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) ：spongy bone

- Metaphysis (diaphysis と epiphyses が合わさるところ )- Diaphysis (shaft) ：compact bone (bone marrow がある) から成る。

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.

ぴったり合う

A r thrology （関節学） / general 同 じ

syndesmology （靭帯学）⇒　 study of joint

Solid joint / Synarthroses（不動結合）

Ⅰ. Syndesmosis（靭帯結合） / fibrous joint

：結合組織の fiber が骨をつないでいる。

・interosseal membrane

・suture (plain, squamous suture, sagittal suture)

・syndesmosis tibiofibularis（足首側）

・syndesmosis coracoclavicularis

・peg-and-sochet / gomphosis（歯の fixation）

Ⅱ. Synchondrosis（軟骨結合） / cartilaginous joint

　：cartilage（軟骨）が骨の間を埋めている。

　　 Temporary

・Epiphysial plate（骨端板）: Hyaline cartilage

・Spheno-occipital synchondrosis： Hyaline cartilage

Constant

・Intervertebral disc：Fibrocartilage

・Symphysis：Fibrocartilage

Ⅲ. Synostosis

　：骨の ossification（骨化）

・Epiphysial plate = Epiphysical disc（骨端板）

・Spheno-occipital synchondrosis

・Hip bone

・Sacrum

Synovial joint / Diarthroses（可動関節）

Ⅰ. Uniaxial joints

・Hinge or ginglimus joint

・Pivot or trochoid joint

Ⅱ. Biaxial joints

・Ellipsoidal joint

・Saddle or sellar joint

Ⅲ. Multiaxial joint

・Ball-and socket or spheroidal joint

Ⅳ. Plain joint

Ⅴ. Condylar joint

Ligament ：靭帯Cartilage ：軟骨Tendon ：腱

Symphysis：（繊維軟骨）結合。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

両 方 の

amphiarthrosis

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

regeneration of muscles

Types of muscles

nucleus contraction striation special structure

Skeletal m. multi periphery（ ） quick + strong・voluntary・ ＋ 省略

Cariac m. uni centrally（ ） quick + strong・involuntary・ ＋

bifucation・intercalated disk・Y Y gap junction（ と のつなぎ目。 ）

smooth m. unislow + week・involuntary・ ―

myofibrils・ がクロスしている。dense body・

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.) ：innervated by somatic NS

- Involuntary (cardiac m., smooth m.) ：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 ： acromial end of the clavicle ⇔ flat articular surface of the acromion

Type of joint ： Synovial joint → plane joint

Additional component：Facets are coverd by fibrocartilage and articular disc is often found.

Ligaments ：Acromioclavicular ligament

Coracoclavicular ligament

Coracoacromial ligament

Movements　　　　：clavicle の動きは scapula と連動する。Scapura の動きは humerus と shoulder の joint と連動する。

2. Stenoclavicular joint

Articular surcaces ： sternal end of the clavicle ⇔ clavicular notch of sternum

Type of joint ： Synovial joint → limited ball and socket joint

Additional component：Facets are covered by fibrocartilage and the joint is completely

divided 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

5. The gross and radiological anatomy and movements of the shoulder joint and the

participating muscles. The rotator cuff.

Shoulder joint

Articular surcaces ： glenoid cavity ⇔ head of humerus

Type of joint ： Synovial joint → ball and socket joint

Additional component：glenoid labrum, fibrous capsule, bursae

Ligaments ：Glenohumeral ligament

Coracohumeral ligament

Movements　　　　：Flexion ⇔ extension

Abduction ⇔ adduction

Rotation

Circumduction

Movements of the shoulder joint

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 ： trochlea of the humerus ⇔ trochlear notch of the ulna

Type of joint ： Synovial joint → hinge joint

Additional component： ----------Ligaments ： ulnar collateral ligament

Movements　　　　： Flexion ⇔ extension

2. Humeroradial joint

Articular surcaces ： capitulum of the humerus ⇔ articular facet of the head of radius

Type of joint ： Synovial joint → ball and socket joint

Additional component： ----------Ligaments ： radial collateral ligament

Movements　　　　： Flexion ⇔ extension

3. Proximal radioulnar joint

Articular surcaces ： articular circumference of head of radius ⇔ radial notch of the ulna

