[MULTIPLE INJURIES] Case Sharing

Normal Anatomy and Physiology

The Skeletal System
Humans are born with over 270 bones, some of which fuse together into a
longitudinal ais, the aial s!eleton, to which the a""endicular s!eleton is
attached#
$he aial s!eleton %&0 bones' is formed by the vertebral column %2(', the rib cage
%)2 "airs of ribs and the sternum', and the s!ull %22 bones and 7 associated
bones'# $he u"right "osture of humans is maintained by the aial s!eleton, which
transmits the weight from the head, the trun!, and the u""er etremities down to
the lower etremities at the hi" *oints# $he bones of the s"ine are su""orted by
many ligaments# $he erectors s"inae muscles are also su""orting and are useful
for balance#
$he a""endicular s!eleton %)2( bones' is formed by the "ectoral girdles %+', the
u""er limbs %(0', the "elvic girdle %2', and the lower limbs %(0'# $heir functions are
to ma!e locomotion "ossible and to "rotect the ma*or organs of locomotion,
digestion, ecretion, and re"roduction#
Function
$he s!eleton serves si ma*or functions#
Support
$he s!eleton "rovides the framewor! which su""orts the body and maintains its
sha"e# $he "elvis, associated ligaments and muscles "rovide a ,oor for the "elvic
structures# -ithout the rib cages, costal cartilages, and intercostal muscles, the
heart would colla"se#
Moement
$he *oints between bones "ermit movement, some allowing a wider range of
movement than others, e#g# the ball and soc!et *oint allows a greater range of
movement than the "ivot *oint at the nec!# .ovement is "owered by s!eletal
muscles, which are attached to the s!eleton at various sites on bones# .uscles,
bones, and *oints "rovide the "rinci"al mechanics for movement, all coordinated by
the nervous system#
Protection
$he s!eleton "rotects many vital organs/
$he s!ull "rotects the brain, the eyes, and the middle and inner ears#
$he vertebrae "rotect the s"inal cord#
$he rib cage, s"ine, and sternum "rotect the human lungs, human heart
and ma*or blood vessels#
$he clavicle and sca"ula "rotect the shoulder#
$he ilium and s"ine "rotect the digestive and urogenital systems and the
hi"#
$he "atella and the ulna "rotect the !nee and the elbow res"ectively#
$he car"als and tarsals "rotect the wrist and an!le res"ectively#
) 0 P a g e
[MULTIPLE INJURIES] Case Sharing
!loo" #ell Pro"uction
$he s!eleton is the site of haemato"oiesis, the develo"ment of blood cells that
ta!es "lace in the bone marrow#
Stora$e
1one matri can store calcium and is involved in calcium metabolism, and bone
marrow can store iron in ferrotin and is involved in iron metabolism# However,
bones are not entirely made of calcium, but a miture of chondroitin sulfate and
hydroya"atite, the latter ma!ing u" 702 of a bone#
The Inte$umentary System
%ypo"ermis
$he hy"odermis is the dee"est section of the s!in# $he hy"odermis refers to
the fat tissue below the dermis that insulates the body from cold
tem"eratures and "rovides shoc! absor"tion# 3at cells of the hy"odermis also
store nutrients and energy# $he hy"odermis is the thic!est in the buttoc!s,
"alms of the hands, and soles of the feet# As we age, the hy"odermis begins
to atro"hy, contributing to the thinning of aging s!in#
&ermis
$he dermis is located between the hy"odermis and the e"idermis# 4t is a
5brous networ! of tissue that "rovides structure and resilience to the s!in#
-hile dermal thic!ness varies, it is on average about 2 mm thic!# $he ma*or
com"onents of the dermis wor! together as a networ!# $his mesh6li!e
networ! is com"osed of structural "roteins %collagen and elastin', blood and
lym"h vessels, and s"eciali7ed cells called mast cells and 5broblasts# $hese
are surrounded by a gel6li!e substance called the ground substance,
com"osed mostly of glycosaminoglycans# $he ground substance "lays a
critical role in the hydration and moisture levels within the s!in#
Epi"ermis
$he e"idermis is the outermost layer of the s!in# Categori7ed into 5ve
hori7ontal layers, the e"idermis actually consists of anywhere between 80
cell layers %in thin areas' to )00 cell layers %in thic! areas'# $he average
e"idermal thic!ness is 0#) millimeters, which is about the thic!ness of one
sheet of "a"er# $he e"idermis acts as a "rotective shield for the body and
totally renews itself a""roimately every 2& days# $he 5rst layer of the
e"idermis is the stratum basale# $his is the dee"est layer of the e"idermis
and sits directly on to" of the dermis# 4t is a single layer of cube6sha"ed cells#
New e"idermal s!in cells, called !eratinocytes, are formed in this layer
