Ministry of Public Health of Ukraine Ukrainian Medical Stomatological Academy

"Approved" at the meeting of the Department of Human Anatomy «29»_08__2020 Minutes № Head of the Department Professor O.O. Sherstjuk ______

METHODICAL GUIDANCE for the lecture

Academic subject Human Anatomy Module No 1 "Anatomy of the locomotor system" Lecture No 2 General osteology. General anatomy of the skeleton of human body. Development and classification of the bones. Bone as a multifunctional organ. General arthrology. The theoretical background to the study of the connection of the bones. Classification of the continuos and discontinuos articulations Year of study І Faculty Foreign students' training faculty, specialty «Medicine» Number of 2 academic hours

Poltava – 2020 1. Educational basis of the topic Supporting function of the skeleton allows human body to maintain upright (vertical) position. Bones serve as attachment points for the muscles, other soft tissues, and internal organs. Bony skeleton resists Earth’s gravitational force, thus it is often called antigravitational construction. Movement cannot be carried out without bones. Bones act as dynamically together levers, which are led into motion by the action of muscles. Skeleton performs protective function in the body. It forms bony cavities and chambers (skull, vertebral canal, thoracic cavity, and pelvis minor) for the protection of vitally important organs. Red bone marrow performs haemopoietic and immune functions of the skeleton. Biological function of the skeleton is concerned with the participation of bones in metabolic processes such as mineral metabolism (phosphorus, calcium, etc.). Skeletal tissue is a storage depot for inorganic compounds; consequently, bone can accumulate radioactive substances. Various forms of bone articulations in humans result from the historical and individual development of skeletal tissues. Bones, being the hardest formations in the skeleton, can articulate with each other via an integral, continuous tissue (connective, cartilaginous, or osseous) as well as via the formation of discontinuous (synovial) .

2. Learning objectives of the lecture: . Teach students to determine the position of bones in three-dimensional space, the projection of organs on the surface of the body along the lines on the trunk. . Determine the location of the bone system in the human body. . Characterize the bones according the development, topography, the presence of an airborne sinus, the structure. . Give a classification of bone connections. To characterize the importance in the practical activity of knowledge about the structure of bones and their connections.

3. Objectives of developing the future specialist’s personality (educational aims and objectives): familiarization with axiological, ethical and deontological principles of medical profession.

4. Interdisciplinary integration The preceding The acquired knowledge subjects Biology Describe the structural features of the bones. To find studying structures on the date bones. Describe the types of connections, types of joints, the spine curves. Physics Analyze plane, the possible movements of the joints 5. The plan and organization of lecture structure No The main stages of the lecture and Type of lecture. Time their content Means of motivation. allocation Teaching materials The preparatory stage 5% 1. Determining the relevance of the pp. 1-2 topic, learning objectives and motivation. The main stage Introductory lecture 85% 2. Delivering the lecture material according to the plan: Feedback and questions 1. General osteology. to students 2. The general anatomy of the skeleton. Classification of bones. PPT presentation with Bone as a multifunctional organ. diagrams and tables. 3. General arthrology. Theoretical background for studying the types of connection of bones. 4. Classification of continuous and discontinuous compounds. 5. Methods of examination of the bone system. The final stage Human Anatomy. In three 10% 3. General conclusions to the lecture. volumes. Volume 1: Answers to possible questions. textbook / Edited by V.G. Tasks for students’ self-directed Koveshnikov. - Lugansk: work. LTD «Virtualnaya realnost», 2009. – 328p.

