Unit 8: Learning Aim A – Muscular skeletal system

The axial skeleton includes all the bones along the body’s long axis, meaning the
bones that form the skull, vertebral column, laryngeal skeleton and thoracic cage.
The appendicular skeleton includes the rest of the bones, meaning the shoulder
girdle, the pelvic girdle, the upper limbs, and the lower limbs.
Long Bone
A long bone is a bone that is longer than it is wide and has a shaft and two ends. Long
bones have a thick outer layer of compact bone as well as marrow inside their
medullary cavities. Examples: upper and lower limb, clavicle.
Short Bone
Short bones are found in the hands and feet. They are mainly made of spongy bone
and are roughly cubic in shape. The outside layer is comprised of compact bone.
Examples: trapezoid, triquetrum, scaphoid.

Flat Bone
Flat bones are made of two layers of compact bones which enclose a layer of spongy
bone. They are flat in shape and have marrow despite not having a bone marrow cavity.
Examples: parietal, hip, scapulae.
Irregular Bone
Irregular bones are built very differently from other bones and therefore do not fit into
any of the previous categories. They usually have a complex shape to protect internal
organs. Examples: vertebrae, hip, skull bones.
Periosteum
An outer layer of periosteum consists mainly of proteins known as collagen. The inner
layer, called cambium, consists of cells that produce bone. After injury, the periosteum
aids in bone regeneration.
Compact Bone
Located beneath the periosteum, the compact bone is composed mainly of structures
called osteons. The density of the bone may seem dense, however it has an extensive
network of passageways called Haversian canals. This structure fills 80% of the bone. It
allows nerves to enter the bone.

Spongy Bone
Spongy bones are flexible, supportive, and provide a buffer against stress. The
trabeculae are one of the main components of these bones. They are found in between
layers of compact bone in flat bones, but in long bones they may appear in the
epiphysis. Spongy bones house bone marrow.

Bone marrow
Among adults, red bone marrow is located in the ends of the humeral, femoral and flat
bone, and it produces white and red blood cells, as well as platelets. It is red at first but
turns yellow over time.
In addition to serving as a fat storage site, yellow bone marrow is also capable of
converting into red bone marrow.

Mineral Homeostasis
During ossification, cartilage turns to bone and undergoes a process called
osteogenesis where mineral ions such as calcium phosphate, magnesium, sodium, and
potassium are deposited on collagen matrix. These minerals are stored in bones when
the fluctuation of minerals is high, and when it is low, they are withdrawn from them.
These minerals give the bones their strength. It is also thought that calcium ions stored
in the bones are used in the blood to clot, and for muscle contraction, and to regulate
mineral balance in the bloodstream.

Types of Joints
Fibrous Joint – This is where the bones are bound by a tough, fibrous tissue (joints
that require strength and stability over range of movement).
Cartilaginous Joint – A type of joint where the bones are entirely connected by
cartilage. These joints allow more movement than fibrous joints.

Synovial Joint – A type of joint characterised by the presence of fluid filled joint cavity
contained within a fibrous capsule.
Types of Synovial Joints
Gliding – This type of joint is formed between two bones. These bones can slide over
each other as they are both flat. The gliding joint allows movement back and forth, and
side to side. An example would be a wrist or an ankle.

Hinge – This type of joint occurs when two bones meet in a fixed position. The
movement of the joint involves flexion and extension. A good example of such would be
a knee or an elbow.

Pivot – This joint rotates within a ring made by a concave surface, and it allows axial
rotation. An example would be the first and second vertebrae.

Condyloid – This type of joint is located on the surface of circular bone synovial and
allows the “two degrees of freedom”. A good example would be a wrist.
Saddle – Allows ratification by reciprocal reception, which interacts like a saddle
opposite to each other. This joint allows the “two degrees of freedom”. An example
would be a trapeziometacarpal.

Ball and Socket – This type of joint allows a lot of freedom because it sits on a ball
allowing it to move in multiple directions. Hips would be a perfect example of a ball and
socket joint.
Abduction – Movement away from the body, which occurs at the hip and shoulder
joints during a jumping jack movement.

Adduction – Movement towards the midline of the body, and the opposite of adduction.

Flexion – Bending a joint, which occurs when the angle of a joint decreases.
Extension – Straightening a joint, which occurs when the angle of a joint increases.

Rotation – Rotation is the movement around the axis. It involves lateral and medial
rotation.
Circumduction – a circular movement that uses abduction, adduction, flexion and
extension. The process of circumduction is achieved by combining shoulder movements
so that the hand traces a circle, and the arm traces a cone.
Muscular system
The muscular system is an organ system made of specialised contractile tissue called
the muscles.

