Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5521_Библиотеки_им_академика_М_И_Перельмана.pdf
Chapter 3 / Body Systems 81
Hair shaft
Nail body
Free edge
of the nail
Follicle
Hair root
Blood vessels
A
Nail bed
Figure 3-20. Structure of fingernail and hair root. (A) Nail. (B) Hair root. (Part B provided by Anatomical Chart Co.)
Nail root
what people commonly call “pores” on the face are actually
the openings of hair follicles.
B
produce milk and are found in the mammary areola; ear
canal glands are modified to produce earwax.
The sebaceous glands are exocrine glands, but their
Cutaneous Glands
The two types of glands in the integument are sudoriferous
(SOO-doh-RIF-fer-us), which produce sweat, and sebaceous
(seh-BAY-shus), which secrete oil. These exocrine glands
release their secretions directly to the outer surface of the
skin through ducts.
Sudoriferous glands, or sweat glands, can be classified
even more specifically as eccrine or apocrine sweat glands.
Eccrine sweat glands are simple coiled tubular glands that
open to the surface of the skin with pores. They are found
ducts do not reach the surface of the skin. Instead, sebaceous glands release their secretion into the hair follicle
and it travels to the skin’s surface through the follicle. They
secrete sebum, which is a mixture of fats, waxes, oil, and cellular debris. It is transported to the surface of the skin via
the hair follicles to soften the skin, hinder evaporation, and
kill bacteria.
The skin does not “breathe” or serve as an exchange for
gases. It is only an avenue for transportation of perspiration
and oil from the sweat and sebaceous glands.
all over the body and are especially abundant in the soles of
the feet, palms of the hands, and forehead, where there are
not many hair follicles. These types of sweat glands secrete
sweat, which is a thin fluid consisting mostly of water, some
salts, and waste. When sweat reaches the surface of the skin,
it evaporates and helps cool the body, which is a very important mechanism of thermal regulation.
The large, branched apocrine sweat glands are found
mostly in the axilla (armpit) and genital area, but they are
also located in the ear canal, eyelid, and mammary areola.
They produce an odorless secretion triggered by puberty,
stress, pain, and excitement, and their ducts open into the
upper part of the hair follicles, but their function is not fully
understood. If bacteria accumulate in the secretion, they
break down the apocrine secretions and an unpleasant odor
is released. Some apocrine glands are highly specialized to
Effects of Massage on the
Integumentary System
The skin is loaded with sensory receptors and is the point
of contact between you and your clients. When you initially place your hands lightly on your client, the touch
can trigger the sympathetic nervous system, or the stressful “fight or flight” response. However, if you sustain the
light touch or moderately increase the pressure, a shift
occurs and the parasympathetic nervous system is activated, which is the relaxation response (See Research
Box3.1). Sustained superficial techniques such as simply
resting your hands on a client’s skin, light strokes, and fine
vibration can reduce anxiety, decrease pain, and decrease
muscletension.
82 INTRODUCTION TO MASSAGE THERAPY
muscles and nearby tissues. Massage is an effective treat-
RESEARCH BOX 3-1
ment for breaking down fascial adhesions to restore circulation and movement.
Massage and the
Parasympathetic Nervous
System Response
Skeletal System
Twenty healthy adults were randomly assigned to
a moderate pressure or light pressure massage
therapy group, and EKGs were recorded during a
3-min baseline, during the 15-min massage period,
and during a 3-min postmassage period. EKG data
were then used to derive the high frequency (HF),
low frequency (LF) components of heart variability
and the low to high frequency ratio (LF/HF) as noninvasive markers of autonomic nervous system activity. The participants who received the moderate
pressure massage exhibited a parasympathetic nervous system response characterized by an increase
in HF, suggesting increased vagal efferent activity
and a decrease in the LF/HF ratio, suggesting a shift
from sympathetic to parasympathetic activity that
peaked during the first half of the massage period.
On the other hand, those who received the light
pressure massage exhibited a sympathetic nervous
system response characterized by decreased HF
and increased LF/HF.
Moderate pressure appears to be necessary for
massage therapy effects. Studies comparing moderate and light pressure massage are reviewed
and they suggest that growth and development
are enhanced in infants and stress is reduced in
adults, but only by moderate pressure massage.
The stimulation of pressure receptors leads to
increased vagal activity which, in turn, seems to
mediate the diverse benefits noted for massage
therapy.
Diego MA, Field T. Moderate pressure massage elicits a parasympathetic
nervous system response. Int J Neurosci 2009;119:630–638.
