Medical Terminology A Word-Building Approach Chapter 6 Skeletal System Jane Rice, RN, CMA-C.

MedicalTerminology

A Word-Building Approach

Chapter 6

Skeletal System

Jane Rice, RN, CMA-C

Copyright ©2008 by Pearson Education, Inc.Pearson Prentice Hall

Upper Saddle River, NJ 07458

Medical Terminology, 6eBy Jane Rice

Figure 6.1The anterior and posterior human skeleton.

Anatomy and Physiology Overview

• The skeletal system consists of cartilage, ligaments, tendons, and 206 bones.

• Together these structures make up the framework or skeleton of the body.

• The skeleton is divided into the axial skeleton (consisting of 80 bones, the principal bones being the skull, spine, ribs, and sternum) and the appendicular skeleton (consisting of 126 bones, the primary bones being the shoulder girdle, arms, hands, pelvic girdle, legs, and feet).

Bones

• The primary organs of the skeletal system.• Bones are 50% water and 50% osseous tissue.

Bones

• Classification of bones– Flat– Long– Short– Irregular– Sesmoid– Sutural or wormian




Figure 6.2Classification of bones by shape.




Bones

• Functions of bones– Provide protection for internal organs.– Provide shape, support, and framework of the body.– Serve as a storage place for mineral salts, calcium, and

phosphorus.– Play an important role in the formation of blood cells

(hematopoiesis) which takes place in the bone marrow.– Provide areas for the attachment of skeletal muscles.– Help to make movement possible through articulation.




Figure 6.3The features found in a long bone.

Bones

• Structure of a Long Bone– Epiphysis

• Ends of a developing bone.

– Diaphysis• Shaft of a long bone.

– Periosteum• Membrane that covers bone except at their articular

surfaces.

– Compact• Dense, hard layer of bone.

Bones

• Structure of a Long Bone– Medullary canal

• Narrow cavity throughout the length of the diaphysis.

– Endosteum• Membrane that lines the medullary canal and contains

bone marrow.

– Cancellous or spongy bone• Reticular tissue that makes up most of the volume of

bone.

Bones

• Bone Markings– Common terms used to describe bone structure

and their role in joining bones together, providing areas for muscle attachments, and serving as passageways for blood vessels, ligaments, and nerves.




CONDYLE

CREST

FISSURE

FORAMEN

FOSSA

HEAD

MEATUS

PROCESS

SINUS

SULCUS

3) Tubercle: Small rounded projection

4) Tuberosity: large rounded or roughened projection

5) Trochanter: very large, blunt projection

(only on femur)

Proximal Tibia

Joints and Movement

• Also known as an articulation, the place where two bones connect.

• Joints are classified as follows:– Synarthrosis

• Does not permit movement.

– Amphiarthrosis• Permits very slight movement.

– Diarthrosis• Allows free movement in a variety of directions.

Joints and Movement

• Types of body movement that occur at the diarthrotic joints:– Abduction

• Moving a body part away from the middle.

– Adduction• Moving a body part toward the middle.

– Circumduction• Moving a body part in a circular motion.

– Dorsiflexion• Bending a body part backward.




Figure 6.4Knee joint.




Figure 6.5Types of body movements.

Classification of Joints Animation

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Movement of Joints Animation

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Adduction Animation

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Extension Animation

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Circumduction Animation

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Dorsiflexion Animation

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Joints and Movement

• Types of body movement that occur at the diarthrotic joints:– Eversion

• Turning outward.

– Extension• Straightening a flexed limb.

– Flexion• Bending a limb.

– Inversion• Turning inward.

Opposition Animation

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Flexion Animation

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Inversion Animation

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Pronation Animation

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Joints and Movement

• Types of body movement that occur at the diarthrotic joints:– Pronation

• Lying prone or face downward.

– Protraction• Moving a body part forward.

– Retraction• Moving a body part backward.

Joints and Movement

• Types of body movement that occur at the diarthrotic joints:– Rotation

• Moving a body part around a central axis.

– Supination• Lying supine or face upward.

Rotation Animation

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Vertebral Column

• Composed of a series of bones called vertebrae. They are connected in such a way as to form four spinal curves.

Vertebral Column

• These curves consist of the:– Cervical

• The first 7 vertebrae.

– Thoracic• The next 12 vertebrae.

– Lumbar• The next 5 vertebrae.

– Sacral• Consists of the sacrum and coccyx (tailbone).




Figure 6.6Vertebral (spinal) column.

Figure 6.7

Normal development of posture and spinal curves. (A) Infant 2–3 months: Holds head erect when held upright; thoracic kyphosis when sitting. (B) 6–8 months: Sits without support; spine is straight. (C) 10–15 months: Walks independently; straight spine. (D) Toddler: Protruding abdomen; lumbar lordosis. (E) School-age child: Height of

shoulders and hips is level; balanced thoracic convex and lumbar concave curves.

The Male and Female Pelvis

• The pelvis is the lower portion of the trunk of the body.

• It is bound anteriorly and laterally by the hip bones (ilium, pubis, and ischium) and posteriorly by the sacrum and coccyx.


