ATLAS OF HUMAN SKELETAL ANATOMY          Juraj Artner (ed.)        ATLAS OF HUMAN        SKELETAL ANATOMY           Artner...
ATLAS OF HUMAN SKELETAL ANATOMYThe BasicsIntroduction to Skeletal AnatomyJ. ARTNERContents1.1. Introduction               ...
ATLAS OF HUMAN SKELETAL ANATOMYdetermine the macroscopic- invisible         Surface anatomy: studies structures onstructur...
ATLAS OF HUMAN SKELETAL ANATOMY1.3. Regions of the Body                                        The regions of the head (Re...
ATLAS OF HUMAN SKELETAL ANATOMYcorresponding Regio divide the neck          submandibulare (4), Tr. caroticum (5),into cen...
ATLAS OF HUMAN SKELETAL ANATOMYFemale individuals have a Regio            located at both sides of Regio pubica,mammaria a...
ATLAS OF HUMAN SKELETAL ANATOMY(Cubitus= the elbow area) above the           The regions of the leg (Regioneselbow joint (...
ATLAS OF HUMAN SKELETAL ANATOMYpedis), directed against the body, and abottom area= the sole (Planta pedis),directed again...
ATLAS OF HUMAN SKELETAL ANATOMY1.4. Tissues of the Body                     arranged in bundles, is less flexible,        ...
ATLAS OF HUMAN SKELETAL ANATOMYcontractions into movements) and          1.5. Planes, Directions and Positionsblood cell f...
ATLAS OF HUMAN SKELETAL ANATOMYThe terms medial and lateral refer to a          the term profundal indicates, that it isst...
ATLAS OF HUMAN SKELETAL ANATOMYcalled       paramediansagittal       or   When describing body or a structure inparasagitt...
ATLAS OF HUMAN SKELETAL ANATOMY1.6. Osteology                               compacta or compact bone tissue) at           ...
ATLAS OF HUMAN SKELETAL ANATOMYThe gross structure of a long bone can       The growth plate (Physis), separatingbe divide...
ATLAS OF HUMAN SKELETAL ANATOMY(depressions) will be described for           tissue and Osteoprogenitor cells (seeeach bon...
ATLAS OF HUMAN SKELETAL ANATOMYThe articular cartilage (Cartilago            in small bony ducts or canals, calledarticula...
ATLAS OF HUMAN SKELETAL ANATOMY   by concentric thin plates of bony tissue       The Haversian canal contains one or   (La...
ATLAS OF HUMAN SKELETAL ANATOMYSome Haversian systems can be              Irregular bones (Ossa irregularia)incomplete (in...
ATLAS OF HUMAN SKELETAL ANATOMYSesamoid bones (Ossa sesamoidea) are         skull to the pelvis. The vertebrala special ty...
ATLAS OF HUMAN SKELETAL ANATOMY  The distal end of Femur has contacts to       of the following six tarsal bones (Ossa  th...
ATLAS OF HUMAN SKELETAL ANATOMYSeven additional bones should be            The therapy comes after the diagnosismentioned ...
ATLAS OF HUMAN SKELETAL ANATOMYReferences(1) Waldeyer, A. Anatomie des Menschen; De    Gruyter: Berlin, 2002;(2) Feneis, H...
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Atlas of human_skeletal_anatomy

  1. 1. ATLAS OF HUMAN SKELETAL ANATOMY Juraj Artner (ed.) ATLAS OF HUMAN SKELETAL ANATOMY Artner Juraj Gergelova Katarina Pekny Petr Anatomy Basics 2003  J. ARTNER, WWW.JURAJARTNER.COM, 2002J.ARTNER ET AL. 2002, WWW.JURAJARTNER.COM PAGE 1
  2. 2. ATLAS OF HUMAN SKELETAL ANATOMYThe BasicsIntroduction to Skeletal AnatomyJ. ARTNERContents1.1. Introduction 1.6. Osteology1.2. Anatomic Nomenclature 1.7. Bone Histology1.3. Regions of the Body 1.8. Types of Bones1.4. Tissues of the Body 1.9. The Human Skeleton1.5. Planes, Directions & Positions 1.A. Clinical Aspects1.1. IntroductionMan has always been fascinated by the Vesalius’s De Humani Corporisinterior of his body. The first written Fabrica (1543), which was adocuments to survive are clay tablets revolutionary step forward in thefrom around 4000BC in Nineveh. The anatomy. Vesalius could correct mostancient Egyptians had specialized ancient writing’s and anatomicknowledge in some areas of human illustration’s errors by his dissectionanatomy, which they used in studies and direct observations.mummification and, to a limiteddegree, surgery. Other great cultures,like the Inuit and the Australianaborigines, developed during theirhunting a detailed knowledge ofmammalian anatomy. The paintings ofthe inner parts of humans had througha large period of most civilizationsspiritual, religious and mysticcomponents, often with unrealistic Fig. 1.1.: Portrait of Andreas Vesaliusbody proportions and parts. Althoughthey are for today’s medical sciences De Humani Corporis Fabrica becameuseless, they reflected the achievement the founding text of modern anatomy,of anatomic wisdom and the progress and inspired many scientists, whoof medical anatomy as a growing compared their results with existingscience. For a long period of time, the texts, corrected errors, and producedanatomy knowledge was a hidden new texts with illustrations. Thetreasure, waiting to be explored. The production of images based oninvention of the printing press in the dissection became a central component15th century, and the development of of scientific anatomy.woodcut and copper-plate engraving,made it possible to publish multiple With the scientific progress of the lastcopies of illustrated anatomy works, to centuries, the accuracy of anatomyteach anatomy and to eradicate the past images grown. The development oferrors. One of the most popular works microscopes allowed us to see andfrom the following time was AndreasJ.ARTNER ET AL. 2002, WWW.JURAJARTNER.COM PAGE 2
