Skeletal System (Encyclopedia of Nursing & Allied Health)

Definition

The skeletal system is a living, dynamic, bony framework of the body, with networks of infiltrating blood vessels.

Description

Inside every person is a skeleton, a sturdy framework of about 206 bones that protects the body's organs, supports the body, provides attachment points for muscles to enable body movement, functions as a storage site for minerals such as calcium and phosphorus, and produces blood cells. Living mature bone is about 60% calcium compounds and about 40% collagen. Hence, bone is strong, hard, and slightly elastic. Humans are born with over 300 bones but some bones, such as those in the skull and lower spine, fuse during growth, thereby reducing the number. Although mature bones consist largely of calcium0% calcium salts and about 30% organic matrix, mostly collagen fibersost bones in the skeleton of vertebrates, including humans, began as cartilage. Cartilage is a type of connective tissue, and contains collagen and elastin fibers. The hard outer part of bones are comprised mostly of a proteins such as collagen, in addition to a substance called hydroxyapatite. This substance is composed primarily of calcium and other minerals, and stores much of the body's calcium; it is primarily responsible for the strength of bones. At the center of each bone is the marrow, which is softer and less dense than the rest of the bone. The marrow contains specialized cells that produce blood cells that run through a bone, with nerves surrounding it.

Individual bones meet at areas called joints and are held in place by connective tissue. Most joints, such as the elbow, are called synovial joints, for the synovial membrane which envelopes the joint and secretes a lubricating fluid. Cartilage lines the surface of many joints and helps reduce friction between bones. The connective tissues linking the skeleton together at the joints are tendons and ligaments. Ligaments and tendons are both made up of collagen, but serve different functions. Ligaments link bones together and help prevent dislocated joints. Tendons link bone to muscle.

Because the bones making up the human skeleton are inside the body, the skeleton is called an endoskeleton. Some animals, such as the crab, have an external skeleton called an exoskeleton.

Types of bone

Bones may be classified according to their various traits, such as shape, origin, and texture. Four types are recognized based on shape. These are long bones, short bones, flat bones, and irregular bones. Long bones have a long central shaft, called the diaphysis, and two knobby ends, called the epiphysis. In growing long bones, the diaphysis and epiphysis are separated by a thin sheet of cartilage. Examples of long bones include bones of the arms and legs, the metacarpals of the hand, metatarsals of the foot, and the clavicle. Short bones are about as long as wide. The patella, carpels of the wrist, and tarsals of the ankle are short bones. Flat bones take several shapes, but are characterized by being relatively thin and flat. Examples include the sternum, ribs, hip bones, scapula, and cranial bones. Irregular bones are the odd-shaped bones of the skull, such as the sphenoid, the sacrum, and the vertebrae. The common characteristic of irregular bones is not that they are similar to each other in appearance, but that they cannot be placed in any of the other bone categories.

Bones may also be classified based on their origin. All bone (as well as muscles and connective tissue) originates from an embryonic connective tissue called mesenchyme, which makes mesoderm, also an embryonic tissue. Some mesoderm forms the cartilaginous skeleton of the fetus, the precursor for the bony skeleton. However, some bones, such as the clavicle and some of the facial and cranial bones of the skull, develop directly from mesenchyme, thereby bypassing the cartilaginous stage. These types of bone are called membrane bone (or dermal bone). Bone which originates from cartilage is called endochondral bone.

Finally, bones are classified based on texture. Smooth, hard bone called compact bone forms the outer layer of bones. Inside the outer compact bone is cancellous bone, sometimes called the bone marrow. Cancellous bone appears open and spongy, but is actually very strong, like compact bone. Together, the two types of bone produce a light, but strong, skeleton.

Structure

The human skeletal system is divided into two main groups: the axial skeleton and the appendicular skeleton. The axial skeleton includes bones associated with the body's main axis including:

• the skull
• the spine or vertebral column
• the ribs

The appendicular skeleton consists of the bones that anchor the body's appendages to the axial skeleton including:

• the pectoral girdle (shoulder area)
• the pelvic girdle (hip area)
• the upper extremities (arms)
• the lower extremities (legs)

AXIAL SKELETON. There are 28 bones in the skull. Of these, eight bones comprise the cranium and provide protection for the brain. In adults, these bones are flat and interlocking at their joints, making the cranium immobile. Fibrous joints, or sutures occur where the bony plates of the cranium meet and interlock. Cartilage-filled spaces between the cranial bones of infants, known as soft spots or fontanelles, allow their skull bones to move slightly during birth. This makes birth easier and helps prevent skull fractures, but may leave the infant with an odd-shaped head temporarily while the skull regains its shape. Eventually, the fontanelles in an infant's head are replaced by bone, and fibrous joints develop. In addition to protecting the brain, skull bones also support and protect the sensory organs responsible for sight, hearing, smell and taste.

