S1 - SWM .pdf

Musculoskeletal System Module Session 1 The Skeletal System – Bones & Joints Dr. Munqith Mazin  The Skeleton – General Points ‫الجمجمة‬ 206 ‫سمعية‬ bones; ‫عظيمات‬ 8 (cranial), 6 (audit...

Musculoskeletal System Module Session 1 The Skeletal System – Bones & Joints Dr. Munqith Mazin  The Skeleton – General Points ‫الجمجمة‬ 206 ‫سمعية‬ bones; ‫عظيمات‬ 8 (cranial), 6 (auditory ossicles), 14 (facial) , ‫العمود الفقري‬ 26‫( الالمي‬vertebral column), 26 1 , 1 , 12+12 (hyoid, sternum & ribs), 64 (upper limb) &62 (lower limb). Bones are different in shape and size. They are linked together to form flexible, solid framework. Functions: 1. Shape 2. Protection 3. Support 4. Levers for movement  Bones – Points of Practical Interest Constituents of bone (35% organic &65% inorganic) Amount of the two constituents varies at different periods of life ‫هاي النسب تختلف حسب العمر وتختلف من عظم الى اخر‬ *Inorganic In a children: organic ( ;)50%( cinagroni ,)50% ylno ro )yticitsale( dneb ot senob esuac yam yrujni )!erutcarf( nekorb yllaitrap *Injury may cause bones to bend (elasticity)or only partially broken (fracture) Aged: large proportion of inorganic and organic material‫هشاشه‬ ‫هش‬ deficient in quantity & quality; bones are more brittle &hence easily fractured. Relative proportion of two constituents also differs inDense part ‫صخري‬ different bones; more inorganic in petrous part of the ‫عظم صدغي‬ temporal bone than in the squamous part; bones of the limbs contain more inorganic than those of the trunk  The Skeleton: Divisions Bilaterally symmetrical Two main divisions 1) the axial skeleton 2) the appendicular skeleton The two divisions have different roles Axial skeleton (mainly protective role for some of the ‫غير حصني‬ body’s vulnerable &vital parts Appendicular skeleton (main role is to provide the body with mobility)  The axial skeleton Bones of the central part of the body Include the skull, the vertebral (spinal) column, the ribs and the sternum ‫يغلف‬ Skull – encases brain Vertebral column – encases the spinal cord ‫قفص‬ Ribs – cage around the heart &lungs  The appendicular skeleton Bones include those of the upper and lower limbs ‫الكتف‬ Include the scapulae ‫الواح‬ (shoulder ‫الحوض‬ ‫الحوض‬ blades) and the pelvis – linking structures between limbs and the axial skeleton  Functions of bones A. Bones perform mechanical functions of support, protection and body movement and ‫تكون الدم‬ B. Physiological functions of haemopoiesis & mineral storage Support – rigid framework ‫االعضاء الداخلية‬ Protection – enclose vital structures &viscera Body movement – anchoring attachments for most muscles; ‫محور‬ act as levers with joints functioning as pivots when muscles contract to cause movement Haemopoiesis – in red marrow Mineral storage – in bone matrix  Types of bones: General shape Mechanical purposes determine different forms ‫الترقوة‬ ‫عظم العضد‬‫عظم الفخذ‬ 1- Long bones –‫القدم‬ ‫عظام املشط‬ in‫مشط‬ the limbs (e.g. clavicle, humerus, femur, metacarpals, metatarsals &phalanges); ‫الحفاظ‬ -form a system of levers which sustain weight of the trunk ‫الحركة‬ &enable locomotion length greater than width ‫ الزم يكون عدنا ال‬long ‫حتى نعرف انو هذا العظم يكون‬ -length greater than width, tubular shaft (diaphysis) & usually an epiphysis at each end; ‫الزورقي‬ ‫الهاللي‬ 2- Short bones – in the hand Carpal ‫العقبي‬ (e.g. scaphoid, lunate) and feet Tarsal ‫الكاحل‬ (e.g. talus, calcaneum); - for strength &compactness &slight/limited movement Function -roughly cuboidal in shape &mainly spongy with a thin ‫قشرة‬ compact crust  Types of bones: General shape ‫قبو‬ 3- Flat bones – in the vault of the skull (e.g. ‫الجداري‬ ‫تصنيف‬ frontal, parietal); scapula is included in this category -principle ‫توفر‬ requirement is either protection &/or provision of broad surface for muscle attachment Function - composed of two thin layers of compact bone enclosing a layer of spongy bone (diploe) 4- Irregular bones – bones of the facial skeleton, vertebrae and pelvic bones - external layer of compact bone &spongy within 5- Sesamoid bones – found in tendons where they ‫تحتك‬ rub over bony surfaces wall ‫ وال‬tendon ‫ الي يصير بني ال‬fraction ‫حتى تمنع ال‬ ‫‪Types of Bone – General shape‬‬ ‫الجداري‬ ‫الوتدي‬ ‫الرضفة ‪ :‬العظم املتحرك في رأس الركبة‬  Surface Markings of Bones Found where fascia, ligaments tendons or aponeuroses are attached to bone Surfaces show various markings &/or irregularities (surface raised or roughened) ‫سن البلوغ‬ Not present ‫تدريجيا‬ at birth; appear ‫واضح‬ at puberty & become progressively more obvious in adult life Pull of fibrous structures causes the periosteum ‫تحتها‬ to be raised and new bone is deposited beneath Pressure on bone surface – may cause a groove, ‫حفرة‬ ‫ ثلم‬/ ‫شق‬ fossa, notch; local bone resorption ‫ اللقيمة‬، ‫ املدور‬، ‫ الكعب‬، ‫الحدبة‬ In some cases, surface markings are large; given special names (e.g. tuberosity, malleolus, trochanter, epicondyle, etc.) structure ‫هاي االشياء الي تحصل تعتمد على قوة ال‬ muscle ‫ 🦴 على سبيل املثال عدنا‬bone ‫املتصل بال‬ aponeuroses : a sheet of pearly white fibrous tissue that takes the place ‫ 💪 وراح‬strong ‫ والي يكون‬tendon ‫وتحتوي على ال‬ of a tendon in flat muscles having a wide area of attachment. ‫يعمل على سحب سطح العظم للخارج‬ Bone Marrow & Periosteum ‫ تحتوي على‬periosteum ‫ال‬ capillaries and nerves ‫ال‬  Bone Marrow & Periosteum Found in marrow cavities of long & short bones and in between bony trabaculae of cancellous bone in flat & irregular bones spongy bone ‫ مرادفة لكلمة‬cancellous bone ‫ال‬ At birth, marrow is red (haemopoiesis); blood forming activities gradually lessens with age – red marrow replaced by yellow (fatty) marrow In the adults, red marrow restricted to bones of the skull, ‫صدرية‬ / ‫الحزام‬ vertebral column, thoracic cage, pectoral & pelvic girdle ‫الطوق‬ bones &head of humerus &femur Periosteum covers all bone surfaces, except at joints; has abundant vascular and nerve supply & the deep layer is osteogenic; sensitive (pain when traumatised) ‫مثبت تماما‬ Periosteum firmly fixed at sites where muscles, tendons and ligaments are attached to bone; Sharpey’s fibre ‫ الي تحت ال‬osteogenic ‫عدنا ال‬ Sharpey’s fibre : lines on protection of the bone ‫ هي‬Periosteum ‫وظيفة ال‬ ‫ تكون قادرة على تكوين ال‬periosteum the surface of the bone rich vessels and nerves ‫باالضافة الى انه يحتوي‬ where muscles , tendon , ‫ 🦴 من يتعرض لكسر او اي شيء‬bone ligament attached 🦴 bone ‫ حتى تغذي ال‬network  Injuries to Bone – Common Fractures (Upper Limb) ‫الترقوة‬ Clavicular fracture Fracture of the surgical neck of humerus Fracture of the shaft of the humerus Supracondylar fracture of the humerus ‫الزج‬ Fracture of the olecranon process Fracture of the distal end of the radius )Colles’ fracture) ‫ عظم قاربي في اليد‬: ‫زورقة‬ Fracture of the scaphoid bone  Injuries to Bone – Common Fractures (Upper Limb) ‫الزندي‬ ‫إبري‬ Clavicular # Colle’s # Olecranon # Scaphoid # Surgical neck of humerus # Injuries to Bone – Common Fractures (Lower Limb) ‫ الى‬head of femur ‫ تجي من منطقة ال‬blood supply ‫ال‬ ‫ ممكن‬intracapsular ‫ بال‬fracture ‫ فاذا كان ال‬neck ‫منطقة ال‬ ‫ بينما اذا صار ال‬neck ‫ بال‬ischemic necrosis ‫يصير‬ ‫ من‬blood supply ‫ ممكن يجي ال‬extracapsular ‫ بال‬fracture ischemic necrosis ‫مكانات اخرى وما يصير‬ ‫الفخذ‬ Fracture of the femoral neck (intracapsular) Intertrochanteric/pertrochanteric fracture (extracapsular) Fracture of the femoral shaft ‫قصبة الساق‬ Tibial shaft fracture Fracture of the fibular neck &shaft Fracture of the lower end of the tibia and ‫املشبك‬ fibula  Injuries to Bone – Common Fractures (Lower Limb) Femoral fractures Tibial and fibular # Intracapsular Extracapsular  Joints Joint – point at which two bones meet (articulation), whether or not movement occurs between them Classified according to the tissues that lie between them (by structure) or by the way they move structure inside the joints ‫التقسيم تبعاً لل‬ Various types of joints ‫اذا كان العظمني‬ 1) Fibrous joints (no movement) ‫مرتبطات ب‬ fibrous tissue 2) Cartilaginous joints (primary & secondary) ‫الزليلي‬ 3) Synovial joints (freely moveable)  Structures forming joints  Bones  Cartilage  Fibrocartilage  Ligaments  Synovial membranes  Fibrous joints Articulating surfaces joined by fibrous tissue Degree of movement ‫طول االلياف يأثر على الحركة فاذا كانت اطول احتمال‬ ‫تصير حركة واذا كانت اقصر فما راح تصير حركة‬ depends upon the length of collagen fibres between the bones ‫قبو‬ ‫الغرز‬ E.g. Sutures of the vault of skull ‫الشظنوب الشظوي‬ Inferior tibiofibular joint  Cartilagenous joints Two types - 1º &2º 1) 1º (Primary) – bones united by a plate of hyaline cartilage (e.g. epiphyseal plate of a growing bone & 1st rib & manubrium sterni); no movement 2) 2° (Secondary) – bones ‫ مغلفة بال‬joint ‫يعني العظمني الي يكونن ال‬ united by a plate/disc of fibrocartilage ‫ وبينهن اكو‬hyaline cartilage fibrocartilage & joint surfaces covered by hyaline cartilage (e.g. inter-vertebral ‫االرتفاق‬ joints(IVJ) symphysis ‫ العانه‬pubis); small amount of movement Secondary ‫ تعني‬symphysis ‫كلمة‬ Cartilagenous joints  Synovial joints Also called freely movable joints Articular surfaces covered by hyaline cartilage separated by a joint cavity; this arrangement permits a great degree of freedom of movement ‫ الي يصير بني‬friction ‫ الي يسهل الحركة ويمنع ال‬synovial fluid ‫ يحتوي على ال‬synovial cavity ‫ال‬ joint capsule ‫ اسمه‬fibrous tissue ‫ وغالف اخر‬synovial membrane ‫العظام وتكون محاطة ب‬ Cavity lined by synovial membrane that extends from the margin of the one articular surface to that of the other Protected on the outside by a tough fibrous ‫مغطى او مشحم‬ ‫لزج‬ tissue – capsule Joint surfaces are lubricated by viscous synovial fluid; produced by the synovial membrane In some joints, such as the knee joint, discs (articular discs) of fibrocartilage are found between joint surfaces Fatty pads lie between synovial membrane and fibrous capsule in some joints(e.g. hip &knee joints)  fibrocartilage ‫تحت الرضفة‬  Degree of movement Fixed ( nonmobile ) - slightly mobile - free mobile Limited by: 1) The shape of the bones Extracapsular lig. 2) Coming together of adjacent anatomical ‫انثناء‬ Intracapsular lig. structures (e.g. flexion of ‫الفخذ‬ the thigh against the anterior