Terminology, the Standard Human, and Scaling



Fig. 1.1
Directions, orientations, and planes used to describe the body in anatomy, along with common coordinate systems described in the text. We will assume both terms in the following pairs mean the same: superior/cranial, inferior/caudal, anterior/ventral, and posterior/dorsal, even though there may be fine distinctions in what they mean, as is depicted here (from [16], with additions. Used with permission)



The first series of anatomical “coordinate systems” relate to direction, and the first set of these we encounter is right versus left. With the xyz coordinate system of the body shown in Fig. 1.1, we see that right means $$y<0$$ and left means $$y>0$$” src=”http://basicmedicalkey.com/wp-content/uploads/2017/06/A114622_2_En_1_Chapter_IEq2.gif”></SPAN>. Right and left, as well as all other anatomical terms, are always from the “patient’s” point of view. This was made perfectly clear to the author during a visit to his son’s ophthalmologist. When he tried to discuss what he thought was his son’s right eye, it was pointed out to the author in no uncertain terms that he was really referring to the patient’s left eye and that he was doing so in an improper manner. Case closed! (Stages in theaters have a similar convention, with stage left and stage right referring to the left and right sides of an actor on stage facing the audience. This was evident in a funny scene in the movie <SPAN class=EmphasisTypeBold>Tootsie</SPAN> when a stagehand was told to focus on the right side of the face of Dorothy Michaels, aka Michael Dorsey, aka Dustin Hoffman—and Dorothy heard this and then turned her (i.e., his) head so the camera would be focusing on the left side of her (i.e., his) face. A comical debate then ensued concerning whose “right” was correct, that of a person on stage or one facing the stage.)</DIV><br />
<DIV id=Par7 class=Para>The second direction is <SPAN class=EmphasisTypeItalic>superior</SPAN> (or <SPAN class=EmphasisTypeItalic>cranial</SPAN>), which means towards the head or above, i.e., to larger <SPAN class=EmphasisTypeItalic>z</SPAN>. <SPAN class=EmphasisTypeItalic>Inferior</SPAN> (or <SPAN class=EmphasisTypeItalic>caudal</SPAN> (kaw’-dul)) means away from the head, i.e., to smaller <SPAN class=EmphasisTypeItalic>z</SPAN>—in an algebraic sense, so more and more inferior means smaller positive numbers and then more highly negative values of <SPAN class=EmphasisTypeItalic>z</SPAN>. (This is relative to a defined <SPAN id=IEq3 class=InlineEquation><IMG alt=$$z=0$$ src= plane. We could choose to define the origin of the coordinate system at the center of mass of the body.) So, the head is superior to the feet, which are inferior to the head. After supplying the body with oxygen, blood returns to the heart through two major veins, the superior and inferior vena cava (vee’-nuh cave’-uh), which collect blood from above and below the heart, respectively. (As you see, words that the author has trouble pronouncing are also presented more or less phonetically, with an apostrophe after the accented syllable.)

Anterior (or ventral) means towards or from the front of the body, i.e., to larger x. Posterior (or dorsal) means towards or from the back, corresponding to smaller algebraic x. The nose is anterior to the ears, which are posterior to the nose.

There is another pair of terms that relate to the y coordinate, specifically to its magnitude. Medial means nearer the midline of the body, i.e., towards smaller |y|. Lateral means further from the midline, i.e., towards larger |y|.

Other anatomical terms require other types of coordinate systems. One set describes the distance from the point of attachment of any of the two arms and two legs from the trunk. Figure 1.1 depicts this with the coordinate r, where $$r=0$$ at the trunk. r is never negative. Proximal means near the point of attachment, i.e., to smaller r. Distal means further from the point of attachment, or larger r.

The last series of directional terms relates to the local surface of the body. This can be depicted by the coordinate $$\rho $$ (inset in Fig. 1.1), which is related to x and y in an $$x-y$$ plane. $$\rho =0$$ on the local surface of the body. Superficial means towards or on the surface of the body, or to smaller $$\rho $$. Deep means away from the surface, or towards larger $$\rho $$.


