Basic Tissues & Structures - Human Anatomy - Color Atlas and Textbook

12/5/2016
Basictissues&structures|HumanAnatomy:ColorAtlasandTextbook
Basictissuesandstructures
Skin
Skin(Fig.1.9 )isaprotectivecoveringforthesurfaceofthebodyandcomprisesasuperficial
layer,calledtheepidermis,andadeeperlayer,thedermis.Theepidermisisanepithelium
consistingofasurfacelayerofdeadcellswhicharecontinuallyshedandreplacedbycellsfrom
itsdeepergerminallayer.Thedermisisalayerofconnectivetissuecontainingbloodvessels,
lymphaticsandnerves.Inmostareasofthebodytheskinisthinandmobileovertheunderlying
structures.Specializationsoftheskinincludefingernailsandtoenails,hairfolliclesandsweat
glands.Onthepalmsofthehandsandsolesofthefeet(andcorrespondingsurfacesofthe
digits),hairfolliclesareabsentandtheepidermisisrelativelythick.Theskinintheseregionsis
alsofirmlyanchoredtotheunderlyingstructures,reducingitsmobilityduringgrippingand
standing.Linesoftension(Langerslines)occurwithinskinandareofimportancetosurgeons.
Scarsfollowingsurgicalincisionsmadealongtheselinestendtobenarrowerthanthosemade
acrossthelinesoftension.
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F IG. 1.9
Multilevelstepdissectionthroughtherightmidcalftoshowlayersof
Skinisusuallywellvascularizedandreceivesbloodfromnumeroussubcutaneousvessels.
Knowledgeofthisvascularsupplyisimportantwhenoperationsthatinvolvetheuseofskin
flapsareundertaken.Skinhasarichnervesupply,respondingtotouch,pressure,heat,cold,
vibrationandpain.Incertainareas,suchasthefingertips,theskinisespeciallysensitiveto
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touchandpressure.Skinisinnervatedbysuperficial(cutaneous)branchesofspinalorcranial
nerves.Theareaofskinsuppliedbyeachcranialorspinalnerveisknownasadermatome
(seeFigs1.37 &1.38 ).
Subcutaneoustissue(superficialfascia)
Immediatelydeeptotheskinisalayeroflooseconnectivetissue,thesubcutaneoustissue(Fig.
1.9 ),whichcontainsnetworksofsuperficialveinsandlymphaticsandistraversedby
cutaneousnervesandarteries.Italsocontainsfat,whichvariesconsiderablyinthicknessfrom
regiontoregionandbetweenindividuals.Forexample,overthebuttockthefatisparticularly
thickwhilstonthebackofthehanditisrelativelythin.Overthelowerabdomenthistissueis
subdividedintotwolayers,asuperficialfattylayerandadeepermembranouslayer.
Deepfascia
Thedeepfascia(Fig.1.9 )consistsofalayerofdenseconnectivetissueimmediatelybeneath
thesubcutaneoustissue.Althoughthinoverthethoraxandabdomen,itformsasubstantial
layerinthelimbs(forexample,fascialataseep.260 )andneck(forexample,investing
fasciaseep.322 ).Nearthewristandanklejointsthedeepfasciaisthickenedtoform
retinacula,whichmaintainthetendonsinpositionastheycrossthejoints.Deepfasciaalso
providesattachmentformusclesandgivesanchoragetointermuscularsepta,whichseparatethe
musclesintocompartments.Bleedingandswellingwithinmusclecompartmentsdueto
crushinginjuriesorfracturesmayraisethepressuresomuchthatitcompressesbloodvessels
andreducesbloodflow.Theresultingischaemiamaybefollowedbyscarringanddeformitywith
contractureofmuscles.
Muscle
Muscleisatissueinwhichactivecontractioneithershortensitscomponentcellsorgenerates
tensionalongtheirlength.Therearethreebasictypes:smoothmusclecardiacstriatedmuscle
voluntarystriatedmuscle.Striatedandsmoothdescribethemicroscopicappearanceofthe
muscle.
Smoothmuscleispresentintheorgansofthealimentary,genitourinaryandrespiratorysystems
andinthewallsofbloodvessels.Capableofslow,sustainedcontraction,smoothmuscleis
usuallycontrolledbytheautonomicnervoussystem(seep.22 ),and,insomeorgans,by
endocrinesecretions(hormones).
