Snell Anatomy Review with Mcqs Snells Clinical Anatomy An Illustrated Reviews with Questions & Explanations, 4E [PDF].pdf. Sorry, something went wrong. Clinical Example: A short case report that dramatizes the relevance of anatomy in medicine introduces each To assist in the quick understanding of anatomic. This article contains Snell's Clinical Anatomy 9th Edition PDF for free download. It is one of the best books for studying clinical anatomy.

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    Short Snell Anatomy Pdf

    If yes then download snell clinical anatomy pdf free and learn human short as compared to other books of Human anatomy and covers all the. Clinical Anatomy. Applied anatomy for students and junior doctors .. unusually short; obviously in this situation the pleura may be opened acci- dentally in. Download Snell's Clinical Anatomy by Regions Tenth Edition PDF Free. Praised for its clear and consistent organization, dynamic illustrations.

    The study of various structures of body is called Anatomy. And the study of structures of Human body is called Human anatomy. There are many books for the study of gross anatomy but few of them are very famous among students and teachers and one the them is called Snell clinical oriented anatomy by regions. Snell anatomy is one of the most sold anatomy book. Not only this, this book has many versions and is improved a lot after all the versions. There are also other books like snell neuroanatomy etc written by snell series. If you want to learn gross anatomy with clinical notes and case studies, then Snell anatomy is the book that you should download. Here at this page you can download and rent it at discount rates. As mentioned, snell anatomy is the book of gross anatomy that describes Human Anatomy by regions. It has various clinical boxes that makes it extremely easy for medical students to learn clinical points along with their studies. Also there are embryological developmental boxes that helps students to learn development of various organs along with their gross anatomy.

    Without these terms, it is impossible to describe in a meaningful way the composition of the body. Moreover, the physician needs these terms so that anatomic abnormalities found on clinical examination of a patient can be accurately recorded. Terms Related to Position All descriptions of the human body are based on the assumption that the person is standing erect,with the upper limbs by the sides and the face and palms of the hands directed forward Fig.

    This is the so-called anatomic position. The various parts of the body are then described in relation to certain imaginary planes. Planes situated to one or the other side of the median plane and parallel to it are termed paramedian.

    A structure situated nearer to the median plane of the body than another is said to be medial to the other. Similarly, a structure that lies farther away from the median plane than another is said to be lateral to the other. Basic Anatomy Anatomy is the science of the structure and function of the body. Clinical anatomy is the study of the macroscopic struc- ture and function of the body as it relates to the practice of medicine and other health sciences.

    Basic anatomy is the study of the minimal amount of anatomy consistent with the understanding of the overall structure and function of the body. Descriptive Anatomic Terms It is important for medical personnel to have a sound knowledge and understanding of the basic anatomic terms. With the aid of a medical dictionary, you will find that understanding anatomic terminology greatly assists you in the learning process. The accurate use of anatomic terms by medical person- nel enables them to communicate with their colleagues both nationally and internationally.

    Without anatomic terms,one superior paramedian plane median sagittal plane proximal end of upper limb lateral border distal end of upper limb medial border dorsal surface of foot plantar surface of foot inferior palmar surface of hand dorsal surface of hand posterior anterior horizontal or transverse plane coronal plane median sagittal plane FIGURE 1.

    Note that the subjects are standing in the anatomic position. Medial rotation is the movement that results in the anterior surface of the part facing medially. Lateral rotation is the movement that results in the anterior surface of the part facing laterally. Pronation of the forearm is a medial rotation of the forearm in such a manner that the palm of the hand faces posteriorly see Fig.

    Supination of the forearm is a lateral rotation of the forearm from the pronated posi- tion so that the palm of the hand comes to face anteriorly see Fig. Circumduction is the combination in sequence of the movements of flexion, extension, abduction, and adduc- tion see Fig.

    Protraction is to move forward; retraction is to move backward used to describe the forward and backward movement of the jaw at the temporomandibular joints.

