Introductions to systems

Skeletal System
• The skeletal system may be divided into two functional
parts:
• The axial skeleton consists of the bones of the head
(cranium or skull), neck (hyoid bone & cervical vertebrae),
& trunk (ribs, sternum, vertebrae, & sacrum).
• The appendicular skeleton consists of the bones of the
limbs, including those forming the pectoral (shoulder) &
pelvic girdles.
Cartilage & Bones
• The skeleton is composed of cartilages & bones.
• Cartilage is a resilient, semirigid form of CT that forms parts of the
skeleton where more flexibility is required
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• Bone, a living tissue, is a highly specialized, hard form of CT that
makes up most of the skeleton. It is the chief supporting tissue of the
body.
• Bones of the adult skeleton provide:
– Support for the body & its vital cavities.
– Protection for vital structures.
– The mechanical basis for movement (leverage).
– Storage for minerals (e.g., calcium).
– A continuous supply of new blood cells (produced by the marrow
contained within many bones).

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• The two types of bone:
– compact (dense) bone
– spongy (trabecular or cancellous) bone.
• are distinguished by the relative amount of solid
matter & by the number & size of the spaces they
contain
• Compact bone provides:
– strength for weight bearing.
– In long bones designed for rigidity & attachment of
muscles & ligaments, the amount of compact bone is
greatest near the middle of the shaft where the bones are
liable to buckle.

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Classification of Bones
• Bones are classified according to their shape.
– Long bones are tubular (e.g., the humerus in the arm).
– Short bones are cuboidal & are found only in the ankle
(tarsus) & wrist (carpus).
– Flat bones usually serve protective functions (e.g., those
forming the cranium protect the brain).
– Irregular bones (e.g., in the face) have various shapes
other than long, short, or flat.

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– Sesamoid bones (e.g., the patella or knee cap) develop in
certain tendons & are found where tendons cross the ends
of long bones in the limbs; they protect the tendons from
excessive wear & often change the angle of the tendons
as they pass to their attachments.
– Accessory (supernumerary) bones develop when
additional ossification centers appear & form extra
bones.
– Heterotopic bones form in soft tissues where they are
not normally present (e.g., in scars).
– Sutural (wormian) bones are small, irregular, worm-like
bones often seen along the sutures of the cranium where
the flat bones abut, particularly related to the parietal
bone

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Structure of a long bone
• the bone shaft, or diaphysis consists of compact bone
forming a cylinder that surrounds a central cavity = the
medullary cavity
 lined with a thin layer of CT called endosteum
 Contains a yellow bone marrow (yellow b/c of large
content of fat)
 on each end of the diaphysis is an epiphysis, consisting
of cancellous bone surrounded by a layer of compact bone
 Red bone marrow is found in the porous chambers of the
spongy bone
 Articular cartilages (composed of thin hyaline cartilage)
caps the epiphysis & facilitates joint movement

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• Along the diaphysis are nutrient foramina = small openings
in to bone that allow for passage of nutrient vessels into the
bone for nourishment of the living tissue
• B/n the diaphysis & epiphysis is an epiphyseal plate of
cartilage
 this is a region of mitotic activity that is responsible for
linear bone growth
 as bone growth is completed, an epiphyseal line replaces
the plates & ossification occurs b/n the epiphysis &
diaphysis
• Periosteum (dense regular CT) covers bone surfaces,
except at articulating surfaces
- highly vascular layer
- serves as a place for muscle-tendon attachment
- responsible for appositional bone growth
 the periosteum is secured to the bone by perforating (sharpey’s)
fibers composed of bundles of collagenous fibers
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8
Vasculature & Innervation of Bones
• Bones are richly supplied with blood vessels.
• Nutrient arteries - (one or more per bone) arise as independent
branches of adjacent arteries outside the periosteum & pass obliquely
through the compact bone of the shaft of a long bone via nutrient
foramina.
 supply the bone marrow, spongy bone, & deeper portions of the
compact bone
• Periosteal arteries - small branches from the of the periosteum,
responsible for nourishment of most of the compact bone.
 a bone from which the periosteum has been removed dies.
• Metaphysial & epiphysial arteries - supply the ends of bones & arise
mainly from the arteries that supply the joints.
 in the limbs, are typically part of a periarticular arterial plexus,
which surrounds the joint, ensuring blood flow distal to the joint
regardless of the position assumed by the joint.
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10
• Veins accompany arteries through the nutrient foramina &
some leave through foramina near the articular ends of the
bones.
• Lymphatic vessels are abundant in the periosteum.
• Nerves accompany blood vessels supplying bones.
• The periosteum is richly supplied with sensory nerves -
periosteal nerves - that carry pain fibers especially sensitive
to tearing or tension  i.e. why bone fractures are very
painful
• The periosteum contains sensory fibers
• Bone is also supplied with sensory endings, e.g., vasomotor
nerves cause constriction or dilation of blood vessels,
regulating blood flow through the bone marrow.

