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28.3.2013 Thursday
2000-2130 English session
2130-2300 Turkish session
TYPES OF ANATOMY
1) REGIONAL ANATOMY
Topographical anatomy
2) SYSTEMATIC ANATOMY
Skeletal system
Lympathic system
Joints
Nervous system
Muscular System
Cardiovascular System
3) Clinical anatomy
Applied anatomy
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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 axis
Abduction moving away from the median plane except digits
Adduction moving towards the median plane
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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sparse cells surrounded by an extracellular network/matrix
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.
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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.
articulating of bones participating
in a synovial joint capped with
articular cartilage
provides smooth, low-friction, gliding surfaces for
free movement
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Types of cartilage
1. Hyaline
most common, matrix w/ moderate amount of collagen fibers articular surfaces of bones
2. Elastic
large number of elastic fibers external ear
3. Fibrocartilage
limited number of cells & ground substance amidst substantial amount of collagen fibers intervertebral discs
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Bones function as
supportive structures for the body
protectors of vital organs
reservoirs of calcium and phosphorus
levers on which muscles act to produce movement
containers for blood-producing cells
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TYPES OF BONES
according to their shape gross anatomy
1) Long bones
2) Short bones
tubular humerus in the arm
cuboidal
tarsus (ankle) carpus (wrist)
3) Flat bones
4) Irregular bones
protective functions
various shapes other than long,
flat bones of the cranium protect the brain
short, or flat
bones of the face
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5) Sesamoid bones
patella or knee cap
protect 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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Cranial Fossae
Anterior cranial fossa
occupied by the inferior and anterior parts of
the frontal lobes of the brain
shallowest cranial fossa
Middle cranial fossa
butterfly-shaped
central part composed of the sella turcica on the
body of the sphenoid
large, depressed lateral parts on each side
Posterior cranial fossa
largest and deepest cranial fossa
formed mostly by the occipital bone
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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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G. sternon, chest
Has three parts:
1. Manubrium
2. Body
3. Xiphoid process
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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.
vertebral body
vertebral arch
seven processes
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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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HUMERUS
 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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stabilizing bone of the forearm
medial and longer of the two forearm bones.
Its more massive
proximal end is
specialized for
articulation with the
humerus proximally
and the head of the
radius laterally.
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lateral and shorter of the two forearm bones.
Its proximal end includes a short head, neck.
Proximally, the head of the radius is concave
for articulation with the humerus during
flexion and extension of the elbow joint.
The head also articulates with the ulna.
The shaft of the radius, in contrast to that of
the ulna, gradually enlarges as it passes
distally.
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 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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TIBIA (SHINE BONE)
on the anteromedial side of the leg, nearly parallel to the fibula
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.
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FIBULA
posterolateral to the tibia
slender
tibiofibular syndesmosis
no function in weight-bearing
serves mainly for muscle attachment.
distal end enlarges prolonged as lateral malleolus
proximal end an enlarged head superior to a small neck.
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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 FOOT
Tarsus (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
Types of synovial joints
according 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 & extension
knee & elbow joints
Types of synovial joints
3. Saddle joints
biaxial joints- flexion & extension, abduction & adduction
carpometacarpal joint at the base of the 1st digit (thumb)
4. Condyloid (ellipsoid type)
biaxial joints- flexion & extension, abduction & adduction
metacarpophalangeal joints (knuckle joints)
radiocarpal joint (wrist)
Types of synovial joints
5. Ball and socket joints (spheroidal joints)
multiple axes and planes: flexion and extension, abduction and
adduction, medial and lateral rotation, and circumduction
hip & shoulder joints
Types of synovial joints
6. Pivot joints
uniaxial joints- rotation around a central axis
proximal & 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 COLUMN
The vertebral column in an adult typically consists of 33 vertebrae
arranged in five regions: 7 cervical, 12 thoracic, 5 lumbar, 5 sacral, and 4
coccygeal.
Joints of the vertebral bodies symphyses (secondary cartilaginous joints)
Joints of the vertebral arches (facet joints)
Craniovertebral (atlanto-axial and atlanto-occipital) joints
Costovertebral joints
Sacroiliac joints
JOINTS OF THE UPPER LIMB
Sternoclavicular 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) joint
permits 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 Joint
located 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 joint
The 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.
