INDIVIDUAL ASSIGNMENT

DERMATOMUSCULOSKELETAL
2 year / 3st Semester / 2021 / FMUI 2020
st

Mohamad Arbian Karim

2006489400 – Group A

PBL Trigger 3

How is The Normal Anatomy, Physiology of The Arm Muscle

Introduction
The arm, also known as the upper extremity, is a functional unit of the upper body. The upper
arm, forearm, and hand are the three components. The arm can also be divided anatomically
into the shoulder, arm, elbow, forearm, wrist, and hand. It has 30 bones and stretches from
the shoulder joint to the fingertips. There are numerous nerves, blood vessels (arteries and
veins), and muscles in the brain. The brachial plexus, one of the two primary nerve plexuses
in the human body, supplies the nerves of the arm.1,2

The upper arm is referred to as the brachium in Latin. This section of the upper limb houses
robust muscles that carry out a significant chunk of upper limb function. The brachial plexus
neurons, as well as other essential peripheral nerves, flow via the upper limb. The brachial
artery is the most significant blood vessel in the upper limb, with branches supplying the
whole upper limb. Because of the above-mentioned important structures, an injury to the
upper arm might result in significant issues across the upper limb which could explain the
damage resulted in the patients right arm.2

In this LTM, we will discuss in detail about the anatomy and physiology of the arm muscle.

Topics Discussion
A. Anatomy of The Arm Muscle

1. Shoulder

Because of the glenohumeral joint's articulation, the shoulder is anatomically and

functionally complicated. It is one of the most freely mobile parts of the human
body. It houses the shoulder girdle, which, through the sternoclavicular joint, joins
the upper limb to the axial skeleton. The shoulder's tremendous range of motion
comes at the price of the joint's stability, making it prone to dislocation and
damage.3

a. Structure and Function

The clavicle and scapula form the shoulder girdle, which articulates with
the upper limb's proximal humerus. The sternoclavicular (SC),
 acromioclavicular (AC), and scapulothoracic joints, as well as the
glenohumeral joint, make up the shoulder.3

The single joint that joins the upper limb to the axial skeleton is the
sternoclavicular joint, which is a synovial saddle joint. It links the clavicle
to the sternum's manubrium and is supported by the costoclavicular
ligament. The acromioclavicular joint joins the scapula's acromion to the
clavicle in a planar synovial joint. The coracoclavicular ligament is the
primary stabilizer, with the supra and inferior acromioclavicular ligaments
acting as supplementary stabilizers. The scapulothoracic joint is the
articulation of the scapula sliding across the posterior thoracic cage, rather
than a genuine joint.3

The glenohumeral joint is a highly mobile ball-and-socket synovial joint

that is supported by the rotator cuff muscles, as well as the biceps and
triceps brachii tendons, which attach to the joint capsule. The glenoid fossa
of the scapula articulates with the humeral head. Because the fossa only
holds around one-third of the humeral head, it is a shallow articulation.
The labrum is a fibrocartilaginous ring that adheres to the glenoid fossa's
outside border and adds depth and support to the humeral head. A small
number of fluid-filled sacs known as bursae surround the capsule and aid
in mobility. These are the subacromial, subdeltoid, subscapular, and
subcoracoid bursae.3

b. Blood Supply

The axillary artery is the shoulder's main blood vessel, with multiple
branches feeding the region. The superior thoracic artery, thoracoacromial
artery, lateral thoracic artery, subscapular artery, anterior humeral
circumflex artery, and posterior humeral circumflex artery are all branches
of the superior thoracic artery.3

c. Nerves

The subscapularis muscle is innervated by the upper and lower branches of

the subscapular nerve. The supraspinatus and infraspinatus muscles are
both innervated by the suprascapular nerve. The teres minor is supplied by
the axillary nerve's posterior branch. The deltoid muscle is also innervated
by the axillary nerve. The spinal accessory nerve/11th cranial nerve
supplies the trapezius, with some direct branches from the cervical plexus.
C3-C5 innervates the levator scapula. The dorsal scapular nerve provides
the rhomboids' nerve supply. The long thoracic nerve provides neural
supply to the serratus anterior. The medial and lateral pectoral nerves
supply the pectoralis major muscle.4
 Fig. 1 Arm Nerves.2
d. Muscles

