Миология


О.В. КАЛМИН
О.А. КАЛМИНА
Т.Н. ГАЛКИНА





                МИОЛОГИЯ




Учебное пособие












Москва ИНФРА-М 2019

УДК 611.73(075.8)
ББК 28.706я73

           ФЗ № Издание не подлежит маркировке 436-ФЗ   в соответствии с п. 1 ч. 2 ст. 1

         К17


Рекомендовано к изданию методической комиссией Медицинского института Пензенского государственного университета (протокол № 3 от 13.11.2014)

      Рецензенты:
           Е.А. Анисимова — доктор медицинских наук, профессор кафедры анатомии человека Саратовского государственного медицинского университета имени В. И. Разумовского;
           И.Н. Чаиркин — доктор медицинских наук, профессор, заведующий кафедрой нормальной анатомии с курсами топографической анатомии и судебной медицины Мордовского государственного университета имени Н. П. Огарева


     Калмин О.В.

К17       Миология : учеб. пособие / О.В. Калмин, О.А. Калмина, Т.Н. Галкина.
      — М. : ИНФРА-М, 2019. — 165 с.


       ISBN 978-5-16-107896-9 (online)

               Пособие содержит в кратком систематизированном виде сведения о мышечной системе. Приводятся данные о мышечных группах, начале и прикреплении, функции, иннервации и кровоснабжении отдельных мышц, фасциях частей тела человека. Приводится описания и схемы основных клетчаточных пространств и мышечных каналов тела человека.
               Издание предназначено для аудиторной и внеаудиторной работы для студентов медицинских специальностей вузов.

               The manual contains brief systematic information about the muscular system. The data on the muscle groups, beginning and attachment, functions, innervation and blood supply of the individual muscles, fascia of the human body parts. A description and diagram of basic cellular spaces and muscle channels of the human body are given.
               The manual is intended for classroom and extracurricular work for medical students.


УДК 611.73(075.8)
ББК 28.706я73


         ISBN 978-5-16-107896-9 (online)     © Калмин О.В., Калмина О.А.,
Галкина Т.Н., 2019

                               Contents



       Introduction ....................................................... 4
       Muscles of the head................................................ 13
       Fasciae of the head ............................................... 22
       Fatty tissue spaces of the head ................................... 29
       Muscles of the neck................................................ 42
       Fasciae of the neck ............................................... 49
       Topographic anatomy of the neck.................................... 56
       Fatty tissue spaces of the neck ................................... 61
       Muscles of the thorax ............................................. 65
       Fasciae ofthe thorax ............................................... 69
       Fatty tissue spaces of the thorax................................... 72
       Diaphragm ......................................................... 73
       Muscles of the abdomen............................................. 75
       Fasciae of the abdominal region ................................... 83
       Topographic anatomy of the abdomenal walls .........................84
       Muscles of the back................................................ 88
       Fasciae of the back ................................................ 96
       Muscles of the upper extremity.................................... 102
       Fasciae of the upper extremity ................................... 115
       Topographic anatomy of the upper extremity........................ 123
       Muscles of the lower extremity.................................... 129
       Fasciae of the lower extremity ................................... 145
       Topographic anatomy of the lower extremity.......................... 153
       Review of movements in the joints ................................ 160
       References ........................................................165

            INTRODUCTION



           The human body has about 637 muscles: 316 of them are paired and 5 -unpaired. Muscles in the body perform many functions: 1) carry out the function of external and internal motion; 2) compose the 35-45% of the human body weight and therefore play a major role in the metabolism; 3) are involved in heat production; 4) are involved in blood circulation; 5) are the part of the proprioceptive sensitivity, or the muscular sense; 6) form the relief of the body together with the bones.
           Each skeletal muscle is an organ that has a proper muscle part (active body or abdomen), belly (venter), and tendinous (passive) part, tendo, and a system of connective tissue membranes, and is provided with vessels and nerves.
           The striated muscle fiber is a specific element of skeletal muscle tissue. Muscle fibers are elongated, their length ranges from a few millimeters up to 10-15 cm. Thickness of fibers in the adult is 40-70 microns, and in individuals who engaged in sports systematically - 100 microns. Muscle fiber is surrounded by a thin membrane - the sarcolemma. There is a sarcoplasm inside the fiber, in which the myofibrils are arranged, that are the specialized structures of contractile fibers. One muscle fiber is formed of the 100 to 1000 myofibrils, which are located along the fiber axis. The diameter of a single myofibril is 12 microns. Myofibrils consist of alternating light and dark areas, called discs. Disks have different optical properties. Bright disks have a simple refraction (isotropic disks), and dark - birefringent (anisotropic disks). These differences depend on the submicroscopic organization of myofibrils. Myofibrils consist of 1500-2000 protofibrils. Protofibrils are composed of proteins actin and myosin, which have a certain spatial configuration. In the basis of the muscle fibers contractility there are changes of the configuration of these molecules. Actin molecules are drawn into the interstices between the molecules of myosin, thereby shortening myofibrils and all muscle fibers.
           Striated muscles have a system of connective tissue membranes. Individual fibers surrounds loose connective tissue, called the endomysium (en-domysium). Adjacent fibers forms together in bundles of 1st order, and they are grouped into larger bundles of 2ⁿd order of which there are more large bundles of 3rd order. Connective tissue surrounding the bundles of all orders is perimysium (perimysium). In perimysium arranged branching vessels and nerves that supply the muscle. The layer of connective tissue covering the muscle from the outside, called epimysium. Connective envelope not only mechanically connects the muscle fibers and bundles, but also make it possible to move them relative to each other during contracting. Membranes allow the muscle to contract as a whole, only the muscle bundles or fibers.
           Tendons consist of collagen fibers of which the ligaments are built. The tendon fibers penetrate the muscle membrane and are closely related to the