Type of joint ： Synovial joint → pivot joint

Additional component： ----------Ligaments ： anular ligament

Movements　　　　： pronation ⇔ supination

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 ： Distal end of radius ⇔ scaphoid, lunate, triquetrum

Type of joint ： Synovial joint → elipsoid joint

Additional component： articular disc

Ligaments ： Movements　　　　： flexion ⇔ extessio

abduction ⇔ adduction

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

- abduction⇔adduction, opposition⇔reposition, slight rotation

・Metacarpophalangeal joint

- ellipsoid joint

- abduction⇔adduction, flexion⇔extension, rotation, circumduction

・Interphalangeal joint

- hinge joint

- flexion⇔extension

10. The anatomy, innervation and function of the spinohumeral and thoracohumeral

muscles.

Thracohumeral muscles

・Pectoralis major : pectoral n.

・Pectoralis minor : pectoral n.

・subclavius : subclavius n.

・serratus anterior : long thoracic n.

Spinohumeral muscles

・Trapezius ：accessory n.

・Levator scapulae ：dorsal scapular n.

・Romboid minor ：dorsal scapular n.

・Romboid major ：dorsal scapular n.

・latissimus dorsi ：thracodorsal n.

トランペットにアクセサリー、エレベーターでスカッとどうさ？

ロンボロンボでラテします？　そらこれどうさ？

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 : arch (arcade) anastomosis

2. Collateral anastomoses : around large joints

3. Venous anastomoses : connecting superficial and deep veins

4. Arteriovenous anastomoses : in capillaries.

12. The systemic circulation: the large branches of the aorta and the great veins.

13. The branches and anastomoses of the axillary artery.

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).

Hotel Spa

Thoracoacromial a.の 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. olfactory n. Nervus olfactorius （嗅） cribriform plate

II. optic n. Nervus opticus （視） optic canal

III. oculomotor n. Nervus oculomotorius （動眼） superior orbital fissure

IV. trochlear n. Nervus trochlearis （滑車） superior orbital fissure

V. trigeminal n. Nervus trigeminus （三叉）

-V/ 1 opthalmic n. Nervus opthalmicus superior orbital fissure

-V/ 2 maxillary n. Nervus maxillaris foramen rotundum

-V/ 3 mandibular n. Nervus mandibularis foramen ovale

VI. abducens n. Nervus abducens （外転） 「アブドゥ、センス！」 superior orbital fissure

VII. facial n. Nervus facialis （顔面） 7は顔。 internal acoustic meatus → facialcanal → stylomastoid foramen

VIII. vestibulocochlear n. Nervus vestibulocochlearis（内耳） 「ベス血風呂、告れや！」 internal acoustic meatus

IX. glossopharyngeal n. Nervus glossopharyngeus （舌咽） 9は苦しい。苦しくてグロッキー。

X. vagus n. Nervus vagus （迷走） 「ベガスで迷って走った。」

XI. accessory n. Nervus accessorius （副）

XII. hypoglossal n. Nervus hypoglossus （舌下） 舌の下 hypoglossal canal

sphenoid bone

’ 嗅いでみる動く車の三つの外 temporal bone

’顔を耳に近づけて舌を迷わす副の下 (J agular foramen occipital bone )は も半分関わっているけど。

foramen spinosum・

foramen lacerum・

external acoustic meatus・

J agular foramen

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)

※サマリー

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 16-18※ th 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

Diameter of the pelvis

I. External diameter of the pelvis

Interspinous diameter① : 25-26 cm

Intercristal diameter② : 28-30 cm

External conjugata③ : 20 cm (＜ 18 cm Section caesare?)

(Baudeloque’s diameter : ボドロック径)

II. Internal diameter of the pelvis

Transverse diameter of pelvic inlet① : 13.5 cm

Oblique diameter of pelvic cavity② : 13.5 cm

A-P(sagittal) diameter of pelvic outlet③ : 11-12 cm

Babies rotate their head during delivery to fit their fronto-occipital axis to the widest diameter at ※

each point.

