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INTRODUCTION TO ANATOMY
TERMINOLOGY IN ANATOMY
16. September.2011 Friday
INTRODUCTION TO ANATOMY
What is anatomy?
The word “anatomy” is derived from “anatomia, anatome” which has a Latin and Ancient Greek
origin. The prefix “ana-“means “up", where “temnein, tome” means "to cut." As a result, anatomy means
“cutting up, cutting through”.
The term human anatomy comprises a consideration of the various structures which make up the
human organism. In a restricted sense it deals merely with the parts which form the fully developed individual
and which can be rendered evident to the naked eye by various methods of dissection.
Types of anatomy
The three main approaches to studying anatomy are regional, systemic, and clinical (or applied),
reflecting the body's organization and the priorities and purposes for studying it. In systematic anatomy,
various structures may be separately considered—and the organs and tissues may be studied in relation to one
another in topographical or regional anatomy.
Regional Anatomy
Regional anatomy (topographical anatomy) considers the organization of the human body as major
parts or segments: a main body, consisting of the head, neck, and trunk (subdivided into thorax, abdomen,
back, and pelvis/perineum), and paired upper limbs and lower limbs. All the major parts may be further
subdivided into areas and regions. Regional anatomy is the method of studying the body's structure by
focusing attention on a specific part (e.g., the head), area (the face), or region (the orbital or eye region);
examining the arrangement and relationships of the various systemic structures (muscles, nerves, arteries, etc.)
within it; and then usually continuing to study adjacent regions in an ordered sequence.
Surface anatomy is an essential part of the study of regional anatomy. Surface anatomy provides
knowledge of what lies under the skin and what structures are perceptible to touch (palpable) in the living
body at rest and in action. In short, surface anatomy requires a thorough understanding of the anatomy of the
structures beneath the surface..
Systematic Anatomy
Systematic Anatomy.—The various systems of which the human body is composed are grouped under the
following headings:
Osteology—the bony system or skeleton.
Syndesmology—the articulations or joints.
Myology—the muscles. With the description of the muscles it is convenient to include that of the fasciæ
which are so intimately connected with them.
Angiology—the vascular system, comprising the heart, bloodvessels, lymphatic vessels, and lymph glands.
Neurology—the nervous system. The organs of sense may be included in this system.
Splanchnology—the visceral system. Topographically the viscera form two groups, viz., the thoracic viscera
and the abdomino-pelvic viscera. The heart, a thoracic viscus, is best considered with the vascular system. The
rest of the viscera may be grouped according to their functions: (a) the respiratory apparatus; (b) the
digestive apparatus; and (c) the urogenital apparatus. Strictly speaking, the third subgroup should include
only such components of the urogenital apparatus as are included within the abdomino-pelvic cavity, but it is
convenient to study under this heading certain parts which lie in relation to the surface of the body, e. g., the
testes and the external organs of generation.
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Clinical Anatomy
Clinical (applied) anatomy emphasizes aspects of bodily structure and function important in the practice of
medicine, dentistry, and the allied health sciences. It incorporates the regional and systemic approaches to
studying anatomy and stresses clinical application.
History of anatomy & anatomy education in the world
The development of anatomy as a science extends from the earliest examinations of sacrificial victims
to the sophisticated analyses of the body performed by modern scientists. It has been characterized, over time,
by a continually developing understanding of the functions of organs and structures in the body. The field of
Human Anatomy has a prestigious history, and is considered to be the most prominent of the biological
sciences of the 19th and early 20th centuries. Methods have also improved dramatically, advancing from
examination of animals through dissection of cadavers to technologically complex techniques developed in
the 20th century.
Ancient anatomy
Egypt
The study of anatomy begins at least as early as 1600 BCE, the date of the Edwin Smith Surgical
Papyrus. This treatise shows that the heart, its vessels, liver, spleen, kidneys, hypothalamus, uterus and
bladder were recognized, and that the blood vessels were known to emanate from the heart.
Greece
The earliest medical scientist of whose works any great part survives today is Hippocrates, a Greek
physician active in the late 5th and early 4th centuries BCE (460 - 377 BCE). His work demonstrates a basic
understanding of musculoskeletal structure, and the beginnings of understanding of the function of certain
organs, such as the kidneys. Much of his work, however, and much of that of his students and followers later,
relies on speculation rather than empirical observation of the body.
In the 4th century BCE, Aristotle and several contemporaries produced a more empirically founded
system, based animal dissection. The first use of human cadavers for anatomical research occurred later in the
4th century BCE when Herophilos and Erasistratus gained permission to perform live dissections, or
vivisection, on criminals in Alexandria under the auspices of the Ptolemaic dynasty.
Galen
The final major anatomist of ancient times was Galen, active in the 2nd century. He compiled much
of the knowledge obtained by previous writers, and furthered the inquiry into the function of organs by
performing vivisection on animals. Due to a lack of readily available human specimens, discoveries through
animal dissection were broadly applied to human anatomy as well. His collection of drawings, based mostly
on dog anatomy, became the anatomy textbook for 1500 years.
Early modern anatomy
The works of Galen and Avicenna, especially The Canon of Medicine which incorporated the
teachings of both, were translated into Latin, and the Canon remained the most authoritative text on anatomy
in European medical education until the 16th century. The first major development in anatomy in Christian
Europe, since the fall of Rome, occurred at Bologna in the 14th to 16th centuries, where a series of authors
dissected cadavers and contributed to the accurate description of organs and the identification of their
functions. A succession of researchers proceeded to refine the body of anatomical knowledge, giving their
names to a number of anatomical structures along the way.
17th and 18th centuries
The study of anatomy flourished in the 17th and 18th centuries. The advent of the printing press
facilitated the exchange of ideas. Because the study of anatomy concerned observation and drawings, the
popularity of the anatomist was equal to the quality of his drawing talents, and one need not be an expert in
Latin to take part. Many famous artists studied anatomy, attended dissections, and published drawings for
money, from Michelangelo to Rembrandt. For the first time, prominent universities could teach something
about anatomy through drawings, rather than relying on knowledge of Latin.
19th century anatomy
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During the 19th century, anatomists anatomists largely finalized and systematized the descriptive
human anatomy of the previous century. The discipline also progressed to establish growing sources of
knowledge in histology and developmental biology, not only of humans but also of animals. Extensive
research was conducted in more areas of anatomy.
History of anatomy education in Turkey
Anatomy education commenced as a distinct course at “Tıbhane-i Cerrahhane-i Amire”, the first medical
school founded by Sultan Mahmut II in March 14th, 1827. It is possible to explain anatomy education in three
periods:
1. Pre-dissection period (1827-1841):
In this period, anatomy education was given theoretically. Anatomy contitutions except bones were
being displayed on charts and models which were brought from Europe.
2. Unmedicated cadaver period (1841-1908):
Anatomy experts were appointed from abroad in this period. First one was Dr. Charles Ambroise Bernard
from Vienna (1808-1844).
After Sultan Abdülmecid has signed the imperical decree allowing dissections with the purpose of education;
practical applications on cadavers began initially. Corpses of slaves and captives were used as cadavers for
dissection. These corpses had no relations and dissections were made until they began to decay. For this
reason, large scale of anatomy education was still given theoretically.
3. Medicated cadaver period (1908-present):
In anatomy education by using the method of giving chemical substance through vein, cadavers began
to be used initally without decaying in this period. As a result, scale of practice in anatomy education
increased considerably.
In this period anatomy education gained new dimensions.Some students were sent to the European
countries. These students had the opportunity of studying with the famous anatomists of the time. They not
only returned to their homeland with the anatomy knowledge but with investigation and education methods as
well. Mazhar Pasha, Prof. Dr. Nurettin Ali Berkol, and Prof. Dr. Zeki Zeren can be considered as the founders
of modern anatomy in Turkey. After 1945, the anatomy education demonstrated a rapid development
considerably. Today, tens of anatomy departments continue their activities.
Ulucam E, Gokce N, Mesut R. Turkish Anatomy Education From the Foundation of The First Modern School
to Today. Journal of the International Society for the History of Islamic Medicine (ISHIM), 2003,2
The full article @ http://www.ishim.net/ishimj/4/09.pdf
Anatomical Position
All anatomical descriptions are expressed in relation to one consistent position, ensuring that descriptions are
not ambiguous. One must visualize this position in the mind when describing patients (or cadavers), whether
they are lying on their sides, supine (recumbent, lying on the back, face upward), or prone (lying on the
abdomen, face downward).
The anatomical position refers to the body position as if the person were standing upright with the:
 head, gaze (eyes), and toes directed anteriorly (forward),
 arms adjacent to the sides with the palms facing anteriorly, and
 lower limbs close together with the feet parallel.
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http://www.tpub.com/content/armymedical/MD0956/MD09560009.htm
Anatomical Planes
Anatomical descriptions are based on four imaginary planes (median, sagittal, frontal, and
transverse) that intersect the body in the anatomical position:
The median plane, the vertical plane passing longitudinally through the body, divides the body into right and
left halves. The plane defines the midline of the head, neck, and trunk where it intersects the surface of the
body. Midline is often erroneously used as a synonym for the median plane.
Sagittal planes are vertical planes passing through the body parallel to the median plane.
Frontal (coronal) planes are vertical planes passing through the body at right angles to the median plane,
dividing the body into anterior (front) and posterior (back) parts.
Transverse planes are horizontal planes passing through the body at right angles to the median and frontal
planes, dividing the body into superior (upper) and inferior (lower) parts. Radiologists refer to transverse
planes as transaxial, which is commonly shortened to axial planes.
Since the number of sagittal, frontal, and transverse planes is unlimited, a reference point (usually a
visible or palpable landmark or vertebral level) is necessary to identify the location or level of the plane, such
as a “transverse plane through the umbilicus”. Sections of the head, neck, and trunk in precise frontal and
transverse planes are symmetrical, passing through both the right and left members of paired structures,
allowing some comparison.
The main use of anatomical planes is to describe sections:
 Longitudinal sections run lengthwise or parallel to the long axis of the body or of any of its parts, and
the term applies regardless of the position of the body. Although median, sagittal, and frontal planes
are the standard (most commonly used) longitudinal sections, there is a 180° range of possible
longitudinal sections.
 Transverse sections, or cross sections, are slices of the body or its parts that are cut at right angles to
the longitudinal axis of the body or of any of its parts. Because the long axis of the foot runs
horizontally, a transverse section of the foot lies in the frontal plane.
 Oblique sections are slices of the body or any of its parts that are not cut along the previously listed
anatomical planes. In practice, many radiographic images and anatomical sections do not lie precisely
in sagittal, frontal, or transverse planes; often they are slightly oblique.
Anatomical Variations
Anatomy books describe (initially, at least) the structure of the body as it is usually observed in
people—that is, the most common pattern. However, occasionally a particular structure demonstrates so much
variation within the normal range that the most common pattern is found less than half the time!
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Turkish Society of Anatomy and Clinical Anatomy (TSACA)
Website: http://anatomidernegi.org
TERMINOLOGY IN ANATOMY
It is important for medical personnel to have a sound knowledge and understanding of the basic
anatomic terms. With the aid of a medical dictionary, you will find that understanding anatomic terminology
greatly assists you in the learning process.
Various adjectives, arranged as pairs of opposites, describe the relationship of parts of the body or
compare the position of two structures relative to each other. Anatomical directional terms are based on the
body in the anatomical position. Four anatomical planes divide the body, and sections divide the planes into
visually useful and descriptive parts.
Anatomical terms are specific for comparisons made in the anatomical position, or with reference to
the anatomical planes:
 Superior refers to a structure that is nearer the vertex, the topmost point of the cranium (Mediev. L.,
skull).
 Cranial relates to the cranium and is a useful directional term, meaning toward the head or cranium.
 Inferior refers to a structure that is situated nearer the sole of the foot.
 Caudal (L. cauda, tail) is a useful directional term that means toward the feet or tail region, represented in
humans by the coccyx (tail bone), the small bone at the inferior (caudal) end of the vertebral column.
 Posterior (dorsal) denotes the back surface of the body or nearer to the back.
Anterior (ventral) denotes the front surface of the body.
 Medial is used to indicate that a structure is nearer to the median plane of the body. For example, the 5th
digit of the hand (little finger) is medial to the other digits.
 Conversely, lateral stipulates that a structure is farther away from the median plane. The 1st digit of the
hand (thumb) is lateral to the other digits.
Other terms of relationship and comparisons are independent of the anatomical position or the
anatomical planes, relating primarily to the body's surface or its central core:
 Superficial, intermediate, and deep (Lat. Profundus, profunda) describe the position of structures
relative to the surface of the body or the relationship of one structure to another underlying or overlying
structure.
 External means outside of or farther from the center of an organ or cavity, while internal means inside or
closer to the center, independent of direction.
 Proximal and distal are used when contrasting positions nearer to or farther from the attachment of a
limb or the central aspect of a linear structure (origin in general), respectively. For example, the arm is
proximal to the forearm and the hand is distal to the forearm.
