Yeditepe University Pharma Anatomy
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Kaan Yücel
M.D., Ph.D.
Midterm @ 9.11.2012
2 p.m.
@ GÜZEL SANATLAR KONFERANS SALONU
GOOD LUCK!!!
INTRODUCTION TO ANATOMY
&
TERMINOLOGY IN ANATOMY
14. 09.2012
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Kaan Yücel
M.D., Ph.D.
1. 1. DEFINITION OF ANATOMY
The word “anatomy” is derived from “anatomia, anatome” which has a Latin and Ancient Greek origin. The prefix “ana-“means “up", where “temnein, tome” means "to cut." As a result, anatomy means “cutting up, cutting through”. The name of the technique became the name of the discipline throughout the history.
The term human anatomy comprises a consideration of the various structures which make up the human organism. In a restricted sense it deals merely with the parts which form the fully developed individual and which can be rendered evident to the naked eye by various methods of dissection. As you see, the difference between two major parts of morphology (morph- Ancient Greek, shape, figure) histology and anatomy is the way you investigate the human body. In histology (the world of tissues and cells), the human body is investigated under a microscope, but in anatomy by the naked eye.
1.2. Types of anatomy
The three main approaches to studying anatomy are regional, systemic, and clinical (or applied), reflecting the body's organization and the priorities and purposes for studying it. In systematic anatomy, various structures may be separately considered. On the other hand, in topographical or regional anatomy, the organs and tissues may be studied in relation to one another. Surface anatomy is an essential part of the study of regional anatomy. Surface anatomy provides knowledge of what lies under the skin and what structures are perceptible to touch (palpable) in the living body at rest and in action. The surface anatomy requires a thorough understanding of the anatomy of the structures beneath the surface.
Clinical (applied) anatomy emphasizes aspects of bodily structure and function important in the practice of medicine, dentistry, and the allied health sciences. It incorporates the regional and systemic approaches to studying anatomy and stresses clinical application.
1.3. The importance of learning anatomy as a future pharmacıst
▪ To understandbodily function and how both structure and function are modified by disease.
▪ To understand the pathway for targeting therapy to a specific site
▪ To communicate with the colleagues properly
1.4. WAYS OF LEARNING ANATOMY
Cadaver: (Merriam Webster dictionary) from Latin, from cadere 'to fall'.A dead body; especially : one intended for dissection.
Dissection: (Oxford dictionary) from Latin dissectus, past participle of dissecare to cut apart, from dis- + secare to cut. The action of dissecting a body or plant to study its internal parts.
Prosection: (Wikipedia) A prosection is the dissection of a cadaver (human or animal) or part of a cadaver by an experienced anatomist in order to demonstrate for students anatomic structure. In a dissection, students learn by doing; in a prosection, students learn by either observing a dissection being performed by an experienced anatomist or examining a specimen that has already been dissected by an experienced anatomist (etymology: Latin pro- "before" + sectio "a cutting
Other materials of learning human anatomy:
✓ Anatomy models
✓ Anatomy atlases (Pictures, drawings)
✓ Videos
✓ Textbooks
✓ Charts
✓ Medical dictionaries, etc.
1.5. Hıstory of anatomy
The development of anatomy as a science extends from the earliest examinations of sacrificial victims to the sophisticated analyses of the body performed by modern scientists. It has been characterized, over time, by a continually developing understanding of the functions of organs and structures in the body. The field of Human Anatomy has a prestigious history, and is considered to be the most prominent of the biological sciences of the 19th and early 20th centuries. Methods have also improved dramatically, advancing from examination of animals through dissection of cadavers to technologically complex techniques developed in the 20th century.
The study of anatomy begins at least as early as 1600 BCE, the date of the Edwin Smith Surgical Papyrus. This treatise shows that the heart, its vessels, liver, spleen, kidneys, hypothalamus, uterus and bladder were recognized, and that the blood vessels were known to emanate from the heart.
The final major anatomist of ancient times was Galen (of Bergama), active in the 2nd century. He compiled much of the knowledge obtained by previous writers, and furthered the inquiry into the function of organs by performing vivisection on animals. Due to a lack of readily available human specimens, discoveries through animal dissection were broadly applied to human anatomy as well. His collection of drawings, based mostly on dog anatomy, became the anatomy textbook for 1500 years.
The works of Galen and Avicenna (Ibn-I Sina), especially The Canon of Medicine which incorporated the teachings of both, were translated into Latin, and the Canon remained the most authoritative text on anatomy in European medical education until the 16th century. Andreas Vesalius is the first modern anatomist who wrote the first anatomy textbook of the modern times; De humani corporis fabrica (On the Fabric of the Human Body).
In our land, anatomy education commenced as a distinct course at “Tıbhane-i Cerrahhane-i Amire”, the first medical school founded by Sultan Mahmut II in March 14th, 1827. Sultan Abdülmecid signed the imperical decree allowing dissections with the purpose of education; practical applications on cadavers began initially in 1841.
1.6. Anatomical Position
All anatomical descriptions are expressed in relation to one consistent position, ensuring that descriptions are not ambiguous. One must visualize this position in the mind when describing patients (or cadavers), whether they are lying on their sides, supine (recumbent, lying on the back, face upward), or prone (lying on the abdomen, face downward).
Figure 1. Anatomical position
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1.7. Anatomical Variations
Anatomy books describe (initially, at least) the structure of the body as it is usually observed in people—that is, the most common pattern. However, occasionally a particular structure demonstrates so much variation within the normal range that the most common pattern is found less than half the time!
It is important for medical personnel to have a sound knowledge and understanding of the basic anatomic terms. With the aid of a medical dictionary, you will find that understanding anatomic terminology greatly assists you in the learning process.
The accurate use of anatomic terms by medical personnel enables them to communicate with their colleagues both nationally and internationally. Without anatomic terms, one cannot accurately discuss or record the abnormal functions of joints, the actions of muscles, the alteration of position of organs, or the exact location of swellings or tumors.
Anatomical terms are descriptive terms standardized in an international reference guide, Terminologia Anatomica (TA). These terms, in English or Latin, are used worldwide. Colloquial terminology is used by—and to communicate with—lay people. Eponyms are often used in clinical settings but are not recommended because they do not provide anatomical context and are not standardized.
Many anatomical terms have both Latin and Greek equivalents, although some of these are used in English only as roots. Thus the tongue is lingua (L.) and glossa (Gk), and these are the basis of such terms as lingual artery and glossopharyngeal nerve.
Various adjectives, arranged as pairs of opposites, describe the relationship of parts of the body or compare the position of two structures relative to each other. Anatomical directional terms are based on the body in the anatomical position. Four anatomical planes divide the body, and sections divide the planes into visually useful and descriptive parts.
2.1. Terms Related to PosItIon
All descriptions of the human body are based on the assumption that the person is standing erect, with the upper limbs by the sides and the face and palms of the hands directed forward. This is the so-called anatomic position. The various parts of the body are then described in relation to certain imaginary planes.
2.1.1. Anatomical Planes
Anatomical descriptions are based on four imaginary planes (median, sagittal, frontal-coronal, and transverse-axial) that intersect the body in the anatomical position:
The median plane, the vertical plane passing longitudinally through the body, divides the body into right and left halves. The plane defines the midline of the head, neck, and trunk where it intersects the surface of the body. Midline is often erroneously used as a synonym for the median plane.
Sagittal planes are vertical planes passing through the body parallel to the median plane. Parasagittal is commonly used but is unnecessary because any plane parallel to and on either side of the median plane is sagittal by definition. However, a plane parallel and near to the median plane may be referred to as a paramedian plane.
Frontal (coronal) planes are vertical planes passing through the body at right angles to the median plane, dividing the body into anterior (front) and posterior (back) parts.
Transverse planes are horizontal planes passing through the body at right angles to the median and frontal planes, dividing the body into superior (upper) and inferior (lower) parts. Radiologists refer to transverse planes as transaxial, which is commonly shortened to axial planes.
Anatomists create sections of the body and its parts anatomically, and clinicians create them by planar imaging technologies, such as computerized tomography (CT), to describe and display internal structures.
Figure 2. Anatomical planes
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2.1.2. Anatomical terms specific for comparisons made in the anatomical position, or with reference to the anatomical planes:
➢ Superior refers to a structure that is nearer the vertex, the topmost point of the cranium (Mediev. L., skull).
➢ Cranial relates to the cranium and is a useful directional term, meaning toward the head or cranium.
➢ Inferior refers to a structure that is situated nearer the sole of the foot.
➢ Caudal (L. cauda, tail) is a useful directional term that means toward the feet or tail region, represented in humans by the coccyx (tail bone), the small bone at the inferior (caudal) end of the vertebral column.
➢ Posterior (dorsal) denotes the back surface of the body or nearer to the back.
Anterior (ventral) denotes the front surface of the body.
➢ Medial is used to indicate that a structure is nearer to the median plane of the body. For example, the 5th digit of the hand (little finger) is medial to the other digits.
➢ Conversely, lateral stipulates that a structure is farther away from the median plane. The 1st digit of the hand (thumb) is lateral to the other digits.
➢ Dorsum usually refers to the superior aspect of any part that protrudes anteriorly from the body, such as the dorsum of the tongue, nose, penis, or foot.
Combined terms describe intermediate positional arrangements: inferomedial means nearer to the feet and median plane—for example, the anterior parts of the ribs run inferomedially; superolateral means nearer to the head and farther from the median plane.
2.1.3. Terms, independent of the anatomical position or the anatomical planes, relating primarily to the body's surface or its central core:
✓ Superficial, intermediate, and deep (Lat. Profundus, profunda) describe the position of structures relative to the surface of the body or the relationship of one structure to another underlying or overlying structure.
✓ External means outside of or farther from the center of an organ or cavity, while internal means inside or closer to the center, independent of direction.
✓ Proximal and distal are used when contrasting positions nearer to or farther from the attachment of a limb or the central aspect of a linear structure (origin in general), respectively. For example, the arm is proximal to the forearm and the hand is distal to the forearm.
Figure 3. Terms related to position
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2.2. Terms of Lateralıty
Paired structures having right and left members (e.g., the kidneys) are bilateral, whereas those occurring on one side only (e.g., the spleen) are unilateral. Something occurring on the same side of the body as another structure is ipsilateral; the right thumb and right great (big) toe are ipsilateral, for example. Contralateral means occurring on the opposite side of the body relative to another structure.
2.3. Terms of Movement
Various terms describe movements of the limbs and other parts of the body. Most movements are defined in relationship to the anatomical position, with movements occurring within, and around axes aligned with, specific anatomical planes. While most movements occur at joints where two or more bones or cartilages articulate with one another, several non-skeletal structures exhibit movement (e.g., tongue, lips, eyelids). Terms of movement may also be considered in pairs of oppositing movements:
Flexion and extension movements generally occur in sagittal planes around a transverse axis.
• Flexion indicates bending or decreasing the angle between the bones or parts of the body. For most joints (e.g., elbow), flexion involves movement in an anterior direction, but it is occasionally posterior, as in the case of the knee joint. Lateral flexion is a movement of the trunk in the coronal plane.
• Extension indicates straightening or increasing the angle between the bones or parts of the body. Extension usually occurs in a posterior direction. The knee joint, rotated 180° to other joints, is exceptional in that flexion of the knee involves posterior movement and extension involves anterior movement.
Figure 4. Flexion and extension
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• Dorsiflexion describes flexion at the ankle joint, as occurs when walking uphill or lifting the front of the foot and toes off the ground.
