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CHAPTER 15 Chapter 15 is titled “Musculoskeletal System” in The Language of Medicine textbook. Introduction The Musculoskeletal System includes the bones, muscles, and joints. Under the introduction, you will see information regarding the functions of the bones, joints, and muscles 

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The bones provide a framework for which the body will be protected and support our internal organs o They also help the body in movement o They also serve as an attachment for our muscles The joints are places where bones come together o We have different types of joints in the body Muscles whether they are attached to bones or internal organs, they are responsible for movement Tendons are connective tissue that binds muscles to bone, and ligaments bind bone to bone Orthopedists are physicians who treat bone, joint, and muscle conditions Rheumatologists are physicians who specialize primarily in joint problems. A medical doctor has the credential MD, whereas Osteopathic physicians have the credential DO (Doctor of Osteopathy) o Both of them can specialize in orthopedics or rheumatology event though their education is very similar, and both of them can perform surgery and prescribe medicine, the osteopaths have additional training which highlights the musculoskeletal system and deal a lot with emphasizing body mechanics that help to promote health We also have a chiropractor o Even though a chiropractor is not a medical doctor, they do have extensive training in using physical manipulation of especially the spinal column and joints and soft tissues A physical therapist has a masters or PhD (a doctoral degree) and they are a healthcare professional who is trained in regards to actually fulfilling a treatment plan that a physician may have to restore a patient’s mobility and to help with pain relief

Bones: Processes and Depressions in Bones 

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Bone processes are areas that stick out or extend from the bone o The purpose of the extension is to serve as an attachment for muscles, tendons, and ligaments Bone depressions are openings or hollow regions o The purpose of these openings are to serve as a connection between bones, or to provide a passageway for the blood vessels and nerves as well There is a table in your textbook which you need to know the description of the bone processes

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o So bone head is described as the rounded end of a bone o Condyle is described as the rounded knuckle like process o Epicondyle is described as a small rounded process around the condyle o Trochanter is the large and small processes that provide tendon attachment o Tuberosity is a small round elevation where tendons and muscles attach You also need to review the list of bone depressions: o A fissure is a narrow groove or slit like opening o Foramen is an opening for blood vessels and nerves o Fossa is a shallow cavity that can be in or on a bone o Sinus is a hollow cavity that is found within bone Your textbook also has figures to show you the bone processes on particular bones: o You should recall most of the medical terms for all of the bones in your body o You need to learn the medical term for a particular bone, translation into English o For example, the medical term for the knee bone is the patella. o You also need to know the spelling and the location o So be mindful of 4 things: medical term, English translation, spelling, and location

Cranial Bones These are the bones you will find as part of the cranium. Your textbook includes a color-coded figure showing the 6 different cranial bones. Be careful not to confuse the 6 cranial bones with the 6 facial bones.  

The frontal bone, a key word here is forehead, it forms the forehead Parietal bone, key word here is roof, it is the roof of the cranium

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The temporal bones are made up of two bones that form the lower sides and base of the cranium o TMJ stands for Temporal Mandibular Joint and this is the area where the temporal and mandibular bones connect The occipital bone, keyword is back and base, it is the back and base of the skull and joins the parietal and temporal bones Sphenoid bone extends behind the eyes and forms part of the base of the skull Ethmoid Bone is a delicate bone that supports the nasal cavity and forms part of the sockets of the eyes Be familiar with these cranial bones

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Facial Bones     

The nasal bones are the two slender bones that support the bridge of the nose Lacrimal bones, you should think tear, these bones are located at the corner of each eye Maxillary bones form the upper jaw Maxillary bones form the upper jaw, and mandibular bones or mandible forms the lower jaw The zygomatic bones are your cheek bones

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The vomer is the small bone that forms the nasal septum. The tip of the nose is cartilage Your textbook includes a table that summarizes the cranial bones and facial bones, and also gives you a description of the location. This should be very helpful in differentiating those

Vertebral Column and Structure of Vertebrae We have many combining forms that all mean vertebrae, spinal column. We only have one combining form that means spinal cord, myel/o. But in this chapter we are only concerned with the spinal column.   