Cardiacstriatedmuscle(myocardium)isconfinedtothewalloftheheartandisabletocontract
spontaneouslyandrhythmically.Itscyclicalactivityiscoordinatedbythespecialized
conductingtissueoftheheartandcanbemodifiedbytheautonomicnervoussystem.
Skeletalmuscle(voluntarystriatedmuscle)isthebasiccomponentofthosemusclesthat
producemovementsatjoints.Theseactionsarecontrolledbythesomaticnervoussystem(seep.
20 )andmaybevoluntaryorreflex.Eachmusclecell(fibre)hasitsownmotornerveending,
whichinitiatescontractionofthefibre.Musclesmaybeattachedtotheperiosteumofbones
eitherdirectlyorbyfibrousconnectivetissueintheformofdeepfascia,intermuscularseptaor
tendons.Directfleshyattachmentcanbeextensivebuttendonsareusuallyattachedtosmall
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areasofbone.Muscleswithsimilaractionstendtobegroupedtogether,andinlimbsthese
groupsoccurincompartments(forinstance,extensorcompartmentofforearm).
Usually,eachendofamusclehasanattachmenttobone.Theattachmentthatremainsrelatively
fixedwhenthemuscleperformsitsprimeactionisknownastheoriginwhereastheinsertionis
themoremobileattachment.However,insomemovementstheoriginmovesmorethanthe
insertiontherefore,thesetermsareofonlylimitedsignificance.
Themusclefibreswithinvoluntarymusclearearrangedindifferingpatternswhichreflectthe
functionofthemuscle.Sometimestheyarefoundasthinflatsheets(asinexternaloblique,Figs
1.10 &1.11 ).Strapmuscles(suchassartorius,Fig.1.12 )havelongfibresthatreach
withoutinterruptionfromoneendofthemuscletotheother.
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F IG. 1.10
Externalobliqueisaflatmusclewithanextensiveaponeurosis.
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F IG. 1.11
Externalobliquecuttoshowitsthickness.
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F IG. 1.12
Sartoriusisastrapmuscle.
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Pennatemusclesarecharacterizedbyfibresthatrunobliquely.Unipennatemuscles(for
exampleflexorpollicislongus,Fig.1.13 )havefibresrunningfromtheirorigintoattachalong
onlyonesideofthetendonofinsertion.Inbipennatemuscles(suchasdorsalinterossei,Fig.
1.14 )thefibresareanchoredtobothsidesofthetendonofinsertion.
F IG. 1.13
Flexorpollicislongusisaunipennatemuscle.
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F IG. 1.14
Dorsalinterosseiarebipennatemuscles.
Multipennatemuscles(forexamplesubscapularis,Fig.1.15 )haveseveraltendonsoforigin
andinsertionwithmusclefibrespassingobliquelybetweenthem.Somemuscles,forinstance
digastric,havetwofleshyparts(bellies)connectedbyanintermediatetendon.
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F IG. 1.15
Subscapularisisamultipennatemuscle.
Mosttendonsarethickandroundorflattenedincrosssection,althoughsomeformthinsheets
calledaponeuroses(seeFig.1.10 ).Whentendonscrossprojectionsortraverseconfined
spacestheyareoftenenvelopedinadoublelayerofsynovialmembranetominimizefriction.
Wheretheycrossjoints,tendonsareoftenheldinplacebybandsofthickfibroustissue,which
preventbowstringingwhenthejointsaremoved.Examplesincludetheretinaculaatthewrist
andanklejoints,andtendonsheathsinthefingersandtoes(Figs1.16 &1.17 ).
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F IG. 1.16
Anteriorviewofthelefthand,dissectedtorevealitsfibroussheaths
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F IG. 1.17
Posteriorviewofthelefthand,dissectedtoshowtheextensorretin
Thenervesupplytoaskeletalmusclecontainsbothmotorandsensoryfibres,whichusually
enterthefleshypartofthemuscle.Groupsofmuscleswithsimilaractionstendtobesupplied
bynervefibresderivedfromthesamespinalcordsegments.
Asverymetabolicallyactivetissue,musclehasaricharterialbloodsupply,usuallycarriedby
severalseparatevessels.Thecontractionandrelaxationofmusclesinthelimbscompressesthe
veinsineachcompartment.Astheveinscontainunidirectionalvalves,thismusclepumpaction
assiststhereturnofvenousbloodfromthelimbstothetrunk.