• Plantarflexion bends the foot and toes toward the ground, as when standing on your toes. Extension of a limb or part beyond the normal limit—hyperextension (overextension)—can cause injury, such as “whiplash” (i.e., hyperextension of the neck during a rear-end automobile collision).
• Abduction and adduction movements generally occur in a frontal plane around an anteroposterior axis. Except for the digits, abduction means moving away from the median plane (e.g., when moving an upper limb laterally away from the side of the body) and adduction means moving toward it.
In abduction of the digits (fingers or toes), the term means spreading them apart—moving the other fingers away from the neutrally positioned 3rd (middle) finger or moving the other toes away from the neutrally positioned 2nd toe. The 3rd finger and 2nd toe medially or laterally abduct away from the neutral position. Adduction of the digits is the opposite—bringing the spread fingers or toes together, toward the neutrally positioned 3rd finger or 2nd toe.
Figure 5. Abduction and adduction
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• Circumduction is a circular movement that involves sequential flexion, abduction, extension, and adduction (or in the opposite order) in such a way that the distal end of the part moves in a circle. Circumduction can occur at any joint at which all the above-mentioned movements are possible (e.g., the shoulder and hip joints).
Figure 6. Circumduction
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• Rotation involves turning or revolving a part of the body around its longitudinal axis, such as turning one's head to face sideways.
• Medial rotation (internal rotation) brings the anterior surface of a limb closer to the median plane, whereas lateral rotation (external rotation) takes the anterior surface away from the median plane.
• Pronation rotates the forearm medially so that the palm of the hand faces posteriorly and its dorsum faces anteriorly. When the elbow joint is flexed, pronation moves the hand so that the palm faces inferiorly (e.g., placing the palms flat on a table).
• Supination is the opposite rotational movement, rotating the forearm laterally, returning the pronated forearm to the anatomical position. When the elbow joint is flexed, supination moves the hand so that the palm faces superiorly.
Figure 7. Supination and pronation
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• Eversion moves the sole of the foot away from the median plane, turning the sole laterally. When the foot is fully everted it is also dorsiflexed.
• Inversion moves the sole of the foot toward the median plane (facing the sole medially). When the foot is fully inverted it is also plantarflexed.
Figure 8. Inversion and eversion
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• Opposition is the movement by which the pad of the 1st digit (thumb) is brought to another digit pad. This movement is used to pinch, button a shirt, and lift a teacup by the handle.
• Reposition describes the movement of the 1st digit from the position of opposition back to its anatomical position.
• Elevation raises or moves a part superiorly, as in elevating the shoulders when shrugging, the upper eyelid when opening the eye, or the tongue when pushing it up against the palate (roof of mouth).
• Depression lowers or moves a part inferiorly, as in depressing the shoulders when standing at ease, the upper eyelid when closing the eye, or pulling the tongue away from the palate.
2.4. PosItIons of the body
The supine position of the body is lying on the back. The prone position is lying face downward.
BONES
(OSTEOLOGY)
21. 09.2012
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Kaan Yücel
M.D., Ph.D.
Osteology (Gk, osteon, bone, logos, science) is the branch of medicine concerned with the development and diseases of bone tissue. The human skeleton is composed of 206 bones in adults.
The skeletal system may be divided into two functional parts:
o The axial skeleton consists of the bones of the head (cranium or skull), neck (hyoid bone and cervical vertebrae), and trunk (ribs, sternum, vertebrae, and sacrum).
o The appendicular skeleton consists of the bones of the limbs, including those forming the pectoral (shoulder) and pelvic girdles.
Figure 1. The skeleton. The axial skeleton in green, and the appendicular skeleton in pink.
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Bone is one of the hardest structures of the animal body, because of the calcification of its extracellular matrix. Living bones have some elasticity (results from the organic matter) and great rigidity (results from their lamellous structures and tubes of inorganic calcium phosphate). Its color, in a fresh state, is pinkish-white externally, and deep red within.
1.1. HISTOLOGY OF THE BONE
Bone is created from osseous connective tissue. Like other types of connective tissue, osseous tissue is composed of relatively sparse cells surrounded by an extracellular network, or matrix. Osteoblasts, a type of bone cell, secrete proteins into the matrix, which provide tensile strength (resistance to stretching and twisting). Mature bone is composed of proteins and minerals. Approximately 60% the weight of the bone is mineral. The rest is water and matrix. About 90% of the matrix proteins are collagen (1/3 of the bone weight), which is the most abundant protein in the body. Collagen is very strong and forms bone, cartilage, skin, and tendons. The minerals of the matrix are mainly calcium phosphate and calcium carbonate. Embedded in the protein network, the minerals provide hardness and compressive strength.
There are four principal types of bone cells: osteogenic cells, osteoblasts, osteocytes, and osteoclasts. The matrix is maintained by osteocytes, the characteristic cells of bone. Histologically, bone is composed of units termed Haversian systems or osteons in which concentric rings of osteocytes are arranged around a central blood vessel. The Volkmann’s canals are perpendicular to the Haversian canals and connect these canals with each other and also with the periosteum of the bone.
The bone tissue is surrounded by a membrane; the periosteum. The periosteum provides a route for the circulatory and nervous supply and actively particiapates in bone growth and repair. The endosteum, lines the marrow cavity and is active during bone growth, repair, and remodeling. It covers the trabeculae of spongy bone and lines the inner surfaces of the central canals.
1.2. CartilageS and Bones
The skeleton is composed of cartilages and bones.
Cartilage is a resilient, semirigid form of connective tissue that forms parts of the skeleton where more flexibility is required—for example, where the costal cartilages attach the ribs to the sternum. Also, the articulating surfaces (bearing surfaces) of bones participating in a synovial joint are capped with articular cartilage that provides smooth, low-friction, gliding surfaces for free movement. Blood vessels do not enter cartilage (i.e., it is avascular); consequently, its cells obtain oxygen and nutrients by diffusion. The proportion of bone and cartilage in the skeleton changes as the body grows; the younger a person is, the more cartilage he or she has. The bones of a newborn are soft and flexible because they are mostly composed of cartilage.
The amount and kind of extracellular fibers in the matrix varies depending on the type of cartilage. In heavy weightbearing areas or areas prone to pulling forces, the amount of collagen is greatly increased and the cartilage is almost inextensible. In contrast, in areas where weightbearing demands and stress are less, cartilage containing elastic fibers and fewer collagen fibers is common.
The functions of cartilage are to:
• support soft tissues;
• provide a smooth, gliding surface for bone articulations at joints; and
• enable the development and growth of long bones.
There are three types of cartilage:
• hyaline-most common; matrix contains a moderate amount of collagen fibers (e.g., articular surfaces of bones);
• elastic:-matrix contains collagen fibers along with a large number of elastic fibers (e.g., external ear);
• fibrocartilage- matrix contains a limited number of cells and ground substance amidst a substantial amount of collagen fibers (e.g., intervertebral discs).
Ossification (bone formation) occurs in one of two ways. Intramembranous ossification occurs within parts of the skull and part of the clavicles. In this process, osteoblasts deposit matrix on a membranous network within the future bone. Once their own extracellular matrix traps the osteoblasts, they become fully mature osteocytes.
By contrast, most of the body's bones form by endochondral (within cartilage) ossification. In this process, a temporary model in the shape of the future bone is made from cartilage laid down by chondrocytes (cartilageforming cells), which later die within the shaft of the future bone. The space created by the death of these cells is invaded by osteogenic (bone-forming) cells. These cells differentiate into osteoblasts and secrete the matrix. As osteoblasts build bone, another type of cell, the osteoclast, dissolves older matrix, enlarging the cavity within. Within the shafts of the long bones, the spaces created are filled with blood-forming tissue, the bone marrow.
Bone is a calcified, living, connective tissue that forms the majority of the skeleton. It consists of an intercellular calcified matrix, which also contains collagen fibers, and several types of cells within the matrix. Bones function as:
• supportive structures for the body;
• protectors of vital organs; e.g., sternum and ribs sternum and ribs protect the thoracic and upper abdominal viscera, skull and vertebral column protect the brain and spinal cord from injury.
• reservoirs of calcium and phosphorus;
• levers on which muscles act to produce movement; as seen in the long bones of the limbs
• containers for blood-producing cells.
1.3. TYPES OF BONES
Bones are classified according to their shape (gross anatomy):
1) Long bones are tubular (e.g., the humerus in the arm).
2) Short bones are cuboidal and are found only in the tarsus (ankle) and carpus (wrist).
3) Flat bones usually serve protective functions (e.g., the flat bones of the cranium protect the brain).
4) Irregular bones have various shapes other than long, short, or flat (e.g., bones of the face).
5) Sesamoid bones (e.g., the patella or knee cap) develop in certain tendons and are found where tendons cross the ends of long bones in the limbs; they protect the tendons from excessive wear and often change the angle of the tendons as they pass to their attachments.
Long bones develop by replacement of hyaline cartilage plate (endochondral ossification). They have a shaft (diaphysis) and two ends (epiphyses). The metaphysis is a part of the diaphysis adjacent to the epiphyses. The diaphysis encloses the marrow cavity.
Figure 2. Diaphysis, metapyhysis, epiphyses
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There are two types of bones according to histological features: compact bone and spongy (trabecular) bone. They are distinguished by the relative amount of solid matter and by the number and size of the spaces they contain All bones have a superficial thin layer of compact bone around a central mass of spongy bone, except where the latter is replaced by a medullary (marrow) cavity. Spongy bone is found at the expanded heads of long bones and fills most irregular bones. Compact bone forms the outer shell of all bones and also the shafts in long bones.
1.4. Bone Markings and Formations
Bone markings appear wherever tendons, ligaments, and fascias are attached or where arteries lie adjacent to or enter bones. Other formations occur in relation to the passage of a tendon (often to direct the tendon or improve its leverage) or to control the type of movement occurring at a joint. Surfaces of the bones are not smooth. Bones display elevations, depressions and holes. The surface features on the bones are given names to distinguish and define them.
1.5. Vasculature and Innervation of Bones
Bones are richly supplied with blood vessels. Veins accompany arteries. Nerves accompany blood vessels supplying bones.
The skull is supported on the summit of the vertebral column, and is of an oval shape, wider behind than in front. It is composed of a series of flattened or irregular bones which, with one exception (the mandible), are immovably jointed together. It is divisible into two parts:
(1) the cranium, which lodges and protects the brain, consists of eight bones
(2) the skeleton of the face, of fourteen
2.1. Ossa Cranii
2.1.1. Occipital bone
The occipital bone is situated at the back and lower part of the cranium, is trapezoid in shape and curved on itself. It is pierced by a large oval aperture, the foramen magnum, through which the cranial cavity communicates with the vertebral canal.
2.1.2. Parietal Bones
The parietal bones form, by their union, the sides and roof of the cranium. Each bone is irregularly quadrilateral in form. The external surface is convex, smooth.
2.1.3. Frontal Bone
The frontal bone is at the front of the skull. It forms the skeleton of the forehead and enters into the formation of the roofs of the orbital and nasal cavities.
2.1.4. Temporal Bones
The temporal bones are situated at the sides and base of the skull. The temporal bone consists of the pathway to the inner ear and contributes to the formation of the jaw with the mandible.
2.1.5. Sphenoid Bone
The sphenoid bone is situated at the base of the skull in front of the temporals and basilar part of the occipital. It somewhat resembles a bat with its wings extended, and is divided into a median portion or body, two great and two small wings extending outward from the sides of the body, and two pterygoid processes which project from it below. It supplies the bed for the pituitary gland.
