Anatomy

Anatomy

- Course outline -

- Upper Limb – - Lower Limb –

(extensive overview)

- Bony structures of the skull, muscles of the back, vertebrae- (incomplete overview)

Temmesfeld ‘06

Table of Contents Bone markings 1st Self Control shoulder region bones muscles structures elbow forearm bones muscles structures hand bones muscles structures arteries, overview nerves, overview 2nd Self Control gluteal region bones muscles structures thigh bones muscles structures crus, leg bones muscles structures pes, foot bones muscles structures arteries, overview nerves, overview 3rd Self Control cranium, major bones cranium, minor bones cranium, openings cranium, structures back, muscles back, joints back, vertebral column

Temmesfeld '06

1.) Capitulum • small head • e.g. small head of the humerus

2.) Condyle or Epicondyle

• rounded, knuckle (Knubbel) shaped • e.g. the two femoral condyle

3.) Crest

• ridge of bone (Leiste des Knochens) • either at the edge or in the middle of the bone • e.g. the iliac crest

4.) Facet

• smooth flat area • usually covered with cartilage (joint) • e.g. facet of the clavicle (for sternoclavicular j.)

5.) Foramen

• passage through a bone • can be used for vasculation of the bone (blood

supply) • e.g. the nutrient formane of the femur

6.) Fossa

• hollow or depressed area (sink like deepening) • e.g. the infraspinous fossa

7.) Groove • elongated depression (ditch, Graben) • e.g. the radial groove of the humerus

8.) Malleolus

• rounded process • e.g.malleolus of the fibula

9.) Notch • bulb like incision at the edge of the bone • e.g. the suprascapular notch

10.) spine

• thorn-like process of the bone • e.g. the scapular spine

11.) trochanter

• lat. trochus,i: tyre • large blunt elevation • e.g. the lesser trochanter of the femur

12.) trochlea

• spool like articular surface (process) • e.g. the trochlea of the humerus

13.) tubercle

• small raised elevation (kleiner Hügel) • not necessarily round • e.g. the greater tubercle of the humerus

14.) tuberosity

• large round elevation • similar to capitulum • difficult to distinguish from tubercle • e.g. radial tuberosity Temmesfeld '06

Temmesfeld '06

upper limb relevant parts of the trunk: bones: clavicula, scapula, sternum, costus primus joints: sternoclavicular joint joint, sternoclavicular

- involved bones: clavicula, sternum, first rib - ligaments (3):

o interclavicular ligament, between two clavicles o 2 costoclavicular ligaments, between 1st rib and clavicles

- muscle attachment sites: o subclavian muscle, o. 1st rib, i. groove of the inf. surface of the clavicle

_shoulder and arm bones: clavicula, scapula, humerus, ulna, radius joints: glenohumeral joint (shoulder joint) joints: joint, glenohumeral (and related struchtures)

- involved bones: clavicula, scapula, humerus - type of joint: ball and socket; flexion, extension, add/abduction, circumduction - innervation: glenohumeral joint - ligaments/tendons:

----- Superior to glenoid cavity, not in touch with glenoid cavity o superior transverse ligament

“closes” the suprascapular notch “pulls” the coracoid process medially

o coracoclavicular ligament conoid ligament

• the medial part of the ligament between clavicle and coracoid process trapezoid ligament

• the lateral part of the ligament between clavicle and coracoid process o acromioclavicular ligament

key part of the acromioclavicular joint capsule (synovial joint) o coracoacromial ligament

intraossal (between two processes of the same bone) ligament like a seal for the gleonoid cavitiy

----- Two layers, somehow wrapping the the glenohumeral joint: Superficial layer (not really part of the glenoid cavity) o supraspinatus tendon o coracohumeral ligament o m. subscapularis tendon

can be seen under biceps -> coracobrachialis -> subscapularis Deep Layer (direct constituents of the gleoid cavity)

o superior glenohumeral ligament o middle glenohumeral ligament

fairly large gap to superior glenohumeral ligament o inferior glenohumeral ligament

quite close to middle glenohumeral ligament ----- o transverse humeral ligament

“closing” the interterbercular groove cavity for intertubercular tendon sheath for biceps brachii tendon

anatomy, 1st sct, elbow and forearm e.b.: Temmesfeld ‚06

1 Temmesfeld '06

muscles: ----- rather dorsal muscles - m. supraspinatus

o i. supraspinous fossa of the scapula o o. superior facet of the greater tubercle of the humerus o movements: ad/abduction o innervation: suprascapular nerve C5, 6 o “dives” between coracoid process and spine (spinatus)

- m. infraspinatus o o. infraspinous fossa of the scapula (medial part) o i. middle facet of the greater tubercle of the humerus (fused with capsule) o movements: lateral rotation of the arm (when arm is moved behind the frontal plane) o innervation: suprascapular nerve C5, 6 o “posterior only” muscle, cover whole scapula

- m. teres minor o o. middle part of the border of the scapular fossa o i. inferior facet of the greater tubercle of the humerus (fused with capsule) o movements: lateral rotation of the arm (when arm is moved behind the frontal plane) o innervation: axillary nerve C5, 6 o very close to m. infraspinatus, but there major gap between m. teres minor and m. teres major

- m. teres major o o. lower part of the border of the scapular fossa o i. medial lip of the bicipital groove of the humerus (anterior side, very close to i. of m.

latissimus dorsi) o movements: medial rotation of the arm (when arm is rotated in an close to 180° angle with the

frontal plane) o innervation: lower subscapular nerve C5, 6 o posterior origin and anterior insertion o covered by pectoralis -> biceps -> brachialis

- m. triceps brachii o o. long head: infraglenoid tubercle of the scapula

small point like origin o o. medial head: posterior shaft of the humerus

huge, longitudinal attachment site not directly palpateable, must real between two other heads under

the lateral head, rather visibly from anterior side o o. lateral head: posterior surface of the humeral shaft

rather elongated attachment site under the greater tubercle of the humerus

o i. (combined) olecranon process of the ulna o movements:

long head: extension of the arm, adduction of the arm lateral head: extension fo the forearm

o innervation: radial nerve C6, 7 o involved in two movements, sometimes heads hard to distinguish, must

remove fascia between two heads - m. latissimus dorsi

o o. lumbar and sacral vertebrae (9th – 12th ribs) o o. posterior third of the iliac crest o i. medial lip of the bicipital groove (above) of the humerus (anterior side, very close to i. of m.

teres major) o movements: adduction of the arm, extension of the arm


2 Temmesfeld '06

o innervation: thoracodorsar nerve C6, 7, 8 o attachment sites at arm a bit tricky (from lateral to medial)

m. pectoralis major, clavicular head m. pectoralis major, sternal head m. latissimus dorsi m. teres major

- m. trpezoideus, upper part o o. external occipital protuberance and third of the nuchal line o i. medial third of the clavicle and lateral part of the acromial process of the scapula o movements: elevation and upward rotation of the scapula o innervation: motory function: cranial nerve XI

sensory function: spinal nerves C2, 3, 4 ----- rather ventral muscles - m. subscapularis

o o. two thirds of the anterior (volar) surface of the scapula o i. lesser tubercle of the hmerus o movements: internal/external rotation of the arm o innervation: subscapular nerves C5, 6 o easy to be mixed up with pectoralis major/minor o at glenohumeral joint: quite board stripe like shape

- m. brachialis o o. middle aspect of the anterior humerus

inferior to previously mentioned four insertions (above) o i. tuberosity and coronoid process of the ulna o movements: flexion of the foramr at the elbow o innervation: musculocutaneous nerve C5, 6 o at dissection: lateral to m. biceps brachi

- m. biceps brachii o o. long head: supraglenoid tubercle and superior glenoiid labrum o o. short head: lateral part of the coracoid process of the scapula o i. tuberosity of the radius and aponeurosis of the biceps itself o movements: flexion of the forearm o innervation: musculocutaneous nerve C5, 6 o the two heads

the short head (lateral to long head) appears long, because major parts of the long head are covered by the deltoid muscle

the long head (medial to short head) appears rather short o most prominent anterior muscle of arm at dissection o long head is fused with glenoid capsule (labrum) o strongest action when forarm is supinated

- m. pectoralis minor o o. anterior surfaces of the ribs 3-5 o i. medial aspect of the coracoid process of the scapula

may also sort of fuse with the coracoacromial ligament o movements: protraction of the scapula

scapula moves somewhat superiorly and laterally occurs when one breathes in very deeply or when

demonstratively showing “strength” by “making tshoulder a bit broader”

he

o innervation: medial pectoral nerve C7, 8, T1 - m. subclavius

o o. junction of 1st rib and sternum o i. groove of inferior surface of the clavicula o movements: pulls the shoulder down and forward

occurs e.g. at sudden disappointment, e.g. player at basketball match gives away the buzzer beater shot closely

o innervation: subclavian branch of the brachial plexus C5, 6 - m. deltoideus, anterior part

o o. anterior side of the lateral part of the clavicle o i. deltoid tuberoity at the lteral shaft of the humerus


3 Temmesfeld '06

o movements: flexion of the arm at the shoulder o innervation: axillary nerve (C5, 6) o covers long head of m. biceps brachii

- m. deltoids, middle part o o. lateral part of the acromial process of the scapula

after the spinal process “went around the corner” (and its name changed into acromion)

o i. deltoid tuberosity at the lateral part of the humerus o movements: abduction of the arm at the shoulder o innervation: axillary nerve C5, 6 o movements of anterior and middle m. deltoideus perpendicular to each other

- m. deltoideus, posterior part o o. inferior edge of the scapular spine

before the spinal process “goes around the corner” (and its name changes into acromion)

o i. deltoid tuberosity at the lateral part of the humerus o movements: extension of the arm at shoulder o movements of the anterior and posterior m. deltoideus are contrary to each other (muscles can

act as antagonists) - m. serratus anterior

o o. roughly: first eight ribs (anterior part at midclavicular line) o i. posterior (volar) surface of the scapula and (only point like attachment??) o movements: upward rotation of the scapula o innervation: long thoracic nerve C5, 6, 7 o covers vulnerable side of human body, not a sophisticated protection

- m. pectoralis major (see also m. latissimus dorsi, above) o o., clavicular head: anterior surface of the middle part of the clavicula o i., clavicular head: lateral lip of the bicipital groove of the humerus

(in figure: 1st attachment site from the left) o o. sternal head:lateral border of the manubrium and body (xiphoid

process) of the sternum o i. sternal head: lateral lip of the bicipital groove of the humerus (medial

to insertion of clavicular head) (in figure: 2nd attachment site from the left, rather smaller)

o movements, clavicular head: adduction and flexion of the arm o movemnts:, sternal head: adduction, internal rotation, extension of the arm o innervation: medial pectoral nerve, lateral pectoral nerve o most striking muscle at dissection, must be removed to investigate all other deeper

structures other relevant structures axillary fossa (arm pit)

- medial border: o m. serratus anterior

- lateral border: o shaft of the humerus o m. biceps brachii o m. coracobrachialis

- superior border: (edge of the body) - inferior border: (edge of the body) - anterior border: (edge of the body) - posterior: border:

o m. subscapularis o m. teres major o m. teres minor o m. infraspinatus

quadrangular space


4 Temmesfeld '06

- medial border: o

- lateral border: o shaft of the humerus o m. latissimus dorsi

- superior border: o tendon of

- inferior border: o m. teres major

- anterior border: o (m. pectoralis major, sternal head)

- posterior: border: o (m. deltoiideus, posterior part)

triangular space

- medial border: o m. subscapularis

- lateral border: o m. triceps brachii, long head

- superior border: o m. subscapularis

- inferior border: o m. teres major

- anterior border: o (m. pectoralis major, sternal head)

- posterior: border: o (m. deltoiideus, posterior part)

bursae:

- subdeltoid bursa - subacrimial bursa

o fused with subdeltoid bursa - m. coracobrachialis bursa

o between m. subscapularis (deep) and m. biceps brachii and m. coracobrachialis (both superficial)

rotator cuff:

formed by tendon, wrapping the glenoid cavity: - m. subscapularis - m. supraspinatus - m. infraspinatus fused with capsule - m. teres minor fused with capsule

glenoid cavity

- contains hyaline cartilage - layers: articular capsule, synovial membrane, glenoid cavity - labrum: brown rings, stabilizing the joint


5 Temmesfeld '06

_elbow and forearm bones: humerus, ulna, radius,

• relevant carpal bones: os trapezium, os scaphoideum, os lunatum, os triquetum, os pisiforme, os hamatum, os capitatum, os trpezoideum

joints: cubital joint joints: joint, cubital, (and related structures)

- involved bones: humerus, radius, ulna - includes three “sub”joints

1. Humeroradial joint - type of joint: hinge joint; flexion,

extension - between capitulum of humerus and

head of the radius 2. Humeroulnar joint

- type of joint: hinge joint; flexion, extension

- between trochlea of the humerus and trochlea notch of the ulna

3. Proximal Radioulnar joint - type of joint: pivot joint; pronation,

suppination - the radio and ulna cross over during

pronation (interchange) Medial view (right arm)

- one common articular capsule for all three joints - ligaments/tendons

----- anterior and lateral ligaments o annular ligament

pertaining to the proximal radioulnar joint between anterior radial notch and posterior radial notch holds (wraps) the head of the radius like a ring

o radial collateral ligament of elbow pertaining to humeroradial joint

between lateral epicondyle of humerus and… annular ligament of radius (supinator crest of the ulna)

----- posterior and lateral ligaments o lateral ulnar collateral ligament

pertaining to the humeroulnar joint between lateral epicondyle of humerus and supinator crest of the ulna counterpart to radial collateral ligament

----- medial anterior/posterior ligaments o ulnar collateral ligament, oblique band

intraossal ligament on the medial side between olecranon process and coronoid process of ulna

Semilateral view

lateral view

“converts” the depression between these two processes into a foramen o ulnar collateral ligament, posterior band

pertaining to the humeroulnar joint between medial epicondyle of the humerus and medial part of the olecranon process

of the ulnar o ulnar collateral ligament, anterior band


1 Temmesfeld '06

pertaining to the humeroulnar joint between medial epicondyle of the humerus and proximal tubercle

of the coronoid process o interossus membrane of forearm

not directly pertaining to cubital joint restricts cross over and positional interchange

medial view o may look differently when forearm is in flexion

- capsule o outward appearance of capsule resembles a tendon itself

- bursa

o subcutaneous bursa of the olecranon process muscles: -----anteroir muscles (medial to lateral, little finger to thumb, mostly flexors)

- m. flexor digitorum profundus o o. upper three quarters of the ulna and

interossus membrane o i. volar surface of the four distal phalanges o movement: flexion of fingers at proximal

interphalangeal joint o innervation: ulnar nerve C8, T1 o located rather anteriorly and medially

- m. flexor digitorum superficialis

order of list:anterior medial to post. medial

o o. medial epicondyle of the humerus via common flexor tendon fused with: o. ulnar head: coronoid process of the ulna

o o. radial head: oblique line at anteriosuperior surface of radius o i. volar surface of the four distal phalanges o movemet: flexion of fingers at proximal interphalangeal joint o innervation: median nerve C7,8 T1

- m. flexor carpi ulnaris o o. medial epicondyle of the humerus via common flexor tendon

o i. pisohamate ligament indirect attachment to os hamatum and os pisiforme

o i. pisometacarpal ligament indirect attachment to thebase of fifth metacarpal bone


2 Temmesfeld '06

o movements: flexion of wrist, ulnar derivation of the wrist (abduction of the hand) o innervation: ulnar nerve C8, T1

