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SKELETAL MUSCLESKHALEEL ALYAHYA, PHD, MED
www.kha lee la lyahya.net
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By Elaine Marieb and Suzanne Keller
By Frank NetterBy Richard Drake,
Wayne Vogl & Adam Mitchell
RESOURCES
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Khaleel Alyahya, PhD, MEd 3
(فكسون العظام لحما )
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INTRODUCTION
▪ Musculoskeletal is a general term which is defined as relatingto muscles and bones of the skeleton.
▪ The musculoskeletal system comprises bones, joints, cartilage,bursae, tendons, muscles and ligaments.
▪ It is the system that moves the body and maintains its form.
▪ Study of this system consists of osteology (the study of bones),arthrology (the study of joints), and myology (the study of muscles).
▪ The musculoskeletal system does not work in isolation.
▪ It is closely linked with many other systems in the body, includingthe nervous system, genitourinary system, circulatory system,immune system, respiratory system, digestive system andendocrine system.
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MUSCLES
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▪ Describe the main criteria of skeletal muscles.
▪ Describe the attachments of skeletal muscles.
▪ Describe the different directions of skeletal muscle fibers.
▪ Describe the mode of action of skeletal muscles.
▪ Describe briefly the naming of skeletal muscles.
▪ Describe briefly the nerve supply of skeletal muscles.
▪ Clinical anatomy
Khaleel Alyahya, PhD, MEd
OBJECTIVES
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MUSCLES TISSUES
▪ Muscle tissue is a unique tissue which has the ability to contract.
▪ As a result of this ability, muscles are responsible for all the bodymovements.
▪ The structural and functional unit of muscle tissue is “muscle cell”.
▪ All muscle cells are elongated and are called “muscle fibers”.
▪ The ability of muscle to contract, or to shorten depends on twotypes of myofilaments (actin & myosin) in the muscle fibers
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CLASSIFICATIONS
Muscles are classified based on the following:
▪ Location
▪ Action
▪ Microscopic structure
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BASED ON LOCATIONS
SKELETAL MUSCLES
ATTACHED TO BONES AND PRODUCE MOVEMENT
SMOOTH MUSCLES
WALLS OF VISCERAL ORGANS
CARDIAC MUSCLES
WALLS OF THE HEART
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BASED ON ACTIONS
VOLUNTARY INVOLUNTARY INVOLUNTARY
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BASED ON MICROSCOPIC STRUCTURES
SKELETAL (STRIATED) CARDIAC (STRIATED) SMOOTH (NONSTRIATED)
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SKELETAL MUSCLE CARDIAC MUSCLE SMOOTH MUSCLE
Voluntary Involuntary Involuntary
Striated Striated Nonstriated
CLASSIFICATION OVERVIEW
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SKELETAL MUSCLES
▪ The ske l et a l mus c les are at t achedt o bones at not le s s t han t wopo i n t s :
o O r i g i n
• A t t a c h e d t o l e s s m o b i l e o ri m m o v a b l e b o n e .
• L e a s t m o v a b l e .
• M o s t l y f l e s h y .
• P r o x i m a l e n d .
o I n se r t i o n
• A t t a c h e d t o t h e m o v a b l e b o n e s .
• M o s t m o v a b l e .
• M o s t l y f i b r o u s .
• D i s t a l e n d .
▪ When t he mus c l e cont r act s , thei n s e r t ion mov es t oward t he or i g in .
▪ A t i ns er t ion , t he musc les a reat t ached by means o f s t rong cord-l i ke t endons or by s heet - l i keaponeuros i s .
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SKELETAL MUSCLES
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MAIN CRITERIA
▪ St r ia ted .
▪ A ttached to ske leton .
▪ Produce mov ement of ske leton .
▪ Voluntary .
▪ Supp l ied by Somat ic Nerv es .
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FUNCTIONS
▪ Body Movement
▪ Maintain Posture
▪ Generate Heat
▪ Stabilizing Joints
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ATTACHMENTS
o O r i g i n
• L e a s t m o v a b l e
• M o s t l y f l e s h y
• P r o x i m a l e n d
o I n se r t i o n
• M o s t m o v a b l e
• M o s t l y f i b r o u s
• D i s t a l e n d
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ATTACHMENTS
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TYPES OF ATTACHMENTS
▪ Ske l et a l musc les a re at tached t obones , car t i lage or l i gaments by :
o T e n d o n s
• A t o u g h c o r d o f f i b r o u sc o n n e c t i v e t i s s u e t h a t u s u a l l yc o n n e c t s m u s c l e t o b o n e a n d i sc a p a b l e o f w i t h s t a n d i n g t e n s i o n .
o A p o n e u r o s i s
• A t h i n b r o a d a n d s t r o n g s h e e t o ff i b r o u s t i s s u e .
o R a p h e
• A n i n t e r d i g i t a t i o n o f t h et e n d i n o u s e n d s o f t h e f l a tm u s c l e s .
