BUKU PANDUAN PRAKTIKUM ANATOMI

BLOK XII
SISTEM MUSKULOSKELETAL

LABORATORIUM ANATOMI
FAKULTAS KEDOKTERAN
UNIVERSITAS MUHAMMADIYAH PURWOKERTO
2021

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 MUSCLE’S SYSTEM
Musculus system:
a. Musculus Caput

b. MusculusCollum

c. Musculus of Superior Extremity

d. Musculus Thorax

e. Musculus Dorsum

f. Musculus ColumnaVertebralis

g. Musculus Abdomen

h. MusculusPelvic

i. Musculusof Inferior Extremity

A. MUSCULUS CAPUT

1. RegionesCraniales

a) M. Occipitofrontalis

b) M. Temporoparietalis

c) GaleaAponeurotica

2. RegionesFaciales

a) M. Orbicularis Oculi

b) M. Corrugator supercili

c) M. Levatorpalpebrae superior

d) M. Procerus

e) M. nasalis

f) M. Orbicularis Oris

g) M. Zygomaticus major

h) M. Zygomaticus minor

i) M.Risorius

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 j) M. Depressor Angulioris

k) M. Levatorlabii superior

l) M. Depressor labii inferior

m) M. Buccinators

n) M. Mentalis

3. Musculus Masticator
a) M. Masseter
b) M. Temporalis
c) M. Pterygoideamedialis
d) M. Pterygoidealateralis

4. Musculusto move the tongue

a) M. Genioglossus
b) M. Hyoglossus
c) M. Palatoglossus

5. Musculuspalatum
a) M. Palatoglossus
b) M. Palatopharynx

6. Musculus Pharynx
a) M. Constrictor pharynges

B. MUSCULUS COLLUM
1. M. Sternocleidomastoideus
2. M. Platysma

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C. MUSCULUS SUPERIOR EXTREMITY

1. Regio deltoid
M. deltoideus
clinical application : intramuscular injection (IM )
2. Regio brachium
a) M. biceps brachii
b) M. triceps brachii
c) M. brachialis

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 3. Regioantebrachium
Musculus Flexor Musculus Extensor
M. Brachioradialis M. extensor digitorium
M. Palmaris longus M. Extensor carpi ulnaris
M. Flexor carpi radialis M. Extensor carpi radialis brevis
M. Flexor carpi ulnaris M. Extensor carpi radialis longus
M. Flexor digitorium superficialis M. Anconeus

4. Regiomanus
a. Tenar
a) M. opponenspollicis
b) M. flexor pollicis
c) M. abductor pollicisbrevis
d) M. adductor pollicis
b. Hipotenar
a) M. opponensdigitiminimi
b) M. abductor digitiminimi
c) M. flexor digitiminimi

D. MUSCULUS THORAX
1. M. pectoralis major et minor
2. M. subclavius
3. M. subscapluaris
4. M. intercostalisexternus
5. M. intercostalisinternus
6. M. tranversusthoracis
7. M. sternalis
8. M. subcostalis
9. M. serratus anterior

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 *Tipsto recognizemusclefibers: musculusintercostalis
Externus : Ifmusclefibersforming the letter"V" ofthe anterior
Internus : Ifmusclefibersforming the letter"A" ofthe anterior
*Aplikasi Klinis

Inspiratory Muscle Expiratory Muscle

Diaphragma M. Intercostales internus
M. Intercostales externa M. Transversus thoracicus
Accesorius Accesorius
- M. Sternocleidomastoideus - M. Obliquus internus et externus
- M. Serratus anterior abdominis
- M. Pectoralis minor - M. Transversus abdominis
- M. Scalenus - M. Rectus abdominis

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E. MUSCULUS DORSUM

1. M. trapezius
2. M. latissimusdorsi
3. M. teres major
4. M. teres minor
5. M. infraspinatus
6. M. supraspinatus
7. M. serratus anterior et posterior
8. M. rhamboideus major et minor
9. M. obliquusexternusabdominis
10. M. obliquusinternusabdominis

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 Trigonumat the Dorsum:
Border Trigonum Auscultation Trigonum Lumbal Petiti
Inferior M. Latissimus dorsi Crista iliaca
Lateral M. Infraspinatus M. Obliquus externus abdominis
Medial M. Trapezius M. Latissimus dorsi
Basis M. Rhamboideus major M. Obliquus internus abdominis
Clinical Application Pulmo Posterior

F. MUSCULUS COLUMNA VERTEBRALIS

1. M. Spinalis
2. M. Longissimus
3. M. Illiocostalis
4. M. Longuscapitis
5. M. Longus coli
6. M. Quadrates lumborum
G. MUSCULUS ABDOMEN
1. M. rectus abdominis
2. M. obliquusexternusabdominis
3. M. obliquusinternusabdominis
4. M. tranversusabdominis
5. Vagina musculi recti abdominis
*Tipsto recognizemusclefibers: musculusintercostalis
Externus : Ifmusclefibersforming the letter"V" ofthe anterior
Internus : Ifmusclefibersforming the letter"A" ofthe anterior
*Trigonum and Diaphragma
Trigonum Diaphragma
Trigonum Urogenitalis (Anterior) Diaphragma Urogenitale
- M. bulbospongiosus Basic muscle of trigonum urogenital
- M. ischiocavernosus - M. spinchteruretrae
- Diaphragma urogenital - M. transversus perinea
profundus
- M.transversus perineasuperficial

