Chapter VI Anatomy and Physiology

The musculoskeletal system provides form, stability, and movement to the human body. It consists of the body's bones (which make up the skeleton), muscles, tendons, ligaments, joints, cartilage, and other connective tissue. The term "connective tissue" is used to describe the tissue that supports and binds tissues and organs together. Its chief components are elastic fibers and collagen, a protein substance. A. Bones Bone, although strong, is a constantly changing tissue that has several functions. Bones serve as rigid structures to the body and as shields to protect delicate internal organs. They provide housing for the bone marrow, where the blood cells are formed.

Bones also maintain the body's reservoir of calcium. In children, some bones have areas called growth plates. Bones lengthen in these areas until the child reaches full height, at which time the growth plates close. Thereafter, bones grow in thickness rather than in length, based on the body's need for additional bone strength in certain areas.

Bones have two shapes: flat (such as the plates of the skull and the vertebrae) and tubular (such as the thighbones and arm bones, which are called long bones). All bones have essentially the same structure. The hard outer part (cortical bone) consists largely of proteins, such as collagen, and a substance called hydroxyapatite, which is composed mainly of calcium and other minerals. Hydroxyapatite is largely responsible for the strength and density of bones.

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The inner part of bones (trabecular bone) is softer and less dense than the hard outer part. Bone marrow is the tissue that fills the spaces in the trabecular bone. Bone marrow contains specialized cells (including stem cells) that produce blood cells. Blood vessels supply blood to the bone, and nerves surround the bone. Bones are covered by a thin membrane called the periosteum. Injury to bone transmits pain because of nerves located mostly in the periosteum. Blood enters bones through blood vessels that enter through the periosteum. B. Joints and Cartilages Joints are the junction between two or more bones. Some joints do not normally move, such as those located between the plates of the skull. Other joints allow a large and complex range of motion. The configuration of a joint determines the degree and direction of possible motion. For example, the shoulder joints, which have a ball-andsocket design, allow inward and outward rotation as well as forward, backward, and sideways motion of the arms. Hinge joints of the knees, fingers, and toes allow only bending (flexion) and straightening (extension). The components of joints provide stability and reduce the risk of damage from constant use. In a joint, the ends of the bones are covered with cartilagea smooth, tough, resilient, and protective tissue composed of collagen, water, and proteoglycans that reduces friction as joints move. (Collagen is a tough fibrous tissue; proteoglycans are substances that provide the cartilage's resilience.) Joints also have a lining synovial tissue) that encloses them to form the joint capsule. Cells in the synovial tissue produce
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a small amount of clear fluid (synovial fluid), which provides nourishment to the cartilage and further reduces friction while facilitating movement.

C. Ligaments

Ligaments are tough fibrous cords composed of connective tissue that contains both collagen and elastic fibers. The elastic fibers allow the ligaments to stretch to some extent. Ligaments surround joints and bind them together. They help strengthen and stabilize joints, permitting movement only in certain directions. Ligaments also connect one bone to another (such as inside the knee).

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A short band of tough but flexible connective tissue that, in most cases, holds two or more bones together at a movable joint. Ligaments restrain the movement of bones at a joint and are therefore important in preventing dislocation. Ligaments are of two types. The majority is composed of collagen fibers and is unstretchable under normal conditions. Examples of this type of ligament are the iliofemoral ligament of the hip joint and the collateral ligaments of the elbow joint. The second type is composed largely of elastic tissue and can therefore regain its original length after stretching. Examples include the ligamentum flavum of the spinal

column and the calcaneonavicular ligament of the foot. D. Muscles Every one of the body's 430 skeletal muscles consists of muscle tissue, connective tissue, nerves and blood vessels. A fibrous fascia called the epimysium covers each muscle and tendon. Tendons connect the muscle belly to bone and they attach to the bone periosteum - more connective tissue that covers all bones. Contraction of the muscle belly pulls on the tendon and in turn, the bone it is attached to. Limb muscles (such as the biceps brachii in the upper arm) have two attachments to bone. The proximal or origin is the attachment closest to the trunk.

The distal or insertion is the attachment furthest from the trunk. Trunk muscles (such as the rectus abdominus in the stomach) also have two attachments - superior (closer to the head) and inferior (further from the head).

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Each muscle belly is made up of muscle cells or fibers. Muscle fibers are grouped into bundles (of up to 150 fibers) called fasciculi. Each fasiculus or bundle is surrounded by connective tissue called perimysium. Fibers within each bundle are surrounded by more connective tissue called endomysium. Each individual fiber consists of a membrane (sarcolemma) and can be further broken down into hundreds or even thousands of myofibrils. Myofibrils are surrounded by sarcoplasm and together they make up the contractile components of a muscle.

Tendons are tough bands of connective tissue made up mostly of a rigid protein called collagen. Tendons firmly attach each end of a muscle to a bone. They are often located within sheaths, which are lubricated to allow the tendons to move without friction. Bursas are small fluid-filled sacs that can lie under a tendon, cushioning the tendon and protecting it from injury. Bursas also provide extra cushioning to adjacent structures that otherwise might rub against each other, causing wear and tearfor example, between a bone and a ligament or a bony prominence and overlying skin (such as in the elbow, kneecap, or shoulder area).
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