Fascia and Extracellular Matrix Quiz

In Memoriam

• Yoni Brand ז"ל, year 3
• Daniel Ben Harosh ז"ל, year 2

Introduction to Anatomy

• Dr. Noa Ben Ami, Head of MSc program, Head of the Lab for Musculoskeletal Pain and Wellness in Medicine
• URL: https://www.ariel.ac.il/wp/back-pain-lab/
• International Society for the Prevention of Overdiagnosis and Overtreatment
• International Forum for Back and Neck Pain

Anatomy

• Description of structures
• Macroscopic structures of the human body
• Ancient science, thousands of years old
• Developed requiring only a body, knife, and observant eye
• Anatomy = temnein = 'to cut'

History of Anatomy

• Ancient Egypt 1600 BCE - papyrus - knowledge of intestines
• Hippocrates 5th century BCE (460 BCE) - Greek physician - father of Western medicine
• Believed in natural causes of disease
• Hippocratic Oath

Hippocratic Oath

• To save lives
• Cause no harm to the patient
• Practice with integrity
• Maintain medical confidentiality
• Provide equitable treatment for all patients
• Modern versions used today based on the ancient version

History of Anatomy

• Ancient Egypt 1600 BCE
• Hippocrates 460 BCE
• Galen 131-201 CE - Greek physician - respected by the Church, dissected animal bodies.
• Dissecting human bodies prohibited until 1300 CE
• Andreas Vesalius (1514-1564) - Renaissance period, first to receive permission to dissect bodies, founder of modern anatomy.
• "On the Fabric of the Human Body" by Andreas Vesalius
• Leonardo da Vinci (1500) - accurate drawings of body parts.

Modern Age

• Leonardo da Vinci (1452-1519) - many anatomical dissections used for detailed anatomical sketches.

Anatomy for Students

• Textbooks recommended: Gray's Anatomy for Students, Atlas of Human Anatomy (Netter) Moore's Clinically Oriented Anatomy
• Ovid - Visible body
• Primal picture -Anatomy. TV

Types of Anatomy

• Systemic Anatomy
• Regional Anatomy
• Clinical Anatomy
• Surface Anatomy

Regional Anatomy

• Chest
• Abdomen
• Pelvic
• Back
• Cervical
• Head
• Upper Limb
• Lower Limb
• Trunk

Anatomicomedical Terminology

• Primarily English and Latin, but currently focused mainly on English usage.
• Structural terms - anatomy is a descriptive science.

Anatomical Position

• All anatomical descriptions relative to a single anatomical position
• Standing upright with palms facing forward, feet flat on the floor
• Standard for comparing and describing anatomical structures and movements.

Supine and Prone Positions

• Supine - lying flat on back
• Prone - lying flat on stomach

Terms of Relationship and Comparison

• Terms describing the location, direction, and relative positions of parts in respect of each other.
• Examples: right, left, superior, inferior, anterior, posterior, medial, lateral, proximal, distal.

Directional Terms

• Superior - Cranial (closer to the head)
• Inferior - caudal (closer to the feet)
• Anterior – ventral (closer to the front)
• Posterior – dorsal (closer to the back)

Combined Terms

• Inferomedial
• Superolateral
• Superficial
• Intermediate
• Deep

Laterality

• Bilateral - occurring on both sides.
• Unilateral - occurring on one side.
• Ipsilateral - on the same side of the body.
• Contralateral - on the opposite side of the body.

Transverse Section of the Leg

• Cross-sectional view just above the middle of the left leg.

Anatomical Planes

• Median plane - divides the body into right and left halves.
• Sagittal planes - parallel to the median plane.
• Frontal (coronal) planes - divides the body into anterior (front) and posterior (back) parts.
• Transverse (horizontal) planes - divides the body into superior (upper) and inferior (lower) parts.

Terms of Movement

Movement

• Flexion - bending a joint or decreasing the angle between bones.
• Extension - straightening a joint or increasing the angle between bones.
• Dorsiflexion - bending the foot upward at the ankle.
• Plantar flexion - bending the foot downward at the ankle.
• Abduction - movement away from the midline of the body.
• Adduction -movement toward the midline of the body.
• Internal Rotation
• External Rotation
• Pronation - rotation of the forearm; turning the palm downward.
• Supination - rotation of the forearm; turning the palm upward.
• Elevation - raising a body part.
• Depression- lowering a body part.
• Adduction (retraction) - movement towards the midline.
• Abduction (protraction) - movement away from the midline.
• Upward rotation
• Downward rotation (return to anatomical position)
• Inversion
• Eversion

Systemic Anatomy

• List of systems: skin, circulatory, digestive, respiratory, urinary, genital, endocrine, and locomotor.
• Describes all major organs in the system, by their functions.