Combining forms for vertebrae or spinal column are vertebr/o, spin/o, and rachi/o The bones are separated by cartilage pads, which are referred to as intervertebral disks or disc When referring to the vertebral column, we start off with the first 7 bones of the spinal columns, it forms the neck C1-C7, 7 cervical vertebrae o Next there are a set of 12 vertebrae known as the thoracic vertebrae T1-T12 o So we have 12 pair of ribs, 12 Thoracic vertebrae o Third set is 5 bones that we refer to as the lumbar vertebrae L1-L5 o Last, we have the sacrum made up of 5 sacral vertebrae that fuse when you are a young child to form one bone o The coccyx is also a fused bone known as the tailbone

Bones of the Thorax, Pelvis, and Extremities Bones of the Thorax       

Remember the name of the collarbone is the clavicle Scapula is your shoulder blade Acromion is where the scapula joins with the clavicle to form a joint above the shoulder o Your textbook shows a picture of where the acromion is Sternum is your breast bone Xiphoid process is the lowest portion of the sternum The uppermost portion of the sternum is called the manubrium You have 12 pairs of ribs, 1-7 are true ribs, 8-10 are false ribs, and 11 and 12 are floating ribs

Bones of the Arm and Hand      

Humerus is the upper arm bone. Ulna is the medial lower arm bone also o This bone is closer to the body in a normal anatomical position The radius is the lateral lower arm bone, so closer to the side of the body in a normal anatomical position and it is in line with your thumb The carpals are your wrist bones Metacarpals are the 5 bones in the palm of the hand Phalanges refers to the finger bones o Each finger has 3 phalanges (proximal, middle, and distal) except for the thumb

Bones of the Pelvis 

We have the pelvic girdle which is the pelvis o It is composed of 3 pairs of fused bones – the ilium, ischium, and pubis  The ilium with an “I” is the largest and uppermost portion of the pelvis. It is sometimes referred to as the iliac crest. It is a very common area for pieces of bone to be taken for a bone graft  The ischium is the lower part of the pelvis  The pubis is the front or anterior part of the pelvis

Bones of the leg and foot 

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The thigh bone is called the femur o It is the longest bone in the body o At its proximal end it has a rounded head that fits into a depression or socket o This socket is referred to as the acetabulum o The head of the femur and the acetabulum form a ball and socket joint that we refer to as the hip joint The patella is the knee cap The two bones in the lower long, one is larger than the other o The larger of the 2 bones is called the tibia  At the distal end of the tibia, close to the ankle, you have a bony prominence on the inside of your ankle, and it is called the medial malleolus  So the medial malleolus is the distal part of the tibia  The tibia is often referred to as the shin bone o The fibula is the smaller of the two lower leg bones  If you looked at the distal end of the fibula, you have a bony prominence on the outside of the ankle, and that is referred to the lateral malleolus, lateral which means to the side, the distal part of the tibia is closer to the midline called the medial malleolus  The tibia, fibula, and talus, which is the first of the tarsals, all come together and form the ankle joint Tarsals are the bones of the hind part of the foot Calcaneus is the largest of the foot bones, and it is also called the heel bone Metatarsals are bones of the midfoot, and phalanges are the toe bones, just like the digits of the hands o Note the big toe bone is made up of only 2 parts, just like the thumb (distal and proximal). The other toes have distal, middle, and proximal o So phalanges refer to both fingers and toes

Your textbook includes a table that includes all of the bones or processes and their common names. This would be helpful when you are studying for an exam.