Terms of Laterality
Paired structures having right and left members (e.g., the kidneys) are bilateral, whereas those
occurring on one side only (e.g., the spleen) are unilateral. Something occurring on the same side of the body
as another structure is ipsilateral; the right thumb and right great (big) toe are ipsilateral, for example.
Contralateral means occurring on the opposite side of the body relative to another structure; the right hand is
contralateral to the left hand.
Terms of Movement
Various terms describe movements of the limbs and other parts of the body. Most movements are
defined in relationship to the anatomical position, with movements occurring within, and around axes aligned
with, specific anatomical planes. While most movements occur at joints where two or more bones or
cartilages articulate with one another, several non-skeletal structures exhibit movement (e.g., tongue, lips,
eyelids). Terms of movement may also be considered in pairs of oppositing movements:
Flexion and extension movements generally occur in sagittal planes around a transverse axis.
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 Flexion indicates bending or decreasing the angle between the bones or parts of the body. For most joints
(e.g., elbow), flexion involves movement in an anterior direction, but it is occasionally posterior, as in the case
of the knee joint. Lateral flexion is a movement of the trunk in the coronal plane.
 Extension indicates straightening or increasing the angle between the bones or parts of the body.
Extension usually occurs in a posterior direction. The knee joint, rotated 180° to other joints, is exceptional in
that flexion of the knee involves posterior movement and extension involves anterior movement.
Positions of the body
The supine position of the body is lying on the back. The prone position is lying face downward.
Cavities in the body
Diaphragm: divides body cavity into thoracic and abdominopelvic cavities.
Mediastinum: contains all structures of the thoracic cavity except the lungs
Ventral Body Cavity Membranes
• Parietal serosa lines internal body walls
• Visceral serosa covers the internal organs
• Serous fluid separates the serosae
Serous Membranes
• Cover the organs of trunk cavities & line the cavity
• Fist represents an organ
• Inner balloon wall represents visceral serous membrane
• Outer balloon wall represents parietal serous membrane
• Cavity between two membranes filled with lubricating serous fluid that is produced by the membranes
• Inflammation of the serous membranes
Serous Membranes: Named for Their Specific Cavities and Organs
 Pericardium refers to heart.
 Pleura refers to lungs and thoracic cavity.
 Peritoneum refers to abdominopelvic cavity.
Other Body Cavities
 Oral and digestive – mouth and cavities of the digestive organs
 Nasal –located within and posterior to the nose
 Orbital – house the eyes
 Middle ear – contain bones (ossicles) that transmit sound vibrations
 Synovial – joint cavities
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OSTEOLOGY
23. September.2011 Friday
Osteology (Gk, osteon, bone, logos, science) is the branch of medicine concerned with the
development and diseases of bone tissue. The human skeleton is composed of 206 bones in adults.
The skeletal system may be divided into two functional parts:
 The axial skeleton consists of the bones of the head (cranium or skull), neck (hyoid bone and cervical
vertebrae), and trunk (ribs, sternum, vertebrae, and sacrum).
 The appendicular skeleton consists of the bones of the limbs, including those forming the pectoral
(shoulder) and pelvic girdles.
Bone is one of the hardest structures of the animal body, because of the calcification of its extracellular
matrix. Living bones have some elasticity (results from the organic matter) and great rigidity (results from
their lamellous structures and tubes of inorganic calcium phosphate). Its color, in a fresh state, is pinkishwhite externally, and deep red within.
Cartilage and Bones
The skeleton is composed of cartilages and bones. Cartilage is a resilient, semirigid form of connective
tissue that forms parts of the skeleton where more flexibility is required—for example, where the costal
cartilages attach the ribs to the sternum. Also, the articulating surfaces (bearing surfaces) of bones
participating in a synovial joint are capped with articular cartilage that provides smooth, low-friction, gliding
surfaces for free movement. Blood vessels do not enter cartilage (i.e., it is avascular); consequently, its cells
obtain oxygen and nutrients by diffusion. The proportion of bone and cartilage in the skeleton changes as the
body grows; the younger a person is, the more cartilage he or she has. The bones of a newborn are soft and
flexible because they are mostly composed of cartilage.
Bone has a protective function; the skull and vertebral column, for example, protect the brain and
spinal cord from injury; the sternum and ribs protect the thoracic and upper abdominal viscera. It serves as a
lever, as seen in the long bones of the limbs, and as an important storage area for calcium salts. It houses and
protects within its cavities the delicate blood-forming bone marrow.
Bones are classified according to their shape (gross anatomy):
1) Long bones are tubular (e.g., the humerus in the arm).
2) Short bones are cuboidal and are found only in the tarsus (ankle) and carpus (wrist).
3) Flat bones usually serve protective functions (e.g., the flat bones of the cranium protect the brain).
4) Irregular bones have various shapes other than long, short, or flat (e.g., bones of the face).
5) Sesamoid bones (e.g., the patella or knee cap) develop in certain tendons and are found where tendons
cross the ends of long bones in the limbs; they protect the tendons from excessive wear and often change the
angle of the tendons as they pass to their attachments.
There are two types of bones according to histological features: compact bone and spongy (trabecular) bone.
They are distinguished by the relative amount of solid matter and by the number and size of the spaces they
contain All bones have a superficial thin layer of compact bone around a central mass of spongy bone, except
where the latter is replaced by a medullary (marrow) cavity. Spongy bone is found at the expanded heads of
long bones and fills most irregular bones. Compact bone forms the outer shell of all bones and also the shafts
in long bones.
Bone Markings and Formations
Bone markings appear wherever tendons, ligaments, and fascias are attached or where arteries lie adjacent
to or enter bones. Other formations occur in relation to the passage of a tendon (often to direct the tendon or
improve its leverage) or to control the type of movement occurring at a joint. Surfaces of the bones are not
smooth. Bones display elevations, depressions and holes. The surface features on the bones are given names to
distinguish and define them.
Vasculature and Innervation of Bones
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Bones are richly supplied with blood vessels. Veins accompany arteries. Nerves accompany blood
vessels supplying bones.
SKULL BONES
The skull is supported on the summit of the vertebral column, and is of an oval shape, wider behind
than in front. It is composed of a series of flattened or irregular bones which, with one exception (the
mandible), are immovably jointed together. It is divisible into two parts: (1) the cranium, which lodges and
protects the brain, consists of eight bones, and (2) the skeleton of the face, of fourteen, as follows:
Occipital.
Two Parietals.
Frontal.
Cranium, 8 bones
Two Temporals.
Sphenoidal.
Ethmoidal.
Two Nasals.
Two Maxillæ.
Two Lacrimals.
Two Zygomatics.
Face, 14 bones
Two Palatines.
Two Inferior Nasal Conchæ.
Vomer.
Mandible.
Ossa Cranii
The Occipital bone: situated at the back and lower part of the cranium, is trapezoid in shape and
curved on itself. It is pierced by a large oval aperture, the foramen magnum, through which the cranial cavity
communicates with the vertebral canal. The curved, expanded plate behind the foramen magnum is named
the squama; the thick, somewhat quadrilateral piece in front of the foramen is called the basilar part, whilst
on either side of the foramen is the lateral portion.
Some prominent features of the occipital bone:
External occipital protuberance: between the summit of the bone and the foramen magnum
Nuchal lines: Lateral to the external occipital protuberance
Cruciate eminence: Divides the interior surface of the occipital bone into four fossae.
Internal occipital protuberance: At the point of intersection of the four divisions of the cruciate eminence
Internal occipital crest: The lower division of the cruciate eminence
The Parietal Bones: form, by their union, the sides and roof of the cranium. Each bone is irregularly
quadrilateral in form. The external surface is convex, smooth, and marked near the center by an eminence, the
parietal eminence (tuber parietale). Crossing the middle of the bone in an arched direction are two curved
lines, the superior and inferior temporal lines.
The Frontal Bone: resembles a cockle-shell in form, and consists of two portions—a vertical portion,
the squama, corresponding with the region of the forehead; and an orbital or horizontal portion, which
enters into the formation of the roofs of the orbital and nasal cavities.
Some prominent features of the frontal bone:
Nasal process: The downward projection of the nasal part of the frontal bone which terminates as the nasal
spine.
Frontal crest: The internal surface of the squama frontalis of the frontal bone is concave and presents in the
upper part of the middle line a vertical groove, the sagittal sulcus, the edges of which unite below to form a
ridge, the frontal crest.
Zygomatic process: is the part of the zygomatic process consisting of the frontal bone.
Skull, 22 bones
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Foramen cecum: The frontal crest of the frontal bone ends below in a small notch which is converted into a
foramen, the foramen cecum (or foramen caecum), by articulation with the ethmoid.
The Temporal Bones: are situated at the sides and base of the skull. Each consists of five parts, viz.,
the squama, the petrous, mastoid, and tympanic parts, and the styloid process.
Some prominent features of the temporal bone:
Zygomatic process: projects from the lower part of the squama as a long, arched process.
The Sphenoid Bone: is situated at the base of the skull in front of the temporals and basilar part of the
occipital. It somewhat resembles a bat with its wings extended, and is divided into a median portion or body,
two great and two small wings extending outward from the sides of the body, and two pterygoid processes
which project from it below.
Some prominent features of the sphenoid bone:
Tuberculum sellæ: behind the chiasmatic groove is an elevation, the tuberculum sellae; and still more
posteriorly, a deep depression, the sella turcica, the deepest part of which lodges the hypophysis cerebri and is
known as the fossa hypophyseos (or fossa hypophysialis).
Clivus: (Latin for "slope") is a part of the cranium, a shallow depression behind the dorsum sellæ that slopes
obliquely backward.
The Ethmoid bone: is exceedingly light and spongy, and cubical in shape; it is situated at the anterior
part of the base of the cranium, between the two orbits, at the roof of the nose, and contributes to each of these
cavities. It consists of four parts: a horizontal or cribriform plate, forming part of the base of the cranium; a
perpendicular plate, constituting part of the nasal septum; and two lateral masses or labyrinths.
Cranial Fossas
The inferior and anterior parts of the frontal lobes of the brain occupy the anterior cranial fossa, the
shallowest of the three cranial fossae. The fossa is formed by the frontal bone anteriorly, the ethmoid bone in
the middle, and the body and lesser wings of the sphenoid posteriorly. The butterfly-shaped middle cranial
fossa has a central part composed of the sella turcica on the body of the sphenoid and large, depressed lateral
parts on each side. The posterior cranial fossa, the largest and deepest of the three cranial fossae, lodges the
cerebellum, pons, and medulla oblongata. The posterior cranial fossa is formed mostly by the occipital bone.
The Facial Bones
1. The Nasal Bones: are two small oblong bones, varying in size and form in different individuals;
they are placed side by side at the middle and upper part of the face, and form, by their junction, “the bridge”
of the nose. Each has two surfaces and four borders.
2. The Maxillæ (Upper Jaw): are the largest bones of the face, excepting the mandible, and form, by
their union, the whole of the upper jaw. Each assists in forming the boundaries of three cavities, viz., the roof
of the mouth, the floor and lateral wall of the nose and the floor of the orbit; it also enters into the formation of
two fossæ, the infratemporal and pterygopalatine, and two fissures, the inferior orbital and pterygomaxillary.
Each bone consists of a body and four processes—zygomatic, frontal, alveolar, and palatine.
3. The Lacrimal Bone: the smallest and most fragile bone of the face, is situated at the front part of
the medial wall of the orbit.
4. The Zygomatic Bone (Malar Bone): is small and quadrangular, and is situated at the upper and
lateral part of the face: it forms the prominence of the cheek, part of the lateral wall and floor of the orbit, and
parts of the temporal and infratemporal fossæ. I
5. The Palatine Bone: is situated at the back part of the nasal cavity between the maxilla and the
pterygoid process of the sphenoid. It contributes to the walls of three cavities: the floor and lateral wall of the
nasal cavity, the roof of the mouth, and the floor of the orbit.
6. The Inferior Nasal Concha (Concha Nasalis Inferior; Inferior Turbinated Bone): extends
horizontally along the lateral wall of the nasal cavity.
7. The Vomer: is situated in the median plane, but its anterior portion is frequently bent to one or
other side. It is thin, somewhat quadrilateral in shape, and forms the hinder and lower part of the nasal septum.
8. The Mandible (Lower Jaw): the largest and strongest bone of the face, serves for the reception of
the lower teeth. It consists of a curved, horizontal portion, the body, and two perpendicular portions, the rami,
which unite with the ends of the body nearly at right angles.
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9. The Hyoid Bone: is shaped like a horseshoe, and is suspended from the tips of the styloid processes
of the temporal bones by the stylohyoid ligaments.
VERTEBRAL COLUMN, RIBS AND THE STERNUM
Ribs
Ribs (L. costae) are curved, flat bones that form most of the thoracic cage. There are three types of ribs:
 True (vertebrocostal) ribs (1st-7th ribs): They attach directly to the sternum through their own costal
cartilages.
 False (vertebrochondral) ribs (8th, 9th, and usually 10th ribs): Their cartilages are connected to the
cartilage of the rib above them; thus their connection with the sternum is indirect.