Field T, Diego M, Hernandez-Reif M. Moderate pressure is essential for
massage therapy effects. Int J Neurosci 2010;120:381–385.
Mechanically, massage warms the skin with friction
and increases circulation of blood and lymph in the skin.
The enhanced heat and circulation stimulate the sebaceous glands to produce more secretions that make the
skin more supple and pliable, and increase sweat production, which has a cooling effect on the body when the
sweat evaporates.
Adhesions in the subcutaneous layer, or superficial fascia, can constrict the circulatory vessels, reducing the local
flow of blood and lymph and restricting movement of
The skeletal system, sometimes called the skeleton, is
made up of the bones of the body, the joints between
bones, and the connective tissue cartilage and ligaments.
Bones come in all shapes and sizes. Because bones are
sometimes viewed simply as the hard structural support of
the body, it is easy to forget that they are alive. Bones are
living tissue.
the individual bones that contribute to the overall functions of the skeletal system and whole-body homeostasis.
Understanding the structures and functions of the skeletal
system helps massage therapists know how to evaluate and
assess their clients’ bodies and provide the safest and most
effective treatment.
There are living processes occurring within
Structures of the Bones
The bones have structural aspects at the cellular level that
are only visible with a microscope. There is also an overall
structural view of the bones that we can see with our eyes,
including visible structures, shapes, and exterior projections
or depressions. There are two types of bone tissue that are
visibly distinguishable: spongy bone and compact bone.
Microscopic Structures of Bones
Different types of bone tissue have a different microscopic
structure that contributes to their different overall appearance. Spongy bone, sometimes called cancellous bone,
resembles a brittle sponge. Its airy, mesh-like structure looks
similar under a microscope. Compact bone, however, looks
dense and ivory-like until you see the microscopic structures. The basic unit of bone tissue is the osteocyte, literally
translated as bone cell. The arrangement of the osteocytes
in compact bone tissue is very different from that in spongy
bone tissue. The osteocytes are microscopically arranged in
visibly concentric rings called lamellae (lah-MEL-lee). The
rings form around a central haversian canal, also called the
central canal, which can contain blood vessels, nerves, and
lymph vessels. The many central canals are interconnected
with blood vessels that travel through Volkmann’s canals,
also called transverse canals. Radiating from the central
canal, out through the lamellae, are canaliculi, which are
minute canals containing osteocyte extensions that transport
nutrients to every osteocyte. Figure 3-21 illustrates compact
and spongy bone tissue.
Microscopic osteoblasts and osteoclasts participate
in bone formation, growth, and remodeling. They are discussed below in this section on the skeletal system.
Chapter 3 / Body Systems
83
Figure 3-21. Structure of a long
bone, including spongy bone and
compact bone.
Proximal
epiphysis
Diaphysis
Distal
epiphysis
Cartilage
Epiphyseal line
Spongy bone
(containing red
marrow)
Medullary (marrow)
cavity
Compact bone
Yellow marrow
Periosteum
Artery
Canaliculi
Haversian
canal
Osteocytes
(the rings of osteocytes
are lamellae)
Periosteum
Visible Structures of Bones
The bones are covered outside with a periosteum (membrane), which is a tough fibrous sheath that covers all but
the joint region of a bone. It is firmly connected to the bone
with hundreds of connective tissue fibers and contains a
network of nerves, blood vessels, and lymphatic vessels that
supply the bone. Osteoblasts, involved in bone formation,
are also present in the periosteum.
Bone Shapes
The human skeleton has bones of all shapes and sizes.
They are classified as short, flat, irregular, and long bones.
Figure3-22 shows the four bone shapes.
Short bones are typically shaped like cubes or elongated
cubes. The carpals of the wrist are short bones. Again, the
periosteum covers all but their articular surfaces. A sesamoid
bone, such as the kneecap, is a special kind of short bone
embedded in tendons or ligaments.
Flat bones are platelike and often slightly curved. The ribs
and cranial bones are flat bones. Red marrow fills cavities of
spongy bone of the flat bones and makes red blood cells (RBCs).
The bones that do not fit into any of the other categories are called irregular bones. The vertebrae and facial
bones are irregular bones.
Long bones are the ones most familiar to people. They
are long and narrow with knobby ends and have a hollow
inner cavity. The structure of a long bone is outlined below.
