Evolve.

Adapt.
Overcome.
CEFI is now ready.

Chapter 6
Skeletal System:
Bones and Joints
ANA101
ANATOMY & PHYSIOLOGY
WITH PATHOPHYSIOLOGY

M. MAGBUHOS, RMT
College of Medical Technology
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LEARNING OBJECTIVES:
• Explain the functions of the skeletal system.
• Describe the components of the extracellular matrix and explain the
function of each.
• Explain the structural differences between compact bone and spongy
bone.
• Outline the processes of bone ossification, growth, remodeling, and
repair.
• Explain the role of bone in calcium homeostasis.
• Describe how parathyroid hormone and calcitonin influence bone
health and calcium homeostasis.
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LEARNING OBJECTIVES:
• List and define the major features of a typical bone.
• Name the bones of the skull and describe their main features as seen
from the lateral, frontal, internal, and inferior views.
• List the bones that form the majority of the nasal septum.
• Describe the locations and functions of the paranasal sinuses.
• List the bones of the braincase and the face.
• Describe the shape of the vertebral column and list its divisions.
• Discuss the common features of the vertebrae and contrast vertebrae
from each region of the vertebral column.
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LEARNING OBJECTIVES:
• List the bones and cartilage of the rib cage, including the three types of
ribs.
• Identify the bones that makeup the pectoral girdle and relate their
structure and arrangement to the function of the girdle.
• Name and describe the major bones of the upper limb.
• Name and describe the bones of the pelvic girdle and explain why the
pelvic girdle is more stable than the pectoral girdle.
• Name the bones that make up the coxal bone. Distinguish between the
male and female pelvis.
• Identify and describe the bones of the lower limb.
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LEARNING OBJECTIVES:
• Describe the two systems for classifying joints.
• Explain the structure of a fibrous joint, list the three types, and give examples of
each type.
• Give examples of cartilaginous joints.
• Illustrate the structure of a synovial joint and explain the roles of the components
of a synovial joint.
• Classify synovial joints based on the shape of the bones in the joint and give an
example of each type.
• Demonstrate the difference between the following pairs of movements: flexion and
extension; plantar flexion and dorsiflexion; abduction and adduction; supination
and pronation; elevation and depression; protraction and retraction; opposition
and reposition; inversion and eversion.
• Describe the effects of aging on bone matrix and joints.
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Case Study
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Components of Skeletal System

• Bones
• Cartilages
• provides a firm yet flexible support within certain structures
• Tendons
• strong bands of connective tissue, attaches skeletal muscles to
bones
• Ligaments
• strong bands of fibrous connective tissue that hold bones together
Bones of the Skeletal System
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Skeletal System Functions

1. Support – bear weight and major supporting tissue of the body
2. Protect - protects the organs it surrounds
3. Movement – contraction of the skeletal muscles moves the bones
4. Storage – minerals in the blood are stored in bone
5. Blood cell production - bones contain cavities filled with red bone
marrow
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Extracellular Matrix
• Bone, cartilage, tendons, and ligaments of the skeletal system
are all connective tissues.
• Their characteristics are largely determined by the
composition of their extracellular matrix.
• The matrix always contains collagen, ground substance, and
other organic molecules, as well as water and minerals.
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Extracellular Matrix
• Collagen is a tough, ropelike protein.
• Proteoglycans are large molecules consisting of many
polysaccharides attaching to and encircling core proteins.
• The proteoglycans form large aggregates and attract water.
• The extracellular matrix of tendons and ligaments contains
large amounts of collagen fibers, making these structures very
tough, like ropes or cables.
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Cartilage Extracellular Matrix

• The extracellular matrix of cartilage contains collagen and
proteoglycans.
• Collagen makes cartilage tough, whereas the water-filled
proteoglycans make it smooth and resilient.
• As a result, cartilage is relatively rigid, but it springs back to its
original shape after being bent or slightly compressed.
• It is an excellent shock absorber.
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Bone Extracellular Matrix

• The extracellular matrix of bone contains collagen, proteoglycans and
minerals, including calcium and phosphate.
• The ropelike collagen fibers lend flexible strength to the bone.
• The mineral component gives bone compression (weight-bearing)
strength.
• Most of the mineral in bone is in the form of calcium phosphate
crystals called hydroxyapatite.
• The collagen and mineral components are responsible for the major
functional characteristics of bone.
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Shape Classification of Bones

