
o Cleft Palate ▪ Sources of Vit. D: sunlight and fortified milk
▪ Two plates of the skull that form the hard palate (roof of the mouth) are not completely joined ▪ Higher risk
▪ Occur in about 1 out of every 600 births ▪ Breast fed infants whose mothers are not exposed to sunlight
▪ Palatoplasty—repair of cleft palate ▪ Breast fed infants who are not exposed to sunlight individuals not consuming
▪ Cheiloplasty/uranoplasty fortified milk (lactose intolerant)
o Club foot o Vit. C deficiency
▪ talipes equinumvarus: inward position of feet (symmetrical or asymmetrical) ▪ Scurvy
▪ Talipes equinovalgum: outward position of feet (symmetrical or asymmetrical) ▪ Shortage of Vit. C, which is required for correct collagen synthesis
▪ Most common congenital disorder of the lower extremity; occurs in 1 out of 1000 births ▪ Fatal if untreated.
▪ One or both feet turn downward and inward ▪ Vit. C source: fruits and vegetables
▪ Genetic and environmental factors in the development of the fetus are the apparent causes ▪ Skeletal effects: bowed legs (genu varum—piki, genu valgum—sakang), stunted
▪ Management: Ponsetti method, Parlik harness (cast for baby) bone growth, and swollen joints
o Osteogenesis Imperfecta ▪ Symptoms:
▪ Brittle bone disease ▪ Dark purplish spots on skin, esp. legs
▪ Born without proper collagen, or ability to make it ▪ Spongy gums, leading to tooth loss
▪ Less collagen than normal or quality is poor ▪ Bleeding from mucous membrane
▪ Weak or fragile bones ▪ Opening of healed scars (evisceration) and separation of knitted bone
▪ 8 types; differing level of severity fractures
▪ No cure; bone fractures are common ▪ Pallor
▪ Blue sclera ▪ Bleeding gums
▪ Gingivitis—may lead to periodontal disease ▪ Sunken eyes
▪ Nosebleeds
 ▪ Frequently observed among elderly persons, alcoholics, malnourished adults, ▪ Infections
smokers ▪ Septic Arthritis
• Secondary Bone Disorders ▪ Caused by an infection (bacterial, fungal, viral) that settled in joints
o Endocrine system dysfunctions ▪ Gonococcal arthritis: symptom of gonorrhea
▪ Gigantism ▪ Rheumatic fever: inflammatory disease. May develop after strep
▪ Results from excess of growth hormone secreted from pituitary gland infection (strep throat, scarlet fever) can involve heart, joints, skin, brain
▪ Growth plates remain open so growth does not stop normally ▪ Inflammation
▪ Diabetes is common—GH antagonizes effect of insulin ▪ Tendonitis
▪ Pituitary Dwarfism ▪ Inflammation of tendons or tendon-muscle attachment
▪ Results from inadequate pituitary gland function ▪ Bursitis
• Bone Cancers ▪ Inflammation of bursae, or small sacs of synovial fluid
o Osteosarcoma ▪ Caused by repetition of movement or excessive pressure
▪ Cancerous tumor of the bone ▪ Common in elbows and knees
▪ Most common primary bone cancer ▪ Treated: rest, analgesics, pressure cuffs (to relieve strain on joint),
▪ Most often occurs in young people between ages 10-30 corticosteroid injection (reduce infection)
▪ 10% develop in people in their 60s-70s o Secondary Disorders
▪ Affects more males ▪ Rheumatoid Arthritis
▪ Tumors develop in bones of arms, legs, pelvis ▪ Inflammatory, autoimmune; causes immune system to attack joints
▪ Metastasized to brain, liver ▪ Uncommon under age 15, incidence increases after until 80
▪ Prognosis depends on stage of metastasis ▪ 1% with women, affected 3-5 times as often as men
o Chondrosarcoma ▪ 4 times more common in smokers
▪ Cancer of cartilage cells ▪ Gout
▪ 2nd most common primary bone cancer ▪ Buildup of uric acid deposits on articular cartilage of joints, tendons and
▪ Uncommon in people younger than 2o surrounding tissues
▪ Grade I tumors are not likely to spread (most common) ▪ Provokes inflammatory reaction
▪ Grade II tumors may spread ▪ Attacks big toes
▪ Grade III tumors are most likely to spread (least common) ▪ Due to poor diet
▪ Wide range of prognoses-good to bad ▪ Extremely painful
o Myeloma
▪ Cancer of the plasma cells contained in the bone marrow
▪ Not usually classified as bone cancer
▪ 5 year relative survival rate is around 34%
▪ Survival is higher in younger people and lower in elderly
▪ Treatment is radiation and chemotherapy
• Joint Disorders
o Sprain
▪ Injury to the ligaments in a joint usually caused by a sudden and unusual movement during
exercise
▪ Grade I: no tear in ligament; slight swelling and pain
▪ Treat with Rest, Ice for 48 hours, Compression with elastic wrap, Elevation above
heart
▪ Grade II: ligament is partially torn; swelling, bruising, difficulty moving joint, non-severe joint;
RICE may work, additional treatment necessary
▪ Grade II: complete tear of ligament; severe pain and bruising; may require cast and PT
o Degenerative Disorders
▪ Osteoarthritis
▪ Low-grade inflammation resulting in pain in the joints, caused by abnormal
wearing of the articular cartilage and destruction or decrease of synovial fluid that
lubricates those joints