Table 1.1
Anatomical terms in anterior regions


















































































Anatomical term

Common term

Abdominal

Abdomen

Antebrachial

Forearm

Axilliary

Armpit

Brachial

Upper arm

Buccal

Cheek

Carpal

Wrist

Cephalic

Head

Cervical

Neck

Coxal

Hip

Crural

Front of leg

Digital

Finger or toe

Frontal

Forehead

Inguinal

Groin

Lingual

Tongue

Mammary

Breast

Mental

Chin

Nasal

Nose

Oral

Mouth

Palmar

Palm

Pedal

Foot

Sternal

Breastbone

Tarsal

Ankle

Thoracic

Chest

Umbilical

Navel



Table 1.2
Anatomical terms in posterior regions





































Anatomical term

Common term

Acromial

Top of shoulder

Femoral

Thigh

Gluteal

Buttock

Occipital

Back of head

Plantar

Sole of foot

Popliteal

Back of knee

Sacral

Between hips

Sural

Back of leg

Vertebral

Spinal column

These directional terms can refer to any locality of the body . Regional terms designate a specific region in the body (Tables 1.1 and 1.2). This is illustrated by an example we will use several times later. The region between the shoulder and elbow joints is called the brachium (brae’-kee-um). The adjective used to describe this region in anatomical terms is brachial (brae’-kee-al) . The muscles in our arms that we usually call the biceps are really the brachial biceps or biceps brachii, while our triceps are really our brachial triceps or triceps brachii . The terms biceps and triceps refer to any muscles with two or three points of origin, respectively (as we will see)—and not necessarily to those in our arms.

The final set of terms describes two-dimensional planes, cuts or sections of the body. They are illustrated in Fig. 1.1. A transverse or horizontal section separates the body into superior and inferior sections. Such planes have constant z. Sagittal sections separate the body into right and left sections, and are planes with constant y. The midsagittal section is special; it occurs at the midline and is a plane with $$y=0$$. The frontal or coronal section separates the body into anterior and posterior portions, as described by planes with constant x.

Much of our outright confusion concerning medical descriptions is alleviated with the knowledge of these three categories of anatomical terminology. There is actually a fourth set of anatomical terms that relates to types of motion. These are discussed in Sect. 1.2.



1.2 Motion in the Human Machine


Anatomical terms refer to the body locally whether it is at rest or in motion. Since we are also concerned with how we move, we need to address human motion [3 ] . We will describe how we move by examining the degrees of freedom of our motion and the means for providing such motion by our joints. We will see that our arms and legs are constructed in a very clever manner . Because joints involve motion between bones, we will need to refer to the anatomy of the skeletal system, as in Fig. 1.2.

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Fig. 1.2
Anatomy of the skeletal system, anterior view, with major bones and joints listed (from [37])

Think of a degree of freedom (DOF) of motion as a coordinate needed to describe that type of motion. If you want to relocate an object, you are generally interested in changing its center of mass and its angular orientation. You may want to change its center of mass from an (xyz) of (0, 0, 0) to (abc). Because three coordinates are needed to describe this change, there are three “translational” degrees of freedom. Similarly, you can change the angular orientation of the object about the x, y, and z axes, by changing the angles this object can be rotated about these three axes: $$\theta _{x}$$, $$\theta _{y}$$, and $$\theta _{z}$$, respectively. So, there are also three rotational degrees of freedom. (Sometimes, these three independent rotations are defined differently, by the three Eulerian angles, which will not be introduced here.)

These six (three plus three) degrees of freedom are independent of each other. Keeping your fingers rigid as a fist, you should be able to change independently either the x, y, z, $$\theta _{x}$$, $$\theta _{y}$$, and $$\theta _{z}$$ of your fist by moving your arms in different ways. You should try to change the x, y, and z of your fist, while keeping $$\theta _{x}$$, $$\theta _{y}$$, and $$\theta _{z}$$ fixed. Also, try changing the $$\theta _{x}$$, $$\theta _{y}$$, and $$\theta _{z}$$ of your fist, while keeping its x, y, and z constant.

