Upper and lower limb anatomy pdf

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upper and lower limb anatomy pdf

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Studying at Cambridge.

Muscles of the Lower Limb

This long-standing question remains unanswered for multiple reasons, including lack of consensus about conceptual definitions and approaches, as well as a reasonable bias toward the study of hard tissues over soft tissues. A major difficulty concerns the non-trivial technical hurdles of addressing this problem, specifically the lack of quantitative tools to quantify and compare variation across multiple disparate anatomical parts and tissue types.

In this paper we apply for the first time a powerful new quantitative tool, Anatomical Network Analysis AnNA , to examine and compare in detail the musculoskeletal modularity and integration of normal and abnormal human upper and lower limbs. In contrast to other morphological methods, the strength of AnNA is that it allows efficient and direct empirical comparisons among body parts with even vastly different architectures e.

However, when muscles are included, the overall musculoskeletal network organization of the upper limb is strikingly different from that of the lower limb, particularly that of the more proximal structures of each limb. Importantly, the obtained data provide further evidence to be added to the vast amount of paleontological, gross anatomical, developmental, molecular and embryological data recently obtained that contradicts the long-standing dogma that the upper and lower limbs are serial homologues.

In addition, the AnNA of the limbs of a trisomy 18 human fetus strongly supports Pere Alberch's ill-named "logic of monsters" hypothesis, and contradicts the commonly accepted idea that birth defects often lead to lower integration i. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Competing interests: The authors have declared that no competing interests exist. A central question in evolutionary biology and biological anthropology is how various anatomical parts of the animal body evolved into very different forms such that all parts still fit together and function properly [ 1 — 5 ]. These concepts are also tightly linked to questions about complexity and evolvability the ability to respond to selective pressure.

For instance, some authors argue that modularity enables flexibility because the direction and magnitude of evolutionary change among and within parts can vary without sacrificing function [ 9 , 11 — 17 ], while others argue that a higher integration less parcellation within an anatomical system, such as the head, may increase evolvability [ 2 ]. These issues are particularly crucial to understand the evolution of human limbs, which is notable among tetrapods and primates for the magnitude of morphological shifts in the musculoskeletal system, including the pervasive changes in the limbs associated with the acquisition of bipedalism [ 18 — 27 ].

However, paradoxically, our knowledge of morphological modularity, integration, complexity and evolvability remains limited even for the musculoskeletal system of our own species, because of the difficulty of studying the myriad interactions among the body's hard and soft-tissues [ 28 , 29 ]. Moreover, in no small part due to the challenge of managing and making sense of complex datasets, most studies have concentrated on a single body region.

Consequently, a wide gap persists in our understanding of human musculoskeletal system as a whole. New approaches are thus needed to identify and compare patterns of organization, integration, modularity, evolvability and complexity between the muscles and bones of the limbs to have a more comprehensive and integrative view of the evolutionary history, as well as on the functional morphology, development and pathology, of the human body in the context of habitual bipedalism.

Anatomical network analysis AnNA of connectivity patterns e. In contrast to evolutionary quantitative genetics and morphometric methods, a unique strength of AnNA is its direct comparisons among different tissues e. Specifically, AnNA evaluates connectivity patterns using tools and statistics borrowed from network theory, formalizing bones, muscles and their physical contacts as the nodes and links of a network model to assess the morphological organization of, and identify patterns of integration and modularity among, muscles and bones [ 44 ].

Importantly, AnNA is a formal framework to study morphological organization free of a priori assumptions about developmental, functional, and phylogenetic relationships among structures. We recently used AnNA to provide new insights on the musculoskeletal organization of the head of human adults, newborns, and fetuses with and without birth defects, as well as some preliminary comparisons between the head and upper limbs [ 29 , 45 , 46 ].

This present paper provides the first application of AnNA to examine and compare in detail the musculoskeletal modularity and integration of the upper and lower limbs ULs, LLs in the normal human adult and newborn phenotype and in a trisomy 18 T18 human fetus.

T18 or Edward's syndrome is a condition caused by the presence of an extra chromosome 18 and usually results in slow embryological growth and low birth weight. Phenotypic abnormalities often include overlapping fingers with clenched fists, problems with organ morphogenesis and a small head [ 47 , 48 ].

