The Realms of the Earth

The earth is unique as it is the only planet that sustains life. This is made possible because of the presence of Land, Water and Air. We classify each of them into separate realms for better understanding and detailed study.
Structurally, the Earth is divided into layers which are both physically and chemically different. The soil which we stand on is the solid layer with different types of rocks and other minerals. This solid part of the earth is called the lithosphere.
Above this solid earth, there is a blanket of gases/ air covering the earth. This blanket contains various gases in differing proportions and is responsible for many of the climatic phenomenon on earth. This layer is called Atmosphere.
As we all know, 3/4th of the earth’s surface is covered by water in the form of oceans, seas, lakes etc. Apart from that water is present under the soil in the form of ground water and as water vapour and clouds in the atmosphere. The whole of this water content of earth is called Hydrosphere.
Life is possible on earth due to the confluence of water, soil and air. The area of earth where all these factors meet and life is present is called Biosphere or Sphere of Life.

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Seasons on The Earth

We have seen in earlier chapter that the sun heats up more when overhead. Similarly, the area of earth where the sun is overhead during the season, gets heated up more than other areas. Because of the axial tilt of the earth, there is an apparent movement of orbital plane in relation to the earth. We feel that the sun migrates from northern hemisphere to southern hemisphere and back in the period of a year. The midday sun is exactly overhead at all latitudes between tropics of Capricorn and cancer, at least once in a year. This area gets maximum heat and is called Torrid Zone.

The sun is never overhead in any place on earth beyond the Tropic of Cancer and Capricorn and the angle of sun’s rays goes on decreasing towards the poles. At areas beyond Arctic Circle and Antarctic Circle, the sun appears just above the horizon and these areas are very cold due to this. These areas are called Frigid Zones. The areas between Torrid Zone and Frigid Zone have a moderate temperature and are called Temperate Zones.

Because of the constant inclination of the earth’s axis in one direction, the Northern hemisphere faces the sun for about half of the year and faces away from the sun for next half of the year.  The part which faces the sun gets more heat and light compared to the other part.  Every point in this hemisphere remains in the sunlight for a longer period of time and hence we say that the days are longer in this hemisphere.

While northern hemisphere faces the sun, southern hemisphere will be facing away and will get less heat and light and will have shorter days and longer nights. This reverses itself in every 6 months.  The hemisphere which faces the sun will be warm and is said to have summer season and the hemisphere which faces away from the sun will be cold and is said to be having winter.  Hence you can say that summer in Northern hemisphere coincides with winter in the Southern hemisphere and vice versa.

There is a season of transition between the two when it is neither too warm nor too hot when the sun is almost around the equator. This season is called autumn or spring.

Spring is the season after winter and before summer. Days become longer and the weather gets warmer in the temperate zone because the Earth tilts towards the Sun. In many parts of the world, plants grow and flowers bloom.

Autumn is the season after summer and before winter. In the United States, this season is also called fall. In many places in the temperate zone, autumn is a time for harvesting most crops. Deciduous trees (trees that lose their leaves every year) lose their leaves, usually after turning yellow, red, or brown.

When it is autumn in the Northern Hemisphere, it is spring in the Southern Hemisphere and vice versa. On the Equator, autumn is very much like spring, with little difference in temperature or in weather.

When the sun reaches the northern-most point it will be overhead at the tropic of cancer, and when it reaches the southern most point it will be overhead the tropic of Capricorn.  The day when the sun is overhead of Tropic of Cancer is called Summer Solstice(Northern Solstice) and the day it is overhead at the tropic of Capricorn it is called Winter Solstice(Southern Solstice ). The day of the solstice is either the “longest day of the year” or the “shortest day of the year” for any place on Earth depending on the hemisphere facing the sun and location of the place.

The Northern Solstice is also called June Solstice as it is usually on June 21. In the Northern Hemisphere the June solstice is called the Summer Solstice (and marks the longest day of the year), while in the Southern Hemisphere it is called the Winter Solstice (and marks the shortest day of the year).

