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Painting by Danny Quirk
Kaan Yücel M.D., Ph.D.
2. October.2012 Tuesday
1.1. CLASSIFICATION OF JOINTS
1.2. STABILITY OF JOINTS
1.3. JOINT VASCULATURE AND
INNVERVATION
2
2.1. TYPES OF MUSCLES
2.2. SKELETAL MUSCLES
2.2.1. Features of muscles
2.2.2. Muscle terminology
2.3.
2.4.
2.5.
2.6.
CONTRACTION OF MUSCLES
FUNCTIONS OF MUSCLES
FASCIA
NERVES AND ARTERIES OF MUSCLES
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science concerned with the
anatomy, function, dysfunction and treatment of joints.
according to the tissues that lie between the bones:
1) Fibrous joints
2) Cartilaginous joints
3) Synovial joints
Fibrous joints
Bones are united by fibrous tissue.
Sutures of the cranium
Fibrous joints
Syndesmosis type of fibrous joint
unites the bones with a sheet of fibrous tissue
either a ligament or a fibrous membrane
partially movable
The interosseous membrane in the forearm is a sheet of fibrous tissue
that joins the radius and ulna in a syndesmosis.
Fibrous joints
Syndesmosis type of fibrous joint
unites the bones with a sheet of fibrous tissue
either a ligament or a fibrous membrane
partially movable
The interosseous membrane in the forearm is a sheet of fibrous tissue
that joins the radius and ulna in a syndesmosis.
Cartilaginous joints
Bones are united by hyaline cartilage or fibrocartilage.
Cartilaginous joints
Pimary cartilaginous joints-synchondroses
hyaline cartilage- growth of a bone during early life
Secondary cartilaginous joints-symphyses
strong, slightly movable joints united by fibrocartilage
Synovial joints
Most common type of joints
Bones united by a joint capsule enclosing an articular cavity.
Provide free movement between the bones they join.
Joint cavity
potential space
contains lubricating synovial fluid, secreted by the
synovial membrane.
Articular cartilage
articular surfaces are covered by hyaline cartilage
Articular capsule
surrounds the joint and formed of two layers.
Articular capsule:
surrounds the joint
two layers.
Fibrous capsule
Synovial membrane
Some synovial joints have other distinguishing features, such as a
fibrocartilaginous articular disc or meniscus, which are present when
the articulating surfaces of the bones are incongruous.
Ligaments
a cord or band of connective tissue uniting two structures.
Articular capsules are usually strengthened by articular ligaments.
Connect the articulating bones to each other.
limit the undesired and/or excessive movements of the joints.
Articular disc: Help to hold the bones together.
Labrum: A fibrocartilaginous ring which deepens the articular surface
for one of the bones.
Bursa
Flattened sacs that contain synovial fluid to reduce friction.
Walls are separated by a film of viscous fluid.
Found wherever tendons rub against bones, ligaments, or other
tendons.
Stability of Joints
1) Negative pressure within the joint cavity
2) Shape, size, and arrangement of the articular surfaces
3) Ligaments
4) Tone of the muscles around the joint
Joint vasculature and innvervation
 Joints receive blood from articular arteries that arise from the
vessels around the joint.
 Articular veins are communicating veins that accompany arteries
(L. venae comitantes) and, like the arteries, are located in the
joint capsule, mostly in the synovial membrane.
 Joints have a rich nerve supply provided by articular nerves with
sensory nerve endings in the joint capsule.
Types of synovial joints
according to shape of articulating surfaces- type of movement they permit
1.Plane joints
uniaxial joints- gliding or sliding
acromioclavicular joint
2. Hinge joints
uniaxial joints- flexion & extension
knee & elbow joints
Types of synovial joints
3. Saddle joints
biaxial joints- flexion & extension, abduction & adduction
carpometacarpal joint at the base of the 1st digit (thumb)
4. Condyloid (ellipsoid type)
biaxial joints- flexion & extension, abduction & adduction
metacarpophalangeal joints (knuckle joints)
radiocarpal joint (wrist)
Types of synovial joints
5. Ball and socket joints (spheroidal joints)
multiple axes and planes: flexion and extension, abduction and
adduction, medial and lateral rotation, and circumduction
hip & shoulder joints
Types of synovial joints
6. Pivot joints
uniaxial joints- rotation around a central axis
proximal & distal radioulnar joints
Tendon Sheath
 A layer of the synovial membrane around a tendon.
 Permits the tendon to move.
EXAMINATION OF JOINTS
The clinician should assess the normal range of movement of all
joints.
.
When the bones of a joint are no longer in their normal anatomic
relationship with one another, then the joint is said to be dislocated.
Examination of the shoulder joint
Knee examination
DISLOCATION OF JOINTS
Some joints are particularly susceptible to dislocation because of:
1. lack of support by ligaments
.
2. the poor shape of the articular surfaces,
3. the absence of adequate muscular support.
