UNIVERSIDAD PRIVADA

TELESUP
FACULTAD DE MEDICINA

FA

INGLES

DOCENTE : Apesteguia Jose

ALUMNOS : Cabrera Avila Brenda

Cornelio Curimania Jimy
Gozme Maldonado Jorge
Garcia Ortiz Raul
Rondon gonzales Jonah
Goycochea Cerna Nicole
Huarcaya Marquez Anthony
Machuca Aliaga Diana
Mautino Reyes Anthony

CICLO : III

LIMA - PERU - 2017

 BONE SYSTEM

The human skeleton is the internal framework of the body. It is composed of around 270
bones at birth – this total decreases to around 206 bones by adulthood after some bones
have fused together. The bone mass in the skeleton reaches maximum density around age
21. The human skeleton can be divided into the axial skeleton and the appendicular
skeleton. The axial skeleton is formed by the vertebral column, the rib cage, the skull and
other associated bones. The appendicular skeleton, which is attached to the axial skeleton,
is formed by the shoulder girdle, the pelvic girdle and the bones of the upper and lower
limbs.

The human skeleton is not as sexually dimorphic as that of many other primate species, but
subtle differences between sexes in the morphology of the skull, dentition, long bones, and
pelvis exist. In general, female skeletal elements tend to be smaller and less robust than
corresponding male elements within a given population. The human female pelvis is also
different from that of males in order to facilitate childbirth. Unlike most primates, human
males do not have penile bones.

Basic Functions of the Bone Skeleton

1. Support: The bones provide a rigid frame of support for muscles and soft tissues.
2. Protection: the bones form several cavities that protect the internal organs that can
be deposited traumatisms. For example, the skull protects the brain against blows,
and the rib cage, consisting of ribs and sternum protects the lungs and heart.
3. Movement: thanks to the muscles that are inserted into the bones through the
tendons and their synchronized contraction, movement occurs.
4. Mineral Homeostasis: Bone tissue stores a number of minerals, especially calcium
and phosphorus, needed for muscle contraction and many other functions. When
needed, the bone releases these minerals into the blood that distributes them to other
parts of the body.
5. Production of blood cells: Within cavities located in certain bones, a tissue called
red bone marrow produces red blood cells or red blood cells through the process
called hematopoiesis.
6. Stock of reserve fat: the yellow marrow consists mainly of adipocytes with few
dispersed red blood cells. It is an important reserve of chemical energy.

FALTA DE PELUCA

The Five Types of Bones

The human skeleton has a number of functions, such as protection and supporting weight.
Different types of bones have differing shapes related to their particular function.
So, what are the different types of bones? How are they categorized?
There are five types of bones in the skeleton: flat, long, short, irregular, and sesamoid.
Let’s go through each type and see examples.
1. Flat Bones Protect Internal Organs

There are flat bones in the skull (occipital, parietal, frontal, nasal, lacrimal, and vomer), the
thoracic cage (sternum and ribs), and the pelvis (ilium, ischium, and pubis). The function of
flat bones is to protect internal organs such as the brain, heart, and pelvic organs. Flat bones
are somewhat flattened, and can provide protection, like a shield; flat bones can also
provide large areas of attachment for muscles.

2. Long Bones Support Weight and Facilitate Movement

The long bones, longer than they are wide, include the femur (the longest bone in the body)
as well as relatively small bones in the fingers. Long bones function to support the weight
of the body and facilitate movement. Long bones are mostly located in the appendicular
skeleton and include bones in the lower limbs (the tibia, fibula, femur, metatarsals, and
phalanges) and bones in the upper limbs (the humerus, radius, ulna, metacarpals, and
phalanges).

3. Short Bones Are Cube-shaped

Short bones are about as long as they are wide. Located in the wrist and ankle joints, short
bones provide stability and some movement. The carpals in the wrist (scaphoid, lunate,
triquetral, hamate, pisiform, capitate, trapezoid, and trapezium) and the tarsals in the ankles
(calcaneus, talus, navicular, cuboid, lateral cuneiform, intermediate cuneiform, and medial
cuneiform) are examples of short bones.

4. Irregular Bones Have Complex Shapes

Irregular bones vary in shape and structure and therefore do not fit into any other category
(flat, short, long, or sesamoid). They often have a fairly complex shape, which helps protect
internal organs. For example, the vertebrae, irregular bones of the vertebral column, protect
the spinal cord. The irregular bones of the pelvis (pubis, ilium, and ischium) protect organs
in the pelvic cavity.

