Chapter 4: The Tissue Level of Organization

HISTOLOGY is the microscopic study of tissue. These are many techniques that can be used, the major
ones including a biopsy and/or an autopsy.
TISSUE: a group of cells that usually have a common embryological origin and work together to carry
out a specific function. There will be communication between these cells that allows them to function as
a unit.
BIOPSY: The removal of tissue samples from patients (surgically or through a needle) for diagnostic
purposes.
AUTOPSY: Examination of the organs and tissues of a dead body to determine cause of death.
Microscopic examination of the removed tissue is often part of the procedure.
TYPES OF TISSUES
Body tissues can be classified into 4 groups.
1. Epithelial tissue: covers surfaces, lines inside of organs and body cavities and forms glands.
2. Connective tissue: protects and supports body, binds organs together, provides immunity.
3. Muscle tissue: movement and generation of heat
4. Nervous tissue: initiate and transmits impulses (action potentials) that control and coordinate the
functioning of the body.
These different tissue types are interdependent. For example, when flexing the arm, the bones cant move
without the skeletal muscle contracting and this contraction cannot occur without the nervous tissue
carrying an impulse to those muscles.
The cells that compose a tissue are not just found near each other. There may be physical connections
that allow for communication between them. These points of contact between the plasma membranes of
2 cells are called GAP JUNCTIONS.

1. EPITHELIAL TISSUE (epithelium)

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There are 2 general classifications of epithelium. The first is COVERING and LINING EPITHELIUM
and the second is GLANDULAR EPITHELIUM. Covering and lining epithelium forms the outside layer
of the skin and the outside and inside layer of internal organs and structures. Glandular epithelium makes
up the secreting portion of the glands.
GENERAL CHARACTERISTICS OF EPITHELIAL TISSUE:
1. Epithelial cells have an APICAL surface and a BASAL surface. The apical surface is free and the basal
surface is connected to a BASEMENT MEMBRANE.
2. Epithelial cells are arranged close together in the tissue.
3. Epithelial cells are arranged in sheets that are either single or layered to form the tissue.
4. Many gap junctions occur in epithelial tissue.
5. Avascular tissue. No blood vessels found in epithelial tissue. The cells rely on diffusion of O2 and
nutrients from nearby vessels.
6. Epithelial tissue has a nerve supply.
7. High rate of mitosis due to location causing wear and tear.
8. FUNCTIONS: protection, filtration, lubrication, secretion, absorption, and other functions.
COVERING AND LINING EPITHELIUM
1. Arrangement of layers: 2 main possibilities = simple and stratified
a. SIMPLE EPITHELIUM: single layer of cells
b. STRATIFIED EPITHELIUM: 2 or more layers of epithelial cells. Mostly found in areas of
high wear and tear
2. Epithelial cell shapes = 3 possible shapes
a. SQUAMOUS Epithelium: flat cells (skin)
b. CUBOIDAL Epithelium: cube shaped cells (kidney tubules)
c. COLUMNAR Epithelium: shaped like columns. Some have cilia on them (trachea)
When describing epithelium, usually 3 words are used: the cell arrangement, cell shape, and word
epithelium - Ex. Simple cuboidal epithelium
In stratified tissue, there may be more than one cell shape in the layers. To name, use the shape of the
top layer of cells. An example is stratified squamous epithelium, where the cell shape of the top layer of
cells is flat (squamous shaped).
GLANDULAR EPITHELIUM:
The function of glandular epithelium is secretion. A GLAND may consist of a cluster of epithelial cells
or just one epithelial cell that is capable of producing a secretion.
There are 2 types of glands: Exocrine and Endocrine glands.
a. Endocrine glands: These are DUCTLESS glands - secretions do not go through a duct. These
secretions are called HORMONES. Example: Pituitary gland.
b. Exocrine glands: glands in which the secretions that are produced flow onto through a tubelike passageway (a DUCT) to get to the surface or the lumen surface of the organ. Example:
Mucus and digestive glands.
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2. CONNECTIVE TISSUE:
This is the most abundant type of tissue in the body. There are a variety of different tissues in this group.
Examples include bone, cartilage, blood, and adipose. Many times, the cells of this type of tissue
produce the extracellular matrix. Those cells that have the suffix blast will produce this matrix while
those cells with cyte at the end of the word will maintain the matrix. Those cells whose name ends in
clast will break the matrix down. Examples of this terminology are: osteoblasts, osteocytes and
osteoclasts.
The extracellular matrix of connective tissue has 3 major components:
1. Protein fibers (examples = collagen and elastin)
COLLAGEN: is the most abundant protein in the body
ELASTIN: a protein that can recoil and return to the original shape after being stretched or
compressed.
2. Ground substance consisting of nonfibrous proteins and other molecules
3. Fluid
General Characteristics of Connective Tissue:
a. Cells are usually scattered. Substance in between the cells is the MATRIX.
b. Connective tissue is not located on surfaces.
c. Most connective tissue has a nerve supply (exception: cartilage)
d. Connective tissue is highly vascularized (exceptions: cartilage and tendons)
e. The matrix may be solid, fluid, semifluid depending upon which tissue it is. Example: Blood has a fluid
matrix and bone has a solid matrix.
All connective tissue is derived from embryonic connective tissue called MESENCHYME.
3. NERVOUS TISSUE: Although the nervous system is very complex, there are only 2 general types of
cells: neuroglia cells (glial cells) and neurons. Neurons carry the impulses that control and coordinate
the body. Neuroglia cells do not carry impulses but support the neurons in different ways.
Neurons are post mitotic but neuroglia cells continue to be mitotic throughout life.
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4. MUSCLE TISSUE: The purposes of muscle are movement, maintaining posture and
thermogenesis. There are 3 different types of muscle tissue: skeletal muscle, smooth muscle and cardiac
muscle.
REVIEW YOUR LAB NOTES FOR THE CHARECTERISTICS OF EACH TYPE OF MUSCLE
Note that skeletal muscles are under voluntary control; however, the nervous system can cause these
muscles to contract without conscious involvement, such as during reflex movement.
Also note that although cardiac muscle is considered involuntary, a person can learn to influence this rate
though meditation and biofeedback.
MEMBRANES
A membrane is a thin sheet of tissue that covers a structure or lines a cavity. Most membranes are
composed from EPITHELIUM and CONNECTIVE tissue under it. The SKIN is the EXTERNAL
MEMBRANE of the body. In addition, there are 3 major categories of INTERNAL MEMBRANES:
MUCOUS MEMBRANES, SEROUS MEMBRANES, and SYNOVIAL MEMBRANES.
1. MUCOUS MEMBRANE: consists of epithelial cells, their basement membrane and the lamina
propria (connective tissue found under the epithelium of mucous membranes) underneath. Mucous
membranes line cavities and canals that open to the outside of the body (digestive system,
reproductive system, excretory system and respiratory system). Many of these mucous membranes
contain GOBLET CELLS or MUCOUS GLANDS that produce MUCUS.
2. SEROUS MEMBRANE: membranes consist of SIMPLE SQUAMOUS EPITHELIUM, the
basement membrane and the lamina propria. Serous membranes line cavities such as those found
lining the chest wall and the abdominal wall. They do not open to the exterior of the body. The cells
of the membrane produce a SEROUS FLUID that decreases friction.
3. SYNOVIAL MEMBRANE: Synovial membranes line the capsule of freely movable joints (shoulder,
thigh). They produce a fluid that decreases friction.

