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Chapter 3 CASE STUDY Khalil Larkins, an 18-year-old senior at Wolfridge High School, was running the 100-meter dash for his qualifying time. As he left his starting block, he heard a “pop” and instantly felt a sharp pain in the upper back part of his left leg. He struggled as he limped off the track. His teammates helped him to the treatment area, where his trainer could assess him. After a quick evaluation, the trainer placed ice on Khalil’s left hamstring, the muscle in the posterior upper leg. Khalil was instructed to stay off his left leg and was given a pair of crutches to use until he could be examined by a physician. The next morning, Khalil’s pain had not subsided, and now there was swelling, bruising, and tenderness at the injury site. Khalil continued Chapter Objectives to use his crutches to move around, and when it was convenient, he iced the back part of his Upon completion of this chapter, you should be able to upper left leg. The following day, Khalil saw 1. identify and defi ne medical terms associated Dr. Schumacher for his initial assessment. with the major structures and functions of the Dr. Schumacher was an orthopedist (OR-thoh- muscular system; PEE-dist), or a medical specialist who treats 2. recognize, defi ne, spell, and pronounce terms conditions and injuries of the musculoskeletal related to the pathology, diagnosis, and (MUS-kyoo-loh-SKEL-uh-tuhl) system, which is treatment of muscular system diseases and made up of the muscular and skeletal structures conditions; and and tissues of the body. 3. identify medical careers associated with the Dr. Schumacher determined that Khalil had a read through this chapter, you will learn medical terms diagnosis and treatment of muscular system strained, or pulled, hamstring in his left leg. that will help you understand the basic structures and diseases and conditions. functions of the muscular system, as well as common YOUR TURN diseases and conditions, diagnostic tests and procedures, What kinds of treatments do you think Dr. Schumacher and surgical and therapeutic treatments. You will refer recommended for Khalil’s hamstring strain? What back to this case study when you interpret Khalil’s facts in the case study led you to this answer? As you medical record in the Chapter Review.

While studying, look for the activity icon to E-flash conditions, diagnostic and surgical procedures, • Practice identifying medical word Cards Medical Word Parts and therapeutic treatment methods. parts and abbreviations with The muscular system is made up of many unique e-flash cards. structures and parts, all of which have specifi c names Combining Form • Review anatomical concepts with interactive art in the healthcare and medical fi elds. Mastery of the (Root Word plus labeling. combining forms, prefi xes, and suffi xes listed in the Combining Vowel) Meaning • Assess your understanding of medical vocabulary with tables that follow will help you understand medical articul/o e-flash cards and vocabulary games. terms pertaining to the muscular system. • Listen to pronunciations of medical terms and spell card/o, cardi/o them in audio activities. duct/o to lead; to carry • Expand your knowledge and skills with animated Combining Forms electr/o electricity videos. The combining forms that follow are common fasci/o fi brous band; in medical terms used to describe muscular system (Continued)

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Combining Form Meaning Prefi x Meaning Suffi x Meaning Types fi br/o fi ber in- in; into; not -tomy process of cutting; incision Muscle is a type of body tissue made up of fl ex/o to bend par-, para- near; beside; alongside; -tonia tone; tension bundles of fi bers (long, slender cells) that are held kines/o, kinesi/o movement beyond; abnormal -trophy condition of growth or together by connective tissue. When stim- lei/o smooth quadri- four development ulate muscle fi bers, the bersfi contract (become shorter and thicker), causing body movement. muscul/o muscle tachy- fast Muscles that are stimulated to move through my/o, myos/o muscle tri- three Ponder This conscious control are called voluntary muscles. myocardi/o heart muscle The phrase “conscious control” does not mean neur/o Suffi xes Trapezius, deltoid, gluteus maximus, sartorius... that your brain has to think about, or plan, every it’s all Greek and Latin. Why do you think so muscular action before it is performed. Rather, orth/o straight; normal The suffi xes that follow are common in medi- many structures in the body get their names from ped/o child; foot cal terms used to describe health conditions, long, sometimes difficult-to-pronounce words that voluntary muscular activity is action that you can control through the force of your will (for example, plant/o sole of the foot diagnostic tests and procedures, and therapeutic originated in ancient cultures? Why would modern- treatments related to the muscular system. You era science and medicine benefit from the continued swallowing). Much voluntary muscular activity radi/o X-rays will encounter many of the same suffi xes in your use of terms that come from Greek and Latin? happens when you are giving little, if any, thought rhabd/o rod-shaped study of other body systems. to the actions that are performed by your body. By sarc/o fl esh; connective tissue contrast, muscles that are not stimulated to move Suffi x Meaning son/o sound and Physiology through conscious control are called involuntary -ac, -al, -ar, -ic pertaining to muscles. You cannot force yourself to move these tax/o coordination; order What is your favorite sport or activity? Do you -algia pain muscles through willpower (for example, the ten/o, tendin/o, enjoy volleyball, football, swimming, cycling, or heart beating). tendon/o -asthenia weakness dancing? Without muscles, none of these activi- Voluntary and involuntary muscles in the body -cele hernia; swelling; ties—or other forms of movement—would be tens/o stretched; strained come in three types: , smooth mus- protrusion possible. ton/o tone; tension cle, and . -ceps heads (attachments) The muscular system is composed of different vers/o turn; turning Skeletal muscle, also called striated (strigh-AY- -dynia pain kinds of tissue that work together to perform sev- ted) muscle, is voluntary muscle that is attached to -ectomy surgical removal; excision eral essential functions. These essential functions Prefi xes include and can be contracted or relaxed through con- -esthesia sensation scious control. Striated muscle has a distinctively The prefi xes that follow are not specifi c to mus- • holding body parts in position and making -gram record; image striped appearance and is composed of muscle cular system terminology. These universal pre- movement possible; fi bers. Skeletal muscle fi bers are long, slender cells fi xes are used in many other medical terms, as you -graphy process of recording • providing a protective covering for the internal grouped and held together with connective tissue will see in your study of medical terminology and -ia condition organs; and covered with fascia (FASH-ee-uh), a band or other body systems. -ion process; state; condition • producing, through movement, nearly 85 per- sheet of fi brous tissue that encloses a muscle or Prefi x Meaning -itis infl ammation cent of the heat that keeps the body warm; group of muscles. Skeletal muscle is found in the a-, an- not; without -logy study of • moving food through the digestive system; scalp, face, mouth, (throat), (voice ab- away; away from -lysis breakdown; separation; • aiding blood fl ow through the as blood box), neck, chest, , arms and hands, , back, and legs and feet. ad- toward loosening returns to the heart; and , also called visceral (VIS-uh-ruhl) bi- two; both -malacia softening • assisting with the movement of fl uids through muscle, is a type of involuntary muscle, meaning it -oma tumor; mass the ducts and vessels of other body systems. brady- slow is not controlled by conscious thought processes. circum- around -paresis weakness Figure 3.1 illustrates some of the major muscles Smooth muscle surrounds internal organs and is in the body. As you view the fi gure, consider what dorsi- back -penia defi ciency found throughout your , , muscles of the body perform what functions. dys- painful; diffi cult -plasty surgical repair intestines, and urinary tract. Smooth muscle con- tracts and relaxes to move contents through body e-, ex- out; away from -plegia Fascinating Fact system passageways. This involuntary move- -plegic pertaining to paralysis hemi- half On average, muscles make up 40 to 45 percent ment, known as peristalsis (PEER-ih-STAHL-sis), hyper- above; above normal; -rrhexis rupture of your body weight. Your body has more than enables blood to travel through and veins, 630 muscles that help you perform different kinds excessive -scope instrument used to view food to move through the stomach and intestines, of movement. hypo- below; below normal; -scopy visual examination using and a fetus to be expelled through the birth canal. defi cient a scope (Continued) (Continued)