5. Sesamoid Bones Reinforce Tendons

sesamoid bones are bones embedded in tendons. These small, round bones are commonly
found in the tendons of the hands, knees, and feet. Sesamoid bones function to protect
tendons from stress and wear. The patella, commonly referred to as the kneecap, is an
example of a sesamoid bone.

FALTA DE RAUL QUE ESTA DE CABEZA SU PARTE

FALTA DE BRENDA
OSTEOARTHRITIS
Osteoarthritis is the most common joint disorder. It is due to aging and wear and tear on a
joint.

CAUSES:

Cartilage is the firm and elastic tissue that protects the bones in the joints and allows them
to slide one over the other. When the cartilage ruptures and wears out, the bones rub against
each other. This often causes pain, swelling and stiffness. As osteoarthritis worsens, bone
spurs or extra bone may form around the joint. The ligaments and muscles around the joint
may become weaker and more rigid.

Before age 55, the disease occurs equally in both sexes. After 55, it is more common in
women.

Other factors can also lead to osteoarthritis:

Osteoarthritis tends to be hereditary. Being overweight increases the risk of osteoarthritis in

the joints of the hip, knee, ankle and foot, because the extra weight causes more wear and
tear. Fractures or other joint injuries can lead to osteoarthritis later in life. This includes
injuries to the cartilage and ligaments in the joints.

Work involving kneeling or squatting for more than an hour a day or involving lifting,
climbing stairs or walking increases the risk of osteoarthritis.
The practice of sports involving a direct impact on the joint (American football), torsion
(basketball or soccer) or throwing also increase the risk of osteoarthritis.

Conditions that can lead to osteoarthritis include: Bleeding disorders that cause bleeding in
the joint, such as hemophilia. Disorders that block the blood supply near a joint and lead to
avascular necrosis. Other types of arthritis, such as chronic gout, pseudogout or rheumatoid
arthritis

SYMPTOM:

The symptoms of osteoarthritis usually appear in middle-aged people and almost every
person has some symptoms towards the age of 70 years.

Joint pain and stiffness are the most common symptoms. The pain is often worse:

After exercise. When you put weight or put pressure on the joint. With osteoarthritis, the
joints become stiffer and more difficult to move over time. You may notice a squeaky,
creaking or crunching sound as the joint moves.

"Morning stiffness" refers to the pain and stiffness that you may feel as soon as you wake
up in the morning. The stiffness of osteoarthritis usually lasts for 30 minutes or less. It can
last more than 30 minutes if the joint is inflamed. It often improves after mild activity that
allows the joint to "warm up".

During the day, the pain may worsen when you are active and feel better when you are
resting. As osteoarthritis worsens, pain may be present when you are resting and may even
wake you up at night.

Some people may have no symptoms, although x-rays show changes in osteoarthritis.

TREATMENT:

Osteoarthritis can not be cured and will most likely get worse over time. However, the
symptoms of osteoarthritis can be controlled.

You may have surgery, but other treatments can improve your pain and make your life
much better. Although these treatments can not make arthritis disappear, they can often
delay surgery.

HANGES IN LIFESTYLE:

Staying active and exercising can maintain overall movement and joint. Ask the doctor to
recommend an appropriate home exercise routine. Exercises in the water, such as
swimming, are useful.

Other lifestyle recommendations include:

 Apply heat and cold to the joint

 Eat healthy foods
 Get enough rest
 Lose weight in case you are overweight
 Protect the joints from injury

If the pain of osteoarthritis gets worse, keeping pace with daily activities can become more
difficult or painful. Making changes in the house can help remove stress from your joints to
relieve some of the pain. If your work is causing you stress in certain joints, you may need
to adapt the work area or change the work tasks.

PHYSIOTHERAPY

It can help improve muscle strength and stiff joints movement, as well as balance. If the
therapy does not cause an improvement after 6 to 8 weeks, it may not work definitively.

Massage therapy can also help provide short-term pain relief. Be sure to work with a
massage therapist with experience in handling sensitive joints.
ORTHOPEDIC DEVICES

Orthopedic formulas and devices can sometimes support weakened joints. Some impede the
movement of the joint; others allow some movement Use an orthopedic device only when
recommended by your doctor or therapist, as misuse can cause joint pain, stiffness, and
pain.

ALTERNATIVE TREATMENTS

Acupuncture is a traditional Chinese treatment. It is believed that when acupuncture

needles stimulate certain points in the body, chemicals that block pain are released.
Acupuncture can provide short-term pain relief for osteoarthritis.