• There are four bone shape classifications: long, short, flat, and
irregular.
• Long bones are longer than they are wide; examples are upper
and lower limb bones.
• Short bones are approximately as wide as they are long; round
or nearly cube-shaped; examples are the bones of the wrist
and ankle.
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Shape Classification of Bones

• Flat bones have a relatively thin, flattened shape and usually
curved; examples are bones of the skull, ribs, sternum, and
scapulae.
• Irregular bones include the vertebrae and facial bones, which
have shapes that do not fit readily into the other three
categories.
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Long Bone Structures

• Diaphysis (shaft):
• compact bone tissue (on
outside), can also contain some
spongy bone
• end of a long bone is mostly
spongy bone
• within joints, the end of a long
bone is covered with hyaline
cartilage called articular
cartilage
• primary ossification center is in
the diaphysis
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Long Bone Structures

• Epiphysis:
• part of a long bone that
develops from a center of
ossification
• ends spongy bone tissue
• Articular cartilage:
• covers epiphyses
• reduces friction
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Long Bone Structures

• Epiphyseal plate (growth
plate):
• site of growth in bone
length between diaphysis
and epiphysis
• when bone stops growing in
length, becomes ossified
and is called the epiphyseal
line
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Long Bone Structures

• Medullary cavity:
• hollow center of diaphysis
filled with red or yellow
marrow
• conversion of red to yellow
marrow begins just before
birth
• Yellow marrow replaces the
red marrow in the long bones
of the limbs, except for some
proximal part of the arm
bones and thigh bones
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Long Bone Structures

• Periosteum:
• membrane around bone’s
outer surface
• outer fibrous layer is dense
irregular collagenous
connective tissue that
contains blood vessels and
nerves.
• inner layer is a single layer of
bone cells, including
osteoblasts, osteoclasts, and
osteochondral progenitor cells
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Long Bone Structures

• Endosteum:
• membrane that lines all
medullary cavities
within bones
• includes osteoblasts,
osteoclasts, and
osteochondral
progenitor cells
Structure of Long Bone
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Bone Marrow
• Bones contain cavities, such as the large medullary cavity in
the diaphysis, as well as smaller cavities in the epiphyses of
long bones and in the interior of other bones.
• These spaces are filled with soft tissue called marrow.
• Red marrow is the location of blood forming cells.
• Yellow marrow is mostly fat.
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Bone Marrow
• In newborns most bones have blood making red bone
marrow.
• In adults red marrow in the diaphysis is replaced by yellow
bone marrow.
• In adults most red bone marrow is in the flat bones and the
long bones of the femur and humerus.
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Compact Bone Tissue

• Location:
• outer part of diaphysis (long bones) and thinner surfaces of other
bones
• Osteon or haversian system:
• structural/functional unit, composed of concentric rings of matrix
which surround central canal and contain osteocytes, concentric
lamella form the rings includes, lacunae and canaliculus
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Compact Bone Tissue

• Lamella:
• rings of bone matrix, oriented around those blood vessels
• Lacunae:
• spaces between lamella, where osteocyte located
• Canaliculus:
• tiny canals transport nutrients and remove waste
• Central canal:
• center of osteon lined with endosteum contains blood vessels,
nerves, and loose connective tissue
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Compact Bone Tissue

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Spongy (Cancellous) Bone Tissue

