Capter 4 & 5

marrow

Fatty, blood-forming tissue in the cavities of long bones

tendon

Fibrous band that connects muscle to bone

arthodesis

Fixation or stiffening of a joint by surgery

arthrodesis

Fixation or stiffening of a joint by surgery

hyperflexion

Flexion of a limb or part beyond the normal limits

pathologic fracture

Fracture occurring at a site already weakened by a disease process, such as cancer

colles fracture

Fracture of the distal radius at the wrist

pott fracture

Fracture of the lower end of the fibula, often with fracture of the tibial malleolus

estrogen

Generic term for hormones that stimulate female secondary sex characteristics

lacrimal

Lacrimal bone forms part of the medial wall of the orbit, or pertaining to tears

cortical

Pertaining to a cortex

medullary

Pertaining to a medulla

prosthetic

Pertaining to a prosthesis

trochlear

Pertaining to a trochlea

vertebral

Pertaining to a vertebra

epiphysial

Pertaining to an epiphysis

necrotic

Pertaining to or affected by necrosis

rheumatic

Pertaining to or characterized by rheumatism

sacral

Pertaining to or in the region of the sacrum

kyphotic

Pertaining to or suffering from kyphosis

scoliotic

Pertaining to or suffering from scoliosis

calcaneal

Pertaining to the calcaneus

zygomatic

Pertaining to the cheekbone

pectoral

Pertaining to the chest

clavicular

Pertaining to the clavicle

orthopedic/ orthopedist

Pertaining to the correction and cure of deformities and diseases of the musculoskeletal system; originally, most of the deformities treated were in children Specialist in orthopedics

femoral

Pertaining to the femur

fibular

Pertaining to the fibula

ischia

Pertaining to the ischium

maxillary

Pertaining to the maxilla

metatarsal

Pertaining to the metatarsus

musculoskeletal

Pertaining to the muscles and the bony skeleton

cervical

Pertaining to the neck region

patellar

Pertaining to the patella bone or the tendon

pelvic

Pertaining to the pelvis

periosteal

Pertaining to the periosteum

pubic

Pertaining to the pubic bone

radial

Pertaining to the radius or to any of the structures (artery, vein, nerve) named after it

cranial

Pertaining to the skull

spinal

Pertaining to the spine

tarsal

Pertaining to the tarsus

tibial

Pertaining to the tibia

ulnar

Pertaining to the ulna or to any of the structures (artery, vein, nerve) named after it

carpal

Pertaining to the wrist

rheumat-

a flow

corticosteroid

a hormone produced by the adrenal cortex

biceps brachii

a muscle of the arm that has two heads or points of origin on the scapula

-ation

a process

Osteogenesis imperfecta (OI):

a rare genetic disorder producing very brittle bones that are easily fractured or broken, often in utero (while inside the uterus). Primary bone cancer is found in three forms: Osteogenic sarcoma occurs most often in bone cells around the knee in adolescents. Ewing sarcoma occurs most often in children and adolescents. Chondrosarcoma arises in cartilage cells, often in the pelvises of older people.

-imus

most

orthopedic technologists and technicians

assist orthopedic surgeons in treating patients.

necr/o-

death

-penia

deficient

-lysis

destruction

rhabdomyolysis

destruction of muscle to produce myoglobin

-ory

having the function of

-ceps

head

cry/o-

icy cloud

-ili-

ilium

-blast

immature cell

immune/o

immune response

pectoral girdle

incomplete bony ring that attaches the upper limb to the axial skeleton

-phalang/e-

phalanx, finger or toe

-phos-

phosphate

physiatry

physical medicine

-locat-

place

-toxi-

poison

amputation

removal of a limb, part of a limb, or other projecting body part

de-

removal, out of

-fication

remove

restor-

renew

-oid

resemble

-oid

resembling

-plasty

reshaping by surgery

ambulatory

surgery or any other care provided without an overnight stay in a medical facility

-ectomy

surgical excision

-ectomy

surgical excisoin

thymectomy

surgical removal of thymus gland

-synov-

synovial membrane

lacrim-

tears

bursa/ bursae

A closed sac containing synovial fluid

capitulum

A small head or rounded extremity of a bone

fiber

A strand or filament

antimetabolite

A substance that replaces or inhibits a specific part of a cell's normal metabolism

bunion

A swelling at the base of the big toe

muscle

A tissue consisting of cells that can contract

re-

again

anti-

against

assist-

aid, hekp

device

an applianec

prosthesis

an artificiel part to remedy a defect in the body

branchi-

arm

peri-

around

orthot-

correct

-cortic-

cortex

-gen-

creation

-genesis

creation, formation

menisc-

crescent, meniscus

scoli/o-

crooked

incis-

cut into

mandibular

pertaining to the mandible

scapular

pertaining to the shoulder blade

skeletal

pertaining to the skeleton

gluteus

referes to one of three muscles in the buttocks

tibi-

tibia

chiropractors (DC)

(DC) focus on the manual adjustment of joints—particularly the spine—in order to maintain and restore health

orthopedic surgeons

(orthopedists) are medical doctors (MDs) who deal with the prevention and correction of injuries of the skeletal system and associated muscles, joints, and ligaments.

bursa

A closed sac containing synovial fluid

disorders of the wrist

A Colles fracture is a common fracture of the radius just above the wrist joint (Figure 4.15) that occurs when a person tries to break a fall with an outstretched hand. Fracture of the scaphoid bone (Figure 4.14)—the most common fracture of a carpal bone—also results from breaking a fall with an outstretched hand, but poor blood supply here makes healing slow and difficult. Carpal tunnel syndrome is inflammation of the tendon synovial sheaths on the back of the wrist arising from repetitive movements such as computer keyboard operation.

osteoblast

A bone-forming cell

osteocyte

A bone-maintaining cell

biphosphonate

A class of drugs used to prevent and treat fragile bones

duchenne muscular dystrophy

A condition with symmetrical weakness and wasting of pelvic, shoulder, and proximal limb muscles

incision

A cut or surgical wound

comminuted

A fracture in which the bone is broken into pieces

osteocalcin

A hormone produced by bone cells

articulation

A joint

Diagnostic Methods for Disorders of Muscles and Tendons

A medical history and physical examination are essential components of a diagnostic examination. Additional diagnostic tests include: Blood tests. Damaged muscles release enzymes such as creatine kinase (CK) and aldolase into the blood, and their levels can be measured. An erythrocyte sedimentation rate (ESR or sed rate) is not specific for any type of disease but indicates the presence of inflammation, and serial readings can be used to measure changes in the severity of an inflammatory process. Electromyography (EMG), which involves inserting an electrode needle into the muscle to be tested to measure its electrical activity as the muscle is relaxed and contracted. Magnetic resonance imaging (MRI) and computed tomography scan (CT or CAT scan), which can show detailed images of damage or disease in muscles. Muscle biopsy, which allows a small piece of muscle to be removed through a hollow needle or small incision and sent to the laboratory for examination and analysis. Genetic testing of blood or other samples, which can show mutations in some of the genes that cause the different types of muscular dystrophy. Myositis specific antibodies (MSA), which can assist in confirming a diagnosis of dermatomyositis or polymyositis. Dozens of myositis-specific and myositis-associated antibodies have been identified, and research is ongoing to define their significance.

kyphosis

A normal posterior curve of the spine that can be exaggerated in disease

deformity

A permanent structural deviation from the normal

eponym

A procedure or a diagnosis with a name derived from the name of the person who discovered it (if it is a disease or condition) or originated it (if it is a procedure)

pubis

Alternative name for the pubic bone

scoliosis

An abnormal lateral curvature of the vertebral column

cyst

An abnormal, fluid-containing sac

quadriceps femoris

An anterior thigh muscle with four heads (origins)

prosthesis

An artificial part to remedy a defect in the body

subluxation

An incomplete dislocation when some contact between the joint surfaces remains

foramen/ foramina

An opening through a structure

brace

Appliance to support a part of the body in its correct position

arthrocentesis

Aspiration of fluid from a joint

ligament

Band of fibrous tissue connecting two structures

pelvis

Basin-shaped ring of bones, ligaments, and muscles at the base of the spine. Also, any basin-shaped cavity, like the pelvis of the kidney

