skeletal disorders. objectives: copyright 2003 by mosby, inc. all rights reserved

SKELETAL DISORDERS

Objectives:

Copyright 2003 by Mosby, Inc. All rights reserved.


Assessment Techniques

• Bone x-rays• Bone marrow aspiration • Bone marrow biopsy • Radionuclide bone scan • Computed axial tomography (CAT) • Magnetic resonance imaging (MRI) • Bone densitometry

4

Bone Scan• Radioactive tracer is given intravenously

• Amount of uptake is related to amount of blood flow to the bone

• “Hot spots” are areas of increased metabolic activity that may indicate cancer, abnormal healing or growth

• “Cold spots” indicate decreased metabolism of decalcified bone, fracture or bone infection

5

Hormonal Abnormalities/Imbalances

• Oversecretion of hGH during childhood produces giantism

• Undersecretion of hGH or thyroid hormone during childhood produces short stature

• Both men or women that lack estrogen receptors on cells grow taller than normal– estrogen is responsible for closure of growth

plate


Disorders of the Skeletal System • Ankylosing spondylitis

– A hereditary chronic spinal disease

• Arthritis– A group of disorders evidenced by inflammation

of a joint, pain and stiffness during movement

• Avulsion fracture– Occurs when a ligament or tendon pulls off part

of a bone during an injury

• Bursitis – Inflammation of the sac around a joint that is

caused by trauma or irritation


Disorders of the Skeletal System (continued)

• Caries – Also called cavities, it is the major cause of tooth

loss

• Carpal tunnel syndrome– A disorder caused by pressure on the median

nerve of the wrist due to repetitive use or trauma

• Degenerative joint disease– Also called osteoarthritis, usually associated with

aging; it is the most common form of arthritis



• Dislocation – When bones move out of their proper

location, usually in the shoulder or hip

• Fracture – A broken bone caused by trauma

• Gout – A painful swelling of a joint that results from

the buildup of uric acid crystals, most commonly in the great toe



• Herniated disk– A ruptured or “slipped” disk between

vertebrae

• Kyphosis – Also called “hunchback” or “humpback,” is

an abnormal curvature of the thoracic part of the spine

• Lordosis – Also called “swayback,” is an abnormal

curvature of the lumbar spine



• Meningomyelocele– Also called spina bifida, is a congenital

condition of the spinal column

• Osteoma– A bone tumor

• Osteomalacia – Also called rickets in children, is a softening

of the bones caused by vitamin D and calcium deficiency



• Osteomyelitis – A bacterial infection of the bone

• Osteoporosis – A weakening of the bones

• Paget’s disease– Also called osteitis deformans, is due to

excessive destruction of bone cells



• Periodontitis – An inflammation of the tissues that keep

teeth in place

• Rheumatoid arthritis – Pain and stiffness in the joints caused by

thickening of the synovial membrane

• Rickets – A painless deformity at the epiphysis of the

bones caused by insufficient vitamin D



• Scoliosis– An abnormal lateral spinal curvature

• Subluxation – A partial dislocation of a joint, such as in the

neck in a “whiplash” injury

• Talipes– A congenital deformity involving the foot

and ankle

Osteoporosis- cont.

• Osteoporosis– Group of diseases in which bone reabsorption

outpaces bone deposit– Spongy bone of the spine is most vulnerable– Occurs most often in postmenopausal women– Bones become so fragile that sneezing or

stepping off a curb can cause fractures

15

Osteoporosis-cont.• Decreased bone mass resulting in porous bones

• Those at risk– white, thin menopausal, smoking, drinking female with

family history – athletes who are not menstruating due to decreased body

fat & decreased estrogen levels– people allergic to milk or with eating disorders whose

intake of calcium is too low

• Prevention or decrease in severity– adequate diet, weight-bearing exercise, & estrogen

replacement therapy (for menopausal women)– behavior when young may be most important factor

Osteoporosis: Treatment

• Calcium and vitamin D supplements

• Increased weight-bearing exercise

• Hormone (estrogen) replacement therapy (HRT) slows bone loss

• Natural progesterone cream prompts new bone growth

• Statins increase bone mineral density

Rickets cont.

