01 Anatomy Workbook

7/29/2019 01 Anatomy Workbook

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TABLE OF CONTENTS

PectoralirdleInu’oduction 2Overview 2Osteology 2Ath.qology 2Bursae 4Musclesf uperficialack nd houlder 5Neurology 7Vascularupply 7

Anatomicallnn’ochl~on 8

Lumbar pine 8

Sacro-niaeoint 8Pubic ymphysis 9Hip_Join~ 10Myologyf Region - 10 ..........Reviewf erve upplyo he egion 11Reviewf asodarupplyO he egion I - -- -

FACULTY

Paul ettler,hi)Paul e~lm"s he ssocial~rofessorn~ hair~a-E he hysicalherapyepartmentt heUniversityf elaware.rior th~L e erveds ssociaterofessornd irectorf he hysical

Therapyrogramt outhwestexas tate niversiW. e as een irectlynvolvedn hysical ~’

therapyducations n nstructoror ighzeeaears.is rimaryeachingreasave een n ross~n~mmynd euroanatomyut e as lso een nvolvedn ~n~iology,xercisehysiology,edllGltion nd admini~tl’ation course.



LOUTLINE NOTES I

pECTORAL GIRDLE

A. Introductoryomments

B. Overview

I. obilityess tability

2. Descriptionsf os~o~,,mnHcotions

C. Ostenlogy

1. ~’num.lavicle,capula(coveringibs -7),

humerus

2. unctionalnit all omponentsust ork ogether,

a true ~nmplef kinematichain;ach lnk ependingon he fl~er

D. Arthrology

1. capulothoracicfi capulan ibs not eal oint,

- supponedbyT.MM,i~,niflc~ntotiondescn~oeelativeo leno-humeralotion

Motionselevation,epression,dducfion,bduction,internalotation,xternalotation,rotractionnd

rewaction

Upwardotationfi uperiorovementf nferiorangle;ownwardopposite

ProWactionABD ith pwardotation

Rewa_c~_’onADD ith ownwardotation

2. Sterno-davtcularOnly place a~ sl~nn m~--hored axial

Clavicleervess strutor IE

Saddleoint

3. nlfl-axlal.hree egreesf reedomHard o escribeotionsn s~okinematicerms



[OUTLINE NOTES [

4. cromino-clavlcular

Gliding3 degreesf reedom

Demo all E otionseflec~_._~ereAcromioclavicularig- apsularype igament

$, Coraco-davicular

Fibroussupportali nment

Coracoclavicularigamentconoldcoracoidrocesso

colloidrocessn lavicle)nd rapezoid~eh~uperiorly

and al~allyn lavicle

6. Coraco-Acromlul

Fibrousfrom oncoidr ~_~ o cromionrocess

Support

Coraco-acromialig~m~n~

7. Gleno-Humeral

Head f umerusn lenoidossaf capula

Ball nd ocket

Multiaxial3 degreesf reedom

D(~cfibcotionsn rthokinemaficeg. BD inf

glidef umerusn leaoidossa

Tremendousobilityoor tability

Head great all, lenoid poor oc~Glanoidabrttmrim f ibroeartilageroundlanoid

deepens ocke~ omew~

No ore h~n /3 f ead v~ n ontactith ossaWhen umerusises p, ithern lexionr BD the ead

must lideown arthrokln~n~tic)

JOinteapsuletr~eh~o he ~rgi~f he lenoidossaand istallyroundhe natomicaleck

Capsuleas xpansionsligs 3 Gleno-Humeral

(Superior,iddle,nd nferior)

The natomyf he leno-hnmerali~m~r~s estdescnl~!y omvari~heir n~eh~nn~o a



[OUTLINE NOTES I

On righthoulder,

Suv uns rom upraglenoidubercleo esser

H or rom 2 1 o’clock;he uperioeglenohume.raliwammelltomplexonsistsf he

ligameat,he ocepsendon,nd he uperior

gle~oidabrum

Middleust elowt, i’om m 3 o’clock

Inf rom nterior~rginf lcnoidabrimanatomicaleck f or rom to o’clock

capsuleery ewl osteriorly;uns rom m 12

o’clocknd s tronglyeinforcedy he otator

cuff endons

The oraco-Humeraligamentuns rom oracoid

processo reaterberdef

The uperiorlemoidabmm mr.hesrom to 1

o’clock

Sum otalf i~m~nusupports airlynsignificant,eed

mnsollamresupport-H oint Use enri E;3Coraco-Humeralcts o elp reve~ubluxafionfjt

E. Bursae

1. uba~’omi~l

betweena’omion_roles__nd eltoidusclend he

tendonsf otatoruff nternally

Sometimesalledubacromialnd ubdelmid

Reduces edon

2. ubsacap1,1~r

Betweenubscapulardon nd capula



[OUTLINE NOTES [

F. Musclesf uperficialack nd houlder

- Trapezius,M:L

Upper

O: Externalccipitalromborance;superioruchaline

I: Clavicle

A: Elevation;pwardotation

Middle

O: Nuc.l~igament

I: Spinef capulaA: Aduction

Lowe~

O: Spinesrom 7 o 12

I: AcromionA: Downwardotation

N: CN XI and 3 and 4

Levator

O: Transve~erocessl hru 4

I: Medialorderf capulaetween

superiornglend oot f pine

A: Elevatecapulaith ownwardotation.

N: .DorsalcapulaC5) ith elp rom 3 nd

Rhomboidajor nd inorO: Spinesf 7 J3ru"5

I: Medicalorderf capularom oot o

inferiorngle

A: Add nd ownwardotationN: Dorsalp,,l~rC5)

L Dor~i

O: Spinesf ow~ T ertebrae,umbodorsuifasc~ rest f lium,ops orm owere

3 or ribs

I: Floor f idpimlroovef umerusA: ADD, xmnsion,nternalotationf ume.s

N: TboracodorsalC6~7,8)



[OUTLINE NOTES [

F. usclesf uperficialack nd houldercont.)

Deltoid,M,P

Anterior

0: ~ third f clavideI: DltoiduberosityfA: Fcxion.nternalotationnd or. DD

Middle

0: AcromionI: Deltoidub

A: ABD

PosteriorO: Spinef capula

I: DeltoidbcrosityA: Extension,at otation,or. BDN: AxillaryC5,C6)

SupraspinamsO: Supraspinamsossa f capula

I: Superioracetf reaterub fA: Externalotation,ixesead f in lenoid,

assistsBD fN: Suprascap.!~r(C5,C6)

Infraspinams

O: InfraspinamsossaI: Middleacetf reaterof

A: Ext. ot fN: Suprascapular(C5,C6)

T Minor

O: Medi~lorderf capula,pperwo hirds

I: Lowest_,~__n re~__te~"of

A: Externalot. fN: AxillaryC5, 6)

Subscap-l~risO: SubsmpularosmI: Lesser of and ngnlef H nim



[OUTLINE " NOTES I

F. usclesf uperficialack nd houldercont.)

Deltoid,M,P cont.)

P. Major and

O: Sternalalf f lavicle,ternumo th ib,cartilagef rueibs,ascia

I: Lateralip f icipimlroovef

A: Flexion;nternalo~ion,orixont~lDDN: Me~i~lnd ateralecwralerve C5,6,7,8,T1)

P. Minor

O: Upperrd. thnndth ibsI: Coracoidrocess

A: DepresscapulaN: Medin!horacic(C8, 1)

Subclavius

O: 1st ibI: Underurfacef lavicle

A: Stabilizelavicle,rawslavicleorwardN: N to ubolaviusC5,C6)

SerratosnteriorO: Outerurfacef ibs to orI: Ventralurfacef edia!orderf capula

A: ProwaaionABD ith pwardotation)of capula

N: Long horacicC5,6,7)

G. Neurology

Brachiullexus,ll omponr.~nd e~’mirmlle~Ves,relativenatomicalocation.

H,Vascular

Subclaviannd xillaryith elativeivisions

Divisionsfi

from st ib o edialordexeresajor

1st ivisionrom st ib o un mrderfnecininr



, IOUTLINE NOTES

ANATOMICAL LECTURR

A. Introductoryomments

b.Lumbar pine Hates 46, 47

I~ steologyalignmem

- prlm~rys. econdary.xrve

-~nmdusibrosus

-nucleusulposus

3. ace~ointsncludingointapsules

-superiorrticularacetnio!l~no

with nferiorof ertebrabovc

-gli~i,~oint

4. Ligamemousupport

- anteriorongit~dln~liganenn-posteriorong~udln~ligamem- ligamenmmlavum-supraspinous- interspinous,-imcrtrax~v~

5. umbosacraloim L5 S1)- drastichallgen haD¢f tlrve,romlordotico ypbotichearorcesre

greatlyncraascdddln~ressuren

discsompareontrast.thigp~ificjointith he est f umbarpine

C. acro-iilacointSD ]Plates45, 34, .35,36

1. ynovialoin*ith imitedotionmay ven

be used,upportedy ery trongigaments



T I NOTE I

4. Liw~m~nmtlS upport Dame and irlpntlfy igaments-PosteriorI

-Sacromberousischialuberosityo he acrum)-Sacrospinousisehhlpinend acrmn),-AnteriorI. liolumbarwansverseprocessf 5 o

medialspectf he lium)-Interosseous

5. ovement~normalnd athologicalNormal mtnlmllmotionppearso e liding

- Rotationf he cJ’umelativeo he lia- the acrumotatesn he agiuallanebout

transversexis o hat ts romonotoryoveseithernt~orlynd neriorlyr osteriorlynd

superiorly-r. ddition,he acrumay e ble o lide

superiorlynd nteriorly

-The mountf otions elatedo ge nd exgreatern omenhan an, speciallyt he imeof artition

