SKELETAL MUSCLESKHALEEL ALYAHYA, PHD, MED

www.kha lee la lyahya.net

By Elaine Marieb and Suzanne Keller

By Frank NetterBy Richard Drake,

Wayne Vogl & Adam Mitchell

RESOURCES

Khaleel Alyahya, PhD, MEd 3

(فكسون العظام لحما )

INTRODUCTION

▪ Musculoskeletal is a general term which is defined as relatingto muscles and bones of the skeleton.

▪ The musculoskeletal system comprises bones, joints, cartilage,bursae, tendons, muscles and ligaments.

▪ It is the system that moves the body and maintains its form.

▪ Study of this system consists of osteology (the study of bones),arthrology (the study of joints), and myology (the study of muscles).

▪ The musculoskeletal system does not work in isolation.

▪ It is closely linked with many other systems in the body, includingthe nervous system, genitourinary system, circulatory system,immune system, respiratory system, digestive system andendocrine system.

Khaleel Alyahya, PhD, MEd4

MUSCLES

▪ Describe the main criteria of skeletal muscles.

▪ Describe the attachments of skeletal muscles.

▪ Describe the different directions of skeletal muscle fibers.

▪ Describe the mode of action of skeletal muscles.

▪ Describe briefly the naming of skeletal muscles.

▪ Describe briefly the nerve supply of skeletal muscles.

▪ Clinical anatomy

Khaleel Alyahya, PhD, MEd

OBJECTIVES

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MUSCLES TISSUES

▪ Muscle tissue is a unique tissue which has the ability to contract.

▪ As a result of this ability, muscles are responsible for all the bodymovements.

▪ The structural and functional unit of muscle tissue is “muscle cell”.

▪ All muscle cells are elongated and are called “muscle fibers”.

▪ The ability of muscle to contract, or to shorten depends on twotypes of myofilaments (actin & myosin) in the muscle fibers

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CLASSIFICATIONS

Muscles are classified based on the following:

▪ Location

▪ Action

▪ Microscopic structure

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BASED ON LOCATIONS

SKELETAL MUSCLES

ATTACHED TO BONES AND PRODUCE MOVEMENT

SMOOTH MUSCLES

WALLS OF VISCERAL ORGANS

CARDIAC MUSCLES

WALLS OF THE HEART

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BASED ON ACTIONS

VOLUNTARY INVOLUNTARY INVOLUNTARY

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BASED ON MICROSCOPIC STRUCTURES

SKELETAL (STRIATED) CARDIAC (STRIATED) SMOOTH (NONSTRIATED)

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SKELETAL MUSCLE CARDIAC MUSCLE SMOOTH MUSCLE

Voluntary Involuntary Involuntary

Striated Striated Nonstriated

CLASSIFICATION OVERVIEW

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SKELETAL MUSCLES

▪ The ske l et a l mus c les are at t achedt o bones at not le s s t han t wopo i n t s :

o O r i g i n

• A t t a c h e d t o l e s s m o b i l e o ri m m o v a b l e b o n e .

• L e a s t m o v a b l e .

• M o s t l y f l e s h y .

• P r o x i m a l e n d .

o I n se r t i o n

• A t t a c h e d t o t h e m o v a b l e b o n e s .

• M o s t m o v a b l e .

• M o s t l y f i b r o u s .

• D i s t a l e n d .

▪ When t he mus c l e cont r act s , thei n s e r t ion mov es t oward t he or i g in .

▪ A t i ns er t ion , t he musc les a reat t ached by means o f s t rong cord-l i ke t endons or by s heet - l i keaponeuros i s .

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SKELETAL MUSCLES

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MAIN CRITERIA

▪ St r ia ted .

▪ A ttached to ske leton .

▪ Produce mov ement of ske leton .

▪ Voluntary .

▪ Supp l ied by Somat ic Nerv es .

