The phalanges are digital bones in the hands and feet of most vertebrates. In primates, the thumbs and big toes have two phalanges; the phalanges are classed as long bones. The phalanges are the bones that make up the toes of the foot. There are 56 phalanges in the human body, with fourteen on each foot. Three phalanges are present on each finger and toe, with the exception of the thumb and large toe, which possess only two; the middle and far phalanges of the fourth and fifth toes are fused together. The phalanges of the hand are known as the finger bones; the phalanges of the foot differ from the hand in that they are shorter and more compressed in the proximal phalanges, those closest to the body. A phalanx is named according to whether it is proximal, middle, or distal and its associated finger or toe; the proximal phalanges are those that are closest to foot. In the hand, the prominent, knobby ends of the phalanges are known as knuckles; the proximal phalanges join with the metacarpals of the hand or metatarsals of the foot at the metacarpophalangeal joint or metatarsophalangeal joint.
The intermediate phalanx is not only intermediate in location, but also in size. The thumb and large toe do not possess a middle phalanx; the distal phalanges are the bones at the tips of the toes. The proximal and distal phalanges articulate with one another through interphalangeal articulations; each phalanx consists of a central part, called the body, two extremities. The body is flat on either side, concave on the palmar surface, convex on the dorsal surface, its sides are marked with rough areas giving attachment to fibrous sheaths of flexor tendons. It tapers from above downwards; the proximal extremities of the bones of the first row present oval, concave articular surfaces, broader from side to side than from front to back. The proximal extremity of each of the bones of the second and third rows presents a double concavity separated by a median ridge; the distal extremities are smaller than the proximal, each ends in two condyles separated by a shallow groove. In the foot, the proximal phalanges have a body, compressed from side to side, convex above, concave below.
The base is concave, the head presents a trochlear surface for articulation with the second phalanx. The middle are rather broader than the proximal; the distal phalanges, as compared with the distal phalanges of the finger, are smaller and are flattened from above downward. In the hand, the distal phalanges are flat on their palmar surface and with a roughened, elevated surface of horseshoe form on the palmar surface, supporting the finger pulp; the flat, wide expansions found at the tips of the distal phalanges are called apical tufts. They support the fingertip nails; the phalanx of the thumb has a pronounced insertion for the flexor pollicis longus, an ungual fossa, a pair of unequal ungual spines. This asymmetry is necessary to ensure that the thumb pulp is always facing the pulps of the other digits, an osteological configuration which provides the maximum contact surface with held objects. In the foot, the distal phalanges are flat on their dorsal surface, it is tapers to the distal end.
The proximal part of the phalnx presents a broad base for articulation with the middle phalanx, an expanded distal extremity for the support of the nail and end of the toe. The phalanx ends in a crescent-shaped rough cap of bone epiphysis — the apical tuft which covers a larger portion of the phalanx on the volar side than on the dorsal side. Two lateral ungual spines project proximally from the apical tuft. Near the base of the shaft are two lateral tubercles. Between these a V-shaped ridge extending proximally serves for the insertion of the flexor pollicis longus. Another ridge at the base serves for the insertion of the extensor aponeurosis; the flexor insertion is sided by two fossae — the ungual fossa distally and the proximopalmar fossa proximally. The number of phalanges in animals is expressed as a "phalangeal formula" that indicates the numbers of phalanges in digits, beginning from the innermost medial or proximal. For example, humans have a 2-3-3-3-3 formula for the hand, meaning that the thumb has two phalanges, whilst the other fingers each have three.