through cell division to re"lace those shed continuously from the u""er
layers of the e"idermis# $his regenerative "rocess is called s!in cell renewal#
As we age, the rate of cell renewal decreases# .elanocytes, found in the
stratum basale, are res"onsible for the "roduction of s!in "igment, or
2 0 P a g e
[MULTIPLE INJURIES] Case Sharing
melanin# .elanocytes transfer the melanin to nearby !eratinocytes that will
eventually migrate to the surface of the s!in# .elanin is "hoto"rotective/ it
hel"s "rotect the s!in against ultraviolet radiation %sun e"osure'#
Su'cutaneous Tissue
$he subcutaneous tissue is a layer of fat and connective tissue that houses
larger blood vessels and nerves# $his layer is im"ortant is the regulation of
tem"erature of the s!in itself and the body# $he si7e of this layer varies
throughout the body and from "erson to "erson#
9 0 P a g e
[MULTIPLE INJURIES] Case Sharing
The Muscular System
$he muscular system is res"onsible for the movement of the human body#
Attached to the bones of the s!eletal system are about 700 named muscles
that ma!e u" roughly half of a "erson:s body weight# ;ach of these muscles
is a discrete organ constructed of s!eletal muscle tissue, blood vessels,
tendons, and nerves# .uscle tissue is also found inside of the heart, digestive
organs, and blood vessels#
S!eletal muscles vary considerably in si7e, sha"e, and arrangement of 5bers#
$hey range from etremely tiny strands such as the sta"edium muscle of the
middle ear to large masses such as the muscles of the thigh# Some s!eletal
muscles are broad in sha"e and some narrow# 4n some muscles the 5bers are
"arallel to the long ais of the muscle< in some they converge to a narrow
attachment< and in some they are obli=ue#
Muscle Types
$here are three ty"es of muscle tissue/ >isceral, cardiac, and s!eletal#
)# >isceral .uscle# >isceral muscle is found inside of organs li!e the stomach,
intestines, and blood vessels# $he wea!est of all muscle tissues, visceral
muscle ma!es organs contract to move substances through the organ#
1ecause visceral muscle is controlled by the unconscious "art of the brain, it
is !nown as involuntary muscle?it cannot be directly controlled by the
conscious mind# $he term @smooth muscleA is often used to describe visceral
muscle because it has a very smooth, uniform a""earance when viewed
under a microsco"e# $his smooth a""earance star!ly contrasts with the
banded a""earance of cardiac and s!eletal muscles#
2# Cardiac .uscle# 3ound only in the heart, cardiac muscle is res"onsible for
"um"ing blood throughout the body# Cardiac muscle tissue cannot be
controlled consciously, so it is an involuntary muscle# -hile hormones and
signals from the brain ad*ust the rate of contraction, cardiac muscle
stimulates itself to contract# $he natural "acema!er of the heart is made of
cardiac muscle tissue that stimulates other cardiac muscle cells to contract#
1ecause of its self6stimulation, cardiac muscle is considered to be
autorhythmic or intrinsically controlled# $he cells of cardiac muscle tissue are
striated?that is, they a""ear to have light and dar! stri"es when viewed
under a light microsco"e# $he arrangement of "rotein 5bers inside of the cells
causes these light and dar! bands# Striations indicate that a muscle cell is
very strong, unli!e visceral muscles# $he cells of cardiac muscle are branched
B or C sha"ed cells tightly connected together by s"ecial *unctions called
intercalated dis!s# 4ntercalated dis!s are made u" of 5ngerli!e "ro*ections
from two neighboring cells that interloc! and "rovide a strong bond between
the cells# $he branched structure and intercalated dis!s allow the muscle
cells to resist high blood "ressures and the strain of "um"ing blood
throughout a lifetime# $hese features also hel" to s"read electrochemical
signals =uic!ly from cell to cell so that the heart can beat as a unit#
9# S!eletal .uscle# S!eletal muscle is the only voluntary muscle tissue in the
human body?it is controlled consciously# ;very "hysical action that a "erson
consciously "erforms %e#g# s"ea!ing, wal!ing, or writing' re=uires s!eletal
muscle# $he function of s!eletal muscle is to contract to move "arts of the
body closer to the bone that the muscle is attached to# .ost s!eletal muscles
are attached to two bones across a *oint, so the muscle serves to move "arts
of those bones closer to each other#
+ 0 P a g e
[MULTIPLE INJURIES] Case Sharing
Names o( Skeletal Muscles
S!eletal muscles are named based on many diDerent factors, including their
location, origin and insertion, number of origins, sha"e, si7e, direction, and
