A.D.A.M. Student atlas of anatomy [2 ed.]

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A.D.A.M. Student Atlas ofAnatomy

This is the second edition of a volume renowned for its innovative approach to understanding the human body. It features full-color art throughout, using a threedimensional approach to anatomic structure. The A.DAM. Student Atlas of Anatomy is an invaluable learning and review tool developed for medical, allied health, and human biology undergraduate and graduate students. This new edition emphasizes surface anatomy and features unique additional views (posterior, medial, lateral) of important structures. It has extensive coverage of those areas, such as the perineum, head, and neck, that are often difficult for students to understand and appreciate. Todd R. Olson is Professor of Anatomy and Structural Biology and Director of Clinical and Developmental Anatomy at the Albert Einstein College of Medicine, New York. Wojciech Pawlina is Professor and Chair of the Department of Anatomy at the Mayo Medical School, College of Medicine, Mayo Clinic, Rochester, Minnesota.

A.D.A.M. Student Atlas ofAnatomy 2nd Edition

Todd R. Olson, Ph.D. Professor Department of Anatomy & Structural Biology Albert Einstein College of Medicine Yeshiva University Bronx, New York

Wojciech Pawlina, M.D. Professor and Chair Department of Anatomy Mayo Medical School College of Medicine, Mayo Clinic Rochester, Minnesota

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Cambridge UNIVERSITY PRESS

Illustrative Art A.D.A.M.®, Inc. Atlanta, Georgia Cadaver Photographs The Bassett Collection Stanford University School of Medicine Stanford, California

CAMBRIDGE UNIVERSITY PRESS

Cambridge, New York, Melbourne, Madrid, Cape Town, Singapore, Sao Paolo, Delhi Cambridge University Press 32 Avenue of the Americas, New York, NY 10013-2473, USA www. Cambridge. org Information on this title: www.cambridge.org/9780521887564 © A.D.A.M., Inc. 2008 This publication is in copyright. Subject to statutory exception and to the provisions of relevant collective licensing agreements, no reproduction of any part may take place without the written permission of Cambridge University Press. First published 2008 Printed in Hong Kong by Golden Cup A catalog record for this publication is available from the British Library. Library of Congress Cataloging in Publication Data

Olson, Todd R. A.D.A.M. student atlas of anatomy / Todd R. Olson, Wojciech Pawlina. - 2nd ed. p. ; cm. Includes bibliographical references and index. ISBN 978-0-521-88756-4 (hardback) - ISBN 978-0-521-71005-3 (paperback) 1. Human anatomy - Atlases. I. Pawlina, Wojciech. II. Title. III. Title: Student atlas of anatomy. IV. Title: ADAM student atlas of anatomy. [DNLM: 1. Anatomy - Atlases. QS 17 052a 2007] QM25.047 2007 6ll.0022'2-dc22

2007034103

ISBN 978-0-521-88756-4 hardback ISBN 978-0-521-71005-3 paperback

Every effort has been made in preparing this publication to provide accurate and up-to-date information that is in accord with accepted standards and practice at the time of publication. Nevertheless, the au¬ thors, editors, and publisher can make no warranties that the information contained herein is totally free from error, not least because clinical standards are constantly changing through research and regulation. The authors, editors, and publisher therefore disclaim all liability for direct or consequential damages re¬ sulting from the use of material contained in this book. Readers are strongly advised to pay careful at¬ tention to information provided by the manufacturer of any drugs or equipment that they plan to use. Cambridge University Press has no responsibility for the persistence or accuracy of URLs for external or third-party Internet Web sites referred to in this book and does not guarantee that any content on such Web sites is, or will remain, accurate or appropriate.

To my mother and father

for the greatest of all contributions to my existence, optimism, and ability to dream and to my teachers, colleagues, and students

for their encouragement and contributions to the realization of this dream. Todd R. Olson

To my father, Dr. Kazimierz Pawlina,

who was my first anatomy teacher and my inspiration to pursue an academic career. Wojciech Pawlina

*

Acknowledgments I (TRO) must express my appreciation and gratitude to Prof. Wojciech Pawlina, M.D., for joining me as a co¬ author on this edition. Wojciech provided substantial help in the production of this work, and his presence as a co-author is a much-deserved recognition of the hours of work and creative input he contributed to the production of both editions of this atlas. We (TRO & WP) wish also to acknowledge the insightful changes in¬ troduced by Prof. Herbert Lippert in the German edition—some of which have been incorporated here—and the helpful comments of Prof. Christian Fontaine, who produced the French translation of the first edition. We also wish to acknowledge and express our gratitude to our colleagues, Dr. Nirusha Lachman at the Mayo Clinic and Dr. Sherry A. Downie at Albert Einstein, for their invaluable help, suggestions, and support in the production of this new edition. The second edition of the A.D.A.M. Student Atlas of Anatomy is truly the product of a major collaborative effort. The authors wish to extend our appreciation to all individuals who worked on this project and, in par¬ ticular, to six people whose contribution to this edition were most noteworthy. At Cambridge University Press, Marc Strauss, who had the determination and skill to assemble the talent needed to undertake the production of a second edition of this work, and Nat Russo, who had the conviction to push for its publica¬ tion. At A.D.A.M., Meredith Nienkamp for her work in championing the second edition and Lisa Higgin¬ botham, who worked tirelessly to produce the new artwork for this edition. Robert A. Chase at Stanford University School of Medicine for allowing us to include photographs from the David L. Bassett anatomical collection. And Matthew Byrd and his superb team at Aptara, Inc., for their excellent work in laying out and producing this book. The dedication to every detail of Matt’s team elevated the content and quality of this edition well beyond what was originally perceived by the authors. Thank you! The talent, dedication, and professionalism of all those at A.D.A.M. who were responsible for the artwork— both in this work and in the A.D.A.M. Interactive Anatomy products—are clearly visible on every page of this atlas. Their efforts and commitment to making this book a learning resource will benefit students everywhere. A.D.A.M. Anatomical Illustration Team: Meredith Nienkamp, VP of Production/Medical Illustrator Mike Gleason, Medical Illustrator Lisa Higginbotham, Medical Illustrator Dan Johnson, Medical Illustrator Kyle McNeir, VP of Production & Internet Design/Medical Illustrator Prior edition contributions made by: Mary Beth Clough, Medical Illustrator Ron Collins, Medical Illustrator Eric D. Grafman, Medical Illustrator Lynda Leigh Levy, Medical Illustrator Virginia Sue Mabry, Illustrator Dee Mustafa-Bowne, Illustrator Ed M. Stewart, Medical Illustrator Gregory M. Swayne, Medical Illustrator Lelayne Weiss, Illustrator The authors and A.D.A.M., Inc., wish to thank all of the individuals at Cambridge University Press whose ex¬ pertise, enthusiasm, and commitment to quality have been at the heart of this project from the beginning: Marc Strauss, Nat Russo, Cathy Felgar, Jennifer Bossert, and Carlos Aguirre. In particular, we wish to thank Marc Strauss for the kindness, patience within limits, and the good humor he displayed in performing his role as the drill sergeant for this entire effort. Finally, we wish to extend our appreciation to Lisa Adamitis, who designed the cover. Todd R. Olson Wojciech Pawlina A.D.A.M., Inc.

.

Preface Although our knowledge of human anatomy has changed relatively little in the past hundred years, the teaching of anatomy in all health science professions has changed profoundly. During most of the 20th centuiy, gross human anatomy was the principle course in the first year of medical school. Today, one hundred years later, the importance of anatomy within the curriculum has been reduced in pedagogic and temporal signifi¬ cance to the degree that first-year medical students spend two to three times more time studying cellular, subcellular, molecular, and biochemical processes than they do the gross structure of the human body. The ma¬ jor reason for this de-emphasis has been the spectacular development of bioscience technology and the re¬ sultant explosion in clinically relevant knowledge that has been incorporated into basic medical education. Anatomists successfully responded to the challenges created by this reduction in curricular importance and time in three ways. First, and most significantly, we have largely reduced the body of knowledge covered in our courses to those aspects of anatomy that are clinically relevant and therefore of greatest potential value to the student’s future clinical practice. Second, we have sifted the body of anatomical knowledge to winnow out the specialist details that must now be taught in postgraduate programs, leaving the anatomical essentials that are fundamental to the basic clinical education of every health sciences and medical student. And third, we have expanded our teaching into the later years of the medical curriculum, introduced specialty and sub¬ specialty focused elective courses for students prior to graduation, and greatly expanded our participation in graduate and continuing education courses. The vertical expansion of anatomical education into these new venues, beyond the traditional first-year course, has allowed a more effective and focused delivery of appro¬ priate anatomical detail to students and graduated physicians who have a direct and specific need to know this information. All three of these new pedagogic frontiers are critical components in the anatomical education of our fu¬ ture healthcare professionals. The purpose of this work is to focus on the initial phase of this educational process in which it is increasingly necessary to distill the voluminous details present in gross anatomy to their fundamental essentials. While there are an ever-growing number of gross anatomy textbooks that have adopted an “essentials” perspective, we have long thought it remarkable that no one has successfully incor¬ porated this perspective into an anatomy atlas for beginning students. This all changed ten years ago when the first edition of the A.D.A.M. Student Atlas of Anatomy was published. From its inception in 1994, we have viewed the A.D.A.M. Student Atlas as, first and foremost, a visual guide and interactive learning resource to be used along with a clinical anatomy textbook. In the organization and content of the A.DAM. Student At¬ las, our goal has been and remains to emphasize those parts of the body and structures that are fundamental to the clinical education of every medical and health sciences student. To accomplish our goal, we decided to include more images of fewer structures and, in particular, more images of those parts of the body that present the beginning student with the greatest difficulties to compre¬ hend and appreciate. We expect and fully hope that most students who use this book will soon become aware of both this distinctive emphasis and limited scope, as well as their own need to consult a more com¬ prehensive atlas as their study of human anatomy matures. Our primary design concept in support of our goal was neither to duplicate the efforts seen in existing comprehensive atlases, which fully display every named feature in the human body, nor to create an atlas to accompany and guide dissection. Nowhere in the A.D.A.M. Student Atlas is the emphasis on essentials of the most difficult regions of the body more evident than in Chapter 4 (“Pelvis and Perineum”), which is substantially longer than normally found in traditional atlases. There were two reasons why this chapter was created in this expanded form: First, there is a clear need to know the basic anatomy of the pelvis and perineum in the major clerkship of obstetrics and gynecology, and it is only slightly less important in urology; second, experience indicates that this region is possibly the most difficult for first time students to understand. The pelvis and perineum pre¬ sent unique problems of spatial and surface relationships, which are compounded by the fact that dissection of the pelvis only partially reveals its contents in situ and the perineum dissection is difficult and timeconsuming, even for an experienced dissector working on an ideal specimen. In contrast to Chapter 4, the preceding chapter on the abdominal contents and their peritoneal relationships is relatively short because the beginning student generally finds them easier to dissect and identify their important anatomical structures and relationships. All of the atlas’s chapters, except the cranial nerves, are topographically/regionally arranged and organized to begin with surface anatomy and to end with the traditional sequences of superficial-to-deep images that the student will see when dissecting. Another innovation that we have included in the A.D.A.M. Student

X

Preface

Atlas is the lengthy systemic sections found at the beginning of the chapteis on-the ttunk, limbs, and head and neck. Systemic descriptions were not included in Chapters 2 and 3, the thoracic and abdominal contents, respec¬ tively, because the systemic anatomy of the body walls of these regions is covered extensively in Chapter 1 on the trunk, and the distribution and pattern of deeper neurovasculature structures can be clearly appreciated in the se quence of dissection images within each of these two chapters. While it is ultimately the objective in teaching patient-oriented anatomy to provide the student with an under¬ standing of the composite anatomy of all or selected regions of the body, experience has convinced us that many, or even most, students initially find it easier to organize information by systems. The addition of these ex¬ tensive systemic sections should not only make the A.D.A.M. Student Atlas a more useful book foi beginning stu¬ dents but also make it a valuable resource for allied health students whose courses are usually systemically taught but who have never had access to a regional atlas that also emphasized this anangement. Another distinctive innovation of the A.D.A.M. Student Atlas is the placement of photographs of dissected or osteological specimens adjacent to newly rendered A.D.A.M. images. The rationale for this arrangement and the way we have chosen to label them is based upon the experience we have had with many first year medical stu¬ dents who purchase an expensive photographic atlas that is then used for a short period of time prioi to laboratory practical exams. These atlases are helpful because students can test their knowledge on the pictures, which more closely approximate what they will see on the practical exam. In structuring the A.D.A.M. Student Atlas, we have selected and arranged the cadaveric photographs to pro¬ vide beginning students with an overview of the more important dissections that she/he will see in the lab. Also, by placing them adjacent to similar A.D.A.M. images, the student gains the benefit of seeing a detailed artistic im¬ age (as opposed to a highly simplified schematic drawing) that enhances and highlights what is most important in this view. While an appreciation of both cross-sectional and radiographic anatomy is important in many areas of basic clinical work, it was impossible, within the scope of this atlas, to incorporate more than a limited number into each chapter. The cross-sections and radiographs that do appear have been included because they either best display the distribution of prominent structures, e.g., peritoneum, or provide another means of visualizing the re¬ lationships within a region. The limited use of these important visual methods and modalities leflects the physi cal restrictions of the book and does not imply that they are unimportant or should not be part of a course in clin¬ ical anatomy. TRO & WP

t

Contents CHAPTER 1

Trunk: Body Wall and Spine

i

CHAPTER 2

Thorax

65

CHAPTER 3

Abdomen

109

CHAPTER 4

Pelvis and Perineum

149

CHAPTER 5

Lower Limb

209

chapter 6

Upper Limb

277

CHAPTER 7

Head and Neck

347

CHAPTER 8

Cranial and Autonomic Nerves

445

Index

471

-

L/ser’s Guide The A.D.A.M. Student Atlas of Anatomy was designed to be an interactive pictorial guide for the beginning student to master human anatomic methodology and basic terminology as well as the three-dimensional re¬ lationships of the body’s constituent parts. The next few pages explain how to use the illustrations and spe¬ cial features of the atlas to their fullest advantage. Three-Dimensional Anatomy Among the problems faced by the beginning anatomy student, none is more universally perplexing than ac¬ quiring an appreciation of the three-dimensional relationships within the human body. Recent anatomy books have addressed this problem largely through the inclusion of cross-sections, CT, and MRI scans. Typi¬ cally, anatomical atlases and textbooks illustrate an area or region from only one of the four traditional verti¬ cal perspectives (i.e., anterior, posterior, medial, or lateral), and students are left to extrapolate the anatomy of the third dimensional from a two-dimensional picture.

Plate 5.17

Superficial Veins of Lower Limb

Superficial circumflex iliac v.'

Ant. femoral cutaneous v.

Perforating or. anastomosing v v.

Lateral malleolus

Great saphenous 1

Small saphenous v.

Dorsal venous arch

Plantar venous network

232

A.D.A.M. I Student Adas of Anatomy

One of the most effective ways of overcoming this problem is to illustrate the region from an orientation that is at right angles to the view in question. Using A.D.A.M. Interactive Anatomy’s distinctive ability to view the body from any one of the four vertical perspectives, figures on many plates depict at least two, and sometime more, orientations. For example, the anterior, medial, and posterior views of the leg in Plate 5.17 make visu¬ alizing the location, distribution, and relationships of the superficial veins, especially the clinically important

XIV

User’s Guide

saphenous vein, and cutaneous nerves of the lower limb much easier. The^extensive use of these multiple views is one of the most striking and valuable characteristics of the A.D.A.M. Student Atlas of Anatomy. Illustrations and Cadaver Photographs The two figures here in Plate 1.48 illustrate how A.D.A.M. illustrations have been paired with photographs taken from Stanford University’s Bassett Collection and intended use in the atlas.

Inguinal Region—Superficial Inguinal Ring

Plate

1.48

Exl. abdominal oblique m. aponeurosis

Ant. superior iliac spine Intercrural fibers of exl. abdominal oblique m. aponeurosis Lateral femoral cutaneous n.

Inguinal lig.

Am. cutaneous br. of iliohypogastric n.

Superficial inguinal ring

Femoral n.

-cmoral sheath surrounding femoral a.

&v

Pubic tubercle Great saphenous v. Deep fascia of penis

Ext. spermatic fascia (from ext. abdominal oblique m. aponeurosis) Ilioinguinal n.

Ant. cutaneous br. of iliohypogastric n.

Ext. abdominal oblique m. aponeurosis

Inguinal lig. Superficial inguinal ring Ext. spermatic fascia (from exl. abdominal oblique m. aponeurosis)

Cribriform fascia

Pubic tubercle Great saphenous v. Ilioinguinal n.

Deep fascia of penis ixt. pudendal a.

Ini. cutaneous br. of femoral n. Darios tunic (from membranous layer of superficial fascia)

Location of testis

Anterior Views of Left Side

Chapter

1

TRUNK: BODY WALL AND SPINE

53

In structuring the A.D.A.M. Student Atlas, we have selected and arranged the cadaveric photographs to pro¬ vide an overview of the more important dissections. By associating these photographs with adjacent A.D.A.M. images that depict similar but not identical anatomy, the student gains the benefit of seeing a de¬ tailed artistic image (as opposed to a highly simplified schematic drawing) to enhance and highlight what is most important to be seen in the photograph of the dissected specimen. Joint Motion and Segmentary Nerve Supply Motions in a single plane at each joint are typically initiated by motor neurons found in four successive spinal cord segments and their spinal nerves. The cranial pair of neurons innervate the muscles that produce move¬ ment in one direction and the caudal two innervate the muscles that produce the opposite motion. An ap¬ preciation of the actions, especially in the limbs, and their innervation is basic clinical knowledge that has practical value to a wide variety of health care professionals. The atlas includes tables that list the muscles

User’s Guide

and the nerve(s) that innervate them. The segmentary origin of each nerve is also listed. In those cases where a specific segmentary level is primarily associated with the supply of the muscle, the level is printed in BOLD. In addition, information about segmentary innervation is provided in illustrations showing how different spinal levels control antagonistic movements in the upper and lower limb.

Plate 6.21

Segmental Innervation of Joint Actions

Anatomical Terminology The anglicized and classical terminology used in the A.D.A.M Student Atlas follows the recent edition of the Terminologica Anatomica. In some case, the use of square [ ] and parentheses ( ) has formal meaning in the internationally recognized code of anatomical nomenclature. [Square] brackets signify: 1. An officially recognized alternative name or synonym. Fibularis [Peroneus] longus m. L. vagus n. [CN X], where CN refers to a cranial nerve L. gastro-omental [gastroepiploic] v. 2. An equivalent anatomical name for this structure. Subcostal n. [T12], where T12 = 12th thoracic spinal n. Cl [Atlas] (Round) brackets identify: 1. An official name of inconsistent structures. (Accessory parotid gland) (Frontal suture) 2. Eponyms and alternative names that are not officially recognized as appropriate in contempo¬ rary usage. Omental foramen (f. of Winslow) L. colic (splenic) flexure Costoaxillary (ext. mammary) v. Hepatopancreatic ampulla (of Vater)

XV

XVI

User’s Guide

3. Additional components of a name that are usually omitted thgt have been added foi claiification or that are supplemental to the name. Greater tuberosity (of humerus) Acromion (process of scapula) Posterior basal bronchopulmonary segment (S10) 4. Motor and sensoiy segmental and spinal nerve levels of a peripheral nerve. Femoral n. (L2-L4) Lat. femoral cutaneous n. (L2,L3) Middle cluneal nn. (dorsal rami of SI-S3) For TWO adjacent spinal nn., they are separated by a comma; however, when more than two spinal nn. are involved, only the cranial and caudal-most are listed, separated by a hyphen. 5. Conditions specific or unique to the image or dissection. L. rectus abdominis m. (reflected medially) R. primary bronchus (pulled to L.) Hyphenated names. Hyphens appear in a name to: 1. More specifically identify a constituent part of a larger complex structure. Triceps brachii m. - long head Pectoralis major m. - sternal head 2. Separate the parts of compound name where the same vowel is found at the end of the first name and beginning of the second. Gastro-omental [gastroepiploic] v. Atlanto-occipital joint Abbreviations The following abbreviations are used in the atlas. Bold entries are abbreviated everywhere they appear, oth¬ er entries are sometimes abbreviated in order to save space. & a. aa. ant. asc. br. brr. comm. desc. ext.

= = = = = = = = = =

and artery arteries anterior ascending branch branches communicating descending external

inf. int. L. lat. ligUgg. m. mm. med. n.

= = = = = = = = = =

inferior internal Left lateral ligament ligaments muscle muscles medial nerve

nn. port. post. proc. pt. R. sup. trib. V.

w.

= = = = = = = = = =

nerves portion posterior process part Right superior tributaiy vein veins

Another system of abbreviation is typically used when segmental structures (i.e., vertebrae, spinal or inter¬ costal nerves, ribs) are superimposed on or immediately adjacent to the structure. Thus, C6 on or next to a vertebra identifies the sixth cervical vertebrae; the “C” distinguishes the vertebral type and the number its seg¬ mental location. Abbreviations used in this way are: C Cc L R S T

= = = = = =

Cervical Coccygeal Lumbar Rib Sacral Thoracic

Trunk: Body Wall and Spine

Surface Anatomy Skeleton Joints & Ligaments Muscles Vasculature Nerves Spinal Cord & Vertebral Canal Anterior Body Wall & Mammary Gland Lateral Body Wall Inguinal Region Superficial Back Deep Back Suboccipital Region

s

Plate

1.1

Surface Anatomy

Deltopectoral triangle

Jugular notch

\ A-Sternal angle

Deltoid m.

Sternum

Pectoralis major m.

Xiphoid process Costal margin ■ 'iM

Linea alba Semilunar line •

Tendinous intersection in rectus abdominis m.

-

M

■ Umbilicus

Iliac crest

Ant. superior iliac spine

Anterior View

2

A.D.A.M.

Student Atlas of Anatomy

Surface Anatomy

Plate 1.2

Ext. occipital protuberance

Mastoid process

Ligamentum nuchae

Spinous process of C7 [Vertebra prominens]

Spine of scapula

Sup. angle of scapula — Deltoid m.

Medial border of scapula

Inf. angle of scapula

Thoracolumbar fascia

Post, superior iliac spine

Gluteus maximus m. Natal cleft

Posterior View

Chapter

1

TRUNK: BODY WALL AND SPINE

3

Plate

1.3

Skeleton—Muscle Attachments

Cl [Atlas]

1st rib Clavicle Jugular notch

Acromion Coracoid process Greater tubercle

Intertubercular sulcus

Lesser tubercle Manubrium

Medial border of scapula

Sternal angle

Body of sternum Inf. angle of scapula Xiphoid process Costal margin

10th costal cartilage

11th rib

12th rib

Iliac crest Tubercle of iliac crest

Promontory of sacrum Ant. superior iliac spine Coccyx

Inguinal lig.

Pubic crest Pubic symphysis Pubic tubercle

Anterior View

4

A.D.A.M.

Student Atlas of Anatomy

Skeleton—Muscle Attachments

Plate 1.4

Spinous process of C7 [vertebra prominens] Spinous process of T1

1st rib Clavicle

Acromion Coracoid process Spine of scapula

Manubrium Sternal angle

Medial border of scapula

Body of sternum

Inf. angle of scapula

Costal margin Spinous process of T12 10th costal cartilage

11th rib 12th rib

Spinous process of L3

Tubercle of iliac crest

Iliac crest

Post, superior iliac spine Ant. superior iliac spine Post, inferior iliac spineInguinal lig.

Coccyx

Pubic tubercle Pubic symphysis

Latissimus dorsi A) Pectoralis major Pectoralis minor A) Rectus abdominis (A) Serratus anterior Lateral View

Chapter

1

Trapezius

TRUNK: BODY WALL AND SPINE

5

Plate 1.5

Skeleton—Muscle Attachments

-Ext. occipital protuberance Mastoid process Inf nuchal line Dens of C2 [Axis]

Cl [Atlas]

Cl

1st rib

Clavicle Sup. angle of scapula Acromion Greater tubercle

Spine of scapula

Lateral border of scapula

Medial border of scapul

Inf. angle of scapula

Angle of 9th rib Costal margin

Spinous process of T12 11th rib

12th rib Transverse process of L3 Iliac crest

Tubercle of iliac crest

Sacrum Post, superior iliac spine Latissimus dorsi

(~^)

Post, inferior iliac spine Levator scapulae — Coccyx

C'j Rhomboid major Rhomboid minor Trapezius

Posterior View

6

A.D.A.M.

Student Atlas of Anatomy

Skeleton—Muscle Attachments

Plate 1.6

Inf. nuchal line - Ext. occipital protuberance Mastoid process Cl [Atlas]

Dens of C2 [Axis]

1st rib

Angle of 9th rib

- Costal margin

Spinous process of T12 11th rib

12th rib

Transverse process of L3

LI

Iliac crest

Iliocostalis Tubercle of iliac crest

Serratus post, superior Post, inferior iliac spine

Post, superior iliac spine

Levatores costarum brevis Levatores costarum longus Semispinalis Longissimus Spinalis Serratus post, inferior

Sacrum

Posterior View

Chapter

1

TRUNK: BODY WALL AND SPINE

7

Plate 1.7

Skeleton—Spine

Dens of C2 Cl [Atlas] C2 [Axis]

Transverse process of C5 C7 [Vertebra prominens] T1

Carotid tubercle of C6

Manubrium Spinous process of T3 Sternal angle

Body of sternum

Transverse process of T10

T12

Costal margin

Body of L3

Iliac crest

Spinous process of L5 Spinous process of SI

Ant. superior iliac spine

Sacrum Post, sacral foramen Col Co2 Co3 Co4

Ant. inferior iliac spine S5 Coccyx

Posterior View of Vertebral Column

Lateral View of Right Half of Skeleton

8

A.D.A.M.

Student Atlas of Anatomy

Skeleton—Spine

Plate 1.8

Dens of C2 Ant. tubercle of Cl -Body of C2

Intervertebral disc Carotid tubercle of C6 Transverse process of C7 1st rib —

Intervertebral foramen

Sup. articular process

Inf. articular process

12th rib

11th rib

Transverse process of L3 Spinous process of L3

• Wing of sacrum [Ala] Promontory of sacrum

Ant. [pelvic] sacral foramen —

Coccyx

Symphysis of pubis

Col Co3 Co4

Anterior View of Vertebral Column Right Lateral View of Median Sectioned Skeleton

Chapter 1

TRUNK: BODY WALL AND SPINE

9

Plate 1.9

Cervical Vertebrae

Lateral View of Ant. tubercle of Cl

Cervical Vertebrae

Post, arch of Cl Transverse process of Cl

Post, tubercle of Cl

Sup. articular process

Spinous process of C2

Inf. articular process Transverse foramen Intervertebral foramen

Ant. tubercle of transverse process

Post, tubercle of transverse process Carotid tubercle of C6 Transverse process of C6

Body of C7 Spinous process [vertebra prominens]

Ant. arch of Cl Dens of C2 Cl [Atlas]

C2 [Axis] Post, tubercle of Cl

Sup. articular process Body of C3

Inf. articular process

Intervertebral disc

Intervertebral foramen

Pedicle

Inf. articular facet Median Section of Cervical Vertebrae

IO

A.D.A.M.

Student Atlas of Anatomy

Cervi cal Verteb rae Ant. arch of Cl

Plate 1.10

Anterolateral View of Cervical Vertebrae

Ant. tubercle of Cl

Spinous process of C2 Ant. tubercle of transverse process

Post, tubercle of transverse process

Body of C3

Sup. articular process Inf. articular process Intervertebral foramen Ant. tubercle of transverse process

Transverse process of C6

Transverse foramen Carotid tubercle of C6

Transverse foramen Inf. articular facet Body of Cl Spinous process of Cl

Dens of C2

Transverse process Post, tubercle of Cl

Post, arch of Cl Transverse foramen Sup. articular process

Spinous process of C2 Inf. articular process

Post, tubercle of transverse process Bifid spinous process Ant. tubercle of transverse process

Carotid tubercle of C6

Transverse process of C6

Spinous process of Cl Posterolateral View of Cervical Vertebrae

Chapter 1

TRUNK: BODY WALL AND SPINE

I I

Plate 1.11

Thoracic Vertebrae

Sup. articular process (Tl) Sup. vertebral notch

Vertebral body (Tl)

Sup. articular process

Anulus fibrosus of intervertebral disc Intervertebral disc Spinous process (13)

Intervertebral foramen

Anulus fibrosus Sup. costal facet

Sup. articular process (T5) Nucleus pulposus of intervertebral disc

Transverse costal facet

Inf. articular process (T5)

Sup. vertebral notch (T5) Inf. vertebral notch (T5)

Pedicle Spinous process (T5) Intervertebral foramen

Body of T8

Transverse process

Lamina of vertebral arch

Inf. articular process Spinous process

Inf. vertebral notch

Lateral View of Thoracic Vertebrae

12

A.D.A.M.

Student Atlas of Anatomy

Midsagittal Section of Thoracic Vertebrae

Thoracic Vertebrae Transverse

Sup. articular process

Plate 1.12

Pedicle

Transverse process Inf. vertebral notch

Body of T8

Inf. articular process Spinous process Sup. vertebral notch

Sup. articular process

Sup. articular process Pedicle

Transverse process

Transverse process

Inf. articular process

Inf. vertebral notch Inf. articular process Anterolateral View of T8, T2, L2 & Til Transverse process Sup. articular process Transverse costal facet

Transverse process

Inf. vertebral notch

Lamina of vertebral arch

Body of T8

Spinous process Spinous process Sup. articular process

Transverse process Transverse process

Sup. costal facet

Sup. articular process

Spinous process

Transverse process Lamina of vertebral arch

Inf. vertebral notch Inf. articular process

Spinous process

Posterolateral View of T8, T2, L2 & Til

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13

Plate 1.13

Lumbar Vertebrae

Lateral View of Lumbar Vertebrae Sup. vertebral notch Transverse process

Sup. articular process

Intervertebral foramen

Body

Intervertebral disc

Pedicle

Lamina of vertebral arch

Mamillary process

Inf. vertebral notch

Inf. articular facet

Sup. articular process

Intervertebral foramen

Spinous process

Intervertebral disc

Pedicle

Lamina of vertebral arch

Mamillary process

Inf. vertebral notch

Median Section of Lumbar Vertebrae

14

A.D.A.M.

Inf. articular facet

Student Atlas of Anatomy

Sup. vertebral notch

Lumbar Vertebrae

Plate 1.14

Sup. articular process Anterolateral View of Lumbar Vertebrae Sup. vertebral notch

Transverse process

Spinous process

Pedicle

Sup. articular process

Body Sup. articular process Intervertebral foramen

Transverse process

Lamina of vertebral arch

Transverse process Mamillary process

Accessory process

Inf. articular facet Inf. vertebral notch

Inf. articular facet

Transverse process

Body

Lamina of vertebral arch Sup. articular process

Spinous process

Transverse process Mamillary process

Posterolateral View of Lumbar Vertebrae Inf. articular facet

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15

Plate 1.15

Sacrum Base of sacrum

Anterior View of Pelvic Surface of Sacrum

Sup. articular process

Lateral part I

Wing of sacrum [Ala] Promontory of sacrum

Sacral part of sup. pelvic aperture (brim)

Transverse line Auricular surface

Ant. [pelvic] sacral foramen Transverse ridge

Apex of sacrum

Sup. articular facet

Body of SI

Auricular surface

Sacral tuberosity

Lateral sacral crest

Intermediate sacral crest

Post, sacral foramen

Median sacral crest Sacral horns

Posterior View of Sacrum

16

A.D.A.M.

Student Atlas of Anatomy

Sacral hiatus

Apex of sacrum

Ribs

Plate 1.16

Head Neck Tubercle Head Neck

Costochondral articulation

Head Neck Tubercle

Posterior angle

Body

Costal groove

8th RIB

Inferior View of Right Ribs 1, 3 & 8 (Right Side)

Crest of rib head Sup. articular facet

Head

Neck Tubercle

Inf. articular facet

Articular facet of tubercle Cut end of rib

6th RIB

Angle Body

Costal groove

Medial View of Proximal End of Right 6th Rib

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17

Plate 1.17

Joints & Ligaments Jugular notch

Interclavicular lig.

