Arbaminch College Of Health Science

Department of Clinical Nursing

UNIT THREE
Muscular system
3.1. Introduction to Muscular System
The term muscle tissue consists predominantly of contractile cells and produces the
movements of various parts of the body by contraction.
Muscle tissue constitutes about 40% to 50% of total body weight
The muscular system, however, refers to the skeletal muscle system: the skeletal muscle
tissue & connective tissue that makeup individual muscle organs, such as the biceps
brachii muscle.
The scientific study of muscles is known as Myology.
3.2. Types of muscle tissue
- Muscle tissue occurs in three types:
1. Skeletal muscle tissue
 Is a muscle tissue mostly attached to bones and moves parts of the skeleton
 Is Striated (i.e. striations, or have alternating light and dark bands, when visualized under a
microscope) and voluntary, i.e. can be made contract and relax by conscious control
 Has two attachments, an origin(which is usually the more fixed and proximal attachment),
and an insertion(which is the more movable and distal attachment)
 Skeletal muscle tissue has a limited capacity for regeneration
2. Cardiac muscle tissue
 Found only in the heart, forms the bulk of heart wall known as the myocardium.
 Striated and involuntary: its contractions are not under conscious control.
 Is innervated by the autonomic nervous system but contracts spontaneously with
out any nerve supply.
 Includes specialized myocardial fibers that form the cardiac conducting system.
 Cardiac muscle can not regenerate.
3. Smooth muscle tissue
 Located in the walls of hollow internal structures, such as blood vessels, air
ways, stomach & intestines
 It participates in internal processes such as digestion & regulation of blood
pressure.
 Non – striated and involuntary
 Better regeneration capacity than skeletal and cardiac muscles
3.3. Functions of muscle tissue
 Muscle tissue has five key functions
1. Producing body movements: - which rely on the integrated functions of bones joints and
skeletal muscles. Example: walking running writing nodding the head
2. Stabilizing body positions: - Skeletal muscle contractions stabilize joints and help maintain
body positions, such as standing and sitting.
3. Regulating organ volume: - Sustained contractions of ring like bands of smooth muscles
called sphincters prevent out flow of contents of a hollow organ
4. Moving substances within the body
- Cardiac muscle contractions pump blood through the body's blood vessels
- Contraction and relaxation of smooth muscle in the walls of blood vessels helps adjust
their diameter & thus regulates blood flow
- Smooth muscle contraction also
 Move food and other substances through the GI tract
 Push gametes through the reproductive system
 Propel urine through the urinary system
 Skeletal muscle contractions aid the return of blood to the heart

Prepared By: Mesfin Beyene(PHO) , 2003 E.C. 38

Arbaminch College Of Health Science
Department of Clinical Nursing

5. Producing heat (Thermo genesis)

 As muscle tissue contracts it produces heat
 Much of the heat released by muscle is used to maintain normal body
temperature
 Involuntary contractions of skeletal muscles known as shivering can help warm
the body by greatly increasing the rate of heat production
3.4. Characteristics of muscle tissue
Muscle tissue has four principal characteristics that enable it to carry out its functions
and thus contributed
1. Excitability (irritability) _ ability to receive and respond to stimuli
2. Contractibility _ ability to contract (shorten and thicken) when stimulated
3. Extensibility_ ability to stretch (extend) with out being damaged
4. Elasticity _ ability to return to its original shape after contraction or extension
3.5. Muscle Structure
3.5.1. Skeletal muscles
Each skeletal muscle is a separate organ composed of hundreds to thousands of
skeletal muscle cells called muscle fibers because of their elongated shapes.
Connective tissues surround muscle fibers and whole muscles, and blood vessels and
nerves penetrate muscle
A. Connective tissue components
Each muscle has two parts: a connective tissue sheath, called fascia and a fleshy part
known as the belly or gaster
There are two types of fascia.
(1). superficial fascia (subcutaneous layer):-located immediately under the skin & composed of
areolar connective tissue and adipose tissue.
(2). Deep fascia :- a sheath which holds muscles together & separates them in to functional
groups, composed of dense, irregular connective tissue.
There are three connective tissue components that extend from the deep fascia and
cover a skeletal muscle tissue. These are:
i. Epimysium: - a connective tissue sheath that wraps the entire muscle.
ii. Perimysium: - a connective tissue that surrounds and holds bundles of muscle
fibers called fascicles (=little bundle).
iii. Endomysium: - a connective tissue that wraps each individual muscle fiber.
 Epimysium, perimysium and endomysium extend beyond the muscle as a
TENDON, which is a cord of connective tissue that attaches a muscle to a bone.
 A broad sheet of connective tissue that may attach to bones or to other muscles
as in the abdomen or across the top of the skull is called APONEUROSIS
B. Nerve and blood supply
For a skeletal muscle fiber to contract: -
 It must be stimulated by an electrical signal (nerve impulse) called a muscle action potential
It requires large amounts of nutrients and oxygen for ATP synthesis
Moreover the waste products as these ATP producing reactions must be eliminated
 Thus, prolonged muscle action depends on rich blood supply to deliver
nutrients and oxygen and remove wastes
 Generally, an artery and one or two veins accompany each nerve that
penetrates a skeletal muscle.
C. Microscopic anatomy
 Each muscle fiber is a cylindrical cell containing several nuclei, covered by a plasma
membrane called sarcolemma
 The cytoplasm of the fibers called a sarcoplasm is filled with myofibrils.
 Each myofibril is a thread – like structure that extends from one end of the muscle fiber to
the other.

