Titelei_Eng.indd 1 08.07.2009 15:30:27Uhr Titelei_Eng.indd 2 08.07.2009 15:30:34Uhr General Anatomy and Musculoskeletal System THIEME Atlas of Anatomy Consulting Editors Lawrence M. Ross, M.D., Ph.D., DepartmentofNeurobiologyandAnatomy UniversityofTexasMedicalSchoolatHouston Edward D. Lamperti, Ph.D., ImmuneDiseaseInstituteand HarvardMedicalSchool Authors Michael Schuenke, M.D., Ph.D., InstituteofAnatomy ChristianAlbrechtUniversityKiel Erik Schulte, M.D., DepartmentofAnatomyandCellBiology JohannesGutenbergUniversity Udo Schumacher, M.D., FRCPath,CBiol,FIBiol,DSc, InstituteofAnatomyII:ExperimentalMorphology CenterforExperimentalMedicine UniversityMedicalCenterHamburg-Eppendorf In collaboration with Jürgen Rude Illustrations by Markus Voll Karl Wesker 1694Illustrations 100Tables Thieme Stuttgart · New York Titelei_Eng.indd 3 10.07.2009 8:05:00Uhr LibraryofCongressCataloging-in-PublicationDataisavailablefromthe Important note: Medicine is an ever-changing science undergoing publisher. continualdevelopment.Researchandclinicalexperiencearecontinu- allyexpandingourknowledge,inparticularourknowledgeofproper ThisbookisanauthorizedandrevisedtranslationoftheGerman treatmentanddrugtherapy.Insofarasthisbookmentionsanydosage editionpublishedandcopyrighted2005byGeorgThiemeVerlag, orapplication,readersmayrestassuredthattheauthors,editors,and Stuttgart,Germany.TitleoftheGermanedition:Schuenkeetal.: publishershavemadeeveryefforttoensurethatsuchreferencesarein AllgemeineAnatomieundBewegungssystem:PrometheusLernatlas accordancewiththestateofknowledgeatthetimeofproductionof derAnatomie. thebook. Nevertheless, this does not involve, imply, or express any guarantee orresponsibilityonthepartofthepublishersinrespecttoanydosage Illustrators instructionsandformsofapplicationsstatedinthebook.Everyuseris MarkusVoll,Fürstenfeldbruck,Germany; requestedtoexaminecarefullythemanufacturers’leafletsaccompa- KarlWesker,Berlin,Germany(homepage:www.karlwesker.de) nyingeachdrugandtocheck,ifnecessaryinconsultationwithaphy- sicianorspecialist,whetherthedosageschedulesmentionedtherein Translator or the contraindications stated by the manufacturers differ from the TerryTelger,FortWorth,Texas,USA statementsmadeinthepresentbook.Suchexaminationisparticularly important with drugs that are either rarely used or have been newly releasedonthemarket.Everydosagescheduleoreveryformofapplica- tionusedisentirelyattheuser’sownriskandresponsibility.Theauthors andpublishersrequesteveryusertoreporttothepublishersanydis- crepanciesorinaccuraciesnoticed.Iferrorsinthisworkarefoundafter publication,erratawillbepostedatwww.thieme.comontheproduct descriptionpage. ©correctedreprint2010 GeorgThiemeVerlag Rüdigerstraße14 D-70469Stuttgart Germany http://www.thieme.de ThiemeNewYork,333SeventhAvenue, NewYork,NY10001USA http://www.thieme.com Typesettingbyweyhingdigital,Ostfildern-Kemnat Someoftheproductnames,patents,andregistereddesignsreferred PrintedinChinabyEverbestPrintingLtd,HongKong tointhisbookareinfactregisteredtrademarksorproprietarynames even though specific reference to this fact is not always made in the text.Therefore,theappearanceofanamewithoutdesignationaspro- PlusVersion–includesonlineaccesstoWinkingSkull.comPLUS prietaryisnottobeconstruedasarepresentationbythepublisherthat itisinthepublicdomain. Thisbook,includingallpartsthereof,islegallyprotectedbycopyright. Softcover Anyuse,exploitation,orcommercializationoutsidethenarrowlimits ISBN978-1-60406-286-1 setbycopyrightlegislation,withoutthepublisher’sconsent,isillegal andliabletoprosecution.Thisappliesinparticulartophotostatrepro- Hardcover duction,copying,mimeographing,preparationofmicrofilms,andelec- ISBN978-1-60406-292-2 tronicdataprocessingandstorage. Titelei_Eng.indd 4 13.07.2009 12:56:16Uhr Foreword Preface OurenthusiasmfortheTHIEMEAtlasofAnatomybeganwheneachof AsitstartedplanningthisAtlas,thepublishersoughtouttheopinions us, independently, saw preliminary