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Anatomy, bones & joints

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This presentation is about the anatomy of the skeleton, bones, joints and anatomical terminology, thanks for your review

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Anatomy, bones & joints

  1. 1. Anatomy, Bones & Joints By: Hossein Khorrami PhD. khorrami4@yahoo.com http://www.scribd.com/khorrami4
  2. 2. Anatomical position  most widely used & accurate for all aspects of the body  standing in an upright posture, facing straight ahead, feet parallel and close, & palms facing forward
  3. 3. Anatomical planes  Median  Frontal (coronal)  Transverse
  4. 4. Body Planes and Sections  Coronal (frontal) plane - Lies vertically and divides body into anterior (front) and posterior (back) parts  Sagittal plane – lies vertically and divides the body into left and right sides.  Median (midsagittal) plane - Specific sagittal plane that lies vertically in the midline  Transverse plane - runs horizontally and divides body into superior (up) and inferior (down) parts
  5. 5. Anatomical directional terms • Anterior  in front or in the front part  Anteroinferior  in front & below  Anterosuperior  in front & above  Posterior  behind, in back, or in the rear  Posteroinferior  behind & below; in back & below  Posterolateral  behind & to one side, specifically to the outside
  6. 6. Orientation and Directional Terms
  7. 7. Orientation and Directional Terms
  8. 8. Orientation and Directional Terms
  9. 9. Regional Terms
  10. 10. Regional Terms
  11. 11. Body Cavities and Membranes  Dorsal body cavity  Cranial cavity  Cranial cavity houses the brain  Vertebral cavity  Vertebral cavity runs through the vertebral column and encloses the spinal cord
  12. 12. Body Cavities and Membranes  Ventral body cavity  Thoracic cavity  Two lateral parts each containing a lung surrounded by a pleural cavity  Mediastinum – contains the heart surrounded by the pericardial sac
  13. 13. Body Cavities and Membranes  Ventral body cavity  Abdominopelvic cavity  Abdominal cavity – contains the liver, stomach, kidneys, and other organs  Pelvic cavity – contains the bladder, some reproductive organs, and rectum
  14. 14. Body Cavities and Membranes  Serous cavities – a slit-like space lined by a serous membrane  Pleura, pericardium, and peritoneum  Parietal serosa – outer wall of the cavity  Visceral serosa covers the visceral organs
  15. 15. Body Cavities and Membranes
  16. 16. Other Body Cavities  Oral cavity  Nasal cavity  Orbital cavities  Middle ear cavities  Synovial cavities
  17. 17. Abdominal Regions and Quadrants  Abdominal regions divide the abdomen into nine regions
  18. 18. Abdominal Quadrants  Abdominal quadrants divide the abdomen into four quadrants  Right upper and left upper quadrants  Right lower and left lower quadrants
  19. 19. Bone functions  Supportive  Protection of brain & Sp.cord  Movement  Storage, minerals, fat  Hematopoiesis
  20. 20. Bone growth  Prenatal, after wk 8, starts mineralization  Postnatal, longitudinal and diameter
  21. 21. Classification of Bones Long bones Typically longer than wide Have a shaft with heads at both ends Contain mostly compact bone  Examples: Femur, humerus  Short bones  Generally cube-shape  Contain mostly spongy bone  Examples: Carpals, tarsals
  22. 22. Classification of Bones, cont.  Flat bones Thin and flattened, usually curved Thin layers of compact bone around a layer of spongy bone  Examples: Skull, ribs, sternum  Irregular bones  Irregular in shape  Do not fit into other bone classification categories  Example: Vertebrae
  23. 23. Bones The adult skeleton has 206 bones Two basic types of bone tissue  Compact bone  Homogeneous  Spongy bone  Small needle-like pieces of bone  Many open spaces
  24. 24. Long Bone Diaphysis  Shaft  Composed of compact bone Epiphysis  Ends of the bone  Composed mostly of spongy bone  Hematopoiesis
  25. 25. Structures of a Long Bone Periosteum  Outside covering of the diaphysis  Fibrous connective tissue membrane Sharpey’s fibers  Secure periosteum to underlying bone Arteries  Supply bone cells with nutrients
  26. 26. Structures of a Long Bone Articular cartilage  Covers the external surface of the epiphyses  Made of hyaline cartilage  Decreases friction at joint surfaces Figure 5.2a
