chapter 15 the musculoskeletal system copyright © 2008, 2005 by saunders, an imprint of elsevier...

Chapter 15Chapter 15The Musculoskeletal The Musculoskeletal

SystemSystem

Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved.

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Learning ObjectivesLearning Objectives

Define terms relating to the structure Define terms relating to the structure and function of bones, joints, and and function of bones, joints, and muscles.muscles.

Describe the process of bone Describe the process of bone formation and growth.formation and growth.

Locate and name the major bones of Locate and name the major bones of the body.the body.

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Learning Objectives Learning Objectives (cont’d.)(cont’d.)

Analyze the combining forms, Analyze the combining forms, prefixes, and suffixes used to prefixes, and suffixes used to describe bones, joints, and muscles.describe bones, joints, and muscles.

Explain various musculoskeletal Explain various musculoskeletal disease conditions and terms related disease conditions and terms related to bone fractures.to bone fractures.

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Learning Objectives Learning Objectives (cont’d.)(cont’d.)

Describe important laboratory tests Describe important laboratory tests and clinical procedures related to and clinical procedures related to the musculoskeletal system, and the musculoskeletal system, and recognize relevant abbreviations.recognize relevant abbreviations.

Apply your new knowledge to Apply your new knowledge to understanding medical terms in understanding medical terms in their proper contexts, such as their proper contexts, such as medical reports and records.medical reports and records.

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Introduction – page 578Introduction – page 578

Musculoskeletal SystemMusculoskeletal System:: bones, muscles, bones, muscles, and joints of the bodyand joints of the body

BonesBones:: structural support and protection of structural support and protection of internal organsinternal organs

MusclesMuscles:: internal and external movement internal and external movement

JointsJoints:: where bones come together/type where bones come together/type determined by need for flexibilitydetermined by need for flexibility

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Physicians Associated Physicians Associated with Musculoskeletal with Musculoskeletal

SystemSystem Orthopedist:Orthopedist: MD, bones, bone disease MD, bones, bone disease

Rheumatologist:Rheumatologist: MD, joints MD, joints

Osteopathic physician:Osteopathic physician: DO, body able to DO, body able to heal itself with proper nutrition and bone heal itself with proper nutrition and bone alignmentalignment

Chiropractor:Chiropractor: physical manipulation of the physical manipulation of the spinal column to relieve pressures on spinal column to relieve pressures on nervesnerves

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Bone Structure – page Bone Structure – page 579579

206 bones in the body206 bones in the body

Long bones: legs and armsLong bones: legs and arms

Short bones: wrist and ankleShort bones: wrist and ankle

Flat bones: shoulder blades and ribsFlat bones: shoulder blades and ribs

Irregular bones: vertebrae and facial Irregular bones: vertebrae and facial bonesbones

Sesamoid bones: knee capSesamoid bones: knee cap

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BONE STRUCTURE – BONE STRUCTURE – page 580page 580

Long, short, flat, sesamoid (in shape)Long, short, flat, sesamoid (in shape) Diaphysis:Diaphysis: shaft shaft Epiphysis:Epiphysis: end end Metaphysis:Metaphysis: cone-like flared portion cone-like flared portion

between end and shaftbetween end and shaft Epiphyseal line or plate:Epiphyseal line or plate: growth growth

plate where cartilage replaced by plate where cartilage replaced by bone for bone growth (in length)bone for bone growth (in length)

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Bone Structure Bone Structure (cont’d.)(cont’d.)