-Greatestoronn arlie~ecadesf ife nd endsto issapearuringhe ourth__~__den en nd

f̄ifth n ome~-By he ixthecadehe ointas nkylosednmen nd ne hird f omen

-General_~!ines robablyue o egenerative

changesuch s JD

Pathologicalany xcessiveotionausedyexcessiveemandlsewhere

6. hqationshipthe est f he pine

-Any ltexationf ositionr lignmentillimpactn he est f he pineUignmant

D. ubic ymphysisPlates35, 36

I. steologyalignmentstresshe mportanceof ali~meat



IOUTLIN NOTES I

E. Hip oint Head f he emur ith cetablum)

- Plates57, 58, 59, 60

I. steologyalignmentf emoralead nd eck ffemur,haR f emur nd cetabulumf elvis-

- ac~abulums im usionf hreeelviconesilium,schiumnd ubis.ot ompletelyused

untilpproYim~telyge welve

2. ointapsule- Acetabu!nrabmm- Transverseigament- lliofcmoraligament

- Ischiofemoral- Pubofemoral

3. ursaessociatedith he ip egion

- niopecdnealdeep o soasendon,nt~dorf ip- Trochanw.xicgluteusaxinusnd lumalubesosity-Ischioglutealischialuberositynd lutcusaximus

F. Myologyf egion Hates 61, 62, 60, 61,

462, 63, 64, 65, 66

1. usclesf he ow ack-Superficialladssimusorsi-Deep exectorpinaeCOmmonrigill;liocost~lis

group,ongissimusroup,nterspinousroupVery eep rotators,uldfidi,m~ptualcs,inmm-ansvetsus

2. Glumal uscles-GlcuRm aximus-Glumus cdius-Gluteesinim~

-Tensorasciaame TFL)

3. eep usclesf uttock

-Piriformisnote he eladonshipf hepiriformi~o he ciatiserve

-Superiornd nferiorenerelli



IOUTL E NOTES I

5. nteriorhigh-Femoralriangle

-Sartorius-Ouadricepsemo~

6. eal!*!high-Adductorongus-Brevus-Pec~eus-Gracilus

-Adductoragnus

7. osteriorhigh- Bicepsemoris- Semitendonosis-Semim~[nbranosis

8. Lateralgh-Fasciaataeiliofibialand TFL

G. Reviewfnerveupply o egion

- Plates66, 67, 68, 69, 70, 71, 72, 73

1. ambo-sacrallexus-Femoralerve-Obmrau3rerve-Superiorlurealerve

-In_Ceriorluteaierve-Posterioremoralutaneous-Scia~ u’bialnd Ommon~’oBealll~v~

2. egmentalerve upply ereaorpinaeand eep usclesf he uttock

EL Reviewf ascularupplyo egion- Plates70, 71, 72, 74

I. emoralrterynd ts erivatives-Deep emoralrtery-Lateralemoralircumflexaso~dln~nd



[OUTLINE NOTES I

.CADAVER DISSECTION

A. Examinationf uperficialow ack

- Plates61,62

1, eflectionf kin nd ubcvr~neOUSat

2. emonswationf uperficialascia

3. dentificationf loodupplycutaneouserve

supplyo kin nd ~scia

4. xposuref uscles

- Superficialuscles;atissimusorsi,

erectorp!nn~

- Deep uscles;ultifidi,otatores,inteJ’spinous,menransverse

B. xaminationf uttockeg/on

- Plates64, 6.5,72, 73, 34, 35, 36

I. xposuref rea ia issectionf kin,at, ascia

2. demificationf uperficialuttockuscles;luO=usaximus,

gluteuscdius,lu~:usinlmus

3. de~icadonf ciaticerve

4. dentifiCationf eep uta~uscles;iriformix,

supe~oremeUus,bmn~r ntemm,nferior

gemeUus,uadramsr;moris,bturatorx~’nus

5. emonsu’ationf ateralasciandtensorasciaame uscle

6. alpationf ony ~ndm~rksn ac3-dm;asc,pusun’iornferiorliacpine,a



[OUTLINE NOTES . [

C. Examinationf uperficialnteriorhigh

"Plates60, 61, 62, 63, 64, 70, 71

I, eflectionf kin nd a~ia

2. dentificationf asciaa~e nd hickenedlateralortion,he lio--tibialractr and

3. uperficialriemadonf emoral’iangle

region;ordersnd ont~n~

4. dentificationf emoralerve,rtery,ein,

and t saphennusein

D. Examinationf eep nteriorhigh nd he Ip oint

- Plates60, 61, 63, 70, 71, 57, 58, .59

1. d~rificafionf usclesn he egion;ar~fius,

rectusemoris,asmsateralis,asmsntennedius,

vastused!~!is,dductorongus,dductoragnus,itiopsoas, nciins

2. alpationf ubic ymphysis

3. eviewf nnmorhigh;uperficialnd eep

E. Dissectionnd denflfl~lonf ip oint- Hates 67, 58, 59

I. dentifl~tionf uperficialointapsuleigamnets;iliofemoral,ubofemoral,nd sehiofemoral

2. eep apsularissection

- Dissec~nf apsule

-Identificationf nternaltrucoJres;igamenmm

fetes,he ceWoularabrum,he ce~ukum

-Dissectionf nntr~ater~in ,~iraen’ncmrm~t



{OUTLINE NOTESI

F. D~secaonnd Identificationf Blood upply- Prates70, 71, 74

1. dentificationf Femoralrterynd ts ranches;

medialemoralircumflex,emroalrofunda,atera

femoralirolmflexith ts ranchesdescendingnd

G. Dissectionnd dentificationf Pubic ymphysis

- l~nt~ 35, .36

I. Joint den~fication

2. nterposedisc



IOUTLINE NOTES I

CLINICAL APPLICATION

A. Lumbo-pelvo-hipegion

B. Clinicalnmple$

1. Clinical rflevanc~ und~ndin~ anatomy

2. Clinkalovmentests

a.Areaff~___ed

b. ll issue

3. sohtes pec’~callys ossible

4. natomyarallelso linicalituations

C. Surfacenatomy

1. alpationips

a.Use dominant eye when possible

b. on’t eel hat ou ee r xpeao eel

c.Concentrateco ot alpateasually

d. ake very ppor,,,iryhroughomparkuve~edences

e.Establishhabitnd tay ith t

f. ary epth f ressureuse inim:d~r,~ry

g. eginalpationf u’ucmresyingost uperficial

and rogresseeperayery ayer

2. Bony nndm2rl~ tO ~ posilionin~



{O TLXNE NOTES I

b. ~vis sacram

- ASIS AIIS

- lll~minnl i~mn~

- Pubicubercle

- Pubic ymphysis

- PSIS- Suicus-ILA

- Sa(:l"otubcrousig~mnet

- Sacralosition- L.q~hiMberosit7

c.Hip-Grmcr ochamer-Femoral’ianglearrm’y-Lymph odes-Sciadcerve

3. Muscles

a.Muscleosition

b. liniczlonsiderations

- Latissimusorsi- Breaorpinae

- Dccp ro~tors

- Quadx’ams umbonml

- Glu~! uscles max/mus medius

- Pidformis- niopsoas- AbdominAl~

- Adductorrevis

¢.Two oint uscles h3mgWlngs

- TFL IT and

-Rec~- Graci/is

D. Jointotion

1. Lumbar



[OUTLINE NOTES ]

2. I oint-highlynflue~_y uscleength-musclesttachedo xtrinsicigament~ndthereforenfluenceontrolf oint

Sacrombemusigamem

bicepsemorisgluteus~Thnus

Sa~’ospinousigamentpiriformis

nio-lumbari~mnt~thickeningf asciaf uadramsuboroum

3. ip oint

a.Rotadon

b. ecreaseincreaseoad y ositionf acrum

c.Psoasursitisecondaryo A

E. llp urgerytotal ointeplacement

F. unctionalctivitiesclinicallysolateach egment

G. linicalonsiderations

I. Straighteg aise

2. Passivenee lexion

H.Conclusion



APPENDIX

The ollowingages ave een eprint~y ermissiony he iba-Geigyorporation.

