I. GENERAL ANATOMY AND ANATOMY OF THE UPPER LIMB 1. General features and classification of bones. Types of ossification.

Feature and classification of bones. 1) Long bone (endochondral ossification) Epiphyses (two ends) Diaphysis (shaft) spongy bone compact bone (bone marrow) Metaphysis (diaphysis epiphyses )

2) Short bone 3) Flat bone 4) Irregular bone 5) Sesamoid bone Type of ossification Intramembranous ossicication Replacement of sheet-like connective

tissue membranes with bony tissue. e.g.: skull Endochondral ossicication Replacement of hyaline cartilage with bony tissue. Most of the bones of the skeleton are formed in this manner. Bones are first formed as hyaline cartilage models.

2. Connections between bones. Classification and general description of joints.

A r thrology/ general syndesmology

study of joint

Solid joint / Synarthroses . Syndesmosis / fibrous joint fiber interosseal membrane suture (plain, squamous suture, sagittal suture) syndesmosis tibiofibularis syndesmosis coracoclavicularis peg-and-sochet / gomphosis fixation . Synchondrosis / cartilaginous joint cartilage Temporary Epiphysial plate: Hyaline cartilage Spheno-occipital synchondrosis Hyaline cartilage Constant Intervertebral discFibrocartilage SymphysisFibrocartilage . Synostosis ossification Epiphysial plate = Epiphysical disc Spheno-occipital synchondrosis Hip bone Sacrum Synovial joint / Diarthroses . Uniaxial joints Hinge or ginglimus joint Pivot or trochoid joint . Biaxial joints Ellipsoidal joint Saddle or sellar joint . Multiaxial joint Ball-and socket or spheroidal joint

. Plain joint . Condylar joint

Ligament Cartilage Tendon

Symphysis pubic symphysis, sacrococcygeal symphysis, mandible, sternum (manubrium & body, xiphoid process & body) hyaline cartilage Fibrocartilage covers the articular faces in: sternoclavicular ioint acromioclavicular joint sacroiliac joint symphysis temporomandibular joint

amphiarthrosis

3.

Types of muscles. General features of skeletal muscles and fasciae. Innervation and regeneration of muscles

Types of muscles
n u cl eu s S kel etal m . m ul ti p eri p h ery co n tracti on q u i ck + stro n g vo l u n tary q u i ck + stro n g i n vo l u n tary sl o w + w eek i n vo l u n tary stri ati on sp eci al stru ctu re b i fu cati on i n tercal ated d i sk Y Y gap j u n cti on m yo fi b ri l s d en se b o d y

C ari ac m .

u n i cen tral l y

sm o o th m .

uni

Muscles are separated by fascia Superficial fascia : under the skin everywhere (except the face). Their name is fascia superficialis . Deep fascia : covering and separating muscle groups (e.g.: fascia lata). Subserous fascia : related to body cavities inside (e.g.: endothoracic fascia). Innervation of muscle

Voluntary muscle (skeletal m.) Involuntary (cardiac m., smooth m.)

innervated by somatic NS innervated by autonomic NS

Regeneration of muscles satelite cell

4.

The bones, joints and movements of the shoulder girdle. Radiological anatomy of the shoulder girdle.

scapula

Clavicle

joints and movements of the shoulder girdle 1. Acromioclavicular join Articular surcaces Type of joint Ligaments acromial end of the clavicle flat articular surface of the acromion Synovial joint plane joint Acromioclavicular ligament Coracoclavicular ligament Coracoacromial ligament Movements claviclescapulaScapurahumerus shoulderjoint 2. Stenoclavicular joint Articular surcaces Type of joint sternal end of the clavicle clavicular notch of sternum Synovial joint limited ball and socket joint by an articular disc. Ligaments Ant. Post. stenoclavicular ligament Interclavicular ligament Costoclavicular ligament Movements Elevation depression Protraction retraction Rotation Radiological anatomy of the shoulder girdle

Additional componentFacets are coverd by fibrocartilage and articular disc is often found.

Additional componentFacets are covered by fibrocartilage and the joint is completely divided

5. The gross and radiological anatomy and movements of the shoulder joint and the participating muscles. The rotator cuff. Shoulder joint Articular surcaces Type of joint Ligaments Movements glenoid cavity head of humerus Synovial joint ball and socket joint Glenohumeral ligament Coracohumeral ligament Flexion extension Abduction adduction Rotation Circumduction Movements of the shoulder joint

Additional componentglenoid labrum, fibrous capsule, bursae

Rotartor cuff

6. The gross and radiological anatomy and movements of the elbow joint and the participating muscles. Cubital or elbow joint 1. Humeroulnar joint Articular surcaces Type of joint Ligaments Movements 2. Humeroradial joint Articular surcaces Type of joint Ligaments Movements capitulum of the humerus articular facet of the head of radius Synovial joint ball and socket joint radial collateral ligament Flexion extension trochlea of the humerus trochlear notch of the ulna Synovial joint hinge joint ulnar collateral ligament Flexion extension

Additional component ----------

Additional component ----------

3. Proximal radioulnar joint Articular surcaces Type of joint Ligaments Movements articular circumference of head of radius radial notch of the ulna Synovial joint pivot joint anular ligament pronation supination

Additional component ----------

movements of the elbow joint and the participating muscles

7. Pronation and supination: participating joints and muscles.

participating joints 1. Proximal radioulnar joint Type of joint: pivot 2. Interosseal membrane Type of joint: syndesmosis 3. Distal radioulnar joint Type of joint: pivot

8.

The gross and radiological anatomy and movements of the wrist joint and the participating muscles.

Radio carpal or wrist joint Articular surcaces Type of joint Ligaments Movements Distal end of radius scaphoid, lunate, triquetrum Synovial joint elipsoid joint flexion extessio abduction adduction

Additional component articular disc

movements of the wrist joint and the participating muscles

9.

Joints and movements of the hand. Radiological anatomy of the hand.

Intercarpal joint Plane joint Gliding and sliding movement

1st calpometacarpal joint saddle joint abductionadduction, oppositionreposition, slight rotation

Metacarpophalangeal joint ellipsoid joint abductionadduction, flexionextension, rotation, circumduction

Interphalangeal joint hinge joint flexionextension

10. The anatomy, innervation and function of the spinohumeral and thoracohumeral muscles. Thracohumeral muscles Pectoralis major Pectoralis minor subclavius serratus anterior : pectoral n. : pectoral n. : subclavius n. : long thoracic n.

Spinohumeral muscles Trapezius Levator scapulae Romboid minor Romboid major latissimus dorsi accessory n. dorsal scapular n. dorsal scapular n. dorsal scapular n. thracodorsal n.

11. Classification (types) and innervation of blood vessels. Types of vascular anastomoses. Classification (types) and innervation of blood vessels 1. Conducting vessels: aorta, pulmonary trunk. 2. Distributing vessels (subclavian a.,axillary a., brachial a.) 3. Resistance vessels: small muscular arteries and arterioles. 4. Exchange vessels: capillaries, venules. 5. Reservoir vessels: veins. Innervation of bleed vessels We find sensory and effector nerve endings in vessel wall. Sensory nerve endings receptors for pressure and the composition of blood (baroreceptors, chemoreceptors). Sensory nerve endings belong to glossopharyngeal (IX) and vagus (X) nerves. Effector nerve endings are postganglionic sympathetic nerve endings which release norepinephrine as transmitter cause smooth muscle contraction in vessel wall vasoconstriction. Types of vascular anastomoses 1. Arterial anastomoses 2. Collateral anastomoses 3. Venous anastomoses : arch (arcade) anastomosis : around large joints : connecting superficial and deep veins

4. Arteriovenous anastomoses : in capillaries.

12. The systemic circulation: the large branches of the aorta and the great veins. Branches of the subclavian artery - Vertebral artery - Internal thoracic artery - Thyrocervical trunk - Costocervical trunk - Transverse cervical a.
(Doral scapular a.)

Subclavian vein runs together with artery. Axillary vein is continuation of the basilica vein (which forms uniting basilic and brachial veins). Subclavian and internal jugular veins form the brachiocephalic vein. The angle of the two veins is called venous angle. Venous angle is the site of junction of large lymphatic trunks (thoracic duct and right lymphatic duct).

13. The branches and anastomoses of the axillary artery.

Hotel Spa Thoracoacromial a. branch acromial branch pectoral branch clavicle branch deltoid branch

14. The branches of the brachial artery; collateral circulation of the elbow.

15. Palmar arterial arches: topography and branches.

16. The venous and lymphatic drainage of the upper limb. > superficial lymph vessels pass to the regional lymph nodes in parallel with the subcutaneous veins > deep lymphatic vessels follow the arteries

17. The organization of spinal cord segments and spinal nerves. The cranial nerves and their main functions.

I. II. III. IV. V.

olfactory n. optic n. oculomotor n. trochlear n. trigeminal n.