Ends of bones covered by articular Ends of bones covered by articular cartilage in the joint: cushions joint cartilage in the joint: cushions joint and allows it to move smoothlyand allows it to move smoothly

Compact bone:Compact bone: contains haversian contains haversian systems for blood vessels, nerves, and systems for blood vessels, nerves, and yellow bone marrow (mostly fat)yellow bone marrow (mostly fat)

CancellousCancellous (spongy/trabecular bone): (spongy/trabecular bone): spaces contain red bone marrow with spaces contain red bone marrow with elements for blood formationelements for blood formation

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Bone MarrowBone Marrow

Yellow marrow:Yellow marrow: chiefly fat chiefly fat

Red marrow:Red marrow: rich with blood rich with blood vessels and immature and mature vessels and immature and mature blood cells in various stages of blood cells in various stages of development; in later life replaced development; in later life replaced with yellow marrowwith yellow marrow

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Bone Processes and Bone Processes and DepressionsDepressions

Processes:Processes: serve as attachments for serve as attachments for muscles and tendonsmuscles and tendons

Depressions:Depressions: openings or hollow openings or hollow regions help join bones or serve as regions help join bones or serve as passageways for nerves and/or passageways for nerves and/or vesselsvessels

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Bone Processes and Bone Processes and DepressionsDepressions

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Cranial Bones – page Cranial Bones – page 582-583582-583

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Cranial Bones and Cranial Bones and Associated Associated StructuresStructures

Frontal boneFrontal bone Parietal boneParietal bone Temporal boneTemporal bone

temporomandibular (TMJ) jointtemporomandibular (TMJ) joint mastoid processmastoid process styloid processstyloid process

Occipital boneOccipital bone foramen magnumforamen magnum

Sphenoid boneSphenoid bone sella turcicasella turcica

Ethmoid boneEthmoid bone

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Facial Bones – page 584Facial Bones – page 584

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SINUSESSINUSES

Air cavitiesAir cavities located in facial located in facial and cranial and cranial bones. They bones. They lighten the skull lighten the skull and warm and and warm and moisten the air moisten the air as it passes into as it passes into the respiratory the respiratory system.system.

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Vertebral Column and Vertebral Column and VertebraeVertebrae

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Vertebral Column and Vertebral Column and Vertebrae Vertebrae – page 586-587– page 586-587

Vertebrae:Vertebrae: 26 bone segments from 26 bone segments from base of skull to tailbone in five base of skull to tailbone in five divisions and separated by pads of divisions and separated by pads of cartilage called cartilage called intervertebral disks.intervertebral disks.

Cervical, thoracic, lumbar, sacralCervical, thoracic, lumbar, sacral

Coccyx:Coccyx: tailbone tailbone

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BONESBONESThorax, Pelvis and Thorax, Pelvis and

ExtremitiesExtremities

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Thorax, Pelvis and Thorax, Pelvis and Extremities Extremities Page 588 - 589Page 588 - 589

Thorax

clavicle

scapula

sternum

ribs

Arm and Hand

humerus

ulna

radius

carpals

metacarpals

phalanges

Pelvis pelvic girdle

ilium

ischium

pubis

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Clavicle and ScapulaClavicle and Scapula

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Arm and HandArm and Hand

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Bones of the Pelvis – page Bones of the Pelvis – page 590590

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Bones of Leg and Foot – Bones of Leg and Foot – 590 - 591590 - 591

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Bones of Leg and Foot Bones of Leg and Foot and Associated and Associated

StructuresStructures FemurFemur

acetabulumacetabulum PatellaPatella TibiaTibia

medial malleolusmedial malleolus FibulaFibula

lateral malleoluslateral malleolus talustalus

TarsalsTarsals calcaneuscalcaneus talustalus

MetatarsalsMetatarsals PhalangesPhalanges

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QUICK QUIZQUICK QUIZ::

1.1. The knuckle-like The knuckle-like process at the end of a process at the end of a bone near the joint…bone near the joint…

A.A. fossafossa

B.B. condylecondyle

C.C. tubercletubercle

D.D. diaphysisdiaphysis

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2.2. Process of bone Process of bone formation____________formation____________

A.A. olecranonolecranon

B.B. ossificationossification

C.C. osteoblastosteoblast

D.D. xiphoid processxiphoid process


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calc/ocalc/o calciumcalcium calci/ocalci/o calciumcalcium kyph/okyph/o posterior curvature posterior curvature

in in thoracic regionthoracic region lamin/olamin/o laminalamina lord/olord/o curvecurve lumb/olumb/o loins, lower backloins, lower back

