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Chapter 45: Diseases of Muscle

INTRODUCTION

Skeletal, or voluntary, muscle constitutes the principal organ of motion, as well as a vast metabolic reservoir. Disposed in more than 600 separate muscles, this tissue makes up as much as 40 percent of the weight of adult human beings. An intricacy of structure and function undoubtedly accounts for its diverse susceptibility to disease, for which reason the main anatomic and clinical facts are provided as an introduction to the muscle diseases.

A single muscle is composed of thousands of muscle fibers that extend for variable distances along its longitudinal axis. Each fiber is a relatively large and complex multinucleated cell varying in length from a few millimeters to several centimeters (34 cm in the human sartorius muscle) and in diameter from 10 to 100 μm. Some fibers span the entire length of the muscle; others are joined end to end by connective tissue. Each muscle fiber is enveloped by an inner plasma membrane (the sarcolemma) and an outer basement membrane. The multiple nuclei of each fiber, which are oriented parallel to its longitudinal axis and may number in the thousands, lie beneath the plasma membrane (sarcolemma); hence they are termed subsarcolemmal, or sarcolemmal nuclei.

The cytoplasm (sarcoplasm) of the cell is abundant, and it contains myofibrils and various organelles such as mitochondria and ribosomes. Each myofibril is enveloped in a membranous net, the sarcoplasmic reticulum (SR; Fig. 45–1). Extensions of the plasma membrane into the fiber form the transverse tubular system (T tubules), which are extracellular channels of communication with the intracellular sarcoplasmic reticulum. The SR and T tubules are anatomically independent but functionally related membrane systems. The junctional gap between the T tubules and SR is occupied by protein formations that are attached to the SR and are referred to as junctional feet; the latter have been identified as ryanodine receptors and are responsible for the release of calcium from the SR, which is a critical step in exciting the muscle (Franzini-Armstrong).

Figure 45–1.

Schematic of the major subcellular components of a myofibril. The transverse (T) system, which is an invagination of the plasma membrane of the cell, surrounds the myofibril midway between the Z lines and the center of the A bands; the T system is approximated to, but apparently not continuous with, dilated elements (terminal cisternae) of the sarcoplasmic reticulum on either side. Thus, each sarcomere (the repeating Z-line-to-Z-line unit) contains two “triads,” each composed of a pair of terminal cisternae on each side of the T tubule. (Reproduced with permission from Peter JB, Skeletal Muscle: Diversity and mutability of its histochemical, electron-microscopic, biochemical and physiologic properties. In Pearson CM, Mostofi FK (eds): The Striated Muscle. Baltimore, Williams & Wilkins, 1973:1-18.)

A diagram depicts the major subcellular components of a myofibril.
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The myofibrils themselves are composed of longitudinally oriented interdigitating filaments (myofilaments) of contractile proteins ...

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