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• elasticity (EE-las-TIS-ih-tee)—the ability of Origin point Frontalis skeletal muscle fi bers to resume their resting Coracoid Origin point process length when a stretching force is removed; for Supraglenoid tuberosity Trapezius example, when a spring is stretched and then released, it returns to its original position. Deltoid Biceps • excitability (also called irritability)—the ability muscle of a skeletal muscle to receive and respond to Pectoralis major a nerve impulse by contracting. For example, nerves send a message to the heart muscle, Triceps brachii and the heart pumps blood through the vessels throughout the body. Insertion point Biceps brachii • extensibility (eks-TENS-ih-BIL-ih-tee)—the abil- Tubercle of ity of the skeletal muscles to be stretched. Extensi- Latissimus dorsi bility is evident in the hamstrings and calf muscles during a toe touch, for example. Abdominal muscles The ratio of muscle to total body weight is often expressed as a percentage. Percentages can Biceps also be expressed as fractions. (For example, Gluteus muscle medius ¼ is 25 percent.) To calculate a percentage, fi rst set up a fraction. Then divide the Gluteus maximus numerator (top number) by the denominator (bottom number). Figure 3.2 The insertion is the attachment site that Sartorius Directions: To practice calculating moves during muscular contraction. The origin is the percentages, do the word problems that follow. muscular attachment site that does not move. Biceps femoris Round your answers to the nearest whole number. connects muscle to bone (Figure 3.3). The Achilles Rectus femoris 1. Blake weighs 140 pounds, 60 pounds of tendon, for example, attaches the gastrocnemius which are muscle. What percentage of (GAS-trok-NEE-mee-us) muscle on the calf of the Gastrocnemius Blake’s body weight is muscle? leg to the calcaneus (kal-KAY-nee-us), or heel bone. 2. What is the percentage of muscle weight are different from ligaments. As you Achilles tendon for an 80-pound female with 35 pounds of learned in Chapter 2: The Skeletal System, a muscle? ligament is a fi brous cord of tissue that attaches

Label bone to bone. Ligaments usually impart stability A. Anterior view B. Posterior view art Muscle Origin and Insertion by holding structures together (Figure 3.3). Figure 3.1 Anterior and posterior views of the major muscles in the body. Skeletal muscle plays a vital role in directional Skeletal Muscle Organization Cardiac muscle, also called myocardial (MIGH- movements of the . The connecting parts Muscle Tissue Properties The basic structure of muscles includes sev- oh-KAR-dee-uhl) muscle, is found only in the of each muscle are specifi c to that muscle and the heart. Like smooth muscle, cardiac muscle is Muscle tissue has many unique properties. It is bone to which the muscle is connected. Skeletal eral connective tissue layers (Figure 3.4). The unconsciously controlled. As cardiac muscle the only tissue in the body that has the following muscle is attached to bone at both ends of the inner layer, or endomysium (EN-doh-MIZ-ee- involuntarily contracts, it pumps blood from the physiological characteristics: muscle. um), is a fi ne sheath of areolar connective tissue around each muscle fi ber. Areolar tissue consists of heart into blood vessels. • automaticity (AW-toh-muh-TIH-sih-tee)—the Typically, during contraction, one end of a mus- loosely woven fi bers and many blood vessels. The ability of a muscle to contract without the involve- cle remains fi xed in its position, and the other end Fascinating Fact of the muscle moves. The origin of a muscle is the perimysium (PEER-ih-MIZ-ee-um) is a sheath ment of a nerve supply. Automaticity is a prop- You probably have heard the saying, “It takes more attachment site that does not move when the muscle of connective tissue that surrounds bundles of erty of visceral, smooth, and cardiac muscles. muscles to frown than it does to smile.” Did you contracts; the insertion is the attachment site that muscle fi bers called fascicles (FAS-ih-kuhlz). The know that you have more than 30 facial muscles • contractility (KAHN-trak-TIL-ih-tee)—the abil- moves during muscular contraction. Figure 3.2 outer layer, or epimysium (EP-ih-MIZ-ee-um), is that produce a range of subtly different expressions ity of a skeletal muscle to contract (shorten); for including happiness, sadness, surprise, anger, fear, illustrates examples of origin and insertion points a dense, fi brous connective tissue that surrounds disgust, and astonishment? example, the biceps muscle contracts when the in the shoulder and forearm. the entire muscle. All of these structures are sur- arm is fl exed. Most skeletal muscle is attached to bone by rounded by fascia (FASH-ee-uh), fi brous con- tendons. A tendon is a band of fi brous tissue that nective tissue that binds muscles into functional