S-adenosylmethionine (SAM) is an artificial form of a natural chemical in the body that can
help reduce inflammation and joint pain.

SURGERY

Severe cases of osteoarthritis necessarily surgery to replace or repair damaged joints.

Surgical options can be:

Arthroscopic surgery to trim broken and injured cartilage Change in alignment of a bone to
relieve tension on said bone or joint (osteotomy) Surgical fusion of the bones, usually in the
vertebral column (arthrodesis) Partial or total replacement of the joint damaged by an
artificial joint (knee arthroplasty, hip arthroplasty, shoulder arthroplasty, ankle arthroplasty,
elbow arthroplasty).

SCOLIOSIS

Scoliosis is a disorder that causes an abnormal curve of the spine, or backbone. The spine
has normal curves when looking from the side, but it should appear straight when looking
from the front. Kyphosis is a curve in the spine seen from the side in which the spine is
bent forward. There is a normal kyphosis in the middle (thoracic) spine. Scoliosis is about
two times more common in girls than boys. It can be seen at any age, but it is most
common in those over about 10 years of age. Scoliosis is hereditary in that people with
scoliosis are more likely to have children with scoliosis; however, there is no correlation
between the severity of the curves from one generation to the next.

WHAT CAUSES SCOLIOSIS?

Scoliosis affects about 2% of females and 0.5% of males. In most cases, the cause of
scoliosis is unknown (known as idiopathic). This type of scoliosis is described based on the
age when scoliosis develops, as are other some other types of scoliosis.
  If the person is less than 3 years old, it is called infantile idiopathic scoliosis.
 Scoliosis that develops between 3-10 years of age is called juvenile idiopathic
scoliosis.
 People who are over 10 years old (10-18 years old) have adolescent idiopathic
scoliosis.

More than 80% of people with scoliosis have idiopathic scoliosis, and the majority of those
are adolescent girls; the most common location for scoliosis is in the thoracic spine.
Medical literature often has more specific names or terms for scoliosis:

 Kyphoscoliosis: a combination of outward and lateral spine curvature

 Dextroscoliosis: curvature of the spine to the right
 Rotoscoliosis (rotatory): curvature of the vertebral column turned on its axis
 Levoconvex: curvature of the spine to the left
 Thoracolumbar: curvature related to both the thoracic and lumbar regions of the
spine

WHAT ARE THE CAUSES OF OTHER TYPES OF SCOLIOSIS?

As stated above, idiopathic scoliosis and its subtypes comprise over 80% of all scoliosis
patients. However, there are three other main types of scoliosis:

 Functional: In this type of scoliosis, the spine is normal, but an abnormal curve
develops because of a problem somewhere else in the body. This could be caused
by one leg being shorter than the other or by muscle spasms in the back.
 Neuromuscular: In this type of scoliosis, there is a problem when the bones of the
spine are formed. Either the bones of the spine fail to form completely or they fail to
separate from each other during fetal development. This type of congenital scoliosis
develops in people with other disorders, including birth defects, muscular
dystrophy, cerebral palsy, or Marfan syndrome (an inherited connective tissue
disease). People with these conditions often develop a long C-shaped curve and
have weak muscles that are unable to hold them up straight. If the curve is present at
birth, it is called congenital. This type of scoliosis is often much more severe and
needs more aggressive treatment than other forms of scoliosis.
 Degenerative: Unlike the other forms of scoliosis that are found in children and
teens, degenerative scoliosis occurs in older adults. It is caused by changes in the
spine due to arthritis known as spondylosis. Weakening of the normal ligaments and
other soft tissues of the spine combined with abnormal bone spurs can lead to an
abnormal curvature of the spine. The spine can also be affected by osteoporosis,
vertebral compression fractures, and disc degeneration.

There are other potential causes of scoliosis, including spine tumors such as osteoid
osteoma. This is a benign tumor that can occur in the spine and cause pain. The pain causes
people to lean to the opposite side to reduce the amount of pressure applied to the tumor.
This can lead to a spinal deformity. In addition, researchers suggest that genetics
(hereditary), muscle disorders, and/or abnormal fibrillin metabolism may play a role in
causing or contributing to scoliosis development.
WHAT ARE SCOLIOSIS SYMPTOMS AND SIGNS?

