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human anatomy mind map
This is a mind map about human anatomy, which is divided into nervous system, circulatory system, reproductive system, urinary system, respiratory system, digestive system, etc.
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human anatomy mind map
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- Outline
human anatomy
Various treatises
Human body composition, systems, divisions
Standard anatomical postures of the human body
body upright
Look straight ahead with both eyes
The upper limbs hang naturally on both sides of the trunk
Palms forward
Lower limbs together, toes pointed forward
Orientation terms, axes and planes of the human body
exercise system
skeleton
bone
The composition of various parts of bone
Whole body bones 206
Axial bone 80
trunk bone 51
vertebra 5
Cervical, thoracic, lumbar, sacral, coccygeal vertebrae
See PPT22
sacrum
coccyx
sternum
Located in the middle of the chest wall
Divided into 3 parts: sternal manubrium, sternal body, and xiphoid process
Key part - sternal angle: The connection point between the sternal manubrium and the body projects slightly forward, called the sternal angle. The two sides are flat against the second rib, which is an important symbol for counting ribs.
rib cage
Skull 23
Divided into facial skull and brain skull
See PPt25-27 for details
Side view of skull 5
Frontal bone, parietal bone, sphenoid bone, temporal bone, occipital bone
Key parts: wing point
The junction of the frontal, parietal, sphenoid, and temporal bones
Weak, easy to fracture, middle meningeal artery passes through
Ossicle 6
Limb bones 126
Upper limb bones 64
Upper limb with bone 2
clavicle, scapula
Free upper limb bones 4
humerus, ulna, radius, hand bones
Lower limb bones 62
Lower limbs with bones
hip bone
Free lower limb bones 5
Femur, patella, tibia, fibula, foot bone
bone structure
Bone quality
organic matter
Inorganic matter
periosteum
marrow
Bone blood vessels, lymph, nerves
Classification of bones
long bone
long tubular
feature
epiphysis
metaphysis
backbone
Distributed on the limbs, pulled by muscles to act as a lever
short bone
Cube
Distributed to wrists and ankles to withstand pressure
flat bone
plate-like
Distributed on the head and chest, forming a cavity for protection
Irregular bones
irregular
Distributes in the spine and skull base to form air-containing cavities
bone connection
direct link
fiber link
ligament, ligament, interosseous membrane
The skull bones are connected by sutures
cartilage connection
bony connection
pelvis
Indirect connection (joint)
Basic structure
articular surface
subtopic
subtopic
joint capsule
subtopic
subtopic
joint cavity
subtopic
subtopic
Auxiliary structure
ligament
articular disc, articular lip
synovial wall, synovial bursa
key joints
(temporal) mandibular joint
constitute
Features
The front part of the joint capsule is weak, and the mandibular joint is prone to forward dislocation.
The temporomandibular joint is a joint joint and both sides must move at the same time.
knee joint
constitute
Lower end of femur, upper end of tibia and patella
3 main ligaments
Patellar ligament, anterior and posterior cruciate ligament, meniscus
Features
The largest and most complex joint in the human body
skeletal muscle
4 forms
longus muscle
brevis muscle
latissimus
orbicularis muscle
structure
muscle belly
tendon
Muscles of various parts 3
head and neck muscles
head muscles
neck muscles
Trunk muscles 5
Back muscles
trapezius muscle
latissimus dorsi
Erector spinae
chest muscles
chest and upper limb muscles
pectoralis major, pectoralis minor, serratus anterior
pectoralis propria
diaphragm
A dome-shaped flat muscle located between the chest and abdomen
Contraction aids inhalation, relaxation aids expiration
important respiratory muscles
abdominal muscles
perineal muscle
limb muscles
Upper limb muscles 4
Upper limb girdle muscles
deltoid muscle
Abduct the shoulder joint, the anterior muscle bundles flex and internally rotate the shoulder joint, and the posterior muscle bundles extend and externally rotate the shoulder joint.
Supraspinatus, infraspinatus, teres major, teres minor, subscapularis
brachial muscles
Front group: biceps brachii
elbow flexion
Back group: triceps brachii
Extend elbow joint
forearm muscles
hand muscles
Lower limb muscles
Three key points to remember
gluteus maximus
Extend and externally rotate the hip joint to keep the body upright
Quadriceps: The largest muscle in the human body
rectus femoris
vastus medialis
vastus intermedius
vastus lateralis
Formation of "patellar ligament"
It is a powerful extensor muscle of the knee joint.
