![]() ![]() More specific study of bone innervation awaited the availability of technology that could microscopically view bone in sufficient detail. His diagram demonstrated nerves entering and leaving the bones of a skeleton. The first documentation of an anatomic relationship between nerves and bone was made via woodcut, by Charles Estienne in Paris in 1545. Conditions such as Sudeck's atrophy in association with chronic regional pain syndrome, heterotopic ossification in the setting of head injury, and Charcot diabetic neuroarthropathy extend the general consideration that nervous and musculoskeletal systems must interact. However, the assumption was always that only the periosteum, and not the bone tissue itself, was innervated. In this article, we review the current state of experimental and clinical evidence implicating the role of nervous tissue in regulating bone biology and discuss the current understanding of molecular signaling between nervous and osseus tissue in the homeostatic maintenance of the skeleton.įrom the time of his or her first fracture reduction in the emergency room, no orthopaedic surgeon has ever doubted that bone was innervated. Specifically considered are the potential neural influences at work in such conditions as osteoporosis, fracture healing, Charcot osteoarthropathy, musculoskeletal pain syndromes, heterotopic ossification, skeletal growth and development, and obesity-related increased bone density. Disorders of nerves - central or peripheral - can have substantial influence on bone health and repair. Potential transmitters of this influence include glutamate, calcitonin gene-related protein (CGRP), substance P, vasoactive intestinal peptide (VIP), pituitary adenylate cyclase activating polypeptide (PACAP), leptin, and catecholamines. Metabolic control of bone is influenced by the nervous system. Their function has recently become the focus of intense study.
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