Chapter 6: Musculoskeletal System Chapter Objectives Upon completion of this chapter the participant will be able to: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. List the functions of bones. Define terms related to bone structure. Distinguish between the axial and appendicular skeleton. Describe the three types of joints. List the 4 types of muscle found in the human body. Differentiate between the types of muscles. Describe the functions of muscles. Analyze, define, spell and pronounce the common terms of the skeletal system. Analyze, define, spell and pronounce terms related to the body’s muscular system. Successfully complete the review exercises at the end of the chapter. Anatomy and Physiology of Bone & Muscles of the Musculoskeletal System Bone Many people think that bones are simply solid masses of non-living tissue. In reality each of the 206 bones of the body is a complex, living organ. The shape, height and weight of our body is determined by the length and thickness of our bones. Besides giving us structure the bone has a number of other functions: As a lever. The bones of the upper and lower limbs pull and push, with the help of muscles. Provide protection and support for inner organs (e.g. skull protects the brain). Blood cells essential for life are produced in the bone marrow Play an important role in regulating the amount of essential nutrients. As a calcium store. 97% of the body's calcium is stored in bone. Bone Structure Bone, a form of connective tissue, is one of the hardest tissues in the human body. The only part of the body that is harder is the enamel of the teeth. Throughout our life bone goes through a process of building up and tearing down. Bone is also capable of healing and repairing itself. Oste/o, oss/e, osse/o and oss/i are the roots for bone. When bone cells are mature they are referred to as osteocytes. Because of osteoclasts (cells that break down and reabsorb bone) the life span of an osteocyte is limited. The cells that create the new bone cells to replace those that are destroyed are referred to as osteoblasts (immature bone). This process of making new bone is referred to as ossification or osteogenesis. This continuous turnover of bone ensures that the bones of the body remain strong. Revised September 2001 -53- Tissues of Bone Bone is made up of four different tissues: Periosteum: Tough fibrous tissue that covers the outside of the bone. Compact Bone: Hard dense strong bone that forms the outer most layer of the bones Spongy Bone: Lighter, less dense tissue that is found in the inner portion of the long bones. Red bone marrow is located in the spongy layer. Medullary Cavity: Located in the shaft of long bones and contains the yellow bone marrow. Internal and External Bone Parts Red marrow Proximal Epiphysis Spongy Bone Medullary cavity Compact Bone Diaphysis Yellow marrow Periosteum Distal Epiphysis Anatomic Landmarks of Bone Epiphysis: Diaphysis: Revised September 2001 The end points of the bone Shaft of the bone -54- Fractures The most common problem that arises with bone is a break or fracture. There are a number of different types of fractures the most common of which are simple (closed) and compound (open). A simple fracture is one where the bone is broken but there is not an open wound through the skin. The compound fracture is one in which the bone is broken and there is an open wound through the skin. Axial and Appendicular Skeleton The skeleton is made up of 206 different bones. To make discussion of the skeleton simpler it is divided into the axial and the appendicular skeletons. The axial skeleton relates to the bones of the head and trunk (skull, spinal column, ribs and sternum). The axial skeleton is made up of 80 bones. The appendicular skeleton consists of the other 126 bones or those of the upper extremities and shoulder plus the lower extremities and pelvis. Joints Joints are the connections that exist between bones. The root for joint is arthr/o, articul/o. Suture: Jagged line where bones join and form a joint that does not move. E.g. skull Two bones are joined by cartilage and they function together as one bone. This is called a cartilaginous joint. Synovial: Joints that are movable; e.g. knee, elbow, hips Other structures which impact on the functioning of the skeletal system are: Ligament: