BODY ORGANIZATION

Anatomical position and terms of direction

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1. Anatomical position and terms of direction

a. b. c. d. Superior or cranial Inferior or caudal Lateral Medial e. Proximal 1. Distal g. Posterior (dorsal) h. Anterior (ventral)

The position of structures within the body, and movement of body parts, is described by this set of terms and always refers to the position of the structure if the individual were standing in the position shown here. The head area is designated by the term cranial, referring to a term for the bones of the skull, while the opposite end of the body is caudal, referring to the tail. Cranial and caudal are synonymous with the terms superior and Inferior, respectively, indicating that a structure is higher or lower. Medial is toward the vertical midline of the body, while lateral is away from the midline. In the limbs, structures near the trunk are proximal, while those further from the trunk are distal. Anterior denotes the "front" of the body (in the direction of travel) while posterior is opposite. In humans, ventral (toward the belly) is equivalent to anterior, while dorsal is the same as posterior. Not shown in the illustration, superficial is near the body surface while deep refers to structures away from the body surface.

Anatomical planes of the body

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2. Anatomical planes of the body a. Frontal (coronal) plane b. Transverse (horizontal) plane c. Median (midsagittal) plane Planes of section are used in des cribing anatomical positions of structures. The three planes are perpendicular to one another, and provide a way to show a two d imensional aspect of a three-dimensional individual. If you were to figu ratively slice completely through the body from head to foot, cutting it into left and right portions, this would be a sagittal section. The mid sagittal plane, or median plane, divides the individual into equal halt' es, while other sagittal sections are parallel to that. A frontal or coro nal plane splits the organism into front and back portions (coronal is usually reserved for planes that pass through the skull), while a tra nsverse or horizontal plane cuts parallel to the ground, creating up per (cranial) and lower (caudal) portions.

3. Anterior regions of the body

a. Head b. Neck (cervical) c. Deltoid d. Sternal e. Pectoral (chest) 1. Brachial (arm) g. Cubital h. Abdominal I. Antebrachial (forearm) j. Trochanteric k. Palmar L Digital (fingers) m. Inguinal and pubic n. Penis (genital) o. Femoral (thigh) p. Knee q. Lig r. Dorsal foot

The head is connected to the trunk through the cervical or neck region. The trunk includes the chest and sternal regions, the abdomen, and the inguinal/pubic and genital regions (the penis, of course, is an organ that is only found in the male). The upper limbs may be divided into the deltoid (shoulder), brachial (upper arm), cubital (front of elbow), antebrachial (lower arm), palmar (hand) and digital (fingers) regions, while the lower limbs include trochanteric (hip), femoral (upper leg), knee, leg and foot. It may be helpful to remember that some regions are correlated with the names of underlying structures: the deltoid and pectoral regions are named for the muscles in that area, while sternal and trochanteric regions refer to skeletal structures underneath.

ORGANIZATION

Posterior regions of the body

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4. Posterior regions of the body a. b. c. d. e. f. g. Head Neck (cervical) Scapular (shoulder blade) Brachial (arm) Vertebral Olecranon (elbow) Lumbar h. Antebrachial (forearm) I. Gluteal j. Femoral (thigh) k. Popliteal I. Surat (calf) m. Calcaneal

From the posterior aspect, one can see areas not visible from the anterior view, such as scapular (shoulder blade), vertebral, lumbar (lower back) and gluteal (buttocks) regions in the trunk. The upper limbs include the olecranon or elbow region, while the lower limbs include popliteal (back of knee), sural (calf) and calcaneal (heel) regions. The olecranon and calcaneus are bone structures in their respective regions.

Body cavities

Dorsal body cavity: a b Thoracic cavity:

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Abdominopelvic cavity:

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5. Body cavities
a. b. c. d. e. Cranial cavity Spinal canal Superior mediastinum Anterior mediastinum Middle mediastinum (pericardial cavity)

1. Pleural cavity
g. Posterior mediastinum h. Abdominal cavity i. Retroperitoneal space j. Pelvic cavity

Body cavities are surrounded by the exterior surface and skeletal elements within the head and trunk region, providing protection and a place for soft tissues and organs to grow and function. The dorsal body cavity is found in the head and along the midline of the posterior aspect of the trunk; it encloses the brain and spinal cord. The larger ventral body cavity is divided into the thoracic and abdominopelvic cavities by the diaphragm. The thoracic cavity includes the right and left pleural cavities containing the lungs, and the mediastinum, bounded by the pleural cavities laterally, the sternum anteriorly, and the vertebral column posteriorly. The trachea, esophagus and the major blood vessels pass through the mediastinum, which may be divided into several compartmentsthe anterior, posterior, superior and middle or pericardial cavity; the latter encloses the heart. The abdominopelvic cavity includes the abdominal cavity, which extends from the inferior surface of the diaphragm to the superior edge of the pelvic bones, and the pelvic cavity with the urinary bladder, reproductive organs and the terminal portion of the digestive tract.

ORGANIZATION
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Skeletal and visceral structures of the head and neck

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6. Skeletal and visceral structures of the head and neck

a. External occipital protuberance b. Styloid process c. C4 - Fourth cervical vertebra d. Carotid tubercle of C6 e. Vertebra prominens f. First rib g. Esophagus h. Acromion process I. Coracoid process j. Scapula k. Sternum I. Clavicle m. Thyroid gland n. Thyroid cartilage o. Hyoid bone p. Mandible q. Nasal bone r. Zygomatic bone s. Frontal bone

An overview of head and neck structures shows skeletal elements surrounding and protecting the brain and spinal cord. The cranium extends from the frontal bone anteriorly to the occipital bone posteriorly. A small bump on its inferior surface is the external occipital protuberance. The facial bones include the nasal and zygomatic bones, which help to form the bridge of the nose and the orbit of the eye, respectively. The mandible is the lower jaw. In the neck region, the esophagus is part of the digestive tract and, anterior to it, the trachea is part of the respiratory system. At the junction of the head and neck is the small hyoid bone, held in place by ligaments from the styloid process of the temporal bone (forming the lateral surfaces of the cranium); the hyoid supports the larynx which is protected by the thyroid cartilage. Inferior to the larynx is the thyroid gland, which secretes the hormone thyroxin. The neck joins the trunk at the pectoral girdleincluding the clavicle and scapulathat supports the upper limbs. The clavicles also provide a connection with the axial skeleton where they articulate with the sternum. The coracoid and acromion processes of the scapula provide an attachment point for numerous muscles and ligaments.

Thoracic, abdominal and pelvic viscera, anterior view

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7. Thoracic, abdominal and pelvic viscera, anterior view

a. b. c. d. e. f. g. h. Thyroid cartilage Thyroid gland Clavicle Arch of aorta (behind sternum) Third rib Outline of heart Left lung Spleen Stomach Transverse colon Small intestine

1. Outline of descending colon

(behind small intestine) m. Sigmoid colon n. Outline of rectum o. Urinary bladder p. Ascending colon q. Gall bladder r. Liver s. Right lung t. Superior vena cava (behind sternum) u. Hyoid bone

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Organs of several body systems share the space within the cavities of the trunk. The superior part of these cavities is protected by the ribs, sternum and vertebral column of the axial skeleton, while the inferior portion is supported by the pelvic girdle. The thoracic cavity contains the lungs which surround the pericardial cavity containing the heart. Venous blood enters the heart through the vena cava and is pumped from the heart to the body through the aorta; this critical area is well protected behind the sternum. In the abdominal cavity, the digestive tract includes the stomach, small intestine, colon (ascending, transverse, descending and sigmoid), and rectum. Accessory glands of the digestive system include the liver, gall bladder and pancreas. The spleen is an organ of the circulatory, lymphatic and immune systems. The urinary bladder is located in the lower part of the abdominal cavity.

Thoracic, abdominal and pelvic viscera, posterior view

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8. Thoracic, abdominal and pelvic viscera, posterior view a. Atlas b. Pharynx c. Thyroid gland d. Trachea e. Right lung 1. Right adrenal gland g. Liver h. Pancreas I. Right kidney j. Small intestine k. Ascending colon L Iliac crest m. Pelvic girdle n. Seminal vesicle o. Sacrum p. Descending colon q. Left ureter r. Left kidney s. Spleen t. Outline of pancreas u. Diaphragm v. Esophagus w. Left lung x. First thoracic vertebra

The posterior view clearly shows the position of the vertebral column, extending from the atlas that articulates with the cranium to the fused vertebrae that form the sacrum, which articulates with the pelvic girdle. The wide pharynx at the rear of the nose and mouth divides into two passagewaysthe posterior esophagus leading to the stomach and the anterior trachea or windpipe. The rear of the thoracic cavity is filled with the lungs. The diaphragm is a thin sheet of muscle that marks the boundary between the thoracic and abdominal cavities, and functions in breathing. Accessory digestive organs include a large liver and the deep, mostly hidden pancreas, while the small intestine and parts of the colon are also visible from this view. The excretory system includes the dorsal, paired kidneys that form urine, and the ureters that carry the urine to the bladder. Superior to the kidney lie paired adrenal glands, part of the endocrine system. The only reproductive structures in view are the seminal vesicles, found only in the male.

ORGANIZATION

Thoracic, abdominal and pelvic viscera, right lateral view

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9. Thoracic, abdominal and pelvic viscera, right lateral view

a. Horizontal fissure of lung b. Gall bladder c. Stomach d. Transverse colon e. Ascending colon 1. Small intestine g. Ovary h. Urinary bladder I. Uterus The right lung is divided into three lobes by the horizontal and oblique fissures. In the abdominal cavity, the digestive tract occupies the largest part of the space, including the stomach, small intestine, colon and rectum. The small intestine terminates on the right side, leading into the ascending colon and then to the transverse colon. The gall bladder, an accessory organ of the digestive system, is found on the posterior surface of the right lobe of the liver. The kidneys lie near the posterior wall of the abdominal cavity, with the right kidney being positioned slightly inferior compared with the left. The kidneys and ascending colon are retroperitoneal, while the small intestine and transverse colon are peritoneal. Ureters lead from the kidneys down to the inferior and anterior position of the bladder. The female reproductive structures, the ovary and uterus may be found between the bones that form the pelvis. j. Rectum k. Ureter L Right kidney m. Li vertebra n. Liver o. Oblique fissure of lung p. Right lung q. C7 vertebra

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Thoracic, abdominal and pelvic viscera, left lateral view 10

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10. Thoracic, abdominal and pelvic viscera, left lateral view

a. C7 vertebra b. Oblique fissure of lung c. Left dome of diaphragm d. Spleen e. L1 vertebra 1. Left kidney g. Ureter h. Rectum 1. Prostate gland j. Urinary bladder k. Descending colon 1. Small intestine m. Transverse colon n. Stomach o. Liver p. Left lung

The left lung is divided into two lobes by an oblique fissure. The diaphragm is located between the thoracic and abdominal cavities, and forms a dome shape when relaxed. Usually lying left and ventral to the lobes of the liver is the stomach, which then leads to the small intestine, colon, and rectum. On the right side, the transverse colon leads to the descending colon, before undigested materials empty into the rectum for compaction and elimination. Posterior to the stomach is the left kidney, with the ureter funneling urine to the bladder. Although many male reproductive structures are located outside the abdominopelvic cavity, the prostate gland is found near the bladder.

INTEGUMENTARY SYSTEM

Layers of the skin and associated structures

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11. Layers of the skin and associated structures
a. b. c. d. e. 1. Sweat gland Meissner's corpuscle Hair Epidermis Dermis Hypodermis g. h. I. j. k. I. Papillary layer Reticular layer Hair follicle Sebaceous gland Pacinian corpuscle Arrector pili muscle The integumentary system includes the largest organ of the body the skin. It functions to protect underlying body parts from water loss, chemical insult, and physical harm. Specialized structures detect pressure, pain or temperature stimuli; Meissner's corpuscles sense light touch while Pacinian corpuscles sense deep pressure. Sebaceous glands secrete lipids that inhibit bacteria and lubricate the hair shaft. Sweat glands secrete water, waste products and electrolytes, in part to cool the skin and reduce body temperature. A cross-section of human skin reveals layers of the skin; the interface between the layers is often indistinct as one layer merges into the next. The epidermis consists of stratified squamous epithelium that provides mechanical protection against invasion by microorganisms. The dermis has a superficial papillary layer of areolar tissue, with capillaries and sensory neurons that supply the epidermis; and a deeper, thicker reticular layer with dense, irregular connective tissue and networks of blood vessels, lymph vessels, and nerve fibers. Many of the accessory organs such as hair follicles and sweat glands are embedded in the reticular layer. The subcutaneous layer, or hypodermis, consists of areolar and adipose tissue; distribution of body fat in this layer varies between the sexes or at different times in life (such as the presence of "baby fat").

SYSTEM

Epidermis

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12. Epidermis Epidermis

a. Stratum corneum b. Stratum lucidum c. Stratum granulosum d. Stratum spinosum e. Stratum basale 1. Melanocyte

Skin epidermis includes numerous layers or "strata" of cells. The innermost "basal" layer of epidermal cells includes cells capable of cell divisionone daughter cell remains in the stratum basale while the other is pushed into the adjacent "spiny" layer, the stratum spinosum, where a few cells may continue to divide. As additional cells are produced and pushed into the stratum spinosum, existing cells are pushed toward the surface. In the stratum granulosum, cells begin to produce keratin and the granular keratohyalin. The thick skin of palms and soles also includes the stratum lucidum, which is extensively keratinized; it is missing in the so-called "thin skin" found over the remainder of the body. The outer layer, the stratum corneum, consists of dead, "cornified" cells that contain keratin and are relatively water resistant. Melanocytes are special cells found in the basal layers; these cells make the pigment melanin and transfer it to keratinocytes. (These pigmented cells are found in deep layers in light-skinned individuals but in more superficial layers in those with darker skin.) Melanin is protective against ultravioletinduced damage.

SYSTEM

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13. Hair
a. b. c. d. Hair follicle Hair root Hair shaft Matrix e. Papilla 1. Sebaceous gland g. Arrector pili muscle h. Bulb

While humans possess less hair than most mammals, hair follicles are found on most areas of the skin except for parts of the hands and feet. Only 2-3% of a human's hairs are found on the head. The hair shaft is composed of dead, keratinized cells arranged in several layers. The hair follicle arises from the hair bulb, usually found in the subcutaneous or hypodermis layer; the follicle continues through the dermis, and the hair shaft that is produced protrudes through the epidermis. At the base of the follicle is the connective tissue papilla, containing capillaries and nerves. Around the papilla is the matrix, consisting of epithelial cells that divide to form the cells of the hair root. As cells continue to be produced in the matrix, they are pushed upward in the follicle, become keratinized, die, and harden to form the hair shaft. Associated arrector pill muscles control the angle of hair position, pulling the hair toward a vertical position when stimulated; the muscles also squeeze on sebaceous glands and push lipid secretions into the follicle to lubricate the hair shaft.

INTEGUMENTARY SYSTEM

Fingernail

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14. Fingernail a. b. c. d. Free edge Hyponychium Nail plate Distal phalanx e. Nail bed 1. Eponychium g. Germinal matrix h. Nail root

Nails form on the dorsal surfaces of the tips of the fingers and toes. They protect the exposed ends of the fingers and toes when they are subjected to mechanical stress, for example, when grasping or running. At the base of the nail, an epidermal fold called the eponychium allows the nail root to remain sequestered below the skin surface, near the distal phalanx bone. New nail is produced at the germinal matrix, near the nail root. The nail plate covers an area of epithelium called the nail bed that is continuous with the germinal matrix on its proximal side; the nail bed contains blood vessels and nerves. As the nail plate is produced, it streams along the surface of the nail bed and is attached to it through grooves on the underside of the nail plate. The free edge of the nail covers the hyponychium, an area where the nail bed meets the adjoining epidermis. The nail itself consists of hard, tightly packed, dehydrated cells that are packed with keratin. The keratin protein forms an extremely strong and hard protein matrix that is not readily soluble in water.

SYSTEM

Skeleton, anterior view

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15.

Skeleton, anterior view

n. Metatarsals o. Phalanges p. Tarsals q. Tibia r. Femur s. Metacarpals t. Carpals u. Lumbar vertebra v. Radius w. Ribs x. Sternum y. Cervical vertebra z. Zygomatic bone

a. Frontal bone b. Maxilla c. Mandible d. Clavicle e. Humerus 1. Costal cartilage g. Thoracic vertebra h. Ulna i. Hip bone (os coxae) j. Sacrum k. Phalanges I. Patella m. Fibula

The axial skeleton has 8o bones, including the skull and associated bones, the rib cage, and the vertebral column. Looking at the axial skeleton from the anterior aspect beginning with the head, one sees the frontal bone which is part of the cranium, the maxilla, zygomatic and mandible which are all facial bones, the cervical, thoracic, and lumbar vertebrae, the sacrum and coccyx, as well as the ribs which are connected to the sternum through the costal cartilage. The cranium and vertebral column protect the brain and spinal cord; the rib cage protects internal organs and facilitates breathing. The appendicular skeleton consists of 126 bones, including the pelvic and pectoral girdles and the limbs. Parts of the appendicular skeleton observed anteriorly include the clavicle of the pectoral girdle, the humerus, ulna, radius, carpals, metacarpals, and phalanges of the upper limbs, the hip bone of the pelvic girdle, the femur, patella, tibia, fibula, tarsals, metatarsals and phalanges of the lower limb. The pectoral and pelvic girdles connect the limbs to the axial skeleton; it is the appendicular skeleton that allows one to move about in the environment.

SKELETAL SYSTEM

Skeleton, posterior view

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16. Skeleton, posterior view Parietal bone Mastoid process Scapula Humerus Ulna 1. Radius g. Carpals h. Sacrum I. Phalanges j. Femur k. Tibia I. Tarsal m. Calcaneus a. b. c. d. e. n. Metatarsals o. Fibula p. Metacarpals q. Hip bone (os coxae) r. Lumbar vertebra s. Ribs t. Thoracic vertebra u. Acromion v. Cervical vertebra w. External occipital protuberance x. Occipital bone

Bones of the cranium include the parietal and occipital; the external occipital protuberance is the bump obvious at the midsagittal point on the inferior margin of the cranium. The spinal cord is protected by vertebrae, including the cervical (7), thoracic (12) and lumbar (5), as well as the fused vertebrae that make up the sacrum. The upper limbs articulate with the scapula of the pectoral girdle; the acromion is a large process of the scapula that articulates with the clavicle, which in turn, attaches to the sternum. Upper limb bones include the humerus, ulna and radius; wrist bones are carpals; hand bones are metacarpals; and finger bones are phalanges. The pelvic girdle supports the weight of the torso and the hip bone articulates with the lower limbs, which include the femur, tibia and fibula; ankle bones are tarsals, the largest of which is the calcaneus or heel bone; foot bones are metatarsals; and toe bones are phalanges.

SKELETAL SYSTEM

Anterior view of the skull

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17. Anterior view of the skull

a. b. c. d. e. Orbit Frontal bone Temporal bone Sphenoid bone Nasal bone f. Zygomatic bone g. Nasal septum h. Maxilla I. Mandible

The skull is composed of eight cranial bones and fourteen facial bones. Looking at the anterior surface, the facial bones include two nasal, two zygomatic, two maxillae, and one mandible. The maxillae and mandible form the upper and lower jaws. The maxillae and zygomatic form the inferior surfaces of the orbits, or eye sockets, while the superior rim of the orbit consists of the frontal bone and the back of the orbit is formed by the sphenoid, both cranial bones. The nasal bones and maxillae form the bridge and lateral rim of the nasal opening. The nasal cavity is subdivided by the nasal septum, formed from deeper facial bones including the vomer and one of the deep cranial bonesthe ethmoid. Cranial bones observed from this aspect include the frontal, which forms the forehead, and two temporal bones on the lateral surfaces.

SYSTEM

Skull, lateral view

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18. Skull, lateral view Coronal suture Parietal bone Zygomatic process Temporal bone Squamous suture Lambdoid suture External occipital protuberance h. Occipital bone I. Mastoid process j. External acoustic meatus k. Styloid process L Mandible m. Maxilla a. b. c. d. e. 1. g. n. Zygomatic bone o. Nasal bone p. Lacrimal bone q. Sphenoid bone r. Frontal bone s. Coronoid process t. Mandibular foramen u. Mandibular notch v. Mandibular condyle w. Ramus of mandible x. Angle of mandible y. Body of mandible z. Mental foramen

Observed from the lateral aspect, one can identify the large braincase formed by the cranial bones, including a single frontal, two parietal, two temporal, one occipital, one sphenoid and one ethmoid which is not seen in this view. The temporal bone has several processes that articulate with bones or provide attachment sites for muscles and ligaments, and the external acoustic meatus or external ear. The temporal bone articulates with the parietal bone at an immovable joint, the squamous suture. The mandible forms the lower jaw; it articulates with the temporal bone at the mandibular condyle. The strong temporalis muscle that closes the jaw attaches at the coronoid process. Openings in the mandible include the mental foramen for nerves and the mandibular foramen for blood vessels and nerves. Other facial bones visible from this aspect include the maxilla, zygomatic, nasal and lacrimal bones.

SKELETAL SYSTEM

Skull, superior view

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19. Skull, superior view a. Frontal bone b. Corona( suture c. Parietal bones d. Sagittal suture e. Lambdoid suture f. Occipital bone

Sutures are immovable joints between cranial bones where the bones are held together securely by dense fibrous tissue. The two parietal bones articulate at the sagittal suture. The frontal bone articulates with the two parietal bones at the corona! suture. The parietal bones meet the occipital bone at the lambdoid suture. However, at birth, an infant's skull is still growing and the bones do not completely meet; they are connected only by relatively large areas of fibrous tissue called fontanels. Most of the fontanels disappear within a few months after birth, although the largest may take a year or two before it closes completely.

SYSTEM

External surface of the base of the skull

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20. External surface of the base of the skull

a. Palatine process of maxilla b. Vomer c. Greater wing of sphenoid bone d. Medial pterygoid plate of sphenoid bone e. Mandibular fossa f. Carotid canal g. Jugular foramen h. Foramen magnum i. External occipital protuberance j. Occipital condyle k. Mastoid process 1. Styloid process m. Foramen lacerum n. Foramen ovate o. Zygomatic arch p. Lateral plate of sphenoid bone q. Palatine bone r. Incisive fossa

The hard palate is formed by the palatine process of the maxillae anteriorly and the palatine bones posteriorly; the incisive fossa forms a passageway for nerves and arteries. The vomer forms the bony part of the nasal septum. The pterygoid plates are extensions of the sphenoid bone that form attachment sites for muscles that move the lower jaw. The foramen magnum is the large hole in the occipital bone through which the spinal cord passes; on either side, the occipital condyles articulate with the first vertebra of the neck. Between the foramen magnum and the external occipital protuberance, a bony crest marks attachment sites for ligaments stabilizing the vertebrae of the neck. The mastoid process of the temporal bone provides an attachment site for muscles rotating the head; muscles attached to the styloid process control the hyoid, the pharynx and the tongue. Holes for passage of blood vessels and nerves include the carotid canal and foramen lacerum in the temporal bone, the foramen ovate in the sphenoid bone, and the jugular foramen formed at the junction of the temporal and occipital bones. A depression in the temporal bone, the mandibular fossa, articulates with the mandible.

