WORKING PAPER

OF
MUSCULOSKELETAL SYSTEM

BY GROUP 3 :
Lisa Mana Lisa (715.6.2.0562)
Hafidhatur Rafiah (715.6.2.0579)
Nila Ratnasari (715.6.2.0623)
Rifngatus Sholeha (715.6.2.0576)
Haris Fernando (715.6.2.0580)
Mohammad Tirto (715.6.2.0592)
Sitti MaIsaroh (715.6.2.0588)
Hairunnisa (715.6.2.0582)
Lia Triana Febriyanti (715.6.2.0577)
Agus indriyani (715.6.2.05)
Achmad Fauzi (715.6.2.05)

WIRARAJA UNIVERSITY
SUMENEP
2015
 Human musculoskeletal system

The human musculoskeletal system (also known as the locomotor system, and
previously the activity system[1]) is an organ system that gives humans the ability to move using
their muscularand skeletal systems. The musculoskeletal system provides form, support,
stability, and movement to the body.
It is made up of the bones of the skeleton, muscles, cartilage,[2] tendons, ligaments, joints,
and other connective tissue that supports and binds tissues and organs together. The
musculoskeletal system's primary functions include supporting the body, allowing motion, and
protecting vital organs.[3] The skeletal portion of the system serves as the main storage system
for calcium andphosphorus and contains critical components of the hematopoietic system.[4]
This system describes how bones are connected to other bones and muscle fibers
via connective tissue such as tendons and ligaments. The bones provide stability to the
body. Muscles keep bones in place and also play a role in the movement of bones. To allow
motion, different bones are connected by joints. Cartilage prevents the bone ends from rubbing
directly onto each other. Muscles contract to move the bone attached at the joint.
There are, however, diseases and disorders that may adversely affect the function and
overall effectiveness of the system. These diseases can be difficult to diagnose due to the close
relation of the musculoskeletal system to other internal systems. The musculoskeletal system
refers to the system having its muscles attached to an internal skeletal system and is necessary
forhumans to move to a more favorable position. Complex issues and injuries involving the
musculoskeletal system are usually handled by aphysiatrist (specialist in physical medicine and
rehabilitation) or an orthopaedic surgeon.

Subsystems
Skeletal

The skeletal system serves many important functions; it provides the shape and form for
the body, support and protection, allows bodily movement, produces blood for the body, and
stores minerals.[5]The number of bones in the human skeletal system is a controversial topic.
Humans are born with over 300 bones; however, many bones fuse together between birth and
maturity. As a result, an average adult skeleton consists of 206 bones. The number of bones
varies according to the method used to derive the count. While some consider certain structures
to be a single bone with multiple parts, others may see it as a single part with multiple
bones.[6] There are five general classifications of bones. These are long bones, short bones, flat
bones, irregular bones, and sesamoid bones. The human skeleton is composed of both fused and
individual bones supported by ligaments, tendons, muscles and cartilage. It is a complex
structure with two distinct divisions; the axial skeleton, which includes the vertebral column,
and the appendicular skeleton.[7]
Function
The skeletal system serves as a framework for tissues and organs to attach themselves to.
This system acts as a protective structure for vital organs. Major examples of this are
the brain being protected by theskull and the lungs being protected by the rib cage.
Located in long bones are two distinctions of bone marrow (yellow and red). The yellow
marrow has fattyconnective tissue and is found in the marrow cavity. During starvation, the body
uses the fat in yellow marrow for energy.[8] The red marrow of some bones is an important site
for blood cell production, approximately 2.6 million red blood cells per second in order to
replace existing cells that have been destroyed by the liver.[5] Here all erythrocytes, platelets, and
most leukocytes form in adults. From the red marrow, erythrocytes, platelets, and leukocytes
migrate to the blood to do their special tasks.
Another function of bones is the storage of certain minerals. Calcium and phosphorus are
among the main minerals being stored. The importance of this storage "device" helps to
regulate mineral balance in the bloodstream. When the fluctuation of minerals is high, these
minerals are stored in bone; when it is low it will be withdrawn from the bone.
Muscular
The body contains three types of muscle tissue: (a) skeletal muscle, (b) smooth muscle,
and (c) cardiac muscle.

On the anterior and posterior views of the muscular system above, superficial muscles
(those at the surface) are shown on the right side of the body while deep muscles (those
underneath the superficial muscles) are shown on the left half of the body. For the legs,
superficial muscles are shown in the anterior view while the posterior view shows both
superficial and deep muscles.

There are three types of musclescardiac, skeletal, andsmooth. Smooth muscles are used
to control the flow of substances within the lumens of hollow organs, and are not consciously
controlled. Skeletal and cardiac muscles havestriations that are visible under a microscope due to
the components within their cells. Only skeletal and smooth muscles are part of the
musculoskeletal system and only the skeletal muscles can move the body. Cardiac muscles are
found in theheart and are used only to circulate blood; like the smooth muscles, these muscles
are not under conscious control. Skeletal muscles are attached to bones and arranged in opposing
groups around joints.[9] Muscles are innervated, to communicate nervous energy to,[10] by nerves,
which conduct electrical currents from the central nervous system and cause the muscles to
contract.[11]
Contraction initiation
In mammals, when a muscle contracts, a series of reactions occur. Muscle contraction is
stimulated by the motor neuronsending a message to the muscles from the somatic nervous
system. Depolarization of the motor neuron results inneurotransmitters being released from
the nerve terminal. The space between the nerve terminal and the muscle cell is called
the neuromuscular junction. These neurotransmitters diffuse across the synapseand bind to
specific receptor sites on the cell membrane of the muscle fiber. When enough receptors are
stimulated, an action potential is generated and the permeability of the sarcolemma is altered.
This process is known as initiation.[12]
Tendons
A tendon is a tough, flexible band of fibrous connective tissue that connects muscles to
bones.[13] The extra-cellular connective tissue between muscle fibers binds to tendons at the
distal and proximal ends, and the tendon binds to the periosteum of individual bones at the
muscle's origin and insertion. As muscles contract, tendons transmit the forces to the relatively
rigid bones, pulling on them and causing movement. Tendons can stretch substantially, allowing
them to function as springs during locomotion, thereby saving energy.
Joints, ligaments, and bursae[edit]
Joints
Human synovial joint composition

