This video is available for licensing on our website. Click HERE!

The musculoskeletal system provides mechanical support for the body, protects internal organs and permits movement. It is composed of bones, cartilage, skeletal muscles, joints, and connective tissues such as tendons and ligaments. Bones also serve as the body’s main mineral reservoir, they store calcium and phosphate and release them according to the body’s needs. Red bone marrow is the body’s production center for blood cells.
The central nervous system controls body movements by stimulating skeletal muscles to contract. Contraction of skeletal muscles moves bones, which act as levers. Bones articulate with each other through joints. Cartilage provides padding for the ends of bones within joints. Muscles are connected to bones by tendons, while bones are held together by ligaments.
Bones are classified according to their shapes and corresponding functions: long bones are responsible for most body movements; short bones provide some limited motion; while flat bones and irregular bones are mainly protective and supportive.
The bone tissue, or osseous tissue, is composed of bone cells and a characteristic extracellular matrix. Bone matrix is made of an organic component, mainly collagen, and an inorganic component of minerals, mainly calcium. Collagen gives bones flexibility while calcium provides stiffness. Without calcium, bones would be soft and bend easily. On the other hand, without collagen, bones would be brittle like chalk.
Bones renew and remodel throughout a person’s life in a process known as bone remodeling, which constantly removes old bone tissue and adds new bone tissue. Bone remodeling serves to re-shape bones to adjust to changing mechanical needs and to repair everyday micro-damages as well as fractures following injuries. This process also underlies the mechanism by which the constant levels of plasma calcium and phosphate are maintained. Bone remodeling is performed by 2 types of cells: osteoclasts, which dissolve bone matrix, and osteoblasts, which deposit new matrix around themselves to form new bone tissue. Bone remodeling is under control of complex signaling pathways. Major regulators include parathyroid hormone, vitamin D, growth hormones, glucocorticoids, thyroid hormones, estrogen and testosterone.
The most common bone disease is osteoporosis, or porous bone, in which bones lose mass and weaken, increasing risks of fractures. Osteoporosis is commonly due to old age and some other unavoidable factors, but can also develop from, or worsen by hormone imbalances, deficiencies in calcium, vitamin D or proteins, and sedentary lifestyles.
The most common and also most movable type of joint is synovial joint. The bones of a synovial joint are separated by a cavity containing synovial fluid, which serves as lubricant. Together, the fluid and the cartilage that lines the bone surfaces make the movements at synovial joints almost friction-free. There are also small fibrous sacs containing synovial fluid, called bursae, located between muscles, or between a tendon and a bone. Bursae cushion muscle movements and help tendons slide smoothly over the joints.
The most common disease of joints is arthritis. There are 2 main types of arthritis:
– Osteoarthritis, also called degenerative joint disease, is the “wear and tear” condition of the joint, commonly due to old age. Osteoarthritis is characterized by loss of cartilage, bone spurring and no major inflammation.
– Rheumatoid arthritis is a result of joint inflammation, with immune cells and inflammatory chemicals causing damage to the joint. It’s not clear how rheumatoid arthritis starts but genetic predisposition together with infection of the joint are likely to be among the causes.
Muscular tissue consists of specialized elongated muscle cells, called muscle fibers, which are bundled into fascicles. Muscle fibers, fascicles and whole muscles are wrapped in layers of connective tissue, which provides support and protection. These connective tissue coverings are continuous with the tendon that connects to a nearby bone. Fascicle arrangement determines the strength of a muscle and the direction it pulls. Most common muscle disorders are caused by injury or overuse, and include sprains, strains, cramps, and tendinitis.

Este vídeo e outras imagens/vídeos relacionados (em alta definição) estão disponíveis para download sob licença aqui!

Às vezes, a cabeça do úmero rasga parte do labrum, se deslocando. Isso é conhecido como uma lesão de Bankart. A lesão de Bankart pode resultar em instabilidade na articulação do ombro e necessitar de cirurgia. Um reparo de Bankart envolve a religação e compressão do labrum rasgado.
As bordas rasgadas do labrum são removidas, revelando o labrum novo.
Pequenos orifícios são perfurados na glenoide para receber um dispositivo de fixação especial, chamado de âncora. Suturas são fixadas às âncoras para puxar o labrum de volta para a glenoide.
Esse processo é repetido até que o labrum seja completamente fixado à glenoide.
Após o procedimento, o braço é colocado numa tipoia durante algumas semanas. Para recuperar o movimento e a força do ombro, a fisioterapia é obrigatória.

Este vídeo e outras imagens/vídeos relacionados (em alta definição) estão disponíveis para download sob licença aqui!

