Noting some skeletal pathologies

Abnormal curvature

Abnormal curvatures of the spine can cause plenty of pain and can lead to several problems. When the curve of the lumbar spine is exaggerated, the abnormal condition is lordosis, more commonly known as swayback. The lumbar spine of a pregnant woman becomes exaggerated because the woman needs to balance the pregnant belly on her frame. However, sometimes the curve remains after pregnancy, when weakened abdominal muscles fail to support the lumbar spine in its normal position. Developing the habit of holding the abdominal muscles in (rather than letting it all hang out, so to speak) helps to strengthen the body’s center and prevent swayback. Losing the beer belly helps, too.

Older men and women sometimes develop a condition called kyphosis (commonly known as hunchback), an abnormally curved spine in the thoracic region. Normal degeneration and compression of the vertebrae tends to straighten the cervical and lumbar regions of the spine and push out the thoracic vertebrae, thus causing kyphosis. Osteoporosis (see the next section) amplifies this.

You may recall being checked for scoliosis during junior-high gym class. The reason for that inspection is because scoliosis (abnormal lateral curvature) first becomes obvious during the late childhood/early teen years — just when people are most self-conscious. Normally, when you look at the spine from the back, it appears to be straight — the curvature is evident only when you view the spine from the side. However, in people with scoliosis, the spine curves side to side (laterally) and looks S-shaped when viewed from the back.

 

Osteoporosis

Osteoporosis is a disease in which bones become fragile, progressively and painlessly. To some extent, the process is inevitable with age, but when too much bone density is lost and small fractures appear, you have osteoporosis. The continuous process of bone resorption (osteoclasts breaking down the matrix) continues, but the osteoblasts (bone-building cells) become less and less active, so more bone is lost than replaced. Osteoporosis occurs most often in postmenopausal women because they lose the protective effect of estrogen on the bones.

Osteoporosis affects all bones, but of special concern are fractures of the hip and spine. A hip fracture almost always requires hospitalization and major surgery. It can impair a person’s ability to walk unassisted and may cause prolonged or permanent disability or even death. Spinal or vertebral fractures also have serious consequences, including loss of height, severe back pain, and deformity.

 

Cleft palate

A cleft palate is a relatively common birth defect that occurs when the palatine bones (a pair of the facial bones) or the maxilla bones fail to fuse during fetal development. This defect creates a problem in which the nasal cavity and oral cavity are open to each other. This problem can affect the palatine bones only or can be part of a syndrome of development problems. Cleft palate, also called hare-lip, is treated with surgery, usually when the child is very young.

 

Arthritis

Arthritis is a name for any of numerous conditions characterized by inflammation of the joints. The inflammation is painful in itself, and it also makes movement difficult and painful. The chronic inflammation can eventually erode the joint’s tissues (bone and cartilage). Treatment consists of controlling pain, reducing inflammation, and slowing the progress of joint damage.

Arthritis conditions are closely associated with immunity: Inflammation is a normal response of the immune system, but chronic inflammation of the joints is pathophysiological. Several arthritis conditions are autoimmune disorders. (See Chapter 13 for a discussion of autoimmunity.) Here are the common forms of arthritis:

• Osteoarthritis (OA) is the most common form. As the joints age and the ravages of normal use accumulate, low-level inflammation sets in. Eventually, the inflammation causes the joint’s cartilage to become thinner and lose elasticity. It can affect people at any age. Many people develop some osteoarthritis of the finger joints in late middle age.
• Rheumatoid arthritis (RA), an autoimmune condition, starts with inflammation of the synovium (joint lining). Later, often years later, the inflamed cells of the synovium begin to produce enzymes that actively destroy both bone and cartilage, restricting movement and increasing pain further.
• Juvenile arthritis (JA), the most common form affecting children under 16, is an autoimmune condition. Most likely, JA is several different autoimmune conditions that vary in the number of affected joints and the age of onset. As with other forms of arthritis, the symptoms are inflammation, joint pain, and stiffness. Sometimes, JA causes the limbs to grow to different lengths.
• Ankylosing spondylitis (AS) affects the spine and the sacroiliac joints. The severity of the pain and inflammation varies, but in its worst form, the chronic inflammation can cause the spine to fuse into a rigid, brittle column, prone to fracture. The eyes, heart, lung, and kidneys can also be affected.
• Gout is a form of arthritis caused by crystallized deposits of uric acid in the joints. Think "sand in the gears". As the uric acid crystals fill the joints, they damage cartilage, synovial membranes, tendons, and even the muscles adjoining the bone. Complications include kidney stones, nerve damage, and circulatory problems. Drugs are available that reduce the amount of uric acid in the blood, preventing its deposition in the joints.

 

Fractures

When bones absorb more force than they can handle, they break. Fractures are classified by the shape of the break, whether or not it spans the whole bone, and if breaks through the skin (called compound if it does; closed if it does not). Not all fractures are visible lines, though. Compression fractures, where the bone crumples but doesn’t literally break, are a common type of pathological fracture — those that have their root in disease (rather than trauma).

The body has its own fracture-repair process similar to remodeling, but key to proper healing is reduction (the correct realignment of the bone) and immobilization (which is maintained by applying casts or other equipment, such as plates or screws).