Atlas of Human Anatomy
ELSEVIER General Anatomy and
Musculoskeletal System
' I M 1ILR
15th Ed itio n
Edited by f Paulsen and J W asrbkc;
FngI«r.h V ersion w ith Latin N om onctm urc
URBAN & FISCHER
Includes online access to www.e-sobotta.com tv
Please note that the book cannot Your online access fo r this
be returned once sticker is book on www.e-sobotta.com :
scratched off.
1. Gently scratch o ff the sticker on the left side to get
Further inform ations is provided at your unigne PIN number.
w w w .e-s o b o tta .c o m /se rv ic e
2. Register once on w w w .e-sobotta.com w ith your
This book has many user name and personal password.
online extras!
3. A fte r login you'll need your PIN num ber to get
Your individual online access enables access to the online offer.
you to:
• use exclusive bonus contents to 4. For any further online visit you only need log in w ith
your user name and password.
this book.
• prepare systematically for exams. Access to the online content fo r this book is granted
For detailed informations see back after activation according to the term s o f use. Full
cover! details and term s of use are available upon registrati
on. Access to the Sobotta online portal w ill be subject
to your acceptance of these term s of use.
Im portant note:
Purchase of this book includes access to the online
version o f this edition as w ell as bonus material fo r
use exclusively by the individual purchaser from the
launch of this site. Library and institutional access and
use are strictly prohibited. Access may not be shared,
resold or otherw ise circulated.
Please note: The sharing of passwords is strictly
prohibited and any a ttem p t to do so w ill invalida
te the passwords immediately and w ithout any
further notice.
Non-binding offer.
User's Guide to the Book
Introductory pages: • Bulleted lists in figu re captions as w e ll as in tables help stru ctu
• The introductory pages provide all relevant anatomical inform a ring com plex facts and provide a better overview.
tions concerning the subject of the chapter. Im portant details • Figures, tables, and te xt boxes are interconnected by cross-
and connections are explained easily to understand. references.
• The Dissection Link fo r each chapter com prises brief and con
cise tips essential fo r the dissection of the respective body re • Cross-references link the figures to the separate Table Booklet
gion. w ith tables of muscles, joints, and nerves, thus providing a suf
• Exam Check Lists provide all keyw ords fo r possible exam ficient anatomical knowledge fo r the exam.
questions.
• Clinical Remarks boxes provide clinical background knowledge
Atlas pages: concerning the anatomical structures illustrated on the page.
• The menu bar on top indicates the topics of each chapter, the
• The dissection link on the page indicates if a tip fo r dissecting
bold print shows the subject of the respective pages. th e illustrated anatom ical region is available on w w w .e -s o b o tta .
• Im portant anatomical structures in the figures are highlighted in com.
bold print. Appendix:
• Small supplem ent sketches located next to com plex view s • List of abbreviations, general te rm s o f direction and position
show visual angles and intersecting planes and, thus, facilitate can be found at the end o f the book.
orientation.
• Detailed figure captions explain the relationships o f anatomical
structures.
Perfect Orientation - the New Navigation System
Upper Extremity The menu bar w ith the
term s printed in bold
The subject of this page indicates the subject of
the current page.
Sketches facilitate
orientation in com plex Im portant anatomical
figures by showing visual stru cture s are printed in
angles and intersecting bold.
planes.
Figure captions explain Clinical R em arks The Clinical Remarks
anatom ical connections boxes describe medical
concerning the a Th*mota» !»«•»« contexts to the
illustrated structures. anatomical structures
illustrated on the page.
For pages w ith this M ostly, these clinical
dissection link detailed aspects are also o f high
dissection tips can be relevance fo r the exam.
found on w w w .e-sobotta.
com.
The following contents can be found in the other tw o volumes:
5 Viscera of the Thorax T h y m u s -♦ T o p o g ra p h y -► S e c tio n s
H eart -♦ L u n g s -► O e s o p h a g u s
Vol. 2 Internal O rga ns 6 Viscera of the Abdom en
D e v e lo p m e n t -► S to m a c h In te s tin e s -► L iv e r a nd G a llb la d d e r
P ancreas - > S p lee n -*■ T o p o g ra p h y -► S e c tio n s
7 Pelvis and Retroperitoneal Space G enitalia
K id n e y and A d re n a l G la n d -> E ffe re n t U rin a ry S ystem
R ectum and A n a l Canal -► T o p o g ra p h y -► S e c tio n s
8 Head
O v e rv ie w -» S ke le to n a nd J o in ts -» M u s c le s -► T o p o g ra p h y -►
Vessels a nd N e rve s N ose -► M o u th and O ral C a v ity S a liv a ry G la n d s
9 Eye
D e v e lo p m e n t -► S ke le to n -» E y e lid s -► L a c rim a l A p p a ra tu s -►
M u scle s o f th e Eye -► T o p o g ra p h y -► E yeball V isu a l P a th w a y
Vol. 3 Head, Neck, and N euroanatom y 10 Ear A u d ito ry Tube -♦ Inner Ear
O v e rv ie w -► O u te r Ear -♦ M id d le Ear
Hearing and E q uilibrium
11 Neck
M u scle s -*• P h a ry n x -► L a ry n x -► T h y ro id G la n d -► T o p o g ra p h y
12 Brain and S pina l Cord S e c tio n s
G e ne ra l -► M e n in g e s and B lo o d S u p p ly -> B ra in
C ranial N e rves -► S p in a l C ord
Paulsen, Waschke
Sobotta
Atlas of Human Anatomy
Latin Nomenclature
General Anatomy and
Musculoskeletal System
T ra n sla te d by
T. K lo n is c h a n d S. H o m b a c h -K lo n is c h
Atlas of Human Anatomy
General Anatomy and
Musculoskeletal System
15th edition
Edited by F. Paulsen and J. Waschke
Translated by T. Klonisch and
S. Hombach-Klonisch, W innipeg, Canada
597 Coloured Plates w ith 700 Figures
ELSEVIER URBAN & FISCHER
URBAN & FISCHER München
Editors
Prof. Dr. Friedrich Paulsen Prof. Dr. Jens Waschke
Dissecting Courses for Students M ore Clinical Relevance in Teaching
In his teaching, Friedrich Paulsen p u ts g re a t em phasis on the fact From March 2011 on, Professor Jens Waschke is Chairman o f
that students can actually dissect on cadavers o f body donors. "The Departm ent I at the Institute o f Anatom y and Cell Biology at the
hands-on experience in dissection is extrem ely im po rtan t n o t only Ludwig-Maximilians-Universitat (LMU) Munich. " For me, teaching at the
fo r the three-dim ensional understanding o f anatom y and as the basis departm ent o f vegetative anatomy, which is responsible for the
fo r virtually every m edical profession, b u t fo r m any students also dissection courses o f both M unich's large universities LM U andTU,
clearly addresses the issue o f death a n d dying fo r th e firs t tim e. The emphasizes the importance o f teaching anatom y w ith clear clinical
m em bers o f the dissection team no t only study anatom y b u t also relevance", says Jens Waschke.
learn to deal w ith this special issue. A t no o th e r tim e m edical "The clinical aspects in the Atlas introduce students to anatom y in the
students w ill have such a close contact to their classm ates and first semesters. A t the same time, it indicates the importance o f this
teachers again." subject fo r future clinical practice, as understanding human anatomy
"The dissection links in the atlas lead to online im ages that are m eans m o re than ju s t m em orization o f structures."
relevant fo r the dissection. You can p rin t the m and take the m along.
The offered dissection tips are n o t instructions, b u t make sure that P rofessor Jens W aschke (born in 1974) habilitated in 2007 after
you are orie nted exceptionally w e ll and n o t 'cutting in the dark'." graduation from Medical School and com pleting a doctoral thesis at
the University of W uerzburg. From 2003 to 2004 he joined Professor
P rofessor Friedrich Paulsen (born 1965 in Kiel) passed the 'A b itu r' in Fitz-Roy Curry at th e U niversity o f California in Davis fo r a nine m onths
Brunswick and trained successfully as a nurse. A fte r studying human research visit. Starting in June 2008, he became the Chairman at the
m edicine in Kiel, he becam e scientific associate at the Institute of Institute o f A natom y and Cell B iology III at th e U niversity of
Anatom y, D epartm ent of Oral and Maxillofacial Surgery and the W uerzburg. In 2005, to g e th e r w ith his colleagues, Professor W aschke
D epartm ent o f Otolaryngology, Head and Neck Surgery o f the w as awarded the A lbert Koelliker Teaching Aw ard of the Faculty of
C hristian-A lbrechts-U niversitat Kiel. In 2002, to g e th e r w ith his M edicine in W uerzburg. In 2006, he w as aw arded the W olfgang
colleagues, he w as awarded the Teaching Aw ard fo r outstanding Bargmann Prize o f th e Anatom ical Society.
teaching in th e field o f anatom y at the M edical Faculty o f the
U niversity o f Kiel. On several occasions he gained w o rk experience His main research area concerns cellular m echanism s th a t control the
abroad in the academic section o f the D epartm ent o f Ophthalm ology, adhesion betw een cells and the cellular junctions establishing the
University of Bristol, UK, w here he did research fo r several m onths. ou ter and inner barriers o f th e human body. The attention is focused
on th e regulations o f th e endothelial barrier in inflam m ation and the
From 2004 to 2010 as a University Professor, he w as head of the m echanism s, w hich lead to th e form atio n o f fatal dermal blisters in
Macroscopic Anatom y and Prosector Section at the Departm ent of pem phigus, an autoim m u ne disease. The goal is to gain a be tter
A nato m y and Cell Biology o f the Martin-Luther-Universitat Halle- understanding o f cell adhesion as a basis fo r the developm ent o f new
W ittenb erg . Starting in April 2010, Professor Paulsen becam e the therapeutic strategies.
Chairman at th e Institute o f A natom y II o f the Friedrich-Alexander-
Universitat Erlangen. Since 2006, Professor Paulsen is a board
m em ber of the Anatomical Society and 2009 he was elected the
general secretary of the International Federation o f Associations of
A nato m y (IFAA).
His main research area concerns th e innate im m une system . Topics
o f special interest are antimicrobial peptides, trefoil factor peptides,
surfactant proteins, mucins, corneal w ound healing, as w ell as stem
cells of the lacrimal gland and diseases such as eye infections, dry
eye, or osteoarthritis.
All business correspondence should be m ade w ith:
Elsevier GmbH, Urban & Fischer Verlag, H ackerbrucke 6, 80335 M unich, Germany, mail to: m edizinstudium @ elsevier.de
Addresses of th e editors: This atlas w as founded by Johannes Sobotta t , form er Professor of
P rofessor Dr. med. Friedrich Paulsen A nato m y and D irector o f th e Anatom ical Institute of th e U niversity in
In stitu t fü r A natom ie II (Vorstand) Bonn, Germany.
Universität Erlangen-Nürnberg
U niversitätsstraße 19 German editions:
91054 Erlangen 1st edition: 19 04-1907 J. F. Lehm anns Verlag, M unich
Germany 2 r|d_'| 1 th edition: 19 13-1 944 J. F. Lehm anns Verlag, M unich
12th edition: 1948 and fo llo w in g editions
P rofessor Dr. med. Jens W aschke
Institut für Anatomie Urban & Schwarzenberg, Munich
Ludwig-M aximilians-Universität 13th edition: 1953, ed itor H. Becher
P ettenkoferstraße 11 14th edition: 1956, ed itor H. Becher
80333 München 15th edition: 1957, ed itor H. Becher
Germany 16th edition: 1967, ed itor H. Becher
17th edition: 1972, editors H. Ferner and J. Staubesand
Addresses of the translators: 18th edition: 1982, editors H. Ferner and J. Staubesand
P rofessor Dr. med. Sabine Hombach-Klonisch 19th edition: 1988, ed itor J. Staubesand
P rofessor Dr. med. Thom as Klonisch 20th edition: 1993, editors R. Putz and R. Pabst
Faculty of M edicine
D epartm ent o f Human A natom y and Cell Science Urban & Schwarzenberg, Munich
University o f Manitoba 21st edition: 2000, editors R. Putz and R. Pabst
745 Bannatyne Avenue
W innipeg M anitoba R3E 0J9 Urban & Fischer, Munich
Canada 22nd edition: 2006, editors R. Putz and R. Pabst
Bibliographic inform ation published by the Urban & Fischer, Munich
Deutsche Nationalbibliothek 23rd edition: 2010, editors F. Paulsen and J. W aschke
The Deutsche Nationalbibliothek lists this publication in the Deutsche
N ationalbibliografie; detailed bibliographic data are available in the Elsevier, Munich
Internet at http://www.d-nb.de.