Chapter 5: Integumentary Systen

The skin is an organ because it consists of different tissues that work together for specific purposes. It is
the largest organ of the human body.
The skin is composed of 2 general parts: the epidermis and the dermis. The epidermis is the superficial
layer of epithelium and the dermis is the deep connective tissue.
Deep to the dermis is the subcutaneous layer (sub Q), which consists of areolar (loose connective tissue)
and adipose tissue. Skeletal muscle is found under this sub Q. This area is also known as the
HYPODERMIS and is the site where the needle reaches in a SUBCUTANEOUS INJECTION.
FUNCTIONS OF SKIN
a. Protection: protects tissues from damage of ultraviolet light from the sun. Also is the first line of
defense against microorganisms (bacteria and viruses) and against dehydration.
b. Sensation: have receptors that can detect heat, cold, touch, pressure and pain.
c. Temperature regulation: Body temp is controlled by blood flow through the skin and by the activity of
sweat glands.
d. Vitamin D production: When the skin is exposed to UV light, a molecule is produced that will later be
transformed into Vitamin D. Vitamin D is important in the absorption of calcium in the digestive system
and therefore important in the strength of bones, as well as the functioning of the nervous system and
blood clotting.
e. Excretion: excretion is the removal of waste products from the body. In addition to water and salts,
sweat contains waste products like urea, uric acid and ammonia.
EPIDERMIS
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The epidermis is described as KERATINIZED STRATIFIED SQUAMOUS EPITHELIUM.

It contains 4 different types of cells including Merkel cells, responsible for reception of light touch and
Langerhans cells, involved in the immune system.
However, the main 2 types are keratinocytes and the melanocytes.
1. KERATINOCYTES: comprises 90% of all of epidermal cells. These cells produce the protein
KERATIN, which waterproofs the skin.
2. MELANOCYTES: produces the pigment MELANIN. Melanocytes exist in the lower portion
of the epidermis and transfer their melanin to keratinocytes by pinocytosis.

There are 4 to 5 regions (strata) of cells that compose the epidermis, depending where the skin is
located.
Most of the skin will have only 4 layers. When an area is exposed to friction constantly, like the palms of
the hands and the sole of the feet, the epidermis will have a 5th layer.
stratum corneum: consists of 25 - 30 layers of flat dead squamous cells that are completely filled with
keratin. They will be continuously shed (DESQUAMATE) and replaced by deeper cells.
stratum lucidum: 3-5 layers of clear, flat dead cells. Found only on palms and soles of feet (= thick skin)
stratum granulosum: 3-5 layers of cells. Keratin begins to be formed and the nuclei of the keratinocytes
begin to degenerate.
stratum spinosum: 8 -10 layers of cells where uptake of melanin from melanocytes to keratinocytes
occurs.
stratum basale: Singles layer of stem cells that are continually going through mitosis producing new
keratinocytes. Melanocytes also found in this area. The cells multiply, produce keratinocytes that push
towards the surface of the skin. The nuclei will eventually degenerate because the cell is moving further
away from the O2 and nutrient source, the blood. The cells die and become filled with keratin by the time
they reach the stratum corneum.
It takes approximately 40-56 days for a cell to be pushed up from the s. basale to the top portion of the
s. corneum. Once they reach the top layer, they desquamate.

At time of birth, the infant has VERNIX CASEOSA covering his/her skin. This is a waxy white
substance coating the newborn that is secreted by the fetus sebaceous glands beginning at 20 weeks
gestation. It is theorized to have antibiotic properties.
SKIN COLOR:
3 pigments are responsible for the color of skin: melanin, carotene and hemoglobin.
1. Melanin: This is the most important group of pigments in skin, hair and eyes. Melanin molecules
have different colors, ranging from yellow to reddish-brown to black. It is also the only one of the 3
pigments that is actually produced in skin cells, the MELANOCYTES and is thought to provide
protection against UV light from the sun. The amount that is there will determine if the skin is pale or
black. The number of melanocytes is about the same in all races - it is the amount of pigment that each
cell produces that differs among the races.
The amount of melanin produced by each melanocyte, the melanins color, and the distribution of these
cells are determined by:
a. Genetics
b. Exposure to light (environment). Exposure to UV rays (sun and tanning booths) produces a tan.