They are all com~in~! n the Atlas f Hnm~nAnatomyy Netter, lnt~ 45-147; 60-162; 70, 73,

334-336;95, 98-402,05. 09, ~-475

Graphic l~ate

Sacrum nd occyx 145Vertebraligaments:umbaregion 146Vertebral o"~ment~:Atmbo~tcr~ 147Musclesf ack:ulr.zi~cialayers 160Musclesf ack: ntermediateaye~ 161Musclesf ack: eep ayers 162Bony rameworkf Thorax 170Cervical ibs Pe!~tod n0m~iifies 173Posteriorhoracicall 178Bones nd igamen~f elvis 334Bonesnd igamentsf elvis 335Sex ifferencesf elvis:easurements 336ClavicleSteraoclavto,l~roint 395Glenolmmeraloint 398Musclesf houlder 399Musclesf otatoruff 400ShoulderAxlU~ 401Asul~ryrtery .4rm~tomosesroundcapula 402

Bronchiallexus:chema 405Bronchialrtery ,4n~tomosesround/how 409Coral one 457Hip 458Femur 459Bony rrangememf Musclesf Hip nd high: nm:ioriew 460Bony rrangemeutaf usclesf ip nd hivah" osterioriew 461Musclesf high:nterioriew 462Musclesf high:-~’ioriew 463Musclesf Thigh: m~or iew 464Musclesf high:osu:rioriew 465Psoas nd ltamsuscles

406Lumbosacralnd occygeallexuses 467r Jlmharlexus 468



Sacrum nd Coccyx

SEE LSO LATES42, 47, 31,334,V~5. J.:,6

Base f sacrum ,, Superior

/articular

ILumbosacral

1

process

Lateralarlicularurfacepart

i Superior canal

.,~:~ Ata wing)

’" -:.~...~" acralart~’"’e,, ~’~i

- of pelvicrim ~ ’~~ ;~

r:: (lineaerminal(s)"e. . ~-

" --Anteriorpelvic) ¯ .,;

¯

sacraloramina

’,’~ i" "

¯ . Sacraliatus~u

Transverse ~ridgeslines)

. . ~

...... - " Median agittal ectionpeI’’! ,x f sacrum ~ "

Coccyx. " ~Facetsf "-

~ ~

~ ~/superiorarticular,

. processes

Pelvicurface .

~"’’r’

Sacral uberosily" ~.’ " "~-/-/-~

Lateralacralrest i~.~...%~

MedianacralrestMedian acral rest ~ [q i:" ~ P"

SacralanalIntermediateacralrest

Inlervertebral ~ ""ii Posterior(dorsal) / i"-~i

sacral oramen ~ ~.~l~ ~ Poslerior



Vertebral igaments: umbar egion

(partiallyLeflateralieWsectioned)~li::~ ~iI I: ~i:i:.. -~

I~lnferiOr rticular rOcess

~, ~.~ -~ ~ Capsule f zygapophyseal oint¯ . (partiallypenedl

Anterior /I ~ Superior rticular rocesslongitudinaligament

"’"-- ransverserocess

Lumbarertebralody --’"¯

,j ~ Spinous process

~:-"~;*~.-.-~::/ ~ Ligamentum flavumIntervertebraldisc ’ " "

~-’~’-~"] ~ lnterspinous igament

~I’ ~-~

AnteriOrlongitudinaligament .l~

’’:’’

~i~mmr~~~’

~ Supraspinous igament

irtebraloramen

,~.:~’:’~:" ~ ~*:...ijt

Interve

Posterior " ~ ...

longitudinaligament ~ "" ~" "~

Posteriorertebralegments:

anterioriew

Anteriorertebralegments:Pediclecuturface).._i

i

posterior view .... : ~ _ .___~<’,.~. -"~’~’-:"

~l~" "/x’diclesectioned); ~:"-.""" "---:""’-

(-~,~=~-:~.~,~,~.,~"~ ~-"-

~ Ligamentum f~,’

.

Pedicle cut surface( /; ~’~

t.".Posteriorurface ¯ -L- ¯ . ~.-~ ,

of vertebral bodies .... "~

Posteriorligament ~ ’,~

uperiorrticularlongitudinal k .......



Vertebral igaments:umbosacralegion

’ uperiorrticular~ process

nteriorligamentongitudinal

! Transverse rocess

-’~’~ / Lamina

lsl lumbar / Inferior rticular rocessPediclecull Posterior

vertebral body ~Pedicle ligamem

/ Intervertebral oramen " ~ "’" ":

Intervertebral I

! ~ !

discs~- - y~Spinousprocess " " ~i

~11~ Interspinous igamentI~

2nd Lumbar ..’ ligament -~-.:~;!!~,IIp:~::

spinal nervei

~/Cupraspin°usSuperior rticular rocesses;~

facet ropism differencen~."’I facet xis) n right ide ,

Spinous rocess_

’, . .Lamina ~"

5lh lumbar~’~~:i~’~

Transverserocess.,~l.,,,~lk.~~.=~. ";" ’.""

body ~":

Inferior articular process ~vertebral .

Ligamenlum flavum"-’-’~ ! ~’ ~-

spinalSth umbar\ /-~ .il~nerve~ Iliolumbar ligament\ .. ~’" :~’-’

¯ . lliacrest

Auricular urface f sacrum Posterior ~.~ ’!(for rticulationith lium) ¯ ~-~

superior ". ’~ #iliac pine ’: ’~

i:~i~...

Sacrum i

inferior .- ...,_,~Coccyx iliac spine~

Leftateraliew .’~ :"~



Musclesf Back: uperficialayers

SuperiorSpinousuchalprocessinef kullC2). I,

~

" /SpinousemispinalisrocessapitisC7)uscle

Sternocleidomastoid muscle~

j Splenius apitis uscle

Posteriorlateral)rianglef eck-.------= //

/ Splenius ervicis uscle

Trapeziususcle~, Levator capulaeuscle

Spine f scapula~ fj Rhomboideus inor muscle cut)

Deltoid muscle~/ Supraspinatus

muscle

Infraspinatus

fascia ~ -- Serratusposterior

Teres inorsuperior uscle

m cle.............~

RhomboideusI maior uscle

Teres ajor (cut)muscle~

"~Infraspinatusfasciaover

~

nfraspinatusLatissimus muscle)dorsiuscle---.....

Teres inorand major

Spinous process (T12)~~

muscles

Thoracolumbar fascia~ ~ Latissimusorsi uscle cut)

Serratusnterioruscle

Externalbdominal?~ ’-~-2’~’~’" Serratusosteriornferiorblique uscle, ’:

~,~." ~ muscle

Internalbdominalblique~ ~i!.~" 12th ib

musclen umbarPetit’s) ..:..~, .

triangle~,. ,.: ~:.’ ,Z~

~ Erector

.~~’,, ..:.,I~P’. ~’~"/"":/

spinae uscle

lilacrest ";.~,f.l~.~~,~ N~"~ ...~/i::~ " ...................



Muscles f Back: ntermediateayers

Superioruchaline f kull ~ ~/Rectus apitis osterior inor uscle

"~’~ ~’~.

~ Superior obliquus capitis muscle

Posterioruberclef tlasCl .-~..~~lt~=.’.=" ’J

Ik~.~-~’1~~ Rectus apitis osterior ajor uscle

Longissimusapitisuse -

~ ~- Inferior biiquus apitis uscleSemispinaiis capitis muscle’~~

~ Longissimus capitis muscle

Spleniusapitisndspteniuservicisuscles-------~.~

~" Semispinaiis apitis uscle cut)

Serratusosterioruperioruscle. ~ Spinalis cervicis muscle

Spinous rocessC7)

"~~ Longissimus ervicis uscle,,iocostalis muscle ~.~

"~ Iliocostaliservicis uscleErectorspinae Longissimususcle

~’~ ~ Iliocostalis horacis muscleuscle

~"~ Hook

Spinalis muscle --

Spinalishoracisuscle

Longissimushoracisuscle

Serratusosteriorinferior muscle ~

~ Ilioeostalis umborum uscle

"’" ’l ~- Spinous rocess T12)Aponeurosisf

transversus abdominis muscle ~

~....~Transversusbdominisuscle nd aponeurosis

Internalbdominal

oblique muscle ~ .--------horacolumbarascia

~,

" (cut dge)

Externaiobliquebdominalmusclecut)~

¯ ..... t!



Muscles f Back: eep Layers

+" ~j~ j Rectus capitis posterior minor muscle

Superior nuchal line of skull~

Masloid rocess--.~/~’,i;:1, / Superior obliquus capitis muscle

¯ ’ ~ Rectus capitis posterior major muscle

Posterioruberclef alias C

~ ~ Transverse process of atlas (C1)

Spinous process of axis (C2)’

InferiorbliquuscapitisuscJe

Semispinalis capitis muscle~~~"-"’-"-~- ongus)

BrevisRotatoreservicisuscles

Spinous rocess C7)

Inlerspinaliservicisuscle

Levator ostae uscle

External ntercostaluscles,

....-.-.-.----ongus Rotatores

_.-.-.----revis~ thoracisuscles

Semispinalishoracis uscle

Brevis ~ Levatores

Longus~ costarum muscles

Thoracolumbar ascia

(anterior layer) / Interspinalis lumborum muscle

Thoracolumbar ascia Lateralntertransversiuscle

(posteriorayer)cut) ----__._ /

Transversus bdominis uscle /lQuadratus lumborum muscle

and po°eurosis-

..~

~ lilac crest

Multifidus uscle

! ~-%+



Bony Framework f Thorax

SEE ALSO LATE 31

Anterioriew ~ ___--------ugular otch

Acromion/~~’~m~"