Foreign editions:
All rights reserved Arabic edition
15th Edition 2011 M odern Technical Center, Damaskus
© Elsevier GmbH, M unich Chinese edition (complex characters)
Urban & Fischer Verlag is an im print o f Elsevier GmbH. Ho-Chi Book Publishing Co, Taiwan
Chinese edition (simplified Chinese edition)
11 12 13 14 15 5432 1 Elsevier, Health Sciences Asia, Singapore
Croatian edition
For copyright concerning the pictorial material see picture credits. Naklada Slap, Jastrebarsko
Czech edition
All rights, including translation, are reserved. No part o f this publication Grada Publishing, Prague
may be reproduced, stored in a retrieval system , or transm itted in any Dutch edition
other form or by any means, electronic, mechanical, photocopying, Bohn Stafleu van Loghum, Houten
recording, or otherw ise w ith o u t the prior w ritte n permission o f the English edition (w ith nom enclature in English)
publisher. Elsevier Inc., Philadelphia
English edition (w ith nom enclature in Latin)
Acquisition editor: Alexandra Frntic, M unich Elsevier GmbH, Urban & Fischer
D evelopm ent editor: Dr. Andrea Beilmann, Munich French edition
Editing: Ulrike Kriegel, buchundmehr, M unich Tec & Doc Lavoisier, Paris
Production manager: Sibylle Hartl, Munich; Renate Hausdorf, Greek edition (w ith nom enclature in Greek)
buchundmehr, Gräfelfing Maria G. Parissianos, A then
Composed by: M itterw eger & Partner, Plankstadt Greek edition (w ith nom enclature in Latin)
Printed and bound by: Firmengruppe appl, W em ding Maria G. Parissianos, A then
Illustrators: Dr. Katja D alkow ski, B uckenhof; Sonja Klebe, Aying- Hungarian edition
Großhelfendorf; Jörg Mair, Munich; Stephan W inkler, Munich Medicina Publishing, Budapest
Cover illustration: Nicola Neubauer, Puchheim Indonesian edition
Cover design: SpieszDesign, Neu-Ulm Penerbit Buku Kedokteran EGC, Jakarta
Printed on 115g Quadro Silk Italian edition
Elsevier Masson STL, Milan
ISBN 978-0-7234-3639-3 Japanese edition
Igaku Shoin Ltd., Tokyo
Korean edition
Elsevier Korea LLC
Polish edition
Elsevier Urban & Partner, W roclaw
Portuguese edition (w ith nom enclature in English)
Editora Guanabara Koogan, Rio de Janeiro
Portuguese edition (w ith nom enclature in Latin)
Editora Guanabara Koogan, Rio de Janeiro
Russian edition
Reed Elsevier LLC, M oscow
Spanish edition
Editorial M edica Panamericana, Buenos A ires/M adrid
Turkish edition
Beta Basim Yayim Dagitim, Istanbul
Ukrainian edition
Elsevier Urban & Partner, W roclaw
C urrent info rm atio n by w w w .elsevier.de and w w w .elsevier.com
Table of contents
G e n e ra l A n a to m y 4
6
Orientation on the Body ............................................................. 12
Surface A na tom y......................................................................... 14
Development................................................................................ 22
Muskuloskeletal S yste m ............................................................. 32
Vessels and N erves..................................................................... 36
Imaging Techniques....................................................................
Integumentary System ..............................................................
T ru n k
Surface A na tom y......................................................................... 42
Development................................................................................ 44
Skeleton ....................................................................................... 46
Im aging........................................................................................ 68
M uscles........................................................................................ 74
Vessels and N erves..................................................................... 96
Topography, Back ....................................................................... 104
Female Breast.............................................................................. 114
Topography, Abdomen and Abdominal Wall .......................... 118
U p p e r E x tr e m ity
Surface A na tom y......................................................................... 130
Development................................................................................ 132
Skeleton ....................................................................................... 134
Im aging........................................................................................ 156
M uscles........................................................................................ 160
Topography................................................................................. 194
Sections ....................................................................................... 239
L o w e r E x tr e m ity
Surface A na tom y......................................................................... 246
Skeleton ....................................................................................... 248
Im aging........................................................................................ 290
M uscles........................................................................................ 296
Topography................................................................................. 326
Sections ....................................................................................... 369
Translators
Prof. Dr. Thomas Klonisch Prof. Dr. Sabine Hombach-Klonisch
Professor Thomas Klonisch (born 1960) studied human medicine at Teaching clinically relevant anatom y and clinical case-based anatom y
th e Ruhr-Universität B ochum and the Justus-Liebig-U niversität (JLU) learning are the main teaching focus o f Sabine Hombach-Klonisch at
Giessen. He successfully com pleted his doctoral thesis at the Institute the Medical Faculty of the University of Manitoba. Since her
of Biochem istry at the Faculty of M edicine of the JLU Giessen and appointm ent in 2004, P rofessor Hombach has been nom inated
became a scientific associate at the Institute of Medical Microbiology, annually fo r teaching awards by the Manitoba Medical Student
University o f Mainz (1989-1991). A s an Alexander von Hum boldt Association.
Fellow he joined the University of Guelph, Ontario, Canada, from
19 91-1992 and, in 1 9 9 3 -1 9 9 4 , continued his research at th e Ontario Sabine Hombach (born 1963) graduated from Medical School at the
Veterinary College, Guelph, Ontario. From 1994-1996, he joined the Justus-Liebig-U niversität Giessen in 1991 and successfully com pleted
im m unoprotein engineering group at the D epartm ent of Immunology, her doctoral thesis in 1994. Following a career break to attend to her
University College London, UK, as a senior research fellow . From tw o children she re-engaged as a sessional lecturer at the Departm ent
1996-2 004 he was a scientific associate at the D epartm ent of o f A natom y and Cell Biology o f the M artin-Luther-Universität
A natom y and Cell Biology, M artin-Luther-U niversität Halle-W ittenberg, Halle-W ittenberg in 1997 and received a post-doctoral fellow ship by
w here he received his accreditation as an atom ist (1999), com pleted the province o f Saxony-Anhalt fro m 1998-2000. Thereafter, she joined
his habilitation (2000), and held continuous national research funding the D epartm ent o f A natom y and Cell Biology as a scientific associate.
by th e German Research Council (DFG) and German Cancer Research Professor Hombach received her accreditation as an atom ist in 2003
Foundation (Deutsche Krebshilfe). In 2004, he w as appointed Full by the German Society of Anatom ists and by the Medical Association
Professor and Head at the D epartm ent o f Human A natom y and Cell o f Saxony-Anhalt and com pleted her habilitation at the Medical Faculty
Science at the Faculty of M edicine, University of Manitoba, W innipeg, o f th e M artin-Luther-U niversität H alle-W ittenberg in 2004. In 2004,
Canada, w here he is currently serving his second term as departm ent Professor Hombach w as appointed Assistant Professor at the
c h a irm a n . Departm ent o f Human A natom y and Cell Science, Faculty o f M edicine
of the University of Manitoba. She has been the recipient of the
His research areas concern the m echanism s em ployed by cancer cells M erck European Thyroid von B asedow Research Prize by th e German
and their cancer stem /progenitor cells to enhance tissue invasiveness Endocrine S ociety in 2002 and received th e M urray L. Barr Young
and survival strategies in response to anticancer tre atm e nts. One Investigator A w ard by the Canadian Association fo r Anatom y, Neurobi
particular focus is on the role o f endocrine factors, such as the ology and Cell Biology in 2009.
relaxin-like ligand-receptor system , in prom oting carcinogenesis.
Her main research interests are in the field o f cancer research and
environm ental toxicants. Her focus in cancer research is to identify
the m olecular m echanism s th a t regulate cancer cell migration and
m etastasis. She em ploys unique cell and animal m odels and human
primary cells to study epigenetic and transgenerational effects
facilitated by environm ental chemicals.
Preface
In the preface to the firs t edition o f his Atlas, Johannes Sobotta w ro te also adopted, although slightly m odified, th e approach m entioned al
in M ay 1904: "M a n y years o f experience in anatom ical dissection led ready in th e preface o f the firs t edition, i.e. com bining th e figures in the
the author to proceed w ith the presentation of the peripheral nervous atlas w ith explanatory te xt w hich is an old trend being currently back
system and the blood vessels such that the illustrations of the book are into fashion once more. Each image is accom panied by a short explana
presented to th e stud ent exactly in th e sam e m anner as body parts are to ry text, w hich serves to introduce students to the image, explaining
presented to the m in th e dissection laboratories, i.e. sim ultaneous w h y the particular preparation and presentation of a region w as select
presentation of blood vessels and nerves of the same region. Alternat ed. The individual chapters w ere system atically organised in term s of
ing descriptive and image materials are distinctive features of this atlas. current subject m atter and prevailing study habits; om itted and incom
The images are the core piece o f the atlas. Apart fro m table legends, plete illustrations - particularly the system atics of the neurovascular
auxiliary and schem atic drawings, the descriptive material includes pathways - w ere supplem ented or replaced. The m ajority of these new
sho rt and concise te x t parts suitable fo r use o f th is book in the gross figures are conceptualised to facilitate studying the relevant pathways
anatom y laboratory." o f blood supply and innervation by didactical aspects. W e have also
As w ith fashions, reading and study habits of students change periodi reviewed many existing figures, reduced figure legends, and highlight
cally. The m ultim edia presence and availability o f inform ation as w ell as ed keywords by bold print to sim plify access to the anatomical con
stim uli are certainly the main reasons o f ever changing study habits. tents. Numerous clinical examples are used to enhance the "lifeless
These developm ents and changing demands of students to textbooks anatom y", present the relevance o f anatom y fo r the future career to
and atlases, w hich they utilise, as w ell as the availability o f digital media the student, and provide a taste of w hat's to come. Introductions to the
o f textbook contents, is accounted fo r by editors and publishers. Apart individual chapters received a new conceptual design, covering in brief
from interviews and system atic surveys of students, the textbook sec a sum m ary of the content, the associated clinical aspects, and relevant
to r is occasionally an indicator enabling the evaluation o f expectations dissection steps fo r the covered topic. It serves as a checklist fo r the
o f students. Detailed textbooks w ith the absolute claim o f com plete requirem ents of the Institute of Medical and Pharmaceutical Examina
ness are exchanged in favour o f educational books that are tailored to tion Q uestions (IMPP) and is based on th e German oral part o f the
the didactic needs of students and the contents of the study of human preclinical medical examination (Physikum). Also new are brief intro
medicine, dentistry, and biomedical sciences, as w ell as the corre ductions to each top ic in em bryology and the online connections o f the
sponding examinations. Similarly, illustrations in atlases such as the atlas w ith the ability to download all images fo r reports, lectures, and
Sobotta, w h ic h contain exact naturalistic depiction o f real anatom ical presentations.
specimens, fascinate doctors and associated medical professions for
many generations throughout the world. However, students some W e w ant to emphasise tw o points:
tim es perceive them as too com plicated and detailed. This awareness 1. The " n e w " Sobotta in th e 23rd edition is not a stud y atlas, claim ing
requires th e consideration o f ho w the strength o f the atlas, w h ich is
known fo r its standards o f accuracy and quality during its centennial com pleteness of a com prehensive knowledge and, thus, does not
existence featuring 22 editions, can be adapted to m odern educational try to convey the intention to replace an accompanying textbook.
concepts w ith o u t com prom ising the oeuvre's unique characteristics 2. No m atter how good the didactic approach, it cannot relieve the stu
and authenticity. A fter careful consideration, Elsevier and the editors dents o f studying, but aid in visualisation. A nato m y is not d iffic u lt to
P rofessor Reinhard Putz and P rofessor Reinhard Pabst, w h o w e re in study, but very tim e-consum ing. Sacrificing th is tim e is w orth w h ile ,
charge o f th e atlas up to its 22ndedition, cam e to th e conclusion th a t a since physicians and patients w ill b e nefit fro m it.
new editorial team w ith the same great enthusiasm fo r anatom y and
teaching w ould m eet the new requirem ents best. Together w ith the The goal o f the 23rd edition o f Sobotta is not only to facilitate learning,
Elsevier publishing house, w e are extrem ely pleased to be charged but also to make learning exciting and attracting, so th a t th e atlas is
w ith th e n e w com position o f th e 23rd edition o f Sobotta. In redesigning, consulted during the study period as w ell as in the course o f profes
a very clear outline of contents and a didactic introduction to the pic sional practice.
tures w a s taken into account. N ot every fashion is accom panied w ith
som ething entirely new. Under didactical aspects w e have revisited the Erlangen and W uerzburg, sum m er 2010, exactly 106 years after the
old concept o f a three-volum e atlas, as used in S obotta's firs t edition, first edition.
w ith : General A nato m y and M usculoskeletal System (vol. 1), Internal
Organs (vol. 2), and Head, Neck, and N euroanatom y (vol. 3). W e have Friedrich Paulsen and Jens W aschke
Acknowledgements
First, w e w ould like to express that the w ork on the Sobotta w as excit Medical School, and colleagues Prof. Dr. med. Peter Kugler, Julius-
ing and challenging. During stages, at w hich one could see the progress M axim ilians-U niversität W uerzburg, and Prof. Dr. rer. nat. G ottfried Bo-
o f developm ent o f individual chapters and new ly developed pictures gusch, Charité Berlin, supported us strongly w ith advice and critical
w ith a slight detachm ent, one obtained satisfaction, was elated w ith com m ents. W e w ould like to specifically em phasise the e ffo rt of Ms.
pride and identified oneself everm ore w ith the Sobotta. Renate Putz, w h o corrected th e m anuscript very carefully; her com
The redesign o f Sobotta is obviously not the sole w o rk o f tw o inexperi m ents w e re o f crucial im portance fo r th e consistency of th e w o rk in it
enced editors, but rather requires m ore than ever a w ell-attuned team self and w ith the earlier editions.
under the coordination of the publisher. W ithout the long experience of For support w ith corrections and revisions, w e express our sincere
Dr. Andrea Beilmann, w ho supervised several editions of the Sobotta thanks to Ms. Stephanie Beilicke, Dr. rer. nat. Lars Bräuer, M s. A n e tt
and exerted the calming influence of the Sobotta team, many things Diker, M r. Fabian Garreis, Ms. Elisabeth George, M s. Patricia Maake,
w o uld have been im possible. W e thank her fo r all th e help and support. Ms. Susann M öschter, Mr. Jörg Pekarskyand Mr. Martin Schicht.