Disorders of Skeletal Muscles

Because you use so many different muscles for various activities, the likelihood of experiencing some form of skeletal muscle disorder in your lifetime is almost certain. Muscle soreness can result from vigorous exercise, particularly if your muscles are not used to it. Exercise increases the lactic acid in your muscle fibers, causing inflammation, and produces soreness in the muscles and nearby connective tissue. Muscle cramps are sudden, short, painful contractions of a muscle or group of muscles. The cause of these cramps is unknown. A poor diet that leads to low blood potassium, calcium, and magnesium levels; caffeine and tobacco use; and reduced blood supply may contribute to muscle cramps. There are no effective medications available. Muscle strains range from a simple stretch to a partial or complete tear in the muscle, tendon, or muscle-tendon combination. Most strains heal with RICE (Figure 5.3), followed by basic exercises to relieve pain and restore mobility. A complete tear may require surgery. A sprain is a stretch or tear of a ligament, often in the ankle, knee, or wrist, and is also treated by RICE. Anabolic steroids are related to testosterone but altered to make skeletal muscle hypertrophy. Used illegally in many sports to boost muscle strength, steroids have noticeable, often irreversible side effects. These include stunted growth in adolescents, shrinking testes and reduced sperm counts, masculinization of women's bodies and voices, delusions, and paranoid jealousy. Long-term effects may be increased risk of heart attack and stroke, kidney failure, and liver tumors. Fibromyalgia affects muscles and tendons all over the body, causing chronic pain, fatigue, and depression. Its cause is unknown and there are currently no laboratory tests for it. The only treatment options are pain management, physiotherapy, and stress reduction.

common disorders of the wrist

Because you use your hands and wrists almost constantly, your wrists can be prone to disorders and injuries. Ganglion cysts are fluid-filled cysts on the back of the wrist, which result from irritation or inflammation of the synovial tendon sheaths in this area. These cysts usually disappear on their own. Stenosing tenosynovitis is a painful inflammation of the synovial sheaths on the back of the wrist. Carpal tunnel syndrome (CTS) develops on the front of the wrist and results from inflammation and swelling of overused tendon sheaths. Repetitive movements, like typing on a computer keyboard, can lead to CTS. A feeling of "pins and needles" or pain and loss of muscle power in the thumb side of the hand are common.

diagnostic procedures for metabolic bone disorders

Bone mineral density (BMD) screening using dual-energy X-ray absorptiometry (DEXA or DXA scan) is used to diagnose and follow osteoporosis. Nuclear bone scan involves a radioactive substance injected into the bloodstream. From there, it travels into the bones and is detected by a special camera. It can show a bone infection, a fracture not clearly seen on X-ray, arthritis, and primary or metastatic cancer. Blood tests examine serum calcium, serum alkaline phosphate, and serum phosphate, which can be abnormal in metabolic bone disorders. Bone biopsy is the ultimate way to establish a diagnosis of osteomalacia.

calcaneus

Bone of the tarsus that forms the heel

temporal

Bone that forms part of the base and sides of the skull

ethmoid

Bone that forms the back of the nose and encloses numerous air cells

palatine

Bone that forms the hard palate and parts of the nose and orbits

zygoma

Bone that forms the prominence of the cheek

canellous

Bone that has a spongy or lattice-like structure

herberden node

Bony lump on the terminal phalanx of the fingers in osteoarthritis

callus

Bony tissue that forms at a fracture site early in healing

hemotoma

Collection of blood that has escaped from blood vessels into tissue

rupture

Break or tear of any body part

labrum

Cartilage that forms a rim around the socket of the hip joint

active

Causing action or change

medulla

Central portion of a structure surrounded by cortex

osteoarthritis

Chronic inflammatory disease of joints

bone fractures

Closed (also called simple fracture) A bone is broken, but the skin is not broken. Open (also called compound fracture) A fragment of the fractured bone breaks the skin, or a wound extends to the site of the fracture. Displaced The fractured bone parts are out of line. Complete A bone is broken into at least two fragments. Incomplete The fracture does not extend completely across the bone. It can be hairline, as in a stress fracture in the foot, when there is no separation of the two fragments. Comminuted The bone breaks into several pieces, usually two major pieces and several smaller fragments. Transverse The fracture is at right angles to the long axis of the bone. Impacted The fracture consists of one bone fragment driven into another, resulting in shortening of a limb. Spiral The fracture spirals around the long axis of the bone. Oblique The fracture runs diagonally across the long axis of the bone. Linear The fracture runs parallel to the long axis of the bone. Greenstick This is a partial fracture. One side breaks, and the other bends. Pathologic The fracture occurs in an area of bone weakened by disease, such as cancer. Compression The fracture occurs in a vertebra from trauma or pathology, leading to the vertebra being crushed. Stress This is a fatigue fracture caused by repetitive, local stress on a bone, as occurs in marching or running.

dislocation

Completely out of joint

osteoporosis

Condition in which the bones become more porous, brittle, and fragile and more likely to fracture

achondroplasia

Condition with abnormal, early conversion of cartilage into bone, leading to dwarfism

clavicle

Curved bone that forms the anterior part of the pectoral girdle

osteopenia

Decreased calcification of bone

hallux valgus

Deviation of the big toe toward the medial side of the foot

physical medicine

Diagnosis and treatment by means of remedial agents, such as exercises, manipulation, heat, etc.

meniscus/ menisci

Disc of cartilage between the bones of a joint, in this case, the knee joint

rickets

Disease due to vitamin D deficiency, producing soft, flexible bones

contract

Draw together or shorten

arthroscope

Endoscope used to examine the interior of a joint

meniscectomy

Excision (cutting out) of all or part of a meniscus

epiphysis

Expanded area at the proximal and distal ends of a long bone to provide increased surface area for attachment of ligaments and tendons

Disorders and Injuries of the Hip Joint

Hip pointer, often a football-related injury, is a blow to the rim of the pelvis that leads to bruising of the bone and surrounding tissues. Osteoarthritis is common in the hip as a result of aging, weight bearing, and repetitive use of the joint. The cartilage on both the acetabulum and the head of the femur deteriorates, causing friction between the bones of the femoral head and the acetabulum that leads to pain and loss of mobility. Rheumatoid arthritis can also affect the hip, beginning in the synovial membrane and progressing to destroy cartilage and bone. Avascular necrosis of the femoral head is the death (necrosis) of bone tissue when the blood supply is cut off (avascular), usually as a result of trauma. Fractures of the neck of the femur occur as a result of a fall, most commonly in elderly women with osteoporosis.

prepatellar

In front of the patella

bursitis

Inflammation of a bursa

tendinitis

Inflammation of a tendon

osteomyelitis

Inflammation of bone and bone marrow

the wrist

In your forearm, the radius bone on the thumb side and the larger ulna bone on the little-finger side articulate at your wrist joint with the small carpal bones.

pectoral girdle

Incomplete bony ring that attaches the upper limb to the axial skeleton

hypertrophy

Increase in size, but not in number, of an individual tissue element

osteogenesis imperfecta

Inherited condition in which bone formation is incomplete, leading to fragile, easily broken bones

multidisciplinary

Involving health care providers from more than one profession

ilium

Large wing-shaped bone at the upper and posterior part of the pelvis

deltoid

Large, fan-shaped muscle connecting the scapula and clavicle to the humerus

acromion

Lateral end of the scapula, extending over the shoulder joint

ischium

Lower and posterior part of the hip bone

mandible

Lower jaw bone

prone

Lying face down, flat on your belly

supine

Lying face up, flat on your spine

osteogenic sarcoma

Malignant tumor originating in bone-producing cells

chondrosarcoma

Malignant tumor originating in cartilage cells

sarcoma

Malignant tumor originating in connective tissue

osteopathy

Medical practice based on maintaining the balance of the body

radiologist

Medical specialist in the use of X-rays and other imaging techniques

cartilage

Nonvascular, firm connective tissue found mostly in joints

chiropractic

Nonvascular, firm connective tissue found mostly in joints

....