  27. 27. Structures of a Long Bone Medullary cavity  Cavity of the shaft  Contains yellow marrow (mostly fat) in adults  Contains red marrow (for blood cell formation) in infants Figure 5.2a
  28. 28. Microscopic Anatomy of Bone Osteon (Haversian System) A unit of bone Central (Haversian) canal Carries blood vessels and nerves Perforating (Volkman’s) canal Canal perpendicular to the central canal Carries blood vessels and nerves
  29. 29. Bone Markings  Surface features of bones  Projections and processes – grow out from the bone surface  Depressions or cavities – indentations  Sites of attachments for muscles, tendons, and ligaments  Passages for nerves and blood vessels
  30. 30. Changes in the Human Skeleton In embryos, the skeleton is primarily hyaline cartilage During development, much of this cartilage is replaced by bone Cartilage remains in isolated areas  Bridge of the nose  Parts of ribs  Joints
  31. 31. Bone Growth Epiphyseal plates allow for growth of long bone during childhood  New cartilage is continuously formed  Older cartilage becomes ossified  Cartilage is broken down  Bone replaces cartilage
  32. 32. Bone Growth Bones are remodeled and lengthened until growth stops  Bones change shape somewhat  Bones grow in width
  33. 33. Long Bone Formation and Growth
  34. 34. Types of Bone Cells Osteocytes  Mature bone cells Osteoblasts  Bone-forming cells Osteoclasts  Bone-destroying cells  Break down bone matrix for remodeling and release of calcium Bone remodeling is a process by both osteoblasts and osteoclasts
  35. 35. COMPOSITION OF BONE: Bone 33% organic 28% collagen 5% non collagenous proteins 67% inorganic Hydroxyapatite
  36. 36. Composition of Bone… Inorganic component:  Hydroxyapatite crystals with carbonate content Organic component: - Osteoid  Type I collagen (95%)  type V collagen (<5%) Non collagenous proteins  Osteocalcin,  Osteopontin,  Bone sialoprotein,  Osteonectin.(SPARC)- Cell adhesion ,proliferation, modulation of cytokine activity.
  37. 37. OSTEOCYTES: Nerve cells Sense the change in environment and send signals that affect response of other cells involved in bone remodelling Maintains balance between resorption and remodelling  Bone that forms more rapidly shows more osteocytes
  38. 38. Osteocytic lacunae Canaliculi- narrow extension of lacunae, permits diffusion of gases and nutrients Maintains bone integrity and vitality Failure of inter connecting system between osteocytes and osteoblasts leads to sclerosis and death of bone
  39. 39. Osteoblasts : Derived from osteoprogenitor cells Periosteum serves as important reservoir . Morphology :  basophilic  cuboidal or slightly elongated cells contain prominent bundles of actin, myosin BONE CELLS:
  40. 40. Osteoblast, Functions  New bone formation  Controls bone mineralization at 3 levels 1. In its initial phase, by production of matrix vesicle 2. At a later stage, by controlling the ongoing process of mineralization 3. By regulating the number of ions available  Regulation of bone remodeling and mineral metabolism
  41. 41. Osteoblasts Functions  Secrete type I collagen, small amount of type V collagen, osteonectin, osteopontin, RANKL, osteoprotegerin, Proteoglycans, latent proteases and growth factors including bone morphogenic proteins  Exhibit high levels of alkaline phosphatase -cytochemical marker
  42. 42. BONE LINING CELLS: Osteoblasts flatten, when bone is not forming and extend along the bone surface and hence the name They are present on periosteal as well as endosteal surfaces
  43. 43. BONE RESORPTION: Osteoclasts Sequence of events of bone resorption: Involves 3 phases First phase - formation of osteoclast Second phase- activation of osteoclast Third phase - resorption of bone
  44. 44.  Alterations in the osteoclast  Removal of hydroxyapatite acidic environment by proton pump  Degradation of organic matrix acid phosphatase, cathepsin B  Removal of degradation products from lacunae endocytosis  Translocation of degraded products and extracellular release
  45. 45. Removal of hydroxyapatite: The initial phase involves the dissolution of the mineral phase – HCl The protons for the acid arise from the activity of cytoplasmic carbonic anhydrase II, which is synthesized in osteoclast. The protons are then released across the ruffled border into the resorption zone by an ATP consuming proton pump.  This leads to a fall in pH to 2.5 to 3.0 in the osteoclast resorption space.
