Опорно-двигателна система на английски език

212 PAGES
ANATOMY, PHYSIOLOGY & PATHOLOGY
NOTES OF THE
PRE-SUMMARIZED
READY-TO-STUDY
HIGH-YIELD NOTES
FOR THE TIME-POOR
MEDICAL, PRE-MED,
USMLE OR PA STUDENT
MUSCULOSKELETAL
SYSTEM
FOURTH EDITION

A Message From Our Team

Studying medicine or any health-related degree can be stressful; believe us, we know from experience! The
human body is an incredibly complex organism, and finding a way to streamline your learning is crucial to succeeding
in your exams and future profession. Our goal from the outset has been to create the greatest educational resource
for the next generation of medical students, and to make them as affordable as possible.

In this fourth edition of our notes we have made a number of text corrections, formatting updates, and
figure updates which we feel will enhance your study experience. We have also endeavoured to use only open-
source images and/or provide attribution where possible.

If you are new to us, here are a few things to help get the most out of your notes:

1. Once saved, the notes are yours for life! However, we strongly advise that you download and save the files
immediately upon purchasing for permanent offline access.

2. Sharing notes is prohibited. All files are share-protected and our system will automatically revoke access to
and lock files if it detects a customer attempting to share or distribute our notes.

3. Your license permits you to do the following:
a. You may download/save/view files on up to 2 simultaneous devices.
b. You may save the files to an external hard drive for backup purposes only.
c. You may print your notes to hard copy on any home printer/photocopier.

4. Once saved, you do not need to download the notes again. You can simply transfer your file/s to your
second personal device (eg: your iPad/tablet) without the need to re-download your files. If you wish to
retire an old device, simply transfer your files to your new device, then delete the files from your old device.

5. Each order has an allocated download allowance. Exceeding your download quota will require you to
request an extension by emailing us at admin@medstudentnotes.com and quoting your order number.

6. If you have any further queries, feel free to check out our FAQ page:
https://www.medstudentnotes.com/pages/faqs or email us at admin@medstudentnotes.com

7. Please ensure you use the SAME Email address for any future purchases. That way, all of your files will be
visible in the one place on your account page.

8. Feel free to use the discount code “TAKE20OFF” for 20% off any future purchases. (Valid for a limited time)

9. If you find these notes valuable but you haven’t yet got our Bundle Deal, (which includes ALL of our
subjects at an 80% discount), then NOW is the time! To upgrade, simply visit this link for instructions:
https://www.medstudentnotes.com/pages/bundle-upgrade-process .

Table Of Contents:

What’s included: Ready-to-study anatomy, physiology and pathology notes of the musculoskeletal system presented
in succinct, intuitive and richly illustrated downloadable PDF documents. Once downloaded, you may choose to
either print and bind them, or make annotations digitally on your ipad or tablet PC.

Anatomy & Physiology Notes:
• GENERAL OVERVIEW OF THE SKELETAL SYSTEM
• GENERAL OVERVIEW OF THE MUSCULAR SYSTEM
• GENERAL MUSCLE PHYSIOLOGY
• PRINCIPLES OF BIOMECHANICS
• MUSCLE REFLEXES
• BONES OF THE SKULL
• BONES OF THE AXIAL SKELETON
• BONES OF THE UPPER LIMBS & SHOULDER GIRDLE
• BONES OF THE LOWER LIMBS & PELVIC GIRDLE
• MUSCLES OF THE AXIAL SKELETON
• MUSCLES OF THE UPPER LIMBS & SHOULDER GIRDLE
• MUSCLES OF THE LOWER LIMBS & PELVIC GIRDLE
• INNERVATION OF THE UPPER LIMBS & SHOULDER GIRDLE
• INNERVATION OF THE LOWER LIMBS & PELVIC GIRDLE
• BLOOD SUPPLY OF THE UPPER LIMBS & SHOULDER GIRDLE
• BLOOD SUPPLY OF THE LOWER LIMBS & PELVIC GIRDLE

Pathology Notes:
- BONY INJURIES
- DESCRIBING AN X-RAY
- NEUROVASCULAR COMPROMISES
- MYOSITIS
- OSTEOMYELITIS
- SEPTIC ARTHRITIS
- BONY TUMOURS
- OSTEOPOROSIS & PAGETS DISEASE
- FIBROMYALGIA
- POLYMYALGIA RHEUMATICA
- CRYSTAL ARTHROPATHIES
- OSTEOARTHRITIS
- RHEUMATOID ARTHRITIS
- SERONEGATIVE (NON-RHEUMATOID) ARTHRITIS
- ARTHRITIS & RHEUMATOLOGY CASES

