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Home , Axial skeleton, Cartilage, Cartilaginous joint, Condyle, Diaphysis, Epicondyle

4 Musculoskeletal System

Learning Objectives Upon completion of this chapter, you will be able to • Identify and define the combining forms, prefixes, and suffixes introduced in this chapter. • Correctly spell and pronounce medical terms and major anatomical relating to the musculoskeletal system. • Locate and describe the major organs of the musculoskeletal system and their functions. • Correctly place in either the axial or the appendicular . • List and describe the components of a long . • Identify bony projections and depressions. • Identify the parts of a synovial . • Describe the characteristics of the three types of muscle . • Use movement terminology correctly. • Identify and define musculoskeletal system anatomical terms. • Identify and define selected musculoskeletal system terms. • Identify and define selected musculoskeletal system diagnostic procedures. • Identify and define selected musculoskeletal system therapeutic procedures. • Identify and define selected relating to the musculoskeletal system. • Define selected abbreviations associated with the musculoskeletal system.

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Function The skeletal system consists of 206 bones that make up the internal framework of the body, called the skeleton. The skeleton supports the body, protects internal organs, serves as a point of attachment for skeletal muscles for body movement, produces cells, and stores minerals. Organs Here are the primary structures that comprise the skeletal system: bones Word Parts Here are the most common word parts (with their meanings) used to build skeletal system terms. For a more comprehensive list, refer to the Terminology section of this chapter. Combining Forms ankyl/o stiff joint metatars/o metatarsals arthr/o joint myel/o , articul/o joint orth/o straight burs/o sac oste/o bone carp/o pector/o chest cervic/o patell/o chondr/o ped/o child; clavicul/o pelv/o coccyg/o phalang/o phalanges cortic/o outer layer pod/o foot cost/o prosthet/o addition crani/o pub/o femor/o radi/o ; ray (X-ray) fibul/o sacr/o humer/o scapul/o ili/o scoli/o crooked ischi/o spin/o spine kyph/o hump spondyl/o vertebrae lamin/o lamina (part of ) stern/o lord/o bent backward synovi/o lumb/o loin (low between and synov/o synovial membrane pelvis) tars/o () mandibul/o thorac/o chest maxill/o tibi/o medull/o inner region uln/o metacarp/o metacarpals vertebr/o vertebra

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Skull

Maxilla Mandible

Cervical vertebrae

Scapula

Sternum Humerus Ribs

Thoracic vertebrae (T11)

Ulna vertebrae (L4) Radius

Ilium Sacrum Coccyx Pubis Carpals Metacarpals Phalanges

Ischium

Femur

Patella

Tibia Fibula

Tarsals Metatarsals Phalanges

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Suffixes -blast immature -listhesis slipping -clasia to surgically break -logic pertaining to study of -desis to fuse -porosis porous

Prefixes dis- apart non- not

Anatomy and of the Skeletal System bone marrow (LIG-ah-ments) bones skeleton joints Med Term Tip Each bone in the is a unique that carries its own blood The term skeleton, from the supply, , and lymphatic vessels. When these bones are connected to each Greek word skeltos meaning other it forms the framework of the body called a skeleton. The skeleton protects “dried up,” was originally used in reference to a dried-up mummi- vital organs and stores minerals. Bone marrow is the site of blood production. fied body, but over time came to A joint is the place where two bones meet and are held together by ligaments. This be used for bones. gives to the skeleton. The skeleton, joints, and muscles together to produce movement. Bones cartilage (CAR-tih-lij) (OSS-tee-oh-blasts) osseous tissue (OSS-ee-us) (OSS-tee-oh-sights) (oss-sih-fih-KAY-shun) What’s In A Name? Bones, also called osseous tissue, are one of the hardest materials in the body. Look for these word parts: Bones are formed from a gradual beginning before birth called ossifi- oste/o = bone cation. The first model of the skeleton, made of cartilage, is formed in the . -blast = immature -cyte = cell Osteoblasts, immature bone cells, gradually replace the cartilage with bone. In -ous = pertaining to a fully adult bone, the osteoblasts have matured into osteocytes that work to maintain the bone. The formation of strong bones is greatly dependent on an adequate supply of minerals such as (Ca) and phosphorus (P).

Bone articular cartilage (ar-TIK-yoo-lar) long bones cancellous bone (CAN-sell-us) (MED-you-lair-ee) compact bone (pair-ee-AH-stee-um) cortical bone (KOR-ti-kal) red bone marrow (dye-AFF-ih-sis) short bones (eh-PIFF-ih-sis) spongy bone flat bones yellow bone marrow irregular bones

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Irregular bones • Figure 4.1 Classification (vertebrae) of bones by shape.

Flat bones (scapula) Short bones (tarsals)

Long bone (humerus)

Flat bones (ribs)

Several different types of bones are found throughout the body and fall into four What’s In A Name? categories based on their shape: long bones, short bones, flat bones, and irregular bones Look for these word parts: articul/o = joint (see Figure 4.1 ■). Long bones are longer than they are wide; examples are the cortic/o = outer layer femur and humerus. Short bones are roughly as long as they are wide; examples medull/o = inner region are the carpals and tarsals. Irregular bones received their name because the shapes oste/o = bone of the bones are very irregular; for example, the vertebrae are irregular bones. Flat peri- = around -al = pertaining to bones are usually plate-shaped bones such as the sternum, scapulae, and pelvis. -ar = pertaining to The majority of bones in the human body are long bones. These bones have -ary = pertaining to similar structure with a central shaft or diaphysis that widens at each end, which is called an epiphysis. Each epiphysis is covered by a layer of cartilage called articular Med Term Tip cartilage to prevent bone from rubbing directly on bone. The remaining surface of Do not confuse a with each bone is covered with a thin membrane called the periosteum, a large bone. A long bone is not necessarily a large bone. The which contains numerous blood vessels, nerves, and lymphatic vessels. The dense bones of your are short and hard exterior surface bone is called cortical or compact bone. Cancellous or spongy in length, but since they are lon- bone is found inside the bone. As its name indicates, spongy bone has spaces in ger than they are wide, they are classified as long bones. it, giving it a spongelike appearance. These spaces contain red bone marrow, which manufactures most of the blood cells and is found in some parts of all bones. Med Term Tip The center of the diaphysis contains an open canal called the medullary cavity. The term diaphysis comes from Early in this cavity also contains red bone marrow, but as we age the red the Greek term meaning “to bone marrow of the medullary cavity gradually converts to yellow bone marrow, grow between.” which consists primarily of cells. Figure 4.2 ■ contains an illustration of the structure of long bones.

Bone Projections and Depressions (KON-dile) neck (ep-ih-KON-dile) process fissure (-er) (SIGH-nus) (for-AY-men) trochanter (tro-KAN-ter) fossa (FOSS-ah) (TOO-ber-kl) tuberosity (too-ber-OSS-ih-tee) Med Term Tip Bones have many projections and depressions; some are rounded and The , commonly referred to as the funny bone, is actually smooth in order to articulate with another bone in a joint. Others are rough a projection of the ulna called to provide muscles with attachment points. The general term for any bony the process.

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Proximal epiphysis Articular cartilage Compact (cortical) bone Articular cartilage Cancellous (spongy) bone Spongy bone

Compact bone

Medullary cavity

Diaphysis

Yellow marrow (fat)

Compact bone

Periosteum

Arteries Distal epiphysis

■ Figure 4.2 Components of a long bone. The entire long bone is on the left side accompanied by a blow-up of the proximal epiphysis and a section of the diaphysis.

projection is a process. Then there are specific terms to describe the different shapes and locations of various processes. These terms are commonly used on operative reports and in physicians’ records for clear identification of areas on Med Term Tip the individual bones. Some of the common bony processes include the following: Newborn have about 300 1. The head is a large, smooth, ball-shaped end on a long bone. It may be sep- bones at birth that will fuse into 206 bones as an adult. arated from the body or shaft of the bone by a narrow area called the neck. 2. A condyle refers to a smooth, rounded portion at the end of a bone. What’s In A Name? 3. The epicondyle is a projection located above or on a condyle. Look for these word parts: 4. The trochanter refers to a large rough process for the attachment of a epi- = above muscle. 5. A tubercle is a small, rough process that provides the attachment for ten- dons and muscles. 6. The tuberosity is a large, rough process that provides the attachment of ten- dons and muscles.

See Figure 4.3 ■ for an illustration of the processes found on the femur. Additionally, bones have hollow regions or depressions, the most common of which are the: 1. Sinus: a hollow cavity within a bone. 2. Foramen: a smooth, round opening for nerves and blood vessels. 3. Fossa: consists of a shallow cavity or depression on the surface of a bone. 4. Fissure: a slit-type opening.

Skeleton What’s In A Name? (app-en-DIK-yoo-lar) axial skeleton (AK-see-al) Look for these word parts: -al = pertaining to The has two divisions: the axial skeleton and the appendicular -ar = pertaining to skeleton. Figures 4.4 and 4.8 illustrate these two .

