Musculoskeletal System

1. Bones (oste/o=bone)- provides the framework around which the body is constructed and protect and support internal organs 2. Joints (arthr/o; articul/o= joint)- places at which bones come together 3. Muscles (my/o; myos/o=muscle)- attached to bones, or to internal organs and blood vessels. They are responsible for movement 1. Bones (oste/o=bone)- provides the framework around which the body is constructed and protect and support internal organs 2. Joints (arthr/o; articul/o= joint)- places at which bones come together 3. Muscles (my/o; myos/o=muscle)- attached to bones, or to internal organs and blood vessels. They are responsible for movement

Terms -Orthopedic- (orth/o= straight; ped/i= child); physicians who treat bone & joint disease -Rheumatologist- (rheumat/o= watery flow); one who specializes in the study of joint diseases (because joint diseases are marked by collection of fluid in joint spaces Chiropractor- (chir/o= hand)- use physical means to manipulate the spinal column -Osteopathy- (oste/o=bone; path= disease)- p/t to diseases of the bone –Osteopathic physicians (DO) -Orthopedic- (orth/o= straight; ped/i= child); physicians who treat bone & joint disease -Rheumatologist- (rheumat/o= watery flow); one who specializes in the study of joint diseases (because joint diseases are marked by collection of fluid in joint spaces Chiropractor- (chir/o= hand)- use physical means to manipulate the spinal column -Osteopathy- (oste/o=bone; path= disease)- p/t to diseases of the bone –Osteopathic physicians (DO)

Bones -Complete organs composed of connective tissue called osseous (bony) tissue ; plus a rich supply of blood vessels and nerves Osseous tissue consists of osteocytes (bone cells), collagen (dense connective tissue), and calcium salts Ossification- bone formation Osteoblasts- immature osteocytes that produce bony tissue that replaces cartilage during ossification Osteoclasts- (-clast=to break); large cells that function to reabsorb, digest bony tissue. They enlarge the inner bone cavity so bones do not become too heavy *Calcium and Phosphorus are minerals necessary to produce enzymes to give bones strength -Complete organs composed of connective tissue called osseous (bony) tissue ; plus a rich supply of blood vessels and nerves Osseous tissue consists of osteocytes (bone cells), collagen (dense connective tissue), and calcium salts Ossification- bone formation Osteoblasts- immature osteocytes that produce bony tissue that replaces cartilage during ossification Osteoclasts- (-clast=to break); large cells that function to reabsorb, digest bony tissue. They enlarge the inner bone cavity so bones do not become too heavy *Calcium and Phosphorus are minerals necessary to produce enzymes to give bones strength

Structure of bones 206 bones in the body Long bones- found in thigh, lower leg, and upper and lower arm; strong and broad at end where they join other bones. They have large surface areas for muscle attachment. Short bones- found in wrist and ankle and are small with irregular shapes Flat bones- cover soft body parts Sesamoid bones- small, round and resembles a sesame seed in shape. They are found near joint. Irregular shaped bones- odd shaped (vertebrae) What is the largest sesamoid bone in the body? ____________________ 206 bones in the body Long bones- found in thigh, lower leg, and upper and lower arm; strong and broad at end where they join other bones. They have large surface areas for muscle attachment. Short bones- found in wrist and ankle and are small with irregular shapes Flat bones- cover soft body parts Sesamoid bones- small, round and resembles a sesame seed in shape. They are found near joint. Irregular shaped bones- odd shaped (vertebrae) What is the largest sesamoid bone in the body? ____________________

Structure of bones Diaphysis- (dia-=through/complete; -physis-to grow) shaft or middle region of a long bone Epiphysis- (epi-=above,upon; -physis= to grown) end of the long bones Metaphysis- (meta-=change/beyond) flared portion of the bone Periosteum- (peri-=surround; oste/o=bone) strong, fibrous, vascular membrane that covers the surface of long bones Articular cartilage- where the ends of long bones and the surface of any bone meet *the bones of a fetus are mostly made of cartilage Diaphysis- (dia-=through/complete; -physis-to grow) shaft or middle region of a long bone Epiphysis- (epi-=above,upon; -physis= to grown) end of the long bones Metaphysis- (meta-=change/beyond) flared portion of the bone Periosteum- (peri-=surround; oste/o=bone) strong, fibrous, vascular membrane that covers the surface of long bones Articular cartilage- where the ends of long bones and the surface of any bone meet *the bones of a fetus are mostly made of cartilage

