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97 Cards in this Set

  • Front
  • Back
What is Bone? (General concepts)
1. Over 206 bones in body
2. specialized form of connective tissue
3. Living tissue which is continually shaped and remodeled by the forces it is subject to
Bone function (general)
1. Provides a rigid skeletal framework to support and protect other body tissues
2. Forms a system of rigid levers that are moved by attached muscles.
Types of Bones (Name the 4 types)
1. Short Bones
2. Flat bones
3. Long bones
4. Irrecular bones
Short Bones
Approximately cubical. Limited gliding motions, shock absorbers.
Ex. Talus
Flat Bones
Protect underlying organs and tissues. Provide areas of attachment for muscles and ligaments
Ex. Sternum
Long Bones
Framework of the appendicular skeleton
Ex. Humerus
Irregular Bone
Different shapes, special functions
Ex. Vertebra, coccyx
Material Constituents of Bone:
Inorganic components
calcium carbonate and calcium phosphate make up 60-70% of weight and give bone its stiffness
Material Constituents of Bone:
Organic components
cells, collagen, a protein that lends flexible strength, and ground substance which contains water.

proper combination of organic and inorganic components make bone strong without being brittle
What factors may affect bone?
Diet, vitamin D from sun, activity level, age, pathology
Classification of Bone Tissue:
Cortical bone
Other names???
- Low porosity
- 5-30% of bone volume occupied by non-mineralized tissue
- more dense = stiffer
Classification of Bone Tissue:
Cancellous bone
Other names: trabecular or spongy bone
- high porosity
- 30-90% of bone volume occupied by non-mineralized tissue
- honeycomb structure
Long Bone Structure:
Diaphysis and Epiphysis
Diaphysis: long shaft of long bone, cylindrical in shape