Ms. Alexandra Frntic, w h o is also part o f th e fou r-m em be r Sobotta For assistance in creating clinical figures, w e express our gratitude to
team, pursued the first major project of her career and tackled it w ith Priv.-Doz. Dr. m ed. Hannes Kutta, Clinic and Polyclinic fo r Oto-Rhino-
passion and enthusiasm . Her liveliness and m anagem ent by m otivation Laryngology at th e U niversity Hospital H am burg-Eppendorf, Prof. Dr.
have enlivened and cheered the editors. W e express our gratitude to med. Norbert Kleinsasser, University Clinic fo r Oto-Rhino-Laryngo-Pa-
Ms. Frntic. W e like to re flect back on th e Sobotta initialisation w e e k in thology, Julius-M axim ilians-U niversität W uerzburg, Prof. Dr. med. A n
Parsberg and w e e k ly conference calls, in w h ic h Dr. Beilmann and Ms. dreas Dietz, Head of Clinic and Polyclinic fo r Oto-Rhino-Laryngology at
Frntic supported us in th e com position o f th e Sobotta and presented an the U niversity Leipzig, Dr. med. Dietrich Stoevesandt, Clinic fo r Diag
admirable w ay to m erge the variety of tw o personalities to achieve a nostic Radiology at the Martin-Luther-Universität Halle-W ittenberg,
single layout. W ithou t the assertiveness, the calls fo r perseverance and Prof. Dr. med. Stephan Zierz, D irector o f th e U niversity Hospital and
the protective hand of Dr. Dorothea Hennessen, w ho directed the Polyclinic fo r Neurology at the Martin-Luther-Universität Halle-W itten-
project o f the "2 3 rd edition o f S obotta" and alw ays believed in her So berg, Dr. med. B erit Jordan, Hospital and Polyclinic fo r Neurology at the
botta team and the tigh t schedule, this edition w ould have not been M artin-Luther-U niversität Halle-W ittenberg, Dr. med. Saadettin Sei,
published. Like a num ber o f previous productions, the routinier Renate University Hospital fo r Ophthalm ology at the Martin-Luther-Universität
H ausdorf led the successful reproduction o f th e atlas. O th er people in Halle-Wittenberg, Mr. cand. med. Christian Schroeder, Eckernförde,
volved in the editing process and th e success o f the 23rd edition o f the and Mr. Denis Hiller, Bad Lauchstädt.
Sobotta and w hom w e sincerely thank are Ms. Susanne Szczepanek W e also w ould like to express our thanks to our anatomical mentors
(m anuscript editing), M s. Julia Baier, Mr. M artin Kortenhaus and Ms. Prof. Dr. med. Bernhard Tillmann, C hristian-A lbrechts-U niversität Kiel,
Ulrike Kriegel (editing), Ms. A m elie Gutsmiedl (formal text editing), Ms. and Prof. Dr. med. Detlev Drenckhahn, Julius-Maximilians-Universität
Sibylle Hartl (internal production), M s. Claudia Adam and M r. Michael Wuerzburg, w hom w e not only ow e our anatomical training, the m oti
W iedorn (formal figure editing and typesetting), Ms. Nicola Neubauer vation fo r subject m atter, and the sense of mission, but also have been
(layout de velopm ent and refining the ty p e s e ttin g data) and th e stu great role m odels in th e ir design o f te xtbooks and atlases, as w e ll as in
dents Doris Bindl, Derkje Hockertz, Lisa Link, Sophia Poppe, Cornelia their teaching excellence.
Rippl and Katherina and Florian Stum pfe. For the com pilation o f the in Our deepest gratitude to our parents, Dr. med. Ursula Paulsen and
dex, w e express ou r gratitude to Dr. Ursula Osterkam p-Baust. Special Prof. Dr. med. Karsten Paulsen, and also A nnelies W aschke and Dr.
thanks are expressed to th e illustrators Dr. Katja D alkow ski, M s. Sonja med. Dieter W aschke, w ho intensely supported and sustained the So
Klebe, Mr. Jörg M air and M r. Stephan W inkler, w h o in addition to revis botta project. Karsten Paulsen, w h o passed aw ay in M ay 2010, studied
ing existing illustrations have developed a variety of excellent figures. anatom y as a medical stud ent fro m th e 4 th edition of Sobotta. D ieter
Priv.-Doz. Dr. rer. nat. H elm ut W icht, Senkenberg Anatom y, Goethe- W aschke used th e 16th edition o f Sobotta and continues to attain
Universität Frankfurt/M ain, has revived the lifelessness o f the introduc know ledge w ith medical literature even during re tirem ent. The 23rd
tions to the chapters indited by the tw o editors through his unique style edition is dedicated to ou r fathers.
o f w ritin g . W e express our gratitude to Priv.-Doz. Dr. rer. nat. W icht. Last b u t not least, w e thank ou r w ive s Dr. med. Dana Paulsen and Su
A big help to us w as th e advisory council, w h ic h in addition to the sanne W aschke, w h o not only had to share us w ith th e Sobotta in the
fo rm e r editors Prof. Dr. med. Dr. h. c. Reinhard Putz, Ludw ig-M axim il- last year, but also w ere on hand w ith help and advice on many issues
ians-U niversität M unich, and Prof. Dr. m ed. Reinhard Pabst, Hannover and have been strongly supportive.
General Anatomy
Orientation on the Body .................. 4
Surface A natom y ............................... 6
D evelopment ....................................... 12
Musculoskeletal System .................. 14
Vessels and Nerves ............................ 22
Imaging Techniques .......................... 32
Integumentary System ...................... 36
Anatomy -
Reveal the Concealed
W hat A n a to m y Is Linguae Anatomiae
"a v a io n n " (anatome) means cut-up, "avai£|jv£tv" (anatemnein) de The language o f th is classical discipline "A n a to m y" (Linguae anato
notes to c u t open. C onsequently, anatom y is dissection and th e anato miae) is predom inantly Latin and (latinized) Greek. In th e past 50 years,
m ists are dissectors. The dissection reveals the otherw ise non-visible som e English term s w ere added. The anatom ic Termini technici (term i
con stituen ts, and is th e m e thod w h ic h nam ed th e science: reveal, nology) are usually m arvellously graphic, concrete, and vivid. Even a
represent, divide, cut, sort, and name. Recognition o f the parts is the w ord m onster like "Cartilago arytenoidea" means sim ply (nothing
key to understanding th e subject. m ore than) "th e cartilage w hich looks like a gravy bo a t". This cartilage
is located above the larynx and really looks like a boat-shaped pitcher to
"A natom y [...] dissects organism s into their [...] constituents [...], ex serve gravy. A t tim e s one needs visual imagination w hich anatom ists
am ining their external, sensorial perceptible properties and their inter do n o t lack. One does not need to be afraid o f term inolo gy, b u t rather
nal structure. It is th e stud y o f death to make conclusions about life. enjoy its diversity. This is done m o st succe ssfully w h e n th is term in o lo
A n a to m y m anually de stroys an ideal creation in order to rebuild it m en gy is translated into one's ow n language and imagination.
tally and to virtually recreate a hum an being. There is n o t a m ore glam
orous task for the human m ind." Body Donations - The Legacy
Joseph Hyrtl (Anatomist, 1811-1894).
A lthough anatom y deals w ith death, it is devoted to life. It is n o t about Dead human bodies are essential fo r carrying out lessons in dissection.
death but rather about the comprehension o f the human body which These bodies are m ade available by body donations. The body donor
functions as a unit. The body donors are m odels only. bequeathed his/her body to an anatom ical institute. This has to be done
in person as a last w ill declaration during the lifetim e o f the donor. Next
There are tw o other medical fields w hich deal w ith dead bodies: foren o f kin are not authorized representatives in th is legal m a tter. Every body
sic m edicine and pathology. P athologists are interested in causes of donor has personally contacted an anatom y institute during his/her life
diseases. Forensic m edicine deals in particular w ith d o ubtfu l causes of tim e and, in th e last w ill, donated his/her body to th e institu tio n fo r
death. W hereas the sole purpose o f anatom ists is to understand the teaching and research after death.
living human body on a continuum from the em bryonic stage to old
age. The body donor usually receives a donor card which always needs to be
at hand. W hen death occurs the body is brought to th e anatom y insti
Eyes and hands are m ost im portant tools of th e anatomist.The tu te and is used fo r lessons in dissection, fo r clinical preparations, fo r
findings revealed by hands, tw eezers, scissors, scalpels, and the visua dem onstration, or fo r surgery courses as w ell as fo r scientific studies.
lization o f these structures by eye is called gross or m acroscopic anato Following the courses and examinations, the m ortal remains are usu
my. Structures in gross anatom y not discernible by the naked eye can ally crem ated and buried in th e c e m e te ry o f honour o f th e university.
be visualized by m icrotom es or light and electron m icroscopes. This The m em orial or funeral service is attended by fam ily m em bers, stu
field is called m icroscopic anatomy. dents, and instructors of the faculty.
Organization and classification are basic aspects o f system atic an ato Depending on institution and/or state/province, there are different regu
my. The body is precisely classified according to system s. The bone lations fo r th e exhibition of bodies and organs. For example, body do
system fo r example includes not only bones, but also bony parts and nors o r organs o f body donors can be exhibited in an anatom ical collec
associated term inology. On th e other hand, tissue system s are orga tion fo r presentation and teaching purposes, if th is is expressed in the
nized according to ty p e s and subtypes. Topographic a n a to m y is the body donor's will.
study o f regions or divisions o f the body and em phasizes th e relations
b e tw e e n various stru cture s in th a t region. The relationship o f fo rm and Reasons fo r body donations are diverse, and body donors represent all
function is term ed functional anatom y. Topographic anatom y and parts o f society. The w idely held assum ption tha t body donors donate
functional anatom y are the suprem e disciplines of the physician and to be granted an inexpensive funeral is proven to be w rong. M any uni
lead th e path to clinical anatom y. This serves as practical application versities charge a fee fo r body donations and th is has not resulted in a
fo r diagnosis and therapy. Lastly, co m p arative a n a to m y serves in evo reduction of body donations.
lutionary phylogeny. It is o f interest to biologists and com pares bodies
and body parts of different creatures.
H istology is a subdivision o f m icroscopic anatom y and is dealing w ith
th e com position o f organ tissue s w h ic h are m u ltice llular in structure.
Cytology, the study of cells, focuses on structure and function of the
single cell. Em bryology, w hich mainly uses the m icroscope fo r exami
nation o f tin y em bryos, describes th e d e velopm ent o f an organism (in
dividual developm ent, ontogenesis).
D issection and analysis is th e trade o f th e anatom y, b u t its real goal is
to m entally assem ble all parts into a functioning w hole. This goal of
understanding the structural design and shape of biological structures
and conceptualizing it as a unified structure-function relationship can
also be called morphology.
2
Clinical Rem arks---------------------------------
Human anatom y is th e basis fo r th e education o f physicians, den
tists, and other health professionals. The anatomical knowledge
is constantly applied in daily patient care and m u st alw ays be re
freshed. The curricula of biomedical studies and education conti
nue to encompass more scientific knowledge. The existing sub
je c ts have to be covered in fe w e r lectures, since com peting
subjects and new technologies require a greater am ount of the
lim ited curriculum hours. Training com petent clinicians and spe
cialists in health-related m edical professions can be achieved e f
fectively by supplem enting anatomical facts w ith clinical exam
ples. This also leads to an application-oriented learning and incre
ases the m otivation of the student. However, the extensive and
tim e -consu m ing stud y o f anatom y should n o t be neglected. In
trinsic and firm anatom y knowledge can then be applied to the
benefit of the patient.
— ► Dissection Link
Dissection is done by hand using a scalpel (non-disposable scalpels!)
and anatomical tw eezers. Structures and organs as w ell as their topo
graphic relationships are exam ined in th is fashion.
The nature o f the tissue diffe rs regionally. Areas w ith a lot o f adipose
tissues that can be rem oved bluntly by hand alternate w ith connective
tissue w hich can be stripped o ff w ith the aid o f scalpel only. A s part
of the preparation, different cavities are exposed w hich are filled w ith
air, liquid, or solid constituents. The tissue o f the organs (parenchy
ma) may - depending on th e fixation - be hard, soft, spongy, tender,
or elastic. P rotected nerves and blood vessels are located in d iffe re n t
layers o f th e body, and th e ir dissection can be o f varying d ifficu lty. In
som e locations these are easily rem ovable, in oth er regions th e y may
adhere to adjacent tissues. To illustrate the muscles, m obilization by
loosening the tig h t surrounding connective tissue sheaths (muscle
fascia) is required.
To prevent damage, special attention needs to be paid to nerves and
blood vessels entering and exiting the m uscle. Partial severance o f sur
rounding ligam ents is needed to open joints. In contrast som e struc
tures such as the inner ear can be exposed w ith a ham m er and chisel
or saws and milling machines.
