Musculoskeletal Disorders Sourcebook, First Edition

Preface

About This Book

Musculoskeletal disorders are the leading cause of disabilities in the United States. In the private sector of the United States, there were 900,380 days away from work, with musculoskeletal disorders accounting for 272,780 (or 30 percent). Musculoskeletal disorder cases were 311,840 in 2011. In 2018, there have been 27.2 musculoskeletal disorder cases per 10,000 full-time workers, compared to 35.4 in 2011. Musculoskeletal disorder cases needed an estimated 12 days off work in 2018, compared to 11 days in 2011. Musculoskeletal disorders cause a huge economic burden, costing the working population millions in earnings and lost working days. Arthritis, injuries related to falls, trauma, osteoporosis, and back pain are some of the most common musculoskeletal conditions and disorders. Many people also suffer from the debilitating effects caused by spinal deformities, congenital musculoskeletal defects, and cancers of the bone and soft tissues.

Musculoskeletal Disorders Sourcebook, First Edition provides comprehensive information about the musculoskeletal system, its functions, and common musculoskeletal disorders affecting the bones, muscles, and joints. This book also provides information regarding musculoskeletal system defects caused by genetic factors and congenital anomalies. Along with cancers of the musculoskeletal system, this book contains information regarding workplace-related musculoskeletal conditions caused by repetitive stress injuries to the bones, muscles and joints, and ways to prevent those injuries. Prevention strategies, strategies for therapeutic management of musculoskeletal pain and rehabilitation strategies are also discussed. The book concludes with a glossary of terms related to musculoskeletal disorders and a directory of organizations for additional information.

How to Use This Book

This book is divided into parts and chapters. Parts focus on broad areas of interest. Chapters are devoted to single topics within a part.

Part 1: An Overview of the Musculoskeletal System and Its Disorders briefs about muscular and skeletal systems and how it functions. It describes muscle and bone diseases and the importance of musculoskeletal health. This part also presents information on the causes and symptoms of musculoskeletal pain, as well as the prevalence of musculoskeletal disorders among different age groups.

Part 2: Common Musculoskeletal Disorders and Conditions covers conditions that affect bones, joints, muscles, and the spine. It also has a dedicated chapter for chronic pain syndromes, and sports injuries. The part concludes by briefing traumatic events that cause musculoskeletal disorders.

Part 3: Work-Related Musculoskeletal Disorders and Ergonomics explores musculoskeletal disorders across major industries. It starts by giving a general overview and goes into an industry-specific overview. It further discusses work environment standards and how to perform risk assessments.

Part 4: Musculoskeletal Disorders Caused by Genetic Factors and Congenital Abnormalities presents major musculoskeletal disorders such as muscular dystrophy (MD), congenital limb defects, and congenital myopathy that result from genetic factors and congenital abnormalities. It also discusses the symptoms, causes, and treatments of such musculoskeletal disorders.

Part 5: Cancers of Musculoskeletal System covers primary cancers that are related to bone, muscle, and joints. It also includes the discussion of rare cancer and neurological disease, its symptoms, and diagnosis.

Part 6: Musculoskeletal Health: Prevention, Management, and Rehabilitation describes preventive measures and safe physical activities for different age categories. It briefs about how to cope up with chronic musculoskeletal pain and complementary and alternative musculoskeletal disorder treatments. The part concludes with exploring the management techniques such as prostheses for various types of amputation and assistive devices that alleviate the pain or improves the movement.

Part 7: Additional Help and Information includes a glossary of terms related to musculoskeletal system and a directory of resources for additional help and support.

Bibliographic Note

This volume contains documents and excerpts from publications issued by the following U.S. government agencies: Centers for Disease Control and Prevention (CDC); ClinicalTrials.gov; Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD); Genetic and Rare Diseases Information Center (GARD); MedlinePlus; National Aeronautics and Space Administration (NASA); National Cancer Institute (NCI); National Center on Birth Defects and Developmental Disabilities (NCBDDD); National Institute for Occupational Safety and Health (NIOSH); National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); National Institute of Neurological Disorders and Stroke (NINDS); National Institute of Standards and Technology (NIST); NIH News in Health; NIH Osteoporosis and Related Bone Diseases – National Resource Center (NIH ORBD – NRC); Occupational Safety and Health Administration (OSHA); Surveillance, Epidemiology, and End Results (SEER) Program; U.S. Bureau of Labor Statistics (BLS); and U.S. Department of Health and Human Services (HHS).

It also contains original material produced by Infobase and reviewed by medical consultants.

