Transcript AP-Chapter-7 - McLaren

ESSENTIALS OF A&P
FOR EMERGENCY CARE
CHAPTER
7
The Muscular System:
Movement for the
Journey
Essentials of A&P for Emergency Care
Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe
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Multimedia Asset Directory
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Slide 82
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Muscle Contraction Animation
Forearm and Hand Muscles Animation
Head and Neck Muscles Animation
Hip and Thigh Muscles Animation
Leg and Foot Muscles Animation
Lower Limb Muscles Animation
Female Pelvic Muscles Animation
Shoulder and Arm Muscles Animation
Trunk and Abdominal Muscles Animation
Upper Arm Muscles Animation
Myofacial Massage Video
Neuromuscular Massage Video
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Multimedia Asset Directory
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Western Massage Video
Physical Therapy Video
Occupational Therapy Video
Massage Therapy Video
Kinesiology Video
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Introduction
• The skeletal system provides the framework for
the body; the system that allows for movement
and locomotion is the muscular system.
• In addition to external motion of the arms and
legs, the muscular system also moves things
inside the body. This internal motion includes
the movement of the digestive system, the
cardiovascular system, and the respiratory
system.
• Different types of muscles allow for both external
and internal movement.
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Learning Objectives
• Differentiate the three major muscle types.
• Explain the difference between voluntary
and involuntary muscles.
• Identify and explain the components of a
muscle cell.
• Describe the cellular activities required for
muscle movement.
• Identify specific skeletal muscles.
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Pronunciation Guide
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acetylcholine (AS eh till KOH leen)
actin (ak TIN)
adenosine triphosphate (ah DEN oh sin)
ataxia (ah TAK see uh)
atrophy (AT roh fee)
diaphragm (DYE ah fram)
electromyography (ee LEK troh my OG rah fee)
fibromyalgia (FIE broh my AL jee uh)
flaccid (FLAS sid)
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Pronunciation Guide
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flexion (FLEK shun)
glycogen (GLIE co jin)
Guillian-Barré syndrome (GEY yan bar RAY)
hypertrophy (high PER troh fee)
intercalated discs (in TER kuh LATE ed)
muscular dystrophy (MUS kyoo lahr DISS troh fee)
myalgia (my AL jee uh)
myasthenia gravis (my as THEE nee uh)
myofibril (my oh FIE bril)
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Pronunciation Guide
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myosin (MY oh sin)
rigor mortis (RIG er MORE tiss)
sarcomeres (SAR koh meres)
sphinters (SFING terz)
tetanus (TET ah nuss)
tonus (TONE us)
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Overview
• Muscle is a general term for all contractile tissue.
• The contractile property of muscle tissue allows
it to become short and thick as a result of a
nerve impulse and then to relax once that
impulse is removed. This alternative contraction
and relaxation causes movement.
• The cells of muscle tissue are called muscle
fibers.
• Muscle tissue is constructed of bundles of these
fibers, each approximately the size of a human
hair.
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Types of Muscles
• The body has three major types of
muscles
– Skeletal
– Smooth
– Cardiac
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Skeletal Muscle
• Skeletal muscles are voluntary muscles
that attach to bones of the skeletal system.
• The fibers appear striped, so they are
sometimes called striated muscle.
• These muscles allow external movement
and are developed through exercise.
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Smooth Muscle
• Smooth muscles are involuntary muscles.
• They are called smooth because they
don’t have the striped appearance of
skeletal muscles.
• These muscles are found within certain
organs, blood vessels, and airways, and
allow for internal movement.
• Change in blood vessel diameter is one
example.
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Cardiac Muscle
• Cardiac muscle is a specialized muscle
with a striated appearance.
• It is found solely in the heart.
• Cardiac muscle is completely involuntary.
• The contraction of this muscle causes your
heart beat, an internal movement.
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Figure 7-1 The three types of muscle: skeletal, cardiac, and smooth.
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Skeletal Muscles
• Skeletal muscles are attached to bones
and provide movement for your body.
• Tendons are fibrous tissues that attach
skeletal muscles to bones, while ligaments
attach bone to bone. Some muscles attach
directly to a bone or soft tissue without a
tendon.
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Skeletal Muscles
• Skeletal muscle is also called voluntary
because movement is controlled by
conscious thought.
• The numerous skeletal muscles are
responsible for movement and maintaining
posture.
• Heat is also produced by skeletal muscles.
