Hand Out in Skeletal and Articular System

Additional Notes:

I. Functions of Bones
1. gives support 5. Provides attachments
2. form blood cells (red marrow) 6. Act as levers
3. protect internal organs 7. Stores fat (yellow marrow)
4. stores and releases minerals

Components:
1. Inorganic components (70%)
a. Hydroxyapatite crystals- Ca, PO4, Carbonates: important for structural bone configuration
b. Alkaline Phosphatase
c. Chondroitin SO4 + Glucosamine- important for bone and cartilage nutrition

2. Organic Components: living components (20%)

a. Cartilage type I- highly vascular e.g. bones, blood vessel walls
b. Cartilage type II – nonvascular
3. Water (10%)

II. Connective Tissue – bones, cartilage, tendons and ligaments

Matrix: contains:
a. collagen – a tough rope-like protein; makes cartilage tough
b. proteoglycans – large molecules consisting of polysaccharides attached to core proteins and makes
cartilage resilient and smooth
* As a result, cartilage is relatively rigid, but springs back to its original shape if it is bent or
slightly compressed; excellent shock absorber

● tendons and ligaments: contain large amounts of collagen fibers making these structures very
tough like ropes and cables
● bones contain collagen and minerals; most minerals in bones are in the form if CaPO4 crystals;
Hydroxyapatite

Structure of Bone
2 types of bone tissue
1. Compact bone
● found in the surface (external layer) of all bones; makes up the bulk of the diaphysis of long bones
● hard and dense, provide protection and support and help resist stress
● arranged in units called osteons or haversian System which provides a special system of channels
responsible for delivering nutrients and oxygen to the bone cells in compact bone
● rich in mineral salts
● no interconnecting spaces are seen

2. Cancellous or Spongy bone

● found within a layer of compact bone
● no osteons or Haversian Systems; instead arranged in columns called trabeculae
● poor in mineral salts
● contains cavities filled with red marrow
● makes up most of the bone tissue of short, flat and irregular bones, and the epiphyses of long
bones
● osteocytes in spongy bone obtain nutrients and oxygen directly from the marrow
Cells Found in Bone
1. Osteoblasts
⮚ are the bone cells responsible for the synthesis and secretion of the bone matrix
⮚ when bone matrix calcified, osteoblasts trapped in the lacunae called osteocytes.

2. Osteocytes
⮚ maintains the integrity of the surrounding amorphous matrix
⮚ releases calcium from the intercellular substance of the bone be resorbing the bone that surround
the cell (osteolysis) when there is increased demand for calcium.

3. Osteoclasts
⮚ primary bone cells responsible for resorption, often located in the concavities called Howship’s
⮚ lacunae- these concavities are actually areas that were resorbed by the osteoclasts

4. Osteoprogenitor or Osteogenic Cells

⮚ found in periosteum, endosteum and vascularized bony canals
⮚ form the layer of the periosteum that is closest to the bony surface
⮚ may become an osteoblast, osteoclast or chondroblast

Periosteum vs. Endosteum

1. Periosteum
⮚ covers the outer surface of a bone EXCEPT in the articulating surfaces
⮚ has an outer fibrous and an inner osteogenic layer
⮚ the outer fibrous layer primarily consists of dense connective tissue
⮚ the inner osteogenic layer is more cellular and more vascular and contains osteoblasts
⮚ with this osteogenic ability, the periosteum plays an important role in the growth, development,
repair and remodeling of bone
2. Endosteum
⮚ lines the interior of the bone cavity
⮚ much thinner than the periosteum and is often made of only a single layer of flattened cells

Bone Growth

Bones grow in length at the epiphyseal plate by a process that is similar to endochondral
ossification. The cartilage in the region of the epiphyseal plate next to the epiphysis continues to
grow by mitosis. The chondrocytes, in the region next to the diaphysis, age and degenerate.
Osteoblasts move in and ossify the matrix to form bone. This process continues throughout
childhood and the adolescent years until the cartilage growth slows and finally stops. When cartilage
growth ceases, usually in the early twenties, the epiphyseal plate completely ossifies so that only a
thin epiphyseal line remains and the bones can no longer grow in length. Bone growth is under the
influence of growth hormone from the anterior pituitary gland and sex hormones from the ovaries
and testes.