About the Health Reference Series

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A Note about Spelling and Style

Health Reference Series editors use Stedman’s Medical Dictionary as an authority for questions related to the spelling of medical terms and The Chicago Manual of Style for questions related to grammatical structures, punctuation, and other editorial concerns. Consistent adherence is not always possible, however, because the individual volumes within the Series include many documents from a wide variety of different producers, and the editor’s primary goal is to present material from each source as accurately as is possible. This sometimes means that information in different chapters or sections may follow other guidelines and alternate spelling authorities. For example, occasionally a copyright holder may require that eponymous terms be shown in possessive forms (Crohn’s disease vs. Crohn disease) or that British spelling norms be retained (leukaemia vs. leukemia).

Medical Review

Infobase contracts with a team of qualified, senior medical professionals who serve as medical consultants for the Health Reference Series. As necessary, medical consultants review reprinted and originally written material for currency and accuracy. Citations including the phrase Reviewed (month, year) indicate material reviewed by this team. Medical consultation services are provided to the Health Reference Series editors by:

Dr. Vijayalakshmi, MBBS, DGO, MD

Dr. Senthil Selvan, MBBS, DCH, MD

Dr. K. Sivanandham, MBBS, DCH, MS (Research), PhD

Health Reference Series Update Policy

The inaugural book in the Health Reference Series was the first edition of Cancer Sourcebook published in 1989. Since then, the Series has been enthusiastically received by librarians and in the medical community. In order to maintain the standard of providing high-quality health information for the layperson the editorial staff at Infobase felt it was necessary to implement a policy of updating volumes when warranted.

Medical researchers have been making tremendous strides, and it is the purpose of the Health Reference Series to stay current with the most recent advances. Each decision to update a volume is made on an individual basis. Some of the considerations include how much new information is available and the feedback we receive from people who use the books. If there is a topic you would like to see added to the update list, or an area of medical concern you feel has not been adequately addressed, please write to: custserv@infobaselearning.com.

Part 1 | An Overview of the Musculoskeletal System and Its Disorders

Chapter 1 | What Is the Musculoskeletal System?

Chapter Contents

Section 1.1—The Skeletal System

Section 1.2—The Muscular System1

Section 1.3—How Does the Musculoskeletal System Function?

Section 1.1 | The Skeletal System

This section includes text excerpted from Introduction to the Skeletal System, Surveillance, Epidemiology, and End Results (SEER) Program, National Cancer Institute (NCI), June 30, 2002. Reviewed March 2022.

Humans are vertebrates, animals having a vertebral column or backbone. They rely on a sturdy internal frame that is centered on a prominent spine. The human skeletal system consists of bones, cartilage, ligaments, and tendons and accounts for about 20 percent of the body weight.

The living bones in our bodies use oxygen and give off waste products in metabolism. They contain active tissues that consume nutrients, require a blood supply and change shape or remodel in response to variations in mechanical stress.

Bones provide a rigid framework, known as the skeleton, that supports and protects the soft organs of the body.

The skeleton supports the body against the pull of gravity. The large bones of the lower limbs support the trunk when standing.

The skeleton also protects the soft body parts. The fused bones of the cranium surround the brain to make it less vulnerable to injury. Vertebrae surround and protect the spinal cord and bones of the rib cage help protect the heart and lungs of the thorax.

Bones work together with muscles as simple mechanical lever systems to produce body movement.

Bones contain more calcium than any other organ. The intercellular matrix of bone contains large amounts of calcium salts, the most important being calcium phosphate.

When blood calcium levels decrease below normal, calcium is released from the bones so that there will be an adequate supply for metabolic needs. When blood calcium levels are increased, the excess calcium is stored in the bone matrix. The dynamic process of releasing and storing calcium goes on almost continuously.

Hematopoiesis, the formation of blood cells, mostly takes place in the red marrow of the bones.

In infants, red marrow is found in the bone cavities. With age, it is largely replaced by yellow marrow for fat storage. In adults, red marrow is limited to the spongy bone in the skull, ribs, sternum, clavicles, vertebrae, and pelvis. Red marrow functions in the formation of red blood cells (RBCs), white blood cells (WBCs) and blood platelets.

Structure of Bone Tissue

There are two types of bone tissue: compact and spongy. The names imply that the two types differ in density, or how tightly the tissue is packed together. There are three types of cells that contribute to bone homeostasis. Osteoblasts are bone-forming cell, osteoclasts resorb or break down bone, and osteocytes are mature bone cells. An equilibrium between osteoblasts and osteoclasts maintains bone tissue.

