SKYPE ANATOMY

MIDTERM NOTES

Kaan Yücel M.D., Ph.D.28.3.2013 Thursday

2000-2130 English session2130-2300 Turkish session

Download skypeSkype username: yeditepeanatomy

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1)REGIONAL ANATOMY

Topographical anatomy

2) SYSTEMATIC ANATOMY

3) Clinical anatomy Applied anatomy

TYPES OF ANATOMY

Skeletal system Lympathic systemJoints Nervous system Muscular SystemCardiovascular System

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The anatomical position refers to the body position as if the person were standing upright with the:

Head, eyes, and toes directed anteriorly (forward) Arms adjacent to the sides with the palms facing anteriorly Lower limbs close together with the feet parallel.

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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.

@ a frontal plane around an anteroposterior axisAbduction moving away from the median plane except digitsAdduction moving towards the median plane

abduction & adduction

The skeletal system may be divided into 2 functional parts:The axial skeleton • head (cranium or skull)• neck (hyoid bone and cervical vertebrae) • trunk (ribs, sternum, vertebrae, and sacrum)The appendicular skeleton • Limbs including those forming the shoulde & pelvic girdles

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HISTOLOGY OF THE BONEsparse cells surrounded by an extracellular network/matrix

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60% the weight of the bone mineral

Rest - water & matrix.

90% of the matrix proteins collagen 1/3 of the bone weight

very strong forms bone, cartilage, skin, and tendons.

The skeleton is composed of cartilages and bones.Cartilage

resilient, semirigid form of connective tissue forms parts of the skeleton where more flexibility is required.

CARTILAGES AND BONES

articulating of bones participating in a synovial joint capped with articular cartilage

provides smooth, low-friction, gliding surfaces for free

movement 11

1. Hyalinemost common, matrix w/ moderate amount of collagen fibers articular surfaces of bones2. Elasticlarge number of elastic fibers external ear3. Fibrocartilagelimited number of cells & ground substance amidst substantial amount of collagen fibers intervertebral discs

Types of cartilage

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Bones function as supportive structures for the bodyprotectors of vital organsreservoirs of calcium and phosphoruslevers on which muscles act to produce movementcontainers for blood-producing cells

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TYPES OF BONESaccording to their shape gross anatomy1) Long bones tubular humerus in the arm

3) Flat bones protective functionsflat bones of the cranium protect the brain

2) Short bonescuboidal tarsus (ankle) carpus (wrist)

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4) Irregular bones various shapes other than long, short, or flat bones of the face

5) Sesamoid bones patella or knee capprotect the tendons from excessive wear often change the angle of the tendons as they pass to their attachments.

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2 types of bones according to histological features compact bone & spongy (trabecular) bone

Spongy bone found @ expanded heads of long bones + fills most irregular bones.

Compact bone forms outer shell of all bones + shafts in long bones.

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SKULL BONES

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8 bones of neurocranium

Anterior cranial fossaoccupied by the inferior and anterior parts of the frontal lobes of the brain shallowest cranial fossa

Middle cranial fossabutterfly-shaped central part composed of the sella turcica on the body of the sphenoid large, depressed lateral parts on each side

Posterior cranial fossalargest and deepest cranial fossaformed mostly by the occipital bone

Cranial Fossae

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Facial Bones (n=14]

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Ribs (L. costae) curved flat bones form most of the thoracic cage. 3 types of ribs: True (vertebrocostal) ribs (1st-7th ribs): directly to the sternum.

False (vertebrochondral) ribs (8th, 9th, and usually 10th ribs): indirect with the sternum

Floating (vertebral, free) ribs (11th, 12th, and sometimes 10th ribs): No connection with the sternum

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S T E R N U M

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G. sternon, chestHas three parts:

1. Manubrium

2. Body

3. Xiphoid process

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.

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vertebral bodyvertebral archseven processes

CLAVICLE (TR. KÖPRÜCÜK KEMİĞİ)

Its medial half articulates with the manubrium of the sternum.

Its lateral half articulates with the scapula.

These curvatures increase the resilience of the clavicle and give it the appearance of an elongated capital S.

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Scapula (Tr. Kürek kemiği)

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.

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largest bone in the upper limb

articulates with the scapula at the glenohumeral joint

articulates with 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.

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HUMERUS

stabilizing bone of the forearm medial and longer of the two forearm bones.

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ULNA

Its more massive proximal end is specialized for articulation with the humerus proximally and the head of the radius laterally.

lateral and shorter of the two forearm bones. Its proximal end includes a short head, neck.