    Inversion is the movement of the foot so that the sole faces in a medial direction see Fig. Eversion is the opposite movement of the foot so that the sole faces in a lateral direction see Fig. Basic Structures Skin The skin is divided into two parts: The epidermis is a stratified epithelium whose cells become flat- tened as they mature and rise to the surface.

    On the palms of the hands and the soles of the feet,the epidermis is extremely thick, to withstand the wear and tear that occurs in these regions. In other areas of the body, for example, on the ante- rior surface of the arm and forearm, it is thin. The dermis is composed of dense connective tissue containing many blood vessels, lymphatic vessels, and nerves. It shows considerable variation in thickness in different parts of the body, tending to be thinner on the anterior than on the posterior surface.

    It is thinner in women than in men. The dermis of the skin is connected to the underlying deep fascia or bones by the superficial fascia, otherwise known as subcutaneous tissue. At these sites, the skin is thinner than elsewhere and is firmly tethered to underlying struc- tures by strong bands of fibrous tissue.

    The appendages of the skin are the nails, hair follicles, sebaceous glands, and sweat glands. The nails are keratinized plates on the dorsal surfaces of the tips of the fingers and toes. The proximal edge of the plate is the root of the nail see Fig. With the exception of the distal edge of the plate, the nail is surrounded and overlapped by folds of skin known as nail folds.

    The sur- face of skin covered by the nail is the nail bed see Fig. Hairs grow out of follicles, which are invaginations of the epidermis into the dermis see Fig. The folli- cles lie obliquely to the skin surface, and their expanded extremities, called hair bulbs, penetrate to the deeper part of the dermis. Each hair bulb is concave at its end, and the Coronal Planes These planes are imaginary vertical planes at right angles to the median plane see Fig.

    Horizontal, orTransverse, Planes These planes are at right angles to both the median and the coronal planes see Fig. The terms anterior and posterior are used to indicate the front and back of the body, respectively see Fig.

    To describe the relationship of two structures, one is said to be anterior or posterior to the other insofar as it is closer to the anterior or posterior body surface.

    In describing the hand, the terms palmar and dorsal surfaces are used in place of anterior and posterior, and in describing the foot, the terms plantar and dorsal surfaces are used instead of lower and upper surfaces see Fig. The terms proximal and distal describe the relative distances from the roots of the limbs; for example,the arm is proximal to the forearm and the hand is distal to the forearm.

    The terms superficial and deep denote the relative distances of structures from the surface of the body, and the terms superior and inferior denote levels relatively high or low with reference to the upper and lower ends of the body. The terms internal and external are used to describe the relative distance of a structure from the center of an organ or cavity; for example, the internal carotid artery is found inside the cranial cavity and the external carotid artery is found outside the cranial cavity.

    The term ipsilateral refers to the same side of the body; for example, the left hand and the left foot are ipsilateral. Contralateral refers to opposite sides of the body; for example, the left biceps brachii muscle and the right rectus femoris muscle are contralateral. The supine position of the body is lying on the back. The prone position is lying face downward. Terms Related to Movement A site where two or more bones come together is known as a joint.

    Some joints have no movement sutures of the skull , some have only slight movement superior tibiofib- ular joint , and some are freely movable shoulder joint. Flexion is a movement that takes place in a sagittal plane. For example, flexion of the elbow joint approxi- mates the anterior surface of the forearm to the anterior surface of the arm. It is usually an anterior movement, but it is occasionally posterior, as in the case of the knee joint see Fig.

    Extension means straightening the joint and usually takes place in a posterior direction see Fig. Lateral flexion is a movement of the trunk in the coronal plane Fig. Abduction is a movement of a limb away from the mid- line of the body in the coronal plane see Fig. Adductionisamovementof alimbtowardthebodyinthe coronal plane see Fig. In the fingers and toes,abduction is applied to the spreading of these structures and adduction is applied to the drawing together of these structures see Fig.

    The movements of the thumb see Fig. Note the difference between flexion of the elbow and that of the knee. A band of smooth muscle, the arrector pili, connects the undersurface of the follicle to the superficial part of the dermis see Fig.