Compact Bone

Compact bone consists of closely packed osteons or haversian systems. The osteon consists of a central canal called the osteonic (haversian) canal, which is surrounded by concentric rings (lamellae) of matrix. Between the rings of matrix, the bone cells (osteocytes) are located in spaces called lacunae. Small channels (canaliculi) radiate from the lacunae to the osteonic (haversian) canal to provide passageways through the hard matrix. In compact bone, the haversian systems are packed tightly together to form what appears to be a solid mass. The osteonic canals contain blood vessels that are parallel to the long axis of the bone. These blood vessels interconnect, by way of perforating canals, with vessels on the surface of the bone.

Spongy (Cancellous) Bone

Spongy (cancellous) bone is lighter and less dense than compact bone. Spongy bone consists of plates (trabeculae) and bars of bone adjacent to small, irregular cavities that contain red bone marrow. Perforating fibers are part of the outer fibrous layer of the periosteum that consists of bundles of strong predominantly type I collagen fibers, connecting the periosteum to the bone. Collagen fibers help in limiting the deformation of tendons and other load-bearing

Figure 1.1. Bone Tissue

tissues. The canaliculi connect to the adjacent cavities, instead of a central haversian canal, to receive their blood supply. It may appear that the trabeculae are arranged in a haphazard manner, but they are organized to provide maximum strength similar to braces that are used to support a building. The trabeculae of spongy bone follow the lines of stress and can realign if the direction of stress changes. Cross sectional view of the spongy (cancellous) bone is shown in Figure 1.1.

Bone Development and Growth

The terms osteogenesis and ossification are often used synonymously to indicate the process of bone formation. Parts of the skeleton form during the first few weeks after conception. By the end of the eighth week after conception, the skeletal pattern is formed in cartilage and connective tissue membranes and ossification begins.

Bone development continues throughout adulthood. Even after adult stature is attained, bone development continues for repair of fractures and for remodeling to meet changing lifestyles. Osteoblasts, osteocytes and osteoclasts are the three cell types involved in the development, growth and remodeling of bones. Osteoblasts are bone-forming cells, osteocytes are mature bone cells and osteoclasts break down and reabsorb bone.

There are two types of ossification: intramembranous and endochondral.

Intramembranous

Intramembranous ossification involves the replacement of sheet-like connective tissue membranes with bony tissue. Bones formed in this manner are called intramembranous bones. They include certain flat bones of the skull and some of irregular bones. The future bones are first formed as connective tissue membranes. Osteoblasts migrate to the membranes and deposit bony matrix around themselves. When the osteoblasts are surrounded by matrix they are called osteocytes.

Endochondral

Endochondral ossification involves the replacement of hyaline cartilage with bony tissue. Most of the bones of the skeleton are formed in this manner. These bones are called endochondral bones. In this process, the future bones are first formed as hyaline cartilage models. During the third month after conception, the perichondrium that surrounds the hyaline cartilage models becomes infiltrated with blood vessels and osteoblasts and changes into a periosteum. The osteoblasts form a collar of compact bone around the diaphysis. At the same time, the cartilage in the center of the diaphysis begins to disintegrate. Osteoblasts penetrate the disintegrating cartilage and replace it with spongy bone. This forms a primary ossification center. Ossification continues from this center toward the ends of the bones. After spongy bone is formed in the diaphysis, osteoclasts break down the newly formed bone to open up the medullary cavity.

The cartilage in the epiphyses continues to grow so the developing bone increases in length. Later, usually after birth, secondary ossification centers form in the epiphyses. Ossification in

Figure 1.2. Bone Growth

the epiphyses is similar to that in the diaphysis except that the spongy bone is retained instead of being broken down to form a medullary cavity. When secondary ossification is complete, the hyaline cartilage is totally replaced by bone except in two areas. A region of hyaline cartilage remains over the surface of the epiphysis as the articular cartilage and another area of cartilage remains between the epiphysis and diaphysis. This is the epiphyseal plate or growth region.

Bone Growth

Bones grow in length at the epiphyseal plate by a process that is similar to endochondral ossification. The cartilage in the region of to the epiphyseal plate, as shown in Figure 1.2, next the epiphysis continues to grow by mitosis. The chondrocytes, in the region next to the diaphysis, age and degenerate. Osteoblasts move in and ossify the matrix to form bone. This process continues throughout childhood and the adolescent years until the cartilage growth slows and finally stops. When cartilage growth ceases, usually in the early twenties, the epiphyseal plate completely ossifies so that only a thin epiphyseal line remains and the bones can no longer grow in length. Bone growth is under the influence of growth hormones from the anterior pituitary gland and sex hormones from the ovaries and testes.