SYSTEM

Median sagittal section of the skull

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21. Median sagittal section of the skull a. b. c. d. e. Frontal bone Frontal sinus Crista galli Nasal bone Cribriform plate of the ethmoid bone 1. Perpendicular plate of the ethmoid bone g. Vomer h. Maxilla 1. Palatine bone j. Mandible k. Coronal suture I Squamosal suture m. Parietal bone n. Temporal bone o. Sella turcica p. Occipital bone q. Internal acoustic meatus r. Sphenoid bone s. Sphenoid sinus

A sagittal section of the skull shows the inner surface of the braincase, including the frontal, parietal, occipital, sphenoid, ethmoid and temporal bones. The inner ear opens through the temporal bone at the internal acoustic meatus. The sella turcica is a saddle-like portion of the sphenoid that encloses the pituitary gland which projects from the surface of the brain. Facial bones include the nasal, vomer, maxilla, palatine, and mandible. Several bones have hollow spaces known as sinuses to make the bones lighter and to provide a source of mucus; cross sections of these bones reveal the frontal sinus and the sphenoid sinus. The nasal cavity lies superior to the hard palate; its roof is formed by the cribriform plate of the ethmoid while the perpendicular plate of the ethmoid forms part of the nasal septum. The crista gain is a ridge of the ethmoid that projects superiorly from the cribriform plate.

SYSTEM

Right temporal and sphenoid bones

Right temporal bone, lateral view

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Sphenoid bone, superior view

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22. Right temporal and sphenoid bones

Temporal bone: a. Squamous part b. Zygomatic process c. Mandibular fossa d. External acoustic meatus e. Styloid process f. Mastoid process Sphenoid bone: g. Hypophysial fossa (sella turcica, pituitary fossa) h. Optic canal i. Lesser wing I. Superior orbital fissure k. Greater wing I Foramen spinosum m. Pterygoid hamulus n. Dorsum sellae o. Foramen ovate P. Foramen rotundum q Anterior clinoid process

The large, flat surface of the temporal bone is the squamous region. The mandibular fossa is a depression that articulates with the mandible. The zygomatic process articulates with the zygomatic bone to form the cheekbone, while the mastoid process is an attachment site for muscles, and the styloid process is an attachment site for muscles and ligaments supporting the hyoid bone. The external acoustic meatus provides the opening for the auditory canal. The sphenoid bone is a butterfly-shaped bone that articulates with both cranial and facial bones and provides crossbracing that serves to strengthen the skull. The central region or body is composed of the dorsum setae and the sella turcica, which contains a depression where the pituitary gland is located, the hypophysial fossa. The lesser wing of the sphenoid is located anterior to the sella turcica; it is penetrated by the optic canal carrying the optic nerve from the rear of the orbit toward the brain. The greater wing is lateral to the body. The superior orbital fissure, foramen spinosum, foramen ovate, and foramen rotundum are passages that carry blood vessels and nerves to the face, jaws or eye region.

SKELETAL SYSTEM

Hyoid bone

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23. Hyoid bone

a. Lesser horn b. Greater horn c. Body The small hyoid bone is located at the base of the tongue and immediately superior to the larynx. It is crucial to human speech as it braces the tongue and larynx to allow a wide range of movements. The body of the hyoid is an attachment site for muscles of the pharynx, larynx and tongue. The greater horns support the larynx and provide attachment sites for muscles moving the tongue. The lesser horns are suspended from the styloid processes of the temporal bones via ligaments.

SYSTEM

Vertebral column, lateral view

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24. Vertebral column, lateral view

a. Cervical vertebrae (cervical curvature) b. Thoracic vertebrae (thoracic curvature) C. Lumbar vertebrae (lumbar curvature) d. Sacrum (pelvic curvature) e. Coccyx

The vertebral column is the part of the axial skeleton that surrounds and protects the spinal cord, while bearing the weight of the head, neck and trunk. The vertebral column is not straight, as can be seen in this lateral view; its curves accommodate the thoracic and abdominopelvic viscera as well as balance the weight of the trunk and head over the lower limbs. Regions of the vertebral column and their corresponding curves include 7 cervical vertebrae (the cervical curve is concave on the posterior surface), 12 thoracic vertebrae (the thoracic curve is convex on the posterior surface), 5 lumbar vertebrae (the lumbar curve is concave), a sacrum (pelvic or sacral curve is convex), and a coccyx.

SKELETAL SYSTEM

Posterior view of the vertebrae

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25. Posterior view of the vertebrae

a. Cervical vertebrae b. Thoracic vertebrae c. Lumbar vertebrae d. Sacrum e. Coccyx

The adult human vertebral column consists of 26 bones-7 cervical vertebrae (C1C7, including the atlas[Ci] and axis[C2D form the neck, 12 thoracic vertebrae (Ti-T12) support the upper back and articulate with ribs, 5 lumbar vertebrae (11-15) support the lower back, a sacrum consisting of 5 fused vertebrae articulates with the pelvis, and a coccyx resulting from the fusion of the final 4-6 vertebrae. Generally, one spinal nerve emerges at each vertebra; however, although there are only 7 cervical vertebrae, there are 8 cervical nerves. Each individual vertebra consists of a vertebral body or centrum that transfers weight to the next lower vertebra, a vertebral arch forming the posterior margin of the vertebral canal, and variable types of processes that either provide attachment points for muscles or articulate with ribs. The 5 sacral vertebrae begin fusing after puberty and are usually completely fused by age 25-30. The coccyx is not completely fused until late in adulthood.

SYSTEM

Atlas (Ci) and axis (C2), superior view a Atlas i

26

Atlas and Axis

KAPLAN) MEDICAL

26. Atlas (Ci) and axis (C2), superior view

a. b. c. d. e. Posterior tubercle Vertebral foramen Lateral mass Transverse foramen Superior articular process (facet) f. Anterior tubercle g. Anterior arch h. Transverse process I. Groove for vertebral artery

j. Posterior arch k. Facet for odontoid

process of axis

I. Bifid spinous process

m. Body of axis n. Odontoid process (dens) o. Arch of axis (lamina) p. Axis q. Atlas

The first cervical vertebra is called the atlas; its superior articular processes have facets that articulate with the occipital condyles of the skull in a type of joint that permits forwardbackward motion of the head. The body of the second cervical vertebra, the axis, has a prominent odontoid process that extends superiorly and articulates with a facet on the atlas, providing a pivot point to allow rotational movement of the head. The facet of the superior articular process of the axis articulates with a similar flat surface on an inferior articular process of the atlas. Like other individual vertebrae, the axis has a prominent dorsal spinous process, which is notched as it is in cervical vertebrae 3-6 and is referred to as bind; the atlas has a smaller dorsal process known as the posterior tubercle. Laterally, a transverse process provides attachment sites for muscles, while the transverse foramen allows passage of vertebral arteries and veins.

SYSTEM

Cervical vertebra, superior and lateral views

27

Superior view

I(APLA) MEDICAL

27. Cervical vertebra, superior and lateral views a. b. c. d. e. Bifid spinous process Vertebral foramen Lamina of vertebral arch Pedicle of vertebral arch Superior articular process 1. Transverse process g. Body h. Uncus of vertebral body I. Transverse foramen j. Inferior articular process

Cervical vertebrae have a relatively large vertebral foramen, since the spinal cord still includes most of the axons that exit the brain, and the vertebral body only needs to support the weight of the head. The vertebral foramen is bounded by the body anteriorly, the pedicles laterally, and the laminae posteriorly. Where the lamina meet is a posteriorly projecting protrusion called the spinous process, which is notched, or bifid, for C2-C6. Articular processes lie at the junction between the pedicles and laminae; each has a relatively flat surface, the facet, which articulates with the articular process of the neighboring vertebra. The superior articular process articulates with the vertebra above, and the inferior articular process articulates with the vertebra below. The uncus is a ridge of bone around the superior edge of the body in cervical vertebrae, increasing the stability of the joint with the vertebra above it. Laterally, transverse processes provide attachment sites for neck muscles; a hole, the transverse foramen, allows passage of vertebral arteries and veins.

SYSTEM

Thoracic vertebra, superior and lateral views

28

Superior view h

Lateral view

KAPLAN) MEDICAL

28. Thoracic vertebra, superior and lateral views

a. b. c. d. e. 1. Spinous process Vertebral foramen Transverse process Superior articular process Superior costal facet Body g. Pedicle h. Lamina I. Costal facet of transverse process j. Inferior articular process k. Inferior costal facet

The twelve thoracic vertebrae each have a larger body and smaller vertebral foramen than found in the cervical vertebrae. A long, slender dorsal spinous process projects inferiorly. The superior and inferior articular processes articulate with adjacent vertebrae. The thoracic vertebrae articulate with ribs; the superior and inferior costal facets arise at the junction between the vertebral body and pedicle for T2-T8, while a single costal facet is found for Ti and T9-712. Two facets are needed for T248 because each pair of ribs lies between two adjacent vertebrae, articulating with the inferior costal facet of the upper vertebra and the superior costal facet of the vertebra inferior to it. For Ti and T9412, a single pair of ribs articulates with a single vertebra. The ribs also articulate with the costal facet of the transverse process in vertebrae Ti-Tto. The multiple articulations help the ribs to be mobile enough for the change in volume of the rib cage during breathing.

SYSTEM

Lumbar vertebra, superior and lateral views

29

Superior view

/a r--

Lateral view

,s

I(APLA) MEDICAL

29. Lumbar vertebra, superior and lateral views a. b. c. d. Spinous process Vertebral foramen Superior articular process Transverse process e. Body of vertebra 1. Pedicie g. Lamina (vertebral arch) h. Inferior articular process

The five lumbar vertebrae are the most massive of the vertebral column since they support the most weight, and each has a thick, oval body. Lumbar vertebrae have the smallest vertebral foramina because many of the axons from the brain have already branched out from the spinal cord into the torso or upper limbs. The spinous process is short, sturdy and projects dorsally; lower back muscles are attached here that adjust the lumbar curve of the vertebral column. The superior articular process faces medially while the inferior articular process faces laterally. Transverse processes are slender and project dorsolaterally.

SYSTEM

Sacrum and coccyx, anterior view

30
a

KAPLAN) MEDICAL
...s

30. Sacrum and coccyx, anterior view

a. Sacral pro montory b. Superior a rticular process c. Lateral m ass (ala)

d. Transverse lines
e. Anterior sacral foramina f. Coccyx

Five sacral vertebrae fuse to form the sacrum, while 3.5 coccygeal vertebrae fuse to form the coccyx. These vertebrae begin fusing after puberty; the sacrum is usually completely fused by the midtwenties, while the coccyx is not completely fused until late in adulthood. The coccyx is a vestigial remnant of the tail of evolutionary ancestors, but in humans, has no vertebral foramen and does not surround a part of the spinal cord. The regions of the sacrum include the sacral promontory that articulates with the last lumbar vertebra (L5), the two broad lateral masses (ala) on either side, and the central sacral body, corresponding to the fused vertebral bodies; the transverse lines mark the position of the intervertebral discs between the bodies of the fused vertebrae. The anterior sacral foramina provide passageways for sacral nerves as well as arteries.

SKELETAL SYSTEM

Sacrum and coccyx, posterior view

31

KAPLAN) MEDICAL
.,..

31. Sacrum and coccyx, posterior view

a. Superior articular process b. Auricular surface c. Lateral sacral crest

d. Median sacral crest

e. Posterior sacral foramina 1. Coccyx

The posterior surface of the sacrum is convex, allowing room within the pelvic region for internal organs and providing many surfaces for attachment of muscles and ligaments. Laterally, the auricular surfaces articulate with the pelvis at the iliac joints. The median sacral crest is a bumpy ridge produced from the fused spinal processes of the sacral vertebrae; deep to this ridge is the sacral canal which is the continuation of the vertebral canal. The lateral sacral crest represents the fused transverse processes of the sacral vertebrae. Between the two ridges are the posterior sacral foramina, passageways for sacral nerves as well as arteries. Sexual differences existin the female, the sacrum is shorter and wider than in the male, with most of the curvature in the lower half, but it is more evenly distributed in the male.

SKELETAL SYSTEM

Intervertebral discs, lateral and midsagittal views

32

1(All MEDICAL

32. Intervertebral discs, lateral and midsagittal views

a. b. c. d. e. 1. Intervertebral disc Superior articular process Transverse process Inferior articular process Intervertebral foramen Anterior longitudinal ligament g. Supraspinous ligament h. Interspinous ligament I. Ligamentum flavum j. Posterior longitudinal ligament

A lateral view of the vertebral column shows that adjacent bodies of the vertebrae are cushioned by the intervertebral discs that permit some extension and flexion of the spine. Intervertebral discs are composed of fibrocartilage that resists compression but allows a little flexibility. The pedicles of adjacent vertebrae are separated by the Intervertebral foramina that allow the passage of nerves entering or exiting from the spinal cord that runs through the vertebral foramen within the vertebral arch formed in part by the pedicles. The lamina of adjacent vertebrae articulate through the facets on the superior and inferior articular processes, while the transverse processes project laterally. Ligaments connect and stabilize the vertebrae. Anterior and posterior longitudinal ligaments run along the bodies of the vertebrae, supraspinous and interspinous ligaments connect the dorsal spinous processes, and the ligamentum flexum connects the adjacent laminae.

SKELETAL SYSTEM

Sternum, anterior view

33

MEDICAL

33. a. b. c. d.

Sternum, anterior view

e. Costal notches 1. Body g. Xiphoid process

Suprasternal notch Clavicular notch Manubrium Sternal angle

The sternum, part of the axial skeleton, functions to protect and support the internal organs of the thoracic cavity, and to form an attachment point for ribs. It has three main portionsthe superior section is the triangular manubrium that articulates with the clavicles, the main body, and the small xiphoid process located inferior to the body. The superior edge of the manubrium has two points of attachment for the clavicles, located laterally on either side of the medial depression known as the suprastemal notch. At the point of attachment between the manubrium and body of the sternum is the sternal angle, a convenient marker located at the level of the second rib. The anterior ends of ribs 1-7 articulate with the sternum; the first rib articulates with the manubrium at sites inferior to the clavicular notches, and ribs 2.7 have cartilage connections to the body of the sternum at the costal notches. Ribs 8.10 are attached by cartilage to the cartilage connections of rib 7. The xiphoid process forms an attachment point for some muscles, including the diaphragm.

SKELETAL SYSTEM

Rib and vertebra, articulated, superior view; rib, posterior view

34

KAPLAN) MEDICAL
s

34. Rib and vertebra, articulated, superior view;

rib, posterior view

a. b. c. d. Thoracic vertebra Head of rib Neck of rib Tubercle of rib e. Angle of rib f. Costal groove g. Sternal extremity

The ribs function to protect the organs of the thoracic cavity and to provide a flexible cavity for breathing. The thoracic vertebrae articulate with the ribs; the head of the rib attaches at the costal facets near the body of the vertebrae while the tubercle of the rib is positioned at the costal facet of the transverse process. The shaft of the rib curves anteriorly at the angle of the rib. Along the inferior border of the internal surface of the rib lies a costal groove which marks the site where nerves and blood vessels pass. Cartilage connected to ribs 17 at the sternal extremity articulate with the sternum at the costal notches. Cartilage attached to ribs 8io, in turn, attaches to the cartilage from rib 7.

SYSTEM

Rib cage, anterior view

35

KAPLA) MEDICAL
s

35. Rib cage, anterior view

a. b. c. d. e. 1st thoracic vertebra Clavicle Scapula Costal cartilage 12th thoracic vertebra f. 1st lumbar vertebra g. 12th rib h. nth rib I. Sternum j. 1st rib

The rib cage consists of the sternum and the 12 pairs of ribs, which are attached posteriorly to the thoracic vertebrae. Ribs 1-7 articulate with the sternum through the costal cartilage; for ribs 8.io the costal cartilage articulates only indirectly with the sternum since it fuses to the cartilage of rib 7 for support. Ribs 11-12 do not attach to the sternum at all; they are connected with other skeletal elements only at the vertebral end. The articulation between the axial skeleton and the pectoral girdle occurs where the clavicle, or collarbone, attaches to the sternum at the manubrium; in turn, the clavicle articulates with the scapula or shoulder blade. The function of the rib cage is to protect the heart, lungs and other thoracic organs as well as to serve as an attachment point for muscles involved in movements of the pectoral girdle and upper limbs, adjustments to the position of the vertebral column, and most importantly, breathing.

SKELETAL SYSTEM

Pectoral girdle and upper limb, anterior view

36

KAPLA) MEDICAL

36. Pectoral girdle and upper limb, anterior view

a. b. c. d. e. 1. Clavicle Acromion process Coracoid process Humerus Radius Sternum g. h. i. j. k. Scapula Ulna Carpals Metacarpals Phalanges

The pectoral girdle is composed of four bones, two clavicles and two scapulae. The acromion and coracoid processes of the scapulae are points of attachment for numerous ligaments and muscles. The clavicle articulates with the sternum of the axial skeleton medially, and with the scapula laterally. The primary function of the pectoral girdle is to provide an anchor for movements of the arm. Each upper limb consists of a humerus in the (upper) arm, an ulna and a radius in the forearm, eight carpal bones in the wrist, five metacarpal bones in the hand, and u; phalanges or finger bones. At the shoulder, the humerus articulates with the scapula to produce a wide range of arm movements; at the elbow, the humerus articulates with the radius and ulna to flex the forearm, while articulation between the radius and ulna allows pronation of the forearm. The complex wrist joint provides for a wide range of movements while the finger joints allow flexion and extension of the fingers.

SKELETAL SYSTEM

Scapula, anterior and lateral views

Anterior view b

37

f Lateral view

MEDICAL

37. Scapula, anterior and lateral views a. b. c. d. Acromion process Superior border Coracoid process Glenoid fossa e. Subscapular fossa 1. Lateral border g. Medial border h. Inferior angle

Viewed from the anterior perspective, the scapula has an obvious large, triangular surface that is roughly concave, forming the subscapular fossa; its edges are, observed in a clockwise direction from this aspect, the superior border, medial border, inferior angle, and lateral border. Between the superior and lateral borders, the scapula articulates with the humerus at the shoulder joint. The glenoid fossa is the concave 'socket' within which the rounded head of the humerus rotates. Two processes also originate in this area and extend superiorly; the more anterior is the coracoid process which is an attachment point for ligaments and tendons; posterior to this is the larger acromion process, which articulates with the clavicle as well as being the attachment point for additional ligaments and tendons of the shoulder joint. The lateral view clearly shows that these two processes project from the thin plane of the scapula; the rounded nature of the glenoid fossa also becomes more obvious.

SYSTEM

Scapula, posterior view

38

KAPLAI9 MEDICAL

38. Scapula, posterior view

a. b. c. d. e. Acromion process Coracoid process Glenoid fossa Infraspinous fossa Lateral border f. g. h. I. J. Inferior angle Medial border Supraspinous fossa Superior angle Spine

The basic triangular shape of the scapula is bound by the superior angle, the medial border, the inferior angle, and the lateral border. Muscles attached to these margins position the scapula; there is no direct articulation of the scapula with the vertebrae or rib cage. Located in the angle between the lateral and superior borders, the glenoid fossa articulates with the humerus of the arm. The posterior surface is marked by the prominent ridge called the scapular spine, which is continuous with the acromion process. The clavicle articulates with the acromion process at the medial surface of its anterior projection. The spine divides the posterior face of the scapula into a smaller supraspinous fossa and a larger infraspinous fossa; both are sites of attachment for numerous muscles of the shoulder and back.

Clavicle and related bones, superior view; clavicle, inferior view

Superior view

39. Clavicle and related bones, superior view;

clavicle, inferior view

a. b. c. d. First thoracic vertebra (Ti) First rib Scapula Acromial end of clavicle e. Conoid tubercle f. Sternal end of clavicle g. Sternum

Looking down from above the head and shoulders reveals the superior aspect of the pectoral girdle including both the clavicle and scapula. The girdle is anchored to the axial skeleton by a single articulation anteriorly, and is held in position posteriorly by many small muscles attached to the scapula; this provides mobility but limited strength to the shoulders as they provide the anchor for arm motions. The S-shaped clavicle articulates medially with the manubrium of the sternum just above the first rib, and laterally with the acromial process of the scapula. The acromial end of the clavicle is broader than the sternal end; at the posterior margin of the inferior surface near the acromial end is the conoid tubercle which is an attachment point for the conoid ligament that also attaches to the coracoid process of the scapula.

SKELETAL SYSTEM

Humerus, anterior and posterior views

40

Anterior view

Posterior view

KAPLA!:1) MEDICAL

40. Humerus, anterior and posterior views

a. b. c. d. e. Greater tubercle Lesser tubercle Intertubercular sulcus Head Anatomical neck 1. Surgical neck g. Deltoid tuberosity h. i. j. k. Supracondylar ridges Lateral epicondyle Coronoid fossa Olecranon fossa 1. Medial epicondyle m. Capitulum n. Trochlea

The rounded head of the humerus moves within the cup-shaped glenoid fossa of the scapula. Adjacent to the head are two projections on the lateral surface of the humerusthe greater tubercle is the most lateral point of the body at shoulder level and the lesser tubercle lies on the anterior, medial surface and is separated from the greater tubercle by a shallow groove, the Intertubercular sulcus. Muscles attach to both tubercles while a large tendon passes along the length of the sulcus. The edge of the joint capsule is called the anatomical neck, while the narrower surgical neck marks the metaphysic of the growing bone. The deltoid muscle attaches to the shaft at the deltoid tuberosity. At the distal end of the humerus, the capitulum and the trochlea articulate with the radius and ulna, respectively. The radial, coronoid and olecranon fossae are depressions that accommodate the radial head, ulnar coronoid process and ulnar olecranon as they move. Laterally, the humerus widens out in the medial and lateral epicondyles; supracondylar ridges provide attachment sites for muscles.

SKELETAL SYSTEM

Ulna and radius, lateral and anterior views

a b

41

d e g

k. Ulna, lateral view

Ulna and radius, anterior view

KAPLAN) MEDICAL

41. Ulna and radius, lateral and anterior views a. b. c. d. e. f. Olecranon process Trochlear notch Coronoid process Radial notch Tuberosity of the ulna Head of radius g. h. I. j. k. I. Radial tuberosity Interosseous margin Ulnar notch Styloid process of ulna Head of ulna Styloid process of radius

The bones of the forearm are the ulna and radius. The more medial and longer ulna articulates with the trochlea of the humerus at the trochlear notch. The superior edge of the trochlear notch is the olecranon process which fits into the olecranon fossa of the humerus when the forearm is extended, and the inferior edge of the trochlear notch is the coronoid process which fits into the coronoid fossa of the humerus when the forearm is flexed. Lateral to the coronoid process, the radial notch of the ulna articulates with the head of the radius. Distal to the radial head, the radial tuberosity forms an attachment site for muscles. A fibrous sheet called the interosseous membrane connects the radius and ulna along the interosseous margins, and serves as a site for muscle attachment. At their distal ends, the ulna and radius articulate with each other, and the radius articulates with bones of the wrist. The lateral surface of the ulnar head articulates with the ulnar notch of the radius. A stytoid process extends distally from each of the bones, providing many attachment sites for ligaments and muscles of the wrist.

