Anatomy,

Physical Examination

& Acupuncture

 

 

By Shaun Francis

 

 


Contents

 

Overview

Anatomical Reference

Anatomical Position

Planes & Sections

Anatomical Terms

Movements

Definitions & Interpretations

Head & Neck

Thorax & Abdomen

Upper Limb

Lower Limb


Overview

In terms of learning acupuncture and anatomy we can use two systems:

(1)   Regional          or

(2)   Systemic

 

In this text we will use both systems. Anatomy of a given region will be discussed along with the local acupoints. Then anatomy will be discussed in summary by systems as will acupuncture points by meridians.

 

The following regions are covered:

-        Head and Neck

-        Thorax and Abdomen

-        Upper Limb

-        Lower Limb

 

Learning by regions allows:

(1)   Greater detail to be covered

(2)   The relationship between adjacent/regional structures to be appreciated

(3)   Differentiation of local structures

(4)   Some acupoint functions to be appreciated

 

In each region the following system layout is used:

-        Bones

-        Joints

-        Movements & ROM

-        Muscles

-        Trigger Points

-        Organs

-        Viscerotomes

-        Arterial Supply

-        Venous Drainage

-        Lymphatic Drainage

-        Innervation

-        Cutaneous Innervation

-        Dermatomes

-        Reflexes

-        Regional Anatomy

-        Surface Anatomy

-        Acupuncture

 

In the last section of the text a summary of each system and meridian allows consolidation of previous information.

 

Learning by systems/meridians allows:

(1)   Continuity of learning

(2)   Understanding of the function and relationship as a system rather than in isolation

(3)   Visualisation and tracing of pathways

 

Clinical notes are mentioned throughout the text.

 

By combining the two methods we embrace the reductionist approach of science to uncover the detail and use the wholistic approach of eastern medicine to uncover the relevance to the whole.


Anatomical Reference

 

Anatomical Position

 

 

 

 

 

Figure 1.0 The Western anatomical position

 

Figure 1.1 The Chinese anatomical position

Note: Chinese anatomical position (figure 1.1) is identical except in regards to the upper limb (arm): the palmar aspect (palm) of the wrist and palm and the cubital fossa (inside elbow) all face the lateral aspect (outside) of the trunk with the thumb most anterior (forward) and the little finger most posterior (rearward). This book refers to the Western anatomical position as depicted above (figure 1.0).

 

 


Anatomical Reference

 

Planes & Sections

 

Coronal: divides into anterior and posterior

Sagital: vertical plane which divides into left and right

Midsagital: vertical plane which divides into two eqaul left and right halves

Transverse/Horizontal: horizontal plane, divides into superior and inferior

Cardinal: two equal halves (superior/inferior, left/right, anterior/posterior)

 

 

Anatomical Terms

All the following terms make reference to the anatomical position, regardless of the actual position of the person being studied.

 

Anterior/Posterior: closer to front/rear

     ie: the chest is anterior to the back; the back is posterior to the chest

Ventral/Dorsal: closer to front/back…..

     ie: the back of the hand is dorsal to the palm; the palm is ventral to the back of the hand

Medial/Lateral: closer/further from midlilne of body

     ie: the little finger is medial to the thumb; the thumb is lateral to the little finger

Ulnar/Radial: closer/further from midlilne of body

     ie: the little finger is on the ulnar aspect of the forearm; the thumb is on the radial aspect of the forearm

Superior/Inferior: higher/lower

     ie: the knee is superior to the ankle; the ankle is inferior to the knee

Proximal/Distal: closer/further from attached limb or trunk

     ie: the wrist is proximal to the shoulder; the shoulder is distal to the wrist

Superficial/Deep: outermost or most external/innermost or most internal

     ie: the skin is superficial to the bones; the bones are deep to the skin

Ipsilateral/Contralateral: related to the same/opposite side of the body

     ie: the right hand is on the ipsilateral side of the body to the right shoulder; the right hand is on the contralateral side of the body to the left shoulder

Bilateral/Unilateral: related to both sides/single side

     ie: we have two kidneys bilaterally; we have one liver unilaterally on the right

Cranial/Caudal: closer/further to frontal pole of brain, changes with relation to the brain

     ie: the frontal lobe is cranial to the occipital lobe; the occipital lobe are caudad to the frontal lobe

Rostral/Caudal: closest/furthest

     ie: the brain is rostral to the spinal cord; the spinal cord is caudad to the brain

 

 

 

 

Figure 1.2 Planes and Sections of the anatomical postion

 

 

 

Upper Limb Reference

 

If we use the terms radial aspect and ulnar aspect on the forearm we eliminate the confusion between the Chinese and Western anatomical positions. The radial aspect is the lateral side whereas the ulnar aspect is the medial side (figure 1.3)

 

Many Chinese texts still use the Chinese anatomical position and we should be aware of which position is being referred to.

 

Figure 1.3 Radial Aspect (Lateral) and Ulnar Aspect (Medial)

 

 


Anatomical Reference

 

Movements

Movements use the same planes and sections as described to the anatomical position.

 

Pronation

Supination

Flexion

Extension

Abduction

Adduction

External/Lateral Rotation

Internal/Medial Rotation

Circumduction

Elevation

Depression

Dorsi Flexion

Plantar Flexion

Eye movements

 


Anatomical Reference

 

Definitions & Interpretations

 

MYOTOMES : masses of muscle innervated by an individual spinal nerve

SCLEROTOMES : areas of bone and periosteum innervated by an individual spinal nerve

DERMATOMES :  areas of skin innervated by an individual spinal nerve

 

 

LEGEND

 

Nerve

Artery

Vein

Lymph

Muscle

Bone


 

 

Head & Neck

 

 

 

 

Bones

 

Joints

 

Movements & ROM

 

Muscles

 

Trigger Points

 

Organs

 

Viscerotomes

 

Arterial Supply

 

Venous Drainage

 

Lymphatic Drainage

 

Innervation

 

Neuroanatomy

 

Cutaneous Innervation

 

Dermatomes

 

Reflexes

 

Regional Anatomy

 

Surface Anatomy

 

Acupuncture

 

 


 

Bones of the Head & Neck

 

Skull

Cranium

Calvaria

 

Parietal Bone - paired

 

Occipital Bone

-         External Occipital Protuberance

-         External Occipital Crest

-         Occipital Condyle

-         Basiocciput

-         Foramen Magnum

o        Transmits

§        Medulla oblongata

§        Meninges

§        Vertebral arteries

§        Meningeal branches of vertebral arteries

§        Spinal roots of accessory nerve

-         Condylar Foramen

o        Transmits condyloid emissiary vein

-         Hypoglossal Canal

o        Transmits hypoglossal nerve (cranial nerve X)

-         Jugular Foramen

o        Between occipital and temporal bones

o        Transmits

§        Accessory nerve

§        Vagus nerve

§        Glossopharngeal nerve

§        Internal jugular vein

 

Frontal Bone

-         Glabella

-         Supraorbital Foramen

o      Transmits supraorbital artery branch of opthalmic artery

 

-         Foramen Cecum  - between frontal and ethmoid bones, transmits emissiary vein to superior sagital sinus

 

 

Temporal Bone - paired

-         Styloid Process

o        Attachment for stylohyoid muscle

-         Mastoid Process

o        Attachment for sternocleidomastoid muscle

-         Zygomatic Process

o        Creates zygomatic arch with temporal process of zygomatic bone

-         External Auditory Meatus

-         Internal Accoustic Meatus

o        transmits facial nerve, vestibulocochlear nerve

-         Carotid Canal

o        transmits internal carotid artery, internal carotid nerve plexus

o        opens into lateral end of foramen lacerum

-         Mastoid Foramen

o        transmits branch of occipital atrery to dura mater, mastoid emissiary vein

-         Stylomastoid Foramen

o        transmits facial nerve

 

Sphenoid Bone

-         Lesser Wing

o        Anterior Clinoid Process

-         Superior Orbital Fissure

o        Transmits frontal nerve, lacrimal nerve and nasocilliary nerve branches of opthalmic nerve (trigemminal nerve), occulomotor nerve, abducens nerve, trochlear nerve, superior opthalmic vein

-         Greater Wing

o        Foramen Spinosum

§        transmits middle meningeal artery branch of maxillary artery (internal carotid artery)

o        Foramen Rotundum

§        transmits maxilliary nerve (trigemminal nerve)

§        opens inferiorly into pterygopalatine fossa

o        Foramen Ovale

§        transmits mandibular nerve (trigemminal nerve)

o        Optic Canal

§        transmits optic nerve, opthalmic artery (internal carotid artery)

-         Sellae Turcicia (Turkish Saddle)

o        Tuberculum Sellae

o        Dorsum Sellae

o        Hypohyseal Fossa (Pituitary Fossa)

-         Pterygoid Process

o        Medial Pterygoid Plate

§        Attachment site of medial pterygoid muscle

o        Lateral Pterygoid Plate

§        Attachment site of lateral pterygoid muscle

-         Posterior Clinoid Process

 

Ethmoid Bone 

n      Cristae Gali

n      Olfactory Formaina

n      Cribriform Plate - transmits olfactory nerve, olfactory bulb

n      Foramen Cecum - between frontal and ethmoid bones, transmits emissiary vein to superior sagital sinus

n      Anterior Ethmoidal Foramen - transmits anterior ethmoidal artery branch of opthalmic artery, anterior ethmoidal nerve branch of long ciliary nerve (nasociliary nerve branch of opthalmic nerve branch of trigemminal nerve ), anterior ethmoidal vein

n      Posterior Ethmoidal Foramen - transmits posterior ethmoidal artery branch of opthalmic artery, posterior ethmoidal nerve branch of long ciliary nerve (nasociliary nerve branch of opthalmic nerve branch of trigemminal nerve), posterior ethmoidal vein

 

Inferior Turbinates or Inferior Concha - paired

 

Zygomatic Bone- paired

n      Temporal Process - creates zygomatic arch with zygomatic process of temporal bone

 

Maxilla - paired

n      Alveolar Margin

n      Incisive Fossa

n      Orbital Surface

n      Infraorbital Foramen - transmits infraorbital nerve branch of maxillary nerve (trigeminal nerve), infraorbital artery branch of maxillary artery (internal carotid artery)

n      Zygomaticofacial Foramen - zygomaticofacial nerve

n      Inferior Orbital Fissure

n      transmits zygomatic nerve branch of maxillary nerve (trigemminal nerve)

 

Nasal Bone - paired

 

Vomer

 

Palantine Bone- paired

n      Vertical Plate

n      Orbital Surface

n      Horizontal Plate

 

Lacrimal Bone - paired

n      Lacrimal Fossa

 

Mandible

n      Coronoid Fossa

n      Mandibular Condyle

n      Ramus of Mandible

n      Mandibular Angle

n      Body

n      Alveolar Margin

n      Mandibular Notch

n      Mental Foramen - transmits mental nerve branch of inferior alveolar nerve (mandibular nerve branch of trigemminal nerve), mental artery branch of inferior alveolar artery (maxillary artery branch of external carotid artery)

n      Mandibular Foramen - transmits inferior alveolar nerve branch of mandibular nerve (trigemminal nerve), inferior alveolar artery branch of maxillary artery (external carotid artery)

 

Hyoid

n      Greater Horn or Greater Cornu

n      Lesser Horn or Lesser Cornu

n      Body

 

Foramen Lacerum - internal carotid artery

 

Anterior Cranial Fossa

Middle Cranial Fossa

Posterior Cranial Fossa

 


 

Joints of the Head & Neck

 

Sutures of the Skull

 

Tempromandibular Joint

 

Atlanto-occipital Joint

 

Atlantoaxial Joint

 

Intervertebral Joints

 


 

Movements & ROM of the Head & Neck

 


 

Muscles of the Head & Neck

 

Palatoglossus Muscle

only muscle of the tongue not supplied by the hypoglossal nerve, also called glossopalatinus muscle

Origin:

Insertion:

Action:

Innervation:

Blood Supply:

 

Palatopharyngeus Muscle

also known as pharyngopalatinus muscle

Origin:

Insertion:

Action:

Innervation:

Blood Supply:

 

Tensor Veli Palatini Muscle

Origin:

Insertion:

Action:

Innervation:

Blood Supply:

 

Levator Veli Palatini Muscle

Origin:

Insertion:

Action:

Innervation:

Blood Supply:

 

Salpingopharyngeus Muscle

Origin:

Insertion:

Action:

Innervation:

Blood Supply:

 

Stylopharyngeus Muscle

Origin:

Insertion:

Action:

Innervation:

Blood Supply:

 

Levator Scapulae Muscle

Origin:

Insertion:

Action:

Innervation:

Blood Supply:

 

Musculus Uvula Muscle

Origin:

Insertion:

Action:

Innervation:

Blood Supply:

 

Anterior Scalene Muscle

Origin:

Insertion:

Action:

Innervation:

Blood Supply:

 

Middle Scalene Muscle

Origin:

Insertion:

Action:

Innervation:

Blood Supply:

 

Posterior Scalene Muscle

Origin:

Insertion:

Action:

Innervation:

Blood Supply:

 

Nasalis Muscle (Compressor Naris Muscle, Dilator Naris Muscle)

Origin:

Insertion:

Action:

Innervation:

Blood Supply:

 

Depressor Septi Muscle

Origin:

Insertion:

Action:

Innervation:

Blood Supply:

 

Aleeue Nasi Muscle

Origin:

Insertion:

Action:

Innervation:

Blood Supply:

 

Procerus Muscle

Origin:

Insertion:

Action:

Innervation:

Blood Supply:

 

Temporoparietalis Muscle

Origin:

Insertion:

Action:

Innervation:

Blood Supply:

 

Splenius Capitis Muscle

Origin:

Insertion:

Action:

Innervation:

Blood Supply:

 

Splenius Cervicis Muscle

Origin:

Insertion:

Action:

Innervation:

Blood Supply:

 

Semispinalis Capitis Muscle

Origin:

Insertion:

Action:

Innervation:

Blood Supply:

 

Semispinalis Cervicis Muscle

Origin:

Insertion:

Action:

Blood Supply:

 

SUBOCCIPITAL MUSCLES

All supplied by posterior primary ramus of C1 (suboccipital nerve)

All supplied by vertebral artery and descending branch of occipital artery

 

Obliquis Capitis Inferior Muscle

Origin: spine of axis

Insertion: transverse process of atlas

Action: rotates atlas and skull around odontoid process of axis

Innervation: posterior primary ramus of C1 and C2

Blood Supply: vertebral artery and descending branch of occipital artery

 

Obliquis Capitis Superior Muscle

Origin: transverse process of atlas

Insertion: above inferior nuchal line (occipital)

Action: extension and lateral rotation of head

Innervation: posterior primary ramus of C1 (suboccipital nerve)

Blood Supply: vertebral artery and descending branch of occipital artery

 

Rectus Capitis Posterior Major Muscle

Origin: spine of axis

Insertion: lateral inferior nuchal line (occipital)

Action: extension, lateral flexion and rotation of head

Innervation: posterior primary ramus of C1 (suboccipital nerve)

Blood Supply: vertebral artery and descending branch of occipital artery

 

Rectus Capitis Posterior Minor Muscle

Origin: posterior tubucel of atlas

Insertion: below inferior nuchal line (occipital)

Action: extension and lateral flexion of head

Innervation: posterior primary ramus of C1 (suboccipital nerve)

Blood Supply: vertebral artery and descending branch of occipital artery

 

MUSCLES OF TYMPANIC CAVITY

Supplied by branches of external carotid artery

 

Stapedius Muscle

Origin: cavity apex of pyramid

Insertion: posterior neck of stapes

Action: increases fluid tension in ear, dampens tympanic membrane, reduces damage from loud noise

Innervation: nerve to stapedius branch of facial nerve whilst in facial canal

ARTERIAL SUPPLY: superior tympanic artery, anterior tympanic artery, stylomastoid artery

 

Tensor Tympani Muscle

Origin: cartilage of eustachian tube and part of greater wing of sphenoid

Insertion: root of handle of maleus (hammer)

Action: tenses tympanic membrane

Innervation: mandibular nerve of trigemminal nerve through otic ganglion

ARTERIAL SUPPLY: superior tympanic artery

 

MUSCLES OF EXTERNAL AURICLE

 

Anterior Auricular Muscle

Origin: temporal fascia and galea aponeurosis

Insertion: anterior part of medial helix

Action: moves ear anteriorly

Innervation: temporal nerve of facial nerve

Blood Supply: superficial temporal artery branch of external carotid artery

 

Superior Auricular Muscle

Origin: temporal fascia and galea aponeurosis

Insertion: superior part of medial helix

Action: elevates ear

Innervation: temporal nerve of facial nerve

Blood Supply: superficial temporal artery branch of external carotid artery

 

Posterior Auricular Muscle

Origin: mastoid process

Insertion: lower part of cranial surface of auricle

Action: moves ear posteriorly (retracts)

Innervation: posterior auricular nerve branch of facial nerve

Blood Supply: posterior auricular artery branch of external carotid artery

 

PHARYNGEAL CONSTRICTOR MUSCLES

 

Inferior Pharyngeal Constrictor Muscle

Origin: oblique line of thyroid cartillage, side of cricoid, cricothyroid muscle

Insertion: posterior median raphe of pharynx, overlaps middle constrictor muscle

Action: contracts pharynx in swallowing

Innervation: pharyngeal plexus from glossopharyngeal nerve and vagus nerve, recurrent laryngeal nerve and external laryngeal nerve branches of vagus nerve

Blood Supply: inferior thyroid artery branch of thyrocervial trunk and ascending pharyngeal artery branch of external carotid artery

 

Middle Pharyngeal Constrictor Muscle

Origin: greater and lesser horns of hyoid, stylohyoid muscle, overlaps superior constrictor

Insertion: posterior median raphe

Action: contracts pharynx in swallowing

Innervation: pharyngeal plexus from glossopharyngeal nerve and vagus nerve

Blood Supply: ascending pharyngeal artery branch of external carotid artery

 

Superior Pharyngeal Constrictor Muscle

Origin: lower third of medial border of medial pterygoid plate (ethmoid), ptergomandibular ligament, side of tongue, alveolar process of mandible

Insertion: posterior median raphe, by aponeurosis to pharyngeal tubercule (occipital)

Action: contracts pharynx in swallowing

Innervation: glossopharyngeal nerve

Blood Supply: ascending pharyngeal artery branch of external carotid artery

 

MUSCLES OF PHONATION

All supplied by superior laryngeal artery (external carotid artery)

 

Cricothyroid Muscle

Origin: arch of cricoid cartillage

Insertion: lower surface of thyroid cartilage

Action: tenses vocal folds

Innervation: external laryngeal nerve branch of superior laryngeal nerve (vagus nerve)

Blood Supply: superior thyroid artery (external carotid artery) and inferior laryngeal artery branch of inferior thyroid artery (thyrocervical trunk)

 

Posterior Cricoarytenoid Muscle

Origin: posterior surface of cricoid cartilage at midline

Insertion: arytenoid cartilage

Action: abducts vocal cords

Innervation: recurrent laryngeal nerve branch of vagus nerve

Blood Supply: superior laryngeal artery branch of superior thyroid artery (external carotid artery) and inferior laryngeal artery branch of inferior thyroid artery (thyrocervical trunk)

 

Lateral Cricoaretynoid Muscle

Origin: lateral aspect of cricoid arch

Insertion: arytenoid cartilage

Action: adducts vocal cords

Innervation: recurrent laryngeal nerve branch of vagus nerve

Blood Supply: superior laryngeal artery branch of superior thyroid artery (external carotid artery) and inferior laryngeal artery branch of inferior thyroid artery (thyrocervical trunk)

 

Transverse Arytenoid Muscle

Origin: arytenoid cartilage

Insertion: muscular process of contralateral arytenoid cartilage

Action: adducts vocal cords

Innervation: recurrent laryngeal nerve branch of vagus nerve

Blood Supply: superior laryngeal artery branch of superior thyroid artery (external carotid artery) and inferior laryngeal artery branch of inferior thyroid artery (thyrocervical trunk)

 

Vocalis Muscle

Origin: internal, inferior and anteromedial thyroid cartilage

Insertion: vocal process of arytenoid cartilage

Action: relaxes vocal cords

Innervation: recurrent laryngeal nerve branch of vagus nerve

Blood Supply: superior laryngeal artery branch of superior thyroid artery (external carotid artery) and inferior laryngeal artery branch of inferior thyroid artery (thyrocervical trunk)

 

Thyroarytenoid Muscle

Origin: internal, inferior and anteromedial thyroid cartilage

Insertion: muscular process and lateral surface of arytenoid cartilage

Action: relaxes vocal cords

Innervation: recurrent laryngeal nerve branch of vagus nerve

Blood Supply: superior laryngeal artery branch of superior thyroid artery (external carotid artery) and inferior laryngeal artery branch of inferior thyroid artery (thyrocervical trunk)

 

LARYNGEAL SPHINCTER MUSCLES

All supplied by superior laryngeal artery branch of superior thyroid artery (external carotid artery)

 

Oblique Arytenoid Muscle

Origin: muscular process of arytenoid cartilage

Insertion: musclular process of contralateral arytenoid cartilage

Action: laryngeal sphincter

Innervation: recurrent laryngeal nerve branch of vagus nerve

Blood Supply: superior laryngeal artery branch of superior thyroid artery (external carotid artery) and inferior laryngeal artery branch of inferior thyroid artery (thyrocervical trunk)

 

Aryepiglotic Muscle

Origin: fibers of oblique arytenoid muscle

Insertion: lateral border of epiglotis

Action: laryngeal sphincter

Innervation: recurrent laryngeal nerve branch of vagus nerve

Blood Supply: superior laryngeal artery branch of superior thyroid artery (external carotid artery) and inferior laryngeal artery branch of inferior thyroid artery (thyrocervical trunk)

 

Thyroepiglotic Muscle

Origin: fibers of thyroarytenoid muscle in aryepiglotic folds

Insertion: epiglotis

Action: laryngeal sphincter

Innervation: recurrent laryngeal nerve branch of vagus nerve

Blood Supply: superior laryngeal artery branch of superior thyroid artery (external carotid artery) and inferior laryngeal artery branch of inferior thyroid artery (thyrocervical trunk)

 

MUSCLES OF MASTICATION

All supplied by mandibular nerve branch of trigemminal nerve

All blood supplied by maxillary artery branch of external carotid artery

 

Masseter Muscle

mastication, deep to parotid gland, parotid duct crosses anteriorly

Origin: zygomatic process of maxilla, zygomatic arch

Insertion: angle, ramus and coronoid process of mandible

Action: closes lower jaw, deviates mandible

Innervation: masseteric nerve branch of mandibular nerve (trigemminal nerve)

Blood Supply: masseteric artery branch of maxillary artery (external carotid artery)

 

Lateral Pterygoid Muscle

Origin: two heads (1) superior : greater wing of sphenoid (2) inferior : lateral surface of lateral ptergoid plate (ethmoid)

Insertion: neck of mandible, articular disc of tempromandibular joint

Action: deviates mandible, protrudes mandible, closes mandible (superior head), opens jaw (inferior head)

Innervation: lateral pterygoid nerve branch of mandibular nerve (trigemminal nerve)

Blood Supply: lateral pterygoid artery branch of maxillary artery (external carotid artery)

 

Medial Pterygoid Muscle

Origin: medial surface of lateral pterygoid plate (ethmoid), palatine bone, pterygoid fossa

Insertion: mandibular ramus, angle of mandible

Action: closes lower jaw, protrude mandible

Innervation: medial pterygoid nerve branch of mandibular nerve (trigemminal nerve)

Blood Supply: medial pterygoid artery branch of maxillary artery (external carotid artery)

 

Temporalis Muscle

Origin: temporal fossa, temporal fascia

Insertion: coronoid process of mandible, ramus of mandible

Action: closes lower jaw, deviates mandible

Innervation: deep temporal nerve branch of mandibular nerve (trigemminal nerve)

Blood Supply: deep temporal artery branch of maxillary artery (external carotid) artery

 

MUSCLES OF FACIAL EXPRESSION

 

Orbicularis Occuli Muscle

ocul = eye

Origin: nasal process of frontal bone, palpebral ligament, lacrimal creast of lacrimal bone

Insertion: around orbit meeting in palpebral raphe, blends with other muslces

Action: closes the eye

Innervation: temporal nerve and zygomatic nerve branches of facial nerve

Blood Supply: opthalmic artery and angular artery branch of facial artery

 

Corrugator Supercilli Muscle

Origin: frontal bone above nose

Insertion: skin of medial eyebrows

Action: draws eyebrows down and medially

Innervation: temporal nerve and zygomatic nerve branchs of facial nerve

Blood Supply: opthalmic artery and superficial temporal artery branch of external carotid artery

 

Orbicularis Oris Muscle

oris = mouth

Origin: alveolar border or maxilla, lateral to midline of mandible

Insertion: around mouth, blends with other muslces

Action: closes lips, protrudes lips

Innervation: buccal nerve of facial nerve

Blood Supply: facial artery branch of external carotid artery

 

Levator Labbi Superior Muscle

labi = lip

Origin: frontal process of maxilla

Insertion: upper lip muscles, nasal cartilage

Action: elevates upper lip, flares nostrils

Innervation: buccal nerve of facial nerve

Blood Supply: facial artery branch of external carotid artery

 

Levator Anguli Oris Muscle

Origin: maxilla inferior to infraorbital foramen

Insertion: modiolus (angle of mouth)

Action: lifts agle of mouth

Innervation: buccal nerve of facial nerve

Blood Supply: facial artery branch of external carotid artery

 

Buccinator Muscle

bucc = cheek, pierced by parotid duct

Origin: posterior alveolar processes of mandible and maxilla

Insertion: modiolus (angle of mouth)

Action: compresses cheeks, prevents food from entering cheeks

Innervation: buccal nerve of facial nerve

Blood Supply: facial artery branch of external carotid artery

 

Risorius Muscle

laughter

Origin: parotid fascia

Insertion: modiolus (angle of mouth)

Action: draws mouth laterally

Innervation: buccal nerve of facial nerve

Blood Supply: facial artery branch of external carotid artery

 

Zygomaticus Major Muscle

blends with orbicularis oris

Origin: zygomatic bone

Insertion: modiolus (angle of mouth)

Action: lifts and raises angle of mouth

Innervation: buccal nerve of facial nerve

Blood Supply: facial artery branch of external carotid artery

 

