MINISTRY OF PUBLIC HEALTH OF UKRAINE Ukranian Medical Stomatological Academy

"Approved" at the meeting of the Department of Human Anatomy «29»_08_2020 Minutes №1 Head of the Department Professor O.O. Sherstjuk ______

METHODICAL GUIDANCE for students' self-directed work at practical sessions (when preparing for and during the practical sessions)

Academic subject Human Anatomy Module №1 "Anatomy of the locomotor system. Splanchnology. Endocrine glands" Year of study І Faculty foreign students' training faculty, specialty «Stomatology»

Poltava 2020 Schedule of classes for students of foreign students' training faculty, specialty “Stomatology” on module №1 “The locomotor system. Splanchnology. Endocrine glands”

Hours № Topic 10 Bones of the facial skull: lacrimal, nasal bones, vomer, 2 zygomatic, palatine bones, concha nasalis inferior. 11 Topography of the cavities of the skull: orbit, oral and nasal 2 cavities, paranasal sinuses, their connections. 12 Cranial vault and basis of the skull. Cranial fossae. 2 13 Temporal, infratemporal, pterygo-palatine fossae, its borders, 2 connections. Skull as whole. Conterforces of the skull. 14 Syndesmology. Structure and classification of articulations. 2 Connections of the vertebral column. Vertebral column as a whole. The curvatures of the vertebral column. 15 Connections of the bones of the skull, connection of the skull 2 with vertebral column. Temporo-mandibular . Structure, biomechanics of movement. Age and sexual differences in the skull. Radioanatomy of the skull. Craniometry. 16 Connections of the bones of the . Connections 2 of the bones of the free upper extremity. 17 Connections of the bones of the pelvis. Pelvis as whole. 2 Connections of the bones of the free lower extremity. Radioanatomy of the bones and its connections. 18 Content module «Osteology. Craniology. Syndesmology». 2 Step-1. Topic 10. Bones of the facial skull: lacrimal, nasal bones, vomer, zygomatic, palatine bones, concha nasalis inferior. 1. Relevance of the topic. Bones of facial skull are an initial sections of the respiratory and digestive systems. They form the skeleton of the face. The specific aims. 2.1.To have general knowledge of the topic studied; 2.2. To understand, to remember and to use the knowledge received; 2.3. To form the professional experience by reviewing, training and authorizing it; 2.4. To be able to find and show studying structures on visual aids. 3. Basic knowledge and skills necessary for study the topic (interdisciplinary integration) The preceding The acquired knowledge subjects Biology Describe the structural features of the skull bones. To find studying structures on the skull. 4. Tasks for students' individual work. 4.1. The list of basic terms, parameters, characteristics which the student should master while preparing for the class. The horizontal plate – lamina horizontalis, greater palatine foramen – foramen palatinum majus, the perpendicular plate – lamina perpendicularis, sphenopalatine notch – incisura sphenopalatina, greater palatine groove – sulcus palatinus major, frontal process – processus frontalis. 4.2. Theoretical Questions: 1. What are the main part of the palatine bone? 2. Name paired bones of the facial skull. 3. What are the main parts of the lacrimal bone? 4. What are the bones of facial skull with pneumatic sinuses? 5. What are the anomalies of the facial bone skull? 6. What processes does the zygomatic bone have? 4.3. Practical tasks pertaining to the topic and to be completed during the class: the bones, schemes, models, structure and features of the skull bones. Content topics classes. The skull is supported on the summit of the vertebral column, and is of an oval shape, wider behind than in front. It is composed of a series of flattened or irregular bones which, with one exception (the mandible), are immovably jointed together. It is divisible into two parts: (1) the cranium, which lodges and protects the brain, consists of eight bones, and (2) the skeleton of the face, of fourteen, as follows: The facial skeleton is composed of 14 bones. Paired Unpaired 1. Maxilla 1. Mandible 2. Zygomatic 2. Vomer 3. Nasal 4. Lacrimal 5. Palatine 6. Inferior nasal concha. The nasal bones (os nasale) are two small bones, varying in size and form in different individuals; they are placed side by side at the middle and upper part of the face, and form, by their junction, “the bridge” of the nose. The lacrimal bone (os lacrimale), the smallest and most fragile bone of the face, is situated at the front part of the medial wall of the orbit. The zygomatic bone (os zygomaticum) is small and quadrangular, and is situated at the upper and lateral part of the face: it forms the prominence of the cheek, part of the lateral wall and floor of the orbit, and parts of the temporal and infratemporal fossae. It presents a malar and a temporal surface; four processes, the frontosphenoidal, orbital, maxillary, and temporal; and four borders. Surfaces. The lateral (malar) surface is convex and perforated near its center by a small aperture, the zygomaticofacial foramen, for the passage of the zygomaticofacial nerve and vessels; below this foramen is a slight elevation, which gives origin to the Zygomaticus. The temporal surface, directed backward and medialward, is concave, presenting medially a rough, triangular area, for articulation with the maxilla, and laterally a smooth, concave surface, the upper part of which forms the anterior boundary of the temporal fossa, the lower a part of the infratemporal fossa. Near the center of this surface is the zygomaticotemporal foramen for the transmission of the zygomaticotemporal nerve. Processes. The frontosphenoidal process is thick and serrated, and articulates with the zygomatic process of the frontal bone. On its orbital surface, just within the orbital margin and about 11 mm. below the zygomaticofrontal suture is a tubercle of varying size and form, but present in 95 per cent. of skulls. The orbital process is a thick, strong plate, projecting backward and medialward from the orbital margin. Its antero-medial surface forms, by its junction with the orbital surface of the maxilla and with the great wing of the sphenoid, part of the floor and lateral wall of the orbit. On it are seen the orifices of two canals, the zygomaticoцrbital foramina; one of these canals opens into the temporal fossa, the other on the malar surface of the bone; the former transmits the zygomaticotemporal, the latter the zygomaticofacial nerve. Its postero-lateral surface, smooth and convex, forms parts of the temporal and infratemporal fossae. Its anterior margin, smooth and rounded, is part of the circumference of the orbit. Its superior margin, rough, and directed horizontally, articulates with the frontal bone behind the zygomatic process. Its posterior margin is serrated for articulation, with the great wing of the sphenoid and the orbital surface of the maxilla. At the angle of junction of the sphenoidal and maxillary portions, a short, concave, non-articular part is generally seen; this forms the anterior boundary of the inferior orbital fissure: occasionally, this non-articular part is absent, the fissure then being completed by the junction of the maxilla and sphenoid, or by the interposition of a small sutural bone in the angular interval between them. The maxillary process presents a rough, triangular surface which articulates with the maxilla. The temporal process, long, narrow, and serrated, articulates with the zygomatic process of the temporal. The palatine bone (os palatinum) is situated at the back part of the nasal cavity between the maxilla and the pterygoid process of the sphenoid. It contributes to the walls of three cavities: the floor and lateral wall of the nasal cavity, the roof of the mouth, and the floor of the orbit; it enters into the formation of two fossae, the pterygopalatine and pterygoid fossae; and one fissure, the inferior orbital fissure. The palatine bone somewhat resembles the letter L, and consists of a horizontal and a vertical part and three outstanding processes—viz., the pyramidal process, which is directed backward and lateralward from the junction of the two parts, and the orbital and sphenoidal processes, which surmount the vertical part, and are separated by a deep notch, the sphenopalatine notch. The Horizontal Part (pars horizontalis; horizontal plate). The horizontal part is quadrilateral, and has two surfaces and four borders. The Vertical Part (pars perpendicularis; perpendicular plate). The vertical part is thin, of an oblong form, and presents two surfaces and four borders. The hyoid bone is shaped like a horseshoe, and is suspended from the tips of the styloid processes of the temporal bones by the stylohyoid . It consists of five segments, viz., a body, two greater cornua, and two lesser cornua. Materials for self-check: A. Materials for the self-check: the bones, schemes, models, structure and features of the skull bones. B. Situational tasks. 1. What processes does the palatine bone have? A. Frontal, temporal B. Alveolar, palatine, frontal C. Alveolar, palatine, frontal, zygomatic D. Anterior, nasal, orbital, infratemporal E. Pyramidal, orbital, sphenoidal 2. Which surfaces does the zygomatic bone have? A. Lateral, temporal, orbital B. Alveolar, palatine, frontal C. Alveolar, palatine, frontal, zygomatic D. Anterior, nasal, orbital, infratemporal E. Pyramidal, orbital, sphenoidal 3. What processes does the zygomatic bone have? A. Frontal, temporal B. Alveolar, palatine, frontal C. Alveolar, palatine, frontal, zygomatic D. Anterior, nasal, orbital, infratemporal E. Pyramidal, orbital, sphenoidal 4. What plates does the palatine bone have? A. Frontal, temporal B. Alveolar, palatine, frontal C. Perpendicular, horizontal D. Anterior, nasal, orbital, infratemporal E. Pyramidal, orbital, sphenoidal 5. After collision of two cars, a driver got deformation of the palatine bone in the area of the greater palatine foramen. What part of the palatine bone can be injured? A. Greater horn B. Horizontal plate C. Perpendicular plate D. Lesser horn E. Body 6. After collision of two cars, a driver got deformation of the palatine bone in the area of the sphenopalatine notch. What part of the palatine bone can be injured? A. Greater horn B. Horizontal plate C. Perpendicular plate D. Lesser horn E. Body 7. After collision of two cars, a victim got destruction of the palatine bone in the area of the pyramidal process. What part of the palatine bone can be damaged? A. Greater horn B. Horizontal plate C. Perpendicular plate D. Lesser horn E. Body 8. After collision of two cars, a victim got destruction of the palatine bone in the area of the orbital process. What part of the palatine bone can be damaged? A. Greater horn B. Horizontal plate C. Perpendicular plate D. Lesser horn E. Body 9. What anatomical structure of the palatine bone serves as an attachment for the lower nasal concha? A. Dental alveoli B. Conchal crest C. Alveolar yokes D. Interalveolar septa E. Nasal crest 10. What anatomical structure of the palatine bone serves as an attachment for the middle nasal concha? A. Dental alveoli B. Ethmoidal crest C. Alveolar yokes D. Interalveolar septa E. Nasal crest References The basic 1. Human Anatomy. In three volumes. Volume 1 / Edited by V.G. Koveshnikov. - Lugansk: LTD «Virtualnaya realnost», 2009. – 328p. 2. 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. 3. Sobotta Atlas of Human Anatomy / Edited by R. Putz and R. Pabst, 14th ed. – Elsevier GmbH, Munich, 2008 . – 895p. 4. Clay JH, Pounds DM. Basic Clinical Massage Therapy: Integrating Anatomy and Treatment. 2003. 5. Grant′s atlas of anatomy ∕ Anne M.R., Arthur F. Dalley II, 12th ed. - Baltimore: Wiliams & Wolters, 2009. – 864 p. 6. Martini Frederic H. Martini′s atlas of the human body, 8th ed. – Pearson Education, 2009. – 250p. 7. Atlas of Human Anatomy / Frank H. Netter, M.D. Arthur F. Dalley; 2nd ed. // ILS, Medimedia USA Company, 1997. – 548p. Additional 1. Langman J. Medical embryology / Langman J. – Baltimore, London, 1981. – 384p. 2. Crouse G.S. Development of the female urogenital system / G.S. Crouse // Semin. Reprod. Endocrinol. – 1986. – V.4, №1. – P. 1-11. 3. Beck F. Human embryology: 2 ed / F. Beck, D. Mossat, D. Davies. - Oxford: Blackwell, 1985. – V. 11. – 372p. 4. Moore Keith L. Clinically oriented anatomy: third ed / Keith L. Moore. – 1992. - 917p. 5. Clinical Anatomy. Applied anatomy for clinical students and junior doctors: eleventh edition / Harold Ellis // Oxford, UK: Blackwell publishing. – 2006. – 455p. 6. Pocket atlas of Human Anatomy / Heinz Feneis, Wolfgang Dauber // Thieme, Stuttgart. – 2000. – 510p. 7. https://human.biodigital.com/ 8. http://anatom.ua/nomina-anatomica/

Topic 11. Topography of the cavities of the skull: orbit, oral and nasal cavities, paranasal sinuses, their connections. 1. Relevance of the topic. Knowledge of the structure of the bone palate and skull sockets required physicians of all specialties. Inflammatory processes in the paranasal sinuses spread through certain anatomical lesions on the dura mater of the brain, vascular nerve bundles. A clear understanding of the spatial arrangement of the bones that form the wall of the nasal cavity and orbit makes it possible to learn the ropes with injuries of the skull, eye removed foreign bodies and flaws. 2. The specific aims. 2.1.To have general knowledge of the topic studied; 2.2. To understand, to remember and to use the knowledge received; 2.3. To form the professional experience by reviewing, training and authorizing it; 2.4. To be able to find and show studying structures on visual aids. 3. Basic knowledge and skills necessary for study the topic (interdisciplinary integration) 3. Basic knowledge, skills necessary for studying the subject (interdisciplinary integration) The preceding The acquired knowledge subjects Biology Describe the structural features of the skull bones. To find studying structures on the skull. 4. Tasks for students' individual work. 4.1. The list of basic terms, parameters, characteristics which the student should master while preparing for the class. Orbital opening – aditus orbitae, fossa for lacrimal gland – fossa glandulae lacrimalis, fossa for lacrimal sac – fossa sacci lacrimalis, the bony nasal cavity – cavitas nasalis ossea, the bony nasal septum – septum nasi osseum, superior wall – paries superior, orbit – orbita. 4.2. Theoretical questions for the class: 1. Name the walls of the orbit. 2. Name the communications of the orbit. 3. What structures form: 1) the superior nasal wall, 2) the lateral nasal wall, 3) the inferior nasal wall? 4. What structures form the bony nasal septum? 5. What formations open into the: 1) superior nasal meatus, 2) middle nasal meatus, 3) inferior nasal meatus? 