• Spongy bone
• It is located at the epiphyses of long bones and center of other
bones.
• It has trabeculae, which are interconnecting rods or plates of bone,
and spaces that contain bone marrow and blood vessels.
• Most trabeculae are thin and consist of several lamellae with
osteocytes located in lacunae between the lamellae
• It has no osteons, osteocytes must obtain nutrients through their
canaliculi.
Spongy Bone Tissue
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Bone Cells
• Osteoblasts: produce collagen and proteoglycans, responsible for the
formation of bone and the repair and remodeling of bone
• derived from osteochondral progenitor cells
• Osteocytes: cells that maintain bone matrix and form from osteoblast
after bone matrix has surrounded it.
• derived from osteoblasts
• retain their connections to neighboring osteocytes through their cell
extensions, becomes inactive but produce the components needed
to maintain
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Bone Cells
• Osteoclasts: bone-destroying cells, contribute to bone repair and
remodeling by removing existing bone, called bone reabsorption or
breakdown of bone.
• mobilizes Ca2+ and phosphate ions for use in many metabolic
processes
• derived from the red bone marrow cells that also differentiate into
monocytes
• precursors attach to the bone matrix where direct contact with
osteoblasts is required to allow eventual maturation
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Bone Formation
• Ossification or osteogenesis is the formation of bone by osteoblasts.
• occurs by appositional growth on the surface of previously existing
material, either bone or cartilage
• Bone formation that occurs within connective tissue membranes is
called intramembranous ossification.
• Bone formation that occurs inside hyaline cartilage is called
endochondral ossification.
• Both methods initially produce woven bone, which is then remodeled
into lamellar bone.
• Both types of bone formation result in compact and spongy bone.
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Bone Formation
• First type of bone that osteoblasts form during ossification is fairly
weak bone called woven bone.
• After formation, osteoclasts break down the woven bone and
osteoblasts build new matrix.
• The process of removing old bone and adding new bone is called bone
remodeling.
• Woven bone is remodeled into a stronger, more permanent type called
lamellar bone.
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Bone Formation
• Lamellar bone is mature bone that is organized into thin, concentric
sheets or layers approximately 3–7 micrometers (μm) thick called
lamellae.
• Collagen fibers of one lamella lie parallel to one another, but at an
angle to the collagen fibers in the adjacent lamellae.
• Osteocytes, within their lacunae, are arranged in layers sandwiched
between lamellae.
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Bone Formation
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Intramembranous Ossification
• Intramembranous ossification occurs when osteoblasts begin
to produce bone within preexisting connective tissue
membranes.
• This occurs primarily in the bones of the skull.
• Osteoblasts line up on the surface of connective tissue fibers
and begin depositing bone matrix to form trabeculae.
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Intramembranous Ossification
• The process begins in areas called ossification centers and the
trabeculae radiate out from the centers.
• Usually, two or more ossification centers exist in each flat skull
bone and mature skull bones result from fusion of these
centers as they enlarge.
• The trabeculae are constantly remodeled and they may
enlarge or be replaced by compact bone.
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Steps in Intramembranous Ossification

1. Begins when some embryonic mesenchymal cells in the membrane
differentiate into osteochondral progenitor cells, then specialize to
become osteoblasts. The osteoblasts produce bone matrix that
surrounds the collagen fibers of the connective tissue membrane, and
the osteoblasts become osteocytes. As a result of this process, many
tiny trabeculae of woven bone develop
2. Additional osteoblasts gather on the surfaces of the trabeculae and
produce more bone, causing the trabeculae to become larger and
longer. Spongy bone forms as the trabeculae join together, resulting in
an interconnected network of trabeculae separated by spaces.
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Steps in Intramembranous Ossification

3. Cells within the spaces of the spongy bone specialize to form red bone
marrow, and cells surrounding the developing bone specialize to form
the periosteum. Osteoblasts from the periosteum lay down bone
matrix to form an outer surface of compact bone.
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Steps in Intramembranous Ossification

• The end products of intramembranous bone formation are bones with
outer compact bone surfaces and spongy centers.
• Remodeling converts woven bone to lamellar bone and contributes to
the final shape of the bone.
Intramembranous Ossification
Bone Formation in the Fetus
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Endochondral Ossification
• Endochondral bone formation is bone formation within a preexisting
cartilage model.
• Some of this cartilage starts at approximately the eighth week of
embryonic development.
• The cartilage model is replaced by bone.
• Initially formed is a primary ossification center, which is bone
formation in the diaphysis of a long bone.
• A secondary ossification center is bone formation in the epiphysis.
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Steps in Endochondral Ossification

1. Chondroblasts build a cartilage model, the chondroblasts
become chondrocytes.
2. Cartilage model calcifies (hardens).
3. Osteoblasts invade calcified cartilage and a primary
ossification center forms diaphysis.
4. Secondary ossification centers form epiphysis.
5. Original cartilage model is almost completely ossified and
remaining cartilage is articular cartilage.
Endochondral Ossification of a Long Bone
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Bone Growth in Width

• Bone growth occurs by the deposition of new bone lamellae
onto existing bone or other connective tissue.
• As osteoblasts deposit new bone matrix on the surface of
bones between the periosteum and the existing bone matrix,
the bone increases in width, or diameter.
• This process is called appositional growth.
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Bone Growth in Width

