CHAPTER I: INTRODUCTION

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Term Prelim

Anatomy
- is the science of the structure and function of the body

Clinical Anatomy
- is the study of the macroscopic structure and function of the body as it relates to the
practice of medicine and other health sciences

Basic Anatomy
- is the study of the minimal amount of anatomy consistent with the understanding of
the overall structure and function of the body

IMPORTANCE OF ANATOMIC TERMS

aid of a medical dictionary, you will find that understanding anatomic terminology
greatly assists you in the learning process
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

CHAPTER I: INTRODUCTION 1
 Frontal / Coronal Sagittal Transverse
- passed through by the Z- - passed through by - passed through by the y-
axis and divides the body the x-axis and axis and divides the body
anteriorly and potseriorly divides the body superiorly / inferiorly or
- side to side motions right /left cephalic / caudal
- front and back

CHAPTER I: INTRODUCTION 2
 EXCEPTION ON THE THUMB

Frontal/Coronal Sagittal
- Motion of thumb is flexion and - Motion of thumb is abduction and
extension adduction

OTHER INFORMATION
There are 4 fingers and 1 thumb in each hand but there are 10 digits (fingers) in the
upper & lower extremities

Thumb (40%) Index (20%)

Middle (20%) Ring (10%)

Little finger (10%)

TERMS RELATED TO POSITION

Anatomical Position
- person is standing erect,
with the upper limbs by the
sides and the face and palms
of the hands directed forward
Median Plane Sagittal Plane
- a vertical plane - any plane parallel to the
passing through the median plane that divides
center of the body, the body into unequal
dividing it into equal right and left portions
right and left halves

Coronal Transverse Horizontal Plane

(frontal) Plane - lies at the right angles to both the
Planes - lies perpendicular median and coronal planes
- are imaginary to the long axis of a - divides the body into upper & lower
vertical planes at given structure & parts
right angles to the divides that the terms “horizontal and
median plane structure in a transverse plane” are often used
crosssectional interchangeably. However, they are
orientation not necessarily equivalent

CHAPTER I: INTRODUCTION 3
 Paramedian
- Planes situated to one
or the other side of the
median plane and parallel
to it
Medial
- structure situated
nearer to the median
plane of the body than
another
Lateral
- structure that lies farther
away from the median
plane than another

Axial Appendicular
- center - limbs

Anterior (ventral) &Posterior Palmar Plantar and

(dorsal) and Dorsal
- are used to indicate the front and back of Dorsal Surfaces
the body, respectively Surfaces - describing the
- to describe the relationship of two - describing foot
structures: one is said to be anterior or the hands - are used instead
posterior to the other insofar as it is closer - are used in of lower and upper
to the anterior or posterior body surface place of surfaces
anterior and
posterior

Proximal and Distal

- describe the relative distances from the roots of the limbs
ex. the arm is proximal to the forearm and the hand is distal to the forearm

Superficial and Deep

- denote the relative distances of structures from the surface of the body

Superior and Inferior

CHAPTER I: INTRODUCTION 4
 - denote levels relatively high or low with reference to the upper and lower ends of
the body
- cranial or cephalic (superior)
- caudal (inferior)

Internal and External

- are used to describe the relative distance of a structure from the center of an organ
or cavity
ex. the internal carotid artery is found inside the cranial cavity and the external
carotid artery is found outside the cranial cavity

Ipsilateral
- refers to the same side of
the body;for example, the left
hand and the left foot are
ipsilateral
Contralateral
- refers to opposite sides of the body; for
ex. the left biceps brachii muscle and the right
rectus femoris muscle are contralateral

Supine Prone
- position of the body is lying on the back - position is lying face
downward

Afferent and Efferent

- the direction of flow relative to a reference point
- Afferent, flow toward the reference point
- Efferent, flow away from the reference

TERMS RELATED TO MOVEMENT

Flexion Extension Dorsiflexion
- is a movement that takes - straightening the - Refers to lifting the top
place in a sagittal plane joint and usually of the foot superiorly,

CHAPTER I: INTRODUCTION 5
 ex. flexion of the elbow joint
approximates the anterior
surface of the forearm to the
anterior surface of the arm
- It is usually an anterior
movement, but it is
occasionally posterior, as in
the case of the knee joint
Plantar Flexion
- Refers to moving the sole of
the foot inferiorly, standing on
toes
- Equivalent to flexion
Rotation
- term applied to the
movement of a part of the
body around its long axis
- with little to no
movement at all
Medial (Internal)
Rotation
- the movement that
results in the anterior
surface of the part facing
medially
Supination of the
forearm
- is a lateral rotation of the
forearm from the pronated
position so that the palm
of the hand comes to face
anteriorly
CHAPTER I: INTRODUCTION
takes place in a toward the shin
posterior direction - Equivalent to extension
Lateral Flexion
- Imprecise term,
that refers to a
sideways bending
movement of the
trunk in the coronal
plane
Abduction Adduction
- is a movement of a - is a movement of a limb
limb away from the toward the midline of the
midline of the body body in the coronal plane
in the coronal plane
Medial (Internal) Lateral (External)
Rotation Rotation
- the movement that - is the movement that
results in the anterior results in the anterior
surface of the part surface of the part facing
facing medially laterally
Lateral (External) Pronation of the
Rotation forearm
- is the movement that - is a medial rotation of
results in the anterior the forearm in such a
surface of the part manner that the palm of
facing laterally the hand faces posteriorly
Circumduction Protraction and
- is the complex Retraction
movements - is to move forward (protraction)
combining - is to move backward
flexion, (retraction)
extension, - used to describe the forward
abduction, and backward movement of the
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 adduction, & jaw at the temporomandibular
rotation joints