Many of T18 individuals die before birth and less than ten percent survive past their first year [ 47 , 48 ]. For instance, any changes in musculoskeletal integration and modularity resulting from phenotypic malformations found in a particular T18 individual can be studied by comparing the abnormal anatomical networks seen in that individual to those present in the normal phenotype.

By including such comparisons, the present work will thus provide new information salient to these and other broader evolutionary and developmental issues that will further clarify the associations and tipping points between normal and abnormal development of the UL and LL, modularity, integration, and anatomical defects. In this section we summarize and compare the AnNA of the three conditions studied: normal adult, normal newborn, and T18 fetus.

We focus on the results of the quantification of basic network parameters, which are further detailed in S1 Results for entire networks and S2 Results for proximal vs. Specific modularity results are discussed extensively in the Discussion section in a broader developmental, functional, pathological and evolutionary context. One of the major goals of the present paper is to compare the musculoskeletal phenotype and network modules of the UL vs.

Therefore, results are presented such that we directly compare the ULs and LLs among all three conditions normal adult, normal newborn, and T The descriptions of the network organization of the ULs will be briefer than those of the LLs as some aspects of the UL organization have been briefly described by us [ 49 ], contrary to that of the LL, which is provided for the first time here.

Finally, we complement the comparative analysis by calculating the similarity between the modular organization identified using AnNA and different hypothesis of functional and developmental groups S4 Results.

The skeletal, muscular and musculoskeletal networks and modules of the left and right ULs of the normal newborn are similar to each other, and similar to those of the adult, comprising 34 bones sparsely connected by 44 articulations, while the muscular system comprises 57 muscles connected by only four contacts and the musculoskeletal system comprises 91 bones and muscles connected by contacts Fig 1 ; Fig 2 ; Table 1.

The skeletal system shows a tree-like, non-hierarchical organization characterized by a low density of connections and a few number of triangular loops i. Muscles of the UL are barely connected with each other, but, when analyzed together with bones, the musculoskeletal system has a high number of triangular relations among bones and muscles, indicating that these parts are highly clustered, and hence they have a hierarchical, small-world organization.

To see similar network plots for all the other skeletal, as well all the muscular and musculoskeletal, systems of all limbs, see S1 — S24 Figs see S1 Methods for labels. A to C dorsal extensor view; D to F ventral flexor view. It should be noted that the skeletal, muscular and musculoskeletal networks and modules of this left normal newborn UL are similar to the right one, and to both the left and right normal adult ULs. B, E Muscle network modules: no muscles create any modules in this network.

The networks and modules of the left and right LLs of the normal adult are similar to each other, but are different to those of the newborn. They include 33 bones connected by 41 articulations, 57 muscles connected by 6 contacts and a musculoskeletal system with 90 bones and muscles connected by contacts. In terms of number of triangular loops i. It should be noted that the skeletal, muscular and musculoskeletal networks and modules of this left normal adult LL are similar to the right one.

The network organization and modules of the left and right LLs of the normal newborn are similar to each other, but are different to those of the adult.

They include 35 bones connected by 46 articulations in contrast to the adult LL, the pelvis is still clearly divided into three separate bones: the ischium, pubis and ilium , 57 muscles connected by 6 contacts as in the adult LL , and a musculoskeletal system with 92 bones and muscles connected by contacts Fig 4 ; Table 3 ; different to adult LL due to the pelvic differences mentioned just above.

Interestingly, the only difference between the adult and newborn LL i. This difference regarding the hierarchical organization is blurred when muscles are added: the musculoskeletal organization of the adult LL remains non-hierarchical during postnatal development, although the overall similarity between the musculoskeletal network of the newborn vs. It should be noted that the skeletal, muscular and musculoskeletal networks and modules of this left normal newborn LL are similar to the right one.

B, E Muscle network modules: as in normal adult see Fig 2. This increase in contacts is sufficient to generate a small-world, hierarchical organization, suggesting that potential modules might be morphologically meaningful e.