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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.

RADIUS

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).

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.

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The skeleton of the lower limb (inferior appendicular skeleton) may be divided into two functional components: 1. pelvic girdle 2. bones of the free lower limb.

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In the mature individual, the pelvic girdle is formed by three bones:Right and left hip bones (coxal bones; pelvic bones): large, irregularly shaped bones, each of which develops from the fusion of three bones, the ilium, ischium, and pubis.

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second largest bone

anterior border of the tibia -most prominent border.

tibia & adjacent medial surface subcutaneous throughout their lengths commonly known as the “shin”periosteal covering and overlying skin vulnerable to bruising.

TIBIA (SHİNE BONE)

on the anteromedial side of the leg, nearly parallel to the fibula

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slendertibiofibular syndesmosisno function in weight-bearingserves mainly for muscle attachment.distal end enlarges prolonged as lateral malleolusproximal end an enlarged head superior to a small neck.

FIBULAposterolateral to the tibia

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PATELLA (KNEE CAP) largest sesamoid bone in the body

embedded in the quadriceps femoris tendon.

joint between the patella and femur share the same articular cavity w/ the joint between femur & tibia

patellar ligament connects the patella to the tibia.

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BONES OF THE FOOTTarsus (7 bones) Metatarsus (5 bones) Phalanges (14 phalanges)

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according to the tissues that lie between the bones:

1) Fibrous joints Syndesmosis type of fibrous joint

2) Cartilaginous joints

3) Synovial joints

Classification of Joints

Types of synovial jointsaccording to shape of articulating surfaces- type of

movement they permit

1.Plane joints uniaxial joints- gliding or sliding acromioclavicular joint

2. Hinge joints uniaxial joints- flexion & extensionknee & elbow joints

Types of synovial joints3. Saddle jointsbiaxial joints- flexion & extension, abduction & adductioncarpometacarpal joint at the base of the 1st digit (thumb)

4. Condyloid (ellipsoid type) biaxial joints- flexion & extension, abduction & adductionmetacarpophalangeal joints (knuckle joints)radiocarpal joint (wrist)

Types of synovial joints5. Ball and socket joints (spheroidal joints)

multiple axes and planes: flexion and extension, abduction and adduction, medial and lateral rotation, and circumductionhip & shoulder joints

Types of synovial joints6. Pivot jointsuniaxial joints- rotation around a central axisproximal & distal radioulnar joints

TEMPOROMANDIBULAR JOINT

mandibular fossa & articular tubercle of temporal bone head of the mandible

articular disc of the TMJ

JOINTS OF THE VERTEBRAL COLUMNThe 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.

Joints of the vertebral bodies symphyses (secondary cartilaginous joints)Joints of the vertebral arches (facet joints)Craniovertebral (atlanto-axial and atlanto-occipital) jointsCostovertebral jointsSacroiliac joints

JOINTS OF THE UPPER LIMBSternoclavicular joint (SC)

sternal end of the clavicle articulates with manubrium & 1st costal cartilage

The only articulation between upper limb & axial skeleton.

During full elevation of the limb, clavicle is raised to 60° angle.

Glenohumeral (shoulder) jointpermits a wide range of movement; mobility makes the

joint relatively unstable. Humeral head articulates w/ glenoid cavity of the scapula

deepened slightly but effectively by the ring-like, fibrocartilaginous glenoid labrum (L., lip).

Glenohumeral (shoulder) joint more freedom of movement than any other

joint in the body results from the laxity of its joint capsule & large size of the humeral head compared with the small size of the glenoid cavity.

movements around three axes flexion-extension, abduction-adduction, rotation

(medial and lateral) of the humerus, circumduction

Elbow Jointlocated inferior to the epicondyles of the humerus

humeroulnar & humeroradial articulations

Proximal (superior) radio-ulnar joint allows movement of the head of the radius on the ulna

Radial head is held in position by the anular ligament of the radius.

Distal (inferior) radio-ulnar jointThe radius moves around the relatively fixed distal end of

the ulna.

Wrist (radiocarpal) joint ulna does not participate in the wrist joint.

Distal end of the radius & articular disc of the distal radio-ulnar joint articulate with

proximal row of carpal bones, except for the pisiform.

FlexionExtensionAbductionAdduction radial deviation-ulnar deviationCircumduction

JOINTS OF THE LOWER LIMBarticulations of the pelvic girdlelumbosacral joints, sacroiliac joints, and pubic symphysis

hip jointsknee jointstibiofibular jointsankle jointsfoot joints

JOINTS OF THE PELVISPubic symphysis

interpubic disc & surrounding ligaments unite the bodies of the pubic bones in the median plane.