Skeletal muscles
Skeletal muscles consist of many different integrated tissues including the skeletal
muscle fibers, connective tissues, nerve fibers and blood vessels. Each skeletal muscle
is characterised by three layers of tissue that connect, enclose, and compartmentalize
the muscle. Each skeletal muscle is surrounded by a connective tissue called
epimysium, which enables the muscle to move and contract, maintaining its structural
integrity at the same time, as well as allowing the muscle to move independently from
other tissues.
Cardiac, Smooth & Skeletal muscles
Cardiac muscle is known known as an involuntary muscle, however its structure is more
akin and therefore slightly different to skeletal muscles and is located in the heart.
Cardiac and skeletal muscles both exist striated because they hold sarcomeres and are
packed into very consistent, repeating plans of bundles. Smooth muscle does not have
any of these attributes, however both cardiac and smooth muscles are involuntary –
skeletal muscles are voluntary. Smooth muscles contract without conscious control and
is found in walls of internal organs such as intestine, bladder, stomach, and blood
vessels (excluding the heart).
Tendon - Muscle attaches to bone through a fibrous connective tissue called the
tendon. Similarly, the muscles may attach to eyeballs or to other structures with the help
of tendons. Bones and structures are moved by tendons. An example of a tendon is the
Achilles tendon and biceps tendon.
Ligaments - Your joints are surrounded by bands of tough elastic tissue. You need
them to connect bones, provide support to joints, and limit joint movement. Your knees,
ankles, elbows, and fingers are all supported by ligaments. When they are stretched or
torn, they may become inflamed. Examples: calcaneofibular ligament, posterior cruciate
ligament.

Structure of Myofibril
Myofibril is made of two types of myofilaments – actin (thin filaments) and myosin (thick
filaments). They overlap each other and make the muscle appear stripy. Their
arrangement is known as the sarcomere.

The diagram above shows a relaxed skeletal muscle. When the muscle is contracted,
as a result of transferring energy (ATP) in the form of Ca2+, the sarcomere “tightens” as
shown below.

Muscle contraction
The myofilaments in the myofibril interact to make a muscle contract. The muscle
receives an impulse from the nerves, what triggers a series of events which results in
the muscle contraction.
The ATP is bound to a binding site on the myosin head and is now hydrolysed by
myosin which works as an enzyme. In the second phase, the muscle receives an
impulse from the nerves and arrives at a neuromuscular junction, which generates an
action potential in the sarcolemma, what then results in the release of Ca2+ from the
sarcoplasmic reticulum in the muscle fascicles. Then myosin binds to actin binding sites
creating a cross-bridge. The cross-bridges act as a connective material which attaches
and detaches actin filaments towards the centre, what shortens the sarcomere, however
this process requires energy. Muscle contraction occurs. In the final phase Ca2+ ions
are removed what causes the tropomyosin to return to its previous state, blocking the
binding site. The myosin detaches from the actin filament. The ATP releases chemical
energy which is then transformed to potential energy and stored in the straightening the
neck place of the myosin. Contraction stops and repeats.

Fast & Slow twitch muscles

Fast twitch muscles contract quickly and use a lot of oxygen instantly (they provide
endurance or long-lasting energy), whereas the slow twitch muscles contract slowly and
do not consume too much oxygen (they provide bursts of energy, what results in getting
tired very quickly).

Antagonistic muscle pairs

In an antagonistic pair one muscle contracts as the other relaxes or lengthens. The
muscle that is responsible for relaxing or lengthening is known as the antagonist
muscle, and the muscle that is contracting is called the agonist. In the pair, one muscle
contracts to move the body part, while the other muscle contracts to return it to its
previous position.
 Joint Antagonistic pair Individual muscle Movement
Elbow Biceps and Triceps Triceps Extends the arm
Biceps Flexes the arm
Knee Quadriceps and Quadriceps Bends the leg
hamstrings Hamstrings Straightens the leg
Shoulder Deltoid and rotator cuff Deltoid Straightens the arm
Rotator cuff Bends the arm
Ankle Gastrocnemius and Gastrocnemius Straightens the leg
tibialis anterior Tibialis anterior Flexes the leg

Arthritis
Arthritis is a condition which causes tenderness and swelling of joints such as the knee
joint. Normally, the knee joint allows flexion, extension, with limited lateral and medial
rotations, and when it is damaged, these movements are very painful, or even
impossible, and so are activities such as walking and running. Symptoms depend on
the type of arthritis and usually include joint or knee pain, redness in the joints and
fever. This condition is caused by bacterial or viral infection, metabolic abnormalities,
which means an imbalance of chemical substances in the body, tear of a joint from
overuse, injuries, old age. Arthritis can be treated with medications such as
corticosteroids to suppress the immune system and ibuprofen to reduce pain, however
in most cases a medical procedure must be performed to heal arthritis. One procedure
involves smoothening or realigning of joint surfaces (Joint smoothening), and another
common procedure involves removing damaged joints and replacing them with artificial
joints (Joint replacement). Most patients prefer smoothening or realigning because it is
less drastic, and the recovery time is much shorter in comparison to removing damaged
joints, however the main treatment for arthritis is lifestyle changes to keep the joints
healthy.

