Anatomy key points.

Skin.

Provides:
Protection
Homeostatic function
Vit D production
Selectively permeable membrane
Sensory function
Secretion
Communication
Provides friction for grip.

Thin skin hairy and pigmented.

Thick skin soles and palms. No hair, little pigment.

4 layers:
Epidermis - Stratified, squamous (squashed) keritinised, epithelial tissue
Dermis Hair follicles, nerves, blood supply
Hypodermis looser connective tissue, has fat.
Deep Fascia.

Also has keratinocytes, lamellar granules for waterproofing, connected to basal

lamina.
50-70 Days from basal lamina to stratum corneum.

Langerhan's cells protect and defend.

Melancytes produce melanin
Merkel cells thought to feel pressure and vibration

Dermis contains:
Collagen and elastin
Papillary layers under epidermis
Reticular layer is deep to epidermis

Hair
Grows down from epithelial tissue, can regenerate
Pilosebaciuos unit = hair, it's follicle, arrector pili muscle, sebaceous gland &
apocrine gland.

Sebum produced by sebaceous gland, released when cell dies. Waterproofs hair.

Sweat glands
Apocrine glands triggered by puberty, found in groin and armpits, linked to
androgen levels.

Eccrine glands are found on palms and soles of feet, enhance grip and sensitivity.
Also used for thermoregulation and excretion.
Hypodermis
Loose connective tissue superficial fascia
Restrict or aid skin mobility
Adipose tissue provides insulation and energy source

Deep fascia:
No fat
Dense, tough, in sheets
Forms compartments, groups muscles together.
Retinacula bands of deep fascia hold tendons in place (like wrists)

02.10.13

Cartilage

Types:
Elastic vocal chords, ears, receives vibrations, flexible, pliable, resists
compression
Fibrocartilage resists shear forces
Hyaline everywhere else. Ends of bones, holds airway open.

Chondro = cartilage.

Bone
Spongy / cancellous / trabecular bone
Compact / haversian bone

Refer to written notes

Embryonic mesenchyme contains stem cells, which can develop into chondroblasts
or osteoblasts.

Proteoglycans and glycosaminoglycans have strong polar charge which retains

water in cartilage. Acts like a sponge, water gets compressed out by movement but
gets attracted back in.

Suppot Storage
Leverage Haemopoiesis production of blood cells.
Attachment for tendons
Protection

Compact bone Spongy Bone

Dense Lattice like
Smooth Struts align along stress lines
Strong Light but strong
Outer layer (cortex) Allows passage of blood vessels
Parts of bone
Periostium Outer covering, vasculorized, nerve supply, source of fibroblasts and
osteoblasts.
Nutrient foramena blood vessels supplying the bone
Osteon round unit of bone. Contains osteocytes, canaliculi , haversian canal in the
middle.
Haversian canal middle of osteon with blood vessel
Volkman's canal connect Haverisan canals of osteons together
Lamella(e) concentric circles (laminate)

Cartilage
Gel like matrix
High water content
Resists compression, shear, tension & is slightly flexible
Avascular yet permeable
Chondroblasts secrete matrix (ground substance and fibres) so capable of
growth
Low metabolic rate, cells gradually mature to chondrocytes
Covered by perichondrium, except where it lies against bone.

Grows in 2 ways:
Appositional growth: grows outwards, the perichondrium pushes chondrocytes (extra
matrix) out creating extra layers
Instersititial Growth: expansion from within the cartilage matrix due to division of
lacunae-bound chondrocytes and secretion of matrix.

Appositional growth results in outward expansion due to the production of cartilage

matrix on the outside of the tissue.
Interstitial growth results in expansion from within the cartilage matrix due to
division of lacunae-bound chondrocytes and secretion of matrix.

Hyaline Cartilage
Mainly ground substance, less fibres, resists shock and compression. Covered by
perichondrium
Fibrous cartilage
Found where there are shear and torsion forces intervertebral disks. Contain
fibroblasts, secrete type 1 collagen
Elastic Cartilage
Stretch and vibration, similar matrix to hyaline but also with elastin fibres.

Hilton's law: joint is innervated by the same nerve that innervates the muscles
that move the joint.
Types of synovial joint 8/10/13
Simple vs compound how many bones in joint.
 Axis of movement
Pivot axis and atlas of neck, elbow.
Hinge knee & ankle
Ball & socket hip, shoulder, 3 axis of movement
Saddle thumb
Ellipsoid / condylar shallow ball and socket, wrist.
Glide / slide / plane: between vertebra & acromioclavicular joint.