  46. 46. As age increases resorption exceeds Cortical bone turnover-5% per year  Trabecular and endosteal surface – 15% per year Coupling The processes of bone synthesis and bone breakdown go on simultaneously and the status of the bone represents the net result of a balance between the two processes. This phenomenon is called coupling.
  47. 47. Hormones and coupling With the exception of calcitonin, all the hormones, cytokines, and growth factors that act on bone, as an organ, mediate their activity through osteoblasts Resorbing hormones act directly on osteoblasts, which then produce other factors that regulate osteoclast activity This results in both bone formation and bone resorption being coupled
  48. 48. To prevent accumulation of damaged bone by regenerating new bone Allowing to respond to the changes in mechanical forces Mineral homeostasis Functions of remodeling
  49. 49. Sequence of events in bone remodelling:
  50. 50. MEDIATORS OF BONE REMODELLING:  Parathyroid hormone  Calcitonin  Vitamin D metabolites i.e., 1, 25-dihydroxycholecalciferol  Cytokines  Prostaglandins  Growth factors  Corticosteroids  Mechanical factors  Bacterial products
  51. 51. Pathologies caused due to improper control of remodelling are: •Osteoporosis •Osteopetrosis* •Malignant bone tumors •Inflammatory joint diseases *Osteopetrosis is a bone disease that makes bones abnormally dense and prone to fracture Autosomal Dominant Osteopetrosis(ADO)
  52. 52. Bone remodeling
  53. 53. Bone formation  Piezoelectric effect  GH  Insulin  Estrogen  Androgen  Vitamin D  TGF-beta  PDGF  Calcitonin  PTH
  54. 54. Hormonal Control of Blood CaPTH; calcitonin secreted Calcitonin stimulates calcium salt deposit in bone Parathyroid glands release parathyroid hormone (PTH) Thyroid gland Thyroid gland Parathyroid glands Osteoclasts degrade bone matrix and release Ca2+ into blood Falling blood Ca2+ levels Rising blood Ca2+ levels Calcium homeostasis of blood: 9–11 mg/100 ml PTH
  55. 55. Response to Mechanical Stress  Trabeculae form along lines of stress  Large, bony projections occur where heavy, active muscles attach
  56. 56. Response to Mechanical Stress  Wolff’s law: a bone grows or remodels in response to the forces or demands placed upon it  Observations supporting Wolff’s law include  Long bones are thickest midway along the shaft (where bending stress is greatest)  Curved bones are thickest where they are most likely to buckle
  57. 57. Response to Mechanical Stress
  58. 58. The Skeletal System
  59. 59. Bones  270-300 bones at birth  206 in adults  Skull: 8  Facial bones: 14  Middle ear: 6  Hyoid  Upper limbs: 64 ( 10+54)  Pelvic girdle: 3  Lower limb: 60 (8+52)  Vertebrae: 33(7+12+5+5+4)  Ribs: 24  Sternum
  60. 60. Joint definition  Joints connect the components of the skeletal system together  They give the skeletal system flexibility, and allow muscles to direct movements by moving bones in different directions
  61. 61. Joints Articulations of bones Functions of joints  Hold bones together  Allow for mobility Ways joints are classified  Functionally  Structurally
  62. 62. Functional Classification of Joints Synarthrosis – immovable joints Amphiarthrosis – slightly moveable joints Diarthrosis – freely moveable joints
  63. 63. Synarthrosis
  64. 64. Functional classification, 187 joints in body  Synarthrosis are immovable joints; these joints are common where protection of delicate internal structures  Skull, mandible  Amphiarthrosis are slightly movable joints; connected by broad flattened disks of fibrocartilage, of a more or less complex structure, which adhere to the ends of each bone  Vertebrae, pubic symphysis, sternocostal joint  Diarthrosis are freely movable joints; these joints dominate in the limbs and areas of the body where movement is important
  65. 65. Amphiarthrosis
  66. 66. Diarthrosis