2.1.6. Ethmoid bone
The etmoid bone is exceedingly light and spongy, and cubical in shape; it is situated at the anterior part of the base of the cranium, between the two orbits, at the roof of the nose, and contributes to each of these cavities. The olfactory nerve fibers pass through this bone.
Figure 3. Skull bones (lateral view)
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2.2. Cranial FossaE
2.2.1. Anterior cranial fossa
The inferior and anterior parts of the frontal lobes of the brain occupy the anterior cranial fossa, the shallowest of the three cranial fossae.
2.2.2. Middle cranial fossa
The butterfly-shaped middle cranial fossa has a central part composed of the sella turcica on the body of the sphenoid and large, depressed lateral parts on each side.
2.2.3. Posterior cranial fossa
The posterior cranial fossa is the largest and deepest of the three cranial fossae. The posterior cranial fossa is formed mostly by the occipital bone.
Figure 4. Cranial Fossae
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2.3. Facial Bones
1. The Nasal Bones: are two small oblong bones, varying in size and form in different individuals; they are placed side by side at the middle and upper part of the face, and form, by their junction, “the bridge” of the nose.
2. The Maxillæ (Upper Jaw): are the largest bones of the face, excepting the mandible, and form, by their union, the whole of the upper jaw. Each assists in forming the boundaries of three cavities, viz., the roof of the mouth, the floor and lateral wall of the nose and the floor of the orbit.
3. The Lacrimal Bone: the smallest and most fragile bone of the face, is situated at the front part of the medial wall of the orbit.
4. The Zygomatic Bone (Malar Bone): is small and quadrangular, and is situated at the upper and lateral part of the face: it forms the prominence of the cheek, part of the lateral wall and floor of the orbit.
The zygomatic arch is formed by the zygomatic process of the temporal bone and the temporal process of the zygomatic bone.
5. The Palatine Bone: is situated at the back part of the nasal cavity. It contributes to the walls of three cavities: the floor and lateral wall of the nasal cavity, the roof of the mouth, and the floor of the orbit.
6. The Inferior Nasal Concha (Concha Nasalis Inferior; Inferior Turbinated Bone): extends horizontally along the lateral wall of the nasal cavity.
7. The Vomer: is situated in the median plane, but its anterior portion is frequently bent to one or other side. It is thin, somewhat quadrilateral in shape, and forms the hinder and lower part of the nasal septum.
8. The Mandible (Lower Jaw): the largest and strongest bone of the face, serves for the reception of the lower teeth.
9. The Hyoid Bone: is shaped like a horseshoe, and is suspended from the tips of the styloid processes of the temporal bones.
Figure 5. Facial bones
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3.1. THORACIC CAGE
The thoracic cage (skeleton) is formed by the sternum and costal cartilages anteriorly, ribs laterally, and thoracic vertebrae posteriorly.
Figure 6. Thoracic cage (skeleton)
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3.1. 1. Ribs
Ribs (L. costae) are curved, flat bones that form most of the thoracic cage. Costal cartilages prolong the ribs anteriorly and contribute to the elasticity of the thoracic wall, providing a flexible attachment for their anterior ends. The first 7 costal cartilages attach directly and independently to the sternum; the 8th, 9th, and 10th articulate with the costal cartilages just superior to them, forming a continuous, articulated, cartilaginous costal margin. The 11th and 12th costal cartilages form caps on the anterior ends of the corresponding ribs and do not reach or attach to any other bone or cartilage.
Intercostal spaces separate the ribs and their costal cartilages from one another. The spaces are named according to the rib forming the superior border of the space—for example, the 4th intercostal space lies between ribs 4 and 5. There are 11 intercostal spaces and 11 intercostal nerves. Intercostal spaces are occupied by intercostal muscles and membranes, and two sets (main and collateral) of intercostal blood vessels and nerves, identified by the same number assigned to the space.
Figure 7. True, false, and floating ribs
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Figure 8. Parts of a typical rib
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3.1.2. Sternum
The sternum (G. sternon, chest) is the long, flat bone that forms the middle of the anterior part of the thoracic cage. It directly overlies and affords protection for mediastinal viscera in general and much of the heart in particular. The sternum is commonly known as the breastbone and is divided into three areas, the upper manubrium, the body, and the xiphoid process. The sternum has the costal facets (places for articulation) for the first seven ribs.
Figure 9. Sternum and its parts
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3.2. Verterbral column
The vertebral column in an adult typically consists of 33 vertebrae arranged in five regions: 7 cervical, 12 thoracic, 5 lumbar, 5 sacral, and 4 coccygeal. The vertebrae gradually become larger as the vertebral column descends to the sacrum and then become progressively smaller toward the apex of the coccyx. The change in size is related to the fact that successive vertebrae bear increasing amounts of the body's weight as the column descends. The vertebrae reach maximum size immediately superior to the sacrum, which transfers the weight to the pelvic girdle at the sacroiliac joints.
The vertebral column is flexible because it consists of many relatively small bones, called vertebrae (singular = vertebra), that are separated by resilient intervertebral (IV) discs.
Vertebrae vary in size and other characteristics from one region of the vertebral column to another, and to a lesser degree within each region; however, their basic structure is the same.
A typical vertebra consists of a vertebral body, a vertebral arch, and seven processes.
Seven processes arise from the vertebral arch of a typical vertebra: one median spinous process, two transverse processes and four articular processes. The spinous process of the seventh cervical vertebra is prominent, that is why we call the seventh cervical vertebra as “vertebra prominens” prominent vertebra.
The vertebral body is the more massive, roughly cylindrical, anterior part of the bone that gives strength to the vertebral column and supports body weight. The size of the vertebral bodies increases as the column descends as each bears progressively greater body weight.
The vertebral arch is posterior to the vertebral body. The vertebral arch and the posterior surface of the vertebral body form the walls of the vertebral foramen. The succession of vertebral foramina in the articulated vertebral column forms the vertebral canal (spinal canal), which contains the spinal cord and the roots of the spinal nerves that emerge from it.
Figure 10. Vertebral column
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Normally the vertebral column has curvatures; cervical lordosis, thoracic kyphosis, and lumbar lordosis. Enlarged curvatures or decreases in these curvatures are related to pathologies. Kyphosis is abnormal curvature of the vertebral column in the thoracic region, producing a "hunchback" deformity. Lordosis is abnormal curvature of the vertebral column in the lumbar region, producing a swayback deformity.
Figure 11. Bones of the upper limb
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4.1. Clavicle (Tr. Köprücük kemiği)
The clavicle (collar bone) connects the upper limb to the trunk. The shaft of the clavicle has a double curve in a horizontal plane. Its medial half articulates with the manubrium of the sternum. Its lateral half articulates with the the scapula. These curvatures increase the resilience of the clavicle and give it the appearance of an elongated capital S. The clavicle:
• increases the range of motion of the limb.
• affords protection to the neurovascular bundle supplying the upper limb.
• transmits shocks (traumatic impacts) from the upper limb to the axial skeleton.
Figure 12. Clavicle
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4.2. Scapula (Tr. Kürek kemİğİ)
The scapula (shoulder blade) is a triangular flat bone that lies on the posterolateral aspect of the thorax. The scapula has an articular surface; a glenoid cavity (G. socket) for the articulation with the head of the humerus.
Figure 13. Scapula
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4.3. Humerus
The humerus (arm bone), the largest bone in the upper limb, articulates with the scapula at the glenohumeral joint and the radius and ulna at the elbow joint. The proximal end of the humerus has a head, surgical and anatomical necks, and greater and lesser tubercles. The spherical head of the humerus articulates with the glenoid cavity of the scapula. The surgical neck of the humerus, a common site of fracture, is the narrow part distal to the head and tubercles. The distal end of the humerus makes up the condyle of the humerus.
Figure 14. Humerus
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4.4. ulna & RADIUS
The two forearm bones serve together to form the second unit of an articulated mobile strut (the first unit being the humerus), with a mobile base formed by the shoulder, that positions the hand. Ulna and radius have the interosseus membrane in between.
The ulna is the stabilizing bone of the forearm and is the medial and longer of the two forearm bones. Its more massive proximal end is specialized for articulation with the humerus proximally and the head of the radius laterally.
The radius is the lateral and shorter of the two forearm bones. Its proximal end includes a short head, neck. Proximally, the head of the radius is concave for articulation with the humerus during flexion and extension of the elbow joint. The head also articulates with the ulna. The shaft of the radius, in contrast to that of the ulna, gradually enlarges as it passes distally. The distal end accommodates the head of the ulna. Its lateral aspect becomes increasingly ridge-like, terminating distally in the radial styloid process.
Figure 15. Ulna and radius
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4.5. Bones of the hand
The wrist, or carpus, is composed of eight carpal bones (carpals) arranged in proximal and distal rows of four: The proximal surfaces of the distal row of carpals articulate with the proximal row of carpals, and their distal surfaces articulate with the metacarpals. The metacarpus forms the skeleton of the palm of the hand between the carpus and the phalanges. It is composed of five metacarpal bones (metacarpals). Each metacarpal consists of a base, shaft, and head. The proximal bases of the metacarpals articulate with the carpal bones, and the distal heads of the metacarpals articulate with the proximal phalanges and form the knuckles. Each digit has three phalanges except for the first (the thumb), which has only two. Each phalanx has a base proximally, a shaft (body) and a head distally.
Figure 16. Bones of the hand
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The skeleton of the lower limb (inferior appendicular skeleton) may be divided into two functional components: the pelvic girdle and the bones of the free lower limb. The pelvic girdle is a ring of bones that connects the vertebral column to the two femurs. The primary functions of the pelvic girdle are bearing and transfer of weight; secondary functions include protection and support of abdominopelvic viscera and housing and attachment for structures of the genital and urinary systems. In the mature individual, the pelvic girdle is formed by three bones: Right and left hip bones (coxal bones; pelvic bones), sacrum.
Figure 17. Bones of the lower limb
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5.1. Hip Bone
The mature hip bone (L. os coxae) is the large, flat pelvic bone formed by the fusion of three primary bones—ilium, ischium, and pubis. The acetabulum (L., shallow vinegar cup) is the large cup shaped cavity or socket on the lateral aspect of the hip bone that articulates with the head of the femur to form the hip joint. All three primary bones forming the hip bone contribute to the formation of the acetabulum.
5.2. Sacrum
The wedged-shaped sacrum (L. sacred) is usually composed of five fused sacral vertebrae in adults. It is located between the hip bones and forms the roof and posterosuperior wall of the posterior half of the pelvic cavity. The sacral canal is the continuation of the vertebral canal in the sacrum.
5.3. Coccyx
The coccyx (tail bone) is a small triangular bone that is usually formed by fusion of the four rudimentary coccygeal vertebrae. The coccyx is the remnant of the skeleton of the embryonic tail-like caudal eminence. The coccyx does not participate with the other vertebrae in support of the body weight when standing; however, when sitting it may flex anteriorly somewhat, indicating that it is receiving some weight. The coccyx provides attachments for muscles.
Figure 18. Hip bone, sacrum and coccyx
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5.4. Femur
The femur is the longest and heaviest bone in the body. It transmits body weight from the hip bone to the tibia when a person is standing. The femur consists of a shaft (body) and two ends, superior or proximal and inferior or distal.
