Study Guidemanual- PAM2LIN PDF

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College of Science, Health & Engineering

Department of Physiology, Anatomy & Microbiology

PAM2LIN/HBS2HAA Anatomy of the Lower Limb & Introduction to Neuroanatomy/ Human Anatomy A Semester 2 Study Guide/Practical Manual 2020

Subject Coordinator: Heath McGowan & Dr Jency Thomas Department of Physiology, Anatomy & Microbiology La Trobe University VICTORIA, 3086 TELEPHONE: 9479 2914

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Subject Co-ordinator:

Heath McGowan Telephone: 9479 2914 E-mail: [email protected] Dr Jency Thomas Telephone: 9479 5755 Email: [email protected]

Printed: 2020 Text and diagrams contributed by members of the Department of Physiology, Anatomy & Microbiology and Rural Human Biosciences.

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USEFUL INFORMATION CONTACTS FOR HBS2HAA COORDINATING STAFF Role Subject coordinator Subject coordinator

Name Heath McGowan Jency Thomas

Building/Rm HS2 309 HS2 429

Phone 9479 2914 9479 5755

Email [email protected] [email protected]

UPDATES AND NOTICES New information is announced in lectures where applicable, and also via LMS. Please check the HBS2HAA LMS site regularly for any announcements or information relevant to this subject including: timetable changes content notes

practical class groups practical test content & marks assessment statement/information

GENERAL INTRODUCTION SECTION OF THE ANATOMY MANUAL You are strongly advised to read thoroughly, and frequently make reference to, the ‘General Introduction’ section of this study guide/practical manual as it gives you all the basic information on the structure of the subject and the resources available to you to assist your studies in this subject this semester.

COMPLETING PRE-LECTURE, PRE-PRACTICAL AND TOPIC OBJECTIVES You are required to complete pre-lecture activities before either attending or viewing the lecture or topic. Prior to practical sessions, ALL pre-practical tasks (e.g. muscle tables) must be completed as time is not allocated during practicals. Aim to have the relevant objectives completed after each topic. Objectives outline the content required to successfully complete the assessment tasks for the subject.

READING A suggested reading list and associated resources are listed for each set of objectives; YOU ARE NOT REQUIRED TO READ ALL OF THE LISTED BOOKS, select the one which suits you best and only read further if you are unable to complete the relevant objectives.

ANATOMICAL VARIATION In some topics you study in this subject, you may find variation between what the lecturer/facilitator has said and what the text-book states, or between different text-books. This is usually because information in texts is largely based on dissection of a limited number of cadaver specimens or work on living subjects- and the human body is variable! Should you find a variation between sources, use the version presented in topic notes. It would be appreciated if you could also bring the variation to the attention of the lecturer who gave the presentation on that topic, so that a comment can be made in future presentations if necessary.

STUDENT RESPONSIBILITY & STUDY PROBLEMS You are responsible for your own notes and study materials in this subject. If you are absent from class, it is your responsibility to obtain notes for yourself – from a classmate in the first instance. If you feel that you are unable to study effectively in this (or any other) subject or you are getting behind in your work seek help from the relevant subject coordinator or from the Faculty of Health Sciences Study Skill Advisors (see Academic language and learning unit ALLU http://www.latrobe.edu.au/students/learning ). It is better to seek help early before problems escalate- do not leave it too late if you are having problems!

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SECTION 2- SUBJECT CONTENTS

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TOPIC 1: EMBRYOLOGY PRE-LECTURE ACTIVITIES 1.

Explain the term segmental innervation. Relate the use of this term with the definitions of dermatome and myotome.

2.

Provide an example of tissue types that these terms represent on the torso (refer to Principal NP10).

CONCEPTS, PRINCIPLES & OBJECTIVES Major new concepts embryonic germ layers (endoderm, mesoderm, ectoderm) somites and their derivatives (sclerotome, myotome, dermatome) body wall and body cavities (= coeloms) somatic and visceral structures plus all other new anatomical structures or events as included in the objectives below. You will need to be able to describe each new concept in terms of what it is, where it is and how it functions.