Prepared By: Mesfin Beyene(PHO) , 2003 E.C. 39

Arbaminch College Of Health Science
Department of Clinical Nursing
 Myofibril consists of two types of protein filaments: Actins (thin myofilaments) & Myosin
(thick myofilaments), which are the contractile unit of the fiber.
 The two myofilaments form highly ordered units called sarcomers, which are joined end-to-
end to form the myofibrils.
 Sarcomere is a structural and functional unit of muscle tissue.
 Muscle fibers also have contained a sarcoplasmic reticulum that stores cations and
molecules of myoglobin; which is an oxygen-binding protein found only in muscle fibers.

3.5.2. Cardiac Muscles

- Cardiac muscles fibers often are branched having a Y-shape; are shorter in length & larger in
diameter than the skeletal muscle fibers; and have a single, centrally located nucleus.
- They are interconnect with one another by irregular transverse thickening of the sarcolemma
called intercalated disc; to hold the fibers together & contain gap junctions, which allow muscle
action potentials to quickly spread from one cardiac muscle fiber to another.
- Unlike other muscle tissues, the heart beats b/c some of the cardiac muscle fibers a
pacemaker to initiate each contraction automatically.

3.5.3. Smooth Muscles

- Smooth muscle fibers are considerably smaller in length and diameter than skeletal muscle
fibers & tapered at both ends.
- Within each fiber is a single, oval, centrally located nucleus. In addition to thick & thin
filaments, smooth muscle fibers also contain intermediate filaments.

Table 3.4.4. : Summary of Differences between Muscle Tissues

Characteristics Skeletal Muscle Cardiac Muscle Smooth Muscle
Location Primarily attached to bones Heart Walls of viscera, airways,
by tendons blood vessels & in eyes
Cell appearance & Long cylindrical with many Branched cylinder usually with Spindle-shaped fiber with one,
features peripherally located nuclei; one centrally located nucleus; centrally located nucleus; not
striated; unbranched intercalated disc join striated
neighboring fibers; striated.
Fiber diameter Very large Large Small
Fiber length Very large Small No
Sarcomeres Yes Yes No
Speed of contraction Fast Moderate Slow
Nervous control Voluntary Involuntary Involuntary
Regeneration Limited None Considerable
capacity

3.6. Physiology of Muscle Contraction

3.6.1. Stimulation and contraction of skeletal muscles
Skeletal muscle cells must be stimulated by nerve impulses (by motor neuron) to
contract. One motor neuron may stimulate a few muscle cells or hundreds of them at the
same time. One neuron along with all the muscle fibers it stimulates is called a Motor unit.
As the axon of a motor neuron enters a skeletal muscle it divides in to branches called
Axon terminals, each of w/c forms a gap junction with the sarcolemma of a muscle fiber.
These junctions are called Neuromuscular junctions (NMJ).
The gap b/n sarcolemma & axon terminal  synaptic cleft
When the nerve impulse reaches the axon terminals, a neurotransmitter chemical called
acetylcholine (Ach) is released from synaptic vesicles of a neuron.
Ach diffuses across the synaptic cleft and attaches to receptors on the sarcolemma
Na rush into muscle cells  excess positive ions in the interior of the cell which upsets the
electrical condition of the cell  electrical current called Action Potential is generated and
travels over the entire length of the sarcolemma  contraction of muscle cell results.

