I.

TYPES OF MUSCLE TISSUE

Muscle tissues are categorized based on their structure, function, and control.

Feature Skeletal Muscle Cardiac Muscle Smooth Muscle

Walls of hollow organs (e.g.,
Location Attached to bones Heart walls
intestines, blood vessels)
Voluntary (conscious Involuntary (autonomic Involuntary (autonomic
Control
control) nervous system) nervous system)
Long, cylindrical, Branched, usually single
Cell Shape Spindle-shaped, single nucleus
multinucleated nucleus
Striations Present Present Absent
Contraction
Fast and powerful Moderate and rhythmic Slow and sustained
Speed
Fatigue
Prone to fatigue Highly fatigue-resistant Very fatigue-resistant
Resistance

II. Skeletal Muscle Characteristics

 Most are attached by tendons to bones

 Cells are multinucleated & cigar-shaped
 Striated (striped appearance)
 Voluntary (under conscious control)
 Surrounded and bundled by connective tissue

III. Naming of Skeletal Muscles

Muscles are named based on different characteristics:

Naming
Description Example
Criterion

Direction of Orientation of muscle fibers

Rectus abdominis (straight), Obliques (diagonal)
Fibers relative to the body's midline

Gluteus maximus (largest), Gluteus minimus

Size Relative size of the muscle
(smallest)

Geometric shape of the

Shape Deltoid (triangular), Trapezius (trapezoid)
muscle

Number of Number of points of origin Biceps brachii (two origins), Triceps brachii
Origins (attachment sites) (three origins)

Location Anatomical location or region Frontalis (on the frontal bone), Tibialis anterior
 Naming
Description Example
Criterion

(near the tibia)

Flexor carpi radialis (flexes the wrist), Extensor

Action Primary movement or function
digitorum (extends the fingers)

Named after bones or

Sternocleidomastoid (originates at the sternum
Attachments structures where the muscle
and clavicle; inserts on the mastoid process)
attaches

IV. Connective Tissue Wrappings of Skeletal Muscle

Flowchart: Connective Tissue Layers (Deep to Superficial)

Muscle Fiber (Cell) → Endomysium → Fascicle (Bundle of Muscle Fibers) → Perimysium

→ Whole Muscle → Epimysium → Fascia

1. Endomysium – Surrounds individual muscle fibers

2. Perimysium – Surrounds fascicles (bundles of muscle fibers)
3. Epimysium – Surrounds the entire muscle
4. Fascia – Outermost connective tissue that separates muscles from one another

V. Skeletal Muscle Attachments

Muscles attach to bones or connective tissues via:

 Tendons – Cord-like structures that attach muscle to bone

 Aponeuroses – Sheet-like structures connecting muscles

Sites of Muscle Attachment:

 Bones
 Cartilages
 Connective Tissue Coverings

VI. Microscopic Anatomy of Skeletal Muscle

Skeletal muscle fibers (muscle cells) are highly specialized and structured to allow contraction.
Each fiber consists of several key components that contribute to muscle function.
1. Sarcolemma (Plasma Membrane)

 The sarcolemma is the plasma membrane of a muscle fiber.

 It transmits action potentials from the neuromuscular junction to the inside of the
muscle fiber.
 It plays a crucial role in excitation-contraction coupling, triggering muscle contraction.

2. Sarcoplasmic Reticulum (Calcium Storage)

 The sarcoplasmic reticulum (SR) is a specialized form of smooth endoplasmic

reticulum.
 It stores and releases calcium ions (Ca²⁺), which are necessary for muscle contraction.
 When stimulated by an action potential, the SR releases calcium, triggering contraction.

3. Myofibrils (Contractile Elements)

 Myofibrils are long, rod-like structures that run the length of the muscle fiber.
 They contain thick and thin myofilaments, which allow contraction.
 The functional unit of a myofibril is the sarcomere.

4. Sarcomere: The Functional Unit of Contraction

A sarcomere is the smallest functional unit of muscle contraction. It is the repeating structural
unit of a myofibril and is composed of thick and thin filaments arranged in a precise pattern.