Bursa: Band of tissue that connects one bone to another. (Ligament/o) Fibrous sac that acts as a cushion for easy movement. (Burs/o) Muscles You have more than 600 muscles in your body. If you were to grip your upper arm with your left hand and move the right hand up and down and rotate it you will feel a series of contractions in the tissue. This is the muscles’ of the arm responding to the command you have given for it to move. While you did this you probably didn’t notice that your heart continued to beat. This beating also involved a muscle contracting but you didn’t have to tell it to beat as you did with your arm. This indicates that they are different types of muscles. In fact you have three types of muscles in your body. Revised September 2001 -55- Types of Muscle Tissue Smooth Muscle: Smooth muscle fibers move the internal organs, such as the blood vessels, ducts from the glands. These muscles have a relatively slow rate of contracting. They are also involuntary in that they are under the control of your brain and you cannot control them. Cardiac Muscle: Similar to smooth muscle and makes up the wall of the heart. It is involuntary in function. Skeletal Muscle: Muscles that attach to bones of the skeleton and make movement possible. We can control the function of these so they are voluntary. Characteristics of Muscle The study of the activity of muscle is referred to as kinesiology (kih-nee-see-ol-oh-jee). The root for movement is kinesi/o and the suffix is -kinesis. The muscles of the body are arranged in pairs and one muscle of the pair causes movement in one direction and the other produces movement in the opposite direction. When one muscle contracts the other relaxes. When a muscle contracts it tightens up and becomes shorter and thicker. When the muscle relaxes it returns to its original form or shape. It is because of this relaxing and contracting that we are able to move about. The term range of motion refers to the movements that are possible by a muscle. One aspect of diagnosing problems of the muscule is to test the range of motion of the system. A variety of muscle movements can be assessed including: Abduction: Movement away from the midline of the body (ab-). Adduction: Movement toward the midline of the body (ad-). Flexion: Decreasing the angle between two bones, or bending a joint flex-). Eg. bending the arm at the elbow Extension: Increasing the angle between two bones, or to straighten out a limb (ex-). Eg. straightening the arm out at the elbow Rotation: To move in a circular motion. Pronation: Rotating a body part so it is facing down. Supination: Rotating a body part so it is facing up. Many muscles have what seem to be very complex names. The naming of a muscle is generally based on one of the following: how they act (flexor carpi radialis muscle) where they are located (rectus abdominus) the direction their fibers run (external abdominal oblique) the number of times they divide (quadriceps femoris) their size (gluteus maximus) their shape (deltoid muscle) Revised September 2001 -56- Pathology of Muscular Diseases and Common Diagnostic Procedures Health problems that affect the way muscles work in our body include: Degeneration of the muscle e.g. Multiple Sclerosis, Parkinson’s Disease Paralysis of muscle e.g. paraplegic Problems with muscle tone, e.g. weakness, loss of tone, increased tone Problems with muscle activity, e.g. impaired movements like tics, spasms; slow movements, rapid movements. The most common procedures done to diagnose problems with the muscles involve graphic records of how a specific muscle is reacting to some form of stimulus. Word Parts for the Musculoskeletal System Roots ankyl/o articul/o; arthr/o burs/o carp/o cervic/o chondr/o clavicul/o coccyg/o cost/o crani/o duct/o electr/o fasci/o femor/o fibr/o, fibros/o fibul/o flex/o humer/o ili/o ischi/o kinesi/o lumb/o mandibul/o maxill/o medull/o metacarp/o metatars/o muscul/o, my/o, myos/o myel/o occipit/o osse/o; oste/o; oss/e; oss/i Revised September 2001 fusion of parts joint bursa wrist bone neck cartilage clavicle; collarbone coccyx; tailbone rib skull draw away electric, electricity fascia femur, thigh bone fibers fibula flexion, bend humerus; upper arm hip ischium (posterior part of hip) movement lower back mandible, lower jaw maxilla, upper jaw