In the distal phalanges of the hand the centres for the bodies appear at the distal extremities of the phalanges, instead of at the middle of the bodies, as in the other phalanges. Moreover, of all the bones of the hand, the distal phalanges are the first to ossify; the distal phalanges of ungulates carry and shape nails and claws and these in primates are referred to as the ungual phalanges. The term phalanx or phalanges refers to an ancient Greek army formation in which soldiers stand side by side, several rows deep, like an arrangement of fingers or toes. Most land mammals including humans have a 2-3-3-3-3 formula in feet. Primitive reptiles had the formula 2-3-4-4-5, this pattern, with some modification, remained in many reptiles and in the mammal-like reptiles; the phalangeal formula in the flippers of cetaceans is 2-12-8-1. In vertebrates, proximal phalanges have a similar placement in the corr
A tendon or sinew is a tough band of fibrous connective tissue that connects muscle to bone and is capable of withstanding tension. Tendons are similar to ligaments. Ligaments join one bone to bone, while tendons connect muscle to bone for a proper functioning of the body. Histologically, tendons consist of dense regular connective tissue fascicles encased in dense irregular connective tissue sheaths. Normal healthy tendons are composed of parallel arrays of collagen fibers packed together, they are anchored to bone by Sharpey's fibres. The dry mass of normal tendons, which makes up about 30% of their total mass, is composed of about 86% collagen, 2% elastin, 1–5% proteoglycans, 0.2% inorganic components such as copper and calcium. The collagen portion is made up of 97–98% type I collagen, with small amounts of other types of collagen; these include type II collagen in the cartilaginous zones, type III collagen in the reticulin fibres of the vascular walls, type IX collagen, type IV collagen in the basement membranes of the capillaries, type V collagen in the vascular walls, type X collagen in the mineralized fibrocartilage near the interface with the bone.
Collagen fibres coalesce into macroaggregates. After secretion from the cell, the cleaved by procollagen N- and C-proteinases, the tropocollagen molecules spontaneously assemble into insoluble fibrils. A collagen molecule is about 300 nm long and 1–2 nm wide, the diameter of the fibrils that are formed can range from 50–500 nm. In tendons, the fibrils assemble further to form fascicles, which are about 10 mm in length with a diameter of 50–300 μm, into a tendon fibre with a diameter of 100–500 μm. Fascicles are bound by the endotendineum, a delicate loose connective tissue containing thin collagen fibrils. and elastic fibres. Groups of fascicles are bounded by the epitenon. Filling the interstitia within the fascia where the tendon is located is the paratenon a fatty areolar tissue; the collagen in tendons are held together with proteoglycan components including decorin and, in compressed regions of tendon, which are capable of binding to the collagen fibrils at specific locations. The proteoglycans are interwoven with the collagen fibrils – their glycosaminoglycan side chains have multiple interactions with the surface of the fibrils – showing that the proteoglycans are important structurally in the interconnection of the fibrils.
The major GAG components of the tendon are dermatan sulfate and chondroitin sulfate, which associate with collagen and are involved in the fibril assembly process during tendon development. Dermatan sulfate is thought to be responsible for forming associations between fibrils, while chondroitin sulfate is thought to be more involved with occupying volume between the fibrils to keep them separated and help withstand deformation; the dermatan sulfate side chains of decorin aggregate in solution, this behavior can assist with the assembly of the collagen fibrils. When decorin molecules are bound to a collagen fibril, their dermatan sulfate chains may extend and associate with other dermatan sulfate chains on decorin, bound to separate fibrils, therefore creating interfibrillar bridges and causing parallel alignment of the fibrils; the tenocytes produce the collagen molecules, which aggregate end-to-end and side-to-side to produce collagen fibrils. Fibril bundles are organized to form fibres with the elongated tenocytes packed between them.
There is a three-dimensional network of cell processes associated with collagen in the tendon. The cells communicate with each other through gap junctions, this signalling gives them the ability to detect and respond to mechanical loading. Blood vessels may be visualized within the endotendon running parallel to collagen fibres, with occasional branching transverse anastomoses; the internal tendon bulk is thought to contain no nerve fibres, but the epitenon and paratenon contain nerve endings, while Golgi tendon organs are present at the junction between tendon and muscle. Tendon length varies from person to person. Tendon length is, in practice, the deciding factor regarding potential muscle size. For example, all other relevant biological factors being equal, a man with a shorter tendons and a longer biceps muscle will have greater potential for muscle mass than a man with a longer tendon and a shorter muscle. Successful bodybuilders will have shorter tendons. Conversely, in sports requiring athletes to excel in actions such as running or jumping, it is beneficial to have longer than average Achilles tendon and a shorter calf muscle.