SKELETAL SYSTEM

Hand, posterior (dorsal) view

42

KAPLAN) MEDICAL
......

42. Hand, posterior (dorsal) view

a. b. c. d. e. f. Phalanges Head of metacarpal Shaft of metacarpal Base of metacarpal Hamate Capitate g. Triquetrum h. Lunate I. Metacarpal J. Trapezoid k. Trapezium L Scaphoid

Eight carpal bones make up the flexible wrist, articulating at individual joints that allow limited, gliding motion between the bone surfaces. The proximal row of carpals includes the scaphoid bone, lunate bone, triquetrum, and pisiform bone; the distal row consists of the trapezium, trapezoid bone, capitate bone, and the hamate bone. Articulating with the distal carpal bones are the five metacarpal bones, forming the hand. The metacarpals are identified by roman numerals; metacarpal I is most lateral, forming the base of the thumb, and articulates with the trapezium. The proximal base of each metacarpal articulates with the carpals. The metacarpal heads articulate distally with phalanges, or finger bones. The thumb has two phalanges; each of the other fingers has three, making a total of 14 phalanges on each hand. The joint between metacarpal I and the trapezium at the base of the thumb is a saddle joint, allowing more range of motion than found with the other metacarpals, and leading to the abilities associated with having an "opposable" thumb.

SYSTEM

Hand, anterior (palmar) view

43

KAI .AN MEDICAL ......_21.)

43. Hand, anterior (paha view

a. b. c. d. e. Phalanges Metacarpal Trapezoid Trapezium Capitate f. Scaphoid
g. Lunate

h. Pisiform
i. Hamate

Since the anatomical position is defined with the palms of the hands facing forward, the thumb is more lateral while the fingers are more medial. Among the proximal carpal bones, the lateral scaphoid bone articulates with the styloid process of the radius; the lunate bone also articulates with the radius. The triquetrum articulates with the cartilaginous disc that separates the head of the ulna from the wrist; the small, anterior peashaped pisiform bone is seen primarily from the anterior view and only articulates with the triquetrum. Among the distal carpal bones, the lateral trapezium articulates with metacarpals I and II; the trapezoid bone articulates with metacarpal II; the capitate articulates with metacarpals II, Ill, and IV; and the hamate articulates with metacarpals IV and V. The distal head of each metacarpal articulates with the more proximal of the phalanges in the finger; the thumb has proximal and distal phalanges while each finger has proximal, medial and distal phalanges.

SYSTEM

Hip bone, lateral view

44

Adult hip bone

p
Hip bone of a child

KAPLAN) MEDICAL

44. Hip bone, lateral view a. b. c. d. e. f. g. h. i. Iliac crest Posterior superior iliac spine Posterior inferior iliac spine Greater sciatic notch Ischia' spine Lesser sciatic notch Ischia' tuberosity Ischial ramus Acetabulum I. Obturator foramen k. Inferior pubic ramus I. Superior pubic ramus m. Anterior inferior iliac spine n. Anterior superior iliac spine o. Ilium p. Ischium q. Pubis

The hip bone, or os coxae, is formed from the fusion of three bonesthe ilium, ischium, and pubis. The fusion lines are visible in the child's hip bone image, showing how the three bones meet to form the acetabulum which is seen clearly in the lateral view and articulates with the head of the femur. Anterior to the acetabulum are the superior and inferior rami of the pubis; posterior to the acetabulum is the ischium, extending from the Ischia( spine on the superior edge to the ischial ramus which meets the inferior pubic ramus. The Ischia' tuberosity is the rounded protrusion that bears one's weight when seated. The space immediately inferior to the acetabulum is the obdurator foramen which is filled by a sheet of collagen fibers that provide sites for attachment of muscles. Superior to the acetabulum is the large broad ilium, which supports the weight of the internal organs of the trunk; muscles, tendons and ligaments attach at sites including the iliac crest and various iliac spines. The greater sciatic notch allows passage of the sciatic nerve to the lower limbs; blood vessels and nerves pass along the lesser sciatic notch.

SKELETAL SYSTEM

Pelvis, anterior view

45

KAPLAN) MEDICAL

45. Pelvis, anterior view

a. b. c. d. e. Iliac crest Sacroiliac joint Greater sciatic notch Anterior superior iliac spine Anterior inferior iliac spine

1. Acetabulum g. Obturator foramen h. Symphysis pubis I. False pelvis j. True pelvis

The pelvis is formed from the two ossa coxae of the appendicular skeleton and the sacrum and coccyx of the axial skeleton. Because it supports the weight of the upper body and mediates the stresses of locomotion, the bones are larger and heavier than those of the pectoral girdle. The ilium of the ox coxae articulates with the sacrum at the sturdy sacroiliac joint. The iliac crest forms the superior, posterior edge of the pelvis, while the anterior superior iliac spines mark the lateral edges. The anterior and inferior limit of the pelvis is composed of the pubis bones, medial to the obdurator foramen; the pubis bones are connected by fibrocartilage at the symphysis pubis. The true pelvis (or lesser pelvis) is the cavity posterior to the pubic symphysis, anterior to the sacrum and coccyx, and bounded by the medial surfaces of the ilia near the greater sciatic notch. The false pelvis (or greater pelvis) is the larger, more superior cavity bounded laterally by the anterior superior iliac spines.

SKELETAL SYSTEM

Differences between male and female pelvis

46

KAPLAN) MEDICAL

46. Differences between male and female pelvis

a. Wing (ala) of ilium b. Subpubic angle, male (narrower) c. True pelvis, male (narrower, heart-shaped) d. Subpubic angle, female (wider) e. True pelvis, female (wider, oval)

Males and females show gender-related differences in the pelvis, due partly to the larger size and muscle mass of males, and partly to adaptations in females for childbearing. Generally, the female pelvis has lighter bones with smoother surfaces; it is broader and has less depth than the male pelvis. The broad surface of the ilium, known as the ala or wing, projects further laterally in females, but the iliac crest is not located as far superior from the level of the sacrum. The subpubic angle formed between the two pubis bones at the pubic symphysis is larger in females. The sacrum and coccyx are less curved in females at the inferior, anterior side, leading to a larger and more circular opening at the inferior side of the cavity known as the true pelvis. Overall, the true pelvis is wider and more oval in females to allow for childbirth, while it is narrower and somewhat heart-shaped in males.

SYSTEM

Lower limb, anterior view

47

-AN 11Apl.....)MEDICAL

47. Lower limb, anterior view

a. b. c. d. Femur Patella Tibia Fibula e. Tarsals 1. Metatarsals g. Phalanges

The lower limb must withstand the stresses of locomotion and bearing the body's weight; for this reason, the bones are more massive than the bones of the upper limbs. The lower limbs are supported by the pelvis. The bones of the lower limbs include the femur, which articulates proximally with the pelvis at the acetabulum of the hip bone and distally with the tibia and patella. Lateral to the tibia is the fibula, but only the tibia articulates with the tarsals, the ankle bones. At the ankle, the foot turns 9o compared with the leg bones, to provide stability as the body's weight is transferred to the ground. The bones of the foot include the metatarsals and the phalanges, or toe bones.

SKELETAL SYSTEM

Femur and patella, anterior and posterior views

48

Anterior view

Posterior view KAPLArs)

MEDICAL

48. Femur and patella, anterior and posterior views

a. b. c. d. e. f. g. Greater trochanter Head of femur Neck of femur Intertrochanteric line Intertrochanteric ridge Lesser trochanter Linea aspera h. Lateral epicondykle I. Medial epicondyle j. Lateral condyle k. Medial condyle L Base of patella m. Apex of patella

The femur, or thigh bone, is the largest and strongest bone in the human body. The head of the femur articulates with the pelvis at the acetabulum; the head is joined to the shaft of the femur through the neck at an angle of about125. The rim of the articular capsule is marked anteriorly by the Intertrochanteric line and posteriorly by the intertrochanteric ridge. Adjacent to the neck are the superior greater trochanter and the inferior lesser trochanter, both sites where large tendons attach. The Linea aspera is a ridge running along the posterior side of the femur where strong hip muscles attach. At the distal end, the femur widens out, forming the lateral and medial epicondyles. Inferior to the epicondyles are the lateral and medial condyles, the surfaces that articulate with the tibia at the knee. A deep groove, the intercondylar fossa, extends between the condyles on the posterior side. Between the condyles anteriorly, there is a smooth surface over which the patella can glide. The patella has an inferior apex connected to the tibia by a ligament; a broad, superior base; a smooth, convex anterior surface; and posterior facets for articulating with the condyles of the femur.

SYSTEM

Tibia and fibula, anterior and posterior views

49

q r Anterior view Posterior view

KAPLAN) MEDICAL

49. Tibia and fibula, anterior and posterior views

a. Lateral tibial condyle b. Intercondylar eminence c. Medial tibial condyle d. Apex of fibula e. Head of fibula 1. Tibial tuberosity g. Soleal line h. Medial crest of fibula I. Anterior border of fibula I. Anterior border (crest) of tibia k. Lateral surface of tibial shaft I Posterior surface of tibia m. Medial surface of tibial shaft n. Interosseous borders o. Malleolar groove p. Medial malleolus q. Lateral malleolus r. Inferior articular surface of tibia

The tibia, or shinbone, articulates with the lateral and medial condyles of the femur at the lateral and medial tibial condyles. Between the condyles, the intercondylar eminence provides attachment for cruciate ligaments. Anteriorly, the tibial tuberosity is a site of attachment for the patellar ligament. The distal end of the tibia has an Inferior articular surface that articulates with a proximal tarsal bone. Adjacent to this is the medial malleolus, a large process that lends stability to the ankle joint; the malleolar groove is a tendon passageway. The fibula, or calf bone, is a long, slender bone. The head of the fibula articulates with the lateral tibial condyle, while the inferior end of the tibia also articulates with a flat region on the side of the fibula. The lateral malleolus is a fibular process that continues inferiorly beyond the articulation with the tibia, providing lateral support for the ankle joint. Along the shaft of both bones, prominent crests, borders, and lines mark the attachment sites for muscles or the interosseous membrane that helps stabilize the positions of the two bones and provides additional muscle attachment sites.

SKELETAL SYSTEM

Bones of the foot, dorsal view

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50. Bones of the foot, dorsal view 1. 2. 3. a. b. c. d. e. f. Phalanges Metatarsals Tarsals Distal phalanges Middle phalanges Proximal phalanges Head of metatarsal Shaft of metatarsal Base of metatarsal g. First (medial) cuneiform h. Second (intermediate) cuneiform I. Third (lateral) cuneiform j. Cuboid k. Navicular 1. Talus m. Calcaneus

The bones of the foot include seven tarsal or ankle bones, five metatarsal or foot bones, and 14 phalanges or toe bones. The toes each have distal, middle and proximal phalanges, with the exception of the most medial "great" toe, which only has two phalanges (like the thumb)the distal and proximal. Each metatarsal has a head that articulates with the proximal phalanges, a shaft, and a base that articulates with the tarsals. The talus is a large tarsal that articulates with the tibia at a process that also articulates with the lateral malleolus of the fibula. The calcaneus or heel bone is the largest tarsal. The navicular bone is anterior to the talus and articulates with the medial, intermediate and lateral cuneiform bones, that in turn articulate with metatarsal bones IIII. Anterior to the calcaneous and lateral to the navicular and cuneiforms is the cuboid bone, which articulates with metatarsals IV and V.

SKELETAL SYSTEM

Bones of the foot, lateral view

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KAPLAN) MEDICAL ....

51. Bones of the foot, lateral view

a. First (medial) cuneiform b. Second (intermediate) cuneiform c. Third (lateral) cuneiform d. Navicular e. Talus 1. Distal phalanx g. Middle phalanx h. Proximal phalanx I. Head of metatarsal j. Shaft of metatarsal k. Base of metatarsal L Cuboid m. Calcaneus

The large tarsus called the talus articulates with the tibia to distribute the weight of the body evenly, both toward the distal end of the metatarsals and also toward the heel. Anteriorly, the talus articulates with the navicular bone, which in turn articulates with the medial, intermediate and lateral cuneiform bones. These tarsals then articulate with metatarsals I, II and III. Additionally, the talus articulates with the calcaneus or heel bone. Anteriorly, the calcaneus articulates with the cuboid bone, which then articulates with metatarsals IV and V. Ligaments and tendons attach to tarsals and metatarsals to maintain an arched position that lifts the medial bones so that blood vessels, nerves and muscles are not squeezed between the bones and the ground. The elasticity of the arch also helps to cushion the shocks that arise as the weight shifts during walking or running. The heads of the metatarsals articulate with the proximal phalanxes of each toe.

ARTICULATIONS

Gomphosis (peg suture)

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52. Gomphosis (peg suture)

a. Tooth b. Alveolar socket c. Enamel d. Dentin e. Pulp f. Gingiva g. Alveolar ridge h. Periodontal ligaments

A gomphosis is a fibrous synarthrotic (immovable) joint holding a tooth in its alveolar socket in the maxilla or mandible. The bulk of the tooth is composed of dentin, a mineralized matrix secreted by cells found in the

pulp cavity. The exposed portion of the tooth is covered by a crystalline calcium phosphate layer called enamelthe hardest substance in the human body. The root of the tooth is bound in place by the periodontal ligament; it is composed of collagen fibers extending from the dentin of the tooth to the bone surrounding the root of the tooth. A bony alveolar ridge forms the deep socket or alveolus where the peg-like
root of the tooth is inserted. Superficial to the bone is the gingiva, mucosal tissue tightly bound to the bone surrounding the teeth; it provides a smooth surface to reduce friction with food.

ARTICULATIONS

Suture

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53. Suture
a. Sagittal suture
A suture is a fibrous synarthrotic (immovable) joint located between the bones of the skull, in order to form a protective case for the brain and sensory organs of the head. Cranial sutures include the sagittat suture shown here, which connects the two parietal bones and extends between the anterior coronal suture and the posterior lambdoid suture. Further attachment between bones at the suture is provided by collagen fibers that bind the bones in a firm but slightly flexible manner. The bone edges at the sutures are interlocking in adults, although they are slightly separated and are only connected by fibrous connective tissue during development to allow both more flexibility of the skull during birth and room for growth as the brain increases in size during the early postnatal period.

ARTICULATIONS

Syndesmosis, posterior view

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54.

Syndesmosis, posterior view

e. Posterior tibiofibular ligament 1. Transverse tibiofibular ligament

a. Tibia b. Fibula c. Interosseous membrane d. Interosseous ligament

A syndesmosis is a fibrous amphiarthrotic (slightly moveable) joint where the articulation between the bones is strengthened considerably by a ligament or network of collagen fibers that connects them. The syndesmosis between the tibia and fibula permits a small amount of movement between them. The interosseous membrane is composed of collagen fibers that connect the interosseous borders along most of the length of the tibia and fibula; it is continuous with the interosseous ligament, composed of fibers which connect the rough surfaces where the tibia and fibula meet. The anterior, posterior and the deeper transverse tibiofibular ligaments are strong bands of collagen that extend from the distal end of the tibia to the lateral malleolus of the fibula. The strength of the tibiofibular articulation is critical for the strength of the ankle joint.

ARTICULATIONS

Synchondrosis

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55. Synchondrosis
a. Sternum: manubrium b. First costal cartilage c. First rib A synchondrosis is a fibrous synarthrotic (immovable) joint where the two articulating bones are joined by cartilage. While there are many examples of synchondroses in the developing skeleton, such as growth plates in the long bones that become completely ossified in the adult, the sternocostal joint between the first rib and the manubrium of the sternum remains a synchondrosis throughout adult life. The costal cartilage of rib i is hyaline cartilage that is continuous with the rib laterally and with the sternum medially. For other ribs, the costal cartilage is continuous with the rib laterally, but either fits into a depression on the sternum (ribs 2-7), connects with the costal cartilage on other ribs (ribs 8-so), or ends in the body wall (ribs 11-12).

1 ARTICULATIONS

Symphysis

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56. Symphysis
a. Intervertebral disc b. Lumbar vertebra c. Sacrum A symphysis is a cartilaginous amphiarthrotic (slightly moveable) joint where a pad of fibrocartilage separates the two bones. Intervertebral discs are found between the bodies of adjacent cervical (except Ci and C2), thoracic, and lumbar vertebrae, and between the fifth lumbar vertebra and the sacrum. The intervertebral disc includes a tough outer layer called the annulus fibrosis composed of layers of collagen fibers oriented at various angles and attached to the bone of the vertebrae, and an inner layer called the nucleus pulposus that is more hydrated and consists of a gel-like material that resists compression. Movement of the vertebral column displaces the nucleus pulposus in the opposite direction, permitting smooth, gliding motion while retaining the appropriate alignment of the vertebrae. The force exerted on the discs as the vertebrae support the weight of the body precludes the presence of blood vessels in the disc cartilage; nutrients must diffuse in from surrounding tissues.

ARTICULATIONS

Synovial joint, diagrammatic sagittal section

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57.

Synovial joint, diagrammatic sagittal section

d. Meniscus e. Articular cartilage

a. Bone b. Joint capsule c. Synovial cavity (synovial fluid)

Synovial joints are diarthrotic (freely moveable) joints where the bone ends are enclosed within a joint capsule, that is lined by an articular membrane. Within the synovial cavity, lubricating synovial fluid is secreted by the areolar tissue of the synovial membrane. The articulating surfaces of the bones are covered by a thin layer of articular cartilage which provides a smooth surface that, when lubricated by synovial fluid, reduces friction and allows ready movement of the joint. In some synovial joints such as the knee, a fibrocartilage pad, the meniscus, further separates the opposing bones of the joint, or adapts the cavity shape to the specific shapes of the bones of the joint. In addition to its role in lubrication, synovial fluid functions in distributing nutrients to cartilage cells and absorbing the shock of pressure changes during movement.

ARTICULATIONS

Tendon sheath

58

c d
e f

CC)

Cross section view

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Anterior view

KAPLAtO MEDICAL

58. Tendon sheath

a. Distal phalanx b. Tendon insertion, flexor digitorum profundus muscle c. Tendon, flexor digitorum profundus muscle d. Middle phalanx e. Fibrous digital sheath, cruciate part A tendon sheath is a tubular pocket lined with synovial sheath and filled with synovial fluid, that may surround tendons where they run along a bony surface. The synovial fluid reduces friction and acts as a shock absorber. Tendon sheaths in the fingers surround the long tendons of the flexor digitorum profundus and the flexor digitorum superficialis that insert upon and flex the distal and middle phalanges, respectively; the origins of these muscles are near the elbow. As its name implies, the flexor digitorum superficialis is closer to the surface as it crosses the palm but, since it inserts on the middle phalanx, the fibers split, allowing the flexor digitorum profundus to pass from deeper to more superficial, on its way to the distal phalanx. The tendon sheath is thicker along the shaft of the phalanges, and thinner and more flexible at the interphalangeal joints. Thickenings of the sheath capsule are termed annular where the fibers are parallel and go around the sheath, and cruciate where the fibers cross over each other. The arrangement of these fibers ensures that the sheath will not be pinched during flexion of the fingers.

f. Proximal phalanx g. Fibrous digital sheath,

annular part h. synovial sheath i. Tendon, flexor digitorum superficialis muscle

ARTICULATIONS

Bursa

59

Sagittal section view

Lateral view

KAPLA) MEDICAL

59. Bursa
a. Calcaneus b. Calcaneal (Achilles) tendon c. Calcaneal bursa

Bursae are small pockets within connective tissue; they contain synovial fluid, reduce friction, and act as shock absorbers. In the foot, a bursa cushions the interface between the calcaneus and the calcaneal (Achilles) tendon. The calcaneal (Achilles) tendon is the largest tendon
of the body; it connects the gastrocnemius, soleus and plantaris muscles of the calf of the leg to their insertion on the calcaneus. The calcaneal bursa cushions the space just above the insertion point and between the tendon and bone; any injury or condition that puts extra strain on the tendon can cause inflammation of the bursa and consequent discomfort.

rARTICULATIONS

Gliding joint

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60. Gliding joint

a. Superior articular process b. Vertebrae c. Inferior articular process A gliding joint is a synovial joint where the two opposing surfaces glide past one another. The movement is usually slight, and rotation is prevented by the shape of the capsule and/or the arrangement of ligaments. Articulations between the superior and inferior articular processes of adjacent vertebrae are gliding joints. The articulating surfaces of these processes are covered with cartilage. When the back is flexed or rotated, small movements occur at these joints but not between the bodies of the vertebrae. As one moves the torso to the right or left, the superior articular process glides smoothly along the lateral surface of the inferior articular process of the adjacent vertebra to the superior side. The process on the left moves in an opposite direction to that on the right. Infraspinous and supraspinous ligaments prevent rotation, while the anterior and posterior longitudinal ligaments hold the vertebral bodies stable relative to one another. This also prevents the occurrence of larger movements that could injure the spinal cord.

ARTICULATIONS

Hinge joint

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61. Hinge joint

a. Humerus b. Ulna A hinge joint is a synovial joint in which movement occurs in only one plane, usually to flex or extend one body part against another. The humeroulnar joint of the elbow is a hinge joint; it includes articulation between the trochlea of the humerus and the trochlear notch of the ulna as well as the articulation of the capitulum of the humerus with the head of the radius. The brachialis muscle attached to the ulna and the biceps brachii muscle attached to the radius both flex the lower arm against the humerus. Muscles attached to the ulnar olecranon extend or straighten the forearm. The elbow joint is very stable because the humerus and ulna interlock, the articular capsule is very thick, and a series of strong ligaments reinforce the joint.

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ARTICULATIONS

Rotating joint

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62. Rotating joint

a. Ulna b. Radius A rotating joint is a synovial joint that rotates one bone in relation to another. At the articulation between the proximal ends of the ulna and radius, movement of the bones is limited to the rotation of the radial shaft; this allows the distal end of the radius to roll across the anterior surface of the ulna. Pronation refers to this movement of the hand from the anatomical position with the palm facing front to the opposite orientation with palm facing back; supination is the opposite motion. Similarly, movement of the hand from the palm up position to the opposite orientation with the palm facing down is also pronation; the opposite motion is also supination.

ARTICULATIONS

Ball and socket joint

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63. Ball and socket joint

a. Ilium b. Femur A ball and socket joint is a synovial joint where the rounded head of one bone moves within a cup-shaped depression in the other. This permits a wide range of motion, including both angular and rotational movements, at this type of joint. In the hip joint, the "ball" is the rounded head of the femur, which is offset about 125 from the shaft of the femur. The head of the femur rests within the acetabulum, which is the depression located at the junction between the ilium, ischium and pubis bones. The joint capsule extends from the lateral and inferior surfaces of the pelvis and joins the femur at the intertrochanteric line and intertrochanteric crest; thus the entire head and neck of the femur are enclosed within the capsule. The hip joint is extremely strong and stable because of the extent of the socket, the strong articular capsule, strong supporting ligaments, and the bulk of the surrounding muscles.

ARTICULATIONS

Condyloid joint

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64.

