INTRODUCTION OF MUSCULOSKELETAL AND AXIAL MUSCLE

INTRODUCTION OF MYOLOGY AND AXIAL MUSCLESindhu WisesaFitranto ArjadiTujuan PembelajaranMemahami struktur otot pada tingkat makroskopisMemahami peranan otot dalam sistem lokomotorIdentifikasi otot pada kepala dan trunkusMengetahui aplikasi klinis terkait struktur makroskopis ototQUIZBerapa Jumlah Otot Skelet di tubuh manusia?Apa Fungsi Otot pada tubuh?Jenis otot apa saja yang ada pada tubuh?

630630 otot630 otot

3Muscle FunctionsProduce movement locomotion & manipulationHelp blood move through veins & food thru small intestinesMaintain postureStabilize jointsCommunication (eg facial muscle)Passage control (eg sphincter muscle)Body temp homeostasis Shivering: movement produces heat energy4

Anatomy of skeletal musclesSkeletal muscle fiber (cell)Muscle FascicleSurrounded by perimysiumSurrounded by endomysiumendomysiumperimysiumSkeletal muscleSurrounded by epimysiumepimysiumtendon

Microanatomy of a Muscle Fiber (cell)

Microanatomy of a Muscle Fiber (Cell)sarcolemmatransverse (T) tubulessarcoplasmic reticulumterminal cisternaemyofibrilthin myofilamentthick myofilamenttriadmitochondria nucleimyoglobin

Muscle fibermyofibrilThin filamentsThick filamentsThin myofilamentMyosin molecule ofthick myofilamentsarcomereZ-line

Thin Myofilament(myosin binding site)

Thick myofilament(has ATP & actin binding site)*Play IP sliding filament theory p.5-14 for overview of thin & thick filaments

Lokasi FasciaSuperficial FasciaDeep FasciaDeep fascia/fasia profundaTerletak diantara otot yang berdekatanSuperficial fascia (hypodermis)adipose diantara kulit dan otot

11Properties of MuscleExcitability: capacity of muscle to respond to a stimulusContractility: ability of a muscle to shorten and generate pulling forceExtensibility: muscle can be stretched back to its original lengthElasticity: ability of muscle to recoil to original resting length after stretched12JENIS OTOT

Endurance fibers (type I )Have many mitochondria-the mitochondria give these fibers a red appearance because one of the mitochondrial enzymes contains FeAlso contain a red pigment called myoglobin which stores O2Contract slowly but resist fatigueFast twitch fibers (type II)Fibers specialized for fast contractions are white-they contain few mitochondriaRelying on glycolysis to supply energy (glycolysis is faster than respiration)Contract rapidly but fatigue quickly

Skeletal Muscle Shapes

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Parallel muscles (range of motionFlat (rectus abdominus)Fusiform (biceps)Strap (sartorius)Radiate (trapezius)SphincterPennate (force)Unipennate (biceps femoris)Bipennate (rectus femoris)Multipennate (deltoid)Shape of Muscles and Fiber ArrangementStrap

Sphinter

16Levers dan vulcrumFirst Class Lever

Second Class Lever

Third Class Lever

Newtons law of motions: - 1st law: A body tends to remain in its inertial state of rest or motion unless and until acted upon by an external disturbing force. - 2nd law: Acceleration of a body is directionally proportional to the net force acting on the body and inversely proportional to its mass. - 3rd law:For every action, there is always an equal and opposite reaction.

Mechanical Properties of Skeletal MuscleStretch-shortening cycles When a muscle is stretched just prior to contraction, the resulting contraction is more forceful than in the absence of the pre-stretch. possible contributors to forceful tension development elastic recoil effect of the series elastic component of the actively stretched muscle stretch reflex of the forced lengthening muscle example: wind-up during baseball pitching Factors affecting Muscle StrengthBody temperatureMuscle hypertrophyMuscle atrophy

Basic Features of a Skeletal MuscleMuscle attachmentsMost skeletal muscles run from one bone to anotherOne bone will move other bone remains fixedOrigin less movable attach- mentInsertion more movable attach- ment