Artery
Volkmann's canal
Structures of a Long Bone
Long bones are longer than they are wide, including bones
such as the femur (FEE-mer) in the thigh and the humerus
(HYOO-mer-us) in the upper arm. Their structure consists
of a long, narrow shaft called the diaphysis (dahy-AFF-ih-sis)
with two knobby ends called epiphyses (ee-PIH-fih-seez) (see
Fig. 3-21 for the structure of a long bone). At the core of the
compact bone diaphysis is the medullary cavity that contains
bone marrow. The medullary cavity is filled with yellow marrow, which contains mostly fat. The epiphyses, the knobby
ends of the long bones, are primarily made of spongy bone
but are wrapped with a thin layer of compact bone. They are
often part of a joint, articulating with other bones. Inside the
epiphyses is red marrow that produces RBCs. Between the
epiphysis and diaphysis is an epiphyseal line that looks like
a thin strip of compact bone in the midst of spongy bone.
The epiphyseal line is what remains of the hyaline cartilage
epiphyseal plate in a child’s growing long bone.
There is a periosteum on the outside and an endosteum
on the inside of long bones. The endosteum is a membrane
lining the interior of the compact bone that separates the
medullary cavity from the compact bone and contains cells
involved in growth and repair of the bone.
Bony Landmarks
The outer texture of bones can be smooth or rough
and may contain projections, depressions, or hollows.
84 INTRODUCTION TO MASSAGE THERAPY
Figure 3-22. The four bone shapes.
Long bone: humerus Flat bone: sternum
Short bone: carpals
Irregular bone: vertebra
Bony landmarks , or bone markings, are the distinguishing
features of bones that can usually be externally palpated
and serve as sites for muscle attachment and safe passageways for nerves and blood vessels. Several specific bony
landmarks are commonly used by healthcare professionals when referring to a client’s anatomy. Generally, projections stick out from the bone to offer an attachment site for
muscles, tendons, aponeuroses, and ligaments. Depressions,
openings, and concave portions of the bone provide smooth
articulating surfaces and holes or openings that are passageways for tendons, nerves, or blood vessels. Sometimes these
formations also provide muscle attachment sites. Bony landmark projections and depressions are included in Table 3-4,
with examples of each.
Skeleton
The skeleton normally contains 206 bones, cartilage, and
joints. The bones of the skeleton can be defined as two
separate groups called the axial and appendicular skeletons.
Cartilage is discussed in the section covering cells and tissues, but we briefly review the skeleton-specific cartilage
in this section. A joint is the mechanical structure where
neighboring bones are attached, often with connective tissue
and cartilage. There are a number of joints in the body that
provide different amounts and different kinds of movement.
Axial Skeleton
The axial skeleton makes up the axis of the body, or the central support structure. It contains 80 bones, including those
of the skull, the vertebral column, and the bony thorax.
Skull
The skull is made up of 8 cranial bones, 14 facial bones, 6
inner ear ossicles, and 1 hyoid bone. Its primary function is
to protect the brain. It has cavities for the eyes, ears, nose,
and mouth, and teeth and jaws for mastication (chewing).
Some of the cranial bones are paired, such as the parietal
and temporal bones, but the sphenoid, ethmoid, frontal, and
occipital bones are not (Fig. 3-23). Most of the facial bones
are paired, including the maxilla (upper jaw), zygomatic
(cheekbones), nasal, lacrimal (tear ducts are here), palatine,
and inferior nasal conchae. Unpaired facial bones include the
mandible (the movable lower jaw) and the vomer bone of
the nose. There are three tiny bones, called ossicles, in each
middle ear.