Figure 19. Femur
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5.5. Tibia & fıbula & patella
The tibia and fibula are the bones of the leg. The tibia articulates with the condyles of the femur superiorly and the talus inferiorly and in so doing transmits the body's weight. The fibula mainly functions as an attachment for muscles, but it is also important for the stability of the ankle joint.
Located on the anteromedial side of the leg, nearly parallel to the fibula, the tibia (shin bone) is the second largest bone in the body. It provides an increased area for articulation and weight transfer. The anterior border of the tibia is the most prominent border. It and the adjacent medial surface are subcutaneous throughout their lengths and are commonly known as the “shin”; their periosteal covering and overlying skin are vulnerable to bruising. The inferior surface of the shaft and the lateral surface of the medial malleolus articulate with the talus. The interosseous border of the tibia is sharp where it gives attachment to the interosseous membrane that unites the two leg bones. Inferiorly, the tibia articulates with the distal end of the fibula.
The slender fibula lies posterolateral to the tibia and is firmly attached to it by the tibiofibular syndesmosis, which includes the interosseous membrane. The fibula has no function in weight-bearing. It serves mainly for muscle attachment. The distal end enlarges and is prolonged as the lateral malleolus. The proximal end of the fibula consists of an enlarged head superior to a small neck. The head has a pointed apex.
The patella (knee cap) is the largest sesamoid bone in the body and is embedded in the quadriceps femoris tendon. The joint between the femur and tibia is the principal articulation of the knee joint, but the joint between the patella and femur shares the same articular cavity. The patellar ligament connects the patella to the tibia.
Figure 20. Tibia and fibula
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5.6. Bones of the foot
The bones of the foot include the tarsus, metatarsus, and phalanges.
There are:
• 7 tarsal bones (calcaneus is one of them)
• 5 metatarsal bones
• 14 phalanges
The calcaneus (L., heel bone) is the largest and strongest bone in the foot. When standing, the calcaneus transmits the majority of the body's weight from the talus to the ground. The metatarsus (anterior or distal foot, forefoot—) consists of five metatarsals that are numbered from the medial side of the foot. The 14 phalanges are as follows: the 1st digit (great toe) has 2 phalanges (proximal and distal); the other four digits have 3 phalanges each: proximal, middle, and distal.
Figure 21. Bones of the foot
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ARTICULATIONS
IN THE BODY
28. 09.2012
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Kaan Yücel
M.D., Ph.D.
Arthrology (Greek a rqron joint –logy) is the science concerned with the anatomy, function, dysfunction and treatment of joints. Joints (articulations) are unions or junctions between two or more bones or rigid parts of the skeleton. Joints exhibit a variety of forms and functions. It is the fact that, whether or not movement occurs between them, it is still called a joint. Some joints have no movement, others allow only slight movement, and some are freely movable, such as the glenohumeral (shoulder) joint.
1.1. Classification of Joints
Joints are classified according to the tissues that lie between the bones: fibrous joints, cartilaginous joints, and synovial joints.
1.1.1. FIBROUS JOINTS
The bones are united by fibrous tissue. The sutures of the cranium are examples of fibrous joints. These bones are close together, either interlocking along a wavy line or overlapping.
A syndesmosis type of fibrous joint unites the bones with a sheet of fibrous tissue, either a ligament or a fibrous membrane. Consequently, this type of joint is partially movable. The interosseous membrane in the forearm is a sheet of fibrous tissue that joins the radius and ulna in a syndesmosis.
1.1.2. CARTILAGINOUS JOINTS
The bones are united by hyaline cartilage or fibrocartilage.
In primary cartilaginous joints, or synchondroses, the bones are united by hyaline cartilage, which permits slight bending during early life. Primary cartilaginous joints permit growth in the length of a bone. When full growth is achieved, the epiphysial plate converts to bone and the epiphyses fuse with the diaphysis. Secondary cartilaginous joints, or symphyses, are strong, slightly movable joints united by fibrocartilage. The fibrocartilaginous intervertebral discs between the vertebrae consist of binding connective tissue that joins the vertebrae together.
1.1.3. SYNOVIAL JOINTS
The bones are united by a joint (articular) capsule enclosing an articular cavity. Synovial joints are the most common type of joints and provide free movement between the bones they join; they are joints of locomotion, typical of nearly all limb joints.
This type of joints has three common features:
1) Joint cavity: The joint cavity of a synovial joint, like the knee, is a potential space that contains a small amount of lubricating synovial fluid, secreted by the synovial membrane.
2) Articular cartilage: The articular surfaces are covered by hyaline cartilage.
3) Articular capsule: This structure surrounds the joint and formed of two layers. Inside the capsule, articular cartilage covers the articulating surfaces of the bones; all other internal surfaces are covered by synovial membrane.
a) Fibrous capsule: It protects and gives firmness to the joint stability.
b) Synovial membrane: It lines the inner surface of the fibrous membrane but does not cover the articular cartilage. The synovial membrane secretes a fluid known as synovial fluid. This fluid helps to minimize the friction by articular sufaces.
Ligaments: A ligament is a cord or band of connective tissue uniting two structures. Articular capsules are usually strengthened by articular ligaments. These are from dense connective tissue and they connect the articulating bones to each other. Articular ligaments limit the undesired and/or excessive movements of the joints.
Articular disc: Help to hold the bones together.
Labrum: A fibrocartilaginous ring which deepens the articular surface for one of the bones.
Bursae: Bursae are flattened sacs that contain synovial fluid to reduce friction. Its walls are separated by a film of viscous fluid. Bursae are found wherever tendons rub against bones, ligaments, or other tendons.
Figure 1. Synovial joint
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Types of synovial joints
The six major types of synovial joints are classified according to the shape of the articulating surfaces and/or the type of movement they permit:
1. Plane joints (gliding joints) permit gliding or sliding movements. The articular surfaces of the plane joints are almost flat. Most plane joints move in only one axis, hence they are called uniaxial joints. An example is the acromioclavicular joint between the acromion of the scapula and the clavicle (acromioclavicular joint).
2. Hinge joints are also uniaxial and permits flexion and extension only, around the transverse axis. Bones are joined with strong collateral ligaments. e.g. elbow and knee joints. Cylindrical projections (condyles) fit into concave shapes.
3. Saddle joints permit abduction and adduction as well as flexion and extension, movements occurring around two axes at right angles to each other; thus saddle joints are biaxial joints that allow movement in two planes, sagittal and frontal. The articular surfaces resemble a saddle shape and are concave and convex respectively. The carpometacarpal joint at the base of the 1st digit (thumb) is a saddle joint.
4. Condyloid joints (ellipsoid type) joints permit flexion and extension as well as abduction and adduction; thus condyloid joints are also biaxial. The metacarpophalangeal joints (knuckle joints) and radiocarpal joint (wrist) are condyloid joints.
5. Ball and socket joints (spheroidal joints) allow movement in multiple axes and planes: flexion and extension, abduction and adduction, medial and lateral rotation, and circumduction; thus ball and socket joints are multi-axial joints. The spheroidal surface of a bone articulates with the socket shaped articular surface of another bone. The hip joint and the shoulder joint are examples for a ball and socket joint.
6. Pivot joints permit rotation around a central axis; thus they are uniaxial. The rounded part of a bone rotates in a sleeve or ring like osteofibrous structure. The rounded end of one bone fits into the sleeve of bone or ligaments. The median atlantoaxial joint is a pivot joint in which the atlas (C1 vertebra) rotates around a finger-like process, the dens of the axis (C2 vertebra), during rotation of the head. Proximal and distal radioulnar joints are also examples for a pivot joint.
Stability of Joints: The stability of a joint depends on four main factors: The negative pressure within the joint cavity, the shape, size, and arrangement of the articular surfaces; the ligaments; and the tone of the muscles around the joint.
Joint vasculature and innvervation: Joints receive blood from articular arteries that arise from the vessels around the joint. Articular veins are communicating veins that accompany arteries (L. venae comitantes) and, like the arteries, are located in the joint capsule, mostly in the synovial membrane. Joints have a rich nerve supply provided by articular nerves with sensory nerve endings in the joint capsule.
2.1. temporomandibular joint (TMJ)
The temporomandibular joint (TMJ) is a synovial joint, permitting gliding and a small degree of rotation in addition to flexion (elevation) and extension (depression) movements. The bony articular surfaces involved are the mandibular fossa and articular tubercle of the temporal bone superiorly, and the head of the mandible inferiorly. The two bony articular surfaces are completely separated by intervening fibrocartilage, the articular disc of the TMJ.
Figure 2. Temporomandibular joint
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The vertebral column in an adult typically consists of 33 vertebrae arranged in five regions: 7 cervical, 12 thoracic, 5 lumbar, 5 sacral, and 4 coccygeal.
The joints of the vertebral column include the:
• Joints of the vertebral bodies
symphyses (secondary cartilaginous joints) designed for weight-bearing and strength
• Joints of the vertebral arches (facet joints)
plane synovial joints between the superior and inferior articular processes (G. zygapophyses) of adjacent vertebrae
• Craniovertebral (atlanto-axial and atlanto-occipital) joints
• Costovertebral joints
• Sacroiliac joints
Joints of the vertebral bodies
The articulating surfaces of adjacent vertebrae are connected by intervertebral discs and ligaments. The intervertebral discs provide strong attachments between the vertebral bodies. The anulus fibrosus (L. anus, a ring) is a bulging fibrous ring forming the circumference of the IV disc. The anterior longitudinal ligament is a strong, broad fibrous band that covers and connects the anterolateral aspects of the vertebral bodies and IV discs. The posterior longitudinal ligament runs within the vertebral canal along the posterior aspect of the vertebral bodies.
Joints of the vertebral arches (facet joints)
The joints of the vertebral arches are joints between the superior and inferior articular processes of adjacent vertebrae. A thin articular capsule attached to the margins of the articlar facets encloses each joint. Those in the cervical region are especially thin and loose, reflecting the wide range of movement. The adjacent vertebral arches are joined by broad, pale yellow bands of elastic tissue called the ligamenta flava (L. flavus, yellow). The facet joints are plane type synovial joint and permit gliding movements.
Movements of the vertebral column
The range of movement of the vertebral column varies according to the region and the individual. The mobility of the vertebral column results primarily from the compressibility and elasticity of the intervertebral discs. The normal range of movement possible in healthy young adults is typically reduced by 50% or more as they age. Movements by the vertebral column include flexion, extension, lateral flexion, rotation, and circumduction.
Craniovertebral joints
There are two sets of craniovertebral joints, the atlanto-occipital joints, formed between the atlas (C1 vertebra), and the occipital bone of the cranium, and the atlanto-axial joints, formed between the atlas and axis (C2 vertebra). The craniovertebral joints are synovial joints that have no intervertebral discs. Their design gives a wider range of movement than in the rest of the vertebral column.
The atlanto-occipital joints permit nodding of the head, such as the flexion and extension of the head occurring when indicating approval (the “yes” movement). There are three atlanto-axial articulations: two (right and left) lateral atlantoaxial joints,and one median atlantoaxial joint. Movement at all three atlanto-axial joints permits the head to be turned from side to side, as occurs when rotating the head to indicate disapproval (the “no” movement).
Figure 3. Anulus fibrosus and nucleus pulposus of an intervertebral disc.