Pelvic inlet　　　　　　　　 　 Pelvic cavity Pelvic outlet

Transvers diameter ⇒　　　Oblique diameter ⇒　　　Sagittal diameter

13.5 cm 　 13.5 cm 12 cm

Greater pelvis

Lesser pelvisTerminalline

Sacral promontarySacroiliac joint

Conjugata diameter of pelvic inlet ( <11cm Section caeare? )

transverse diameter of pelvic inlet

Oblique diameter of pelvic inlet

Pubic symphysis

Pubic arch

Ililpubic eminence

Ischial spine

Ischial tuberosity

Pelvic inlet

Pelvic outlet

Pelvic cavity

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

pelvis.

Joints of pelvis

Sacroiliac joint

Articular facets : Sacrum & Ilium

Type of joint : Synovial joint → Plane joint

Additional component : The articular surfaces are covered by fibrocartilages

ligaments : Interosseous sacroiliac ligament

Anterior / Ventral sacroiliac ligament

Posterior / Dorsal sacroiliac ligament

Movement : Small anteroposterior rotation

Pubic symphysis (hemidiarthrosis)

Articular facets : between pubis

Type of joint : Solid joint (Synarthrosis) → Synchondrosis

Additional component : Interpubic disc（＋articular surface が fibrocartilage でカバーされてる）

ligaments : Superior pubic ligament

Arquate (Inferior) pubic ligament

Movement : 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 ligament①

Lumbosacral ligament②

II. Sacroiliac joint

Anterior sacroiliac ligament③

Interosseous sacroiliac ligament④

Posterior sacroiliac ligament⑤

III. Pubic symphysis

Superior pubic ligament⑥

Arquate (Inferior) pubic ligament⑦

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.

その他、Proper ligaments Sacrospinous ligaments⑧ Sacrotuberous ligaments⑨ Obturator membrane⑩ Inguinal ligament (POUPART)⑪ Transverse acetabular ligament⑫

Radiological anatomy of the pelvis

1. Lateral part of the sacrum 12. Pubic tubercle

2. Gas in colon 13. Lesser trochanter

3. Ilium 14. Neck of femur

4. Sacroiliac joint 15. Greater trochanter

5. Ischial spine 16. Head of femur

6. Superior ramus of pubis 17. Acetabular fossa

7. Inferior ramus of pubis 18. Anterior inferior iliac spine

8. Ischial tuberosity 19. Anterior superior iliac spine

9. Obturator foramen 20. Posterior inferior iliac spine

10. Intertrochanteric crest 21. Posterior superior iliac spine

11. Pubic symphysis 22. Iliac crest

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

muscles.

Hip joint

Articular facet : Acetabulum of the hip bone (lunate surface) → head of femur

Type of joint : Synovial joint → Ball and socket joint (multi-axial joint)

Additional component : Acetabular labrum (fibrocartilage)

Fibrous capsule

Ligaments : 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 (Bertini’s ligament)

・Ischiofemoral ligament

・Pubofemoral ligament

Movements : Flexion (60°) ⟷ Extension (5-15°)

Abduction ⟷ Adduction

Medial rotation ⟷ Lateral rotation

Circomduction

Movement and the participating muscles of hip joint

Zona orbicularis

Acetabula labrum

Rotator1.piriformis2.obturator externus3.obturator internus4.gemellus superior5.gemellus inferior 6.quadratus femoris

Adductor1.addctor magnus2.adductor brevis3.adductor longus4.pectineus5.gracilis

Abductor1.gluteus minimus2.gluteus medius3.tensor fasciae latae

Flexor1.iliacus2.psoas major3.rectus femoris4.sartorius

Extensor1.biceps femoris2.semimembranosus3.semitendinosus4.gluteus maximus

Radiological anatomy of the hip joint

1. Anterior superior iliac spine2. Ilium3. Anterior inferior iliac spine4. Arcuate line5. Acetabular fossa6. Head of femur7. Fovea of ligament of head8. Superior pubic ramus9. Obturator foramen10. Inferior pubic ramus11. Pubic symphysis12. Ischium13. Lesser trochanter14. Intertrochanteric crest15. Greater trochanter16. Neck of femur

