The mediastinum IIthe vessels of the thorax
Inferior thyroid Superficial cervical Suprascapular Thyrocervical trunk Vertebral Scalenus anterior Dorsal scapular Subclavian Thyroidea ima Costocervical trunk Deep cervical Superior intercostal Upper two posterior intercostals also supply_s Bronchial Oesophageal Mediastinal The branches of the arch and the descending thoracic aorta Left brachiocephalic Right lymph duct Inferior thyroid Left internal jugular Vertebral Left subclavian Internal thoracic Left superior intercostal Posterior...
Arteries of the upper limb
Subscapular Axillary nerve Circumflex scapular Ulnar artery Ulnar nerve Pisiform Common interosseous Posterior interosseous The arterial system of the upper limb. The main nerves that are related to the arteries are shown in green. Only the major arterial branches are labelled
Hip movements
A wide range of movement is possible at the hip due to the ball and socket articulation. Flexion 0-120 iliacus and psoas predominantly. Rectus femoris, sartorius and pectineus to a lesser degree. Extension 0-20 gluteus maximus and the hamstrings. Adduction 0-30 adductor magnus, longus and brevis predominantly. Gracilis and pectineus to a lesser degree. Abduction 0-45 gluteus medius, gluteus minimis and tensor fasciae latae. Lateral rotation 0-45 piriformis, obturators, the gemelli, quadratus...
The ankle and foot I
The ankle joint from behind, to show how the talus is held in position by ligaments between the tibia and fibula above and the calcaneus below The ankle joint from behind, to show how the talus is held in position by ligaments between the tibia and fibula above and the calcaneus below Bifurcate ligament Cuboid Cervical ligament Long plantar ligament Calcaneofibular ligament The ankle joint, lateral aspect after removal of the capsular ligament Sustentaculum tali Facet for medial malleolus...
Fig11
The thoracic cage. The outlet inlet of the thorax is outlined Suprasternal notch Manubrium Third rib Bilateral cervical ribs. On the right side the brachial plexus is shown arching over the rib and stretching its lowest trunk Bilateral cervical ribs. On the right side the brachial plexus is shown arching over the rib and stretching its lowest trunk Transverse process with facet for rib tubercle
The contents of the anterior flexor compartment of the forearm
Muscles Fig. 37.1 the muscles within this compartment are considered in superficial, intermediate and deep layers. All of the muscles of the superficial group and part of flexor digitorum superficialis arise from the common flexor origin on the medial epicondyle of the humerus. With the exceptions offlexor carpi ulnaris and the ulnar half of flexor digitorum profundus, all of the muscles of the anterior compartment are supplied by the median nerve or its anterior interosseous branch see Muscle...
The arteries of the abdomen
The abdominal aorta and its branches. Red labels ventral branches Blue labels lateral branches Green labels branches to body wall The abdominal aorta and its branches. Red labels ventral branches Blue labels lateral branches Green labels branches to body wall Superior pancreatico duodenal Right gastro-epiploic Inferior pancreatico duodenal The superior mesenteric artery and its branches The coeliac artery and its branches. The three primary branches are labelled in red Anterior and posterior...
The pelvis IIthe contents of the pelvis
Uterosacral ligament Endopelvic fascia External iliac vessels Round ligament The broad ligament cut off close to the uterus External iliac artery Inferior epigastric artery Ductus deferens Obliterated umbilical artery Obturator artery Attachment of levator ani Obturator nerve Iliolumbar artery Superior gluteal artery Lateral sacral artery Inferior gluteal artery Inferior vesical and middle rectal arteries
Nerve supply of the chest wall Fig 22
The intercostal nerves are the anterior primary rami of the thoracic segmental nerves. Only the upper six intercostal nerves run in their intercostal spaces, the remainder gaining access to the anterior abdominal wall. Branches of the intercostal nerves include Cutaneous anterior and lateral branches. A collateral branch which supplies the muscles of the intercostal space also supplied by the main intercostal nerve . Sensory branches from the pleura upper nerves and peritoneum lower nerves ....
Cricoid cartilage level of C6
Arytenoid cartilages attached to upper border of the cricoid by synovial joints so that they can slide and rotate. Each has an anterior vocal process and a lateral muscular process Figs 62.2 and 62.3 . Epiglottis a leaf-shaped piece of elastic cartilage attached to the back of the thyroid cartilage Fig. 62.2 and projecting upwards behind the hyoid. Thyrohyoid ligament joins the hyoid and the thyroid Fig. 62.1 . Cricovocal membrane cricothyroid ligament attached to the upper border of the...