 Floating (vertebral, free) ribs (11th, 12th, and sometimes 10th ribs): The rudimentary cartilages of
these ribs do not connect even indirectly with the sternum; instead they end in the posterior abdominal
musculature.
Typical ribs (3rd-9th) have the following components:
 Head
 Neck
 Tubercle
 Body (shaft)
Costal cartilages prolong the ribs anteriorly and contribute to the elasticity of the thoracic wall, providing
a flexible attachment for their anterior ends. The first 7 costal cartilages attach directly and independently to
the sternum; the 8th, 9th, and 10th articulate with the costal cartilages just superior to them, forming a
continuous, articulated, cartilaginous costal margin. The 11th and 12th costal cartilages form caps on the
anterior ends of the corresponding ribs and do not reach or attach to any other bone or cartilage.
Intercostal spaces separate the ribs and their costal cartilages from one another. The spaces are named
according to the rib forming the superior border of the space—for example, the 4th intercostal space lies
between ribs 4 and 5. There are 11 intercostal spaces and 11 intercostal nerves. Intercostal spaces are occupied
by intercostal muscles and membranes, and two sets (main and collateral) of intercostal blood vessels and
nerves, identified by the same number assigned to the space.
Sternum
The sternum (G. sternon, chest) is the long, flat bone that forms the middle of the anterior part of the
thoracic cage. It directly overlies and affords protection for mediastinal viscera in general and much of the
heart in particular. The sternum is commonly known as the breastbone and is divided into three areas, the
upper manubrium, the body, and the xiphoid process.
Manubrium: The manubrium (L. handle, as in the handle of a sword, with the sternal body forming the
blade) is a roughly trapezoidal bone. The manubrium is the widest and thickest of the three parts of the
sternum. The easily palpated concave center of the superior border of the manubrium is the jugular notch
(suprasternal notch). The other anatomical feature at that part of the sternum; the clavicular notches form
the sternoclavicular joints on both sides.
Body of the sternum: The body of the sternum is longer, narrower, and thinner than the manubrium. Xiphoid
process: (from xiphias “swordfish”) the smallest and most variable part of the sternum, is thin and elongated.
Verterbral column
The vertebral column in an adult typically consists of 33 vertebrae arranged in five regions: 7 cervical,
12 thoracic, 5 lumbar, 5 sacral, and 4 coccygeal. The vertebrae gradually become larger as the vertebral
column descends to the sacrum and then become progressively smaller toward the apex of the coccyx. The
change in size is related to the fact that successive vertebrae bear increasing amounts of the body's weight as
the column descends. The vertebrae reach maximum size immediately superior to the sacrum, which transfers
the weight to the pelvic girdle at the sacroiliac joints.
The vertebral column is flexible because it consists of many relatively small bones, called vertebrae (singular
= vertebra), that are separated by resilient intervertebral (IV) discs.
Vertebrae vary in size and other characteristics from one region of the vertebral column to another, and to a
lesser degree within each region; however, their basic structure is the same.
A typical vertebra consists of a vertebral body, a vertebral arch, and seven processes.
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The vertebral body is the more massive, roughly cylindrical, anterior part of the bone that gives strength to
the vertebral column and supports body weight. The size of the vertebral bodies increases as the column
descends as each bears progressively greater body weight.
The vertebral arch is posterior to the vertebral body and consists of two (right and left) pedicles and laminae.
The pedicles are short, stout cylindrical processes that project posteriorly from the vertebral body. The
vertebral arch and the posterior surface of the vertebral body form the walls of the vertebral foramen. The
succession of vertebral foramina in the articulated vertebral column forms the vertebral canal (spinal canal),
which contains the spinal cord and the roots of the spinal nerves that emerge from it.. Seven processes arise
from the vertebral arch of a typical vertebra:
 One median spinous process projects posteriorly from the vertebral arch at the junction of the
laminae.
 Two transverse processes project posterolaterally from the junctions of the pedicles and laminae.
 Four articular processes—two superior and two inferior—also arise from the junctions of the
pedicles and laminae, each bearing an articular surface (facet).
The spinous and transverse processes provide attachment for deep back muscles and serve as levers,
facilitating the muscles that fix or change the position of the vertebrae.
BONES OF THE UPPER LIMB & THE SHOULDER
Clavicle (Tr. Köprücük kemiği)
The clavicle (collar bone) connects the upper limb to the trunk. The shaft of the clavicle has a double curve in
a horizontal plane. Its medial half is convex anteriorly, and its sternal end is enlarged and triangular where it
articulates with the manubrium of the sternum at the sternoclavicular (SC) joint. Its lateral half is concave
anteriorly, and its acromial end is flat where it articulates with the acromion of the scapula at the
acromioclavicular (AC) joint. These curvatures increase the resilience of the clavicle and give it the
appearance of an elongated capital S.
The clavicle:
 increases the range of motion of the limb.
 affords protection to the neurovascular bundle supplying the upper limb.
 transmits shocks (traumatic impacts) from the upper limb to the axial skeleton.
Some prominent features of the superior and inferior surfaces of the clavicle:
Sternal end
Acromial end
Scapula (Tr. Kürek kemiği)
The scapula (shoulder blade) is a triangular flat bone that lies on the posterolateral aspect of the
thorax. The convex posterior surface of the scapula is unevenly divided by a thick projecting ridge of bone,
the spine of the scapula, into a small supraspinous fossa and a much larger infraspinous fossa. The concave
costal surface of most of the scapula forms a large subscapular fossa. The broad bony surfaces of the three
fossae provide attachments for fleshy muscles. The spine continues laterally as the flat expanded acromion
(G. akros, point), which forms the subcutaneous point of the shoulder and articulates with the acromial end of
the clavicle. Superolaterally, the lateral surface of the scapula has a glenoid cavity (G. socket), which receives
and articulates with the head of the humerus at the glenohumeral joint. The glenoid cavity is a shallow,
concave, oval fossa (L. fossa ovalis), directed anterolaterally and slightly superiorly—that is considerably
smaller than the ball (head of the humerus) for which it serves as a socket. The beak-like coracoid process
(G. korakōdés, like a crow's beak) is superior to the glenoid cavity. The scapula has medial, lateral, and
superior borders and superior, lateral, and inferior angles. The glenoid cavity is the primary feature of the
head. The shallow constriction between the head and the body defines the neck of the scapula. The superior
border of the scapula is marked by the suprascapular notch, which is located where the superior border joins
the base of the coracoid process.
Humerus
The humerus (arm bone), the largest bone in the upper limb, articulates with the scapula at the
glenohumeral joint and the radius and ulna at the elbow joint. The proximal end of the humerus has a head,
surgical and anatomical necks, and greater and lesser tubercles. The spherical head of the humerus
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articulates with the glenoid cavity of the scapula. The surgical neck of the humerus, a common site of fracture,
is the narrow part distal to the head and tubercles.
The shaft of the humerus has two prominent features: the deltoid tuberosity laterally, and the oblique
radial groove posteriorly. The inferior end of the humeral shaft widens as the sharp medial and lateral
supraepicondylar (supracondylar) ridges form and then end distally in the especially prominent medial
epicondyle and the lateral epicondyle, providing for muscle attachment. The distal end of the humerus—
including the trochlea; the capitulum; and the olecranon, coronoid, and radial fossae—makes up the condyle
of the humerus.
Bones of Forearm
The two forearm bones serve together to form the second unit of an articulated mobile strut (the first
unit being the humerus), with a mobile base formed by the shoulder, that positions the hand.
The ulna is the stabilizing bone of the forearm and is the medial and longer of the two forearm bones.
Its more massive proximal end is specialized for articulation with the humerus proximally and the head of the
radius laterally. For articulation with the humerus, the ulna has two prominent projections: (1) the olecranon,
which projects proximally from its posterior aspect (forming the point of the elbow) and serves as a short
lever for extension of the elbow, and (2) the coronoid process, which projects anteriorly.
The radius is the lateral and shorter of the two forearm bones. Its proximal end includes a short head,
neck, and medially directed tuberosity. Proximally, the smooth superior aspect of the discoid head of the
radius is concave for articulation with the capitulum of the humerus during flexion and extension of the elbow
joint. The head also articulates peripherally with the radial notch of the ulna; thus the head is covered with
articular cartilage. The neck of the radius is a constriction distal to the head. The shaft of the radius, in
contrast to that of the ulna, gradually enlarges as it passes distally. The distal end of the radius is essentially
four sided when sectioned transversely. Its medial aspect forms a concavity, the ulnar notch which
accommodates the head of the ulna. Its lateral aspect becomes increasingly ridge-like, terminating distally in
the radial styloid process.
Bones of the hand
The wrist, or carpus, is composed of eight carpal bones (carpals) arranged in proximal and distal rows
of four:
The proximal surfaces of the distal row of carpals articulate with the proximal row of carpals, and their distal
surfaces articulate with the metacarpals.
The metacarpus forms the skeleton of the palm of the hand between the carpus and the phalanges. It is
composed of five metacarpal bones (metacarpals). Each metacarpal consists of a base, shaft, and head. The
proximal bases of the metacarpals articulate with the carpal bones, and the distal heads of the metacarpals
articulate with the proximal phalanges and form the knuckles.
Each digit has three phalanges except for the first (the thumb), which has only two. Each phalanx has a base
proximally, a shaft (body) and a head distally.
BONES OF THE LOWER LIMB & THE PELVIC GRIDLE
The skeleton of the lower limb (inferior appendicular skeleton) may be divided into two functional
components: the pelvic girdle and the bones of the free lower limb. The pelvic girdle is a ring of bones that
connects the vertebral column to the two femurs. The primary functions of the pelvic girdle are bearing and
transfer of weight; secondary functions include protection and support of abdominopelvic viscera and housing
and attachment for structures of the genital and urinary systems.
In the mature individual, the pelvic girdle is formed by three bones:
 Right and left hip bones (coxal bones; pelvic bones): large, irregularly shaped bones, each of which
develops from the fusion of three bones, the ilium, ischium, and pubis.
 Sacrum: formed by the fusion of five, originally separate, sacral vertebrae.
Male and female pelves are distinct. The characteristic features of the normal (gynecoid) female pelvis reflect
the fact that the fetus must traverse the pelvic canal during childbirth. Because atypical female pelves may not
be conducive to a vaginal birth, determination of the pelvic diameters is of clinical importance.
Hip Bone
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The mature hip bone (L. os coxae) is the large, flat pelvic bone formed by the fusion of three primary
bones—ilium, ischium, and pubis.
The ilium is the superior, fan-shaped part of the hip bone. The ala, or wing, of the ilium represents the
spread of the fan, and the body of the ilium, the handle of the fan. On its external aspect, the body participates
in formation of the acetabulum. The iliac crest, the rim of the fan, has a curve that follows the contour of the
ala between the anterior and the posterior superior iliac spines. The anteromedial concave surface of the ala
forms the iliac fossa.
The ischium has a body and ramus (L. branch). The body of the ischium helps form the acetabulum
and the ramus of the ischium forms part of the obturator foramen. The large posteroinferior protuberance of
the ischium is the ischial tuberosity. The small pointed posteromedial projection near the junction of the ramus
and body is the ischial spine.
The pubis is an angulated bone with a superior ramus, which helps form the acetabulum, and an
inferior ramus, which helps form the obturator foramen. A thickening on the anterior part of the body of the
pubis is the pubic crest, which ends laterally as a prominent swelling, the pubic tubercle.
The acetabulum (L., shallow vinegar cup) is the large cupshaped cavity or socket on the lateral aspect of the
hip bone that articulates with the head of the femur to form the hip joint. All three primary bones forming the
hip bone contribute to the formation of the acetabulum.
Sacrum
The wedged-shaped sacrum (L. sacred) is usually composed of five fused sacral vertebrae in adults. It
is located between the hip bones and forms the roof and posterosuperior wall of the posterior half of the pelvic
cavity. The sacral canal is the continuation of the vertebral canal in the sacrum. On the pelvic and posterior
surfaces of the sacrum between its vertebral components are typically four pairs of sacral foramina for the exit
of the posterior and anterior rami of the spinal nerves. Its superior articular processes articulate with the
inferior articular processes of the L5 vertebra. The anterior its tapering inferior end, projecting edge of the
body of the S1 vertebra is the sacral promontory (L. mountain ridge). The apex of the sacrum has an oval facet
for articulation with the coccyx.
Coccyx
The coccyx (tail bone) is a small triangular bone that is usually formed by fusion of the four
rudimentary coccygeal vertebrae. The coccyx is the remnant of the skeleton of the embryonic tail-like caudal
eminence. The coccyx does not participate with the other vertebrae in support of the body weight when
standing; however, when sitting it may flex anteriorly somewhat, indicating that it is receiving some weight.
The coccyx provides attachments for muscles.
