MLSLAB releasing a lipid-rich secretion that

maintains hydration and protection against

MODULE 2: COVERING, SUPPORT AND MOVEMENT OF foreign materials.
THE HUMAN BODY ■ Stratum Lucidum
● “clear layer”
● unique only in the thick skin areas subject
UNIT 1
to friction and abrasion- fingertips, palms
(INTEGUMENTARY SYSTEM) and soles of the foot, consisting of four to
6 layers of flattened, clear, dead
STRUCTURE OF THE SKIN keratinocytes.
- The skin and its derivatives (hair, nails, sweat and oil glands) ■ Stratum Corneum (nearest)
constitutes the Integumentary System in the regulation of body ● “horny layer”
temperature through evaporation of sweat and constriction of ● consists of 20-30 layers of continuously
blood vessels, production of Vitamin D that aids in calcium replaced nucleated keratinocytes. In thin
metabolism, activation of steroid hormones such as collagenase, skin, which covers the rest of the body, the
protection from biological, chemical and physical assaults Stratum Lucidum appears to be absent
through acidic and bactericidal secretions, migration of immune and the other strata are thinner.
cells as well as excretion of limited amounts of
nitrogen-containing wastes ammonia, urea, uric acid).

LAYERS OF THE SKIN

● EPIDERMIS
○ The Epidermis (epi=” upon”) has 5 layers/strata.
■ Stratum Basale aka stratum germinativum
(deepest)
● “germinating layer”
● consisting of a single row of continually
renewing keratinocytes, tactile epithelial
cells and 10-25% melanocytes that
reaches into the next layer,
■ Stratum Spinosum
● “prickly layer”
● consisting of 8-10 layers of keratinocytes
interspersed abundantly with melanin
granules and dendritic cells.
■ Stratum Granulosum
● “granular layer” ● DERMIS
● consisting of 1-5 layers of keratinocytes
undergoing apoptosis and keratinization,
forming keratohyalin and lamellar granules
 ○ The Dermis is highly vascularized and richly supplied with
nerve fibers and lymphatic vessels. It is composed of two
distinct layers- the papillary and reticular:
■ The thin, superficial papillary layer, accounts for
20% of the thickness of the dermis, made up of
areolar connective tissue, interlaced with
collagen, elastic fibers and small blood vessels.
Located therein are peg-like projections known as
dermal papillae that contain free nerve endings
(pain receptors) and touch receptors (tactile or
Meissner’s corpuscles).
■ The deeper reticular layer, accounting for about
80% of the thickness of the dermis, is coarse,
dense irregular connective tissue. The
extracellular matrix houses adipose cells and
interlacing collagen fibers.
HAIR, NAILS, SWEAT AND OIL GLANDS
● HAIR
○ The hair or pili is divided into two (2) main regions:
■ namely the shaft, which projects above the
surface of the skin where keratinization is
complete
■ and the root that penetrates into the dermis
where keratinization is still ongoing.
○ These 2 regions consist of three (3) concentric layers of
keratinized cells:
■ medulla,
■ cortex
■ cuticle.
○ Surrounding the root is the hair follicle that is made up of
the epithelial root sheath.
○ The hair bulb, evident as an onion shaped structure,
comprises the base of the follicle and the surrounding
dermal sheath, which houses the hair papilla,
■ a nipple shaped indentation which contains
areolar connective tissue and many blood vessels
that nourish the growing hair follicle.
■ The bulb also contains the hair matrix that arises
from the stratum basale, the site of cell
division. Therefore, as the hair matrix produces
new hair cells, the older part is pushed upwards,
its fused cells become increasingly keratinized
and die.
○ Additionally, each hair follicle has an attached bundle of
smooth muscle cells known as an arrector pili muscle
which when contracted pulls the hair follicle upright and
dimples the skin surface to produce goose bumps in
response to cold temperatures or fear; moreover, it forces
sebum out of hair follicles to the skin surface where it
acts as a skin lubricant.
● NAILS
○ Nails are plates of tightly packed, hard, dead and
keratinized cells that functions to:
■ protect the dorsal surface of the distal ends of the
digits,
■ enhance touch perception and manipulation,
■ relieve itches though scratching and
■ help to groom the body in various ways.
○ Each nail has a free edge, a nail plate/body and a nail
root. The free edge extends past the distal end of the
digit and beneath it,
 ○ where most dirt and debris accumulate is the
hyponychium which mainly secures the nail to the
fingertip.
○ The nail plate/body is the visible portion resting on the
vascular nail bed,
○ to which the whitish, crescent-shaped area of the
proximal end is called the lunula.
○ The epithelium proximal to the nail root (embedded in the
skin) is the nail matrix which produces new nail cells. Nail
folds overlap the proximal and lateral borders of the nail.
○ The cuticle/eponychium is the nail fold that projects onto
the nail body.
● SWEAT
○ Sweat glands, aka sudoriferous glands are distributed
over the entire skin surface except the nipples and parts
of the external genitalia. Divided into two, namely: eccrine
and apocrine.
■ Eccrine (Merocrine) are simple coiled tubular
sweat glands, far more numerous and abundant
on the palms, soles of the feet, and forehead,
extends to open directly onto the skin surface in a
funnel-shaped pore at the skin surface and by
their sweat production help to control body
temperature.
■ In contrast, the apocrine glands are confined
chiefly in the axillary and genital regions and
usually open into hair follicles. Apocrine secretion
contains the same basic components as true
sweat, plus fatty substances and proteins.
● Ceruminous glands are modified
apocrine glands found in the lining of the
external ear canal forming a sticky, bitter
substance called cerumen, or earwax.