marrow, inner portion of an organ metacarpals (bones of the hand) metatarsals (bones of the foot) muscle bone marrow, spinal cord occiput (back part of the head) bone -57- pariet/o patell/a; patell/o pelv/i; pelv/o phalang/o radi/o radicul/o sacr/o scapul/o spondyl/o; vertebr/o stern/o synov/i/o tempor/o tendin/o, ten/o, tend/o tens/o thorac/o tibi/o ton/o uln/o parietal bone of the head patella; kneecap pelvis phalanges; bone of the finger or toes radius; bone of the lower arm nerve root sacrum scapula vertebra sternum; breastbone synovium; synovial fluid that lubricates temporal bone of the head tendon stretch out chest tibia; bone of the lower leg tone ulnar; bone of the lower arm Suffixes -asthenia -centesis -clasis -clast -clonus -desis -kinesis -lysis -malacia -osis -paresis -plegia -porosis -thermy -trophy no strength, weakness surgical puncture to remove fluid surgical fracture or refracture breakdown turmoil surgical fusion or binding movement set free softening abnormal condition partial paralysis paralysis porous open spaces heat nourishment Prefixes abadbibradyexhemiorthoquadrtri- Revised September 2001 away from toward two slow extension, away from half straight four three -58- Term Analysis and Definition Word Part Term articul/o arthr/o articular articul = joint -ar = pertaining to Pertaining to a joint arthralgia arthr = joint -algia = pain Painful joint arthritis -itis = inflammation Inflammation of a joint arthropathy - pathy = disease Disease of a joint arthroplasty -plasty = surgical repair Surgical repair of a joint arthroscopy -scopy = examination using a scope Examination of a joint using a scope. arthrotomy -tomy = surgical incision Surgical incision into a joint. periarthritis peri = around -itis =inflammation Inflammation around a joint. carpal carp/o = wrist -al = pertaining to Pertaining to the wrist carpectomy -ectomy = surgical removal Surgical removal of a bone of the wrist. cervic/o cervical cervic = neck -al = pertaining to Pertaining to the neck chondr/o chondrocyte chondr = cartilage -cyte = cell Cartilage cells chondroma -oma = tumor Tumor of the cartilage chondrosarcoma -sarcoma = malignant tumor Malignant tumor of cartilage clavicular clavicul = collarbone, clavicle -ar = pertaining to Pertaining to the collarbone carp/o clavicul/o Revised September 2001 Term Analysis -59- Definition Word Part Term Term Analysis Definition coccyg/o coccygeal coccyg = coccyx, tail bone -al = pertaining to Pertaining to the tailbone cost/o costal cost = rib -al = pertaining to Pertaining to the ribs Pertaining to the ribs and vertebrae costovertebral -vertebr = vertebrae craniotomy crani = skull -tomy = surgical incision Surgical incision into the skull cranioplasty -plasty = surgical repair Surgical repair of the skull craniofacial -faci = face -al = pertaining to Pertaining to the skull and face fascial fasci = fascia (band of tissue around muscle) -al = pertaining to Pertaining to fascia fasciectomy -ectomy = surgical excision Excision of fascia fascitis -itis =inflammation Inflammation of fascia femor/o femoral femor = femur, thigh bone -al = pertaining to Pertaining to the thigh bone fibul/o fibular fibul = fibula -ar = pertaining to Pertaining to the fibula fibr/o fibros/o fibrous fibr/o = fiber -ous = pertaining to Pertaining to fibrous tissue. humer/o humeral humer = humerous, upper arm -al = pertaining to Pertaining to the upper arm ili/o iliac ili = hip -ac = pertaining to Pertaining to the hip iliosacral sacr = sacrum -al = pertaining to Pertaining to the hip and sacrum crani/o fasci/o Revised September 2001 -60- Word Part Term ischi/o ischial ischi = ischium -al = pertaining to Pertaining to the ischium ischiorectal rect = rectum Pertaining to the ischium and the rectum kinesi/o kinesiology kinesi = movement -logy = study of Study of movment lumb/o lumbodynia lumbo = lower back -dynia = pain Pain in the lower back lumbosacral -sacr = sacrum -al = pertaining to Pertaining to the lower back and sacrum mandibul/o mandibular mandibul = mandible, lower jaw -ar = pertaining to Pertaining to the lower jaw maxill/o maxillary maxill = maxilla, upper jaw -ary = pertaining to Pertaining to the upper jaw metacarp/o metacarpal metacarp = bones of the hand -al = pertaining to Pertaining to the bones of the hand metatars/o metatarsal Pertaining