c. Hormones. During pregnancy, when hormone levels are high, a woman may experience darkening
around the eyes known as a mask of pregnancy, an appearance of a line on the middle od the abdomen
as well as darkening of the nipples.
Melanin is synthesized from an amino acid, tyrosine, in melanocytes in the presence of an enzyme called
TYROSINASE.
tyrosine ------------------------- melanin
tryrosinase
Exposure to UV radiation (sunlight) will increase the enzymatic activity of tyrosinase and lead to more
melanin production. The skin will become darker, or tan, offering protection from UV radiation to the
body. Note that sunless tanning preparations cause a chemical reaction with the keratin in the epidermal
cells, resulting in a pigment.
An inherited lack of melanin formation is ALBINISM. Individual has melanocytes and tyrosine but do
not produce tyrosinase and therefore are unable to produce melanin. They lack color in their hair, eyes
and skin.
SUNLESS TAN lotions work by chemically reacting with the keratin in the epidermal keratinocytes
2. Carotene: This is a yellowish-orange pigment that can accumulate in the stratum corneum and
subcutaneous layer. The individuals diet is the source of this pigment and those individuals who eat a lot
of carrots can develop an orange cast to their skin, due to the large amount of carotene in carrots.
Decreasing the ingestion of these foods will decrease the deposit and therefore the yellow tinge to the
skin.
3. Hemoglobin: This is the red pigment found in red blood cells that carries oxygen. In the skin of
Caucasians, where there is little melanin, the skin appears pink.
DERMIS
The dermis is composed of connective tissue containing collagen and elastic fibers.
COLLAGEN: a protein that gives connective strength and pliability. It is the most abundant protein in
connective tissue. ELASTIN: also a protein that gives skin plasticity.
The dermis is subdivided into 2 parts: the more superficial papillary region and the deeper reticular
region. If the skin is overstretched as in a pregnancy or fast increase in muscle or fat deposits, the dermis
may tear and leave lines through the epidermis called STRIAE, also called stretch marks.
There are 3 types of injections:
1. INTRADERMAL injection: (tuberculin skin test) injection into the dermis
2. SUBCUTANEOUS injection: injection into the fatty tissue of the hypodermis referred to as
a SUB-Q injection
3. INTRAMUSCULAR injection: an injection into the skeletal muscle deep to the hypodermis.
Referred to as an IM injection.
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The border between the epidermis and dermis is not straight but contain distinctive rising areas referred
to as DERMAL PAPILLAE. These ridges are reflected onto the overlying epidermis and will be
responsible for fingerprints and footprints. These patterns are unique to each individual, including
identical twins.
Tattoos and the dermis: Tattooing involves the placement of pigment into the skin's dermis. After initial
injection, pigment is dispersed throughout the damaged layer down through the epidermis and upper
dermis, activating the immune systems phagocytes to engulf the pigment particles. As healing proceeds,
the damaged epidermis flakes away, eliminating surface pigment. In the dermis, the injury stimulates the
formation of new connective tissue cells, fibroblasts, that will trap the pigmented phagocytes just below
the dermis/epidermis boundary. Its presence there is very stable, but in the long term (decades) the
pigment tends to migrate deeper into the dermis, accounting for the degraded detail of old tattoos.
The dermis also has structures like hair follicles, glands, and nails are called Accessory Skin Structures.
Accessory Skin Structures = glands, nails, and hair (epidermal derivatives)
Glands:
1. Sebaceous glands: These are oil glands that are located in the dermis and usually connected to hair
follicles. The SEBUM from these glands prevents the hair from becoming brittle and breaking and
maintains the moisture of the skin.
2. Sudoriferous glands: These are sweat glands located throughout the body. There are 2 types:
merocrine and apocrine.
a. Merocrine (eccrine) sweat glands are more abundant than apocrine. The sweat from these
glands is very watery and they are responsible for temperature homeostasis
b. Apocrine glands are mostly found in the axillary and groin areas. They become active at time
of puberty. The sweat from these glands is viscous and is produced during stress or excitement. Bacteria
grow rapidly on this secretion and the breakdown of the sweat by the bacteria can lead to body odor.
Influenced by sex hormones.
Emotional sweating is used in polygraph tests (lie detectors) and is based on the idea that lying is a
stressful activity that causes sweating. Due to the salt content of sweat, a small amount of electricity can
be conducted through this secretion and measured.
3. Ceruminous glands: These are modified sweat glands that are found only in the outer ear. They
produce a waxy secretion called CERUMEN, which offers protection from some debris.
4. Mammary glands: These are modified sweat glands located in the breasts that, under the control of
hormones, produce milk for newborns.
Nails: These are plates of tightly packed, hard, keratinized cells that lie over epidermis of the dorsal,
distal portion of digits. The LUNULA is a thickened area of the nail that covers the matrix, the
mitotically active.
Nails grow from the base, do not have a resting period and fingernails grow faster than toenails.
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Hair (pili): characteristic of all mammals is the presence of hair. In humans, hair is found most places
on the body.
By the 5th month of fetal development, the fetus body is covered by unpigmented hair called LANUGO.
Near the time of birth, TERMINAL HAIRS that are course and pigmented, replace the lanugo on the
scalp and eyebrows. VELLUS HAIRS, which are short and fine, replace the lanugo on the rest of the
body. At time of puberty, terminal hair in the pubic, axillary regions, and in males on the chest and face,
replaces the vellus hair. The main functions of hair are protection, decrease in friction (in pubic region
during sexual intercourse), and odor retention associated with sexual arousal.
A hair is composed of columns of dead keratinized epithelial cells. The SHAFT of the hair projects above
the skin, while the ROOT is the portion that is beneath the skin. Surrounding the hair is the HAIR
FOLLICLE. At the base of the hair follicle is the BULB that contains the mitotically active cells.
Sebaceous glands are closely associated with the hair follicle, as is an ARRECTOR PILI muscle, a
smooth muscle that will lift the hair when it contracts, causing goose bumps in humans.
Hair is produced in cycles that involve a growth stage and a resting stage and is dependent upon where it
is located. Eyelashes grow for 30 days and rest for 105 days, while scalp hair grows for a period of 3
years and rests for 1-2 years. At any given time, 90% of scalp hair is in a growing stage. There appears
to be maximum lengths that hair will grow to, genetically determined.
Loss of hair can indicate a problem. Temporary loss can be due to drugs, diet, stress, and high fevers.
Hormonal changes can also result in hair loss and cause a shift from terminal hair to vellus hair
production beginning at the temples and spreading to the crown of the head. This is a genetic condition
seen in men and is referred to as male pattern baldness. Pregnant females may also see a change during
the 9 months.
Medication used to promote hair growth in balding individuals, example Minoxidil, was originally a
blood pressure medication. This is sold over the counter as ROGAINE.
Hair color
The color of hair is determined genetically. It is produced by melanocytes within the hair bulb and passed
to the keratinocytes of the hair cortex and medulla. Blonde hair has a small amount of melanin whereas
black has much more. Lighter brown hair has a smaller amount of lighter melanin and red hair contains
melanin that has more copper in it. As aging occurs and protein synthesis decreases, the amount of
melanin in the hair decreases, resulting in a gray-white color.