- m. flexor digitorum siperficialis o o. medial epicondyle of the humerus via common flexor tendon o i. volar surface of the middle phalanges o movements: flexion of the fingers o innervation: median nerve C7, 8, T1 o located laterally to m. flexor digitorum profundus

- m. palmaris longus o. medial epicondyle of the humerus via common flexor tendon

o i. flexor retinaculum develeops branches distally of flexor retinaculum, attaching

o the palmar fascia, sometimes called palmar aponeurosis o movement: not important, helps with flexion of the hand o innervation: median nerve C6, 7 o small venter and long tendon, forming the palmar aponeurosis

- m. flexor carpi radialis o o. medial epicondyle of the humerus via common

flexor tendon o i. base of the second (and) third metacarpal bones o movement: flexion of wrist o innervation: median nerve C6, 7 o quite eminet muscle at dissection

- m. flexor policis longus o o. varies: usually middle anterior surface of the radius

and interossus membrane, can have two o i. palmar aspect of the base of the phalanges of the

pollex o movement: flexion of the thumb at the interphalangeal joint o innervation: interossous branch of the median nerve o hard to find in dissection: venter of the muscle is very close to flexor digitorum superficialis at

the lateral side, deep - m. pronator quadratus

o o. distal one forth of the anterior medial side of the ulna o i. distal one forth of the anterior lateral side of the radius o movements: pronation of the forearm o innervation: interossus branch of the median nerve C8, T1 o deepest anterior muscle

- m. pronator teres o o. medial epicondyle of the humerus via common flexor tendon o o. ulnar head

coronoid process of the ulna o i. lateral aspect in the middle part of the radial shaft o movement: pronation of the forarm o innervation: median nerve C6, 7 o most lateral of all flexion muscles

-----posterior muscles (lateral to medial, thumb to little finger) - m. brachioradialis

o o. lateral ridge of middle humeral shaft between m. triceps brachii, lateral head and brachialis

o i. styloid process of the radius o movement: flexion of the forearm at the elbow o innervation: radial nerve C5, 6

- m. extensor carpi radialis longus o o. lower lateral ridge of the humeral shaft o i. base of the dorsal surface of the second metacarpal o movement: extension of wrist


3 Temmesfeld '06

o innervation: radial nerve C5,6 o is quite lateral rather than posterior

- m. extensor carpi radialis brevis o o. lateral epicondyle of the the humerus, via commom extensor tendon o i. dorsal surface of the base of the third metacarpal o movement: extension of the wrist o innervation: radial nerve C6, 7

- m. abductor policis longus o o. posterior surfaces of ulna, radius and interossus membrane o i. lateral part of the base of the first metacarpal

that is rather anterioirly o movement: abduction og the thumb ( o innervation: radial nerve C6, 7, 8

- m. extensor policis brevis o o. posterior surface of the ulna and interossous m

i. distal phalembrane

o anx of the pollex thumb at

o ve C6, 7, 8 -

e ulna and interossous membrane

o extension of the thumb at the

s -

erus, via commom extensor tendon igits

finger attaches to middle finger (twice) and ring

o movements: exte the fingers at three joints

t

o 8 -

the humerus, via commom extensor tendon )

finger) o

uals communis

- face of the ulna

istal phalanx of t

rsses m. extensor digitorum communis and m. extensor minimi

- m. supinator picondyle of the humerus

o movements: extension of the the interphalangeal joint

innervation: radial nerm. extensor policis longus o o. posterior surface of tho i. distal phalanx of the pollex

movements:interphalangeal joint

o innervation: radial nerve C6, 7, 8 o medial to m. extensor policis brevim. extensor digitorum communis o o. lateral epicondyle of the humo i. dorsal parts of the proximal/middle and distal phalanges of the four do i. dorsal part of the middle phalanges of the four digits

distal tendon of muscle divides into two • one continues to the index • the other divides a little later and

finger nsion of

metacarpophalangeal joints proximal interphalangeal join distal interphalangeal joint

innervation: radial nerve C6, 7,m. extensor digiti minimi o o. lateral epicondyle ofo i. divides into two slips (running nearly undistinguishable close together

one attaches to the middle phalanx digiti minimi (little finger) the other one attaches to the distal phalanx digiti minimi (little

movement: extension of the little finger o innervation: radial nerve C6, 7, 8 o this muscle misses in some individo is located medially to extensor digitorumm. extensor digiti indicis o o. posterior middle suro i. dorsal surface of the the middle and d he index finger o movement: extension of the index finger o innervation: radial nerve o very, very hard to find, co

deeply

o o. lateral eo o. supinator crest of the ulna


4 Temmesfeld '06

o i. anterior lateral surface of the radius (as name suggests)

(superficial mi.removed) -

the humerus, via commom extensor tendon

- rior surface of the lateral epicondyle of the humerus

o “puuls synovial fliud out of the way during

o 7, 8

-- temic concepts

o movements: suppination of the forearmo innervation: radial nerve C6, 7, 8 o deep layered: superficially invisiblem. extensor carpi ulnaris o o. lateral epicondyle of o i. tubercles on the medial side of the fifth metacarpal o movements: extension of the wrist o innervation: radial nerve C6, 7, 8 m. aconeus

- o. poste- i. lateral aspect of the olecranon movements: no primary movement, extension of the forearm innervation: radial nerve C

-- -sys in the hand including fingers is a matter of agreement about what is what

the hand:

- nt teral classification cal position

ion anatomical postion for forearm

- flexion or extension o raising the hand, e.g. when greeting or waving: extension o showing somebody the volar (back of the hand) surface of

flexion a erior, posterior, medial and laStructures are referred to slightly different atnatomi(anterior view) anatomical posit

- flexor muscles of the forearm or side

on flexor tendon as their origin

lis rficialis

o flexor tendon as their origin

profundus

o rather located at the anterio all flexor muscles having the comm

all anterior muscles attached to the medial epicondyle m. palmaris longus m. flexor carpi radia m. flexor digitorum sipe m. flexor carpi ulnaris

all flexor muscles not having the common m. brachioradialis m. flexor digitorum

e.g. medial epicondyle of the humerus

flexion extension

in anatomical position: foream will

ially

anatomical position of forearm

ctures of the arm will an

y

- structures of the appear rather anteriorly than laterally and rather posteriorly than med

inand hand

- struappear rather anteriorly thmedially and rather posteriorly than laterallforearm is less forearm is com-

supinated pletely supinated


5 Temmesfeld '06

- ext se

common extensor tendon as their origin:

o ng the common extensor tendon as their origin:

-

olicis longus

tus - circ all layers and proximal/distal positions

-- (lateral to medial)

1. m. flexor digitorum profundus . m. extensor carpi radialis longus

rficialis

lis munis

rpi ulnaris

musculi of the pollex (thumb) uscles, all located at the very distal part of the antebrachium

r -

- (lateral to medial, thumb to little finger)

res

ay down form cubital joint r posterior)

o le of the anterior forearm

o

existent

urosis attached to it o

aris longus

o

en or muscles of the forearm o rather located on posterior sido all extensor muscles having the

all muscles attached to the lateral epicondyle m. extensor carpi radialis brevis m. extensor digitorum communis m. extensor digiti minimi m. extensor carpi ulnaris

all extensor muscles not havi m. extensor carpi radialis longus (attached to supracondyle aspect)

non extensor and non flexor muscles of the forearm o m. aconeus o m. supinatoro m. abductor po m. pronator teres o m. pronator quadraumnavigation of the arm at

-- -anteroir muscles (medial to lateral) -----posterior muscles 1

2. m. flexor carpi ulnaris 2. m. extensor carpi radialis brevis 3. m. flexor digitorum sipe 3. m. abductor policis longus 4. m. palmaris longus 4. m. extensor policis brevis 5. m. flexor carpi radia 5. m. extensor policis longus 6. m. flexor policis longus 6. m. extensor digitorum com7. m. pronator quadratus 7. m. extensor digiti minimi 8. m. pronator teres 8. m. extensor indicis 9. m. brachioradialis 9. m. supinator 10. m. extensor ca 11. m. aconeus -

o the pollex has extra four mo m. flexor policis longus – anterior- o m. abductor policis longus – posterioo m. extensor policis brevis – posterior - o m. extensor policis longus – posterior - order of anterior muscle tendons at forearmas seen in dissection 1. Superficial layer

o m. pronator te• short muscle • insertion half w• very lateral (could be defined as anterior om. flexor carpi radialis • quite eminent musc• tendon is rather long • m. flexor carpi radialism. palmaris longus • relatively small, if• small venter • palmar aponem. flexor digitorum superficialis

can also be lateral to m. palm rather deep part of superficial layer four tendons: 2,3,4,5

m. flexor carpi ulnaris


6 Temmesfeld '06

very medial like a cD

ollateral shield 2. ee L

ing m. flexor carpi radialis and m. flexor digitorum superficialis away

the anterior side the one of m. flexor digitorum superficialis

o

3,4,5 o

ior forearm muscles - ord o al to medial, thumb to little finger)

ialis ished by looking at distal part of brachialis; the muscel next to it is the

o m. dialis longus ialis

ialis o

tensor carpi radialis longus

o communis rearm

n (2, 3&4), venter quite large

o een m. extensor digitorum communis

o or carpi ulnaris scle of the posterior forearm

2. ee Lcles

p ayer o after pullo m. flexor pollicis longus

the only m. pollicis on large proximal attachment site medial to

m. flexor digitorum profundus very braod band four tendons: 2,

m. pronator quadratus deepest of the anter

er f posterior muscle tendons at forearm (lateras seen in dissection 1. Superficial layer

o m. brachiorad• can be distingu

brachioradialis extensor carpi ra

• at bit deeper to m. brachiorad• very close together with brachioradm. extensor carpi radialis bravis • another bit deeper than m. ex• “short, but deep” m. extensor digitorum

eminent muscle of posterior fo @ wrist joint: clearly visible two tendo four tendons: 2,3,4,5

m. extensor digiti minimi hard to distinguish betw small

m. extens most eminet medial m

D p ayer -----thumb mus

ollicis longus

o . brevis is of the posterior side

o . is longus m. pollicis of the posterior side

---- t r

o m. abductor p makes a sharp corner appears short

m extensor pollicis middle of the three m. pollic appears long

m extensor pollic most lateral of the three

-o he muscles o m. extensor indicis

. extensor digiti minimi s of the index finger

ther relevant structures:

just medial to m forms the deeper tendon at the phalange

o

anatomical snuff box when thumb is in extension (visible live, without dissection ☺ )

ateral) - car l

by posteriorly: al bones: os trapezium, os trapezoid, os capitate, os hamate

anterior retinaculum

con

-

depressed area formed by m. extensor pollicis brevis (medial) and m. extensor pollicis longus (l

pa tunnel: formed

distal row of carprly:

flexostains all


7 Temmesfeld '06

tendons of mi. flexor digitorum profunus and superficialis flexor pollicis longus median nerve


8 Temmesfeld '06

_hand bones: humerus, ulna, radius, - os trapezium, os scaphoideum, os

lunatum, os triquetum, os pisiforme, os hamatum, os capitatum, os trpezoideum

joints: - distal radioulnar joint - carpal joint - intercarpal joints - carpalometacarpal joints - intermetacarpal joints - metacarpalophalangeal joints - interphalangeal joints joints: joint, distal radioulnar

- involved bones: radius, ulna - type of joint: pivot joint; pronation,

suppination - between

o head of the ulna and o ulnar notch of the radius

- has an articular disc, also called transverse ligament (red, hatching) - ligaments/tendons

o no additional ligaments (apart from articular disc)

----- supplementary ligaments dot not pertain to any joint, but are located nearby

- palmar ulnocarpal ligament o between

ulnar styloid process and palmar side of the bases of os lunate and os triquetrum

o has two slightly separated bands o can be easily mixed up with the radiocarpal ligament

- ulnar collateral ligament of wrist o between

apex of ulnar styloid process and anterior band: medial side of os pisiforme posterior band: medial side of os triquetrum

o has a mini articular disc at its distal, laterla part (near the carpal bones), serving as the distal border of the prestyloid process of the synovial capsule

joint, carpal

- involved bones: radius, os scaphoid, os lunate, os triquetrum, os pisiforme (ulna is not involved)

- type of joint: condyloid (ellipsoid) joint (complementary convex aconcave surface); flexion, extension, abduction, adduction (the lattertwo movements are more restricted)

nd

- ligaments/tendons: o palmar radiocarpal ligaments

between: • distal end of the radius and medial radioulnar articular disc

and

anatomy, 1st sct, hand e.b.: Temmesfeld‚ 06

1 Temmesfeld '06

• proximal row of carpal joints (expect for os pisiforme; os scaphoideum, os lunate, os triquetrum)

o radial collateral ligament of wrist between • apex of styloid process of radius and • radial side of scaphoideum very tiny and very lateral

o dorsal radiocarpal ligament between • distal end of radius and • dorsal surfaces of os scaphoideum, os lunate and os triquetrum • easily visible transverse band, largest band of the dorsal side

joints, intercarpal

- involved bones: all carpal bones o proximal row: os scaphoideum, os lunate, os triquetrum, os pisiforme o distal row: os trapezium, os trapezoid, os capitate, os hamate

- type of joints: plane joint; gliding and sliding movements - includes three classifications of joints:

1. Joints between the bones of the proximal row of the carpus 2. Joints between the bones of the distal row of the carpus 3. Midcarpal joints: between proximal and distal row of the carpus 4. Pisotriquetral joint between os triquetrum and os pisiforme

• because os pisiforme is the only bone, not located in the coronal carpal plane

- a common joint capsule for the and carpal metacarpal joints is formed, the wrist joint has also a separated capsule

- ligaments/tendons o all bones are attached to each other by

anterior posterior and interossous ligaments

joints, carpalmetacarpal and intermetacarpal joints

- involved bones: distal row of carpal bones os trapezium, os trapezoid, os capitate, os hamate

- type of joints: all but thumb: plane joint; gliding and sliding movements thumb: saddle joint, flexion, etension, abduction, adduction

- a common joint capsule for the intercarpal and carpalmetacarpal joints, with the exception of the articulation carpalmetacarpal pollicis (thumb)

- special issues with articulation carpalmetacarpal pollicis (thumb) separated joint capsule saddle joint fibrous layer sourrounds synovial membrane

- ligaments/tendons o all bones are attached to each other by

• anterior (palmer) carpometacarpal ligaments • posterior (dorsal) carpometacarapl ligaments • anterior (palmer) intermetacarpal ligaments • posterior (dorsal) intermetaarpal ligaments • supplementary more distal intermetacarpal ligaments

joints, metacarpalphalangeal - involved bones: four metacarpal bones 2,3,4,5; four proximal phalanges - type of joint: condyloid (ellipsoid) joint (complementary convex and concave surface); flexion,

extension, abduction, adduction (the latter two movements are more restricted)


2 Temmesfeld '06

- ligaments/tendons o palmar metacaralphalangeal ligaments

• anteriorly between o metacarpals and o proximal phalanges

o deep transverse metacarpal ligaments • between metacarpals

o collateral metacarpophalangeal ligaments • medially and laterally between

o metacarpals and o proximal phalanges

• consists of two parts o cord like part beinig stronger o fan-like part being a little less strong

joints, interphalangeal - involved bones: proximal, middle and (distal) phalanges - type of joint: hinge type of joint; flexion and extension - ligaments/tendons

o collateral interphalangeal ligaments • medially and laterally between phalanges • consists of two parts

o cord like part beinig stronger o fan-like part being a little less strong

muscles: ----- anterior muscles (deep to superficial) - palmar interossei also called lumbricals (three m.)

