MUSCULAR SYSTEM

1. MUSCULAR SYSTEM 

2. Introduction Without the muscular system we would be unable to sit, stand, walk, speak, or grasp objects. Blood would not circulate, because there would be no heartbeat to propel it through the vessels. The lungs could not rhythmically empty and fill, nor could food move through the digestive tract.

3. Structure and Function The human body has more than 600 muscles

5. Structure and Function Muscle tissue is specialized for contraction. The contraction mechanism is the same in each of the types of muscle tissue, but the organization of the fibers and filaments differ in each. Muscles may be directly or indirectly (via tendons) attached to bones. Muscles are also found in and around body organs and structures.

6. Structure and Function Movement Posture and Body Position Support Soft Tissue Guard Entrances and Exits Involuntary Bodily Processes Thermogenesis

7. Structure and Function Movement � muscle contractions pull on tendons and move the bones of the skeleton. Posture and Body Position � Without constant muscle tension, you could not sit upright without collapsing or stand without toppling over. Support Soft Tissue � The abdominal wall and the floor of the pelvic cavity consist of layers of muscle that support the weight of visceral organs and shield internal tissues from injury.

8. Structure and Function Guard Entrances and Exits � Skeletal muscles guard openings to the digestive and urinary tracts, and provide voluntary control over swallowing , defecation, and urination. Involuntary Bodily Processes � For example, contraction of the heart is an involuntary bodily process- the nervous system does not provide voluntary control over the cardiac muscle cells.

9. Structure and Function Thermogenesis � Muscle contractions require energy, and whenever energy is used in the body, some of its converted to heat. The heat lost by the working muscles keeps the body temperature in the normal range.

10. Characteristics of Muscles Excitability Contractibility Extensibility Elasticity

11. Excitability Irritability, the ability to respond to a stimulus such as a nerve impulse

12. Contractibility Muscle fibers that are stimulated by nerves contract, or become short and thick, which causes movement

13. Extensibility The ability to be stretched

14. Elasticity Allows the muscle to return to its original shape after it has contracted or stretched

16. Skeletal Muscle Makes up more than 40% of a person�s body weight Looks striated, or banded, under the microscope Skeletal muscles have three parts Origin is one end of the muscle, attached to the less movable part of the bone Insertion is the other end of the muscle, attached to the more movable part of the bone The action, or body, is the thick middle part of the muscle

17. Skeletal Muscles (cont.) Skeletal muscles attach to bones in different ways Tendons-strong tough, fibrous connective- tissue cords Fascia- a tough sheetlike membrane that covers and protects the tissue

18. Visceral Muscle Lines various hollow organs Makes up the walls of blood vessels Found in the tubes of the digestive system Smooth and has no striations Controlled by the autonomic nervous system

19. Cardiac Muscle Found only in the heart Striated muscle Under involuntary control Has specialized cells that provide a stimulus for contraction

20. Naming Skeletal Muscles The names assigned to muscles provide clues to their identification. Orientation of muscle fibers Regional location Structural features Shape, length, size, superficial or deep Origin and insertion Primary function

21. Naming Skeletal Muscles Some muscles, often with Greek or Latin roots, refer to the orientation of muscle fibers. For example �rectus� means straight and rectus muscle fibers generally run along the long axis of the body. In a few cases, a muscle is such a prominent feature that the regional name alone can identify it, such as the temporalis muscle of the head.

22. Naming Skeletal Muscles Other muscles are named after structural features. For example, a biceps muscle has two tendons of origin, whereas the triceps has three. Muscle names can reflect shape, length, size, and whether a muscle is visible at the surface or lying beneath. Maximus means large. Minimus means small. Longus means long. Brevis means short.

23. Naming Skeletal Muscles The first part of some names indicate the origin and the second part the insertion, such as the brachioradialis. Other names may indicate the primary function of the muscle, such as the flexor digitorum. Some muscles are named according to their shape, such as the deltoid (triangular), the trapezius (trapezoid), or the rhomboids (diamond shape).

24. Temporomandibular Joint The principle muscles opening the mouth are the external pterygoids Closing the mouth are the masseter, the temporalis, and the internal pterygoids.

25. The Scapulohumeral Group This group extends from the scapula to the humerus and includes the muscles inserting directly on the humerus Rotates the shoulder laterally, and depresses and rotates the head of the humerus.

