MECHANICS OF MOVEMENT

Tissues and Structures Involved

Muscle Nerve Bone Cartilage

What are Tendons? Role of Joints Mechanics of Joints Making it all work
Frolich, Human Anatomy, Mechanics of Movement

Nerve and Muscle--the Motor Unit

Motor neurons review
Ventral horn spinal cord Ventral root to spinal nerve to dorsal or ventral ramus Nerve is bundle mixed neurons One motor neuron synapes with several muscle cells

Motor Unit is one motor neuron plus the muscle cells it synapses Action potential-controlled conduction of electrical messages in neurons and muscle by depolarization of cell membrane

Fig. 14.6, M&M

Frolich, Human Anatomy, Mechanics of Movement

Neuro-Muscular Junction
Action potential in nerves triggers chemical release at synapse which triggers action potential in muscle

Fig. 14.5, M&M

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See also photo in Fig. 10.2 from M&M to see capillaries around muscle cells

Frolich, Human Anatomy, Mechanics of Movement

Bone and Cartilage

Bone as tissue Bones as structures formed from bone, cartilage and other tissues Location of cartilage in skeleton and relation to joints

Fig. 6.1, M&M

Frolich, Human Anatomy, Mechanics of Movement

HOW MOVEMENT HAPPENS: Muscles Pull on Tendons to Move Bones at Connections called Joints or Articulations

Frolich, Human Anatomy, Mechanics of Movement

Tendon
Generally regular connective tissue Musculo-skeletal connections
Muscle to bone Muscle to muscle Bone to bone

Fig. 4.15f, M&M

Frolich, Human Anatomy, Mechanics of Movement

Tendons
Tendons are structures that connect bone to muscle and are made up of tendon tissue Can have various shapes Typical is cord-like tendon of biceps Sheeths are common-aponeuroses e.g. acromiotrapezius origin from thoracic vertebral spines
Fig. 10.3, M&M
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Ligaments
Ligaments connect bone-tobone or reinforce joints--they are made up of tendinous tissue as well E.g. knee ligaments

Fig. 9.12, M&M

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Joints or Articulations
Connections between bones Usually, but not always allow for movement Formed from various connective tissues
Fibrous Cartilaginous Synovial (most complex--typical limb joints)

Frolich, Human Anatomy, Mechanics of Movement

Fibrous joints
Suture
Bones tightly bound by minimal fiber Only found in skull Syndemoses
Bones connected by ligaments E.g. tibiofibular ligament, interosseous membrane of radius/ulna

Gomphoses
Peg in socket joint Only found in teeth/alveoli
Fig. 9.1 a, M&M

Frolich, Human Anatomy, Mechanics of Movement

Fibrous joints
Suture
Bones tightly bound by minimal fiber Only found in skull

Syndemoses
Bones connected by ligaments E.g. tibiofibular ligament, interosseous membrane of radius/ulna Gomphoses
Peg in socket joint Only found in teeth/alveoli
Fig. 9.1 b, M&M

Fig. 8.4, M&M

Frolich, Human Anatomy, Mechanics of Movement

Fibrous joints
Suture
Bones tightly bound by minimal fiber Only found in skull

Syndemoses
Bones connected by ligaments E.g. tibiofibular ligament, interosseous membrane of radius/ulna

Gomphoses
Peg in socket joint Only found in teeth/alveoli
Fig. 9.1 c, M&M

Frolich, Human Anatomy, Mechanics of Movement

Cartilaginous Joints
Synchondrosis
Hyaline cartilage unites bones Epiphyseal growth plates Costal cartilage-sternum
Fig. 9.2, M&M

Symphyses
Fibrocartilage unites bones Pubic symphysis Intervertebral disc

Frolich, Human Anatomy, Mechanics of Movement

Synovial Joints
Most common joints in body Most mobile joints Have
Articular surfaces on bone with hyaline cartilage Completely enclosed joint capsule formed from ligamentous connective tissue Synovial fluid within capsule lubricates joint Some have meniscus or articular disc(e.g. knee, jaw joint)
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Also see Fig. 9.3, M&M

Frolich, Human Anatomy, Mechanics of Movement

Frolich, Human Anatomy, Mechanics of Movement

Frolich, Human Anatomy, Mechanics of Movement

Synovial Joint Shape Types

Plane joints--intercarpal joints Hinge joints--elbow,ankle, interj-phalangeal Pivot joints--radio-ulnar joint Condyloid joints (egg into oval)--metacarpophalangeal Saddle joints--carpo-metacarpal joint of thumb Ball-and-socket--hip, shoulder