/ Manubrium

Coracoid / / AngleSternum

process /~.......~ody

Glenoid //

Scapula- foss;-’~//

r,~mlll~ Xiphoid

Subscapular /

fossa~-s I- / I

False ribs-~

~~

~ Floating ibs

f / Clavicle

Rib ~Tubercle\

Acromion

’~ Supraspinatus

fossa/ ~g,e\

BodyX~Spine

Scapula

Infraspinatusfossa

i

~True rib~



Cervical ibs nd Related nomalies

SEE t..50 LATES 8, 04, 05

Scalene usclesAnterior

Middle,,~

Cervicalib ~ Cervicalib dhereso

compresses ~ 1st horacicib y

~’/" ~

subclavian /. ~" ~.~’-~.ense ibrous and !~

artery:

Nd,,atat,on

~

~

~’,,.brachiallexuselevatedy

cervicalib

~i,, t.YJ "

Rudimentary

with osffixedbrachiallexus ,,~.~

,~ ,~

~., ,



Posteriorhoracicall

Superioruchal ine Spleniusapitisuscle

Externalccipitalrotuberance Accessoryerve XI)

\

Posteriorlateral)rianglef eck \ Levator capulaeuscle

/

Sternocleidomastoicluscle / Rhomboideus inor muscle

/

Trapezius muscle ~ ’ / Rhomboideusajor muscle

\

Spine f scapula~ ’Supraspinatususcle

/Infraspinatusascia Infraspinatususcle

Deltoid uscle

~

/ Spine nd

~ Acromion of scapula

.~

Teres inor

Teres inor muscle

muscle ’~’~

~ / Teres maior

Teres ajor

~-’1~1~ "~muscle

muscle ~.__

,,.,~ Spinousprocessesf

thoracicvertebrae

~ I.atissimusors~L~t[iSsmusclecut)

/1 L dwer gitationsf

Latissimus orsi muscle-~’~l ~ serratus anterior uscle

\Digitationsf xternal

"’~: abdominal blique uscleExternalbdominal ",

\ [oblique uscle

4.

.’i



Bones nd igamentsf Pelvis

SEE ALSO LATE 57

Midsagittalection ":-~"-~’~""~/Vertebral ody of L5

lilac Intermediateine/ False pelvisrestt nternalip

j /. Lumbosacralntervertebratisc

lilac ossa wing)~,.~

Anterioruperior/..,/ Sacral promontory

lilacpine

’~"""~i’ /iGreaterciatic oramenArcuale line ~

~/True elvis

Anteriornferior

~

/ Ischial pineiliac spine ~

SacrospinousigamentIliopubic eminence~~ / /

/ Lesser ciaticoramenObturatoran J,

I:. Sacrotuberousigament

Superiorubic amus/ Coccyx

Pecten ubis ..._..~...~(pectinealine)’

",’~’~~ i/Ischialuberosity

Pubic tubercle ~ :~ ~~

surface, ’\ ,F-.

Obturator membrane / ~ ~ "~’7~. "~ ¯ . .~

Lateral iew Supraspinous ligament ~ i~~ ~ Vertebral ody of L4

.~?~"~. Intermediateine

~1 "[~ "~ "~

/ Externalip ~ lilacrestPosterior,nteriornd_~

~ ~ - ,Tubercleinferior gluteal lines ~’;F

/ Wing (ala) of iliumPosterioruperiorilac pine

i~I~.

,~ ,.~-..~ (glutealurface)

i}i" :."

/ ~ody f iliumacrum median rest ::

¯ nterioruperior

Posteriornferior ilac pine ’ ’~.~’ ,, /illac pine~,~ ~-~ :" ~ :"~:-" . Anteriornferior

Posterioracroiliacigament

i~1~"~!- "~

¯"------ r/ ¯ lilacpine

Greater cia ic foramen "~"J

/, Acetabulum

H

,r"~-~- .~,..~ Fibrocartilaginousargin

Sacrotuberousigament f .~ (labruml

i~, / . -- Bony margin

Posteriornd ateral

~ Zi

/ Notch

Lunateuri:ace

sacrococcygealigaments .-~ .~...~1~. ::-



Bones nd Ligamentsf Pelvis continued)

SEE ALSO LATE 45

~j Iliolumbar igament" . ~:-~.__.__.-~-ilacrest

!~..~.~..~-~--....

"41~:~n,.._~_~ :~-~- Supraspinousigament

l...~.

": .~:s: -- Posterioruperiorliac pine

~ Posterioracroiliacigaments

¯ : ’ - , ~ Tuberclef lilac rest

;i~:!~,~_~ ~ Posteriordorsal)acral oramina

,o;~.~:.. / Anterioruperiorilac pine

_~,~:~ . Greaterciaticoramen

, --.;,::. ~ Sacrospinous igament

./~.. . _~_. .~i acrotuberousigament

=~’.’

~i "~ ¯ Lesserciaticoramen

~.., / margincetabular (limbus)

~\ Ischialuberosity/

~/ Tendon f long head of Anterior

/biceps emoris uscle longitudinal

/ ligament

!;"Iliolumbar ~ !~!l~!i~

: ~".?’~. Iliac ligament . --.--.

"~-~a~,.fossa "~

i.{ i~,o

)Posterior ~ ~’,’ ., ’i~~ep ~sacrococcygea,’ Externallip.~__7~

~ t!~t~uperficialligaments ~" I Tubercle~ i~lilac rest 1 ntermediateine-’~Li

’"’ ’ = ’:’~I’!~ateralacrococcygeal Internal lip.~l -

ligament ~

Posterioriew Anterior acroiliaciigament-~/

..........acral romontory----~

Greater ciatic oramen i

Sacrotuberous igament ~ .*’.q’~Anterior uperior ilac pine~ ~’-~--~-~/

Linea . z Sacrospinousligament~_..Ik -~~. :..-’~

termmahs ---~Anteriornferiorilac pine

Ischialpine----’-----’~i~7~ Anterior



Sex Differencesf Pelvis: easurements

SEE ALSO LATE 31

Femaleelvis:nterioriew..~ ....!L .. .

~~, I ¯ . Conjugate--11 m)II~,~~ Diametersf~~Transverse (--13 cm)I pelvic inlet

o que:.scml~ ~~~~lnschial spine

~t~i~. ~ ~ Iliopubic eminence

6"

. .- hr~

} .. "

, Ji ....}

Male elvis:nterioriew( : {’ ~"

All easurementslightlyhortern ~;-., /~relationo body ize han n emale

~ !~

Pelvicnlet rientedore ntero-~.~osteriorlyhan n femalehere -, . . ’~

¯ it endstoe ransverselyval ~. ..::Pubic ymphysiseepertaller)

!~

Pubic rch subpubicnglel arrower

Ischialuberositiesess ar part .~

lilacingsess lared

Pubic Iransverse

~s

"f pelvic

ymphys=s

~~

:’"

; "" ~’.’~ Sacra "~" ""’~"

/ ipromontory

/..~:~,:;. .:-,’~>

,..-~-. "~ ."/~Conlugate.

.~! ’~"~-~’.L. .

~ ~/ c/iameter ~



Claviclend ternoclavicularoint

Right lavicle

~perior surface

Acromialextremity~’;: ~~ POsterior

~r~~ ")~._ Sternal ext remity

4nte~

.,~ Inferiorurface .Impressionor ostoclavicularAcromia|xtremity ~f ~~ --" r /ligamentcostal ubercle)

St r lera.zo,d,,n..------ .trem,tConoid ubercle" / "~

Groove or subdaviususcle ~w-

Trapeziususcle i Muscle origins

Superior urface ~ Muscle insertions

~~

i Ligament attachments

F", Po~i.. ter/; ..

Deltoid uscle

Deltoid uscle I"

4 ~Inferiorurface

Pectoralisajor uscle

i~L Anterior /Pectoraiis ajor uscle

CoracodavicularTrapezoid

~~-- /~o~"v’

~-.~W~tOclavicular

ligament

ligament~ ligament--,./Conoid igament

Subclaviususcle

Sternohyoiduscle

AntenorternoclavicularigamentSternoclavicularoint

nterclavicular /ArticulariscClavicle ~ _~11~_. X_ .. ligament /_ o ~".. Joint cavity

S u bclavi u s m u scle .~.~----~li~’~~ ~ . ,.~...~.~.’.~~’t

,.:>~. .,,~,~%. .*.~ .~i~li~’-" .X :.%~’~.~ .... -" ;-J/’~~y~.~Costoclavlcu ar igamentCostoclavicular ligament.~~’~ ~.-.. ~1,~ ~-~" ~,~/~.~~

p. ~ .. . ¯ ta



oint

Altterior view .~-’~ .~..~-- Clavicle

" i~;=~m~’~.:~.~ligament f Coraco-Coracoacroma gament f,~ .:~_ .j.~ .,~ ..-.~-~:~q.:~(~-~r

""~’~. "~’~ .~’.’~d ~ : cavcuar

¯ ~~, ~:\ ;’: .~ Conoid( ligamentop p,natustendon co. ......Coracohumeraligament .._ .7~’~-.:.b-.~’~’=~ . .., YrsJ~: ~., ,~’~_~ .