The preparation requires a lot of patience, manual dexterity, and spatial
imagination. One gains great experiences and valuable insights w hich
are not offered by any anatom y textbook or atlas. These include the
three-dim ensional understanding of the structures of the human body,
the confrontation w ith death, but also team w ork.
exa m :h e ck lis t
• M ain axes • m ain planes • dire ctio n s and p o s itio n in g o f bo dy
parts • d ire ctions o f m o vem en t • ra diolog ica l te rm s o f sectional
planes • general e m b ryo lo g y • general surface p ro je ctio n o f
in n e r organs • skeletal o ve rvie w • bone structure • bone
developm ent • bony connections • type o f jo in ts • exam ination
o f jo in ts • m uscle type s • m uscle m echanics • cardiovascular
system • greater and lesser bloo d circula tory system • portal
system • o ve rview : lym ph system • spinal nerve • o ve rview :
cen tral, p e rip h e ra l, and a u to n o m ic ne rvous system • skin and
fin g e r nails • im a g in g tech nique s: ra diograph , u ltra so u n d , MRI,
CT, and s c in tig ra p h y
Surface anatomy O rie n ta tio n on th e b o d y -> S urface a n a to m y -> D e ve lo p m e n t
Axes and planes
1 sagittal plane
2 m idsagittal plane
3 frontal plane
4 transverse o r horizontal plane
5 sagittal axis
6 transvere axis
7 longitudinal o r vertical axis
Figs. 1.1a to c Planes and axes. c frontal plane = coronal plane (Planum frontale); encompasses longitu-
a sagittal plane (Planum sagittale), encom passes sagittal and longitu- dinal and transverse axes
dinal axes
b transverse plane = horizontal plane (Planum transversale), encom
passes transverse and sagittal axes
Main Axes M ain Planes
median (sagittal) plane
sagittal axis is positioned perpendicular to transverse sym m etry plane, divides the body into
and longitudinal axis sagittal plane tw o equal halves
transverse axis is positioned perpendicular to longitudinal transverse plane runs parallel to the median (sagittal)
and sagittal axis frontal plane plane
longitudinal or vertical is positioned perpendicular to sagittal and any cross-sectional plane of the body
axis transverse axis
parallel to the forehead
Direction of M ovem ent Radiological Section Planes
extension stretching of the torso or the extrem ities Radiological Terms Anatom ical Terms
flexion bending of the torso or the extrem ities sagittal section sagittal plane
abduction m oving extrem ities away from the torso coronal section frontal plane
adduction m oving extrem ities tow ards the torso axial section transverse plane
elevation lifting of arms above the horizontal plane Radiology term in olog y in im aging procedures (com puted tom og ra ph y and m agnetic
resonance im aging) d efin es th e three main anatom ical planes as sections w ith their
rotation turning extrem ities inwards and outwards o w n nom enclature.
around a longitudinal axis
circum duction spinning motion
M u sculo skele ta l system -► Vessels and nerves -► Im a g in g te ch n iq u e s -► In te g u m e n ta ry system
Directional information and relationships
Figs. 1.2a and b Lines for orientation, directional inform ation
and relationships.
a ventral view
b dorsal view
Terms of Direction and Positioning of Body Parts
cranial or superior tow ards the head apical pointed or belonging to the tip
basal
caudal or inferior towards the sacrum dexter pointed tow ards the base
sinister
anterior or ventral towards the front or abdomen pro xim a l right
distal
posterior or dorsal towards the back ulnar left
radial
lateral sideways, away from the midline tibial tow ards the torso
fibular
m e dial centered, tow ards the midline volar or palmar tow ards the end of the limbs
plantar
median or medianus w ithin the median plane dorsal tow a rds the ulna
in te rm e d ia l positioned in betw een tow ards the radius
central towards the interior of the body tow ards the tibia
peripheral tow ards the body surface tow a rds the fibula
profundus located deeply tow ards the palm of the hand
superficial or superficialis located superficially tow ards the sole of the foot
external or externus located externally (extrem ities) tow ards the back
(dorsum) o f the hand or the foot
internal or internus located internally frontal
rostral tow ards the forehead
(literally translated: „to w ards the
beak") towards the mouth or tip of
the nose (exclusively used for
directional and positional information
related to th e head)
Surface anatomy O rie n ta tio n on the b o d y — S urface a n a to m y -> D e ve lo p m e n t
Parts of the body
Fig. 1.3 and Fig. 1.4 Surface anatom y of the male (-» Fig. 1.3) The body is divided into head (Caput), neck (Collum), torso (Truncus)
and the fem ale (-* Fig. 1.4); ventral view. w ith che st (Thorax), abdom en (Abdomen), pelvis (Pelvis), back (Dor
Anatomical term inology generally refers to the upright position w ith the sum), and upper (M em brum superius) and low er (M em brum inferius)
face directed forw arzd, arms positioned sidew ays, palms pointing to extrem ities. The extrem ities divide into the upper arm (Brachium), fore
wards the body or forw ard, legs positioned beside each other w ith fee t arm (Antebrachium), hand (Manus) and upper leg (Femur), low er leg
pointing forw ard. (Crus), fo o t (Pes).
M u sculo skele ta l system -► Vessels and nerves -► Im a g in g te ch n iq u e s -► In te g u m e n ta ry system
Parts of the body
1.5 1.6
Fig. 1.5 and Fig. 1.6 Surface anatom y of the male (-» Fig. 1.5)
and fem ale (-► Fig. 1.6); dorsal view .
i- Clinical Rem arks------------------------------------ The history is usually taken before physical exam ination takes place,
but in an em ergency im m ediate tre atm e nt is required and taking
During anam nesis (from ancient Greek. avanvr|oi<;, anam nesis = th e medical histo ry is postponed. The goal o f th e accurate medical
m em ory) - taking a medical history - th e histo ry o f a patient is histo ry is to na rrow d o w n th e possible differential diagnoses. This
carefully examined w ith reference to current sym ptom s. A detailed process o f elim ination is based on key sym ptom s and exclusion cri
medical history includes biological, psychological, and social as teria. Following the medical history, further investigations are often
pects. This gathered inform ation often perm its conclusions regard necessary to effectively diagnose a medical condition.
ing risk factors and causal relationships. The anamnesis does not
have a direct therapeutic goal, although talking about and clarifying
the issues may have a salutary effect.
Surface anatomy O rie n ta tio n on the b o d y — S urface a n a to m y -► D e ve lo p m e n t ->
Regions of the body
Regio sternocleidom astoidea Regio cervicalis anterior
Regio deltoidea Regio cervicalis lateralis
Trigonum clavipectorale
Regio axillaris Regio presternalis
Regio mamm aria Regio pectoralis
Regio brachii anterior Regio infram am m aria
Regio cubitalis anterior, Fossa cubitalis — Regio epigastrica
Regio antebrachii posterior Regio hypochondriaca
Regio antebrachii anterior Regio um bilicalis
Regio abdom inalis lateralis
Dorsum manus Regio inguinalis
Regio p ubica [Hypogastrium ]
Trigonum fem oris Regio urogenitalis
Regio fem oris anterior
Regio genus anterior
Regio cruris posterior
Regio cruris anterior
Dorsum pedis
Fig. 1.7 Body regions; ventral view .
The body surface is divided into regions fo r be tter description and
orientation. Regio: region; Trigonum : triangle.
M u sculo skele ta l system -► Vessels and nerves -► Im a g in g te ch n iq u e s -► In te g u m e n ta ry system
Regions of the body
Regio deltoidea Regio parietalis
R egio s c a p u la ris -------------/ Regio occipitalis
Regio axillaris Regio cervicalis posterior
Regio brachii posterior Regio vertebralis
Regio cubitalis posterior
Regio infrascapularis
Regio antebrachii anterior
Regio antebrachii posterior
Regio fem oris posterior Planta
Regio genus posterior, Fossa poplitea
Regio surae
Regio cruris posterior
Regio cruris anterior
Dorsum pedis
C alx [Regio calcanea]
Fig. 1.8 Body regions; dorsal view.
The body surface is divided into regions fo r be tter description and
orientation. Regio: region; Trigonum: triangle.
Surface anatomy O rie n ta tio n on th e b o d y -> S urface a n a to m y - * D e ve lo p m e n t
Inner organs, surface projection
G landula thyroidea
--------- Trachea
P ulm o
Diaphragm a -
— Hepar —
— Gaster
— S plen [Lien]
— Pancréas -
—Duodénum
— Jéjunum
lleum
A ppendix verm iform is
R e ctum
Figs. 1.9a and b Projection of inner organs onto th e body surface. (Hepar), stom ach (Gaster), spleen (Splen [Lien]), pancreas, duodenum ,
P rojection o f inner organs on to th e ventral abdom inal w all (a) and onto jejun um , kidney (Ren), colon, ileum , appendix (Appendix verm iform is),
th e dorsal w all o f th e tru nk (b): esophagus, thyroid gland (Glandula thy and rectum (Rectum).
roidea), w in d pipe (Trachea), lung (Pulmo), heart (Cor), diaphragm , liver
i- Clinical Remarks------------------------------------
Even w ith o u t technical instrum ents, an exam iner is able to obtain to beat or shake) is perform ed fo r diagnostic purposes and involves
orientation on individual organs and th e ir projection onto the body tapping the body surface of the patient. Percussion induces vibra
surface of the patient through practice. Auscultation (to auscultate tions of the tissue beneath the surface of the body. The resulting
originates fro m the Latin w ord "auscultare" and means listening) sounds provide inform ation about the state of the tissue. Thus, the
is part o f th e physical exam ination and includes th e listening to the size and position o f an organ (e.g. liver) or the air content o f th e tis
sounds of the organs typically done w ith a stethoscope. Percussion sue (e.g. lung) can be assessed.
(to percuss originates fro m the Latin w o rd "p e rcu ta re " and means
M u sculo skele ta l system -► Vessels and nerves -► Im a g in g te ch n iq u e s -► In te g u m e n ta ry system
Inner organs, surface projection
P ulm o
Diaphragm a
------ H e p a r --------
------ G a s te r---------
- Vesica biliaris
Splen [Lien] —
------- C o lo n ---------
-------- Ren -----------
Intestinum tenue
A ppendix verm iform is
R e ctum
Figs. 1.10a and b Projection of inner organs onto th e body diaphragm , liver (Hepar), stom ach (Gaster), gall bladder (Vesica
surface. Projection of inner organs onto the right w all of the torso biliaris), spleen (Splen [Lien]), colon, kidney (Ren), sm all intestine
(a) and on to th e le ft w all o f th e to rs o (b): lung (Pulmo), heart (Cor), (Intestinum tenue), appendix (Appendix verm iform is), and rectum
Clinical Remarks For example, appendicitis (inflammation of the appendix [Appen
dix verm iform is]) is usually accom panied by d is c o m fo rt in th e right
Through knowledge of the projection of the internal organs onto lower abdomen.
the body surface, disease specific sym ptom s can already be linked
to organs during physical exam ination. In addition to th e pa tient's
history, firs t clues of the diseased organ(s) involved can be deduced.
Surface anatomy O rie n ta tio n on the b o d y S urface a n a to m y D e ve lo p m e n t ->
D e ve lo pm e n t
Figs. 1.11a to i First w eek of embryogenesis: fertilization and (c). S ubsequent cell divisions (2-, 4-, 8- and 16-cell stages; d -h ) gen
im p la n ta tio n . [21] erate a cell aggregate (M orula) w h ich is transported into th e uterine
W ith in 24 hours a fte r ovulation (a), fe rtilizatio n (b) norm ally occurs in cavity. A t approxim ately day 5 after fertilization, th e morula develops
the ampulla of the oviduct. The fusion of the pronuclei of the ovum and into a fluid-filled cyst (blastocyst; i) w h ic h im plants into th e uterine
sperm into a single diploid nucleus creates the zygote mucosa at days 5-6.
M orula S yncytiotrophoblast
Inner cell m ass — Epiblast E m bryoblast
(E m b ryo blast) H ypoblast
Trophoblast
B lastocyst cavity Cytotrophoblast
Endom etrial glands
Endom etrial capillaries S yncytiotrophoblast
Uterine epithelium A m niotic cavity
Uterine lumen Germ plate
Trophoblast B lastocyst cavity
C
Figs. 1.12a to e First and second w eek of embryogenesis: the bilaminar em bryonic disc w ith ectoderm (columnar cells at th e dor
bilam inar em bryonic disc. [21] sal surface of the em bryoblast) and entoderm (cuboidal cells at the ven
Upon d iffe ren tiation o f th e morula (a) into th e blastocyst, th e latter tral surface). The ectoderm form s a dorsally located cavity w hich beco
generates an inner cell mass (em bryoblast) and a larger fluid-filled m es the am niotic cavity. The ventrally located blastocyst cavity
(blastocyst cavity) outer cell layer (trophoblast; b). Through interac becom es th e prim ary yolk sac w h ich is lined by en toderm . A t day 12,
tions between maternal tissues and the trophoblast cells the utero the secondary yolk sac (yolk sac proper) form s. The original blastocyst
placental circulation is fo rm e d (c-e). The em bryoblast develops into cavity is lined by extra-em bryonic m esoderm .
