Egerton University

Department Of Biochemistry and Molecular Biology

Bioc 110: Human Morphology and Developmental Anatomy

Anatomy describes the structures of the body -- their scientific names, composition, loca-
tion, and associated structures.
The study of anatomy is divided into 2 major fields:
1. Gross anatomy is the study of large visible structures
2. Microscopic anatomy is the study of structures that are too small to see, such as cells
and molecules.
Gross anatomy, also called macroscopic anatomy, is separated into 5 major divisions:
1. Surface anatomy describes surface forms and marks
2. Regional anatomy describes the organization of specific areas of the body such as the
head or hand.
3. Systemic anatomy describes groups of organs that function together for a single pur-
pose.
4. Developmental anatomy describes the structural changes in an organism from fertilized
egg to maturity. Embryology is the anatomical study of early development.
5. Clinical anatomy describes various medical specialties, including medical anatomy
(changes that occur during illness), and radiographic anatomy
Microscopic anatomy is divided into two major divisions:
1. Cytology, the study of cells and their structures.
2. Histology, the study of tissues and their structures.

Levels of organization of organisms

Our bodies are organized at many different levels.
The levels of organization of living things, from smallest to largest, are:
1. Atoms: basic units of all matter.
2. Elements: each kind of atom. e.g. oxygen, hydrogen, nitrogen,sulfur,carbon.
3. Molecule: combination of two or more atoms. e.g. 02.
N/B a compound is a molecule containing atoms of more than one element: e.g. h20, c02,
protein, lipid and carbohydrate.
4. Cells: smallest independent units of life.
5. Tissues: group of similar cells that perform a specific function.
There are four types of tissues:
a. epithelial tissue: found in skin and lining of organs
b. connective tissue: found in many organs.
e.g.skin, blood vessels
c. muscle tissue:
1.) Skeletal muscle--in the limbs, face, abdomen, etc.
2.) Smooth muscle-- in the digestive system, blood vessel, uterus, etc.
3.) Cardiac muscle--in the heart.
d. nerve tissue: found in the brain, spinal cord, and nerves.
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6. Organ: group of two or more kinds of tissue bound together to form a structure. (e.g.
stomach, liver, skin.)
7. System: a group of organs with their tissues that work together to perform a major
function.
a. integumentary system: made of skin, nails, hair, sweat glands and oil glands.
b. skeletal system: made of bone and cartilage.
c. muscular system (skeletal--smooth--cardiac).
d. nervous system: made of brain--spinal cord-- peripheral nerves--sensory organs.
e. endocrine system: made of ductless glands.
f. cardiovascular system: made of heart, blood and blood vessels.
g. respiratory system: made up airways and lungs.
h. digestive system: made up of organs from mouth to anus and accessory structures
(liver, pancreas, etc)
i. urinary system: made of kidneys, ureters, bladder, urethra.
j. reproductive system: made of ovaries, testes, germ cells, accessory glands and ducts.
k. lymphatic system: made of lymph nodes, lymphatic blood vessels, tonsils.
l. immune system: made of lymphocytes (t and b).
8. Organism - the complete human (the animal); the highest level of organization
Anatomical position:
In the anatomical position, the body is standing erect and facing forward, the feet are to -
gether, and the arms are hanging at the sides with the palms facing forward.
Planes: imaginary flat surfaces.
1. midsagittal or median plane: divides the body symmetrically into left and right halves.
2. parasagittal or sagittal plane: divides the body asymmetrically into left and right parts.
3. Frontal or coronal plane: divides the body asymmetrically into anterior and posterior
sections.
4. Transverse or horizontal plane: divides the body horizontally into superior and infe-
rior sections

Main regions of the body:

1. Axial part: head neck, thorax, abdomen, and pelvis.
2. appendicular part: upper limbs, lower limbs.
Body cavities:
The body cavities house and protect the internal organs.
The two main body cavities are: ventral and dorsal.
1. The ventral (anterior) body cavity is located in the front aspect of the body and di-
vided into:
a. thoracic cavity: = upper cavity. it is composed of:
1.) Pericardial cavity: contains the heart. it is lined by the pericardium (= serous mem-
brane).
2.) Pleural cavities (2): contains the lungs. it is lined by the pleura (= serous membrane).
3.) The mediastinum: region or space between the lungs, the thoracic inlet, and the di-
aphragm. It contains the esophagus, trachea, primary bronchi, thymus gland, heart
(pericardial cavity), large blood vessels and lymphatic vessels.
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b. abdominopelvic cavity = lower ventral cavity. it is lined by a serous membrane called
the peritoneum. It is subdivided into two portions:
1.) The abdominal cavity: it is separated from the thoracic cavity by the diaphragm mus-
cle.
it contains stomach, spleen, liver, gallbladder, pancreas, most of the small intestine, most of
the large intestine, kidneys, adrenal glands, ureters, and many major blood vessels.
2.) The pelvic cavity: contains urinary bladder, the remainder of the small and large in-
testines, remainder of the ureters, vermiform appendix, and internal portions of the repro -
ductive organs of the male and female.
The abdominopelvic cavity can be subdivided either into 4 quadrants or into 9 regions.
a.) quadrants: used by clinicians or surgeons.
(1.) Right upper quadrant
(2.) Left upper quadrant
(3.) Right lower quadrant
(4.) Left lower quadrant
b.) regions: used by anatomists:
(1.) Right hypochondriac region
(2.) Epigastric region -
(3.) Left hypochondriac region
(4.) Right lumbar region
(5.) Umbilical region -
(6.) Left lumbar region
(7.) Right iliac region -
(8.) Hypogastric region
(9.) Left iliac region
2. The dorsal (posterior) body cavity: is located near the back of the body. It is divided
into two cavities:
a. cranial cavity: formed by the cranial bones; it houses the brain.
b. vertebral (spinal) cavity: formed by vertebrae of the backbone, it contains spinal cord,
and roots of spinal nerves.
Frames of reference for anatomical studies
Anatomical directions refer to the patient’s left or right.
Each direction is paired with an opposite; caudal is the opposite of cranial, anterior is the
opposite of posterior.
A lateral view is from the side. an anterior view is from the front.
An area may be nearer to (proximal) or farther away from (distal) the medial or central re-
gion of the body.
Moving from exterior references to the internal organs requires a 3-dimensional descrip-
tion, imagined as an axis or plane cut through the body.
A specific slice along these planes is called a section.
The 3 sectional planes are:
1. Sagittal plane (the length of the body, front to back), including the midsagittal or median
section and left or right parasagittal sections.

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2. Frontal plane (the length of the body, side to side), also called coronal plane, resulting in
anterior and posterior portions.
3. Transverse plane (at right angles to the sagittal and frontal planes), also called a trans -
verse section or cross section, resulting in inferior and superior portions.
Body cavities and serous membranes
Internal compartments called body cavities protect internal organs, hold them in place, and
allow them to change size and shape. All the internal organs found within these cavities are
called viscera.
Moist layers of connective tissue called serous membrane cover both the walls of internal
cavities (parietal layer) and the visceral organs themselves (visceral layer), providing a
double layer of membrane between an organ and its surroundings. Serous membrane con-
tains a watery lubricant that reduces friction, allowing organs to expand and contract
freely.
The ventral body cavity (coelom) is divided by the diaphragm muscle into 2 parts:
1. A superior thoracic cavity, containing the
(a) Pleural cavity (left and right, divided by the mediastinum)
Organs: lungs
Membranes: visceral and parietal pleura
(b) Pericardial cavity organs: heart
Membranes: visceral and parietal pericardium
2. And an inferior abdominopelvic cavity, containing the
(a) Peritoneal cavity
Membranes: visceral and parietal peritoneum
(b) Abdominal cavity (superior peritoneal)
Organs: liver, stomach, spleen, intestine
(c) Pelvic cavity (inferior peritoneal)
Organs: intestine, bladder, reproductive organs.

Other body cavities

a. oral cavity (mouth)

b. nasal cavity (sinuses for air passage)
c. orbital cavities (eyes)
d. middle ear cavities (in temporal bone)
e. synovial cavities (freely moveable joints).

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 SUPPORT AND MOVEMENT
BONE TISSUE AND THE SKELETAL SYSTEM
Bone, or osseous tissue, is a hard, dense connective tissue that forms most of the adult
skeleton, the support structure of the body. In the areas of the skeleton where bones move
(for example, the ribcage and joints), cartilage, a semi-rigid form of connective tissue,
provides flexibility and smooth surfaces for movement. The skeletal system is the body
system composed of bones and cartilage and performs the following critical functions for
the human body:
• supports the body
• facilitates movement
• protects internal organs
• produces blood cells
• stores and releases minerals and fat
Bone Classification
The 206 bones that compose the adult skeleton are divided into five categories based on
their shapes. Their shapes and their functions are related such that each categorical shape
of bone has a distinct function.

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Classifications of Bones Bones are classified according to their shape

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Long Bones
A long bone is one that is cylindrical in shape, being longer than it is wide. Keep in mind,
however, that the term describes the shape of a bone, not its size. Long bones are found in
the arms (humerus, ulna, radius) and legs (femur, tibia, fibula), as well as in the fingers
(metacarpals, phalanges) and toes (metatarsals, phalanges). Long bones function as levers;
they move when muscles contract.
Short Bones
A short bone is one that is cube-like in shape, being approximately equal in length, width,
and thickness. The only short bones in the human skeleton are in the carpals of the wrists
and the tarsals of the ankles. Short bones provide stability and support as well as some
limited motion.
Flat Bones
The term “ flat bone” is somewhat of a misnomer because, although a flat bone is typically
thin, it is also often curved.
Examples include the cranial (skull) bones, the scapulae (shoulder blades), the sternum
(breastbone), and the ribs. Flat bones serve as points of attachment for muscles and often
protect internal organs.
Irregular Bones
An irregular bone is one that does not have any easily characterized shape and therefore
does not fit any other classification. These bones tend to have more complex shapes, like
the vertebrae that support the spinal cord and protect it from compressive forces. Many
facial bones, particularly the ones containing sinuses, are classified as irregular bones.
Sesamoid Bones
A sesamoid bone is a small, round bone. These bones form in tendons (the sheaths of
tissue that connect bones to muscles) where a great deal of pressure is generated in a joint.
The sesamoid bones protect tendons by helping them overcome compressive forces.
Sesamoid bones vary in number and placement from person to person but are typically
found in tendons associated with the feet, hands, and knees. The patellae (singular =
patella) are the only sesamoid bones found in common with every person.

Bone tissue
Bone tissue (osseous tissue) differs greatly from other tissues in the body. Bone is hard
and many of its functions depend on that characteristic hardness.
Gross Anatomy of Bone
The structure of a long bone allows for the best visualization of all of the parts of a bone. A
long bone has two parts: the diaphysis and the epiphysis. The diaphysis is the tubular
shaft that runs between the proximal and distal ends of the bone. The hollow region in the
diaphysis is called the medullary cavity, which is filled with yellow marrow. The walls of
the diaphysis are composed of dense and hard compact bone.