HYPODERMIS
The hypodermis is the underlying connective tissue of the skin, mostly consisting of adipose. Its purpose
is to connect the skin to the skeletal muscle. This is not anatomically considered part of the skin and is
referred to as hypodermis, subcutaneous tissue or superficial fascia.
Half of the adults body fat is stored in the hypodermis, which functions to store energy, protection and
insulation of the body. The amount of fat is dependent upon age, sex, diet and genetics.
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The Skin and Homeostasis

THERMOREGULATION AND THE SKIN:
One of the functions of the skin is to help maintain the homeostasis of the body temperature at 37 C. If
the environmental temperature is high, heat receptors in the skin will send impulses to the brain.
The brain then sends impulses to the sweat glands to produce perspiration. As this fluid EVAPORATES
from the surface of the skin, the skin is cooled off and returns to normal. Also, more blood will be
circulated to the skin and will release heat to the outside of the body.
In the cold, the brain will send information to the muscle layer of blood vessels causing them to
constrict. When this occurs, less blood will go into the vessels of the skin and therefore less heat will be
lost.
The Skin and Administering medications: Some lipid-soluble medications pass easily through the
skin. These tend to slowly diffuse through into the blood and be taken to other parts of the body.
Examples include nicotine patches, birth-control patches, and Dramamine patches. Other epithelial
coverings, like mucus membranes, also allow for absorption such as the mucous membrane in the mouth
used for administration of NITROGLYCERIN for chest pain and the mucous membrane in the rectum,
used for administration of medication thought suppositories.
The Skin and Burns: Tissue damage due to heat, electricity, radioactivity or strong chemicals that
DENATURE proteins in the exposed cells is called a BURN. Generally, the SYSTEMIC effects of a
burn are greater than the local effects.
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Classification of Burns:
Depending upon the depth, burns are classified as PARTIAL-THICKNESS BURNS that are subdivided
into first and second degree burns or FULL THICKNESS BURNS that are also referred to as third
degree burns.
First-degree burn: involves only the surface epidermis, mild pain and redness with no blisters. Typical
sunburn.
Second-degree burn: destroys all of the epidermis and may destroy some of the papillary region of the
dermis. Redness, blisters, edema and pain are the symptoms. No injury to accessory skin structures. The
regeneration of skin occurs from the epidermis of the hair follicles, sweat glands and from the unharmed
tissue around the involved area.
Third-degree burn: destroys epidermis, dermis and epidermal derivatives and may also involve deeper
tissue. They may also be surrounded by areas that have suffered first and second degree burns which still
may be sensitive the third degree burned areas no longer have dermal sensory receptors so may not
experience feeling. Skin functions are lost and regeneration can only occur from tissue in adjoining areas.
Often, skin grafts are necessary.
Serious burns destroy the bodys first line of defense, making the person susceptible to infections.
A major burn of the face can lead to respiratory problems while those in the joints lead to scar tissue
formation that restricts movement. Deep partial burns and full thickness burns can result in scar tissue
that experiences contracture disfigurement follows.
SKIN GRAFTS are performed to avoid this and to speed healing. In a SPLIT SKIN GRAFT, the
epidermis and part of the dermis are removed from another part of the body and placed over the burned
area. Interstitial fluid nourishes this graft and the dermis becomes vascularized. The area that the graft
was taken from still maintains some of its dermis and therefore will still have accessory structures
containing epithelium within them. These hair follicles and sweat glands will be the source of the new
epithelium.
When the loss of skin is so extensive that conventional grafting is not possible, a self-donation procedure
is used in which small amounts of an individuals epidermis are removed and grown in a lab. This will
produce sheets of new skin. These will be transplanted back to the person where needed and is termed
AUTOLOGOUS SKIN TRANSPLANTATION. This new skin will only be epidermis and does not
contain glands or hair. This procedure takes 3-4 weeks. A person needs some type of covering to protect
him during this time. During the waiting period, skin from a human cadaver may be used
(homograft) or from another animal, like a goat (heterograft).
When burns are extensive, the bodys first mode of defense is destroyed and it is left vulnerable to
infection. The patient is maintained in an ASEPTIC environment to decrease exposure to
microorganisms that could enter and cause infection. ANTIBIOTICS are given as a PROPHYLACTIC
step and DEBRIDEMENT is also done. This is the removal of dead tissue from the burned area, which
helps to clean the wound and remove tissue in which infection could develop. Maggots can be used.
Despite all the procedures available, infection is the major causes of death among burn victims.

12

There is also generalized depression of the immune system because the burned tissue is recognized as a
foreign substance and overwhelms the immune system. There will be a decrease in the activity of the
cells and substances of this protective mechanism and the body is more susceptible.
Aside from the threat of infection, the LOSS OF FLUIDS is another problem facing the patient as well
as an increase in the occurrence of BLOOD CLOTS in blood vessels. This is due to an increase of
clotting factors in the blood (due to a decrease in fluid volume).
Physiological Changes and Burns:
Within minutes of a deep burn, capillaries become more permeable, allowing for the release of fluid from
the blood into the tissue spaces. This results in EDEMA (swelling) and a decrease in the amount of
blood in the cardiovascular system. This decrease in blood volume can lead to tissue damage due to lack
of adequate oxygen, shock and death. The change in the tissue of the blood vessels can lead to blood
clotting.
Self Investigation: What is the RULE OF NINES? Does it apply to both adults and infants?
(a) In an adult, surface areas can be estimated using the rule of nines: Each major area of the body is 9%,
or a multiple of 9%, of the total body surface area. (b) In infants and children, the head represents a
larger proportion of surface area, and so the rule of nines is not as accurate for children, as can be seen
in this illustration of a 5-year-old child.
SKIN PATHOLOGY:
Skin cancer: Skin cancer is the most common type of cancer and is usually associated with
overexposure to the sun or TANNING LIGHTS. With exposure, the DNA in the skin cells change
(mutate) leading to uncontrolled cell division and abnormal behavior. Melanin protects the DNA those
with fair skin and less melanin are more susceptible to skin cancer.
3 most common forms of skin cancer:
1. BASAL CELL CARCINOMA: Accounts for 75% of all skin cancer. Tumors arise from s. basale of
epidermis and have a variety of appearances. Usually slow metastasis.
2. SQUAMOUS CELL CARCINOMA: This is the second most common skin cancer that arises from
the s. spinosum. Usually slow metastasis.
3. MALIGNANT MELANOMA: This is a life- threatening CA arising from melanocytes, many times
found within a preexisting mole. Treatments of melanomas, which are confined to the epidermis, are
usually successful however, melanomas metastasize rapidly therefore early detection is important.
Remember the ABCDE rule when examining a possible melanoma
A = asymmetry (one side of the lesion does not match the other)
B = border irregularity
C = color pigmentation is not uniform
D = diameter greater than 6mm
E = evolving lesion changes appearance over time.

OTHER PATHOLOGIES of the skin

Decubitus: bedsore or pressure sore; caused by prolonged deficiency of blood to tissues overlying a
bony projection. The deficiency causes a breakdown of the skin resulting in cracking, infection, and deep
13

damage. Commonly seen in patients that are bedridden for a long time, on buttocks, sacrum, and heels.
Turning is necessary.
Psoriasis: Chronic skin condition in which the skin cells divides 7 times more frequently than normal.
This leads to excessive cell accumulation, seen as scaly reddened patches on skin surface. Some cancer
drugs can be used for treatment.
Vitiligo: The development of patches of white skin due to abnormal or lack of melanocytes in an area.
May be an autoimmune response.