The rotator cuff muscles are the main muscle group that supports the
shoulder joint. The supraspinatus, infraspinatus, teres minor, and
subscapularis are the four rotator cuff muscles. As they insert on the
proximal humerus, the rotator cuff muscles form a musculotendinous cuff.4

The greater tuberosity is where the rotator cuff muscles join to the
proximal humerus anteriorly. By articulating with the scapula inside the
glenoid cavity, the rotator cuff muscles offer significant structural support
to the glenohumeral joint and keep the humeral head in a strong posture.
The chest muscles also help to support the shoulder joint structurally.4

The supraspinatus originates in the supraspinatus fossa above the scapula's

spine, crosses the shoulder joint, passes beneath the coracoacromial arch,
and inserts at the larger tubercle of the humerus above the glenohumeral
joint. The supraspinatus muscle helps to stabilize the glenohumeral joint
by abducting the humerus up to 30 degrees.4

The infraspinatus muscle originates from the infraspinatus fossa behind the
scapula's spine and attaches below the supraspinatus tendon on the larger
tubercle of the proximal humerus. The infraspinatus muscle rotates the
humerus from the outside.4

The teres minor muscle originates from the inferior portion of the dorsal
scapula at the lateral edge of the scapula, just inferior to the infraspinatus.
Below the infraspinatus, the teres minor inserts on the larger tubercle of
the humerus. The Teres minor rotates the humerus externally and aids in
humeral abduction.4

The subscapularis originates in the scapula's subscapular fossa and inserts

on the humerus's lesser tubercle as well as a piece of the anterior capsule
of the shoulder joint. The muscle is separated from the scapula's neck by a
vast bursa; the subscapularis rotates and abducts the humerus internally.4

The rhomboid minor originates from the nuchal ligament and spinous
processes of C7-T1. T2-T5's spinous processes give rise to the rhomboid
major. The rhomboid muscles attach to the medial edge of the scapula and
function along with the levator scapulae muscles to raise the scapula's
medial border. The lower trapezius, which is supported by gravity in the
upright posture, is the only muscle that serves to depress the shoulder.4

The trapezius is a big triangular-shaped muscle that runs down the back of
the shoulder. The trapezius muscle arises from the superior aspect of the
nuchal line in the occipital, cervical, and upper thoracic regions and inserts
at the lateral aspect of the clavicle, acromion, and scapula spine.
Depending on whether the upper or lower muscle fibers are recruited, the
trapezius muscle may both elevate and depress the shoulder. The fibers are
geometrically opposed and the forces are balanced when the complete
trapezius muscle contracts, resulting in no shoulder movement.4

The deltoid muscle is located on the outside of the shoulder and is

responsible for abducting the humerus. The deltoid muscle has three
origins: the clavicle's body, the scapula's spine, and the acromion. The
insertion of the deltoid muscle is on the deltoid tuberosity of the humerus.
The deltoid muscle's function varies depending on which muscle fibers are
engaged. The anterior deltoid flexes and rotates the humerus medially, the
middle deltoid abducts the humerus, and the posterior deltoid extends and
rotates the humerus externally.4
 Fig. 2 Shoulder Joint and Shoulder Muscles.5

2. Anterior and Posterior of The Upper Arm Compartment

a. Structure and Function

Biceps brachii, coracobrachialis, and brachialis are muscles in the anterior

fascial compartment. The three heads of the triceps muscle are housed in
the posterior fascial compartment muscle. The anterior compartment of the
arm is responsible for forearm flexion, while the posterior compartment
contains the forearm extensors.2,6

b. Blood Supply

The anterior compartment of the arm is supplied by the brachial artery,

whereas the posterior compartment is supplied by the profunda brachii.6
Fig. 2 Brachial Artery and Branches.7