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Anatomy of a Long Bone A typical long bone shows the gross anatomical characteristics
of bone.
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The wider section at each end of the bone is called the epiphysis (plural = epiphyses),
which is filled with spongy bone.
Red marrow fills the spaces in the spongy bone. Each epiphysis meets the diaphysis at the
metaphysis, the narrow area that contains the epiphyseal plate (growth plate), a layer of
hyaline (transparent) cartilage in a growing bone. When the bone stops growing in early
adulthood (approximately 18–21 years), the cartilage is replaced by osseous tissue and the
epiphyseal plate becomes an epiphyseal line.
The outer surface of the bone is covered with a fibrous membrane called the periosteum.
The periosteum contains blood vessels, nerves, and lymphatic vessels that nourish
compact bone. Tendons and ligaments also attach to bones at the periosteum. The
periosteum covers the entire outer surface except where the epiphyses meet other bones
to form joints. In this region, the epiphyses are covered with articular cartilage, a thin
layer of cartilage that reduces friction and acts as a shock absorber.
Bone Markings
The surface features of bones vary considerably, depending on the function and location in
the body.
There are three general classes of bone markings: (1) articulations, (2) projections, and (3)
holes. As the name implies, an articulation is where two bone surfaces come together.
These surfaces tend to conform to one another, such as one being rounded and the other
cupped, to facilitate the function of the articulation.
A projection is an area of a bone that projects above the surface of the bone. These are the
attachment points for tendons and ligaments. In general, their size and shape is an
indication of the forces exerted through the attachment to the bone.
A hole is an opening or groove in the bone that allows blood vessels and nerves to enter
the bone.
Bone Cells and Tissue
Bone contains a relatively small number of cells entrenched in a matrix of collagen fibers
that provide a surface for inorganic salt crystals to adhere. These salt crystals form when
calcium phosphate and calcium carbonate combine to create hydroxyapatite, which
incorporates other inorganic salts like magnesium hydroxide, fluoride, and sulfate as it
crystallizes, or calcifies, on the collagen fibers. The hydroxyapatite crystals give bones their
hardness and strength, while the collagen fibers give them flexibility so that they are not
brittle.
Although bone cells compose a small amount of the bone volume, they are crucial to the
function of bones. Four types of cells are found within bone tissue: osteoblasts, osteocytes,
osteogenic cells, and osteoclasts.
Compact and Spongy Bone
The differences between compact and spongy bone are best explored via their histology.
Most bones contain compact and spongy osseous tissue, but their distribution and
concentration vary based on the bone’s overall function. Compact bone is dense so that it
can withstand compressive forces, while spongy (cancellous) bone has open spaces and
supports shifts in weight distribution.

Divisions of the Skeletal System

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The skeletal system includes all of the bones, cartilages, and ligaments of the body that
support and give shape to the body and body structures. The skeleton consists of the
bones of the body. For adults, there are 206 bones in the skeleton. Younger individuals
have higher numbers of bones because some bones fuse together during childhood and
adolescence to form an adult bone. The primary functions of the skeleton are to provide a
rigid, internal structure that can support the weight of the body against the force of gravity,
and to provide a structure upon which muscles can act to produce movements of the body.
The lower portion of the skeleton is specialized for stability during walking or running. In
contrast, the upper skeleton has greater mobility and ranges of motion, features that allow
you to lift and carry objects or turn your head and trunk.
In addition to providing for support and movements of the body, the skeleton has
protective and storage functions. It protects the internal organs, including the brain, spinal
cord, heart, lungs, and pelvic organs. The bones of the skeleton serve as the primary
storage site for important minerals such as calcium and phosphate. The bone marrow
found within bones stores fat and houses the blood-cell producing tissue of the body.
The skeleton is subdivided into two major divisions—the axial and appendicular.
THE AXIAL SKELETON
The skeleton is subdivided into two major divisions—the axial and appendicular. The axial
skeleton forms the vertical, central axis of the body and includes all bones of the head,
neck, chest, and back. It serves to protect the brain, spinal cord, heart, and lungs. It also
serves as the attachment site for muscles that move the head, neck, and back, and for
muscles that act across the shoulder and hip joints to move their corresponding limbs.
The axial skeleton of the adult consists of 80 bones, including the skull, the vertebral
column, and the thoracic cage. The skull is formed by 22 bones. Also associated with the
head are an additional seven bones, including the hyoid bone and the ear ossicles (three
small bones found in each middle ear). The vertebral column consists of 24 bones, each
called a vertebra, plus the sacrum and coccyx. The thoracic cage includes the 12 pairs of
ribs, and the sternum, the flattened bone of the anterior chest.
The Skull
The cranium (skull) is the skeletal structure of the head that supports the face and
protects the brain. It is subdivided into the facial bones and the brain case, or cranial
vault. The facial bones underlie the facial structures, form the nasal cavity, enclose the
eyeballs, and support the teeth of the upper and lower jaws. The rounded brain case
surrounds and protects the brain and houses the middle and inner ear structures.
In the adult, the skull consists of 22 individual bones, 21 of which are immobile and united
into a single unit. The 22nd bone is the mandible (lower jaw), which is the only moveable
bone of the skull.
Lateral View of Skull
A view of the lateral skull is dominated by the large, rounded brain case above and the
upper and lower jaws with their teeth below. Separating these areas is the bridge of bone
called the zygomatic arch. The zygomatic arch is the bony arch on the side of skull that
spans from the area of the cheek to just above the ear canal. It is formed by the junction of
two bony processes: a short anterior component, the temporal process of the zygomatic
bone (the cheekbone) and a longer posterior portion, the zygomatic process of the
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temporal bone, extending forward from the temporal bone. Thus the temporal process
(anteriorly) and the zygomatic process (posteriorly) join together, like the two ends of a
drawbridge, to form the zygomatic arch. One of the major muscles that pulls the mandible
upward during biting and chewing arises from the zygomatic arch.
On the lateral side of the brain case, above the level of the zygomatic arch, is a shallow
space called the temporal fossa. Below the level of the zygomatic arch and deep to the
vertical portion of the mandible is another space called the infratemporal fossa. Both the
temporal fossa and infratemporal fossa contain muscles that act on the mandible during
chewing.

Lateral View of Skull The lateral skull shows the large rounded brain case, zygomatic
arch, and the upper and lower jaws.
The zygomatic arch is formed jointly by the zygomatic process of the temporal bone and
the temporal process of the zygomatic bone. The shallow space above the zygomatic arch is
the temporal fossa. The space inferior to the zygomatic arch and deep to the posterior
mandible is the infratemporal fossa.
Bones of the Brain Case
The brain case contains and protects the brain. The interior space that is almost completely
occupied by the brain is called the cranial cavity. This cavity is bounded superiorly by the
rounded top of the skull, which is called the calvaria (skullcap), and the lateral and
posterior sides of the skull. The bones that form the top and sides of the brain case are
usually referred to as the “flat” bones of the skull.
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The floor of the brain case is referred to as the base of the skull. This is a complex area that
varies in depth and has numerous openings for the passage of cranial nerves, blood
vessels, and the spinal cord. Inside the skull, the base is subdivided into three large spaces,
called the anterior cranial fossa, middle cranial fossa, and posterior cranial fossa
(fossa = “trench or ditch”).
The brain case consists of eight bones. These include the paired parietal and temporal
bones, plus the unpaired frontal, occipital, sphenoid, and ethmoid bones.
Sutures of the Skull
A suture is an immobile joint between adjacent bones of the skull. The narrow gap
between the bones is filled with dense, fibrous connective tissue that unites the bones. The
long sutures located between the bones of the brain case are not straight, but instead
follow irregular, tightly twisting paths. These twisting lines serve to tightly interlock the
adjacent bones, thus adding strength to the skull for brain protection.
The two suture lines seen on the top of the skull are the coronal and sagittal sutures. The
coronal suture runs from side to side across the skull, within the coronal plane of section.
It joins the frontal bone to the right and left parietal bones. The sagittal suture extends
posteriorly from the coronal suture, running along the midline at the top of the skull in the
sagittal plane of section. It unites the right and left parietal bones. On the posterior skull,
the sagittal suture terminates by joining the lambdoid suture. The lambdoid suture
extends downward and laterally to either side away from its junction with the sagittal
suture. The lambdoid suture joins the occipital bone to the right and left parietal and
temporal bones. This suture is named for its upside-down "V" shape, which resembles the
capital letter version of the Greek letter lambda (Λ). The squamous suture is located on
the lateral skull. It unites the squamous portion of the temporal bone with the parietal
bone. At the intersection of four bones is the pterion, a small, capital-H-shaped suture line
region that unites the frontal bone, parietal bone, squamous portion of the temporal bone,
and greater wing of the sphenoid bone. It is the weakest part of the skull. The pterion is
located approximately two finger widths above the zygomatic arch and a thumb’s width
posterior to the upward portion of the zygomatic bone.
The Thoracic Cage
The thoracic cage (rib cage) forms the thorax (chest) portion of the body. It consists of the
12 pairs of ribs with their costal cartilages and the sternum. The ribs are anchored
posteriorly to the 12 thoracic vertebrae (T1–T12). The thoracic cage protects the heart and
lungs.