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■ Figure 4.3 Bony processes found on the femur. Greater trochanter Fovea capitis Neck Head Trochanteric line Lesser trochanter

Patellar surface Lateral epicondyle Medial epicondyle Lateral condyle Medial condyle

Axial Skeleton Med Term Tip Newborn infants have about 300 (ock-SIP-eh-tal) bones at birth that will fuse into coccyx (COCK-six) (PAL-ah-tine) 206 bones as an adult. cranium (KRAY-nee-um) (pah-RYE-eh-tal) (ETH-moyd) facial bones sacrum (SAY-crum) (SFEE-noyd) (HIGH-oyd) sternum (STER-num) intervertebral disk (in-ter-VER-teh-bral) (TEM-por-al) (LACK-rim-al) (VER-teh-bral) mandible (MAN-dih-bl) bone (VOH-mer) maxilla (mack-SIH-lah) (zeye-go-MAT-ik) The axial skeleton includes the bones of the head, neck, spine, chest, and trunk of the body (see Figure 4.4 ■). These bones form the central for the whole body and protect many of the internal organs such as the , , and . The head or skull is divided into two parts consisting of the cranium and facial bones. These bones surround and protect the brain, , , , What’s In A Name? and oral cavity from . The muscles for and moving the head Look for these word parts: are attached to the cranial bones. The cranium encases the brain and consists -al = pertaining to of the frontal, parietal, temporal, ethmoid, sphenoid, and occipital bones. The facial -ar = pertaining to bones surround the mouth, nose, and eyes, and include the mandible, maxilla,

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■ Figure 4.4 Bones of the axial skeleton. Skull (22) Cranium (8)

Face (14)

Sternum (1)

Ribs (24)

Vertebrae (24)

Sacrum (1)

Coccyx (1)

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■ Figure 4.5 Bones of the skull. Frontal bone

Parietal bone Suture

Occipital bone

Sphenoid bone Temporal bone Nasal bone Lacrimal bone Orbit Vomer Maxilla

Zygomatic bone

Mandible ()

zygomatic, vomer, palatine, nasal, and lacrimal bones. The cranial and facial bones are illustrated in Figure 4.5 ■ and described in Table 4.1 ■. The hyoid bone is a single U-shaped bone suspended in the neck between the mandible and . It is a point of attachment for swallowing and speech muscles. The trunk of the body consists of the vertebral column, sternum, and rib cage. The vertebral or spinal column is divided into five sections: cervical vertebrae, thoracic vertebrae, lumbar vertebrae, sacrum, and coccyx (see Figure 4.6 ■ and Table 4.2 ■). Located between each pair of vertebrae, from the cervical through the lumbar Med Term Tip regions, is an intervertebral disk. Each disk is composed of to provide The term coccyx comes from a cushion between the vertebrae. The rib cage has 12 pairs of ribs attached at the the Greek word for the cuckoo because the shape of these back to the vertebral column. Ten of the pairs are also attached to the sternum small bones extending off the in the front (see Figure 4.7 ■). The lowest two pairs are called floating ribs and sacrum resembles this ’s bill.

Table 4.1 Bones of the Skull Name Number Description Cranial Bones Frontal bone 1 Forehead Parietal bone 2 Upper sides of cranium and roof of skull What’s In A Name? Occipital bone 1 Back and base of skull Look for these word parts: -al = pertaining to Temporal bone 2 Sides and base of cranium -ar = pertaining to Sphenoid bone 1 -shaped bone that forms part of the base of the skull, floor, and sides of orbit -oid = resembling -tic = pertaining to Ethmoid bone 1 Forms part of eye orbit, nose, and floor of cranium Facial Bones Lacrimal bone 2 Inner corner of each eye Nasal bone 2 Form part of and support bridge of nose Maxilla 1 Upper jaw Mandible 1 Lower jawbone; only movable bone of the skull Zygomatic bone 2 Cheekbones Vomer bone 1 Base of nasal septum Palatine bone 1 Hard palate (PAH lat) roof of oral cavity and floor of nasal cavity

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Manubrium True ribs (7 pairs) Cervical 1-7 Axis Body

Ribs Sternum (12 pairs) Thoracic 1-12 False ribs Lumbar 1-5 (3 pairs)

Sacrum Floating ribs Coccyx (2 pairs)

■ Figure 4.6 Divisions of the vertebral column. ■ Figure 4.7 The structure of the rib cage.

Table 4.2 Bones of the Vertebral/Spinal Column Name Number Description Cervical vertebra 7 Vertebrae in the neck region Thoracic vertebra 12 Vertebrae in the chest region with ribs attached Lumbar vertebra 5 Vertebrae in the small of the back, about waist level Sacrum 1 Five vertebrae that become fused into one triangular-shaped at the base of the vertebral column Coccyx 1 Three to five very small vertebrae attached to the sacrum, often become fused

are attached only to the vertebral column. The rib cage serves to provide support for organs, such as the heart and lungs.

Appendicular Skeleton carpals (CAR-pals) patella (pah-TELL-ah) clavicle (CLAV-ih-kl) pectoral girdle (PEK-toh-ral) What’s In A Name? femur (FEE-mer) pelvic girdle (PEL-vik) Look for these word parts: fibula (FIB-yoo-lah) phalanges (fah-LAN-jeez) pector/o = chest pelv/o = pelvis humerus (HYOO-mer-us) pubis (PYOO-bis) -al = pertaining to ilium (ILL-ee-um) radius (RAY-dee-us) -ic = pertaining to innominate bone (ih-NOM-ih-nayt) scapula (SKAP-yoo-lah) ischium (ISS-kee-um) tarsals (TAHR-sals) Med Term Tip lower extremities tibia (TIB-ee-ah) The term girdle, meaning some- metacarpals (met-ah-CAR-pals) ulna (UHL-nah) thing that encircles or confines, metatarsals (met-ah-TAHR-sals) upper extremities refers to the entire bony struc- ture of the and the pel- os coxae (OSS / KOK-sigh) vis. If just one bone from these areas is being discussed, like the ilium of the pelvis, it would be .The appendicular skeleton consists of the pectoral girdle, upper extremities, pelvic named as such. If, however, the girdle, and lower extremities (see Figure 4.8 ■). These are the bones for our append- entire pelvis is being discussed, it would be called the pelvic ages or limbs and along with the muscles attached to them, they are responsible girdle. for body movement.

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■ Figure 4.8 Bones of the appendicular skeleton.

Clavicle (2) Scapula (2) Pectoral girdles (4)

Humerus (2)

Radius (2)

Ulna (2)

Upper extremities (60)

Carpals (16)

Metacarpals (10)

Phalanges (28)

Hipbone Pelvic girdles (2) (coxe) (2)

Femur (2)

Patella (2)

Tibia (2)

Fibula (2)

Lower extremities (60)

Tarsals (14) Metatarsals (10) Phalanges (28)

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The pectoral girdle consists of the clavicle and scapula bones. It functions to attach the upper extremity, or , to the axial skeleton by articulating with the sternum anteriorly and the vertebral column posteriorly. The bones of the upper extremity include the humerus, ulna, radius, carpals, metacarpals, and pha- langes. These bones are illustrated in Figure 4.9 ■ and described in Table 4.3 ■.

■ Figure 4.9 Anatomical and common names for the pectoral girdle and upper Clavicle extremity. (collarbone) Scapula (shoulder blade) Humerus (upper arm bone) Humerus (upper arm bone)

Radius Radius ( bone) (forearm bone) Ulna Ulna (forearm bone) (forearm bone)

ANTERIOR POSTERIOR (front) (back)

Table 4.3 Bones of the Pectoral Girdle and Upper Extremity Name Number Description Pectoral Girdle Clavicle 2 Collar bone Scapula 2 Shoulder blade Upper Extremity Humerus 2 Upper arm bone Radius 2 Forearm bone on side of lower arm Ulna 2 Forearm bone on little side of lower arm Carpals 16 Bones of wrist Metacarpals 10 Bones in palm of Phalanges 28 Finger bones; three in each finger and two in each thumb

The pelvic girdle is called the os coxae or the innominate bone or hipbone. It contains the ilium, ischium, and pubis. It articulates with the sacrum posteriorly to attach the lower extremity, or , to the axial skeleton. The lower extremity bones include the femur, patella, tibia, fibula, tarsals, metatarsals, and phalanges. These bones are illustrated in Figure 4.10 ■ and described in Table 4.4 ■

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■ Figure 4.10 Anatomical Ilium and common names for the pelvic girdle and lower extremity. Pubis Ischium

Femur Femur ( bone) (thigh bone)

Patella ( cap) Fibula Fibula (lower leg bone) (lower leg bone) Tibia Tibia Tarsal (ankle bone) Tarsal (ankle bone) Metatarsal (foot bone) Metatarsal (foot bone) Phalange ( bone) ANTERIOR POSTERIOR (front) (back)

Table 4.4 Bones of the Pelvic Girdle and Lower Extremity Name Number Description Pelvic Girdle/Os Coxae Ilium 2 Part of the hipbone Ischium 2 Part of the hipbone Pubis 2 Part of the hipbone Lower Extremity Femur 2 Upper leg bone; thigh bone Patella 2 Knee cap Tibia 2 Shin bone; thicker lower leg bone Fibula 2 Thinner, long bone in lateral side of lower leg Tarsals 14 Ankle and heel bones Metatarsals 10 Forefoot bones Phalanges 28 Toe bones; three in each toe and two in each great toe

Joints articulation (ar-tik-yoo-LAY-shun) bursa (BER-sah) cartilaginous joints (car-tih-LAJ-ih-nus) (sin-OH-vee-al) fibrous joints (FYE-bruss) synovial membrane