The arm
The main blood vessels and nerves of the front of the arm Cephalic vein Brachioradialis Radial nerve The major nerves in the back of the arm Cross-section through the arm just above the elbow. The thick black lines represent the deep fascia and the intermuscular septa Cross-section through the arm just above the elbow. The thick black lines represent the deep fascia and the intermuscular septa The major nerves in the back of the arm Biceps brachii Loose connective tissue Median nerve Brachial...
Atypical ribs 1st 2nd 10th 11th 12th
The 1st rib see Fig. 63.2 is short, flat and sharply curved. The head bears a single facet for articulation. A prominent tubercle scalene tubercle on the inner border of the upper surface represents the insertion site for scalenus anterior. The subclavian vein passes over the 1st rib anterior to this tubercle whereas the subclavian artery and lowest trunk of the brachial plexus pass posteriorly. A cervical rib is a rare 'extra' rib which articulates with C7 posteriorly and the 1st rib...
The infrahyoid strap muscles
Sternothyroid arises from the back of the manubrium and ascends to be attached to the outer surface of the thyroid cartilage. Thyrohyoid is a continuation of the latter and is attached to the hyoid bone. Sternohyoid is superficial to the other two and runs from the manubrium to the lower border of the hyoid. Omohyoid the superior belly is attached to the hyoid and runs down to its intermediate tendon and then continues as the inferior belly across the posterior triangle to be attached to the...
Surface anatomy of the upper limb
The axilla with the arm fully abducted The axilla with the arm fully abducted The biceps tendon and aponeurosis which are a guide to the positions of the brachial artery and the median nerve at the elbow Strong contraction of the pectoral muscles produced by adduction The biceps tendon and aponeurosis which are a guide to the positions of the brachial artery and the median nerve at the elbow Strong contraction of the pectoral muscles produced by adduction The visible tendons at the front of the...
The popliteal fossa Fig 486
The femoral artery and vein pass through the hiatus in adductor magnus to enter the popliteal fossa and in so doing become the popliteal vessels. The popliteal fossa is rhomboidal in shape. Its boundaries are the biceps tendon superolateral and semimembranosus reinforced by semitendinosus superomedial . The medial and lateral heads of gastrocnemius form the inferomedial and inferolateral boundaries, respectively. The roof consists of deep fascia which is penetrated at an inconstant position by...
The pleura and airways
The principal structures in the hilum of the lung Pulmonary artery Bronchus Pulmonary veins Lymph node Cut edge of pleura Pulmonary ligament The principal structures in the hilum of the lung The anterior relations of the trachea The anterior relations of the trachea Apical Posterior Apico-posterior Anterior Anterior basal s Lateral basal Posterior basal The respiratory tract is most often discussed in terms of upper and lower parts. The upper respiratory tract relates to the nasopharynx and...
The shoulder glenohumeral joint
The glenoid cavity and its associated ligaments and rotator cuff muscles The glenoid cavity and its associated ligaments and rotator cuff muscles Supraspinatus seen through suprascapular notch Anterior aspect of the shoulder joint Tendon of supraspinatus, blending with capsular ligament Coracohumeral ligament Opening of subscapularis bursa Subscapularis Sheath of synovial membrane Anterior aspect of the shoulder joint Type the shoulder is a synovial 'ball and socket' joint which permits...
The venous and lymphatic drainage of the upper limb and the breast
The superficial venous system of the upper limb and two major cutaneous nerves The superficial venous system of the upper limb and two major cutaneous nerves Cephalic vein pierces clavipectoral fascia A section through the breast to show its major relations. The inset shows the radial arrangement of the lactiferous ducts Lactiferous sinus Nipple Areola -Montgomery's gland A section through the breast to show its major relations. The inset shows the radial arrangement of the lactiferous ducts...
Surface landmarks around the hip and gluteal region
The anterior superior iliac spine is a prominent landmark at the anterior end of the iliac crest. The greater trochanter of the femur lies approximately a hands-breadth below the iliac crest. It is made more prominent by adducting the hip. The ischial tuberosity is covered by gluteus maximus when the hip is extended. It can be palpated in the lower part of the buttock with the hip flexed. The femoral pulse Fig. 52.1 is most easily felt halfway between the anterior superior iliac spine and the...
The sacral plexus L4S4 Fig 451
Origins from the anterior primary rami of L4-S4. Course the sacral nerves emerge through the anterior sacral foramina. The nerves unite, and are joined by the lumbosacral trunk L4,5 , anterior to piriformis. Branches the branches of the sacral plexus include The superior gluteal nerve L4,5,S1 arises from the roots of the sciatic nerve and passes through the greater sciatic foramen above the upper border of piriformis. In the gluteal region it runs below the middle gluteal line between gluteus...