Lumbosacral joints L5 and S1 vertebrae articulate

Sacrococcygeal joint

Types of Muscles based on distinct characteristics

Functionalvoluntary vs. involuntary

Histological striated vs. smooth or unstriated

Anatomical (location)@ body wall (soma) and limbs @ hollow organs (viscera) or blood vessels

FEATURES OF SKELETAL MUSCLES

HEAD OR BELLY fleshy, reddish, contractile portions

TENDON white non-contractile portions composed mainly of organized collagen bundles, that provide a means of attachment.

Many terms provide information about a structure's ShapeSizeLocationFunction Resemblance of one structure to another

CLASSIFICATION OF MUSCLESaccording to their shapes

Flat musclesparallel fibers often with an

aponeurosisPennate muscles

feather-like (L. pennatus, feather), arrangement of fasicles

Fusiform musclesspindle shaped with a round, thick belly (or bellies)

and tapered endsConvergent

muscles Quadrate muscles

Circular or sphincteral muscles

more than one head of attachment or more than one contractile belly

Biceps muscles two heads of attachment triceps muscles three heads

Two belliesdigastric musclegastrocnemius muscle

Multi-headed or multi-bellied muscles

Skeletal muscles function by contracting they pull and never push.

When a muscle contracts and shortensone of its attachments usually remains fixed the other attachment (more mobile) pulled toward it

movement

CONTRACTION OF MUSCLES

Functions of muscles

Prime mover (agonist) main muscle responsible for producing a specific movement of the body. Fixator steadies the proximal parts of a limb through isometric contraction while movements are occurring in distal parts.Synergist complements the action of a prime mover. Usual to have several synergists assisting a prime mover in a particular movement

Antagonist a muscle that opposes the action of another muscle. A primary antagonist directly opposes the prime mover, synergists may also be opposed by secondary antagonists.

The same muscle may act as a prime mover, antagonist, synergist, or fixator under different conditions.

Muscles of the Face and the Scalp

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.

Cutaneous (sensory) innervation of the face and anterosuperior part of the scalp is provided primarily by the trigeminal nerve (CN V).

Motor innervation to the facial muscles is provided by the facial nerve (CN VII).

Sternocleidomastoid (SCM) muscle broad, strap-like muscle with two heads

One head attaches to the sternumOne head attaches to clavicle.

Bilateral contractions extension of the elevating the chin Unilateral contraction laterally flexes the neck

MUSCLES OF THE NECK

Trapezius muscle large, flat triangular muscle

Covers the posterior aspect of the neck & superior half of the trunkA direct attachment of the pectoral girdle to the trunk. A ssists in suspending the upper limb.

4 anterior axioappendicular muscles (pectoral muscles) move the pectoral girdle.Pectoralis major is the biggest of these four.

MUSCLES OF THE PECTORAL & SCAPULAR REGIONS

powerful adduction and medial rotation of the arm

Posterior shoulder muscles Superficial extrinsic shoulder muscles trapezius and latissimus dorsi Deep extrinsic shoulder musclestwo musclesIntrinsic shoulder musclesdeltoid, teres major, four rotator cuff muscles

latissimus dorsi (L. widest of back)

passes from the trunk to the humerus and acts directly on the shoulder joint and indirectly on the pectoral girdle.

extends, retracts, and rotates the humerus medially when folding the arms behind the back or scratching the skin over the opposite scapula

Muscles of the Arm & the HandOf the four major arm muscles: three flexors (biceps brachii, brachialis, and coracobrachialis) in the anterior (flexor) compartment supplied by the musculocutaneous nerveone extensor (triceps brachii) in the posterior compartment, supplied by the radial nerve.

flexor muscles of the forearm anterior (flexor-pronator) compartment of the forearm

extensor muscles of the forearm posterior (extensor-supinator) compartment of the forearm

Muscles of the Gluteal Region, Back, Leg & the Footgluteus maximus largest, heaviest, and most coarsely fibered muscle of the body.

most superficial gluteal muscle

extension and lateral rotation of the thigh

anterior thigh musclesflexors of the hip and extensors of the knee. sartorius, the “tailor's muscle” longest muscle in the body.quadriceps femoris (L., four-headed femoral muscle) It covers almost all the anterior aspect and sides of the femur. extensor of the leg. The posterior thigh muscles include

the hamstring muscles: (1) semitendinosus, (2) semimembranosus, and (3) biceps femoris (long head).