Nervus olfactorius Nervus opticus

cribriform plate optic canal superior orbital fissure superior orbital fissure

Nervus oculomotorius Nervus trochlearis Nervus trigeminus Nervus opthalmicus Nervus maxillaris Nervus mandibularis Nervus abducens Nervus facialis 7 9

-V/1 opthalmic n. -V/2 maxillary n. -V/3 mandibular n. VI. VII. VIII. IX. X. XI. XII. abducens n. facial n.

superior orbital fissure foramen rotundum foramen ovale superior orbital fissure internal acoustic meatus facial canal stylomastoid foramen internal acoustic meatus

vestibulocochlear n. Nervus vestibulocochlearis glossopharyngeal n. vagus n. accessory n. hypoglossal n. Nervus glossopharyngeus Nervus vagus Nervus accessorius Nervus hypoglossus

Jagular foramen

sphenoid bone

hypoglossal canal

temporal bone (Jagular foramenoccipital bone)

foramen spinosum foramen lacerum external acoustic meatus

18. Trunks, cords and nerves of the brachial plexus.

19. The injuries to the brachial plexus: types and symptoms. ERB-DUCHENNE PARALYSIS (C5, 6) : supraspinatus, infraspinatus, biceps, deltoideus, teres minor, brachialis muscular palsies. Arm is rotated medially, hand is pronated (arrows). May happen during childbirth. 20. Branches of the median nerve. arm Formed on the anterolateral aspect of the axillary a. by the union of lateral and medial cords. Descends in the medial bicipital groove Runs downward on the axillary a. then further on the brachial a. Gradually crosses the brachial a. anteriorly to lie medial to the artery at the elbow Gives no branches to structures of the arm forearm Enters the forearm on the front of the brachialis m. medial to the brachial artery. Branches ( in the forearm):

21. Branches of the ulnar nerve. Arises from the medial cord Descends in the medial bicipital groove toward the medial epicondyle(groove for the ulnar n. on the humerus) Enters the forearm by passing behind the medial epicondyle between the two heads of the flexor carpi ulnaris. It runs downwards between the flexor carpi ulnaris and flexor digitorum profundus muscles. Emerges with the ulnar artery from behind the flexor carpi ulnaris above the wrist. Crosses the anterior surface of the flexor retinaculum with ulnar artery on its lateral side. Then divides into superficial and deep branches: 1. Superficial branch: Gives rise to common and proper palmar digital branches providing the sensory innervation of 3 ulnar borders of the digits on the palmar side. 2. Deep branch: supplies the hypothenar mm. & the adductor pollicis m. & deep head of the flexor pollicis brevis m. & the mesothenar mm. except the 2 radial lumbricals

It gives off the dorsal branch above the wrist, which in turn gives rise to dorsal digital branches providing cutaneous innervation for 5 ulnar borders of the digits on the dorsal side (except: distal phalanges).

22. Branches of the radial nerve. Arises from the posterior cord of the brachial plexus. After leaving the axilla it spirals posteriorly around the humerus and joins the deep brachial a. After piercing the intermuscular septum it re-enters the anterior compartment to pass downward and forward between the brachialis m. and brachioradialis m.

Then it gives rise to the deep and superficial ramuses. Superficial ramus / branch: Descends alongside the ulnar border of brachioradialis m. In the middle-third of the forearm it runs together with the radial artery.

Deep branch (in the forearm)

23. Skin innervation of the upper limb.

24. Axillary fossa, triangular and quadrandular axillary spaces. Deltopectoral trigone: space between the deltoid and pectoralis major muscles, beneath the clavicle. The cephalic vein pierces through and discharges into the axillary vein. Quadrangular space: humerus, teres major, teres minor, long head of triceps. Circumflex vessels of the humerus, axillary nerve. Triangular space: long head of the triceps, teres major, teres minor. The corcumflex vessels of the scapula are transmitted.

25. Sectional anatomy of the arm: fascial (osteofibrous) compartments, muscle groups, vessels and nerves. The cubital fossa.

Radial & median nerves in the cubital fossa

26. Sectional anatomy of the forearm: fascial (osteofibrous) compartments, muscle groups, vessels and nerves.

27. Topography of the volar and dorsal wrist regions: tendons, tendon sheaths, osteofibrous compartments, vessels and nerves. The carpal tunnel. The anterior (volar) wrist reagion The main structure is the carpal tunnel. Tendons of the flexor muscles are covered by tendon sheaths. Median nerve: located in the tunnel. Ulnar nerve and ulnar artery run medially, NOT entering the carpal tunnel. Radial artery and nerve branches run laterally around the distal end of the radius and the foveola radialis (anatomical snuff-box). Minor structure is the Guyon-tunnel, which is more superficial compared to the carpal tunnel.

28. Dorsum of the hand. The anatomical snuffbox (Foveola radialis).

29.

Palm of the hand: muscles, fasciae, compartments, vessels and nerves.

II. ANATOMY OF THE LOWER LIMB 1. The hip bone, the sacrum, os coccygis. The hip bone (= coxal bone)
Ilium Pubis Ischium

Synostosis : fused by 16-18th years of age Pelvis Composed of four bones : 2 hip bones + Sacrum + Coccyx (= os coccyges)
Pelvic girdle : hip bone + Sacrum

2. The structure and diameters of the bony pelvis. Structure of the pelvis Greater pelvis : separated from lessor pelvis by the terminal line & oblique plane. Lessor or true pelvis : inlet cavity outlet
Greater pelvis Pelvic cavity Terminal line Pelvic outlet Lesser pelvis Pelvic inlet

Diameter of the pelvis I. External diameter of the pelvis Interspinous diameter Intercristal diameter External conjugata : 25-26 cm : 28-30 cm : 20 cm ( 18 cm Section caesare?)

(Baudeloques diameter : ) II. Internal diameter of the pelvis Transverse diameter of pelvic inlet Oblique diameter of pelvic cavity A-P(sagittal) diameter of pelvic outlet
Sacral promontary

: 13.5 cm : 13.5 cm : 11-12 cm

( <11cm Section caeare? )

Conjugata diameter of pelvic inlet

Sacroiliac joint

transverse diameter of pelvic inlet

Oblique diameter of pelvic inlet Ililpubic eminence Pubic symphysis Pubic arch Ischial spine Ischial tuberosity

Babies rotate their head during delivery to fit their fronto-occipital axis to the widest diameter at each point. Pelvic inlet Transvers diameter 13.5 cm Pelvic cavity Oblique diameter 13.5 cm Pelvic outlet Sagittal diameter 12 cm

3.

The joints and ligaments of the pelvis. The statics and radiological anatomy of the pelvis.

Joints of pelvis Sacroiliac joint Articular facets Type of joint Additional component ligaments : Sacrum & Ilium : Synovial joint Plane joint : The articular surfaces are covered by fibrocartilages : Interosseous sacroiliac ligament Anterior / Ventral sacroiliac ligament Posterior / Dorsal sacroiliac ligament Movement : Small anteroposterior rotation

Pubic symphysis (hemidiarthrosis) Articular facets Type of joint Additional component ligaments Movement : between pubis : Solid joint (Synarthrosis) Synchondrosis : Interpubic discarticular surface fibrocartilage : Superior pubic ligament Arquate (Inferior) pubic ligament : small degree of angulation, rotation and displacement

ligements of pelvis : ligaments are found at the lumbosacral joint, sacroiliac joint, and pubic symphysis I. Lumbosacral joint Iliolumbar ligament Lumbosacral ligament II. Sacroiliac joint Anterior sacroiliac ligament Interosseous sacroiliac ligament Posterior sacroiliac ligament III. Pubic symphysis Superior pubic ligament Arquate (Inferior) pubic ligament Statics of the pelvis The sacrospinous and sacrotuberous ligaments are major components of the lateral pelvic walls that help define the apertures between the pelvic cavity and adjacent regions through which structures pass. These ligaments stabilize the sacrum on the pelvic bones by resisting the upward tilting of the inferior aspect of the sacrum. They also convert the greater and lesser sciatic notches of the pelvic bone into foramina. Proper ligaments Sacrospinous ligaments Sacrotuberous ligaments Obturator membrane Inguinal ligament (POUPART) Transverse acetabular ligament

Radiological anatomy of the pelvis

1. Lateral part of the sacrum 2. Gas in colon 3. Ilium 4. Sacroiliac joint 5. Ischial spine 6. Superior ramus of pubis 7. Inferior ramus of pubis 8. Ischial tuberosity 9. Obturator foramen 10. Intertrochanteric crest 11. Pubic symphysis

12. Pubic tubercle 13. Lesser trochanter 14. Neck of femur 15. Greater trochanter 16. Head of femur 17. Acetabular fossa 18. Anterior inferior iliac spine 19. Anterior superior iliac spine 20. Posterior inferior iliac spine 21. Posterior superior iliac spine 22. Iliac crest

4.