o between medial/lateral aspects of the 2nd, 3rd and 4th metacarpals, but not the thumb

o movement: flexion of the fingers o innervation: ulnar nerve C8, T1

- m. adductor policis o o. transverse head (inferior): palmar third metacarpal o o. oblique head (superior): palmar side of os capitate o movement: adduction of the thumb o innervation: ulnar nerve, C8, T1

- m. opponens pollici o o. distal retinaculum and os trapezium (most lateral bone of the distal row) o i. lateral part of the first metacarpal o movement: opposition of the thumb o innervation: median nerve, C8, T1

- m. opponens digiti minimi o o. distal retinaculum and os hamate (most medial bone of the distal row) o i. medial palmar surface of the digitus minimus o movement: opposition of the digitus minimus o innervation: ulnar nerve, C8, T1

- m. flexor digiti minimi o o. flexor retinaculum o i. medial part of the proximal phalanx of the digitus minimus o movement: flexion of the digitus minimus o innervation: ulnar nerve, C8, T1

- m. flexor policis brevis o o. superficial head: retinaculum and os trapezium o o. deep head: floor of carpal tunnel o movement: flexion of the thumb o innervation: median nerve and ulnar nerve (sup. and deep head, respectively) o runs sort of parallel to m. opponens pollici

- m. abductor digiti minimi


3 Temmesfeld '06

o o. tendon of flexor carpi ulnaris o i. middle part of the proximal phalanx o movement: abduction of the digitus minimus o innervation: ulnar nerve C8, T1

- m. abductor pollicis brevis o o. retinaculum o i. lateral part of the proximal phalanx of the pollex o movement: abduction of the pollex o innervation: branch of median nerve C8, T1 o runs superficial to m. opponent pollicis and flexor pollicis brevis

- m. palmaris brevis o between palmar aponeurosis and skin of ulnar side of palm o movement: tenses skin o innervation: ulnar nerve C8, T1

----- posterior muscles - dorsal interossei

o between medial/lateral side of the digits including the thumb o movement: flexion of the digits (bringing fingers close together) o innervation: ulnar nerve C8, T1

other relevant structures: - commom flexor tendon sheaths (also referred to as bursae):

o wrapping around tendons of m. flexor digitorum superficialis and m. flexor digitorum profundus o allow grinding less gliding o begins proximally deep o the flexor retinaculum o splits up in to the respective…

- digital synovial sheaths - fibrous digital sheats

o wrapped around digitalsynovial sheaths at the phalanges of 2nd, 3rd and 4th digits only, but not around the thumb

o also referred to as “pulleys” - thenar eminence

o the eminence visible close to the thumb o muscles:

m. abductor pollicis brevis m. opponens pollicis m. flexor pollicis

- hypothenar eminence o the eminence smaller thant the thenar one, located near the digitus minimus o muscles:

m. abductor digiti minimi m. opponens digiti minimi m. flexor digit minimi brevis

- PAD o Palmar interossei ADduct the metacarpalphalangeal joint

- DAB o Dorsal interossei Abduct the metacarpalphalangeal joint


4 Temmesfeld '06

axillary fossa - anterior border: pectoralis major - lateal border: upper third of the humeral shaft - medial border: serratus anterior and ribs - posterior border: teres major and latissimus dorsi

axillary artery

- originates from subclavian artery - begins at the first rib (changes its name there) - “ends” the lower border of the teres major - three parts based on the insertion of the pec. minor 1. above pec. minor

o supreme thoracic artery 2. under pec. minor

o thoracoacromial trunk to pec. major and pec. minor to coracoid process ro acromial process may have multiple branches rather superior

o lateral thoracic artery to serratus anterior often with long thoracic nerve

3. below pec. minor o subscapular artery

curly shape divides into

• thoracodorsal artery, to lat. dorsi and • circumflex scapular artery

o humeral circumflex branches may either originate from one branch like trunk or are independently

attached to the axillary artery circumnavigate the head of the humerus through quadrangular space

brachial artery

- “begines” below m. teres major - branches immediately:

o deep radial artery, travelling with the radial nerve

Temmesfeld '06

- four main nerves „leaving“ the brachial plexus o musculotcutaneous nerve C5, 6 o axillary nerve C5, 6 o radial nerve, C5-T1 o median nerve, C6-8, T1 o ulnar nerve C7,8 T1

- nerves of the arm o median nerve, running anteriorly to elbow joint

does not innervate anything at the arm, but supplies articular branches to elbow joint

o ulnar nerve, running posteriorly to elbow joint does not innervate anything at the arm, but supplies articular branches to elbow joint

o radial nerve, coming from the posterior side, running anteriorly to elbow joint o musculocutaneous nerve, not passing the elbow joint

- anterior innervation of the arm: o musculocutaneous nerve

- posterior innervation of the arm o radial nerve

- nerves of the forearm o deep radial nerve, originating from radial nerve, running anteriorly o median nerve, running anteriorly o ulnar nerve, running posteriorly to elbow joint, coming on the anterior side

- anterior innervation of forearm o median nerve

- posterior innervation of forearm o radial nerve

- nerves of the wrist/hand o two main nerves entering the hand

ulnar nerve median nerve (via carpal tunnel) communication of ulnar and medial nerve at wrist joint

- anterior innervation of the hand o ulnar nerve:

two main branches • r. profundus doing a sharp corner into into the palm (dives away) • r. superficialis branching into two communal digital nerve

o one for the little finger, turning into the proper digital nerve o one for the ring finger

branching into one proper digital nerve (little finger) one proper digital nerve (ring finger, medial side)

muscles and cutaneuous areas • hypothenar muscles

o opponens digiti minimi o flexor digiti minimi o abductor digiti mnimi

• interosseous muscles o all dorsal o lateral of digits four and five o medial of digitus minimus

• flexor pollicis brevis; adductor pollicis brevis (thenar space) • dorsal and palmar aspects of distal 1 ½ digits

Temmesfeld '06

o median nerve having four subbranches, four communal digital nerves first one, branching into

• lateral proper nerve of the ring finger • medial proper nerve of the middle finger

second one, branching into • lateral proper nerve of the middle finger • medial proper nerve of the index finger

third one, turning into lateral proper nerve of the index finger fourth one, turning into medial proper digital nerve of the thumb the median nerve “itself” turns into the lateral proper nerve of the thumb

• muscles and cutaneuous areas thenar muscles:

• opponens pollicis • abductor pollicis brevis • not: flexor pollicis brevis; adductor pollicis brevis

lateral lumbricales digits 2,3 cutaneous innervation:

• palm • anterior aspects of 3 ½ fingers • dorsal distal aspects of 3 ½ fingers

Temmesfeld '06

lower limb pelvic girdle and adjacent structures: bones: hip bone (os inomina), including os illium, os ischium and os pubis joints: symphysis pubica, sacro-illiac joint, lumbosacral joint, sacrococycal joint, hip joint joints: joint: symphysis pubica - involved bones: two pubic bones - type of joint: secondary cartiliaginous joint - ligaments:

o superior pubic ligament between superior surfaces of the pubic tubercles

o arcuate pubic ligament inferior to interpubic disc

- interpubic disc o fibrcartilageous disc connecting the two pubic bones at their faciei symphysiali o has a central cavity

- no direct muscle attachment sites joint: sacro-illiac joint - involved bones: tos sacrum, os illium - type of joint:

o plane joint (anetriorly) between auricular surfaces of ilium and sacrum

o syndesmosis (posteriorly) between iliac tuberosity and sacral tuberosity

- ligaments: o anterior sacroiliac ligaments (two on each sides)

between • capsular thickeining from the third sacral segment • lateral side of the iliac fossa

o posterior sacroiliac ligament two bands

1. short band o between:

intermediate and lateral crest posteriosuperio iliac spine

2. long band o between

third and fourth sacral vertebrae postereosuperio iliac spine

the short band is much weaker o supraspinous ligament

connect spinous processes of vertebrae and sacrum from C7 down to the sacrum o interosseous sacroiliac ligament

between • sacroauricular surface • depressions of the iliac tuberosity

joint: lumbosacral - involved bones: 5. lumbar vertebra, os sacrum - between

o body of 5. lumbar vertebra o body of 1. sacral vertebra (the anterior edge of the body of the S1 vertebra is called

promontory, Vorgebirge) ??????

anatomy, 2nd sct, pelvic girdle and adjacent structures e.b.: Temmesfeld ‚06

1 Temmesfeld '06

- intervetrebral or articular disc (fibrous cartilage) - ligaments:

o intertransverse ligament between

• inferior aspect of the transverse process of the 5. olumbar vertebra (this ligament connects the transverser processes of all vertebrae)

• (superior tubercle from the sacral bone) o anterior longitudinal ligament

between • anterior aspects of the passing vertebrae • pelvic surface of the anterior sacrum

o supraspinous ligament connects spinous processes of all vertebrae (including sacral vertebrae)

o ligamentum flavum connects the laminae of the adjacent vertebrae enters the sacral canal ?????? broad and thick in lumbar region

joint: sacrococygeal joint - involved bones: os sacrum, os coccyx - between

o apex of the sacrum o base of the cocyx

- type of joint: secondary cartilaginous joint - articular fibrocartilage disc - ligaments:

o anterior and posterior sacrococcygeal ligaments between

• ventral and dorsal surface of the apex of the sacrum • ventral and dorsal surface of the coccyx

joint: hip joint - involved bones: os inomina (all three sub-bones), os femur - between

o acetabulum of hip bone (acetabulum, lat. = sauce pan) comprised of four (five) aspects:

1. facies lunate (lunate surface of acetabulum) o form three quarters of a circle with acetabular rim

2. limbus acetabuli (acetabular rim) o the edge of the facies lunate o forms three quarters of the circle with facies lunate

3. labrum acetabuli (acetabular lip) o fibrcartilaginous rim o increases the acetabular articular area for about 10% o attached to acetabular rim

4. incisura acetabuli (acetabular notch) o constitutes the missing one quarter of the circle of the acetbulum

5. (fossa acetabuli acetabular fossa) o is niot directly involved in the hip joint

o head of femur - type of joint: multiaxial ball and socket joint (spheroidal joint) - flexion, extension, abduction, adduction, lateral rotation, medial rotation -> circumduction - femoral head is completely covered with articular cartilage - the articular capsule is composed of a synovial membrane lining a fibrous cartilage capsule

o orbicular zone fibers of the fibrous capsule usually follow a spiral path around the head of the femur however some deeply layered fibers circumfence the capitis femuris strictly orbiculary, thus

forming the orbicular zone - ligaments

o pubofemoral ligament


2 Temmesfeld '06

between • iliopubic eminence down to the superior pubic ramus • deep aspect of the iliofemoral ligament and joint capsule

o iliofemoral ligament two bands

• oblique lateral band o between

anterior inferior iliac spine and acetabular rim superolateral aspect of the intertrochanteric line of the femur

• vertical medial band o between

anterior inferior iliac spine and acetabular rim inferiormedial aspect of the intertrochanteric line of the femur

o ischiofemoral igament between

• ischial part of acetabulum • medial to the base of the greater trochanter

o ligamentum teres capitis femoris (round ligament of the head of the femur) between

• acetabular notch and transverse acetabular ligament • fovea capitis femoris

synovial fold provides a pathway for the foveal artery, supplying the head of the femur

additional ligaments: lumbopelvic ligaments - iliolumbar ligament

o two bands iliolumbar band

• between o anterior-inferior surface of transverse process of fifth lumbar vertebra o iliac crest of the pelvis

lumbosacral band • between

o inferior surface of transverse process of fifth lumbar vertebra o anterior-superio-lateral surface of sacrum, blending with anterior sacro-iliac ligament

sacroischial ligaments - sacrospinous ligament

o between lateral aspect of os sacrum and os coccyx at their junction (sacrococcycal joint) ischial spine

ilioischial ligaments - sacrotuberous ligament

o between posterior superior iliac spine blending with fibers from the posterior sacroiliac ligament medial edge if ischial tuberosity large broad band, most prominent on the dorsal side of the pelvis

ischiopubic ligament - obtrurator membrane

o closes obtrurate foramen nearly completely o leaves a tiny canal open, called the obtrurator canal

illiopubic ligaments - inguinal ligament


3 Temmesfeld '06

o between anterior-superior aspect of iliac spine pubic tubercle

o provides a bridge for vessels radiating into the pelvic cavitiy muscles: - m. gluteus maximus

o o. illium, sacrum, coccyx, sacrotuberous ligament site runs parallel to os sacrum

o i. gluteal tuberosity, iliotibial tract o innervation: inferior gluteal nerve o movements: lateral extension and rotation

- m. gluteus medius o o. ilium between iliac crest and anterior and posterior gluteal lines

between insertion sites of m.gluteus maximus and m. gluteus minimus o i. greater trochanter of femur o innervation: superior gluteal nerve o movements: medial abduction and rotation, stabilization of pelvis o is usually covered by gluteal aponeurosis

- m. gluteus minimus o o. ilium between anterior and inferior gluteal lines

inferolateral to insertion site of m. gluteus medius o i. greater trochanter of femur o innervation: superior gluteal nerve o movements: medial abduction and rotation o covered by m. gluteus maximus and m. gluteus minimus

- m. tensor fascia lata o o. iliac crest, anterior superior iliac spine o i. iliotibial tract o innervation: superior gluteal nerve o movements: medial abduction, flexion and rotation

- m. piriformis o o. pelvic surface of sacrum, sacrotuberous ligament o i. superior aspect of greater trochanter o innervation: sacral nerve o movement: lateral rotation of thigh o goes through greater sciatic foramen (foramen ischiadicum) and divides it into three parts

1. superiopisiformal part 2. m. pisiformis itself 3. interiopisiformal part

- m. obturator internus o o. ischiopubic rami (sometimes just ischial ramus), obturator membrane o i. greater trochanter of femur o innervation: n. obturator internus o movements: lateral abduction and rotation o closes the lesser sciatic formamen posteriorly, then runs anteriorly around the femur to attach

to the greater trochanter o visible in pposterior dissection as the tendinous part of the hardly visible muscle group,

composed of m. gemellus superior m. obturator internus m. gemellus inferior

- m. gemellus superior o i. ischial spine o o. obturator internus tendon o innervation: n. obturator internus o movement: lateral rotation o with the tendon of the obturator internus it attaches to the greater trochanter

- m. gemellus inferior


4 Temmesfeld '06

o i. ischial tuberosity o o. obturator internus tendon o innervation: n. obturator internus o movement: lateral rotation o with the tendon of the obturator internus it attaches to the greater trochanter

- m. quadratus femoris o o. ischial tuberosity o i. intertrochantic crest o innervation: n. quadratus femoris o movement: lateral rotation

- m. psosas major o o. sides of T12-L5 vertebrae o i. lesser trochanter (medial trochanter) of femur o innervation: anterior rami of lumbar nerve o movement: flexion of thigh o m. iliacus and tendon of m. psoas major are called iliopsosas

- m. psosas minor o o. sides of L12-T5 vertebrae o i. iliopubic eminence, via iliopectineal arch o i. iliopectineal line, via iliopectineal arch o innervation: anterior rami of lumbar nerve o movement: flexion of tigh o highly tendinous muscle o muscle belly rather small o iliopectineal arch: a fascious tendon dviding into two parts for the two insertions

- m. iliacus o o. iliac crest, iliac fossa, anterior sacroiliac ligament o i. tendon of m. psosas major o innervation: femoral nerve o movement: flexion of thigh o m. iliacus and tendon of m. psoas major are called iliopsosas o attaches to lesser trochanter via tendon of m. psosas major