Cartilage
Cartilageisavarietyofhardconnectivetissuewhichgainsitsnutritionbydiffusionfromblood
vesselsinthesurroundingtissues.Itisclassifiedbyitshistologicalstructureintohyaline
cartilage,fibrocartilageandelasticcartilage.
Hyalinecartilageoccursincostalcartilages(seeFig.1.11 ),thecartilagesofthelarynxand
trachea,andindevelopingbones.Insynovialjoints(seeFig.1.23 )itformstheglassy,smooth
articularsurfaceswhichreducefrictionduringmovement.Articularcartilageispartlynourished
bydiffusionfromthesynovialfluidinthejointcavity.
Theinclusionoftoughinelasticcollagenfibresinthematrixconstitutesfibrocartilage,whichis
strongerandmoreflexiblethanthehyalinetype.Fibrocartilageisfoundinintervertebraldiscs
(seeFig.1.22 ),thepubicsymphysis,themanubriosternaljoint,andasarticulardiscsinsome
synovialjoints(forexample,kneeandtemporomandibular).
Elasticcartilage,whichoccursintheexternalearandepiglottis,isthemostflexibleformof
cartilage.Itcontainspredominantlyelasticfibresandhasayellowishappearance.
Cartilagemaybecomecalcifiedinoldage,becomingharderandmorerigid.
Bone
Boneformsthebasisoftheskeletonandischaracterizedbyahard,calcifiedmatrixwhichgives
rigidity.Inmostbonestwozonesarevisible.Nearthesurfacetheoutercorticallayerofbone
appearssolidandiscalledcompactbone,whereascentrallytheboneisknownasspongy
(cancellous)bone.Manybonescontainacavity(medulla)occupiedbythebonemarrow,a
potentialsiteofbloodcellproduction(Fig.1.18 ).
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F IG. 1.18
Longitudinalsectionofanadulttibia.
Thenumerousbonescomprisingthehumanskeletonvaryconsiderablyinshapeandsize,and
areclassifiedintolongbones(forexample,femur),shortbones(bonesofthecarpus),flatbones
(parietalboneofskull),irregularbones(maxillaofskull)andsesamoidbones(patella).
Sesamoidbonesdevelopintendons,generallywherethetendonpassesoverajointorbony
projection.Somebonesaredescribedaspneumatizedbecauseoftheirairfilledcavities(for
instance,ethmoid).
Boneisenvelopedbyathinlayeroffibroustissuecalledperiosteum(seeFig.1.9 )which
providesanchorageformuscles,tendonsandligaments.Periosteumisasourceofcellsforbone
growthandrepairandisrichlyinnervatedandexquisitelysensitivetopain.
Bonehasaprofusebloodsupplywhichisprovidedpartlyviatheperiostealvesselsandpartlyby
nutrientarteries,whichenterbonesvianutrientforaminaandalsosupplythemarrow.
Fracturedbonesoftenbleedprofuselyfromdamagedmedullaryandperiostealvessels.
Severalnamesaregiventothedifferentpartsofalongboneinrelationtoitsdevelopment(Fig.
1.19 ).Theshaft(ordiaphysis)ossifiesfirstandisseparatedbygrowthplatesfromthe
secondarycentresofossification(orepiphyses)whichusuallylieattheextremitiesofthebone.
Thepartofadiaphysisnexttoagrowthplateiscalledametaphysisandhasaparticularlyrich
bloodsupply.Whenincreaseinbonelengthceases,thegrowthplatesdisappearandthe
epiphysesfusewiththediaphysis.
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F IG. 1.19
Anteriorviewofachildstibia.
Skeleton
Theskeleton(Fig.1.20 )iscomposedofbonesandcartilagesheldtogetherbyjoints,and
givesrigidityandsupporttothebody.Ithasaxialandappendicularcomponents.Theaxial
componentincludestheskull,vertebralcolumn,ribs,costalcartilagesandsternum.The
appendicularskeletoncomprisesthebonesoftheupperandlowerlimbsandtheirassociated
girdles.Inthisbook,individualbonesaredescribedintheappropriateregions.
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F IG. 1.20
Joints
Anteriorandposteriorviewsoftheskeleton.