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 Trigonum Analis (Posterior) Diaphragma Pelvic
- M. levatorani Forming the basis ofthe
- M. spinchteraniexternus pelviccavity
- M. ischiococcygeus - M. levatorani
- M. ischiococcygeus

H. MUSCULUS OF INFERIOR EXTREMITY

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1. Regio Gluteal
a) M. gluteus maximus
b) M. gluteus medius
c) M. gluteus minimus
d) M. piriformis
e) M. obturatorius
f) M. adductor longus et brevis
*Clinical Application :M. Gluteus Maximus and Medius  (IM)

2. RegioFemoris
a) M. quadriceps femoris
*Clinical Application :
- M. rectus femoris
 Hamstring Muscle :
- M. vastuslateralis
 M. semitendinosus
- M. vastusmedialis
- M. vastusintermedius  M. semimembranosus

b) M. sartorius  M. biceps femoris

c) M. gracilis  M. vastuslateralisoxytocin
d) M. tensor fascia latae
injection when parturition
e) M. semitendinosus
f)M. semimembranosus  TendoM.quadricepsfemoris= tendo
g) M. biceps femoris patellapatella reflex

3. RegioCruris
a) M. popliteus
b) M. tibialisAnterior
c) M. tibialis posterior
d) M. peroneus longus/fibularislongus
e) M. peroneus brevis
f)Musculus triceps surae => M. gastrocnemius(caput medial et lateral)
M. soleus
*Combined tendo =>Tendo Achilles
*Clinical Applicationplantaris reflex

4. RegioPedis

- M. digitorium longus

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 GENERAL OSTEOLOGY

PART OF SKELETAL SYSTEM :

1. Axial Skeleton
a. Osteology of Caput
b. Osteology of Collura
c. Osteology of Thorax
d. Osteology of Vertebrae / Columna Vertebralis
2. Appendicular Skeleton
a. Osteology of Superior Extremity
b. Osteology of Inferior Extremity

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ANATOMICAL TERMS  glenoid : cekungan seperti
1. Elevation and Projection mangkok
 auricular : bentuk telinga  margo : batas
 facies : permukaan  capitulum : penonjolan menyerupai
 lamina : lempeng / lembaran kepala yang kecil
 spina: penonjolan yang panjang  caput : penonjolan menyerupai
menyerupai duri (tajam) kepal
 squamous : pipih
 trochlea: permukaan yang
menyerupai katrol 2. Hole or Canal
 tuberositas : peninggian besar  Canalis : saluran
dengan permukaan kasar  Fissura : celah; narroe slit passage
 limbus : batas sebuah alur  Cavum : rongga besar
 epiphysis : penonjolan yang  Cavitas : open enclosed area notch,
terbentuk pada tulang; merupakan rongga yang lebih kecil
batas tulang  Foramen : lubang
 crista : rigi (rough, narrow  Fossa : lekuk yang lebar
elevation)  Sulcus : alur yang memanjang
 epicondylus : peninggian diatas  Fovea : cekungan sempit ; pit or
sendi cuplike depression (jamak dan
 incisura : takik kecil = foveola)
 eminentia : peninggian dengan  Sinus : ruangan tertutup yang
daerah yang menonjol diselubungi oleh membrane
 protuberantia : bump, tonjolan dari mucosa.
peninggian  Meatus : liang; pintu menuju
 hamulus : penonjolan menyerupai sebuah saluran
kait (hook-like projection)  Impression : penekanan pada
 linea: garis, rigi tapi tidak meninggi tulang karena stuktur lain
 processus : tonjolan yang  Ductus : pipa, saluran
meruncing
 trochanter : tempat dimana
melekatnya otot – otot yang
memutar femur
 tuber: penonjolan bulat yang besar
 tuberculum : penonjolan bulat
yang lebih kecil

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 I. AXIAL SKELETON
A. CAPUT
1) Ossa Cranium/Neurocranium
a. Os Occipitalis
b. Os parietalis
c. Os frontalis
d. Os temporalis
e. Os sphenoidalis
f. Os ethmoidalis
Os cranium will form a cavity called cavum cranii

2) Ossa Fascialis/Viscerocranium
a. Os Nasalis
b. Os Maxillaris
c. Os Zygomaticum
d. Os Mandibularis
e. Os Vomer
f. Os Lacrimalis
g. Os Palatina
h. Concha Nasalis Inferior
3) Sutura/suturesarefibrousjointsbetweentwo bonesthat did notallow forthe
movement ofthe jointsbetweenthe bones ofthe cranium
a. Sutura Coronalis
b. Sutura Sagittalis
c. Sutura Lambdoidea
d. Sutura Squamosa
4) Other structure
a. Foramen Magnum
b. Palatum Durum
c. Palatum Molle
d. Nares Anterior
e. Septum Nasalis