Even though bones stop growing in length in early adulthood, they can continue to increase in thickness or diameter throughout life in response to stress from increased muscle activity or to weight. The increase in diameter is called appositional growth. Osteoblasts in the periosteum form compact bone around the external bone surface. At the same time, osteoclasts in the endosteum break down bone on the internal bone surface, around the medullary cavity. These two processes together increase the diameter of the bone and, at the same time, keep the bone from becoming excessively heavy and bulky.

Classification of Bones

Long Bones

The bones of the body come in a variety of sizes and shapes. The four principal types of bones are long, short, flat and irregular. Bones that are longer than they are wide are called long bones. They consist of a long shaft with two bulky ends or extremities as shown in Figure 1.3. They are primarily compact bone, but may have a large amount of spongy bone at the ends or extremities. Long bones include bones of the thigh, leg, arm, and forearm.

Short Bones

Short bones are roughly cube shaped with vertical and horizontal dimensions approximately equal. They consist primarily of spongy bone, which is covered by a thin layer of compact bone. Short bones include the bones of the wrist and ankle.

Flat Bones

Flat bones are thin, flattened, and usually curved. Most of the bones of the cranium are flat bones.

Figure 1.3. Long Bones

Irregular Bones

Bones that are not in any of the above three categories are classified as irregular bones. They are primarily spongy bone that is covered with a thin layer of compact bone. The vertebrae and some of the bones in the skull are irregular bones. All bones have surface markings and characteristics that make a specific bone unique. There are holes, depressions, smooth facets, lines, projections and other markings. These usually represent passageways for vessels and nerves, points of articulation with other bones or points of attachment for tendons and ligaments.

Figure 1.4. Cranial Bones

Figure 1.5. Facial Bones

Divisions of the Skeleton

The adult human skeleton usually consists of 206 named bones. These bones can be grouped in two divisions: axial skeleton and appendicular skeleton. The 80 bones of the axial skeleton as shown in Figure 1.4 (cranial bones), Figure 1.5 (facial bones), Figure 1.6

Figure 1.6. Auditory Ossicles

Figure 1.7. Vertebral Column

(auditory ossicles), and Figure 1.7 (vertebral column), and Figure 1.8 (thoracic cage) form the vertical axis of the body. They include the bones of the head, vertebral column, ribs and breastbone or sternum. The appendicular skeleton consists of 126 as shown in Figure 1.9 (pectoral girdles), Figure 1.10 (upper extremity), Figure 1.11 (pelvic girdle), and Figure 1.12 (lower extremity) and includes

Figure 1.8. Thoracic Cage

Figure 1.9. Pectoral Girdles

Figure 1.10. Upper Extremity

Figure 1.11. Pelvic Girdle

Figure 1.12. Lower Extremity

the free appendages and their attachments to the axial skeleton. The free appendages are the upper and lower extremities, or limbs, and their attachments which are called girdles. The named bones of the body are listed below by category.

Axial Skeleton (80 Bones)

Skull (28)

Cranial Bones

Parietal (2)

Temporal (2)

Frontal (1)

Occipital (1)

Ethmoid (1)

Sphenoid (1)

Facial Bones

Maxilla (2)

Zygomatic (2)

Mandible (1)

Nasal (2)

Platine (2)

Inferior nasal concha (2)

Lacrimal (2)

Vomer (1)

Auditory Ossicles

Malleus (2)

Incus (2)

Stapes (2)

Hyoid (1)

Vertebral Column

Cervical vertebrae (7)

Thoracic vertebrae (12)

Lumbar vertebrae (5)

Sacrum (1)

Coccyx (1)

Thoracic Cage

Sternum (1)

Ribs (24)

Appendicular Skeleton (126 bones)

Pectoral Girdles

Clavicle (2)

Scapula (2)

Upper Extremity

Humerus (2)

Radius (2)

Ulna (2)

Carpals (16)

Metacarpals (10)

Phalanges (28)

Pelvic Girdle

Coxal, innominate, or hip bones (2)

Lower Extremity

Femur (2)

Tibia (2)

Fibula (2)

Patella (2)

Tarsals (14)

Metatarsals (10)

Phalanges (28)

Articulations

An articulation, or joint, is where two bones come together. In terms of the amount of movement they allow, there are three types of joints: immovable, slightly movable and freely movable.

Synarthroses

Synarthroses are immovable joints. The singular form is synarthrosis. In these joints, the bones come in very close contact and are separated only by a thin layer of fibrous connective tissue. The sutures in the skull are examples of immovable joints.