  3. 3. ATLAS OF HUMAN SKELETAL ANATOMYdetermine the macroscopic- invisible Surface anatomy: studies structures onstructures of tissues. The development or immediately underlying the surfaceof diagnostic and visualization of the bodytechniques like the x- ray, CT or MR Systematic anatomy: studies variousallowed us to see all structures of the systems of which the human body isbody and their topographic composedrelationship. Topographical (regional) anatomy: studies the organs and tissues in relation to one another Embryology: studies the development of tissues and organs Cytology: studies the cells and cellular structure 1.2. Anatomic Nomenclature Toward the end of the l9th century, about 50000 anatomical names were in use for some 5000 structures in the human body. By 1895, a list of anatomic terms had been prepared and was accepted by scientists at Basle, known as the Basle Nomina anatomica. The list consisted of about 4500 Latin terms. It was the first important step in the development of an international scientific language. The list was modified since then several times.Fig. 1.2.: Title page illustration for DeHumani Corporis Fabrica by Jan In Paris in 1955, internationalStephan van Calcar, showing an agreement was reached on a Latinanatomy dissection lesson with system of nomenclature based largelyVesalius. (Paris, Bibl. de l’Academie on the Basle Nomina anatomica. Sincenationale de medecine) then, international medical publications should use the standardized LatinThe term anatomy comes from the terminology for anatomic descriptions.Greek and Latin “to cut up” or todissect. It is the study of body The following chapters explain thestructures and the basis of medical most common anatomic terms andknowledge. descriptions. They are the basis for theToday’s anatomy is divided into learning and further understanding ofsubdivision like the macroscopic and anatomy.the microscopic anatomy, also calledhistology. The field of the macro-anatomy, also called Gross anatomy isto study all visible structures, the fieldof histology is to study tissues andtheir (micro) structures. Otherspecialized anatomic subdivisions are:J.ARTNER ET AL. 2002, WWW.JURAJARTNER.COM PAGE 3
  4. 4. ATLAS OF HUMAN SKELETAL ANATOMY1.3. Regions of the Body The regions of the head (RegionesThe human body consists of the capitis) are Regio facialis (facial),following parts (Partes corporis): Regio frontalis (forehead), Regio parietalis (area above the parietalCaput- the head bone), Regio temporalis (area aboveCollum- the neck the temporal bone) and RegioThorax- the chest occipitalis (area above the occipitalAbdomen- the stomach bone).Pelvis- the pelvis Regio facialis is further divided into aMembrum superius- the arm(s) Regio orbitalis (area above the bonesMembrum inferius- the leg(s) of the eye socket), Regio nasalis (nose), Regio oralis (mouth), Regio Caput buccalis (cheek), Regio zygomatica (area above the cheekbone), Regio Collum infraorbitalis (area under the eye socket) and a Regio mentalis (chin). Thorax 10 Abdomen 1M. sup. M. sup. 11 9 2 Pelvis 8 4 3 7 5 6M. inf. M. inf. Fig. 1.4.: Regiones capitis Reg. frontalis (1), Reg. orbitalis (2), Reg. nasalis (3), Reg. infraorbitalis (4), Reg. oralis (5), Reg. mentalis (6), Reg. buccalis (7), Reg. zygomatica (8), Reg. temporalis (9), Reg. parietalis (10), Reg. occipitalis (11)Fig. 1.3.: Parts of the human body. The regions of the neck (RegionesThe regions (Regiones corporis) are cervicales) can be described by findingdescribed similar to body parts but the Regio sternocleidomastoidea,more specific. Their anatomic borders above the muscle of the same nameconsist of skeletal, muscular and (Musculus sternocleidomastoideus;surface components. Their knowledge origin at the upper part of theis important in medical practice, for sternoclavicular joint; insertion at theexample to describe localizations of Processus mastoideus of the skullpain on patients. base). The muscle and theJ.ARTNER ET AL. 2002, WWW.JURAJARTNER.COM PAGE 4
  5. 5. ATLAS OF HUMAN SKELETAL ANATOMYcorresponding Regio divide the neck submandibulare (4), Tr. caroticum (5),into central neck regions and the side R. cervicalis lateralis (6)regions (Regiones cervicales laterales),with a fluent transition into the back The Regiones pectorales of the Thoraxregion of the neck (Regio cervicalis (regions of the chest) are marked byposterior; syn.: Regio nuchalis) over the following borders:the Musculus trapezius. The upper border represents theThe central neck regions are the Clavicula (collarbone), Regio deltoideafollowing: Trigonum submentale above the Musculus deltoideus (the(submental triangle) is located between side border), and the Arcus costalisthe chin (Regio mentalis), Os (the curve of the lowest ribs) at thehyoideum, between the frontal part of bottom. Due to the different sexualthe digastric muscle (Venter anterior characteristics are the regions of theM. digastrici; origin at the inner side of chest different in female and male.Processus mastoideus of the skullbase; insertion at the inner side of Regio praesternalis above the SternumMandibula= jaw bone), and the middle (breastbone) exists in female and maleaxe of the neck. The Trigonum individuals. Regio pectoralis is locatedmusculare (muscular triangle) is on both sides of this area, marked bylocated directly under the Trigonum the Musculus pectoralis major (largesubmentale, marked by the middle axe breast muscle; origin at Clavicula,of the neck, the lower parts of sides of Sternum and the first 4-6 ribs;Musculus sternocleidomastoideus and insertion at the upper part ofMusculus omohyoideus (origin at the Humerus= upper arm). At the side ofupper part of the shoulder blade= this region is the area of the armpitScapula; insertion at Os hyoideum). (Regio axillaris), located between theThe Trigonum submandibulare is Regio pectoralis and the upper arm.located between Musculus digastricus Trigonum clavipectorale is a triangularand the area above the Mandibula (jaw area, marked by Regio deltoidea (Areabone). Trigonum caroticum is located above the Musculus deltoideus; originbetween the back part of Musculus at Scapula and Clavicula; insertion atdigastricus, M. sternocleidomastoideus Humerus), Regio pectoralis andand the upper part of M. omohyoideus. Clavicula. 