Vocabulary:
Cyanosis: a bluish color caused by decreased blood oxygen content, is an indication of impaired
circulatory or respiratory function
Jaundice: A yellowish skin color, can occur when the liver is damaged by a disease such as viral hepatitis.
Impetigo (know symptoms and what causes it): usually produces blisters or sores on the face, neck,
hands, and diaper area. It is primarily caused by Staphylococcus aureus, and sometimes by
Streptococcus pyogenes.
Erythema: is increased redness of the skin resulting from increased blood flow through the skin.

Chapter 6: Bone Tissue and the Skeletal System

The skeletal system has 4 components bone, cartilage, tendons, and ligaments all are different types
of connective tissue.
Functions of Bone:
1. SUPPORT: Bones provide a hard framework that ANCHORS soft tissue of the body.
2. PROTECTION: to internal organs by this hard tissue that overlies and/or surrounds them.
Example: cranium and brain, spinal cord and vertebral column
3. MOVEMENT: bones provide leverage for muscle contraction.
4. STORAGE: Some minerals in the blood, like calcium, are taken into the bone and stored. When
levels in the blood decrease, the minerals move from the bone into the blood, maintaining a homeostatic
level. Also adipose tissue, a source of energy, is stored in the YELLOW BONE MARROW within bone
cavities.
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5. BLOOD CELL PRODUCTION: occurs in RED BONE MARROW of certain bones (cranium,
sternum, ribs, vertebrae, sacral and hip bones (Os coxae), head of femur and humerus). The
production of blood cells = hemopoiesis
CARTILAGE
As with bone, cartilage is a component of the human skeletal system. These 2 tissues are closely related
to each other.
CHONDROBLASTS are cells that produce new cartilage matrix. When this material surrounds these
cells, there is a decrease in the O2 level and they differentiate into mature cartilage cells, the
CHONDROCYTES, which maintain the cartilage. This round cell is found within LACUNAE.
Blood vessels and nerves are found only in the perichondrium and dont enter the cartilage itself.
Therefore, nutrients and oxygen diffuse through the cartilage matrix to the cells. Due to this low level of
needed materials, cartilage takes a long time to heal.
PERICHONDRIUM is a double layer of connective tissue that is found on the outside of cartilage.
Blood vessels and nerves penetrate the outer portion of this sheath but not the cartilage itself. Therefore
nutrients must diffuse from these blood vessels to the chondrocytes.
There are 3 types of cartilage hyaline cartilage, fibrocartilage and elastic cartilage. They are located in
different areas of the body. The difference is dependent upon how flexible the matrix is.
1. Hyaline Cartilage: The most abundant type of cartilage, found at the ends of long bones and in the
costal (rib) area. Also seen in the embryo as the material that will be replaced by bone in endochondral
ossification: very strong, but not very flexible.
2. Fibrocartilage: Tough but flexible cartilage. Seen forming intervertebral discs and pubic symphysis.
The matrix has a lot of collagen.
3. Elastic Cartilage: Very flexible. Contains many collagen and elastin fibers in matrix.
Example: pinna of the ear.
MESENCHYME LEADING TO CARTILAGE and BONE FORMATION
During embryological development, MESENCHYME STEM CELLS or MSCs (embryological
connective tissue), gives rise to all definitive connective tissue, such as blood, adipose, cartilage, among
others. Bone is also included in this group because of its connective tissue classification.
Some mesenchyme gives rise to OSTEOCHONDRAL PROGENITOR CELLS, a type of stem cell.
These eventually will become cartilage or bone. OCPCs are located in the perichondrium, the
periosteum, and the endosteum.

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This development from one type of cell into another is referred to as DIFFERENTIATION the process
by which cells undergo a change toward a more specialized form or function.
HISTOLOGY OF BONE:
Osseous tissue consists of widely spread cells, separated by matrix.
4 Principal Osseous Cells:
1. OSTEOCHONDRAL PROGENITOR CELLS: All connective tissue develops embryologically
from MESENCHYME cells. Some of these mesenchyme cells become Osteochondral Progenitor Cells.
These cells are stem cells, able to go through mitosis. They eventually become osteoblasts or
chondroblasts.
2. OSTEOBLASTS: cells that form bone but no longer can go through mitosis.
They will secrete material that will compose the matrix of the bone, like collagen.
All osteoblasts are derived from osteochondral cells.
OSSIFICATION (osteogenesis): formation of bone by osteoblasts.
3. OSTEOCYTES: mature bone cells that are derived from osteoblasts-they are the main cell of
osseous tissue and maintain the bones matrix. No mitosis occurs in these cells. They differentiate from
osteoblasts as the osteoblasts surround themselves with matrix and reduce O2 supply.
Osteoblasts originally form bone tissue and osteocytes maintain daily cellular activity. Osteocytes are
found within LACUNAE. They are cells that have long processes that run through the CANALICULI
16

and come into close contact with those processes of other osteocytes. Diffusion of O 2 and nutr\ients is
possible.
Mesenchyme cells osteochondral progenitor cells osteoblasts osteocytes
4. OSTEOCLASTS: Derived from stem cells in the red bone marrow (not from the osteochondral
progenitor cells in bone and cartilage). They will settle on surfaces of bone and are responsible for
RESORPTION or breakdown of the matrix. This resorption of bone is important in the growth and
repair of bone and is a natural process that is constantly occurring. In health, resorption is in balance
with OSTEOGENESIS (formation of new bone by osteoblasts). These cells have many nuclei and have
ruffled edges.
BONE MATRIX
The MATRIX of bone is solid, composed of 35% organic and 65% inorganic material. The organic
material consists primarily of the protein collagen. The inorganic material is primarily of a calcium
phosphate crystal called HYDROXYAPATITE. The collagen is responsible for flexibility and the
inorganic material gives it strength.
These salts are deposited in the framework of COLLAGEN FIBERS, which gives flexibility to the hard
inorganic material. It is produced by osteoblasts.
PATHOLOGY OSTEOGENESIS IMPERFECTA: genetic disease in which there is a mutation in a
gene governing the formation of collagen. The result varies but less collagen will be produced, leading to
abnormal bone formation as well as decrease strength and flexibility in tendons. Osteogenesis Imperfecta
can be either barely noticed by the patient or can result in death soon after birth due to fracture of the
extremities occurring before and during birth and an inability to breathe because of small thorax and rib
fractures.
ARRANGEMENT OF BONE - CANCELLOUS and COMPACT BONE
Compact Bone: An arrangement of bone tissue that is very tight and dense. Because of this, compact
bone will be arranged in OSTEONS, a system of osteocytes that are arranged around a HAVERSIAN
CANAL, which contains blood vessels.
Compact bone composes the outside of all bones.
Cancellous Bone (spongy bone): An arrangement of bone that consists of separate plates called
TRABECULAE. Between these trabeculae are spaces filled with bone marrow and blood vessels.
NO OSTEONS EXIST IN CANCELLOUS BONE. This type of arrangement makes up the internal
portion of bone.