4.3. Practical tasks pertaining to the topic and to be completed during the class: the bones, schemes, models, structure and characteristics of the cranial cavity. The content of the topic. The Orbits (orbitae). The orbits are two quadrilateral pyramidal cavities, situated at the upper and anterior part of the face, their bases being directed forward and lateralward, and their apices backward and medialward, so that their long axes, if continued backward, would meet over the body of the sphenoid. Each presents for examination a roof, a floor, a medial and a lateral wall, a base, and an apex. The roof is concave, directed downward, and slightly forward, and formed in front by the orbital plate of the frontal; behind by the small wing of the sphenoid. It presents medially the trochlear fovea for the attachment of the cartilaginous pulley of the Obliquus oculi superior; laterally, the lacrimal fossa for the lacrimal gland; and posteriorly, the suture between the frontal bone and the small wing of the sphenoid. The floor is directed upward and lateralward, and is of less extent than the roof; it is formed chiefly by the orbital surface of the maxilla; in front and laterally, by the orbital process of the zygomatic bone, and behind and medially, to a small extent, by the orbital process of the palatine. At its medial angle is the upper opening of the nasolacrimal canal, immediately to the lateral side of which is a depression for the origin of the Obliquus oculi inferior. The medial wall is nearly vertical, and is formed from before backward by the frontal process of the maxilla, the lacrimal, the lamina of the ethmoid, and a small part of the body of the sphenoid in front of the optic foramen. The lateral wall, directed medialward and forward, is formed by the orbital process of the zygomatic and the orbital surface of the great wing of the sphenoid. The base of the orbit, quadrilateral in shape, is formed above by the supraorbital arch of the frontal bone, in which is the supraorbital notch or foramen for the passage of the supraorbital vessels and nerve; below by the zygomatic bone and maxilla, united by the zygomaticomaxillary suture; laterally by the zygomatic bone and the zygomatic process of the frontal joined by the zygomaticofrontal suture; medially by the frontal bone and the frontal process of the maxilla united by the frontomaxillary suture. The Nasal Cavity (cavum nasi; nasal fossa). The nasal cavities are two irregular spaces, situated one on either side of the middle line of the face, extending from the base of the cranium to the roof of the mouth, and separated from each other by a thin vertical septum. They open on the face through the pear-shaped anterior nasal aperture, and their posterior openings or choanae communicate, in the fresh state, with the nasal part of the pharynx. They are much narrower above than below, and in the middle than at their anterior or posterior openings: their depth, which is considerable, is greatest in the middle. They communicate with the frontal, ethmoidal, sphenoidal, and maxillary sinuses. Each cavity is bounded by a roof, a floor, a medial and a lateral wall. The passageways, which occupy spaces between the nasal conchae, are called nasal meatuses. There are three of them: - superior nasal meatus (meatus nasi superior) lies between the superior and middle nasal conchae; posterior ethmoidal cells and the sphenoidal sinus (slightly higher) open into this meatus; - middle nasal meatus (meatus nasi medius) resides between the middle and interior nasal conchae; the frontal and maxillary sinuses as well as the anterior and middle ethmoidal cells open into middle meatus; - inferior nasal meatus (meatus nasi inferior) lies below the inferior nasal concha; the nasolacrimal canal, canal is nasolacrimalis, opens into this meatus. The air-filled cavities of the sphenoid, frontal, and ethmoid bones as well as the maxillary sinus are called the paranasal sinuses. The choanae are each bounded above by the under surface of the body of the sphenoid and ala of the vomer; below, by the posterior border of the horizontal part of the palatine bone; laterally, by the medial pterygoid plate; they are separated from each other by the posterior border of the vomer. Materials for the self-check: A. Materials for the self-check: the bones, schemes, models, structure and features of the skull bones. B. Situational tasks. 1. Purulence of orbit soft tissues took place after an eye′s trauma. Through what anatomical formation can the purulent process spread to the middle cranial fossa? A. Through the anterior ethmoidal foramen. B. Through the posterior ethmoidal foramen. C. Through the superior orbital fissure. D. Through the inferior orbital fissure. E. Through the zygomaticoorbital foramen. 2. Chronic rhinitis is complicated with the signs of maxillary sinus mucous tunic affection (maxillary sinusitis). Through what nasal cavity formation has the infection spread? A. Ethmoidal infundibulum. B. Sphenoethmoidal recess. C. Sphenopalatine foramen. D. Maxillary hiatus. E. Ethmoid cells. 3. During the first days of a newborn child, a pediatrician detected that milk gets into the child's nasal cavity. What malformation does this fact indicate? A. Esophagus constriction. B. Diverticulum of esophagus. C. Esophageal atresia. D. Cleft clip. E. Non-closed palate. 4. During a meal milk gets into the nasal cavity of a newborn child. What is the probable cause of this pathology? A. Cleft palate. B. Nasal septum deviation to the right. C. Basal skull fracture. D. Cleft clip. E. Nasal septum deviation to the left. 5. Purulence of orbit soft tissues took place after an eye’s trauma. Through what anatomical formation can the purulent process spread to the pterygopalatine fossa? A. Through the round foramen. B. Through the inferior orbital fissure. C. Through the pterygoid canal. D. Through the superior orbital fissure E. Through the zygomaticoorbital foramen. 6. A sick has an acute inflammation of nasolacrimal duct mucous membrane. It is known that after influenza nasal discharges had been observed for a long time. From what part of the nasal cavity could the infection get to the nasolacrimal duct? A. Superior nasal meatus. B. Middle nasal meatus. C. Inferior nasal meatus. D. Common nasal meatus. E. Sphenoethmoidal recess. 7. A patient has a suppurative inflammation of the sphenoid sinus. What part of the nasal cavity does the pus flow out into? A. Meatus nasi inferior. B. Meatus nasi communis. C. Meatus nasi medius. D. Meatus nasi superior. E. Infundibulum. 8. A patient has a suppurative inflammation of the middle ethmoidal cells. What part of the nasal cavity does the pus flow out into? A. Meatus nasi inferior. B. Meatus nasi medius. C. Meatus nasi communis. D. Meatus nasi superior. E. Infundibulum. 9. A patient has a suppurative inflammation of the posterior ethmoidal cells. What part of the nasal cavity does the pus flow out into? A. Meatus nasi inferior. B. Meatus nasi medius. C. Meatus nasi communis. D. Meatus nasi superior. E. Infundibulum. 10. A patient has a suppurative inflammation of the frontal sinus. What part of the nasal cavity does the pus flow out into? A. Meatus nasi inferior. B. Meatus nasi medius. C. Meatus nasi communis. D. Meatus nasi superior. E. Infundibulum. References The basic 1. Human Anatomy. In three volumes. Volume 1 / Edited by V.G. Koveshnikov. - Lugansk: LTD «Virtualnaya realnost», 2009. – 328p. 2. 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. 3. Sobotta Atlas of Human Anatomy / Edited by R. Putz and R. Pabst, 14th ed. – Elsevier GmbH, Munich, 2008 . – 895p. 4. Clay JH, Pounds DM. Basic Clinical Massage Therapy: Integrating Anatomy and Treatment. 2003. 5. Grant′s atlas of anatomy ∕ Anne M.R., Arthur F. Dalley II, 12th ed. - Baltimore: Wiliams & Wolters, 2009. – 864 p. 6. Martini Frederic H. Martini′s atlas of the human body, 8th ed. – Pearson Education, 2009. – 250p. 7. Atlas of Human Anatomy / Frank H. Netter, M.D. Arthur F. Dalley; 2nd ed. // ILS, Medimedia USA Company, 1997. – 548p. Additional 1. Langman J. Medical embryology / Langman J. – Baltimore, London, 1981. – 384p. 2. Crouse G.S. Development of the female urogenital system / G.S. Crouse // Semin. Reprod. Endocrinol. – 1986. – V.4, №1. – P. 1-11. 3. Beck F. Human embryology: 2 ed / F. Beck, D. Mossat, D. Davies. - Oxford: Blackwell, 1985. – V. 11. – 372p. 4. Moore Keith L. Clinically oriented anatomy: third ed / Keith L. Moore. – 1992. - 917p. 5. Clinical Anatomy. Applied anatomy for clinical students and junior doctors: eleventh edition / Harold Ellis // Oxford, UK: Blackwell publishing. – 2006. – 455p. 6. Pocket atlas of Human Anatomy / Heinz Feneis, Wolfgang Dauber // Thieme, Stuttgart. – 2000. – 510p. 7. https://human.biodigital.com/ 8. http://anatom.ua/nomina-anatomica/

Topic 12. Cranial vault and basis of the skull. Cranial fossae. 1. Relevance of the topic. Skull as a whole is a skeleton for the brain, sensory organs, initial parts of digestive and respiratory systems. Trough the base of the skull come nerves and vessels. 2. The specific aims. 2.1.To have general knowledge of the topic studied; 2.2. To understand, to remember and to use the knowledge received; 2.3. To form the professional experience by reviewing, training and authorizing it; 2.4. To be able to find and show studying structures on visual aids. 3. Basic knowledge and skills necessary for study the topic (interdisciplinary integration) The preceding The acquired knowledge subjects Biology Describe the structural features of the skull bones. To find studying structures on the skull. 4. Tasks for students' individual work. 4.1. The list of basic terms, parameters, characteristics which the student should master while preparing for the class. The anterior cranial fossa - fossa anterior cranii; cecum foramen - foramen cecum; cribriform plate - lamina cribrosa; middle cranial fossa - fossa cranii media; optic canal - canalis opticus; superior orbital fissure - fissura orbitalis superior; carotid groove - sulcus caroticus; Turkish saddle - sella tursica; pituitary fossa - fossa hypophysialis. 4.2. Theoretical questions: 1. The structure of the cranial fossae, their parts, borders. 2. Formation of the cranial vault. 3. The formation of the external surface of the skull base. 4. The formation of the internal surface of the skull base. 5. Name the borders of the anterior, middle and posterior cranial fossaea. 4.3. Practical tasks pertaining to the topic and to be completed during the class: the bones, schemes, models, structure and features of the skull bones. The content of the topic. The inferior surface of the base of the skull, exclusive of the mandible, is bounded in front by the incisor teeth in the maxillae; behind, by the superior nuchal lines of the occipital; and laterally by the alveolar arch, the lower border of the zygomatic bone, the zygomatic arch and an imaginary line extending from it to the mastoid process and extremity of the superior nuchal line of the occipital. It is formed by the palatine processes of the maxillae and palatine bones, the vomer, the pterygoid processes, the under surfaces of the great wings, spinous processes, and part of the body of the sphenoid, the under surfaces of the squamae and mastoid and petrous portions of the temporals, and the under surface of the occipital bone. The anterior part or hard palate projects below the level of the rest of the surface, and is bounded in front and laterally by the alveolar arch containing the sixteen teeth of the maxillae. Upper Surface of the Base of the Skull. The upper surface of the base of the skull or floor of the cranial cavity presents three fossae, called the anterior, middle, and posterior cranial fossae. Anterior Fossa (fossa cranii anterior). The floor of the anterior fossa is formed by the orbital plates of the frontal, the cribriform plate of the ethmoid, and the small wings and front part of the body of the sphenoid; it is limited behind by the posterior borders of the small wings of the sphenoid and by the anterior margin of the chiasmatic groove. The Middle Fossa (fossa cranii media). The middle fossa, deeper than the preceding, is narrow in the middle, and wide at the sides of the skull. It is bounded in front by the posterior margins of the small wings of the sphenoid, the anterior clinoid processes, and the ridge forming the anterior margin of the chiasmatic groove; behind, by the superior angles of the petrous portions of the temporals and the dorsum sellae; laterally by the temporal squamae, sphenoidal angles of the parietals, and great wings of the sphenoid. The Posterior Fossa (fossa cranii posterior). The posterior fossa is the largest and deepest of the three. It is formed by the dorsum sellae and clivus of the sphenoid, the occipital, the petrous and mastoid portions of the temporals, and the mastoid angles of the parietal bones; it is crossed by the occipitomastoid and the parietomastoid sutures, and lodges the cerebellum, pons, and medulla oblongata. It is separated from the middle fossa in and near the median line by the dorsum sellae of the sphenoid and on either side by the superior angle of the petrous portion of the temporal bone. Materials for self-check: A. Materials for the self-check: the bones, schemes, models, structure and features of the skull bones. B. Situational tasks. 1. Patient admitted to hospital with an injury of the base of the skull. On the radiological investigation in a patient was diagnosed destruction and increase of the hypophyseal fossa. What anatomical structure will be damaged? A. Optic canal B. Foramen rotundum C. Pterygoid canal D. Superior orbital fissure E. Sphenoidal sinus 2. On the radiological investigation in a patient was diagnosed increase of the Turkish saddle's cavity, destruction of the different part of the hypophyseal fossa and anterior clinoid processes. What endocrine gland is damaged? A. The pituitary gland (hypophysis) B. Epiphysis C. Suprarenal gland D. Thyroid gland E. Parathyroid gland 3. A casualty has a fracture of the base of the skull. Line of the injure passed through Prechiasmatic sulcus and carotid sulcus. What part of the sphenoid bone is damaged? A. Greater wing B. Body C. Lesser wing D. Pterygoid process E. Posterior clinoid process 4. After collision of two cars, a victim got destruction of the temporal bone in the area of the stylomastoid foramen. What part of the temporal bone can be injured? A. Body B. Tympanic C. Petrous D. Squamous E. Mastoid process 5. After collision of two cars, a victim got destruction of the temporal bone in the area of the jugular fossa. What part of the temporal bone can be injured? A. Body B. Tympanic C. Petrous D. Squamous E. Mastoid process 6. After collision of two cars, a victim got destruction of the temporal bone in the area of the jugular notch. What part of the temporal bone can be injured? A. Body B. Tympanic C. Petrous D. Squamous E. Mastoid process 7. After collision of two cars, a victim got destruction of the temporal bone in the area of the carotid canal. What part of the temporal bone can be injured? A. Body B. Tympanic C. Petrous D. Squamous E. Mastoid process 8. After collision of two cars, a victim got destruction of the temporal bone in the area of the petrosal fossula. What part of the temporal bone can be injured? A. Body B. Tympanic C. Petrous D. Squamous E. Mastoid process 9. After collision of two cars, a victim got destruction of the temporal bone in the area of the musculotubal canal. What part of the temporal bone can be injured? A. Body B. Tympanic C. Petrous D. Squamous E. Mastoid process 10. After collision of two cars, a victim got destruction in the area of the musculotubal canal. What bone can be damaged? A. Occipital B. Temporal C. Parietal D. Frontal E. Sphenoid References The basic 1. Human Anatomy. In three volumes. Volume 1 / Edited by V.G. Koveshnikov. - Lugansk: LTD «Virtualnaya realnost», 2009. – 328p. 2. 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. 3. Sobotta Atlas of Human Anatomy / Edited by R. Putz and R. Pabst, 14th ed. – Elsevier GmbH, Munich, 2008 . – 895p. 4. Clay JH, Pounds DM. Basic Clinical Massage Therapy: Integrating Anatomy and Treatment. 2003. 5. Grant′s atlas of anatomy ∕ Anne M.R., Arthur F. Dalley II, 12th ed. - Baltimore: Wiliams & Wolters, 2009. – 864 p. 6. Martini Frederic H. Martini′s atlas of the human body, 8th ed. – Pearson Education, 2009. – 250p. 7. Atlas of Human Anatomy / Frank H. Netter, M.D. Arthur F. Dalley; 2nd ed. // ILS, Medimedia USA Company, 1997. – 548p. Additional 1. Langman J. Medical embryology / Langman J. – Baltimore, London, 1981. – 384p. 2. Crouse G.S. Development of the female urogenital system / G.S. Crouse // Semin. Reprod. Endocrinol. – 1986. – V.4, №1. – P. 1-11. 3. Beck F. Human embryology: 2 ed / F. Beck, D. Mossat, D. Davies. - Oxford: Blackwell, 1985. – V. 11. – 372p. 4. Moore Keith L. Clinically oriented anatomy: third ed / Keith L. Moore. – 1992. - 917p. 5. Clinical Anatomy. Applied anatomy for clinical students and junior doctors: eleventh edition / Harold Ellis // Oxford, UK: Blackwell publishing. – 2006. – 455p. 6. Pocket atlas of Human Anatomy / Heinz Feneis, Wolfgang Dauber // Thieme, Stuttgart. – 2000. – 510p. 7. https://human.biodigital.com/ 8. http://anatom.ua/nomina-anatomica/