Joints are structures that connect individual bones and may allow bones to move against
each other to cause movement. There are two divisions of joints, diarthroses which allow
extensive mobility between two or more articular heads, and false joints or synarthroses, joints
that are immovable, that allow little or no movement and are predominantly fibrous. Synovial
joints, joints that are not directly joined, are lubricated by a solution called synovial fluid that is
produced by the synovial membranes. This fluid lowers the friction between the articular
surfaces and is kept within an articular capsule, binding the joint with its taut tissue.[7]
Ligaments
A ligament is a small band of dense, white, fibrous elastic tissue.[7] Ligaments connect
the ends of bones together in order to form a joint. Most ligaments limit dislocation, or prevent
certain movements that may cause breaks. Since they are only elastic they increasingly lengthen
when under pressure. When this occurs the ligament may be susceptible to break resulting in an
unstable joint.
Ligaments may also restrict some actions: movements such as hyper extension and hyper
flexion are restricted by ligaments to an extent. Also ligaments prevent certain directional
movement.[14]
Bursae
A bursa is a small fluid-filled sac made of white fibrous tissue and lined with synovial
membrane. Bursa may also be formed by a synovial membrane that extends outside of the joint
capsule.[8] It provides a cushion between bones and tendons and/or muscles around a joint; bursa
are filled with synovial fluid and are found around almost every major joint of the body.

Clinical significance
Further information: Musculoskeletal disorders, Rheumatology and Orthopedic surgery

Because many other body systems, including the vascular, nervous, and integumentary
systems, are interrelated, disorders of one of these systems may also affect the musculoskeletal
system and complicate the diagnosis of the disorder's origin. Diseases of the musculoskeletal
system mostly encompass functional disorders or motion discrepancies; the level of impairment
depends specifically on the problem and its severity. In a study of hospitalizations in the United
States, the most common inpatient OR procedures in 2012 involved the musculoskeletal system:
knee arthroplasty, laminectomy, hip replacement, and spinal fusion.[16]
Articular (of or pertaining to the joints)[17] disorders are the most common. However, also
among the diagnoses are: primary muscular diseases, neurologic (related to the medical science
that deals with the nervous system and disorders affecting it)[18] deficits,
toxins, endocrine abnormalities,metabolic disorders, infectious diseases, blood and vascular
disorders, and nutritional imbalances.
Disorders of muscles from another body system can bring about irregularities such as:
impairment of ocular motion and control, respiratory dysfunction, and bladder malfunction.
Complete paralysis,paresis, or ataxia may be caused by primary muscular dysfunctions
of infectious or toxic origin; however, the primary disorder is usually related to the nervous
system, with the muscular system acting as the effector organ, an organ capable of responding to
a stimulus, especially a nerve impulse.[4]
One understated disorder that begins during pregnancy is Pelvic girdle pain, it is complex
and multi-factorial and likely to be also represented by a series of sub-groups driven by pain
varying from peripheral or central nervous system,[19] altered laxity/stiffness of muscles,[20] laxity
to injury of tendinous/ligamentous structures[21] to mal-adaptive body mechanics.[19]
 Musculoskeletal System Diseases

Arthritis As we age, our joint tissues become less resilient to wear and tear and start to
degenerate manifesting as swelling, pain, and oftentimes, loss of mobility of joints. Changes
occur in both joint soft tissues and the opposing bones, a condition called osteoarthritis. A more
serious form of disease is called rheumatoid arthritis. The latter is an autoimmune disease
wherein the body produces antibodies against joint tissues causing chronic inflammation
resulting in severe joint damage, pain and immobility.

Osteoporosis Porous bone. The bane of the old, especially, women. The hard, rock-like
quality of bone is dependent upon calcium. When too much calcium is dissolved from bones or
not enough replaced, bones lose density and are easily fractured. Estrogen, the female sex
hormone, helps maintain proper calcium levels in bones. Once the ovaries stop producing the
hormone, women are at higher risk of developing osteoporosis. A collapse of bony vertebrae of
the spinal column results in loss of height and stooped posture. Hip fractures are a common
occurrence.

Osteomalacia Soft bones. If not enough calcium is deposited during early childhood
development, the bones do not become rock-hard, but rubbery. Both adequate calcium in the diet
and vitamin D, primarily, from normal sunlight exposure or supplementation, are necessary for
normal bone development. Before vitamin supplementation to milk, rickets, another name for
osteomalacia in children, was common resulting in the classic bowed legs of the afflicted child.

Carpal tunnel syndrome People whose job involves repeated flexing of their wrist (typing,
house painting) may develop tingling and/or pain in their thumb, index and middle fingers along
with weakness of movements of the thumb, especially, grasping an object. The main nerve for
finely controlled thumb movements passes through a bony/ligamentous canal on the bottom of
the wrist. Repetitive flexing movements may inflame and thicken the ligament over the tunnel
through the carpal (wrist) bones trapping and compressing the nerve.

Tendonitis Repeated strain on a tendon, attachment of a muscle to bone, can inflame the
tendon resulting in pain and difficulty with movement involving the muscle. Tendons have a
poor blood supply; therefore, they typically take a long time to heal on the order of six weeks or
more.

Rotator cuff tear Muscles surrounding the shoulder joint are involved in rotating the shoulder
with upper arm and hand forward and backward, among other movements. The tendons of these
muscles also contribute to the structural strength of the shoulder joint. Hard, fast movements,
such as in tennis and baseball can tear one of these tendons resulting in pain and decreased
mobility of the shoulder. Surgery may be needed to repair a torn tendon.
Bursitis A bursa is a small, closed bag with a minimum amount of lubricatory fluid that serves
as a shock absorber where bones make close contact and to minimize trauma and friction where
tendons cross bones and joints. Inflammation leads to pain and immobility in a joint area.

