Directional Terms and Movement Terminology

Superior vs. Inferior

- Superior : Closer to the head (higher position).
- Inferior: Closer to the feet (lower position) (Fig. 1.2).

Superficial vs. Deep

- *Superficial*: Closer to the skin surface.
- *Deep*: Farther from the skin surface (Fig. 1.2).

Bilateral vs. Unilateral

- *Bilateral*: Structures/occurrences on both sides (e.g.,
eyes).
- *Unilateral*: Structures/occurrences on one side (e.g.,
spleen).
- Clinical example: "Bilateral amputee" (both legs lost) vs.
"unilateral paralysis" (one-sided).

Ipsilateral vs. Contralateral

- *Ipsilateral*: Same side of the body.
- *Contralateral*: Opposite side of the body.
Embryological/Gross Anatomy Terms
- Ventral: Anterior aspect (torso, hands, feet).
- Hand: Palmar (ventral/anterior).
- Foot: Plantar (ventral/inferior).
- Dorsal: Posterior aspect.
- Canial/Rostralr: Toward the head.
- Caudal: Toward the tail.

Limb-Specific Terms
- Proximal: Nearer to the trunk (e.g., elbow is proximal to
the wrist).
- Distal: Farther from the trunk (e.g., elbow is distal to the
shoulder).
- Radial: Outer border (upper limb).
- Ulnar: Inner border (upper limb).
- Tibial: Inner border (lower limb).
- Fibular: Outer border (lower limb).
- Flexor/Extensor Surfaces:
- Upper limb: Anterior = flexor, posterior = extensor.
- Lower limb: Posterior = flexor, anterior = extensor.
- Palmar (volar): Palm of the hand.
- Plantar: Sole of the foot.

Clinical Example:
- "Pain superior to the left ear, traveling over the skull and
down the contralateral torso."
- "Superficial burns on the medial right upper limb and deep
burns on the lateral ipsilateral lower limb."

Movement Terminology
- Flexion: Reduces joint angle (e.g., bending elbow).
- *Extension*: Increases joint angle (e.g., straightening
elbow).
- *Abduction*: Movement away from midline (e.g., raising
arm sideways).
- *Adduction*: Movement toward midline.
- *Medial Rotation*: Inward rotation (toward midline).
- *Lateral Rotation*: Outward rotation (away from midline).
- *Circumduction*: Circular movement (combination of
above).
- *Pronation*: Forearm rotation (palm faces down).

### Movement Terminology

- *Supination*: Palm faces anteriorly or upward.
- *Protraction*: Segment glides anteriorly (forward
protrusion).
- *Retraction*: Segment glides posteriorly.
- *Inversion*: Inward (medial) rotation of the sole of the
foot.
- *Eversion*: Outward (lateral) rotation of the sole of the
foot.
- *Dorsiflexion*: Bringing toes toward the tibia (standing on
heels).
- *Plantarflexion*: Pointing toes downward (toes lower
than heel).

### Movements Across Joints

- *Flexion/Extension*: Decreasing/increasing joint angle
(anterior/posterior movement).
- *Abduction/Adduction*: Movement away from/toward the
midline.
- *Medial/Lateral Rotation*: Rotation toward/away from the
midline along longitudinal axis.
- *Circumduction*: Circular "windmill" motion combining all
above movements.

---

## SKIN (Integumentary System)

- *Integument*: Includes skin (epidermis + dermis) and
appendages (sweat glands, hair, nails) - the body's largest
organ (Fig. 1.3).

### Functions
1. *Protection*: Against injury, infection, and water loss.
2. *Sensation*: Contains sensory receptors.
3. *Excretion*: Eliminates waste through sweat.
4. *Thermoregulation*: Regulates body temperature.
5. *Water Balance*: Epidermis relies on dermal blood
vessels for nourishment.