Organization of the Sarcomere

A. Thick Filaments (Myosin Filaments)

 Composed of the protein myosin

 Each myosin molecule contains two polypeptide chains, each with a club-shaped
head
 Has ATPase enzymes that hydrolyze ATP, providing energy for contraction
 Forms cross-bridges with actin during contraction

B. Thin Filaments (Actin Filaments)

Composed of three proteins:

1. Actin – Main protein forming the double-helical filament

2. Tropomyosin – Covers the binding sites on actin and prevents interaction with myosin
when the muscle is at rest
3. Troponin – A three-subunit protein complex that binds:

 One subunit to actin

 One subunit to tropomyosin
  One subunit to Ca²⁺ ions (which triggers contraction)

Structural Zones of the Sarcomere

 Z-line (Z-disc) – Defines the boundary of each sarcomere; anchors actin filaments
 M-line – Center of the sarcomere; holds myosin filaments in place
 H-zone – Region where only thick filaments are present (disappears during contraction)
 A-band – Region containing both actin and myosin filaments (remains the same length
during contraction)
 I-band – Region containing only thin filaments (shortens during contraction)

At Rest:

 The H-zone is visible because myosin and actin do not completely overlap.
 Tropomyosin blocks the actin-myosin binding sites, preventing contraction.

Summary of Sarcomere Organization:

Component Function

Thick Filaments (Myosin) Contains myosin heads that bind to actin for contraction

Thin Filaments (Actin, Actin provides a binding site, tropomyosin blocks it, and
Tropomyosin, Troponin) troponin binds calcium to initiate contraction

Z-line Boundary of the sarcomere; anchors thin filaments

M-line Center of the sarcomere; holds myosin filaments in place

Region with only thick filaments (disappears during

H-zone
contraction)

A-band Overlapping thick and thin filaments (remains constant)

I-band Region with only thin filaments (shortens during contraction)

VII. Nerve Stimulus to Muscles

Skeletal muscles contract in response to nerve stimulation from motor neurons.

Flowchart: Nerve Stimulus Process

Motor Neuron → Releases Acetylcholine (ACh) → ACh Binds to Receptors on Sarcolemma

→ Action Potential Travels Through T-Tubules → Sarcoplasmic Reticulum Releases Ca²⁺
→ Muscle Contraction Begins

VIII. Transmission of Nerve Impulse to Muscle

Steps in Transmission of Nerve Impulse

When a nerve impulse reaches a muscle fiber, it triggers a series of steps that lead to muscle
contraction and relaxation:

1. Nerve impulse arrives, releasing acetylcholine (ACh) from the axon terminal.
2. ACh binds to receptors on the sarcolemma, generating an action potential.
3. The action potential travels down the T-tubules, triggering calcium release.
4. Calcium binds to troponin, exposing actin's binding sites. Myosin heads attach to
actin, forming cross-bridges.
5. Muscle contracts as myosin pulls actin inward, shortening the sarcomere.
6. Acetylcholinesterase breaks down ACh, stopping the signal.
7. Calcium is reabsorbed into the sarcoplasmic reticulum.
8. Tropomyosin covers actin's binding sites, detaching cross-bridges.
9. Muscle relaxes due to a lack of calcium and ATP.

Correct Order of Excitation-Contraction Coupling:

1. Action potential arrives at the motor neuron, and acetylcholine (ACh) is released.
2. Acetylcholine binds to receptors on the motor endplate.
3. Depolarization increases Na⁺ and K⁺ conductance in the motor endplate.
4. The action potential spreads along the sarcolemma of the muscle fiber.
5. The action potential travels down the T-tubules.
6. Calcium ions are released from the sarcoplasmic reticulum.
7. Calcium ions bind to troponin, exposing myosin-binding sites on actin.
8. Troponin-tropomyosin complex undergoes a conformational change.
9. Myosin heads form cross-bridges with actin.
10. Myosin heads perform the power stroke, sliding actin over myosin.
11. ATP binds to myosin heads, causing detachment from actin.
12. Calcium ions are pumped back into the sarcoplasmic reticulum.

IX. Energy for Contraction

 Creatine Phosphate (CP) System – Immediate energy supply for short bursts.
 Anaerobic Glycolysis – Fast ATP production without oxygen, leading to lactic acid buildup.
 Aerobic Respiration – The most efficient ATP source, using oxygen for sustained activity.

Explanation: Energy for Muscle Contraction

Muscles need ATP (Adenosine Triphosphate) to contract. ATP is produced through three
major pathways:

1. Creatine Phosphate (CP) System

o Fastest energy source (lasts ~15 seconds).
o Used for short bursts of high-intensity activity (e.g., sprinting, weightlifting).
 o Creatine phosphate donates a phosphate group to quickly regenerate ATP.

2. Anaerobic Glycolysis (No Oxygen)

o Produces ATP quickly, breaking down glucose into lactic acid.
o Lasts about 30-60 seconds before muscle fatigue sets in.
o Used in activities like fast running, intense cycling, or heavy lifting.