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FUNCTIONS

▪ Body Movement

▪ Maintain Posture

▪ Generate Heat

▪ Stabilizing Joints

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ATTACHMENTS

o O r i g i n

• L e a s t m o v a b l e

• M o s t l y f l e s h y

• P r o x i m a l e n d

o I n se r t i o n

• M o s t m o v a b l e

• M o s t l y f i b r o u s

• D i s t a l e n d

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ATTACHMENTS

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TYPES OF ATTACHMENTS

▪ Ske l et a l musc les a re at tached t obones , car t i lage or l i gaments by :

o T e n d o n s

• A t o u g h c o r d o f f i b r o u sc o n n e c t i v e t i s s u e t h a t u s u a l l yc o n n e c t s m u s c l e t o b o n e a n d i sc a p a b l e o f w i t h s t a n d i n g t e n s i o n .

o A p o n e u r o s i s

• A t h i n b r o a d a n d s t r o n g s h e e t o ff i b r o u s t i s s u e .

o R a p h e

• A n i n t e r d i g i t a t i o n o f t h et e n d i n o u s e n d s o f t h e f l a tm u s c l e s .

• E x a m p l e : m y l o h y o i d r a p h e

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TENDONS

RAPHE

APONEUROSIS

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DIRECTIONS OF MUSCLES

▪ Th e r a n g e o f m o t i o n a n d t h e p o w e r o f am u s c l e d e p e n d s o n t h e a r r a n g e m e n t o fi t s f a s c i c l e s .

▪ Th e f i b e r a r r a n g e m e n t c a n b e :

o P a r a l l e l

• M o r e r a n g e o f m o v e m e n t , l e s s p o w e r f u l .

o P e n n a t e

• M o r e p o w e r f u l , l e s s r a n g e o f m o v e m e n t .

• U n i p e n n a t e

• B i p e n n a t e

• m u l t i p e n n a t e

o T r i a n g u l a r

• H a v e a b r o a d a t t a c h m e n t f r o m w h i c h t h ef a s c i c l e s c o n v e r g e t o a s i n g l e t e n d o n .

o F u s i f o r m

o S p i n d l e - s h a p e d ( r o u n d , t h i c k b e l l y , &

t a p e r e d e n d s ) .

o C i r c u l a r

o S u r r o u n d a b o d y o p e n i n g o r o r i f i c e ,c o n s t r i c t i n g i t w h e n c o n t r a c t e d .

▪ Th e l o n g p a r a l l e l a r r a n g e m e n t g i v em o r e r a n g e o f m o t i o n b u t i s n o t u s u a l l yv e r y p o w e r f u l .

▪ Th e p e n n a t e m u s c l e s s h o r t e n v e r y l i t t l eb u t a r e v e r y p o we r f u l .

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DIRECTIONS OF MUSCLES

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MODE OF ACTIONS

▪ P r ime Mover (Agon i s t )o I t i s t h e c h i e f m u s c l e r e s p o n s i b l e f o r a

p a r t i c u l a r m o v e m e n t .

▪ Antagon i s to I t o p p o s e s t h e a c t i o n o f t h e p r i m e

m o v e r .

o B e f o r e c o n t r a c t i o n o f p r i m e m o v e r ,a n t a g o n i s t m u s t b e r e l a x e d .

▪ Synerg i s to M u s c l e s t h a t a s s i s t t h e p r i m e m o v e r i n a

p a r t i c u l a r m o v e m e n t .

▪ F ixa to ro I t s c o n t r a c t i o n d o e s n o t p r o d u c e

m o v e m e n t b y i t s e l f , b u t i t s t a b i l i z e s t h eo r i g i n o f t h e p r i m e m o v e r s o t h a t i t c a na c t e f f i c i e n t l y .

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MODE OF ACTIONS

PRIME MOVER ANTAGONIST SYNERGI ST F I XATOR

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PRIME MOVER (AGONIST)

▪ I t i s the chief musclerespons ible for a part icularmovement.