- m. obturaor externus o o. margins of obturator foramen and obturator membrane o i. trochanteric fossa of femur (near the intertrochaneric line) o innervation: n. obturator o movement: lateral rotation, stabilization of femoral head in acetabulum o small muscle unable to act independently

- m. pectineus o o. superior ramus of pubis o i. pectineal line of femur, inferior to lesser trochanter (medial side) o innervation: femoral nerve o movement: adduction and flexion o closes obturator foramen anteriorly

additional structures: - pelvic inlet

o the virtual line between intervertebral joint between 4th and 5th lumbar vertebra pubic symphysis

o froms an oblique plane descending posteriorly to anteriorly - pelvic brim

o also called linea terminalis o includes the iliopectineal line o virtual line in the transverse plane at the level of the sacral promontory o separates false from true pelvis

- pelvis major o also called false pelvis, or greater pelvis o approximately the space between the two wings alae of the hip bone


5 Temmesfeld '06

o space between the virtual transverse plane between the two tips of the ala ilii pelvic brim

- pelvis minor o also called true pelvis, or lesser pelvis o true pelvic cavitiy o space between

pelvic brim pelvic diaphragm

- pelvic diaphragm o muscolufascial floor of the pelvis o formed by levator ani and coccygeus muscles o separates true pelivis from perineum

- pelvic outlet o virtual transverse plane going through

inferiormost tip of coccyx inferior pubic symphysis

- perineum o anteriorly: pubic symphysis o anterolaterally: inferior pubic ramus and ischial ramus o laterally: ischial tuberosity o posterolaterllay: sacrotuberous ligament o most inferior structure of pelvis

- sciatic foramina o greater sciatic foramen

the closure of the greater sciatic notch (incisura ischiadica major) laterally: greater sciatic notch medially:

• sacroiliac ligament (between ilium and sacrum; anastomosis with sacrotuberous ligament)

• sacrotuberous ligament (between sacrum and ischium; anastomosis with sacroiliac ligament

inferiorly: sacrospinous ligament and greater sciatic notch all other borders: the ossal edges of the illium (superiorly) and ischium (inferiorly) the “door” for all nerves and arteries leaving the pelvis provides pathway for

• m. piriformis o divides the greater sciatic formanen into three parts

1. superiopisiformal part 2. m. pisiformis itself 3. interiopisiformal part

• superior and inferior gluteal blod vessels • internal pudendal vessels • pudendal nerve • sciatic nerve (major nerve of the leg) • posterior femoral cutaneous nerve • innervating nerves for m. obtrurator internus and m. quadratus femoris

o lesser sciatic foramen the closure of the lesser sciatic notch (incisura ischiadica minor) superiorly: sacrospinous ligament (radiates from the ischial spine medially) inferiorly: sacrotuberous ligament medially: sacrotuberous ligament the “door” for all arteries and nerves leaving or entering the perineum provides pathway for:

• tendon of m. obturator internus • innervation of m. obturator internus • internal pudendal vessels • pudendal nerve

all structures “leaving” the pelvic cavity via the greater sciatic formanen and re-entering it via the lesser sciatic formanen


6 Temmesfeld '06

• internal pudendal vessels and nerves • innervation of m. obturator internus

- diameters of the pelvis o conjugate diameter

also called saggital diameter or obstretic diameter • apex of sacrum • inferior edge of pubic symphysis

12-13 cm o transverse diameter

in the mid-coronal plane, which also contains the pelvic axis 12-13cm

o oblique diameter iliosacral joint iliopubic eminence

- iliopectineal line o formed by

arcuate line over iliopubic eminence superior pubic ramus pectin pubis (pectineal line)

o makes up the pelvic brim in this region - obturator membrane

o closes obturator foramen o leaves a small gap uncovered, which serves as a pathway for the obturaot artery o edges of obturator foramen

posterior obturator tubercle anterior obturator tubercle obturator crest inferior pubic ramus ischial ramus

- iliotibial tract o aponeurosis thickening of the fascia at the lateral thigh down to the knee joint o serves as insertion sites for

m. gluteus maximus m. tensor fascia lata

o forms fibrous capsule of knee joint - fascia lata

o membraneous deep fascia, wrapping the whole leg o has internally pointing protrusions, which form

medial intermuscular septum lateral intermuscular septum

o attachment sites: pubic symphysis obturator crest (sometimes called pubic crest) pubic rami [superior and inferior (to obturator foramen)] ischial tuberosity inguinal ligament sacrotuberous ligament os sacrum os coccyx

- fossa ovalis o alos called saphenous opening o hole in the fascia lata, for branching of saphenous vein from femoral vein o lateral border is calles falcifrom margin o great saphenous vein branches inferiorly to femoral sheath

- femoral sheath o funnel shaped fascial tube o located at the subinguenal space o content is referred to as vascular lacuna o divided into three compartments:


7 Temmesfeld '06

1. lateral compartment • contains femoral artery • femoral branch of the genitofemoral nerve

2. intermediate compartment • contains femoral vein

3. medial compartment • mostly called femoral canal • contains

o loose connective tissue o lymph nodes o lymphatic vessels

• abdominal aspect called fermoral ring • abdominal opening closed by femoral septum

o blends inferiorly with the adventitia of the blood vessels it contains femoral artery femoral vein

o inferior to the femoral sheath, the great saphenous vein branches from the femoral vein through great saphenous opening

- femoral ring, borders o lateral: vertical septum to the femoral vein (within femoral sheath) o posterior: superior ramus of pubis covered by the fascia of m. pectineus o medial: lacunar ligament o anterior: medial part of the inguinal ligament

- iliopectineal arch o formed by

tendon of m. psosas minor inguinal ligament

- muscular lacuna o formed by

iliopsosas • m. iliacus and tendon of m. psoas major are called iliopsosas

iliopectineal arch fascia of iliacus joined with inguinal ligament

o contains the femoral nerve - synostosis

o the “joints” between the hip bones are formed in scoop of the ossification process and are called synostosis

- iliopubic tract o thickened fibers of the transverse fascia o runs deeply (posteriorly) to the inguineal ligament

- inguinal triangle o inferior border: inguinal ligament o medial border: m. rectus abdominis o lateral and superior border: inferior epigastric vessels

- falciform margin o the margin of the inguinal opening (for the branching of the great saphenous vein from the

femoral vein) - subinguinal space

o the space spanned by the flexor retinaculum from the ASIS to the pubic tubercle - lacunar ligmanent

o some deep fibers of the inguineal ligament o do not attach to pubic tubercle, but to superior pubic ramus

- pectineal ligament o some deep fibers of the inguineal ligament o most lateral para running fibers of inguineal ligament o attach to pectienal line of os pubis


8 Temmesfeld '06

lower limb thigh: bones: hip bone (os inomina), including os illium, os ischium and os pubis, os femur, os tibia, os fibula, os patella joints: knee joint (articulation genus) joints: joint: knee joint, articulatio genu - involved bones: os femur, os patella, os tibia - type of joint: hinge type of synovial joint, additional gliding and sliding movements around vertical

longitudinal axis - articular surfaces

o lateral femorotibial articulation between lateral condyles of os femur and os tibia

o medial femorotibial articulation between medial condyles of os femur and os tibia

o femoropatellar articulation between femur and patella

- joint capsule: o external fibrous layer

continuous with tendon of m. quadriceps femoris posterior opening as an exit channel for the tendon of the m. popliteus

o internal synovial membrane two vertical synovial folds (see p.686, moore)

• lateral and medial alar folds o in the anterior part of the triangle formed by the two menisci and the patellar

ligament • infrapatellar folds

o in the medium part of the triangle formed by the two menisci and the patellar ligament

- infrapatellar fat pad o pad of adipose tissue inferior to patella

- two menisci o fibrocartilageous tissue o lateral meniscus

between lateral condyles of femur and tibia o medial meniscus

between medial condyles of femur C shape

- ligaments: o intracapsular ligaments:

cruciate ligaments • in joint capsule, but outside of the space enclosed by the synovial membrane • posterior cruciate ligament

o posterior intercondylar area of the tibia o anterior part of the lateral surface of the medial condyle

• anterior cruciate ligament o anterior intercondylar area of the tibia o posterior part of the medial side of the lateral epicondyle

• cross each other (chiasm) in an x shaped manner transverse ligaments

• joins the two anterior aspects of the menisci posterior meniscofemoral ligament

• joins the lateral meniscus to the posterior cruciate ligament (when it “passes by”) o extracapsular ligaments:

patellar ligament:

anatomy, 2nd sct, thigh e.b.: Temmesfeld ‚06

1 Temmesfeld '06

• formed by the distal part of the tendon of m. quadriceps femoris • inferiorly to the os patella it attaches to the tibial tuberosity

fibular collateral ligament • lateral epicondyle of the femur • lateral surface of fibular head

tibial collateral ligament • joint with articular capsule, hence intrinsic • medial epicondyle of the femur • medial condyle and superior part of the surface of the tibia

oblique popliteal ligament • located on posterior side • arises from tendon of m. semimembranosus, as a nearly perpendicular side branch • runs roughly in the transverse plane • joins the articular capsule at the lateral femoral condyle

arcuate popliteal ligament • posterior aspect of fibular head • passes over the tendon of m. popliteus • spreads of posterior knee joint and combines with the fibrous layer of the articular

capsule - bursae

o at least 12 bursae around knee joint o all of them communicate somewhat with then synovial capsule o anteriolateral bursae

suprapatellar bursa subcuntanbeous prepatellar bursa deep infrapatellar bursa subcutaneous patellar bursa

o posterior bursae gastrocnemius bursa popliteus bursa anserine bursa semimembranosus bursa

muscles: --- anterior compartment--- - m. pectineus

o o. superior ramus of os pubis o i. pectineal line of femur o innervation: femoral nerve o movement: adduction and flexion o closes obturator foramen anteriorly

- m. sartorius o o. anterior superior iliac spine o i. superior part of medial surface of tibia o innervation: femoral nerve o movement: flexion, abduction, lateral rotation, flexion at knee joint o prominent, because it runs very oblique

- m. quadriceps femoris o composed of four parts o longest and strongest muscle of the human body o m. rectus femoris

o. anterior inferior iliac spine i. base of patella via common quadriceps tendon innervation: femoral nerve movements: extension of the crus

o m. vastus medialis o. greater trochanter and lateral lip of the linea aspera i. base of patella via common quadriceps tendon innervation: femoral nerve


2 Temmesfeld '06

movements: extension of the crus o m. vastus intermedius

o. anteriolateral surface of the shaft of the femur i. base of patella via common quadriceps tendon innervation: femoral nerve movements: extension of the crus

o m. vastus lateralis o. greater trochanter and lateral lip of the linea aspera i. base of patella via common quadriceps tendon innervation: femoral nerve movements: extension of the crus

--- medial compartment--- - m. adductor longus

o o. body of os pubis, inferiomedial to pubic crest o i. middle third of the linea aspera of the shaft of the femur o innervation: obturator nerve o movement: adduction of thigh

- m. adductor brevis o o. body of os pubis, inferior pubic ramus

inferior to insertion m. adductor longus -> located deeply towards m. adductor longus o i. pectineal line and proximal part of lateral lip of the linea aspera o innervation: obturator nerve

attachment sites of m. adductor magnus

o movement: aduction tigh - m. adductor magnus

o o. adductor part: inferior ramus of os pubis

o o. hamstring part: ischial tuberosity o i. adductor part: gluteal tuberosity,

medial lip of linea aspera, far down pass the popliteal surface

o i. hamstring part: adductor tubercle of femur

o innervation: adductor part: obturator nerve hamstring part: tibial part of sciatic

nerve (n. ischiadicus) o movement:

adductor part: adduction of thigh hamstring part: extension of thigh

o hamstring part part also called m. adductor minimus

o at the insertion site of adductor part (medial lip of linea aspera) and hamstring part (adductor tubercle), the two parts of the tendon form an arch like structure leaving an opening between them: the adductor hiatus

- m. gracilis o o. body and inferior ramus of os pubis o i. superior part of medial surface of the

shaft of the femur o innervation: obturator nerve o movement: adduction and flexion o tiny muscle (gracilis (lat.) = thin)

- m. obturator externus o o. margins of obturator foramen o i. trochanteric fossa o innervation: obturator nerve o movement: lateral rotation of tigh


3 Temmesfeld '06

o closes obturator foramen anteriorly --- posterior compartment--- - m. semitendinosus

o o. ischial tuberosity o i. medial surface of the posterior part of the tibia o innervation: tibial division of the sciatic nerve (n.

ischiadicus) o movement: extension of thigh, flexion of crus o most medial muscle of posterior compartment o long tendon distally o seems to be fused with long head of m. biceps femoris

- m. semimembranosus o o. ischial tuberosity o i. posterior part of medial condyle of tibia o innervation: tibial division of the sciatic nerve (n.

ischiadicus) o movement: extension of thigh, flexion of crus o tendon very prominent, semimembranous appearance as

name suggests - m. biceps femoris

o o. long head: ischial tuberosity o o. short head: linea aspera and (pectineal line) o i. lateral side of head of fibula

split into two by fibular collateral ligament (see lower figure)

o innervation: long head: tibial division of the sciatic nerve (n.

ischiadicus) short head: common fibular division of sciatic nerve

o movement: flexion and lateral rotation additional structures: - adductor canal

o also called subsartorial canal, hunter canal bordero s:

y: m. vastus medialis

r longus o

femoral triangle

tendon form an arch

o acc

rve

o ided to the popliteal fossa, where they turn into popliteal vessels

anteriorl laterally: m. vastus medialis medially: m. sartorius posteriorly: m. adducto

longitudinal extensions: from the apex of the

(cross-over of m. sartorius and m. adductor longus) adductor hiatus two parts of the like structure at the insertion site of adductor part (medial lip of linea aspera) and hamstring part (adductor tubercle) leaving an opening between them: the adductor hiatus ommodates:

femoral artery femoral vein saphenous ne n. vastus medialis

femoral vessels are gu


4 Temmesfeld '06

-

orly: inguinal ligament

sas major and m. iliacus)

o fem a ts base riorly

- partment

laterlly: m. biceps femoris tendon nd tendon of m. semitendinosus (which is more

erally: lateral head of m. gastrocnemius

meous keratinizing epithelium, epidermis) o

essels: lar anastomosis

icular branches

• p teal vein

c nerve (n. ischiadicus) branches at superior aspect of popliteal fossa

laterally een tibial and common fibular nerve

- all mus

- thigh: see pelvic girdle and adjacent structures

superficial)

o rm serinus, because the attachment sites of these three tendons resembles the

-

femoral triangle o borders:

superi medially: m. adductor longus laterally: m. sartorius floor of femoral triangle

