CHAPTER ONE: INTRODUCTION

Body Positions:- Anatomic Position = standing erect, upper limbs at side, face and palms of hands directed forward.- Supine Position = lying on the back- Prone Position = lying face downwards

Planes of the Body: Median Sagittal Plane = vertical plane passing through center of body; divides body into equal left & right halves* Paramedian = any plane on either sides of and parallel to the Median Sagittal Plane* Medial (nearer) or Lateral (farther to Median)* Ipsilateral (same side) & Contralateral Coronal Plane= vertical planes at right angles to Median Sagittal; divides body into equal anterior & posterior halves Horizontal or Transverse or Axial Plane = divides body into superior & inferior parts.

Terms Describing Location: Anterior (Ventral) & Posterior (Dorsal) Medial & Lateral Superior & Inferior Proximal & Distal = closer or farther compared to structures origin Internal & External = distance of a structure from the center of an organ or cavity Cranial & Caudal = sometimes used instead of Superior & Inferior Rostral = used particularly in the head; describe the position of a structure with reference to the nose. Superficial & Deep = relative positions of two structures with respect to the surface Terms Related to Movement: Flexion = movement along sagittal plane only; decreases joint angle Extension = increases joint angle Abduction = movement of a limb away from Median Sagittal Plane but occurs along Coronal Plane Adduction = movement towards midline Rotation = movement of a body part around its long axis * Medial Rotation = results in the anterior surface of the part facing medially-- Pronation = medial rotation of the forearm; palm of the hand faces posteriorly * Lateral Rotation = results in the anterior surface of the part facing laterally -- Supination = lateral rotation of the forearm; palm of the hand comes to face anteriorly Circumduction = circular limb movement; combines flexion, extension, adduction & abduction Inversion = movement of the foot so that the sole faces in a medial direction Eversion = sole faces in a lateral direction Protraction & Retraction

Basic Structures: Skin* Epidermis = stratified epithelial tissue * Dermis = dense connective tissue- Skin Appendages:1. Nail = dorsal, keratinized plates2. Hair Follicles = invagination of epidermis extending to dermis Parts of Body w/o Hair:- LiPa SoSi Pe-Clit-La- Lips; Palm & Soles; Sides of Fingers, Toes & Feet; Glans Penis; Clitoris; Labia Minora & Internal Surface of Labia Majora3. Sebaceous Glands = sloping undersurface of the follicles and lie within the dermis4. Sweat Glands = extends to dermis & ends may lie in superficial fascia; deepest appendageParts of Body w/o Sweat Glands:- CLiP- Lips (red margin); Glans Penis; Clitoris

Fascia* Superficial Fascia or Subcutaneous Tissue= mixture of loose areolar and adipose = unites the dermis of the skin to the underlying deep fascia= contains bundles of collagen fibers:- New Boy Scouts of Philippines- nape, back, soles, palms= devoid of adipose:- SPACE- Scrotum, Penis, Auricles, Clitoris, Eyelids* Deep Fascia= membranous layer of connective tissue= Parts of the Body:* Neck well-defined layers* Thorax & Abdomen film of areolar tissue covering the muscles and aponeuroses* Limbs sheath around the muscles and other structures; Fibrous Septa may extend to deep surface membranes and divide muscle groups into compartments* Joint Regions as Retinacula; thickened to form restraining bands

MusclesA. Skeletal Muscles~ Origin = attachment that moves least~ Insertion = moves the most(may be interchangeable)Ends of Muscles:- Tendon = cords of fibrous tissue, connects muscle to bones, cartilage or ligaments- Aponeuroses = attached to flattened muscles; histologically similar to tendons but are sparingly supplied withblood vesselsandnerves- Raphe = interdigitation of tendinous ends