Tendon length is determined by genetic predisposition, has not been shown to either increase or decrease in response to environment, unlike muscles, which can be shortened by trauma, use imbalances and a lack of recovery and stretching. Traditionally, tendons have been considered to be a mechanism by which muscles connect to bone as well as muscles itself, functioning to transmit forces; this connection allows tendons to passively modulate forces during locomotion, providing additional stability with no active work. However, over the past two decades, much research focused on the elastic properties of some tendons and their ability to function as springs. Not all tendons are required to perform the same functional role, with some predominantly positioning limbs, such as the fingers when writing and others acting as springs to make locomotion more efficient. Energy storing tendons can recover energy at high efficiency. For example, during a human stride, the Achilles tendon stretches as the ankle joint dorsiflexes.
During the last portion of the stride, as the foot plantar-flexes (pointing the
International Standard Serial Number
An International Standard Serial Number is an eight-digit serial number used to uniquely identify a serial publication, such as a magazine. The ISSN is helpful in distinguishing between serials with the same title. ISSN are used in ordering, interlibrary loans, other practices in connection with serial literature; the ISSN system was first drafted as an International Organization for Standardization international standard in 1971 and published as ISO 3297 in 1975. ISO subcommittee TC 46/SC 9 is responsible for maintaining the standard; when a serial with the same content is published in more than one media type, a different ISSN is assigned to each media type. For example, many serials are published both in electronic media; the ISSN system refers to these types as electronic ISSN, respectively. Conversely, as defined in ISO 3297:2007, every serial in the ISSN system is assigned a linking ISSN the same as the ISSN assigned to the serial in its first published medium, which links together all ISSNs assigned to the serial in every medium.
The format of the ISSN is an eight digit code, divided by a hyphen into two four-digit numbers. As an integer number, it can be represented by the first seven digits; the last code digit, which may be 0-9 or an X, is a check digit. Formally, the general form of the ISSN code can be expressed as follows: NNNN-NNNC where N is in the set, a digit character, C is in; the ISSN of the journal Hearing Research, for example, is 0378-5955, where the final 5 is the check digit, C=5. To calculate the check digit, the following algorithm may be used: Calculate the sum of the first seven digits of the ISSN multiplied by its position in the number, counting from the right—that is, 8, 7, 6, 5, 4, 3, 2, respectively: 0 ⋅ 8 + 3 ⋅ 7 + 7 ⋅ 6 + 8 ⋅ 5 + 5 ⋅ 4 + 9 ⋅ 3 + 5 ⋅ 2 = 0 + 21 + 42 + 40 + 20 + 27 + 10 = 160 The modulus 11 of this sum is calculated. For calculations, an upper case X in the check digit position indicates a check digit of 10. To confirm the check digit, calculate the sum of all eight digits of the ISSN multiplied by its position in the number, counting from the right.
The modulus 11 of the sum must be 0. There is an online ISSN checker. ISSN codes are assigned by a network of ISSN National Centres located at national libraries and coordinated by the ISSN International Centre based in Paris; the International Centre is an intergovernmental organization created in 1974 through an agreement between UNESCO and the French government. The International Centre maintains a database of all ISSNs assigned worldwide, the ISDS Register otherwise known as the ISSN Register. At the end of 2016, the ISSN Register contained records for 1,943,572 items. ISSN and ISBN codes are similar in concept. An ISBN might be assigned for particular issues of a serial, in addition to the ISSN code for the serial as a whole. An ISSN, unlike the ISBN code, is an anonymous identifier associated with a serial title, containing no information as to the publisher or its location. For this reason a new ISSN is assigned to a serial each time it undergoes a major title change. Since the ISSN applies to an entire serial a new identifier, the Serial Item and Contribution Identifier, was built on top of it to allow references to specific volumes, articles, or other identifiable components.
Separate ISSNs are needed for serials in different media. Thus, the print and electronic media versions of a serial need separate ISSNs. A CD-ROM version and a web version of a serial require different ISSNs since two different media are involved. However, the same ISSN can be used for different file formats of the same online serial; this "media-oriented identification" of serials made sense in the 1970s. In the 1990s and onward, with personal computers, better screens, the Web, it makes sense to consider only content, independent of media; this "content-oriented identification" of serials was a repressed demand during a decade, but no ISSN update or initiative occurred. A natural extension for ISSN, the unique-identification of the articles in the serials, was the main demand application. An alternative serials' contents model arrived with the indecs Content Model and its application, the digital object identifier, as ISSN-independent initiative, consolidated in the 2000s. Only in 2007, ISSN-L was defined in the
Inflammation is part of the complex biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or irritants, is a protective response involving immune cells, blood vessels, molecular mediators. The function of inflammation is to eliminate the initial cause of cell injury, clear out necrotic cells and tissues damaged from the original insult and the inflammatory process, initiate tissue repair; the five classical signs of inflammation are heat, redness and loss of function. Inflammation is a generic response, therefore it is considered as a mechanism of innate immunity, as compared to adaptive immunity, specific for each pathogen. Too little inflammation could lead to progressive tissue destruction by the harmful stimulus and compromise the survival of the organism. In contrast, chronic inflammation may lead to a host of diseases, such as hay fever, atherosclerosis, rheumatoid arthritis, cancer. Inflammation is therefore closely regulated by the body. Inflammation can be classified as either chronic.