Prepared By: Mesfin Beyene(PHO) , 2003 E.C. 40

Arbaminch College Of Health Science
Department of Clinical Nursing
During contraction, myosin heads of the thick filaments pull on the thin filaments,
causing the thin filaments to slide toward the center of sarcomere.
Although the sarcomere shortens because of the increased overlap of thin & thick
filaments, the lengths of the thin & thick filaments do not change. The sliding of filaments &
shortening of sarcomeres in turn cause the shortening of the muscle fibers.
This process, the sliding-filament mechanism of muscle contraction, occurs only when:
a). the level of calcium ions (Ca2+) is high enough (should be released from the sarcoplasmic
reticulum to the sarcoplasm)
b). ATP is available for active transport of Ca2+.
3.6.2. Relaxation of Muscle
- Two changes permit a muscle fiber to relax after it has contracted:
i).The neurotransmitter Ach is rapidly broken down by the enzyme Acetyl cholinesterase (AchE).
ii). Calcium ions are rapidly transported from the sarcoplasm into the sarcoplasmic reticulum.
3.6.3.Types of muscle contraction
Muscle contractions are classified as either
1. Isotonic, or
2. Isometric
 Isotonic contraction _ shortening of muscle occurs with constant amount of tension
Example: - Movement of fingers to make a fist
 Isometric contraction_ the length of the muscles does not change, but the amount of tension
increases during the contraction process.
Example:- Clenching the fist harder and harder
3.7. Muscle Attachments
- Most muscles extend from one bone to another & cross at least one movable joint.
- Some muscles are not attached to bone at both ends. For example, some facial muscles
attach to the skin, w/c moves as the muscles contracts.
- The point of attachment of each muscle is its origin and insertion, where at this point the
muscle is connected to the bone by a tendon.
-The origin is the most stationary end of the muscle and the insertion is the end of the muscle
attached to the bone undergoing the greatest movement.

3.8. Naming of Skeletal Muscles

Most of the skeletal muscles are named according to one or more of the following principles:
i. Direction of the muscle fibers relative to the longitudinal axis of midline of the body.
- Rectus:- have parallel fibers to the midline of the body, eg. Rectus abdominis
- Transverse:- perpendicular fibers to the midline, eg. Transverse abdominis
- Oblique:- fibers run diagonally, eg. External oblique
ii. Location or structure to which a muscle is found closely related, Example;
- Frontal:- a muscle near the frontal bone
- Tibialis anterior:- a muscle near the front of tibia
iii. Size:- the relative size of the muscle
- Maximus:- means largest, eg. Gluteus maximus
- Minimus:- means smallest, eg. Gluteus minimus
- Longus:- means longest, eg. Adductor longus
- Brevis:- means short, eg. Peroneous brevis
iv. Number of origins or the number of tendons of origin, for example
- Biceps:- means two origins, eg. Biceps brachii
- Triceps:- means three origins, eg. Triceps brachii
- Quadraceps:- four origins, eg. Quadriceps femoris
v. Shape
- Deltoid:- means triangular, eg. Deltoid muscle
- Trapezius:- means trapezoid, eg. Trapezius
- Serratus:- means saw-toothed, eg. Serratus anterior
- Rhomboideus:-

Prepared By: Mesfin Beyene(PHO) , 2003 E.C. 41

Arbaminch College Of Health Science
Department of Clinical Nursing

vi. Origin & insertion, for example

- Sternocleidomastoid:- originates on sternum & clavicle and inserts on mastoid process
vii. Action:- based on their principal action of the muscle
- Flexor _ muscle decreasing the angle at a joint, eg. Flexor carpiradialis
- Extensor_ increasing the angle at a joint, eg. Extensor carpiradialis
- Abductor _ moving a bone away from the midline, eg. Abductor policis brevis
- Adductor_ moving a bone closer to the midline, eg. Adductor longus
- Rotator _ moving a bone around its longitudinal axis, eg. Obturator externus
- Levator _ producing an upward movement, eg. Levator labii superioris
- Depressor_ producing an upward movement, eg. Depressor labii inferioris
- Pronator _ turning the palm downward or posteriorly, eg. Pronator teres
- Supinator _ turning the palm upward of anteriorly, eg. supinator
- Sphincter _ controlling the size of an opening, eg. External anal sphinicter
- Tensor _ Making a body part more rigid, eg. Tensor fasciae latae