Inversion Eversion
- is the movement of the foot so that the - is the opposite movement of the foot
sole faces in a medial direction so that the sole faces in a lateral
direction

BASIC STRUCTURES
Skin
- for protection, heat regulation, sensation, absorption, excretion, and secretion
- first line of defence from diseases
- divided into two: epidermis (superficial part) and dermis (deep part)

Epidermis
- is a stratified epithelium whose cells become flattened as they mature and rise to the
surface
- outermost layer
- On palms of the hands and soles of the feet; extremely thick, to withstand the wear
and tear that occurs in these regions.
- In other areas of the body; on the anterior surface of the arm and forearm, it is thin

CHAPTER I: INTRODUCTION 7
 FIVE SUBLAYERS

Stratum Corneum
- Outermost layer of the skin
- Made up of dead keratinized cells

Stratum Lucidum
- Thin, clear layer, usually present in thicker skin
- Very unique, absent but seen on palms & soles
- Prone to wear and tear

Stratum Granulosum
- Made up of diamond shaped cells and contains keratin

Stratum Spinosum
- Made up of spined polyhedral cells that are connected by desmosomes

Stratum Basale / Germativum

- Deepest layer, where cells are found; melanocytes (melanin, skin color) &
keratinocytes (keratin, wear & tear)

CHAPTER I: INTRODUCTION 8
 Dermis
- Is composed of dense connective tissue containing many blood vessels, lymphatic
vessels, and nerves
- It shows considerable variation in thickness in different parts of the body, tending to
be thinner on the anterior than on the posterior surface
- It is thinner in women than in men

Two types; papillary and reticular

Papillary
- The thin top layer of the dermis has connective tissue and blood vessels that
give nutrients to the epidermis and help control temperature of the skin
Reticular
- Lower layer, consists of dense irregular connective tissue
- Important in giving the skin overall strength and elasticity, as well as housing
other important epithelial derived structures; glands and hair follicles

Subcutaneous Tissue
- Or superficial fascia
- Dermis of the skin is connected to the underlying deep fascia or bones by the
subcutaneous tissue

CHAPTER I: INTRODUCTION 9
 Skin Creases
- The skin over joints always folds in the same place
- At these sites, the skin is thinner than elsewhere and is firmly tethered to underlying
structures by strong bands of fibrous tissue

APPENDAGES OF THE SKIN:

o Nails
- are keratinized plates on the dorsal surfaces of the tips of the fingers and toes

CHAPTER I: INTRODUCTION 10
 Root of the nail
- The proximal edge of the plate

Nail folds
- Folds of skin that surrounds and overlaps the nails

Nail bed
- The surface of skin covered by the nail

o Hair follicles
- Hair grows out of follicles
- which are invaginations of the epidermis into the dermis
- The follicles lie obliquely to the skin surface

CHAPTER I: INTRODUCTION 11
 Hair Bulbs
- Expanded extremities
- penetrate to the deeper part of the dermis
- Each hair bulb is concave at its end

Hair Papilla
- Vascular connective tissue that occupies the concavity of the hair bulb

Arrector Pili
- A band of smooth muscle
- connects the undersurface of the follicle to the superficial part of the dermis
- The muscle is innervated by sympathetic nerve fibers, and its contraction causes
the hair to move into a more vertical position
- it also compresses the sebaceous gland and causes it to extrude some of its
secretion

Gooseflesh
- dimpling of the skin surface caused by pulling of the muscle

Hairs
- are distributed in various numbers over the whole surface of the body, except on
the lips, the palms of the hands, the sides of the fingers, the glans penis and

CHAPTER I: INTRODUCTION 12
 clitoris, the labia minora and the internal surface of the labia majora, and the soles
and sides of the feet and the sides of the toes

o Sebaceous glands

- pour their secretion, the sebum, onto the shafts of the hairs as they pass up through
the necks of the follicles.
- They are situated on the sloping undersurface of the follicles and lie within the
dermis
Sebum
- is an oily material that helps preserve the flexibility of the emerging hair
- oils the surface epidermis around the mouth of the follicle

o Sweat glands

CHAPTER I: INTRODUCTION 13
 - are long, spiral, tubular glands distributed over the surface of the body, except on
the red margins of the lips, the nail beds, and the glans penis and clitoris
- extend through the full thickness of the dermis, and their extremities may lie in the
superficial fascia
- the most deeply penetrating structures of all the epidermal appendages
- important for heat regulation, conserve, and dissipate heat
- simulated when there’s extreme heat (organs/ cells of the body’s temperature is not
37-37.4)
- simulated to release sweat which regulates heat

TWO TYPES
Eccrine Appocrine
- extreme areas (forehead) - pubic hairs, axilla (produces more
- found in the surface of the skin (visible) sweat)
*sweat has no smell, bacteria causes
the sweat to smell

Hypermydrosis Hypodermis Pressure

- abnormal sweating - or sebaceous layer, fatty layer ulcer
*Hairs lie flat – pores are (heat regulation) - due to
open - for cushion and insulation excessive
- adipose layer; superficial fascia pressure/friction

RECEPTORS
- sends signals to the brain and nervous system
ex. withdrawal reflex

CHAPTER I: INTRODUCTION 14
 Free nerve endings – pain, heat, cold
Merke discs – touch
Krause & bulbs – touch
Root hair plexus – touch
Meissner corpuscles – touch
Pasinian corpuscles – touch
Ruffinii endings – pressure

Contractive formation
- Shrinking of skin bums

Subdermal Layer
- all structures beneath the skin; fascia, bones, & muscles

CHAPTER I: INTRODUCTION 15
 FASCIA
- the connective tissue that encloses the body deep to the skin and also envelops and
separates individual muscles and groups of muscles as well as deeper organs
- (think of it as) the connective tissue sheaths that hold the structures of the body
together in organized arrangements
- Reduce friction
- divided into two types superficial and deep—and lie between the skin and the
underlying muscles and bones