Amphiarthroses

Slightly movable joints are called amphiarthroses. The singular form is amphiarthrosis. In this type of joint, the bones are connected by hyaline cartilage or fibrocartilage. The ribs connected to the sternum by costal cartilages are slightly movable joints connected by hyaline cartilage. The symphysis pubis is a slightly movable joint in which there is a fibrocartilage pad between the two bones. The joints between the vertebrae and the intervertebral disks are also of this type.

Diarthroses

Most joints in the adult body are diarthroses, or freely movable joints. The singular form is diarthrosis. In this type of joint, the ends of the opposing bones are covered with hyaline cartilage, the articular cartilage (Covers the ends of bones and allows the distribution of compressive loads over the cross section of bones), and they are separated by a space called the joint cavity. The components of the joints are enclosed in a dense fibrous joint capsule as shown in Figure 1.13. The outer layer of the capsule consists of the ligaments that hold the bones together. The inner layer is the synovial membrane that secretes synovial fluid into the joint cavity for lubrication. Because all of these joints have a synovial membrane, they are sometimes called synovial joints.

Figure 1.13. Synovial Joints

Section 1.2 | The Muscular System

This section includes text excerpted from Introduction to the Muscular System, Surveillance, Epidemiology, and End Results (SEER) Program, National Cancer Institute (NCI), June 30, 2002. Reviewed March 2022.

The muscular system is composed of specialized cells called muscle fibers. Their predominant function is contractibility. Muscles, attached to bones or internal organs and blood vessels, are responsible for movement. Nearly all movement in the body is the result of muscle contraction. Exceptions to this are the action of cilia, the flagellum on sperm cells, and amoeboid movement of some white blood cells (WBCs).

The integrated action of joints, bones, and skeletal muscles produces obvious movements such as walking and running. Skeletal muscles also produce more subtle movements that result in various facial expressions, eye movements, and respiration.

In addition to movement, muscle contraction also fulfills some other important functions in the body, such as posture, joint stability, and heat production. Posture, such as sitting and standing, is maintained as a result of muscle contraction. The skeletal muscles are continually making fine adjustments that hold the body in stationary positions. The tendons of many muscles extend over joints and in this way contribute to joint stability. This is particularly evident in the knee and shoulder joints, where muscle tendons are a major factor in stabilizing the joint. Heat production, to maintain body temperature, is an important by-product of muscle metabolism. Nearly 85 percent of the heat produced in the body is the result of muscle contraction.

Structure of Skeletal Muscle

A whole skeletal muscle is considered an organ of the muscular system. Each organ or muscle consists of skeletal muscle tissue, connective tissue, nerve tissue, and blood or vascular tissue.

Skeletal muscles vary considerably in size, shape, and arrangement of fibers. They range from extremely tiny strands such as the stapedium muscle of the middle ear to large masses such as the muscles of the thigh. Some skeletal muscles are broad in shape and some narrow. In some muscles the fibers are parallel to the long axis of the muscle; in some, they converge to a narrow attachment, and in some they are oblique.

Each skeletal muscle fiber is a single cylindrical muscle cell. An individual skeletal muscle may be made up of hundreds, or even thousands, of muscle fibers, bundled together and wrapped in a connective tissue covering. Each muscle is surrounded by a connective tissue sheath called the epimysium, as shown in Figure 1.14. Fascia, connective tissue outside the epimysium, surrounds and separates the muscles. Portions of the epimysium project inward to divide the muscle into compartments. Each compartment contains a bundle of muscle fibers. Each bundle of muscle fiber is called a fasciculus and is surrounded by a layer of connective tissue called the perimysium. Within the fasciculus, each individual muscle cell, called a muscle fiber, is surrounded by connective tissue called the endomysium.

Figure 1.14. Muscle Structure

Skeletal muscle cells (fibers), such as other body cells, are soft and fragile. The connective tissue covering furnishes support and protection for the delicate cells and allow them to withstand the forces of contraction. The coverings also provide pathways for the passage of blood vessels and nerves.

Commonly, the epimysium, perimysium, and endomysium extend beyond the fleshy part of the muscle, the belly or gaster, to form a thick rope-like tendon or a broad, flat sheet-like aponeurosis. The tendon and aponeurosis form indirect attachments from muscles to the periosteum of bones or to the connective tissue of other muscles. Typically a muscle spans a joint and is attached to bones by tendons at both ends. One of the bones remains relatively fixed or stable while the other end moves as a result of muscle contraction.

