Chapter 8 - Orthopedics/Skeletal System

orth/o

straight

ped/o

child

-ics

knowledge, practice

functions of the skeletal system

• structurally support the body

• protect soft tissues

• protection for internal organs

• storage site for calcium and phosphorus

Anatomy of the skeleton

divided into two major regions

• Axial Skeleton

  • forms central frame work of the body

  • supports and protects vital organs

  • includes bones of the skull, vertebral column, and thoracic cage

• Appendicular Skeleton

  • bones of the upper and lower limbs and what attaches them to the axial

  • includes bones of the hands, shoulders, arms, hips, legs, and feet

  • primarily functions to support movement and locomotion

Long Bone Structure

Major regions:

• Diaphysis: shaft of the bone

• Epiphyses: enlarged ends of the bone

Internal Structures:

• Cortical Bone: Dense outer layer that provides strength

• Cancellous bone: spongy internal bone with marrow-filled spaces

• Medullary cavity: hollow space in the shaft containing primarily yellow marrow in adults

Osteoma

type of bone tumor

• Benign growth

Osteosarcoma

type of bone tumor

• malignant growth of osteoblasts

Ewing sarcoma

type of bone tumor

• malignant growth

• primarily affects children and young adults

• more frequent in males than females

oste/o

bone

chondroma

benign tumor of the cartilage

chondr/o

cartilage

connective tissues of the bones include:

• cartilage

• ligaments

• joints

What does red and yellow marrow do?

Red marrow produces blood

yellow marrow primarily stores fat

chondromalacia patellae

softening and deterioration of the cartilage on the underside of the patella

• may cause pain in the front of the knee

  • especially when climbing stairs, squatting or bending the knee

• can result from repetitive stress improper patellar alignment or injury

-malacia

softening

-blast

developing cell

sarc/o

connective issue

FX/Fx

Fracture

• break in bone caused by injury, repetitive stress, or an underlying disease

types of fractures

• stress fracture

  • a small crack in the bone caused by repetitive loading or overuse

• Pathologic fracture

  • break in the bone weakened by disease such as osteoporosis

Malunion

a FX that heals in an abnormal position or alignment

por/o

pores; small openings

Ways to describe a fracture

• Is the skin broken

  • open fx: Broken bone with an external wound

  • closed fx: skin remains intact over the fracture

• Are the bones aligned

  • nondisplaced: bone fragments emain aligned

  • displaced: bone fragments have shifted out of alignment

comminut/o

break into small pieces

comminuted fracture

broken into many pieces

Transverse fracture

broken cleanly across

colles fracture

a common break at the wrist, typically happens because of trying to catch oneself when one falls

oblique fracture

breaks at an angle

spiral fracture

bone becomes twisted

greenstick fracture

where one side breaks but the other stays intact

hairline fractures

common fracture in older people, small crack like

compression fracture

pressure causes fracturing, common in the vertebrae

depressed fracture

a fracture that presses down

depress/o

press down

osteomalacia

softening of the bones

• caused by inadequate minderalization

  • most commonly due to Vitamin D deficiency

  • causes bone wekness, pain, and increased risk of fractures

    • a similar disease in children is called rickets

  • inadequate sunlight can contribute to Vitamin D deficiency

Rickets

an osteomalacia like disease seen in children

Osteomyelitis

infection and inflammation of bone tissue and bone marrow, most commonly caused by bacteria

• bacteria may reach bones through the bloodstream

• can cause bone pain, swelling, fever

Osteoporosis

condition in which bone breakdown exceeds bone formations, results in reduced bone density and increased risk of fractures. Thinning of the bone structure.