6. The lecture material. Classification of Joints. The articulations are divided into three classes: synarthroses or immovable, amphiarthroses or slightly movable, and diarthroses or freely movable, joints. Synarthroses (immovable articulations). Synarthroses include all those articulations in which the surfaces of the bones are in almost direct contact, fastened together by intervening connective tissue, bone tissue or hyaline cartilage, and in which there is no appreciable motion. There are three varieties of : syndesmosis, and synostosis. Synchondrosis - continuous connection of bones by means of a cartilaginous tissue. Depending on duration of the existence the synchondroses are be: •Temporary – exist only up to definite age, then are substituted by synostoses: synchondrosis between sphenoid and occipital bones. •Permanent – exist during all life: between pyramid of the temporal bone and occipital bone. Synostosis – continuous connection of bones by means of a bone tissue. Syndesmosis – continuous connection of bones by means of a connective tissue. •If the connective tissue fills in a large interspace between bones, such connection gains a kind of interosseous membranes. •If the intermediate connective tissue gains a constitution of fibrous bundles, such connection gains a kind of . •When the intermediate connective tissue gains a condition of a thin interlayer between bones of a skull, then it is a sutura. Depending on the shape of connecting osteal edges distinguish following suturae: sutura serrata (the edges of the bones are serrated like the teeth of a fine saw), sutura squamosa (formed by the overlapping of contiguous bones by broad bevelled margins, as in the squamosal suture between the temporal and parietal) and sutura plana (simple apposition of contiguous rough surfaces, as in the articulation between the maxillae, or between the horizontal parts of the palatine bones). Amphiarthroses (slightly movable articulations). In these articulations the contiguous bony surfaces are either connected by broad flattened disks of fibrocartilage, of a more or less complex structure, as in the articulations between the bodies of the vertebrae; or are united by an interosseous , as in the inferior tibiofibular articulation. The first form is termed a the second a syndesmosis. Diarthroses (freely movable articulations). This class includes the greater number of the joints in the body. In a diarthrodial joint the contiguous bony surfaces are covered with articular cartilage, and connected by ligaments lined by . The joint may be divided, completely or incompletely, by an or , the periphery of which is continuous with the fibrous capsule while its free surfaces are covered by synovial membrane. The varieties of joints in this class have been determined by the kind of motion permitted in each. There are two varieties in which the movement is uniaxial, that is to say, all movements take place around one axis. In one form, the ginglymus, this axis is, practically speaking, transverse; in the other, the trochoid or pivot-joint, it is longitudinal. There are two varieties where the movement is biaxial, or around two horizontal axes at right angles to each other, or at any intervening axis between the two. These are the condyloid and the saddle-joint. There is one form where the movement is polyaxial, the enarthrosis or ball-and-socket joint; and finally there are the arthrodia or gliding joints. The articulations of the vertebral column consist of (1) a series of joints between the vertebral bodies, and (2) a series of joints between the vertebral arches. 1. Articulations of Vertebral Bodies (intercentral ligaments). The articulations between the bodies of the vertebrae are synarthrodial joints, and the individual vertebrae move only slightly on each other. When, however, this slight degree of movement between the pairs of bones takes place in all the joints of the vertebral column, the total range of movement is very considerable. The ligaments of these articulations are the following: The Anterior Longitudinal. The Posterior Longitudinal. The Intervertebral Fibrocartilages. The Anterior Longitudinal Ligament (ligamentum longitudinale anterius) – the anterior longitudinal ligament is a broad and strong band of fibers, which extends along the anterior surfaces of the bodies of the vertebrae, from the axis to the sacrum. The Posterior Longitudinal Ligament (ligamentum longitudinale posterius) – The posterior longitudinal ligament is situated within the vertebral canal, and extends along the posterior surfaces of the bodies of the vertebrae, from the body of the axis, where it is continuous with the membrana tectoria, to the sacrum. The Intervertebral Fibrocartilages (fibrocartilagines intervertebrales; intervertebral disks). The intervertebral fibrocartilages are interposed between the adjacent surfaces of the bodies of the vertebrae, from the axis to the sacrum, and form the chief bonds of connection between the vertebrae. 