The southern solstice is also called December Solstice and is usually on December 21. At the moment of the December solstice, the Sun is directly overhead some point on the Tropic of Capricorn; this is the furthest south that the subsolar point ever reaches. In the Southern Hemisphere, the December solstice is called the Summer Solstice (and marks the longest day of the year), while in the Northern Hemisphere it is called the Winter Solstice (and marks the shortest day of the year).

Similarly, the day when the sun is directly overhead the equator is called Equinox. There are two equinoxes each year. On these days, the nights are equal in length at all latitudes North and South. The word equinox comes from two Latin words meaning “equal” and “night”. Around the day of the equinox, the length of the day and the length of the night are almost equal. They occur on or around March 21 and September 21.

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Positions on Earths Surface & Time zones

To locate points on earth, we use a set of imaginary lines called latitudes and longitudes. They are drawn with reference to north and south poles. The midpoints between the North Pole and the South Pole are joined to draw a line which divides the earth into two equal hemispheres. This line is called equator or zero degrees latitude. Lines are drawn parallel to the equator and are called Parallels or Latitudes.

The latitudes on the surface of the Earth give the distance north and south of the equator. It is measured in degrees. Every degree is subdivided into 60 minutes and each minute is divided into 60 seconds. It is represented as X0 Y’ Z” meaning X degrees, Y minutes and Z seconds.  Everything north or south of the equator is designated either as north latitude or south latitude. The Antarctic Circle (66° 33′ South of Equator), Tropic of Capricorn (23° 26′ South of Equator), Tropic of Cancer (23° 26′ North of Equator), and Arctic Circle (66° 33′ North of Equator), are all circles of latitude.

Longitude or meridian is another set of imaginary lines drawn on the surface of earth connecting North and South Pole and hence it will be perpendicular to latitudes and equator. As all longitudes are equal and there is no distinguishing or natural starting point, we take the meridian passing through the Royal Observatory, Greenwich in London as the prime meridian or zero degrees meridian. The Prime Meridian is 0° (zero degrees), and the farthest away is +180° eastward and -180° westward.

As day and night are caused due to rotation of the earth on its axis when the sun rises at a meridian it will be sunset at the opposite meridian. So the time is measured with the help of sunrise and sunset. We know that a day is divided into 24 hours and a sphere is 3600 each hour is represented by 15 degrees. As the earth rotates from west to east places east of Greenwich will be ahead of Greenwich and those to the west will be behind.

The earth rotates 360 degrees in about 24hrs which mean 15 degrees an hour or 1 second in 4 minutes. Thus, when it is 12 noon at Greenwich, the time at 15 degrees east of Greenwich will be 15×4=60 minutes, i.e. 1 hour ahead of Greenwich Time which means 1 pm. But at 15 degrees west of Greenwich, the time will be behind Greenwich Time by 1 hour i.e. it will be 11 am. Similarly, at 180 degrees it will be midnight when it is 12 noon at Greenwich.

As the time changes depending on longitude, it will be difficult to calculate the time at each point if we are moving east to west or west to east. So we have accepted a convention by which we consider a meridian as standard time meridian for that country and the time of the Standard Time Meridian as the time for that country. In some countries with a large east-west extent, there may be multiple time zones specific to different regions. As per International conventions, each country can choose its time zones which are in multiples of 30 minutes variation from Greenwich Mean Time (multiples of 7 ½  degrees in longitude).

Sun is the source of energy for the earth in form of heat and light and we have experienced that the sun’s heat is more intense during midday when the sun is directly overhead and it is less when the sun is at the horizons. In general, the sun’s light has to pass through a lot more atmosphere (or a greater thickness of air) in the morning and evening to get to a vertical surface than it does when it is at zenith to a horizontal surface.

 

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The Earth & The Universe

We live in a mammoth universe surrounded by an infinite number of stars and other celestial bodies. This universe is said to have originated as a result of a massive explosion about 14 billion years ago, called ‘The Big Bang’.