Topic 13. Temporal, infratemporal, pterygo-palatine fossae, its borders, connections. Skull as whole. Conterforces of the skull. 1. Relevance of the topic. Skull as a whole is a skeleton for the brain, sensory organs, initial parts of digestive and respiratory systems. Trough the base of the skull come nerves and vessels. The specific aims. 2.1.To have general knowledge of the topic studied; 2.2. To understand, to remember and to use the knowledge received; 2.3. To form the professional experience by reviewing, training and authorizing it; 2.4. To be able to find and show studying structures on visual aids. 3. Basic knowledge and skills necessary for study the topic (interdisciplinary integration) The preceding The acquired knowledge subjects Biology Describe the structural features of the skull bones. To find studying structures on the skull. 4. Tasks for students' individual work. 4.1. The list of basic terms, parameters, characteristics which the student should master while preparing for the class. The anterior cranial fossa - fossa anterior cranii; cecum foramen - foramen cecum; cribriform plate - lamina cribrosa; middle cranial fossa - fossa cranii media; optic canal - canalis opticus; superior orbital fissure - fissura orbitalis superior; carotid groove - sulcus caroticus; Turkish saddle - sella tursica; pituitary fossa - fossa hypophysialis. 4.2. Theoretical questions: 1. Name the sutures of the calvaria. 2. The structure of the cranial fossae, their parts, borders. 3. Formation of the cranial vault. 4. The formation of the external surface of the skull base. 5. The formation of the internal surface of the skull base. 6. Name the borders of the anterior, middle and posterior cranial fossaea. 4.3. Practical tasks pertaining to the topic and to be completed during the class: the bones, schemes, models, structure and features of the skull bones. The content of the topic. The skull as a whole may be viewed from different points, and the views so obtained are termed the normae of the skull; thus, it may be examined from above (norma verticalis), from below (norma basalis) – external base of the skull, from the side (norma lateralis), from behind (norma occipitalis), or from the front (norma frontalis). Norma Verticalis. When viewed from above the outline presented varies greatly in different skulls; in some it is more or less oval, in others more nearly circular. The surface is traversed by three sutures, viz.: (1) the coronal sutures, nearly transverse is direction, between the frontal and parietals; (2) the sagittal sutures, medially placed, between the parietal bones, and deeply serrated in its anterior two-thirds; and (3) the upper part of the lambdoidal suture, between the parietals and the occipital. The point of junction of the sagittal and coronal suture is named the bregma, that of the sagittal and lambdoid sutures, the lambda; they indicate respectively the positions of the anterior and posterior fontanelles in the fetal skull. In front is the glabella, and on its lateral aspects are the superciliary arches, and above these the frontal eminences. Norma Lateralis. When viewed from the side the skull is seen to consist of the cranium above and behind, and of the face below and in front. The cranium is somewhat ovoid in shape, but its contour varies in different cases and depends largely on the length and height of the skull and on the degree of prominence of the superciliary arches and frontal eminences. Entering into its formation are the frontal, the parietal, the occipital, the temporal, and the great wing of the sphenoid. The point of meeting of the parietomastoid, occipitomastoid, and lambdoidal sutures is known as the asterion. Norma Occipitalis. When viewed from behind the cranium presents a more or less circular outline. In the middle line is the posterior part of the sagittal suture connecting the parietal bones; extending downward and lateralward from the hinder end of the sagittal suture is the deeply serrated lambdoidal suture joining the parietals to the occipital and continuous below with the parietomastoid and occipitomastoid sutures. Norma Frontalis. When viewed from the front the skull exhibits a somewhat oval outline, limited above by the frontal bone, below by the body of the mandible, and laterally by the zygomatic bones and the mandibular rami. Inner Surface of the Skull-cap. The inner surface of the skull-cap is concave and presents depressions for the convolutions of the cerebrum, together with numerous furrows for the lodgement of branches of the meningeal vessels. Differences in the Skull Due to Age. At birth the skull is large in proportion to the other parts of the skeleton, but its facial portion is small, and equals only about one-eighth of the bulk of the cranium as compared with one-half in the adult. The frontal and parietal eminences are prominent, and the greatest width of the skull is at the level of the latter; on the other hand, the glabella, superciliary arches, and mastoid processes are not developed. Ossification of the skull bones is not completed, and many of them, e. g., the occipital, temporals, sphenoid, frontal, and mandible, consist of more than one piece. Unossified membranous intervals, termed fontanelles, are seen at the angles of the parietal bones; these fontanelles are six in number: two, an anterior and a posterior, are situated in the middle line, and two, an antero-lateral and a postero-lateral, on either side. The smallness of the face at birth is mainly accounted for by the rudimentary condition of the maxillae and mandible, the non-eruption of the teeth, and the small size of the maxillary air sinuses and nasal cavities. At birth the nasal cavities lie almost entirely between the orbits, and the lower border of the anterior nasal aperture is only a little below the level of the orbital floor. With the eruption of the deciduous teeth there is an enlargement of the face and jaws, and these changes are still more marked after the second dentition. The skull grows rapidly from birth to the seventh year, by which time the foramen magnum and petrous parts of the temporals have reached their full size and the orbital cavities are only a little smaller than those of the adult. Growth is slow from the seventh year until the approach of puberty, when a second period of activity occurs: this results in an increase in all directions, but it is especially marked in the frontal and facial regions, where it is associated with the development of the air sinuses. Obliteration of the sutures of the vault of the skull takes place as age advances. This process may commence between the ages of thirty and forty, and is first seen on the inner surface, and some ten years later on the outer surface of the skull. The dates given are, however, only approximate, as it is impossible to state with anything like accuracy the time at which the sutures are closed. Obliteration usually occurs first in the posterior part of the sagittal suture, next in the coronal, and then in the lambdoidal. In old age the skull generally becomes thinner and lighter, but in a small proportion of cases it increases in thickness and weight, owing to an hypertrophy of the inner table. The most striking feature of the old skull is the diminution in the size of the maxillae and mandible consequent on the loss of the teeth and the absorption of the alveolar processes. This is associated with a marked reduction in the vertical measurement of the face and with an alteration in the angles of the mandible. Sexual Differences in the Skull. Until the age of puberty there is little difference between the skull of the female and that of the male. The skull of an adult female is, as a rule, lighter and smaller, and its cranial capacity about 10 per cent less, than that of the male. Its walls are thinner and its muscular ridges less strongly marked; the glabella, superciliary arches, and mastoid processes are less prominent, and the corresponding air sinuses are small or rudimentary. The upper margin of the orbit is sharp, the forehead vertical, the frontal and parietal eminences prominent, and the vault somewhat flattened. The contour of the face is more rounded, the facial bones are smoother, and the maxillae and mandible and their contained teeth smaller. From what has been said it will be seen that more of the infantile characteristics are retained in the skull of the adult female than in that of the adult male. A well-marked male or female skull can easily be recognized as such, but in some cases the respective characteristics are so indistinct that the determination of the sex may be difficult or impossible. Materials for self-check: A. Materials for the self-check: the bones, schemes, models, structure and features of the skull bones. B. Situational tasks. 1. Patient admitted to hospital with an injury of the base of the skull. On the radiological investigation in a patient was diagnosed destruction and increase of the hypophyseal fossa. What anatomical structure will be damaged? A. Optic canal B. Foramen rotundum C. Pterygoid canal D. Superior orbital fissure E. Sphenoidal sinus 2. On the radiological investigation in a patient was diagnosed increase of the Turkish saddle's cavity, destruction of the different part of the hypophyseal fossa and anterior clinoid processes. What endocrine gland is damaged? A. The pituitary gland (hypophysis) B. Epiphysis C. Suprarenal gland D. Thyroid gland E. Parathyroid gland 3. A casualty has a fracture of the base of the skull. Line of the injure passed through Prechiasmatic sulcus and carotid sulcus. What part of the sphenoid bone is damaged? A. Greater wing B. Body C. Lesser wing D. Pterygoid process E. Posterior clinoid process 4. After collision of two cars, a victim got destruction of the temporal bone in the area of the stylomastoid foramen. What part of the temporal bone can be injured? A. Body B. Tympanic C. Petrous D. Squamous E. Mastoid process 5. After collision of two cars, a victim got destruction of the temporal bone in the area of the jugular fossa. What part of the temporal bone can be injured? A. Body B. Tympanic C. Petrous D. Squamous E. Mastoid process 6. After collision of two cars, a victim got destruction of the temporal bone in the area of the jugular notch. What part of the temporal bone can be injured? A. Body B. Tympanic C. Petrous D. Squamous E. Mastoid process 7. After collision of two cars, a victim got destruction of the temporal bone in the area of the carotid canal. What part of the temporal bone can be injured? A. Body B. Tympanic C. Petrous D. Squamous E. Mastoid process 8. After collision of two cars, a victim got destruction of the temporal bone in the area of the petrosal fossula. What part of the temporal bone can be injured? A. Body B. Tympanic C. Petrous D. Squamous E. Mastoid process 9. After collision of two cars, a victim got destruction of the temporal bone in the area of the musculotubal canal. What part of the temporal bone can be injured? A. Body B. Tympanic C. Petrous D. Squamous E. Mastoid process 10. After collision of two cars, a victim got destruction in the area of the musculotubal canal. What bone can be damaged? A. Occipital B. Temporal C. Parietal D. Frontal E. Sphenoid References The basic 1. Human Anatomy. In three volumes. Volume 1 / Edited by V.G. Koveshnikov. - Lugansk: LTD «Virtualnaya realnost», 2009. – 328p. 2. 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. 3. Sobotta Atlas of Human Anatomy / Edited by R. Putz and R. Pabst, 14th ed. – Elsevier GmbH, Munich, 2008 . – 895p. 4. Clay JH, Pounds DM. Basic Clinical Massage Therapy: Integrating Anatomy and Treatment. 2003. 5. Grant′s atlas of anatomy ∕ Anne M.R., Arthur F. Dalley II, 12th ed. - Baltimore: Wiliams & Wolters, 2009. – 864 p. 6. Martini Frederic H. Martini′s atlas of the human body, 8th ed. – Pearson Education, 2009. – 250p. 7. Atlas of Human Anatomy / Frank H. Netter, M.D. Arthur F. Dalley; 2nd ed. // ILS, Medimedia USA Company, 1997. – 548p. Additional 1. Langman J. Medical embryology / Langman J. – Baltimore, London, 1981. – 384p. 2. Crouse G.S. Development of the female urogenital system / G.S. Crouse // Semin. Reprod. Endocrinol. – 1986. – V.4, №1. – P. 1-11. 3. Beck F. Human embryology: 2 ed / F. Beck, D. Mossat, D. Davies. - Oxford: Blackwell, 1985. – V. 11. – 372p. 4. Moore Keith L. Clinically oriented anatomy: third ed / Keith L. Moore. – 1992. - 917p. 5. Clinical Anatomy. Applied anatomy for clinical students and junior doctors: eleventh edition / Harold Ellis // Oxford, UK: Blackwell publishing. – 2006. – 455p. 6. Pocket atlas of Human Anatomy / Heinz Feneis, Wolfgang Dauber // Thieme, Stuttgart. – 2000. – 510p. 7. https://human.biodigital.com/ 8. http://anatom.ua/nomina-anatomica/

Topic 14. Syndesmology. Structure and classification of articulations. Connections of the vertebral column. Vertebral column as a whole. The curvatures of the vertebral column. 1. Relevance of the topic. The between bones form skeleton as a whole. To know different kinds of joints in different places of the human body it is necessary for studying next topics of human anatomy and other medical sciences. The specific aims. 2.1.To have general knowledge of the topic studied; 2.2. To understand, to remember and to use the knowledge received; 2.3. To form the professional experience by reviewing, training and authorizing it; 2.4. To be able to find and show studying structures on visual aids. 3. Basic knowledge and skills necessary for study the topic (interdisciplinary integration) The preceding The acquired knowledge subjects Biology Describe the types of connections, types of joints, the spine curves. Physics Analyze plane, the possible movements of the joints 4. Tasks for students' individual work. 4.1. The list of basic terms, parameters, characteristics which the student should master while preparing for the class. Continuous connection - ; connections (joints) bone - articulatio; cartilage connection (articulatio cartilaginea) - (synchondrosis); bone connection (articuldtio ossea) - synostosis 4.2. Theoretical questions for the class: 1. Classification of bone joints on the development, structure and function. 2. Classification continuous connections bones. 3. The main elements of the joints. 4.Classification of joints on the number of axes of motion (biomechanical classification). 5. Classification of joints in the form of joint surfaces. 6. Classification of joints in the number of joint surfaces, simple, complicated, complex and combined joints. 7. Scheme of the descriptions of joints. 8. Spine, its departments curves. The functions of the spine, its curves. 4.3. Practical tasks pertaining to the topic and to be completed during the class: the bones, schemes, models to identify compounds of the primary and secondary elements joints, analyze kinds of the vertebral connections. The contents of the topic. 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 synarthrosis: syndesmosis, synchondrosis 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 ligaments. •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. Materials for self-check: A. Tasks for self-check (tables, diagrams): to draw the scheme of classification in note-book, to find different kinds of connection in vertebral column on the visual aid. B. Situational tasks. 1. 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. 2. X-ray examination of a patient has shown a thoracic spine disk herniation. What kind of vertebrae conjugation has undergone pathological changes? A. Syndesmosis. B. Diarthrosis. C. Articulation. D. Synchondrosis. E. Synostosis. 3. A patient 45 years of age with suspected inflammation of the membranes of the brain needed to obtain cerebrospinal fluid. Diagnostic puncture is made between the arcs of the lumbar vertebrae (L3 - L4). Through what a bunch of needle should penetrate into the puncture? A. Intertraverse. B. Posterior longitudinal. C. Anterior longitudinal. D. Supraspinal. E. Yellow. 4. The patient was observed: severe headache, stiff neck muscles, repeated vomiting, pain on percussion of the skull, increased sensitivity to light stimuli. The diagnosis - meningitis. A victim needed in lumbar puncture. Name regions are used for the punctures of the vertebral canal. A. Between the L2 and L3 B. Between the Th12 and L1 C. Between the Th11 and L2 D Between the Th10 and L1 E Between the Th11 and Th12 5. Which of the following types of connections bones is continuous? A. Symphysis. B. Joints. C. Sinovial. D. Syndesmosis. E. Hemiarthroses. 