MUSCULOSKELETAL SYSTEM

EMERITA C. MENDOZA, R.N., M.D.

FUNCTIONS OF THE SKELETAL SYSTEM
1. Bony framework for the body 2. Protects delicate vital organs 3. Levers that transmit muscular forces
 tendons  ligaments

4. Bone marrow produces blood cells 5. Storage for calcium and phosphorus

Structure of a Bone
• • • • periosteum Diaphysis Epiphysis Metaphysis  mature to epiphyseal lines • Marrow cavity with yellow bone marrow • endosteum

PARTS OF A BONE

Types of Bone
• According to location: • Axial – found along our midline axis • Appendicular – found in our extremities • According to shape: • flat & irregular bones – many axial bones • long and short bones – in our limbs • pneumatic bones – have air spaces, e.g., skull • sesamoid – in tendons, e.g., patella

Types of Bone
• According to structure: • Compact or dense bone – outer casing • Spongy or cancellous bone – interior marrow • According to development: • Endochondral – during fetal development, ossifies from a cartilage stage, e.g., long bones • Membranous – develop from non-cartilage connective tissue, e.g., flat, irregular bones

Bone Ossification
OSTEOBLASTS • bone-building cells • Secrete the protein collagen • Apatite – CaPO4 that crystallizes around collagen fibers, forming hard bone matrix • Osteoblasts become isolated/trapped in the lacunae  osteocytes

Bone Resorption
OSTEOCLASTS • Cells that break down or collapse bone • Large cells that move about secreting enzymes that digest bone *Osteoclasts & osteoblasts work together to shape bones and to form the precise grain needed in the finished bone

How many bones are in our skeleton?
• Axial: • • • • • • • skull cranium 22 & face auditory oss 6 hyoid 1 vertebrae 26 Ribs 24 sternum 1 • Appendicular: • • upper limb girdle 64 lower limb girdle 62

• Axial = • Appendicular = • Total =

80 126

206

The Skull
• 8 cranial bones • 14 facial bones • 6 small bones in the middle ear

The Cranium
• protects the brain • 4 major divisions: • frontal bone - anterior
• • • • • • • parietals – central temporals - lateral occipital – posterior Plus the: sphenoid - base ethmoid – roof of nostrils frontal bone also known as the “forehead bone”

The Facial bones
• • • • • • • • • 2 nasal bones 2 inferior nasal conchae 1 vomer – floor of nasal cavity 2 palatine – roof of oral cavity 2 zygomatic “cheekbones” 2 maxillae for upper jaw 1 mandible for lower jaw 2 lacrimal, where tears flow

Mandible articulates with the cranium at the temporomandibula joint (TMJ)

The Auditory Ossicles
• • • sense vibration 3 inner ear bones: malleus or hammer – articulates with eardrum incus or anvil – articulates with malleus & stapes stapes or stirrup – articulates with oval window

Cranial Sutures
• Sagittal – joint bet the two parietal bones • Coronal – joins the parietal bones to the frontal bone • Lambdoidal – joint bet the parietal bones and the occipital bone

Fontanelles or soft spots
• Fibrous connective tissue or cartilage that occur at the angles of the parietal bone • Anterior – closes at 1218 months • Posterior – closes at 34 months

Sinuses
• Air spaces lined w/ mucous membrane found in some cranial bones • The paranasal sinuses (located in the frontal, maxillary, sphenoid, & ethmoid bones) are continuous w/ the nose and throat

The Vertebral Column or Spine
• • Supports the body & bears its weight Regions: – 7 cervical – 12 thoracic – 5 lumbar – Sacrum – Coccygeal S-shaped Vertebrae are attached to each other via synovial joints & by intervertebral discs

• •

The Normal Spine
• • • • Has normal curves: lordosis – cervical, lumbar concaving kyphosis – thoracic convexity intervertebral discs – maintain flexibility, absorb shock; outer annulus fibrosis, inner gelatinous nucleus pulposus With age, loss of H2O content causes decrease in disc height

The Thoracic Cage or rib cage
• Bony cage formed by the sternum, the thoracic vertebrae, & 12 pairs of ribs • Protects the organs of the chest • Supports the pectoral girdle & upper extremities • Role in respiration

The Ribs
Articulates with the thoracic vertebrae at facets • Since there are 12 thoracic vertebrae, how many ribs should we have? • 12 pairs or a total of 24 • Spaces in between the ribs are called intercostal spaces (ICS) •

True, False, & Floating Ribs
• Ribs 1-7 are “true” ribs, because they attach directly to the sternum • Ribs 8-10 are “false” ribs, because they attach to the rib above • Ribs 11-12 are “floating” ribs, because they have no anterior attachments

The Pectoral Girdle or shoulder
• Attaches the UE to the axial skeleton • Consists of:
– Scapula – shoulder blade – Clavicle – collar bone

• Articulates with the sternum via the clavicle but not with the vertebral column

The “Shoulder Blade”: Scapula
• Major parts of the shoulder blade: • spine of scapula, or acromion, with coronoid • coracoid process • glenoid fossa • clavicular facet
• The scapula serves as origin for many muscles, articulates with the clavicle, and offers the fossa for humeral articulation (the shoulder joint).

