1. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Medical Language, Second Edition Susan Turley CHAPTER Medical Language Second Edition Orthopedics 9

2. 10 Fun Facts about your Muscles! 1. You have all the muscle fiber you will ever have at birth. Once damaged they can’t be replaced. 2. Arnold Schwarzenegger has as many muscle fibers as you – They’re just thicker! 3. A single muscle cell of the Sartorius muscle in the thigh can be more than 12 inches long. 4. There are more than 600 voluntary muscles in the body. 5. The strongest muscle of the body is the masseter muscle used for chewing! 6. Your hand contains 20 different muscles. 7. If all your muscles could pull in one direction you could create a force of 25 tons! 8. Muscles account for approximately 40% of your body weight. 9. It takes 17 muscles in your face to smile, but it takes 43 muscles to frown. 10. You take approximately 5 million steps per year using your leg muscles!

3. Orthopedics (Muscular) The medical specialty that studies the anatomy and physiology of the muscular and skeletal systems and uses diagnostic tests, medical and surgical procedures, and drugs to treat muscular and skeletal diseases.

4. Figure 9-1 Muscular system

5. Anatomy and Physiology The muscular system moves the bony framework of the body Approximately 700 skeletal muscles in the body, as well as tendons and other structures of the muscular system Some skeletal muscles are readily visible on the surface of the body, while others are located more deeply.

6. Anatomy and Physiology (cont’d) All of the muscles of the body (or the muscles in a particular part of the body) are referred to as the musculature. The muscular system is also known as the musculoskeletal system because, without the muscles, the bones would not be able to move, and without the bones, the muscles would lack support.

7. Anatomy of the Muscular System Types of Muscles – Skeletal muscles – Cardiac muscle – Smooth muscles

8. Anatomy of the Muscular System (cont’d) Skeletal Muscles – Provide the means by which the body can move. – Are voluntary muscles that contract and relax in response to conscious thought. – Are also striated and show bands of color when seen under the microscope. – Of the three types of muscles, only skeletal muscle belongs to the muscular system.

9. Anatomy of the Muscular System (cont’d) Cardiac Muscle – The cardiac muscle or heart pumps blood through the circulatory system. – It is an involuntary muscle that is not under conscious control.

10. Anatomy of the Muscular System (cont’d) Smooth Muscles – Are involuntary, nonstriated muscles – Form a continuous, thin layer around many organs and structures (blood vessels, intestines, etc.)

11. Figure 9-2 Types of muscle

12. Muscle Origins, Insertions, and Related Structures A muscle is attached to a bone by a tendon, a cordlike, nonelastic, white fibrous band of connective tissue. The origin or beginning of a muscle is where its tendon is attached to a stationary or nearly stationary bone.

13. Muscle Origins, Insertions, and Related Structures (cont’d) The insertion or ending of a muscle is where its tendon is attached to the bone that moves when the muscle contracts and relaxes. The belly of a muscle is where its mass is the greatest, usually midway between the origin and insertion.

14. Muscle Origins, Insertions, and Related Structures (cont’d) A bursa, a long, thin synovial membrane filled with synovial fluid, acts as a cushion to reduce friction where a tendon rubs against the bone. Each muscle is wrapped in fascia, a thin connective tissue that joins to the tendon. Aponeurosis is connective tissue that attaches a flat muscle to bone or to other, deeper muscles.

15. Muscle Origins, Insertions, and Related Structures (cont’d) Retinaculum is a band of fibrous tissue and fascia that holds down the extensor and flexor tendons that cross the wrist and ankle.

16. Muscles Animation Click on the screenshot to view an animation on the topic of muscles. Back to Directory

17. Figure 9-3 Tendon

18. Muscle Names Muscle names are in Latin. They describe where the muscle is located, its shape, its size, or what action it performs.