M u sculo skele ta l system -► Vessels and nerves -► Im a g in g te ch n iq u e s -► In te g u m e n ta ry system
D e ve lo pm e n t
P rim itive node
Prim itive streak
Am nion Connecting stalk
Prechordal plate
E c to d e rm
Entoderm Yolk sac
Figs. 1.13a and b Third w eek of embryogenesis: layer). The notochordal process develops a lum en (notochordal canal)
gastrulation. [21] and becom es the notochord (Chorda dorsalis; prim itive stabilizing
Developm ent of the trilam inate em bryonic disc initiates w ith the appe stru ctu re o f th e em bryo) w h ich regresses later in d e velopm ent (b). Re
arance of the prim itive streak at the dorsal surface of the ectoderm . At lics o f th e notochord can be fou nd in th e Nuclei pulposi located w ith in
its cranial section, th e prim itive streak is dem arcated by th e prim itive the vetrebral discs. Some mesoderm cells migrate cranially past the
node (a). Cells m igrating o u t o f th e prim itive streak fo rm th e intra- prechordal plate to create the primordial heart. The three germ layers
em bryonic m esoderm located betw een the top of the yolk sac and (ectoderm, m esoderm , entoderm ) are the building blocks fo r th e deve
the ectoderm o f the am niotic cavity (gastrulation). Some o f these cells lopm ent of all organs. Further inform ation on the germ layers partici
form the notochordal process w hich extends tow ards the cranial part pating in specific organ form atio n can be fou nd in em bryolo gy te x t
o f the em bryo w here the prechordal plate has form ed (adhesion books.
between ectoderm and entoderm w ith o u t an intervening mesoderm
Surface anatomy O rie n ta tio n on th e b o d y -> S urface a n a to m y -> D e ve lo p m e n t
Skeleton
Fig. 1.14 S keleton , S ystem a skeletale; ventral view . [10] • air-filled bones (Ossa pneumatica), e.g. frontal bone, ethm oid bone,
The bones of the skeleton are grouped according to their shape and maxilla, sphenoid bone
structure: irregular bones (Ossa irregularia, cannot be grouped w ith the other
bones), e.g. vertebrae, mandible
long bones (Ossa longa), e.g. hollow bones o f the extrem ities, like sesam oid bones (Ossa sesamoidea, bones em bedded in tendons),
fem ur and humerus e.g. patella, Os piriform is
o short bones (Ossa brevia), e.g. carpal and tarsal bones accessory bones (Ossa accessoria, accessory bones not com m only
fla t bones (Ossa plana), e.g. ribs, sternum , scapula, pelvis, bones fou nd in all hum an skeletons), e.g. sutural bones o f th e skull, cervical
of the skull rib
M u sculo skele ta l system Vessels and nerves Im aging te ch n iq u e s -► In te g u m e n ta ry system 1
Structure of bones
Epiphysis proxim alis Linea epiphysialis Fig. 1.15 Long bones (hollow bones). Os longum.
M etaphysis proxim alis M etaphysis proxim alis Section through the proximal part o f the fem oral bone o f an adult. Peri
A p o p h y s is osteum of th e diaphysis has been rem oved and folded sideways. Dor
D ia p h y s is S ubstantia spongiosa sal view . Sectioned fem oral bone displays tw o distinct types o f bones
A pophysis w ith no clear separation betw een them :
• Substantia compacta or corticalis (compacta, com pact bone, very
S ubstantia com pacta
thin in th e epiphysis, substantial in th e diaphysis) and
C avitas m edullaris • Substantia spongiosa (spongiosa, spongy or cancellous bone, sub
P e rio s te u m
stantial presence exclusively in th e epiphysis and metaphysis).
In th e diaphysis, th e com pacta appears as a solid m ass; th e spongio
sa in epi- and m etaphysis creates a three-dim ensional n e tw o rk o f deli
cate branched bones (trabeculae). D epending on the physical forces
applying, the y are divided into traction or com pression trabeculae. The
space in betw een the trabeculae is filled w ith blood-form ing bone mar
ro w (young person) o r fa tty lipids (old person). The orientation o f the
individual trabeculae is parallel to th e lines o f ten sile and com pressive
stress generated w ith in th e bone. (In th e fe m u r, th e se forces are prox
imal and eccentric, adding additional bending stress to the bone.) A
long evolutionary process resulted in a light bone, com bining m axim al
mechanical robustness w ith minim al bone deposit.
M etaphysis distalis Individual lamella O steon w ith co nce ntric lamellae
o f the circum ferential Interstitial lamellae
Epiphysis distalis V O L K M A N N ’s ca na l
Cartilago articularis la m e lla e with blood vessel
Foramen nutritium
||t------ O steo n w ith
HAVERS’ canal with co nce ntric lamellae
blood vessel S pongy trabeculae
V O L K M A N N ’s canal
w ith blood vessel
Fig. 1.16 S tru ctu re of a long h o llo w bone. Os longum . lamellae (special lam ellae) w hich are grouped concentrically around a
The basic histological structure of both a m ature com pact bone and a HAVERS' canal and can be a fe w centim eters in length. Collagen fibres
m ature spongy bone is sim ilar and represents a lam ellar bone. The s h o w perpendicular orientation in adjacent lam ellae o f an osteon.
m ature bone is com posed o f lamellar concentric units, named oste Remnants of previous osteons, called interstitial lam ellae, are located
ons, m o st fre q u e n tly fou nd in th e com pacta o f long bones. In spongy betw een osteons. The outer and inner surface of the com pacta is com
bones, the lamellae are prim arily oriented parallel to the trabecular sur posed of lamellae surrounding the com plete bone. These are called
face. In th e com pact bone, lamellae o f bone m atrix w ith central blood outer and inner circum ferential lamellae.
vessels create osteons, a system (HAVERS' system ) of five to 20 bony
i- Clinical Remarks------------------------------------ sively occurs w ith narrow, irritation-free fracture gaps and does not
involve callus form ation, as is achieved surgically by osteosynthesis
The fracture of a bone leads to the form ation o f tw o or more frag w ith plates and screws fo r optimal alignm ent of fractured ends. As
m e nts w ith o r w ith o u t dislocation. A part fro m pain, tru e signs are ab part o f the prim ary fracture healing, the fracture gap is bridged by
normal mobility, grinding sounds w ith m ovem ent (crepitation), axis capillaries fro m opened HAVERS' canals w hich are surrounded by
m isalignm ent, an initial m uscle stupor (lack o f m uscle activity), and osteons spanning the gap. The secondary fracture healing often
corresponding radiograph findings. Ideally, healing o f a fra cture in form s a slightly thicke r callus w hich is gradually converted into func
volves com plete immobilization and weight-bearing restrictions. Suc tional bone mass.
cessful healing of a fracture is achieved w h e n th e fo rm e rly injured
bone regains its full weight-bearing capacity and long bones have
reform ed the m edullary cavity. The prim ary fracture healing exclu
15
Surface anatomy O rie n ta tio n on th e b o d y -> S urface a n a to m y -> D e ve lo p m e n t
Os scaphoideum 3 .-6 . M O s pisiform e 8 .-12 . Y Talus 7. EM Os cuneiform e m ediale 2 .-3 . Y
Os lunatum 3 .-6 . Y O s triquetrum 1 - 4 . Y Calcaneus 5 .-6 . EM Os cuneiform e interm edium 3 .-4 . Y
Os trapezium 3 .-8 . Y O s ham atum 2 .-5 . M
Os trapezoideum 3 .-7 . Y 0 s naviculare 4. Y Os cuneiform e laterale 12. M
O s capitatum 2 .-4 . M O s cuboideum 10. EM
Fig. 1.17 and Fig. 1.18 Ossification of th e skeleton of th e upper od, resulting in th e diaphyses (diaphyseal ossification) fro m ossifica
(-* Fig. 1.17) and lo w er ex tre m ities (-* Fig. 1.18); position o f th e epi- tion centres w h ic h in part fo rm during th e second half o f th e fetal peri
and apophysial ossification centres and chronological sequence of the od and in th e firs t years o f life w ith in th e cartilaginous epi- and
form ation of these ossification centres. apophyses (epi- and apophyseal ossification) No fu rth e r increase in
The tim ing fo r these bone nucléation sites to appear holds clues as to body height occurs once the cartilaginous epiphyseal gaps ossify and
the stage reached in skeletal de velopm ent and, thus, to the individual disappear (synostosis). Thereafter, isolated bone nucléation sites are
skeletal and bone age. W e distinguish ossification centres form ed no m ore visible in th e X-ray image.
around the shaft (diaphysis) o f the cartilage m odel during the fetal peri
i- Clinical Remarks----------------------------------------------------------------------------------------
For tre atm e nt plans and th e prognosis o f orthopaedic diseases and any existing grow th reserves are of great importance,
deform ities during childhood, the determ ination o f skeletal age and
M u sculo skele ta l system Vessels and nerves Im aging te ch n iq u e s -► In te g u m e n ta ry system
Fig. 1.19 Fibrous jo int, Junctura fibrosa [Syndesmosis]. Fig. 1.20 Cartilaginous joint, Junctura cartilaginea [Synchondro
Fibrous jo in ts b e tw een bones are fou nd in sutures o f th e skull, syndes sis],
m oses (e.g. fibrous connections b e tw e e n th e tibia and fibula o r th e ra Cartilaginous joints connect bones through hyaline cartilage (synchon
dius and ulna), and go m phoses (e.g. fibrous anchoring o f th e te e th in drosis, e.g. connection b e tw een 1. rib and clavicle) or fibrocartilage
the ir alveolar sockets o f the maxilla and mandibula). (symphysis, e.g. Sym physis pubica).
M em brana Hyaline cartilage
fib ro s a Subchondral bone
Capsula articularis • Joint space
C avitas articularis
I synovialis
P e rio s te u m
P licae synoviales
Fig. 1.21 Osseous jo in t, Junctura ossea [Synostosis]. Fig. 1.22 S ynovial (true) jo in t, Junctura synovialis [A rticu latio sy-
A t the osseous joints bones are fused as exem plified by the sacrum. novialis, Diarthrosis]; schem atic sectional view , (according to [1])
Hyaline cartilage at the bony ends covers the subchondral bone. The
S ubchondral bone tissue joint capsule encloses the jo in t cavity and consists of an outer fibrous
m em brane (M em brana fibrosa) and an innner synovial m em brane
(M em brana synovialis). The synovial m em brane secretes the synovia
into th e joint cavity w hich acts as the grease of the joint. W hen the
freedom o f m otion o f a joint is restricted by an exceptionally strong joint
capsule, th is jo in t is called am phiarthrosis (e.g. sm all carpal jo in ts o f the
hand and foot; Articulatio sacroiliaca).
c a rtila g e
Mem brana fibrosa Fig. 1.23 S tructure of th e jo in t capsule. [24]
The jo in t capsule is com posed o f th e M em brana fibrosa and th e M e m
M em brana synovialis brana synovialis. The M em brana fibrosa consists of tough fibrous tis
B lood vessels sue. The M e m b ran a synovialis is com posed o f th e fo llo w in g layers; a
L ip o c y te superficial loose layer of A cells (type A synovialocytes or M cells, spe
cialized macrophages w hich metabolize the m etabolic com pounds pro
Tide m ark duced by the cells in the jo in t cartilage), B cells (type B synovialocytes
Z one o f calcified m atrix or F cells, active fibroblasts w hich produce and secrete the outer colla
gen and proteoglycan aggregates, i.e. hyaluronic acid o f the synovia)
and th e subsynovial connective tissue rich in capillaries, fibroblasts, and
lipocytes. Collagen fib re s w ith in th e articular cartilage are arranged in
arcades (BENNINGHOFF's arcades).
Surface anatomy O rie n ta tio n on th e b o d y -> S urface a n a to m y -> D e ve lo p m e n t
Types of joints
Figs. 1.24a to g Joints, Juncturae synoviales [Articulationes, d condylar joint, A rticulatio ovoidea, A rticulatio ellipsoidea:
Diarthroses]. biaxial joint, perm its flexion, extension, abduction, adduction, and re
Joints usually increase th e range of m otion significantly. They are stricted rotational m ovem ent
classified according to the shape of their articulating surfaces and/or e saddle joint, A rticulatio sellaris: biaxial joint, perm its flexion, exten
the freedom of m ovem ent the y allow. Based on the main axes of sion, abduction, adduction, and restricted rotational m ovem ent
m otion, w e distinguish uniaxial, biaxial, and m ultiaxial joints, f spheroidal or ball and socket joint, A rticulatio spheroidea: m ulti
a hinge jo in t, A rticu latio cylindrica (G inglym us): uniaxial joint, per axial joint, perm its flexion, extension, abduction, adduction, and rota
m its flexion and extension tional m ovem ent
b conoid jo in t, A rticu latio conoidea: uniaxial joint, pe rm its rotational g plane joint, A rticulatio plana: joint perm its sim ple gliding m ove
movement m e nts in d iffe re n t directions
c p ivo t jo in t, A rticu latio trochoidea: uniaxial joint, pe rm its rotational
movement
M u sculo skele ta l system Vessels and nerves Im aging te ch n iq u e s -► In te g u m e n ta ry system
Range of joint m ovem ent
Figs. 1.25a and b Docum entation of th e range of jo int m ovem ent: position w h e n exam ining th e jo in ts (a v ie w fro m th e fro n t and b fro m
neutral-null m ethod. th e side). The e xte n t o f achievable m o ve m e n t fro m th is null position is
The neutral-null m ethod is a standardized goniom etrie m ethod to deter expressed in degrees o f angle m easured. First the active range o f mo
m ine th e active range o f m o v e m e n t in a joint. An up right position w ith v e m e n t aw ay fro m th e body is de term in ed, fo llo w e d by th e active ran
arms hanging dow n to each side is considered the zero degree starting ge of m ovem ent tow ards the body.
