Special notes for the lateral wall

①The spheno-ethmoidal recess is situated between the superior concha and the body of the sphenoid bone.

②The spheno-palatine foramen opens into the pterygopalatine fossa.

③The lower orifice of the naso-lacrimal canal opens into the inferior meatus.

3. The Communications of the Nasal Cavity

Piriform foramenFace

Posterior nasal aperture Nasopharynx

Sphenopalatine foramenPterygopalatine fossa

Cribriform foramenAnterior cranial fossa

Nasolacrimal cuctOrbital cavity

4. The Paranasal Sinuses

The sinuses Open into

Frontal sinuses middle nasal meatus Ethmoidal sinuses middle and sup. nasal meatus Sphenoidal sinuses sphenoethmoidal recess Maxillary sinuses middle nasal meatus ( poor drainage )

Ⅴ. The Skull at the Birth

1. The skull is large in proportion to the body 1/4 ( Adult 1/7 )

2. The facial portion is small to the cranial portion 1/8 ( Adult 1/4 )

3. The orbits are relatively large.

4. The nasal cavity is small in site.

5. Some bones are rudimentary.

6. The fontanels are unossified between the bones.

Section 4 The Bones of the Limbs

The appendicular skeleton include the bones of the upper and lower limbs.

Ⅰ. Bones of the Upper Limb includes shoulder girdle and bones of the freely movable upper limb.

Ⅰ） The Should Cirdle It consist of the scapula and clavicle.

1. The clavicle It is S-shaped, and joins the trunk with the upper limb. The rounded medial end, termed sternal end, termed sternal end, joint the manubrium by sternoclavicular joint. The flattened lateral (or acromial) end articulates with the scapula.

2. The scapula which is a triangular flat bone situated on the thorax. It has three borders, the meadial, lateral and superior borders; Three angles: the superior, inferior and lateral; and two surfaces: the anterior or costal and the posterior or dorsal surfaces. There is a notch on the superior border, termed scapular notch, lateral to this, a thick bent coracoid process projects forward. The lateral angle of the scapula is a thickened one, which has a concave articular surface, the glenoid cavity. There two tubercles above and below the cavity, termed the supraglenoid and infraglenoid tubercles. The inferior angle is lower end of scapula, at the level of the seventh rib, which is a landmark in the back for determination of the order of the ribs. The costal surface is concave know as subscapular fossa. The spine of scapula is a triangular crest on the dorsal surface. The supraspinus fossa and infraspinus fossa are above and below the spine. The acromin is a triangular bony plate, which has an oval small focet for articulation with the clavicle.

Ⅱ）The Mobility Skeleton of the Upper Limb

1. The composition

The proximal The middle The distal

Humerus Radius, ulna Carpal 8 Metacarpal 5 Phalanges 14

2. The humerus:

head of humerus shalft of humerus

anatomical neck deltoid tuberosity

surgical neck sulcus for radial n.

greater tubercle trochlea of humerus

lesser tubercle olecranon fossa

intertubercular sulcus lateral epicondyle

crest of greater tubercle medial epicondyle

crest of lesser tubercle sulcus of ulnar n.

3. The radius:

head of radius articular circumference

neck of radius tuberosity of radius

shaft of radius interosseous border

ulnar notch styloid process ( radius )

4. The ulna:

troclear notch tuberosity of ulna

coronoid process shaft of ulna

olecranon articularcircumfrence

radial notch styloid process ( ulna )

5. The bones of the hand:

The carpal bones is divided into two groups:

The proximal group: scaphoid, lunate, triangular and pisiform bone.

The metacarpal bones----base, head, shaft.

The phalanges----proximal, middle and distal phalanx, tuberosity of phalanges.

Ⅱ. Bones of the lower limb includes the pelvic girdle and the bones of the freely movable lower limb:

Ⅰ）The Pelvic girdle is formed by two hip bones. The composition of the hip bone which is fused by the ilium, ischium and pubis.

The ilium: liliac body, ala, crest, tuberosity

anterior superior iliac spine

anterior inferior iliac spine

posterior superior iliac spine

posterior inferior iliac spine

iliac fossa, arcuate line.

The ischium: ischial tuberosity, ischial spine, ischial body, greater sciatic notch, lesser cciatic notch.

The pubis: pubic body, superior ramus of pubis, iliopubic eminence, pubic tubercle, pubic crest, pectum of pubis, symphyseal surface, obturator foramen, pubic arch, subpubic angle ( in man ), acetabular fossa, acetabular notch, lunate surface.

Ⅱ）Mobility Skeleton of Lower Limb which is divided into three parts, the proximal----femur; the middle----bibia, fibula; distal----tarsus( 7 ).

1. The femur:

head of femur pectineal line

fovea for lig. of head medial condyle

neck of femur patellar surface

greater trochanter lateral condyle

intertrochanteric crest intercondylar fossa

intertrochanteric line medial epicondyle

shaft of femur lateral epicondyle

linea aspera addactor tubercle

gluteal tuberosity

2. The tibia:

Superior articular surface shaft of tibia

medial and lateral condyles interosseous border

intercondylar eminence popliteal line

articular surface for fibula medial melleolua

tuberosity of tibia fibular notch

3. The fibula: head of fibula, neck of fibula, shaft of fibula, tuberosity of fibula, interosseous border, lateral melleolus, articular surface.

4. The patella

5. The tarsus: talus calcaneus navicular and cuboid bone, first second and third cuneforms should be remembered.

6. The metatarsus 5, phalanges 14, the tuberosity of the fifth metatarsus is obvious land mark which can be felt on the living body.

Section 1 Introduction

The bones are connected together by articulations which are formed by means of fibrous, cartilaginous or osseous tissues at different parts of their surface.

