Musculoskeletal Introduction to MSK

AY 2019-2020 Dr. Paredes

Module 2 8/19/19

LEARNING OBJECTIVES
• Discuss the anatomical plane
• List anatomical surface landmarks
• Discuss the components and functions of the MSS
• Describe relation between bones & skeletal muscles in
producing body movement
• Identify the major regions and compartments of the upper
and lower extremity

Prone position
BASIC ANATOMICAL TERMS
Anatomical Position: • The back of the body is directed upwards
• Body is straight in standing position with eyes also looking • The body lies in a horizontal plane with face directed
straight downwards.
• Palms are hanging by the sides close to the body and are facing
forwards
• Feet also point forwards and the legs are fully extended
Figure 3. Prone Position

Lithotomy position:
• The body is lying in a supine with hips and knees fully extended
• The feet are strapped in position to support the flexed knees
and hips

Figure 4. Lithotomy Position

Figure 1. Anatomical Position

Supine position:
• Body is lying down with face pointing upwards
• All the remaining positions are similar to anatomical position
with the only difference of being in a horizontal plane rather
than a vertical plane

Figure 2. Supine Position

M2L1 Andaya, Peltra, Villamin Transhead: Dolor 1 of

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 ANATOMICAL TERMS DESCRIBING PLANES FOR DESCRIBING RELATIONS

Figure 5. Anatomical Planes

Median or Mid-Sagittal plane:

• Plane which divides the body into equal right and left halves

Sagittal plane:
• Plane parallel to the median plane. This plane divides the body
into unequal right and left halves
Figure 6. Anatomical Relations
Frontal plane:
• Vertical plane at right angle to median plane. If you draw a • Anterior means towards the front.
line from one ear to another from above the head and then • Posterior means towards the back.
divide the whole body along this line, the plane formed will be • Superior means towards the head.
frontal plane. It is also known as coronal plane. • Inferior means towards the feet.
• Medial means towards the median plane (near the middle of
Transverse plane: the body).
• Horizontal plane of the body. It is perpendicular to both • Lateral means away from the median plane (away from the
frontal and median plane. middle of the body).

Oblique plane: Anatomical terms for limbs:

• Any plane other than the above described planes will be • Proximal means near the trunk
oblique plane. • Distal means away from the trunk
• Preaxial border means the outer border in the upper limb and
inner border in the lower limb.
• Postaxial border means outer border in upper limb and inner
border in lower limb
• Flexor surface means anterior surface of the upper limb and
posterior surface of the lower limb
• Extensor surface means the posterior surface of upper limb
and anterior surface of the lower limb.

Anatomical terms for describing muscles:

• Origin: The relatively fixed end of muscle during natural
movements of the muscle
• Insertion: The relatively mobile end of the muscle during
natural movements of the muscle
• Belly: The fat fleshy part of the muscle which is contractile in
function
• Tendon: The fibrous and non-contractile part of the muscle
which attaches muscle to the bone.
• Aponeurosis: It is a flattened tendon arising from the
connective tissues around the muscle.

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 For Describing Movements

Main Criteria of Skeletal Muscles

• Voluntary
• Striated
• Attached to skeleton
• Produce movement of skeleton
• Supplied by somatic nerves

Figure 7. Anatomical Movements

• Flexion: A movement by which the angle of a joint is

decreased
• Extension: A movement by which the angle of a joint is
increased
• Adduction: Movement toward the central axis
• Abduction: Movement away from the central axis
• Medial rotation: Rotation toward the medial side of the body
• Lateral rotation: Rotation towards the lateral side of the body
• Pronation: This movement occurs in the forearm whereby the
palm is turned backwards
• Supination: This movement also occurs in the forearm
Figure 8. Types of Attachment
whereby the palm is turned forwards

Attachments MOSTLY TWO:

MUSCULAR SYSTEM
ORIGIN: Least movable, mostly fleshy, proximal end.
INSERTION: Most movable, mostly fibrous, distal end.
Muscular system is composed of:
Involuntary Types of Attachments
• Smooth: Found in the walls of viscera. Muscles are attached to bones, cartilage or ligaments by:
• Cardiac: Found only in the heart. a. Tendons: Cords of fibrous tissue.
Voluntary b. Aponeurosis: A thin broad and strong sheet of fibrous tissue.
• Skeletal: attached to bones (for movement c. Raphe: An interdigitation of the tendinous ends of the flat muscles.