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Thoracic Cage The thoracic cage is formed by the (a) sternum and (b) 12 pairs of ribs with
their costal cartilages.
The ribs are anchored posteriorly to the 12 thoracic vertebrae. The sternum consists of the
manubrium, body, and xiphoid process. The ribs are classified as true ribs (1–7) and false
ribs (8–12). The last two pairs of false ribs are also known as floating ribs (11–12).
The Appendicular Skeleton
The appendicular skeleton includes all bones of the upper and lower limbs, plus the
bones that attach each limb to the axial skeleton. There are 126 bones in the appendicular
skeleton of an adult. The bones that attach each upper limb to the axial skeleton form the
pectoral girdle (shoulder girdle).
PECTORAL GIRDLE
This consists of two bones, the scapula and clavicle. The clavicle (collarbone) is an S-
shaped bone located on the anterior side of the shoulder. It is attached on its medial end to
the sternum of the thoracic cage, which is part of the axial skeleton. The lateral end of the
clavicle articulates (joins) with the scapula just above the shoulder joint. You can easily
palpate, or feel with your fingers, the entire length of your clavicle.
The scapula (shoulder blade) lies on the posterior aspect of the shoulder. It is supported
by the clavicle, which also articulates with the humerus (arm bone) to form the shoulder
joint. The scapula is a flat, triangular-shaped bone with a prominent ridge running across
its posterior surface. This ridge extends out laterally, where it forms the bony tip of the
shoulder and joins with the lateral end of the clavicle.
Both of these bones serve as important attachment sites for muscles that aid with
movements of the shoulder and arm.
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The right and left pectoral girdles are not joined to each other, allowing each to operate
independently. In addition, the clavicle of each pectoral girdle is anchored to the axial
skeleton by a single, highly mobile joint. This allows for the extensive mobility of the entire
pectoral girdle, which in turn enhances movements of the shoulder and upper limb.
Bones of the Upper Limb
The upper limb is divided into three regions. These consist of the arm, located between the
shoulder and elbow joints; the forearm, which is between the elbow and wrist joints; and
the hand, which is located distal to the wrist. There are 30 bones in each upper limb. The
humerus is the single bone of the upper arm, and the ulna (medially) and the radius
laterally) are the paired bones of the forearm. The base of the hand contains eight bones,
each called a carpal bone, and the palm of the hand is formed by five bones, each called a
metacarpal bone. The fingers and thumb contain a total of 14 bones, each of which is a
phalanx bone of the hand.
Humerus
The humerus is the single bone of the upper arm region. At its proximal end is the head of
the humerus.
This is the large, round, smooth region that faces medially. The head articulates with the
glenoid cavity of the scapula to form the glenohumeral (shoulder) joint. The margin of the
smooth area of the head is the anatomical neck of the humerus.
Located on the lateral side of the proximal humerus is an expanded bony area called the
greater tubercle. The smaller lesser tubercle of the humerus is found on the anterior
aspect of the humerus. Both the greater and lesser tubercles serve as attachment sites for
muscles that act across the shoulder joint. Passing between the greater and lesser
tubercles is the narrow intertubercular groove (sulcus), which is also known as the
bicipital groove because it provides passage for a tendon of the biceps brachii muscle. The
surgical neck is located at the base of the expanded, proximal end of the humerus, where
it joins the narrow shaft of the humerus. The surgical neck is a common site of arm
fractures. The deltoid tuberosity is a roughened, V-shaped region located on the lateral
side in the middle of the humerus shaft. As its name indicates, it is the site of attachment
for the deltoid muscle.
Distally, the humerus becomes flattened. The prominent bony projection on the medial
side is the medial epicondyle of the humerus. The much smaller lateral epicondyle of
the humerus is found on the lateral side of the distal humerus. The roughened ridge of
bone above the lateral epicondyle is the lateral supracondylar ridge. All of these areas
are attachment points for muscles that act on the forearm, wrist, and hand. The powerful
grasping muscles of the anterior forearm arise from the medial epicondyle, which is thus
larger and more robust than the lateral epicondyle that gives rise to the weaker posterior
forearm muscles.
The distal end of the humerus has two articulation areas, which join the ulna and radius
bones of the forearm to form the elbow joint. The more medial of these areas is the
trochlea, a spindle- or pulley-shaped region (trochlea = “pulley”), which articulates with
the ulna bone. Immediately lateral to the trochlea is the capitulum (“small head”), a knob-
like structure located on the anterior surface of the distal humerus. The capitulum
articulates with the radius bone of the forearm. Just above these bony areas are two small
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depressions. These spaces accommodate the forearm bones when the elbow is fully bent
(flexed). Superior to the trochlea is the coronoid fossa, which receives the coronoid
process of the ulna, and above the capitulum is the radial fossa, which receives the head of
the radius when the elbow is flexed. Similarly, the posterior humerus has the olecranon
fossa, a larger depression that receives the olecranon process of the ulna when the
forearm is fully extended.
Ulna
The ulna is the medial bone of the forearm. It runs parallel to the radius, which is the
lateral bone of the forearm. The proximal end of the ulna resembles a crescent wrench with
its large, C-shaped trochlear notch. This region articulates with the trochlea of the
humerus as part of the elbow joint. The inferior margin of the trochlear notch is formed by
a prominent lip of bone called the coronoid process of the ulna. Just below this on the
anterior ulna is a roughened area called the ulnar tuberosity. To the lateral side and
slightly inferior to the trochlear notch is a small, smooth area called the radial notch of
the ulna. This area is the site of articulation between the proximal radius and the ulna,
forming the proximal radioulnar joint. The posterior and superior portions of the
proximal ulna make up the olecranon process, which forms the bony tip of the elbow.
More distal is the shaft of the ulna. The lateral side of the shaft forms a ridge called the
interosseous border of the ulna.
This is the line of attachment for the interosseous membrane of the forearm, a sheet of
dense connective tissue that unites the ulna and radius bones. The small, rounded area that
forms the distal end is the head of the ulna. Projecting from the posterior side of the ulnar
head is the styloid process of the ulna, a short bony projection. This serves as an
attachment point for a connective tissue structure that unites the distal ends of the ulna
and radius.
In the anatomical position, with the elbow fully extended and the palms facing forward, the
arm and forearm do not form a straight line. Instead, the forearm deviates laterally by 5–15
degrees from the line of the arm. This deviation is called the carrying angle. It allows the
forearm and hand to swing freely or to carry an object without hitting the hip. The carrying
angle is larger in females to accommodate their wider pelvis.
Radius
The radius runs parallel to the ulna, on the lateral (thumb) side of the forearm. The head
of the radius is a disc-shaped structure that forms the proximal end. The small depression
on the surface of the head articulates with the capitulum of the humerus as part of the
elbow joint, whereas the smooth, outer margin of the head articulates with the radial notch
of the ulna at the proximal radioulnar joint. The neck of the radius is the narrowed region
immediately below the expanded head. Inferior to this point on the medial side is the
radial tuberosity, an oval-shaped, bony protuberance that serves as a muscle attachment
point. The shaft of the radius is slightly curved and has a small ridge along its medial side.
This ridge forms the interosseous border of the radius, which, like the similar border of
the ulna, is the line of attachment for the interosseous membrane that unites the two
forearm bones. The distal end of the radius has a smooth surface for articulation with two
carpal bones to form the radiocarpal joint or wrist joint. On the medial side of the distal
radius is the ulnar notch of the radius. This shallow depression articulates with the head
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of the ulna, which together form the distal radioulnar joint. The lateral end of the radius
has a pointed projection called the styloid process of the radius. This provides
attachment for ligaments that support the lateral side of the wrist joint. Compared to the
styloid process of the ulna, the styloid process of the radius projects more distally, thereby
limiting the range of movement for lateral deviations of the hand at the wrist joint.

Carpal Bones
The wrist and base of the hand are formed by a series of eight small carpal bones. The
carpal bones are arranged in two rows, forming a proximal row of four carpal bones and a
distal row of four carpal bones. The bones in the proximal row, running from the lateral
(thumb) side to the medial side, are the scaphoid (“boat-shaped”), lunate
(“moonshaped”),
triquetrum (“three-cornered”), and pisiform (“pea-shaped”) bones. The small, rounded
pisiform bone articulates with the anterior surface of the triquetrum bone. The pisiform
thus projects anteriorly, where it forms the bony bump that can be felt at the medial base
of your hand. The distal bones (lateral to medial) are the trapezium (“table”), trapezoid
(“resembles a table”), capitate (“head-shaped”), and hamate (“hooked bone”) bones.

16
Bones of the Wrist and Hand The eight carpal bones form the base of the hand.
Metacarpal Bones
The palm of the hand contains five elongated metacarpal bones. These bones lie between
the carpal bones of the wrist and the bones of the fingers and thumb. The proximal end of
each metacarpal bone articulates with one of the distal carpal bones. Each of these
articulations is a carpometacarpal joint. The expanded distal end of each metacarpal bone
articulates at the metacarpophalangeal joint with the proximal phalanx bone of the
thumb or one of the fingers. The distal end also forms the knuckles of the hand, at the base
of the fingers. The metacarpal bones are numbered 1–5, beginning at the thumb.
The first metacarpal bone, at the base of the thumb, is separated from the other metacarpal
bones. This allows it a freedom of motion that is independent of the other metacarpal
bones, which is very important for thumb mobility. The remaining metacarpal bones are
united together to form the palm of the hand. The second and third metacarpal bones are
firmly anchored in place and are immobile. However, the fourth and fifth metacarpal bones
have limited anterior-posterior mobility, a motion that is greater for the fifth bone. This
mobility is important during power gripping with the hand. The anterior movement of
these bones, particularly the fifth metacarpal bone, increases the strength of contact for the
17
medial hand during gripping actions.
Phalanx Bones
The fingers and thumb contain 14 bones, each of which is called a phalanx bone (plural =
phalanges). The thumb (pollex) is digit number 1 and has two phalanges, a proximal
phalanx, and a distal phalanx bone. Digits 2 (index finger) through 5 (little finger) have
three phalanges each, called the proximal, middle, and distal phalanx bones. An
interphalangeal joint is one of the articulations between adjacent phalanges of the digits.
The Pelvic Girdle and Pelvis
The pelvic girdle (hip girdle) is formed by a single bone, the hip bone or coxal bone
(coxal = “hip”), which serves as the attachment point for each lower limb. Each hip bone, in
turn, is firmly joined to the axial skeleton via its attachment to the sacrum of the vertebral
column. The right and left hip bones also converge anteriorly to attach to each other. The
bony pelvis is the entire structure formed by the two hip bones, the sacrum, and, attached
inferiorly to the sacrum, the coccyx.
Unlike the bones of the pectoral girdle, which are highly mobile to enhance the range of
upper limb movements, the bones of the pelvis are strongly united to each other to form a
largely immobile, weight-bearing structure. This is important for stability because it
enables the weight of the body to be easily transferred laterally from the vertebral column,
through the pelvic girdle and hip joints, and into either lower limb whenever the other
limb is not bearing weight. Thus, the immobility of the pelvis provides a strong foundation
for the upper body as it rests on top of the mobile lower limbs.
Pelvis The pelvic girdle is formed by a single hip bone. The hip bone attaches the lower
limb to the axial skeleton through its articulation with the sacrum. The right and left hip
bones, plus the sacrum and the coccyx, together form the pelvis.
Hip Bone
The hip bone, or coxal bone, forms the pelvic girdle portion of the pelvis. The paired hip
bones are the large, curved bones that form the lateral and anterior aspects of the pelvis.
Each adult hip bone is formed by three separate bones that fuse together during the late
teenage years. These bony components are the ilium, ischium, and pubis. These names are
retained and used to define the three regions of the adult hip bone.
The ilium is the fan-like, superior region that forms the largest part of the hip bone. It is
firmly united to the sacrum at the largely immobile sacroiliac joint. The ischium forms
the postero-inferior region of each hip bone. It supports the body when sitting. The pubis
forms the anterior portion of the hip bone. The pubis curves medially, where it joins to the
pubis of the opposite hip bone at a specialized joint called the pubic symphysis.

Ilium
When you place your hands on your waist, you can feel the arching, superior margin of the
ilium along your waistline. This curved, superior margin of the ilium is the iliac crest. The
rounded, anterior termination of the iliac crest is the anterior superior iliac spine. This
important bony landmark can be felt at your anterolateral hip. Inferior to the anterior
superior iliac spine is a rounded protuberance called the anterior inferior iliac spine.
Both of these iliac spines serve as attachment points for muscles of the thigh. Posteriorly,
the iliac crest curves downward to terminate as the posterior superior iliac spine.
18
Muscles and ligaments surround but do not cover this bony landmark, thus sometimes
producing a depression seen as a “dimple” located on the lower back. More inferiorly is the
posterior inferior iliac spine.
This is located at the inferior end of a large, roughened area called the auricular surface of
the ilium. The auricular surface articulates with the auricular surface of the sacrum to
form the sacroiliac joint. Both the posterior superior and posterior inferior iliac spines
serve as attachment points for the muscles and very strong ligaments that support the
sacroiliac joint.
The shallow depression located on the anteromedial (internal) surface of the upper ilium is
called the iliac fossa. The inferior margin of this space is formed by the arcuate line of the
ilium, the ridge formed by the pronounced change in curvature between the upper and
lower portions of the ilium. The large, inverted U-shaped indentation located on the
posterior margin of the lower ilium is called the greater sciatic notch.
Ischium
The ischium forms the posterolateral portion of the hip bone. The large, roughened area of
the inferior ischium is the ischial tuberosity. This serves as the attachment for the
posterior thigh muscles and also carries the weight of the body when sitting. You can feel
the ischial tuberosity if you wiggle your pelvis against the seat of a chair. Projecting
superiorly and anteriorly from the ischial tuberosity is a narrow segment of bone called
the ischial ramus. The slightly curved posterior margin of the ischium above the ischial
tuberosity is the lesser sciatic notch. The bony projection separating the lesser sciatic
notch and greater sciatic notch is the ischial spine.
Pubis
The pubis forms the anterior portion of the hip bone. The enlarged medial portion of the
pubis is the pubic body. Located superiorly on the pubic body is a small bump called the
pubic tubercle. The superior pubic ramus is the segment of bone that passes laterally
from the pubic body to join the ilium. The narrow ridge running along the superior margin
of the superior pubic ramus is the pectineal line of the pubis.
The pubic body is joined to the pubic body of the opposite hip bone by the pubic
symphysis. Extending downward and laterally from the body is the inferior pubic ramus.
The pubic arch is the bony structure formed by the pubic symphysis, and the bodies and
inferior pubic rami of the adjacent pubic bones. The inferior pubic ramus extends
downward to join
the ischial ramus. Together, these form the single ischiopubic ramus, which extends from
the pubic body to the ischial tuberosity. The inverted V-shape formed as the ischiopubic
rami from both sides come together at the pubic symphysis is called the subpubic angle.
Pelvis
The pelvis consists of four bones: the right and left hip bones, the sacrum, and the coccyx.
The pelvis has several important functions. Its primary role is to support the weight of the
upper body when sitting and to transfer this weight to the lower limbs when standing. It
serves as an attachment point for trunk and lower limb muscles, and also protects the
internal pelvic organs. When standing in the anatomical position, the pelvis is tilted
anteriorly. In this position, the anterior superior iliac spines and the pubic tubercles lie in
the same vertical plane, and the anterior (internal) surface of the sacrum faces forward and
19
downward.
The three areas of each hip bone, the ilium, pubis, and ischium, converge centrally to form
a deep, cup-shaped cavity called the acetabulum. This is located on the lateral side of the
hip bone and is part of the hip joint. The large opening in the
anteroinferior hip bone between the ischium and pubis is the obturator foramen. This
space is largely filled in by a layer of connective tissue and serves for the attachment of
muscles on both its internal and external surfaces.

