Home

ISLAMIC MEDICAL EDUCATION RESOURCES 04

0102-LOCOMOTOR / MUSCULO-SKELETAL SYSTEM, (IDHAAM & ASHALAAT)

Lecture for 2nd year medical students on 9th February 2001

A. EXTERNAL ORGANS DESCRIBED IN THE QUR’AN

The following head and neck organs were mentioned in the Qur'an: head, ra’as (p 279 2:196, 5:6, 7:15, 12:36, 12:41, 14:43, 17:51, 19:4, 20:94, 44:48, 48:27, 63:5); cheek, khadh (2:19, 71:7, 8:21, 75:4); chin, dhiqn (17:107, 17:109, 36:8); neck, raqbat (22:9, 47:4); neck, ‘unq (p 281 8:12, 8:12, 13:4, 17:13, 17:29, 26:4, 34:33, 36:8, 40:71, 111:5), and face, wajh (p 283 2:144, 2:149-150, 5:6, 12:96, 18:2, 47:27, 75:22, 75:24). The following parts of the upper limb were mentioned in the Qur'an: digit (2:19, 71:7, 8:21, 75:4), elbow, mirfaq (p 283 5:6), hand, yad (p 283-4 2:249, 2:249, 4:43, 5:6, 5:28, 5:33, 5:38, 5:94, 7:108, 7:123, 7:195, 14:9, 20:17, 20:22, 20:71, 24:24, 24:40, 25:27, 26:33, 26:49, 27:12, 28:32, 36:65, 38:44, 48:10, 111:1). Digits are used to point in salat (KS p. 86), in dua (KS p. 86), and in khutbah (KS p. 86). The following parts of the trunk were mentioned by the Qur'an: back, dhahr (p 280 2:101, 3:187, 6:3, 6:94, 7:172, 9:35, 21:39, 84:10, 94:3), upper arm, ‘idhd (28:35),  forehead, jabiin (9:35, 37:102),  janb (3:191, 9:103, 9:35, 32:6). The following parts of the lower limb were mentioned in the Qur'an: leg, rijl (p 280 2:196, 2:250, 3:147, 5:6, 5:33, 7:195, 8:11, 20:71, 24:24, 24:31, 24:45, 26:49, 36:65, 38:42, 41:29, 47:7, 55:41, ?55:63), shin, saaq (37:44, 75:29), and ka’ab (5:6). The skeleton which has three main functions of support, movement, and protection was mentioned in the Qur’an as bones, ‘adhm, p 281 8:12, 17, 111:5, 17:49, 17:98, 19:4, 23:14, 23:35, 23:82, 37:16, 37:53, 56:47, 75:3, 79:11). Muscles are mentioned in the Qur'an as meat, lahm (23:14, 49:12): Human civilization is based on the energy produced by contractions of human and animal muscles. The prophet said that a human has 360 joints (KS p.105)

 

B. USE OF ORGANS: ibadat & ma’asiyat

Organs are used for worship, work, aggression, and sinning. Prostration in salat is on 17 bones (MB # 464 p 252, KS p. 274). Organs can also be misused to commit sins. Zina of organs other than the genitalia eg the eye, ear, and the leg was mentioned by the prophet (KS p. 264, MB #2061 p 968). Organs will act as witnesses against the owner on the last day so that he or she cannot deny their sins. Wudhu, a type of ibadat in itself and is also a pre-condition for other types of ibadat, has special hygienic significance. Only exposed organs are washed: the face, hands, forearm, leg, ear, mouth, nose, and hair (Muslim #436, 437). Cleaning the nose (Muslim #462) clears germs and dirt. Wudhu is not valid without istinja that cleans the excreta away.

 

C. USE OF ORGANS:  MOVEMENT and MANIPULATION by LIMBS

HAND MANIPULATION

The upper limb is for manipulation and is specialized for manual dexterity. The lower limb is for posture and mobility and is specialized for weight bearing and walking. The sophisticated human hand is responsible for the advanced human civilization. It is also responsible for the destruction of war and a lot of human tragedies. Humans are able to use their hands to make tools that enable them to exploit their environment more efficiently. The hands are capable of very precise movements using the small muscles of the hand (thenar eminence, thenar eminence, and the longitudinal muscles of the palm). The hand has three types of grip: power grip, hook grip, and precision grip. The upper and forearms are levers to position the hand. They are capable of very fine and sophisticated movements. Most land animals walk and support their weight on 4 limbs and therefore cannot develop a civilization like that of humans.