  67. 67. Structural classification  Fibrous joints allow very little movement, and are composed of fibrous (dense) connective tissue  skull sutures, tibia and fibula  Cartilaginous joints allow very little or no movement, and are characterized by a connection between adjoining bones made of cartilage, no joint cavity  1. Fibrocarlilage  2. Hyaline cartilage  The pubic symphysis, intervertebral joints and connection between the first rib and sternum are slightly movable cartilaginous joints. The epiphyseal plate of growing bones is an immovable cartilaginous joint.  Synovial joints are the most complex of the joint types. They are characterized by articular (hyaline) cartilage covering the ends of bones, a fibrous articular capsule (composed of fibrous connective tissue) lined with synovial membrane, a joint cavity containing synovial fluid and reinforcing ligaments to hold the bones together  Between the bones of the limbs.  Bursae: flattened fibrous sacs lined with synovial membrane that develop in areas of friction  Tendon sheaths are special bursae that wrap around tendons in areas of friction
  68. 68. Fibrous Joints Bones united by fibrous tissue Examples  Sutures  Syndesmoses  Allows more movement than sutures  Example: distal end of tibia and fibula
  69. 69. Cartilaginous Joints Bones connected by cartilage Examples  Pubic symphysis  Intervertebral joints
  70. 70. Synovial Joints Articulating bones are separated by a joint cavity Synovial fluid is found in the joint cavity
  71. 71. Features of Synovial Joints Articular cartilage (hyaline cartilage) covers the ends of bones Joint surfaces are enclosed by a fibrous articular capsule Have a joint cavity filled with synovial fluid Ligaments reinforce the joint
  72. 72. Structures Associated with the Synovial Joint Bursae – flattened fibrous sacs  Lined with synovial membranes  Filled with synovial fluid  Not actually part of the joint Tendon sheath  Elongated bursa that wraps around a tendon
  73. 73. Synovial joints  Some synovial joints such as knee and hip have fatty pads between the fibrous capsule and the bone  Some have discs or wedges of fibrocartilage separating the articular surface of bones (menisci of knee)  Some synovial joints have bursa which is a fluid filled sac containing the synovial fluid to decrease the friction
  74. 74. The Synovial Joint
  75. 75. Synovial joints  Joint cavity  Articular cavity  Articular capsule  Synovial fluid  Reinforcing ligaments  Nerve & blood vessels
  76. 76. Synovial joint
  77. 77. Types of Synovial Joints Based on Shape
  78. 78. Types of Synovial Joints Based on Shape
  79. 79. Synovial joints classification  Nonaxial(plane): carpal bones  Uniaxial joint: one degree of freedom  Hinge: elbow  Pivot: Atlas & Axis  Biaxial joint:  Saddle: thumb carpal-metacarpal  Condyloid: MCP in fingers  Triaxial joint(multiaxial joint)  Ball & socket: humeroscapular
  80. 80. • Plane joints connect two flat surfaces of bone to one another, and only allow side-to-side movement with no rotation, so called nonaxial joints. Flat wrist bones • Hinge joints connect a cylindrical bone end to a concave portion of another bone. Rotation can occur in only one plane (like a door hinge), so called uniaxial joints. Elbow and ankle • Pivot joints connect the rounded end of one bone to a ring or sheath formed by another bone, so are uniaxial joints. Radius & ulna, atlas & axis • Condyloid joints fit the rounded convex articular surface of one bone into the rounded concave surface of another bone. Allow side to side and forwards- backwards movements, but no rotation, similarly to saddle joints, so are biaxial joints. Knuckles • Saddle joints are characterized by concave and convex surfaces on both articular surfaces. Allow side to side and forwards-backwards movements, but no rotation, so are biaxial joints. Carpal & metacarpal of the thumb • Ball-and-socket joints join the spherical end of one bone to the concave, rounded socket of another bone. Allow movement in all axes and rotation, and are therefore multiaxial joints. shoulder and hip
  81. 81. Motion depends on:  Joints  Muscle and tendon  Ligaments  Capsule  Skin  Other soft tissues such as vessels, adipose tissue, nerves & etc.