Extension/Flexion 0° Figs. 1.26a to c D ocum entation of the range of jo in t m ovement:
0°_ 20° - 20° E xam ples.
a The normal healthy knee joint has the follow ing range of m ovem ent:
5° extension and 140° flexion (not shown). The 90° angle of the an
kle joint in relation to the fo o t is considered the null position. This
allows fo r a 20° extension and 40° flexion under normal conditions
(not show n). The normal range o f m o vem en t in the knee jo in t is
5°-0 °-1 4 0 ° (knee stretched, null position, knee bent), tha t o f the
ankle joint is 2 0 °-0 °-4 0 ° (dorsal extension, null position, plantar flex
ion).
b stretching of the knee im possible (see Clinical Remarks box)
c com plete stiffness of the knee (see Clinical Remarks box)
i- Clinical Remarks------------------------------------ knee is in 20° flexion, but can be furth e r bent to 140°). A com plete
stiffening of th e knee due to ossification (ankylosis) results in the
Lim itations of jo in t m ovem ent are associated w ith a decreased knee being fixed in a 20° angle o f flexion. The m ovem ent form u
range o f m o vem en t. A contraction is indicated if th e jo in t m obility la is 0 °-2 0 °-2 0 ° (-» Fig. 1,26c: knee extension is not possible, null
is restricted or the neutral position o f a joint is not reached. The position is not achieved, the knee is bent at 20° and cannot be bent
neutral-null m ethod is used to do cum ent exactly the m obility o f the further).
impaired joint. For a lim ited m obility of flexion contracture the
m otion form ula reads fo r exam ple, 0 °-2 0 °-1 4 0 ° (-* Fig. 1.26b: ex
ten sion o f th e knee is n o t possible, null position is not achieved, the
Surface anatomy O rie n ta tio n on th e b o d y -► S urface a n a to m y D e ve lo p m e n t
Types of muscles S tratum fibrosum
S tra tu m synoviale, V a g in a Vagina
Pars parietalis s y n o v ia lis te n d in is
te n d in is
1 line o f force o f the m uscle S tra tu m synoviale,
2 virtual lever arm o f the m uscle Pars tendinea
3 axis o f rotation o f the joint
(O rigo)
Fascia (C avitas synovialis)
Caput
1 Tendo
E p ite n d in e u m
Venter
Tendo
(In s e rtio )
Phalanx m edia
2
Fig. 1.27 O rganization principle of skeletal muscles, exem plified Fig. 1.28 S tructure of a te n d o n sheath. V agina tendinis. Vagina
by the brachial muscle, M . brachialis. synovialis, exem plified by a finger.
Skeletal m uscles m ove bones in the ir jo in ts and have a fixed point of Tendon sheaths reduce friction during m ovem ent and protect tendons
origin (Origo) and a flexible point o f insertion (Insertio). They are sur which are deflected by m uscles and bones. The com position of a ten
rounded by a fascia. The belly of the m uscle (Venter, Gaster) connects don is sim ilar to th a t o f a jo in t capsule. The inner layer o f the tendon
w ith the bone through a tendon. The am ount of force a m uscle can sheath (Stratum synoviale, Pars tendinea) is part o f th e tendon, w h e re
transfer onto a jo in t depends on the length of the lever (vertical dis as th e ou ter layer (S tratum synoviale, Pars parietalis) is part o f th e Stra
tance of the vector force of the m uscle and th e rotational axis o f the tu m fib ro su m o f th e ten don sheath. The gap b e tw een both layers (Ca-
joint = lever arm o f force). The length o f the lever varies depending on vitas synovialis) contains synovial fluid (Synovia).
th e jo in t position and is know n as virtual lever. Small blood vessels reach the tendon via Vincula brevia and longa
(small ligam ents from the m esotendineum ).
Figs. 1.29a to g Types of muscles.
M icroscopically, fibres of skeletal m uscles exhibit typical cross-stria-
tions. Based on the ir shape skeletal m uscles can be divided into:
a single head, parallel m uscle fibres (M usculus fusiform is)
b double head, parallel m uscle fibres (M usculus biceps)
c double belly, parallel m uscle fibres (M usculus biventer)
d multi-head, flat m uscle (M usculus planus)
e m ulti-belly m uscle w ith tendinous intersections (M usculus intersec-
tus)
f unipennate m uscle (M usculus sem ipennatus)
g bipennate m uscle (M usculus pennatus)
i- D efinition---------------------------------------------- tain and protect inner organs. Joints provide flexible connections
between bones.
From a functional view point, passive and active m usculoskeletal • The active m usculoskeletal system consists of the skeletal
system s can be distinguished: m uscles w h ich m ove th e bones in th e jo in ts and can be con
• The passive m usculoskeletal system includes bones, joints, trolled voluntarily.
and ligam ents. The skeleton creates th e shape o f th e body, is an
attachm ent point fo r muscles, and form s body cavities tha t con
M u sculo skele ta l system Vessels and nerves Im aging te ch n iq u e s -► In te g u m e n ta ry system
Muscle biomechanics
M . levator scapulae
Clavicula
• S c a p u la
H u m e ru s
F t (vertical)
Fig. 1.30 Forces of muscles and tendons; vector forces of the m uscle is tra nsferred to th e tendon. In th is case, m uscle force (F m ) and
muscles and tendons exem plified by the M m . levator scapulae tendon force (Ft) are alm ost equal. However, w hen the m uscle fibres
and rhom bo idei. (according to [1]) are oriented in an angle to th e pull by th e tendon (e.g. M m . rhom boidei
There is a direct proportional relationship betw een the m uscle force m ajor and minor), only part o f th e con tractile force is transferred to the
and the physiological cross-section of this m uscle (lifting force of a tendon. Here the vertical tendon force (F t [vertical]) is reduced by the
m uscle relative to th e cross-section o f all m uscle fib re s positioned per factor cos a and the transverse tendon force (Ft [transverse]) is reduced
pendicular to the direction of these fibres). W hen the direction of a by th e factor sin a relative to the m uscle force (F m ).
tendon and the vector force of the m uscle align, the full force of the
O ne-arm ed lever
T w o -a rm e d le ver
Fig. 1.31 Lever and m uscle action; m ajor m uscles o f th e e lb o w joint tow ards the torso the M . brachioradialis and the M. brachialis have a
and th e ir anatom ical levers (red lines), (according to [1]) long and short anatomical lever arm, respectively. W hen m uscle force
The lever arm is th e part o f a lever w hich acts betw een the centre of is applied via an one-arm ed lever, th e skeletal co m p o n e n t w ill m ove in
rotation and the point w here the force acts. For skeletal com ponents to th e direction o f a traction force o f th is m uscle (e.g. M m . brachioradialis,
be m oved around a rotational axis of a joint, a m uscle m ust use an ana biceps brachii, brachialis). W ith a tw o-arm ed lever, the point o f muscle
tom ical (existing) lever arm to create a torque. The length of the lever origin is m oved in th e direction o f the m uscular traction, b u t th e main
arm depends on the distance betw een the origin of a m uscle and the part o f th e skeletal com pone nt is m oved in th e op posite dire ction (e.g.
centre o f rotation o f the joint. For example, w h e n the arm is m oved M . trice p s brachii; com pare -* Fig. 1.27).
Surface anatomy O rie n ta tio n on th e b o d y -> S urface a n a to m y -> D e ve lo p m e n t
The cardiovascular system
Tem poralis pulse A. carotis com m unis
F acialis pulse A. subclavia
A. carotis interna A rcus aortae
A. carotis externa Pars ascendens aortae
C arotid pulse [Aorta ascendens]
Cor
Truncus brachiocephalicus Pars descendens aortae [Aorta descendens],
Pars tho ra cica aortae [Aorta thoracica]
A. axillaris Truncus coeliacus
A. m esenterica superior
A. brachialis A. renalis
B rachialis pulse Pars descendens aortae [Aorta descendens],
A. profunda brachii Pars abdom inalis aortae [Aorta abdom inalis]
A. testicularis*
C ubital pulse B ifurcatio aortae
A. ulnaris A. m esenterica inferior
A. iliaca com m unis
A. interossea com m unis A. iliaca externa
A. iliaca interna
A. radialis
R adial pulse
U lnaris pulse
Fem oral pulse
Fig. 1.32 O verview of th e arteries of the A. tibialis posterior P opliteal pulse
system ic circulation. A. tibialis anterior
The function o f arteries is to transport blood A. fibularis Tibialis po sterio r pulse
from the heart to the periphery o f the body or D orsalis pedis pulse
into the lungs. W e distinguish arteries of the A. dorsalis pedis
elastic type (e.g. aorta, arteries close to the
heart) and arteries of the m uscular type (m ost
of the arteries, e.g. Aa. brachialis and fem ora
lis). Blood travels through arteries w ith ever
more narrow diam eter to reach arterioles and
enter into a capillary ne tw ork w here th e ex
change of oxygen takes place betw een the
blood and th e tissue.
* in w o m e n : A. ovarica
I- Clinical Remarks------------------------------------ on the dorsum of the foot. The examination o f the arterial pulse re
veals many clues about the frequency o f the heartbeat, differences
In m any parts o f th e body, large and m edium -sized arteries run o f blood flo w in the upper and low er extrem ity, and holds general
near the body surface. The pulse can be fe lt by pressing the artery clues about the circulation o f the blood in a particular body section.
against a harder underlying structure. The m ost distal palpable pulse
and thus farthest fro m the heart is the pulse o f the A. dorsalis pedis
M u sculo skele ta l S ystem -► Vessels and nerves Im a g in g te ch n iq u e s -► In te g u m e n ta ry system 1
The cardiovascular system
(Sinus valvulae)
V. ju g u la ris e xte rn a brachiocephalica sinistra Valvulae venosae
V. ju g u la ris a n te rio r
V. ju g u la ris in terna V. su b cla via
V. b ra c h io c e p h a lic a d e xtra V. c a v a su p e rio r
V. azygo s V. th o ra c ic a in te rn a
Cor
V. axilla ris Vv. hepaticae
V. ce p h a lica
1.34
V. b a silica
Vv. brachiales V. renalis
V. m e d ian a V. te s tic u la ris sin istra *
cubiti V. p o rta e h e p a tis
V. splenica
V. te s tic u la ris
dextra* V. m e se n te rica in fe rio r
V. m e se n te ric a su p e rio r
V. iliaca V. ca va in fe rio r
com m unis
V. tib ia lis Fig. 1.33 and Fig. 1.34 O ve rv iew of th e
V. iliaca p o s te rio r veins of th e systemic circulation
in te r n a (-* Fig. 1.33) and venous valves
V. iliaca (-» Fig. 1.34).
e x te rn a Veins transport blood from the periphery of
the body back to the heart. They expand easily
V. fem o ra lis and function as reservoirs. The veins o f the
system ic circulation transport deoxygenated
V. sa ph en a m a g na blood, those of the lung circulation transport
oxygenated blood. M o st veins are concom i
P resen tation of veins ta n t veins, m eaning they run in parallel w ith
left arm: deep corresponding arteries. Com pared to th e ar
right arm: superficial teries, the ir course is variable and the blood
left side o f the head: deep pressure is significantly lower. Veins, capillari
right side o f th e head: superficial es, and venoles are part of the lo w pressure
system of blood circulation. M o st of the time,
veins transport blood against gravitational
force. Thus, larger veins o f the extrem ities
and the low er neck region possess valves (ve
nous valves) to support the venous blood flo w
back to the heart. Apart fro m the valves, mus
cles and the arterial pulse (only w hen venous
valves are present) also affect th e venous
blood flow.
A rrow s pointing upwards indicate the direc
tion o f blood flow . W hen blood accumulates
(arrows pointing downw ards) the valves
close.
M ost parts of the body contain a superficial
venous system in the subcutaneous fa t pad
which com m unicates w ith a deeper venous
system running parallel to the arteries (both
system s are separated by venous valves so
that blood can only travel unidirectionally from
the superficial to the deep veins).
* in w om e n: V. ovarica
23
Surface anatomy O rie n ta tio n on th e b o d y -> S urface a n a to m y -> D e ve lo p m e n t
Systemic, pulmonary, and fetal blood circulation
Lig. arteriosu m *
Fossa ovalis A rcus aortae
V. c a v a su p e rio r
Ductus arteriosus**
Foramen ovale Truncus pulm onalis
Pulmo dexter A trium sinistrum
Pulm o sinister
Ventriculus dexter A trium dextrum
V. c a v a in ferior Ventriculus sinister
Ductus ve n o su s*** Hepar
V. u m b ilic a lis V. c a v a in ferior
V. c a v a in te rio r
Lig. v e n o s u m ****
P la cen ta Pars abdom inalis aortae
Funiculus um bilicalis [Aorta abdom inalis]
V. p o rta e h e p a tis
Lig. teres hepatis
Vesica biliaris [fellea]
Aa. um bilicales
Fig. 1.35 The prenatal circulation; schem atic representation, • Ductus venosus (ARANTII)
(according to [1]) • Foramen ovale
A rro w s indicate th e direction o f blood flo w . The prenatal circulation is • Ductus arteriosus (BOTALLI) betw een Truncus pulm onalis and
different from the circulation after birth.