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B. COLLUM
The bonesin the neck(the partofbackbone ossa vertebrae) called os vertebralis pars
cervicalis. Consist of 7 segment vertebrae. Spesifically :

1) Columna vertebrae pars cervicalis I (C1) called atlas

2) Columna vertebrae pars cervicalis II (C2) called axis
3) Columnavertebrae pars cervicalis VII (C7) called vertebrae prominens
* Clinical Aspect : Vertebrae Cervicalis Dyslocations

C. THORAX
1) Thorax wall formed by :
a. Columna vertebrae thoracalis
b. Costae and Spatium intercostalis
c. Sternum and Cartilaginea costalis
d. Membrana suprapleuris
e. Diaphragma
2) Thorax cavity/cavitas thoracis consist of :
a. Mediastinum
b. Pulmonalis cavity/cavitas pulmonalis
3) Thorax doors
a. Connection with nape of the neck  apertura thoracis superior (thoracic outlet
b. Connection with abdomen
4) Structure of skeletal thorax wall :
I. Sternum
a. Manubrium sterni
Structure :

- Incisura jugularis
- Incisura clavicularis
- Incisura costalis I
- Incisura costalis II
- Angulus sterni
b. Corpus sterni
c. Processus xyphoideus

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II. Cartilago costalis
III. Costae and Spatium intercostalis
 Consist of :
a. Costae vera (Costae I-VII)
b. Costae spuriae (Costae VII-X)
c. Costae fluctantes (Costae IX-XII)
 General structure of costae :

- Caput costae (Capitulum costae)

- Collum costae
- Tuberculum costae
- Corpus costae
- Angulus costae
- Sulcus costae
 Spatium intercostalis (SIC)

The cavity between costae containing three muscle of respiration

IV. Columna Vertebrae

Clinical Aplication:

1. Thoracosynthesis for pleural effusion at spatium intercostalis V-VI

2. Thoracostomy for pneumothorax

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D. VERTEBRAE
1) Columna vertebralis/skeletal vertebraeconsist of :
a. Vertebrae cervicalis I-VII  curvatura lordosis
b. Vertebrae thoraccica I-XII  curvatura kyphosis
c. Vertebrae lumbalis I-V  curvatura lordosis
d. Vertebrae sacralis I-V  curvatura kyphosis (os sacrum)
e. Vertebrae coccygis I-IV  os coccygis

*Clinical applications : abnormality at curvatura columna vertebralis, for

example : kyphosis, lordosis, scoliosis

2) Columna vertebrae consist of :

a. Segments of vertebrae
b. Articulatio
c. Pad of fibrocartilago  discus intervertebralis

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3) Part of vertebrae (General characteristics of vertebrae)
a. Corpus vertebrae
b. Arcus vertebrae
c. Foramen vertebralis
d. Foramen intervertebralis
e. Pediculus
f. Lamina arcus vertebrae
g. Incisura vertebralis superior et inferior
h. Processus at arcus :
- Processus spinosus
- Processus tranversus
- Processus articularis superior
- Processus articularis inferior

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 Discus Intervetebralis
- Thickest in the cervical and lumbal ( the most prevalent movement)
- Every discus consist of :
 Anulus Fibroses
 Nucleus pulposes

 Canalis vetebralis -> channel which is formed from a series of vertebrates

foramen

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 Tabel 1. Comparison of Vetebrae Cervicalis Atipical

Vetebrae Cervicalis Vetebrae Cervicalis III

Vetebrae Cervicalis I
II (Vetebrae Prominens)

Corpus Hasn’t Has Has

Processus Hasn’t Has processes Processes spinosus not

Spinosus spinosus bifida bifida and most longer
(Prominens)

Arcus :

- Anterior Has Hasn’t Hasn’t

- Posterior Has Has Has

Has the lateral masses Has dens Large processus

on each side (dextra et transverses with small
sinistra, superior et foramen transversarium
inferior) with facies place through vena
articulates in the upper vertebralis
surface for jointed with
condylus occipitalis and
facies on lower surface
to jointed with axis

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 Tabel 2. Comparison Of Vetebrae Tipical As Constituent Of Columnae Vetebrae

Vetebrae Cervicales Vetebrae Thoracica Vetebrae Lumbales

Corpus Small, the widthfromside Medium, heart shaped Large, kidney shaped
to side

Processus Small and bifida Long,sloping Short, flat, rectangular

Spinosus downward shape, leading to
therear

Foramen Large and triangle Small and round Large and round
vertebrale shaped

Processus Has the Has Fovea Costalis Large and

Transversus foramentransversarium jointed with slender,hasn’t fovea
and passed by tuberculum costae ; costalis and facies
arterivertebralis from hasn’t foramen articularis jointed with
C1-C6 transversarium costa ; hasn’t foramen
transversarium