Acute inflammation is the initial response of the body to harmful stimuli and is achieved by the increased movement of plasma and leukocytes from the blood into the injured tissues. A series of biochemical events propagates and matures the inflammatory response, involving the local vascular system, the immune system, various cells within the injured tissue. Prolonged inflammation, known as chronic inflammation, leads to a progressive shift in the type of cells present at the site of inflammation, such as mononuclear cells, is characterized by simultaneous destruction and healing of the tissue from the inflammatory process. Inflammation is not a synonym for infection. Infection describes the interaction between the action of microbial invasion and the reaction of the body's inflammatory response—the two components are considered together when discussing an infection, the word is used to imply a microbial invasive cause for the observed inflammatory reaction. Inflammation on the other hand describes purely the body's immunovascular response, whatever the cause may be.
But because of how the two are correlated, words ending in the suffix -itis are sometimes informally described as referring to infection. For example, the word urethritis means only "urethral inflammation", but clinical health care providers discuss urethritis as a urethral infection because urethral microbial invasion is the most common cause of urethritis, it is useful to differentiate inflammation and infection because there are typical situations in pathology and medical diagnosis where inflammation is not driven by microbial invasion – for example, trauma and autoimmune diseases including type III hypersensitivity. Conversely, there is pathology where microbial invasion does not cause the classic inflammatory response – for example, parasitosis or eosinophilia. Acute inflammation is a short-term process appearing within a few minutes or hours and begins to cease upon the removal of the injurious stimulus, it involves a coordinated and systemic mobilization response locally of various immune and neurological mediators of acute inflammation.
In a normal healthy response, it becomes activated, clears the pathogen and begins a repair process and ceases. It is characterized by five cardinal signs:An acronym that may be used to remember the key symptoms is "PRISH", for pain, immobility and heat; the traditional names for signs of inflammation come from Latin: Dolor Calor Rubor Tumor Functio laesa The first four were described by Celsus, while loss of function was added by Galen. However, the addition of this fifth sign has been ascribed to Thomas Sydenham and Virchow. Redness and heat are due to increased blood flow at body core temperature to the inflamed site. Loss of function has multiple causes. Acute inflammation of the lung does not cause pain unless the inflammation involves the parietal pleura, which does have pain-sensitive nerve endings; the process of acute inflammation is initiated by resident immune cells present in the involved tissue resident macrophages, dendritic cells, Kupffer cells and mast cells. These cells possess surface receptors known as pattern recognition receptors, which recognize two subclasses of molecules: pathogen-associated molecular patterns and damage-associated molecular patterns.