Femur
The femur is the longest and heaviest bone in the body. It transmits body weight from the hip bone to
the tibia when a person is standing. The femur consists of a shaft (body) and two ends, superior or proximal
and inferior or distal. The superior (proximal) end of the femur consists of a head, neck, and two trochanters
(greater and lesser). The neck of the femur is trapezoidal, with its narrow end supporting the head and its
broader base being continuous with the shaft. The greater trochanter is a large, laterally placed bony mass that
projects superiorly and posteriorly where the neck joins the femoral shaft. The medial and lateral femoral
condyles make up nearly the entire inferior (distal) end of the femur.
Bones of the Leg
The tibia and fibula are the bones of the leg. The tibia articulates with the condyles of the femur
superiorly and the talus inferiorly and in so doing transmits the body's weight. The fibula mainly functions as
an attachment for muscles, but it is also important for the stability of the ankle joint.
Tibia
Located on the anteromedial side of the leg, nearly parallel to the fibula, the tibia (shin bone) is the
second largest bone in the body. It flares outward at both ends to provide an increased area for articulation and
weight transfer. The superior (proximal) end widens to form medial and lateral condyles that overhang the
shaft medially, laterally, and posteriorly, forming a relatively flat superior articular surface, or tibial plateau.
This plateau consists of two smooth articular surfaces that articulate with the large condyles of the femur. The
tubercles fit into the intercondylar fossa between the femoral condyles.
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The anterior border of the tibia is the most prominent border. It and the adjacent medial surface are
subcutaneous throughout their lengths and are commonly known as the “shin”; their periosteal covering and
overlying skin are vulnerable to bruising. At the superior end of the anterior border, a broad, tibial tuberosity
provides distal attachment for the patellar ligament, which stretches between the inferior margin of the patella
and the tibial tuberosity.
The inferior surface of the shaft and the lateral surface of the medial malleolus articulate with the talus.
The interosseous border of the tibia is sharp where it gives attachment to the interosseous membrane that
unites the two leg bones. Inferiorly, the sharp border is replaced by a groove, the fibular notch that
accommodates and provides fibrous attachment to the distal end of the fibula.
Fibula
The slender fibula lies posterolateral to the tibia and is firmly attached to it by the tibiofibular
syndesmosis, which includes the interosseous membrane. The fibula has no function in weight-bearing. It
serves mainly for muscle attachment. The fibers of the tibiofibular syndesmosis are arranged to resist the
resulting net downward pull on the fibula. The distal end enlarges and is prolonged as the lateral malleolus.
The malleoli form the outer walls of a rectangular socket (mortise), which is the superior component of the
ankle joint, and provide attachment for the ligaments that stabilize the joint. The proximal end of the fibula
consists of an enlarged head superior to a small neck. The head has a pointed apex. The head of the fibula
articulates with the fibular facet on the lateral tibial condyle.
Bones of the foot
The bones of the foot include the tarsus, metatarsus, and phalanges. There are 7 tarsal bones, 5
metatarsal bones, and 14 phalanges. The calcaneus (L., heel bone) is the largest and strongest bone in the foot.
When standing, the calcaneus transmits the majority of the body's weight from the talus to the ground.
The navicular (L., little ship) is a flattened, boat-shaped bone located between the head of the talus
posteriorly and the three cuneiforms anteriorly. The cuboid, approximately cubical in shape, is the most lateral
bone in the distal row of the tarsus. The three cuneiform bones are the medial (1st), intermediate (2nd), and
lateral (3rd). The metatarsus (anterior or distal foot, forefoot—) consists of five metatarsals that are numbered
from the medial side of the foot. The 14 phalanges are as follows: the 1st digit (great toe) has 2 phalanges
(proximal and distal); the other four digits have 3 phalanges each: proximal, middle, and distal.
GENERAL CONSIDERATIONS ON JOINTS
Syndesmology (Greek expression band, bond –logy) is the medical discipline where joints and
ligaments of the body are studied. Joints (articulations) are unions or junctions between two or more bones or
rigid parts of the skeleton. Joints exhibit a variety of forms and functions. It is the fact that, whether or not
movement occurs between them, it is still called a joint. Some joints have no movement, others allow only
slight movement, and some are freely movable, such as the glenohumeral (shoulder) joint
Classification of Joints
Joints are classified according to the tissues that lie between the bones: fibrous joints, cartilaginous joints, and
synovial joints.
Fibrous joints: The bones are united by fibrous tissue. The amount of movement occurring at a fibrous joint
depends in most cases on the length of the fibers uniting the articulating bones. The sutures of the cranium are
examples of fibrous joints. A syndesmosis type of fibrous joint unites the bones with a sheet of fibrous tissue,
either a ligament or a fibrous membrane. Consequently, this type of joint is partially movable. The
interosseous membrane in the forearm is a sheet of fibrous tissue that joins the radius and ulna in a
syndesmosis. A dentoalveolar syndesmosis (gomphosis or socket) is a fibrous joint in which a peglike process
fits into a socket articulation between the root of the tooth and the alveolar process of the jaw.
Mobility of this joint (a loose tooth) indicates a pathological state affecting the supporting tissues of the tooth.
Cartilaginous joints: The bones are united by hyaline cartilage or fibrocartilage. In primary cartilaginous
joints, or synchondroses, the bones are united by hyaline cartilage, which permits slight bending during early
life. Secondary cartilaginous joints, or symphyses, are strong, slightly movable joints united by
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fibrocartilage. The fibrocartilaginous intervertebral discs between the vertebrae consist of binding connective
tissue that joins the vertebrae together.
Synovial joints: The bones are united by a joint (articular) capsule (composed of an outer fibrous layer lined
by a serous synovial membrane) spanning and enclosing an articular cavity. Synovial joints are the most
common type of joints and provide free movement between the bones they join; they are joints of locomotion,
typical of nearly all limb joints.
This type of joints has three common features:
1) Joint cavity: The joint cavity of a synovial joint, like the knee, is a potential space that contains a small
amount of lubricating synovial fluid, secreted by the synovial membrane.
2) Articular cartilage: The articular surfaces are covered by hyaline cartilage.
3) Articular capsule: This structure surrounds the joint and formed of two layers. Inside the capsule,
articular cartilage covers the articulating surfaces of the bones; all other internal surfaces are covered by
synovial membrane.
a) Fibrous capsule: It protects and gives firmness to the joint stability.
b) Synovial membrane: It lines the inner surface of the fibrous membrane but does not cover the articular
cartilage. The synovial membrane secretes a fluid known as synovial fluid. This fluid helps to minimize the
friction by articular sufaces.
Ligaments: A ligament is a cord or band of connective tissue uniting two structures. Articular capsules are
usually strengthened by articular ligaments. These are from dense connective tissue and they connect the
articulating bones to each other. Articular ligaments limit the undesired and/or excessive movements of the
joints.
Articular disc: Help to hold the bones together.
Labrum: A fibrocartilaginous ring which deepens the articular surface for one of the bones.
Bursae: Bursae are flattened sacs that contain synovial fluid to reduce friction. Its walls are separated by a
film of viscous fluid. Bursae are found wherever tendons rub against bones, ligaments, or other tendons.
Stability of Joints: The stability of a joint depends on four main factors: The negative pressure within the
joint cavity, the shape, size, and arrangement of the articular surfaces; the ligaments; and the tone of the
muscles around the joint.
Joint vasculature and innvervation: Joints receive blood from articular arteries that arise from the
vessels around the joint. The arteries often anastomose (communicate) to form networks (periarticular arterial
anastomoses) to ensure a blood supply to and across the joint in the various positions assumed by the joint.
Articular veins are communicating veins that accompany arteries (L. venae comitantes) and, like the arteries,
are located in the joint capsule, mostly in the synovial membrane. Joints have a rich nerve supply provided by
articular nerves with sensory nerve endings in the joint capsule.
JOINTS IN THE HEAD
The temporomandibular joint (TMJ) is a synovial joint, permitting gliding and a small degree of
rotation in addition to flexion (elevation) and extension (depression) movements. The bony articular surfaces
involved are the mandibular fossa and articular tubercle of the temporal bone superiorly, and the head of the
mandible inferiorly. The two bony articular surfaces are completely separated by intervening fibrocartilage,
the articular disc of the TMJ.
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.
The joints of the vertebral column include the:
 Joints of the vertebral bodies.
 Joints of the vertebral arches.
 Craniovertebral (atlanto-axial and atlanto-occipital) joints.
 Costovertebral joints.
 Sacroiliac joints.
The joints of the vertebral bodies are designed for weight-bearing and strength. The articulating surfaces
of adjacent vertebrae are connected by intervertebral (IV) discs and ligaments. The IV discs provide strong
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attachments between the vertebral bodies. The anulus fibrosus (L. anus, a ring) is a bulging fibrous ring
forming the circumference of the IV disc. The anterior longitudinal ligament is a strong, broad fibrous band
that covers and connects the anterolateral aspects of the vertebral bodies and IV discs. The posterior
longitudinal ligament runs within the vertebral canal along the posterior aspect of the vertebral bodies.
The joints of the vertebral arches are joints between the superior and inferior articular processes of
adjacent vertebrae. Each joint is surrounded by a thin joint capsule. The laminae of adjacent vertebral arches
are joined by broad, pale yellow bands of elastic tissue called the ligamenta flava (L. flavus, yellow).
There are two sets of craniovertebral joints, the atlanto-occipital joints, formed between the atlas
(C1 vertebra), and the occipital bone of the cranium, and the atlanto-axial joints, formed between the atlas
and axis (C2 vertebra). The craniovertebral joints are synovial joints that have no IV discs. Their design gives
a wider range of movement than in the rest of the vertebral column.
JOINTS OF THE UPPER LIMB
The sternoclavicular joint (SC) is a synovial joint. The sternal end of the clavicle articulates with the
manubrium and the 1st costal cartilage. The articular surfaces are covered with fibrocartilage.
The SC joint is divided into two compartments by an articular disc. The SC joint is the only articulation
between the upper limb and the axial skeleton.
The acromioclavicular joint (AC joint) is a synovial joint, which is formed by the lateral part of the
acromion. The acromial end of the clavicle articulates with the acromion of the scapula. The articular surfaces,
covered with fibrocartilage, are separated by an incomplete wedge-shaped articular disc. The acromion of the
scapula rotates on the acromial end of the clavicle.
The glenohumeral (shoulder) joint is a synovial joint that permits a wide range of movement;
however, its mobility makes the joint relatively unstable. The large, round humeral head articulates with the
relatively shallow glenoid cavity of the scapula, which is deepened slightly but effectively by the ring-like,
fibrocartilaginous glenoid labrum (L., lip). The glenohumeral joint has more freedom of movement than any
other joint in the body. This freedom results from the laxity of its joint capsule and the large size of the
humeral head compared with the small size of the glenoid cavity.
The elbow joint, a synovial joint, is located inferior to the epicondyles of the humerus. There are
humeroulnar and humeroradial articulations. The collateral ligaments of the elbow joint are strong triangular
bands that are medial and lateral thickenings of the fibrous layer of the joint capsule: the radial collateral
ligament and the ulnar collateral ligament. Flexion and extension occur at the elbow joint.
Only some of the bursae around the elbow joint are clinically important. The three olecranon bursae are the:

Intratendinous olecranon bursa

Subtendinous olecranon bursa

Subcutaneous olecranon bursa
The proximal (superior) radio-ulnar joint is a synovial joint that allows movement of the head of the
radius on the ulna. The radial head is held in position by the anular ligament of the radius. The distal
(inferior) radio-ulnar joint is a synovial joint. The radius moves around the relatively fixed distal end of the
ulna.
The wrist (radiocarpal) joint is a synovial joint. The ulna does not participate in the wrist joint. The
distal end of the radius and the articular disc of the distal radio-ulnar joint articulate with the proximal row of
carpal bones, except for the pisiform. The intercarpal (IC) joints interconnect the carpal bones. The
carpometacarpal (CMC), intermetacarpal (IM) joints, metacarpophalangeal joints, and interphalangeal joints
are other joints in the hand.
JOINTS OF THE PELVIS
Pubic symphysis fibrocartilaginous consists of an interpubic disc and surrounding ligaments uniting
the bodies of the pubic bones in the median plane.
Lumbosacral joints; L5 and S1 vertebrae articulate The other joint in the pelvis is the sacrococcygeal
joint.
JOINTS OF THE LOWER LIMB
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The joints of the lower limb include the articulations of the pelvic girdle—lumbosacral joints,
sacroiliac joints, and pubic symphysis. The remaining joints of the lower limb are the hip joints, knee joints,
tibiofibular joints, ankle joints, and foot joints.
The hip joint forms the connection between the lower limb and the pelvic girdle. It is a strong and
stable synovial joint. The head of the femur is the ball, and the acetabulum is the socket. The hip joint is
designed for stability over a wide range of movement. Next to the glenohumeral (shoulder) joint, it is the most
movable of all joints. During standing, the entire weight of the upper body is transmitted through the hip
bones to the heads and necks of the femurs.