Comparison of the Female and Male Pelvis

The differences between the adult female and male pelvis relate to function and body size.
In general, the bones of the male pelvis are thicker and heavier, adapted for support of the
male’s heavier physical build and stronger muscles. The greater sciatic notch of the male
hip bone is narrower and deeper than the broader notch of females. Because the female
pelvis is adapted for childbirth, it is wider than the male pelvis, as evidenced by the
distance between the anterior superior iliac spines. The ischial tuberosities of females are
also farther apart, which increases the size of the pelvic outlet. Because of this increased
pelvic width, the subpubic angle is larger in females (greater than 80 degrees) than it is in
males (less than 70 degrees). The female sacrum is wider, shorter, and less curved, and the
sacral promontory projects less into the pelvic cavity, thus giving the female pelvic inlet
(pelvic brim) a more rounded or oval shape compared to males.
The lesser pelvic cavity of females is also wider and more shallow than the narrower,
deeper, and tapering lesser pelvis of males. Because of the obvious differences between
20
female and male hip bones, this is the one bone of the body that allows for the most
accurate sex determination.
Bones of the Lower Limb
Like the upper limb, the lower limb is divided into three regions. The thigh is that portion
of the lower limb located between the hip joint and knee joint. The leg is specifically the
region between the knee joint and the ankle joint. Distal to the ankle is the foot. The lower
limb contains 30 bones. These are the femur, patella, tibia, fibula, tarsal bones, metatarsal
bones, and phalanges. The femur is the single bone of the thigh. The patella is the kneecap
and articulates with the distal femur. The tibia is the larger, weight-bearing bone located
on the medial side of the leg, and the fibula is the thin bone of the lateral leg. The bones of
the foot are divided into three groups. The posterior portion of the foot is formed by a
group of seven bones, each of which is known as a tarsal bone, whereas the mid-foot
contains five elongated bones, each of which is a metatarsal bone. The toes contain 14
small bones, each of which is a phalanx bone of the foot.
Femur
The femur, or thigh bone, is the single bone of the thigh region. It is the longest and
strongest bone of the body, and accounts for approximately one-quarter of a person’s total
height. The rounded, proximal end is the head of the femur, which articulates with the
acetabulum of the hip bone to form the hip joint. The fovea capitis is a minor indentation
on the medial side of the femoral head that serves as the site of attachment for the
ligament of the head of the femur. This ligament spans the femur and acetabulum, but is
weak and provides little support for the hip joint. It does, however, carry an important
artery that supplies the head of the femur.

21
Femur and Patella The femur is the single bone of the thigh region. It articulates
superiorly with the hip bone at the hip joint, and inferiorly with the tibia at the knee joint.
The patella only articulates with the distal end of the femur.
22
The narrowed region below the head is the neck of the femur. This is a common area for
fractures of the femur. The greater trochanter is the large, upward, bony projection
located above the base of the neck. Multiple muscles that act across the hip joint attach to
the greater trochanter, which, because of its projection from the femur, gives additional
leverage to these muscles. The greater trochanter can be felt just under the skin on the
lateral side of your upper thigh. The lesser trochanter is a small, bony prominence that
lies on the medial aspect of the femur, just below the neck. A single, powerful muscle
attaches to the lesser trochanter. Running between the greater and lesser trochanters on
the anterior side of the femur is the roughened intertrochanteric line. The trochanters
are also connected on the posterior side of the femur by the larger intertrochanteric
crest.
The elongated shaft of the femur has a slight anterior bowing or curvature. At its proximal
end, the posterior shaft has the gluteal tuberosity, a roughened area extending inferiorly
from the greater trochanter. More inferiorly, the gluteal tuberosity becomes continuous
with the linea aspera (“rough line”). This is the roughened ridge that passes distally along
the posterior side of the mid-femur. Multiple muscles of the hip and thigh regions make
long, thin attachments to the femur along the linea aspera.
The distal end of the femur has medial and lateral bony expansions. On the lateral side, the
smooth portion that covers the distal and posterior aspects of the lateral expansion is the
lateral condyle of the femur. The roughened area on the outer, lateral side of the condyle
is the lateral epicondyle of the femur. Similarly, the smooth region of the distal and
posterior medial femur is the medial condyle of the femur, and the irregular outer,
medial side of this is the medial epicondyle of the femur. The lateral and medial condyles
articulate with the tibia to form the knee joint. The epicondyles provide attachment for
muscles and supporting ligaments of the knee. The adductor tubercle is a small bump
located at the superior margin of the medial epicondyle. Posteriorly, the medial and lateral
condyles are separated by a deep depression called the intercondylar fossa. Anteriorly,
the smooth surfaces of the condyles join together to form a wide groove called the patellar
surface, which provides for articulation with the patella bone. The combination of the
medial and lateral condyles with the patellar surface gives the distal end of the femur a
horseshoe (U) shape.
Patella
The patella (kneecap) is largest sesamoid bone of the body. A sesamoid bone is a bone that
is incorporated into the tendon of a muscle where that tendon crosses a joint. The
sesamoid bone articulates with the underlying bones to prevent damage to the muscle
tendon due to rubbing against the bones during movements of the joint. The patella is
found in the tendon of the quadriceps femoris muscle, the large muscle of the anterior
thigh that passes across the anterior knee to attach to the tibia. The patella articulates with
the patellar surface of the femur and thus prevents rubbing of the muscle
tendon against the distal femur. The patella also lifts the tendon away from the knee joint,
which increases the leverage power of the quadriceps femoris muscle as it acts across the
knee. The patella does not articulate with the tibia.
Tibia
The tibia (shin bone) is the medial bone of the leg and is larger than the fibula, with which
23
it is paired. The tibia is the main weight-bearing bone of the lower leg and the second
longest bone of the body, after the femur. The medial side of the tibia is located
immediately under the skin, allowing it to be easily palpated down the entire length of the
medial leg.
The proximal end of the tibia is greatly expanded. The two sides of this expansion form the
medial condyle of the tibia and the lateral condyle of the tibia. The tibia does not have
epicondyles. The top surface of each condyle is smooth and flattened. These areas
articulate with the medial and lateral condyles of the femur to form the knee joint.
Between the articulating surfaces of the tibial condyles is the intercondylar eminence, an
irregular, elevated area that serves as the inferior attachment point for two supporting
ligaments of the knee.
The tibial tuberosity is an elevated area on the anterior side of the tibia, near its proximal
end. It is the final site of attachment for the muscle tendon associated with the patella.
More inferiorly, the shaft of the tibia becomes triangular in shape. The anterior apex of
MH this triangle forms the anterior border of the tibia, which begins at the tibial
tuberosity and runs inferiorly along the length of the tibia. Both the anterior border and
the medial side of the triangular shaft are located immediately under the skin and can be
easily palpated along the entire length of the tibia. A small ridge running down the lateral
side of the tibial shaft is the interosseous border of the tibia. This is for the attachment of
the interosseous membrane of the leg, the sheet of dense connective tissue that unites
the tibia and fibula bones. Located on the posterior side of the tibia is the soleal line, a
diagonally running, roughened ridge that begins below the base of the lateral condyle, and
runs down and medially across the proximal third of the posterior tibia. Muscles of the
posterior leg attach to this line.
The large expansion found on the medial side of the distal tibia is the medial malleolus
(“little hammer”). This forms the large bony bump found on the medial side of the ankle
region. Both the smooth surface on the inside of the medial malleolus and the smooth area
at the distal end of the tibia articulate with the talus bone of the foot as part of the ankle
joint. On the lateral side of the distal tibia is a wide groove called the fibular notch. This
area articulates with the distal end of the fibula, forming the distal tibiofibular joint.
Fibula
The fibula is the slender bone located on the lateral side of the leg. The fibula does not bear
weight. It serves primarily for muscle attachments and thus is largely surrounded by
muscles. Only the proximal and distal ends of the fibula can be palpated.
The head of the fibula is the small, knob-like, proximal end of the fibula. It articulates with
the inferior aspect of the lateral tibial condyle, forming the proximal tibiofibular joint.
The thin shaft of the fibula has the interosseous border of the fibula, a narrow ridge
running down its medial side for the attachment of the interosseous membrane that spans
the fibula and tibia. The distal end of the fibula forms the lateral malleolus, which forms
the easily palpated bony bump on the lateral side of the ankle. The deep (medial) side of
the lateral malleolus articulates with the talus bone of the foot as part of the ankle joint.
The distal fibula also articulates with the fibular notch of the tibia.
Tarsal Bones
The posterior half of the foot is formed by seven tarsal bones. The most superior bone is
24
the talus. This has a relatively square-shaped, upper surface that articulates with the tibia
and fibula to form the ankle joint. Three areas of articulation form the ankle joint: The
superomedial surface of the talus bone articulates with the medial malleolus of the tibia,
the top of the talus articulates with the distal end of the tibia, and the lateral side of the
talus articulates with the lateral malleolus of the fibula. Inferiorly, the talus articulates with
the calcaneus (heel bone), the largest bone of the foot, which forms the heel. Body weight
is transferred from the tibia to the talus to the calcaneus, which rests on the ground. The
medial calcaneus has a prominent bony extension called the sustentaculum tali (“support
for the talus”) that supports the medial side of the talus bone.
The cuboid bone articulates with the anterior end of the calcaneus bone. The cuboid has a
deep groove running across its inferior surface, which provides passage for a muscle
tendon. The talus bone articulates anteriorly with the navicular bone, which in turn
articulates anteriorly with the three cuneiform (“wedge-shaped”) bones. These bones are
the medial cuneiform, the intermediate cuneiform, and the lateral cuneiform. Each of
these bones has a broad superior surface and a narrow inferior surface, which together
produce the transverse (medial-lateral) curvature of the foot. The navicular and lateral
cuneiform bones also articulate with the medial side of the cuboid bone.
Metatarsal Bones
The anterior half of the foot is formed by the five metatarsal bones, which are located
between the tarsal bones of the posterior foot and the phalanges of the toes. These
elongated bones are numbered 1–5, starting with the medial side of the foot. The first
metatarsal bone is shorter and thicker than the others. The second metatarsal is the
longest. The base of the metatarsal bone is the proximal end of each metatarsal bone.
These articulate with the cuboid or cuneiform bones. The base of the fifth metatarsal has a
large, lateral expansion that provides for muscle attachments.
This expanded base of the fifth metatarsal can be felt as a bony bump at the midpoint along
the lateral border of the foot.
The expanded distal end of each metatarsal is the head of the metatarsal bone. Each
metatarsal bone articulates with the proximal phalanx of a toe to form a
metatarsophalangeal joint. The heads of the metatarsal bones also rest on the ground
and form the ball (anterior end) of the foot.
Phalanges
The toes contain a total of 14 phalanx bones (phalanges), arranged in a similar manner as
the phalanges of the fingers. The toes are numbered 1–5, starting with the big toe ( hallux).
The big toe has two phalanx bones, the proximal and distal phalanges. The remaining toes
all have proximal, middle, and distal phalanges. A joint between adjacent phalanx bones is
called an interphalangeal joint.