The musculoskeletal system comprises 89 bones and muscles connected by contacts Fig 5 ; Table 4. That is, the whole network organization of the T18 left UL is far from being chaotic. The only difference between the muscular systems of the T18 left and the normal newborn LLs is that, in the T18 left LL and also the T18 right LL , the gastrocnemius and soleus muscles are fused, forming a single module instead of two 1-muscle modules, in a total of 50 muscular modules vs.

This differences, and other differences concerning the bone-muscle connections in the T18 left LL, result in a musculoskeletal network with two fewer modules 7 vs.

A, D Skeletal network modules: as in normal newborn see Fig 3. The T18 right UL musculoskeletal system comprises 86 bones and muscles connected by contacts, and shows a small-world, hierarchical organization. A horizontal flip was done with Photoshop, so the modules of this right UL can be more easily compared with those of the left ULs shown in Figs 1 and 4.

The only difference between the muscular modularity of the T18 left and right LLs is that on the right side the popliteus is missing, and therefore there is one less 1-muscle module, in a total of 49 modules vs. The similarity between the right vs. A horizontal flip was done with Photoshop, so the modules of this right UL can be more easily compared with those of the left ULs shown in Figs 2 , 3 and 5.

A, D Skeletal network modules: as in normal newborn see Fig 4. This is the first study using AnNA for the LLs of any tetrapod species, using a wide range of AnNA methods to acquire a vast amount of quantitative data for both the LLs and ULs in order to offer a comprehensive discussion of, and comparison between, these limbs. The S1 — S24 Figs display a schematic summary of the anatomical networks of all limbs compared in the present work.

These type of schemes are extremely useful to easily visualize and compare the overall connectivity patterns and network organization of each system: skeletal, muscular or musculoskeletal. Fig 1 provides an example of this in the skeletal networks of the normal adult UL vs. For instance, in the UL, the condensation, bifurcation, and segmentation of the ulna produces the formation of cartilages of the primary axis, such as the triquetrum 'ulnare' in amphibians and lunate 'intermedium' in amphibians , in a proximodistal sequence.

Then the condensation and bifurcation of the lunate gives rise to two proximal centralia, each then giving rise to each of the two distal centralia N. In turn, condensation, bifurcation and segmentation of the triquetrum will give rise to the digital arch in a posteroanterior ulno-radial in human anatomy sequence, to the hamate and digit 4 this digit is the primary axis of the phalangeal region , to the capitate and digit 3, the trapezoid and digit 2, and trapezium and digit 1.

The hamate, capitate, trapezoid and trapezium correspond to the '4th, 3rd, 2nd and 1st distal carpals' of amphibians, so in this model digit 5 is often seen as a de novo condensation. Regarding the scaphoid 'radiale' in amphibians , it segments from the radius, i. For instance, the ulna itself does not articulate with any carpal bone, while the radius articulates distally with the scaphoid, but also with the lunate.

Also, the triquetrum articulates with two cartilaginous carpals lunate and hamate; the pisiform being a sesamoid bone , while the scaphoid articulates with four trapezium, trapezoid, capitate and lunate. That is, there is no clear preaxial connectivity dominance as in the UL e. However, three points should be made. Firstly, in adults of early tetrapod taxa the ulna articulated with the triquetrum that is why anatomists named this bone 'ulnare' in those tetrapods [ 54 ].

Secondly, there are however connectivity patterns in early tetrapods and closely related sarcopterygian fish that do not mirror the ontogenetic relationships predicted in that model. Including AnNA in future embryological and developmental experimental works might help to better understand the details of, and changes in the patterns of connectivity during, skeletal morphogenesis in the UL and LL of humans and other tetrapods.

As the same five modules are also seen in the skeletal organization of the foot, this could be used as an argument to support the view of those authors arguing that the bones that are usually designated as metacarpal 1 and metatarsal 1 actually correspond to the proximal phalanges of the thumb and big toe, respectively.

That is, that these digits have three phalanges each, as do the other digits, and that the true metatarsal 1 and metacarpal 1 are actually missing see, e. For instance, some musculoskeletal modules of the normal UL extend from the body midline to the distal phalanx of the thumb arm-forearm-thumb movement module, including latissimus dorsi and flexor and extensor pollicis longus.