Muscular dystrophy Muscular dystrophy is a group of inherited diseases in which the muscles
that control movement progressively weaken. The prefix, dys-, means abnormal. The root, -
trophy, refers to maintaining normal nourishment, structure and function. The most common
form in children is called Duchenne muscular dystrophy and affects only males. It usually
appears between the ages of 2 to 6 and the afflicted live typically into late teens to early 20s.

Myasthenia gravis Muscular weakness, profound. This is an autoimmune disease that

involves production of antibodies that interfere with nerves stimulating muscle contractions.
Face and neck muscles are the most obviously affected, manifesting as drooping eyelids, double
vision, difficulty swallowing and general fatigue. There is no actual paralysis of muscles
involved, but a rapid fatiguing of function.

Lupus erythematosus An autoimmune disease wherein the body produces antibodies against a
variety of organs, especially connective tissues of skin and joints. Mild Lupus may involve a
distinctive butterfly-shaped rash over the nose and cheeks. Mild lupus may also involve myalgia
and arthralgia (remember these words?) Severe or systemic lupus (SLE) involves inflammation
of multiple organ systems such as the heart, lungs, or kidneys. By the way, lupus means wolf
in Latin. Maybe a reference to the facial rash that might give a patient a wolf-like appearance.
Orthopaedist To straighten up children. Orthopaedics is a surgical subspecialty that in the
past devoted much of its time to treating musculoskeletal deformities in children. Now with
improved prenatal diagnosis and better nutrition, orthopaedists still treat children with spine and
limb deformities but also adults with complicated bone fractures, damaged tendons or ligaments,
or needing surgery to replace a damaged hip or knee joint.

Rheumatologist To study the flux of fluids. Say, what? Rheuma is an old medical term for a
watery discharge. Among other diseases, rheumatologists treat joint diseases such as the various
forms of arthritis including rheumatoid arthritis. Inflamed joints accumulate fluid and swell
among other signs and symptoms. This medical subspecialty also evaluates and treats
osteoporosis, tendonitis, gout and lupus among many other chronic musculoskeletal pain
disorders.

Osteopath/osteopathic physician (D.O.) The name sounds like a specialty limited to bone
disease, but actually, osteopathic physicians are one of two arms of the medical profession that
differ in history and philosophy. At one time there were many kinds of medical schools
originating from various philosophies; allopathic, osteopathic, homeopathic. Osteopathy
originated in the 1890s in response to despair at the lack of effectiveness of many forms of then
primitive treatments. Osteopathy developed an emphasis on the influence of the musculoskeletal
system and its interrelationship to other body systems. D.O.s make use of osteopathic
manipulation (bones, ligaments, joints) along with medication, surgery and all other medical
treatments used by M.D. physicians. Also, preventive care has always been a major emphasis of
osteopathic care. M.D.s and D.O.s are licensed by all state medical boards. Learn about
the doctor of osteopathic medicine program at Des Moines University.

Podiatrists, traditionally known as foot doctors, are surgical subspecialists in diseases and
structural problems of the feet. They not only provide care for corns, calluses, ingrown toenails
and heel spurs, but also treat foot and ankle injuries, deformities and diseases. Many systemic
diseases manifest signs and symptoms in appearance of the feet such as poor wound healing in
diabetes. They also can prescribe special shoes and inserts to treat chronic foot pain and walking
problems. Podiatrists may further specialize in sports medicine, geriatrics or diabetic foot care.
Learn about the doctor of podiatric medicine program at Des Moines University.

Physical therapist This health care professional has at least two years of specialized training
beyond a college degree. PTs are rehabilitation specialists treating a multitude of medical
problems including patients recovering from joint surgery, limb amputation, a stroke, heart
attack and suffering with chronic neuromuscular diseases. In addition to other treatment
modalities, they teach patients exercises to strengthen their body, increase mobility and how to
prevent recurrence of injury. Learn about the doctor of physical therapy program at Des Moines
University.

Arthroscopy A fiberoptic instrument is introduced into a joint cavity in order to visualize

surfaces of bones entering into a joint, find tears in internal joint structures and evaluate sources
of inflammation.

Bone scan A radioactive element in very small amounts, not enough to cause any radiation
injury to the patient, is introduced into the blood stream. The specially selected element
accumulates in bone and using a much more sophisticated version of the old Geiger Counter
instrument, the distribution of the element is used to diagnose potential bone tumors among other
bone pathologies.

Electromyography A big, scary word! But, you are experienced by now in taking them apart.
I like to start at the end and work backward: a recording of muscle electrical activity. Fine
needles are introduced into muscles in order to make recordings of contractile activity. This
procedure is useful in evaluating causes of paralysis, diagnosing muscular dystrophy and other
neuromuscular disorders.

