General Anatomy and Musculoskeletal System (THIEME Atlas of Anatomy)

555 Pages·2010·189.45 MB·English

by  Michael Schuenke

THIEME
Atlas of Anatomy
General Anatomy and Michael Schuenke
Erik Schulte
Musculosl<eletal System Udo Schumacher
Consulting f.clitor~
Lawrence M. Ross
Edward D.lamperti
11lus£rc11ions by
Markus Voll
l<arJWesker
I
Thieme
@!)Thieme

General Anatomy
and Musculoskeletal System
THIEME
Atlas of Anatomy
Consulting Editors
Lawrence M. Ross, M.D., Ph.D.,
Department of Neurobiology and Anatomy
University ofTexas Medical School at Houston
Edward D. Lamperti, Ph.D.,
Immune Disease Institute and
Harvard Medical School
Authors
Michael Schuenke, M.D., Ph.D.,
Institute of Anatomy
Christian Albrecht University Kiel
Erik Schulte, M.D.,
Department of Anatomy and Cell Biology
johannes Gutenberg University
Udo Schumacher, M.D.,
FRCPath, CBiol, FIBiol, DSc,
Institute of Anatomy II: Experimental Morphology
Center for Experimental Medicine
University Medical Center Hamburg-Eppendorf
In collaboration with jurgen Rude
Illustrations by
Markus Voll
Karl Wesker
1694 Illustrations
100Tables
Thieme
Stuttgart· New York
l.ibroryof Congress Carologing-in-Publication Daro is available from the Important note: Medicine is an ever-changing science undergoing
publisher. continual development. Research and clinical experience are continu
ally expanding our knowledge, in particular our knowledge of proper
This book is an authorized and revised translation of the German treatment and drug therapy. Insofar as this book mentions any dosage
edition published and copyrighted 2005 by Georg Thieme Verlag, or application, readers may rest assured that the authors, editors, and
Stuttgart, Germany. Title of the German edition: Schuenke et al.: publishers have made every effort to ensure that such references are in
Allgemeine Anatomie und Bewegungssystem: Prometheus Lernatlas accordance with the state of knowledge at the time of production of
der Anatomie. the book.
Nevertheless, this does not involve, imply, or express any guarantee
or responsibility on the part of the publishers in respect to any dosage
Illustrators instructions and forms of applications stated in the book. Every user Is
Markus Voll, Fiirstenfeldbnuck, GeiTilany; requestl!d to eumlne carefully the manufacturers' leaflets accompa
Karl Wesker, Berlin, Germany (homepage: www.karlwesker.de) nying each drug and to check, if necessary in consultation with a phy
sician or specialist, whether the dosage schedules mentioned therein
Translator or the contraindications stated by the manufacturers differ from the
TerryTelger, Fort Worth, Texas, USA statements made in the present book. Such examination is particularly
important with drugs that are either rarely used or have been newly
released on the market. Every dosage smedule or every form of applica
tion used is entirely at the user's own risk and responsibility. The authors
and publishers request every user to report to the publishers any dis
crepancies or Inaccuracies noticed. If errors In this work are found after
publication, errata will be posted at www.thleme.com on the product
description page.
e corrected reprint 2010
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Foreword Preface
Our errthusiasm fur the THIEME Atlas of Anatomy began when each of As it started planning this Atlas, the publisher sought out the opinions
us, Independently, saw preliminary material from this Atlas. Both of and needs of students and lecturers In both the United States and
us were Immediately captivated by the new approach, the conceptual Europe. The goal was to find out what the "Ideal" atlas of anatomy
organization, and by the stunning quality and detail of the Images of should be-Ideal for students wanting to learn from the atlas, master
the Atlas. We were delighted when the editors at Thieme offered us the the extensive amourrts of Information while on a busy class schedule,
opportunity to cooperate with them In making this outstanding re and, In the process, acquire sound, up-to-date knowledge. The result of
source available to our students and colleagues In North America. this work Is this Atlas. The THIEME Atlas of Anatomy, unlike most other
atlases, Is a comprehensive educational tool that combines Illustrations
As consulting editors we were asked to review, fur accuracy, the English with explanatory text and summarizing tables, introducing clinical
edition of the THIEME Atlas of Anatomy. Our work involved a conversion applications throughout, and presenting anatomica I concepts in a
of nomenclature to terms in common usage and some organizational step-by-step sequence that allows for the integration of both system
changes to reflect pedagogical approaches in anatomy programs in by-system and topographical views.