Zygomaticus Minor Muscle

Origin: zygomatic bone

Insertion: skin of upper lip

Action: elevates upper lip

Innervation: buccal nerve of facial nerve

Blood Supply: facial artery branch of external carotid artery

 

Mentalis Muscle (chin)

Origin: mandible below incisors

Insertion: skin of chin

Action: protrudes lower lip, wrinkles chin

Innervation: mandibular nerve of facial nerve

Blood Supply: facial artery branch of external carotid artery

 

Drepressor Anguli Oris Muscle

Origin: oblique line of mandible, lateral mental tubercule of mandible

Insertion: modiolus (angle of mouth)

Action: lowers angle of mouth

Innervation: mandibular nerve of facial nerve

Blood Supply: facial artery branch of external carotid artery

 

Drepressor Labbi Inferior Muscle

Origin: mandible between symphysis and mental foramen

Insertion: skin of lower lip

Action: draws lower lip down and laterally

Innervation: mandibular nerve of facial nerve

Blood Supply: facial artery branch of external carotid artery

 

EPICRANIAL MUSCLES

All supplied by facial nerve, commonly known as occipitofrontalis muscle with two bellies (occipitalis muscle and frontalis muscle)

 

Frontalis Muscle

no bony attachments

Origin: galea aponeurosis

Insertion: skin above nose and eyes

Action: raiseseyebrows, wrinkles brow

Innervation: temporal nerve branch of facial nerve

Blood Supply: supraorbital artery and supratrochlear artery branches of the opthalmic artery and superficial temporal artery branch of external carotid artery

 

Occipitalis Muscle

Origin: lateral supeior nuchal line and external occipital protuberance of occipital

Insertion: galea aponeurosis

Action: draws back scalp

Innervation: posterior auricular nerve branch of facial nerve

Blood Supply: occipital artery branch of external carotid artery

 

MUSCLES OF THE TONGUE

Three extrinsic and three intrinsic muscles of the tongue all motor fibers supplied by the hypoglossal nerve and all blood supplied by branches of the external carotid artery

Palatoglossus muscle only extrinsic muscle of the tongue not supplied by hypoglossal nerve it is supplied by the pharyngeal plexus

 

Genioglossus Muscle

chin to tongue

Origin: upper genial tubercle of mandible

Insertion: under surface of tongue and hyoid bone

Action: protrudes, retracts and depresses tongue

Innervation: hypoglossal nerve

Blood Supply: sublingual artery branch of lingual artery and submental artery branch of facial artery (both from external carotid artery)

 

Styloglossus Muscle

Origin: anterior border of styloid process of temporal bone

Insertion: side of tongue

Action:

Innervation: hypoglossal nerve

Blood Supply: sublingual artery branch of lingual artery (external carotid artery)

 

Hyoglossus Muscle

Origin: sides and body of greater horn of hyoid

Insertion: side of tongue

Action: draws side of tongue down and depresses tongue

Innervation: hypoglossal nerve

Blood Supply: sublingual artery branch of lingual artery and submental artery branch of facial artery (both from external carotid artery)

 

Longitudinalis Linguae Muscle

two divisions

Origin: superior : submucous fibers at back of tongue, inferior : under surface of tongue between genioglossus muscle and hyoglossus muscle

Insertion: superior : tip of tongue to join same muscle of opposite side, inferior : tip of tongue to blend with styloglossus muscle

Action: superior : turns tip and sides up, inferior : turns tip and sides down, both shorten tongue

Innervation: hypoglossal nerve

Blood Supply: deep lingual artery branch of lingual artery and branches of facial artery (both from external carotid artery)

 

Transversus Linguae Muscle

Origin: median fibrous septum

Insertion: dorsum and sides of tongue

Action: narorws and elongates tongue

Innervation: hypoglossal nerve

Blood Supply: deep lingual artery branch of lingual artery and branches of facial artery (both from external carotid artery)

 

Verticlais Linguae Muscle

Origin: mucous membrane on dorsum of foretongue

Insertion: dorsum to under surface of tongue

Action: flatten and broaden tongue

Innervation: hypoglossal nerve

Blood Supply: deep lingual artery branch of lingual artery and branches of facial artery (both from external carotid artery)

 

MUSCLES OF THE ORBIT

4 of 6 supplied by occulomotor nerve (cranial nerve III). Others by trochela nerve (cranial nerve IV) and abducens nerve (cranial nerve VI).

(LR6SO4)3 – nerve supply of orbital muscles: lateral rectus by cranial nerve VI (trochlea nerve), superior oblique by cranial nerve IV (abducens nerve), all the rest by cranial nerve III (occulomotor nerve)

 

Levator Palpebrae Superior Muscle

Origin: roof of orbit

Insertion: superficial, middle and deep aponeurotic sheaths

Action: elevates upper eyelid (middle lamella acts involuntarily)

Innervation: occulomotor nerve

Blood Supply: supraorbital artery and muscular artery branch of opthalmic artery (internal carotid artery)

 

4 rectus muscles have a linear line of action. All but lateral rectus muscle supplied by occulomtor nerve.

 

Inferior Rectus Muscle

Origin: lesser wing of sphenoid (common tendonus ring), margin of optic canal

Insertion: posterior scelerocorneal junction

Action: depresses, laterally rotates, adducts eye

Innervation: occulomotor nerve

Blood Supply: muscular artery branch of opthalmic artery (internal carotid artery) and infraorbital artery branch of maxillary artery (external carotid artery)

 

Superior Rectus Muscle

Origin: lesser wing of sphenoid (common tendonus ring) , margin of optic canal

Insertion: posterior scelerocorneal junction

Action: elevates, medially rotates and adducts eye, intorsion

Innervation: occulomotor nerve

Blood Supply: supraorbital artery and muscular artery branch of opthalmic artery (internal carotid artery)

 

Lateral Rectus Muscle

Origin: lesser wing of sphenoid (common tendonus ring) , margin of optic canal

Insertion: posterior scelerocorneal junction

Action: abducts eye

Innervation: abducens nerve

Blood Supply: muscular artery branch of opthalmic artery (internal carotid artery)

 

Medial Rectus Muscle

Origin: lesser wing of sphenoid (common tendonus ring) , margin of optic canal

Insertion: posterior scelerocorneal junction

Action: adducts eye

Innervation: occulomotor nerve

Blood Supply: muscular artery branch of opthalmic artery (internal carotid artery)

 

Oblique muscles have a non linear line of action.

 

Superior Oblique Muscle

Origin: body of sphenoid

Insertion: superior posterior lateral sclera via trochlea

Action: depresses, medially rotates, abducts eye

Innervation: trochlear nerve

Blood Supply: muscular artery branch of opthalmic artery (internal carotid artery)

 

Inferior Oblique Muscle

Origin: orbital surface of maxilla

Insertion: inferior posterior lateral sclera via trochlea

Action: elevates, laterally rotates, abducts eye

Innervation: occulomotor nerve

Blood Supply: muscular artery branch of opthalmic artery (internal carotid artery) and infraorbital artery branch of maxillary artery (external carotid artery)

 

SUPERFICIAL NECK MUSCLES

 

Platysma Muscle

broad, flat

Origin: subcutaneous skin over delto-pectoral region

Insertion: skin over mandible

Action: depresses mandible and lower lip, tenses skin of lower neck

Innervation: cervical nerve branch of facial nerve

Blood Supply: superficial vessels of neck

 

Sternocleidomastoid  Muscle

sternum, clavicle and mastoid process of temporal bone

deep to platysma muscle, limit of posterior and anterior triangles of neck, two heads

Origin: medial : manubrium, lateral : medial clavicle

Insertion: mastoid process of temporal bone

Action: ipsilateral rotation, neck flexion, lateral flexion of neck

Innervation: motor supply by spinal accessory nerve branch of accessory nerve, sensory supply by ventral rami of C2 and C3

Blood Supply: superior portion supplied by branch of occipital artery (external carotid artery), inferior portion supplied by branch of superior thyroid artery(external carotid artery)

 

Trapezius Muscle

Origin: occipital bone, spines of C7 and all thoracic vertabrae

Insertion: acromium and spine of scapula and lateral third of clavicle

Action: extends head, stabilises, retracts, raises, rotates, adducts, elevates and depresses scapula

Innervation: motor supply by spinal accessory nerve branch of accessory nerve, sensory supply by ventral rami of C3 and C4

Blood Supply: transverse cervical artery branch of thyrocervical trunk

 

INFRAHYOID MUSCLES

Upper portions supplied by superior root of ansa cervicalis (C2), lower portions by inferior root of ansa cervicalis (C2, C3)

All supplied mainly by inferior thyroid artery (thyrocervical trunk) but also superior thyroid artery (external carotid artery)

 

Thyrohyoid Muscle

superior continuation of sternothyroid muscle

Origin: oblique line of thyroid cartilage

Insertion: body of hyoid

Action: depresses hyoid, elevates larynx

Innervation: C1 through decendens hyperglossi

Blood Supply:

 

Omohyoid Muscle

two bellies, omo = shoulder

Origin: superior belly : lateral hyoid, inferior belly : superior scapula

Insertion: clavicle by pulley tendon

Action: depresses and retracts hyoid and larnyx

Innervation: ansa cervicalis (C2, C3)

Blood Supply: infrahyoid artery branch of superior thyroid artery and sternocleidomastoid artery (external carotid artery)

 

Sternohyoid Muscle

Origin: posterior manubrium, sternal end of clavicle

Insertion: body of hyoid

Action: depresses hyoid and larnyx

Innervation: ansa cervicalis

Blood Supply: infrahyoid artery branch of superior thyroid artery and lingual artery (external carotid artery)

 

Sternothyroid Muscle

Origin: posterior manubrium

Insertion: oblique line of thyroid cartillage

Action: depresses hyoid and larnyx

Innervation: ansa cervicalis

Blood Supply: infrahyoid artery branch of superior thyroid artery (external carotid artery)

 

SUPRAHYOID MUCLES

 

Mylohyoid Muscle

myo = molar

Origin: internal mandible

Insertion: body of hyoid and mediam raphe (middle join of muscle)

Action: elevates hyoid, raises floor of mouth, depresses mandible when hyoid fixed

Innervation: mylohyoid nerve branch of mandibular nerve (trigemminal nerve)

Blood Supply: mylohyoid artery branch of inferior alveolar artery, branch of maxillary artery (external carotid artery)

 

Stylohyoid Muscle

Origin: styloid process of temporal bone

Insertion: lateral hyoid

Action: pulls hyoid superiorly and posteriorly during swallowing

Innervation: facial nerve

Blood Supply: facial artery and occipital artery

 

Posterior Digastric Muscle

Origin: mastoid process of temporal bone

Insertion: lateral hyoid (greater horn) by pulley tendon

Action: combined action of posterior and anterior drepresses mandible to open mouth, fixes hyoid

Innervation: facial nerve

Blood Supply: branch of external carotid artery

 

Anterior Digastric Muscle

deep to submandibular gland

Origin: internal lower mandible

Insertion: lateral hyoid (greater horn) by pulley tendon

Action: combined action of posterior and anterior drepresses mandible to open mouth and fixes hyoid

Innervation: mylohyoid nerve branch of mandibular nerve (trigemminal nerve)

Blood Supply: branch of external carotid artery

 

Geniohyoid Muscle

genio = chin

Origin: inner surface of mandible

Insertion: body of hyoid

Action: elevates tongue, depresses mandible, works with mylohyoid muscle

Innervation: branch of C1 following hypoglossal nerve

Blood Supply: lingual artery branch of external carotid artery

 


 

Organs of the Head & Neck

 

EYE

BONES :

MUSCLES

levator palpebrae superior, superior rectus, inferior rectus, medial rectus, lateral rectus, superior oblique, inferior oblique, constrictor pupillae, cilliary muscles, dilator pupillae

GLANDS :

lacrimal

BLOOD SUPPLY

ARTERIES

opthalmic artery (interal carotid) which passes through superior orbital fissure

infraorbital branch of maxillary (exteral carotid)

VEINS

vena vorticosa, supratrochlear, supraorbital

NERVES

opthalmic branch of trigemminal nerve and all its divisions

occulomotor nerve

trochlear nerve

abducens nerve

infraorbital branch of maxillary nerve (trigemminal)

SYMPATHETIC STIMULATION

PARASYMPATHETIC STIMULATION

ASSOCIATED TISSUE

 

EAR

fenestra vestibuli (oval), fenestra cochleae (round), cochlea, vestibular apparatus,

BONES :

stapedius, incus, malleus

MUSCLES

internal : tensor tympani, stapedius

external : anterior auricular, superior auricular, posterior auricular

GLANDS :

none

BLOOD SUPPLY

ARTERIES

VEINS

NERVES

facial nerve ands its geniculate ganglion, vestibulocochlear nerve and its division into the vestibular nerve (balance) and its vestibular ganglion and cochlear nerve (hearing) and its cochlear ganglion.

Four nerves pass in front of ear from trigeminal nerve (supratrochlear, supraorbital, zygomaticotemporal, auriculotemporal) to sensory supply skin of scalp.

Four nerves pass behind ear from spinal nerves (great auricular, lesser occipital from ventral rami, greater and third occipital from dorsal rami) to sensory supply skin of scalp.