26. The Scapulohumeral Group Supraspinatus � runs above the glenohumeral joint; inserts on to the greater tubercle Infraspinatus and Teres minor � cross the glenohumeral joint posteriorly; insert above the greater tubercle

27. The Scapulohumeral Group Subscapularis � originates on the anterior surface of the scapula and crosses the joint anteriorly; iniserts on the lesser tubercle.

28. The Axioscapular Group This group attaches the trunk to the scapula and includes the trapezius, rhomboids, serratus anterior and levator scapulae. These muscles rotate the scapula.

29. The Axiohumeral Group This group attaches the trunk to the humerus and the pectoralis major and minor and the latissimus dorsi. The muscle produce internal rotation of the shoulder.

30. The Elbow The muscles traversing the elbow include the biceps and brachioradialis (flexion), the triceps (extension), the pronator teres (pronation), and the supinator (supination).

31. The Wrist and Hands Wrist flexion arises from the two carpal muscles, located on the radial and ulnar surfaces. Two radial and one ulnar muscle provide wrist extension. Supination and pronation result from muscle contraction of the forearm.

32. The Wrist and Hands The thumb is powered by three muscles that form the thenar eminence and provide flexion, abduction, and opposition The muscles of extension are at the base of the thumb along the radial margin

33. The Wrist and Hands Movement in the digits depends on the action of the flexor and extensor tendons of muscles in the forearm and wrist. The instrinsic muscles of the hand attaching to the metacarpal bones are involved in flexion (lumbricals), abduction (dorsal interossei), and adduction (palmar interossei) of the fingers

34. The Wrist and Hands Holding the tendons and tendon sheath in place is a transverse ligament, the flexor retinaculum

35. The Spine The trapezius and latissimus dorsi form the outer layer of muscles attaching to each side of the spine. They overlie two deeper muscle layers � a layer attaching the head, neck, and spinous processes (splenius capitis, splenius cervicis, and sacrospinalis) and a smaller layer of instrinsic muscles between vertebrae.

36. The Spine Muscles attaching to the anterior surface of the vertebrae, including the psoas muscles and the muscles of the abdominal wall, assist with flexion.

37. The Hip Four powerful muscle groups move the hip: Flexor group Extensor group Adductor group Abductor group

38. Flexor Group This group lies anteriorly and flexes the thigh The primary hip flexor is the iliopsoas, extending from above the iliac crest to the lesser trochanter

39. The Extensor Group Lies posteriorly and extend to the thigh The gluteus maximus is the primary extensor of the hip It forms a band crossing from its origin along the medial pelvis to its insertion below the trochanter

40. The Adductor Group Is medial and swings the thigh toward the body The muscles in this group arise from the rami of the pubis and ischium and insert on the posteromedial aspect of the femur.

41. The Abductor Group Lateral, extending from the iliac crest to the head of the femur, and moves the thigh away from the body This group includes the gluteus medius and minus These muscles help stabilize the pelvis during the stance phase of gait

42. The Knee Powerful muscles move and support the knee. The quadriceps femoris extends the leg, covering the anterior, medial, and later aspects of the thigh The hamstring muscles lie on the posterior aspect of the thigh and flex the knee.

43. The Knee The meninsci and two important pairs of ligaments, the collaterals and the cruciates, are crucial to stability of the knee

44. The Menensci The medial and lateral menisci cushion the action of the femur on the tibia These crescent shaped fibrocartilaginous discs add a cup like surface to the otherwise flat tibial plateau

45. Collateral Ligaments The medial collateral ligament (MCL), not easily palpable, is a broad, flat ligament connecting the medial fermoral epiccondyle to the medial condyle of the tibia The medial portion of the MCL also attaches to the medial meniscus

46. Collateral Ligaments The lateral collateral ligament (LCL) connects the lateral femoral epicondyle and the head of the fibula. The MCL and LCL provide medial and lateral stability to the knee joint

47. Cruciate Ligaments The anterior cruciate ligament (ACL) crosses obliquely from the anterior medial tibia to the lateral femoral condyle, preventing the tibia from sliding forward on the femur

48. Cruciate Liagments The posterior cruciate ligament (PCL) crosses from the posterior tibia and lateral meniscus to the medial femoral condyle, preventing the tibia from slipping backward on the femur Because these ligaments lie within the knee joint, they are not palpable

49. The Ankle and Foot Movement at the ankle joint is limited to dorsiflexion and plantar flexion Plantar flexion is powered by the gastrocnemius, the posterior tibial muscle, and the toe flexors Their tendons run behind the malleoli