### Clinical Aspects

- *Psoriasis*: Thickened epidermis due to rapid cell
turnover.
- *Albinism/Vitiligo*: Loss of melanin (white patches).
- *Skin Cancers*: Linked to UV exposure.
- *Burns*: Cause evaporative water loss.y
- *Infections*: Result from compromised skin function.
- *Boils*: Infections of hair follicles/sebaceous glands.
- *Sebaceous Cysts*: Caused by blocked sebaceous ducts.
- *Skin Grafting*: Replaces lost skin (split-thickness or
full-thickness).

---

## FASCIA
Types
1. *Superficial Fascia*:
- Located between skin and deep fascia.
- Loose, fatty connective tissue
(hypodermis/subcutaneous layer).
- Contains lymphatics, blood vessels, and nerves.

2. Deep Fascia:
- Dense connective tissue.
- Modifications include:
- *Retinacula*: Hold tendons in place (act as pulleys).
- *Intermuscular Septa*: Separate muscle groups.
Intermuscular septa form compartments to separate the
different muscle groups.​
Ligaments hold bones together.​
Deep to deep fascia are the deep lymphatics, arteries and
veins.​
Deep fascia helps in the venous return by forming a tight
sleeve around the contracting muscles. The veins which lie
between the deep fascia and muscles are thus compressed
when muscles relax (milking action). Also when muscles
relax blood is drawn into perforators by suction effect. This
blood is pumped into deep veins by contraction of muscles.
Blood in veins jumps up by this action as dictated by the
direction of valves.

–The deep fascia indicates the planes along which

the infection can spread from a given site.

BONES​
It is a hard, living, specialized connective tissue.
Osteology​
Study of bones. There are 206 bones in the body.

Functions of the Bones

●​ Give shape and support to the body.​

●​ Provide surface for muscle attachments.

●​ Protect vital organs such as brain, heart, lung, etc.​

●​ Bone marrow produces blood cells.​

●​ Store house of calcium and phosphate.​

The skeleton has two parts:

1.​Axial skeleton: Skull, vertebral column, ribs, sacrum.​

2.​Appendicular skeleton: Limb bones, pectoral girdle

(clavicle and scapula), pelvic girdle (hip bones).​

Classification of Bones

Bones are classified according to shape, development or

structure.

A. According to Shape:
 1.​Long bones have long shaft (diaphysis) and two
ends (epiphysis), e.g. humerus, radius, ulna,
femur, tibia, fibula. Metatarsal, metacarpals,
phalanges have only one epiphysis.​

2.​Short bones are usually cuboid, cuneiform,

scaphoid, etc., e.g. carpal and tarsal bones.​

3.​Flat bones resemble plates, e.g. skull bones —

frontal, parietal, etc., ribs, sternum, scapula.​

4.​Irregular bones, e.g. vertebrae, hip bone.​

5.​Pneumatic bones are the irregular bones with

air-filled spaces within them, e.g. maxilla,
sphenoid, ethmoid.​

6.​Sesamoid bones are the bones found inside the

tendons. They have no periosteum, e.g. patella,
pisiform. Patella is the largest sesamoid bone.​

B. According to Development:

1.​Membranous bones ossify in membrane, e.g.

frontal bone in the skull, clavicle.​
 2.​Cartilaginous bones ossify in cartilage, e.g. bones
of the limbs, vertebral column.​

C. According to Structure:

1.​Compact bone dense in texture, e.g. cortex of

long bones (greatest in shaft region).​

2.​Spongy or cancellous bone made of meshwork

of trabeculae and spaces, e.g. ends of long
bones.​

Parts of a Long Bone

A long bone has a shaft (diaphysis) and two ends
(epiphysis).

●​ Periosteum: The shaft is covered by periosteum and

has a cortex and a medullary (marrow) cavity. The
periosteum is a fibrous membrane. It is made of outer
fibrous and inner cellular layer. Periosteum has a rich
nerve supply which makes it very sensitive. The
muscles are attached to the periosteum. It is supplied
by the periosteal arteries.​
 ●​Endosteum is a vascular membrane lining the
marrow cavity.​

Blood supply of a long bone is derived from :

1.​Nutrient artery.​

2.​Periosteal arteries.​

3.​Epiphyseal arteries.​

4.​Metaphyseal arteries.​

Development of Bones
●​ Develop from either cartilaginous or membranous
ossification.​

●​ Primary centers of ossification appear before birth.