The hip joint: gross and radiological anatomy, movements and the participating muscles.

Hip joint Articular facet Type of joint Additional component Ligaments : Acetabulum of the hip bone (lunate surface) head of femur : Synovial joint Ball and socket joint (multi-axial joint) : Acetabular labrum (fibrocartilage) Fibrous capsule : Intracapsula ligament Transverse acetabular ligament lig. of the head of the femur carries an artery of acetabular br. Of obturator a. Zona orbicularis ligament (anular ligamtent) Extracapsula ligament Iliofemoral ligament (Bertinis ligament) Ischiofemoral ligament Pubofemoral ligament Movements : Flexion (60) Extension (5-15) Abduction Adduction Medial rotation Lateral rotation Circomduction
Acetabula labrum

Zona orbicularis

Movement and the participating muscles of hip joint

Rotator 1.piriformis 2.obturator externus 3.obturator internus 4.gemellus superior 5.gemellus inferior 6.quadratus femoris Adductor 1.addctor magnus 2.adductor brevis 3.adductor longus 4.pectineus 5.gracilis Abductor 1.gluteus minimus 2.gluteus medius 3.tensor fasciae latae Flexor 1.iliacus 2.psoas major 3.rectus femoris 4.sartorius Extensor 1.biceps femoris 2.semimembranosus 3.semitendinosus 4.gluteus maximus

Piriformis Obturator externus Obturator internus Gemellus superior Gemellus inferior Quadratus femoris Adductor magnus Adductor brevis Adductor longus Pectineus Gracilis Gluteus minimus Gluteus medius Tensor fasciae latae Iliacus psoas major & minor Rectus femoris Sartorius Biceps femoris (long head) Semimembranosus Semitendinosus Gluteus maximus internal rotation

external rotation external rotation external rotation external rotation external rotation external rotation external rotation adduction adduction adduction adduction adduction adduction adduction adduction external rotation adduction adduction

abduction

extension

extension extension extension

extension flexion flexion flexion flexion abduction abduction abduction flexion flexion flexion flexion

external rotation external rotation

external rotation

abduction

flexion extension extension extension

external rotation

extension

Radiological anatomy of the hip joint 1. Anterior superior iliac spine 2. Ilium 3. Anterior inferior iliac spine 4. Arcuate line 5. Acetabular fossa 6. Head of femur 7. Fovea of ligament of head 8. Superior pubic ramus 9. Obturator foramen 10. Inferior pubic ramus 11. Pubic symphysis 12. Ischium 13. Lesser trochanter 14. Intertrochanteric crest 15. Greater trochanter 16. Neck of femur

5.

The femur, tibia, fibula. Connections between tibia and fibula.

Femur

Patella

Tibia and fibula

Connections between tibia and fibula Superior tibiofibular joint Articular facets Type of joint Additional component ligaments Movement : Post. Surf. of lat. condyle of tibia head of fibula : Synovial joint plane joint : ---------: Anterior ligament of fibular head Posterior ligament of fibular head : They permit gliding or slipping in any direction.

Crural interosseous membrane Syndesmosis Syndesmosis tibiofibularis Articular facets Type of joint Additional component ligaments Movement 6. : Fibular groove on tibia fibula : Solid joint (Synarthrosis) Syndesmosis : ---------: Anterior tibiofibular ligament Posterior tibiofibular ligament : ----------

The knee joint: gross and radiological anatomy, movements and participating muscles.

Knee joint Articular facets 1 Type of joint 1 Articular facets 2 Type of joint 2 Additional component : Condyles of femur Condyles of the tibia : Synovial joint Trochoginglymus joint (Pivot + hinge joint) = Condylar synovial joint? : Patellar surface of the femur patella : Synovial joint saddle joint : Meniscus, Bursae

Lateral meniscus O shape More movable

Posterior crucial ligament

Medial meniscus C shape Less movable

Attached to the med. Collateral lig.

Posterior crucial ligament Transverse ligament of knee

Bursae: Bursae communicating with the cavity of the knee joint 1. Suprapatellar bursa 2. Popliteus bursa 3. Semimembranosus bursa 4. Bursae of the medial and lateral gastrocnemius Bursae non-communicating with the cavity of the knee joint 5. Prepatellar subcutaneous bursa 6. Prepatellar subfascial bursa 7. Prepatellar subtendineous bursa 8. Infrapatellar subcutaneous bursa 9. Deep infrapatellar bursa

1.

8.9

Ligaments: Intracapsular Anterior cruciate ligament Posterior cruciate ligament Transverse ligament of knee Extracapsular Medial (tibial) collateral ligament Lateral (fibular) collateral ligament Patellar ligament (tendon of quadriceps femoris) Medial and lateral patellar retinacula (tendon of quadriceps femoris) Oblique popliteal ligament Arcuate popliteal ligament

Movements: Flexion Extension Passive rotation: at the end of extension lateral rotation at the beginning of flexion medial rotation Movement and the participating muscles of knee joint

Radiological anatomy of the knee joint 1. Femur 2. Patella 3. Medial epicondyle of femur 4. Lateral epicondyle of femur 5. Medial condyle of femur 6. Lateral condyle of femur 7. Intercondylar eminence 8. Intercondylar fossa 9. Knee joint 10. Lateral condyle of tibia 11. Medial condyle of tibia 12. Tibia 13. Fibula 1. Femur 2. Lateral condyle of femur 3. Medial condyle of femur 4. Fabella* 5. Patella 6. Base of patella 7. Apex of patella 8. Intercondylar eminence 9. Apex of head of fibula 10. Fibula 11. Tibia 12. Tibial tuberosity
*Fabella: sesamoid bone in the tendon of the (lateral head of) gastrocnemius muscle; anatomical variant in approx. 10-30% of the population).

7.

The ankle (talocrural) joint: gross and radiological anatomy, movements and participating muscles.

Talocrural joint (ankle joint) Articular facets Type of joint Additional component ligaments : trochlea of the talus inf. Articular surface of the tibia + tibial and fibular malleolus : Synovial joint Hinge joint : ---------: deotoid (or medial / tibial collateral) ligament Anterior tibiotalar ligament Posterior tibiotalar ligament Tibiocalcaneal ligament Tibionavicular ligament Lateral / fibular collateral ligament Anterior talofibular ligament Posterior talofibular ligament Calcaneofibular ligament Movement : Dorsi flexion (10) Plantar flexion (20)

T=Talus, Ca=Calcaneus, N=Navicular bone, Cu=Cuboid bone, MC=Medial cuneiform, IMC=Intermediate C, LC=Lateral C.

Movements and participating muscles of the talocrural joint

Tibialis anterior Extensor digitorum longus Extensor hallucis longus Fibularis tertius Fibularis longus Fibularis brevis Triceps surae Tibialis posterior Flexor digitorum longus Flexor hallucis longus dorsiflexion dorsiflexion dorsiflexion dorsiflexion planter flexion planter flexion planter flexion planter flexion planter flexion planter flexion

Radiological anatomy of the talocrural joint

1. Fibula 2. Tibia 3. Fibular notch of tibia 4. Malleolar fossa 5. Lateral malleolus 6. Talocrural joint 7. Medial malleolus 8. Talus

1. Fibula 2. Tibia 3. Talocrural joint 4. Medial malleolus 5. Trochlea of talus 6. Talus 7. Posterior tubercle of talus 8. Calcaneus 9. Sustentaculum tali 10. Tarsal sinus 11. Navicular 12. Cuneiforms 13. Cuboid

8.

Anatomy of the intertarsal joints and surgical lines of the foot. Movements of the foot: participating muscles.