Vocabulary: Bones You need to know the following Vocabulary Bone terms listed in your textbook:                     

Acetabulum Acromion Bone Depression Bone Process Cranial Bones Diaphysis Disk (disc) Epiphysis Facial Bones Foramen Magnum Ligament Malleolus Manubrium Olecranon Orthopedist Ribs Sinus Temporomandibular Joint Tendon Vertebra Xiphoid Process

Combining Forms: Bones General For the terminology regarding the combining forms for the bones of the musculoskeletal system, you need to know all of them listed in your textbook:  

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calc/o, calci/o means calcium kyph/o specifically refers to a posterior curvature in the thoracic spine referred to as humpback or hunchback o A person who has this condition has a hump on their back is referred to kyphosis lamin/o means lamina, this is part of the vertebral arch lord/o specifically refers to an anterior curvature of the lumbar region referred to swayback lumb/o means lower back myel/o means bone marrow in this chapter, it is not spinal column

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o It also means spinal cord in the nervous system orth/o means straight oste/o means bone scoli/o specifically refers to a lateral, to the side, curve o It is crooked or bent spondyl/o means vertebra vertebr/o means vertebra

Suffixes: Bones For the terminology regarding the suffixes for the bones of the musculoskeletal system, you need to know all of them listed in your textbook:       

-blast means embryonic or immature -clast means to break -listhesis means slipping -malacia means softening -physis means to grow -porosis means poor or passage -tome means the instrument itself used to cut

Combining Forms: Specific Bones For the combining forms regarding the terms related to specific bones of the musculoskeletal system, you need to know all of them listed in your textbook. Most of these come from the actual medical term for the bone, but you do have a couple of exceptions that don’t come directly from the term.             

acetabul/o means acetabulum (hip socket) calcane/o (calcaneus (heel) carp/o means carpals (wrist bones) clavicul/o means clavicle (collar bone) cost/o does not come from the word ribs, but means ribs o It can be true, false, or floating ribs crani/o means cranium (skull) femor/o means femur (thigh bone) fibul/o means fibula (smaller lower leg bone) humer/o means Humerus (upper arm bone) ili/o means ilium (upper part of pelvic bone) ischi/o means ischium (posterior part of pelvic bone) malleol/o means malleolus (process on each side of the ankle) mandibul/o means mandible (lower jawbone)

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maxilla/o means maxilla (upper jawbone) metacarp/o means metacarpals (hand bones) metatars/o means metatarsals (foot bones)

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olecran/o means olecranon (elbow) patell/o means patella (kneecap)

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pelv/o means pelvis (hipbone) perone/o does not come from the word fibula, but means fibula phalang/o means phalanges (finger and/or toe bones) pub/o means pubis (anterior part of the pelvic bone) radi/o means radius (forearm bone – thumb side) scapul/o means scapula (shoulder blade) stern/o means sternum (breastbone) tars/o means tarsals (bones of hindfoot) tibi/o means tibia (shin bone) uln/o means ulna (forearm bone – little finger side)

Pathology – Bones: In regards to the bone pathology of the musculoskeletal system, I will go over the terms you need to know. You need to know the definition of the terms in bold to the right, you do not have to know all the detail unless I specifically list it. 

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Ewing Sarcoma o It is an eponym, named after a person o It is a rare malignancy o It is a tumor that arises in bone o It most often occurs in children Exostosis is a benign bony growth arising from the surface of bone A bunion is a swelling of the metatarsophalangeal joint near the base of the big toe and it is accompanied by the building up of soft tissue and bone on that distal or medial aspect of the first metatarsal Fracture is a traumatic breaking of a bone o We do have some pathological fractures, that are not traumatic, and they are caused by disease, but they are not as common. o The most common cause of a fracture is trauma or injury. o You need to know the difference between a closed and open fracture.  In a closed fracture, even though the bone is broken, the skin is still intact, and there is no open wound in the skin  In an open or compound fracture, you have a broken bone and an open wound in the skin  For some reason, the bone protrudes through the skin

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Crepitus is the crackling sound produced when ends of bones rub each other or rub against roughened cartilage How do we treat fractures?