3. Aerobic Respiration (With Oxygen)

o Most efficient method, generating ATP for hours.
o Uses oxygen to break down glucose or fat into ATP.
o Supports long-duration activities like marathons, jogging, and endurance
cycling.

Muscle Fatigue

 If ATP demand exceeds supply, muscles become fatigued.

 Without enough ATP, muscle performance declines, leading to exhaustion.

X. Muscle Performance (Fast and Slow Fibers)

Type IIx (Fast- Type IIb (Fast-

Type I (Slow- Type IIa (Fast-
Feature Twitch, Twitch,
Twitch) Twitch, Oxidative)
Glycolytic) Glycolytic)
Contraction
Slow Fast Very Fast Very Fast
Speed
Size of Motor
Small Medium Large Large
Neuron
Fatigue
High Moderate Low Low
Resistance
Primarily Aerobic Aerobic + Anaerobic Primarily Primarily
Energy Source (Oxygen- (Can switch energy Anaerobic Anaerobic
dependent) systems) (Glycolytic) (Glycolytic)
Power Output Low Moderate High Very High
Mitochondrial
High Moderate Low Low
Density
Myoglobin High (Red Moderate (White Low (White Very Low (White
Amount Muscles) Muscles) Muscles) Muscles)
Maximum >30 minutes
5–20 minutes <1–2 minutes <30 seconds
Duration of Use (Hours)
Endurance, high Fast and Maximum power,
Balanced endurance
Key Features myoglobin, high powerful, high fatigues quickly,
and power, versatile
mitochondria glycogen use anaerobic
Specific Activity Long-distance Middle-distance Sprinting, Sprinting,
running, cycling, running, swimming, weightlifting, maximal lifts,
 Type IIx (Fast- Type IIb (Fast-
Type I (Slow- Type IIa (Fast-
Feature Twitch, Twitch,
Twitch) Twitch, Oxidative)
Glycolytic) Glycolytic)
mixed endurance &
posture explosive power explosive efforts
power sports

XI. Sliding Filament Theory of Muscle Contraction

Flowchart: Muscle Contraction Process

Calcium Released → Troponin Activated → Myosin Cross-Bridges Form → Actin Pulled

Inward → Muscle Shortens

XII. Twitch Contraction

A brief contraction of a muscle fiber in response to a single nerve impulse.

Phases of a Twitch Contraction:

1. Latent Period – Time between stimulus and contraction

2. Contraction Period – Muscle fibers shorten
3. Relaxation Period – Muscle tension decreases

XIII. Wave (Temporal) Summation and Tetanus

 Wave Summation – Increased force by repeated stimulation

 Tetanus – Sustained muscle contraction due to rapid stimuli

XIV. Types of Muscle Contractions

 Isotonic – Muscle changes length while generating force

o Concentric – Muscle shortens (lifting a weight)
o Eccentric – Muscle lengthens (lowering a weight)
 Isometric – Muscle generates force without changing length

XV. Abnormal Contractions of Skeletal Muscle

Abnormal muscle contractions occur due to neuromuscular dysfunction, metabolic imbalances,
or nervous system disorders. These contractions can range from mild involuntary movements
to painful and persistent contractions.

Types of Abnormal Muscle Contractions

1. Spasm

 Definition: A sudden, involuntary contraction of a single muscle or a group of muscles.

 Causes: Can be triggered by nerve irritation, fatigue, dehydration, or electrolyte
imbalances.
 Example: Eyelid twitching (myokymia) or muscle spasms after intense exercise.

2. Cramps

 Definition: A painful, spasmodic contraction of muscles.

 Causes:
o Inadequate blood flow to muscles
o Overuse of muscles
o Dehydration
o Holding a position for too long
o Electrolyte imbalance (low potassium, calcium, or magnesium levels)
 Example: Leg cramps during sleep (nocturnal leg cramps) or charley horse cramps
in athletes.

3. Tic

 Definition: Repetitive, involuntary movements of small muscle groups, especially in

the face.
 Causes: Often associated with stress, neurological disorders, or Tourette syndrome.
 Example: Blinking, facial twitches, or repeated throat clearing.

4. Tremor

 Definition: Rhythmic, involuntary shaking of muscles, usually in the hands, head, or

voice.
 Causes:
o Neurological disorders (e.g., Parkinson’s disease)
o Anxiety or stress
o Caffeine overdose
 Example: Essential tremors (shaking of hands during movement).
5. Tardive Dyskinesia

 Definition: Involuntary, repetitive movements, often affecting the face, tongue, and
limbs.
 Causes:
o Long-term use of antipsychotic medications
o Dopamine dysfunction in the brain
 Example: Lip-smacking, blinking, or uncontrollable facial movements.