Condyloid joint
c. Lunate d. Triquetrum

a. Radius b. Scaphoid

A condyloid joint is a synovial joint in which an oval or ellipsoidal articular face of one bone rests within a slight depression on the opposing surface. This permits movement at the joint to occur in either of two planes. At the wrist, the articular surface at the distal end of the radius is a broad shallow depression. The articular surfaces of the scaphoid and lunate bones are more convex and shaped to fit the depression in the radius. This allows not only for the flexion or extension of the hand at the wrist, but also for moving the hand toward the body (adduction) or away from the body (abduction) when considering the anatomical position of the hand. Movement at the wrist also involves the ulna and the triquetrum bone, which do not articulate with each other, but with a fibrocartilage pad between them. The wrist is stabilized laterally and medially by the styloid processes of the radius and ulna, respectively.

65. Saddle joint

a. Trapezium b. First metacarpal A saddle joint is a synovial joint where opposing articular faces are convex along one axis and concave along the other. This allows angular motion in a variety of directions, but prevents rotation. A saddle joint exists in the carpometacarpal joint at the base of the thumb, at the articulation between the trapezium and metacarpal. The range of movements allowed at this joint include flexion and extension in the plane of the palm, abduction and adduction in a plane at a right angle to the palm, circumduction and opposition. It is the latter motion that is important in the concept of the "opposable thumb," the evolution of which is thought to have allowed humans to develop fine motor skills and tool making capability.

ARTICULATIONS

Temporomandibular joint, sagittai section

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66. Temporomandibular joint, sagittal section

a. Zygomatic process of temporal bone b. Articular surface, mandibular fossa of temporal bone c. Articular disc

d. Articular capsule
e. Head of mandible f. Mandible

The temporomandibular joint is a synovial joint with the unusual characteristic of having an articular disk dividing the articular capsule into two parts. The lower joint compartment is formed between the head of the mandible and the articular disk; movements are rotationalopening and closing the jaw. As the jaw closes, the coronoid process of the mandible slides into a cavity medial to the zygomatic process of the temporal bone. The upper joint compartment is formed between the mandibular fossa of the temporal bone and the articular disk; movements here are translationalmoving the jaw forwards and backwards or side-to-side. The great mobility of the mandible enables flexibility while chewing or talking, but also results in a joint that can be easily dislocated by forceful forward or lateral displacement of the mandible.

ARTICULATIONS

Shoulder joint, frontal section

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67. Shoulder joint, frontal section

a. Acromion b. Articular cartilage c. Glenoid labrum d. Spine of scapula e. Glenoid fossa f. Scapula The shoulder joint (glenohumoral joint) is the synovial joint with the greatest range of motion in the human body. The rounded head of the humerus articulates with the scapula at the cup-shaped glenoid fossa, which is deepened by a lip-like projection of cartilage called the glenoid labrum. The head of the humerus is covered with a thin, smooth layer of articular cartilage to minimize friction. The articular capsule is relatively loose to permit an extensive range of motion; it extends from the scapula to the anatomical neck of the humerus. The tendon of the long head of the biceps brachii muscle attaches within the glenohumoral articular capsule; the tendon is protected by a synovial sheath to minimize friction. g. Articular capsule h. Humerus i. Synovial sheath j. Tendon, biceps brachii muscle (long head)

ARTICULATIONS

Shoulder ligaments, anterior view

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68. Shoulder ligaments, anterior view

a. Acromion b. Acromioclavicular ligament c. Coracoacromial ligament d. Coracoclavicular ligment, trapezoid ligament e. Coracoclavicular ligament, conoid ligament f. Clavicle g. Coracohumeral ligament h. Transverse humeral ligament i. Humerus j. Articular capsule k. Coracoid process of scapula L Scapula

The shoulder joint is partly stabilized by the bones of the pectoral girdleparticularly where the acromion and coracoid process of the scapula extend laterally, superior to the head of the humerus. Another measure of stability for the shoulder comes from ligaments. The acromioclavicular, coracoacromial and coracoclavicular ligaments connect the two processes of the scapula with the clavicle. The coracohumoral ligament arises on the coracoid process and passes across the joint to the greater tubercle of the humerus. The transverse humoral ligament passes between the greater and lesser tubercles of the humerus, forming a canal along the intertubercular groove for the passage of the tendon of the biceps brachii. But by far, the majority of the stability of the shoulder joint comes from the muscles that move the humerusespecially the muscles collectively known as the "rotator cuff", including the supraspinatus, the infraspinatus, the subscapularis, and the teres minor.

s
ARTICULATIONS

Elbow joint, sagittal section

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69. Elbow joint, sagittal section

a. Triceps muscle b. Body of humerus c. Brachialis muscle d. Biceps brachii muscle e. Trochlea of humerus f. Joint cavity g. Ulna h. Ulnar artery

The strongest part of the complex elbow joint can be seen in a sagittal section through the humeroulnar joint when the forearm is extended. This hinge joint is capable of flexing or extending the forearm. The trochlea of the humerus fits into the trochlear notch of the ulna. Muscles that flex the forearm include the brachialis that inserts on the coronoid process of the ulna, and to a lesser extent, the biceps brachii that inserts on the radius. Extension of the forearm is accomplished by contraction of the triceps muscle which inserts on the olecranon of the ulna.

ARTICULATIONS

Elbow ligaments, anterior view

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70.

Elbow ligaments, anterior view

h. Interosseous membrae i. Radius j. Radial tuberosity k. Radial annular ligament I. Radial collateral ligament m. Capitulum of humerus n. Lateral epicondyle

a. Humerus b. Medial epicondyle c. Ulnar collateral ligament d. Trochlea of humerus e. Ulnar tuberosity f. Oblique cord g. Ulna

The elbow joint is very stable for several reasons: the humerus and ulna interlock, the articular capsule is very thick, and several strong ligaments reinforce the joint. The ulnar collateral ligament extends from the medial epicondyle of the humerus anteriorly to the coronoid processes of the ulna and posteriorly to the olecranon. The annular ligament binds the head of the radius with the radial notch of the ulna. The radial collateral ligament extends from the lateral epicondyle of the humerus to the annular ligament. Although the radioulnar articulation allows rotational movement of the radius around the ulna, the interosseous membrane allows only limited movement between the two bones. The fibers of the oblique cord pass obliquely between the bones just inferior to the ulnar and radial tuberosities.

ARTICULATIONS

Hip joint, frontal section

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71. Hip joint, frontal section

a. Coxal bone b. Articular cartilage c. Acetabular labrum

d. Zona orbicularis of capsule

e. Articular capsule f. Femur

The hip joint is a sturdy synovial joint (ball and socket joint) between the globular head of the femur and the cup-like acetabulum of the coxal bone. A thin layer of articular cartilage covers both bone surfaces to reduce friction. A fibrocartilage lip called the acetabular labrum extends the edge of the acetabulum to increase its depth; it is located slightly beyond the widest diameter of the femoral head to hold it firmly in place. The articular capsule is strong and dense; it completely encloses the head and neck of the femur, and extends beyond the edge of the acetabulum. The capsule includes longitudinal bands of fibers that stretch between the hip bone and the femur to strengthen the joint; the zona orbicularis of the capsule includes deep circular fibers that form a collar to hold the head of the femur tightly in the socket. The joint permits a range of movements: flexion and extension, adduction and abduction, circumduction and rotation.

ARTICULATIONS

Pelvic ligaments, posterior view

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72. Pelvic ligaments, posterior view

a. Iliac crest b. Posterior superior iliac spine c. Iliolumbar ligament d. Fifth lumbar vertebra e. Supraspinous ligament f. Short dorsal sacroiliac ligaments g. Long dorsal sacroiliac ligament Strong ligaments are necessary to stabilize the pelvis. The supraspinous ligament that runs along the edges of the vertebral dorsal spinous processes continues along the median sacral crest. In addition, the iliolumbar ligament connects the fifth lumbar vertebra both to the sacrum and the iliac crest. The sacroiliac joint is stabilized by the horizontal short dorsal sacroiliac ligament between the sacrum and the tuberosity of the ilium and by the oblique long dorsal sacroiliac ligament connecting the sacrum to the posterior superior iliac spine. The sacrotuberous ligament is connected at one end to the posterior inferior iliac spine, the lower part of the sacrum, and the coccyx; the other end attaches to the tuberosity and ramus of the ischium. Nearby, the sacrospinous ligament extends from the sacrum and coccyx to the spine of the ischium. The sacrococcygeal joint is stabilized by several ligaments, including the superficial dorsal sacrococcygeal ligament. At the hip joint, strong ligaments reinforce the articular capsule that encloses the head and much of the neck of the femur. h. Femur i. Sacrospinous ligament j. Superficial dorsal sacrococcygeal ligament

k. Sacrotuberous ligament
I. Articular capsule of the hip joint

I ARTICULATIONS

Knee joint, anterior view

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73. Knee joint, anterior view

a. Femur b. Patella c. Fibular collateral ligament (lateral collateral ligament) d. Lateral meniscus e. Lateral condyle of tibia f. Fibula The articulation between the femur and tibia at the knee joint performs a simple hinge function, primarily facilitating flexion and extension of the lower leg. However, a small amount of medial and lateral rotation (10 and 3o respectively) is also possible. The medial and lateral condyles of the femur articulate with the medial and lateral condyles of the tibia; the medial and lateral menisci are fibrocartilage pads that cushion and separate the bones within the joint. The patella is held in place anterior to the distal portion of the femur by the patellar ligament distally and the quadriceps muscle tendon proximally; it not only protects the knee joint but also provides increased leverage for the quadriceps muscle during knee extension. The patella resides at its most superior location during full extension of the knee, and moves as much as 7 cm inferiorly during flexion, until it is located between the distal ends of the femoral condyles. To the side, the knee joint is stabilized by the tibial (medial) collateral ligament and the fibular (lateral) collateral ligament. g. Tibia h. Tibial collateral ligament (medial collateral ligament) i. Medial condyle of tibia j. Medial meniscus k. Patellar ligament

ARTICULATIONS

Bent knee joint, anterior view with patella removed

74

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74. Bent knee joint, anterior view with patella removed

a. Femur b. Articular cartilage c. Anterior cruciate ligament d. Lateral meniscus e. Lateral condyle of tibia 1. Fibula With the knee bent and the patella removed, the interior of the synovial joint is revealed. The articular cartilage protecting the articular surface of the femur extends superiorly behind the position of the patella, as part of the femoropatellar joint. The two femoral condyles are separated from the two tibial condyles by the medial and lateral menisci. These pads of fibrocartilage fill in the space between the convex surface of the femoral condyle and the flatter surface of the tibial condyle; they act as durable shock absorbers and contribute to both stability and lubrication in the joint. Ligaments stabilize the joint; the anterior cruciate ligament (ACL) extends between the lateral condyle of the femur posteriorly and the intercondylar region of the tibia anteriorly; the posterior cruciate ligament (PCL) connects the posterior intercondylar region of the tibia with the medial condyle of the femur anteriorly. The ACL resists forces pushing the tibia forward, while the PCL resists forces pushing the tibia posteriorly relative to the femur. Excessive abduction or adduction motion at the knee joint is limited by the fibular (lateral) and tibial (medial) collateral ligaments. g. Tibia h. Tibial collateral ligament i. Medial condyle of tibia j. Medial meniscus k. Posterior cruciate ligament

ARTICULATIONS

Knee joint, sagittal section

75

t KA PLAje ) MEDICAL

75. Knee joint, sagittal section

a. Femur b. Lateral menniscus, posterior horn c. Fibula d. Tibia e. Patellar ligament A sagittal section through the lateral condyles of the femur and tibia reveals the anterior-posterior relationships of the fully-extended knee joint. Articular cartilage covers the convex articular surface of the femur and the flatter articular surface of the tibia. Between the two articular cartilages lies the C-shaped lateral meniscus, with posterior and anterior horns positioned to fill the area between the curving articular surfaces. Popliteal ligaments strengthen the back of the synovial articular capsule. The fibula articulates with the tibial epicondyle laterally and posteriorly; a collateral ligament extends from the fibula to the lateral epicondyle of the femur to strengthen the joint. Anteriorly, the patella moves along the femoral articular surface when the quadriceps muscle flexes the knee; the articular cartilage of the patella is one of the thickest due to the intense stresses of this movement. The quadriceps muscle tendon attaches on the superior surface and is continuous with the inferior patellar ligament. The infrapatellar fat pad absorbs shocks and fills in the space below and behind the patella. f. Lateral meniscus, anterior horn g. Infrapatellar fat pad

h. Patella
i. Articular cartilage

ARTICULATIONS
"I

Ankle joint, posterior view

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KAPLAN) MEDICAL
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76. Ankle joint, posterior view

a. Fibula b. Posterior tibiofibular ligament c. Transverse tibiofibular ligament d. Posterior talofibular ligament e. Posterior talocalcaneal ligament f. Calcaneofibular ligament g. Calcaneal (Achilles) tendon h. Calcaneus i. Medial talocalcaneal ligament I. Talus k. Deltoid ligament, tibiocalcaneal part I. Deltoid ligament, tibiotalar part m. Tibia

The posterior view of the ankle joint shows several ligaments that stabilize the articulations between the leg and ankle bones. The largest tendon in the human body is the calcaneal tendon (also known as the Achilles tendon) that connects three lower leg musclesthe gastrocnemius, the soleus, and the plantariswith their insertion on the calcaneus, the largest of the tarsal bones. Above the ankle, the distal articulation of the tibia and fibula are stabilized by the posterior and transverse tibiofibular ligaments. Laterally, the ankle joint is stabilized by connections between the lateral malleolus of the fibula and the tarsal bones, including the talofibular and calcaneofibular ligaments. On the medial side, the ankle is stabilized by ligaments connecting the medial malleolus of the tibia with tarsal bones such as the calcaneus and the talus, including the tibiocalcaneal and tibiotalar parts of the deltoid ligament. Articulations between the tarsal bones are also stabilized by ligaments, such as the medial and posterior talocalcaneal ligaments connecting the talus and calcaneus.

ARTICULATIONS

Ankle joint, frontal section

77

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77. Ankle joint, frontal section

a. Tibia b. Articular cartilage c. Medial malleolus of tibia d. Deltoid ligament, posterior tibiotalar part e. Deltoid ligament, tibiocalcaneal part A frontal section through the talus shows its articulations with the tibia, fibula, and calcaneus. The talus rests on the calcaneus and supports the tibia; the ankle is stabilized on either side by the lateral malleolus of the fibula and the medial malleolus of the tibia. The articular sufaces of all these bones are covered with articular cartilage. On the medial side, the deltoid ligament attaches to the medial malleolus of the tibia and parts of it connect to the tarsal bones in four places, including the posterior tibiotalar part (to the talus) and the tibiocalcaneal part (to the calcaneus). Laterally, the fibula is connected to the calcaneus by the calcanealfibular ligament. Further stability of the ankle is provided by the sturdy connection between the tibia and fibula along much of their shafts, the tibiofibular syndesmosis. f. Calcaneus g. Calcaneofibular ligament h. Lateral malleolus of fibula i. Talus j. Tibiofibular syndesmosis k. Fibula

Superficial muscles of the body, anterior view

78. Superficial muscles of the body, anterior view

a. Frontalis b. Orbicularis oris c. Sternocleidomastoid d. Deltoid e. Biceps brachii 1. Brachioradialis g. Palmaris longus h. Iliopsoas I. Pectineus j. Quadriceps femoris k. Peroneus longus I. Tibialis anterior m. Extensor digitorum longus n. Orbicularis oculi o. Trapezius p. Pectoralis major q. Serratus anterior r. Brachialis s. External oblique t. Rectus abdominus u. Tensor fasciae latae v. Adductor longus w. Sartorius x. Gracilis y. Gastrocnemius z. Soleus

Contraction of muscle tissue initiates virtually every movement made by the human body. When you blink your eyes, you are using the orbicularis ocull to close the eyelids; when you wrinkle your brow, you contract the frontalis muscle; when you play the trumpet, you use a sphincter muscle around the mouth called the orbicularis oris. The shoulders and arms are moved by a series of muscles attached to the pectoral girdle and the bones of the arm, such as the deltoid, pectoralis major, biceps brachii, and brachialis. Movement of the lower limbs is used to propel the individual from one place to another; this involves muscles attached to the pelvic girdle and the leg bones, such as the quadriceps lemon's, sartorius, gracilis, and gastrocnemius. Muscles in the body wall of the trunk that constrict to rotate the torso or aid in respiration and defecation include the rectus abdominus and external oblique.

Superficial muscles of the body, posterior view

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79. Superficial muscles of the body, posterior view a. b. c. d. e. f. g. h. I. j. k. L Sternocleidomastoid Trapezius Teres Major Brachioradialis Extensor carpi radialis longus Flexor carpi ulnaris Extensor carpi ulnaris Gracilis Adductor magnus Biceps femoris Gastrocnemius Calcaneal tendon m. Soleus n. Semitendinosus o. Semimembranosus p. Iliotibial tract q. Gluteus maximus r. Gluteus medius s. Extensor digitorum t. Extensor carpi radialis brevis u. External abdominal oblique v. Latissimus dorsi w. Triceps x. Deltoid

More than 600 muscles carry out the actions of moving body parts; in many cases, their names are descriptive regarding the location, origin, insertion, action, shape, etc. Thus, the two trapezius muscles together form a trapezoid shape between the neck, shoulders, and thoracic vertebrae; they act to shrug the shoulders and to pull the shoulder blades toward the vertebrae. The flexor carpi ulnaris and extensor carpi ulnaris are two muscles that act to flex or extend the wrist (carpus); they originate on the ulna. The triceps muscle is named because it has three heads that originate on either the scapula or the humerus; the muscle has a single tendon that inserts on the olecranon of the ulna so that it acts to extend the forearm. The gluteal muscles in the butt are named for their sizethe gluteus maximus is larger than the gluteus medius or the deeper gluteus minimus.

Muscle forms: fusiform and flat sheet

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80. Muscle forms: fusiform and flat sheet

Fusiform: Broad, flat sheet:

a. Basic fusiform, Palmaris longus b. Bicipital, Biceps femoris c. Tricipital, Triceps surae (gastrocnemius and soleus) d. Quadriceps femoris

e. Latissimus dorsi

Fusiform muscles are wide in the middle and taper at both ends. The patmaris longus is a slender, fusiform muscle that originates on the humerus and ends in a long tendon that inserts on the palmar fascia. A bicipital muscle has two heads or origins, as the biceps femoris with the long head originating on the ischium and the short head on the femur; the muscle inserts at the knee and both heads act to flex the knee. The triceps surae is a tricipital muscle with three heads; this composite muscle consists of the gastrocnemius with two heads originating on the femur and the soleus which originates on the tibia; the triceps surae inserts on the calcaneus and acts in plantar flexion of the foot. The quadriceps femoris is a quadricipital muscle with four heads originating on the ilium and femur; the muscle inserts on the patella and extends the knee. Other muscles occur in broad, flat sheets, such as the latissimus dorsi which is a triangular, flat muscle that originates along the thoracic and lumbar vertebrae as well as the sacrum and ilium; it inserts on the humerus and acts to extend, adduct and rotate the shoulder.

Muscle forms: pennate, circular, and multicaudal

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81. Muscle forms: pennate, circular, and multicaudal

Pennate: a. Unipennate, semimembranosus b. Bipennate, tibialis anterior c. Multipennate, deltoid Circular: d. External sphincter ani, deep portion Multicaudal: e. Flexor digitorum profundus

In pennate muscles, the contracting fibers attach to the tendon at an oblique angle; they provide more stability and force, but the tendon is not moved as far as when the fibers are parallel to the tendon. All the muscle fibers are on the same side of the tendon in unipennate muscles, such as the semimembranosus muscle which extends between the ischium and the tibia. Bipennate muscles are more common and have muscle fibers on both sides of the tendon, including the tibialis anterior which is a shin muscle that flexes the foot. In multipennate muscles, the fibers attach on both sides of the tendon, and the tendon branches within the muscle; an example is the deltoid muscle that forms the rounded shape of the shoulder. Circular, or sphincter, muscles are arranged concentrically around an opening; a good example is the deep portion of the external sphincter ani muscle which closes off the anal canal at its orifice. Multicaudal muscles attach at multiple sites; the flexor digitorum profundus is a single muscle that inserts on the phalanges of the four fingers to flex them.

SYSTEM

Muscle forms: cylindrical, triangular, quadrilateral, biventral, multiventral

82

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82. Muscle forms: cylindrical, triangular, quadrilateral, biventral, multiventral

a. Cylindrical, teres major b. Triangular, deltoid c. Quadrilateral, pronator quadratus d. Biventral, digastric e. Multiventral, rectus abdominis

Named from the Latin word for round or cylindrical, the teres major muscle extends between the scapula and humerus; it adducts and rotates the arm. The triangular deltoid muscle covers the shoulder joint, extending from the clavicle and scapula to the humerus; different parts of the muscle act to flex, extend or rotate the humerus. The pronator quadratus muscle is a square, or quadrilateral, muscle that extends between the ulna and radius at their distal end; it acts to pronate the forearm. The digastric muscle consists of two bellies with different origins that unite in a single tendon that inserts on the hyoid bone; the longer, posterior belly originates on the mastoid process of the temporal bone, while the anterior belly arises on the mandible. The rectus abdominis muscle has multiple insertions; it arises on the pubis bone and three portions of the muscle insert on the fifth, sixth and seventh ribs.

Muscles of facial expression, anterior view

83. Muscles of facial expression, anterior view

a. b. c. d. Frontalis Procerus Orbicularis oculi Levator labii superioris alaeque nasi e. Levator labii superioris f. Zygomaticus minor g. Zygomaticus major h. Levator anguli oris I. Orbicularis oris j. Risorius k. Depressor anguli oris L Platysma m. Depressor labii inferioris n. Mentalis

Facial expressions result from muscular contractions that move the skin in particular facial regions. The frontalis muscle raises the eyebrows and wrinkles the brow. The procerus muscle wrinkles the skin at the top of the nose and flares the nostrils. The orbicularis oculi muscle closes the eye. The upper lip can be made to snarl by the levator [Ail superioris alaeque nasi muscle or to be raised
by the levator [Ail superioris muscle. The muscles known as the zygomaticus minor and major, and levator anguli oris, draw the corners of the mouth superiorly and are used in smiling. The orbicularis oris is a sphincter muscle around the mouth that aids in pursing the lips. The risorius muscle draws the corner of the mouth laterally in a grimace and the depressor anguli oris muscle draws the corner of the mouth downwards in a frown. The depressor labii inferioris muscle pulls the lower lip down, while the mentalis muscle is involved in wrinkling the chin. The platysma draws the corners of the mouth down in expression of fright as well as drawing the skin of the neck upward when the teeth are clenched.