Piriformis 　 external rotation 　 abduction 　 extension

Obturator externus 　 external rotation adduction 　 　 　

Obturator internus 　 external rotation adduction 　 　 extension

Gemellus superior 　 external rotation adduction 　 　 extension

Gemellus inferior 　 external rotation adduction 　 　 extension

Quadratus femoris 　 external rotation adduction 　 　 　

Adductor magnus 　 external rotation adduction 　 　 extension

Adductor brevis 　 　 adduction 　 flexion 　

Adductor longus 　 　 adduction 　 flexion 　

Pectineus 　 external rotation adduction 　 flexion 　

Gracilis 　 　 adduction 　 flexion 　

Gluteus minimus 　 　 　 abduction 　 　

Gluteus medius 　 　 　 abduction 　 　

Tensor fasciae latae internal rotation 　 　 abduction flexion 　

Iliacus 　 external rotation 　 　 flexion 　

psoas major & minor 　 external rotation 　 　 flexion 　

Rectus femoris 　 　 　 　 flexion 　

Sartorius 　 external rotation 　 abduction flexion 　

Biceps femoris (long head) 　 　 　 　 　 extension

Semimembranosus 　 　 　 　 　 extension

Semitendinosus 　 　 　 　 　 extension

Gluteus maximus 　 external rotation 　 　 　 extension

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 : Post. Surf. of lat. condyle of tibia ⇔ head of fibula

Type of joint : Synovial joint → plane joint

Additional component : ----------

ligaments : Anterior ligament of fibular head

Posterior ligament of fibular head

Movement : They permit gliding or slipping in any direction.

Crural interosseous membrane

（これもおそらく Syndesmosis）

Syndesmosis tibiofibularis

Articular facets : Fibular groove on tibia ⇔ fibula

Type of joint : Solid joint (Synarthrosis) → Syndesmosis

Additional component : ----------

ligaments : Anterior tibiofibular ligament

Posterior tibiofibular ligament

Movement : ----------

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

Knee joint

Articular facets 1 : Condyles of femur → Condyles of the tibia

Type of joint 1 : Synovial joint → Trochoginglymus joint (Pivot + hinge joint)

= Condylar synovial joint?

Articular facets 2 : Patellar surface of the femur → patella

Type of joint 2 : Synovial joint → saddle joint

Additional component : Meniscus, Bursae

Posterior crucial ligament

Posterior crucial ligament

前

右足内側

Lateral meniscus・O shape・More movable

Medial meniscus・C shape・Less movable・ Attached to the med.

Collateral lig.

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

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

1.

8.9

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. Femur2. Patella3. Medial epicondyle of femur4. Lateral epicondyle of femur5. Medial condyle of femur6. Lateral condyle of femur7. Intercondylar eminence8. Intercondylar fossa9. Knee joint10. Lateral condyle of tibia11. Medial condyle of tibia12. Tibia13. Fibula

1. Femur2. Lateral condyle of femur3. Medial condyle of femur4. Fabella*5. Patella6. Base of patella7. Apex of patella8. Intercondylar eminence9. Apex of head of fibula10. Fibula11. Tibia12. Tibial tuberosity*Fabella: sesamoid bone in the tendon of the (lateral head of) gastrocnemius muscle; anatomicalvariant 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 : trochlea of the talus ⇔

inf. Articular surface of the tibia + tibial and fibular malleolus

Type of joint : Synovial joint → Hinge joint （トロクレアだから）Additional component : ----------

ligaments : 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.「樽なか、キュー、食うねいいフォーム」

Movements and participating muscles of the talocrural joint

Radiological anatomy of the talocrural joint

1. Fibula2. Tibia3. Fibular notch of tibia4. Malleolar fossa5. Lateral malleolus6. Talocrural joint7. Medial malleolus8. Talus

Tibialis anterior dorsiflexion 　Extensor digitorum longus

dorsiflexion 　

Extensor hallucis longus

dorsiflexion 　

Fibularis tertius dorsiflexion 　

Fibularis longus 　 planter flexion

Fibularis brevis 　 planter flexion

Triceps surae 　 planter flexion

Tibialis posterior 　 planter flexion

Flexor digitorum longus

　 planter flexion

Flexor hallucis longus 　 planter flexion

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 : Posterior talar articular surface ⇔ Posterior calcaneal articular surface

Type of joint : Synovial joint → Pivot joint

Additional component : ----------

ligaments : 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 : Synovial joint → Boll-and-socket joint