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Bone Markings
• Bone markings appear where
– tendons, ligaments, & fascias are attached or
– arteries lie adjacent to or enter bones.
– or occur in relation to the passage of a tendon (often to
direct the tendon or improve its leverage)
– or to control the type of movement occurring at a joint .
The various markings & features of bones
are:
* Articular Processes (of the joints)
• Condyle - large, rounded articular prominence, usually occurring in
pairs (e.g., the lateral femoral condyle).
• Head - rounded articular projection supported by a more constricted
portion of a bone (neck)
• Facet - smooth, flat surface on a bone usually covered with cartilage
• Capitulum - small, round, articular head (e.g., the capitulum of the
humerus). 12
* Depressions & Openings
Fissure - cleft-like opening b/n adjacent parts of bones
through which vessels & nerves pass
Foramen - hole through which blood vessels, nerves,
ligaments can pass
Meatus/ canal - tunnel-like passageway through a bone
Sinus/ labyrinth - cavity within a bone with narrow opening
Groove - elongated depression or furrow (e.g., the radial
groove of the humerus).
Sulcus - groove or depression that accommodates a soft
structure such as vessels, nerve, tendon
Fossa - depression in/on a bone (e.g., the infraspinous fossa of
the scapula).
Notch - indentation at the edge of a bone (e.g., the greater
sciatic notch).
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* Processes/elevations for attachment (tendons,
ligaments,..)
• Epicondyle: eminence superior to a condyle (e.g., the
lateral epicondyle of the humerus).
• Line/ linea: linear elevation (e.g., the soleal line of the
tibia).
• Malleolus: rounded process (e.g., the lateral malleolus of
the fibula).
• Protuberance: projection of bone (e.g., the external
occipital protuberance).
• Spine: thorn-like process (e.g., the spine of the scapula).
• Spinous process: projecting spine-like part (e.g., vertebral
spinous process

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• Trochanter: large blunt elevation (e.g., the greater
trochanter of the femur).
• Trochlea: spool-like articular process or process that
acts as a pulley (e.g., trochlea of the humerus).
• Tubercle: small raised eminence (e.g., the greater
tubercle of the humerus).
• Tuberosity: large rounded elevation (e.g., the ischial
tuberosity).
• Process - prominent projection or point of attachment
• Crest or crista: prominent ridge

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• Other features:
– Body: main part
– Neck: constriction between head & body
– Margin or border: edge
– Angle: bend
– Ramus: branch off body
– Hamulus: hook-shaped process
– Cornu: horn-shaped process

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BONE FRACTURES
• Simple, or closed. The fractured bone does not break
through the skin.
• Compound or open. The fractured bone is exposed to the
outside through an opening in the skin.
• Partial (fissured). The bone is incompletely broken
• Complete. The fracture has separated the bone into two
pieces.
• Capillary. A hair like crack occurs within the bone.
• Comminuted. The bone is splintered into small fragments.
• Spiral. The fracture line is twisted as it is broken.
• Greenstick. In this incomplete break one side of the bone is
broken, & the other side is bowed

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• Impacted. One broken end of a bone is driven into the
other.
• Transverse. The fracture occurs across the bone at right
angles to the shaft.
• Oblique. The fracture occurs across the bone at an oblique
angle to the long axis of the bone
• Colles’. A fracture of the distal portion of the radius
• Pott’s. A fracture of either or both of the distal ends of the
tibia & fibula at the level of the malleoli
• Avulsion. A portion of a bone is torn off
• Depressed. The broken portion of the bone is driven in
wards, as in certain skull fractures
• Displaced. In this fracture, the bone fragments are not in
anatomical position
• Non displaced. In this fracture, the bone fragments are in
anatomical alignment.
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THE MUSCULAR SYSTEM
• Muscle comprises the largest group of tissues in the body,
accounting for approximately half of the body’s weight.
• Skeletal muscle about 40% BW in men & 32% in women