The most common symptom of scoliosis is an abnormal curve of the spine. Often this is a
mild change and may be first noticed by a friend or family member or physician doing
routine screening of children for school or sports. The change in the curve of the spine
typically occurs very slowly so it is easy to miss until it becomes a more severe physical
deformity. It can also be found on a routine school screening examination for scoliosis.
Those affected may notice that their clothes do not fit as they did previously, they may
notice an uneven waist, or that pant legs are longer on one side than the other.
Scoliosis may cause the head to appear off center, leaning to one side or notice one hip or
shoulder to be higher than the opposite side. Someone may have a more obvious curve on
one side of the rib cage on their back from twisting of the vertebrae and ribs. If the scoliosis
is more severe, it can make it more difficult for the heart and lungs to work properly. This
can cause shortness of breath and chest pain.
In most cases, scoliosis is not painful, but there are certain types of scoliosis than can cause
back pain, rib pain, neck pain, muscle spasms, and abdominal pain. Additionally, there are
other causes of these nonspecific pains, which a doctor will want to look for as well to rule
out other diseases.

WHAT IS THE TREATMENT FOR SCOLIOSIS?

Treatment of scoliosis is based on the severity of the curve and the chances of the curve
getting worse. Certain types of scoliosis have a greater chance of getting worse, so the type
of scoliosis also helps to determine the proper treatment. There are three main categories of
treatment: observation, bracing, and surgery. Consequently, there are treatments available
that do not involve surgery, but in some individuals, surgery may be their best option.
Functional scoliosis is caused by an abnormality elsewhere in the body. This type of
scoliosis is treated by treating that abnormality, such as a difference in leg length. A small
wedge can be placed in the shoe to help even out the leg length and prevent the spine from
curving. There is no direct treatment of the spine because the spine is normal in these
people.
Neuromuscular scoliosis is caused by an abnormal development of the bones of the spine.
These types of scoliosis have the greatest chance for getting worse. Observation and
bracing do not normally work well for these people. The majority of these people will
eventually need surgery to stop the curve from getting worse.
Treatment of idiopathic scoliosis usually is based on the age when it develops.
In many cases, infantile idiopathic scoliosis will improve without any treatment. X-rays can
be obtained and measurements compared on future visits to determine if the curve is getting
worse. Bracing is not normally effective in these people.
Juvenile idiopathic scoliosis has the highest risk for getting worse of all of the idiopathic
types of scoliosis. Bracing can be tried early if the curve is not very severe. The goal is to
prevent the curve from getting worse until the person stops growing. Since the curve starts
early in these people, and they have a lot of time left to grow, there is a higher chance for
needing more aggressive treatment or surgery.
Adolescent idiopathic scoliosis is the most common form of scoliosis. If the curve is small
when first diagnosed, it can be observed and followed with routine X-rays and
measurements. If the curve or Cobb angle stays below about 20-25 degrees (Cobb method
or angle, is a measurement of the degree of curvature), no other treatment is needed. The
patient may return to see the doctor every three to four months to check for any worsening
of the curve. Additional X-rays may be repeated each year to obtain new measurements and
check for progression of the curve. If the curve is between 25-40 degrees and the patient is
still growing, a brace may be recommended. Bracing is not recommended for people who
have finished growing. If the curve is greater than 40 degrees, then surgery may be
recommended.

As explained above, scoliosis is not typically associated with back pain. However, in some
patients with back pain, the symptoms can be lessened with physical therapy, massage,
stretches, and exercises, including yoga (but refraining from twisting pressures on the
spine). These activities can help to strengthen the muscles of the back. Medical treatment is
mainly limited to pain relievers such as nonsteroidal anti-inflammatory medications
(NSAIDs) and anti-inflammatory injections. These treatments are not, however, a cure for
scoliosis and will not be able to correct the abnormal curve.