Cardiovascular System
Comprises the heart > blood vessels > blood.
Functions of CVS:
Distribute O2 cells and nutrients
Production of red blood cells
Immunity
Carries away waste Co2
Protective
Store of iron
Communication hormones
Heat redistribution

Heart > arteries >> Arterioles >>> Capillaries >>> venules >> veins > heart

Arteriovenous anastomosis > an anastomosis is a connection between two arteries

or veins either arterio arterial anastomosis or veno venous anastomosis. Provides
an alternative route for blood to flow in case of blockage. Apart from in end arteries,
such as hip joints.
Gut - Portal venous system.
Capillaries flow from one capillary bed to another then drain into the hepatic portal
vein. Carries blood to liver, evaluated around liver sinusoids & rejoins main system
via hepatic vein.
Veins: Arteries:
Colour, close to surface Strong walls to resist & aid blood pressure
Valves

Blood vessel walls:

Tunica adventitia sheath, thick, connective tissue. Carries blood vessels & nerves
to arteries : vasa vasorum.
Tunica media Smooth muscle, elastic fibres
Tunica intima Endothelium inner epithelial layer,

Arteries:
Thick tunica media with elastic fibres in it. Elastic arteries high collagen, muscular
arteries less elastic more smooth muscle.

Arterioles:
Thick tunica media less elastic fibres. Smooth muscle under sympathetic control.
Can close lumen.

Capillaries:
1 cell thick.
Veins helped to drain back to heart by arteriovenous pump artery in the middle
surrounded by veins. Compressed by muscle.
BLOOD COMPOSITION SEE SLIDES.

Lymphatic system
Lymph Capillaries
As blood passes through the tissues of the body, it enters thin-walled capillaries to
facilitate diffusion of nutrients, gases, and wastes. Blood plasma also diffuses
through the thin capillary walls and penetrates into the spaces between the cells of
the tissues. Some of this plasma diffuses back into the blood of the capillaries, but a
considerable portion becomes embedded in the tissues as interstitial fluid. To
prevent the accumulation of excess fluids, small dead-end vessels called lymphatic
capillaries extend into the tissues to absorb fluids and return them to circulation.

Lymph
The interstitial fluid picked up by lymphatic capillaries is known as lymph. A special
type of lymph, known as chyle, is produced in the digestive system as lymph
absorbs triglycerides from the intestinal villi. Due to the presence of triglycerides,
chyle has a milky white coloration to it.
Right hand quadrant drains into jugulovenousangle before entering back into blood
circulation.
Cysterna Chyll located at the lower end of the thoracic duct , takes lymph from
intestinal trunk and two lumbar trunks. Receives fatty chyle from intestines & forms
the beginning of the primary lymph vessel, the thoracic duct. This transports lymph
and chyle from the abdomen via the aortic opening to the junction of the left
subclavian vein and the internal jugular vein.

Nervous system 9.10.13 (File C, 1-4)

Allows us to respond to changes in our internal and external envrironment.
Nervous system detects, integrates with endocrine system & produces hormones in
response.
Controls many bodily functions:
Breathing
 Heart rate
swallowing
movement and reflexes
Allows thought & feeling higher functions

CNS PNS
Brain & spinal cord only. Everything else.

Efferent / motor nerves carry impulses away

Afferent / sensory nerves carry impulses towards. Afferent is affected.

Neurons in CNS
Supply and maintain muscles muscle wasting may mean neuron damage.
Neuroglia (in CNS)
To surround neurons and hold them in place,
To supply nutrients and oxygen to neurons,
To insulate one neuron from another,
To destroy pathogens and remove dead neurons
Oligodendroglia provide insulation & support for axons in the brain. Same
function as Schwann cells in PNS.
Astrocytes important in blood/brain barrier wraps around capillaries to prevent
capillary 'leakage' into the brain (like lymph).
Ependymal cells produce CSF cerebrospinal fluid.

Neurons in PNS
Satellite cells line external surfaces of neurons in PNS, also surround neuron cell
bodies within ganglia. Similar function to astrocytes in CNS.
Neurolemma / neurolemmocytes / Schwann cells fatty, forms myelin sheath
around axons.
(See slide ^)

Muscles generally have myelinated neurons so travel fast allows saltatory

conduction.
ANS: Doesn't so generally slower.