4~" ~’-;-~-~’.. ~~’ ~:’" Superiorransverse

Greater tubercle and N [,:" :, ":’~"~ ~ ~ scapularigamentnd

Lesser tubercle .......~ ~."; ,~-. "~’~,L-.~_~-/.’~4. ~ scapularotch

of humerus ~-::.::’._" ~:~!’::"- ’" ~[: . ;/.~’~~~N~-. ~" Coracoidrocess

Transverse ligament of humerus-~-"~’~-’~~~

~" ~..~ ~ Open’nes of subscapularIntertubercular synovial she~" .~’~::’. ~ bursa o~shouer nt,commun,catesw.b.na,

" " i ~’~ ~’~’~ ~: "Brokenine ndicates~UDScapmar s te ,oon ,cur, ’~ ’~’7~ ’~ positionf subscapular

Biceps brachii tendon (~ead)’~"~ ~ ~1~

\,..~

bursa

ew F "~ ~"~"~;~’-’~"ai~L~’:’: ( !’~’~1~’~ fi::i~Supraspinatus muscle

I i~ :!!~ r ~ Subdeltoid bursa with extension under

t~ j,’.i..~ ~ " --~" ’ ~.. ~ acromionandcoracoacromialligament~~-~.~~usc,e ~~~ .reflected),,.,,~.:~:.".~.~," "~.~:.- ~,,..,,~.’~. . ~ _~ SuDscapularisuscle

~, ~,’,’~ / ."C"--.~; "~-- " ~.~

’t~..~~Subdeltoidursa

X~".~: \ upraspinatusendon

~~~\ ;apsularigament

~~ r~ ’~’q~-- Deltoid \ Syn::lr::m~ ane

°u eGlenoid

, labrum¯

Coracoacromialgament

Acromion /

~~..~ ~..Coracoid p~essupraspinat us tendon ’.~ ~ "~ -- -

¯ ,~ ~ ~ ~ ~L..~.oraconumeraligament ,,~joinedO apsule) ,~~-:~ ~

~~.~i~~ ~-----Biceps brachii tendon

[!

.. "" 2.’,’;i:’ "" i "_ ." . "nohumera, °*a’l~"J~,~s%



Musclesf Shoulder

SEE AtSO LATES 2, 60, 74, 75, 77, 78

Pos~riorview ", ~ Semispinalisapitisuscle toN°t onnectedlimb

~~ Spienius capitis muscle j

upper

j Spinous rocess f C7Levator capulaeuscle

Trapezius muscle ~~ Rhomboideus minor muscle

,~Rhomboideus major muscle

Deltoid .~:~~

Acrom=on"muscle. ~ ~’"=

~i""" upraspinatususcle

P Spine f capula

]nfraspinatus...______! -"’~- nfraspinatususcle

fascia

~ Teres minor muscle

rTeres ajor uscle

i" Latissimusorsi uscle

~- "~-

’ Long head }Triceps

~. ~7~

-~

" brachii~ ~ Lateral head muscle:.~=

", ......... ~" :-i~ ! ~ Spinous process of T12

Trianglef uscultation . "~" "

: -- ~ .._._.--Trapeziususcle

Omohyoiduscle, ,~,l

i ~i~cervicalinvesting),~cia

Anteriorie~f"~ Sternocleldomastoid

Acromion ~ ...... - ¯

. u.eeltopectoralriangle

~ Clavicle

Deltoid uscle--’-""-

beadeltoid branch of y~

~’ !" ~"Clavicularhoracoacromiallter

~

~ StemocostalPectorali~

Cephalic vein /

f ~. headmajor

Biceps ~ Long head-~.~ ~ Abdom na

muscle



Muscles f Rotatoruff

SuperioriewCoracodavicularigamentTrapezoidconoidigamentligament Coracoid rocess

~..

Subscapularisendon

,Coracoacromialigament

Acromioclavicularointii

J JtendonSUpraspinatus

j, ....

Infraspinatus/

¯ . ",.~tendon

Teres inortendon

...

". .~ .,~Acr°mi°n

a. ., ;,:~Infraspinatususcle

Claviclej \Spinef scapula

~0 PSubscapularisuscle

~Supraspinatususcle ~’ ~"/".....

Superiorargin f scapula

¯ Coracoacromialigament

Coracoid rocess~upraspinatususcle

AcromionSuperiorransverse Spine f scapula

scapularigamentnd

tendonSupraspinatusscapularotch

i~b~Acromion

/,

~" ".4"

~ ~ ~ ~tendon~ ~ Infra-

Lon~ }’.~

, -~.t .. -~-~pinatus¯ ’ .~,"’~ ’ " ".Cj~--uscle

tenoon ~ /~ .. ~,.=,~ ~

of biceps,’ , , ’", - "~

brachii ~~ -~I Teresmuscle

~I rn!n2r_



Scapulohumeralissection

SEE ALSO PLATE 50

Anterioriew Coracoacromialigament

AcromioilCoracoid rocess

"~/ )rascapularrterynd ewe

reaterurdeofhumerus\’uprasp’natusendon

Bupe.ort.nrsesea

/-:- ’=...~,~ ligamentnd scapularotch

¯ Subscapularistendon......_.."~-. ~ Pectoralisinor endon cut)

Intertubercularynovial heath ~-- Biceps rachii endon

(shortead)cut)ndAnteriorircumflexumeralrtery--.....,

coracobrachialisendon

Biceps rachiiendon(cut)

(long head) (cut)~ Subscapularis uscle

Axillaryerve nd"~ Subscapularrtery

osteriorircu..umeralrtery

~ Lower subscapular erve

Quadrangular space’/~(to eres ajor uscle)

Radial erve ,~__~,,~ Circumflex capular rtery

head/~~ Thoracodorsalrtery nd

Biceps{Long /~

nerve to atissimusorsibrachii muscle)muscle Short head

,/~ Subscapularis uscle

Coracobrachiaiisuscle

Triangularpace/

~Teres major muscle

Latissimusorsi uscle

/ Suprascapular rtery nd nerve

~.~.~,~r~’~\cromi°n

Posterior view ~ ,~

~’~ \~..~.~..--n f raspinats tendon re fleeted)/-~

~.-~’_...-apsulef houlderoint

Superior transverse scapular~ .ligamentnd capularotch ’~’7~’~-,f~-/~-~_~

, . .~...~’". / Deltoid uscle reflected}

Supraspinatususcle cut) ......-Teresinor uscle

Spine f scapula"-~ ~"--~~/-

....- uadrangularpace

~.-~’~’,~"~-~" ~ itransmittingxillary

:~.-~-~.~.,Jlr/~E~i,~ nerve nd osteriorcircumflexumeralrtery

Infraspinatususcle cut)t"



Axillary rtery nd nastomosesround capula

SEE ALSO LATES 8, 409

Anterioriew Transverse cervical arte ry~.~~ ~/Inferior thyroid artery

Sup rascapular artery .~i;~~

/Thyrocervical trunk

~ Subclavian rtery

acromiallexus~

~ /¯ Anteriorcalene uscle

Dorsal scapular rtery ~:" ’ ’!!, ~= Clavicle (cut)

’~ Superior thoracicoracoidrocess----’----" " .

.f arteryAnteriorircumflexhumeral

artery ~ . ~r’---..~. horacoacromialrtery

~ ClavicularranchPosteriorircumflex

humeral artery~ Acromial ranch

~~l~~ ~ Delt°id branchSubscapular artery/ ’ ’J " ~ Pectoral branch

Circumflexscapular rtery )

~..... ~ 1, , indicatest,

i 2nd nd3rd arts fBrachialrtery

/

~"axillaryrtery

Thoracodorsal artery / " ’’

/ateralhoracicrteryOmohyoiduscle inferiorelly)

¯/ .Suprascapularrtery

Levatorcapulaeuscle ~Acromial branch of

i

~’..

~

thoracoacromialrtery

Dorsal capular rtery --’~"~. Acromion nd

: acromiallexus

Supraspinatususcle cut) ~.~.~ -- Infraspinous~ branch f

suprascaputariSuperiorransverse i artery

scapularigamentr

and scapular notch / i Posterior

~

circumflexhumeral

Spine f scapula , :~-arteryin

¯ .~ quadrangularspace) ndascendingnd

Infraspinatus uscle cut)/

~~~"’’~ branchesdescending



Brachiallexus: chema

Note: sual ompositionhown.Prefixedlexusas arge4 t~

S too_~contributionut acks 1.

~1¢~’~ ¯ "/fromC°ntributiostfixedlexusacks S but

~~/fC4

has 2 ontribution

’~ .t t~,.~

Dorsalcapularnerve C5) rDa°r~Sul

~ f ~-~

TnI rvherenicSuprascapular ~ ~

" ¯ nerve C5, ) i’ : :’~-~’~

To subclavius

Lateralelt

...usculocutaneous

i Contributionnewe (C5, 6, 7),.~jJ

~~

from 2

¯ .’;~:~ To ongusolli

~\

and scalene

Axillary~

,~ ...~=~"1st ibmu.c

nerve (C5, 61 ~c~1C5, , , 1

Radial newe~~

\ 1st intercostalerve

~Medial ectoral erve C8, 1)

Long horacic(C5, 6, 7, 8, T1)~

’~ \ ~Ml~ed:: nr~: b ~lcCh~:: : :::~::

nerveC5, , )

e IT1)Median erve(C5, , , , 1)

~

" nerve C8, 1)

Ulnar erve ~Upper ubscapularerve C5, )T1)C7, ,

~ Thoracodorsalmiddleubscapular)erve Ch, ,



Brachiai rtery nd Anastomoses round lbow

SEE ALSO LATE. 02

ClavicularranchPectoralranch

Acromial branch.

~

~,;~:;,eltoid branch ~

Thoracoacromial artery ~ ".’,

.~ ¯~~!