22Muscle Attachments

Tipe Otot 1. Prime mover otot utama yang melakukan gerakan : m.brachialis2. Antagonis otot yang melawan gerakan otot prime mover : m. triceps brachii cegah gerakan yang berlebihan dan luka3. Synergis otot yang membantu gerakan otot prime mover dan membantu melawan rotasi m.biceps brachii4. Fiksator/stabilizer stabilisasi origo otot prime moverotot yang memegang scapula di tempatm. rhomboideus

Antagonistic Muscles

Agonist and Antagonist

AntagonistAgonistAgonistAntagonist26

shortening isometric lengthening(Isotonic: shortening against fixed load, speed dependent on MATPase activity and load)Three Potential Actions During Muscle Contraction:

Most likely to causemuscle injuryBiceps muscle shortensduring contractionBiceps muscle lengthensduring contraction

Contraction Speed

ISOMETRIK ISOTINIK

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Neuromuscular Junction31

Motor UnitAll the muscle cells controlled by one nerve cell32A motor unit is all the muscle cells controlled by one nerve cell. This diagram represents two motor units. Motor unit one illustrates two muscle cells controlled by one nerve cell. When the nerve sends a message it will cause both muscle cells to contract. Motor unit two has three muscle cells innervated by one nerve cell.

Golgi Tendon Organs

Number of motor units declines during aging- extensor digitorum brevis muscle of humansCampbell et al., (1973) J Neurol Neurosurg Psych 36:74-182.AGE-ASSOCIATED ATROPHY DUE TO BOTH

Individual fiber atrophy (which may be at least partially preventable and reversible through exercise). Loss of fibers (which as yet appears irreversible). Tetanus

35This slide illustrates how a muscle can go into a sustained contraction by rapid neural stimulation. In number four the muscle is in a complete sustained contraction or tetanus.

CNS(BRAIN)(INFO.)EFF.(instruction:CONSCIOUS)EFFECTOR(SKELETAL MUSCLE)COORDINATEDMOVEMENTGENERAL SOMATIC EFFERENT (GSE) SYSTEM(CONTRACTION)EXTRAPYRA-MIDALSYSTEMPYRAMIDAL SYSTEMCIRCUITBASAL GANGLIA/ CEREBELLUM/THALAMUS/ CORTEXCOMPONENTS OF THE MOTOR SYSTEM:PYRAMIDAL & EXTRAPYRAMIDALCEREBRAL CORTEXCere-bell.BRAIN STEMSPINAL CORDTHAL.BGExt. amyg., HPTPyramidal syst.Extrapyr. syst.BGBasal gangliaCerebellum, BG, thalamus: involve in the extrapyramidal circuits that influence pyramidal activitiesSTRUCTURAL & FUNCTIONAL ASPECTS OF THE GSE SYSTEM THE BRAIN EXERTS ACTIVE AND SUBTLE INFLUENCE ON THE ACTIVITY OF SKELETAL MUSCLES THROUGH DESCENDING MOTOR PATHWAYS THAT MAKE UP THE UPPER MOTOR NEURONS (UMN)

1. UMN

ORIGINATING FROM CELL BODIES IN THE CEREBRAL CORTEX AND BRAINSTEM (Regulates/modulates) FUNCTION: UMN LMN* (cranial/spinal nerves)*LMNs located in the BULBUS (pons + medulla), their fibers are sent (through cranial/spinal nerves) to the muscle fibers innervatedSkeletalm.Cortex: UMNBulbus:LMN.2. LMN** ALPHA MNsEXTRAFUSAL MUSCLE FIBERSGAMMA-EFFERENT MNsINTRAFUSAL MUSCLE FIBERS

** LMNs located in the anterior horn of the spinal cord (through the spinal nerves) sent to the muscle fibers innervatedSkeletal m.Ant. horn of the spinal cordAlpha MN Gamma MNLMNMuscle Spindle