    The muscle is innervated by sympathetic nerve fibers, and its contraction causes the hair to move into a more vertical position; it also com- presses the sebaceous gland and causes it to extrude some of its secretion. The pull of the muscle also causes dimpling of the skin surface, so-called gooseflesh. Hairs are dis- tributed in various numbers over the whole surface of the Sebaceous glands pour their secretion, the sebum, onto the shafts of the hairs as they pass up through the necks of the follicles.

    They are situated on the sloping undersur- face of the follicles and lie within the dermis see Fig. Sebum is an oily material that helps preserve the flexibility of the emerging hair.

    It also oils the surface epidermis around the mouth of the follicle. Sweat glands are long, spiral, tubular glands distributed over the surface of the body, except on the red margins of the lips, the nail beds, and the glans penis and clitoris see Fig.

    These glands extend through the full thickness of the dermis, and their extremities may lie in the superficial fascia. The sweat glands are therefore the most deeply pen- etrating structures of all the epidermal appendages.

    Note that hair follicles extend down into the deeper part of the dermis or even into the super- ficial fascia, whereas sweat glands extend deeply into the superficial fascia.

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    The relationship of the nail to other structures of the finger is also shown. Skin Infections The nail folds, hair follicles, and sebaceous glands are com- mon sites for entrance into the underlying tissues of pathogenic organisms such as Staphylococcus aureus. Infection occurring between the nail and the nail fold is called a paronychia. Infection of the hair follicle and sebaceous gland is responsible for the com- mon boil.

    A carbuncle is a staphylococcal infection of the superfi- cial fascia. It frequently occurs in the nape of the neck and usually starts as an infection of a hair follicle or a group of hair follicles. Sebaceous Cyst A sebaceous cyst is caused by obstruction of the mouth of a sebaceous duct and may be caused by damage from a comb or by infection. It occurs most frequently on the scalp. Shock A patient who is in a state of shock is pale and exhibits goose- flesh as a result of overactivity of the sympathetic system, which causes vasoconstriction of the dermal arterioles and contraction of the arrector pili muscles.

    Skin Burns The depth of a burn determines the method and rate of healing. A burn that extends deeper than the sweat glands heals slowly and from the edges only, and con- siderable contracture will be caused by fibrous tissue.

    Snell Clinical Anatomy An Illustrated Review with Questions and Explanations

    To speed up healing and reduce the incidence of contracture, a deep burn should be grafted. Skin Grafting Skin grafting is of two main types: In a split-thickness graft, the greater part of the epidermis, including the tips of the dermal papillae, is removed from the donor site and placed on the recipient site.

    This leaves at the donor site for repair purposes the epidermal cells on the sides of the dermal papillae and the cells of the hair follicles and sweat glands. A full-thickness skin graft includes both the epidermis and the dermis and, to survive, requires rapid establishment of a new cir- culation within it at the recipient site. The donor site is usually covered with a split-thickness graft.

    In certain circumstances, the full-thickness graft is made in the form of a pedicle graft, in which a flap of full-thickness skin is turned and stitched in position at the recipient site, leaving the base of the flap with its blood supply intact at the donor site.

    Later, when the new blood supply to the graft has been established, the base of the graft is cut across. In the scalp, the back of the neck, the palms of the hands, and the soles of the feet, it contains numerous bundles of collagen fibers that hold the skin firmly to the deeper struc- tures.

    In the eyelids, auricle of the ear, penis and scrotum, and clitoris, it is devoid of adipose tissue. The deep fascia is a membranous layer of connective tis- sue that invests the muscles and other deep structures see Fig. In the neck, it forms well-defined layers that may play an important role in determining the path taken by pathogenic organisms during the spread of infection.

    In the thorax and abdomen, it is merely a thin film of areolar tissue covering the muscles and aponeuroses. In the limbs, it forms a defi- nite sheath around the muscles and other structures, holding them in place.

    Fibrous septa extend from the deep surface of the membrane, between the groups of muscles, and in many places divide the interior of the limbs into compartments see Fig. In the region of joints, the deep fascia may be consid- erably thickened to form restraining bands called retinacula Fig.

