Bones and JointsNormal Structure of Bones Depends on  Interaction of bones with muscles Hormonal regulation of calcium and phosphate metabolism Homeostasis of bone formation and bone resorption Osteoclasts vs. osteoblastsFunctions of Bones Movement of limbs, via mechanical support of muscles Protection of the internal organs Ribs, skull House bone marrow cells Medullary canal Storage of calcium and phosphate saltsFacts to know about Bones Bones are living tissues Constantly change, based on stress (pressure and tension) Hypertrophy, deconditioning Bones are not affected by autoimmune diseases Joints are affected by autoimmune diseases Rheumatoid arthritisJoints Form the junction between 2 bones Provide skeletal support Provide firmness to the skeleton Provide ability for movement to occurPathologySprain Injury to the ligamentous structures around a joint Classified depending on amount of tissue damage First, second, third degreeDislocations Complete loss of joint integrity with loss of anatomic relationships Often significant ligamentous damage occurs Subluxation: partial disruption of anatomic relationship within the jointHeterotropic Ossification Bone formation in muscle and other soft tissue areas Occurs mostly after trauma Symptoms: May be asymptomatic Pain and loss of motion Edema, warmth, erythema, tenderness PT: Gentle PROM- no forcible manipulationOsteogenesis Imperfecta “defective bone formation” Related to gene mutations encoding collagen type I Collagen type I Widespread in the body Thin skin, defective heart valves Affects bones and connective tissue Clinical presentation depends on severity of diseaseOsteogenesis Imperfecta“This newborn has short extremities due to multiple intrauterine fractures. Multiple rib fractures were present also. This is the neonatal lethal type of OI.”http://www.brown.edu/Courses/Digital_Path/systemic_path/bone/ogi1.htmlOsteomyelitis Inflammation of the bones caused by an infectious organism In children, infection occurs via the circulatory system Bacteria enters the metaphysis through arteries supplying nutrients to the bone Metaphysis very porous, so the infection spreads easily and multiplies rapidly→ forms pus → spreads to the to adjacent portions of the epiphysisOsteomyelitis Pus filled cavities form → body attempts to wall off infection by producing reactive bone Bone deformities result, increasing predisposition to fractures Fractures heal poorly because of pus in the area In adults… usually result of puncture wound into bone or respiratory/urinary tract infectionOsteomyelitishttp://graphics8.nytimes.com/images/2007/08/01/health/adam/9712.jpg http://podiatry.files.wordpress.com/2007/03/fig1staphsimosteo.jpgOsteomyelitis Clinical Manifestations Vary between adults and children Pain Fever Local manifestations: edema, erythema, tendernessOsteomyelitis Risk factors: Chronic illness Surgical procedure to bone Open fracture Implanted orthopedic device Treatment Antibiotics Surgical drainage of pus Surgical repair of defectOsteoporosis Characterized by reduction of total bone mass density (BMD)and microdamage to bone structure that results in susceptibility to fractureshttp://content.revolutionhealth.com/contentimages/images-image_popup-w7_osteoporosis.jpg http://www.healthline.com/images/staywell/37381.jpgOsteoporosis Most common metabolic bone disease Osteoporosis is a major public health threat for an estimated 44 million Americans Primarily a disease of older age But…can occur at any age 80% are ♀Adopted from: http://www.nof.org/osteoporosis/diseasefacts.htmOsteoporosis Risk Factors Gender Race Family history Age Low body weight Early menopause  Low physical activity levels Calcium and Vit D intake alcohol, smoking, caffeineOsteoporosis Severity depends on: Initial bone mass Bone mass peaks at ages 25-35 Then bone resorption > bone formation Process accelerated after menopause  Body size Diet and lifestyle (intake of Vit D and calcium, ETOH, smoking) Hormones (estrogen) Age-related changes with metabolismOsteoporosis Primary Etiology unknown Accounts for most cases Disease of elderly ♀>♂ Secondary Hormonal disturbances Inadequate intake or malabsorption  Immobilization Drugs (anticonvulsants, anticoagulants) Tumors (hormonal lesions, lesions that destroy the bone directly)Osteoporosis Clinical Presentation Symptoms can be nonspecific Fractures Head of femur, distal radius, vertebrae, hips, ribs  In vertebrae, usually anterior wedge or compression fracture Vertebral fractures cause: Dowager’s hump Gradual height loss Protuberant lower abdomen Forward flexed postureOsteoporosis  Prevention 85-90% of adult bone mass is acquired by age 18 in girls and 20 in boys Tips Intake of Vit. D and Calcium Weight bearing and strengthening exercise Avoid smoking and excessive alcoholAdopted from: http://www.nof.org/osteoporosis/diseasefacts.htmOsteoporosis  Diagnosis: Bone mineral density testing X-rays to diagnose fractures Treatment: No cure Intervention to stop the progression of bone loss Medications ExerciseOsteomalacia “softening of the bones”  Vitamin D deficiency or deficiency of phosphate metabolism causes inadequate mineralization of bone matrix Diagnosis difficult and delayed Most initially present with diffuse, generalized aching and fatigue Deformities of bones common Bowlegs common because bones unable to carry body weight Thoracic kyphosisPaget’s Disease Metabolic bone disease Etiology  Unknown Pathogenesis Initial stage: osteoclasts proliferate unrestrained Bone resorption rapid and osteoblasts cannot keep up Bone replaced with fibrous tissue Osteoblastic sclerotic phasePaget’s Disease Symptoms Asymptomatic  Bone pain, arthritis, deformities, fractures Thickened cranial bones may compress CNs →headaches, hearing loss, dizziness Treatment Meds to inhibit bone resorption Goal is to induce full remission and prevent complications of the diseasePaget’s Disease PT  Symptomatic treatment Encourage regular exercise Fall preventionFractures Defect in the