Structure of bones Compact bone- layer of hard, dense bone that lies under the periosteum near the diaphysis of long bones Haversian canal- small canals containing blood vessels that bring O2 and nutrients; remove waste products (CO2) Cancellous bone- “spongy or trabecular”; porous and less dense than compact bone; red bone marrow is located here –Trabeculae- spongy latticework Compact bone- layer of hard, dense bone that lies under the periosteum near the diaphysis of long bones Haversian canal- small canals containing blood vessels that bring O2 and nutrients; remove waste products (CO2) Cancellous bone- “spongy or trabecular”; porous and less dense than compact bone; red bone marrow is located here –Trabeculae- spongy latticework

Bone Processes Bone processes are enlarged areas to serve as attachment for muscles and tendons Bone head- rounded end of a bone separated from the body of the bone by a neck Greater Trochanter- large process on the femur for attachment of tendons and muscle (lesser trochanter is just smaller) Condyle- rounded, knuckle-like process at a joint Tubercle- rounded process on many bones for attachment of tendons and muscles –Tuberocity- small rounded elevation on a bone Bone processes are enlarged areas to serve as attachment for muscles and tendons Bone head- rounded end of a bone separated from the body of the bone by a neck Greater Trochanter- large process on the femur for attachment of tendons and muscle (lesser trochanter is just smaller) Condyle- rounded, knuckle-like process at a joint Tubercle- rounded process on many bones for attachment of tendons and muscles –Tuberocity- small rounded elevation on a bone

Bone openings or hollow regions Fossa- shallow cavity in or on a bone Foramen- opening for blood vessels and nerves Fissure- narrow, deep, slit-like opening Sinus- hollow cavity within a bone Fossa- shallow cavity in or on a bone Foramen- opening for blood vessels and nerves Fissure- narrow, deep, slit-like opening Sinus- hollow cavity within a bone

Copyright © 2001 by W. B. Saunders Company. All rights reserved. A) Divisions of a long bone and interior bone structure. B) Composition of compact (cortical) bone. Fig. 15-1AB. Forward Back MENU

Copyright © 2001 by W. B. Saunders Company. All rights reserved. A) Divisions of a long bone and interior bone structure. B) composition of compact (cortical) bone. Fig. 15-1AB. Forward Back MENU

Copyright © 2001 by W. B. Saunders Company. All rights reserved. Bone processes on the femur and humerus. Fig. 15-2AB. Forward Back MENU

Copyright © 2001 by W. B. Saunders Company. All rights reserved. Cranial bones (lateral view). Fig Forward Back MENU

Copyright © 2001 by W. B. Saunders Company. All rights reserved. Cranial bones (looking downward at floor of cranial cavity). Fig Forward Back MENU

Copyright © 2001 by W. B. Saunders Company. All rights reserved. Facial bones. Fig Forward Back MENU

Copyright © 2001 by W. B. Saunders Company. All rights reserved. Sinuses of the skull. Fig Forward Back MENU

Copyright © 2001 by W. B. Saunders Company. All rights reserved. Vertebral column. Fig Forward Back MENU

Bones of the Thorax (chest cavity) Clavicle Scapula Sternum Ribs Acromion Clavicle Scapula Sternum Ribs Acromion

Bones of the Arm and Hand Humerus –Olecranon Ulna Radius Carpals Metacarpals Phalanges Humerus –Olecranon Ulna Radius Carpals Metacarpals Phalanges

Pelvic Bones Pelvic girdle – pelvis; collection of bones composed of: ilium ischium pubis *Pubic Symphysis- Anterior part of pelvis where cartilage connects Pelvic girdle – pelvis; collection of bones composed of: ilium ischium pubis *Pubic Symphysis- Anterior part of pelvis where cartilage connects

Bones of the Leg and Foot Femur Patella Tibia (medial) -Malleous Fibula (lateral) Tarsals -(7 bones)- *calcaneus- heel bone is the largest and sits on talus Metatarsals Phalanges of the toes Femur Patella Tibia (medial) -Malleous Fibula (lateral) Tarsals -(7 bones)- *calcaneus- heel bone is the largest and sits on talus Metatarsals Phalanges of the toes