    Their function is to hold underlying tendons in posi- tionortoserveaspulleysaroundwhichthetendonsmaymove. Fasciae and Infection A knowledge of the arrangement of the deep fasciae often helps explain the path taken by an infection when it spreads from its primary site.

    In the neck, for example, the various fascial planes explain how infection can extend from the region of the floor of the mouth to the larynx. Skeletal Muscle Skeletal muscles produce the movements of the skeleton; they are sometimes called voluntary muscles and are made up of striped muscle fibers.

    A skeletal muscle has two or more attachments. The attachment that moves the least is referred to as the origin, and the one that moves the most, the insertion Fig. Under varying circumstances, the median nerve brachial artery ulnar nerve medial intermuscular septum coracobrachialis deep fascia superficial fascia skin triceps radial nerve lateral intermuscular septum brachialis humerus cephalic vein musculocutaneous nerve biceps FIGURE 1.

    Note how the fibrous septa extend between groups of muscles, dividing the arm into fascial compartments. The fleshy part of the muscle is referred to as its belly see Fig.

    The ends of a muscle are attached to bones, cartilage, or ligaments by cords of fibrous tissue called tendons Fig. Occasionally, flattened muscles are attached by a thin but strong sheet of fibrous tissue called an aponeurosis see Fig. A raphe is an interdigita- tion of the tendinous ends of fibers of flat muscles see Fig.

    Internal Structure of Skeletal Muscle The muscle fibers are bound together with delicate areolar tissue, which is condensed on the surface to form a fibrous envelope, the epimysium.

    The individual fibers of a muscle are arranged either parallel or oblique to the long axis of the muscle Fig. Because a muscle shortens by one third to one half its resting length when it contracts, it follows that muscles whose fibers run parallel to the line of pull will bring about a greater degree of movement compared with those whose fibers run obliquely. Examples of muscles with parallel fiber arrangements see Fig. Muscles whose fibers run obliquely to the line of pull are referred to as pennate muscles they resemble a feather see Fig.

    A unipennate muscle is one in which the tendon lies along one side of the muscle and the muscle fibers pass obliquely to it e. A bipennate muscle is one in which the tendon lies in the center of the muscle and the muscle fibers pass to it from two sides e.

    A multipennate mus- cle may be arranged as a series of bipennate muscles lying alongside one another e. For a given volume of muscle substance, pennate mus- cles have many more fibers compared to muscles with par- allel fiber arrangements and are therefore more powerful; in other words, range of movement has been sacrificed for strength.

    Skeletal Muscle Action All movements are the result of the coordinated action of many muscles. A muscle may work in the following four ways: Prime mover: A muscle is a prime mover when it is the chief muscle or member of a chief group of muscles responsible for a particular movement. For example, the quadriceps femoris is a prime mover in the movement of extending the knee joint Fig.

    Any muscle that opposes the action of the prime mover is an antagonist. For example, the biceps femoris opposes the action of the quadriceps femoris when the knee joint is extended see Fig. Before a prime mover can contract, the antagonist muscle must be equally relaxed; this is brought about by nervous reflex inhibition. A fixator contracts isometrically i.

    For example, the muscles attaching the shoulder girdle to the trunk contract as fixators to allow the deltoid to act on the shoulder joint see Fig. In many locations in the body, the prime mover muscle crosses several joints before it reaches the joint at which its main action takes place. To prevent unwanted movements in an intermediate joint, groups of muscles called synergists contract and stabilize the intermediate joints. For example, the flexor and extensor muscles of the carpus contract to fix the wrist joint, and this allows the long flexor and the extensor muscles of the fingers to work efficiently see Fig.

    These terms are applied to the action of a particular mus- cle during a particular movement; many muscles can act as a prime mover, an antagonist, a fixator, or a synergist, depending on the movement to be accomplished. A relaxed and a contracted muscle are also shown; note how the muscle fibers, on contraction, shorten by one third to one half of their resting length. Note also how the mus- cle swells. Muscles can even contract paradoxically, for example, when the biceps brachii, a flexor of the elbow joint, con- tracts and controls the rate of extension of the elbow when the triceps brachii contracts.