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groups and envelops other structures in the body, such as , nerves, and blood vessels. Nerve impulses are vital to the directional The muscular system has its own blood and nerve Ligament motion of the body. When nerve impulses are supply. Muscles have arteries, veins, and capillaries impaired, a condition called paralysis (puh- Bone due to their remarkable energy needs and the meta- RAL-uh-sis) can occur. Paralysis prevents bolic waste they generate as a product of contraction. muscular movement. The term neuromuscular Joint capsule (NEW-roh-MUS-kyoo-ler) is used to describe Fascinating Fact or defi ne the relationship between nerves and muscles in the body. Skeletal The eye muscles are the most active muscles in muscle the body. Scientists estimate that these muscles Directions: On a separate sheet of paper, may move more than 100,000 times a day. dissect the word neuromuscular into its individual word parts. Identify each word part (combining form, prefi x, or suffi x). Then defi ne Directional Motion each word part and the term as a whole. Tendon Three factors make the muscular system capa- ble of moving the body: muscle type, muscle Many types of muscular movement have a excitability (stimulation of a muscle by a nerve directional opposite; therefore, the directional impulse), and opposition between agonist (AG- motions produced by agonist and antagonist mus- uh-nist) and antagonist (an-TAG-uh-nist) muscle cles are typically categorized in pairs, as described pairs (Figure 3.5). in the table that follows, with a couple of excep- Agonist and antagonist muscle pairs work in tions. These movements are described from the Figure 3.3 Tendons connect muscle to bone, and ligaments connect bone to bone. opposition to create body movement. In these perspective of anatomical position. pairs, the agonist is the muscle that causes the pri- mary movement. The antagonist is the muscle that works against this movement. For example, when Directional Movements you fl ex your arm, your biceps muscle functions as the agonist. When you straighten your arm, the abduction Movement of a body Muscle fiber biceps muscle becomes the antagonist while the ab-DUK-shun part away from the triceps muscle functions as the agonist to achieve ab- = away from midline of the body. primary muscular movement. For this reason, duct/o = to lead -ion = process; state; agonist muscles are referred to as “prime movers.” condition Fascicle (wrapped by perimysium) adduction Movement of a body Tension uh-DUK-shun part toward the in biceps ad- = toward midline of the body. Blood vessel (agonist) duct/o = to lead -ion = process; state; condition Endomysium (covers fibers) Triceps relaxed inversion The turning inward of (antagonist) in-VER-zhun the sole of the foot. Perimysium (covers fascicle) in- = in; into vers/o = turn; turning Bone -ion = process; state; Epimysium condition (wraps entire muscle) eversion The turning outward ee-VER-zhun of the sole of the foot. Tendon Fascia e- = out; away from vers/o = turn; turning Animation -ion = process; state; condition Label Figure 3.5 Agonist and antagonist muscular pairs art work in opposition. (Continued) Figure 3.4 The organization of skeletal muscle.

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Directional Movements Directional Movements Major Muscles and Their table, along with brief descriptions of their main functions. elevation Raising of a body part. rotation Movement of a body Functions part around its The is made up of many muscles, Fascinating Fact depression Lowering of a body longitudinal axis— all with specifi c functions and names. People in The term hamstring derives its name from part. that is, lengthwise. the fi elds of healthcare and medicine need to be eighteenth-century English butchers, who used (Imagine doing “the string to hang slaughtered pigs (ham) by the fl exion The movement of two familiar with the major muscles of the body. The Twist” with your foot.) muscles in the back of the knees. FLEK-shun body surfaces toward major muscles of the body are listed in the following fl ex/o = to bend each other, as in the act medial (internal) Movement medially, -ion = process; state; of bending. rotation or toward the midline condition of the body. (Imagine extension The straightening of a rotating one foot Muscle Location Primary Functions eks-TEN-shun limb after it has been inward, toward the frontalis forehead Raises eyebrows; wrinkles forehead. ex- = out; away from fl exed. other foot.) frun-TAY-lis tens/o = stretched; strained lateral (external) Movement laterally, trapezius upper back and neck Extends neck; elevates, adducts, and -ion = process; state; rotation or away from the truh-PEE-zee-us rotates scapula. condition midline. (Imagine rotating one foot deltoid external shoulder Abducts, fl exes, extends, and rotates hyperextension The act of bending a outward, away from DEL-toyd arm. HIGH-per-eks-TEN-shun joint or limb beyond the other.) hyper- = above normal normal extension or pectoralis major chest Flexes, adducts, and rotates arm. tens/o = stretched; range of motion. pronation Rotational motion of pek-tuh-RAY-lis MAY-jer strained proh-NAY-shun the forearm in which -ion = process; state; the palm moves to face triceps brachii posterior upper arm Extends forearm. condition downward. TRIGH-seps BRAY-kee-igh dorsifl exion Movement of the sole supination Rotational motion of biceps brachii anterior upper arm Flexes arm and forearm; supinates DOR-sih-FLEK-shun of the foot upward SUP-ih-NAY-shun the forearm in which BIGH-seps BRAY-kee-igh (rotates) hand. (fl exed toward the dorsi- = back the palm moves to face fl ex/o = to bend lower leg). latissimus dorsi midback and lower spine Extends, adducts, and rotates arm. upward. -ion = process; state; luh-TIS-ih-mus DOR-sigh condition circumduction Rotation of an arm or abdominal muscles to pubic bone Flex and rotate trunk. plantar fl exion Motion of the plantar SER-kum-DUK-shun leg (as if “drawing a PLAN-ter FLEK-shun surface (sole of the circum- = around circle” with the limb). gluteus medius medial muscle of buttocks; Adducts and rotates thigh. duct/o = to lead plant/o = sole of the foot) away from the This type of motion GLOO-tee-us MEE-dee-us outer surface of -ion = process; state; foot midline of the body. occurs in multiple condition -ar = pertaining to planes. gluteus maximus outer muscle of buttocks Extends and rotates thigh. fl ex/o = to bend GLOO-tee-us MAK-sih-mus -ion = process; state; condition sartorius anterior thigh (crosses thigh Flexes and rotates thigh; fl exes leg. sar-TOR-ee-us obliquely) (Continued) biceps femoris (hamstring) posterior thigh Extends thigh; fl exes and rotates leg. BIGH-seps FEM-uh-ris rectus femoris (quadricep) anterior thigh Flexes thigh; extends leg. REK-tus FEM-uh-ris gastrocnemius prominent muscle in posterior Flexes foot and leg. GAS-trok-NEE-mee-us calf tibialis anterior anterior lower leg Dorsifl exes and inverts foot. TIH-bee-AL-is an-TEER-ee-er