Muscles Internal Structure:1. Endomysium =- wraps every muscle fiber2. Perimysium = wraps fascicles3. Epimysium = wraps entire muscleMuscle Fiber Configuration = muscle fibers can be arranged parallel or oblique to the long axis; parallel ones can cause greater degree of movement.* Ex. of Muscles w/ Parallel Fiber Arrangement~ Sternocleidomastoid~ Rectus Abdominis~ Sartorius* Pennate Muscles = fascicles attach obliquely to tendon; also called penniform; allow better stabilization, force production but compromises flexibility Unipennate = fascicles on same side of tendonEx. extensor digitorum longus Bipennate = fascicles on both side of central tendonEx. rectus femoris Multipennate = central tendon branches w/in a pinnate muscle~ arranged as a series of bipennate muscles lying alongside one anotherEx. acromial fibers of the deltoid~ tendon lying within its center and the muscle fibers passing to it from all sides, converging as they goEx. tibialis anteriorMuscle Action 1. Prime Mover = it is the chief muscle or member of a chief group of muscles responsible for a particular movt.Ex. quadriceps femoris ~ knee extension rhomboids ~ retracts scapula2. Antagonist = opposes the action of the p.m.Ex. biceps femoris ~ vs. knee joint extension serratus anterior ~ vs. scapula retraction* Nerve Reflex Inhibition = PM & Antagonist cant contract together, action must be opposed3. Fixator = contracts isometrically but only increases tone but not cause movt; stabilizes origin of PM for efficiency4. Synergist = prevent unwanted movements in an intermediate joint

Nerve Supply Skeletal Muscle-- Motor Point = point of entry of nerve to muscle at midpoint of deep surface often near margin** Muscle Tone = also tonus or residual muscle tension; continuous and passive partialcontraction of the muscles maintained by unconscious nerve impulses if innervations are interrupted, muscle becomes flaccidNaming of Skeletal Muscles-- Shape: Ex. Deltoid (triangular), Teres (round), Rectus (straight)-- Size: Major (large), Latissimus (broadest), Longissimus (longest)-- No. of Bellies: Biceps (2 heads), Quadriceps (4 heads), Digastrics (2 bellies)Naming of Skeletal Muscles (continued)-- Position: Pectoralis (chest), Supraspinatus (above spine), Brachii (arms) -- Depth: Profundus (deep), Superficialis, Externus (external)-- Attachment: Sternocleidomastoid, Coracobrachialis-- Action: Extensor, Flexor, Constrictor

B. Smooth Muscles = long, spindle-shaped cells; arranged in bundles or sheets

Parts of the Body w/ Smooth Muscles: 1. Digestive System~ Circular = squeezes contents~ Longitudinal = pulls the wall of the tube proximally over the contents 2. Uterus & Urethra (storage organs)~ Irregularly arranged fibers; Interlaced w/ one another; produces slow, sustained movement; expels contents of organs 3. Blood Vessels~ Circular = alters flow of blood by modifying volume of the lumen

C. Cardiac Muscles = branched, striated muscles that unite with each other; arranged in whorls & spirals

Joints = site where two or more bones come together regardless of movement between themClassification According to Tissue Composition:1. Fibrous Joints = fibrous tissue joins the articulating surfaces of the bones very little movt.Ex. sutures of the skull, inferior tibiofibular joints2. Cartilaginous Joints Primary Cartilaginous Joints- bones are united by a plate or bar of hyaline cartilage, NO movt.Ex. Epiphysis & Diaphysis of a growing bone; First Rib & Manubrium Sterni Secondary Cartilaginous Joints- bones are united by a plate of fibrocartilage and the articular - surfaces of the bones are covered by a thin layer of hyaline cartilage- only minimal movt.Ex. symphisis pubis; intervertebral column3. Synovial Joints = thin layer of hyaline cartilage covers articular surfaces of the bones & separated by a joint cavityParts of Synovial Joint: * Synovial Membrane = lines joint cavity; extends from and to margins of articular surfaces* Fibrous Capsule = external to synovial membrane; its toughness offers protection* Synovial Fluid = produced by Syno. Mem; lubricates articular surfaces* Articular Disks = discs or wedges of fibrocartilage interposed between articular bone surfaces* Fatty Pads = lies between the synovial membrane and the fibrous capsule or bone. Ex. knee & hip joints* Ligaments = unites bones; most lie outside the capsule but some are within the capsule like the Cruciate Ligaments of the knees