The round head of the femur articulates with the cup-like acetabulum of the hip bone. The lip-shaped
acetabular labrum (L. labrum, lip) is a fibrocartilaginous rim attached to the margin of the acetabulum,
increasing the acetabular articular area by nearly 10%. The hip joints are enclosed within strong joint
capsules, formed of a loose external fibrous layer (fibrous capsule) and an internal synovial membrane.
The knee joint is our largest and most superficial joint. It is a synovial joint, allowing flexion and
extension; however, these movements are combined with gliding and rolling and with rotation. Although the
knee joint is well constructed, its function is commonly impaired when it is hyperextended (e.g., in body
contact sports, such as ice hockey).
The articular surfaces of the knee joint are characterized by their large size and their complicated and
incongruent shapes. The knee joint consists of three articulations:
 Two femorotibial articulations (lateral and medial) between the lateral and the medial femoral and
tibial condyles.
 One intermediate femoropatellar articulation between the patella and the femur.
The fibula is not involved in the knee joint.
The stability of the knee joint depends on (1) the strength and actions of the surrounding muscles and their
tendons and (2) the ligaments that connect the femur and tibia. Of these supports, the muscles are most
important; therefore, many sport injuries are preventable through appropriate conditioning and training. The
most important muscle in stabilizing the knee joint is the large quadriceps femoris, particularly the inferior
fibers of the vastus medialis and lateralis.
The joint capsule is strengthened by five extracapsular or capsular (intrinsic) ligaments: patellar ligament,
fibular collateral ligament, tibial collateral ligament, oblique popliteal ligament, and arcuate popliteal
ligament. They are sometimes called external ligaments to differentiate them from internal ligaments, such as
the cruciate ligaments. The intra-articular ligaments within the knee joint consist of the cruciate ligaments and
menisci. There are at least 12 bursae around the knee joint because most tendons run parallel to the bones and
pull lengthwise across the joint during knee movements. Flexion and extension are the main knee movements;
some rotation occurs when the knee is flexed.
The tibia and fibula are connected by two joints: the tibiofibular joint and the tibiofibular
syndesmosis (inferior tibiofibular) joint. In addition, an interosseous membrane joins the shafts of the two
bones. The tibiofibular joint (superior tibiofibular joint) is a synovial joint between the flat facet on the
fibular head and a similar articular facet on the lateral tibial condyle. The tibiofibular syndesmosis is a
compound fibrous joint. It is the fibrous union of the tibia and fibula by means of the interosseous membrane
(uniting the shafts) and the anterior, interosseous, and posterior tibiofibular ligaments (the latter making up the
inferior tibiofibular joint, uniting the distal ends of the bones). The integrity of the inferior tibiofibular joint is
essential for the stability of the ankle joint because it keeps the lateral malleolus firmly against the lateral
surface of the talus.
The ankle joint (talocrural articulation) is located between the distal ends of the tibia and the fibula
and the superior part of the talus. The ankle joint is reinforced laterally by the lateral ligament of the ankle.
The many joints of the foot involve the tarsals, metatarsals, and phalanges.
MUSCLES
General Considerations on Muscles
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The muscular system consists of all the muscles of the body. The disciplined related to the study of
muscles is myology. Musculus (muscle) is derived from the word mus-mouse; musculus- little mouse. All
skeletal muscles are composed of one specific type of muscle tissue. These muscles move the skeleton,
therefore, move the body parts.
There are three muscle types:
 Skeletal striated muscle is voluntary somatic muscle that makes up the gross skeletal muscles that
compose the muscular system, moving or stabilizing bones and other structures (e.g., the eyeballs).
Striated muscles are innervated by the somatic nervous system.
 Cardiac striated muscle is involuntary visceral muscle that forms most of the walls of the heart and
adjacent parts of the great vessels, such as the aorta, and pumps blood.
 Smooth muscle (unstriated muscle) is involuntary visceral muscle that forms part of the walls of
most vessels and hollow organs (viscera), moving substances through them by coordinated sequential
contractions (pulsations or peristaltic contractions). Non-striated and cardiac muscle are innervated by
the autonomic nervous system.
All skeletal muscles, commonly referred to simply as “muscles,” have fleshy, reddish, contractile portions
(one or more heads or bellies) composed of skeletal striated muscle. Some muscles are fleshy throughout, but
most also have white non-contractile portions (tendons), composed mainly of organized collagen bundles, that
provide a means of attachment. When referring to the length of a muscle, both the belly and the tendons are
included. In other words, a muscle's length is the distance between its attachments.
Most skeletal muscles are attached directly or indirectly to bones, cartilages, ligaments, or fascias or to
some combination of these structures. Some muscles are attached to organs (the eyeball, for example), skin
(such as facial muscles), and mucous membranes (intrinsic tongue muscles). Muscles are organs of
locomotion (movement), but they also provide static support, give form to the body, and provide heat.
The architecture and shape of muscles vary. The tendons of some muscles form flat sheets, or
aponeuroses, that anchor the muscle to the skeleton (usually a ridge or a series of spinous processes) and/or to
deep fascia (such as the latissimus dorsi muscle of the back), or to the aponeurosis of another muscle (such as
the oblique muscles of the anterolateral abdominal wall).
Muscle terminology
Many terms provide information about a structure's shape, size, location, or function or about the
resemblance of one structure to another.
 Most muscles are named on the basis of their function or the bones to which they are attached. The
abductor digiti minimi muscle, for example, abducts the little finger.
 Some muscles have descriptive names to indicate their main characteristics. The deltoid muscle,
which covers the point of the shoulder, is triangular, like the symbol for delta, the fourth letter of the
Greek alphabet. The suffix -oid means “like”; therefore, deltoid means like delta.
 Other muscles are named on the basis of their position (medial, lateral, anterior, posterior) or length
(brevis, short; longus, long).
 Some muscles are named according to their shape—the piriformis muscle, for example, is pear shaped
(L. pirum, pear + L. forma, shape or form).
 Other muscles are named according to their location. The temporal muscle is in the temporal region
(temple) of the cranium (skull).
Muscles may be described or classified according to their shape, for which a muscle may also be named:
 Flat muscles have parallel fibers often with an aponeurosis—for example, the external oblique (broad flat
muscle). The sartorius is a narrow flat muscle with parallel fibers.
 Pennate muscles are feather-like (L. pennatus, feather) in the arrangement of their fascicles, and may be
unipennate, bipennate, or multi-pennate—for example, the extensor digitorum longus (unipennate), the rectus
femoris (bipennate), and deltoid (multi-pennate).
 Fusiform muscles are spindle shaped with a round, thick belly (or bellies) and tapered ends—for
example, biceps brachii.
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 Convergent muscles arise from a broad area and converge to form a single tendon—for example, the
pectoralis major.
 Quadrate muscles have four equal sides (L. quadratus, square)—for example, the rectus abdominis,
between its tendinous intersections.
 Circular or sphincteral muscles surround a body opening or orifice, constricting it when contracted—
for example, orbicularis oculi (closes the eyelids).
 Multi-headed or multi-bellied muscles have more than one head of attachment or more than one
contractile belly, respectively. Biceps muscles have two heads of attachment (e.g., the biceps brachii), triceps
muscles have three heads (e.g., triceps brachii), and the digastric and gastrocnemius muscles have two
bellies.
Contraction of muscles
Skeletal muscles function by contracting; they pull and never push. When a muscle contracts and
shortens, one of its attachments usually remains fixed while the other (more mobile) attachment is pulled
toward it, often resulting in movement. Attachments of muscles are commonly described as the origin and
insertion; the origin is usually the proximal end of the muscle, which remains fixed during muscular
contraction, and the insertion is usually the distal end of the muscle, which is movable. However, this is not
always the case. Some muscles can act in both directions under different circumstances. For example, when
doing pushups, the distal end of the upper limb (the hand) is fixed (on the floor) and the proximal end of the
limb and the trunk are being moved. Whereas the structural unit of a muscle is a skeletal striated muscle fiber,
the functional unit of a muscle is a motor unit, consisting of a motor neuron and the muscle fibers it controls.
When a motor neuron in the spinal cord is stimulated, it initiates an impulse that causes all the muscle fibers
supplied by that motor unit to contract simultaneously.
Functions of muscles
Muscles serve specific functions in moving and positioning the body.
A prime mover (agonist) is the main muscle responsible for producing a specific movement of the body. It
contracts concentrically to produce the desired movement, doing most of the work (expending most of the
energy) required. A fixator steadies the proximal parts of a limb through isometric contraction while
movements are occurring in distal parts. A synergist complements the action of a prime mover. An
antagonist is a muscle that opposes the action of another muscle. The same muscle may act as a prime mover,
antagonist, synergist, or fixator under different conditions.
Nerves and arteries to muscles
Variation in the nerve supply of muscles is rare; it is a nearly constant relationship. In the limb, muscles of
similar actions are generally contained within a common fascial compartment and share innervation by the
same nerves. The blood supply of muscles is not as constant as the nerve supply and is usually multiple.
Arteries generally supply the structures they contact.
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.
The occipitofrontalis is a flat digastric muscle which elevates the eyebrows and produce transverse wrinkles
across the forehead. This gives the face a surprised look.
Several muscles alter the shape of the mouth and lips during speaking as well as during such activities as
singing, whistling, and mimicry. The shape of the mouth and lips is controlled by a complex threedimensional group of muscular slips, which include the following:
 Elevators, retractors, and evertors of the upper lip.
 Depressors, retractors, and evertors of the lower lip.
 The orbicularis oris, the sphincter around the mouth.
 The buccinator in the cheek.
The platysma (G. flat plate) is a broad, thin sheet of muscle in the subcutaneous tissue of the neck. It helps
depress the mandible and draw the corners of the mouth inferiorly.
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The function of the eyelids (L. palpebrae) is to protect the eyeballs from injury and excessive light. The
eyelids also keep the cornea moist by spreading the tears. The orbicularis oculi closes the eyelids and
wrinkles the forehead vertically. The muscles of the nose may provide evidence of breathing behaviors.
Cutaneous (sensory) innervation of the face and anterosuperior part of the scalp is provided primarily by the
trigeminal nerve (CN V), whereas motor innervation to the facial muscles is provided by the facial nerve (CN
VII).
Muscles of the Neck
The sternocleidomastoid (SCM) muscle is a broad, strap-like muscle that has two heads: The
rounded tendon of the sternal head attaches to the manubrium, and the thick fleshy clavicular head attaches to
the superior surface of the clavicle. Bilateral contractions of the SCMs will cause extension of the elevating
the chin. Acting unilaterally, the SCM laterally flexes the neck (bends the neck sideways) and rotates the head
so the ear approaches the shoulder of the ipsilateral (same) side.
Trapezius is a large, flat triangular muscle that covers the posterolateral aspect of the neck and thorax.
The trapezius provides a direct attachment of the pectoral girdle to the trunk. This large, triangular muscle
covers the posterior aspect of the neck and the superior half of the trunk. It was given its name because the
muscles of the two sides form a trapezium (G. irregular four-sided figure). The trapezius assists in suspending
the upper limb.
Muscles of the Pectoral and Scapular Regions
Four anterior axioappendicular muscles (thoracoappendicular or pectoral muscles) move the pectoral
girdle: pectoralis major, pectoralis minor, subclavius, and serratus anterior.
The pectoralis major is a large, fan-shaped muscle that covers the superior part of the thorax. It has
clavicular and sternocostal heads. It produces powerful adduction and medial rotation of the arm when acting
together. The pectoralis minor lies in the anterior wall of the axilla where it is almost completely covered by
the much larger pectoralis major. The subclavius lies almost horizontally when the arm is in the anatomical
position. This small, round muscle is located inferior to the clavicle and affords some protection to the
subclavian vessels and the superior trunk of the brachial plexus if the clavicle fractures. The serratus anterior
overlies the lateral part of the thorax and forms the medial wall of the axilla (L. serratus, a saw).
The posterior axioappendicular muscles (superficial and intermediate groups of extrinsic back muscles)
attach the superior appendicular skeleton (of the upper limb) to the axial skeleton (in the trunk). The posterior
shoulder muscles are divided into three groups:
 Superficial posterior axioappendicular (extrinsic shoulder) muscles: trapezius and latissimus dorsi.
 Deep posterior axioappendicular (extrinsic shoulder) muscles: levator scapulae and rhomboids.
 Scapulohumeral (intrinsic shoulder) muscles: deltoid, teres major, and the four rotator cuff muscles.
The name latissimus dorsi (L. widest of back) was well chosen because the muscle covers a wide area of the
back. This large, fan-shaped muscle passes from the trunk to the humerus and acts directly on the
glenohumeral joint and indirectly on the pectoral girdle (scapulothoracic joint).
The six scapulohumeral muscles (deltoid, teres major, supraspinatus, infraspinatus, subscapularis,
and teres minor) are relatively short muscles that pass from the scapula to the humerus and act on the
glenohumeral joint. The deltoid is a thick, powerful, coarse-textured muscle covering the shoulder and
forming its rounded contour. As its name indicates, the deltoid is shaped like the inverted Greek letter delta
(Δ).