GENERAL OVERVIEW OF THE SKELETAL SYSTEM

GENERAL OVERVIEW OF THE SKELETAL SYSTEM

Functions:
• Support
• Protection
• Movement
• Storage
o Minerals
§ Ca+ - used in many processes in body
§ Must be maintained at certain levels in blood.
o Marrow
§ Haematopoietic stem cells
§ Fat
• Blood Production – Haematopoiesis

Metabolism of bone & its hormonal control
• Calcitonin → Ca+ salt deposit in bone
• Parathyroid hormone → Resorption of Ca+ from bone by osteoclasts → increases blood Ca+ levels
• Estrogen → Restrains Osteoclast activity & Promotes deposition of new bone.

Anatomy & Physiology, Connexions Web site. http://cnx.org/content/col11496/1.6/, Jun 19, 2013., CC BY 3.0
<https://creativecommons.org/licenses/by/3.0>, via Wikimedia Commons

Osteoporosis:
• Bone resorption outstrips deposition → bone density decreases – risk of fractures increases.
o Cancellous bone is affected first – has a quicker turnover (remodelling rate)
o Trabeculae become porous & lighter or even disappear
o Common in Postmenopausal Women: reduced levels of Estrogen → increased osteoclast activity.
Source: Unattributable

Bone Composition:
• Organic
o Collagen & other proteins
o 35%
o Flexibility
o Tensile Strength
• Inorganic
o Mineral Salts
o 65%
o Compression Strength
o Reason why it preserves so well.

Bone & Associated Tissue Histology:
• Bone
o Compact Bone
§ Thicker
§ Denser
§ Comprised of Osteons – basic units of compact bone
• Haversian Canal
o Blood Vessels
o Nerve Fibres
• Lamellae
o Rings of Collagen Fibres around Haversian Canals
o Collagen Fibres oppose each other diagonally
o Resists torsional stress
• Lacunae
o Tiny caverns between the Lamellae
o Residences of the osteocytes
• Osteocytes
o Living cells of bone tissue
o Maintains health of bone matrix
o If an osteocyte dies, the surrounding bone matrix is resorbed by osteoclasts.
• Canaliculi
o Tiny plasma membrane extensions of the osteocytes
o Allows communication between osteocytes
o Allows nutrient sharing between osteocytes

CNX OpenStax, CC BY 4.0 <https://creativecommons.org/licenses/by/4.0>, via Wikimedia Commons
http://histology.med.yale.edu/bone/bone_reading.php

o Cancellous Bone (Spongy)
§ Trabeculae (struts) relay stress to the dense compact bone
§ Houses marrow in between trabeculae.
§ Blood Vessels
§ Osteoblasts
§ Fat Cells

Source: Creative commons 4.0; Openstax

• Cartilage:
o Avascular
o Chondrocytes in columns in lacunae
o Ground Substance – fibres + H2O

OpenStax College, CC BY 3.0 <https://creativecommons.org/licenses/by/3.0>, via Wikimedia Commons

Bone Development:
• Intramembranous Bone Formation
o Ossification Within Membranes
§ Cranial bones of skull
§ Clavicles
OpenStax College, CC BY 3.0 <https://creativecommons.org/licenses/by/3.0>, via Wikimedia Commons


• Endochondral Bone Formation
o From Cartilage
§ Hyaline cartilage
§ Primary ossification centre in diaphysis
§ Secondary ossification centre in epiphyses
§ Epiphyseal plate (growth plate)
o 5 Phases:
§ Phase 1 & 2:
• In Utero
• Hyaline cartilage template
• Osteoblasts begin depositing bone
• Bone Collar forms around diaphysis
• Cartilage cells in centre die – leaves cavity
• 1O Ossification centre forms
§ Phase 3:
• In Utero
• Blood vessels penetrate into centre cavity
• Fibroblasts enter through blood
• Fibroblasts convert to osteoblasts
• Spongy bone forms along shaft

§ Phase 4:
• At Birth
• Elongation of diaphysis
• 2O Ossification centre forms in Epiphysis
• Medullary (Marrow) Cavity forms.
§ Phase 5:
• Growth & Maturation
• Complete ossification of Epiphyses
• Hyaline cartilage remains at:
o Epiphyseal (growth) plate
o Articular surface