PAMPs are compounds that are associated with various pathogens, but which are distinguishable from host molecules. DAMPs are compounds that are associated with host-related cell damage. At the onset of an infection, burn, or other injuries, these cells undergo activation and release inflammatory mediators responsible for the clinical signs of inflammation. Vasodilation and its resulting increased blood flow causes increased heat. Increased permeability of the blood vessels results in an exudation of plasma proteins and fluid into the tissue, which manifests itself as swelling; some of the released mediators such as bradykinin increase the sensitivity to pain. The mediator molecules alter the blood vessels to
The metatarsophalangeal joints are the joints between the metatarsal bones of the foot and the proximal bones of the toes. They are condyloid joints, meaning that an elliptical or rounded surface comes close to a shallow cavity; the ligaments are two collateral. The movements permitted in the metatarsophalangeal joints are flexion, abduction and circumduction. Bunion Hallux rigidus Metatarsophalangeal joint sprain This article incorporates text in the public domain from page 359 of the 20th edition of Gray's Anatomy Diagram at webmd.com
A joint or articulation is the connection made between bones in the body which link the skeletal system into a functional whole. They are constructed to allow for different types of movement; some joints, such as the knee and shoulder, are self-lubricating frictionless, are able to withstand compression and maintain heavy loads while still executing smooth and precise movements. Other joints such as sutures between the bones of the skull permit little movement in order to protect the brain and the sense organs; the connection between a tooth and the jawbone is called a joint, is described as a fibrous joint known as a gomphosis. Joints are classified both functionally. Joints are classified structurally and functionally. Structural classification is determined by how the bones connect to each other, while functional classification is determined by the degree of movement between the articulating bones. In practice, there is significant overlap between the two types of classifications. Monoarticular – concerning one joint oligoarticular or pauciarticular – concerning 2–4 joints polyarticular – concerning 5 or more joints Structural classification names and divides joints according to the type of binding tissue that connects the bones to each other.
There are four structural classifications of joints: fibrous joint – joined by dense regular connective tissue, rich in collagen fibers cartilaginous joint – joined by cartilage. There are two types: primary cartilaginous joints composed of hyaline cartilage, secondary cartilaginous joints composed of hyaline cartilage covering the articular surfaces of the involved bones with fibrocartilage connecting them. Synovial joint – not directly joined – the bones have a synovial cavity and are united by the dense irregular connective tissue that forms the articular capsule, associated with accessory ligaments. Facet joint – joint between two articular processes between two vertebrae. Joints can be classified functionally according to the type and degree of movement they allow: Joint movements are described with reference to the basic anatomical planes. Synarthrosis – permits little or no mobility. Most synarthrosis joints are fibrous joints. Amphiarthrosis – permits slight mobility. Most amphiarthrosis joints are cartilaginous joints.
Synovial joint – movable. Synovial joints can in turn be classified into six groups according to the type of movement they allow: plane joint and socket joint, hinge joint, pivot joint, condyloid joint and saddle joint. Joints can be classified, according to the number of axes of movement they allow, into nonaxial, monoaxial and multiaxial. Another classification is according to the degrees of freedom allowed, distinguished between joints with one, two or three degrees of freedom. A further classification is according to the number and shapes of the articular surfaces: flat and convex surfaces. Types of articular surfaces include trochlear surfaces. Joints can be classified based on their anatomy or on their biomechanical properties. According to the anatomic classification, joints are subdivided into simple and compound, depending on the number of bones involved, into complex and combination joints: Simple joint: two articulation surfaces Compound joint: three or more articulation surfaces Complex joint: two or more articulation surfaces and an articular disc or meniscus The joints may be classified anatomically into the following groups: Joints of hand Elbow joints Wrist joints Axillary articulations Sternoclavicular joints Vertebral articulations Temporomandibular joints Sacroiliac joints Hip joints Knee joints Articulations of footUnmyelinated nerve fibers are abundant in joint capsules and ligaments as well as in the outer part of intraarticular menisci.
These nerve fibers are responsible for pain perception. Damaging the cartilage of joints or the bones and muscles that stabilize the joints can lead to joint dislocations and osteoarthritis. Swimming is a great way to exercise the joints with minimal damage. A joint disorder is termed arthropathy, when involving inflammation of one or more joints the disorder is called arthritis. Most joint disorders involve arthritis, but joint damage by external physical trauma is not termed arthritis. Arthropathies are called polyarticular when involving many joints and monoarticular when involving only a single joint. Arthritis is the leading cause of disability in people over the age of 55. There are many different forms of arthritis; the most common form of arthritis, occurs following trauma to the joint, following an infection of the joint or as a result of aging and the deterioration of articular cartilage. Furthermore, there is emerging evidence that abnormal anatomy may contribute to early development of osteoarthritis.