Anterior View of Sternocostal Articulations

Ant. sternoclavicular lig. Clavicle

Articular disc of sternoclavicular joint Costoclavicular lig.

Sternal angle Manubrium

2nd intercostal space Manubriosternal joint

Radiate sternocostal lig. 4th costal notch of sternum

Costochondral articulation Body of sternum Costal cartilage

Radiate sternocostal lig.

Interchondral lig.

8th costal cartilage Xiphoid process

Transverse process of L5

Iliolumbar lig.

Iliac crest

Ligamentum flavurn Post, superior iliac spine Post, sacroiliac ligg. Post, inferior iliac spine Greater sciatic notch Lateral sacral crest Greater sciatic foramen Median sacral crest

Post, sacrococcygeal ligg.

Sacrospinous lig.

Ischial spine

Lesser sciatic foramen

Coccyx Sacrotuberous lig. Obturator foramen

Ischial tuberosity

Posterior View of Pelvic Ligaments

18

A.D.A.M.

Student Atlas of Anatomy

Joints & Ligaments

Sup. articular facet

Post, longitudinal lig.

Plate 1.18

Sup. articular facet

Ligamentum flavum Ligamentum flavum

Interspinous lig. 3rd rib

Interspinous lig. Spinous process Spinous process

Intervertebral disc Transverse process

Transverse process Ant. longitudinal lig.

5th rib

Zygapophyseal joint Pedicle

Lamina

Interspinous lig. Articular capsule of zygapophyseal joint

Articular capsule of zygapophyseal joint

Intervertebral foramen

Supraspinous lig.

Inf. articular facet

Ant. longitudinal lig.

Lateral View of Lumbar Vertebral Ligaments

Posterior View of T2-T7 Costovertebral Ligaments

Anulus fibrosus

Nucleus pulposus

Post, longitudinal lig.

Dura mater Arachnoid mater

Denticulate lig.

T10 spinal nerve

Pia mater

Gray matter

Transverse process White matter Sup. articular process Ligamentum flavum

Articular capsule of zygapophyseal joint

Interspinous lig.

Spinous process

Superior View of Til

Supraspinous lig.

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19

Table 1.1

Muscles—Thoracic Wall

Superior or Medial Attachment

Muscle

External intercostal

Innermost intercostal

Action(s)

Innervation

\

Sup. border of rib bounding intercostal space caudally, muscular from costal tubercle to end of rib with membranous connection to sternum

\

Inf. border of rib that bounds intercostal space cranially

Internal intercostal

Inferior or Lateral Attachment

Elevate ribs in inspiration

Sup. border of rib bounding intercostal space caudally, muscular from angle to sternum

1st to 11th intercostal nn. & subcostal n.

Separated from int. intercostal mm. only by neurovascular bundle

/

/

Subcostal

Inf. border lateral to angle of rib that bounds intercostal space cranially

Int. surface near angle of rib that bounds intercostal space caudally, best developed between ribs 6 & 12, may cross 2 intercostal spaces

Transversus thoracis

Int. surface of body & xiphoid of sternum

Inf border of 2nd to 6th costal cartilages

2nd to 6th intercostal nn.

Depress costal cartilages in expiration

Transverse processes of C7 to Til

Between tubercle & angle on ext. surface of rib caudal to vertebral attachment

Dorsal primary rami of C8 & T1 to T11 spinal nn.

Elevate ribs in inspiration; laterally flex spine

Serratus posterior superior

Inf. part of ligamentum nuchae & spinous process from C7 to T2/T3

Sup. border of 2nd to 5th ribs just lateral to angles

2nd to 5th intercostal nn.

Elevate ribs in inspiration

Serratus posterior inferior

Spinous processes & thoracolumbar fascia from T11/T12 to L3

Inf border of 9th/ 10th to 12th ribs just lateral to angles

9th to 11th intercostal nn. & subcostal n.

Depress ribs in expiration

Depress ribs in expiration

/

Levatores costarum

L. c. brevis m. L. c. longus m.

Serratus post, superior m.

costarum mm.

Serratus

Posterior View

20

A.D.A.M.

Student Atlas of Anatomy

Muscles—Thoracic Wall

Plate 1.19

Anterior View Body of sternum

Transversus thoracis mm.

Innermost intercostal mm.

Subcostal mm. Xiphoid process

Ext. intercostal mm. Angle of rib Ext. intercostal membranes

Costochondral articulation

Body of sternum 4th and 5th intercostal spaces (mm. removed)

Int. intercostal mm.

Lateral View

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2I

Table 1.2

Muscle

Muscles—Abdominal Wall

Lateral or Superior Attachment

Medial or Inferior Attachment

Innervation

Ext. surfaces of 5th to 12th ribs

Linea alba, pubic tubercle & ant. half of iliac crest

Inf. six thoracic nn. & subcostal n.

Action(s) X

External oblique

Interna] oblique

Thoracolumbar fascia, ant. twothirds of iliac crest & lateral half of inguinal lig.

Inf. borders of 10th to 12th ribs, linea alba & pubis via the conjoint tendon

Compress & support abdominal ^

'

viscera; flex & rotate tunk

> S Ventral rami of T6 to Ll

Transversus abdominis

Int. surfaces of 7th to 12th costal cartilages, thoracolumbar fascia, iliac crest & lateral third of inguinal lig.

Linea alba with aponeurosis of int. oblique, pubic crest & pecten pubis via conjoint tendon j

Rectus abdominis

Xiphoid process & 5th to 7th costal cartilages

Pubic symphysis & pubic crest

Ventral rami of inf. six thoracic nn.

Flex trunk & compress abdominal viscera

Quadratus lumborum

Medial half of inf. border of 12th rib & tips of lumbar transverse processes

Iliolumbar lig. & int. lip of iliac crest

Ventral rami of T12 & Ll to L4

Extend & laterally fixes the vertebral column; flex 12th rib during inspiration

Cremaster

Inf. edge of int. abdominal oblique, inguinal lig., pubic tubercle & pubic crest

Invest spermatic cord and testis

Genital br. of genitofemoral n. (Ll &L2)

Retract testis

Compress & support abdominal viscera

Ll

Quadratus lumborum m. L3

Transverse process

Iliac crest

L5

Tubercle of iliac crest

Post, superior iliac spine

Posterior View

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Student Atlas of Anatomy

Muscles—Abdominal Wall

Plate 1.20

Body of sternum

Linea alba Rectus sheath—ant. layer

Ext. abdominal oblique m, Int. abdominal oblique m. Int. abdominal oblique m. aponeorsis

Ext. abdominal oblique m. aponeurosis

Iliac crest

Intercrural fibers

Ant. superior iliac spine Superficial inguinal ring Conjoint tendon

Cremaster m. & fascia Inguinal lig. Pubic tubercle

Spermatic cord

Testis

Anterior Views

Xiphoid process

Rectus sheath—post, layer Linea alba Semilunar line

Rectus abdominis m. Transversus abdominis m. Transversus abdominis m. aponeurosis

Arcuate line

Tendinous intersection

Transversalis fascia Pubic crest Inguinal lig.

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23

Table 1.3

Intrinsic Muscles of the Back

Intrinsic Muscles of the Back2 Inferior or Medial Attachment

Muscle

Superior or Lateral Attachment

Innervation

Action(s)

SUPERFICIAL LAYER—SPINOTRANSVERSE GROUP

Splenius capitis

_ ,

.

. .

Splenius cervicis

Inf. half of ligamentum nuchae, spmous processes of C7 to

Mastoid process, lateral third of the sup nuchal line

Dorsal primary rami of middle cervical spinal nn.

Spinous processes of T3/T4 t0 T6

Post, tubercles of transverse processes of Cl to C3

Dorsal primary rami of lower cervical spinal nn.

Unilaterally, rotate & laterally flex neck to same side, ^ bilaterally, extend the neck & head ,

INTERMEDIATE LAYER—ERECTOR SPINAE GROUP Iliocostalis m. I. cervicis I. thoracis I. lumborum

Sacrum, medial part of iliac crest, 12th to 3rd ribs

Angles of all ribs, transverse processes of C7 to C4

Longissimus m. L. capitis L. cervicis L. thoracis

Sacrum, transverse processes of all vertebrae from L5 to C7, transverse & articular processes of C6 to C4

Transverse processes of all vertebrae from T12 to C2, angles of all ribs, mastoid process

Spinalis m. S. capitis S. cervicis 5. thoracis

Spinous processes of L2/L3 to Til, ligamentum nuchae & spinous processes of T2 to C7 transverse processes of C7/C6 to C2, articular processes of C6 to C4

Spinous processes from T9/T8 to yCl/C6, spinous processes of C3/C4 & C2, occipital bone between & inf nuchal lines with semispinalis m. F /

\

^

Unilaterally, flex vertebral column to same side; l bilaterally, extend vertebral r column; important in maintaining erect posture while standing or walking

Dorsal primary rami of all \ cervical, thoracic & lumbar spinal nn.

)

DEEP LAYER—TRANSVERSOSPINAL GROUP Transverse processes of all vertebrae from T10 to C3, articular processes of C6 to C4

Spinous processes from T4 to C2, occipital bone between sup. & inf. nuchal lines; usually includes spinalis capitis m.

Multifidus

All lamina from S4 to C2 transverse processes L5 to Tl, articular processes C7 to C3

Spinous process of all vertebrae; spans 1 to 3 vertebrae

Dorsal primary rami of T6 to Cl spinal nn.

Rotatores

Transverse processes of all vertebrae L5 to T2

Lamina & roots of spinous process of next vertebra superiorly; best developed in thoracic region

Dorsal primary rami of L4 to Tl spinal nn.

Semispinalis m. S. capitis S. cervicis S. thoracis

Dorsal primary rami of T6 Tl, all cervical spinal nn.

Unilaterally, lateral flex and/or rotate vertebral column & head to opposite side; bilaterally, extend vertebral column & head

Unilaterally, lateral flex and/or rotate vertebral column to > opposite side; bilaterally, extend or stabilize vertebral column

“The most superficial layer also includes the trapezius, latissimus dorsi, levator scapulae & rhomboid muscles which move the upper limb. The intermediate layer is formed by the serratus posterior muscles. The muscles of both of these layers are considered extrinsic to the back. The intrinsic muscles of the back form the deepest three muscle layers of the back.

24

A.D.A.M.

Student Atlas of Anatomy

Muscles—Intrinsic Back

Plate 1.21

Ext. occipital protuberance Mastoid process

Transverse process of Cl Ligamentum nuchae

Splenius capitis m. Splenius cervicis m. Spinous process of C7 [vertebra prominens]

Spinous process of T4

Spinous process of T6

Posterior Views

Inf. nuchal line

Transverse process of Cl Spinous process of C2 Semispinalis m Multifidi mm.

Spinous process

Transverse process of T7

Rotatores mm. (multifidi mm. removed) Transverse process of T10

Spinous process of T12

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25

Plate 1.22

Muscles—Erector Spinae

Mastoid process

Longissimus capitis m.

Longissimus cervicis m.

Angle of rib

Longissimus thoracis m.

Longissimus m.

Spinalis thoracis m.

Spinalis m.

Spinous process of L2

26

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Student Atlas of Anatomy

Muscles—Suboccipital

Muscle

Inferior or Medial Attachment

Superior or Lateral Attachment

Innervation

Table 1.4

Action(s)

DEEP LAYER—SUBOCCIPITAL GROUP Rectusjapitis posterior

Spinous proces$ of C2

Lateral part of inf. nuchal

\

Rectus capitis posterior mjnor

_ , , Post, tubercle of Cl

. Medial part of mf. nuchal line

Obliquus capitis superior

_ . Transverse process of Cl

Sup. to inf. nuchal line

Obliquus capitis inferior

Spinous process of C2

Transverse process of Cl

. Dorsal primary ramus of Cl ‘ [suboccipital] n.

t

\ I I

Unilaterally, rotate head to same side; bilaterally, extend head at atlanto-occipital joint

Unilaterally, rotate Cl & head to same side around odontoid process; bilaterally, extend head at atlanto-axial joint

Dens of C2 Inf. nuchal line

Ext. occipital protuberance

Obliquus capitis superior m. Mastoid process

Atlanto-occipital joint

Transverse process of Cl Rectus capitis post, minor m. Rectus capitis post, major m.

Post, tubercle of C1 Obliquus capitis inferior m. Spinous process of C2

Posterior View

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TRUNK: BODY WALL AND SPINE

27

Plate 1.23

Vasculature—Arteries

Ascending cervical a. Vertebral a. common carotid a.

Inf. thyroid a. Costocervical trunk

Transverse cervical a. Thyrocervical trunk

Supreme (Highest) intercostal a.

R. subclavian a.

Dorsal scapular a.

L. subclavian a.

Suprascapular a.

Brachiocephalic trunk

Axillary a.

Arch of aorta 2nd post, intercostal a.

Thoracoacromial trunk Ascending aorta

Subscapular a.

2nd ant. intercostal a.

Thoracic aorta

Int. thoracic a.

Perforating br. of int. thoracic

7th post, intercostal a.

5th ant. intercostal a. Musculophrenic a. Sup. epigastric a. Celiac trunk Sup. mesenteric a. Renal a. 11th post, intercostal a.

R. ovarian a. 2nd lumbar a.

Subcostal a. Abdominal aorta

Inf. epigastric a.

Femoral a.

Right Lateral View

28

A.D.A.M.

Student Atlas of Anatomy

Vasculature—Arteries

R. common carotid a.

Plate 1.24

Ascending cervical a.

Thyrocervical trunk

Inf. thyroid a.

Costocervical trunk

Vertebral a.

Suprascapular a.

Transverse cervical a.

R. subclavian a.

L. subclavian a.

Dorsal scapular a. Brachiocephalic a. 2nd post, intercostal a. Thoracoacromial trunk

Arch of aorta Axillary a.

Axillary a.

Subscapular a.

Sternal angle

Ascending aorta Subscapular a. Thoracic aorta

7th post, intercostal a. 5th ant. intercostal a.

Perforating br. of int. thoracic a. 7th post, intercostal a. Int. thoracic a. Musculophrenic a.

Celiac trunk

Sup. epigastric a

Sup. mesenteric a.

Renal a. 2nd lumbar a.

L. testicular a. Subcostal a.

11th post, intercostal a. Abdominal aorta

Inf. mesenteric a. Iliolumbar a. Median sacral a.

Common iliac a.

Inf epigastric a.

Int. iliac a.

Ext. iliac a. Deep circumflex iliac a.

Femoral a.

Anterior View

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29

Plate 1.25

Vasculature—Veins

Vertebral v. Deep cervical v.

Int. jugular v. Ext. jugular v.

Suprascapular v.

Ant. jugular v.

Supreme (Highest) intercostal v.

R. subclavian v.

Cephalic v.

R. brachiocephalic v.

Arch of azygos v.

Axillary v. Thoracoacromial v.

R. sup. intercostal v.

Sup. vena cava Subscapular v.

Lateral thoracic v. Int. thoracic v.

Brachial v. Perforating br. of int. thoracic

4th ant. intercostal v.

Azygos v.

Post, intercostal v.

Hepatic v. Musculophrenic v.

Subcostal v.

Inf. vena cava Sup. epigastric v. L. renal v.

Ascending lumbar v.

R. renal v.

1 st lumbar v. 11th intercostal v.

Subcostal v.

Inf. epigastric v.

Inguinal lig. Pubic tubercle Great saphenous v. Femoral v.

Right Lateral View

30

A.D.A.M.

Student Atlas of Anatomy

Plate 1.26

Vasculature—Veins

Ext. jugular v.

Int. jugular v.

Ant. jugular v. Vertebral v. R. subclavian v.

Transverse cervical v. Suprascapular v.

R. brachiocephalic v.

Thoracoacromial Cephalic v. Axillary v. Highest intercostal v.

Lateral thoracic v.

Sup. vena cava |- Brachial v.

}'

A

Int. thoracic v.-A

Perforating br. of int. thoracic v. Int. thoracic v. 4th ant. intercostal v. Azygos v. Post, intercostal v.

Musculophrenic v. Ascending lumbar v. Ascending lumbar v. 1st lumbar v.

Sup. epigastric v.

11th intercostal v. Inf. vena cava

Subcostal v.

Common iliac v. Inf. epigastric v. Int. iliac v.

Ext. iliac v.

Deep circumflex iliac v.

Inf. epigastric v.

Femoral v. Great saphenous v.

Anterior View

Chapter 1

TRUNK: BODY WALL AND SPINE

3i

Plate 1.27

Azygos, Hemiazygos & Lumbar Veins

Vertebral v.

Vertebral v.

L. supreme intercostal v.

R. supreme (highest) intercostal v.

Inf. thyroid v. R. brachiocephalic v.

L. superior intercostal v. L. int. thoracic v.

R. int. thoracic v. L. brachiocephalic v. 3rd post, intercostal v. R. superior intercostal v. Thymic v. Sup. vena cava

Azygos v.

Accessory hemiazygos v.

7th post, intercostal v.

Hemiazygos v.

Lumbar azygos w.

L. inf. phrenic & suprarenal Subcostal v. Inf. vena cava L. renal v. R. renal v.

L. gonadal v.

R. gonadal v.

L. ascending lumbar v.

R. ascending lumbar v. Lumbar v. 4th lumbar v.

Middle sacral v. Iliolumbar v. L. common iliac v.

R. common iliac v.

Anterior View

32

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Student Atlas of Anatomy

Intercostal Vessels

Intervertebral v. Dorsal br. of post, intercostal v.

Erector spinae m.

Plate 1.28

Spinal br. of post, intercostal a. Dorsal br. of post. intercostal v. Trapezius m. Post, intercostal a.

Post, intercostal v.

Int. intercostal m. membrane Innermost intercostal m.

Serratus anterior m.

Ext. intercostal m.

Post, intercostal a.

Int. intercostal m. R. post, intercostal a.

Lateral cutaneous br. of post, intercostal v.

L. post, intercostal a. Lateral cutaneous br. of post, intercostal a.

Accessory hemiazygos v. fe.

Hemiazygos v. Aorta

Ext. intercostal m.

Azygos v.

Serratus anterior m.

Ant. intercostal v.

Int. thoracic vv.— venae comitantes Ant. intercostal a. Pectoralis major m.

Int. thoracic a.

Sternum Perforating br. of int. thoracic a.

Anterosuperior View

Intervertebral foramen Ant. longitudinal lig. Ant. external venous plexus

Transverse process of T8 Post, external venous plexus Basivertebral v. 6th intervertebral v. Intervertebral disc

Spinous process of T8

Post, internal venous plexus

Spinous process of T9

Ant. internal venous plexus

Median Section of 18-110 Viewed from Left Post, longitudinal lig.

ANTERIOR

POSTERIOR -►

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33

Plate 1.29

Spinal Cord Vasculature

Posterior View-

Anterior View Sup. cerebellar a. Post, cerebral a. Basilar a.

Ant. inferior cerebellar a.

Post, inferior cerebellar a.

R. vertebral a.

L. vertebral a.

R. vertebral a

CERVICAL

Transverse process of C6

Costocervical trunk

L. ascending cervical a. L. deep cervical a.

R. subclavian a. R. subclavian a. L. subclavian a. 2nd intercostal n. 2nd intercostal n.

Ganglion of 5th thoracic spinal n. Ant. spinal a.

L. posterior spinal a.

6th post, intercostal a. Pial plexus

THORACIC R. posterior spinal a.

Major ant. radicular a.

Pedicle of T10 vertebra

Spinal br. of 9th intercostal a.

T10

T10 Pial plexus

Til

Til

Post, radicular a. from spinal br. of subcostal a.

Ant. radicular a.

T12 Spinal br. of subcostal a.

Anastomotic loops between ant. & post, spinal aa.

Conus medullaris Internal filum terminale of pia mater

T12 Anastomotic loops between ant. & post, spinal aa.

LUMBAR 4th lumbar n.

Cauda equina

SACRAL Cauda equina

External filum terminale of dura mater

34

A.D.A.M.

COCCYGEAL

Student Atlas of Anatomy

External filum terminale of dura mater

Spinal Cord Vasculature

Plate 1.30

Thoracic (descending) aorta

Post, intercostal aa.

Superior View of T12

Ant. longitudinal lig. Post, longitudinal lig. Dura mater Ant. internal venous plexus Arachnoid mater

Pia mater Intervertebral v.

T11 spinal n

Spinal br. Ant. spinal a. & v. Dorsal br. of post, intercostal a. Transverse process

Post, internal venous plexus

Ant. & post, radicular aa.

R. post, spinal a.

White matter

Ligamentum flavum

Gray matter Spinous process

Post, spinal v.

White matter

Anterosuperior View of T9 Level

Ant. spinal a.

R. posterior spinal a.

Post, spinal v. L. posterior spinal a.

Gray matter

Posterolateral spinal v.

Ant. spinal v.

Post, radicular a. from spinal br. of subcostal a. Ant. radicular a. Ganglion of 8th spinal n.

Pia mater Pial plexus

Spinous process Subarachnoid space Post, internal venous plexus Arachnoid mater Spinal br. of 9th intercostal a. Subdural space Intervertebral v.

Dura mater

Dorsal br. of post, intercostal a.

Ant. internal venous plexus

Arterial br. to centrum & dura mater

Basivertebral v. Post, longitudinal lig.

Fat in epidural space

Ant. longitudinal lig.

9th post, intercostal a.

Chapter 1

TRUNK: BODY WALL AND SPINE

35

Plate 1.31

Dermatomes & Cutaneous Innervation

Transverse cervical n. (C2, C3)

DERMATOMES

Platysma m. Supraclavicular nn. (C3, C4)

. •••

Deep fascia covering deltoid m.

Sup. br. of lateral brachial cutaneous n. (C5, C6)

Lateral cutaneous brr. of T2-T11 ventral rami of spinal nn.

Ant. cutaneous brr. of Tl-Tl 1 ventral rami of spinal nn.

Lateral cutaneous br. of ventral ramus of subcostal n. (T12) Ant. cutaneous br. of ventral ramus of subcostal n. (T12)

Lateral cutaneous br. of iliohypogastric n. (LI)

Ant. cutaneous br. of iliohypogastric n. (LI) Lateral femoral cutaneous n. (L2, L3) Genital br. of genitofemoral n. (LI, L2)

Femoral br. of genitofemoral n. (LI, L2) Dorsal n. of penis (S2, S3)

Ant. cutaneous br. of femoral n. (L2, L3)

Anterior View

36

A.D.A.M.

Student Atlas of Anatomy

Dermatomes & Cutaneous Innervation

Plate 1.32

3rd occipital n

Dorsal rami of greater occipital n. (C2)

DERMATOMES

Lesser occipital n. (C2, C3)

Greater auricular n. (C2, C3)

Medial cutaneous brr. of dorsal rami of C4-C8 spinal nn.

Lateral supraclavicular n. (C3, C4) • •

. Sup. br. of lateral brachial cutaneous n. (C5, C6)

Med. brachial cutaneous n. (C8, Tl) Intercostobrachial n. (Tl, T2) Medial cutaneous brr. of dorsal rami of T1-T6 spinal nn.

Lateral cutaneous brr. of T4-T11 ventral rami of spinal nn.

Lateral cutaneous brr. of dorsal rami of T7-T12 spinal nn.

Lateral cutaneous br. of subcostal n. (T12)

T12. • «

L*f*.

...

Lateral cutaneous br. of iliohypogastric n. (LI)

.

Sup. cluneal nn. (dorsal rami of L1-L3)

51

Middle cluneal nn. (dorsal rami of S1-S3)

•••• 52

Lateral femoral cutaneous n. (L2, L3)

53

S5

Posterior View

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37

Plate 1.33

Nerves

Brachial plexus (C5-T1)

Long thoracic n. (C5-C7)

1st intercostal n.

Medial pectoral n. (C8, Tl) Lateral pectoral n. (C5-C7) Ant. cutaneous brr. of intercostal nn.

Lateral cutaneous br. of intercostal n. Intercostal n.

Genitofemoral n. (LI, L2)

Ant. cutaneous br. of 10th intercostal n. (T10) Lateral cutaneous br. of iliohypogastric n. (LI)

Umbilicus

Subcostal n. (T12) Sup. cluneal nn. (L1-L3) Iliohypogastric n. (LI) Lateral cutaneous br. of subcostal n. (T12)

Ilioinguinal n. (LI)

Inf. cluneal nn. (SI—S3)

Right Lateral View

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Student Atlas of Anatomy

Nerves

Brachial plexus (C5-T1)

Plate 1.34

1st intercostal n.

1st intercostal n. Lateral pectoral n. (C5-C7)

Lateral pectoral n. (C5-C7)

Medial pectoral n. (C8, Tl)

Lons thoracic n. (C5-C7)

Lateral cutaneous br. of intercostal n. Lateral cutaneous br. of intercostal n. Intercostal n.

Ant. cutaneous brr. of intercostal nn.

Genitofemoral n. (LI, L2) Subcostal n. (T12) Subcostal n. (T12) Ant. cutaneous br. of 10th intercostal n. (T10)

Genitofemoral n. (LI, L2)

Lateral cutaneous br. of iliohypogastric n. (LI)

Iliohypogastric n. (LI)

Lateral cutaneous br. of subcostal n. (T12)

Ilioinguinal n. (LI)

Anterior View

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39

Intercostal Nerves

Plate 1.35

Rhomboid major m

Erector spinae m.

Lateral muscular br. of dorsal ramus

Medial cutaneous br. of dorsal / ramus Dorsal ramus of spinal n.

Trapezius m.

Dorsal root ganglion

Scapula

Int. intercostal membrane covering ext. intercostal m.

Gray ramus communicans

6th intercostal n.

4th intercostal n.

TRANSVERSE SECTION OF T5 Ventral ramus of T4 spinal n.

White ramus communicans

Lateral cutaneous br. of ventral ramus of spinal n.

Gray ramus communicans

Greater splanchnic nn.

Sympathetic ganglia Innermost intercostal m Transversus thoracis m

SfS/TWBJSBK'*”

'»

Ext. intercostal m. Body of sternum

Int. intercostal m

Pectoralis major m. Ant. cutaneous br. of ventral ramus of intercostal n.

Anterosuperior

40

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Student Atlas of Anatomy

Spinal Cord & Membranes

Plate 1.36

Arachnoid mater

Pia mater T10

Spinous process

Til

Dura mater Dorsal root ganglion of subcostal n. (T12)

T12

Conus medullaris

Arachnoid mater Gray & white rami communicantes Dorsal primary ramus T , . Lumbar spinal n.

Subarachnoid space

Gray rami communicantes Epidural space

Internal filum terminale of pia mater

Cauda equina

Dorsal primary ramus

Termination of dura sac External filum terminale of dura mater

Coccyx

Posterior View

Median Section Viewed from Right

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Anterior Body Wall—Superficial

Plate 1.37

Ext. jugular v. Ant. jugular v. Sternocleidomastoid m.

Superficial cervical w.

Trapezius m.

Platysma m.

Acromion

Deep fascia

Clavicle Cephalic v.

Hiatus of deltopectoral triangle

Deltoid m.

Axillary tail of breast

Pectoralis major m.

Manubrium

Basilic v. Perforating brr. of int. thoracic a. & ant. cutaneous br. of intercostal n. Suspensory ligg Body of sternum Nipple Serratus anterior m. Ampulla of lactiferous duct Costal margin Rectus sheath—ant. layer

Thoracoepigastric v.

Ant. cutaneous br. of intercostal n. Linea alba

Ext. abdominal oblique m. Lateral cutaneous br. of intercostal n.

Umbilicus

Ant. superior iliac spine

Inguinal lig. Superficial circumflex iliac v. & a.

Intercrural fibers of ext. abdominal oblique m. aponeurosis

Superficial epigastric v. & a Femoral n. Superficial inguinal ring Suspensory lig. of penis Femoral v.

Falciform edge of saphenous hiatus

Spermatic cord Femoral a.

Lateral femoral cutaneous n.

External spermatic fascia Sartorius m.

Great saphenous v.

Deep fascia of penis

Anterior View

42

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Student Atlas of Anatomy

Anterior Body Wall—Intermediate

Trapezius m. (sectioned)

Plate 1.38

Ext. jugular v.

Manubrium

Clavicle

Subclavius m.

Subclavian a. & v.

Pectoralis minor m. Acromion Tendon of biceps brachii m.—long head

Coracoid process of scapula

Tendon of biceps brachii m.—short head

Lateral pectoral n. Medial pectoral n.

Deltoid m. sectioned

Manubrium

Lateral thoracic a.

Body of sternum

Axillary lymph nodes

Basilic v. Long thoracic n.

Ext. intercostal membranes

Serratus anterior m.

Serratus anterior m.

Ext. intercostal mm.

Ext. intercostal m.

Rectus abdominis m. Linea alba Rectus sheath—ant. layer

10th Intercostal v., a. & n.

Ext. abdominal oblique m. Int. abdominal oblique m.

Rectus sheath (cut edge) Iliac crest

Rectus abdominis m.

Ant. superior iliac spine

Transversus abdominis m. Tendinous intersection

Lateral femoral cutaneous n.

Lateral femoral cutaneous n.

Iliohypogastric n

Inguinal lig. Ilioinguinal n Femoral n. Femoral sheath containing femoral a. & femoral v.

Suspensory lig. of penis

Cremaster m. Femoral a.

Spermatic cord Pampiniform venous plexus

Sartorius m.

Dorsal a. & n., deep dorsal v. of penis

Anterior View

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43

Plate 1.39

Anterior Body Wall—Deep

Trachea Manubrium

Trapezius m. (sectioned) Subclavian a.

Acromion

Int. thoracic a. Int. thoracic v.

Sternal angle Deltoid m. (sectioned)

Ant. intercostal a.

Intercostal n.

Innermost intercostal m.

Innermost intercostal m. membrane Serratus anterior m. Lateral cutaneous br. of intercostal n. Latissimus dorsi m. Ant. cutaneous br. of intercostal n.

Transversus thoracis m. Int. intercostal mm.

Costal margin Sup. epigastric a. & v.

Xiphoid process Rectus sheath—post, layer

Ant. muscular br. of intercostal n Rectus abdominis m.

Ext. abdominal oblique m.

Ext. abdominal oblique m. Linea alba Subcostal a., v. & n.

Tendinous intersection Semilunar line

Int. abdominal oblique m. Transversus abdominis m.

Rectus sheath (cut edge)

Iliohypogastric n. Arcuate line Ilioinguinal n. Ant. superior iliac spine

Transversus abdominis m. aponeurosis

Inf. epigastric a. & v. Inguinal lig.

Transversalis fascia Femoral n.

Ext. spermatic fascia

Femoral sheath

Deep fascia of penis Femoral a.

Anterior View

44

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Student Atlas of Anatomy

Anterior Body Wall

Plate 1.40

Trachea Subclavian a.

Costal pleura Manubrium Int. intercostal m.

Int. thoracic v.

Ext. intercostal m.

Int. thoracic a. Ant. intercostal a.

Intercostal n. Pectoralis major m. Costal cartilage

Anterior View of Left Superior Portion of Thoracic Wall

Sup. epigastric a. & v. Costal margin

Ext. abdominal oblique m.

Rectus abdominis m.

Rectus sheath (cut edge) Ant. muscular br. of intercostal n.

Tendinous intersection

Tansversus abdominis m. Semilunar line

Ant. muscular br. of intercostal n.

L. rectus abdominis m. (reflected medially)

Rectus sheath—post, layer

Anterior View of Subcostal Portion of Abdominal Wall

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Plate 1.41

Anterior Body Wall—Mammary Gland

Paratracheal lymph nodes Platysma m. Inf. deep lymph nodes

Ant. cutaneous br. of intercostal n.

Subclavian v. Subclavian & apical lymph nodes

Cephalic v.

Pectoral fascia

Axillary lymph nodes

Mammary br. of int. thoracic v. & a.

Lat. lymph nodes

Pectoral lymph nodes Axillary tail of breast

Suspensory ligg. Nipple Lateral mammary v.

Glandular lobe Mammary br. of lateral thoracic a. Lymphatic vessel Lateral cutaneous br. of intercostal n.