Secondary centers appear after birth.​

●​ Lower end of femur is exception and has medicolegal

importance. Its lower end has the secondary center
which appears just before birth and indicates viability
of baby which is dead.​
Clinical Aspects

1.​Osteomalacia: Softening of bone due to lack of

calcium because of vitamin D deficiency (adults).​

2.​Rickets is a metabolic disturbance resulting in

inadequate calcification (children).
 3.​Osteomyelitis: Inflammation of bone marrow and
adjacent bone.​

4.​Epiphyseal cartilage/plate fractures are serious as

they cause shortening of the bone.​

5.​Osteoporosis: Decrease in organic and inorganic

components of bone.​

6.​Fracture is a break in the continuity of bone;

commonly due to an injury. It may be an open
(exposed to exterior by torn skin) or closed fracture
(not exposed to exterior by intact skin). Healing is by
formation of a collar and callus (remember 2 C's).​

Bones of the Limbs

Upper limb

●​ Clavicle – Collar bone​

●​ Scapula – Shoulder blade​

●​ Humerus – Arm bone​

●​ Radius/Ulna – Forearm bone​

●​ Carpal bone – Wrist bone​

 ●​ Metacarpal – Hand bone​

●​ Phalanges – Digits​

Lower limb

●​ Hip bone –​

●​ Femur – Thigh bone​

●​ Patella – Knee caps​

●​ Tibia – Shin bone (leg)​

●​ Fibula – Leg bone​

●​ Tarsal Bones – Ankle/heel​

●​ Metatarsal – Foot​

●​ Phalanges – Digits​

Terms used for describing Bony Features

1.​Elevations​
a. Linear elevations: Line, lip or crest.​
b. Sharp elevations: Spine, styloid process, etc.​
c. Rounded elevations: Tubercle, tuberosity,
 malleolus, trochanter, epicondyle.​

2.​Depressions – Pit, fovea, fossa, groove, notch,

sulcus.​

3.​Openings – Foramen, canal, hiatus.​

4.​Cavities – Sinus, antrum.​

5.​Smooth articular areas – Facet, condyle, head,

capitulum, or trochlea.​

○​ Ramus is a broad process.​

Bone Parts Definitions

●​ Head: Enlarged part at the end, usually proximal.​

●​ Anatomical neck: Narrow part.​

●​ Surgical neck: Part of bone most likely to break.​

●​ Shaft: Long, smooth part of bone between ends.​

●​ Crest: Ridge for muscle attachment.​

●​ Condyle: Rounded part, for joints.​

 ●​ Fossa: Hollow or depressed area.​

Epicondyle

Bump near condyle, for muscle attachment.

Tubercle

Small bump, for muscle attachment.

Tuberosity

Large bump, for muscle attachment.

Trochanter

Large protrusion, for muscle attachment (found only in

femur).
Foramen

Opening for nerves and blood vessels.

JOINTS

Site where two or more bones meet (Table 1.1).

Types:

●​ Fibrous joint: Articular surfaces joined by fibrous

tissue. Little/no movement possible (Fig. 1.6A).​

●​ Cartilaginous joint: Little/no movement possible.​

 ○​ Primary — Bone ends are united by hyaline
cartilage (Fig. 1.6B).​

○​ Secondary — Bone ends are covered by hyaline

cartilage and united by fibrocartilage (Fig. 1.6C).​

●​ Synovial joint: Bone ends are covered by hyaline

cartilage (articular cartilage). Have capsule, synovial
membrane, synovial fluid in cavity, and are most
mobile joints. They may be of the following variety:
Plane, hinge, pivot, condyloid, ellipsoid, saddle, or ball
and socket type (Figs 1.6D and 1.7).​