O xygen ated blood is tra nspo rted fro m th e placenta and through the Arcus aortae
um bilical vein to the liver w here m o st o f the blood is drained by the • Aa. um bilicales and V. um bilicalis
D uctus venosus (ARANTII) dire ctly into th e V. cava inferior. From here,
the major part of the blood reaches the right atrium of the heart, cros A t this point, the cardiovascular system only consists of the heart, the
ses over to th e le ft atrium via th e open Foram en ovale in th e atrial system ic circulation (body circulation; supply of body tissues, and the
septum , enters the left ventricle, and is ejected into the aorta and sys sm aller pulm onary circulation (gas exchange) (-» Fig. 5.10). The ejection
te m ic circulation. Venous blood o f the upper half o f the body enters fraction o f the heart o f a resting adult is 70 ml.
th e right atrium through th e V. cava superior and is directed m o stly into A pproxim ately 64% o f blood resides in the venous system at any given
the right ventricle. W hen the heart contracts, m ost of the ejection frac m o m ent and th is can increase to approxim ately 80% (blood reservoir).
tion is transported via th e Ductus arteriosus (BOTALLI) directly into the The small arteries and arterioles of the m uscles mainly determ ine the
A orta descendens. Both sho rtcuts in th e heart (open Foram en ovale vascular resistance. In th e arterial system (high pressure system ) the
and open D uctus arteriosus [BOTALLI]) are required since in th e fe tu s average blood pressure is approxim ately 100 m m Hg (= m m m ercury
th e fluid-filled lungs are not y e t inflated and constitute a barrier. Blood colum n), w h ereas in th e venous system it is approxim ately 20 m m H g.
fro m th e fetal sy s te m ic circulation is routed m ainly via th e internal iliac Both system s are separated by the capillary bed w here the exchanges
arteries (Aa. iliaca internae) into th e paired um bilical arteries (Aa. um o f gas and nutrients take place.
bilicales) located w ithin the umbilical cord to reach the placenta. A se
quence of events shortly after birth w hich involves the term ination of • BOTALLO’s ligam ent
th e placental circulation, the inflation o f the lungs, and the onset of * * BOTALLO’s duct
breathing in th e new born results in th e occlusion of: * * * ARANTIUS’ duct
* * * * ARANTIUS’ ligament
M u sculo skele ta l system -♦ Vessels and nerves Im aging te ch n iq u e s -► In te g u m e n ta ry system
Portal vein system
V. a zyg o s V. h em iazyg o s
(Plexus venosus subm ucosus)
V. p h re n ica in fe rio r
V. h e p a tica
(R. oeso ph a ge a lis)
V. g a s tric a sin istra
V. p o r ta e h e p a tis V. sp le n ica [lienalis]
V. renalis sin istra
V. m e se n te rica V. lu m b a lis a scen de n s
s u p e rio r V. m e se n te rica in fe rio r
V. p a ra u m b ilica lis V. c o lic a sin istra
V. c a v a in fe rio r
V. e p ig a strica V. sig m o id e a
s u p e rfic ia lis V. re c ta lis su p e rio r
V. iliaca co m m u n is
V. e p ig a s tric a in fe rio r
V. ilia c a in te rn a
Vv. rectales inferiores
Fig. 1.36 Portal vein, V. p o rtae hepatis, and inferior vena cava, blood fro m m ost unpaired abdominal organs (stomach, parts o f the in
V. cava inferior; sem i-schem atic representation; trib utarie s to inferior testine, pancreas, spleen) is drained into th e portal vein and fro m here
vena cava in blue; tributaries to th e portal vein in purple. Potential into the liver. This way, m ost o f the nutrients absorbed through th e in
portal-system ic anastom oses are encircled in black. testinal tract firs t reach th e liver and are metabolized there. Not until the
The portal-venous circulation constitutes a special part o f the system ic blood has passed th e liver, is it drained via th e liver veins (Vv. hepaticae)
circulation. Here, tw o separate capillary beds (intestine, liver) are con into the inferior vena cava and the system ic circulation.
nected in sequence. Prior to reaching th e sy s te m ic circulation, venous
i- Clinical Remarks------------------------------------
In patients w ith liver cirrhosis significantly less blood flo w s through flo w and w ill fo rm varicose veins. This can lead to oesophageal
the liver due to higher resistance of the liver and therefore in varices in th e region o f th e gastro-oesophageal junction, to th e rare
creased portal vein pressure. Bypassing the liver, the remainder form ation o f a Caput medusae (M edusa head) in the region o f para
o f the blood flo w s through portocaval anastom oses directly into the um bilical veins, o r it can result in th e occurrence o f varicose veins in
system ic circulation. However, the veins in th e anastom osis region the anal canal. Especially oesophageal varices can easily be injured
are structurally not w ell suited to accom m odate the increased blood during food uptake and cause life-threatening haemorrhages.
Surface anatomy O rie n ta tio n on th e b o d y -> S urface a n a to m y -> D e ve lo p m e n t
Lymphatic system
Truncus jugularis N odi lym phoidei cervicales
V. ju g u la ris in terna A rcus d uctu s thoracici
D uctus lym phaticus de xter Pars cervicalis
(Angulus venosus) Pars thoracica
V. su b cla via D uctus thoracicus
Truncus bronchom ediastinalis
Truncus subclavius Pars abdom inalis
N odi lym phoidei axillares Cisterna chyli
Nodi lym phoidei abdom inis Trunci intestinales
parietales et viscerales
N odi lym phoidei pelvis
parietales e t viscerales
N odi lym phoidei inguinales
Vasa lym phatica
Drainage via D uctus lym phaticus dexter
Drainage via Ductus thoracicus
Fig. 1.37 O verview of th e lym phatic system. drains into th e le ft venous angle (Angulus venosus, located b e tw e e n V.
Starting in th e body periphery, lym ph capillaries collect interstitial fluid jugularis interna sinistra and V. subclavia sinistra) via th e D uctus th o ra
(lymph) and transport it via collecting ducts into lym ph vessels and cicus. The D uctus lym phaticus d exter drains th e lym ph collected
lymph nodes. Lymph nodes responsible for the collection and filtration from the right upper quadrant into the right venous angle (located be
of a particular body region are called regional lymph nodes. Those tw e e n V. jugularis interna dextra and V. subclavia dextra).
lymph nodes accepting lym ph fluid from diffe ren t lymph nodes are In addition to th e lym ph vessels and lym ph nodes th e lym phoid tissue
called collector lym ph nodes. also includes lym phatic organs (thymus, bone m arrow, spleen, ton
Finally, the lym ph reaches tw o m ajor lym phatic ducts, the D uctus tho sils, mucosa-associated lym phoid tissue [MALT]). The lym phatic sys
racicus and Ductus lym phaticus dexter, w hich drain the lym ph into the te m has im po rtan t fu n ctio n s in im m u ne responses and resorption of
venous blood of the system ic circulation. The m ajor part o f th e lymph lipids.
M u sculo skele ta l system -♦ Vessels and nerves Im aging te ch n iq u e s -► In te g u m e n ta ry system
Lymph nodes
Vas lym phaticum efferens Lym ph node artery
Lym ph node vein H ilu s
Lymph node
Vas lym phaticum afferens lens- or bean-shaped w ith a diam eter o f 5-20 mm). The body contains
about 1,000 lym ph nodes and o f those 200 to 300 are located in the
Fig. 1.38 Lymph nodes w ith in- and ou tg oing lym ph vessels; neck alone. Functionally, lymph nodes are part of the im m une system
semi-schematic representation. and play an im po rtan t role in th e defence against infections.
Lymph nodes are part o f the lym phatic system and considered
secundary lym phatic organs. They com e in various shapes (m ostly
Follicular dendritic lym phatica
c e lls in a afferentia
secundary follicle In te rd ig ita tin g
d e n d ritic c e lls in th e
S ubcapsular or paracortical zone
cortical sinus
ITrabeculae .
S econdary follicle
(B cell zone) Interm ediary sinus
C apillary web
Paracortical zone
(T cell zone)
M edullary sinus
Subcapsular o r '
co rtica l sinus
Vas lym phaticum Macrophage
efferens
Fig. 1.39 Lym ph nodes; schem atic cross-section, (according to [2]) lial venules, follicular and inte rdigita ting de ndritic cells, m edullary sinus,
This cross-section o f a representative lym ph node show s in- and outgo interm ediate sinus, and subcapsular or cortical sinus (w ith cellular com
ing lym ph vessels (Vasa afferentia and Vasa efferentia), blood supply, position shown).
and com partm entalization of the lymph node into B region (secondary
follicle), T region (paracortical zone) w ith postcapillary or high endothe- * Reticular cells lining the sinus w all also reside w ithin the sinus.
Clinical Remarks or malignant disease (e.g. m etastasis of a malignant tum our or a
generalized disorder o f the lym phatic system such as HODGKIN's
The exam ination of lym ph nodes is an im portant aspect o f the disease).
physical exam ination o f a patient. The exam ination includes the pal
pable lym ph nodes o f the neck, the axilla, and the groin. The enlarge
m ent of lym ph nodes can be a sign of inflam m ation (lymphadenitis)
Surface anatomy O rie n ta tio n on th e b o d y -> S urface a n a to m y -> D e ve lo p m e n t
Nervous system
E n c e p h a lo n Nn. craniales
M edulla spinalis
Plexus cervicalis Plexus brachialis
R. ventralis nervi spinalis
Plexus lum bosacralis
Fig. 1.40 and Fig. 1.41 O rgan ization of th e nervous system ; ing past experiences (memory). The nervous system is also essential
ventral (-* Fig. 1.40) and dorsal v ie w (-» Fig. 1.41). (according to [2]) fo r conceptualizing im aginations (thinking), generating em otions, and
The nervous system is com posed o f the central (CNS; brain, spinal adapting quickly to changes in the surrounding w orld and the body inte
cord) and peripheral nervous system (PNS). The PNS is m ainly com rior. W e distinguish the autonom ic (visceral, regulating the activities of
posed o f spinal nerves (w ith connections to the spinal cord) and cranial the intestines, predom inantly involuntary) and the som atic (innervation
nerves (w ith connections to th e brain). o f skeletal muscles, cognitive perception o f sensory input) nervous
The nervous system is involved in com plex fu n ctio n s th a t include the system. Both system s interact w ith and affect each other. Apart from
regulation o f the activities o f the m uscles and the intestines, the com the nervous system , overall body functions are also regulated by the
munication w ith the environm ent and the inner self, and memoriz endocrine system .
M u sculo skele ta l system -♦ Vessels and nerves Im aging te ch n iq u e s -► In te g u m e n ta ry system
Spinal nerves
R adix p o sterio r
R adix an terio r
R. posterior
N. intercostalis
R. cutaneus lateralis
R. cutaneus anterior
R. c o m m u n ican s
G anglion tru nci sym pathici
N n. spinales:
Nn. cervicales
Nn. thoracici
Nn. lumbales
Nn. sacrales
N .coccygeus
Fig. 1.42 S chem atic representation of a spinal nerve (spinal cord nerves are located in th e dorsal ro ot ganglia (Ganglia sensoria nervi
segm ent) exem p lified by tw o thoracic nerves; v ie w fro m above in spinalis). Their processes enter the spinal cord via the dorsal roots.
an oblique lateral angle. Rami com m unicantes connect the spinal cord w ith the sym pathetic
The human body has 31 pairs o f spinal nerves (eight cervical, tw e lv e chain o f ganglia (Ganglia trunci sym pathici) o f th e sym pathetic trunk
thoracic, five lumbar, five sacral pairs, and one coccygeal pair). Each (Truncus sym pathicus). All branches of the dorsal spinal nerves as w ell
spinal nerve is com posed o f an anterior root (Radix anterior) and a dor as the ventral branches of the thoracic spinal nerves T2 to T11 have a
sal ro o t (Radix posterior). The cell bodies (Perikarya) o f m o to r nerves segmental arrangement. The other ventral branches converge to form
are located in th e grey m a tte r w ith in th e spinal cord. Their axons leave plexus (Plexus cervicalis, brachialis, lumbosacralis).
the spinal cord form ing the anterior root. The perikarya of sensory
r- Clinical Rem arks------------------------------------ can lead to palsy or excessive excitation of nerve cells (neurons).
P olyneuropathy resem bles a clinical scenario in w h ich m any ner
Excessive alcohol consum ption, Diabetes m ellitus, vitam in B defi ves are affected.
ciency, intoxication w ith heavy m etals and drugs as w e ll as impaired
blood perfusion can result in disturbances o f peripheral nerves. This
Surface anatomy O rie n ta tio n on th e b o d y -> S urface a n a to m y -> D e ve lo p m e n t
Autonom ic nervous system
Fig. 1.43 A u to n o m ic nervous system . [22] naline (epinephrine) and noradrenaline (norepinephrine) into the circula
The autonom ic nervous system consists of the sympathicus, parasym tion.
pathetic (Parasympathicus and enteric nervous system . The nuclei o f th e Parasym pathicus are located in th e brain ste m and
The nerve cells o f th e S ym pathicu s are located in th e lateral horn of the sacral spinal cord. Preganglionic parasym pathetic axons reach gan
th e thoracolum bar segm ent of the spinal cord. Their axons project into glia close to the ir target organs. Here, they synapse w ith postganglionic
the ganglia o f the sym pathetic chain and the ganglia o f th e g a stro in te s neurons which send short axons to their target organs. The parasympa
tinal tract. Here, the preganglionic fibres synapse on postganglionic thetic system regulates food intake and digestion as w ell as sexual
neurons which send their processes to the target organ. Activation of arousal. The Parasympathicus is th e antagonist o f th e Sympathicus.
th e sym p hate tic system occurs during m obilization o f th e body and in The enteric nervous system regulates th e activity o f the intestinal
em ergency situations (the three Fs: frig ht, flight, fight). The medulla of tra ct and is controlled by Sym pathicus and Parasympathicus.
th e adrenal gland is part o f th e s ym p athe tic system and secretes adre-
i- Clinical Remarks------------------------------------ oth er disorders (e.g. au ton om ic dysregulation due to stress, se
vere pain, o r psychiatric disorders). D epending on th e a ffe cte d re
Disorders o f th e auton om ic nervous system play a role in alm o st gion of the autonom ic nervous system , disorders of the circulatory
all medical disciplines. These disorders can present as separate dis system , digestion, sexual function, or other functions may prevail.
eases (e.g. hereditary au tonom ic neuropathy), as a consequence of
o th e r diseases (e.g. au tonom ic neuropathy in diabetes m e llitu s or
PARKINSON'S disease), or in response to external conditions and
M u sculo skele ta l system -♦ Vessels and nerves Im aging te ch n iq u e s -► In te g u m e n ta ry system
Autonom ic nervous system
G anglion cervicale Pons N. o c u lo m o to riu s [III]
superius N. fa c ia lis [VII]
M edulla oblongata N. glossopharyngeus
N. cardiacus [IX]
cervicalis superior A. carotis com m unis
G anglion cervicale N. va g u s [X]
A. subclavia
m edium laryngeus recurrens dexter N. laryngeus
N. cardiacus recurrens sinister
cervicalis medius aortae; Plexus cardiacus
G anglion Pars ascendens aortae Truncus vagalis anterior
c e rv ic o th o ra c ic u m Truncus vagalis posterior
[s tellatu m ] Pars tho ra cica aortae Plexus oesophageus
A nsa subclavia
N. cardiacus Truncus coeliacus; Pars cranialis
cervicalis inferior Plexus coeliacus Pars pelvica
G anglia coeliaca
Truncus sym pathicus; Radix parasym pathica
G anglia thoracica A. renalis; Plexus renalis [Nn. splanchnici pelvici]
A. m esenterica superior; G anglia pelvica
N. splanchnicus m ajor 5XUS m e se n te ric u s su p e rio r
Pars a bd om in alis aortae;
Rr. c o m m u n ica n te s exus aorticus abdom inalis
A. m esenterica inferior;
N. splanchnicus m inor Plexus m esentericus inferior
P lexus h ypogastricus superior
Truncus sym pathicus;
G anglia lum balia A. iliaca com m unis
Nn. splanchnici lum bales N. hypogastricus
Truncus sym pathicus; Plexus hypogastricus inferior
G anglia sacralia
Nn. splanchnici
sacrales
G anglion im par
Fig. 1.44 Representation of th e Sym pathicus, Pars sympathica. Fig. 1.45 Representation of th e Parasym pathicus, Pars
The entire sym pathetic chain o f ganglia and the ir interganglionic con para sym p ath ic a.
nections located to both sides o f the vertebral colum n are called the The parasym pathetic fibres (purple) norm ally run tog ethe r w ith other
Truncus sym pathicus (green). nerves fibres.