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Joints
Jointsareclassifiedaccordingtotheirstructureintofibrous,cartilaginousandsynovialtypes.In
fibrousjoints(Fig.1.21 )whicharerelativelyimmobile,thetwobonesarejoinedbyfibrous
tissue(forexample,suturesseenbetweenthebonesoftheskull).
F IG. 1.21
Theinferiortibiofibularjointisanexampleofafibrousjoint.
Cartilageisinterposedbetweenboneendsincartilaginousjoints.Primarycartilaginousjoints
containhyalinecartilage,areusuallycapableofonlylimitedmovement,andaredescribed
betweentheribsandsternum.Insecondarycartilaginousjoints(Fig.1.22 ),fibrocartilage
unitestheboneends.Thesejoints,whichgenerallyallowmoremovementthanthoseofthe
primarytype,alllieinthemidline.Examplesincludetheintervertebraldiscs,the
manubriosternaljointandthepubicsymphysis.
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F IG. 1.22
Sagittalsectiontoshowanintervertebraldisc,asecondarycartilagi
Synovialjoints
Themostcommontypeofjointisthesynovialjoint,whichiscomplexandusuallyhighlymobile.
Theyareclassifiedaccordingtotheshapeofthejointsurfaces(suchasplane,saddle,balland
socket)orbythetypeofmovementtheypermit(suchassliding,pivot,hinge).Inatypical
synovialjoint(Fig.1.23 )thearticulatingsurfacesarecoatedwithhyalinecartilageandthe
bonesarejoinedbyafibrouscapsule,atubularsleevewhichisattachedaroundtheperipheryof
theareasofarticularcartilage.Ineverysynovialjoint,alloftheinterior(exceptforintra
articularcartilage)islinedwithsynovialmembrane.Thisthinvascularmembranesecretes
synovialfluidintothejointspace,providingnutritionforthecartilageandlubricationforthe
joint.
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F IG. 1.23
Coronalsectionthroughametacarpophalangealjoint,asynovialjoi
Thecapsuleisusuallythickenedtoformstrengtheningbandsknownascapsularligaments(for
example,thepubofemoralligament).Inaddition,fibrousbands,discretefromthecapsule,may
formextracapsularligaments(suchasthecostoclavicularligament).Insomejointsthereare
intracapsularligaments(forinstance,theligamentoftheheadofthefemur)whicharecovered
bysynovialmembrane.Tendonssometimesfusewiththecapsule(asintherotatorcuff)orthey
mayrunwithinthejoint,coveredbysynovialmembrane,beforegainingtheirbonyattachment
(forexample,bicepsbrachiiattheshoulderjointFig.1.24 ).
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F IG. 1.24
Removalofpartoftheshoulderjointcapsulerevealstheintracapsul
Fluidcontainingsacsofsynovialmembranecalledbursae(Fig.1.25 )separatesometendons
andmusclesfromotherstructures.Bursaewhichlieclosetojointsmaycommunicatewiththe
cavityofthejointthroughasmallopeninginthecapsule(asdoesthesubscapularisbursa).
F IG. 1.25
Sagittalsectionthroughtheelbowjoint.Theolecranonbursadoesn
Insomejoints(forexample,theknee)adiscofcartilageisinterposedbetweenthearticular
cartilagecoveringtheboneends(Fig.1.26 ).Thisprovidesamatchedshapeforeachbone
end,thusallowingfreermovementwithoutcompromisingstability.Inaddition,differenttypes
ofmovementarepermittedineachhalfofthejoint.
F IG. 1.26
Disarticulatedkneejointtoshowthemenisci.
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Stabilityvariesconsiderablyfromonesynovialjointtoanother,asseveralfactorslimitexcessive
movementandcontributetothestabilityofthejoint.Theseincludetheshapeofthearticulating
surfaces,thestrengthofthecapsuleandassociatedligaments,thetoneofthesurrounding
musclesand,wherepresent,intraarticulardiscsandligaments.Atthehipjointtheligaments
andtheshapeofthebonesprovidethemainstability,whereasthetoneofthesurrounding
musclesismoreimportantinstabilizingtheshoulderjoint.Lackofstabilityassociatedwith
muscleweaknessortraumamayresultindislocationsothatthecartilagecoveredsurfacesno
longerarticulate.Dislocationmaydamageadjacentbloodvesselsandnerves.
Joints,particularlytheircapsules,receivearichsensoryinnervationderivedfromthenerves
supplyingthemusclesthatactonthejoint.Forinstance,theaxillarynervesuppliestheshoulder
jointanddeltoid.