• creates many large porous areas in the bone

Thoracic cage anatomy

Protects the heart and lungs and consists of ribs, sternum, and thoracic vertabrae

sternum

• Manbrium

• body

• xiphoid process

12 pairs of ribs

• ribs 1-7 are referred to as “true” ribs

  • directly attached

• ribs 8-10 are referred to as “false” ribs

  • indirectly attached

• 11-12 are referred to as “floating”ribs

  • no anterior attachment

Anatomy of the vertebral column

consists of 5 regions which help support hte body and protect the spinal cord

• cervical

  • 7 vertabrae (C1-C7)

  • Neck

• Thoracic

  • 12 Vert (T1-T12)

  • thorax

• Lumbar

  • 5 vert (L1-L5)

  • Lower bacl

• Sacrum

  • 5 fused vertebrae

• coccyx

  • usually 4 fused vertebrae

Pectus excavatum

congenital chest wall deformity in which the sternum is displaced inward

• creates a sunken or funnel shaped appearance of the chest

• often called funnel chest

• severe cases may compress the heart and lungs, affecting breathing and exercise tolerance

Kyphosis

abnormal posterior curvature of the thoracic sipne

• AKA humpback

kyph/o

bent; humpbacked

lordosis

abnormal anterior curvature of the lumbar spine

• AKA swayback

scoliosis

abnormal c or s shaped lateral curvature of the spine

• dexteroscoliosis = right sided

• levoscoliosis = left sided

Ankylosing Spondylitis

chronic inflammation disease that primarily affects the spine, causing pain and stiffness

• over time inflammation can lead to fusion of the vertebrae, reducing spinal flexibility and mobility

Spondylolisthesis

spinal condition in which one vertebrae slips forward over the vertebrae below it, causing misalignment of the spine

• may result from degenerative changes, stress fractures or injury

• can cause lower back pain, stiffness or nerve

-listhesis

slipping, displacement

anatomy of the leg bones

• femur

  • thigh bone of the upper leg

• tibia

  • shin bone of the lower leg

• fibula

  • thin lateral bone of the lower leg

• patella

  • kneecap

Bones of the foot

• tarsals

  • 7 bones forming the ankle and rearfoot

• metatarsals

  • 5 long bones forming the forefoot

• phalanges

  • 14 toe bones

    • 2 in the great/big toe, 3 in the other toes

from ankle to toes is goes: Tarsals, Metatarsals, Phalanges

Genu Valgum

Genu = knee

Valgum = angled outward (referring to the distal section of a limb)

Called knock-knees

• when knees touch together, causing the legs/feet to be angled outward

Genu Varum

Genu = Knee

Varum = angled inward (referring to the distal section of a limb)

Called Bowlegs

• when knees angle outward, causing the legs/feet to be angled inward

Hallux valgus

deformity in which the great toe (the hallux) angles toward the other toes causing a bony prominence (bunion) at the base of the great toe

• may cause pain swelling and difficulty wearing shoes

Talipes Equinovarus

AKA Clubfoot

congenital foot deformity in which the foot is turned inward and downward, often with the heel elevated

• may affect one or both feet

• the foot is typically stiff and cannot easily be moved into its normal position

• early treatment usually with gental manipulation and serial casting can often correct the deformity without major surgery

talipes

foot/ankle deformity

equin/o

horse-like; heel elevated foot pointed downward

varus

turning inward

Anatomy of joints

joints (articulations) are locations where two or more bones meet

• suture joints: immovable joints found between bones of the skull

• symphysis joints: slightly movable joints connected by fibrocartilage, such as the pubic symphysis and joints between vertebral bodies

• synovial joints: freely movable joints that allow a wide range of movements, such as the knee and hip

cartilage anatomy

Cartilage: connective tissue that provides cushioning and support within joints

• Articular Cartilage: covers the ends of bones, reducing friction and absorbing shock during movement

• Meniscus: a pad of fibrocartilage found in certain joints that helps distribute weight and absorb shock

Ligaments

strong bands of fibrous connective tissue that connect bone to bone, providing joint stability and limiting excessive movement

• ligaments connect bone to bone, tendons connect muscle to bone

Arthalgia

pain in the joint due to injury inflammation, or infection from various causes

arthropathy

general term for disease of the joint from any cause

dislocation

complete displacement of a bone from its normal position within a joint, causing loss of contact between the articulating surfaces

• causes

  • most commonly due to trauma, such as a fall or sports injury

  • congenital/development conditions: abnormal hip joint development in infants can result in hip dislocations