Classification of Synovial Joints : Arrangement of Articular Surfaces & Types of Movement1. Plane = apposed articular surfaces are flat or almost flat; allows bones to slide against each other. see p.16, Fig. 1-14Ex. sternoclavicular and acromioclavicular joints2. Hinge = resembles door hinges, allows flexion, extension. Ex. knee, elbow, ankle3. Pivot = central bony pivot is surrounded by bony, ligamentous ring; see p.16, F.1-14= rotation as only possible movt. Ex. atlantoaxial (neck) and superior radioulnar (wrist) joints4. Condyloid = has 2 distinct convex surfaces articulating w/ 2 concave surfaces; flexion, extension, abduction, and adduction possible together w/ small amount of rotationEx. metacarpophalangeal joint (knuckles) 5. Ellipsoid = elliptical convex articular surface fits into an elliptical concave articular surface; all movts except rotation. Ex. wrist joint 6. Saddle = articular surfaces are reciprocally concavoconvex and resemble a saddle on horse's back; allows all movt (e,f,ab,ad,r). Ex. carpometacarpal joint of thumb 7. Ball-and-Socket = ball-shaped head of one bone fits into a socket-like concavity of another; allows e, f, ad, ab, medial rotation, lateral rotation, and circumductionEx. shoulder and hip joints

Joint Stability: 3 Factors Articular Surfaces- Shape**BUT: shape is not a factor in the ff: acromioclavicular joint, the calcaneocuboid joint, and the knee joint- Arrangement- Size Ligaments* Fibrous Ligaments = prevent excess movt; stretches when stressed for excessively long periods. Ex. flat feet* Elastic Ligaments = return to their original length after stretching; Ex. bones of inner ear

Muscle Tone Ex. humerus-scapula joint = could easily dislocate w/o muscle tone knee joint = unstable w/o quadriceps femoris muscle tonic activityNerve Supply of Joints:Hiltons Law = sensory nerve supplying a joint also supplies the muscles moving the joint & the skin overlying the insertions of these muscles

Clinical Notes:Syringomyelia = loss of sensation of pain in the joints, nervous system diseaseObturator Nerve = supplies both hip & knee joint

Ligaments = band of connective tissue uniting two structures; may be of two types:1. Dense Collagen Fibers = unstretchableEx. iliofemoral (hip) & collateral (elbow) lig.2. Elastic Tissue = regain original length after stretchingEx. ligamentum flavum (vertebrae) calcaneonavicular (foot) ligament Bursae = lubricating device consisting of a closed fibrous sac lined with a delicate smooth membrane= walls are separated by a film of viscous fluid; commonly found close to joints where the skin rubs against underlying bony structures

Synovial Sheath = tubular bursa that surrounds a tendon; tendon invaginates the bursa from one side so that the tendon becomes suspended w/in the bursa by a mesotendon = sometimes mesotendon disappears or remains in the form of narrow threads, the vincula (long flexor tendons in fingers,toes)

Blood Vessels Artery = carry blood away from heart~ Arteriole = < 0.1mm, smallest arteries~ Anastomosis = artery-to-artery connection~ Anatomic & Functional End Arteries* Anatomic = terminal branches do not anastomose with branches of arteries supplying adjacent areasEx. arteries supplying the arms and legs Collateral Circulation = detour of the circulation especially among large arteries that cross joints. see p.18 * Functional = terminal branches do anastomose with those of adjacent arteries; tissue dies if one of the arteries is blocked. Ex. Coronary Arteries

Veins = carry blood to heart, some have valves~ Venules = smallest veins~ Tributaries = network of smaller veins that unite to form larger veins~ Venous Plexuses = Larger veins that join with one another~ Portal System = system of vessels interposed between two capillary beds.** Venae Comitantes = two veins that usually accompany medium-sized, deep arteries** Portal Vein = convergence of all veins leaving the gastrointestinal tract; proceeds to liver** Sinusoids = capillary-like vessels in the liver; blood comes from the Portal VeinParts of Body w/Sinusoids- Marrow, Spleen, Liver, other Endocrine Glands** Arteriovenous Anastomosis = direct connection of arterioles & venules w/o passing through capillaries; fingers & toes

Capillaries = connects arterioles to venules Sinusoids vs. Capillaries = both are thin- walled, but sinusoids have irregular cross-diameters and are wider.