    The nerve enters the muscle at about the midpoint on its deep surface, often near the margin; the place of entrance is known as the motor point. This arrangement allows the mus- cle to move with minimum interference with the nerve trunk. Naming of Skeletal Muscles Individual muscles are named according to their shape, size, number of heads or bellies, position, depth, attach- ments, or actions.

    Some examples of muscle names are shown in Table 1. Muscle Tone Determination of the tone of a muscle is an important clinical examination. If a muscle is flaccid, then either the afferent, the efferent, or both neurons involved in the reflex arc necessary for the production of muscle tone have been interrupted. For example, if the nerve trunk to a muscle is severed, both neurons will have been interrupted.

    If poliomyelitis has involved the motor anterior horn cells at a level in the spinal cord that innervates the muscle, the efferent motor neurons will not function.

    If, conversely, the muscle is found to be hypertonic, the possibility exists of a lesion involving higher motor neurons in the spinal cord or brain. Muscle Attachments The importance of knowing the main attachments of all the major muscles of the body need not be emphasized.

    Only with such knowledge is it possible to understand the normal and abnormal actions of individual muscles or muscle groups. How can one even attempt to analyze, for example, the abnormal gait of a patient without this information? Muscle Shape and Form The general shape and form of muscles should also be noted, since a paralyzed muscle or one that is not used such as occurs when a limb is immobilized in a cast quickly atrophies and changes shape.

    In the case of the limbs, it is always worth remembering that a muscle on the opposite side of the body can be used for comparison. Quadriceps femoris extending the knee as a prime mover, and biceps femo- ris acting as an antagonist. Biceps femoris flexing the knee as a prime mover, and quadriceps acting as an antagonist. Muscles around shoulder girdle fixing the scapula so that movement of abduction can take place at the shoulder joint.

    Flexor and extensor muscles of the carpus acting as synergists and stabilizing the carpus so that long flexor and extensor tendons can flex and extend the fingers. Smooth Muscle Smooth muscle consists of long,spindle-shaped cells closely arranged in bundles or sheets. In the tubes of the body, it provides the motive power for propelling the contents through the lumen. In the digestive system, it also causes the ingested food to be thoroughly mixed with the digestive juices. A wave of contraction of the circularly arranged fib- ers passes along the tube, milking the contents onward.

    By their contraction, the longitudinal fibers pull the wall of the tube proximally over the contents. This method of propul- sion is referred to as peristalsis. In storage organs such as the urinary bladder and the uterus, the fibers are irregularly arranged and interlaced with one another. Their contraction is slow and sustained and brings about expulsion of the contents of the organs.

    In the walls of the blood vessels, the smooth muscle fibers are arranged circularly and serve to modify the caliber of the lumen. Cardiac Muscle Cardiac muscle consists of striated muscle fibers that branch and unite with each other. Joints are classified according to the tissues that lie between the bones: Fibrous Joints The articulating surfaces of the bones are joined by fibrous tissue Fig.

    The sutures of the vault of the skull and the inferior tibi- ofibular joints are examples of fibrous joints. Cartilaginous Joints Cartilaginous joints can be divided into two types: A primary cartilaginous joint is one in which the bones are united by a plate or a bar of hyaline cartilage. Thus, the union between the epiphysis and the of the heart.

    Its fibers tend to be arranged in whorls and spirals, and they have the property of spontaneous and rhythmic contraction. Specialized cardiac muscle fibers form the conducting system of the heart. Cardiac muscle is supplied by autonomic nerve fibers that terminate in the nodes of the conducting system and in the myocardium. Necrosis of Cardiac Muscle The cardiac muscle receives its blood supply from the coro- nary arteries.