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Figure 4. Craniovertebral joints
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4.1. STERNOCLAVICULAR JOINT
The sternoclavicular joint (SC) is a synovial joint. The sternal end of the clavicle articulates with the manubrium and the 1st costal cartilage. The articular surfaces are covered with fibrocartilage. The SC joint is the only articulation between the upper limb and the axial skeleton. Although the SC joint is extremely strong, it is significantly mobile to allow movements of the pectoral girdle and upper limb. During full elevation of the limb, the clavicle is raised to approximately a 60° angle.
4.2. ACROMIOCLAVICULAR JOINT
The acromioclavicular joint (AC joint) is a synovial joint. The acromial end of the clavicle articulates with the acromion of the scapula. The articular surfaces, covered with fibrocartilage, are separated by an incomplete wedge-shaped articular disc.
4.3. GLENOHUMERAL (SHOULDER) JOINT
The glenohumeral (shoulder) joint is a synovial joint that permits a wide range of movement; however, its mobility makes the joint relatively unstable. The large, round humeral head articulates with the relatively shallow glenoid cavity of the scapula, which is deepened slightly but effectively by the ring-like, fibrocartilaginous glenoid labrum (L., lip). The glenohumeral joint has more freedom of movement than any other joint in the body. This freedom results from the laxity of its joint capsule and the large size of the humeral head compared with the small size of the glenoid cavity.
The glenohumeral joint allows movements around three axes and permits flexion-extension, abduction-adduction, rotation (medial and lateral) of the humerus, and circumduction.
Figure 5. Sternoclaviular, acromioclavicular and glenohumeral joints
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4.4. ELBOW JOINT
The elbow joint, a synovial joint, is located inferior to the epicondyles of the humerus. There are humeroulnar and humeroradial articulations. The collateral ligaments of the elbow joint are strong triangular bands that are medial and lateral thickenings of the fibrous layer of the joint capsule: the radial collateral ligament and the ulnar collateral ligament. Flexion and extension occur at the elbow joint. The joint has also bursae, some of which are clinically important.
Figure 6. Elbow joint
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4.5. PROXIMAL & DISTAL RADIOULNAR JOINTS
The proximal (superior) radio-ulnar joint is a synovial joint that allows movement of the head of the radius on the ulna. The radial head is held in position by the anular ligament of the radius. The distal (inferior) radio-ulnar joint is a synovial joint. The radius moves around the relatively fixed distal end of the ulna.
4.6. WRIST (RADIOCARPAL) JOINT
The wrist (radiocarpal) joint is a synovial joint. The ulna does not participate in the wrist joint. There eight carpal bones in two rows: four in the proximal, and four in the distal row. The distal end of the radius and the articular disc of the distal radio-ulnar joint articulate with the proximal row of the carpal bones, except for the pisiform. The movements are flexion—extension, abduction—adduction (radial deviation-ulnar deviation), and circumduction.
The intercarpal (IC) joints interconnect the carpal bones. The carpometacarpal (CMC), intermetacarpal (IM) joints, metacarpophalangeal joints, and interphalangeal joints are other joints in the hand.
The joints of the lower limb include the articulations of the pelvic girdle (pelvis) —lumbosacral joints, sacroiliac joints, and pubic symphysis. The remaining joints of the lower limb are the hip joints, knee joints, tibiofibular joints, ankle joints, and foot joints.
Pubic symphysis is a fibrocartilaginous joint and consists of an interpubic disc and surrounding ligaments uniting the bodies of the pubic bones in the median plane.
Lumbosacral joints; L5 and S1 vertebrae articulate with each other.
The other joint in the pelvis is the sacrococcygeal joint.
6.1. HIP JOINT
The hip joint forms the connection between the lower limb and the pelvic girdle. It is a strong and stable synovial joint. The head of the femur is the ball, and the acetabulum is the socket. The hip joint is designed for stability over a wide range of movement. Next to the glenohumeral (shoulder) joint, it is the most movable of all joints. During standing, the entire weight of the upper body is transmitted through the hip bones to the heads and necks of the femurs.
The round head of the femur articulates with the cup-like acetabulum of the hip bone. The lip-shaped acetabular labrum (L. labrum, lip) is a fibrocartilaginous rim attached to the margin of the acetabulum, increasing the acetabular articular area by nearly 10%. The hip joints are enclosed within strong joint capsules, formed of a loose external fibrous layer (fibrous capsule) and an internal synovial membrane.
Ligaments of the hip joint:
Transverse acetabular ligament continuation of acetabular labrum
3 intrinsic ligaments
Iliofemoral ligament anteriorly and superiorly, strongest ligament of the body
Pubofemoral ligament anteriorly and inferiorly
Ischiofemoral ligament posteriorly
Ligament of the head of the femur
Hip movements are flexion-extension, abduction-adduction, medial-lateral rotation, and circumduction.
The degree of flexion and extension possible at the hip joint depends on the position of the knee.
Figure 7. Hip joint
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6.2. KNEE JOINT
The knee joint is our largest and most superficial joint. It is a synovial joint, allowing flexion and extension; however, these movements are combined with gliding and rolling and with rotation. Although the knee joint is well constructed, its function is commonly impaired when it is hyperextended (e.g., in body contact sports, such as judo).
The articular surfaces of the knee joint are characterized by their large size and their complicated and incongruent shapes. The knee joint consists of three articulations:
• Two femorotibial articulations (lateral and medial) between the lateral and the medial femoral and tibial condyles. The femoral condyles articulate with menisci (crescentic plates of cartilage) and tibial condyles to form the knee joint. The menisci and tibial condyles glide as a unit across the inferior and posterior aspects of the femoral condyles during flexion and extension.
• One intermediate femoropatellar articulation between the patella and the femur.
The fibula is not involved in the knee joint.
The stability of the knee joint depends on (1) the strength and actions of the surrounding muscles and their tendons and (2) the ligaments that connect the femur and tibia. Of these supports, the muscles are most important. The most important muscle in stabilizing the knee joint is the large quadriceps femoris.
The joint capsule is strengthened by five extracapsular or capsular (intrinsic) ligaments. The intra-articular ligaments within the knee joint consist of the cruciate ligaments and menisci.
There are at least 12 bursae around the knee joint because most tendons run parallel to the bones and pull lengthwise across the joint during knee movements. Flexion and extension are the main knee movements; some rotation occurs when the knee is flexed.
Figure 8. Knee joint
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6.3. JOINTS BETWEEN TIBIA & FIBULA
The tibia and fibula are connected by two joints: the tibiofibular joint and the tibiofibular syndesmosis (inferior tibiofibular) joint. In addition, an interosseous membrane joins the shafts of the two bones. The tibiofibular joint (superior tibiofibular joint) is a synovial joint between the flat facet on the fibula and a similar articular facet on the lateral side of the tibia distally.
The integrity of the inferior tibiofibular joint is essential for the stability of the ankle joint because it keeps the lateral malleolus firmly against the lateral surface of the talus.
6.4. ANKLE JOINT
The ankle joint (talocrural articulation) is a hinge type synovial joint located between the distal ends of the tibia and the fibula and the superior part of the talus. The ankle joint is reinforced laterally by the lateral ligaments of the ankle (ligament which attach to the fibula). The medial ligament of the ankle is also called the deltoid ligament. The ankle joint is one of the most commonly injured joints in the body with the lateral ankle sprain being the most frequent type of sprain.
The many joints of the foot involve the tarsals, metatarsals, and phalanges. Inversion and eversion of the foot are the main movements involving these joints.
ARCHES OF THE FOOT
Because the foot is composed of numerous bones connected by ligaments, it has considerable flexibility that allows it to deform with each ground contact, thereby absorbing much of the shock. Furthermore, the tarsal and metatarsal bones are arranged in longitudinal and transverse arches are streghtened by the ligaments of the foot as well as the tendons passing over the foot. The arches add to the weight-bearing capabilities and resiliency of the foot. Thus much smaller forces of longer duration are transmitted through the skeletal system.
The arches distribute weight over the pedal platform (foot), acting not only as shock absorbers but also as springboards for propelling it during walking, running, and jumping. The resilient arches add to the foot's ability to adapt to changes in surface contour.
The arches of the foot include:
• Medial longitudinal arch of the foot
• Lateral longitudinal arch of the foot
• Transverse arch of the foot runs from side to side.
The medial and lateral parts of the longitudinal arch serve as pillars for the transverse arch. The integrity of the bony arches of the foot is maintained by both passive factors and dynamic supports.
Figure 9. Arches of the foot
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MUSCLES
IN THE BODY
5. 10.2012
[pic]
Kaan Yücel
M.D., Ph.D.
The muscular system consists of all the muscles of the body. The disciplined related to the study of muscles is myology. Musculus (muscle) is derived from the word mus-mouse; musculus- little mouse. All skeletal muscles are composed of one specific type of muscle tissue. These muscles move the skeleton, therefore, move the body parts.
1.1. TYPES OF MUSCLES
There are three muscle types:
• Skeletal striated muscle is voluntary somatic muscle that makes up the gross skeletal muscles that compose the muscular system, moving or stabilizing bones and other structures (e.g., the eyeballs). Striated muscles are innervated by the somatic nervous system.
• Cardiac striated muscle is involuntary visceral muscle that forms most of the walls of the heart and adjacent parts of the great vessels, such as the aorta, and pumps blood.
• Smooth muscle (unstriated muscle) is involuntary visceral muscle that forms part of the walls of most vessels and hollow organs (viscera), moving substances through them by coordinated sequential contractions (pulsations or peristaltic contractions). Non-striated and cardiac muscles are innervated by the autonomic nervous system.
All skeletal muscles, commonly referred to simply as “muscles,” have fleshy, reddish, contractile portions (one or more heads or bellies) composed of skeletal striated muscle. Some muscles are fleshy throughout, but most also have white non-contractile portions (tendons), composed mainly of organized collagen bundles, that provide a means of attachment. When referring to the length of a muscle, both the belly and the tendons are included. In other words, a muscle's length is the distance between its attachments.
Most skeletal muscles are attached directly or indirectly to bones, cartilages, ligaments, or fascias or to some combination of these structures. Some muscles are attached to organs (the eyeball, for example), skin (such as facial muscles), and mucous membranes (intrinsic tongue muscles). Muscles are organs of locomotion (movement), but they also provide static support, give form to the body, and provide heat.
The architecture and shape of muscles vary. The tendons of some muscles form flat sheets, or aponeuroses, that anchor the muscle to the skeleton (usually a ridge or a series of spinous processes) and/or to deep fascia (such as the latissimus dorsi muscle of the back), or to the aponeurosis of another muscle (such as the oblique muscles of the anterolateral abdominal wall).
1.2. Muscle terminology
Many terms provide information about a structure's shape, size, location, or function or about the resemblance of one structure to another.
Muscles may be described or classified according to their shape, for which a muscle may also be named:
• Flat muscles have parallel fibers often with an aponeurosis—for example, the external oblique (broad flat muscle). The sartorius is a narrow flat muscle with parallel fibers.
• Pennate muscles are feather-like (L. pennatus, feather) in the arrangement of their fascicles, and may be unipennate, bipennate, or multi-pennate—for example, the extensor digitorum longus (unipennate), the rectus femoris (bipennate), and deltoid (multi-pennate).
• Fusiform muscles are spindle shaped with a round, thick belly (or bellies) and tapered ends—for example, biceps brachii.
• Convergent muscles arise from a broad area and converge to form a single tendon—for example, the pectoralis major.
• Quadrate muscles have four equal sides (L. quadratus, square)—for example, the rectus abdominis, between its tendinous intersections.
• Circular or sphincteral muscles surround a body opening or orifice, constricting it when contracted—for example, orbicularis oculi (closes the eyelids).