▪ Example:

o B i ceps B r ach i i i s th e p r i me mo v e rfo r f l ex i o n o f t h e e l bo w jo i n t an df o r e a r m .

o Q u a d r i ceps F emo r i s i s th e p r i memo v e r fo r ex t e n s i o n o f t h e k ne ej o i n t .

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PRIME MOVER

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ANTAGONIST

▪ I t opposes the action of thepr ime mover .

▪ Before contract ion of pr imemover , antagoni s t must berelaxed.

▪ Example:

o T r i ceps B r ach i i i s th e a n t ago n i s t fo rp r i me mo v er fo r f l e x i o n o f t h ee l bow j o i n t a n d f o r e a r m .

o B i ceps F e m o r i s ( F l e xo r o f k n e e ) .

o I t o ppo s es t he a c t i o n o f qu a d r i cepsw h e n t h e k n e e j o i n t i s e x t e n d e d .

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ANTAGONIST

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SYNERGIST

▪ Muscles that ass i s t the pr imemover in a part icularmovement.

▪ Synergi s ts are sometimescal led neutral i zers becausethey help cancel out , orneutra l i ze, extra motion fromthe agonists to make surethat the force generatedworks wi thin the desi redplane of mot ion.

▪ Example:

o B r ach i a l i s musc l e fo r B i ceps p r i mem o v e r m u s c l e .

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SYNERGIST

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FIXATOR

▪ I t s contract ion does notproduce movement by i tsel fbut i t s tabi l i zes the or igin ofthe pr ime mover so that i tcan act eff ic ient ly .

▪ Example:

o D el to i d mu sc l e fo r B i ceps p r i mem o v e r m u s c l e .

o M usc l es a t ta ch i ng th e s hou l de rgi r d l e to t he t r u nk c o n t r ac t to f i xs ho u l de r g i r d l e , a l l ow i ng d e l to i dm usc l e ( t a k i ng o r i g i n f ro m s ho u l de rg i r d l e ) to mo v e s ho u l de r jo i n t(h u m e r u s ) .

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FIXATOR

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NAMING OF MUSCLES

▪ S i zeo M a j o r o r M a x i m u s ( l a r g e )

▪ Pos i t ion

o P e c t o r a l i s ( p e c t o r a l r e g i o n )

▪ Depth

o S u p e r f i c i a l i s ( s u p e r f i c i a l )

▪ Shape

o D e l t o i d ( t r i a n g u l a r )

▪ Number o f Heads

o B i c e p s ( 2 h e a d s )

o T r i c e p s ( 3 h e a d s )

▪ At tachments

o C o r a c o b r a c h i a l i s

▪ Act ion

o F l e x o r d i g i t o r u m : f l e x i o n o f d i g i t s

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TYPES OF BODY MOVEMENTS

▪ F l e x i o n

o M o v e m e n t t h a t b r i n g s t h e t w o b o n e s c l o s e rt o e a c h o t h e r ( d e c r e a s e s t h e a n g l e o fj o i n t ) .

▪ E x t e n s i o n

o M o v e m e n t t h a t i n c r e a s e s t h e a n g l e , o r t h ed i s t a n c e b e t w e e n t h e t w o b o n e s .

▪ A d d u c t i o n

o M o v e m e n t o f t h e l i m b t o w a r d t h e m i d l i n e

o f t h e b o d y .

▪ A b d u c t i o n

o M o v e m e n t o f t h e l i m b a w a y f r o m t h e

m i d l i n e o f t h e b o d y .

▪ R o t a t i o n

o M o v e m e n t o f a b o n e a r o u n d a v e r t i c a l

a x i s .

▪ C i rc u m d u ct i o n

o C o m b i n a t i o n o f a l l t h e a b o v e m o v e m e n t s .

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TYPES OF BODY MOVEMENTS

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MUSCLE EXERCISE

▪ T h e amo u n t o f w o rk do ne by a m usc l ei s r e f l ec t e d i n c ha nge s i n t h e m usc l ei t s e l f .