Ⅰ. The Classification of Articulation

Ⅰ）Inmovable Articulations ( synarthoses ) which include the fibrous joints( membrane ), cartilaginous joints( synchodrosis ) and synosteosis, for example, the suture articulations in the skull and ligament syndesmoses(e.g., the yellow lig. ).

Ⅱ）Movable Articulations ( diarthroses, synovial joint ) the bones are connected by the joint capsule and ligament. The joint cavity presents freely movable.

Ⅲ）Semisynovial Joint: e.g. Pubic symphysis.

Ⅱ. The Structure of the Synovial Joint

Ⅰ）The Essential Structure

1. The articular surfaces. Generally there are two articular surfaces in a joint, the articular head and fossa, which are covered by the cartilage.

2. The joint capsule. It enclosed the joint cavity, and consists of the fibrous layer and synovial layer. The synovial layer lies insides of the fibrous capsule, which produces some synovial fluid that lubricates the joint.

3. The joint cavity which is closed by synovial membrane and articular cartilage.

Ⅱ）The Accessory Structure

1. The ligament

2. The articular disc

3. The glenoid labrum with bursa

Ⅲ）The movement of joint:

1. Gliding or slipping movement

2. Flexion and extension ( Angular movement )

3. Adduction and abduction

4. Pronation and supination

5. Rotation

6. Circumduction

Section 2 The Articulations of Axis Skeleton

The 24 pieces of vertebrae, the sacrum and the coccyx are connected together to form the vertebral column which supports the skull and bears the weight of the upper part of the body. And the spinal cord, the spinal nerve roots, and meninges are located in the vertebal canal.

Ⅰ. The Joints Between the Vertebra The vertebrae are connected by joints, intervertebral disc and ligaments.

Ⅰ）The Articulations Between the Vetebrae Bodies
Annulus fibrosus----fibrous loop

1. The Intervertebral Discs

Nucleus pulposas----pulpiform nucleas

2. The anterior longitudinal ligament

3. The posterior longitudinal ligament

Ⅱ）The Articulations of the Vertebral Arches

1. The joints of articular processes

2. Yellow ligament ( ligamenta flava)

3. Interspinous ligaments and intertransverse ligaments

4. Supraspinous ligaments

Ⅲ）The Lumbosacral Joints

Ⅳ）The Atlantooccipital Joints

Ⅱ. The Vertebral Column and Its Movements

Ⅰ）The View From the Lateral Aspect

The physiological curves:

1. The thoracic and pelvic carves ( concave ventrally ) as primary carves.

2. The cervical and lumbar curves ( convex forward ), as the secondary curves.

Ⅱ）The movements:

1. Flexion and extension

2. Lateral flexion

3. Rotation

4. Circumduction

Ⅲ. The Thorax

Ⅰ）The shape which is conical in shape, being narrow above and broad below, falttened from before backward. It has the upper opening or thoracic inlet and the lower opening or thoracic outlet. And the inlet is small and the outlet is wide and irregular.

12 thoracic vertebrae

Ⅱ）The Composition 12 pairs of ribs with costal cartilages

1 sternum

Ⅲ）The Upper Opening ( Thoracic inlet ) is formed by the upper margin of the first vertebra, manubrium and first pair of ribs.

Ⅳ）The Lower Opening ( Thoracic outlet ) is bounded by the 12^th vertebra, 12^th and 11^th ribs, costal arch and xiphoid process.
Section 3 The Articulations of the Cranial Bones
Most of the cranial bones are connected by the sutures and synchondrosis (synostosis ) except hyoid and mandible.

Ⅰ. The Temporomandibular Joint It is formed by the head of the mandible with mandibular fossa and the articular tubercle of the temporal bone.

The articular capsule is attached to the margins of the circumference at the fossa and the neck of the mandible.

The articular cabety is divided into two parts by the disk. Also there is the strong lateral ligament to reinforce the joint.

Ⅱ. The Movements of the Temporomandibular Joint.

1. Opening and closing of the mouth

2. Protuusion

2. Retraction

4. Lateral movement of the jaws

Usually above movements are conbined in mastication.

Ⅰ. The Joints of the Upper Limb

Ⅰ）The Articulation of the Girdle of the Upper Limb

1. The Sternoclavicular Joint It is formed by the medial end of the clavicle, the clavicular notch of sternum, and the first costal cartilage.

The characteristics of the joint: Its capsule is strong, thick and strengthened by ligaments.

The movements of the joint are following: superiorly, inferiorly, anteriorly, posteriorly, in a circumductory path and also rottory.

2. The acromioclavicular joint It is formed by the lateral end of the clavicle and the medial border of the acromion. The movement is gliding.

3. The coracoclavicular ligament.

4. The coracoacromial ligament.

Ⅱ）The Articulations of the Free Upper Limb

1. The shoulder joint: which is a typical ball and socket joint between the glenoid cavity of the scapula and the head of the humerus. The shallow glenoid cavity is deeped by the glenoid lip. The joint capsule is a loose cac, thin, especially, lower portion, attached to the margin of the glenoid cavity, also it si attached to the anantomical neck of the humerus.

The long head of the biceps brachii arises from the supraglenoid tubercle, passes through the joint cavity. The capsule is strengthened superiorly by the coracohumeral ligament which passes from the base of the coracoid process to the greater tubercle of the humerus.

The long head of the biceps brachii arises from the supraglenoid tubercle, passes through the joint cavity. The capsule si strengthened superiorly by the coracohumeral ligament which passes from the base of the coracoid process to the greater tubercle of the humerus.

The movements of the shoulder joint: which is the most movable joint in the body: flexion and extension; abduction and adduction; rotation ( medial and lateral ); circumduction.

2. The elbow joint It is a compound joint in one synovial cavity, made up of three articulations as follows: the humero-ulnar joint; the humeral radial joint; the proximal radioulnar joint.

The joint capsule is much thin and loose. There are some ligaments, the radial collateral ligament, the ulnar collateral ligament and the annular ligament which strengthen the capsule.