6. Name basic elements of the joint. A. Articular discs, articular cavity, B. Synovial membrane, synovial villi, synovial folds C. Articular discs, articular meniscus, glenoid labrum, intraarticular ligaments D. Articular cartilage, articular capsule, articular cavity, synovial fluid E. Synovial membrane, articular cavity, synovial fluid 7. Specify the accessory elements of the joint. A. Articular discs, articular cavity, synovial fluid B. Synovial membrane, synovial villi, synovial folds C. Synovial membrane, articular cavity, synovial fluid D. Articular cartilage, articular capsule, articular cavity, synovial fluid E. Articular discs, articular meniscus, glenoid labrum, intraarticular ligaments 8. What groups are divided joints in shape of the articular surfaces? A. Saddle. B. Compound. C. Combined. D. Complex. E. Simple. 9. Name movements that occur around the sagittal axis. A. Flexion - extension B. Abduction-adduction C. Rotation D. Circular rotation E. All answers are correct 10. Name movements that occur around the vertical axis. A. Flexion - extension B. Abduction-adduction C. Rotation D. Circular rotation E. All answers are correct References The basic 1. Human Anatomy. In three volumes. Volume 1 / Edited by V.G. Koveshnikov. - Lugansk: LTD «Virtualnaya realnost», 2009. – 328p. 2. 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. 3. Sobotta Atlas of Human Anatomy / Edited by R. Putz and R. Pabst, 14th ed. – Elsevier GmbH, Munich, 2008 . – 895p. 4. Clay JH, Pounds DM. Basic Clinical Massage Therapy: Integrating Anatomy and Treatment. 2003. 5. Grant′s atlas of anatomy ∕ Anne M.R., Arthur F. Dalley II, 12th ed. - Baltimore: Wiliams & Wolters, 2009. – 864 p. 6. Martini Frederic H. Martini′s atlas of the human body, 8th ed. – Pearson Education, 2009. – 250p. 7. Atlas of Human Anatomy / Frank H. Netter, M.D. Arthur F. Dalley; 2nd ed. // ILS, Medimedia USA Company, 1997. – 548p. Additional 1. Langman J. Medical embryology / Langman J. – Baltimore, London, 1981. – 384p. 2. Crouse G.S. Development of the female urogenital system / G.S. Crouse // Semin. Reprod. Endocrinol. – 1986. – V.4, №1. – P. 1-11. 3. Beck F. Human embryology: 2 ed / F. Beck, D. Mossat, D. Davies. - Oxford: Blackwell, 1985. – V. 11. – 372p. 4. Moore Keith L. Clinically oriented anatomy: third ed / Keith L. Moore. – 1992. - 917p. 5. Clinical Anatomy. Applied anatomy for clinical students and junior doctors: eleventh edition / Harold Ellis // Oxford, UK: Blackwell publishing. – 2006. – 455p. 6. Pocket atlas of Human Anatomy / Heinz Feneis, Wolfgang Dauber // Thieme, Stuttgart. – 2000. – 510p. 7. https://human.biodigital.com/ 8. http://anatom.ua/nomina-anatomica/

Topic 15. Connections of the bones of the skull, connection of the skull with vertebral column. Temporo-mandibular joint. Structure, biomechanics of movement. Age and sexual differences in the skull. Radioanatomy of the skull. Craniometry. 1. Relevance of the topic. Connections between the bones of the skull form skull as a whole – a skeleton for the brain, sensory organs, initial parts of digestive and respiratory systems. Temporo-mandibular joint is a main part of vocal apparatus. 2. The specific aims. 2.1.To have general knowledge of the topic studied; 2.2. To understand, to remember and to use the knowledge received; 2.3. To form the professional experience by reviewing, training and authorizing it; 2.4. To be able to find and show studying structures on visual aids. 3. Basic knowledge and skills necessary for study the topic (interdisciplinary integration) The preceding The acquired knowledge subjects Biology Describe development of bone system and joints; determine the starting position of the human body; types of human physique (dolihomorfnic, mesomorphic, brahiomorfic); find all kinds of uninterrupted connections on the skull, find articular surfaces and ligaments of temporomandibular joint Physics Demonstrate biomechanics of movements 4. Tasks for students' individual work. 4.1. The list of basic terms, parameters, characteristics which the student should master while preparing for the class. Continuous connection – synarthrosis, temporal-mandibular joint - articulatio temporomandibularis. 4.2. Theoretical questions for the class: 1. Structure, function, biomechanics movements of the atlanto-occipital joint. 2. The structure, function, biomechanics movements of the atlanto-axial joint. 3. Classification of compounds skull 4. Name fontanelles, terms their ossification. 5. Sutures of the skull. 6. The structure of the temporomandibular joint. 7. Biomechanics movements in TMJ. 8. The structure of the capsule TMJ. 4.3. Practical tasks pertaining to the topic and to be completed during the class: the bones, schemes, models to identify compounds of the primary and secondary elements of joints. The content of the topic. The ligaments connecting the vertebral column with the cranium may be divided into two sets: those uniting the atlas with the occipital bone, and those connecting the axis with the occipital bone. Articulation of the Atlas with the Occipital Bone (articulatio atlantoccipitalis). The articulation between the atlas and the occipital bone consists of a pair of condyloid joints. The Articular Capsules (capsulœ articulares; capsular ligaments). The articular capsules surround the condyles of the occipital bone, and connect them with the articular processes of the atlas: they are thin and loose. The Anterior Atlantoccipital Membrane (membrana atlantoccipitalis anterior; anterior atlantoцccipital ligament). The anterior atlantoccipitalis membrane is broad and composed of densely woven fibers, which pass between the anterior margin of the foramen magnum above, and the upper border of the anterior arch of the atlas below; laterally, it is continuous with the articular capsules; in front, it is strengthened in the middle line by a strong, rounded cord, which connects the basilar part of the occipital bone to the tubercle on the anterior arch of the atlas. The Posterior Atlantoccipital Membrane (membrana atlantoccipitalis posterior; posterior atlantoccipital ligament). The posterior atlantoccipital membrane, broad but thin, is connected above, to the posterior margin of the foramen magnum; below, to the upper border of the posterior arch of the atlas. The Lateral Ligaments. The lateral ligaments are thickened portions of the articular capsules, reinforced by bundles of fibrous tissue, and are directed obliquely upward and medialward; they are attached above to the jugular processes of the occipital bone, and below, to the bases of the transverse processes of the atlas. The Membrana Tectoria (occipitoaxial ligament). The membrana tectoria is situated within the vertebral canal. It is a broad, strong bands which covers the odontoid process and its ligaments, and appears to be a prolongation upward of the posterior longitudinal ligament of the vertebral column. It is fixed, below, to the posterior surface of the body of the axis, and, expanding as it ascends, is attached to the basilar groove of the occipital bone, in front of the foramen magnum, where it blends with the cranial dura mater. The Alar Ligaments (ligamenta alaria; odontoid ligaments). The alar ligaments are strong, rounded cords, which arise one on either side of the upper part of the odontoid process, and, passing obliquely upward and lateralward, are inserted into the rough depressions on the medial sides of the condyles of the occipital bone. Connections of the bones of the skull. Entering into skulls formation are the frontal, the parietal, the occipital, the temporal, and the great wing of the sphenoid. These bones are joined to one another and to the zygomatic by the following sutures: the zygomaticotemporal between the zygomatic process of the temporal and the temporal process of the zygomatic; the zygomaticofrontal uniting the zygomatic bone with the zygomatic process of the frontal; the sutures surrounding the great wing of the sphenoid, viz., the sphenozygomatic in front, the sphenofrontal and sphenoparietal above, and the sphenosquamosal behind. The sphenoparietal suture varies in length in different skulls, and is absent in those cases where the frontal articulates with the temporal squama. The point corresponding with the posterior end of the sphenoparietal suture is named the pterion; it is situated about 3 cm. behind, and a little above the level of the zygomatic process of the frontal bone. Articulation of the Mandible (Temporomandibular Articulation). The parts entering into its formation on either side are: the anterior part of the mandibular fossa of the temporal bone and the articular tubercle above; and the condyle of the mandible below. The ligaments of the joint are the following: The Articular Capsule. The Temporomandibular. The Sphenomandibular. The Articular Disk. The Stylomandibular. The Articular Capsule (capsula articularis; capsular ligament). The articular capsule is a thin, loose envelope, attached above to the circumference of the mandibular fossa and the articular tubercle immediately in front; below, to the neck of the condyle of the mandible. The Temporomandibular Ligament (ligamentum temporomandibulare; external lateral ligament). The temporomandibular ligament consists of two short, narrow fasciculi, one in front of the other, attached, above, to the lateral surface of the zygomatic arch and to the tubercle on its lower border; below, to the lateral surface and posterior border of the neck of the mandible. It is broader above than below, and its fibers are directed obliquely downward and backward. The Sphenomandibular Ligament (ligamentum sphenomandibulare; internal lateral ligament). The sphenomandibular ligament is a flat, thin band which is attached above to the spina angularis of the sphenoid bone, and, becoming broader as it descends, is fixed to the lingula of the mandibular foramen. The Articular Disk (discus articularis; interarticular fibrocartilage; articular meniscus) — The articular disk is a thin, oval plate, placed between the condyle of the mandible and the mandibular fossa. Its upper surface is concavo-convex from before backward, to accommodate itself to the form of the mandibular fossa and the articular tubercle. Its under surface, in contact with the condyle, is concave. The Stylomandibular Ligament (ligamentum stylomandibulare). The stylomandibular ligament is a specialized band of the cervical fascia, which extends from near the apex of the styloid process of the temporal bone to the angle and posterior border of the ramus of the mandible, between the Masseter and Pterygoideus internus. Materials for self-check: A. Tasks for self-check (tables, diagrams): table - types of the skull connections, draw the axis movements in TMJ. B. Situational tasks. 1. 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 2. At the victim is determined the right size separation angle of the mandible, the displacement of the fragment backward and upward. What ligament is attached to the angle of mandible? A. Lateral B. Articular disk C. Sphenomandibular D. Stylomandibular E. Alar 3. The boxer who was hit in the area of the temporomandibular joint, diagnosed with traumatic dislocation. The displacement of which the articular surfaces will go beyond the physiological norm? A. The head of the mandible and styloid process B. Coronoid process and the spine of the sphenoid C. Coronoid process and the submandibular fossa D. The head of the mandible and zygomatic process E. The head of the mandible and the mandibular fossa 4. 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 5. Because of the accident, the victim cannot nod your head (flexion and extension of the head forward and backward). What joint can be compromised? A. Lateral atlanto-axial. B. Atlanto-occipital. C. Median atlanto-axial. D. Temporomandibular. E. Zygapophysial 6. To reposition the lower jaw dislocation to take it down. What anatomical structure determines such action? A. Condylar process of the mandible. B. Mandibular fossa of the temporal bone. C. Articular tubercle of the temporal bone. D. Styloid process of the temporal bone. E. Coronoid process of the mandible. 7. Because of the accident, the victim cannot nod tilt the head to the right or left. What joint can be compromised? A. Lateral atlanto-axial. B. Atlanto-occipital. C. Median atlanto-axial. D. Temporomandibular. E. Zygapophysial 8. Name the articular surfaces of the atlanto-occipital joint. A. The articular surface of the dens and anterior arch of the atlas B. The condyles of the occipital bone and the superior articular facets of the atlas C. The inferior articular surface of the atlas and superior articular surface of the axis D. The head of the mandible and the mandibular fossa E. The capitulum of the humerus and the articular surface of the head of the radius 9. Name the articular surfaces of the median atlanto-axial joint. A. The articular surface of the dens and anterior arch of the atlas B. The condyles of the occipital bone and the superior articular facets of the atlas C. The inferior articular surface of the atlas and superior articular surface of the axis D. The head of the mandible and the mandibular fossa E. The capitulum of the humerus and the articular surface of the head of the radius 10. Name the articular surfaces of the lateral atlanto-axial joint. A. The articular surface of the dens and anterior arch of the atlas B. The condyles of the occipital bone and the superior articular facets of the atlas C. The inferior articular surface of the atlas and superior articular surface of the axis D. The head of the mandible and the mandibular fossa E. The capitulum of the humerus and the articular surface of the head of the radius References The basic 1. Human Anatomy. In three volumes. Volume 1 / Edited by V.G. Koveshnikov. - Lugansk: LTD «Virtualnaya realnost», 2009. – 328p. 2. 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. 3. Sobotta Atlas of Human Anatomy / Edited by R. Putz and R. Pabst, 14th ed. – Elsevier GmbH, Munich, 2008 . – 895p. 4. Clay JH, Pounds DM. Basic Clinical Massage Therapy: Integrating Anatomy and Treatment. 2003. 5. Grant′s atlas of anatomy ∕ Anne M.R., Arthur F. Dalley II, 12th ed. - Baltimore: Wiliams & Wolters, 2009. – 864 p. 6. Martini Frederic H. Martini′s atlas of the human body, 8th ed. – Pearson Education, 2009. – 250p. 7. Atlas of Human Anatomy / Frank H. Netter, M.D. Arthur F. Dalley; 2nd ed. // ILS, Medimedia USA Company, 1997. – 548p. Additional 1. Langman J. Medical embryology / Langman J. – Baltimore, London, 1981. – 384p. 2. Crouse G.S. Development of the female urogenital system / G.S. Crouse // Semin. Reprod. Endocrinol. – 1986. – V.4, №1. – P. 1-11. 3. Beck F. Human embryology: 2 ed / F. Beck, D. Mossat, D. Davies. - Oxford: Blackwell, 1985. – V. 11. – 372p. 4. Moore Keith L. Clinically oriented anatomy: third ed / Keith L. Moore. – 1992. - 917p. 5. Clinical Anatomy. Applied anatomy for clinical students and junior doctors: eleventh edition / Harold Ellis // Oxford, UK: Blackwell publishing. – 2006. – 455p. 6. Pocket atlas of Human Anatomy / Heinz Feneis, Wolfgang Dauber // Thieme, Stuttgart. – 2000. – 510p. 7. https://human.biodigital.com/ 8. http://anatom.ua/nomina-anatomica/