● OIL GLANDS
○ Oil glands, aka sebaceous glands are simple branched
alveolar glands present on all skin surfaces except in the
thick skin of the palms and soles. These glands secrete
an oily/fatty substance called sebum with bactericidal
properties through the hair follicles or occasionally to a
pore on the skin surface which softens and lubricates the
hair and skin, prevents hair from becoming brittle, and
slows water loss from the skin when external humidity is
low.
CLINICAL CONDITIONS OF THE SKIN
● SKIN DISCOLORATION
○ Cyanosis refers to the bluish discoloration of the skin
due to decreased levels of hemoglobin, the
iron-containing- oxygen carrying pigment found in red
blood cells evident during heart failures and severe
respiratory disorders. In Dark-skinned individuals,
cyanosis is apparent in the mucous membranes and nail
beds.
○ Pallor or blanching refers to a change in skin color
during episodes of fear, anger, and certain other types of
emotional stress. Pale skin may also signify anemia or
low blood pressure.
○ Jaundice refers to the abnormal yellow skin tone which
usually signifies a liver disorder in which normally
secreted bile pigments accumulate in the blood and are
therefore deposited in the body tissues.
● SKIN LESION
● Skin lesions may be flat or raised. If you run your finger
over the lesion but do not feel the lesion, the lesion is flat.
○ If it is flat and small (<1 cm), it is a macule. Seen
in malignant melanomas and the fungal infection,
Tinea versicolor.
○ If it is flat and large, (>1 cm), it is a patch, evident
in Seborrheic dermatitis and vitiligo; however, if
you run your finger over the lesion and it is
○ palpable above the skin, it is raised.
○ If a raised spot is small (<1 cm), it is a papule.
○ Examples are skin tags and basal cell carcinoma.
If a raised spot is larger (>1 cm), it is a plaque,
commonly seen in psoriasis and atopic dermatitis.
○ If the lesion is raised, fluid-filled, and small (<1
cm), it is a vesicle, evident in infections caused by
 the Herpes simplex virus and contact dermatitis the keratinocytes of the stratum spinosum.
from poison ivy. It tends to grow rapidly and metastasize if
○ If the lesion is raised, fluid-filled and larger (>1 not removed. If it is caught early and
cm), it is a bulla, commonly seen in insect bites. removed surgically or by radiation therapy,
○ Additional raised lesions are pustules that are a the chance of complete cure is good.
collection of neutrophils or keratin seen in acne 3. Melanoma, cancer of melanocytes, is the
vulgaris. most dangerous skin cancer, accounting
○ Furuncles due to inflamed hair follicles. A for only 2-3%. It is highly metastatic and
collection of multiple furuncles is known as resistant to chemotherapy. The key to
carbuncles. surviving melanoma is early detection.
○ Subcutaneous mass/cyst encapsulated Chance of survival is poor if the lesion is
collections of fluid that may be fixed/mobile. over 4 mm thick. The usual therapy for
○ Wheals are areas of localized edema that comes melanoma is wide surgical excision
and goes within 1-2 days, seen in urticaria or accompanied by immunotherapy.
hives.
○ Burrows evident as small linear pathways
caused by the scabies mite.
● SKIN CANCER
- Of all of the body’s organs, none is more easily exposed
to infection, disease, and injury than the skin. Its location
makes it vulnerable to damage from trauma, sunlight,
microbes, and pollutants in the environment.
Overexposure to UV radiation is the single most
important risk factor for skin cancer. Predisposing factors
may include: frequent irritation of the skin by infections,
chemicals, or physical trauma in a limited number of
cases. The three (3) major forms of skin cancer are basal
cell carcinoma, squamous cell carcinoma, and
melanoma.
1. Basal Cell Carcinoma is the least
malignant and most common accounting
for nearly 80% of cases. Stratum basale
cells proliferate, invading the dermis and
hypodermis. It is relatively slow-growing, ● BURNS
and metastasis seldom occurs before it is - Burns are devastating tissue damage inflicted by intense
noticed. Full cure by surgical excision is heat, electricity, radiation, or certain chemicals, all of
the rule in 99% of cases. which denature cell proteins and kill cells in the affected
2. Squamous Cell Carcinoma is the second areas. The immediate threat to life results from
most common skin cancer, arising from catastrophic loss of body fluids leading to dehydration
 and electrolyte imbalance, then renal failure and
circulatory shock.
- Burns are classified according to their severity (depth) as
first-, second-, or third-degree burns.
➔ In first-degree burns, only the epidermis is
damaged
➔ Second-degree burns injure the epidermis and the
upper region of the dermis.
◆ First- and second-degree burns are
referred to as partial-thickness burns.
➔ Third-degree burns are full-thickness burns,
involving the entire thickness of the skin. Since
the nerve endings have been destroyed, the
burned area is not painful.
- In general, burns are considered critical if any of the
following conditions exists: (1) Over 25% of the body
has second-degree burns, (2) over 10% of the body
has third-degree burns and (3) there are third-degree
burns of the face, hands, or feet.

UNIT 2
( SKELETAL SYSTEM )

TOPIC 1: STRUCTURE OF THE SKELETAL SYSTEM

CLASSIFICATION OF BONES
- The skeletal system is made up of 206 bones. It also includes generated in a joint. The sesamoid bones protect tendons
cartilage, tendons and ligaments. There are two, primary by helping them overcome compressive forces.
divisions of the skeletal system: the axial skeleton and the Sesamoid bones vary in number and placement from
appendicular skeleton. The primary purpose of the human person to person but are typically found in tendons
skeletal system is to provide locomotion, support and protection associated with the feet, hands, and knees. The patellae
for the body. Vital organs, such as the brain, heart, and lungs, (singular = patella) are the only sesamoid bones found in
are protected by the skeletal system. In addition to locomotion, common with every person. Table 6.1 reviews bone
support, and protection, the skeletal system also produces red classifications with their associated features functions,
blood cells, and stores important minerals for the body. and examples.