Four muscles in the anterior compartment of the legdorsiflexors of the ankle joint, elevating the forefoot and

depressing the heellateral compartment of the leg smallest (narrowest) of the leg compartments

fibularis longus and brevis muscles Evertors of the foot

Posterior compartment of the leg

plantarflexor compartment

is largest of the three leg compartmentsinversion of the foot

superficial group of calf muscles gastrocnemius, soleus, and plantaris.

transverse abdominalinternal obliquesexternal obliquesrectus abdominis

6 abdominal muscles

1.1. REGIONS/T ERMS

Thoracic cavitycavity between neck and abdomen protected by the thoracic wall.

Thoracic wallbounds the thoracic cavity. formed by the skin, bones, fasciae, and muscles.

Thoracic cagebony portion of the thoracic wallthoracic skeleton

1.3. BOUNDARIES OF THE THORAXSuperior• Jugular notch• Sternoclavicular joint• Superior border of clavicle• Acromion• Spinous processes of C7

Inferior • Xiphoid process• Costal arch• 12th and 11th ribs• Vertebra T12

2.1. FUNCTIONS OF THE THORACIC WALL1) Protects vital thoracic and abdominal organs2) Resists the negative (sub-atmospheric) internal pressures

generated by the elastic recoil of the lungs and inspiratory movements.

3) Provides attachment for and support the weight of the upper limbs.

4) Provides the origins of many of the muscles that move and maintain the position of the upper limbs relative to the trunk.

5) Provides attachments for muscles of the abdomen, neck, back, and respiration.

3. SKELETON OF THE THORACIC WALL1) 12 pairs of ribs and associated costal cartilages2) 12 thoracic vertebrae and the intervertebral (IV) discs

interposed between them3) Sternum

4.1. Superior thoracic aperture

“doorway” between the thoracic cavity and the neck and upper limbbounded: Posteriorly vertebra T1Laterally 1st pair of ribs and their costal cartilagesAnteriorly superior border of the manubrium

Trachea Esophagus nerves, and vessels that supply and drain the head, neck, and upper limbs.

4.2. Inferior thoracic aperture

By closing the inferior thoracic aperture, the diaphragm separates the thoracic and abdominal cavities almost completely.

bounded:Posteriorly 12th thoracic vertebraPosterolaterally 11th and 12th pairs of ribs Anterolaterally joined costal cartilages of ribs 7-10 costal margins Anteriorly xiphisternal joint

6. MUSCLES OF THE THORACIC WALL

Serratus posterior Levator costarum Intercostal muscles(External, internal and innermost) Subcostal Transverse thoracic

6.1. Accessory muscles of respiration

upper accessory muscles assist with inspiration.

upper chest, and abdominal muscles assist with expiration.

7. 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 vertical, lateral, and A-P directions.

Diaphragm contracts DepressionDiaphragm relaxes Elevation (during passive expiration)

Elevation &depression of the ribs

• Near the angles of the ribs, the nerves pass between internal intercostal & innermost intercostal muscles.

V.A.N.

• Neurovascular bundles sheltered by the inferior margins of the overlying rib.

10.3. DERMATOMES

Through its posterior ramus and the lateral and anterior cutaneous branches of its anterior ramus, most thoracic spinal nerves (T2-T12) supply a strip-like dermatome of the trunk extending from the posterior median line to the anterior median line.

Skin area supplied by a segment of the spinal cord

T2- Sternal angleT4- NippleT6- Xiphoid processT8- Costal archT10-UmbliculusT12-Midpoint between umbilicus and symphysis pubis

11. BREASTS Mammary glands: Series of ducts and associated secretory lobules.

Form 15 to 20 lactiferous ducts open nipple.

Nipple is surrounded by a circular pigmented area of skin areola (L. small area).

Lymphatic drainage of the breast75% (lateral breast quadrants) Axillary lymph nodes

Most of the remaining (medial breast quadrants) parasternal lymph nodes or to the opposite breast

Lymph from inferior quadrants may pass deeply to abdominal lymph nodes.

1. MEDIASTINUM(Interpleaural space)

Thoracic cavity is divided into 3 major spaces1) mediastinum 2) right pulmonary cavity3) left pulmonary cavity

central compartment of the thoracic cavity

Mediastinum extends fromsuperior thoracic aperture superiorly to diaphragm inferiorly

from sternum & costal cartilagesanteriorly to bodies of thoracic vertebrae posteriorly