There are several different types of braces available for scoliosis. Some need to be worn
nearly 24 hours a day and are removed only for showering. Others can be worn only at
night. The ability of a brace to work depends on the person following the instructions from
the doctor and wearing the brace as directed. Braces are not designed to correct the curve.
They are used to help slow or stop the curve from getting worse with good back brace
management treatment. Intermittent or chronic discomfort may be a side effect of any
treatments used to slow or correct the spinal curvature.
If the curve stays below 40 degrees until the person is finished growing, it is not likely to
get worse later in life. However, if the curve is greater than 40 degrees, it is likely to
continue to get worse by 1-2 degrees each year for the rest of the person's life, a long-term
effect of the disease. If this is not prevented, the person could eventually be at risk for heart
or lung problems. The goals of surgery for scoliosis are as follows: correcting and
stabilizing the curve, reducing pain, and restoring a more normal curve and appearance to
the spinal column.
Surgery involves correcting the curve back to as close to normal as possible and performing
a spinal fusion to hold it in place. This is done with a combination of screws, hooks, and
rods that are attached to the bones of the spine to hold them in place. The surgeon places
bone graft around the bones to be fused (spinal fusion) to get them to grow together and
become solid. This prevents any further curvature in that portion of the spine. In most
cases, the screws and rods will remain in the spine and not need to be removed. There are
many different ways for a surgeon to perform the fusion surgery. It may be all performed
from a single incision on the back of the spine or combined with another incision along
your front or side. This decision is based on the location and severity of the curve.
Surgery recovery and scar formation varies some from person to person. A doctor will use
medications to control the patient's pain initially after surgery. A patient will likely be up
out of bed to a chair the first day after surgery and will work with a physical therapist who
will assist him or her in walking after the surgery. As the patient continues to recover, it is
important to improve muscle strength. The physical therapist can help the patient with
exercises for the muscles that will also help with the pain. Typically, a young person will
miss about six weeks of school and may take about six months to return to their normal
activities, although recovery time varies between individuals.
As with any surgery, there are risks of surgery for scoliosis. The amount of risk depends
partially on the patient's age, the degree of curve, the cause of the curve, and the amount of
correction attempted. In most cases, the surgeon will use a technique called
neuromonitoring during surgery. This allows the surgeon to monitor the function of the
spinal cord and nerves during surgery. If they are being placed at increased risk of damage,
the surgeon is alerted and can adjust the procedure to reduce those risks. There is a small
risk of infection with any surgery. This risk is decreased with the use of antibiotics, but it
can still occur in some cases. Other potential risks include injury to nerves or blood vessels,
bleeding, continued curve progression after surgery, broken rods or screws, and the need
for further surgery. Each of these is rare.
If a tumor such as osteoid osteoma is the cause of the scoliosis, surgery to remove the
tumor is generally able to correct the curve.
People with degenerative scoliosis will often have more complaints of back pain and leg
pain. This is related to the arthritis in the back and possible compression of the nerve roots
that lead to the legs. Nonoperative treatment including physical therapy, exercises, and
gentle chiropractic can help relieve these symptoms in some cases. People who fail to
improve with these treatments may benefit from surgery. X-rays and possible MRIs will be
obtained to plan for surgery. The surgery could include only a decompression or removal of
bone spurs that are compressing the nerves. In some cases, a fusion will be necessary to
stabilize the spine and possibly correct the abnormal curve. The cost of scoliosis surgery
can be high; according to the Spinal Cord Society of surgeons, an average cost per
operation (rod implants to straighten the spine) is $150,000 and may be higher or lower
depending on the individual procedure.

LORDOSIS
In the back there are two concavities and which they call lordosis: the cervical and the
lumbar. When these curves are very pronounced we call them hyperlordosis.

Mechanical hyperlordosis is distinguished:

 With pelvic imbalance forward (anteversion).

 With pelvic imbalance combined with backward movement of the lumbar and sacral
spine (chicken ass).

Hyperlordosis with malformation:

 Spondylolysis

En cualquiera de los casos, viene acompañada normalmente con cifosis dorsal importante:
hipercifosis; ya que la columna vertebral tiende a compensar curvaturas ante cualquier
anomalía en la misma.
CAUSES

Although in many cases it is understood that it can be congenital there are several causes
why this curvature can increase with the passage of time:

 Abdominal hypotonia: there is very low muscle tone in the area of the muscles of
the abdomen, which leads to overweight, causing the lumbar spine to overlap.

 Pregnancy: hence the frequent back pains in women with an advanced state of
pregnancy.

 Repetitive surgical interventions in the abdominal area: as in cases of inguinal

hernias with continuous relapses or recurrences.

 Shortening of the hamstring muscles: by keeping the muscles in the back of the legs
contracted.

SYMPTOM.

There are well tolerated hyperlodosis, mostly genetic cause, but this is not usually the most
common. When the origin is in postural adaptations, poor sports or work habits,
compensation for some disease (eg Scheuerman's disease) or lack of flexibility of muscle
chains, then muscle contractures and pain appear to inform us That something does not
work well in our body.

The increase of these curves causes an exaggerated pressure on the vertebral articulations
(interapofisarias articulations). In a first phase the pain will appear due to the irritation of
the sensitive elements of the area (nerves, ligaments, short muscles) and over time the
increased pressure will accelerate the degenerative processes (osteoarthritis, stenosis,
spondylosis.

DIAGNOSIS.

A clinical examination by a qualified professional is usually sufficient; the diagnosis can be

confirmed by a profile radiograph in standing position