Muscle biopsy Cutting out a small tissue sample of muscle in order to examine it under a
microscope. This procedure can be useful in diagnosing muscular dystrophy and other
neuromuscular disorders.
 Structure and Function of the Musculoskeletal System
Professor Alan Hedge DEA 3250/6510 Functions of the Musculoskeletal System Support and
protect the body and its organs. Provide motion. Musculoskeletal System: Major substructures
Tendons. Ligaments. Fascia. Cartilage. Bone. Muscle. Joints - allow motion between body
segments. Connective Tissues Cells. Extracellular matrix: z Fibers: Collagen Elastin z
Ground substance. Connective Tissue Cells Fibroblasts - cells producing the matrix for skin,
tendons and ligaments. Chrondrocytes - cells producing the matrix for cartilage. Osteocytes -
cells producing the matrix for bone. 1 Professor Alan Hedge, Cornell University, August 2013
Connective Tissue Matrix Collagen fibers: z Type I - tendons, ligaments, bone, skin. z Type II -
cartilage. z Type III - blood vessel walls. Mechanical properties depend on fiber types and fiber
arrangements. Tendons Ligaments Fascia Mechanical Properties of Fibers Stress - force on a
fiber e.g. weight. Strain - % stretching of fibers. Elastic limit - point at which the elasticity of
the fiber is lost. Failure - point at which the fiber breaks. Collagen Collagen molecule - a triple
helix of three extended protein chains wrapped around one another. Numerous rodlike collagen
molecules cross-link together to form unextendable collagen fibrils. Collagen fibrils are striped
because of the regular repeating arrangement of the collagen molecules within the fibril.
Collagen fibers Strength of collagen is 50% strength of bone. Under tension, collagen fibers
first elongate slightly and then become increasing stiff until failure. Collagen fibrils have the
tensile strength of steel. Elastic Fibers Elastin - polypeptide chains cross-linked together to
form rubberlike, elastic fibers. Elastin molecule uncoils when the fiber is stretched and
spontaneously recoils when the stretching force is relaxed. Elastic fibers Weak and brittle
fibers. At low loads they strain greatly and can increase ~200% in length before failure. 2
Professor Alan Hedge, Cornell University, August 2013 Tendon structure Tendon Tendon
sheath: z Synovium - lubricant producing tissue. z Synovial fluid - lubricant fluid. Tendons and
Ligaments At certain points, ligaments surround parts of the tendon sheath to act as: z Pulleys
retinaculae that keep tendons attached to joints when muscles contract z Tendon guides
retinaculae that restrict lateral tendon movement Ligament attachments allow tendons to work
around corners, as in the fingers and toes. Tendons Tendons connect muscle to bone to create
movement. Collagen in Tendons Tendons comprise parallel bundles of collagen fibers, with
few elastic fibers and ground substance. Finger Movement Tendon and Muscle Muscle fiber
wrapped in endomysium Fibers bundled into fascicles (up to 200 fibers) wrapped in
perimysium Fasciculi bundled together and interspersed with blood vessels and nerves in
muscle and wrapped in epimysium Epimysium and perimysium tissues taper at each end to
form tendons Cartilage: 3 types Hyaline cartilage z Solid matrix, cells (chrondrocytes) densely
clustered z present in the growth plates at the end of bones and on the articular surfaces of joints.
Also present in the respiratory tract (e.g. trachea). Fibrocartilage z solid matrix, cells widely
interspersed among collagen fibers z present in intervertebral discs, Elastic cartilage z solid
matrix, cells in small groups between many elastic fibers z present in ears, nose, epiglottis etc. 3
 Professor Alan Hedge, Cornell University, August 2013 Bone Adult human skeleton has 206
bones. Babies born with ~ 300 bones but fusion occurs as a child develops. 99% of bodies
calcium is in bone. 80% of bone tissue by weight is minerals. Longest bone (femur) Smallest
bone (stapes) Males have slightly thicker and longer legs and arms Females have a wider
pelvis and a larger pelvic cavity Bone groups Axial skeleton (80 bones) z skull (29 bones) z
thorax (25 bones) z vertebrae (33 bones) z Auditory ossicles z Hyoid bone Appendicular
skeleton (126 bones) z pectoral girdle (4 bones) z upper extremity (60 bones) z lower extremity
(60 bones) z and pelvic girdle (2 bones) Long bones Round bones comprising: z diaphysis -
shaft z epiphyses - 2 expanded ends Bone Structure and Growth Ossification - processes of
bone formation. z Osteoblasts - cells that form the bone matrix. They transform into z Osteocytes
- cells isolated inside the mineralized bone matrix. z Osteoclasts - cells important to bone
remodeling. Types of Bone Cancellous (spongy) bone - less dense bone tissue found at the
epiphyses of the long bones and in axial bones, such as the skull. 30-90% porosity. Cortical
(compact) bone - tissue with high proportion of bone. 5-30% porosity. Anisotropy All bone is
anisotropic (i.e. its mechanical property changes when loads are applied in different directions).
4 Professor Alan Hedge, Cornell University, August 2013 Bone: Mechanical properties Most
important properties are strength and stiffness of bone. Fractures occur when the bone is loaded
to failure. Compression fractures are commonest in cancellous bone (e.g. fractured skull)
Bending and torsional fractures are commonest in cortical bone (e.g. broken tibia). Speed of
loading to fracture. Human Muscles Muscular system is 50% of total human body weight.
>600 skeletal muscles, which enables the human body to move and stand erect. Skeletal
muscles are arranged in overlapping intricate layers: z Superficial muscles z Deep muscles
Skeletal muscle Skeletal muscle is striated (striped), and excludes cardiac and smooth muscle.
Skeletal muscle is under voluntary control. Each muscle is a separate organ. Each muscle is
attached to bone by tendons that cross one or more joints. Generally, skeletal muscles generate
moments about joints. Muscle fibers Long, cylindrical cells containing multiple nuclei. Most of
the fiber volume is occupied by the contractile elements - myofibrils. Myofibrils show a
banding pattern (transverse striation) of thick myofilaments (myosin) and thin ones (actin). The
