Musculoskeletal and Dermatology Physiology

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jknell
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210714
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Musculoskeletal and Dermatology Physiology
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2013-04-02 11:39:42
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  1. Epidermis Layers
    • From surface to base:
    • -Stratum Corneum (keratin)
    • -Stratum Lucidum
    • -Stratum Granulosum
    • -Stratum Spinosum (spines = desmosomes)
    • -Stratum Basale (stem cells)

    "Californias Like Girls in String Bikinis"

  2. Epidermal Appendages
    • Sebaceous Glands
    • Eccrine Glands
    • Apocrine Glands
  3. Sebaceous Glands
    • -Holocrine (rupture of plasma membrane) secretion of sebum
    • -Associated with hair follicle
  4. Eccrine Glands
    • -Secrete sweat
    • -found throughout the body

    "Eccrine glands are Everywhere"
  5. Apocrine Glands
    • -Secrete milky viscous fluid
    • -Found in axillae, genitalia and areolae
    • -Not functional until puberty
    • -Malodorous because of bacterial action
  6. Epithelial Cell Junctions
    -types
  7. Tight Junction
    • "Zona Occludens"
    • -apical surface of cells?

    • Function:
    • -prevents paracellular movement of solutes

    • Structure:
    • -claudins
    • -occludins
  8. Adherens Junction
    • "Zonula Adherens"
    • -found below tight junctions

    • Function:
    • -forms "belt" connecting actin cytoskeletons of adjacent cells

    • Structure:
    • -CADherins (Ca2+ dependent adhesion proteins)

    • Disease:
    • -loss of E-cadherin promotes metastasis
  9. Desmosome
    "Macula Adherens"

    • Function:
    • -structural support between cells

    • Structure:
    • -via keratin interactions

    • Disease:
    • -Pemphigus Vulgaris (autoantibodies)
  10. Gap Junction
    • Function:
    • -permit electrical and chemical communication between cells

    • Structure:
    • -connexins (channel proteins)
  11. Hemidesmosomes
    • Function:
    • -connect basal cells to underlying basement membrane

    • Structure:
    • -via keratin interactions

    • Disease:
    • -Bullous pemphigoid (autoantibodies)
    • "hemidesmosomes are down bullow"
  12. Integrins
    • -membrane proteins that maintain integrity of basement membrane
    • -bind to laminin in basement mebrane
  13. Pudendal Nerve Block
    "Saddle nerve block"

    -relieve pain of delivery

    Landmark = ischial spine
  14. Appendix Landmarks
    2/3 of the way from the umbilicus to ASIS

    McBurney's point
  15. LP Landmark
    Iliac Crest
  16. Rotator Cuff Muscles
    SItS (small t for teres minor)

    • Supraspinatus
    • Infraspinatus
    • Teres Minor
    • Subscapularis

    Innervated by C5-C6

  17. Supraspinatus
    • Function:
    • -abducts arm initially (before deltoid)

    Most common rotator cuff injury

  18. Infraspinatus
    • Function:
    • -laterally rotates arm

    Pitching injury

  19. Teres Minor
    • Function:
    • -adducts and laterally rotates arm

  20. Subscapularis
    • Function:
    • -medially rotates and adducts arm

  21. Wrist Bones
    "Slide Left Tiny Pinky, Here Comes The Thumb"

    • Scaphoid
    • Lunate
    • Triquetrium
    • Pisiform
    • Hamate
    • Capitate
    • Trapezoid
    • Trapezium

    • Scaphoid:
    • -most commonly fractured carpal bone
    • -prone to avascular necrosis due to retrograde blood supply

    • Lunate:
    • -dislocation may cause acute carpal tunnel syndrome

  22. Brachial Plexus
    • "Randy Travis Drinks Cold Beer"
    • -Roots
    • -Trunks
    • -Divisions
    • -Cords
    • -Branches