• m. iliopsosas (m. psoor l nerve and vessels enter triangle superiorly at i

o femoral nerve and vessels exit it at the apex of the triangle infepopliteal fossa o fat filled como borders:

supero superomedially: m. semimembranosus a

lateral) inferolat

inferomedially: medial head of m. gastrocnemius posteriorly: popliteal fascia and skin (stratified sqa

contents: blood v

• form genicu• popliteal artery, with perpend

o superior lateral genicular artery o superior medial genicular artery o middle medial genicular artery o inferior lateral genicular artery o inferior medial genicular artery o po li

nerves: • sciati• tibial nerve, medially • common fibular nerve,• sural nerve, communication betwcles acting on the hip joint and their respective movements

o learn figure 5.55 p. 681, “Moore” all other remarkable structures of the

- pes anserinus (geese’s foot) o tendons of (from deep to

m. semitendinosus m. gracilis m. sartorius

fo the pes anshape and structure of a geese’s foot


5 Temmesfeld '06

lower limb crus: bones: os femur, os tibia, os fibula, os patella, tarsal bones (os talus, os calcaneus, os naviculare, os cuboideum, os cuneiforme laterale, os cuneiforme intermediale, os cuneiforme mediale) joints: proximal tibiofibular joint, distal tibiofibular joint, ankle joint (articulatio talocruralis) joints: joint: proximal tibiofibular - involved bones: os tibia, os fibula - type of joint: plane joint - movement: gliding and sliding movements - articular surfaces:

o facet of fibular head o facet of lateral tibial condyle

- ligaments: o anterior ligament of fibular head o posterior ligament if fibular head

- popliteus bursa o may communicate with synovial capsule of knee joint

joint: distal tibiofibular - involved bones: os tibia, os fibula - type of joint:

o fibrous syndesmosis, at anterior inferior tibiofibular ligament o plane joint, at posterior inferior tibiofibular ligament

- movement: gliding and sliding movement - articular surfaces:

o facet of the inferior end of the fibula rough triangular surface

o facet of the inferior end of the tibia, lateral - ligaments:

o interosseous membrane also called interosseous tibiofibular ligament between the shafts of the two bones

o anterior inferior tibiofibular ligament o posterior inferior tibiofibular ligament o transverse tibiofibular ligament

essential for stability of ankle joint medial malleolus (tibia) lateral malleolus (fibula)

joint: ankle joint, articulatio talocruralis - involved bones: os tibia, os fibula, os talus - type of joint: hinge-type of synovial joint - movements:

o dorsiflexion (dorsal flexion) produced by the muscles of anterior compartment of the crus

o plantar flexion produced by the muscles of the posterior compartment of the crus

o inversion also called tarsal suppination, medial abduction inferior ankle joint is involved only

o eversion also called tarsal pronation, lateral abduction inferior ankle joint is involved only

- articular surfaces:

anatomy, 2nd sct, crus e.b.: Temmesfeld ‚06

1 Temmesfeld '06

o tibia and fibular form a mortise (Falz, Fuge) o roof of the malleolar mortise:

inferior facet of tibia superior facet of talus

o medial wall of the malleolar mortise: medial malleolus medial surface of the talus

- ligaments: o lateral ligament of the ankle

form sort of inverse T structure reinforce joint capsule collateral compound ligament, composed of

1. anterior talofibular ligament o lateral malleolus (fibula) o neck of talus

2. posterior talofibular ligament o malleolar fossa o lateral tubercle of talus o runs horizontally (transverse plane) o fairly strong

1. calcaneofibular ligament o tip of the lateral malleolus o lateral surface of the calcaneus o runs somewhat vertically

o medial ligaments of the ankle rather strong also called deltoid ligament composed of four fused ligaments

1. anterior tibiotalar ligament 2. tibionavicular ligament 3. tibiocalcalcaneal ligament 4. posterior tibiotalar ligament

muscles: --- anterior compartment--- - m. tibialis anterior

o o. lateral condyle and superior half of lateral surface and interosseous membrane of tibia o i. medial and inferior surface of os cuneiform medialis and base of 1st metatarsal o innervation: deep fibular nerve o movement: dorsiflexion and inversion of foot o most prominent muscle with its belly lateral to the medial facet of the tibia

- m. extensor digitorum longus o o. lateral condyle of tibia and superior part of medial surface of fibula o i. middle and distal phalanges of lateral four digits o innervation: deep fibular nerve o movement: dorsiflexion and extension of digits 2,3,4,5 o tendon splits into four at retinaculum musculorum inferior

- m. extensor hallucis longus o o. middle part of anterior surface of fibula and interosseous membrane o i. dorsal aspect of the phalanx hallucis distalis o innervation: deep fibular nerve o movement: extension of hallux and dorsiflexion of ankle o at tendinous part of m. tibialis anterior: m. extensor hallucis longus is in between m. tibialis

anterior and tendinous part of m. extensor digitorum longus - m. fibularis tertius

o o. inferior third of anterior surface of fibular o i. dorsum of base of 5th metatarsal bone o innervation: deep fibular nerve o movement: dorsiflexion of ankle and inversion of foot


2 Temmesfeld '06

o the muscle is continuous with the m. extensor digitorum longus, however at the level of the retinaculum musculorum extensorum inferior under the vagina tendium musculi extensoris digitorum pedis longi it splits into two and the tendon of m. fibularis tertius attaches to the base of the 5th metatarsal bone

o also acts as an inversor --- lateral compartment, evetor compartment--- - m. fibularis longus

o o. head and superior two thirds of fibula o i. os cuneiforme medialis and base of 1st metatarsal bone o innervation: superficial fibular nerve o movement: eversion of foot, also called tarsal pronation or lateral abduction o can be found when following the tendon of m. biceps femoris over the head of the fibula o helps to prevent “ankle twist”

- m. fibularis brevis o o. inferior two thirds of lateral surface of fibula o i. dorsal surface of tuberosity (lateral side of base of 5th metatarsal) o innervation: superficial fibular nerve o movement: eversion of foot, also called tarsal pronation or lateral abduction)

--- posterior compartment, superficial--- - m. triceps surae

o composed of tow independent muscels o m. gastrocnemius

o. lateral head: lateral aspect of lateral condyle of femur o. medial head: medial aspect of medial condyle of femur i. posterior surface of os calcaneus via calcaneal tendon (Achilles tendon) innervation: tibial nerve movement: plantar flexion during extension of knee, raises heel during walking

o m. soleus o. fibular:caput, facies posterior, margo

posterior of fibula, o. tibial: facies posterior of tibia, soleal

line of tibia, arcus tendinous between fibula and tibia

i. posterior surface of os calcaneus via calcaneal tendon (Achilles tendon)

innervation: tibial nerve movement: plantar flexion

- m. plantaris o o. inferior end of lateral supracandylar line

of femur o i. posterior surface of os calcaneus via

calcaneal tendon (Achilles tendon) o innervation: tibial nerve o movement: weak assists in plantar flexion o very small muscle belly o looks like m. palmaris longus in upper limb,

just there is no aponeurosis --- posterior compartment, deep--- - m. popliteus

o o. lateral surface of lateral condyle of femur o i. posterior surface of fibula, superior to

soleal line o innervation: tibial nerve, L4, L5, S1 o movement: unlocking knee by rotating

femur about 5° on fixed tibia - m. flexor hallucis longus


3 Temmesfeld '06

o o. inferior two thirds of posterior surface of fibula o i. base of phalanx hallucis distalis o innervation: tibial nerve, S2, S3 o movement: flexion of hallux at all joints o can be found inferior to origin site of m. soleus

- m. flexor digitorum longus o o. medial aspect of posterior surface tibia, inferior to soleal line o i. base of distal phalanges of digits 2,3,4,5 o innervation: tibial nerve, S2, S3 o movement: flexion of toes, plantarflexion

- m. tibialis posterior o o. interosseous membrane, posterior surface of tibia and fibula o i. tuberosity of

os naviculare, os cuneiforme lateralis, os cuboid, bases of metatarsals 2,3,4

o innervation: tibial nerve, L4, L5 o movement: plantarflexion and inversion of foot (also called suppination, medial abduction)

additional structures: - intermuscular septa

o anterior intermuscular septum & posterior intermuscular septum o both of the line the lateral compartment

- superior extensor retinaculum o deep fascia passing from the fibula to the tibia, superiorly to the malleoli

- inferior extensor retinaculum o deep fascia passing anteriosuperior surface of the calcaneus and forming a loop over the

tendons of m. fibularis tertius and m. extensor digitorum longus o has a Y-shape

- superior fibular retinaculum o between lateral malleolus (fibula) and inferioroposteriorly to posterior articular facet of

calcaneal bone o accommodates

tendon of m. fibularis longus tendon of m. fibularis brevis

- inferior fibular retinaculum o intraosseous retinaculum in calcaneal bone o accommodates

tendon of m. fibularis longus tendon of m. fibularis brevis


4 Temmesfeld '06

lower limb pes: bones: os tibia, os fibula, tarsal bones (os talus, os calcaneus, os naviculare, os cuboideum, os cuneiforme laterale, os cuneiforme intermediale, os cuneiforme mediale), ossa metatarsals, ossa phalanges tali joints: - subtalar joint (talocalcaneal joint), - transverse tarsal joint (calcaneocuboid and

calcaneonavicular joints) - intertarsal joints

o cuboidonavicular joint o cuboidocuneiforme lateralis joint o naviculocuneiforme lateral, intermedialis and

medialis o intercuneiform joints o tarsometatarsal joints o intermetatarsal joints

- metatarsophalangeal joint - interphalangeal joint joints: joint: subtalar joint - involved bones: os talus, os calcaneus - type of joint: plane type of synovial joint - movements: inversion and eversion - articular surfaces:

o inferior surface of body of talus (facies articularis calcaneo posterior)

o superior surface of calcaneus (facies articularis talaris posterior)

- joint capsule: o fibrous outer layer of joint capsule

- ligaments: o medial talocalcaneal ligament o posterior talocalcaneal ligament o lateral talocalcaneal ligament o interosseous talocalcaneal ligament

lies within the tarsal sinus joint: talocalcaneonavicular joint - involved bones: os talus, os calcaneus, os naviculare - type of joint: synovial joint, spheroid (ball and socket) type of joint - movements: gliding and rotation

o inversion and eversion of foot -> circumduction

- articular surfaces: o head of talus o os calcaneus o os naviculare

- joint capsule: o incomplete enclosement

- ligaments: plantar calcaneonavicular

ligament also called spring ligament

anatomy, 2nd sct, pes e.b.: Temmesfeld ‚06

1 Temmesfeld '06

tow bands joint: calcaneocuboid joint - involved bones: os calcaneus, os cuboid - type of joint: plane type of synovial joint - movements: inversion and eversion of foot - articular surfaces:

o anterior end of os calcaneus o posterior surface of os cuboid

- joint capsule: o fibrous outer layer of joint capsule

- ligaments: o dorsal calcaneocuboid ligament o plantar calcaneocuboid ligament

also called short plantar ligament joint: cuneonavicular joint - involved bones: os cuneiforme lateralis, intermedialis and medialis - type of joint: plane type of synovial joint - movements: gliding and sliding movements - articular surfaces:

o anterior surface of os naviculare o base of ossa cuneiformes

- joint capsule: o common joint capsule for all the three joints

- ligaments: o dorsal cuneinavicular ligament o plantar cuneinavicular ligament

joint: tarsometatarsal joint and intermetatarsal joints - involved bones: os cuboid, ossa cuneiforme lateralis, intermedialis and medialis, ossa metatarsi - type of joint: plane type of synovial joint - movements: gliding and sliding movments - articular surfaces:

o anterior aspect of os cuboid and ossa cuneiforme o base of metatarsal bones

- joint capsule o separate joint capsules

- ligaments: o four plantar metatarsal ligaments

connect bases of metatarsal bones o dorsal tarsometatarsal ligaments o plantar tarsometatarsal ligaments o deep transverse metatarsal ligaments

joint: metatarsophalangeal joints - involved bones: ossa metatarsi, ossa tarsi phalangealis - type of joint: condyloid (spheroid joints) - movements: flexion, extension, abduction, adduction (circumduction) - articular surfaces:

o heads of metatarsal bones o bases of phalanges proximales

- joint capsule: o separate joint capsule for each joint

- ligaments: o collateral ligaments o plantar ligaments

joint: interphalangeal joint - involved bones: ossa phalangeales


2 Temmesfeld '06

- type of joint: hinge type of synovial joint - movements: flexion, extension - articular surfaces:

o distal end of proximal phalanx with base of distal phalanges, respectively - joint capsule:

o separate joint capsule for each joint - ligaments:

o collateral ligaments o plantar ligaments

muscles: --- Superficial anterior layer I --- - m. abductor hallucis

o o. medial tubercle of tuberosity of os calcaneus o i. medial side of base of 1st proximal phalanx o innervation: medial plantar nerve o movement: abduction hallux

- m. flexor digitorum brevis o o. medial tubercle of tuberosity of os calcaneus o i. middle phalanges of digits 2,3,4,5 o innervation: medial plantar nerve o movement: flexion of toes

- m. abductor digiti minimi o o. lateral tubercle of tuberosity of os calcaneus o i. lateral side of 5th proximal phalanx o innervation: medial plantar nerve o movement: abduction of digitus minimus

--- Superficial anterior layer II --- - m. quadratus plantae

o o. medial surface of plantar surface of os calcaneus o i. posterolateral side of tendon of m. flexor digitorum longus o innervation: lateral plantar nerve o movement: assists m. flexor digitorum longus in flexion o can be found, just beneath the plantar aponeurosis and the m. flexor digitorum brevis, on the

posterior aspect - m. lumbricales

o o. tendons of m. flexor digitorum longus o i. medial aspect of phalangeal bones of digits 2,3,4,5 o innervation:

m. lumbricalis for the 2nd digit: medial plantar nerve m. lumbricalis for digits 3,4,5: later plantar nerve

o can be founds omewhere between the branches of tendon of m. flexor digitorum longus --- Deep anterior layer I --- - m. flexor hallucis brevis

o o. plantar surfaces of os cuboid and ossa cuneiforme intermedialis and lateralis o i. medial and lateral side of base of proximal phalanx hallucis o innervation: medial planter nerve o movement: flexion of hallux o the tendon splits into two , prior “arriving” at the proximal phalanx

- m. adductor hallucis o o. transverse head: plantar ligaments of metatarsophalangeal joints (5,4,3,2) o o. oblique head: bases of ossa metatarsales 2,3,4 o i. lateral side of base of proximal phalanx hallucis o innervation: deep branch of lateral plantar nerve o movement: adduct 1st digit and assists maintaining the transverse arch of the foot

- m. flexor digiti minimi brevis o o. base of 5th metatarsal bone


3 Temmesfeld '06

o i. base of proximal phalanx of 5th toe o innervation: superficial branch lateral plantar nerve o movement: flexion digitus minimus

--- Deep anterior layer II--- - m. interosseosus plantaris

o three muscles between 5,4 metatarsals between 4,3 metatarsals between 3,2 metatarsals

o o. bases and medial sides of metatarsals 3-5 o i. medial side of bases of proximal phalanges of digits 5,4,3 o innervation: lateral plantar nerve o movement: adduction of digits 4,3,2 (PAD – Plantar ADduction)

- m. interosseous dorsalis o four muscles

between 5,4 metatarsals between 4,3 metatarsals between 3,2 metatarsals between 2,1 metatarsals

o o. adjacent sides of metatarsal bones o i. medial side of proximal phalanx of digits 2 and lateral sides of proximal phalanges of digits

3,4,5, o innervation: lateral plantar nerve o movement: abduction of digits 2,3,4,5 (DAB – Dorsal ABduction)

--- Dorsal muscles--- - m. extensor digitorum brevis

o o. os calcaneus, floor of tarsal sinus o i. lateral surfaces of the tendons of m. extensor digitorum longus at the proximal phalanx o innervation: deep fibular nerve o movement: extension digits 2,3,4,5