Bloodvesselsaroundjointsfrequentlytakepartinrichanastomoses,whichallowalternative
pathwaysforbloodflowwhenthejointhasmovedtoadifferentpositionandensurean
adequatesupplytothesynovialmembrane(suchasinthekneejointFig.1.27 ).
F IG. 1.27
Branchesofthepoplitealarteryanastomosearoundthekneejoint.
Serousmembranesandcavities
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Serousmembranesandcavities
Pericardium,pleuraandperitoneumcomprisetheserousmembranesliningthecavitiesthat
separatetheheart,lungsandabdominalviscera,respectively,fromtheirsurroundingstructures.
Wherethemembranelinestheouterwallofthecavityitiscalledparietal,andwhereitcovers
theappropriateorganitiscalledvisceral.Theparietalandvisceralpartsareincontinuity
aroundtherootoftheviscusandareseparatedfromeachotherbyacavity,whichnormally
containsonlyathinfilmofserousfluid.Themembranesareinclosecontactbutarelubricated
bytheinterveningfluid,whichpermitsmovementbetweentheviscusanditssurroundings(Fig.
1.28 ).
F IG. 1.28
TransversesectionthroughthethoraxatthelevelofT5showingth
Bloodvessels
Bloodvesselsconveybloodaroundthebodyandareclassifiedintothreemaintypes:arteries,
capillariesandveins.
Arteriesarerelativelythickwalledvesselswhichconveybloodinabranchingsystemof
decreasingcalibreawayfromtheheart(Fig.1.31 ).Somearteriesarenamedaftertheregion
throughwhichtheypass(suchasthefemoralartery),whileothersarenamedaccordingtothe
structurestheysupply(forinstance,therenalartery).Thelargestvessels,suchastheaorta,have
elasticwallsandthereforearecalledelasticarteries.Theygiverisetoarterieswhosewallsare
moremuscular(musculararteries),suchastheradialarteryintheforearm.Aparticularlythick
smoothmusclecoatisalsoafeatureofthewallsofthemicroscopicarterioles.Thetoneof
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arteriolarsmoothmuscleisunderthecontroloftheautonomicnervoussystemandhormones,
andisanimportantfactorinthemaintenanceofpressureinthearterialsystem.Ingeneral,
therearefewalternativepathwaysforarterialbloodtoreachitsdestination.However,insome
regions(forexample,jointsandatthebaseofthebrain),arterialsupplyisprovidedbymore
thanonevessel(seeFig.1.27 ).Sucharteriesmaycommunicatedirectlywitheachotherat
sitesknownasarterialanastomoses.Arterialpulsesmaybefelteasilyinsuperficialarteriessuch
astheradialarteryatthewrist.Identifyingpulsesindeeplylocatedarteriessuchasthe
abdominalaortamayrequirefirmpressure.
Capillarieslinkthesmallestarteriesandthesmallestveinsandconveybloodatlowpressure
throughthetissues.Collectively,thesethinwalledmicroscopicvesselshaveaveryextensive
surfacearea,facilitatinggaseousandmetabolicexchangebetweenthebloodandtissues.
Veinscarrybloodatlowpressurefromthecapillarybedbacktotheheart(seeFig.1.32 ).
Theymaybedeep(accompanyingarteries)orsuperficial(lyinginthesuperficialfascia)(Fig.
1.29 )andareusuallylinkedbyvenousanastomoses.Veinsaccompanyingarteriesareoften
arrangedasseveralinterconnectingvesselscalledvenaecomitantes.Inthelimbsthedeepveins
canbecompressedbylocalmuscularaction,thusassistingvenousreturn.Manyveins
(excludingthevenaecavae,thosedrainingvisceraandthosewithinthecranium)contain
unidirectionalvalveswhichdirecttheflowofbloodtowardstheheart(Fig.1.30 ).Thevenous
patternisoftenvariable,andnumerousanastomoticconnectionsprovidealternativepathways
forvenousreturn.Insomeregions,numerousintercommunicatingveinsformmeshworks
calledplexuses(suchasthepelvicvenousplexus).Inthecranialcavity,venousbloodiscarried
inspecialvesselsformedbytheduramaterliningtheinterioroftheskull.Theseduralsinuses
receivebloodfromthebrain.