contractile unit of the myofibril is called the sarcomere. Structure of Skeletal Muscle Skeletal
muscle is covered by a fascia called the epimysium. The epimysium penetrates and subdivides
the muscle into muscle fiber bundles called the fascicles (fasciculi). Each fascicle is covered by
connective tissue called the perimysium. Each individual muscle fiber is covered by connective
tissue called the endomysium. 5 Professor Alan Hedge, Cornell University, August 2013
Connective tissue provides pathways for nerves and blood vessels + contributes to the
mechanical properties of the muscle. Skeletal Muscle Structure Actin & Myosin filamentary
protein molecules form the sarcomeres, and these bundle to form myofibrils, which bundle to
form muscle fibers. Longest fibers ~30 cm long, 0.05-0.15 mm wide, and contain several
thousand nuclei. Motor Units Motor unit - group of muscle fibers innervated by branches of the
same efferent neuron. Functional unit of the muscle. Motor units are small in muscles
requiring precise control (e.g. eye muscles), and large in coarse acting muscles (e.g.
gastrocnemius muscle). Motor units work in an all-or-none way. Progressive contraction
occurs because of recruitment of motor units. Sarcomere Sarcomere and Contraction Muscle
Action Actin & Myosin filamentary protein molecules interact to create movement. The
Myosin head firmly attaches to the Actin filament. When the Myosin head swivels it pulls the
Actin filament forward. Many Myosin head swiveling simultaneously, or nearly so, pull the
entire thin actin myofilament. Muscle fibers Slow twitch fibers (type 1) S fibers, fatigue
resistant, red fibers, slow myosin, contraction times from 100-120 msecs. Fast twitch fibers
(type II) white fibers, fast myosin, contraction times from 40- 45 msecs., subdivided into: z FR
fibers (type IIa) aerobic, fatigue resistant z FF fibers (type IIx) type IIb, anaerobic, fatigable
Average person has 50% type 1, 25% type IIa, 25% type IIx Elite distance runners have more
type I fibers Elite sprinters have more type IIx fibers Exercise can convert type I and IIx fibers
to type IIa fibers Muscles and Aging Loss of muscle mass begins around age 25 years By age
50 there is a 10% loss of skeletal muscle mass By age 80 there is a 50% loss of skeletal muscle
mass Most loss is loss of muscle fibers and fast fibers atrophy at a higher rate than slow fibers
In aged muscle up to 30% of fibers have morphed into something between a fast and slow fiber 6
Professor Alan Hedge, Cornell University, August 2013 Muscle fibers are never regained
Muscle bulk can be increased with weight training and this thickens the muscle fibers Muscle
Junctions Myotendinal junction - area where tendon fibers insert into muscle connective tissue
and also into bone matrix (Sharpeys fibers). Neuromuscular junction - motor endplate where
nerve fibers connect with myofibrils. In leg muscle one neuron innervates several hundred to
>1000 muscle fibers. In finger muscles one neuron innervates one to a few muscle fibers.
Musculotendinous Unit Skeletal muscles anchor to the skeleton via either a: z Tendon narrow
cord of connective tissue z Aponeurosis broad band of connective tissue Skeletal Muscle
Innervation Nerves (neurons) connect from the brain and spinal cord to muscles. Efferent
nerves carry motor instructions for contraction to the muscles. Afferent nerves carry sensory
information to the brain. z Proprioceptive feedback - muscle tone. z Kinesthetic feedback -
muscle + joint status. Mixed nerves carry a mix of both sensory and motor neurons (e.g. median
nerve). Properties of Skeletal Muscle Isometric (static, eccentric) contraction when the
muscle force is less than the external load the muscles contract to change muscle tone without
changing length. This increases postural stability. Isotonic (dynamic, concentric) contraction -
when muscle force is greater than the external load the muscle contracts in length. This produces
movement at joints. Static contraction is prone to rapid fatigue. Dynamic contraction increases
blood flow through muscles which slows fatigue. Muscle Organization at Joints Agonist muscle
- the muscle directly engaged in contraction (e.g. in flexing the elbow the biceps brachii is the
agonist). Antagonist - the opposing muscle in relaxation (e.g. in flexing the elbow the triceps is
the antagonist). Joints A joint is the union of 2 or more bones. 3 types of joint are found in the
body. z Synovial joint (diarthrodial joint) - no tissue between the articular surfaces. Most of the
body joints are this type. z Fibrous joint - fibrous tissue bridge between bones (e.g. skull). z
Cartilagenous joint - cartilage bridge between bones (e.g. intervertebral disc in spine). 7
Professor Alan Hedge, Cornell University, August 2013 Structure of a Synovial Joint Joint
capsule - fibrous capsule around the joint. Synovial membrane - membrane lining the joint
capsule and surrounding the synovial cavity. This tissue secretes the lubricating synovial fluid.
Synovial cavity (joint cavity) - cavity containing synovial fluid + bone ends Articular cartilage
(hyaline cartilage) - cartilage covering articular surfaces of the bone ends. Joint degeneration
Cartilage does not have a good capillary blood supply. Cartilage has a poor ability to repair and
regenerate itself. With age, overuse and/or disease, such as arthritis, the articular cartilage
degenerates and bone ends make more direct contact, causing inflammation and pain.
Intervertebral Disc Structure Nucleus pulposus - incompressible watery gel contained within an
elastic sac. Annulus fibrosis - fibrocartilage lamellae arranged in layers around the nucleus.
Fiber orientation varies from layer to layer. End plates - hyaline cartilage end plates protect
each end of the disc. Motion segment - 2 vertebrae either side + intervertebral disc. Bone and
Muscle Loss in Space In space, astronauts will experience a deterioration in their
musculoskeletal system: z 1 to 2 % loss of bone mass each month. z Up to 20% loss of skeletal
muscle mass within 2 weeks if the astronaut does not exercise: Visiting astronauts (< 2 weeks)
exercise 30 minutes/day Space station astronauts exercise 2 hours/day. 8 Professor Alan
Hedge, Cornell University, August 20
Musculoskeletal System Medical Record