50. The Ankle and Foot The dorsiflexors include the anterior tibia muscle and the toe extensors They lie prominently on the anterior surface, or dorsum, of the ankle, anterior to the malleoli

51. The Ankle and Foot Ligaments extend from each malleolus onto the foot Medially, the triangular shaped deltoid ligament fans out from the inferior surface of the medial malleolus to the talus and proximal tarsal bones, protecting against stress from eversion (ankle bows inward)

52. The Ankle and Foot Laterally, the three ligaments are less substantial, with higher risk for injury: The anterior talofibular ligament � most at risk for injury from inversion (ankle bows outward) injuries; The calcaneofibular ligament; and the posterior talofibular ligament

53. The Ankle and Foot The strong Achilles tendon attaches the gastronemius and soleus muscles to the posterior calcaneus The plantar fascia inserts on the medial tubercle of the calcaneus

54. Additional Muscle Groups

55. Sternocleidomastoid Location: Side of neck Function: Turns and flexes head

56. Trapezius Location: Upper back and neck Function: Extends head, moves shoulder

57. Deltoid Location: Shoulder Function: Abducts arm, injection site

58. Biceps brachii Location: Upper arm Function: Flexes lower arm and supinates hand

59. Triceps brachii Location: Upper arm Function: Extends and adducts lower arm

60. Pectoralis major Location: Upper chest Function: Adducts and flexes upper arm

61. Intercostals Location: Between ribs Function: Moves ribs for breathing

62. Rectus abdominus Location: Ribs to pubis (pelvis) Function: Compresses abdomen and flexes vertebral column

63. Latissimus dorsi Location: Spine around to chest Function: Extends and adducts upper arm

64. Gluteus maximus Location: Buttocks Function: Extends and rotates thigh, injection site

65. Sartorius Location: Front of thigh Function: Abducts thigh, flexes leg

66. Quadriceps femoris Location: Front of thigh Function: Extends leg, injection site

67. Tibialis anterior Location: Front of lower leg Function: Flexes and inverts foot

68. Gastrocnemius Location: Back of lower leg Function: Flexes and supinates sole of the foot

69. Basic Types of Muscle Movement Adduction Abduction Flexion Extension Rotation

70. Adduction Moving a body part toward the midline

71. Abduction Moving a body part away from the midline

72. Flexion Decreasing the angle between two bones, or bending a body part

73. Extension Increasing the angle between two bones, or straightening a body part

74. Rotation Turning a body part around its own axis; for example, turning the head from side to side.

75. Circumduction Moving in a circle at a joint, or moving one end of a body part in a circle while the other end remains stationary, such as swinging a arm in a circle

76. Body Mechanics Body Mechanics is the way in which the body moves and maintains balance while making the most efficient use of all its body parts. To prevent injury to yourself and others while working in the health field, it is important to observe good body mechanics

77. Four Main Reasons for Using Good Body Mechanics Muscles work best when used correctly. Correct use of muscles makes lifting, pulling and pushing easier Prevents unnecessary fatigue, strain and saves energy Prevents injury to self and others

78. Eight Basic Rules of Good Body Mechanics 1)Maintain a broad base of support by keeping the feet 8-10 inches apart 2)Bend from the hips and knees to get close to an object, and keep your back straight 3)Use the strongest muscles to do the job (shoulders, upper arms, hips and thighs) 4)Use the weight of your body to help push or pull an object. Whenever possible, push, slide, or pull rather than lift

79. Eight Basic Rules of Good Body Mechanics 5)Carry heavy objects close to the body 6)Avoid twisting your body as you work. Turn with your feet and entire body when you change direction of movement 7)Avoid bending for long periods 8)If a patient or object is too heavy for you to lift alone, always get help

80. Diseases and Abnormal Conditions

81. Muscular Dystrophy Muscular dystrophy is a group of disorders that involve muscle weakness and loss of muscle tissue that get worse over time.

82. Symptoms Symptoms vary with the different types of muscular dystrophy. All of the muscles may be affected. Or, only specific groups of muscles may be affected, such as those around the pelvis, shoulder, or face. Muscular dystrophy can affect adults, but the more severe forms tend to occur in early childhood.