6. Myoclonus

 Definition: Sudden, brief, jerky muscle contractions that occur spontaneously or in

response to stimuli.
 Causes:
o Sleep disturbances (hypnic jerks before sleep)
o Neurological disorders (epilepsy, multiple sclerosis)
 Example: Hiccups or sudden jerks when falling asleep.

7. Athetosis

 Definition: Slow, writhing, involuntary movements, primarily in the fingers and hands.
 Causes:
o Cerebral palsy or basal ganglia damage
 Example: Uncontrolled finger twisting or hand movements in neurological disorders.

XVI. Psychological & Physiological Factors Affecting Muscle Spasms

Muscle spasms, tremors, and tics are not only caused by physiological factors but can also be
exacerbated by psychological conditions, particularly stress, anxiety, and mental health
disorders. Several studies emphasize the strong link between neuromuscular activity and
emotional well-being.

1. Key Psychological & Physiological Factors Influencing Muscle Spasms

🔹 Psychological Stress & Anxiety:

 Strongly linked to exacerbating involuntary muscle contractions.

 Emotional states like fear, tension, and anger activate the Autonomic Nervous System
(ANS), triggering muscle spasms and tics.
 Chronic stress increases cortisol levels, which may impair motor control.

🔹 Mental Health Disorders & Motor Control:

 Depression, PTSD, and generalized anxiety disorder have documented effects on

muscle control.
  People experiencing chronic stress are more prone to muscle spasms, tremors, and
tics.

🔹 Neurological Disorders & Stress-Induced Muscle Dysfunctions:

 Stress can unmask underlying neurological conditions such as Parkinson’s disease.

 Certain disorders like Tardive Dyskinesia (linked to long-term psychiatric medication
use) may worsen under psychological stress.

2. Case Studies & Research Findings

📌 Study 1: Psychological and Physiological Factors Related to Muscle Spasms and Tics – A
Comprehensive Review
🔹 Key Findings:

 Mental health and muscle function are deeply interconnected.

 Stress-induced neuromuscular dysfunction is common in individuals with PTSD,
anxiety, and depression.
 Calls for holistic treatment approaches integrating mental health care with
neuromuscular therapy.

📌 Study 2: Eyelid Myokymia (EM) in Medical Students (Hadžić, Kukić, Zvorničanin, 2016)
🔹 Key Findings:

 44% of medical students reported eyelid twitching (EM) before exams.

 Women were 2.46 times more likely to experience EM than men.
 Energy drinks significantly increased the risk of EM (P = 0.046).
 Reduced sleep was linked to a higher frequency of symptoms (P = 0.014).
 Increased stress levels correlated with a greater likelihood of EM (P = 0.042).

📌 Study 3: How Stress Can Unmask Parkinson’s Disease (van der Heide et al., 2024)
🔹 Key Findings:

 Stress can accelerate the onset of Parkinson’s symptoms in individuals with

subclinical Parkinson’s Disease (PD).
 Tremors appeared following intense stressful events and persisted even after stress
was reduced.
 Suggests that stress might play a role in triggering Parkinson’s progression.

XVII. Psychological Disorders Associated with the Muscular System

Psychological disorders can directly or indirectly affect the muscular system, leading to
involuntary muscle contractions, chronic pain, and movement disorders. Mental health
conditions such as stress, anxiety, and depression can worsen or trigger neuromuscular
conditions.
1. Stress and Its Impact on the Muscular System

 Plays a critical role in triggering cardiac arrhythmias and sudden cardiac death.
 Increases muscle tension, leading to chronic pain and spasms.
 Studies show a high prevalence of stress disorders in individuals with muscular
dystrophies.
 Prolonged stress leads to overactivation of the autonomic nervous system, worsening
neuromuscular symptoms.

2. Dystonia and Mental Health

 Dystonia is a neurological disorder causing involuntary muscle contractions, leading to

abnormal postures and repetitive movements.
 Strong correlation between dystonia severity and mental health issues:
o Anxiety and depression scores are higher in individuals with cervical dystonia.
o A study in the Journal of Neurology found that people with cervical dystonia
had significantly increased anxiety and depression levels compared to the
general population.

3. Psychogenic Pain (Functional Pain Syndrome)

 Pain that originates in the brain rather than from a direct injury or illness.
 Can be triggered by mental health conditions, past trauma, stress, and neurological
dysfunction.
 Commonly affects the muscular system, leading to chronic muscle pain without an
identifiable physical cause.
 Associated Conditions:
o Fibromyalgia (widespread muscle pain linked to psychological stress)
o Tension headaches
o Chronic back pain with no structural damage