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V.

Anatomy and Physiology

Bone Bones have three mechanical functions 1. Support of body tissues as provided by the skeletal framework 2. Protection of the body organs 3. Movement, affected by contraction of muscles pulling on bones that provide leverage for motion. Other functions of the bones are as follows: 1. Storage of calcium. 2. Their marrow produces red blood cells ( hematopoiesis) Bones are composed of both living cells and non-living intracellular material. The living cells are the osteoblast, osteoclasts, and osteocytes. The non-living intracellular material ( bone matrix) consist of mucopolysaccharides and collagen. There are four types of bones, according to their shape: 1. Long ( femur, humerus) 2. Short ( carpals, tarsals) 3. Flat ( skull) 4. Irregular ( vertebrae) Each is composed of spongy ( cancellous) and dense ( compact) bone. The bone is made up of Haversian units. The Haversian units is composed of the following structures; 1. Lamellae- these are concentric cylindric layers of calcified matrix. 2. Haversian canal- it is located at the center of concentric rings. It contains capillaries. 3. Lacunae- these are small spaces between the rings of the lamellae. These are occupied by bone cells (osteocytes) 4. Canaliculi-these are very small canals that connect the lacunae with Haversian canal. These are through which the bone receives its nutrients. A long bone is composed or epiphysis (ends of the bone) and diaphysis (shaft)

The periosteum is a white fibrous membrane that covers the bone, excepts on its articular surfaces. The articular surfaces of the bone are covered by hyaline cartilage. The periosteum provides attachment for muscle fibers. The endosteum line the marrow filled medullary cavity and the Haversian canals. Blood is supplied to the bone three routes: 1. The arterioles in the Haversian canals. 2. Vessels in the periosteum that penetrate the bone through Volkmanns canals. 3. Vessels in the marrow and the ends of the bone. Bone is healing through callus formation. New growth of bone is callus. The five stages of callus formation are as follows: 1. Hematoma Formation- Bone is highly vascular so, bleeding occurs at both ends of the fractured bone. Increased capillary permeability permits further extravasations of blood into injured area. Blood collects in the periosteal sheath or adjacent tissues and fastens the broken ends together. 2. Fibrin Meshwork Formation- Fibroblasts invade the hematoma causing it to become organized into fibrin meshwork. WBCs wall off the area, localizing the inflammation. 3. Invasion by Osteoblasts- As osteoblasts invade the fibrous union to make it firm, blood vessels develop from capillary buds, thereby establishing a longer and begin to incorporate calcium deposits. 4. Callus Formation- Osteoblasts continue to lay the network of bone build up as osteoclasts destroys dead bone and help synthesize new bone. Collagen strengthens and becomes further impregnated with calcium. 5. Remodelling- Excess callus is reabsorbed and trabecullar bone is laid down along lines of stress. Factors impending good callus formation are: 1. Inadequate reduction of fracture 2. Excessive edema at the fracture site impending the supply of nutrients to the area. 3. Too much bone lost at the time of injury to permit sufficient bridging of the broken ends. 4. Inefficient immobilization 5. Infection of the site of injury 6. Bone necrosis 7. Anemia or other systemic conditions 8. Endocrine imbalances 9. Poor dietary intake

Muscle Muscle are divided into the following major groups: 1. Skeletal ( Stiriated, Voluntary) 2. Visceral ( Smooth, Involuntary) 3. Cardiac The different types of muscle contractions are as follows: 1. Tonic- a continual partial contraction that is vital in maintenance of posture. 2. Isotonic- a contraction in which tension and length of the muscle change. 3. Isometric- tension within the muscle increases but the muscle does not shorten. 4. Twitch- a jerky reaction to a single stimulus. 5. Tetanic- a more sustained contraction, produced by a series of stimuli in rapid succession. 6. Fibrillation- asynchronous contraction of individual fibers. 7. Convulsive- abnormal uncoordinated tetanic contractions occurring in varying groups of muscle. Efficient and adequate muscle contractions is dependent on several factors: adequate blood supply to and from the muscle fibers, effective innervations. The cerebellum is primarily responsible for control of muscle movement. Somatic motor neurons are the nerve cells that transmit impulses to skeletal muscles. A motor unit is the neuron and the muscle cell it activates. Acetylcholine, a chemical contained in small vesicles in the axon terminal promotes actual muscle contraction. Muscle contraction occurs when acetylcholine contacts the sarcolemma at the motor end plate or neuromuscular junction. Other structures of the musculoskeletal system are as follows: 1. Cartilage- these are fibers embedded in a firm gel. These reduce friction in the joint. 2. Ligaments- these are bands of dense fibrous connective tissue that are flexible and tough. These attach bone to bone. 3. Tendons- these are bands of dense fibrous tissues that attach muscle to bone.

4. Fascia- this is a sheet of loose connective tissue that may be found directly under skin ( superfiscial fascia) or a sheet of dense, fibrous connective tissue making up sheath of muscles, nerves and blood vessels (deep fascia) 5. Bursae- these are small sacs of connective tissue located wherever pressure is exerted over moving parts. These are located between skin and bone, between tendons and bone, or between muscles. Bursae are lined with synovial membrane and contain synovial fluid. They serve as cushions between moving parts.

Joints The joints provide flexibility within skeletal framework. The major classifications of joints are: 1. Synarthroses (fibrous joints)- Allow no movement ( e.g. sutures of the skull) 2. Amphiarthroses ( cartilaginous joints)- Allow little movemt ( e.g. intervertebral joints) 3. Diarthroses ( synovial joints)- Allow free movement (e.g. hip, knee, shoulder, elbow) The synovial membrane produces synovial fluid that lubricates the joint The diarthrodial joints permit one or more of the following movements: flexion, extension, adduction, abduction, rotation, circumduction, supination, pronation, inversion, eversion, protraction or retraction. Small pieces of dense cartilage are interpaced between the articulating surfaces called menisci (e.g. medial meniscus and lateral meniscus of the knee joint)