SYMPATHETIC STIMULATION

PARASYMPATHETIC STIMULATION

ASSOCIATED TISSUE

 

THYMUS

lymphatic structure

 

PAROTID GLAND

The parotid gland lies superior to facial and posterior auricular branches of external carotid artery but is inferior to superficial temporal branchs of external carotid artery. External carotid artery then passes superiomedially to the parotid gland. It lies superficial to masseter muscle and its duct passes anteriorly over masseter to pierce buccinator muscle and empty into the cheek near the second superior molar.

 

THYROID GLAND

An endocrine (ductless) gland located in the anterior, superior part of the trachea inferior to the larynx. Attaches to the fifth or sixth tracheal ring to the oblique line of the thyroid cartilage. Enclosed in a sheath which enables it to move with the trachea in swallowing and speaking. Usually larger in women. Two lobes joined medially by small isthmus. Lies deep to sternohyoid muscle, sternothyroid muscle, omohyoid muscle and anterior border of sternocleidomastoid muscle. Parafollicular cells between follicles in the connective tissue produces thyrocalitonin which lowers the level of blood calcium. Follicle cells in the simple cuboidal epithelium produce thyroglobulin. Lumen stores colloid (thyroglobulin and iodine) which eventually becomes thyroid hormone, which stimulates glucose oxidation increasing basal metabolic rate and also effects blood pressure and is important in tissue growth and development.

Cardiac and laryngeal (recurrent laryngeal, superior laryngeal) branches of the vagus nerve and branches of the cervical ganglia of the sympathetic trunk.

Apex of each lobe recieves superior thyroid artery (external carotid), base and deep lobes receives inferior thyroid artery.

Three pairs of veins drain the thyroid gland

n      superior thyroid vein at the upper end of each lobe which can join the internal jugular or facial vein

n      middle thyroid which joins internal jugular

n      inferior thyroid which follows the front of the trachea to the brachiocephalic vein

 

PARATHYROID GLAND

An endocrine (ductless) gland with paired superior and inferior lobes. Lie on the posterior surface of the thyroid capsule. Chief cells secrete parathyroid hormone which increases the level of blood calcium. Oxyfill cells are also present in the parathyroid but their function is unknown.

 

SUBMANDIBULAR GLAND

 

SUBLINGUAL GLAND

 

LACRIMAL GLAND

 

NOSE

Olfactory nerves (smell) only in superior concha pass into cribriform plate into olfactory bulbs.

 

TONGUE

n      BONES

n      MUSCLES

n      GLANDS

n      BLOOD

n      NERVES

SYMPATHETIC STIMULATION

PARASYMPATHETIC STIMULATION

ASSOCIATED TISSUE


 

Trigger Points of the Head & Neck

 


 

Arterial Supply of the Head & Neck

 

Arteries of the head and neck arise from the thyrocervical artery and vertebral artery branches of the subclavian artery as well as the common carotid artery which arises from the brachiocephalic artery on the right and the aortic arch on the left.

 

Carotid Sheath

fuses with the pretracheal fascia (surrounds the food and air passages as they pass from the neck into the upper thorax), prevertebral fascia, investing layer of deep cervical fascia

carotid body, carotid sinus baroreceptor (blood pressure)

 

Common Carotid Artery

The common carotid artery branches off the brachiocephalic artery on the right and off the aortic arch on the left. It branches to form the external carotid artery and internal carotid artery

External Carotid Artery :

n      Ascending Pharyngeal artery branches posteriorly, supplies palatoglossus muscle, palatopharyngeus muscle, inferior pharyngeal constrictor muscle

n      Superior Thyroid artery branches anteriorly, accompanies external superior laryngeal nerve branch of vagus nerve

( trachea, oesophagus)

n      Infrahyoid artery which supplies sternothyroid muscle, sternohyoid muscle, omohyoid muscle, thyrohyoid muscle

n      Superior Laryngeal artery which supplies cricothyroid muscle, posterior cricoarytenoid muscle, lateral cricoaretynoid muscle, transverse arytenoid muscle, vocalis muscle, thyroarytenoid muscle, oblique arytenoid muscle, aryepiglotic muscle, thyroepiglotic muscle, thyroid gland, upper parts of larynx and laryngeal part of pharynx, accompanies internal superior laryngeal nerve branch of vagus nerve to pierce thyroid membrane and enter the pharynx

n      Sternocleidomastoid artery which supplies superior portions of sternocleidomastoid muscle, inferior omohyoid muscle

n      Lingual artery which supplies sternohyoid muscle and branches anteriorly

n      Dorsal Lingual artery

n      Deep Lingual artery which supplies longitudinalis linguae muscle, transversus linguae muscle, verticalis linguae muscle

n      Sublingual artery which supplies genioglossus muscle, hyoglossus muscle, styloglossus muscle

n      Occipital artery branches posteriorly, accompanies greater occipital nerve, pierces trapezius and supplies most of the posterior half of the scalp

n      Sternocleidomastoid artery which supplies inferior portions of sternocleidomastoid muscle

n      Posterior Auricular artery which supplies occipitalis muscle, posterior auricular muscle branches posteriorly

n      Stylomastoid artery which supplies stapedius muscle

n      Facial artery branches anteriorly

n      Submental artery which supplies genioglossus muscle, hyoglossus muscle

n      Ascending Palatine artery which supplies uvula muscle, palatoglossus muscle, palatopharyngeus muscle

n      Inferior Labial artery

n      Superior Labial artery

n      Lateral Nasal artery

n      Angular artery which supplies orbicularis occuli muscle

       External Carotid artery then enters medial to the parotid gland

n      Maxillary artery branches anteriorly

n      Deep Auricular artery

n      Anterior Tympanic which supplies stapedius muscle

n      Middle Meningeal artery which enters cranial cavity

n      Superior Tympanic artery which supplies stapedius muscle, tensor tympani muscle

n      Accessory Meningeal artery

n      Inferior Alveolar artery

n      Mylohyoid artery which supplies mylohyoid muscle

n      Masseteric artery which supplies masseter muscle

n      Pterygoid artery

n      Anterior Deep Temporal artery which supplies temporalis muscle

n      Posterior Deep Temporal artery which supplies temporalis muscle

n      Buccal artery which supplies buccinator muscle

n      Posterior Superior Alveolar artery

n      Pharyngeal artery

n      Sphenopalatine artery enters nasal cavity through sphenopalatine foramen

n      Artery to Pterygoid Canal artery

n      Infraorbital artery which supplies inferior rectus muscle, inferior oblique muscle

n      Middle Superior Alveolar artery

n      Anterior Superior Alveolar artery

n      Superficial Temporal artery which supplies frontalis muscle, anterior auricular muscle, superior auricular muscle and divides :

n      Transverse Facial artery

n      Middle Temporal artery which supplies temporalis muscle

and then passes through the parotid gland.

 

As Sarah Lies Flat Oscars Penis Swells Majestically - major branches of external carotid artery

 

Internal Carotid Artery :

Passes into the carotid canal (temporal bone) and moves from lateral to medial along foramen lacerum to enter at its medial margin. Lies within the cavernous sinus as the carotid siphon. Supplies the dura, hypophysis, typanic cavity, trigemminal ganglion, optic nerve, optic chiasm, hypothalamus and genu of internal capsule. Gives off…

n      Opthalmic Artery which passes through the optic canal with the optic nerve and has nine (9) divisions :

n      Dorsal Nasi artery

n      Cilliary artery

n      Muscular artery which supplies lavator palpabrae superior muscle, superior oblique muscle, superior rectus muscle, inferior rectus muscle, inferior oblique muscle, medial rectus muscle, lateral rectus muscle

n      Supratrochlear artery

n      Supraorbital artery which supplies lavator palpabrae superior muscle, superior rectus muscle

n      Anterior Ethmoidal artery

n      Posterior Ethmoidal artery

n      Central Retinal artery is the only blood supply to the inner five layers of the retina

n      Lacrimal artery

n      Lateral Palpebral artery

n      Medial Palpebral artery which communicates with medial branch of opthalmic artery anterior to anterior ethmoidal artery

Internal carotid artery then becomes

n      Anterior Cerebral artery passing anteriorly, supplies the optic chiasm, medial surface of frontal lobe and parietal lobe, corpus callosum, leg and foot areas of paracentral lobule (motor and sensory cortices) and give of a branch …

n      Medial Striate Artery of Heubner which supplies the caudate nucleus, putamen and anterior limb of internal capsule

Left and right anterior cerebral arteries are joined via the …

n      Anterior Communicating artery

n      Middle Cerebral artery laterally as the internal carotid artery bifurcates, supplies lateral convexity of the hemisphere, insula, trunk arm and face areas of paracentral lobule (motor and sensory cortices), Broca area, Wernicke’s area, caudate nucleus, putamen and globus pallidus and branches as …

n      Lateral Striate artery to supply the anterior and posterior limbs of the internal capsule

The middle cerebral artery then passes posteriorly and becomes the …

n      Posterior Communicating artery arises from the carotid siphon and joins the posterior cerebral artery, supplies optic chiasm, optic tract, hypothalamus, subthalamus and anterior half of ventral thalamus

n      Anterior Choroidal artery supplies the choroid plexus of the temporal horn and lateral ventricle, hippocuampus, amygdala, optic tract, lateral geniculate body, globus pallidus, ventral part of posterior limb of internal capsule, proximal portion of optic radiations as they leave the lateral geniculate body (Meyer’s Loop)

n      Posterior Cerebral artery which supplies posterior half of thalamus, medial geniculate body, lateral geniculaet body, occipital lobe, visual cortex, inferior surface of temporal lobe,

n      Lateral Posterior Choroidal artery which supply dorsal thalamus, pineal body and choroid plexus of third and lateral ventricles

n      Medial Posterior Choroidal artery which supply dorsal thalamus, pineal body and choroid plexus of third and lateral ventricles

The left and right posterior cerebral arteries which has a branch passing medially to the from the…

n      Basilar artery which are formed by the fusion of the left and right vertebral arteries, gives rise to…

n      Pontine artery supplies corticospinal tracts and inta-axial exiting fibers of abducens nerve

n      Short Circmferential artery

n      Penetrating Circumferential artery

n      Anterior Inferior Cerebellar artery supplies the inferior surface of cerebellum, facial nucleus and intra-axial fibers of facial nerve, spinal trigemminal nucleus and spinal trigemminal tract, vestibular nuclei, cochlear nuclei, intra-axial fibers of vestibulocochlear nerve, spinothalamic tract and hypothalospinal tract

n      Labrynthine artery supplies the cochlea and vestibular apparatus

n      Superior Cerebellar artery supplies the superior surface of cerebellum, dentate nucleus, rostral pons, lateral pons, superior cerebellar peduncle and spinothalamic tract

n      Posterior Cerebral artery

 

Circle of Willis

Formed by anterior communicating artery, anterior cerebral artery, internal carotid artery, posterior communicating artery and posterior cerebral artery

 

Vertebral Artery :

The vertebral artery branches off the subclavian artery and is medial to the internal carotid artery it supplies the muscles of the suboccipital region : rectus capitis posterior minor muscle, rectus capitits posterior major muscle, obliquis capitis inferior muscle, obliquis capitis superior muscle.

n      Anterior Spinal artery supplies the anterior two thirds of spinal cord including lateral horn and ventral horn, pyramids, medial leminiscus, intra-axial fibers of hypoglossal nerve in medulla

n      Posterior Inferior Cerebellar artery supplies the dorsolateral zone of medulla, inferior surface of cerebellum, choroid plexus of fourth ventricle, medial vestibular nuclei, inferior vestibular nuclei, inferior cerebellar peduncle, nucleus ambiguis, intra-axial fibers of glossopharyngeal nerve and vagus nerve, spinothalamic tract, spinal trigemminal nucleus, spinal tirgemminal tract, hypothalamospinal tract, gives rise to …

n      Posterior Spinal artery supplies posterior one third of spinal cord including dorsal horn and dorsal column, gracile fasciculus, cuneate fasciculus, gracile nucleus, cuneate nucleus

The left and right verterbal arteries fuse to form the basilar artery superiorly approximately at the level of the pontomedullary junction

 

Thyrocervial Trunk :

The thyrocervical trunk branches off the subclavian artery and divides :

n      Inferior Thyroid artery which supplies the thyroid gland

n      Inferior Laryngeal artery which supplies posterior cricoarytenoid muscle

n      Transverse Cervical artery


 

Venous Drainage of the Head & Neck

 

External Jugular Vein

external jugular vein feeds into the brachiocephalic vein and lies superficial to sternocleidomastoid muscle

n      Suprascapular vein

n      Transverse Cervical vein

n      Anterior Jugular vein

n      Jugular Arch which joins its counterpart

n      Communicating vein to join Common Facial vein of Internal Jugular vein

n      Posterior Auricular from behind the ear

n      posterior division of Retromandibular vein is fed from

n      Retromandibular vein

n      Superficial Temporal vein

n      Maxillary vein

n      Transverse Facial vein

n      anterior division of Retromandibular vein is fed from

n      Facial vein

n      Deep Facial vein

n      Infraorbital vein

n      Angular vein

n      Supraorbital vein

n      Supratrochlear vein

n      communicates with Internal Jugular vein via common facial

 

Internal Jugular Vein

Internal Jugular vein feeds into Brachiocephalic vein

n      Common Facial vein joins with anterior division of Retromandibular vein

n      Continues into

Opthalmic Vein

 

SINUSES

Sigmoid sinus is a continuation of the transverse sinus, joins with internal jugular vein

Occipital Sinus lies in the falx cerebri and drains into the confluence of sinuses

Petrosquamous sinus

Basillar Plexus sinus connets inferior petrosal sinuses, communicates with internal vertebral venous plexus

Straight Sinus runs along attachment of falx cerebri to tentorium cerebelli, joins inferior sigital sinus to transverse sinus

Sphenoparietal sinus lies along posterior edge of lesser wing of sphenoid, drains into cavernous sinus

Superior Sagital sinus midline of convex border of falx cerebri

Marginal

Superior Petrosal sinus lies in margin of tentorium cerebelli, travels from posterior cavernous sinus into transverse sinus

Inferior Petrosal sinus drains cavernous sinus into internal jugular vein, runs in groove between petrous part of temporal and basilar part of occipital

Midle Meningeal sinus

Cavernous sinus located either side of sella turcica and body of sphenoid, internal carotid artery and abducens nerve pass through, occulomotor, trochlear, opthalmic and maxillary nerves travel froward in lateral wall, communicates with pterygoid venous plexus by emissary veins, recieves superior opthalmic vein

Lymphatic Drainage of the Head & Neck

 


 

Innervation of the Head & Neck

 

CRANIAL NERVES (TWELVE)

All originate from the brain superior to the spinal cord.