- m. extensor hallucis brevis o o. os calcaneus, floor of tarsal sinus, common with origin of m. extensor digitorum brevis o i. surface of the tendon of m. extensor hallucis longus at the proximal phalanx o innervation: deep fibular nerve o movement: extension of hallux

additional structures: - tarsal sinus

o the cavity between os talus and calcaneus - arches of foot

o longitudinal arch of the foot medial longitudinal arch of the foot

• higher and more important • involved bones

o os calcaneus o caput tali o os naviculare o ossa cuneiformes o three ossa metatarsals (1,2,3)

lateral longitudinal arch of the foot • involved bones

o os calcaneus o os cuboid o ossa metatarsals (4,5)

passively strengthened by • plantar aponeurosis • long plantar ligament


4 Temmesfeld '06

• short plantar ligament (plantar calcaneocuboid ligament) • spring ligament (plantar calcaneonavicular ligament)

actively strengthened by • intrinsic plantar muscles

o m. abductor digiti minimi o m. flexor digitorum brevis o m. abductor hallucis o m. quadratus plantae

• m. flexor hallucis longus • m. tibialis posterior • m. tibialis anterior • m. fibularis longus

o transverse arch of foot involved bones

• os cuboid • ossa cuneiformes • bases of ossa metatarsals

- synovial sheath around muscular tendons in foot o four synovial sheaths around muscular tendons o mainly at the passage of the respective tendons below the extensor retinaculum


5 Temmesfeld '06

blood_vessels: - internal iliac artery (all branches and vessels will remain in the pelvic cavitiy)

o relevant posterior branches superior gluteal artery inferior gluteal artery internal pudendal artery (terminal branch)

o relevant anterior branches obturator artery

• passes through the obturator canal, together with o obturator nerve o obturator vein

- external iliac artery o leaves the pelvic cavity via the femoral sheath,together with

femoral vein femoral branch of genitofemoral nerve

o relevant medial branches inferior epigastric artery superior epigastric artery superficial external pudendal artery deep external pudendal artery medial circumflex femoral artery further down… descending genicular artery

• articular branch of descending genicular artery • saphenous branch of descending articular artery

o relevant lateral branches deep circumflex iliac artery superficial circumflex iliac artery lateral circumflex iliac artery

• asecending branch of the lateral circumflex iliac artery • descending branch of the lateral circumflex iliac artery

deep artery of thigh • perforating branches

- popliteal artery o changes name from femoral artery after passing though the adductor hiatus o relevant medial branches

superior medial genicular artery middle genicular artery inferior medial genicular artery

o relevant lateral branches superior lateral genicular artery inferior lateral genicular artery

o splits into two inferior to popliteal fossa anterior tibial artery

• medial malleolar artery • lateral malleolar artery

o communication with perforating branch of fibular artery • dorsal artery of foot

o lateral tarsal artery forms dorsal arch

o medial tarsal artery posterior tibial artery

• fibular artery (runs on the posterior surface of the interosseous membrane) o perforating branch (joins the lateral malleolar artery on the anterior side) o supplies lateral malleolus

• lateral plantar artery o communal plantae tarsal arteries o communal plantar digital areteries

perforating branches o proper plantar digital arteries

• medial plantar artery o communicates with lateral plantar artery medial to the halluc

- patellar anastomosis o contributors

descending branch from lateral circumflex iliac artery superior lateral genicular artery superior medial genicular artery inferior lateral genicular artery inferior medial genicular artery posterior tibial recurrent artery

Temmesfeld '06

nerves: - lumbar plexus, terminal branches and contribuations

o T12, L1 subcostal nerve iliohypogastric nerve ilioingiuneal nerve

o L1, L2 genotiofemoral nerve

o L2, L3 lateral cutaneous nerve of thigh muscular branches to posas and iliacus muscle (iliopsoas) femoral nerve, medial branch turns into saphenous nerve at the level of the

knee o L2, L3, L4

accessory obturator nerve (not important) obturator nerve

o L4 lumbosacral trunk

- sacral plexus, terminal branches and contribuations o L4, L5, S1, S2 (anterior divisions)

superior gluteal nerve inferior gluteal nerve nerve to m. piriformis sciatic nerve (nervus ischiadicum)

• tibial nerve perforating cutaneous nerve

o L4, L5, S1, S2, S3 (posterior divisions) sciatic nerve (nervus ischiadicum)

• common fibular nerve (peroneal nerve) nerve to m. quadratus femoris nerve to m. obturator internus posterior cutaneous nerve of thigh

• posterior contribuation pudendal nerve

- innervation of muscles in gluteal region

o inferior gluteal nerve (L4, L5, S1, S2 (anterior division)) m. gluteus maximus

o superior gluteal nerve (L4, L5, S1, S2 (anterior division)) m. gluteus medius m. gluteus minimus m. tensor fascia lata

o n. m. pitriformis (L4, L5, S1, S2 (anterior division)) m. prirfromis

o n. m. obturator internus (L4, L5, S1, S2, S3 (posterior divisions)) m. obturator internus m. obturator externus m. gemellus superior m. gemellus inferior

o femoral nerve m. pectineus m. iliacus

o lumbar nerve m. psosas minor m. iliacus

- innervation of muscles of thigh

o anterior compartment (extensor compartment)

Temmesfeld '06

femoral nerve • m. pectineus • m. quadriceps femoris

o m. vastus medialis o m. vastus intermedialis o m. vastus lateralis o m. rectus femoris

• m. sartorius o adductor compartment (medial compartment)

obturator nerve (L2, L3, L4, posterior division) • m. adductor longus • m. adductor magnus

o adductor part o !!! hamstring part (also called m. adductor minimus is innervated by

the tibial part of sciatic nerve) • m. adductor brevis • m. gracilis • m. obturator externus

tibial part of sciatic nerve (sacral plexus) • m. adductor magnus

o hamstring part (m. adductor minimus) o posterior compartment (hamstring compartment)

tibial part of sciatic nerve (anterior division of sacral plexus) • m. semitendinosus • m. semimemnranosus • m. biceps femoris

o long head fibular part of sciatic nerve (posteriorn division of sacral plexus)

• m. biceps femoris o short head

- innervation of crus

o anterior compartment of crus deep fibular nerve (from the sciatic nerve -> common fibular nerve)

• m. tibialis anterior • m. extensor digitorum longus • m. extensor hallucis longus • m. fibularis tertius

o lateral compartment superficial fibular nerve

• m. fibularis longus • m. fibularis brevis

o superficial posterior compartment of crus tibial nerve

• m. triceps surae • m. plantaris

o deep posterior compartment of crus tibial nerve

• m. popliteus • m. flexor hallucis longus • m. flexor digitorum longus • m. tibialis posterior

- innervation of the foot

o superficial plantar compartment I medial plantar nerve

• m. abductor hallucis • m. flexor digitorum brevis

Temmesfeld '06

• m. abductor digiti minimi o superificial plantar compartment II

lateral plantar nerve • m. quadratus plantae • m. lumbricales

o m. lumbricali for digits 3,4,5 medial plantar nerve

• m. lumbricales o m. lumbricali for digit 2

o deep plantar compartment I medial plantar nerve

• m. flexor hallucis brevis lateral plantar nerve

• m. flexor digiti minimi brevis • m. adductor hallucis (the muscle with the tow heads)

o deep plantar compartment II lateral plantar nerve

• m. interosseous plantaris • m. interosseous dorsalis

o dorsal compartment deep fibular nerve (from common fibular nerve -> sciatic nerve)

• m. extensor digitorum brevis • m. extensor hallucis brevis

Temmesfeld '06

skull general: - bones:

o pneumatized contains air spaces or sini os frontale os sphenoid os ethmoidale os temporale

o non-pneumatized os occipitale os parietale maxilla vomer mandibula os palatine os interparietale

• also called os incae o accessory bones

inferior nasal concha zygomatic nasal lacrimal bones

- cranium

o neurocranium roof

• called calvaria • formed by intramembraneous ossification

base • called basicranium • partially formed by endochondral ossification

bones • frontale, ethmoid, sphenoid, occipital • temporal, parietal

o occur in pairs, i.e. they are bilateral o viscercranium

sparated from neurocramuim by orbitomeatal line • from inferior margin of orbit to external acoustic meatus

- sutures o 1° cartliagenous joint o also called synchondroses o hyaline cartilage can be found between bones o pterion o sutural bone o sutures of cranium

coronal • between frontal and parietal bones

lambdoid • between parietal and occipital bones

frontal • between frontal bones of newborns • in some adults:

o remmant may remain o called metopic suture o located at midline of gabella

intermaxiallary

anatomy, 3rd SCT, skull e.b.: Temmesfeld ‚06

1 Temmesfeld '06

• also called median palatine suture • between two maxillary bones • unclosure results in cleft lip

interpalatine • between two palatine bones

transverse palatine suture • between palatine process of maxialla and actual palatine bone

saggital • between two parietal bones

sqamous suture • between temporal and parietal bones

major bones - frontal bone

o parts squamous part nasal part orbital part

o margins parietal margin supra-orbital margin

o facies temporal facet

o processes zygomatic process

• lateral to supra-orbital margin o notches (incisurae)

supra-orbital incisura • can be a foramen in some individuals

incisura ethmoidalis • attachment site of ethmoid bone

o arci arcus supercilliaris

o spines nasal spine

o tubercles frontal tubercle

• superior to arcus supercilliaris o foramina

anterior thmoidal formanen • between incisura ehtmoidale and orbital part

o other gabella

• depression between two arci supercilliarae - temporal bone

o lateral view partes, anterior to posterior

• pars squamosa • pars typanica • pars petrosa

fissurae • fissura petrosquamosa

o between pars squamosa and pars petrosa • fissura petrotympatica

o between petrosus and tympanic part • fissura tympanomastoidea

o on posterior side of external acoustic meatus


2 Temmesfeld '06

processes • zygomatic process

o large anteriorly pointing process • mastoid process

o postero-inferior to fissure tympanomastoidea • styloid process

o straight inferior to external acoustic meatus o vagina processi styloid

anterior to styloid process itself margins

• margo parietalis • margo spenoidalis

o faced anteriorly • margo occipitalis

tuberculi • tuberculum articulare

o located on inferior aspect of zygomatic process o contributes to temporomandibular joint

fossae • mandibular fossa

o located on inferoposterior aspect of zygomatic process meati

• external acoutstic meatus incisurae (notches)

• incisura parietalis • incisura mstoidiea

o located on posteroinderior side of mastoid process foramina

• foramen mastoideum o can be located anywhere on mastoid process

o medial view pori

• porus acoutsticus internus o the internal opening of ear canal on the temporal bone

fissurae processes

• processus intrajugularis o posterior to styloid proces

tuberculi fossae

• fossa subarcuata o superior to porus acouticus internus

margins • margo superior partis petrosae

meati incisurae, notches

• incisura pareitalis foramina aperturae

• aperture externa aquaeductus vestibule o opening for the canals of the vistubar organ

sulci, grooves • suclcus sinus sgmoidei

o located on anterior aspect of depression formed by mastoid process • sulcus arterialis

eminences • emenentia arcurata

other • apex partis petrosae • trigeminal imression


3 Temmesfeld '06

o the medial part of the rim of the pyramide o posteromedial to arcuate eminence

o inferior view processes

• processa intrajugularis o on anterioromedial aspect of jugular fossa

incisurae • incisura mastoidea

o posterioromedial to mastoid process sulci

• sulcus arteria occipitalis o between mastoid process and margo occipitalis

foramina • foramen stylomastoideum

o posterior and directly adjacent to styloid process other

• canalis musculotubaris o anterior to canalis caroticus

• apex partis petrosae • canalis caroticus

o mostprominent opening on inferior aspect of temporal bone • fossula petrosae

o between canalis caroticus and jugular fossa - parietal bone

o lateral view tuberosity

• parietal tuberosity o in the middle of parietal boen, hardly visible

margines • margo saggitalis

o “articulates” with other parietal bone o forms the saggital suture

• margo squamosus o on inferior aspect

foramina • foramen parietale

o on superior portion of bone o posterior to saggital margin

other • linea temporalis superior

o forms a secotr of a circle o larger diameter

• line temproalis inferior o forms a sector of a circle o smaller diameter

o medial view sulci

• sulcus arteria meningae mediae o forms well visible anastomosing and tree like ascending network of grooves

o inferior view - occipital bone

o inferior view partes

• pars lateralis o lateral part of foramen magnus o despite of name this part is located rather medially with regard to the whole bone

• pars basalis o most anterior sheet-like protrusion of bone


4 Temmesfeld '06

processes • process jugularis

fossae • fossa condylaris

o lateral to foramen magnum margines

• margo mastoideus foramina

• foramen magnum o the lrgest opening of the skull

other • squama occipitalis • linea nucha suprema

o inferior to squama occipitalis • linea nuch superior

o inferior to linea nuch suprema o inferior the surface of the bone gets a bit rough

• canalis hypoglossi o located on inner side of bone o superior to foramen magnum

• canalis condylaris o continuation of fossa condylaris o superior to canalis hypoglossi o medial to process jugularis

• crista occipitalis externa o runs perpendicular to muchal lines o from linea nucha suprema down to foramen magnum o located in mid-saggital plane

• protuberentia occipitalis externa o at tip of crist occipitalis externa

o ventral view partes fissurae processes tuberculi

• tuberculum jugulare o superior to hypoglossal canal o located roughly lateral to the middle of the formaen magnum

fossae • fossa cerebalis

o one on each side, right and left o for cerebrum (brain) o superior fossa of the two big occipital fossae

• fossa cerebellaris o one on each side, right and left o for cerebellum (little brain) o inferior fossa of the two big occipital fossae

margines • margo lambdoideus

o superior border of bone o forms lambdoid suture

• margo mastoideus o forms suture with temporal bone

incisurae sulci foramina other

• eminentia cruriformis o parallel to sulcus sinus transversi

• canalis condylaris


5 Temmesfeld '06

o medial to process jugularis o superiolateral to canalis hypoglossi

• sulcus sinus sigmoidi o continuation of sulcus sinus sigmoidi in temporal bone o posterior to process jugularis

• crista occipitalis interna o runs in mid-saggital plane o inferiorly to protuberentia occipitalis interna: o separates the two aspects (right and left) of the foosa cerebralis and fossa

cerebellaris • sulcus sinus saggitalis superioris

o counterpart of crist occipitalis interna superior to protuberentia occipitalis interna o separates the two aspects (right and left) of the foosa cerebralis and fossa

cerebellaris • sulcus sinus transveri

o between fossa cerebralis and fossa cerebellaris • protuberentia occipitalis interna

o intersection of sulcus sinus trnasversi and crist occipitalis interna inferiorly and sulcus sinus saggitalis superioris superiorly

- sphenoid bone

o ventral view partes fissurae

• fissure orbitalis superior o between geater and lesser wing of sphenoid bone o part of the orbit

processes • pterygoid process

o plates run in saggital plane (parallel to crista sphenoidalis) o lateral plate

thicker than medial plate o incisura pterygoidea o medial plate

thinner hamulus pterygoideus

inferiormost tip of medialm plate of pterygoid process tuberculi fossae margines

• margo zygomaticus o where spenboid bone “articulates” with zygomatic bone o located in orbit

incisurae sulci foramina

• foramen rotundum o inferior to facies orbitalis o still cannot be seen from external cranial base o the only formanen, which can be seen from anterior view of bone

other • crista sphenoidalis

o in mid-saggital plane o anterior pointing protrusion on body of the bone

• ala minor • ala major

o facies orbitalis contributes to orbit

o facies temporalis “the other side” of facies orbitalis


6 Temmesfeld '06

• crista infratemporalis o view of external cranial base: o at the anterior tip of the temporal bone

• spina sphenoidalis o in external cranial base: o at posterior tip of sphenoid bone