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Joints are formed when two or more bones meet. This is also referred to as an articulation. There are three types of joints based on the amount of movement allowed between the bones: synovial joints, cartilaginous joints, and fibrous joints (see Figure 4.11 ■). Most joints are freely moving synovial joints (see Figure 4.12 ■), which are enclosed by an elastic joint capsule. The joint capsule is lined with synovial mem- brane, which secretes synovial fluid to lubricate the joint. As noted earlier, the ends of bones in a synovial joint are covered by a layer of articular cartilage. Cartilage is very tough, but still flexible. It withstands high levels of stress to act as a shock What’s In A Name? absorber for the joint and prevents bone from rubbing against bone. Cartilage is Look for these word parts: found in several other areas of the body, such as the nasal septum, external , articul/o = joint , larynx, , bronchi, and intervertebral disks. One example fibr/o = of a synovial joint is the ball-and-socket joint found at the shoulder and . The synovi/o = synovial membrane -al = pertaining to ball rotating in the socket allows for a wide range of . Bands of strong -ous = pertaining to connective tissue called ligaments bind bones together at the joint. Some synovial joints contain a bursa, which is a saclike structure composed Med Term Tip of connective tissue and lined with synovial membrane. Most commonly found is an of the between bones and ligaments or , bursas to reduce friction. bursa located between bony Some common bursa locations are the elbow, knee, and shoulder joints. prominences such as at the shoulder. Housemaid’s knee, a Not all joints are freely moving. Fibrous joints allow almost no movement since term thought to have originated the ends of the bones are joined by thick fibrous tissue, which may even fuse into from the damage to the solid bone. The sutures of the skull are an example of a . Cartilaginous that occurred when maids knelt joints allow for slight movement but hold bones firmly in place by a solid piece to scrub floors, is a form of bursitis and carries the medical of cartilage. An example of this type of joint is the pubic , the point at name . which the left and right pubic bones meet in the front of the lower .

Skull

Fibrous joint (skull suture)

Pelvis Medullary cavity

Periosteum

Spongy bone Compact bone

Hand Synovial membrane

Articular cartilage

Joint cavity (contains synovial fluid)

Joint capsule

Synovial joint ■ Figure 4.11 Examples of three types ■ Figure 4.12 Structure of a generalized synovial of joints found in the body. joint.

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Practice As You Go

A. Complete the Statement

1. The two divisions of the human skeleton are the ______and ______.

2. The five functions of the skeletal system are to ______, ______, ______, ______, and ______.

3. ______bones are roughly as long as they are wide.

4. The membrane covering bones is called the ______.

5. Another name for spongy bone is ______bone.

6. ______joints are the most common joints in the body.

7. A ______is a smooth, round opening in bones.

8. The ______is the shaft of a long bone.

Terminology Word Parts Used to Build Skeletal System Terms The following lists contain the combining forms, suffixes, and prefixes used to build terms in the remaining sections of this chapter.

Combining Forms ankyl/o stiff joint femor/o femur metatars/o metatarsus arthr/o joint fibul/o fibula myel/o bone marrow, burs/o bursa humer/o humerus spinal cord carp/o carpus ili/o ilium orth/o straight cervic/o neck ischi/o ischium oste/o bone chondr/o cartilage kyph/o hump patell/o patella clavicul/o clavicle lamin/o lamina path/o coccyg/o coccyx lord/o bent backward ped/o child; foot cortic/o outer layer lumb/o loin phalang/o phalanges cost/o rib mandibul/o mandible pod/o foot crani/o skull maxill/o maxilla prosthet/o addition cutane/o medull/o inner portion pub/o pubis erythr/o red metacarp/o metacarpus radi/o radius, ray (X-ray)

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Terminology (continued) sacr/o sacrum spondyl/o vertebra tars/o tarsus sarc/o flesh stern/o sternum thorac/o scapul/o scapula synov/o synovial tibi/o tibia scoli/o crooked membrane uln/o ulna spin/o spine system/o system vertebr/o vertebra

Suffixes -ac pertaining to -graphy process of -otomy cutting into recording -al pertaining to -ous pertaining to -iatry medical treatment -algia -pathy disease -ic pertaining to -ar pertaining to -plasty surgical repair -itis inflammation -ary pertaining to -porosis porous -listhesis slipping -centesis puncture to -scope instrument for withdraw fluid -logy study viewing -clasia surgically break -malacia abnormal softening -scopy process of visually examining -desis to fuse -metry process of measuring - narrowing -eal pertaining to -oma tumor -tic pertaining to -ectomy surgical removal -ory pertaining to -tome instrument to cut -genic producing -osis abnormal condition -gram record

Prefixes anti- against ex- outward non- not bi- two inter- between per- through dis- apart intra- within sub- under

Adjective Forms of Anatomical Terms Term Word Parts Definition carpal carp/o = carpus pertaining to the carpus (CAR-pal) -al = pertaining to cervical cervic/o = neck pertaining to the neck (CER-vih-kal) -al = pertaining to clavicular clavicul/o = clavicle pertaining to the clavicle (cla-VIK-yoo-lar) -ar = pertaining to coccygeal coccyg/o = coccyx pertaining to the coccyx (cock-eh-JEE-all) -eal = pertaining to costal cost/o = rib pertaining to the rib (COAST-all) -al = pertaining to

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Adjective Forms of Anatomical Terms (continued) Term Word Parts Definition

cranial crani/o = skull pertaining to the skull (KRAY-nee-all) -al = pertaining to femoral femor/o = femur pertaining to the femur (FEM-or-all) -al = pertaining to fibular fibul/o = fibula pertaining to the fibula (FIB-yoo-lar) -ar = pertaining to humeral humer/o = humerus pertaining to the humerus (HYOO-mer-all) -al = pertaining to iliac ili/o = ilium pertaining to the ilium (ILL-ee-ack) -ac = pertaining to intervertebral inter- = between pertaining to between vertebrae (in-ter-VER-teh-bral) vertebr/o = vertebra -al = pertaining to intracranial intra- = within pertaining to within the skull (in-trah-KRAY-nee-al) crani/o = skull -al = pertaining to ischial ischi/o = ischium pertaining to the ischium (ISH-ee-all) -al = pertaining to lumbar lumb/o = low back pertaining to the low back (LUM-bar) -ar = pertaining to mandibular mandibul/o = mandible pertaining to the mandible (man-DIB-yoo-lar) -ar = pertaining to maxillary maxill/o = maxilla pertaining to the maxilla (mack-sih-LAIR-ree) -ary = pertaining to metacarpal metacarp/o = metacarpus pertaining to the metacarpus (met-ah-CAR-pal) -al = pertaining to metatarsal metatars/o = metatarsus pertaining to the metatarsus (met-ah-TAHR-sal) -al = pertaining to patellar patell/o = patella pertaining to the patella (pa-TELL-ar) -ar = pertaining to phalangeal phalang/o = phalanges pertaining to the phalanges (fay-lan-JEE-all) -eal = pertaining to pubic pub/o = pubis pertaining to the pubis (PYOO-bik) -ic = pertaining to radial radi/o = radius pertaining to the radius (RAY-dee-all) -al = pertaining to sacral sacr/o = sacrum pertaining to the sacrum (SAY-kral) -al = pertaining to scapular scapul/o = scapula pertaining to the scapula (SKAP-yoo-lar) -ar = pertaining to sternal stern/o = sternum pertaining to the sternum (STER-nal) -al = pertaining to tarsal tars/o = tarsus pertaining to the tarsus (TAHR-sal) -al = pertaining to

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Adjective Forms of Anatomical Terms (continued) Term Word Parts Definition

thoracic thorac/o = thorax pertaining to the thorax (tho-RASS-ik) -ic = pertaining to tibial tibi/o = tibia pertaining to the tibia (TIB-ee-all) -al = pertaining to ulnar uln/o = ulna pertaining to the ulna (UHL-nar) -ar = pertaining to vertebral vertebr/o = vertebra pertaining to a vertebra (VER-the-bral) -al = pertaining to

Practice As You Go

B. Adjective Form Practice Give the adjective form for the following bones.

1. femur ______

2. sternum ______

3. clavicle ______

4. coccyx ______

5. maxilla ______

6. tibia ______

7. patella ______

8. phalanges ______

9. humerus ______

10. pubis ______

Pathology Term Word Parts Definition Medical Specialties chiropractic -tic = pertaining to Healthcare profession concerned (ki-roh-PRAK-tik) with diagnosis and treatment of malalignment conditions of the spine and musculoskeletal system with the intention of affecting the and improving health. Healthcare professional is a chiropractor.