  82. 82. Capsular joint  Joint mobilization  Capsular excess  Joint play
  83. 83. The Axial Skeleton Forms the longitudinal part of the body Divided into three parts  Skull  Vertebral column  Bony thorax
  84. 84. The Axial Skeleton
  85. 85. The Vertebral Column Vertebrae separated by intervertebral discs The spine has a normal curvature Each vertebrae is given a name according to its location
  86. 86. Structure of a Typical Vertebrae
  87. 87. Cervical vertebrae  Unlike the other parts of the spine, the cervical spine has TRANSVERSE FORAMINA in each vertebra for the vertebral arteries  Classify to upper and lower parts
  88. 88. Cervical, Upper part  The upper cervical spine consists of the atlas (C1) and the axis (C2)  These first 2 vertebrae are quite different from the rest of the cervical spine  The atlas articulates superiorly with the occiput (the atlanto-occipital joint) and inferiorly with the axis (the atlantoaxial joint)  The atlantoaxial joint is responsible for 50% of all cervical rotation; the atlanto-occipital joint is responsible for 50% of flexion and extension  The unique features of C2 anatomy and its articulations complicate assessment of its pathology
  89. 89. Atlas & Axis Zygapophyseal Joint
  90. 90. Steel’s Rule of Thirds  At the level of the atlas, the odontoid process, the subarachnoid space, and spinal cord each occupy one third of the area of the spinal canal
  91. 91. Axis  The axis is composed of a vertebral body, heavy pedicles, laminae, and transverse processes, which serve as attachment points for muscles  The axis articulates with the atlas via its superior articular facets, which are convex and face upward and outward
  92. 92. Axis  At birth, a vestigial cartilaginous disc space called the neurocentral synchondrosis separates the odontoid process from the body of C2  The synchondrosis is seen in virtually all children aged 3 years and is absent in those aged 6 years  The apical portion of the dens ossifies by age 3-5 years and fuses with the rest of the structure around age 12 years  This synchondrosis should not be confused with a fracture
  93. 93. Lower Cervical Spine
  94. 94. Joint of Luschka
  95. 95. Joint of Luschka  The joint believed to be the result of degenerative changes in the annulus, which lead to fissuring in the annulus and the creation of the joint  Can develop osteophytic spurs, which can narrow the intervertebral foramina
  96. 96. Facet Joints  The facet joints in the cervical spine are diarthrodial synovial joints with fibrous capsules  The joint capsules are more lax in the lower cervical spine than in other areas of the spine to allow gliding movements of the facets  The joints are inclined at an angle of 45° from the horizontal plane and 85° from the sagittal plane  This alignment helps prevent excessive anterior translation and is important in weight-bearing
  97. 97. Intervertebral Discs  These disks are composed of 4 parts: the nucleus pulposus in the middle, the annulus fibrosis surrounding the nucleus, and 2 end plates that are attached to the adjacent vertebral bodies  They serve as force dissipators, transmitting compressive loads throughout a range of motion  The disks are thicker anteriorly and therefore contribute to normal cervical lordosis
  98. 98. Cervical
  99. 99. Rule of Threes
  100. 100. Regional Characteristics of Vertebrae
  101. 101. Facet Joints*  To guide and limit mvmts in vertebral segments  Cartilage  Synovial fluid  Nerve & blood vessels  Ligaments  *Zygapophyseal(Z-joint)
  102. 102. Facet Joint Orientation, Cervical  Cervical Region: 45 degrees; frontal plane; all movements are possible such as flexion, extension, lateral flexion, and rotation  The articulating facets in the cervical vertebrae face 45o to the transverse plane and lie parallel to the frontal plane, with the superior articulating process facing posterior and up and the inferior articulating processes facing anteriorly and down
  103. 103. Facet Joint Orientation, Thoracic  Thoracic Region: 60 degrees; frontal plane; lateral flexion and rotation; no flexion/extension  The facet joints between adjacent thoracic vertebrae are angled at 60° to the transverse plane and 20° to the frontal plane, with the superior facets facing posterior and a little up and laterally and the inferior facets facing anteriorly, down, and medially
  104. 104. Costovertebral Joints
  105. 105. Ribs