Muscle tissue has four principal characteristics:

1. Excitability – the property of receiving & responding to stimuli.
2. Contractility – the ability to shorten & thicken (contract).
3. Extensibility – the ability to be stretched (extended).
4. Elasticity - the ability to return to original shape after contraction or
extension

Four basic functions of muscle are:

• Movement - all 3 types of muscle
– Movement of body parts
– Movement of fluids & semisolids through the body (blood,
lymph, food, bile, urine, semen, feces…)
– Movement of a newborn through the birth canal 19
• Maintaince of posture - skeletal muscle
– allowing us to remain upright, keeping our head up right, keep you
on two feet
• Heat production (thermogenesis) - skeletal muscle
– Generation of heat via shivering – an involuntary contraction of sk
m.
• Stabilization of joints - skeletal muscle
– Muscles keep the tendons that cross the joint taut  maintain the
integrity of the joint.
Types of muscles
• Depends on the presence or absence of cross striations, location &
functions.
• Muscle is classified into 3 categories according to morphology &
physiological function:

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Skeletal Muscles
• are attached to bones at either end or both ends
• points of attachment of each muscle are its origin or insertion.
• connected to the bone by a tendon or aponeurosis (a flat sheet like
tendon).
Origin is usually the proximal end of the muscle, the most stationary
end
Insertion is usually the distal end of the muscle attached to the bone
undergoing the greatest movement.

Connective tissues associated with muscles

Tendon is a toughened dense regular CT that connects a muscle to the
perisoteum of a bone.
• It functions to transfer the force of contraction from the muscles to
the bone to be moved.
Aponeurosis is a flat, sheetlike tendon that occurs where the attachment
is over a broad line. 21
Fascias (L. fasciae)
• constitute the wrapping, packing, & insulating materials of the deep
structures of the body.
• superficial fascia = subcutaneous tissue
• deep fascia:
• The deep fascia is a dense, organized CT layer, devoid of fat, that
covers most of the body deep to the skin & subcutaneous tissue.
• Extensions from its internal surface invest (cover) deeper structures,
such as individual muscles & neurovascular bundles, as investing
fascia.
– varies in thickness widely.
– absent in the face & ischioanal fossa
• In the limbs, groups of muscles with similar functions sharing the
same nerve supply are located in fascial compartments, separated by
thick sheets of deep fascia, called intermuscular septa, that extend
centrally from the surrounding fascial sleeve to attach to the bones.

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 The deep fascia, along with contracting muscles, & venous valves
work together as a musculovenous pump to return blood to the heart,
esp. in the LL where blood must move against the pull of gravity
Subserous fascia
• lies b/n the internal surfaces of the musculoskeletal walls & the serous
membranes lining the body cavities.
• contains varying amounts of fatty tissue
– include the endothoracic, endoabdominal, & endopelvic fascias;
the latter two may be referred to collectively as extraperitoneal
fascia.

• Retinaculum is a thin strong band of CT, formed by thickening of the

deep fascia, that prevents the springing of tendons especially in the
wrist & ankle.
• endomysium – a fine sheath of CT surrounding the individual fibers
• perimysium binds groups of fibers together into bundles called
fasiculi.
• epimysium covers the entire muscle & is continuous with tendon.
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Naming of Skeletal Muscles
• Skeletal muscles are named on the basis of shape, location,
attachment orientation of fibers, relative position, or function.
• The following are some examples of how the names of muscles have
been logically derived.
1. Shape: rhomboideus (like a rhomboid), trapezius (like a trapezoid) or
denoting the number of heads of origin triceps (three heads), biceps
(two heads).
2. Location: pectoralis (in the chest, or pectus), intercostal (b/n ribs),
brachium (upper arm).
3. Attachment: many facial muscles (zygomaticus, temporialis, nasalis,
sternocleidomastoid (sternum, clavicle, & mastoid process of the
skull)
4. Size: maximus (large) minimus (smaller), longus (long), brevis (short)
5. Orientation of fibers: rectus (straight), transverses (across) oblique….
6. Relative position: lateral, medial, internal, & external.
7. Function: adductor, flexor, extensor, pronator, & levator (lifter)