83. Symptoms Mental retardation (only present in some types of the condition) Muscle weakness that slowly gets worse Delayed development of muscle motor skills Difficulty using one or more muscle groups Drooling Eyelid drooping (ptosis) Frequent falls Problems walking (delayed walking

84. Causes and Risk Factors Many diseases called muscular dystrophies (MD) are inherited disorders, such as: Becker's muscular dystrophy Duchenne muscular dystrophy Emery-Dreifuss muscular dystrophy Facioscapulohumeral muscular dystrophy Limb-girdle muscular dystrophy Myotonia congenita Myotonic dystrophy

85. Tests and Diagnosis A physical examination and your medical history will help the doctor determine the type of muscular dystrophy. Specific muscle groups are affected by different types of muscular dystrophy.

86. Tests and Diagnosis A muscle biopsy may be used to confirm the diagnosis. In some cases, a DNA blood test may be all that is needed. Other tests may include: Electrocardiography (ECG) Electromyography (EMG) Serum CPK

87. Tests and Diagnosis This disease may also alter the results of the following tests: Aldolase AST Creatinine LDH Myoglobin - urine/ serum

88. Treatments There are no known cures for the various muscular dystrophies. The goal of treatment is to control symptoms. Physical therapy may help patients maintain muscle strength and function. Orthopedic appliances such as braces and wheelchairs can improve mobility and self-care abilities. In some cases, surgery on the spine or legs may help improve function.

89. Treatments Corticosteroids taken by mouth are sometimes prescribed to children to keep them walking for as along as possible. The person should be as active as possible. Complete inactivity (such as bedrest) can make the disease worse.

90. Complications Cardiomyopathy Decreased ability to care for self Decreased mobility Joint contractures Mental impairment (varies) Respiratory failure Scoliosis

91. Prevention Genetic counseling is advised when there is a family history of muscular dystrophy. Women may have no symptoms but still carry the gene for the disorder. Duchenne muscular dystrophy can be detected with about 95% accuracy by genetic studies performed during pregnancy.

92. Fibromyalgia Fibromyalgia is a common condition characterized by long-term, body-wide pain and tender points in joints, muscles, tendons, and other soft tissues. Fibromyalgia has also been linked to fatigue, morning stiffness, sleep problems, headaches, numbness in hands and feet, depression, and anxiety. Fibromyalgia can develop on its own or along with other musculoskeletal conditions such as rheumatoid arthritis or lupus.

93. Symptoms The overwhelming characteristic of fibromyalgia is long-standing, body-wide pain with defined tender points. Tender points are distinct from trigger points seen in other pain syndromes. Unlike tender points, trigger points can occur in isolation and represent a source of radiating pain, even in the absence of direct pressure.

94. Symptoms Fibromyalgia pain can mimic the pain that occurs with various types of arthritis. However, the significant swelling, destruction, and deformity of joints seen in diseases such as rheumatoid arthritis does not occur with fibromyalgia syndrome alone.

95. Symptoms The soft-tissue pain of fibromyalgia is described as deep-aching, radiating, gnawing, shooting or burning, and ranges from mild to severe. Fibromyalgia sufferers tend to wake up with body aches and stiffness.

96. Symptoms For some patients, pain improves during the day and increases again during the evening, though many patients with fibromyalgia have day-long, unrelenting pain. Pain can increase with activity, cold or damp weather, anxiety and stress.

97. Specific Symptoms Body aches Chronic facial muscle pain or aching Fatigue Irritable bowel syndrome Memory difficulties and cognitive difficulties Multiple tender areas (muscle and joint pain) on the back of the neck, shoulders, sternum, lower back, hips, shins, elbows, knees

98. Specific Symptoms Numbness and tingling Palpitations Reduced exercise tolerance Sleep disturbances Tension or migraine headaches

99. Causes and Risk Factors The cause of this disorder is unknown. Physical or emotional trauma may play a role in development of the syndrome. Some evidence suggests that fibromyalgia patients have abnormal pain transmission responses.

100. Causes and Risk Factors It has been suggested that sleep disturbances, which are common in fibromyalgia patients, may actually cause the condition. Another theory suggests that the disorder may be associated with changes in skeletal muscle metabolism, possibly caused by decreased blood flow, which could cause chronic fatigue and weakness.

101. Causes and Risk Factors Others have suggested that an infectious microbe, such as a virus, triggers the illness. At this point, no such virus or microbe has been identified. Pilot studies have shown a possible inherited tendency toward the disease, though evidence is very preliminary. Men and women of all ages get fibromyalgia, but the disorder is most common among women aged 20 to 50.