The eight bones of the cranium are:

• frontal
• parietal (2)
• temporal (2)
• ethmoid
• sphenoid
• occipital

Frontal view of the adult human skeleton. (Delmar Publishers, Inc. Reproduced by permission.)

The frontal bone forms the forehead and eyebrows. Behind the frontal bone are the two parietal bones. Parietal bones form the roof of the cranium and curve down to form the sides of the cranium. Also forming the sides of the cranium are the two temporal bones, located behind the eyes. Each temporal bone encloses the cochlea and labyrinth of the inner ear, and the ossicles, three tiny bones of the middle ear which are not part of the cranium. The ossicles are the malleus (hammer), incus (anvil), and stapes (stirrups). The temporal bones also attach to the lower jaw, and this is the only moveable joint in the skull. Between the temporal bones is the irregular shaped sphenoid bone, which provides protection for the pituitary gland. The small ethmoid bone forms part of the eye socket next to the nose. Olfactory nerves, or sense of smell nerves, pass through the ethmoid bone on their way to the brain. Forming the base and rear of the cranium is the occipital bone. The occipital bone has a hole, called the foramen magnum, through which the spinal cord passes and connects to the brain.

Fourteen bones shape the cheeks, eyes, nose, and mouth. These include:

• the nasal (2)
• zygomatic (2)
• maxillae (2)
• mandible

The upper, bony bridge of the nose is formed by the nasal bones and provides an attachment site for the cartilage making up the softer part of the nose. The zygomatic bones form the cheeks and part of the eye sockets. Two bones fuse to form the maxillae, the upper jaw of the mouth. These bones also form the hard palate of the mouth. The mandible forms the lower jaw of the mouth and is moveable, enabling chewing of food and speech. The mandible is the bone which connects to the temporal bones.

Located behind these facial bones are other bones which shape the interior portions of the eyes, nose, and mouth. These include:

• lacrimal (2)
• palatine (2)
• conchae (2)
• vomer bones

In addition to these 28 skull bones is the hyoid bone, located at the base of the tongue. Technically, the hyoid bone is not part of the skull but it is often included with the skull bones. It provides an attachment site for the tongue and some neck muscles.

Several of the facial and cranial bones contain sinuses, or cavities, that connect to the nasal cavity and drain into it. These are the frontal, ethmoid, sphenoid, and maxillae bones, all located near the nose. Painful sinus headaches result from the build up of pressure in these cavities. Membranes that line these cavities may secrete mucous or become infected, causing additional aggravation for humans.

The skull rests atop of the spine, which encases and protects the spinal cord. The spine, also called the vertebral column or backbone, consists of 33 stacked vertebrae, the lower ones fused. Vertebra are flat with two main features. The main oval shaped, bony mass of the vertebra is called the centrum. From the centrum arises a bony ring called the neural arch which forms the neural canal (also called a vertebral foramen), a hole for the spinal cord to pass through. Short, bony projections (neural spines) arise from the neural arch and provide attachment points for muscles. Some of these projections (called transverse processes) also provide attachment points for the ribs. There are also small openings in the neural arch for the spinal nerves, which extend from the spinal cord throughout the body. Injury to the column of vertebrae may cause serious damage to the spinal cord and the spinal nerves, and could result in paralysis if the spinal cord or nerves are severed.

There are seven cervical, or neck, vertebrae. The first one, the atlas, supports the skull and allows the head to nod up and down. The atlas forms a condylar joint (a type of synovial joint) with the occipital bone of the skull. The second vertebra, the axis, allows the head to rotate from side to side. This rotating synovial joint is called a pivot joint. Together, these two vertebrae make possible a wide range of head motions.

Below the cervical vertebrae are the 12 thoracic, or upper back, vertebrae. The ribs are attached to these vertebrae. Thoracic vertebrae are followed by five lumbar, or lower back, vertebrae. Last is the sacrum, composed of five fused vertebrae, and the coccyx, or tail bone, composed of four fused bones.

