Introduction to myology

Introduction to angiology
Prof. Dr. Mihly, Andrs

09 Sep 2014

MUSCLE FASCICLE FIBER

(EPIMYSIUM, PERIMYSIUM, ENDOMYSIUM)

MORPHOLOGICAL VARIETIES OF SKELETAL MUSCLE

(MUSCLES AS ORGANS)

Skeletal muscle: 5
electron microscopy

Muscles work in lever

systems: as the insertion and
the action of the load are
separated by the fulcrum
they work in a first-class
lever. In cases of
second-class- and third-class
levers, the action of the
muscle may be different,
according to the relation
and distance of the muscle
force, the load and the
fulcrum.
(A: m. triceps brachii;
B: m. triceps surae;
C: m. biceps brachii)

GREATER FORCE

GREATER SPEED

Brachialis muscle: anatomical

structure and function (third-class lever)
ATTACHMENT
OF THE BELLY

Upon contraction
of the muscle,
the humerus and
the ulna move closer
(flexion)

VENTER (BELLY)

TENDON INSERTION

THE FINE STRUCTURE OF THE MYOTENDINOUS JUNCTION

End-piece of myofiber/myofibrils

Tendon collagen

Reticular fibers connecting

collagen bundles and BL

Basal lamina (BL)

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Effector nerve ending (motor endplate =

nerve-muscle synapse or junction)
in skeletal muscle (mnj: motor endplate;
arrows: motor nerve fibers).
Every muscle fiber has motor endplate.
The chemical transmitter of the
motor endplate is acetylcholine.
Muscle cell membrane has nicotinic
acetylcholine receptors. The surplus
acetylcholine will be degraded
by the enzyme acetylcholinesterase.
Acetylcholinesterase was
stained in this motor endplate

Sensory nerve endings

in muscle: muscle spindle (A)
tendon organ (B)
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THE MUSCLE FIBER IS A SYNCYTIUM

The syncytium is made by the fusion of small
cells: the myoblasts. The myoblast is the
undifferentiated cell in the embryo.
Fusion of the myoblasts results in myotube
formation. Differentiation of the myotube will
result in the appearance of myofibrils.
Finally, nerves grow to the myotube and
provide innervation, and the formation
of motor endplates (neuromuscular junctions),
which release acetylcholine, which further
stimulates the maturation of the muscle.
In adult, muscles have satellite cells (small,
undifferentiated cells between the muscle fibers).
Satellite cells stand for regeneration and
healing of the injured muscle.
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Tendon sheaths of the long flexor muscles of the fingers. The sheaths
protect the tendons running in the wrist region. Some sheaths are
continuous from the wrist to the tip of the finger (I. and V.). Others
will be interrupted in the hand and commence again on the fingers
(II., III., IV.).
Vagina communis tendinum
musculorum flexorum (common
sheath of the finger flexors)

Vagina tendinis musculi

flexoris pollicis longi (sheath
containing a single tendon)

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Fascicles in the bipennate muscle (dorsal interosseus muscles)

The fascicles insert to a thin

tendon in the middle

Thin tendon in the middle

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Tendons, which are flat, not rope-like: tendinous intersections

(musculus rectus abdominis). Flat, broad tendon = aponeurosis of
the external oblique muscle of the abdominal wall.

Tendinous intersections
Typical aponeurosis

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Muscles are separated by fasciae

Superficial fascia: under the skin
everywhere (except the face). Their name
is fascia superficialis.
Deep fascia: covering and separating
muscle groups (e.g.: fascia brachii, fascia
lata).
Subserous fascia: related to body
cavities inside (e.g.: endothoracic fascia).
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Muscles of the trunk moving

the arm and the shoulder

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Movements in the pectoral girdle

and the shoulder
The clavicle articulates to the sternum
(sternoclavicular joint) and to the shoulder
blade (acromioclavicular joint).
The scapula is fixed to the thorax by muscles
which also mediate movements.
The arm joins to the girdle at the
glenohumeral joint.
Stability and movements of the pectoral
girdle is achieved by the muscles which
connect to the vertebral column, thorax,
head and neck.
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Muscles connecting the upper limb with

the trunk
Trapezius: from midline ligaments and bony
structures (from the occipital bone, down to thoracic
vertebra #12) to clavicle, acromion and scapular
spine. Motor innervation: accessory nerve.
Rhomboid minor & major: from vertebral spines (C7T5) to medial border of scapula. Innervation: dorsal
scapular nerve.
Levator scapulae: from the transverse processes of
C1-4 to superior angle of scapula. Innervation:
dorsal scapular nerve.
Latissimus dorsi: from vertebral column (T7sacrum), iliac crest, lower ribs to the floor of the
intertubercular sulcus. Innervation: thoracodorsal n.
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Muscles connecting the UL to the trunk