  106. 106. Facet Joint Orientation, Lumbar  Lumbar Region: 90 degrees; sagittal plane; only flexion and extension  The facet joints in the lumbar region lie in the sagittal plane; the articulating facets are at right angles to the transverse plane and 45° to the frontal plane  The superior facets face medially, and the inferior facets face laterally, this changes at the lumbosacral junction, where the apophyseal joint moves into the frontal plane and the inferior facet on L5 faces front  This change in orientation keeps the vertebral column from sliding forward on the sacrum
  107. 107. Discus  Nucleus pulposus  Annulus fibrosus
  108. 108. Discus  Pressure on lumbar disc  Lying or standing: 17 PSI  Sitting or bending to lift: up to 300 PSI
  109. 109. Disc Problems  Disc Prolapse: annulus fibrosus is intact  Disc Protrusion: annulus fibrosus involved  Disc Herniation: tearing annulus fibrosus & bulge out nucleus 
  110. 110. Herniation Stages  1) Disc Degeneration: chemical changes associated with aging causes discs to weaken, but without a herniation  2) Prolapse: the form or position of the disc changes with some slight impingement into the spinal canal. Also called a bulge or protrusion  3) Extrusion: the gel-like nucleus pulposes breaks through the annulus fibrosus but remains within the disc  4) Sequestration: nucleus pulposus breaks through the annulus fibrosus and lies outside the disc in the spinal canal
  111. 111. Disc problem, Risk Factors  Aging  Decrease bone density, muscle & ligament weakness  Improper lifting  Smoking  Strenuous repetitive activities  Obesity  Sudden pressure
  112. 112. Lumbar Area Problems  Lordosis  Disc problems  Facet joints problems(dysfunction)  Degenerative vertebrae secondary to degenerative disc  Spondylolisthesis
  113. 113. Posterior Longitudinal Ligament
  114. 114. Facet Joint Syndrome  OA  Disc degeneration  Pressure overload  Aging
  115. 115. Facet Joint Syndrome  Narrowing the joint space  Friction and destroying articular cartilage and the fluid  Wear away cartilage  Bone spurs  Compress nerve  More bone spurs extend to the spinal canal  Spinal stenosis
  116. 116. Facet Joint Symptoms  Difficulty in head rotation  Difficulty in straightening back and get up of a chair  Pain, numbness, muscle weakness,..
  117. 117. FJS Treat  Ice, to reduce inflammation  Ultrasound, Electrostimulation to reduce muscle spasm  Massage, traction, mobilization to increase ROM and reduce pain  Exercise for more stability
  118. 118. Spondylolisthesis  Birth defect  Rapid growth during adolescence  Football  Weightlifting  Wrestling  Gymnastics  Track and field…
  119. 119. Sternum
  120. 120. Clavicle
  121. 121. Acromioclavicular Joint  To allow the scapula additional range of rotation on the thorax  Allow for adjustments of the scapula (tipping and internal/external rotation) outside the initial plane of the scapula in order to follow the changing shape of the thorax as arm movement occurs  The joint allows transmission of forces from the upper extremity to the clavicle
  122. 122. Sternoclavicular Joint  Plane style synovial joint  Fibrocartilage joint disk  Ligaments  Anterior sternoclavicular ligament  Posterior sternoclavicular ligament  Costoclavicular lig  Interclavicular lig
  123. 123. Sternoclavicular Joint
  124. 124. The Bony Thorax Forms a cage to protect major organs
  125. 125. The Bony Thorax Made-up of three parts  Sternum  Ribs  Thoracic vertebrae
  126. 126. The Appendicular Skeleton Limbs (appendages) Pectoral girdle Pelvic girdle
  127. 127. The Pectoral (Shoulder) Girdle Composed of two bones  Clavicle – collarbone  Scapula – shoulder blade These bones allow the upper limb to have exceptionally free movement
  128. 128. Bones of the Shoulder Girdle
  129. 129. Bones of the Shoulder Girdle
  130. 130. Bones of the Upper Limb The arm is formed by a single bone  Humerus
  131. 131. Bones of the Upper Limb The forearm has two bones  Ulna  Radius
  132. 132. Bones of the Upper Limb The hand  Carpals – wrist  Metacarpals – palm  Phalanges – fingers So Long To Pinky, Here Comes The Thumb
  133. 133. Right Hand
  134. 134. Bones of the Pelvic Girdle Hip bones Composed of three pair of fused bones  Ilium  Ischium  Pubic bone The total weight of the upper body rests on the pelvis Protects several organs  Reproductive organs  Urinary bladder  Part of the large intestine
  135. 135. The Pelvis
  136. 136. The Pelvis: Right Coxal Bone
  137. 137. Gender Differences of the Pelvis
  138. 138. Lower Limbs The thigh has one bone  Femur – thigh bone
  139. 139. Lower Limbs, distal The leg has two bones  Tibia  Fibula
  140. 140. Foot The foot  Tarsus – ankle  Metatarsals – sole  Phalanges – toes