Topic 16. Connections of the bones of the shoulder girdle. Connections of the bones of the free upper extremity. 1. Relevance of the topic. Chest – is part of the skeleton of the trunk, it form storage for organs of respiratory system, part of digestive system, heart and big vessels, etc. Connections of the bones of the upper limb form skeleton of the free upper extremity and upper extremity girdle. 2. The specific aims. 2.1.To have general knowledge of the topic studied; 2.2. To understand, to remember and to use the knowledge received; 2.3. To form the professional experience by reviewing, training and authorizing it; 2.4. To be able to find and show studying structures on visual aids. 3. Basic knowledge and skills necessary for study the topic (interdisciplinary integration) The preceding The acquired knowledge subjects Biology Describe phylogeny bone system and joints; determine the starting position of the human body; types of human physique (dolihomorfic, mesomorphic, brahiomorfic); Physics Demonstrate biomechanics of movements 4. Tasks for students' individual work. 4.1. The list of basic terms, parameters, characteristics which the student should master while preparing for the class. Continuous connection - synarthrosis, sternocostal joint - articulatio sternocostalis, joint of the head of the rib - articulatio capitis costae. 4.2. Theoretical questions for the class: 1. Connections between ribs and vertebral column. 2. Connections between ribs and sternum. 3. Walls, boundaries of the . 4. Types of constitution of the chest. 5. The structure of the shoulder joint, biomechanics movements. 6. The structure of the elbow joint, biomechanics of movement. 7. Connections of the forearm. 8. The structure of the joint, biomechanics movements. 9. Articulationes of the hand bones. 4.3. Practical tasks pertaining to the topic and to be completed during the class: the bones, schemes, models to identify compounds of the primary and secondary elements of the joints, to analyze features of the free upper extremity. The content of the topic. Connecting edges of the breast: The articulations of the ribs with the vertebral column may be divided into two sets, one connecting the heads of the ribs with the bodies of the vertebrae, another uniting the necks and tubercles of the ribs with the transverse processes. 1. Articulations of the Heads of the Ribs (articulationes capitulorum; costocentral articulations) — These constitute a series of joints, and are formed by the articulation of the heads of the typical ribs with the facets on the contiguous margins of the bodies of the thoracic vertebrae and with the intervertebral fibrocartilages between them; the first, tenth, eleventh, and twelfth ribs each articulate with a single vertebra. The ligaments of the joints are: The Articular Capsule (capsula articularis; capsular ligament).—The articular capsule surrounds the joint, being composed of short, strong fibers, connecting the head of the rib with the circumference of the articular cavity formed by the intervertebral fibrocartilage and the adjacent vertebrae. The Radiate Ligament (ligamentum capituli costae radiatum; anterior costovertebral or stellate ligament). — The radiate ligament connects the anterior part of the head of each rib with the side of the bodies of two vertebrae, and the intervertebral fibrocartilage between them. The Interarticular Ligament (ligamentum capituli costae interarticulare).—The interarticular ligament is situated in the interior of the joint. It consists of a short band of fibers, flattened from above downward, attached by one extremity to the crest separating the two articular facets on the head of the rib, and by the other to the intervertebral fibrocartilage; it divides the joint into two cavities. In the joints of the first, tenth, eleventh, and twelfth ribs, the interarticular ligament does not exist; consequently, there is but one cavity in each of these articulations. 2. Costotransverse Articulations (articulationes costotransversariae) — The articular portion of the tubercle of the rib forms with the articular surface on the adjacent transverse process an arthrodial joint. Sternocostal Articulations (Articulationes Sternocotales). The articulations of the cartilages of the true ribs with the sternum are arthrodial joints, with the exception of the first, in which the cartilage is directly united with the sternum, and which is, therefore, a synarthrodial articulation. The ligaments connecting them are: 1. The Articular Capsules (capsulae articulares; capsular ligaments). The articular capsules surround the joints between the cartilages of the true ribs and the sternum. They are very thin, intimately blended with the radiate sternocostal ligaments, and strengthened at the upper and lower parts of the articulations by a few fibers, which connect the cartilages to the side of the sternum. 2. The Radiate Sternocostal Ligaments (ligamenta sternocostalia radiata; chondrosternal or sternocostal ligaments).—These ligaments consist of broad and thin membranous bands that radiate from the front and back of the sternal ends of the cartilages of the true ribs to the anterior and posterior surfaces of the sternum. They are composed of fasciculi which pass in different directions. The superior fasciculi ascend obliquely, the inferior fasciculi descend obliquely, and the middle fasciculi run horizontally. 3. The Interarticular Sternocostal Ligament (ligamentum sternocostale interarticulare; interarticular chondrosternal ligament). This ligament is found constantly only between the second costal cartilages and the sternum. The cartilage of the second rib is connected with the sternum by means of an interarticular ligament, attached by one end to the cartilage of the rib, and by the other to the fibrocartilage which unites the manubrium and body of the sternum. 4. The Costoxiphoid Ligaments (ligamenta costoxiphoidea; chondroxiphoid ligaments). These ligaments connect the anterior and posterior surfaces of the seventh costal cartilage, and sometimes those of the sixth, to the front and back of the xiphoid process. Interchondral Articulations (articulationes interchondrales; articulations of the cartilages of the ribs with each other). The contiguous borders of the sixth, seventh, and eighth, and sometimes those of the ninth and tenth, costal cartilages articulate with each other by small, smooth, oblong facets. Each articulation is enclosed in a thin articular capsule, lined by synovial membrane and strengthened laterally and medially by ligamentous fibers (interchondral ligaments) which pass from one cartilage to the other. Connections of the shoulder girdle. Sternoclavicular articulation. The sternoclavicular articulation is a double arthrodial joint. The parts entering into its formation are the sternal end of the clavicle, the upper and lateral part of the manubrium sterni, and the cartilage of the first rib. The articular surface of the clavicle is much larger than that of the sternum, and is invested with a layer of cartilage, 68 which is considerably thicker than that on the latter bone. Acromioclavicular articulation. (Articulatio Acromioclavicularis; Scapuloclavicular Articulation). The acromioclavicular articulation is a joint between the acromial end of the clavicle and the medial margin of the acromion of the scapula. Humeral Articulation or Shoulder-joint (Articulatio Humeri). The shoulder-joint is an enarthrodial or ball-and-socket joint. The bones entering into its formation are the hemispherical head of the humerus and the shallow glenoid cavity of the scapula, an arrangement which permits of very considerable movement, while the joint itself is protected against displacement by the tendons which surround it. The joint is protected above by an arch, formed by the coracoid process, the acromion, and the coracoacromial ligament. The articular cartilage on the head of the humerus is thicker at the center than at the circumference, the reverse being the case with the articular cartilage of the glenoid cavity. The Articular Capsule (capsula articularis; capsular ligament). The articular capsule completely encircles the joint, being attached, above, to the circumference of the glenoid cavity beyond the glenoidal labrum; below, to the anatomical neck of the humerus, approaching nearer to the articular cartilage above than in the rest of its extent. The Coracohumeral Ligament (ligamentum coracohumerale). This ligament is a broad band which strengthens the upper part of the capsule. It arises from the lateral border of the coracoid process, and passes obliquely downward and lateralward to the front of the greater tubercle of the humerus, blending with the tendon of the Supraspinatus. Glenohumeral Ligaments. In addition to the coracohumeral ligament, three supplemental bands, which are named the glenohumeral ligaments, strengthen the capsule. The Transverse Humeral Ligament is a broad band passing from the lesser to the greater tubercle of the humerus, and always limited to that portion of the bone which lies above the epiphysial line. It converts the intertubercular groove into a canal. The Glenoidal Labrum (labrium glenoidale; glenoid ligament) is a fibrocartilaginous rim attached around the margin of the glenoid cavity. Elbow-joint (Articulatio Cubiti). The elbow-joint is a ginglymus or hinge-joint. The trochlea of the humerus is received into the semilunar notch of the ulna, and the capitulum of the humerus articulates with the fovea on the head of the radius. The articular surfaces are connected together by a capsule, which is thickened medially and laterally, and, to a less extent, in front and behind. The Anterior Ligament. The anterior ligament is a broad and thin fibrous layer covering the anterior surface of the joint. It is attached to the front of the medial epicondyle and to the front of the humerus immediately above the coronoid and radial fossae below, to the anterior surface of the coronoid process of the ulna and to the annular ligament, being continuous on either side with the collateral ligaments. The Posterior Ligament.This posterior ligament is thin and membranous, and consists of transverse and oblique fibers. Above, it is attached to the humerus immediately behind the capitulum and close to the medial margin of the trochlea, to the margins of the olecranon fossa, and to the back of the lateral epicondyle some little distance from the trochlea. Below, it is fixed to the upper and lateral margins of the olecranon, to the posterior part of the annular ligament, and to the ulna behind the radial notch. The Ulnar Collateral Ligament (ligamentum collaterale ulnare; internal lateral ligament). This ligament is a thick triangular band consisting of two portions, an anterior and posterior united by a thinner intermediate portion. The Radial Collateral Ligament (ligamentum collaterale radiale; external lateral ligament). This ligament is a short and narrow fibrous band, less distinct than the ulnar collateral, attached, above, to a depression below the lateral epicondyle of the humerus. Radioulnar Articulation (Articulatio Radioulnaris). The articulation of the radius with the ulna is effected by ligaments which connect together the extremities as well as the bodies of these bones. Proximal Radioulnar Articulation (articulatio radioulnaris proximalis; superior radioulnar joint).—This articulation is a trochoid or pivot-joint between the circumference of the head of the radius and the ring formed by the radial notch of the ulna and the annular ligament. Middle Radioulnar Union. The shafts of the radius and ulna are connected by the Oblique Cord and the . Distal Radioulnar Articulation (articulatio radioulnaris distalis; inferior radioulnar joint). This is a pivot-joint formed between the head of the ulna and the ulnar notch on the lower end of the radius. Radiocarpal Articulation or Wrist-joint (Articulatio Radiocarpea). The wrist-joint is a condyloid articulation. The parts forming it are the lower end of the radius and under surface of the articular disk above; and the navicular, lunate, and triangular bones below. The articular surface of the radius and the under surface of the articular disk form together a transversely elliptical concave surface, the receiving cavity. The superior articular surfaces of the navicular, lunate, and triangular form a smooth convex surface, the condyle, which is received into the concavity. Intercarpal Articulations (Articulationes Intercarpeae). These articulations may be subdivided into three sets: 1. The Articulations of the Proximal Row of Carpal Bones. 2. The Articulations of the Distal Row of Carpal Bones. 3. The Articulations of the Two Rows with each Other. Articulations of the Proximal Row of Carpal Bones. These are arthrodial joints. The navicular, lunate, and triangular are connected by dorsal, volar, and interosseous ligaments. Articulations of the Distal Row of Carpal Bones. These also are arthrodial joints; the bones are connected by dorsal, volar, and interosseous ligaments. Articulations of the Two Rows of Carpal Bones with Each Other.—The joint between the navicular, lunate, and triangular on the one hand, and the second row of carpal bones on the other, is named the midcarpal joint, and is made up of three distinct portions: in the center the head of the capitate and the superior surface of the hamate articulate with the deep cup-shaped cavity formed by the navicular and lunate, and constitute a sort of ball-and-socket joint. On the radial side the trapezium and trapezoid articulate with the navicular, and on the ulnar side the hamate articulates with the triangular, forming gliding joints. Carpometacarpal Articulations (Articulationes Carpometacarpeae). This is a joint of reciprocal reception between the first metacarpal and the greater multangular; it enjoys great freedom of movement on account of the configuration of its articulars urfaces, which are saddle-shaped. The joint is surrounded by a capsule, which is thick but loose, and passes from the circumference of the base of the metacarpal bone to the rough edge bounding the articular surface of the greater multangular; it is thickest laterally and dorsally, and is lined by synovial membrane. Articulations of the Other Four Metacarpal Bones with the Carpus (articulationes carpometacarpeae). The joints between the carpus and the second, third, fourth, and fifth metacarpal bones are arthrodial. The bones are united by dorsal, volar, and interosseous ligaments. Metacarpophalangeal articulations (Articulationes metacarpo-phalangeae). These articulations are of the condyloid kind, formed by the reception of the rounded heads of the metacarpal bones into shallow cavities on the proximal ends of the first phalanges, with the exception of that of the , which presents more of the characters of a ginglymoid joint. Each joint has a volar and two collateral ligaments. Articulations of the Digits (Articulationes Digitorum Manus). The interphalangeal articulations are hinge-joints; each has a volar and two collateral ligaments. The arrangement of these ligaments is similar to those in the metacarpophalangeal articulations. The Extensor tendons supply the place of posterior ligaments. Materials for self-check: A. Tasks for self-check (tables, diagrams): table - types of connections, connection schematically depict the bones of the body, draw the axis of movements in the joints. B. Situational tasks. 1. Patient admitted to hospital with an injury of the vertebral column at the level vertebrae that have one full facet for connecting with the corresponding ribs. In addition, they do not have the rib facets on the transverse processes. Name level of the damage. A. Th 1-2 B. Th 9-10 C. L 1-2 D. Th 11-12 E. Th 4-5 2. The patient went to a doctor about the blunt chest trauma. On examination, defined rib fracture, which corresponds to the lower angle of the scapula. What is this rib? A. 3. B. 4 C. 12 D. 11 E. 7 3. Patient admitted to hospital with an injury of the vertebral column at the level vertebrae that has a single semi-facet on the upper border of its body for connecting with the corresponding rib. Name level of the damage. A. Th 1-2 B. Th 10 C. L 1-2 D. Th 11-12 E. Th 4-5 4. Patient admitted to hospital with an injury of the vertebral column at the level vertebrae that has one full facet for connecting with the corresponding rib on its upper border. In addition, it has a semi-facet for the articulation with the corresponding rib on its lower border. Name level of the damage. A. Th 1-2 B. Th 9-10 C. L 1-2 D. Th 11-12 E. Th 4-5 5. According Re-program the patient identified cracks of the ribs, which belong to true ribs. Determine the level of damage: A. 4-6 B. 7-9 C. 10 D. 11-12 E. 8-10 6. According Re-program the patient identified cracks of the ribs, which belong to false ribs. Determine the level of damage: A. 4-6 B. 7-9 C. 10 D. 11-12 E. 8-10 7. According Re-program the patient identified cracks of the ribs, which belong to floating ribs. Determine the level of damage: A. 4-6 B. 7-9 C. 10 D. 11-12 E. 8-10 8. Which of the following statements concerning the inferior thoracic aperture are correct, except? A. It is closed by the diaphragm B. Structures passing through the inferior thoracic aperture between the thorax and abdomen include the inferior vena cava and esophagus. C. The superior thoracic aperture s much larger than the inferior thoracic aperture. D. It is bounded by 12th thoracic vertebra posteriorly and by costal cartilages of ribs 7 through 10 anteriorly. E. It is bounded by the xiphisternal junction anteriorly. 