The movement of the elbow joint: flexion and extension, pronation and supination.

3. The articulations between radius and ulna:

② the interosseous membrane

③ the distal radioulnar joint

The movements: pronation and supination.

4. The Radiocarpal Joint

It is formed by two joint surfaces which are the distal surface of the radial end together with the disc below ulna, and the proximal surfaces of 3 carpal bones, the scaphoid, lunate and triquetral.

Ⅱ. The Articulaions of the Lower Limb

It includes those of the pelvic girdle, and the free lower limb.

Ⅰ）The Articulations of the Girdle of the Lower Limb

1. The composition of the pelvis It is formed by the sacrum, coccyx and two hip bones, and divided into the greater and lesser pelvis by the terminal line.

The pelvic inlet is indicated by the terminal line. The pelvic outlet is bounded by the apex of the coccyx, ischial tuberosity, sacrotuberous ligament, pubic arch, lowerborder of the symphysis pubis.

2. The sacro-iliac joint is formed by the articular surfaces of the sacrum and ilium, and strengthened by the ligaments, especially, interosseous sacroiliac ligament.

3. The symphysis pubis There is a interpubic disc in this articulation which is strengthened by the superior pubic ligament and arcuate pubic ligament.

4. Some important ligament of the pelvis

The sacrospinous ligament

The sacrotuberosity ligament

The iliolumbar ligament

The obturator membrane

Ⅱ）The Articulation of the Free Lower Limb

1. The hip joint is a typical ball and socket joint, formed by the acetabulum of the hip bone and the head of the femur.

The capsule is attached to the rim of the acetabulum, intertrochanteric line and crest.

The cavity of the joint is deeped by the acetabular lip, and the femoral capitate ligament is in it.

The accessory structure of the joint: The acetabular labrum, acetabular ligament, capitate ligment, iliofermoral ligament.

The movement of the joint: flexion, and extension, adduction and abduction, medial and lateral rotation, circumduction.

2. The knee joint It is the largest and most complicated joint of the body. It is made up of the articulations between the femoral and tibial condyles, and between the patella and the femur.

The capsule is attached to circumference of the articular surfaces.

The accessory structures of the joints.

The discs: medial and lateral meniscus.

In the cavity: the anterior cruciate ligament the posterior cruciate ligament.

Around the capsule: the medial ( tibial ) collateral ligament. The lateral (fibular) collateral ligament. The oblique popliteal ligament. The transverse ligament of the knee. The suprapatellar bursa. The synovial folds.

The movements: flexion and extension, medial and lateral rotation (in flexion position).

3. The tibio-fibular articulations: There are three articulations in it, the proximal tibiofibular joint; the interosseous membrane; the distal tibiofibular articulation (ligament).

4. The ankle joint: The articular surface of the distal end of the tibia and fibula form a socket which is articulated with trochlea of the talus. The joint capsule is attached to the circumference of the articular surface and strengthened by the ligaments which are the medial (or deltoid) ligament, the anterior talobibular ligament, the posterior talofiburlar ligament and the calcaneofibular ligament.

The movements: dorsoflexion and plantal flexion abduction and adduction.

5. The articulation of the foot It includes those of the ankle joint, intertatarsal joints, tarsometatarsal joint, inermetatarsal joints, metatarsophalangeal joint and the interphalangeal joints.

6. The arches of the foot The bone of the foot are arranged in three arches. They are the medial longitudinal arch which is formed by the calcaneus, talus, navicular, cuneiforms, and the first, second, third metatarsals. And the talus is the kty bone in this arch. The lateral longitudinal arch is formed by the calcaneas, cuboid and the lateral two metatarsals. The transverse arch is formed by the cuboid, the three cuneiforms, and the bases of the metatarsal bones.

Chapter 3 Myology

Section 1 Introduction

The muscles may be divided into the three types: the skeletal muscle, smooth muscle and cardiac muscle. Here the skeletal muscle is only discussed, which is a part of the locomotor system. It is called voluntary muscle because its contraction is under the voluntary control. About 40% of the body weight is provided from the skeletal muscle. They produce all the voluntary movements, and are essential to the performance of a great variety of body function. Every piece of the skeletal muscles possesses a definite shape, structure, location and accessory apparatus, also has rich supply of the bolld vessels, lymphatics, and nerves. So that, the natural shape, location and action of the muscles are frequently discussed in this chapter.

Ⅰ. The Morphology: Each muscle is composed of the muscular fibres. Generally it can be divided into the belly and tendon, and the later is attached to the bone. The muscles vary extremely in their shape. It may be long, short, broad and circular band-like. In addintion, some muscles have more than one belly or one origin. Some of them, howener, resemblance to feathers, so we called them as pinnate muscles.

Ⅱ. The origin and Insertion: the end of fixed attachement of the muscle is called the origin,the movable one the insertion. Most of muscles are attached either derectly or by there tendons to bones, cartilages, ligaments and so on. In the limbs the more distal parts are usually mobile. Therefore, the distal attachement is usually called the insertion. Some proximal end are generally called the origin.

Ⅲ. The Action: the students should try to learn the origin and insertion of the major muscleofthe body. These, of necessity, include some knowledge of the joint which muscle passes. So that the action of the muscle can be understand. The basic action of the muscle is the contraction. When the action of the muscle operates over some articulation we can see the group of the muscles to make the movement of the joint. According to the action of the function of the muscles the skeletal muscles can be divided into the following: the prime mover, antagonist, synergist. Which are controlledly the nerves?

Ⅳ. The Supplementaty Structrue of Muscles

Ⅰ) The Fascia is formed by connective tissue, and divided into the superficial and deep fascia.

Ⅱ) The Synovial Bursa is a connective tissue sac with a slippery inner surface, and filled with synovial fluid. The bursa is present near the joint.