25
 THE INTEGUMENTARY SYSTEM
The Integumentary system consist the skin and its derivatives. These include hair, nails,
and several types of glands. Skin is the largest organ in the body occupying almost 2m 2 of
surface area thickens of 2mm. Skin has 3 main parts. These are the epidermis, dermis and
hypodermis.
The skin is made of multiple layers of cells and tissues, which are held to underlying struc -
tures by connective tissue. The deeper layer of skin is well vascularized (has numerous
blood vessels). It also has numerous sensory, and autonomic and sympathetic nerve fibers
ensuring communication to and from the brain.

Figure 1: Layers of Skin.

The skin is composed of two main layers (Fig. 1): the epidermis, made of closely packed ep -
ithelial cells, and the dermis, made of dense, irregular connective tissue that houses blood
vessels, hair follicles, sweat glands, and other structures. Beneath the dermis lies the hypo-
dermis, which is composed mainly of loose connective and fatty tissues.

26
The Epidermis
The epidermis is composed of keratinized, stratified squamous epithelium. It is made of
four or five layers of epithelial cells, depending on its location in the body. It does not have
any blood vessels within it (i.e., it is avascular). Skin that has four layers of cells is referred
to as “thin skin.” From deep to superficial, these layers are the stratum basale, stratum
spinosum, stratum granulosum, and stratum corneum. Most of the skin can be classified as
thin skin. “Thick skin” is found only on the palms of the hands and the soles of the feet. It
has a fifth layer, called the stratum lucidum, located between the stratum corneum and the
stratum granulosum.
The cells in all of the layers except the stratum basale are called keratinocytes. A ker-
atinocyte is a cell that manufactures and stores the protein keratin. Keratin is an intracel-
lular fibrous protein that gives hair, nails, and skin their hardness and water-resistant
properties. The keratinocytes in the stratum corneum are dead and regularly slough away,
being replaced by cells from the deeper layers
Stratum Basale
The stratum basale (also called the stratum germinativum) is the deepest epidermal layer
and attaches the epidermis to the basal lamina, below which lie the layers of the dermis.
The cells in the stratum basale bond to the dermis via intertwining collagen fibers, referred
to as the basement membrane. A finger-like projection, or fold, known as the dermal
papilla (plural = dermal papillae) is found in the superficial portion of the dermis. Dermal
papillae increase the strength of the connection between the epidermis and dermis; the
greater the folding, the stronger the connections made Figure 2.

27
Figure 2: Layers of the Epidermis
The epidermis of thick skin has five layers: stratum basale, stratum spinosum, stratum
granulosum, stratum lucidum, and stratum corneum.

The stratum basale is a single layer of cells primarily made of basal cells. A basal cell is a
cuboidal-shaped stem cell that is a precursor of the keratinocytes of the epidermis. All of
the keratinocytes are produced from this single layer of cells, which are constantly going
through mitosis to produce new cells. As new cells are formed, the existing cells are
pushed superficially away from the stratum basale. Two other cell types are found dis-
persed among the basal cells in the stratum basale. The first is a Merkel cell, which func-
tions as a receptor and is responsible for stimulating sensory nerves that the brain per -
ceives as touch. These cells are especially abundant on the surfaces of the hands and feet.
The second is a melanocyte, a cell that produces the pigment melanin. Melanin gives hair
and skin its color, and also helps protect the living cells of the epidermis from ultraviolet
(UV) radiation damage.
Stratum Spinosum
As the name suggests, the stratum spinosum is spiny in appearance due to the protruding
cell processes that join the cells via a structure called a desmosome. The desmosomes in-
28
terlock with each other and strengthen the bond between the cells. It is interesting to note
that the “spiny” nature of this layer is an artifact of the staining process. Unstained epider-
mis samples do not exhibit this characteristic appearance. The stratum spinosum is com-
posed of eight to 10 layers of keratinocytes, formed as a result of cell division in the stra-
tum basale. Interspersed among the keratinocytes of this layer is a type of dendritic cell
called the Langerhans cell, which functions as a macrophage by engulfing bacteria, foreign
particles, and damaged cells that occur in this layer.
The keratinocytes in the stratum spinosum begin the synthesis of keratin and release a wa-
ter-repelling glycolipid that helps prevent water loss from the body, making the skin rela-
tively waterproof. As new keratinocytes are produced atop the stratum basale, the ker-
atinocytes of the stratum spinosum are pushed into the stratum granulosum.
Stratum Granulosum
The stratum granulosum has a grainy appearance due to further changes to the ker-
atinocytes as they are pushed from the stratum spinosum. The cells (three to five layers
deep) become flatter, their cell membranes thicken, and they generate large amounts of the
proteins keratin, which is fibrous, and keratohyalin, which accumulates as lamellar gran-
ules within the cells. These two proteins make up the bulk of the keratinocyte mass in the
stratum granulosum and give the layer its grainy appearance. The nuclei and other cell or -
ganelles disintegrate as the cells die, leaving behind the keratin, keratohyalin, and cell
membranes that will form the stratum lucidum, the stratum corneum, and the accessory
structures of hair and nails.
Stratum Lucidum
The stratum lucidum is a smooth, seemingly translucent layer of the epidermis located
just above the stratum granulosum and below the stratum corneum. This thin layer of cells
is found only in the thick skin of the palms, soles, and digits. The keratinocytes that com -
pose the stratum lucidum are dead and flattened. These cells are densely packed with elei-
den, a clear protein rich in lipids, derived from keratohyalin, which gives these cells their
transparent (i.e., lucid) appearance and provides a barrier to water.
Stratum Corneum
The stratum corneum is the most superficial layer of the epidermis and is the layer ex-
posed to the outside environment. The increased keratinization (also called cornification)
of the cells in this layer gives it its name. There are usually 15 to 30 layers of cells in the
stratum corneum. This dry, dead layer helps prevent the penetration of microbes and the
dehydration of underlying tissues, and provides a mechanical protection against abrasion
for the more delicate, underlying layers. Cells in this layer are shed periodically and are re-
placed by cells pushed up from the stratum granulosum (or stratum
lucidum in the case of the palms and soles of feet). The entire layer is replaced during a pe-
riod of about 4 weeks.
Dermis
The dermis might be considered the “core” of the integumentary system (derma- = “skin”),
as distinct from the epidermis (epi- = “upon” or “over”) and hypodermis (hypo- = “below”).
It contains blood and lymph vessels, nerves, and other structures, such as hair follicles and
sweat glands. The dermis is made of two layers of connective tissue that compose an inter -
connected mesh of elastin and collagenous fibers, produced by fibroblasts.
29
Papillary Layer
The papillary layer is made of loose, areolar connective tissue, which means the collagen
and elastin fibers of this layer form a loose mesh. This superficial layer of the dermis
projects into the stratum basale of the epidermis to form finger-like dermal papillae.
Within the papillary layer are fibroblasts, a small number of fat cells (adipocytes), and an
abundance of small blood vessels. In addition, the papillary layer contains phagocytes, de-
fensive cells that help fight bacteria or other infections that have breached the skin. This
layer also contains lymphatic capillaries, nerve fibers, and touch receptors called the
Meissner corpuscles.
Reticular Layer
Underlying the papillary layer is the much thicker reticular layer, composed of dense, ir-
regular connective tissue. This layer is well vascularized and has a rich sensory and sympa-
thetic nerve supply. The reticular layer appears reticulated (netlike) due to a tight mesh -
work of fibers. Elastin fibers provide some elasticity to the skin, enabling movement. Col-
lagen fibers provide structure and tensile strength, with strands of collagen extending into
both the papillary layer and the hypodermis. In addition, collagen binds water to keep the
skin hydrated.

Hypodermis
The hypodermis (also called the subcutaneous layer or superficial fascia) is a layer di-
rectly below the dermis and serves to connect the skin to the underlying fascia (fibrous tis-
sue) of the bones and muscles. It is not strictly a part of the skin, although the border be-
tween the hypodermis and dermis can be difficult to distinguish. The hypodermis consists
of well vascularized, loose, areolar connective tissue and adipose tissue, which functions as
a mode of fat storage and provides insulation and cushioning for the integument.
Accessory Structures of the Skin
Hair
Hair is a keratinous filament growing out of the epidermis. It is primarily made of dead,
keratinized cells. Strands of hair originate in an epidermal penetration of the dermis called
the hair follicle. The hair shaft is the part of the hair not anchored to the follicle, and
much of this is exposed at the skin’s surface. The rest of the hair, which is anchored in the
follicle, lies below the surface of the skin and is referred to as the hair root. The hair root
ends deep in the dermis at the hair bulb, and includes a layer of mitotically active basal
cells called the hair matrix. The hair bulb surrounds the hair papilla, which is made of
connective tissue and contains blood capillaries and nerve endings from the dermis.
Just as the basal layer of the epidermis forms the layers of epidermis that get pushed to the
surface as the dead skin on the surface sheds, the basal cells of the hair bulb divide and
push cells outward in the hair root and shaft as the hair grows. The medulla forms the
central core of the hair, which is surrounded by the cortex, a layer of compressed, kera-
tinized cells that is covered by an outer layer of very hard, keratinized cells known as the
cuticle.