Skeletal muscles have an abundant supply of blood vessels and nerves. This is directly related to the primary function of skeletal muscle, contraction. Before a skeletal muscle fiber can contract, it has to receive an impulse from a nerve cell. Generally, an artery and at least one vein accompany each nerve that penetrates the epimysium of a skeletal muscle. Branches of the nerve and blood vessels follow the connective tissue components of the muscle of a nerve cell and with one or more minute blood vessels called capillaries.

Muscle Types

In the body, there are three types of muscle: skeletal (striated), smooth, and cardiac.

Skeletal Muscle

Skeletal muscle, attached to bones, is responsible for skeletal movements. The peripheral portion of the central nervous system (CNS) controls the skeletal muscles. Thus, these muscles are under conscious, or voluntary, control. The basic unit is the muscle fiber with many nuclei. These muscle fibers are striated (having transverse streaks) and each acts independently of neighboring muscle fibers.

Smooth Muscle

Smooth muscle, found in the walls of the hollow internal organs such as blood vessels, the gastrointestinal tract, bladder, and uterus, is under control of the autonomic nervous system. Smooth muscle cannot be controlled consciously and thus acts involuntarily. The nonstriated (smooth) muscle cell is spindle-shaped and has one central nucleus. Smooth muscle contracts slowly and rhythmically.

Cardiac Muscle

Cardiac muscle, found in the walls of the heart, is also under control of the autonomic nervous system. The cardiac muscle cell has one central nucleus, such as smooth muscle, but it also is striated, such as skeletal muscle. The cardiac muscle cell is rectangular in shape. The contraction of cardiac muscle is involuntary, strong, and rhythmical.

Muscle Groups

There are more than 600 muscles in the body, which together account for about 40 percent of a person’s weight.

Most skeletal muscles have names that describe some feature of the muscle. Often several criteria are combined into one name. Associating the muscle’s characteristics with its name will help you learn and remember them. The following are some terms relating to muscle features that are used in naming muscles.

Size. Vastus (huge); maximus (large); longus (long); minimus (small); brevis (short).

Shape. Deltoid (triangular); rhomboid (such as a rhombus with equal and parallel sides); latissimus (wide); teres (round); trapezius (such as a trapezoid, a four-sided figure with two sides parallel).

Direction of fibers. Rectus (straight); transverse (across); oblique (diagonally); orbicularis (circular).

Location. Pectoralis (chest); gluteus (buttock or rump); brachii (arm); supra- (above); infra- (below); sub (under or beneath); lateralis (lateral).

Number of origins. Biceps (two heads); triceps (three heads); quadriceps (four heads).

Origin and insertion. Sternocleidomastoideus (origin on the sternum and clavicle, insertion on the mastoid process); brachioradialis (origin on the brachium or arm, insertion on the radius).

Action. Abductor (to abduct a structure); adductor (to adduct a structure); flexor (to flex a structure); extensor (to extend a structure); levator (to lift or elevate a structure); masseter (a chewer).

Muscles of the Head and Neck

Humans have well-developed muscles in the face that permit a large variety of facial expressions. Because the muscles are used to show surprise, disgust, anger, fear, and other emotions, they are an important means of nonverbal communication. Muscles of facial expression include frontalis, orbicularis oris, laris oculi, buccinator, and zygomaticus. These muscles of facial expressions are identified in Figure 1.15.

There are four pairs of muscles that are responsible for chewing movements or mastication. All of these muscles connect to the mandible and they are some of the strongest muscles in the body.

Figure 1.15. Head and Neck Muscle

There are numerous muscles associated with the throat, the hyoid bone and the vertebral column; only two of the more obvious and superficial neck muscles are identified in the illustration: sternocleidomastoid and trapezius.

Muscles of the Trunk

The muscles of the trunk include those that move the vertebral column, the muscles that form the thoracic and abdominal walls, and those that cover the pelvic outlet.

The erector spinae group of muscles on each side of the vertebral column is a large muscle mass that extends from the sacrum to the skull. These muscles are primarily responsible for extending the vertebral column to maintain erect posture. The deep back muscles occupy the space between the spinous and transverse processes of adjacent vertebrae.

The muscles of the thoracic wall are involved primarily in the process of breathing. The intercostal muscles are located in spaces between the ribs. They contract during forced expiration. External

Figure 1.16. Trunk Muscle

intercostal muscles contract to elevate the ribs during the inspiration phase of breathing. The diaphragm is a dome-shaped muscle that forms a partition between the thorax and the abdomen. It has three openings in it for structures that have to pass from the thorax to the abdomen.

The abdomen, unlike the thorax and pelvis, has no bony reinforcements or protection. The wall consists entirely of four muscle pairs, arranged in layers, and the fascia envelops them. The abdominal wall muscles are identified in Figure 1.16.