9. All the following statements concerning the xiphisternal junction are correct, EXCEPT: A. It is synchondrosis B. It is situated between the body and xiphoid process C. With age it becomes a synostosis D. It is located at the vertebral level of T9 E. It is located at the level of the cartilage of the 11th rib 10. What are the boundaries of thoracic inlet? A. Body T1 vertebra, manubrium sterni, 1-st rib. B. Body T2 vertebra, manubrium sterni, 1-st rib, clavicle. C. Body C7 vertebra, manubrium sterni, 1-st rib, clavicle. D. Infrastemal angle, T12 vertebra, 7-12 ribs. E. Body C6 vertebra, manubrium sterni, 1-st rib, clavicle. 11. Name the articular surfaces of the shoulder joint. A. The circumference of the head of the radius and the radial notch of the ulna B. The articular circumference of the ulna and the ulnar notch of the radius C. The glenoid cavity of the scapula and head of the humerus D. The trochlea of the humerus and the trochlear notch of the ulna E. The capitulum of the humerus and the articular surface of the head of the radius 12. Name the articular surfaces of the humero-ulnar joint. A. The circumference of the head of the radius and the radial notch of the ulna B. The articular circumference of the ulna and the ulnar notch of the radius C. The glenoid cavity of the scapula and head of the humerus D. The trochlea of the humerus and the trochlear notch of the ulna E. The capitulum of the humerus and the articular surface of the head of the radius 13. Name the articular surfaces of the humeroradial joint. A. The circumference of the head of the radius and the radial notch of the ulna B. The articular circumference of the ulna and the ulnar notch of the radius C. The glenoid cavity of the scapula and head of the humerus D. The trochlea of the humerus and the trochlear notch of the ulna E. The capitulum of the humerus and the articular surface of the head of the radius. 14. Name the articular surfaces of the proximal radio-ulnar joint. A. The circumference of the head of the radius and the radial notch of the ulna B. The articular circumference of the ulna and the ulnar notch of the radius C. The glenoid cavity of the scapula and head of the humerus D. The trochlea of the humerus and the trochlear notch of the ulna E. The capitulum of the humerus and the articular surface of the head of the radius. 15. Name the articular surfaces of the distal radio-ulnar joint. A. The circumference of the head of the radius and the radial notch of the ulna B. The articular circumference of the ulna and the ulnar notch of the radius C. The glenoid cavity of the scapula and head of the humerus D. The trochlea of the humerus and the trochlear notch of the ulna E. The capitulum of the humerus and the articular surface of the head of the radius 16. Name the articular surfaces of the radiocarpal joint. A. The circumference of the head of the radius and the radial notch of the ulna B. The articular circumference of the ulna and the ulnar notch of the radius C. Carpal articular surface of the radius and articular surfaces of the scaphoid, lunate and triquetral bones D. The trochlea of the humerus and the trochlear notch of the ulna E. The capitulum of the humerus and the articular surface of the head of the radius 17. Name the ligaments of the elbow joint. A. Dorsal radiocarpal, palmar radiocarpal B. Interosseous intercarpal, dorsal and palmar intercarpal, radiate carpal C. Radiate carpal, interosseous metacarpal D. Ulnar collateral, radial collateral, annular ligament of radius E. Dorsal and palmar carpometacarpal 18. Name the ligaments of the radiocarpal joint. A. Dorsal radiocarpal, palmar radiocarpal B. Interosseous intercarpal, dorsal and palmar intercarpal, radiate carpal C. Radiate carpal, interosseous metacarpal D. Ulnar collateral, radial collateral, annular ligament of radius E. Ulnar collateral of wrist, radial collateral of wrist, dorsal radiocarpal, palmar radiocarpal References The basic 1. Human Anatomy. In three volumes. Volume 1 / Edited by V.G. Koveshnikov. - Lugansk: LTD «Virtualnaya realnost», 2009. – 328p. 2. 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. 3. Sobotta Atlas of Human Anatomy / Edited by R. Putz and R. Pabst, 14th ed. – Elsevier GmbH, Munich, 2008 . – 895p. 4. Clay JH, Pounds DM. Basic Clinical Massage Therapy: Integrating Anatomy and Treatment. 2003. 5. Grant′s atlas of anatomy ∕ Anne M.R., Arthur F. Dalley II, 12th ed. - Baltimore: Wiliams & Wolters, 2009. – 864 p. 6. Martini Frederic H. Martini′s atlas of the human body, 8th ed. – Pearson Education, 2009. – 250p. 7. Atlas of Human Anatomy / Frank H. Netter, M.D. Arthur F. Dalley; 2nd ed. // ILS, Medimedia USA Company, 1997. – 548p. Additional 1. Langman J. Medical embryology / Langman J. – Baltimore, London, 1981. – 384p. 2. Crouse G.S. Development of the female urogenital system / G.S. Crouse // Semin. Reprod. Endocrinol. – 1986. – V.4, №1. – P. 1-11. 3. Beck F. Human embryology: 2 ed / F. Beck, D. Mossat, D. Davies. - Oxford: Blackwell, 1985. – V. 11. – 372p. 4. Moore Keith L. Clinically oriented anatomy: third ed / Keith L. Moore. – 1992. - 917p. 5. Clinical Anatomy. Applied anatomy for clinical students and junior doctors: eleventh edition / Harold Ellis // Oxford, UK: Blackwell publishing. – 2006. – 455p. 6. Pocket atlas of Human Anatomy / Heinz Feneis, Wolfgang Dauber // Thieme, Stuttgart. – 2000. – 510p. 7. https://human.biodigital.com/ 8. http://anatom.ua/nomina-anatomica/

Topic 17. Connections of the bones of the pelvis. Pelvis as whole. Connections of the bones of the free lower extremity. Radioanatomy of the bones and its connections. 1. 1. Relevance of the topic. Uninterupted connections of the pelvic bones and hip joint have main supportive and locomotor function during straightwalking. The knee and foot joints often have inflammation. Flat feet is a contraindication for some professions. Knowing their structure necessary for further study of compounds attachment of muscles and skeletopy vessels and nerves, and for further study courses traumatology, radiology, surgery. 2. The specific aims. 2.1.To have general knowledge of the topic studied; 2.2. To understand, to remember and to use the knowledge received; 2.3. To form the professional experience by reviewing, training and authorizing it; 2.4. To be able to find and show studying structures on visual aids. 3. Basic knowledge and skills necessary for study the topic (interdisciplinary integration). The preceding The acquired knowledge subjects Biology Describe phylogeny bone system and joints; determine the starting position of the human body; types of human physique (dolihomorfic, mesomorphic, brahiomorfic); Physics Demonstrate biomechanics of movements 4. Tasks for students' individual work. 4.1. The list of basic terms, parameters, characteristics which the student should master while preparing for the class. Connection pelvic girdle - articulationes cinguli membri inferioris; obturator membrane - membrana obturatoria, pubic symphysis - symphysis pubica, hip joint - articulatio coxae, knee joint – articulatio genus, ankle joint – articulatio talocruralis, synovial bags - synoviales bursae, meniscus - meniscus. 4.2. Theoretical questions for the class: 1. Name continuous connection of the pelvis. 2. The structure of the sacroiliac joints. 3. Structure of the pubic symphysis, sexual features. 4. General plan of the pelvis. 5. The structure of the pelvis 6. Name the dimensions of the greater and lesser pelvis in women. 7. What are the distinctions between the male and female pelvis? 8. The structure of the hip joint. 9. Name basic parts of knee joint. 10. Name basic parts of ankle joint. 11. Name basic parts of the joints of the foot. 12. Name the show and surgical joints of the foot. 4.3. Practical tasks pertaining to the topic and to be completed during the class: the bones, schemes, models to identify compounds of the primary and secondary elements joints, to analyze connection features free zone and lower limbs. The content of the topic. The Pelvis. The pelvis, so called from its resemblance to a basin, is a bony ring, interposed between the movable vertebrae of the vertebral column which it supports, and the lower limbs upon which it rests; it is stronger and more massively constructed than the wall of the cranial or thoracic cavities, and is composed of four bones: the two hip bones laterally and in front and the sacrum and coccyx behind. The pelvis is divided by an oblique plane passing through the prominence of the sacrum, the arcuate and pectineal lines, and the upper margin of the symphysis pubis, into the greater and the lesser pelvis. The circumference of this plane is termed the linea terminalis or pelvic brim. The Greater or False Pelvis (pelvis major).—The greater pelvis is the expanded portion of the cavity situated above and in front of the pelvic brim. It is bounded on either side by the ilium; in front it is incomplete, presenting a wide interval between the anterior borders of the ilia, which is filled up in the fresh state by the parietes of the abdomen; behind is a deep notch on either side between the ilium and the base of the sacrum. It supports the intestines, and transmits part of their weight to the anterior wall of the abdomen. The Lesser or True Pelvis (pelvis minor).—The lesser pelvis is that part of the pelvic cavity which is situated below and behind the pelvic brim. Its bony walls are more complete than those of the greater pelvis. For convenience of description, it is divided into an inlet bounded by the superior circumference, and outlet bounded by the inferior circumference, and a cavity. Differences between the Male and Female Pelves.—The female pelvis is distinguished from that of the male by its bones being more delicate and its depth less. The whole pelvis is less massive, and its muscular impressions are slightly marked. The ilia are less sloped, and the anterior iliac spines more widely separated; hence the greater lateral prominence of the hips. The preauricular sulcus is more commonly present and better marked. The superior aperture of the lesser pelvis is larger in the female than in the male; it is more nearly circular, and its obliquity is greater. The cavity is shallower and wider; the sacrum is shorter wider, and its upper part is less curved; the obturator foramina are triangular in shape and smaller in size than in the male. The inferior aperture is larger and the coccyx more movable. The sciatic notches are wider and shallower, and the spines of the ischia project less inward. The acetabula are smaller and look more distinctly forward. The ischial tuberosities and the acetabula are wider apart, and the former are more everted. The pubic symphysis is less deep, and the pubic arch is wider and more rounded than in the male, where it is an angle rather than an arch. Articulations of the Pelvis. The ligaments connecting the bones of the pelvis with each other may be divided into four groups: 1. Those connecting the sacrum and ilium. 2. Those passing between the sacrum and ischium. 3. Those uniting the sacrum and coccyx. 4. Those between the two public bones. 1. Sacroiliac Articulation (articulatio sacroiliaca).—The sacroiliac articulation is an amphiarthrodial joint, formed between the auricular surfaces of the sacrum and the ilium. 2. Ligaments Connecting the Sacrum and Ischium. The Sacrotuberous. The Sacrospinous. The Sacrotuberous Ligament (ligamentum sacrotuberosum; great or posterior sacrosciatic ligament).—The sacrotuberous ligament is situated at the lower and back part of the pelvis. It is flat, and triangular in form; narrower in the middle than at the ends; attached by its broad base to the posterior inferior spine of the ilium, to the fourth and fifth transverse tubercles of the sacrum, and to the lower part of the lateral margin of that bone and the coccyx. The Sacrospinous Ligament (ligamentum sacrospinosum; small or anterior sacrosciatic ligament).—The sacrospinous ligament is thin, and triangular in form; it is attached by its apex to the spine of the ischium, and medially, by its broad base, to the lateral margins of the sacrum and coccyx, in front of the sacrotuberous ligament with which its fibers are intermingled. These two ligaments convert the sciatic notches into foramina. 3. Sacrococcygeal Symphysis (symphysis sacrococcygea; articulation of the sacrum and coccyx).—This articulation is an amphiarthrodial joint, formed between the oval surface at the apex of the sacrum, and the base of the coccyx. It is homologous with the joints between the bodies of the vertebrae, and is connected by similar ligaments. Coxal Articulation or Hip-joint (Articulatio Coxae). This articulation is an enarthrodial or ball-and-socket joint, formed by the reception of the head of the femur into the cup-shaped cavity of the acetabulum. The articular cartilage on the head of the femur, thicker at the center than at the circumference, covers the entire surface with the exception of the fovea capitis femoris, to which the ligamentum teres is attached; that on the acetabulum forms an incomplete marginal ring, the lunate surface. Within the lunate surface there is a circular depression devoid of cartilage, occupied in the fresh state by a mass of fat, covered by synovial membrane. The Glenoidal Labrum (labrum glenoidale; cotyloid ligament).—The glenoidal labrum is a fibrocartilaginous rim attached to the margin of the acetabulum, the cavity of which it deepens; at the same time it protects the edge of the bone, and fills up the inequalities of its surface. It bridges over the notch as the transverse ligament, and thus forms a complete circle, which closely surrounds the head of the femur and assists in holding it in its place. It is triangular on section, its base being attached to the margin of the acetabulum, while its opposite edge is free and sharp. Its two surfaces are invested by synovial membrane, the external one being in contact with the capsule, the internal one being inclined inward so as to narrow the acetabulum, and embrace the cartilaginous surface of the head of the femur. It is much thicker above and behind than below and in front, and consists of compact fibers. The Transverse Acetabular Ligament (ligamentum transversum acetabuli; transverse ligament).