• E x a m p l e : m y l o h y o i d r a p h e
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TENDONS
RAPHE
APONEUROSIS
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DIRECTIONS OF MUSCLES
▪ Th e r a n g e o f m o t i o n a n d t h e p o w e r o f am u s c l e d e p e n d s o n t h e a r r a n g e m e n t o fi t s f a s c i c l e s .
▪ Th e f i b e r a r r a n g e m e n t c a n b e :
o P a r a l l e l
• M o r e r a n g e o f m o v e m e n t , l e s s p o w e r f u l .
o P e n n a t e
• M o r e p o w e r f u l , l e s s r a n g e o f m o v e m e n t .
• U n i p e n n a t e
• B i p e n n a t e
• m u l t i p e n n a t e
o T r i a n g u l a r
• H a v e a b r o a d a t t a c h m e n t f r o m w h i c h t h ef a s c i c l e s c o n v e r g e t o a s i n g l e t e n d o n .
o F u s i f o r m
o S p i n d l e - s h a p e d ( r o u n d , t h i c k b e l l y , &
t a p e r e d e n d s ) .
o C i r c u l a r
o S u r r o u n d a b o d y o p e n i n g o r o r i f i c e ,c o n s t r i c t i n g i t w h e n c o n t r a c t e d .
▪ Th e l o n g p a r a l l e l a r r a n g e m e n t g i v em o r e r a n g e o f m o t i o n b u t i s n o t u s u a l l yv e r y p o w e r f u l .
▪ Th e p e n n a t e m u s c l e s s h o r t e n v e r y l i t t l eb u t a r e v e r y p o we r f u l .
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DIRECTIONS OF MUSCLES
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MODE OF ACTIONS
▪ P r ime Mover (Agon i s t )o I t i s t h e c h i e f m u s c l e r e s p o n s i b l e f o r a
p a r t i c u l a r m o v e m e n t .
▪ Antagon i s to I t o p p o s e s t h e a c t i o n o f t h e p r i m e
m o v e r .
o B e f o r e c o n t r a c t i o n o f p r i m e m o v e r ,a n t a g o n i s t m u s t b e r e l a x e d .
▪ Synerg i s to M u s c l e s t h a t a s s i s t t h e p r i m e m o v e r i n a
p a r t i c u l a r m o v e m e n t .
▪ F ixa to ro I t s c o n t r a c t i o n d o e s n o t p r o d u c e
m o v e m e n t b y i t s e l f , b u t i t s t a b i l i z e s t h eo r i g i n o f t h e p r i m e m o v e r s o t h a t i t c a na c t e f f i c i e n t l y .
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MODE OF ACTIONS
PRIME MOVER ANTAGONIST SYNERGI ST F I XATOR
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PRIME MOVER (AGONIST)
▪ I t i s the chief musclerespons ible for a part icularmovement.
▪ Example:
o B i ceps B r ach i i i s th e p r i me mo v e rfo r f l ex i o n o f t h e e l bo w jo i n t an df o r e a r m .
o Q u a d r i ceps F emo r i s i s th e p r i memo v e r fo r ex t e n s i o n o f t h e k ne ej o i n t .
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PRIME MOVER
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ANTAGONIST
▪ I t opposes the action of thepr ime mover .
▪ Before contract ion of pr imemover , antagoni s t must berelaxed.
▪ Example:
o T r i ceps B r ach i i i s th e a n t ago n i s t fo rp r i me mo v er fo r f l e x i o n o f t h ee l bow j o i n t a n d f o r e a r m .
o B i ceps F e m o r i s ( F l e xo r o f k n e e ) .
o I t o ppo s es t he a c t i o n o f qu a d r i cepsw h e n t h e k n e e j o i n t i s e x t e n d e d .
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ANTAGONIST
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SYNERGIST
▪ Muscles that ass i s t the pr imemover in a part icularmovement.
▪ Synergi s ts are sometimescal led neutral i zers becausethey help cancel out , orneutra l i ze, extra motion fromthe agonists to make surethat the force generatedworks wi thin the desi redplane of mot ion.
▪ Example:
o B r ach i a l i s musc l e fo r B i ceps p r i mem o v e r m u s c l e .