Endoneurium: connective tissue that covers axon & schwann cells.

Bundle of endoneurium (axon & schwann cells): Fasicle.
Bundle of fasicles together: nerve
Blood supply to nerve is the vasa nervorum.
Nerves contain mixed neural fibres not just 1 type of nerve, may be afferent /
efferent / CNS / PNS all in one bundle.

CNS
Bundle of cell bodies in CNS is called nuclei. They have no myelin sheaths so are
grey in colour grey matter.
Bundles of axons connecting different nuclei are tracts lots of myelin so look white.

Spinal cord
About 45cm long
Starts at brain medulla oblongarta
Exits skull through foramen magna
Ends at conus medullaris, around L1 / L2
After conus medullaris is the cauda equina.
Cauda equina tethered to coccyx by filum terminale ligament.

In babies the spinal cord extends further as the skeleton isn't as larger.
Around the thickness of the index finger, but thicker around junction with arms and
legs to allow for additional nerves from extremities:
Cervical enlargement
Lumbar enlargement

Anatomy of spinal cord.

Picture above doesn't show lateral column, only visible in certain areas
(T1-L2) which caries the motor neurons of the SNS White rami
communicans.
Coverings of CNS:
Dura Mater (tough mother) outside layer. Tough. Attached inside cranium but
not attached in spinal cord, protected by fat filled epidural layer which also
carries the venus plexus blood vessels. Blends with epinurium
Arachnoid mater middle layer. Avascular. Fibroelastic connective tissue.
Connects to Pia mater across the subarachnoid space.
Subarachnoid space filled with CSF.
Pia mater Encloses spinal cord. Follows all of the nooks and crannies, covers
blood vessels and veins.
All of the meninges continue below the conus medullaries into the cauda equina.
CSF is still produced into the subarachnoid space, so can safely (!) take sample of
CSF without damage to spinal cord.

PNS
31 pairs of spinal nerves.
12 pairs of cranial nerves
C1 > T12, exit adjacent to vertebra.
L1> Travel further before exit.
All spinal nerves are PNS. All spinal nerves divide into:
Posterior (dorsal) primary rami: carries only mixed nerves that supply the back
(deep muscles) and skin.
Anterior primary rami: does everything else, forming spaghetti junctions (plexi) to
arms and legs.
Dermatomes: Area of skin innervated by single spinal nerve.
Myotomes: Unilateral area of muscle mass innervated by single spinal nerve.

Plexi: mixed nerves. Several different plexus (plexi?) groups. Combine sets of
ventral rami into a singular mixed nerve. Like a motorway junction.

ANS:
Controlled by hypothalamus. Integrated with endocrine system.

Motor ANS has cell body within motor horn. Motor nerves have 1 axon all the way
down from cell body to end of nerve.
Sensory nerves has a synapse in the middle, so has 2 neurons. 1 from cell body to
synapse, 1 from synapse to end of nerve.
^^ & see hand drawn diagram.

Ganglion: collection of cell bodies outside CNS.

Motor neurons of ANS found in anterior horn.
Efferent sympathetic neurons all in lateral column, T1 > L2 only, intermediolateral
horn.

Ganglions connected to spinal nerve but also ganglion above and spinal nerve
below.
15.10.13
1st spinal nerve enters ganglion through white ramus commnicans (white, myalin)
2nd spinal nerve enters through grey ramus communicans (grey, no myalin)

Carry spinal nerves to ganglion chain. May synapse straight away, or may travel up
or down through ganglia before joining spinal nerve and synapsing closer to the
target organ ganglionic chain.

Blood supply
Spine supplied by 2 posterior and 1 anterior spinal arteries. 2 posterior in sub
arachnoid space. Single spinal anterior artery has little in the way of anastomosis,
can cause issues.
Segmental medullary arteries branch off descending aorta and back to add to spinal
cord. Artery of Adamkiewicz
Internal venous plexus (anterior and posterior) both lie anteriorly in the epidural
space, drains vertebral canals into segmental intervertebral vein.
External venous plexus (also anterior & posterior, anastamose freely with each
other) located anteriorly to the spinal bodies and posteriorly to SP's.
They don't have valves. Because if free drainage into other areas of the body,
venus plexus an allow spread of metastasized cancers.