  23. Better Brachial Plexus Picture
  24. Brachial Plexus Nerves
    -Long Thoracic Nerve

    • -Dorsal Scapular Nerve
    • -Suprascapular Nerve

    -Lateral Pectoral

    • -Upper Subscapular Nerve
    • -Thoracodorsal Nerve
    • -Lower Subscapular Nerve

    • -Medial Pectoral
    • -Medial Brachial Cutaneous
    • -Medial Antebrachial Cutaneous

    • -Musculocutaneous
    • -Axillary
    • -Median
    • -Radial
    • -Ulnar
  25. Long thoracic Nerve
    • Innervates:
    • -serratus anterior (abduction above horizontal position)

    • Palsy:
    • -scapular winging
    • -can be injured during mastectomy (winging and ipsilateral lymphedema
  26. Dorsal Scapular Nerve
    • Innervates:
    • -Levator Scapulae
    • -Rhomboids
  27. Suprascapular Nerve
    • Innervates:
    • -supraspinatus
    • -infraspinatus
  28. Lateral Pectoral
    • Innervates:
    • -Pectoralis Major
  29. Upper Subscapular Nerve
    • Innervates:
    • -subscapularis
  30. Thoracodorsal Nerve
    • Innervates:
    • -Latissimus Dorsi
  31. Lower Subscapular Nerve
    • Innervates:
    • -Subscapularis
    • -Teres Major
  32. Medial Pectoral Nerve
    • Innervates:
    • -Pectoralis Major
    • -Pectoralis Minor
  33. Medial Brachial Cutaneous
    • Innervates:
    • -sensory to medial arm
  34. Medial Antebrachial Cutaneous
    • Innervates:
    • -sensory to medial forearm
  35. Upper Extremity Innervation


    • -C7 root
    • -Upper trunk
    • -Axillary nerve
    • -Radial nerve (spinal groove)
    • -Median nerve
    • -Ulnar nerve
    • -Deep branch of radial nerve
    • -Anterior Interosseus nerve
    • -Recurrent branch of median nerve
  36. Musculocutaneous Nerve
    • Nerve Roots:
    • -C5-C7
    • -terminal lateral cord

    • Innervates:
    • 1. MOTOR (flexion of arm at elbow):
    • -Biceps
    • -Brachialis
    • -Coracobrachialis

    • 2. SENSORY
    • -Lateral forearm

    • Typical Injury:
    • -upper trunk compression
  37. Axillary
    • Nerve Roots:
    • -C5, C6
    • -Posterior Cord

    • Innervates:
    • 1. MOTOR:
    • -deltoid (abduction of arm at shoulder)

    • 2. SENSORY:
    • -over deltoid

    • Typical Injury:
    • -fractured surgical neck of humerus


    • Injury Sign:
    • -atrophied deltoid
  38. Median Nerve
    • Nerve Roots:
    • -C5-C8, T1
    • -Terminal lateral and medial cords

    • Innervates:
    • 1. MOTOR:
    • -Thenar Muscles (opposition of thumb)
    • -FDS, FDP 2 and 3, FPL (lateral finger flexion)
    • -FCR (radial wrist flexion)
    • -PT, PQ (forearm pronators)

    • 2. SENSORY:
    • -dorsal and plamar aspects of lateral 3.5 fingers
    • -thenar eminence

    • Typical Injury:
    • -Proximal lesion: fracture of supracondylar humerus
    • -Carpal tunnel syndrome 
    • -Superficial laceration of recurrent branch of median nerve

    • Injury Sign:
    • -Ape hand (loss of thumb opposition)
    • -Pope's Blessing Hand
  39. Radial Nerve
    • Nerve Roots:
    • -C5-C8, T1
    • -Terminal posterior cord

    • Innervates:
    • 1. MOTOR:
    • -Brachioradialis
    • -Extensors of wrist and fingers
    • -Supinator
    • -Triceps
    • "BEST extensors"