Ⅲ) The Synovial Tendon Sheath is a double layered synovial sheath, in which the tendon runs, generally locates in the hand and foot.

Ⅳ) The Sesamoid Bones which are developed in some tendons near the joint.

Section 2 The Muscles of the Trunk

The muscles of the trunk may be divided into many groups: Rhe muscles of the back, the muscles of the thorax, the diaphragm, the muscles of the abdomen and the muscles of the perineam. The last one will be discussed in the urigenital system.

Ⅰ. The Muscles of the Back. Which are located on the posterior aspect of the trunk, and canbe divided into two groups, the superficial and the deep. The superficial group includes the trapezius, latissimus dorsi, levotor scapulae and rhomboid muscles. The deep group is a complex group of muscles, which is mainly concerned the movement of the vertebral column.

Ⅰ) The Trapezius which is a large, triangular muscle. It arises from the superior muchal line,external protuberance of the occipital bone, nuchal ligament, spine of 7th C vertebra, spines and supraspinous ligament of the thorax vertebrae. And it is inserted into the lateral 1/3 of the clavicle, acromion, and the spine of the scapula.

Actions ①Steadies, raises, descends, retracts, and rotates the scapula; ②Extends the head;③Dropping shoulder.

Ⅱ) The Latissimus Drsi It is a large wide, triangular muscle, and located the both sides of theback. It arises from the spines of the lower six thoracic vertebrae, the thoracolumbar fascia, lumbar and sacral spinous process, and the iliac crest. And it is inserted into the floor of the intertubercular groove.

Ⅲ) Sacrospinal Muscle It is located in the vertebral groove on both side of the spine. The Function: Bend and rotate the spinal column by acting on one side; extend the spinal column by acting on both sides.

Ⅳ) The others: The levator scapulae, rhomboid muscles, and thoracolumbar fascia

Ⅱ. The Muscles of the Neck by their situations they are divided into four groups: the superficial, suprahyoid, infrahyoid and the deep group.

Ⅰ) The Superficial Group

1. The platysma is a very thin and located in the superficial fascia of the neck.

2. The sternocleidomastoid muscle It arises from the manubrium and the medial 1/3 of the clavicle, and is inserted into the mastoid process of the temporal bone.

The actions: ①The head is inclined laterally and the face is rotated to the opposite. ②Flexthe neck by the acting of both sides.

Ⅱ) The Hyoid Muscles

1. The suprahyoid muscles: Digastric muscle, mylohyoid muscle, stylohyoid muscle, geniohyoid muscle.

2. The infrahyoid muscles: The sternohyoid muscle, omohyoid muscle, aternothyroid muscle, theyrohyoid muscle.

Ⅲ) The Deep Cervical Muscles The group of these muscles are located in front on both sidesof the cervical vertebral column. They are the scalenus anterior, scalenus medius, scalenus posterior.

The scalenus anterior which arises from the transverse process of the cervical vertebra, and isinserted into the first rib. Above the first rib, there is a triangular space, scalene fissure between the anterior and middle scalenus. The brachial plexus and subclavian artery emerge from this space.

The action of the scalenus anterior and scalenus medius which elevate the first rib to breath deeply, flex and rotate the cervical vertebral column to the opposite side.

Ⅲ. The Muscles of the Thorax which are divided into two groups: the extrinsic and intrinsic muscles.

Ⅰ) The extrinsic muscles which include the pectoralis major, pectoralis minor, seratus anterior and subcleivius.

1. The pectoralis major This is large, thick and fan-shaped muscle, covers the upperpart of the chest. It arises from the medial half of the clavicle, the anterior surface of the sternum, the first six costal cartilages, and the aponeurosis of the external oblique mascle of the abdomen. And it is inserted into the crest of the greater tubercle of the humerus.

The Actions: ①Flexes, adducts, and rotates the humerus medially; ②Draws the body upward when the arms are fixed, ③Elevates the ribs to help the inspiration when the scapula is fixed.

2. The pectoralis minor is deep to the pectoralis major.

3. The seratus anterior overlies the lateral portion of the thorax..

Ⅱ) The Intrinsic Muscles which are located between the fibs and sternum or vertebrae. The chief muscles of this group are the external and the internal intercostals muscles.

1. The external intercostals muscles which are located intercostals spaces superficially, arise from the lower border of each rib, and are inserted into the upper border of the rib below.

2. The internal intercostals muscles They are lacated in each intercostals space deep to the external intercostalmuscles. Their fibers run obliquely at right angle to those of the external intercostals muscles. The actions: the external intercostals muscles elevate the ribs to help inspiration, and the inernal interrcostal muscles muve the ribs downwards to help expiration.

Ⅳ. The Diaphragm It is a dome-shaped septum between the thoracic and abdominal cavity. It is divided into the central tendon and peripheral muscular portion.

There are three openings in the diaphragm: ①The aortic hiatus is at the level of the 12^th thoracic vertebra, which transmits the abdominal aorta, the thoracic duct and ofthen the azygos vein. ②The esophageal hiatus is at the level of the 10^th thoracic vertebra, which transmits the esophagus, vagal trunks. ③The vena caval foramen is at the level of 8^th thoracic vertebra, transmits the inferior vena cava.

The actions: ①the chiefly a muscle of inspiration, when diaphragm contracts it will descends. The volumn of thoracic cavity is increased to help the inspiration. ②to increase the intra-abdominal pressure.

Ⅴ. The Muscles of the Abdomen They lie between the lower margin of the thorax and the pelvis, which are divided into two groups: the anterolateral and posterior groups.

Ⅰ）The Aanterolateral Group which forms the anterolateral wall of the abdominal cavity, and consists of three flat muscles: the external oblique, internal oblique, and transverse abdominis; one straplike muscle, the rectus abdominis.