Muscles of the Arm & the Hand
Of the four major arm muscles, three flexors (biceps brachii, brachialis, and coracobrachialis) are in
the anterior (flexor) compartment, supplied by the musculocutaneous nerve, and one extensor (triceps
brachii) is in the posterior compartment, supplied by the radial nerve. The ulnar nerve supplies the flexor
carpi ulnaris and flexor digitorum profundus (media half) and hypothenar muscles. The biceps brachii is the
flexor of the arm. The brachialis is the main flexor of the forearm. The coracobrachialis helps flex and
adduct the arm and stabilize the glenohumeral joint. The triceps brachii is the main extensor of the forearm.
There are 17 muscles crossing the elbow joint, some of which act on the elbow joint exclusively,
whereas others act at the wrist and fingers.
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The flexor muscles of the forearm are in the anterior (flexor-pronator) compartment of the forearm and are
separated from the extensor muscles of the forearm by the radius and ulna and, in the distal two thirds of the
forearm, by the interosseous membrane that connects them. The extensor muscles of the forearm are in the
posterior (extensor-supinator) compartment of the forearm, and all are innervated by branches of the radial
nerve. The intrinsic muscles of the hand are located in five compartments.
Muscles of the Gluteal Region, Back, the Leg & the Foot
The large anterior compartment of the thigh contains the anterior thigh muscles, the flexors of the hip
and extensors of the knee. The pectineus is a flat quadrangular muscle located in the anterior part of the thigh.
The iliopsoas is the chief flexor of the thigh, the most powerful of the hip flexors. The sartorius, the “tailor's
muscle” (L. sartus, patched or repaired), is long and ribbon-like. It passes lateral to medial across the
superoanterior part of the thigh. The sartorius, the longest muscle in the body.
The quadriceps femoris (L., four-headed femoral muscle) forms the main bulk of the anterior thigh
muscles and collectively constitutes the largest and one of the most powerful muscles in the body. It covers
almost all the anterior aspect and sides of the femur. The quadriceps femoris (usually shortened to quadriceps)
is the great extensor of the leg.
The rectus femoris received its name because it runs straight down the thigh (L. rectus, straight). The
names of the three large vastus muscles (vasti) indicate their position around the femoral shaft; vastus
lateralis, medialis and intermedius. The muscles of the medial compartment of the thigh comprise the
adductor group.
Gluteal and posterior thigh regions
The gluteus maximus is the most superficial gluteal muscle. It is the largest, heaviest, and most
coarsely fibered muscle of the body. The main actions of the gluteus maximus are extension and lateral
rotation of the thigh. The smaller gluteal muscles, gluteus medius and gluteus minimus, are fan shaped, and
their fibers converge in the same manner. The pear-shaped piriformis (L. pirum, a pear), obturator internus
and the superior and inferior gemelli (L. geminus, small twin) are the other muscles of the region, as well as
the quadratus femoris and the obturator externus. The posterior thigh muscles include the hamstring
muscles: (1) semitendinosus, (2) semimembranosus, and (3) biceps femoris (long head). The four muscles
in the anterior compartment of the leg are the tibialis anterior, extensor digitorum longus, extensor
hallucis longus, and fibularis tertius. The lateral compartment of the leg is the smallest (narrowest) of the
leg compartments. The lateral compartment contains the fibularis longus and brevis muscles.
The posterior compartment of the leg (plantarflexor compartment) is the largest of the three leg
compartments. The superficial group of calf muscles (muscles forming prominence of “calf” of posterior leg)
includes the gastrocnemius, soleus, and plantaris. The gastrocnemius and soleus share a common tendon,
the calcaneal tendon, which attaches to the calcaneus. The calcaneal tendon (L. tendo calcaneus, Achilles
tendon) is the most powerful (thickest and strongest) tendon in the body. Collectively these two muscles make
up the three-headed triceps surae (L. sura, calf). These muscles raise heel during walking; flex the leg at the
knee joint. Four muscles make up the deep group in the posterior compartment of the leg: popliteus, flexor
digitorum longus, flexor hallucis longus, and tibialis posterior.
Of the 20 individual muscles of the foot, 14 are located on the plantar aspect, 2 are on the dorsal aspect,
and 4 are intermediate in position.
THORACIC WALL, MEDIASTINUM
&
CARDIOVASCULAR SYSTEM
14. October. 2011 Friday
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THORACIC WALL
1. Thorax
The thorax is the part of the body between the neck and abdomen.
Posterior surface is formed by the 12 thoracic vertebræ and the posterior parts of the ribs.
Anterior surface is formed by the sternum and costal cartilages.
Lateral surfaces are formed by the ribs, separated from each other by the intercostal spaces, eleven in
number, which are occupied by the intercostal muscles and membranes.
The floor of the thoracic cavity is deeply invaginated inferiorly (i.e., is pushed upward) by viscera of the
abdominal cavity.
Regions
• Thoracic wall
• Thoracic cavity
The thorax includes the primary organs of the respiratory and cardiovascular systems. The majority of the
thoracic cavity is occupied by the lungs, which provide for the exchange of oxygen and carbon dioxide
between the air and blood. Most of the remainder of the thoracic cavity is occupied by the heart and structures
involved in conducting the air and blood to and from the lungs. Additionally, nutrients (food) traverse the
thoracic cavity via the esophagus, passing from the site of entry in the head to the site of digestion and
absorption in the abdomen.
2. Thoracic Wall
The true thoracic wall includes the thoracic cage and the muscles that extend between the ribs as well
as the skin, subcutaneous tissue, muscles, and fascia covering its anterolateral aspect. The same structures
covering its posterior aspect are considered to belong to the back. The mammary glands of the breasts lie
within the subcutaneous tissue of the thoracic wall.
The domed shape of the thoracic cage provides its components enabling to:
 Protect vital thoracic and abdominal organs (most air or fluid filled) from external forces.
 Resist the negative (sub-atmospheric) internal pressures generated by the elastic recoil of the lungs and
inspiratory movements.
 Provide attachment for and support the weight of the upper limbs.
 Provide the anchoring attachment (origin) of many of the muscles that move and maintain the position
of the upper limbs relative to the trunk, as well as provide the attachments for muscles of the abdomen,
neck, back, and respiration.
The thorax is one of the most dynamic regions of the body. With each breath, the muscles of the thoracic
wall—working in concert with the diaphragm and muscles of the abdominal wall—vary the volume of the
thoracic cavity, first by expanding the capacity of the cavity, thereby causing the lungs to expand and draw air
in and then, due to lung elasticity and muscle relaxation, decreasing the volume of the cavity and causing
them to expel air.
3. Skeleton of Thoracic Wall
The thoracic skeleton forms the osteocartilaginous thoracic cage, which protects the thoracic viscera
and some abdominal organs. The thoracic skeleton includes 12 pairs of ribs and associated costal cartilages,
12 thoracic vertebrae and the intervertebral (IV) discs interposed between them, and the sternum. The ribs and
costal cartilages form the largest part of the thoracic cage; both are identified numerically, from the most
superior (1st rib or costal cartilage) to the most inferior (12th).
3.1.Thoracic Vertebrae
Characteristic features of thoracic vertebrae include:
 Most thoracic vertebrae are typical in that they have bodies, vertebral arches, and seven processes for
muscular and articular connections
 Bilateral costal facets (demifacets) on the vertebral bodies, usually occurring in inferior and superior pairs,
for articulation with the heads of ribs. Atypical thoracic vertebrae are 1, 10 (sometimes), 11 and 12 have
single facets.
 Costal facets on the transverse processes
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 Spinous processes.
Typically, two demifacets paired and the posterolateral margin of the IV disc between them form a single
socket to receive the head of the rib of the same identifying number as the inferior vertebra (e.g., head of rib 6
with the superior costal facet of vertebra T6).
3.2. Ribs, Costal Cartilages, and Intercostal Spaces
Ribs (L. costae) are curved, flat bones that form most of the thoracic cage. There are three types of ribs that
can be classified as typical or atypical:
 True (vertebrocostal) ribs (1st-7th ribs): They attach directly to the sternum through their own costal
cartilages.
 False (vertebrochondral) ribs (8th, 9th, and usually 10th ribs): Their cartilages are connected to the
cartilage of the rib above them; thus their connection with the sternum is indirect.
 Floating (vertebral, free) ribs (11th, 12th, and sometimes 10th ribs): The rudimentary cartilages of
these ribs do not connect even indirectly with the sternum; instead they end in the posterior abdominal
musculature.
Typical ribs (3rd-9th) have the following components:
 Head: wedge-shaped and has two facets, separated by the crest of the head; one facet for articulation with
the numerically corresponding vertebra and one facet for the vertebra superior to it.

Neck: connects the head of the rib with the body at the level of the tubercle.
 Tubercle: located at the junction of the neck and body; articulates with the corresponding transverse
process of the vertebra, and a rough nonarticular part provides attachment for the costotransverse ligament.
 Body (shaft): thin, flat, and curved, most markedly at the costal angle where the rib turns anterolaterally.
The angle also demarcates the lateral limit of attachment of the deep back muscles to the ribs. The concave
internal surface of the body has a costal groove paralleling the inferior border of the rib, which provides some
protection for the intercostal nerve and vessels.
Atypical ribs 1st, 2nd, and 10th-12th ribs are dissimilar.
Costal cartilages prolong the ribs anteriorly and contribute to the elasticity of the thoracic wall, providing a
flexible attachment for their anterior ends.
Intercostal spaces separate the ribs and their costal cartilages from one another. The spaces are named
according to the rib forming the superior border of the space—for example, the 4th intercostal space lies
between ribs 4 and 5. There are 11 intercostal spaces and 11 intercostal nerves. Intercostal spaces are occupied
by intercostal muscles and membranes, and two sets (main and collateral) of intercostal blood vessels and
nerves, identified by the same number assigned to the space.
Sternum (Breastbone, Tr. iman tahtası)
The sternum (G. sternon, chest) is the long, flat bone that forms the middle of the anterior part of the
thoracic cage. It directly overlies and affords protection for mediastinal viscera in general and much of the
heart in particular. The sternum is commonly known as the breastbone and is divided into three areas, the
upper manubrium, the body, and the xiphoid process. The manubrium and body of the sternum lie in slightly
different planes superior and inferior to their junction, the manubriosternal joint; hence, their junction forms a
projecting sternal angle (of Louis). Xiphoid process is an important for the inferior border of the heart and
upper border of the liver.
4. Thoracic Apertures
While the thoracic cage provides a complete wall peripherally, it is open superiorly and inferiorly. The
superior opening is a passageway that allows communication with the neck and upper limbs. The larger
inferior opening provides the ring-like origin of the diaphragm, which completely occludes the opening.
Structures that pass between the thoracic cavity and the neck through the superior thoracic aperture:
Trachea
Esophagus
Nerves, and vessels that supply and drain the head, neck, and upper limbs.
Joints of Thoracic Wall
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Although the joints between the bones of the thorax have limited movement ability, the whole outcome of
these movements permit expansion of the cavity during inspiration. During inspiration, the thoracic cavity
can expand in antero-posterior, vertical and transverse dimensions.
1. Costa transverse joints
2. Sterno costal joint
3. Costachondralis joint
4. Intercondral Joints
5. Sternal Joints
Muscles of Thoracic Wall
Some muscles attached to and/or covering the thoracic cage are primarily involved in serving other
regions. Several (axioappendicular) muscles extend from the thoracic cage (axial skeleton) to bones of the
upper limb (appendicular skeleton). Muscles, such as sternocleidomasteoid muscle, abdominal muscles,
pectoral muscles, function as accesory muscles of respiraton and work in forced respiration; when the person
needs to breathe in and out more than usual; 100 meter sprinters, patients with respiratory problems.
Muscles of the thoracic wall
– Serratus posterior muscles
– Levator costarum muscles
– Intercostal muscles(External, internal and innermost)
– Subcostal muscle
– Transverse thoracic muscle
These muscles either elevate or depress the ribs helping to increse the volume of the thoracic cavity.
The diaphragm is a shared wall (actually floor/ceiling) separating the thorax and abdomen. Although
it has functions related to both compartments of the trunk, its most important (vital) function is serving as the
primary muscle of inspiration.
6. Vasculature of Thoracic Wall
In general, the pattern of vascular distribution in the thoracic wall reflects the structure of the thoracic
cage—that is, it runs in the intercostal spaces, parallel to the ribs.
7.1. Arteries of Thoracic Wall
The arterial supply to the thoracic wall derives from the branches of the:
 Thoracic aorta
 Subclavian artery
 Axillary artery
The intercostal arteries course through the thoracic wall between the ribs.
4.2. Veins of Thoracic Wall
The intercostal veins accompany the intercostal arteries and nerves and lie most superior in the costal
grooves. There are 11 posterior intercostal veins and one subcostal vein on each side. The posterior intercostal
veins anastomose with the anterior intercostal veins (tributaries of internal thoracic veins).
Most posterior intercostal veins (4-11) end in the azygos/hemiazygos venous system, which conveys venous
blood to the superior vena cava (SVC).