Intertarsal joints 1. Subtalar joint = Posterior talocalcanean joint Articular facets Type of joint Additional component ligaments : Posterior talar articular surface Posterior calcaneal articular surface : Synovial joint Pivot joint : ---------: Lateral talocalcanean ligament Medial talocalcanean ligament Interosseous talocalcanean ligament (lies in the sinus tarsi) Posterior talocalcanean ligament Movements : Inversion Eversion

2. Talocalcaneonavicular joint Articular facets : between talus and navicular bone Talar articular surface of navicular bone Navicular articular surface Between talus and calcaneus (Anterior) Anterior talar articular surface Anterior calcaneal articular surface (Middle) Middle talar articular surface Middle calcaneal articular surface Type of joint Additional component ligaments Movements : Synovial joint Boll-and-socket joint : ---------: Talonavicular ligament Plantar calcaneonavicular ligament = spring ligament : Inversion Eversion

3. Calcaneocuboid joint Articular facets Type of joint Additional component ligaments : Facies articularis cuboidea calcanei Facies articularis calcanea ossis cuboidei : Synovial joint Plane joint (Amphiarthrosis) : ---------: Dorsal Dorsal calcaneocuboid ligament Bifucate ligament - Calcaneonavicular ligament, - Calcaneocuboid ligament Plantar Plantar calcaneocuboid ligament = short plantar ligament Plantar calcaneonavicular ligament = spring ligament Long plantar ligament Movements surgical lines of the foot Chopart line (Transverse tarsal joint) -Talonavicular joint + Cacanelcuboid joint -amputationBifurcate ligament Lisfranc line (Tarsometatarsal joint) : Gliding?

Movement and the participating muscles of the foot

Extensor digitorum longus Fibularis tertius Fibularis longus Fibularis brevis Tibialis anterior Extensor hallucis longus Triceps surae Tibialis posterior Flexor digitorum longus Flexor hallucis longus eversion eversion eversion eversion inversion inversion inversion inversion inversion inversion

9.

The anatomy of the foot arches. Radiological anatomy of the foot.

Foot arches Longitudinal plantar arches Medial arch : calcaneal tuberosity - talus - navicular bone - cuneiform bones - heads of I-III metatarsal bones Lateral arch : calcaneal tuberosity - cuboid bone - heads of IV-V metatarsal bones

These arches are mainly maintained by: sustentaculum tali long plantar ligament plantar calcaneonavicular ligament (spring ligament) plantar aponeurosis plantar muscles

Transvers plantar archs are mainly maintained by: plantar ligaments tendon of fibularis longus

Transvers plantar arches At the level of the distal tarsal bones At the level of the heads of the metatarsal bones:

tendon of tibialis posterior

: medial cuneiform bone intermediate cuneiform bone cuboid bone : The head of II-III metatarsal bonesSesamoid bonesmedial support The head of V metatarsal bonelateral support

Radiological anatomy of the foot

A-E: Toes 1-5. (A:Great toe) I-V. Metatarsals 1,3: Distal phalax 4: Middle phalax 2,5: Proximal phalax 6. Interphalangeal joints 7. Metatarsophalangeal joints 8. Sesamoids 9. Head of metatarsal 10. Shaft (body) of metatarsal 11. Base of metatarsal 12. Cuneiforms 13. Navicular 14. Cuboid 15. Talus 16. Calcaneus 17. Tibia 18. Fibula 19. Tarsometatarsal joints 20. Transverse midtarsal joint

10. Arteries of the lower limb, anastomoses between the branches of the femoral artery. Arteries of the lower limb

anastomoses between the branches of the femoral artery An anastomosis in the upper part of the thigh, formed between; acetabular branch from the obturator artery (internal iliac artery ) inferior gluteal artery (internal iliac artery ) lateral femoral circumflex artery medial femoral circumflex artery 11. Venous and lymphatic drainage of the lower limb; clinical significance of the perforating veins. Venous drainage of the lower limb The main superficial veins : great saphenous vein begins on the medial side of the dorsal venous network (where it can be found for catheterization) In the femoral triangle, it pierces the cribriform fascia (at the saphenous opening) and the femoral sheath, ending in the femoral vein. Great saphenous vein begins on the lateral side of the dorsal venous network of the foot pierces the fascia of the popliteal fossa, and ends variably in the popliteal, great saphenous, or some muscular veins. small saphenous veins

The main deep veins : femoral vein & popliteal vein artery Most of the blood from the lower limb is returned by way of the deep veins.

Clinical significance of the perforating veins The superficial and deep veins are connected by perforating veins. An important series is found in the leg, where valves direct blood from superficial to deep veins. Muscular action, combined with the arrangement of the valves, is important in returning blood from the lower limb, and venous return is much reduced during quiet standing. Lymphatic drainage Lymphatic vessels of the lower limb are drained: superficial inguinal lymph nodes superficial inguinal lymph nodes deep inguinal lymph nodes external iliac lymph nodes popliteal lymph nodes deep popliteal lymph nodes efferents accompany the femoral blood vessels deep inguinal lymph nodes 12. Branches of the lumber plexus

Iliohypogastric n. Ilioinguinal n.

: skin innervation lower part of abdominal wall + gluteal region muscle innervation abdominal muscles : inguinal canal skin innervation external genital organ muscle innervation abdominal muscles

 Lateral cutaneous femoral n. : skin innervation anterolateral skin of the thigh Genitofemoral n. : genital branch spermatic cord femoral branch lacuna vasorumthigh skin innervation Inguinal ligamentskin Femoral n. : lacuna muscronervosathigh Anterior cutaneous femoral n. skin innervation anterior part of the thigh Muscular branches muscle innervation all extensors of the thigh + pectineus muscle Saphenus n. Femoral n. Adductor canalSaphenus vein skin innervation anteromedial part of the leg medial part of the foot Obturator n. : Obturator canal muscle innervation adductor muscles except pectineus muscle obturator externus skin innervation medial aspect of the thigh The anterior branch : in front of the adductor brevis The posterior branch: behind the adductor brevis 13. Branches of the sacral plexus. The branches of the tibial and common fibular (peroneal) nerves. Branches of the sacral plexus Sacral plexus - Sciatic plexus (L4-5, S1-3) - Pudendohaemorrhoidal plexus (S3-4) Superior gluteal n. grater sciatic foramen suprapiriform hiatus superior gluteal a. Inferior gluteal n. infrapiriform hiatus inferior gluteal a. Sciatic n. thigh flexor innervate

Branches of the tibial and common fibular nerves Sciatic nerve poplital fossa tibial nerve common fibular nerve Tibial n.

Common fibular n.

14. Sensory innervation of the skin of the lower limb.

15. Muscles of the hip. Supra- and infrapiriform foramina. Muscles of the hip

16. Subinguinal hiatus. Femoral canal. Subinguinal hiatus

The borders of subinguinal hiatus: Superior: inguinal lig inferior: iliopubic eminence, body and sup.ramus of pubis, pubic tubercle It is divided into 3 compartments or lacunae, so the contents from lateral to medial are : 1) Lacuna musculonervosa : femoral nerve & iliopsoas muscle & lat. femoral cutaneous n. 2) Lacuna vasorum : femoral artery & vein & femoral branch of genitofemoral n. 3) Lacuna lymphatica : it is common site of herniation and contains lymph nodes & lymphatic vessels. Femoral canal The borders of femoral canal: Anterior: inguinal ligament + fascia lata Medial: fascia of pectineus muscle Lateral: femoral vein This canal is the medial compartment of femoral sheath, however, femoral canal opens inferiorly to sapheneus hiatus and superiorly to abdominal cavity at the femoral ring (here clinically is important as a site of femoral hernia) femoral canal contains the lymphatic vessels & node of Rosenmuller.

17. Femoral triangle, adductor canal, popliteal fossa. Femoral triangle

The borders of the triangle: Superior: inguinal ligament Lateral: Sartorius muscle Medial: Adductor longus muscle Its floor is provided laterally by iliopsoas & medialy by pectineus muscle,The roof is formed by fascia lata Contains (from med to lat): Femoral vein Femoral artery Femoral nerve V A N

adductor canal

Vastoadductor lamina:
Pathway of saphenous nerve. it emerges behind covering the of

aponeurotic

adductor canal, it descends vertically along the medial side of the knee and pierces the Vastoadductor the lamina of

between sartorius

tendons

and

gracilis

muscles, then it becomes subcutaneous.

This canal is an aponeuretic canal which is about 10 cm length. It provides an intermuscular passage through which the femoral vessels pass to reach the popliteal fossa. The borders of adductor canal: Anterior: vasto-adductorial membrane & Sartorius muscle. Lateral: vastus medialis muscle Medial: Adductor longus & magnus muscle Note: This canal starts from inferior angle of femoral triangle and ends in the adductor hiatus. Contains: Femoral artery Femoral vein Saphenous nerve ( it is the largest cutaneus branch of femoral nerve ).

popliteal fossa

Popliteal fossa is a diamond-shaped space in the posterior surface of the knee joint. The borders of this fossa: Superolateral: Tendon of Biceps femoris m. Superomedial: Tendons of Semimembranosus & Semitendinosus muscle. inferiomedial and lateral: Medial & lateral heads of the Gastrocnemius muscle. The base of this fossa is made by: 1) Popliteal surface of femur 2) Posterior part of knee joint capsule. 2) Popliteus muscle Contents of it from superficial to deep: Tibial nerve & Common fibular (peroneal) nerve Lesser saphenous vein Popliteal vein Popliteal artery

18. Sectional anatomy of the thigh: fascial (osteofibrous) compartments, muscle groups, vessels and nerves.

Anterior muscle compartment /extensors of the thigh sartorius m. quadriceps femoris m. Medial muscle compartment /adductors of the thigh pectineus m. adductor longus m. adductor brevis m. adductor magnus m. gracilis m. Posterior muscle compartment / flexors of the thigh / ischiocrural mm. / hamstring mm. biceps femoris m. semitendinosus m. semimembranosus m.