2. Articulations of Vertebral Arches.—The joints between the articular processes of the vertebrae belong to the arthrodial variety and are enveloped by capsules lined by synovial membranes; while the laminae, spinous and transverse processes are connected by the following ligaments: The Ligamenta Flava. The Ligamentum Nuchae. The Supraspinal. The Interspinal. The Intertransverse. The Ligamenta Flava (ligamenta flava). The ligamenta flava connect the laminae of adjacent vertebrae, from the axis to the first segment of the sacrum. The Supraspinal Ligament (ligamentum supraspinale; supraspinous ligament). The supraspinal ligament is a strong fibrous cord, which connects together the apices of the spinous processes from the seventh cervical vertebra to the sacrum. The Ligamentum Nuchae. The ligamentum nuchae is a fibrous membrane, which, in the neck, represents the supraspinal ligaments of the lower vertebrae. It extends from the external occipital protuberance and median nuchal line to the spinous process of the seventh cervical vertebra. The Interspinal Ligaments (ligamenta interspinalia; interspinous ligaments). The interspinal ligaments thin and membranous, connect adjoining spinous processes and extend from the root to the apex of each process. They meet the ligamenta flava in front and the supraspinal ligament behind. They are narrow and elongated in the thoracic region; broader, thicker, and quadrilateral in form in the lumbar region; and only slightly developed in the neck. The Intertransverse Ligaments (ligamenta intertransversaria). The intertransverse ligaments are interposed between the transverse processes. In the cervical region they consist of a few irregular, scattered fibers; in the thoracic region they are rounded cords intimately connected with the deep muscles of the back; in the lumbar region they are thin and membranous. 7. Materials for activating students during the lecture: Human skeleton. Tables. Models. Theoretical questions. 1. Name basic parts of the skeleton. 2. Name the regions of the vertebral column. 3. Name parts of a typical vertebra. 4. What are the characteristic features of 1) cervical vertebrae; 2) thoracic vertebrae; 3) lumbar vertebrae? 5. Why is the sternum widely used for the red bone marrow puncture? 6. What bones constitute the ? 7. The bones of the hand. The structure, abnormalities. 8. Pelvic and hip bones. Features of the structure, abnormalities. 9. The bones of foreleg and foot. The structure, abnormalities. 10. General syndesmology. Types of connections. Classification of joints. The connection between the vertebrae. Vertebral column as a whole. Curves of the spine. Pathology and abnormalities. Age features. 11. Atlanta-occipital and atlanta-axial joints, strycture, biomechanics of movement. Temporo-mandibular joint, structure, biomechanics of movement. 12. Connections ribs with the sternum. 13. The connections of the upper limb bones. 14. The shoulder and elbow joints. The structure, biomechanics of movement. Connections forearm and hand. 15. The connections of the lower limb bones. 16. Pelvis as a whole. The dimensions of the pelvis. Age and sex characteristics. 52. Hip joint. The structure, biomechanics of movement. 17. Knee joint, structure, biomechanics of movement. 18. The joints of the foot, the foot as a whole. X-ray anatomy of bones and joints. Situational problems 1. X-ray examination revealed the child's cervical rib. Determine this state: A. Norm B. Development options *C. Pathology D. Tumor E. No correct answer 2. Because the fracture of the ribs was injured anterior scalene muscle. What is the rib? A. The third B. The fifth C. The tenth *D. The first E. The second 3. Because of trauma, the patient got fracture of the coracoid process. What bone damaged? A. The 1st rib. B. Collarbone. C. Sacrum. D. The cervical vertebra. *E. Scapula. 4. Because of an accident injure, the patient got the damage near the handle (manubrium) sternum. On palpation: tenderness, swelling. Damage to any of these ribs were perhaps. *A. I, II ribs B. X-XII ribs C. IX-XII ribs D. III, IV, V ribs D. IV rib 5. Because of trauma, patient suffered from the broken rib, which was accompanied by bleeding from the subclavian artery. What rib was damaged? A. II *B. I C. III D. IV E. V 6. After a fall from a height a casualty is diagnosed a compression fracture of lumbar vertebra. The curvature of lumbar lordosis has sharply increased. Injury of what ligaments can cause such change of vertebral column curvature? A. Intertraverse. B. Posterior longitudinal. *C. Anterior longitudinal. D. Supraspinal. E. Yellow. 