The vertebral column helps to support the weight of the body and protects the spinal cord. Cartilaginous joints rather than synovial joints occur in the spine. Disks of cartilage lie between the bony vertebrae of the back and provide cushioning, like shock absorbers. The vertebrae of the spine are capable of only limited movement, such bending and some twisting.

A pair of ribs extends forward from each of the 12 thoracic vertebrae, for a total of 24 ribs. Occasionally, a person is born with an extra set of ribs. The joint between the ribs and vertebrae is a gliding (or plane) joint, a type of synovial joint, as ribs do move, expanding and contracting with breathing. Most of the ribs (the first seven pair) attach in the front of the body via cartilage to the long, flat breastbone, or sternum. These ribs are called true ribs. The next three pair of ribs are false ribs. False ribs attach to another rib in front instead of the sternum, and are connected by cartilage. The lower two pair of ribs which do not attach anteriorly are called floating ribs. Ribs give shape to the chest and support and protect the body's major organs, such as the heart and lungs. The rib cage also provides attachment points for connective tissue, to help hold organs in place. In adult humans, the sternum also produces red blood cells as well as providing an attachment site for ribs.

APPENDICULAR SKELETON. The appendicular skeleton joins with the axial skeleton at the shoulders and hips. Forming a loose attachment with the sternum is the pectoral girdle, or shoulder. Two bones, the clavicle (collar bone) and scapula (shoulder blade), form one shoulder. The scapula rest on top of the ribs in the back of the body. It connects to the clavicle, the bone which attaches the entire shoulder structure to the skeleton at the sternum. The clavicle is a slender bone that is easily broken. Because the scapula is so loosely attached, it is easily dislocated from the clavicle, hence the dislocated shoulder injuries commonly suffered by persons playing sports. The major advantage to the loose attachment of the pectoral girdle is that it allows for a wide range of shoulder motions and greater overall freedom of movement.

Unlike the pectoral girdle, the pelvic girdle, or hips, is strong and dense. Each hip, left and right, consists of three fused bones, the ilium, ischium, and pubic. Collectively, these three bones are known as the innominate bone.

The innominates fuse with the sacrum to form the pelvic girdle. Specifically, the iliums shape the hips and the two ischial bones support the body when a person sits. The two pubic bones meet anteriorly at a cartilaginous joint. The pelvic girdle is bowl-shaped, with an opening at the bottom. In a pregnant woman, this bony opening is a passageway through which her baby must pass during birth. To facilitate the baby's passage, the body secretes a hormone called relaxin which loosens the joint between the pubic bones. In addition, the pelvic girdle of women is generally wider than that of men. This also helps to facilitate birth, but is a slight impediment for walking and running. Hence, men, with their narrower hips, are better adapted for such activities. The pelvic girdle protects the lower abdominal organs, such as the intestines, and helps supports the weight of the body above it.

The arms and legs, the upper and lower appendages of the body, are very similar in form. Each attaches to the girdle, pectoral or pelvic, via a ball and socket joint, a special type of synovial joint. In the shoulder, the socket, called the glenoid cavity, is shallow. The shallowness of the glenoid cavity allows for great freedom of movement. The hip socket, or acetabulum, is larger and deeper. This deep socket, combined with the rigid and massive structure of the hips, give the legs much less mobility and flexibility than the arms.

The humerus, or upper arm bone, is the long bone between the elbow and the shoulder. It connects the arm to the pectoral girdle. In the leg the femur, or thigh bone, is the long bone between the knee and hip which connects the leg to the pelvic girdle. The humerus and femur are sturdy bones, especially the femur, which is a weight bearing bone. Since the arms and legs are jointed, the humerus and femur are connected to other bones at the end opposite the ball and socket joint. In the elbow, this second joint is a type of synovial joint called a hinge joint. Two types of synovial joints occur in the knee region, a condylar joint (like the condylar joint in the first vertebra) which connects the leg bones, and a plane, or gliding joint, between the patella (knee cap) and femur.

At the elbow the humerus attaches to a set of parallel bones, the ulna and radius, bones of the forearm. The radius is the bone below the thumb that rotates when the hand is turned over and back. The ulna and radius then attach to the carpel bones of the wrist. Eight small carpel bones make up the wrist and connect to the hand. The hand is made up of five long, slender metacarpal bones (the palms) and 14 phalanges of the hand (fingers and thumb). Some phalanges form joints with each other, giving the human hand great dexterity.