1. The table for 3 flat muscles

ext. oblique m. int. oblique m. tran. abdominis

Origin lower 8 ribs Thoracolumbar fascia Lower 6 costal cart. Ant.2/3 of iliac crest Thoracolumbar fascia Lat. 2/3 of inquinal lig. Iliac crest Iat. Of inquenal lig 1/3 Direction Downward Upward & forward Horizontally of fibers forward at the right angle medially to the ext. oblique m. Insertion Iliac crest Linea alba Rectus sheath Inquinal lig. Cart. of 7th to 10th ribs Conjoint tendon Broad aponeurosis Pubic crest Conjoint tendon Spermatic cord Formed Linea alba Conjoint tendon ………. structure Inquinal lig. Cremaster m…………... the same Sup. inquinal ring Rectus sheath…………. Rectus sheath

2. The rectus abdominis which lies each side of the linea alba. It arises from the pubic symphysis and the pubic crest, and inserted into the xiphoid process and anterior portion of the costal arch.

3. The actions of the anterolateral muscles: ①Support and protect the viscera. ②Maintain and increase the intra-abdominal pressure. ③The important actions are in respiration, defecation, micturition, parturition, vormiting and cough. Also to help the movement of the column.

Ⅱ）The posterior group include the Psoas Major and Quadratus Lumborum. The psoas major will be discussed in the muscles of the lower limb. The guatratus lumborum lies both side of the column.

Section 3 The Muscles of the Head

The muscles of the head can be divided into the muscles of fasial expression and muscles of mastication.

Ⅰ. The muscles of the facial expression which are the epicranial muscles (occipitofrontalis muscle), orbicularis oculi, oricularis oris, baccinator muscles and muscles aroud the nose. Most of them arise from the skull and are inserted into the skin of the face. They pull the skin in various direction to express the emotion. The muscles around the mouth, eyes, nose, and ears are the sphincters and dilators, which close or open the orifices.

Ⅱ. The muscles of mastication They pass the base of the skull to the lower jaw.

Section 4 The Muscles of the Upper Limb

According to different portions the muscles of upper limb are divided into four groups: the muscles of the girdle, the muscles of arm, the muscles of forearm, and the muscles of the hand.

Ⅰ. The Muscles of the Shoulder which surround protect and act the shoulder joint. They arise from the shoulder girdle and are inserted into thehumerus.

And the supraspinous muscle lies in the supraspinous fossa, deep to the trapeius muscle. The infraspinous muscle is in the infraspirnous fossa, and covered by the deltoid and trapezius muscles. The teres minor lies below the infraspinous muscle. Other muscle is the subscapular muscle which is a large, thick triangular lining on the costal surface of the scapula.

Ⅱ. The Muscles of the Arm which are divided into the anterior and posterior muscles

The table for muscles of the arm

Name Origin Insertion Actions
ANTERIOR GROUP	Coracoid process Tuberosity of radius Flexes elbow joint Biceps (short head) Brachii Supraglenoid Fascia of forearm Supinates forearm tubercle(long head) Flexes shoulder joint
	Coracob- Coracoid Middle part Flexes and rachialis process of humerus adducts the arm
	Brachialis Lower part of Coracoid process Flexes below Humerus tuberosity of ulna joint
POSTERIOR	Infraglenoid Triceps tuberosity of scapula Olecranon of Extends the forearm Bracii (long head) the ulna Extends and The lateral to the groove abducts the for radial n.(lat. head) shoulder joint The medial to the groove for radial n. (med. head)

Ⅲ. The Muscles of the Forearm which consist of the anterior and posterior groups.

Ⅰ）The Anterior Group is located in front and medial side of the forearm, and divided into two layers: the superficial and deep.

1. The superficial layer is consists of 6 muscles which are arranged from the lateral to the medial side: The brachioradialis muscle, pronator teres, flexor carpi radialis muscle, palmaris longus, flexor carpi ulnaris and the flexor digitorum superficialis.

The pronator teres It forms the medial borndary of the cuboid fossa, and lacates the front of the proximal portion of the forearm. It arises from the medial enpicondyle of the humerus, and inserted into the middle of the lateral surface of the radius.

The actions of the pronator teres: pronates forearm; flexes elbow joint.

2. The deep layer include 3 muscles: the flexor pollicis longus, the flexor digitorum profundus and the pronator quadratus. They are closely to contact the radius, ulna and interossous membrane.

Ⅱ）The Posterior Group The muscles of this group can be divided into two layers, the superficial and deep layer. They are lacated on the back of the forearm.

Ⅳ. The Muscles of the Hand which include 3 groups as follows:

Abductor pollicis brevis

1. The lateral group: Flexor pollicis brevis

Oppponeus pollicis

Adductor pollicis

Lumbrical muscles

2. The intermediate group: Palmar interossei

Dorsal interossei

Abductor digiti minimis

3. The medial group: hypothenar Flexor digiti minimi brevis

Opponeus digiti minimi

Section 5 The Muscles of the Lower Limb

Which are divided into foru parts: The muscles of the hip, the muscles of the thigh, the muscles of the leg, and the muscles of the foot.

Ⅰ. The Muscles of the Hip They are divided into the anterior group and posterior group according to their location.

Ⅰ）The Anterior Group

1. The Iliopsoas It is consists of the psoas major and iliac muscle; the psoas major lies lateral to the lumbar region of the vertebral column, iliac fossa and roof of the thigh. It arises from the transverse processes. Vertebral bodies and intervertebral discs of L1 to L5 vertebrae, and inserted into the lesser trochanter of the femur. The iliac muscle lies the lateral side of the psoas major in the iliac fossa.

The Actions: Flexes the thigh; rotate the thigh lateally; if the lower limb is fixed it bends the vertebral column forward and flexes the lumbar region laterally.

2. The Tensor Fasciae Latae lies on the lateroanterior sides of the thigh.

Ⅱ）The Posterior Group which lies chiefly in the gluteal region, so that they are also called the gluteal muscles.