102. Tests and Diagnosis Diagnosis of fibromyalgia requires a history of a least 3 months of widespread pain, and pain and tenderness in at least 11 of 18 tender-point sites. These tender-point sites include fibrous tissue or muscles of the:

103. These tender-point sites include fibrous tissue or muscles of the: Arms (elbows) Buttocks Chest Knees Lower back Neck Rib cage Shoulders Thighs

104. Treatments In mild cases, symptoms may go away when stress is decreased or lifestyle changes are implemented. A combination of treatments including medications, patient education, physical therapy, and counseling are usually recommended. Many fibromyalgia sufferers have found support groups helpful.

105. Treatments In 2007, the Food and Drug Administration approved Pregabalin (Lyrica) as the first drug for the treatment of fibromyalgia. In June 2008, a second drug, Cymbalta, which was previously approved for treating depression, was FDA approved for treating fibromyalgia as well. In 2009 the FDA approved milnacipran (Savella) for the treatment of fibromyalgia.

106. Treatments Studies show that antidepressants in low doses can decrease depression, relax craniofacial and skeletal muscles, improve sleep quality, and release pain-killing endorphins. Other medications that are used include anti-inflammatory pain medications and medications that work on pain transmission pathways, such as Gabapentin.

107. Treatments Eating a well-balanced diet and avoiding caffeine may help with problems sleeping, and may help reduce the severity of the symptoms. Lifestyle measures to improve the quality of sleep can be effective for fibromyalgia.

108. Treatments Some reports indicate that fish oil, magnesium/malic acid combinations, or vitamins may be effective. Reducing stress and improving coping skills may also help reduce painful symptoms.

109. Treatments Studies have shown that fibromyalgia symptoms can be relieved by aerobic exerccise. The best way to begin a fitness program is to start with short sessions of just a few minutes of gentle, low-impact exercises such as walking and swimming.

110. Compartment Syndrome Compartment syndrome occurs when too much pressure builds up in and around the muscles. It can result from crushing injuries, extended pressure on a blood vessel, swelling inside a cast, or complications from surgery. 

111. Compartment Syndrome Symptoms - include severe pain, a feeling of fullness or tightness in the muscle, and a tingling sensation. Numbness indicates cellular death, and it may be difficult to restore full function once it reaches that point. Treatment - Surgery to relieve the pressure is usually required.

112. Rhabdomyolosis Damages both the muscles and the kidneys by causing the muscle fibers to breakdown and be released into the blood stream. The fibers erode into a substance called myoglobin, which blocks the kidney structures and can lead to kidney failure. Etiology - Alcoholism, heatstroke, cocaine and heroin overdoses, seizures, and severe exertion are possible causes. 

113. Rhabdomyolysis Treatment - If the condition is caught early, intravenous fluids are given to restore hydration. Once kidney damage occurs, treatment focuses on restoring renal functions and preventing further damage. Signs of rhabdomyolysis include weakness, muscle stiffness and pain, joint pain and weight gain.

114. Myasthenia Gravis A neuromuscular disorder characterized by variable weakness of voluntary muscles, which often improves with rest and worsens with activity. The condition is caused by an abnormal immune response.

115. Myasthenia Gravis Myasthenia gravis affects about 3 of every 10,000 people and can affect people at any age. It is most common in young women and older men.

116. Signs and Symptoms Muscle weakness, including: Difficulty swallowing, frequent gagging, or choking Paralysis Muscles that function best after rest Drooping head Difficulty climbing stairs Difficulty lifting objects Need to use hands to rise from sitting positions Difficulty talking Difficulty chewing

117. Signs and Symptoms Vision problems: Double vision Difficulty maintaining steady gaze Eyelid drooping Additional symptoms that may be associated with this disease: Hoarseness or changing voice Fatigue Facial paralysis Drooling Breathing difficulty

118. Causes and Risk Factors Weakness occurs when the nerve impulse to initiate or sustain movement does not adequately reach the muscle cells. This is caused when immune cells target and attack the body's own cells (an autoimmune response).

119. Causes and Risk Factors This immune response produces antibodies that attach to affected areas, preventing muscle cells from receiving chemical messages (neurotransmitters) from the nerve cell.

120. Causes and Risk Factors The cause of autoimmune disorders such as myasthenia gravis is unknown. In some cases, myasthenia gravis may be associated with tumors of the thymus (an organ of the immune system).

121. Causes and Risk Factors Patients with myasthenia gravis have a higher risk of having other autoimmune disorders like thyrotoxicosis, rheumatoid arthritis, and systemic lupus erythematosus.

122. Test and Diagnosis Examination may be normal or may show muscle weakness that progressively worsens as the muscle is used. In many patients the eye muscles are affected first. Reflexes and sensation are normal. Weakness may affect the arms, legs, breathing or swallowing muscles, and any other muscle group.