3 4 2 1 2 1 5 4 3 6 1 1 Fig. 1.6.: Regiones pectoralesFig. 1.5.: Regiones cervicales Reg. pectoralis (1), Reg. praesternalisReg. sternocleidomastoidea (1), Tr. (2), Tr. clavipectorale (3), Reg.submentale (2), Tr. musculare (3), Tr. axillaris (4)J.ARTNER ET AL. 2002, WWW.JURAJARTNER.COM PAGE 5
  6. 6. ATLAS OF HUMAN SKELETAL ANATOMYFemale individuals have a Regio located at both sides of Regio pubica,mammaria above the lower parts of marked by Planum intertuberculare atRegio pectoralis, marked by the breast the top and the course of the groinborders. ligament (Ligamentum inguinale;The back of Thorax is divided into between the frontal upper spine of thethree regions, a Regio vertebralis pelvic bone= Spina iliaca anteriorabove the spinal column (Columna superior to the hump of the pubicvertebralis), Regio scapularis above bone= Tuberculum pubicum) at theScapula, and Regio subscapularis bottom.between Regio scapularis, vertebralis The abdominal back can be dividedand the last ribs. into three areas. The first area is the Regio vertebralis, a continuation of theThe regions of the stomach (Regiones Regio vertebralis of Thorax, with aabdominales) can be described by flowing transition into Regio sacralisusing virtual lines: a vertical line at the bottom. The third area, Regiothrough the middle of Clavicula lumbaris (syn. lumbalis), is located at(medioclavicular line), a horizontal both sides of the abdominal Regioline through the halfway between vertebralis and marked by the Regioupper Sternum and the upper genital glutaealis (of the leg) at the bottom.region (the horizontal layer is calledPlanum transpyloricum), and ahorizontal line between the humps ofthe pelvic bone (Tuberculum iliacum)on both sides (the horizontal layer iscalled Planum intertuberculare). 1Regio epigastrica is located right under 2the Processus xiphoideus (at thebottom of Sternum) of the skeletal 4 3 4Thorax, marked by Planum 6transpyloricum at the bottom, and the 6medioclavicular lines on both sides. 5Regio hypochondriaca is located onboth sides of Regio epigastrica,marked also by Thorax, themedioclavicular line and Planum Fig. 1.7.: Regiones abdominalestranspyloricum. Regio umbilicalis Reg. epigastrica (1), Reg.(area around the belly) is marked by hypochondriaca (2), Reg. umbilicalismedioclavicular lines on both sides, by (3), Reg. lateralis (4), Reg. pubica (5),Planum transpyloricum at the top and Reg. inguinalis (6)Planum intertuberculare at the bottom.Regio lateralis is located on both sides The arm consists of the followingof Regio umbilicalis, marked by regions (Regiones membri superioris):Planum transpyloricum, Planum Regio deltoidea (located above theintertuberculare and medioclavicular Musculus deltoideus; origin at Scapulalines on both sides. and Clavicula; insertion at Humerus) isRegio pubica is located under the followed downwards by RegioRegio umbilicalis, with a flowing brachialis anterior and posteriortransition into the lower located non- (Brachium= the upper arm, anterior=abdominal genital region (Regio frontal part, posterior= back part) andurogenitalis). Regio inguinalis is Regio cubitalis anterior and posteriorJ.ARTNER ET AL. 2002, WWW.JURAJARTNER.COM PAGE 6
  7. 7. ATLAS OF HUMAN SKELETAL ANATOMY(Cubitus= the elbow area) above the The regions of the leg (Regioneselbow joint (Articulatio cubiti). The membri inferioris) begin under Regioforearm region (Regio antebrachialis inguinalis on the front side and underanterior and posterior) ends at the area Regio lumbaris on the back.above the wrist (Carpus; Regio The front side of the Femur (thigh) iscarpalis anterior and posterior). The called Regio femoralis anterior, thehand (Manus) can be divided into a back side is covered by Regiofrontal part (palm) and a back (Palma glutaealis above the Musculus glutaeusand Dorsum manus). It can be further maximus (origin at Os ilium, Osdivided into a Thenar (the ball of the sacrum and Os coccygis= the coccyx;thumb), a Hypothenar (the ball of the insertion at Femur and Tractuslast finger), a Metacarpus area (above iliotibialis) and Regio femoralisthe metacarpal bones), and the fingers posterior, divided by Sulcus glutaealis(Digiti: I- Pollex, II- Index, III- Digitus (bottom furrow).medius, IV- Digitus anularis, and V- Regio femoralis anterior contains aDigitus minimus). region inside, called Trigonum femorale, marked by Musculus sartorius (origin at the frontal upper spine of the pelvic bone= Spina iliaca 1 anterior superior; insertion at upper Tibia) and Musculus adductor longus (origin at the pubic bone= Os pubis; insertion at the back shaft of Femur 2 bone= Linea aspera) at the sides and Regio inguinalis at the top. The area around the knee joint is called Regio genus (anterior and posterior). 3 4 2 5 1 6 7 3 8 Fig. 1.9.: Regiones femoralis et genusFig. 1.8.: Regiones membri superioris Reg. femoralis anterior (1), Tr.Reg. deltoidea (1), Reg. brachialis femorale (2), Reg. genus anterior (3)anterior (2), Reg. cubitalis anterior (3),Reg. antebrachialis anterior (4) and The lower leg (Crus) begins under thisposterior (5), Reg. carpalis anterior et area, consisting of Regio cruralisposterior (6), Dorsum manus (7), anterior and posterior (the calf area isDigiti, in this illustration pointing at also called Sura or Regio suralis). TheDigitus secundus= Index (8) area of the heel is called Regio calcanea (Calx). The foot (Pes) can be divided into an upper area (DorsumJ.ARTNER ET AL. 2002, WWW.JURAJARTNER.COM PAGE 7