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     muscle fibers. Endomysium, perimysium and epimisium pass in tendon and become endotendinium (endotendineum), peritendinium (peritendineum) and epitendinium (epitendineum). Therefore, the tendon cannot be separated from the muscle without damaging the muscle's abdomen. In most of the muscles, especially in the limbs, the tendons are in the form of elongated cylindrical strands. On the trunk, some muscles form the lamellar tendinous stretchings, called aponeurosis (aponeurosis). The transformation of abdominal muscle in a tendon is continuous.
           The vascular gates are located proximal to the geometric center of the muscle, which include arteries and nerves (into the muscle), and veins (out of the muscle). Muscle receives its blood supply from the surrounding arteries. Blood vessels branch out, and then go to perimysium strata along the muscle bundles. In the bundles of the 1st order the arterioles branch onto the capillaries which penetrate into bundles and entwist by longitudinal loops each muscle fiber, propagating in the endomysium.
           There are 3 types of nerve fibers in the muscle: 1) motor - by them the impulses are transmitted to the muscle, causing contraction of striated fibers; 2) sensitive - carry impulses of proprioceptive sensitivity from the muscle; 3) sympathetic - regulate blood circulation and metabolism.
           The set of muscle fibers innervated by a single motor nerve fiber, called motor unit (myon). Myon is a structural unit of the muscle. Muscles can contract by separate myons. In muscle with different dynamics and subtlety of functions differentiation myons consist of a relatively small number of muscle fibers. In the muscles with more or less standard function, the main significance of which is not a dynamic function of the motion, but the static function of holding, in muscles with positional function more muscle fibers included in myon. Fibers belonging to the same myon are not always located nearby; they usually alternate with fibers of other myons.
           Every muscle has a beginning (origo) and insertion (insertion). On the extremities the beginning of the muscle lies proximal and insertion - distally. On the trunk - the beginning lies medial, and insertion - lateral. These places are constant in muscle and remain in place.
           During the muscle contraction, one of the end is fixed. This is a punc-tum fixum. The other one moves with the bone to which it is attached. This is a punctum mobile. Mobile point is always attracted to a fixed point. In contrast to the beginning and muscle insertions, these terms can be interchanged. One and the same end of the muscle can be now fixed, then moving.
           Muscles are divided by their position in the human body, by the form, by the fiber orientation, by the function, by relative to the joints:
           1.        According to the structure or the number of heads: the fusiform muscles are more common. They have a clearly apparent belly (venter), head and tail. The muscles may have two, three or four heads, and two venters.
           2.        By the shape: square, triangle, circle.