Muscles

Functions of muscles
Movement bones / internal structures, heart, food, bladder
Static support muscle tone.
Protect and stabilise joints.
Aids venous drainage (arteriovenous pump) & lymphatic drainage
Generates heat
Stores glycogen

3 types of muscle:
Cardiac
Skeletal - voluntary
Smooth

Sarco = relating to muscle.

Myofibril contains actin & myosin myofilaments.
Greater muscle mass = increased protein within cells, not more muscle cells.

Cardiac muscle.
Heart & ascending aorta only
Strong, fast contration
Shorter, more branches intercallated disks.
Behaves as synsytium due to tightness of fibres
Spontaneously contracts doesn't initiate contraction. Strength and rate of
contraction modified by ANS.
Aerobic needs blood supply.
Smooth muscles
Slow, rhythmic contraction. Quite excitable, powerful. Non striated. Can stay
contracted for a long time. Controlled by ANS / hormones.

Smooth Cardiac Skeletal

Innvervation ANS ANS Somatic
Location Viscera, blood Heart Body muscles
vessels, hollow Ascending aorta
organs, arrector pili, Pulmonary trunk
in eye
Shape Single spindle Branching Long fibres
Sheets Connected No branching
Histology Non Striated Striated Striated.
One or two nuclei Multi nucleated at
periphery

Muscle names
Insertations and origins:
Origins usually more proximal attachment. Moves least.
Insertations usually more distal.
Often bone, can be fascia and skin.
Tendon dense, regular connective tissue. Bundles of collagen tissue in fasicles.
Some blood vessels but mainly collagen. Covered with epitendon.
Aponeurosis flattened tendon, attaches to crests (iliac) or line of bony
prominences.
Raphe midline between two muscle groups: Iliococcygeal raphe.

Serous membrane
Walls of epithelium, secreates fluid into cavity, allows inner movement without
friction. - heart.

Muscle contraction.
Isometric contraction 'same measurement' not changing length.
Isotonic - tone remains consistant can change length
Reflexive no voluntary control.

Muscles work together:

Prime mover concentric
Antagonist opposite movement eccentrically contracting
Synergist Complements prime mover by stabilising.
Fixator muscles stabilise main trunk.

Neurovasular supply
Neuromuscular spindle contains intrafusal (motor and sensory) fibres wrapped
around sensory nerve. Measures changes in tension, temperature, velocity of
changes. Entres muscle at neurovascular hilum usually bit that moves least.

Golgi tendon organs specialised, give info about musche stretch and strain.
17.10.13

Spine
C7 most promenent
T3 Spine of scapula
T7 Bottom of scapula
T12 12th Rib
L4 Iliac crest

Vertebrae linked by ligament.

2 catilaginous joint symphesis
Posterior aspect of the spine has synovial joints between the articular facet.

Anterior longitudinal ligament

Attached to anterior aspects of spinal bodies & anterior aspects of intervertebral
disks. Collagen will blend with the periosteum. From Occipital bone, all vertebral
bodies to coccyx. Margin of foramen magnum at occiput.
Posterior longitudinal ligament
Inside vertebrate canal, to front of vertebral arch. Not well attached at borders,
better at top and bottom of disk. Posterior surface of vertebral bodies . At C2, it
changes name, carries on but called tectorial membrane. Goes to coccyx. Resists
flexion. Richly innervated by sensory nerves to detect stretch and pain. Sits in
epidural space.
Supraspinous Ligament
Forms triangular shape at occiput ligamentum nuchae. C7>C1 external occipital
protruberence.
Intersegmental ligament
Joins vertebra to vertebra below SP to SP. See slide.
Intertransverse joins TP to TP.
Ligamentum Flavum Yellow. High elastin fibres, connects lamina to lamina.
Inside vertebral canal. Looses elasticity in elderly & buckles on extension.
All highly innervated & all have mechanoreceptors.

Intervertebral disks
Superior and inferior lines with hyaline cartilage (vertebral end plate) between body
or vertebra and disk.
Nucleus pulposus > middle of disk jam. 70-90% water.
Annulus fibrosus > tough outside doughnut. Concentric lamellae of collagen
fibres.
Proteoglycans and glucosaminoglycans thicken water and are positively charged to
draw water in. Important in nucleus pulposus as water gets compressed out during
the day. Pulposus also acts as a fulcrum.
Segmental branches of aorta supply the vertebral column. Only periphery of disks is
vascularised.
Innervated by sympathetic verves. Injured disks are better innervated.

Venous Drainage & blood supply missing!!!