Lateral thoracic a.

Lactiferous sinus

Anterior View

46

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Student Atlas of Anatomy

Mammary Gland

Plate 1.42

Pectoral fascia

Ant. cutaneous br. of intercostal n.

Retromammary space Mammary br. of lateral thoracic a.

Suspensory ligg.

Mammary br. of int. thoracic v. & a.

Lactiferous sinus

Lateral mammary v.

Nipple Pectoral fascia Lactiferous ducts

Mammary br. of lateral thoracic a.

Lateral cutaneous br. of intercostal n. Glandular lobe Thoracoepigastric v. ■

Right Lateral View of Median Sectioned Breast

Mammary br. of int. thoracic v. & a.

Pectoral fascia

Ant. cutaneous br. of intercostal n. Lateral mammary v.

Mammary brr. of lateral thoracic a.

Nipple Suspensory ligg.

Areola

Thoracoepigastric v. Lateral cutaneous br. of intercostal n.

Mammary br. of int. thoracic v. & a.

Anterior View of Right Breast

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Plate 1.43

Anterior Body Wall—Internal Surface

Subclavian v. & a.

1 st rib

Cupola Int. thoracic a. & v. Endothoracic fascia (superficial to pleura) Int. intercostal m. Ext. intercostal m. Ant. intercostal a. & v. Costal parietal pleura 3rd intercostal n. Mediastinal parietal pleura (cut edge)

Transversus thoracis m. Ext. intercostal m.

Diaphragmatic parietal pleura

Int. intercostal m.

Diaphragm

Innermost intercostal m.

Costodiaphragmatic recess Falciform lig. Costal cartilage Sup. epigastric a. & v. Round lig. of liver & paraumbilical v. Peritoneum Semilunar line (internal)

Umbilicus

Transversalis fascia

Ext. abdominal oblique m

Rectus sheath—post, layer

Int. abdominal oblique m Trans versus abdominis m.

Transversalis fascia (cut edge)

Medial umbilical fold

Arcuate line of rectus sheath Inf. epigastric a. & v.

Lateral umbilical fold

Deep circumflex iliac a. & v. Median umbilical fold Rectus sheath—post, layer

Iliacus m.

Testicular a. & v.

Urinary bladder (covered by peritoneum)

Site of deep inguinal ring Ext. iliac a. & v. Iliac fascia Rectovesical fold (cut edge)

Obturator a.

Ureter

Urinary bladder

Ductus deferens Seminal vesicle

Obturator internus m. & membrane

Prostate gland

Urogenital diaphragm

Pelvic diaphragm

Sectioned femur

Ischioanal fossa Central tendon of perineum

Posterior (Internal) View of Anterior Body Wall

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Anterior Body Wall—Internal Surlace

Plate 1.44

Body of T2 Subclavian v. & a. 1st rib Trachea & esophagus Arch of aorta

Sup. vena cava

Descending aorta — Azygos v. Int. intercostal m. Int. thoracic a. & v.

Ascending aorta Costal parietal pleura

Transversus thoracis m. 5th rib

Diaphragm

Posterior (Internal) View of Anterior Thoracic Wall

Peritoneum

Median umbilical fold

Lateral umbilical fold

Medial umbilical fold

Urinary bladder (covered by peritoneum)

Deep inguinal ring

Rectovesical fold (cut edge) Iliacus m.

Urinary bladder

Vermiform appendix Sigmoid colon Promontory of sacrum

Posterosuperior View of Anterior Abdominal Wall & Pelvic Contents

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49

Plate 1.45

Lateral Body Wall—Superficial

Coracoid process of scapula Acromion Cephalic v.

Infraspinatus m

Ext. intercostal membrane Pectoralis minor m.

Teres minor m. Median n.

Triceps brachii m. —long head

Axillary a. & v. Lateral cutaneous br. of intercostal n.

Teres major m.

Serratus anterior m.

Long thoracic n.

Thoracodorsal a. Ext. intercostal m. Ext. abdominal oblique m. Ext. abdominal oblique m. aponeurosis Serratus post, inferior m. Rectus sheath—ant. layer Thoracolumbar fascia—ant. layer Int. abdominal oblique m. Iliac crest

Gluteus maximus m.

Ant. superior iliac spine

Tensor fasciae latae m. Subclavian a. Iliotibial tract Ext. intercostal membrane Sartorius m.

Serratus post, superior m.

Right Lateral Views Ext. intercostal m. Lateral cutaneous br. of intercostal n.

Ext. intercostal m. Ext. abdominal oblique m.

Serratus post, inferior m.

Thoracolumbar fascia Int. adbominal oblique m. Iliac crest

Iliotibial tract

50

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Post, scalene m.

Lateral Body Wall—Deep

Plate 1.46

Splenius capitis m. Subclavian a.Intercostal a. & n.

Lateral cutaneous br. of intercostal n.

Rectus abdominis m.

Innermost intercostal m.

Innermost intercostal m. membrane

Transversus abdominis m. Thoracolumbar fascia Iliac crest

Splenius capitis m. -Subclavian a. Manubrium Sternal angle Right Lateral Views Body of sternum Lateral cutaneous br. of intercostal n.

Iliocostalis m.

Internal intercostal m.

Rectus abdominis m.

Longissimus m

Int. abdominal oblique m. Rectus sheath—ant. layer

r~“

Ant. superior iliac spine

Tensor fasciae latae m. Iliotibial tract

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5i

Plate 1.47

Inguinal Region—Superficial Fascia

Thoracoepigastric v.

Ant. superior iliac spine

Superficial fascia—membranous layer

Inguinal lig. Superficial circumflex iliac v.

Superficial epigastric a. Superficial epigastric v.

Lateral femoral cutaneous n.

Fundiform lig. of penis

Superficial inguinal lymph nodes

Superficial inguinal ring Ilioinguinal n. Falciform margin of saphenous hiatus Ext. pudendal a.

Cribriform fascia Superficial inguinal lymph nodes

Ext. pudendal v. Ant. femoral cutaneous nn.

Superficial dorsal v. of penis

Fascia lata Anterior scrotal a.

Great saphenous v.

Superficial epigastric v.

Inguinal lig. Superficial circumflex iliac v.

Superficial fascia— membranous layer

Superficial inguinal lymph nodes

Ext. pudendal a. Ilioinguinal n.

Ext. pudendal v.

Fascia lata

Great saphenous v.

Ant. femoral cutaneous nn.

Lateral femoral cutaneous n.

Anterior Views of Right Side

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Student Atlas of Anatomy

Inguinal Region—Superficial Inguinal Ring

Plate 1.48

Ext. abdominal oblique m. aponeurosis Iliac crest

Ant. superior iliac spine

Intercrural fibers of ext. abdominal oblique m. aponeurosis

Lateral femoral cutaneous n. Ant. cutaneous br. of iliohypogastric n.

Inguinal lig.

Superficial inguinal ring Femoral n.

Femoral sheath surrounding femoral a. & v.

Pubic tubercle

Great saphenous v.

Deep fascia of penis

Ext. spermatic fascia (from ext. abdominal oblique m. aponeurosis) Ilioinguinal n.

Ant. cutaneous br. 01 iliohypogastric n

Ext. abdominal oblique m. aponeurosis

Superficial inguinal rinj

Inguinal lig.

Ext. spermatic fascia (from ext. abdominal oblique m. aponeurosis)

Cribriform fascia

Pubic tubercle Great saphenous v.

Ilioinguinal n.

Deep fascia of penis ixt. pudendal a.

.nt. cutaneous br. of femoral n.

Dartos tunic (from membranous layer of superficial fascia)

Anterior Views of Left Side

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53

Plate 1.49

Inguinal Region—External Spermatic Fascia

Ant. superior iliac spine Ext. abdominal oblique m. aponeurosis Lateral femoral cutaneous n.

Inguinal lig. Conjoint tendon [falx inguinalis]

Ext. spermatic fascia covering cremaster

Pubic tubercle Dorsal n. & a. of penis Femoral sheath surrounding femoral a. & v. Ext. spermatic fascia

Ilioinguinal lig. Great saphenous v.

Int. abdominal oblique m. Ext. abdominal oblique m. aponeurosis (cut) Inguinal lig. Ilioinguinal lig.

Lateral femoral cutaneous n.

Ext. spermatic fascia

Femoral sheath surrounding femoral a. & v. Pubic tubercle Great saphenous v. Cremaster m. (from int. abdominal oblique m.) Ext. spermatic fascia (reflected)

Anterior Views of Right Side

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Student Atlas of Anatomy

Inguinal Region—Cremaster Muscle

Plate 1.50

Int. abdominal oblique m. Iliohypogastric n.

Rectus sheath—ant. layer

Ant. superior iliac spine

Int. abdominal oblique m. aponeurosis -

Inguinal lig.

Ilioinguinal n. Conjoint tendon [falx inguinalis]

Cremaster m. (from int. abdominal oblique m.)

Pubic tubercle

Genital br. of genitofemoral n.

Cremaster m.

Testis

Ext. abdominal oblique m. aponeurosis (cut edge)

Ant. superior iliac spine

Ilioinguinal n.

Rectus sheath—ant. layer

Iliohypogastric n. Int. abdominal oblique m. Inguinal lig.

Int. spermatic fascia Cremaster m. (reflected) Conjoint tendon [falx inguinalis]

Cremaster m. (from int. abdominal oblique m.) Ext. spermatic fascia (cut)

Anterior Views of Left Side

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55

Plate 1.51

Inguinal Region—Internal Spermatic Fascia

Iliac crest Rectus abdominis m. Iliohypogastric n. Transversus abdominis m. aponeurosis

Ilioinguinal n. Ant. superior iliac spine

Transversus abdominis m. Inguinal lig. Int. spermatic fascia Site of deep inguinal ring in transversalis fascia Conjoint tendon [falx inguinalis]

Pubic tubercle

Cremasteric a. & v.

Testis (covered by internal spermatic fascia)

Iliohypogastric n. Ant. superior iliac spine Int. abdominal oblique m. (reflected)

Ilioinguinal n. Transversus abdominis m.

Int. abdominal oblique m.

Site of deep inguinal ring in transversalis fascia

Ext. abdominal oblique m. aponeurosis (cut edge)

Inguinal lig. Conjoint tendon [falx inguinalis]

Int. spermatic fascia Cremaster m.

Pubic tubercle

Anterior Views

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Inguinal Region—Pampiniform Plexus

Plate 1.52

Iliac crest

Transversalis fascia Int. epigastric a. & v.

Ant. superior iliac spine

Inguinal lig.

Int. spermatic fascia (from transversalis fascia)

Site of deep inguinal ring in transversus abdominis m.

Pubic tubercle

Pampiniform plexus

Int. spermatic fascia (cut)

Testicular a.

Testis (covered by internal spermatic fascia)

Transversus abdominis m. aponeurosis Transversalis fascia Site of deep inguinal ring in transversus abdominis m.

Inguinal lig. Conjoint tendon [falx inguinalis] (cut) Pampiniform plexus Testicular a.

Pubic tubercle

Ductus deferens

Int. spermatic fascia

Cremaster m.

Anterior Views

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Plate 1.53

Superficial Back

3rd occipital n.

Semispinalis capitis m.

Dorsal ramus of greater occipital n. (C2)

Sternocleidomastoid m.

Lesser occipital n. (C2, C3) Splenius capitis m.

Greater auricular n. (C2, C3) Medial cutaneous brr. of dorsal rami of C4-C8 spinal nn.

Levator scapulae m. Acromion

Lateral supraclavicular n. (C3, C4) Deltoid m. Infraspinatus m. Teres minor m. Teres major m.

Triceps brachii m.—long head Triangle of auscultation

Medial cutaneous brr. of dorsal rami of T1-T6 spinal nn.

Trapezius m. Lateral cutaneous brr. of T4-T11 ventral rami of spinal nn.

Lateral cutaneous brr. of dorsal rami of T7-T12 spinal nn. Latissimus dorsi m. Lumbar triangle

Lateral cutaneous br. of subcostal n. (T12) Ext. abdominal oblique m. Lateral cutaneous br. of iliohypogastric n. (LI) Iliac crest Sup. cluneal nn. (dorsal rami of L1-L3)

Thoracolumbar fascia—post, layer

Middle cluneal nn. (dorsal rami of S1-S3)

Lateral femoral cutaneous n. (L2, L3)

Gluteus maximus m.

Iliotibial tract

Posterior View

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Superficial Back

Plate 1.54

—= Sternocleidomastoid m.

Splenius capitis m.

Trapezius m. Acromion

Deltoid m.

Teres major m.

Triceps brachii m. —long head Medial cutaneous brr. of dorsal rami of T1-T6 spinal nn.

Medial cutaneous brr. of dorsal rami of T1-T6 spinal nn.

Lateral cutaneous brr. of T4—T11 ventral rami of spinal nn.

Latissimus dorsi m.

Thoracolumbar fascia—post, layer

Ext. abdominal oblique m. Lumbar triangle Iliac crest Sup. cluneal nn. (dorsal rami of L1-L3)

Gluteus maximus m.

Posterior View

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Intermediate Back

Plate 1.55

Ligamentum nuchae Greater occipital n.

Sternocleidomastoid m.

Semispinalis capitis m. Accessory n. [CN XI] (to trapezius m.)

Splenius capitis m. Spinalis cervicis m. Serratus post, superior m.

Levator scapulae m.

Trapezius m. (sectioned)

Transverse cervical a. & v.

Acromion

Dorsal scapular a. & v.

Supraspinatus m. (sectioned) Supraspinatus m. Deltoid m. (sectioned)

Infraspinatus m.

Subscapularis m. Rhomboid minor m. Teres major m.

Teres major m.

Splenius cervicis m.

Circumflex scapular a. & v. Spinalis m. Rhomboid major m. Longissimus m.

Serratus anterior m.

Iliocostalis m.

Thoracodorsal n.

Ext. intercostal m.

Thoracodorsal a. & v.

Serratus post, inferior m.

Int. abdominal oblique m.

Iliac crest Erector spinae m.—common tendon

Post, superior iliac spine

Posterior View

6o

A.D.A.M.

Student Atlas of Anatomy

Deep Back

Plate 1.56

Mastoid process Suboccipital triangle Semispinalis capitis m. Lesser occipital n. (C2, C3) Spinalis cervicis m.

Longissimus m. Accessory n. [CN XI] (to trapezius m.)

Dorsal scapular n. (C5)

Levator scapulae m. Post, scalene m. Iliocostalis m.

Int. intercostal m. Subscapularis m.

Interspinous lig.

Semispinalis thoracis m.

Teres major m.

Int. intercostal m.

Longissimus m.

Int. intercostal membrane Ext. intercostal m.

Multifidus m. Levatores costarum mm.

Spinalis m. Rotatore m. Iliocostalis m. Thoracolumbar fascia—ant. layer Transversus abdominis m. Rotatores mm. Subcostal n. (T12) Intertransversarius m. Iliohypogastric n. (LI) Iliac crest

Erector spinae m.—common tendon Post, superior iliac spine

Posterior View

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Plate 1.57

Suboccipital Region

Ext. occipital protuberance Inf. nuchal line

Rectus capitis posterior minor m.

Occipital a.

Greater occipital n. (dorsal ramus of C2)

Sternocleidomastoid m.

Obliquus capitis superior m.

3rd occipital n. (dorsal ramus of C3) Suboccipital n. (dorsal ramus of Cl) Rectus capitis posterior major m. Lesser occipital n. (C2, C3) Transverse process of Cl Greater occipital n. Post, tubercle of Cl

Greater auricular n. (C2, C3)

Dorsal ramus of C2 n. Transverse cervical n. (C2, C3) Obliquus capitis inferior m. Intertransversarius m.

Semispinalis capitis m

Spinous process of C2 Spinalis cervicis m. Middle scalene m. Accessory n. [CN XI] (to trapezius m.) Dorsal scapular n. (C5) Trapezius m. (sectioned)

Post, scalene m.

Post, scalene m.

Levator scapulae m.

Posterior View

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Suboccipital Region

Plate 1.58

Sup. nuchal line Ext. occipital protuberance Occipital a.

Inf. nuchal line

Mastoid process

Rectus capitis posterior major m.

Obliquus capitis superior m. Rectus capitis posterior minor m. Suboccipital n. (dorsal ramus of Cl) Post, tubercle of Cl Obliquus capitis inferior m. Semispinalis capitis m. (reflected)

Spinous process of C2 Greater occipital n. (dorsal ramus of C2)

Semispinalis cervicis m. 3rd occipital n. (dorsal ramus of C3)

Posterior View of Cranial Base & Upper Cervical Region

Inf. nuchal line

Obliquus capitis superior m.

L. Rectus capitis posterior minor m.

Occipital a.

R. Rectus capitis posterior minor m.

Mastoid process

Rectus capitis posterior major m.

Transverse process of Cl

Greater occipital n. (dorsal ramus of C2)

Obliquus capitis inferior m. Occipital a.

Spinous process of C2

Hypoglossal n. [CN XII]

Multifidus m.

Vagus n. [CN X]

Semispinalis cervicis m.

Posterior View of Right Suboccipital Triangle

Chapter

1

TRUNK: BODY WALL AND SPINE

63

Thorax

Surface Anatomy Topography of Viscera Lungs, Trachea, & Bronchi Pericardium & Heart Mediastinum Paravertebral Structures Esophagus Superior Thoracic Aperture Diaphragm

65

Plate 2.1

66

Surface Anatomy

A.D.A.M. I Student Atlas of Anatomy

Surface Anatomy

Posterior View

Plate 2.2

Right Lateral View

Chapter 2

I THORAX

67

Plate 2.3

Topography of Viscera

Jugular notch Manubrium

Cupula of pleura over apex of L. lung

Sternal angle Body of sternum

Sup. lobe of L. lung

Sup. lobe of R. lung Horizontal fissure of R. lung

4th costal cartilage

R. nipple & areola Cardiac notch of L. lung R. dome of the diaphragm Oblique fissure of L. lung

Middle lobe of R. lung Oblique fissure of R. lung

Pericardium

Xiphoid process

Inf. margin of inf. lobe of L. lung

Inf. margin of inf. lobe of R. lung Costal cartilage Costodiaphragmatic pleural recess Costal margin Pleural reflection

Falciform lig. & round lig. of liver

Transpyloric plane 11th rib Subcostal plane

12th rib Gallbladder

Duodenum Liver

Anterior View

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Student Atlas of Anatomy

Stomach

Topography of Viscera

Plate 2.4

Spinous process of T1

Apex of L. lung

1st rib Apex of R. lung Oblique fissure of L. lung Sup. lobe of R. lung

Sup. lobe of L. lung I lorizontal fissure of R. lung Inf. lobe of L. lung

Middle lobe of R. lung

Oblique fissure of R. lung L. triangular lig. Inf. lobe of R. lung Inf. margin of L. lung

Inf. margin of inf. lobe of R. lung

Costodiaphragmatic recess of pleural cavity

Peritoneal reflection superimposed over bare area of liver

Spleen

Pleural reflection

R. triangular lig. of liver

Liver

L. kidney

R. kidney L. ureter

R. ureter

L. suprarenal gland

R. suprarenal gland

Posterior View

Chapter 2 I

THORAX

69

Plate 2.5

Topography of Viscera

Spinous process of C7 [vertebra prominens]

Cupula of pleura over apex of lung

Sup. lobe of R. lung

Sternal angle

Horizontal fissure of R. lung

R. dome of diaphragm

Middle lobe of R. lung Inf. lobe of R. lung

Oblique fissure of R. lung Inf. margin of R. lung

R. costodiaphragmatic recess of pleural cavity

Pleural reflection

Gallbladder R. kidney

Iliac crest

Right Lateral View

70

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Student Atlas of Anatomy

Topography of Viscera

Plate 2.6

SITES OF AUSCULTATION OF VALVES

Aortic Pulmonic Tricuspid

Mitral

i LOCATION OF VALVES

Pulmonic Aortic Tricuspid

Mitral

Anterior View

Chapter 2 I

THORAX

7i

Plate 2.7

Thoracic Viscera In Situ

Thyroid gland

Trachea

Inf. thyroid v. R. internal jugular v.

L. internal jugular v.

Ant. scalene m.

L. common carotid a.

Phrenic n.

Ext. jugular v.

Thymus gland

L. brachiocephalic v.

R. brachiocephalic v. (cut end)

Subclavian v. & a.

Coracoid process Axillary v. & a. Lateral pectoral n.

Sternal angle

Medial pectoral n. Int. thoracic v. &

Sup. lobe of L. lung Sup. lobe of R. lung Transversus thoracis m. Manubrium Cardiac notch of L. lung Horizontal fissure of R. lung Inf. lobe of L. lung

Middle lobe of R. lung

Oblique fissure of L. lung

Inf. lobe of R. lung

Xiphoid process Costodiaphragmatic recess

Costodiaphragmatic recess

Linea alba Sup. epigastric a. & v.

Diaphragm

Rectus sheath—post, layer Transversus abdominis m.

Anterior View

72

A.D.A.M. I Student Atlas of Anatomy

Thoracic Viscera In Situ

Thyroid gland

Plate 2.8

L. common carotid a.

Vagus n.

L. internal jugular v. L. brachiocephalic v.

Phrenic n. Ant. scalene m.

Clavicle

Deltoid m.

Thymus gland

Axillary v. & a. Manubrium

Sup. lobe of R. lung Sternal angle

Sup. lobe of L. lung

Cardiac notch of L. lung Oblique fissure of R. lung Inf. lobe of L. lung Oblique fissure of L. lung

Xiphoid process

Diaphragm

Linea alba

Diaphragm

Rectus abdominis m. (cut edge)

Rectus sheath—post, layer

Anterior View

Chapter 2 I

THORAX

73

Plate 2.9

Lungs—Medial

Apex of R. lung

Superior lobe

Area for trachea Esophageal area

Groove for R. brachiocephalic v.

Groove for arch of azygos v. Brr. of R. pulmonary a. Oblique fissure Groove for sup. vena cava

R. superior lobe (eparterial) bronchus

Pulmonary lymph nodes Horizontal fissure

R. middle & inf. lobe bronchi R. sup. & inf. pulmonary vv.

Cardiac impression Groove for esophagus Middle lobe

Vertebral surface of R. lung

Pulmonary lig.

Inferior lobe

Oblique fissure

Diaphragmatic surface

Medial View of Right Lung

Apex of L. lung Groove for L. subclavian a.

Area for trachea & esophagus

Groove for L. brachiocephalic v.

Groove for arch of aorta

Groove for 1st rib

Oblique fissure Pleura (cut edge)

Area for thymus & mediastinal fatty tissue

Vertebral surface of L. lung Hilum of lung L. pulmonary a. Mediastinal surface

L. main bronchus

Superior lobe

Pulmonary lymph nodes

Cardiac impression

L. sup. & inf. pulmonary vv. Inferior lobe

Oblique fissure Groove for descending aorta Diaphragmatic surface Pulmonary lig. Lingula

Groove for esophagus

Medial View of Left Lung

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Student Atlas of Anatomy

Lungs—Medial

Plate 2.10

Apex of R. lung Area for trachea Esophageal area

Groove for arch of azygos v. Groove for sup. vena cava

Oblique fissure R. superior lobe (eparterial) bronchus

Superior lobe Brr. of R. pulmonary a.

R. sup. & inf. pulmonary vv. Hilum of lung

Inferior lobe Ant. margin

Costal surface Cardiac impression

Vertebral surface of R. lung

Middle lobe

Oblique fissure Diaphragmatic surface of inf. lobe Inf. margin

Posteromedial View of Right Lung

Apex of L. lung Groove for arch of aorta Groove for L. subclavian a.

Groove for 1 st rib

Oblique fissure Superior lobe L. pulmonary a.

L. main bronchus

Area for thymus & mediastinal fatty tissue

Inferior lobe L. sup. & inf. pulmonary vv.

Ant. margin Vertebral surface of L. lung

Cardiac impression Groove for descending aorta Oblique fissure Pulmonary lig. Lingula

Diaphragmatic surface

Medial View of Left Lung

Chapter 2 I THORAX

75

Plate 2.11

Trachea, Bronchi & Lungs

SUPERIOR LOBE SEGMENTS

left —►

— RIGHT

Apical (R.S1) R.S1 Posterior (R.S2) Anterior (R.S3) R.S2 MIDDLE LOBE SEGMENT Medial (R.S5)

L.S4 R.S4

INFERIOR LOBE SEGMENTS

L.S5

LINGULAR DIVISION

R.S5

Superior (R.S6) L.S7-8 Medial basal (R.S7) Ant. basal (R.S5)

R.S7

R.S8

Lateral basal (R.S9)

;io

L.S10

L.S9

Post, basal (R.S10) R.S9

Medial View of Right Lung

Anterior View

-RIGHT

R.S2

LEFT

Annular ligg.

Tracheal cartilages

Trachea

R.S6 Sup. lobe (eparterial) bronchus

S5

Sup. lobe bronchus

To superior lobe

R.S10

Lmsular lobe bronchus

To inf. lobe bronchus

To middle lobe

To lingula

B4

Lateral View of Right Lung

To inferior lobe

To inferior lobe

Anterior View of Trachea & Bronchial Tree

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To superior lobe

Trachea, Bronchi & Lungs

Plate 2.12

SUPERIOR LOBE SEGMENTS

Apicoposterior (L.S1’2) Anterior (L.S3) Superior (L.S4)

LINGULAR _ DIVISION Inferior (L.S3)

INFERIOR LOBE SEGMENTS

Superior (L.S6)

Post, basal (L.S10)

Lateral basal (L.S9)

Anteromedial basal (L.S7-8)

Medial View of Left Lung

Posterior View

L.S1-2

L.S3

■ \ ^

Obturator foramen

Pubic tubercle

◄ Superior View Pubic crest

Sup. pubic ramus

Chapter 4

PELVIS AND PERINEUM

i55

Plate 4.7

Pelvic Muscles—Superficial Perineal

Clitoris

Symphysis of pubis

Ext. urethral meatus Ischiocavernosus m. Vaginal opening Bulbospongiosus m Inf. pubic ramus

Inf. fascia of urogenital diaphragm (perineal membrane) Ischial tuberosity

Superficial transverse perineal m. Vestible of vagina

Central tendon of perineum (perineal body) Ext. anal sphincter m.

Anus Anococcygeal lig.

Sacrum

Coccyx

Female—Inferior View

Corpora cavernosa Corpus spongiosum Deep fascia of penis (Buck’s)

Bulbospongiosus m. Inf. pubic ramus

Ischiocavernosus m. Superficial transverse perineal m.

Inf. fascia of urogenital diaphragm (perineal membrane) Ischial tuberosity

Central tendon of perineum (perineal body)

Ext. anal sphincter m.

Anus

Coccyx

Male—Inferior View

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Student Atlas of Anatomy

Pelvic Muscles—Urogenital Diaphragm

Plate 4.8

Symphysis of pubis

Arcuate pubic lig.

Opening for deep dorsal v. & dorsal aa. of clitoris

Transverse perineal lig. urethrae m.

_Urogenital diaphragm

Urethra

Deep transverse perineal m.

Vagina

Ischial spine Ischial tuberosity

Coccyx

Female—Inferior View

Symphysis of pubis Opening for deep dorsal v. & dorsal aa. of penis Arcuate pubic lig. Urethra

Transverse perineal lig.

Sphincter urethrae m.

Inf. pubic ramus

Deep transverse perineal m.

Bulbourethral glands (of Cowper)

Coccyx

Urogenital diaphragm

Ischial tuberosity

Male—Inferior View

Chapter 4

PELVIS AND PERINEUM

i57

Plate

4.9

Pelvic Muscles—Pelvic Diaphragm

Symphysis of pubis Arcuate pubic lig. Urethra Puborectahs m.

Vagina

Pubococcygeus m.

Ischial tuberosity

Levator ani m. Pelvic diaphragm

Ihococcygeus m.

Coccygeus m.

Ischial spine

Central tendon of perineum (perineal body)

Anal canal

Anococcygeal lig.

Sacrum

Coccyx

Female—Inferior View

Symphysis of pubis

Arcuate pubic lig.

Urethra Puborectalis m.

Pubococcygeus m.

Inf. pubic ramus

Levator ani m.

Ihococcygeus m.

Pelvic diaphrag Ischial tuberosity

Coccygeus m. Ischial spine

Central tendon of perineum (perineal body)

Anal canal

Anococcygeal lig.

Male—Inferior View

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Student Atlas of Anatomy

Coccyx

Pelvic Muscles—Pelvic Diaphragm

Muscle

Superior or Lateral Attachment

Inferior or Medial Attachment

Ischiocavernosus

Int. surface of ischial ramus & tuberosity laterally

Sides & ventrum of crus of penis ^ in (3 or clitoris medially in $

Bulbospongiosus

Dorsum of clitoris in 2; inf. fascia of urogenital diaphragm, sides & dorsum of penile bulb in pudendal n. (S2^4)

Perineal body medially

Compresses urethra in 8 & $ & vagina in 9

Supports pelvic viscera

Sup. fascia of pelvic diaphragm Tendinous arch of levator ani m. Coccygeus m.

Vagina

Rectum

Obturator foramen

Transverse perineal lig.

Coccyx

Iliococcygeus m. Pubococcygeus m. Puborectalis m.

Urethra

Ext. anal sphincter mm.

Arcuate pubic lig

Urogenital diaphragm

Levator ani m.

Sphincter urethrae m. Superficial transverse perineal m. Deep transverse perineal m Inf. fascia of urogenital diaphragm (perineal membrane)

Female Perineum & Muscles—Left Lateral View

Chapter 4

PELVIS AND PERINEUM

i59

Male Coronal Section—Anterior View

Plate 4.10 Pelvic Muscles—Male

Pelvic Muscles—Female

Plate 4.11

Plate 4.12

Femoropelvic Muscles

Post. sup. iliac spine Post. inf. iliac spine Sacrum Piriformis m.

Greater sciatic foramen

Sacrospinous lig. Sacrotuberous lig. (cut) Greater trochanter of femur

Obturator internus m.

Sacrotuberous lig. (cut off)

Ischial tuberosity

Right Gluteal Region—Posterior View

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Student Atlas of Anatomy

Femoropelvic & Anal Sphincter Muscles

Table 4.2

Muscles of the Pelvic Diaphragm

Muscle

Superior or Lateral Attachment

Inferior or Medial Attachment

Puborectalis

Body of pubis anteriorly

Fibers of opposite side post. ' to rectum

Pubococcygeus

Body of pubis and obturator fascia anteriorly

Coccyx & anococcygeal lig. posteriorly

Iliococcygeus

Ischial spine & tendinous arch of pelvic fascia laterally

Coccyx & anococcygeal lig. posteriorly

Ischial spine & sacrospinous lig. laterally

Coccyx & S5 vertebra medially

Brr. of S3-5 spinal nn.

Inferior or Lateral Attachment

Innervation

Action(s)

N. to obturator internus (L5-S2)

Rotates thigh laterally

Ventral rami of SI & S2

Rotates thigh laterally

Coccygeus

Innervation

Action(s) Maintains anorectal flexure by drawing anal canal anteriorly

i Inf. rectal n. (S2, 3) & perineal brr. of S3, 4 spinal n.

Supports pelvic viscera

Supports pelvic viscera

,

Supports pelvic viscera

Muscles of the Pelvic Walls

Muscle

Superior or Medial Attachment

Obturator internus

Pelvic surfaces of ilium & ischium; obturator membrane

Piriformis

Pelvic surface of 2nd^lth sacral segments; sup. margin of greater sciatic notch, & sacrotuberous lig.

'

> Greater trochanter of femur

Median View—Right Side of Medial Section

Levator ani m.

Middle rectal fold Rectal fold (from left side) Rectal fascia

Anal columns

Sup. fascia of pelvic diaphragm

Anococcygeal lig. Deep part Superficial part

Puborectalis m.

Ext. anal sphincter m.

Subcutaneous part Int. rectal venous plexus Ext. anal sphincter m.—superficial part Int. anal sphincter in. Intersphincteric space Anal sinus

Pectinate line Anus

Anal canal Skin Ext. rectal venous plexus

Chapter 4

Intermuscular groove (white line of Hilton)

PELVIS AND PERINEUM

163

Plate 4.13

Arteries of the Pelvis—Male

Inf. mesenteric a. Abdominal aorta Lumbar or ureteric a.