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Bone Growth in Length

• Growth in the length of a bone, which is the major source of
increased height in an individual, occurs in the epiphyseal
plate.
• This type of bone growth occurs through endochondral
ossification.
• Chondrocytes increase in number on the epiphyseal side of
the epiphyseal plate.
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Bone Growth in Length

• Then the chondrocytes enlarge and die.
• The cartilage matrix becomes calcified.
• Much of the cartilage that forms around the enlarged cells is
removed by osteoclasts, and the dying chondrocytes are
replaced by osteoblasts.
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Bone Growth in Length

• The osteoblasts start forming bone by depositing bone
lamellae on the surface of the calcified cartilage.
• This process produces bone on the diaphyseal side of the
epiphyseal plate.
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Endochondral Bone Growth
Comparison of Intramembranous and Endochondral Ossification
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Bone Remodeling
• Bone remodeling involves:
• removal of existing bone by osteoclasts and
• deposition of new bone by osteoblasts
• occurs in all bones
• responsible for changes in bone shape, bone
• repair, adjustment of bone to stress, and
• calcium ion regulation
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Bone Repair
1. Broken bone causes bleeding and a blood clot forms.
2. Callus forms which is a fibrous network between 2
fragments.
3. Cartilage model forms first then, osteoblasts enter the callus
and form cancellous bone this continues for 4-6 weeks after
injury.
4. Cancellous bone is slowly remodeled to form compact and
cancellous bone.
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Bone Repair
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Bone and Calcium Homeostasis

• Bone is a major storage site for calcium
• Movement of calcium in and out of bone helps determine
blood levels of calcium
• Calcium moves into bone as osteoblasts build new bone
• Calcium move out of bone as osteoclasts break down bone
• Calcium homeostasis is maintained by parathyroid hormone
(PTH) and calcitonin
Calcium Homeostasis
Normal Bones in the Adult Human Skeleton
Normal Bones in the Adult Human Skeleton
Bones of the Skeletal System
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Bone Anatomical Terms

• Foramen:
• hole
• Example - foramen magnum
• Fossa:
• depression
• Example - glenoid fossa
• Process:
• projection
• Example - mastoid process
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Bone Anatomical Terms

• Condyle:
• smooth, rounded end
• Example - occipital condyle
• Meatus:
• canal-like passageway
• Example - external auditory meatus
• Tubercle:
• lump of bone
• Example - greater tubercle
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Bone Anatomical Terms

• The axial skeleton is composed of the skull, the vertebral
column, and the thoracic cage.
• The skull has 22 bones divided into those of the braincase and
those of the face.
• The braincase, which encloses the cranial cavity, consists of 8
bones that immediately surround and protect the brain.
• The bony structure of the face has 14 facial bones.
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Bone Anatomical Terms

• Thirteen of the facial bones are rather solidly connected to
form the bulk of the face.
• The mandible, however, forms a freely movable joint with the
rest of the skull.
• There are also three auditory ossicles in each middle ear (six
total).
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Cranial Bones
Frontal bone
• Anterior part of cranium
Parietal bones
• Sides and roof of cranium
Occipital bones
• Posterior portion and floor of cranium
Temporal bones
• Inferior to parietal bones on each side of the cranium
• Temporomandibular joint
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Cranial Bones
Sphenoid bone
• Forms part of cranium floor, lateral posterior portions of eye
orbits, lateral portions of cranium anterior to temporal bones
• Sella turcica
Ethmoid bone
• Anterior portion of cranium, including medial surface of eye
orbit and roof of nasal cavity
• Nasal conchae
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Facial Bones
Maxillae
• Form upper jaw, anterior portion of hard palate, part of
lateral walls of nasal cavity, floors of eye orbits
• Maxillary sinus
Palatine bones
• Form posterior portion of hard palate, lateral wall of nasal
cavity
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Facial Bones
Zygomatic bones
• Cheek bones
• Also form floor and lateral wall of each eye orbit
Lacrimal bones
• Medial surfaces of eye orbits
Nasal bones
• Form bridge of nose
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Facial Bones
Vomer
• In midline of nasal cavity
• Forms nasal septum with the ethmoid bone
Inferior nasal conchae
• Attached to lateral walls of nasal cavity
Mandible
• Lower jawbone
• Only movable skull bone
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Bones of the Nasal Cavity
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Paranasal Sinuses
• Several of the bones associated with the nasal cavity have
large cavities within them, called the paranasal sinuses which
open into the nasal cavity.
• The paranasal sinuses are:
• Frontal
• Ethmoid
• Sphenoid
• Maxillary
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Hyoid Bone
• The hyoid bone is an unpaired, U-shaped bone that is not part
of the skull and has no direct bony attachment to the skull or
any other bones.
• The hyoid bone has the unique distinction of being the only
bone in the body that does not articulate with another bone.
• The hyoid bone provides an attachment for some tongue
muscles, and it is an attachment point for important neck
muscles that elevate the larynx.
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Vertebral Column
• The vertebral column, or spine, is the central axis of the
skeleton, extending from the base of the skull to slightly past
the end of the pelvis.
• In adults, it usually consists of 26 individual bones, grouped
into five regions.
• The adult vertebral column has four major curvatures:
cervical, thoracic, lumbar and sacrococcygeal.
• The cervical region curves anteriorly.
• The thoracic region curves posteriorly.
• The lumbar region curves anteriorly
• The sacral and coccygeal regions together curve posteriorly
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Vertebral Column
• 7 cervical vertebra
• 12 thoracic vertebra
• 5 lumbar vertebra
• 1 sacrum
• 1 coccyx
• Atlas:
• 1st vertebra
• holds head
• Axis:
• 2nd vertebra
• rotates head
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Functions of Vertebral Column