abdominal wall) 3) Presence of ligaments uniting the bones – e.g. extra- & intracapsular lig. (e.g. cruciate ligaments) (‫االربطة الصليبية )يساعد في الحفاظ على استقرار الركبة‬ ‫ كل ما تحدد الحركة‬strong and short ‫ كل ما تكون‬ligaments ‫ال‬  Types of Synovial Joints They are classified according to arrangement of articular surfaces and types of movements ‫الكرة واملقبس‬ 1) Ball &Socket – permit movement in several axes; a rounded head fits into a concavity (e.g. shoulder & hip joints) ‫املفصل‬ 2) Hinge – permit flexion & extension only (e.g. elbow joint) ‫الحركة باتجاه واحد‬  ‫سرج‬ Types of Synovial Joints 3) Saddle – concave & convex joint surfaces (e.g. 1st MPJ) metacarpophalangeal joint ‫مزلق‬ 4) Plane – permit gliding or sliding movements (e.g. acromioclavicular joint) ‫حركة انزالقية فقط‬ ‫محور‬ 5) Pivot – allow rotation; a ‫حركة دورانية فقط ) بروز‬ round bony process fits into a ( ‫ تجويف دائري‬+ ‫دائري‬ bony ligamentous socket (e.g. atlantoaxial joint & proximal Radio-ulnar joint) 6) Condyloid – permit flexion & extension, adduction, adduction & circumduction ‫حركة كلية‬ (e.g. MPJ) saddle ‫االصابع عدا االبهام النه يكون‬  Stability of Joints Depends on 3main factors: 1) Shape, size & Bony factor arrangement of articular surfaces 2) Ligaments – prevent excessive movement; if stresses continue, ligaments stretch ‫تناغم‬ 3) Tone of muscles Degree of contraction of muscle  Neurovascular Supply to Joints  Capsule &ligaments receive abundant sensory supply  Nerve supplying the joint also supplies the muscles moving the joint &overlying skin (Hilton’s law)  Stretching of the capsule and ligaments produces reflex contraction of muscles around the joint; excessive joint ‫ الي تحيط بال‬muscle ‫ يوصل الى ال‬artery ‫ او اي‬nerve ‫ يگول أي‬Hilton’s law ‫عدنا‬ stretching produces pain joint ‫ الي يكون موجود حول ال‬skin ‫ نفسه وكذلك يغذي ال‬joint ‫اكيد راح ينطي فرع الى ال‬  Stretch receptors in the capsule & ligaments – ‫معلومات استقبال الحس العميق‬ proprioception information to CNS for position of joints; information ‫الوضعي‬ from muscle & tendons ‫تنسيق‬ supplements – maintains postural tone and co-ordination of voluntary movement  Rich network of blood vessels‫مفاغرة‬around the joint (peri- articular network or anastomoses); blood vessels ‫مدعم‬ innervated by sympathetic fibres – control blood supply  Bursae associated with joints Closed‫السائل اللزج‬ fibrous sacs containing viscous fluid protection and decrease friction ‫ هم تكون عبارة عن اكياس وكذلك تكون وظيفتها‬Bursae ‫ال‬ Found where tendons rub against bones, ligaments or other tendons Commonly found close to joints where the skin rubs against underlying ‫من حني اخر‬ bony surfaces; occasionally the cavity of the bursa communicates with the cavity of a synovial joint Inflammation of the bursa may result from repeated ‫منزل‬and/or ‫ربة‬ excessive trauma ‫رجل الدين‬ – “housemaid’s ‫عامل منجم‬ knee”, “clergyman’s knee”, “miner’s knee”, ‫كيسي قبل الرضفة‬ “student’s ‫التهاب‬ elbow” (pre- patellar bursitis, olecranon bursitis, subacromial bursitis, etc.) ‫ والي تمنع احتكاك‬knee joint ‫ تكون اكثر شيء موجودة بال‬bursae ‫ال‬ ‫ مع العظم باالضافة الى انه بعض ال‬tendon ‫الجلد مع العظم او ال‬ ‫ وبعضها بالخارج‬synovial membrane ‫ تكون داخل ال‬bursae  MSK Injuries ‫خلع جزئي‬ Dislocation and subluxation of joints Fractures ‫تمزق‬ Ligament tear ‫اسم اخر لهشاشة العظام‬ Degenerative joint diseases Joint infection Joint effusion Heamarthrosis