Myasthenia gravis is a chronic autoimmune disease (see Chapter 7) characterized by varying degrees of weakness of the skeletal muscles. The weakness increases with activity and decreases with rest. Facial muscles are often involved, causing problems with eye and eyelid movements, chewing, and talking. Antibodies produced by the immune system block the passage of stimuli from motor nerves to muscles, making movements limited. Myopathy is any muscular disease resulting in muscle weakness. The ICD-10 lists 15 codes for different types of myopathy. Dermatomyositis is a myopathy producing muscle weakness and skin changes around the eyes and over the knuckles. Polymyositis is a myopathy producing muscle weakness. Muscular dystrophy is a general term for a group of hereditary, progressive disorders affecting skeletal muscles. Duchenne muscular dystrophy (DMD) is the most common in boys, beginning with difficulty walking around the age of 3. Generalized muscle weakness and atrophy progress, and few live beyond 20 years of age. There is no effective treatment. Rhabdomyolysis is the breakdown of muscle fibers, which releases a protein pigment (myoglobin) into the bloodstream. Myoglobin breaks down into toxic compounds that cause kidney failure. Muscle trauma, severe exertion (marathon running), alcoholism, and use of cocaine, heroin, amphetamines, or phencyclidine (PCP) can cause this disorder. Tenosynovitis is an inflammation of the sheath that surrounds a tendon, often in the wrist and hands. Repetitive use of these tendons can produce pain, tenderness in the tendon, and difficulty in related joint movement.

biopsy

Process of removing tissue from a living person for laboratory examination

therapist

Professional trained in the practice of a particular therapy

phalanx/ phalanges

One of the bones of the digits (fingers or toes)

vertebra/ vertebrae

One of the bones of the spinal column

diseases of bone

One of the major bone diseases is osteoporosis, which results from a loss of bone density (Figure 4.4). More common in women than in men, the incidence of osteoporosis increases with age. In the United States alone, 10 million people are living with osteoporosis and 18 million more have low bone density (osteopenia). Osteopenia puts people at risk for developing osteoporosis. In women, production of the hormone estrogen decreases after menopause, weakening the body's protection against bone loss and potentially resulting in fragile, brittle bones. In men, lower levels of testosterone have a similar but less noticeable effect. Women at risk for osteoporosis should have a bone mineral density (BMD) screening using a DEXA scan, which is a measuring device that uses low-energy radiation beams. Men and women over 50 are often advised to follow a daily regimen of 1,200 milligrams (mg) of calcium, 400 to 600 international units (IU) of vitamin D, and 15 minutes of real sun exposure. In addition, there are several FDA-approved medications available for treating osteoporosis.

orthotic

Orthopedic appliance to correct an abnormality

disorders of the hand

Osteoarthritis (OA) in the hand joints occurs from wear and tear leading to deterioration of joint cartilage. Small bony spurs called Heberden nodes form over the joint. Rheumatoid arthritis (RA), with destruction of joint surfaces, joint capsules, and ligaments, leads to noticeable deformity and joint instability (Figure 4.17). RA occurs mostly in women, between ages 40 and 60, and affects the synovial membrane lining the joints and tendons. Lumps known as rheumatic nodules form over the small joints of the hand and wrist.

Other bone diseases that may not be as prevalent or publicized as osteoporosis are the following:

Osteomyelitis: an inflammation of bone and bone marrow caused by a bacterial infection, such as staphylococcus. Osteomalacia: a disease (known as rickets in children) caused by vitamin D deficiency where the calcium-lacking bones become soft and flexible, lose their ability to bear weight, and become bowed. Achondroplasia: a very rare condition where the long bones stop growing in childhood, but the axial skeleton bones are not affected (Figure 4.5). People with this condition are short in stature, with the average adult measuring about 4 feet tall. Although intelligence and life span are normal, the disease is caused by a spontaneous gene mutation that then becomes a dominant gene for succeeding generations.

cortex

Outer portion of an organ, such as bone

physical medicine and rehabilitation

PM&R health professionals are listed and defined at the beginning of this chapter. Physical medicine and rehabilitation is also called physiatry. Its goal is to develop a comprehensive program to put together the different pieces of a person's life—medical, social, emotional, and vocational—after injury or disease. PM&R programs cover a wide spectrum, from prevention of injury in athletes to treating sports-related injuries in sports medicine to coping with complicated multiple trauma. Mr. Hank Johnson (see Case Report 5.2) will need a program designed specifically to get him back on his feet literally and in so many other ways.

rheumatism

Pain in various parts of the musculoskeletal system

necrosis

Pathologic death of cells or tissue

Disorders and Injuries of the Ankle and Foot

Podiatry podiatry (poh-DIE-ah-tree) The diagnosis and treatment of disorders and injuries of the foot. is a health care specialty concerned with the diagnosis and treatment of disorders and injuries of the foot and toenails. A podiatrist is not an MD but is a doctor of podiatric medicine (DPM). Bunions, deformities that appear as swollen bones, often occur at the base of the big toe. A bunion is also called a hallux valgus, and it causes the metatarsophalangeal joint to misalign and stick out. Pott fracture is a fracture of the fibula near the ankle, often accompanied by a fracture of the medial malleolus of the tibia.

chiropractor

Practitioner of chiropractic

osteopath

Practitioner of osteopathy

-podiatrist

Practitioner of podiatry

pronation/ pronate

Process of lying face down or of turning a hand or foot with the volar (palm or sole) surface down

supination

Process of lying face upward or of turning a hand or foot so that the palm or sole is facing up

amputation

Process of removing a limb, part of a limb, a breast, or other projecting part

olecranon

Prominent, proximal extremity of ulna

Therapeutic Methods of Disorders of Muscles and Tendons

RICE (rest, ice, compression, and elevation) is used in the acute phase for muscle and tendon strains and sprains. Physical therapy (PT) and exercise are important in the treatment of muscle diseases and involve range of motion exercises to prevent contracture of joints and exercises and resistance training to restore muscle mass and strength. Medications are used frequently in muscle diseases. Acetaminophen (paracetamol) and hydrocodone can be used for pain in the acute stages following injury. For the inflammatory myopathies, oral corticosteroids are often the first line of treatment, sometimes with the anti-metabolite drugs methotrexate or azathioprine. For patients who do not respond to standard treatments, immunosuppressive drugs can be used. Surgical treatments include tendon reconstruction, in which the two ends of a ruptured or torn tendon are sutured back together. In ligament injuries of the elbow joint in high-level, overhead-throwing athletes, such as baseball pitchers, reconstruction techniques and tendon grafting are often used with success. Orthopedic appliances such as braces and walkers are used during recovery from muscle and tendon injury.

therapeutic

Relating to the treatment of a disease or disorder

aspiration/ aspirate

Removal by suction of fluid or gas from a body cavity

detoxification

Removing poison from a tissue or substance

common disorders of the shoulder girdle

Rotator cuff tears (a frequent injury to the shoulder girdle) are caused by wear and tear from overuse in work situations or in certain sports, such as baseball, football, and golf. These tears can be partial or complete. Tendonitis of the shoulder joint is caused when the rotator cuff and/or biceps tendon becomes inflamed from overuse. Bursitis, inflammation of the lubricating sac of the rotator cuff, can also be produced by overuse.