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SYNERGIST
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FIXATOR
▪ I t s contract ion does notproduce movement by i tsel fbut i t s tabi l i zes the or igin ofthe pr ime mover so that i tcan act eff ic ient ly .
▪ Example:
o D el to i d mu sc l e fo r B i ceps p r i mem o v e r m u s c l e .
o M usc l es a t ta ch i ng th e s hou l de rgi r d l e to t he t r u nk c o n t r ac t to f i xs ho u l de r g i r d l e , a l l ow i ng d e l to i dm usc l e ( t a k i ng o r i g i n f ro m s ho u l de rg i r d l e ) to mo v e s ho u l de r jo i n t(h u m e r u s ) .
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FIXATOR
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NAMING OF MUSCLES
▪ S i zeo M a j o r o r M a x i m u s ( l a r g e )
▪ Pos i t ion
o P e c t o r a l i s ( p e c t o r a l r e g i o n )
▪ Depth
o S u p e r f i c i a l i s ( s u p e r f i c i a l )
▪ Shape
o D e l t o i d ( t r i a n g u l a r )
▪ Number o f Heads
o B i c e p s ( 2 h e a d s )
o T r i c e p s ( 3 h e a d s )
▪ At tachments
o C o r a c o b r a c h i a l i s
▪ Act ion
o F l e x o r d i g i t o r u m : f l e x i o n o f d i g i t s
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TYPES OF BODY MOVEMENTS
▪ F l e x i o n
o M o v e m e n t t h a t b r i n g s t h e t w o b o n e s c l o s e rt o e a c h o t h e r ( d e c r e a s e s t h e a n g l e o fj o i n t ) .
▪ E x t e n s i o n
o M o v e m e n t t h a t i n c r e a s e s t h e a n g l e , o r t h ed i s t a n c e b e t w e e n t h e t w o b o n e s .
▪ A d d u c t i o n
o M o v e m e n t o f t h e l i m b t o w a r d t h e m i d l i n e
o f t h e b o d y .
▪ A b d u c t i o n
o M o v e m e n t o f t h e l i m b a w a y f r o m t h e
m i d l i n e o f t h e b o d y .
▪ R o t a t i o n
o M o v e m e n t o f a b o n e a r o u n d a v e r t i c a l
a x i s .
▪ C i rc u m d u ct i o n
o C o m b i n a t i o n o f a l l t h e a b o v e m o v e m e n t s .
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TYPES OF BODY MOVEMENTS
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MUSCLE EXERCISE
▪ T h e amo u n t o f w o rk do ne by a m usc l ei s r e f l ec t e d i n c ha nge s i n t h e m usc l ei t s e l f .
▪ M usc l e i nac t i v i ty l e ad s t o m usc l ew e a k n es s a n d w a s t i ng .
▪ R egu l a r e xe r c i se i nc r e ase s m usc l es i z e , s t r e n g t h a n d e n d u r a n c e .
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MUSCLES INNERVATION
▪ T h e som a t i c ne rvo u s sy s t e m ( i s th e
p a r t o f t he p e r i phe r a l n e rv o us
s y s t em ) as so c i a t e d wi th sk e l e ta l
m usc l e v o l un t a r y co n t ro l o f bo dy
m o v e men t s .
▪ T h e n e rv es supp l y i ng t h e sk e l e t a l
m u s c l e s a r e M i xe d .
o 6 0 % a r e M o t o r
o 4 0 % a r e S e n s o r y
▪ I t c o n t a i n s s o m e A u t o no mi c f i b e r s
o S y m p a t h e t i c
▪ T h e n e rv e e nt e r s t h e mu sc l e a t abo u t
th e m i d d l e p o i n t o f i t s d e e p s u r f a c e.
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BLOOD SUPPLY
▪ D u r i ng e x t r em e phy s i ca l e x e r t i on ,
mo r e t h a n 80% o f ca r d i ac o u tp u t ca n
b e d i r e c t e d t o c o n t r a ct i ng m u s c l e s .
▪ T h e v ascu l a r i n f l ow to sk e l et a l m usc l es
i s p ro v i de d by p r i ma ry a r t e r i e s , w h i ch
r e p re s en t t he l a s t b r anch e s o f th e
a r te r i a l supp l y th a t a r i se b efo r e en t r y
i n t o t h e t i s s u e .
