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Textbook ofGeneral Anatomy

Textbook ofGeneral Anatomywith Systemic Anatomy,Radiological Anatomy, Dissection of Cadaver (Introduction)Case Scenarios & Clinical ApplicationsV S u bh ad r a Dev iS ri P a d ma vaS ri V e n ka t e sw a raE x- V i ce PSP ro f e soD e p a rt met h i M e d i ca l CI n st i t u t e o f Mri n ci p a l ( Aca dD e p a rt meri V e n ka t e sw aT i ru p a t i , An d hM S ( An a t o my)ra n d H e a dn t o f An a t o myo l l e g e f o r W o me n ( S P M C - W )e d i ca l S ci e n ce s ( S V I M S ) U n i vee mi c) , P ro f e sora n d H e a dn t o f An a t o myra M e d i ca l C o l l e g era P ra d e sh , I n d i arsi t yJAYPEE BROTHERS MEDICAL PUBLISHERSThe Health Sciences PublisherNew Delhi London Panama

PrefaceThe prerequisite for understanding the patient is the strong basic fundamental concepts inthe medical curriculum followed by its clinical application. Integration of basic and clinicalsciences leads to contextual learning, active rather than passive involvement in the process oflearning, which in turn, improves problem-solving skills of medical professionals, which is thesingle best approach to alleviate the suffering in the diseased.The Textbook of General Anatomy is conceived with a strong belief to inspire the newentrants into the portals of medicine about the importance of learning basic skills, knowledgeand attitude before they embark on reading the important branch of medicine the anatomy,that requires in-depth region-wise knowledge and skills.This book provides basic knowledge required for understanding the dissection of cadaverand study of various regions of the body adopting integrated approach. This book was preparedas per the syllabus of anatomy recommended by the Medical Council of India (MCI) and othermedical-related boards in Asia.All possible care was taken to ensure that the information provided facilitates understandingof importance of each of the systems in the body and their clinical relevance to motivatethe students of medicine on the importance of basics and its application in practicing theprofession.A simple language, easy-to-understand illustrations, flowcharts, tables and presentationin boxes are the unique adoptions in this book to drive the new age generation of students tomake it student friendly. These are highly useful for the readers to recall and for competitiveexamination preparation.The additional components that are included in this book to enrich the knowledge ofreaders is the gross anatomical, developmental, microscopic, radiological and clinical caseinsights in the form of author’s own images, personal collections and collection from severalclinicians/practitioners.This book can be used as a self-study guide by students of medical, dental and allied healthcourses to understand the basic concepts of human anatomy.As this is a single person’s effort, there is every possibility of omissions and commissionsthat needs the feedback from the anatomists, medical and allied specialists of all generationsand above all the students for whose benefit writing of this book is envisioned.V Subhadra Devi

ContentsChapter 1: Introduction to Anatomy 1Definition of Anatomy 1Structure Contributing to Function 1Evolutionary Revolutions in Anatomy 1Importance of Anatomy 2Subdivisions of Anatomy 2Approaches for Studying Anatomy 5Anatomical Position and Planes 5Anatomical Terminology 8History of Anatomy 13Chapter 2: Levels of Organization and Tissues of the Body Levels of Organization of the Human BodyCell 17Development of a Human Being 17Tissues of the Body 21Epithelial Tissue 21Connective Tissue 271717Chapter 3: Introduction to Skin and Fascia35 Skin 35 Fascia 42 Cavities of the Body 48Chapter 4: Skeletal System Skeletal System Cartilage 54 Bone 55Chapter 5: Introduction to Muscular System 5353General Features of Muscular Tissue 74Types of Muscle 75Structure of Skeletal Muscle 76Structural Components of a Skeletal Muscle 81Blood Supply of Skeletal Muscle 84Innervation of Skeletal Muscle 85Importance of Skeletal Muscle 88Functions 89Structures Associated with Skeletal Muscle 89Classification of Muscles 89Actions of Skeletal Muscles 92Naming of Muscles 9374