L. common iliac a. R. common iliac a L. ext. iliac a. Sup. rectal a. L. int. iliac a. R. ureter L. sup. gluteal a. R. sup. gluteal a.

R. testicular a. R. deep iliac circumflex v. & a.

R. inf. gluteal a. L. obturator a.

R. ext. iliac a. L. ureter (cut) R. int. iliac a.

Sup. rectal a.

R. obturator a. L. inf. gluteal a.

Inf epigastric a. & v. Median umbilical lig.

L. umbilical a.

R. umbilical a. R. sup. vesical a.

L. middle rectal a.

L. medial umbilical lig. A. to ductus deferens

A. to ductus deferens L. ductus deferens

L. inf pudendal a. Dorsal a. of penis L. inf vesical a. A. to ductus deferens L. inf. rectal a. L. testicular a. & v. cut

Levator ani m.

L. testis

L. perineal a.

L. post, scrotal a. & v.

L. sup. vesical a.

Medial View with Peritoneum Removed

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Student Atlas of Anatomy

Arteries of the Pelvis—Female

Inf. mesenteric a.

Abdominal aorta

L. common iliac a.

Plate 4.14

_ . ^ ... R. int. iliac a.

R. common iliac a.

L. ext. iliac a.

L. int. iliac a. Sup. rectal a. L. ovary R. sup. gluteal a.

R. deep iliac circumflex v. & a.

R. inf. gluteal a. L. sup. gluteal a.

R. ovarian a.

L. obturator a. Sup. rectal a. L. umbilical a.

R. ureter L. uterine a. R. ext. iliac a. Inf. epigastric a. & v.

L. inf. gluteal a.

Median umbilical lig. L. ureter (cut) Uterus L. middle rectal a. L. medial umbilical lig. L. vaginal aa. L. sup. vesical a. L. int. pudendal a.

L. middle rectal a.

L. dorsal a. of clitoris L. inf rectal a.

L. perineal a. Visceral fascia

L. post, labial a.

Medial View with Peritoneum Removed

Chapter 4

PELVIS AND PERINEUM

165

Plate 4.15

Veins of the Pelvis—Male

Inf. vena cava

Inf. mesenteric v.

Sup. rectal v. R. testicular v. L. ext. iliac v.

L. int. iliac v. R. int. iliac v. L. sup. gluteal v. R. deep iliac circumflex v.

R. inf. gluteal v.

R. ext. iliac v. Obturator v.

Sup. rectal v. Inf. gluteal v. Inf. epigastric v. Inf. vesical v. L. ureter (cut)

Sup. vesical v.

Ductus deferens Middle rectal v. Vesical venous plexus Int. pudendal v.

Deep dorsal v. of penis

Visceral fascia Prostatic venous plexus

Pampiniform venous plexus

Inf. rectal v. Int. pudendal v.

Post, scrotal vv.

Medial View with Peritoneum Removed

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Student Atlas of Anatomy

Veins of the Pelvis—Female

Inf. mesenteric v.

Inf vena cava

Plate 4.16

Sup. rectal v.

L. ext. iliac v. R. ovarian v L. sup. gluteal v. L. int. iliac v.

R. int. iliac v.

L. ovary Obturator v. R. ext. iliac v. Sup. vesical v. R. deep iliac circumflex v.

Sup. rectal v. Inf gluteal v.

R. & L. uterine tubes L. uterine v. Inf. epigastric v.

Middle rectal v.

Int. pudendal v.

Uterine v. Uterovaginal venous plexus

Rectal venous plexus Vesical venous plexus L. ureter (cut) L. vagina vv. Deep dorsal v. of clitoris Inf. rectal v.

Visceral fascia

Post, labial v.

Int. pudendal v.

Medial View with Peritoneum Removed

Chapter 4

PELVIS AND PERINEUM

167

Plate 4.17

Dermatomes & Cutaneous Nerves—Male

Lat. cutaneous br. of subcostal n. Lat. cutaneous br. of iliohypogastric n.

Ant. cutaneous br. of subcostal n.

Ant. cutaneous br. of iliohypogastric n.

Lat. femoral cutaneous n.

Femoral br. of genitofemoral n. Ilioinguinal n.

Dorsal n. of penis

Ant. scrotal n.

Cutaneous br. of obturator n.

Anterior View

Genital br. of genitofemoral n.

Post, scrotal nn.

Medial br. of ant. femoral cutaneous n. Cutaneous br. of obturator n. -

Perineal br. of post, femoral cutaneous n.

Post, femoral cutaneous n.

Inf. rectal nn.

Inf. cluneal nn

Medial cluneal n.

Anococcygeal nn

Col

Lithotomy View

168

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Student Atlas of Anatomy

Dermatomes & Cutaneous Nerves—Female

Plate 4.18

Lat. cutaneous br. of subcostal n.

Lat. cutaneous br. of iliohypogastric n.

Ant. cutaneous br. of subcostal n.

Ant. cutaneous br. of iliohypogastric n.

Femoral br. of genitofemoral n.

Genital br. of genitofemoral n. Ilioinguinal n.

Ant. labial n. Lat. femoral cutaneous n.

Cutaneous br. of obturator n.

Anterior View

Medial br. of ant. femoral cutaneous n. Cutaneous br. of obturator n.

Ant. labial n.

Post, labial nn.

Post, femoral cutaneous n.

Inf. rectal nn. Perineal br. of post, femoral cutaneous n. Inf. cluneal nn.

Medial cluneal nn. Anococcygeal nn.

Col

Lithotomy View

Chapter 4

PELVIS AND PERINEUM

169

Plate 4.19

Pelvic Nerves—Male

Inf. mesenteric a.

Abdominal aorta

Abdominal aortic n. plexus

L. common iliac a. R. common iliac a

R. ureter R. int. iliac a. R. ureteric n. plexus Sacral plexus Sup. hypogastric plexus

Sympathetic trunk

N.

Hypogastric nn. Pelvic splanchnic nn. R. ext. iliac a. Inf. hypogastric plexus

R. testicular n. plexus

Sacral splanchnic nn.

Median umbilical lig.

Rectal plexus

L. ductus deferens n. plexus Vesical plexus

Pudendal n.

Suspensory lig. of

Pelvic autonomic n. plexus

Prostatic plexus

Perineal n. Inf. rectal n.

Dorsal n. of penis

Urogenital diaphragm Post, scrotal nn.

L. testis

Cavernous nn. of penis

Medial View with Peritoneum Removed

170

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Pelvic Nerves—Female

Plate 4.20

Inf. mesenteric a.

Sup. hypogastric plexus

L. common iliac a.

R. int. iliac a. Hypogastric nn.

L. ovary

R. ureteric n. plexus

Inf hypogastric plexus R. Pelvic splanchnic nn. R. ovarian plexus R. ext. iliac a. Uterovaginal autonomic n. plexus Uterus

Median umbilical lig.

Inf. hypogastric plexus

Vesical plexus Pelvic splanchnic nn. Rectal plexus Uterovaginal autonomic n. plexus Pudendal n.

Visceral fascia

Perineal n. Dorsal n. of clitoris

Urogenital diaphragm Pelvic autonomic n. plexus Post, labial n.

Inf. rectal n.

Medial View Peritoneum Removed

Chapter 4

PELVIS AND PERINEUM

171

Plate 4.21

Pelvic Autonomic Nerves—Male

LARGE INTESTINE (L. colic or splenic flexure)

RECTUM

Distal third of transverse colon

Inf. hypogastric (pelvic) plexus

DESCENDING COLON

SIGMOID COLON

Urinary bladder

Parasympathetic Innervation

Vesical plexus nn. to helicine aa. of penile erectile bodies PENIS

Pelvic splanchnic nn.

Inf. hypogastric (pelvic) plexus

ANAL CANAL

Greater splanchnic n. (T6-T9) Abdominal aorta

Rectal plexus

T10 Celiac ganglia Til

Preganglionic Parasympathetic Fibers Postganglionic Parasympathetic Fibers Preganglionic Sympathetic Fibers Postganglionic Sympathetic Fibers

Celiac trunk

T12

Sup. mesenteric ganglion

Lesser splanchnic n. (T10.T12)

Aorticorenal ganglia Sup. mesenteric a.

Least splanchnic n. (T12) Lumbar splanchnic nn.

Inf. mesenteric ganglion URETER Common iliac aa.

Sympathetic chain

Sup. hypogastric plexus Int. iliac a. Ext. iliac a. Hypogastric nn.

URINARY BLADDER

Sacral splanchnic n. to inf. hypogastric (pelvic) plexus PENIS Sympathetic Innervation

PROSTATE

ANAL CANAL TESTIS

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Student Atlas of Anatomy

Pelvic Autonomic Nerves—Female

Plate 4.22

Preganglionic Parasympathetic Fibers Postganglionic Parasympathetic Fibers

LARGE INTESTINE

Preganglionic Sympathetic Fibers Postganglionic Sympathetic Fibers

Parasympathetic Innervation

Distal third of transverse colon

URETER

DESCENDING COLON

52

SIGMOID COLON

53 Inf. hypogastric (pelvic) plexus

54

OVARY

Pelvic splanchnic nn.

UTERINE TUBE UTERUS

Inf. hypogastric (pelvic) plexus

URINARY BLADDER Uterovaginal plexus Vesical brr.

RECTUM

VAGINA

Rectal brr.

Greater splanchnic n. (T6T9)

CLITORIS

Abdominal aorta

Lesser splanchnic n. (T10.T11)

Celiac ganglia Celiac trunk

Least splanchnic n.

(T12)

Sup. mesenteric ganglion Sup. mesenteric a.

Lumbar splanchnic nn. Aorticorenal ganglion

Inf. mesenteric ganglion

URETER

Sympathetic chain

Common iliac aa. Sup. hypogastric

Ext. iliac a. Ovarian a. and plexus

OVARY

Hypogastric nn.

UTERUS

Sacral splanchnic nn. to inf. hypogastric (pelvic) plexus

URINARY BLADDER RECTUM VAGINA

CLITORIS

Sympathetic Innervation ANAL CANAL

Chapter 4

PELVIS AND PERINEUM

i73

Plate 4.23

Superficial Lymphatics Linea alba

Ext. abdominal oblique m. aponeurosis

Lateral femoral cutaneous n. Ant. cutaneous br. of iliohypogastric Inguinal lig.

Superficial inguinal lymph nodes—proximal group

Fundiform lig. of penis Ilioinguinal n.

Superficial inguinal ring Femoral v. Spermatic cord

Superficial inguinal lymph nodes—distal group

Femoral a.

Great saphenous v.

Body of penis

Fascia lata

Gians penis

Ext. spermatic fascia

Male Anterior View

Highest deep inguinal node Accessory saphenous v. Superficial inguinal lymph nodes—horizontal group Fascia lata Labium majus (cut edge) Femoral a.

Superficial inguinal lymph nodes—vertical group

Femoral v.

Labium minus

Great saphenous v.

External urethral meatus Deep inguinal lymph node Vestibule of vagina Superficial perineal fascia— membranous layer (Colles’)

Vaginal opening

Vestibule of vagina Perineal raphe Post, labial commissure

Female Lithotomy View

174

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Student Atlas of Anatomy

Deep Lymphatics

Plate 4.24

Abdominal aorta

Preaortic lymph nodes

Lateral aortic lymph nodes L. common iliac a.

R. common iliac lymph nodes R. int. iliac a.—post, division

Medial View with Peritoneum Removed

Sacral lymph nodes R. int. iliac a.

R. ext. iliac a. R. int. iliac lymph nodes R. ext. iliac lymph nodes R. int. iliac a.—ant. division

L. ductus deferens

R. inf. gluteal a.

Urinary bladder Presymphyseal nodes

Rectum

Bulbospongiosus m. R. int. pudendal a.

Pararectal lymph nodes L. testicular a. & pampiniform v. plexus

Epididymis Levator ani m. L. testis

Right Half of Pelvis—Anterior View

Perirenal fat

Inf. vena cava R. ureter

Genitofemoral n. R. common iliac lymph nodes Psoas major m.

Middle sacral v. Promontory lymph nodes (middle sacral)

R. ext. iliac lymph nodes

R. int. iliac a.—post, division

Lateral femoral cutaneous n.

R. int. iliac a.—ant. division R. femoral n. Obturator a. Deep circumflex iliac v. & a. Pelvic splanchnic nn. R. ext. iliac lymph nodes Rectum Inguinal lig.

Accessory obturator a.

Inf. epigastric a. Urinary bladder Deep inguinal lymph nodes

R. femoral a. R. femoral v.

Chapter 4

PELVIS AND PERINEUM

r75

Plate 4.25

9

Urogenital Tract—Female

Characteristic Female Structures

L. ureter R. ureter

Sacrum

L. ovary 9 L. uterine tube 9

9 Uterus

L. round lig. of uterus 9

Median umbilical lig. (urachus) 9R. round lig. of uterus—in R. inguinal canal

Urinary bladder Symphysis of pubis Urethra Labium majus 9

Anterior View

R. ureter

9 L. uterine tube L. ovary 9

Median umbilical lig. (urachus)

Uterus 9

9 L. round lig. of uterus (cut)

L. ureter :

| 9 R. round lig. of uterus—in inguinal canal Vagina Symphysis of pubis

Urinary bladder

Urethra

Urogenital diaphragm

9 Labium majus

Medial View

176

A.D.A.M.

Student Atlas of Anatomy

Urogenital Tract—Male

Chapter 4

Plate 4.26

PELVIS AND PERINEUM

177

4.27

Pelvic Contents—Female

Transverse Section at L4—Superior View

Plate

178

A.D.A.M

Student Atlas of Anatomy

Plate

4.28

Pelvic Cavity—Superior View

Pelvic Contents—Female

Chapter 4

PELVIS AND PERINEUM

i79

Plate 4.29

Pelvic Contents—Female

Body of uterus

Sigmoid mesocolon

Sacrum Omental [epiploic] appendages

Rectum L. ovary Sup. transverse rectal fold L. uterine tube

Post, fornix of vagina

Sigmoid colon

Fundus of uterus Rectouterine pouch(of Douglas)

Vesicouterine pouch

Median umbilical lig. Middle transverse rectal fold

Urinary bladder

Coccyx

Symphysis of pubis Cervix of uterus Retropubic space (of retzius) Inf. transverse rectal fold

Clitoris

Ant. fornix of vagina

Urogenital diaphragm

Anal canal Urethra Anus Vaginal opening Central tendon of perineum (perineal body)

Vagina

Vestibule of vagina

Median Section—Right Lateral View

180

A.D.A.M.

Student Atlas of Anatomy

Pelvic Contents—Female

Sacrum

Rectum

R. int. iliac a.

Sigmoid colon

Sigmoid mesocolon

Plate

4.30

Omental [epiploic] appendages L. uterine tube

L. ovary

touterine pouch (of Douglas) < Body of uterus

Coccyx* Fundus of uterus

Post, fornix of vagina =

Median umbilical lig.

Vesicouterine pouch Middle transverse rectal foldUrinary bladder

Retropubic space (of retzius)

Cervix of uterus *

Ant. fornix of vagina«

Symphysis of pubis

Clitoris Anal canal Anus

Central tendon of perineum (perineal body)

Vagina

Vestibule of vagina

' Vaginal opening

Urethra

Median Section—Right Lateral View of Left Pelvis

Chapter 4

PELVIS AND PERINEUM

181

Plate 4.31

Pelvic Contents—Female

L. ureter L. ovarian a. & v.

Int. iliac lymph nodes Inf. hypogastric plexus

Infundibulum of uterine tube

2nd sacral n. L. ext. iliac a. & v.

Sympathetic trunk

Ext. iliac lymph nodes 3rd sacral n.

Round lig. of uterus

Body of uterus

L. ovary

Coccyx

Coccygeus m.

Median umbilical lig.

Fundus of uterus

Cervix

Pelvic diaphragm

Symphysis of pubis Ext. anal sphincter m.

Urinary bladder

Anal canal Ext. anal sphincter m.

Vagina

Urogenital diaphragm

Median Section—Right Lateral View with Peritoneum Removed

182

A.D.A.M.

Student Atlas of Anatomy

Pelvic Contents—Female

L. int. iliac v.

Plate 4.32

L. int. iliac a.

Sympathetic trunk Ext. iliac lymph nodes

L. ureter

Inf. hypogastric plexus

L. ovarian a. & v.

L. ext. iliac a. & v.

Infundibulum Coccyx

of uterine tube

L. ovary Rectum (transversely cut)

Ext. iliac lymph nodes

Cervix Median umbilical lig.

Body of uterus

Vagina

Inf. iliac lymph nodes

Fundus of uterus

Urinary bladder

Symphysis of pubis

Left Half of Hemisected Pelvis—Medial View with Peritoneum Removed

Chapter 4

PELVIS AND PERINEUM

183

Plate

4.33

Pelvic Contents—Female

L. int. iliac a. Int. iliac a.—post, division Iliolumbar a. Iliac crest

1st sacral n.

Iliacus m.

Lateral sacral a.

Lateral femoral cutaneous

Sympathetic trunk

2nd sacral n. L. ext. iliac a. & v. Piriformis m. Transversus abdominis m.— covered by fescia 3rd sacral n. Femoral n. Int. iliac a.— ant. division

Inf. gluteal a.

4th sacral n.

Umbilical a. & v.

Pudendal n. Int. pudendal a. & v. Sacrospinous lig. Symphysis of pubis

Int. pudendal v. & a.

Pudendal n. Tendinous arch of levator ani m.

Obturator a., v. & n.

Sup. fascia of pelvic diaphragm (cut)

Anal canal Vaginal opening Obturator internus m. (covered by fascia) Levator ani m. (cut)

Urethra (cut)

Median Section—Right Lateral View with Peritoneum Removed

184

A.D.A.M.

Student Atlas of Anatomy

Pelvic Contents—Female

Plate 4.34

R. common iliac v. & a. Int. iliac a. Sympathetic trunk

1st sacral n.

L. common iliac a.

L. int. iliac a.

Lateral femoral cutaneous n. Transversus abdominis m.— covered by fascia

Piriformis m.

2nd sacral n.

3rd sacral n Int. iliac a.— ant. division

4th sacral n Tendinous arch of levator ani muscle cut & edge of sup. fascia of pelvic diaphragm

L. ext. iliac a. & v.

Inf. gluteal a. Iliacus m. (covered by fascia)

Int. pudendal a. Obturator a., v. & n.

Tendinous arch of levator ani m.

Levator ani m. (cut)

Symphysis of pubis

Anal canal

Vaginal opening

Urethra (cut)

Median Section—Right Lateral View with Peritoneum Removed

Chapter 4

PELVIS AND PERINEUM

185

Plate 4.35

Lateral Pelvic Wall—Female

Gray ramus 1 st sacral n. communicantes Sympathetic trunk

Genitofemoral n. Iliacus m.

Sup. gluteal a. Transversus abdominis m.—covered by fascia

2nd sacral n.

Psoas minor m. tendon

Piriformis m.

Lumbosacral trunk

3rd sacral n. Inf. gluteal a.

Psoas major m. Sacral plexus Femoral n. Obturator n.

4th sacral n. Pudendal n. Int. pudendal a. & v. (cut)

L. ext. iliac a. & v.

Obturator fascia Obturator a. & v. (cut)

Pudendal n. Levator ani m. (cut)

Symphysis of pubis

Anococcygeal lig. (body) Ext. anal sphincter & puborectalis mm. Anal canal

Tendinous arch of levator ani m.

Ext. anal sphincter m. Urogenital diaphragm

Obturator internus m. (covered by obturator fascia)

Median Section—Right Lateral View with Peritoneum Removed

186

A.D.A.M.

Student Atlas of Anatomy

Lateral Pelvic Wall—Female

Sympathetic trunk

Sacral plexus

Gray ramus communicantes

1st sacral n.

Plate 4.36

Promontory of sacrum

Psoas minor m. tendon Piriformis m. Psoas major m.

2nd sacral n. Lumbosacral trunk Transversus abdominis m.— covered by fascia

3rd sacral n.

4th sacral n.

Obturator n.

Iliacus m. (covered by fascia) Int. pudendal a. & v. (cut) Sup. gluteal a.

Inf. gluteal a. Obturator a. & v. (cut)

Levator ani m. (cut)

Tendinous arch of levator ani m.

Urethra

Symphysis of pubis

L. ext. iliac a. & v., v.

Median Section—Right Lateral View with Peritoneum Removed

Chapter 4

PELVIS AND PERINEUM

187

Plate 4.37

Pelvic Contents—Male

L. int. iliac a. Ureter Promontory of sacrum

L. common iliac a.

Hypogastric nn.

Iliacus m. L. ext. iliac a.

Int. iliac lymph nodes Ext. iliac lymph nodes

2nd sacral n.

L. ext. iliac v.

Inf. hypogastric plexus

L. umbilical a. L. ductus deferens

Piriformis m. L. obturator a. Pelvic splanchnic nn. L. medial umbilical fold Ischial spine

Median umbilical lig. & fold (urachus)

Coccygeus m. Urinary bladder Tendinous arch of levator ani m.

Symphysis of pubis

Levator ani m.

Suspensory lig. of penis

L. seminal vesicle

Ampulla of L. ductus deferens

Anal canal

Prostate gland

Urogenital diaphragm

Median Section—Right Lateral View with Peritoneum Removed

188

A.D.A.M.

Student Atlas of Anatomy

Deep dorsal v. of penis

Pelvic Contents—Male

Hypogastric nn. R. femoral n.

Promontory of R. common iliac a. & v. (cut branches)

Plate 4.38

L. common iliac a. Ureter

R. lumbosacral trunk

L. int. iliac a. Iliacus m. L. ext. iliac a.

R. 1st sacral n. Ext. iliac lymph nodes Middle sacral a.

Piriformis m.

2nd sacral n.

Pelvic splanchnic nn.

L. ext. iliac v.

L. obturator a. Inf. hypogastric plexus L. medial umbilical fold

Anal canal

Median umbilical lig. & fold (urachus)

L. seminal vesicle R.

Prostate gland

Ampulla of L. ductus deferens R. & L.

r ,irPtpr (cut)

Symphysis of pubis

L. ductus deferens

Urinary bladder (empty)

Left Half of Hemisected Pelvis with Bladder Pulled Anteriorly—Medial View

Chapter 4

PELVIS AND PERINEUM

189

Plate 4.39

Peritoneal Fasciae & Spaces—Female

Parietal peritoneum

Ulterine tube (covered by peritoneum) Ovary

Visceral peritoneum

Vesical fascia Uterovaginal fascia

Linea alba Deep abdominal wall fascia

Rectum

Superficial abdominal fascia—fatty layer (Camper’s)

Rectal fascia Vesicouterine pouch

Median umbilical lig. (urachus)

Rectouterine pouch (of Douglas) Sup. fascia of pelvic diaphragm

Transversalis fascia

Inf. fascia of pelvic diaphragm

Superficial abdominal fascia— membranous layer (Scarpa’s)

Levator ani m.

Uterus Urinary bladder

Anococcygeal lig.

Suspensory lig. of clitoris

Anal canal

Central tendon of perineum (perineal body)

Retropubic space (of Retzius)

Superficial perineal pouch

Urogenital diaphragm (deep perineal pouch) Vagina Superficial perineal fascia (Colies’)

Inf. fascia of urogenital diaphragm

Urethra (Perineal membrane)

Median Section—Left Lateral View

19O

A.D.A.M.

Student Atlas of Anatomy

Peritoneal Fasciae & Spaces—Male

Plate 4.40

Seminal vesicle _ . . Parietal peritoneum Vesical fascia

Urinary bladder

Visceral Prostate pland peritoneum / S

n

/

Rectovesical pouch

Deep abdominal wall fascia Linea alba Superficial abdominal fascia—fatty layer (Camper’s) Rectum Transversalis fascia

Superficial abdominal fascia— membranous layer (Scarpa’s)

Rectal fascia

Median umbilical lig. (urachus) Urorectal fascia (of Denonvilliers)

Fundiform lig. Retropubic space (of Retzius)

Levator ani m. Suspensory lig. of penis —-ffl/'/ | Corpus spongiosum Sup. fascia of pelvic diaphragm

Deep fascia of penis (Buck’s) Corpus cavernosum

Inf. fascia of pelvic diaphragm

Superficial fascia of penis (dartos fascia)

Anococcygeal lig.

Cremasteric fascia Urethra

Anal canal

Dartos tunic (from superficial abdominal fascia—membranous layer (Scarpa’s))

Central tendon of perineum (perineal body) \

\

Cavity of tunica vaginalis testis

ficial perineal fascia (Colles’) Superficu

Superficial perineal pouch

Epididymis Urogenital diaphragm (in deep perineal pouch)

Int. spermatic fascia Cremasteric fascia

Tunica albuginea—penis

Ext. spermatic fascia Testis covered by tunica albuginea

Visceral layer Parietal layer

Tunica vaginalis testis

Bulbospongiosus m.

Inf. fascia of urogenital diaphragm (perineal membrane)

Median Section—Left Lateral View

Chapter 4

PELVIS AND PERINEUM

191

Plate 4.41

Perineum—Female I LEFT-►

RIGHT

LEFT-

RIGHT Ischioanal fossa Urinary bladder

Vestibulum of vagina

Levator ani m. Obturator internus m.

Crus of clitoris

Superficial perineal fascia—membranous layer (Colles’)

Pudendal canal (Alcock’s) Inf. pubic ramus

Ischiocavernosus m.

Superficial perineal pouch

Superficial perineal fascia—membranous layer (Colies’)—cut edge

Inf. pubic ramus

Central tendon of perineum (perineal body)

Post, labial aa.

Superficial perineal fascia—membranous layer (Colies’) (cut edge)

Superficial perineal fascia—membranous layer (Colles’)

Post, labial nn.

Post, labial n.

Post, labia! a.

Clitoris

Deep perineal fascia (Gallaudet’s)

Anus

Inf. fascia of urogeni¬ tal diaphragm

Sacrotuberous lig.

Ischial tuberosity Inf. rectal a. & v.

Ext. anal sphincter m.

Bulbospongiosus m.

Ischioanal fossa Anococcygeal lig. Gluteus maximus m.

Coronal Section—Anterior View

Coccyx

Lithotomy View

RIGHT

Vestibule of vagina

Clitoris

Labium minus

Superficial perineal fascia—membranous layer (Colles’)—cut edge

LEFT

Gracilis m.

Inf. pubic ramus

Post, labial nn.

Superficial perineal fascia—membranous layer (Colles’) Deep perineal fascia (Gallaudet’s) Adductor magnus m.

Post, labial aa.

Central tendon of perineum (perineal body)

Ischioanal fossa

Ischial tuberosity Inf. rectal a. & v.

Gluteus maximus m.

Ext. anal sphincter m. Levator ani m.

Anococcygeal lig.

Lithotomy View 192

A.D.A.M.

Student Atlas of Anatomy

Perineum—Male I RIGHT

LEFT-►

Plate 4.42

-RIGHT

LEFT-

Ext. spermatic fascia over testis & spermatic cord

Urinary bladder Bulbourethral gland Spongy part (of Cowper) of urethra Post, scrotal a. & n.

Prostate gland

Urethra (membra¬ nous part)

Superficial perineal fascia— membra¬ nous layer (Colles’)

Levator ani m.

Central tendon of perineum (perineal body)

Ischial tuberosity

Obturator membrane

Obturator internus m. Int. puden¬ dal a. & v.

Pudendal canal (Alcock’s)

Sacrotuberous lig. A11118

Ischioanal fossa

Pudendal n.

Sphincter urethrae m.

Inf. pubic ramus Inf. fascia of uro¬ genital diaphragm

Duct of bulbourethral gland Ext. anal sphincter m.

Crus of penis

Ischiocavernosus m. Gluteus maximus m.

Coccyx Bulbospongiosus m. uccp

pei meai

Superficial perineal fascia— \ ' i ■ „ membranous layer (Colles’) Bulb of penis *ascla (Gallaudet s)

Lithotomy View Coronal Section—Anterior View

Gracilis m.

RIGHT

Post, scrotal aa.

Body of penis

LEFT Scrotum

Superficial perineal fascia— membranous layer (Colies’)

Adductor magnus m.

Fascia lata

Semitendinosus m.

Semimembranosus m. Central tendon of perineum (perineal body) Perineal br. of post, femoral cutaneous n.

Post, scrotal nn.

Ext. anal sphincter m. Inf. fascia of urogenital diaphragm (perineal membrane)

Ischioanal fossa

Inf. cluneal nn.

Int. rectal a.

Gluteus maximus m.

Medial

Coccyx

Anococcygeal lig.

Lithotomy View

Chapter

4 I

PELVIS AND PERINEUM

i93

Plate

4.43

Perineum—Female

— RIGHT

II

LEFT-►

— RIGHT T T rpf n ro

riitrrrk

LEFT—►

Bulbospongiosus m.

Trigone Ischiocavernosus m. Ostium of ureter

Labium minus Post, labial n.

Urinary bladder Obturator interims m.

Levator ani m.

Vestibule of vagina

Post, labial a. Inf. pubic ramus

Superficial perineal fascia

Deep transverse perineal m.

Inf. fascia of urogenital diaphragm (perineal membrane)

Central tendon of perineum (perineal body)

Inf. pubic ramus

Superficial trans¬ verse perineal m.

Post, labial n. Ischial tuberosity

Crus of clitoris

Levator ani m.

Post, labial a. Inf. fascia of urogenital diaphragm (perineal membrane)

Fat in ischioanal fossa

Inf. rectal a., n. & v.

Ischiocavernosus m. Superficial perineal fascia Bulb of vestibule

Deep perineal fascia (Gallaudet’s) Ext. urethral meatus

Bulbospongiosus m.

Anus Gluteus maximus m.

Anococcygeal

nxt. anal sphincter m.

Coccyx

lig.

Coronal Section—Anterior View Lithotomy View

— RIGHT

Clitoris

LEFT-► Labium minus

Crus of clitoris

Superficial perineal fascia

Deep perineal fascia (Gallaudet’s)—cut edge

Bulbospongiosus m.

Inf. pubic ramus

Post, labial n.

Ischiocavernosus m. Adductor magnus m. Inf. fascia of urogenital diaphragm (perineal membrane)

Central tendon of perineum (perineal body)

Post, labial a.

Ischial tuberosity

Superficial transverse perineal m. Ischioanal fossa Inf. rectal a., n. & v.

Gluteus maximus m.

Levator ani m.

Anus Ext. anal sphincter m.

Coccyx

Lithotomy View

194

A.D.A.M.

Student Atlas of Anatomy

Anococcygeal lig.

Perineum—Male — RIGHT

Corpus spongiosum

LEFT-►

Plate

— RIGHT

cord (cut)

Urethra

II

LEFT-*~

Prostate gland

Bulbospongiosus m.

4.44

Urinary bladder

Lateral puboprostatic lig.

Obturator internus m.

Perineal n.

Inf. fascia of urogenital diaphragm (perineal membrane)

Levator ani m.

Ischiocavernosus m. Perineal a.

Cemtal tendon of perineum (perineal body)

Urogenital diaphragm

Pudendal n.

Pudendal n.

Superficial transverse perineal m.

Ischial tuberosity

Inf. pubic ramus

Inf. rectal a., n. & v.

Ext. anal sphincter m.

Ischiocavernosus m.

Anus

Crus of penis

Perineal n. Urethra

Coccyx

\

Corpus spongiosum

Gluteus maximus m. Bulbospongiosus m.

Lithotomy View

Coronal Section—Anterior View

Body of penis

—RIGHT

L. scrotum

LEFT-► Deep perineal fascia (Gallaudet’s)

Bulbospongiosus m.

Corpus spongiosum

Ischiocavernosus m Superficial perineal fascia Femoral a. & v.

Inf. pubic ramus Adductor longus m.

Obturator externus m. Crus of penis N. to bulbospongiosus m.

Perineal a. Superficial transverse perineal m.

Pudendal n.

Central tendon of perineum (perineal body)

Ischial tuberosity

Ext. anal sphincter m. Ischioanal fossa Inf. rectal a., n. & v. Gluteus maximus m.