• canalis pterygoideus o at attachmet site of medial plate of pterygoid process

• facies maxillaris o between canalis pterygoideus and facies orbitalis

• apertura sinus spenoidalis o leads to spenoidal sinus

o dorsal view partes fissurae

• superior orbital fissure o between tow alae of sphenoid

processes • posterior clinoid process

o two lateral tips of dorsum sellae, due to its curvature in coronal plane • anterior clinoid process

o at posteromedial aspect of ala minor of sphenoid o

tuberculi • tuberculum sellae

o in mid-saggital plane on anterior portion of sella turcica fossae

• scaphoid fossa o at the base of attachment of pterygoid process between lateral and medial plate

• pterygoid fossa o spanned by the lateral plate of the pterygoid process

• hypophyseal fossa o the fossa formed by the sella turcica

margines • squamous margin

o posterior margin of cerebral facet incisurae sulci

• sulcus arterialis o at cerebral (inner) facet

• sulcus tubae auditoriae o superomedial to spina sphenoidalis

• sulcus caroticus o lateral to dorsum sellae, but directly adjacent

foramina • formane ovale

o posterolateral to foramen rotundum o quite large

• formane spinosum o posterolateral to formane ovale

other • dorsum sellae

o the posteriormost portion of the Turkish saddle • facies cerebralis of ala major

o on posterior side there is only one counterfacet to the two facet of ala major on the anterior side (facies orbitalis and facies temporalis)

• pterygoid canal o passes through sphemoid bone anteriorly

• rostrum sphemoidale


7 Temmesfeld '06

o spine like process in mid-saggital plane between the medial plates of the ptergoid process

• iugum sphenoidale o groove like structre anterior to hypophyseal fossa

• canalis opticus o on inner curvature of anterior clinoid process

• sphenoid emissary foramen o medial to formane ovale o inconstant

- maxillary bone

o lateral view partes fissurae processes

• frontal process o forms medial border of orbital fossa

• alveolar process o attachment site for teeth

• zygomatic process tuberculi

• tuber maxillare o on posteriormost aspect of alveolar process

fossae • fossa canina

o anterior to zygomatic process, inferior to infra-orbital foramen margines

• margo infraorbitalis o superior to zygomatic process

incisurae • incisura nasalis

o superior to anterior nasal spine • incisura lacrimalis

o on descending posterior margin of frotnal process sulci

• sulcus infraorbitalis foramina

• foramen infra-orbitale o anterior to zygomatic process

• foramina alveolaria o posterior to zygomatic process

other • juga alveoli

o the depression of the alveolar process between each tooth o superior view

partes fissurae processes tuberculi fossae margines incisurae sulci foramina

• foramina incisivi o immerdiately lateral to anterior nasal spine

other • sinus maxillaris

o connected to nasal cavity via maxillary hiatus o located on posteroinferior aspect of semilunar hiatus


8 Temmesfeld '06

• canalis nasolacrimalis o anteromedially to maxillary sinus

o inferior view partes fissurae processes tuberculi fossae margines incisurae sulci

• sulci palatini o medial to molar teeth

foramina other

• spina palatinae o somehere in between the sulci palatini

o medial view partes fissurae processes tuberculi fossae margines incisurae sulci foramina other

• crista conchalis o anterior attachment site for inferior nasal concha o recall: inferior nasal concha is mainly attached at the conchal crest of palatine bone

- mandible bone

o lateral view partes

• pars alveolaris fissurae processes

• condylar process o posterior

• coronoid process o anterior

tuberculi fossae margines incisurae

• incisura mandibulae o between coronoid and condylar processes

sulci foramina

• formamen mentale other

• caput mandibulae o head of condylar process

• fovea pterygoidea • ramus mandibulae • protuberentia mentalis

o anterior-inferiormost part of mandibula o medial view

partes


9 Temmesfeld '06

fissurae processes tuberculi fossae

• fossa digstrica o inferior to spina mentalis o formed by two mandibular bones

margines incisurae sulci

• sulcus mylohyoideus o runs anteroinferiorly to lingula mandibulae

foramina • foramen mandibulae

other • lingua mandibulae

o inferior to incisura mandibulae o accomodates foramen mandibulae

• linea mylohyoidea o inferior to torus mandibularis

• spina mentalis o on medialmost aspect of mandibula

• linea obliqua o continuation of coronoid process o runs anteroinferiorly


10 Temmesfeld '06

skull minor bones - ethmoidal bone

o cristae crista galii

• “the crest of the rooster” • visible in internal cranial base

o laminae, plates lamina orbitalis

• orbital plate • contribution to the orbital fossa

lamina perpendicularis • perpendicular plate • in the middle of the bone • contributes to nasal septum in its superior part

ciribrosa plate • perpendicular to crisgta galii

o foramina foramen crirobrosa

o bullae ehtmoidal bulla

• the largest ethmoidal cell • inferior to orbital plate

o processes uncinate process

• lateral to concha nasalis media o other

concha nasalis media • the posterior continuation of the perpendicular plate • lateral to perpendicular plate

ehtmoidal lybyrinth • comprised of ethmoidal cells

sinus ethmoidalis • visible from superior view • present holes in superior part orbital plate

ala cristae galii • anterior-inferior to crista galii

cribrifom plate • the extensions of alae crista galii

- nasal bone

o on nasal part o makes a smooth surface out of the nasal part

- vomer

o lateral view partes

• pars cuneiformis vomeris o « articulates » with palatine process of maxilla (more anteriorly) and palatine bone

(a bit more posteriorly) o contributes to ossal nasal septum antero-inferiorly

fissurae processes tuberculi fossae margines


1 Temmesfeld '06

incisurae sulci

• sulcus vomeris o bivalent on both sides of vomer

foramina other

• crista choanalis vomeris • alae vomeris

o on superior aspect of vomer o articulate with sphenoid bone

- concha nasalis inferior

o sits on crista conchalis o recall : superior concha is part of ethmoid bone

- lacrimar bone

o between orbital plate of ethmoid and … o frontal process of maxilla o fossa sacci lacrimalis

fossa of lacrimal sac o crista lacrimalis posterior

border lacrimal sac posteriorly anterior border: margo lacrimalis of maxialla (on frontal process)

- palatine bone

o medial view partes fissurae processes

• orbital process o superiormost structure of palatine bone

• sphenoid process o on superoposterior aspect

• pyramid process of palatine bone o inferoposteriormost strucutre of palatine bone

tuberculi fossae margines incisurae

• incisura sphenopalatina o between orbital process and sphenoidal process o contributes inferiorly to foramen sphenopalatinum

sulci foramina

• formane palatinum majus o anterior to pyramid process

other • perpendicular plate

o the main « body » of the bone o form medial view: medial portion faces nasal cavity, hence facies nasalis

• crista conchalis o inferiormost portion 0f perpendicular plate o faces into nsal cavity

• facies nasalis o faces into nasal cavity

• spina nasalis posterior o faces superioposteriorly

• horizontal plate o its edge (facies palatine) “articulates” with other palatine bone (palatine is a bivalent

bone)


2 Temmesfeld '06

• facies palatina o the strucuture which “articulates” with other palatine bone on the medial edge of the

horizontal plate o lateral view

partes fissurae processes tuberculi fossae margines incisurae sulci

• sulcus palatinus major o roughly in coronal plane o goes all the way up/down posterior to facies maxillaris

foramina other

• perpendicular plate o faces the maxillary bone, hence facies maxillaries

o dorsal view partes fissurae processes tuberculi fossae margines incisurae sulci foramina other

• facies palatine o faces to palatine process of maxillary bone

• posterior nasal spine o just before palatine bone “articulates” with other palatine bone

• crista nasalis o elevation anterior to posterior nasal spine

- zygomatic bone

o lateral view partes fissurae processes

• temporal process o “articulates” with zygomatic process of squamous part of temporal bone

• frontal process o contributes to superolateral aspect of orbit o “articulates” with frontal bone

tuberculi fossae margines

• margo infraorbitalis o medialmost process like structure

incisurae sulci foramina

• foramen zygomatico-orbitale o on lateral side o located in facies orbitalis

• foramen zygomatico-faciale o inferolateral to orbit


3 Temmesfeld '06

other • facies orbitalis

o contributes to lateral aspect of orbit • facies lateralis

o lateral facet • eminentia orbitalis

o between frontal and temporal process structures - temporal lines

o form oval like rounding o continuation of curvature spanned by

zygomatic process of temporal bone and zygomatic bone

- fontanellae

o anterior fontanella between two unjoined frontal bones two parietal bones in other words: the openend coronal suture

o posterior fontanella between occipital bone two parietal bones in other words: the opened lambdoid suture

- pterion o intersection of

parietal frontal occipital spenoidal bone

- jugular foramen o made up by tow notches

- tegmen tympani o roof of tympanic cavity o lateral to arcuate eminence

- porus acousticus internus o located inside the acoustic meatus o accommodates aperture of the vestibular aqueduct

- sphenopalatine foramen o formed by sphenopalatine notch of palatine bone and body of sphenoid o leads to pterygopalatine fossa

- pterygopalatine fossa o also called sphenopalatine fossa o inferior to sphenopalatine foramen

- trigeminal nerve o 5th cranial nerve o gives rise to … o ophthalmic nerve o maxillary nerve o mandibular nerve

- fascial nerve o 7th cranial nerve o fascila nerve in petrosal pyramide

enters pyramid through internal acoustic meatus of tympanic part of the temporal bone reaches anterior border of pyramide turns 90° laterally (genus)


4 Temmesfeld '06

gives branch: greater petrosal nerve dives down to base of pyramid reaches lateral border gives branch: cordotympanic nerve leaves cranial base via foramen stylomastoideum

- mandibular fossa o

- internal cranial base o anterior cranial base

floor: • anterior: frontal bone • posterior:

o lesser wing of sphenoid o ethmoid bone

posterior border: edge of the wing of sphenoid lateral border: frontal bone

o middle cranial base anterior border: lateral border: squamous part of temporal bone posterior border: petrose crest

o posterior cranial fossa anterior border:

• laterally: petrosal crest • middle: dorsum sellae, climus

lateral, posterior: occipital bone - sella turcica

o structures … o iugum sphenoid o climus o chiasmata groove o hypophyseal fossa o dorsum sellae

- filla olfactoria - inferior nasal meatus - spheno-ethmoid recess

o where - nasal septum

o superior part: perpendicular plate of ethmoid bone o inferior part: vomer o superior border:

anteriorly: nasal bone posteriorly: spheno-ethmoid recess

o lateral border: anteriorly: frontal process of maxilla above:

• nasal bone • lacrimar bone

a bit inferiorly: • frontal surface of maxilla

ethmoidal labyrinth medial plate of pterygoid process perpendicular plate of palatine bone

o inferior border: pallatine process of maxilla pallatine bone

o anterior border: anterior nasal spine o posterior border:

posterior nasal spine nasal crest of palatine bone

• the superior margin of the perpendicular plate


5 Temmesfeld '06

- infundibulum o located in ehtmoidal labyrinth

- middle nasal meatus - oral cavity

o anterior, lateral and superior border: alveolar process of maxilla o anterior and inferior border: alveolar process of mandibula o superior border:

palatine process of maxilla horizontal plate of palatine bone

- nasal cavity o anterior border: piriforme aperture o posterior border: choanae o superior border: body pf sphenoid bone o inderior border: palatine bone o pathway to nasal pharynx

through choana - temporal fossa

o accommodates temporal muscle and pterion o superior, posterior border:

superior temporal line inferior temporal line

o anterior border: zygomatic process of frontal bone zygomatic bone

o medial border facies temporalis of ala major of sphenoid pars squamosa of temporal bone

- infratemporal fossa o under infratemporal crest of sphenoid

runs parallely and medially to zygomatic arch o accommodates

maxillary artery and nerve venous maxillary plexus foramina ovale and spinosum

o anterior border: temporal surface of maxilla o medial border: pterygoid process of sphenoid o superior border:

infratemproal crest of sphenoid sphenoidal margin of temporal bone

o posterior border: mastoid process of temporal bone styloid process of temporal bone

o lateral border: ramus of mandibula o inferior border: body of mandibula

- orbital fossa o anterior border:

orbital part of frontal bone lesser wing of sphenoid bone

o medial border: frontal process of maxillary bone lacrimar bone orbital part of ethmoid bone (a bit superiorly)

o posterior border: orbital process of palatine lesser wing of sphenoid

o lateral border: anteriorly: zygomatic bone posteriorly: greater wing of sphenoid

- semilunar hiatus o between


6 Temmesfeld '06

uncinate process and … bulla

o leads to maxillary sinus - scaphoid fossa

o auditory tube also called tuba auditora, Eustachian tube between inner ear and pharynx

- para-nasal sini o sphenoidal sinus

connected to nasal cavity via aperture sinus sphenoidalis o frontal sinus

connected to nasal cavity via anterior ethmoidal cells more superiorly: frontonasal duct

o maxiallary sinus connected to nasal cavity via semilunar hiatus

• more detailed: via maxillary hiatus o the postero-inferior portion of the semilunar hiatus

o ehtmoidal cells largest cellum: ethmoidal bulla


7 Temmesfeld '06

skull cranial nerves - CN 01: olfactory nerve - CN 02: optic nerve - CN 03: oculomotor nerve CN 03 - CN 04: trochlear nerve - CN 05: trigeminal nerve

o branches: ophthalmic nerve, CN 05, I maxillary nerve, CN 05, II madibular nerve, CN 05, III

o motor root three branches

o sensory root one branch

- CN 06: abducent nerve - CN 07: facial nerve

o motor root o sensory root

- CN 08: vestibulocochlear nerve - CN 09: glossopharyngeal nerve - CN 10: vagus nerve

o motor root o sensory root

- CN 11: accessory nerve - CN12: hypoglossal nerve openings, interna land external cranial base ---scala anterior --- - cribriform plate

o CN 01, olfactory nerve o anterior ethmoidal nerve and vessels

- foramen caecum o emissary vein

---scala media --- - optic canal

o CN 02, optic nerve o ophthalmic artery

- superior orbital fissure o CN 03, oculomotor nerve o CN 04, trochlear nerve o CN 06, abducent nerve o CN 05, branch I, ophthalmic nerve o superior ophthalmic vein o internal carotid plexus o orbital branch of middle meningeal artery o recurrent branch of lacrimal artery

- foramen rotundum o CN 05, branch II, maxillary nerve

- formane ovale o CN 05, branch III, mandibular nerve o CN 05, branch III, branch, recurrent meningeal branch of mandibular nerve o accessory meningeal artery o emissary veins

- formane spinosum


1 Temmesfeld '06

o middle meningeal artery o meningeal branch of mandibular nerve

- emissaria sphenoidale o emissary vein

- petrosal foramen o CN 09, glossopharyngeal nerve, branch, lesser petrosal nerve, if not though f. lacerum

- foramen lacerum o CN 07, facial nerve, branch, greater petrosal nerve o CN 09, glossopharyngeal nerve, branch, lesser petrosal nerve o meningeal branch of ascending pharyngeal artery o emissary vein o internal carotid artery

- hiatus for greater petrosal nerve o CN 07, facial nerve, branch, greater petrosal nerve

- hiatus for lesser petrosal nerve o CN 09, glossopharyngeal nerve, branch, lesser petrosal nerve

---scala posterior --- - internal acoustic meatus

o CN 07, facial nerve o CN 08, vestibulocochlear nerve o labyrinthine artery

- aperture of vestibular aqueduct o endolymphatic duct and sac

- jugular foramen o anteriorly:

CN 09, glosso pharyngeal nerve CN 10, vagus nerve CN 11, accessory nerve ascending pharyngeal artery

o posteriory: internal jugular vein

- hypoglossal canal o CN 12, hypoglossal nerve o meningeal branch of ascending pharyngeal artery o emissary vein

- condylar canal o emissary vein o meningeal branch of occipital artery

- foramen magnum o medulla oblongata, Rückenmark o meninges o CN 09, accessory nerve, spinal part o vertebral arteries o anterior and posterior spinal arteries o meningeal branch of upper cervical nerves o cervical venous plexus

---external cranial base --- - pterygoid canal

o CN 07, facial nerve, greater petrosal nerve o depp petrosal nerve o vidian artery

- petrosquamous fissure o petrosquamous vein

- cochlear canaliculus o perilymphatic duct o emissary vein

- carotid canal o internal carotid artery


2 Temmesfeld '06

o internal carotid plexus o internal carotid venous plexus

- fossula petrosa o CN 09, glossopharyngeal nerve, sensory ganglion o CN 09, glossopharyngeal nerve, tympanic nerve o inferior tympanic artery

- tympanic canaliculus o CN 09, glossopharyngeal nerve, tympanic nerve o inferior tympanic branch of ascending pharyngeal artery

- mastoid canaliculus o auricular branch of vagus nerve

- tympanomastoid fissure o auricular branch of vagus nerve, exit

- stylomastoid foramen o CN 07, facial nerve o stylomastoid branch of posterior auricular artery

- canalis musculotubaris o auditory tube

also called Eustachian tube, pharyngotympanic tube o m. tensor tympani

---orbital fossa --- - frontal foramen or fissure

o CN 04, trochlear nerve, supratrochlear nerve o supratrochlear vessels

- supraorbital fissure o CN 05, trigeminal nerve, supraorbital nerve o supraorbital vessels

- anterior ethmoidal foramen o CN 05, trigeminal nerve, anterior ethmoidal nerve

- posterior ethmoidal foramen o CN 05, trigeminal nerve, posterior ethmoidal nerve o posterior ethmoidal vessels

- zygomatic canal o zygomatic orbital canal

CN 05, trigeminal nerve, zygomatic nerve o zygomatic facial canal

CN 05, trigeminal nerve, zygomatic nerve, zygomatic facial nerve o zygomatic temporal canal

CN 05, trigeminal nerve, zygomatic nerve, zygomatic temporal nerve - nasolacrimal canal

o nasolacrimal duct - inferior orbital fissure

o medial part CN 05, trigeminal nerve, maxillary nerve CN 05, trigeminal nerve, zygomatic nerve CN 05, trigeminal nerve, inferior orbital nerve orbital branches of pterygopalatine ganglion

o lateral part infrorbital vessels inferior ophthalmic vein

- infraorbital fissure o CN 05, trigeminal nerve, infraorbital nerve o infraorbital vessels

---nasal cavity --- - piriform aperture

o the nasal opening o passing structures: semmi, air

- choana


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o in nasa cavity o passing structures: semmi, air

- sphenopalatine foramen o sphenopalatine artery o posterior nasal nerves o leads to sphenopalatine fossa inferiorly

- semilunar hiatus o leads to maxillary sinus via maxillary hiatus o in posterior part of semilunar hiatus

- ethmolidal infundibulum o anterior part of semilunar hiatus o leads to frontal sinus via frontonasal duct

- aperture of sphenoid sinus - nasolacrimal canal - nasolacrimal duct - incisive canal

o sphenopalatine artery o medial nasal and nasopalatine nerves o posterior nasal and nasopalatine arteries

---pterygopalatine fossa --- - foramen rotundum

o CN 05, trigeminal nerve, maxillary nerve - sphenopalatine foramen

o sphenopalatine artery o posterior nasal nerve

- pterygoid canal o CN 07, facial nerve o deep petrosal nerve o vidian artery

- inferior orbital fissure o medial part leads to pterygopalatine fossa

CN 05, trigeminal nerve, maxillary nerve CN 05, trigeminal nerve, zygomatic nerve CN 05, trigeminal nerve, inferior orbital nerve ptherygopalatine ganglion

- major palatine canal and minor palatine canal o greater palatine nerve o lesser palatine nerve o descending palatine artery

- pterygomaxillary fissure o sphenopalatine artery

---oral cavity --- - incisive foramen

o sphenopalatine artery o posterior and medial nasal nerve

- greater palatine foramen o greater palatine nerve o descending palatine artery

- lesser palatine foramen o lesser palatine nerves


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skull structures - temporal lines

o form oval like rounding o continuation of curvature spanned by

zygomatic process of temporal bone and zygomatic bone

- fontanellae

o anterior fontanella between two unjoined frontal bones two parietal bones in other words: the openend coronal suture

o posterior fontanella between occipital bone two parietal bones in other words: the opened lambdoid suture

- pterion o intersection of

parietal frontal occipital spenoidal bone

- jugular foramen o made up by tow notches

- tegmen tympani o roof of tympanic cavity o lateral to arcuate eminence

- porus acousticus internus o located inside the acoustic meatus o accommodates aperture of the vestibular aqueduct

- sphenopalatine foramen o formed by sphenopalatine notch of palatine bone and body of sphenoid o leads to pterygopalatine fossa

- pterygopalatine fossa o also called sphenopalatine fossa o inferior to sphenopalatine foramen o lateral border: pterygomaxillary fissure o medial border: sphenopalatine foramen

leads through nasal cavity o anteriosuperior border: inferior orbital fissre o posterosuperiorly border: foramen rotundum and pterygoid canal

leads to middle cranial fossa o contents:

maxillary nerve (from foramen rotundum) ptergopalatine ganglion (through inferior orbital fissure) terminal third of the maxillary artery (pterygopalatien foramen)

- trigeminal nerve o 5th cranial nerve o gives rise to … o ophthalmic nerve o maxillary nerve o mandibular nerve

- fascial nerve


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o 7th cranial nerve o fascila nerve in petrosal pyramide

enters pyramid through internal acoustic meatus of tympanic part of the temporal bone reaches anterior border of pyramide turns 90° laterally (genus) gives branch: greater petrosal nerve dives down to base of pyramid reaches lateral border gives branch: cordotympanic nerve leaves cranial base via foramen stylomastoideum

- mandibular fossa o anteriorly to external acoustic meatus

- internal cranial base o anterior cranial base

floor: • anterior: frontal bone • posterior:

o lesser wing of sphenoid o ethmoid bone

posterior border: edge of the wing of sphenoid lateral border: frontal bone

o middle cranial base anterior border: lateral border: squamous part of temporal bone posterior border: petrose crest

o posterior cranial fossa anterior border:

• laterally: petrosal crest • middle: dorsum sellae, climus

lateral, posterior: occipital bone - sella turcica

o structures … o iugum sphenoid o climus o chiasmata groove o hypophyseal fossa o dorsum sellae

- filla olfactoria o filaments of olfactory nerve

- piriform aperture o the nasal opening

- inferior nasal meatus o inferior to inferior nasal concha

- spheno-ethmoid recess o where

- nasal septum o superior part: perpendicular plate of ethmoid bone o inferior part: vomer o superior border:

anteriorly: nasal bone posteriorly: spheno-ethmoid recess

o lateral border: anteriorly: frontal process of maxilla above:

• nasal bone • lacrimar bone

a bit inferiorly: • frontal surface of maxilla

ethmoidal labyrinth medial plate of pterygoid process


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perpendicular plate of palatine bone o inferior border:

pallatine process of maxilla pallatine bone

o anterior border: anterior nasal spine o posterior border:

posterior nasal spine nasal crest of palatine bone

• the superior margin of the perpendicular plate - infundibulum

o located in ehtmoidal labyrinth - middle nasal meatus - oral cavity

o anterior, lateral and superior border: alveolar process of maxilla o anterior and inferior border: alveolar process of mandibula o superior border:

palatine process of maxilla horizontal plate of palatine bone

- nasal cavity o anterior border: piriforme aperture o posterior border: choanae o superior border: body pf sphenoid bone o inderior border: palatine bone o pathway to nasal pharynx

through choana - temporal fossa

o accommodates temporal muscle and pterion o superior, posterior border:

superior temporal line inferior temporal line

o anterior border: zygomatic process of frontal bone zygomatic bone

o medial border facies temporalis of ala major of sphenoid pars squamosa of temporal bone

- infratemporal fossa o under infratemporal crest of sphenoid

runs parallely and medially to zygomatic arch o accommodates

maxillary artery and nerve venous maxillary plexus foramina ovale and spinosum

o anterior border: temporal surface of maxilla o medial border: pterygoid process of sphenoid o superior border:

infratemproal crest of sphenoid sphenoidal margin of temporal bone

o posterior border: mastoid process of temporal bone styloid process of temporal bone

o lateral border: ramus of mandibula o inferior border: body of mandibula

- orbital fossa o anterior border:

orbital part of frontal bone lesser wing of sphenoid bone

o medial border: frontal process of maxillary bone lacrimar bone


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orbital part of ethmoid bone (a bit superiorly) o posterior border:

orbital process of palatine lesser wing of sphenoid

o lateral border: anteriorly: zygomatic bone posteriorly: greater wing of sphenoid

- semilunar hiatus o between

uncinate process and … bulla

o leads to maxillary sinus - scaphoid fossa

o auditory tube also called tuba auditora, Eustachian tube between inner ear and pharynx

- para-nasal sini o sphenoidal sinus

connected to nasal cavity via aperture sinus sphenoidalis o frontal sinus

connected to nasal cavity via anterior ethmoidal cells more superiorly: frontonasal duct

o maxiallary sinus connected to nasal cavity via semilunar hiatus

• more detailed: via maxillary hiatus o the postero-inferior portion of the semilunar hiatus

o ehtmoidal cells largest cellum: ethmoidal bulla


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back muscles of the back - extrinsic

o superficial trapizius latissimus dorsi levator scapulae rhomboideus

• under trapezius o intermediate

serratus posterior • superior part

o attaches to 1st three ribs • inferior part

o also three parts - intrinsic

o superficial splenius muscles

• splenius cervices • splenius capitis

o intermediate erector spinae

• iliocostalis o lateral o three parts

thoracis lumbaris cervicalis

• longissimus o intermediate

• spinalis o medial

o deep transversospinal muscles

• semispinalis o attach one spinous process with a transverse process of a vertebra, three four

vertebrae further down o semispinalis capitis o semispinalis thoracis o semispinalis cervicis

• rotatores o from transverse process to junction of lamina arch and transverse process of

adjacent vertebra • multifidus

o attach one spinous process with a transverse process of a vertebra, three four vertebrae further down

interspinal intertrasnverse elevators of ribs

• from transverse process to superior tubercle of the rib - fascia thoracolumbaris

o under rhomboideus and latissimus dorsi

anatomy, 3rd SCT, skull Temmesfeld ‚06

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back ribs - true ribs: 1st to 7th rib - flase ribs: 8th to 10th - floating ribs: 11th and 12th - typical ribs, 3rd to 10th rib

o head o neck o tubercle o body

- atypical ribs, 1st, 2nd, 10th, 11th, 12th ribs o 1st rib: scalene tubercle

articulates with one vertebra only o 2nd rib: tuberosity for m. serratus anterior o 10th – 12th ribs

articulate with one only one vertebra, respectively o 11th and 12th

short no neck no tubercle

joints - zygopophysial joints

o joints of the vertebral arches o involved bones: vertebral bones o type of joint: plant type of joint o movements: gliding movement o articular surfaces:

between superior and inferior articular processes of two adjacent vertebrae o joint capsule:

thin loos joint capsule o ligaments:

ligamentum flavum interspinous ligaments supraspinous ligament

- atlonato-occipital joint

o involved bones: os occipitale, atlas o type of joint: condyloid type of joint o movements:

nodding the head, flexion lateral bending little rotation

o articular surfaces: occipital condyles superior articular surfaces of the lateral aspect of the atlas

o joint capsule: thin loos joint capsule

o ligaments: o anterior and posterior atlanto-occipital membranes

help to prevent excessive movement - atlanto-axial joint

o involved bones: atlas, axis o type of joint:


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lateral joint: plane type medial joint: pivot type

o movements: rotation o articular surfaces:

lateral (2): • inferior facets of lateral aspects

medial (1): • dens of axis • anterior arch of atlas

o joint capsule: thin loose joint capsule

o ligaments: transverse ligament of the atlas

• holds the dens in place in foramen vertebrale longitudinal ligaments

• anterior • posterior

- costovertebral joints, typical

o includes two joint joints of the head of the rib costotransverse joint

o involved bones: rib, two vertebrae o type of joint:

joints of the head of the rib: gliding and sliding costotransverse joint: gliding movements

o movements: pump-handle movement bucket-handle movement

• two costal joints are involved o costovertebral joint o costosternal joint

o articular surfaces: joint of head of the rib

• costal facet of two adjacent vertebrae • head of the rib

costotransverse joint • tubercle of rib • transverse costal facet

o joint capsule: joints of the head of the rib

• two synovial cavities • separated by intra-articular ligament • strong fibrous capsules

costotransverse joint • thin, loose joint capsule

o ligaments: - costochonral joints

o the joints between two ribs at their sternal end o hyaline cartilaginous joints o no movement

- intechondral joints

o between ribs: 6, 7, 8, 9 o plane type of synovial joints o strengthened by interchondral ligaments

- sternocostal joints

o involved bones: stermum, costae 1 - 7


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o type of joint:

joints of the head of the rib: gliding and sliding costotransverse joint: gliding movements

o movements: pump-handle movement bucket-handle movement

• two costal joints are involved o costovertebral joint o costosternal joint

o articular surfaces: 1st rib

• chondral cartilage • manubrium of sternum

2nd rib • chondral cartilage • manubrium of sternum • body of sternum

3rd to 6th rib • chondral cartilage • body of sternum

7th rib • chondral cartilage • xiphoid process

o ligaments: radiate sternocostal ligament

- temporomandibular joint

o involved bones: os mandibula, os tempora o type of joint: modified hinge joint o movements:

elevation depression protrusion retrusion lateral movements

o articular surfaces: condyle of mandible articular tubercle of temporal bone mandibular fossa

o joint capsule: articular disc thin loose joint capsule two synovial membranes

• superior synovial membrane • inferior synovial membrane

o ligaments: lateral ligament stylomandibular ligament sphenomandibular ligament

• from spine of sphenoid to • lingua of mandible


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skull vertebral column - vertebrae

o 7 cervical o 12 thoracic o 5 lumbar o 5 sacral o 4 coccygeal

varies o altogether: 33 vertebrae

- 1st cervical vertebra: atlas

o articulates with occipital bone superiorly o articular suface on occipital bone: condylar process o articular surface on atlas: facies articularis superior o foramen transversarium

in transverse process - 2nd cervical vertebra: axis

o dens axis superior pointing process articulating with the fovea dentis of atlas

o foramen transversion in transverse process

- 7th cervical vertebra o also clled vertebra promines o prominent spinous process

- cervical vertebra, general o foramen vertebrale o laminar arch

more posterior o pedical arch

closer to body - ligaments

o ligamentum longitudinale anterius o ligamentum longitudinal posterius

lines anterior surface of foramen vertebrale o tectorial membrane

runs in foramen vertebrale on bosa of spinal cord

o ligamentum intertransversarium connects spinous processes with each other

o ligament um flavum lines posterior surface of foramen vertebrale

- curvatures

o cervical convex, hence lordosis

o thoracic concave, hence kyphosis

o lumbar convex, hence lordosis

o sacral concave, hence kyphosis


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Anatomy

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