▪ T h e p r i ma ry a r t e r i e s a r e app ro p r i a te l y
d i s t r i bu t e d a l o ng th e l o ng a x i s o f th e
m usc l e a n d g i v e r i se t o fe e d a r t e r i e s
t h a t co u r s e to w a r d t he ep i mys i um o f
t h e mu sc l e at r i g h t o r o b l i qu e ang l es
t o th e p r i ma r y a r te r i e s .
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CLINICAL ANATOMY
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Muscular Dystrophy
A genetic disease
that cause a
damage of muscle
fibers.
Muscle Cramps
Can occur suddenly
and involuntarily in one
or more muscles.
Fibromyalgia
People experience
long-term,
widespread pain
and tender points in
joints, muscles,
tendons and other
soft tissues.
Strains
Overstretching or
tearing muscles or
tendons results in
a strain.
Contusions
Often caused by a
direct trauma or
repeated blow to the
muscle. In some cases,
the condition can be
caused by falling on a
hard surface.
MUSCLE DISEASES
▪ M usc l e d i se as e s an d i n j u r i e s a r e co mmo n , e s pec i a l l y i n spo r t s ac t i v i t i e s . A sev ere
m usc l e i n j u ry c a n k eep y o u f ro m p a r t i c i pa t i ng i n th e ac t i v i t i e s t h a t yo u l o v e a n d
e n j o y f o r l i v i ng .
▪ M usc l e d i se a se s a nd i n j u r i e s cou l d be o ne o f th e m a jo r f ac to r s t h a t th r e a t som eon e ’ s
p r o f es s i o na l c a r e e r ( s ) .
Khaleel Alyahya, PhD, MEd40
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▪ F i b r o m y a l g i a i s a t e r m u s e d t o d e s c r i b e a
c o m m o n s y n d r o m e i n w h i c h p e o p l e
e x p e r i e n c e l o n g - t e r m , w i d e s p r e a d p a i n
a n d t e n d e r p o i n t s i n j o i n t s , m u s c l e s ,
t e n d o n s a n d o t h e r s o f t t i s s u e s .
▪ I t a l s o r e s u l t s i n d i s t u r b e d s l e e p a n d
e x h a u s t i o n .
▪ T h e c a u s e i s u n k n o w n b u t p o s s i b l e
t r i g g e r s i n c l u d e v i r a l i n f e c t i o n , p h y s i c a l
a n d e m o t i o n a l s t r e s s .
▪ I t t e n d s t o b e m o r e c o m m o n i n p e o p l e
w i t h p r e - e x i s t i n g l u p u s , r h e u m a t o i d
a r t h r i t i s , o r a n k y l o s i n g s p o n d y l i t i s .
▪ T h e r e i s n o c u r e b u t s y m p t o m a t i c
t r e a t m e n t c a n h e l p s o m e p a t i e n t s .
FIBROMYALGIA
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▪ T h e m u s c l e c r a m p i s a s u d d e n a n d i n v o l u n t a r y
c o n t r a c t i o n o f o n e o r m o r e o f y o u r m u s c l e s .
▪ I f y o u ' v e e v e r b e e n a w a k e n e d i n t h e n i g h t o r
s t o p p e d i n y o u r t r a c k s , y o u k n o w t h a t m u s c l e
c r a m p s c a n c a u s e s e v e r e p a i n .
▪ M u s c l e c r a m p s c a n m a k e i t t e m p o r a r i l y i m p o s s i b l e
t o u s e t h e a f f e c t e d m u s c l e .
▪ L o n g p e r i o d s o f e x e r c i s e o r p h y s i c a l l a b o r ,
p a r t i c u l a r l y i n h o t w e a t h e r , c a n l e a d t o m u s c l e
c r a m p s .
▪ S o m e m e d i c a t i o n s a n d c e r t a i n m e d i c a l c o n d i t i o n s
a l s o m a y c a u s e m u s c l e c r a m p s .
▪ O v e r u s e o f a m u s c l e , d e h y d r a t i o n , m u s c l e s t r a i n
o r s i m p l y h o l d i n g a p o s i t i o n f o r a p r o l o n g e d
p e r i o d c a n c a u s e a m u s c l e c r a m p .
▪ Y o u m i g h t b e a t h i g h e r r i s k o f m u s c l e c r a m p s i f
y o u h a v e d i a b e t e s , o r n e r v e , l i v e r o r t h y r o i d
d i s o r d e r s .
MUSCLE CRAMP
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▪ M u s c u l a r d y s t r o p h y ( M D ) r e f e r s t o a g r o u p o f
h e r e d i t a r y d i s e a s e s t h a t w e a k e n d i ff e r e n t m u s c l e
g r o u p s i n v a r i o u s w a y s .