5. Nerves of Thoracic Wall
The 12 pairs of thoracic spinal nerves supply the thoracic wall. As soon as they leave the intervertebral
(IV) foramina in which they are formed, the mixed thoracic spinal nerves divide into anterior and posterior
(primary) rami or branches. The anterior rami of nerves T1-T11 form the intercostal nerves that run along the
extent of the intercostal spaces.
The intercostal nerves pass to and then continue to course in or just inferior to the costal grooves,
running inferior to the intercostal arteries (which, in turn, run inferior to the intercostal veins). The
neurovascular bundles (and especially the vessels) are thus sheltered by the inferior margins of the overlying
rib.
6.1. Dermatomes
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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. The skin area supplied by a segment of the spinal cord.
6.2. Atypical Intercostal nerves
1st intercostal nerve
2nd intercostal nerve
7th-11th intercostal nerve
12th intercostal nerve
7. Breasts
The breasts are the most prominent superficial structures in the anterior thoracic wall, especially in
women. The breasts (L. mammae) consist of glandular and supporting fibrous tissue embedded within a fatty
matrix, together with blood vessels, lymphatics, and nerves. Both men and women have breasts; normally
they are well developed only in women. The mammary glands are in the subcutaneous tissue overlying the
pectoralis major and minor muscles. At the greatest prominence of the breast is the nipple, surrounded by a
circular pigmented area of skin, the areola (L. small area).
The mammary glands within the breasts are accessory to reproduction in women. They are rudimentary and
functionless in men, consisting of only a few small ducts or epithelial cords. Usually, the fat present in the
male breast is not different from that of subcutaneous tissue elsewhere, and the glandular system does not
normally develop.
7.1. Female Breasts
The amount of fat surrounding the glandular tissue determines the size of non-lactating breasts. The
roughly circular body of the female breast rests on a bed that extends transversely from the lateral border of
the sternum.
The arterial supply of the breast:
1. Medial mammary branches
2. Lateral mammary branches, lateral thoracic and thoracoacromial arteries
3. Posterior intercostal arteries 2nd-4th
The venous drainage of the breast is mainly to the axillary vein, but there is some drainage to the internal
thoracic vein.
The lymphatic drainage of the breast is important because of its role in the metastasis of cancer cells.
Most lymph, especially from the lateral breast quadrants, drains to the axillary lymph nodes. Most of the
remaining lymph, particularly from the medial breast quadrants, drains to the parasternal lymph nodes or to
the opposite breast, whereas lymph from the inferior quadrants may pass deeply to abdominal lymph nodes.
The nerves of the breast derive from anterior and lateral cutaneous branches of the 4th-6th intercostal nerves.
MEDIASTINUM
(Interpleaural space)
The thoracic cavity is divided into three major spaces: the central compartment or mediastinum that
houses the thoracic viscera except for the lungs and, on each side, the right and left pulmonary cavities
housing the lungs.
The mediastinum (Mod. L. middle septum, L, mediastinus, midway), occupied by the mass of tissue
between the two pulmonary cavities, is the central compartment of the thoracic cavity. It is covered on
each side by mediastinal pleura and contains all the thoracic viscera and structures except the lungs.
Mediastinum extends from superior thoracic aperture superiorly to the diaphragm inferiorly and from sternum
and costal cartilages anteriorly to to the bodies of the thoracic vertebrae posteriorly.
The looseness of the connective tissue and the elasticity of the lungs and parietal pleura on each side of
the mediastinum enable it to accommodate movement as well as volume and pressure changes in the thoracic
cavity, for example, those resulting from movements of the diaphragm, thoracic wall, and tracheobronchial
tree during respiration, contraction (beating) of the heart and pulsations of the great arteries, and passage of
ingested substances through the esophagus.
The mediastinum is divided into superior and inferior parts for purposes of description.
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•
Superior mediastinum
– Superior to sternal angle
Inferior mediastinum: Inferior to sternal angle
• Anterior mediastinum
– Between the anterior surface of pericardium and posterior surface of the sternum
• Middle mediastinum
– Pericardium, heart and beginings of the great vessels emerging from the heart lie here
• Posterior mediastinum
– Lies posterior to the pericardium and diaphragm
Some structures, such as the esophagus, pass vertically through the mediastinum and therefore lie in more
than one mediastinal compartment.
Contents of the superior mediastinum
1) Thymus
2) Great vessels related to the heart with the veins
3) Inferior continuation of the cervical viscera (trachea anteriorly and esophagus posteriorly) and related
nerves (left recurrent laryngeal nerve)
4) Thoracic duct and lymphatic trunks
5) Prevertebral muscles
Anterior mediastinum
It lies between the sternum anteriorly and the pericardium posteriorly. Superiorly it continues with the
superior mediastinum starting at the level of sternal angle.
Contents of the anterior mediastinum
Remnants of thymus
Branches of the internal thoracic artery
Posterior Mediastinum
The posterior mediastinum (the posterior part of the inferior mediastinum) is located inferior to the sternal
angle, posterior to the pericardium and diaphragm, and between the parietal pleura of the two lungs.
Contents of the posterior mediastinum
• Thoracic aorta
• Thoracic duct
• Posterior mediastinal lymph nodes
• Azygos and hemiazygos veins
• Esophagus
• Esophageal nerve plexus
• Thoracic sympathetic trunks
• Thoracic splanchnic nerves
CARDIOVASCULAR SYSTEM
.
The vascular system is divided for descriptive purposes into (a) the blood vascular system, which
comprises the heart and blood vessels for the circulation of the blood; and (b) the lymph vascular system,
consisting of lymph glands and lymphatic vessels, through which a colorless fluid, the lymph, circulates. The
two systems communicate with each other and are intimately associated developmentally. The heart is the
central organ of the blood vascular system, and consists of a hollow muscle; by its contraction the blood is
pumped to all parts of the body through a complicated series of tubes, termed arteries. The arteries undergo
enormous ramification in their course throughout the body, and end in minute vessels, called arterioles, which
in their turn open into a close-meshed network of microscopic vessels, termed capillaries. After the blood has
passed through the capillaries it is collected into a series of larger vessels, called veins, by which it is returned
to the heart. The passage of the blood through the heart and blood-vessels constitutes what is termed the
circulation of the blood.
HEART
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The heart, slightly larger than a clenched fist, is a double, self-adjusting suction and pressure pump,
the parts of which work in unison to propel blood to all parts of the body.
The right side of the heart (right heart) receives poorly oxygenated (venous) blood from the body through the
superior vena cava (SVC) and inferior vena cava (IVC) and pumps it through the pulmonary trunk and
arteries to the lungs for oxygenation. The left side of the heart (left heart) receives well-oxygenated (arterial)
blood from the lungs through the pulmonary veins and pumps it into the aorta for distribution to the body.
The heart has four chambers: right and left atria and right and left ventricles. The atria are receiving
chambers that pump blood into the ventricles (the discharging chambers). The synchronous pumping actions
of the heart's two atrioventricular (AV) pumps (right and left chambers) constitute the cardiac cycle. The cycle
begins with a period of ventricular elongation and filling (diastole) and ends with a period of ventricular
shortening and emptying (systole).
The wall of each heart chamber consists of three layers, from superficial to deep:
 Endocardium, a thin internal layer
 Myocardium, a thick, helical middle layer composed of cardiac muscle.
 Epicardium, a thin external layer
Externally, the atria are demarcated from the ventricles by the coronary sulcus (atrioventricular
groove), and the right and left ventricles are demarcated from each other by anterior and posterior
interventricular (IV) sulci (grooves). The heart appears trapezoidal from an anterior or posterior view, but in
three dimensions it is shaped like a tipped-over pyramid with its apex (directed anteriorly and to the left), a
base (opposite the apex, facing mostly posteriorly), and four sides.
The four surfaces of the heart are the:
 Anterior (sternocostal) surface
 Diaphragmatic (inferior) surface
 Right pulmonary surface
 Left pulmonary surface
Right atrium
The right atrium forms the right border of the heart and receives venous blood from the SVC, IVC, and
coronary sinus. The ear-like right auricle is a conical muscular pouch that projects from this chamber like an
add-on room, increasing the capacity of the atrium as it overlaps the ascending aorta.
The interior of the right atrium has a smooth, thin-walled, posterior part (the sinus venarum) on which the
venae cavae (SVC and IVC) and coronary sinus open, bringing poorly oxygenated blood into the heart.
The interatrial septum separating the atria has an oval, thumbprint-size depression, the oval fossa (L. fossa
ovalis), which is a remnant of the oval foramen (L. foramen ovale) and its valve in the fetus. Opening of the
coronary sinus is also located in the right atrium.
Right ventricle
The right ventricle forms the largest part of the anterior surface of the heart, a small part of the
diaphragmatic surface, and almost the entire inferior border of the heart. The right ventricle receives blood
from the right atrium through the right AV (tricuspid) orifice. Tendinous cords (L. chordae tendineae)
attach to the free edges and ventricular surfaces of cusps, much like the cords attaching to a parachute. The
tendinous cords arise from the apices of papillary muscles, which are conical muscular projections with bases
attached to the ventricular wall. Regurgitation of blood (backward flow of blood) from the right ventricle back
into the right atrium is blocked during ventricular systole by the valve cusps. The interventricular septum
(IVS), is obliquely placed partition between the right and left ventricles.
Left Atrium
The left atrium forms most of the base of the heart. The valveless pairs of right and left pulmonary
veins enter the atrium. The tubular, muscular left auricle, its wall trabeculated with pectinate muscles, forms
the superior part of the left border of the heart. A semilunar depression in the interatrial septum indicates the
floor of the oval fossa; the surrounding ridge is the valve of the oval fossa (L. valvulae foramen ovale).
The interior of the left atrium has:
 Pectinate muscles
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 Four pulmonary veins (two superior and two inferior)
 An interatrial septum
 A left AV orifice through which the left atrium discharges the oxygenated blood it receives from the
pulmonary veins into the left ventricle.
Left Ventricle
The left ventricle forms the apex of the heart, nearly all its left (pulmonary) surface and border, and most of
the diaphragmatic surface. Because arterial pressure is much higher in the systemic than in the pulmonary
circulation, the left ventricle performs more work than the right ventricle.
The interior of the left ventricle has:
 A smooth-walled, non-muscular, superoanterior outflow part, the aortic vestibule, leading to the aortic
orifice and aortic valve.
 A double-leaflet mitral valve that guards the left AV orifice.
The mitral valve has two cusps. The semilunar aortic valve, between the left ventricle and the ascending aorta,
is obliquely placed.
Vasculature of the Heart
The blood vessels of the heart comprise the coronary arteries and cardiac veins, which carry blood to
and from most of the myocardium.
Arterial Supply of the Heart
The coronary arteries, the first branches of the aorta, supply the myocardium and epicardium. The right
and left coronary arteries arise from the corresponding aortic sinuses. Anastomoses between the branches of
the coronary arteries exist, which enables the development of the collateral circulation. The coronary arteries
supply both the atria and the ventricles. The right coronary artery (RCA) arises from the right aortic sinus of
the ascending aorta. The left coronary artery (LCA) arises from the left aortic sinus of the ascending aorta.
Venous Drainage of the Heart
The heart is drained mainly by veins that empty into the coronary sinus and partly by small veins that empty
into the right atrium.
Lymphatic Drainage of the Heart
A single lymphatic vessel, formed by the union of various lymphatic vessels from the heart ends in the inferior
tracheobronchial lymph nodes, usually on the right side.
STIMULATING, CONDUCTING, AND REGULATING SYSTEMS OF HEART
Stimulating and Conducting System of the Heart
The conducting system consists of nodal tissue that initiates the heartbeat and coordinates contractions
of the four heart chambers, and highly specialized conducting fibers for conducting them rapidly to the
different areas of the heart. The impulses are then propagated by the cardiac striated muscle cells so that the
chamber walls contract simultaneously.
Impulse generation and conduction can be summarized as follows:
 The SA node (pacemaker of the heart; in the right atrium) initiates an impulse that is rapidly conducted
to cardiac muscle fibers in the atria, causing them to contract.
 The impulse spreads by myogenic conduction, which rapidly transmits the impulse from the SA node
to the AV node (in the right atrium).
 The signal is distributed from the AV node through the AV bundle and its branches (the right and left
bundles), which pass on each side of the IVS to supply subendocardial branches to the papillary
muscles and the walls of the ventricles.
Innervation of the Heart
Innervation of the heart is through the autonomic nerves (both sympathetic and parasympathetics)
from the cardiac plexus.
PERICARDIUM
The pericardium is a fibroserous membrane that covers the heart and the beginning of its great
vessels. The pericardium is a closed sac composed of two layers.
The pericardium is a closed sac composed of two layers:
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1) Fibrous pericardium (external)
continuous with the central tendon of the diaphragm
2) Serous pericardium (internal)
Parietal layer
Visceral layer (epicardium)
Visceral and parietal layers are continuous with each other where the great vessels enter and leave the
heart. Inner surface is lined by the parietal layer of the serous pericardium and these layers are strictly attached
to each other. The fibrous pericardium protects the heart against sudden overfilling because it is so unyielding
and closely related to the great vessels that pierce it superiorly.