Muscle Spindle Responses

MOTOR UNITMotor neuron together with muscle fibers (myofibers) it innervatesIn humans:A single motor unit causes the contraction of 6-30 fibers (small MU: in some eye muscles) to over 1,000 fibers (large MU: in powerful leg muscles)NEUROMUSCULAR JUNCTION (NMJ)/MOTOR-END PLATE (MEP):The junctin of a motor unit and muscle fibersCHARACTERISTICS OF MOTOR UNIT (MU) SMALL MU: Fast movement Weak movement Easily fatigue(e.g., external eye muscles) LARGE MU: Slow movement Strong movement Not easily fatigue(e.g., muscles of upper arm and upper leg/thigh) Motor Unit RatiosBack muscles1:100Finger muscles1:10Eye muscles1:144Motor units come indifferent sizes. *The ratio is about one nerve cell to 100 muscle cells in the back. *Finger muscles have a much smaller ratio of 1:10. *Eye muscles have a 1:1 ratio because of the precise control needed in vision.

MOTOR AREA (4,6+8, 3,1,2, 5,7)Cerebral cortex efferent (descendens) pathways 1.Corticobulbar tract2. Corticorubral2. Corticonuclear 3. Corticospinal tractCerebral cortexBulbusNuc. ruberNuc. cran.Ant. horn ofthe spin. cord123MIDLINE

CORTICOBULBAR TRACT

Cerebral cortex

Bulbus

Pons Med.oblongata

pyramisPyramidaldecussation1.CORTICOSPINAL TRACT:1A. Anterior corticospinal tract (10% of fibers)1B. Lateral corticospinal tract (pyramidal tract)(90% of fibers)11A1B

MOTOR CORTEX (MC)Primary MC(voluntary movement)2. Supplementary MC(programming of complex movement)3. Premotor cortex(complex movement)123GENERAL FUNCTIONS OF CEREBRAL CORTEX

MOTOR HOMUNCULUS

SENSORY HOMUNCULUSMOTOR HOMUNCULUSMotor representation of the various parts of the body

Different parts of the body are represented in the cortex according to their functional importance(Note the large areas devoted to the fingers, thumb, and face)UPPER MOTONEURON (UMN)&LOWER MOTONEURON (LMN)1. CEREBRAL CORTEX (Area 4; 6,8; 3,1,2;5,7)UMNTHE LOCATION OF ITS CELL BODY (SOMA) Corticospinal tractCorticobulbar tractBulbusSpinal cord(Anterior horn)CEREBRAL CORTEXMESENCEPHALONBRAIN STEM

BASAL GANGLIA/NUCLEI1. Lenticular nuc.:Globus pallidusPutamen 2. Caudate nuc.: A. Caput B. Corpus C. Caudate 3. Amygdala

12A2B2C32. MESENCEPHALONRUBER NUC.SPINAL CORD (Anterior horn)TECTAL NUC.INTERSTITIAL NUC.RubrospinalTectospinalInterstitiospinaltracttracttract3. BRAIN STEM (truncus cerebri): Bulbus (Pons + med. Obl.)RETICULAR NUC.SPINAL CORDVESTIBULAR NUC.ReticulospinalVestibulospinaltract tractLMNLOWER MOTONEURON (LMN)1. BRAIN STEM THE LOCATION OF ITS CELL BODYMOTORIC NUCLEI OF CERTAIN CRANIAL NERVES(N III, N IV, N V, N VI, N VII, N IX, N X, N XII)

N IIIN IVEXTRAOCULAR MUSCLESN VI

N VN VIIBRANCHIOGENIC MUSCLES *N IXVISCERAL ARCH I, II and IIIN X

N XIITONGUE MUSCLES

(* BRANCHIOGENIC MUSCLES:- Facial/mimic muscles- Sternocleidomastoid- Platysma- Laryngeal muscles- Trapezius- Pharyngeal muscles)EXTRAFUSAL MUSCLE FIBERS2. ANTERIOR HORN OF THE SPINAL CORDAlpha MNGamma MNINTRAFUSAL MUSCLE FIBERSSOMATOMOTORIC SYSTEM INITIATIONVOLUNTARYNONSTEREOTYPIC(specific, smooth, precise, skilled) INDIVIDUAL MUSCLE MOVEMENT BODY POSITION (rough)TONUSINHIBITION/ACTIVATION