123. Repetitive stimulation (type of nerve conduction study) is more sensitive. Single-fiber EMG can be very sensitive. Acetylcholine receptor antibodies may be present in the blood. A Tensilon test is positive in some cases but must be interpreted carefully by an experienced doctor. Baseline muscle strength is evaluated. After Tensilon (edrophonium, a medication that blocks the action of the enzyme that breaks down the transmitter acetylcholine) is given, muscle function may improve. The patient may need a CT or MRI scan of the chest to look for a possible tumor in the thyroid.

124. Treatment There is no known cure for myasthenia gravis. However, treatment may result in prolonged periods of remission. Lifestyle adjustments may enable continuation of many activities. Activity should be planned to allow scheduled rest periods. An eye patch may be recommended if double vision is bothersome. Stress and excessive heat exposure should be avoided because they can worsen symptoms.

125. Treatment Some medications, such as neostigmine or pyridostigmine, improve the communication between the nerve and the muscle. Prednisone and other medications that suppress the immune response (such as azathioprine, cyclosporine, or mycophenolate mofetil) may be used if symptoms are severe and there is inadequate response to other medications.

126. Treatment Plasmapheresis, a technique in which blood plasma containing antibodies against the body is removed from the body and replaced with fluids (donated antibody-free plasma or other intravenous fluids), may reduce symptoms for up to 4 - 6 weeks and is often used to optimize conditions before surgery

127. Treatment When other treatments do not improve systems, patients may receive intravenous immunoglobulin. Surgical removal of the thymus (thymectomy) may result in permanent remission or less need for medicines. Patients with eye problems may try lens prisms to improve vision. Surgery may also be performed on the eye muscles.

128. Complications Restrictions on lifestyle (possible) Side effects of medications (see the specific medication) Complications of surgery Myasthenic crisis (breathing difficulty), may be life threatening

129. Diseases and Abnormal Conditions (cont.) Muscle sprain A traumatic injury to the tendons, muscles, or ligaments of a joint Muscle strain Torn or stretched tendons and muscles, causing pain

130. Pharmacology

131. Complete a Medication Worksheet for the following drugs: Lyrica Savella Cymbalta Gabapentin Fish Oil Prednisone Neostigmine Pyridostigmine Azathioprine Cyclosporine Mycophenolate mofetil Soma Flexeril Valium Skelaxin Myfortic Robaxin Zanaflex

132. Medication Sheet should include: Drug Generic and Brand Name Classification Preparation Route available Dosage available Frequency administered Drug Action Side Effects Incompatibilities Administered Times Contraindications Teaching Health Care Provider Implications

133. Related Health Careers Athletic Trainer Chiropractor Doctor of Osteopathic Medicine Massage Therapist Myologist Neurologist Orthopedist Physiatrist Physical Therapist Podiatrist Prosthetist Rheumatologist Sports Medicine Physician

134. Medical Terminology Root Word(s): My(o)- a word element denoting muscle Myasthenia- muscular weakness Myocardial- pertaining to the heart of the muscle Myokinesis- movement of the muscle Myodynia- pain of the muscle Myomalacia- abnormal muscle softening Electromyography- electrical recording of muscle activity Myositis- inflammation of muscle Myopathy- any disease of muscle

135. Medical Terminology Root Word(s): Rhabdomy(o)- denotes skeletal muscle Rhabdomyoma- a benign tumor of the skeletal muscle Rhabdomyosarcoma- a malignant tumor of the skeletal muscle

136. Medical Terminology Root Word(s): Leiomy(o)- denotes smooth muscle Leiomyoma- benign tumor of the smooth muscle Leiomyosarcoma- malignant tumor of the smooth muscle

137. Abbreviations (D) d- day D&C- Dilatation and Cutterage DA- Dental Assistant DC- Doctor of Chiropractic DDS- Doctor of Dental Surgery DEA- Drug Enforcement Agency del- Delivery Dept- Department

138. Abbreviations (D) DH- Dental Hygenist DHHS- Department of Health and Human Services Diff- Differential White Blood Cell Count DDM- Doctor of Dental Medicine DNR- Do Not Resuscitate DO- Doctor of Osteopathy DOA- Dead on Arrival DOB- Date of Birth

139. Abbreviations (D) DPM- Doctor of Pediatric Medicine DPT- Diptheria, Pertussis, Tetanus DW- Distilled Water Dx- Diagnosis