We would like each of our arms and legs to have these six degrees of freedom. How does the body do it? It does it with joints, also known as articulations. Two types of articulations, fibrous (bones joined by connective tissue) and cartilaginous (bones joined by cartilage) joints, can bend only very little. One type of fibrous joint is the suture joint that connects the bony plates of the skull. These plates interdigitate through triangle-like tooth patterns across more compliant seams with fibers, so this joint can bear and transmit loads, absorb energy, and provide flexibility for growth, respiration, and locomotion [17, 18]. There is a joint cavity between the articulating bones in synovial joints . Only these synovial joints have the large degree of angular motion needed for motion. As seen in Fig. 1.3, in synovial joints cartilage layers on the ends of opposing bones are contained in a sac containing synovial fluid . The coefficient of friction in such joints is lower than any joints made by mankind. (More on this later.)

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Fig. 1.3
The right knee synovial joint, with a anterior view with the kneecap (patella) removed and b in sagittal section (photo) . Also see Fig. 3.​3e (from [37])

There are several types of synovial joints in the body, each with either one, two, or three degrees of angular motion. Each has an analog with physical objects, as seen in Fig. 1.4. For example, a common door hinge is a model of one degree of angular freedom. Universal joints, which connect each axle to a wheel in a car, have two angular degrees of freedom. A ball-and-socket joint has three independent degrees of angular motion. The water faucet in a shower is a ball-and-socket joint. The balls and sockets in these joints are spherical. Condyloid or ellipsoidal joints are ball-and-socket joints with ellipsoidal balls and sockets. They have only two degrees of freedom because rotation is not possible about the axis emanating from the balls. A saddle joint, which looks like two saddles meshing into one another, also has two degrees of angular motion. Other examples are shown in Fig. 1.4.

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Fig. 1.4
Six types of synovial joints, including a: a hinge joint (1D joint) , as in the elbow joint for flexion and extension, b pivot joint (1D joint), as in the atlantoaxial joint in the spinal cord for rotation, c saddle joint (2D), which is both concave and convex where the bones articulate, as in the joint between the first metacarpal and the trapezium in the hand, d condyloid or ellipsoidal joint (2D), as in the metacarpophalangeal (knuckle) joint between the metacarpal and proximal phalanx for flexion and extension, abduction and adduction, and circumduction, e plane joint (2D), as in the acromioclavicular joint in the shoulder for gliding or sliding, and f ball-and-socket joint (3D), as in the hip joint (and the shoulder joint) for flexion and extension, abduction and adduction, and medial and lateral rotation. See Figs. 1.9 and 1.10 for definitions of the terms describing the types of motion about joints and the diagrams in Fig. 1.11 for more information about synovial joints (from [26]. Used with permission)

Now back to our limbs. Consider a leg with rigid toes. The upper leg bone (femur) is connected to the hip as a ball-and-socket joint (three DOFs) (as in the song “Dry Bones” aka “Them Bones” in which “The hip bone is connected to the thigh bones, ….” The knee is a hinge (one DOF). The ankle is a saddle joint (two DOFs). This means that each leg has six degrees of angular motion, as needed for complete location of the foot. Of course, several of these degrees of freedom have only limited angular motion.

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Fig. 1.5
Nonunique way of positioning the right arm. This is demonstrated by grasping the armrest while sitting, with the six coordinates of the hand (three for position and three for angle) being the same in both arm positions. This is possible because the arm can use its seven degrees of freedom to determine these six coordinates (from [3]. Copyright 1992 Columbia University Press. Reprinted with the permission of the press)


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Fig. 1.6
a Anatomy of the hand and b the degrees of freedom of the hand and fingers, with joints (spaces) having one (spaces with flat terminations) or two (curved terminations, with a “2” below the joint) degrees of freedom (from [3]. Copyright 1992 Columbia University Press. Reprinted with the permission of the press)

Now consider each arm, with all fingers rigid. The upper arm (humerus) fits into the shoulder as a ball-and-socket joint (three DOFs). The elbow is a hinge (one DOF). The wrist is an ellipsoidal joint (two DOFs). That makes six DOFs. The leg has these six DOFs, but the arm has one additional DOF, for a total of seven. This additional DOF is the screwdriver type motion of the radius rolling on the ulna (Figs. 1.2, 2.​7, and 2.​8), which is a pivot with 1 DOF. With only six DOFs you would be able to move your hand to a given x, y, z, $$\theta _{x},\theta _{y},\theta _{z}$$ position in only one way. With the additional DOF you can do it in many ways, as is seen for the person sitting in a chair in Fig. 1.5. There are many more degrees of freedom available in the hand, which enable the complex operations we perform, such as holding a ball . Figure 1.6 shows the bones of the hand, and the associated articulations and degrees of freedom associated with the motion of each finger.