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BONE ANATOMY
STRUCTURE OF A LONG BONE:
DIAPHYSIS: The shaft of the bone
EPIPHYSIS: The extremities or ends of the bone.
EPIPHYSEAL GROWTH PLATE: growth area of bone (originally hyaline cartilage). This area closes as
person ages and is known as EPIPHYSEAL LINE.
ARTICULAR CARTILAGE: thin layer of hyaline cartilage covering surface of bone where it meets
another bone within a joint; reduces friction.
PERIOSTEUM: membrane around the surface of the bone, except where there is articular surface.
MEDULLARY CAVITY: space within the diaphysis that contains the yellow marrow and, in specific
bones, red marrow.
ENDOSTEUM: membrane lining of medullary cavity.

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BONE DEVELOPMENT
The skeleton during early development is composed of fibrous connective tissue and hyaline cartilage,
not bone. As the embryo develops, bone will replace these 2 types of tissue.
Ossification (production of bone tissue) begins at about 5 weeks gestation and continues throughout a
persons life.
There are 2 types of ossification, based on the original tissue that the bone replaces
INTRAMEMBRANEOUS OSSIFICATION and ENDOCHONDRAL OSSIFICATION.
1. INTRAMEMBRANEOUS OSSIFICATION direct ossification
a. At about 5-6 weeks of development, mesenchyme forms a fibrous connective tissue membrane
around the brain and where the mandible and clavicles will be.
b. These mesenchymal cells become osteochondral progenitor cells that then become osteoblasts.
c. As the osteoblasts produce matrix, they differentiate into osteocytes due to a decrease in oxygen.
Bone has been formed directly from mesenchyme, within a membrane. In humans, this type of
ossification occurs only in the flat bones of the skull, mandible and clavicles.
2. ENDOCHONDRAL OSSIFICATION indirect ossification
This is the method that most bones in the human body are formed.
a. Mesenchymal cells collect in regions of where bone will form.
b. Mesenchymal cells differentiate into osteochondral progenitor cells.
c. Osteochondral progenitor cells become chondroblasts and form a HYALINE CARTILAGE MODEL,
which will have the same shape as the bone that will later be formed will have. These cells become
surrounded by cartilage matrix, decrease O2 and differentiate into chondrocytes. A hyaline cartilage
model has been formed
d. Blood vessels invade this cartilage model bringing with them osteochondral progenitor cells that
become osteoblasts, replacing the chondrocytes. These osteoblasts produce bone that replaces the
cartilage, starting at the PRIMARY OSSIFICATION CENTERS of each bone.
e. Replacement of cartilage by bone continues until all of the cartilage, EXCEPT IN THE
EPIPHYSEAL PLATES, is replaced by bone. In mature bone, these plates will also ossify, restricting
future elongation and be referred to as EPYPHSEAL LINES.
Summary
Mesenchymal cells osteochondral progenitor cells
Chondroblasts differentiate into

Chondrocytes due to decrease in O2

OCPC become osteoblasts,
which form matrix in all areas
except epiphyseal growth plate.

chondroblasts which form a

small cartilaginous model of the bone

blood vessels invade the cartilaginous model

bringing a new population of OCPC with them

Osteoblasts eventually become osteocytes due to decrease in O2.

BONE is formed.

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Note that in ENDCHONDRAL OSSIFICATION, the development of bone is not direct. The structure is
first hyaline cartilage and then is replaced by bone.
Ossification of all bones will be complete by age 25, with the medial epiphysis of the clavicle being the
last to stop growing.
FACTORS AFFECTING BONE GROWTH
a. Genetics
b. Nutrition: The formation of bone is dependent upon mitosis and differentiation of stem cells. Any
metabolic disorder that affects overall health will effect rate of mitosis and therefore have serious
effects on skeletal growth. VITAMIN D is important for absorption of CALCIUM from the digestive
system.
c. Hormones:
GROWTH HORMONE, a hormone from the pituitary gland of the brain, is important in bone formation
and growth.
THYROID HORMONE and PARATHYROID HORMONES are also important in growth.
SEX HORMONES are also important in bone growth. Estrogens (female sex hormones) and
testosterones (male sex hormones) initially stimulate bone growth. When there is an increase in these
hormone levels around puberty, a growth spurt will follow. However, these hormones that initially
stimulate growth are also responsible for closure of the epiphyseal plates and therefore are responsible
for stopping growth. It has been hypothesized that estrogens cause a quicker closure and that is why
females tend to be shorter than males.
Remodeling is the ongoing replacement of old bone tissue by new bone tissue.
Bone tissue is never at rest and changes are constantly happening, even after the bone reaches its final
length and shape.
This remodeling will take place at different rates, depending upon the bone and the age of the person.
The distal portion of the femur will be replaced every 4 months, while the shaft will not be completely
replaced after the individual reaches adulthood.
Two other hormones involved in bone development are PARATHYROID HORMONE and
CALCITONIN, antagonistic hormones, and together will regulate the balance of calcium between the
bone and the blood and are therefore vital in bone remodeling.
BLOOD CALCIUM HOMEOSTASIS:
Bones are important in regulating blood calcium levels that must be maintained within tight limits.
PTH and Calcitonin are 2 antagonistic hormones that work together to maintain homeostatic blood
calcium levels
Parathyroid Hormone (PTH ) is a hormone of the parathyroid glands and is the major regulator of
blood calcium levels. When the blood calcium level decreases, the secretion of PTH increases, resulting
in an increase in the activity of osteoclasts.
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PTH: AIM increase calcium level in the blood Ca+2 derived from bone.

PTH also has an effect on the kidneys and digestive system that will act to increase calcium levels in the
blood.
Cancerous tumors can secrete hormones that the normal tissue would not do (paraneoplastic syndrome).
When a malignant neoplasm secretes PTH, bones become very thin and break easily. The increase in
Ca+2 in the blood can also cause problems.
Calcitonin is a hormone that is secreted by the thyroid gland and decreases osteoclast activity, leading to
a decrease in blood calcium concentration. High levels of calcium in the blood stimulate synthesis and
release.
Calcitonin: AIM decrease calcium level in the blood. Calcium is taken into the bone.