xiiTextbook of General AnatomyChapter 6: Introduction to Arthrology/Joints 98Definition 98Classification of Joints 98Fibrous Joints 100Cartilaginous Joints 103Synovial Joints 105Basic Terms Used for Describing Movements in JointsTerminology of Body Movements 115112Chapter 7: Introduction to Blood Vascular System Purpose and Functions 121Types of Circulation of Blood 126Classification of Blood Vessels 127Structure of Vascular Tree from Center to PeripheryAnastomoses 131Collateral Circulation 131End-Arteries 133Vasa Vasorum 134121127Chapter 8: Introduction to Lymphatic System138 Defense Mechanisms of the Body 140 Functions of Lymphatic System 140 Components of Lymphatic System 141Chapter 9: Introduction to Nervous System Chapter 10: Introduction to Splanchnology 152Subdivisions of Nervous System 152Nervous Tissue 153Spinal Cord and Spinal Segments 163Receptors 166Reflex Arc 169Nerve Fibers and their Myelination 170Autonomic Nervous System 176180Respiratory System 181Digestive System 185Urinary System 191Reproductive System 192Male Reproductive System 193Female Reproductive System 194Endocrine System 196Chapter 11: Introduction to Radiological Anatomy Classification of Radiological Procedures202202

xiiiContentsChapter 12: Introduction to Surface Anatomy215 Importance 215 Techniques Used 215Chapter 13: Introduction to Dissection of Cadaver Dissection 224Cadaver Respect 225Care of Cadaver 225Dissection Safety Measures224226Chapter 14: Multiple Choice Questions in General Anatomy237Index243

6CHAPTERIntroduction to Arthrology/JointsLearning Objectives Definition of joint Classification of different types of jointswith examples General features of a synovial joint Bursa Clinical case with anatomicalexplanationDefinitionA joint or articulation is a connection ora junction between two or more bones orcartilages to permit movement. All the 206 bones of the body with theexception of hyoid bone in the neck areconnected to at least one other bone. Study of joints is called arthrology (Greekarthron joint) or syndesmology (Greeksyndesmo fastening or joining). A joint can also be called an articulation(Latin articulatio connecting) or anarticulus. Some joints are merely bonds of unionbetween different bones and do not allowmovement. Joints of the skull (sutures)belong to this category. Some joints allow slight movement (intervertebral discs), while some others(shoulder) allow great freedom ofmovement. The number of joints in a child is morethan that of adult. As growth proceedssome of the bones fuse together, e.g. ilium,ischium, and pubis fuse to form hip bone;the two halves of frontal bone and that ofmandible fuse; the five sacral vertebraefuse to form single sacrum; and the fourcoccygeal vertebrae fuse to form singlecoccyx.Articulating parts in different bones: Long bones articulate at their endsFlat bones articulate at marginsShort or irregular bones articulate at theirarticular surfaces.Classification of JointsJoints are classified based on structure, region,and function (Flowcharts 6.1 to 6.3). Structural: Depending on the type ofmaterial binding articulating bones Regional: Depending on location Functional: Depending on the range ofmovement Combined: Combination of structure andfunction.

Introduction to Arthrology/JointsFlowchart 6.1: Broad classification of joints.Flowchart 6.2: Combined (structural and functional) classification of joints.Flowchart 6.3: Combined classification of joints and subtypes.99