  8. 8. ATLAS OF HUMAN SKELETAL ANATOMYpedis), directed against the body, and abottom area= the sole (Planta pedis),directed against the ground.The foot can be further divided, similarto the hands, into a Tarsus, Metatarsusand Digiti (Toes; I= Hallux, II= 1Digitus secundus, III= Digitus tertius,IV= Digitus quartus, V= Digitusminimus). 2 2 1 3 3 4 4 5 6 5 6Fig. 1.10.: Regiones membri inferiorisReg. femoralis anterior (1), Tr.femorale (2), Reg. genus anterior (3),Reg. cruralis anterior (4), Dorsum Fig. 1.11.: Regiones membri inferiorispedis (5), Digiti (6) Reg. glutaealis (1), Reg. femoralis posterior (2), Reg. genus posterior (3), Reg. cruralis posterior= Reg. suralis (4), Reg. calcanea (5), Planta pedis (6)J.ARTNER ET AL. 2002, WWW.JURAJARTNER.COM PAGE 8
  9. 9. ATLAS OF HUMAN SKELETAL ANATOMY1.4. Tissues of the Body arranged in bundles, is less flexible, but much stronger than the looseTissues are defined as cells (and connective tissue.ground substance) acting together in Elastic conective tissue (in ligaments)the performance of a special body has more bundles of elastic fibers thanfunctions. collagene fibers.The primary tissue categories of the Reticular connective tissue (as ahuman body are epithelial, connective, supportive framework for bone marrowmuscle, and nervous. The blood could and lymphatic tissue) consists ofbe also seen as a special tissue type. reticular fibers, produced by special cells (reticulacytes).Epithelial tissues are composed ofclosely aggregated cells and their Adipose tissue is a special type ofextracellular matrix, forming a connective tissue specialized to lipidprotecting barrier around and in the (fat) storage, formed by large cellsbody. Further functions of epithelial (adypocytes) with small extracellulartissues are absorption of nutrients and matrix. It can be divided into a yellowsecretion of substances. Cells may be (anywhere in a adults body) and ajoined to a single layer (for example brown (infants) adipose tissue. Yellowalveolar epithelia in lungs, which adipose tissue stores lipids, providesprovide a little difusion distance for the thermic and mechanic isolation andoxygen) or as multiple layers (for body shape. Brown adipose tissueexample skin epithelia). The type of generates heat by utilizing fatty acids.cells may vary from cuboidal (forexample in kidney tubules) to Cartilage is a connective tissue with acolumnar (for example in the digestive solid extracellular matrix, specializedtract) to flattened squamous cells (for to bear mechanical stress. The cellsexample in blood vessels). (chondrocytes) are embedded in theEpithelial cells can also form glands, matrix. There are three types ofwhich secrete their products into ducts cartilage, classified according to the(exocrine glands) or into blood vessels type of fiber in the matrix.(endocrine glands). Hyaline cartilage (found at the ends of the long bones and ribs, and forms theConnective tissues provide support, fetal skeleton that is later ossified andprotection and stability, produce blood becomes bone) has a matrix with onlycells and fill (empty) spaces. The cells very fine collagenous fibers.are separated by extacellular matrix Elastic cartilage (found at the auricle(produced by themselves), consisting of the ear, ear canal, eustachian tube,of fibre proteins like collagen or and epiglottis) has a matrix containingelastin, glycoproteins, glycosamino- many elastic fibers.glycans and tissue fluids. The Fibrocartilage (found in theextracellular matrix is responsible for intervertebral discs and the knee joint)the stabile or elastic tissue function. contains a dense network of collagenTypes of connective tissue are: fibers with a good resistance to tensionLoose connective tissue (around blood and pressure.vessels, groups of muscle cells,...),which is well vascularized and flexible Bone tissue is the forming componentbut not very resistant to stretch. of the skeletal system, protecting innerDense connective tissue (in ligaments body cavities, providing movement (asand tendons) has many collagen fibers a lever, by converting muscleJ.ARTNER ET AL. 2002, WWW.JURAJARTNER.COM PAGE 9