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Pathology (continued) Term Word Parts Definition orthopedics (Orth, ortho) orth/o = straight Branch of medicine specializing (or-thoh-PEE-diks) ped/o = child, foot in the diagnosis and treatment of -ic = pertaining to conditions of the musculoskeletal system; also called orthopedic . Physician is an orthopedist or orthopedic surgeon. Name derived from straightening (orth/o) deformities in children (ped/o). orth/o = straight Healthcare profession specializing (or-THOT-iks) -tic = pertaining to in making orthopedic appliances such as braces and splints. Person skilled in making and adjusting these appliances is an orthotist. podiatry pod/o = foot Healthcare profession specializing in (po-DYE-ah-tree) -iatry = medical treatment diagnosis and treatment of disorders of the feet and lower . Healthcare professional is a podiatrist. prosthetics prosthet/o = addition Healthcare profession specializing in (pross-THET-iks) -ic = pertaining to making artificial body parts. Person skilled in making and adjusting prostheses is a prosthetist. Signs and Symptoms arthr/o = joint joint pain (ar-THRAL-jee-ah) -algia = pain bursitis burs/o = bursa inflammation of a bursa (ber-SIGH-tis) -itis = inflammation callus The of bone tissue that forms (KAL-us) at a fracture site during its . chondromalacia chondr/o = cartilage softening of the cartilage (kon-droh-mah-LAY-she-ah) -malacia = abnormal softening crepitation The noise produced by bones (krep-ih-TAY-shun) or cartilage rubbing together in conditions such as . Also called . ostealgia oste/o = bone bone pain (oss-tee-AL-jee-ah) -algia = pain oste/o = bone inflammation of bone and bone (oss-tee-oh-mi-ell-EYE-tis) myel/o = bone marrow marrow -itis = inflammation synov/o = synovial membrane inflammation of synovial membrane (sih-no-VI-tis) -itis = inflammation

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Pathology (continued) Term Word Parts Definition Fractures closed fracture Fracture in which there is no open skin wound. Also called a simple fracture.

A

B

■ Figure 4.13 A) Closed (or simple) fracture and B) open (or compound) fracture.

Colles’ fracture A common type of wrist fracture. (COL-eez)

■ Figure 4.14 Colles’ fracture. (Charles Stewart MD FACEP, FAAEM)

comminuted fracture Fracture in which the bone is (kom-ih-NYOOT-ed) shattered, splintered, or crushed into many small pieces or fragments. compound fracture Fracture in which the skin has been broken through to the fracture. Also called an open fracture (see Figure 4.13B ■).

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Pathology (continued) Term Word Parts Definition compression fracture Fracture involving loss of height of a vertebral body. It may be the result of trauma, but in older people, especially women, it may be caused by conditions like . fracture A broken bone. (FX, Fx) greenstick fracture Fracture in which there is an incomplete break; one side of bone is broken and the other side is bent. This type of fracture is commonly found in children due to their softer and more pliable bone structure. impacted fracture Fracture in which bone fragments are pushed into each other. oblique fracture Fracture at an angle to the bone. (oh-BLEEK)

■ Figure 4.15 X-ray showing oblique fracture of the humerus. (Charles Stewart MD FACEP, FAAEM)

pathologic fracture path/o = disease Fracture caused by diseased or (path-a-LOJ-ik) -logic = pertaining to study of weakened bone. spiral fracture -al = pertaining to Fracture in which the fracture line spirals around the shaft of the bone. Can be caused by a twisting injury and is often slower to heal than other types of fractures. stress fracture A slight fracture caused by repetitive low-impact , like running, rather than a single forceful impact.

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Pathology (continued) Term Word Parts Definition transverse fracture Complete fracture that is straight across the bone at right angles to the long axis of the bone.

■ Figure 4.16 X-ray showing transverse fracture of radius. (James Stevenson/Science Photo Library/Photo Researchers, Inc.)

Bones chondr/o = cartilage A tumor, usually benign, that forms in (kon-DROH-mah) -oma = tumor cartilage. Ewing’s sarc/o = flesh Malignant growth found in the shaft (YOO-wings / sar-KOH-mah) -oma = tumor of long bones that spreads through the periosteum. Removal is the treatment of choice because this tumor will metastasize or spread to other organs. exostosis ex- = outward A bony, outward projection from the (eck-sos-TOH-sis) oste/o = bone surface of a bone; also called a bone -osis = abnormal condition spur. myeloma myel/o = bone marrow A tumor that forms in bone marrow (my-ah-LOH-mah) -oma = tumor tissue. oste/o = bone A tumor, usually benign, that consists (oss-tee-oh-kon-DROH-mah) chondr/o = cartilage of both bone and cartilage tissue. -oma = tumor osteogenic sarcoma oste/o = bone The most common type of bone (oss-tee-oh-GIN-ik / sark-OH-mah) -genic = producing . Usually begins in osteocytes sarc/o = flesh found at the ends of long bones. -oma = tumor osteomalacia oste/o = bone Softening of the bones caused by a (oss-tee-oh-mah-LAY-she-ah) -malacia = abnormal softening deficiency of calcium. It is thought to be caused by insufficient sunlight and D in children. oste/o = bone A general term for . (oss-tee-OPP-ah-thee) -pathy = disease

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Pathology (continued) Term Word Parts Definition osteoporosis oste/o = bone Decrease in bone mass producing a (oss-tee-oh-por-ROH-sis) -porosis = porous thinning and weakening of the bone with resulting fractures. The bone becomes more porous, especially in the spine and pelvis. Paget’s disease A fairly common metabolic disease (PAH-jets) of the bone from unknown causes. It usually attacks middle-aged and older adults and is characterized by bone destruction and deformity. Named for Sir James Paget, a British surgeon. rickets Deficiency in calcium and (RIK-ets) found in early childhood that results in bone deformities, especially bowed legs. Spinal Column ankyl/o = stiff joint Inflammatory spinal condition (ang-kih-LOH-sing / spon-dih-LYE-tis) spondyl/o = vertebra resembling -itis = inflammation and results in gradual stiffening and fusion of the vertebrae. More common in men than in women. herniated nucleus pulposus (HNP) Herniation or protrusion of an (HER-nee-ated / NOO-klee-us / intervertebral disk; also called pull-POH-sus) herniated disk or ruptured disk. May require surgery.

■ Figure 4.17 Magnetic resonance imaging (MRI) image demonstrating a back herniated disc. (Michelle Milano/ Shutterstock) kyph/o = hump Abnormal increase in the outward (ki-FOH-sis) -osis = abnormal condition curvature of the thoracic spine. Also known as hunchback or humpback. See Figure 4.18 ■ for an illustration of abnormal spine curvatures.

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Pathology (continued) Term Word Parts Definition

■ Figure 4.18 Abnormal spinal curvatures: kyphosis, Kyphosis lordosis, and scoliosis. (excessive posterior thoracic (excessive anterior lumbar (lateral curvature) curvature - hunchback) curvature - swayback)

lordosis lord/o = bent backward Abnormal increase in the forward (lor-DOH-sis) -osis = abnormal condition curvature of the lumbar spine. Also known as swayback. See again Figure 4.18 for an illustration of abnormal spine curvatures. scoliosis scoli/o = crooked Abnormal lateral curvature of the (skoh-lee-OH-sis) -osis = abnormal condition spine. See again Figure 4.18 for an illustration of abnormal spine curvatures. spin/o = spine Congenital anomaly occurring when (SPY-nah / BIF-ih-dah) bi- = two a vertebra fails to fully form around the spinal cord. spinal stenosis spin/o = spine Narrowing of the spinal canal causing (ste-NOH-sis) -al = pertaining to pressure on the cord and nerves. Word Watch Watch how the term stenosis is used in this condition. It most often appears as the suffix -stenosis. However, in this case, it is used as a freestanding word.

spondyl/o = vertebra The forward sliding of a lumbar (spon-dih-loh-liss-THEE-sis) -listhesis = slipping vertebra over the vertebra below it. spondylosis spondyl/o = vertebra Specifically refers to ankylosing (spon-doh-LOH-sis) -osis = abnormal condition of the spine, but commonly used in reference to any degenerative condition of the vertebral column.

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Pathology (continued) Term Word Parts Definition Cervical muscle and or as a result of a sudden movement forward and backward of the head and neck. Can occur as a result of a rear-end auto collision. Joints bunion Inflammation of the bursa of the first (BUN-yun) metatarsophalangeal joint (base of the big toe). dislocation dis- = apart Occurs when the bones in a joint are displaced from their normal alignment and the ends of the bones are no longer in contact. oste/o = bone Arthritis resulting in degeneration (OA) (oss-tee-oh-ar-THRY-tis) arthr/o = joint of the bones and joints, especially -itis = inflammation those bearing weight. Results in bone rubbing against bone. Also called degenerative joint disease (DJD). rheumatoid arthritis arthr/o = joint Chronic form of arthritis with (RA) (ROO-mah-toyd / ar-THRY-tis) -itis = inflammation inflammation of the joints, swelling, stiffness, pain, and changes in the cartilage that can result in crippling deformities; considered to be an .

■ Figure 4.19 Patient with typical rheumatoid arthritis .

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Pathology (continued) Term Word Parts Definition sprain Damage to the ligaments surrounding a joint due to overstretching, but no dislocation of the joint or fracture of the bone.

sub- = under An incomplete dislocation, the joint (sub-LUCKS-a-shun) alignment is disrupted, but the ends of the bones remain in contact. systemic erythematosus system/o = system Chronic inflammatory autoimmune (SLE) (sis-TEM-ik / LOOP-us / -ic = pertaining to disease of connective tissue affecting air-ih-them-ah-TOH-sis) erythr/o = red many systems that may include joint pain and arthritis. May be mistaken for rheumatoid arthritis. talipes Congenital deformity causing (TAL-ih-peez) misalignment of the ankle joint and foot. Also referred to as a .