—This ligament is in reality a portion of the glenoidal labrum, though differing from it in having no cartilage cells among its fibers. It consists of strong, flattened fibers, which cross the acetabular notch, and convert it into a foramen through which the nutrient vessels enter the joint. The Knee-joint (Articulatio Genu). The knee-joint was formerly described as a ginglymus or hinge-joint, but is really of a much more complicated character. It must be regarded as consisting of three articulations in one: two condyloid joints, one between each condyle of the femur and the corresponding meniscus and condyle of the tibia; and a third between the patella and the femur, partly arthrodial, but not completely so, since the articular surfaces are not mutually adapted to each other, so that the movement is not a simple gliding one. The existence of the patellar fold of synovial membrane would further indicate a tendency to separation of the synovial cavity into two minor sacs, one corresponding to the lateral and the other to the medial joint. The bones are connected together by the following ligaments: The Articular Capsule. The Ligamentum Patellae. The Oblique Popliteal. The Tibial Collateral. The Fibular Collateral. The Anterior Cruciate. The Posterior Cruciate. The Medial and Lateral Menisci. The Transverse. The Coronary. The Articular Capsule (capsula articularis; capsular ligament) — The articular capsule consists of a thin, but strong, fibrous membrane which is strengthened in almost its entire extent by bands inseparably connected with it. The Ligamentum Patellae (anterior ligament) — The ligamentum patellae is the central portion of the common tendon of the Quadriceps femoris, which is continued from the patella to the tuberosity of the tibia. It is a strong, flat, ligamentous band, about 8 cm. in length, attached, above, to the apex and adjoining margins of the patella and the rough depression on its posterior surface. The Oblique Popliteal Ligament (ligamentum popliteum obliquum; posterior ligament) — This ligament is a broad, flat, fibrous band, formed of fasciculi separated from one another by apertures for the passage of vessels and nerves. The oblique popliteal ligament forms part of the floor of the popliteal fossa, and the popliteal artery rests upon it. The Tibial Collateral Ligament (ligamentum collaterale tibiale; internal lateral ligament) — The tibial collateral is a broad, flat, membranous band, situated nearer to the back than to the front of the joint. The Fibular Collateral Ligament (ligamentum collaterale fibulare; external lateral or long external lateral ligament) — The fibular collateral is a strong, rounded, fibrous cord, attached, above, to the back part of the lateral condyle of the femur, immediately above the groove for the tendon of the Popliteus; below, to the lateral side of the head of the fibula, in front of the styloid process. The Cruciate Ligaments (ligamenta cruciata genu; crucial ligaments).—The cruciate ligaments are of considerable strength, situated in the middle of the joint, nearer to its posterior than to its anterior surface. They are called cruciate because they cross each other somewhat like the lines of the letter X; and have received the names anterior and posterior, from the position of their attachments to the tibia. The Anterior (ligamentum cruciatum anterius; external crucial ligament) is fixed into the medial and back part of the lateral condyle of the femur. The Posterior Cruciate Ligament (ligamentum cruciatum posterius; internal crucial ligament) is stronger, but shorter and less oblique in its direction, than the anterior. Is fixed into the lateral and front part of the medial condyle of the femur. The Menisci (semilunar fibrocartilages) — The menisci are two crescentic lamellae, which serve to deepen the surfaces of the head of the tibia for articulation with the condyles of the femur. The Transverse Ligament (ligamentum transversum genu).—The transverse ligament connects the anterior convex margin of the lateral meniscus to the anterior end of the medial meniscus; its thickness varies considerably in different subjects, and it is sometimes absent. The coronary ligaments are merely portions of the capsule, which connect the periphery of each meniscus with the margin of the head of the tibia. Articulations between the Tibia and Fibula. The articulations between the tibia and fibula are effected by ligaments which connect the extremities and bodies of the bones. The ligaments may consequently be subdivided into three sets: (1) those of the Tibiofibular articulation; (2) the interosseous membrane; (3) those of the Tibiofibular syndesmosis. Tibiofibular Articulation (articulatio tibiofibularis; superior tibiofibular articulation). This articulation is an arthrodial joint between the lateral condyle of the tibia and the head of the fibula. Connections of the foot bones. Foot as a whole. Talocrural Articulation or Ankle-joint (Articulatio Talocruralis). The ankle- joint is a ginglymus, or hinge-joint. The structures entering into its formation are the lower end of the tibia and its malleolus, the malleolus of the fibula, and the transverse ligament, which together form a mortise for the reception of the upper convex surface of the talus and its medial and lateral facets. The bones are connected by the following ligaments: The Articular Capsule. The Deltoid. The Anterior Talofibular. The Posterior Talofibular. The Calcaneofibular. Talocalcaneal Articulation (articulatio talocalcanea).—The articulations between the calcaneus and talus are two in number — anterior and posterior. Of these, the anterior forms part of the talocalcaneonavicular joint, and will be described with that articulation. The posterior or talocalcaneal articulation is formed between the posterior calcaneal facet on the inferior surface of the talus, and the posterior facet on the superior surface of the calcaneus. It is an arthrodial joint, and the two bones are connected by an articular capsule and by anterior, posterior, lateral, medial, and interosseous talocalcaneal ligaments. Talocalcaneonavicular Articulation (articulatio talocalcaneonavicularis).— This articulation is an arthrodial joint: the rounded head of the talus being received into the concavity formed by the posterior surface of the navicular, the anterior articular surface of the calcaneus, and the upper surface of the planter calcaneonavicular ligament. There are two ligaments in this joint: the articular capsule and the dorsal talonavicular. Calcaneocuboid articulation (articulatio calcaneocuboidea).—The ligaments connecting the calcaneus with the cuboid are five in number, viz., the articular capsule, the dorsal calcaneocuboid, part of the bifurcated, the long plantar, and the plantar calcaneocuboid. The Bifurcated Ligament (ligamentum bifurcatum) — The bifurcated ligament is a strong band, attached behind to the deep hollow on the upper surface of the calcaneus and dividing in front in a Y-shaped manner into a calcaneocuboid and a calcaneonavicular part. The calcaneocuboid part is fixed to the medial side of the cuboid and forms one of the principal bonds between the first and second rows of the tarsal bones. The calcaneonavicular part is attached to the lateral side of the navicular. The Long Plantar Ligament (ligamentum plantare longum) — The long plantar ligament is the longest of all the ligaments of the tarsus: it is attached behind to the plantar surface of the calcaneus in front of the tuberosity, and in front to the tuberosity on the plantar surface of the cuboid bone, the more superficial fibers being continued forward to the bases of the second, third, and fourth metatarsal bones. This ligament converts the groove on the plantar surface of the cuboid into a canal for the tendon of the Peronaeus longus. Tarsometatarsal Articulations (Articulationes Tarsometatarseae). These are arthrodial joints. The bones entering into their formation are the first, second, and third cuneiforms, and the cuboid, which articulate with the bases of the metatarsal bones. Intermetatarsal Articulations (Articulationes Intermetatarseae). The base of the first metatarsal is not connected with that of the second by any ligaments; in this respect the great toe resembles the thumb. The bases of the other four metatarsals are connected by the dorsal, plantar, and interosseous ligaments. Metatarsophalangeal Articulations (Articulationes Metatarsophalangeae). The metatarsophalangeal articulations are of the condyloid kind, formed by the reception of the rounded heads of the metatarsal bones in shallow cavities on the ends of the first phalanges. Articulations of the Digits (Articulationes Digitorum Pedis). The interphalangeal articulations are ginglymoid joints, and each has a plantar and two collateral ligaments. Arches of the Foot. In order to allow it to support the weight of the body in the erect posture with the least expenditure of material, the foot is constructed of a series of arches formed by the tarsal and metatarsal bones, and strengthened by the ligaments and tendons of the foot. The main arches are the antero-posterior arches, which may, for descriptive purposes, be regarded as divisible into two types—a medial and a lateral. The medial arch is made up by the calcaneus, the talus, the navicular, the three cuneiforms, and the first, second, and third metatarsals. Its summit is at the superior articular surface of the talus, and its two extremities or piers, on which it rests in standing, are the tuberosity on the plantar surface of the calcaneus posteriorly and the heads of the first, second, and third metatarsal bones anteriorly. The chief characteristic of this arch is its elasticity, due to its height and to the number of small joints between its component parts. Its weakest part, i. e., the part most liable to yield from overpressure, is the joint between the talus and navicular, but this portion is braced by the plantar calcaneonavicular ligament, which is elastic and is thus able to quickly restore the arch to its pristine condition when the disturbing force is removed. The The lateral arch is composed of the calcaneus, the cuboid, and the fourth and fifth metatarsals. Its summit is at the talocalcaneal articulation, and its chief joint is the calcaneocuboid, which possesses a special mechanism for locking, and allows only a limited movement. The most marked features of this arch are its solidity and its slight elevation. In addition to the longitudinal arches the foot presents a series of transverse arches. At the posterior part of the metatarsus and the anterior part of the tarsus the arches are complete, but in the middle of the tarsus they present more the characters of half-domes the concavities of which are directed downward and medialward, so that when the medial borders of the feet are placed in apposition a complete tarsal dome is formed. The transverse arches are strengthened by the interosseous, plantar, and dorsal ligaments, by the short muscles of the first and fifth toes (especially the transverse head of the Adductor hallucis), and by the Peronaeus longus, whose tendon stretches across between the piers of the arches. Materials for self-control: A. Tasks for self-control (tables, diagrams, drawings, graphs): table - types of connections, connection schematically depict bone free zone and the lower limb, draw the axis movements of the hip joint, draw the axis movements of the knee joint, joints of the foot. B. Situational tasks. 1. 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. 2. A gynecologist dimensioned the pelvis of a 25-year-old pregnant woman. The distance between the iliac crests was measured with the help of a pelvimeter. What size of the large pelvis was dimensioned? A. Intertrochanteric distance. B. True conjugate. C. Interspinous distance. D. Intercristal distance. E. Anatomical conjugate. 3. A gynecologist dimensioned the pelvis of a 20-year-old pregnant woman. The distance between the greater trochanters of the femurs was measured with the help of a pelvimeter. What size of the large pelvis was dimensioned? A. Anatomical conjugate. B. True conjugate. C. Interspinous distance. D. Intercristal distance. E. Intertrochanteric distance. 4. A gynecologist dimensioned the pelvis of a 18-year-old pregnant woman. The distance from the promontory to the upper point of the pubic symphysis was measured. What size of the lesser pelvis was dimensioned? A. Anatomical conjugate. B. True conjugate. C. Interspinous distance. D. Intercristal distance. E. Intertrochanteric distance. 5. A gynecologist dimensioned the pelvis of a 19-year-old pregnant woman. The distance from the promontory to the most protruding point on the posterior surface of the pubis symphysis was measured. What size of the lesser pelvis was dimensioned? A. Anatomical conjugate. B. True conjugate. C. Interspinous distance. D. Intercristal distance. E. Intertrochanteric distance. 6. A doctor defined sizes of the pelvis of the pregnant woman. He measured the distance between two superior anterior iliac spines. What size of the pelvis was defined? A. Intertrochanteric distance. B. Intercristal distance. C. Interspinous distance. D. True conjugate. E. Anatomical conjugate. 7. A doctor defined sizes of the pelvis of the pregnant woman. He measured the distance between two iliac crests. What size of the pelvis was defined? A. Intertrochanteric distance. B. Intercristal distance. C. Interspinous distance. D. True conjugate. E. Anatomical conjugate. 8. A doctor defined sizes of the pelvis of the pregnant woman. He measured the distance between two greater trochanters. What size of the pelvis was defined? A. Intertrochanteric distance. B. Intercristal distance. C. Interspinous distance. D. True conjugate. E. Anatomical conjugate. 9. Name intraarticular structures. A. Intertrochanteric distance. B. Iliofemoral ligament, pubofemoral ligament. C. Acetabular labrum, transverse acetabular ligament, ligament of head of femur. D. Ischiofemoral ligament. E. Zona orbicularis. 10. Name intraarticular structure. A. Intertrochanteric distance. B. Iliofemoral ligament, pubofemoral ligament. C. Acetabular labrum. D. Ischiofemoral ligament. E. Zona orbicularis. 11. A 25-year-old man appealed to a doctor with complaints of movements damage in the knee joint - anteroposterior displacement of the crus about the femur (so-called drawer sign) - that appeared after a trauma. What ligaments of the knee joint are injured? A. Collateral. B. Arcuate popliteal. C. Cruciate. D. Interosseous membrane of leg. E. Oblique popliteal. 12. During a football match a player-injured a knee joint. A roentgenogram shows the fracture of the bone, which is in the thickness of the quadriceps muscle of the thigh tendon. To what group of bones does this bone refer? A. Pneumatic bones. B. Flat bones. C. Tubular bones. D. Sesamoid bones. E. Mixed bones. 13. As a result of a fall the distal tibiofibular connection was injured. What type of bones union has been injured? A. Symphisis. B. Synchondrosis. C. Synostosis. D. Diarthrosis. E. Syndesmosis. 14. During a football match a player injured a knee joint. Name the articular surfaces of the knee joint. A. The articular surfaces of the femoral condyles and tibial condyles, the articular surface of the patella B. Auricular surfaces of the ilium and sacrum C. The head of the fibula and fibular articular surface of the tibia D. The lunate surface of the acetabulum and the head of the femur E. Lateral surfaces of the ilium and sacrum 15. During a football match a player injured an ankle joint. Name the articular surfaces of the ankle joint. A. The head of the fibula and fibular articular surface of the tibia B. Auricular surfaces of the ilium and sacrum C. The articular surfaces of the femoral condyles and tibial condyles, the articular surface of the patella D. The articular surfaces of the distal ends of the tibia and fibula, the trochlear articular surface of the talus E. Lateral surfaces of the ilium and sacrum 16. During a football match a player injured the talocrural joint. Name the articular surfaces of the talocrural joint. A. The head of the fibula and fibular articular surface of the tibia B. Auricular surfaces of the ilium and sacrum C. The articular surfaces of the femoral condyles and tibial condyles, the articular surface of the patella D. The articular surfaces of the distal ends of the tibia and fibula, the trochlear articular surface of the talus E. Lateral surfaces of the ilium and sacrum 17. During a football match a player injured the subtalar joint. Name the articular surfaces of the subtalar joint. A. The head of the fibula and fibular articular surface of the tibia B. Auricular surfaces of the ilium and sacrum C. The articular surfaces of the femoral condyles and tibial condyles, the articular surface of the patella D. The posterior articular surfaces of the talus and calcaneus E. Lateral surfaces of the ilium and sacrum 18. Name the ligament of the tarsus. A. The medial B. Anterior talofibular C. Posterior talofibular D. Talocalcaneal interosseous E. Calcaneofibular 19. Name the ligament of the tarsus. A. The medial B. Anterior talofibular C. Posterior talofibular D. Tarsal interosseous E. Calcaneofibular 20. Name the articular surfaces of the knee joint. A. The head of the fibula and fibular articular surface of the tibia B. Auricular surfaces of the ilium and sacrum C. The articular surfaces of the femoral condyles and tibial condyles, the articular surface of the patella D. The lunate surface of the acetabulum and the head of the femur E. Lateral surfaces of the ilium and sacrum References The basic 1. Human Anatomy. In three volumes. Volume 1 / Edited by V.G. Koveshnikov. - Lugansk: LTD «Virtualnaya realnost», 2009. – 328p. 2. 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. 3. Sobotta Atlas of Human Anatomy / Edited by R. Putz and R. Pabst, 14th ed. – Elsevier GmbH, Munich, 2008 . – 895p. 4. Clay JH, Pounds DM. Basic Clinical Massage Therapy: Integrating Anatomy and Treatment. 2003. 5. Grant′s atlas of anatomy ∕ Anne M.R., Arthur F. Dalley II, 12th ed. - Baltimore: Wiliams & Wolters, 2009. – 864 p. 6. Martini Frederic H. Martini′s atlas of the human body, 8th ed. – Pearson Education, 2009. – 250p. 7. Atlas of Human Anatomy / Frank H. Netter, M.D. Arthur F. Dalley; 2nd ed. // ILS, Medimedia USA Company, 1997. – 548p. Additional 1. Langman J. Medical embryology / Langman J. – Baltimore, London, 1981. – 384p. 2. Crouse G.S. Development of the female urogenital system / G.S. Crouse // Semin. Reprod. Endocrinol. – 1986. – V.4, №1. – P. 1-11. 3. Beck F. Human embryology: 2 ed / F. Beck, D. Mossat, D. Davies. - Oxford: Blackwell, 1985. – V. 11. – 372p. 4. Moore Keith L. Clinically oriented anatomy: third ed / Keith L. Moore. – 1992. - 917p. 5. Clinical Anatomy. Applied anatomy for clinical students and junior doctors: eleventh edition / Harold Ellis // Oxford, UK: Blackwell publishing. – 2006. – 455p. 6. Pocket atlas of Human Anatomy / Heinz Feneis, Wolfgang Dauber // Thieme, Stuttgart. – 2000. – 510p. 7. https://human.biodigital.com/ 8. http://anatom.ua/nomina-anatomica/