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 2. Minor or Minimus (small).
3. Latissimus (broad).
Directions of Muscle Fibers 4. Longus (long).
Parallel to body midline 5. Brevis (short).
-More range of movement, less powerful. Pennate (oblique body Position:
midline) 1. Pectoralis (pectoral region)
-More powerful, less range of movement. Depth:
1. Unipennate 1. Superficialis (superficial).
2. Bipennate 2. Profundus (deep).
3. Multipennate 3. Externus (external).
4. Parallel Shape:
1. Deltoid (triangular).
2. Teres (rounded)
3. Rectus (straight).
Number of Heads:
1. Biceps (2 heads).
2. Triceps (3 heads).
3. Quadriceps (4 heads).
Attachments:
1. Coracobrachialis (from coracoid process to arm).
Action:
Flexor digitorum: flexion of digits.

Nerve Supply
• The nerves supplying the skeletal muscles are Mixed.
o 60% are Motor.
o 40% are Sensory.
• It contains some Autonomic fibers (Sympathetic).
• The nerve enters the muscle at about the middle point of its
deep surface.

Dorsal body cavity

• Cranial cavity – protects the brain
• Spinal cavity – spinal cord
Ventral body cavity
• Thoracic cavity – heart and lungs Abdominopelvic cavity
abdominal cavity –digestive organs
Figure 9. Skeletal Muscle pelvic cavity – reproductive and urinary organs

MODE OF ACTIONS
• Prime mover (Agonist): It is the chief muscle responsible for a
particular movement Example: Quadriceps Femoris is the
prime mover for extension of the knee joint

• Antagonist : It opposes the action of the prime mover.

*Before contraction of prime mover, antagonist must be relaxed.

Example: Biceps Femoris (Flexor of knee) opposes the action of
quadriceps when the knee joint is extended.

Synergist :
Prevents unwanted movement in an intermediate joint crossed by the
Prime Mover. Example: Flexors and Extensors of wrist joint contract to
fix wrist joint in order that flexors and extensors of fingers works
efficiently.

Fixator :
Its contraction does not produce movement by itself but it stabilizes the
origin of the prime mover so that it can act efficiently. Example: Muscles
attaching the shoulder girdle to the trunk contract to fix shoulder girdle,
allowing deltoid muscle (taking origin from shoulder girdle) to move
shoulder joint (humerus).

Size:
1. Major or Maximus (large)
Figure 10. Ventral Cavity

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ADDITIONALS: Dermatome Map

REFERENCES
• https://www.mananatomy.com/basic-anatomy/basic-
anatomical-terms
• http://slideplayer.com/slide/4783323/
• http://slideplayer.com/slide/7587476/
• https://www.studyblue.com/#flashcard/view/2976209
• http://www.apsubiology.org/anatomy/2010/2010_Exam_Revi
ews/Exam_4_Review/CH_13_Peripheral_Nerve_Terminology.
htm

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 LIMB DEVELOPMENT AND MUSCLE (LECTURIO VIDEO) LIMB ROTATION

Initially, the embryo has no limbs. • upper limb rotates dorsally

• lower limb rotates ventrally
APPEARANCE OF THE LIMBS
Upper and lower limb buds bend at the elbow and knee with the palms

Day 24 – UPPER LIMB BUD extends from the body and soles of the feet facing medially. By day 56, they have rotated in

Day 26 – LOWER LIMB BUD opposite directions so that the elbow points posteriorly and the knee

Week 5 – distinct TAIL SEGMENT (gradually disappears as lower limbs points anteriorly.

enlarge)

LIMB BUDS:
- appear as flippers
- will form hand and foot plates
Digital rays (wc become fingers and toes) appear in the plates
Tissue between rays undergo APOPTOSIS and disappears gradually
- completed by Day 52 (distinct and separated FINGERS) & Day 56
(distinct and separated TOES)

MUSCLE MIGRATION (WEEK 7)

• Spinal nerves reach myotomes and associate with developing
muscles
• Myotome splits into two:
1. Epimere (dorsal region) - becomes the intrinsic muscles of the back
2. Hypomere (ventral region) – becomes the muscles of the body walls
and the limb