Following is an abstract of a simulated patient medical record. Identify each italicized word. If
the meaning doesnt come right away, take apart the word. If you recognize the organ involved,
use the context to help you figure out the full meaning. Terms are not limited to musculoskeletal
system. Remember, this is a cumulative exercise! If you cant think of the meaning, hover your
cursor over the word for a tip.

A 62 year old male comes to his family physician complaining of pain in his right knee. He
walks with a limp which he says is getting worse and is related to an old football injury. During
the course of the examination he reveals that he also suffers from a nervous bladder
with polyuria, dysuria and nocturia, but denies hematuria. He smokes two packs a day, breaths
are wheezy and he is short of breath, but denies hemoptysis.

Physical exam: right knee was swollen, warm and had limited range of motion which was painful
to perform. Mild exercise increases wheezing and causes dyspnea. Examination of the heart size
reveals cardiomegaly. No hepatomegaly or splenomegaly was found upon abdominal
examination.

Current medication: Prevacid for gastroesophageal reflux disease, nitroglycerine for angina
pectoris.

Past medical history: GERD diagnosed with esophagogastroduodenoscopy (EGD). Angina

pectoris diagnosed with treadmill test, cardiac scan and cardiac catherization.

Past surgical history: orchidopexy for cryptorchidism at age nine, tonsillectomy, appendectomy.

Family medical history: mother has chronic nephritis; will be starting dialysis.

Recommended treatments: refer to pulmonologist to evaluate possible emphysema. Refer

to orthopaedist for arthroscopic evaluation of knee. Refer to urologist to evaluate for prostatic
hypertrophy, possible cystoscopy. Office phlebotomist drew specimens for lab work.

Get a piece of paper and pencil and write down two column headings: Signs and Symptoms.
Then take the following items and put them under the proper heading. You remember the
difference between a sign and a symptom, right? You might want to review the context of these
items in the case above before deciding.

Item: cardiomegaly, pain in right knee, right knee is swollen, nervous bladder.pr

In plain English

A 62 year old male comes to his family physician complaining of pain in his right knee. He
walks with a limp which he says is getting worse and is related to an old football injury. During
the course of the examination he reveals that he also suffers from a nervous bladder with
frequent urination, painful/difficult urination and getting up at night to urinate, but denies blood
in the urine. He smokes two packs a day, breaths are wheezy and he is short of breath, but denies
coughing up blood.

Physical exam: right knee was swollen, warm and had limited range of motion which was painful
to perform. Mild exercise increases wheezing and causes difficulty breathing. Examination of the
heart size reveals an enlarged heart. No enlargement of the liver or spleen was found upon
abdominal examination.
Current medication: Prevacid for severe heartburn, nitroglycerine for chest pain related to the
heart.

Past medical history: GERD diagnosed with visual examination of the esophagus, stomach and
duodenum with a fiberoptic instrument. Angina pectoris diagnosed with treadmill test, injecting a
radioactive element into blood stream to evaluate heart structure and function and threading a
hollow tube through arteries to the heart to inject dye opaque to X-rays to demonstrate coronary
arteries.

Past surgical history: surgical fixation of the testis for undescended testicles at age nine, removal
of tonsils, removal of appendix.

Family medical history: mother has chronic inflammation of kidneys; will be starting medical
procedure cleansing waste from blood in kidney failure.

Recommended treatments: refer to specialist in lung diseases to evaluate possible destruction of

lung membranes needed for oxygen exchange. Refer to specialist in musculoskeletal diseases for
visualization of joints with a fiberoptic instrument (evaluation of knee). Refer to specialist in
lower urinary tract diseases and diseases of the male reproductive tract to evaluate for
enlargement of the prostate, possible visualization of the interior of the bladder with a fiberoptic
instrument. Office technician or nurse trained to cut into veins to draw blood drew specimens
for lab work.

By the way, what the patient complains of or describes are symptoms: knee hurts, frequent
urination. What the doctor observes and/or measures are signs: right knee is swollen, enlarged
heart.
 Muscular system Anatomi

Muscle Types

There are three types of muscle tissue: Visceral, cardiac, and skeletal.

Visceral Muscle. Visceral muscle is found inside of organs like the stomach, intestines,
and blood vessels. The weakest of all muscle tissues, visceral muscle makes organs contract to
move substances through the organ. Because visceral muscle is controlled by the unconscious
part of the brain, it is known as involuntary muscleit cannot be directly controlled by the
conscious mind. The term smooth muscle is often used to describe visceral muscle because it
has a very smooth, uniform appearance when viewed under a microscope. This smooth
appearance starkly contrasts with the banded appearance of cardiac and skeletal muscles.

Cardiac Muscle. Found only in the heart, cardiac muscle is responsible for pumping
blood throughout the body. Cardiac muscle tissue cannot be controlled consciously, so it is an
involuntary muscle. While hormones and signals from the brain adjust the rate of contraction,
cardiac muscle stimulates itself to contract. The natural pacemaker of the heart is made of
cardiac muscle tissue that stimulates other cardiac muscle cells to contract. Because of its self-
stimulation, cardiac muscle is considered to be autorhythmic or intrinsically controlled.

The cells of cardiac muscle tissue are striatedthat is, they appear to have light and dark
stripes when viewed under a light microscope. The arrangement of protein fibers inside of the
cells causes these light and dark bands. Striations indicate that a muscle cell is very strong,
unlike visceral muscles.

The cells of cardiac muscle are branched X or Y shaped cells tightly connected together
by special junctions called intercalated disks. Intercalated disks are made up of fingerlike
projections from two neighboring cells that interlock and provide a strong bond between the
cells. The branched structure and intercalated disks allow the muscle cells to resist high blood
pressures and the strain of pumping blood throughout a lifetime. These features also help to
spread electrochemical signals quickly from cell to cell so that the heart can beat as a unit.
 Skeletal Muscle. Skeletal muscle is the only voluntary muscle tissue in the human
bodyit is controlled consciously. Every physical action that a person consciously performs
(e.g. speaking, walking, or writing) requires skeletal muscle. The function of skeletal muscle is
to contract to move parts of the body closer to the bone that the muscle is attached to. Most
skeletal muscles are attached to two bones across a joint, so the muscle serves to move parts of
those bones closer to each other.

Skeletal muscle cells form when many smaller progenitor cells lump themselves together
to form long, straight, multinucleated fibers. Striated just like cardiac muscle, these skeletal
muscle fibers are very strong. Skeletal muscle derives its name from the fact that these muscles
always connect to the skeleton in at least one place.

Gross Anatomy of a Skeletal Muscle

Most skeletal muscles are attached to two bones through tendons. Tendons are tough
bands of dense regular connective tissue whose strong collagen fibers firmly attach muscles to
bones. Tendons are under extreme stress when muscles pull on them, so they are very strong and
are woven into the coverings of both muscles and bones.