Composition of the Human Body

• Cells
• Tissues
• Organs
• Systems

Skin

• Largest organ in the body
• Epidermis – waterproof barrier, creates skin tone
• Dermis – tough connective tissue, contains hair follicles and sweat glands
• Hypodermis (subcutaneous tissue) – fat and connective tissue
• Protection
• Containment
• Heat regulation
• Sensation
• Synthesis and storage of Vitamin D

Connective Tissue

• Connects, supports, and separates tissues and organs
• Fibroblast
• Collagen fibers
• Elastic fibers
• Extracellular matrix
• Bone, cartilage, tendons, ligaments, and fasciae are all examples of connective tissues

Fascia

• Sheets of connective tissue covering and supporting body parts.
• Superficial fascia (subcutaneous layer)
• Deep fascia
• Subserous fascia

Deep Fascia in Limbs

• Surrounds the entire region of the limbs.
• Sends septa that attach to bone.
• Separates and groups muscles into functional groups.

Muscles of the Leg - Cross-Section

• Different muscles, and supporting structures in the leg.

Sensory Receptors

• Mechanoceptors - respond to mechanical pressure and stretching in the skin and fascia
• Nociceptors -pain receptors
• Proprioceptors – position, movement and balance sensors.

Proprioceptors

• Sense of body position and movement in space.
• Internal sense of position and movement.
• Important for coordination, balance, and posture.

Retinaculum

• Fibrous bands that hold tendons in place.
• Situated in the wrist and ankle

Bursae

• Small fluid-filled sacs that cushion and reduce friction at points where tendons and ligaments rub against bone.
• Subcutaneous bursae- under the skin
• Subfascial bursae- under the fascia
• Subtendinous bursae – under the tendon
• Synovial tendon sheaths – tubes that enclose tendons near joints.

Bursitis

• Inflammation and swelling of a bursa.
• Olecranon bursa
• Subacromial bursa
• Trochanteric bursa

The Skeletal System

• Bones form the framework of the body, supporting and protecting organs.
• Includes 206 different bones.
• List of bones and anatomical regions

Bone Structure and Development

• Compact bone (cortical) - 80%
• Spongy bone (trabecular) - 20%
• Bone Marrow
• Periosteum
• Bone modeling/remodeling
• Peak bone mass

Fracture types

• Greenstick
• Spiral
• Comminuted
• Transverse
• Compound
• Vertebral compression
• Clinical considerations

The Articular System (Arthrology)

• Joints and ligaments
• Joints are the connection points of two or more bones.

Classification of Joints

• Fibrous - lack movement
• Cartilaginous - limited movement
• Synovial - extensive movement

Types of Synovial Joints

• Plane (gliding) joint
• Hinge joint
• Ball-and-socket joint
• Saddle joint
• Condyloid joint
• Pivot joint

Cartilage

• Hyaline cartilage - most common type
• Elastic cartilage-found in ear, epiglottis
• Fibrocartilage - located in areas needing strength and shock absorption (intervertebral discs)

Synovial Joint structure

• Articular cartilage
• Congruency
• Synovial membrane
• Synovial fluid
• Capsule
• Ligaments

Properties of a Synovial joint

• Fibrous Capsule
• Synovial Membrane
• Articular Cartilage
• Joint Cavity
• Supporting Ligaments Intrinsic & Extrinsic

Types of Muscle Contractions

• Concentric
• Eccentric
• Isometric

Muscle Functions

• Prime mover (agonist)
• Fixator
• Synergist
• Antagonist

Muscle Types - Classification

• Flat/parallel
• Pennate
• Fusiform
• Convergent
• Quadrate/quadrilateral
• Circular
• Multi-headed/multi-bellied

Muscle Names

• Based on location, shape, function, orientation

Muscle Action - Contraction

• They pull, never push
• Origin - fixed end of muscle
• Insertion - movable end of muscle

Muscle Action - Reverse Action

• A muscle can move its origin towards its insertion (e.g., Gluteus Maximus moving the hip bone toward the femur during trunk flexion).

Muscle Action - Tonic Contraction

• Partial muscle contraction for posture, stability, and readiness for action.

Muscle Action - Isotonic Contraction

• Concentric - muscle shortens while contracting
• Eccentric - muscle lengthens while contracting
• Isometric - muscle contracts, but length doesn't change.

Eccentric Contraction

• Muscle lengthens while contracting.
• Important for control, deceleration, and stabilization.