Superficial Fascia Deep Fascia

CHAPTER I: INTRODUCTION 16
 - or subcutaneous tissue, is a
mixture of loose areolar and
adipose tissue that unites the
dermis of the skin to the underlying
deep fascia
- cushion and insulation
- fatty layer/adipose layer/
hypodermis
- In the scalp, the back of the neck,
the palms of the hands and the
soles of the feet, it contains
numerous bundles of collagen
fibers that hold the skin firmly to
the deeper structures
- In the eyelids, auricle of the ear,
penis and scrotum, and clitoris, it is
devoid of adipose tissue
- Muscular fascia or visceral fascia
- is a membranous layer of connective tissue
that invests the muscles and other deep
structures
- Reduces friction
- Wraps bundle of muscles, when it moves it
- Trace where the spread of infection roots
from
- In the neck, it forms well-defined layers that
may play an important role in determining the
path taken by pathogenic organisms during
the spread of infection
- In the thorax and abdomen, it is merely a
thin film of areolar tissue covering the
muscles and aponeuroses
- In the limbs, it forms a definite sheath
around the muscles and other structures,
holding them in place

Fibrous septa
- extend from the deep surface of the membrane, between the groups of muscles,
and in many places divide the interior of the limbs into compartments
*In the region of joints, the deep fascia may be considerably thickened to form
restraining bands called retinacula

Retinacula
- function is to hold underlying tendons in position or to serve as pulleys around which
the tendons may move

MUSCLE
- function: movement
- three types of muscle are skeletal, smooth, and cardiac

Skeletal Muscle
- produce the movements of the skeleton
- sometimes called voluntary muscles
- are made up of striated muscle fibers. A skeletal muscle has two or more
attachments

CHAPTER I: INTRODUCTION 17
 Origin
- attachment that moves the least, more
proximal
Belly
- fleshy part of the muscle
Aponeurosis
- a thin but strong sheet of fibrous tissue
that attaches flattened muscles
INTERNAL STRUCTURE OF SKELETAL MUS
CLE
Epimysium
- or investing deep fascia
- a fibrous envelope formed by muscle
fibers that are bound together with
delicate areolar tissue, which is
CHAPTER I: INTRODUCTION
Insertion
- one that moves the most, more distal
- when it muscle contracts, it is drawn
proximally toward the origin
* degree of mobility of the attachments
may be reversed; therefore, the terms
origin and insertion are interchangeable
Tendons
- cords of fibrous tissues which attaches
the ends of a muscle to bones,
cartilage, or ligaments
Raphe
- is an interdigitation of the tendinous
ends of fibers of flat muscles
Parallel-fibered Muscles
- Have a greater excursion
Ex. Sternocleidomastoid, the rectus
abdominis, and the Sartorius (muscles
with parallel fiber arrangements)
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 condensed on the surface
- The individual fibers of a muscle are
arranged either parallel or oblique to the
long axis of the muscle
- Because a muscle shortens by one
third to one half its resting length when it
contracts, it follows that muscles whose
fibers run parallel to the line of pull will
act over a longer distance and bring
about a greater degree of movement
compared with those whose fibers run
obliquely.

Pennate muscles

- Muscles whose fibers run obliquely to the line of pull (they resemble a feather)
- For a given volume of muscle substance, have many more fibers compared to
muscles with parallel fiber arrangements and are therefore more powerful; in other
words, range of movement has been sacrificed for strength
- Produce more force but have less acursion

Unipennate muscle Bipennate muscle Multipennate muscle

- the tendon lies along - the tendon lies in the - may be arranged as a
one side of the muscle center of the muscle series of bipennate
and the muscle fibers and the muscle fibers muscles lying alongside

CHAPTER I: INTRODUCTION 19
 pass obliquely to it (e.g.,
extensor digitorum
longus)
pass to it from two one another (e.g.,
sides (e.g., rectus acromial fibers of the
femoris) deltoid)
- or may have the tendon
lying within its center and
the muscle fibers passing
to it from all sides,
converging as they go
(e.g., tibialis anterior)

Force (strength)
- that a muscle produces when it contracts is directly proportional to the physiological
crosssectional area of the muscle

NERVE SUPPLY OF SKELETAL MUSCLE

Nerve trunk
- to a muscle is a mixed nerve, about 60% is motor (what the brain elicits, makes it
voluntary) and 40% is sensory (what the brain accepts)
- innervated by sympathetic autonomic fibers (can contract involuntarily
- nerve enters the muscle at about the midpoint on its deep surface,
- often near the margin; the place of entrance is known as the motor point
*arrangement allows the muscle to move with minimum interference with the nerve
trunk

CHAPTER I: INTRODUCTION 20
 Efferent – carrying away
Afferent – bringing to
Motor unit
- constituted by a single motor neuron plus all the muscle fibers innervated by that
neuron

Size of a motor unit

- varies greatly from muscle to muscle according to the size and function of the
muscle
Large motor unit
- up to several hundred muscle fibers per neuron are characteristics of the large
trunk and lower limb muscles
Small motor units
- as few as 5 to 10 muscle fibers per neuron are features of precision movement
muscles such as the extraocular muscles and the small muscles in the hand

NAMING OF SKELETAL MUSCLES

- Individual muscles are named according to their shape, size, number of heads or
bellies, position, depth, attachments, or action
Ex.
Latissimus Dorsi – broadest muscle at the back
Biceps Brachii – two- headed muscle in the arm
Quadriceps Femoris – four-headed muscle in femur
Extensor Carpi Ulnar – extends the wrist ulnarly