Epiphysis: Ends of long bones where longitudinal growl occurs

Epiphyseal plates, made of hyaline cartilage, produce new cells during and shortly following adolescence(fuse=longitudinal growth terminates)
Long Bone Structure:
Condyles, Articular Cartilage, and Medullary Cavity
Condyles: bulbous ends
Articular Cartilage: self-lubricating; protects ends of long bones
Medullary cavity: Central hollow within diaphysis
Long Bone Structure:
ENdosteum and Periosteum
Endosteum: Layer that lines the inner surfaces like the medullary cavity
Periosteum: Tough fibrous layer covering the outside of the bone
Bone Growth: Longitudinal development:
-Occurs at epiphysis/epipyseal plate (growth plate), composed of hyaline cartilage.
-During/shortly after adolescence the plate disappears and the bone fuses, terminating longitudinal growth
- Most epiphyses close around age 18 although some may be present until age 25
Bone Growth: Circumferential development
-occurs throughout most of the lifespan, but most rapid before adulthood
- after teens stop growing in height their bones gontinue to grow more dense until age 30 when peak bone mass is reached, remains steady until life changes/age cause bone loss
Bone Growth: Process leading to maintaining bone mass
-Internal layer of periosteum contains osteoblasts, which are bone FORMING cells. It builds concentric layers of new bone on top of existing ones
- at the same time, bone is resorbed around the circumference of the medullary cavity by osteoclasts, bone ABSORBING cells.
-In healthy adult bone, clast and blast activity is balanced
Bone Modeling/Remodeling
Bone mineralization, remodeling and bone strength in both children and adults are a function of stresses on the skeleton.
--With REDUCED stress, osteoclasts function fine, but the osteoblasts slow in activity = decrease bone density, weight & strength (atrophy)
-- With INCREASED, the osteoblasts are stimulated giving increased osteoblast activity = increased bone density, weight & strength. (Hypertrophy)
Link between falls and fractures
Among individuals aged 65+, fall are a factor in over 90% of fractures of the hip, distal forearm and proximal humerus
Repetitive vs traumatic load
Traumatic: force strong enough to cause an injury, such as a fracture (disruption in continuity of bone)
Repetitive: repeated application of a non-traumatic load that is usually of low magnitude, sometimes causes stress fractures as a result
Types of Fractures: (Described means other than direction)
Open vs Closed
Complete vs Incomplete
Comminuted
Impacted
Avulsion
Compression
Spiral
Epiphyseal
Depressed
Greenstick
Stress/fatigue fx: fx resulting from repetitive loading.
Open vs. closed: open= fragment of bone protrudes through the skin.
Complete/Incomplete: complete= bone broken into at least 2 parts. Incomplete = fx does not extend across bone so it still is in 1 piece.
Comminuted: bone that breaks into >2 pieces.
Impacted: One fragment driven into another portion of a bony articulation.
Avulsion: Occurs when a tendon or ligament pulls a chip of bone away from the rest of the bone.
Compression: bone is crushed, often porous bone
Spiral" Ragged break from excessive twisting force applied
Epiphyseal: epiphysis separates from diaphysis
Depressed: broken bone portion pressed inward (ex skull)
Greenstick: bone breaks incompletely, common in children
Common SPECIFIC fractures
1. Greenstick
Greenstick: fracture resulting from bending in which one side of the bone is fractured and the other side remains in tact, usually in children
Coles fracture: Fracture of dustal radius with dorsal displacement
Boxer's: fracture of 5th metacarpal neck
Types of Fractures described by direction of fracture within bone
1. Linear: fx run parallel to long axis of bone
2. Transverse: fx at a right angle to shaft of bone
3. Oblique: fx runs on a diagonal to long axis
4. Spiral: fx runs circularly around bone
Bone Healing (4 main steps)
1. Hematoma forms
2. Fibrocartilaginous callus forms
3. Bony callus forms
4. Bone remodeling occurs
Osteopenia
-Condition of reduced bone mineral density that predisposes the individual to fractures.
-34 million people in the US have low bone mass at the hip (at risk for osteoporosis)
Osteoporosis
-A disorder involving decreased bone mass and strength with one or more resulting fractures
- occurs when not enough bone is formed OR too much bone is removed
-Affects 10 million people in US
- diagnosed by bone density test, less than 2.5 standard deviations below that of normal adult
Osteoporosis Risk Factors
-H/O of fracture in self or 1st degree relative
- smoking
-Low body weight (under 127 lbs)
-Adv. age
-Caucasian risk => risk but people from all ethnic groups suffer from OP
- dementia
-female
-estrogen or testosterone deficiency
-history of calcium and vitamin D deficiency
-excessive alcohol intake
- use of meds like steroids, cancer treatments etc
Consequences of Osteoporosis
-as many as 1:2 women and 1:4 men will suffer a fracture due to osteoporosis, typically vertebrae, proximal femur, distal forearm
-vertebral fx associated with back pain, height loss, kyphosis... activity limitations (bending, reaching)
-hip fx associated with high morbidity and mortality
-surgery can repair or replace hips, 40% of survivors do not return to previous functioning and 30% ine year post-surgery mortality
What are joints? (general)
-aka articulation
-structure that connects two components
- the name tells us the articulating structures
-design and function are related
-stability as primary function vs mobility. as joints become more mobile they are less stable
-Structure varies from person to person, but differences in soft tissue = differences in ROM
Joint Classifications: Overview
1. Synarthroses (immovable): Sutures, syndesmoses, gomphosess
2. Amphiarthroses (slightly movable): synchondroses, symphse
3. Diarthroses (freely movable): gliding, hinge, pivot, condyloid, saddle, ball and socket
Synarthroses (general definition)
Fibrous joints held together by tight short fibers. Immovable or very slight movement.
Types of Synarthroses
1. Suture: Irregularly grooved articulating bone sheets mate closely; tightly connected by fibers continuous with the periosteum.

2. Syndesmoses: Dense fibrous tissue binds bones, permitting extremely limited movement.

3. Gomphoses: The only example is a tooth in the alveolar pocket of the mandible or maxilla.
Amphiarthroses (general definition)
Cartilaginous joints attenuate applied forces and permit more motion of the adjacent bones than synarthrodial joints.
Types of Amphiarthroses
1. Synchondroses: “Held by cartilage”. Bones held by thin layer of hyaline cartilage.

