MUSCULOSKELETAL CONCEPTS

MUSCULOSKELETAL includes: y Bones y Joints y Muscle y Tendons y Ligaments y Bursae of the body ANATOMY AND PHYSIOLOGY BONY STRUCTURES -provides protection for vital organs like the brain, heart and lungs. BONY SKELETON -provides a sturdy framework to support bony structures. BONE MATRIX -stores a calcium, phosphorus, magnesium and fluoride. *98% of total body calcium is present in bones. BONES are composed of: HEMATOPOIESIS -is a process wherein the red bone marrow located within bone cavities produces red and white blood cells. JOINTS -hold the bones together and allow the body to move. *The muscle attached to the skeleton contracts, moving the bones and producing heat, helps maintain body temperature STRUCTURES AND FUNCTION OF SKELETAL SYSTEM *there are 206 bones in the human body and divided into 4 categories: y Long bones ( e.g femur ) y Short bones ( e.g metacarpals ) y Flat bones ( e.g sternum ) y Irregular bones ( e.g vertebrae ) *shaped and construction of a specific bones are determined by its function and forces exerted on it. BONE CONSTRUCTION y Cancellous ( trabecular ) y Cortical ( compact ) *long bones are shaped like rods or shafts with rounded ends. *SHAFTS ( diaphysis )-------------cortical bones *END OF THE BONE ( epiphyses )------------cancellous bone EPIPHYSEAL PLATE -separates the epiphyses from diaphysis -center for longitudinal growth in children -in adult it is calcified a. cells b. protein matrix c. mineral deposits 3 BASIC TYPES OF CELL a. osteoblast b. osteocytes c. osteoclasts OSTEOBLASTS -bone formation -secretes bone matrix ( consists of collagen and ground substances (glycoprotein and proteoglycans) Provides a framework in which inorganic mineral salts are deposited. OSTEOCYTES -mature bone cells involved in bone maintenance function -located in lacunae (bone matrix unit) OSTEOCLASTS -located in shallow Howships Lacunae (small pits on the bone) -are multinuclear cells involved in destroying, resorbing and remolding bones. OSTEON (Haversian System) -microscopic functioning unit of mature cortical bones. -center is Haversian Canal (contains capillary) -lamellae circles of mineralized bone matrix around the capillary ENDS OF A LONG BONES -covered at a joint by articular cartilages -cartilage is tough, elastic avascular tissue LONG BONES -designed for weight bearing and movements SHORT BONES -consists of cancellous bone covered by a layer of compact bones. FLAT BONES -important site for hematopoiesis and frequently provide vital organ protection. -they are made of cancellous bone layered between compact bones. IRREGULAR BONES -have unique shaped related to their function -similar structures with flat bones.

MUSCULOSKELETAL CONCEPTS
TRABECULAE (irregular lattice network) -is where lacunae in cancellous bones are layered -fills by Red Bone Marrow * capillaries nourish osteocytes located in the lacunae PERIOSTEUM -a dense, fibrous membrane covering the bones -nourishes bone and allows for its growth -provides attachment of tendons and ligaments -contains nerves, blood vessels and lymphatics -contains osteoblasts ENDOSTEUM -a thin, vascular membrane that covers the marrow cavity of long bones and spaces in cancellous bones -osteoclasts dissolves bone to maintain marrow cavity. BONE MARROW -is a vascular tissue located in Medullary (shaft) cavity of long bones and in flat bones. RED BONE MARROW -located mainly in the sternum,ilium, vertebrae and ribs in adult -responsible for producing red and white blood cells. *In adults, long bone is filled with fatty and yellow marrow. *Cancellous Bone receives a rich blood supply through metaphyseal and epiphyseal vessels. PERIOSTEAL VESSEL -carry blood to compact bone through minute Volkmanns Canal NUTRIENTS ARTERIES -penetrate the periosteum and enter the medullary cavity through foramina (small opening) Supplies blood to marrow and bone BONE FORMATION (OSTEOGENESIS) OSSIFICATION -is a process by which the bone matrix (collagen fibers and ground substances) is formed and hardening minerals (e.g calcium salts) are deposited on the collagen fibers. COLLAGEN FIBERS -give tensil strength to the bones CALCIUM -provides compressional strength Vitamin D (calcitrol) * functions to increase the amount of calcium in the blood by promoting absorption of calcium from the gastrointestinal tract *Bone 2 BASIC PROCESSESS OF OSSIFICATION 1. Endochondral 2. intramembranous

*Most bones in the body are formed by endochondral ossication, in which a cartilage-like tissue (osteoid) is formed, resorbed, and replaced by bone. *Intramembranous ossication occurs when bone develops within membrane, as in the bones of the face and skull.
BONE MAINTENANCE

is a dynamic tissue in a constant state of turnover resorption and formation.

REGULATING FACTORS that determine the balance between bone formation and bone resorption include: * * * * *

local stress vitamin D parathyroid hormone calcitonin blood supply.

FUNCTION acts to simulate bone formation and remodeling. INFORMATION Weight-bearing bones are thick and strong. Without weight-bearing or stress, as in prolonged bed rest, the bone loses calcium (resorption) and becomes osteopenic and weak. The weak bone may fracture easily. A deciency of vitamin D results in bone mineralization decit, deformity, and fracture.

FACTORS Local Stress (weight bearing)

* It also facilitates mineralization of osteoid tissue. Parathyroid * Parathyroid hormone and Hormone regulates calcitonin the concentration of calcium in the blood, in part by promoting movement of calcium from the bone *Calcitonin inhibits bone resorption and increases the deposit of calcium in bone.

Are the major hormonal regulators of calcium homeostasis. - In response to low calcium levels in the blood, increased levels of parathyroid hormone prompt the mobilization of calcium, the demineralization of bone, and the formation of bone cysts.

MUSCULOSKELETAL CONCEPTS

Blood Supply

affects bone formation

With diminished blood supply or hyperemia (congestion), osteogenesis (bone formation) and bone density decrease. Bone necrosis occurs when the bone is deprived of blood.

BONE HEALING 4 AREAS OF FRACTURE HEALING y Bone marrow, where endothelial cells rapidly undergo transformation and become osteoblastic bone-forming cells Bone cortex, where new osteons are formed Periosteum, where a hard callus/bone is formed through intramembranous ossification peripheral to the fracture, and where a cartilage model is formed through endochondral ossication adjacent to the fracture site External soft tissue, where a bridging callus (brous tissue) stabilizes the fracture

y y

stimulated by the release and activation of biologic regulators and signaling molecules:
6 STAGES OF FRACTURE HEALING (Buckwalter) 1.Hematoma and inflammation 2. Angiogenesis and cartilage formation

3. Cartilage calcication 4. Cartilage removal 5. Bone formation 6. Remodeling