• Multi-headed or multi-bellied muscles have more than one head of attachment or more than one contractile belly, respectively. Biceps muscles have two heads of attachment (e.g., the biceps brachii), triceps muscles have three heads (e.g., triceps brachii), and the digastric and gastrocnemius muscles have two bellies.
Figure 1. Classifications of muscles according to their shapes
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1.3. Contraction of muscles
Skeletal muscles function by contracting; they pull and never push. When a muscle contracts and shortens, one of its attachments usually remains fixed while the other (more mobile) attachment is pulled toward it, often resulting in movement. Attachments of muscles are commonly described as the origin and insertion; the origin is usually the proximal end of the muscle, which remains fixed during muscular contraction, and the insertion is usually the distal end of the muscle, which is movable. However, this is not always the case. Some muscles can act in both directions under different circumstances.
Whereas the structural unit of a muscle is a skeletal striated muscle fiber, the functional unit of a muscle is a motor unit, consisting of a motor neuron and the muscle fibers it controls. When a motor neuron in the spinal cord is stimulated, it initiates an impulse that causes all the muscle fibers supplied by that motor unit to contract simultaneously.
1.4. Functions of muscles
Muscles serve specific functions in moving and positioning the body.
A prime mover (agonist) is the main muscle responsible for producing a specific movement of the body. It contracts concentrically to produce the desired movement, doing most of the work (expending most of the energy) required. A fixator steadies the proximal parts of a limb through isometric contraction while movements are occurring in distal parts. A synergist complements the action of a prime mover. An antagonist is a muscle that opposes the action of another muscle. The same muscle may act as a prime mover, antagonist, synergist, or fixator under different conditions.
1.5. Nerves and arteries to muscles
Variation in the nerve supply of muscles is rare; it is a nearly constant relationship. In the limb, muscles of similar actions are generally contained within a common fascial compartment and share innervation by the same nerves. The blood supply of muscles is not as constant as the nerve supply and is usually multiple. Arteries generally supply the structures they contact.
The facial muscles (muscles of facial expression) move the skin and change facial expressions to convey mood. Most muscles attach to bone or fascia and produce their effects by pulling the skin.
The occipitofrontalis is a flat digastric muscle which elevates the eyebrows and produce transverse wrinkles across the forehead. This gives the face a surprised look.
Several muscles alter the shape of the mouth and lips during speaking as well as during such activities as singing, whistling, and mimicry. The shape of the mouth and lips is controlled by a complex three-dimensional group of muscular slips, which include the following:
• Elevators, retractors, and evertors of the upper lip.
• Depressors, retractors, and evertors of the lower lip.
• The orbicularis oris, the sphincter around the mouth.
• The buccinator in the cheek.
Figure 2. Facial muscles
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The platysma (G. flat plate) is a broad, thin sheet of muscle in the subcutaneous tissue of the neck. It helps depress the mandible and draw the corners of the mouth inferiorly.
Cutaneous (sensory) innervation of the face and anterosuperior part of the scalp is provided primarily by the trigeminal nerve (CN V), whereas motor innervation to the facial muscles is provided by the facial nerve (CN VII).
Figure 3. Platysma
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The sternocleidomastoid (SCM) muscle is a broad, strap-like muscle with two heads. One head attaches on the sternum, and the other on the clavicle. Bilateral contractions of the SCMs will cause extension of the elevating the chin. Acting unilaterally, the SCM laterally flexes the neck (bends the neck sideways) and rotates the head so the ear approaches the shoulder of the ipsilateral (same) side.
Figure 4. Sternocleidomastoid muscle
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Trapezius is a large, flat triangular muscle that covers the posterior aspect of the neck and the superior half of the trunk. The trapezius provides a direct attachment of the pectoral girdle to the trunk. It was given its name because the muscles of the two sides form a trapezium (G. irregular four-sided figure). The trapezius assists in suspending the upper limb.
Four anterior axioappendicular muscles (pectoral muscles) move the pectoral girdle. Pectoralis major is the biggest of these four. The pectoralis major is a large, fan-shaped muscle that covers the superior part of the thorax. It produces powerful adduction and medial rotation of the arm.
The superficial and intermediate groups of extrinsic back muscles attach the superior appendicular skeleton (of the upper limb) to the axial skeleton (in the trunk).
The posterior shoulder muscles are divided into three groups:
• Superficial extrinsic shoulder muscles: trapezius and latissimus dorsi.
• Deep extrinsic shoulder muscles: two muscles
• Intrinsic shoulder muscles: deltoid, teres major, and the four rotator cuff muscles.
The name latissimus dorsi (L. widest of back) was well chosen because the muscle covers a wide area of the back. passes from the trunk to the humerus and acts directly on the shoulder joint and indirectly on the pectoral girdle. The latissimus dorsi extends, retracts, and rotates the humerus medially (e.g., when folding the arms behind the back or scratching the skin over the opposite scapula).
The deltoid is a thick, powerful, coarse-textured muscle covering the shoulder and forming its rounded contour. As its name indicates, the deltoid is shaped like the inverted Greek letter delta (Δ). The deltoid abducts the arm.
Figure 5. Muscles of the chest and abdomen
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Figure 6. Lattisimus dorsi & Trapezius
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Of the four major arm muscles, three flexors (biceps brachii, brachialis, and coracobrachialis) are in the anterior (flexor) compartment, supplied by the musculocutaneous nerve, and one extensor (triceps brachii) is in the posterior compartment, supplied by the radial nerve.
The biceps brachii is the flexor of the arm. The brachialis is the main flexor of the forearm. The triceps brachii is the main extensor of the forearm.
Figure 7. Muscles of the arm
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There are 17 muscles crossing the elbow joint, some of which act on the elbow joint exclusively, whereas others act at the wrist and fingers.
The flexor muscles of the forearm are in the anterior (flexor-pronator) compartment of the forearm and are separated from the extensor muscles of the forearm by the radius and ulna and, in the distal two thirds of the forearm, by the interosseous membrane that connects them.
The extensor muscles of the forearm are in the posterior (extensor-supinator) compartment of the forearm, and all are innervated by branches of the radial nerve. The intrinsic muscles of the hand are located in five compartments.
The gluteus maximus is the most superficial gluteal muscle. It is the largest, heaviest, and most coarsely fibered muscle of the body. The main actions of the gluteus maximus are extension and lateral rotation of the thigh. The smaller gluteal muscles, gluteus medius and gluteus minimus, are fan shaped, and their fibers converge in the same manner.
Figure 8. Gluteal region muscles
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The large anterior compartment of the thigh contains the anterior thigh muscles, the flexors of the hip and extensors of the knee. The sartorius, the “tailor's muscle” (L. sartus, patched or repaired), is long and ribbon-like. It passes lateral to medial across the superoanterior part of the thigh. The sartorius is the longest muscle in the body.
The quadriceps femoris (L., four-headed femoral muscle) forms the main bulk of the anterior thigh muscles and collectively constitutes the largest and one of the most powerful muscles in the body. It covers almost all the anterior aspect and sides of the femur. The quadriceps femoris (usually shortened to quadriceps) is the great extensor of the leg.
The muscles of the medial compartment of the thigh comprise the adductor group.
The posterior thigh muscles include the hamstring muscles. The hamstrings play a crucial role in many daily activities, such as, walking, running, jumping, and controlling some movement in the trunk. In walking, they are most important as an antagonist to the quadriceps in the deceleration of knee extension.
Figure 9. Hamstring muscles (posterior thigh muscles) and posterior leg (calf) muscles
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Figure 10. Anterior thigh muscles
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There are four muscles in the anterior compartment of the leg; dorsiflexors of the ankle joint, elevating the forefoot and depressing the heel. The lateral compartment of the leg is the smallest (narrowest) of the leg compartments. The lateral compartment contains the fibularis longus and brevis muscles. Both muscles are evertors of the foot, elevating the lateral margin of the foot.
The posterior compartment of the leg (plantarflexor compartment) is the largest of the three leg compartments. Muscles in the posterior (plantarflexor) compartment of leg, the largest of the three leg compartments, are organized into two groups, superficial and deep, by the transverse intermuscular septum. Generally, the muscles mainly plantarflex and invert the foot and flex the toes. The superficial group of calf muscles (muscles forming prominence of “calf” of posterior leg) includes the gastrocnemius, soleus, and plantaris. The gastrocnemius and soleus share a common tendon, the calcaneal tendon, which attaches to the calcaneus. The calcaneal tendon (L. tendo calcaneus, Achilles tendon) is the most powerful (thickest and strongest) tendon in the body. These muscles raise heel during walking; flex the leg at the knee joint. Four muscles make up the deep group in the posterior compartment of the leg.
Of the 20 individual muscles of the foot, 14 are located on the plantar aspect, 2 are on the dorsal aspect, and 4 are intermediate in position.
The six abdominal muscles all affect body posture. The deeper the muscle is located (i.e. the closer to the spine), the more powerful effect it will have, and therefore, the greater capacity it will have for creating and maintaining a healthy spine. From deep to superficial the abdominal muscles are:
• transverse abdominal
• internal obliques
• external obliques
• rectus abdominis
The transverse abdominus muscle is the deepest of the 6 abdominal muscles. The rectus abdominus muscle is the most superficial of the abdominal muscles covered by the aponeurosis of the transversus abdominis. The rectus abdominis has tendineous intersections.
Figure 11. Abdominal muscles
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THORACIC WALL
MEDIASTINUM
CARDIVASCULAR SYSTEM
12. 10.2012
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Kaan Yücel
M.D., Ph.D.
The thorax is the part of the body between the neck and abdomen. Posterior surface is formed by the 12 thoracic vertebræ and the posterior parts of the ribs. Anterior surface is formed by the sternum and costal cartilages. Lateral surfaces are formed by the ribs, separated from each other by the intercostal spaces, eleven in number, which are occupied by the intercostal muscles and membranes.
The floor of the thoracic cavity is deeply invaginated inferiorly (i.e., is pushed upward) by viscera of the abdominal cavity.
Regions
• Thoracic wall
• Thoracic cavity
The thorax includes the primary organs of the respiratory and cardiovascular systems. The majority of the thoracic cavity is occupied by the lungs, which provide for the exchange of oxygen and carbon dioxide between the air and blood. Most of the remainder of the thoracic cavity is occupied by the heart and structures involved in conducting the air and blood to and from the lungs. Additionally, nutrients (food) traverse the thoracic cavity via the esophagus, passing from the site of entry in the head to the site of digestion and absorption in the abdomen.
Thoracic Wall
The true thoracic wall includes the thoracic cage and the muscles that extend between the ribs as well as the skin, subcutaneous tissue, muscles, and fascia covering its anterolateral aspect. The same structures covering its posterior aspect are considered to belong to the back. The mammary glands of the breasts lie within the subcutaneous tissue of the thoracic wall.
The domed shape of the thoracic cage provides its components enabling to:
• Protect vital thoracic and abdominal organs (most air or fluid filled) from external forces.
• Resist the negative (sub-atmospheric) internal pressures generated by the elastic recoil of the lungs and inspiratory movements.
• Provide attachment for and support the weight of the upper limbs.
• Provide the anchoring attachment (origin) of many of the muscles that move and maintain the position of the upper limbs relative to the trunk, as well as provide the attachments for muscles of the abdomen, neck, back, and respiration.