OpenStax College, CC BY 3.0 <https://creativecommons.org/licenses/by/3.0>, via Wikimedia Commons

Bone Remodelling:
• Bone is living tissue
• Requires blood supply & Constant remodelling
• Bone remodels in response to:
o Calcium requirements in body...and
o Mechanical Stress
• Resorption – destruction of old bone matter by Osteoclasts:
o Large multinucleated cells
o Plasma membrane attaches to bone
o Forms a seal
o Secretes enzymes (collagenase), acid & lysosomes
o Creates a recess (Howship’s Lacunae)
o Bone matrix at site gets eroded
o Endocytoses digested material
o Packages digested material
o Exocytoses digested material into extracellular matrix
o Material taken away by blood
• Apposition – deposition of new bone matter by Osteoblasts:
o Large Golgi – cells of high protein & proteoglycan synthesis
o Secrete osteoid (unmineralised organic bone matrix) into lacunae
o Osteoid + mineralisation = mature bone
o Osteoblasts trapped in matrix become osteocytes when bone formation has ceased.

• Eg: Bone Remodelling in Response to Stress:
§ Bone is modelled to more efficiently withstand the force.

• Eg: Long Bone Growth:
• Length
o Apposition at epiphyseal line
o By osteoblasts
• Width
o Apposition by osteoblasts
o Resorption (bone removal) by osteoclasts

OpenStax College, CC BY 3.0 <https://creativecommons.org/licenses/by/3.0>, via Wikimedia Commons

Classification of Bones:
• Long
o Humerus
o Femur
• Short
o Carpals
o Tarsals
• Flat
o Sternum
o Scapula
• Irregular
o Vertebra
o Innominate Bones (Ossa Coxae)
• Sesamoid
o Patella
o Other bones inside tendons – can occur in tendons of the big toe

OpenStax College, CC BY 3.0 <https://creativecommons.org/licenses/by/3.0>, via Wikimedia Commons

Appendicular Vs. Axial Skeleton:

OpenStax College, CC BY 3.0 <https://creativecommons.org/licenses/by/3.0>, via Wikimedia Commons

Pectoral Girdle:
- Scapula & Clavicle
- Anchors upper limbs to axial skeleton

OpenStax College, CC BY 3.0 <https://creativecommons.org/licenses/by/3.0>, via Wikimedia Commons

Pelvic Girdle:
- 2 coxal hip bones: one on each side of sacrum
- Each consists of:
o Ilium
o Ischium
o Pubis
o pubic symphysis
- Collectively known as either:
o The Ossa Coxae...or
o Innominate Bones
- Anchors Lower limbs to Axial Skeleton

OpenStax College, CC BY 3.0 <https://creativecommons.org/licenses/by/3.0>, via Wikimedia Commons

Long Bone Structure:
• Diaphysis
o Shaft
o Hollow
o Strength + Lightness
o Contains marrow (yellow in adult)
• Epiphysis
o Expanded ends of bones
o Proximal & Distal
o Covered in articular cartilage.
o Boundary defined by epiphyseal line.
• Medullary (Marrow) Cavity
o Marrow cavity
o Red Marrow & Yellow (fatty) marrow
o Site of haematopoiesis (blood cell production)
o Stores fat
o Makes bone lighter – but still strong.
• Periosteum
o Connective tissue covering
o Covers all bones
o Fibrous outer
§ Sharpey’s fibres
o Inner
§ Osteoblasts
§ Osteoclasts
• Nutrient Foramen
o External opening of the nutrient canal in a bone.
o Provides blood supply
o Arteries & Nerves
o More prevalent towards epiphysis


OpenStax College, CC BY 3.0 <https://creativecommons.org/licenses/by/3.0>, via Wikimedia Commons

OpenStax College, CC BY 3.0 <https://creativecommons.org/licenses/by/3.0>, via Wikimedia Commons

Joints:
• Junction between 2 or more bones
• Not necessarily moving joints (Eg: cranial sutures)
• 3 Types:
o Fibrous Joints
§ No movement
§ Joined by fibrous tissue
§ No joint cavity
§ Eg: Cranial Sutures
§ Eg: Syndesmoses – between tibia & fibula @ ankle.

OpenStax College, CC BY 3.0 <https://creativecommons.org/licenses/by/3.0>, via Wikimedia Commons

o Cartilaginous Joints
§ Varying amount of movement
§ Joined by cartilage
§ No joint cavity
§ 2