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Diseases and Conditions How is the flexibility in your upper and lower a flat surface, place the palms of your hands Perhaps you or someone you know has experienced carpal tunnel extremities? In the passive range-of-motion (ROM) in the palms of your classmate’s hands. Next, syndrome, uses a wheelchair due to paralysis, or has been diagnosed exercises that follow, you and a classmate will take curl your fingers around your classmate’s turns being the patient and the physical therapist. fingers; then straighten your fingers. with a chronic disease such as muscular dystrophy. In this section, you will learn about common characteristics of diseases and conditions that Record your answers to the following questions as h. Thumb and Finger Touches—As your affect the muscular system. you work through each exercise. partner supports your elbow on a flat surface, 1. In which passive ROM exercises did you touch the tip of each of your fingers with the tip Disease/Condition Defi nition demonstrate more joint flexibility? of your thumb. adhesion Normally, the formation of a fi brous 2. Which exercises do you think might help you i. Finger Spreads—As your partner supports band of tissue that holds two parts or to strengthen certain and muscles? your elbow on a flat surface, spread each of ad-HEE-zhun surfaces together, as in the healing of Directions: your fingers away from the midline of your hand. a wound. In a disease condition, the a. “Snow Angel Arms”—In a sitting position, formation of a fi brous band of tissue j. “Snow Angel Legs”—Lie in a supine (flat keep your left arm straight at your side; that holds two surfaces together due to on your back) position. As your classmate then move the arm straight out while your infl ammation or trauma (Figure 3.6). classmate supports your left elbow and wrist. provides support beneath your left knee and Repeat these steps with your right arm as your ankle, move your left leg straight out to your ataxia Inability to coordinate voluntary side; then move it back to its “starting” position. partner supports your right elbow and wrist. uh-TAKS-see-uh muscle activity; characterized by shaky, Repeat the exercise with your right leg. b. “Brush Your Hair”—As your classmate a- = without unsteady movements. supports your elbow and wrist, bend your left l. “Bicycle”—Lie in a supine position. With tax/o = coordination or right arm at the elbow and bring your arm one leg straight and your classmate providing -ia = condition over your head. support beneath the knee and ankle of your atrophy Wasting away or shrinkage of muscle c. “Let’s Go Bowling”—Begin with your arm other leg, bend the supported leg at your size. straight at your side; then move the arm knee. Then straighten your leg and lower it to AT-troh-fee slightly behind your back while your partner its original position. a- = without supports your elbow and wrist. l. “The Twist”—Lie in a supine position on a -trophy = condition of growth or development d. “Open the Door”—As your classmate mat. With one leg straight and your partner supports your elbow, place one hand in the providing support beneath the knee and ankle palm of his or her other hand and rotate your of your other leg, rotate your entire supported forearm upward. Then rotate it downward, as if leg inward; then rotate it outward. turning a doorknob. m. Ankle Circles—With your leg on a mat, and e. “Come Here”—Begin with your elbow your classmate providing support above and supported on a desk, a table, or the arm of below your ankle, rotate your foot in a circle to a chair. As your classmate provides support the right; then rotate it in a circle to the left. above and below your wrist, flex your palm NOTE: For the exercises that follow, you and your toward the ventral (interior) side of your classmate should wear gloves. forearm. Then extend the back of your hand n. Toe Curls—Lie with your legs straight on a toward the top of your forearm. mat. With your classmate providing support at f. “Wave Goodbye”—Begin with your elbow your ankle, she or he curls your toes inward supported on a flat surface. As your classmate and then straightens them. provides support above and below your wrist, o. Toe Spreads—As you lie with your leg on a turn your hand toward your thumb; then turn mat, your partner moves each of your toes your hand toward your pinky finger. away from your middle toe and then back g. Finger Curls—With your elbow supported on toward your middle toe.

Figure 3.6 Abdominal adhesion. Endoscopic view of a patient’s abdomen with adhesions between the omentum (bottom left) and the abdominal wall (top). The omentum is a membranous sac that hangs down from the stomach, covering the intestines. Adhesions are growths of fi brous (scar) connective tissue formed as a response to tissue trauma. They often result from abdominal surgery. If the adhesions cause severe pain or obstruct part of the bowel, they are removed surgically.

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Normal heart Hypertrophic cardiomyopathy Disease/Condition Defi nition carpal tunnel syndrome Disorder marked by pain, burning, and (CTS) itching or tingling due to an infl amed median nerve and tendons in the wrist; commonly associated with repetitive activity and/or overuse injury. contracture Permanent tightening of skin, muscles, kun-TRAK-cher tendons, ligaments, and fascia (a band or sheet of fi brous tissue that encloses muscle tissue); most commonly due to lack of use or immobilization. Duchenne muscular Progressive disease that weakens the dystrophy (DMD) muscles of the shoulder and pelvic doo-SHEN MUS-kyoo-ler girdle. DMD is a sex-linked recessive Enlargement DIS-truh-fee trait that affects mostly males. of the heart muscle dystaxia Partial ataxia; a mild form of ataxia (lack dis-TAK-see-uh of muscular coordination that produces dys- = painful; diffi cult shaky, unsteady movements). tax/o = coordination Right Left -ia = condition ventricle ventricle Figure 3.7 At left, a normal heart; at right, a heart affected by muscular hypertrophy. fasciitis Infl ammation of a fascia (a band or sheet FAS-ee-IGH-tis or FASH-ee- of fi brous tissue that encloses a muscle IGH-TIS or group of muscles). Disease/Condition Defi nition fasci/o = fi brous band; fascia hypotonia Loss of muscle tone. -itis = infl ammation HIGH-poh-TOH-nee-uh hypo- = below normal; fl accidity Condition or state in which muscles defi cient Acromion fl uh-SIH-dih-tee are fl abby, relaxed, or have defective or -tonia = tone; tension absent tone. Tone is the normal tension Swollen present in muscles in a resting state. impingement syndrome Condition that occurs when tendons bursa im-PINJ-ment of the shoulder become impinged, hemiparesis Weakness or slight paralysis on one side or compressed, by the bones of the Inflamed tendon HEM-ee-puh-REE-sis of the body. shoulder (Figure 3.8). hemi- = half -paresis = weakness muscular dystrophy (MD) Genetic disease characterized by MUS-kyoo-ler DIS-truh-fee progressive muscular weakness and hemiplegia Total paralysis on one side of the body. dys- = painful; diffi cult skeletal muscle deterioration (Figure 3.9). HEM-ee-PLEE-jee-uh -trophy = condition of hemi- = half growth or development -plegia = paralysis myalgia or myodynia Muscle pain. hypertrophy Excessive growth or abnormal migh-AL-jee-uh or MIGH-oh- DIN-ee-uh high-PER-truh-fee enlargement of a muscle (Figure 3.7 on Figure 3.8 When the bones my/o = muscle hyper- = above normal; the next page). of the shoulder compress the -algia / -dynia = pain excessive shoulder tendon, the result is -trophy = condition of impingement syndrome. growth or development myasthenia gravis Chronic autoimmune disease MIGH-uhs-THEE-nee-uh characterized by voluntary muscle GRAV-is weakness that worsens after activity and my/o = muscle improves after rest. -asthenia = weakness