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Muscle shapes
• Flat muscles have parallel fibers often with an aponeurosis, for e.g.,
external oblique.
• Pennate muscles are feather-like (L. pennatus, feather) in the
arrangement of their fascicles, & may be unipennate, bipennate, or
multi-pennate, for e.g., extensor digitorum longus (unipennate),
bellies of the gastrocnemius (bipennate), & deltoid (multi-pennate).
• Fusiform muscles are spindle shaped with a round, thick belly (or
bellies) & tapered ends, for e.g., biceps brachii.
• Quadrate muscles have four equal sides (L. quadratus, square), for
e.g., pronator quadratus.
• Circular or sphincteral muscles surround a body opening or orifice,
constricting it when contracted, for e.g., orbicularis oris
• Multi-headed or multi-bellied muscles have more than one head of
attachment or more than one contractile belly, respectively, e. g.,
biceps brachii (two heads of attachment), triceps - three heads; the
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digastric & gastrocnemius muscles have two bellies
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The Circulatory system
• transports fluids throughout the body
• it consists of the cardiovascular & lymphatic systems.
• CVS = heart & blood vessels
• 3 types of blood vessels: arteries, veins, & capillaries
• Capillaries form a capillary bed, where the interchange of
oxygen, nutrients, waste products, & other substances with
the extracellular fluid occurs.
• Blood from the capillary bed passes into thin-walled
venules, which resemble wide capillaries.

Venules small veins larger veins.

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• 3 types of arteries:
– Large elastic arteries (conducting arteries) have many
elastic layers (sheets of elastic fibers) in their walls.
• initially receive the cardiac output
– Medium muscular arteries (distributing arteries) have
walls that consist chiefly of circularly disposed smooth
muscle fibers.
– Small arteries & arterioles have relatively narrow lumina
& thick muscular walls.
• Anastomoses (communications) b/n the multiple branches
of an artery provide numerous potential detours for blood
flow in case the usual pathway is obstructed.

30
• If a main channel is occluded, the smaller alternate
channels can usually increase in size in a relatively short
time, providing a collateral circulation that ensures the
blood supply to structures distal to the blockage.
• Arteries that do not anastomose with adjacent arteries are
anatomical or true terminal or end arteries.
 Occlusion of an end artery interrupts the blood supply to
the structure or segment of an organ it supplies.
• True terminal arteries supply the retina, for e.g., where
occlusion will result in blindness.
• Functional terminal arteries (arteries with ineffectual
anastomoses) supply segments of the brain, liver, kidneys, spleen,
& intestines; they may also exist in the heart.

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Veins
• more abundant than arteries
• the walls of veins are thinner than those of their companion arteries
because of the lower BP in the venous system
• pulmonary veins are atypical in that they carry arterial blood
• There are three sizes of veins:
– Venules are the smallest veins & drain capillary beds
• Small veins are the tributaries of larger veins that unite to form
venous plexuses & are unnamed.
– Medium veins drain venous plexuses & accompany medium
arteries.
– Large veins drain medium veins & empty into the heart, e.g., vena
cava.
• In the limbs, & in some other locations where blood flow is against
gravity, the medium veins have valves & named according to the
artery they accompany.
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• Those that accompany deep arteries - accompanying veins (L. venae
comitantes) - surround them in an irregular branching network.
  serves as a countercurrent heat exchanger, the warm arterial
blood warming the cooler venous blood as it returns to the heart
from a cold extremity
• Systemic veins are more variable than arteries, & venous
anastomoses, direct or indirect, b/n two veins occur more often b/n
them.
• The outward expansion of the bellies of contracting skeletal muscles
in the limbs, limited by the deep fascia, compresses the veins, milking
the blood superiorly toward the heart; another (musculovenous) type
of venous pump.
• The valves of the veins break up the columns of blood, thus relieving
the more dependent parts of excessive pressure, allowing venous
blood to flow only toward the heart.

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34
• In some regions, there are direct connections between
the small arterioles & venules proximal to the capillary
beds they supply & drain.

• The sites of such communications -arteriolovenular

anastomoses (AV shunts) -permit blood to pass
directly from the arterial to the venous side of the
circulation without passing through capillaries.

 AV shunts are numerous in the skin, where they have

an important role in conserving body heat.

• In some situations, blood passes thru two capillary

beds before returning to the heart; a venous system
linking two capillary beds constitutes a portal venous
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system.
Lymphatic System
• The lymphatic system constitutes a sort of overflow system that
provides for the:
– drainage of surplus tissue fluid & leaked plasma proteins to
the bloodstream
– removal of debris from cellular decomposition & infection.
Other functions include:
– absorption & transport of dietary fat (e.g., lacteals receive all
lipid & lipid-soluble vitamins absorbed by the intestine)
– formation of a defense mechanism for the body (e.g.,
lymphocytes).