Carry special sensory, general somatic efferent and afferent, general visceral efferent and afferent (parasympathetic)…

 

“2,2,4,4”

2 - I, II originate from the forebrain

2 - III, IV originate from the midbrain

4 - V, VI, VII, VIII originate from the pons

4 - IX, X, XI, XII originate from the medulla

 

Ooh, Ooh, Ooh, To Touch And Feel Virgin Girls Vaginas And Hymens” - order of cranial nerves

Some Say Marry Money But My Brother Says Bad Boys Marry Money” - order of sensory or motor

 

I - The Olfactory Nerve

Olfaction (smell)

FUNCTION : sensory

Origin: forebrain

PASSAGE : cribriform palate of ethmoid bone

cell bodies located in nasal mucosa, continues on to brain as olfactory bulbs

 

II - The Optic Nerve

Vision, “tract of the brain”

FUNCTION : sensory

Origin: forebrain

PASSAGE : optic canal of sphenoid bone

ganglion cells located in the retina, accompanied by opthalmic artery through optic foramen to optic chiasma and continues on to opposite side of the brain as optic tracts

 

III - The Occulomotor Nerve

Occular (eye) movement

FUNCTION: motor

Origin: mid-brain

PASSAGE : superior orbital fissure of sphenoid bone

supplies four of six extrinsic muscles for eye movement : medial rectus muscle, inferior rectus muscle, superior rectus muscle and inferior oblique muscle as well as the dilator pupillae muscle and cilliary muscles (focal length) and levator palpebrae superior muscle

 

IV - The Trochlea Nerve

Passes through the trochela (L. pulley)

FUNCTION: motor

Origin: dorsal mid-brain (only cranial nerve to originate from dorsal surface of brain)

PASSAGE : superior orbital fissure

supplies superior oblique muscle for eye movement (depresses medially rotated eye, abducts and medially rotates)

 

V - The Trigeminal Nerve

teeth, skin of face, muscles (including mastication)

trigeminal ganglion inside of cranium

FUNCTION: sensory and motor (only Mandibular nerve)

Origin: pons

sensory supply to the skin of most of the face

scalp receives sensory branches from all three divisions of the trigeminal nerve

Trigeminal ganglion divides into three branches :  Opthalmic nerve, Maxillary nerve, Mandibular nerve

n      Opthalmic Nerve

five branches reach skin of face : Supraorbital nerve, Supratrochlear nerve, Lacrimal nerve, Infratrochlear nerve, Anterior Ethmoidal nerve

sensory supply to upper eyelid, forehead, anterior scalp, dorsum and upper nose

FUNCTION : sensory

PASSAGE : Divides into three branches within cavernous sinus all of which pass through superior orbital fissure (ethmoid):

n      Frontal nerve which divides :

n      Supraorbital nerve laterally which passes through supraorbital foramen (frontal) and then superficialy supplying forehead and scalp

n      Supratrochlear nerve medially which passes superiorly out of the orbit medial to supraorbital nerve to supply medial forehead and scalp

n      Lacrimal nerve which supplies the lacrimal gland, upper eyelid and is joined by a branch of the zygomatic nerve (mandibular branch of trigemminal)

n      Nasociliary nerve which divdes :

n      Short Ciliary nerve which supplies the ciliary ganglion (which also contains motor fibers from occulomotor nerve which supply pulillary constrictors and cilliary muscles)

n      Long Ciliary nerve which feeds into the eyeball

n      Before continuing medially to form :

n      Anterior Ethmoidal which supplies the nose tip

n      Posterior Ethmoidal

n      Infratrochlear nerve is the anterior continuation which supplies the lacrimal sack, skin of upper eyelid and upper portion of lateral nose

n      Maxillary Nerve 

sensory supply to lower eyelid, side of lower nose, upper cheek, upper lip

three branches reach skin of face : Infraorbital nerve, Zygomaticofacial nerve, Zygomaticotemporal nerve

FUNCTION : sensory

PASSAGE : foramen rotundum into pterygopalatine fossa then divides :

n      Zygomatic nerve which passses into the orbit and divides :

n      Zygomaticofacial nerve (cutaneous) which passes through zygomaticofacial foramen (maxilla) and supplies surrounding skin and lateral area of eye

n      Zygomaticoltemporal nerve (cutaneous) which passes through the anterior wall of the temporal fossa to join the lacrimal nerve branch of opthalmic nerve to sensory supply the anterior temple

n      Infraorbital nerve which divides

n      Posterior Superior Alveolar nerve which supplies posterior upper teeth and then continues on to pass through inferior orbital fissure (sphenoid)

n      Middle Superior Alveolar nerve which supplies middle upper teeth

n      Anterior Superior Alveolar nerve which supplies anterior upper teeth

It then continues on through infraorbital foramen (maxilla) to divide into :

n      Inferior Palpebral nerve which supplies lower eyelid

n      Nasal nerve which supplies ala of nose

n      Superior Labial nerve which supplies upper lip and cheek

Maxillary nerve then continues to join the pterygopalatine ganglion via the Ptergopalatine nerve and then divides :

n      Into the pterygopalatine ganglion which gives off the Posterior Superior Nasal nerve which supplies nose and palate which extends to the anterior maxilla as

n      Nasopalatine nerve which supplies mucosa of the hard palate

n      Palatine nerve which supplies the palate and divides

n      Posterior Inferior Nasal nerve which supplies the nose and palate

n      Lesser Palatine nerve to back of throat

n      Greater Palatine nerve along roof of mouth

n      Nerve of the Pterygoid Canal which divides to :

n      Join the greater petrosal nerve of the facial nerve which joins the geniculate ganglion

n      Deep Petrosal nerve which joins the internal carotid nerve

n      Mandibular Nerve

sensory supply to anterolateral ear, from ear to scalp, tympanic membrane, external auditory meatus, cheek, lower lip, chin, supplies muscles of mastication

three branches reach skin of face : Mental nerve, Buccal nerve, Auriculotemporal nerve

FUNCTION : sensory and motor

PASSAGE : sensory and motor roots join and pass through foramen ovale then divide :

n      To form an Anterior Division of Mandibular nerve

n      Lateral Pterygoid nerve which supplies lateral pterygoid muscle

n      Buccal  nerve which supplies sensory to entire thickness of cheek

n      Masseteric nerve which supplies masseter muscle

n      Posterior Deep Temporal nerve which supplies posterior portion of temporalis muscle

n      Anterior Deep Temporal nerve which supplies anterior portion of temporalis muscle

n      Medial Pterygoid nerve which supplies medial pterygoid muscle

n      Auriculotemporal nerve which supplies anterolateral ear, external accoustic meatus, lateral skin of head, tempromandibular joint, tympanic membrane, parotid gland, from ear to scalp

n      Inferior Alveolar nerve which gives off a branch:

n      Mylohyoid nerve which supplies mylohyoid muscle, anterior digastric muscle

Inferior Alveolar nerve then enters the mandibular foramen (mandible) to supply sensory to the lower molar and premolar teeth and divides terminally :

n      Incisor nerve which supplies the icisor teeth and canine teeth

n      Mental nerve which passes through the mental foramen (mandible) as three branches to supply sensory to the chin, lower lip and gingiva

n      Lingual nerve which supplies sensory (touch) fibers to anterior two thirds of tongue and is joined by chorda tympani nerve of the facial nerve, it supplies secretomotor fibers to the sublingual gland, it continues and gives branches to supply the submandibular ganglion which supplies the submandibular gland

facial communicating nerve

otic ganglion (tensor tympani muscle)

tensor veli palatini muscle

 

VI - The Abducens Nerve (lateral eye movement)

FUNCTION : motor

Origin: pons

PASSAGE : superior orbital fissure of sphenoid

Passes through cavernous sinus before entering superior orbital fissure

Supplies lateral rectus muscle for eye movement

 

VII - The Facial Nerve (facial expression)

geniculate ganglion inside facial canal

FUNCTION : motor and sensory

Origin: pons

PASSAGE : into internal acoustic meatus (temporal) and out of stylomastoid foramen (temporal), supplies stapedius muscle and passes alongside vestibulocochlear nerve whilst passing through inner ear

Two deep branches:

n      Joins pterygopalatine ganglion of trigemminal nerve as Greater Pertrosal nerve carrying parasympathetic nerve fibers to nasal mucosa and lacrimal gland

n      Contributes to the tympanic plexus of the glossopharyngeal nerve

n      Contributes to the inferior ganglion of the vagus nerve

n      Another branch divides :

n      To join mandibular nerve branch of trigemminal nerve as Chorda Tympani nerve then divides :

n      To join lingual nerve of trigemminal carrying sensory fibers for taste to anterior two thirds of tongue

n      To join submandibular ganglion of trigemminal nerve carrying parasympathetic nerve fibers to submandibular and sublingual glands and anterior two thirds of tongue (secretions)

n      To pass through stylomastoid foramen inferior-superficially

From stylomastoid foramen divides :

n      To supply stylohyoid muscle and posterior digastric muscle

n      As Posterior Auricular nerve which supplies posterior auricular muscle, occipitalis muscle

n      To enter the parotid gland and then exits as five superficial branches which supply motor fibers to muscles of facial expression (still as facial nerve):

n      Temporal nerve which supplies frontalis muscle, anterior auricular muscle, superior auricular muscle, corrugator supercill muscle, orbicularis occuli muscle

n      Zygomatic nerve which supplies orbicularis occuli muscle, corrugator supercilli muscle

n      Buccal nerve which supplies buccinator muscle, risorius muscle, zygomaticus major muscle, zygomaticus minor muscle, levator labi superior muscle, levator anguli oris muscle, orbicularis oris muscle

n      Marginal Mandibular nerve which supplies depressor anguli oris muscle, depressor labi inferior muscle, mentalis muscle, orbicularis oris muscle

n      Cervical nerve which supplies platysma muscle

 

Tall Zulus Bear Many Children” - superficial branches of the facial nerve

 

VIII - The Vestibulocochlear Nerve

Vestibule (balance), Cochelar (hearing)

FUNCTION : sensory

Origin: pons

PASSAGE : internal acoustic meatus of temporal

Divides whilst in temporal bone into :

n      Vestibular nerve which becomes the Vestibular Ganglion (balance)

n      Cochlear nerve which becomes the Cochlear Ganglion  (Spiral Ganglion) (hearing)

 

IX - The Glossopharyngeal Nerve

Glossal (tongue) and pharynx

superior ganglion, inferior ganglion (larger)

FUNCTION : motor and sensory

Origin: medulla

PASSAGE : jugular foramen (between temporal and occipital)

Joins otic ganglion of trigemminal nerve as lesser petrosal nerve supplying preganglionic parasympathetic fibers, communicates with the vagus nerve

With the pharyngeal nerve branch of the vagus nerve and the sympathetic forms the pharyngeal plexus trunk which lies on the middle pharyngeal constrictor muscle

supplies inferior pharyngeal constrictor muscle, middle pharyngeal constrictor muscle, stlyopharyngeus muscle, palatine tonsil and soft palate, pharynx, sensory and taste of posterior third of tongue, carotid sinus and carotid body (carotid sinus nerve), vallate papillae

 

X - The Vagus Nerve

Vagus (L. wanderer), organs

superior ganglion, inferior ganglion (larger)

FUNCTION : motor and sensory

Origin: medulla

PASSAGE : jugular foramen (between temporal and occipital)

n      supplies motor muscles of pharynx and soft palate

n      supplies sensory fibers to larynx

n      supplies parasympathetic fibers to heart, lungs, stomach, pyloric and cardiac sphincters of stomach, gall bladder, sphincter of Odi, liver, colon

n      Carotid Sinus and Carotid Body (Carotid Sinus nerve), Nerve to the Carotid Body

n      thyroid gland

n      Superior Laryngeal nerve which divides :

n      External Laryngeal nerve which supplies cricothyroid muscle, inferior pharyngeal constrictor muscle

n      Internal Laryngeal nerve which pierces the thyroid membrane and supplies the surface of larynx, piriform recess, epiglottic vallecula, small posterior part of dorsum of tongue

n      Recurrent Laryngeal nerve which supplies all muscles of larynx : posterior cricoarytenoid muscle, lateral cricoaretynoid muscle, transverse arytenoid muscle, vocalis muscle, thyroarytenoid muscle, oblique arytenoid muscle, aryepiglotic muscle, thyroepiglotic muscle, inferior pharyngeal constrictor muscle

n      secretory to all glands (…), palatoglossus muscle, all muscles of pharynx except stylopharyngeus muscle, all muscles of palate except tensor veli palatini muscle