Other forms of arthritis are rheumatoid arthritis and psoriatic arthritis, which are autoimmune diseases in which the body is attacking itself. Septic arthritis is caused by joint infection. Gouty arthritis is caused by deposition of uric acid crystals in the joint that results in subsequent inflammation. Additionally, there is a less common form of gout, caused by the formation of rhomboidal-shaped crystals of calcium pyrophosphate; this form of gout is known as pseudogout. Temporomandibular joint syndrome involves the jaw joints and can cause facial p
In medicine, a prosthesis or prosthetic implant is an artificial device that replaces a missing body part, which may be lost through trauma, disease, or a condition present at birth. Prostheses are intended to restore the normal functions of the missing body part. Amputee rehabilitation is coordinated by a physiatrist as part of a inter-disciplinary team consisting of physiatrists, nurses, physical therapists, occupational therapists. Prostheses can be created by hand or with CAD, a software interface that helps creators visualize the creation in a 3D form. A person's prosthesis should be designed and assembled according to the person's appearance and functional needs. For instance, a person may need a transradial prosthesis, but need to choose between an aesthetic functional device, a myoelectric device, a body-powered device, or an activity specific device; the person's future goals and economical capabilities may help them choose between one or more devices. Craniofacial prostheses include extra-oral prostheses.
Extra-oral prostheses are further divided into hemifacial, nasal and ocular. Intra-oral prostheses include dental prostheses such as dentures and dental implants. Prostheses of the neck include larynx substitutes and upper esophageal replacements, Somato prostheses of the torso include breast prostheses which may be either single or bilateral, full breast devices or nipple prostheses. Penile prostheses are used to treat erectile dysfunction. Limb prostheses include both upper- and lower-extremity prostheses. Upper-extremity prostheses are used at varying levels of amputation: forequarter, shoulder disarticulation, transhumeral prosthesis, elbow disarticulation, transradial prosthesis, wrist disarticulation, full hand, partial hand, partial finger. A transradial prosthesis is an artificial limb. Upper limb prostheses can be categorized in three main categories: Passive devices, Body Powered devices, Externally Powered devices. Passive devices can either be passive hands used for cosmetic purpose, or passive tools used for specific activities.
An extensive overview and classification of passive devices can be found in a literature review by Maat et.al. A passive device can be static, meaning the device has no movable parts, or it can be adjustable, meaning its configuration can be adjusted. Despite the absence of active grasping, passive devices are useful in bimanual tasks that require fixation or support of an object, or for gesticulation in social interaction. According to scientific data a third of the upper limb amputees worldwide use a passive prosthetic hand. Body Powered or cable operated limbs work by attaching a harness and cable around the opposite shoulder of the damaged arm; the third category of prosthetic devices available are myoelectric arms. These work by sensing, via electrodes, when the muscles in the upper arm move, causing an artificial hand to open or close. In the prosthetics industry, a trans-radial prosthetic arm is referred to as a "BE" or below elbow prosthesis. Lower-extremity prostheses provide replacements at varying levels of amputation.
These include hip disarticulation, transfemoral prosthesis, knee disarticulation, transtibial prosthesis, Syme's amputation, partial foot, toe. The two main subcategories of lower extremity prosthetic devices are trans-femoral. A transfemoral prosthesis is an artificial limb. Transfemoral amputees can have a difficult time regaining normal movement. In general, a transfemoral amputee must use 80% more energy to walk than a person with two whole legs; this is due to the complexities in movement associated with the knee. In newer and more improved designs, carbon fiber, mechanical linkages, computer microprocessors, innovative combinations of these technologies are employed to give more control to the user. In the prosthetics industry a trans-femoral prosthetic leg is referred to as an "AK" or above the knee prosthesis. A transtibial prosthesis is an artificial limb. A transtibial amputee is able to regain normal movement more than someone with a transfemoral amputation, due in large part to retaining the knee, which allows for easier movement.
Lower extremity prosthetics describes artificially replaced limbs located at the hip level or lower. In the prosthetics industry a trans-tibial prosthetic leg is referred to as a "BK" or below the knee prosthesis. Physical therapists are trained to teach a person to walk with a leg prosthesis. To do so, the physical therapist may provide verbal instructions and may help guide the person using touch or tactile cues; this may be done in a home. There is some research suggesting that such training in the home may be more successful if the treatment includes the use of a treadmill. Using a treadmill, along with the physical therapy treatment, helps the person to experience many of the challenges of walking with a prosthesis. In the United Kingdom, 75% of lower limb amputations are performed due to inadequate circulation; this condition is associated with many other medical conditions including diabetes and heart disease that may make it a challenge to recover and use a pro