F IG. 1.29
Multilevelstepdissectionthroughtherightlegshowingthebloodv
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F IG. 1.30
Portionofsaphenousveinopenedlongitudinallyandincrosssection.
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F IG. 1.31
Principalsystemicarteries.
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F IG. 1.32
Principalsystemicveins.
Lymphaticvesselsandnodes
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Lymphaticvesselsandnodes
Tissuefluidiscollectedbymicroscopicopenendedchannelscalledlymphatics.Froma
particularregionororgan,thesevalvedlymphaticvesselsdrainintoaggregationsoflymphoid
tissue(calledlymphnodesFig.1.33 )whichfilterlymph.Groupsoflymphnodesareoften
foundclosetoanorgan(forexample,hilarnodes)orattherootofalimb(forexample,axillary
lymphnodes).Ultimately,lymphdrainsintothevenoussystemintherootoftheneckthrough
largerlymphchannelscalledthethoracicductandtherightlymphatictrunk(Fig.1.34 ).
F IG. 1.33
Inguinallymphnode.
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F IG. 1.34
Themainlymphaticnodesandvessels.
Becausetheyfilterthefluidpassingthroughthem,lymphnodesmaybecomeinvolvedinthe
spreadofinfectionormalignancy(forexample,cancer).Thus,thesurgeonremovinga
cancerousorganmayalsoexcisethelymphnodesdrainingthatorgan.
Nervoustissue
Nervoustissuecontainstwotypesofcell:neuronesandneuroglia.Theneuroneisthefunctional
unitresponsiblefortheconductionofnerveimpulses.Itconsistsofacellbodyandits
associatedprocesses.Onetypeofprocess,ofwhichthereisonlyoneperneurone,istheaxon.
Thismayberelativelyshortbutsometimesisverylong,asinperipheralnerveswhereaxons
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comprisetheindividualnervefibres.Theneurogliaundertakesupportingrolesandinclude
Schwanncells,whichprovidethemyelinsheathsaroundaxons.Thesesheathsinsulatethe
axons,increasingtheirspeedsofconduction.
Thenervoussystemconsistsofcentralandperipheralparts.Thebrainandspinalcordcomprise
thecentralnervoussystem.
Theperipheralnervoussystemconsistsofspinal,cranialandautonomicnerves,andtheir
associatedganglia.BundlesofnervecellprocessesandtheirsupportingSchwanncellsform
peripheralnerves.Severalnerveprocesses,boundtogetherbyconnectivetissue,formanerve
bundlenumerousbundles,surroundedbyafibroussheath(epineurium),constitutethe
completeperipheralnerve.Nervecellbodiesalsoformpartoftheperipheralnervoussystem
andareusuallygroupedtogetherintoganglia.Theperipheralnervoussystemisdividedinto
somaticandautonomicparts.
Somaticnerves
Ingeneral,thesomaticnervesinnervateskeletalmuscleandtransmitsensationfromallpartsof
thebodyexcepttheviscera.Twelvepairsofcranialnervesareattachedtothebrainandare
named:olfactory(I),optic(II),oculomotor(III),trochlear(IV),trigeminal(V),abducens(VI),
facial(VII),vestibulocochlear(VIII),glossopharyngeal(IX),vagus(X),accessory(XI),
hypoglossal(XII).Mostofthesenervessupplystructuresintheheadandneck,butthevagus
nervealsosuppliesthoracicandabdominalviscera.
Spinalnervesarealsoinpairsandeachisattachedtoaspecificsegmentofthespinalcordby
anteriorandposteriorroots.Thereareeightcervical(C1C8),twelvethoracic(T1T12),five
lumbar(L1L5),fivesacral(S1S5),andoneortwococcygeal(Co)spinalnerves(seeFig.
1.35 ).
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F IG. 1.35
Lateralviewofthedistributionoftheanteriorramiofthespinalner
Thoracicspinalnervesillustratethetypicalsegmentalpatternofdistributiontothebodywall
(Fig.1.36 ).Theareaofskinsuppliedbyonespinal(orcranial)nerveiscalledadermatome
(Figs1.37 &1.38 ).Inthetrunkthedermatomepatterninvolvessubstantialoverlap
betweenadjacentareas.Similarly,allthemusclessuppliedbyasinglespinal(orcranial)nerve
compriseamyotome.