~ Superior horacic artery/xillaryrtery " ’

~.!~

i ~_-----ateralhoracicrteryAnterior ircumflex umeral rtery ---~---~--

r-

Posteriorircumflexumeralr te y’ -~-~------------

i~il .~

/Subscapular artery

~*~i ’~.._.-.--ircumflexcapular

f~~ artery

Brachialrter~ ,,

! i Thoracodorsalrtery

Deep rachialrtery -

~’ 7":’~

~ Level f lower argin

~ " of teres ajor uscle

i:~;]{~s~!

iS landmarkor name

-; ~. , change rom xillary

Radialollateralrtery

i~:’’~"~::~’"1~1~i’

to rachialrtery

Middle collateral artery~

--Superiorlnar ollateralrtery~r

Inferiorlnarollateralrter

Radial ecurrent rtery~ ~:

Interosseousecurrentrtery / .~

_ . . ~ ~ ..__.--=-Anteriorlnar ecurrentrtery



Coxal one

SEE LSO LATE.$3 I, 334, 35

Latera vew ~ ~ Intermediateine

J~’~’~"~ c~ "’~-}~ Tubercle ~ lilac crest

( Anterior /.~’~’. .~1 ~~ External hp

Gluteal ) Infer ""=:("~

"

lines ~ Poste°rr~’~ , .~"~--~~ Wi ng (ala, o f ,,, u".~" k~" (gtutealurface)

P°;teerr /~;" ~; ~ .": 1 ~ ~ Anterior superior lilac spine

iliac~’ /£ !~ ~ ~" , ..a,p,ne.’. -

..~ I .-~ / Anteriornferiorilac pine

P°steri°r ~"~ji

/ ~ " ’ V

inferior . _

lilac spine~ ~l~ - " " Acetabulum

°.’ " Lunate urfaceS Notch

/

//Margin limbus)Greaterciaticotch

Body of ilium .~ / Superior ubic amus

¯ ," ,~ ~ ~"

Ischial pine// , Pubic ubercle ~" ~ ~’

Lesser ciaticotch ¯ ¯

Body of ischium/)bturator

Obturatorrest

foramen ""’-Inferiorubic amus/.Intermediateine lilac

¯ schial.tuberosity-~Ramusf schium’-’-"

"~

"~

~_~lnternal.~..- ...

.

.

lip ~ crest

~ - - ~ ~ lilacuberosit,/

/~=~ ~ -: Posterior

Anterioruperiorilac pine......~l~ :--’~2- superior

Wing ala) f lium ... . "~

lilacpine

(lilac fossa)--’~ : "~.....;. ~

~,.,

r ..Auricular

Anteriornferiorilac pine.-....~.~"

| ~.~L~ surface

¯ ~ (for acrum)

Arcuateine - . ~, " ’

~: Posterior

Iliopubic eminence~ ! , .’.~t -~ inferior

~’ ", ’~F~ i~~ iliacpine

Superior ubic amus . ? ~.~..,-~-~ .q. =-~,-..-~-’~: ."..--- Greaterciaticotch



Hip Joint

(~i

Anterior iew

Anterior "~ ~

,/IliofemoraligamentY ligamentf Bigelow)

superior ’~/ Iliopectinealursa over ap n ligaments)

lilac spine~-~ / / Pubofemoraligament

/ ObturatorreslAnteriornferior ~. /

,ilac spine~Superiorubic amus

Greatertrochanter /

\~j,

Posterior iew

I liofemoraligament

;~il~ + I

.: ;~.:~+ / Ischiofemoral ligamenl

~L~:. .......

+/..~.~Z,7~’¯ ~_~.~ Zona orbicularis

..... Y / Greater

Ischia V ~ "~~~

,ser rochanter spine ~ ~~

,ntertroehanterieline~+d + /~,~+ Protrusion +

~li~ ~r~ of ynovial

,+,~. ~. ~lb’~ ~ Intertrochanteric

Ioint pened:~,-.,.~. crest

lateralview .+.,.

.’~’~,:,, ~ ~ "Lessertrochanter

¯ . +.:~~1 ’Anterioruperiorilac pree

Lunate urface / ~~ " +:.¯ + .__._..-------Anteriornferiorliac pineof acetabulum~

,-" ,-. :

/ Iliopubic eminence

Articular artilage~’~ ....._~eetabularabrumfibrocartilaginous)

’~ Fat n cetabularossa coveredyGreater ~: ~’~ " ~.~

synovialmembrane)t rochanter ""’-T~ ........

__ bl+ua+t°r+~rt__e_ry



Femur

Anterior iew Posterior iew

Greater Head Trocflantericossa Greater

trochanler..- // Head~ "’-~-’~"~i~

trochanter

~

"’~ ~Fovea of head ~ "~

¯ Foveaf ead .--..._~ r.

f..-. , e . ~ ~-- ~ Line f capsular eflection " .

Neck /

Intertrochantericrest

LesserrochanterCalcar ~

InterlrochantericineLesser trochanter"

¯ !~:

Pectinealin ~/~l

’..~_~: Glutealuberosity /

~ ~::~i ! ",~ .-~.’,

{i i! i ~

Linea speraMedial lip -~"-~

.Lateral ip -’~’~

i!

~ ¯ ~ : / Nutrient

~-~ /

foramen

? ,Body shaft)

Body shaft)

/

:! /

, /

t"~:,!: ,~,~Line f capsular eflection

;’

~ ,, v

! AdduCtor ubercle, / Z



Bony ttachmentsf Muscles f Hip and Thigh: nterior iew

o, muscle

,,a<usm°sc,e-----B~tm~"I~2i~~;~,V~Tc~Va’~°d

~a.or,usmusde~-ts~

~\ ~/;!,,ec,,neu~musc’ePiriformisuscle

~"~" ’r "~’~/Adductor Iongus muscle

Obturator internus " ~,~’:i~~n"~eme"us°sc’es//t~

Gluteus minimus muscle P’~ ~ ~!~"Gracilisuscle

Vastusateralisuscle i

Ili°ps°as muscle Jt ~ "~ Obtu rator externus muscle

uscle// Adductor magnus muscle

VastusedialisQuadratusemoris uscle

Vastus intermedius muscie~

Origins

Insertions

Articularis genus muscle---~!

! .,~,~ ~ Adductor magnus muscle



Bony ttachmentsf Muscles f Hip and Thigh: osterior iew

¯ -~ Gluleus edius uscle

/ ....

"+’:~"-" i ~’~ Gluteus minimus muscle

"’+~" /Tensor asciae atae uscle

Gluteus aximus muscle ~-----..~., ,++. -- Sartorlus uscle

! J ~,¢ ,~r~.~ Rectus femoris muscle

+ Obturatorxternus uscleuperioreme,,os /muscle ~~ ~. ~ Gluteus medius muscle

Quadratus femoris muscle ~ Quadratusemoris uscle\ ..ff

~’~ Iliopsoas musclebturator internus muscle----------~/

~

..~

Adductor magnus muscle~ ~ Gluteus maximus muscle

Biceps emoris long ead) ! Jastusateralisuscle

and semitendinosususcles

y

:Jductor agnus uscle

Semimembranosus uscle~ Adductor brevis muscle

Pectineususcle~Vastus intermedius muscle

Vastus medialis muscle /-- Biceps emoris uscle short ead)

Origins

Insertions Adductor Iongus muscle / Adductor magnus muscle

/Vastus lateralis uscle

Adductor agnus uscle,/ ~

Plantarisuscle

.~ 1.Gastrocnemius uscle (lateral ead)

Gastrocnemiususcle medial ead)~ ~-i , " ~ Popliteus muscle



nterior iews

tperiorilacpine

muscleAnterioruperiorliac pine

Dr muscle Sartoriususcleorigin)

AnteriornferiorGluteus edius uscle

/ lilacpine

InguinaligamentLigamentsof"hipoint

Pectineus

latae uscle /muscle

muscle

~h=.,~ensorasciaeatae uscleor

Rectus emoris uscle

Iliopsoasuscle

Js muscle

"-Gracilisuscle

scle

Vastusateralisuscle

Vastus ntermedius I

ndon

Patella

\

Sartoriusendon

}

Gracilisendon Pes nserinus

¯Semitendinosusendon

Iliotibialractcut)



Muscles f Thigh: nterioriews continued)

~"~:’~’~ Pectineususclecut nd eflected)

Deep dissectioni

~;:i~~-%’.

Anterioruperiortiac ~.’-:.’~."- ;"

iplne-~.,~ ~:~,~’"--" Superioramus f pubis

~ .:"~""’~.Anteriornferiorliacpine---.-._._~ L

. ~. ~" Adductorongus usclecut nd eflected)Ligamentsf ip oint !~ ,,

. ..-"

Greaterrochanterf femur ~. -__ /.Adductorrevisuscle(cut)

%~~T--" \ " ’~’~ Pubic tubercleIliopsoas uscle cut) .... .

Pectineus muscle ~(cut nd eflected)

~ Gracilis muscle (cut)

Adductor revis uscle~ Obturator externus muscle

(cut and reflected)

Vastus intermedius muscle~

~ Quadratusemoruse

AdductOr(cutnd Iongus uscle~ ~.~Adductor minimus part ofeflected)

"~’Adductoragnus uscle

Femoralrterynd ein

passes hroughiatusof adductor magnus muscle.~

Openingsor perforatingranches

Vastusedialisusclecut)of eep emoralrtery

\

Rectus emoris endon cut)

Vastusateralisusclecut)~XXX~

L -~!