Pectoralis major: from the clavicle, sternum, rib
cartilages to crista tuberculi majoris. Innervation:
medial and lateral pectoral nerves.
Pectoralis minor: from ribs #3-5 to coracoid process.
Innervation: medial and lateral pectoral nerves.
Subclavius: between the clavicle and the first rib.
Innervation: nerve to the subclavius.
Serratus anterior: from the outer surfaces and upper
borders of the upper 8 ribs to the medial border of
the scapula (runs beneath the scapula). Innervation:
long thoracic nerve.
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MOVEMENTS IN THE SHOULDER GIRDLE

Retraction: medial border of the scapula
approaches the vertebral column (bracing
the shoulder).
Protraction: movement of the scapula on the
chest wall forwards (rounding the shoulder).
Elevation: shrugging the shoulder.
Depression: pectoral girdle pulled
downwards.
Lateral rotation: the inferior angle of the
scapula moves laterally, the glenoid fossa
turned increasingly upwards.
Medial rotation: return from the previous
movement.
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Scapula and clavicle move together, helping

upper limb movements

Retraction: rhomboidei, trapezius.

Protraction: serratus anterior, pectoralis minor.
Elevation: trapezius upper part, levator scapulae.
Depression: trapezius lower part.
Lat. rotation: trapezius upper, serratus anterior.
Medial rotation: rhomboids, levator scapulae,
pectoralis minor.
Participation of the m. subclavius: stabilization of
the clavicle.
Rotation of the clavicle: during the extreme flexion
or extension of the arm (pectoralis major, latissimus
dorsi).

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Abduction and elevation of the arm with the

concomitant movements (rotation) of the
scapula on antero-posterior X-ray pictures.

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Trapezius muscle

Deltopectoral
triangle

Deltoid muscle

Pectoralis
major

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Pectoralis major
cut, pectoralis minor
revealed.

Pectoralis minor

Serratus anterior
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M. levator scapulae
Supraspinatus
Rhomboid minor

Rhomboid major
Infraspinatus
Teres major

Serratus anterior
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Deltopectoral triangle

M. trapezius

M. deltoideus

M.pectoralis major

M. serratus anterior

Anterior and lateral trunk muscles

participating in
shoulder and upper arm movements
(from the Collection of the Anatomy
Department, Szeged).

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Shoulder:
strong elevation
and depression,
with some
protraction at the
end of movement
(trapezius, levator
scapulae,
rhomboids).

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Shoulder:
strong elevation
and depression
(trapezius).

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Shoulder: strong
retraction.
Arm: slight
adduction and
lateral
rotation, extension.
Trapezius, rhomboids,
deltoid, infraspinatus,
teres minor

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Arm:
Extension, flexion,
medial rotation
(pectoralis major),
adduction
(latissimus dorsi).
Shoulder:
protraction
(serratus anterior).

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Arm:
abduction.
Shoulder:
elevation.
Muscles:
trapezius,
deltoideus
supraspinatus.

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Arm:
adduction
(latissimus dorsi,
teres major).
Shoulder:
depression
(rhomboidei,
trapezius lower
segment).

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ANGIOLOGY
Anatomy and histology of the
cardiovascular system

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The cast of the cavities

of the human heart.
ARCUS AORTAE: beginning of systemic
circulation

TRUNCUS PULMONALIS: beginning

of pulmonary circulation

Blood circulation is
maintained by the
pumping work of
the heart (Harvey, 1628).

Left ventricle
Right ventricle
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VEIN

AR
TE
RY

The blood vascular system consists of arteries,

arterioles, capillaries, venules and veins.