• The important components of the lymphatic system are:

– Lymphatic plexuses: networks of lymphatic capillaries that
originate blindly in the extracellular (intercellular) spaces of
most tissues.

– Lymphatic vessels (lymphatics): a nearly bodywide network

36
of thin-walled vessels with abundant lymphatic valves.
– Lymphatic capillaries & vessels: occur almost everywhere
blood capillaries are found, except, for example, teeth, bone,
bone marrow, & the entire central nervous system (excess tissue
fluid here drains into the cerebrospinal fluid).
– Lymph (L. lympha, clear water): the tissue fluid that enters
lymph capillaries & is conveyed by lymphatic vessels. Usually
clear, watery, & slightly yellow, lymph is similar in composition
to blood plasma.
– Lymph nodes, small masses of lymphatic tissue located along
the course of lymphatic vessels through which lymph is filtered
on its way to the venous system.
– Lymphocytes, circulating cells of the immune system that react
against foreign materials.
– Lymphoid tissue, sites that produce lymphocytes, such as that
aggregated in the walls of the digestive tract (alimentary canal);
in the spleen, thymus, & lymph nodes; & as myeloid tissue in
red bone marrow.

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The Nervous System
• enables the body to react to continuous changes in its internal &
external environments.
• controls & integrates the various activities of the body, such as
circulation & respiration.
2 dvisions:
• Structurally into the central nervous system (CNS) & peripheral
nervous system (PNS).
• Functionally into the somatic nervous system (SNS) & autonomic
nervous system (ANS).
CNS
• consists of the brain & spinal cord
• A nucleus: collection of nerve cell bodies in the CNS is called.
• A tract: bundle of nerve fibers (axons) connecting neighboring or
distant nuclei of the CNS.
• The brain & spinal cord are composed of gray matter & white matter.
• The nerve cell bodies constitute the gray matter; the interconnecting
fiber tract systems form the white matter
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• the meninges: 3 membranous layers - pia mater, arachnoid mater, &
dura mater
• the meninges & the cerebrospinal fluid (CSF) surround & protect the
CNS.
Peripheral Nervous System
• consists of nerve fibers & cell bodies outside the CNS that conduct
impulses to or away from the CNS
• A peripheral nerve fiber consists of an axon, its neurolemma, &
surrounding endoneurial CT
– myelinated nerve fibers
– unmyelinated nerve fibers
• A peripheral nerve consists of:
– a bundle of peripheral nerve fibers or fascicles
– CT coverings that surround & bind the nerve fibers & fascicles
together, &
– blood vessels (vasa nervorum) that nourish the nerve fibers & their
coverings

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3 CT coverings:
• Endoneurium: delicate CT immediately surrounding the
neurolemma cells & axons.
• Perineurium: a layer of dense CT that encloses a fascicle of
peripheral nerve fibers, providing an effective barrier
against penetration of the nerve fibers by foreign
substances.
• Epineurium: a thick CT sheath that surrounds & encloses a
bundle of fascicles, forming the outermost covering of the
nerve; it includes fatty tissue, blood vessels, & lymphatics.
• A collection of nerve cell bodies outside the CNS is a
ganglion.
– there are both motor (autonomic) & sensory ganglia.
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• Cranial nerves exit the cranial cavity through
foramina (openings) in the cranium
– are identified by a descriptive name (e.g., trochlear) or a
Roman numeral (e.g., CN IV).
– only 11 of the 12 pairs of cranial nerves arise from the
brain; the other pair (CN XI) arises from the superior part
of the spinal cord.
• Spinal nerves exit the vertebral column (spine)
through intervertebral foramina.
– all 31 pairs arise from the spinal cord & are identified by
a letter & number (e.g., T4) designating the order of their
origin from the 31 consecutive spinal cord segments (C,
cervical; T, thoracic; L, lumbar; S, sacral; Co,
coccygeal). 41
42
Spinal Nerves
• arise from the spinal cord as rootlets), which converge to
form two nerve roots:
– An anterior (ventral) root: consists of motor (efferent) fibers
passing from nerve cell bodies in the anterior horn of spinal cord
gray matter to effector organs located peripherally.
– A posterior (dorsal) root: consisting of sensory (afferent) fibers
from cell bodies in the spinal sensory or posterior (dorsal) root
ganglion that extend peripherally to sensory endings & centrally to
the posterior horn of spinal cord gray matter.
• The posterior & anterior nerve roots unite to form a mixed
spinal nerve
• This immediately divides into two primary rami: a posterior
(dorsal) ramus & an anterior (ventral) ramus.
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• As branches of the mixed spinal nerve, the posterior & anterior rami
carry both motor & sensory fibers
• Nerves supplying muscles of the trunk or limbs (motor nerves)
contain about 40% sensory fibers, which convey pain &
proprioceptive information.
• Conversely, cutaneous (sensory) nerves contain motor fibers, which
serve sweat glands & the smooth muscle of blood vessels & hair
follicles.
 refers to majority of the nerve fibers
• A dermatome: the unilateral area of skin innervated by the fibers of a
single spinal nerve
• A myotome: the unilateral muscle mass receiving innervation from
the fibers conveyed by a single spinal nerve
• The posterior rami remain separate from each other, supplying nerve
fibers to the synovial joints of the vertebral column, deep muscles of
the back, & the overlying skin in a segmental pattern.