Combining FormCombining Form MeaningMeaning

COMBINING FORMS COMBINING FORMS AND SUFFIXESAND SUFFIXES

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myel/omyel/o bone marrowbone marrow orth/oorth/o straightstraight oste/ooste/o bonebone scoli/oscoli/o crookedcrooked spondyl/ospondyl/o vertebravertebra vertebr/overtebr/o vertebravertebra



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-blast-blast embryonic cellembryonic cell -clast-clast to breakto break -listhesis-listhesis slippingslipping -malacia-malacia softeningsoftening -physis-physis to growto grow -porosis-porosis pore, passagepore, passage -tome-tome instrument to cutinstrument to cut

SuffixSuffix MeaningMeaning


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acetabul/oacetabul/o acetabulum (hip acetabulum (hip socket)socket)

calcane/ocalcane/o calcaneus (heal)calcaneus (heal) carp/ocarp/o carpals (wrist bones)carpals (wrist bones) clavicul/oclavicul/o clavicle (collar bone)clavicle (collar bone) cost/ocost/o ribsribs crani/ocrani/o cranium (skull)cranium (skull)



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femor/ofemor/o femur femur (thigh bones)(thigh bones)

fibul/ofibul/o fibula fibula (smaller lower leg (smaller lower leg bone)bone)

humer/ohumer/o humerus humerus (upper arm (upper arm bone)bone)

ili/oili/o ilium ilium (upper part of pelvic (upper part of pelvic bone)bone)

ischi/oischi/o ischium ischium (part of pelvic (part of pelvic bone)bone)

malleol/omalleol/o malleolus malleolus

Combining Form MeaningCombining Form Meaning


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mandibul/omandibul/o mandible mandible (lower jaw (lower jaw bone)bone)

maxill/omaxill/o maxilla maxilla (upper jaw bone)(upper jaw bone) metacarp/ometacarp/o metacarpals metacarpals (hand (hand

bones)bones) metatars/ometatars/o metatarsals metatarsals (foot (foot

bones)bones) olecran/oolecran/o olecranon olecranon (elbow)(elbow) patell/opatell/o patella patella (kneecap)(kneecap)

pelv/ipelv/i pelvispelvis

Combining Form MeaningCombining Form Meaning


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perone/operone/ofibulafibula phalang/ophalang/o phalanges phalanges (finger, (finger,

toe bones)toe bones)

pub/opub/o pubispubis radi/oradi/o radiusradius scapul/oscapul/o scapula scapula (shoulder (shoulder

blade)blade)



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stern/ostern/o sternum sternum (breastbone)(breastbone)

tars/otars/o tarsalstarsals tibi/otibi/o tibia tibia (shin bone)(shin bone) uln/ouln/o ulna ulna (lower arm (lower arm

bone)bone)



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hypercalcemiahypercalcemia

hyper-hyper-

calc/o: calciumcalc/o: calcium

-emia-emia

Excessive calcium in the bloodExcessive calcium in the blood

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kyphosiskyphosis

kyph/o: humpbackkyph/o: humpback posterior curvature in the posterior curvature in the

thoracic regionthoracic region

-osis-osis

Abnormal posterior Abnormal posterior curvature of the thoracic curvature of the thoracic vertebraevertebrae

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laminectomylaminectomy

lamin/o: laminalamin/o: lamina Part of the vertebral archPart of the vertebral arch

-ectomy-ectomy

Removal of a lamina Removal of a lamina To relieve the symptoms of a To relieve the symptoms of a

ruptured intervertebral disc ruptured intervertebral disc (disk) or compression of the (disk) or compression of the spinal cord after injury spinal cord after injury

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lordosislordosis

lord/o: curve, swaybacklord/o: curve, swayback anterior curvature of the anterior curvature of the

lumbar regionlumbar region

-osis-osis

Abnormal anterior Abnormal anterior curvature of the curvature of the backbones in the backbones in the lumbar regionlumbar region