  141. 141. Arches of the Foot Bones of the foot are arranged to form three strong arches  Two longitudinal  One transverse
  142. 142. Assessment  Manual muscle test (MMT)  Range Of Motion (ROM)
  143. 143. ROM benefits  To determine presence of impairment  Establishing a diagnosis  Evaluation of progress  Modify the treatment  Motivate the patient  Research
  144. 144. Definitions  Power: work produced /time  For more power: more repetition  Strength: contract against external load  Endurance: perform activities over prolonged period  Flexibility: ability to move a single joint or series of joints smoothly & easily through an unrestricted pain-free ROM  Plasticity: property of skeletal muscle that allow for a new & greater length after a stretch that has been applied
  145. 145. Manual Muscle Testing(MMT) Grade Result 0 No contraction, no movement 1 Visible contraction, a little 2 Visible contraction, full ROM in elimination of gravity 3 Visible contraction, full ROM against gravity 4 Full ROM with moderate resistance 5 Full ROM with max resistance
  146. 146. Joint improvement  Passive range of motion  Active range of motion  Active assistive range of motion  Strengthening  Isometric  Isotonic  Concentric  Eccentric  Stretching
  147. 147. Benefits of exercises  Increase & maintain muscle strength  Increase endurance  Improve & maintain ROM  Increase circulation  Increase flexibility  Improve balance & coordination  Increase CV fitness  Improve sense of wellbeing
  148. 148. Stretching, indications  Adhesion, contracture, scar tissue  Decreased ROM(may lead deformity)  Part of a fitness program to prevent injury  Warm-up & cool-down exercise
  149. 149. Stretching, contra-indications  Recent fracture, incomplete bony union  Muscle ossification  Acute inflammation, infection  Sharp pain  Hematoma in muscle or area  Hypermobility
  150. 150. Characters of stretching  Intensity  Duration: 30sec  Frequency: 5-7/day  Speed: slowly
  151. 151. Inflammatory Conditions Associated with Joints Bursitis – inflammation of a bursa usually caused by a blow or friction Tendonitis – inflammation of tendon sheaths Arthritis – inflammatory or degenerative diseases of joints  Over 100 different types  The most widespread crippling disease in the United States
  152. 152. Clinical Forms of Arthritis Osteoarthritis  Most common chronic arthritis  Probably related to normal aging processes Rheumatoid arthritis  An autoimmune disease – the immune system attacks the joints  Symptoms begin with bilateral inflammation of certain joints  Often leads to deformities
  153. 153. Clinical Forms of Arthritis Gouty Arthritis  Inflammation of joints is caused by a deposition of urate crystals from the blood  Can usually be controlled with diet
  154. 154. Developmental Aspects of the Skeletal System At birth, the skull bones are incomplete Bones are joined by fibrous membranes – fontanelles Fontanelles are completely replaced with bone within two years after birth
  155. 155. The Skull Two sets of bones  Cranium  Facial bones Bones are joined by sutures Only the mandible is attached by a freely movable joint
  156. 156. The Skull
  157. 157. Human Skull, Superior View
  158. 158. Human Skull, Inferior View
  159. 159. Paranasal Sinuses Hollow portions of bones surrounding the nasal cavity
  160. 160. Paranasal Sinuses Functions of paranasal sinuses  Lighten the skull  Give resonance and amplification to voice
  161. 161. The Hyoid Bone The only bone that does not articulate with another bone Serves as a moveable base for the tongue
  162. 162. The Fetal Skull The fetal skull is large compared to the infants total body length
  163. 163. The Fetal Skull Fontanelles – fibrous membranes connecting the cranial bones  Allow the brain to grow  Convert to bone within 24 months after birth
  164. 164. Thank you
  165. 165. Bone Fractures A break in a bone Types of bone fractures  Closed (simple) fracture – break that does not penetrate the skin  Open (compound) fracture – broken bone penetrates through the skin Bone fractures are treated by reduction and immobilization  Realignment of the bone
  166. 166. Common Types of Fractures
  167. 167. Repair of Bone Fractures Hematoma (blood-filled swelling) is formed Break is splinted by fibrocartilage to form a callus Fibrocartilage callus is replaced by a bony callus Bony callus is remodeled to form a permanent patch
  168. 168. Stages in the Healing of a Bone Fracture

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