Similarly, in the leg, the femur forms a joint with the patella and with the fibula and tibia bones of the lower leg. The tibia, or shin bone, is larger than the fibula and forms the joint behind the patella with the femur. Like the femur, the tibia is also a weight bearing bone. At the ankle joint, the fibula and tibia connect to the tarsals of the upper foot. There are seven tarsals of the upper foot, forming the ankle and the heel. The tarsals in turn connect to five long, slender metatarsals of the lower foot. The metatarsals form the foot's arch and sole and connect to the phalanges of the feet (toes). The 14 foot phalanges are shorter and less agile than the hand phalanges. Several types of synovial joints occur in the hands and feet, including plane, ellipsoid and saddle. Plane joints occur between toe bones, allowing limited movement. Ellipsoid joints between the finger and palm bones give the fingers circular mobility, unlike the toes. The saddle joint at the base of the thumb helps make the hands the most important part of the body in terms of dexterity and manipulation. A saddle joint also occurs at the ankles.

Bone development and growth

Since most bone begins as cartilage, it must be converted to bone through a process called ossification. The key players in bone development are cartilage cells (chondrocytes), bone precursor cells (osteoprogenitor cells), bone deposition cells (osteoblasts), bone resorption cells (osteoclasts), and mature bone cells (osteocytes).

During ossification, blood vessels invade the cartilage and transport osteoprogenitor cells to a region called the center of ossification. At this site, the cartilage cells die, leaving behind small cavities. Osteoblast cells form from the progenitor cells and begin depositing bone tissue, spreading out from the center. Through this process, both the spongy textured cancellous bone and the smooth outer compact bone forms. Two types of bone marrow, red and yellow, occupy the spaces in cancellous bone. Red marrow produces red blood cells while yellow marrow stores fat in addition to producing blood cells.

Eventually, in compact bone, osteoblast cells become trapped in their bony cavities, called lacunae, and become osteocytes. Neighboring osteocytes form connections with each other and thus are able to transfer materials between cells. The osteocytes are part of a larger system called the Haversian system. These systems are like long tubes, squeezed tightly together in compact bone. Blood vessel, lymph vessels, and nerves run through the center of the tube, called the Haversian canal, and are surrounded by layers of bone, called lamellae, which house the osteocytes. Blood vessels are connected to each other by lateral canals called Volkmann's canals. Blood vessels are also found in spongy bone, without the Haversian system. A protective membrane called the periosteum surrounds all bones.

Bone development is a complex process, but it is only half the story. Bones must grow, and they do so via a process called remodeling. Remodeling involves resorption of existing bone inside the bone (enlarging the marrow cavities) and deposition of new bone on the exterior. The resorptive cells are the osteoclasts and osteoblast cells lay down the new bone material. As remodeling progresses in long bones, a new center of ossification develops, this one at the swollen ends of the bone, called the epiphysis. A thin layer of cartilage called the epiphyseal plate separates the epiphysis from the shaft and is the site of bone deposition. When growth is complete, this cartilage plate disappears, so that the only cartilage remaining is that which lines the joints, called hyaline cartilage. Remodeling does not end when growth ends. Osteocytes, responding to the body's need for calcium, resorb bone in adults to maintain a calcium balance.

Function

The skeletal system has several important functions:

• It provides shape and form to the body, while allowing for body movement.
• It supports and protects vital organs and muscles.
• It produces red blood cells for the body in the bone marrow. Each second, an average of 2.6 million red blood cells are to replace worn out blood cells and those destroyed by the liver.
• It stores minerals including calcium and phosphorus. When excess are present in the blood, the bones will store minerals. When the supply in the blood runs low, minerals will be withdrawn from the bones to replenish the blood supply.

Common diseases and disorders

Even though bones are very strong, they may be broken. Most fractures do heal. The healing process may be stymied if bones are not reset properly or if the injured person is the victim of malnutrition. Osteoprogenitor cells migrate to the site of the fracture and begin the process of making new bone (osteoblasts) and reabsorbing the injured bone (osteoclasts). With proper care, the fracture will fully heal, and in children, often without a trace.

The joint between the mandible and the temporal bones, called the temporomandibular joint, is the source of the painful condition known as temporomandibular joint dysfunction, or TMJ dysfunction. Sufferers of TMJ dysfunction experience a variety of symptoms including headaches, a sore jaw, and a snapping sensation when moving the jaw. There are several causes of the dysfunction. The cartilage disk between the bones may shift, or the connective tissue between the bones may be situated in a manner that causes misalignment of the jaw. Sometimes braces on the teeth can aggravate TMJ dysfunction. The condition may be corrected with exercise, or in severe cases, surgery. Another condition, cleft palate, is due to the failure of the maxillary bones in the jaw to completely fuse in the fetus.