The shoulder joint, temporomandibular joint, & acromioclavicular joints
DAMAGE TO LIGAMENTS
Ligaments prone to excessive stretching & even tearing and rupture.
.
If possible, the apposing damaged surfaces of the ligament are
brought together by positioning and immobilizing the joint.
In severe injuries, surgical approximation of the cut ends may be
required.
OSTEOARTHRITIS
Synovial joints are well designed to withstand wear, but heavy use
.
over several years can cause degenerative
changes.
Some destruction is inevitable during such activities as jogging, which
wears away the articular cartilages and sometimes erodes the
underlying articulating surfaces of the bones.
OSTEOARTHRITIS
The normal aging of articular cartilage begins early in adult life and
.
progresses slowly thereafter, occurring
on the ends of the articulating
bones, particularly those of the hip, knee, vertebral column, and
hands.
OSTEOARTHRITIS
 Degenerative joint disease or osteoarthritis is often
.
accompanied by stiffness, discomfort, and pain.
 Osteoarthritis is common in older people and usually affects
joints that support the weight of their bodies (e.g., the hips and
knees).
ARTHROSCOPY
Cavity of a synovial joint can be examined by inserting a cannula
.
and an arthroscope (a small telescope)
into it.
Enables to examine joints for abnormalities, such as torn menisci
(partial articular discs of the knee joint).
Some surgical procedures can also be performed.
interested in all the muscles in the body
Musculus (muscle) mus-mouse; musculus- little mouse.
So called because the shape and movement of some muscles (notably biceps) were thought to
resemble mice.
If you bend and straighten your arm at the elbow, you should see the front of the upper arm
move under the skin. To the ancient Romans this movement resembled a little mouse scurrying
beneath the skin.
Skeletal muscles move the skeleton, as a result the body.
Types of Muscles
based on distinct characteristics
Functional
voluntary vs. involuntary
Histological
striated vs. smooth or unstriated
Anatomical (location)
@ body wall (soma) and limbs
@ hollow organs (viscera) or blood vessels
Skeletal striated muscle
voluntary somatic muscle
gross skeletal muscles that compose the muscular system
moving or stabilizing bones and other structures (e.g., the eyeballs).
Innervated by the somatic nervous system.
Cardiac striated muscle
involuntary visceral muscle
forms the walls of the heart and adjacent parts of the great vessels.
pumps blood.
Smooth muscle (unstriated muscle)
involuntary visceral muscle
forms part of the walls of most vessels and hollow organs (viscera)
moving substances through them
coordinated sequential contractions (pulsations or peristaltic contractions).
Innervated by the autonomic nervous system.
FEATURES OF SKELETAL MUSCLES
HEAD OR BELLY fleshy, reddish, contractile portions
TENDON white non-contractile portions
composed mainly of organized collagen bundles, that provide a means of attachment.
Most skeletal muscles attach to
Directly or indirectly to bones
Cartilages
Ligaments
Fascias
or combinations of the ones above
Some to organs (eyeball)/skin (facial muscles)/mucous membranes(intrinsic tongue muscles
Muscles are organs of locomotion (movement)
also:
provide static support
give form to the body
provide heat
Some tendons form flat sheets aponeuroses
anchor the muscle
to the skeleton
to deep fascia
to aponeurosis of another muscle
Many terms provide information about a structure's
Shape
Size
Location
Function
Resemblance of one structure to another
Basis of function
Bones attached to
Abductor digiti minimi muscle abducts the little finger.
Sternocleidomastoid muscle (G. kleidos, bolt or bar, clavicle)
attaches inferiorly to the sternum and clavicle and superiorly to the
mastoid process of the temporal bone of the cranium.
Levator scapulae elevates the scapula (L. shoulder blade).
Descriptive names
Deltoid muscle
triangular, like the symbol for delta, the fourth letter of the Greek
alphabet.
-oid “like”;
deltoid means like delta.
Position
medial, lateral, anterior, posterior
Length
brevis, short; longus, long
Shape
piriformis muscle
pear shaped (L. pirum, pear + L. forma, shape or form).
Location
temporalis muscle
in the temporal region (temple) of the cranium (skull).
according to their shapes
Flat muscles
parallel fibers often with an aponeurosis
External oblique muscle
broad flat muscle
Sartorius
narrow flat muscle with parallel fibers
longest muscle in the body
Pennate muscles
feather-like (L. pennatus, feather), arrangement of fasicles
Unipennate
Extensor
digitorum
longus
Bipennate
Rectus
femoris
Multi-pennate
Deltoid
Fusiform muscles
spindle shaped with a round, thick belly (or bellies) and tapered ends
Convergent muscles
arise from a broad area
converge to form a single tendon
Quadrate muscles
four equal sides (L. quadratus, square)
rectus abdominis
between its tendinous intersections.