In the beginning, the entire universe was a condensed very hot, small, and dense structure (called a “singularity”). This singularity was very unstable as pressure mounted up and it exploded forming stars, groups of stars called galaxies and stellar systems containing planets along with stars. As a result of this explosion, the universe is still expanding today, but getting colder as well.

A star is a massive ball of plasma (very hot gas) held together by gravity. It radiates energy in the form of heat, light etc., due to nuclear reactions happening inside it. A planet is an object like Earth that orbits a star and is large enough to have sufficient gravity to make it almost spherical in shape. It is smaller than a star, and it does not make light. Objects that orbit planets are called satellites. A star and everything which orbits it is called a star system.

After the Big Bang, the cloud of dust was not uniformly distributed across ‘the universe’. The areas where the dust particles concentrated attracted more materials from the surrounding cloud due to t the gravitational force of attraction. Such thicker clouds spreading across very large areas were named as ‘Nebula’ and consisted mainly of hydrogen. As the nebula grew further, there were localised clumps of gases. These clumps attracted more materials and became heavier to develop into stars, while the whole of the nebula developed into a galaxy or cluster of stars.

Before the stars developed within the nebula the core of each gas clump was surrounded by rotating disk of gases and dust around a gas core. As the universe cooled down the rotating disc of gases condensed and clung together at various areas to form planets and the gas core developed into a star.

The star system containing our planet earth is called solar system after the star which is in the centre of this system, Sun (word “solar” derives from the Latin “sol,” which means the sun). The Sun is orbited by planets, asteroids, comets and other things. An asteroid is an object in the Solar System that travels around the Sun, but smaller than a planet.

The name “asteroid” means “like a star” in the ancient Greek language because ancient people thought they are small stars. They are a swarm of small bodies in between the orbits of mars and Jupiter, which revolve around the sun. There is an opinion that the name “planetoid” (“like a planet”) would be a better name. Most asteroids in the Solar System are in the asteroid belt between Mars and Jupiter. Many are not in the main asteroid belt. The ones that come close to Earth are called Near-Earth asteroids.

A comet is a ball consisting mostly ice that moves around in outer space, often described as “dirty snowballs”. The orbital inclinations of comets are usually high and not near the ecliptic where most solar system objects are found. Those are very far away from the Sun, but some comets come near enough to Earth for us to see at night. They have long “tails” because the Sun melts the ice and points directly away from the Sun because it is blown by the solar wind. The hard centre of the comet is the nucleus.

There are eight planets in the Solar System. From closest to farthest from the Sun, they are Mercury, Venus, Earth, Mars, Jupiter, Saturn, Uranus, and Neptune. The first four planets called terrestrial planets or inner planets are mostly made of rock and metal, and mostly solid. The last four planets called gas giants and are mostly made of gas. Even though they are made of gas, they have much more mass than the terrestrial planets. All the nine planets of the solar system revolve around the sun in elliptical orbits in the counter-clockwise direction. The time taken by the planets to revolve around the sun increases with their distance from the sun. They also rotate on their own axes. Except for Venus and Uranus rotates counter-clockwise as seen from above the North Pole; that is to say, from west to east. Uranus rotates “on its side,” 90 degrees away from its orbital motion while Venus rotates backwards compared to the other planets, both likely due to an early asteroid hit which disturbed its original rotation.

Pluto had been called a planet since it was discovered in 1930, but in 2006 astronomers meeting at the International Astronomical Union decided on the definition of a planet, and Pluto did not fit. Instead, they defined a new category of dwarf planet, into which Pluto did fit, along with some others. These small Planets are sometimes called plutinos.

A satellite is a smaller body which moves around a larger body held in orbit by gravitation. The term is commonly used for moons which go around planets. Six of the planets and three of the dwarf planets in our solar system are orbited by moons. For example, Moon is the satellite of Earth.