• As the hypomere migrates into the limb buds, it splits into a

dorsal muscle mass (EXTENSORS) and a ventral muscles mass
(FLEXORS)
• Spinal nerves split into a dorsal (posterior) ramus to the
epimere and a ventral (anterior) ramus to the hypomere

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 LIMB INNERVATION
• Hypomere-derived muscle and dermatomes from C4-T2
migrate into upper limb bud
• Hypomere-derived muscle and Dermatomes from L4-
S3 migrate into the lower limb bud
• Limbs extend and rotate; muscles and dermatomes drag
their nerve supply behind them, create brachial and
lumbosacral plexi

DEVELOPMENT OF VASCULATURE
• Capillary networks in limb buds associate with nearby arteries;
as limb bud enlarges, a primary axillary artery extends from
large arteries into core of developing limb bud
• these arteries supply blood to developing muscles and bones
in the limbs; new arteries extend from primary axillary artery
and other portions rescind as the limb matures
• venous system of vessels are located in the limb buds, form
large subcutaneous veins and veins that parallel the arteries
MUSCLE

REFERENCES:

Youtube: Limb Development and Muscl

e Migration – Embryology | Lecturio

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 LEARNING OBJECTIVES
Explain the emryologic origin of:
1. Muscle
2. Bones
3. Joints
4. Ligaments and tendons

Some cells from the VLL also migrate across the lateral somatic frontier
into the parietal layer into the parietal layer of the lateral plate
mesoderm.

This frontier separates two mesodermal domains in the embryo:

1) Primaxial domain
• surrounds the neural tube
• contains only somite-derived cells
(paraxial mesoderm)
• Differentiates into: muscles of the back,
some muscles of the shoulder girdle, and
intercostal muscles.
MUSCLE •
2) Abaxial domain
The muscular system develops from the mesodermal germ layer and • consists of the parietal layer of lateral
consists of skeletal, smooth and cardiac muscle. plate mesoderm in combination with
somite-derived cells that migrate across
Skeletal Muscle: comes from the Paraxial mesoderm the lateral somatic frontier into this
region.
• Somites: gives rise to muscle of axial skeleton, body wall, and • Differentiates into: infrahyoid,
limbs abdominal wall (rectus abdominus,
• Somitomeres: gives rise to the muscles of head external and internal obliques,
transversus abdominus) and limb
Smooth Muscle and Cardiac Muscle: comes from the visceral splanchnic muscles
mesoderm

Progenitor cells for muscle tissues are derived from the VLL
(Ventrolateral) and DML (Dorsomedial) edges of the
prospectivedermomytome.
They both contribute to the formation of the myotome.

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Types of skeletal muscles: BONE

1) Epaxial Muscles
• Muscles of the back The Skeletal System is composed of the the axial and appendicular

• Innervated by ventral primary rami skeleton.

2) Hypaxial Muscles
• Muscles of the limbs and body wall
• Innervated by ventral primary rami

Axial skeleton

• head (cranium)
• neck (hyoid bone and cervical vertebrae)
• trunk (ribs,sternum, vertebrae and sacrum)

Appendicular Skeleton

• bones of the limbs

• pectoral girdle
Molecular Signals: • pelvic girdle
Molecular signals for muscle cell induction arise from tissues adjacent to
In general, the skeletal system develops from the paraxial mesoderm,
prospective muscle cells.
lateral plate (parietal layer) mesoderm, and neural crest.
a) Ventrolateral cells
Induced by signals (BMPs) from lateral plate mesoderm and (WNTs) 1) Paraxial mesoderm forms a segmented series of tissue blocks
on each side of neural tube called:
from overlying ectoderm
• somitomeres (cranial)
b) Dorsomedial cells -this is where the remainder of the skull is derived from
Induced by signals (SHH and WNTs) from neural tube and notochord • Somites (caudal)
respectively -differentiates into sclerotome (ventromedial) and
dermomyotome (dorsolateral)

Connective tissue derived from somites, parietal mesoderm, and neural

At the end of the 4th week, sclerotome cells forms into the mesenchyme
crest (head region) provides a template for establishment of muscle (embryonic connective tissue). The mesenchymal cells will migrate and
patterns. differentiate into:
• Fibroblasts
• Chondroblasts (cartilage forming)
Most smooth muscles and cardiac muscle fibers are derived from
• Osteoblasts (bone forming)
splanchnic mesoderm. However, some smooth muscles of pupil,
mammary gland, and sweat glands differentiate from ectoderm. Paraxial mesoderm accounts for the axial level of the body.