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• The types of fibers conveyed by cranial or spinal peripheral
nerves are as follows:
Somatic fibers
• General sensory fibers (general somatic afferent [GSA] fibers)
– transmit sensations from the body to the CNS;
– may be exteroceptive sensations from the skin (pain, temperature,
touch, & pressure) or pain & proprioceptive sensations from muscles,
tendons, & joints.
• Somatic motor fibers (general somatic efferent [GSE] fibers)
transmit impulses to skeletal (voluntary) muscles.
Visceral fibers
• Visceral sensory fibers (general visceral afferent [GVA] fibers)
transmit pain or subconscious visceral reflex sensations
(information concerning distension, blood gas, & blood pressure
levels, for example) from hollow organs & blood vessels to the
CNS.
• Visceral motor fibers (general visceral efferent [GVE] fibers)
transmit impulses to smooth (involuntary) muscle & glandular
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tissues = autonomic
Somatic Nervous System
• composed of somatic parts of the CNS & PNS
• provides sensory & motor innervation to all
parts of the body, except the viscera in the
body cavities, smooth muscle, & glands
• The somatic sensory system transmits
sensations of touch, pain, temperature, &
position from sensory receptors.
– Most of these sensations reach conscious levels
(i.e., we are aware of them).
• The somatic motor system innervates only
skeletal muscle, stimulating voluntary &
reflexive movement by causing the muscle to
contract 46
Autonomic Nervous System
• consists of motor fibers that stimulate smooth (involuntary)
muscle, modified cardiac muscle (conducting tissue of heart), &
glandular (secretory) cells.

47
• The efferent nerve fibers & ganglia of the ANS are organized
into two systems or divisions:
– the sympathetic (thoracolumbar) division &
– the parasympathetic (craniosacral) division.

• Conduction of impulses from the CNS to the effector organ

involves a series of two multi-polar neurons.

• The cell body of the first presynaptic (preganglionic) neuron is

located in the gray matter of the CNS.

• Its fiber (axon) synapses only on the cell body of a postsynaptic

(postganglionic) neuron

• The cell bodies of the latter second neurons are located outside
the CNS in autonomic ganglia, with fibers terminating on the
effector organ (smooth muscle, modified cardiac muscle, or
glands). 48
49
Sympathetic (Thoracolumbar) Division of the ANS

• The cell bodies of the presynaptic neurons of the

sympathetic division of the ANS are found in the
intermediolateral cell columns (IMLs) or nuclei of the
spinal cord

• The paired (right & left) IMLs are a part of the gray
matter of the thoracic (T1-12) & the upper lumbar (T1-
L2 or 3) segments of the spinal cord.