F IG. 1.36
Courseanddistributionofatypicalthoracicspinalnerve.Inferioras
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F IG. 1.37
Dermatomesofthetrunk.
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F IG. 1.38
Dermatomesofthelimbs.
Theregularpatternofinnervationinthetrunkismodifiedinthelimbs,eachbeingsuppliedby
severalspinalnervesthroughacomplexnetwork,aplexus(suchasthebrachialplexusofthe
upperlimbFig.1.39 ).Plexusformationmodifiesthepatternofmyotomessothatspinalcord
segmentsinnervatemusclesaccordingtotheirprimeactions.Forexample,flexorsoftheelbow
jointaresuppliedbythespinalcordsegmentsC5andC6.Sensorycellbodiesarelocatedin
gangliaonperipheralnervesnearthecentralnervoussystem(forinstance,trigeminalganglion,
posteriorrootganglia).However,thecellbodiesofsomaticmotornervesarelocatedinthe
centralnervoussystem.
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F IG. 1.39
Theaxillahasbeendissectedtoshowthebrachialplexus.
Autonomicnerves
Theautonomicnervoussysteminnervatessmoothandcardiacmuscle,andglands.Itisdivided
intotwoparts,sympatheticandparasympathetic,whoseeffectsforthemostpartareanta
gonistic(forexample,sympatheticstimulationincreaseswhileparasympatheticstimulation
reducesheartrate).Inbothsympatheticandparasympatheticcomponents,preganglionic
myelinatedaxonsleavethecentralnervoussystemandsynapseonneuronesinperipheral
gangliadistributedthroughoutthebody.Thepostganglionicaxonsthatpasstotheeffector
organsarenonmyelinated.Autonomicsensoryfibresaccompanyautonomicefferentfibresin
peripheralnervesbuttheircellbodiesarelocatedintheposteriorrootgangliaincompanywith
somaticsensoryneurones.
Thepartsofthecentralnervoussystemfromwhichtheautonomicnervesemergedifferforthe
sympatheticandparasympatheticcomponents(Fig.1.40 ).
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F IG. 1.40
Patternofinnervationintheparasympatheticandsympatheticauto
Sympatheticnerves
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Preganglionicsympatheticfibresleavethecentralnervoussysteminthespinalnervesofallthe
thoracicandtheuppertwolumbarsegments(thoracolumbaroutflow)andenterthe
ganglionatedsympathetictrunksviawhiteramicommunicantes.Thetwosympathetictrunkslie
oneithersideofthevertebralcolumnandextendthroughoutmostofitslength.Eachtrunk
consistsofsympatheticgangliaandinterconnectingnervetrunks.
Unmyelinatedpostganglionicaxonsdestinedforthebloodvesselsandsweatglandsofthebody
wall,includingthelimbs,leavethegangliabygreyramicommunicantesandaredistributedby
thespinalnerves.Specialvisceralbranchespassdirectlyfromthetrunkstoreachthe
appropriateorgan.
Postganglionicsympatheticnervefibresareoftenconveyedtotheirdestinationsasplexuses
intimatelyrelatedtothewallsofarteries.
Parasympatheticnerves
Intheparasympatheticsystem,myelinatedpreganglionicfibresleavethecentralnervous
systemaspartofcranialnervesIII,VII,IXandXandaspartofsacralspinalnervesS2,S3and
S4toformthecraniosacralautonomicoutflow.Thesepreganglionicfibressynapseinganglia
lyingclosetoorinthewallofthetargetorgan.Relativelyshortnonmyelinatedpostganglionic
axonsemergefromthesegangliatoinnervatetheappropriatetissue.Intheheadtherearefour
pairedganglia(ciliary,pterygopalatine,submandibularandotic)thatreceivepreganglionic
parasympatheticfibresfromcranialnervesIII,VIIandIX.Thepostganglionicfibresfromthese
gangliasupplytheeye,andlacrimal,nasalandsalivaryglands.Preganglionicfibresfromthe
vagus(X)nervesynapsewithpostganglionicneuronesthatinnervatecervical,thoracicand
abdominalviscera.Preganglionicfibresfromthesacralnerves(pelvicsplanchnicnervesornervi
erigentes)supplythepelvicorgans.Theparasympatheticgangliaassociatedwiththevagusand
sacralnervesusuallycomprisesmallclustersofcellsinthewallsoftheinnervatedorgans(Fig.
1.40 ).
39/39

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