Even though bones stop growing in length in early adulthood, they can continue to increase in
thickness or diameter throughout life in response to stress from increased muscle activity or to
weight. The increase in diameter is called appositional growth. Osteoblasts in the periosteum form
compact bone around the external bone surface. At the same time, osteoclasts in
the endosteum break down bone on the internal bone surface, around the medullary cavity. These
two processes together increase the diameter of the bone and, at the same time, keep the bone from
becoming excessively heavy and bulky. (ref: NIH National Cancer Institute SEER training modules)
Classification of Bones according to Form

Long bones Humerus

, femur, fibula, tibia, phalanges, radius, ulna, metacarpals
Flat bones Skull bones (frontal, parietal and occipital bones); sternum, scapula
Short bones Carpals (except pisiform). Tarsals (except calcaneus)
Irregular bones Vertebra, pelvis, skull bones(sphenoid and maxilla), calcaneus
Pneumatic bones Skull bones whose marrow cavity has been replaced by air spaces
which are extensions of the nasal cavity and form resonating
chambers
Sesamoid bones Patella, pisiform

Parts of long bone

1. Epiphysis
⮚ part of the bone subjacent to the site of articulation; distal and proximal ends of the bone
⮚ site of secondary ossification center
2. Metaphysis
⮚ in mature bone this is where the diaphysis joins the epiphyses
⮚ in growing bone this is the location of the epiphyseal plate
⮚ site where increase in bone length occurs
3. Diaphysis
⮚ body or shaft of the bone bounded by the metaphysis superiorly and inferiorly
⮚ long, cylindrical, main portion of bone
⮚ site of primary ossification center

4. Epiphyseal Plate or Epiphyseal Cartilage

⮚ present only in young bone
⮚ cartilage between the epiphysis and diaphysis (in metaphysic) which is eventually replaced by
bone.
⮚ Made of hyaline cartilage; allows the diaphysis to grow in length but not in width

5. Medullary Cavity:
⮚ filled with yellow and red bone marrow
⮚ children have more red bone marrow
⮚ as person ages, red marrow us replaced with fat or yellow marrow
⮚ adult’s red marrow is confined in the central axis and in most proximal epiphysis
● Periosteum – covers the outer surface
● Endosteum – lines the inner surface

206 Bones – total number of bones in the body

Axial Skeleton

8 cranial bones – 1 frontal, 2 parietal, 1 occipital,2 temporal, 1 sphenoid, 1 ethmoid

13 facial bones – 2 maxillae, 2 palatine, 2 zygomatic,2 lacrimal,2 nasal, 2 inferior nasal conchae, 1 vomer
1 mandible
6 middle ear bones – 2 malleus/hammer, 2 incus/anvil, 2 stirrup/stapes
1 hyoid
26 vertebral bones – 6 cervical, 12 thoracic, 5 lumbar, 1 sarum,1 coccyx
25 thoracic cage – 24 ribs : 1-8 true ribs, 9-10 false ribs,11-12 floating ribs
1 sternum
80 – total axial bones

Appendicular Skeleton
4 pectoral – 2 scapula, 2 clavicle
60 upper limb bones – 2 humerus, 2 radius, 2 ulna,16 carpal bones, 10 metacarpal, 28 phalanges
2 pelvic bones
60 lower limb bones – 2 femur, 2 tibia, 2 fibula,2 patella,14 tarsal,10 metatarsal, 28 phalanges
126 – total appendicular bones
80 axial bones+ 126 appendicular bones = 206 bones
 Articular System

Joint – point of contact between two bones

Structural Classification
1. Fibrous – held by fibrous connective tissue without synovial cavity
2. Cartilaginous – held by cartilage; without synovial cavity
3. Synovial – united by dense irregular connective tissue; with synovial cavity

Functional Classification of Joints

1. Synarthrosis – immovable
2. Amphiarthrosis – slightly movable
3. Diarthrosis – firmly movable

I. Fibrous Joints – permit little or no movement

1. Sutures – e.g. skull bones
2. Syndesmosis – with interosseous membrane e.g. Distal tibiofibular jt.
3. Gomphosis - e.g. dentoalveolar jt. (rooths of teeth)