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        3.       By length: long, short and wide.
        4.        By the course of the muscle fibers: a parallel course, an oblique course (cirrus) - unipennate, bipennate, multipennate (fan-shaped).
        5.        By functions: flexors and extensors, abductors and adductors, supinators and pronators, constrictors (sphincters), straining, elevating and lowering.
        6.        Toward the joints, through which the muscles are thrown: one, two, or multiarticular. Multiarticular muscles are located more superficially than monoarticular, as they are longer.
        7.       By position: superficial and deep, outer and inner, lateral and medial.
        Muscles are equipped with an accessory apparatus. The accessory apparatus of muscles include fasciae, synovial bursae, fibrous and synovial tendon’s sheath, muscle blocks and sesamoid bones.
        The fasciae are the shell constructed of loose or dense fibrous connective tissue that covers the muscles, forms the sheaths to blood vessels and nerves and surrounds various organon. Fasciae are divided into superficial and deep.
        Superficial fascia (fascia superficialis) is located under the skin and connected to it by connective tissue tenia. In those places where the skin has more pressure from the outside, superficial fascia merges with the underlying tissues.
        Deep fascia (fascia profunda) covers parts of the body and is called in these areas: cervical fascia, pectoral fascia, axillary fascia, etc. Deep fascia forms the sheaths for the individual muscles and muscle groups. On the edge of the muscles or muscle groups fascia merges with the bone. In the contact points between the fascia covering the adjacent muscles or muscle groups, there is a fusion of the fascia, and intermuscular septum formed, which, in turn, is fused with the bone. As a result the closed osseous and fibrous sheaths for muscle is forming.
        Fasciae play an important supporting function. Together with the fatty tissue, they form so called soft stroma of the body. Fasciae are the places of starting and attaching of many skeletal muscles. In certain places under the effect of lateral pressure of tendons the fasciae become thicker, forming a retinaculum under which the tendons pass.
        The synovial bursae (bursae synoviales) are the small cavities lined with synovial membrane and containing synovia. Synovial bursae reduce friction and pressure on tissue and thereby facilitate the movements. They can be single-chamber and multi-chamber. There are several types of synovial bursae depends on their localization:
        1.        Subcutaneous bursae are located in the subcutaneous tissue between the skin and the bone, usually over the bone prominences.
        2.       Subfascial bursae are similar to subcutaneous.
        3.        Axillary bursae are formed where the muscles pass over the exuberance of the bones.

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          4.       Subtendon bursae are located between the tendons of the muscles and bones or lay between the near placed tendons.
          Tendon’s sheaths (vaginae tendinum) are fibrous and synovial. Fibrous tendon’s sheaths (vaginae tendinum fibrosae) represent the channels, that limited by thickened fascia, in which the tendons pass.
          Synovial tendon’s sheaths (vaginae tendinum synoviales) have a more complex structure. They represent a sleeve with double-walled, that put on the tendon. Parietal (outer) and tendinous (inner) part of the sheaths are lined with synovial layer, there is a cavity between them that contains synovia. Tendinous portion of the synovial’s sheath is adherent to the tendon. It is connected to the parietal part by special folds, called mesotendon (mesenterium of the tendon). In mesotendon there are blood vessels and nerves that supply the tendon. Synovial’s sheaths are located in places where tendons of several muscles are placed in a close distance.
          The blocks of muscles are the bone projections that have a groove covered with cartilage for tendon, and are located in places where tendons change the direction.
          The sesamoid bones (ossa sesamoidea), being included in the muscle's tendons increase the angle at which the tendon attaches to the bone, and this increases the traction force of the muscle.

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Fig. 1. The names of the muscles on the features of their structure (Ivanitsky M. F., 1985):

  1 - two-bellied muscle; 2 - semimembranosus muscle; 3 - semitendinous muscle; 4 - twoheaded muscle (of arm); 5 - three-headed muscle (of crus); 6 - four-headed muscle (of thigh)

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Fig. 2. The names of the muscles on their form (Ivanitsky M. F., 1985):

      1 - deltoid muscle; 2 - rhomboid muscle; 3 - quadrate muscle (of thigh); 4 - trapezius muscle; 5 - serratus muscle (serratus anterior); 6 - salens muscle; 7 - piriform muscle; 8 -lumbrical muscles; 9 - orbicular muscle (of eye); 10 - pyramidal muscle; 11 - teres muscle (teres major); 12 - triangular muscle

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 Fig. 3. The names of the muscles according to their function (Ivanitsky M. F., 1985):

  1 - flexor muscle (flexor pollicis longus); 2 - extensor muscle (extensor pollicis longus); 3 - abductor muscle (abductor pollicis brevis); 4 - adductor muscle (adductor brevis); 5 -pronator muscle (pronator quadratus); 6 - supinator muscle (supinator); 7 - erector muscle (levator scapulae); 8 - depressor muscle (depressor septi nasi); 9 - tensor muscle (tensor fasciae latae); 10 - masseter muscle (masseter); 11 - sphincter muscle (external anal sphincter); 12 - dilator muscle (dilator pupillae)

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Fig. 4. Features of the internal structure of the muscle (Ivanitsky M. F., 1985):
1 - fusiform muscle; 2 - unipennate muscle; 3 - bipennate muscle; 4 - multipennate muscle

Fig. 5. Examples of muscle in relation to joints (Ivanitsky M. F., 1985):

1 - single-joint muscle (anconeus); 2 - diarticular muscle (rectus femoris); 3 - multiarticu-lar muscle (flexor hallucis longus)

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