 

POSTURE and MOVEMENT

Humans have an upright posture and are able to walk on the lower limbs leaving the upper limb free for manipulation. Control of posture and movement in humans is very advanced to enable upright walking. Posture-regulating system involves the central nervous system and muscles. Voluntary muscles are finely controlled (Ganong p. 185). Synovial joints allow a wide range of movements. The pyramidal system plays a role in modulation of movements and posture. Using the fight or flight instincts, humans like animals are adapted to fight or run away in case of danger.

 

EXERTING FORCE AND PRODUCING WORK

Various parts of the musculo-skeletal system act as levers and pulleys. They allow exertion of force to produce a greater force elsewhere. The system has a mechanical efficiency higher than that of man-made machines.

 

PHYSICAL EXERCISE

Continuous movement and exercise of the musculo-skeletal system is a physiological necessity for growth in infants and to prevent disuse atrophy. Salat as physical exercise that is repeated five times a day. Nafila prayers are an additional opportunity for physical exercise. Salat exercises most muscle groups. Although we say that salat has the benefit of physical exercise, we should not forget that this is not its only or even most important reason. Salat is first and foremost ibadat that is carried out for the pleasure of Allah. The Prophet exercised by wrestling as a young man. He used to race against his wife Aishah. The Prophet used to walk in haste, harwalat. Omar Ibn al Khattab encouraged youths to play games that give them strength such as horse riding. Physical exercise is best undertaken while doing some work that is useful for the community. It does not make much sense to exercise just for the sake of exercises

 

D. USE OF ORGANS: SOCIAL INTERCOURSE

The human facial muscles play a very important role in verbal and non-verbal communication making possible the building of a sophisticated civilization. Facial expressions can show happiness or anger. The Prophet used to show anger on his face. He also smiled and laughed. The human handshake or hugs convey messages of friendship. Body language and body posture can convey very sophisticated messages and emotions. The vocal apparatus, the mouth, the tongue, pharynx, and the larynx, Larynx, hanjara (33:10, 40:18) or hulqum (56:87) help in producing noises that may be happiness, anger, or fear. They also produce words that have enabled humans have the most sophisticated language and enable recitation of the Qur’an in a sweet voice (Muslim #1728, 1730, 1732, 1734, 1735). The vocal cords of the larynx vibrate to produce laryngeal sound. The larynx controls loudness, pitch, and quality of sound. The mouth, the pharynx, and the nasal cavities modify the laryngeal sounds. The tongue,  (lisaan, p 282-3 5:78 … 90:8-9): The changing shape of the tongue controls airflow producing different sounds. By changing position the tongue varies the size and shape of the buccal cavity that acts as a resonator. Muteness, bukm, was mentioned in the Qur'an. 2:18, 2:171, 6:39, 8:22, 16:76, 19:97

 

E. PATHOLOGY

Diseases of skeletal muscles can be classified as: muscular dystrophies, congenital myopathies, myopathies of metabolic errors of metabolism, inflammatory myopathies, toxic myopathies, and diseases of the neuro-muscular junction. Muscular dystrophies may be X-linked dystrophy like Duchenne's dystrophy or myotonic dystrophy. Toxic myopathies occur in thyroid diseases, ethanol myopathy, and drug-induced myopathies. Two syndromes are conditions of the NMJ junction: myasthenia gravis and the Lambert-Easton myasthenic syndrome

 

The following diseases of joints are common: osteoarthritis (OA), rheumatoid arthritis (RA), juvenile rheumatoid arthritis, sero-negative spondyloarthropathies, Reiter's syndrome, infectious arthritis, and crystal arthropathies. Osteoarthritis is the most common joint disease. It is an oligoarticular disease of cartilage with no inflammation. The risk of OA increases with age; it rises exponentially above the age of 50 years. Males are at higher risk of hip OA whereas females are at higher risk of knee and hand OA. Rheumatoid arthritis is a chronic inflammatory disorder that affects many tissues and organs: skin, blood vessels, heart, lungs, and muscles. Its principal effects are on joints. RA affects 1% of the world population with females at higher risk than males. Risk peaks in 3rd-4th decades. The cause of RA is unknown but there is evidence pointing to an autoimmune basis. Juvenile RA is a childhood disease that starts before the age of 16 years. The female to male ratio is 2:1. Seronegative spondyloarthropathy s related to HLA-B27. Ankylosing spondyarthritis. Reiter's syndrome is a triad of arthritis, non-gonococcal urethritis, and conjuctivitis. Risk is higher in males and peaks in the 3rd-4th decades of life. It is thought to be due to autoimmune reaction initiated by prior infection. Infectious arthritis may be bacterial or tuberculous. Crystal arthropathis are gouty arthritis and the calcium phosphate deposition disease..

 

Professor Omar Hasan Kasule Sr. February 2001