Major new principles E1 Tissues of the same type, irrespective of their location in the body, usually derive from the same embryonic germ layer. NP10 Nerve fibres derived from a single spinal segment innervate a particular area of skin (dermatome) and a particular block of muscle (myotome).

Objectives You will need to use concepts and principles in order to complete the objectives below. You should then aim to understand how these concepts and principles aid your study of anatomy as a whole. Trilaminar embryo 1.

List the three germ layers of a trilaminar embryo and state when this stage of development is reached. Name the tissue types which will derive from each of the layers of a trilaminar embryo.

2.

List the four different types of mesoderm. Consider Principle E1 and apply this principle by providing an example of a structure that will derive from each type of mesoderm in the adult.

3.

Define coelom and list the cavities of the adult body that derive from coelomic cavities. Hence differentiate between somatic (body wall) and visceral structures related to these cavities. Distinguish between tissue types/layers/organs that are typically somatic and those that are typically visceral and state the significance of this for innervation by components of the nervous system.

Somites 4. Define somite and briefly explain the process of its development. 5.

State the number of somites and how many in each location.

6.

Describe the differentiation of a somite (into sclerotome, myotome & dermatome) and the contribution each of these components of a somite makes to the adult body.

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State the innervation of a somite and therefore describe the relationship between myotomes and dermatomes and the segmental innervation of the muscles and skin of the trunk. State why the somite may be considered to be the basis of the segmental organization of the body.

Origin and innervation of the trunk 8.

State the origin of the bony structure of the vertebral column.

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State the embryological origins of the muscles of the anterior and posterior trunk and therefore their innervation.

Reading & Resources- select from relevant parts of: Marieb & Hoehn: Chapter 28. Moore & Persaud: Chapters: 3 -6 Schoenwolf: Chapters 3, 4, 7 – 10 Anatomy TV Diagrams-

on page 10-12

Practical exercises Relevant parts of Practical 6 and all subsequent practicals

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POST-LECTURE ACTIVITY Trilaminar embryo Diagram A: Transverse section of a trilaminar embryo

Name the three layers of the trilaminar embryo in Diagram A. a: b:

a

b

c:

c

From which of these layers do the major tissue types derive from? Connective:

Muscle: Nervous:

Epithelial:

Diagram B: transverse section through a trilaminar embryo.

c

b a

d

Which embryonic germ layer is: a, b, c & d all part of in Diagram B?

Name each of these components. a: b: c: d:

State which components of the nervous system will innervate components a and b. a:

b: Name the component that the developing limb bud will derive from?

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TRILAMINAR EMBRYO (3rd week) (transverse sections)

TRILAMINAR EMBRYO GERM DISC

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SOMITE DIFFERENTIATION (4th week) (transverse section)

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SOMITE INNERVATION (longitudinal section)

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TOPIC 2: INTRODUCTION TO THE LOWER LIMB PRE-LECTURE ACTIVITIES 1. Define 'lower limb' and describe its relationships to the pelvic girdle and axial skeleton. Identify the bones, joints and regions of the lower limb. Explain how the lower limb conforms to the pattern of a typical pentadactyl limb. 2. Use the diagram below to name the regions and locate the major muscle groups of the lower limb.

REGIONS AND MUSCLE GROUPS OF THE LOWER LIMB Lateral view

CONCEPTS, PRINCIPLES & OBJECTIVES Major new concepts pentadactyl limbs line of weightbearing limb buds limb rotation anatomical spaces: femoral triangle, popliteal fossa, tarsal tunnel reflexes: spinal assessing the functioning of spinal segments

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Major new principles E2 In the foetus, the upper and lower limbs rotate in different directions from their original embryological position. M13 Stability of the body in any posture requires the line of the centre of gravity to fall within the base of support. M14 Maintenance of an upright posture depends, in part, upon the coordinated activity of flexor and extensor muscle groups. M24 During any closed-chain movements of the lower limb, proximal limb segments will move over the weightbearing distal segment. V9

Major arteries are situated on the flexor surface of joints.