The thorax is one of the most dynamic regions of the body. With each breath, the muscles of the thoracic wall—working in concert with the diaphragm and muscles of the abdominal wall—vary the volume of the thoracic cavity, first by expanding the capacity of the cavity, thereby causing the lungs to expand and draw air in and then, due to lung elasticity and muscle relaxation, decreasing the volume of the cavity and causing them to expel air.
Skeleton of Thoracic Wall
The thoracic skeleton forms the osteocartilaginous thoracic cage, which protects the thoracic viscera and some abdominal organs. The thoracic skeleton includes 12 pairs of ribs and associated costal cartilages, 12 thoracic vertebrae and the intervertebral (IV) discs interposed between them, and the sternum. The ribs and costal cartilages form the largest part of the thoracic cage; both are identified numerically, from the most superior (1st rib or costal cartilage) to the most inferior (12th).
Figure 1. Thoracic cage (skeleton)
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Thoracic Apertures
While the thoracic cage provides a complete wall peripherally, it is open superiorly and inferiorly. The superior opening is a passageway that allows communication with the neck and upper limbs. The larger inferior opening provides the ring-like origin of the diaphragm, which completely occludes the opening.
Structures that pass between the thoracic cavity and the neck through the superior thoracic aperture:
Trachea
Esophagus
Nerves, and vessels that supply and drain the head, neck, and upper limbs.
Figure 2. Superior and inferior thoracic apertures
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Joints of Thoracic Wall
Although the joints between the bones of the thorax have limited movement ability, the whole outcome of these movements permit expansion of the cavity during inspiration. During inspiration, the thoracic cavity can expand in antero-posterior, vertical and transverse dimensions.
1. Costa transverse joints
2. Sterno costal joint
3. Costachondralis joint
4. Intercondral Joints
5. Sternal Joints
Muscles of Thoracic Wall
Some muscles attached to and/or covering the thoracic cage are primarily involved in serving other regions. Several (axioappendicular) muscles extend from the thoracic cage (axial skeleton) to bones of the upper limb (appendicular skeleton). Muscles, such as sternocleidomasteoid muscle, abdominal muscles, pectoral muscles, function as accesory muscles of respiraton and work in forced respiration; when the person needs to breathe in and out more than usual; 100 meter sprinters, patients with respiratory problems.
Muscles of the thoracic wall
– Serratus posterior muscles
– Levator costarum muscles
– Intercostal muscles (External, internal and innermost)
– Subcostal muscle
– Transverse thoracic muscle
These muscles either elevate or depress the ribs helping to increse the volume of the thoracic cavity.
The diaphragm is a shared wall (actually floor/ceiling) separating the thorax and abdomen. Although it has functions related to both components of breathing, expiration is considered as a passive process.
Figure 3. Muscles of the thoracic wall
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When we need more air while breathing (running fast or problems in the lung), we used the accessory respiratory muscles such as pectoralis major muscle, sternocleidomastoid muscle, trapeziu muscles. Abdominal muscles are accessory muscles for expiration. These muscles extend the space so that more air can enter.
Vasculature of Thoracic Wall
In general, the pattern of vascular distribution in the thoracic wall reflects the structure of the thoracic cage—that is, it runs in the intercostal spaces, parallel to the ribs.
Nerves of Thoracic Wall
The 12 pairs of thoracic spinal nerves supply the thoracic wall. As soon as they leave the intervertebral (IV) foramina in which they are formed, the mixed thoracic spinal nerves divide into anterior and posterior (primary) rami or branches. The anterior rami of nerves T1-T11 form the intercostal nerves that run along the extent of the intercostal spaces. The intercostal nerves pass to and then continue to course in or just inferior to the costal grooves, running inferior to the intercostal arteries (which, in turn, run inferior to the intercostal veins). The neurovascular bundles (and especially the vessels) are thus sheltered by the inferior margins of the overlying rib.
MOVEMENTS OF THE Thoracic Wall
One of the principal functions of the thoracic wall and the diaphragm is to alter the volume of the thorax and thereby move air in and out of the lungs.
During breathing, the dimensions of the thorax change in the vertical, lateral, and anteroposterior directions. Elevation and depression of the diaphragm significantly alter the vertical dimensions of the thorax. Depression results when the muscle fibers of the diaphragm contract. Elevation occurs when the diaphragm relaxes.
Figure 4. Movements of the thoracic wall
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Introduction to anatomy
Definition of anatomy
etymology: “cutting through” in Ancient Greek and Latin. Anatomy deals with parts of the human body and investigates the body by the naked eye.
Types of anatomy
1. Regional (topographical) anatomy 2. Systematic anatomy 3. Clinical (applied) anatomy
In systematic anatomy, various structures may be separately considered. On the other hand, in topographical or regional anatomy, the organs and tissues may be studied in relation to one another. Surface anatomy is an essential part of the study of regional anatomy. Clinical (applied) anatomy emphasizes aspects of bodily structure and function important in the practice of medicine, dentistry, and the allied health sciences. It incorporates the regional and systemic approaches to studying anatomy and stresses clinical application.
The importance of learning anatomy as a futue pharmacist
-To understandbodily function and how both structure and function are modified by disease.
-To understand the pathway for targeting therapy to a specific site
-To communicate with the colleagues properly
The ways of learning anatomy
Cadaver
Dissection
Prosection
Other materials of learning human anatomy: anatomy models, anatomy atlases, videos, textbooks, charts, medical dictionaries, etc.
The field of Human Anatomy has a prestigious history, and is considered to be the most prominent of the biological sciences of the 19th and early 20th centuries. The final major anatomist of ancient times was Galen (of Bergama), active in the 2nd century. His collection of drawings, based mostly on dog anatomy, became the anatomy textbook for 1500 years. Andreas Vesalius is the first modern anatomist who wrote the first anatomy textbook of the modern times; De humani corporis fabrica (On the Fabric of the Human Body.
Anatomical position
All anatomical descriptions are expressed in relation to one consistent position, ensuring that descriptions are not ambiguous.
head, gaze (eyes), and toes directed anteriorly (forward), arms adjacent to the sides with the palms facing anteriorly, and lower limbs close together with the feet parallel
Variations: Occasionally a particular structure demonstrates so much variation within the normal range that the most common pattern is found less than half the time!
Terminology in anatomy
Anatomical planes
median, sagittal, frontal-coronal, and transverse-axial) that intersect the body in the anatomical position.
The sagittal plane, like an arrow, divides the body into right and left, coronal anterior to posterior, and axial superior to inferior parts.
With reference to the anatomical planes
Superior inferior anterior posterior medial lateral
Relating primarily to the body's surface
Superficial, intermediate, and deep (Lat. profundus, profunda) external internal proximal distal
Terms of laterality
Unilateral and bilateral, ipsilateral and contralateral
Terms of movemement
Flexion extension abduction adduction circumduction (medial and lateral) rotation
Pronation, supination, eversion, inversion, opposition, reposition, elevation, depression
Positions of the body
The supine position of the body is lying on the back. The prone position is lying face downward.
1. INTRODUCTION TO ANATOMY
The anatomical position refers to the body position as if the person were standing upright with the:
➢ head, gaze (eyes), and toes directed anteriorly (forward),
➢ arms adjacent to the sides with the palms facing anteriorly, and
➢ lower limbs close together with the feet parallel.
2. TERMINOLOGY IN ANATOMY
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Osteology (Gk, osteon, bone, logos, science) is the branch of medicine concerned with the development and diseases of bone tissue. The human skeleton is composed of 206 bones in adults.
The skeletal system may be divided into two functional parts:
oThe axial skeleton consists of the bones of the head (cranium or skull), neck (hyoid bone and cervical vertebrae), and trunk (ribs, sternum, vertebrae, and sacrum).
oThe appendicular skeleton consists of the bones of the limbs, including those forming the pectoral (shoulder) and pelvic girdles.
The skeleton is composed of cartilages and bones. Cartilage is an avascular form of connective tissue consisting of extracellular fibers embedded in a matrix that contains cells localized in small cavities. Bone is a calcified, living, connective tissue that forms the majority of the skeleton. It consists of an intercellular calcified matrix, which also contains collagen fibers, and several types of cells within the matrix.
Bones function as:
• supportive structures for the body;
• protectors of vital organs; e.g., sternum and ribs sternum and ribs protect the thoracic and upper abdominal viscera, skull and vertebral column protect the brain and spinal cord from injury.
• reservoirs of calcium and phosphorus;
• levers on which muscles act to produce movement; as seen in the long bones of the limbs
•containers for blood-producing cells.
The skull is supported on the summit of the vertebral column, and is of an oval shape, wider behind than in front. It is composed of a series of flattened or irregular bones which, with one exception (the mandible), are immovably jointed together. It is divisible into two parts:
(1) the cranium, which lodges and protects the brain, consists of eight bones
(2) the skeleton of the face, of fourteen
The thoracic cage (skeleton) is formed by the sternum and costal cartilages anteriorly, ribs laterally, and thoracic vertebrae posteriorly.
The vertebral column in an adult typically consists of 33 vertebrae arranged in five regions: 7 cervical, 12 thoracic, 5 lumbar, 5 sacral, and 4 coccygeal. The vertebrae gradually become larger as the vertebral column descends to the sacrum and then become progressively smaller toward the apex of the coccyx.
The clavicle (collar bone) connects the upper limb to the trunk. The shaft of the clavicle has a double curve in a horizontal plane. Its medial half articulates with the manubrium of the sternum. Its lateral half articulates with the the scapula.
The scapula (shoulder blade) is a triangular flat bone that lies on the posterolateral aspect of the thorax. The scapula has an articular surface; a glenoid cavity (G. socket) for the articulation with the head of the humerus.
The humerus (arm bone), the largest bone in the upper limb, articulates with the scapula at the glenohumeral joint and the radius and ulna at the elbow joint.
The two forearm bones serve together to form the second unit of an articulated mobile strut (the first unit being the humerus), with a mobile base formed by the shoulder, that positions the hand.
The wrist, or carpus, is composed of eight carpal bones (carpals) arranged in proximal and distal rows of four: The proximal surfaces of the distal row of carpals articulate with the proximal row of carpals, and their distal surfaces articulate with the metacarpals.
The skeleton of the lower limb (inferior appendicular skeleton) may be divided into two functional components: the pelvic girdle and the bones of the free lower limb. The pelvic girdle is a ring of bones that connects the vertebral column to the two femurs. The primary functions of the pelvic girdle are bearing and transfer of weight; secondary functions include protection and support of abdominopelvic viscera and housing and attachment for structures of the genital and urinary systems. In the mature individual, the pelvic girdle is formed by three bones: Right and left hip bones (coxal bones; pelvic bones), sacrum. The tibia and fibula are the bones of the leg. The tibia articulates with the condyles of the femur superiorly and the talus inferiorly and in so doing transmits the body's weight. The fibula mainly functions as an attachment for muscles, but it is also important for the stability of the ankle joint.
The patella (knee cap) is the largest sesamoid bone in the body and is embedded in the quadriceps femoris tendon.
The bones of the foot include the tarsus, metatarsus, and phalanges.
There are:
• 7 tarsal bones (calcaneus is one of them)
• 5 metatarsal bones
• 14 phalanges
2. INTRODUCTION TO OSTEOLOGY
3. SKULL BONES
3. THORACIC CAGE & vertebral column
True (vertebrocostal) ribs (1st-7th ribs): They attach directly to the sternum through their own costal cartilages.
False (vertebrochondral) ribs (8th, 9th, and usually 10th ribs): Their cartilages are connected to the cartilage of the rib above them; thus their connection with the sternum is indirect.