Fig. 3 Profunda Brachii Artery.8

c. Nerves and Muscles

Biceps brachii is a muscle in the upper arm. Major forearm flexion,

supination, and resistance to shoulder dislocation are the functions of this
muscle.  Short head originates from the coracoid process. The long head is
from the scapula's supraglenoid tubercle.  Insertion is in the Forearm fascia
and radial tuberosity (as bicipital aponeurosis).  Musculocutaneous
nerve (C5, C6) innervates this muscle.6

The brachialis muscle’s function is flexion of the forearm. The distal

anterior humerus is its origin. The insertion is at the coronoid process and
ulnar tuberosity. Musculocutaneous nerve (C5, C6, C7 small contribution)
innervates this muscle.6

The function of Coracobrachialis are flexion and adduction of the arm. The
origin is at the coracoid process. Insertion of this muscle is at the middle of
the humerus, on its medial aspect. Musculocutaneous nerve (C5, C6, C7)
innervates this muscle.6

The functions of the triceps brachii are as a major extensor of the forearm
and resisting dislocation of the shoulder. The origin for lateral head is
above the radial groove, for medial head is below the radial groove, for
long head is at the infraglenoid tubercle of scapula. Olecranon process of
ulna and forearm fascia are where the insertion is at. Innervation is from
the radial nerve (C6,C7,C8).6

The function of the anconeus are as an extension of forearm and

stabilization of elbow joint. Origin is at the lateral epicondyle of humerus.
Insertion is at the olecranon process and posterior ulna. Innervation is from
the radial nerve (C7, C8, T1).6
 Fig. 4 Ventral Muscles of The Upper Arm5

3. Forearm

a. Structure and Function

The upper extremity's forearm goes from the elbow to the wrist. The
forearm is made up of two bones: the radius laterally and the ulna
medially. It is divided into two compartments: anterior (flexor) and
posterior (extensor) (extensor). There are twenty muscles in total between
the two compartments.9

The elbow, forearm, wrist, and fingers of the hand are all moved by the
forearm or antebrachium muscles. Intrinsic and extrinsic muscles are the
two types of muscles. By pronating and supinating the radius and ulna, the
intrinsic muscles move the forearm. The digits of the hand are flexed and
extended by the extrinsic muscles. The brachioradialis, a muscle that runs
 from the arm to the wrist and helps to flex the elbow, spans the elbow
joint.9

b. Blood Supply

The brachial artery separates into two terminal branches as it goes down
the arm and past the elbow: the radial artery and the ulnar artery. The
blood supply for the whole forearm and hand is provided by these two
arteries.9

Just distal to the radial head, the radial artery sends off the recurrent radial
branch, which returns up the arm to establish an anastomosis with the
radial collateral of the deep brachial artery. The supinator and
brachioradialis muscles get blood from the recurrent radial branch. The
radial artery then travels down the forearm to the wrist, wrapping
posteriorly before entering the hand.9

As it travels through the elbow, the ulnar artery splits into two recurrent
branches, the anterior and posterior. These two arteries branch off the deep
brachial artery and form anastomoses with the inferior and superior
collateral arteries. The pronator teres and brachialis get blood from the
anterior ulnar recurrent artery, whereas the proximal sections of the flexor
muscles, bones, and elbow joint receive blood from the posterior ulnar
recurrent artery. The ulnar artery gives rise to the common interosseous
branch, which divides into the anterior and posterior interosseous arteries
after giving off the recurrent branches. These arteries are named after the
side of the interosseous membrane on which they flow. The anterior
interosseous branch provides blood to the flexor compartment muscles. It
will ultimately penetrate the interosseous membrane and anastomose with
the posterior interosseous artery, which provides the blood supply for the
extensor compartment of the forearm, as it travels down the forearm.9

c. Nerves

The median, ulnar, and radial nerves are the three primary nerves in the
forearm. The skin is additionally innervated by three nerves (medial,
lateral, and posterior cutaneous nerves). The brachial plexus in the axillary
area of the arm branches into these nerves, which go down the upper
extremity to the hand. The flexor compartment muscles are innervated by
the median and ulnar nerves, whereas the extensor compartment muscles
are innervated by the radial nerve.9