• The Male Pelvis– Shaped like a funnel; forms a narrower outlet than

the female.– Is heavier and stronger than the female pelvis,

making it suitable for lifting and running.




Figure 6.8(a)The male pelvis (android) is shaped like a funnel, forming a narrower outlet than the female.

Male Pelvis Animation

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• The Female Pelvis– Shaped like a basin; may be oval to round, and is

wider than the male pelvis.– It is constructed to accommodate the fetus during

pregnancy and to facilitate its downward passage through the pelvic cavity in childbirth.

– It is broader and lighter than the male pelvis.




Figure 6.8(b)The female pelvis (gynecoid) is shaped like a basin.

Female Pelvis Animation

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Life Span Considerations:The Child

• Bones begin to develop during the second month of fetal life as cartilage cells enlarge, break down, disappear, and are replaced by bone-forming cells called osteoblasts.

• This is known as endochondral ossification.• Bone cells deposit organic substances in the

spaces vacated by cartilage to form bone matrix.


• As the process proceeds, blood vessels form within the bone and deposit salts that serve to harden the developing bone.

• The bones of children tend to bend before breaking, but when they break, they heal more quickly.

• This occurs because there is a rich blood supply to the bones, their periosteum is thick, and osteogenic activity is high.


• A high calcium content is critical to the strength of bones.

• The portions of developing bones are as follows:– Epiphyseal plate

• The center for longitudinal bone growth in children.

– Epiphyses• The ends of the long bones.

– Diaphysis• The shaft of long bones.




Figure 6.9Epiphyseal plate (arrows). (Courtesy of Teresa Resch)

Life Span Considerations:The Older Adult

• Women build bones until about the age of 35, then begin to lose about 1% of bone mass annually. Men start losing bone mass 10 to 20 years later.

• Most of the changes in the skeletal system associated with age occur in the connective tissue.


• Loss of bone mass and strength is due to the loss of bone mineral content during later life. Calcium salts may be deposited in the matrix and cartilage becomes hard and brittle.

• Age-related osteoporosis, loss of bone mass, is often seen in older women and men.


• Low levels of calcium can:– Make older people susceptible to osteoporosis

and stress fractures.– Result in slower, impaired bone healing due to

osteoblasts being less able to use calcium to restructure bone tissue.

• Medical Words and Definitions with Word Parts

• These terms (shown in black in the Building Your Medical Vocabulary feature) can be analyzed and defined by dividing them into component parts.

1. Prefixes (P)2. Roots (R)3. Combining Forms (CF)4. Suffixes (S)

Building Your Medical Vocabulary

• Medical Words and Definitions without Word Parts• These terms (shown in pink in the Building Your Medical Vocabulary feature)

are not usually analyzed and defined by dividing them into component parts.

Building Your Medical Vocabulary




Figure 6.10This girl has a long leg cast, which was applied after surgery to correct her clubfoot.




Figure 6.11(A) Genu valgum, or knock-knee. Note that the ankles are far apart when the knees are together. (B) Genu varum, or bowleg. The

legs are bowed so that the knees are far apart as the child stands.




Figure 6.12Hammertoe.




Figure 6.13Abscess of the brain due to osteomyelitis.




Figure 6.14Typical hand deformities associated with rheumatoid arthritis.

(Reprinted with permission of Photo Researchers, Inc.)




Figure 6.15Does this child have legs of different lengths or scoliosis? Look at the level of the iliac crests and shoulders to see if they are level.

See the more prominent crease at the waist on the right side? This child could have scoliosis.




Figure 6.16Traction is the application of a pulling force to maintain bone alignment during fracture healing. Different fractures require different types of traction. (A) Skin traction (also called

straight traction) such as Buck’s traction shown here, is often used for hip fractures. (B) Balanced suspension traction is commonly used for fractures of the femur. (C) Skeletal traction, in which the pulling force is applied directly to the bone, may be used to treat fractures of the humerus.

Drug Highlights

• Anti-inflammatory agents are classified as steroidal (corticosteroids) and nonsteroidal. Used to relieve swelling, tenderness, redness, and pain of inflammation.

• Corticosteroids– Steroid substances with potent anti-inflammatory

effects.• Nonsteroidal (NSAIDs)

– Agents that are used to treat arthritis and related disorders.

Drug Highlights

• Disease-Modifying Antirheumatic Drugs (DMARDS)– May influence the course of the disease

progression.• Cox-2 inhibitors

– Cyclooxygenase (COX) is an enzyme involved in normal cellular function and also in the inflammatory response.

Drug Highlights

• Antitumor Necrosis Factor Drugs (Anti-TNF)– Slows or halts the destruction of the joint by

disrupting the activity of tumor necrosis factor (TNF), a substance involved in the body’s immune response.

• Agents Used to Treat Gout– Acute attacks are treated with colchicines.– Once acute attack of gout is controlled, drug

therapy to control hyperuricemia can be initiated.

Drug Highlights

• Agents Used to Treat or Prevent Postmenopausal Osteoporosis– Medications reduce the activity of the cells that

cause bone loss and increases the amount of bone in most patients.