CLINICAL ANATOMY

●​ Dislocation is disruption of the normal anatomical

relationship that 2 or more articulating surfaces share
at a joint.​

●​ Subluxation is partial dislocation.​

●​ Arthritis (inflammation).​

●​ Arthroscopy is visualizing the interior of a synovial joint

for pathology using a small telescopic device.​

Ligaments
Ligaments are tough bands of connective tissue going from
bone to bone. They are important factors to maintain
stability of a joint, e.g. cruciate, deltoid, ligamentum flavum
and nuchae.

CLINICAL ANATOMY

Sprain is an injury to a ligament as a result of undue

stretch, to which it may be subjected.

BURSAE AND SYNOVIAL SHEATHS

●​ They contain synovial fluid which is a clear or pale

yellow, viscous fluid (Fig. 1.8).​

●​ They may become inflamed resulting in bursitis or

tenosynovitis.​

●​ Bursae prevent friction when one structure like muscle,

tendon or skin slides over bone.​

●​ Synovial sheaths envelop tendons and prevent them

from being subjected to friction while sliding.​

MUSCLES
Tissues endowed with the property to contract and relax.
These are of three varieties:

1.​Skeletal: Strong, quick, voluntary contraction. Found

attached to skeleton.​

2.​Cardiac: Strong, quick, involuntary contraction. Found

in heart.​

3.​Smooth: Weak, slow, involuntary contraction. Found in

wall of hollow viscus, vessels, etc.​

Muscle Attachments and Terms Used

●​ Origin: The end of the muscle which is relatively fixed

during contraction (on stationary bone—fixed) (Fig.
1.9).​

●​ Insertion: End which moves (on bone that is

moving—movable).​

●​ Proximal and distal attachments (better descriptions

that can be used in limbs).
Fig. 1.6: Types of joints

●​ A: Fibrous tissue — Fibrous joint​

●​ B: Hyaline cartilage — Primary cartilaginous joint​

 ●​ C: Fibrocartilage, Hyaline cartilage — Secondary
cartilaginous joint​

●​ D: Articular cartilage, Synovial membrane, Cavity,

Capsule — Synovial joint​

Table 1.1: Examples of joint types

Joint types Examples

Fibrous joint
Sutures Skull
Syndesmosis Interosseous membrane and inferior
tibiofibular joint
Gomphosis Between teeth and jaws
Cartilaginous
joint
Primary Epiphyseal plates of long bones,
cartilaginous between occipital and sphenoid bones of
joint skull
Secondary Intervertebral discs, symphysis pubis
cartilaginous
joint
Synovial joint
Plane Acromioclavicular
Hinge Elbow
Pivot Superior radioulnar and median
atlantoaxial
Condyloid Knee
Ellipsoid Wrist
Saddle Carpometacarpal joint of thumb
Ball and socket Hip and shoulder

Fig. 1.7: Types of synovial joints

●​ Plane​

●​ Hinge​

●​ Saddle​
2 Convex surfaces, 2 Concave surfaces​

●​ Ball and socket​

●​ Pivot​

●​ Ellipsoid​

●​ Condyloid​

Fig. 1.8: Bursa and synovial sheath

Bursa:

●​ Membrane​

●​ Fluid​

Synovial Sheath:

●​ Tendon​

●​ Synovial sheath​

●​ Visceral layer​

●​ Parietal layer​

●​ Mesotendon​

Fig. 1.9: Parts of muscle

●​ Belly: Fleshy and contractile part of the muscle.​

●​ Tendon: The fibrous, non-contractile and cord-like part

of a muscle.​

●​ Aponeurosis: The flattened tendon (Fig. 1.9).​

●​ Raphe: A fibrous band of interdigitating fibres of

tendons or aponeurosis (Fig. 1.9).​
 ●​ Compartments: Units of muscles with similar actions,
blood supply, and innervations.​

●​ Agonists: Contracting/shortening muscles.​

●​ Antagonists: Relaxing/extending muscles usually

opposite to the agonist group muscles.​

Clinical Anatomy

Paralysis – loss of muscle innervation by interruption of its

nerve supply results in spastic or flaccid paralysis.