Practice As You Go

C. Fracture Type Matching Match each fracture type to its definition.

1. ______comminuted a. fracture line is at an angle

2. ______greenstick b. fracture line curves around the bone

3. ______compound c. bone is splintered or crushed

4. ______simple d. bone is pressed into itself

5. ______impacted e. fracture line is straight across bone

6. ______transverse f. skin has been broken

7. ______oblique g. no open wound

8. ______spiral h. bone only partially broken

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Diagnostic Procedures Term Word Part Definition Diagnostic Imaging arthr/o = joint X-ray record of a joint, usually taken after (AR-throh-gram) -gram = record the joint has been injected by a contrast medium. arthrography arthr/o = joint Process of X-raying a joint, usually after (ar-THROG-rah-fee) -graphy = process of injection of a contrast medium into the joint recording space. bone scan Nuclear medicine procedure in which the patient is given a radioactive dye and then scanning equipment is used to visualize bones. It is especially useful in identifying stress fractures, observing progress of treatment for osteomyelitis, and locating cancer metastases to the bone. dual- absorptiometry (DXA) -metry = process of Measurement of using low- (ab-sorp-she-AHM-eh-tree) measuring dose X-ray for the purpose of detecting osteoporosis. myelography myel/o = spinal cord Study of the spinal column after injecting (my-eh-LOG-rah-fee) -graphy = process of opaque contrast material; particularly useful recording in identifying herniated nucleus pulposus pinching a spinal .

Med Term Tip The combining form myel/o means “marrow” and is used for both the spinal cord and bone marrow. To the ancient Greek philosophers and physicians, the spinal cord appeared to be much like the marrow found in the medullary cavity of a long bone. radi/o = ray Diagnostic imaging procedure using X-rays -graphy = process of to study the internal structure of the body; recording especially useful for visualizing bones and joints. Endoscopic Procedures arthroscope arthr/o = joint Instrument used to view inside a joint. (AR-throw-skop) -scope = instrument for viewing arthr/o = joint Examination of the interior of a joint by (ar-THROS-koh-pee) -scopy = process of visually entering the joint with an arthroscope. The examining arthroscope contains a small television camera that allows the physician to view the interior of the joint on a monitor during the procedure. Some joint conditions can be repaired during arthroscopy.

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Therapeutic Procedures Term Word Part Definition Medical Treatments arthr/o = joint Involves the insertion of a needle into the joint (ar-thro-sen-TEE-sis) -centesis = puncture to cavity in order to remove or aspirate fluid. May withdraw fluid be done to remove excess fluid from a joint or to obtain fluid for examination. orthotic orth/o = straight Orthopedic appliance, such as a brace or splint, (or-THOT-ik) -tic = pertaining to used to prevent or correct deformities. prosthet/o = addition Artificial device used as a substitute for a body (pross-THEE-sis) part that is either congenitally missing or absent as a result of accident or disease. An example would be an artificial leg. Surgical Procedures Partial or complete removal of a limb for a variety (am-pew-TAY-shun) of reasons, including tumors, gangrene, intractable pain, crushing injury, or uncontrollable . arthroclasia arthr/o = joint To forcibly break loose a fused joint while the (ar-throh-KLAY-see-ah) -clasia = surgically break patient is under . Fusion is usually caused by the buildup of tissue or adhesions. arthr/o = joint Procedure to stabilize a joint by fusing the bones (ar-throh-DEE-sis) -desis = to fuse together. arthroscopic surgery arthr/o = joint Performing a surgical procedure while using an (ar-throh-SKOP-ic) -scopy = process of visually arthroscope to view the internal structure, such as a examining joint. -ic = pertaining to arthr/o = joint Surgical procedure that cuts into a joint capsule. (ar-THROT-oh-mee) -otomy = cutting into bone graft Piece of bone taken from the patient used to take the place of a removed bone or a bony defect at another site. bunionectomy -ectomy = surgical removal Removal of the bursa at the joint of the great toe. (bun-yun-ECK-toh-mee) burs/o = bursa Surgical removal of a bursa. (ber-SEK-toh-mee) -ectomy = surgical removal chondrectomy chondr/o = cartilage Surgical removal of cartilage. (kon-DREK-toh-mee) -ectomy = surgical removal chondroplasty chondr/o = cartilage Surgical repair of cartilage. (KON-droh-plas-tee) -plasty = surgical repair craniotomy crani/o = skull Surgical procedure that cuts into the skull. (kray-nee-OTT-oh-mee) -otomy = cutting into lamin/o = lamina Removal of the vertebral posterior arch to correct (lam-ih-NEK-toh-mee) -ectomy = surgical removal severe back problems and pain caused by compression of a . osteoclasia oste/o = bone Surgical procedure involving the intentional (oss-tee-oh-KLAY-see-ah) -clasia = surgically break breaking of a bone to correct a deformity. osteotome oste/o = bone Instrument used to cut bone. (OSS-tee-oh-tohm) -tome = instrument to cut

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Therapeutic Procedures (continued) Term Word Part Definition

oste/o = bone Surgical procedure that cuts into a bone. (oss-tee-OTT-ah-me) -otomy = cutting into percutaneous diskectomy per- = through A thin catheter tube is inserted into the (per-kyou-TAY-nee-us / cutane/o = skin intervertebral disk through the skin and the disk-EK-toh-mee) -ous = pertaining to herniated or ruptured disk material is sucked out or -ectomy = surgical removal a laser is used to vaporize it. spin/o = spine Surgical immobilization of adjacent vertebrae. -al = pertaining to This may be done for several reasons, including correction for a herniated disk. synov/o = synovial Surgical removal of the synovial membrane. (sih-no-VEK-toh-mee) membrane -ectomy = surgical removal total hip (THA) arthr/o = joint Surgical reconstruction of a hip by implanting a (ar-thro-PLAS-tee) -plasty = surgical repair prosthetic or artificial hip joint. Also called total (THR).

■ Figure 4.20 Prosthetic hip joint. (Lawrence Livermore National Library/Science Photo Library/Photo Researchers, Inc.)

total knee arthroplasty (TKA) arthr/o = joint Surgical reconstruction of a knee joint by (ar-thro-PLAS-tee) -plasty = surgical repair implanting a prosthetic knee joint. Also called total (TKR). Fracture Care cast Application of a solid material to immobilize an extremity or portion of the body as a result of a fracture, dislocation, or severe injury. It may be made of plaster of Paris or fiberglass. fixation Procedure to stabilize a fractured bone while it heals. includes casts, splints, and pins inserted through the skin. includes pins, plates, rods, screws, and wires that are applied during an open reduction.

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Therapeutic Procedures (continued) Term Word Part Definition

reduction Correcting a fracture by realigning the bone fragments. Closed reduction is doing this manipulation without entering the body. Open reduction is the process of making a at the site of the fracture to do the reduction. This is necessary when bony fragments need to be removed or internal fixation such as plates or pins are required. traction Applying a pulling on a fractured or dislocated limb or the vertebral column in order to restore normal alignment.

Pharmacology Classification Word Parts Action Examples bone reabsorption Conditions that result in weak alendronate, Fosamax; inhibitors and fragile bones, such as ibandronate, Boniva osteoporosis and Paget’s disease, are improved by medications that reduce the reabsorption of bones. calcium supplements Maintaining high blood levels , Oystercal, and vitamin D therapy of calcium in association Tums; calcium citrate, Cal- with vitamin D helps maintain Citrate, Citracal bone density; used to treat osteomalacia, osteoporosis, and rickets. cortic/o = outer A produced by the prednisone; layer adrenal that has very methylprednisolone, Medrol; strong anti-inflammatory dexamethasone, Decadron properties. It is particularly useful in treating rheumatoid arthritis. nonsteroidal anti- non- = not A large group of (other ibuprofen, Advil, Motrin; inflammatory drugs -al = pertaining to than corticosteroids) that naproxen, Aleve, Naprosyn; (NSAIDs) anti- = against provide mild pain relief and salicylates, Aspirin -ory = pertaining to anti-inflammatory benefits for conditions such as arthritis.

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Abbreviations AE above elbow NSAID nonsteroidal anti-inflammatory AK above knee OA osteoarthritis BDT bone density testing ORIF open reduction–internal fixation BE below elbow Orth, ortho orthopedics BK below knee P phosphorus C1, C2, etc. first cervical vertebra, second cervical RA rheumatoid arthritis vertebra, etc. Ca calcium RLE right lower extremity DJD degenerative joint disease RUE right upper extremity DXA dual-energy absorptiometry SLE systemic FX, Fx fracture T1, T2, etc. first thoracic vertebra, second thoracic vertebra, etc. HNP herniated nucleus pulposus THA total hip arthroplasty JRA juvenile rheumatoid arthritis THR total hip replacement L1, L2, etc. first lumbar vertebra, second lumbar TKA total knee arthroplasty vertebra, etc. LE lower extremity TKR total knee replacement LLE left lower extremity UE upper extremity LUE left upper extremity

Practice As You Go

D. What’s the Abbreviation?

1. total knee replacement ______

2. herniated nucleus pulposus ______

3. upper extremity ______

4. fifth lumbar vertebra ______

5. above the knee ______

6. fracture ______

7. nonsteroidal anti-inflammatory drug ______

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Section II: at a Glance

Function Muscles are bundles, sheets, or rings of tissue that produce movement by contracting and pulling on the structures to which they are attached. Organs Here is the primary structure that comprises the muscular system: muscles Word Parts Here are the most common word parts (with their meanings) used to build muscular system terms. For a more comprehensive list, refer to the Terminology section of this chapter.