2. Symphyses: Plates of thin hyaline cartilage separate a disc of fibrocartilage from the bones.
Diarthroses (general definition)
Diarthroses are joints in which the articulating bones are covered with hyaline/articular cartilage. An articular capsule surrounds the joint which is
lined with a synovial membrane which secrets synovial fluid.

Ligaments help to support the joint.

Most joints in the body are diarthrotic or
freely movable.
Joint Capsule: Outter Layer
FIBROUS layer
-Encloses ends of 2 bones and attaches further down the bones than the inner layer
- Receives extra support by ligament and tendons.
- Poor blood supply but good nerve supply
- Heals more slowly...feels more pain.
- Receives input on speed, direction of movement, compression vs. tension, vibration and pain
Joint Capsule: Inner layer
SYNOVIAL layer
- Highly vascularized (good blood supply) but poorly innervated.
- Constricts or dilates in response to heat or cold. (swells in heat; constricts in cold.)
- Synovial membrane which lines the inner layer of the capsule has a primary role in production of synovial fluid.
Associated structures for Diarthroses
1. Bursae: small capsules lined with syn. membranes, filled with syn. fluid. Function: cushion structures they separate.
2. Tendon Sheaths: double-layered synovial structures that surround tendons in close assoc. with bones.
How are Diarthroses categorized?
1. the axes of rotation present: unaxial, biaxial, multiaxial
2. The planes of movement: frontal, transverse, sagittal
Types of Diarthroses:
Gliding: non-axial
Articulating bone surfaces are nearly flat in this type of joint
Movement = non-axial gliding
Examples: intermetatarsal, intercarpal, intertarsal, facet joint of vertebrae
Types of Diarthroses:
Hinge: uniaxial
-One articulating bone is convex and
the other is concave.
-Strong collateral ligaments restrict motion to a hinge-like movement.
Examples: ulnohumeral, interphalangeal joints.
Types of Diarthroses:
Pivot: uniaxial
Rotation is permitted around one axis
Examples: atlantoaxial, proximal/distal radioulnar
Types of Diarthroses:
Condyloid: biaxial
- One articulating bone surface is convex, and the other is concave
- Flexion, extension, abduction, adduction and circumduction permitted.
- Ex. : 2-5th MP joints; radiocarpal joint
Types of Diarthroses:
Saddle: biaxial
-The articular bone surfaces are both shaped like the seat of a riding saddle (have convex and concave components).
- Movement = like condyloid, but with > ROM. Example: CMC of thumb
Types of Diarthroses:
Ball and socket: tri-axial
- Joint surfaces are reciprocally convex and concave.
- Allow flexion/extension, abduction/adduction, rotation, 3 planes.
- Example: hip and glenohumeral joint
What is articular cartilage and what does it do?
- Articular cartilage is a special type of dense, white connective tissue
- 1-5 mm thick; coats ends of bones articulating at diarthrodial joints.
- Purposes:
1. Spreads load to reduce stress
2. Allows movement with minimum friction and wear
Structure of articular cartilage (3 layers)
Outer Layer:
- collagen fibers arranged parallel to surface= smooth surface.
- Function: ↓friction; distribute forces

Middle Layer:
- Collagen fibers coiled and open.
Function:
1) Allows change in length of cartilage; helps absorb forces.
2) Facilitates flow of fluid OUT of cartilage during joint compression

Inner Layer:
Calcified layer of cartilage.
Function: Anchors cartilage to bone.
Articular cartilage (location and function)
-Found in intervertibral disks and menisci of knee
-purposes:
1. Spreads load to reduce stress
2. Improvement of the fit of the articulating surfaces
3. Limit slip of one bone w/ respect to another
4. Protect the periphery of the articulation
5. Lubrication
6. Shock absorption
Articular Connective tissue: Tendons
- Connect muscles to bones
- Composed primarily of collagen and elastin
- Non-contractile; will return to original length after being stretched (unless overstretched)
- Respond to stress: hypertrophy/atrophy
Articular Connective tissue: Ligaments
- Connect bones to other bones.
- Composed primarily of collagen and elastin
- Non-contractile; will return to original length after being stretched (unless overstretched)
- Respond to stress: hypertrophy/atrophy
Joint Stability and influences
Stability: Ability to resist dislocation and injury to surrounding structures.

