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

2. The anterior and posterior human skeleton.
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Medical Terminology, 6e
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Figure 6.1
The anterior and posterior human skeleton.

3. 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).

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

5. Bones Classification of bones Flat Long Short Irregular Sesmoid
Sutural or wormian

6. Classification of bones by shape.
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Figure 6.2
Classification of bones by shape.

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8. 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.

9. The features found in a long bone.
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Figure 6.3
The features found in a long bone.

10. Bones Structure of a Long Bone Epiphysis Diaphysis Periosteum Compact
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.

11. Bones Structure of a Long Bone Medullary canal Endosteum
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.

12. 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.

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14. CONDYLE

15. CREST

16. FISSURE

17. FORAMEN

18. FOSSA

19. HEAD

20. MEATUS

21. PROCESS

22. SINUS

23. SULCUS

24. 3) Tubercle: Small rounded projection
4) Tuberosity: large rounded or roughened projection
5) Trochanter: very large, blunt projection
(only on femur)
Proximal Tibia

25. 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.

26. 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.

27. Figure 6.4 Knee joint. Copyright ©2008 by Pearson Education, Inc.
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Figure 6.4
Knee joint.

28. Types of body movements.
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Figure 6.5
Types of body movements.

29. Classification of Joints Animation
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30. Movement of Joints Animation
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31. Click here to view an animation of adduction.
Adduction Animation
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32. Click here to view an animation of extension.
Extension Animation
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33. Circumduction Animation
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34. Dorsiflexion Animation
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35. 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.

36. Click here to view an animation of hand opposition.
Opposition Animation
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37. Click here to view an animation of flexion.
Flexion Animation
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38. Click here to view an animation of inversion.
Inversion Animation
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39. Click here to view an animation of pronation
Pronation Animation
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40. 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.

41. 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.

42. Click here to view an animation of rotation.
Rotation Animation
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43. Vertebral Column
Composed of a series of bones called vertebrae. They are connected in such a way as to form four spinal curves.

44. Vertebral Column These curves consist of the: Cervical Thoracic Lumbar
The first 7 vertebrae.
Thoracic
The next 12 vertebrae.
Lumbar
The next 5 vertebrae.
Sacral
Consists of the sacrum and coccyx (tailbone).

45. Vertebral (spinal) column.
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Figure 6.6
Vertebral (spinal) column.

46. 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.

47. 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.

48. The Male and Female Pelvis
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.

49. Copyright ©2008 by Pearson Education, Inc.
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Figure 6.8(a)
The male pelvis (android) is shaped like a funnel, forming a narrower outlet than the female.

50. Click here to view an animation of the male pelvis.
Male Pelvis Animation
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51. The Male and Female Pelvis
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.

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

53. Female Pelvis Animation
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54. 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.

55. Life Span Considerations: The Child
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.

56. Life Span Considerations: The Child
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.

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

58. 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.

59. Life Span Considerations: The Older Adult
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.

60. Life Span Considerations: The Older Adult
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.

61. Building Your Medical Vocabulary
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.
Prefixes (P)
Roots (R)
Combining Forms (CF)
Suffixes (S)

62. 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.

63. Copyright ©2008 by Pearson Education, Inc.
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Figure 6.10
This girl has a long leg cast, which was applied after surgery to correct her clubfoot.

64. Copyright ©2008 by Pearson Education, Inc.
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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.

65. Figure 6.12 Hammertoe. Copyright ©2008 by Pearson Education, Inc.
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Figure 6.12
Hammertoe.

66. Abscess of the brain due to osteomyelitis.
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Figure 6.13
Abscess of the brain due to osteomyelitis.

67. Typical hand deformities associated with rheumatoid arthritis.
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Figure 6.14
Typical hand deformities associated with rheumatoid arthritis.
(Reprinted with permission of Photo Researchers, Inc.)

68. Copyright ©2008 by Pearson Education, Inc.
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Figure 6.15
Does 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.

69. Copyright ©2008 by Pearson Education, Inc.
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Figure 6.16
Traction 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.

70. 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.

71. 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.

72. 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.

73. 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.

74. 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.

75. Click here to view a video on the topic of arthroscopy.
Arthroscopy Video
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76. Diagnostic and Lab Tests
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.

77. Using a goniometer to measure joint ROM.
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Figure 6.17
Using a goniometer to measure joint ROM.

78. Diagnostic and Lab Tests
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.

79. Diagnostic and Lab Tests
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.

80. Diagnostic and Lab Tests
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.

81. Diagnostic and Lab Tests
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.

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83. 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.

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

85. Abnormal Curvatures of the Spine
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.

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

87. Abnormal Curvatures of the Spine
Scoliosis
An abnormal lateral curvature of the spine, which usually appears in adolescence, during a period of rapid growth.

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

89. 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.

90. Arthritis Types of arthritis include: Osteoarthritis Gout
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.

91. Click here to view a video on the topic of arthritis.
Arthritis Video
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92. X-ray showing typical joint changes associated with osteoarthritis.
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Figure 6.19
X-ray showing typical joint changes associated with osteoarthritis.
(Source: Getty Images/Stone Allstock.)

93. Gout of the finger joint.
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Figure 6.20
Gout of the finger joint.
(Source: Reprinted from the Clinical Slide Collection on the Rheumatic Diseases, © 1991, Used by permission of the American College of Rheumatology.)

94. Multisystem effects of rheumatoid arthritis.
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Figure 6.21
Multisystem effects of rheumatoid arthritis.

95. 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.

96. Copyright ©2008 by Pearson Education, Inc.
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Figure 6.22
Cross-section of wrist showing tendons and nerves involved in carpal tunnel syndrome.

97. Carpal Tunnel Syndrome Video
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98. 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.

99. Various types of fractures.
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Figure 6.23
Various types of fractures.

100. Fractures Classification of Fractures: Closed or simple
Open or compound
Comminuted
Transverse
Greenstick

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

102. Fractures Classification of Fractures: Spiral Colles’ Pott’s
Compression
Epiphyseal

103. Bone Healing Animation
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104. 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.

105. Spinal changes caused by osteoporosis.
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Figure 6.25
Spinal changes caused by osteoporosis.