● ACCORDING TO SHAPE ● ACCORDING TO LOCATION
○ Long Bones are cylindrical in shape, being longer than it ○ The AXIAL SKELETON forms the vertical, central axis of
is wide. Keep in mind, however, that the term describes the body and includes all bones of the head, neck, chest,
the shape of a bone, not its size. Long bones are found in and back. It consists of 80 bones, including the skull, the
the arms (humerus, ulna, radius) and legs (femur, tibia, vertebral column, and the thoracic cage. These bones
fibula), as well as in the fingers (metacarpals, phalanges) protect the brain, spinal cord, heart, and lungs. It also
and toes (metatarsals, phalanges). Long bones function serves as the attachment site for muscles that move the
as levers; they move when muscles contract. head, neck, and back, and for muscles that act across
○ Short Bones are cube-like in shape, being approximately the shoulder and hip joints to move their corresponding
equal in length, width, and thickness. The only short limbs.
bones in the human skeleton are in the carpals of the
wrists and the tarsals of the ankles. Short bones provide
stability and support as well as some limited motion.
○ The term “flat bone” is somewhat of a misnomer
because, although a FLAT BONE is typically thin, it is
also often curved. Examples include the cranial (skull)
bones, the scapulae (shoulder blades), the sternum
(breastbone), and the ribs. Flat bones serve as points of
attachment for muscles and often protect internal organs.
○ An IRREGULAR BONE is one that does not have any
easily characterized shape and therefore does not fit any
other classification. These bones tend to have more
complex shapes, like the vertebrae that support the
spinal cord and protect it from compressive forces. Many
facial bones, particularly the ones containing sinuses, are
classified as irregular bones.
○ The APPENDICULAR SKELETON consists of 126 bones
○ A SESAMOID BONE is a small, round bone that, as the
and includes the free appendages and their attachments
name suggests, is shaped like a sesame seed. These
to the axial skeleton. The free appendages are the upper
bones form in tendons (the sheaths of tissue that connect
and lower extremities, or limbs, and their attachments
bones to muscles) where a great deal of pressure is
which are called girdles. It gives the shape to the body
 and it supports the body weight, without the bones you
can’t stand or sit erect.
TOPIC 2: BONE STRUCTURE
○ FUNCTIONS
BONE STRUCTURE
(OSSEOUS TISSUE)
● SPONGY BONE
- The spongy bone is a much porous kind of bone which is
found in the animals. The spongy bones are also called
Cancellous bones or the Trabecular bones. This bone
is highly vascularized and consists of red bone marrow.
Usually, spongy bone is situated at the end of long
bones, with the surrounding of harder compact bone.
This bone also presents in the ribs, inside the vertebrae,
in the joint bones, and in the skull. Spongy bones are
weaker and softer as compared to compact bones, but it
is much flexible too. It is referred to by a lattice-like matrix
network, known as trabeculae, which gives it a spongy
shape.
○ STRUCTURE
■ The spongy bone is made up of cells, known as
Osteocytes which lie in small cavities called
Lacunae.
■ The lacunae and their osteocytes are present in
trabeculae matrix on the bone with the bone
marrow.
■ Blood vessels travel from the harder compact
bone toward the spongy bone, by supply the
materials which are necessary for the production
of blood cells.
■ Osteocytes located to close to the blood vessel,
which can take on nutrients and expel the waste
material
● with the help of tiny interconnecting
channels found on the surface of
trabeculae, known as Canaliculi. Spongy
bone can also convert to the compact
■ bones through the osteoblasts action. The bone
cells which secrete the material produce compact
bone matrix. It is done by this process which the
long bones in a human embryo develop.
1. Store of Bone Marrow
- Bone marrow is also known as Myeloid tissue. It
occurs when blood vessels crowd together by the
trabecular matrix and they condense. The
compact bone is denser with having few open
spaces, the spongy bone is good for form and
stores bone marrow across the lattice-like
trabeculae network. Compact bone is made up of
primarily of fat in its medullar cavity, and it stores
yellow bone marrow. The spongy bone has red
bone marrow which is used in erythropoiesis.
2. Site of Erythropoiesis
- The red blood cells create in the red bone marrow
at the rate of approximate 2 million per second,
inside the spongy bone. This faster production of
red blood cells is possible by the highly
vascularized nature of spongy bone that can
transfer the adequate amount of glucose, amino
acids, lipids, and trace elements, which is
necessary to make red blood cells. when the old
and damaged red blood cells are near to die, they
return to bone marrow and here they
phagocytized by the macrophages. This process
lies in spleen and liver.
3. Reduces the Weight of the Skeleton
- The low density and low weight of spongy bone
balance out the heavier and denser compact bone
in order to reduce the overall weight of the
skeleton. This act makes it easier for the
movement of muscle to the limbs.
4. Adds Strength and Flexibility to Bones
- The trabeculae of the spongy bone work to form
along with lines of stress, which gives the bone
strength and the flexibility in this area. Spongy
 bone also lies in joints and work as a shock the minerals to and from the compact bone. The
absorber when we jump, walk, or run. minerals are deposited for storage within the
5. Mineral Storage lamellae when blood levels are high. When levels
- The human skeleton has the storage of 99% of are low, minerals are absorbed out of the lamellae
calcium and 85% of phosphorus. The blood and transported throughout the body.
mineral contents must be regulated in order to
sure the proper functioning of muscles and the
nervous system. It is a quick method mediated by
hormones, which release minerals into the
bloodstream when it is needed.

● COMPACT BONE
- Compact bones are also called cortical bones, which
contain osteons or Haversian systems. The compact
bone gets its white, smooth structure owing to the
connective tissues that cover around 3⁄4 part of the bone
from inside. The shafts found in long bones are also
compact bones. These bones are tough and hard with
negligible gaps inside them.