• Supports body weight
• Protects the spinal cord
• Allows spinal nerves to exit the spinal cord
• Provides a site for muscle attachment
• Provides movement of the head and trunk
Vertebral Column
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Regional Differences in Vertebrae
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Thoracic Cage
• Protects vital organs
• 12 pair of ribs
• Sternum:
• breastbone
• True ribs:
• attach directly to sternum by cartilage
• False ribs:
• attach indirectly to sternum by cartilage
• Floating ribs:
• not attached to sternum
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Bones of the Pectoral Girdle

• Scapula:
• shoulder blade
• Clavicle:
• collar bone
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Upper Limb Bones

• Humerus:
• upper limb
• Ulna:
• forearm
• Radius:
• forearm
• Carpals:
• wrist
• Metacarpals:
• hand
Upper Limb Bones
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Pelvic Girdle
• Where lower limbs attach to the body
• Pelvis:
• includes pelvic girdle and coccyx
• Ischium:
• inferior and posterior region
• Ilium:
• most superior region
• Acetabulum:
• hip socket (joint)
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Hip Bones
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Lower Limb Bones

• Femur:
• thigh
• Patella:
• knee cap
• Tibia:
• large lower leg
• Fibula:
• small lower leg
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Lower Limb Bones

• Tarsals:
• ankle
• Metatarsals:
• foot
• Phalanges:
• toes and fingers
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Articulations
• Articulations (joints) are where two bones come together.
• Joints can be classified structurally as fibrous, cartilaginous, or
synovial, according to the major connective tissue type that
binds the bones together and whether a fluid-filled joint
capsule is present.
• Joints are also be classified in functional categories according
to their degree of motion as synarthroses, amphiarthroses, or
diarthroses.
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Structural Classification of Joints

• Fibrous joint:
• united by fibrous connective tissue
• subclasses are sutures, syndesmosis, and gomphoses
• Cartilaginous:
• united by means of cartilage
• subclasses are synchondroses and symphysis
• Synovial:
• joined by a fluid cavity
• Most joints of the appendicular skeleton
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Functional Classification of Joints

• Synarthrosis:
• non-movable joint
• Example – skull bone articulations
• Amphiarthrosis:
• slightly movable joint
• Example - between vertebrae
• Diarthrosis:
• freely movable joint
• Example - knee, elbow, and wrist articulations
Fontanels and Sutures
Structure of a Synovial Joint
Types of Synovial Joints
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Types of Movement
• Flexion: bending
• Extension: straightening
• Abduction: movement away from midline
• Adduction: movement toward the midline
• Pronation: rotation of the forearm with palms down
• Supination: rotation of the forearm with palms up
• Rotation: movement of a structure about the long axis
Types of Movement
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Effects of Aging on the Skeletal System and