Combining Forms /o to bring myos/o muscle extens/o to stretch out /o sole of foot fasci/o fibrous band rotat/o to revolve fibr/o fibers ten/o flex/o to bend tend/o tendon kinesi/o movement tendin/o tendon muscul/o muscle vers/o to turn my/o muscle

Suffixes Prefixes -asthenia ab- away from -ion action ad- toward -kinesia movement circum- around -tonia tone e- outward -trophic pertaining to development

114

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Frontalis

Orbicularis oris

Sternocleidomastoid

Deltoid

Pectoralis

Biceps brachii

Rectus abdominis

Brachioradialis External oblique

Sartorius

Rectus femoris

Vastus medialis

Tibialis anterior Gastrocnemius

115

M04_FREM0254_06_SE_C04.indd 115 18/12/14 10:12 pm 116 Chapter 4 Anatomy and Physiology of the Muscular System fibers muscles Med Term Tip The term muscle is the diminu- Muscles are bundles of parallel muscle tissue fibers. As these fibers contract (shorten tive form of the Latin word mus in length) they produce movement of or within the body. The movement may or “little mouse.” This is thought take the form of bringing two bones closer together, pushing through the to describe how the skin ripples when a muscle contracts, like a digestive system, or pumping blood through blood vessels. In addition to pro- little mouse running. ducing movement, muscles also hold the body erect and generate heat.

Types of Muscles involuntary muscles voluntary muscles skeletal muscle

What’s In A Name? The three types of muscle tissue are skeletal muscle, smooth muscle, and cardiac muscle Look for these word parts: (see Figure 4.21 ■). Muscle tissue may be either voluntary or involuntary. Voluntary cardi/o = heart -ac = pertaining to muscles are those muscles for which a person consciously chooses to contract and in- = not for how long and how hard to contract them. The skeletal muscles of the arm and leg are examples of this type of muscle. Involuntary muscles are the muscles under the control of the subconscious regions of the brain. The smooth muscles found in internal organs and cardiac muscles are examples of involuntary muscle tissue.

Skeletal muscle

Cardiac muscle

Smooth muscle

■ Figure 4.21 The three types of muscles: skeletal, smooth, and cardiac.

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Skeletal Muscle (FASH-ee-ah) striated muscles (stry-a-ted) motor neurons tendon (TEN-dun) myoneural junction (MY-oh-NOO-rall)

A skeletal muscle is directly or indirectly attached to a bone and produces volun- Med Term Tip tary movement of the skeleton. It is also referred to as a striated muscle because The human body has more than 400 skeletal muscles, which of its striped appearance under the microscope (see Figure 4.22 ■). Each muscle account for almost 50% of the is wrapped in layers of fibrous connective tissue called fascia. The fascia tapers body’s weight. at each end of a skeletal muscle to form a very strong tendon. The tendon then inserts into the periosteum covering a bone to anchor the muscle to the bone. Skeletal muscles are stimulated by motor neurons of the nervous system. The point at which the contacts a muscle is called the myoneural junction.

Smooth Muscle What’s In A Name? visceral muscle (vis-she-ral) Look for these word parts: cardi/o = heart Smooth muscle tissue is found in association with internal organs. For this rea- What’s In A Name? -ac = pertaining to son, it is also referred to as visceral muscle. The name smooth muscle refers to the Look for these word parts: in- = not muscle’s microscopic appearance; it lacks the striations of skeletal muscle (see cardi/o = heart my/o = muscle again Figure 4.22). Smooth muscle is found in the walls of the hollow organs, neur/o = nerve such as the , tube-shaped organs, such as the respiratory airways, and viscer/o = internal organ blood vessels. It is responsible for the involuntary muscle action associated with -al = pertaining to movement of the internal organs, such as churning food, constricting a , and uterine contractions.

Cardiac Muscle myocardium (my-oh-CAR-dee-um) Cardiac muscle, or myocardium, makes up the wall of the heart (see again Figure 4.22). With each involuntary contraction the heart squeezes to pump blood out of its chambers and through the blood vessels. This muscle is more thoroughly described in Chapter 5, Cardiovascular System.

Visceral Skeletal Cardiac (smooth) (striated)

No striations Striations Striations

Central nucleus Peripheral Central nuclei nuclei

Contracts Slowly Rapidly Rapidly Found Viscera, blood vessels Trunk, extremities, Heart head and neck ■ Figure 4.22 Characteristics of the three Control Involuntary Voluntary Involuntary types of muscles.

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Practice As You Go

E. Complete the Statement

1. Another name for visceral muscle is ______muscle.

2. Nerves contact skeletal muscle fibers at the ______junction.

3. The three types of muscle are ______, ______, and ______.

Naming Skeletal Muscles (BYE-seps) rectus abdominis (REK-tus / ab-DOM-ih-nis) extensor carpi sternocleidomastoid (STER-noh-KLY-doh external oblique MASS-toid) flexor carpi (GLOO-tee-us / MACKS-ih-mus)

The name of a muscle often reflects its location, origin and insertion, size, action, fiber direction, or number of attachment points, as illustrated by the following examples: • Location: the term rectus abdominis means straight (rectus) abdominal muscle. • Origin and insertion: the sternocleidomastoid is named for its two ori- gins (stern/o for sternum and cleid/o for clavicle) and single insertion (mastoid process). • Size: when gluteus, meaning rump area, is combined with maximus, meaning large, we have the term gluteus maximus.

What’s In A Name? • Action: the flexor carpi and extensor carpi muscles are named as such Look for these word parts: because they produce flexion and extension at the wrist. cleid/o = clavicle external oblique extens/o = to stretch out • Fiber direction: the muscle is an abdominal muscle flex/o = to bend whose fibers run at an oblique angle. stern/o = sternum • Number of attachment points: the prefix bi-, meaning two, can -al = pertaining to bi- = two form the medical term biceps, which refers to the muscle in the upper ex- = outward arm that has two or connecting points.

Skeletal Muscle Actions action insertion antagonistic pairs origin

Skeletal muscles are attached to two different bones and overlap a joint. When a muscle contracts, the two bones move, but not usually equally. The less movable of the two bones is considered to be the starting point of the muscle and is called the origin. The more movable bone is considered to be where the

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muscle ends and is called the insertion (see Figure 4.23 ■). The type of movement a muscle produces is called its action. Muscles are often arranged around joints in antagonistic pairs, meaning that they produce opposite actions. For example, one muscle will bend a joint while its antagonist is responsible for straighten- ing the joint. Some common terminology for muscle actions are described in Table 4.5 ■.

■ Figure 4.23 Origin and insertion of a muscle

Origins

Biceps brachii

Insertion

Action-Flexion

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Table 4.5 Muscle Actions Grouped by Antagonistic Pairs Action Word Parts Description abduction ab- = away from Movement away from midline of the body (see Figure 4.24 ■) (ab-DUCK-shun) duct/o = to bring -ion = action adduction ad- = toward Movement toward midline of the body (see again Figure 4.24) (ah-DUCK-shun) duct/o = to bring -ion = action flexion flex/o = to bend Act of bending or being bent (see Figure 4.25 ■) (FLEK-shun) -ion = action

180°

Abduction to 180°

180° 160°

Flexion to 160°

Abduction to 50°

0° 0° Extension

■ Figure 4.24 Abduction and adduction ■ Figure 4.25 Flexion and of the . extension of the elbow joint.

extension extens/o = to stretch out Movement that brings limb into or toward a straight condition (see again Figure 4.25) (eks-TEN-shun) -ion = action dorsiflexion dors/o = back of body Backward bending, as of hand or foot (see Figure 4.26A ■) (dor-see-FLEK-shun) flex/o = to bend -ion = action plantar flexion plant/o = sole of foot Bending sole of foot; pointing downward (see Figure 4.26B ■) (PLAN-tar / FLEK-shun) -ar = pertaining to flex/o = to bend -ion = action

AB ■ Figure 4.26 Dorsiflexion (A) and plantar flexion (B) of the ankle joint. (Poulsons Photography/ Shutterstock)

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Table 4.5 Muscle Actions Grouped by Antagonistic Pairs (continued) Action Word Parts Description eversion e- = outward Turning outward (see Figure 4.27 ■) (ee-VER-zhun) vers/o = to turn -ion = action inversion in- = inward Turning inward (see again Figure 4.27 ) (in-VER-zhun) vers/o = to turn -ion = action pronation To turn downward or backward as with the hand or foot (see Figure 4.28 ■) (proh-NAY-shun)

supination Turning the palm or foot upward (see again Figure 4.28) (soo-pin-NAY-shun) elevation To raise a body part, as in shrugging the depression A downward movement, as in dropping the shoulders The circular actions described below are an exception to the antagonistic pair arrangement. circumduction circum- = around Movement in a circular direction from a central point as if drawing a large, imaginary circle (sir-kum-DUCK-shun) duct/o = to bring in the air -ion = action opposition Med Term Tip Moving thumb away from palm; the ability to move the thumb into contact with the other are the only with fingers opposable . rotation rotat/o = to revolve Moving around a central axis -ion = action

Inversion to 30° 30°

Eversion 20° to 20°

Supination Pronation to 90° to 90°

0° 0°

■ Figure 4.28 Pronation and supination of the ■ Figure 4.27 Eversion and inversion of the foot. forearm.