Copyright © 2001 by W. B. Saunders Company. All rights reserved. Bones of the foot. Fig AB. AB Forward Back MENU

Copyright © 2001 by W. B. Saunders Company. All rights reserved. Bones of the thorax, pelvis, and extremities. Fig Forward Back MENU

Copyright © 2001 by W. B. Saunders Company. All rights reserved. Bones of the thorax, pelvis, and extremities. Fig Forward Back MENU

Fractures- break in a bone Closed fx – bone is broken but no open wound Open fx- bone is broken and a fragment of bone protrudes through skin Crepitus- crackling sound when ends of bones rub each other or roughened cartilage Colles fx- occurs near the wrist joint at lower end of radius Comminuted fx- bone splintered or crushed into several pieces Compression fx- bone is compressed Greenstick fx- bone is partially broken; typically occurs in children Impacted fx- one fragment is driven firmly into another Closed fx – bone is broken but no open wound Open fx- bone is broken and a fragment of bone protrudes through skin Crepitus- crackling sound when ends of bones rub each other or roughened cartilage Colles fx- occurs near the wrist joint at lower end of radius Comminuted fx- bone splintered or crushed into several pieces Compression fx- bone is compressed Greenstick fx- bone is partially broken; typically occurs in children Impacted fx- one fragment is driven firmly into another

Open fracture

Colles Fracture

Thumb fracture

Comminuted Fracture

Copyright © 2001 by W. B. Saunders Company. All rights reserved. Types of fractures. Fig Forward Back MENU

Pathologic conditions Ewing Sarcoma- malignant bone tumor Exostosis- bony growth arising from the surface of bone (ex=out; -ostosis= bone condition) Osteogenic sarcoma- (-genic= produced by); malignant tumor arising from bone (osteosarcoma) Osteomalacia- (-malcia=softening) softening of bone (loss of calcium) Osteomyelitis- (myel/o= spinal cord; bone marrow); inflammation of bone & bone marrow due to infection Osteoporosis- (-porosis= condition of pores (space); decrease in bone density (mass); thinning of bone Osteopenia- (-penia= deficieny); interior of bones is diminished in structure Osteodystrophy- (dys- bad, painful, difficult, abnormal) (-trophy- nourishment or development); poor formation of bone Ewing Sarcoma- malignant bone tumor Exostosis- bony growth arising from the surface of bone (ex=out; -ostosis= bone condition) Osteogenic sarcoma- (-genic= produced by); malignant tumor arising from bone (osteosarcoma) Osteomalacia- (-malcia=softening) softening of bone (loss of calcium) Osteomyelitis- (myel/o= spinal cord; bone marrow); inflammation of bone & bone marrow due to infection Osteoporosis- (-porosis= condition of pores (space); decrease in bone density (mass); thinning of bone Osteopenia- (-penia= deficieny); interior of bones is diminished in structure Osteodystrophy- (dys- bad, painful, difficult, abnormal) (-trophy- nourishment or development); poor formation of bone

Pathological Conditions Talipes- congenital abnormality in hindfoot (involving talus; clubfoot) Kyphosis- “hunchback”; spine curvature in thoracic cavity Lordosis- lumbar spine curves outward Scoliosis- lateral curvature of spine Sciatica- pain radiating down the leg (nerve) Talipes- congenital abnormality in hindfoot (involving talus; clubfoot) Kyphosis- “hunchback”; spine curvature in thoracic cavity Lordosis- lumbar spine curves outward Scoliosis- lateral curvature of spine Sciatica- pain radiating down the leg (nerve)

Copyright © 2001 by W. B. Saunders Company. All rights reserved. Scanning electromicrograph (A: Normal bone; B: Bone with osteoporosis). Fig AB. (From Dempster DW, Shane E, Horbert W, et al: A simple method for correlative light and scanning electron microscopy of human iliac crest bone biopsies: qualitative observations in normal and osteoporotic subjects. J Bone Miner Res, 1986; 1:15.) Forward Back MENU

Types of joints Joint (arthr/o)- a coming together of two or more bones Suture joint- immovable joint Synovial joint- freely moveable Joint capsule- bones in a synovial joint composed of fibrous tissue Ligaments- connect bone to bone; thick fibrous band of connective tissue –Sprain - trauma to a joint with pain, swelling and injury to ligaments Articular Cartilage- covers the smooth end of the joints surface Joint (arthr/o)- a coming together of two or more bones Suture joint- immovable joint Synovial joint- freely moveable Joint capsule- bones in a synovial joint composed of fibrous tissue Ligaments- connect bone to bone; thick fibrous band of connective tissue –Sprain - trauma to a joint with pain, swelling and injury to ligaments Articular Cartilage- covers the smooth end of the joints surface