100Textbook of General AnatomySubdivision of each with type, its specificidentification features with examples waspresented in Table 6.1 and Figures 6.1A to C.FeaturesFibrous Joints (Flowcharts 6.2 and6.3 and Figs. 6.1A to C) These are immovable/fixed joints, i.e.synarthroses.Articular surfaces are joined by fibroustissue.Table 6.1: Classification of joints.A. Structural classificationFibrous jointsCartilaginous jointsSynovial joints Fibrous tissue will be binding The intervening tissue between Articulating surfaces of bones the articulating endsIt is a solid joint without jointcavityThese joints provide stabilitywith no movementThey are protective in function.Example—joints betweenbones of skull (sutures)the articulating ends is eithera hyaline cartilage or afibrocartilage These joints lack a joint cavity It has limited mobility Examples—intervertebral disc,pubic symphysisare not united directly A membrane lined cavity filled with lubricating fluid enclosesthe bones and allows freemovementCartilage with synovialmembrane enclosing a jointcavity is presentThese joints allow a wide rangeof movementMobility is greater but stabilityis lessThese are the most commonjoints of the bodyExamples—hip joint,shoulder joint, knee joint, andsternoclavicular jointB. Regional classificationSkull typeVertebral typeLimb typeNo mobility but stableLimited mobility but very secureand stableMobile but not very secureSynarthrosesAmphiarthrosesDiarthroses Immovable joints: No mobility Example—sutures of skull Slightly movable joints: Freely movable joints:Cartilaginous and slightly movable(amphiathroses)Synovial and freely movable(diarthroses)C. Functional classificationSome degree of mobility.Hence, called amphi (twosided) arthroses because it isneither completely mobile norcompletely immobile Example—intervertebral discsMaximum degree (wide range)of mobility The name “diarthroses” isfrequently applied to thesynovial type of joint, wherethe movements are free andthe participating bones areseparated from each other,qualifying the adjective “two” Examples—shoulder, hip, andknee jointsD. Combination of structure and functionFibrous and immovable(synarthroses)

Introduction to Arthrology/JointsABCFigs. 6.1A to C: Classification of joints. (A)Synarthrosis—fibrous joint; (B) Amphiarthrosis—cartilaginous joint; (C) Diarthrosis—synovial joint. The edges of bones are dove-tailed intoone another. It lacks a joint cavity.The fibrous joints are further classified intovarious subtypes with each having specificfeatures.Subtypes of Fibrous Joints Sutures (synostosis) (Fig. 6.2):– Latin Sutura, derived from suo asewing or a seam. This type of joint isfound only in the skull. Synostosis: Obliteration of sutureleads to union of the articulatingbones by bone tissue itself. This iscalled synostosis (syn osteo joining by bone). When a suture obliterates, synostosis occurs first on the deeper aspect of the suture (internalor endocranial aspect) and gradually extends on to the superficial(external or pericranial) aspect.Complete obliteration occurs muchlater in life.– Fibrous tissue connects the bonesas sutural ligament (thin connectivetissue layer).– Majority are seen between bones thatossify in membrane.– These gradually ossify with advancingage.– These are immovable.– Seen between skull bones, e.g. sagittaland coronal sutures.– In a growing child they exhibit littlemobility.– Types: Depending on shape ofarticulating surfaces and articularmargins: Plane suture: The articulating margins are plane and united by suturalligament, e.g. joint between palatine processes of two maxillae (Fig.6.2A). Serrate suture: Saw-toothed appearance of bone edges, e.g. sagittalsuture of skull (Fig. 6.2B). Squamous suture: Edges of bonesoverlap, e.g. suture between parietal and squamous parts of temporal bone (Fig. 6.2C). Denticulate suture: The margins arelike teeth, e.g. lambdoid suture (Fig.6.2D). Schindylesis (wedge and groove suture): Edge of one bone fits into thegroove of the other bone, e.g. jointbetween rostrum of sphenoid andupper margin of vomer (Fig. 6.2E).Syndesmosis (Fig. 6.3):– Greek—Syndesmos ligament.– Surfaces of bones are united byfibrous connection, most commonly101

102Textbook of General AnatomyABCDEFigs. 6.2A to E: Fibrous joint—sutures: (A) Plane suture (Palatine process of two maxilla); (B) Serrate suture(Sagittal suture); (C) Denticulate suture (Lambdoid suture); (D) Squamous suture (Between parietal andsquamous part of temporal bone); (E) Schindylesis (Wedge and groove suture).Fig. 6.3: Fibrous joint—syndesmosis.by interosseous ligaments that persistthroughout life. It is also representedby slender fibrous cord or aponeuroticmembrane.– Slight degree of movement is possibledepending on the distance betweenbones and degree of flexibility ofuniting fibrous tissue.– For example, interosseous membranebetween forearm bones and leg bones,inferior tibiofibular joint; ligamentaflava (ligaments between spines ofvertebrae); and posterior part ofsacroiliac joint.