North America. This task was eased greatly by the clear organization of
the original text. In all of this, we have tried diligently to remain faithful Since the THIEME Atlas of Anatomy is based on a fresh approach to the
to the irrtentions and insights of the original authors. underlying subject matter itself, it was necessary to create for it an
entirely new set of illustrationr-a task that took eight years. Our goal
We would like to thank the team at Thieme Medical Publishers who was to provide illustrations that would compellingly demonstrate
worked with us. Heartfelt thanks go first to Cathrin E. Schulz, M.D .• anatomical relations and concepts, revealing the underlying simplicity
Senior Editor, fur her assistance and constant encouragemerrt and of the logic and order of human anatomy without sacrificing detail or
availability. aesthetics.
We would also like to extend our thanks to Stefanie Langner, Production With the THIEME Atlas of Anatomy, it was our intention to create an
Manager, and Annie Hollins, Assistant Editor, fur checking and correcting atlas that would guide students in their initial study of anatomy,
our work and preparing this volume with care and speed. stimulate their errthusiasm for this intriguing and vitally important
subject. and provide a reliable reference for experienced students
Lawrence M. Ross, and professionals alike.
Edward D. Lamperti
"If you want ID attain the possible, you must attempt the impossible"
(Rablndranath Tagore).
Michael Schiinke, Erik Schulte, Udo Schumacher,
Markus Vall, and Karl Wesker
Acknowledgments
First we wish tD thank our families. This atlas is dedicab!d to them. We are grateful toAntje Buhl, who was there from the beginning as proj
ect assistant. working "behind the scenes• on numerous tasks such as
We also thank Prof. Reinhard Gossrau, M.D., for his critical comments repeated proofreading and helping to arrange the figure labels.
and suggestions. We are grab!ful tD several colleagues who rendered
valuable help In proofreading: Mrs. Gabriele Schunke, Jakob Fay, M.D., We owe a great dept of thanks to Martin Spencker, Managing Director
Ms. Claudia Ducker, Ms. Slmln Rassoull, Ms. Heinke Teichmann, and Ms. of Educational Publications at Thieme, especially tD his ability tD make
Sylvia Zllles. We are also grateful to Dr. julia jOrns-Kuhnke for helping quick and unconventional decisions when dealing with problems and
with the figure labels. uncertainties. His openness to all the concerns of the authors and art
ists established conditions for a cooperative partnership.
We extend spedal thanks to Stephanie Gay and Bert Sender, who com
posed the layouts. Their ability to arrange the text and illustrations on Without exception, our collaboration with the entire staff at Thieme
facing pages for maximum clarity has contributed greatly to the quality Medical Publishers was consistently pleasant and cordial. Unfortunately
of the Atlas. we do not have room to list everyone who helped in the publication of
this atlas, and we must limit our acknowledgments to a few colleagues
We particularly acknowledge the efforts oft hose who handled this proj who made a particularly notable contribution: Rainer Zepf and Martin
ect on the publishing side: Waletzko for support in all technical matters; Susanne Tochterrnann
Wenzel and Manfred Lehnert, representing all those who were involved
JGrgen Luthje, M.D .• Ph.D., executive editor at Thieme Medical Publish in the production of the book; Almut Leopold for the Index; Marie-Luise
ers, has "made the impossible possible.• He not only reconciled the Kurschner and her team for creating the cover design; to Birgit Carlsen
wishes of the authors and artists with the demands of reality but also and Anne Dobler, representing all those who handled marketing, sales,
managed to keep a team of frve people working together for years on a and promotion.
project whose goal was known to us from the beginning but whose full
dimensions we came to appreciate only over time. He is deserving of The Authors
our most sincere and heartfelt thanks.
Sabine Bartl, developmental editor, became a touchstone for the au
thors in the best sense of the word. She was able to deb!rmine whether
a beginning student, and thus one who is not (yet) a professional, could
clearly appreciate the logic of the presentation. The authors are In
debted tD her.