The anterior interosseous nerve is one of the primary branches of the

median nerve. The flexor pollicis longus, a portion of the flexor digitorum
profundus, and various muscular branches that travel straight to flexor
compartment muscles are all innervated by this nerve. The ulnar nerve
does not have any terminal branches until it reaches the hand, but it does
feed the flexor carpi ulnaris and the medial side of the flexor digitorum
profundus with muscle branches as it travels down the forearm. The
 posterior interosseous nerve, which feeds the supinator and extensor carpi
radialis brevis, is derived from the radial nerve.9

d. Muscles

Within the forearm, muscles are classically grouped into anterior and
posterior compartments.10

1. Anterior Compartment:

a. Flexor carpi radialis, palmaris longus, and the humeral

heads of the pronator teres and flexor carpi ulnaris -
originate from the common flexor origin. The coronoid process
gives rise to the ulnar head of the pronator teres. The olecranon
gives birth to the ulnar head of the flexor carpi ulnaris. The
pronator teres is a muscle that attaches to the lateral surface of
the radius and controls forearm pronation and flexion. Each of
the other muscles attaches to the wrist or hand and controls
more distal motions.10
b. Flexor digitorum superficialis - comes from the medial
epicondyle of the humerus, the coronoid process, and the
anterior border of the radius, and inserts on the middle
phalanges of the medial four fingers.10
c. Flexor digitorum profundus - arises from the ulna and
interosseous membrane and inserts on the distal phalanges.10
d. Flexor pollicis longus - originates from the radius and the
interosseous membrane and inserts on the distal phalanx of the
thumb.10
e. Pronator quadratus - originates from the distal end of the ulna
and inserts on the distal end of the radius. Responsible for
forearm pronation.10
 Fig. 5 Superficial Layer of The Ventral Muscles of The Forearm5

2. Posterior Compartment

a. Brachioradialis, extensor carpi radialis longus, extensor

carpi radialis brevis, extensor digitorum, extensor digiti
minimi, and extensor carpi ulnaris - originate from the
humerus's distal lateral edge. The brachioradialis inserts
immediately proximal to the radius's styloid process and is
important for forearm bending, particularly in pronation. The
remaining muscles that originate in this region enter distally
and are responsible for wrist and hand movements.10
b. Supinator - originates from the lateral epicondyle, radial
collateral and annular ligaments, supinator fossa, and the crest
 of the ulna with insertion on the lateral side of the radius. It is
responsible for forearm supination.10
c. Abductor pollicis longus and extensor pollicis longus -
originates from the posterior surface of the ulna and
interosseous membrane with attachments in the hand.10
d. Extensor indicis - originates from the posterior surface of the
distal third of the ulna and the interosseous membrane with
attachment in the hand.10
e. Extensor pollicis brevis - originates from the posterior surface
of the distal third of the radius and the interosseous membrane
with attachment in the hand.10

Fig. 6 Superficial Layer of The Dorsal Muscles of The Forearm5

4. Hand
a. Structure and Function
A large number of muscles have their origins and/or insertions in the hand.
The origin and insertions of the intrinsic muscles of the hand are located
within the carpal and metacarpal bones. Extrinsic hand muscles originate
outside the hand, usually in the forearm, and enter into hand structures.
Any muscle tendon that crosses a joint will act on that joint, as a rule of
thumb. Forearm muscles that span the carpometacarpal joint, for example,
cause flexion or extension of the wrist joint.11