19. Sectional anatomy of the leg (crus): fascial (osteofibrous) compartments, muscle groups, vessels and nerves.

Anterior muscles of the leg / extensor group tibialis anterior m. extensor hallucis longus m. extensor digitorum longus m. > peroneus tertius m. Lateral muscles of the leg / peroneal group peroneus / fibularis longus m. peroneus / fibularis brevis m. Posterior muscles of the leg / flexor group superficial muscles / calf muscles triceps surae m. gastrocnemius m. lateral head medial head soleus m. plantaris m. deep muscles / deep layer popliteus m. flexor digitorum longus m. tibialis posterior m. flexor hallucis longus m.

20. Topography of the medial and lateral malleolar regions. Topography of the medial malleolar regions

21. Dorsum of the foot: muscles, fasciae, tendons, tendon sheaths, vessels and nerves.

22. Sole (planta) of the foot: muscles, tendons, fasciae, compartments, vessels and nerves.

III. BONES, JOINTS AND MUSCLES OF THE TRUNK 1. The bones and joints of the thorax. The movements of respiration. Bones 1. sternum
Clavicular notch

2. Ribs

Joints
1) Costovertebral joint Type: Pivot joint synovial joint Movements: Elevation Depression 1. Joint of head of rib Surfaces: Articular facet of head of rib Sup. costal facet Inf. costal facet (intervertebral discs) Ligaments: Intra-articular Lig. (from intervertebral disc) Radiate Lig. *1st , 10th, 11th, and 12th ribs articulate with each thoracic vertebra. *2nd - 9th ribs articulate with two thoracic vertebrae (demifacet). 2. Costotransverse joint Surfaces: Articular facet of tubercle of rib Transverse process Ligaments: Lat. costotransverse Lig. Costotransverse Lig.

2) Sternocostal joints 1. 1st rib Type: Synchondrosis Movements: Some twisting

Surfaces: Sterna facet of 1st rib Costal facet of sternum 2. 2nd 7th ribs Type: Plane joint Diarthroses (synovial joints) Movements: Slightly gliding Surfaces: Sternal facet of 2nd to 7th ribs Costal facet of sternum 3) Interchondral joints Type: Synovial joints Movements: Very slight rotations Surfaces: Between 6th to 10th costal cartilages *Articulation between costal cartilages of 9th and 10th ribs is fibrous! 4) Manubriosternal joint Type: Symphysis (synchondrosis) Movements: No movement Surfaces: Manubrium Body of sternum * This joint is the level of the sternal angle.

5) Xiphisternal joint Type: Symphysis (synchondrosis) Movements: No movement Surfaces: Xiphoid process Body of sternum Ligaments: Xiphisternal ligament * This joint is the level of the diaphragm." **These joints often fuse and become synosteosis in older individuals. The movements of Respiration Inspiration Movements: The rib cage is elevated. The sternum moves to the superior-anterior direction. The diaphragm moves to downward. Using muscles: Ext. intercostal muscle Serratus post. sup. muscle Levator costarum Expiration Movements: The rib cage is depressed. The sternum moves to the inferior-posterior direction. The diaphragm moves upward. Using muscles: Int. intercostal muscle Innermost intercostal muscle Subcostalis Transverses thoracis Serratus post. inf. Muscle

2. The vertebral column: gross anatomy, syndesmology and X-ray anatomy. Gross anatomy of the vertebral column Features of the vertebrae Cervical vertebrae Quite small quadrangular body Vertebral foramen: wide, triangular Transverse foramina (only in cervical!!) : contain vertebral a. & v. Spinous process looks like tail of swallow Articular surfaces of zigapophyseal joints : Horizontal plane Spinous process of C7: tubercle, palpable Vertebral prominence * Atlas: does not have the body **Axis: Dense process (odontoid process) is the most specific structure Thoracic vertebrae Heart shape body Vertebral foramen: small, round Spinous process: position posteriorly, downward Its structure seems to be a roofing tile Articular surfaces of zygapophyseal joints: Frontal plane Four costal facets: two on the body(false) and two on the transverse process (true) Lumbar vertebrae Bean shape body Vertebral foramen: triangular, small Spinous process: big, wide, looks like ax Articular surfaces of zygapophyseal joints: Sagittal plane Openings of the vertebral column Canal for vertebral arteries [C1-C6] Contents: vertebral vessels Formed by: Foramina transversaria Vertebral canal Contents: spinal cord [C1 L2] Formed by: Proximal opening

 towards the foramen magnum Parts (segments) Vertebral foramina Sacral canal Side wards exits Intervertebral foramina > Contents: spinal nerves > Sup. vertebral notch + Inf. vertebral notch [C2-L5] > Ant. sacral foramina +Post. sacral foramina [Sacrum] Distal opening Curvatures Primary curvatures of vertebral column Kyphoses (pl.) Thoracic kyphosis Sacral kyphosis Secondary curvatures of vertebral column Lordoses (pl.) Cervical lordosis Lumbar lordosis *Scoliosis: deviation to either side of the median sagittal plane Syndesmoses of vertebral column Ligaments between the vertebrae >between occipital bone and 7thcervical vertebra Nuchal Lig. > between the vertebral bodies: Ant. longitudinal Lig. Post. longitudinal Lig. > between the vertebral arches: Ligamenta flava (yellow) > between the transverse processes: Intertransverse Lig. > between the spinous processes: Interspinous Lig. Supraspinous Lig.

X-ray anatomy 3. The muscles of the thorax. The intercostal space. The muscles of thethorax Pecorals, serratus anterior, subclavius, intercostal muscles External intercostals, internal intercostals, innermost intercostals, transversus thoracis, subcostalis, levator costarum Inner chest wall anteriorly: 1. Internal intercostals 2. Transversus thoracis 3. Sternocostal ligaments 4. Diaphragm is visible, too. Gross anatomy

Inner chestand abdominal wall posteriorly: 1. Subcostal muscles 2. Internal intercostal muscles 3. M. transversus abdominis 4. M. iliacus and psoas major are visible

Intercostal space The space formed by ribs, intercostal muscles, and costal grooves. There are 12 ribs on each side, so there are 11 intercostal spaces. 3 muscles create this space: Ext. intercostal muscles Int. intercostal muscles Innermost intercostal muscles Contents: 1) Intercostal veins 2) Intercostal arteries 3) Intercostal nerves the injection (pancture) will be operated just above the each rib!!

4. The diaphragm. Dome-shape muscle (dome-shaped musculofibrous septum). separates the thoracic cavity (heart, lungs & ribs) from the abdominal cavity. performs an important function in respiration: as the diaphragm contracts, the volume of the thoracic cavity increases and air is drawn into the lungs. Origins and insertion Part Sternal part Costal part Lumbar part Origin Xiphoid process lower six ribs Medial & lateral lumbocostal arches (= arcuate ligament). L1-3 vertebrae for the right crus, L1-2 vertebrae for the left crus.