sacrum

Segment of the vertebral column that forms part of the pelvis

diastasis

Separation of normally joined parts

amputations

Seventy-five percent of all amputations are performed on people over 65 years of age with peripheral vascular disease (PVD). This includes complications from arteriosclerosis and diabetes. Most of these cases involve below-the-knee amputations (BKAs). On the other hand, the wars in Iraq and Afghanistan led to soldiers losing their arms and legs from have the detonation of explosive devices. In some of these cases, amputations are also required, depending on the level of damage an explosion has caused to the soldier's body. Rehabilitation after amputation is an increasingly important component in rehabilitation programs. Immediately after surgery, the objectives of the rehabilitation team are to: Promote healing of the stump; Strengthen the muscles above the site of the amputation; Strengthen arm muscles to assist in ambulation or help with walking using a cane, crutches, or other assistive devices; Prevent contractures or tightening of the joints above the amputation (knee and hip for BKAs); Shrink the post-amputation stump with elastic cuffs or bandages to fit the socket of a temporary prosthesis (Figure 5.12); and Provide emotional, psychological, and family support.

cruciate

Shaped like a cross. In this case, the two internal ligaments of the knee joint cross over each other to form an "X"

scapula/ scapulae

Shoulder blade

disorders of the shoulder girdle

Shoulder separation is a dislocation of the acromioclavicular joint, often caused by a fall onto the point of the shoulder. Shoulder dislocation occurs when the ball of the humerus slips out of the scapula's socket, usually anteriorly. Shoulder subluxation occurs when the ball of the humerus slips partially out of position in the socket, and then moves back in.

humerus

Single bone of the upper arm

collateral

Situated at the side, often to bypass an obstruction

periosteum

Strong membrane surrounding a bone

functions of skeletal muscle

Skeletal muscles, which are attached to one or more bones, are also called voluntary muscles. This means that you have conscious control of your muscles, which perform your movements. Each muscle consists of bundles of muscle cells (often called fibers because of their length), blood vessels, and nerves. Connective tissue sheets hold your muscle fibers together and connect the muscles to your bones. Your skeletal muscle has the following functions: Movement. All skeletal muscles are attached to bones so when a muscle contracts, your bones move, too (Figure 5.1). This allows you to walk, run, and work with your hands. Posture. The tone of your skeletal muscles holds you straight when sitting, standing, or moving. Body heat. When skeletal muscles contract, they produce the heat needed to maintain your body temperature. Respiration. Skeletal muscles move the chest wall as you breathe. Communication. Skeletal muscles enable you to speak, write, type, gesture, and smile.

coccyx

Small tailbone at the lowest end of the vertebral column

trochlea

Smooth articular surface of bone on which another glides

osteomalacia

Soft, flexible bones lacking in calcium (rickets)

muscle and hip and thigh

Some of your body's most powerful muscles support your hip joint and move your thigh. These muscles originate on the pelvic girdle and are inserted into the femur. Among these prominent muscles are your three gluteus muscles—maximus, medius, and minimus (Figure 5.7)—and the adductor muscles that run down your inner thigh.

orthotist

Specialist who makes and fits orthopedic appliances

stable

Steady, not varying

skeletal system provides

Support: The bones of your vertebral column, pelvis, and legs hold up your body. The jawbone supports your teeth. Protection: The skull protects your brain. The vertebral column protects your spinal cord. The rib cage protects your heart and lungs. Blood formation: Bone marrow in many bones is the major producer of blood cells, including most of those in your immune system Mineral storage and balance: The skeletal system stores calcium and phosphorus and releases them when your body needs them for other purposes. Detoxification: Bones remove metals like lead and radium from your blood, store them, and slowly release them for excretion. Endocrine regulation: Bone cells release a hormone called osteocalcin, which increases insulin secretion and reduces stores of fat.

Therapeutic Procedures for Bone Disorders

Surgery is a common treatment for many bone disorders. In bone cancer, the surgeon removes the entire tumor with margins that are negative for cancer cells. Modern surgical techniques have reduced the need for amputation in limb bone cancer. Surgical techniques used for specific bones, joints, and their disorders have been discussed previously in this chapter. Chemotherapy is the use of anticancer drugs, often in combinations, to kill cancer cells. Numerous drugs are available. Radiotherapy uses high-energy X-rays to kill cancer cells and is often used with surgery. Cryosurgery uses liquid nitrogen to freeze and kill cancer cells. Drug therapy for metabolic bone disorders includes, for osteoporosis, estrogen replacement therapy (ERT), anti-estrogens (SERMs), or bone-preserving medications such as calcitonin. A class of drugs called bisphosphonates prevents the loss of bone mass and is used in the treatment of osteoporosis, Paget disease, osteogenesis imperfecta, and any condition that features bone fragility.

arthroplasty

Surgery to repair, as far as possible, the function of a joint

whiplash

Symptoms caused by sudden, uncontrolled extension, and flexion of the neck, often in an automobile accident

stabilize

To make or hold firm and steady

therapy

Systematic treatment of a disease, dysfunction, or disorder

rheumatoid arthritis

Systemic disease affecting many joints

common disorders of the elbow

Tennis elbow is a common injury. Upper arm and forearm muscle tendons are inserted into the upper arm bone just above the elbow joint. Small tears in these tendons at their attachments can be caused by trauma or overuse of the elbow joint. Treatment is rest, ice, pain medication, massage, and stretching exercises.

injuries to the knee joint

The anterior cruciate ligament (ACL) is the most commonly injured ligament in the knee (Figure 4.23), particularly in football players and female athletes. The injury is often caused by a sudden hyperflexion of the knee joint when landing awkwardly on flat ground, as in Gail Griffith's case. Because of its poor vascular (blood) supply, the torn ligament does not heal and has to be surgically mended. Other commonly injured major ligaments are the medial and lateral collateral ligaments and the posterior cruciate ligament. Meniscus injuries result from a twist to the knee that tears the meniscus. The torn meniscus flips in and out of the joint as it moves, locking the knee and creating pain. Losing a meniscus leads to arthritic changes, so repair of the meniscus, as in Ms. Griffith's case, instead of removal (a meniscectomy) is preferred. Patellar subluxation or dislocation produces an unstable, painful kneecap. Prepatellar bursitis ("housemaid's knee") produces painful swelling over the bursa at the front of the knee and is seen in people who kneel for extended periods of time, like carpet layers. Tendinitis of the patellar tendon results from overuse during activities like cycling, running, or dancing. Pain is felt where the tendon is inserted into the tibia, and this is treated with R.I.C.E (rest, ice, compression, elevation).

occipital

The back of the skull

shoulder girdle

The bones and joints of your shoulder girdle connect your axial skeleton to your upper limbs. The bones of the shoulder girdle are the scapulae (shoulder blades) and clavicles (collarbones). The scapula extends over the top of the shoulder joint to form a roof called the acromion, which is attached to the clavicle at the acromioclavicular (AC) joint. Several ligaments hold together the articulating surfaces of the humerus and scapula. The shoulder joint between the scapula and the humerus bone of the upper arm (Figure 4.11) is a ball-and-socket joint, allowing the head of the humerus greater range of motion than any other joint in the body. This broad range of motion does have one drawback; because the shoulder joint is very unstable, it's prone to dislocation.

classification of bones

The bones of your skeletal system are classified by their shape. Each falls into one of the following four shape categories: Long (considerably longer than they are wide), like the main bones of the limbs, palms, soles, fingers, and toes; Short (nearly as long as they are wide), like the patella (kneecap) and the bones of the wrists and ankles; Flat, like the bones of the skull and the ribs; or Irregular, like the vertebrae.