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Practice As You Go

F. Terminology Matching Match each term to its definition.

1. ______abduction a. backward bending of the foot

2. ______rotation b. bending the foot to point toes toward the ground

3. ______plantar flexion c. straightening motion

4. ______extension d. motion around a central axis

5. ______dorsiflexion e. motion away from the body

6. ______flexion f. moving the thumb away from the palm

7. ______adduction g. motion toward the body

8. ______opposition h. bending motion

Terminology Word Parts Used to Build Muscular System Terms The following lists contain the combining forms, suffixes, and prefixes used to build terms in the remaining sections of this chapter.

Combining Forms bi/o = life kinesi/o = movement ten/o = tendon carp/o = wrist later/o = side tend/o = tendon electr/o = muscul/o = muscle tendin/o = tendon fasci/o = fibrous band my/o = muscle fibr/o = fibers myos/o = muscle

Suffixes -al = pertaining to -desis = to fuse -itis = inflammation -algia = pain -dynia = pain -kinesia = movement -ar = pertaining to -gram = record -logy = study of -asthenia = weakness -graphy = process of recording -opsy = view of

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Suffixes -otomy = cutting into -rrhaphy = suture -trophic = pertaining to development -ous = pertaining to -rrhexis = rupture -trophy = development -pathy = disease -tonia = tone -plasty = surgical repair

Prefixes a- = without epi- = above poly- = many brady- = slow hyper- = excessive pseudo- = false dys- = abnormal; difficult hypo- = insufficient

Adjective Forms of Anatomical Terms Term Word Parts Definition fascial fasci/o = fibrous band pertaining to fascia (FAS-ee-all) -al = pertaining to muscular muscul/o = muscle pertaining to muscles (MUSS-kew-lar) -ar = pertaining to musculoskeletal muscul/o = muscle pertaining to the muscles and skeleton (MUSS-kew-loh-SKEL-eh-tal) -al = pertaining to tendinous tendin/o = tendon pertaining to tendons (TEN-din-us) -ous = pertaining to

Pathology Term Word Parts Definition Medical Specialties kinesi/o = movement The science that studies movement, how it (kih-NEE-see-oh-loh-jee) -logy = study of is produced, and the muscles involved. Signs and Symptoms Scar tissue forming in the fascia surrounding a muscle, making it difficult to stretch the muscle. atonia a- = without The lack of . -tonia = tone a- = without Poor muscle development as a result of (AT-rah-fee) -trophy = development muscle disease, nervous system disease, or lack of use; commonly referred to as muscle . bradykinesia brady- = slow Having slow movements. (brad-ee-kih-NEE-see-ah) -kinesia = movement

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Pathology (continued) Term Word Parts Definition Abnormal shortening of muscle fibers, (kon-TRACK-chur) tendons, or fascia, making it difficult to stretch the muscle. dyskinesia dys- = difficult, abnormal Having difficult or abnormal movement. (dis-kih-NEE-see-ah) -kinesia = movement dystonia dys- = abnormal Having abnormal muscle tone. -tonia = tone hyperkinesia hyper- = excessive Having an excessive amount of movement. (high-per-kih-NEE-see-ah) -kinesia = movement hyper- = excessive Having excessive muscle tone. -tonia = tone hypertrophy hyper- = excessive Increase in muscle bulk as a result of use, (high-PER-troh-fee) -trophy = development as with lifting weights. hypokinesia hypo- = insufficient Having an insufficient amount of (HI-poh-kih-NEE-see-ah) -kinesia = movement movement. hypo- = insufficient Having insufficient muscle tone. -tonia = tone intermittent claudication Attacks of severe pain and lameness (klaw-dih-KAY-shun) caused by of the muscles, typically the calf muscles; brought on by even very short distances. my/o = muscle Muscle pain. (my-AL-jee-ah) -algia = pain myasthenia my/o = muscle . (my-ass-THEE-nee-ah) -asthenia = weakness my/o = muscle Muscle tone. -tonia = tone Sudden, involuntary, strong . tenodynia ten/o = tendon Tendon pain. (ten-oh-DIN-ee-ah) -dynia = pain Muscles fasciitis fasci/o = fibrous band Inflammation of fascia. (fas-ee-EYE-tis) -itis = inflammation fibr/o = fibers Condition with widespread aching and (figh-broh-my-AL-jee-ah) my/o = muscle pain in the muscles and . -algia = pain lateral epicondylitis later/o = side Inflammation of the muscle attachment to (ep-ih-kon-dih-LYE-tis) -al = pertaining to the lateral epicondyle of the elbow. Often epi- = above caused by strongly gripping. Commonly -itis = inflammation called . muscul/o = muscle Inherited disease causing a progressive (MD) (MUSS-kew-ler / DIS-troh-fee) -ar = pertaining to muscle degeneration, weakness, and dys- = abnormal atrophy. -trophy = development my/o = muscle A general term for muscle disease. (my-OPP-ah-thee) -pathy = disease

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Pathology (continued) Term Word Parts Definition myorrhexis my/o = muscle Tearing a muscle. (my-oh-REK-sis) -rrhexis = rupture poly- = many The simultaneous inflammation of two or (pol-ee-my-oh-SIGH-tis) myos/o = muscle more muscles. -itis = inflammation pseudohypertrophic muscular pseudo- = false A type of inherited muscular dystrophy dystrophy hyper- = excessive in which the muscle tissue is gradually (soo-doh-HIGH-per-troh-fic) -trophic = pertaining to replaced by fatty tissue, making development the muscle look strong. Also called muscul/o = muscle Duchenne’s muscular dystrophy. -ar = pertaining to dys- = abnormal -trophy = development torticollis Severe neck pulling the head to (tore-tih-KOLL-iss) one side. Commonly called wryneck or a crick in the neck. Tendons, Muscles, and/or Ligaments syndrome (CTS) carp/o = wrist Repetitive motion disorder with pain -al = pertaining to caused by compression of the finger flexor tendons and median nerve as they pass through the carpal tunnel of the wrist. Cyst that forms on tendon sheath, usually (GANG-lee-on) on hand, wrist, or ankle. repetitive motion disorder Group of chronic disorders involving the tendon, muscle, joint, and nerve damage, resulting from the tissue being subjected to pressure, vibration, or repetitive movements for prolonged periods. injury The rotator cuff consists of the joint capsule of the shoulder joint reinforced by the tendons from several shoulder muscles. The high degree of flexibility at the shoulder joint puts the rotator cuff at risk for strain and tearing. strain Damage to the muscle, tendons, or ligaments due to overuse or overstretching. tendinitis tendin/o = tendon Inflammation of a tendon. (ten-dih-NIGH-tis) -itis = inflammation

Diagnostic Procedures Term Word Parts Definition Clinical Laboratory phosphokinase (CPK) Muscle found in skeletal muscle (KREE-ah-teen / foss-foe-KYE-nase) and cardiac muscle. Blood levels become elevated in disorders such as heart attack, muscular dystrophy, and other skeletal muscle .

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Diagnostic Procedures (continued) Term Word Parts Definition Additional Diagnostic Procedures deep tendon (DTR) Muscle contraction in response to a stretch caused by striking the muscle tendon with a . Test used to determine if muscles are responding properly. electromyogram (EMG) electr/o = electricity The hardcopy record produced by (ee-lek-troh-MY-oh-gram) my/o = muscle . -gram = record electromyography (EMG) electr/o = electricity Study and record of the strength and (ee-lek-troh-my-OG-rah-fee) my/o = muscle quality of muscle contractions as a result of -graphy = process of electrical stimulation. recording muscle bi/o = life Removal of muscle tissue for pathological (BYE-op-see) -opsy = view of examination.

Therapeutic Procedures Term Word Parts Definition Surgical Procedures carpal tunnel release carp/o = wrist Surgical cutting of the ligament in the wrist -al = pertaining to to relieve nerve pressure caused by carpal tunnel syndrome, which can result from repetitive motion such as typing. fasci/o = fibrous band A surgical procedure that cuts into fascia. (fas-ee-OT-oh-mee) -otomy = cutting into myoplasty my/o = muscle A surgical procedure to repair a muscle. (MY-oh-plas-tee) -plasty = surgical repair myorrhaphy my/o = muscle To suture a muscle. (MY-or-ah-fee) -rrhaphy = suture tendoplasty tend/o = tendon A surgical procedure to repair a tendon. (TEN-doh-plas-tee) -plasty = surgical repair tendotomy tend/o = tendon A surgical procedure that cuts into a (tend-OT-oh-mee) -otomy = cutting into tendon. tenodesis ten/o = tendon Surgical procedure to stabilize a joint (ten-oh-DEE-sis) -desis = fuse by anchoring down the tendons of the muscles that move the joint. tenoplasty ten/o = tendon A surgical procedure to repair a tendon. (TEN-oh-plas-tee) -plasty = surgical repair tenorrhaphy ten/o = tendon To suture a tendon. (tah-NOR-ah-fee) -rrhaphy = suture

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Pharmacology Classification Word Parts Action Examples skeletal muscle -al = pertaining to to relax skeletal cyclobenzaprine, Flexeril; relaxants muscles in order to reduce carisoprodol, Soma muscle spasms. Also called .

Abbreviations CTS carpal tunnel syndrome EMG electromyogram CPK creatine phosphokinase IM intramuscular DTR deep tendon reflex MD muscular dystrophy

Practice As You Go

G. What’s the Abbreviation?

1. intramuscular ______

2. deep tendon reflex ______

3. muscular dystrophy ______

4. electromyogram ______

5. carpal tunnel syndrome ______

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Real-World Applications

Medical Record Analysis This Discharge Summary contains 10 medical terms. Underline each term and write it in the list below the report. Then define each term. You will find Chapter 14 of your textbook helpful with the rehabilitation terms.