function#
Eocation# .any muscles derive their names from their anatomical region# $he
rectus abdominis and transverse abdominis, for eam"le, are found in the
abdominal region# Some muscles, li!e the tibialis anterior, are named after
the "art of the bone %the anterior "ortion of the tibia' that they are attached
to# Fther muscles use a hybrid of these two, li!e the brachioradialis, which is
named after a region %brachial' and a bone %radius'#
Frigin and 4nsertion# Some muscles are named based u"on their connection
to a stationary bone %origin' and a moving bone %insertion'# $hese muscles
become very easy to identify once you !now the names of the bones that
they are attached to# ;am"les of this ty"e of muscle include the
sternocleidomastoid %connecting the sternum and clavicle to the mastoid
"rocess of the s!ull' and the occi"itofrontalis %connecting the occi"ital bone
to the frontal bone'#
Number of Frigins# Some muscles connect to more than one bone or to more
than one "lace on a bone, and therefore have more than one origin# A muscle
with two origins is called a bice"s# A muscle with three origins is a trice"s
muscle# 3inally, a muscle with four origins is a =uadrice"s muscle#
Sha"e, Si7e, and Girection# -e also classify muscles by their sha"es# 3or
eam"le, the deltoids have a delta or triangular sha"e# $he serratus muscles
feature a serrated or saw6li!e sha"e# $he rhomboid ma*or is a rhombus or
diamond sha"e# $he si7e of the muscle can be used to distinguish between
two muscles found in the same region# $he gluteal region contains three
muscles diDerentiated by si7e?the gluteus maimus %large', gluteus medius
%medium', and gluteus minimus %smallest'# 3inally, the direction in which the
muscle 5bers run can be used to identify a muscle# 4n the abdominal region,
there are several sets of wide, ,at muscles# $he muscles whose 5bers run
straight u" and down are the rectus abdominis, the ones running transversely
%left to right' are the transverse abdominis, and the ones running at an angle
are the obli=ues#
3unction# .uscles are sometimes classi5ed by the ty"e of function that they
"erform# .ost of the muscles of the forearms are named based on their
function because they are located in the same region and have similar
sha"es and si7es# 3or eam"le, the ,eor grou" of the forearm ,ees the
wrist and the 5ngers# $he su"inator is a muscle that su"inates the wrist by
rolling it over to face "alm u"# 4n the leg, there are muscles called adductors
whose role is to adduct %"ull together' the legs#
Sarcomere Structure
Sarcomeres are made of two ty"es of "rotein 5bers/ thic! 5laments and thin
5laments#
$hic! 5laments# $hic! 5laments are made of many bonded units of the
"rotein myosin# .yosin is the "rotein that causes muscles to contract#
$hin 5laments# $hin 5laments are made of three "roteins/
8 0 P a g e
[MULTIPLE INJURIES] Case Sharing
)# Actin# Actin forms a helical structure that ma!es u" the bul! of the
thin 5lament mass# Actin contains myosin6binding sites that allow
myosin to connect to and move actin during muscle contraction#
2# $ro"omyosin# $ro"omyosin is a long "rotein 5ber that wra"s around
actin and covers the myosin binding sites on actin#
9# $ro"onin# 1ound very tightly to tro"omyosin, tro"onin moves
tro"omyosin away from myosin binding sites during muscle
contraction#
Functional Types o( Skeletal Muscle Fi'ers
S!eletal muscle 5bers can be divided into two ty"es based on how they
"roduce and use energy/ $y"e 4 and $y"e 44#
$y"e 4 5bers are very slow and deliberate in their contractions# $hey are very
resistant to fatigue because they use aerobic res"iration to "roduce energy
from sugar# -e 5nd $y"e 4 5bers in muscles throughout the body for stamina
and "osture# Near the s"ine and nec! regions, very high concentrations of
$y"e 4 5bers hold the body u" throughout the day#
$y"e 44 5bers are bro!en down into two subgrou"s/ $y"e 44 A and $y"e 44 1#
$y"e 44 A 5bers are faster and stronger than $y"e 4 5bers, but do
not have as much endurance# $y"e 44 A 5bers are found
throughout the body, but es"ecially in the legs where they wor!
to su""ort your body throughout a long day of wal!ing and
standing#
$y"e 44 1 5bers are even faster and stronger than $y"e 44 A, but
have even less endurance# $y"e 44 1 5bers are also much lighter in
color than $y"e 4 and $y"e 44 A due to their lac! of myoglobin, an
oygen6storing "igment# -e 5nd $y"e 44 1 5bers throughout the body,
but "articularly in the u""er body where they give s"eed and strength
to the arms and chest at the e"ense of stamina#
( 0 P a g e