The liver gallbladder and biliary tree
The venous circulation through the liver. The transmission of blood from the portal system to the inferior vena cava is via the liver lobules fig. 18.2 Branch of hepatic artery Branch of portal vein a A liver lobule to show the direction of blood flow from the portal system to the centrilobular veins and thence to the inferior vena cava b The blood flow through the sinusoids of the liver lobule and the passage of bile from the bile canaliculi to the bile ducts The liver predominantly occupies...
The radius and ulna Fig 275
Both the radius and ulna have interosseous, anterior and posterior borders. The biceps tendon inserts into the roughened posterior part of the radial tuberosity. The anterior part of the tuberosity is smooth where it is covered by a bursa. The radial head is at its proximal end whilst the ulnar head is at its distal end. The lower end of the radius articulates with the scaphoid and lunate carpal bones at the wrist joint. The distal ulna does not participate directly in the wrist joint. The...
The deep fascia of the thigh fascia lata
This layer of strong fascia covers the thigh. It is attached above to the inguinal ligament and bony margins of the pelvis and below to the tibial condyles, head of the fibula and patella. Three fascial septa pass from the deep surface of the fascia lata to insert onto the linea aspera of the femur and consequently divide the thigh into three compartments. On the lateral side the fascia lata is condensed to form the iliotibial tract Fig. 47.4 . The tract is attached above to the iliac crest and...
The autonomic nervous system
The different lengths of the pre- and postganglionic fibres of the autonomic nervous system. Preganglionic fibres red Postganglionic fibres green The sympathetic right and parasympathetic left outflows The sympathetic right and parasympathetic left outflows Preganglionic fibres Branch to blood vessels Descending branch The various possible courses of the preganglionic fibres 1, 2 amp 3 and postganglionic fibres A, B and C of the sympathetic nervous system The autonomic nervous system comprises...
The abdominal wall
Two muscles of the anterior abdominal wall. The external oblique on the right and the internal oblique on the left - Cut edge of external oblique Linea alba Cut edge of external oblique Internal oblique Anterior superior iliac spine Inguinal ligament Conjoint tendon Pubic tubercle The fibrous layer of superficial fascia can be likened to a pair of bathing trunks sewn to the thigh below the inguinal ligament and clinging to the penis and scrotum except for the glans Transverse sections through...
The knee joint and popliteal fossa
Ligamentum patellae Semitendinosus Gracilis Sartorius Knee joint, lateral aspect after removal of part of the capsular ligament Quadriceps Dotted line indicates the extent of the suprapatellar bursa Knee joint, lateral aspect after removal of part of the capsular ligament Knee joint, posterior aspect after removal of the capsular ligament Oblique popliteal ligament Posterior cruciate ligament Knee joint, posterior aspect after removal of the capsular ligament Popliteal surface of femur...
The pelvic viscera
Uterovesical pouch Bladder Urethra Vagina Vestibule Perineal body Sagittal sections through the male and female pelves Recto-uterine pouch Posterior fornix of vagina Cervix of uterus Sphincter ani externus Anal canal Bladder Suspensory ligament Prostatic urethra Membranous urethra Sagittal sections through the male and female pelves A vertical section through the uterus and vagina. Note the relation of the uterine artery to the ureter Internal os Supravaginal cervix Cervical canal Intravaginal...
The pharynx and larynx
Attachment of thyrohyoid Attachment of sternohyoid Inferior constrictor Cricothyroid Cricoid cartilage Superior laryngeal Internal laryngeal External laryngeal The pharynx and larynx, and some of the related nerves Left, the cricothyroid muscle and right, the posterior crico-arytenoid A midline section of the larynx to show the cricovocal membrane and vocal ligaments Arytenoid Muscular process Crico-arytenoid muscle posterior Cricoid Left, the cricothyroid muscle and right, the posterior...
The orbit and eyeball
Frontal Lacrimal Trochlear Oculomotor Abducent Nasociliary The back of the orbit to show the origins of the muscles that move the eyeball and the nerves that enter through the superior orbital fissure and the optic canal Central artery of retina Ophthalmic artery Oculomotor Fibrous ring The back of the orbit to show the origins of the muscles that move the eyeball and the nerves that enter through the superior orbital fissure and the optic canal The muscles that move the eyeball seen from above...
The trigeminal nerve V
Nasociliary Long posterior ciliary The course and branches of the ophthalmic division Parasympathetic fibres are shown in orange Supratrochlear Supraorbital Skin of face The course and branches of the ophthalmic division Parasympathetic fibres are shown in orange Lacrimal gland Ophthalmic division F. rotundum Maxillary division Mandibular division Sphenopalatine ganglion Greater palatine Lesser palatine Posterior superior dental Incisive fossa The course and branches of the maxillary division...