forearm, wrist, and hand

The muscles of your forearm are responsible for various movements. These muscles supinate and pronate your forearm (turning it upward and downward), flex and extend your wrist joint and hand, and move your hand medially and laterally (back and forth crossways). These terms of movement are detailed in Chapter 2. Your forearm is bigger near the elbow because the forearm muscles are fleshy and bulky. Your wrist is much thinner because these muscles have become tendons that pass over your wrist on the way to being inserted into your finger bones.

tarsus

The collection of seven bones in the foot that form the ankle and instep

acetabulum

The cup-shaped cavity of the hip bone that receives the head of the femur to form the hip joint

podiatry

The diagnosis and treatment of disorders and injuries of the foot

carpus

The eight carpal bones of the wrist

elbow joint

The elbow joint has two articulations: A hinge joint between the humerus and the ulna bone of the forearm, which allows flexion and extension of the elbow; and A gliding joint between the humerus and the radius bone of the forearm, which allows pronation and supination of the forearm and hand.

glucose

The final product of carbohydrate digestion and the main sugar in blood

metacarpal

The five bones between the carpus and the fingers

the hand

The five fingers of your single hand have 14 bones called phalanges. The thumb has two phalanges, and each of the remaining four fingers has three (Figure 4.14). In your palm, the five bones closest to the fingers are metacarpals; these connect to the phalanges at the metacarpophalangeal joints. The metacarpals connect at the wrist to eight small carpal bones, which then connect the hand to the bones of the forearm. All of these bones require numerous joints with ligaments to connect and stabilize them.

metatarsus

The five parallel bones of the foot between the tarsus and the phalanges

rehabilitation definitions

The following definitions of terms or phrases specific to rehabilitation will help you to understand more precisely the different kinds of rehabilitation in which you may be involved as a health professional. Rehabilitation medicine focuses on function. Being able to function is essential to an individual's independence and ability to have a good quality of life. Restorative rehabilitation restores a function that has been lost, such as after a hip fracture, hip replacement, or stroke. This process can be intense, but it's also usually short term. Maintenance rehabilitation strengthens and maintains a function that is gradually being lost. It is less intense than restorative rehabilitation but often long term. Problems of senescence (old age), like difficulty with balance or flexibility, require this long-term approach. Rehabilitation medicine is also involved with the prevention of function loss and the prevention of injury. In sports medicine, an example is the prevention of shoulder and elbow injuries often experienced by baseball pitchers. Activities of daily living (ADLs) are the routine activities of personal care. The six basic ADLs are eating, bathing, dressing, grooming, toileting, and transferring. Assistive devices are designed to make ADLs easier to perform and help maintain the patient's independence. Examples of these devices include reachers and grabbers, easy-pull sock aids, long shoehorns, jar openers, and eating aids (Figure 5.11). ADLs are also a measurement to assess therapy needs and monitor its effectiveness Instrumental activities of daily living (IADLs) relate to independent living. These activities include managing money, using a telephone, cooking, driving, shopping for groceries and personal items, and doing housework.

radius

The forearm bone on the thumb side

maximus

The gluteus maximus muscle is the largest muscle in the body, covering a large part of each buttock

medius

The gluteus medius muscle is partly covered by the gluteus maximus

minimus

The gluteus minimus is the smallest of the gluteal muscles and lies under the gluteus medius

stroke rehabilitation

The goals of Mr. Johnson's rehabilitation program are to enable him to: Walk safely using an assistive device. Use his hands with accuracy. Restore his speech abilities. Prevent a second stroke. Because he received thrombolytic therapy (see Chapter 6) within 3 hours of his stroke's onset, he has a 50% chance of being left with little or no residual difficulty, compared to a 35% chance had he not received the therapy. Social workers are helping Mr. Johnson's wife to make their home safe for his return, including obtaining adaptive equipment. Raised toilet seats, handrails in the bath and shower, eating devices, and other adaptive equipment will help Mr. Johnson perform activities of daily living during his recovery. Social workers will also help Mrs. Johnson to work with Medicare to obtain the maximum allowable benefits. Anyone who has had one stroke is at high risk for having a second stroke. Therefore, during this rehabilitative period, Mr. Johnson will be evaluated for such risk factors as narrowing of the carotid arteries with plaque, thrombosis (see Chapter 6), and the presence of atrial fibrillation (see Chapter 6).

dorsal

pertaining to the back of any part of the body

insertion (insert)

The insertion of a muscle is the attachment of a muscle to a more movable part of the skeleton, as distinct from the origin

acromioclavicular

The joint between the acromion and the clavicle

sacroiliac joint

The joint between the sacrum and the ilium

temporomandibular joint

The joint between the temporal bone and the mandible

metacarpophalangeal

The joints between the metacarpal bones and the phalanges

tibia

The larger bone of the lower leg

ulna

The medial and larger bone of the forearm

Muscles and Tendons of the Lower Leg, Ankle, and Foot

The muscles of your lower leg move your ankle, foot, and toes. Your front leg muscles bend your foot backward at the ankle and extend your toes. The side or lateral leg muscles turn your foot outward or evert it. Your back leg muscles plantar-flex your foot at the ankle, flex your toes, and turn in or invert your foot. The gastrocnemius muscle (Figure 5.10(a)), located at the back of your leg, forms a large part of your calf. The distal end of this muscle joins the tendon of the smaller calf (soleus) muscle to create the Achilles (calcaneal) tendon, which is attached to the heel bone (calcaneus) (Figure 5.10(b)). Together, your gastrocnemius muscle and Achilles tendon make it possible for you to "push off" when jumping or running. For more detailed foot movement descriptions, you may review the terms in Chapter 2.

-or

a deer

lumbar

The region of the back and sides between the ribs and pelvis

debridement

The removal of injured or necrotic tissue

diaphysis

The shaft of a long bone

fibula

The smaller of the two bones of the lower leg

activity

The state of being active

radiology

The study of medical imaging

talus

The tarsal bone that articulates with the tibia to form the ankle joint

femur

The thigh bone

parietal

The two bones forming the sidewalls and roof of the cranium

cranium

The upper part of the skull that encloses and protects the brain

atrophy

The wasting away or diminished volume of tissue, an organ, or a body part

rehabilitation

Therapeutic restoration of an ability to function as before

Surgical Procedures of the Knee Joint

There are several procedures and surgery options for those who sustain knee injuries. Arthrocentesis is the aspiration of knee joint fluid, which is examined to establish a diagnosis. Infected fluid may be drained off or medication, such as local corticosteroids, may be inserted. Arthrography is an X-ray of a joint after injection of a contrast medium (harmless dye) into the joint to make the inside details of the joint visible. Diagnostic arthroscopy is an exploratory procedure performed using an arthroscope to examine the internal compartments of the knee joint. Surgical arthroscopy is performed through an arthroscope. This can be a debridement or removal of torn tissue like a meniscus or a ligament. It can also be a repair of a torn ligament by suturing, or tendon autograft, or repair of a torn meniscus. Arthroplasty involves a total replacement of the knee joint (Figure 4.24), usually because of osteoarthritis. The damaged cartilage and bone from the knee joint's surface are removed and replaced with metal and plastic.

types of muscle

There are three types of muscle: skeletal, cardiac, and smooth. Skeletal muscles contract on demand to provide posture and locomotion. Cardiac and smooth muscle contract without conscious thought, cardiac muscle to power the heart contractions and smooth muscle to power the movement of food through the digestive system via peristalsis.