Circular or sphincteral muscles
surround a body opening or orifice, constricting it when contracted
orbicularis oculi closes the eyelids
Multi-headed or multi-bellied muscles
more than one head of attachment or more than one contractile belly
Biceps muscles
two heads of attachment
triceps muscles
three heads
Two bellies
digastric muscle
gastrocnemius muscle
Skeletal muscles function by contracting
they pull and never push.
When a muscle contracts and shortens
one of its attachments usually remains fixed
the other attachment (more mobile) pulled toward it
movement
Attachments of muscles
origin & insertion
Origin proximal end of the muscle
remains fixed during muscular contraction.
Insertion distal end of the muscle
movable
This is not always the case.
Some muscles can act in both directions under different
circumstances.
Reflexive Contraction
automatic (reflexive) contraction, not voluntarily controlled
Respiratory movements of the diaphragm
Myotatic reflex
Tonic Contraction
slight contraction@ rest
Muscle tone (tonus)
No movement, but
Certain firmness in muscles
Assistance to the stability of joints
Maintenance of posture
Keeping the muscles ready to respond to stimuli
Absent only when?
unconscious (during deep sleep or under general anesthesia)
after a nerve lesion resulting in paralysis
Phasic Contraction:
There are two main types of phasic (active) muscle contractions:
(1) isotonic contractions, in which the muscle changes length in
relationship to the production of movement.
(2) isometric contractions, in which muscle length remains the
same—no movement occurs, but the force (muscle tension) is
increased above tonic levels to resist gravity or other antagonistic
force.
When a muscle contracts its length decreases by 1/3 or ½.
Whereas the structural unit of a muscle is a skeletal striated muscle
fiber, the functional unit of a muscle is a motor unit, consisting of a
motor neuron and the muscle fibers it controls.
When a motor neuron in the spinal cord is stimulated, it initiates an
impulse that causes all the muscle fibers supplied by that motor unit
to contract simultaneously.
The number of fibers varies according to the size and function of the
muscle.
Large motor units, in which one neuron supplies several hundred
muscle fibers, are in the large trunk and thigh muscles.
Functions of muscles
Prime mover (agonist)
main muscle responsible for producing a specific movement of the body.
Does most of the work (expending most of the energy) required.
In most movements, there is a single prime mover, but some movements involve two prime
movers working in equal measure.
Fixator
steadies the proximal parts of a limb through isometric contraction
while movements are occurring in distal parts.
Synergist
complements the action of a prime mover.
Usual to have several synergists assisting a prime mover in a particular movement.
Antagonist
a muscle that opposes the action of another muscle.
A primary antagonist directly opposes the prime mover,
synergists may also be opposed by secondary antagonists.
The same muscle may act as a prime mover, antagonist, synergist, or
fixator under different conditions.
Nerves and arteries to muscles
 Variation in the nerve supply of muscles is rare; it is a nearly constant
relationship.
 In the limb, muscles of similar actions are generally contained within
a common fascial compartment and share innervation by the same
nerves.
Nerves and arteries to muscles
Nerves supplying skeletal muscles (motor nerves) usually enter the
fleshy portion of the muscle (vs. the tendon), almost always from the
deep aspect (so the nerve is protected by the muscle it supplies).
The blood supply of muscles is not as constant as the nerve supply
and is usually multiple.
Fascia (L. fasciae)
wrapping, packing, and insulating materials of the deep structures of the body
Underlying the subcutaneous tissue superficial fascia
Deep fascia
dense, organized connective tissue layer, devoid of fat
covers most of the body deep to the skin and subcutaneous tissue
In the limbs, groups of muscles with similar functions sharing the same
nerve supply are located in fascial compartments, separated by thick
sheets of deep fascia, called intermuscular septa, that extend centrally
from the surrounding fascial sleeve to attach to bones.
These compartments may contain or direct the spread of an infection or
a tumor.
Subserous fascia
between the internal surfaces of the musculoskeletal walls and the serous membranes
lining the body cavities.
These are the endothoracic, endoabdominal, and endopelvic fascias;
the latter two may be referred to collectively as extraperitoneal fascia.
lateral side of the abdomen
MUSCLE TONE
Determination of the tone of a muscle is an important clinical
.
examination.
If a muscle is flaccid, then either the afferent, the efferent, or both
neurons involved in the reflex arc necessary for the production of
muscle tone have been interrupted.
If, conversely, the muscle is found to be hypertonic, the possibility
exists of a lesion involving higher motor neurons in the spinal cord or
brain.
MUSCLE SHAPE AND FORM
The general shape and form of muscles
should also be noted, since
.
a paralyzed muscle or one that is not used (such as occurs when a
limb is immobilized in a cast) quickly atrophies and changes shape.
ELECTROMYOGRAPHY
(EMG)
a technique for evaluating & recording electrical
. activity produced by skeletal muscles
A diagnostic procedure to assess the health of muscles and the
nerve cells that control them (motor neurons).
Can reveal nerve dysfunction, muscle dysfunction or problems with
nerve-to-muscle signal transmission.
Performed using an instrument called an electromyograph, to
produce a record called an electromyogram.