The pelvic outlet is formed by two muscular sheets and their associated fascia.

Muscles of the Upper Extremity

The muscles of the upper extremity include those that attach the scapula to the thorax and generally move the scapula, those that attach the humerus to the scapula and generally move the arm, and those that are located in the arm or forearm that move the forearm, wrist, and hand. Figure 1.17 shows some of the muscles of the upper extremity.

Muscles that move the shoulder and arm include the trapezius and serratus anterior. The pectoralis major, latissimus dorsi, deltoid, and rotator cuff muscles connect to the humerus and move the arm.

Figure 1.17. Upper Extremity Muscle

The muscles that move the forearm are located along the humerus, which include the triceps brachii, biceps brachii, brachialis, and brachioradialis. The 20 or more muscles that cause most wrist, hand, and finger movements are located along the forearm.

Muscles of the Lower Extremity

The muscles that move the thigh have their origins on some part of the pelvic girdle and their insertions on the femur. The largest muscle mass belongs to the posterior group, the gluteal muscles, which, as a group, adduct the thigh. The iliopsoas, an anterior muscle, flexes the thigh. The muscles in the medial compartment adduct the thigh. Figure 1.18 shows some of the muscles of the lower extremity.

Muscles that move the leg are located in the thigh region. The quadriceps femoris muscle group straightens the leg at the knee. The hamstrings are antagonists to the quadriceps femoris muscle group, which are used to flex the leg at the knee.

The muscles located in the leg that move the ankle and foot are divided into anterior, posterior, and lateral compartments. The tibialis anterior, which dorsiflexes the foot, is antagonistic to the gastrocnemius and soleus muscles, which plantar flex the foot.

Figure 1.18. Lower Extremity Muscle

Section 1.3 | How Does the Musculoskeletal System Function?

How Does the Musculoskeletal System Function? © 2022 Infobase. Reviewed March 2022.

The human skeletal system, which comprises of bones and cartilage, acts as a framework for the human body. In order for the body to move freely the bones functions together with muscles. The muscular structure in the human body is composed of various types of muscle that play a crucial role in the body. It allows a person to perform essential activities such as day-to-day movement, speaking, chewing food, and lifting objects. Temperature regulation and vision are also functions of the muscular system.

Musculoskeletal System

The skeletal and muscular system performs functions side-by-side and is collectively termed as the musculoskeletal system, which is also known as the locomotor system. It provides body posture, structure, in addition to controlling and regulating movement in the human body. It comprises muscles attached to the skeletal system that is around 700 in number and called by various names. These muscles constitute approximately half the total of an individual’s body weight. The muscles of the musculoskeletal system are composed of skeletal muscle tissue, nerves, blood vessels, and tendons. The musculoskeletal system has five main functions: heat generation, blood circulation, protection, support, and movement, which is its most significant function. The musculoskeletal system consists of parts that include:

Bones

Cartilage

Joints

Muscles

Ligaments

Tendons

Bursae

Muscles of the Musculoskeletal System

Two types of muscles are found in the musculoskeletal system, known as the skeletal and smooth muscles. Skeletal muscles are known as the only voluntary muscles in the body. They are controlled consciously. All conscious physical activity such as writing, speaking, running, or walking requires skeletal muscles. The skeletal muscle contracts to move parts of the body closer to the bone where the muscle is attached. Almost all skeletal muscles are attached with at least two bones with a joint in between. This kind of attachment of skeletal muscles is facilitated by tendons that are dense bands of connective tissue made of collagen fiber. Skeletal muscles move by contracting and reducing their length, tugging on the tendons, and bringing bones closer together. Skeletal muscles also form lever systems with bones and joints where the muscle is the effort force, the joint the fulcrum, the bone moved by the muscle is the lever, and the object upon which movement is executed is the load. The elbow joint is a good example.

Muscle Contraction

Muscles initiate contraction when the motor nerve cells, also known as motor neurons, contact the muscle cells at the neuromuscular joint (NMJ). These neurons release neurotransmitters at these points in the muscle that cause contraction. Muscle contraction remains in action as long as the motor neurons release neurotransmitters at the NMJ of muscle cells. When the neurotransmitter release stops, the muscle reverses the contraction.