Lymphatic System- NO Circulation occurs w/in Lymph System Lymphatic Tissue = connective tissue with large no. of lymphocytes. Ex. Thymus, Lymph Nodes, Spleen, Lymphatic Nodules Lymphatic Vessels = drainage system, drains fluids from tissues bringing them back to the blood; appears beaded due to valves along the vesselsParts of Body w/o Lymphatic Vessels:- Nervous System, Eyeball, Internal Ear, Skin Epidermis, Bone & Cartilage

Path of Lymph to Blood: Interstitial Fluid Lymph in Lymph Capillaries Small Lymph Vessels Large Lymph Vessels pass through Lymph Nodes Right Lymphatic Duct or Thoracic Duct Blood Vessels

Nervous SystemCentral NS = Brain & Spinal CordPeripheral NS 12 pairs of Cranial Nerves~ Olfactory, Optic, Occulomotor, Trochlear, Trigeminal, Abducens, Facial, Vestibulo- cochlear, Glossopharyngeal, Vagus, Spinal Accessory, Hypoglossal 31 pairs of Spinal Nerves & Associated Ganglia~ 8C, 12T, 5L, 5S, 1C (Vertebrae=7,12,5,5,4-5)~ Spinal Cord terminates @ L1s lower border~ Cauda Equina (L2-5,S1-5,C1)~ Each SN has 2 Roots:* Anterior Root (Efferent) cell bodies @ Anterior Gray Horn * Posterior Root (Afferent) cell bodies @ Posterior Root Ganglion

Anterior Ramus muscles, skin of antero- lateral body wall & of all limbs;~ also called Ventral Ramus~ generally larger than Posterior Ramus~ forms Plexuses, a network of intersecting nerves) from SN in the Cervical, Lumbar & Sacral region; Thoracic SN are independent of each other and innervates the chestPosterior Ramus muscles & skin of the backMeningeal Branch Vertebrae, Coverings of Meninges ** Rami Communicantes = arises from Thoracic SN, part of Sympathetic NS of the Autonomic NSA. Autonomic Nervous System-- acts as the control system-- governs involuntary functions-- controlled by the hypothalamus-- functional branches:~ Sympathetic Nervous System (SNS)~ Parasympathetic Nervous System (PNS)~ Enteric Nervous System (ENS)

Sympathetic Nervous System~ Efferent Fibers- cell bodies (Sympathetic Connector Neurons) are at Lateral Gray Horn- only from T1 to L2 of Spinal Cord- have myelinated axonsUltimate Route:1.) Excitor Cells in Paravertebral Ganglion in the Sympathetic Trunk* innervates smooth muscles of the blood vessels, sweat glands, and arrector pili* Figure A1 (T2-T4) see F.1-27 p.31Preganglionic Mid-Thoracic Postganglionic Mid-Thoracic

Ultimate Route (continued):* Figure A2 (T1)Preganglionic Upper Thoracic Postganglionic Cervical* Figure A3 (T12, L1-2)Preganglionic Lower Thoracic & Upper Lumbar Postganglionic Lower Lumbar & Sacral Figure A1. Sympathetic Connector Neurons (Red) Excitor Cell (Green)Figure A2. Sympathetic Connector Neurons (Red) Excitor Cell (Green)

2.) Does Not Synapse; forms 3 Splanchnic Nerves~ Greater Splanchnic Nerve (T5-T9)~ Lesser Splanchnic Nerve (T10-T11)~ Lowest Splanchnic Nerve (T12) [when present] see Figure B and Figure 1-27 p.31