The Sun contains 99.9 percent of the Solar System’s mass and is mostly made out of hydrogen and helium. The Sun is about 1.3 million times larger than earth and a hundred times as wide as the Earth. It has a mass of 1.9891×1030 kg, which is 333,000 times the mass of the Earth.

The Earth is the third planet in the solar system by the distance from the sun and fifth in size. It is the only planet known to have life on it and was formed around 4.5 billion years ago. As every planet, the earth rotates on its own axis and revolves around the sun. As the earth orbits the sun, it completes one rotation every 23.9 hours. This is called as a day. It takes 365 ¼ days to complete one trip around the sun. The extra quarter of the day presents a challenge to our calendar system, which counts one year as 365 days. To keep our yearly calendar consistent with our orbit around the sun, every four years we add one day and is called leap day, and the year is called the Leap year. While the Earth revolves around the Sun once (one “year”) for every 365¼ times and it rotates once (one “day”), Plane of rotation is slightly tilted from the axis of rotation. The seasonal changes on Earth are because of the 23.4-degree axial tilt of its rotation and slightly elliptical path around the Sun.

The Earth is the only planet in our Solar System that has a large amount of liquid water. About 71% of the surface of the Earth is covered by oceans. Because of this, it is sometimes called the “Blue Planet”.

The Earth is generally 150,000,000 kilometres away from the Sun (this distance is named an “Astronomical Unit”). The Earth moves along its way at an average speed of about 30 km a second. The closest distance Earth is to the sun, or perihelion, is 146 million km (91 million miles) and the farthest or aphelion is 152 million km (94.5 million miles). It takes light (or any other electromagnetic radiation) just over eight minutes to travel from Sun to Earth.

The Moon is Earth’s only satellite. Our moon is about a quarter the size of the Earth. The gravity on the moon is one-sixth of the Earth’s gravity. The moon is an average of 384,400 km away from earth and is drifting away from Earth at the rate of four centimetres each year. The Moon revolves around the Earth in about every 27⅓ days. As the Earth goes round the Sun at the same time, the changing light of the Moon takes about 29½ days to go from dark to bright to dark again. Because the earth is moving as well as rotating on its own axis as it orbits the sun- from our perspective the moon appears to orbit us every 29 days.

 

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Brachial Plexus

The brachial plexus is a network of nerve fibres that supplies the skin and musculature of the upper limb. It begins in the root of the neck, passes through the axilla, and enters the upper arm.

The anterior rami of cervical spinal nerves C5, C6, C7 and C8 along with the first thoracic spinal nerve T1 forms this plexus.

The Brachial plexus is divided into Roots, Trunks, Divisions, Cords and Branches for easier understanding. This division is of no functional and practical significance. Roots and trunks lie in the neck in relation with the subclavian artery, divisions lie behind the clavicle, and cords and branches lie in the axilla around the axillary artery.

Roots of the Brachial Plexus are the spinal nerve rami from where it originates. As we already saw the roots are C5, C6, C7, C8 and T1. At each vertebral level, a pair of spinal nerves arise on either side through intervertebral foramina and divides into anterior and posterior nerve fibres. The posterior rami innervate the skin and muscles of the body. The anterior rami form the plexus.

At the base of the neck, the roots join together to form the trunks. They are Superior, Middle and Inferior trunks. While C5 and C6 forms the superior trunk and C8 and T1 forms the inferior trunk, the middle trunk is a continuation of C7. These trunks move laterally and cross the posterior triangle of the neck.

In the posterior triangle of the neck, the trunks divide into two branches one of which moves anteriorly and the other moves posteriorly, thus forming anterior and posterior divisions. The three anterior and three posterior nerve fibres thus formed moves to the axilla.

These divisions join together to form cords in the axilla. The cords are named based on its relative position to the axillary artery. Anterior divisions of superior and middle trunks merge together to form lateral cord and all the posterior divisions merge together to form posterior cord. The anterior division of inferior trunk continues as the medial cord.