Flexion
Extension
Abduction
Adduction
radial deviation-ulnar deviation
Circumduction
JOINTS OF THE LOWER LIMB
articulations of the pelvic girdle
lumbosacral joints, sacroiliac joints, and pubic symphysis
hip joints
knee joints
tibiofibular joints
ankle joints
foot joints
JOINTS OF THE PELVIS
Pubic 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
Functional
voluntary 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
Shape
Size
Location
Function
Resemblance of one structure to another
according to their shapes
Flat muscles
parallel fibers often with an aponeurosis
Pennate muscles
feather-like (L. pennatus, feather), arrangement of fasicles
Fusiform muscles
spindle shaped with a round, thick belly (or bellies) and tapered ends
Convergent muscles
Quadrate muscles
Circular or sphincteral muscles
Multi-headed or multi-bellied muscles
more than one head of attachment or more than one contractile belly
Biceps muscles
two heads of attachment
triceps muscles
three heads
Two bellies
digastric muscle
gastrocnemius muscle
Skeletal muscles function by contracting
they pull and never push.
When a muscle contracts and shortens
one of its attachments usually remains fixed
the other attachment (more mobile) pulled toward it
movement
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 sternum
One head attaches to clavicle.
Bilateral contractions extension of the elevating the chin
Unilateral contraction laterally flexes the neck
Trapezius muscle
large, flat triangular muscle
Covers the posterior aspect of the neck & superior half of the trunk
A 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.
powerful adduction and
medial rotation of the arm
Posterior shoulder muscles
Superficial extrinsic shoulder muscles
trapezius and latissimus dorsi
Deep extrinsic shoulder muscles
two muscles
Intrinsic shoulder muscles
deltoid, 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 Hand
Of the four major arm muscles:
three flexors (biceps brachii, brachialis, and coracobrachialis)
in the anterior (flexor) compartment
supplied by the musculocutaneous nerve
one 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 Foot
gluteus maximus
largest, heaviest, and most coarsely fibered muscle of the body.
most superficial gluteal muscle
extension and lateral rotation of the thigh
anterior thigh muscles
flexors 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 leg
dorsiflexors of the ankle joint, elevating the forefoot and depressing the heel
lateral 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 compartments
inversion of the foot
superficial group of calf muscles
gastrocnemius, soleus, and
plantaris.
6 abdominal muscles
transverse abdominal
internal obliques
external obliques
rectus abdominis
1.1. REGIONS/T ERMS
Thoracic cavity
cavity between neck and
abdomen
protected by the thoracic wall.
Thoracic wall
bounds the thoracic cavity.
formed by the skin, bones,
fasciae, and muscles.
Thoracic cage
bony portion of the thoracic
wall
thoracic skeleton
1.3. BOUNDARIES OF THE THORAX
Superior
•
•
•
•
•
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 WALL
1) Protects vital thoracic and abdominal organs
2) 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 WALL
1) 12 pairs of ribs and associated costal cartilages
2) 12 thoracic vertebrae and the intervertebral (IV) discs
interposed between them
3) Sternum
4.1. Superior thoracic aperture
“doorway” between the thoracic cavity and the neck and upper limb
bounded:
Posteriorly vertebra T1
Laterally 1st pair of ribs and their costal cartilages
Anteriorly 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 vertebra
Posterolaterally 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 Depression
Diaphragm 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
Skin area supplied by a segment of the spinal cord
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.
T2- Sternal angle
T4- Nipple
T6- Xiphoid process
T8- Costal arch
T10-Umbliculus
T12-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).
75% (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)
central compartment of the thoracic cavity
Thoracic cavity is divided into 3 major spaces
1) mediastinum
2) right pulmonary cavity
3) left pulmonary cavity
Mediastinum extends from
superior thoracic aperture
superiorly
to
diaphragm
inferiorly
from sternum & costal cartilages
anteriorly
to
bodies of thoracic vertebrae
posteriorly