V10 Major arteries entering a limb supply particular proximal muscle compartments and may also continue on through the limb to supply related distal compartments. V11 Major veins and lymphatics originating distally in a limb drain successive and specific muscle compartments (deep vessels) or areas of skin (superficial vessels) as they travel proximally. V8

Superficial lymphatics follow veins; deep lymphatics follow arteries.

P5 A painful or swollen lymph node may indicate spread of infection or disease from the region drained by the lymphatics which pass through the lymph node. NP11 The myotome pattern in a limb is such that muscles producing movements at more inferior joints in a limb tend to be innervated by nerve fibres derived from more inferior spinal segments. NP13 The dermatome pattern in a limb is a sequence of areas of skin arranged distally along the pre-axial border and then proximally along the post-axial border, innervated by more inferior spinal segments. NP12 The functioning of spinal segments can be assessed by testing the sensation in the related dermatomes, testing the movements brought about by muscles derived from the related myotomes, and by testing the spinal reflexes related to this level of the spinal cord. NP27 Reflexes are generally adaptive (useful) and provide fast stereotyped responses to potentially harmful stimuli.

Objectives You will need to use concepts and principles in order to complete the objectives below. You should then aim to understand how these concepts and principles aid your study of anatomy as a whole. General 1. Describe the position of the ‘line of centre of gravity’. Explain the significance of the position of the line of centre of gravity for stability of the lower limb.

Limb bud development 2. Define and identify on appropriate diagrams and models the following features of a developing limb bud: a. pre- and post-axial borders b. ventral and dorsal surfaces

15 3. Describe the rotation of each of the lower limbs during development and, therefore, the reorientation of the ventral and dorsal surfaces and pre- and post-axial borders in the adult. Name the structures which mark the pre- and post-axial borders in both the developing limb bud and the adult limb. a. Hence distinguish between the use of the following pairs of terms: ventral/dorsal and anterior/posterior. b. Describe the implication of the rotation for location of flexor and extensor muscle groups in the lower limb.

Muscles and movements of the lower limb 4. Relate the movements occurring by the major muscle groups to the principal joints of the lower limb and the requirements for balance and posture. 5. Review the concepts of open-chain and closed-chain movements. Explain the significance of these types of movements for the lower limb.

Anatomical spaces 6. Review the concept of an anatomical space in terms of its boundaries, functions and openings. 7. Identify on cadaver specimens, models, diagrams and on yourself, the following anatomical spaces. Femoral triangle Adductor canal & hiatus Popliteal fossa Tarsal tunnel

Vessels of the lower limb 8. Consider principle V10. Name the major artery entering the lower limb and state its origin. Use principle V10 to suggest the likely location of major arteries distally in the lower limb – which anatomical spaces are these likely to be located in? 9. Describe the origin, course and termination of the long (or great) saphenous and short saphenous veins. Explain their relationship to each other and to the deep veins of the lower limb and what principle is referred to. 10. Describe the general pattern of lymphatic drainage of the lower limb, the location and distribution of inguinal and popliteal lymph nodes and their related areas of drainage. Explain the relationship of these lymph nodes to the containment of infection spreading from different areas of the foot and other regions of the lower limb and trunk. Justify your explanation with related principles.

Innervation of the lower limb 11. Use the terms ‘spinal segment' and ‘spinal nerve’ to define a 'dermatome' and a 'myotome'. Review the embryological origins of dermatomes and myotomes. 12. Describe the pattern of dermatome distribution in the lower limbs. Confirm that this exemplifies the typical pattern of dermatome distribution in a limb after embryological limb rotation is accounted for. Explain the significance of the axial lines. 13. Describe the myotome distribution in the lower limb (as an example of a typical limb) and identify myotomes commonly involved in movements at joints of the lower limb.

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Reading & Resources- select from relevant parts of: Moore et al. (2014): Clinically Oriented Anatomy (7th Ed.) Drake: Chapter 6 Schoenwolf: Chapter 8 Snell: Chapter 1 Anatomy TV

Bone diagrams- on page 17-22

Practical exercises Relevant parts of Practicals 8 & 9 and all subsequent practicals.