Table of Contents
General Anatomy
Human Phylogeny and Ontogeny 5 The Musc:les
1.1 Human Phylogeny .................................... 2 5.1 The Skeletal Muscles ................................. 40
1.2 Human Ontogeny: 5.2 The Tendons and Mechanisms
Overview, Fertilization, and Earliest That Assist Muscle Function .......................... 42
Developmental Stages .............................. 4
1.3 Gastrulation, Neurulation, and Somite Formation ••••••• 6
6 The Vessels
1.4 Development of the Fetal Membranes and Placenta ..... 8
1.5 Development of the Pharyngeal (Branchial) Arches 6.1 Overview of the Human Cardiovascular System ••.•.••.•. 44
in Humans ......................................... 10 6.2 The Structure ofA rteries and Veins .................... 46
1.6 Early Embryonic Circulation and the Development 6.3 The Terminal Vascular Bed ............................ 48
of Major Blood Vessels .. • . .. . • . • .. • . • .. • . • . • .. • . • .. • . 12
1.7 Bone Development and Remodeling •.•.••.•.•.••.•.••. 14
7 The Lymphatic System and Glands
1.8 Ossification of the Umbs ............................. 16
1.9 DevelopmentandPositionofthelimbs ................ 18 7.1 The Human Lymphatic System ........................ 50
7.2 Exocrine and Endocrine Glands ........................ 52
2 Overview of the Human Body
8 General Neuroanatomy
2.1 The Human Body
(Proportions, Surface Areas, and Body Weights) •.••.•.••. 20 8.1 Development of the Central Nervous System (CNS) .••.•. 54
2.2 The Structural Design oft he Human Body •.•.•.••.•.••. 22 8.2 Neural Crest Derivatives and the Development
of the Peripheral Nervous System (PNS) •.•.•..•.•.••.•. 56
8.3 Topography and Structure of the Nervous System ........ 58
3 Surface Anatomy of the Body, Landmarks
8.4 Cells of the Nervous System .......................... 60
and Reference Lines
8.5 Structure of a Spinal Cord Segment .................... 62
3.1 Terms of Location and Direction, Cardinal Planes 8.6 Sensory Innervation:
andAxes ........................................... 24 An Overview ..................................... 64
3.2 Body Surface Anatomy ............................... 26 8.7 Dermatomes and Cutaneous Nerve Territories •.•.••.•. 66
3.3 Body Surface Contours and Palpable Bony Prominences •• 28 8.8 Motor Innervation .................................. 68
3.4 Landmarks and Reference Lines on the Human Body ••••• 30 8.9 Differences between the Central
3.5 Body Regions (Regional Anatomy) ••••••••••••••••••••• 32 and Peripheral Nervous Systems ...................... 70
8.10 The Autonomic Nervous System ...................... 72
4 The Bones and Joints
4.1 The Bony Skeleton and the Structure of Tubular Bones .•.. 34
4.2 Continuous and Discontinuous joints:
Synarthroses and Diarthroses ......................... 36
4.3 Basic Principles of joint Mechanics .•....•......•....•.. 38
IX
Table ofC ontents
Trunk Wall
Bones, Ugament:s, and Joints
3.4 The Chest Wall Muscles and Endothoraclc Fascia •••••••• 144
1.1 TheSkeletonoftheTrunk .•..........•.....•....•.... 76 3.5 Thoracoabdominal junction:
1 .2 The Bony Spinal Column ..•....•.....•.....•....•.... 78 The Diaphragm .................................... 146
1.3 Development of the Spinal Column .....•.....•......... 80 3.6 The Lateral and Anterior Abdominal Wall Muscles ••••••• 148
1.4 The Structure of a Vertebra •..........•.....•....•.... 82 3.7 Structure of the Abdominal Wall
1.5 The Cervical Spine ..•.....•....•................•.... 84 and Rectus Sheath .................................. 150
1 .6 The Thoradc Spine .•.....•....•...........•....•.... 86 3.8 The Pelvic Aoor Muscles:
1 .7 The Lumbar Spine ..•.....•....•................•.... 88 Overview of the Perineal Region
1 .8 The Sacrum and Coccyx •.••.•.••.•.•.••.•.••.•.••.•.• 90 and Superficial Fasciae ............................. 152
1 .9 The Intervertebral Disk: Structure and Function .•.••.•.• 92 3.9 Structure oft he Pelvic Floor and Pelvic Spaces:
1.10 The Ligaments of the Spinal Column: Female versus Male •.••.•.•.••.•.••.•.••.•.•.••.•. 154