Table 3.9.: Show: Different Types of Muscles with Their Attachments & Action

Muscles Location Muscle Type Origin Insertion Action

- Occipitofrontalis Occipital bone Skin of eye brow Elevates eye brow
- Orbicularis occuli Maxilla, frontal Skin around the eye Closes eye
Face
- Extrensic eye muscles Orbit of the eye On eye ball Eye ball movements
&
Neck Face - Orbicularis oris Maxilla, mandible Skin around the lips Closes lips
Muscles - Temporalis Temporal bone Mandible Closes the jaw
- Buccinator Mandible & maxilla Corner of the mouth Whistling & aids chewing
- Massater Zygomatic bone Mandible Closes jaw in chewing
- Trapezius Occipital, vertebrae Scapula, clavicle Support & rotates scapula
Neck - Sternocleidomastoid Sternum, clavicle Mastoid process Rotates head & flexes neck
- External intercostals Infer. Border of rib Super. border of rib ↑es thorax dimension during
above below forceful inhalation
Chest
(respiratory) - Internal intercostals Super. border of rib Infer. Border of rib ↓es thrax dimension during
below above forceful exhalation
- Diaphragm Sternum, last 6 ribs Central tendon ↑es vertical length of thorax
during inhalation
- Pectoralis major Strenum,ribs,clavicle Humerus(tubercle) Adduct & flexes arm
Chest
Chest - Latismus dorsi Vertebrae Humerus(tubercle) Adducts & extends arm
and
(for UL)
Upper - Teres major Scapula Humerus(tubercle) Adducts & extends arm
Limb - Infarspinalis Scapula Humerus(tubercle) Extends arm
Muscles
- Deltoid Scapula, clavicle Humerus(shaft) Abducts, flexes & extends arm
- Brachialis Humerus(shaft) Ulna(coracoid Flexes forearm
Arm process)
- Biceps brachi Scapula(coracoid Radial tuberiosity Flexes forearm
process)
- Triceps brachi Humerus,scapula Ulna(olicranon proc.) Extends forearm
- Anterior forearm msc's Medial epicondyle Bones of hand Flex wrist & fingers
Forearm - Posterior forearm msc' Lateral epicondyle Bones of hand Extend wrist & fingers
Hand - Inrinsic hand msc's Carpals, metacarpals phalanges Abduct, adduct, flex & extend
fingers
Abdomen Back - Erector spinae Ilium, sacrum Superior vertebrae Extend & abduct vertebrae

Prepared By: Mesfin Beyene(PHO) , 2003 E.C. 42

Arbaminch College Of Health Science
Department of Clinical Nursing
& - Rectus abdominis Pubis Xiphoid-process Flex vertebrae, compress abdomen
Back - Transverse abdominis Rib cage, vertebrae Xophoid p., vertebr. Compresses abdomen
Muscles Abdomen
- External oblique Rib cage Iliac crest, fascia of Flex & rotate vertebrae &
recttus Abdominis compress abdomen
- Internal oblique Iliac crest, vertebrae Ribs, fascia of rectus “ “ “
abdominis
- Tensor fascia latae ASIS 0f ilium Tibia(lateral epicond) Abduct thigh
- Adductor msc's of thigh Pubis Femur Adduct thigh
- Gluteus maximus Ilium, sacrum, cocyx Femur(lateral side) Extends & abducts thigh
Buttock
& - Gluteus midius Ilium Femur(trochanter) Abducts thigh
Lower Anterior - Quadriceps femoris ASIS Tibial tuberiosity Extends leg & flexes thigh
Limb & ASIS Tibia
- Sartorius Flexesleg & thigh
Muscles Posterior
Thigh - Hamstring muscles Ischium, femur Fibula Flexes leg & extends thigh