Additional component : ----------

ligaments : Talonavicular ligament

Plantar calcaneonavicular ligament = spring ligament

Movements : Inversion ⇔ Eversion

1. Fibula2. Tibia3. Talocrural joint4. Medial malleolus5. Trochlea of talus6. Talus7. Posterior tubercle of talus8. Calcaneus9. Sustentaculum tali10. Tarsal sinus11. Navicular12. Cuneiforms13. Cuboid

3. Calcaneocuboid joint

Articular facets : Facies articularis cuboidea calcanei ⇔

Facies articularis calcanea ossis cuboidei

Type of joint : Synovial joint → Plane joint (Amphiarthrosis)

Additional component : ----------

ligaments : 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 : Gliding?

surgical lines of the foot

Chopart line (Transverse tarsal joint)

-Talonavicular joint + Cacanelcuboid joint

-amputation の時は Bifurcate ligament を切る

Lisfranc line (Tarsometatarsal joint)

Movement and the participating muscles of the foot

Extensor digitorum

longuseversion 　

Fibularis tertius eversion 　

Fibularis longus eversion 　

Fibularis brevis eversion 　

Tibialis anterior 　 inversion

Extensor hallucis

longus　 inversion

Triceps surae 　 inversion

Tibialis posterior 　 inversion

Flexor digitorum

longus　 inversion

Flexor hallucis longus 　 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

Transvers plantar arches

・At the level of the distal tarsal bones

: medial cuneiform bone – intermediate cuneiform bone – cuboid bone

・At the level of the heads of the metatarsal bones:

: The head of II-III metatarsal bones のところが一番高い。Sesamoid bones が medial

support。The head of V metatarsal bone が lateral support。Radiological anatomy of the foot

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・tendon of tibialis posterior

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

Arteries of the lower limb

A-E: Toes 1-5. (A:Great toe)I-V. Metatarsals

1,3: Distal phalax4: Middle phalax2,5: Proximal phalax6. Interphalangeal joints7. Metatarsophalangeal joints8. Sesamoids9. Head of metatarsal10. Shaft (body) of metatarsal11. Base of metatarsal12. Cuneiforms13. Navicular14. Cuboid15. Talus16. Calcaneus17. Tibia18. Fibula19. Tarsometatarsal joints20. Transverse midtarsal joint

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 から分岐している)

・inferior gluteal artery (internal iliac artery から分岐している)

・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) →　足の内側を上がっていく → 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 ではバルブがないのは珍しいことではない。・small saphenous veins

- begins on the lateral side of the dorsal venous network of the foot →上がって行く → pierces the fascia of the popliteal fossa, and ends variably in the popliteal, great saphenous,

or some muscular veins.

The main deep veins :

・femoral vein & popliteal vein

- artery と一緒に走る。たくさんのバルブあり。- 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

① Iliohypogastric n. : skin innervation – lower part of abdominal wall + gluteal region

muscle innervation – abdominal muscles

② Ilioinguinal n. : inguinal canal へ入るskin innervation – external genital organ

muscle innervation – abdominal muscles

Th12

L1

L2

L3

L4

L5

Genitofemoral n.L1 – L2

Obturator n.L2 – L4

(subcostal n.)

Iliohypogatric n.Th12 – L1

Ilioinguinal n.L1

Lumbosacral trunk↓

Sacral plexus

Lateral cutaneous femoral n.L2 – L3

Femoral n.L2 – L4

③ Lateral cutaneous femoral n. : skin innervation – anterolateral skin of the thigh

④ Genitofemoral n. : genital branch

spermatic cord の中身femoral branch

lacuna vasorum を通って thigh へskin innervation – Inguinal ligament の少し下あたりの skin

⑤ Femoral n. : lacuna muscronervosa を通って thigh へ 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.の最も長いブランチ。Adductor canal を通る。Saphenus vein と並走。skin innervation – anteromedial part of the leg

medial part of the foot

⑥ Obturator n. : Obturator canal を通る。 muscle innervation – adductor muscles except pectineus muscle

obturator externus も。 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. ※ は grater sciatic foramen の suprapiriform hiatus を superior gluteal a. と、Inferior gluteal n. は infrapiriform hiatus を inferior gluteal a. と共に通る。Sciatic n. ※ は thigh の flexor を innervate する。

4 Superior gluteal n. + N. for inferior gemellus m. + N. for quadratus femoris m. (L4-5, S1)

5 5 Inferior gluteal n. + N for superior gemellus m. + Internal obturator m. (L5, S1-2)

1 1 1 Posterior cutaneous femoral n. (S1-3)

2 2 2 Pudendal n. (S2-4)

3 3 3 Sciatic n. (L4-5, S1-3)

4 4

5

Branches of the tibial and common fibular nerves

Sciatic nerve が poplital fossa の少し上で tibial nerve と common fibular nerve に分かれる。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.