Flexible hip joint
triceps surae
medial head of gastrocnemius
Lateral head of gastrocnemius
soleus muscle
Formation of "Achilles tendon"
digestive system
Composition 9
Digestive tube 6
oral cavity
pharynx
esophagus
three narrow
The junction between the esophagus and the pharynx, the intersection between the esophagus and the left bronchus, and the place where it passes through the diaphragm
Clinical: Foreign bodies are easily retained and damaged, and are also a common location for tumors.
Stomach
cardia
Entrance
Greater curvature of stomach
Lesser curvature of stomach
pylorus
exit
small intestine
duodenum
25cm, C shape
Large duodenal papilla---where bile and pancreatic juice flow into the small intestine
jejunum
Thick, rich blood vessels, high and dense mucosal folds
ileum
Thinner, fewer blood vessels, and sparse mucosal folds
the large intestine
Cecum
appendix
colon
characteristic structure
colon band
colon bag
Intestinal fat tag
rectum
anal canal
digestive gland 3
salivary glands
liver
form
Irregular wedge shape
Divided into upper and lower sides
The lower part is also called the visceral surface and has three H-shaped grooves; there is a transverse fissure in the center called the porta hepatis.
Key parts----porta liver
Yes Hepatic duct, proper hepatic artery, hepatic portal vein, lymphatic vessels, and nerves are the gateway to and from the liver.
The structure that enters and exits the liver porta is called the hepatic pedicle
extrahepatic biliary system
composition
gallbladder
Pear-shaped, located in the gallbladder fossa, divided into 4 parts: base, body, neck, and tube
bile duct
common hepatic duct
cystic duct
Converges into the "common bile duct" --- forms with the pancreatic duct the hepatopancreatic ampulla --- the large papilla of the duodenum
Bile flow path
Not eating
bile
left hepatic duct
right hepatic duct
common hepatic duct
cystic duct
gallbladder
after eating
bile
gallbladder
cystic duct
common hepatic duct
hepatopancreatic ampulla
duodenal papilla
duodenum
Function
Secrete bile, participate in metabolism, interpret defense, store glycogen
pancreatic
The second largest digestive gland in the human body
branch
Upper gastrointestinal tract 5
Mouth, pharynx, esophagus, stomach, duodenum (small intestine)
Lower gastrointestinal tract 3
Jejunum (small intestine), ileum (small intestine), large intestine
Function
Digest and absorb ingested food to provide the body with needed materials and energy
respiratory system
composition
Respiratory 5
Upper respiratory tract
nose
external nose
nasal cavity
paranasal sinuses
4 composition
frontal sinus
ethmoid sinus
sphenoid sinus
maxillary sinus
clinical
The nasal mucosa and paranasal sinus mucosa are continuous and can easily cause inflammation.
Because the opening of the maxillary sinus is higher than the sinus floor, secretions are difficult to discharge.
Postural drainage is very important when there is fluid in the sinus cavity.
pharynx
throat
lower respiratory tract
trachea
bronchi
lung
Location
Located in the chest, above the diaphragm, on both sides of the mediastinum
form
Conical
branch
apex of lung
lung base
Rib surface, longitudinal surface (both sides)
Leading edge, trailing edge, lower edge (three edges)
Differences between left and right lungs
Left lung - narrow and long
Divided into upper and lower lobes
Right lung - wide and short
Divided into three lobes: upper, middle and lower lungs
important part
hilum
Entrance and exit points for bronchial tubes, blood vessels, lymphatic vessels, and nerves in the center of the mediastinum
Characteristics of the pleural cavity
The cavity contains a small amount of slurry and the internal pressure is lower than atmospheric pressure
Due to intracavity negative pressure and serous adsorption, the visceral and parietal pleura are tightly attached to each other.
is a potential cavity
External air enters the pleural cavity and separates the visceral and parietal pleura, which affects breathing.