- Tibialis anterior Tibia Tarsus, metatarsal Dorsiflexes foot

LL Leg & - Deep anterior leg msc's Tibia , fibula Bones of foot Extends toes
Foot
- Deep posterior leg msc's Tibia, fibula Bones of foot Evert foot
- Intrinsic foot msc's Tarsals,metatarsal Bones of foot “ , flex & extend toes

 Some of the most important muscles of the human

body with their functions
The deltoid muscle
Fleshy, triangle shaped muscles that form the rounded curve shape of your shoulders
Because it is so bulky, it is a favorite injection site when a relatively small amounts of
medication (<5ml) must be given IM.
Gluteus maximums
Gluteus maximums
 Superificial muscle of the hip that forms most of the flesh of the buttock
 Powerful hip extensor that acts to bring the thigh in a straight line with the pelvis
Gluteus medius
 Runs from the ileum to the femur beneath the gluteus maximums
 Is a hip abductor and is important in steadying the hip during walking
 Is an important muscle for giving IM injection, particularly when > 5ml is administered the
medial part of each buttock, which contains the large, fleshy gluteus maximums, overlies the
large sciatic nerve, injection on the area needs safety of site selection. This can be
accomplished by mentally dividing the buttock into four equal quadrants. The upper outer
quadrant (UOQ) then overlies the gluteus medius muscle, which is usually a very safe site
for an IM injection.
Vastus lateralis
 One of the four muscles forming the quadriceps
 Together with other muscles of the quadriceps, it acts to extend the knee powerfully
 Vastus lateralis & rectus femoris (the other muscle forming the quadriceps) are sometimes
used as IM injection sites, particularly in infants, who have poorly developed gluteus
muscles.

Prepared By: Mesfin Beyene(PHO) , 2003 E.C. 43

Arbaminch College Of Health Science
Department of Clinical Nursing
3.10. Weak places in the abdominal wall

There are weak places in the abdominal wall at sites where there is interruption of discontinuity
of the abdominal muscle. The usual sites of these areas are:-
1. The umbilicus _ a small scar on the abdomen that marks they former attachment of the
umbilical cord to the fetus
2. Inguinal canal:- An oblique canal in the lower part of the anterior abdominal wall above
the medial part of the inguinal ligament, which is about
4 cm in length
- It extends from the deep inguinal ring laterally to the superficial inguinal
ring medially
3. Femoral ring:- The mouth of the femoral canal, which is the medial compartment of the
femoral sheath

 The protrusion of an organ or part of an organ (example, the intestine) through these
weak places in the abdominal wall is called HERNIA
 There are different types of hernia often depending on the site where it appeared; such
as umbilical hernia, diaphragmatic(hiatal) hernia, inguinal hernia, femoral hernia etc…
 Diaphragmatic(Hiatal) hernia: is the protrusion of the lower esophagus, stomach,
or intestine into the thoracic cavity through the esophageal hiatus.
 Inguinal hernia: protrusion of the contents through the inguinal canal below the
inguinal ligament.
Classification:
 Indirect type: passes through internal inguinal ring along the inguinal canal.
May extend down to the scrotum.
 Direct type : Bulges through the post wall of inguinal canal
 Umbilical hernia: develop at the umbilical ring and may be present at birth or
develop gradually during the life of the individual.
 Femoral hernia: is a protrusion of the content through the femoral ring.
 Important terminologies
Hernial sac - is an out pouch of the peritoneum.
Content - is a viscus or any other organ inside a sac. It can be:
- Small bowel and omentum – the commonest
- Large bowel appendix
- The bladder
Reducible hernia- when the protruded viscus can be returned back to the abdomen
Irreducible hernia- when the contents can’t be returned back
Obstructed hernia- the content of the hernia (intestine) is occluded but no impairment of
vascular supply
Strangulated hernia- when the vascularity of protruded viscus is impaired
Richter’s hernia- when only one side of the wall of the intestine is herniated. Here
strangulation of the bowel can occur with out intestinal obstruction
Sliding hernia- when an extra peritoneal structure form part of the wall of the sac

Prepared By: Mesfin Beyene(PHO) , 2003 E.C. 44