We can also see why it is clever and good engineering that the knee hinge divides the leg into two nearly equal sections and the elbow hinge divides the arm into two nearly equal sections. In the two-dimensional world of Fig. 1.7 this enables a greater area (volume for 3D) to be covered than with unequal sections.

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Fig. 1.7
Range of hand motion in two dimensions for different lengths of the upper and lower arms (from [3]. Copyright 1992 Columbia University Press. Reprinted with the permission of the press)

In preparation for our discussion of statics and motion of the body, we should consider the building blocks of human motion. There are four types of components: bones, ligaments, muscles, and tendons. Each has a very different function and mechanical properties. Bones are often lined with hyaline (high’u-lun) articular cartilage at the synovial joints . Ligaments hold bones together. Muscles, in particular skeletal muscles, are the motors that move the bones about the joints. (There is also cardiac muscle—the heart—and smooth muscle—of the digestive and other organs.) Tendons connect muscles to bones . Muscles are connected at points of origin and insertion via tendons; the points of insertion are where the “action” is. Figure 1.8 shows several of the larger muscles in the body, along with some of the tendons.

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Fig. 1.8
a Anterior and b posterior views of some of the larger skeletal muscles in the body. Several muscles are labeled: S sternocleidomastoid, T trapezius, D deltoid, P pectoralis major, E external oblique, L latissimus dorsi, G gluteus maximus. In (b), the broad-banded tendon extending from the gastrocnemius and soleus (deep to the gastrocnemius, not shown) muscles to the ankle (calcaneus) is the calcaneal (or Achilles) tendon (from [26]. Used with permission)

Muscles work by contraction only, i.e., only by getting shorter. Consequently, to be able to move your arms one way and then back in the opposite direction, you need pairs of muscles on the same body part for each opposing motion . Such opposing pairs, known as “antagonists,” are very common in the body.

We now return to our brief review of terminology, this time to describe the angular motion of joints . It is not surprising that these come in opposing pairs (Figs. 1.9 and 1.10) as supplied by antagonist muscles . When the angle of a 1D hinge, such as the elbow, increases it is called extension and when it decreases it is flexion. When you rotate your leg away from the midline of your body, it is abduction, and when you bring is closer to the midline, it is adduction. When you rotate a body part about its long axis it is called rotation. The screwdriver motion in the arm is pronation (a front facing hand rotates towards the body) or supination (away from the body), and so supination is the motion of a right hand screwing in a right-handed screw (clockwise looking distally from the shoulder to the hand) and pronation is that of a right hand unscrewing a right-handed screw (counterclockwise looking distally from the shoulder to the hand). Examples of the rotation axes for the synovial joints used in these opposing motions are given in Fig. 1.11.

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Fig. 1.9
Several antagonistic motions allowed by synovial joints. See other motions in Fig. 1.10 (from [26]. Used with permission)


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Fig. 1.10
More antagonistic motions allowed by synovial joints. See other motions in Fig. 1.9 (From [26]. Used with permission)


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Fig. 1.11
Rotation axes for four types of synovial joints are shown for each depicted rotation direction: a one axis for a hinge joint (1D joint), b two axes for a saddle joint (2D), c two axes for an ellipsoidal joint (2D), and d three axes for a ball-and-socket joint (3D) (from [32])

One example of opposing motion is the motion of the arm (Fig. 1.12 ) . The biceps brachii have two points of origin and are inserted on the radius (as shown in Fig. 2.​10 below). When they contract, the radius undergoes flexion about the pivot point in the elbow . The triceps brachii have three points of origin, and a point of insertion on the ulna. They are relaxed during flexion. During extension they contract, while the biceps brachii are relaxed. This is an example of a lever system about a pivot point. (This is really a pivot axis normal to the plane of the arm, as is illustrated in Fig. 1.11a for a hinge joint.)