Figure A3. Sympathetic Connector Neurons (Red) Excitor Cell (Green)

Figure B. Sympathetic Connector Neurons (Red) Excitor Cell (Green)

(Sympathetic Nervous Sytem, continued...)- Splanchnic Nerves are preganglionic- the postganglionic fibers arise in the celiac & renal plexuses as axons of excitor cells- innervate smooth muscles & visceral glands- some preganglionic fibers from the greater splanchnic nerve may even travel up until the suprarenal medulla (considered modified sympathetic excitor cells)(Sympa. NS. Continued...)- the Sympathetic Trunk is found all along the entire length of the vertebral column- No. Of Ganglia: 3 at trunk of neck; 11-12 at thorax; 4-5 lumbar; 4-5 in the pelvis- meets at terminal of vertebral column and known as Ganglion Impar.

~ Afferent Fibers- travel from the viscera through the sympathetic ganglia without synapsing- are also myelinated- Pathway: (In order., from periphery)> Nerve fibers from Viscera> Whire Rami Communicantes> Spinal Nerve> Cell Bodies [post. Root ganglia]> central axon enters CNS

Parasympathetic Nervous System~ Efferent Fibers (2 sites = cranial & sacral)Cranial: - cells are called connector cells (CC)- CC-cell bodies are found in the brain in the same nuclei as the 3rd, 8th, 9th, 10th Cran.Nrvs. - the preganglionic fibers also leave the brain contained in these cranial nerves- these cranial preganglionic CCs synapse with excitor cells in peripheral ganglia: > ciliary, pterygopalatine, submandibular, andotic gangliaSacral:- cell bodies of sacral CC are found in the gray matter in the S2, S3 and S4 segmets of the spinal cord- sacral CCs leave the cord from the anterior nerve roots spinal nerves then forms pelvic-splanchnic nerves- postganglionic fibers occur in ganglia of > hypogastric plexuses & visceral walls ~ Afferent Fibers- have their cell bodies located either in the sensory ganglia of cranial nerves or posterior root ganglion of the sacro- spinal nerves- REMEMBER: Autonomic NS is purely motor!!!- Afferent Fibers carry infor such as muscle stretch and lack of oxygen

Mucous Membranes~ basically composed of epithelial cells and lamina propria (layer of connective tissue). - muscularis mucosa, smooth muscles sometimes found in mucous membranes- may or may not secrete mucus on its surface

Serous Membranes~ composed of mesothelial cells and supported by a thin layer of connective tissue~ may be:Parietal Layer = lines cavity wall** develops from the somatopleure (inner cell layer of mesoderm also, lateral plate mesoderm) ** innervated by spinal nerves, thus, can feel sensations & painVisceral Layer = covers the organs** develops from splanchnopleure** innervated by autonoimic NS; insensitive to touch & temp. But sensitive to stretch ~ cavities of the trunk:> pleural, pericardial, peritoneal~ serous exudate = liquid in visceral cavities

Bone~ can be classified according to: Composition- - Compact Bone- - Cancellous Bone Region Axial Skeleton Skull28Sternum1 Hyoid1Ribs24 Vertebrae 26 Appendicular Skeleton Clavicle 2Scapula 2 Upper Extremities Humerus 2Carpals 16Radius 2Metacarpals 10Ulna 2Phalanges 28 Lower ExtremitiesFemur 2Tarsals 14Tibia 2Metatarsals 10Fibula 2Phalanges 28Patella 2 Pelvic GirdleHip Bone (fused) 2 General Shape- - Long Bones (humerus, femur, meta- carpals, metatarsals, and phalanges)- - Short Bones (scaphoid, lunate, talus, calcaneum)- - Flat Bones - - Irregular Bones- - Sesamoid Bones (vertebrae, pelvic girdle)

Bone Marrow- - in adults: bones of skull, vertebrae, ribs, girdle bones, head of humerus & femur

Cartilage- - Hyaline- - Fibrocartilage - - Elastic (only the one capable of healing themselves with fibrous tissue)