Surface anatomy O rie n ta tio n on th e b o d y -> S urface a n a to m y -> D e ve lo p m e n t
Radiography, fluoroscopy
S capula, Angulus superior Arcus aortae
Costa I A. pulm onalis sinistra
V. c a v a s u p e rio r Truncus pulm onalis
B ifurcatio tracheae, C arina tracheae V. p u lm o n a lis
S capula, M argo medialis
Scapula, M argo medialis
B ronchus principalis dexter B ronchus principalis sinister
Auricula sinistra
V. p u lm o n a lis V. p u lm o n a lis
A. pulm onalis dextra Ventriculus sinister
ie
Atrium dextrum Diaphragm a, (Cupula sinistra)
V. p u lm o n a lis
Fundus gastricus
V. ca va in fe rio r
Diaphragma, (Cupula dextra)
Recessus costodiaphragm aticus
Fig. 1.46 Conventional radiograph (X-ray), overview of the in a posterior-anterior (PA) dire ction (patient faces radiographic film ). In
th orax. [27] th e lying position, th e X-rays pass through the patient in an anterior-
Radiography is one o f th e m o s t fre q u e n tly used im aging tech nique s in po sterior (AP) direction. A good radiographic im age o f th e tho rax dis
hospitals and local clinical practice. Familiarity w ith the imaging tech plays the m ajor bronchi and blood vessels of the lung, the cardiomedi-
nique is essential in understanding h o w such im ages are being astinal conture, the diaphragm, the ribs, and th e peripheral s o ft tissue.
generated and w h a t type o f radiographic im age is view ed. S im ple radio-
graphic images o f the thorax are among those m ost frequently generat * conture of the breast (mamma)
ed. W ith a patient standing upright, the X-rays pass through the thorax
G aste r
Vertebra lum balis
Fig. 1.47 Conventional radiograph (X-ray), colon fluoroscopy
after barium sw allow test. [8 ]
In a radiograph, ho llo w organs, such as arteries, veins, and intestinal
loops, are poor in contrast and need to be filled w ith a substance that
absorbs X-rays to increase contrast. These substances m ust not be
toxic to the patient. A frequently used substance to increase contrast of
th e gastro-intestinal tra ct is th e insoluble, non-toxic, high de nsity salt
barium sulfate. For applications in vessels iodine-containing m olecules
are usually em ployed. These substances are safe and w ell tolerated by
m ost patients and can also be used to image the kidneys, ureters, and
bladder (intravenous urogram [IVU], intravenous pyelogram [IVP]) as
the y are excreted by the kidneys.
M u sculo skele ta l system Vessels and nerves Im a g in g te ch n iq u e s -► In te g u m e n ta ry system
Scintigraphy and ultrasound
Fig. 1.48 S cintigraphy, scintigram o f th e th yro id gland. [27] ray em itter has to be adm inistered to the patient. The radio-isotope
In scintigraphy, gam m a rays (a fo rm o f electrom a gne tic rays) are used tech netiu m -99 m (99mjc) is m o s t fre q u e n tly used and injected as a
to generate an image. Gamma rays are produced as a result of the de cocktail together w ith other molecules. Upon injection, images are gen
cay o f unstable atom ic nuclei, w hereas X-rays are excess energy re erated by a gam m a cam era, depending on h o w th e radiopharm acon is
leased during the bom bardm ent of atom s w ith electrons. The gamma absorbed, distributed, metabolized, or excreted by the body.
M em brum inferius Caput, Frons
Nasus
Labium superius
Regio mentalis
Fig. 1.49 Sonography, ultrasound im age of a fe tu s a t w e e k 28 of inner organs and th e ir c o n te n t (fetus in th e uterus), registered by the
pregnancy; lateral view. sam e piezo-electric elem ent, and transform ed back into electrical im
Exam inations o f th e body em ploying ultrasound are com m on in all m e pulses by th e crystal. This info rm atio n is the n analysed by a com pute r
dical specialties. Ultrasound represents a series o f high-frequency and presented on a screen. This way, the m ovem ents of the extrem i
sound w aves (not an electrom agnetic beam) generated by electric im ties o f the fetus and the opening o f the m outh can be view ed as a live
pulses in piezo-electric crystals. These sound w aves are reflected from im a g e .
Surface anatomy O rie n ta tio n on th e b o d y -> S urface a n a to m y -> D e ve lo p m e n t
Com puted tom ography (CT) and 3-D CT angiography
O rbita C oncha nasalis m edia
C oncha nasalis inferior
S eptum nasi
S inus m axillaris
Fig. 1.50 Com puted tom ography, coronal com puted tom ogram the transverse or, as show n here, the coronal plane. The patient rests
(CT) o f th e sinuses. [11] on a table and, w hile circulating the body, an X-ray tube takes one sec
C om puted tom ography (CT) w a s developed by Sir G odfrey H ounsfield tional im age a fte r th e other. O nce all im ages have been acquired, the
in th e 1970es and has undergone con stant re finem e nt. The com puted individual sectional images are calculated by a com puter applying com
tom ograph generates a series of sectional im ages through th e body in plex mathem atical algorithms.
Pars descendens aortae [Aorta descendens] A. lienalis
Pars abdom inalis aortae [Aorta abdom inalis] Ren sinistrum
Truncus coeliacus Ureter sinister
V erte b ra lu m b a lis IV
A. m esenterica superior A. iliaca com m unis sinistra
A. renalis dextra Vertebra lum balis V
Ren dextrum Os ilium sinistrum
A. iliaca interna sinistra
Ureter dexter
Pars abdom inalis aortae [Aorta abdom inalis] C aput fem oris sinistra
B ifu rc a tio Foramen obturatum sinistrum
A. iliaca com m unis dextra
A. iliaca interna dextra
O s ilium dextrum
Spina iliaca anterior superior dextra
A. iliaca externa
A. profunda fem oris
O s pubis sinistrum
Fig. 1.51 3-D CT angiography, 3-D CT an gio gram o f d ifferen t blood vessel, the region o f interest is scanned during fast intravenous
structures of the abdomen and pelvis (volume-rendering injection o f a iodine-containing substance to increase contrast of the
techn iqu e, VRT) derived fro m m u ltid etecto r CT sections. [27] structure. The resulting sectional images of branching vessels are then
M o dern c o m pute d tom ography tech nolog y (e.g. 64-lines volum e spiral assem bled by a com puter to generate a 3-D image.
m u ltila yer CT) provides n e w dim ensions and indications fo r CT diag
nostics and guarantees minim al dosage exposure for patients. * clinical term : A. fem oralis superficialis
CT angiography is based on th e sam e m u ltila yer CT technology. In a
M u sculo skele ta l system Vessels and nerves Im a g in g te ch n iq u e s -► In te g u m e n ta ry system
M agnetic resonance imaging (MRI)
Sinus frontalis Lobus frontalis sinister
Corpus callosum , Genu V entriculus lateralis
C orpus callosum , Splenium Capsula interna, Crus anterius
Nucleus lentiform is, Putamen
Lobus tem poralis
Thalam us sinister
Ventriculus lateralis sinister
Lobus occipitalis
Fig. 1.52 M a g n e tic resonance to m o g rap h y (M RT) or im aging briefly exposed to radiofrequency pulses to system atically change the
(MRI), axial (transverse) m agnetic resonance im age of the brain alignm ent of these protons.
(T 2-w e ig h ted ). [27] W hen returning to their original position, the protons e m it a w eak radio
In m agnetic resonance imaging patients are exposed to a pow erful m ag w ave th a t is detected by the instrum ent. The strength, frequency, and
ne tic field. This causes all protons o f hydrogen atom s in th e body to tim e it takes fo r th e protons to return to th e ir original position is an im
align w ith the magnetic field w hich effectively transform s these portant inform ation contained w ithin the em itted signal and analysed
hydrogen protons to becom e miniature magnets. Then patients are by a com puter to generate an image.
Femur V. p o p lite a
M . q uadriceps fem oris, Tendo V. sa ph en a parva
P a te lla Lig. cruciatum anterius
Cartilagines articulares A. poplitea
C orpus adiposum infrapatellare* T ib ia
Plica infrapatellaris
Lig. patellae
Tuberositas tibiae
Fig. 1.53 M a g n e tic resonance to m o g rap h y, sagittal m agnetic dark, fat: bright; e.g. jo in t effusion dark) and T2-w eighted (fluids: bright,
resonance im age (M RI) of a knee (T 2-w e ig h ted ). [27] fat: grey; e.g. the conspicuous HOFFA's fat pad betw een the patella
Altering the sequence of impulses used to excite protons allows for and tibia) images. Thus, specifically T-w eighted images em phasise par
different characteristic features o f these protons to be analysed. These ticular tissue com partm ents. MRI can also be used to generate angio
characteristics are called " w e ig h tin g " o f an MRI scan. A ltera tions in grams of the peripheral and central circulation.
pulse fre que ncy and scanning param eters result in T1 -w e ig h te d (fluids:
* HOFFA's fa t pad
Surface anatomy O rie n ta tio n on th e b o d y -> S urface a n a to m y -> D e ve lo p m e n t
Nails
Vallum unguis M argo liber H yponychium
Lunula M atrix unguis
Corpus unguis
E p o n y c h iu m Nail w all
Lunula
Fig. 1.54 Distal finger phalanx w ith nail. Fig. 1.55 Distal fin ger phalanx; nail partially rem oved.
The nail (Unguis) is a convex-shaped, tra nslucen t keratin plate on the The epithelium located beneath th e fre e margin o f the nail at th e tip s of
upper side o f the distal phalanx o f the finger and toe. It serves to pro th e phalanges is called hyponychium (also know n as "q u ic k "). Beneath
te ct the tips o f the fingers and toes and supports the grasping function th e epithelial hyponychium lies th e fibrous base o f th e nail bed w h ich is
o f th e fingers. The nail em beds into cutaneous slits (nail grooves, Val tigh tly connected w ith the periost of th e distal phalanx. The proximal
lum unguis) and its lateral margin is covered by th e cutaneous nail w all hyponychium fo rm s th e nail m atrix (M atrix unguis) w h ich generates the
or fold on both sides o f th e nail. The epithelial layer exte nding fro m the nail plate. The Lunula is th e visible part o f th e nail m atrix.
nail w all at th e base o f th e nail on to th e dorsal nail plate is called epony-
chium . The nail plate is anchored here to th e nail bed, th e skin beneath
th e nail plate.
Corpus unguis M atrix unguis
H yponychium E p o n y c h iu m
M argo liber Vallum unguis
Nail bed
Phalanx distalis A poneurosis dorsalis
A rticu latio interphalangea distalis
E pid e rm is Capsula articularis
D e rm is
S ubcutis
M. flexor digitorum profundus, Tendo
Fig. 1.56 Distal finger phalanx; Phalanx distalis; sagittal section.
The nail bed com prises th e region b e tw e e n th e nail and th e distal pha
lanx. It consists o f epithelium (Hyponychium and M atrix unguis) and the
underlying dermis.
i- Clinical Remarks------------------------------------ o f th e nail plate. N um erous system ic diseases are associated w ith
nail changes. For exam ple, psoriasis leads to th e form atio n o f sm all
W h ite spots under nails are due to de fe ctive fusio n o f th e nail plate pits, oily spots and som etim es crum bly nails up to a com plete nail
w ith th e nail bed. Changes in light re flection at th e se points cause dystrophy. Follow ing skin and nail injuries, th e nail can be colonized
th e nail plate to appear m ilky-w h ite (sim ilar to th e Lunula). The lack by fungi (onychomycosis). Treatm ent of fungal infections of the
of fusion may have diffe ren t reasons, fo r exam ple it occurs through toenails is often lengthy.
physical traum a, it may result fro m certain m edication, or it is linked
to various diseases. B rittle nails signal lack o f biotin (vitam in H).
Biotin is required fo r the form ation o f keratin, the main com ponent
The words you are searching are inside this book. To get more targeted content, please make full-text search by clicking here.
Discover the best professional documents and content resources in AnyFlip Document Base.
Search