Influences:
- Shape of articulating surfaces
- Joint position: close vs. loose packed
- Arrangement of ligaments, muscles, tendons
- Presence of fascia: fibrous connective tissue
Joint Flexibility and influences
Flexibility: Term used to describe ROM allowed in
each of the planes of motion.

Influences:
- Shape of articulating surfaces
- Presence of fatty tissue or muscle
- Extensibility of collagenous tissues and muscles crossing the joint= most common factor that influences mobility.
Rheumatoid Vs Osteo-arthrisis
finish this later :)
Muscle Functions -- Mobility and Stability
Mobility: Produce or control movement of bony lever around axis
Stability: Resist movement of joint surface by approximating joint surfaces
Skeletal Muscles
Skeletal muscle provides forces that assist joints to move in and out of close and loose packed positions
Skeletal Muscles: Close packed positions
--position in which articulating bomes have their maximum area of contact with each other. Joint stability is greatest.
--close-packed position for knee wrist and interphalangeal joints is at full extension, and for the ankle it's full dorsiflexion
--any movement away from clse-packed position takes a joint into the loose-packed positionin which area of contact and joint stability is reduced.
Examples of close-packed positions of specific joints:
1. humeroulnar joint in extension
2. Facet joints of spine in extension
3. knee in extension and external rotation
4. radiocarpal joint in extension
5. Interphalangeal (IP) joints in extension
6. MP in flexion
Examples of Loose Packed Positions in specific joints
Reduced contact
e.g. Shoulder: G-H joint: 55 degrees abduction, 30 degrees horizontal adduction, AC Joint and SC Joint: Arm resting at side
Agonist (definition)
Agonist: Muscle direct engaged in a contraction that is responsible for producing desired motion at a joint-prime mover
Antagonist (definition)
Antagonist: Muscle generates force that opposes the force generated by the agonist or has the potential to oppose the agonist. Can slow/stop mvt at end of ROM to protect joints through eccentric contractions
Synergists (definition)
Synergists are muscles which help the agonist to perform the desired action and may also stabilize the joint to prevent undesired motion (i.e. wrist ext with finger flexion)
Example of Agonists/Antagonists/Synergists in Wrist Flexion
Synergists -- finger flexors

come back to this card with more info :)
Types of Muscle Tissue: Contractile vs non contractile
Contractile: Visoelastic muscle tissue that has capacity to develop tension-nervous system stimulates this
Non contractile: Connective tissue with no ability to actively shorten/lengthen. Contributes but not actively, such as tendon, ligaments etc
Properties of Muscle tissue:
Concractility
Irritability
Contractility: Unique to muscle tissue, relates to ability to actively develop tension either with shortening/lengthening/holding a position
Irritability: Ability of muscles to respond to chemical, electrical and mechanical stimuli (action potential)

These are unique to muscle tissue!
Muscle Structure:

- Muscle fasciculi
-Muscle Fiber/Cell
Muscle fasciculi: bundles of muscle fibers
Muscle fiber (cell): Capable of shortening to ½ its length. Therefore longer fibers can shorten over a greater distance than shorter fibers.
Do muscles with shorter or longer fibers move the joint through a greater ROM?
Muscles with longer fibers move joint through a greater ROM
Info about muscles cells
-- how to increase diameter
--arrangements?
Called “fibers” because of their threadlike appearance. The diameter of each fiber increases with physical training. Muscle fibers also have different arrangements (parallel or pennate) which affects the length-shortening relationship.
Muscle Fiber Structure:
Nuclei
Nuclei are located immediately under plasma membrane, which in the muscle cells is referred to as the sarcolemma. This is the delicate membrane surrounding each muscle fiber.
Muscle Fiber Structure:
-Sarcoplasm
-Myofibrils
Sarcoplasm: cytoplasm of muscle cells (found outside of the nucleus)
Myofibrils: Contact basic contractile structures of muscle fiber, the sarcomere
Sarcomere (definition)
Portion of myofribril which is arranged in bands or zones and contains myofilaments. It is the contractile unit of the myofibril and is considered the basic structural unit of the myofibril.
Myofilaments (definition)
--Small structures within the sarcomere and myofibril. --Two types of myofilaments: thick and thin.
--Myosin (protein) forms the bulk of the thick filaments.
--Actin (different type of protein) forms the long backbone of the thin filament.
**Both involved in the contraction sliding filament theory
Epimyosin, Parimyosin, Endomyosin
Define these!!!
Sliding Filament Theory of Muscle Contraction
When a muscle contracts, each sarcomere shortens and becomes thicker, but the myofilaments remain the same length.
Specifically, the thick and thin filaments slide past one another, increasing their overlap during contraction and decreasing their overlap during relaxation or stretch.
Sliding Filament Theory of Muscle Contraction
-- summary of what it looks like in shortened/lengthened state
When shortening or lengthening the actin proteins move toward myosin proteins or away from myosin proteins, respectively.
In maximally lengthened position, there is no “crossing over” of actin and myosin and no tension can be generated.
In a maximally shortened position, maximum overlap has occurred and no new tension can be developed.
Functional Motor Unit
Consists of a single alpha motor neuron and all the muscle fibers that the motor neuron innervates.
Alpha Motor Neuron: cell body of neuron located in anterior horn of gray matter in spinal cord.
Axon: Long fiber extending from a cell body which transmits nerve impulses to skeletal muscle.
Motor Unit Function
--Many motor units must fire to cause an entire muscle to contract and units all fire at different times and repeatedly
--Size of the motor unit determined by the number of fibers it contains( larger cell bodies associated with larger, gross movements and smaller cell bodies associated with smaller movements)
--Nervous system automatically selects motor units with small cell bodies first so that less tension is generated and less energy is expended
Motor Unit functional Application
What determines response to stimulus?
--Magnitude of response to a stimulus by muscle is affected by the number of muscle fibers stimulated.
--Conduction velocity of impulse is determined by diameter of axon.
--Total response of muscle affected by number of motor units firing at one time and by the frequency of the motor unit firing.
Muscle Fiber Characteristics
--how many types and what are the types?
--Do we all have same distribution of types in our muscles?
--Three types of fibers (I, IIB, IIA) in each muscle. The proportion of fibers in each muscle varies, depending upon the muscle's function.
--Each muscle is composed of a combination of each of the 3 types of fibers but due to genetics, variation exist among individuals in the percentage of each fiber type
Type 1 Muscle Fiber
Type I: Slow Twitch: fatigue slowly and carry one sustained activity-think of endurance events/stability/postural muscles (soleus) recruited by body first to conserve energy.
Type IIB Muscle Fiber
Type IIB: Fast Twitch: Respond more rapidly to stimulus, but fatigue more quickly. Take longer time to recover after a big initial response-think fast powered mobility muscles for jumping/sprinting-hamstrings
*Some conversion from Type IIB to IIA with endurance training
Type IIA Muscle Fiber