TYPES OF MUSCLE CONTRACTION

CHAPTER I: INTRODUCTION 21
 1. Isometric Contraction 2. Isokinetic 3. Isotonic Contraction
- Length of muscle is the Contraction The same tone
same - Possible only with a a. Concentric – muscle
- Muscle contracts but machine shortens, still contracting
does not shorten nor - CPM (continuous b. Eccentric – muscle
lengthen passive machine) lengthens, still contracting
- Not allowed on patients
w/ cardiac problems due
to the valsalva maneuver
(holding of breath,
weightlifting)
- Should have the patient
counting

Smooth Muscle

CHAPTER I: INTRODUCTION 22
 - Not striated, involuntary
- Slow and sustained
- Consists of long, spindle-shaped cells closely arranged in bundles or sheets
- In tubes of the body, it provides the motive power for propelling contents through the
lumen
- Digestive system, it mixes ingested food with digestive juices
- In walls of the blood vessels, are arranged circularly and serve to modify the caliber
of the lumen

* Depending on the organ, smooth muscle fibers may be made to contract by local
stretching of the fibers, by nerve impulses from autonomic nerves, or by hormonal
stimulation

Peristalsis
- Method of propulsion
- A wave of contraction of the circularly arranged fibers passes along the tube, milking
the contents onward. By their contraction, the longitudinal fibers pull the wall of the
tube proximally over the contents

Cardiac Muscle

CHAPTER I: INTRODUCTION 23
 - consists of striated muscle fibers that branch and unite with each other
- It forms the myocardium of the heart
- Its fibers tend to be arranged in whorls and spirals
- they have the property of spontaneous and rhythmic contraction
- is supplied by autonomic nerve fibers that terminate in the nodes of the conducting
system and in the myocardium
Conducting system of the heart
- formed by specialized cardiac muscle fibers

JOINTS
- A site where two or more bones come together, whether or not movement occurs
between them
- classified according to the tissues that lie between the bones: fibrous joints,
cartilaginous joints, and synovial joints
Some joints have no movement (sutures of the skull)
Some have only slight movement (superior tibiofibular joint)
Some are freely movable (shoulder joint)

JOINT CLASSIFICATION
Three main types that are based on the tissues that lie in the joint space between the
bones

Fibrous Joints Cartilaginous Joints Synovial Joints

CHAPTER I: INTRODUCTION 24
 - articulating - the space between the
surfaces of the articulating bony surfaces
bones are tightly is filled with a cartilaginous
linked by fibrous pad
tissue that fills the - divided into two types:
joint space, and primary and secondary
thus very little Primary Cartilaginous
movement is Joint
possible - Or synchondrosis
ex. sutures of the - the bones are united by a
vault of the skull plate or a bar of hyaline
and the inferior cartilage
tibiofibular joints - no movement is possible
ex. the epiphyseal plate
between the epiphysis and
the diaphysis of a growing
bone (temporary
synchondrosis) and the 1st
sternocostal joint between
rib and the manubrium
sterni (permanent
synchondrosis)
Secondary Cartilaginous
Joint
- Or symphysis
- bones are united primarily
by a plate or pad of
fibrocartilage and the
articular surfaces of the
bones are covered by a
thin layer of hyaline
cartilage
- located along the midline
of the body
- small amount of
movement is possible
ex. interevetebral joints
between the vertebral
bodies, the
CHAPTER I: INTRODUCTION
- articular surfaces of the
bones are covered by a thin
layer of hyaline cartilage
separated by a fluid filled joint
cavity
- arrangement permits a great
degree of freedom of
movement
- shape of bones
participating, approximation
of adjacent anatomic
structures, and presence of
fibrous ligaments uniting the
bones contribute to limiting
the degree of movement
Synovial membrane
- lines the cavity of the joint
which extends from the
margins of one articular
surface to those of the other
Capsule of the joint
- a tough fibrous membrane
that protects the synovial
membrane on the outside
Synovial Fluid
- a viscous fluid that
lubricates the articular
surfaces
- produced by the synovial
membrane
Articular Discs
- the knee joint, discs or
wedges of fibrocartilage are
interposed between the
articular surfaces of the
bones
Fatty pads
- are found in some synovial
joints lying between the
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 manubriosternal joint, & synovial membrane and the
symphysis pubis fibrous capsule or bone
ex. found in the hips and
knee joints

Extrascapular Ligaments
- Most ligaments that lie outside the joint capsule

Intrascapular Ligaments
- Some important ligaments that lie within the capsule

Cruciate ligaments
- lie within the capsule

TYPES OF MOVEMENTS
Plane joints

- the apposed articular surfaces are flat or almost flat, and this permits the bones to
slide on one another.
ex. sternoclavicular and acromioclavicular joints

CHAPTER I: INTRODUCTION 26
 UNIAXIAL BIAXIAL MULTIAXIAL
Hinge joints Condyloid joints Saddle joints
- resemble the hinge on a - have two distinct - the articular surfaces are
door, so that flexion and convex surfaces that reciprocally
extension movements are articulate concavoconvex and
possible with two concave resemble a saddle on a
ex. the elbow, knee, and surfaces horse’s back
ankle joints - The movements of - these joints permit
flexion, extension, flexion, extension,
Pivot joints abduction, abduction,
and adduction are adduction, and rotation
- a central bony pivot is
possible together with a ex. the carpometacarpal
surrounded by a bony–
ligamentous ring and small joint of the thumb
amount of rotation
rotation is the only
ex. the
movement possible Ball-and-socket joints
- a ball-shaped head of