Function
gas exchange, speech, smell
urinary system
Get to the point
Composition of the urinary system 4
kidney
form
Shaped like broad beans
The upper and lower ends, the front and rear sides, and the inner and outer edges
three important parts
renal hilum
Medial edge depression
renal pedicle
The structure that enters and exits the renal hilum, surrounded by connective tissue
Including renal artery, renal vein, renal pelvis, nerves, lymphatic vessels
renal sinus
Deep depressions within the renal parenchyma
Construct 8
renal cortex
renal medulla
Renal pyramidal composition
renal column
renal papilla
Composed of 2-3 renal pyramidal tips
nipple hole
Urine flows into the renal calyces
renal calyces
Large calyx of kidney
2-3 renal calyces merge
renal pelvis
2-3 large renal calyces merge
ureter
three parts
abdomen
Basin
wall interior
three narrow
3
starting point
Across the iliac vessels
Penetrating the bladder wall
Clinical: Prevent urine reflux; easy to retain foreign bodies, such as kidney stones
bladder
trigone of bladder
The triangular area between the ureteral orifices on both sides and the internal urethral orifice
Features
Lack of submucosal tissue, no mucosal folds are formed and remain smooth regardless of whether the bladder is full or empty
urethra
Characteristics of male and female urethras
male
three narrow
internal urethral orifice
membranous urethra
External urethral orifice (narrowest)
Three enlargements
urethra and prostate
bulb of urethra
navicular fossa of urethra
two bends
pubic subcurvature
pubic lordosis
female
Wide, short, straight, opening in the front of the vagina
More susceptible to urinary tract infections
reproductive system
Get to the point
Uterus
Location
Center of pelvic cavity, between bladder and rectum
Connected to the vagina below, with fallopian tubes and ovaries on both sides
form
Inverted pear shape
composition
fundus of uterus
uterine cavity
intrauterine os
Between the bottom and the neck is the "uterine body"
cervix
upper part of vagina
Vagina
external uterine orifice
circulatory system
composition
Cardiovascular System
Composition 4
Heart
Location: Located in the middle mediastinum of the chest
shape
inverted cone
branch
apex, bottom of heart
both sides
sternocostal surface, diaphragm
Three fates
left, right, down
four ditches
coronal sulcus, anterior and posterior interventricular sulcus, interatrial sulcus
internal structure
right atrium
right ventricle
Left atrium
left ventricle
Ventricles have valves
The heart has valves that allow blood to flow in only one direction (mitral, tricuspid, semilunar valves)
They switch on and off as the ventricles contract
heart conduction system
Key part - sinoatrial node
The normal pacemaker for cardiac rhythmic activity and capable of autonomous excitement
Located near the ostium of the superior vena cava, subepicardial in the right atrial wall
Function
Produce conduction impulses and maintain rhythmic contractions
arterial blood supply of heart
left and right coronary arteries
artery
Basic concept - the blood vessels that carry blood away from the heart
composition
pulmonary artery
systemic arteries
aorta
ascending aorta
aortic arch
Descending aorta
Thoracic aorta
abdominal aorta
trunk arteries, major arteries throughout the body
Arteries in various parts
capillaries
basic concept
tubes connecting arteries and veins
Features
The tube wall is composed of a layer of endothelial cells
Large quantity, thin tube wall, high permeability
Function
Blood and tissue exchange substances
After passing through the capillaries of the body, arterial blood becomes venous blood!
After passing through the alveolar capillaries, venous blood becomes arterial blood!
vein
Basic concept - blood vessels that carry blood back to the heart
composition
pulmonary veins
Systemic veins (getting to the point)
superior vena cava system
Superficial superior vena cava 3
cephalic vein
basilic vein
median cubital vein
inferior vena cava system
superficial inferior vena cava 2
great saphenous vein
small saphenous vein
portal vein system
clinical significance
See book P77
Cardiovenous system
blood circulation
systemic circulation
left ventricle
Aorta and its branches at all levels
capillaries in organs
veins at all levels
Superior and inferior vena cava and coronary sinus
right atrium
Pulmonary circulation
right ventricle
Pulmonary artery and its branches
alveolar capillaries
Pulmonary veins and their branches at all levels
Left atrium
Lymphatic system---get to the point---Cisterna chyli
In front of the 1st lumbar vertebra
It is composed of the left and right lumbar trunks and intestinal trunks and is sac-shaped.
The thoracic duct originates here.