• Analgesics are agents that relieve pain without causing loss of consciousness.– They are classified as narcotic and non-narcotic.

Diagnostic and Lab Tests

• Arthrography– Diagnostic examination of a joint in which air and

then a radiopaque contrast medium are injected into the joint space and x-rays are taken.

• Arthroscopy– Examination of internal structures of a joint via an

arthroscope. Usually done after arthrography and before joint surgery.

Arthroscopy Video

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• Goniometry– Measurement of joint movement and angles via a

goniometer.• Photon Absorptiometry

– Bone scan that uses a low beam of radiation to measure bone-mineral density and bone loss in the lumbar vertebrae to diagnose and monitor osteoporosis.




Figure 6.17Using a goniometer to measure joint ROM.


• Thermography– Process of recording heat patterns of the body surface.

• X-ray– Examination of bones by the use of an electromagnetic

wave of high energy produced by the collision of a beam of electrons with a target in a vacuum tube.

• Alkaline Phosphatase Blood Test– Blood test to determine the level of alkaline

phosphatase.


• Antinuclear Antibodies (ANA)– Present in a variety of immunologic diseases.

• Bone Mineral Density Test (BMD)– Used to measure bone mass or bone mineral density.– Different machines measure density in different bony

areas.• C-Reactive Protein Blood Test

– Positive results may indicate RA, acute inflammatory changes, and widespread metastasis.


• Calcium (Ca) Blood Test– An increase in calcium levels in the blood may

indicate metastatic bone cancer, acute osteoporosis, prolonged immobilization, and the healing of fractures. Levels may be decreased in osteomalacia and rickets.

• Phosphorus (P) Blood Test– Levels of phosphorus in blood may increase in

osteoporosis and fracture healing.


• Serum Rheumatoid Factor (RF)– An immunoglobulin present in the serum of 50 –

95% of adults with RA.• Uric Acid Blood Test

– Uric acid is increased in gout, arthritis, multiple myeloma, and rheumatism.




Abnormal Curvatures of the Spine

• Kyphosis– Normal thoracic curvature becomes exaggerated,

producing a humpback appearance, which may be caused by a congenital defect, a disease process, a malignancy, compression fracture, faulty posture, etc.




Figure 6.18(a)Abnormal curvatures of the spine: (A) kyphosis


• Lordosis– An abnormal anterior curvature of the spine.– The condition may be referred to as swayback, as

the abdomen and buttocks protrude due to an exaggerated lumbar curvature.




Figure 6.18(b)Abnormal curvatures of the spine: (B) lordosis


• Scoliosis– An abnormal lateral curvature of the spine, which

usually appears in adolescence, during a period of rapid growth.




Figure 6.18(c)Abnormal curvatures of the spine: (C) scoliosis.

Arthritis

• Inflammation of one or more joints.• Treatment varies and is aimed at reducing pain

and discomfort along with preventing disabilities.

• Medications, exercise, activity modifications, and surgery are included.

Arthritis

• Types of arthritis include:– Osteoarthritis

• The most common form of arthritis in the U.S., resulting from years of accumulated wear and tear of weight-bearing joints and those of the fingers.

– Gout• A hereditary metabolic disease seen most often in men

over the age of forty.

– Rheumatoid arthritis• An autoimmune disorder that affects both males and

females of all ages.

Arthritis Video

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Figure 6.19X-ray showing typical joint changes associated with osteoarthritis.

(Source: Getty Images/Stone Allstock.)




Figure 6.20Gout of the finger joint.

(Source: Reprinted from the Clinical Slide Collection on the Rheumatic Diseases, © 1991, 1995. Used by permission of the American College of Rheumatology.)




Figure 6.21Multisystem effects of rheumatoid arthritis.

Carpal Tunnel Syndrome

• Results from pressure on the median nerve, resulting in numbness, pain, and eventually, hand weakness.

• Occurs because of repetitive movement of the wrist.

• Treatment includes night splints, modifying the work area, medications, and surgery.




Figure 6.22Cross-section of wrist showing tendons and nerves involved in carpal tunnel syndrome.

Carpal Tunnel Syndrome Video

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Fractures

• Fractures are classified according to their external appearance, the site of the fracture, and the nature of the crack or break in the bone.




Figure 6.23Various types of fractures.

Fractures

• Classification of Fractures:– Closed or simple– Open or compound– Comminuted– Transverse– Greenstick




Figure 6.24Open fracture of the wrist. (Source: Pearson Education/PH College)

Fractures

• Classification of Fractures:– Spiral– Colles’– Pott’s– Compression– Epiphyseal

Bone Healing Animation

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Osteoporosis

• Condition characterized by the progressive loss of bone density and thinning of bone tissue.

• Occurs when the body fails to form enough new bone, or when too much old bone is reabsorbed by the body, or both.




Figure 6.25Spinal changes caused by osteoporosis.

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Medical Terminology A Word-Building Approach Chapter 6 Skeletal System Jane Rice, RN, CMA-C.

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