Surgical Procedures of the Hip Joint

There are two standard surgical procedures for replacing or repairing the hip joint. Arthroplasty, a total replacement of the hip joint with a metal prosthesis, is the most common hip surgery today. Here, the diseased parts of the joint are removed and replaced with artificial parts made of titanium and other metals, ceramics, and plastics. Arthrodesis is a surgical procedure that fixates or stiffens a joint.

patella/ patellae

Thin, circular bone in front of the knee joint, embedded in the patellar tendon

structure of bones

Think about how long your arms and legs are, and then consider how few bones make up all that length. In that context, it's likely no surprise that long bones are the most common bones in your body (Figure 4.2). The shaft (diaphysis) of a long bone contains compact bone (also called cortical bone), while each end of the bone (the epiphysis) is composed of spongy bone. Sandwiched between the diaphysis and epiphysis are thin layers of cartilage cells in the epiphysial plate or line that allow your bones to grow longer. A tough, connective tissue sheath called periosteum covers the outer surface of all bones; it protects the bone and anchors blood vessels and nerves to the bone's surface. Strong collagen fibers attach the periosteum to the cortical bone. Inside the diaphysis is a hollow cylinder called the medulla (Figure 4.2b), which contains bone marrow, a fatty tissue in adults. Red bone marrow with blood cells in varying stages of development can be found in the epiphyseal ends of the bone and in the flat bones of the skull, the sternum, and the hip bones. Because red bone marrow is normally concentrated here, the medulla of the sternum and hip bone is the ideal source for bone marrow aspiration, a procedure where a needle is inserted into the bone to withdraw a sample of bone marrow fluid and cells to be checked for abnormalities. Most bones have a strong blood supply (Figure 4.3) because of the blood vessels that travel through them in a system of small Haversian canals. The good supply of blood through your bones promotes healing.

chemotherapy

Treatment using chemical agents

radiotherapy

Treatment using radiation

symphysis/ symphyses

Two bones joined by fibrocartilage; in this case, the two pubic bones

articulate

Two separate bones have formed a joint

maxilla

Upper jawbone, containing right and left maxillary sinuses

cryosurgery

Use of liquid nitrogen or argon gas in surgery to freeze and kill abnormal tissue

occupational therapy

Use of work and recreational activities to increase independent function

haversian canals

Vascular canals in bone

spine

Vertebral column or a short projection from a bone

arthroscopy

Visual examination of the interior of a joint

sphenoid

Wedge-shaped bone at the base of the skull

healing of fractures

When a bone is fractured, blood vessels bleed into the fracture site, forming a hematoma (Figure 4.7a). After a few days, bone-forming cells called osteoblasts move in and start to produce new bone cells (osteocytes), which form a callus (Figure 4.7b). Osteblasts continue to produce bone cells, which form cancellous (spongy) bone to replace the callus (Figure 4.7c). As more bone cells form, the spongy bone structure is replaced by compact bone, which fuses together the bone segments (Figure 4.7d). Uncomplicated fractures take 8 to 12 weeks to heal.

disorders of the elbow joint

When you bend your elbow, you can easily feel the bony prominence (the olecranon Figure 4.13) that extends from the ulna. The olecranon can be easily fractured by a direct blow to the elbow or by a fall on a bent elbow. The olecranon bursa is a thin, slippery sac between the skin and the prominence of the olecranon bone. It contains a small amount of fluid to enable the skin to move freely over the bone. If the bursa becomes irritated or inflamed, fluid accumulates and bursitis occurs. Treatment is aspiration and an antibiotic if indicated by laboratory investigation of the aspirated fluid. Tennis elbow is caused by overuse of the elbow joint or poor form when playing tennis or golf. The pain occurs when ligaments and muscle tendons around the joint tear. Treatment is rest, ice, pain medication, massage, and stretching exercises. When a child falls on an outstretched arm, the force of hitting the ground can be transmitted up the arm to cause a fracture of the elbow joint. This accounts for about 10% of all fractures in children.

the skull

When you glance at your face in the mirror, chances are you're not thinking about what's behind your brown eyes or your slightly crooked smile. You see one image—not its layers, pieces, or parts. However, the human skull (Figure 4.9) is made up of 22 separate bones. Your cranium, the upper part of the skull that encloses the cranial cavity and protects the brain, contains 8 of these 22 bones; your facial skeleton contains the rest. The bones of the cranium are joined together by sutures (joints that appear as seams), which are covered on the inside and outside by a thin layer of connective tissue. These bones have the following functions: The frontal bone forms the forehead, roofs of the (eye) orbits, and part of the floor of the cranium and contains a pair of right and left frontal sinuses above the orbits. Parietal bones form the bulging sides and roof of the cranium. The occipital bone forms the back of and part of the base of the cranium. Temporal bones form the sides of and part of the base of the cranium. The sphenoid bone forms part of the base of the cranium and the orbits. The ethmoid bone is hollow and forms part of the nose, the orbits, and the ethmoid sinuses. These bones of the skull provide protection for the brain and the organs of vision, taste, hearing, equilibrium, and smell. The lower part of the skull houses the bones of the facial skeleton (Figure 4.10). These bones do the following Maxillary bones form the upper jaw (maxilla), hold the upper teeth, and are hollow, forming the maxillary sinuses. Palatine bones are located behind the maxilla and cannot be seen on a lateral view of the skull. Zygomatic bones are the prominences of the cheeks (cheekbones) below the eyes. Lacrimal bones form the medial wall of each orbit. Nasal bones form the sides and bridge of the nose. The mandible is the lower jawbone, which holds the lower teeth. The mandible articulates (joins) with the temporal bone to form the temporomandibular joint (TMJ).

the hand

When you look at the palm of your hand, you'll see a prominent pad of muscles (the thenar eminence) at the base of your thumb (Figure 5.6). A smaller pad of muscles (the hypothenar eminence) is located at the base of your little finger. The back of your hand is called the dorsum.

avascular

Without a blood supply

arthrography

X-ray of a joint taken after the injection of a contrast medium into the joint

diagnostic procedures for bone cancer

X-ray shows the location, shape, and size of a bone tumor. Nuclear bone scan (described above). Computed tomography (CAT or CT) scan provides a series of detailed pictures of parts of the body, taken from different angles, that are created by an X-ray machine linked to a computer. Magnetic resonance imaging (MRI) uses a magnet linked to a computer to create detailed pictures of body parts without using X-rays. Positron emission tomography (PET) scan uses radioactive glucose that is injected into the bloodstream and a scanner that makes a computerized picture of body parts where the glucose is being used. Cancer cells can use more glucose than normal cells and can be detected by the scan. Biopsy can be a needle or incisional biopsy.

structure of the axial skeleton

Your axial skeleton, the upright axis of your body, includes the: vertebral column, skull, and rib cage. The axial skeleton protects the brain, spinal cord, heart, and lungs—most of the major centers of human physiology. Within the vertebral column, there are 26 bones divided into the following five regions: Cervical region, with 7 vertebrae, labeled C1 to C7 and curved anteriorly; Thoracic region, with 12 vertebrae, labeled T1 to T12 and curved posteriorly; Lumbar region, with 5 vertebrae, labeled L1 to L5 and curved anteriorly; Sacral region, with 5 bones that in early childhood fuse into 1 bone curved posteriorly; and Coccyx (tailbone), with 4 small bones fused together into 1 bone curved posteriorly. The spinal cord lies protected in the vertebral canal of the vertebral column. Spinal nerves travel from the spinal cord to other parts of the body through the intervertebral foramina. Intervertebral discs consisting of fibrocartilage (a form of cartilage) are also found in the axial skeleton. These discs inhabit the intervertebral space between the bodies of adjacent vertebrae and provide extra support and cushioning (acting as shock absorbers) for the vertebral column. The vertebral column, like any other body part, is susceptible to injury and disease. One common disorder of the vertebral column is scoliosis, an abnormal lateral curvature of the spine that occurs in both children and adults. Abnormal curvature of the spine is more common in older people, particularly those with osteoporosis; in this case, the normal anteriorly concave curvature in the thoracic region (kyphosis) is exaggerated.

