Introduction to Myology, Neurology & Angiology

action of muscles anatomical classification of muscles angiology axon cardiac muscle cardiovascular system central nervous system cervical concentric dendrites distal attachment eccentric endomysium epimysium fascia fascisles golgi tendon organs intermuscular septa lymphatic system muscle attachments muscle belly muscle fibre muscle tissue myology nerve cells nerve root nervous system neurogenic control neurology perimysium plexi proximal attachment skeletal muscle smooth muscle spinal nerve synovial tendon sheaths tendons thoracic vertebra vertebral column white fibros tissue

Myology Neurology Angiology Physiotherapy Solihull Simon Evans


  • 3 types of muscle tissue in the human body
    • Smooth (unstriated or involuntary): Found in the walls of blood vessels and organs
    • Cardiac: Specialised form of striated muscle - not under voluntary control
    • Skeletal (striated or voluntary): Largest proportion of muscle tissue mass in the body - under voluntary control

    Muscle Tissue

    • Each muscle is made up of collections of elongated cells - the fibres - which are made up of:
      • Contractile Elements (actin/myosin) - proteins which interact to generate force
      • Non contractile elements - structural proteins whose role is to maintain the relative positions of the contractile elements

    General form of Muscles

    • Muscle belly - area where all muscle tissue is situated
      • Each fibre is bound by a layer of Endomysium
      • Fibres are then bundled into Fascisles
      • Fascicles are bound by the Perimysium
      • Groups of fascicles for the muscle - bound by the Epimysium
    • Role of muscles is to produce movement - to do this they must attach to the structures they move
    • Attachments may be:
      • Directly into the periosteum via connective tissue elements of the muscle (endomysium, perimysium and epimysium)
      • Or via Tendons - tough rounded cords of White Fibrous Tissue
      • Extremely high tensile strength due to high collagen content
      • Blend with periosteum
      • Contain specialised nerve endings to detect load – Golgi tendon organs
      • Or via an aponeurosis 
      • These are sheets of fibrous tissue which may be present instead of tendons (microscopically very similar)
        • May attach directly into bone or soft tissue
        • Collagen fibres often arranged at angle to each other
        • Note: Muscles attachments to bone via condensation of tissues will often lead to the development of a prominence (less likely where muscles attach directly into bone)

    Synovial Tendon Sheaths

    • Some tendons which pass over or under bony or fibrous structures may be subject to friction:
      • To prevent excessive friction some tendons are covered in invaginated synovial sheaths
    • 2 layers of Synovial Sheaths:
      • Innermost - Visceral
      • Outermost - Parietal
    • Separated by a thin film of synovial fluid (lubrication)
    • In other cases the tendon may be separated from underlying structures by a Synovial Bursa

    Muscle Attachments

    • To be known in detail for all relevant muscles….
    • Proximal Attachment (Origin) - usually closest point to axial skeleton (Tends to be point of least movement)
    • Distal Attachment (Insertion) - usually furthest from axial skeleton (Tends to be point of freest movement)
    • A muscle will normally produce movement at each joint it crosses (if it contracts in isolation)

    Anatomical Classification of Muscles

    • Muscles are classified according to shape and orientation of fibres
    • Muscles with fibres parallel to (or almost) line of pull
    • Provide a contraction over a large range but limited strength
    • Pennated Muscles 
    • Role of pennation is to increase force generation
    • Achieved by increasing number of fibres contributing to force (see sarcomeres in parallel)

    Action of Muscles

    • Each Muscle fibre is under neurogenic control (i.e Stimulation & contraction of individual fibres)
    • Force may be sufficient to produce movement
    • If force generated by muscle exceeds external force (weight of limb, resistance etc.)
    • Approximation of attachments - Concentric contraction
    • If external force exceeds that generated by the muscle contraction that occurs is Eccentric (e.g. lowering weight)


    • The limbs, trunk and head are invested in a double ‘stocking’ of connective tissue - Fascia
    • Divided into:
      • Superficial - subcutaneous, dense ,irregular connective tissue allows skin mobility and may contain muscles e.g. platysma
    • Deep - tough, collagenous (resembles aponeuroses) inelastic
      • Provides attachment for some muscles
      • May form Intermuscular Septa 
      • Compartmentalises limbs
      • May attach to superficial bony points

       Learning of Muscles (e.g. Gluteus Maximus)