Table 1.2: Classification based on arrangement of fibres (Fig. 1.10)

Classifi Arrangement of fibres Examples

cation
Parallel Muscle fibers parallel to Strap-like - Sartorius
one another Quadrilateral -
Thyrohyoid
Fusiform -
Lumbricals
Triangul Muscle fibers converge Temporalis
ar into a tendon
Pennate Muscle fibers present on Unipennate -
one side of tendon Peroneus tertius
Muscle fibers present on Bipennate - Dorsal
two sides of tendon interossei
Muscle fibers converge Multipennate /
on tendon which is in the Circumpennate -
central axis of the muscle Deltoid, Tibialis
anterior

Fig. 1.10: Arrangement of fibers in skeletal muscle

●​ Unipennate​

●​ Bipennate​

●​ Multipennate​
Fibrous septa​

●​ Circumpennate​

●​ Parallel​

●​ Quadrilateral​

●​ Long strap​

●​ Fusiform​

●​ Triangular​
CIRCULATORY SYSTEM

Includes:

●​ Systemic circulation from left ventricle of heart to

tissues of body and back to right atrium of heart.​

●​ Pulmonary circulation from right ventricle of heart to

lungs and back to left atrium of heart.​

●​ Portal circulation from one capillary bed to another

before reaching the heart. They are uncommon as the
capillary beds normally drain into the heart and not into
another capillary bed (Fig. 1.11).​

●​ Lymphatic system includes lymphoid organs and

lymphatic vessels. Functions to protect the body from
invasion and damage by microorganisms and foreign
substances.​
Lymphoid organs or tissues include:​
– Lymph nodes.​
– Thymus.​
– Spleen.​
– Tonsils.​
– Bone marrow.​

Terms used for describing vessels:

 1.​Arteries: Carry oxygenated blood away from heart.
Exceptions are pulmonary and umbilical arteries which
carry deoxygenated blood. Arteries are like trees. They
have branches. No valves are present.​

2.​Veins: Carry deoxygenated blood from the heart.

Exceptions are pulmonary and umbilical veins. Veins
are like rivers. They receive tributaries. Venous
plexus is communication between veins. Valves are
seen.​

3.​Capillaries: These are network of microscopic vessels

(Fig. 1.12).

Clinically Oriented Anatomy​

Fig. 1.11: Portal circulation

4. Anastomosis is a communication between neighboring

arteries which helps in collateral circulation (Fig. 1.12).

5. Arteriovenous shunts provide direct routes between

arteries and veins bypassing capillaries.

6. Lymphatics carry tissue fluid. Lymphatic vessels include

lymph capillaries, smaller and larger lymphatic vessels and
terminal collecting ducts [right lymphatic duct and left
lymphatic duct (thoracic duct)]. The bigger lymph vessels
[right lymphatic duct and left lymphatic duct (thoracic duct)]
drain into the veins at the root of the neck. Lymph vessels
have valves to prevent backflow of lymph.

Note​
1. End arteries: These arteries do not have anastomoses
with neighbouring arteries. Their blockade results in death
of tissue supplied by them, e.g. arteries in kidney and
spleen, coronary arteries, central artery of retina, central
arteries of brain. They may be anatomical or functional end
arteries.

Fig. 1.12: Connections between arteries and veins

●​ Arteriovenous anastomosis​

●​ Anastomosis​

●​ Capillary network​

●​ Venous plexus

Fig. 1.13: Direction of blood flow in circulatory system

(Based on the calibre/size/diameter)

●​ Heart​

○​ → Large arteries​

○​ → Medium arteries​

○​ → Small arteries​

○​ → Arterioles​

○​ → Capillaries​
 ○​ → Tissues​

○​ → Capillaries​

○​ → Venules​

○​ → Small veins​

○​ → Medium veins​

○​ → Large veins​

○​ → Heart​

2. Tortuous or wavy arteries:​

They run a wavy course to allow for their elongation; in
times of:

a. The area of their location being subjected to movement

[facial artery (face), lingual artery (tongue)]; or​
b. Movements of the organ which they supply [splenic
artery (spleen), uterine artery (allow for increased size of
uterus in pregnancy)].