    A sudden block of one of the large branches of a coronary artery will inevitably lead to necrosis of the cardiac muscle and often to the death of the patient. Fibrous joint coronal suture of skull. Cartilaginous joint joint between two lumbar vertebral bodies. Synovial joint hip joint. No movement is possible. A secondary cartilaginous joint is one in which the bones are united by a plate of fibrocartilage and the articu- lar surfaces of the bones are covered by a thin layer of hya- line cartilage.

    Examples are the joints between the vertebral bodies see Fig. A small amount of movement is possible. Synovial Joints Thearticularsurfacesof thebonesarecoveredbyathinlayer of hyaline cartilage separated by a joint cavity see Fig. This arrangement permits a great degree of freedom of movement.

    The cavity of the joint is lined by synovial membrane, which extends from the margins of one articu- lar surface to those of the other. The synovial membrane is protected on the outside by a tough fibrous membrane The articular surfaces are lubricated by a viscous fluid called synovial fluid, which is produced by the synovial membrane.

    In certain synovial joints, for example, in the knee joint, discs or wedges of fibrocartilage are interposed between the articular surfaces of the bones. These are referred to as articular discs. Fatty pads are found in some synovial joints lying between the synovial membrane and the fibrous capsule or bone. Examples are found in the hip see Fig. The degree of movement in a synovial joint is limited by the shape of the bones participating in the joint, the coming together of adjacent anatomic structures e.

    Most ligaments lie outside the joint capsule, but in the knee some important ligaments, the cruciate liga- ments, lie within the capsule Fig.

    Synovial joints can be classified according to the arrange- ment of the articular surfaces and the types of movement that are possible. In plane joints, the apposed articular sur- faces are flat or almost flat, and this permits the bones to slide on one another.

    Examples of these joints are the sternoclavicular and acromioclavicular joints Fig. Hinge joints resemble the hinge on a door, so that flexion and extension movements are possible. Examples of these joints are the elbow, knee, and ankle joints see Fig.

    In pivot joints, a central bony pivot is sur- rounded by a bony—ligamentous ring see Fig. The atlantoaxial and superior radioulnar joints are good examples. Condyloid joints have two distinct convex surfaces that articulate with two concave sur- faces.

    The movements of flexion, extension, abduc- tion, and adduction are possible together with a small amount of rotation. The metacarpophalangeal joints or knuckle joints are good examples see Fig. The movements of flexion,extension,abduction, and adduction can take place, but rotation is impossible. These joints permit flexion, extension, abduction, adduction, and rotation. The best example of this type of joint is the carpometacarpal joint of the thumb see Fig. In ball-and-socket joints, a ball- shaped head of one bone fits into a socketlike concavity of another.

    This arrangement permits free movements, including flexion, extension, abduction, adduction, medial rotation, lateral rotation, and circumduction. The shoulder and hip joints are good examples of this type of joint see Fig. Stability of Joints The stability of a joint depends on three main factors: Articular Surfaces The ball-and-socket arrangement of the hip joint see Fig. Other examples of joints, however, in which the shape of the bones contributes little or noth- ing to the stability include the acromioclavicular joint, the calcaneocuboid joint, and the knee joint.

    Ligaments Fibrous ligaments prevent excessive movement in a joint see Fig. For example, the ligaments of the joints between the bones forming the arches of the feet will not by themselves support the weight of the body. Shape of articular surfaces. Muscle tone. Plane joints sternoclavicular and acromioclavicular joints.

    Hinge joint elbow joint. Pivot joint atlantoaxial joint. Condyloid joint metacarpophalangeal joint. Ellipsoid joint wrist joint. Saddle joint carpometacarpal joint of the thumb. Ball-and-socket joint hip joint. Elasticligaments, conversely,return to their original length after stretching.

    The elastic ligaments of the auditory ossicles play an active part in supporting the joints and assisting in the return of the bones to their original position after movement. MuscleTone In most joints, muscle tone is the major factor controlling stability. For example, the muscle tone of the short muscles around the shoulder joint keeps the hemispherical head of the humerus in the shallow glenoid cavity of the scapula. Without the action of these muscles, very little force would The knee joint is very unstable without the tonic activity of the quadriceps fem- oris muscle.