Synovial Joints

Types of Joints Synovial Membrane- lies under the joint capsule and lines the synovial cavity between the bones. -The synovial fluid contains water and nutrients that lubricate the joint. -Bursae (bursa)-sac that contains synovial fluid that are located near but not within a joint -Tendons -connective tissue that connects muscle to bone -Tenorrhaphy- suture of a tendon Synovial Membrane- lies under the joint capsule and lines the synovial cavity between the bones. -The synovial fluid contains water and nutrients that lubricate the joint. -Bursae (bursa)-sac that contains synovial fluid that are located near but not within a joint -Tendons -connective tissue that connects muscle to bone -Tenorrhaphy- suture of a tendon

Copyright © 2001 by W. B. Saunders Company. All rights reserved. The knee (A: Sagittal; B: Frontal). Fig AB. AB Forward Back MENU

Pathological conditions Arthritis- inflammation of a joint –Ankylosing Spondylitis- (ankyl/o= stiff; spondyl/o=spine or vertebrae) chronic, progressive arthritis with stiffening of spinal joints/pelvis –Gouty Arthritis -inflammation and painful swelling of joints caused by excessive uric acid in the body (hyperuricemia); typically affects the big toe and is often called “podagra” –Osteoarthritis -(OA); progressive, degenerative joint disease characterized by loss of articular cartilage and hypertrophy of bone Arthritis- inflammation of a joint –Ankylosing Spondylitis- (ankyl/o= stiff; spondyl/o=spine or vertebrae) chronic, progressive arthritis with stiffening of spinal joints/pelvis –Gouty Arthritis -inflammation and painful swelling of joints caused by excessive uric acid in the body (hyperuricemia); typically affects the big toe and is often called “podagra” –Osteoarthritis -(OA); progressive, degenerative joint disease characterized by loss of articular cartilage and hypertrophy of bone

Copyright © 2001 by W. B. Saunders Company. All rights reserved. Osteoarthritis and rheumatoid arthritis. Fig Forward Back MENU

Pathological Conditions Rheumatoid Arthritis (RA)- Chronic disease in which joints become inflamed and painful. It is thought to be an autoimmune reaction against joint tissues –Pyrexia (fever) – symptom of RA Ankylosis - condition of stiff, bent joint Bunion - abnormal swelling of the medial aspect of the joint between the big toe and first metatarsal Carpal Tunnel Syndrome-compression of the median nerve as is passes between the ligament, bones and tendons of the wrist. Arthroplasty- surgical repair of a joint Spondyloliasthesis- slipping or subluxation of vertebrae Rheumatoid Arthritis (RA)- Chronic disease in which joints become inflamed and painful. It is thought to be an autoimmune reaction against joint tissues –Pyrexia (fever) – symptom of RA Ankylosis - condition of stiff, bent joint Bunion - abnormal swelling of the medial aspect of the joint between the big toe and first metatarsal Carpal Tunnel Syndrome-compression of the median nerve as is passes between the ligament, bones and tendons of the wrist. Arthroplasty- surgical repair of a joint Spondyloliasthesis- slipping or subluxation of vertebrae

Spondylolisthesis

Copyright © 2001 by W. B. Saunders Company. All rights reserved. Carpal tunnel syndrome. Fig AB. Forward Back MENU

Pathological Conditions Herniation of an intervertebral disk- abnormal protrusion of a fibrocartilaginous intervertebral disc into the spinal nerves Ganglion cyst- A fluid-filled cyst arising from the joint capsule or a tendon Injury to a Joint: Dislocation -Displacement of a bone from its joint –Reduction= restoration of bones to normal position –Subluxation= partial dislocation Herniation of an intervertebral disk- abnormal protrusion of a fibrocartilaginous intervertebral disc into the spinal nerves Ganglion cyst- A fluid-filled cyst arising from the joint capsule or a tendon Injury to a Joint: Dislocation -Displacement of a bone from its joint –Reduction= restoration of bones to normal position –Subluxation= partial dislocation