  10. 10. ATLAS OF HUMAN SKELETAL ANATOMYcontractions into movements) and 1.5. Planes, Directions and Positionsblood cell formation, and storingminerals like calcium (which give the In order to describe positions andbone the specific rigidity). More orientations of structures of the humanspecific information about the bone body in three dimensions, the body istissue will be desribed in chapter 1.7. supposed to be in standing position,Osteology. looking forward, arms at sides with palms of the hands pointing forward,Muscular tissue is composed of fibers, and feet together pointing forward.which contain contractile actin andmyosin filaments. They allow themuscle to provide contractions,movement or to turn body parts,depending on the location, the originand the insertion of the muscle. Threetypes of muscles can be found inhuman body, depending on themicroscopic appearance, location andfunction:Skeletal muscle, which is undervoluntary control, is attached to thebones and moving body parts.Smooth muscle, found in organs andvessels, is under control of theautonomous nervous system(involuntary). Fig. 1.12.: Standard anatomic positionCardiac muscle is located in heart, isstriated like skeletal muscle To describe topographic relationships(histology), but it is under control of of structures or parts to other structuresthe autonomous nervous system in body, we use following terms:(involuntary) like the smooth muscle The terms superior or cranial (cephalic) indicate that a structure isNervous tissue is distributed through located at a higher level or closer tothe whole body, consisting of cells head. The opposite of these are the(called Neurons) with fibers (called terms inferior or caudal, whichDentrites if conducting signals to indicate that a structure is located at aNeuron body from and Axons if lower level or downwards. In case ofconducting signals to the periphery), the limbs, the terms proximal andspecialized in communication and distal indicate the level or the relativesignal transmission, and of cells distance from the attached end of the(Schwann cells and Glia), which limb (for example: the arm in standardencircle and isolate the fibers. The anatomic position; proximal wouldnervous network system is divided into mean near to the shoulder; distala central nervous system (brain and would mean further away or locatedspinal cord) and into a peripheral lower).nervous system (covering all body The terms anterior or ventral indicate aparts). relation to the front of the body or a structure. The terms posterior or dorsal indicate that a structure is located near to the back of body.J.ARTNER ET AL. 2002, WWW.JURAJARTNER.COM PAGE 10
  11. 11. ATLAS OF HUMAN SKELETAL ANATOMYThe terms medial and lateral refer to a the term profundal indicates, that it isstructures position in relation to the located deeper.medial plane (or the long axis) of the The terms internal and externalbody or a structure (medial: toward describe a structure’s position or amidline; lateral: away from midline or view in relation to inner and outerlocated at the side). surfaces (for example in organs orThe terms superficial or profundal are cavities).used to describe a position or location The term ipsilateral indicates that tworelative to the surface of areas, structures are located at same side ofstructures or tissues. The term body. The term contralateral indicatessuperficial indicates that a structure is the opposite (opposite side of body).located close to the surface of a tissue, superior (cranial) dorsal (posterior) lateral lateral frontal (anterior) inferior (caudal)Fig. 1.13.: Positions, relative locations and directionsBecause of different presentations of The sagittal (median) plane is abody structures in images (for example vertical anteroposterior plane, whichillustration, x-ray, or Ct), it is divides the body into right and leftimportant to know the planes of halves. Slices paralleling this plane arereference:J.ARTNER ET AL. 2002, WWW.JURAJARTNER.COM PAGE 11
  12. 12. ATLAS OF HUMAN SKELETAL ANATOMYcalled paramediansagittal or When describing body or a structure inparasagittal planes. three dimensions, there are six standardThe frontal (or coronal) plane stands perspectives, which can be also putat right angle to the sagittal plane and together or mixed (example: a viewdivides body into anterior and from behind and the base) if followingposterior halves. the rules of three dimensionalThe transverse (or horizontal) plane presentations (a useful help is to putstands perpendicular to the sagittal and the body into a virtual cube).coronal plane and divides the body The following perspectives were firstinto superior and inferior halves. In described on skulls but can be used forcase of an organ or other body the whole body.structure, the horizontal plane is at The perspective from in front is calledright angle to the long axis of that Norma frontalis, from behind calledstructure (cross section). Norma occipitalis or dorsalis. The sideIt is also possible to make oblique perspective is called Norma lateralis.planes (for example MR- tomography Norma basalis (or basilaris) is thespecial cuts), which lie at any other perspective from the base, Normaangles. verticalis from above. Like already mentioned, two perspectives can be put together to achieve an oblique view of Sagittal plane some structures (for example posterolateral view). Some authors use also the terms Aspectus or Facies to describe a perspective of a view (Aspectus inferior, superior, anterior, posterior, Coronal plane lateralis or Facies interna, externa, inferior, superior, anterior, posterior and lateralis). Facies superior Facies lateralis Facies anterior Transverse plane Norma (Aspectus) lateralis Norma frontalis (Aspectus anterior) Aspectus anterolateralis Fig. 1.15.: Examples for views, areasFig. 1.14.: Planes of the human body and perspectivesJ.ARTNER ET AL. 2002, WWW.JURAJARTNER.COM PAGE 12