○ STRUCTURE
■ The basic units of compact bone are called
osteons or Haversian systems. These are
cylinder-shaped structures that have a mineral
matrix and are home to osteocytes (mature bone
cells) that are trapped in the matrix. Lamellae are
formed by osteons that align themselves in a
parallel orientation to form layers along the long
axis of the bone. The small open spaces created
in the lamellae by the osteocytes are called
lacunae. Canaliculi are small channels that create
a network between the lacunae to aid in the
diffusion of material between the bone cells. The
lamellae create circular canals called Haversian
canals that contain nerves and blood vessels
○ FUNCTIONS ● COMPACT VS. SPONGY BONE
■ The function of compact bone is to help to keep ○ Though both comprise the two major types of osseous
the levels of these minerals at constant within the tissue, the key difference between compact and spongy
blood. The arteries and veins that run through the bone occurs in their structure and in terms of the
Haversian canals provide a means to transport functions they perform. Compact bone is hard and forms
 the outer layer of any bone. On the other hand, spongy
bone is softer, and forms the inner layer of bones while
covering a large surface area.
○ The main function of compact bone is to support the
whole body, whereas spongy bones support the body
structure. The latter helps save materials, and provide
movement to the key body organs. Compact bones are
heavy and tough as they store calcium in them,
contributing to over 80% of total human skeleton weight.
Spongy bones are lighter in weight; the lesser amount of
calcium supply to these bones makes them weak and
vulnerable to breaking easily.
- Within about 48 hours after the fracture, chondrocytes from the
endosteum have created an internal callus (plural = calli) by
secreting a fibrocartilaginous matrix between the two ends of
the broken bone, while the periosteal chondrocytes and
osteoblasts create an external callus of hyaline cartilage and
bone, respectively, around the outside of the break (Figure 2b).
This stabilizes the fracture.
- Over the next several weeks, osteoclasts resorb the dead bone;
osteogenic cells become active, divide, and differentiate into
osteoblasts. The cartilage in the calli is replaced by trabecular
bone via endochondral ossification (Figure 2c).
- Eventually, the internal and external calli unite, compact bone
TOPIC 3: FRACTURES AND BONE DISORDERS replaces spongy bone at the outer margins of the fracture, and
healing is complete. A slight swelling may remain on the outer
surface of the bone, but quite often, that region undergoes
FRACTURE AND BONE REPAIR
remodeling (Figure 2d), and no external evidence of the fracture
- When a bone breaks, blood flows from any vessel torn by the
remains.
fracture. These vessels could be in the periosteum, osteons,
and/or medullary cavity. The blood begins to clot, and about six
TYPES OF FRACTURE
to eight hours after the fracture, the clotting blood has formed a
● Stable Fracture
fracture hematoma (Figure 2). The disruption of blood flow to
○ This is the type of fracture that occurs when an injury
the bone results in the death of bone cells around the fracture.
causes the bone to break clean, with its parts in
alignment. This means that the bone maintains its original
position.
● Transverse Fracture
○ A transverse fracture is one that occurs at a 90-degree
angle, straight across the bone. It happens when the
impact comes perpendicular to the site of injury.
● Compound Fracture
○ This is one of the most severe injuries: A compound or
open fracture is when the bone pierces the skin when it
breaks. Surgery is usually called for due to its severity
and the risk of infection.

● Comminuted Fracture
○ A comminuted fracture leaves the bone in fragments. It
is most common after severe trauma, such as a car
accident, and is more likely to occur in the hands or feet.
● Hairline Fracture
○ A hairline fracture is also known as a stress fracture and
occurs mostly on the legs and feet. It is a result of
repetitive movement and occurs when athletes
suddenly increase the frequency or intensity of
workouts such as running or jogging.

● Oblique Fracture
○ An oblique fracture occurs when the bone breaks at an
angle. It tends to occur most often on long bones, such
as the femur or tibia. This type of injury causes a visible
deformity beneath the skin. ● Avulsion Fracture
○ An avulsion fracture is a break at the site where bone
attaches to a tendon or ligament. When this happens,
 the tendon or ligament pulls off a part of the bone it’s
attached to.
● Greenstick Fracture
○ In a Greenstick fracture, a portion of the bone breaks
but not completely through. The injured bone may also
bend near the broken portion. This type of injury is most
common in children.
COMMON BONES DISORDERS
- Pathophysiology is a term which describes the changes that
● Spiral Fracture
○ This happens when a bone is wrenched by the forceful
rotation or twisting of a limb. It results in a clean break
where the bone completely breaks into two fragments.
● Pathological Fracture
○ Pathological fractures occur when a patient has an
illness that has weakened their bones, such as
osteoporosis, arthritis, osteomyelitis, osteosarcoma, or
metabolic bone disorders.
occur when normal biological processes become abnormal.
Osteoporosis pathophysiology, therefore, refers to the
changes that occur in the body as a result of osteoporosis.
People with this condition suffer from a number of symptoms
relating to loss of bone density, often as a result of long-term
calcium deficiency.
● Osteoporosis
○ The principal cause of osteoporosis
pathophysiology is an imbalance between two
factors relating to maintenance of bone density.
These factors are bone formation and bone
resorption. Normal healthy bone is constantly
being repaired and remodeled; some estimates
indicate that up to ten percent of bone tissue is
undergoing this process in a healthy body.
■ Bone formation is a process in which bone
matter is deposited by cells called
osteoblasts.
 ■ Bone resorption is the opposite process:
cells called osteoclasts absorb bone
matter.
○ These two processes must stay in perfect balance
for maintenance of healthy levels of bone density.
In someone with osteoporosis, bone formation
and bone resorption are unbalanced, causing
bone to become less dense, more brittle, and
more prone to fracture.
○ Several different factors may lead to an imbalance
between bone deposition and resorption.