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Disease/Condition Defi nition myoma (continued) leiomyosarcoma Malignant tumor of smooth muscle. LIGH-oh-MIGH-oh-sar- KOH-muh lei/o = smooth my/o = muscle sarc/o = fl esh -oma = tumor; mass rhabdomyoma Benign tumor consisting of striated RAB-doh-migh-OH-muh muscle that occurs on or in the smooth rhabd/o = rod-shaped muscle of the heart (Figure 3.10). my/o = muscle -oma = tumor; mass rhabdomyosarcoma Malignant tumor of skeletal muscle. (RMS) RAB-doh-MIGH-oh-sar- KOH-muh rhabd/o = rod-shaped my/o = muscle sarc/o = fl esh -oma = tumor; mass myomalacia Abnormal softening of muscle tissue. Rhabdomyoma Figure 3.9 Muscular dystrophy is a genetic disease marked by deterioration of MIGH-oh-muh-LAY-shee-uh skeletal muscle and progressive muscular weakness. Figure 3.10 A rhabdomyoma my/o = muscle is a benign tumor consisting -malacia = softening of striated muscle in or on the Disease/Condition Defi nition heart. myoparesis Weakness or mild muscular paralysis. myocele Herniation or protrusion of muscle MIGH-oh-puh-REE-sis MIGH-oh-seel through a tear in the fascia. my/o = muscle my/o = muscle -paresis = weakness -cele = hernia; swelling; protrusion myorrhexis Rupture or tearing of a muscle. MIGH-oh-REK-sis myolysis Degeneration or deterioration of muscle my/o = muscle migh-AH-lih-sis tissue. -rrhexis = rupture my/o = muscle -lysis = breakdown myositis Infl ammation of a muscle. MIGH-oh-SIGH-tis myoma Tumor of the muscle. myos/o = muscle migh-OH-muh -itis = infl ammation my/o = muscle -oma = tumor; mass paraplegia Paralysis of both legs and, often, the PAIR-uh-PLEE-jee-uh lower trunk. leiomyoma Benign tumor of smooth muscle, such para- = beside; alongside LIGH-oh-migh-OH-muh as that found in the heart, bladder, or -plegia = paralysis lei/o = smooth . my/o = muscle paresthesia Abnormal sensation that typically is -oma = tumor; mass PAIR-es-THEE-zee-uh not painful, such as tingling, numbness, par- = abnormal itching, prickling, or burning. An -esthesia = sensation example of a common form of temporary paresthesia is when your foot “falls asleep,” causing a “pins and needles” sensation after you have sat on it too long.

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Disease/Condition Defi nition Disease/Condition Defi nition plantar fasciitis Infl ammation of the plantar fascia (the tremor An involuntary, repetitive shaking PLAN-ter FAS-ee-IGH-tis or thick band of tissue in the sole of the or quivering of a part or parts of the FASH-ee-IGH-TIS foot between the heel bone and the toes), body. Causes include illness (such plant/o = sole of the foot resulting in heel pain. as Parkinson’s disease), fever, or -ar = pertaining to hypothermia (dangerously low body fasci/o = fi brous band; temperature). fascia -itis = infl ammation quadriplegia Paralysis of all four extremities. QUAH-drih-PLEE-jee-uh Inquiring Minds quadri- = four A trained individual conducting a postmortem exam can estimate the -plegia = paralysis time of a person’s death by studying a few revealing facts, such as body temperature and the presence (or absence) of body stiffness, rigor or rigidity Muscular stiffness/stiff muscle, as in called rigor mortis. (The term postmortem comes from the Latin words RIG-er or rih-JIH-dih-tee rigor mortis (Latin rigor = “stiffness”; post, which means “after,” and mortem, meaning “death.”) Use of a rectal mortis = “of death”). thermometer is the most accurate method of assessing the temperature of Stiffness that occurs in dead bodies due a corpse. The normal body temperature of a living person is 98.6 degrees to chemical changes in the muscles. Fahrenheit (F), and normal rectal temperature is 99.6 degrees F. In a temperature-controlled environment, the body temperature of a deceased sarcopenia Loss of muscle mass, strength, and person drops an average of 1.5 degrees F per hour. Rigor mortis sets SAR-koh-PEE-nee-uh function as a result of aging. in approximately 2 to 4 hours after death, peaks around 12 to 18 hours sarc/o = fl esh postmortem, and usually fades 24 to 36 hours after death. At this stage, -penia = defi ciency decomposition (decay) begins to occur. Imagine that you are a forensic pathologist, a medical professional who shin splint Painful condition caused by muscle determines cause of death by examining corpses. You establish that the tearing away from the . rectal temperature of a corpse at midnight was 95 degrees F. You also note that rigor mortis was present. Based on these factors, what do you estimate spasm Involuntary sudden movement or to be the time of death? What medical terms would you, as a forensic convulsive muscular contraction. Such a pathologist, need to know to communicate your observations? Summarize movement is described as spastic. your observations and share with a partner using the appropriate medical vocabulary. sprain The stretching or tearing of a ligament, which connects bone to bone. strain The stretching or tearing of a muscle or tendon, the latter of which connects Diagnostic Tests and Procedures muscle to bone; pulled muscle or pulled A diagnostician uses different kinds of tools and methods to aid in tendon. pinpointing the causes of patients’ health problems. Following are some of the most common tests and procedures used to diagnose diseases and tenalgia or tenodynia Pain in the tendon. conditions of the muscular system. tuh-NAL-jee-uh or TEN-oh- DIN-ee-uh Test/Procedure Defi nition ten/o = tendon -algia / -dynia = pain biopsy The removal of a small piece of living tissue for microscopic examination tendinitis or tendonitis Infl ammation of a tendon. (Figure 3.11). TEN-dih-NIGH-tis or TEN- duh-NIGH-tis computerized tomography Process in which radiographic images tendin/o, tendon/o = tendon (CT) of a specifi c section of the body are -itis = infl ammation also called taken from multiple angles. The images are then analyzed using a computer to computed tetany A state of sustained muscular identify muscular injury or disease. CT tomography (CT) or TET-uh-nee contraction. scans provide more detailed imagery computerized axial than standard X-rays. tomography (CAT)