Lacuna musculonervosa

Lacuna vasorum

Lacuna lymphatica

Pubic tubecle

A.S.I.P

Inguinal ligamentPectineus m.

Lymphatic vessels

Lymph node (Rosenmüller)

Femoral n.

Lateral cutaneous femoral n.

Genitofemoral n.のfemoral branch

Femoral a. Femoral v.

Femoral canal

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 V

Femoral artery A

Femoral nerve N

adductor canal

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 ).

Vastoadductor lamina:Pathway of saphenous nerve.it emerges behind the aponeurotic covering of adductor canal, it descends vertically along the medial side of the knee and pierces the Vastoadductor lamina between the tendons of sartorius and gracilis muscles, then it becomes subcutaneous.

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

2. Ribs

Clavicular notch

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.) ← 要はせむし− Thoracic kyphosis

− Sacral kyphosis

Secondary curvatures of vertebral column≪ ≫

・ Lordoses (pl.)　← そっくり返ってる− 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

見つけられず。。。

3. The muscles of the thorax. The intercostal space.

The muscles of thethorax

・Pecorals, serratus anterior, subclavius, intercostal muscles （ノートより）・External intercostals, internal intercostals, innermost intercostals, transversus thoracis,

subcostalis, levator costarum　（Gross anatomy より）

Inner chest wall anteriorly:

1. Internal intercostals

2. Transversus thoracis

3. Sternocostal ligaments

4. Diaphragm is visible, too.

Inner chest-

and 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 Origin

Sternal part Xiphoid process

Costal part lower six ribs

Lumbar partMedial & lateral lumbocostal arches (= arcuate ligament).

L1-3 vertebrae for the right crus, L1-2 vertebrae for the left crus.

・これらの間に Sternocostal triangle と lumbocostal triangle ができている。・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 diaphragm’s 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

分け方（授業スライド）

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)

-Scarpa’s fascka (membranous layer)

-Superficial arteries, veins and lymphatic vessels

3. Muscles and Deep fasciae

4. Fascia transversalis

5. Peritoneum（腹膜）

I.- Nodi laterales- Nodi subscapulares- Nodi pectorales- Nodi paramammarii

II.- Nodi centrales- Nodi interpectorales

III.- Nodi apicales- Nodi parasternales

Muscles of abdominal wall

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

Muscles of the posterior abdominal wall

Deep muscles of the back

M. erector spinae:

1. M. iliocostalis

2. M. longissimus

3. M. spinalis

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.

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

まとめ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 (Meckel’s 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 (Glasers’s 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.

Apex of pyramid

Anterior (facing middle cranial fossa)

Posterior (facing posterior cranial fossa)

Foramen lacerum

Trigeminal impressionSulcus and canal for greater potrosal nerveSulcus and canal for lessor potrosal nerve

Jagular notch

Internal acoustic meatus

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

① Sagittal suture

② Coronal suture

③ Squamous suture

④ Lamboid suture

⑤ Frontal suture Glabella

⑥ Nasion: suture between nasal bones

2) Fontanelle

: the structure can be seen at points where more than 2 bones meet, sutures are wide

: there are 4 fontanelles

① Anterior fontanelle Bregma

② Posterior fontanelle Lambda

③ Sphenoidal fontanelle Pterion

④ Mastoid fontanelle Asterion

8. The sphenoid bone.

② Anterior clinoid process

① posterior clinoid process

⑤ Optic canal

⑥ Sphenoid sinus: paranasal sunus の一つ

④ Greater wing

③ lessor wing

⑨ Lateral pterygoid process ⑧ mediall pterygoid process

② Anterior clinoid process

① posterior clinoid process⑩ sella turcica

: pituitary glandが乗るところ

⑤ Optic canal

⑪ foramen rotundum

⑫ foramen ovale

⑬ foramen spinosum

④ Greater wing

③ lessor wing

⑭superior orbital fissure

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 : opens through the infundibulum into the middle meatus.