Levator ani m.

Anus Coccyx

Anococcygeal lig.

Lithotomy View

Chapter 4

PELVIS AND PERINEUM

i95

Plate

4.45

— RIGHT

Ant. recess of ischioanal fossa

Perineum—Female LEFT

Urinary bladder Urethra Deep transverse perineal m.

III RIGHT

Urethra

LEFT —►

Clitoris

R. labium minus

Crus of clitoris Inf. fascia of urogenital diaphragm

Inf. fascia of urogeni¬ tal diaphragm Superficial perineal fascia

Inf. pubic ramus

Levator ani m.

Vestibule of vagina

Obturator membrane

Perineal a. Greater vestibular gland

Superficial trans¬ verse perineal m. covered by fascia

Pudendal n. Post, labial n.

Bulb of the vestibule

Pudendal n.

Inf. pubic ramus

Ischial tuberosity Sacrotuberous lig.

Crus of clitoris Perineal a.

Ischioanal fossa

Fat in ischioanal fossa

Bulb of vestibule

Ext. anal sphincter Bulbospongiosus m.

Sphincter urethrae m.

Inf. rectal a.

Inf. rectal n.

Gluteus maximus m. Levator ani m.

Coronal Section—Anterior View Lithotomy View

Mons pubis

— RIGHT

Clitoris

LEFT-►

R. labium minus

Crus of clitoris L. labium minus

Urethra Pectineus m. Gracilis m. Adductor brevis m.

Ischiocavernosus m.—cut edge

Gracilis m. (cut)

Vestibule of vagina

Bulb of the vestibule Inf. pubic ramus

Adductor magnus m.

Inf. fascia of urogenital diaphragm

Superficial perineal fascia Greater vestibular gland

Perineal a.

Ischial tuberosity Ischioanal fossa

Superficial transverse perineal m

Gluteus maximus m.

Ext. anal sphincter m. Anus

Inf. rectal a.

Lithotomy View

196

A.D.A.M.

Student Atlas of Anatomy

Levator ani m.

Perineum—Male ■RIGHT

Corpus cavernosum

Deep fascia of penis

III

Plate

■RIGHT

LEFT

4.46

LEFT

Corpus spongiosum Bulbourethral gland (of Cowper)

Spermatic cord (cut)

Bulbospongiosus m. (cut at midline)

Urinary bladder Urogenital diaphragm

Crus of penis Levator ani m.

Corpus spongiosum

Levator ani m.

Ischiocavernosus m. Inf. fascia of urogenital diaphragm

Ant. recess of ischioanal fossa

Pudendal n. Levator ani m.

Ischial tuberosity

Pudendal n.

Inf pubic ramus Perineal a. Crus of penis

Inf. rectal a. Inf. rectal n.

Post, scrotal a. Ischiocavernosus m Post, scrotal n. Inf. fascia of Corpus spongiosum urogenital Bulbospongiosus diaphragm m. (cut at midline)

Ext. anal sphincter nt.

Lithotomy View Coronal Section—Anterior View

— RIGHT

LEFT —►

r

Adductor longus m. (cut) Corpus spongiosum

L. Ischiocavernosus m.

Bulbospongiosus m. (cut at midline) L. crus of penis Obturator externus m.

Adductor longus m. Inf. pubic ramus

Inf fascia of urogenital diaphragm

R. crus of penis Perineal a.

L. ischiocavernosus m.

Ischial tuberosity

Pudendal n.

Bulb of penis

:rficial transverse perineal m.

Levator ani m. Inf. rectal n. Ext. anal sphincter m.

Anus

Inf. rectal a.

Lithotomy View

Chapter 4 I

PELVIS AND PERINEUM

i97

Plate

4.47

Perineum—Female

RIGHT

IV RIGHT

LEFT

Urinary bladder

Urethra

LEFT —>

Sphincter urethrae Mons pubis "'m' Porh°n °f . \ urogenital pubicdig

Obturator mternus m.

\ ^'aP^ra§1T1 x

Inf. fascja 0f urogenital / diaphragm (cut & reflected) 7 Perineal a.

Inf. pubic ramus Superficial per¬ ineal fascia

Ischioanal fossa

Vagina Deep transverse perineal m.

R. labium minus Ischial tuberosity

Inf. pubic ramus Crus of clitoris Sphinctor urethrae m. portion of urogenital diaphragm

Ischiocavernosus m

Inf. fascia of urogenital diaphragm (cut & reflected)

Superficial perineal fascia

Bulb of the vestibule

Int. pudendal a.

Central tendon of perineum (per¬ ineal body)

Superficial perineal fascia Inf. pudendal a.

Sacrotuberous lig. Anus

Levator ani m. Ischioanal fossa

Gluteus maximus m.

anal sphincter m.

Anococcygeal lig.

Inf. rectal a.

Coronal Section—Anterior View Lithotomy View RIGHT

LEFT

Adductor longus m.

Clitoris

Suspensory lig. of clitoris

Mons pubis

Intercavernosus septum Gracilis m. Inf. fascia of urogenital diaphragm (cut & reflected)

Sphincter urethrae m. portion of urogenital diaphragm

Urethra

Ischiocavernosus m. (visible through investing fascia)

Inf. pubic ramus

Perineal a.

Vagina

Inf. pudendal a.

Superficial perineal fascia

Deep transverse perineal m. Central tendon of perineum (perineal body)

Ischial tuberosity

Levator ani m. Ischioanal fossa Inf. rectal a. Gluteus maximus m

Anus

Anococcygeal lig.

Lithotomy View

198

A.D.A.M.

Student Atlas of Anatomy

Ext. anal sphincter m.

Perineum—Male ■RIGHT

Corpus cavernosus R. spermatic cord (cut)

Plate

■RIGHT

LEFT-

Urethra

Bulbourethral gland (of Cowper)

IV

LEFT Prostate Urinary bladder gland

Corpus spongiosum

4.48

Urethra Lateral puboprostatic lig.

Obturator internals m.

Inf. pubic ramus Transverse perineal lig. Bulb of penis Sphincter urethrae m.

Crus of penis (reflected)

Dorsal a. of penis

Inf. fascia of uro¬ genital diaphragm

Ischioanal fossa

Deep transverse perineal m. Inf. pudendal a.

Ischial tuberosity

Inf. pubic ramus

Levator ani m. Sacrotuberous lig. Ext. anal sphincter m. Inf. rectal a.

Sphinctor Duct of urethrae m. bulbourethral glands Corpus Bulbourethral spongiosum gland (of Cowper)

Inf. fascia of urogenital diaphragm

Gluteus maximus m. Anococcygeal lig.

Coccyx

Anus

Lithotomy View

■RIGHT LATERAL

Inf. pudendal a.

Crus of penis (reflected)

Coronal Section—Anterior View

RIGHT HALF

MEDIAL

LEFT HALF

Corpus cavernosus

LEFT LATERAL-

Corpus spongiosum

R. spermatic cord (cut) Body of L. pubis

Obturator membrane

Corpus spongiosum Lateral surface of body of r. pubis

Dorsal a. of penis Deep a. of penis

Dorsal a. y* of penis Crus of penis (reflected)

Duct of bulbourethr al glands Deep a. of penis

Bulbourethral gland (of Cowper)

Inf. pudendal a.

Bulb of penis (in median section)

Obturator a.

Inf. pubic ramus

Sphincter urethrae m.

Inf. pubic ramus Bulb of penis Inf. fascia of urogenital diaphragm

Inf. fascia of urogenital diaphragm (cut)

Inf. rectal a.

Anus Ischioanal fossa

Levator ani m.

Deep transverse perineal m.

Inf. rectal a.

Ischioanal fossa

Ext. anal sphincter m.

Lithotomy View

Chapter 4

PELVIS AND PERINEUM

199

r

Plate

4.49

Perineum—Female

— RIGHT

V

LEFT-►

Arcuate

Urethra Ant. recess of ischioanal fossa

LEFT-

— RIGHT Ischiocavernosus m. (covered by fascia)

Urinary bladder

Urethra

Clitoris Transverse perineal lig. Dorsal n. of clitoris

Labium minus Vagina Superficial perineal fascia

Inf. pubic ramus

Int. pudendal a.

Coccyx Inf. pubic ramus

Ischial tuberosity Levator ani m. Levator ani m.

Sacrotuberous lig. Post. Labial a.

Crus of clitoris Ischiocavernosus m.

Superficial perineal fascia

Ischioanal fossa

Gluteus maximus m. Sphincter urethrae m. Ext. anal sphincter m. Anococcygeal lig.

Coronal Section—Anterior View

Anus

Inf. rectal a.

Lithotomy View

— RIGHT

Labium minus

LEFT-► Clitoris

Gracilis m.

Mons pubis Dorsal n. of clitoris

Adductor magnus m.

Adductor longus m. (cut)

Transverse perineal lig. Urethra

Obturator externus m.

Ischiocavernosu s m. (covered by fascia)

Obturator a. Sphincter urethrae m. (cut) portion of urogenital diaphragm

Vagina

Superficial perineal fascia

Inf. pubic ramus

Central tendon of perineum (perineal body)

Ext. anal sphincter m.

Post, labial a.

Ischioanal fossa Int. pudendal a. Inf. rectal a. Ischial tuberosity

Gluteus maximus m.

Sacrotuberous lig. Anus

Levator ani m.

Lithotomy View

200

A.D.A.M.

Student Atlas of Anatomy

Perineum—Male V — RIGHT

LEFT-

— RIGHT

Spermatic cord Dorsal a. & v. of penis

Duct of bulbourethral gland (cut)

LEFT-

Ant. recess of ischioanal fossa

Transverse perineal lig. Sphincter urethrae m.

Plate 4.50

Prostate gland

Levator ani m.

Urethra

Bulbourethral gland (of Cowper) Inf. pubic ramus Superficial perineal fascia— membranous layer (Colles’)

Deep transverse perineal m. Central tendon of _ perineum (perineal body) |

Inf. pubic ramus

Ischial tuberosity

Int. pudendal a. (cut)

Levator ani m. Ext. anal sphincter m.

UrethraXlnt/ P^dendal a. (cut)

Sacrotuberous lig. Sphincter urethrae m.

Gluteus maximus m. Inf. rectal a.'

Coccyx Anus

Duct of bulbourethral gland (cut)

Bulbourethral gland (of Cowper)

Inf. rectal n.

Anococcygeal lig.

Coronal Section—Anterior View Lithotomy View

RIGHT LATERAL

RIGHT HALF

MEDIAL

LEFT HALF

LEFT LATERAL —►

Lateral surface of body of R. pubis

Dorsal n. of penis

Dorsal a. & v. of penis Corpus spongiosum

Arcuate pubic lig.

Dorsal a. 0f penis

Dorsal n. of penis

Lateral surface of body of L. pubis

Duct of bulbourethral gland (cut)

Arcuate pubic lig.

Bulbospongiosus m. Obturator a. Duct of bulbourethral gland (cut)

Obturator membrane

Transverse perineal lig.

Ischiocavernosus m.

Obturator a.

Urethra Transverse perineal lig.

Urethra

Inf. pubic ramus

Sphincter urethrae m.

Bulbourethral gland (of = J Cowper)

Ischiocavernosus m. Inf. pubic ramus

Deep transverse perineal m.

Int. pudendal a. (cut)

Int. pudendal a. (cut) Postenol of urogenital diaphragm

Ischioanal fossa

Central tendon of perineum (perineal body)

Inf. rectal n.

Inf. rectal a.

Levator ani m. Central tendon of perineum (perineal body)

Ischioanal fossa

Anus

Ext. anal sphincter m.

Ext. anal sphincter m.

Inf. rectal a.

Inf. rectal n.

Lithotomy Views

Chapter 4

PELVIS AND PERINEUM

201

Plate 4.51

Perineum—Female VI

— RIGHT

LEFT —►

— RIGHT

LEFT —►

Urethra

Levator ani m.

''Clitoris

Arcuate pubic lig.

Labium minus

Ant. recess of ischioanal fossa

Ischiocavernosus m.— covered by fascia

Urinary bladder Sup. fascia of pelvic diaphragm

Inf. pubic ramus

Vagina

Levator ani m.

Superficial perineal fascia

Obturator internus m.

Ischial tuberosity

Ischial tuberosity Inf. rectal a. Sacrotuberous lig.

Inf. pubic ramus Inf. fascia of pelvic diaphragm

Ischiocavernosr

Central tendon of perineum (perineal body)

Superficial perineal fascia

Ischioanal fossa

Fat in ischioanal fossa

Inf. rectal n.

Ext. anal sphincter m.

Gluteus maximus m.

Coronal Section—Anterior View Anococcygeal lig.

Anus

Lithotomy View

Labium minus

Clitoris

— RIGHT

Sup. pubic ramus

LEFT

Obturator externus m. Urethra

Int. pudendal v. Ischiocavernosus m. Inf. pubic ramus Vagina Deep a. of clitoris Superficial perineal fascia Inf. rectal a. Inf. rectal n. Central tendon of perineum (perineal body)

Ischial tuberosity

Sacrotuberous lig.

Ischioanal fossa Levator ani m.

Gluteus maximus m.

Ext. anal sphincter m. Anococcygeal lig.

Lithotomy View

202

A.D.A.M.

Student Atlas of Anatomy

Perineum—Male — RIGHT

LEFT —►

VI

Plate

— RIGHT

4.52

LEFT —►

Arcuate Spermatic cord

Pubic symphysis Obturator internus m.

Deep dorsal vv. of penis Urethra

Urinary bladder Prostate gland

Prostate gland Obturator membrane Inf. pubic ramus Ischial tuberosity Levator ani m. Sacrotuberous lig. Anus Levator ani m. Ischioanal fossa

Anococcygeal lig.

Obturator membrane

Inf. pubic ramus

Ischioanal fossa

Coccygeus m.

Gluteus maximus m.

Arcuate pubic lig.

Coronal Section—Anterior View

Ext. anal sphincter m.

Lithotomy View — RIGHT

LEFT —►

Puboprostatic m. Arcuate pubic lig.

Obturator membrane Urethra

Obturator canal

Prostate gland

Puborectalis m. part of levator ani m.

Levator ani m.

Obturator internus m. fascia

Obturator internus m.

Ischial tuberosity

Central tendon of perineum (perineal body)

Ischioanal fossa

Sacrotuberous lig.

Pubococcygeal m. part of levator ani m.

Iliococcygeal m. part of levator ani m.

Ext. anal sphincter m.

Anococcygeal lig.

Anus Coccyx

Lithotomy View

Chapter 4

PELVIS AND PERINEUM

203

Plate 4.53

Pudendal Structures

Sup. gluteal a. & v.

Gluteal surface of ilium

Iliac tuberosity Tubercle of iliac crest

Sup. gluteal n. Post. sup. iliac spine Tensor fascia lata m.

Sacrum

Gluteus medius m.

Pirifomis m.

Inf gluteal n. Inf. gluteal a. & v. Sup. gemellus m. Greater trochanter of femur

Pudendal n.

Obturator internus m. tendon Sacrospinous lig. N. to obturator internus m. Coccyx

Inf gemellus m.

Int. pudendal a. & v.

Post, femoral cutaneous n.

Obturator internus m. Quadratus femoris m.

Sacrotuberous lig. Lesser trochanter of femur

Ischial tuberosity

Inf. cluneal nn.

Perineal br. of post, femoral cutaneous n.

Sciatic n.

Gluteal Region—Posterior View

204

A.D.A.M.

Student Atlas of Anatomy

Pudendal Structures MIDLINE

Plate 4.54

RIGHT —►

Piriformis m.

Gluteus medius m.

Sacrum Sup. gluteal a. & v. Coccyx Inf. gluteal a. & v. Sacrospinous lig.

Inf. gluteal n.

Coccygeus m.

Sciatic n.

Anococcygeal lig.

Post, femoral cutaneous n.

Levator ani m. Quadratus femoris m. R. ischial tuberosity

Inf. rectal a. & n.

Anus

Obturator internus m. Bulbospongiosus m. Lesser trochanter of femur Body of penis (cut) Scrotum (cut)

Inferior Oblique View of Right Male Perineum & Pudendal Canal

Sup. gluteal a. & v.

Ant. sup. iliac spine

Piriformis m. (cut) Gluteal surface of ileum Sciatic n. Labrum of acetabulum Sacrum = Inguinal lig.

Sacrotuberous lig.

Obturator n.

Inf. gluteal a. & v.

Femoral v.

Sacrotuberous lig.

Inf. surface of levator ani m.

Pudendal n.

Int. pudendal a. & v. — POSTERIOR

ANTERIOR —►

Pudendal n.

R. Ischial tuberosity

Dissection of Female Perineum from Lateral Approach (Acetabulum Removed)

Chapter 4 I

PELVIS AND PERINEUM

205

Plate

4.55

Rectum & Anal Canal—Arteries

R. common iliac a.

Abdominal aorta Inf. mesenteric a.

Obliterated umbilical a. in medial umbilical fold

L. colic a. Sigmoidal aa.

R. int. iliac a.

Sup. rectal a.

L. iliolumbar a. (seen through ilium)

R. iliolumbar a. (seen through ilium)

Tubercle of iliac crest R. ext. iliac a. (seen through ilium)

L. int. iliac a.— post, division

R. obturator a.

Sup. gluteal a. R. sup. vesical a.

R. inf. vesical a.

Quadratus femoris m.

L. int. iliac a.—ant. division

Obturator internus m. Inf. gluteal a. Pudendal canal (Alcock’s)

Lateral sacral a. Levator ani m. (cut) Inf. rectal a.

R. ureter Middle rectal a. Ext. anal sphincter m.

Posterior View with Sacrum Removed

206

A.D.A.M.

Student Atlas of Anatomy

Rectum & Anal Canal—Veins

Inf. vena cava

Plate 4.56

Sup. rectal v.

Middle sacral v.

Inf. mesenteric v.

Lateral sacral v.

Sigmoid vv.

R. ext. iliac v.

Sup. vesical v.

Obturator v. Sigmoid colon

R. int. iliac v. Inf. gluteal v. Uterine v. Piriformis m. Middle rectal v. Int. pudendal v. Vaginal v.

Perimuscular rectal venous plexus Obturator internus Obturator internus m.

Pudendal canal (Alcock’s)

Levator ani m.

Int. pudendal v.

Ext. rectal plexus

ext. rectal venous plexuses

Communication between int. & perimuscular rectal venous plexuses

Int. rectal plexus

Coronal Section—Anterior View

Chapter 4

! PELVIS AND PERINEUM

207

Plate 4.57

Rectum & Anal Canal

Rectum

Visceral peritoneum

Sigmoid colon

Rectosigmoid junction

Sup. rectal fold

Tendinous arch of pelvic fascia

Levator ani m. Middle rectal fold

Sup. fascia of pelvic diaphragm

Inf. rectal fold

Obturator internus m. Pudendal canal with pudendal n. & int. pudendal a. & v.

Levator ani m.

Ext. anal sphincter m. Ext. rectal venous plexus

Anorectal (Pectinate) line Intermuscular groove (white line of Hilton)

Coronal Section—Anterior View

208

A.D.A.M

Student Atlas of Anatomy

Int. rectal venous plexus

Lower Limb

Surface Anatomy Skeleton Muscles Arteries Veins Nerves Lymphatics Anterior Thigh & Femoral Triangle Posterior Thigh & Gluteal Region Medial & Lateral Thigh Anterior Leg Lateral Leg Posterior Leg Medial Leg Knee Region Dorsal Surface of the Foot 209

Plate 5.1

Surface Anatomy

Ext. abdominal oblique m.Ext. abdominal oblique m.

lliac crest Iliac crest

Ant. superior iliac spine -

Ant. superior iliac spine

| Gluteus medius m.-p>

I

Greater trochanter of femur -

- Inguinal lig.

Gluteus medius m. Inguinal lig.

- Pubic tubercle

Tensor fasciae latae m.

™

• Spermatic cord Sartorius m.^ M

Rectus femoris m.

Gluteus maximus m.

-Penis

m

-Scrotum Adductor mm

- Tensor fasciae latae m.

Greater trochanter of femur

Iliotibial tract

Gluteal fold (sulcus) Rectus femoris m..

Biceps femoris m.

- Sartorius m.

Vastus lateralis m.

Post, compartment of thigh (hamstring) mm.

Vastus lateralis m. -

Quadriceps femoris m. tendon -Vastus medialis m.

Biceps femoris m. —long head

Iliotibial tract-

Iliotibial tract -Patella

Biceps femoris m. -long head tendon

Patella Tibialis anterior m.

-Patellar lig. Head of fibula

-Tibial tuberosity 'Sartorius & gracilis mm. tendons Tibialis anterior m. Gastrocnemius m. —lateral head —

_Gastrocnemius m. —medial head

Fibularis [Peroneus] longus & brevis mm.

Gastrocnemius m.__ —lateral head

Ant. border of tibia-

Extensor digitorum longus m. Soleus m.

Fibularis [Peroneus] tertius m.Tendo calcaneus (Achilles tendon)

-Medial malleolus

Lateral malleolus -

-Tibialis anterior m. tendon

Dorsal surface of foot Extensor digitorum^ longus m. tendons

Extensor digitorum brevis m.

Plantar surface of foot _ Extensor hallucis longus m. tendon

_

Anterior View

2 10

Lateral malleolus

Tuberosity of calcaneus

A.D.A.M. i Student Atlas of Anatomy

Tuberosity of 5th metatarsal bone

Dorsal surface of foot

Lateral View

Surface Anatomy

Plate 5.2

-Iliac crest

Sacrum

’ Gluteus medius m. — Greater trochanter of femur Gluteus maximus m.

Gluteus maximus m. I;

iiki, - Gluteal fold (sulcus) Gluteal fold (sulcus) -

“

|

Adductor longus m. ■ Adductor magnus m.

,Post. compartment of thigh (hamstring) mm.

Adductor magnus m. ' Vastus lateralis m.

Post, compartment of thigh (hamstring) mm. ~

Vastus medialis m. -Sartorius m. -Biceps femoris m.—long head

Semitendinosus m. -

-Gracilis m. -Popliteal fossa Patella-

Sartorius & gracilis mm.

'Biceps femoris m. Pes anserinus (tendons of sartorius, gracilis & semitendinosus mm.)

Gastrocnemius m.— medial & lateral heads

J'' "

_ Gastrocnemius m. —medial head

I

Ant. border of tibia _

- Soleus m. Soleus m.-

- Medial malleolus

-Tendo calcaneus (Achilles tendon) Medial malleolus Tuberosity of calcaneus -

-Lateral malleolus

Tibialis posterior & ' flexor digitorum longus mm. tendons

Tibialis anterior m. tendon- Tuberosity of 5th metatarsal bone • Plantar surface of foot Dorsal surface of foot -

-Plantar surface of foot

Head of 1st metatarsal bone -

Posterior View

Medial View

Chapter 5

I

LOWER LIMB

21 I

Plate

5.3

Skeleton & Muscle Attachments ^ Sacroiliac joint Iliac fossa

Anterior View

/, Ala of sacrum

Iliac crest

Promontory of sacrum

Tubercle of iliac crest Ant. superior iliac spine

Body of ilium

Ant. inferior iliac spine

Sacrum

Head of femur

Gluteus minimus

Adductor longus

Vastus lateralis

Iliotibial tract

Vastus medialis

Piriformis

Pubic crest

Iliopsoas

Articularis genu

Symphysis of pubis

Vastus intermedius

Patellar ligament

Obturator externus

Sartorius

Sup. pubic ramus

Neck of femur

Pectineal line of pubis Coccyx

Greater trochanter of femur Iliopubic eminence

Pubic tubercle

Intertrochanteric line Ischium

Obturator foramen Lesser trochanter of femur Inf. pubic ramus

Shaft of femur

ML

Psoas major m. (lower portion)

Iliacus m

Psoas minor m.

Sartorius m. Adductor tubercle Supracondylar ridge

Pectineus m. Patella

Rectus femoris m.

Lateral epicondyle

Adductor longus m.

Medial epicondyle Lateral condyle

Medial condyle

Apex of head

Piriformis m.

Intercondylar eminence

Adductor brevis m.

Gluteus minimus m.

Head of fibula Medial & lateral condyles of tibia

Obturator externus m.

Proximal tibiofibular joint Tibial tuberosity

Vastus lateralis m.

Quadratus femoris m.

Neck of fibula Gracilis m.

Fibula

Tibia Adductor magnus m. Vastus intermedius m Iliopsoas m. Vastus medialis m.

Articularis genu m.

HP Gracilis

Psoas major

(^) Adductor brevis

Rectus femoris

(A Quadratus femoris

Psoas minor

Biceps femoris

Adductor magnus m.

Adductor magnus Iliotibial tract

I) Semitendinosus

Pectineus

Quadriceps femoris m. tendon (via patellar lig.)

Biceps femoris m.

Iliacus

Sartorius m.

Gracilis m.

Anterior View

212

A.D.A.M. I Student Atlas of Anatomy

Semitendinosus m.

Skeleton & Muscle Attachments

Sacroiliac joint

Iliac crest

Plate

5.4

Posterior View

L5 Post, superior iliac spine

Ala of ilium

Sacrum

Sartorius

Post, inferior iliac spine

Semimembranosus

Head of femur Neck of femur

Body of ilium Ischial spine

Greater trochanter of femur

Rectus femoris

LA Popliteus

Tensor fasciae latae

|j|^ Adductor magnus

Gluteus medius

Sup. pubic ramus Intertrochanteric crest

Body of ischium

Gluteus minimus Lesser trochanter

Obturator foramen

IB Gluteus maximus

^

|

Obturator internus

Quadratus femoris | Inferior gemellus

Gluteal tuberosity

Inf. pubic ramus Ischial

Medial lip of linea aspera

Trochanteric fossa

Lateral lip of linea aspera

Linea aspera Pectineal line of femur

Popliteal surface

Femur

Tensor fasciae latae m.

Gluteus medius m.

Supracondylar line Sartorius m.

Gluteus minimus m. Intercondylar line

Gluteus maximus m.

Rectus femoris m.

Intercondylar fossa Adductor tubercle Lateral epicondyle

Inf. gemellus m.

Sup. gemellus m.

Medial epicondyle Lateral condyle

Medial condyle

Apex of head

Intercondylar eminence

Gluteus medius m.

Obturator internus m.

Quadratus femoris m.

Biceps femoris m. —long head

Lateral condyle Medial condyle

Iliopsoas m.

Semimembranosus m.

Tibia

Head of fibula

Soleal line of tibia

Fibula

Gluteus maximus m.

Adductor magnus m.

Vastus lateralis m.

Semitendinosus m. Pectineus m.

Vastus intermedius m.

Adductor brevis m.

Biceps femoris m. —short head

Vastus medialis m.

Adductor longus m.

Adductor magnus m.

i Superior gemellus Semitendinosus Biceps femoris

Vastus medialis

O

o

Adductor brevis

Plantaris m.

Adductor longus

Gastrocnemius

Vastus lateralis

Iliopsoas

Vastus intermedius

Pectineus

Plantaris

Adductor magnus m.

Gastrocnemius m. —lateral head

Gastrocnemius m.— medial head

Popliteus m.

Semimembranosus m.

Popliteus m.

Posterior View

Chapter 5

! LOWER LIMB

213

Plate 5.5

Skeleton & Muscle Attachments

Femur

Anterior View Patella

Supracondylar line Lateral epicondyle

Adductor tubercle Medial epicondyle

Lateral condyle of femur

Medial condyle of femur Lateral condyle of

(A) Fibularis [Peroneus| brevis

ill) Extensor hallucis longus

ateral «P of linea aspera of femur

Vastus medialis

Intertrochanteric line & medial lip of linea aspera of femur

Vastus intermedius

Antf f lateral surfaces of shaft ol femur

\

\

N

/

) (L2, L3 & L4)

lig. to tibial tuberosity

)

^

\

Extend leg at knee joint; rectus femoris also helps iliopsoas to flex thigh

)

aln this and subsequent tables, the numbers indicate the spinal cord segmental innervation of the nerves. For example, LI, L2 and L3 indicate that the nerves supplying the psoas major muscle are derived from the first three lumbar segments of the spinal cord; the boldface (LI, L2) indicates the main segmental innervation. Damage to one or more of these spinal cord segments or to the motor nerve roots arising from them results in paralysis of the muscles involved.

T12

LI

Psoas minor m.

Iliac fossa

Psoas major m. Iliac crest L5

Iliacus m.

Iliopubic eminence

Lesser trochanter

Anterior View

2l6

A.D.A.M. I Student Atlas of Anatomy

Anterior Thigh Muscles

Plate

5.7

Gluteal fascia (over gluteus maximus m.) Ant. superior iliac spine

Iliac crest

Gluteal fascia (over gluteus medius m.)

Gluteus maximus m. Tensor fasciae latae m.

Tensor fasciae latae m.

Iliotibial tract Iliotibial tract

Sartorius m.

Lateral condyle of tibia Medial condyle of tibia

Lateral condyle of tibia

Lateral View

Anterior View

Ant. inferior iliac spine

Greater trochanter of femur

Femur

-Rectus femoris m.

Vastus intermedius m. Vastus lateralis m. tendon (cut off)

li

Vastus lateralis m.

Rectus femoris m. tendon (cut off)

Vastus medialis m.

Vastus medialis m. tendon

Quadriceps femoris nt. tendon

Patella Patellar lig.

Patella

Patellar lig.

■Tibial tuberosity

Tibial tuberosity

Anterior Views

Chapter 5

I

LOWER LIMB

217

Table 5.2

Gluteal & Posterior Thigh Muscles

Gluteal Muscle

Proximal Attachment

Distal Attachment

Gluteus maximus

Ext. surface of ala of ilium, including iliac crest, dorsal surface of sacrum & coccyx and sacrotuberous lig.

Most fibers end in iliotibial tract which inserts into lateral condyle of tibia; some fibers insert on gluteal tuberosity of femur

Gluteus medius

Ext. surface of ilium between ant. & post, gluteal lines

Lateral surface of greater trochanter of femur

Innervation

Main Actions

Inf. gluteal n. (L5, SI &S2)

Extends thigh & assists in its lat. rotation; also assists in raising trunk from flexed position

Abduct & medially rotate thigh; steady pelvis

> Sup. gluteal n. (L5 & SI)

Gluteus minimus

Ext. surface of ilium between ant. & inf. gluteal lines

Ant. surface of greater trochanter of femur

Piriformis

Ant. surface of sacrum between S2 & S4

Superior border of greater trochanter of femur

Obturator internus

Pelvic surface of obturator ' membrane & surrounding bones

, Brr. from ventral rami of SI & S2

'

N. to obturator internus (L5&S1) ) Same nerve supply as obturator internus

> Trochanteric fossa“

Superior gemellus

Ischial spine

Inferior gemellus

Ischial tuberosity

Quadratus femoris

Lateral border of ischial tuberosity

Laterally rotate extended thigh & abduct flexed thigh

Same nerve supply as quardratus femoris /

t

Quadrate tubercle and intertrochanteric crest of femur

N. to quadratus femoris (L5&S1)

Laterally rotates thighb

“The gemelli muscles join the tendon of the obturator internus muscle as it attaches to the trochanteric fossa. bThere are six lateral rotators of the thigh: piriformis, obturator internus, gemelli (superior and inferior), quadratus femoris and obturator extemus. These muscles also help to stabilize the hip joint.

Post. Thigh Muscle

Proximal Attachment

Semitendinosus

Distal Attachment

Innervation

Medial surface of sup. part of tibia

1

1

1

l Tibial division of sciatic f n. (L5, SI & S2)

> Ischial tuberosity

Semimembranous

Biceps femoris Long head Short head

Main Actions

)

Post, part of medial condyle of tibia

Ischial tuberosity Lateral lip of distal half of linea aspera & lateral supracondylar line

) Tibial division of sciatic n. (L5, SI & S2)

^ Lateral side of head of fibula

Common fibular (peroneal) division of sciatic n. (L5, S1&S2)

] Extend thigh; flex leg and rotate it medially; when ' } thigh & leg are flexed, they can extend pelvis (and trunk)

J }

Flexes leg & rotates it laterally; extends thigh (e.g., when starting to walk)

Greater sciatic notch

Sacrum

Piriformis m. Ischial spine

Sacrospinous lig. Greater trochanter of femur

Sup. pubic

Sup. gemellus m. Obturator internus m.