1. The Gluteus Maximus It is a large, thick muscle which arises from the iliac ala, sacrum and coccyx, and the sacrotuberous ligament. It is inserted into the iliotibial band and the guluteal tuberosity of the femur.

The actions: extends the thigh; rotates laterally; and keeps the posture.

2. The Gluteus medius and gluteus minimus They are located deep to the gluteus maximus in order.

3. The Piriformis muscle It lies deep to gluteus medius, and is a landmark muscle.

Ⅱ. The Muscles of the Thigh They are divided into three groups: the anterior, posterior and the medial.

Ⅰ）The Anterior Group The Satorius and the Quadriceps Femoris are in this group. They extend the knee and help to flex the hip.

1. The Satorius It arises from the anterior superior iliac spine, passes the upper and anterior part of the thigh to the medial side of the knee, and inserted into the medial surface of the upper part of the tibia.

The actions: Extends the hip and knee joint, medially rotates the flexed knee.

2. The Qquadriceps Femoris It lies in front of the thigh. It is the largest and most powerful muscle of the body. It is composed of 4 muscles: the rectus muscles, the vastus medialis, the vastus lateralis, and the vastu intermedius. That is to say, these four muscles forms a strong quadriceps femoris which arises from the anteroinferior iliac spine, line aspera, anterior surface of the femur. It is inserted into the tibial tuberosity by the patellar ligament.

The actions: Extends the leg, flexes the thigh, act in climbing, running, rising from a sitting position, and walking up and down stairs.

Ⅱ）The Medial Group These muscles locate on the medial side of the thigh. They are chiefly adductors of the thigh: The pectineal muscle, adductou longus, gracilis, adductou magnus. The adductor magnus has a insertion on the adductor tubercle above the medial epicondyle of the femur. There is a hiatus between the aponeurotic insertion of the adductor magnus and the femur, which is termed the adductou hiatus. Which allows the femeral vessels passing through it ingo the popliteal fossa.

The action of the muscles of the anterior group: adduct, flex, and laterally rotate the thigh.

Ⅲ）The Posterior Group In this group there are 3 large muscles on the back of the thigh. Thesemuscles are, as well as, called the hamstring muscles. They are the biceps femoris, the semitendinous muscle, and the semimembranous muscle.

The actions: extends the thigh, flexes the leg, rotates the leg when the knee joint is flexed.

Ⅲ. The Muscles of the Leg It is divided into 3 groups:

Ⅰ）The Anterior Group Which lies in the front of the tibia, fibula and the interosseous membrane. There are 3 muscles in this group. They are the tibialis anterior, the extensors digitorum longus, and the extensor hallucis longus. The tibialis anterior arises from the lateral surface of the tibia, and is inserted the medial cuneisform bone and the base of the first metatarsal bone. It locates on the lateral side of the tibia, and its tendon becomes free in the distal 1/3 of the leg, passes deep to the retinaculum to the medial border of the foot.

The action of the anterior group: Dorsiflex the ankle joint, invert the foot, extend the big toe,and extend digitorum longus.

Ⅱ）The Lateral Group It lies on the lateral side of the tibia, and consists of two muscles.

Ⅲ）The Posterior Group which plantar-flex ankle joint, and is divided into following layers.

1. The Tibialis posterior lies laterally to the flexor digitorum longus. It arises from the tibia, fibula and posterior surface of the interosseous membrane, and is inserted into the navicular, intermediate and lateral cuneiforms, and the bases of the 2^nd, 3^rd, 4^th, metatarsals.

Acitons: flexes the ankle joint, inverted the foot medially.

2. The Triceps surae muscle. It is one of the powerful muscles. It has three heads, the two heads arise from the medial and lateral condyles of the femur respectively, which form the inferolateral and inferomedial bandaries of the popliteal fossa and unite together to form the convex strong muscle as termed gastrocnemius. And another head is the soleus which lies immediately deep to the gastrocnemius, and arises from the upper part of the posterior surface of the tibia and fibula. The gastrocnemius and soleus muscles unite together to become the strongest cal caneal tendon which inserts into the calcaneus bone.

The actions: Plantarflex the ankle joint: steadies the leg on the foot during standing; flexs the knee.

Ⅳ. The Muscles of the Foot The extensor digitorum brevis on the dorsum, the muscles of the sole are divided into 3 groups as follow:

The splanchnology usually concerns with the study of the viscera. According to the function which they perform, the viscera includes the digestive system, urigenital system and endocrine system.

Most organs of these system are located in the thoracic cavity and the abdominal cavity, and some of them are associated with the pleura and peritoneum.

In this course, we will discuss the general morphology and structure of the viscera. As well as, some function will be concerned in our lessons.

Ⅰ. The Common Used Reference Lines of the Thorax

1. The anterior median line A vertical line through the median of the sternum.

2. The midclacicular line It extends downward vertically from the midpoint of the clavicle and ususlly coincides with mammary line in male.

3. The anterior axillary line A vertical line downward from the anterior axillary fold.

4. The midaxillary line A vertical line midway between anterior and posterior axillary line.

5. The posterior axillary line A vertical line downward from the posterior axillary fold.

6. The scapular line A vertical line through the inferior angle of the scapula.

7. The posterior median line A vertical line through the spines of the thoracic vertebrae.

Ⅱ. The Abdominal Regions In order to describe the abdominal regions which contains the viscera. The abdomen is divided into nine regions by four imaginary planes, the upper and lower horizontal plane, and the right and left vertical planes. It is often used in the clinic.

The upper horizontal plane passes through the lowest point of the costal arch. And the lower horizontal plane passes both iliac tubercles. The right and left vertical plane across the middle point of the inquinal ligament passing above two horizontal plane at the right angle. In this way the avdomen is divided into following portions.