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Figure 7-2 Anterior and posterior view of major muscles.
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Contraction and Relaxation
• Movement of the body is the result of contraction
(shortening) of certain muscles while there is
relaxation of others.
• The primary mover (or agonist) is the chief
muscle causing movement. As the muscle
contracts it pulls the bone, causing movement.
• Point of origin – The end of the muscle that is
attached to the stationary bone
• Point of insertion – Muscle end attached to the
moving bone
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Contraction and Relaxation
• Synergistic muscles assist the primary
mover.
• Antagonist muscles cause movement in
the opposite direction of the agonist.
• All movement is a result of contraction of
primary movers and relaxation of opposing
muscles.
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Figure 7-3 Coordination of antagonist muscles to perform movement.
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The Diaphragm
• The primary mover of breathing is the
diaphragm.
• This dome-shaped muscle separates the
abdominal cavity from the thoracic cavity
and is responsible for performing the
major work of bringing atmospheric air into
our lungs.
• This muscle is under both voluntary and
involuntary control.
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Figure 7-4 The diaphragm: The major muscle of breathing.
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Movement Terminology
• Rotation describes circular movement that
occurs around an axis.
• Circumduction describes circular
movement of the end of a limb.
• Abduction means to move away from the
midline of the body.
• Adduction occurs when you produce a
movement toward the midline.
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Movement Terminology
• Extension is a term used for increasing the
angle between two bones connected at a
joint. The muscle that straightens a joint is
called the extensor muscle.
• Flexion is the opposite of extension,
decreasing the angle between two bones.
The muscle that bends the joint is called
the flexor muscle.
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Figure 7-5 The types of skeletal movement. (A) Flexion and extension of left forearm.
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Figure 7-5 (continued) The types of skeletal movement. (B) Flexion and extension of the
leg.
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Muscle Fibers
• Each muscle cell is an elongated fiber
known as the muscle fiber, and can be up
to 12 inches in length.
• Several muscle fibers can be bundled
together to form a specific muscle
segment.
• Each muscle fiber is composed of several
myofibrils.
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Sarcomeres
• Sarcomeres are the functional contractile
units of each fiber.
• Each sarcomere has two types of
threadlike structures called thick and thin
myofilaments.
• Thick myofilaments are made up of the
protein myosin.
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Sarcomeres
• Thin myofilaments are made up of the
protein actin.
• The sarcomere has actin and myosin
filaments arranged in repeating units
separated from each other by dark bands
called Z lines which give the striated
appearance to skeletal muscle.
• Z lines are the borders of each sarcomere.
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Muscle Contraction
• Contraction of a muscle causes the two
types of myofilaments to slide toward each
other and shorten each sarcomere, and
therefore the entire muscle.
• Muscle contraction requires that temporary
connections of cross-bridges are formed
between the myosin head and the actin.
These pull the sarcomere together.
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Figure 7-6 (A) The muscle segment.
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Figure 7-6 (continued) (B) The muscle segment with sarcomere.
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Figure 7-6 (continued) (C) Relaxed and contracted sarcomeres.
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ATP and Calcium
• Energy is needed for contraction and
relaxation. This energy comes from ATP
(adenosine triphosphate) which help the
myosin heads form and break the crossbridges with actin.
• Calcium is stored away from the actin and
myosin in the sarcoplasmic reticulum (SR)
during relaxation of the muscle.
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ATP and Calcium
• During contraction, the calcium is released
from the SR and causes actin, myosin,
and ATP to interact, which causes the
contraction. When calcium leaves the
muscle and returns to the SR, the crossbridge attachments are broken and the
muscle relaxes.
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ATP and Calcium
• When the nervous system tells a muscle to
contract, the signal causes the muscle fiber
to open sodium ion channels.
• Sodium ions flow into the muscle fiber,
exciting it.
• When the muscle becomes excited, calcium
is released from the SR.
• It is the calcium that causes the muscles to
contract.
• Calcium is then pumped back into the SR.
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Applied Science: Inter-Relatedness
of the Neuromuscular System
• Contraction of skeletal muscle requires the
coordination of both the muscular and
nervous systems.
• The initiation of a skeletal muscular
contraction requires an impulse from a
motor neuron of the nervous system to
cause a release of a neurotransmitter
substance called acetylcholine, which sets
the process of muscle contraction into
motion.
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Applied Science: Inter-Relatedness
of the Neuromuscular System
• It is the acetylcholine which opens sodium
channels, exciting the muscle fibers.
