In this chapter we will study
methods used to diagnose bone disorders;
three noncancerous bone diseases—osteoporosis, osteomyelitis, and osteochondrosis; and
four forms of bone cancer—osteosarcoma, chondrosarcoma, fibrosarcoma, and myeloma.
Diagnosing Bone Disorders
As living organs, bones are subject not only to
fractures but also to several other diseases.
and symptoms of a disorder of the bone tissue per se
can be difficult to distinguish from those of other
skeletomuscular diseases, thus testing the diagnostic
skill of a physician. Some of the procedures described
in this chapter of the clinical manual also apply to
chapters 9 and 10, which deal with the skeleton as a
whole and the joints, respectively.
Pain is the most common symptom of a bone
disorder, but patients often wait until other symptoms
arise before seeking help. Such delay may allow the
disease to reach a more advanced stage or to involve
additional tissues or body structures.
Pain alone does
little to help a clinician make the proper diagnosis.
The physical examination must include careful
observation of the patient’s gait and posture for clues
as to which bones or joints are involved. Bone
abnormalities can often be detected by palpation. In
addition, various tests can aid diagnosis, including the
such as X rays and CT and
MRI scans may reveal dislocations, tumors, and
changes in bone size.
(densitometry) help detect bone
cancers, infections, necrosis, trauma, degenerative
bone diseases, and metabolic disorders that affect
To perform a bone scan, the patient
is injected with a radioisotope that has an affinity
for bone. After allowing the radioisotope to
accumulate in the bones, the pattern of gamma-
ray emission is monitored.
Diseased bones show
a different pattern of emission than healthy bones.
is the process of making an X ray
of the blood vessels.
The circulatory system must
be injected with a contrast medium, such as
barium or iodine compounds, to enhance the
visibility of the vessels on an X ray. Although this
procedure is not limited to examination of the
skeletal system, it is useful for evaluating the
blood flow to the bones.
can provide clues to bone
disorders by measuring the concentrations of
enzymes and other chemicals in the blood serum.
For example, an elevated concentration of alkaline
phosphatase may indicate bone cancer or osteitis
deformans. Bone cancer, fractures, and long-term
immobility can raise the serum calcium
concentration. Bone tumors raise the serum
is used to evaluate both the gross and
microscopic anatomy of a small sample of bone.
Common Bone Disorders