Key issues
See PPT54
Function
nervous system
nervous system components
Central Nervous System
spinal cord
Location: In the spinal canal
shape
flat cylindrical
6 grooves and cracks
anterior median cleft
posterior median sulcus
Anterolateral groove X2
Posterolateral groove X2
Enlarged by 2
Neck enlargement C4-T1
Lumbosacral enlargement L2-S3
Its following tapering is called: conus medullaris
filum terminale: the very end of the spinal cord
3 internal structure
Gray matter: butterfly-shaped surrounding the central canal
Anterior horn (motor efferent neurons, anterior horn motor cells)
composition
medial anterior horn nucleus
Innervated - trunk muscles
lateral anterior horn nucleus
Innervate-limb muscles
Clinical significance: anterior horn injury---skeletal muscle paralysis
Mainly related to muscle movement
Intermediate zone (gray matter between the front and rear corners)
composition
mediomedial nucleus
Dominance - visceral sensation
mediolateral nucleus
Dominate - visceral movements
Clinical significance: Intermediate zone injury---visceral dysfunction
Mainly related to the feeling and movement of internal organs
Posterior horn (sensory, communication neurons)
composition
dorsal limbic nucleus
Colloidal substance
posterior horn proper nucleus
Conduction - pain, temperature, rough touch
Thoracic core
Clinical significance: Damage to the posterior horn---Reflexes are reduced or disappeared
Mainly related to sensation and conduction
central tube
White matter: located around gray matter
composition
front line
Contains ascending and descending fiber bundles
lateral cord
Contains ascending and descending fiber bundles
Back cord
Contains only ascending fiber bundles
fiber bundle components
Ascending (sensory) fiber bundle 4
thin beam and wedge beam
Located in the back cord, with the thin bundle inside
Control-proprioception and fine touch of the trunk and limbs on the same side
Spinothalamic tracts (anterior and lateral tracts)
Located in the anterior part of the lateral funiculus and the anterior funiculus
Innervation--superficial sensation of the trunk and limbs, the anterior bundle conducts rough touch, and the lateral bundle conducts pain and temperature sensation
spinocerebellar tract
located posteriorly around the periphery of the lateral funiculus
Non-conscious proprioception to the cerebellum
Descending (motor) fiber bundle 3
corticospinal tract
Start and end: precentral gyrus of cerebral cortex--anterior horn of spinal cord
composition
lateral corticospinal tract
Characteristics - Cross in the medulla oblongata
Innervates - skeletal muscles of one limb
Clinical - Judging the side of paralysis based on the cross
anterior corticospinal tract
Characteristics - uncrossed in medulla oblongata, bilateral innervation
Innervation - skeletal muscles of the trunk bilaterally
Clinical - Trunk muscles are generally not paralyzed
significance
The largest and most important motor conduction tract
rubrospinal tract
vestibulospinal tract
clinical
Anesthesia - below the first lumbar vertebra
Total spinal cord transection---paraplegia
Damage to the anterior horn of the spinal cord - movement disorders, polio
Spinal cord hemitransection---sensory and motor disorders
Function
Conducting function: connecting the brain and spinal cord
Reflex functions: somatic reflexes and visceral reflexes
Brain 6
brainstem
Overview
Location: Connected to the diencephalon above, the spinal cord below, and the cerebellum on the back
Have fourth ventricle
Function: Participate in cardiovascular exercise, breathing, swallowing, vomiting and other important physiological activities as well as book P97
Shape and composition
Ventral aspect of brainstem
midbrain
Location: Upper brainstem
Composition: Cerebral peduncle, interpeduncular fossa
Connected cranial nerve: III oculomotor nerve
pons
Location: middle of brainstem
Composition: Basal part, basilar sulcus, medullary pontine sulcus
Connected cranial nerves: V trigeminal nerve, VI abducens nerve, VII facial nerve. VIII vestibulocochlear nerve
Medulla oblongata
Location: lowest part of brainstem
Composition: pyramidal (corticospinal tract), pyramidal decussation, olive
Connected cranial nerves: IX glossopharyngeal nerve, X vagus nerve, XI accessory nerve, XII hypoglossal nerve
dorsal aspect of brainstem
Connected cranial nerves: The IV trochlear nerve is the only cranial nerve that exits the brain from the dorsal aspect of the brainstem
internal structure
Gray matter (not tested)
white matter
Ascending (sensory) fiber bundle 4
medial lemniscus
Innervation - proprioception of the contralateral trunk, limbs, and fine touch
spinal lemniscus
Innervates - gross touch, pain, and temperature sensation on the contralateral trunk and limbs
trigeminal system
lateral lemniscus
Descending (motor) fiber bundles
pyramidal tract
corticospinal tract
lateral corticospinal tract
Features
at the medullary chiasm
Innervates - skeletal muscles of one limb
clinical
Judgment of paralysis side based on cross
anterior corticospinal tract
Features
Uncrossed, bilaterally innervated in medulla oblongata
Innervation - skeletal muscles of the trunk bilaterally
clinical
Trunk muscles are generally not paralyzed
cortical brainstem tract
Features
Innervates most of the bilateral motor nuclei
The lower half of the facial nerve nucleus and the hypoglossal nucleus only receive innervation from the contralateral cortical brainstem tract.