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The concentration of calcium must remain within homeostatic levels or pathologies occur.
STEPS IN BONE REPAIR:
Bone is a living tissue that can be repaired after damage is done to it.
FRACTURE: any break in a bone.
a. HEMATOMA FORMATION:
HEMATOMA: a localized mass of blood confined within an organ or space.
When a fracture occurs, the blood vessels in the area are broken, blood rushes into the injured area and a
clot forms 6-8 hours after injury.
Osteocytes around the site die due to a disruption of the blood and therefore of oxygen.
Inflammation occurs, bringing phagocytic cells (white blood cells) and osteoclasts into the area to clean
up the dead and dying bone cells.
b. CALLUS FORMATION:
CALLUS: mass of tissue that forms at the fracture site and attempts to connect the broken ends of the
bones.
This connective tissue will be invaded by chondroblasts from the periosteum and endosteum of the
broken bone. Cartilage is formed and chondoblasts become chondrocytes.

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c. CALLUS OSSIFICATION:
Similar to fetal development, the chondrocytes will eventually be replaced by osteoblasts and new bone
will be formed.
d. REMODELING OF BONE:
The final phase of fracture repair is REMODELING of the bony callus by osteoblasts and osteoclasts.
Repair may be so complete that no evidence of a break remains. However, the repaired area may remain
slightly thicker.
In order for this fracture repair to occur, the 2 portions of the broken bone must be located very near to
each other and held stationery. If this is not possible, another material must be used to join the bone
living bone from another, dead bone from a cadaver, or a type of coral that resembles cancellous bone.
EXERCISE AND BONE
Bone can become stronger in response to mechanical stress, including walking. When a person is
immobile, the bone will decrease in strength and size. This is also observed when a cast immobilizes a
limb and when an astronaut is in space where there is no gravity. Mechanical stress applied to bone
increases osteoblast activity.
AGING AND BONE LOSS:
With age there is a decrease in bone mass. This is due to, in women, a decrease in estrogen with
menopause, which leads to a decrease in calcium deposits in matrix. Also seen in men usually not until
age 60 due to decrease in testosterone.
With age, there is also an overall decrease in protein synthesis. For bone, this means a decrease in the
amount of collagen and elastin made and therefore a decrease in bone strength and flexibility. The chance
of bone fractures, especially hip fractures will increase with age, and these fractures take a longer time to
repair.
OSTEOPOROSIS is a pathology that leads to porous bones. It is characterized by decrease bone mass
and the bones are more likely to fracture.
In this condition, bone resorption (osteoclasts) occurs faster than bone formation (osteoblasts). It
affects middle age and older people, primarily women.
Osteoporosis is also seen in young people whose caloric intake is inadequate, those with eating disorders
and those with low fat content (ballet dancers).
The beginning of bone loss is OSTEOPENIA.
First sign of osteoporosis may be a PATHOLOGICAL SPONTANEOUS FRACTURE, where the bone
becomes so thin that it cannot take the stress of everyday life.
Chapter 7: Axial Skeleton and Chapter 8: Appendicular Skeleton
(note: majority of this information will be covered in lab)
The bones can be classified according to shape. Long bones, short bones (tarsals and carpals),
flat bones (cranial bones), irregular bones (vertebrae), Wormian bones (skull), and sesamoid bones
(small bones embedded in tendons like the patella).
DIVISION OF THE HUMAN SKELETON:
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The adult human skeleton consists of approximately 206 bones divided into 2 subdivisions; the AXIAL
SKELETON and the APPENDICULAR SKELETON.
AXIAL SKELETON: skull, vertebral column, ribs, sternum, hyoid, and ossicles
APPENDICULAR SKELETON: pectoral girdle (clavicle + scapula), humerus, radius, ulna,
carpals, metacarpals and phalanges, and pelvic girdle (os coxae), femur, tibia, fibula, tarsals, metatarsals
and phalanges.
At birth, the human has approximately 270 bones. Some of these bones will ossify together with time,
resulting in a smaller number in the adult, approximately 206.
Most of this work has been completed in the lab. The following are a few extra facts about the bones.
AXIAL ADDITIONS:
SKULL: The skull of a newborn consists of fibrous connective tissue areas that have not yet ossified.
These soft spots are called FONTANELS and enable the fetal skull to modify it size and shape during a
vaginal delivery, and to adjust to the increase in the size of the brain. The ANTERIOR FONTANEL is the
largest and finishes ossifying at 2 years of age.
Note that the top portion of the skull (skullcap) is termed the CALVARIA.
The skull may have a few extra small bones referred to as WORMIAN BONES, existing within sutures.
There is one type referred to as an INCA BONE which is larger than most and midline between the
junction of the lambdoidal and sagittal sutures. This bone was common in the skulls of the Incas and is
still present in their Andean descendants.
A SINUS is an opening within a bone that is lined with mucous membrane. The bones around the nasal
cavity have large sinuses within them called the PARANASAL SINUSES. These empty areas will decrease
the weight of the skull and act as a resonating chamber for the voice. There are sinuses in the frontal,
maxillary, ethmoidal and sphenoidal bones.
NASAL SEPTUM: There is one NASAL CAVITY that is divided by a NASAL SEPTUM (Septum =
division). This anatomical wall between the 2 NOSTRILS is composed of the PERPINDCULAR
PLATE of the ETHMOID BONE, the VOMER and the anterior SEPTAL CARTILAGE (pg. 206).
This is located mid-sagitally but can be injured by a trauma and is placed laterally to one side. This is a
DEVIATED SEPTUM that may be severe enough to cause difficulty in breathing. Surgical repair can be
done with excellent results.
Fracture of the Cribriform Plate of the ethmoid bone Trauma can pierce the membranes around the brain and cause the loss of clear cerebrospinal fluid (CSF)
through the nose. Because of this, infection is very possible.
CLEFT PALATE: usually the palatine processes of the maxillary bones unite during 10-12 weeks
gestation. If this does not happen, a CLEFT PALATE can occur. This is a condition in which there is an
opening between the oral and nasal cavity and feeding the infant is difficult. Surgical results are excellent.
In many instances, a CLEFT LIP accompanies this condition. As with the hard palate, anterior portion of
the maxillae do not fuse with each other.