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Reduction is restoration of the bone to its normal position A closed reduction is without surgical incision, whereas an open reduction requires an incision in the skin for access to the fracture site ORIF means Open Reduction/ Internal Fixation  

This often involves insertion of metal plates, screws, rods, or pins to stabilize the bone o You do need to know the different types of fractures  A Colles fracture is near the wrist at the distal end of the radius  A comminuted fracture is where bone is splintered and crushed into several pieces  A compression fracture is where bone collapses or is compressed and it occurs in the vertebrae.  A greenstick fracture is where bone is partially broken or breaks on one surface and bends on another often occurring in the forearm  An impacted fracture is where one fragment is driven firmly into the other and usually occurs at the head of the femur or head of the Humerus Osteogenic Sarcoma (osteosarcoma) is a malignancy o A cancer that arises from osteoblast cells and is found primarily in children and adolescents 

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Osteomalacia is softening of bone caused by not enough calcium in the bone. o It occurs primarily as a disease of infancy and childhood and is referred to as Rickets Osteomyelitis is an inflammation of bone and bone marrow, and it is secondary to some sort of infection that has spread Osteoporosis is a decrease in bone density mass o Some people have bone density tests performed in order to diagnose osteoporosis, which is thinning and weakening of bone often due to old age o Sometimes osteoporosis causes kyphosis, a posterior curvature of the spine in the thoracic region. The patient’s height will start to diminish, and lose 6-9 inches in height by age 70 Talipes is a congenital abnormality of the hindfoot (baby is born with it) o The most common form of this is called Talipes Equinovarus also known as clubfoot

Joints: Types of Joints   

A joint articulation is a coming together of two or more bones Some joints are immovable, these are referred to as suture joints like between the skull bones Other joints are partially moveable

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Other joints are freely moveable, these are referred to as synovial joints like the ball-and-socket type (at the hip and shoulder joints) and hinge type (at elbow, knee, and ankle joints) The bones in a synovial joint have a joint capsule composed of fibrous tissue There are ligaments there that anchor one bone to another bone that help with the strength Articular cartilage is at the end of a joint The synovial membrane lies under the joint capsule and lines the synovial cavity between the bones o The synovial cavity is filled with a special lubricating fluid produced by the synovial membrane o The synovial fluid contains water and nutrients that nourish as well as lubricate the joints so that friction on the articular cartilage is minimal o We should be able to move our joints without hearing any noise due to synovial fluid

Bursae Bursae are closed sacs of synovial fluid lined with synovial membrane and are located near but not within a joint.  

The bursae serve as layers of lubrication between the tissues Common sites of bursae are between tendons and bones, between ligaments and bones, and between skin and bones in areas where bony anatomy is prominent

Vocabulary: Joints You need to know the following Vocabulary Joint terms listed in your textbook:        

Articulation Bursa (plural: bursae) Ligament Synovial Cavity Synovial Fluid Synovial Joint Synovial Membrane Tendon

Combing Forms: Joints For the terminology regarding the combining forms for the joints of the musculoskeletal system, you need to know all of them listed in your textbook:   

ankyl/o means stiff arthr/o means joint articul/o also means joint

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burs/o means bursa chrondr/o means cartilage ligament/o means ligament

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rheumat/o means watery flow, so you would see a rheumatologist for any type of joint disorder, such as arthritis synov/o means synovial membrane ten/o means tendon tendin/o also means tendon

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Suffixes: Joints For the terminology regarding the suffixes for the joints of the musculoskeletal system, you need to know all of them listed in your textbook:  

-desis means to bind or tie together, often we might fuse bones together is called arthrodesis -stenosis means narrowing

Pathology – Joints: In regards to the joint pathology of the musculoskeletal system, I will go over the terms you need to know. You need to know the definition of the terms in bold to the right, you do not have to know all the detail unless I specifically list it. 

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Arthritis which generally means inflammation of any joint o We have different types of arthritis and we will over a few of the more common forms  Ankylosing Spondylitis is a chronic progressive arthritis with stiffening of joints, primarily of the spine  Gouty Arthritis (gout) is inflammation and painful swelling of joints caused by excessive uric acid in the body  Osteoarthritis (OA) is a progressive, degenerative joint disease with loss of articular cartilage and hypertrophy of bone at articular surface  Also known as DJD, Degenerative Joint Disease  It commonly affects the elderly population.  Rheumatoid Arthritis (RA) is a chronic joint condition with inflammation and pain caused by an autoimmune reaction against joint tissue, particularly the synovial membrane  Your textbook includes a picture of what a normal joint looks like, osteoarthritis, and rheumatoid arthritis Bunion is enlargement of bone or tissue around the joint at the...