      • Functional group (Hip extensor)
      • General form / classification (Quadrilateral)
      • General position (Posterior aspect of hip. Gives buttock contour)
      • Proximal and distal attachments
      • Direction of fibres (downwards forwards and laterally)
      • Actions muscle can produce (Hip extension - primary role, lateral rotation and upper fibres may assist with abduction)
      • Nerve Supply (Inferior Gluteal Nerve L5, S1 and S2)
      • Function of the muscle - do not simply state action (Extension phase of gait, stepping up, standing up etc. Provides lateral stability of knee via ITB. When working with reverse attachments will raise trunk from flexed position by pulling pelvis back over femurs)
      • Palpation (Spread hand down from PSIS)

      Introduction to Neurology

      • In order for any living organism to adapt to and survive environmental changes it must:
        • Identify the changes – sensory feedback
        • Integrate and analyse the information
        • Effect a response
      • This is the role of the nervous system
      • Nervous system made up of a group of highly specialised cells for the transfer of information between the periphery and brain / spinal cord

      The Nerve Cells

      • These are nerve cells or neurones - excitable cells that do not reproduce and typically demonstrate extreme longevity (100 billion in brain)
      • Each neurone has a: 
        • Cell Body
        • Neuronal processes:
          • Dendrites - many short processes to receive information from other neurone - pass information towards the cell body
          • One axon - long process the passage of information away from the cell body
      • Supporting cells - support neurones (up to 900 billion through CNS)

      Divisions of the Nervous System

      • Broadly divided up into:
        • Central Nervous System (CNS) - brain and spinal cord housed in the skull and vertebral column
        • Formed by collection of cells bodies and bundles of axons
          • Divided into grey matter - mostly cells
          • White matter - mostly projections

      Divisions of the Nervous System 

      • Peripheral Nervous System:
        • Connects CNS with target organs
        • Sensory (afferent) division - information relayed from periphery to CNS (from sensory organs in tissues)
        • Motor (efferent) division - information / commands relayed from CNS to effector organs (muscles and glands)
          • Somatic - controls voluntary actions of skeletal muscles
          • Autonomic nervous system - involuntary control of target organs (controls blood vessels, gut, heart etc) via the sympathetic and parasympathetic divisions

      The Nerve Root

      • The vertebral column is subdivided into 4 sections and each section is made up of a number of vertebrae, each identified by a letter (denoting which section it belongs to) and a number (denoting where it lies within the section)
      • The spinal cord is also divided in segments - each segment gives rise to a pair of ‘mixed spinal nerves’ 
      • Each spinal nerve root is identified in a similar way to the vertebra - (the only exception being in the cervical region):
        • 31 pairs of spinal nerves 
        • C1 to C8
        • C1 Nerves exit between the occiput & C1
        • C2 Nerves exit between C1 & C2 etc
        • C8 Nerves exit between C7 & T1
        • From T1 Nerve onwards the nerve will exit between its corresponding vertebra and the one below

      The Mixed Spinal Nerve

      • Each mixed spinal nerve is formed by the ventral / anterior (motor) and dorsal / posterior (sensory) roots fusing to form the mixed spinal nerve.
      • The mixed spinal nerve then divides into anterior and posterior primary rami (mixed) - each containing sensory, motor and autonomic nerves.

      The Plexi

      • Posterior (dorsal) primary rami pass backward to provide the sensory and motor innervation of the back
      • In the thoracic region the anterior primary rami pass forwards between adjacent ribs to supply the skin and muscles of this region as the intercostal nerves
      • The anterior (ventral) primary rami in the cervical, lumbar and sacral regions pass forwards, divide and fuse with each other to form peripheral nerves of the limbs and trunk
      • These ramifications and anastamoses are known as the plexi.
      • There are 3 main somatic plexi:
        • The Brachial – supplying the upper limb
        • The Lumbar – supplying the anterior and medial thigh
        • The Sacral – supplying the rest of the lower limb
      • From here the peripheral nerves form (e.g. sciatic, median etc)

      Introduction to Angiology

      • This involves the study of the circulatory systems of the body
        • The Cardiovascular System
        • The Lymphatic System
      • All living tissues will require appropriate nutrients for survival and an efficient system for removal of metabolic waste products

      The Cardiovascular System

      • Includes the heart (the pump of the CV system) – 4 chambers
      • The Arterial systems – take oxygenated blood to tissues and deoxgenated blood to the lungs
      • The Venous systems – take deoxygenated blood from the tissues back to the heart and oxygenated blood from the pulmonary system back to the heart

      The Lymphatic System

      • In addition to the venous systems the role of the lymphatic system is to assist with drainage of interstitial fluid from the tissues
      • This systems is made up of vessels & organs
      • Lymphatic vessels transport fluid that has escaped from the vascular system into the tissues back into the blood
      • Lymph organs house phagocytes and lymphocytes essential for defence mechanisms of the body 

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