Joints
1. Decreased Collagen Production
2. Loss of Bone Density
3. Degenerative Changes
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Clinical Impact
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Osteogenesis Imperfecta
• Osteogenesis imperfecta is also known as brittle bone
disorder.
• Connective tissue disease is caused by mutations that yield
reduced or defective type I collagen.
• Type I collagen is the major collagen of bone, tendon, and skin
• There is considerable variability in the appearance and
severity of OI symptoms, which is partially explained by
different types of mutations.
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Osteogenesis Imperfecta
• Mildest and most common form of OI is called type I. It is
caused by too little formation of normal type I collagen.
• The majority of patients have a mutation in a type I collagen
gene that creates a stop codon, so that the gene no longer
encodes a functional protein.
• The more severe types of OI occur when mutated collagen
genes are transcribed and the resulting mRNA codes for a
defective protein.
• The more defective the protein, the weaker the collagen fiber
and the more severe the disorder.
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Osteogenesis Imperfecta
• Most severe forms of OI are defective-collagen and collagen-
deficiency disorders.
• Patients may exhibit any of the following characteristics:
bones predisposed to fracture, especially before puberty; a
tendency to develop spinal curvature; loose joints; brittle
teeth; hearing loss; and a blue tint to the whites of the eyes.
• There is no cure for OI, and treatments are primarily directed
at reducing the risk for fractures.
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Classification of Bone Fractures

• The most commonly used classification involves the severity of
the injury to the soft tissues surrounding the bone.
• An open fracture (formerly called a compound fracture) occurs
when an open wound extends to the site of the fracture or
when a fragment of bone protrudes through the skin.
• If the skin is not perforated, the fracture is called a closed
fracture (formerly called a simple fracture).
• If the soft tissues around a closed fracture are damaged, it is
called a complicated fracture.
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Classification of Bone Fractures

• An incomplete fracture does not extend completely across the
bone, whereas in a complete fracture the bone is broken into
at least two fragments.
• An incomplete fracture on the convex side of the curve of the
bone is a greenstick fracture.
• Hairline fractures are incomplete fractures in which the two
sections of bone do not separate; hairline fractures are
common in the skull.
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Classification of Bone Fractures

• A comminuted fractureis a complete fracture in which the
bone breaks into more than two pieces—usually two major
fragments and a smaller fragment.
• In an impacted fracture, one fragment is driven into the
spongy portion of the other fragment.
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Classification of Bone Fractures

• Fractures classified according to the direction of the fracture
within the bone.
• Linear fractures run parallel to the length of the bone, and
transverse fractures are at right angles to the length of the
bone.
• Spiral fractures take a helical course around the bone, and
oblique fractures run obliquely in relation to the length of the
bone.
• Dentate fractures have rough, toothed, broken ends, and
stellate fractures have breakage lines radiating from a central
point.
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Disruption of Bone Homeostasis by Bacteria

• Osteomyelitis is a bacterial infection in bone, usually the
aggressive pathogen Staphylococcus aureus is the causative
organism.
• This bacterium is more commonly found on our skin but can move
into bone in three major ways:
• The bacterium spreads to the bone through the bloodstream from
another infected location in the body, such as an abscessed tooth
• It penetrates the bone through an open wound on the skin, which
may occur in severe cases of diabetes
• It is introduced into a joint or bone during surgery—for example,
while putting a pin in a broken bone.
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Disruption of Bone Homeostasis by Bacteria

• Once bacteria are in the bone, their presence induces a severe
inflammatory response, which is then followed by progressive
bone loss.
• Osteomyelitis can be difficult to treat. This difficulty is due to
the bacteria simultaneously initiating three responses in the
bone, which together result in devastating bone loss.
• These responses are increased development of osteoclasts,
stimulation of the secretion of inflammation-causing
chemicals, and disruption of the chemical signaling between
osteoblasts and osteoclasts.
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Disruption of Bone Homeostasis by Bacteria

• The most common treatment for osteomyelitis is a 4- to 8-
week course of antibiotics.
• The doctor may prescribe intravenous dosing with the
antibiotics; thus, patients are often fitted with a peripherally
inserted central catheter (PICC) line.
• If the infection persists, it may be necessary to perform
surgery in which the infected tissue is removed, in a process
called debridement.
• In cases of severe tissue damage, a bone graft is necessary.
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Cleft Lip or Palate