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Blood vessels I.
Conducting vessels: aorta, pulmonary
trunk.
Distributing vessels (subclavian a.,
axillary a., brachial a.)
Resistance vessels: small muscular
arteries and arterioles.
Exchange vessels: capillaries, venules.
Reservoir vessels: veins.
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Blood vessel anastomoses

Arterial anastomoses: arch (arcade) anastomosis
(or end-to-end anastomosis: palmar arch);
convergence anastomosis (vertebral arteries
basilar artery).
Collateral anastomoses: around large joints
(shoulder, elbow).
Venous anastomoses: perforating veins on the
limbs (connecting superficial and deep veins).
Arteriovenous anastomoses: in microcirculation
metarterioles connect arteriole and venule,
circumventing capillaries.
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Arcade-like end-to-end
anastomosis between the
branches of the inferior and
superior mesenteric arteries
(arcus Riolani).

Arteria mesenterica superior

anastomosis

Arteria mesenterica inferior

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Arteries of the forearm and hand: deep palmar arch is visible.

The deep palmar arch is and arch-like anastomosis
between the radial and ulnar arteries.

a. radialis

a. ulnaris
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Blood vessels II.

Circulus arteriosus Willisii

1. Elastic arteries (aorta).

2. Muscular arteries (princeps
pollicis artery).
3. Arterioles: small vessels,
containing endothelium and
1-3 smooth muscle layers
only (diameter: less than
0.3 mm).

Arteria basilaris

Convergence anastomosis between two

vertebral arteries.
Arteria vertebralis
40 mm

Elastic artery (aorta)

The media contains dozens of elastic laminae

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Muscular artery

Nerves in the
adventitia

lumen
Smooth muscle
in the media

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Blood vessels III. Veins

Reservoir vessels: their thin distensible wall
allows them to contain large amount of
blood.
We have superficial and deep veins.
Veins often possess valves inside, which
direct blood flow in one direction (toward the
heart).
Anastomoses between veins: venous
plexuses, perforating veins.
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Blood vessels IV. Portal veins

The abdominal digestive organs possess
portal circulation: the veins collected from
capillaries form a second capillary network in
the liver. Two capillary beds are present, one
in the organs (e.g.: stomach), the other in the
liver.
Portal circulation aims at the transport of
substances which were absorbed in the gut
from the food, into the liver, targeting the
hepatocytes.
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Innervation of blood vessels

We find sensory and effector nerve endings in vessel
wall.
Sensory nerve endings: receptors for pressure and
the composition of blood (baroreceptors,
chemoreceptors). Sensory nerve endings belong to
glossopharyngeal (IX) and vagus (X) nerves.
Effector nerve endings are postganglionic
sympathetic nerve endings which release
norepinephrine as transmitter: cause smooth muscle
contraction in vessel wall vasoconstriction.
Inhibition of norepinephrine action vasodilatation.
Some organs (salivary glands) possess
parasympathetic vasodilator nerve endings which
release vasoactive intestinal polypeptide (VIP).
Blood vessel smooth muscle can be relaxed by
tissue mediators which are relased from other cells:
endothelial cell, mast cell.
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MICROCIRCULATION
The local circulation of the organs contains a complex pattern of
arterioles, metarterioles, capillaries and venules. These microvessels are regulated by nerves, hormones and local tissue
mediators.
Metarterioles branch from arterioles and contain less smooth
muscle. Capillaries branch from metarterioles and, at the origin
of the capillary, a smooth muscle sphincter is present, which
regulates the amount of blood flowing through the capillary.
Capillaries are true exchange vessels. The endothelial cells and
some tissue cells together with the endothelium may exert strict
regulation on the exchange of material (barriers). No muscle
cells are present around capillaries.
From capillaries we enter the postcapillary venules (some
amount of smooth muscle is present in their wall).
The arteriovenous metarteriole-anastomoses may play a
substantial role in the regulation of local blood flow
(e.g.: in the skin).
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Arteriole: scanning EM

Smooth muscle cells

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Arteriole: electron microscopic structure.

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Contracted arteriole under the electron microscope.

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Arterioles (1-4) and capillaries

(asterisk shows metarteriole)

4
3

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Types of capillaries:
1. Continuous capillary
(picture): in lungs,
muscle, brain.
2. Fenestrated capillary:
kidney, endocrine
glands, gut.
3. Sinusoid capillary:
liver, red bone
marrow.
Capillary diameter:
5-8 micrometers
(sinusoid capillaries
are larger).
Endothelial cell + basal
lamina. Pericytes
may attach to capillaries.
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rbc

Capillaries in connective tissue and muscle (rbc: red blood cell)

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Capillaries (A,B) and arteriole (C) with pericytes (P).