Muscles of facial expression, lateral view

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84. Muscles of facial expression, lateral view

a. Frontalis part, occipitofrontalis b. Orbicularis oculi c. Procerus d. Nasalis e. Levator labii superioris alaeque nasi 1. Levator labii superioris g. Orbicularis oris h. Depressor labii inferioris i. Depressor anguli oris j. Risorius k. Platysma 1. Zygomaticus major m. Zygomaticus minor n. Zygomatic arch

Muscles controlling facial expression often originate on bones and insert on the skin of the face. The frontalis portion of the occipitofrontalis muscle covers the forehead from above the hairline to the eyebrows. The orbicularis oculi muscle arises on the frontal bone and circles the eye to the temple and the cheek. The procerus muscle extends from the nasal bone to the skin of the medial forehead, while the nasalis muscle extends from the maxilla to the nasal bone and compresses the nasal cartilage. The levator labii superioris alaeque nasi extends from the maxilla to the upper lip and the levator labii superioris muscle arises on the margin of the orbit and inserts on the upper lip. The orbicularis oris is a sphincter muscle whose fibers arise on the maxilla and mandible, and insert on the skin around the lips. The depressor labii inferioris and the depressor anguli oris muscles arise on the mandible and insert on the lower lip or corner of the mouth, respectively. The risorius muscle pulls the corner of the mouth laterally. The platysma is a broad, flat muscle that covers the neck between the clavicle and the mandible. The zygomaticus minor and major muscles arise along the zygomatic arch and insert on the upper lip or corner of the mouth, respectively.

Superficial muscles of mastication, lateral view

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85. Superficial muscles of mastication, lateral view

a. Temporalis b. Zygomatic arch c. Orbicularis oris d. Buccinator e. Mandible 1. Masseter

Mastication, or chewing, involves the jaw opening and closing, accomplished by muscles that move the mandible at the temperomandibular joint. The temporalis muscle originates on the temporal bone, passes medial to the zygomatic arch and inserts on the mandible on the anterior and medial aspects of the coronoid process. The masseter muscle arises on the zygomatic arch, passes lateral to the broad surface of the mandible, and inserts along the angle and lower part of the ramus of the mandible. The temporalis and masseter both elevate and retract the mandible. The buccinator muscle is a quadrilateral facial muscle located between the maxilla and mandible. It inserts on the orbicularis oris muscle and acts to flatten the cheek against the teeth, acting as an auxiliary mastication muscle holding the food between the teeth during mastication.

SYSTEM

Deep muscles of mastication, lateral view

86

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86. Deep muscles of mastication, lateral view

a. Buccinator muscle b. Mandible c. Medial pterygoid muscle The deep muscles of mastication are attached on the medial aspect of the mandible. During mastication, the jaw is opened by action of the lateral pterygoid muscle. The lateral pterygoid originates on the sphenoid bone and inserts on the coronoid process of the mandible and on the articular disc of the temperomandibular joint. The lateral pterygoids act both to lower the mandible and to bring it forward. Closing of the jaw during chewing involves elevation of the mandible by actions of the masseter, temporalis, and medial pterygoid muscles. The medial pterygoid has two heads, one originating on the sphenoid bone and the other from the palatine bone. The muscle inserts on the medial side of the ramus of the mandible to elevate it. The medial pterygoid and masseter work together, respectively, on the medial and lateral aspects of the mandible to raise it. Both the medial and lateral pterygoid muscles can also act to move the mandible side-to-side. d. Zygomatic arch (cut) e. Lateral pterygoid muscle

SYSTEM

Muscles of the neck, anterior view

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87. Muscles of the neck, anterior view

a. Hyoid bone b. Superior belly of omohyoid muscle c. Inferior belly of omohyoid muscle d. Scapula

e. f. g. h. i.

Manubrium of sternum Clavicle Sternocleidomastoid muscle Sternohyoid muscle Mastoid process of temporal bone

Muscles in the neck control the position of the larynx, contribute to mastication and respiration, and support activities of the tongue and pharynx. The inferior belly of the omohyoid muscle arises on the scapula, runs parallel to the clavicle while being held in position by connective tissue, and the tendon then turns superiorly where it becomes the superior belly. The superior belly of the omohyoid inserts on the hyoid bone and acts to depress the larynx. The stemohyoid muscle also acts to depress the larynx; it originates on the manubrium of the sternum and inserts on the hyoid. The two heads of the stemocleidomastoid muscle arise on the sternum and clavicle and manubrium of the sternum; the muscle inserts on the mastoid process of the temporal bone. Acting separately, the sternocleidomastoids on each side rotate the head; acting together, they flex the neck and assist in respiration along with the scalene muscles.

SYSTEM

1
88

Suprahyoid and infrahyoid muscles of the neck, anterior view

KAPLA 1 MEDICAL .2)

s

88. Suprahyoid and infrahyoid muscles of the neck,

anterior view
a. Mylohyoid muscle b. Mastoid process of temporal bone c. Thyroid cartilage d. Sternothyroid muscle e. Scapula 1. Sternum g. Inferior belly of omohyoid muscle

h. Sternohyoid muscle i. Superior belly of omohyoid

muscle

j. Stylohyoid k. Posterior belly of digastric

muscle

I. Mandible
m. Anterior belly of digastric muscle

Suprahyoid muscles are located above (superior to) the hyoid bone. The mylohyoid muscle is flat and triangular; it arises along the mandible and inserts on the hyoid bone. The mylohyoid forms the floor of the oral cavity and acts to raise the hyoid and lower the mandible. The digastric muscle opens the jaw (when the masseter and temporalis are relaxed); it inserts on the hyoid bone; the posterior belly originates on the mastoid process of the temporal bone, the anterior belly arises on the mandible. The stylohyoid muscle arises on the styloid process of the temporal bone, inserts on the hyoid bone and acts to elevate the larynx and aid in swallowing. The infrahyoid muscles include the omohyoid, stemohyoid, and stemothyroid, all of which insert on the hyoid and depress the larynx. The sternothyroid muscle arises on the posterior aspect of the sternum and inserts on the thyroid cartilage.

Prevertebral region and root of the neck, anterior view

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89. Prevertebral region and root of the neck, anterior view

a. Rectus capitis lateralis muscle b. Longus capitis muscle c. Longus colli muscle d. Levator scapulae muscle e. Left rib 1. Second rib g. Scapula h. Sternum i. Right rib j. Posterior scalene muscle k. Middle scalene muscle 1. Anterior scalene muscle m. Carotid tubercle of sixth cervical vertebra n. Transverse process of atlas o. Rectus capitis anterior muscle

The scalene muscles of the neck arise on the transverse processes of the cervical vertebrae and insert on the first two ribs; they act to rotate the neck and to assist in respiration. The anterior scalene muscle originates on C3-6 and inserts on the first rib; the middle scalene originates on C2-7 and also inserts on the first rib. The posterior scalene muscle arises on C4-6 and inserts on the second rib. The neck is flexed at the joint between the atlas and the occipital bone by several muscles that arise on the vertebrae and insert on the occipital bone. The longus capitus muscle arises from the transverse processes of C3-6, and inserts on the occipital bone to flex the neck. The small rectus capitis anterior and lateralis muscles both originate on the atlas (Ci) and insert on the occipital bone to flex the atlanto-occipital joint. The longus colli muscle originates both on the transverse processes of C3-7 and the vertebral body of Ti-3, inserts on C1-4, and acts to flex and rotate the neck. The levator scapulae muscle arises on C1-4 and inserts on the scapula to either raise the scapula or incline the neck toward that side.

Muscles of the neck, lateral view

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90. Muscles of the neck, lateral view

a. Hyoid bone b. Superior belly of omohyoid muscle c. Sternothyroid muscle d. Sternocleidomastoid muscle e. Inferior belly of omohyoid muscle 1. Clavicle g. First rib h. Sternum I. Occipital bone j. Trapezius muscle k. Levator scapulae muscle I Middle scalene muscle m. Anterior scalene muscle n. Scapula

The trapezius is a broad, superficial muscle that originates along the dorsal midline, from the occipital bone, ligaments along the cervical vertebrae, or thoracic vertebrae. The muscle inserts on the acromion process and spine of the scapula as well as part of the clavicle. Its actions may include extension of the neck, elevation of the clavicle, or a variety of movements of the scapula. The levator scapulae extends between the cervical vertebrae and the scapula; it also elevates the scapula. The stemocleidomastoid muscle extends from the sternum and clavicle to the temporal bone and acts to flex or rotate the neck. The omohyoid and stemothyroid muscles arise on the scapula or sternum, respectively, and act to depress both the hyoid bone and the larynx. The anterior and middle scalene muscles originate on the cervical vertebrae and insert on the first rib; they rotate the neck and aid in respiration.

SYSTEM

Neck, transverse section

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91. Neck, transverse section

a. Sternocleidomastoid muscle b. Anterior scalene muscle c. Middle scalene muscle d. Posterior scalene muscle e. Levator scapulae muscle 1. Trapezius muscle g. Spinal cord

h. Body of C5 vertebra
i. Sternothyroid muscle

j. Sternohyoid muscle
k. Thyroid cartilage L Pharynx m. Platysma

A transverse section of the neck shows the central spinal cord lying posterior to the body of the C5 vertebra, and the anterior pharynx lying behind the larynx and its thyroid cartilage. The superficial platysma is the most anterior of the muscles; lying between it and the thyroid cartilage are the stemothyroid and stemohyoid muscles that depress the larynx. Anteriolaterally, the stemocleidomastoid muscle extends from the sternum and clavicle to the mastoid process. Deep to this, the anterior, middle, and posterior scalene muscles extend

from the cervical vertebrae to the first or second rib and act to flex the neck. Alongside the scalene muscles, the levator scapulae muscle acts to lift the scapula or bend the neck. On the posterior aspect of the neck, the broad, flat trapezius muscle is most superficial.

Ocular muscles, lateral view and superior view

92

Lateral view

Superior view

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92. Ocular muscles, lateral view and superior view a. Lateral rectus muscle b. Superior rectus muscle c. Levator palpebrae superioris muscle d. Superior oblique muscle e. Inferior oblique muscle f. Inferior rectus muscle g. Optic nerve h. Medial rectus muscle I. Optic chiasma

The extrinsic eye muscles work together to produce movements of the eyeball. Four rectus muscles originate on the sphenoid bone near the optic nerve, and insert on the surface of the eyeball. They are the superior rectus muscle to move the eyeball to look up, the inferior rectus muscle to move the eyeball to look down, the medial rectus muscle to rotate the eyeball medially, and the lateral rectus muscle to rotate the eyeball laterally. The superior oblique muscle primarily rotates the eye medially, while the inferior oblique laterally rotates it; in addition, actions of the oblique muscles include depression and abduction, or elevation and abduction, respectively. The levator palpabrae superioris muscle extends from the sphenoid bone to the eyelid and acts to elevate and retract the eyelid.

Intrinsic muscles of the tongue, sagittal section

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93. Intrinsic muscles of the tongue, sagittal section

a. Superior longitudinal muscle of tongue b. Transverse lingual muscle c. Lingual tonsil; root of tongue d. Cartilage of epiglottis e. Thyroid cartilage

1. Hyoid bone
g. Mylohyoid muscle

h. Geniohyoid muscle
i. Genioglossus muscle I. Mandible

The intrinsic muscles of the tongue are those that lie entirely within the tongue and act to alter the shape of the tongue for swallowing and talking. The superior longitudinal muscle lies just under the mucous membrane and runs from the root to the tip of the tongue and acts to shorten the upper surface of the tongue. The transverse lingual muscle arises along the lingual septum and inserts on the mucous membranes at the lateral margins of the tongue. At the posterior end of the tongue are lingual tonsils, masses of lymphatic tissue; the epiglottis lies at the opening to the pharynx. The floor of the oral cavity is formed by the mylohyoid muscle extending between the mandible and the hyoid bone; the geniohyoid muscle arises at the center of the mandible and inserts on the hyoid. The genioglossus muscle arises on the mandible and acts to protrude the tongue and depress its center.

Extrinsic muscles of the tongue, pharynx and larynx, lateral view

Pharynx, posterior view

95

KAPLA) MEDICAL
....

Superficial shoulder muscles, anterior view

SYSTEM

Muscles of the shoulder, scapula and arm, anterior view

97

!CAPLAN) MEDICAL

Deep muscles of the shoulder and arm, anterior view

98

Muscles with scapular attachments, posterior view

99

I(APLA) MEDICAL
....

Muscles with scapular attachments, posterior view

99

KAPLA) MEDICAL
s

Superficial and intermediate muscles of the back, posterior view

100

!CAPLAN) MEDICAL
....

SYSTEM

s
101

Deep muscles of the back, posterior view

KAPLAN) MEDICAL

Anterior brachial muscles (flexors), lateral view

Posterior brachial muscles (extensors), lateral view

103

KAPLAii) MEDICAL
,..

Superficial flexor muscles of the forearm, anterior view

104

KAPLAN) MEDICAL
......

SYSTEM

Superficial extensor muscles of the forearm, lateral view (hand pronated)

105

s...._1'1 MEDICAL ICAl

SYSTEM

Deep flexor muscles of the forearm, anterior view

106

KAPLAJ) MEDICAL

SYSTEM

Deep extensor muscles of the forearm, posterior view

107

I(APLAN
....

MEDICAL

SYSTEM

Muscles of the hand, posterior (dorsal) view

109

I_AN MEDICAL

Muscles of the hand, anterior (palmar) view

110

KAPLA) MEDICAL
s.

Intercostal muscles, anterior view

111

KAPLAN) MEDICAL
.,...

Diaphragm, anterior view

112

KAPLA MEDICAL

Superficial abdominal muscles, anterior view

114

s KAPLAI, I) MEDICAL

Deep abdominal muscles, anterior view

115

KAPLAN) MEDICAL
"....

Posterior abdominal wall muscles, anterior view

116

KAPLAN) MEDICAL

Pelvic diaphragm, superior view

117

1 KAPLAts) MEDICAL
...

Perineal muscles, inferior view

118

Male

KAPLAN) MEDICAL
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Urogenital diaphragm, inferior view

119

!CAPLAN) MEDICAL

Lower limb muscles, anterior view

120

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Muscles of the lower limb, posterior view

Superficial femoral muscles, anterior view

Deep femoral muscles, anterior view

Medial femoral muscles, medial view

Lateral femoral muscles, lateral view

125

KAPLAN) MEDICAL
....

SYSTEM

Gluteal muscles, posterior view

126

KAPLAINI) MEDICAL
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Posterior femoral muscles, posterior view

127

KAPLAN) MEDICAL

1
Posterior thigh and gluteal muscles, deep dissection, posterior view

128

KAPLAN) MEDICAL

Muscles of the anterior compartment of the leg, anterior view

130

KAPLAN) MEDICAL
.....

Muscles of the lateral compartment of the leg, lateral view

131

KAPLAls

MEDICAL

SYSTEM

Deep muscles of the leg, anterior view

132

KAPLAN) MEDICAL

SYSTEM

Muscles of the superficial posterior compartment of the leg, posterior view

133

-c

g
e

KAPLA) MEDICAL

SYSTEM

Muscles of the deep posterior compartment of the leg, posterior view

134

KAPLA) MEDICAL ......

Muscles of the dorsal foot

135

KAPLAN) MEDICAL

SYSTEM

Plantar muscles of the foot, first and second layers

136

MEDICAL

Plantar muscles of the foot, third layer

137. Plantar muscles of the foot, third layer

a. Proximal phalanx of great toe b. Flexor hallucis brevis muscle c. Cuboid bone d. Tendon of fibularis (peroneus) longus muscle e. Adductor hallucis muscle, oblique head
1. Flexor digiti minimi brevis

muscle g. Adductor hallucis muscle, transverse head h. Proximal phalanx

The flexor hallucis brevis muscle arises on the cuboid and lateral cuneiform tarsal bones, inserts on the proximal phalanx of the great toe, and flexes the great toe. The adductor hallucis muscle arises in two headsthe oblique on the base of metatarsals IIIV and the transverse on the plantar ligaments. The adductor hallucis inserts on the proximal phalanx of the great toe; it adducts and flexes the great toe. The flexor digits minimi brevis muscle arises at the base of metatarsal V. inserts on the lateral side of the proximal phalanx of toe 5, and flexes the metatarsophalangeal joint of toe 5. The tendon of the fibularis (peroneus) longus muscle crosses the sole of the foot obliquely and inserts at the base of the first metatarsal bone and on the medial cuneiform bone. It extends the foot and everts the sole of the foot.

71. Hip joint, frontal section

a. Coxal bone b. Articular cartilage c. Acetabular labrum

d. Zona orbicularis of capsule

e. Articular capsule 1. Femur

The hip joint is a sturdy synovial joint (ball and socket joint) between the globular head of the femur and the cuplike acetabulum of the coxal bone. A thin layer of articular cartilage covers both bone surfaces to reduce friction. A fibrocartilage lip called the acetabular labrum extends the edge of the acetabulum to increase its depth; it is located slightly beyond the widest diameter of the femoral head to hold it firmly in place. The articular capsule is strong and dense; it completely encloses the head and neck of the femur, and extends beyond the edge of the acetabulum. The capsule includes longitudinal bands of fibers that stretch between the hip bone and the femur to strengthen the joint; the zona orbicularis of the capsule includes deep circular fibers that form a collar to hold the head of the femur tightly in the socket. The joint permits a range of movements: flexion and extension, adduction and abduction, circumduction and rotation.

72. Pelvic ligaments, posterior view

a. b. c. d. e. Iliac crest Posterior superior iliac spine Iliolumbar ligament Fifth lumbar vertebra Supraspinous ligament f. Short dorsal sacroiliac ligaments g. Long dorsal sacroiliac ligament

h. Femur I. Sacrospinous ligament

I.

Superficial dorsal sacrococcygeal ligament k. Sacrotuberous ligament I. Articular capsule of the hip joint

Strong ligaments are necessary to stabilize the pelvis. The supraspinous ligament that runs along the edges of the vertebral dorsal spinous processes continues along the median sacral crest. In addition, the iliolumbar ligament connects the fifth lumbar vertebra both to the sacrum and the iliac crest. The sacroiliac joint is stabilized by the horizontal short dorsal sacroiliac ligament between the sacrum and the tuberosity of the ilium and by the oblique long dorsal sacroiliac ligament connecting the sacrum to the posterior superior iliac spine. The sacrotuberous ligament is connected at one end to the posterior inferior iliac spine, the lower part of the sacrum, and the coccyx; the other end attaches to the tuberosity and ramus of the ischium. Nearby, the sacrospinous ligament extends from the sacrum and coccyx to the spine of the ischium. The sacrococcygeal joint is stabilized by several ligaments, including the superficial dorsal sacrococcygeal ligament. At the hip joint, strong ligaments reinforce the articular capsule that encloses the head and much of the neck of the femur.

73. Knee joint, anterior view

a. Femur b. Patella c. Fibular collateral ligament (lateral collateral ligament) d. Lateral meniscus e. Lateral condyle of tibia 1. Fibula g. Tibia h. Tibial collateral ligament (medial collateral ligament) I. Medial condyle of tibia j. Medial meniscus k. Patellar ligament

The articulation between the femur and tibia at the knee joint performs a simple hinge function, primarily facilitating flexion and extension of the lower leg. However, a small amount of medial and lateral rotation (io and 3o respectively) is also possible. The medial and lateral condyles of the femur articulate with the medial and lateral condyles of the tibia; the medial and lateral menisci are fibrocartilage pads that cushion and separate the bones within the joint. The patella is held in place anterior to the distal portion of the femur by the patellar ligament distally and the quadriceps muscle tendon proximally; it not only protects the knee joint but also provides increased leverage for the quadriceps muscle during knee extension. The patella resides at its most superior location during full extension of the knee, and moves as much as 7 cm inferiorly during flexion, until it is located between the distal ends of the femoral condyles. To the side, the knee joint is stabilized by the tibial (medial) collateral ligament and the fibular (lateral) collateral ligament.

74. Bent knee joint, anterior view with patella removed

a. b. c. d. e. Femur Articular cartilage Anterior cruciate ligament Lateral meniscus Lateral condyle of tibia 1. Fibula g. Tibia h. Tibial collateral ligament I. Medial condyle of tibia j. Medial meniscus k. Posterior cruciate ligament

With the knee bent and the patella removed, the interior of the synovial joint is revealed. The articular cartilage protecting the articular surface of the femur extends superiorly behind the position of the patella, as part of the femoropatellar joint. The two femoral condyles are separated from the two tibial condyles by the medial and lateral menisci. These pads of fibrocartilage fill in the space between the convex surface of the femoral condyle and the flatter surface of the tibial condyle; they act as durable shock absorbers and contribute to both stability and lubrication in the joint. Ligaments stabilize the joint; the anterior cruciate ligament (ACL) extends between the lateral condyle of the femur posteriorly and the intercondylar region of the tibia anteriorly; the posterior cruciate ligament (PCL) connects the posterior intercondylar region of the tibia with the medial condyle of the femur anteriorly. The ACL resists forces pushing the tibia forward, while the PCL resists forces pushing the tibia posteriorly relative to the femur. Excessive abduction or adduction motion at the knee joint is limited by the fibular (lateral) and tibial (medial) collateral ligaments.

75. Knee joint, sagittal section

a. Femur b. Lateral menniscus, posterior horn c. Fibula d. Tibia e. Patellar ligament 1. Lateral meniscus, anterior horn g. Infrapatellar fat pad h. Patella I. Articular cartilage

A sagittal section through the lateral condyles of the femur and tibia reveals the anterior-posterior relationships of the fully-extended knee joint. Articular cartilage covers the convex articular surface of the femur and the flatter articular surface of the tibia. Between the two articular cartilages lies the C-shaped lateral meniscus, with posterior and anterior horns positioned to fill the area between the curving articular surfaces. Popliteal ligaments strengthen the back of the synovial articular capsule. The fibula articulates with the tibial epicondyle laterally and posteriorly; a collateral ligament extends from the fibula to the lateral epicondyle of the femur to strengthen the joint. Anteriorly, the patella moves along the femoral articular surface when the quadriceps muscle flexes the knee; the articular cartilage of the patella is one of the thickest due to the intense stresses of this movement. The quadriceps muscle tendon attaches on the superior surface and is continuous with the inferior patellar ligament. The infrapatellar fat pad absorbs shocks and fills in the space below and behind the patella.

76. Ankle joint, posterior view

a. Fibula b. Posterior tibiofibular ligament c. Transverse tibiofibular ligament d. Posterior talofibular ligament e. Posterior talocalcaneal ligament f. Calcaneofibular ligament g. Calcaneal (Achilles) tendon h. Calcaneus i. Medial talocalcaneal ligament j. Talus k. Deltoid ligament, tibiocalcaneal part I. Deltoid ligament, tibiotalar part m. Tibia

The posterior view of the ankle joint shows several ligaments that stabilize the articulations between the leg and ankle bones. The largest tendon in the human body is the calcaneal tendon (also known as the Achilles tendon) that connects three lower leg musclesthe gastrocnemius, the soleus, and the plantariswith their insertion on the calcaneus, the largest of the tarsal bones. Above the ankle, the distal articulation of the tibia and fibula are stabilized by the posterior and transverse tibiofibular ligaments. Laterally, the ankle joint is stabilized by connections between the lateral malleolus of the fibula and the tarsal bones, including the talofibular and calcaneofibular ligaments. On the medial side, the ankle is stabilized by ligaments connecting the medial malleolus of the tibia with tarsal bones such as the calcaneus and the talus, including the tibiocalcaneal and tibiotalar parts of the deltoid ligament. Articulations between the tarsal bones are also stabilized by ligaments, such as the medial and posterior talocalcaneal ligaments connecting the talus and calcaneus.