▪ M usc l e i nac t i v i ty l e ad s t o m usc l ew e a k n es s a n d w a s t i ng .

▪ R egu l a r e xe r c i se i nc r e ase s m usc l es i z e , s t r e n g t h a n d e n d u r a n c e .

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MUSCLES INNERVATION

▪ T h e som a t i c ne rvo u s sy s t e m ( i s th e

p a r t o f t he p e r i phe r a l n e rv o us

s y s t em ) as so c i a t e d wi th sk e l e ta l

m usc l e v o l un t a r y co n t ro l o f bo dy

m o v e men t s .

▪ T h e n e rv es supp l y i ng t h e sk e l e t a l

m u s c l e s a r e M i xe d .

o 6 0 % a r e M o t o r

o 4 0 % a r e S e n s o r y

▪ I t c o n t a i n s s o m e A u t o no mi c f i b e r s

o S y m p a t h e t i c

▪ T h e n e rv e e nt e r s t h e mu sc l e a t abo u t

th e m i d d l e p o i n t o f i t s d e e p s u r f a c e.

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BLOOD SUPPLY

▪ D u r i ng e x t r em e phy s i ca l e x e r t i on ,

mo r e t h a n 80% o f ca r d i ac o u tp u t ca n

b e d i r e c t e d t o c o n t r a ct i ng m u s c l e s .

▪ T h e v ascu l a r i n f l ow to sk e l et a l m usc l es

i s p ro v i de d by p r i ma ry a r t e r i e s , w h i ch

r e p re s en t t he l a s t b r anch e s o f th e

a r te r i a l supp l y th a t a r i se b efo r e en t r y

i n t o t h e t i s s u e .

▪ T h e p r i ma ry a r t e r i e s a r e app ro p r i a te l y

d i s t r i bu t e d a l o ng th e l o ng a x i s o f th e

m usc l e a n d g i v e r i se t o fe e d a r t e r i e s

t h a t co u r s e to w a r d t he ep i mys i um o f

t h e mu sc l e at r i g h t o r o b l i qu e ang l es

t o th e p r i ma r y a r te r i e s .

Khaleel Alyahya, PhD, MEd38

CLINICAL ANATOMY

Muscular Dystrophy

A genetic disease

that cause a

damage of muscle

fibers.

Muscle Cramps

Can occur suddenly

and involuntarily in one

or more muscles.

Fibromyalgia

People experience

long-term,

widespread pain

and tender points in

joints, muscles,

tendons and other

soft tissues.

Strains

Overstretching or

tearing muscles or

tendons results in

a strain.

Contusions

Often caused by a

direct trauma or

repeated blow to the

muscle. In some cases,

the condition can be

caused by falling on a

hard surface.

MUSCLE DISEASES

▪ M usc l e d i se as e s an d i n j u r i e s a r e co mmo n , e s pec i a l l y i n spo r t s ac t i v i t i e s . A sev ere

m usc l e i n j u ry c a n k eep y o u f ro m p a r t i c i pa t i ng i n th e ac t i v i t i e s t h a t yo u l o v e a n d

e n j o y f o r l i v i ng .

▪ M usc l e d i se a se s a nd i n j u r i e s cou l d be o ne o f th e m a jo r f ac to r s t h a t th r e a t som eon e ’ s

p r o f es s i o na l c a r e e r ( s ) .

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▪ F i b r o m y a l g i a i s a t e r m u s e d t o d e s c r i b e a

c o m m o n s y n d r o m e i n w h i c h p e o p l e

e x p e r i e n c e l o n g - t e r m , w i d e s p r e a d p a i n

a n d t e n d e r p o i n t s i n j o i n t s , m u s c l e s ,

t e n d o n s a n d o t h e r s o f t t i s s u e s .

▪ I t a l s o r e s u l t s i n d i s t u r b e d s l e e p a n d

e x h a u s t i o n .