Sternocostal triangle lumbocostal triangle Insert into central tendon Innervation The diaphragm is primarily innervated by the phrenic nerve which is formed from the cervical nerves C3, C4, and C5. (A useful mnemonic to remember this is, "C-3, 4, 5 keep the diaphragm alive.") central portion of the diaphragm : sends sensory afferents via the phrenic nerve peripheral portions of the diaphragm : send sensory afferents via the intercostal nerves crus (singular), crura (plural) One of the diaphragms origins. The crura are tendinous in structure, and blend with the anterior longitudinal ligament of the vertebral column. right crus (L1-3) left crus (L1-2) Medial arcuate ligament (medial lumbocostal arch) L1 passes over psoas muscle Lateral arcuate ligament (lateral lumbocostal arch) L1 rib12 passes over quadratus lumborum

5. The topography of the thoracic cavity, structure of the thoracic wall, the projection of the thoracic organs onto the surface. Topography of thoracic cavity Filled laterally by the lungs - each lying in its pleural cavity Space between the pleural cavities = mediastinum Heart (lying in its pericardial sac) Great vessels Oesophagus Trachea Thymus Thoracic duct and other major lymph trunks Lymph nodes Phrenic and vagus nerves Thoracic wall Layers: I. Skin II. Serratus anterior & fascia III. external thoracic fascia IV. Muscles external & internal intercostal muscles V. Endothoracic fascia

The profection of the thoracic organs onto the surface

6. The anatomy, blood supply and lymphatic drainage of the female breast. Blood supply comes from the axillary artery (through the lateral thoracic a.) internal thoracic a. (through the perforating branchs)

Lymphatic drainage
I. - Nodi laterales - Nodi subscapulares - Nodi pectorales - Nodi paramammarii II. - Nodi centrales - Nodi interpectorales III. - Nodi apicales - Nodi parasternales

7. The broad muscles of the abdominal wall; the rectus abdominis muscle and the rectus sheath. 1. Skin 2. Subcutaneous Tissue -Camper's fascia (fatty layer) -Scarpas fascka (membranous layer) -Superficial arteries, veins and lymphatic vessels 3. Muscles and Deep fasciae 4. Fascia transversalis 5. Peritoneum

Muscles of abdominal wall

Anterior -rectus abdominis m. -pyramidalis m. Lateral -External obliqe m. -internal obliqe m. -transversus abdominis m. psoterior -quadratus lumborum m. -iliacus m. -psoas major m. -psoas minor m.

8. The muscles of the posterior abdominal wall and the deep muscles of the back. Muscles of the posterior abdominal wall

psoterior -quadratus lumborum m. -iliacus m. -psoas major m. -psoas minor m.

Deep muscles of the back M. erector spinae: 1. M. iliocostalis 2. M. longissimus 3. M. spinalis

 TL: thoracolumbar fascia V: vertebra R: rib P: psoas major Q: quadratus lumborum 1: iliocostalis 2: longissimus 3: spinalis 4: semispinalis 5: multifidus 6: rotatores

9. Hernial canals on the anterior and posterior abdominal wall.

Inferior lumbar triangle and the superior lumbar triangle

IV. THE SKULL 1. The external base of the skull.

2. Anterior cranial fossa.

3. Middle cranial fossa.

4. Posterior cranial fossa.

5. The temporal bone. Characteristics: 1. Includes the bony parts of the external, middle and internal ears. 2. Forms the articular cavity of the temporomandibular joint. 3. Takes part in the formation of the zygomatic arch. 4. Take part of the base and the lateral wall of the skull. 5. Contains the carotid canal and facial canal. It developes from 4 parts: 1. Pars squamosa 2. Pars petrosa 3. Pars tympanica 4. Pars hyoidea ( derives from the post. part of the II. pharyngeal arch) Items of the pars squamosa: Mandibular fossa (Fossa mandibularis): articular cavity of the temporomandibular joint Articular tubercle (Tuberculum articulare): an elevation anterior to mandibular fossa and covered by cartilage. It has role in movements of temporomandibular joint. Processus zygomaticus: it connects with the zygomatic bone to form the zygomatic arch. Parts of the pars petrosa: A. Pyramid, that has a base, an apex and 3 surfaces. B. Pars mastoidea A. Items of the Pyramid: 1. Base: it take part in the formation of the lateral wall of the skull and gives rise to the pars mastoidea. 2. Apex: takes part in the formation of the base of the skull extending to the body of the sphenoid bone. 3. Items of the anterior surface: Impressio trigemini (Meckels fossa): located at the apex and contains the Gasserian ganglion (trigeminal ganglion). Hiatus of the canal of the greater petrosal nerve (hiatus canalis nervi petrosi majoris): opening of the canal of the greater petrosal nerve (the first branch of the facial nerve). Hiatus of the canal of the lesser petrosal nerve (hiatus canalis nervi petrosi minoris): opening of the canal of the lesser petrosal nerve ( from glossopharyngeal nerve). Groove of the greater petrosal nerve (sulcus nervi petrosi majoris). Groove of the lesser petrosal nerve (sulcus nervi petrosi minoris).

 Sphenopetrosal synchondrosis: Fibrocartilaginous joint between the greater wing of the spenoid bone and the petrous bone. Foramen lacerum: irregular opening at the apex of the petrous bone filled with fibrous cartilage through which the greater and lesser petrosal nerves leave the cranial cavity. 4. Items of the posterior surface: Internal acustic meatus (meatus acousticus internus): connects the posterior cranial fossa with the internal ear. It contains: - Vestibulocochlear nerve - Facial nerve Sulcus sinus petrosi superioris: Lies along the superior margin of petrous bone containing the superior petrous sinus. Sulcus sinus petrosi inferioris: Along the junction of the petrous bone (pyramid) and occipital bone (petrooccipital synchondrosis) containing the inferior petrosal sinus. 5. Items of the inferior surface: Styloid process / Processus styloideus (pars hyoidea) Stylomastoid foramen (Foramen stylomastoideum) Jugular notch (incisura jugularis) - It forms the number 8-shaped jugular foramen with the jugular notch of the occipital bone. The jugular foramen contains the IX., X., XI. cranial nerves. Carotid canal (canalis caroticus): Bony canal of the internal carotid artery. Its external opening is located anteromedially to the jugular fossa. B. Items of the pars mastoidea: Mastoid process (processus mastoideus) Groove for the sigmoid sinus (Sulcus sinus sigmoidei) : ends at the jugular foramen where the internal jugular vein starts as direct continuation of the sigmoid sinus. Pars tympanica: Meatus acousticus externus (it joins the cartilaginous part of the ext. acoustic meatus, its internal opening is closed by the tympanic membrane) Porus acousticus externus ( external opening of the bony external acoustic meatus) Fissura petrotympanica (Glaserss fissure) : Deep fissure between the petrous and tympanic parts leading into the tympanic cavity. It contains the chorda tympani (facial nerve) leaving the tympanic cavity and entering the infratemporal fossa. Anterior to the petrotympanic fissure the petrosquamous fissure is found that leads into the cranial cavity.

6. The frontal bone. The ethmoid bone. Norma frontalis et lateralis: radiological anatomy of the skull. Frontal bone
Squama frontalis: Coronal suture (Sutura coronalis): between the two parietal bones and the frontal bone. Temporal surface (Facies temporalis): it takes part in the formation of the temporal fossa. Zygomatic process (Processus zygomaticus): connects with the zygomatic bone. Frontal tuber (Tuber frontale): ossification centres in the embryonic life. Supraorbital margin (Margo supraorbitalis): superior border of the aditus orbitae. Superciliary arch (Arcus superciliaris): bony ridge just above and paralleling the supraorbital margin. Glabella: very slight protuberance between the superciliary arches. Supraorbital foramen (Foramen supraorbitale / incisura supraorbitalis): opening or notch on the inner third of the supraorbital margin containing the supraorbital vessels and nerve. Frontal notch (Incisura frontalis / foramen frontale): notch or foramen on the inner third of the supraorbital margin medially to the supraorbital foramen containing the frontal vessels and nerve. Frontal crest (Crista frontalis): bony ridge on the inner surface of the squama for the fixation of the cerebral falx. Foramen cecum: blind opening at the root of the frontal crest , but in childhood an emissary vein passes through it. Groove for the superior sagittal sinus (Sulcus sinus sagittalis superioris): contains a potion of the superior sagittal sinus. Grooves of the anterior meningeal artery (Sulcus arteriae meningeae anterioris): they contain the branches of the anterior meningeal artery.