Bones are affected by poor diet and are also subject to a number of diseases and disorders. Some examples include scurvy, rickets, osteoporosis, arthritis, and bone tumors. Scurvy results from the lack of vitamin C. In infants, scurvy causes poor bone development. It also causes membranes surrounding the bone to bleed, forming clots which are eventually ossified, and thin bones which break easy. In addition, adults are affected by bleeding gums and loss of teeth. Before modern times, sailors were often the victims of scurvy, due to extended periods of time at sea with limited food. They consequently tried to keep a good supply of citrus fruits, such as oranges and limes, on board because these fruits supply vitamin C. By the twenty-first century, scurvy had become extremely rare in Western societies.

Rickets is a children's disease resulting from a deficiency of vitamin D. This vitamin enables the body to absorb calcium and phosphorus; without it, bones become soft and weak and actually bend, or bow out, under the body's weight. Vitamin D is found in milk, eggs and liver, and may also be produced by exposing the skin to sunlight. Pregnant women can also suffer from a vitamin D deficiency, osteomalacia, resulting in soft bones. The elderly, especially women who had several children in succession, sometimes suffer from osteoporosis, a condition in which a significant amount of calcium from bones is dissolved into the blood to maintain the body's calcium balance. Weak, brittle bones dotted with

pits and pores are the result. Osteoporosis occurs most often in older people and in women after menopause. It affects nearly half of all those, men and women, over the age of 75. Women, however, are five times more likely than men to develop the disease. They have smaller, thinner bones than men to begin with, and they lose bone mass more rapidly after menopause (usually around age 50), when they stop producing a bone-protecting hormone called estrogen. In the five to seven years following menopause, women can lose about 20% of their bone mass. By age 65 or 70, though, men and women lose bone mass at the same rate. As an increasing number of men reach an older age, they are becoming more aware that osteoporosis is an important health issue for them as well.

Arthritis is another condition commonly afflicting the elderly. This is an often painful inflammation of the joints. Arthritis is not restricted to the elderly, and even young people can suffer from this condition. There are several types of arthritis, such as rheumatoid, rheumatic, and degenerative. Arthritis basically involves the inflammation and deterioration of cartilage and bone at the joint surface. In some cases, bony protuberances around the rim of the joint may develop. Most people will probably develop arthritis if they live to a significant older age. Degenerative arthritis is the type that commonly occurs with age. The knee, hip, shoulder, and elbow are the major targets of degenerative arthritis. A number of different types of tumors, some harmless and others more serious, may also affect bones.

KEY TERMS

Boneomposed primarily of a non-living matrix of calcium salts and a living matrix of collagen fibers, bone is the major component that makes up the human skeleton. Bone produces blood cells and functions as a storage site for elements such as calcium and phosphorus.

Calcium naturally occurring element which combines primarily with phosphate to form the nonliving matrix of bones.

Cartilage type of connective tissue that takes three forms: elastic cartilage, fibrocartilage, and hyaline cartilage. Hyaline cartilage forms the embryonic skeleton and lines the joints of bones.

Haversian systemubular systems in compact bone with a central Haversian canal which houses blood and lymph vessels surrounded by circular layers of calcium salts and collagen, called lamellae, in which reside osteocytes.

Marrow type of connective tissue which fills the spaces of most cancellous bone and which functions to produce blood cells and store fat.

Ossificationhe process of replacing connective tissue such as cartilage and mesenchyme with bone.

Osteoblasthe bone cell which deposits calcium salts and collagen during bone growth, bone remodeling and bone repair.

Osteoclasthe bone cell responsible for reabsorbing bone tissue in bone remodeling and repair.

Osteocyteature bone cell which functions mainly to regulate the levels of calcium and phosphate in the body.

Skeletononsists of bones and cartilage which are linked together by ligaments. The skeleton protects vital organs of the body and enables body movement.

Synovial jointne of three types of joints in the skeleton and by far the most common. Synovial joints are lined with a membrane which secretes a lubricating fluid. Includes ball and socket, pivot, plane, hinge, saddle, condylar, and ellipsoid joints.

Vertebratesncludes all animals with a vertebral column protecting the spinal cord such as humans, dogs, birds, lizards, and fish.

Crystal Heather Kaczkowski, MSc.