▪ T h e c a u s e i s u n k n o w n b u t p o s s i b l e

t r i g g e r s i n c l u d e v i r a l i n f e c t i o n , p h y s i c a l

a n d e m o t i o n a l s t r e s s .

▪ I t t e n d s t o b e m o r e c o m m o n i n p e o p l e

w i t h p r e - e x i s t i n g l u p u s , r h e u m a t o i d

a r t h r i t i s , o r a n k y l o s i n g s p o n d y l i t i s .

▪ T h e r e i s n o c u r e b u t s y m p t o m a t i c

t r e a t m e n t c a n h e l p s o m e p a t i e n t s .

FIBROMYALGIA

Khaleel Alyahya, PhD, MEd41

▪ T h e m u s c l e c r a m p i s a s u d d e n a n d i n v o l u n t a r y

c o n t r a c t i o n o f o n e o r m o r e o f y o u r m u s c l e s .

▪ I f y o u ' v e e v e r b e e n a w a k e n e d i n t h e n i g h t o r

s t o p p e d i n y o u r t r a c k s , y o u k n o w t h a t m u s c l e

c r a m p s c a n c a u s e s e v e r e p a i n .

▪ M u s c l e c r a m p s c a n m a k e i t t e m p o r a r i l y i m p o s s i b l e

t o u s e t h e a f f e c t e d m u s c l e .

▪ L o n g p e r i o d s o f e x e r c i s e o r p h y s i c a l l a b o r ,

p a r t i c u l a r l y i n h o t w e a t h e r , c a n l e a d t o m u s c l e

c r a m p s .

▪ S o m e m e d i c a t i o n s a n d c e r t a i n m e d i c a l c o n d i t i o n s

a l s o m a y c a u s e m u s c l e c r a m p s .

▪ O v e r u s e o f a m u s c l e , d e h y d r a t i o n , m u s c l e s t r a i n

o r s i m p l y h o l d i n g a p o s i t i o n f o r a p r o l o n g e d

p e r i o d c a n c a u s e a m u s c l e c r a m p .

▪ Y o u m i g h t b e a t h i g h e r r i s k o f m u s c l e c r a m p s i f

y o u h a v e d i a b e t e s , o r n e r v e , l i v e r o r t h y r o i d

d i s o r d e r s .

MUSCLE CRAMP

Khaleel Alyahya, PhD, MEd42

▪ M u s c u l a r d y s t r o p h y ( M D ) r e f e r s t o a g r o u p o f

h e r e d i t a r y d i s e a s e s t h a t w e a k e n d i ff e r e n t m u s c l e

g r o u p s i n v a r i o u s w a y s .

▪ A p e r s o n a ff e c t e d w i t h M D h a s a g e n e t i c m u t a t i o n

t h a t p r e v e n t s t h e r e p a i r o f m u s c l e t i s s u e .

▪ T h i s m u s c l e w e a k e n i n g o c c u r s g r a d u a l l y o v e r t i m e .

▪ S y m p t o m s m a y s t a r t a t a n y t i m e f r o m i n f a n c y

t h r o u g h t o a d u l t h o o d .

▪ B y a g e 1 0 t o 1 2 y e a r s c h i l d r e n w i l l o f t e n b e i n a

w h e e l c h a i r .

▪ T h i s d i s e a s e a l s o a ff e c t s o t h e r b o d y s y s t e m s s o

p a t i e n t s n e e d r e g u l a r r e s p i r a t o r y a n d c a r d i a c

a s s e s s m e n t .

▪ I t i s l i k e l y t h a t t h e s e p a t i e n t s w i l l e v e n t u a l l y n e e d

a v e n t i l a t o r t o b r e a t h e .

▪ P e o p l e w i t h D M D u s u a l l y d o n o t s u r v i v e b e y o n d

t h e i r l a t e t e e n s o r e a r l y a d u l t h o o d .