Type IIA: Fast Twitch Oxidative Glycolytic: Produce fast contraction and fatigues more slowly than Type IIB, but more quickly than Type I.
*Some conversion from Type IIB to IIA with endurance training
Recruitment of Muscle Fibers of different types
--Different thresholds for activation?
Neurons that innervate Type I fibers often have low thresholds and are easy to activate. Type I: first fibers recruited to save energy (Slow twitch)
Type II fibers are supplied by larger neurons compared to Type I and are more difficult to activate
Fiber arrangement: Paralell
Arrangement of mm fibers can impact function
Parallel/Strap/Fusiform: Fibers oriented parallel to longitudinal axis of muscle
eg. sartorius, sternocleidomastoid
Enables greater shortening of entire muscle than is possible with a more oblique arrangement so larger ROM can be obtained
Fiber arrangement: Pennate
Oblique Arrangement-Pennate is latin for feather
Shorter fibers, lie at angle to the long axis
eg) deltoid-multipennate
eg) FPL-bipennate
Allows more fibers to be packed in an area so they can generate more force than a muscle of the same size
Examples of Parallel arrangement
Sartorius
Rectus abdominus
Sternocleidomastoid
Examples of Penate arragement
flexor pollicis longus (bipennate)
deltoid (multipennate = multiple angles)
Gastrocnemius (bipennate)
Muscle Connective Tissue
--Interconnected tissue which surrounds individual fibers, groups of muscle fibers, entire muscle, and tendons. Lies under the skin and acts as an insulator and attaches to muscles and tendons.
--Important in developing PASSIVE tension to muscle
Muscle Connective Tissue structure
Endomysium
Perimysium
epimysium
sharpey's fibers
fascia
Endomysium: surrounds individual muscle fibers
Perimysium: Surrounds fasciculi
Epimysium: Surrounds entire muscle
Sharpey's fibers: Tendon sheath
Fascia: A fibrous membrane covering, supporting, and separating muscles. Also connects skin with underlying tissue. Can be superficial or deep.
More muscle connective tissue structure
Retinaculum
Retinaculum: Thickenings for deep fascia that hold tendons in position when the muscles contract.
Function: Prevents overstretching of muscle fibers, contributes to force developed by muscle, allows for smooth transmission of force from muscle to bone
What is the difference between muscle and connective tissue?
Muscle is ACTIVE, connective tissue is passive
What is role of connective tissue?
Passive tension is developed in the passive noncontractile components of a muscle and forms a passive elastic component of a muscle.
Characteristics of connective tissue
Extensibility and elasticity
Characteristics:
Extensibility (can be stretched or increased in length), elasticity (can return to normal resting length), and the fact that they cannot contract actively
Elastic behavior of a muscle
-- Parallel Elastic Component (PEC)
-- Series Elastic Component (SEC)
Both allow muscle to stretch and recoil in a reasonable amount of time
PEC:
--Muscular connective tissues plus sarcolemma, nerves and blood cells. These tissues run parallel to muscle fibers . Tissues shorten or lengthen when the muscle shortens/lengthens to act in parallel.
SEC:
Tendon is main component. Tendon will be under tension when the muscle actively shortens. Tendon stores energy at contraction and uses it for protection against injury, deccelerates gently
Types of Muscle Contractions:
Isotonic vs isometric
Isotonic: Muscle changes length and moves a load. Can be either concentric (muscle shortens) or eccentric (muscle lengthens)
Isometric: Muscle keeps the same length during the contraction but still generates tension. Both distal and proximal attachments are fixed. Shortening occurs at sarcomere level. Ex. holding an object
Muscle Contractions:
concentric and eccentric
-type of isotonic contraction
-concentric (muscle shortens) most common target in rehab. Muscle shortening causes bony lever to be pulled close together towards center of the muscle. Responsible for most volitional movements. (Third class lever created)
-eccentric (muscle lengthens) Occurs when muscle tension is insufficient to control opposing force. Lengthening of muscle occurs. The direction of joint motion is opposite to the net muscle force. The muscle involved acts as a brake and controls the movement. (Second Class lever)
eg) lower object to a table
Summary of ways we can classify muscles
1. Shape -- fiber length
2. Location-- Multi Joint/Single Joint (will discuss more in Part 2)
3. Function-Act Concentrically, Eccentrically, Isometrically and what does it do?
4. Role During Movement -- agonist, antagonist, synergist