Processus Facies to posterior and Facies to posterior and Facies to medial

Articularis superior lateral
Superior

Processus Facies to inferior and Facies to anterior and Facies to lateral

Articularis anterior medial excepted T12
Inferior facing to lateral side

Fovea Costalis Hasn’t Fovea costalis on the Hasn’t

corpus side jointed
with capitulum costae

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 II. APPENDICULAR SKELETON
A. OSTEOLOGI EXTRIMITAS SUPERIOR

1. Os. Clavicula

 Extrimitas sternalis

 Corpus claviculae

 Extrimitas acromialis

 Tuberculum conoideum

*Clinical applications: Fracture

2. Os. Scapula

Part :

 Collum scapulae

 Acromion (processus acromialis)

 Spina scapulae

 Cavitas glenoidalis

 Processus coracoideus

 Fossa supraspinata

 Fossa infraspinata

Angulus superior Margo :

 Angulus inferior  Margo superior

 Angulus lateralis  Margo medial

 Angulus acromii  Margo lateral

Facies :

 Facies costalis

 Facies posterior

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3. Os. Humerus
Facies :
Part :
 Facies anteromedialis
 Caput humeri
 Facies anterolateralis
 Tuberculum majus
 Facies posterior
 Sulcus intertubularis
 Facies articularis carpalis
 Tuberculum minus
Margo :
 Collum anatomicum
 Margo medial
 Collum chirurgicum
 Margo lateral
 Corpus humeri

 Condylus humeri

 Epycondilus medialis

 Epycondilus lateralis

 Fossa olecrani

4. Os. Radius

Part : Facies :

 Caput radii  Facies anterior

 Collum radii  Facies posterior

 Corpus radii  Facies medial

 Foramen nutricium  Facies lateral

 Proc. Styloideus radii

 Tuberositas radii

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5. Os. Ulna

Part : Facies :

 Olecranon  Facies anterior

 Caput ulnae  Facies posterior

 Corpus ulnae  Facies medial

 Proc. Styloideus ulnae  Facies lateral

 Tuberositas ulnae

6. Bones at manus region

 Os. Carpi :

- Os scaphoideum
- Os lunatum
- Os triquetrum
- Os pisiforme
- Os trapezium
- Os trapezoideum
- Os capitatum
- Os hamatum

 Os. Metacarpi :

 Ossa digitorium : - Phalanx proximalis

- Phalanx medialis

- Phalanx distalis

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B. PELVIS Consists of Hard Part(Bone) & Soft Part (Ligamentum&Muscle)

1. Ossa Pelvis

Consists of 4 bone :

a. Os Coxae (two)

b. Os Sacrum (one)

c. Os Coccygeus (one)

Ossa Coxae divided into three parts :

a. Os Ilium

b. Os Ischium ; acetabulum

c. Os Pubis ; symphisis ossis pubis

2. Pelvic Door

Divided into three parts :

a. Apertura pelvis Superior (pintu atas panggul), the boundaries :

a) Promontorium os sacrum

b) Linea terminalis

c) Margo superior symphisis ossis pubis

b. Pintu tengah panggul (Narrow field of pelvic), the boundaries :

a) Os sacrum 4-5

b) Spina ischiadicae

c) Margo inferior symphisis ossis pubis

c. Apertura pelvis inferior (pintu bawah panggul), the boundaries :

Consists of two triangles with the same basis :

a) Front of triangle

- Arcus Pubicus

- Connecting line between tuber ischiadicum dextra et sinistra

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 b) Rear of triangle

- End of os sacrum

- Ligamentum sacro tuberosum dextra

- Ligamentum sacro tuberosum sinistra

- Connecting line between tuber ischiadicum dextra et sinistra

3. Pelvic cavity

Consists of two cavity :

a. Pelvic major (false greater pelvis)

b. Pelvic minor (true messer pelvis)

C. OSTEOLOGY EXTREMITAS INFERIOR

1. Femur
Part : Facies :
 Caput femoris
 Facies patellaris
 Collum femoris
 Facies popliteal
 Corpus femoris
 Trochanter major
 Trochanter minor
 Linea intertrochanter
 Crista intertrochanter
 Linea *aspera
 Tuberositas glutea
 Epicondylus medialis
 Epicondylus lateralis
 Condylus medialis
 Condylus lateralis
 Incisura intercondylaris
 Fossa intercondylaris

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2. Patella
 Facies anterior (rough)
 Facies articularis (soft)
 Basis patella (superior)
 Apex patella (inferior)

3. Tibia
 Condylus lateralis
 Condylus medialis
 Corpus tibiae
 Malleolus medialis
 Tuberositas tibiae
 Tuberculum intercondylare mediale
 Tuberculum intercondylare laterale
 Faces fibularis
4. Fibula
 Caput fibulae
 Collura fibulae
 Apex capitis fibulae
 Malleolus lateralis