    • 2. SENSORY:
    • -posterior arm
    • -dorsoradial hand and thumb

    • Typical Injury:
    • -Fracture at midshaft of humerus (spiral groove)
    • -"Saturday night palsy" (extended compression of axilla by chair or crutches)

    • Injury Signs:
    • -Wrist drop
  40. Ulnar Nerve
    • Nerve Roots:
    • -C8, T1
    • -terminal medial cord

    • Innervates:
    • 1. MOTOR:
    • -FCU (ulnar wrist flexion)
    • -Ulnar FDP (medial finger flexion)
    • -Intrinsic hand muscles

    • 2. SENSORY:
    • -Medial 1.5 fingers (dorsal and palmar)
    • -hypothenar eminence

    • Typical Injury:
    • -Proximal lesion: fracture of medial epicondyle of humerus "funny bone"
    • -Distal Lesion: trauma to heel of hand, fracture to hook of hamate

    • Injury Signs:
    • -radial deviation of wrist upon wrist flexion
  41. Innervation of Hand
  42. Cutaneous Innervation of Hand
  43. Dermatomes of Upper Limb/Hand
    • C6: A-OK
    • C7: flipping off
  44. Hand Muscles
    -groups
    • Thenar
    • Hypothenar
    • Dorsal Interosseous
    • Palmar Interosseus
    • Lumbricals
  45. Thenar Muscles
    • Innervation:
    • -median nerve

    • Muscles:
    • -Opponens pollicis
    • -Abductor pollicis brevis
    • -Flexor pollicis brevis

    "OAF"
  46. Hypothenar Muscles
    • Innervation:
    • -Ulnar nerve

    • Muscles:
    • -Opponens digiti minimi
    • -Abductor digiti minimi
    • -Flexor digiti minimi

    "OAF"
  47. Dorsal Interosseous Muscles
    • Innervation:
    • -Ulnar nerve

    • Function:
    • -abduct the fingers

    DAB= Dorsals ABduct
  48. Palmar Interosseous Muscles
    • Innervation:
    • -Ulnar nerve

    • Function:
    • -adduct the fingers

    PAD = Palmar ADduct
  49. Lumbricals
    • Innervation:
    • -Median Nerve (radial: first and second)
    • -Ulnar nerve (ulnar: third and fourth)

    • Function:
    • -flex MCP joint
    • -extend DIP and PIP joints
    • "Queen's wave"
  50. Lower Extremity Nerves
    • Obturator
    • Femoral
    • Common Peroneal
    • Tibial
    • Superior Gluteal
    • Inferior Gluteal
  51. Obturator Nerve
    • Nerve Roots:
    • -L2-L4

    • Innervates:
    • 1. MOTOR
    • -Thigh adductors (External obturator, Adductor lungs, Adductor brevis, Adductor Magnus, Gracilis)

    • 2. SENSORY:
    • -medial thigh

    • Typical Injury:
    • -anterior hip dislocation
  52. Femoral Nerve
    • Nerve Roots:
    • -L2-L4

    • Innervates:
    • 1. MOTOR:
    • -Quadraceps (Rectus femoris, Vastus lateralis, Vastus medialis, Vastus intermedius)
    • -Function: Thigh Flexion and Leg extension

    • 2. SENSORY:
    • -anterior thigh
    • -medial leg

    • Typical Injury:
    • -pelvic fracture
  53. Common Peroneal Nerve
    • Nerve Roots:
    • -L4-S2

    • Innervates:
    • 1. MOTOR
    • -Anterior compartment of leg
    • -Lateral compartment of leg
    • -Foot eversion and dorsiflexion
    • -toe extension

    • 2. SENSORY:
    • -Anterolateral leg and dorsal aspect of foot

    • Typical Injury:
    • -trauma or compression of lateral aspect of leg
    • -fibula neck fracture

    • Signs of Injury:
    • -foot drop
    • -foot slap
    • -steppage gait

    "PED = Peroneal Everts and Dorsiflexes; if injured foot dropPED"
  54. Tibial Nerve
    • Nerve Roots:
    • -L4-S3