30
Hair texture (straight, curly) is determined by the shape and structure of the cortex, and to
the extent that it is present, the medulla. The shape and structure of these layers are, in
turn, determined by the shape of the hair follicle. Hair growth begins with the production
of keratinocytes by the basal cells of the hair bulb. As new cells are deposited at the hair
bulb, the hair shaft is pushed through the follicle toward the surface. Keratinization is com-
pleted as the cells are pushed to the skin surface to form the shaft of hair that is externally
visible. The external hair is completely dead and composed entirely of keratin. For this rea-
son, our hair does not have sensation. Furthermore, you can cut your hair or shave without
damaging the hair structure because the cut is superficial.
The wall of the hair follicle is made of three concentric layers of cells. The cells of the inter-
nal root sheath surround the root of the growing hair and extend just up to the hair shaft.
They are derived from the basal cells of the hair matrix. The external root sheath, which
is an extension of the epidermis, encloses the hair root. It is made of basal cells at the base
of the hair root and tends to be more keratinous in the upper regions. The glassy mem-
brane is a thick, clear connective tissue sheath covering the hair root, connecting it to the
tissue of the dermis.
Each hair root is connected to a smooth muscle called the arrector pili that contracts in
response to nerve signals from the sympathetic nervous system, making the external hair
shaft “stand up.”
Nails
The nail bed is a specialized structure of the epidermis that is found at the tips of our fin -
gers and toes. The nail body is formed on the nail bed, and protects the tips of our fingers
and toes as they are the farthest extremities and the parts of the body that experience the
maximum mechanical stress (Figure 4). In addition, the nail body forms a back-support for
picking up small objects with the fingers. The nail body is composed of densely packed
dead keratinocytes. The epidermis in this part of the body has evolved a specialized struc-
ture upon which nails can form. The nail body forms at the nail root, which has a matrix of
proliferating cells from the stratum basale that enables the nail to grow continuously. The
lateral nail fold overlaps the nail on the sides, helping to anchor the nail body. The nail fold
that meets the proximal end of the nail body forms the nail cuticle, also called the epony-
chium. The nail bed is rich in blood vessels, making it appear pink, except at the base,
where a thick layer of epithelium over the nail matrix forms a crescent-shaped region
called the lunula. The area beneath the free edge of the nail, furthest from the cuticle, is
called the hyponychium. It consists of a thickened layer of stratum corneum.

31
Figure 4: Nails. The nail is an accessory structure of the integumentary system.

Glands of the Skin

Glands of the skin are the sudoriferous and sebaceous glands.
Sweat Glands
When the body becomes warm, sudoriferous glands produce sweat to cool the body.
Sweat glands develop from epidermal projections into the dermis and are classified as me-
rocrine glands; that is, the secretions are excreted by exocytosis through a duct without af-
fecting the cells of the gland. There are two types of sweat glands, each secreting slightly
different products.
An eccrine sweat gland is type of gland that produces a hypotonic sweat for thermoregu-
lation. These glands are found all over the skin’s surface, but are especially abundant on the
palms of the hand, the soles of the feet, and the forehead. They are coiled glands lying deep
in the dermis, with the duct rising up to a pore on the skin surface, where the sweat is re -
leased. This type of sweat, released by exocytosis, is hypotonic and composed mostly of
water, with some salt, antibodies, traces of metabolic waste, and dermicidin, an antimicro-
bial peptide. Eccrine glands are a primary component of thermoregulation in humans and
thus help to maintain homeostasis.
An apocrine sweat gland is usually associated with hair follicles in densely hairy areas,
such as armpits and genital regions.
Apocrine sweat glands are larger than eccrine sweat glands and lie deeper in the dermis,
sometimes even reaching the hypodermis, with the duct normally emptying into the hair
follicle. In addition to water and salts, apocrine sweat includes organic compounds that
make the sweat thicker and subject to bacterial decomposition and subsequent smell. The
release of this sweat is under both nervous and hormonal control, and plays a role in the
poorly understood human pheromone response. Most commercial antiperspirants use an
aluminum-based compound as their primary active ingredient to stop sweat. When the an-
tiperspirant enters the sweat gland duct, the aluminum-based compounds precipitate due
to a change in pH and form a physical block in the duct, which prevents sweat from coming
out of the pore.
Sebaceous Glands

32
A sebaceous gland is a type of oil gland that is found all over the body and helps to lubri-
cate and waterproof the skin and hair. Most sebaceous glands are associated with hair folli-
cles. They generate and excrete sebum, a mixture of lipids, onto the skin surface, thereby
naturally lubricating the dry and dead layer of keratinized cells of the stratum corneum,
keeping it pliable. The fatty acids of sebum also have antibacterial properties, and prevent
water loss from the skin in low-humidity environments. The secretion of sebum is stimu-
lated by hormones, many of which do not become active until puberty. Thus, sebaceous
glands are relatively inactive during childhood.

33
 THE NERVOUS SYSTEM
The nervous system can be divided into two major regions: the central and peripheral
nervous systems. The central nervous system (CNS) is the brain and spinal cord, and the
peripheral nervous system (PNS) is everything else.
The brain is contained within the cranial cavity of the skull, and the spinal cord is
contained within the vertebral cavity of the vertebral column. The peripheral nervous
system is so named because it is on the periphery—meaning beyond the brain and spinal
cord.
NERVOUS TISSUE
Nervous tissue is composed of two types of cells, neurons and glial cells. Neurons are the
primary type of cell that associates with the nervous system. They are responsible for the
computation and communication that the nervous system provides. They are electrically
active and release chemical signals to target cells. Glial cells, or glia, are known to play a
supporting role for nervous tissue. Neurons are important, but without glial support they
would notbe able to perform their function.
Neurons
Neurons are the cells considered to be the basis of nervous tissue. They are responsible for
the electrical signals that communicate information about sensations, and that produce
movements in response to those stimuli, along with inducing thought processes within the
brain. An important part of the function of neurons is in their structure, or shape. The three
dimensional shape of these cells makes the immense numbers of connections within the
nervous system possible.
Parts of a Neuron
The main part of a neuron is the cell body, which is also known as the soma (soma =
“body”). The cell body contains the nucleus and most of the major organelles. But what
makes neurons special is that they have many extensions of their cell membranes, which
are generally referred to as processes. Neurons are usually described as having one, and
only one, axon—a fiber that emerges from the cell body and projects to target cells. That
single axon can branch repeatedly to communicate with many target cells. It is the axon
that propagates the nerve impulse, which is communicated to one or more cells. The other
processes of the neuron are dendrites, which receive information from other neurons at
specialized areas of contact called synapses. The dendrites are usually highly branched
processes, providing locations for other neurons to communicate with the cell body.
Information flows through a neuron from the dendrites, across the cell body, and down the
axon. This gives the neuron a polarity—meaning that information flows in this one
direction. Figure 12.8 shows the relationship of these parts to one another.

34
Figure 12.8 Parts of a Neuron The major parts of the neuron are labeled on a multipolar
neuron from the CNS.
Where the axon emerges from the cell body, there is a special region referred to as the
axon hillock. This is a tapering of the cell body toward the axon fiber. Within the axon
hillock, the cytoplasm changes to a solution of limited components called axoplasm.
Because the axon hillock represents the beginning of the axon, it is also referred to as the
initial segment.
Many axons are wrapped by an insulating substance called myelin, which is actually made
from glial cells. Myelin acts as insulation much like the plastic or rubber that is used to
insulate electrical wires. A key difference between myelin and the insulation on a wire is
that there are gaps in the myelin covering of an axon. Each gap is called a node of Ranvier
and is important to the way that electrical signals travel down the axon. The length of the
axon between each gap, which is wrapped in myelin, is referred to as an axon segment. At
the end of the axon is the axon terminal, where there are usually several branches
extending toward the target cell, each of which ends in an enlargement called a synaptic
end bulb. These bulbs are what make the connection with the target cell at the synapse.
Types of Neurons
There are many neurons in the nervous system—a number in the trillions. And there are
many different types of neurons.
35
They can be classified by many different criteria. The first way to classify them is by the
number of processes attached to the cell body. Using the standard model of neurons, one of
these processes is the axon, and the rest are dendrites. Because information flows through
the neuron from dendrites or cell bodies toward the axon, these names are based on the
neuron's polarity (Figure 12.9).

Figure 12.9 Neuron Classification by Shape Unipolar cells have one process that
includes both the axon and dendrite. Bipolar cells have two processes, the axon and a
dendrite. Multipolar cells have more than two processes, the axon and two or more
dendrites.

Unipolar cells have only one process emerging from the cell. True unipolar cells are only
found in invertebrate animals, so the unipolar cells in humans are more appropriately
called “pseudo-unipolar” cells. Unipolar cells are exclusively sensory neurons and have two
unique characteristics. First, their dendrites are receiving sensory information, sometimes
directly from the stimulus itself. Secondly, the cell bodies of unipolar neurons are always
found in ganglia.
Bipolar cells have two processes, which extend from each end of the cell body, opposite to
each other. One is the axon and one the dendrite. Bipolar cells are not very common. They
are found mainly in the olfactory epithelium (where smell stimuli are sensed), and as part
of the retina.
Multipolar neurons are all of the neurons that are not unipolar or bipolar. They have one
36
axon and two or more dendrites (usually many more).With the exception of the unipolar
sensory ganglion cells, and the two specific bipolar cells mentioned above, all other
neurons are multipolar.
Neurons can also be classified on the basis of where they are found, who found them, what
they do, or even what chemicals they use to communicate with each other.
Glial Cells
Glial cells, or neuroglia or simply glia, are the other type of cell found in nervous tissue.
They are considered to be supporting cells, and many functions are directed at helping
neurons complete their function for communication. The name glia comes from the Greek
word that means “glue,” and was coined by the German pathologist Rudolph Virchow, who
wrote in 1856: “This connective substance, which is in the brain, the spinal cord, and the
special sense nerves, is a kind of glue (neuroglia) in which the nervous elements are
planted.”
There are six types of glial cells. Four of them are found in the CNS and two are found in the
PNS.
Glial Cells of the CNS
One cell providing support to neurons of the CNS is the astrocyte, so named because it
appears to be star-shaped under the microscope (astro- = “star”). Astrocytes have many
processes extending from their main cell body (not axons or dendrites like neurons, just
cell extensions). Those processes extend to interact with neurons, blood vessels, or the
connective tissue covering the CNS that is called the pia mater. Generally, they are
supporting cells for the neurons in the central nervous system. Some ways in which they
support neurons in the central nervous system are by maintaining the concentration of
chemicals in the extracellular space, removing excess signaling molecules, reacting to
tissue damage, and contributing to the blood-brain barrier (BBB). The blood-brain
barrier is a physiological barrier that keeps many substances that circulate in the rest of
the body from getting into the central nervous system, restricting what can cross from
circulating blood into the CNS. Nutrient molecules, such as glucose or amino acids, can pass
through the BBB, but other molecules cannot.
Also found in CNS tissue is the oligodendrocyte, sometimes called just “oligo,” which is
the glial cell type that insulates axons in the CNS. The name means “cell of a few branches”
(oligo- = “few”; dendro- = “branches”; -cyte = “cell”). There are a few processes that extend
from the cell body. Each one reaches out and surrounds an axon to insulate it in myelin.
One oligodendrocyte will provide the myelin for multiple axon segments, either for the
same axon or for separate axons.
Microglia are, as the name implies, smaller than most of the other glial cells. Ongoing
research into these cells, although not entirely conclusive, suggests that they may originate
as white blood cells, called macrophages, that become part of the CNS during early
development.
The ependymal cell is a glial cell that filters blood to make cerebrospinal fluid (CSF), the
fluid that circulates through the CNS. Because of the privileged blood supply inherent in
the BBB, the extracellular space in nervous tissue does not easily exchange components
37
with the blood. Ependymal cells line each ventricle, one of four central cavities that are
remnants of the hollow center of the neural tube formed during the embryonic
development of the brain. The choroid plexus is a specialized structure in the ventricles
where ependymal cells come in contact with blood vessels and filter and absorb
components of the blood to produce cerebrospinal fluid. They also have cilia on their apical
surface to help move the CSF through the ventricular space.
Glial Cells of the PNS
One of the two types of glial cells found in the PNS is the satellite cell. Satellite cells are
found in sensory and autonomic ganglia, where they surround the cell bodies of neurons.
They provide support, performing similar functions in the periphery as astrocytes do in
the CNS—except, of course, for establishing the BBB.
The second type of glial cell is the Schwann cell, which insulate axons with myelin in the
periphery. Schwann cells are different than oligodendrocytes, in that a Schwann cell wraps
around a portion of only one axon segment and not others.
Oligodendrocytes have processes that reach out to multiple axon segments, whereas the
entire Schwann cell surrounds just one axon segment. The nucleus and cytoplasm of the
Schwann cell are on the edge of the myelin sheath.
The Central Nervous System
The brain and the spinal cord are the central nervous system, and they represent the main
organs of the nervous system.
The spinal cord is a single structure, whereas the adult brain is described in terms of four
major regions: the cerebrum, the diencephalon, the brain stem, and the cerebellum.
The Cerebrum
The iconic gray mantle of the human brain, which appears to make up most of the mass of
the brain, is the cerebrum (Figure 13.6). The wrinkled portion is the cerebral cortex,
and the rest of the structure is beneath that outer covering.
There is a large separation between the two sides of the cerebrum called the longitudinal
fissure. It separates the cerebrum into two distinct halves, a right and left cerebral
hemisphere. Deep within the cerebrum, the white matter of the corpus callosum
provides the major pathway for communication between the two hemispheres of the
cerebral cortex.