Functions of the Musculoskeletal System

Skeletal muscles in the musculoskeletal system often work in groups to achieve accurate movements. However, they are rarely seen working solely, especially for body movements. The muscle producing a particular body movement is called a prime mover or an agonist. This muscle will be attached to a specific bone and will always pair with an antagonist muscle that produces an opposing force on the same bone. A working example of this instance could be how the biceps and triceps of the upper arm work opposite to each other to extend and bend the arm. Beyond the agonist/antagonist muscle pairing of the musculoskeletal system, other muscles known as synergists support the movements of the agonistic muscles by stabilizing movements and reducing extra movements. Synergists are found near the agonistic muscles and are often attached to the same bone as the agonist. The other type, known as fixator muscles, help in movement by keeping the origin region of the musculoskeletal system stable. For instance, when using the arms to lift something heavy, fixator muscles in the trunk region hold the body straight and immobile to keep the balance while lifting.

Process of the Musculoskeletal System

In the musculoskeletal system, the process of movement in a particular bone and skeletal muscle proceeds when:

The nervous system signals the NMJ in the skeletal muscle cells with the help of a neurotransmitter to activate the muscle.

It is followed by the muscle fibers contracting in response to the neurotransmitter, causing a molecular electrochemical gradient in the muscle that further activates cellular processes involving calcium ions, adenosine triphosphate molecules, troponin, actin, and myosin.

Once contracted, the muscles pull on the tendons attaching them to the bones. This force by the tendon pulls on the bone resulting in movement.

The muscle begins to relax only when the nervous system stops the release of the neurotransmitter in the muscle cells.

Once the muscle is relaxed, it releases tension and moves the bone to a resting position.

References

Eustice, Carol. The Musculoskeletal System and Disease, Verywell Health, July 20, 2020.

Kumar, Karthik. What Are the Five Main Functions of the Muscular System? MedicineNet, May 12, 2021.

Musculoskeletal System, Cleveland Clinic, December 11, 2020.

Overview of the Musculoskeletal System, The LibreTexts Libraries, August 14, 2020.

Skeletal Muscles, The LibreTexts Libraries, March 6, 2021.

Taylor, Tim. Muscular System, Innerbody Research, October 10, 2021.

Chapter 2 | Muscle and Bone Diseases: An Overview

Muscle Disorders

Muscles help us to move and help our bodywork. Different types of muscles have different jobs. There are many problems that can affect muscles. Muscle disorders can cause weakness, pain, or even paralysis.

Bone Diseases

Bones help us to move, give a shape and support to our body. They are living tissues that rebuild constantly throughout our life. During childhood and teens, body adds new bone faster than it removes old bone. After about age 20, body can lose bone faster than make bone. To have strong bones when we are young, and to prevent bone loss when we are older, we need to get enough calcium, vitamin D, and exercise. We should also avoid smoking and drinking too much alcohol.

Bone diseases can make bones easy to break.

Some Common Musculoskeletal Conditions

The musculoskeletal system consists of the body’s bones, muscles, tendons, ligaments, joints, and cartilage.

Back Pain

Back pain is one of the most common medical problems in the United States. It can range from a dull, constant ache to sudden, sharp pain. Sometimes it can come on suddenly – from an accident, a fall, or lifting something heavy, or it can develop slowly because of age-related degenerative changes to the spine. In some cases, inflammatory disorders or other medical conditions cause back pain.

Treatment varies depending on the cause and symptoms; however, there are steps you can take to improve your health and lower your chance of developing chronic or long-lasting back pain.

Bursitis

Bursitis is the inflammation of the bursa, a small, fluid-filled sac that acts as a cushion between a bone and other moving parts, such as muscles, tendons, or skin.

With bursitis, the bursa becomes red and fluid increases, causing swelling and pain.

Fibromyalgia

Fibromyalgia is a chronic (long-lasting) disorder that causes pain and tenderness throughout the body, as well as fatigue and trouble sleeping. Scientists do not fully understand what causes it, but people with the disorder have a heightened sensitivity to pain.

There is no cure for fibromyalgia, but doctors and other healthcare providers can help manage and treat the symptoms. Treatment typically involves a combination of exercise or other movement therapies, psychological and behavioral therapy, and medications.

Fibrous Dysplasia

Fibrous dysplasia happens when abnormal fibrous (scar-like) tissue replaces healthy bone. The fibrous tissue weakens the bone over time, which can lead to fractures (breaks) and misshapen bones.

Some people with fibrous dysplasia have no symptoms, or only a few symptoms, usually in one bone (monostotic). Other people may have multiple affected bones (polyostotic) and experience more symptoms. The disease may occur alone or as part of a condition known as McCune-Albright syndrome, which affects the bone as well as the skin and endocrine (hormone-producing) tissues.

Unfortunately, there is no cure for fibrous dysplasia; however, treatments may help to relieve pain, and supportive measures such as physical therapy may help strengthen muscle and improve range of motion.

Growth Plate Injuries

The growth plate is the area