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orthopedicsorthopedics

orth/o: straightorth/o: straight ped/o: childped/o: child -ic-ic -s-s Pertaining to bonesPertaining to bones

Orthopedists originally Orthopedists originally straightened the bones straightened the bones of children of children

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scoliosisscoliosis

scoli/o: crooked, scoli/o: crooked, bentbent lateral curvaturelateral curvature

-osis-osis Abnormal Abnormal

condition of a condition of a lateral curvature lateral curvature of the spineof the spine

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osteomalaciaosteomalacia

oste/ooste/o

-malacia-malacia Softening of boneSoftening of bone

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osteoporosisosteoporosis

oste/ooste/o

-porosis: pore, -porosis: pore, passagepassage

Condition of Condition of increased porosity of increased porosity of bonebone

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carpalcarpal

carp/o: carpals carp/o: carpals wrist boneswrist bones

-al-al

Pertaining to the Pertaining to the carpals carpals

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supraclavicularsupraclavicular

supra-supra-

clavicul/o: clavicleclavicul/o: clavicle collar bonecollar bone

-ar-ar

Pertaining to above the claviclePertaining to above the clavicle

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chondrocostalchondrocostal

chondr/o: cartilagechondr/o: cartilage cost/ocost/o

-al-al

Pertaining to the cartilage attached Pertaining to the cartilage attached to the ribsto the ribs

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craniotomycraniotomy

crani/ocrani/o

-tomy-tomy

Incision of the Incision of the craniumcranium

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PATHOLOGIC PATHOLOGIC CONDITIONSCONDITIONS

Ewing sarcomaEwing sarcoma:: malignant bone tumor malignant bone tumor exostosisexostosis:: bony growth on surface of bony growth on surface of

bonebone osteogenic sarcomaosteogenic sarcoma:: malignant tumor malignant tumor

arising from bone arising from bone osteomalaciaosteomalacia:: softening of bone softening of bone osteomyelitisosteomyelitis:: inflammation secondary inflammation secondary

to infectionto infection talipestalipes:: congenital abnormality of congenital abnormality of

hindfoot involving the talus (clubfoot)hindfoot involving the talus (clubfoot)

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Pathologic Conditions Pathologic Conditions Fractures of BonesFractures of Bones

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Pathologic ConditionsPathologic Conditions

Normal BoneNormal Bone Bone with osteoporosisBone with osteoporosis

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Joints – page 602Joints – page 602

Joint (articulation):Joint (articulation): coming coming together of two or more bonestogether of two or more bones

Suture joints:Suture joints: immovable (skull) immovable (skull)

Synovial joints:Synovial joints: freely movable (ball freely movable (ball and socket types, e.g. hip or shoulder), and socket types, e.g. hip or shoulder), (hinge type, e.g., elbow, knee, ankle)(hinge type, e.g., elbow, knee, ankle)

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Synovial JointsSynovial Joints

Joint capsule surrounds boneJoint capsule surrounds bone

Ligaments band bones togetherLigaments band bones together

Bones covered by articular cartilageBones covered by articular cartilage

Synovial membrane lies under capsule Synovial membrane lies under capsule and lines synovial cavity; filled with and lines synovial cavity; filled with synovial fluidsynovial fluid

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BursaeBursae Closed sacks of synovial fluid with a synovial Closed sacks of synovial fluid with a synovial

membrane located membrane located near,near, but not within a joint. but not within a joint. Needed where sliding must take place Needed where sliding must take place

Common sites: Common sites: between tendons (connective tissue connecting between tendons (connective tissue connecting

muscle to bone) and bonesmuscle to bone) and bones

between ligaments (binding bone to bone) and bonebetween ligaments (binding bone to bone) and bone

between skin and bones (with prominent bony between skin and bones (with prominent bony anatomy)anatomy)

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JointsJoints

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3.3. Connective tissue that Connective tissue that binds muscles to binds muscles to bones____________bones____________