5. Ossa tarsalia
 Os. Talus
 Os. Calcaneus
 Os. Naviculare
 Os. Cuboideum
 Os cuniforme mediate
 Os. Cuniforme intermedium
 Os cuniforme laterale
 Hallux
 Arcus transversal
 Arcus longitudinal

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*ARTICULATION (jenis articulatio)
1. Sinartosis (does not producemovement)
 Sutura
 Gpmphosis
 Synchondrosis
 Synostosis
2. Amphiarthosis (The resulting slight movement)
 Syndesmosis
 Symphisis
3. Diarthosis (canproducemovement)
Synovial:
 Gliding joint
 Hinge joint
 Pivot joint
 Ellipsoidal joint
 Saddle joint
 Ball and socket joints

KLASIFIKASI SENDI :

A. Berdasarkan struktural (tipe material atau jaringan yang menghubungkan sendi) :

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1. Fibrous Joint : kedua tulang ini dihubungkan oleh jaringan ikat fibrosa. Jumlah
pergerakan yang terjadi pada fibrous joint bergantung pada panjangnya serat yang
menghubungakan kedua tulang. Contoh :

a. Sutura : berupa pita kolagen tidak keras. Pada saat dewasa terjadi penulangan,
disebut synostosis; sutura pada cranium(kedua tulang cranium saling mengunci
dengan garis zig zag/ overlap)

b. Syndesmosis : dihubungkan oleh ligamentum atau membrana fibrosa contoh :

membrana interossea, syndesmosis tibiofibularis inferioris/distalis

c. Gomphosis : sendi pada dentoalveolar, dihubungkan oleh ligamentum

periodontale

2. Cartilaginous Joint : struktur sendi ini dihubungkan oleh kartilago hyaline atau
fibrocartilage.

a. Primary cartilaginous joint / synchondrosis kedua tulang dihubungkan oleh

kartilago hyaline, yang memungkinkan adanya sedikit pergerakan selama awal
kehidupan. Primary cartilaginous joints biasanya akan menyatu seperti pada
epiphysial plate tulang panjang. Primary cartilaginous joints ini memberikan
waktu bagi tulang untuk tumbuh memanjang. Ketika panjang maximum tercapai,

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 epiphysial plate berubah menjadi tulang (fusi dengan diaphysis).Contoh : discus
epiphysialis, synchondrosis sphenooccipitalis, synchondrosis manubriosternalis

b. Secondary cartilaginous joints atau symphisis merupakan sendi yang kuat, sedikit
gerak, dan terhubung oleh jaringan fibrokartilago. Contoh : discus
intervertebralis jaringan fibrokartilago menghubungkan vertebra sehingga dapat
memeberikan kekuatan dan sebagai shock absorption ; symphisis pubis

3. Synovial Joint : dihubungkan oleh capsul sendi (terdiri dari lamina fibrosa atau
membran yang dibatasi oleh serous synovial membrane). Capsul sendi ini
menyelubungi cavitas articularis. Cavitas articularis dari synovial joint merupakan
ruang potensial yang mengandung sedikit cairan synovial yang disekresikan oleh
membrane synovial yang berfungsi sebagai lubricant. Didalam capsul, terdapat
cartilago sendi membungkus permukaan sendi/ facies articularis pada tulang, sisanya
akan cavitas articularis akan dilapisi oleh membrane synovial.

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 Synovial joints merupakan jenis sendi yang paling umum. Dengan struktur
seperti yang telah dijelaskandiatas memungkinkan adanya gerakan bebas antar tulang
yang dihubungkan oleh sendi jenis ini. Terdapat 6 tipe synovial joints yang
diklasifikasikan berdasarkan bentuk permukaan sendi atau tipe gerakan yang
memungkinkan terjadi,berikut klasifikasinya :

a. Articulatio plana (planar) : gerak sliding, permukaan sendi tulang hampir

rata dengan gerakan yang dibatasi oleh capsul sendi. Art. plana banyak
ditemukan dan ukurannya kecil. Contoh : art.acromioclavicularis,
intercarpalia, intermetacarpalia, carpometacarpalia

b. Gynglymus (hinge/engsel) : uniaxial1 derajat kebebasan gerak (hanya

fleksi- ekstensi), gerakan ini terjadi pada bidang sagittal yang mengelilingi
axis transversus. Contoh : art.humeroulnaris, interphalangea

c. Articulatio trochoidea (pivot) → uniaxial 1 derajat kebebasan yaitu

memutari axis longitudinal tubuh Contoh : art.radioulnaris proximalis,
art.atlantoaxialis

d. Articulatio sellaris (saddle) → biaxial, 2 derajat kebebasan gerak (fleksi-

ekstensi gerakan pada bidang sagittal mengitari axis transverse, abduksi-
adduksi gerakan pada bidang frontal mengitari axis sagittal) , gerakan
sirkumduksi juga mungkin terjadi. permukaan sendi salah satu tulang
berbentukmirip pelana kuda sehingga disebut saddle/ sellaris (sella
=tempat duduk) Contoh : art.carpometacarpalis I

