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Ortho A&P 1

Orthopedics

QuestionAnswer
Components of the MS System Bone, Articular Tissue, Connective Tissue
Articular Tissue Cartilage, Synovium
Connective Tissue Muscle, Ligaments, Tendons
Bones: Numbers 80 in axial skeleton; 126 in appendicular skeleton; 27 in the hand
Regions of long bones Epiphysis; Physis; Metaphysis ; Diaphysis
Epiphysis = above growth plate
Physis = growth plate
Diaphysis = shaft
Physis in children: is open (i.e., growth plate)
Types of Bone Cortical; Cancellous
Cortical bone = Compact, makes up 80% of skeleton (e.g., diaphysis of long bones)
Cancellous bone = Spongy or trabecular ; more prominent in spine & pelvis (e.g., metaphysis of long bones)
Periosteum = Highly vascular membrane that covers bone; more prominent in children
Bone Marrow = Source of hematopoietic progenitor cells
Highly vascular membrane that covers bone; more prominent in children Periosteum
Source of hematopoietic progenitor cells Bone Marrow
Organic Bone Matrix wrt weight Organic matrix composes 40% of bone dry wt
Organic Bone Matrix = Type I Collagen, Proteoglycans, Noncollagenous matrix proteins, GFs & cytokines
Type I Collagen = 90% of organic matrix
Bone strength from: Type I Collagen (tensile strength); Proteoglycans (compressive strength)
Noncollagenous matrix proteins promote: mineralization & bone formation
Growth factors & cytokines = Interleukins, transforming growth factor
Inorganic Bone Matrix = Calcium hydroxyapatite; Osteocalcium phosphate (Brushite)
Mineral components wrt weight Mineral components compose 60% of the dry wt of bone
Metaphyseal - Epiphyseal System Arises from periarticular vascular plexus
Periosteal System Low pressure capillary system supplies outer 1/3 of diaphyseal cortex
Bone maintained by metabolism of: Ca & PO4
Amount Ca & PO4 in bone 99% of Ca & 85% of PO4 found in Bone
Needed for gut Ca absorption: Vitamin D
Increases plasma Ca by increasing gut absorption & bone resorption: PTH
Osteoblasts = Cells that form bone, producing type I collagen
Osteoclasts = Cells that resorb bone
Osteocytes = Cells that maintain bone; make up 90% of mature skeleton
Fracture Healing: stages Inflammation, Repair, Remodeling
Fracture Healing: Remodeling stage Begins mid repair phase; continues for several months
Types of Cartilage Fibrocartilage, Elastic cartilage, Fibroelastic cartilage, Articular cartilage
Fibrocartilage Area for bone & tendon insertion
Elastic cartilage Nose, auricle
Fibroelastic cartilage: Menisci (functions to deepen articular surface & stabilize joint)
Articular cartilage: Hyaline (aids in load distribution & decreasing joint friction)
Synovium = Membrane lines the joint; mediates exchange of nutrients between blood & joint fluid
Synovial (Joint) Fluid: Nourishes articular cartilage; lubricates articular surfaces
Bursa: Fluid-filled potential space over areas of friction
Combine into myofibrils: Actin & Myosin filaments
Myofibrils combine into: muscle fibers
Muscle fibers combine into: muscle fascicles
Blood supply to long bones Nutrient Artery System; Metaphyseal-Epiphyseal System; Periosteal System
Nutrient Artery System: Nutrient a. enters diaphyseal cortex thru nutrient foramen into medullary canal
Bone remodeling MOA Osteoclasts resorb bone followed by new bone deposition by osteoblasts
Wolff’s law Increase in external stress leads to bone formation; removal of external stress leads to bone resorption
Change in bone marrow with aging Red (active) marrow changes to yellow (fatty, inactive) marrow
Peak bone mass at age: 16 to 25 y.o.
Isotonic contraction: Constant tension through ROM
Concentric contraction: muscle shortens
Eccentric contraction: muscle elongates
Isometric contraction: Muscle tension with length constant
Isokinetic contraction: Concentric or eccentric contraction at constant speed over ROM
Gait Analysis: Width of the gait: Normal =2-4 in heel to heel; Wide based gaits = instability
Gait Analysis: Ctr of gravity: Normal gait oscillates no more than 2 in. vertically; pain & mx weakness => pt shifts COG over affected hip
Gait Analysis: Pelvic shift: pelvis & trunk shift laterally 1 in. to wt bearing side
Gait Analysis: Pelvic shift: in gluteus mx weakness: lateral shift is accentuated to the side involved
Gait Analysis: Length of step: Ave length is 15 in. With age/ fatigue/ pathology: step is shortened
Gait Analysis: Cadence: Ave cadence is 90-120 steps/ min. With age/ fatigue/ pain: cadence is decreased to conserve energy
Gait Analysis: Pelvic rotation: Normal during swing phase = 40 degrees in leg that is moving forward; if pain or stiffness in hip, pelvis will not rotate normally
Antalgic gait: Limp from pain
Wide based gait = Instability from cerebellar disease or peripheral neuropathy
Steppage gait = Weak ankle dorsiflexors results in increase knee & hip flexion
Flat foot gait = Gastrocnemius/ Soleus weakness (S1-S2 radiculopathy)
Back Knee gait = Quadriceps weakness forces pt to push on thigh w/ hand to try to lock knee in stance phase
Trendelenberg (abduction lurch) gait = Gluteus medius weakness (L5); pt lurches toward weak side to place COG over hip
Extensor lurch = Gluteus max weakness (S1); pt thrusts thorax posteriorly to maintain hip extension
Foot Drop = Weakness of tibialis anterior (L4)
Created by: Abarnard
 

 



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