2. Maxillary sinus : opens through the hiatus semilunaris into the middle meatus.

3. Sphenoid sinus : opens through its anterior wall into the spheno-ethmoidal recess.

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.

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:

Maxilla①

Zygomatic bone②

Frontal bone③

Ethmoid bone④

Lacrimal bone⑤

Sphenoid bone⑥

⑦ 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:

① Maxilla (ant. 3/4)

② 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 ：epithel, capillary endothel, mesothel (peritoneum)

・cuboid ：thyroid gland

・columnar ：intestine (brush border), oviduct (ciliated)

Psudostratified

・columnar ：Ductus epididymidis (stereocilia)

Ductus deferens ( 〃 ) Bronchioles (kinocilia)

Auditory tube ( 〃 )

ドクター　駅で台まだです。ディファレンス、無論来おる。王子鳥チュー　ステレオで昨日知った。

Stratified

・squamous ：Keratinized （ドライ）→　skin

Non-keratinaized（モイスト）→ esophagus

・cuboid ：sweat gland

・columnar ：conjunctiva （結膜のこと）　　コンニャク千葉

Transitional ：renal pelvis, urinary bladder (umbrella cell)

[Glandular epithelium]

Unicellular ：goblet cell

Multicellular ：Endocrine

Exocrine - melocrine ：作ったものだけ出す - apocrine ：作ったもの＋自分の一部が出ていく　 - holocrine ：作ったもの＋自分も全破壊して出ていく

　　　　　メロ　アホ　自滅

[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：スーダンから太った人が凍結されて来るイメージ

　　

ECM of connective tissue

Fibers

・collagen fiber ：eosin

・reticular fiber ：silver impregnation, PAS 　　　シルバーパス

・elastic fiber ：orcein, Resorcin-fuchsin おるセイン？　リゾ（ット）に福神（漬け）

（・microfibrils）

コラ、レット選べ！

Amorphous material （ amouphos : 形のない ）

・GAG and proteoglycans

・Adhesion molecules (tight junction, desmosome, gap junction, connexon)

Types of connective tissue

Loose connective tissue

　　　Every where. Fiber 3 種類とも勢揃い。　　プチプチのイメージ

Dense connective tissue　(more fibers, less cells)

　　　－Regular　：tendon, ligament (collagen fiber がパラレル) ロープのイメージ

　　　－Irregular　：skin, dermis (collagen fiber がパラレルじゃない)　セーフティネットのイメー

ジ

Specialized connective tissue

　　　－adipose　：fat. energy storage.　　　　　　　－reticular　：spleen, lymph node (reticular cell が外側や梁を作っている) 鉄骨のイメージ

くれ、汁！紫の！マスト！

（中胚葉）

3. Types and structure of cartilage.

・Collagen fiber & elastic fiber が ground substance の chondroitin sulfate に embedded。

Hyaline cartilage ：joint 一番多い、スムース　　薬用鉢のイメージ

Fibrocartilage ：knee meniscus, vertebral disk コラーゲンの塊　クッションのイメージ

Elastic cartilage ：eternal ear, nose　flexible スプリングのイメージ

・Chondron が historogical basic unit.

Composed of

- chondrocyte

- lacuna

- extracellular matrix

lacuna は condron の

　　　　　　　　　　 テリトリーを守っている。

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 ：derived from mesenchymal cell

・osteoblast

・osteocyte ：processes in canaliculi [plural]

・osteoclast ：phagocytotic cells / phagocytes

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

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.

nucleus contraction striation special structure

Skeletal m. multi periphery（ ） quick + strong・voluntary・ ＋ 省略

Cariac m. uni centrally（ ） quick + strong・involuntary・ ＋

bifucation・intercalated disk・Y Y gap junction（ と のつなぎ目。 ）

smooth m. unislow + week・involuntary・ ―

myofibrils・ がクロスしている。dense body・

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 ⇒　branch to axon and dendrite

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

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