One facial bone is unique. Although not considered a
true skull bone, the hyoid (HAHY-oyd) bone is located just
superior to the larynx and deep to the base of the tongue
(See Plate 4-35 in the special muscle section at the end of
Chapter 4 for an illustration of the hyoid bone). It is unique
in that it does not articulate with any other bones. Instead,
it acts as the attachment site for muscles involved in raising
Chapter 3 / Body Systems
Landmark Description Location Example
Projections
Condyle Smooth, rounded Articular ends of bones Occipital condyles
Crest Prominent ridge or border Along an edge Iliac crest
85
Epicondyle Rough, rounded Above or around a
condyle
Lateral and medial epicondyles of
humerus
Head Rounded, knobby End of long bone Head of humerus, head of femur
Line Long ridge Shaft of bone Linea aspera
Process Fingerlike Sticks out of a bone Xiphoid process, olecranon process
Ramus Slightly flattened, bar-like Near joint Pubic ramus
Spine Sharp, bladelike Muscle attachment site Spine of scapula, ASIS
Trochanter Blunt, rough, bump Muscle attachment site Greater and lesser trochanters of femur
Cranium
Cervical vertebrae
Clavicle
Sternal notch
Scapula
Costal cartilage
Sternum
Xiphoid process
Humerus
Ribs
Radius
Ulna
Carpals
Metacarpals
Phalanges
Hyoid
bone
Head of humerus
Greater tubercle
Bicipital groove
Medial epicondyle
of humerus
Lateral epicondyle
of humerus
Iliac crest
Ilium
Anterior superior
iliac spine (ASIS)
Sacrum
Coccyx
Pubis
Pubic ramus
Pubic symphysis
Obturator foramen
Femur
Patella
Medial malleolus
Lateral malleolus
Axial skeleton
Appendicular skeleton
Tibia
Fibula
Tarsals
Metatarsals
Phalanges
Anterior view
continues on following page
86 INTRODUCTION TO MASSAGE THERAPY
Landmark Description Location Example
Tubercle Small, rough bump Head of bone, for muscle
attachment
Tuberosity Rough bump Neck portion of bone, for
Greater and lesser tubercles of
humerus
Deltoid tuberosity
muscle attachment
Depressions and openings
Foramen Hole Through a bone Obturator foramen, foramen magnum
Fossa Concave Articular bone surface Supraspinous and infraspinous fossa
of scapula
Groove Small, concave, furrow-like Muscle attachment site Bicipital groove of humerus
Meatus Short, tube-shaped
Through a bone Auditory meatus
passageway
Notch Concave, half-moon Cut-out in a bone Sternal notch, sciatic notch of pelvis
Sinus Air-filled cavity Mucus-lined areas Cranial bone (frontal sinus)
Cranium
Occipital condyle
Cervical vertebrae
Clavicle
Deltoid tuberosity
Humerus
Vertebral column
Supraspinous
fossa
Spine of scapula
Scapula
Ribs
Radius
Ulna
Carpals
Metacarpals
Phalanges
Ischium
Ischial tuberosity
Ilium
Sacrum
Coccyx
Greater trochanter
Lesser trochanter
Linea aspera
Femur
Tibia
Fibula
Calcaneous
Posterior view
Chapter 3 / Body Systems
Parietal
bone
87
Sphenoid bone
Frontal bone
Temporal
bone
Occipital
bone
External auditory
meatus
A
Frontal bone
Parietal
bone
Mastoid process of
temporal bone
Styloid process of
temporal bone
Ethmoid bone
Nasal bone
Lacrimal bone
Zygomatic
bone
Maxilla
Mandible
Zygomatic process
of temporal bone
Temporal
bone
Zygomatic
bone
Vomer
Maxilla
Mandible
Nasal bone
Sphenoid bone
B
Figure 3-23. Bones of the skull, including cranial and facial bones. (A) Lateral view. (B) Anterior view.
88 INTRODUCTION TO MASSAGE THERAPY
Maxilla
Zygomatic bone
Palatine bone
Sphenoid bone
Vomer
Temporal bone
Occipital condyle
Foramen magnum
Occipital bone
C
Figure 3-23. (continued) (C) Inferior view.
and lowering the larynx to provide speech and for moving
the tongue in the process of swallowing.
Vertebral Column
The vertebral column, or spine, is made up of a series of irregularly shaped bones called vertebrae that act as a group to support the skull, protect the spinal cord, and provide passageways
Functions:Parts:
Spinous
process (1)
Transverse
process (2)
Articular
processes
Vertebral
arch
Vertebral
body
Vertebral foramen
Muscle attachment
and movement
Restriction of
movement
Protection of
spinal cord
Support of
body weight
for the nerves. The average adult vertebral column has 26 vertebrae, separated by intervertebral discs of cartilage.
Each vertebra has specialized structures, including a
body, foramen, vertebral arch, one spinous process, two
transverse processes, and four articular processes (Fig.3-24).
The vertebral body resembles a hockey puck and bears
weight. The foramen is a hole near the center of the vertebra
Superior
articular process
Transverse
process
Spinous
process
Inferior
articular facet
Superior
vertebral notch
Lamina
Pedicle
Vertebral
body
Inferior vertebral
notch
B. Lateral viewA. Superior view
Figure 3-24. Structures and functions of a vertebra.
Chapter 3 / Body Systems
89
through which passes the spinal cord. The vertebral arch is
the portion of the bone that arches around the posterior surface of the foramen, consisting of a pair of pedicles and a
pair of laminae. The spinous process is the one that points
out posteriorly and is most easily palpated. The transverse
processes point out laterally. The four articular processes,
sometimes called facets, are small bumps that allow the vertebrae to articulate with each other. Although each vertebra
has the structures mentioned above, vertebrae in different
regions of the spine also have specialized structures.