• In transverse sections of this part of the spinal cord,

the IMLs appear as small lateral horns of the H-
shaped gray matter, looking somewhat like an
extension of the cross-bar of the H b/n the posterior &
50
the anterior horns.
51
• The cell bodies of postsynaptic neurons of the
sympathetic nervous system occur in two
locations:
– Paravertebral ganglia are linked to form right & left
sympathetic trunks (chains) on each side of the
vertebral column & extend essentially the length of
this column.
• The superior paravertebral ganglion (the superior cervical
ganglion of each sympathetic trunk) lies at the base of the
cranium.
• The ganglion impar forms inferiorly where the two trunks
unite at the level of the coccyx.
– Prevertebral ganglia are in the plexuses that
surround the origins of the main branches of the
abdominal aorta, e.g., the two large celiac ganglia
that surround the origin of the celiac trunk 52
53
• the axons of presynaptic neurons leave the spinal
cord thru anterior roots & enter the anterior rami of
spinal nerves T1-L2 or 3.
• immediately then, all the fibers leave the anterior rami
of the spinal nerves & pass to the sympathetic trunks
thru white rami communicantes.
• within the sympathetic trunks, presynaptic fibers follow
one of four possible courses:
– Ascend in the sympathetic trunk to synapse with a
postsynaptic neuron of a higher paravertebral ganglion.
– Descend in the sympathetic trunk to synapse with a
postsynaptic neuron of a lower paravertebral ganglion.
– Enter & synapse immediately with a postsynaptic neuron of
the paravertebral ganglion at that level.
– Pass thru the sympathetic trunk without synapsing,
continuing thru an abdominopelvic splanchnic nerve (a
branch of the trunk involved in innervating abdominopelvic
54
viscera) to reach the prevertebral ganglia.
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 Presynaptic sympathetic fibers that provide autonomic
innervation within the head, neck, body wall, limbs, & thoracic
cavity follow one of the first three courses, synapsing within the
paravertebral ganglia.

 Presynaptic sympathetic fibers innervating viscera within the

abdominopelvic cavity follow the fourth course.

 The postsynaptic sympathetic fibers, destined for distribution

within the neck, body wall, & limbs, pass from the paravertebral
ganglia of the sympathetic trunks to adjacent anterior rami of
spinal nerves through gray rami communicantes

 enter all branches of all 31 pairs of spinal nerves, including the posterior
rami

 The sympathetic system's primary function is to innervate all

the body's blood vessels 56
Splanchnic nerves
• convey visceral efferent (autonomic) & afferent fibers to & from the viscera
of the body cavities.
• Postsynaptic sympathetic fibers destined for the viscera of the thoracic
cavity (e.g., the heart, lungs, & esophagus) pass thru cardiopulmonary
splanchnic nerves to enter the cardiac, pulmonary, & esophageal plexuses.
• The presynaptic sympathetic fibers involved in the innervation of viscera of
the abdominopelvic cavity (e.g., the stomach & intestines) pass to the
prevertebral ganglia thru abdominopelvic splanchnic nerves (making up the
greater, lesser, least, & lumbar splanchnic nerves).
• All presynaptic sympathetic fibers of the abdominopelvic splanchnic nerves,
except those involved in innervating the suprarenal (adrenal) glands,
synapse here.
• The postsynaptic fibers from the prevertebral ganglia form periarterial
plexuses, which follow branches of the abdominal aorta to reach their
destination.
• Some presynaptic sympathetic fibers pass thru the celiac ganglia without
synapsing, continuing to terminate directly on cells of the medulla of the
suprarenal gland.
• The suprarenal medullary cells function as a special type of postsynaptic
57
neuron.
58
Parasympathetic (Craniosacral) Division of the
ANS
• Presynaptic parasympathetic neuron cell
bodies are located in two sites within the CNS,
their fibers exiting by two routes:
– In the brainstem, the fibers exit the CNS within
cranial nerves (CN) III, VII, IX, & X;
• constitute the cranial parasympathetic outflow.

– In the sacral segments of the spinal cord (S2-4), the

fibers exit the CNS thru the anterior roots of sacral
spinal nerves S2-4 & the pelvic splanchnic nerves
that arise from their anterior rami;
• constitute the sacral parasympathetic outflow. 59
• the cranial outflow provides parasympathetic innervation of the
head, & the sacral outflow provides the parasympathetic
innervation of the pelvic viscera.
 the cranial outflow thru the vagus nerve (CN X) provides
innervation to all the thoracic viscera & most of the
gastrointestinal (GI) tract from the esophagus thru most of the
large intestine (to its left colic flexure).
• The sacral outflow to the GI tract supplies only the descending
& sigmoid colon & rectum.
• The parasympathetic system is much more restricted than the
sympathetic system in its distribution.
– distributes only to the head, visceral cavities of the trunk, & erectile
tissues of the external genitalia.
– does not reach the body wall (except external genitalia) or limbs;

 except for the initial parts of the anterior rami of spinal nerves
S2-4, its fibers are not components of spinal nerves or their
branches. 60
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