Topic 18. Content module «Osteology. Craniology. Syndesmology». Step-1. 1. Relevance of the topic. Knowledge of the general laws of the structure and development of bones and their connections are the basis for the study of all clinical disciplines. 2. The specific aims. 2.1.To have general knowledge of the topic studied; 2.2. To understand, to remember and to use the knowledge received; 2.3. To form the professional experience by reviewing, training and authorizing it; 2.4. To be able to find and show studying structures on visual aids. 3. Basic knowledge and skills necessary for study the topic (interdisciplinary integration) The preceding The acquired knowledge subjects Biology Describe phylogeny of the skeletal system; determine the starting position of the human body Physics Demonstrate biomechanics of joint work 4. The tasks for students' individual work. 4.1. The list of basic practical skills that the student must show on the bones and human anatomical preparations, tables and diagrams: 4.2. Theoretical questions for the class: 1. Define anatomy as a science. 2. Explain the origin of the word ’anatomy’. 3. How are such methods as analysis and synthesis used for studying anatomy? 4. Why is it essential to study the phylogeny and ontogeny? 5. What are the main principles of the modern anatomical nomenclature? 6. What is the universal body posture accepted in anatomy? 7. Name the axes and planes, which are drawn through the human body. 8. Explain the following terms: medial and lateral, ventral and dorsal, cranial and caudal, proximal and distal. 9. Name basic parts of the skeleton. 10. Name the regions of the vertebral column. 11. Name parts of a typical vertebra. 12. What are the characteristic features of 1) cervical vertebrae; 2) thoracic vertebrae; 3) lumbar vertebrae? 13. What are the characteristic features and clinical applications of the VI and VII cervical vertebra? 14. What are the main distinctions of the atlas from other vertebrae? What is the origin of its name? 15. What are the characteristic features of the second cervical vertebra? 16. Which processes are responsible for the formation of the crests of the sacrum? 17. What is the coccyx? 18. Name parts of the rib. 19. How are the ribs classified based on their attachment to the sternum? 20. What are the characteristic features of the first rib? 21. Name parts of the sternum. 22. What is the sternal angle? Name its function. 23. Why is the sternum widely used for the red bone marrow puncture? 24. Why is the skull divided into two regions? Name these regions. 25. What is the structure of cranial flat bones? 26. What resides in the Turkish saddle? Why is the X-ray examination of the Turkish saddle has clinical importance? 27. What do the mastoid air cells of the temporal bone communicate with? What is its clinical importance? 28. Point out the tegmen tympani. What is its clinical importance? 29. Name major canals of the temporal bone. 30. Describe the path of the facial canal. 31. What does the musculotubal canal contain? What parts is it divided into? 32. Name the sutures of the calvaria. 33. Name the three cranial fossae. 34. What structures bound: 1) temporal fossa; 2) infratemporal fossa; 3) pterygopalatine fossa? 35. Name the opening, through which the pterygopalatine fossa communicates with the other parts of the skull. 36. Name the walls of the orbit. 37. Name the communications of the orbit. 38. Name the walls of the nasal cavity. 39. What bones constitute the shoulder girdle? 40. What surfaces, angles, and borders are present on the scapula? 41. The humerus. The bones of the forearm. The structure, abnormalities. 42. The bones of the hand. The structure, abnormalities. 43. Pelvic and hip bones. Features of the structure, abnormalities. 44. The bones of foreleg and foot. The structure, abnormalities. 45. 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. 46. Atlanta-occipital and atlanta-axial joints, strycture, biomechanics of movement. Temporo-mandibular joint, structure, biomechanics of movement. 47. Connections ribs with the sternum. 48. The connections of the upper limb bones. 49. The shoulder and elbow joints. The structure, biomechanics of movement. Connections forearm and hand. 50. The connections of the lower limb bones. 51. Pelvis as a whole. The dimensions of the pelvis. Age and sex characteristics. 52. Hip joint. The structure, biomechanics of movement. 53. Knee joint, structure, biomechanics of movement. 54. Connectings of the foreleg and foot bones. 55. The joints of the foot, the foot as a whole. X-ray anatomy of bones and joints. 4.3. Practical tasks pertaining to the topic and to be completed during the class: work with the bones and wet preparations, models, decision of test tasks and situational problems with the database "Step 1". Content of the topic: see. materials of the practical sessions №1-№17. Materials for self-check: A. Tasks for self-check: B. Tasks for self-check: 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. A patient got the trauma of the back, which was accompanied with fracture of the scapula in the lateral part of the spine scapulae. What anatomical formation of the scapulae was damaged? A. Angulus superior. B. Angulus inferior. C. Acromion. D. Processus coracoideus. E. Tuberculum infraglenoidale. 7. Because of trauma, the patient got fracture of the glenoid cavity. What bone was damaged? A. The 1st rib. B. Collarbone. C. Sacrum. D. The cervical vertebra. E. Scapula. 8. The patient went to a doctor about the blunt chest trauma. On examination, defined rib fracture, which corresponds to the lower angle of the scapula. What is this rib? A. 3. B. 4. C. 12 D. 11 E. 7 9. Because of trauma, the patient got fracture of the infraglenoid tubercle. What was bone damaged? A. The 1st rib. B. Collarbone. C. Sacrum. D. The cervical vertebra. E. Scapula. 10. Because of a fall, a 70-year-old man had a femur fracture. In what part of femur do fractures happen the most often? A. Middle. B. The lower third. C. The upper third. D. Condylus. E. Neck. 11. During the volleyball match, the player got injury of the knee joint. On the X-ray, we can see a bone fracture in the tendon of the quadriceps muscle of thigh. What bone must be damaged? A. Ilium B. Pubis C. Ischium D. Kneecap (patella) E. Hip bone 12. The patient has a bleeding from a head's wound. At what point should press the carotid artery temporarily stop the bleeding? A. To the top of the neck. B. To the anterior tubercle on the transverse process of the 4th cervical vertebrae. C. To the anterior tubercles on the transverse process of the 6th cervical vertebrae. D. To the anterior tubercle on the transverse process of the 5th cervical vertebrae. E. To the anterior tubercle on the transverse process of the 7th cervical vertebrae. 13. As a result of injuries of the cervical part of the vertebral column the patient got fractures of the transverse processes of the 4th and the 5th of the cervical vertebrae. What complication can occur in the patient? A. A break of the spinal cord B. A bleeding from carotid arteries. C. The damage of the trachea. D. A bleeding from the vertebral artery E. no correct answer 14. The patient has a bleeding from a branch of the carotid artery. To temporarily stop the bleeding from the carotid artery should press to the tubercle of the transverse process of the cervical vertebra. What is it? A. II. B. V. C. IV. D. III. E. VI. 15. The patient has fracture processes of the cervical vertebrae, which have foramens for the passage of vessels. What are the processes of cervical vertebrae have holes: A. Transverse. B. Spinous. C. Superior articular. D. Inferior articular. E. Mammillary. 16. On radiographs of the patient revealed a fracture of the vertebra, which has a dens (tooth). Define this vertebra: A. CIV B. CI C. CII D. CIII E. CV 17. The patient's vertebra was injured after an accident. The damaged vertebra has no body. Determine the location of damage: A. LI B. ThII C. SII D. CI E. CVI 18. After falling from a height, a patient got the damage of the vertebral column, which was accompanied by the bleeding from the vertebral artery. Which department vertebral column was damaged? A. CVII - ThIII B. ThVII - LIII C. ThII - ThVI D. LI - LV E. CII - CVI 19. Patient admitted to hospital with an injury of the vertebral column at the level vertebrae that has a single semi-facet on the upper border of its body for connecting with the corresponding rib. Name level of the damage. A. Th 1-2 B. Th 10 C. L 1-2 D. Th 11-12 E. Th 4-5 20. Patient admitted to hospital with an injury of the vertebral column at the level vertebrae that have one full facet for connecting with the corresponding ribs. In addition, they do not have the rib facets on the transverse processes. Name level of the damage. A. Th 1-2 B. Th 9-10 C. L 1-2 D. Th 11-12 E. Th 4-5 21. Purulence of occipital soft tissues took place after a trauma. Through what anatomical formation can the purulent process spread to the cranial cavity? A. Foramen caecum B. Condylar canal C. Supraorbital foramen D. Optic canal E. Carotid canal 22. A casualty has a crack in the region of the groove for superior sagittal sinus. What part of the occipital bone can be injured? A. Internal surface of the squamous part B. External surface of the squamous part C. Basilar part D. Lateral part E. Nasal part 23. A casualty has a crack in the region of the groove for inferior petrosal sinus. What part of the occipital bone can be injured? A. Internal surface of the squamous part B. External surface of the squamous part C. Basilar part D. Lateral part E. Nasal part 24. After collision of two cars, a driver got deformation of the left occipital condyle. What part of the occipital bone can be injured? A. Basilar part B. External surface of the squamous part C. Internal surface of the squamous part D. Lateral part E. Nasal part 25. After collision of two cars, a driver got deformation of the superior orbital fissure. What part of the sphenoid bone can be injured? A. Body B. Greater wing C. Lesser wing D. Pterygoid process E. Nasal part 26. After collision of two cars, a driver got deformation of the foramen rotundum. What part of the sphenoid bone can be injured? A. Body B. Greater wing C. Lesser wing D. Pterygoid process E. Nasal part 27. After clash of two cars, a victim got destruction of the temporal bone in the area of the groove for sigmoid sinus. What part of the temporal bone can be injured? A. Body B. Tympanic C. Petrous D. Squamous E. Mastoid process 28. After clash of two cars, a victim got destruction of the temporal bone in the area of the external acoustic opening. What part of the temporal bone can be injured? A. Body B. Tympanic C. Petrous D. Squamous E. Mastoid process 29. After clash of two cars, a victim got destruction of the temporal bone in the area of the zygomatic process. What part of the temporal bone can be injured? A. Body B. Tympanic C. Petrous D. Squamous E. Mastoid process 30. After collision of two cars, a victim got destruction of the temporal bone in the area of the mandibular fossa. What part of the temporal bone can be injured? A. Body B. Tympanic C. Petrous D. Squamous E. Mastoid process 31. A child was admitted to clinic with inflammation of the middle ear. Disease began with nasopharynx inflammation. It is detected that the infection lo the tympanic cavity through the auditory tube located in: A. Canalis caroticus. B. Canaliculus tympanicus. C. Canalis musculotubarius. D. Canaliculus chordae tympani. E. Canaliculi caroticotympanici. 32. An 8-year-old boy with purulent otitis has the infection spread from the tympanic cavity into the bulb of internal jugular vein. Such complication develop in case of one of the tympanic cavity walls thinning. What wall is it? A. Medial B. Superior. C. Lateral. D. Inferior. E. Anterior. 33. A 9-year-old girl with purulent otitis has the infection spread from the tympanic cavity into the middle cranial fossa. Such complication develop in case of one of the tympanic cavity walls thinning. What wall is it? A. Medial B. Anterior. C. Lateral. D. Inferior. E. Superior. 34. A 9-year-old boy with purulent otitis has the infection spread from the tympanic cavity into the inner ear. Such complication develop in case of one of the tympanic cavity walls thinning. What wall is it? A. Medial B. Anterior. C. Lateral. D. Inferior. E. Superior. 35. A 10-year-old boy with purulent otitis has the infection spread from the tympanic cavity into the bony labyrinth. Such complication develop in case of one of the tympanic cavity walls thinning. What wall is it? A. Medial B. Anterior. C. Lateral. D. Inferior. E. Superior. References The basic 1. Human Anatomy. In three volumes. Volume 1 / Edited by V.G. Koveshnikov. - Lugansk: LTD «Virtualnaya realnost», 2009. – 328p. 2. 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. 3. Sobotta Atlas of Human Anatomy / Edited by R. Putz and R. Pabst, 14th ed. – Elsevier GmbH, Munich, 2008 . – 895p. 4. Clay JH, Pounds DM. Basic Clinical Massage Therapy: Integrating Anatomy and Treatment. 2003. 5. Grant′s atlas of anatomy ∕ Anne M.R., Arthur F. Dalley II, 12th ed. - Baltimore: Wiliams & Wolters, 2009. – 864 p. 6. Martini Frederic H. Martini′s atlas of the human body, 8th ed. – Pearson Education, 2009. – 250p. 7. Atlas of Human Anatomy / Frank H. Netter, M.D. Arthur F. Dalley; 2nd ed. // ILS, Medimedia USA Company, 1997. – 548p. Additional 1. Langman J. Medical embryology / Langman J. – Baltimore, London, 1981. – 384p. 2. Crouse G.S. Development of the female urogenital system / G.S. Crouse // Semin. Reprod. Endocrinol. – 1986. – V.4, №1. – P. 1-11. 3. Beck F. Human embryology: 2 ed / F. Beck, D. Mossat, D. Davies. - Oxford: Blackwell, 1985. – V. 11. – 372p. 4. Moore Keith L. Clinically oriented anatomy: third ed / Keith L. Moore. – 1992. - 917p. 5. Clinical Anatomy. Applied anatomy for clinical students and junior doctors: eleventh edition / Harold Ellis // Oxford, UK: Blackwell publishing. – 2006. – 455p. 6. Pocket atlas of Human Anatomy / Heinz Feneis, Wolfgang Dauber // Thieme, Stuttgart. – 2000. – 510p. 7. https://human.biodigital.com/ 8. http://anatom.ua/nomina-anatomica/