Gout

Form of inflammatory arthritis caused by the accumulation of uric acid crystals in joints

• causes sudden episodes of severe pain, redness, and swelling

• most commonly affects the base of the great toe

RA

Rheumatoid Arthritis

• acute and chronic inflammatory disease of the connective tissue, particularly the joints

  • autoimmune condition in which the body’s own antibodies attack cartilage and tissues

  • joints are red and swollen with progressive deformity

OA

Osteoarthritis

• chronic inflammation, pain, and stiffness in the joints as cartilage wears away and bone rubs on bone

sprain

overstretching or tearing of ligaments around a joint

• term comes from middle english (spreynd) meaning to press out

subluxation

partial dislocation with slight displacement of bone ends from the joint

• the difference between a dislocation and subluxation is the degree of separating of the articulating bones

  • subluxation is partial

  • dislocation is complete

torn meniscus

a tear in the cartilage pad in the knee joint because of an injury

• causes pain swelling and difficultly moving the knee

hemarthrosis

condition of blood in the joint cavity, usually due to blunt trauma or penetrating injury

RF

Rheumatoid Factor

• RF=autoantibody produced by the immune system

  • binds to a protein called immunoglobulin G (IgG)

  • This binding can lead to inflammation and damage to the joints

• blood tests for RF are usually positive in patients w/ rheumatoid arthritis

rheumat/o

watery flow; associated w/ rheumatic conditions

Uric Acid

blood test that shows elevated level in patients w/ gout and gouty arth

X-ray

most common diagnostic procedure for the skeletal system

• primary X-Ray means it is for diagnosing fractures, dislocations, and bone tumors

meniscus direct meaning/translation

crescent-shaped

• greek for little moon

Bone density tests

measures bone mineral density (BMD) to diagnose osteoporosis

• AKA bone densiometry

2 types:

• DEXA

  • dual energy x-ray absorptiometry (uses 2 x-ray beams)

• QCT

  • Quality Computerized tomography (x-ray+CT)

BMD

bone mineral density

Cast

a layer of plaster or fiberglass applied around a fractured bone to immobilize the bone as it heals

Closed Reduction

procedure in which bone ends in a displaced fracture are manually manipulated back into place

• often followed with a cast

Goniometry

procedure that measures the angle of a joint and its range of motion

ROM

range of motion

orthosis

a orthopedic device like a brace or splint that is used to keep a body part straight and immobile

• or to correct an orthopedic problem

PT

physical therapy

• exercise that improves a patients ROM, joint mobility, strength, and balance

  • passive: exercises are done my the therapist

  • active: exercises are done by the patient

goni/o

angle

traction

procedure that uses weight to pull the bone ends of a fracture into correct alignment

• skin traction uses wraps or straps

• skeletal traction uses surgically inserted pins or wires

prosthesis

a orthopedic device like a leg or arm that is created for a patient following an amputation

• greek for in addition, to place or put

prosth/o

artificial part

Analgesics

treats pain associated with bone injury or surgery

an- = without

alges/o=pain

-ic=pertaining to

bone resorption inhibitors

prevents osteoclasts from breaking down bone, helping to treat osteoporosis

corticosteroids

decreases severe inflammation

gold compound drugs

• Inhibits immune respose

• Used to treat RA

• Contains real gold

NSAIDs

nonsteroidal anti-inflammatories

• treat inflammation and pain from osteoarthritis and orthopedic injury

Amputation

removal of all or part of an extremity damaged by trauma or disease

BKA

Below the knee amputaion

• performed at the level of the tibia and fibula

AKA

Above the Knee Amputation

• performed at the level of the femur

Arthrocentesis

Removal of accumulated fluid from an injured joint using a needle inserted in the joint space

• -centesis = procedure to puncture

arthrodesis

fusion of bones in a deteriorated, unstable joint

-desis

procedure to fuse together

arthroscopy

visualization of the inside of a joint using an arthroscope inserted into the joint

bone graft

replacement of bones severely damaged due to bone cancer

• autograft = patients own bone

• allograft = cadaver bone