Unlike adults, newborn babies have as many as 34 vertebrae. The spine is the first bony structure to develop in
the fetus and has concave thoracic and pelvic curves that
protect the organs. Further along in postfetal development,
the vertebral column acquires convex curves in the cervical
and lumbar regions. The convex cervical curve matures as
the infant begins to hold up its head, and the convex lumbar
curve matures when the baby begins to stand and walk in
an upright position (Fig. 3-25). These normal spinal curves,
in addition to the cartilaginous intervertebral discs, give the
spine the mechanical springlike properties of strength and
flexibility.
Once completely formed, the spine has five distinct sections (Fig. 3-26):
• Cervical—7 vertebrae
• Thoracic—12 vertebrae
Vertebral
body
Intervertebral
foramen
Intervertebral
disc
Lumbosacral
angle
Coccyx
Adult
Figure 3-25. Spinal curves of a fetus and an adult.
Cervical
vertebrae
Thoracic
vertebrae
Lumbar
vertebrae
Sacrum
Coccyx
Fetus
• Lumbar—5 vertebrae
• Sacral—5 vertebrae in childhood become a single
fused bone in adults
• Coccygeal—3 to 5 vertebrae in childhood become a
single fused bone in adults
The seven cervical (SER-vih-kul) vertebrae are relatively
small and allow considerable neck movement. They are
numbered C1 through C7, starting at the superior end. The
first two vertebrae are often referred to as the atlas (C1),
which allows us to nod the head “yes” and the axis (C2),
which allows us to rotate the head side to side as in shaking
the head “no.” A common anatomical landmark is the spinous process of C7, which protrudes on the posterior side
of the neck as the most prominent bump.
The 12 thoracic (thoh-RASS-ik) vertebrae are slightly
larger than the cervical vertebrae and are similarly numbered T1 through T12. They have additional articulating
surfaces that act as rib attachments for the posterior ends of
the 12 pairs of ribs. The first intervertebral foramen occurs
between C7 and superior to T1, allowing the spinal nerve
C8 to exit the spinal cord.
The five lumbar vertebrae, numbered L1 through L5,
are even heavier and larger to support the greater mechanical stress on the lumbar region. This section bears the
weight of the rest of the spine and supports the trunk.
The sacral section of the spine, also called the sacrum
(SAY-krum), is a single bone composed of five vertebrae that are
normally fused together. The sacrum usually fuses anywhere
from age 16 to 59, but occasionally fusion does not occur. This
bone articulates superiorly with L5 and inferiorly with the coccyx (KAHK-sikz), but it also articulates laterally with the iliac
bones of the pelvis to create the posterior wall of thepelvis.
The coccygeal section of the vertebral column is also
called the coccyx. It is a single bone made of three to five
vertebrae that are usually fused together. Located at the tail
end of the spine, it is sometimes called the tailbone, and
articulates with the sacrum at its superior surface. There are
rare occasions when the sacrum has fused to the coccyx.
Bony Thorax
The bony thorax consists of the 12 pairs of ribs and the sternum. It functions as a protective cage for the lungs and the
other organs of the thoracic cavity.
Like the thoracic vertebrae that they contact posteriorly, the ribs are numbered in pairs from 1 to 12 (Fig. 3-27).
The first seven pairs are called true ribs because they also
attach to the anterior portion of the sternum via the individual costal cartilages. The false ribs pairs 8 through 10, do
not have their own individual anterior attachments. Instead,
they all attach to the cartilage of the seventh true rib. The
last two pairs are considered floating ribs because they have
no anterior attachment. Between the ribs, in the intercostal
spaces, there are muscles, blood vessels, and nerves.
90 INTRODUCTION TO MASSAGE THERAPY
Figure 3-26. Anterior, lateral, and posterior
views of the vertebral column.
Atlas (C1)
Axis (C2)
7 Cervical
12 Thoracic
5 Lumbar
Figure 3-27. Bony thorax, anterior view.
Sacrum
(5 segments)
Coccyx (4 segments)
Anterior View Right lateral view Posterior view
Sternal notch
Clavicular notch
T1
True
ribs
False
ribs
7
10
1
2
3
4
5
6
12
T11
11
T12
L1
L2
8
9
Manubrium
Sternal
angle
Body
Xiphoid
process
Sternum
Costal
cartilage
Floating ribs