19. Table 9-1 Muscle Names and Their Meanings

20. Table 9-1 (cont’d) Muscle Names and Their Meanings

21. Figure 9-4 Origin and insertion of a muscle

22. Relaxed Muscle Contracted Muscle Z lineMyosinActinZ line Sarcomore Cross-bridgesZ line Movement of Actin Filament Actin Binding sites Cross-bridge Myosin Figure 36-8 Muscle Contraction Section 36-2

23. Relaxed Muscle Contracted Muscle Z lineMyosinActinZ line Sarcomore Cross-bridgesZ line Movement of Actin Filament Actin Binding sites Cross-bridge Myosin Figure 36-8 Muscle Contraction Section 36-2 During muscle contraction, the knoblike head of a myosin filament attaches to a binding site on actin, forming a cross-bridge.

24. Relaxed Muscle Contracted Muscle Z lineMyosinActinZ line Sarcomore Cross-bridgesZ line Movement of Actin Filament Actin Binding sites Cross-bridge Myosin Figure 36-8 Muscle Contraction Section 36-2 During muscle contraction, the knoblike head of a myosin filament attaches to a binding site on actin, forming a cross-bridge. Powered by ATP, the myosin cross- bridge changes shape and pulls the actin filament toward the center of the sarcomere.

25. Relaxed Muscle Contracted Muscle Z lineMyosinActinZ line Sarcomore Cross-bridgesZ line Movement of Actin Filament Actin Binding sites Cross-bridge Myosin Figure 36-8 Muscle Contraction Section 36-2 During muscle contraction, the knoblike head of a myosin filament attaches to a binding site on actin, forming a cross-bridge. Powered by ATP, the myosin cross- bridge changes shape and pulls the actin filament toward the center of the sarcomere. The cross-bridge is broken, the myosin binds to another site on the actin filament, and the cycle begins again.

26. Types of Muscle Movement Muscles function in antagonistic pairs to produce movement. These are opposite movements controlled by muscle pairs: – Flexion and extension – Abduction and adduction – Rotation to the right and to the left – Supination and pronation – Eversion and inversion

27. Table 9-2 Types of Muscle Movement

28. Table 9-2 (cont’d) Types of Muscle Movement

31. Figure 9-5 Extension, abduction, and dorsiflexion Rubberball/Getty Images Inc – Rubberball-Royalty Free

32. Figure 9-6 Extension, adduction, pronation, abduction, flexion, and plantar flexion Mark Anderson/Rubberball/Getty Images Inc – Rubberball-Royalty Free

33. Figure 9-7 Rotation

34. Figure 9-8 Extension, supination, abduction, flexion, and inversion Anthony Saint James/Getty Images – Photodisc-Royalty Free

35. Muscles of the Head and Neck Frontalis Temporalis Orbicularis oculi Orbicularis oris Masseter Buccinator Sternocleidomastoid Platysma

36. Figure 9-9 Muscles of the head and neck

37. Muscles of the Shoulders, Chest, and Back Deltoid Pectoralis major Intercostal muscles Trapezius Latissimus dorsi

38. Figure 9-10 Muscles of the shoulder and chest

39. Figure 9-11 Muscles of the shoulder and back

40. Muscles of the Upper Extremity Biceps brachii Triceps brachii Brachioradialis Thenar muscles

41. Figure 9-12 Muscles of the upper extremity

42. Figure 9-13 Extensor muscles of the forearm and the extensor retinaculum Reprinted from McMinn’s Color Atlas of Human Anatomy, 2/E. McMinn, Hutchings, Human Anatomy, 19,46,66,71.78,127,137,237,238. Copyright 2002, with permission from Elsevier.

43. Muscles of the Abdomen External abdominal oblique Internal abdominal oblique Rectus abdominis

44. Figure 9-14 Muscles of the abdomen

45. Muscles of the Lower Extremity Anterior Leg – Rectus femoris – Sartorius – Vastus lateralis and vastus medialis – Peroneus longus – Tibialis anterior

46. Muscles of the Lower Extremity (cont’d) Posterior Leg – Gluteus maximus – Biceps femoris – Semitendinosus and semimembranosus – Gastrocnemius

47. Muscles of the Lower Extremity (cont’d) Quadriceps femoris is a collective name for the group of four muscles on the anterior aspect of the thigh: – Rectus femoris – Vastus lateralis – Vastus intermedius (beneath the vastus lateralis) – Vastus medialis

48. Muscles of the Lower Extremity (cont’d) Hamstrings is a collective name for the group of three muscles on the posterior aspect of the thigh: – Biceps femoris – Semitendinosus – Semimembranosus

49. Figure 9-15 Muscles of the lower extremity.

50. Physiology of a Muscle Contraction A muscle is composed of several muscle fascicles, each of which is wrapped in fascia and connected to the tendon. Each muscle fascicle is a bundle of individual muscle fibers.