Discharge Summary Admitting Diagnosis: Osteoarthritis bilateral knees. Final Diagnosis: Osteoarthritis bilateral knees with right TKA History of Present Patient is a 68-year-old male. He reports he has experienced occasional knee pain and swelling Illness: since he injured his knees playing football in high school. These symptoms became worse while he was in his 50s and working on a concrete surface. The right knee has always been more painful than the left. He saw his orthopedic surgeon six months ago because of constant knee pain and swelling severe enough to interfere with and all activities. He required a cane to walk. CT scan indicated severe bilateral osteoarthritis. He is admitted to the hospital at this time for TKR right knee. Summary of Hospital Patient tolerated the surgical procedure well. He began intensive for lower Course: extremity ROM and strengthening and training with a walker. He received occu- pational therapy instruction in ADLs, especially and personal care. He was able to transfer himself out of bed by the third post-op day and was able to ambulate 150 ft with a walker and dress himself on the fifth post-op day. Discharge Plans: Patient was discharged home with his wife one week post-op. He will continue rehabilitation as an outpatient. Return to office for post-op checkup in one week.

Term Definition

1. ______

2. ______

3. ______

4. ______

5. ______

6. ______

7. ______

8. ______

9. ______

10. ______

128

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Chart Note Transcription The chart note below contains 11 phrases that can be reworded with a medical term that you learned in this chapter. Each phrase is identified with an underline. Determine the medical term and write your answers in the space provided.

Pearson General Hospital Emergency Room Record

Task Edit View Time Options Help Download Archive Date: 17 May 2015

Current Complaint: An 82-year-old female was transported to the Emergency Room via ambulance with severe left hip pain following a fall on the ice. Past History: Patient suffered a broken wrist bone 1 2 years earlier that required immobilization by solid material. 2 Following this broken bone, 3 her physician who specializes in treat- ment of bone conditions 4 diagnosed her with moderate porous bones 5 on the basis of a computer-assisted X-ray. 6 Signs and Symptoms: Patient reported severe left hip pain, rating it as 8 on a scale of 1 to 10. She held her hip in a bent position 7 and could not tolerate movement toward a straight position. 8 X-rays of the left hip and leg were taken. Diagnosis: Shattered broken bone 9 in the neck of the left thigh bone. 10 Treatment: Implantation of an artificial hip joint 11 on the left.

1. ______

2. ______

3. ______

4. ______

5. ______

6. ______

7. ______

8. ______

9. ______

10. ______

11. ______

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Case Study Below is a case study presentation of a patient with a condition covered by this chapter. Read the case study and answer the questions below. Some questions will ask for information not included within this chapter. Use your text, a medical dictionary, or any other reference material you choose to answer these questions.

Mary Pearl, age 60, has come into the physician’s office complaining of swelling, stiffness, and arthralgia, especially in her , , and . A bone scan revealed acute inflammation in multiple joints with damaged articular cartilage and an erythrocyte sedimentation rate blood test indicated a significant level of acute inflammation in the body. A diagnosis of acute episode of rheumatoid arthritis was made. The physician ordered nonsteroidal anti-inflammatory medication and physi- cal therapy. The therapist initiated a treatment program of hydrotherapy and AROM exercises.

(Monkey Business Images/Shutterstock)

Questions

1. What pathological condition does this patient have? Look this condition up in a reference source and include a short description of it.

______

2. What type of long-term damage may occur in a patient with rheumatoid arthritis?

______

3. Describe the other major type of arthritis mentioned in your textbook.

______

4. What two diagnostic procedures did the physician order? Describe them in your own words. What were the results? (One of these procedures is described in Chapter 6 of your text.)

______

5. What treatments were ordered? Explain what the physical therapy procedures involve (refer to Chapter 14).

______

6. This patient is experiencing an acute episode. Explain what this phrase means and contrast it with chronic.

______

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Practice Exercises

A. Word Building Practice

The combining form oste/o refers to bone. Use it to write a term that means:

1. bone cell ______

2. immature bone cell ______

3. porous bone ______

4. disease of the bone ______

5. cutting into a bone ______

6. instrument to cut bone ______

7. inflammation of the bone and bone marrow ______

8. abnormal softening of bone ______

9. bone and ______

The combining form my/o refers to muscle. Use it to write a term that means:

10. muscle disease ______

11. surgical repair of muscle ______

12. suture of muscle ______

13. record of muscle electricity ______

14. muscle weakness ______

The combining form ten/o refers to tendons. Use it to write a term that means:

15. tendon pain ______

16. tendon suture ______

The combining form arthr/o refers to the joints. Use it to write a term that means:

17. to fuse a joint ______

18. surgical repair of a joint ______

19. cutting into a joint ______

20. inflammation of a joint ______

21. puncture to withdraw fluid from a joint ______

22. pain in the joints ______

The combining form chondr/o refers to cartilage. Use it to write a term that means:

23. surgical removal of cartilage ______

24. cartilage tumor ______

25. abnormal softening of cartilage ______

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B. Name That Suffix

Suffix Example from Chapter

1. to fuse ______

2. weakness ______

3. slipping ______

4. to surgically break ______

5. movement ______

6. porous ______

C. Spinal Column Practice

Name the five regions of the spinal column and indicate the number of bones in each area.

Name Number of Bones 1. ______

2. ______

3. ______

4. ______

5. ______

D. Prefix and Suffix Practice Circle the prefix and/or suffix. Place a P for prefix or an S for suffix over these word parts, then define the term.

1. arthroscopy______

2. intervertebral______

3. chondromalacia______

4. diskectomy______

5. intracranial______

6. spondylosis______

E. Define the Combining Form

Definition Example from Chapter

1. lamin/o ______

2. ankyl/o ______

3. chondr/o ______

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Definition Example from Chapter

4. spondyl/o ______

5. my/o ______

6. orth/o ______

7. kyph/o ______

8. tend/o ______

9. myel/o ______

10. articul/o ______

F. Fill in the Blank carpal tunnel syndrome rickets lateral epicondylitis systemic lupus scoliosis osteogenic sarcoma pseudohypertrophic erythematosus herniated nucleus osteoporosis muscular dystrophy pulposus spondylolisthesis

1. Mrs. Lewis, age 84, broke her hip. Her physician will be running tests for what potential ailment? ______

2. Jamie, age six months, is being given orange juice and vitamin supplements to avoid what condition? ______

3. George has severe elbow pain after playing tennis four days in a row. He may have ______.

4. Marshall’s doctor told him that he had a ruptured disk. The medical term for this is ______.

5. Mr. Jefferson’s physician has discovered a tumor at the end of his femur. He has been admitted to the hospital for a biopsy to rule out what type of bone cancer? ______

6. The school nurse has asked Janelle to bend over so that she may examine her back to see if she is developing a lateral curve. What is the nurse looking for? ______

7. Gerald has experienced a gradual loss of muscle strength over the past five years even though his muscles look large and healthy. The doctors believe he has an inherited muscle disease. What is that disease? ______

8. Roberta has suddenly developed arthritis in her hands and knees. Rheumatoid arthritis had been ruled out, but what other autoimmune disease might Roberta have? ______

9. Mark’s X-ray demonstrated forward sliding of a lumbar vertebra; the radiologist diagnosed ______.

10. The orthopedist determined that Marcia’s repetitive wrist movements at work caused her to develop ______

G. Name That Anatomical Name

1. knee cap ______

2. ankle bones ______

3. collar bone ______

4. thigh bone ______

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5. toe bones ______

6. wrist bones ______

7. shin bone ______

8. shoulder blade ______

9. finger bones ______

H. What Does it Stand For?

1. DJD______

2. EMG______

3. C1______

4. T6______

5. IM______

6. DTR______

7. JRA______

8. LLE______

9. ortho______

10. CTS______

I. Define the Term

1. chondroplasty______

2. bradykinesia______

3. osteoporosis______

4. lordosis______

5. atrophy______

6. myeloma______

7. prosthesis______

8. craniotomy______

9. arthrocentesis______

10. bursitis______

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J. Pharmacology Challenge

Fill in the classification for each drug description, then match the brand name.

Drug Description Classification Brand Name

1. ______Treats mild pain and is an anti-inflammatory ______a. Flexeril

2. ______Hormone with anti-inflammatory properties ______b. Aleve

3. ______Reduces muscle spasms ______c. Fosamax

4. ______Treats conditions of weakened bones ______d. Oystercal

5. ______Maintains blood calcium levels ______e. Medrol

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M04_FREM0254_06_SE_C04.indd 135 18/12/14 10:13 pm 136 Chapter 4

Labeling

Image A

Write the labels for this figure on the numbered lines provided.

1. ______17. ______

18. ______2. ______

19. ______3. ______20. ______4. ______

5. ______21. ______

6. ______22. ______

7. ______23. ______

8. ______24. ______

9. ______25. ______

10. ______26. ______

27. ______11. ______

12. ______

13. ______

14. ______

15. ______

16. ______

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Image B

Write the labels for this figure on the numbered lines provided. 4. ______

1. ______5. ______

6. ______

7. ______

2. ______8. ______

3. ______

Image C

Write the labels for this figure on the numbered lines provided. 1. ______

2. ______

3. ______

4. ______

5. ______

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