38
Figure 13.6 The Cerebrum The cerebrum is a large component of the CNS in humans, and
the most obvious aspect of it is the folded surface called the cerebral cortex.

Many of the higher neurological functions, such as memory, emotion, and consciousness,
are the result of cerebral function.
The complexity of the cerebrum is different across vertebrate species. The cerebrum of the
most primitive vertebrates is not much more than the connection for the sense of smell. In
mammals, the cerebrum comprises the outer gray matter that is the cortex and several
deep nuclei that belong to three important functional groups. The basal nuclei are
responsible for cognitive processing, the most important function being that associated
with planning movements. The basal forebrain contains nuclei that are important in
learning and memory. The limbic cortex is the region of the cerebral cortex that is part of
the limbic system, a collection of structures involved in emotion, memory, and behavior.
Cerebral Cortex
The cerebrum is covered by a continuous layer of gray matter that wraps around either
side of the forebrain—the cerebral cortex. This thin, extensive region of wrinkled gray
matter is responsible for the higher functions of the nervous system. A gyrus (plural =
gyri) is the ridge of one of those wrinkles, and a sulcus (plural = sulci) is the groove
between two gyri. The pattern of these folds of tissue indicates specific regions of the
cerebral cortex.
The head is limited by the size of the birth canal, and the brain must fit inside the cranial
cavity of the skull. Extensive folding in the cerebral cortex enables more gray matter to fit
into this limited space. If the gray matter of the cortex were peeled off of the cerebrum and
laid out flat, its surface area would be roughly equal to one square meter.
The folding of the cortex maximizes the amount of gray matter in the cranial cavity. During
39
embryonic development, as the telencephalon expands within the skull, the brain goes
through a regular course of growth that results in everyone’s brain having a similar
pattern of folds. The surface of the brain can be mapped on the basis of the locations of
large gyri and sulci.
Using these landmarks, the cortex can be separated into four major regions, or lobes. The
lateral sulcus that separates the temporal lobe from the other regions is one such
landmark. Superior to the lateral sulcus are the parietal lobe and frontal lobe, which are
separated from each other by the central sulcus. The posterior region of the cortex is the
occipital lobe, which has no obvious anatomical border between it and the parietal or
temporal lobes on the lateral surface of the brain. From the medial surface, an obvious
landmark separating the parietal and occipital lobes is called the parietooccipital sulcus.
The fact that there is no obvious anatomical border between these lobes is consistent with
the functions of these regions being interrelated.
Subcortical structures
Beneath the cerebral cortex are sets of nuclei known as subcortical nuclei that augment
cortical processes. The nuclei of the basal forebrain serve as the primary location for
acetylcholine production, which modulates the overall activity of the cortex, possibly
leading to greater attention to sensory stimuli. Alzheimer’s disease is associated with a loss
of neurons in the basal forebrain. The hippocampus and amygdala are medial-lobe
structures that, along with the adjacent cortex, are involved in long-term memory
formation and emotional responses. The basal nuclei are a set of nuclei in the cerebrum
responsible for comparing cortical processing with the general state of activity in the
nervous system to influence the likelihood of movement taking place. For example, while a
student is sitting in a classroom listening to a lecture, the basal nuclei will keep the urge to
jump up and scream from actually happening. (The basal nuclei are also referred to as the
basal ganglia, although that is potentially confusing because the term ganglia is typically
used for peripheral structures.)
The major structures of the basal nuclei that control movement are the caudate, putamen,
and globus pallidus, which are located deep in the cerebrum. The caudate is a long
nucleus that follows the basic C-shape of the cerebrum from the frontal lobe, through the
parietal and occipital lobes, into the temporal lobe. The putamen is mostly deep in the
anterior regions of the frontal and parietal lobes. Together, the caudate and putamen are
called the striatum. The globus pallidus is a layered nucleus that lies just medial to the
putamen; they are called the lenticular nuclei because they look like curved pieces fitting
together like lenses. The globus pallidus has two subdivisions, the external and internal
segments, which are lateral and medial, respectively.
The Diencephalon
The diencephalon is the one region of the adult brain that retains its name from
embryologic development. The etymology of the word diencephalon translates to “through
brain.” It is the connection between the cerebrum and the rest of the nervous system, with

40
one exception. The rest of the brain, the spinal cord, and the PNS all send information to
the cerebrum through the diencephalon. Output from the cerebrum passes through the
diencephalon. The single exception is the system associated with olfaction, or the sense of
smell, which connects directly with the cerebrum. The diencephalon is deep beneath the
cerebrum and constitutes the walls of the third ventricle. The diencephalon can be
described as any region of the brain with “thalamus” in its name. The two major regions of
the diencephalon are the thalamus itself and the hypothalamus. There are other structures,
such as the epithalamus, which contains the pineal gland, or the subthalamus, which
includes the subthalamic nucleus that is part of the basal nuclei.
Thalamus
The thalamus is a collection of nuclei that relay information between the cerebral cortex
and the periphery, spinal cord, or brain stem. All sensory information, except for the sense
of smell, passes through the thalamus before processing by the cortex. Axons from the
peripheral sensory organs, or intermediate nuclei, synapse in the thalamus, and thalamic
neurons project directly to the cerebrum. It is a requisite synapse in any sensory pathway,
except for olfaction. The thalamus does not just pass the information on, it also processes
that information. For example, the portion of the thalamus that receives visual information
will influence what visual stimuli are important, or what receives attention.
The cerebrum also sends information down to the thalamus, which usually communicates
motor commands. This involves interactions with the cerebellum and other nuclei in the
brain stem. The cerebrum interacts with the basal nuclei, which involves connections with
the thalamus. The primary output of the basal nuclei is to the thalamus, which relays that
output to the cerebral cortex. The cortex also sends information to the thalamus that will
then influence the effects of the basal nuclei.
Hypothalamus
Inferior and slightly anterior to the thalamus is the hypothalamus, the other major region
of the diencephalon. The hypothalamus is a collection of nuclei that are largely involved in
regulating homeostasis. The hypothalamus is the executive region in charge of the
autonomic nervous system and the endocrine system through its regulation of the anterior
pituitary gland. Other parts of the hypothalamus are involved in memory and emotion as
part of the limbic system.
Brain Stem
The midbrain and hindbrain (composed of the pons and the medulla) are collectively
referred to as the brain stem. The structure emerges from the ventral surface of the
forebrain as a tapering cone that connects the brain to the spinal cord. Attached to the
brain stem, but considered a separate region of the adult brain, is the cerebellum. The
midbrain coordinates sensory representations of the visual, auditory, and somatosensory
perceptual spaces. The pons is the main connection with the cerebellum. The pons and the
41
medulla regulate several crucial functions, including the cardiovascular and respiratory
systems and rates.