51. Physiology of a Muscle Contraction (cont’d) These muscle fibers run parallel to each other so that, when they contract, they all pull in the same direction. A muscle fiber (which is actually one long muscle cell) has hundreds of nuclei along its length to speed up the chemical processes that must occur before it can contract.

52. Physiology of a Muscle Contraction (cont’d) Each muscle fiber is composed of myofibrils that contain the proteins actin and myosin. A muscle contracts in response to an electrical impulse from a nerve. Each muscle fiber is connected to a single nerve cell at the neuromuscular junction.

53. Acetylcholine is a chemical messenger that changes the permeability of the muscle fiber, which shortens the muscle and produces a muscle contraction. Muscles are in a state of mild, partial contraction because of nerve impulses from the brain and spinal cord. Physiology of a Muscle Contraction (cont’d)

54. Figure 9-17 Parts of a muscle

55. Figure 9-18 Muscle strength and size

56. Diseases and Conditions Diseases of the Muscles – Atrophy – Avulsion – Compartment syndrome – Contracture – Fibromyalgia

57. Figure 9-19 Muscle contracture Michal Heron/Pearson Education/PH College

58. Diseases and Conditions (cont’d) Diseases of the Muscles (cont’d) – Hyperextension-hyperflexion injury – Muscle contusion – Muscle spasm – Muscle strain – Muscular dystrophy

59. Figure 9-20 Muscular dystrophy Pearson Education/PH College

60. Diseases and Conditions (cont’d) Diseases of the Muscles – Myalgia – Myasthenia gravis – Myopathy – Myositis

61. Diseases and Conditions (cont’d) Diseases of the Muscles (cont’d) – Repetitive strain injury (RSI) – Rhabdomyoma – Rhabdomyosarcoma – Rotator cuff tear

62. Diseases and Conditions (cont’d) Movement Disorders – Ataxia – Bradykinesia – Dyskinesia – Hyperkinesis – Restless legs syndrome (RLS) – Tremor

63. Diseases and Conditions (cont’d) Diseases of the Bursa, Fascia, or Tendon – Bursitis – Dupuytren’s contracture – Fasciitis – Ganglion – Pitcher’s elbow

64. Figure 9-21 Ganglion Dr. P. Marazzi/Photo Researchers, Inc.

65. Diseases and Conditions (cont’d) Diseases of the Bursa, Fascia, or Tendon (cont’d) – Shin splints – Tendonitis – Tennis elbow – Tenosynovitis

66. Laboratory and Diagnostic Procedures Blood Tests – Acetylcholine receptor antibody – Creatine phosphokinase (CPK-MM)

67. Laboratory and Diagnostic Procedures (cont’d) Muscle Tests – Electromyography (EMG) – Tensilon test

68. Medical and Surgical Procedures Medical Procedures – Braces and adaptive devices – Deep tendon reflexes (DTR)

69. Figure 9-22 Braces Glaser & Associates/Custom Medical Stock Photo, Inc.

70. Figure 9-23 Deep tendon reflex PhotoAlto/Ale Ventura/Getty Images Royalty Free - PhotoAlto

71. Medical and Surgical Procedures (cont’d) Medical Procedures (cont’d) – Muscle strength test – Rehabilitation exercises – Trigger point injections

72. Medical and Surgical Procedures (cont’d) Surgical Procedures – Fasciectomy – Fasciotomy – Ganglionectomy

73. Medical and Surgical Procedures (cont’d) Surgical Procedures (cont’d) – Muscle biopsy – Myorrhaphy

74. Medical and Surgical Procedures (cont’d) Surgical Procedures (cont’d) – Tenorrhaphy – Thymectomy

75. Figure 9-25 Intramuscular injection Elena Dorfman/Pearson Education/PH College

76. Abbreviations