▪ A p e r s o n a ff e c t e d w i t h M D h a s a g e n e t i c m u t a t i o n
t h a t p r e v e n t s t h e r e p a i r o f m u s c l e t i s s u e .
▪ T h i s m u s c l e w e a k e n i n g o c c u r s g r a d u a l l y o v e r t i m e .
▪ S y m p t o m s m a y s t a r t a t a n y t i m e f r o m i n f a n c y
t h r o u g h t o a d u l t h o o d .
▪ B y a g e 1 0 t o 1 2 y e a r s c h i l d r e n w i l l o f t e n b e i n a
w h e e l c h a i r .
▪ T h i s d i s e a s e a l s o a ff e c t s o t h e r b o d y s y s t e m s s o
p a t i e n t s n e e d r e g u l a r r e s p i r a t o r y a n d c a r d i a c
a s s e s s m e n t .
▪ I t i s l i k e l y t h a t t h e s e p a t i e n t s w i l l e v e n t u a l l y n e e d
a v e n t i l a t o r t o b r e a t h e .
▪ P e o p l e w i t h D M D u s u a l l y d o n o t s u r v i v e b e y o n d
t h e i r l a t e t e e n s o r e a r l y a d u l t h o o d .
MUSCULAR DYSTROPHY
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▪ A s t r a i n o ccur s w h e n a m usc l e a nd /o r
t e n d o n i s o v e r s t r e t che d o r t o r n .
▪ T h e r e i s no f r ac t u re o r d i s l o ca t i o n
p r e s e n t .
▪ P a i n , w e akn es s an d m usc l e sp asm s a re
c o m m o n symp to ms e xpe r i enc e d a f te r a
s t r a i n o c cur s .
▪ R e s t , app l i ca t i o n o f i ce an d a
co mpr es s i o n b an d age a r e effect i v e
t r e a t m e n t s .
STRAIN
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▪ O f t en c aus ed b y a di r ec t t r aum a o r
r e p e a t e d b l o w t o t h e m u s c l e .
▪ I n so me c as es , t h e co n di t i o n ca n b e
c a u s e d b y f a l l i ng o n a h a r d s u r f a c e .
▪ C h a r a c t e r i s t i c s i n c l ud e :
• d i s c o l o r e d s k i n t h a t l o o k s r e d , g r e e n ,
p u r p l e , b l u e , o r b l a c k
• a s m a l l b u m p o v e r t h e a r e a i n s o m e
c a s e s
• p a i n t h a t ’ s u s u a l l y w o r s e w h e n p r e s s u r e
i s a p p l i e d t o t h e a r e a .
CONTUSIONS
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▪ T h e EM G i s a d i ag no s t i c t e s t u se d to
i de n t i f y n e u ro pa t h i c a n d myo path i c
d i s o r d er s .
▪ E l ec t ro d es a re p l ace d o n t h e m usc l e
a n d a r e us ed t o r eco r d mo t o r un i t
a c t i v i t y a t r es t a n d a l so du r i ng m usc l e
c o n t r a ct i on .
ELECTROMYOGRAPHY
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▪ T h e CT i s a d i agno s t i c t es t p e r fo rm e d
t o i de n t i f y d i so r de r s o f t h e so f t t i s s u es ,
b o n e a n d m u s c l e .
▪ C ro ss - s ect i o na l i mage s a r e t a k en u s i ng
a co mpu t e r i n co n ju nct i on w i t h x - r ay
b e a m s .
COMPUTED TOMOGRAPHY
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▪ M RI i s a d i agno s t i c t es t t h a t c r e a t es
i mages o f so f t t i s su e us i ng r a d i o w av e s
a n d a m a g n e t i c f i e l d
MAGNETIC RESONANCE IMAGING
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▪ M i n o r m u s c l e i n j u r i e s m a y b e t r e a t e d
w i t h s i m p l e h o m e r e m e d i e s , s u c h a s
r e s t , a p p l y i n g i c e , u s i n g c o m p r e s s i o n
b a n d a g e , a n d e l e v a t i n g y o u r i n j u r e d
l i m b .
▪ A n t i - i n f l a m m a t o r y m e d i c a t i o n .
▪ P h y s i o t h e r a p y
▪ S e v e r e m u s c l e i n j u r i e s n e e d t o b e
c h e c k e d b y a q u a l i f i e d h e a l t h c a r e
p r o v i d e r .
▪ A t o r n m u s c l e o r t e n d o n m a y n e e d t o
b e s u r g i c a l l y r e p a i r e d .
MUSCLE TREATMENTS
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