GROUP OF MUSCLES MOVEMENT*LOWER MOTONEURONS (LMNs)* COORDINATED MOVEMENT PYRAMIDAL SYST. EXTRAPYRAMIDAL SYST.(* LMN: Motoric neuron which axon directly innervate the effector/skeletal muscle)SKELETAL MUSCLES* e.g., extensors, flexorsPYRAMIDAL CORTEXCRUS CEREBRICORTICOSPINAL (MIDBRAIN)TRACTPONS

PYRAMIS(MED. OBLONGATA)

PYR. DECUSSATIONLATERAL CORTICOSPINALTRACT

ANTERIOR CORTICOSPINALTRACT

LMN (ANTERIOR HORN OF THE SPINAL CORD)Lamina Rexed IV, V, VI, VII, IXLMN(ANT. HORN OFTHE SPINAL CORD(LAM. REXED VIII) MIDLINEREXED LAMINAIIIIIIIVVVIVIIIXVIIIXPYRAMIDAL SYSTEMCLINICAL CORRELATION PARALYSIS/PLEGIAPARESIS(TOTAL PARALYSIS)(PARTIAL PARALYSIS)

Severed AB Severed AB

MONOPLEGIAHEMIPLEGIAPARAPLEGIATETRAPLEGIA(One limb)(Half of the (Right + left(Four limbs) body: lower limbs)

one upper limb (the same side) +one lower limbPLEGIAMUSCLEPARALYSIS / PLEGIA PYRAMIDAL TRACT LESION

RIGHT (DEXTER) LEFT (SINISTER)

ACORTICOSPINAL TRACT PYRAMIDAL DECUSSATION CLATERALCORTICOSPINAL TRACTB D SUPERIOR EXTREMITY INFERIOR EXTREMITYLESION:A LEFT HEMIPLEGIA (HEMIPLEGIA SINISTRA) / CONTRALATERALB RIGHT HEMIPLEGIA / IPSILATERALC LEFT INFERIOR EXTREMITY PARALYSIS RIGHT SUPERIOR EXTREMITY PARALYSIS (HEMIPLEGIA CRUCIATA) LEFT SUPERIOR EXTREMITY LEFT INFERIOR EXTREMITY RIGHT SUPERIOR EXTREMITY RIGHT INFERIOR EXTREMITY

TETRAPLEGIADPenamaan OtotArah serabutMis : rectus (straight)Ukuran relatif ototMis : maximus (largest), major (larger of group)Lokasi Mis : : many muscles are named for bones (e.g., temporalis)Jumlah origoMis : : triceps (three heads)Lokasi origo dan insersioMis : : sterno (on the sternum)Bentuk Mis : : deltoid (triangular)Aksi ototMis : : flexor and extensor (flexes or extends a bone)

Atrofi Otot

Hipertrofi

Muscles in Facial Expression

63Muscles in Facial Expression

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UMNPYR. CORTEX

CORTICOBULBAR TRACT

PONSBULBUSMED. OBL.

LMNCORTICOBULBAR TRACTCharacteristics of the bulbar nuclei innervationIn general: crossed + uncrossed 121 & 2: nuclei in the bulbusLMN IN THE BULBUS MOTORIC NUCLEI OF: N III, N IV, N VIEXTRAOCULAR MUSCLESN VMASTICATORY MUSCLESN VIIFACIAL (MIMIC) MUSCLESN IX, N XPALATUM MOLLE MUSCLESPHARYNGEAL MUSCLES (cranial LARYNGEAL MUSCLESpart)ESOPHAGUSN XITRAPEZIUSSTERNOCLEIDOMASTOID (caudalLARYNGEAL MUSCLESpart)PHARYNGEAL MUSCLESN XIITONGUE MUSCLESCHARACTERISTICS OF CORTICOBULBAR TRACTIN GENERAL: CRANIAL NERVE NUCLEI RECEIVE BILATERAL INNERVATION FROM THE CEREBRAL CORTEXEXCEPTIONS:

- N VI: CROSSED ONLY (CONTRALATERAL)A.CRANIAL (bilateral) - N VII: 2 NUCLEI B. CAUDAL (contralateral) N VI NUCLEUS N VII NUCLEIUpper facial musclesLower facial musclesCORTEXCORTEXABCORTICOBULBAR TRACT CEREBRAL CORTEXCEREBRAL CORTEX (UMN) (UMN)IPSILAT. (uncrossed) A: BILATERALCONTRALAT.(crossed)B: UNCROSSED (UNILATERAL)Innervation of nuclei in the bulbusAB(left)(right)n. facialis69

EYE MUSCLE

Otot Pengunyah4 otot besar, muncul dari kranium dan masuk ke mandibulaTemporalis & Masseter menaikkan mandibulaM. pterigoideus medial & lateral bantu menaikkan & gerakan mengayun rahang bawah ke arah lateral.