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HYOID BONE: U shaped bone, unique because it does not articulate with other bones. It is found
between the mandible and the larynx and provides attachment for muscles of the tongue.
VERTEBRAL COLUMN: composed of 26 bones, distributed in 5 regions: 7 cervical vertebrae, 12
thoracic, 5 lumbar, the sacrum (5 FUSED vertebrae) and coccyx (4 FUSED vertebrae).
(Think: breakfast, lunch, and dinner at 7, 12, and 5)
There are INTERVERTEBRAL DISKS in between the bodies of adjacent vertebrae. These structures are
composed of fibrocartilage and are shock absorbers.
PATHOLOGY: HERNIATED (ruptured) DISK (slipped disk)
This pathology occurs when there is a rupture of a portion of the disk so that it is dislocated and leans
on spinal nerves. Can be very painful. Surgical intervention may be useful, removing a portion or the
entire disk and, when needed, fusing 2 vertebrae together.
There are 4 NORMAL CURVATURES of the spinal column: The infant is born with the THORACIC and
SACRAL curvatures. As the child lifts his head, the CERVICAL CURVATURE develops. As the child
becomes BIPEDAL, the LUMBAR CURVATURE develops
ABNORMAL CURVATURE OF THE SPINE:
SCOLIOSIS: lateral bend of the vertebral column, usually in the thoracic region.
KYPHOSIS: exaggeration of the thoracic curvature. Also known as hunchback.
LORDOSIS: exaggeration of lumbar curvature. Seen in pregnancy and also known as swayback.

APPENDICULAR ADDITIONS:
2 girdles exist to suspend the arms and legs.
PECTORAL GIRDLE: consists of the clavicle and the scapula, joined at the ACROMIOCLAVICULAR
JOINT. This is the most superior girdle that supports the arms.
PELVIC GIRDLE: formed by the anterior PUBIC SYMPHYSIS, joining the 2 OS COXAE.
The pubic symphysis is held together by FIBROCARTILAGE.
Chapter 9: Joints
Muscles pull on bones to make them move, but movement would not be possible without articulations
(joints) between the bones.
ARTICULATION: place where 2 bones come together. Some of these articulations are movable but
some are not.
The 3 major types of joints are classified as FIBROUS, CARTILAGINOUS and SYNOVIAL. This
classification system is based on the type of connective tissue that binds the 2 bones together.
1. Fibrous Joints: consists of 2 bones that are united by FIBROUS CONNECTIVE TISSUE. They
have little or no movement and do not have a joint cavity.
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a. Sutures immovable joints found in skull

b. Gomphoses a peg shaped structure fits into sockets and is held in place by connective tissue
the teeth.
2. Cartilaginous Joints: bones are united by hyaline or fibrous cartilage.
a. symphysis: a slightly movable joint where fibrocartilage unites the 2 bones. pubic
symphysis.
b. synchondrosis connecting material is hyaline cartilage. Epiphyseal plates of long bones are
temporary joints.
3. Synovial Joints: These are joints that have SYNOVIAL FLUID and are freely movable. Many of the
joints in the appendicular skeleton are synovial elbow, hip, knee. The ends of the bones are covered by
hyaline cartilage.
Self Investigation:

Joint Changes during Pregnancy

QUESTIONS:
What hormones cause changes in joints of a pregnant woman?
What joint are these changes beneficial in? What types of changes occur?
Why may the expectant mom suffer from fallen arches during pregnancy?
What major joint of the infant be negatively affected by increase in hormones in the mother?

GENERAL STRUCTURE of SYNOVIAL JOINTS

1. There is a joint cavity that contains 2 bones.
2. Articular cartilage covers articulating surfaces.
3. An ARTICULAR CAPSULE holds bones together. There are 2 parts to this capsule.
a. Fibrous capsule: Superficial connective tissue that attaches to periosteum of bones
surfaces also called LIGAMENTS.
LIGAMENT: Bundle of fibers connecting bone to bone.
b. Synovial membrane: inner portion of the articular capsule that secretes SYNOVIAL FLUID.
This is a fluid inside of a synovial joint that decreases friction when the bones move. It has the
appearance of raw eggs, and its consistency changes, depending upon the amount of movement - When
there is no movement the synovial fluid is thick, but will become thinner with joint movement.
This fluid also provides nourishment to the articular cartilage, which is avascular. It contains phagocytic
cells that remove debris from the area. With over usage and stress on the joint, there may be an increase
in the production of the synovial fluid = water on the knee is a possibility. This may need to be removed.
Other structures associated with some synovial joints:
Bursa: saclike structure filled with fluid. It is located between the skin and bone where there is a lot of
friction. Inflamed bursa: bursitis
Meniscus: pads of fibrocartilage found within some joints.
TYPES OF MOVEMENT WITHIN SYNOVIAL JOINTS
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ELEVATION AND DEPRESSION: upward and downward movement of body part.

Example: Mandible and shrugging of shoulders.
PROTRACTION AND RETRACTION: forward and backward movement of a body part, parallel to the
ground. Example: Mandible
INVERSION AND EVERSION: movement of sole of foot inwards and outwards
DORSIFLEXION AND PLANTER FLEXION: bending the foot towards the body and pointing it away
from the body.
SUPINATION AND PRONATION: movement of forearm so palm faces forward (anatomical position)
or posteriorly.
ADDUCTION AND ABDUCTION: movement towards the midline or away
FLEXION AND EXTENSION: decrease or increase the angle between 2 bones
JOINT PATHOLOGY
3 types of arthritis
1. RHEUMATOID ARTHRITIS: An autoimmune disease. The body attacks CARTILAGE and
SYNOVIAL MEMBRANES of joints. There will be inflammation of the joint, swelling, pain. If this type
of arthritis is not treated, the synovial membranes become thicker and produce more fluid (water on the
knee). There may also be abnormal growth of tissue formed by the inflamed synovial membrane =
PANNUS. The pannus may grow large enough to distort the joints. Destruction of the cartilage leads to
the bones within the joint ossifying together.
2. OSTEOARTHRITIS: This is a degenerative joint disease which is much more common than
Rheumatoid Arthritis. Its onset is usually associated with aging.
There is deterioration of the articular cartilage with osteoarthritis, but no synovial membrane
involvement. There is inflammation, pain and decrease in the use of the joint.
3. GOUTY ARTHRITIS: This is a metabolic disease.
Uric acid is a waste product produced by the cells, and much of it will be excreted through urine. When
a person has gout, they will be producing too much uric acid - more than can be excreted. The uric acid
will build up in the blood and some will form salt crystals that deposit in the joints, causing pain and
decrease in motion. Bones can also fuse because the crystals will wear away at the cartilage.
Usually seen in men with a family history and usually in the joints of the big toe.
A tophus (Latin: "stone", plural tophi) is a deposit of monosodium urate crystals in people with
longstanding high levels of uric acid in the blood. Tophiseen in gout.

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