The type of joint, in part, determines the range and direction of movement
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Fig. 9.9, M&M

Frolich, Human Anatomy, Mechanics of Movement

Frolich, Human Anatomy, Mechanics of Movement

Frolich, Human Anatomy, Mechanics of Movement

Frolich, Human Anatomy, Mechanics of Movement

Frolich, Human Anatomy, Mechanics of Movement

Frolich, Human Anatomy, Mechanics of Movement

Frolich, Human Anatomy, Mechanics of Movement

X-ray of hand affected by arthritis

Frolich, Human Anatomy, Mechanics of Movement

Artificial Hip Joint

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Arthritis
Arthritis = inflammation of the joints. Term also used by lay people to describe pain in soft tissues. Over 200 forms of arthritis. About 30% of adults have arthritis. Major symptom =PAIN in or around joints

ARTHRITIS
OSTEOARTHRITIS: common in older people. The articular cartilage begins to break down, and bone spurs start to grow. RHEUMATOID ARTHRITIS: Its an autoimmune disease where body attacks and destroys the cartilage in synovial joints. It is NOT known for having spurs, like osteoarthritis. GOUTY ARTHRITIS (gout). Caused by eating too much red meat or protein. The breakdown product is urea, and acid, which causes uric acid crystals in the cooler areas of the body, especially big toes.

Risk Factors for Arthritis

Age > 40 years Women > men Obesity Previous joint injury Ethnic background

Osteoarthritis
Your mother, who is overweight, has pain in both knees whenever she walks too far. Her knees are stiff in the morning and hurt before it rains. The pain gets better when she rests or takes acetaminophen, ibuprofen, or naprosyn over the counter. Her knees are big, bony, and sometimes swollen, but dont get red or warm.

Osteoarthritis

21 million Americans have osteoarthritis

 Breakdown in cartilage and new bone

formation

 Increased risk with older age, obesity,

overuse or previous injury to joints

Osteoarthritis
Common spots of osteoarthritis  hips  knees  hands, especially base of thumb  base of great toe  spine What is not osteoarthritis? Red, hot joints

Frolich, Human Anatomy, Mechanics of Movement

Osteoarthritis
Treatment
 weight reduction  exercise  physical and occupational therapy  joint protection  pain relief
  

over the counter medications, esp. acetaminophen prescription medications joint injections

 joint replacement

Gout
 Your brother, who has high blood pressure,
woke up in the middle of the night with excruciating pain in his right great toe. It hurt so bad he could not stand to have the sheet rest on his foot last night; he couldnt sleep. The joint at the base of the toe is red, hot, swollen and very tender. His other joints are OK. He had an episode just like this 5 months ago, and it went away by itself, over 5-7 days.

Gout
 Gout is caused by too much uric acid in the body.
Crystals of uric acid form inside a joint and cause inflammation, which makes the joint red, hot, swollen and painful.

runs in families more common in men, women after menopause, and African
Americans. Other risk factors include

obesity high blood pressure drinking too much alcohol kidney failure water pills

Gout  Treatment: See a doctor for evaluation and

medicine to reduce inflammation and pain. May need to medicine to prevent future attacks.

 Can develop into chronic arthritis and cause

joint destruction.

Tendonitis

 Your son just spent two weeks painting

his house. Now, his shoulders hurt whenever he reaches overhead, even to put on a shirt. He has never had any shoulder pain before and his other joints are fine.

Frolich, Human Anatomy, Mechanics of Movement

Tendonitis

 Diagnosis = shoulder tendonitis.

Tendonitis = inflammation of a tendon. A tendon is a tissue cord that holds a muscle onto a bone.  Treatments
reduce/stop doing whatever caused it  non-steroidal anti-inflammatory agents  steroid injections  physical therapy splinting, heat, ice


Bursitis

 Bursitis = inflammation of a bursa. A bursa

is a closed fluid-filled sac that functions as a gliding surface to reduce friction between tissues of the body.  Common sites of bursitis
outer shoulder area outer hip area elbow over and below the knee cap

Frolich, Human Anatomy, Mechanics of Movement

Rheumatoid arthritis
-chronic, progressive inflammatory disorder which attacks the smaller synovial joints of the hands and feet and can cause synositis and erosion of the cartilage of the joints. - Sometimes bigger joints like the shoulder and knees can also get involved. - This inflammatory process can also extend to the lungs, heart, skin and the eyes.