Intrinsic hand muscles arise from the bones, ligaments, and fascia of the
hand and enter into them. Fine motor actions are predominantly produced
by these muscles. There are three compartments in these muscles: thenar,
hypothenar, and adductor.11

The thenar muscles act on the thumb as a set of three muscles. The thenar
eminence is a bulge on the palmar surface of the thumb and palm formed
by these muscles. Opponens pollicis, the biggest of the three muscles,
starts in the trapezium's tubercle and inserts at the lateral border of the
thumb's metacarpal. By flexing and medially rotating the metacarpal on
the trapezium's axis, it allows the thumb to conduct opposition, which is
the motion of reaching across the palm towards the little finger. The
abductor pollicis brevis muscle is the major muscle that provides
opposition. It is located anterior to the opponens pollicis. It starts at the
scaphoid and trapezium tubercles and ends at the lateral aspect of the
thumb's proximal phalanx. Abductor pollicis brevis also works by pulling
the thumb away from the midline, which is how all muscles abduct. The
flexor pollicis brevis originates from the trapezium's tubercle via the deep
head and the flexor retinaculum via the superficial head, and inserts at the
base of the thumb's proximal phalanx. The recurrent branch of the median
nerve innervates these three muscles. With fibers from both the median
and ulnar nerves, the flexor pollicis brevis receives dual innervation. The
median nerve innervates the superficial head, whereas the ulnar nerve
innervates the deep head.11

The hypothenar muscles contract on the little finger, forming a bulge on

the medial palmar surface known as the hypothenar eminence, which is
smaller than the thenar eminence. The opponens digiti minimi starts at the
hook of hamate and the transverse carpal ligament, and ends on the ulnar
side of the fifth metacarpal. The small finger is drawn radially by
contraction of the opponens digiti minimi, extending across the palm
through flexion and supination, and thereby executing opposition. The
thumb and little finger may contact thanks to the movement of the
opponens pollicis and opponens digiti minimi. The abductor digiti minimi
originates from the pisiform bone and the flexor carpi ulnaris tendon, and
it inserts at the ulnar base of the tiny finger's proximal phalanx. Abduction
is possible when this muscle is contracted, just as the abductor pollicis
brevis muscle guides the thumb away from the midline when it is
contracted. The flexor digiti minimi brevis begins at the hook of hamate
and the transverse carpal ligament, and ends at the base of the tiny finger's
 proximal phalanx. The palmaris brevis arises from the transverse carpal
ligament and inserts on the medial palm's skin. It allows the skin on the
palmar surface of the hand to wrinkle and protects the ulnar nerve. All
muscles in the hypothenar compartment are innervated by the ulnar
nerve.11

The adductor compartment is occupied by the adductor pollicis muscle.

The oblique and transverse heads are where the adductor pollicis muscle
begins. The capitate, second, and third metacarpals form the oblique head,
which inserts at the ulnar base of the thumb's proximal phalanx. The
transverse head emerges from the third metacarpal and inserts into the
medial aspect of the thumb's proximal phalanx. Innervation is provided via
the ulnar nerve. The metacarpophalangeal joint may be adducted and
flexed with the help of this muscle.11

Extrinsic hand muscles originate in the forearm and are found on the
anterior and posterior aspects of the forearm, with flexors anteriorly and
extensors posteriorly. These muscles perform the gross movements of the
hand and wrist.11