Control-movement of skeletal muscles of head, face, and neck
clinical
Injury to one side is only seen in paralysis of the nucleoglossus muscle in the lower part of the facial muscle
extrapyramidal system
grid
cerebellum
Location: Located in the posterior fossa of the skull, adjacent to the brainstem in front of the fourth ventricle
shape
3 parts
cerebellar vermis
narrow part of middle cerebellum
cerebellar hemisphere
enlargement on both sides
cerebellar tonsils
The protrusions on both sides of the hemisphere
Clinical: Increased intracranial pressure, causing cerebellar tonsil herniation
3 ditches
original split
Position: Above, V-shaped
posterosylvian fissure
Location: below
Horizontal crack
Location: Trailing edge of hemisphere
3 blades---cortex on the surface of cerebellum
pompon leaf
Below the cerebellum, it is bounded by the posterosylvian fissure and the posterior lobe
Together with the vestibular nuclei, they form the “vestibular cerebellum”
anterior lobe
Above the cerebellum, in front of the primary fissure
The cerebellar vermis and the middle part of the hemispheres form the "spinal cerebellum"
posterior lobe
between primary fissure and sylvian fissure
The outer part of the hemisphere makes up the "cerebellum"
internal structure
cerebellar cortex
cerebellar nuclei
Fastie nucleus, bulbar nucleus, plugate nucleus, dentate nucleus
Function
Maintain body balance
Regulate muscle tone
Coordinate muscle movements
clinical
Injuries can result in --- balance imbalance, ataxia, intention tremor, nystagmus, hypotonia
diencephalon
Location: Between the midbrain and telencephalon, covered by the telencephalon on both sides and back, only part of the diencephalon is visible on the bottom surface of the brain
Have third ventricle
It communicates with the lateral ventricles anteriorly (on both sides), and communicates with the fourth ventricle posteriorly via the mesencephalic aqueduct.
Internal structure 5
dorsal thalamus
The Y-shaped inner medullary plate is divided into 3 parts
pronuclear group
medial core group
lateral nucleus group
dorsal nucleus group
ventral nuclear complex
ventral anterior nucleus
ventral intermediate nucleus
ventral posterior nucleus
ventromedial nucleus
ventrolateral nucleus
Receives fibers from the trigeminal lemniscus and medial lemniscus
Function
The human subcortical sensory center has the ability to appreciate rough sensations and pleasant and unpleasant emotions
relay station for sensory pathways
epithalamus
posterior thalamus
subthalamus
hypothalamus
significance
subcortical center second only to telencephalon
telencephalon
Overview: Located at the top of the brain, it is the most advanced part of the brain and occupies a dominant position.