The grouping of the thumb and digits 2 and 3 in the digits movement musculoskeletal module Fig 2 ; Table 1 is interesting because the thumb has a developmental and evolutionary history that is markedly different to that of other digits e. In addition, the existence of a digits 4—5 movement musculoskeletal module in humans is also interesting, and unexpected functionally and evolutionary, because digit 4 is the first to form developmentally in our species while digit 5 forms later often starting to form only after digit 3, and even 2, in mice and humans and is functionally different from the other fingers e.

That is, the whole musculoskeletal network organization of the normal UL seems to reflect function slightly more than development S4 Results. In recent works we described and compared in some detail two models that reflect two very different ways of viewing birth defects [ 46 , 61 ].

Therefore, here we will just provide a short introduction to them; for more details readers should refer to those two works, and particularly to the original papers [ 62 , 63 ]. In short, Alberch's ill-named theory "the logic of monsters" LoMo [ 62 , 63 ] argued that teratologies are forms that lack adaptive function but that normally preserve structural order, being based on an "internalist" developmental framework.

That is, due to strong internal developmental constraints and thus a limited set of possible phenotypic outcomes, a teratological form has to follow the rules that pertain to the normal developmental mechanisms available. Alberch thus suggested that the study of birth defects can be particularly useful to better understand normal development, thus coming back to a view that was often followed by researchers between the 11th and 17th centuries but then mainly became abandoned—and often ridiculed—by various researchers in the 18th century [ 64 ].

For instance, the LoMo has very different assumptions and predictions than models that have been more accepted by pathologists and comparative anatomists in the last decades, such as the "lack of homeostasis" model of Shapiro [ 63 ], which tend to see birth defects as more random, chaotic phenotypic features.

In fact, the only major point in which the two models agree is that the developmental processes that will be the most often and seriously affected are those that are more unstable leading to variations in the normal population. An illustrative example, predicted by both the LoMo and "lack of homeostasis" models, is that a very common human variation polymorphism , the absence of palmaris longus muscle seen in c.

However, the "lack of homeostasis" model predicts this outcome because it assumes a generalized decreased developmental and physiological homeostasis, while the LoMo predicts it because it assumes a logical parallel between variant and defective development, due to strict developmental constraints.

That is, while the "lack of homeostasis" model argues that defects are in general more random and disorganized due to a general disturbance of homeostasis, the LoMo predicts that defects are more "logical" and "constrained" because constraints are in general still kept intact by internal homeostasis.

Therefore, contrary to the former model, the LoMo predicts that congenital malformations and plastic variations found in a certain taxon often also mirror features that are consistently found in the normal phenotype of individuals of other taxa.

This prediction has been supported by studies showing that the existence of similar patterns of intra-specific diversity in a taxon plasticity and inter-specific diversity in different taxa is usually the result of similar developmental mechanisms [ 65 ]. AnNA is a powerful tool to contribute to such discussions, which have important medical, developmental and evolutionary implications.

Arterial Supply of the Lower Limb

Describe the bones of the lower limb, including the bones of the thigh, leg, ankle, and foot. Like the upper limb, the lower limb is divided into three regions. The thigh is that portion of the lower limb located between the hip joint and knee joint. The leg is specifically the region between the knee joint and the ankle joint. Distal to the ankle is the foot.

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Upper and lower limb standards in newborn

I thought it was just undergraduate high spirits. She followed me down the street, lecturing me loudly on cowardice and Country and Lord Kitchener. There exist different muscles, which we have covered in class over the past few weeks. With the midterms just around the corner, it is important to remember what we learnt. Take the quiz and gauge your understanding.

This long-standing question remains unanswered for multiple reasons, including lack of consensus about conceptual definitions and approaches, as well as a reasonable bias toward the study of hard tissues over soft tissues. A major difficulty concerns the non-trivial technical hurdles of addressing this problem, specifically the lack of quantitative tools to quantify and compare variation across multiple disparate anatomical parts and tissue types. In this paper we apply for the first time a powerful new quantitative tool, Anatomical Network Analysis AnNA , to examine and compare in detail the musculoskeletal modularity and integration of normal and abnormal human upper and lower limbs.

The Lower Limb

This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables. These three volumes, which long have been familiar to medical students, provide a source of information on anatomy which is appreciated not only by students but by practitioners, especially those interested in surgery.

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8.4 Bones of the Lower Limb

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