material from this Atlas. Both of and needs of students and lecturers in both the United States and uswereimmediatelycaptivatedbythenewapproach,theconceptual Europe. The goal was to find out what the “ideal” atlas of anatomy organization,andbythestunningqualityanddetailoftheimagesof shouldbe—idealforstudentswantingtolearnfromtheatlas,master theAtlas.WeweredelightedwhentheeditorsatThiemeofferedusthe theextensiveamountsofinformationwhileonabusyclassschedule, opportunity to cooperate with them in making this outstanding re- and,intheprocess,acquiresound,up-to-dateknowledge.Theresultof sourceavailabletoourstudentsandcolleaguesinNorthAmerica. thisworkisthisAtlas.TheTHIEMEAtlasofAnatomy,unlikemostother atlases,isacomprehensiveeducationaltoolthatcombinesillustrations Asconsultingeditorswewereaskedtoreview,foraccuracy,theEnglish with explanatory text and summarizing tables, introducing clinical editionoftheTHIEMEAtlasofAnatomy.Ourworkinvolvedaconversion applications throughout, and presenting anatomical concepts in a ofnomenclaturetotermsincommonusageandsomeorganizational step-by-stepsequencethatallowsfortheintegrationofbothsystem- changes to reflect pedagogical approaches in anatomy programs in by-systemandtopographicalviews. NorthAmerica.Thistaskwaseasedgreatlybytheclearorganizationof theoriginaltext.Inallofthis,wehavetrieddiligentlytoremainfaithful SincetheTHIEMEAtlasofAnatomyisbasedonafreshapproachtothe totheintentionsandinsightsoftheoriginalauthors. underlying subject matter itself, it was necessary to create for it an entirelynewsetofillustrations—ataskthattookeightyears.Ourgoal 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., anatomicalrelationsandconcepts,revealingtheunderlyingsimplicity Senior Editor, for her assistance and constant encouragement and ofthelogicandorderofhumananatomywithoutsacrificingdetailor availability. aesthetics. WewouldalsoliketoextendourthankstoStefanieLangner,Production With the THIEME Atlas of Anatomy, it was our intention to create an Manager,andAnnieHollins,AssistantEditor,forcheckingandcorrecting atlas that would guide students in their initial study of anatomy, ourworkandpreparingthisvolumewithcareandspeed. stimulate their enthusiasm for this intriguing and vitally important subject, and provide a reliable reference for experienced students LawrenceM.Ross, andprofessionalsalike. EdwardD.Lamperti “Ifyouwanttoattainthepossible,youmustattempttheimpossible” (RabindranathTagore). MichaelSchünke,ErikSchulte,UdoSchumacher, MarkusVoll,andKarlWesker Titelei_Eng.indd 5 08.07.2009 15:30:34Uhr Titelei_Eng.indd 6 08.07.2009 15:30:34Uhr Acknowledgments Firstwewishtothankourfamilies.Thisatlasisdedicatedtothem. WearegratefultoAntjeBühl,whowastherefromthebeginningasproj- ectassistant,working“behindthescenes”onnumeroustaskssuchas WealsothankProf.ReinhardGossrau,M.D.,forhiscriticalcomments repeatedproofreadingandhelpingtoarrangethefigurelabels. andsuggestions.Wearegratefultoseveralcolleagueswhorendered valuablehelpinproofreading:Mrs.GabrieleSchünke,JakobFay,M.D., WeoweagreatdeptofthankstoMartinSpencker,ManagingDirector Ms.ClaudiaDücker,Ms.SiminRassouli,Ms.HeinkeTeichmann,andMs. ofEducationalPublicationsatThieme,especiallytohisabilitytomake SylviaZilles.WearealsogratefultoDr.JuliaJürns-Kuhnkeforhelping quick and unconventional decisions when dealing with problems and withthefigurelabels. uncertainties.Hisopennesstoalltheconcernsoftheauthorsandart- istsestablishedconditionsforacooperativepartnership. WeextendspecialthankstoStephanieGayandBertSender,whocom- posedthelayouts.Theirabilitytoarrangethetextandillustrationson Without exception, our collaboration with the entire staff at Thieme facingpagesformaximumclarityhascontributedgreatlytothequality MedicalPublisherswasconsistentlypleasantandcordial.Unfortunately oftheAtlas. wedonothaveroomtolisteveryonewhohelpedinthepublicationof thisatlas,andwemustlimitouracknowledgmentstoafewcolleagues