Trochanteric fossa

Trochanteric fossa Inf. pubic ramus

Intertrochanteric crest Ischial spine

Inf. gemellus m. Ischial tuberosity

Quadrate tubercle of femur

_ , Sacrotuberous lig. (cut)

Ischial tuberosity

Ischial tuberosity

Quadratus femoris m. Posterior Views

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A.D.A.M. ! Student Atlas of Anatomy

Gluteal & Posterior Thigh Muscles Iliac crest

Plate 5.8

Iliac crest

Ilium

Post, gluteal line

Gluteus medius m.

Sacrum

Ant. gluteal line

I

Greater trochanter of femur

Gluteus minimus m.

Gluteal tuberosity

Iliotibial tract

Gluteus maximus m.

Greater trochanter of femur

Posterior View

Ischial tuberosity

Greater trochanter of femur

Lateral Views

Ischial tuberosity

Biceps femoris m.—long head

Semitendinosus m. Biceps femoris m.—short head Semimembranosus m.

Medial condyle of tibia

Head of fibula

Posterior Views

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Table 5.3

Medial Thigh Muscles

Muscle3

Proximal Attachment

Distal Attachment

Pectineus

Pecten pubis

Adductor longus

Innervation

Main Actions

Pectineal line of femur

Femoral nerve (L2 & L3) & br. from obturator n. (L2, L3)

Adducts; flexes & laterally rotates thigh

Body of pubis, inf. to pubic crest

Middle third of linea aspera of femur

Obturator n. ant. br. (L2, L3 & L4)

Adducts thigh

Adductor brevis

Body & inf. ramus of pubis

Pectineal line & proximal part of linea aspera of femur

Obturator n. (L2, L3 & L4)

Adducts thigh & may act to flex hip

Adductor magnus

Inf. ramus of pubis, ramus of ischium (adductor part) & ischial tuberosity

Gluteal tuberosity, linea aspera med. supracondylar line (adductor part) & adductor tubercle of femur (hamstring part)

Adductor part, obturator n. (L2, L3 & L4) Hamstring part, tibial portion of sciatic n. (L4)

Adducts thigh; its adductor part also flexes thigh & its hamstring part extends it

Gracilis

Body & inf. ramus of pubis

Sup. part of med. surface of tibia

Obturator n. (L2, L3 & L4)

Adducts thigh, flexes leg & helps to rotate it medially

Obturator externus

Margins of obturator foramen & ext. surface of obturator membrane

Trochanteric fossa of femur

Obturator n. (L3 & L4)

Laterally rotates thigh

aThe last five muscles are called the adductors of the thigh.

Sup. pubic ramus

Anterior Views Pectineal line of pubis [Pecten pubis] Inf. pubic ramus

Pectineus m. Adductor brevis m. Pectineal line of femur (seen through shaft of femur)

Linea aspera (seen through femoral shaft)

Sup. pubic ramus Trochanteric fossa (seen through greater trochanter)

Obturator externus m.

Inf. pubic ramus

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A.D.A.M. I Student Atlas of Anatomy

Medial Thigh Muscles

Plate 5.9

Pubic crest Inf. pubic ramus

Adductor longus m.

Gracilis m.

Linea aspera (seen through femoral shaft)

Medial condyle of tibia

Inf. pubic ramus

Ischial tuberosity

Linea aspera (on posterior surface of femoral shaft)

Adductor magnus m,

Adductor hiatus

Adductor tubercle

Anterior Views

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Table 5.4

Anterior & Lateral Leg Muscles

Anterior Muscle

Proximal Attachment

Distal Attachment

Tibialis anterior

Lateral condyle & sup. half of lateral surface of tibia

Medial & inf. surfaces of medial cuneiform bone & base of 1st metatarsal bone

Extensor hallucis longus

Middle part of ant. surface of fibula & interosseous membrane

Dorsal aspect of base of distal phalanx of 1st digit (hallux)

Extensor digitorum longus

Lateral condyle of tibia, sup. 3/4 of ant. surface of fibula & interosseous membrane

Middle & distal phalanges of lateral 4 digits via extensor expansions

Fibularis |Peroneus| tertius

Inferior third of ant. surface of fibula & interosseous membrane

Dorsum of base of 5th metatarsal bone

Main Actions

Deep fibular [peroneal] n. (L4 & L5)

Dorsiflexes & inverts foot

Extends 1st digit & dorsiflexes foot

V Deep fibular [peroneal] n. / (L5&S1)

Proximal Attachment

Distal Attachment

Fibularis [Peroneus] longus

Head & sup. 2/3 of lateral surface of fibula

Base of 1st metatarsal bone & medial cuneiform bone

Inf. 2/3 of lateral surface of fibula

Dorsal surface of tuberosity of 5th metatarsal bone

Extends lateral 4 digits & dorsiflexes foot

Dorsiflexes foot & aids in eversion of it

/

Lateral Muscle2

Fibularis [Peroneus] brevis

Innervation

Innervation 'l

Main Actions

Everts & plantarflexes foot 1 Superficial fibular (peroneal) n. r (L5, SI & S2)

J

Everts foot & weakly plantarflexes foot

“The fibularis [peroneus] longus and brevis were named because their proximal attachment is to the fibula. Peroneus is the Greek word for the Latin term fibula and has also been used to identify these muscles.

Lateral condyle of tibia Lateral condyle of tibia Head of fibula

Tibialis anterior m. Interosseous membrane

Extensor digitorum longus m.

Fibularis [Peroneus| tertius m. tendon Medial cuneiform bone Extensor digitorum longus m. tendons Base of 1st metatarsal bone Extensor expansions Distal phalanges

Anterior Views

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A.D.A.M. i Student Atlas of Anatomy

Anterior & Lateral Leg Muscles

Plate 5.10

Head of fibula

Fibularis [Peroneus) longus m

Fibula

Fibularis [Peroneus] brevis m.

Sup. fibular [peroneal] retinaculum Sup. fibular [peroneal] retinaculum Lateral malleolus

Lateral malleolus Inf. fibular [peroneal] retinaculum

Inf. fibular [peroneal] retinaculum

Fibularis [Peroneus] longus m. tendon (seen through tarsal bones) Tuberosity of 5th metatarsal bone

Lateral Views

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Table 5.5

Posterior Leg Muscles

Distal Attachment

Proximal Attachment

Muscles

Main Actions

Innervation

SUPERFICIAL GROUP

\

Lateral head: Lateral aspect of lateral condyle of femur Medial head: Popliteal surface of femur, sup. to medial condyle

Gastrocnemius

\ Tibialn. (L5, SI &S2)

Weakly assists gastronemius in plantarflexing foot & flexing knee joint

Medial side of tendo calcaneus

/

Proximal Attachment

Distal Attachment

Popliteus

Lateral epicondyle of femur & lateral meniscus

Post, surface of tibia, sup. to soleal line

Flexor hallucis longus

Inf. 2/3 of post, surface of fibula & inf. part of interosseous membrane

Base of distal phalanx of 1st digit (hallux)

Flexor digitorum longus

Medial part of post, surface of tibia, inf. to soleal line & by a broad aponeurosis to fibula

Bases of distal phalanges of lateral 4 digits

Tibialis posterior

Interosseus membrane, post, surface of tibia inf. to soleal line & post, surface of fibula

Tuberosity of navicular, cuneiform & cuboid bones, & bases of 2nd, 3rd & 4th metatarsal bones

Muscles

Plantarflexes foot

J

Inf. end of lat. supracondylar line of femur & oblique popliteal lig.

Plantaris

Plantarflexes foot, raises heel during walking & flexes knee joint

Post, surface of tuberosity of calcaneus via tendo calcaneus

Post, aspect of head of fibula, sup. l/4th of post, surface of fibula, soleal line & medial border of tibia

Soleus

\

Innervation

Main Actions

Tibial n. (L4, L5 & SI)

Weakly flexes knee & unlocks it

DEEP GROUP

\ Flexes 1st digit at all joints and plantarflexes foot ? I lulal 11.

Popliteal plane (surface) of femur

OJ) Flexes 4 digits & plantarflexes foot

Tibial n. (L4-L5)

Plantarflexes & inverts foot

Supracondylar line

Lateral condyle of femur

Plantaris m.-LS Lateral condyle of tibia Soleal line

S-Gastrocnemius m.—lateral head

Gastrocnemius m.—medial head

Soleus m.

Plantaris m. tendon

Tendo calcaneus (Achilles tendon)

Tendo calcaneus (Achilles tendon)—cut Tuberosity of calcaneus

Posterior Views of Superficial Muscles

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A.D.A.M. ! Student Atlas of Anatomy

Tuberosity of calcaneus

Posterior Leg Muscles

Plate

5.11

Tibia Tibia Fibula

Tibialis posterior m. Flexor digitorum longus m.

Flexor retinaculum

Flexor retinaculum

Tuberosity of calcaneus

Navicular bone Medial cuneiform bone Metatarsal bone

Distal phalanges

Lateral epicondyle of femur

Popliteus m.

Fibula

Tibia

Medial malleolus

Flexor retinaculum

Flexor hallucis longus m.

Tuberosity of calcaneus

Lateral Sesamoid bones—Medial

Distal phalanx of 1st digit

Posterior Views of Deep Muscles

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! LOWER LIMB

225

Table 5.6

Intrinsic Foot Muscles

Proximal Attachment

Muscle

Distal Attachment

Innervation

Main Actions

FIRST LAYER3 Medial side of base of proximal ' phalanx & medial sesamoid bone of 1st digit (hallux)

Abductor hallucis

Medial process of calcaneal tuberosity, flexor retinaculum & plantar aponeurosis

Flexor digitorum brevis

Medial process of tuber calcanei, plantar aponeurosis & intermuscular septa

Both sides of middle phalanges of lateral 4 digits

Abductor digiti minimi

Medial & lateral processes of calcaneal tuberosity, plantar aponeurosis & intermuscular septa

Lateral side of base of proximal phalanx of 5th digit (little toe)

Lateral plantar n. (S2 & S3)

Abducts & flexes 5th digit

Medial surface & lateral margin of plantar surface of calcaneus

Posterolateral margin of tendon of flexor digitorum longus

Lateral plantar n. (S2 & S3)

Assists flexor digitorum longus in flexing lateral 4 digits

Tendons of flexor digitorum longus

Medial sides of bases of proximal phalanges of lateral 4 digits & extensor expansions of extensor digitorum longus m. tendons

Medial one: medial plantar n. (S2 & S3) Lateral three: lateral plantar n. (S2 & S3)

Flex proximal phalanges & extend middle & distal phalanges of lateral 4 digits

Plantar surfaces of cuboid & lateral cuneiform bones

Both sides of base of proximal phalanx of 1st digit

Medial plantar n. (S2 & S3)

Flexes proximal phalanx of 1st digit (hallux)

Oblique head: Bases of metatarsal bones 2-4 Transverse head: Plantar ligg. of metatarsophalangeal joints 2-5

Tendons of both heads attached to lateral side of base of proximal phalanx & lat. sesamoid bone of 1st digit (hallux)

Deep br. of lateral plantar n. (S2 & S3)

Adducts 1st digit; assists in maintaining transverse arch of foot

Base of 5th metatarsal bone

Base of proximal phalanx of 5th digit

Superficial br. of lateral plantar n. (S2 & S3)

Flexes proximal phalanx of 5th digit

Bases & medial sides of metatarsal bones 3-5

Medial sides of bases of proximal phalanges of digits 3-5

Adjacent side of metatarsal bones 1-5

1st: medial side of proximal phalanx of 2nd digit 2nd-4th: lateral sides of digits 2-4

Abducts & flexes 1st digit ) Medial plantar n. (S2 & S3) Flexes lateral 4 digits (toes)

SECOND LAYER Quadratus plantae

Lumbricalis

THIRD LAYER Flexor hallucis brevis

Adductor hallucis

Flexor digiti minimi brevis

FOURTH LAYER Plantar interossei (3 muscles)

\ Adduct digits (2-4) & flex metatarsophalangeal joints

^ uaterai plantar n.

Dorsal interossei (4 muscles)

/

Abduct digits (2-4) & flex metatarsorphalangeal joints

“Independent of the individual actions associated with them, the primary function of the first layer of intrinsic muscles of the foot is to sustain the longitudinal arch of the foot (i.e., resisting forces tending to spread or flatten it).

Dorsal Surface View 226

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Student Atlas of Anatomy

Intrinsic Foot Muscles

FIRST LAYER

Plate 5.12

Proximal phalanx of 1st digit

FIRST LAYER Middle phalanges

Medial sesamoid bone Proximal phalanx of 5th digit

Flexor digitorum brevis m.

Abductor digiti minimi m. Abductor hallucis m.

Tuberosity of calcaneous

Distal phalanges

SECOND LAYER

Proximal phalanges

Lumbricals mm. Plantar Surface Views Flexor digitorum longus m. tendon

r

Tuberosity of calcaneus

Quadratus plantae m.

\

Adductor hallucis m.—transverse head

FOURTH LAYER THIRD LAYER Proximal phalanges

Lateral & medial sesamoid bones Base of proximal phalanx

Adductor hallucis m.—oblique head

4th metatarsal bone

Flexor hallucis brevis m.

Plantar interossei mm.

Flexor digiti minimi brevis m.

Base of 5th metatarsal bone

Lateral cuneiform bone Head of talus

Cuboid bone

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227

Plate 5.13

Gait Cycle—Stance Phase

Initial contact (heel strike)

Loading response (foot flat)

Midstance

Terminal stance (heel off)

Preswing (toe off) (heel strike)

-Push OffPropulsion & swing limb advancement

Right Stance Phase (60%) of Gait Cycle Single limb support (40%) Supporting body weight

Double limb support

(10%) Weight acceptance

Double limb support

(10%)

Phase Subdivisions

Functional Objectives

Active Muscle Groups

Primary Muscle(s)

Initial contact

Lower forefoot to substrate

Tibialis anterior

Maintain longitudinal arch of foot

Ankle dorsiflexors (eccentric contraction) Hip extensors Intrinsic muscles of foot Long tendons of foot

Weight bearing Decelerate mass (slow dorsiflexion)

Knee extensors Ankle plantar flexors

Stabilize pelvis

Hip abductors

Maintain longitudinal arch of foot

Intrinsic muscles of foot Long tendons of foot

Quadriceps Triceps surae (soleus & gastrocnemius) Gluteus medius & minimus, tensor of fascia lata Flexor digitorum brevis Tibialis posterior, long flexors of digits

Stabilize knee Control dorsiflexion (sustain momentum)

Knee extensors Ankle plantarflexors (concentric contraction) Hip abductors

(heel strike)

(controlled plantarflexion until forefoot contacts substrate) Continue deceleration (slow forward swing)

Loading response (flat foot)

Midstance

Stabilize pelvis

Terminal stance

Maintain longitudinal arch of foot

Intrinsic muscles of foot Long tendons of foot

Propel & accelerate mass

Ankle plantarflexors (concentric contraction) Hip abductors

(heel off)

Stabilize pelvis Maintain arches of foot, fix forefoot

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Intrinsic muscles of foot Long tendons of foot

Gluteus maximus Flexor digitorum brevis Tibialis anterior

Quadriceps Triceps surae (soleus contraction) Gluteus medius & minimus, tensor of fascia lata Flexor digitorum brevis Tibialis posterior, long flexors of digits Triceps surae (gastrocnemius & soleus) Gluteus medius & minimus, tensor fascia latae Adductor hallucis Tibialis posterior, fibularis longus

Gait Cycle—Swing Phase

Preswing (toe off)

Initial swing

Midswing

Terminal swing

Plate 5.14

Initial contact (heel strike)

-Push OffPropulsion & swing limb advancement End of Stance Phase

A

Double limb support

(10%)

Right Swing Phase (40%)

Beginning of next cycle

Single limb support (40%)

Double limb support

Phase Subdivisions

Functional Objectives

Active Muscle Groups

Primary Muscle(s)

Preswing

Propel & accelerate mass

Long flexors of digits

Maintain arches of foot, fix forefoot

Intrinsic muscles of foot Long tendons of foot Flexors of hip (eccentric contraction)

Flexor hallucis longus, flexor digitorum longus Adductor hallucis Tibialis posterior, fibularis longus Iliopsoas, rectus femoris

(toe off)

Accelerate thigh; swing

Initial swing

Accelerate thigh Clear foot

Midswing

Maintain flexed knee Clear foot

Terminal swing

Decelerate thigh & leg

(heel strike)

Extend knee for heel strike (control stride length), prepare for contact with substrate Position foot Absorb shock at impact

Flexors of hip (concentric contraction) Ankle dorsiflexors

Illiopsoas, rectus femoris, sartorius Tibialis anterior

Knee flexors (concentric contraction) Ankle dorsiflexors

Hamstrings, sartorius Tibialis anterior

Hip extensors (eccentric contraction) Knee extensors (concentric contraction) Ankle dorsiflexors Knee extensors (eccentric contraction)

Gluteus maximus, hamstrings Quadriceps Tibialis anterior Quadriceps

During normal walking on a level surface in a straight line at a constant speed, a single gait cycle begins with heel strike (initial contact) of one foot and ends with the heel strike (initial contact) of the same foot. Each cycle is divided into stance and swing phases and each phase is further subdivided into component parts. The stance phase for each limb is that interval of the cycle that begins with heel strike (initial contact) and ends with toe off. During stance phase, the foot is stationary relative to the substrate and is weight bearing. Swing phase occurs between toe off and heel strike (initial contact). The limb in swing phase is non-weight bearing and moves in the desired direction of travel. Tables under each set of figures indicate the functional objectives of the major muscle groups and primary muscles that are active during each subdivision of stance and swing phases.

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229

Plate 5.15

Arteries of Lower Limb

Deep circumflex iliac a.

Ext. iliac a.

Abdominal aorta

Common iliac a. Abdominal aorta

Superficial circumflex iliac a.

Middle sacral a.

Ascending br. of lateral femoral circumflex a.

Int. iliac a.

Inf. epigastric a.

Lateral femoral circumflex a.

Common iliac a.

Iliolumbar a.— Sup. gluteal a.

Ext. iliac a. Int. iliac a.

Lateral sacral a. -

Deep circumflex iliac a.

Inf. — gluteal a.

Ext. pudendal a. Deep femoral a.

Medial femoral circumflex a.

Obturator a. Int. pudendal a._

Deep femoral a.

Inf. rectal a.

Descending br. of lateral femoral circumflex a.

Femoral a. Sciatic br. of inf. gluteal a.

Perforating aa. (I III) Femoral a.

Descending br. of lateral femoral circumflex a.

Perforating aa. (I—II)

Descending genicular a. Popliteal a. Sup. lateral genicular a.

Descending genicular a. Sup. medial genicular a.

Sup. medial genicular a. Popliteal a.

Inf. lateral genicular a.

Genicular anastomoses

Ant. tibial recurrent a.

Genicular anastomoses

Middle genicular a. Inf. medial genicular a.

Inf. medial genicular a. Ant. tibial a.

Post, tibial a.

Ant. tibial a. Post tibial a.

Fibular [Peroneal] a.

Lateral malleolar br. of ant. tibial a. Medial malleolar br. of ant. tibial a.

Medial malleolar br. of post, tibial a.

Medial malleolar br. of ant. tibial a.

Dorsalis pedis a. Lateral tarsal a.

Medial tarsal aa.

Post, tibial a.

Dorsalis pedis a.

Deep plantar br. of dorsalis pedis a.

Lateral plantar a.

Arcuate a.

Plantar arch Dorsal metatarsal aa.

Medial plantar a.

Dorsal digital a.

Anterior View

23O

A.D.A.M.

Student Atlas of Anatomy

Medial View

Arteries of Lower Limb

Plate

5.16

Sup. gluteal a.

Sup. gluteal a. Inf. gluteal a.

Lateral femoral circumflex a.

Obturator a.

Deep br. of sup. gluteal

Superficial br. of SUP' gluteal alnH gluteal a.

Ascending br. of lateral femoral circumflex a.

Ascending br. of lateral femoral circumflex a.

Lateral femoral circumflex a.

Sciatic br. of inf. gluteal a.

Deep femoral a.

Sciatic br. of inf. gluteal a.

Descending br. of lateral femoral circumflex a.

Deep femoral a.

Femoral a.

Femoral a.

Descending br. of lateral femoral circumflex a.

Perforating aa. (I-III)-

Perforating aa. (I HI)

Descending genicular a. Sup. medial genicular a. Sup. lateral genicular a.

Sup. lateral genicular a. Genicular anastomoses

Popliteal a. Popliteal a.

Inf. lateral genicular a.

Middle genicular a.

Middle genicular a.

Inf. medial genicular a.

Inf. lateral genicular a. Circumflex fibular a. Circumflex fibular a.

Post, tibial a.

Ant. tibial recurrent a.

Ant. tibial a. Post, tibial a.

Ant. tibial a.

Fibular [peroneal] a.

Fibular [peroneal] a.

Lateral malleolar br. of ant. tibial a.

Post, tibial a. Medial malleolar br. of post tibial a.

I_Lateral malleolar br. of

fibular [peroneal] a.

Lateral malleolar br. of fibular [peroneal] a. Dorsalis pedis a.

Lateral plantar a.

Medial plantar a.

Plantar arch

Deep plantar br. of dorsalis pedis a.

Dorsal metatarsal a.

Arcuate a.

Plantar metatarsal aa.

Deep br. of medial plantar a. Superficial br. of medial plantar a.

Plantar digital aa.

Posterior View

Lateral View

Chapter 5 I LOWER LIMB

231

Plate

5.17

Superficial Veins of Lower Limb

Superficial epigastric v. Superficial circumflex iliac v. Ext. pudendal v. R. ext. iliac v. Great saphenous v. Ant. femoral cutaneous v.

Ext. pudendal v.

Accessory saphenous v. Accessory saphenous v.

Ant. femoral cutaneous v.

Perforating or anastomosing v.

Great saphenous v.

Genicular vv.

Genicular vv. —

Perforating or anastomosing v. Perforating or anastomosing vv.

Great saphenous v.

Perforating or anastomosing vv.

Perforating or anastomosing v.

Lateral malleolus Medial malleolus Medial malleolus Small saphenous v.

Accessory saphenous v. Dorsal metatarsal vv.

Dorsal venous arch

Great saphenous

Dorsal venous arch Perforating or anastomosing vv.

Dorsal digital v.

Anterior View

Lat. suralcutaneous n. Great saphenous v.

Medial sural cutaneous n.

Sural n. Small saphenous v.

Perforating or anastomosing v.

Lateral malleolus

Plantar venous network Posterior View

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Medial View

Deep Veins of Lower Limb

Plate 5.18 Inf. vena cava

Inf. vena cava

R. common iliac v. R. int. iliac v.

R. ext. iliac v. R. common iliac v.

R. ext iliac v.

Sup. gluteal v.

Superficial circumflex iliac v. Deep circumflex iliac v.-

' R. int. iliac v.

Inf. gluteal v.

Obturator v.

Int. pudendal v.

Great saphenous v.

Great saphenous v. (cut) Deep femoral v.

Femoral v. ■ Ext. pudendal v. Deep. Femoral v.

Perforating vv. -

Perforating vv.

' Femoral v.

&

Small saphenous v. (cut)

Descending genicular v.

Sup. medial genicular v.

Descending genicular v. - Popliteal v.

Sup. lateral genicular v..

Middle genicular v. ' Sup. medial genicular v.

Popliteal v. Inf. medial genicular v.

Inf. lateral genicular v. Inf. medial genicular v.

I-Inf. vena cava Tibialis anterior v.

Sup. gluteal v.

Tibialis anterior w. ■

Post, tibial v. Inf. gluteal v. Int. pudendal v. Venous rete of dorsalis pedis v. Deep, femoral v. Lateral plantar v. Venous network of dorsalis pedis v.

Perforating v.

Femoral v. Descending genicular v.

Medial plantar v. g. ■ Perforating v.

Sup. medial genicular v.

Anterior View

1-Sup. lateral genicular v.

Small saphenous v. (cut)

Medial View

v_

Popliteal v.

Middle genicular v.

Inf lateral genicular v. Inf. medial genicular v.

Tibialis anterior v. Fibular [peroneal] v.

Post, tibial v.

Medial plantar v.

Lateral plantar v.

Plantar venous network

Posterior View

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Plate 5.19

Dermatomes & Cutaneous Nerves of Lower Limb

TIO

Lateral cutaneous br. of subcostal n. (T12) Ant. cutaneous br. of subcostal n. (T12) Lateral cutaneous br. of iliohypogastric n.

T12 ■ Ant. cutaneous br. of iliohypogastric n.

Femoral br. of genitofemoral n. Lateral femoral cutaneous n. Genital br. of genitofemoral n.

Cutaneous br. of obturator n.

br. -Ant. femoral cutaneous nn. Intermediate br.

Br. of lateral sural cutaneous n.

Infrapatellar br. of saphenous n.

Saphenous n.

Superficial fibular [peroneal] n.

Lateral dorsal cutaneous n. of foot

Dorsal digital nn. Dorsal digital br. of deep fibular [peroneal] n.

Anterior Views

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Student Atlas of Anatomy

Dermatomes & Cutaneous Nerves of Lower Limb

Plate 5.20

Post, labial n.

Ilioinguinal n.

Medial br. of post, femoral cutaneous n. Cutaneous br. of obturator n.

Ant. femoral cutaneous n.

Intermediate br. Medial br.

Post, femoral cutaneous n.

Infrapatellar br. of saphenous n. Medial crural br. of saphenous n.

Saphenous n.

Medial calcaneal br. of tibial n.

Medial Views

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Plate 5.21

Dermatomes & Cutaneous Nerves of Lower Limb

Sup. cluneal nn. Lateral cutaneous br. of iliohypogastric n.

Middle cluneal nn.

Inf. cluneal nn. Lateral femoral cutaneous nn.

Perineal br. of post, femoral cutaneous n. Post, femoral cutaneous n. Cutaneous br. of obturator n.

Post, femoral cutaneous n.Medial crural br. of saphenous n.

Sural communicating br. of common fibular [peroneal] n.

Small saphenous v.

Medial sural cutaneous n.

Sural n.

Medial calcaneal br. of saphenous n.

Lateral calcaneal br. of sural n.

Posterior Views

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Dermatomes & Cutaneous Nerves of Lower Limb Lateral cutaneous br. of subcostal n.

Plate 5.22

Ant. cutaneous br. of intercostal nn. (T9-T11)

Lateral cutaneous br. of iliohypogastric n.

T10 Til T12

Sup. cluneal nn.

Lateral femoral cutaneous n. Inf. cluneal nn.

Intermediate br. of ant. cutaneous n. Post, femoral cutaneous n.

Lateral sural cutaneous n.

Sural communicating br. of common fibular [peroneal] n.

Medial sural cutaneous n.

Sural n.

Superficial fibular [peroneal] n.

Lateral dorsal cutaneous n. of foot

digital nn.

Deep fibular [peroneal] n.

Lateral Views

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Plate 5.23

Segmental Innyervation & Joint Actions

HIP

External/Lateral Rotation

Internal/Medial Rotation

ANKLE—Talocrural Joint FOOT—Metatarsophalangeal Joints

Dorsiflexion

L4

Dorsiflexion or extension L5,S1

S1,S2

\ 238

A.D.A.M.

Plantarflexion Plantarflexion

Student Atlas of Anatomy

S1,S2

Lumbosacral & Coccygeal Plexi

Plate 5.24

Intercostal nn. —

T10 Til Psoas minor m.

Lumbar portion of sympathetic trunk Subcostal n. (T12)

Quadratus lumborum m.

Iliohypogastric n. (T12) Ilioinguinal n. (LI)

Psoas major m. Lateral femoral cutaneous n. (L2,L3) Uiacus m. Genitofemoral n. (L1,L2) Obturator n. (L2-L4)

L1 ® Lumbosacral trunk (L4,L5) Femoral n. (L2-L4)

Inguinal lig.

Genital br. of genitofemoral n. (L1,L2)

Femoral br. of genitofemoral n. (L1,L2)

N. to pectineus m. (L2-L4)

Sciatic n. (L4-S3) Muscular brr. of femoral n. (L2-L4)

Ganglion impar

Pelvic portion of sympathetic trunk

Obturator n. (L2-L4)

Cutaneous brr. of femoral n. (L2-L4)

Anterior View

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239

Plate 5.25

Deep Nerves of Lower Limb

Subcostal n.

Iliohypogastric n. Lateral femoral cutaneous n.

Ilioinguinal n. Lateral femoral cutaneous n.

Genitofemoral n.

Femoral n.

Genitofemoral n.

Lumbosacral trunk Lumbosacral trunk

Femoral br. of genitofemoral n.

Obturator n. Femoral n.

Genital br. of genitofemoral n.

Genital br. of genitofemoral n.

Obturator n.

Femoral br. of genitofemoral n.

N. to pectineus m

Pudendal n.

Saphenous n. Obturator n. Sciatic n.

Muscular (deep) brr. of femoral n.

Muscular (deep) br. of femoral n.

Post, femoral cutaneous n.

Recurrent articular n.

Tibial n.

Common fibular [peroneal] n.

Superficial fibular [peroneal] n.

Muscular brr. of tibial n. Deep fibular [peroneal] n.

Intermediate dorsal cutaneous n. of foot

Medial dorsal cutaneous n. of foot

Lateral plantar n.

Medial plantar n. Dorsal digital nn.

Medial (terminal) br. of deep fibular [peroneal] n.

Anterior View

24O

A.D.A.M. ' Student Atlas of Anatomy

Medial View

Deep Nerves of Lower Limb

■ Sup. gluteal n.

Plate 5.26

I-Sup. gluteal r

■ Inf. gluteal n.

Obturator n. -

Femoral n. Pudendal n.

Pudendal n.■ Sciatic n.

Post. femoral_E cutaneous n.

Sciatic n

I ■

a i

Muscular brr. of sciatic n.

_

Muscular brr. of femoral n.

Post, femoral cutaneous n.

v «

Common fibular [peroneal] n. Tibial n. - Lateral sural cutaneous n. Medial sural cutaneous n. -

Common fibular [peroneal] n.

Deep fibular [peroneal] n. 7

. Sural communicating br. of common fibular [peroneal] n. Deep fibular_ [peroneal] n.

Muscular brr. of deep fibular [peroneal] n. Superficial fibular [peroneal] n.

Sural n.-

Superficial fibular [peroneal] n.

Tibial n.-

Medial plantar

n.-

Lateral plantar n. Dorsal digital nn.

Common digital plantar nn. -

1 Posterior View

Lateral View

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241

Plate 5.27

Lumbar Plexus

Subcostal n. (T12)

Subcostal n. (T12) Quadratus lumborum m.

Psoas minor m.

Iliohypogastric n. (LI) Iliohypogastric n. (LI) Ilioinguinal n. (LI) Ilioinguinal n. (LI) Psoas major m. Genitofemoral n. (L1,L2) Iliac crest Lateral femoral cutaneous n. (L2,L3)

Genitofemoral n. (L1,L2) Femoral br. of genitofemoral n. (L2) Iliacus m.

Femoral n. (L2-L4)

Lumbosacral trunk (L4,L5) Lateral femoral cutaneous n. (L2,L3)

Obturator n. (L2-L4)

Genital br. of genitofemoral n. (L1,L2) Lumbosacral trunk (L4,L5)

Inguinal lig.

Obturator n. (L2-L4)

Femoral n. (L2-L4)

Iliopsoas m. tendon

Obturator n. (L2-L4)

Anterior View

242

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Student Atlas of Anatomy

Sacral & Coccygeal Plexi

Plate 5.28

Medial View of Right Sacral & Coccygeal Plexi Gray rami communicantes

L4 contribution to femoral n.

Sup. gluteal nn. (L4-S1)

Inf. gluteal nn. (L5-S2) Lumbosacral trunk (L4,L5) N. to piriformis m. (S1,S2)Dorsal division of S2

Ventral division of S2 Col

Sciatic n.