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Biopsy Puncture needle site

To triceps To biceps

To dry-earth strap

Figure 3.11 During a muscle biopsy, a small piece of muscle tissue is removed Figure 3.13 An electromyogram, or EMG, is a graphic recording of the for microscopic examination. contraction of a muscle produced by electrical stimulation.

Test/Procedure Defi nition Test/Procedure Defi nition deep tendon refl exes Evaluation of involuntary muscular radiography Diagnostic imaging technique that uses (DTR) responses with a refl ex hammer RAY-dee-AH-gruh-fee electromagnetic waves to create images (Figure 3.12). Patients under heavy radi/o = X-rays of the inside of the body. X-rays are used sedation or in a deep coma do not -graphy = process of to check for structural abnormality or exhibit these refl exes. recording disease. electromyogram (EMG) A graphic recording of the contraction range-of-motion (ROM) Diagnostic procedure performed to ee-LEK-troh-MIGH-oh-gram of a muscle as a result of electrical testing evaluate the extent to which joints can be electr/o = electricity stimulation (Figure 3.13 on the next moved in a variety of directions. my/o = muscle page). -gram = record; image sonography Diagnostic imaging method involving goniometry The measurement of range of motion in suh-NAH-gruh-fee the use of high-frequency sound waves GOH-nee-AH-muh-tree a joint. son/o = sound to generate images of structures in the Figure 3.12 A neurologist -graphy = process of body, such as muscles, ligaments, and magnetic resonance A noninvasive scanning test that performs a deep tendon refl ex recording displaced or dislocated structures. Also imaging (MRI) involves use of an electromagnetic fi eld (DTR) test on a patient. called diagnostic sonography or, more and radio waves to visualize soft-tissue commonly, ultrasound. structures. nuclear medicine imaging Diagnostic imaging technique in (NMI) which a radioactive substance and a special camera are used to visualize Fascinating Fact structures and functions in the body. The term goniometry comes from the Greek gonia (“angle”) and metron The radioactive substance is injected into (“measure”). More precisely, goniometry is the measurement of the angles produced by joints during range-of-motion activity. or swallowed by the patient.

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Treatment Defi nition Directions: In a group of three or four students, research one of the following topics. Then prepare and present a report to the class. As you work on this project, practice your ability to cooperate, contribute, Rest Most common fi rst-aid treatment for and collaborate with members of your team. Ice muscular injuries; often referred to as 1. Choose one of the individuals below. Using reliable resources for research if necessary, discuss the Compression “RICE.” importance of the individual’s contributions to our understanding of the human muscular system. Elevation • Jacopo Berengario da Carpi (RICE) • Leonardo da Vinci tenotomy Incision to the tendon, usually to repair a • William Harvey teh-NAH-tuh-mee deformity caused by a shortened muscle. • John Moir ten/o = tendon • Juan Valverde de Amusco -tomy = process of cutting; incision • 2. Investigate the pros and cons of a high-protein diet as it relates to safe bodybuilding techniques. 3. Visit the National Institutes of Health website and type the phrase “anabolic steroid abuse” in the search box. What are anabolic steroids? What are their effects on health? Why do people abuse Therapeutic Drug Treatments these drugs? What can be done to prevent steroid abuse? Injuries and conditions of the muscular system often require treat- ment with medications. The following list includes common drugs and their pharmacodynamics (actions in the body). Surgical Procedures and Therapeutics Drug Effect on the Body Once a muscular condition or disease has been diagnosed, a treat- analgesic A drug that relieves pain; includes ment plan can be developed and implemented. For example, when an AN-uhl-JEE-zik nonprescription pain relievers, such as EMG (electromyogram) reveals symptoms of muscle weakness, physical aspirin, and prescription pain relievers, therapy may be the recommended treatment. such as hydrocodone. Following is a list of common surgical and noninvasive treatments for anti-infl ammatory A drug that reduces infl ammation. diseases and conditions of the muscular system. Treatment Defi nition antispasmodic or A drug prescribed to suppress smooth- anticholinergic muscle contractions of the bladder, myoplasty Surgical repair of a muscle through AN-tee-spaz-MAH-dik or stomach, or intestine. MIGH-oh-PLAS-tee plastic surgery. AN-tee-koh-lih-NER-jik my/o = muscle -plasty = surgical repair narcotic A drug that, in moderate doses, physical therapy Treatment to rehabilitate a patient depresses the central , disabled by illness or injury. Common relieves pain, and induces . methods include exercise; hydrotherapy Taken in excess, narcotics produce (water therapy), shown in Figure 3.14; unconsciousness, stupor, coma, and ultrasound; and diathermy (DIGH-uh- possibly death. THER-mee), or deep heating of body nonsteroidal A group of drugs with analgesic, Figure 3.14 Hydrotherapy is tissues using a high-frequency electrical (NON-steer-ROY-duhl) anti-infl ammatory, and antipyretic current. often recommended for patients anti-infl ammatory drugs with arthritis because the (AN-tee-pigh-RET-ik) (fever-reducing) (NSAID) range-of-motion (ROM) Exercises performed to improve or buoyancy of the water means properties. Aspirin, ibuprofen, and therapy maintain joint mobility and fl exibility. less weight-bearing impact on naproxen are common over-the-counter Active ROM exercises are those that can the joints. (OTC) NSAIDs. This group of drugs is be performed on your own. Assisted set apart from other drugs that have ROM exercises require minor assistance the same properties because they are due to mild weakness, pain, or stiffness. nonsteroidal. (Steroidal drugs have Passive ROM exercises are performed narcotic effects and may result in by a physical therapist on a person addiction.) who requires total assistance to do the exercises.