A.A. ligamentligament

B.B. articulationarticulation

C.C. synovial membranesynovial membrane

D.D. tendontendon

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ankyl/oankyl/o stiffstiff

arthr/oarthr/o jointjoint

articul/oarticul/o jointjoint

burs/oburs/o bursabursa

chondr/ochondr/o cartilagecartilage


COMBINING FORMS COMBINING FORMS 4-605Page 604-605

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ligament/oligament/o ligamentligament

rheumat/orheumat/o watery flowwatery flow

synov/osynov/o synovial synovial

membranemembrane

ten/oten/o tendontendon

tendin/otendin/o tendontendon


COMBINING FORMS COMBINING FORMS

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SUFFIXES – page 604SUFFIXES – page 604

-desis-desis to bind, tie to bind, tie togethertogether

-stenosis-stenosis narrowingnarrowing


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Pathoology - Joints – Pathoology - Joints – page 606page 606

Arthritis:Arthritis: inflammation of joints inflammation of joints Ankylosing spondylitis:Ankylosing spondylitis: chronic chronic

progressive stiffening of joints, mostly spineprogressive stiffening of joints, mostly spine Gouty arthritis:Gouty arthritis: inflammation due to inflammation due to

excessive uric acid in bodyexcessive uric acid in body Osteoarthritis (OA):Osteoarthritis (OA): loss of articular loss of articular

cartilage and formation of bone spurs at cartilage and formation of bone spurs at articular surfacesarticular surfaces

Rheumatoid arthritis (RA):Rheumatoid arthritis (RA): autoimmune autoimmune reaction against joint tissues (synovial reaction against joint tissues (synovial membrane)membrane)

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Osteoarthritis and Osteoarthritis and Rheumatoid ArthritisRheumatoid Arthritis

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Pathologic ConditionsPathologic Conditions

BunionBunion:: swelling of medial aspect of joint swelling of medial aspect of joint between big toe and first metatarsal bonebetween big toe and first metatarsal bone

Carpal tunnel syndromeCarpal tunnel syndrome:: compression of compression of median nerve as it passes between median nerve as it passes between ligament and bones and tendons of the ligament and bones and tendons of the wrist.wrist.

DislocationDislocation:: displacement of bone from a displacement of bone from a jointjoint

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BunionBunion

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Pathological Joint Pathological Joint Conditions Conditions (cont’d.)(cont’d.)

Carpal tunnel syndrome

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DislocationDislocation

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Pathologic Conditions Pathologic Conditions

Ganglion: Ganglion: a fluid-filled cyst arising a fluid-filled cyst arising from the joint capsule or a tendon in from the joint capsule or a tendon in the wrist.the wrist.

Herniation of an intervertebral Herniation of an intervertebral disk:disk: abnormal protrusion of the disk abnormal protrusion of the disk into the neural canal or against spinal into the neural canal or against spinal nerves.nerves.

Lyme disease:Lyme disease: recurrent arthritis, recurrent arthritis, myalgia, malaise and neurologic and myalgia, malaise and neurologic and cardiac symptoms.cardiac symptoms.

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GanglionGanglion

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Herniated DiskHerniated Disk

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Pathologic Conditions Pathologic Conditions (cont’d.)(cont’d.)

Sprain:Sprain: trauma to joint with pain, trauma to joint with pain, swelling and injury to ligamentsswelling and injury to ligaments

Systemic lupus erythematosus Systemic lupus erythematosus (SLE):(SLE): chronic inflammatory disease chronic inflammatory disease involving joints, skin, kidneys, nervous involving joints, skin, kidneys, nervous system, heart and lungs affecting system, heart and lungs affecting collagen in tendons, ligaments, bones, collagen in tendons, ligaments, bones, and cartilage all over the bodyand cartilage all over the body

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Chapter 15Chapter 15Muscles – page 611Muscles – page 611

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MusclesMuscles

Three types of muscles: striated, smooth, Three types of muscles: striated, smooth, cardiaccardiac