 

XI - The Accessory Nerve (segment follows vagus nerve)

FUNCTION : motor

Origin: medulla

PASSAGE : cranial rootlet accompanies vagus nerve containing motor fibers, spinal rootlet gives rise to spinal accessory nerve and both pass through jugular foramen

spinal accessory which supplies sternocleidomastoid muscle, trapezius muscle

 

XII - The Hypoglossal Nerve

Glossal (tongue)

FUNCTION : motor

Origin: medulla

PASSAGE : hypoglossal canal

Loops around occipital artery, and passes between external carotid artery and interal jugular vein

Before entering tounge region gives off a infrerior branch which joins ansa cervicalis and runs inferiorly as decendens hyposi to supply thyrohyoid muscle

Then continues to supply three extrinsic muscles of the tongue: hyoglossus muscle (and its subdivision chondroglossus muscle), styloglossus muscle and genioglossus muscle and three intrinsic muscles of the tongue : longitudinalis linguae muscle, transversus linguae muscle and verticalis linguae muscle

 

CERVICAL PLEXUS

Located deep to sternocleidomastoid muscle and formed of the first four cervical nerves (C1, C2, C3, C4)

Dorsal roots contain afferent sensory fibers with cell bodies in the dorsal root ganglion

Ventral roots contain efferent motor fibers with cell bodies in the anterior horn of the spinal column

Dorsal and ventral rami contain afferent and efferent fibers

 

The trapezius muscle receives sensory fibers from the third and fourth cervical nerves

 

C1 Dorsal Ramus

obliqus capitis superior muscle
rectus capitis posterior minor muscle
rectus capitis posterior major muscle
obliqus capitis inferior muscle.

 

Greater Occipital Nerve

SOURCE : C2 Dorsal Ramus

accompanies occipital artery and supplies scalp up to sensory area of opthalmic nerve, passes posterior to ear

 

Lesser Occipital Nerve

SOURCE : ventral???? rami of C2 and C3

supplies skin of scalp behind ear (posterolateral aspect of neck), passes posterior to ear

 

Third Occipital Nerve

SOURCE : dorsal ramus of C3, passes posterior to ear

 

Greater Auricular Nerve

SOURCE : ventral rami of C2 and C3

skin of ear and over parotid gland, passes anterior to ear

 

Ansa Cervicallis Nerve

SOURCE : ventral rami of C1, C2 and C3

omohyoid muscle, sternohyoid muscle, sternothyroid muscle (all infrahyoid muscles except thyrohyoid muscle)

 

PARASYMPATHETIC NERVOUS SYSTEM

 

SYMPATHETIC NERVOUS SYSTEM

Cervical Sympathetic Ganglia

Three ganglia (superior, middle and inferior). Lie anterolateral to vertebral column. Receive no white rami communicantes as more superior than most superior white rami and therefore receive preganglionic fibers from superior thoracic spinal nerves.

 

Superior Cervical Sympathetic Ganglia

Located at the level of C1 and C2

 

Middle Cervical Sympathetic Ganglia

Located anterior to inferior thyroid artery branch of thyrocervical trunk (subclavian artery) at the level of the cricoid cartilage (larynx) and transverse process of C6 anterior to vertebral artery (subclavian artery)

 

Inferior Cervical Sympathetic Ganglia

Located anterior to transverse process of C7, superior to neck of 1st rib, posterior to the origin of the vertebral artery ()

Usually fused with the 1st and sometimes the 2nd thoracic sympathetic ganglia to form the stellate ganglion (or cervicothoracic ganglion).

 

AUTONOMIC NERVOUS SYSTEM

SOMATIC NERVOUS SYSTEM

 

 


 

Neuroanatomy (Head & Neck)

 

NEUROANATOMY

 

5 MAIN LOBES : frontal, parietal, occipital, temporal, insula

LOBES : inferior

 

GYRI :

Opercular Gyrus : Patch A of inferior temporal lobe

Triangular Gyrus : Patch B of inferior temporal lobe

Orbital Gyrus : Patch C of inferior temporal lobe

precentral gyrus, postcentral gyrus, gyrus rectus, supramarginal gyrus, angular gyrus, middle temporal gyrus, superior temporal gyrus, inferior temporal gyrus

 

SULCI :

Central Sulcus : seperates frontal lobe from parietal lobe

Lateral Sulcus : consists of ascending ramus, anterior ramus, and posterior ramus

precentral sulcus, postcentral sulcus, calcurine fissure, superior temporal sulcus, inferior temporal sulcus, intraparietal sulcus

 

VENTRICLES :

3rd Ventricle

4th Ventricle

Lateral Ventricle

Cerebral Aqueduct

Central Canal

 

FRONTAL LOBE

personality

 

PARIETAL LOBE

“committee”, Wernick’s Area (speech text)

 

OCCIPITAL LOBE

Calcurine fissure (visual)

 

TEMPORAL LOBE

memory and hearing, Brodman’s Area (41/42) (hearing)

 

INSULA LOBE

integration, smell and taste

 

Rhomboid Fossa : floor of the 4th ventricle, contains 4 drain holes (2 pairs)

Septum Pellucidum : twin layer that separates lateral ventricels

Superior Colliculus : visual, lateral geniculate nucleus (LGN), two bulbs

Inferior Colliculus : auditory, medial geniculate nucleus (MGN), two bulbs

Corporaquadgemina : superior and inferior colliculi

Cerebral Aqueduct : joins 3rd ventricle to 4th ventricle

Broca’s Area : Patch A (Opercular Gyrus) and Patch B (Triangular Gyrus)

Corpus Collosum

Posterior Commisuary

Anterior Commisuary

Fornix

Meninges

Faux Cerebri

Cutaneous Innervation of the Head & Neck

 


 

Dermatomes of the Head & Neck

 


 

Reflexes of the Head & Neck

 


 

Regional Anatomy of the Head & Neck

 

TRIANGLES OF THE NECK

 

Posterior Triangle

floor : serratus anterior muscle, omohyoid muscle, anterior scalene muscle
Suboccipital Triangle

Anterior Triangle

bounded by : sternocleidomastoid muscle
Carotid Traingle

 

SCALP

Skin

Close subcutaneous tissue - main nerves and vessels

Aponeurosis

Loose Connective Tissue

Periostium - outer layer of skull


 

Surface Anatomy of the Head & Neck

 


 

Acupuncture of the Head & Neck

 


 

Thorax & Abdomen

 

 

 

 

Bones

 

Joints

 

Movements & ROM

 

Muscles

 

Trigger Points

 

Organs

 

Arterial Supply

 

Venous Drainage

 

Lymphatic Drainage

 

Innervation

 

Neuroanatomy

 

Cutaneous Innervation

 

Dermatomes

 

Reflexes

 

Regional Anatomy

 

Surface Anatomy

 

Acupuncture


 

Bones of the Thorax & Abdomen

 

Sternnum

n      Manubrium - jugular notch, clavicular notch

n      Body of Sternum - sternal angle

n      Xiphoid Process - which originally cartilage but calcifies eventually after birth

 

Ribs - twelve ribs, head, tubercule, neck, costal groove (intercostal artery, intercostal vein and intercostal

nerve inferiorly), ribs pass forward and down,

n      True Ribs (1st - 7th) - attached to the sternum by individual costal cartilages

1st Rib - atypical, attaches T1 only, anteriorly attaches to top of manubrium, scalene tubercule for 

anterior scalene muscle, subclavian vein, subclavian artery and brachial plexus lie ontop of

2nd Rib - attaches T1 & T2, attaches to manubrosternal joint (sternal angle), tuberocity

for the serratus anterior muscle

n      Typical Ribs (3rd - 9th) - heads connect to two vertebrae, corresponding thoracic vertebrae and superior vertebrae, two articular facets,

3rd Rib - attaches T2 & T3

4th Rib - attaches T3 & T4        

5th Rib - attaches T4 & T5

6th Rib - attaches T5 & T6, attaches to xiphosternal joint

7th Rib - attaches T6 & T7

n      False Ribs (8th -12th) - 8th-10th ribs are connected to the costal cartillages above them to join sternum via 7th costal cartilage

8th Rib -

9th Rib -

10th Rib - attaches T10 only

n      Floating Ribs (11th - 12th) - only connected to vertebrae, no anterior attachment, no cartilage attachment to sternum, are not connected to transverse processes

11th Rib - attaches T11 only

12th Rib - attaches T12 only

 

Vertebrae - 24 vertabrae (» 33 including sacral & coxygeal), contain vertebral canal which contains the spinal cord, secondary curves are due to intervertebral discs, primary curves are due to the shape of the vertebral bodies

n      Cervical - 7 vertebrae, secondary curve (arches anteriorly), transverse formaina in transverse processes transmit vertebral artery (except C7), vertebral vein and autonomic nerve, possibly bifid spinous processes, smallest body, have anterior tubercule and posterior tubercule

C1 (atlas) - attaches superiorly to occipital bone of skull

Pons posticus – bony process forming a partial or complete bridge from the spinous process to the vertebral body, creates the arcuate foramen which transmits the vertebral artery, contradindicates cervical manipulation

C2 (axis) - dens (odontoid process)

Os odontoidium – agenesis or hypoplasia of odontoid process, accompanied by hyperplasia of anterior tubercule in accommodation, contraindicates cervical manipulation

C3 -

C4 -

C5 -

C6 -

C7 - transverse foramina does not transmit vertebral artery, is identifiable as the most superior vertebrae with a large spinous process that does not move with head rotation (it is the only cervical vertebrae that does not).

Cervical ribs (transitional vertebrae) – a rib of C7 joins 1st rib anterio-laterally, may manifest with thoracic outlet syndrome

 

n      Thoracic - 12 vertebrae, primary curve (arches posteriorly)

T1 - attaches to 1st rib

T2 - attaches to 1st and 2nd rib

T3 - attaches to 2nd and 3rd rib

T4 - attaches to 3rd and 4th rib

T5 - attaches to 4th and 5th rib

T6 - attaches to 5th and 6th rib

T7 - attaches to 6th and 7th rib

T8 - attaches to 7th and 8th rib

T9 - attaches to 8th and 9th rib

T10 - attaches to 10th rib

T11 - attaches to 11th rib

T12 - attaches to 12th rib

n      Lumbar - five vertabrae, secondary curve (arches anteriorly), largest body

L1 -

L2 -

L3 -

L4 -

L5 - attaches inferiorly to sacrum 

n      Saccrum - 5 vertebrae fused to form one bone, attaches superiorly to L5 and inferiorly to coccyx, primary curve (arches posteriorly), Sacral Foramina, Lateral Sacral Crest, Median Sacral Crest, Apex, Ala

n      Coccyx – 4-5 vertebrae fused to form one bone, “tail”, attaches superiorly to saccrum


 

Joints of the Thorax & Abdomen

 

Manubrosternal Joint

 

Xiphisternal Joint

 

Costovertebral Joint

 

Sternocostal Joint

 

Lumbosacral

 

 

Intervertebral Discs

            Prolapsed intervertebral disc (colateral or lateral)

lamina joined by ligamentum flava (“yellow”) which is highly elastic

anterior longitudinal ligament

posterior longitudinal ligament

 

LIGAMENTS

lateral and medial arcuate ligament (diaphragm muscle)

JOINTS

manubrosternal joint : synovial, contains fibrocartilage

ACTIONS

 


 

Movements & ROM of the Thorax & Abdomen

 


 

Muscles of the Thorax & Abdomen

 

Muscles of the Posterior Abdominal Wall

Quadratus Lumborum

Psoas Minor

Iliopsoas

Psoas Major

Iliacus

 

Muscle

 

Erector Spinae (spinotransverse) : spinalis, longissimus (thoracis, cervicis, capitis), illiocostalis (lumborus, thoracis, cervicis), splenius (capitus, cervicis)

 

Transversospinal : semispinalis, multifidus, rotatores

 

Interspinalis

 

Intertransversaria

 

MUSCLES OF THE THORACIC WALL

 

External Intercostal Muscle

fibers runs to form a “V”, 11 pairs

Origin: inferior border of upper rib

Insertion: superior border of lower rib

Action: elevates ribs during respiration, depresses ribs in forced respiration

Innervation: intercostal nerve

Blood Supply: intercostal arteries

 

Internal Intercostal Muscle

fibers run perpendicular to external intercostal muscle to form a “L”, 11 pairs

Origin: superior border of lower rib

Insertion: inferior border of upper rib

Action: depresses ribs during respiration, elevates ribs in forced expiration

Innervation: intercostal nerve

Blood Supply: intercostal arteries

 

Innermost Intercostals Muscle

11 pairs

Origin: superior border of lower rib

Insertion: inferior border of upper rib

Action: assists in respiration

Innervation: intercostal nerve

Blood Supply: intercostal arteries

 