• During fetal development, the facial bones sometimes fail to
fuse with one another.
• A cleft lip results if the maxillae do not form normally, and a
cleft palate occurs when the palatine processes of the maxillae
do not fuse with one another.
• A cleft palate produces an opening between the nasal and oral
cavities, making it difficult to eat or drink or to speak
distinctly. An artificial palate may be inserted into a newborn’s
mouth until the palate can be repaired.
• A cleft lip alone, or both cleft lip and palate, occurs
approximately once in every 1000 births and is more common
in males. A cleft palate alone occurs approximately once in
every 2000 births and is more common in females.
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Abnormal Spinal Curvatures

• In some people, the normal spinal curvature becomes
distorted due to disease or a congenital defect.
• The three most common spinal curvatures are lordosis,
kyphosis, and scoliosis.
• Lordosis (hollow back) is an exaggeration of the convex curve
of the lumbar region.
• Kyphosis (hump back) is an exaggeration of the concave curve
of the thoracic region. It is most common in postmenopausal
women but can also occur in men and becomes more
prevalent as people age.
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Abnormal Spinal Curvatures

• Scoliosis is an abnormal lateral and rotational curvature of the
vertebral column, which is often accompanied by secondary
abnormal curvatures, such as kyphosis.
• Treatments for abnormal spinal curvature depend on the age
and overall medical condition of the person.
• However, most treatments include repeated examinations to
monitor the status of the curvature, a back brace, and surgery
when the curving is not slowed by bracing.
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Abnormal Spinal Curvatures

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Herniated Intervertebral Disk

• A herniated disk (ruptured disk) results when the annulus fibrosus
breaks or balloons, releasing all or part of the nucleus pulposus.
• The herniated part of the disk may push against and compress the
spinal cord, cauda equina, or spinal nerves.
• The compression compromises the normal function of this
nervous tissue and produces pain and numbness in the limb it
supplies.
• The inferior lumbar and inferior cervical intervertebral disks are
the most common disks to become herniated because the
vertebral column has a lot of mobility in these areas.
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Herniated Intervertebral Disk

• Herniated disks can be repaired in one of several ways.
• One procedure is prolonged bed rest, based on the tendency
for the herniated part of the disk to recede and the annulus
fibrosus to repair itself.
• A laminectomy is the removal of a vertebral lamina, or
vertebral arch.
• A hemilaminectomy is the removal of a portion of a vertebral
lamina.
• These procedures reduce the compression of the spinal nerve
or spinal cord.
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Herniated Intervertebral Disk

• Fenestration involves removal of the nucleus pulposus, leaving
the annulus fibrosus intact.
• In extreme cases, the entire damaged disk is removed and a
metal cage is inserted into the space previously occupied by
the disk.
• Red bone marrow stem cells harvested from the hip are then
injected into the space to allow for new bone growth.
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Carpal Tunnel Syndrome