    • Innervates:
    • 1. MOTOR
    • -Posterior leg
    • -foot inversion
    • -foot plantarflexion
    • -toe flexion

    • 2. SENSORY:
    • -sole of foot

    • Typical Injury:
    • -knee trauma

    TIP "Tibial Inverts and Plantarflexes, If injured can't stand on TIPtoes"
  55. Superior Gluteal
    • Nerve Root:
    • -L4-S1

    • Innervation:
    • 1. MOTOR:
    • -thigh abduction

    • Typical Injury:
    • -posterior hip dislocation
    • -polio!

    • Injury Sign:
    • -positive Trendeleburg sign: contralateral hip drops when standing on leg ipsilateral to side of lesion
  56. Inferior Gluteal
    • Nerve Root:
    • -L5-S2

    • Innervation:
    • 1. MOTOR

    • Typical Injury:
    • -posterior hip dislocation

    • Injury Signs:
    • -can't jump, climb stairs, rise from seated position
    • -can't push inferiorly (downward)
  57. Anterior Compartment of Thigh
    • Muscles:
    • -Rectus femoris
    • -Vastus medialis
    • -Vastus intermedius
    • -Vastus lateralis
    • -Sartorius

    • Function:
    • -extend the knee joint
    • -flexion of the hip

    • Blood Supply:
    • -Femoral artery

    • Innervation:
    • -Femoral nerve
  58. Medial Compartment of the Thigh
    • Muscles:
    • -Gracilis
    • -Adductor Magnus
    • -Adductor Brevis
    • -Adductor Longus

    • Function:
    • -adduction of the leg

    • Blood Supply:
    • -Obturator Artery

    • Innervation:
    • -Obturator nerve
  59. Posterior Compartment of the Thigh
    • Muscles:
    • -Biceps Femoris
    • -Semitendinosus
    • -Semimembranosus

    • Function:
    • -extension of the hip
    • -rotation of the hip

    • Blood Supply:
    • -perforating arteries (from deep artery of the thigh)

    • Innervation:
    • -sciatic nerve
  60. Anterior Compartment of the Leg
    • Muscles:
    • -Tibialis anterior
    • -Extensor digitorum longus
    • -Extensor hallucis longus
    • -Fibularis

    • Function:
    • -dorsiflexion
    • -foot inversion

    • Blood Supply:
    • -anterior tibial artery
    • Innervation:
    • -deep fibular (peroneal) nerve
  61. Lateral Compartment of the Leg
    • Muscles:
    • -Fibularis longus
    • -Fibularis brevis

    • Function:
    • -foot eversion

    • Blood Supply:
    • -fibular artery

    • Innervation:
    • -superficial fibular nerve
  62. Superficial Posterior Compartment of the Leg
    • Muscles:
    • -Gastrocnemius
    • -Soleus
    • -Plantaris

    • Function:
    • -plantarflexion

    • Blood Supply:
    • -posterior tibial artery

    • Innervation:
    • -Tibial nerve
  63. Deep Posterior Compartment of the Leg
    • Muscles:
    • -Flexor digitorum longs
    • -Flexor hallucis longus
    • -Tibialis Posterior
    • -Popliteus

    • Function:
    • -plantar flexion

    • Blood Supply:
    • -Posterior tibial artery

    • Innervation:
    • -Tibial nerve
  64. Skeletal Muscle Conduction to Contraction
    1. AP depolarization opens presynaptic voltage gated Ca2+ channels, inducing NT release

    2. NT binds to postsynaptic membrane leading to muscle cell depolarization that the motor end plate

    3. Depolarization travels along muscle cell and down the T tubule

    • 4. Depolarization of voltage-sensitive Dihydropyridine receptor results in opening of the ryanidine receptor on the sarcoplasmic reticulum (mechanically coupled or CICR).
    • -induces Ca2+ release from sarcoplasmic reticulum