CHAPTER I: INTRODUCTION 27
 ex. the atlantoaxial and
superior radioulnar joints
metacarpophalangeal one bone fits into a
joints or knuckle joints socketlike concavity of
another
- This arrangement
Ellipsoid joints
permits free movements,
- an elliptical convex
including flexion,
articular surface fits into
extension, abduction,
an
adduction,
elliptical concave
medial rotation, lateral
articular surface
rotation, and
- The movements of
circumduction.
flexion, extension,
ex. the shoulder and hip
abduction,
joints
and adduction can take
place, but rotation is
impossible.
ex. the wrist joint

Stability of Joints
- depends on three main factors: the shape, size, and arrangement of the articular
surfaces; the ligaments; and the tone of the muscles around the joint

ARTICULAR SURFACES
- The ball-and-socket arrangement of the hip joint and the mortise arrangement of the
ankle joint are good examples of how bone shape plays an important role in joint
stability
- However, some other joints the shape of the bones contributes little or nothing to the
stability include the acromioclavicular joint, the calcaneocuboid joint, and the knee
joint

LIGAMENTS
- A cord or band of fibrous connective tissue uniting thwo or more structures
- In musculoskeletal system, ligaments typically bind bones at joints
- Function: help movements; prevents unwanted motion
- Two types: prevent motion and lengthens or shortens

CHAPTER I: INTRODUCTION 28
 Fibrous ligaments
- prevent excessive movement in a joint,
but if the stress is continued for an
excessively long period, then fibrous
ligaments stretch
ex. the ligaments of the joints between
the bones forming the arches of the feet
will not by themselves support the
weight of the body
-Should the tone of the muscles that
normally support the arches become
impaired by fatigue, then the ligaments
will stretch and the arches will collapse,
producing flat feet
Elastic ligaments
- conversely, return to their original
length after stretching
- The elastic ligaments of the auditory
ossicles play an active part in supporting
the joints and assisting in the return of
the bones to their original position after
movement
*fibula is longer than the tibia
*ligaments prevent unwanted movement
of ankle-joint
Strain – muscle
Sprain - ligament

MUSCLE TONE
- is the major factor controlling stability
ex. the muscle tone of the short muscles around the shoulder joint keeps the
hemispherical head of the humerus in the shallow glenoid cavity of the scapula

CHAPTER I: INTRODUCTION 29
 Without the action of these muscles, very little force would be required to
dislocate this joint
The knee joint is very unstable without the tonic activity of the quadriceps
femoris muscle
The joints between the small bones forming the arches of the feet are largely
supported by the tone of the muscles of the leg, whose tendons are inserted into
the bones of the feet
Nerve supply of joints
- The capsule and ligaments receive an abundant sensory nerve supply

Hilton’s Law
- A sensory nerve supplying a joint also supplies the muscles moving the joint and the
skin overlying the insertions of these muscles

BURSA

- A lubricating device consisting a closed fibrous sac lined internally with synovial
membrane
- Function: to reduce friction & facilitate movement
- typically found in areas subject to friction and serve 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
- They are commonly found close to joints where the skin rubs against underlying
bony structures
ex. the prepatellar bursa

CHAPTER I: INTRODUCTION 30
 - Occasionally, the cavity of a bursa communicates with the cavity of a synovial joint
ex, the suprapatellar bursa communicates with the knee joint and the subscapularis
bursa communicates with the shoulder joint
Synovial membrane
- Secretes a film of viscous fluid that fills the sac

SYNOVIAL SHEATH

- is a tubular bursa that surrounds a tendon

- To lubricate and reduce friction between tendon & surrounding structure
- Covers the joint
- The tendon invaginates the bursa from one side so that the tendon becomes
suspended within the bursa by a mesotendon
- occur where tendons pass under ligaments and retinacula and through osseofibrous
tunnels

Mesotendon
- enables blood vessels to enter the tendon along its course
- In certain situations, when the range of movement is extensive, the mesotendon
disappears or remains in the form of narrow threads, the vincula

BLOOD VESSELS
- are of three types: arteries, veins, and capillaries

CHAPTER I: INTRODUCTION 31
 Arteries
- transport oxygenated blood (carried by haemoglobin) from the heart and distribute it
to the various tissues of the body by means of their branches
- do not have valves
- except pulmonary artery
→ Arterioles
The smallest arteries, <0.1 mm in diameter
→ Anastomosis
- joining of branches of arteries
- individual arteries may connect with other arteries via a communicating branch
- exchange blood in capillary bed

Anatomic end arteries Functional end arteries

- are vessels whose terminal branches
do not anastomose with branches of
arteries supplying adjacent areas
- provide the sole source of blood to a
specific target area
- Occlusion will result in death of the
target tissues
- are vessels whose terminal branches
do anastomose with those of adjacent
arteries, but the caliber of the
anastomosis is insufficient to keep the
tissue alive should one of the arteries
become blocked

THREE LAYERS OF THE ARTERY

CHAPTER I: INTRODUCTION 32
 Tunica Adventitia
- Or externa
- Strong outer covering
- Composed of connective
tissue, collagen, & elastic
fibers
Tunica Media Tunica Intima
- Middle layer of the - Inner layer
wall - Composed of an elastic
- Thick muscle tissue to membrane lining and
produce a greater smooth endothelium
muscle contraction to covered by elastic tissues
pump blood away from
the heart

Veins
- are vessels that transport/carries deoxygenated blood back to the heart; many of
them possess valves
- except pulmonary vein & umbilical vein
*incompetency, stagnant blood, regurgitation of deoxygenated blood to the organ
systems causes edema

CHAPTER I: INTRODUCTION 33
 Edema
- swelling of soft tissues due to excess fluid accumulation

Valves
- function to prevent reflux of blood because deoxygenated blood cannot be utilized
by cell or tissues
- to move in one direction towards the heart

Venules Tributaries Venae Comitantes

- The smallest veins
- Smaller veins
- unite to form larger
veins, which commonly
join with one another to
form venous plexuses
- two veins that often
accompany medium-sized
deep arteries, one on
each side
*Veins leaving the
gastrointestinal tract do
not go directlyto the heart
but converge on the portal
vein;