e. Articulatio condyloidea : Satu condylus → biaxial, 2 derajat kebebasan

gerak (fleksi-ekstensi, abduksi-adduksi / circumduksi) Contoh :
art.humeroradialis Dua condylus → uniaxial, 1 derajat kebebasan gerak
(fleksi-ekstensi) Contoh : art.femorotibialis

f. Articulatio ellipsoidea → biaxial, 2 derajat kebebasan gerak (fleksi-

ekstensi, abduksi-adduksi/circumduksi) Contoh : art.radiocarpea

g. Articulatio spheroidea (ball-and-socket) → multiaxial, tiga derajat

kebebasan gerak (fleksi-ekstensi, adduksi-abduksi, rotasi) Contoh :
art.humeri, art.coxae

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B. Berdasarkan fungsional (derajat pergerakan)

1. sinarthrosis: tidak dapat digerakkan

2. amphiarthrosis: sedikit dapat digerakkan

3. diarthrosis: bebas digerakkan

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 FISIOLOGI MUSKULOSKELETAL

1. Fisiologi skeletal
Tulang adalah suatu jaringan dinamis yang tersusun oleh 3 jenis sel yaitu
osteoblas, osteosit, dan osteoklas, yang berperan pada proses remodelling tulang.
Osteoblas berfungsi membangun tulang dengan membentuk kolagen tipe 1
dan proteoglikan sebagai matrix tulang melalui proses osifikasi. Selain itu osteoblas
mensekresi fosfatase alkali, yang sebagiannya akan memasuki aliran darah (oleh
karena itu kadar fosfatase alkali yang tinggi merupakan indikator baik dalam
penyembuhan fraktur).
Osteosit adalah sel-sel tulang dewasa sebagai lintasan pertukaran kimiawi
tulang yang padat. Sedangkan osteoklas berfungsi untuk mengasorbsi mineral dan
matriks tulang agar pecah dan larut sehingga kalsium dan fosfat terlepas kedalam
darah. Sel ini mengikis tulang.
Pertumbuhan embriologi tulang
Perkembangan tulang menjadi 2 tahap, tahap pertama terjadi pada minggu
kelima perkembangan embrio, sedangkan tahap kedua terjadi setelah minggu ketujuh.
Lalu tulang akan terbentuk melalui 2 cara yaitu secara langsung dan tidak langsung
atau osifikasi desmal atau osifikasi endokondral.

2. Fisiologi otot
Otot merupakan organ tubuh yang mempunyai kemampuan mengubah energi
kimia menjadi energi mekanik/gerak sehingga dapat berkontraksi untuk
menggerakkan rangka.
Satu gelendong otot tersusun oleh fasicle yang merupakan berkas otot yang
terdiri atas beberapa sel otot atau muscle fiber. Muscle fiber tersusun oleh miofibril,
sedangkan miofibril tersusun oleh miofilamen yaitu aktin dan miosin. Miofibril
dibangun oleh 3 jenis protein yaitu protein kontraktil (miosin dan aktin), protein
regulator yang merupakan bagian dari filamen tipis/aktin (tropomiosin dan troponin),
dan protein struktural. Dapat dilihat lebih jelas pada gambar dibawah ini.

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Kontraksi dan relaksasi otot skelet.

Kontraksi dan relaksasi otot terjadi karena adanya mekanisme sliding filament,
seperti berikut :

 Kepala miosin melekat dan berjalan sepanjang filamen tipis di kedua ujung
sarkomer, menarik filamen tipis ke arah M line
 Filamen tipis masuk dan bertemu di pusat sarkomer
 Dorongan masuk filamen tipis sampai saling tumpang tindih
 Z disc saling mendekat, sarkomer memendek
 Panjang fiamen tebal dan tipis secara individu tidak berubah
 Pemendekan sarkomer menyebabkan pemendekan seluruh serabut otot,
selanjutnya ototnya memendek kontraksi

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 Untuk terjadinya mekanisme sliding filamen tersebut terjadi beberapa proses
secara singkatnya akan dijelaskan pada skema dibawah ini :

kepala miosin
impuls menjalar
berikatan dengan miosin binding site
melalui saraf
aktin

pelepasan
Ca keluar dan
neurotransmitter terjadi mekanisme
berikatan dengan
(Ach) di ujung sliding filamen
troponin
terminal saraf

merangsang
Ach berikatan dengan menarik actin menuju
Reticulum
reseptor pada NMJ ke arah M line
Sarkoplasma

terjadi MAP (Muscle menjalar ke tubulus

Action Potential) transversus
kontraksi otot

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 CLINICAL APPLICATION

3. Fracture

A fracture is a broken bone. A bone may be completely fractured or partially

fractured in any number of ways (crosswise, lengthwise, in multiple pieces).