• This all occurs at the neuromuscular
junction.
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From the Streets:
Neuromuscular Blockade
• Rapid Intubation Sequence (RSI)
– A procedure used in emergency situations to
place an ET tube.
– Involves use of medications that act on the
neuromuscular junction.
– There are two ways to block neuromuscular
junction.
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Muscular Fuel
• Muscles, like all tissue, need fuel in the form
of food and oxygen to survive and function.
• The body stores glycogen in the muscle,
where it waits to be converted to a useable
energy source. When needed, glycogen is
converted to glucose which releases energy.
• Muscles with very high demands also store
fat and use it as energy. Energy release
causes heat production. That is why an
exercising athlete gets overheated.
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Muscular Fuel
• Higher demand muscles also have a
greater blood supply to carry muchneeded oxygen.
• The greater blood supply gives them a
darker color.
• An example of this is a chicken which has
white and dark meat.
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Rules for Naming Muscles
•
Muscles can be named based on any of
the following criteria
– Muscle location (Example: Biceps brachii is
in the arm. Brachii = arm.)
– Number of origins (Example: Biceps brachii
has two origins. Biceps = two heads.)
– Action (Example: Adductor longus adducts
the thigh.)
– Size (Example: Gluteus maximus. Maximus
= biggest.)
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Rules for Naming Muscles
•
Muscles can be named based on any of
the following criteria
– Location of attachments (Example:
Brachioradialis. Radialis refers to the
radius.)
– Shape (Example: Deltoid is triangular. Delta
= triangle.)
– Direction of fibers (Example: Rectus
abdominis. Rectus = straight.)
– Combination (Example: Pectoralis major.
Pectoral = shoulder, major = big.)
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Figure 7-7 Skeletal facial muscles.
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Figure 7-8 Skeletal muscles of the posterior and anterior trunk.
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Figure 7-9 Skeletal muscles of the shoulder, arm, and hand.
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Figure 7-10 Skeletal muscles of the hip and leg.
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Smooth Muscle
• Smooth muscle, also called visceral
muscle, is found in the organs, except for
the heart.
• It can also be found in blood vessels and
bronchial airways.
• The ability of smooth muscle to contract
and relax is essential to the internal
processes of our body, like digestion and
regulation of blood pressure.
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Smooth Muscles
• Smooth muscles are involuntary muscles
and don’t contract as rapidly as skeletal
muscles (skeletal muscles contract 50
times faster).
• Smooth muscle receives a smaller blood
supply, resulting in poor repair of injured
tissue.
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Vasodilation and Vasoconstriction
• Enlarging the diameter of a blood vessel is
called vasodilation.
• Decreasing the diameter of a blood vessel
is called vasoconstriction.
• Vasodilation can lead to a decrease in
blood pressure due to smooth muscle
relaxation in the blood vessel, while
vasoconstriction increases blood pressure.
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Respiratory Smooth Muscle
• Smooth muscle is also found in the
airways of the respiratory system. Excess
constriction of smooth muscle in the
respiratory system occurs during an
asthma attack.
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Respiratory Smooth Muscle
• A special type of smooth muscle is called
a sphincter and can be found throughout
the digestive system. These donut-shaped
muscles act as doorways to let material in
and out. Contraction closes the door while
relaxation opens it.
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Cardiac Muscle
• The walls of the heart are made mostly of
cardiac muscle. When the muscle fibers
contract, they force blood from the heart
causing it to circulate through the blood
vessels in your body.
• Cardiac muscle is involuntary.
• Cardiac muscle fibers are shorter, and
receive a richer supply of blood than any
other muscle in the body.
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Cardiac Muscle
• The cardiac muscle fibers are connected by
intercalated discs, causing one fiber to
contract and then pull the next one into a
contraction creating a domino effect. This
wave of motion squeezes blood out very
efficiently.
• Cardiac muscle does not repair itself.
Damage to cardiac muscle always leaves a
scar. Scar tissue doesn’t contract like normal
tissue because it is rigid. This decreases
cardiac output.
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Figure 7-11 Heart and intercalated discs.
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From the Streets:
Laboratory Testing in Heart Attack
• Heart attack occurs when an artery that
supplies blood to the heart is blocked.
• Left untreated, the affected are of the
heart muscle will die (myocardial
infarction).
• Because of this, it is important for
emergency personnel to recognize heart
attacks, now referred to as acute coronary
syndrome.