104. Superficial flexor muscles of the forearm, anterior view a. b. c. d. e. 1. Palmaris longus muscle Humerus Flexor carpi radialis muscle Pronator teres muscle Flexor carpi ulnaris muscle Flexor digitorum superficialis muscle g. Radius h. Ulna I. Second metacarpal bone J. Pisiform bone k. Hamate bone l. Fifth metacarpal bone m. Middle phalanx

The palmaris longus muscle arises on the medial epicondyle of the humerus and flexes the wrist by inserting on the palm and a band of connective tissue in the wrist called the flexor retinaculum. The flexor carpi radialis muscle arises on the medial epicondyle of the humerus, inserts at the base of the second and third metacarpal bones, and both flexes and abducts the wrist. The flexor carpi ulnaris muscle originates on the medial epicondyle of the humerus as well as adjacent parts of the ulna; it inserts on the pisiform and hamate carpal bones, and on the fifth metacarpal bone. The flexor carpi ulnaris both flexes and adducts the wrist. The flexor digitorum superficialis muscle arises on the medial epicondyle of the humerus as well as adjacent surfaces of the ulna and radius; it inserts on the middle phalanges of fingers 2-5 by long tendons and acts to flex the fingers at the joints between the metacarpals and proximal phalanges as well as the joint between the proximal and middle phalanges. The pronator teres muscle arises on the medial epicondyle of the humerus as well as the coronoid process of the ulna, inserts on the lateral, distal surface of the radius, and pronates the forearm.

105. Superficial extensor muscles of the forearm, lateral

view (hand pronated)

a. Lateral epicondyle of humerus b. Ulna c. Extensor digitorum muscle d. Extensor carpi ulnaris muscle e. Extensor digiti minimi muscle f. Extensor expansion g. Distal phalanx h. Second metacarpal bone i. Radius j. Extensor carpi radialis brevis muscle k. Extensor carpi radialis longus muscle l. Brachioradialis muscle

The brachioradialis muscle arises on the ridge above the lateral epicondyle of the humerus, inserts on the lateral, distal part of the radius and flexes the forearm at the elbow. The extensor carpi radialis brevis and extensor carpi radialis longus muscles flex the wrist; the brevis originates on the ridge above the lateral epicondyle of the humerus and inserts at the base of the second metacarpal bone, the longus arises on the lateral epicondyle of the humerus, inserts at the base of the third metacarpal, and abducts as well as extends the wrist. The extensor carpi ulnaris muscle arises on both the lateral epicondyle of the humerus and adjacent surfaces of the ulna, inserts at the base of the fifth metacarpal, and both extends and adducts the wrist. The extensor digitorum muscle arises on the lateral epicondyle of the humerus and its tendons insert on the phalanges of fingers 2-5; it extends those four fingers as well as extending the wrist. The extensor digiti minimi muscle arises by tendon from the lateral epicondyle of the humerus, inserts on the extensor expansion of finger 5 and extends that finger at all joints.

106. Deep flexor muscles of the forearm, anterior view

a. Humerus b. Ulna c. Flexor digitorum profundus muscle d. Pronator quadratus muscle e. Distal phalanges f. Flexor pollicis longus g. Radius

The flexor digitorum profundus muscle originates on the olecranon and other proximal portions of the ulna; it inserts with four long tendons on the distal phalanges to flex the joint between the middle and distal phalanges. The flexor pollicis longus muscle arises along the shaft of the radius and inserts on the distal phalanx of the thumb to flex the joints of the thumb. The pronator quadratus muscle arises on the distal quarter of the ulna and inserts on the corresponding portion of the radius; it pronates the forearm as well as maintains the positions of the radius and ulna in relation to each other.

107. Deep extensor muscles of the forearm, posterior view

a. Ulna b. Extensor pollicis longus muscle c. Extensor indicis muscle d. Extensor expansion of index finger e. Distal phalanx

1. Radius g. Extensor pollicis brevis muscle h. Abductor pollicis longus muscle I. Supinator muscle

The relative positions of the radius and ulna control hand position; in the supine position, the palm of the hand faces forward. The supinator muscle arises on the lateral epicondyle of the humerus and adjacent parts of the ulna, passes dorsal to the radius and inserts on its lateral surface; it works in supination along with the biceps brachii. The abductor pollicis longus muscle arises on the posterior surfaces of the radius and ulna, inserts on the first metacarpal and trapezium bones, and acts to abduct and extend the thumb. The extensor pollicis longus muscle originates on the ulna, inserts on the distal phalanx of the thumb, and extends the thumb. The extensor pollicis brevis muscle arises on the radius, inserts on the proximal phalanx of the thumb and extends the thumb. The extensor indicis muscle arises on the ulna, inserts on the extensor expansion of the second metacarpal and extends the index finger.

108. Transverse sections of the arm

a. Biceps brachii muscle b. Brachialis muscle c. d. e. f. g. h. i. j. k. Humerus Triceps muscle, lateral head Triceps muscle, long head Triceps muscle, medial head Tendons of flexor digitorum superficialis muscle Tendon of flexor carpi radialis muscle Tendon of flexor pollicis longus muscle Tendon of abductor pollicis longus muscle Tendon of extensor pollicis brevis muscle m. Tendon of extensor carpi radialis longus muscle n. Tendon of extensor carpi radialis brevis muscle o. Tendon of extensor pollicis longus muscle p. Tendons of extensor digitorum muscle q. Tendon of extensor digiti minimi muscle r. Tendon of extensor carpi ulnaris muscle s. Ulna t. Pronator quadratus muscle u. Tendon of flexor carpi ulnaris muscle v. Tendons of flexor digitorum profundus muscle

I. Radius

The relative positions of the arm muscles are seen in the upper arm. The biceps brachii and brachialis muscles are anterior to the humerus and flex the elbow joint; the three portions of the triceps muscle act together to extend the elbow. Most of the forearm muscles occupy the proximal portion of the forearm, while their tendons extend distally to control wrist, hand and finger motion. Anterior to the ulna and radius are the tendons of Flexor muscles, while the tendons of extensor muscles are posterior to the two bones. The pronator quadratus muscle extends between the radius and ulna, acting to pronate the forearm and to bind the two bones together.

109. Muscles of the hand, posterior (dorsal) view

a. Insertion of lateral slips of extensor digitorum muscle and interosseous and lumbrical muscles b. Third interosseous muscle c. Tendons of extensor digiti minimi muscle d. Tendon of extensor carpi ulnaris muscle e. Extensor retinaculum f. Tendon of extensor carpi radialis brevis muscle g. Tendon of extensor carpi radialis longus muscle h. Tendon of extensor indicis muscle I. Tendons of extensor digitorum muscle j. First interosseous muscle k. Extensor expansion L Insertion of central slip of extensor digitorum muscle

The extensor retinaculum is a wide band of connective tissue along the wrist; it holds tendons in place as they extend from muscles in the forearm to their insertion points in the hand. Each of the four tendons of the extensor digitorum muscle spreads out across the joint at the base of the proximal phalanx to form a broad hood called the extensor expansion, continues along the proximal phalanx, then splits to form a central slip that inserts on the middle phalanx and two lateral slips that pass along the side of the first interphalangeal joint. The two lateral slips rejoin and insert on the distal phalanx along with tendons from the interosseous and lumbrical muscles. The tendons of the extensor indicis and extensor digiti minimi muscles parallel those of the extensor digitorum to insert on the second and fifth finger, respectively. The tendons of the extensor carpi radialis longus, extensor carpi radialis brevis, and extensor carpi ulnaris insert on the base of the second, third, and fifth metacarpals, respectively. Interosseous muscles are bipennate muscles that originate along the sides of the metacarpals and insert on the extensor expansions, acting to abduct the fingers.

110. Muscles of the hand, anterior (palmar) view

a. Tendons of flexor digitorum profundus muscle b. Tendons of flexor digitorum superficialis muscle c. First and second lumbrical muscles d. Proximal phalanx e. Adductor pollicis muscle 1. Flexor pollicis brevis muscle g. Abductor pollicis brevis muscle

h. Flexor retinaculum I. Pisiform bone

I. Abductor digiti minimi muscle k. Flexor digiti minimi brevis muscle 1. Opponens digiti minimi muscle m. Fourth and fifth lumbrical muscles n. Proximal phalanx

The tendons of the flexor digitorum superficialis muscle are stabilized at the wrist as they pass under the flexor retinaculum, and insert on the middle phalanges. The tendons of the flexor digitorum profundus muscle are deeper at the wrist and palm, but pass through the superficial tendons to insert on the distal phalanx. On the lateral (thumb) side of the hand, the adductor pollicis, flexor pollicis brevis and abductor pollicis brevis muscles insert on the proximal phalanx of the thumb to control its movements. On the medial side of the hand, the abductor digiti minimi and flexor digiti minimi muscles arise on the pisiform and hamate bones respectively, insert on the proximal phalanx, and act to abduct or flex the little finger. The opponens digit! minimi muscle acts to bring the little finger in opposition with the thumb. Four wormlike lumbrical muscles extend between the tendons of the flexor digitorum profundus and the extensor expansions (dorsal) to simultaneously flex the metacarpophalangeal joints and extend the interphalangeal joints.

111. Intercostal muscles, anterior view

a. External intercostal muscle b. First rib c. First thoracic vertebra d. Costal cartilage e. Internal intercostal muscle

Respiration involves changes in pressure within the thoracic cavity due to movements of the ribs and diaphragm that change the volume of the cavity. The intercostal muscles extend between the ribs and function in the respiratory movements of the ribs. Eleven external intercostal muscles on each side arise from the inferior border of ribs 1-11 and act to lift the rib during inspiration. The external intercostals pass obliquely forward and down to insert on the next lower rib, ranging from the tubercles posteriorly to the end of the ribs anteriorly, except that the lower two extend to the costal cartilage and the upper two don't quite reach the end of the rib. Eleven internal intercostal muscles on each side originate at the costal groove on the interior, inferior surface of ribs 1-11, pass obliquely down and laterally to insert on the superior margin of the next lower rib. They bring the ribs closer together during exhalation.

112. Diaphragm, anterior view

a. Xiphoid process b. Esophageal hiatus c. Diaphragm d. Aortic hiatus e. Medial arcuate ligament f. Left crus of diaphragm g. Right crus of diaphragm h. Third lumbar vertebra

The diaphragm is a broad, thin dome-shaped muscle that separates the thoracic cavity from the abdominal cavity. The muscle originates laterally and anteriorly around the inferior margin of the rib cage and costal cartilages, as well as the posterior aspect of the xiphoid process of the sternum. Posteriorly, the diaphragm arises from the medial arcuate ligament, allowing the psoas major muscle to pass vertically along the body wall. Muscular fibers of the right crus of the diaphragm arise on vertebrae I.1-3, while the left crus arises on 11-2; the median arcuate ligament unites the two crura and passes over the aortic hiatus. Openings in the diaphragm allow important structures to be continuous between the two cavities; these openings include the esophageal hiatus and the aortic hiatus. The diaphragm plays an important role in respiration; contraction of the muscle causes the "dome" to move inferiorly, expanding the thoracic cavity and triggering inhalation by reducing intrathoracic pressure. Relaxation of the diaphragm allows it to return to a convex shape that makes the thoracic cavity smaller; elasticity of the lungs then expels air.

113. Diaphragm, inferior view

a. b. c. d. Costal cartilage Esophageal hiatus Aortic hiatus Diaphragm f. Lateral arcuate ligament and twelfth rib g. Medial arcuate ligament h. Vena caval foramen i. Central tendon of diaphragm

e. First lumbar vertebra

Muscle fibers of the diaphragm arise from the medial arcuate ligament attached to the transverse process of vertebra Li, the lateral arcuate ligament along the twelfth rib, the interior surface of the anterior and lateral parts of the inferior ribs and costal cartilage, and the posterior surface of the sternum at the xiphoid process. Anterior to the lumbar vertebrae, muscle fibers of the right and left crura arise and pass to either side of the aortic hiatus, an opening behind the fibers of the diaphragm that allows passage of the abdominal aorta from the thoracic cavity to the abdomen. Other openings in the diaphragm include the esophageal hiatus for passage of the esophagus toward the stomach, and the vena caval foramen that allows the posterior vena cava to return toward the heart. The muscle fibers of the diaphragm converge on the central tendon, which has no skeletal attachment, but is fused on its superior surface with the pericardium.

114.

Superficial abdominal muscles, anterior view

f. Pubic tubercle g. Symphysis pubis h. Spermatic cord I. Umbilicus I. External abdominal oblique muscle k. Aponeurosis, external abdominal oblique muscle L Fifth rib

a. Sternum b. Cut edge of aponeurosis, external abdominal oblique muscle c. Aponeurosis, internal abdominal oblique muscle d. Internal abdominal oblique muscle e. Inguinal ligament

The external abdominal oblique muscle is the most superficial of the muscles in the torso wall. It is a broad, flat muscle that arises on the anterior angles of the inferior eight ribs and inserts on the pubic tubercle, the inguinal ligament, and the iliac crest. The fibers of the broad, flat internal abdominal oblique muscle run perpendicular and deep to the fibers of the external abdominal oblique. The internal abdominal oblique arises on the fascia of the lower back, the iliac crest and the inguinal ligament and inserts on the inferior border of the lower three ribs and on the linea alba. Both abdominal oblique muscles end in broad aponeuroses that together form the anterior wall of the abdomen. Near the inguinal ligament, a triangular hole in the aponeurosis provides for passage of the spermatic cord (in males) or the round ligament of the uterus (in females). Acting together, the two abdominal oblique muscles on each side compress the abdomen, aiding in breathing and defecation, or flex the trunk. Acting separately, they rotate the trunk.

115. Deep abdominal muscles, anterior view

a. b. c. d. e. Sternum Fifth rib Tendinous intersection Rectus abdominis muscle Arcuate line 1. Symphysis pubis g. Aponeurosis of transversus abdominis muscle h. Iliac crest i. Transversus abdominis muscle j. Umbilicus k. Cut edges of rectus abdominis muscle

The transversus abdominis muscle lies deep to the internal and external abdominal oblique muscles and works with them to compress the abdomen. The transversus abdominis originates on the iliac crest, the inguinal ligament and the costal cartilage of ribs 7-12. The aponeurosis of the transversus abdominis inserts on the linea alba. The rectus abdominis muscle extends vertically along either side of the linea alba, and acts to depress the ribs, flex the spine and stabilize the pelvis during walking. It originates along the symphysis pubis and inserts on the costal cartilages of ribs 5 7 and the xiphoid process of the sternum. Inferior to the arcuate line, the aponeurosis of the other abdominal muscles is superior to the rectus abdominus; superficial to the arcuate line, parts of the aponeurosis lie both superficial and deep to the rectus abdominis, forming a sheath that encloses the muscle. At several tendinous intersections, the rectus abdominis muscle is firmly attached to the part of the sheath that stretches anterior to the muscle.
-

116. Posterior abdominal wall muscles, anterior view

a. Diaphragm b. Lateral arcuate ligament c. Quadratus lumborum muscle d. Lumbar vertebrae e. Iliac crest 1. Femur g. Iliacus muscle h. Iliolumbar ligament i. Umbilicus j. Psoas major muscle k. Medial arcuate ligament

The quadratus lumborum muscle arises from the iliac crest and the iliolumbar ligament, which extends between the transverse processes of the 5th lumbar vertebra and the iliac crest. The quadratus lumborum passes under the edge of the diaphragm at the lateral arcuate ligament and inserts on the lowest rib and the transverse processes of lumbar vertebrae 1-4; together, the two quadratus lumborum muscles act to depress the rib cage and individually each flexes the spine laterally. The psoas major muscle originates on the transverse processes and bodies of the lumbar vertebrae, passes under the edge of the diaphragm at the medial arcuate ligament, and inserts on the lesser trochanter of the femur. The iliacus muscle arises on the concave superior surface of the ala of the ilium, and its fibers join the tendon of the psoas major to insert on the lesser trochanter of the femur. The psoas major and the iliacus are part of a group of muscles known as hip flexorsthey flex the hip and laterally rotate the thigh.

117. Pelvic diaphragm, superior view

Coccyx Coccygeus muscle Anal canal Levator ani muscle, iliococcygeus e. Levator ani muscle, pubococcygeus f. Levator ani muscle, puborectalis a. b. c. d. g. Symphysis pubis h. Hiatus of urethra i. Obturator internus muscle, and overlying obturator fascia j. Tendinous arch for origin of levator ani muscle

Looking down on the pelvis from the abdomen, one can see the pelvic diaphragm that separates the pelvic cavity from the perineal region and supports the pelvic viscera including bladder and intestines. The coccygeus muscle arises on the spine of the ischium and the sacrospinous ligament, and widens to insert along the coccyx. The levator ani muscle consists of three parts: the iliococcygeus extends from the ischial spine and adjacent tendinous arch of the pelvic fascia to the coccyx; the pubococcygeus stretches from the pubic bone to the coccyx and surrounds the urethra; and the puborectalis arises from the symphysis pubis, surrounds the anal canal and meets with corresponding fibers from the opposite side to support the rectum. The obturator intemus muscle is covered by an overlying fascia; the muscle originates on the fascia as well as the adjacent margins of the pubis and ischium. The obturator internus inserts on the greater trochanter of the femur and rotates the thigh laterally.

118. Perinea( muscles, inferior view

a. b. c. d. e. f. Coccyx Anococcygeal ligament Levator ani muscle Ischia' tuberosity Ischiocavernosus muscle Bulbocavernosus (bulbospongiosus) muscle g. Central tendinous point of perineum h. Inferior fascia, urogenital diaphragm i. Superficial transverse perinea( muscle External anal sphincter I. muscle k. Urogenital hiatus

The levator an! muscle extends from the surface of the lower pelvis to the coccyx and the midline; those fibers anterior to the coccyx join with the fibers from the opposite side to form the anococcygeal ligament. The external anal sphincter muscle is an elliptically-shaped group of muscle fibers that surrounds the anus; external fibers arise on the anococcygeal ligament and insert on the central tendinous point of the perineum and deeper fibers form a complete sphincter. The superficial transverse perinea( muscle also inserts on the central tendinous point of the perineum. The ischiocavemosus muscle arises on the ischial tuberosity and ramus and inserts on the pubic symphysis. The ishiocavernosus compresses and stiffens the penis (in males) or clitoris (in females). The bulbospongiosus (or bulbocavernosus) muscle originates on the collagen sheath at the base of the penis (in males) or the clitoris (in females); the fibers cross over the urethra (in males) or the urethra and vagina (in females) and insert on the central tendinous point of the perineum. The bulbospongiosus acts in males to stiffen the penis and eject urine or semen; in females, the muscle stiffens the clitoris and narrows the urogenital hiatus or vaginal opening.

119. Urogenital diaphragm, inferior view

a. Superficial transverse perineal muscle b. Deep transverse perineal muscle c. Sphincter urethrae muscle d. Symphysis pubis e. Arcuate pubic ligament f. Transverse perineal ligament g. Urethra h. lschial tuberosity i. Vagina

The urogenital diaphragm refers to the thin layer of muscle at the outlet of the pelvis. Posterior and inferior to the symphysis pubis, the arcuate pubic ligament is a thick, triangular ligament connecting the two pubic bones. The transverse perineal ligament is a region of thickened fascia between the urogenital diaphragm and the arcuate pubic ligament. The deep transverse perineal muscle arises on the ischial ramus, and inserts at the central tendinous point of the perineum. The small superficial transverse perineal muscle extends transversely between the ischial tuberosity and the central tendinous point of the perineum. The sphincter urethrae muscle arises from the inferior pubic ramus; fibers from both sides meet to form a sphincter that constricts the urethra in the male and compresses both the urethra and vagina in the female.

120. Lower limb muscles, anterior view

Anterior femoral muscles: a. Sartorius muscle b. Rectus femoris muscle c. Vastus medialis muscle d. Vastus lateralis muscle Anterior compartment muscles: j. Tibialis anterior muscle k. Extensor digitorum longus muscle I. Extensor hallucis longus muscle Posterior compartment muscles: m. Gastrocnemius muscle n. Soleus muscle Lateral femoral muscles: o. Tensor fasciae latae muscle

Medial femoral muscles:

e. Pectineus muscle f. Adductor longus muscle g. Gracilis muscle Lateral compartment muscles: h. Fibularis (peroneus) longus muscle i. Fibularis (peroneus) brevis muscle

The tensor fasciae latae muscle flexes the hip. Anterior femoral muscles include the sartorius muscle that flexes the knee and the rectus femoris, vastus lateralis and vastus medialis muscles that extend the knee. Medial femoral muscles include the pectineus and adductor longus muscles that flex, adduct and medially rotate the hip; and the gracilis muscle that also flexes the knee. On the lateral side of the lower leg, the Fibularis longus and Fibularis brevis muscles evert the foot and plantar flex the ankle. The anterior side of the lower leg includes the tibialis anterior muscle that dorsiflexes the ankle and inverts the foot; and the extensor digitorum longus and extensor hallucis longus muscles that extend the joints of the toes. On the posterior side of the lower leg are the gastrocnemius and soleus muscles that plantar flex the ankle and adduct the foot; the gastrocnemius also flexes the knee.

121. Muscles of the lower limb, posterior view

Posterior femoral muscles: a. Biceps femoris muscle b. Semitendinosus muscle c. Semimembranosus muscle Superficial posterior compartment of the leg: d. Plantaris muscle e. Gastrocnemius muscle Lateral femoral (glutea0 muscles: 1. Gluteal fascia over gluteus medius muscle g. Gluteus maximus Medial femoral muscles: h. Adductor magnus muscle i. Gracilis muscle j. Calcaneal tendon k. Iliotibial tract

The superficial gluteus maximus muscle extends and laterally rotates the hip, while the deeper gluteus medius muscle abducts and medially rotates the hip. Along with other muscles, the gluteus maximus inserts on the iliotibial tract, a layer of fascia that lies posterior to the tensor fasciae latae muscle, interconnecting the femur, patella and tibia, and stabilizing the knee. On the medial side, the adductor magnus muscle abducts the hip; portions of the muscle also flex and medially rotate or extend and laterally rotate the hip. The gracilis muscle adducts and medially rotates the hip as well as flexing the knee. Other femoral muscles that flex the knee include the semitendinosus muscle, the biceps lemon's muscle that also extends and laterally rotates the hip, and the semimembranosus muscle that also flexes and medially rotates the hip. The gastrocnemius muscle flexes the knee, plantar flexes the ankle, and adducts the foot. The plantaris muscle inserts on the calcaneal tendon to flex the knee and plantar flex the ankle.