Muscles move by shortening their length, pulling on tendons, and moving bones closer to
each other. One of the bones is pulled towards the other bone, which remains stationary. The
place on the stationary bone that is connected via tendons to the muscle is called the origin. The
place on the moving bone that is connected to the muscle via tendons is called the insertion. The
belly of the muscle is the fleshy part of the muscle in between the tendons that does the actual
contraction.

Names of Skeletal Muscles

Skeletal muscles are named based on many different factors, including their location,
origin and insertion, number of origins, shape, size, direction, and function.

Location. Many muscles derive their names from their anatomical region. The rectus
abdominis and transverse abdominis, for example, are found in the abdominal region. Some
muscles, like the tibialis anterior, are named after the part of the bone (the anterior portion of the
tibia) that they are attached to. Other muscles use a hybrid of these two, like the brachioradialis,
which is named after a region (brachial) and a bone (radius).

Origin and Insertion. Some muscles are named based upon their connection to a
stationary bone (origin) and a moving bone (insertion). These muscles become very easy to
identify once you know the names of the bones that they are attached to. Examples of this type of
muscle include the sternocleidomastoid (connecting the sternum and clavicle to the mastoid
process of the skull) and the occipitofrontalis (connecting the occipital bone to the frontal bone).

Number of Origins. Some muscles connect to more than one bone or to more than one
place on a bone, and therefore have more than one origin. A muscle with two origins is called a
biceps. A muscle with three origins is a triceps muscle. Finally, a muscle with four origins is a
quadriceps muscle.

Shape, Size, and Direction. We also classify muscles by their shapes. For example, the
deltoids have a delta or triangular shape. The serratus muscles feature a serrated or saw-like
shape. The rhomboid major is a rhombus or diamond shape. The size of the muscle can be used
to distinguish between two muscles found in the same region. The gluteal region contains three
muscles differentiated by sizethe gluteus maximus (large), gluteus medius (medium), and
gluteus minimus (smallest). Finally, the direction in which the muscle fibers run can be used to
identify a muscle. In the abdominal region, there are several sets of wide, flat muscles. The
muscles whose fibers run straight up 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
obliques.

Function. Muscles are sometimes classified by the type of function that they perform.
Most of the muscles of the forearms are named based on their function because they are located
in the same region and have similar shapes and sizes. For example, the flexor group of the
forearm flexes the wrist and the fingers. The supinator is a muscle that supinates the wrist by
rolling it over to face palm up. In the leg, there are muscles called adductors whose role is to
adduct (pull together) the legs.

Groups Action in Skeletal Muscle

 Skeletal muscles rarely work by themselves to achieve movements in the body. More
often they work in groups to produce precise movements. The muscle that produces any
particular movement of the body is known as an agonist or prime mover. The agonist always
pairs with an antagonist muscle that produces the opposite effect on the same bones. For
example, the biceps brachii muscle flexes the arm at the elbow. As the antagonist for this motion,
the triceps brachii muscle extends the arm at the elbow. When the triceps is extending the arm,
the biceps would be considered the antagonist.

In addition to the agonist/antagonist pairing, other muscles work to support the

movements of the agonist. Synergists are muscles that help to stabilize a movement and reduce
extraneous movements. They are usually found in regions near the agonist and often connect to
the same bones. Because skeletal muscles move the insertion closer to the immobile origin,
fixator muscles assist in movement by holding the origin stable. If you lift something heavy with
your arms, fixators in the trunk region hold your body upright and immobile so that you maintain
your balance while lifting.

Skeletal Muscle Histology

Skeletal muscle fibers differ dramatically from other tissues of the body due to their
highly specialized functions. Many of the organelles that make up muscle fibers are unique to
this type of cell.

The sarcolemma is the cell membrane of muscle fibers. The sarcolemma acts as a
conductor for electrochemical signals that stimulate muscle cells. Connected to the sarcolemma
are transverse tubules (T-tubules) that help carry these electrochemical signals into the middle of
the muscle fiber. The sarcoplasmic reticulum serves as a storage facility for calcium ions (Ca2+)
that are vital to muscle contraction. Mitochondria, the power houses of the cell, are abundant
in muscle cells to break down sugars and provide energy in the form of ATP to active muscles.
Most of the muscle fibers structure is made up of myofibrils, which are the contractile structures
of the cell. Myofibrils are made up of many proteins fibers arranged into repeating subunits
called sarcomeres. The sarcomere is the functional unit of muscle fibers. (See Macronutrients for
more information about the roles of sugars and proteins.)
Sarcomere Structure

Sarcomeres are made of two types of protein fibers: thick filaments and thin filaments.

Thick filaments. Thick filaments are made of many bonded units of the protein myosin. Myosin
is the protein that causes muscles to contract.

Thin filaments. Thin filaments are made of three proteins:

Actin. Actin forms a helical structure that makes up the bulk of the thin filament mass. Actin
contains myosin-binding sites that allow myosin to connect to and move actin during muscle
contraction.

Tropomyosin. Tropomyosin is a long protein fiber that wraps around actin and covers the myosin
binding sites on actin.

Troponin. Bound very tightly to tropomyosin, troponin moves tropomyosin away from myosin
binding sites during muscle contraction.

The muscular system is the body's network of tissues that controls movement both of the
body and within it (such as the heart's pumping action and the movement of food through the
gut). Movement is generated through the contraction and relaxation of specific muscles.

The muscles of the body are divided into two main classes: skeletal (voluntary) and
smooth (involuntary). Skeletal muscles are attached to the skeleton and move various parts of the
body. They are called voluntary because a person controls their use, such as in the flexing of an
arm or the raising of a foot. There are about 650 skeletal muscles in the whole human body.
Smooth muscles are found in the stomach and intestinal walls, vein and artery walls, and in
various internal organs. They are called involuntary muscles because a person generally cannot
consciously control them. They are regulated by the autonomic nervous system (part of the
nervous system that affects internal organs).