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Fig. 1.12
Opposing motions of the lower arm with antagonist muscles, with flexion by contraction of the biceps brachii and extension by the contraction of the triceps brachii. The axis of rotation is seen in Fig. 1.11a


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Fig. 1.13
Rotations of the right eye. A dashed line has been added across the iris to help view the rotations (based on [38])


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Fig. 1.14
Ocular muscles, with the eyelid (palpebra) pulled up as shown. The tendon of the superior oblique muscle (marked in two regions) passes through the trochlea loop (from [37])

A second place where there is such opposing motion is the eye. The three types of opposite motion in each eye (monocular rotations) are shown in Fig. 1.13. During adduction the eye turns in to the midline, while during abduction it turns out. The eyeball can also undergo elevation (eye rotating upward, or supraduction) or depression (eyeball rotating downward, or infraduction). Less common is the rotation of the eyeball about an axis normal to the iris, in opposing intorsion (incycloduction) or extorsion (excycloduction) motions . There are three pairs of opposing muscles per eye, each attached to the skull behind the eye, that control these motions (Fig. 1.14 , Table 1.3). However, of these three pairs, only one is cleanly associated with only one of these pairs of opposing motions. Adduction occurs with the contraction of the medial rectus muscle, while abduction occurs when the lateral rectus contracts. The primary action of the superior rectus is elevation, while that of the opposing inferior rectus is depression. The primary action of the superior oblique is also depression, while that of the opposing inferior oblique is also elevation. These last two pairs of muscles have secondary actions in adduction/abduction and intorsion/extorsion that depend on the position of the eye . Binocular vision requires coordinated motion of the three opposing muscle pairs in both eyes, as described in Table 1.4.


Table 1.3
Ocular muscle functions




































Muscle

Primary action

Secondary action

Lateral rectus

Abduction

None

Medial rectus

Adduction

None

Superior rectus

Elevation

Adduction, intorsion

Inferior rectus

Depression

Abduction, extorsion

Superior oblique

Depression

Intorsion, abduction

Inferior oblique

Elevation

Extorsion, abduction


Based on [38]



Table 1.4
Muscle combinations of both eyes for gaze directions




































Direction of gaze

Right eye muscle

Left eye muscle

Eyes up, right

Superior rectus

Inferior oblique

Eyes right

Lateral rectus

Medial rectus

Eyes down, right

Inferior rectus

Superior oblique

Eyes down, left

Superior oblique

Inferior rectus

Eyes left

Medial rectus

Lateral rectus

Eyes up, left

Inferior oblique

Superior rectus


Based on [38]


1.3 The Standard Human





Table 1.5
A description of the “Standard Man”





























































































Age

30 yr

Height

1.72 m (5 ft 8 in)

Mass

70 kg

Weight

690 N (154 lb)

Surface area

1.85 m$$^{2}$$

Body core temperature

$$37.0\,{^\circ }$$C

Body skin temperature

$$34.0\,{^\circ }$$C

Heat capacity

0.83 kcal/kg-$$^{\circ }$$C (3.5 kJ/kg-$$^{\circ }$$C)

Basal metabolic rate

70 kcal/h (1,680 kcal/day, 38 kcal/m$$^{2}$$-h, 44 W/m$$^{2}$$)

Body fat

$$15\%$$

Subcutaneous fat layer

5 mm

Body fluids volume

51 L

Body fluids composition

$$53\%$$ intracellular; $$40\%$$ interstitial, lymph; $$7\%$$ plasma

Heart rate

65 beats/min

Blood volume

5.2 L

Blood hematocrit

0.43

Cardiac output (at rest)

5.0 L/min

Cardiac output (in general)

3.0 + 8 $$\times $$ O$$_{2}$$ consumption (in L/min) L/min

Systolic blood pressure

120 mmHg (16.0 kPa)

Diastolic blood pressure

80 mmHg (10.7 kPa)

Breathing rate

15/min

O$$_{2}$$ consumption

0.26 L/min

CO$$_{2}$$ production

0.21 L/min

Total lung capacity

6.0 L

Vital capacity

4.8 L

Tidal volume

0.5 L

Lung dead space

0.15 L

Lung mass transfer area

90 m$$^{2}$$

Mechanical work efficiency

0–25%


There are wide variations about these typical values for body parameters. Also, these values are different for different regions; the ones in the table typify American males in the mid-1970s. Values for women are different than for men; for example, their typical heights and weights are lower and their percentage of body fat is higher

Using data from [7, 41]

We will often, but not always, model humans assuming numerical values for mass, height, etc. of a “standard” human, a 70 kg man with parameters similar to those in Table 1.5. The distributions of body heights and weights, and of course their averages, differ in different regions and change with time. For example, heights of western European men increased by $$\sim $$8–17 cm over the last two centuries, with much of these increases being very recent, with typical rates of $$\sim $$1–2 cm/decade [13].