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From the Streets:
Laboratory Testing in Heart Attack
• Ultimate goal is provide treatment and
restore blood flow before a significant
mass of the heart muscle is permanently
damaged.
• Several diagnostic tools are routinely used
to determine whether a heart attack has
occurred.
– Electrocardiogram (ECG)
– X-rays
– Laboratory tests
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Clinical Application:
Muscle Tone
• Have you ever had a cast on for an
extended period of time? When removed,
the arm or leg is much smaller and weaker
than the limb without the cast. Why?
• Normally all muscles exhibit muscle tone
(tonus), which is the partial contraction of
a muscle with resistance to stretching. The
muscle fibers in an athlete increase in
diameter (hypertrophy) and become
stronger.
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Clinical Application:
Muscle Tone
• Hypertrophy refers to increased growth. In the
clinical setting, as muscles are used less and
less, they begin to lose their tone and become
flaccid (soft and flabby), as in a bedridden
patient.
• Muscles may waste away (atrophy) from lack of
use. One of the reasons patients are gotten out
of bed as soon as possible is to prevent atrophy
from occurring.
• While skeletal muscle can regenerate from
damage, extensive damage results in scarring.
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Common Muscular System
Disorders
• Myalgia – pain or tenderness in a muscle
• Fibromyalgia– affects women under 40,
but is not fully understood; symptoms
include aches, pains, and muscle stiffness
with specific tender points; the cause is
unknown, but is linked with chronic fatigue
syndrome.
• Ataxia – irregular muscle action with lack
of coordination
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Common Muscular System
Disorders
• Paralysis – partial or total loss of function
in voluntary muscles
• Spasm or cramp – involuntary sudden and
violent contraction of a muscle for a
prolonged period of time
• Sprains – tears or breaks in ligaments
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Common Muscular System
Disorders
• Strains – actual tears in muscles or
tendons
• Shin splints – inflammation of the extensor
muscles and surrounding tissues of the
lower leg, found in runners
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Common Muscular System
Disorders
• Hernia – tear in the muscle wall with an
organ protruding through the opening
• Tendonitis – inflammation of tendons
• Electromyography – a diagnostic test in
which a muscle, or group of muscles, is
stimulated with an electrical impulse,
causing contraction, allowing the strength
of the contraction to be measured
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From the Streets:
Musculoskeletal Back Disorders
• Back pain is one of the most common
complaints in modern emergency medical
practice.
• EMS personnel particularly vulnerable to
back injury.
• Minimize chance of injury using proper
lifting techniques and requesting
assistance when needed.
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Figure 7-12 There are many physical demands in EMS. Lifting and moving
patients and equipment can cause low back injury if not performed properly.
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Figure 7-13 EMS personnel should always use proper lifting techniques. By lifting
with the legs the large paraspinous muscles are not overstressed.
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Figure 7-14 Back strains in EMS personnel usually occur when a team member
moves awkwardly during a lift. Twisting, turning, or other movements can place
stress on the large back muscles and result in back strain.
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Neuromuscular Disorders
• These disorders involve both the nervous
and muscular systems.
• Myasthenia gravis – gradually increasing
profound muscle weakness, with drooping
of the eyelid as the first symptom
• Muscular dystrophy – inherited muscular
disease in which muscle fibers degenerate
and there is progressive muscular
weakness
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Neuromuscular Disorders
• Guillain-Barré syndrome is a disorder of the
peripheral nervous system that causes flaccid
paralysis and the loss of reflexes, ascending
from the feet and progressing to the head.
Paralysis peaks in 10–14 days and then
subsides gradually.
• Tetanus – creates rigid paralysis, and any minor
stimulus causes muscles to go into a major
spasm. It is a result of toxins produced by a
bacteria found in the ground and can result from
any puncture wound, not just a rusty nail.
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Snapshots from the Journey
• The three main types of muscles are
skeletal, smooth, and cardiac. Skeletal
muscle is striated, or striped, voluntary
muscle that allows movement, stabilizes
joints, and helps maintain body
temperature.
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Snapshots from the Journey
• Smooth muscle is a non-striated
involuntary muscle found in the organs of
the body and linings of vessels; it
facilitates internal movement within the
body. Cardiac muscle is involuntary,
striated muscle found only in the heart.
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Snapshots from the Journey
• All movement is a result of contraction of
primary movers and relaxation of opposing
muscles.