The cords give out five major branches in and around axilla which are the main innervations of the upper limb. They are as follows.

Musculocutaneous Nerve arising from Roots C5, C6 and C7. Its motor Functions is to Innervate the brachialis, biceps brachii and coracobrachialis muscles. It gives off the lateral cutaneous branch of the forearm, which innervates the lateral half of the anterior forearm, and a small lateral portion of the posterior forearm.

Branches of the Brachial Plexus
Branches from the roots
• Nerve to serratus anterior (C5, C6, C7)
• Dorsal scapular nerve (C5)
• Muscular branches to the 3 scalene muscles
Branches from the trunks
• Suprascapular nerve (C5, C6)
• Subclavius nerve (C5, C6)
Branches from the cords
o Medial cord
• Medial head of median nerve (C8, T1)
• Medial pectoral (C8, T1)
• Ulnar nerve (C8, T1)
• Median cutaneous nerve of forearm (C8, T1)
• Medial cutaneous nerve of arm (T1)
o Lateral cord
• Lateral pectoral (C5, C6, C7)
• Lateral head of median (C5, C6, C7)
• Musculocutaneous (C5, C6, C7)
o Posterior cord
• Radial (C5,C6,C7,C8,T1)
• Axillary (C5, C6)
• Nerve to latissimus dorsi (C6, C7, C8)
• Subscapular (C5, C6)

Axillary Nerve originates from C5 and C6and innervates the teres minor and deltoid muscles. It gives off the superior lateral cutaneous nerve of the arm, which innervates the inferior region of the deltoid (“regimental badge area”). Median Nerve originates from C6 – T1. (Also contains fibres from C5 in some individuals) and innervates most of the flexor muscles in the forearm, the thenar muscles, and the two lateral lumbricals that move the index and middle fingers. It gives off the palmar cutaneous branch, which innervates the lateral part of the palm, and the digital cutaneous branch, which innervates the lateral three and a half fingers on the anterior (palmar) surface of the hand. Radial Nerve arises from C5-C8 and T1 and innervates the triceps brachii and the extensor muscles in the posterior compartment of the forearm. It also innervates the posterior aspect of the arm and forearm and the posterior, lateral aspect of the hand.Ulnar Nerve is formed from C8 and T1. It innervates the muscles of the hand (apart from the thenar muscles and two lateral lumbricals), flexor carpi ulnaris and medial half of flexor digitorum profundus. It senses the anterior and posterior surfaces of the medial one and half fingers and associated palm area.

Clinical Significance:

There are two major types of injuries that can affect the brachial plexus. An upper brachial plexus injury(Erb’s Palsy) affects the superior roots, and a lower brachial plexus injury(Klumpke Palsy) affects the inferior roots.

Erbs Palsy results in abduction at the shoulder, lateral rotation of the arm, supination of the forearm, and flexion at the shoulder. Loss of sensation down the lateral side of the arm, which covers the sensory innervation of the axillary and musculocutaneous nerves.

The affected limb hangs limply, medially rotated by the unopposed action of pectoralis major. The forearm is pronated due to the loss of biceps brachii. This is position is known as ‘waiter’s tip’, and is characteristic of Erb’s palsy.

Nerves originating from the roots C5 and C6 are affected, including Musculocutaneous and Axillary.

In Klumpke Palsy, Ulnar and median nerves originating from T1 are affected. All the small muscles of the hand (the flexors muscles in the forearm are supplied by the ulnar and median nerves, but are innervated by different roots).  Loss of sensation along the medial side of the arm. The metacarpophalangeal joints are hyperextended, and the interphalangeal joints are flexed. This gives the hand a clawed appearance.