122. Superficial femoral muscles, anterior view

Abdominal muscles related to the leg: a. Psoas major muscle b. lliacus muscle Anterior femoral muscles: c. Sartorius muscle Quadriceps femoris muscle: d. Rectus femoris Medial femoral muscles:

g. Pectineus muscle h. Gracilis muscle I. Adductor longus muscle

j. Inguinal ligament k. Tendon of rectus femoris

muscle

1. Patella
m. Pubic tubercle n. Pecten pubis

e. Vastus lateralis
f. Vastus medialis

The psoas major muscle originates on the lumbar vertebrae while the iliacus muscle arises on the broad, concave superficial surface of the ilium; both muscles insert on the lesser trochanter of the femur and flex the hip. The quadriceps femoris muscle is composed of four muscles that attach at the patella and continue as the patellar ligament to insert on the tibial tuberosity and act to extend the knee. The rectus femoris arises on the ilium; it flexes the hip as well as the knee. The vastus medialis, vastus lateralis and the vastus intermedius all originate on the femur. Like the rectus femoris, the sartorius muscle arises on the iliac spine; it inserts on the tibia and flexes the knee as well as flexing and laterally rotating the hip. Three medial femoral muscles adduct and rotate the hip medially. The adductor longus muscle arises on the ramus of the pubis and the pectineus muscle originates along the pectin pubis, a ridge on the superior side of the ramus of the pubis bone; both insert along the femur and also flex the hip. The gracilis arises on the ramus of the pubis, inserts on the tibia and also flexes the knee.

123. Deep femoral muscles, anterior view

a. Pecten pubis Medial femoral muscles: b. Obturator externus muscle c. Adductor brevis muscle d. Adductor magnus muscle e. Gracilis muscle Anterior femoral muscle: f. Vastus intermedius muscle g. Adductor hiatus h. Patella I. Iliofemoral ligament j. Greater trochanter of femur

The vastus intermedius muscle is deep to the rectus femoris; it arises on the upper part of the femur, inserts on the patella along with the other quadriceps tendons, continuing on as the patellar ligament, and acts to flex the knee. The obturator extemus muscle arises on the obturator foramen, inserts on the fossa medial to the greater trochanter on the posterior side of the femur and rotates the hip laterally. The adductor brevis and adductor magnus muscles originate on the inferior ramus of the pubis and insert on the femur; both adduct the hip. In addition, the adductor brevis flexes the hip while different portions of the adductor magnus may either flex or extend the hip. The adductor hiatus is a space near the insertion of the adductor magnus where blood vessels pass. The gracilis muscle also arises on the inferior ramus of the pubis; it inserts on the medial surface of the tibia below the medial condyle, and both flexes the knee and adducts the hip.

124. Medial femoral muscles, medial view a. Right hip bone Medial femoral muscles: b. Pectineus muscle c. Obturator externus muscle d. Adductor longus muscle e. Gracilis muscle 1. Adductor magnus muscle g. Femur h. Tibia On the medial aspect of the thigh, the most superficial muscle is the gracilis; it extends from the pubis part of the hip bone to the tibia and flexes the knee as well as adducts the hip. The adductor magnus is a large, powerful muscle that arises on the pubis and ischium and inserts along the femur. The adductor magnus adducts the hip; in addition, the superior portion flexes the thigh while the inferior portion extends it. The adductor longus and pectineus muscles extend between the pubis bone and the femur; they act to flex and adduct the hip, and assist in medial rotation. The obturator extemus muscle extends between the margin of the obturator foramen and the posterior surface of the greater trochanter of the femur; it rotates the thigh laterally as well as assists in adduction.

125. Lateral femoral muscles, lateral view

Lateral femoral (gluteal) muscles: a. Gluteus medius muscle b. Gluteus maximus muscle c. Tensor fasciae latae muscle d. Iliotibial tract e. Femur 1. Tibia g. Iliac crest

On the lateral aspect of the hip, the gluteus maximus muscle is the most superficial of the gluteal muscles; it arises along the posterior iliac crest, the sacrum and the coccyx. The fibers of the gluteus maximus pass inferiorly and laterally to insert on the iliotibial tracta band of collagen tissue that passes down along the thigh to insert on the tibia. The gluteus maximus is the major extensor of the hip joint and also acts in lateral rotation. The deeper gluteus medius muscle originates on the ilium, below the iliac crest, and inserts on the greater trochanter of the femur. The gluteus medius is the major abductor of the hip; portions of it may assist in rotating the hip either medially or laterally. The tensor fasciae latae muscle arises on the anterior iliac crest and the fasciae lata, and inserts on the iliotibial tract. The tensor fasciae latae abducts the thigh and rotates the hip medially.

126. Gluteal muscles, posterior view

a. b. c. d. e. f. g. Posterior superior iliac spine Gluteus medius muscle Piriformis muscle Superior gemellus muscle Obturator internus muscle Greater trochanter of femur Inferior gemellus muscle h. Quadratus femoris muscle i. Lesser trochanter of femur j. Sacrotuberous ligament k. Iliotibial tract I Glluteus maximus muscle m. Gluteal fascia

The superficial gluteus maximus muscle arises on the iliac crest, inserts on the iliotibial tract, and is a major extensor of the hip. Deep to the gluteus maximus, the gluteus minimus arises from the ilium, inserts on the greater trochanter of the femur, and abducts the hip. The piriformis muscle originates on the anterior part of the sacrum and inserts on the greater trochanter of the femur; it rotates the hip laterally. The superior gemellus muscle arises on the spine of the ischium, the obturator internus muscle originates on the obturator foramen and the inferior gemellus muscle arises on the ischial tuberosity. These three muscles insert together on the greater trochanter of the femur and rotate the hip laterally. The quadratus femoris muscle arises on the ischium, inserts on the posterior surface of the femur between the greater and lesser trochanters, and also rotates the hip laterally.

127. Posterior femoral muscles, posterior view

a. b. c. d. Femur Biceps femoris muscle Fibula Tibia e. Semimembranosus muscle 1. Semitendinosus muscle g. Tuberosity of ischium

On the posterior aspect of the thigh, the long head of the biceps femoris muscle arises on the posterior surface of the ischial tuberosity, and the deeper short head arises midway down the femur, along the linea aspera. The two heads unite and insert together on the apex on the head of the fibula and on the lateral tibial condyle. It flexes the knee as well as extending the thigh. The semimembranosus muscle arises on the ischial tuberosity and inserts on the medial condyle of the tibia; it extends the thigh, flexes the knee, and rotates the tibia medially. The more superficial semitendinosus muscle originates on the ischial tuberosity and inserts on the medial side of the tibia shaft; it flexes and medially rotates the knee, and extends the thigh.

128. Posterior thigh and gluteal muscles, deep dissection, posterior view
a. Gluteus minimus muscle b. Inferior gemellus muscle c. Quadratus femoris muscle d. Linea aspera of femur e. Biceps femoris muscle, short head f. Fibula g. Tibia

h. Semimembranosus muscle
i. Adductor magnus muscle j. Obturator internus muscle k. Superior gemellus muscle I. Piriformis muscle

The gluteus minimus lies deep to the gluteus medius; it arises on the outer surface of the ilium, inserts on the greater trochanter of the femur, and abducts the hip. The piriformis, superior gemellus, obturator internus, inferior gemellus and quadratus femoris muscles arise along the pelvis, insert on or near the greater trochanter of the femur, and rotate the thigh laterally. A deep view of the posterior thigh muscles shows the short head of the biceps femoris, as it arises along the linea aspera, a ridge of roughened surface that runs longitudinally along the posterior surface of the femur. The short head is joined by the long head of the biceps femoris that arises on the ischium and both parts insert together on the fibula and the lateral condyle of the tibia. The adductor magnus muscle arises on the hip bone and inserts along the length of the linea aspera, and both adducts and medially rotates the hip. The semimembranosus muscle arises on the ischium, inserts on the medial tibial condyle, and flexes the knee, extends the thigh, and rotates the tibia medially.

129. Thigh, transverse section

a. b. c. d. e. Rectus femoris muscle Femur Vastus medialis muscle Femoral artery Femoral vein f. Sartorius muscle g. Gracilis muscle h. Adductor magnus muscle

I. Semitendinosus muscle
j. Semimembranosus muscle k. Biceps femoris muscle, long head I. Biceps femoris muscle, short head m.Vastus lateralis muscle n. Vastus intermedius muscle

A transverse section of the thigh, shown a short distance above the knee, illustrates the relative positions of the femoral muscles. Anterior to the femur lies the vastus medialis, vastus intermedius, and vastus lateralis muscles. Most superficial on the anterior aspect is the rectus femoris. These anterior muscles all insert on the patella and act to extend the knee. On the posterior-lateral side of the femur are the short head and long head of the biceps femoris. Between the biceps femoris and the large adductor magnus muscles are the superficial semitendinosus and the deeper semimembranosus muscles; they flex the knee. On the medial aspect are the gracilis and sartorius muscles; they, too, flex the knee. Because of the unique combination of origin and insertion for each, some of these muscles also rotate the hip either medially or laterally, or adduct the hip. The femoral artery and vein both lie deep within the thigh muscles.

130. Muscles of the anterior compartment of the leg,

anterior view
Lateral condyle of tibia Head of fibula Tibialis anterior muscle Extensor digitorum longus muscle e. Extensor hallucis longus muscle 1. Lateral malleolus g. Tendon of fibularis (peroneus) brevis muscle a. b. c. d. h. Tendons of extensor digitorum longus muscle i. Inferior extensor retinaculum j. Medial malleolus k. Tendon of tibialis anterior muscle 1. Tendon of extensor hallucis longus muscle m. Distal phalanx

In anatomical terms, the lower limb is divided into two regionsthe thigh above the knee and the leg below the knee. The anterior compartment of the leg has several muscles involved in dorsiflexion, or movement of the foot to decrease the angle between the foot and leg. The tibialis anterior muscle arises on the lateral condyle of the tibia, and its tendon inserts on the medial cuneiform tarsal and first metatarsal bones. The extensor digitorum longus muscle originates on the lateral condyle of the tibia and the anterior surface of the fibula; its tendons insert on the superior surface of the phalanges of toes 2-5 and it extends the toes in addition to dorsiflexion of the foot. The extensor hallucis longus muscle originates on the fibula and its tendon inserts on the distal phalanx of the great toe; it extends the great toe in addition to dorsiflexion of the foot. The inferior extensor retinaculum is a band of collagen fibers that extends from the calcaneus laterally to the medial malleolus of the tibia; it stabilizes the synovial sheaths for the tendons of the fibularis brevis, tibialis anterior, extensor digitorum longus, and extensor hallucis longus as they cross the ankle joint.

131. Muscles of the lateral compartment of the leg,

lateral view
a. Fibularis (peroneus) longus muscle b. Fibularis (peroneus) brevis muscle c. Lateral malleolus d. Tendon of peroneus brevis muscle e. Fifth metatarsal bone 1. Tendon of peroneus longus muscle g. Head of fibula

The fibularis longus (also known as the peroneus longus) muscle arises at the head of the fibula; the muscle parallels the bone and its tendon passes posterior to the lateral malleolus of the fibula and under the sole of the foot before inserting at the base of the first metatarsal bone. The fibularis longus acts in plantarflexion of the foot (increases the angle between the foot and leg) and also everts the foot (moves the sole away from the median plane). Because it passes under the longitudinal arch of the foot, it also serves to support the arch. The fibularis brevis (or peroneus brevis) muscle lies deep to the fibularis longus; it originates along the middle part of the fibula and its tendon runs posterior to the lateral malleolus and inserts at the base of the fifth metatarsal bone. The fibularis brevis is also involved in plantar flexion and eversion of the foot.

132. Deep muscles of the leg, anterior view

a. Tibia b. Interosseous membrane c. Inferior extensor retinaculum d. Medial malleolus e. Tendon of extensor hallucis longus muscle f. Tendon of fibularis (peroneus) brevis muscle g. Lateral malleolus h. Extensor hallucis longus muscle i. Fibularis (peroneus) brevis muscle j. Fibula

The interosseous membrane consists of connective tissue fibers that attach to both the tibia and fibula, stabilizing their positions relative to each other, dividing the anterior from the posterior compartment of the leg, and providing attachment sites for muscles. The extensor hallucis longus muscle arises from the middle half of both the fibula and interosseous membrane; its tendon passes through a channel formed by fibers of the inferior extensor retinaculum passing on either side, then inserts at the base and dorsal surface of the distal phalanx of the great toe. It acts both to dorsiflex the ankle and to extend the great toe. The fibularis brevis muscle arises along the midsection of the fibula and its tendon inserts on the fifth metatarsal bone. The fibularis brevis plantar flexes the ankle and everts the foot.

133. Muscles of the superficial posterior compartment

of the leg, posterior view

a. Plantaris muscle b. Gastrocnemius muscle c. Aponeurosis of gastrocnemius muscle d. Lateral malleolus e. 1. g. h. i. Calcaneal (Achilles) tendon Calcaneus Medial malleolus Soleus muscle Femur

The gastrocnemius muscle has two heads; one arises on the lateral condyle of the femur, the other on the femur above the medial condyle. The deeper soleus muscle originates on the head of the fibula and adjacent areas on the shafts of both the tibia and fibula. The tendon of the gastrocnemius joins with the tendon of the soleus to form the calcaneal tendon that inserts on the large tarsus known as the calcaneus. The calcaneal tendon is commonly known as the Achilles tendon. Both muscles act in plantar flexion of the ankle, and in adduction and inversion of the foot. In addition, the gastrocnemius flexes the knee. The plantaris muscle arises from the lateral supracondylar ridge of the femur; its long tendon inserts on the calcaneal tendon, and it weakly flexes the knee and plantar flexes the ankle.

134. Muscles of the deep posterior compartment of the leg,

posterior view
a. Femur b. Fibula c. Flexor hallucis longus d. Calcaneus e. Tendon of flexor digitorum longus muscle f. Tendon of tibialis posterior muscle g. Medial malleolus h. Flexor digitorum longus muscle i. Tibialis posterior muscle j. Popliteus muscle k. Tibia

Deep to the gracilis and soleus muscles, the flexor digitorum longus muscle arises on the tibia, and its tendon passes behind the medial malleolus and under the sole before it divides into four tendons that insert on the inferior surfaces of the distal phalanges of toes 2-5. It flexes the joints of those toes. The flexor hallucis longus arises on the fibula and the interosseous membrane; its tendon passes behind the talus, under the sole of the foot, and inserts on the distal phalanx of the great toe. It flexes the joints of the great toe. The tibialis posterior arises on the interosseous membrane and adjacent areas of the tibia and fibula; its tendon splits into slips that insert on the navicular and second cuneiform tarsals as well as the plantar surfaces of metatarsals 2-4. The tibialis posterior acts to adduct and invert the foot as well as to plantar flex the ankle. The popliteus muscle originates on the lateral condyle of the femur, inserts on the posterior surface of the shaft of the tibia, and medially rotates the tibia at the knee (or laterally rotates the femur).

135. Muscles of the dorsal foot

Middle phalanx Distal phalanx Extensor expansion Tendons of extensor digitorum longus muscle e. Extensor digitorum brevis muscle a. b. c. d. 1. Calcaneus g. Extensor hallucis brevis muscle h. Tendon of extensor hallucis longus muscle i. Dorsal interosseous muscles

The tendons of the extensor digitorum longus muscle are joined by other extensor tendons to form the extensor expansions that insert on the superior surfaces of the phalanges of toes 2-5 and extend the toes at the interphalangeal joints. The extensor digitorum brevis muscles arise on the calcaneus and insert on the dorsal surfaces of the toes to extend the metatarsophalangeal joints of toes 2-4. The dorsal interosseous muscles arise along the sides of the metatarsal bones, insert on the sides of toes 2-4 and abduct toes 3 and 4 at the metatarsophalangeal joints. The tendon of the extensor hallucis longus muscle inserts on the dorsal surface of the phalanges of the great toe to extend the digit. The extensor hallucis brevis muscle arises on the calcaneus bone, inserts on the proximal phalanx of the great toe, and extends the toe.

136. Plantar muscles of the foot, first and second layers

a. Middle phalanx b. Flexor digitorum brevis muscle c. Tendon of flexor hallucis longus muscle d. Lumbrical muscles e. Tendon of flexor digitorum longus muscle 1. Abductor hallucis muscle g. Calcaneus h. Quadratus plantae (flexor accessorius) muscle i. Abductor digiti minimi muscle j. Proximal phalanx k. Distal phalanx

The most superficial of the plantar muscles is the flexor digitorum brevis muscle; it arises on the calcaneus, inserts on the sides of the middle phalanges of toes 2-5 and flexes the toes at the proximal interphalangeal joints. Deep to the flexor digitorum brevis, one can see the tendons of the flexor digitorum longus muscle which insert on the inferior surface of the distal phalanges to flex toes 2-5 at the interphalangeal joints. The lumbrical muscles arise from the tendons of the flexor digitorum longus and insert on the extensor expansions of toes 2-5 to extend the interphalangeal joints but flex the metatarsophalangeal joints. With an action similar to the lumbricals, the quadratus plantae arises on the calcaneus and inserts on the tendons of the extensor digitorum longus. On the lateral side of the foot, the abductor digiti minimi muscle originates on the calcaneus, inserts on the lateral side of the proximal phalanx of toe 5, and abducts the toe. On the medial side, the tendon of the flexor hallucis longus muscle inserts on the inferior surface of the distal phalanx of the great toe, and flexes the joints of the great toe. The abductor hallucis muscle originates on the calcaneus, inserts on the medial side of the proximal phalanx of the great toe, and abducts the great toe.

SKELETAL SYSTEM (contd)

29. 30. 31. 32. 33. 34. 35. 36. 37. 38. 39. 40. 41. 42. 43. 44. 45. 46. 47. 48. 49. 50. 51. Lumbar vertebra, superior and lateral views Sacrum and coccyx, anterior view Sacrum and coccyx, posterior view Intervertebral discs, lateral and midsagittal views Sternum, anterior view Rib and vertebra, articulated, superior view; rib, posterior view Rib cage, anterior view Pectoral girdle and upper limb, anterior view Scapula, anterior and lateral views Scapula, posterior view Clavicle and related bones, superior view; clavicle, inferior view Humerus, anterior and posterior views Ulna and radius, lateral and anterior views Hand, posterior (dorsal) view Hand, anterior (palmar) view Hip bone, lateral view Pelvis, anterior view Differences between male and female pelvis Lower limb, anterior view Femur and patella, anterior and posterior views Tibia and fibula, anterior and posterior views Bones of the foot, dorsal view Bones of the foot, lateral view

ARTICULATIONS
52. 53. 54. 55. 56. 57. 58. 59. Gomphosis (peg suture) Suture Syndesmosis, posterior view Synchondrosis Symphysis Synovial joint, diagrammatic sagittal section Tendon sheath Bursa

ARTICULATIONS (cont d) 60. 61. 62. 63. 64. 65. 66. 67. 68. 69. 70. 71. 72. 73. 74. 75. 76. 77. Gliding joint Hinge joint Rotating joint Ball and socket joint Condyloid joint Saddle joint Temporomandibular joint, sagittal section Shoulder joint, frontal section Shoulder ligaments, anterior view Elbow joint, sagittal section Elbow ligaments, anterior view Hip joint, frontal section Pelvic ligaments, posterior view Knee joint, anterior view Bent knee joint, anterior view with patella removed Knee joint, sagittal section Ankle joint, posterior view Ankle joint, frontal section

78. 79. 80. 81. 82. 83. 84. 85. 86. 87. 88. 89.

Superficial muscles of the body, anterior view Superficial muscles of the body, posterior view Muscle forms: fusiform and flat sheet Muscle forms: pennate, circular, and multicaudal Muscle forms: cylindrical, triangular, quadrilateral, biventral, multiventral Muscles of facial expression, anterior view Muscles of facial expression, lateral view Superficial muscles of mastication, lateral view Deep muscles of mastication, lateral view Muscles of the neck, anterior view Suprahyoid and infrahyoid muscles of the neck, anterior view Prevertebral region and root of the neck, anterior view KAPLAN) MEDICAL

90. 91. 92. 93. 94. 95. 96. 97. 98. 99. 100. 101. 102. 103. 104. 105. 106. 107. 108. 109. 110. 111. 112. 113. 114. 115. 116. 117. 118. 119. 120. 121.

Muscles of the neck, lateral view Neck, transverse section Ocular muscles, lateral view and superior view Intrinsic muscles of the tongue, sagittal section Extrinsic muscles of the tongue, pharynx and larynx, lateral view Pharynx, posterior view Superficial shoulder muscles, anterior view Muscles of the shoulder, scapula and arm, anterior view Deep muscles of the shoulder and arm, anterior view Muscles with scapular attachments, posterior view Superficial and intermediate muscles of the back, posterior view Deep muscles of the back, posterior view Anterior brachial muscles (flexors), lateral view Posterior brachial muscles (extensors), lateral view Superficial flexor muscles of the forearm, anterior view Superficial extensor muscles of the forearm, lateral view (hand pronated) Deep flexor muscles of the forearm, anterior view Deep extensor muscles of the forearm, posterior view Transverse sections of the arm Muscles of the hand, posterior (dorsal) view Muscles of the hand, anterior (palmar) view Intercostal muscles, anterior view Diaphragm, anterior view Diaphragm, inferior view Superficial abdominal muscles, anterior view Deep abdominal muscles, anterior view Posterior abdominal wall muscles, anterior view Pelvic diaphragm, superior view Perineal muscles, inferior view Urogenital diaphragm, inferior view Lower limb muscles, anterior view Muscles of the lower limb, posterior view

122. 123. 124. 125. 126. 127. 128. 129. 130. 131. 132. 133. 134. 135. 136. 137.

Superficial femoral muscles, anterior view Deep femoral muscles, anterior view Medial femoral muscles, medial view Lateral femoral muscles, lateral view Gluteal muscles, posterior view Posterior femoral muscles, posterior view Posterior thigh and gluteal muscles, deep dissection, posterior view Thigh, transverse section Muscles of the anterior compartment of the leg, anterior view Muscles of the lateral compartment of the leg, lateral view Deep muscles of the leg, anterior view Muscles of the superficial posterior compartment of the leg, posterior view Muscles of the deep posterior compartment of the leg, posterior view Muscles of the dorsal foot Plantar muscles of the foot, first and second layers Plantar muscles of the foot, third layer

NERVOUS SYSTEM
138. 139. 140. 141. 142. 143. 144. 145. 146. 147. 148. 149. 150. Nervous system, anterior view Neuron Synapse, cutaway view Central nervous system, sagittal section Brain, lateral view Brain, superior view Brain, inferior view Brain, midsagittal section Brain, frontal section Brain, transverse section Brainstem, posterior view Brainstem, lateral view Limbic system

I(APLA N MEDICAL

NERVOUS SYSTEM (cont'd) 151. 152. 153. 154. 155. 156. 157. 158. 159. 160. 161. 162. 163. 164. 165. 166. 167. 168. 169. 170. 171. 172. 173. Functional areas of the cerebrum Ventricles of the brain Cerebrospinal fluid pathway Meninges of the brain, frontal section Facial nerve and cutaneous branches of the cervical plexus Spinal cord and spinal nerves Branching of a typical spinal nerve, transverse section Spinal membranes and nerve roots Spinal cord, transverse sections Cranial nerves, inferior view Emerging spinal nerves, lateral view Plexuses and thoracic nerves, posterior view Cervical plexus, posterior view Brachial plexus, anterior view Lumbar plexus, anterior view Sacral plexus, posterior view Abdominal sympathetic nerves, anterior view Nerves of the upper limb, anterior view Nerves of the lower limb, posterior view Nerves of the wrist and hand, anterior (palmar) and transverse views Dermatomes, anterior and posterior views Autonomic nervous system, sympathetic division Autonomic nervous system, parasympathetic division

SENSORY SYSTEMS
174. 175. 176. 177. 178. 179. 180. 181. Skin receptors (touch), microscopic view Tongue (taste), superior view Papillae and taste buds of the tongue Nose (smell), midsagittal view Olfactory epithelium Eye and lacrimal apparatus (vision), anterior view Eye (vision), sagittal view Optic retina, ophthalmoscopic and microscopic views

S SORYSYSTEMS front'
182. 183. 184. 185. 186. Auditory system (hearing), anterior view Middle ear, anterior view Inner ear, anterior view Membranous labyrinth of the inner ear, anterior view Cochlea and Organ of Corti, microscopic view

ENDOCRINE SYSTEM
187. 188. 189. 190. 191. 192. 193. 194. 195. 196. 197. 198. Male endocrine system, anterior view Female endocrine system, anterior view Pituitary gland (hypophysis) and pineal body, sagittal section Pituitary gland (hypophysis) hormones and target organs, male Pituitary gland (hypophysis) hormones and target organs, female Thyroid gland, anterior view Parathyroid glands, posterior view Pancreas, anterior view Adrenal gland, anterior and sagittal section views Testis, anterior view Ovary, posterior view and transverse section Placenta, fetal aspect, with diagrammatic transverse section

199. 200. 201. 202. 203. 204. 205. 206. 207. 208. 209.