Floating (vertebral, free) ribs (11th, 12th, and sometimes 10th ribs): The rudimentary cartilages of these ribs do not connect even indirectly with the sternum; instead they end in the posterior abdominal musculature.
Head: wedge-shaped and has one facet for articulation with the numerically corresponding vertebra and one facet for the vertebra superior to it.
Neck: connects the head of the rib with the body at the level of the tubercle.
Tubercle: located at the junction of the neck and body; articulates with the corresponding transverse process of the vertebra.
Body (shaft): thin, flat, and curved, is most markedly at the costal angle where the rib turns anterolaterally. The inferior margin of the internal surface is marked by a distinct costal groove, which provides some protection for the intercostal nerve and vessels.
• 7 cervical vertebrae between the thorax and skull characterized mainly by their small size and the presence of a foramen in each transverse process, bifid spinous process, except C7
• 12 thoracic vertebrae characterized by their articulated ribs, spinous processes projecting inferiorly
• inferior to the thoracic vertebrae are five lumbar vertebrae, which form the skeletal support for the posterior abdominal wall and are characterized by their large size, small processuses spinousus projecting posteriorly
• five sacral vertebrae fused into one single bone called the sacrum, which articulates on each side with a pelvic bone and is a component of the pelvic wall;
• inferior to the sacrum is a variable number, usually four, of coccygeal vertebrae, which fuse into a single small triangular bone called the coccyx.
4. BONES OF THE UPPER LIMB
5. BONES OF THE LOWER LIMB & PELVIC GRIDLE
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Arthrology (Greek a rqron joint –logy) is the science concerned with the anatomy, function, dysfunction and treatment of joints. Joints (articulations) are unions or junctions between two or more bones or rigid parts of the skeleton. It is the fact that, whether or not movement occurs between them, it is still called a joint. Some joints have no movement, others allow only slight movement, and some are freely movable.
Joints are classified according to the tissues that lie between the bones: fibrous joints, cartilaginous joints, and synovial joints.
FIBROUS JOINTS
The bones are united by fibrous tissue.
CARTILAGINOUS JOINTS
The bones are united by hyaline cartilage or fibrocartilage.
SYNOVIAL JOINTS
The bones are united by a joint (articular) capsule (composed of an outer fibrous layer lined by a serous synovial membrane) spanning and enclosing an articular cavity. Synovial joints are the most common type of joints and provide free movement between the bones they join; they are joints of locomotion, typical of nearly all limb joints. There are six types of synovial joints according to the shape of the articulating surfaces and/or the type of movement they permit.
JOINTS IN THE HEAD
The temporomandibular joint (TMJ) is a synovial joint, permitting gliding and a small degree of rotation in addition to flexion (elevation) and extension (depression) movements.
The joints of the vertebral column include the:
• Joints of the vertebral bodies.
• Joints of the vertebral arches.
• Craniovertebral (atlanto-axial and atlanto-occipital) joints.
• Costovertebral joints.
• Sacroiliac joints.
JOINTS OF THE UPPER LIMB
The sternal end of the clavicle articulates with the manubrium and the 1st costal cartilage. The articular surfaces are covered with fibrocartilage. The SC joint is the only articulation between the upper limb and the axial skeleton.
The acromioclavicular joint (AC joint) is a synovial joint. The acromial end of the clavicle articulates with the acromion of the scapula.
The glenohumeral (shoulder) joint permits a wide range of movement; however, its mobility makes the joint relatively unstable. The large, round humeral head articulates with the relatively shallow glenoid cavity of the scapula. The glenohumeral joint has more freedom of movement than any other joint in the body.
The elbow joint, a synovial joint, is located inferior to the epicondyles of the humerus. There are humeroulnar and humeroradial articulations.
The proximal (superior) radio-ulnar joint is a synovial joint that allows movement of the head of the radius on the ulna. The distal (inferior) radio-ulnar joint; the radius moves around the relatively fixed distal end of the ulna.
The wrist (radiocarpal) joint is a synovial joint. The ulna does not participate in the wrist joint.
JOINTS OF THE LOWER LIMB
The joints of the lower limb include the articulations of the pelvic girdle—lumbosacral joints, sacroiliac joints, and pubic symphysis. The remaining joints of the lower limb are the hip joints, knee joints, tibiofibular joints, ankle joints, and foot joints.
Pubic symphysis consists of an interpubic disc and surrounding ligaments. Lumbosacral joints; L5 and S1 vertebrae articulate. The other joint is the sacrococcygeal joint.
The hip joint forms the connection between the lower limb and the pelvic girdle. It is a strong and stable synovial joint. The head of the femur is the ball, and the acetabulum is the socket.
The knee joint is our largest and most superficial joint. It is a synovial joint, allowing flexion and extension; however, these movements are combined with gliding and rolling and with rotation.
The knee joint consists of three articulations:
• Two femorotibial articulations (lateral and medial) between the lateral and the medial femoral and tibial condyles.
• One intermediate femoropatellar articulation between the patella and the femur. The fibula is not involved in the knee joint.
The tibia and fibula are connected by two joints: the tibiofibular joint and the tibiofibular syndesmosis (inferior tibiofibular) joint. The ankle joint (talocrural articulation) is located between the distal ends of the tibia and the fibula and the superior part of the talus.
4. INTRODUCTION TO ARTHROLOGY
5. JOINTS IN THE HEAD
3. JOINTS OF THE VERTEBRAL COLUMN
4. JOINTS OF THE UPPER LIMB
5. JOINTS OF THE LOWER LIMB
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The muscular system consists of all the muscles of the body. The disciplined related to the study of muscles is myology. All skeletal muscles are composed of one specific type of muscle tissue. These muscles move the skeleton, therefore, move the body parts.
There are three muscle types:
• Skeletal striated muscle is voluntary somatic muscle that makes up the gross skeletal muscles. Striated muscles are innervated by the somatic nervous system.
• Cardiac striated muscle is involuntary visceral muscle that forms most of the walls of the heart and adjacent parts of the great vessels
• Smooth muscle (unstriated muscle) is involuntary visceral muscle. Non-striated and cardiac muscles are innervated by the autonomic nervous system.
Many terms provide information about a structure's shape, size, location, or function or about the resemblance of one structure to another. Muscles may be described or classified according to their shape, for which a muscle may also be named.
A prime mover (agonist) is the main muscle responsible for producing a specific movement of the body. A fixator steadies the proximal parts of a limb. A synergist complements the action of a prime mover. An antagonist is a muscle that opposes the action of another muscle.
The facial muscles (muscles of facial expression) move the skin and change facial expressions to convey mood. Most muscles attach to bone or fascia and produce their effects by pulling the skin.
The platysma (G. flat plate) is a broad, thin sheet of muscle in the subcutaneous tissue of the neck. It helps depress the mandible and draw the corners of the mouth inferiorly.
Cutaneous (sensory) innervation of the face and anterosuperior part of the scalp is provided primarily by the trigeminal nerve (CN V), whereas motor innervation to the facial muscles is provided by the facial nerve (CN VII).
The sternocleidomastoid (SCM) muscle is a broad, strap-like muscle that has two heads: The rounded tendon of the sternal head attaches to the manubrium, and the thick fleshy clavicular head attaches to the superior surface of the clavicle. Trapezius is a large, flat triangular muscle that covers the posterolateral aspect of the neck and thorax.
Four anterior pectoral muscles move the pectoral girdle: pectoralis major, pectoralis minor, subclavius, and serratus anterior.
The name latissimus dorsi (L. widest of back) was well chosen because the muscle covers a wide area of the back. This large, fan-shaped muscle passes from the trunk to the humerus and acts directly on the glenohumeral joint and indirectly on the pectoral girdle (scapulothoracic joint).
The six scapulohumeral muscles including the deltoid muscle are relatively short muscles that pass from the scapula to the humerus and act on the glenohumeral joint.
Of the four major arm muscles, three flexors (biceps brachii, brachialis, and coracobrachialis) are in the anterior (flexor) compartment, supplied by the musculocutaneous nerve, and one extensor (triceps brachii) is in the posterior compartment, supplied by the radial nerve.
There are 17 muscles crossing the elbow joint, some of which act on the elbow joint exclusively, whereas others act at the wrist and fingers.
The flexor muscles of the forearm are in the anterior (flexor-pronator) compartment of the forearm and are separated from the extensor muscles of the forearm by the radius and ulna and, in the distal two thirds of the forearm, by the interosseous membrane that connects them. The extensor muscles of the forearm are in the posterior (extensor-supinator) compartment of the forearm, and all are innervated by branches of the radial nerve. The intrinsic muscles of the hand are located in five compartments.
The gluteus maximus is the most superficial gluteal muscle. It is the largest, heaviest, and most coarsely fibered muscle of the body. The main actions of the gluteus maximus are extension and lateral rotation of the thigh.
The posterior thigh muscles include the hamstring muscles. There are four muscles in the anterior compartment of the leg. The large anterior compartment of the thigh contains the anterior thigh muscles, the flexors of the hip and extensors of the knee. The posterior compartment of the leg (plantarflexor compartment) is the largest of the three leg compartments. The superficial group of calf muscles (muscles forming prominence of “calf” of posterior leg) includes the gastrocnemius, soleus, and plantaris. The gastrocnemius and soleus share a common tendon, the calcaneal tendon, which attaches to the calcaneus. The calcaneal tendon (L. tendo calcaneus, Achilles tendon) is the most powerful (thickest and strongest) tendon in the body.
Four muscles make up the deep group in the posterior compartment of the leg. Of the 20 individual muscles of the foot, 14 are located on the plantar aspect, 2 are on the dorsal aspect, and 4 are intermediate in position.
1. GENERAL CONSIDERATIONS ON MUSCLES
2. MUSCLES OF THE FACE & SCALP
3. MUSCLES OF THE NECK
4. MUSCLES OF PECTORAL AND SCAPULAR REGIONS
5. MUSCLES OF THE ARM, FOREARM & HAND
6. MUSCLES OF THE GLUTEAL REGION & LOWER LIMB
7. MUSCLES OF THE ABDOMEN
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THORACIC WALL
The thorax is the part of the body between the neck and abdomen. Posterior surface is formed by the 12 thoracic vertebræ and the posterior parts of the ribs. Anterior surface is formed by the sternum and costal cartilages. Lateral surfaces are formed by the ribs, separated from each other by the intercostal spaces, eleven in number, which are occupied by the intercostal muscles and membranes. The true thoracic wall includes the thoracic cage and the muscles that extend between the ribs as well as the skin, subcutaneous tissue, muscles, and fascia covering its anterolateral aspect. The same structures covering its posterior aspect are considered to belong to the back. The mammary glands of the breasts lie within the subcutaneous tissue of the thoracic wall.
The thoracic skeleton forms the osteocartilaginous thoracic cage, which protects the thoracic viscera and some abdominal organs. The thoracic skeleton includes 12 pairs of ribs and associated costal cartilages, 12 thoracic vertebrae and the intervertebral (IV) discs interposed between them, and the sternum.
One of the principal functions of the thoracic wall and the diaphragm is to alter the volume of the thorax and thereby move air in and out of the lungs.
During breathing, the dimensions of the thorax change in the vertical, lateral, and anteroposterior directions. Elevation and depression of the diaphragm significantly alter the vertical dimensions of the thorax. Depression results when the muscle fibers of the diaphragm contract. Elevation occurs when the diaphragm relaxes.
1. THORACIC WALL
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