Síndrome da dor miofascial é uma doença comum de dor crônica que pode afetar várias partes do corpo. A síndrome da dor miofascial é caracterizada pela presença de pontos híper-irritáveis localizados no músculoesquelético chamados de pontos gatilho. Um ponto gatilho pode ser sentido como uma banda ou um nódulo no músculo, com uma consistência mais dura que o normal. A palpação de pontos gatilho pode causar dor numa área diferente do corpo. Isto se chama dor referida. A dor referida torna o diagnóstico difícil, uma vez que vai replicar os sintomas de condições mais comumente conhecidas. Por exemplo, a dor associada ao ponto gatilho que causa dor na cabeça ou na região do pescoço pode manifestar-se como cefaleia tensional, dor na articulação temporomandibular, dor ocular ou zumbido.
Os sintomas da síndrome da dor miofascial incluem dor regional persistente, comumente associada a uma limitação do movimento do músculo afetado. A dor é mais frequentemente identificada na cabeça, pescoço, ombros, extremidades e na zona lombar.
Os pontos gatilho desenvolvem-se como consequência de lesões musculares. Estas podem ser trauma agudo causado por uma lesão desportiva, acidente, ou sobreutilização crônica do músculo causada por atividades ocupacionais repetitivas, stress emocional ou postura incorreta. Um ponto gatilho é composto por vários nódulos de contração onde as fibras musculares individuais contraem e não conseguem relaxar. Estas fibras fazem o músculo mais curto e constituem uma banda tensa – um grupo de fibras musculares tensas ao longo da extensão entre o ponto gatilho e a inserção muscular. A contração continuada do sarcômero muscular comprime a irrigação sanguínea local, resultando numa carência energética na área. Esta crise metabólica ativa os receptores de dor, gerando um padrão regional de dor que segue uma passagem nervosa específica. Os padrões de dor são, portanto, consistentes e bem documentados por vários músculos.
O tratamento da síndrome da dor miofascial pretende libertar os pontos gatilho e fazer o músculo afetado voltar ao seu tamanho e força normal. As opções mais comuns de tratamento incluem:
– Terapia manual, como massagem, envolve a aplicação de um determinado nível de pressão para libertar os pontos gatilho. O resultado da terapia manual depende muito da habilidade do terapeuta.
– A técnica de Spray e Alongamento em que se usa um vaporizador refrescante para baixar a temperatura da pele rapidamente enquanto se alonga, passivamente, o músculo alvo. Uma baixa repentina da temperatura da pele confere alívio da dor, permitindo que o músculo alongue completamente, o que liberta o ponto gatilho.
– Injeções no ponto gatilho de soluções salinas, anestesias locais ou esteroides são aceitos como tratamentos eficazes para os pontos gatilho miofasciais.
– Injeções secas – inserção da agulha sem injetar nenhuma solução – são consideradas tão eficazes como as infiltrações.

The videos on this page can be downloaded upon purchase of a license on Alila Medical Media website. Click here!

Frozen shoulder, also known as adhesive capsulitis, is a common condition characterized by pain and limited motions of the shoulder joint. Symptoms usually begin gradually, worsen with time and then resolve on their own, typically within a couple of years.

Anatomy: The shoulder joint is enclosed in a layer of connective tissue, called the shoulder capsule. In frozen shoulder, this capsule is inflamed, thickens and becomes tight. This makes shoulder movements difficult and painful.

Frozen shoulder develops in three stages:

The “freezing” stage is characterized by increasing shoulder pain. The pain is usually felt over the outer shoulder area and sometimes on the upper arm.

The “frozen” stage is marked by progressive loss of shoulder movement, while painful symptoms may actually improve.

In the “thawing” stage, shoulder motions slowly improve. Patients regain most or all shoulder movements, but the process may take months or even years to complete.

Frozen shoulder can be prevented by keeping the shoulder joint fully moving. Often, a shoulder starts to hurt with the onset of inflammation in the capsule. Because pain discourages movement, immobilization subsequently enables scar tissue deposits, which thicken the capsule and freeze the shoulder.

Treatment aims to speed up the natural recovery phase of the disease. The focus of treatment is to control pain and restore motion.

Non-surgical treatments include:

• Non-steroidal anti-inflammatory drugs, steroid injections – to reduce pain and inflammation.
• Physical therapy, stretching exercises – to restore motion range.

Surgical treatments are only recommended when conservative management has failed. These include:

Manipulation under anesthesia: In this procedure, the patient is put to sleep and the shoulder is forced to move in all directions to loosen or rupture the capsule.

Arthroscopic capsular release: In this procedure, the tight portion of the joint capsule is cut using small instruments inserted through keyhole incisions around the shoulder.

The videos on this page can be downloaded upon purchase of a license on Alila Medical Media website. Click here!

Piriformis syndrome is a neuromuscular condition where the piriformis muscle – one of the deep gluteal muscles – presses on and compresses the sciatic nerve causing pain, tingling and numbness in the buttock area and down the path of sciatic nerve to the thigh and leg.
Sciatic nerve runs UNDER the piriformis muscle and may be irritated when the muscle is too tight or shortened due to spasms. Piriformis syndrome is to be differentiated from sciatica which shows similar symptoms but has different causes.
Diagnosis is commonly done by EXCLUSION of sciatica. Because sciatica usually associates with compression of sciatic nerve roots by a herniated disc, sciatic symptoms in the ABSENCE of spinal disc herniation are indicative of piriformis syndrome.
Causes and risk factors of piriformis syndrome include:
– Anatomical abnormality of the nerve-muscle relation. Some people are more likely to get piriformis syndrome than others.
– Tightness or spasm of the piriformis muscle due to overuse injury. This commonly happens in sport activities that put pressure on the piriformis muscle such as bicycling, running without proper stretching, or any activity that involves repeated movements of the legs performed in sitting position.
Treatment options include:
– Stretching exercises, massage, avoidance of causative activities.
– Anti-inflammatory drugs, muscle relaxants for relief of symptoms.
– Physical therapy that strengthens the gluteus maximus, gluteus medius, and biceps femoris is usually recommended to reduce strain on the piriformis muscle.