Pericytes regulate the regeneration of microvessels (angiogenesis).

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Pinocytosis in the endothelium

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Continuous capillary (A) and fenestrated capillary (B).

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AORTA
Originates from the left ventricle: ascending aorta, aortic arch, descending
aorta. Thoracic aorta, abdominal aorta. Abdominal aorta divides at the level
of L4 into common iliac arteries. The common iliac arteries further divide
into external iliac and internal iliac (hypogastric) arteries.

SUPERIOR VENA CAVA (SVC)

The SVC transports venous blood from head, neck, upper limb and upper
trunk. Internal jugular veins and subclavian veins form the brachiocephalic
vein. Their junction is called the venous angle of Pirogov. The SVC is formed
by the right and left brachiocephalic veins.
INFERIOR VENA CAVA (IVC)
The IVC commences at L4 in the abdominal cavity from the two common
iliac veins. The common iliac veins are formed by the internal iliac veins and
the external iliac veins.
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Aorta ascendens (3), arcus

aortae, aorta descendens (thoracica).
Arcus aortae:
-Truncus brachiocephalicus (5)
-Arteria carotis communis sinistra (12)
-Arteria subclavia sinistra (14)
Truncus brachiocephalicus (5):
-Arteria carotis communis dextra (16)
-Arteria subclavia dextra (18)
Arteria subclavia (14,18):
-Arteria vertebralis (22)
-Arteria thoracica interna (11)
-Truncus costocervicalis (6)
-Arteria thyroidea inferior (9)
Ribs are also visible.

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Subclavian artery
Origin: brachiocephalic trunk (right), aortic
arch (left). Between clavicle and first rib it
becomes the axillary artery.
Three sections from its origin: (1) from origin
to the scalenus anterior muscle; (2) behind
the scalenus anterior muscle; (3) from the
muscle to the edge of the first rib.
Branches supply neck tissues, upper chest
wall and UL.
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Branches of the subclavian artery

Vertebral artery: supplies the brain and
spinal cord
Internal thoracic artery: supply the chest wall
Thyrocervical trunk: (1) inferior thyroid
artery; (2) superfical cervical artery; (3)
suprascapular artery; (4) transverse cervical
artery
Costocervical trunk: (1) deep cervical artery;
(2) superior intercostal artery
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Subclavian branches supplying the

shoulder region
Suprascapular artery: supplies the supraspinatus
and infraspinatus muscles, the clavicle, scapula,
acromioclavicular and glenohumeral joints.
Anastomosing with the branches of the circumflex
scapular artery.
Dorsal scapular artery: runs from the superior angle
(scapula) down along the medial scapular border.
Supplies scapula and muscles on it. Anastomosing
with branches of the subscapular artery. The dorsal
scapular artery can be a separate branch from the
subclavian artery, or it may be the strong branch of
the transverse cervical artery.
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Subclavian vein, axillary vein

Subclavian vein runs together with artery.
Axillary vein is continuation of the basilicbrachial veins (which forms uniting basilic
and brachial veins).
Axillary vein receives the cephalic vein in the
deltopectoral trigone.
Subclavian and internal jugular veins form
the brachiocephalic vein. The angle of the
two veins is called venous angle. Venous
angle is the site of junction of large
lymphatic trunks (thoracic duct and right
lymphatic duct).
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Recommended handout

Mihly, A.: Myology Notes. Free access

for students from the webpage of the
Anatomy Department.

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Picture sources
Anatomy Collection, Department of Anatomy, Szeged.
Histology collection, Department of Anatomy, Szeged.
Standring, S (Chief Editor): Grays Anatomy. 40th
Edition. Churchill-Livingstone, 2008.
Fawcett, DW: A textbook of histology. Saunders,
Philadelphia, 1986.
Delavier, F: Strength Training Anatomy. Human Kinetics,
2006.
Weir, J, Abrahams, PH: Imaging atlas of human
anatomy. Mosby-Wolfe, 1997.
Thiel, W: Photographic atlas of practical anatomy.
Springer, 1997.
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