21.10.13
Recurrent meningeal nerve (innervates the posterior aspect of the disk): Goes
back into intervertebral canal. Contains sensory & motor nerves, innervates blood
vessels. May go up 2 or 3 levels & gather information, can also travel contralaterally.
Goes into the cranial space & innervates dura inside.
Innervates: Blood vessels in intervertebral canal, provides sensory nerves to Post
Long. Ligament, periostium of vertebral bodies & pedicles, posterior / posteriolateral
aspects L V disks & dura mata.
Dorsal primary rami:
Curves posteriorly. Divides into 3 branches, medial, intermedial & lateral.
Medial innervates facet joints, may travel upwards, also innervates joint
capsule and synovial membrane
Intermedial innervates the posterior aspect of the lamina & erector spinai
muscles
Lateral branch has a cutaneous branch that innervates the skin.
See class handouts also.

06.11.13
Sacro iliac joint.
Anterior auricular surface of ilium - Synovial plane joint
Posterior syndesmosis posterior inter osseous ligament.
Articular surfaces rough prevent movement of spinal column.
Weight bearing
Allows slight rotation for locomotion.
Shock absorbing
Pelvic bowl opens to allow parturition.
Sacral surface lined with hyaline cartilage
Ilium more fibrous hyaline cartilage higher resistance to shear forces.
Interosseous ligaments
 Sacrum: inverted keystone in arch.
Posterior interosseous ligaments hold inominates over sacrum to stabilise
base when weight bearing

Anterior sacroiliac ligament > anterior to anterior synovial capsule.
Lumbosacral ligamet > attaches to TP of L4 L5, runs to inominate & ala of
sacrum, out towards iliac crest, sometimes down arcuate line.
>Reinforces anterior aspect of joint.
Iliolumbar ligament > also attaches to TP of L4 L5, runs to iliac crest.

Posterior Ligaments
Syndesmosis behind synovial joint.
Short Posterior sacroiliac ligament lies over and reinforces the
syndesmosis

Posterior long sacroiliac ligament

from PSIS to lateral sacrum (S3/S4 lateral tubercles)
Forms tunnel for dorsal rami
tension can produce pain in buttocks
Counternutation tightens long SI ligament

Sacrotuberous ligament
PSIS (ilium) dorsal SI ligament to lateral margin of sacrum
Travels down to ischial tuberosity

Sacrospinous ligament
attaches to ischial spine
From lateral edge of coccyx below SI joint.

Boundaries of greater sciatic foramen:

G sciatic notch
sacrospinous and sacrotuberous ligaments
Boundaries of lesser sciatic foramen:
Lesser sciatic notch
sacrospinous and sacrotuberous ligaments
Piriformis and obturator internus leave through greater sciatic foramen.

Piriformis takes origin from anterior surface of sacrum, S2 to S4

Attaches to greater trochanter.
Obturater internus: Attaches to membrane on inside, passes out through lesser
sciatic foramen. Attaches to femur.
Iliolumbar ligament:
TP of L5 & L4 to iliac crest & fossa. Straight across the front. Muscular when young,
ligamentous when older. Prevents spondylolysthesis. Becomes continuous with the
thoracolumbar fascia.

Common iliac artery > external iliac artery goes to leg, > internal iliac artery stays
in pelvis.

Hilton's law can't apply to iliac.

Pubic symphesis 2ndary cartilagionous joint with interpubic disk. Anterior &
posterior pubic ligaments continuous with abdominal musculature.
Superior pubic ligaments run pubic tubercle to pubic tubercle > provides stability
against innominate rotation.

Inferior pubic ligament runs pubic ramus to pubic ramus.

Deep dorsal sacrococcygeal, continuation of PLL.

Superficial sacrococcygeal contunation of ligamentum flavum.

Muscles of back
Extrinsic: innervated by ventral rami of spinal nerves. Connect lumbar to axial
skeleton.
Intrinsic: Core stability, innervated by dorsal rami. Very proprioxeptive.

Extrinsic: Superficial & intermediate.

Superficial:
trapezius
levatator scapule
latissimus dorsi
Rhomboid minor.
Intermediate:
Serratus posterior inferior
Serratus posterior superior
All nerves except genitofemoral and obturator emerge lateral to psoas.

I twice get laid on Friday's >

Iliohypergastric
Ilioinguinal (I, twice)
Genitofemoral
Lateral femoral cutaneous
Obturator
Femoral

2 from 1
2 from 2
2 from 3