Introduction to Arthrology/Joints Gomphosis/peg and socket joint (Fig. 6.4):– Gomphos bolt, Osis condition.– A peg-shaped process gets insertedinto a socket and is united by fibroustissue.– For example, articulation of roots ofteeth into alveolar sockets anchoredby periodontal ligament.– This type of arrangement does notallow movement of tooth. If movementis allowed it is pathological and resultsin loosening of tooth.Fontanel (Fig. 6.5) In the newborn and in infants theconnective tissue between bones of skullis much wider especially in the skull cap,i.e. between sagittal, coronal, squamous,and lambdoid sutures. These are calledfontanels.During the time of parturition (delivery ofthe fetus) the fontanel provides flexibilityfor the delivery of the fetal head to passthrough birth canal by overlapping ofbones of vault or skull cap.After birth these fontanel allow expansionof skull with enlargement of brain.The fontanel decrease in width during 1styear after birth when the skull bones areenlarging and it becomes the suture.At some sutures, the connective tissue willossify and be converted into bone.Cartilaginous Joints(Flowcharts 6.1 to 6.3 and Fig. 6.1)Features Fig. 6.4: Fibrous joint—gomphosis.These are slightly movable joints, i.e.amphiarthroses.Fig. 6.5: Fontanel.103

104Textbook of General Anatomy Cartilage is present between articulatingsurfaces. Fibrous capsule holds the bones andcartilage in place.The cartilaginous joints are furtherclassified into various subtypes with eachhaving specific features.Classification and Features ofSubtypes with Examples Primary cartilaginous joints: Synchondroses/hyaline cartilaginous joints (Fig.6.6).– It is temporary. At a certain agecartilaginous plate is replaced by bone,i.e. it is ossified leading to synostosis.– Bones are lined by a plate of hyalinecartilage.– Primarily designed for bone growth.– All primary cartilaginous joints arequite immovable.– They are very strong.– Examples: Joints between epiphysis and diaphysis of a growing long bones: Itis replaced by bone when growth inlength of diaphysis is completed. ItFig. 6.6: Cartilaginous (primary) joint—synchondroses. is a temporary synchondrosis. Joint between basiocciput and basis phenoid: Synchondrosis is converted to synostosis around 25 years ofage. First chondrosternal joint: Articulation between costal cartilage of 1strib and manubrium. Anterior ends of 11 pairs of ribswith their costal cartilages.Secondary cartilaginous joints: Fibro cartilaginous/symphyses (Fig. 6.7).– These joints are permanent and persistthroughout life, except symphysismenti which is temporary.– Articular surfaces are covered by a thinlayer of hyaline cartilage and united bya disc of fibrocartilage/fibrous tissue.– Typically they occur in the medianplane of the body. Hence, they are alsocalled midline joints.– These permits limited movements dueto compressive fibrocartilage.– Examples: Intervertebral discs between thebodies of vertebra Manubriosternal joint Symphysis pubisFig. 6.7: Cartilaginous (secondary) joint—symphysis.