The digestive system means study of the alinmetary canal of the organs, which includes the digestive canal and certain accessory organs, such as the lips, cheeks, palate, tongue and the teeth, as well as includes some glands, the salivary glands, liver and pancreas. The alimentary canal is about 9 m long extends from the mouth to the anus. It consists of the following parts: the mouth, the pharynx, the esophagus, the stomach, and the small and large intestines.

Section 1 The Oral Cavity

The oral cavity can be divided into the vestibule and the oral proper cavity. The vestibule of the mouth is a slit-like space. And the oral cavity proper is vounded by the alveolar arches, the isthmus of fauces, the palate, and the tongue.

The isthmus of fauces is the bound of the oral cavity and phyrax between the palatoglossal folds.

Ⅰ）The Teeth There are two sets of teeth in man, the deciduous and permanent.

The structure of teeth: Which includes the crown, the root, the neck, and the pulp. The vessels and nerves pass the apical foramen at the apex of the teeth root into the pulp.

Ⅱ）The Tongue It is divided into three parts: the apex, body and the root. It has a dorsal andinferior surface, on the dorsal surface there is a V-shaped groove termed the sulcus terminalis, which is the boundary between the oral part and the pharyngeal part of the tongue. Also there are four types of papillae on the tongue. They are the vallate papillae, fungiform papillae, filiform papillae and the foliate papillae.

There is a lingual frenulum which is a vertical fold of mucous membrane in the midline between the tongue and the floor of the mouth. On the both side of the lower end of the frenulum there is a small elevation, the sublingual papilla, on the surface of which is the orifice of the duct of the submandidubular salivary gland.

The Muscles of the tongue The muscles of the tongue are consist of intrinsic and extrinsic muscles. The intrinsic muscles lie entirely in the tongue. And extrinsic muscles are three each side, the hyoglossus, the styloglossus, and the genioglossus. The genioglossus draws the tongue forward and downward, and helping to protrude the tongue. It arises from the middle spine of the mandible, and is inserted into the both sides of the mental line of the tongue.

Ⅲ）The Salivary Gland There are 3 parts of the major salivary glands whose ducts open into the mouth. As well as, there are many minor salivary glands in the lips, chee,s, tontue and palate.


Table of salivary gland

Name Position Orifice

Parotid Gland The anteroinferior to the ear The oral surface of The posterior border of masseter the cheek opposite The posterior mandibular fossa the crown of the 2nd upper molar tooth Submandibular In the upper part of neck, below The floor of the mouth Gland the floor of the mouth, and deep to the mandibular body Sublingual Gland Beneath the musous membrane the surface of sublingual fold of the floor of the mouth

The Parotid Duct: It is about 5 cm long, passes forwards across the masseter muscle and then turns inwards. It pieces the buccinator muscle and opens upon a small papilla on the oral surface of the cheek opposite the crown of the second upper molar tooth.

Section 2 The Pharynx

The pharynx is the part of the alimentary canal; it is located behind the masal cavity, the mouth and the larynx. It extends from the base of the skull to the level of 6^th cervical vertebra to continue the esophagus. The pharynx may be divided into three parts: the nasal, oral and the laryngeal.

1. The Nasopharynx Anteriorly it communicates with the nasal cavity through two large choanae. The pharyngeal opening of the auditory tube presents on the lateral wall of it. Antero-supero-posteriorly to this opening there is a prominent termed the torus tubarins, behind which lies the slitlike pharyngeal recess.

2. The oropharynx which is the continuous with the mouth through the isthmus of the fauces. The palatine tonsil is located on each side of the oropharynx. And lodged in a tonsillar fossa.

3. The laryngopharynx which communicates above with the oropharynx and below with esophagus. Anteriorly it communicates with the cavity of the larynx through the inlet of the larynx. The piriform fossa lies on each side of the laryngeal orifice.

Section 3 The Esophagus

The esophagus is a muscular tube, about 25cm long, is continuous from the pharynx to the stomach, it passes down through the lower part of the neck and the superor and posterior parts of the midastinum, pierces the diaphragm at the level of the 10^th thoracic vertebra, ends the cardial orifice of the stomach.

There are 3 narrow portions for the esophagus: ①at its commencement, 15cm long from theinxisor teeth; ②at the level where the left bronchus crossed, 25cm long from the incisor teeth;③where it passes through the diaphragm, 46cm long from the incisor teeth.

Section 4 The Stomach

The stomach is located between the end of the esophagus and the beginning of the small intestine. It lies in the epigastric, unbilical, and the left hypochondriac regions of the abdomen. The shape and the position of stomach are varied from person to person. And the capacity varies with age, being about 30ml at birth, and about 1500ml in the adult.

1. The Features: cardiac, cardiac notch, fundus, body, angular notch, pyloric autrum, pyrorus, pyloric sphincter, greater and lesser curvature, anterior and posterior surface.

2. The stomach bed: are most important, the pancreas, the upper pole of the left kidney, the left supararenal gland, the left crus of the diaphragm, the left colic flecture, the spleen, and the posterior wall of the omental bursa. In fact, the stomach bed is the posterior relation of the stomach.

Section 5 The Small Intestine

It is a convoluted tube, extending from the pyrorus to the iliocaecal valve, where it joints the large intestine. It is about 6-7m long. The small intestine can be divided into the duodenum, jejunum, and the ileum.

Ⅰ. The Duodemum which is the shortest, widest and most fixed part of the small intestine, it hasn’t mesentery, and is only partially covered with peritoneum. The shape of the duodenum like and incomplete cirecle, which encloses the head of the pancreas. It lies entirely above the level of the umbilicus. It begins at the pylorus and end opposite the 2^nd lumbar vertebra in the jejunum. And it can be divided into four parts.

Ⅰ）The Superior part It begins at the pylorus, and ends the area of the neck of the gallbladder. This part also is called the bulbus duodeni in the clinic.