Pelvic splanchnic nn. (parasympathetic S2-S4)

Common fibular [peroneal] n. (L4-S2) Tibial n. (L4^S3)

Anococcygeal n. (S5,Col) Perineal br. of 4th sacral n. (S4) Pudendal n. (S2-S4)

N. to quadratus femoris & inf. gemellus mm. (L4—SI) N. to obturator internus & sup. gemellus mm. (L5-S2)

Perforating cutaneous n. (S2,S3) Post, femoral cutaneous n. (S1-S3)

Lumbosacral trunk

Pelvic portion of sympathetic trunk Sup. gluteal n. N. to quadratus femoris m.

Femoral n. (from lumbar plexus)

N. to obturator interims m.

Pelvic splanchnic nn. (cut) (parasympathetic to pelvis plexus)

Sacrospinous lig.

Ganglion impar

Pudendal n.

Sacrotuberous lig. Obturator a., v. & n. (from lumbar plexus) Fat in lesser sciatic foramen

Inf. rectal n. Medial View of Right Plexi

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243

Plate 5.29

Superficial Lymphatics

Superficial inguinal lymph nodes (proximal group)

Deep inguinal lymph nodes Superficial inguinal lymph nodes (distal group)

Great saphenous v.

Lymphatic vessels

Lymphatic vessels

Lymphatic vessels

Anterior View

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A.D.A.M. ! Student Atlas of Anatomy

Lymphatics of Lower Limb

Plate 5.30

Superficial popliteal lymph nodes

Deep popliteal lymph nodes

Deep fascia (cut edge)

Lymphatic vessels Small saphenous v.

Lymphatic vessels

Posterior View

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245

Plate 5.31

Anterior Thigh

◄ Anterior View

Int. abdominal oblique m. Iliohypogastric n. Ant. superior iliac spine

Inguinal lig. Femoral sheath

Iliopsoas m.

Ilioinguinal n. Femoral n. Pectineus m. Femoral br. of genitofemoral n

Pubic tubercle Genital br. of genitofemoral n.

Tensor fasciae latae m. Great saphenous v. Sartorius m.

Femoral v.

Saphenous n.

Femoral a. Adductor longus m.

Iliotibial tract Gracilis m. Muscular brr. of obturator n.

Vastus lateralis m.

Adductor magnus m.

Rectus femoris m.

Sartorius m. Quadriceps femoris m. tendon

Common iliac v. & a.

Lateral femoral cutaneous n. Deep iliac circumflex a.

Int. iliac a.

Vastus medialis m.

Sup. lateral genicular v. & a.

Descending genicular a. & v.

Ext. iliac a. & v.

Tensor fascia latae m.

Lateral sacral a. Iliopsoas m.

Iliotibial tract Sup. medial genicular a. & v. Biceps femoris m.

Gluteus medius m.

Inf. epigastric a. & v.

Gluteus minimus m. Patella

Lateral patellar retinaculum

Femoral br. of genitofemoral n.

Iliofemoral lig.

Patellar lig.

Inf. lateral genicular a. & v. Extensor digitorum longus m.

Ant. superior iliac spine

Medial patellar retinaculum

Pubic tubercle Greater trochanter of femur Iliotibial tract

Tibial collateral lig. Sartorious m. tendon Inf. medial genicular a. & v.

Fibularis [Peroneus] longus m.

Femoral v.

Trochanteric bursa

Pectineus m. Great saphenous v. Femoral a.

Lateral femoral circumflex a. & v.

Deep femoral a. & v.

Muscular br. of femoral n.

Tibial tuberosity

Adductor longus m. Muscular brr. of obturator

Tibialis anterior m. Gastrocnemius m. —medial head

Saphenous n.

Adductor magnus m.

Vastus intermedius m. (deep to rectus femoris m.) Gracilis m. Vastus lateralis m. Vastus medialis m. Quadriceps femoris m. tendon Sup. lateral genicular v. & a. Biceps femoris m. Lateral patellar retinaculum Patellar lig.

Descending genicular a. & v. Medial sup. genicular a. & v. Patella Infrapatellar br. of saphenous n. Medial patellar retinaculum Inf. medial genicular a. & v.

Inf. lateral genicular a. & v. Sartorius m. tendon Ant. tibial a. & v. Tibial tuberosity Anterior View ►

Fibularis [peroneus] longus m. Gastrocnemius m.—medial head Tibialis anterior m.

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A.D.A.M. ! Student Atlas of Anatomy

Anterior Thigh

Plate 5.32

M Anterior View

Iliacus m. Ant. superior iliac spine Gluteus minimus m.

Piriformis m.

Gluteus medius m. Coccygeus m.

Iliofemoral lig Greater trochanter of femur

Pubofemoral lig. Pubic tubercle

Pectineus m.

Ant. br. of obturator n. Iliotibial tract Muscular br. of obturator n. Femoral v. Femoral a.

Adductor brevis m. Adductor magnus m.

Vastus lateralis m. (coronal section)

Gracilis m.

Articularis genu m.

Vastus medialis m. (coronal section)

Ant. sacroiliac lig.

Descending genicular v. Sup. lateral genicular v. & a.

Suprapatellar bursa Sup. medial genicular a. & v.

Patella

Articular capsule of knee joint

Inf. lateral genicular a. & v.

Gluteus minimus m.

Gluteus medius m. Piriformis m.

Iliofemoral lig. Trochanteric bursa

Pubofemoral lig. Pubic tubercle

Ant. division of Muscular brr. of obturator n.

Patellar lig Common fibular (peroneal) n.

Tensor fascia latae m.

Inf. medial genicular a. & v.

Obturator externus m.

Quadratus femoris m

Inf. pubic ramus

Tibial tuberosity

Fibularis [peroneus] longus m. (sectioned)

Post, division of muscular brr. of obturator n.

Iliotibial tract

Femoral v. & a.

Gastrocnemius m.—medial head Ant. tibial a & v.

Adductor magnus m. Vastus lateralis m. (coronal section)

Gracilis m.

Tendon of Adductor magnus m.

Infrapatellar br. of saphenous n. Descending genicular a.

Suprapatellar bursa Fat in adductor hiatus Sup. lateral genicular v. & a.

Sup. medial genicular a. & v.

Patella Articular capsule of knee joint Inf. lateral genicular a. & v.

Patellar lig. Tibial collateral lig.

Common fibular [peroneal] n. Anterior View ►

Inf. medial genicular a. & v. Tibial tuberosity

Ant. tibial a. & v. Fibularis [peroneus] longus m. (sectioned)

Gastrocnemius m.—medial head

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247

Plate 5.33

Femoral Triangle

Lateral femoral cutaneous n.

Peritoneum

Testicular a. & v.

Ant. superior iliac spine

Greater omentum seen through peritoneum

Deep circumflex iliac a. Inguinal lig.

Inf. epigastric a. Iliopsoas m. Femoral a.

Femoral n.

Iliotibial tract

Femoral v.

Femoral br. of genitofemoral n. Lacunar lig. (cut) Superficial epigastric a.

Superficial circumflex iliac a.

Great saphenous v. Deep femoral a. Ext. pudendal a. Tensor fascia latae m. Pectineus m. Ant. cutaneous br. of femoral n. Tendon of adductor brevis m.

Muscular brr. of deep femoral a. (deep to rectus femoris m.)

Brr. of ant. br. of obturator n.

Adductor magnus m. Vastus lateralis m.

Rectus femoris m. Gracilis m. Iliotibial tract

Sartorius m.

Adductor longus m.

Anterior View of Right Proximal Thigh

248

A.D.A.M.

Student Atlas of Anatomy

Femoral Triangle

Plate 5.34

Inguinal lig. Lateral femoral cutaneous n.

Deep circumflex iliac a.

Inf. epigastric a.

Superficial circumflex iliac a.

Superficial epigastric a.

Femoral v.

Tensor fascia latae Iliopsoas m.

Lymph vessels

Femoral n.

Ext. pudendal a.

Femoral a.

Great saphenous v.

Sartorious m.

Pectineus m. Deep inguinal lymph node

Deep femoral a.

Pubic tubercle Iliotibial tract Femoral br.of genitofemoral n.

Brr. of ant. br. of obturator n.

Rectus femoris m.

Iliotibial tract Adductor longus m.

Gracilis m. Adductor brevis m.

Muscular br. of deep femoral a. (deep to rectus femoris m.)

Anterior View of Right Proximal Thigh

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249

Plate 5.35

Posterior Thigh

Gluteus medius m.—covered by fascia

Gluteus maximus m.

Adductor magnus m.

Iliotibial tract Gluteus medius m. Vastus lateralis m.

Sup. gluteal a. & v.

Gracilis m.

Piriformis m. Semimembranosus m. Post, femoral cutaneous n.

Inf. gluteal n. Biceps femoris m.—long head

Semitendinosus m.

Inf. gluteal a. & v. Inf. gemellus m. Sacrotuberous lig.

Biceps femoris m.—short head

\

Popliteal a. & v.

Tibial n. Plantaris m.

Saphenous n.

Common fibular [Peroneal] n.

Pudendal n. Obturator interims m. Ischial tuberosity

Gracilis m,

Gastrocnemius m. —medial head Small saphenous v.

Medial sural cutaneous n.

Sciatic n. Adductor magnus m.

Adductor magnus m.

Lateral sural cutaneous n.

Gastrocnemius m.—lateral head

Quadriceps femoris m.

Semimembranosus m.

Semitendinosus m.

Vastus lateralis m.

Post, femoral cutaneous n.

Biceps femoris m. —long head

Biceps femoris m. —short head

Saphenous n.

Posterior Views

Tibial n.

Popliteal a. & v. Common fibular n. Lateral sural cutaneous n. Gastrocnemius m.— medial head

Medial sural cutaneous n.

Small saphenous v. Gastrocnemius m. —lateral head

25O

A.D.A.M.

Student Atlas of Anatomy

Posterior Thigh

Plate 5.36

Sup. gluteal a. & v.

Iliac crest

Sup. gluteal n.

N. to obturator internus & sup. gemellus mm.

Post, femoral cutaneous n. Gluteus medius m.

Inf. gluteal a. & v. Gluteus minimus m. (cut) Inf. gluteal n.

Int. pudendal a. & v.

Greater trochanter of femur Sup. gemellus m.

Sacrotuberous lig.

Inf. gemellus m.

Pudendal n Ischial tuberosity

Quadriceps femoris m.

Gracilis m. Adductor magnus m. Muscular br. of sciatic n. Sciatic n. Iliac crest Adductor magnus m. Vastus lateralis m. Semimembranosus m.

Sup. gluteal a. & v.

Sacrospinous lig. Gluteus medius m. (cut)

Semitendinosus m. Biceps femoris m. —short head Tibial n.

Inf. gluteal a. & v. Greater trochanter of femur

Common fibular [peroneal] n.

Medial sural cutaneous n.

Saphenous n.

Sup. gemellus m.

Obturator internus m.

Plantaris m.

Popliteal a. & v.

Biceps femoris m. head (cut)

Inf gemellus m. Ischial tuberosity

Quadriceps femoris m.

Gracilis m. Perforating v.

Lateral sural cutaneous n. Gastrocnemius m.—medial head

Vastus lateralis m.

Gastrocnemius m. —lateral head

Small saphenous v. Adductor magnus m.

Biceps femoris m. —short head Adductor hiatus

Popliteal a. & v.

Saphenous n. -Tibial n. Posterior Views

Adductor magnus m. tendon

Plantaris m. Biceps femoris m. —long head (cut)

Gastrocnemius m.—medial head Gastrocnemius m. —lateral head

Small saphenous v.

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251

r

Gluteal Region

Plate 5.37

Iliac crest

Ant. gluteal line

Sup. gluteal a. & n.

Post, inferior iliac spine Gluteus minimus m.

Gluteus medius m. (coronal section)

Post, sacroiliac lig.

Sup. gluteal a. & v. (cut) Piriformis m. N. to obturator internus & sup. gemellus mm.

Inf. gluteal n.

Inf. gluteal a. Pudendal n.

Sacrospinous lig. Int. pudendal a. & v.

Sup. & inf. gemellus mm.

Coccyx Sciatic n.

Greater trochanter of femur

Sacrotuberous lig. Pudendal n.

Quadratus femoris m.

Obturator internus m.

Sciatic br. of inf. gluteal a. Post, femoral cutaneous n.

Ischial tuberosity

Adductor magnus m. Gracilis m. Vastus lateralis m.

Adductor magnus m

Semimembranosus m. Semitendinosus m.

Biceps femoris m.—long head

Posterior View

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A.D.A.M. ! Student Atlas of Anatomy

Gluteal Region

Plate 5.38

Post gluteal line Gluteus maximus m. (cut off)

Gluteus medius m. (cut off)

Sup. gluteal a. & v.

Iliac crest

Post, sacroiliac lig. Ant. gluteal line Piriformis m. Post, inferior iliac spine

Inf. gluteal n. Gluteus minimus m. Inf. gluteal a.

Coccyx Tensor fasciae latae m. Sacrotuberous lig.

Sup. & inf. gemellus mm.

Greater trochanter of femur

Levator ani m. Quadratus femoris m. Sciatic n.

Anus

Ischial tuberosity

Gluteus maximus m. (insertion into iliotibial tract cut)

Posterolateral View

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253

Plate 5.39

Medial & Lateral Thigh

Common iliac a.

◄ Medial View

Iliac crest Int. iliac a. Lateral sacral a. & v. Piriformis m.

Ext. iliac a.

Umbilical a. Obturator a. & v.

Sacrospinous lig. Gluteus maximus m.

Symphysis of pubis

Obturator internus m. Adductor longus m. Latissimus dorsi m.

Adductor magnus m.

Int. oblique abdominal m.

Semimembranosus m. Rectus femoris m. Gracilis m.

Ext. oblique abdominal m. Iliac crest

Sartorius m.

Semitendinosus m.

Gluteus medius m. (covered by fascia)

Vastus medialis m. Sup. medial genicular a. & v.

Gluteus maximus m. Tensor fasciae latae m.

Synovial capsule of knee joint a

Patella

Sartorius m.

Medial patellar retinaculum

Saphenous n.

Inf. medial genicular a. & v.

Rectus femoris m.

Sartorius m. tendon Pes anserinus—

Plates 5.40 & 5.41 (top)

Gracilis m. tendon Semitendinosus m. tendon

Iliotibial tract Biceps femoris m.—long head Vastus lateralis m.

Gastrocnemius m.—medial head

Plates 5.40 & 5.41 (bottom)

Biceps femoris m.—short head

Quadriceps femoris m. tendon

Patella Common fibular [peroneal] n.

Lateral sural cutaneous n.

Lateral View ►

Lateral patellar retinaculum

Patellar lig.

Gastrocnemius m.—lateral head — Fibularis [Peroneus] longus m. Tibialis anterior m.

254

A.D.A.M. I Student Atlas of Anatomy

Cross Sections of Thigh

Plate 5.40

ANTERIOR Rectus femoris m.

Vastus intermedius m. Vastus medialis m.

Femur

Deep femoral a. & v. Sartorius m. Medial intermuscular septum

Vastus lateralis m.

Saphenous n. Great saphenous v. Femoral a. & v.

LATERAL

Adductor longus m.

Iliotibial tract

MEDIAL Adductor brevis m.

Lateral intermuscular septum Sciatic n. Gracilis m.

Biceps femoris m.—short head

Adductor magnus m. Biceps femoris m.—long head Semimembranosus m. Semitendinosus m.

POSTERIOR

Distal Views of Right Thigh

ANTERIOR Quadriceps femoris m. tendon

Articularis genus m.

Vastus medialis m. Vastus lateralis m. Popliteal a. & v.

LATERAL

Great saphenous v.

Iliotibial tract

MEDIAL

Tibial n

Sartorius m.

Adductor magnus m. tendon Biceps femoris m.—short head Saphenous n. Gracilis m.

Common fibular [peroneal] n.

Semimembranosus m. Biceps femoris m.—long head Semitendinosus m.

POSTERIOR

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255

Plate 5.41

Cross Sections of Thigh ANTERIOR Rectus femoris m.

Vastus intermediurtn. Vastus medialis m.

Femur

Deep femoral a. & v.

Sartorius m. Vastus lateralis m. Great saphenous v. Femoral a. & v. Adductor longus m. — LATERAL

Iliotibial tract

MEDIAL —

Adductor brevis m. Biceps femoris m.—short head

Sciatic n. Gracilis m. Adductor magnus m.

Biceps femoris m.—long head Semimembranosus m. Semitendinosus m. POSTERIOR

Distal Views of Right Thigh

ANTERIOR Quadriceps femoris m. tendon

Articularis genus m.

Vastus medialis m. Vastus lateralis m. Popliteal a. & v.

Femur

LATERAL

Great saphenous v.

Iliotibial tract

Tibial n.

MEDIAL

Sartorius m.

Adductor magnus m. tendon Biceps femoris m.—short head Saphenous n. Gracilis m.

Common fibular [peroneal] n.

Semimembranosus m. Biceps femoris m.—long head Semitendinosus m. POSTERIOR

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A.D.A.M. I Student Atlas of Anatomy

Topography of Thigh Femoral n.

Femoral a. & v.

Plate

5.42

Inguinal lig.

Pectineus m. Tensor fasciae latae m.

Pubic tubercle

Posterior View ▼

Sartorius m Great saphenous v.

Ischial tuberosity

Adductor longus m. Rectus femoris m.

Gluteal fascia covering greater trochanter of femur

Muscular br. of femoral n.

Iliotibial tract Gluteus maximus m.

Plates 5.40 & 5.41 (top) Gracilis m. Perineal brr. of post, femoral cutaneous n.

Vastus lateralis m. Vastus medialis m.

Gracilis m. Post, femoral cutaneous n.

Plates 5.40 & 5.41 (bottom) Adductor magnus m. driceps femoris m. tendon Semimembranosus m

Biceps femoris m.— long head

Patella Semitendinosus m.

Biceps femoris m.—short head

Patellar lig. Medial patellar retinaculum

Tibial n. Common fibular [peroneal] n. Popliteal a. & v. (in vascular sheath)

Anterior View ▲ Lateral sural cutaneous n. Great saphenous v.

Tibial n.

Small saphenous v.

Gastrocnemius m.—medial & lateral heads

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Plate

5.43

Hip Joint Iliac crest Post, superior iliac spine Ala of ilium

Posterior View ►

Tubercle of iliac crest Greater sciatic notch Body of ilium

Medial sacral crest

Ischial spine Post, sacral foramina Rectus femoris m. tendon (cut) Sacrum

Sacrospinous lig. Iliofemoral lig.

Coccyx

Greater trochanter of femur

Sacrotuberous lig.

Ischiofemoral lig. Body of pubis Trochanteric fossa Zona orbicularis

Obturator foramen Inf. pubic ramus

Intertrochanteric crest

Body of ischium Lesser trochanter Ischial tuberosity Gluteal tuberosity Biceps femoris m.—tendon of long head Pectineal line of femur

Femur

Iliac fossa Sacroiliac joint Iliac crest

Tubercle of iliac crest Ala of sacrum Greater sciatic notch

Promontory of sacrum

Ant. superior iliac spineAnt. inferior iliac spine

Ant. sacral foramina Sacrospinous lig.

Rectus femoris m. tendon (cut)

Sup. pubic ramus

Iliopubic eminence

Coccyx

Iliofemoral lig

Pubic crest

Greater trochanter of femur Pubofemoral lig.

Symphysis of pubis

Intertrochanteric line

Body of pubis

Lesser trochanter of femur

Pubic tubercle Pectineal line of pubis Inf. pubic ramus Ischium

Obturator foramen Sacrotuberous lig.

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A Anterior View

AP Radiograph of Hip Joint

Greater sciatic notch

Sacroiliac joint

Plate

5.44

Ala of sacrum

Iliac fossa

Promontory of sacrum

Ant. sacral foramina Body of ilium Ant. inferior iliac spine Acetabular fossa

Head of femur Coccyx Greater trochanter of femur Trochanteric fossa Intertrochanteric crest Sup. pubic ramus Neck of femur

Pubic tubercle

Femoral calcar Symphysis of pubis

Body of pubis Femur

Pectineal line of femur

Body of ischium

Ischial tuberosity foramen

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Plate 5.45

Anterior Leg

Vastus lateralis m Vastus medialis m.

VastusTateralis m. (sectional)

Quadriceps femoris m. tendon

Iliotibialtract

Femur

Vastus medialis m. (sectioned)

Patella Biceps femoris m. tendon

Biceps femoris m. tendon

Tibial collateral lig.

Sup. medial genicular;

Sup. lateral genicular a. Lat. patellar retinaculum

Patellar lig. Fibular collateral lig

Inf. articular surface of femur

Head of fibula Inf. lateral genicular a.

Inf. medial genicular a

Gastrocnemius m.—medial head Fibularis [Peroneus] longus m.

Head of fibula

Tibia Common fibular [peroneal] n Superficial fibular [peroneal] n.

Tibialis anterior m Soleus m.

Fibularis [Peroneus] brevis m.

Deep fibular [peroneal] n.

Anterior Views Extensor digitorum longus m. Sup. extensor retinaculum Extensor hallucis longus m. tendon

Vastus lateralis m.

Inf. extensor retinaculum Extensor digitorum longus m. tendons

Extensor hallucis brevis m.

Fibularis

Biceps femoris m. tendon

Sup. medial genicular a.

Lat. patellar retinaculum

Lateral malleolar br. of ant. tibial a. Lateral malleolus

Medial br. of deep fibular [peroneal] n.

Inf. lateral genicular a. Inf. medial genicular a.

Gastrocnemius m.—medial head

Fibularis [Peroneus] longus m.

- Soleus m.

Ant. tibial a. Ant. tibial v. Fibularis [Peroneus] brevis m.

Extensor digitorum longus m.

Extensor hallucis longus m.

Medial malleolus Fibularis [Peroneus] tertitus m. & tendon

Dorsalis pedis a. & v. Extensor hallucis longus m. tendon Extensor hallucis brevis m.

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Interosseous membrar

Fibularis [Peroneus] longus m.

Vastus medialis m.

Tibia

Tibia

Soleus m.

c . , . SuP' lateral genicular a.

Ant. tibial recurrent a.

Gastrocnemius m.— medial head

Ant. tibial a.

brevis m. Medial malleolus

Ant. tibial recurrent a.

Medial malleolar br. of ant. tibial a. Medial malleolus Dorsalis pedis a. Arcuate a. 1st metatarsal bone Dorsal digital aa.

Plate 5.46

Lateral Leg

Vastus lateralis m.

Iliotibial tract Biceps femoris m.— long head

Biceps femoris m.—long head

Lateral sup. genicular a. & v.

-Vastus lateralis m. Biceps femoris m.— short head

Lateral sup. genicular a. & v.

Biceps femoris m.— short head

Lateral condyle of femur

Common fibular [peroneal] n.

Lateral condyle of femur Common fibular [peroneal] n. Patella

Patella

Lat. sural cutaneous n.

Lat. sural cutaneous n.

Patellar lig.

Lateral condyle of tibia Deep fibular [peroneal n/

Head of fibula

Ant. tibial recurrent a.

Small saphenous v.

Small saphenous v.

Gastrocnemius m.—lateral head

Gastrocnemius m.—lateral head Tibialis anterior m.

Superficial fibular [peroneal] ]

Soleus m.

Fibularis [Peroneus] longus m.

Tibia

Fibula Soleus m Extensor digitorum longus m.

Tibialis anterior m. (sectioned)

Extensor digitorum longus m.

Superficial fibular [peroneal] n. Fibula

Tendo calcaneus (Achilles tendon) Tendo calcaneus (Achilles tendon)

Sup. extensor retinaculum Lateral malleolus

Calcaneus

Extensor hallucis longus m. tendon

Extensor hallucis longus m. tendon ip. & inf. fibular [peroneal] retinaculum

Lateral malleolus

Inf. extensor retinaculum Extensor digitorum longus m. tendon sheath

Calcaneus

Fibularis [Peroneus] brevis m. tendon L

J

Fibularis [Peroneus] tertius m. tendon Extensor digitorum brevis m.

Extensor digitorum longus m. tendons

Extensor digitorum hrpt/ic brevis m m.

Abductor digiti minimi m.

Abductor digiti minimi m

Biceps femoris m.—long head Vastus lateralis m. Biceps femoris m.—short head

Sup. lateral genicular a.

Biceps femoris m. tendon Common fibular [peroneal] n. Lat. sural cutaneous n.

Lateral Views

Lateral condyle of femur

Patella

Head of fibula Inf. lateral genicular a. & v. Small saphenous v.

Gastrocnemius m.—lateral head

Deep fibular [peroneal] n. Superficial fibular [peroneal] n.

Soleus m.

Extensor digitorum longus m.

Tibialis anterior m.

Fibularis [Peroneus] brevis m

Tendo calcaneus (Achilles tendon) Fibula Calcaneus

Lateral malleolus

Extensor digitorum longus m. tendons Extensor digitorum brevis m. Extensor hallucis longus m. tendon Abductor digiti minimi pedis m Extensor hallucis brevis m. Chapter

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Plate

5.47

Posterior Leg & Popliteal Fossa

Gracilis m.

Adductor magnus m. tendon

Biceps femoris m.—short head

Saphenous n.

Tibial n.

Biceps femoris m.—long head Saphenous n.

Semitendinosus m Semimembranosus m.

Popliteal a. & v.

Biceps femoris m.—short head

Gastrocnemius m. —medial head

Common fibular [peroneal] n.

Plantaris m. Popliteal a. & v Common fibular [peroneal] n. Tibial n. Cut tendon of semimembranosus m.

Lateral sural cutaneous n. Medial sural cutaneous n.

Popliteus m.

Plate 5.48 (top) Cut end of Gastrocnemius m.—medial head

Small saphenous v.

Gastrocnemius m. —lateral head

Gastrocnemius m. —medial head (coronal section)

Gastrocnemius m. —medial head

Tibial n

Fibula Fibular [Peroneal] a. & v.

Fibularis [Peroneus] longus m. Tibialis posterior m. Flexor digitorum longus m.

Plate 5.48 (bottom)

Posterior tibial a.

Soleus m. Fibularis [Peroneus] brevis m. Plantaris m. tendon

Post, tibial a.

Fibularis [Peroneus] brevis m.

Flexor hallucis longus m.

Flexor hallucis longus m. Post, tibial v.

Posterior tibial vv.

Fibularis [Peroneus] longus m.

Tendo calcaneus (Achilles tendon)

Tuberosity of calcaneus Tuberosity of calcaneus

Posterior Views

Popliteal a. & v. Tibial n. Saphenous n. Adductor magnus m. tendon

Tibial n.

Biceps femoris m.—short head Common fibular [peroneal] n. Cut tendon of biceps femoris m.—long head - Plantaris m.

Tibial collateral lig. Arcuate popliteal lig. Oblique popliteal lig.

Gastrocnemius m.—medial head (cut end of med. head)

Soleus m.

Fibularis [Peroneus] longus m. Plantaris m. tendon

Fibularis [Peroneus] brevis m. Flexor hallucis longus m.

Post, tibial a. Tendo calcaneus (Achilles tendon) (partially cut) Post, tibial v. Tuberosity of calcaneus

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Cross Section of Legs

Plate 5.48

ANTERIOR Subcutaneous infrapatellar bursa Tibialis anterior m. Tibia

Extensor digitorum longus m.

Interosseous membrane

Saphenous n.

Ant. intermuscular septum

Tibialis posterior m.

Fibularis [Peroneus] longus m.

MEDIAL

LATERAL

Great saphenous v. Fibula Synovial bursa of pes anserinus

Common fibular [peroneal] n.

Pes anserinus

Flexor hallucis longus m Medial sural cutaneous n. Tibialn.

Gastrocnemius m.—lateral head Popliteal a. & v. Plantaris m.

Gastrocnemius m. —medial head Lateral sural cutaneous n.

Small saphenous v.

POSTERIOR

Distal Views of Right Leg

ANTERIOR Tibialis anterior m.

Anterior tibial a. & v.

Deep fibular [peroneal] n. Tibia

Extensor hallucis longus m. Tibialis posterior m.

Peroneal a. & v. Extensor digitorum longus m. Ant. intermuscular septum Saphenous n. Interosseous membrane Superficial fibular [peroneal] n.

Great saphenous v.

Fibularis [Peroneus] longus m. Plantaris m. tendon

LATERAL

MEDIAL Flexor digitorum longus m.

Fibula

Gastrocnemius n.—:medial head Fibularis [Peroneus] brevis m.

Post, tibial a. Post, tibial v.

Post, intermuscular septum Tibial n.

Flexor hallucis longus m.

Soleus m. Tendo calcaneus (Achilles tendon)

Small saphenous v. Sural n.

POSTERIOR

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Plate

5.49

Medial Leg Articularis genu m

Vastus medialis Sup. medial genicular a. & v.

Intrapatellar br. of saphenous n.

Patellar lig. Inf. medial genicular a. & v.

Tibial n.

Descending genicular a. & v. Gracilis m.

Sup. medial genicular a. & v.

Sartorius m. Medial patellar retinaculum

Popliteal a. & v.

Tibial collateral lig.

Patella Tibial n.

Semimembranosus m. Inf. medial genicular a. & v. Saphenous n.

Soleus m.

Semitendinosus m. Tibialis anterior m

—

Cu

Gastrocnemius m

sag sec

Posterior tibial a. & r

Gastrocnemius m.

Medial suface of tibia Flexor digitorum longus m.

Medial suface of tibia Soleus m.

Medial malleolus

Tibialis anterior m. Flexor hallucis longus m.

Extensor hallucis longus m. tendon sheath Flexor digitorum longus m.

Sup. extensor retinaculum

Posterior tibial a. Tibialis posterior m. tendon

Tendo calcaneous (Achilles tendon) Medial plantar n.

Flexor retinaculum

Tibialn.

Medial malleolus

Lateral plantar n.

Calcaneus Inf. extensor retinaculum

1 st metatarsal bone

Deltoid lig. Tibialis anterior nr. tendon —

1st metatarsal bone

Quadratus plantae

Tibialis posterior m. tendon sheath Plantar aponeurosis

Flexor hallucis brevis m.

Medial Views

Abductor hallucis m.

Vastus medialis

Saphenous n. Popliteal a. & v.

Descending genicular a. & v.

Sup. medial genicular a. & v. Tibial collateral lig.

Inf. medial genicular a. & v.

Saphenous n. Gastrocnemius m. (cut in sagital section)

Medial suface of tibia Soleus m. Tibialis anterior m.

Flexor digitorum longus m

Posterior tibial a. Tendo calcaneous (Achilles tendon)

Medial malleolus Tibialis posterior m. tendon Calcaneus Extensor hallucis longus m. tendon Abductor hallucis m. Tibialis anterior m. tendon Flexor digitorum brevis m.

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A.D.A.M. i Student Atlas of Anatomy

Lateral, Anterior & Medial Knee

Plate 5.50

Rectus femoris m. Gracilis m. Great saphenous v. Sartorius m. Vastus lateralis m. Vastus medialis m. Iliotibial tract

Quadriceps femoris m. tendon Descending genicular a. & v.

Sup. lateral genicular a. & v. Biceps femoris m. tendon

Sup. medial genicular a. & v. Tibial collateral lig.

Lateral patellar retinaculum Inf. lateral genicular a. & v.

Medial patellar retinaculum

Head of fibula

Patellar lig. Sartorius m. tendon Inf. medial genicular a. & v.

Ant. tibial recurrent a. & v.

Tibial tuberosity Extensor digitorum longus m.

Tibialis anterior m.

Fibularis [Peroneus] longus m.

Gastrocnemius m.

Superficial fibular [peroneal] n. -

- Medial surface of tibia

Anterior View

Membranous roof of adductor canal

Adductor magnus m.

Rectus femoris m. Vastus medialis m. Descending genicular a. & v.

Quadriceps femoris m. tendon

Iliotibial tract

Vastus lateralis m.

Heads of beceps femoris m. tendon

Lateral sup. genicular a. & v.

Plantaris m.

Quadriceps femoris m. tendon

Fibular collateral lig.

Patella

Common fibular [peroneal] n.

Saphenous n.

Tendon of semimembranosus m.

Patella Patellar lig.

Tibial collateral lig.

Inf. medial genicular a. & v.

Semitendinosus m. tendon

Lateral patellar retinaculum

Popliteus m.