Overview and Thoracolumbar Region .•.••.•.••.•.••.•.• 94 3.10 The Muscles of the Female Pelvic Floor and Wall. .•.••.•. 156
1.11 Overview of the Ligaments of the Cervical Spine .•.••.•.• 96 3.11 The Pelvic Floor Muscles:
1 .1 2 The Ligaments of the Upper Cervical Spine The Levator ani .................................. 158
(Atlanto·ocdpital and Atlantoaxial joints) •.•.••.•.••.•.• 98 3.12 Their Relation to Organs and Vessels
1 .13 The Intervertebral Facet joints, Motion Segments, in Males and Females ••.•.•.••.•.••.•.••.•.•.••.•. 160
and RangeofMotion inDifferent Spinal Regions .•.••.•. 100
1.14 The UncovertebraiJoints of the Cervical Spine ••.•.••.•. 102 4 Neurovascular Systems: Forms and Relations
1.15 Degenerative Changes in the Lumbar Spine •.••.•.••.•. 104
1.16 TheThoradcSkeleton .•.••.•.••.•.•.••.•.••.•.••.•. 106 4.1 The Arteries ....................................... 162
1.17 The Sternum and Ribs .•.••.•.••.•.•.••.•.••.•.••.•. 108 4.2 The Veins ......................................... 164
1.18 The Costovertebral Joints and Thoracic Movements • . . • . 110 4.3 The Lymphatic Vessels and Lymph Nodes •.•.••.•.••.•. 166
1.19 TheBonyPelvis •.•.••.•.••.•.••.•.•..•.•.••.•.••.•.•1 12 4.4 The Nerves ........................................ 168
1.20 The Pelvic Ligaments and Pelvic Measurements • . • . • • . • . 114
1 .21 The Sacroiliac Joint . • • . • . • • . • . • • . • . • . . • . • . • • . • . • • . • . 116 5 Neurovascular Systems: Topographical Anatomy
2 Musculature: Functional Groups 5.1 AnteriorTrunkWall:
Surface Anatomy and Superficial Nerves and Vessels •.... 170
2.1 The Muscles of the Trunk Wall, Their Origin 5.2 Posterior Trunk Wall:
and Function .••.•.••.•.••.•.••.•.•..•.•.••.•.••.•. 118 Surface Anatomy and Superficial Nerves and Vessels •.... 172
2.2 The Intrinsic Back Muscles: 5.3 Posterior Trunk Wall:
Lateral Tract ••.•.••.•.••.•.••.•.•..•.•.••.•.••.•. 120 Posterior View ................................... 174
2.3 Medial Tract ••.•.••.•.••.•.••.•.•.••.•.•..•.•.••. 122 5.4 Anterior View ...•....•.....•..........•.....•.... 176
2.4 The Short Nuchal and Craniovertebral Joint Muscles 5.5 AnteriorTrunkWall:
and the Prevertebral Muscle ••••••••••••••••••••••• 124 Overview and Location of Clinically Important
2.S The Muscles of the Abdominal Wall: Nerves and Vessels ............................... 178
Lateral and Oblique Muscles ••••••••••••••••••••••• 126 5.6 Nerves, Blood Vessels, and Lymphatics
2.6 Anterior and Posterior Muscles ......•...........•.. 128 in the Female Breast ...•.....•....•..........•.... 180
2.7 The Functions of the Abdominal Wall Muscles •....•.. 130 5.7 The Inguinal Canal ....•.....•..........•.....•.... 182
2.8 The Muscles of the Thoracic Cage 5.8 Anterior Abdominal Wall: Anatomy and Weak Spots •.... 184
(lntercostales, Subcostales, Scaleni, 5.9 Inguinal and Femoral Hernias ...•....•..........•.... 186
and Transversus thoracis) •....•.....•.....•....•... 132 5.10 Rare External Hernias ............................... 188
2.9 The Diaphragm ........•....•.....•.....•........ 134 5.11 Diagnosis and Treatment of Hernias ...•.....•....•.... 190
2.10 The Muscles of the Pelvic Floor 5.12 Development ofthe External Genitalia •.....•....•.... 192
(Pelvic Diaphragm, Urogenital Diaphragm, Sphincter 5.13 Male External Genitalia:
and Erectile Muscles) .....•....•................•... 136 Testicular Descent and the Spermatic Cord .•....•.... 194
5.14 The Testis and Epididymis ...•..........•.....•.... 196
5.15 The Fasciae and Erectile Tissues of the Penis .......... 198
3 Musculature: Topographical Anatomy
5.16 NervesandVesselsofthePenis •....•.....•....•.... 200
3.1 The Back Muscles and Thoracolumbar Fascia ..•....•... 138 5.17 Female External Genitalia:
3.2 The Intrinsic Back Muscles: Overview and Episiotomy .......................... 202
Lateral and Medial Tracts •....•................•... 140 5.18 Neurovascular Structures, Erectile Tissues,
3.3 Short Nuchal Muscles ...•....•.....•.....•........ 142 Erectile Muscles, and Vestibule ••••••••••••••••••••• 204
X