Innervation to remember

Terminal Branch Sensory Innervation Muscular Innervation
musculocutaneous nerve Skin of the anterolateral forearm Brachialis, biceps brachii, coracobrachialis
axillary nerve Skin of lateral portion of the shoulder and upper arm Deltoid and teres minor
radial nerve Posterior aspect of the lateral forearm and wrist; posterior arm Triceps brachii, brachioradialis, anconeus, extensor muscles of the posterior arm and forearm
median nerve Skin of lateral 2/3rd of hand and the tips of digits 1-4 Forearm flexors, thenar eminence, lumbricals of the hand 1-2
ulnar nerve Skin of palm and medial side of hand and digits 3-5 Hypothenar eminence, some forearm flexors, thumb adductor, lumbricals 3-4, interosseous muscles

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Cranial Nerves

CN I – Olfactory
CN II – Optic
CN III – Oculomotor
CN IV – Trochlear
CN V – Trigeminal
CN VI – Abducens
CN VII – Facial
CN VIII – Auditory
CN IX – Glossopharyngeal
CN X – Vagus
CN XI – Accessory
CN XII – Hypoglossal

Most of the nerves originate from the spinal cord. The remaining nerves which originate directly from the Brain are called Cranial Nerves. 10 of 12 of the cranial nerves originate in the brainstem. Cranial nerves relay information between the brain and parts of the body, primarily to and from regions of the head and neck.

The cranial nerves are considered components of the peripheral nervous system (PNS), although on a structural level the olfactory, optic and terminal nerves are more accurately considered part of the central nervous system (CNS).

All the cranial nerves are paired and are present on both sides.
There are twelve cranial nerves pairs, which are assigned Roman numerals I–XII. Some experts argue that there are 13 cranial nerves including nerve ‘zero’. The numbering of the cranial nerves is based on the rostral-caudal (front to back) position in which they emerge from the brain.
The Cranial Nerve Zero is a very small terminal nerve (nerve N or O) existing in humans but may not be functional. In other animals, it appears to be important to sexual receptivity based on perceptions of pheromones.

Some Important Points to Remember

1. The only cranial nerve which arises on dorsal aspect – Trochlear nerve

2. The cranial nerve with longest intracranial course – Trochlear nerve

3. The cranial nerve with the longest course – Vagus ( Vagabond Nerve / Wandering Nerve )

4. The cranial nerve most commonly involved in raised intracranial tension – Abducens

5. The cranial nerve most commonly involved in basal skull fractures – Facial Nerve

6. Commonest cranial nerve affected in spinal anaesthesia – Abducens

7. Cranial nerves carrying parasympathetic fibres – 3, 7, 9, 10

8. Thinnest cranial nerve – Trochlear Nerve

9. Thickest cranial nerve – Trigeminal Nerve

10. Cranial nerve palsies in which deviation occurs to the healthy side (opposite side ) – VII and X

11. Cranial nerve palsies in which deviation occurs to same side (diseased side ) – V and XII

12. Cranial nerve involved in Bell’s palsy – VII

13. Cranial nerve involved in herpes zoster ophthalmicus – V

14. Cranial nerve involved in Ramsay hunt syndrome – VII

15. TIC Douloureux – Neuralgia of V nerve ( Trigeminal Neuralgia )

16. Neuralgic pain in the tongue, soft palate, pharynx – Neuralgia of glossopharyngeal nerve

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Joints of the Body

A joint is defined as the point at which two or more bones articulate. Joints can be easily classified by the type of tissue present. Using this method, we can split the joints of the body into fibrous, cartilaginous and synovial joints.

Fibrous joints can be further subclassified into sutures, gomphoses and syndesmoses.

Sutures are immovable joints (called a synarthrosis), only found between the flat, plate-like bones of the skull.

Gomphoses are also immovable joints and can be found where the teeth articulate with their sockets, with periodontal ligaments.

Syndesmoses are slightly movable joints (called an amphiarthrosis) comprised of bones held together by an interosseous membrane. Eg: The middle radio-ulnar and middle tibiofibular joint

Cartilaginous joints have bones attached with fibrocartilage or hyaline cartilage.