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E-flash Common Medical Abbreviations Cards Careers to Consider The following medical abbreviations are commonly used in refer- ence to the muscular system. These abbreviations provide a shorthand method of communication among healthcare professionals concerning If you pursue any of the following careers, you will interact on a regular basis with patients who have pathological conditions, diagnostic tests, surgical procedures, and thera- conditions or diseases of the muscular system. For more detailed information on the career opportuni- peutic treatments. These abbreviations can be found in this chapter and ties discussed in this section, visit the US Bureau of Labor Statistics website. in the medical record activity that follows. Exercise physiologists develop individualized Abbreviation Meaning Abbreviation Meaning Certifi ed Fitness Trainer exercise plans based on their clients’ needs, and amb ambulate (walk) NMI nuclear medicine A certifi ed fi tness trainer (CFT) serves as a they design exercise programs to help athletes imaging leader and instructor in exercise programs and achieve specifi c goals. CAT computerized NSAID nonsteroidal anti- helps people achieve and maintain a healthful lifestyle. This career path demands a passion for To prepare for a career in this fi eld, candidates axial tomography infl ammatory must have at least a bachelor’s degree in exercise drug being physically active, healthy, and fi t. CFTs must have excellent communication skills and a physiology. With further education and success- CFT certifi ed fi tness OTC over-the-counter talent for encouraging and motivating others. ful completion of the Exercise Physiologist Certi- trainer fi ed (EPC) exam, administered by the American Certifi ed fi tness trainer programs take, on aver- c/o complains of; PCN penicillin Society of Exercise Physiologists (ASEP), a person age, six months to complete. These programs complaining of can obtain board certifi cation. Exercise physiolo- teach a well-rounded curriculum that includes gists are employed in a variety of environments, CPR cardiopulmonary PCP primary care coursework in exercise programs, nutrition, anat- resuscitation physician including healthcare facilities, fi tness centers, col- omy and physiology, and psychology. Admission leges and universities, athletic or military training CT computed PFT personal fi tness to a CFT program generally requires a high school facilities, and rehabilitation centers. tomography; trainer diploma and current certifi cation in fi rst aid and computerized cardiopulmonary resuscitation (CPR). tomography Sports Medicine Physician CTS carpal tunnel PRN, p.r.n. as needed (from the A sports medicine physician treats and pre- syndrome Latin pro re nata) vents sports-related injuries of the bones, joints, DMD Duchenne Pt, pt. patient and muscles. These healthcare professionals are muscular qualifi ed to diagnose and treat patients, pre- dystrophy scribe medication and therapy, and perform sur- gery. They attend an accredited medical school to DTR deep tendon refl ex PT physical therapy obtain a Medical Doctor (MD) degree or a Doctor EMG electromyogram Q2–3H every two or three of Osteopathic Medicine (DO) degree. Both types hours of physicians must complete residency programs h hour(s) Q8H every eight hours and obtain a license to practice. Sports medicine (from the Latin physicians may work exclusively for an athletic quaque octava hora) team, for a university sports program or fi tness Hx, hx history R right center, in a private practice, or with a group of The work environment for CFTs varies widely. physicians. IM intramuscular RICE rest, ice, Certifi ed fi tness trainers are employed in fi tness compression, and health clubs, gyms, hospitals, resorts, country elevation clubs, universities, and yoga and Pilates studios. A L left RMS rhabdomyosarcoma CFT may also choose to work as a personal fi tness MD muscular ROM range of motion trainer (PFT), traveling to people’s homes and dystrophy developing custom-tailored exercise programs to help clients become physically fi t. mg milligram(s) wt weight MRI magnetic y/o years old; year-old Exercise Physiologist resonance imaging (as in 18-year-old) N/A not applicable An exercise physiologist is a healthcare pro- fessional who performs exercise stress tests and evaluates a person’s physical condition, focus- ing on cardiovascular health and metabolism.