The superficial and deep muscle layers of the posterior forearm are
separated. Extensor muscles make up the majority of the group. The
extensor carpi radialis longus, extensor carpi radialis brevis, extensor
digitorum, extensor digiti minimi, and extensor carpi ulnaris are among the
superficial layers. The adduction and abduction of the wrist, as well as the
extension of the MCP and IP joints of the fingers, are all assisted by this
set of muscles. The abductor pollicis longus, extensor pollicis longus,
extensor pollicis brevis, and extensor indicis are all part of the deep group.
This set of muscles helps in wrist extension, thumb abduction and
extension, and 2nd digit extension.11

b. Blood Supply

The deep palmar and superficial palmar arches supply the hand's major
blood supply. The radial artery's superficial branch anastomoses with the
superficial palmar arch. The radial artery's deep branch passes through the
dorsal interossei muscle before anastomosing at the deep palmar arch. The
ulnar artery is divided into two branches: a deep branch that connects to
the deep palmar arch and a superficial branch that connects to the
superficial palmar arch. This anastomosing network permits blood to flow
in numerous directions, allowing for a large amount of collateral blood
flow to avoid ischemic harm.11

c. Nerves

The ulnar, median, and radial nerves supply innervation to the hand
muscles. The ulnar nerve emerges from the brachial plexus's medial chord.
The ventral rami of the C8 and T1 nerve roots give rise to the nerve. The
brachial plexus's lateral and medial cords come together to form the
median nerve. Through the T1 nerve root, the nerve emerges from the
 ventral rami of the C5. The radial nerve is a terminal branch of the
posterior cord that develops from the ventral rami of the C5 through the T1
nerve root.11

d. Muscles

i. Intrinisic Hand Muscles11

1. Thenar Muscles
a. Opponens pollicis
b. Abductor pollicis brevis
c. Flexor pollicis brevis
2. Hypothenar Muscles
a. Opponens digiti minimi
b. Abductor digiti minimi
c. Flexor digiti minimi brevis
d. Palmaris brevis
3. Adductor Muscles
a. Adductor pollicis
4. Interossei Muscles
a. Dorsal Interossei
b. Palmar Interossei
5. Lumbricals

ii. Extrinsic Hand Muscles11

1. Flexor Muscles: Superficial Group
a. Flexor carpi radialis
b. Palmaris longus
c. Flexor carpi ulnaris
2. Flexor Muscles: Intermediate Group
a. Flexor digitorium superficialis
3. Flexor Muscles: Deep Group
a. Flexor digitorum profundus
b. Flexor pollicis longus

iii. Extensor Muscles11

1. Extensor Muscles: Superficial Group
a. Extensor carpi radialis longus
b. Extensor carpi radialis brevis
c. Extensor digitorum
d. Extensor digiti minimi
e. Extensor carpi ulnaris
2. Extensor Muscles: Deep Group
a. Abductor pollicis longus
b. Extensor pollicis longus
c. Extensor pollicis brevis
d. Extensor indicis
Fig. 7 Tendons of The Back of The Hand, Dorsum Manus.5
 Fig. 8 Superficial Muscle Layer of The Palm of The Hand, Palma
Manus.5
 Fig. 9 Middle layer of Muscles in The Palm of The hand, Palma
Manus.5

B. Physiology of The Skeletal Muscle

1. Overview of Muscle Tissue

Muscle tissue is one of the body's four basic tissue types (along with epithelial,
neural, and connective tissues), and it comes in three varieties: skeletal muscle,
cardiac muscle, and smooth muscle. The plasma membranes of all three muscular
tissues contain a property called excitability, which allows them to change their
electrical states (from polarized to depolarized) and transmit an electrical wave
called an action potential along the length of the membrane. While the nervous
system has some impact on the excitability of cardiac and smooth muscle, skeletal
muscle is fully reliant on nervous system signals to function properly. Other
stimuli, such as hormones and local stimuli, can elicit responses in both cardiac
and smooth muscle.12

Fig. 10 The Three Types of Muscle Tissue: The body contains three types of
muscle tissue: (a) skeletal muscle, (b) smooth muscle, and (c) cardiac muscle.12