2) Lateral Plate Mesoderm

• This layer of the mesoderm forms bones of the
pelvic and shoulder girdles, limbs, and sternum

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3) Neural Crest cells B. VISCEROCRANIUM
• Neural crest cells in the head region also differentiates into
mesenchyme and participate in formation of bones of the face Formed by two pharyngeal arches
and skull including nasal and lacrimal bones 1) Maxillary process
-Gives rise to maxilla, zygomatic bone, and portion of
temporal bone
Ossification starts as early as 9th week. However, ossification is not 2) Mandibular process
complete until age 20. All bones are derived from mesenchyme -Gives rise to incus, malleus, and stapes

(embryonic connective tissue) by two different processes. C. VERTEBRAE AND VERTEBRAL COLUMN

Derived from sclerotome of somites from the paraxial mesoderm.

Sclerotome cells migrate around the spinal cord and notochord to merge
with cells from the opposing somite on the other side of the neural tube.

Sclerotome of each somite undergoes resegmentation. The caudal half

of each sclerotome grows into and fuses with the cranial half of each
subjacent sclerotome, thus forming each vertebra.

Mesenchymal cells between cephalic and caudal parts of the original

sclerotome segment do not proliferate. They contributeto formation of
the intervertebral disc.

1) Intramembranous Ossification (Membranous bone formation)

• Mesenchymal models of bones form during the embryonic
period
• Direct ossification of mesenchymal cells into bones
• Happens in some bones such as the flat bones of the skull

2) Endochondrial Ossification (Cartilaginous bone formation)

• Cartilage models of the bones form from mesenchyme during
fetal period
• Mesenchymal cells first give rise to hyaline cartilage models
which ossifies into bones
• Happens in most bones including the base of the skull and
limbs

EMBRYOLOGIC ORIGINS
A. NEUROCRANIUM
D. RIBS
1) Membranous Neurocranium
• Formed through Intramembranous ossification Bony portion of each rib is derived from sclerotome cells that remain in
• Derived from neural crest cells and paraxial mesoderm paraxial mesoderm and that grows out from the costal processes of
thoracic vertebrae.
2) Cartilaginous Neurocranium (a.k.a chondrocranium)
• Formed through endochondrial ossficiation Costal cartilages are formed by sclerotome cells that migrate across the
lateral somatic frontier into the adjacent lateral plate mesoderm.
• Consists of separate cartilages such as prechordal
chondocranium and chordal chondocranium E. STERNUM

Develops independently in the parietal layer of lateral plate mesoderm

in the ventral body wall.

Two sternal bands are formed in the parietal layer of lateral plate
mesoderm in either side of the midline.

These later fuse to form cartilaginous models of the manubrium,

sternbrae and xiphoid process.

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 JOINTS REFERENCES:
• Langman’s Embryology
Joints (articulations)
- unions or junctions between two or more bones or • Moore’s Clinical Oriented Anatomy
rigid parts of the skeleton. • https://discovery.lifemapsc.com/in-vivo-development/bone
• https://embryology.med.unsw.edu.au/embryology/index.php
Classification:
/Musculoskeletal_System_-_Joint_Development
• Fibrous (synarthrodial) - immoveable joints found in cranial • https://opentextbc.ca/anatomyandphysiology/chapter/9-7-
vault and teeth development-of-joints/
• Cartilagenous (synchondroses and sympheses) - partially
moveable joints
• Synovial (diarthrosis) - freely moveable joints are the most
common found in the skeleton

Movements:

• Hinge - (elbow and knee) Flexion/Extension

• Pivot - (neck, atlas and axis bones) Rotation of one bone
around another
• Ball and Socket - (shoulder and hip)
• Saddle - (thumb)
• Condyloid - (wrist joints)
• Gliding - (intercarpal joints) Gliding movements

The synovial joints will form between the adjacent cartilage

models, in an area called the joint interzone. Cells at the center of this
interzone region undergo cell death to form the joint cavity, while
surrounding mesenchyme cells will form the articular capsule and
supporting ligaments.

LIGAMENTS AND TENDONS

Tendons for the attachment of muscles to bones are derived from

sclerotome cells lying adjacent to myotomes at the anterior and
posterior borders of somites.

The transcription factor SCLERAXIS regulates development of

tendons.

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