• The bones and ligaments that form the walls of the carpal tunnel
do not stretch.
• Edema (fluid buildup) or connective tissue deposition may occur
within the carpal tunnel as a result of trauma or some other
problem.
• The edema or connective tissue may apply pressure against the
nerve and vessels passing through the tunnel, causing carpal
tunnel syndrome, which is characterized by tingling, burning, and
numbness in the hand.
• Carpal tunnel syndrome occurs more frequently in people whose
work involves extending the wrist and flexing the fingers.
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Gluteal Injections
• The large gluteal muscles (hip
muscles) are a common site for
intramuscular injections.
• Gluteal injections are made in the
superolateral region of the hip
because a large nerve (the sciatic
nerve) lies deep to the other gluteal
regions.
• The landmarks for such an injection
are the anterior superior iliac spine
and the tubercle of the iliac crest,
which lies about one-third of the way
along the iliac crest from anterior to
posterior.
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Broken Hip
• A femoral neck fracture is commonly,
but incorrectly, called a broken hip.
• Femoral neck fractures are among the
most common injuries resulting in
morbidity (disease) and mortality
(death) in older adults.
• Despite treatment with anticoagulants
and antibiotics, about 5% of patients
with femoral neck fractures develop
deep vein thrombosis (blood clot),
and about 5% develop wound
infections; either condition can be life-
threatening.
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Spina Bifida
• Sometimes vertebral laminae
partly or completely fail to fuse
(or even fail to form) during fetal
development, resulting in a
condition called spina bifida
(split spine).
• This defect is most common in
the lumbar region. If the defect
is severe and involves the spinal
cord, it may interfere with
normal nerve function below the
point of the defect.
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Gingivitis
• The gingiva, or gums, are the soft tissues covering the alveolar process.
• Neglect of the teeth can result in gingivitis, an inflammation of the
gingiva that is often caused by bacterial infection. Left untreated,
gingivitis can spread to the tooth socket, resulting in periodontal
disease.
• In periodontal disease, plaque and bacteria accumulate, resulting in
inflammation that gradually destroys the periodontal ligaments and the
bone. Teeth may become so loose that they come out of their sockets.
• Proper brushing, flossing, and professional cleaning to remove plaque
can usually prevent gingivitis and periodontal disease.
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Rheumatoid Arthritis
• Rheumatoid arthritis (RA) is the second most common type of
arthritis.
• RA is a general connective tissue disorder that affects the skin,
vessels, lungs, and other organs, but it is most pronounced in
the joints.
• RA is severely disabling and most commonly destroys small
joints, such as those in the hands and feet.
• The initial cause of RA is unknown but may involve a transient
infection or an autoimmune disease that develops against
collagen.
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Rheumatoid Arthritis
• People with classic RA have a protein, rheumatoid factor, in
their blood.
• In RA, the synovial fluid and associated connective tissue cells
proliferate, forming a pannus(clothlike layer), which causes
the joint capsule to become thickened and destroys the
articular cartilage.
• In advanced stages, opposing joint surfaces can become fused.
• Juvenile rheumatoid arthritis is similar to the adult type in
many ways, but no rheumatoid factor is found in the serum.
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Systems Pathology
Osteoporosis
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Osteoporosis
• Osteoporosis, or porous bone, is a loss of bone matrix.
• The loss of bone mass makes bones so porous and weakened
that they become deformed and prone to fracture.
• The occurrence of osteoporosis increases with age. In both
men and women (although it is 2.5 times more common in
women), bone mass starts to decrease at about age 40 and
continually decreases thereafter.
• Women can eventually lose approximately one-half, and men
one-quarter, of their spongy bone.
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Osteoporosis
• In women, decreased production of the female reproductive
hormone estrogen can cause osteoporosis, mostly in spongy
bone, especially in the vertebrae of the spine and the bones
of the forearm.
• Collapse of the vertebrae can cause a decrease in height or,
in more severe cases, kyphosis in the upper back.
• Estrogen levels decrease after menopause, removal of the
ovaries, amenorrhea (lack of a menstrual cycle) due to
extreme exercise or anorexia nervosa (self-starvation), and
cigarette smoking.
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Osteoporosis
• In men, reduction in testosterone levels can cause a loss of
bone tissue. However, this is less of a problem in men than in
women because men have denser bones than women, and
testosterone levels generally don’t decrease significantly
until after age 65.
• Inadequate dietary intake or absorption of calcium,
sometimes due to certain medications, can also contribute
to osteoporosis. Absorption of calcium from the small
intestine decreases with age.
• Finally, too little exercise or disuse from injury can also cause
osteoporosis. Significant amounts of bone are lost after 8
weeks of immobilization.
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Osteoporosis
• Early diagnosis of osteoporosis can lead to more preventive
treatments. Instruments that measure the absorption of
photons (particles of light) by bone are used; of these, dual-
energy x-ray absorptiometry (DEXA) is considered the best.
• Supplementation with dietary calcium and vitamin D and
exercise are the best preventive and rehabilitory measures to
prevent bone loss or regain mild bone loss. Calcitonin
(Miacalcin) inhibits osteoclast activity, as does alendronate
(Fosamax), which binds to hydroxyapatite. Although
osteoporosis is linked to estrogen loss, estrogen therapy has
been associated with many side eff ects, including breast
cancer, and is no longer recommended as a treatment.
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Osteoporosis
Interactions Among Organ Systems and Osteoporosis
Representative Diseases and Disorders: Skeletal System
Representative Diseases and Disorders: Skeletal System
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THANK YOU!
• REFERENCES:
• Seeley’s Essentials of Anatomy and Physiology 10th Edition By Cinnamon
VanPutte and Jennifer Regan and Andrew Russo, 2019
• Seeley’s Laboratory Manual Essentials of Anatomy & Physiology 8th Edition By
Kevin Patton