Contractility, or the capacity of the cells to shorten and create force, is a

characteristic shared by all three kinds of muscle. While muscle tissue can shrink
as a result of contractions, it also has the potential to stretch and expand beyond
 the cells' resting length. Muscle elasticity permits it to return back to its normal
length after being stretched.12
When a protein called actin is pulled by a protein called myosin, the mechanical
process of contracting (shortening) begins, and there are changes in the
microscopic arrangement of these contractile proteins among the three muscle
types. The actin and myosin proteins are distributed extremely consistently in the
cytoplasm of individual muscle cells in both skeletal and cardiac muscle, resulting
in an alternating light and dark striped pattern known as striations. With a light
microscope at a high magnification, the striations may be seen. Because the
contractile proteins are not grouped in such a regular way, smooth muscle (called
for its absence of striations) does not form this striped pattern.12

Skeletal muscle cells (also known as muscle fibers) are multinucleated, with
nuclei positioned on the cell's periphery, beneath the cell plasma membrane (also
called sarcolemma in muscle). Embryonic myoblasts, each with its own nucleus,
unite with hundreds of other myoblasts to produce long multinucleated skeletal
muscle fibers throughout early development.12

2. Skeletal Muscle Function

The capacity of skeletal muscle to contract and create movement is its most well-
known attribute. Skeletal muscles are involved in both producing and stopping
movement, such as fighting gravity to maintain posture. To keep a body upright or
balanced in any position, small, continual changes of the skeletal muscles are
required. Muscles also keep the bones and joints from moving too much,
preserving skeletal stability and preventing injury or distortion.12

Skeletal muscles influence the movement of different substances by being placed

at the entrances of internal passages throughout the body. These muscles provide
voluntary control of activities such as swallowing, urine, and feces. Internal
organs (especially those in the abdomen and pelvis) are additionally protected by
skeletal muscles, which function as an external barrier or shield against external
harm and support the weight of the organs.12

Skeletal muscles generate heat, which helps to keep the body in a state of
homeostasis. Muscle contraction needs energy, and heat is created as ATP is
broken down. This heat is most visible during exercise, when persistent muscular
activity raises body temperature, and when shivering induces random skeletal
muscle spasms to create heat.12

3. Skeletal Muscle Structure

Each skeletal muscle is an organ made up of a variety of interconnected tissues.

Skeletal muscle fibers, blood vessels, nerve fibers, and connective tissue are
among these tissues. Each skeletal muscle contains three layers of connective
tissue that surround it, give it structure, and compartmentalize the muscle fibers
inside it. The epimysium, a sheath of thick, uneven connective tissue that
surrounds each muscle, allowing it to contract and move strongly while retaining
structural integrity. Muscle is also separated from other tissues and organs in the
region by the epimysium, allowing it to move independently.12
 Fig. 11 The Three Connective Tissue Layers: Bundles of muscle fibers, called
fascicles, are covered by the perimysium. Muscle fibers are covered by the
endomysium.12

Muscle fibers are arranged into fascicles, which are bordered by a middle layer of
connective tissue termed the perimysium, inside each skeletal muscle. This
fascicular organization is widespread in limb muscles; it allows the nervous
system to activate a subset of muscle fibers inside a fascicle of the muscle to elicit
a specific action. Each muscle fiber is coated in a thin connective tissue layer of
collagen and reticular fibers called the endomysium inside each fascicle. The
endomysium surrounds the cells' extracellular matrix and aids in the transmission
of force generated by muscle fibers to the tendons.12

The collagen in the three connective tissue layers intertwines with the collagen of
a tendon in skeletal muscles that interact with tendons to pull on bones. The
periosteum, which covers the bone, merges with the tendon at the opposite end.
The stress caused by muscle fiber contraction is subsequently conveyed through
the connective tissue layers, to the tendon, and finally to the periosteum, which
pulls on the bone to allow the skeleton to move. The mysia may also merge with
an aponeurosis, a wide, tendon-like sheet, or fascia, the connective tissue between
skin and bones, in other sites. An example of an aponeurosis is a large strip of
connective tissue in the lower back into which the latissimus dorsi muscles (the
"lats") join.12