The eye
The conjunctiva covers the surface of the eye and is reflected onto the inner surface of the eyelids, the angle of reflection forming the fornix of the conjunctival sac. The conjunctiva over the surface of the eye is thin so that a conjunctival haemorrhage is bright red as the blood remains fully oxygenated. The tarsal plates are composed of dense fibrous tissue, more compact in the upper than the lower eyelid. Outside these are the muscle fibres of the palpebral part of the orbicularis oculi,...
The arteries I
The course and main branches of the external carotid artery. The inferior thyroid artery is also shown Maxillary Occipital Tonsillar branch Hypoglossal nerve Internal carotid External carotid Carotid sinus Superior thyroid Recurrent laryngeal nerve The course and main branches of the external carotid artery. The inferior thyroid artery is also shown Carotid angiogram showing internal carotid stenosis Carotid angiogram showing internal carotid stenosis Anterior clinoid process Central artery of...
The peritoneum
Diaphragm Upper recess of omental bursa Liver Lesser omentum Epiploic foramen in the distance Omental bursa Pancreas Stomach Transverse mesocolon Duodenum third part Transverse colon Small intestine Mesentery Greater omentum Fusion between layers of greater omentum Fig.14.1 A vertical section through the abdomen to show the peritoneal relations. Lesser sac i Greater sac I Epiploic foramen of Winslow Portal vein Inferior vena cava Aorta Left kidney Splenic artery Lienorenal ligament Spleen Short...
The hip joint and gluteal region
Greater trochanter Pubofemoral ligament - Origins of rectus femoris Iliofemoral ligament Fat pad The structures around the acetabulum The structures around the acetabulum The hip joint Figs 46.1, 46.2 and 46.5 Type the hip is a synovial ball and socket joint. The articulation is between the rounded femoral head and the acetabulum which, like the shoulder, is deepened at its margins by a fibrocartilaginous rim the labrum acetabulare. The central and inferior parts of the acetabulum are devoid of...
Surface anatomy of the abdomen
Transpyloric plane Subcostal plane Level of umbilicus Transtubercular plane McBurney's point and some of the structures that may be palpated in the abdomen Gall bladder when distended Lower pole of right kidney sometimes McBurney's point Inguinal ligament Deep inguinal ring and inferior epigastric artery Liver, lower edge sometimes Linea alba Spleen, anterior notched margin when grossly enlarged Linea semilunaris lateral border of rectus External oblique aponeurosis Internal oblique A...
The axilla
Vertical and horizontal sections through the axilla the planes of the sections are shown in the central diagram Short head of biceps Coracobrachialis Lateral cord Axillary artery Medial cord Axillary vein Posterior cord Latissimus dorsi tendon Chest wall Vertical and horizontal sections through the axilla the planes of the sections are shown in the central diagram The main contents of the axilla from the front. The posterior cord is hidden behind the axillary artery The main contents of the...
SB The elbow joint and cubital fossa
The bones of the elbow joint the dotted lines represent the attachments of the capsular ligament The bones of the elbow joint the dotted lines represent the attachments of the capsular ligament Median nerve Brachial artery Medial epicondyle Flexor carpi radialis Palmaris longus Flexor carpi ulnaris Lax part of capsule Annular ligament The ligaments of the elbow joint and the superior radio-ulnarjoint The ligaments of the elbow joint and the superior radio-ulnarjoint The cubital fossa. It is...
Surface anatomy of the thorax
The surface markings of the lungs and pleural cavities The surface markings of the lungs and pleural cavities Beginning of transverse fissure Costodiaphragmatic recess The surface markings of the heart. The areas of auscultation for the aortic, pulmonary, mitral and tricuspid valves are indicated by letters The surface markings of the heart. The areas of auscultation for the aortic, pulmonary, mitral and tricuspid valves are indicated by letters
The posterior abdominal wall
The structures of the posterior abdominal wall The structures of the posterior abdominal wall Gonadal artery Inferior mesenteric artery The small diagram shows how the renal columns represent the cortices of adjacent fused lobes The small diagram shows how the renal columns represent the cortices of adjacent fused lobes The anterior relations of the kidneys The anterior relations of the kidneys The posterior relations of the kidneys Diaphragm Outline of pleura 12th rib Transversus abdominis...