to the bones of the foot my/o muscul/o myos/o muscular metatars = bones of the foot -al = pertaining to muscul = muscle -ar = pertaining to myalgia my = muscle -algia = pain Pain in a muscle polymyositis poly- = many myos = muscle -itis = imflammation Inflammation of many muscles myopathy -pathy = disease Muscle disease myeloma myel = bone marrow, spinal cord -oma = tumor Tumor of the bone marrow or spinal cord osteomyelitis oste/o = bone -itis = inflammation Inflammation of the bone and bone marrow. myel/o Revised September 2001 Term Analysis -61- Definition Pertaining to muscle Word Part Term oste/o oss/e oss/i osseous osse = bone -ous = pertaining to Pertaining to bone. osteoblast -blast = immature Immature bone cell osteochondritis -itis = inflammation chondr/o = cartilage Inflammation of bone & cartilage osteocyte -cyte = cell Mature bone cell osteogenesis -genesis = formation Bone formation (ossification) osteoma -oma = tumor Tumor of the bone osteosarcoma -sarcoma = malignant tumor Malignant tumor of bone patellar patell = kneecap -ar = pertaining to Pertaining to the kneecap patellopexy -pexy = surgical fixation Surgical fixation of the knee infrapatellar infra = below Pertaining to below the kneecap suprapatellar supra = above Pertaining to above the kneecap pelvic pelv = pelvis -ic = pertaining to Pertaining to the pelvis pelvimeter -meter = instrument used to measure Instrument used to measure the size of the pelvis phalang/o interphalangeal inter- = between phalang = one of the bones of the fingers or toes -eal = pertaining to Pertaining to a bone of the fingers or toes radi/o radiocarpal joint radi- = bones of the lower arm carp = wrist -al = pertaining to Pertaining to the joint between the lower arm and wrist sacr/o sacral sacr = sacrum -al = pertaining to Pertaining to the sacrum patell/a, patell/o pelv/i, pelv/o Revised September 2001 Term Analysis -62- Definition Word Part Term scapul/o subscapular sub- = below scapul = scapula -ar = pertaining to Pertaining to below the scapula spondyl/o spondylitis spondyl = vertebra -itis = inflammation Inflammation of the vertebra spondylopathy -pathy = disease Disease of the vertebra sternal stern = breastbone, stenum -al = pertaining to Pertaining to the breastbone costosternal cost = rib Pertaining to ribs and breastbone synovial synov = synovial membrane/fluid -al = pertaining to Pertaining to the synovial membrane or the fluid that lubricates the joint synovitis -itis = inflammation Inflammation of the synovial membrane tendinitis tendin = tendon -itis =inflammation Inflammation of a tendon tendinous -ous = pertaining to Pertaining to a tendon tenodesis -desis = surgical fixation Surgical fixation of a tendon tenotomy -tomy = surgical incision Surgical incision into a tendon thorac/o thoracic thorac = chest -ic = pertaining to Pertaining to the chest tibi/o tibiofibular Pertaining to the tibia and fibula ton/o atonic tibi = tibia fibul = fibula ar = pertaining to a = without, no ton = tone -ic = pertaining to hyper = excessive Pertaining to excessive tone stern/o synov/i synov/o tendin/o, ten/o tend/o hypertonic Term Analysis uln = ulnar, bone of Revised September 2001 -63- Definition Pertaining to no tone Word Part Term Term Analysis uln/o ulnar the lower arm -ar = pertaining to Pertaining to the bone of the lower arm vertebr/o vertebrofemoral vertebr = vertebra femor = femur -al = pertaining to Pertaining to the vertebrae and femur -centesis arthrocentesis arthro = joint -centesis = surgical puncture Surgical puncture into a joint to remove fluid -clasis osteoclasis oste = bone -clasis = surgical fracture Surgical fracture of a bone -clast osteoclast oste = bone -clast = breakdown Cell which breaks down bone -desis arthrodesis arthr = joint -desis = surgical fusion Surgical fusion of a joint -malacia osteomalacia oste = bone -malacia = softening Softening of the bone chondromalacia chondr = cartilage Softening of cartilage kyphosis kyph = humpback -osis = abnormal condition Abnormal curvature of the spine. osteoporosis oste = bone -porosis = porous -osis ortho- orthopedics Revised September 2001 ortho = straight ped = child -ic = pertaining to -64- Definition Abnormal condition where bone becomes to porous Surgical speciality dealing with correction of deformities of the skeletal system Summary Exercises Chapter 6 Exercise 6.1 Select the option that best answers the question. 