Orbital parts (Partes orbitales): form a part of the roof of the orbit. Ethmoidal notch (Incisura ethmoidalis): a notch separating the two orbital parts. Ethmoidal foveolae (Foveolae ethmoidales): small depressions along the two sides of the ethmoidal notch that take part in the formation of some ethmoidal air-cells. Anterior and posterior ethmoidal foramina (Foramina ethmoidalia anterius et posterius): openings of the anterior and posterior ethmoidal canals at the junction of the orbital part of the frontal bone and the orbital lamina of the ethmoidal bone, containing the ant. and post. ethmoidal vessels and nerves. Fossa of the lacrimal gland (Fossa glandulae lacrimalis): contains the lacrimal gland. Trochlear spine (Spina trochlearis): small bony hook for the attachment of the tendon of the superior obliquus bulbi muscle. Impressiones digitatae: they are visible on the cerebral surface and the frontal gyri lie in them. Juga cerebralia: small elevations having the sulci separating the frontal gyri just lying on them. Nasal part(Pars nasalis):connects anteriorly the two orbital parts. Nasal spine (Spina nasalis): small bony spine connecting with the nasal bones. Frontal sinus (Sinus frontalis): paranasal sinus in the squama, having its opening on the two sides of the nasal spine

Ethmoid bone
Perpendicular plate (Lamina perpendicularis) : it forms the bony nasal septum with the vomer. Crista galli: it is the process of the perpendicular plate projecting upwards, that involved in the fixation of the cerebral falx. Cribriform plate (Lamina cribrosa) : horizontal perforated lamina through which the olfactory fila and the anterior ethmoidal vessels and nerve pass. Ethmoidal labyrinth (Labyrinthus ethmoidalis) / Ethmoidal air-cells (Cellulae ethmoidales) : they belong to the paranasal sinuses and open into the nasal cavity.They are divided anterior, middle and posterior groups of the air-cells. Orbital lamina (Lamina orbitalis / lamina papyracea): it is a very thin bony lamina closing the ethmoidal labyrinth on the orbital side. Anterior and posterior ethmoidal canals (Canales ethmoidales anterior et posterior): they are formed by the frontal bone and the orbital lamina, containing the anterior and posterior ethmoidal vessels and nerves. Superior nasal concha (Concha nasalis superior): bony process projecting into the nasal cavity and closing the posterior ethmoidal air-cells on their nasal side. Below the superior nasal concha the superior nasal meatus is located. Middle nasal concha (Concha nasalis media): bony process projecting into the nasal cavity below the superior nasal concha and meatus, and closing the anterior ethmoidal air-cells on their nasal side. Below the middle nasal concha the middle nasal meatus is located.

Ethmoidal bulla (Bulla ethmoidalis): largest anterior ethmoidal air-cell above the semilunar hiatus. Uncinate process (Processus uncinatus): hooklike process below the semilunar hiatus. Semilunar hiatus (Hiatus semilunaris): semilunar opening bordered superiorly by the ethmoidal bulla and inferiorly by the uncinate process through which the the frontal sinus, anterior and middle ethmoidal air-cells and maxillary sinus open into the middle nasal meatus. Ethmoidal infundibulum (Infundibulum ethmoidale):funnel-shaped canal passing through the ethmoidal labyrinth from the semilunar hiatus connecting the frontal sinus and anterior ethmoidal air-cells with the middle nasal meatus.

Norma frontlis et lateralis

Radiological anatomy of the skull

7. The occipital and the parietal bones. Sutures and fontanelles.

Occipital bone Foramen magnum Sphenooccipital synchondrosis (Synchondrosis sphenooccipitalis) Petrooccipital synchondrosis (Synchondrosis petrooccipitalis) Pars basilaris: Clivus Pharyngeal tubercle (Tuberculum pharyngeum) Groove for the inferior petrosal sinus (Sulcus sinus petrosi inferioris) Partes laterales: Jugular tubercle (Tuberculum jugulare) Hypoglossal canal (Canalis hypoglossi) Jugular notch (Incisura jugularis) Intrajugular process (Processus intrajugularis) Groove for the sigmoid sinus (Sulcus sinus sigmoidei) Condylar fossa (Fossa condyloidea) Occipital condyles (Condyli occipitales) Squama occipitalis: External occipital protuberance (Protuberantia occipitalis externa) Internal occipitalis protuberance (Protuberantia occipitalis interna) External occipital crest (Crista occipitalis externa)

Internal occipital crest (Crista occipitalis interna) Groove for the superior sagittal sinus (Sulcus sinus sagittalis superioris) Groove for the transverse sinus (Sulcus sinus tansversi) Groove for the sigmoid sinus (Sulcus sinus sigmoidei) Cerebellar fossa (Fossa cerebellaris) Cerebral fossa (Fossa cerebralis) Parietal bone Sutures: 1. Sutura lambdoidea: between occipital squama and parietal bones. 2. Sutura coronalis: between parietal bones and frontal bone. 3. Sutura squamosa: between squamous part of the temporal bone and the parietal bone on both sides. 4. Sutura sagittalis: between parietal bones. Items of the internal (cranial) surface: Groove for superior sagittal sinus (Sulcus sinus sagittalis superioris): It contains the superior sagittal sinus (venous sinus) and continues onto the frontal and occipital bones. Granular foveolae (Foveolae granulares): irregular depressions along the sulcus sinus sagittalis superior containing the arachnoidal granulations ( small processes of the arachnoid involved in the drainage of the cerebrospinal fluid.) Arterial sulci (Sulci arteriosi): they contain branches of the meningeal arteries and continue onto the frontal and temporal bones. Item of the external surface: Tuber parietale: ossification centre in the embryonic life

Suture and fontanelles

1) Suture : the narrow separation between the bones of the skull : it will be ossified after the birth : there are 4 main sutures and 2 others 2) Fontanelle : the structure can be seen at points where more than 2 bones meet, sutures are wide : there are 4 fontanelles Anterior fontanelle Bregma Sagittal suture Coronal suture Squamous suture Lamboid suture Frontal suture Glabella Nasion: suture between nasal bones

Posterior fontanelle Lambda Sphenoidal fontanelle Pterion Mastoid fontanelle Asterion

8. The sphenoid bone.

9. The bony nasal cavity. The paranasal sinuses. Nasal cavity The 2 nasal cavities are the uppermost parts of the respiratory tract and contain the olfactory receptors. The anterior apertures of the nasal cavities are the nares. The posterior apertures are the choanae, which open into the nasopharynx.

Bony nasal cavities: 1. Ethmoid bone 2. Inferior nasal concha 3. Nasal bone 4. Maxilla 5. Palatine bone 6. Sphenoid bone 7. Frontal bone 8. Lacrimal bone 9. Vomer

Lateral wall: It is characterized by 3 curved shelves of bone (conchae). *Chonchae : 3 curved shelves of bone and characterize the lateral wall of nasal cavity. : divide each nasal cavity into four air channels Inferior nasal meatus between the inferior concha and the nasal floor Middle nasal meatus between the inferior and middle concha Superior nasal meatus between the middle and superior concha Spheno-ethmoidal recess between the superior concha and the nasal roof.

Paranasal sinuses Air-filled spaces, communicating with the nasal cavity, within the bones of the skull and face. Sineses have several biological role, such as > Decreasing the relative weight of the front of the skull > Humidifying and heating the inhaled air Types: 1. Frontal sinus 2. Maxillary sinus 3. Sphenoid sinus 4. Ethmoidal cells > Anterior: opens into the infundibulum > Middle: opens into the hiatus semilunaris > Posterior: opens into superior meatus *Nasolacrimal duct (tear duct) opens into the inferior meatus. : opens through the infundibulum into the middle meatus. : opens through the hiatus semilunaris into the middle meatus. : opens through its anterior wall into the spheno-ethmoidal recess.

10. The mandible and the maxilla.

Mandible Body (Corpus mandibulae): Base of the mandible (Basis mandibulae) Alveolar part (Pars alveolaris) Alveolar arch Dental alveoli (Alveoli dentales) Interalveolar septa (Septa interalveolaria)

Interradicular septa (Septa interradicularia) Mental protuberance (Protuberantia mentalis) Mental foramen (Foramen mentale) Mandibular canal (Canalis mandibulae) mental a. & n. Mental spine (Spina mentalis) Sublingual fovea (Fovea sublingualis) sublingual gland Digastric fossa (Fossa digastrica) digastricus muscle Mylohyoid line ( Linea mylohyoidea) mylohyoideus muscle Angle of the mandible (Angulus mandibulae): Masseteric tuberosity (Tuberositas masseterica) Pterygoid tuberosity (Tuberositas pterygoidea) Ramus mandibulae: Condylar process (Processus condylaris) Head of the mandible (Caput mandibulae) Neck of the mandible (Collum mandibulae) Coronoid process (Processus coronoideus) Mandibular notch (Incisura mandibulae) Mandibular foramen (Foramen mandibulae) Mandibular canal (Canalis mandibulae): inferior alveolar a. & n. Lingula of mandible (Lingula mandibulae) Mylohyoid sulcus (Sulcus mylohyoideus) for mylohyoid nerve Maxilla Body (corpus maxillae): Anterior surface: Infraorbital margin (Margo infraorbitalis) Infraorbital foramen (Foramen infraorbitale) Infraorbital canal (canalis infraorbitalis) Canalicules originating from infraorbital sulcus (supply of middle-superior teeth), canalicules originating from infraorbital canal ( supply of anteriorsuperior teeth) Inferior orbital fissure (Fissura orbitalis inferior):infraorbital a. & n., zygomatic n. Canine fossa (Fossa canina) Orbital surface (Facies orbitalis / superior): Inferior orbital fissure (Fissura orbitalis inferior) Infraorbital sulcus(Sulcus infraorbitalis) Infratemporal surface (Facies infratemporalis/ posterior): Pterygomaxillary fissure (Fissura pterygomaxillaris) Tuber maxillae