The pericardial cavity is the potential space between opposing layers of the parietal and visceral
layers of serous pericardium. It normally contains a thin film of fluid that enables the heart to move and beat
in a frictionless environment. There are two potential spaces, i.e. sinuses in pericardium; transverse
pericardial sinus and oblique pericardial sinus. The arterial supply of the pericardium is mainly from a
slender branch of the internal thoracic artery. The venous drainage of the pericardium is from the
pericardiacophrenic veins. The nerve supply of the pericardium is from the phrenic nerves).
THE GREAT VESSELS
The right and left brachiocephalic veins are formed by the union of the internal jugular and
subclavian veins. The brachiocephalic veins unite to form the superior vena cava (SVC). The superior vena
cava (SVC) returns blood from all structures superior to the diaphragm, except the lungs and heart. It ends by
entering the right atrium of the heart.
The ascending aorta begins at the aortic orifice. Its only branches are the coronary arteries, arising from the
aortic sinuses. The arch of the aorta (aortic arch) is the curved continuation of the ascending aorta. . The
usual branches of the arch are the brachiocephalic trunk, left common carotid artery, and left subclavian
artery.
The ligamentum arteriosum, the remnant of the fetal ductus arteriosus, passes from the root of the left
pulmonary artery to the inferior surface of the arch of the aorta
ANATOMY OF THE RESPIRATORY SYSTEM
21. October. 2011 Friday
NOSE & ASSOCIATED STRUCTURES
Nose is divisible into two parts as external nose and nasal cavity.
Functions of the nose and the nasal cavities are:
 Olfaction (sense of smell)
 Respiration
 Filtration of the dust in the inspired air
 Humidification and warming of the inspired air (cooling the internal carotid artery for brain)
 Reception of the secretions from the paranasal sinuses and nasolacrimal ducts
External Nose
The external nose extends the nasal cavities onto the front of the face and positions the nares so that they point
downward. It is pyramidal in shape with its apex anterior in position. The upper angle of the nose between the
openings of the orbits is continuous with the forehead.
The external nose has five parts:
1) Dorsum
2) Root
3) Apex
4) Nares (nostrils, anterior nasal apertures)
5) Alae of the nose
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External nose has bony and cartilaginous parts.
Bones contributing to the structure of the external nose are as follows:
 Nasal bones
 Frontal process of maxilla
 Nasal part of frontal bone
Cartilages contributing to the structure of the external nose:
 Lateral cartilages (paired)
 Alar cartilages (paired)
 Septal cartilage (single)
Nasal Cavities:
The two nasal cavities are the uppermost parts of the respiratory tract and contain the olfactory receptors. The
nasal cavities are separated:
 from each other by a midline nasal septum;
 from the oral cavity below by the hard palate; and
 from the cranial cavity above by parts of the frontal, ethmoid, and sphenoid bones.
Nasal septum is composed of three structures:
1) Perpendicular plate of the ethmoid bone
2) Vomer
3) Septal cartilage
Each nasal cavity is divided into olfactory area (upper 1/3) and respiratory area (lover 2/3).
Posteriorly, each nasal cavity communicates with the nasopharynx through two openings called choana.
Walls of the nasal cavity
Each nasal cavity has a floor, roof, medial wall, and lateral wall.
The lateral wall is characterized by three curved shelves of bone (conchae), which are one above the other and
project medially and inferiorly across the nasal cavity.
The conchae divide each nasal cavity into four air channels:
These conchae increase the surface area of contact between tissues of the lateral wall and the respired air. The
openings of the paranasal sinuses, which are extensions of the nasal cavity that erode into the surrounding
bones during childhood and early adulthood, are on the lateral wall and roof of the nasal cavities. In addition,
the lateral wall also contains the opening of the nasolacrimal duct, which drains tears from the eye into the
nasal cavity.
Roof of the nasal cavity (anterior to posterior)
 nasal bone
 frontal bone
 cribriform plate of the ethmoid bone
 body of the sphenoid bone
Floor of the nasal cavity is formed by the hard palate (palatine process of maxilla and horizontal plate of the
palatine bone).
Lateral wall of the nasal cavity (anterior to posterior)
 frontal process of maxilla
 lacrimal bone
 superior nasal concha (of the ethmoid bone), middle nasal concha (of the ethmoid bone), inferior nasal
concha
 perpendicular plate of the palatine bone
 medial lamina of the pterygoid process.
Medial wall of the nasal cavity is formed by the nasal septum. The medial wall has a smooth surface,
whereas the lateral wall is uneven due to the existance of the nasal conchae.
The spaces between the nasal conchae and the lateral wall of the nasal cavity are called the meatus.
 Superior nasal meatus
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 Middle nasal meatus
 Inferior nasal meatus
The nose has an extensive arterial supply. The branches of the maxillary, ophthalmic and facial arteries supply
the nose.
Veins of the nose
There is a rich network of veins deep to the mucosa of the nose. This venous network is important in warming
the air before it enters the trachea and the lungs. The veins of the nose drain into facial, opthalmic and
sphenopalantine veins.
Nerves of the nose
Sensory innervation of the nose is mainly from the maxillary nerve and the ophthalmic nerve.
Within the epithelium of the olfactory region lies the olfactory cells (neurons). The peripheral processes of
these cells terminate under the mucosa and are sensitive to odour molecules in the air. The central processes
forms the olfactory nerves (CN I).
Paranasal sinuses
Paranasal sinuses are air filled spaces lying within the bones around the nasal cavity. The paranasal sinuses
develop as outgrowths from the nasal cavities and erode into the surrounding bones. All are:
 lined by respiratory mucosa, which is ciliated and mucus secreting;
 open into the nasal cavities; and
 innervated by branches of the trigeminal nerve [V].
Sinuses are named according to the bones they are located in:
 Frontal sinuses
 Ethmoid sinuses
 Sphenoid sinuses
 Maxillary sinuses
Frontal sinus
The frontal sinuses, one on each side, are variable in size and are the most superior of the sinuses. The
frontal sinus lies within the inner and outer plates of the frontal bone, posterior to the supercilliary arches and
the root of the nose. It drains into the middle nasal meatus.
Ethmoid sinuses
Several ethmoid air cells (3-15) collectively are called the ethmoid sinuses.
Ethmoid air cells form three groups:
Anterior group
Middle group
Posterior group
Sphenoid sinus
The sphenoid sinus is situated within the body of the sphenoid bone. It drains into the sphenoethmoidal recess.
Maxillary sinus
The maxillary sinuses, one on each side, are the largest of the paranasal sinuses and completely fill the bodies
of the maxillae. Each is pyramidal in shape with the apex directed laterally and the base deep to the lateral
wall of the adjacent nasal cavity. The maxillary opening drains into the middle nasal meatus.
Larynx
Larnynx is the organ of phonation (vocalization). It is formed of cartilage, muscles and connective tissue.
Larynx’s inner surface is covered by the respiratory mucosa. The cavity of the larynx is continuous below
with the trachea, and above opens into the pharynx (nasopharynx). During swallowing, the dramatic upward
and forward movements of the larynx facilitate closing the laryngeal inlet and opening the esophagus.
Skeleton of larynx is formed of 3 unpaired and 3 paired cartilages
Unpaired cartilages
 Thyroid cartilage (biggest)
 Cricoid cartilage
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 Epiglottic cartilage
Paired cartilages
 Arytenoid
 Corniculate
 Cuneiform
Thyroid cartilage
The thyroid cartilage is the largest cartilage of the larynx. It is formed of two laminae which fuse anteriorly at
the thyroid angle to form laryngeal prominence (Adam’s apple).
Fibroelastic membrane of the larynx
It lies under the mucosa of the larynx. The fibroelastic membrane of the larynx has thickenings at certain
regions and forms some of the ligaments between the cartilages. It is formed of two parts:
 Quadrangular membrane
 Conus elasticus
Conus elasticus (cricovocal membrane): Its free upper margin thickens to form the vocal ligament, which is
covered by mucosa to form the vocal fold. The opening between the two vocal folds is called rima glottis.
Each vocal ligament, converges anteriorly and attaches to the anterior part of the inner surface of the thyroid
cartilage (thyroid angle). Posteriorly they individually attach to the vocal processes of the arytenoid cartilages.
Rima glottis widens during inspiration and two vocal folds are approximated during phonation. Various
changes of the vocal folds determine the color, pitch and the tones of sound. Pitch increases with tensing,
decreases by relaxation. Intensity of expiration determines the loudness of sound.
Laryngeal Muscles
Extrisic muscles (covered in the neck)
These are the suprahyoid and infrahyoid muscles. They either depress or elavate the larynx and hyoid bone.
Intrinsic muscles: There are six intrinsic muscles in the larnyx. They move the laryngeal parts.
Vasculature of the larynx
The major blood supply to the larynx is by the superior and inferior laryngeal arteries:
Nerves of the larynx
Larynx is innervated by the inferior and superior laryngeal nerves. Both the inferior and superior laryngeal
nerves are branches of the vagus nerve (CN X).
Trachea
The trachea extends from the inferior end of larynx to the level of T5-T6 vertebra. It terminates by
dividing into right and left main bronchi at the sternal angle. Right main bronchus is wider, shorter, runs more
vertically.
The main bronchi give branches inside the lungs that form the bronchial tree.
Lobar bronchi (secondary bronchi)
3 on the right, 2 on the left
Segmental bronchi (tertiary bronchi)
Supply the bronchopulmonary segments
Trachea is formed of tracheal rings which are incomplete posteriorly.
Pleaura & the Lungs
Pleura
Each pulmonary cavity (right and left) is lined by a pleural membrane (pleura) that also reflects onto
and covers the external surface of the lungs occupying the cavities. Each lung is invested by and enclosed in a
serous pleural sac that consists of two continuous membranes: the visceral pleura, which invests all surfaces
of the lungs forming their outer surface, and the parietal pleura, which lines the pulmonary cavities. The
parietal pleaura also lines the inner surface of the thorax.
The pleural cavity—the potential space between the layers of pleura—contains a capillary layer of
serous pleural fluid, which lubricates the pleural surfaces and allows the layers of pleura to slide smoothly
over each other during respiration.
Lungs
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The two lungs are organs of respiration and lie on either side of the mediastinum surrounded by the
right and left pleural cavities. Air enters and leaves the lungs via main bronchi, which are branches of the
trachea. Their main function is to oxygenate the blood by bringing the inspired air into close relation with the
venous blood in the pulmonary capillaries. The pulmonary arteries deliver deoxygenated blood to the lungs
from the right ventricle of the heart. Oxygenated blood returns to the left atrium via the pulmonary veins.
Each lung bears the following features:
 Apex (upper pole)
 Three surfaces (costal, mediastinal and diaphragmatic).
 Root of the lung is formed by the structures entering and leaving the lung through its hilum.
 There are two lobes in the left lung seperated by the oblique fissure.
 There are three lobes in the right lung seperated by horizontal and oblique fissures.
Tracheobronchial Tree
 Trachea
 Principal bronchus
 Lobar bronchi (secondary bronchi)
 Segmental bronchi (tertiary bronchi)
 Terminal bronchiol
 Respiratory bronchiol
 Alveolar duct
 Alveolar sac
 Alveolus
Each lobar bronchus divides into several tertiary segmental bronchi that supply the bronchopulmonary
segments. The bronchopulmonary segments are the largest subdivisions of a lobe.
Vasculature of the pleaura and the lungs
Each lung has a pulmonary artery (carries venous blood) and two pulmonary veins (carries arterial blood)
Each lobe and segment has its own artery. Branching of the arteries follow the bronchial tree and terminate as
capillaries around the alveols. Intersegmental part of the pulmonary veins run within the septa and drain the
segments. Pulmonary veins also drain the visceral pleura. Veins of the parietal pleura drain into the systemic
veins mainly through the intercostal veins.
Bronchial arteries
Left bronchial arteries (from thoracic aorta) are paired and the right bronchial artery (usually arises from 3rd
posterior intercostal artery) is one single artery.
Parietal pleura is supplied by the arteries of the thoracic wall.
Bronchial veins
Right bronchial vein drains into the azygos vein, whereas left bronchial vein drains into the accessory
hemiazygos vein.
Nerves of the lungs and pleura
Lungs are innervated by pulmonary plexuses, which contains both sympathetic and parasympathetic nerves
Innervation of the lungs. The vagus nerve supplies parasympathetic innervation (bronchoconstrictor,
vasodilator to the lung vessels, secretomotor to the glands). The sympathetic innervation comes from the
sympathetic trunk (bronchodilator, vasoconstrictor to the lung vessels, inhibitor to the glands). Innervation of
the parietal pleura is by intercostal and phrenic nerves.
Lymph nodes
Lymphatics form a superficial and a deep plexus.
Dr.Kaan Yücel
http://www.youtube.com/yeditepeanatomy
Yeditepe Anatomy
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