We will need details of human anatomy in some cases, and these are provided for the standard human now and in subsequent chapters as needed. We will also need to use the findings of anthropometry, which involves the measurement of the size, weight, and proportions of the human body. Of particular use will beanthropometric data, such as those in Table 1.6 and Fig. 1.15, which provide the lengths of different anatomical segments of the “average” body as a fraction of the body height H.

Table 1.7 gives the masses (or weights) of different anatomical parts of the body as fractions of total body mass $$m_{\mathrm {b}}$$ (or equivalently, total body weight $$W_{\mathrm {b}}$$). The mass and volume of body segments are determined on cadaver body segments, respectively by weighing them and by measuring the volume of water displaced for segments immersed in water. (This last measurement uses Archimedes’ Principle, described in Chap. 7.) The average density of different body segments can then be determined, as in Table 1.7. The volumes of body segments of live humans can be measured by water displacement (Problem 1.39) and then their masses can be estimated quite well by using these cadaver densities. Whole body densities of live humans can be measured using underwater weighing, as is described in Problem 1.43 . A relation for average body density is given below in (1.3). This is closely related to determining the percentage of body fat, as is presented below in (1.4) and (1.5).


Table 1.6
Body segment lengths. Also see Fig. 1.15




















































Segment

Segment length$$^\mathrm{a}$$/body height H

Head height

0.130

Neck height

0.052

Shoulder width

0.259

Upper arm

0.186

Lower arm      

0.146

Hand

0.108

Shoulder width

0.259

Chest width

0.174

Hip width/leg separation

0.191

Upper leg (thigh)

0.245

Lower leg (calf)

0.246

Ankle to bottom of foot

0.039

Foot breadth

0.055

Foot length

0.152


$$^\mathrm{a}$$Unless otherwise specified

Using data from [42]



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Fig. 1.15
Body segments length, relative to body height H (from [9], as from [31]. Reprinted with permission of Wiley)

The normalized distances of the segment center of mass from both the proximal and distal ends of a body segment are given in Table 1.8. (Problems 1.45 and 1.46 explain how to determine the center of mass of the body and its limbs.) The normalized radius of gyration of segments about the center of mass, the proximal end, and the distal end are presented in Table 1.9. (The radius of gyration provides a measure of the distribution of mass about an axis, as described in (3.​28) and Fig. 3.​24b. Problem 3.​16 describes how the radii of gyration in Table 1.9 are related.)

Note that all of the data in these different tables are not always consistent with each other because of the variations of sources and the different ranges of subjects and methods used for each table.

We have a tremendous range of mobility in our articular joints, but not as much as in the idealized joints in Fig. 1.4. The average ranges of mobility in people are given in Table 1.10 for the motions depicted in Fig. 1.16, along with the standard deviations about these values. (For normal or Gaussian distributions with an average, A, and standard deviation, SD, about 68% of all values are between A $$-$$ SD and A $$+$$ SD.) Three degrees of freedom are given for the shoulder and hip, two for the wrist and the foot (listed separately as foot and ankle), and one each for the elbow and forearm. The knee, as idealized above, has one DOF, but two are listed here: the flexion in a 1 D hinge and also some rotation of the upper and lower leg about the knee.


Table 1.7
Masses and mass densities of body segments


























































Segment

Segment mass/total body mass $$m_{\mathrm {b}}$$

Mass density (g/cm$$^{3}$$)

Hand

0.006

1.16

Forearm

0.016

1.13

Upper arm

0.028

1.07

Forearm and hand

0.022

1.14

Total arm

0.050

1.11

Foot

0.0145

1.10

Lower leg (calf)

0.0465

1.09

Upper leg (thigh)

0.100

1.05

Foot and lower leg

0.061

1.09

Total leg

0.161

1.06

Head and neck

0.081

1.11

Trunk

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Jun 11, 2017 | Posted by in GENERAL & FAMILY MEDICINE | Comments Off on Terminology, the Standard Human, and Scaling

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