Subcostalis Muscle

Origin: inner surface of each rib near angle

Insertion: medially two or three ribs below

Action: depresses ribs in expiration

Innervation: intercostal nerve

Blood Supply: intercostal arteries

 

Transversus Thoracis Muscle

Origin: inner surface of lower sternum

Insertion: inner surfaces of costal cartilages of 2nd to 6th ribs

Action: depresses ribs in expiration

Innervation: intercostal nerve

Blood Supply: intercostal arteries

 

Transversus Abdominus Muscle

fibers run like a “girdle”

Origin: inner illiac crest (innominate), lateral third of inguinal ligament, thoracolumbar fascia and cartilage of 7th to 12th ribs

Insertion: linea alba

Action: tenses abdonimal wall and assists lateral flexion

Innervation: 7th to 12th intercostal nerve, iliohypogastric nerve, ilioinguinal nerve

Blood Supply: lower intercostal artery, subcostal branch of internal thoracic (subclavian artery), lumbar artery

 

RECTUS SHEATH

 

Rectus Abdominus Muscle

Origin: cartillages of 5th to 7th ribs and xiphoid process

Insertion: pubic crest between tubercule and symphysis (innominate)

Action: flexes trunk and compresses abdomen

Innervation: 7th to 12th intercostal nerve

Blood Supply: superior epigastric branch of internal thoracic (subclavian artery), inferior epigastric branch of external illiac artery

 

Transverse Oblique Muscle

Origin:

Insertion:

Action:

 

Internal Oblique Muscle

fibers run parallel to internal intercostals “L”

Origin: middle illiac crest (innominate), lateral third of inguinal ligament and thoracolumbar fascia

Insertion: linea alba and lower border of 10th or 11th to 12th ribs

Action: ipsilateral rotation of trunk, lateral flexion and flexion of trunk, compresses abdomen

Innervation: 7th to 12th intercostal nerve, iliohypogastric nerve, ilioinguinal nerve

Blood Supply: lower intercostal artery, subcostal branch of internal thoracic (subclavian artery), lumbar artery

 

External Oblique Muscle

fibers run parallel to external intercostals “V”

Origin: lower border of 5th to 12th ribs

Insertion: outer illiac crest (innominate), inguinal ligament and anterior layer of rectus sheath (aponeurosis)

Action: contralateral rotation of trunk, lateral flexion and flexion of trunk and compresses abdomen

Innervation: 7th to 12th intercostal nerve, iliohypogastric nerve, ilioinguinal nerve

Blood Supply: lower intercostal artery, subcostal branch of internal thoracic (subclavian artery), lumbar artery

 

Pyramidial Muscle

Origin: ventral surface of pubis

Insertion: linea alba between umbilicis and pubic symphysis (innominate)

Action: tenses linea alba

Innervation: subcostal nerve

Blood Supply: superior epigastric branch of internal thoracic (subclavian artery), inferior epigastric branch of external illiac artery

 

Levator Costarum Muscle

Origin:

Insertion:

Action:

Innervation:

Blood Supply:

 

Cremaster Muscle

Origin:

Insertion:

Action:

Innervation:

Blood Supply:

Latissimus Dorsi Muscle

Origin: spinous process of T7 to L5, supraspinous ligament, upper 2-3 sacral segments, iliac crest, lower 8th or 9th to 12th ribs, inferior angle of scapula

Insertion: floor of bicipital (intertubercular) groove of humerus, part of crest of lesser tubercule of humerus

Action: extends arm from flexion, internally (medially) rotates arm, adducts arm, downward rotates scapula

Innervation: thoracodorsal nerve, C6 to C8

Blood Supply: thoracodorsal artery

 

Diaphragm Muscle

Origin: inner xiphoid process, inner surface of 7th-12th ribs, L1-L2/L3

Insertion: central tendon of diaphragm

Action: draws central tendon down to increase thoracic cavity volume

Innervation: phrenic nerve and intercostal nerve (C3-C5)

“C3, 4, 5 Keeps Us Alive”.

Phrenic nerve splits to innervate the crural and costal portions separately. This actions allows most of the diaphragm to contract and increase intra-abdominal pressure but remain uncontracted around the oesophagus for the act of emesis (vomiting).

Blood Supply: inferior phrenic artery, superior phrenic artery and musculophrenic branch of internal thoracic (subclavian artery)

Vena Caval Foramen

-      located in the central tendon

-      allows passage at the level of T8:

·     “Vena cava” has eight letters à T8

·     inferior venae cava

Oesophageal Hiatus:

-      allows passage at the level of T10:

·     “oesophagus” has ten letters à T10

·     eosophagus

·     left gastric artery

·     left gastric vein

-      bounded bilaterally by the left crus and right crus

Aortic hiatus

-      located posterior to diaphragm muscle

-      allows passage at the level of T12:

·     “aortic hiatus” has twelve letters à T12

·     thoracic aorta

·     thoracic duct

Lumbocostal Arches

 

 

Illiopsoas Muscle

Composed of illiacus muscle and psoas major muscle

 

Illiacus Muscle

Origin: inner surface of upper illiac fossa (innominate), anterior inferior illiac spine and anterior capsule of hip joint

Insertion: illiopsoas tendon to lesser trochanter of femur and medial aspect of linea aspera

Action: hip flexion and external rotation of femur

Innervation: femoral nerve, L2, L3, L4

Blood Supply: iliolumbar artery, deep circumflex iliac artery

 

Psoas Major Muscle

Origin: bodies of T12 to L4, intervertebral discs and transverse processes of L1 to L4

Insertion: illiopsoas tendon to lesser trochanter (femur) and medial aspect of linea aspera

Action: hip flexion and external rotation (femur)

Innervation: ventral rami, L1, L2, L3, L4

Blood Supply: iliolumbar artery, lumbar artery, subcostal artery

 

Psoas Minor Muscle

Origin:

Insertion:

Action:

Blood Supply:

 

Quadratus Lumborum Muscle

Origin: lateral lip of iliac crest (innominate) and iliolumbar ligament

Insertion: posterior inferior aspect of 12th rib and transverse process of L1 to L4

Action: stabilises and depresses 12th rib (expands thoracic cavity) and eccentrically stabilises lateral flexion to opposite side

Innervation: ventral rami, L1, L2, L3, L4

Blood Supply: lumbar artery, subcostal artery

 

ERECTOR SPINAE (SPINOTRANSVERSE) Muscle

All supplied by dorsal rami of spinal nerve

All supplied by muscular branches of the aorta

Common action of bilaterally extending the vertebral column, maintaining posture and stabilises vertebral column during flexion and unilaterally bending the vertebral column laterally and ipsilaterally rotating the vertebral column

 

Iliocostalis Lumborum Muscle

Origin: common tendonous origin from sacrum, iliac crest (innominate) and spinous processes of lower thoracic and most lumbar vertebrae

Insertion: lower border of angles of 6th to 12th ribs

Action: bilaterally extends and stabilised during flexion of the vertebral column and maintains posture and unilaterally bends laterally and ipsilaterally rotates the vertebral column

Innervation: dorsal rami of spinal nerve

Blood Supply: muscular branches of aorta

 

Iliocostalis Thoracis Muscle

Origin: upper border of 6th to 12th ribs medial to iliocostalis lumborum’s insertion

Insertion: lower border of angles of 1st to 6th ribs

Action: bilaterally extends and stabilised during flexion of the vertebral column and maintains posture and unilaterally bends laterally and ipsilaterally rotates the vertebral column

Innervation: dorsal rami of spinal nerve

Blood Supply: muscular branches of aorta

 

Iliocostalis Cervicis Muscle

Origin: angles of 1st to 6th ribs

Insertion: transverse processes of C4 to C6

Action: bilaterally extends and stabilised during flexion of the vertebral column and maintains posture and unilaterally bends laterally and ipsilaterally rotates the vertebral column

Innervation: dorsal rami of spinal nerve

Blood Supply: muscular branches of aorta

 

Longissimus Thoracis Muscle

Origin: common tendonous origin

Insertion: transverse process of T1 to T12 (all), between tubercules and angles of 1st to 12th ribs (all) and transverse processes of upper lumbar vertebrae

Action: bilaterally extends and stabilised during flexion of the vertebral column and maintains posture and unilaterally bends laterally and ipsilaterally rotates the vertebral column

Innervation: dorsal rami of spinal nerve

Blood Supply: muscular branches of aorta

 

Longissisus Cervicis Muscle

Origin: transverse processes of T1 to T6

Insertion: transverse processes of C2 to C6

Action: bilaterally extends and stabilised during flexion of the vertebral column and maintains posture and unilaterally bends laterally and ipsilaterally rotates the vertebral column

Innervation: dorsal rami of spinal nerve

Blood Supply: muscular branches of aorta

 

Longissimus Capitis Muscle

Origin: transverse and auricular processes of middle and lower cervical vertebrae and transverse processes of upper thoracic vertebrae

Insertion: posterior aspect of mastoid process of temporal bone

Action: bilaterally extends and stabilised during flexion of the vertebral column and maintains posture and unilaterally bends laterally and ipsilaterally rotates the vertebral column

Innervation: dorsal rami of spinal nerve

Blood Supply: muscular branches of aorta

 

Spinalis Thoracis Muscle

Origin: common tendonous origin

Insertion: spinous processes of T3 to T8

Action: bilaterally extends and stabilised during flexion of the vertebral column and maintains posture and unilaterally bends laterally and ipsilaterally rotates the vertebral column

Innervation: dorsal rami of spinal nerve

Blood Supply: muscular branches of aorta

 

Spinalis Cervicis Muscle

Origin: spinous processes of C6 to T2

Insertion: spinous processes of C2 and mybe C3 and C4

Action: bilaterally extends and stabilised during flexion of the vertebral column and maintains posture and unilaterally bends laterally and ipsilaterally rotates the vertebral column

Innervation: dorsal rami of spinal nerve

Blood Supply: muscular branches of aorta

 

Spinalis Capitis Muscle

Origin: spinous processes of lower cervical and upper thoracic vertebrae

Insertion: between superior and inferior nuchal lines (occipital bone)

Action: bilaterally extends and stabilised during flexion of the vertebral column and maintains posture and unilaterally bends laterally and ipsilaterally rotates the vertebral column

Innervation: dorsal rami of spinal nerve

Blood Supply: muscular branches of aorta

 

TRANSVERSOSPINAL MUSLCES

All innervated by dorsal rami of spinal nerve

All supplied blood by muscular branches of aorta

 

Semispinalis Thoracis Muscle

Origin: transverse processes of T6 to T12

Insertion: spinous processes of lower cervical and upper thoracic vertebrae

Action: bilaterally extends vertebral column, especially head and neck, controls contralateral, maintains head posture

Innervation: dorsal rami of spinal nerve

Blood Supply: muscular branches of aorta

 

Semispinalis Cervicis Muscle

Origin: transverse processes of T1 to T6, sometimes lower thoracic

Insertion: spinous processes of lower C2 to T5, sometimes T6

Action: bilaterally extends vertebral column, especially head and neck, controls contralateral flexion, maintains head posture

Innervation: dorsal rami of spinal nerve

Blood Supply: muscular branches of aorta

 

Semispinalis Capitis Muscle

Origin: transverse processes of T1 to T6, auricular processes of C4 to C7

Insertion: between superior and inferior nuchal lines of occipital bone

Action: bilaterally extends vertebral column, especially head and neck, controls contralateral flexion, maintains head posture

Innervation: dorsal rami of spinal nerve

Blood Supply: muscular branches of aorta

 

Multifidus Muscle

Origin:

  Cervical region : auricular processes of lower cervial vertebrae

  Thoracic region : transverse processes of all thoacic vertebrae

  Lumbar region : mamillary processes of all lumbar vertebrae, deep surface of tendonious origin of erector spinae muscle, lower portion of dorsal sacrum, posterior superior illiac spine

Insertion: spious processes extending from C2 to L5 (skips 2-4 vertebrae superiorly)

Action: bilaterally extends vertebral column, controls contralateral flexion, unilaterally rotates vertebral column to opposite side

Innervation: dorsal rami of spinal nerve

Blood Supply: muscular branches of aorta

 

Long Rotatores Muscle

Origin: transverse process of each vertebrae (ie : T7)

Insertion: spinous process of  vertebrae two superiorly (ie : T5)

Action: contralateral rotation, bilaterally extends vertebral column

Innervation: dorsal rami of spinal nerve

Blood Supply: muscular branches of aorta

 

DEEP BACK Muscle

 

Short Rotatores Muscle

Origin: transverse process of each vertebrae (ie : T7)

Insertion:  base of spinous processes of superior vertebrae (ie : T6)

Action: contralateral rotation, bilaterally extends vertebral column

Innervation: dorsal rami of spinal nerve

Blood Supply: muscular branches of aorta

 

Interspinalis Muscle

Origin: spinous process of each vertebrae (ie : T7)

Insertion: spinous process of superior vertebrae (ie : T6)

Action:extends vertebral column

Innervation: dorsal rami of spinal nerve

Blood Supply: muscular branches of aorta

 

Intertransversari Muscle

Origin:

Cervical region: anterior tubercule of transverse process of vertebrae, posterior tubercule of transverse process or vertebrae

Throacic region: poorly developed

Lumbar region: lateral aspect of transverse process of vertebrae, mamillary process of vertebrae