  13. 13. ATLAS OF HUMAN SKELETAL ANATOMY1.6. Osteology compacta or compact bone tissue) at the outer parts of bones (thick wall atOsteology as a science, a subdivision the shaft of long bones, thin layer atof anatomy, surgery, orthopedics and the ends), the other consists of thinmany other clinical fields is focusing fibers and sheets of bone, trabeculae,on the study of bone tissue. which form a reticular, spongy like network at the ends of long bonesTwo different bone components can be (Substantia spongiosa, trabecular orfound (macroscopically) at human cancellous bone tissue) and inbones: one dense in texture (Substantia vertebrae.Substantia spongiosa(trabecularis)Substantia compactaFig. 1.16.: Frontal section through the head of Femur (bone of the thigh)© Pekny P., 2002Substantia compacta (cortical bone) is found primary in the shaft of long bones andforms the outer shell around Substantia spongiosa (cancellous bone) at the end ofjoints. The inner parts of the head are filled with spongy bone tissue.J.ARTNER ET AL. 2002, WWW.JURAJARTNER.COM PAGE 13
  14. 14. ATLAS OF HUMAN SKELETAL ANATOMYThe gross structure of a long bone can The growth plate (Physis), separatingbe divided into the following regions: the Epiphysis from the Metaphysis in - Epiphysis with articular (joint) growing bones, is the zone of cartilages ossification (bone growth). In adult - Diaphysis bones (which are fully- grown) only a - Metaphysis scar is present. - Epiphyseal (growth) plate (Physis) in actively growing bonesEpiphysis is located at the ends of longbones, between articular cartilages andthe growth plate. It is present at eachend of long limb bones. Exceptions arethe metacarpal and metatarsal bones,bones of the fingers and toes(Phalanges), the ribs (Costae) and thecollarbones (Clavicula), where theEpiphysis is at only one end present.The interior of this region is filled withspongy trabecular bone tissue withonly a thin external cover of compactbone.Diaphysis is the shaft of long bones. Itis located between both Metaphysesand consists of compact bone wallsand an inner cavity (Cavitasmedullaris), filled with the bonemarrow. Fig. 1.18.: Development of long bones The arrows show the direction of the endochondral ossification within a hyaline cartilage model, which provides a template of the shape of the bone to be formed. In the next step, the cartilage is replaced by bone. This type of ossification is found in long and short bones, but not in flat bones. Further macroscopically visible structures, like Foramina (holes in a bone through which nerves or nutritiveFig. 1.17.: Diaphysis of a long bone vessels pass), Processus (bony© Pekny P., 2002 prominences), Tuberositas (raised and rough elevations of bone to which aMetaphysis is located between the ligament, tendon, or muscle attaches),growth plate and the Diaphysis. The Spinae (sharp lumps), Tuberculumcortical bone thins here relative to the (rounded lumps), Sulci (grooves),Diaphysis. Incisurae (incisions) and FossaeJ.ARTNER ET AL. 2002, WWW.JURAJARTNER.COM PAGE 14
  15. 15. ATLAS OF HUMAN SKELETAL ANATOMY(depressions) will be described for tissue and Osteoprogenitor cells (seeeach bone in further chapters. next chapter), called Periosteum. It is anchored to the bony surface byThe external surface of bones (except Sharpey fibers (fibrae) that penetratethe articular cartilages) is surrounded into the bone.by a thin layer of dense connective Epiphysis Diaphysis EpiphysisFig. 1.19.: Frontal and horizontal sections through HumerusJ.ARTNER ET AL. 2002, WWW.JURAJARTNER.COM PAGE 15
  16. 16. ATLAS OF HUMAN SKELETAL ANATOMYThe articular cartilage (Cartilago in small bony ducts or canals, calledarticularis) is located at joints, Canaliculi.movable areas where bones are in Osteocytes have a reduced syntheticcontact with other bones. The function and mitotic activity (cell division). Inof the articular cartilage (hyaline most cases they stay at their locationcartilage) is to provide a smooth until they die. In some cases they cancontact surface in a joint (Facies reactivate into Osteoblasts by returningarticularis). It consists, similar to other into the Osteoprogenitor cell stage andconnective tissues of cells further differentiation.(Chondrozytes) and extracellularmatrix, but has in contrast to othertissues no vascularization (vessels) and The third cell types are thenutrients have to diffuse from synovial multinucleated Osteoclasts, derivedfluid (nutrient rich fluid in the joint from the monocytic- macrophagecapsule). Therefore the cartilage is system (cells specialized in eating andmore susceptible to damages, than digestion of bacteria, cell structures,most other tissues. We will discuss etc…). They are responsible for thejoints and joint- associated structures bone resorption and bone remodelingfor each articulation separately. during life. The resorption craters, Osteoclasts are lying in during the matrix resorption are called Howship1.7. Bone Histology lacunae.Like all connective tissues, cartilageand bone consist of cells andextracellular matrix.The matrix consists of fibers (collagen,reticular, and elastic) and amorphousground substance, which containsproteoglycans, abundant calcium andphosphorus, bicarbonate, citrate, Canaliculusmagnesium, potassium, sodium andhyaluronic acid in the bone tissue, Osteocyteswhich is called Osteoid before itbecomes calcified and hard.The cells of the bone tissue can be Fig. 1.20.: Osteocytes in Lacunaeclassified by their function and Also in picture: Canaliculi aroundactivity. Osteocytes, Lamellae, and HaversianOsteoblasts which are located on the channels with central vesselssurface of bone or Osteoid produce the (explained in text)extracellular matrix and enzymesneeded for the calcification of the The components of bone tissue are inmatrix (Osteoid). After an Osteoblast compact bones organized into strongis encased (covered) by Osteoid matrix units, called Osteons or Haversianproduced by itself, it becomes an systems, lamellar cylinders along theOsteocyte. When the extracellular long axis of bones with an averagematrix becomes hard it is located in a diameter of 0,05mm.small cavity, called Lacuna and Each Haversian system consists of acontacts its neighboring Osteocytes central canal (Haversian canal orthrough thin cellular extensions, lying Canalis centralis Havers), surroundedJ.ARTNER ET AL. 2002, WWW.JURAJARTNER.COM PAGE 16