Knees

Your knees do plenty of bending, whether you're climbing the stairs, exercising, sitting cross-legged, or squatting down to collect something from the floor. Each of your knees is a hinged joint formed with these four bones: The lower end of the femur, shaped like a horseshoe; The flat upper end of the tibia; The flat triangular patella (kneecap), embedded in the patellar tendon and articulating with the femur (Figure 4.22a); and The fibula, which forms a separate joint—the tibiofibular joint (Figure 4.22b)—by articulating with the tibia. Mechanically, the patella's role is to provide a 30% strength increase in the extension of the knee joint. Within the knee joint, two crescent-shaped pads of cartilage—the medial and lateral menisci—lie on top of the tibia and articulate with the femur. This cartilage helps to distribute weight more evenly across the joint surface to minimize wear and tear. The knee joint has a fibrous capsule, lined with synovial membrane that secretes synovial fluid to lubricate the joint. Four ligaments hold the knee joint together: the medial and lateral collateral ligaments located outside the joint and the anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) located inside the joint cavity, crossing over each other to form an "X" (Figure 4.22b). The thigh muscles which move the knee joint are described in Lesson 5.3 of the next chapter.

upper arm and elbow joint

Your muscles connect your humerus (upper arm bone) to your shoulder girdle, vertebral column, and ribs. These muscles enable your arm to move freely at the shoulder joint. Your major anterior muscles (those at the front of your body) are the deltoid (shoulder muscle) and pectoralis major (chest muscle) (Figure 5.5a). Among the major posterior muscles is the latissimus dorsi, found in your back (Figure 5.5b). Muscles that move your elbow joint and forearm originate on the upper arm bone or shoulder girdle and are inserted into the bones of your forearm. On the front of the arm, you have a group of three muscles (Figure 5.5a)—biceps brachii, brachialis, and brachioradialis. These muscles flex your forearm at the elbow joint and rotate your forearm and hand sideways or laterally (supination). A single muscle on the back of your arm (the triceps brachii) extends your elbow joint and forearm (Figure 5.5b).

shoulder girdle

Your pectoral (shoulder) girdle connects your axial skeleton to your upper limbs and helps you to move these limbs. Without your shoulder girdle, you wouldn't be able to throw a ball, drive a car, or reach that top shelf of your closet or kitchen cabinet. In fact, you wouldn't be able to move your upper limbs. The muscles and tendons in your shoulder girdle get plenty of use. Four muscles that originate on your scapula wrap around the shoulder joint and fuse together. This fusion forms one large tendon (the rotator cuff), which is inserted into the humerus (Figure 5.4). Your rotator cuff keeps the ball of the humerus tightly in the scapula's socket and provides the kind of strength needed by baseball pitchers.

pelvic girdle

Your pelvic girdle consists of your two hip bones that articulate anteriorly with each other at the symphysis pubis and posteriorly with the sacrum (a triangular-shaped bone in your lower back). This forms the bowl-shaped pelvis. The two joints between your hip bones and the sacrum are called sacroiliac joints. The pelvic girdle has these functions: Supports the axial skeleton; Transmits the upper body's weight to the lower limbs; Provides attachments for the lower limbs; and Protects the internal reproductive organs, urinary bladder, and distal segment of the large intestine. Each of your hip bones is actually a fusion of three bones: the ilium, ischium, and pubis (Figure 4.18a). This fusion occurs in the region of the acetabulum, a cup-shaped cavity on the lateral surface of the hip bone that receives the head of the femur, or thigh bone. The lower part of the pelvis is formed by the lower ilium, ischium, and pubic bones that surround a short canal-like pelvic cavity, through which the rectum, vagina, and urethra pass. In females, the infant passes down this canal during childbirth.

structure of skeletal muscle

Your skeletal muscle fibers are narrow and measure up to 1½ inches long. Bundles of these fibers create separate muscles, which are held in place by fascia (Figure 5.2), a thick layer of connective tissue. Fascia extends beyond the muscle to form a tendon, which attaches to a bone's periosteum at the origin and insertion of the muscle. Because skeletal muscle fibers contain striations (alternating dark and light bands of protein filaments responsible for muscle contraction), skeletal muscle can also be called striated muscle. You have the same number of muscle fibers as an adult that you had in late childhood. Exercise and/or weightlifting will enlarge (hypertrophy) your muscles, increasing the thickness of your muscle fibers. If you neglect these muscles, they will shrink (atrophy).

the muscles

Your thigh muscles move your knee joint and lower leg. Your anterior thigh (the front of your thigh) contains your large quadriceps femoris muscle. This muscle has four heads: the rectus femoris, vastus lateralis, vastus medialis, and the vastus intermedius (which lies beneath the rectus femoris). These four muscle heads join into the quadriceps tendon (which contains the patella) and continue as the patellar tendon to be inserted into the tibia (Figure 5.8). The quadriceps muscle extends (straightens) the knee joint and, because of the lower leg's weight, it has to be a very strong muscle. Your posterior (rear) thigh is composed mostly of your three hamstring muscles—the biceps femoris, semimembranosus, and semitendinosus (Figure 5.9). These muscles flex (bend) your knee joint and rotate your leg. The hollow area at the back of your knee between your hamstring tendons is the popliteal fossa.

upper arm and elbow joint

Your upper arm extends from your shoulder to your elbow and contains only one bone, the humerus (Figure 4.12). The smooth surface of the hemispherical head that articulates with the socket of the scapula is covered with articular cartilage. At the lower end of the humerus, the trochlea articulates with the ulna bone of the forearm and the capitulum articulates with the radius

stanic

a class of drug used to lower blood cholesterol levels

muscle

a tissue consisting of cells that can contract

sprain

a wrench or tear in a ligament

-malacia

abnormal softness

hyper-

above, excessive

acromi/o-

acromion

-ize

action

-met

action

abduction (abduct)

action of moving away from the midline

adduction

action of moving toward the midline

-ion

action, condition

meta-

after, subsequent to

-tars-

ankle

tars-

ankle

physiotherapy

another term for physical therapy

myopathy

any disease of muscle

dis-

apart, away from

-form-

appearance, form

podiatrists

are practitioners in the diagnosis and treatment of disorders and injuries of the foot.

brachi/o-

arm

ab-

away from

dors-

back

occipit-

back of the head

dys-

bad, difficult

pre-

before, in front of

ventr-

belly

-is

belonging to, pertaining to

hypo-

below, smaller

-flex-

bend

supinat-

bend

pronat-

bend down

kyph/o-

bent, humpback

hallux

big

-vascul-

blood vessel

hemat-

bloos

physi/o-

body

physic-

body

oste/o-

bone

-myel-

bone marrow

-carp/o-

bones of the wrist

4 components of the skeletal system:

bones, cartilage, tendons, and ligaments.

comminut-

break into pieces

burs-

bursa

glut-

buttocks

calcan-

calcaneus

-calc-

calcium

gastrocnem-

calf of leg

-chondr/o-

cartilage

chondr/o-

cartilage

-cyte

cell

-metabol-

change

de-

change

zygomayt-

cheekbone

chem/o-

chemical

-in

chemicalcompound

pector-

chest

-ped-

child

-clavicul-

clavicle

-ate

composed of

-ism

condition

-ity

condition

-osis

condition

-sis

condition

-ity

condition, state

-stalsis

constrict

-path

disease

-pathy

disease

path/o-

disease

-luxat-

dislocate

-tract

draw

-pract-

efficient, practical

-lash

end of whip

physical therapists

evaluate and treat pain, disease, or injury by physical therapeutic measures, as opposed to medical or surgical measures

hyper-

excessive

femor-

femur

temor-

femur

fibr/o-

fiber

tendon

fibour band that connects muscle to bone

fibul-

fibula

origin

fixed source of a muscle at its attachment to bone

sarc-

flesh

ganglion

fluis-containing swelling attached to the synovial sheath of a tendon

pod-

foot

-plasia

formation

quadri-

four

volunt-

free will

cortic/o

from the cortex

de-

from, out of

-ose

full of

-glob-

globe

-physis

growth

poplit/e-

ham, back of knee

chir/o-

hand

osteopathic physicians

have earned a doctor of osteopathy (DO) degree and receive additional training in the musculoskeletal system and how it affects the whole body.