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LIMB BUD DEVELOPMENT

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WEIGHTBEARING IN THE LOWER LIMB

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SPACES OF THE LOWER LIMB

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DERMATOMES OF THE LOWER LIMB

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AREAS OF SKIN SUPPLIED BY CUTANEOUS NERVES OF THE LOWER LIMB

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MYOTOMES AND MOVEMENTS OF THE LOWER LIMB

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TOPIC 3: PELVIS PRE-LECTURE ACTIVITIES 1. Osteological features of the hip bone The hip bone has many bony markings. They can be: Depressions (e.g. fossa) Openings (e.g. foramen) Protrusions (e.g. tuberosity) Each marking is named according to its shape and the bone is resides on. For example, the ischial tuberosity is a tuberous protrusion located on the ischium bone, on the posterior – inferior aspect of the hip bone With the aid of an atlas or textbook, use the structures listed under the heading ‘Hip Bone’ Error! Bookmark not defined. of your Study Guide to label the hip bone diagrams on page 33-34. 2. Ligaments and membranes of the pelvis Draw, shade and label the following structures on the diagram of ‘Pelvic Ligaments and Membranes’ on page 27 in the Study Guide, using both anterior and posterior views. Anterior • inguinal ligament • obturator membrane Posterior • sacrospinous ligament • sacrotuberous ligament 3. Using the diagram ‘Openings from the Pelvis’ on page 30 in your Study Guide, identify and circle the following openings: 1) 2) 3) 4)

Under inguinal ligament Obturator canal Greater sciatic foramen Lesser sciatic foramen

POST-LECTURE ACTIVITY Then draw and list the neurovascular structures passing through each opening. Also indicate the anatomical region each structure is passing from and to.

CONCEPTS, PRINCIPLES & OBJECTIVES Major new concepts anatomical space pelvis (cf pelvic girdle, hip bone) line of the centre of gravity course of an anatomical structure axis of a joint plus all other new anatomical structures or events as included in the objectives below. You will need to be able to describe each new concept in terms of what it is, where it is and how it functions.

24 Major new principles General The course of an anatomical structure may be defined in terms of where it starts (origin), where it ends (termination) and how it gets there (i.e., major anatomical relationships it has on its way from its origin to its termination). Anatomical spaces A1

An anatomical space is defined by boundaries and has openings for communication with other regions of the body.

A2

The boundaries of a space can be actual anatomical structures or defined by landmarks agreed by anatomical convention.

A3

The boundaries of a space can be hard or soft tissues.

A4

The functions of a space relate to the structures within it or passing through it.

A5

Every exit is an entrance somewhere else.

A6

The openings between spaces can be described using the same terms as those for the spaces themselves, i.e., openings have boundaries and have functions relating to the structures passing through them.

Musculoskeletal D3

The development of age- or gender-based differences is reflected, in part, in a sequence of physically and functionally related changes to both soft tissue and skeletal components of the human body.

T4

Structures designed for weightbearing tend to have larger surface areas in order to reduce potential tissue damage and increase stability.

T5

Structures involved in shock absorption must be deformable in order to assist in dissipation and/or spreading of forces applied to them.

M3

Simple movements in an anatomical plane of reference take place around an axis which is perpendicular to that plane.

Neurovascular V3

Arteries and veins are continuous throughout their course but may change their names in different parts of their course, e.g., where they branch or receive tributaries respectively.

N15

Peripheral nerves and their component fibre types are continuous throughout their course but may change their name in different parts of their course (e.g., where they branch or fuse in the periphery of the body).

Objectives You will need to use concepts and principles in order to complete the objectives below. You should then aim to understand how these concepts and principles aid your study of anatomy as a whole.

Osteology of hip bone 1.

Identify and name the borders, surfaces and major bone markings on the hip bone (see bone diagrams on page 33-34).

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Describe in general terms, the development and pattern of ossification of the hip bone.

Pelvis as a basin 3.

Define pelvis and state its relationship to the hip bones and to the pelvic girdle. Describe the normal orientation of th...