The Cerebellum
The cerebellum, as the name suggests, is the “little brain.” It is covered in gyri and sulci
like the cerebrum. The cerebellum is largely responsible for comparing information from
the cerebrum with sensory feedback from the periphery through the spinal cord. It
accounts for approximately 10 percent of the mass of the brain.
The Spinal Cord
The description of the CNS is concentrated on the structures of the brain, but the spinal
cord is another major organ of the system. Whereas the brain develops out of expansions
of the neural tube into primary and then secondary vesicles, the spinal cord maintains the
tube structure and is only specialized into certain regions. As the spinal cord continues to
develop in the newborn, anatomical features mark its surface. The anterior midline is
marked by the anterior median fissure, and the posterior midline is marked by the
posterior median sulcus. Axons enter the posterior side through the dorsal (posterior)
nerve root, which marks the posterolateral sulcus on either side. The axons emerging
from the anterior side do so throughthe ventral (anterior) nerve root. Note that it is
common to see the terms dorsal (dorsal = “back”) and ventral (ventral = “belly”) used
interchangeably with posterior and anterior, particularly in reference to nerves and the
structures of the spinal cord. On the whole, the posterior regions are responsible for
sensory functions and the anterior regions are associated with motor functions. This
comes from the initial development of the spinal cord, which is divided into the basal
plate and the alar plate. The basal plate is closest to the ventral midline of the neural tube,
which will become the anterior face of the spinal cord and gives rise to motor neurons. The
alar plate is on the dorsal side of the neural tube and gives rise to neurons that will receive
sensory input from the periphery.
The length of the spinal cord is divided into regions that correspond to the regions of the
vertebral column. The name of a spinal cord region corresponds to the level at which
spinal nerves pass through the intervertebral foramina. Immediately adjacent to the brain
stem is the cervical region, followed by the thoracic, then the lumbar, and finally the sacral
region. The spinal cord is not the full length of the vertebral column because the spinal
cord does not grow significantly longer after the first or second year, but the skeleton
continues to grow. The nerves that emerge from the spinal cord pass through the
intervertebral formina at the respective levels. As the vertebral column grows, these
nerves grow with it and result in a long bundle of nerves that resembles a horse’s tail and
is named the cauda equina. The sacral spinal cord is at the level of the upper lumbar
vertebral bones. The spinal nerves extend from their various levels to the proper level of
42
the vertebral column.
Gray Horns
The gray matter is subdivided into regions that are referred to as horns. The posterior
horn is responsible for sensory processing. The anterior horn sends out motor signals to
the skeletal muscles. The lateral horn, which is only found in the thoracic, upper lumbar,
and sacral regions, is the central component of the sympathetic division of the autonomic
nervous system.
White Columns
Just as the gray matter is separated into horns, the white matter of the spinal cord is
separated into columns. Ascending tracts of nervous system fibers in these columns carry
sensory information up to the brain, whereas descending tracts carry motor commands
from the brain. Looking at the spinal cord longitudinally, the columns extend along its
length as continuous bands of white matter. Between the two posterior horns of gray
matter are the posterior columns. Between the two anterior horns, and bounded by the
axons of motor neurons emerging from that gray matter area, are the anterior columns.
The white matter on either side of the spinal cord, between the posterior horn and the
axons of the anterior horn neurons, are the lateral columns. The posterior columns are
composed of axons of ascending tracts. The anterior and lateral columns are composed of
many different groups of axons of both ascending and descending tracts—the latter
carrying motor commands down from the brain to the spinal cord to control output to the
periphery.
The Peripheral Nervous System
The PNS is not as contained as the CNS because it is defined as everything that is not the
CNS. Some peripheral structures are incorporated into the other organs of the body. In
describing the anatomy of the PNS, it is necessary to describe the common structures, the
nerves and the ganglia, as they are found in various parts of the body. Many of the neural
structures that are incorporated into other organs are features of the digestive system;
these structures are known as the enteric nervous system and are a special subset of the
PNS.
Ganglia
A ganglion is a group of neuron cell bodies in the periphery. Ganglia can be categorized, for
the most part, as either sensory ganglia or autonomic ganglia, referring to their primary
functions. The most common type of sensory ganglion is a dorsal (posterior) root
ganglion. These ganglia are the cell bodies of neurons with axons that are sensory endings
in the periphery, such as in the skin, and that extend into the CNS through the dorsal nerve
root. The ganglion is an enlargement of the nerve root. The cells of the dorsal root ganglion
are unipolar cells, classifying them by shape. Also, the small round nuclei of satellite cells
can be seen surrounding—as if they were orbiting—the neuron cell bodies.
43
Another type of sensory ganglion is a cranial nerve ganglion. This is analogous to the
dorsal root ganglion, except that it is associated with a cranial nerve instead of a spinal
nerve. The roots of cranial nerves are within the cranium, whereas the ganglia are outside
the skull. For example, the trigeminal ganglion is superficial to the temporal bone
whereas its associated nerve is attached to the mid-pons region of the brain stem. The
neurons of cranial nerve ganglia are also unipolar in shape with associated satellite cells.
The other major category of ganglia are those of the autonomic nervous system, which is
divided into the sympathetic and parasympathetic nervous systems. The sympathetic
chain ganglia constitute a row of ganglia along the vertebral column that receive central
input from the lateral horn of the thoracic and upper lumbar spinal cord. Superior to the
chain ganglia are three paravertebral ganglia in the cervical region. Three other
autonomic ganglia that are related to the sympathetic chain are the prevertebral ganglia,
which are located outside of the chain but have similar functions. They are referred to as
prevertebral because they are anterior to the vertebral column. The neurons of these
autonomic ganglia are multipolar in shape, with dendrites radiating out around the cell
body where synapses from the spinal cord neurons are made. The neurons of the chain,
paravertebral, and prevertebral ganglia then project to organs in the head and neck,
thoracic, abdominal, and pelvic cavities to regulate the sympathetic aspect of homeostatic
mechanisms.
Another group of autonomic ganglia are the terminal ganglia that receive input from
cranial nerves or sacral spinal nerves and are responsible for regulating the
parasympathetic aspect of homeostatic mechanisms. These two sets of ganglia,
sympathetic and parasympathetic, often project to the same organs—one input from the
chain ganglia and one input from a terminal ganglion—to regulate the overall function of
an organ. For example, the heart receives two inputs such as these; one increases heart
rate, and the other decreases it. The terminal ganglia that receive input from cranial nerves
are found in the head and neck, as well as the thoracic and upper abdominal cavities,
whereas the terminal ganglia that receive sacral input are in the lower abdominal and
pelvic cavities.
Terminal ganglia below the head and neck are often incorporated into the wall of the target
organ as a plexus. A plexus, in a general sense, is a network of fibers or vessels. This can
apply to nervous tissue (as in this instance) or structures containing blood vessels (such as
a choroid plexus). For example, the enteric plexus is the extensive network of axons and
neurons in the wall of the small and large intestines. The enteric plexus is actually part of
the enteric nervous system, along with the gastric plexuses and the esophageal plexus.
Though the enteric nervous system receives input originating from central neurons of the
autonomic nervous system, it does not require CNS input to function. In fact, it operates
independently to regulate the digestive system.
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Nerves
Bundles of axons in the PNS are referred to as nerves. These structures in the periphery are
different than the central counterpart, called a tract. Nerves are composed of more than
just nervous tissue. They have connective tissues invested in their structure, as well as
blood vessels supplying the tissues with nourishment. The outer surface of a nerve is a
surrounding layer of fibrous connective tissue called the epineurium. Within the nerve,
axons are further bundled into fascicles, which are each surrounded by their own layer of
fibrous connective tissue called perineurium. Finally, individual axons are surrounded by
loose connective tissue called the endoneurium. These three layers are similar to the
connective tissue sheaths for muscles. Nerves are associated with the region of the CNS to
which they are connected, either as cranial nerves connected to the brain or spinal nerves
connected to the spinal cord.
Cranial Nerves
The nerves attached to the brain are the cranial nerves, which are primarily responsible for
the sensory and motor functions of the head and neck (one of these nerves targets organs
in the thoracic and abdominal cavities as part of the parasympathetic nervous system).
There are twelve cranial nerves, which are designated CNI through CNXII for “Cranial
Nerve,” using Roman numerals for 1 through 12. They can be classified as sensory nerves,
motor nerves, or a combination of both, meaning that the axons in these nerves originate
out of sensory ganglia external to the cranium or motor nuclei within the brain stem.
Sensory axons enter the brain to synapse in a nucleus. Motor axons connect to skeletal
muscles of the head or neck. Three of the nerves are solely composed of sensory fibers; five
are strictly motor; and the remaining four are mixed nerves.
The olfactory nerve and optic nerve are responsible for the sense of smell and vision,
respectively. The oculomotor nerve is responsible for eye movements by controlling four
of the extraocular muscles. It is also responsible for lifting the upper eyelid when the eyes
point up, and for pupillary constriction. The trochlear nerve and the abducens nerve are
both responsible for eye movement, but do so by controlling different extraocular muscles.
The trigeminal nerve is responsible for cutaneous sensations of the face and controlling
the muscles of mastication. The facial nerve is responsible for the muscles involved in
facial expressions, as well as part of the sense of taste and the production of saliva. The
vestibulocochlear nerve is responsible for the senses of hearing and balance. The
glossopharyngeal nerve is responsible for controlling muscles in the oral cavity and
upper throat, as well as part of the sense of taste and the production of saliva.
The vagus nerve is responsible for contributing to homeostatic control of the organs of
the thoracic and upper abdominal cavities. The spinal accessory nerve is responsible for
controlling the muscles of the neck, along with cervical spinal nerves. The hypoglossal
nerve is responsible for controlling the muscles of the lower throat and tongue.
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Three of the cranial nerves also contain autonomic fibers, and a fourth is almost purely a
component of the autonomic system. The oculomotor, facial, and glossopharyngeal nerves
contain fibers that contact autonomic ganglia. The oculomotor fibers initiate pupillary
constriction, whereas the facial and glossopharyngeal fibers both initiate salivation. The
vagus nerve primarily targets autonomic ganglia in the thoracic and upper abdominal
cavities.
Another important aspect of the cranial nerves is the functional role each nerve plays. The
nerves fall into one of three basic groups. They are sensory, motor, or both. The first,
second, and eighth nerves are purely sensory: the olfactory (CNI), optic (CNII), and
vestibulocochlear (CNVIII) nerves.
The three eye-movement nerves are all motor: the oculomotor (CNIII), trochlear (CNIV),
and abducens (CNVI). The spinal accessory (CNXI) and hypoglossal (CNXII) nerves are also
strictly motor. The remainder of the nerves contain both sensory and motor fibers. They
are the trigeminal (CNV), facial (CNVII), glossopharyngeal (CNIX), and vagus (CNX) nerves.
The nerves that convey both are often related to each other. The trigeminal and facial
nerves both concern the face; one concerns the sensations and the other concerns the
muscle movements. The facial and glossopharyngeal nerves are both responsible for
conveying gustatory, or taste, sensations as well as controlling salivary glands. The vagus
nerve is involved in visceral responses to taste, namely the gag reflex.
Spinal Nerves
The nerves connected to the spinal cord are the spinal nerves. The arrangement of these
nerves is much more regular than that of the cranial nerves. All of the spinal nerves are
combined sensory and motor axons that separate into two nerve roots.
The sensory axons enter the spinal cord as the dorsal nerve root. The motor fibers, both
somatic and autonomic, emerge as the ventral nerve root. The dorsal root ganglion for each
nerve is an enlargement of the spinal nerve.
There are 31 spinal nerves, named for the level of the spinal cord at which each one
emerges. There are eight pairs of cervical nerves designated C1 to C8, twelve thoracic
nerves designated T1 to T12, five pairs of lumbar nerves designated L1 to L5, five pairs of
sacral nerves designated S1 to S5, and one pair of coccygeal nerves. The nerves are
numbered from the superior to inferior positions, and each emerges from the vertebral
column through the intervertebral foramen at its level. The first nerve, C1, emerges
between the first cervical vertebra and the occipital bone. The second nerve, C2, emerges
between the first and second cervical vertebrae. The same occurs for C3 to C7, but C8
emerges between the seventh cervical vertebra and the first thoracic vertebra. For the
thoracic and lumbar nerves, each one emerges between the vertebra that has the same
designation and the next vertebra in the column. The sacral nerves emerge from the sacral
foramina along the length of that unique vertebra.
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Spinal nerves extend outward from the vertebral column to enervate the periphery. The
nerves in the periphery are not straight continuations of the spinal nerves, but rather the
reorganization of the axons in those nerves to follow different courses. Axons from
different spinal nerves will come together into a systemic nerve. This occurs at four
places along the length of the vertebral column, each identified as a nerve plexus, whereas
the other spinal nerves directly correspond to nerves at their respective levels. In this
instance, the word plexus is used to describe networks of nerve fibers with no associated
cell bodies.
Of the four nerve plexuses, two are found at the cervical level, one at the lumbar level, and
one at the sacral level. The cervical plexus is composed of axons from spinal nerves C1
through C5 and branches into nerves in the posterior neck and head, as well as the phrenic
nerve, which connects to the diaphragm at the base of the thoracic cavity.
The other plexus from the cervical level is the brachial plexus. Spinal nerves C4 through
T1 reorganize through this plexus to give rise to the nerves of the arms, as the name
brachial suggests. A large nerve from this plexus is the radial nerve from which the
axillary nerve branches to go to the armpit region. The radial nerve continues through the
arm and is paralleled by the ulnar nerve and the median nerve. The lumbar plexus
arises from all the lumbar spinal nerves and gives rise to nerves enervating the pelvic
region and the anterior leg. The femoral nerve is one of the major nerves from this plexus,
which gives rise to the saphenous nerve as a branch that extends through the anterior
lower leg. The sacral plexus comes from the lower lumbar nerves L4 and L5 and the sacral
nerves S1 to S4. The most significant systemic nerve to come from this plexus is the sciatic
nerve, which is a combination of the tibial nerve and the fibular nerve. The sciatic nerve
extends across the hip joint and is most commonly associated with the condition sciatica,
which is the result of compression or irritation of the nerve or any of the spinal nerves
giving rise to it.
These plexuses are described as arising from spinal nerves and giving rise to certain
systemic nerves, but they contain fibers that serve sensory functions or fibers that serve
motor functions. This means that some fibers extend from cutaneous or other peripheral
sensory surfaces and send action potentials into the CNS. Those are axons of sensory
neurons in the dorsal root ganglia that enter the spinal cord through the dorsal nerve root.
Other fibers are the axons of motor neurons of the anterior horn of the spinal cord, which
emerge in the ventral nerve root and send action potentials to cause skeletal muscles to
contract in their target regions. For example, the radial nerve contains fibers of cutaneous
sensation in the arm, as well as motor fibers that move muscles in the arm.
Spinal nerves of the thoracic region, T2 through T11, are not part of the plexuses but
rather emerge and give rise to the intercostal nerves found between the ribs, which
articulate with the vertebrae surrounding the spinal nerve.
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