CHAPTER I: INTRODUCTION 34
 Portal Vein
- this vein enters the liver and breaks up again into veins of diminishing size, which
ultimately join sinusoids, in the liver
- where veins converge after leaving the gastrointestinal tract
Portal System

- is thus a system of vessels interposed between two capillary beds

Capillaries
- are microscopic vessels in the form of a network connecting the arterioles to the
venules
- where gas exchange happens
- smallest blood vessels
- oxygenated blood to arteries – deoxygenated to veins
Sinusoids

CHAPTER I: INTRODUCTION 35
 - resemble capillaries in that they are thin-walled blood vessels, but they have an
irregular cross diameter and are wider than capillaries
- They are found in the bone marrow, the spleen, the liver, and some endocrine
glands

Arteriovenous anastomoses

- direct connections occur between the arteries and the veins without the intervention
of

CHAPTER I: INTRODUCTION 36
 capillaries
- in tips of the fingers and toes

LYMPHATIC SYSTEM
- essentially a drainage system, and there is no circulation
- consists of lymphatic tissues and lymphatic vessels

Lymph

- is the name given to tissue fluid once it has entered a lymphatic vessel
- clear, colorless tissue fluid that is collected from tissues throughout the body
- consists of a liquid portion and a cellular portion that is composed mainly of WBC
(primarily lymphocytes)
- collected in a vast network of vessels and eventually mostly returned to the venous
system

Lymphatic Lymphocytes Lymphatic Lymph capillaries

tissues vessels
- act as barriers - are a network of
- are a type of to pathogens - are tubes that fine vessels that
connective tissue - in the spleen, assist the drain lymph from
that contains large filter the blood cardiovascular the tissues

CHAPTER I: INTRODUCTION 37
 numbers of system in the - larger and more
lymphocytes removal of irregular than
- essential for the tissue fluid from blood capillaries
immunological the tissue - possess few
defences of the spaces of the valves, present in
body against body; the most locations
bacteria and vessels then where blood
viruses return the fluid capillaries are
- serves to to the blood found
produce - have a beaded - The capillaries
lymphocytes appearance are in turn drained
- is organized into because of the by small lymph
the following presence of vessels, which
organs: numerous unite to form large
valves along lymph vessels
the thymus
their course *Before lymph is
the lymph nodes
- are found in all returned to the
the spleen
tissues and bloodstream, it
tonsils
the lymphatic organs of the passes through at
body except: least one lymph
nodules (not
the central node and often
organized to
be considered as nervous system through several
the eyeball, *collecting vessels
organs)
the internal ear tend to run in
the epidermis multiples rather
of the skin than as single
the cartilage channels and often
the bone accompany veins.
Usually present a
beaded or knotted
appearance
because of the
presence of
numerous valves
along the course

Lacteals

CHAPTER I: INTRODUCTION 38
 - Blind-ending projections of lymph capillaries in the villi of the small intestine
- Absorb chyle (emulsified fat) – produced during digestion

Valve cusps

- Are directed so as to allow lymph flow only toward the heart

Lymphatic trunks or ducts

CHAPTER I: INTRODUCTION 39
 - Largest collecting vessels, where the lymph reaches the bloodstream at the root of
the neck
- Major lymphatic tubes that are the most apparent at the gross dissection level
- Right lymphatic duct (formed when vessels unite, then drains into the venous
system) and thoracic duct (where lymph from the rest of the body drains, empties into
the left side of the venous system: may posses few valves)
- Arrangement is extremely variable
Cisterna chyli

CHAPTER I: INTRODUCTION 40
 - A dilated sac forming the origin of the thoracic duct may be only a plexus of vessels
in the upper lumbar region

Afferent vessels Efferent vessels

- lymph vessels that carry lymph to a - those that transport it away from a
lymph node node

Flow of lymph
- driven by extravessel forces

Lymphedema
- abnormally large accumulation of fluid due to the obstruction of lymph flow from a
given area

Mucous Membrane
- tissue layer that lines the luminal surface of an organ or passageway and
communicates with the surface of the body
- may or may not secrete mucus on its surface
- consists of lamina propria

Lamina propria Muscularis mucosa

- layer of epithelium supported by a - smooth muscle, sometimes present in
layer of connective tissue the connective tissue

Serous Membrane

CHAPTER I: INTRODUCTION 41
 - line the thoracic & abdominopelvic cavities of the trunk and are reflected onto the
mobile viscera lying within these cavities
- consists of a smooth layer of mesothelium supported by a thin layer of connective
tissue

Parietal Layer Visceral Layer

- serous membrane lining the wall of the
cavity
- developed from the somatopleure
(inner cell of mesoderm)
- richly supplied by spinal nerves
- sensitive to all common sensations;
touch and pain
- covering the viscera
- developed from the splanchnopleure
(inner cell layer of mesoderm)
- supplied by visceral afferent nerves
- insensitive to touch and temperature
but very sensitive to stretch
*the narrow, sit-like interval that
separates these layers forms the
pleural, pericardial, and peritoneal
cavities & contains a small amount of
serous fluid

Serous fluid

- the exudates of the serous membrane

- lubricates the surfaces of the membranes and allows the two layers to slide readily
on each other

NERVOUS SYSTEM
- together with the endocrine system, controls and integrates the activities of the
different parts of the body
- receives, stores, controls
- divided into two; central and peripheral

CHAPTER I: INTRODUCTION 42
 Central Nervous System
- consists of the brain and spinal cord
- large number of nerve cells

Neuroglia
- specialized tissue, supports the process of the central nervous system

Neurons
- term given to the nerve cell & all its processes dendrites and axons
- each neuron has three main components: cell body and two types of processes