1. Which term means inflammation of the tissue around bone? 1. Periostitis 2. Infraostitis 3. Osteomyelitis 2. Which term means disease of the cartilage? 1. Chondropathy 2. Chondritis 3. Chondroplasty 3. Which term means a malignant tumor of the bone? 1. Myeloma 2. Osteoma 3. Osteosarcoma 4. Which term means a loss of bone density and an increase in its porous state? 1. Osteomalacia 2. Sarcoma 3. Osteoporosis 5. Which term means inflammation of bone? 1. Osseous 2. Osteitis 3. Osteoitis 6. What is the medical term for removal of the synovial membrane? 1. Synovectomy 2. Synovotomy 3. Synovitis 7. Which term best describes pain in fibrous tissue throughout the body? 1. Fibromyalgia 2. Carpal tunnel syndrome 3. Myalgia 8. Which term means pain in several muscles? 1. Myositis 2. Polymyalgia 3. Myalgia Revised September 2001 -65- 9. Which term means suturing torn fascia? 1. Fascioplasty 2. Fasciotomy 3. Fasciorrhaphy 10. Which term refers to a muscle that moves a part toward the midline? 1. Abductor 2. Adductor 3. Extension 11. Which of the following terms means abnormal hardening of muscle tissue? 1. Myosclerosis 2. Myomalacia 3. Myonecrosis 12. Which term means delayed relaxation of a muscle after a strong contraction? 1. Myotonia 2. Dystonia 3. Atrophy 13. Which term means to suture a muscle wound? 1. Myorrhaphy 2. Myotomy 3. Myectomy 14. Which of the following terms means to free a tendon from adhesions? 1. Tenotomy 2. Tenodesis 3. Tenolysis 15. Which type of muscles are found in hollow structures and organs? 1. Striated 2. Visceral 3. Voluntary 16. Which term means abnormally increased motor function or activity? 1. Hypokinesia 2. Hyperkinesia 3. Bradykinesia Revised September 2001 -66- Exercise 6.2 Complete the statement with the appropriate word or words. 1. The medical term for a painful joint is _________________________________. 2. Inflammation of the vertebrae is referred to as __________________________. 3. A surgical puncture into a joint to remove fluid is referred to as ______________. 4. An X-Ray examination of a joint after a dye has been injected is referred to as an _______________________________________________________________. 5. The bony structure which protects the brain is the ________________________. 6. ___________________________ is the shaft portion of the bone. 7. Inflammation of a rib is referred to as __________________________________. 8. Softening of bone is referred to as ____________________________________. 9. Surgical removal of part of the skull is referred to as ______________________. 10. An immature bone cell is referred to as a(n) ____________________________. 11. ____________________________________ means inflammation of the fascia. 12. The medical term for suturing a tendon is _________________________. 13. Surgical removal of a tendon is referred to as ___________________________. 14. _________________ means pertaining to the fascia surrounding muscle tissue. 15. Surgical removal of fascia is referred to as _____________________________. 16. The study of muscle activity is termed _________________________________. 17. ______________________________ is a malignant tumor derived from muscle. 18. Muscle pain or tenderness is referred to as _____________________________. 19. The term for abnormal softening of the muscle is ________________________. 20. Medical term for inflammation of several voluntary muscles is ______________. Exercise 6.3 Create the medical term for the following definition. 1. Record of the electrical currents in a muscle ____________________________ 2. Slow movement _________________________________________________ Revised July 2000 -67- 3. Wasting away of muscle ___________________________________________ 4. Muscle pain ____________________________________________________ 5. Inflammation of a muscle __________________________________________ 6. Excessive movement ______________________________________________ 7. Any muscle disease _______________________________________________ 8. Impaired movement _______________________________________________ 9. Enlargement of an organ from the increase in cell size ____________________ 10. Inflammation of many muscles _______________________________________ Revised July 2000 -68-