//--/Medaep°ndy!eaddulctotube,le

femur

Lateral picondylef femur\/ /Gracilis uscle cut)

Pateila,~!/I jTibial ollateral igament

Lateral patellar retinaculum~

t i/Medial patellar retinaculum



Musclesf Hip nd high:ateraliew

1 ~ External abdominal..... oblique uscleilacrest--~ ~ c,

c:

Fasc’a~lu,oa,poneoros,s,

~ ~

over gluteus medius muscle ~ ’:’ ~ Anterior superior¯ lilacpine

"-""’--’---artoriususcle

Gluteus maximus muscle-- ~,~, , ,

,,,*

?_-; ~,~

- , Tensorasciaeatae uscle

’ )’" :rS

¯ [, . Rectusfemorismuscle

:~.t ¯

;̄;t!-

Iliotibial ract ~--- ~i.l ¢’ ~

j/,, ¯ ....

Biceps femoris muscle { Long headShort head~

/ Lanntc~(~ eCr~;dt uebOJrcilbiaSemimembranosus uscle

Fibular collateral ligament ~ /~ atellaLateralatellaretinaculum



Musclesf Hip nd high: osterioriews

FOR PIRIFORMIS ND OBTURATOR NTERNUS SEE ALSO PLATES 337, 338; FOR OBTURATOR XTERNUS EE PLATE 463

Superficialissection Deeperissection

- - ilacrest /’~

/Fascia (gluteal aponeurosis) ver

Gluteus edius uscleGluteus inimus uscle .~

Gluteus maximus muscle-~-~/Piriformisuscle....~

SciaticerveSacrospinous igament .~

Superior emellus uscle

Obturatornternus uscle -i

Inferior emellus uscle

Sacrotuberous igament ~’ /

Quadratus femoris muscle.

Ischial uberosity

Greater rochanter

Semitendieosususcle

hdBiceps emoris uscle(longa

! /~Adducto,inimusa~ fAdductor agnus uscle

/ Semimembranosusmuscle ~

Iliotibialract--------------.__

Gracilisuscle

Biceps emoris uscle.~~- Short head ----.....____..._......._~~~- Long head

~Semimembranosus~muscle

~.....~ Semitendinosus musclePoplitealesselsnd ibialerve

.._..---Commoneroneal erve

Plantarisuscle

Gastrocnemiususcle /

Medial head//

Sartoriususcle



Psoas nd liacususcles

SEE ALSO LATE 46

J.

12th ib

~,- ~-~Quadratus umborum ~

/’. ,

muscle~

-’-~:_.

,~

- / Origin of psoas major

~ T12 ’~

/ musclefromvertebral

~"’""’~~"’" "~ "’ bodies,ransverseTransversusbdominis "~ " :’~ ’- processesndmuscle (cut)~ "

~ Lt ~ intervertebraliscsJ’~ ~ (T12-L4)nd rigin

.... ~’ of psoas inor uscleliohypogastricnerve.~,~

~1-!-"~11

from ertebralodies

Ilioinguinal nerve~~,: L2

(T12, 1)

Psoas inor~i ’" ’ " ~

.._...--umbarlexus

muscleL3 "i

Psoas ajormuscle~ . ~r

/Lumbosacral trunkGenitofemoralnerve~ " /~ L4

Lateralemoral ~;,

r?..~.~. ~,.~

;~ Illiacrest

L5 ~cutaneous nerve ~ ¯

ter,oruperior

Iliacus muscle ~"i

lilacpine

Femoral erve

,Superior pubic.ramus ~jlliopectineal ursa

\~~ Iliofemoralreaterofrochanter ~¯

ligamentf

~~ ~ ~i~

hip Oint

femur -~.f

J of gigelow)

(yligament

.

passes ackward

~.i

to insertionn ~,

lesser rochanter D

!ody shaft) f femur

~

- i.~.~_~



Lumbosacral nd Coccygeal lexuses

IntercostalerveTll) .~P~’/ ~-,------" ’;~ m Anteriordivision

Subcostalerve T12) ~.~ ~::~,..T12 Posteriorivision

(T12,11i°hyP°gastricL1)erve -~f~"~ I. r~

Sympatheticrunk

Tolli°inguinalerve Cl) ~ psoas aior nd

~ communlcantes Rami

~ ;-- ’

~ L !’ii~;

Genitofemoral~

.~erve L1,2).~.

Lateralemoralutaneous ,~~

-~nerve L2, ) ~.

~L.

Genitalranch ndu

Lumbar lexusFemoral ranch-~-----~"

of genitofemoralerve

To psoas ajor nd ..~ - L3 ,,~iliacususcles !

Anteriorranches

Lateralranches .!of subcostal nd ~

~-~i" -iliohypogastricerves .~;.~.,. .

Lumbosacral runk~.

To quadratus’femoris ,~-~.,,

and nferioremellus . ,..,~.

musclesL4, , l)

To obturatornternus

and superior gemellus~ * Sacral lexusmusclesL5, 1,2),

SuperiorlutealnerveL4, , 1)

To piriformisuscle $1, ) ""’’--

Obtu rator nerve (L2,~3, 4)

Accessorybturatorerve "~ Coccygealplexus(L3, 4) (inconstant) JInferior gluteal nerve (L i, 51~ ~ Pelvic planchnic

Femoral nerve (L2, 3, 4)/~ ~ ~ nerves nervi rigentes)

PerforatingutaneousnerveS , )



Lumbar lexus

Schema Subcostal nerve (T12).~~~._~ T12

White nd gray ami ommunicantes --~i---- L1

¯Iliohypogastric nerve:".’"

/ / / ̄ \

/,Y

-/,~, "

L2Ilioinguina{erve ~,,/ / ,~"~"--"~~-N~; -

J

/

""~ Ventral_ " -t rami fenitofemoralerve / ;"""’*

~-~~j/~ ~ -~ L3spinal

/ ¯:-~ ~ nervesLateralemoral /,..,../;¢;. :.utaneouserve " ," /

Gray rami communicantes~e. ~ ....... L4

to psoas and iliacus muscles ~..."’ ’. ,,,,~.

Femoral ne rye ~/~,)~

,-~

L5

Accessorybturatorerve often bsent)/ ’"IY

~ Anterior division

Obturatorerve ~ :’::-’*"?

trunk/,~

~;~;;.osteriorivision

Lumbosacral

/White and grayDiaphragm (cut)--_..... rami ommunicantes

Subcostal erve T12) /Subcostal erve (T12)

j [~...-liohypogastic erveSympathetic runk~

.~llioinguinai

Iliohypogastricerve-~

~.--TransverSUSmuscleerveabdominislioinguinalerveI

Genitofemoralerve cut)~

~ ’*-’*-"Quadratusl umborummuscle

[~’~ soas ajor uscleLateralemoral ~ ~-Gray rami communicantes

cutaneouserve’

~______~__~’~enitofemoralerveFemoral nerve --\, ,,-,~ - Iliacususcle



Sacral nd occygeallexuses

Schema ~L4 LL~mbosacralrunk

1 Anteriorivision~ i L5

’~: ~ Posteriorivision ~r" ~

/ Gray rami communicantes

S~,lanchnicerves

Superior luteai erve .~~1~ 2 ~ Pelvicp~ ~3~ (parasympathetic o

inferiorypogastricInferiorluteal erve.~,,.{pelvicllexus)

Nerve o piriformisuscle

I

Tibial neWeeroneal~~

~ $5ciaticerve CoccygealerveCommon p

nerve ~ ~ Anococcygeal nerve

Perinealranchf 4th acralewe

Nerve o levatornt nd occygeususcles

Pudendal erve

Nerve o quadratusemoHs nd nferioremellususc s Perforatingutaneouserve ~.~,

Nerve o obturatornternusnd uperioremellususclesPosterioremoralutaneouserve

~" =;2...

Sympathetic runkLumbosacralrunk ~

Gray rami communicantes

Psoas ajor uscle, / )lanchnicSuperiorlutealrtery nd erve nervescut)

(parasympatheticObturator erve to elviclexus)

Iliacususcle

Inferior luteal rtery ~

Nerve o quadratusemorisuscle-.--~

Internaludendalrtery .

Nerve o obturatornternususcle - ~\I "~

Pudendal erve ~ ’’=’’e~.,~l~

Obturatornternususcle--~"

e .....: .....b.: .......