CHAPTER I: INTRODUCTION 43
 Dendrites Axon
- short process of the cell body - Longest process of the cell body
- conduct nerve impulses toward the cell - Conduct impulses away from the cell
body body
*The interior of the central nervous
system is organized into gray and white
matter

Nuclei
- Cell bodies within the CNS that are located in clusters

CHAPTER I: INTRODUCTION 44
 Gray matter White matter

- consists largely of nerve cells - consists largely of nerve fibers (axons)

embedded in neuroglia
- large population of nonmyelinated cell
bodies presents a relatively dull, grayish
color
- in the spinal cord, organized in a
characteristic Hshaped (butterfly
shaped) pattern
embedded in neuroglia
- large population of myelinated
processes here which gives tissue a
relatively white, glistening color
*named because of their relative color
tones in fresh tissue
Paired Posterior (dorsal) &
Anterior (ventral) gray horns

- Extend along the length of the cord

Paired lateral gray horns

- Bulge out in the thoracic and upper

lumbar portions of the cord

Central Canal
- Containing cerebrospinal fluid runs
the internal length of CNS

THREE MENINGES

- Or membranes, surround the entire CNS (brain + spinal cord)

- Serve to protect, anchor, and stabilize the CNS and also contain surrounding sac of
cerebrospinal fluid

CHAPTER I: INTRODUCTION 45
 Dura mater – most external membrane
Arachnoid mater – middle membrane
Pia mater – innermost layer

Peripheral Nervous System

- consists of a paired series of cranial and spinal nerves and their associated ganglia
- On dissection, the cranial and spinal nerves are seen as grayish white cords. They
are made up of bundles of nerve fibers (axons) supported by delicate areolar tissue
- 12 pairs of cranial nerves & 31 pairs of spinal nerves
Cranial nerves – 12 pairs; exits the brain
Spinal nerves – 31 pairs; exits the spinal cord (8 cervical, 12 thoracic, 5 lumbar,
5
sacral, 1 coccygeal)
*650 muscles (skeletal)

CHAPTER I: INTRODUCTION 46
 Ganglion
- A cluster of neuron cell bodies located outside the CNS

Cranial Nerves

- Branch off the brain and upper spinal cord & pass through openings (loramina) in
the skull
- All are distributed in the head and neck except cranial nerve (CN) X (vagus nerve) –
which supplies structures in the thorax and abdomen

Spinal Nerves

CHAPTER I: INTRODUCTION 47
 - Leave the spinal cord and pass through intervertebral foramina in the vertebral
column
- Named according to the region of the vertebral column with which they are
associated
- Passes through the IVF and immediately divides into a smaller posterior ramus and
larger anterior ramus
Paired anterior and posterior rootlets
- A paired bundle where each spinal nerve originates
- Connected to the spinal cord along the lines of the anterior and posterior gray horns

Anterior and Posterior Root Posterior Root Ganglion

CHAPTER I: INTRODUCTION 48
 - Formed when each bundle of anterior
and posterior rootlets join together
within the vertebral canal
- Each pair merges within an
intervertebral foramen (IVF) and forms
an individual spinal
nerve
- Possessed by each posterior root
- Located at the IVF
Efferent (motor) nerve fibers
- Bundles that comprise the anterior
rootlets and roots
- Carry nerve impulses away from the
CNS
Afferent (sensory) nerve fibers
- Bundles that contains the posterior
rootlets and roots
- Carry impulses to the CNS
- Concerned with conveying information
about touch, pain, temperature, & other
sensations from the periphery

Autonomic Nervous System

- Controls the involuntary activities
- part of the nervous system concerned with the innervation of involuntary structures
such as the heart or cardiac muscle, smooth muscle, and glands throughout the body
- distributed throughout the central and peripheral nervous system
- divided into sympathetic and parasympathetic divisions which often function as
antagonistic systems – opposition to one another

CHAPTER I: INTRODUCTION 49
 Hypothalamus
- of the brain, controls the ANS and integrates the activities of the autonomic and
neuroendocrine systems, thus preserving homeostasis
Sympathetic Division
- Supplies all the parts of the body via a
complex nerve network that can
frustrate beginning students (and many
instructors)
- Prepare body for an emergency
- Accelerates heart rate, causes
constriction of the peripheral blood
vessels, and raises the blood pressure
- brings about a redistribution of the
blood so that it leaves the areas of the
skin and intestine and becomes
available to the brain, heart, and skeletal
muscle
- it inhibits peristalsis of the intestinal
tract and closes the sphincters
CHAPTER I: INTRODUCTION
Parasympathetic Division
- More limited in scope and less
complex in its geography
- Distribution is focused on the head, the
body cavities, and external genitalia
- Conserving & restoring energy
- Slows heart rate, increase peristalsis
of the intestine and glandular activity,
and open the sphincters
*both divisions have afferent and
efferent fibers
50
 BONES
- is a living tissue capable of changing its structure as the result of the stresses to
which it is subjected
- Like other connective tissues, consists of cells, fibers, and matrix
- hard because of the calcification of its extracellular matrix and possesses a degree
of
elasticity because of the presence of organic fibers
- has a protective function; the skull and vertebral column
- houses and protects within its cavities the delicate blood-forming bone marrow
- serves as a lever as seen in the long bones of the limbs, and as an important
storage area for calcium salts

Periosteum

- thick layer of fibrous tissue

- covers all bone surfaces, other than the articulating surfaces
- has an abundant vascular supply
- cells on its deeper surface are osteogenic
- particularly well united to bone at sites where muscles, tendons and ligaments are
attached to bone

Sharpey’s Fibers

CHAPTER I: INTRODUCTION 51
 - extend from the periosteum into the underlying bone
- receives a rich nerve supply
- very sensitive to trauma