Alveolar foramina (Foramina alveolaria) Alveolar canals (Canales alveolares) Nasal surface (Facies nasalis): Maxillary hiatus (Hiatus maxillaris) (sinus maxillaris / Highmore sinus Nasolacrimal canal (Canalis nasolacrimalis) Frontal process (Processus frontalis): Anterior lacrimal crest (Crista lacrimalis anterior) Zygomatic process (Processus zygomaticus) Alveolar process (Processus alveolaris): Superior alveolar arch (Arcus alveolaris superior) Dental alveoli (Alveoli dentales) Interalveolar septa (Septa interalveolaria) Interradicular septa (Septa interradicularia) Juga alveolaria Piriform aperture (Apertura piriformis) Palatine process (Processus palatinus): Median palatine suture (Sutura palatina mediana) Transverse palatine suture (Sutura palatina transversa) Nasal crest (Crista nasalis) Anterior nasal spine (Spina nasalis anterior) Incisive bone (Os incisivum) Incisive suture (Sutura incisiva) Incisive canal (Canalis incisivus) Incisive foramen (Foramen incisivum)

11. The orbit. The hard palate. Orbit Bones: Maxilla Zygomatic bone Frontal bone Ethmoid bone Lacrimal bone Sphenoid bone Palatine bone

Hard palate It separates the oral cavity from the nasal cavities. It consists of a bony plate covered above and below by mucosa. Posteriorly, it is continuous with the soft palate. Bones: Maxilla (ant. 3/4) Palatine bones (post. 1/4) Features: Incisive fossa (on maxilla) Incisive papilla Palatine raphe Trv. palatine folds (palatine rugae)

12. Functional anatomy of the temporomandibular joint.

Temporomandibular joint Type: Ginglymoarthroidal joint (Hinge + Plane joints) Discontinuous joint; synovial joint Movements: Elevation Depression of the mandible Protraction Retraction Mastication Surfaces: Mandibular fossa of the temporal bone Head of the mandible (= condylar process) Ligaments: Temporomandibular lig. Outer oblique portion Inner horizontal portion Stylomandibular lig. Sphenomandibular lig. Accessory components: Articular disc Articular capsule

13. Functional anatomy of the atlantooccipital and atlantoaxial joints.

Atlantooccipital joint Type: Ellipsoid joint (Condylar joint) Discontinuous joint; synovial joint Movements: Lateral flexion (sagittal axis) : sideways bending tilting of the head Anteflexion Retroflexion (horizontal axis) : forward and backward movements

Surfaces: Occipital condyles of skull Sup. articular surfaces of the atlas Ligaments: Ant. atlanto-occipital membrane Post. atlanto-occipital membrane Atlantoaxial joints Type: Pivot joint (Trochoid joint) Discontinuous joint; synovial joint Movements: Rotations (vertical axis): It occurs when rotating the head to indicate disapproval. I. Median atlanto-axial joint Type: Pivot joint Surfaces: Ant. part: facet for dens of atlas + ant. articular facet of the dens Post. part: post. articular facet of the dens + transverse Lig. of the atlas Ligaments: Alar Lig. Apical Lig. of dens Cruciate Lig. of atlas Longitudinal bands Transverse Lig. of atlas Tectorial membrane II. Lateral atlanto-axial joint Type: Plane joint (Amphiarthrosis) Surfaces: Inf. articular facet of the atlas Sup. articular facet of the axis

V. CYTOMORPHOLOGY AND THE BASIC TISSUES 1. General description and types of epithelial tissue.

General desctiption of epithelial tissue [Covering epithelium] Simple squamous cuboid columnar Psudostratified columnar Ductus epididymidis (stereocilia) Ductus deferens ( ) Bronchioles (kinocilia) Auditory tube ( )

epithel, capillary endothel, mesothel (peritoneum) thyroid gland intestine (brush border), oviduct (ciliated)

Stratified squamous Keratinized skin Non-keratinaized esophagus cuboid columnar Transitional [Glandular epithelium] Unicellular Multicellular goblet cell Endocrine Exocrine - melocrine - apocrine - holocrine sweat gland conjunctiva

renal pelvis, urinary bladder (umbrella cell)

[Sensory epithelium] [Pigmented epithelium]

2. General description and types of connective tissue. Connects, holds, and supports other body tissues. Parts of the connective tissue: Cells Extracellular matrix (ECM) Cell of connective tissue

Frozen section, Sudan

ECM of connective tissue Fibers collagen fiber eosin reticular fiber silver impregnation, PAS elastic fiber orcein, Resorcin-fuchsin microfibrils

Amorphous material amouphos : GAG and proteoglycans Adhesion molecules (tight junction, desmosome, gap junction, connexon) Types of connective tissue Loose connective tissue Every where. Fiber 3 (more fibers, less cells)

Dense connective tissue Irregular

Regular tendon, ligament (collagen fiber) skin, dermis (collagen fiber)

Specialized connective tissue adipose fat. energy storage. reticular spleen, lymph node (reticular cell)

3. Types and structure of cartilage. Collagen fiber & elastic fiber ground substance chondroitin sulfate embedded Hyaline cartilage Fibrocartilage Elastic cartilage joint

knee meniscus, vertebral disk eternal ear, nose flexible

Chondron historogical basic unit. Composed of - chondrocyte - lacuna - extracellular matrix

lacunacondron

4. Structure of bone tissue: the cells and the extracellular matrix. Histogenesis of bone. Types of ossification. The cells and the extracellular matrix cells osteoprogenitor cell osteoblast osteocyte osteoclast extracellular matrix inorganic substances hydroxyapatite crystals amorphous substances type I collagen fibers Histogenesis of bone Primary angiogenic ossification Oosteoblasts are deposited directly from the blood vessels, without any previous connective tissue or cartilage. It occurs only in special situations e.g.: after extraction of a tooth processes in canaliculi [plural] phagocytotic cells / phagocytes derived from mesenchymal cell

Secondary ossification Intramembranous ossicication Replacement of sheet-like connective tissue membranes with bony tissue. e.g.: skull Endochondral ossicication Replacement of hyaline cartilage with bony tissue. Most of the bones of the skeleton are formed in this manner. the future bones are first formed as hyaline cartilage models.

> anatomical structure compact bone / cortical bone (substantia compacta) spongy bone / cancellous bone (substantia spongiosa) medullary cavity / marrow space > microscopic structure - periosteum - outer circumferential lamellae - osteon > basic histological unit > special laminae > Haversian canal / canal of Havers > Volkmann's canal > interstitial lamellae > internal general laminae > endosteum

5.

General description and types of muscle tissue.

n u cl eu s co n tracti on q u i ck + stro n g vo l u n tary q u i ck + stro n g i n vo l u n tary sl o w + w eek i n vo l u n tary stri ati on sp eci al stru ctu re b i fu cati on i n tercal ated d i sk Y Y gap j u n cti on m yo fi b ri l s d en se b o d y

S kel etal m .

m ul ti p eri p h ery

C ari ac m .

u n i cen tral l y

sm o o th m .

uni

6.

Light and electron microscopic structure of the neuron; electron microscopic structure of the interneuronal synapsis.

Neuron Structure: Cell body (soma, perikaryon) Contains the nucleus and other cell organelles Basophilic granular areas called Nissl bodies Dendrites Receive stimuli from sensory cells, axons, or other neurons Convert these signals to small electric pulses Axon conducts impulses away from the cell body to axon terminals axolemma: plasma membrane of axon, axoplasm: contents of axolemma Classifications: 1) Morphologic classification: Unipolar neuron: single process Bipolar neuron: single axon, single dentrite Multipolar neuron: single axon, many dentdrites Pseudounipolar neuron : single process extend from cell body 2) Functional classification: Sensory neuron: receives stimulations from environment and conducts impulses to CNS. Motor neuron: conducts impulses from CNS to PNS. Interneurons: connects other neurons. 7. Light and electron microscopic structure of the glial cells glial cells / neuroglia > not polarized > "take care of" the neurons > may modify the operation of the nerve cells branch to axon and dendrite

types of glial cells according to their major functions, procceses and location peripheral neuroglia (glial cells in the peripheral nervous system) > Schwann cell > satellite cell central neuroglia (glial cells in the central nervous system) > microglial cells - oligodendroglial cell - microglia of Hortega / mesoglial cell > macroglial cells - astrocytes - fibrous astrocyte - protoplasmic astrocyte > ependymal cell / ependymocyte