Striated:Striated: under voluntary control—they under voluntary control—they move all the bones as well as face and move all the bones as well as face and eyeseyes

Smooth:Smooth: control is involuntary—they control is involuntary—they move internal organs (digestive tract, move internal organs (digestive tract, blood vessels, ducts of glands)blood vessels, ducts of glands)

Cardiac:Cardiac: not consciously controlled and not consciously controlled and found exclusively in the heartfound exclusively in the heart

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Types of MuscleTypes of Muscle

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Named Skeletal MusclesNamed Skeletal Muscles

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Named Skeletal MusclesNamed Skeletal Muscles

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Actions of Muscles – Actions of Muscles – page 613page 613

flexionflexion extensionextension abductionabduction adductionadduction

rotationrotation dorsiflexiondorsiflexion plantar plantar

flexionflexion supinationsupination pronationpronation

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Actions of Muscles Actions of Muscles (cont’d.)(cont’d.)

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4.4. Movement AWAY from the Movement AWAY from the midline of the midline of the body____________body____________

A.A. adductionadduction

B.B. abductionabduction

C.C. flexionflexion

D.D. dorsiflexiondorsiflexion

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fasci/ofasci/o faciafacia fibr/ofibr/o fibrousfibrous leiomy/oleiomy/o smooth smooth

musclemuscle my/omy/o musclemuscle


COMBINING FORMS page COMBINING FORMS page 614-615 614-615

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myocardi/omyocardi/o heart muscleheart muscle myos/omyos/o musclemuscle plant/oplant/o sole of the footsole of the foot rhabdomy/orhabdomy/o skeletal muscle skeletal muscle

connected connected to bonesto bones

Sarc/oSarc/o fleshflesh


COMBINING FORMSCOMBINING FORMS

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--astheniaasthenia lack of strengthlack of strength

-trophy-trophy development, development, nourishmentnourishment


SUFFIXES – page 615SUFFIXES – page 615

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PREFIXESPREFIXES

ab-ab- away fromaway from ad-ad- towardtoward dorsi-dorsi- backback poly-poly- many, muchmany, much

PrefixePrefixe MeaningMeaning

PREFIXES – page 615PREFIXES – page 615

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Pathologic Pathologic Conditions - 616Conditions - 616

Muscular dystrophy:Muscular dystrophy: group of group of inherited diseases with progressive inherited diseases with progressive muscle weakness and degeneration muscle weakness and degeneration without nervous system involvementwithout nervous system involvement

Polymyositis:Polymyositis: chronic inflammatory chronic inflammatory myopathy; may be an autoimmune myopathy; may be an autoimmune disorderdisorder

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Laboratory Tests Laboratory Tests Related to Muscle – Related to Muscle –

page 616page 616 Antinuclear antibody test (ANA)Antinuclear antibody test (ANA) Erythrocyte sedimentation rate Erythrocyte sedimentation rate

(ESR)(ESR) Rheumatoid factor test (RF)Rheumatoid factor test (RF) Serum calcium (Ca)Serum calcium (Ca) Serum creatine kinase (CK)Serum creatine kinase (CK) Uric acid testUric acid test

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Clinical Procedures Clinical Procedures Related to Bones, Joints, Related to Bones, Joints,

and Muscleand Muscle ArthrocentesisArthrocentesis ArthrographyArthrography ArthroplastyArthroplasty ArthroscopyArthroscopy Bone density testBone density test Bone scanBone scan Computed Computed

tomography (CT)tomography (CT)

DiskographyDiskography Electromyography Electromyography

(EMG)(EMG) Magnetic Magnetic

resonance imaging resonance imaging (MRI)(MRI)

Muscle biopsyMuscle biopsy

chapter 15 the musculoskeletal system copyright © 2008, 2005 by saunders, an imprint of elsevier...

Documents

body bones

facial bones sesamoid

facial bones irregular

function of bones

major bones

body long bones

ankle short bones

arms short bones