Hip Dysplasia
Hip dysplasia is a condition affecting hip joints as the socket part does not fully cover
the ball part of the upper thighbone, what results in dislocation of hip bone. The hip joint
is a multiaxial joint and allows a range of motion: abduction, adduction, flexion,
extension, circumduction, external and internal rotation. When damaged, activities such
as walking, running and even sitting will likely be painful. Symptoms of the disease
include limited range of motion, asymmetry and swayback. The limited range of motion
means that the affected hip is less flexible. Asymmetry means one leg is longer than the
other, and the swayback involves limping and exaggerated spine curvature. Hip
dysplasia can be healed as a result of various treatments such as arthroscopy (tools
and cameras inserted into the body through small incisions to visualize the inside of a
joint and apply treatment), periacetabular osteotomy, which involves repositioning the
socket by cutting it free from the pelvis to match better with the ball (Infants only), and
hip replacement (replacing hip joint with a prosthetic implant). The hip replacement is
the main treatment for hip dysplasia as it is very effective and eliminates the risk of the
condition coming back.

Hypermobility
Hypermobility syndrome is when a person has the ability to move joints beyond limits,
what results in pain and stiffness in certain body parts such as fingers, hips and knees.
Other symptoms include spraining or dislocating joints. In the knee joint, there is flexion,
extension, as well as lateral and medial rotation, and when it is damaged, these
movements are painful, or even impossible to perform, as well as activities like walking
and running. Hypermobility is a consequence of a lack of vitamins and regular exercise.
This syndrome can be treated with vitamins, painkillers (Pharmacotherapy) and a set of
exercises to protect and strengthen joints (Lifestyle changes). The main treatment for
this condition is either simply exercising daily (this is because this form of treatment is
very simple, effective and ensures immunity to the syndrome), or hip replacement
(replacing hip joint with a prosthetic implant) depending on the joint being affected.

Arthritis, Hip Dysplasia & Hypermobility Comparison

Both arthritis and hypermobility affect the knee joint (hypermobility also affects finger
and hip joints), which allows extension, flexion, and partly medial and lateral rotation –
these movements are important to perform activities such as walking or running,
whereas hip dysplasia affects the hip joint (hypermobility also affects hip joints), making
movements such as flexion, extension, abduction, adduction, circumduction, external
and internal rotation very difficult - and therefore activities such as sitting, walking and
running. Located behind the knee, the quadriceps femoris muscles (vastus lateralis,
rectus femoris, vastus intermedius, vastus medius) contracts in order to extend, and the
hamstring group muscles flex the knee. While the gluteus maximus muscle extends the
hip, the gluteus medius and minimus rotate it and abduct it. From an abducted position,
the adductors (longus, magnus, petineus, adductor brevis, gracilis) move the femur
towards the midline. Since both arthritis and hypermobility affect the knee joint, in this
case, the best treatment for these two conditions is lifestyle changes such as exercising
and vitamins to strengthen the joints, because it is simple and prevents them from
recurring, whereas the main hip dysplasia treatment involves replacing the damaged hip
with a prosthetic implant, and this treatment is most used because it is permanent and
effective. Arthritis mainly affects the knee joint, making everyday activities such as
walking painful, and can be treated with exercises. Hip dysplasia is more serious as it
affects the hip joint, which is essential to normally walk, run, or even sit properly, and
the hip replacement involves surgery. Hypermobility affects both of these joints and
combines the effects therefore making this condition the most severe out of all three, as
it can be cured with a set of exercises, however it may also require surgery.

Evaluation of hypermobility treatments

The lifestyle change and pharmacotherapy treatment for hypermobility described above
is very simple and comes with side effects which are beneficial for patients. It helps to
reduce pain during the treatment, strengthen joints and allow all the movements of a
healthy joint. Psychologically, the patient will know that their condition is not severe and
that undemanding activities can heal the syndrome, meaning that their mental attitude is
positive which is beneficial for the outcome of treatment. The patient will exercise daily,
what is beneficial not only towards a successful end of the treatment but will also
positively affect their health and well-being. Most importantly, the patient will get to know
people who similarly to them suffer from certain syndromes and diseases, meaning that
they will likely support each other. The limitation of this treatment is that the time of
rehabilitation is in most cases unknown and may take anywhere from a few days to
even weeks, and of course there is no guarantee that the treatment will be successful.
The treatment for hypermobility, in the case of hip joint being affected, involves
performing hip replacement surgery. It eliminates hypermobility by replacing damaged
joints with new ones, what then once again allows all the movements of a healthy hip.
Psychologically, the patient knows their condition requires surgery and because of this,
they will be overthinking, considering fatal outcomes, meaning that their mental attitude
will be negative. They will be unable to walk for several weeks until they have fully
recovered, what means their life will be affected physically. Because of this, their social
life may be affected as they cannot walk what makes attending activities such as dance
parties pretty complicated. The limitation of hip replacement is a long recovery time,
which varies depending on the outcome of the procedure, and if there will be any
complications such as infections. Overall, the second treatment is a more reliable option
because it eliminates hypermobility once and for all, whereas with the first treatment
there is no guarantee that the condition will not come back as soon as patient decides
to stop exercising and taking prescribed medication.
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