• Rickets

• Risk Factors/Causes:– Bones of children are inadequately mineralized

causing softened, weakened bones– Bowed legs and deformities of the pelvis, skull,

and rib cage are common– Caused by insufficient calcium in the diet, or by

vitamin D deficiency

18

Rickets cont.

• Rickets Treatment:– Dietary changes– Exercise– Reversible if caught early

• Osteomalacia• new adult bone produced during remodeling fails to

ossify

• hip fractures are common

Osteomalacia cont.

• Osteomalacia– Bones are inadequately mineralized causing

softened, weakened bones– Main symptom is pain when weight is put on

the affected bone– Caused by insufficient calcium in the diet, or by

vitamin D deficiency

Paget’s Disease cont.

• Characterized by excessive bone formation and breakdown

• Pagetic bone with an excessively high ratio of woven to compact bone is formed

• Pagetic bone, along with reduced mineralization, causes spotty weakening of bone

• Osteoclast activity wanes, but osteoblast activity continues to work

Paget’s Disease cont.

• Usually localized in the spine, pelvis, femur, and skull

• Unknown cause (possibly viral)

• Treatment includes the drugs Didronate and Fosamax

22

HOMEOSTATIC IMBALANCES of Joints

• Lyme disease is a bacterial disease which is transmitted by deer ticks. Symptoms include joint stiffness, fevers, chills, headache, and stiff neck.

• Ankylosing spondylitis affects joints between the vertebrae and between the sacrum and hip bone. Its cause is unknown.

• Ankle Sprains and Fractures: The ankle is the most frequently injured major joint. Sprains are the most common injury to the ankle; they are treated with RICE. A fracture of the distal leg that involves both the medial and lateral malleoli is called a Pott’s fracture.

23

Rheumatism and Arthritis cont.• Osteoarthritis is a degenerative joint disease

commonly known as “wear-and-tear” arthritis. It is characterized by deterioration of articular cartilage and bone spur formation. It is noninflammatory and primarily affects weight-bearing joints.

• Gouty arthritis is a condition in which sodium urate crystals are deposited in soft tissues of joints, causing inflammation, swelling, and pain. If not treated, bones at affected joints will eventually fuse, rendering the joints immobile.

24

Rheumatoid Arthritis

• Autoimmune disorder• Cartilage attacked• Inflammation, swelling

& pain • Final step is fusion of

joint

25

Osteoarthritis• Degenerative joint disease

– aging, wear & tear

• Noninflammatory---no swelling– only cartilage is affected not synovial membrane

• Deterioration of cartilage produces bone spurs– restrict movement

• Pain upon awakening--disappears with movement

26

Gouty Arthritis

• Urate crystals build up in joints---pain– waste product of DNA & RNA metabolism– builds up in blood– deposited in cartilage causing inflammation &

swelling

• Bones fuse

• Middle-aged men with abnormal gene


Issues and Innovations • Progress in dental care

– Corrective measures including bonding, bleaching, and implants

• Bone substitutes and repairs– Bone replacing material including organoapatites

and coral– Surgical implants for cranial and joint injuries– Bone regeneration

28

Hip Replacement (Innovations)

29

Arthroscopy & Arthroplasty

• Arthroscopy = examination of joint– instrument size of pencil– remove torn knee cartilages & repair ligaments– small incision only

• Arthroplasty = replacement of joints– total hip replaces acetabulum & head of femur– plastic socket & metal head– knee replacement common

30

Innovations for cartilage replacement

• In cartilage transplantation chondrocytes are removed from the patient, grown in culture, and then placed in the damaged joint.

• Eroded cartilage may be replaced with synthetic materials

• Researchers are also examining the use of stem cells to replace cartilage.

skeletal disorders. objectives: copyright 2003 by mosby, inc. all rights reserved

Documents

bone infection slide

skeletal disorders

bone osteoporosis

broken bone

irritation slide

bone hot spots

bone tumor osteomalacia

lumbar spine slide