Compact bone Cancellous bone Trabeculae

- appears as a solid mass - consists of a - are arranged in such a

branching network of manner as to resist the
trabeculae stresses and strains to
which the bone is
exposed

CLASSIFICATION
- Grouped based on their general shape
- Two main groups: axial & appendicular skeleton

Axial Skeleton

CHAPTER I: INTRODUCTION 52
 - Consists of the elements forming the central axis of the body
Appendicular Skeleton
- Consists of the bones forming the upper and lower limb girdles and extremities

Long Bones Short Bones

- found in the limbs (e.g., the humerus, - found in the hand and foot (e.g., the
femur, metacarpals, metatarsals, and scaphoid, lunate, talus, and calcaneum)
phalanges) - are roughly cuboidal in shape
- length is greater than their breadth - are composed of cancellous bone
- they have a tubular shaft, the - surrounded by a thin layer of compact
diaphysis, and usually an epiphysis at bone.
each end - are covered with periosteum, and the
Epiphyseal cartilage articular surfaces are covered by hyaline
- in growng phase, seperates the cartilage
diphysis from the epiphysis
Metaphysis
- part of the diaphysis that lies adjacent
to the epiphyseal cartilage
Shaft
- has a central marrow cavity containing
bone marrow
- outer part, composed of compact bone
that is covered by periosteum
Ends of the long bones
- composed of cancellous bone
surrounded by a thin layer of compact

CHAPTER I: INTRODUCTION 53
 bone
Hyaline Cartilage
- covers the articular surface of the ends
of the bones

Flat bones Irregular Sesamoid bones

bones
- found in the vault of the skull - are small nodules of
(e.g., the frontal and parietal - include those bone that are found in
bones) not assigned to certain tendons where
- They are composed of thin the previous they rub over bony
inner and outer layers of groups (e.g., the surfaces
compact bone, the tables bones of the - The greater part of a
- The scapulae, although skull, the sesamoid bone is buried
irregular, are included in this vertebrae, and in the tendon, and the
group the pelvic free surface is covered
Diploë bones) with cartilage
- Spongy cancellous bone, - They are Patella
separates the outer and inner composed of a
layers of the skull thin shell of - largest sesamoid
bone
compact bone
with an interior - located in the tendon
made up of of the quadriceps
femoris
cancellous bone

BONE SURFACES MARKINGS

CHAPTER I: INTRODUCTION 54
 - surfaces of bones show various markings or irregularities
- Where bands of fascia, ligaments, tendons, or aponeuroses are attached to bone,
the surface is raised or roughened
- roughenings are not present at birth. They appear at puberty and become
progressively more obvious during adult life.
- The pull of these fibrous structures causes the periosteum to be raised and new
bone to be deposited beneath
- In certain situations, the surface markings are large and are given special names

Bone marrow

- occupies the marrow cavity in long and short bones and the interstices of the
cancellous bone in flat and irregular bones
- At birth, the marrow of all the bones of the body is red and hematopoietic
- This blood-forming activity gradually lessens with age, and the red marrow is
replaced by yellow marrow
- At 7 years of age, yellow marrow begins to appear in the distal bones of the limbs.
- This replacement of marrow gradually moves proximally, so that by the time
- the person becomes an adult, red marrow is restricted to the bones of the skull, the
vertebral column, the thoracic cage,the girdle bones, and the head of the humerus
and femur

BONE DEVELOPMENT
- developed by two processes: membranous and endochondral

Membranous membrane Endochondral Formation

- bone is developed directly from a - a cartilaginous model is first laid down
connective tissue membrane and is later replaced by bone

CHAPTER I: INTRODUCTION 55
 *bones of the vault of the skull are developed rapidly by the membranous method in
the embryo, and this serves to protect the underlying developing brain. At birth, small
areas of membrane persist between the bones. This is important clinically because it
allows the bones a certain amount of mobility, so that the skull can undergo molding
during its descent through the female genital passages
*long bones of the limbs are developed by endochondral ossification, which is a slow
process that is not completed until the 18th to 20th year or even later

Diaphysis

- center of bone formation

found in the shaft of the bone

Epiphyses

- centers at the ends of the

bone

Epiphyseal Plate

- plate of cartilage at each

end, lying between the
epiphysis and diaphysis in a
growing bone
Metaphysis

- is the part of the diaphysis

that abuts onto the
epiphyseal plate

CHAPTER I: INTRODUCTION 56
 CARTILAGE
- is a form of connective tissue in which the cells and fibers are embedded in a gel-
like matrix, the fibers lending firmness and resilience
Perichondrium
- Covers the cartilages, except on the exposed surfaces in joints

THREE TYPES

Hyaline Cartilage Fibrocartilage Elastic Cartilage

- has a high proportion of - has many collagen - possesses large

amorphous matrix that
has the same refractive
index as the fibers
embedded in it
- Throughout childhood
and adolescence, it plays
an important part in the
growth in length of long
bones
fibers embedded in a
small amount of matrix
and is found in the
discs within joints and
on the articular
surfaces of the clavicle
and mandible
- if damaged, repairs
itself slowly in a manner
numbers of elastic fibers
embedded in matrix
- it is flexible and is found
in the auricle of the ear,
the external auditory
meatus, the auditory tube,
and the epiglottis
- if damaged, repairs itself
with fibrous tissue

CHAPTER I: INTRODUCTION 57
 - has a great resistance to
wear and covers the
articular surfaces of
nearly all synovial joints
- incapable of repair when
fractured; the defect is
filled with fibrous tissue
CHAPTER I: INTRODUCTION
similar to fibrous tissue
elsewhere.
- Joint discs have a
poor blood supply and
therefore do not repair
themselves when
damaged
58