Clinical Anatomy
 ●​ Atherosclerosis is accumulation of fat in walls of the
arteries, leading to the narrowing of their lumen.​

●​ Varicose veins is abnormally dilated and tortuous

veins.​

●​ Lymphangitis and lymphedema refer to inflammation

of lymph vessels and lymph nodes respectively.​

Nervous System

The nervous system is divided structurally into:

1.​Central nervous system.​

2.​Peripheral nervous system.​

Central nervous system is made up of:

1.​Brain​

2.​Spinal cord​

●​ The brain is safely preserved in the cranial cavity and

is surrounded by the meninges of the brain (cranial).​
 ●​ The spinal cord is present inside the vertebral canal
and is covered by the spinal meninges.

Peripheral nervous system is made up of:

1.​Cranial nerves attached to brain.​

2.​Spinal nerves attached to spinal cord.​

The nervous system is divided functionally into:

1.​Somatic nervous system (under will)—somatic parts

of central and peripheral nervous system.​

2.​Autonomic nervous system (not under

will)—autonomous parts of central and peripheral
nervous system.​

●​ Autonomic nervous system is self-regulating. Higher

centers are in brainstem and hypothalamus. Two
components: Sympathetic and parasympathetic.​
● Sympathetic mobilizes body energy to deal with
stress and emergency.​
● Parasympathetic conserves body energy.​

●​ Both comprise preganglionic and postganglionic

neurons with ganglion intervening.​

Ganglia are groups of neuronal cell bodies in Peripheral

nervous system.
Typical Spinal Nerve

It is formed as follows (Fig. 1.14):

1.​Ventral rootlets from ventral horn of spinal cord join to

form ventral root (motor).​

2.​Dorsal rootlets from dorsal horn of spinal cord join to

form dorsal root (sensory).​

3.​Ventral and dorsal root join to form spinal nerve. Close

to this formation, a dorsal root or spinal ganglion is
present on dorsal root.​

4.​Immediately after formation of spinal nerve (in

intervertebral foramen) the spinal nerve divides into
ventral and dorsal rami. Each of these rami contains
autonomic, sensory and motor fibres.​

5.​The ventral ramus is connected to sympathetic

ganglion by a lateral white ramus.​

Fig. 1.14: Typical spinal nerve

(Labeled diagram includes: Dorsal root, Dorsal root

ganglion, Dorsal ramus, Spinal nerve, Gray ramus, White
ramus, Ventral ramus, Sympathetic ganglion, Lateral
branch, Anterior branch, Ventral root, Spinal cord, and
nerve fibers: Sensory, Motor, Autonomic)
General Anatomy

communicans (contains myelinated fibers, myelin gives

white colour hence called so) and a medial grey ramus
communicans (contains unmyelinated fibers giving greyish
colour hence called so).

IMAGING TECHNIQUES

These are employed to study the different structures of the

body in a noninvasive manner (without cutting the body) to
detect any abnormalities. These include:

●​ Conventional radiography (uses X-rays).​

– Cheap.​
– Risks exposure to X-rays.​

●​ CT (computerized tomography) scan (uses X-rays).​

– Reliable.​
– Risks exposure to X-rays.​

●​ MRI (magnetic resonance imaging) scan (uses

magnetic field and radio waves).​
– Reliable.​
– No risk of exposure to X-rays.​
– Expensive.​

●​ Ultrasound scan (uses sound waves).​

– Safe.​
– Fails to visualize structures hidden by bone as
ultrasound has difficulty in penetrating the bone.