Weparticularlyacknowledgetheeffortsofthosewhohandledthisproj- whomadeaparticularlynotablecontribution:RainerZepfandMartin ectonthepublishingside: Waletzko for support in all technical matters; Susanne Tochtermann- WenzelandManfredLehnert,representingallthosewhowereinvolved JürgenLüthje,M.D.,Ph.D.,executiveeditoratThiemeMedicalPublish- intheproductionofthebook;AlmutLeopoldfortheIndex;Marie-Luise ers, has “made the impossible possible.” He not only reconciled the Kürschnerandherteamforcreatingthecoverdesign;toBirgitCarlsen wishesoftheauthorsandartistswiththedemandsofrealitybutalso andAnneDöbler,representingallthosewhohandledmarketing,sales, managedtokeepateamoffivepeopleworkingtogetherforyearsona andpromotion. projectwhosegoalwasknowntousfromthebeginningbutwhosefull dimensionswecametoappreciateonlyovertime.Heisdeservingof TheAuthors ourmostsincereandheartfeltthanks. Sabine Bartl, developmental editor, became atouchstone for the au- thorsinthebestsenseoftheword.Shewasabletodeterminewhether abeginningstudent,andthusonewhoisnot(yet)aprofessional,could clearly appreciate the logic of the presentation. The authors are in- debtedtoher. Titelei_Eng.indd 7 08.07.2009 15:30:34Uhr Titelei_Eng.indd 8 08.07.2009 15:30:34Uhr Table of Contents General Anatomy 1 HumanPhylogenyandOntogeny 5 TheMuscles 1.1 HumanPhylogeny.................................... 2 5.1 TheSkeletalMuscles................................. 40 1.2 HumanOntogeny: 5.2 TheTendonsandMechanisms Overview,Fertilization,andEarliest ThatAssistMuscleFunction .......................... 42 DevelopmentalStages .............................. 4 1.3 Gastrulation,Neurulation,andSomiteFormation ....... 6 6 TheVessels 1.4 DevelopmentoftheFetalMembranesandPlacenta ..... 8 1.5 DevelopmentofthePharyngeal(Branchial)Arches 6.1 OverviewoftheHumanCardiovascularSystem.......... 44 inHumans ......................................... 10 6.2 TheStructureofArteriesandVeins .................... 46 1.6 EarlyEmbryonicCirculationandtheDevelopment 6.3 TheTerminalVascularBed ............................ 48 ofMajorBloodVessels ............................... 12 1.7 BoneDevelopmentandRemodeling ................... 14 7 TheLymphaticSystemandGlands 1.8 OssificationoftheLimbs ............................. 16 1.9 DevelopmentandPositionoftheLimbs ................ 18 7.1 TheHumanLymphaticSystem ........................ 50 7.2 ExocrineandEndocrineGlands........................ 52 2 OverviewoftheHumanBody 8 GeneralNeuroanatomy 2.1 TheHumanBody (Proportions,SurfaceAreas,andBodyWeights).......... 20 8.1 DevelopmentoftheCentralNervousSystem(CNS) ...... 54 2.2 TheStructuralDesignoftheHumanBody .............. 22 8.2 NeuralCrestDerivativesandtheDevelopment ofthePeripheralNervousSystem(PNS) ................ 56 8.3 TopographyandStructureoftheNervousSystem........ 58 3 SurfaceAnatomyoftheBody,Landmarks 8.4 CellsoftheNervousSystem .......................... 60 andReferenceLines 8.5 StructureofaSpinalCordSegment .................... 62 3.1 TermsofLocationandDirection,CardinalPlanes 8.6 SensoryInnervation: andAxes ........................................... 24 AnOverview ..................................... 64 3.2 BodySurfaceAnatomy ............................... 26 8.7 DermatomesandCutaneousNerveTerritories......... 66 3.3 BodySurfaceContoursandPalpableBonyProminences .. 28 8.8 MotorInnervation .................................. 68 3.4 LandmarksandReferenceLinesontheHumanBody ..... 30 8.9 DifferencesbetweentheCentral 3.5 BodyRegions(RegionalAnatomy) ..................... 32 andPeripheralNervousSystems ...................... 70 8.10 TheAutonomicNervousSystem ...................... 72 4 TheBonesandJoints 4.1 TheBonySkeletonandtheStructureofTubularBones.... 34 4.2 ContinuousandDiscontinuousJoints: SynarthrosesandDiarthroses ......................... 36 4.3 BasicPrinciplesofJointMechanics ..................... 38 IX Titelei_Eng.indd 9 08.07.2009 15:30:34Uhr