Introduction to Arthrology/Joints Symphysis menti. This is the onlysymphysis devoid of fibrocartilage. Synovial JointsFeatures These are freely movable joints, i.e.diarthroses. Wide range of movement ispossible.Most of the joints of appendicular skeletonbelong to this group.Articular surfaces are covered by cartilage.Ligaments hold the bones together.Joint cavity is present and it containssynovial fluid.Joint cavity is enveloped by articularcapsule which consists of an outer fibrouscapsule and an inner synovial membrane.Sometimes the joint cavity is dividedcompletely or incompletely by articulardisc or meniscus of fibrocartilage. Movements of joints vary from a simplegliding to a wide range.Factors contributing for the stability of thejoint are:– Bony contour– Ligaments– Muscles– Atmospheric pressure: Negligible factor.Synovial joints are important in the field ofhealth sciences, i.e. in medicine, nursing,physiotherapy, sports medicine, andmassage therapies.Description of General Structure ofSynovial JointThe basic structure of synovial joint can bedescribed under Figure 6.8.Articulating Bones The articulating surfaces are called maleand female surfaces.Fig. 6.8: Synovial joint—general structure.105

108Textbook of General AnatomyFig. 6.9: Bursae around knee. The bursae are present in almost all majorjoints of the body.There are four types of bursa:1. Synovial bursa: Majority of the bursaeare synovial, e.g. knee joint, andshoulder joint.2. Adventitious bursa: This bursadevelops if any surface of the body issubjected to repeated stress. They arecalled accidental bursa, e.g. bunion. Bunion is a deformity of great toe.The bursa at the metatarsophalangeal joint of big toe is swollen andthe head of first metatarsal tilts to aside and a large bump is seen.3. Subcutaneous bursa: It is locatedbetween the skin and the bonyprominence near the joint. Forexample, Olecranon bursa (studentselbow), prepatellar bursa (housemaidsbursa), superficial infrapatellar bursa,and Achilles bursa. Students elbow (Olecranon bursa)—located between the loose skinof the elbow and the ulna. Wheninflamed there will be pain, swelling, and redness of elbow withrestriction of movement. If infected, the bursa will open and the pusgets drained. Prepatellar bursa (housemaidsbursa)4. Subtendinous bursa: It is presentbetween the tendon and bone orbetween adjacent tendons or betweentendon and ligament. They are seen inthe limbs, e.g. retrocalcaneal bursa. Itis present from birth.5. Submuscular bursa: It is seen betweenmuscles, e.g. greater trochantericbursa, iliopsoas bursa, medial andlateral gastrocnemius bursae, andsubpopliteal bursae.Different types of bursae in the body, theirlocation, and type are presented in Table. 6.2.Classification of synovial joints (Flowchart 6.3):A. Based on number of articulating bones:Presented in Table 6.3.

109Introduction to Arthrology/JointsTable 6.2: Location of various bursae and their clinical importance.Name of bursaLocationTypeClinical importanceUlnar bursaBegins at wrist and ends at themiddle of palmSubtendinousRadial bursaExtends from wrist crease to distalphalanx of thumbSubtendinousHorse shoe abscess resultsfrom infection of radial or ulnarbursaSubpopliteal bursaBetween the lateral condyle of thefemur and the popliteus muscleSubmuscularIliopsoas bursaBetween the front of the hip jointand the iliopsoas muscle (flexorof hip)SubmuscularLargest bursa in the bodyIliopsoas bursitis—pain at thefront of the hip radiating downto the knee or even into thebuttocksGreatertrochanteric bursaSuperficial to greater trochanter offemurSubmuscularInflammation of this bursa is thecommon cause of hip painMedialgastrocnemiusBetween the medial head of thegastrocnemius and the capsule ofknee jointSubtendinousLateralgastrocnemiusBetween lateral head of thegastrocnemius and the capsule ofknee jointSubtendinousAnserine bursaBetween the medial (tibial)collateral ligament and thetendons of the sartorius, gracilis,and semitendinosus (i.e. the pesanserinus)SubmuscularInflammation of the bursa dueto constant friction becauseof certain pos

Autonomic Nervous System 176 Chapter 10: Introduction to Splanchnology 180 Respiratory System 181 Digestive System 185 Urinary System 191 Reproductive System 192 Male Reproductive System 193 Female Reproductive System 194 Endocrine System 196 Chapter 11: Introduction to Radiological Anatomy 202 Classi cation of Radiological .

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