MUSCULAR DYSTROPHY

Khaleel Alyahya, PhD, MEd43

▪ A s t r a i n o ccur s w h e n a m usc l e a nd /o r

t e n d o n i s o v e r s t r e t che d o r t o r n .

▪ T h e r e i s no f r ac t u re o r d i s l o ca t i o n

p r e s e n t .

▪ P a i n , w e akn es s an d m usc l e sp asm s a re

c o m m o n symp to ms e xpe r i enc e d a f te r a

s t r a i n o c cur s .

▪ R e s t , app l i ca t i o n o f i ce an d a

co mpr es s i o n b an d age a r e effect i v e

t r e a t m e n t s .

STRAIN

Khaleel Alyahya, PhD, MEd44

▪ O f t en c aus ed b y a di r ec t t r aum a o r

r e p e a t e d b l o w t o t h e m u s c l e .

▪ I n so me c as es , t h e co n di t i o n ca n b e

c a u s e d b y f a l l i ng o n a h a r d s u r f a c e .

▪ C h a r a c t e r i s t i c s i n c l ud e :

• d i s c o l o r e d s k i n t h a t l o o k s r e d , g r e e n ,

p u r p l e , b l u e , o r b l a c k

• a s m a l l b u m p o v e r t h e a r e a i n s o m e

c a s e s

• p a i n t h a t ’ s u s u a l l y w o r s e w h e n p r e s s u r e

i s a p p l i e d t o t h e a r e a .

CONTUSIONS

Khaleel Alyahya, PhD, MEd45

▪ T h e EM G i s a d i ag no s t i c t e s t u se d to

i de n t i f y n e u ro pa t h i c a n d myo path i c

d i s o r d er s .

▪ E l ec t ro d es a re p l ace d o n t h e m usc l e

a n d a r e us ed t o r eco r d mo t o r un i t

a c t i v i t y a t r es t a n d a l so du r i ng m usc l e

c o n t r a ct i on .

ELECTROMYOGRAPHY

Khaleel Alyahya, PhD, MEd46

▪ T h e CT i s a d i agno s t i c t es t p e r fo rm e d

t o i de n t i f y d i so r de r s o f t h e so f t t i s s u es ,

b o n e a n d m u s c l e .

▪ C ro ss - s ect i o na l i mage s a r e t a k en u s i ng

a co mpu t e r i n co n ju nct i on w i t h x - r ay

b e a m s .

COMPUTED TOMOGRAPHY

Khaleel Alyahya, PhD, MEd47

▪ M RI i s a d i agno s t i c t es t t h a t c r e a t es

i mages o f so f t t i s su e us i ng r a d i o w av e s

a n d a m a g n e t i c f i e l d

MAGNETIC RESONANCE IMAGING

Khaleel Alyahya, PhD, MEd48

▪ M i n o r m u s c l e i n j u r i e s m a y b e t r e a t e d

w i t h s i m p l e h o m e r e m e d i e s , s u c h a s

r e s t , a p p l y i n g i c e , u s i n g c o m p r e s s i o n

b a n d a g e , a n d e l e v a t i n g y o u r i n j u r e d

l i m b .

▪ A n t i - i n f l a m m a t o r y m e d i c a t i o n .

▪ P h y s i o t h e r a p y

▪ S e v e r e m u s c l e i n j u r i e s n e e d t o b e

c h e c k e d b y a q u a l i f i e d h e a l t h c a r e

p r o v i d e r .

▪ A t o r n m u s c l e o r t e n d o n m a y n e e d t o

b e s u r g i c a l l y r e p a i r e d .

MUSCLE TREATMENTS

Khaleel Alyahya, PhD, MEd49

Questions?alkhaleel@ksu.edu.sa

CONTACT ME

LINKEDIN

/khaleelya

TWITTER

@khaleelya

EMAIL

alkhaleel@ksu.edu.sa

PHONE

966114670811