Blood vessels abound in every skeletal muscle, supplying it with nutrients,

oxygen, and waste elimination. Furthermore, the axon branch of a somatic motor
neuron supplies every muscle fiber in skeletal muscle, signaling the fiber to
contract. Unlike cardiac and smooth muscle, skeletal muscle can only contract
when it receives signals from the nervous system.12

4. Skeletal Muscle Fiber

Muscle fibers are the name given to skeletal muscle cells because they are long
and cylindrical (or myofibers). Skeletal muscle fibers may be relatively enormous
in comparison to other cells, with diameters of up to 100 m and lengths of up to 30
 cm (11.8 in) in the upper leg's Sartorius. The vast amounts of proteins and
enzymes required to keep these big protein dense cells functioning normally are
produced by having multiple nuclei. Skeletal muscle fibers also include cellular
organelles seen in other cells, such as mitochondria and endoplasmic reticulum, in
addition to nuclei. Some of these structures, on the other hand, are specialized in
muscle fibers. The sarcoplasmic reticulum (SR) is a specialized smooth
endoplasmic reticulum that stores, releases, and recovers calcium ions (Ca++).12

Sarcolemma (from the Greek sarco, which means "flesh") refers to the plasma
membrane of muscle fibers, whereas sarcoplasm refers to the cytoplasm. Proteins
are arranged within muscle fibers into myofibrils, which span the length of the cell
and include sarcomeres joined in series. Because myofibrils are only around 1.2
μm in diameter, there can be hundreds to thousands of them (each with thousands
of sarcomeres) inside a single muscle fiber. The sarcomere is a highly structured
collection of contractile, regulatory, and structural proteins that is the smallest
functional unit of a skeletal muscle fiber. The contraction of individual skeletal
muscle fibers is caused by the shortening of these particular sarcomeres (and
ultimately the whole muscle).12

Fig. 12 Muscle Fiber: A skeletal muscle fiber is bordered by the sarcolemma, a

plasma membrane that contains sarcoplasm, the cytoplasm of muscle cells.
Myofibrils, which contain sarcomeres with light and dark areas that give the cell
its striated appearance, make up a muscle fiber.12

5. The Sarcomere

The striated appearance of skeletal muscle fibers is due to the arrangement of the
thick and thin myofilaments within each sarcomere, which is defined as the
portion of a myofibril contained between two cytoskeletal structures termed Z-
 discs (also called Z-lines). The dark striated A band is composed of the thick
filaments containing myosin, which span the center of the sarcomere extending
toward the Z-dics. A protein called myomesin anchors the thick filaments in the
centre of the sarcomere (the M-line). Thin actin filaments are tethered to the Z-
discs by a protein termed α-actinin in the lighter I band areas. The thin filaments
expand into the A band and overlap with portions of the thick filament as they go
toward the M-line. Because of the thicker myosin filaments and overlap with the
actin filaments, the A band is black. Because the thin filaments do not reach into
the H zone in the center of the A band, it is a little lighter in color.12

Because Z-discs define a sarcomere, a single sarcomere has one dark A band on
each end and half of the lighter I band on each end. The myofilaments themselves
do not change length during contraction; instead, they glide across each other,
shortening the space between the Z-discs. The length of the A band remains
constant (because to the thick myosin filament), while the H zone and I band areas
diminish. These are locations where the filaments do not overlap, and when
filament overlap rises during contraction, these no overlap zones diminish.12

Summary

Muscle is the tissue in humans that permits them to move their bodies or items around within
them. Skeletal muscle, cardiac muscle, and smooth muscle are the three forms of muscular
tissue. The majority of the skeletal muscle in the body moves by acting on the skeleton.
Which is why our musculoskeletal anatomy is very dependent on each other to move and to
prevent dislocations from happening in our body.
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