    The joints between the small bones forming the arches of the feet are largely supported by the tone of the muscles of the leg, whose tendons are inserted into the bones of the feet see Fig. Nerve Supply of Joints The capsule and ligaments receive an abundant sensory nerve supply. Examination of Joints When examining a patient, the clinician should assess the nor- mal range of movement of all joints.

    When the bones of a joint are no longer in their normal anatomic relationship with one another, then the joint is said to be dislocated. Some joints are particularly susceptible to dislocation because of lack of sup- port by ligaments, the poor shape of the articular surfaces, or the absence of adequate muscular support.

    The shoulder joint, temporomandibular joint, and acromioclavicular joints are good examples. Dislocation of the hip is usually congenital, being caused by inadequate development of the socket that normally holds the head of the femur firmly in position.

    The presence of cartilaginous discs within joints, especially weightbearing joints, as in the case of the knee, makes them par- ticularly susceptible to injury in sports. During a rapid movement, the disc loses its normal relationship to the bones and becomes crushed between the weightbearing surfaces. Incertaindiseasesofthenervoussystem e. This means that the warn- ing sensations of pain felt when a joint moves beyond the nor- mal range of movement are not experienced.

    This phenomenon results in the destruction of the joint. The knowledge of the classification of joints is of great value because, for example, certain diseases affect only certain types of joints. Gonococcal arthritis affects large synovial joints such as the ankle, elbow, or wrist, whereas tuberculous arthritis also affects synovial joints and may start in the synovial membrane or in the bone.

    Remember that more than one joint may receive the same nerve supply. For example, both the hip and knee joints are sup- plied by the obturator nerve. Thus, a patient with disease limited to one of these joints may experience pain in both. Commonly found in association with joints, ligaments are of two types. Most are composed of dense bundles of collagen fibers and are unstretchable under nor- mal conditions e.

    The second type is composed largely of elastic tissues and can therefore regain its original length after stretching e. Damage to Ligaments Joint ligaments are very prone to excessive stretching and even tearing and rupture. If possible, the apposing damaged surfaces of the ligament are brought together by positioning and immobilizing the joint. In severe injuries, surgical approxi- mation of the cut ends may be required.

    The blood clot at the damaged site is invaded by blood vessels and fibroblasts. The fibroblasts lay down new collagen and elastic fibers, which become oriented along the lines of mechanical stress.

    Its walls are separated by a film of viscous fluid. Bursae are found wher- ever tendons rub against bones, ligaments, or other ten- dons. They are commonly found close to joints where the skin rubs against underlying bony structures, for example, the prepatellar bursa Fig. Occasionally, the cavity of a bursa communicates with the cavity of a synovial joint. For example, the suprapatellar bursa communicates with the knee joint see Fig.

    Synovial Sheath A synovial sheath is a tubular bursa that surrounds a tendon. The tendon invaginates the bursa from one side so that the tendon becomes suspended within the bursa by a mesoten- don see Fig. The mesotendon enables blood vessels to enter the tendon along its course. In certain situations,when the range of movement is extensive, the mesotendon disap- pears or remains in the form of narrow threads, the vincula e.

    Synovial sheaths occur where tendons pass under liga- ments and retinacula and through osseofibrous tunnels. Their function is to reduce friction between the tendon and its surrounding structures. Four bursae related to the front of the knee joint. Note that the suprapatellar bursa communicates with the cavity of the joint. Synovial sheaths around the long tendons of the fingers. How tendon indents synovial sheath during development, and how blood vessels reach the tendon through the mesotendon.

    Trauma and Infection of Bursae and Synovial Sheaths Bursae and synovial sheaths are commonly the site of trau- matic or infectious disease. For example, the extensor tendon sheaths of the hand may become inflamed after excessive or unaccustomed use; an inflammation of the prepatellar bursa may occur as the result of trauma from repeated kneeling on a hard surface. Arteries transport blood from the heart and distrib- ute it to the various tissues of the body by means of their branches Figs.