■ One of the most common is the reduction
in estrogen levels which occurs in
post-menopausal women. This reduction
causes the bone resorption rate to
increase relative to the bone formation
rate.
○ Another common mechanism of osteoporosis
pathophysiology is calcium deficiency.
○ Bone matter is continually being deposited and
reabsorbed in part to provide the body with the
supply of calcium it needs for essential tasks such
as muscle contraction and neurotransmission.
Reabsorbed bone releases calcium, which enters
the bloodstream and is distributed to cells which
require it. When calcium is not provided by the
diet, more of the mineral must be retained from
the bones, and this process reduces the rate at
which bone matter is deposited by osteoblasts.
■ This deficiency can be exacerbated by
lack of vitamin D.
● Osteoarthritis
○ Osteoarthritis is a chronic, inflammatory joint
disease. OA include cartilage erosion as well as
inflammation. Complex networks of risk factors
and biochemical parameters, including cytokines,
proteolytic enzymes trigger the disease. By
knowing the exact mechanism of progressive of
disease progression, it may help in finding the
new drug for reducing pain and curing of the joint
disease. It is a complex disease whose
pathogenesis, changes the tissue homeostasis
of articular cartilage and subchondral bone,
determine the predominance of destructive
processes. A key role in the pathophysiology of
articular cartilage is played by cell/extracellular
matrix (ECM) interactions.
General changes in bone and cartilage in OA
■ loss of cartilage, joint space narrowing,
hypertrophic bone changes
■ osteophytes formation, osteophytes
were defined as outgrowth of the bone and
cartilage occurring at the joint margin
■ One of the mechanisms of articular
cartilage damage is stiffness of
subchondral bone, if the bone becomes
stiffer; it may be less able to absorb impact
loads, which may in turn lead to increased
stresses in the cartilage.
● Rheumatoid Arthritis
○ Rheumatoid arthritis (RA) is a chronic systemic
inflammatory disease whose hallmark feature is
a persistent symmetric polyarthritis (synovitis) that
affects the hands and feet (see the image below).
Any joint lined by a synovial membrane may be
involved, however, and extra-articular involvement
of organs such as the skin, heart, lungs, and eyes
can be significant. RA is theorized to develop
when a genetically susceptible individual
experiences an external trigger (e.g., cigarette
smoking, infection, or trauma) that triggers an
autoimmune reaction.
○ The hallmark swelling, bony erosions, and
synovial thickening reflect the underlying
inflammatory and autoimmune processes. The
interaction of environmental factors and genetic
susceptibility leads to altered post-transcriptional
 regulation and self-protein citrullination early in
the disease process.
○ Citrullination is a normal physiologic process in
dying cells, and under normal circumstances, the
cells do not come in contact with the immune
system. When clearance is inadequate, however,
peptidylarginine deiminase (PAD) enzymes and
citrullinated proteins leak out of the dying cells
and contact the immune system. The PAD
enzymes citrullinated extracellular proteins
containing arginine, creating citrullinated antigens.
Patients with certain HLA-DRB1 genotypes,
termed shared epitopes, generate peptides no
longer recognized as “self” and consequently
develop ACPA. Downstream consequences
include immune complex development and loss of
tolerance to self. RF is also indicative of
autoantibody production.
● Abnormal Spinal Curvature
○ LORDOSIS, also called swayback, wherein the
spine of a person curves significantly inward at
the lower back. The following conditions can
cause lordosis:
■ achondroplasia, a disorder in which
bones do not grow normally, resulting in
the short stature associated with dwarfism.
■ spondylolisthesis, a condition in which
the vertebra, usually in the lower back,
slips forward
■ osteoporosis.
○ KYPHOSIS is characterized by an abnormally
rounded upper back (more than 50 degrees of
curvature). This may be caused by:
■ abnormal vertebrae development in utero
(congenital kyphosis)
■ Poor posture or slouching (postural
kyphosis)
■ Scheuermann's disease, a condition that
causes vertebrae to be misshaped
(Scheuermann's kyphosis)
■ Arthritis
■ Osteoporosis
■ Spina bifida, a birth defect in which the
spinal column of the fetus does not close
completely during development inside the
womb
■ Spine infections
■ Spine tumors
 ○ A person with SCOLIOSIS has a sideways curve
to their spine. The curve is often S-shaped or
C-shaped. Medical experts don’t know what
causes the most common type of scoliosis seen in
juveniles, but scoliosis in adults is generally
caused by disease, acute injury, spinal infection or
a late-developing birth defect.
UNIT 4
( MUSCULAR SYSTEM )
TOPIC 1: ANATOMY OF THE MUSCLE
- Movement is one of the basic characteristics of life. With
movement, an organism can reach towards resources to provide
for its sustenance, find others of its own kind, retreat from
predators, or chase down its prey. The muscles in our body
provide us with the means for locomotion, expression,
communication, and other basic bodily functions.
MUSCULAR TISSUE
- The muscular system is composed of three different types of
muscle tissue:
- skeletal muscle,
- cardiac muscle,
- smooth muscles.
- The scope of the muscular system in part with physiology however is
more focused on skeletal muscles. Thus, the muscular system is also
often referred to as the musculoskeletal system in some literary
sources.
- There are more than 600 skeletal muscles in the human body,
many arguing that there are up to 800. Collectively, they
constitute 40-50% of our body mass. Our skeletons provide a
“scaffolding” that allows the muscles to form and contours of our
body.
- The primary function of most skeletal muscles is to produce
movement (locomotion). The entire muscular system however is
also responsible for performing two other essential functions of
the human body: heat production, storage and transport of
substances within the body, and posture.
1. Locomotion - Skeletal muscle contraction and extension
produce movement of the body in its parts or as a whole.