Synchondroses or primary cartilaginous joints involve only hyaline cartilage. The joints can be immovable (synarthroses) or slightly movable (amphiarthroses). Eg: The joint between the diaphysis and epiphysis of a growing long bone

Symphyses or secondary cartilaginous joint can involve fibrocartilage or hyaline cartilage and are slightly movable (amphiarthroses), an example of a which is the pubic symphysis.

A synovial joint is a joint filled with synovial fluid which tends to be fully moveable (diarthroses), and are the main type of joint found in the body. They allow a huge range of movements are classified by their movement.

Hinge Permits flexion and extension. Elbow joint is a notable example.
Pivot Allows rotation; a, round bony process fits into a bony ligamentous socket. Examples include the atlantoaxial joint & proximal radio-ulnar joint (top of the neck and elbow)
Ball & Socket Permits movement in several axes; a rounded head fits into a concavity. An example is the glenohumeral joint (shoulder).
Saddle Concave and convex joint surfaces unite at saddle joints, e.g. Metatarsophalangeal joint (toes)
Plane Permit gliding or sliding movements, e.g. Acromioclavicular joint (collarbone to shoulder blade)
Condyloid Permits flexion, extension, adduction, abduction and circumduction e.g. Metacarpophalangeal joint (in the middle of your hand).
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Anatomical Terms for Movements

Flexion refers to a movement that decreases the angle between two body parts.

Extension refers to a movement that increases the angle between two body parts.

Abduction is a movement away from the midline – just as abducting someone is to take them away.

Adduction is a movement towards the midline.

Medial rotation is a rotational movement towards the midline. It is sometimes referred to as internal rotation.

Lateral rotation is a rotating movement away from the midline.

Elevation refers to movement in a superior direction (e.g. shoulder shrug), depression refers to movement in an inferior direction.

Pronation at the forearm is a rotational movement where the hand and upper arm are turned inwards. Pronation of the foot refers to turning of the sole outwards so that weight is borne on the medial part of the foot.

Supination of the forearm occurs when the forearm or palm are rotated outwards. Supination of the foot refers to turning of the sole of the foot inwards, shifting weight to the lateral edge.

Inversion and eversion refer to movements that tilt the sole of the foot away from (eversion) or towards (inversion) the midline of the body.

Dorsiflexion refers to flexion at the ankle so that the foot points more superiorly. Dorsiflexion of the hand is a confusing term, and so is rarely used. The dorsum of the hand is the posterior surface, and so movement in that direction is the extension. Therefore we can say that dorsiflexion of the wrist is the same as the extension.

Plantar Flexion refers extension at the ankle so that the foot points inferiorly. Similarly, there is a term for the hand, which is palmar flexion.

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Trios from Homeopathic Materia Medica

Trio of Condylomata – Thuja, Staphysagria, Nitric Acid – (Nash)
Trio of Cholera – Camphor, Veratrum Alb, Cuprum Metallicum
Trio of Climacteric Remedies – Lachesis, Sepia, Sulphur
Trio of Offensive Urine – Nitric Acid, Kreosotum, Sepia
Trio of Offensiveness – Mercurius Solubilis, Kreosotum, Baptisia Tinctoria – (Nash)
Trio of Pain – Coffea, Chamomilla, Aconitum Napellus
Trio of Pleurisy – Aconitum Napellus, Bryonia Alba, Sulphur – (Nash)
Trio of Ptosis – Sepia, Causticum, Gelsemium – (Nash)
Trio of Restlessness – Aconitum Napellus, Arsenic Alb, Rhus Toxicodendron
Trio of Spasmodic Cough – Drosera, Ipecacuanha, Cuprum Metallicum – (Nash)
Trio of Weakness – Arsenic Alb, Muriatic Acid, Carbo Vegetabilis – (Nash)
Three Remedies for the Treatment of Chronic Rheumatism And Paralysis – Causticum, Rhus Toxicodendron, Sulphur – (Nash)

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