    The smallest arteries, 0. The joining of branches of arteries is called an anastomosis. Arteries do not have valves. Anatomic end arteries Fig. Functional end arteries are vessels whose terminal branches do anastomose with Veins are vessels that transport blood back to the heart; many of them possess valves. The smallest veins are called venules see Fig.

    The smaller veins, or tributaries, unite to form larger veins, which commonly join with one another to form venous plexuses. Medium-size deep arter- ies are often accompanied by two veins, one on each side, called venae comitantes. A portal system is thus a system of vessels interposed between two capillary beds. Capillaries are microscopic vessels in the form of a net- work connecting the arterioles to the venules see Fig. Sinusoids resemble capillaries in that they are thin- walled blood vessels, but they have an irregular cross diam- eter and are wider than capillaries.

    They are found in the bone marrow, the spleen, the liver, and some endocrine glands. In some areas of the body, principally the tips of the fingers and toes, direct connections occur between the arteries and the veins without the intervention of capil- laries. Anastomosis between the branches of the superior mesenteric artery.

    A capillary network and an arteriovenous anastomosis. Anatomic end artery and functional end artery. A portal system. Structure of the bicuspid valve in a vein. Diseases of Blood Vessels Diseases of blood vessels are common. The surface anatomy of the main arteries, especially those of the limbs, is dis- cussed in the appropriate sections of this book. All large arteries that cross over a joint are liable to be kinked during movements of the joint.

    However, the distal flow of blood is not interrupted because an adequate anastomosis is usually between branches of the artery that arise both proximal and dis- tal to the joint.

    The alternative blood channels, which dilate under these circumstances, form the collateral circulation. Knowledge of the existence and position of such a circulation may be of vital importance should it be necessary to tie off a large artery that has been damaged by trauma or disease. Coronary arteries are functional end arteries, and if they become blocked by disease coronary arterial occlusion is com- mon , the cardiac muscle normally supplied by that artery will receive insufficient blood and undergo necrosis.

    Blockage of a large coronary artery results in the death of the patient. See the clinical example at the beginning of this chapter. Lymphatic tissues are a type of connective tissue that contains large numbers of lymphocytes.

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    Lymphatic tissue is organized into the following organs or structures: Lymphatic tissue is essential for the immunologic defenses of the body against bacteria and viruses. Lymphatic vessels are tubes that assist the cardio- vascular system in the removal of tissue fluid from the tissue spaces of the body; the vessels then return the fluid to the blood. The lymphatic system is essentially a The thoracic duct and right lymphatic duct and their main tributaries.

    The areas of body drained into thoracic duct clear and right lymphatic duct black. General structure of a lymph node.

    Lymph vessels and nodes of the upper limb. Lymphatic vessels are found in all tissues and organs of the body except the central nervous system, the eyeball, the inter- nal ear, the epidermis of the skin, the cartilage, and the bone.

    Lymph is the name given to tissue fluid once it has entered a lymphatic vessel. Lymph capillaries are a net- work of fine vessels that drain lymph from the tissues.

    The capillaries are in turn drained by small lymph vessels,which unite to form large lymph vessels. But you must use anatomy atlas along with this book as diagrams given in this book are not the best. The best thing about this book is the clinical sections. Almost all clinical aspects are given along each topic.

    Embryological sections are also given that tells about the derivation of different organs and structures. Chapter 1:The introduction:- This chapter includes all the basic things necessary for understanding the entire book.

    It includes the concept of planes,axis,anatomical terms etc. Chapter 2:The thorax part This chapter includes the anatomy of thoracic wall and organs etc in it.

    Chapter 3:The thorax part This chapter is about the anatomy of thoracic cavity. Chapter 4:The abdomen part The anatomy of abdominal wall. Chapter 5:The abdomen part The anatomy of abdominal cavity. Chapter 7:The pelvis part The anatomy of pelvic cavity.

    Chapter 8:The perineum:- Chapter 9:The upper limb:- This chapter is about the complete anatomy of upper limb which includes all the bones,joins,muscles,ligaments,tendons and nerves etc.

    Chapter The lower limb:- The chapter contains the brief anatomy of lower limb.

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