-itis

inflammation

-sitis

inflammation

arthritis

inflammation of a joint or joints

tendinitis/tendonitis

inflammation of a tendon

tenosynovitis

inflammation of a tendon and its surrounding synovial sheath

myositis

inflammation of muscle tissue

disciplin-

instruction

-scope

instrument to examine visually

Sacroiliac (SI) joint strain

is a common cause of lower back pain. Unlike most joints, the SI joint (Figure 4.19) is designed to move only 1/4 of an inch during weight-bearing and forward-bending movements. Its main function is to provide shock absorption for the spine. Because stretching in the SI joint ligaments makes this joint overly mobile, it's susceptible to wear and tear, including painful arthritis. Another cause of pain in the SI joint is trauma, when tearing of the joint ligaments allows too much motion. A clinical examination, joint X-ray (radiology), and CT scan may be used to diagnose the presence of sacroiliac strain. For temporary pain relief, a local anesthetic can be injected into the joint. Standard treatment involves stabilizing the joint with a brace and strengthening the lower back muscles with physical therapy. Occasionally, arthrodesis of the joint is necessary. Diastasis symphysis pubis sometimes occurs during pregnancy. It is caused by excessive stretching of pelvic ligaments, which widens the joint between the two pubic bones. This leads to pain and difficulty in walking, climbing stairs, and turning over in bed. During pregnancy, however, hormones generally enable connective tissue in the SI joint area to relax so the pelvis can expand enough to allow birth without causing SI joint strain.

ischi-

ischium, hip bone

arthr-

joint

arthr/o-

joint

articul-

joint

athr-

joint

-duct

lead

-duct-

lead

bio-

life

gastrocnemius

major muscle in the back of the lower leg (the calf)

-mandibul-

mandible

mandibul-

mandible

multi-

many

maxilla-

maxilla

-therapy

medical treatment

medulla-

medulla

activ-

movement

-my-

muscle

-my/o-

muscle

muscul/o-

muscle

my/o-

muscle

contracture

muscle shortening due to spasm or fibrosis

brachioradialis

muscle that helps flex the forearm

voluntary muscle

muscle that is under the control of the will

brachialis

muscle that lies underneath the biceps and is the strongest flexor of the forearm

adductor

muscle that moves that thigh toward the midline

stenosis

narrowing of a passage

phys-

nature

-ive

nature of

cervic-

neck

passive

not active

-trophy

nourishment

ventral (opposite of dorsal)

pertaining to the belly or situated nearer to the surface of the belly

gluteal

pertaining to the buttocks

pectoral

pertaining to the chest

brachi/i

of the arm

dorsi

of the bakc

-or

one who does

-logist

one who studies, specialist

-por/o-

opening

-surg-

operate

strain

overstretch or tear in a muscle or tendon

-algia

pain

fibromyalgia

pain in the muscle fibers

palat-

palate

thenar

palm

rotator cuff

part of the capsule of the shoulder joint

-patell-

patella

patell-

patella

pelv-

pelvis

-alis

perating to

-al

pertaining to

-alis

pertaining to

-ar

pertaining to

-ary

pertaining to

-eal

pertaining to

-ed

pertaining to

-ial

pertaining to

-ic

pertaining to

-ite

pertaining to

-ius

pertaining to

-tic

pertaining to

-us

pertaining to

ic-

pertaining to

tic-

pertaining to

incisional

pertaining to an incision

-ine

pertaining to e

-iatrist

practitioner

-suppress-

press under

prevent-

prevent

-ation

process

-ion

process

-ery

process of

-graphy

process of recording

prevention

process to prevent occurrence of a disease or health problem

-ion

process, action

-gen

produce, create

myoglobin

protein of muscle that stores and transports oxygen

prosthet-

prothesis

amput-

prune

pub-

pubis

contract-

pull together

trochle-

pulley

-centesis

puncture

insert-

put together

-ative

quality of

radi/o-

radiation, X-rays

-radi

radius

radi-

radius

-habilitat-

restore

-ure

result of

rhabd/o

rod-shaped

rotat-

rotate

-bride-

rubble, rubbish

sacr-

sacrum

sacr/o-

sacrum

scapul-

scapula

fascia

sheet of fibrous connective tissue

-later-

side

ethm-

sieve

-skelet-

skeleton

skelet-

skeleton

crani-

skull

capit/u

small head

-lum

small structure

-phon-

sound

-ist

specialist

physiatrist

specialist in physical medicine

spin-

spine

eminence

stand out

stabil-

steady, fixed

-steroid

steroid

orth/o-

straight

-um

structure

-logy

study of

-in

substance

immunosuppressive

substance that causes failure of the immune system

gluc-

sugar, glucose

ten/o-

tendon

tendin-

tendon

tone

tension present in resting muscles

-or

that which does something

dorsum

the back of any part of the body, including the hand

hypothenar eminence

the fleshy mass at he base of the little finger

thenar eminence

the fleshy mass at the bottom of the thumb

calcaneus

the heel bone

popliteal fossa

the hollow at the back of the knee

-scopy

the process of using an instrument to examine visually

calcaneal (same as achilles tendon/ achilles)

the tendon of the heel formed from gastrocnemius and soles muscles and inserted into the calcaneus

latissimus dorsi

the widest (broadest) muscle in the back

restorative rehabilitation

therapy that promotes renewal of health and strength

thym-

thymus gland

tempor/o-

time, temple

fract-

to break

aspirat-

to breathe on

-desis

to fuse together

amput-

to prune, top off

-log-

to study

whip-

to swing

-opsy

to view

co-

together

ad-

toward

-iatr-

treatment

-iatry

treatment

therap-

treatment

therapeut-

treatment

therapy

treatment

therapy-

treatment

delt-

triangle

-oma

tumor, mass

valgus

turn out

bi-

two

uln-

ulna

sub-

under, below, slightly

epi-

upon, above

physical therapy

use of remedial processes to overcome a physical defect

vertebr-

vertebra

ambulat-

walking

pariet-

wall

peristalsis

waves of alternate constriction and relaxation in a tube

sphen-

wedge

latiss-

wide

with, together

with, together

a-

without

estr/o-

woman

occupation-

work

physical therapist assistants

work under the direction of a physical therapist to assist patients with their physical therapy.

carp-

wrist bones

radi/o-

x-ray, radiation

Bones and Joints of the Hip and Thigh

your hip joint is a ball-and-socket mechanism formed by the head of your femur (thigh bone) and the acetabulum (cup-shaped hip socket) of your hip bone (Figure 4.20). The labrum is the articular cartilage that forms a rim around the hip joint socket, cushioning the joint and helping to keep your femoral head in place in the socket. Finally, the hip joint is secured by a thick joint capsule reinforced by strong ligaments that connect the neck of the femur to the rim of the hip socket.

Bones and Joints of the Lower Leg, Ankle, and Foot

your lower leg has two differently sized bones: the large medial tibia and the thin lateral fibula. The lower end of your tibia on its medial border forms a prominent process called the medial malleolus. The lower end of your fibula forms the lateral malleolus (Figure 4.25). You can palpate (feel) both these prominences at your own ankle, which has two joints: One between the lateral malleolus of the fibula and the talus; and One between the medial malleolus of the tibia and the talus. The talus is the most superior of the seven tarsal bones of the ankle (Figure 4.25), and its upper surface articulates with the tibia. The heel bone is called the calcaneus. The tarsal bones help the ankle bear the body's weight. Strong ligaments on both sides of the ankle joint hold the joint together Attached to the tarsal bones are the five parallel metatarsal bones (Figure 4.26). These bones form the instep and the ball of the foot, where they bear weight. Each toe has three phalanges, except for the big toe, which has only two. This configuration is identical to the thumb and its relation to the hand.