The “Collar bone”: Clavicle
• • small, thin, long & flat bone articulates with the sternum at the angle of Louis; and with the shoulder blade by a facet that accepts the shoulder blade, and by strong ligaments to the shoulder blade If fractured, the shoulder falls medially, forward, and slightly downward commonly known as a “greenstick” fx in children

• •

The Upper Extremity
• Consists of 30 bones:
– – – – – – Humerus – upper arm Ulna - forearm Radius - forearm Carpal bones - wrist Metacarpals - palm Phalanges - fingers

Upper Arm: The Humerus
• articulates with the pectoral girdle at the glenoid fossa of the shoulder joint • typical long bone • articulates with the radius & ulna at the humeral capitulum & olecranon fossa-trochlea of the elbow joint, respectively • has radial and ulnar grooves – for nerves • Commonly fractured, described in 1/3’s

Forearm: Radius & Ulna
• • The smaller radius articulates with the humerus with its head The larger, wrench-shaped ulna, articulates with the humerus at the ulnar olecranon Both articulate with carpals of the hand as the carpal or wrist joint via facets and styloid processes Radial = thumb side Ulnar = pinky side

• •

Hand bones, Palm: Carpals
• 8 short bones in 2 rows • Proximal: (r-u) scaphoid, lunate, triquetrium, pisiform • Distal: (r-u) trapezium, trapezoid, capitate, hamate • “Scared Lovers Try Positions That They Can’t Handle” • If you fall and land on your hand, which bone is most likely to break? • Colle’s fx = dinner fork deformity of the wrist due to fx of the radius

More Hand bones:
• • • • • There are 5 pairs of metacarpals, or “knuckles bones” Each finger, or digit, has 3 phalanges The thumb has 2 phalanges metacarpo-phalangeal joints are MCP’s joints between 1st & 2nd phalanges are PIP’s joints between 2nd & 3rd phalanges are DIP’s

metacarpals and phalanges

The Pelvic Girdle
• Supports the LE & is the site of attachment of major muscles of the trunk and LE • Supports the weight of the upper body & protects the organs that lie within • Two innominate bones + sacrum & coccyx = pelvic girdle

Parts of the “Hip bone”

• • • • • • • • • •

Looks like two fish eating a butterfly ASIS = anterior superior iliac spine, important landmark PSIS – lies deep to a dimple ischial tuberosity – part we sit on symphysis pubis – fibroelastic connection between two pubic bones acetabulum – depression for the head of the femur greater sciatic notch – opening for sciatic nerve lesser sciatic notch obturator foramen – for obturator nerve linea terminalis, or pelvic brim – separates “false pelvis” above from “true pelvis” below

Female pelvis
• Broader and more shallow • Pelvic inlet is larger & more circular • Ischial spines are shorter with greater relative distance bet them • Greater angle bet the pubic bones • Adapted for a developing baby & its delivery

The Lower Extremity
• Consists of 30 bones:
– Femur – upper leg or thigh – Patella – or kneecap – Tibia & fibula – lower leg or shin – Tarsal bones – back part of foot & heel – Metatarsals – main part of the foot – Phalanges - toes

The “thigh bone”: Femur
• • • longest bone of the body acetabular head articulates with the pelvic acetabulum neck – commonly fractured, esp. in postmenopausal women with osteoporosis (excessive bone resorption) greater trochanter – for attachments, e.g., gluteus m lesser trochanter – for the iliopsoas m. shaft epicondyles – for attachment of medial & lateral collateral ligaments of the knee joint to the leg bones, and articulation with the tibia trochlea – facet for patella

• • • •

The “knee cap”: Patella
• • • sesamoid bone articulates with the femoral trochlea above and the tibial head below surrounded by ligaments,e.g., anterior & posterior cruciates, medial (tibial) & lateral (fibular) collaterals prepatellar bursa is associated with gouty arthritis when excess uric acid is produced, causing arthritic pain

The leg bones: Tibia & Fibula
• • • • • • • • leg also known as crus, anterior leg as shin articulates with the femur via the larger, medial tibia the smaller, lateral fibula is mostly for attachment of mm tibia-fibula joined together by an interosseous membrane medial (tibial) malleolus = inner ankle, area prone to sprain lateral (fibular) malleolus = outer ankle, prone to fracture lower quadrangular surface of tibia bears much weight on the foot

The Ankle Bones
tibia fibula talus

The Foot bones, Sole: Tarsals
• the tall talus receives the weight from the tibia • rests on a “calcified rock,” the calcaneus • mid-sole are the navicular, cuboid, and three cuneiforms • cuboid and cuneiforms articulate with the metatarsals

The Toes: Metatarsals & Phalanges
• • • • • • cuboid articulates with metatarsals 4-5 cuneiforms articulate with metatarsals 1-3 the four smaller toes have 3 phalanges the big toe, like the thumb, has two the second metatarsal is prone to march fx hallux valgus - The 1st MTP joint may be affected by pointed shoes The 1st MTP is also commonly inflamed in gouty arthritis

Joints (Articulations)
• • Point of contact bet two bones For flexibility and movement

Synovial Joints
• Most of body’s joints • Joint capsule lined w/ a smooth synovial membrane that secretes a lubricating synovial fluid • Fluid-filled sacs called bursae cushion the movement of bone over other tissues

Types of Movable Joints
• • Enarthrosis – ball-and-socket of shoulder, hip Ginglymus – hinge of elbow, digits, ankle, mandible Condyloid – knee, MCP, wrist Trochoid – pivot of atlas, radioulnar Arthrodial – sliding of acromioclavicular jt, CMC, knee, ribs, sternoclavicular, subtalar, tibiofibular Saddle - vertebra

• • •

MUSCULAR SYSTEM
• ORIGIN:
– The attachment of muscle to the less movable bone

• INSERTION
– The attachment of the muscle to the more movable bone

Flexion

Decreasing the angle between two bones; bending a limb Extension Increasing the angle between two bones; straightening out a limb Abduction Movement away from the midline of the body Adduction Movement toward the midline of the body Rotation Circular movement around an axis Dorsiflexion Backward (upward) bending of the foot Plantar flexion Bending the sole of the foot downward toward the ground; toe pointing Supination As applied to the hand, the act of turning the palm forward, or up Pronation As applied to the hand, the act of turning the palm backward, or down

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