• Large muscles consist of many single
muscle fibers comprised of myofibrils. The
smallest functional contractile unit is called
a sarcomere. Each sarcomere unit
contains the two threadlike contractile
proteins myosin and actin.
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Snapshots from the Journey
• Muscles contract as the actin and myosin
protein filaments, in the presence of ATP
and calcium, form crossbridges that cause
the filaments to slide past each other,
thereby causing the muscle to contract or
shorten.
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Snapshots from the Journey
• There is a relationship between the
nervous and muscular systems in which
the motor neuron of the nervous system
initiates the activity of muscle contraction
through the release of a neurotransmitter.
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Snapshots from the Journey
• There are many common diseases and
conditions of the muscles, and because
the nervous system is so closely related,
there are also many common
neuromuscular diseases.
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Case Study
• A 30-year-old patient complains of
ascending flaccid paralysis that began with
tingling in the toes and muscle weakness.
This individual presented to the
emergency department after the leg
weakness became so profound that he
could barely walk, and now he notices his
arms weakening. Loss of reflexes were
also noted.
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Case Study Questions
• What disease do you think this is?
• Knowing that the patient is losing the
ability to use skeletal muscles, what lifethreatening condition could occur?
• What vital signs would you need to
monitor?
• Why is muscle atrophy a problem?
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Case Study Questions
• What areas of patient care need to be
addressed?
• What is the likely prognosis?
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From the Streets
You respond to a 70 year-old female
experiencing a gastrointestinal bleed. She
appears lethargic and is hypotensive,
tachycardic, and has pale, cool, & clammy
skin.
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From the Streets Questions
• Why does the patient have pale & cool
skin?
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From the Streets Questions
• Why does the patient have pale & cool
skin? This is due to peripheral
vasoconstriction
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From the Streets
• A patient is experiencing neurogenic
shock after falling 20 feet out of a deer
stand. The patient transected his spinal
cord at T-5 and is hypotensive with pink &
warm skin below the level of the injury.
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From the Streets Questions
• Why does this patient have pink & warm
skin?
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From the Streets Questions
• Why does this patient have pink & warm
skin? This is due to vasodilation
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End of Chapter
Review Questions
1. Another name for voluntary muscle is:
a.
b.
c.
d.
Skeletal
Smooth
Cardiac
Non-striated
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Review Questions
2. Which structure does not contain smooth
muscle?
a.
b.
c.
d.
Blood vessels
Heart
Digestive tract
Bronchi
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Review Questions
3. Most skeletal muscles attach to bones
via:
a.
b.
c.
d.
Ligaments
Joints
Flexors
Tendons
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Review Questions
4. The state of partial skeletal muscle
contraction is known as:
a.
b.
c.
d.
Homeostasis
Muscle tone
Partialus contractus
Flexerus
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Review Questions
5. Cardiac muscle:
I. Is a voluntary muscle
II. Has intercalated discs to assist contraction
III. Regenerates after injury
IV. Lines the blood vessel
a.
b.
c.
d.
I only
I and II
II only
I, II, III, and IV
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Review Questions
6. Jill falls and twists her ankle. Later she
cannot dorsiflex her foot. Her doctor tells
her she has torn a tendon and must have
surgery. Which tendon?
a. Patellar
b. Calcaneal
c. Rotator cuff
d. Anterior cruciate
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Review Questions
7. Sam wakes up one morning unable to
move his toes. Within a few hours he
can’t move his legs and call 911. By
morning he is completely paralyzed.
What has happened to him?
a. Tetanus
b. Guillain Barre
c. Muscular dystrophy
d. Muscular atrophy
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Review Questions
1. A sudden or violent muscle contraction is
a _________.
2. Partial or total loss of voluntary muscle
use is _________.
3. A tear in the muscle wall through which
an organ can protrude is a __________.
4. The body stores a carbohydrate called
___________ in the muscle; it can be
converted to a usable energy source.
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Review Questions
5. _____ means pain or tenderness in the
muscle.
6. Elbow flexion is the action of the
_______ muscle.
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Review Questions
1. List the three major muscle types and give an
example of each.
2. Explain the relationship between origin,
insertion and action of skeletal muscle.
3. List the criteria for naming muscles and give
an example of each criteria.
4. Explain the steps needed in a skeletal muscle
contraction.
5. Considering the knee, list the major muscles
involved in control of the joint, their
attachments and their actions.
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