7. The patient was admitted to the Surgery Department with a dislocation of the temporomandibular joint. The general ligament, which reinforces the temporomandibular joint, was damaged. Name this ligament. A. Mandibular B. Sphenomandibular *C. Lateral D. Stylomandibular E. Medial 8. After being released from a dam in the victim marked depression of consciousness, there are many cuts on her head and neck, small wounds on his face and a fracture of the temporomandibular joint. What bones can be damaged? *A. The mandible and the temporal bone B. The sphenoid bone and the mandible C. The frontal bone and nasal bones D. The temporal bone and the maxilla E. The zygomatic bone and the lacrimal bone 9. A gynecologist dimensioned the pelvis of a 29-year-old pregnant woman. The distance between two anterior superior iliac spines was measured with the help of a pelvimeter. What size of the large pelvis was dimensioned? A. Intertrochanteric distance. B. Intercristal distance. *C. Interspinous distance. D. True conjugate. E. Anatomical conjugate. 8. Tasks for self-check 1. Thematical tables. 2. The human skeleton. 3. Educational literature, methodical guidance for the lecture. 9. Materials for the next lecture (key issues) Next lecture topic: «General myology. The theoretical background to the study of the muscular system. Muscle as an organ. Accessory structures of the muscle. Morphological bases of the contractile function of the muscles and the analysis of their motor impact on the skeleton». Questions: 1. General characteristic of the muscular system. 2. Topography of the head. 3. Muscles of the head. 4. Fascia of the cranial vault. 10. References: The basic literature 1. Human Anatomy. In three volumes. Volume 1 / Edited by V.G. Koveshnikov. - Lugansk: LTD «Virtualnaya realnost», 2009. – 328p. 2. Human Anatomy. In three volumes. Volume 2 / Edited by V.G. Koveshnikov. - Lugansk: LTD «Virtualnaya realnost», 2008. – 248p. 3. Human Anatomy. In three volumes. Volume 3 / Edited by V.G. Koveshnikov. - Lugansk: LTD «Virtualnaya realnost», 2009. - 384p. 4. Gray's anatomy for students / Richard L. Drake, A. Wayne Vogl, and Adam W. M. Mitchell; illustrations by Richard M. Tibbitts and Paul E. Richardson; photographs by Ansell Horn. - 2nd ed. 2012- 1103p. 5. Sobotta Atlas of Human Anatomy / Edited by R. Putz and R. Pabst, 14th ed. - Elsevier GmbH, Munich, 2008 . - 895p. 6. Clay JH, Pounds DM. Basic Clinical Massage Therapy: Integrating Anatomy and Treatment. 2003. 7. Grant's atlas of anatomy/Anne M.R. Agur, Arthur F. Dailey II, 14th ed. - Baltimore: Wolters Kluver, 2017. - 864 p. 8. Martini Frederic H. Martini's atlas of the human body, 8th ed. - Pearson Education, 2009. - 250p. 9. Atlas of Human Anatomy / Frank H. Netter; 7nd ed. // Elsevier Inc, 2019. - 548p. 10.Human Anatomy: textbook / Cherkasov V.G., Herasymiuk I.Ye., Holovatskyi A.S., Kovalchuk O.I. [et al.]. - Vinnytsia Nova Knyha, 2018. - 464 p. The additional literature 1. Beck F. Human embryology: 2 ed / F. Beck, D. Mossat, D. Davies. - Oxford: Blackwell, 1985. - V. 11. - 372p. 2. Moore Keith L. Clinically oriented anatomy: third ed / Keith L. Moore. - 1992. - 917p. 3. Clinical Anatomy. Applied anatomy for clinical students and junior doctors: eleventh edition / Harold Ellis // Oxford, UK: Blackwell publishing. - 2006. - 455p. 4. Pocket atlas of Human Anatomy / Heinz Feneis, Wolfgang Dauber // Thieme, Stuttgart. - 2000. — 5 Юр. Information resources 1. http://www.umsa.edu.ua/kafhome/anatomy/kaf_anatomy_download.html 2. http://anatom.ua/basis/ukr/ 3. http://anatom.ua/basis/rus/ Electronic educational resources 1. Human Anatomy. In three volumes. Volume 1 [educational resources] / edited by V. G. Koveshnikov. - Lugansk: «Шико» TOB «Віртуальна реальність», 2006. - 328 p. https://www.twirpx.com/file/1763162/ 2. Human Anatomy. In three volumes. Volume 2 [educational resources] / edited by V. G. Koveshnikov. - Lugansk: «Шико» TOB «Віртуальна реальність», 2006. - 248 p. https://www.twirpx.eom/file/l 763164/ 3. Human Anatomy. In three volumes. Volume 3 [educational resources] / edited by V. G. Koveshnikov. - Lugansk: «Шико» TOB «Віртуальна реальність», 2006. - 384 p. https://www.twirpx.eom/file/l 763169/ 4. For English-speaking students: a. https://www.umsa.edu.ua/fakultets/stomat/kafedry/anatomiy/resources/navchal ni- materiali-dlya-studentiv-medichnogo-fakultetu b. https://www.umsa.edu.ua/fakultets/stomat/kafedry/anatomiy/resources/uchbovi -materiali-dlya- studentiv-stomatologichnogo-fakultetu-al

The methodical guidance has been compiled by N.L. Svinthythka, Associate Professor at the Department of Human Anatomy, PhD in Medicine, Associate Professor