73Musculature of the TongueOtot Intrinsic = vertical, transversal, longitudinalOtot extrinsic hubungkan lidah dg hyoid, styloid process, palate dan dalam pipiLidah memndah makanan ke gigi dan memasukkan ke pharynx

Intrinsic tongue musclesExtrinsic tongue muscles74

NECK

Otot yang terlibat dalam penelananM. pharyngeal constrictor menekan makanan ke tenggorokanM. infrahyoid menarik larynx ke bawah M. laryngealis intrinsik mengatur pembicaraan

77Otot Suprahyoid dan MenelanDigastric & Mylohyoid = buka mulutGeniohyoid = lebarkan pharynx selama menelanStylohyoid = menaikkan hyoidThyrohyoid = menaikkan larynx, menutup glottis

Mylohyoid

78Muscle spamodic and torticolis

ThoracoAbdomincal Muscle

Ventilation anatomical aspect

Diafragma, tekanan negatif, surfactan82Ventilation anatomical aspect

Otot2 PernapasanBernapas membutuhkan ototDiaphragma, m. Intercostalis eksternus m. Intercostalis internusKontraksi 2 otot pertama : inspirasi, Kontraksi otot 3 : forced expirationNormal expirasi butuh sedikit aktivitas otot elastic recoil & gravitasi mengempiskan dadaOtot inspirasi sbg rem, shg exhalasi mjd halus

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Otot Pernapasan -- DiaphragmKubah otot antara rongga thoraks & abdominalFasikulus oror melebar sbg central tendon fibrosaKontraksi membuat rata Menambah dimensi vertikal toraks, manarik udara ke dalam paruMenaikkan tekanan abdomen untuk mebantu mengeluarkan urine, feces & bantu persalinan

Central tendon85

Otot Pernapasan - IntercostalisIntercostalis ExternusMelebar kebawah & anterior antar costa Menarik rongga dada ke atas dan kedepan saat inspirasiIntercostalis InternusMelebar ke depan & anterior antar costa Menarik rongga dada ke bawah saat forced expiration

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Abdominal MuscleOtot Dinding AbdomenDinding Abdomen- bagian depan ; karakteristik - kulit : funiculus umbilicalis- fasia :aponeurosislinea alba- musculus* M. Obliquus Abdominis Ext * M. Obliquus Abdominis Intr* M. Rectus Abdominis* M. Transversus Abdominis* M. PyramidalisFungsiPenahan organ dalam/ visceraStabilisasi kolumna vertebralisBantu napas, BAB, BAK dan persalinan

Rectus Abdominis & Obliquus ExternusObliquus Externussuperficialdownward anterioringuinal ligament

Rectus abdominisvertikal, strapliketendinous intersectionsSelebung rectus linea alba

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Obliquus Internus -Transversus AbdominisM. obliquus InternusanteriorlyupwardsTransverse abdominalOrientasi serabut arah horizontal Lapisan terdalam90OTOT PUNGGUNG

Otot Punggung Superficial Trapezius

Latissimus dorsiSemispinalisSpleniusLevator scapulaeRhomboideusSupraspinatusInfraspinatusTeres majorGluteus maximusGluteus medius

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Otot Punggung ProfundaGrup Erector spinae 3 otot columnaDari sacrum ke costaMelebar ke kolumna vertebral Grup Semispinalis vertebrae ke vertebraeMelebar le leherMultifidisvertebrae ke vertebraerotasi kolumna vertebral Quadratus lumborumilium tke costa 12lateral fleksiMultifidisErector spinaeQuadratus lumborumSemispinalis93Trigonum Auscultation

Strain and sprain

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