Elbow Dislocation

Knee Dislocations

Ankle dislocation and fx

Pathological Conditions Lyme Disease- a recurrent disorder marked by severe arthritis, myalgia, malaise, and neurologic and cardiac syndromes Sytemic Lupus Erythematosus (SLE)- chronic inflammatory autoimmune disease involving joints, skin, kidneys, nervous system, heart and lungs; characterized by ‘butterfly rash” Lyme Disease- a recurrent disorder marked by severe arthritis, myalgia, malaise, and neurologic and cardiac syndromes Sytemic Lupus Erythematosus (SLE)- chronic inflammatory autoimmune disease involving joints, skin, kidneys, nervous system, heart and lungs; characterized by ‘butterfly rash”

Copyright © 2001 by W. B. Saunders Company. All rights reserved. Protrusion of an intervertebral disc. *Laminectomy- operation to relieve symptoms of a slipped disk Fig Forward Back MENU

Muscles Cardiac muscle- striated in appearance but is like smooth muscle in action; no conscious controlled; Smooth muscle- involuntary or visceral muscle that move internal organs. They have no dark or light bands, fibrils, or cytoplasm Leiomyosarcoma- malignant tumor of smooth muscle Striated muscle- voluntary or skeletal muscle that move all bones –Fascia- fibrous tissue that envelops and separates muscles and contains the blood, lymph, and nerves Cardiac muscle- striated in appearance but is like smooth muscle in action; no conscious controlled; Smooth muscle- involuntary or visceral muscle that move internal organs. They have no dark or light bands, fibrils, or cytoplasm Leiomyosarcoma- malignant tumor of smooth muscle Striated muscle- voluntary or skeletal muscle that move all bones –Fascia- fibrous tissue that envelops and separates muscles and contains the blood, lymph, and nerves Uterine leiomyosarcomaCardiac TissueSmooth Tissue Striated Tissue

Muscles Skeletal muscle- over 600 in the human body. The point of attachment of the muscle to a stationary bone is called origin (beginning). When the muscle contracts, another bone to which it is attached to does move. The point of junction of the muscle to the bone that does move is called the insertion of the muscle. * Most often, the origin of a muscle lies proximal in the skeleton and insertion lies distal. Atrophy- wasting away of muscle (shrinking of size) Skeletal muscle- over 600 in the human body. The point of attachment of the muscle to a stationary bone is called origin (beginning). When the muscle contracts, another bone to which it is attached to does move. The point of junction of the muscle to the bone that does move is called the insertion of the muscle. * Most often, the origin of a muscle lies proximal in the skeleton and insertion lies distal. Atrophy- wasting away of muscle (shrinking of size)

Copyright © 2001 by W. B. Saunders Company. All rights reserved. Origin and insertion of the biceps. Fig Forward Back MENU

Major Muscles

Terms for muscle/joint movement Abduction- movement away from midline Adduction- movement toward the midline Dorsiflexion- backward (upward) bending of the foot Plantarflexion- bending the sole of foot downward to ground Extension- straightening of flexed limb Flexion- bending a joint Supination- turning the palm forward Pronation- turning the palm backward Rotation- circular movement around a central point Abduction- movement away from midline Adduction- movement toward the midline Dorsiflexion- backward (upward) bending of the foot Plantarflexion- bending the sole of foot downward to ground Extension- straightening of flexed limb Flexion- bending a joint Supination- turning the palm forward Pronation- turning the palm backward Rotation- circular movement around a central point

Copyright © 2001 by W. B. Saunders Company. All rights reserved. Types of muscular actions. Fig Back MENU

Abbreviations ROM- range of motion ACL- anterior cruciate ligament PCL- posterior cruciate ligament MCL- medial collateral ligament LCL- lateral collateral ligament EMG- electromyography RA- rheumatoid arthritis PT- physical therapy NSAID- nonsteriodal anti-inflammatory drug TMJ- temporomandibular joint THR- total hip replacement TKR- total knee replacement ROM- range of motion ACL- anterior cruciate ligament PCL- posterior cruciate ligament MCL- medial collateral ligament LCL- lateral collateral ligament EMG- electromyography RA- rheumatoid arthritis PT- physical therapy NSAID- nonsteriodal anti-inflammatory drug TMJ- temporomandibular joint THR- total hip replacement TKR- total knee replacement