2. Heat Production - Muscle cells produce heat like all
cells through catabolism. But because skeletal muscles
make up a majority of our body weight and are highly
active, they become responsible for most of our body
heat.
3. Storing and moving substances within the body -
Smooth Muscles like the pyloric sphincter regulates the
flow of food from the stomach to the duodenum. Smooth
muscles in the walls of blood vessels help adjust the rate
and volume of blood flow.
4. Posture - While skeletal muscles are regarded to have
“voluntary” control, a continued partial contraction of
many skeletal muscles are subconsciously involved in
performing static tasks such as standing or sitting. Thus,
the human body is maintained in a relatively stable
position due to certain skeletal muscles.
TYPES OF MUSCLES

● Skeletal Muscles
○ are named because most skeletal muscles move bones,
although a few skeletal muscles are attached to or move
the skin or even other skeletal muscles. Skeletal muscle
tissue is striated: Alternating light and dark protein
bands (striations) are seen when the tissue is examined
under a microscope. Skeletal muscle tissue is
voluntary in action as they can be consciously, or
voluntarily, controlled in response to inputs through nerve
cells. Most skeletal muscles are also controlled
subconsciously to some extent. For example, the
diaphragm is a skeletal muscle that alternately contracts
and relaxes without conscious control during breathing.
Keywords: Skeletal, striated, voluntary
● Cardiac Muscles
○ is found only in one organ: the heart, forming most of the
heart wall. Cardiac muscle is also striated, but unlike
skeletal muscle tissue, its action is involuntary. The
alternating contraction and relaxation of the heart is not
consciously controlled. The functional anatomy of cardiac
muscle tissue resembles that of skeletal muscle to a
degree, but exhibits features related to its role in
continuously pumping blood. Unlike skeletal muscle, in
which a nervous impulse excites the sarcolemma to
produce its own impulse, cardiac muscle is
self-exciting. This self-induced impulse is referred to as
auto-rhythmicity in cardiac muscle cells that exhibit an
autonomous rhythm of excitation and contraction to keep
the heart pumping. It should be noted however, that the
rate of self-induced activity can be regulated through
hormones and neurotransmitters. (Keywords: Cardiac,
striated, involuntary)
● Smooth Muscle
○ tissue is widely distributed throughout the body, located in
the walls of hollow internal structures like blood vessels,
airways, digestive and urinary tracts, and in other
locations such as in the eye. Smooth muscle does not
have striations when viewed under the microscope, thus
looking non-striated. Which is why it is referred to as
smooth. The action of smooth muscle is involuntary,
but its style of contraction varies by the type of smooth
muscle. There are two types of smooth muscle; visceral
and multiunit smooth muscle tissue. (Keywords:
Smooth, non-striated, involuntary)
CONNECTIVE TISSUE COMPONENTS
- Connective tissue surrounds and protects muscular tissue. The
subcutaneous layer or hypodermis, which separates muscles
from skin, is composed of areolar connective tissue and adipose
tissue.
Three layers of connective tissue extend from the fascia to protect and
strengthen skeletal muscle:
1. Epimysium - the outermost layer, encircling the entire
muscle
2. Perimysium - surrounds groups of 10 to 100 or more
muscle fibers, separating them into bundles called
fascicles.
3. Endomysium - a thin sheath of areolar connective tissue
that penetrates the interior of each fascicle and separates
individual muscle fibers from one another.
All three layers are present in skeletal muscles, while certain layers are
missing in both cardiac and smooth muscles. Only the epimysium is
present in all three types of muscle.
All three layers are connective tissue that attaches skeletal muscle to
other structures, such as bone or another muscle. A tendon is a cord of
dense regular connective tissue composed of parallel bundles of
collagen fibers that attach a muscle to the periosteum of a bone.
ANATOMY OF THE SKELETAL MUSCLE CELL
- Skeletal muscle cells are generally called muscle fibers instead
of cells (myocytes) because of their threadlike shape. Skeletal
muscle fibers have many of the same structural parts as other
cells, several however, bear different names. A skeletal muscle
fiber varies in diameter (10-100μm) based on the location of the
muscle.
● Myofibrils
- Myofibrils are composed of long proteins including actin,
➢ Sarcolemma – the plasma membrane of a muscle fiber
➢ Sarcoplasm – cytoplasm of a muscle fiber
➢ Sarcoplasmic reticulum – a structure analogous, but
not identical, to the endoplasmic reticulum of other cells.
The membrane of SR continually pumps Ca++ ions from
the sarcoplasm and stores them within its sacs.
Extensive in skeletal muscles.
➢ T tubules – allow electrical signals, or impulses, traveling
along the sarcolemma to move deeper into the cell Forms
“triads” with the sarcoplasmic reticulum
➢ Mitochondria – produces ATP. Most numerous in
skeletal muscle tissue.
➢ Myofibrils – contain thousands of thick and thin
myofilaments. Extend lengthwise along skeletal muscle
fibers and almost fill their sarcoplasm
➢ Nuclei - peripherally located along the long, cylindrical
fiber
myosin, tropomyosin, and troponin. Muscles contract
 by sliding the thick (myosin) and thin (actin,
tropomyosin, troponin) filaments along each other. ● Sarcomere
- The sarcomere is the basic contractile unit of the muscle
cell.
- The sarcomere is a segment of the myofibril between two
successive Z discs. The Z disk, or Z line, is a dense
plate of thin myofilaments where they directly anchor. The
thick myofilaments are anchored together by protein
molecules that form the M line.
- Thin myofilaments contain actin, troponin, and tropomyosin
protein molecules. The actin protein in thin filaments are
chemically attracted to myosin protein in thick filaments, but at
rest the active sites on the actin molecules are covered by long
tropomyosin molecules. The tropomyosin molecules in turn are
held in this blocking position by troponin molecules spaced at
intervals along the thin filament.