Tendon of sartorious m. Gastrocnemius m.

Patellar lig.

Lateral sural cutaneous n.

Tendon of gracilis m

don of biceps femoris m. Ant. tibial recurrent a. & v.

Head of fibula Small saphenous

Sup. medial genicular a. & v.

\

Tibialis anterior m. Medial suface of tibia

Gastrocnemius m.

Medial View

Extensor digitorum longus m.

Soleus m. Fibularis [Peroneus] longus m.

Tibialis anterior m.

Superficial fibular [peroneal] n.

Lateral View Chapter

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265

Plate

5.51

Posterior Knee

Vastus lateralis m. (sectioned)

Gracilis m. (cut)

Descending genicular a. & v. (sectioned) Vastus medialis m. (sectioned) Popliteal plane (surface) of femur Sup. lateral genicular a. & v. Sup. medial genicular a. & v.

Biceps femoris m. (cut) Ant. cruciate lig.

Sartorius n. (cut)

Lateral condyle Medial condyle Popliteus m. tendon Medial meniscus

Fibular collateral lig.

Tibial collateral lig.

Lateral meniscus Inf. lateral genicular a. & v. Proximal tibiofibular joint

Post, meniscofemoral lig. Inf. medial genicular a. & v.

Head of fibula

Post, cruciate lig. Great saphenous v. Common fibular [peroneal] n.

Saphenous n. Gracilis m. tendon (cut)

Ant. tibial a. & v.

Semitendinosus m. tendon (cut) Gastrocnemius m.—med. head (sectioned & cut) Fibularis [Peroneus] longus m.

Posterior Views

Vastus lateralis m. (sectioned)

Gracilis m. (cut)

Descending genicular a. & v. Popliteal plane (surface) of femur Vastus medialis m. (sectioned) Sup. medial genicular a. & v. Sartorius m. (cut) Post, surface of articular capsule of knee joint

Sup. lateral genicular a. & v. Plantaris m. (cut) Biceps femoris m.—short head (coronal section) Gastrocnemius m.—lateral head (cut) Fibular collateral lig.

Gastrocnemius m.—medial head (cut) Biceps femoris m.—long head tendon (cut) Tibial collateral lig.

Arcuate popliteal lig.

Semimembranosus m. tendon Post. lig. of head of fibula Oblique popliteal lig. Head of fibula Great saphenous v Saphenous n.

Popliteus m. (cut ends)

Gracilis m. tendon (cut) Semitendinosus m. tendon (cut)

Common fibular [peroneal] n. Tibialis posterior m.

Gastrocnemius m.—med. head (sectioned & cut) Fibularis [Peroneus] longus m.

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A.D.A.M. I Student Atlas of Anatomy

Knee Joint

Plate 5.52

ANTERIOR

Distal View of Articular Surface of Right Femur

Deep (Subtendinosus) infrapatellar bursa

Synovial capsule of knee joint

Patellar lig.

Medial patellar retinaculum Post, meniscofemoral lig.

Lateral patellar retinaculum

Fibrous capsule of knee joint

Ant. cruciate lig.

LATERAL

Ant. meniscofemoral lig.

Post, cruciate lig.

Lateral condyle of femur

MEDIAL Tibial collateral lig. Synovial bursa

Fibular collateral lig. Medial condyle of femur Popliteus m. tendon Great saphenous v.

Biceps femoris m.

Common fibular [peroneal] n. Gracilis m. tendon Sartorius m.

Gastrocnemius m.—lateral head

Small saphenous v.

Popliteal fascia

Semitendinosus m. tendon

Plantaris m. Tibial n.

Semimembranosus m. Popliteal v.

Popliteal a.

Gastrocnemius m.—medial head

POSTERIOR Popliteal v. & a. Popliteal fascia

Gastrocnemius m.—medial head

Tibialn. Semimembranosus m.

Plantaris m.

Small saphenous v. Medial sural cutaneous n. Semitendinous m. tendon Gastrocnemius m.—lateral head Sartorius m.

Common fibular [peroneal] n.

Gracilis m.

Post, meniscofemoral lig.

Saphenous n.

Biceps femoris m.

LATERAL

Great saphenous v.

Popliteus m. tendon

MEDIAL

Sup. articular surface of tibia

Post, cruciate ligament

Med. meniscus Fibular collateral lig. Tibial collateral lig. Lateral meniscus

Ant. meniscofemoral lig.

Synovial capsule of knee joint

Sup. articular surface of tibia (lateral condyle)

Intercondylar eminence Ant. cruciate lig.

Infrapatellar fat pad Transverse lig. of knee joint

Distal View of Articular Surface of Right Tibia

Patellar lig.

ANTERIOR Chapter 5

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267

Plate

5.53

Knee Joint

Plane of Medial View below

Sup. medial genicular a. & v.

Sup. lateral genicular a. & v. Adductor magnus m. tendon

Medial epicondyle Iliotibial tract Articular surface of medial condyle of femur Lateral epicondyle Articular surface of lateral condyle of femur

Post, cruciate lig. Ant. cruciate lig.

Fibular collateral lig. Lateral meniscus

Medial meniscus Tibial collateral lig.

Transverse lig. of knee joint

Medial condyle of tibia Inf. lateral genicular a. & v. Inf. medial genicular a. & v. Head of fibula Lateral condyle of tibia Ant. tibial a. & v.

Great saphenous v.

Common fibular [peroneal] n. (sectioned)

Tibial tuberosity

Soleus m. Soleus m. Fibula Tibia

Interosseous membrane

Anterior View

Vastus intermedius m.—tendon

Femur

Rectus femoris m. Articularis genu m. Long head Quadriceps femoris m. tendon -Biceps femoris m. Suprapatellar synovial bursa

Short head

Patella Common fibular [peroneal] n. Subcutaneous prepatellar bursa

Plantaris m.

Articular surfaces Alar folds

Lateral condyle of femur

Lateral meniscus

Deep infrapatellar bursa Subcutaneous infrapatellar bursa Patellar lig.

Popliteus m.

Infrapatellar fat pad Lateral condyle of tibia Tibial tuberosity

-Gastrocnemius m.—lateral head

Soleus m.

Neck of fibula Tibia Interosseous membrane

Medial View of Parasagittal Section Through Lateral Condyles

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Student Atlas of Anatomy

A-P & Lateral Radiographs of Knee

Femur

Plate 5.54

Femoral a.

Descending genicular a.

Sup. medial genicular a.

Sup. lateral genicular a.

Popliteal a. Middle genicular a.

Lat. condyle of femur

Intercondylar eminence Med. condyle of tibia Lat. condyle of tibia

Inf. medial genicular a. Fibula Tibia

Anteroposterior View of Right Knee Arteriogram

Femur

Adductor tubercle

Patella

Intercondylar eminence

Tibia

Head of fibula

Fibula

Lateral View of Right Knee

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269

Plate 5.55

Sole of Foot Proper digital a., v. & n.

Flexor sheaths of flexor digitorum longus m. tendons

Flexor sheath of flexor hallucis longus m. tendon

Proper plantar digital nn. Superficial transverse metatarsal lig. Flexor hallucis longus m. tendon

Digital branch of medial plantar n. Transverse fasciculi

Medial plantar a.

Digital slips of plantar aponeurosis Plantar aponeurosis Tuberosity of 5th metatarsal bone Cutaneous br. of medial plantar v. Cutaneous br. of lateral plantar v. Abductor hallucis m.

Abductor digiti minimi m. Lateral band of plantar aponeurosis

Deltoid lig.

Flexor retinaculum

Tibial n. Superior fibular [peroneal] retinaculum

Post, tibial a.

Inferior fibular [peroneal] retinaculum Tendo calcaneous [Achilles tendon] Proper digital a., v. & n.

Flexor sheath of flexor hallucis longus m. tendon Flexor hallucis longus m. tendon Flexor hallucis brevis m. Proper plantar digital nn. Adductor hallucis m. Common plantar digital n. (br. of lateral plantar n.)

Common plantar digital n. (br. of medial plantar n.) Deep plantar arterial arch

Pleural lumbrical mm. of foot

Lateral plantar n. Lateral plantar a. Tuberosity of 5th metatarsal bone Abductor digiti minimi m. Cutaneous br. of lateral plantar v.

Medial plantar n. Flexor digitorum brevis m. Cutaneous br. of medial plantar Medial plantar a. Abductor hallucis m.

Fibularis [peroneus] longus m. tendon

Tuberosity of calcaneus Lateral malleolus

Fibularis [Peroneus] longus m. tendon

Tibial n. Post, tibial a.

27O

A.D.A.M.

Student Atlas of Anatomy

Sole of Foot

Plate 5.56

Proper digital a.

Plantar View of 2nd Deep Layer Flexor sheath of flexor hallucis longus m. tendon

Flexor hallucis longus m. tendon

Flexor sheaths of flexor digitorum longus m. tendons

Flexor hallucis brevis m. Plantar metatarsal a. Adductor hallucis m.

Common plantar digital a. Deep plantar arterial arch 1st metatarsal bone

Plantar lumbrical mm. of foot

Flexor digitorum longus m. tendon

Abductor digiti minimi m. Lateral plantar n. Lateral plantar a.

Medial cuneiform bone

Tuberosity of 5th metatarsal bone Tuberosity of navicular bone Quadratus plantae m. Head of talus

bialis m. tendon sheath Lateral malleolus

Medial malleolus

Calcaneus Proper digital a. Fibularis [Peroneus] longus m. tendon Flexor hallucis longus m. tendon Flexor hallucis longus m. tendon sheath

Plantar metatarsal a. Transverse head

Common plantar digital aa.

Oblique head

of adductor hallucis m.

Plantar interosseous mm.

Plantar metatarsal a.

Flexor digiti minimi brevis m.

1st metatarsal bone Fibularis [Peroneus] longus m. tendon

Deep plantar arterial arch Lateral plantar a.

Tibialis posterior m. tendon

Tuberosity of 5th metatarsal bone

Tuberosity of navicular bone

Deep br. of lateral plantar n. Plantar calcaneonavicular (spring) lig.

Fibularis [Peroneus] longus m. tendon

Tibialis posterior m. tendon

Long plantar lig

Sustentaculum tali

Deltoid lig. Fibularis [Peroneus] longus m. tendon Tibialis posterior m. tendon

Plantar View of 3rd Deep Layer

Flexor hallucis longus m. tendon Flexor digitorum longus m. tendon (cut)

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271

Plate

5.57

Dorsum of Foot

Tibia Extensor digitorum longus m.

Sup. extensor retinaculum Great saphenous v.

Superficial fibular [peroneal] n.

Tibialis anterior nr. tendon sheath

Extensor digitorum longus m. tendon

Medial malleolus Inf. extensor retinaculum

Lateral malleolus Extensor hallucis longus m. tendon sheath

Deltoid lig.

Extensor digitorum brevis m.

Extensor digitorum longus m. tendon sheaths

Fibularis [Peroneus] tertius m. tendon Extensor hallucis brevis m.

5th metatarsal bone Abductor digiti minimi m.

Deep fibular [peroneal] n.

Dorsal metatarsal aa.

Extensor hallucis longus m. tendon

Proper digital aa.

Dorsal Surfaces Interosseus membrane

Ant. tibial a. Fibula

Tibia

Tibia Fibula

Deep fibular [peroneal] n.

Ant. tibiofibular lig. Lateral malleolus

J Lateral malleolus

Ant. talofibular lig.

Medial malleolus

Articular surface of talus

Lateral collateral lig.

Deltoid lig. Fibularis [Peroneus] longus m. tendon

Extensor digitorum brevis m.

Calcaneocuboid part of bifurcate lig.

Dorsalis pedis a.

Extensor hallucis brevis m.

Dorsal metatarsal lig. Abductor digiti minimi m.

1 st dorsal interosseous m. Collateral lig. 1st metatarsal bone

Interosseus membrane

Medial malleolus Articular surface of talus Deltoid lig. Calcaneonavicular part of bifurcate lig. Dorsal cuneonavicular lig. Dorsal cuneocuboid lig. Dorsal tarsometatarsal lig. 1st dorsal interosseous m.

Deep fibular [peroneal] n. Articular capsule Extensor expansion Proper digital aa. Dorsal metatarsal aa.

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A.D.A.M. I Student Atlas of Anatomy

Ligaments & Tendons of Foot Flexor digitorum longus m.

Plate 5.58

Medial View

Tibia Flexor hallucis longus m.

Tibialis posterior m. tendon (cut) Tendo calcaneus (Achilles tendon)

Medial malleolus Post, tibiotalar lig.

Post, talocalcaneal lig. Tuberosity of calcaneus

Tibiocalcaneal lig. Deltoid lig. —

Sustentaculum tali Tibionavicular lig. Ant. tibiotalar lig. Tibialis posterior m. tendon (cut)

Tibialis anterior m. tendon (cut)

Plantar calcaneocuboid lig. Dorsal talonavicular lig. Long plantar lig. Dorsal cuneonavicular lig.

Flexor digitorum longus m. tendon Lateral plantar n.

Dorsal tarsometatarsal lig.

2nd metatarsal bone Flexor hallucis longus m. tendon

Fibula

Collateral metatarsophalangeal lig.

Tendo calcaneus (Achilles tendon) Tibia Tibia

Collateral interphalangeal lig.

Post, tibiofibular lig.

Ant. tibiofibular lig.

Post, talofibular lig.

Lateral malleolus Articular surface of talus

Superior fibular (peroneal) retinaculum

Extensor hallucis longus m. tendon

Calcaneofibular lig. Calcaneus

Ant. talofibular lig.

Fibularis [Peroneus] longus m. tendon (cut) Lateral talocalcaneal lig.

Long plantar lig.

Dorsal talonavicular lig.

Dorsal calcaneocuboid lig.

Bifurcate lig. Calcaneocuboid part of bifurcate lig. Calcaneonavicular part of bifurcate lig.

Fibularis [Peroneus] brevis m. tendon (cut)

Dorsal cuboideonavicular lig. Dorsal tarsometatarsal lig.

Dorsal cuneonavicular lig.

Flexor digiti minimi brevis m.

Dorsal interosseous mm.

Collateral metatarsophalangeal lig. Articular capsule

Lateral View Collateral interphalangeal lig.

Chapter 5

LOWER LIMB

273

5.59

Foot—Skeleton

\- 1st Distal phalanx

Plate

274

A.D.A.M

Student Atlas of Anatomy

Lateral &

Radiographs of Foot

0

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a
Palatine aponeurosis

t

Palatoglossus

Palatine aponeurosis

Side of tongue

Palatopharyngeus

Hard palate & palatine aponeurosis

Lateral wall of pharynx

Musculus uvulae

Posterior nasal spine & palatine aponeurosis

Mucosa of uvula

Elevates posterior part of tongue & draws soft palate onto tongue

l Pharyngeal br. of vagus n. ' (CN X) via pharyngeal plexus

Tenses soft palate & pulls walls of pharynx superiorly, anteriorly, and medially during swallowing Shortens uvula & pulls it superiorly

/

Extrinsic Muscles of the Tongue Stable Attachment

Mobile Attachment

Genioglossus

Sup. part of mental spine of mandible

Dorsum of tongue & body of hyoid bone

Hyoglossus

Body & greater horn of hyoid bone

Side of tongue

Styloglossus

Styloid process & stylohyoid lig.

Side & inf. aspect of tongue

Palatoglossus

Palatine aponeurosis of soft palate

Side of tongue

Muscle

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Student Atlas of Anatomy

Innervation \

Actions Protrudes, retracts & depresses tongue; its post, part protrudes tongue

> Hypoglossal n. CN XII

Depresses & retracts tongue Retracts tongue & draws it up to create a trough for swallowing

Pharyngeal br. CN X & pharyngeal plexus

Elevates post, part of tongue

Muscles—Soft Palate & Tongue

Plate

7.23

Cartilaginous part of auditory tube [eustachian tube] Levator veli palatini m. Tensor veli palatini m.

Soft palate

Sup. pharyngeal constrictor m. (cut) Inf. longitudinal m. of the tongue Palatoglossus m. Styloglossus m.

Palatopharyngeus m. Middle pharyngeal constrictor m. Genioglossus m. Stylohyoid lig. Geniohyoid m. Hyoglossus m. Mylohyoid m. (sectioned) Hyoid bone

Inf. pharyngeal contrictor m.

Thyrohyoid membrane

Thyroid cartilage Cricothyroid m.

Esophagus

Tracheal cartilage

Lateral View of Tongue & Pharyngeal Muscles

Chapter 7

HEAD AND NECK

375

Table 7.6

Muscles—Hyoid

Suprahyoid Muscles3

Muscle

Superior Attachment

Inferior Attachment

Innervation

Mylohyoid

Mylohyoid line of mandible

Oral raphe & body of hyoid bone

Mylohyoid n., a br. of inf. alveolar n. (CN V3)

Elevates hyoid bone, floor of mouth & tongue during swallowing & speaking

Geniohyoid

Inf. mental spine of mandible

Cl via the hypoglossal n. (CN XII)

Pulls hyoid bone anterosuperiorly, shortens floor of mouth & widens pharynx

Facial n. (CN VII)

Elevates & retracts hyoid bone, thereby elongating floor of mouth

Main Actions

> Body of hyoid bone

Stylohyoid

Styloid process of temporal bone ■

Anterior belly: Mylohyoid n.,

Anterior belly: Digastric fossa of

Digastric

Intermediate tendon to body ’ & greater horn of hyoid bone

mandible Posterior belly: Mastoid notch of

temporal bone /

a br. of inf. alveolar n. (CN V3) Posterior belly: Facial n. (CN VII) '

Depresses mandible, raises hyoid bone & steadies it during swallowing & speaking

aThese muscles connect the hyoid bone to the skull.

Mandible

Digastric m.—ant. belly

Mylohyoid in.

Submental triangle (part of ant. triangle)

Submandibular triangle (part of ant. triangle) Medial pterygoid m. Stylohyoid m. Fibrous loop for intermediate tendon of digastric m. Digastric m.—post, belly

Sternocleidomastoid m. (cut)

Carotid triangle (part of ant. triangle) Thyrohyoid m.

Sternocleidomastoid m. Ant. scalene m.

Omohyoid m.—sup. belly

Muscular triangle (part of ant. triangle) Sternothyroid m.

ternohyoid m.

Fascial loop for intermediate tendon of omohyoid m.

Occipital triangle (part of post, triangle)

Omohyoid m.—inf. belly Supraclavicular triangle (part of post, triangle)

—RIGHT

LEFT—►

Anterior View with Superficial Muscles on Left & Deeper Muscles on Right

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Student Atlas of Anatomy

Muscles—Hyoid

Table 7.7

Infrahyoid Muscles3 Muscle

Origin

Insertion

Innervation

Actions

Sternohyoid

Manubrium of sternum & medial end of clavicle

Body of hyoid bone

Cl, C2 & C3 from ansa cervicalis

Depresses hyoid bone after it has been elevated during swallowing

Sternothyroid

Post, surface of manubrium of sternum

Oblique line of thyroid cartilage

C2 & C3 by a br. of ansa cervicalis

Depresses hyoid bone & larynx

Thyrohyoid

Oblique line of thyroid cartilage

Inf. border of body & greater horn of hyoid bone

Cl via hypoglossal n. (CN XII)

Depresses hyoid bone & elevates larynx

Omohyoid

Sup. border of scapula near suprascapular notch

Inf. border of hyoid bone

C1,C2&C3 by a br. of ansa cervicalis

Depresses, retracts & steadies hyoid bone

■These four step-like muscles anchor the hyoid bone (ie., they fix and steady it). They are concerned with the suprahyoid muscles in movements of the tongue, hyoid bone, and larynx in both swallowing and speaking.

Hyoglossus m. Stylohyoid m.

Digastric m.—post, belly

Genioglossus m.

Styloglossus m. (cut)

Mandible (median section)

Fibrous loop for intermediate tendon of digastric m.

Geniohyoid m. Digastric m.—ant. belly

Thyrohyoid m. Mylohyoid m.

Omohyoid m.—sup. belly Sternohyoid m. Esophagus Sternothyroid m. Fascial loop for intermediate tendon of omohyoid m.

Omohyoid m.---inf belly

- Trachea

Lateral View with Right Half of Mandible Removed

Chapter 7

HEAD AND NECK

377

Table 7.8

Muscles—Pharyngeal

Lateral Attachments

Muscle

Medial Attachments

Innervation

Main Actions

CIRCULAR PHARYNGEAL MUSCLES Superior constrictor

Pterygoid hamulus, ptergomandibular raphe, post, end of mylohyoid line of mandible & side of tongue

Middle constrictor

Stylohyoid lig. and greater & lesser horns of hyoid bone

Inferior constrictor

Oblique line of thyroid cartilage & side of cricoid cartilage

Median raphe of pharynx & pharyngeal tubercle

Constrict wall of pharynx during swallowing

/ Median raphe of pharynx \ /

Pharyngeal & sup. laryngeal brr. of vagus n. [CN X] \ through pharyngeal plexus

LONGITUDINAL PHARYNGEAL MUSCLES Hard palate & palatine aponeurosis

Post, border of lamina of thyroid cartilage & side of pharynx & esophagus

Salpingopharynegeus

Cartilaginous part of auditory tube

Blends with palatopharynegeus

Stylopharyngeus

Styloid process of temporal bone

Post. & sup. borders of thyroid cartilage with palatopharynegus m.

Palatopharyngeus

Elevate pharynx & larynx during swallowing speaking3

Glossopharyngeal n. [CN IX]

i

“The salpingopharyngeus muscle also opens the auditory tube.

L. cartilaginous part of auditory tube [eustachian tube]

L. tensor veli palatini m. Muscles of soft palate (sectioned)

L. levator veli palatini m.

R. sup. pharyngeal constrictor m. (cut) Hard palate (sectioned)

L. salpingopharyngeus m.

Tongue

L. palatopharyngeus m.

Inf. longitudinal m. of tongue

R. middle pharyngeal constrictor m.

R. inf. pharyngeal constrictor m.

R. stylohyoid lig. (cut)

Lateral View of Neck & Median Sectioned Skull

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Student Atlas of Anatomy

Hyoid bone

Muscles—Laryngeal & Pharyngeal

Plate 7.24

Stylohyoid lig. Stylopharyngeus m.

Sup. pharyngeal constrictor m. Inf. longitudinal m. of tongue

Styloglossus m. (cut)

Middle pharyngeal constrictor m.

Genioglossus m.

Geniohyoid m. Mylohyoid m. (cut) Inf. pharyngeal constrictor m. (thyropharyngeal portion)

Hyoglossus m. Hyoid bone Thyrohyoid membrane

Inf. pharyngeal constrictor m. (cricopharyngeal portion)

Thyroid cartilage Cricothyroid m.

Esophagus Tracheal cartilage

Lateral View with Right Half of Mandible Removed

Chapter 7

HEAD AND NECK

379

Table

7.9

Muscles—Laryngeal

Muscles of the Larynx Muscle

Origin

Insertion

Innervation

Main Actions

Cricothyroid

Anterolateral part of cricoid cartilage

Inf. margin & inf. horn of thyroid cartilage

Sup. larnyngeal n. [CN X]

Stretches & tenses the vocal fold

Posterior cricoarytenoid

Post, surface of laminae of cricoid cartilage

Lateral cricoarytenoid

Arch of cricoid cartilage

Thyroarytenoid"

Post, surface of thyroid cartilage

Muscular process of arytenoid process

Transverse & oblique arytenoids

One arytenoid cartilage

Opposition arytenoid cartilage

Close laryngeal aditus by approximating arytenoid cartilages

Vocal isb

Angle between laminae of thyroid cartilage

Vocal process of arytenoid cartilage

Alters vocal fold during phonation

Abducts vocal fold

Muscular process of arytenoid cartilage

Adducts vocal fold ) Recurrent laryngeal n. [CN X]

Relaxes vocal fold

aThe superior fibers of the thyroarytenoid muscle pass into the aryepiglottic fold, and some of them reach the epiglottic cartilage. These fibers constitute the thyroepiglottic muscle, which widens the inlet of the larynx. bThese short fine muscular slips are derived from the most medial fibers of the thyroarytenoid muscle.

t

Body of hyoid bone

ANTERIOR Epiglottis

Vocal ligg.

Lesser horn of hyoid bone

Vocalis m. Thyroarytenoid m.

Thyroepiglottic lig.

Cricothyroid m.

Greater horn of hyoid bone

Lateral cricoarytenoid m.

Transverse arytenoid m. Cricothyroid joint (fibrous capsule) Oblique arytenoid m. Post, cricoarytenoid m. Superior View

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Student Atlas of Anatomy

Muscles—Laryngeal

Epiglottis

Plate

7.25

Hyoid bone Lesser horn of hyoid bone Greater horn of hyoid bone

Lateral thyrohyoid lig.

Aryepiglottic m. Sup. horn of thyroid cartilage Median thyrohyoid lig. Sup. thyroid notch

Laryngeal prominence Inf. horn of thyroid cartilage Articular capsule of cricothyroid joint

Cricothyroid m.

Epiglottis

Cricoid cartilage

Median cricothyroid lig. Tracheal ring

Aryepiglottic m.

Trachealis m.

Anterior View Corniculate cartilage

Arytenoid cartilage

Oblique arytenoid m.

Lateral cricoarytenoid m.

Cricoid cartilage Epiglottis Lesser horn of hyoid bone Greater horn of hyoid bone

Lateral thyrohyoid lig.

Posterior View

Sup. horn of thyroid cartilage Corniculate cartilage Thyroid cartilage Arytenoid cartilage

Thyroepiglottic lig.

Cricothyroid m. Transverse arytenoid m.

Post, cricoarytenoid m.

Inf. horn of thyroid cartilage Articular capsule of cricothyroid joint Lamina of cricoid cartilage

Tracheal cartilages Trachealis m.

Posterior View

Chapter 7 ! HEAD AND NECK

381

Table

7.10

Muscle

Muscles—Lateral & Prevertebral

Inferior Attachment

Superior Attachment

Innervation

Main Actions

Accessory n. [CN XI] (motor); sensory fibers of C2 cervical spinal n.

Various: both sides together support head, move chin upward, and pull back of head down. One side alone turns chin upward and to opposite side.

Sternocleidomastoid \ Sternal head

Ventral surface of the manubrium sterni

Clavicular head

Cranial surface of medial third of clavicle

Splenius capitis

Inf. half of ligamentum nuchae & spinous process of sup. six thoracic vertebrae

Lateral surface of mastoid > process; sup. nuchal line of occipital bone ,

Lateral aspect of mastoid process & lateral third of sup. nuchal line

Dorsal rami of middle cervical spinal nn.


Sup. orbital fissure

Foramen rotundum

Foramen ovale

CN V2

Mandibular (V3)

CN V3 CN VI—ABDUCENS N. Int. acoustic meatus

FACIAL N. CN VII

CN VIINervus intermedius

CN VIII

CN VIII—VESTIBULOCOCHLEAR N.

CN IX" CN X CN XI

CN IX—GLOSSOPHARYNGEAL N.

CN X— VAGUS N. CN XII CN XI—ACCESSORY N.

Jugular foramen

Hypoglossal canal

Cl—1st cervical spinal n.

CN XUHYPOGLOSSAL N.

Chapter 8

CRANIAL AND AUTONOMIC NERVES

447

Plate 8.2

Olfactory Nerve—CN

I

Olfactory n. (CN I) ^ Tract

Nerves

Bulb I

Cribriform plate (ethmoid bone)

Frontal sinus Hypophysis (pituitary gland) Area of olfactory epithelium Sella turcica Nasal septum (perpendicular plate of ethmoid bone) Sphenoid sinus Nasal septum (cartilaginous part) Choanae (int. nares) Right Lateral View of Nasal Septum

Nasal septum (vomer bone)

Ext. (ant.) nares

Cribrifoim plate

Olfactory bulb

Olfactory nn.

Olfactory tract

Frontal sinus

Hypophysis (pituitary gland)

Area of olfactory epithelium

Choanae (int. nares) Middle concha

Crista galli Olfactory bulb

Inf. concha

Sup. concha

Olfactory n. Frontal bone

Sagittal Section: View of Lateral Wall of Right Nasal Cavity

Olfactory epithelium Cribriform plate

Sup. concha

Ethmoid sinus Nasal septum Ethmoid bone Middle concha

Vomer

Inf. concha

Coronal Section of Superior Part of Nasal Cavity & Ant. Cranial Fossa

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Student Atlas of Anatomy

Optic Nerve—CN II

Plate 8.3

Levator palpebrae superioris m. Sup. orbital fissure

Sup. rectus m.

\\ Sup. oblique m.

Trochlea

Lateral rectus m.

LATER/*

Inf. orbital fissure

Inf. oblique m.

Inf rectus m.

Common annular tendon Optic n. [CN II]

Medial rectus m.

Levator palpebrae superioris m. (cut) Optic tract

Sup. orbital fissure

Sclera of eyeball

Roof of orbit

Sup. oblique m. Anterior View of Right Orbit B

Sup. rectus m.

Conjunctiva (cut edge)

Pupil

Cornea

Inf. oblique m.

Inf rectus m.

Foramen rotundum

Common annular tendon

Optic nerve in dural sheath

Maxillary sinus

Opening to middle nasal meatus

Lateral View of Parasagittal Section of Right Orbit

Chapter 8 I

CRANIAL AND AUTONOMIC NERVES

449

Plate

8.4

Oculomotor Nerve—CN III

Sup. orbital fissure

Levator palpebrae superioris m. Sup. rectus m.

Ciliary ganglion

Sup. oblique m. Trochlea

Lateral rectus m.

Sup. division of CN III

Oculomotor n. [CN III]

Medial rectus m. Anterior View of Right Orbit Inf. division of CN III

MEDIAL —►

Inf. orbital fissure Inf. oblique m.

Inf. rectus m.

" Common annular tendon

Levator palpebrae superioris m.

Sup. rectus m.

Sclera

Sup. division of CN III

Common annular tendon

Oculomotor n. [CN III] — Short ciliary nn. Inf. division of CN III Inf. oblique m. Ciliary ganglion

Parasympathetic root of ciliary ganglion

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A.D.A.M. ! Student Atlas of Anatomy

Parasagittal Section Through Right Orbit

Ciliary Ganglion

Plate 8.5

Oculomotor (parasympathetic) root of Ciliary ganglion Sup. colliculus of midbrain

Short ciliary nn.

\ Oculomotor n. [CN III]

Sphincter pupillae m.

Ciliary m. Trigeminal ganglion

Ophthalmic n. (V1)

Nasociliary (sensory) root of ciliary ganglion

Pons Ophthalmic a. Sympathetic root of ciliary ganglion (from internal carotid plexus) Ciliary ganglion Sup. colliculus of midbrain

\

Short ciliary nn.

..

Lateral horn of spinal cord

Dilator pupillae m. Int. carotid a.

1st thoracic sympathetic trunk ganglion

ganglion

••

••••••

Preganglionic Parasympathetic Fibers

••

••••••

Afferent Fibers

Postganglionic Parasympathetic Fibers

• • tW- •••••••

Preganglionic Sympathetic Fibers Postganglionic Sympathetic Fibers

Chapter 8

CRANIAL AND AUTONOMIC NERVES

45

Plate 8.6

Trochlear Nerve—CN

Sup. orbital notch (foramen)

IV

Sup. oblique m. tendon

Sup. orbital fissure

Trochlea

Trochlear n. [CN IV]

Levator palpebrae superioris m. tendon

Anterior View of Right Orbit

MEDIAL —►

Lateral rectus m. tendon

Inf. colliculus of midbrain

Common annular tendon

Sup. orbital fissure

Trochlear n. [CN IV]

Sup. oblique m.

Trochlea

'.4

*A Parasagittal Section Through Right Orbit

452

A.D.A.M. i Student Atlas of Anatomy

Trigeminal Nerve—CN

V1

Ophthalmic Division

Plate

8.7

Anterior View of Right Orbit

Frontal n.

Supraorbital n.

B

Nasociliary n. [V1] Communicating br.

Ciliary ganglion — LATERAL Zygomatic n. [V2] Zygomatic bone

Nasociliary (sensory) root of ciliary ganglion Ophthalmic n. [V1]

Nasociliary n. [V