    5. Released Ca2+ binds troponin C causing a conformational change that moves tropomyosin out of the myosin-binding groove on actin filaments
  65. Sarcomere


    • Z line:
    • -forms the borders of the sarcomere
    • -Z is the last letter of the alphabet, Z band is the last part of the sarcomere

    • M line:
    • -in the Middle of the sarcomere
    • -within the H band

    • A band:
    • -entire length of a single thick filament
    • -A band is Always the same length

    • I band:
    • -only actin (thin filament)
    • -I is a thin letter

    • H band:
    • -only myosin (thick filament)
    • -H is a thick letter

    Contraction results in shortening of H and I bands and between the Z lines (HIZ shrinkage)

    A band remains the same length
  66. Type 1 Muscle Fibers
    Slow Twitch, Red Fibers

    Increased mitochondria and myoglobin concentration → ↑ oxidative phosphorylation

    Allows for sustained contraction

    "1 slow red ox"
  67. Type 2 Muscle Fibers
    Fast Twitch, White Fibers

    Decreased mitochondria and myglobin concentration → ↑ Anaerobic glycolysis

    Weight training results in hypertrophy of fast twitch fibers
  68. Skeletal and Cardiac Muscle Contraction
    • 1. "Cocked State"
    • -ATP hydrolysis cocks the myosin head (not attached to actin)

    • 2. "Cross-Bridged State"
    • -Ca2+ binds troponin C, causing conformational change
    • -this displaces tropomyosin and allows the myosin head to bind actin

    • 3. "Power Stroke State"
    • -Pi is release changing myosin head conformation and causing the power stroke

    • 4. "Released State"
    • -ADP dissociates and ATP binds myosin head, causing release from actin filament
    • -lack of ATP causes rigor mortis
  69. Smooth Muscle Contraction
    1. AP depolarizes SM membrane

    2. Voltage gated Ca2+ channels open leading to increased Ca2+ in the cytoplasm

    3. Ca2+ binds calmodulin and activates MLCK

    4. MLCK phosphorylates actin leading to cross-bridge formation and muscle contraction

    • Inhibition of Smooth Muscle contraction:
    • -NO activates GC, activates cGMP which inhibits MLCK
  70. Endochondral Ossification
    • Location:
    • -bones of axial and appendicular skeleton
    • -base of skull

    1. Cartilaginous model of bone is made by chondrocytes

    2. Osteoclasts and osteoblasts later replace with woven bone and then remodel to lamellar bone

    • Woven bone:
    • -haphazard arrangement of collagen fibers
    • -weak
    • -in adults occurs after fractures and in Paget's disease

    • Lamellar bone:
    • -collagen arranged in sheets
    • -strong
  71. Membranous Ossification
    • Location:
    • -calvarium
    • -facial bones

    1. Woven bone formed directly without cartilage

    2. Later remodeled to lamellar bone
  72. Osteoblasts
    -function
    -origin
    • Function:
    • -blasts build bone
    • -secrete collagen and catalyze mineralization

    • Origin:
    • -differentiate from mesenchymal stem cells in periosteum
  73. Osteoclasts
    -function
    -origin
    • Function:
    • -multinucleated cells that dissolve bone by secreting acid and collagenases

    • Origin:
    • -differentiate from monocytes/macrophages
  74. Parathyroid Hormone
    -low intermittent levels
    -chronic high levels
    • Low-Intermittent levels
    • -anabolic effects (building bone) on osteoblasts and osteoclasts (indirect)

    • Chronic high levels:
    • -ie: primary hyperparathyroidism
    • -catabolic effects (osteitis fibrosa cystica)
  75. Estrogen
    -function
    -deficiency
    • Function:
    • -inhibits apoptosis in bone-forming osteoblasts
    • -induces apoptosis in bone-resorbing osteoclasts

    • Estrogen Deficiency:
    • -ie: surgical, postmenopausal
    • -excess remodeling cycles and bone resorption lead to osteoporosis

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