Types of Fractures

Bones are rigid, but they do bend or "give" somewhat when an outside
force is applied. However, if the force is too great, the bones will break, just as a
plastic ruler breaks when it is bent too far.

The severity of a fracture usually depends on the force that caused the
break. If the bone's breaking point has been exceeded only slightly, then the bone
may crack rather than break all the way through. If the force is extreme, such as
in an automobile crash or a gunshot, the bone may shatter.

If the bone breaks in such a way that bone fragments stick out through the
skin, or a wound penetrates down to the broken bone, the fracture is called an
"open" fracture. This type of fracture is particularly serious because once the skin
is broken, infection in both the wound and the bone can occur.

Common types of fractures include:

 Stable fracture. The broken ends of the bone line up and are barely
out of place.
 Open, compound fracture. The skin may be pierced by the bone or by

a blow that breaks the skin at the time of the fracture. The bone may or
may not be visible in the wound.
 Transverse fracture. This type of fracture has a horizontal fracture

line.

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  Oblique fracture. This type of fracture has an angled pattern.

 Comminuted fracture. In this type of fracture, the bone shatters into

three or more pieces.

Cause

The most common causes of fractures are:

 Trauma. A fall, a motor vehicle accident, or a tackle during a

football game can all result in fractures.
 Osteoporosis. This disorder weakens bones and makes them more
likely to break.
 Overuse. Repetitive motion can tire muscles and place more force on
bone. This can result in stress fractures. Stress fractures are more
common in athletes.

Symptoms

Many fractures are very painful and may prevent you from moving the
injured area. Other common symptoms include:

 Swelling and tenderness around the injury

 Bruising
 Deformity — a limb may look "out of place" or a part of the bone may

puncture through the skin

4. Sprain and Strain

Sprains and strains are common orthopedic injuries. A sprain is an injury to a
ligament, which is a band of tissue that connects one bone to another. A strain is
an injury to a muscle or tendon, which is a band of tissue that connects muscle to
bone. A strain is also sometimes referred to as a "torn muscle" or "muscle pull."
These injuries can occur in any body part but are most often found in the
lower and upper extremities, such as the ankle, knee, elbow, or wrist. The most
common sprain site is the ankle joint. More than 628,000 ankle sprains are
estimated to occur annually in the United States. The most common strain sites
are the lumbarspine (lower back) and the hamstring muscle in the back of the
thigh.

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Causes
A sprain is usually caused by trauma to a joint (the space between bones).
Twisting or forces overstretch the ligaments (such as hyperextension or
hyperflexion) and can cause tears in the ligament tissue, which can be graded
from mild to severe depending on the amount of damage. Sprains can happen
when people twist an ankle or knee or fall on an elbow or shoulder. A strain is
usually the result of overstretching or overuse of muscles and tendons. An
acute strain can be the result of sudden twisting or trauma to the muscles or
tendons. Chronic strains are the consequence of overuse of muscles and
tendons, such as with athletes who train constantly and do not rest adequately.

Sign and Symptomp

Sprains tend to have symptoms more localized to the injured joint.

When the joint is injured, it's possible to feel a tear or pop in the joint. Pain is
usually immediate, and depending on the severity of the injury, it may not be
possible to use the joint. Signs and symptoms of sprains include

 pain,
 swelling,
 bruising,
 instability of the joint,
 decreased range of motion.

Strains, whether acute or chronic, have symptoms localized to the

muscle groups or tendons that are injured. Pain can be over a small area, or a
larger area, such as a group of muscles. Pain can be immediate in an acute
strain, or it may be delayed in the case of an overuse injury. Signs and
symptoms of strains include

 pain,
 inflammation,
 muscle spasm,
 muscle cramping,
 muscle weakness,
 bruising may occur but may be delayed for several days.

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5. Dislocation
A joint dislocation, or luxation, occurs when there is an abnormal separation
in the joint, where two or more bones meet. A partial dislocation is referred to as
a subluxation. Dislocations are often caused by sudden trauma on the joint like an
impact or fall. A joint dislocation can cause damage to the surrounding ligaments,
tendons, muscles, and nerves. Dislocations can occur in any joint major
(shoulder, knees, etc.) or minor (toes, fingers, etc.). The most common joint
dislocation is a shoulder dislocation.

Treatment for joint dislocation is usually by closed reduction, that is, skilled
manipulation to return the bones to their normal position. Reduction should be
done only by trained people, because it can cause injury.

Causes

Joint dislocations are caused by trauma to the joint or when an individual falls
on a specific joint. Great and sudden force applied, by either a blow or fall, to the
joint can cause the bones in the joint to be displaced or dislocated from normal
position. With each dislocation, the ligaments keeping the bones fixed in the
correct position can be damaged or loosened, making it easier for the joint to be
dislocated in the future.