❖ Components of the sarcomere:

➢ Z discs – narrow, plate-shaped regions of
dense materials that separate one
sarcomere from the next
➢ M line – region in the center of H zone
that contains proteins that hold thick
filaments together at the center of the
sarcomere
- Thick myofilaments are made up of almost entirely myosin
➢ A band – the segment that runs the entire
molecules. Note that the myosin molecules are shaped like golf
length of the thick filaments, and includes
clubs, with their long shafts bundled together to form a thick
parts of thin filaments that overlap thick
filament and their “heads” sticking out from the bundle. The
filaments
myosin heads are chemically attracted to the actin molecules of
➢ I band – the segment that includes the Z
nearby thin filaments. When they bridge the gap between
line and the ends of the thin filaments
adjacent myofilaments, the myosin heads are called cross
where they do not overlap the thick
bridges.
filaments
➢ H zone - narrow region in center of each A
Understanding the function of both thin and thick myofilaments will help
band that contains thick filaments but no
understand the basic function of contraction in muscle fibers, as well as
thin filaments
understanding the structure and function of the sarcomere.
In addition to the contractile and regulatory proteins making up the thin
and thick filaments, each sarcomere has numerous elastic filaments.
❖ Titin (connectin) is the third most plentiful protein in skeletal
muscle (after actin and myosin). Titin is 50 times larger than an
average-sized protein. Each titin molecule spans half a
sarcomere, anchoring the ends of the thick filaments to the Z line ANATOMY OF THE CARDIAC MUSCLE
(from the Z disc to the M line). Titin stabilizes the position of the - Cardiac muscle tissue is only found in the heart. Forming the
thick filament and can stretch and then spring back unharmed bulk of the wall of each heart chamber, cardiac muscle contracts
due to its size. This protein accounts for much of the elasticity rhythmically and continuously to provide the pumping action
and extensibility of myofibrils. necessary to maintain a relative constancy of blood flow through
❖ α-Actinin is a structural protein that attaches to actin molecules the internal environment.
of thin filaments to titin molecules - Each cardiac muscle fiber contains parallel myofibrils (10-20 μm)
❖ Myomesin molecules form the M line of the sarcomere. This with one centrally located nucleus. Each myofibril comprises
protein binds to titin molecules and connects adjacent thick sarcomeres that give the whole fiber a striated appearance.
filaments to one another. However, the cardiac muscle fiber does not taper like a skeletal
❖ Nebulin is a long, nonelastic protein wrapped around the entire muscle fiber, but, instead, forms strong electrically coupled
length of each thin filament. This protein helps anchor thin junctions (intercalated discs) with other fibers.
filaments to Z discs and regulates the length of thin filaments
during development.
❖ Dystrophin is a protein that holds the actin filaments to the
sarcolemma. Dystrophin and a complex of connected molecules
anchors the muscle fibers to the surrounding matrix so that the
muscle doesn’t break during a contraction. It is highly related to
muscular disorders.

- This feature, along with the branching exhibited by
individual cells, allows cardiac fibers to form a
continuous, electrically coupled mass, called a syncytium
(meaning “unit of combined cells”). Cardiac muscles thus
form a continuous, contractile band around the heart
chambers that conducts a single impulse across a
virtually continuous sarcolemma – features necessary for
an efficient coordinated pumping action.
Unlike skeletal muscle tissue with an extensive sarcoplasmic reticulum,
cardiac muscles have sparse sarcoplasmic reticulum and a thicker
transverse tubule, forming “diads” instead of “triads”.
- Intercalated discs are cell membranes that separate individual
cardiac muscle cells from one another. At each intercalated disc
the cell membranes fuse with one another in such a way that
they form permeable “communicating” junctions (gap junctions)
that allow rapid diffusion of ions. Therefore, from a functional
point of view, ions move with ease in the intracellular fluid along
the longitudinal axes of the cardiac muscle fibers so that action
potentials travel easily from one cardiac muscle cell to the next,
past the intercalated discs. Thus, cardiac muscle is a syncytium
of many heart muscle cells in which the cardiac cells are so
interconnected that when one of these cells become excited, the
action potential spreads to all of them.
- These discs contain desmosomes, which hold the fibers
together, and gap junctions, which allow muscle action potentials
to spread from one cardiac muscle fiber to another.
- The heart actually is composed of two syncytiums: the atrial
syncytium and the ventricular syncytium, which constitutes the
walls of the two ventricles. The atria are separated from the
ventricles by fibrous tissue that surrounds the atrioventricular
(A-V) valvular openings between the atria and ventricles.
Normally, potentials are not conducted from the atrial syncytium
into the ventricular syncytium directly through this fibrous tissue.
Instead, they are conducted only by way of a specialized
conductive system called the A-V bundle. This division of the
muscle of the heart into two functional syncytiums allows the
 atria to contract a short time ahead of ventricular contraction,
which is important for effectiveness of heart pumping.
- Cardiac muscle tissue has an endomysium and perimysium, but
lacks an epimysium.
ANATOMY OF THE SMOOTH MUSCLES
- Like cardiac muscle tissue, smooth muscle tissue is usually
activated involuntarily. Of the two types of smooth muscle tissue,
the more common type is visceral (single-unit) smooth muscle
tissue. It is found in tubular arrangements that form part of the
walls of small arteries and veins and of hollow organs such as
the stomach, intestines, uterus, and urinary bladder.
- The second type of smooth muscle tissue, multiunit smooth
muscle tissue, consists of individual fibers, each with its own
motor neuron terminals and with few gap junctions between
neighboring fibers. Stimulation of one visceral muscle fiber
causes contraction of many adjacent fibers, but stimulation of
one multiunit fiber causes contraction of that fiber only. Multiunit
smooth muscle tissue is found in the walls of large arteries, in
airways to the lungs, in the arrector pili muscles that attach to
hair follicles, in the muscles of the iris that adjust pupil diameter,
and in the ciliary body that adjusts focus of the lens in the eye.