  17. 17. ATLAS OF HUMAN SKELETAL ANATOMY by concentric thin plates of bony tissue The Haversian canal contains one or (Lamellae). The lamellae are held two blood vessels and thin nerve together by oblique (Sharpey) and filaments. It communicates with the reticular fibers between them. The bone marrow cavity (Cavitas Lacunae are also situated between the medullaris) and the Periosteum Lamellae, occupied by Osteocytes. (outside of bone) through oblique Small communication canals (through canals (Volkmann canals, which Lamellae) between two Lacunae are penetrate the lamellar structures. called Canaliculi. Cartilago articularis Substantia spongiosa (trabecularis)Epiphysis Lamellae Substantia compactaDiaphysis Cavitas medullaris Osteon Canaliculus Canalis Volkmann Canalis centralis Havers Fig. 1.21.: Structures of long bone Microscopic view of compact bone tissue with Haversian systems J.ARTNER ET AL. 2002, WWW.JURAJARTNER.COM PAGE 17
  18. 18. ATLAS OF HUMAN SKELETAL ANATOMYSome Haversian systems can be Irregular bones (Ossa irregularia)incomplete (interstitial lamellae), for cannot be grouped into the upperexample non- circular. Such systems categories because of their shape. Theyare remnants left behind from former consist of spongy bone covered by aHaversian systems by bone remodeling thin layer of compact bone. Irregularduring life. bones are the Vertebrae, Os sacrum, Mandibula, Os sphenoidale...1.8. Types of BonesBased on shape, bones (Ossa) can beclassified as follows: Os longumLong bones (Ossa longa) are longerthan they are wide, are tubular in shapeand have two ends. The longcylindrical body (Corpus, Diaphysis)consists of compact bone and has acentral medullar cavity. The endsconsist of spongy bone surrounded bya thin layer of compact bone. Typicallong bones are the tubular bones of thelimbs (Humerus, Radius, Ulna,Femur...). Os breveShort bones (Ossa brevia) are cubicalin shape. They consist of spongy bonecovered by a thin layer of compactbone. Ossa brevia can be found in thewrist and ankle (Carpus and Tarsus).Flat bones (Ossa plana) are thin andhave broad surfaces. They are Os planumcomposed of two layers of compactbone tissue enclosing between them avariable quantity of cancellous bone(called in the skull bones Diploe withinner and outer table). The Diploe canbe locally absorbed and becomepneumatic in some skull bones,forming inner bone cavities filled withair (Sinus). Such pneumatic skullbones are also called Ossa pneumatici.The flat bones are Os coxae (the hipbone), Scapula (shoulder blade), Os irregulareSternum (breastbone), Costae (ribs),and some skull bones (Os frontale, Osoccipitale, Os parietale…). Fig. 1.22.: Types of bonesJ.ARTNER ET AL. 2002, WWW.JURAJARTNER.COM PAGE 18
  19. 19. ATLAS OF HUMAN SKELETAL ANATOMYSesamoid bones (Ossa sesamoidea) are skull to the pelvis. The vertebrala special type of bones which occur in column normally consists of 26tendons. A typical sesamoid bone is irregular bones, separated from eachthe Patella of the knee. According to other by fibrous pads called Discisome authors Patella can also belong to intervertebrales, which protect thethe group of short or flat bones. vertebral column by making the contact surfaces smoother and by absorbing shocks.1.9. The Human Skeleton The primary function of the vertebral column is the protection of the spineBones are forming a protective and (Medulla spinalis), the supporting ofsupportive framework, the skeleton. standing posture of the body and of theThe functions of the skeleton are the thoracic cage. The 12 pairs of ribsfollowing: (Costae) of the thoracic cage (Thorax) are fixed to the sides of Vertebrae,The skeletal system protects and contacting at the front of the thoracicstabilizes inner structures like thoracic cage the breastbone (Sternum). Oneorgans (lungs, heart) or the brain it acts collarbone (Clavicula) is attached atas a lever to provide movements by each side of the upper frontal parts ofmuscular contractions and supports the Sternum, contacting the shoulder bladebody’s upright posture, it produces (Scapula), located at the upper parts ofblood cells in marrow the thoracic backside.