Cardiovascular overview, anterior view Circulation (diagrammatic) Blood cells, microscopic view Anatomical relationships of the heart Heart, anterior view Heart, posterior view Heart, frontal (coronal) section Valves of the heart in ventricular systole, superior view Valves of the heart in ventricular diastole, superior view Conduction system of the heart, frontal (coronal) view Artery and vein structure

KAPLAN) MEDICAL

MIIIIIIIMIIIIIMIMIIIIMIIIIM
210. 211. 212. 213. 214. 215. 216. 217. 218. 219. 220. 221. 222. 223. 224. 225. 226. 227. 228. 229. 230. 231. Arterial system, anterior view Carotid and vertebral arteries, lateral view Branches of the aortic arch, anterior view Brain arteries Middle cerebral artery, lateral view Cerebral arteries, sagittal view Ophthalmic artery, superior view Upper limb arteries, anterior view Lower limb arteries, anterior view Abdominal and thoracic branches of the aorta, anterior view Middle thorax, transverse section viewed from below Digestive system arteries, anterior view Pelvic arteries, male, medial view Pelvic arteries, female, medial view Venous system, anterior view Veins of the head and neck, lateral view Upper limb veins, anterior view Lower limb veins, anterior and posterior view Azygos veins, anterior view Portal system of veins, anterior view Abdominal and thoracic veins of the dorsal wall, anterior view Fetal circulation

LYMPHATIC SYSTEM
232. 233. 234. 235. 236. 237. 238. 239. 240. Overview, anterior view Lymphatic drainage areas, anterior view Lymphatic capillaries, microscopic view Lymphatic drainage at the root of the neck, anterior view Tonsils, sagittal view Waldeyer's ring, anterior view Spleen, anterior view Lymph node, microscopic view of transverse section Intestinal lacteals, anterior and microscopic views

1
RESPIRATORY SYSTEM
241. 242. 243. 244. 245. 246. 247. 248. 249. 250. 251. 252. 253. 254. 255. Respiratory overview, anterior view Larynx, trachea and bronchi, anterior view Nasal septum, medial view Nasal cartilages, lateral view Lateral wall of nasal cavity, medial view Nasal conchae, larynx, and sinuses, coronal section Larynx, anterior view Larynx, sagittal section Larynx, posterior view Glottis, superior view Trachea and bronchial tree, anterior and transverse section views Lung lobes and pleura, anterior view Lung hila, medial view Air pathway and alveolus Thorax, transverse section viewed from below

DIGESTIVE SYSTEM
256. Overview, anterior view 257. Overview, lateral view 258. Mouth and oral cavity, anterior view 259. Oral cavity, sagittal section 260. Oral salivary glands, anterior view 261. Salivary glands, lateral view 262. Tooth, sagittal section view 263. Upper teeth, inferior view 264. Esophagus, anterior view 265. Greater omentum, anterior view 266. Stomach, anterior view 267. Stomach, anterior cutaway view 268. Small intestine, anterior view 269. Large intestine, anterior view 270. Liver, anterior view 271. Liver, posterior view

KAPLAN) MEDICAL
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INTRODUCTION

Illustrator:

Stephanie McCann, MA, is an independent medical and scientific illustrator. She received her MA in Medical and Biological Illustration from The Johns Hopkins University, and BA in Fine Arts at the University of California, Santa Cruz. She is currently an instructor at Santa Barbara City College, teaching Biological Illustration (Biology Department) and Adobe Illustrator (Multimedia Arts and Technology Department). Stephanie's studio is located in Santa Barbara, California. Joanne Kivela Tillotson, PhD, has been teaching undergraduate biology laboratories for over 14 years, the last io of which have been at Purchase College, State University of New York, where she has received the Pedagogy Award for innovative use of technology in the teaching laboratory, and the SUNY Chancellor's Award for Excellence in Teaching. Dr. Tillotson received her BS degree in Biology from the University of Dubuque and PhD in Biochemistry from Michigan State University.

Text:

Chief Medical Sonia E. Reichert, MD, previously served as Director of Curriculum for Kaplan Medical and is currently Consultant: an Internal Medicine Resident at SUNY Downstate at Brooklyn. Dr. Reichert is a regular participant of National Board conferences and has many years of experience in the creation and development of Kaplan Medical's online, print, DVD, and other media related educational tools in the medical and allied health fields. She is the leading national expert in the content, scoring, and structure of medical licensing and allied health exams. Medical Proofreader: Sailesh Harwani, MD, PhD

KAPLAN) MEDICAL

CONTENTS

BODY ORGANIZATION
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Anatomical position and terms of direction Anatomical planes of the body Anterior regions of the body Posterior regions of the body Body cavities Skeletal and visceral structures of the head and neck Thoracic, abdominal and pelvic viscera, anterior view Thoracic, abdominal and pelvic viscera, posterior view Thoracic, abdominal and pelvic viscera, right lateral view Thoracic, abdominal and pelvic viscera, left lateral view

INTEGUMENTARY SYSTEM
11. 12. 13. 14. Layers of the skin and associated structures Epidermis Hair Fingernail SKELETAL SYSTEM 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. Skeleton, anterior view Skeleton, posterior view Anterior view of the skull Skull, lateral view Skull, superior view External surface of the base of the skull Median sagittal section of the skull Right temporal and sphenoid bones Hyoid bone Vertebral column, lateral view Posterior view of the vertebrae Atlas (Ci) and axis (C2), superior view Cervical vertebra, superior and lateral views Thoracic vertebra, superior and lateral views

KAPLA) MEDICAL

KAPLAI MEDICAL

Anatomy Flashcards

Includes 10
INTERACTIVE COLORING CARDS a

i CLEARLY LABELED AND DETAILED

FULL-COLOR CARDS

ILLUSTRATIONS: STEPHANIE McCANN, MA TEXT: JOANNE KIVELA TILLOTSON, PhD CHIEF MEDICAL CONSULTANT: DR. SONIA REICHERT, MD

This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is sold with the understanding that the publisher is not engaged in rendering legal, accounting, or other professional service. If legal advice or other expert assistance is required, the services of a competent professional should be sought.

2009 Kaplan, Inc. Published by Kaplan Publishing, a division of Kaplan, Inc. 1 Liberty Plaza, 24th Floor New York, NY 10006 All rights reserved. The text of this publication, or any part thereof, may not be reproduced in any manner whatsoever without written permission from the publisher.

Printed in China January 2009 10 9 8 7 6 5 ISBN-13: 97 8-1- 4 2 77 - 9 694 - 3 Kaplan Publishing books are available at special quantity discounts to use for sales promotions, employee premiums, or educational purposes. Please email our Special Sales Department to order or for more information at kaplanpublishing@kaplan.com , or write to Kaplan Publishing, 1 Liberty Plaza, 24th Floor, New York, NY 10006.

Kaplan's Anatomy Flashcards is designed to help students of human anatomy learn and memorize the many structures and systems within the human body. Learning human anatomy is a challenge that is best met through a three-part process:
having clear visualizations of the body's anatomical structures gaining a thorough understanding of the relationships between anatomical structures and their functions working consistently to review the anatomy in order to internalize anatomical information for future recall The front of each card contains a vivid and precise full-color illustration. Clear lines and labels on each image indicate the structures to be learned, with the identification key listed on the reverse side. In addition, each card contains a descriptive text, which enhances understanding of the functions and relationships of each structure. The set is organized and color-coded according to 15 anatomical systems for ease-of-use, and can easily be carried around for learning and review on the go. As a bonus, this set includes io coloring cards from Kaplan's topselling Anatomy Coloring Book. Students can color each image and test their knowledge of various anatomical structures for the ultimate in academic retention and recall. Kaplan's Anatomy Flashcards is the ideal human anatomy study resource for medical and nursing students, healthcare practitioners, and anyone interested in improving their knowledge of human anatomy.

KAPLAN) MEDICAL ,....

Illustrator:

Stephanie McCann, MA, is an independent medical and scientific illustrator. She received her MA in Medical and Biological Illustration from The Johns Hopkins University, and BA in Fine Arts at the University of California, Santa Cruz. She is currently an instructor at Santa Barbara City College, teaching Biological Illustration (Biology Department) and Adobe Illustrator (Multimedia Arts and Technology Department). Stephanie's studio is located in Santa Barbara, California. Joanne Kivela Tillotson, PhD, has been teaching undergraduate biology laboratories for over 14 years, the last io of which have been at Purchase College, State University of New York, where she has received the Pedagogy Award for innovative use of technology in the teaching laboratory, and the SUNY Chancellor's Award for Excellence in Teaching. Dr. Tillotson received her BS degree in Biology from the University of Dubuque and PhD in Biochemistry from Michigan State University.

Text:

Chief Medical Sonia E. Reichert, MD, previously served as Director of Curriculum for Kaplan Medical and is currently Consultant: an Internal Medicine Resident at SUNY Downstate at Brooklyn. Dr. Reichert is a regular participant of National Board conferences and has many years of experience in the creation and development of Kaplan Medical's online, print, DVD, and other media related educational tools in the medical and allied health fields. She is the leading national expert in the content, scoring, and structure of medical licensing and allied health exams. Medical Proofreader: Sailesh Harwani, MD, PhD

KAPLAN) MEDICAL

Other Books by Kaplan Medical

Anatomy Coloring Book medEssentials: High-Yield USMLETM Step i Review USMLETM Step i Qbook, Fourth Edition USMLETM Step 2 CK Qbook, Fourth Edition USMLETM Step 3 Qbook, Fourth Edition USMLETM Medical Ethics: The loo Cases You Are Most Likely to See on the Exam USMLETM Step
2

CS: Complex Cases

USMLETM Flashcards: The 200 Diagnostic Tests You Need to Know for the Exam USMLETM Physical Findings Flashcards: The 200 Questions You Are Most Likely to See on the Exam USMLETM Pharmacology & Treatment Flashcards: The 200 Questions You Are Most Likely to See on the Exam


1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Anatomical position and terms of direction Anatomical planes of the body Anterior regions of the body Posterior regions of the body Body cavities Skeletal and visceral structures of the head and neck Thoracic, abdominal and pelvic viscera, anterior view Thoracic, abdominal and pelvic viscera, posterior view Thoracic, abdominal and pelvic viscera, right lateral view Thoracic, abdominal and pelvic viscera, left lateral view

INTEGUMENTARY SYSTEM
11. 12. 13. 14. Layers of the skin and associated structures Epidermis Hair Fingernail

SKELETAL SYSTEM
15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. Skeleton, anterior view Skeleton, posterior view Anterior view of the skull Skull, lateral view Skull, superior view External surface of the base of the skull Median sagittal section of the skull Right temporal and sphenoid bones Hyoid bone Vertebral column, lateral view Posterior view of the vertebrae Atlas (Ci) and axis (C2), superior view Cervical vertebra, superior and lateral views Thoracic vertebra, superior and lateral views

KAPLA_t0 MEDICAL

SKELETAL SYSTEM (coati)

29. 30. 31. 32. 33. 34. 35. 36. 37. 38. 39. 40. 41. 42. 43. 44. 45. 46. 47. 48. 49. 50. 51. Lumbar vertebra, superior and lateral views Sacrum and coccyx, anterior view Sacrum and coccyx, posterior view Intervertebral discs, lateral and midsagittal views Sternum, anterior view Rib and vertebra, articulated, superior view; rib, posterior view Rib cage, anterior view Pectoral girdle and upper limb, anterior view Scapula, anterior and lateral views Scapula, posterior view Clavicle and related bones, superior view; clavicle, inferior view Humerus, anterior and posterior views Ulna and radius, lateral and anterior views Hand, posterior (dorsal) view Hand, anterior (palmar) view Hip bone, lateral view Pelvis, anterior view Differences between male and female pelvis Lower limb, anterior view Femur and patella, anterior and posterior views Tibia and fibula, anterior and posterior views Bones of the foot, dorsal view Bones of the foot, lateral view

ARTICULATIONS
52. 53. 54. 55. 56. 57. 58. 59. Gomphosis (peg suture) Suture Syndesmosis, posterior view Synchondrosis Symphysis Synovial joint, diagrammatic sagittal section Tendon sheath Bursa

DIGESTIVE SYSTEM (cont'd)

272. 273. 274. 275. 276. Gall bladder, pancreas and duodenum, anterior view Gall bladder, pancreas and duodenum, anterior cutaway view Rectum, coronal section view Abdomen, transverse section at T12, seen from below Abdomen, transverse section at Li, seen from below

URINARY SYSTEM
277. 278. 279. 280. 281. 282. 283. 284. 285. Overview, female urinary system, anterior view Anatomical relationships of the urinary system, anterior view Overview, male urinary system, anterior view Overview, male urinary system, viewed from the left Kidney, anterior view Kidney, frontal section view Kidney and renal artery, frontal section view Female urinary bladder, frontal section view Nephron of the kidney, microscopic view

REPRODUCTIVE SYSTEM
286. 287. 288. 289. 290. 291. 292. 293. 294. 295. 296. 297. 298. Overview male reproductive system, anterior view Male pelvis, anterolateral view Male reproductive system, sagittal section view Testes, anterior view Seminal vesicles, prostate gland and seminiferous tubules, posterior view Penis, ventral and cross section views Spermatogenesis, microscopic view Overview female reproductive system, anterior view Female pelvis, anterior view Female reproductive system, sagittal section view Ovary, frontal section view Female reproductive system, menstrual cycle Uterus, ovaries and vagina, frontal section, posterior view

REPRODUCTIVE SYSTEM (cont'd)

299. Mammary gland and lymphatic drainage, anterior view 300. Female external genitalia, inferior view

COLORING CARDS
301. 302. 303. 304. 305. 306. 307. 308. 309. 310. Regions of the abdomen, anterior view Skeletal system, anterior view Nervous system, posterier view Lymphatic system Muscular system Digestive system Cardiovascular system: arteries Skeletal system: hand, posterior (dorsal) view Nervous system: brain, midsagittal section Respiratory system

l'1_) .Ati MEDICAL

This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is sold with the understanding that the publisher is not engaged in rendering legal, accounting, or other professional service. If legal advice or other expert assistance is required, the services of a competent professional should be sought.

2009 Kaplan, Inc. Published by Kaplan Publishing, a division of Kaplan, Inc. 1 Liberty Plaza, 24th Floor New York, NY l0006 All rights reserved. The text of this publication, or any part thereof, may not be reproduced in any manner whatsoever without written permission from the publisher.

Printed in China January 2009 10 9 8 7 6 5 ISBN-13: 978-1-4277-9694-3 Kaplan Publishing books are available at special quantity discounts to use for sales promotions, employee premiums, or educational purposes. Please email our Special Sales Department to order or for more information at kaplanpublishing@kaplan.com , or write to Kaplan Publishing, i Liberty Plaza, 24th Floor, New York, NY 101306.

Illustrator:

Stephanie McCann, MA, is an independent medical and scientific illustrator. She received her MA in Medical and Biological Illustration from The Johns Hopkins University, and BA in Fine Arts at the University of California, Santa Cruz. She is currently an instructor at Santa Barbara City College, teaching Biological Illustration (Biology Department) and Adobe Illustrator (Multimedia Arts and Technology Department). Stephanie's studio is located in Santa Barbara, California. Joanne Kivela Tillotson, PhD, has been teaching undergraduate biology laboratories for over 14 years, the last io of which have been at Purchase College, State University of New York, where she has received the Pedagogy Award for innovative use of technology in the teaching laboratory, and the SUNY Chancellor's Award for Excellence in Teaching. Dr. Tillotson received her BS degree in Biology from the University of Dubuque and PhD in Biochemistry from Michigan State University.

Text:

Chief Medical Sonia E. Reichert, MD, previously served as Director of Curriculum for Kaplan Medical and is currently Consultant: an Internal Medicine Resident at SUNY Downstate at Brooklyn. Dr. Reichert is a regular participant of National Board conferences and has many years of experience in the creation and development of Kaplan Medical's online, print, DVD, and other media related educational tools in the medical and allied health fields. She is the leading national expert in the content, scoring, and structure of medical licensing and allied health exams. Medical Proofreader: Sailesh Harwani, MD, PhD

IIA P LAN) MEDICAL

Other Books by Kaplan Medical

Anatomy Coloring Book medEssentials: NighYield USMLETM Step: Review USMLETM Step i Qbook, Fourth Edition USMLETM Step 2 CK Qbook, Fourth Edition USMLETM Step 3 Qbook, Fourth Edition USMLETM Medical Ethics: The zoo Cases You Are Most Likely to See on the Exam USMLETM Step 2 CS: Complex Cases USMLETM Flashcards: The 200 Diagnostic Tests You Need to Know for the Exam USMLETM Physical Findings Flashcards: The zoo Questions You Are Most Likely to See on the Exam USMLETM Pharmacology & Treatment Flashcards: The zoo Questions You Are Most Likely to See on the Exam

Kaplan's Anatomy flashcards is designed to help students of human anatomy learn and memorize the many structures and systems within the human body. Learning human anatomy is a challenge that is best met through a three-part process: having clear visualizations of the body's anatomical structures gaining a thorough understanding of the relationships between anatomical structures and their functions working consistently to review the anatomy in order to internalize anatomical information for future recall The front of each card contains a vivid and precise full-color illustration. Clear lines and labels on each image indicate the structures to be learned, with the identification key listed on the reverse side. In addition, each card contains a descriptive text, which enhances understanding of the functions and relationships of each structure. The set is organized and color-coded according to 15 anatomical systems for ease-of-use, and can easily be carried around for learning and review on the go. As a bonus, this set includes io coloring cards from Kaplan's topselling Anatomy Coloring Book. Students can color each image and test their knowledge of various anatomical structures for the ultimate in academic retention and recall. Kaplan's Anatomy Flashcards is the ideal human anatomy study resource for medical and nursing students, healthcare practitioners, and anyone interested in improving their knowledge of human anatomy.

!CAPLAN) MEDICAL

BODYORGANIZATION
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Anatomical position and terms of direction Anatomical planes of the body Anterior regions of the body Posterior regions of the body Body cavities Skeletal and visceral structures of the head and neck Thoracic, abdominal and pelvic viscera, anterior view Thoracic, abdominal and pelvic viscera, posterior view Thoracic, abdominal and pelvic viscera, right lateral view Thoracic, abdominal and pelvic viscera, left lateral view

INTEGUMENTARYSYSTEM
11. 12. 13. 14. Layers of the skin and associated structures Epidermis Hair Fingernail

SKELETAL SYSTEM
15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. Skeleton, anterior view Skeleton, posterior view Anterior view of the skull Skull, lateral view Skull, superior view External surface of the base of the skull Median sagittal section of the skull Right temporal and sphenoid bones Hyoid bone Vertebral column, lateral view Posterior view of the vertebrae Atlas (Ci) and axis (C2), superior view Cervical vertebra, superior and lateral views Thoracic vertebra, superior and lateral views

!CAPLAN) MEDICAL

29. 30. 31. 32. 33. 34. 35. 36. 37. 38. 39. 40. 41. 42. 43. 44. 45. 46. 47. 48. 49. 50. 51.

SKELETAL SYSTEM (cont'd) r Lumbar vertebra, superior and lateral views Sacrum and coccyx, anterior view Sacrum and coccyx, posterior view Intervertebral discs, lateral and midsagittal views Sternum, anterior view Rib and vertebra, articulated, superior view; rib, posterior view Rib cage, anterior view Pectoral girdle and upper limb, anterior view Scapula, anterior and lateral views Scapula, posterior view Clavicle and related bones, superior view; clavicle, inferior view Humerus, anterior and posterior views Ulna and radius, lateral and anterior views Hand, posterior (dorsal) view Hand, anterior (palmar) view Hip bone, lateral view Pelvis, anterior view Differences between male and female pelvis Lower limb, anterior view Femur and patella, anterior and posterior views Tibia and Fibula, anterior and posterior views Bones of the foot, dorsal view Bones of the foot, lateral view ARTICULATIONS Gomphosis (peg suture) Suture Syndesmosis, posterior view Synchondrosis Symphysis Synovial joint, diagrammatic sagittal section Tendon sheath Bursa

52. 53. 54. 55. 56. 57. 58. 59.

52. Gomphosis (peg suture)

a. Tooth b. Alveolar socket c. Enamel d. Dentin e. Pulp f. Gingiva g. Alveolar ridge h. Periodontal ligaments

A gomphosis is a fibrous synarthrotic (immovable) joint holding a tooth in its alveolar socket in the maxilla or mandible. The bulk of the tooth is composed of dentin, a mineralized matrix secreted by cells found in the pulp cavity. The exposed portion of the tooth is covered by a crystalline calcium phosphate layer called enamelthe hardest substance in the human body. The root of the tooth is bound in place by the periodontal ligament; it is composed of collagen fibers extending from the dentin of the tooth to the bone surrounding the root of the tooth. A bony alveolar ridge forms the deep socket or alveolus where the peg-like root of the tooth is inserted. Superficial to the bone is the gingiva, mucosal tissue tightly bound to the bone surrounding the teeth; it provides a smooth surface to reduce friction with food.

53. Suture
a. Sagittal suture
A suture is a fibrous synarthrotic (immovable) joint located between the bones of the skull, in order to form a protective case for the brain and sensory organs of the head. Cranial sutures include the sagittal suture shown here, which connects the two parietal bones and extends between the anterior coronal suture and the posterior lambdoid suture. Further attachment between bones at the suture is provided by collagen fibers that bind the bones in a firm but slightly flexible manner. The bone edges at the sutures are interlocking in adults, although they are slightly separated and are only connected by fibrous connective tissue during development to allow both more flexibility of the skull during birth and room for growth as the brain increases in size during the early postnatal period.