Ⅱ）The Descending Part Its medial side is related to the head of the pancreas and common bile duct. The two ducts come into the midial wall of the descending part of the duodenum, and to form a short, dilated tube which is termed the hepatopancreatic ampulla.

Ⅲ）The Horizontal Part which begins at the right side of the lower border of the third lumbar vertebra. The anterinor surface is covered with peritoneum.

Ⅳ）The Ascending Part At he level of the upper border of the second lumbar vertebra, where it turns ventrally at the duodenojejunal flexure and is continuous with the jejunum. Its right border attaches the upper part of the root of the mesentery. The terminal part of the duodenum and duodenojejunal flexure are fixed on the posterior wall of the abdominal cabity by suspensory muscle of the duodenum which also is termed the ligament of Treitz.

Ⅱ. The Jejunum and Ileum which are continuous with the duodenum from the duodenojejunal flexure to the ileocaecal orifice where it joins the large intestine. The upper 2/5 of this seganent of the small intestine is called the jejunum, and another lower 3/5 is the ileum. The most part of ileum is located in the right lower part of the abdominal cavity.

Section 6 The Large Intestine

The large intestine has a greater caliber. Usually its most part is more fixed on the posterior wall of the abdominal cavity. There are three considerable characteristics, the taeniae coli or longitudinal bands; the haustracoli or sacs; the epiploic appendices or adipose projections.

The parts of the large intestine: the caecum, the vermiform appendix, the colon-the ascending, transverse, descending and the sigmoid colon, and the rectum.

Ⅰ. The caecum Usually it is located in the rught iliac fossa. The caecum is generally covered completely with peritoneum. There are the ileocaecal valves on the wall of the caecum where the ileum come into to joint the large intestine.

Ⅱ. The Vermiform Appendix It is varialble position, and usually it locates in the right iliac fossa.

The Projection of the Root of the Appendix which is at the conjuction of the middle 1/3 and the lateral 1/3 of the line which connects the umbilicum and the anterior-superior iliac spine.

Ⅲ. The Rectum and Anal Canal which is continuous with the sigmoid colon at the S3. It lies in the pelvic cavity.

The Rectum

1. Sacral flexure-downward and backward

2. Perineal fexure-downward and forward

3. Rectal ampulla-dilatation

4. Transverse rectal folds-two on left, one on right.

Anal canal

1. Anal columns 5. Anal pectin

2. Anal valves 6. White line

3. Anal sinus 7. Internal anal sphincter

4. Pectinate line 8. External anal sphincter

Section 7 The Liver

The liver is the largest gland in the body.

Ⅰ. The Position: In the right hypochondriac region,

the epigastric region,

the left hypochondriac region (a little part).

Ⅱ. The Lobes: Right lobe-large

Left lobe-small

Quadrite lobe

Caudate lobe-tail lobe

Ⅲ. The Features: Wedge-shaped organ

Two surfaces: the superior and inferior

“H”shaped structure formed by two longitudinal sulci and transverse sulcus

Ⅳ. The Ligaments: Falciform lig.

Round lig.

Right and left triangular lig.

Ant. And post. coronary lig.

Ⅴ. The Hepatic Porta (Porta Hepatis ) The transevese sulcus is called the hepatic porta.

1. Left and Right hepatic duct

2. Left and Right branches of the proper hepatic A.

3. Left and Right branches of the portal V.

4. Nerves

5. Lumphatics

Above structures which are surrounded by the connective tissue called Hapatic pedicle.

Ⅵ. The Structure Formed of “H”-shaped Sulcus

1. Left-anteriorly: hepatic round ligament

2. Left-posteriorly: hepatic venous ligament

3. Right-anteriorly: fossa for gallbladder

4. Right-posteriorly: sulus ofr vena cave

5. Transverse sulcus: hepatic porta

Ⅶ. The Surface Anatomy

The inferior bound of the liver is the same as its lower margin which may be represented by and oblique line beginning the lowest point of the right costal arch at the right midaxillary line, and runs to the left along the costal arch, as far as the tip of 9^th costal cartilage, crossing to the top of the left 8^th costal cartilage, and ending in the 5^th intercostals space at the left midclavicular line.

The superior bound of the liver is the same as the dome of the diaphragm, which begins 10^th rib at the right midaxillary line, runs to the superior border of 7^th rib along the thoracic wall, passing 5^th costal cartilage at the midclavicular line, and reach 5^th intercostals space to the medial side of the left midclavicular line to unite with the lower margin of the liver.

Section 8 The Gallbladder and The Biliary Ducts

Ⅰ. The Gallbladder which lies in the fossa for gallbladder on the visceral surface of the liver.

Ⅱ. The Features

1. A pear-shaped organ

2. Fundus

3. Body

4. Neck

Ⅲ. Biliary Apparatus (bile ducts )

1. Left and right hepatic duct

2. Common hepatic duct

3. Cystic duct

4. Gallbladder

5. Common bile duct

Ⅳ. The Bypass of the Bile From the liver bile is produced by the hepatocytes in the liverbile ductulesright and left hepatic ductcommon hepatic ductcystic ductgallbladdercystic ductcommon bile ductdesending duodenum.

Ⅴ. The Special Notes

1. Major duodenal papulla In the medial wall of the descending part of the duodenum the common bile duct contact with the pancreatic duct and unite to form hepatopancreatic ampulla which opens into the descending part of the duodenum on the summit of the Marjou Duodenal Papulla.

2. The sphincter of oddi There is the circular muscle around the lower part of the bile duct, ampulla and terminal part of the main pancreatic duct, which is termed the Sphincter of Oddi (sphincter of hepatopancreatic ampulla ).

Section 9 The Pancreas

The pancreas is only smaller gland than the liver. It is located the posterior wall of the abdominal cavity at the level of L1, 2, behind the stomach and other many orghns.

Ⅰ. The