II. Cartilaginous
1. Synchondrosis – connected by hyaline cartilage e.g. epiphyseal plate of long bones
2. Symphysis – connected by fibrocartilage e.g. pubic symphysis

III. Synovial – connected by articular cartilage

A. Multiaxial – ball and Socket (enarthrodial, spheroidal, Universal) e.g. hip and shoulder jt.
B. Biaxial
b.1 Condyloid – e.g Metacarpophalangeal jt.
b.2. Ellipsoid – e.g. radiocarpal jt., mandibular, talotibial jt.
b.3 Saddle – e.g. carpometacarpal joint of the thumb

C. Uniaxial
c.1 Hinge (ginglymus) –e.g. IP jt., MCP jt., Talocrural jt.
c.2. Pivot (trochoid) – e.g. atlantolaxial jt, proximal radioulnar jt.,distal radioulnar joint.

D. Non – axial – e.g. acromioclavicular and interclavicular joint

Clinical Application

1. Vitamin A (retinol) responsible for chondroblasts

Condition Image
1. Vitamin A (retinol)
responsible for chondroblasts
osteoblastic and osteoclastic
activity
● Deficiency leads to night
blindness (rods more affected).
● Oversecretion leads to
periosteal and subperiosteal bone
formation (too much osteoblastic
activity inside and outside the
bone.
2. Vitamin C – important in
collagen synthesis and very good
for the healing process, good
antioxidant
● Deficiency leads to
Scurvy – s/sx: bleeding gums,
darkening of perioral area
because blood vessels easily
burst, brittle bones,
petechiae

3. Achondroplasia –
intramembranous ossification
persists with absence of
endochondral ossification

* most common form of short-

limb dwarfism
* severe mental retardation
4. Cleidocranial Dysostosis/
Dysplasia – underdeveloped
skull and clavicle

5. Paget’s dse /Osteitis

Deformans an autosomal
dominant dse

* Osteoblastic and osteoclastic

activity happening at the same
time
* Abnormally large skull and
irregularly shaped bones or limbs
6. Marfan’s syndrome –
abnormally long bones

Hypophosphatasia or
Hypophosphatemic rickets

type of osteomalacia with

involvement of kidneys due to
low Alkaline Phosphatase
(AP)
s/sx: brittle bones
tx: dialysis
Vitamin D (or, more
specifically, calcitriol) is
a steroid hormone that is
produced in the skin by the
action of
sunlight’s ultraviolet rays
on its precursor, 7-
dehydrocholesterol
(provitamin D3). Vitamin D
is also absorbed from the
diet, especially from
fortified milk and from
liver and fish oils.
Deficiency leads to a
condition called Rickets

. Heterotrophic Ossification –
due to high AP; hard bones
* Incidence of affectation: Hip>
Knee> Shoulder> Elbow
* with pathologic hard or
pathologic bone to bone end feel
* s/sx: hyperthermia or calor on
jts and body, fever, inflammation,
noninfectious
* meds: Disodium Etidronate
* Surgery: wedge resection
 Fracture- any break in the
continuity of the bone
*Healing process faster in upper
limb- 10 wks vs. 20 wks for lower
limbs
* Bone remodeling is maximum
at 2 yrs

Disclaimer: Images taken from various websites

* Stages of fracture healing (FGCCR)

1. Fracture hematoma – extravasation of fluid or blood
2. Granulation tissue formation – increased collagen fibers🡪 increased fibroblastic activity
May use Electrical stimulation: constant direct current
3. Callus formation – increased osteoblastic activity
a. Soft callus- initially formed
b. Hard callus- its presence signifies (+) union, POP cast may be removed and may start AROME
since bone is clinically healed at this stage
c. Types of union:
1. Delayed union – healed at a longer period
2. Mal union – healed at the right time but with deformities
3. Nonunion - > 6 mos. Fractured bone still not healed; may lead to
pseudoarthrosis
4. Consolidation – well-bridged bone but with excessive bony calluses
5. Remodeling – increased osteoblastic activity; must be complete by 2 yrs.

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