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 Some individuals are prone to dislocations due to congenital conditions, such
as hypermobility syndrome and Ehlers-Danlos Syndrome. Hypermobility
syndrome is genetically inherited disorder that is thought to affect the encoding of
the connective tissue protein’s collagen in the ligament of joints. The loosened or
stretched ligaments in the joint provide little stability and allow for the joint to be
easily dislocated.

Symptoms

The following symptoms are common with any type of dislocation.

 Intense Pain
 Joint instability
 Deformity of the joint area
 Reduced muscle strength
 Bruising or redness of joint area
 Difficulty moving joint
 Stiffness

6. Osteomyelitis
Osteomyelitis is inflammation of the bone caused by an infecting organism.
Although bone is normally resistant to bacterial colonization, events such as
trauma, surgery, the presence of foreign bodies, or the placement of prostheses
may disrupt bony integrity and lead to the onset of bone infection. Osteomyelitis
can also result from hematogenous spread after bacteremia. When prosthetic
joints are associated with infection, microorganisms typically grow in biofilm,
which protects bacteria from antimicrobial treatment and the host immune
response.
Early and specific treatment is important in osteomyelitis, and identification of
the causative microorganisms is essential for antibiotic therapy.The major cause
of bone infections is Staphylococcus aureus. Infections with an open fracture or
associated with joint prostheses and trauma often must be treated with a
combination of antimicrobial agents and surgery. When biofilm microorganisms
are involved, as in joint prostheses, a combination of rifampin with other
antibiotics might be necessary for treatment.

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 Anatomy
The bony skeleton is divided into two parts: the axial skeleton and the
appendicular skeleton. The axial skeleton is the central core unit, consisting of the
skull, vertebrae, ribs, and sternum; the appendicular skeleton comprises the bones
of the extremities. The human skeleton consists of 213 bones, of which 126 are
part of the appendicular skeleton, 74 are part of the axial skeleton, and six are part
of the auditory ossicles.
Hematogenous osteomyelitis most commonly involves the vertebrae, but
infection may also occur in the metaphysis of the long bones, pelvis, and clavicle.
Vertebral osteomyelitis involves two adjacent vertebrae with the corresponding
intervertebral disk. (See the image below.) The lumbar spine is most commonly
affected, followed by the thoracic and cervical regions.

Posttraumatic osteomyelitis begins outside the bony cortex and works its way in
toward the medullary canal, typically found in the tibia. Contiguous-focus
osteomyelitis often occurs in the bones of the feet in patients with diabetes mellitus
and vascular compromise.

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7. Tendon rupture
A tendon is the fibrous tissue that attaches muscle to bone in the human body.
The forces applied to a tendon may be more than 5 times your body weight. In
some rare instances, tendons can snap or rupture. Conditions that make a rupture
more likely include the injection of steroids into a tendon, certain diseases (such
as gout or hyperparathyroidism), and having type O blood.
Although fairly uncommon, a tendon rupture can be a serious problem and
may result in excruciating pain and permanent disability if untreated. Each type
of tendon rupture has its own signs and symptoms and can be treated either
surgically or medically depending on the severity of the rupture and the
confidence of the surgeon.
The 4 most common areas of tendon rupture include:

 Quadriceps

 A group of 4 muscles that come together just above your kneecap

(patella) to form the patellar tendon.

 Often called the quads, this group of muscles is used to extend the leg
at the kneeand aids in walking, running, and jumping.
Achilles

 This tendon is located on the back portion of the foot just above the
heel. It is the site where the calf muscle attaches to the heel of the foot
(the calcaneus bone).
 This tendon is vital for pushing off with the foot. The Achilles helps
you stand on your tiptoes and push off when starting a foot race.

Rotator cuff
 Your rotator cuff is located in the shoulder and is actually composed of
4 muscles that function together to raise your arm out to the side, to
help you rotate the arm, and to keep your shoulder from popping out of
its socket.
 The rotator cuff tendon is one of the most common areas in the body
affected by tendon injury. Some studies of people after death have
shown that 8% to 20% have rotator cuff tears.

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 Biceps
 The biceps muscle of the arm functions as a flexor of the elbow. This
muscle brings the hand toward the shoulder by bending at the elbow.
 Ruptures of the biceps are classified as proximal (close) or distal (far).
Distal ruptures are extremely rare. The proximal rupture occurs where
the biceps attaches at the top of your shoulder.

Symptomps

An injury that is associated with the following signs or symptoms may be a

tendon rupture:

 A snap or pop you hear or feel

 Severe pain

 Rapid or immediate bruising

 Marked weakness
 Inability to use the affected arm or leg

 Inability to move the area involved

 Inability to bear weight

 Deformity of the area

Symptoms associated with specific injuries include the following:

 Achilles tendon rupture: You will be unable to support yourself on your

tiptoes on the affected leg (you may be able to flex your toes downward
because supporting muscles are intact).

 Rotator cuff rupture: You will be unable to bring your arm out to the
side.

 Biceps tendon rupture: You will have decreased strength of elbow

flexion and decreased ability to raise the arm out to the side when the
hand is turned palm up.

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