Frolich, Human Anatomy, Mechanics of Movement

This is a differentiating point with Osteoarthritis where the pain is aggravated by movement and only one of the larger joint is involved. The tendons, the cartilage and the bone surfaces of the joint get eroded leading to limitations of movement and Typical feature in RA is early deformity of the joint. morning stiffness It becomes increasingly Rheumatoid Arthritis Pain which difficult to perform daily minor later is relieved by movements. tasks like holding a glass or a This pain and stiffness typically also spoon. appears after a period of inactivity being again relieved by movements.

Frolich, Human Anatomy, Mechanics of Movement

OTHER ORGANS AND PARTS OF THE BODY, BESIDES THE JOINTS. 1. Skin: Small rheumatoid nodules appear subcutaneously ( below the skin).They may vary in size from a few millimeters to a few centimeters. They usually appear on the bony prominences. Reddish or purplish discoloration patches appear on the skin due to vasculitis of the small blood capillaries. 2. Glands around the eyes and throat become enlarged due to inflammation leading to dryness of the eyes and the throat. 3. Inflammation of the Pleura ( lining of the lungs) leads to Pleurisy which gives rise to symptoms of chest pain which increases on deep breathing, cough and shortness of breadth. 4. Inflammation of the Pericardium due to RA causes chest pain due to pericarditis, Patients of RA are prone to atherosclerosis, thereby making them more inclined to get a heart attack or a stroke. Anaemia is also caused by RA because it causes reduction in the red blood cells in the blood. Carpal Tunnel Syndrome is caused due to pinching of the median nerve as a result of the swelling of the wrist joints. Osteoporosis (reduced bone density) results due to immobilization of the joints and can also occur due to side effects of medication given for RA. ( such as steroids).

Frolich, Human Anatomy, Mechanics of Movement

Rheumatoid Arthritis Treatment. (A) Therapy for Rheumatoid Arthritis. 1. Physiotherapy for Rheumatoid Arthritis is where the physio guides you to exercise the muscles of the affected joints to maintain the mobility and reduce pain 2. Occupational Therapy for Rheumatoid Arthritis Rheumatoid Arthritis Drugs are Surgery for Rheumatoid basically used for relief of symptoms and to suppress the auto Arthritis immune system which causes Rheumatoid Arthritis. 1. Non steroid anti inflammatory drugs (NSAIDs)

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Frolich, Human Anatomy, Mechanics of Movement

Serious types of arthritis  Lupus (systemic lupus erythematosus)  Scleroderma  Sjogrens syndome  Lyme disease  Ankylosing spondylitis  Psoriatic arthritis  Infectious arthritis

Skin Cancer
This is the most common cancer in the USA, and its major risk factor is exposure to ultraviolet light. 1) BASAL CELL CARCINOMA: Cancer of the blood vessels. Almost never metastasizes or crosses the basement membrane Looks like shiny nodules 2) SQUAMOUS CELL CARCINOMA 25% of all cancers Will metastasize if not treated. 3) MELANOMA: cancer of the melanocytes of the epidermis Highly metastatic. Asymmetrical, sharp but irregular borders and edges Not uniform in color.

BURNS
FIRST DEGREE: Minor burn to the epidermis; sunburn SECOND DEGREE: Dermis separates from epidermis; blister THIRD DEGREE: Hypodermis is burned. (most severe type of burn)

TYPES OF FRACTURES
COMMINUTED: The most serious; bone shatters into many small pieces. Bone graft might be needed. SPIRAL: Bone was twisted. GREENSTICK: most common in children COMPRESSION: bone is crushed, like the vertebrae in osteoporosis. STRESS: least serious, get tiny, almost invisible breaks. COMPOUND FRACTURES: Bone breaks and goes through skin. Increased chance of infections, which can be lifethreatening. SIMPLE FRACTURES: Skin is not broken. PATHOLOGICAL FRACTURE: When the bone (especially the hip bone of someone with osteoporosis) breaks first, then the patient falls.

Prelim exam: Tuesday next week

Introduction Anatomical terms and Directions Skin clinical Bones bone formation, clinical Joints - scantron

Frolich, Human Anatomy, Mechanics of Movement