shape
3 ditches
lateral groove
central sulcus
parieto-occipital sulcus
5 leaves
frontal lobe
Temporal lobe
Occipital lobe
parietal lobe
insula
3 sides
dorsolateral surface
upper lateral surface of hemisphere
frontal lobe
lateral groove
anterior central sulcus
central sulcus
anterior central gyrus
parietal lobe
Postcentral sulcus
back to center
medial surface
Bottom
2 rooms
left and right lateral ventricles
Communicates with the third ventricle through the left and right interventricular foramen
Composition and internal structure
Cerebral cortex - gray matter covering the surface
Inside
basal ganglia
striatal nucleus
caudate nucleus
lentiform nucleus
claustrum
amygdala
lateral ventricle
medulla
contact fiber
commissural fibers
projection fibers
Concentrated to form an "inner capsule"
Located between the caudate nucleus, dorsal thalamus and lentiform nucleus
Clinical: Injury can lead to "triple deviation syndrome"
Functional localization of cerebral cortex
Key points to remember are two
Motor center (first somatic motor area)
Precentral gyrus and anterior part of paracentral lobule
Sensory center (first somatosensory area)
Precentral gyrus and posterior part of paracentral lobule
peripheral nervous system
spinal nerve
quantity
31 pairs
8 pairs of cervical nerves, 12 pairs of thoracic nerves, 5 pairs of lumbar nerves, 5 pairs of sacral nerves, and 1 pair of coccygeal nerves
Internal structure (at the intervertebral foramen)
Front root
Fiber content
somatic motor fibers
Innervation - skeletal muscles
visceral motor fibers
Innervates - cardiac muscle, smooth muscle, muscle glands
Composed of motor neuron axons in the anterior horn and intermediate zone of the spinal cord
posterior root
Fiber content
somatosensory fibers
Dominance-skin, motor system
visceral sensory fibers
Control-visceral, cardiovascular, glandular
Composed of central processes of sensory neurons in spinal ganglia (dorsal horn of spinal cord)
4 branches (exiting the intervertebral foramen)
anterior branch
Thoracic nerve--distributed segmentally
Anterior branch of thoracic nerve 12
Intercostal nerves 1-11
Subcostal nerve 12
Clinical: intercostal puncture
4 nerve plexuses
cervical plexus
Located deep to the sternocleidomastoid muscle and composed of the anterior branches of C1--4
composition
skin branch
Muscular branch: the most important muscle branch-phrenic nerve
diaphragm exercise
brachial plexus
Located at the base of the neck, composed of C5--T1 anterior branch
composition
skin branch
Muscle branch
Divided into five, focusing on the median nerve
Start and end: inner to outer bundle--middle of forearm--palm
Clinical: Injury leading to ape palm
Lumbar plexus
Located deep to the psoas major muscle and composed of the anterior rami of T12-L4
composition
cutaneous and muscular branches
femoral nerve focus
Start and end: L2-4 anterior branch
Clinical: Femoral nerve anesthesia, femoral vein puncture, femoral artery puncture
sacral plexus
Located in front of the sacrum and piriformis muscle, distributed in the buttocks, hamstrings, calves and feet; composed of the lumbosacral trunk and the anterior branches of the sacral and coccygeal nerves
composition
cutaneous and muscular branches
sciatic nerve focus
Start and end: L4-S3 anterior branch
Meaning: The largest nerve in the human body
Overview: thick, skin and muscles located on the anterolateral part of the trunk and limbs
posterior branch
Overview: Small, innervating dorsal muscles and skin
recurrent meningeal branch
Transportation Branch
Walking distribution rule 4
Often accompanied by blood vessels, forming vascular nerve bundles
Divided into cutaneous branches, muscular branches, and articular branches
There are certain segments and overlaps in the thorax and abdomen
The nerves are solid, white, and have some toughness.
cranial nerve
quantity
12 pairs of nerves
Serial number and nature (see book 107-109 and PPT30-56)
128 sensory, 346 11 12 motor, 579 10 mixed
Key nerves
Trigeminal nerve
Fiber content
general somatosensory fibers
spinal trigeminal nucleus
trigeminal pontine nucleus
Special somatosensory fibers
Trigeminal motor nucleus - masticatory muscles
clinical
sensory impairment
Loss of corneal reflex
Paralysis of masticatory muscles
trigeminal neuralgia
vagus nerve
splanchnic nerves
nerve conduction pathways
See the book
Nervous system basics
Basic structural units: neurons and glia
Mainly see ppt
basic concept
gray matter
Neuronal cells and dendrites aggregate
Nucleus
gray matter clumps
white matter
collection of various nerve fibers
fiber bundle
Nerve fiber aggregation with basically the same origin, end, course and function
grid
Neuron cell bodies and fibers intertwined
middle
Ganglion
Aggregation of morphologically and functionally similar neuronal cell bodies
nerve
nerve fiber aggregation
week
The area between the ditches is the "back"
If there is a cross, it is the dominant side.
P96
The cystic duct and common hepatic duct are "close" to each other
Only nerves I and II are not connected to the brainstem
Understanding the spinal cord
Control voluntary movement of skeletal muscles