- In (a), one autonomic motor neuron synapses with several
visceral smooth muscle fibers, and action potentials spread to
neighboring fibers through gap junctions. In (b), three autonomic
neurons synapse with individual multiunit smooth muscle fibers.
Stimulation of one multiunit fiber causes contraction of that fiber
only.
- Visceral smooth muscle fibers connect to one another by gap
junctions and contract as a single unit. Multiunit smooth fibers
lack gap junctions and thus contract independently.
● Microscopic Anatomy of a Smooth Muscle Fiber
- A single relaxed smooth muscle fiber is 30-200μm long. It
is thickest in the middle and tapers at each end. Within
each fiber is a single, oval, centrally located nucleus. The
sarcoplasm of smooth muscle fibers contains both thick
filaments and thin filaments, in ratios between 1:10 and
1:15, but they are not arranged in orderly sarcomeres as
in striated muscle. Smooth muscle fibers also contain
intermediate filaments. Because the various filaments
have no regular pattern of overlap, smooth muscle fibers
do not exhibit striations causing a smooth appearance.
- Smooth muscle fibers also lack transverse tubules and
scanty sarcoplasmic reticulum for storage for Ca++.
Although there are no transverse tubules in smooth
muscle tissue, there are small pouch-like invaginations of
the plasma membrane called caveolae that contain
extracellular Ca++ that can be used for muscular
contraction.
- In smooth muscle fibers, the thin filaments attach to
structures called dense bodies, which are functionally
similar to Z discs in striated muscle fibers. Some dense
bodies are dispersed throughout the sarcoplasm; others
are attached to the sarcolemma. Bundles of intermediate
filaments also attach to dense bodies and stretch from
one dense body to another.
 such as food in the digestive tract, to move
through the body.
2. Multiunit smooth muscle. Multi-unit smooth muscle differs
from single-unit in that each smooth-muscle cell receives
its own synaptic input. Multiunit smooth muscle cells
rarely possess gap junctions, and thus are not electrically
coupled. As a result, contraction does not spread from
one cell to the next, but is instead confined to the cell that
was originally stimulated, allowing the muscle to have
finer control.
Smooth muscle is organized in two ways:
a. Stimuli for multiunit smooth muscles come from
1. Single-unit smooth muscle. Single-unit muscle has its
autonomic nerves or hormones but not from
muscle fibers joined by gap junctions so that the muscle
stretching. This type of tissue is found around
contracts as a single unit.
large blood vessels, in the respiratory airways,
a. Single-unit smooth muscle consists of multiple
and in the eyes.
cells connected through connexins that can be
stimulated in a synchronous pattern from only one
The function of smooth muscle tissue differs based on the organ system
synaptic input. Connexins allow for cell-to-cell
it helps regulate:
communication between groups of single-unit
● Gastrointestinal tract - propulsion of the food bolus
smooth muscle cells. This intercellular
● Cardiovascular - regulation of blood flow and pressure via
communication allows ions and molecules to
vascular resistance
diffuse between cells giving rise to calcium waves,
● Renal - regulation of urine flow
resulting in synchronous contraction to occur. This
● Genital - contractions during pregnancy, propulsion of sperm
type of smooth muscle is commonly called
● Respiratory tract - regulation of bronchiole diameter
visceral muscle due to it being found in the walls
● Integumentary - raises hair with arrector pili muscle
of all visceral organs except the heart. Visceral
● Sensory - dilation and constriction of the pupil as well as
smooth muscle has a stress-relaxation response.
changing lens shape
This means that as the muscle of a hollow organ
is stretched when it fills, the mechanical stress of
Smooth muscle tissue does not have a perimysium and epimysium, only
the stretching will trigger contraction, but this is
an endomysium connective tissue.
immediately followed by relaxation so that the
organ does not empty its contents prematurely.
This is important for hollow organs, such as the
stomach or urinary bladder, which continuously ABNORMAL MUSCLE CONTRACTION
expand as they fill. The smooth muscle around
these organs also can maintain a muscle tone 1. Spasm: A sudden involuntary contraction of a single muscle in a
when the organ empties and shrinks, a feature large group of muscles
that prevents “flabbiness” in the empty organ. 2. Cramp: A painful spasmodic contraction caused by inadequate
b. In general, visceral smooth muscle produces blood flow to muscles overuse of a muscle, dehydration, injury,
slow, steady contractions that allow substances,
 holding a position for prolonged periods, and low blood levels of
electrolytes, such as potassium
3. Tic: A spasmodic twitching made involuntarily by muscles that
are ordinarily under voluntary control. Twitching of the eyelid and
facial muscles are examples of tics
4. Tremor: A rhythmic, involuntary, purposeless contraction that
produces a quivering or shaking movement
5. Fasciculation: An involuntary, brief twitch of an entire motor unit
that is visible under the skin; it occurs irregularly and is not
associated with movement of the affected muscle. Fasciculations
may be seen in multiple sclerosis or in amyotrophic lateral
sclerosis (Lou Gehrig’s disease).
6. Fibrillation: An abnormal type of contraction in which individual
fibers contract asynchronously rather than at the same time. This
produces a flutter of the muscle but no effective movement.
Fibrillation can also occur in cardiac muscle, where it reduces
the heart’s ability to pump blood. A spontaneous contraction of a
single muscle fiber that i
7. s not visible under the skin but can be recorded by
electromyography. Fibrillations may signal destruction of motor
neurons.
8. Convulsions: An Abnormal, uncoordinated tetanic contractions
of varying groups of muscles. Convulsions may result from a
disturbance in the brain or seizure in which the output along
motor nerves increases and becomes disorganized.