(Haematopoiesis) and stores almost all The limbs begin with the contact ofbody calcium. Scapula to the upper arm bone (Humerus) at the height of the upperThe skeleton of an adult consists of chest, and with the contact of the206 bones. This number must be seen pelvic girdle (consisting of three bones,as a variable because of possible which are attached to the sacralvariations in the number of the ribs, the vertebral column) with the thigh bonesacral vertebrae or of the sesamoid (Femur) at the height of pelvis on bothbones. sides.Following the body axis, the skeleton Humerus has contact to two bones,may be divided into an axial skeleton, Radius and Ulna. In standard anatomicwhich consists of the bones of the position, Ulna is located medialwardskull, the hyoid bone, the vertebral and Radius lateralward. Both bonescolumn and the thoracic cage, and into form with their distal ends a forkedan appendicular skeleton, consisting of articulation surface for the proximalthe pectoral- and the pelvic girdle and carpal bones (Ossa carpi). There areof the bones of the upper- and the eight Ossa carpi on both sides. Thelower limbs. distal carpal bones have contact to theOne of the most important skeletal five metacarpal bones (Ossaparts is the skull (Cranium) consisting metacarpi), which have contacts to theof 22 flat and irregular bones, proximal finger bones (Phalanges).separated from each other by With the exception of the (first) thumb,immovable joints called Suturae. Its consisting of two Phalanges, eachprimary function is the protection of finger consists of three Phalanges.the brain, lying in a bony cavity. Additional sesamoid bones can occurAt the skull- base, skull is in contact at the medial portion of the firstwith the vertebral column (Columna Phalanx.vertebralis), which extends from theJ.ARTNER ET AL. 2002, WWW.JURAJARTNER.COM PAGE 19
  20. 20. ATLAS OF HUMAN SKELETAL ANATOMY The distal end of Femur has contacts to of the following six tarsal bones (Ossa three bones, the medialward located tarsi) has contacts to five metatarsal Tibia, the lateralward located Fibula, bones (Ossa metatarsi). and the Patella, located in front of the The bone distribution in the toes is distal Femur end. Tibia and Fibula similar to the fingers of the hand. form with their distal ends, similar to There are only two Phalanges the bones of the forearm, a forked following the first Os metatarsale, articulation surface for the proximal every other toe has three Phalanges. tarsal bone called Talus. The distal row Cranium Clavicula Columna vertebralis Sternum Scapula Humerus CostaeRadius Os coxae Radius Ossa carpi Ossa metacarpi Phalanges Femur UlnaPatella Tibia Fibula Ossa tarsi Phalanges Ossa metatarsi Fig. 1.23.: Models of the human skeleton, Aspectus anterior and posterior J.ARTNER ET AL. 2002, WWW.JURAJARTNER.COM PAGE 20
  21. 21. ATLAS OF HUMAN SKELETAL ANATOMYSeven additional bones should be The therapy comes after the diagnosismentioned for the completeness of the which can be in case of some fracturesskeleton: The hyoid bone (Os a reposition of fragments and a plaster,hyoideum), located under the frontal in other cases surgical fracturepart of the skull above the larynx, and stabilization. It does not matter whichthe three small auditory bones therapy type we choose, in both cases(Ossicula auditoria) at each side, a second x-ray for the control ofhidden in cavities in temporal bones of therapy (reposition) success has to bethe skull. made. The diagnosis and therapy of benign1.A. Clinical Aspects and malignant tumors is the next example. The knowledge of the exactThis chapter deals with the question tumors location, expansion and dignity“Why is anatomy so important for is the base for the further radiotherapydoctors?” or “Why should I know or the surgical treatment.about human anatomy?”We will try to put more such chaptersor clinical cases to the following workto show how anatomy can be used inpractice (and why a medicine studentshould know it).Every day doctors are confronted withpatients with broken bones (fractures).A fracture is an interruption of bonecontinuity and needs (with theexception of very little fractures) to becorrected.A doctors first step in the diagnosis isthe inspection of the area (searching Fig. 1.24.: Image of a physician,for possible edges under the skin, open showing a suspicious area located infractures, bleedings, and additional the upper right lung; (Image is publicinjuries of nerves, vessels or soft property, acquired from the Nationaltissues). The next step in the diagnosis Health Image Library, US)is always an x-ray, where an image isdeveloped by different ray- absorptions As you can see, the clinicalin structures. visualization methods (x-ray, ct, mr,Computer tomography is similar to this angiography...) are the doctor’s littleprocedure, which is often used in helpers, but the knowledge must bediagnosis of skull fractures and achieved through intensive study. Itbleedings or other complicated can be achieved only by studying,fractures. A computer tomography visualization and practice.image is a horizontal cut through the We hope that this chapter and the nextbody at a specific height (horizontal chapters will help you to understandplanes). and learn anatomy.In both cases a good knowledge oftopographic anatomy is needed.J.ARTNER ET AL. 2002, WWW.JURAJARTNER.COM PAGE 21
  22. 22. ATLAS OF HUMAN SKELETAL ANATOMYReferences(1) Waldeyer, A. Anatomie des Menschen; De Gruyter: Berlin, 2002;(2) Feneis, H. Anatomisches Bildwörterbuch der internationalen Nomenklatur; Thieme: Stuttgart, 1993;(3) Wolf- Heidegger, G. Atlas der Human Anatomie; Karger: Basel, 1990;(4) Platzer, W. Atlas der topographischen Anatomie; Thieme: Stuttgart, 1982;(5) Anderson, J. Grants atlas of anatomy; Williams & Wilkins: Baltimore, 1983;(6) Williams Grays Anatomy of the Human Body; Churchill Livingstone: 1995;(7) Benninghoff, A., Görttler, K. Makroskopische und Mikroskopische Anatomie des Menschen; Urban & Schwarzenberg: München, 1994;(8) Kahle, W., Leonhardt, H., Platzer, W. Taschenatlas der Anatomie; Thieme: Stuttgart, 1979;J.ARTNER ET AL. 2002, WWW.JURAJARTNER.COM PAGE 22

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