Another difference between skeletal and smooth muscles is that skeletal muscles are
made of tissue fibers that are striated or striped. These alternating bands of light and dark result
from the pattern of the filaments (threads) within each muscle cell. Smooth muscle fibers are not
striated.

The cardiac or heart muscle (also called myocardium) is a unique type of muscle that
does not fit clearly into either of the two classes of muscle. Like skeletal muscles, cardiac
muscles are striated. But like smooth muscles, they are involuntary, controlled by the autonomic
nervous system.
 The longest muscle in the human body is the sartorius (pronounced sar-TOR-ee-us). It
runs from the waist down across the front of thigh to the knee. Its purpose is to flex the hip and
knee. The largest muscle in the body is the gluteus maximus (pronounced GLUE-tee-us MAX-si-
mus; buttocks muscles). It moves the thighbone away from the body and straightens out the hip
joint.

Skeletal muscles

Skeletal muscles are probably the most familiar type of muscle. They are the muscles that
ache after strenuous work or exercise. Skeletal muscles make up about 40 percent of the body's
mass or weight. They stabilize joints, help maintain posture, and give the body its general shape.
They also use a great deal of oxygen and nutrients from the blood supply.

Skeletal muscles are attached to bones by tough, fibrous connective tissue called tendons.
Tendons are rich in the protein collagen, which is arranged in a wavy way so that it can stretch
and provide additional length at the muscle-bone junction.

Words to Know

Autonomic nervous system: Part of the nervous system that regulates involuntary action, such as
of the heart and intestines.

Extensor muscle: Muscle that contracts and causes a joint to open.

Flexor muscle: Muscle that contracts and causes a joint to close.

Myoneural juncture: Area where a muscle and a nerve connect.

Tendon: Tough, fibrous connective tissue that attaches muscle to bone.

Skeletal muscles act in pairs. The flexing (contracting) of one muscle is balanced by a
lengthening (relaxation) of its paired muscle or a group of muscles. These antagonistic (opposite)
muscles can open and close joints such as the elbow or knee. An example of antagonistic
muscles are the biceps (muscles in the front of the upper arm) and the triceps (muscles in the
back of the upper arm). When the biceps muscle flexes, the forearm bends in at the elbow toward
the biceps; at the same time, the triceps muscle lengthens. When the forearm is bent back out in a
straight-arm position, the biceps lengthens and the triceps flexes.

Muscles that contract and cause a joint to close, such as the biceps, are called flexor
muscles. Those that contract and cause a joint to open, such as the triceps, are called extensors.
Skeletal muscles that support the skull, backbone, and rib cage are called axial skeletal muscles.
Skeletal muscles of the limbs (arms and legs) are called distal skeletal muscles.

Skeletal muscle fibers are stimulated to contract by electrical impulses from the nervous
system. Nerves extend outward from the spinal cord to connect to muscle cells. The area where a
muscle and a nerve connect is called the myoneural juncture. When instructed to do so, the nerve
releases a chemical called a neurotransmitter that crosses the microscopic space between the
nerve and the muscle and causes the muscle to contract.

Skeletal muscle fibers are characterized as fast or slow based on their activity patterns. Fast (also
called white) muscle fibers contract

rapidly, have poor blood supply, operate without oxygen, and tire quickly. Slow (also
called red) muscle fibers contract more slowly, have better blood supplies, operate with oxygen,
and do not tire as easily. Slow muscle fibers are used in movements that are ongoing, such as
maintaining posture.

Smooth muscles

Smooth muscle fibers line most of the internal hollow organs of the body, such as the intestines,
stomach, and uterus (womb). They help move substances through tubular areas such as blood
vessels and the small intestines. Smooth muscles contract automatically, spontaneously, and
often rhythmically. They are slower to contract than skeletal muscles, but they can remain
contracted longer.

Like skeletal muscles, smooth muscles contract in response to neurotransmitters released

by nerves. Unlike skeletal muscles, some smooth muscles contract after being stimulated by
hormones (chemicals secreted by glands). An example is oxytocin, a hormone released by the
pituitary gland. It stimulates the smooth muscles of the uterus to contract during childbirth.

Smooth muscles are not as dependent on oxygen as skeletal muscles are. Smooth muscles
use carbohydrates to generate much of their energy.

Cardiac muscle

The cardiac muscle or myocardium contracts (beats) more than 2.5 billion times in an
average lifetime. Like skeletal muscles, myocardium is striated. However, myocardial muscle
fibers are smaller and shorter than skeletal muscle fibers.

The contractions of the myocardium are stimulated by an impulse sent out from a small
clump (node) of specialized tissue in the upper right area of the heart. The impulse spreads
across the upper area of the heart, causing this region to contract. This impulse also reaches
another node, located near the lower right area of the heart. After receiving the initial impulse,
the second node fires off its own impulse, causing the lower region of the heart to contract
slightly after the upper region.
Disorders of the muscular system

The most common muscular disorder is injury from misuse. Skeletal muscle sprains and
tears cause excess blood to seep into the tissue in order to heal it. The remaining scar tissue
results in a slightly shorter muscle. Overexertion or a diminished blood supply can cause muscle
cramping. Diminished blood supply and oxygen to the heart muscle causes chest pain called
angina pectoris.

The most common type of genetic (inherited) muscular disorder is muscular dystrophy.
This disease causes muscles to progressively waste away. There are six forms of muscular
dystrophy. The most frequent and most dreaded form appears in boys aged three to seven. (Boys
are usually affected because it is a sex-linked condition; girls are carriers of the disease and are
usually not affected.) The first symptom of the disease is a clumsiness in walking. This occurs
because the muscles of the pelvis and the thighs are first affected. The disease spreads to muscles
in other areas of the body, and by the age of ten, a child is usually confined to a wheelchair or a
bed. Death usually occurs before adulthood.

Another form of muscular dystrophy appears later in life and affects both sexes equally.
The first signs of the disease appear in adolescence. The muscles affected are those in the face,
shoulders, and upper arms. People with this form of the disease may survive until middle age.