Muscle action and Function

• Agonist
• Fixators
• Synergists
• Antagonists

Muscle Control

• Muscle spindles
• Golgi tendon organs

Tendon

• Connective tissue that attaches muscle to bone.
• Achilles tendon, and other tendons

Tendon Structure

• Endotenon
• Epitenon
• Primary fascicle
• Secondary fascicle
• Collagen fibers
• Fibrils

Clinical Considerations (Tendons and Muscles)

• Osgood-Schlatter disease
• Sever's disease
• Shin splints
• Tennis elbow
• Rotator cuff tears

The Circulatory System

• Closed system for blood transportation.
• Heart
• Blood vessels -arteries, veins, capillaries
• Pulmonary and systemic circulation

Blood Vessels

• Three layers:
• Tunica intima (innermost layer, endothelium)
• Tunica media (middle layer, smooth muscle)
• Tunica adventitia (outer layer, connective tissue)

Blood Vessels - Types

• Arteries
• Veins
• Capillaries
• Arterioles
• Venules
• Capillary beds

Blood Capillaries

• Exchange site for oxygen, nutrients, and waste products.

Systemic Circulation

• Blood flows from the heart through the body, delivering oxygen and nutrients and removing waste.

Pulmonary Circulation

• Blood flows from the heart to the lungs for oxygenation and carbon dioxide removal.

Cardiovascular System Function

• Transports oxygen, nutrients, hormones, and removes waste products from the body.
• Regulates body temperature and fluid balance.

Veins

• Carry blood back to the heart.
• Have valves to prevent backflow.
• Have a thinner and more elastic wall than arteries.
• More numerous than arteries

Venous Return

• Muscles of the lower body assist in blood flow upward back to the heart.
• Valve
• Respiratory
• Arteriovenous Pump

Clinical Considerations (Blood Vessels)

• Arteriosclerosis
• Varicose veins

Lymphatic System

• Parallel to the circulatory system
• Removes excess tissue fluid (lymph).
• Drains lymph from tissues back to the circulatory system.
• Plays an important role in the immune system.

Lymphatic System Functions

• Transport clean fluids back to the blood
• Drain excess fluids from tissues
• Remove "debris" from cells
• Transport fats from the digestive system

Lymphatic System Components

• Lymphatic plexuses
• Lymphatic vessels
• Lymph
• Lymph nodes
• Lymphocytes
• Lymphoid organs

Lymphatic Trunks

• Right lymphatic duct
• Thoracic duct
• Cisterna chyli

Lymphatic System Function

• Absorbs and transports fats and nutrients from the digestive tract..
• Plays an important role in the immune system by removing pathogens and cell debris.

The Nervous System

• Central nervous system (CNS)
• Peripheral nervous system (PNS)
• Somatic nervous system
• Autonomic nervous system

The Nervous System - CNS

• Brain
• Spinal cord
• Nuclei
• Tracts
• Meninges
• Cerebrospinal fluid (CSF)

The Spinal Cord

• Conus medullaris
• Filum terminale
• Cauda equina
• Lumbar cistern
• CSF

The Peripheral Nervous System (PNS)

• Nerves
• Ganglia
• Endoneurium
• Perineurium
• Epineurium
• Cranial nerves
• Spinal nerves

Spinal nerves

• Posterior (primary) rami
• Anterior (primary) rami
• Plexus

Dermatomes and Myotomes

• Dermatomes - area of skin receiving sensory innervation from a specific spinal nerve.
• Myotomes - group of muscles receiving motor innervation from a specific spinal nerve.

Autonomic Nervous System

• Sympathetic - fight or flight response
• Parasympathetic - rest and digest response

Visceral Sensation

• Pain
• Hunger/ fullness
• Nausea
• Discomfort

The Alimentary/Digestive System

• Process of breaking down food, then absorbing nutrients
• Includes mouth, esophagus, stomach, intestines, accessory organs

The Respiratory System

• Provides oxygen for cellular respiration and removes carbon dioxide.
• Includes nose, pharynx, larynx, trachea, bronchi, and lungs.

The Urinary System

• Kidneys
• Ureters
• Urinary bladder
• Urethra

Genital System (Reproductive System)

• Ovaries
• Fallopian tubes
• Uterus
• Vagina
• Testes
• Vas deferens
• Accessory glands

The Endocrine System

• Collection of glands that regulate body activities through hormones.
• Pituitary
• Thyroid
• Adrenals
• Pancreas
• Ovaries
• Testes
• Pineal

The Locomotor System

• Integrating skeletal, muscular, and nervous systems.