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Chapter 3 Review Chapter 3 Review Anatomy and Physiology Example: muscular Dissection: muscul / ar Directions: Provide the correct term(s) for each For each exercise that follows, write your answers on a separate sheet of paper. muscul / o (combining form) = muscle question that follows. -ar (suffix) = pertaining to Identify the Anatomical Structure 1. What type of body tissue is made up of bundles of Definition: pertaining to muscle fibers held together by connective tissue? Directions: Identify the correct anatomical term that corresponds to each letter in the diagram. 1. hypertrophy 2. What are the three types of muscle tissue in the 2. dystaxia body? Give an example of each. A 3. hypotonia 3. What term is used to describe muscles that are controlled consciously? 4. myomalacia B 4. What term is used to describe muscles that 5. leiomyosarcoma cannot be consciously controlled? 6. paresthesia C 5. Which property describes the ability of muscle 7. hyperextension to shorten (for example, the biceps muscle when D 8. adduction flexed)? 9. myocele 6. Which property describes the ability of skeletal 10. eversion E muscle fibers to resume their resting length when a stretching force is removed? 11. circumduction 12. fibromyalgia F 7. Identify the term for the attachment site of a muscle that does not move when the muscle contracts. Matching G 8. What is the name for the attachment site of a muscle that moves during muscular contraction? Directions: Match the combining form (root word and H 9. What is the term for the band of fibrous tissue that combining vowel) to the correct meaning. connects muscle to bone? 1. fibr/o a. heart muscle 10. What is the term for the band of fibrous tissue that 2. rhabd/o b. coordination; order connects bone to bone? 3. lei/o c. muscle 4. muscul/o d. tendon I Word Construction 5. plant/o e. rod-shaped Directions: Using word parts and meanings presented J 6. kinesi/o f. movement in the chapter, build the medical term described in 7. or th/o g. stretched; strained each definition that follows. K 8. articul/o h. straight; normal 1. surgical repair of a muscle 9. sarc/o i. tone; tension L 2. pertaining to muscle 10. tax/o j. smooth 3. process of leading toward M 11. flex /o k. flesh 4. pertaining to the sole of the foot 12. ton/o l. joint 5. the study of movement N 13. tendin/o m. to bend 6. paralysis of half (of the body) O 14. myocardi/o n. fiber 7. without growth or development 15. tens/o o. sole of the foot 8. three heads (a muscle with three heads or attachments) Spelling A. Anterior view B. Posterior view 9. pertaining to paralysis of four (extremities) Directions: Identify the correctly spelled medical term 10. process of leading away from in each numbered item. 11. process of bending 1. fasciitis fasceitis Word Parts 5. -asthenia 11. -plegic 12. inflammation of the tendon fashiitis fascitis 6. kinesi/o 12. quadri- 2. hypertonnia hipertonia Directions: Write the meaning(s) of each word Word Surgery hypertonia hypertoenia part listed. Identify each word part by type (prefix, 7. myocardi/o 13. -ar combining form, or suffix). 8. ad- 14. -tonia Directions: Dissect each medical term into its word 3. myalgea myalgia mialgea mialgia 1. muscul/o 3. ab- 9. -paresis 15. fibr/o parts. Identify the word-part types (prefix, combining form, or suffix), and write the meaning(s) of each word 4. dorsaflexion dorsiflexion 2. tendin/o 4. -malacia 10. my/o part. Then write a definition of the term. dorsaflection dorsiflection

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Chapter 3 Review Chapter 3 Review 5. lieomyoma laiomyoma Interpreting Abbreviations Medical Record Practice leomyoma leiomyoma Directions: Write the correct medical term or phrase Following is a physical therapy report for Khalil, the 18-year-old high school senior who was introduced in 6. dystraphy distrophy for each abbreviation listed. the Case Study. Read Khalil’s medical record. Then, on a separate sheet of paper, write a definition for each dystrophy distraphy 1. mg 9. ROM highlighted term and abbreviation. 7. kinesiology kenesiology kynesiology kinesialogy 2. DTR 10. PRN 3. amb 11. EMG 8. paraplegea periplegia HERMAN ORTHOPEDIC CLINIC peraplegia paraplegia 4. IM 12. h 987 Medical Drive, Hospital City, US 12345 9. fibermyalgia fibromyalgia 5. L 13. R PHONE: (xxx) xxx-4321 FAX: (xxx) xxx-2910 fibromyalgea fibremyalgia 6. wt 14. RICE PHYSICAL THERAPY NOTE 10. myorrhexis myorhexis 7. PCN 15. PT myorrexis myarhexis PT NAME: Khalil Larkins 8. NSAID 16. CT ID NO: 86523497 Pronunciation Search the Source DATE: 03/20/20xx Directions: Pronounce each term below, then write PCP: Dr. Evan Schumacher 1. There are more than 30 different forms of the correct spelling. muscular dystrophy, but Duchenne muscular Subjective Data: Pt. is an 18 y/o male c/o pain, swelling, and tenderness to L hamstring area. 1. FASH-ee-uh dystrophy tops the list. Working with a partner, Past Medical Hx: No prior surgeries. 2. MUS-kyoo-ler visit the National Institutes of Health (NIH) website Social Hx: No alcohol or drug use. and research the facts about DMD. What is it? 3. QUAH-drih-PLEE-jik Current Limitations: Unable to amb and bear wt on L leg. What are the common signs and symptoms? How 4. high-PER-truh-fee does DMD develop? What is its prevalence? Limitation before Injury: N/A 5. TRIGH-seps 2. A sprain and a strain are similar types of injuries Medications: Ibuprofen 800 mg Q8H PRN for pain. 6. DOR-sih-FLEK-shun but involve different body parts. Visit the NIH Allergies: PCN 7. HEM-ih-PLEE-jee-uh website and research the facts about both Current Pain Level: 8 on a 1–10 pain scale. 8. fas-ee-IGH-tis or fash-ee-IGH-TIS types of injuries. What are the similarities and differences? What body parts are affected during Pt Goal: Pain free, return of full ROM and strength. 9. MIGH-uhs-THEE-nee-uh a strain and a sprain? What is the leading cause Objective Data: 10. HEM-ee-puh-REE-sis of each injury? How is each injury treated? Injury Involved: L hamstring strain. 11. MIGH-oh-KAR-dee-um 12. migh-AH-lih-sis Matching Terms of Directional Motion Identifying Abbreviations Directions: Match each directional movement to the Directions: Write the correct abbreviation for each correct definition. a. movement away from the medical term or phrase listed. 1. abduction midline of the body 1. electromyogram 2. adduction b. raising of a body part 2. muscular dystrophy 3. rotation c. straightening of a limb 3. years old; year-old 4. circumduction d. rotational movement in 4. physical therapy 5. flexion which the palm moves to 5. computerized axial tomography 6. extension face downward 6. range of motion 7. supination e. rotation of a limb, as if drawing a circle 7. primary care physician 8. pronation f. movement of a body part Treatment 1. Rest the injury. 8. nonsteroidal anti-inflammatory drug 9. elevation around its longitudinal Recommendations: 2. Ice to injured site Q2–3H. 9. computed tomography; computerized tomography 10. depression axis 3. Compression bandage to minimize bleeding into the tissue. 10. rest, ice, compression, elevation g. movement toward the 4. Elevation of the injury to decrease swelling. 11. nuclear medicine imaging midline of the body 5. Continue RICE treatment for the next 48 h. 12. carpal tunnel syndrome h. rotational movement in 6. Use crutches for next 48 h. 13. history which the palm moves to 7. After 48 h, alternate ice and heat. 14. Duchenne muscular dystrophy face upward 8. Return to PT department for initial stretching and strengthening 15. complains of; complaining of i. lowering of a body part exercises in 72 h. 16. intramuscular j. bending

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