Arteries nd Nerves f Thigh: nterior iews

SEE LSO LATE 50h

Anterioruperiorliac pine Superficialissections

Lateralemoralutaneouservecut)guina[ligament Tensorasciaeatae * ,

musc,eretracted) ~’~::~ ~ ~;~/Sartoriususclecut)

Iliopsoas muscle ~ ~.~~’~/

SuperficialircumflexGluteus ~. ~,.~’:/ {I /

Iliopsoasusclelilacessels

minimusand medius

Superficialmuscles

arteryndepigastricessels

vein

Superficialnd

Oyr~~

!~ ~- Deep xternal ~ ~.

pudendalessels

muscle¯

Lateral¯ circumflex Deep

¯ . fem femoral/. " arter artery

Rectus¯ femoris Juctor

: muscle---____ Iongus uscle

:~: Vastus’.~J!: medialis (opened y

muscle ~ removal fsartorius

muscle)

Femoralsheath )henous

Femoralerve,

~artery nd vein¯ vastus edialis, Pectmeus

~muscle

muscle

~aeep emoralrtery magnus uscle

~mracilis

uscleSaphenous roof f istal

nerve nd adductoranalAdductor

saphenousIongus branch f entrancefmuscle

descending femoralesse(s, cu,a ,opo0- "~ prius

artery ~ space

- ~- muscle

i ~ " ~Articularranch Sartorius



Arteries nd Nerves f Thigh: nterior iews continued)

SEE ALSO LATES 06, 07

Deep issection

/ External ilac rtery nd veineepcircumflexliacartery~

~. Inguinal Poupart’s)igamentLateralemoralutaneouserve /

/ Femoral rtery nd vein(cut)

/artoriususclecut)’ /. Pectineususcle cut)

Iliopsoas uscle "~:~-~ Obturator foramen

Tensor asciae atae ~ ~- Obturatorxternususclemuscle retracted)

~Adductor ongus uscle cut)Gluteus edius nd

gluteus inimus uscles /

ActeriorivisionndsteriorivisionfFemoral nerve’/

~obturator nerveectus emorisusclecut)

Ascending, transverse and/

~Quadratus femoris muscledescending ranches f ~ ~ --Adductor brevis muscleLateralircumflexemoral

artery/,,z ~ Branches f posterior ivisionMedial ircumflexemoral rtery/ of obturatorerve

/Pecfineus uscle cut)/

~Adduct°r magnus muscle

Deep emoralrtery ~Gracili$ muscle

Perforatingranches~ Cutaneous ranch f obturator erve

/Adductor ongus uscle cut)

~ Femoral rtery nd vein cut)

/Vastus ateralisuscle ~ Descending enicular rtery

muscle/

~ Articular branch-- Saphenous branch

Vastusntermedius

Rectus emoris uscle cut) ¯ :

Saphenous nerve/ (cut)

Membranous roof of ~Adductor agnus endon

adductoranal opened)

/ ,. ~ ~ /MecJial picondy!e f femur



Arteriesnd erves f Thigh: osterior/ew

SEE ALSO LATE 0B

Deepdissection

Superiorlunealnerves ~ (glutealponeurosis)nd

gluteusediusmuscle(cut)Gluteus aximus uscle cut)

~eriorlutealrterynd erveMiddle luneal erves ..~_

luteus inimus uscle

Inferior luteal rtery nd nerve qfasciaeatae uscle

Pudendal nerve ~ !rmis uscle

Nerve o bturatornternusluteus edius usclecutl

and superior emellus uscles...~I

Posterior emoral utaneous erve ~~meilususcle

r trochanterf femurSacrotuberousigament

"~.~ rator nternususcle

Ischial tuberosity~gemellus uscle

Inferior cluneal nerves (cut)/;luteusaximususclecut)

Adductor magnus muscle / moris uscle

Gracilis muscle~~;~ ircumflexemoral¯ artery

Sciaticerve

~J

dis uscteand liotibialract

Muscularranchesf sciaticerve

luctorinimusart f

Semitendinosus uscle(retracted) adductor agnus uscle

Semimembranosus muscle ~ , arteryfromdeep "y)

Sciaticerve

~’-{[~ Articular branch ~-

1us muscle

,~r ~a perforatingrteries

’~’~:~"-" Adductor hiatus ~(from eep emoralrtery)

perforatingrterytermination

Popliteal ein and artery~ of eep emoralrtery)

Medial upenor enicular rtery~ head retracted)iceps feoris

muscleA .4.4, ,*t.*.. ,k~erl~



Nerves f Hip nd uttock

lilacrest

Gluteus aximus uscle cut)

I

Superiorlutealerve I ~luteus

mediusmuscle(cut)

\ 1 ~ ~/

Gluteus~/minimususcle

/~ Piriformisuscle

Sdlaticerve

Inferiorlutealerve

Posterior femoral ~Superior emellus uscle

/Tensorasciaeataeutaneous nerve

/muscleNerve o superioremellusand bturatornternususcles Gluteus edius

/muscle cut)Pudendal erve

\

,~

trnus uscle,sc.ia,pine~ ~b O~tura.

Sacrospinous.~ Lt Nn~er~eotr°gell

ligament ~ and quadratus

~.~;.. femoris uscle

(and ranch o

cutaneouserve

GreaterrochanterSacrotuberous ~ of femur

ligament-------’-------

~Intertrochanteric

Inferior ~.~"- crestrectalerve

Dorsal nerve of /

~ Inferior gemellus

penis clitoris)muscle

,=.

eajQuadratusemoris

Perinmuscle

nerve’

Posteriorcrotal~ Gluteus maximus

nerves’-./ muscle cut)(labiall

/



Arteries f Femoral ead and Neck

SEE ALSO LATE 81

Anterior iew Posterior iew

Retinacular/ Superior,, Foveolarartery

--Superior Retinaculararteries

arteries ,c Anterior Ioften inute)-- osterior

(subsynovial) ( Inferior~ .~ ~:~ ~ ~!/ ....

"~ jlnferior )

(subsynoviai)

~’~-- ~;. ,~.~ " "~.._.-nastomosisnastomosis

between me~ ~

#’"and ateral

. ’~(~i~,~circumflex

~ Ischiofemoral

femoral ~ ~~" ligamentnd

arteries/ F ~i~ ~m,~. --

- --~ joint apsule

,,,ooaS.emora,rte. /

ligament nd ~. ’--~’7~ tendon circumflex ,~)~ !

joint capsule/ XJ~~’~ edialircumflex femoralLateralartery

r’

Ascendin~ ~l~

circumflex/~,~

,

Deep emoral ~" ,

ransversg: ~ femoralrtery

", ~’escending / arterybranchesf ~ Nutrient rtery

Lateralircumflex ~ of femur

femoral artery

artery

of femur

Anterioriew n ilu

Coronal section Medial circumflex /~l/r~ ~lliopsoas~, .’//’;

femoralrtery \ muscle

Acetabularabrum.-~- Anastomosis : Femoral

Ligamentsnd ~artery

iointapsulLateralircumflex

t"~¯ Pectineus

e~ ~femoral artery ~ /

/muscie

Ascending,-~. ~ ,ynovialTransverse, ~

membraneDescending,,

\

Retinacularbranches

~

arteries~

¢~ " .

" Foveolar

¯ ’, artery

::.-.~’~ /Obturator

~:~ artery ,

~’_~ ~ :~"~,~.,.

.. 7, - .~- .,t,- j.,f~ Medial

\ ,~ ~.~,~7 "~,~ :.;~.~.’ circumflex

~-~. #_- -’~’: ’~: ",2"-~

femoral



Thigh:erial ross ections

Sartoriususcle Fasciaata

Deep emoralrtery nd einBranchesf femoralerve

PectineususcleFemoralrtery nd ein

Iliopsoasuscle~ Adductor ongus uscle

Great aphenouseinRectus emoris uscle

/\ Obturatorerve anteriorivision)Lateral emoral utaneouserve\

J Adductor revis uscleVastus edialis uscle~

ObturatorerveVastus ntermediususcle

/(posteriorivision)

Femur\/Gracilis uscle

\\Vastusateraiisuscle~ Adductor magnus muscle

Tensorasciaeatae uscle"~ "/j, ciaticerve

/ Posterior emoralliotibialractcutaneous erve

Gluteus aximus uscle ,~

~./Semimembranosus musclei~- Semitendinosususcle

~

.~ Biceps emoris uscle long ead)Vastus edialis uscle~

Rectus emorisuscle.~.~

!

j, Medial ntermusculareptum

Vastus ntermediususcle ~ ’. -~..-~̄j Sartorius uscle

Vast s~lateralisuscle/ Nerve to vastus

Iliotibialract~ medialisuscle

I in dductor

Lateralnter- ~ Saphenous nerve canal

muscular septum ~ ~ Femoral rtery nd vein

Biceps ~ Short head ~ ~ Deep emoral rtery nd veinfemorismuscle Long head ~ ~ Great saphenous ein

Semltendinosususcle---~Adductor ongus muscle

’" "~ Gracilis uscleemimembranosus muscle-~ ~ " ~

"Adductor brevisuscle\

~Adductor agnus muscle

Quadriceps emons tendon /~ Sciatic erve

Vastus ntermedius uscle ~ VI I

IlioUbialractastus edia s musc

Vastus ateralisuscle~ Sartorius uscle



REFERENCES

Bogduk,: The linicalnatomyf the ervicalorsalnmi~ pine,:319-330,982.

Ev~’wh. ., alnbefg:uscle lretch~8 In Manual herapy,olume I, lt~a ,,h~hm 984.

Ne~er, tlas f Human natomy, gs. 48-475.

Not’din;., nd nnk,’]~II: as/e iomeehalll~f the usculeekeletaiystem,econd dition,

Lea nd ebiger,hii~,’~phia,989.

V, qllimJ, .L., arwick,L, nd yson, .: ray’s natmny 7th dition,hurehinivin~t~ne,

London, 989.

Documents

01 Anatomy Workbook