Cranial nerves VIXII
The nerve passes through the middle ear and the parotid gland The nerve passes through the middle ear and the parotid gland The spinal root of the accessory is shown in yellow Superior laryngeal Internal laryngeal VI. The abducent nerve see Fig. 56.3 leaves the brain at the posterior border of the pons and has a long intracranial course so is often the first nerve to be affected in raised intracranial pressure to the cavernous sinus, where it is closely applied to the internal carotid artery,...
The leg
Tibialis anterior Subcutaneous surface of tibia The extensor dorsiflexor group of muscles Superior and inferior extensor retinacula Extensor digitorum brevis Peroneus tertius The lateral side of the leg and foot Peroneus brevis Peroneus retinaculum Peroneus tertius The extensor dorsiflexor group of muscles The lateral side of the leg and foot Plantaris Gastrocnemius lateral head Peroneus brevis Peroneus longus Fibula Flexor Cross-section through the leg, to be studied in conjunction with...
Surface anatomy of the lower limb
The anatomy of femoral and inguinal herniae. Note the relation of the deep inguinal ring to the inferior epigastric artery and the relation of the two types of hernia to the pubic tubercle Psoas tendon Pectineus Femoral hernia The anatomy of femoral and inguinal herniae. Note the relation of the deep inguinal ring to the inferior epigastric artery and the relation of the two types of hernia to the pubic tubercle Visible structures on the medial side of the lower limb Visible structures on the...
The deltopectoral triangle clavipectoral fascia and the anatomical spaces Fig
The deltopectoral triangle is the region that is bounded by deltoid, pectoralis major and superiorly by the small bare length of clavicle that does not provide an origin for either of these muscles. The clavipectoral fascia is a sheet of strong connective tissue. The uppermost part of this fascia forms the floor of the deltopectoral triangle. It is attached superiorly to the clavicle around the subclavius muscle. Below it splits to enclose pectoralis minor. The fascia continues downwards as...
The extensor aspects of the leg and dorsum of the foot
The extensor group consists of four muscles in the leg see below and extensor digitorum brevis in the foot. These muscles dorsiflex the foot. The contents of the extensor compartment of the leg are as follows Muscles tibialis anterior, extensor hallucis longus, extensor digito-rum longus and peroneus tertius unimportant in function see Muscle index, p. 166 . Artery the anterior tibial artery p. 95 and its venae comitantes form the vascular supply of the extensor compartment. The artery...
The axillary nerve C56
Type mixed sensory and motor nerve. Origin it arises from the posterior cord of the brachial plexus. Course it passes through the quadrangular space with the posterior circumflex humeral artery. It provides a motor supply to deltoid and teres minor a sensory supply to the skin overlying deltoid and an articular branch to the shoulder joint. Effect of injury the axillary nerve is particularly prone to injury from the downward displacement of the humeral head during shoulder dislocations. Motor...
The pectoral and scapular regions
Muscles of the scapular region and back Muscles of the scapular region and back Deltoid Cephalic vein Pectoralis major sternocostal head Coraco-brachialis Biceps Triceps medial head Serratus anterior Brachialis Biceps tendon Brachioradialis Bicipital aponeurosis Muscles of the pectoral region and upper arm Muscles of the pectoral region and upper arm The triangular and quadrangular spaces Axillary nerve and posterior circumflex humeral artery The triangular and quadrangular spaces The upper...
Portosystemic anastomoses
A number of connections occur between the portal and systemic circulations. When the direct pathway through the liver becomes congested such as in cirrhosis the pressure within the portal vein rises and under these circumstances the porto-systemic anastomoses form an alternative route for the blood to take. The sites of porto-systemic anastomosis include The lower oesophagus p. 11 formed by tributaries of the left gastric portal and oesophageal veins systemic via the azygos and hemi-azygos...
The ear and lymphatics and surface anatomy of the head and neck
Ridge produced by lateral semicircular canal Tegmen tympani A diagram representing the middle ear as an opened-out box A diagram representing the middle ear as an opened-out box Greater petrosal nerve Lesser petrosal nerve Auditory tube Tympanic plexus Promontory Tympanic branch Glossopharyngeal nerve The left tympanic membrane, as seen through an auriscope. The 'cone of light' is caused by the reflection of the light of the auriscope The principal groups of lymph nodes of the head and neck...
The small intestine Fig 161
The small intestine is approximately 6 m long and comprises the duodenum, jejunum and ileum. A large internal surface area throughout the small intestine facilitates absorption of digested products. The small intestine is suspended from the posterior abdominal wall by its mesentery which contains the superior mesenteric vessels, lymphatics and autonomic nerves. The origin of the mesentery measures approximately 15 cm and passes from the duodenojejunal flexure to the right sacro-iliac joint. The...