Insertion:

Cervical region: anterior tubercule of superior vertebrae, posterior tubercule of superior vertebrae   

Thoracic region: poorly developed

Lumbar region: lateral aspect of transverse process of superior vertebrae, accessory process of superior vertebrae

Action: laterally flexes each pair of vertebrae

Innervation: dorsal rami of spinal nerve

Blood Supply: muscular branches of aorta

 

Longus Coli Muscle

Origin: lower anterior vertebral bodies and transverse processes of vertebrae

Insertion: anterior vertebral bodies and transverse processes of vertebrae several segments above

Action: flexes the head and neck

Innervation: ventral rami of C2 to C6

Blood Supply: muscular branches of aorta

 

Longus Capitis Muscle

Origin: upper anterior vertebral bodies and transverse processes of vertebrae

Insertion: anterior vertebral bodies and transverse processes of vertebrae several segments above

Action: flexes the head and neck

Innervation: ventral rami of C1 to C3

Blood Supply: muscular branches of aorta

 

Rectus Capitis Anterior Muscle

Origin: anterior base of transverse process of atlas

Insertion: occipital bone anterior to formamen magnum

Action: flexes the head

Innervation: ventral rami of C2 and C3

Blood Supply: muscular branches of aorta

 

Rectus Capitis Lateralis Muscle

Origin: transverse process of atlas

Insertion: jugular process of occipital bone

Action: bends head laterally

Innervation: ventral rami of C2 and C3

Blood Supply: muscular branches of aorta

 

Papillary Muscle

Origin:

Insertion:

Action:

Innervation:

Blood Supply:

 

Dartos Muscle

Origin:

Insertion:

Action:

Innervation:

Blood Supply:

 

Cremaster Muscle

Origin:

Insertion:

Action:

Innervation:

Blood Supply:

 

Muscles of the Urogenital Diaphragm

Both innervated by the perineal nerve (pudnedal nerve [S2, S3, S4])

 

Deep Transverse Perineal Muscle (Transversus Perinei Muscle)

Origin: medial surface of the ischial ramus

Insertion: perineal body (central perineal tenson), also the vaginal wall in females

Action: steadies the perineal body, supports the pelvic floor and viscera as part of urogential diaphragm

Innervation: perineal nerve (pudnedal nerve [S2, S3, S4])

Blood Supply:

 

Sphincter Urethrae Muscle

Origin: medial surface of inferior pubic ramus bilaterally, base of bladder,

Male: invests the prostrate in the male anteriorly and anteriolaterally

Female: inferior portion blends with the anterolateral wall of the vagina (urethrovaginal sphincter)

Insertion: fibers join at midline around the urethra, some fibers encircle the membranous urethra in the male

Action: voluntary sphincter compresses the urethra

Male: membranous urethra

Female: urethra and vagina

Innervation: perineal nerve (pudnedal nerve [S2, S3, S4])

Blood Supply:


 

Trigger Points of the Thorax & Abdomen

 


 

Organs of the Thorax & Abdomen

 

PERICARDIUM

Fibrous Pericardium :

Serous Pericardium :

Transverse Sinus :

Oblique Sinus :

 

CARDIOVASCULAR SYSTEM

 

HEART

Passage of Blood

Systemic venous circulation to right atrium via superior vena cava and inferior vena cava

Right atrium to right ventricle via tricuspid (atrioventricular) valve

Right ventricle to pulmonary circulation via pulmonary (semilunar) valve into pulmonary trunk

Pulmonary circulation to left atrium via pulmonary vein

Left atrium to left ventricle via biscupid (atrioventricular) valve

Left ventricle to systemic arterial circulation via aortic (semilunar) valve into ascending aorta

 

left pulmonary artery has a fibrous connection to the arch of aorta called ligamentum arteriosum which is the remains of ductus ateriosus

 

Valves

Semilunar Valves : separate the ventricles from the major arteries

n      Pulmonary Valve : separates the right ventricle from the pulmonary circulation

n      Aortic Valve : separates the left ventricle from the systemic circulation

Atrioventricular Valves : separate the atria from the ventricles

n      Tricuspid Valve : separates the right atrium from the right ventricle

n      Biscupid or Mitral Valve : separates the left atrium from the left ventricle

 

Most of the right atrium is formed from the joining of the superior vena cava and inferior vena cava, the small muscular portion, the right auricle, makes up the rest of the right atrium and lies anteriorly.

Most of the left atrium is formed from the joining of the pulmonary vein, the small muscular portion, the left auricle, makes up the rest of the atrium and lies anteriorly.

Papillary muscle act to ensure the atrioventricular valves don’t collapse into the atria from the pressure.

Blood supply to the heart comes directly from the ascending aorta.

Fossa Ovalis is a hole which allows the right and left atria to communicate whilst an ebryo. This becomes covered by a fibrous layer before birth.

 

Sinoatrial (SA) node, atrioventricular (AV) node, purkinje fibers, atrioventricular bundle, cardiac plexus, bundle of his, autorhythmic,

SYMPATHETIC STIMULATION

PARASYMPATHETIC STIMULATION

right coronary artery, left coronary artery (circumflex), pulmonary arteries, anterior interventricular artery, posterior interventricular artery, pulmonary trunk, right marginal artery,

great cardiac vein, middle cardiac vein, small cardiac vein, oblique cardiac vein

ligamentum arteriosum, coronary sulcus, coronary sinus, pericardium (fibrous, serous), trabeculae carnae, chordae tendinae, barareceptors, blood pressure, anterior interventricular groove, left auricular process, right auricular process, apex, fossa ovalis, interatrial septum, musculi pectinati, crista terminalis, infundibulum, atrioventricular septum,

 

 

RESPIRATORY SYSTEM

 

Inspiration

Muscles of Inspiration

Quiet (Unforced) Inspiration

diaphragm muscle, external intercostal muscle, interchondral internal intercostal muscle,

 

Forced Inspiration

anterior scalene muscle, middle scalene muscle, posterior scalene muscle, serratus posterior superior muscle, serratus posterior inferior muscle, quadratus lumborum muscle, lavatores costarum muscle,

 

Both the diaphram muscle and external intercostal muscles are capable of maintaing inspiration (and expiration) by themselves, although breathing may be laboured.

 

Quiet (Unforced) Expiration

Expiration requires no muscular assistance but relies on the elastic recoil of the lung and the chest wall.

 

Muscles of (Active) Expiration

internal intercostal muscle, subcostal muscle, transversus thoracis muscle, rectus abdomius muscle

 

Trachea

-      is the inferior continuation of the respiratory system inferior to the larynx

-      begins at the inferior border of cricoid cartilage at C6

-      bifurcates at the level of the sternal angle and the junction of T4 and T5 into

-      Right Bronchus

·         is shorter and more vertical compared to left bronchus

·         more common site for foreign body lodgement

-      Left Bronchus

·         Primary Bronchi

o        Tertiary Bronchi

§        Terminal Bronchi

·        Alveolar Sacs

o        Alveoli

 

Lungs

Right Lung is smaller, heavier, shorter, wider

n      Right Main (primary) Bronchi is inferior to arch of azygous vein, single bronchial artery

n      Superior (Upper) Lobar (secondary)  Bronchi 

n      Segmental (tertiary) Bronchi

n      Apical bronchopulmonary segment

n      Posterior bronchopulmonary segment

n      Anterior bronchopulmonary segment

n      Horizontal Fissure

n      Middle Lobar (secondary)  Bronchi

n      Segmental (tertiary) Bronchi

n      Superior Linguilar bronchopulmonary segment

n      Inferior Linguilar bronchopulmonary segment

n      Oblique Fissure

n      Inferior Lobar (secondary)  Bronchi

n      Segmental (tertiary) Bronchi

n      Lateral Basal bronchopulmonary segment

n      Posterior Basal bronchopulmonary segment

n      Anterior Basal bronchopulmonary segment

n      Medial Basal bronchopulmonary segment

Left Lung two bronchial arteries

n      Left Main (primary) Bronchi

n      Upper Lobar (secondary) Bronchi

n      Segmental (tertiary) Bronchi

n      Apicoposterior bronchopulmonary segment

n      Anterior bronchopulmonary segment

n      Medial bronchopulmonary segment

n      Lateral bronchopulmonary segment

n      Oblique Fissure along the line of the 6th rib

n      Lingula

n      Lower Lobar (secondary) Bronchi

n      Segmental (tertiary) Bronchi

n      Lateral Basal bronchopulmonary segment

n      Posterior Basal bronchopulmonary segment

n      Anterior Basal bronchopulmonary segment

n      Medial Basal bronchopulmonary segment

 

apex, root, base

pulmonary hilum

pulmonary ligament

Bronchopulmonary Branches are the units of the lungs, they consist of secondary or tertiray broncus, branches of the pulmonary artery and lung tissue

Cardiac Notch

Linguala (tongue) is a tongue shaped portion of the left lung covering part of the pericardium medially, corresponds to the middle lobe of the right lung

Visceral Pleura extends into fissures

 

pulmonary vein

pulmonary artery

Hilum :

pulmonary artery superior

brachial artery

bronchus posterior

two pulmonary vein anterior and inferior

bronchial vein

arteries and bronchi tend to branch together

 

 

DIGESTIVE SYSTEM

Mucosa

n      Epithelium

n      Lamina Propria

n      Muscularis Mucosa

Submucosa : which contains the submucosal nerve plexus

Muscularis which contains the myenteric nerve plexus between the two muscle layers

n      Inner Circular muscle layer

n      Outer Longitudinal muscle layer

Serosa (Adventitia)

 

Foregut

Structures:

-                                   Stomach

-                                   Duodenal Cap

-                                   Descending Duodenum

-                                   Liver

-                                   Gall bladder

-                                   Pacreas

Arterial Supply:

Celiac trunk and its branches

Venous Drainage:

Portal vein

Lymphatic Drainage:

Celiac nodes and its branches

Innervation:

-      Parasympathetic: vagus nerve (perivascular)

-      Smypathetic: greater thoracic splanchnic nerves (T6 to T10)

Referred Pain:

Epigastric region

 

Midgut

Structures:

Structures:

-                                   Horizontal Duodenum

-                                   Ascending Duodenum

-                                   Jejunum

-                                   Ilium

-                                   Cecum

-                                   Ascengin Colon

-                                   Transverse Colon (first 2/3rds)

Arterial Supply:

Superior Mesenteric artery and its branches

Venous Drainage:

Superior Mesenteric vein

Lymphatic Drainage:

Supeiror Mesenteric nodes

Innervation:

-      Parasympathetic: vagus nerve (perivascular)

-      Smypathetic: lesser thoracic splanchnic nerves (T9 to L1)

Referred Pain:

Umbilical region

 

Hindgut

Structures:

-                                   Transverse Colon (distal 1/3rd)

-                                   Descending Colon

-                                   Sigmoid Colon

-                                   Rectum

-                                   Anal Canal (superior portion)

Arterial Supply:

Inferior Mesenteric artery and its branches

Venous Drainage:

Inferior Mesenteric vein

Lymphatic Drainage:

-      Inferior Mesenteric nodes

-      Right and Left Common Iliac nodes drains rectum

Innervation:

-      Parasympathetic: vagus nerve (perivascular)

-      Smypathetic: lesser thoracic splanchnic nerves (T9 to L1)

Referred Pain:

Hypogastric (suprapubic) region

 

STOMACH

The stomach is the continuation of the gastrointestinal tract between the oesophagus superiorly and the small intestine (duodenum) inferiorly.

Cardiac Notch : lies between the fundus and the oesophagus

Angular Notch : lies between the body and pylorus

Greater Curve : lateral edge of the stomach, gives rise to the lesser omentum

Lesser Curve : medial edge of the stomach, gives rise to the greater omentum

Cardiac Stomach :

Fundic Stomach :

Body of the Stomach :

Pyloric Stomach : communicates with the duodenum via the pyloric sphincter

 

The Stomach has an additional layer of muscle in the muscularis :

n      Innermost Oblique

 

rugae, pyloric sphincter, cardiac sphincter

 

SMALL INTESTINE

deuodenum, jejunum, illeum, deuodenal flexure, greater deuodenal papilla, lesser deuodenal papilla, hepatopancreatic ampulla, arcades, lymphoid aggregations, the messentery

 

LARGE INTESTINE

ileocecal junction, ileocecal valve, caecum, viriform appendix, ascending colon, transverse colon, descending colon, sigmoid colon, rectum, anorectal junction, anus, sphincters, appendices epiploicae (small fat bags), sigmoid mesocolon, transverse mesocolon

Teniae Coli : are the longitudinal muscle which form three bands around the innner circular muscle layer thus forming a “three leaf clover” appearance of three haustra (semilunar folds)

n      Tenia Libera : lies anteriorly

n      Tenia Mesocolica : lies medial to the ascending and descending colon and realtes to the origin of the mesocolon on the transverse colon

n      Tenia Omentalis : lies posteriorly and medially at transverse colon below origin of greater omentum

 

PANCREAS

pancreatic duct, inferior pancreaticoduodenal artery, empties into duodenum, pancreatic juice is basic (high pH)

Exocrine : glucagon (beta cells), insulin (alpha cells), somatostatin (delta cells)

Endocrine :

Pancreatitis, alcoholism

 

LIVER

largest visceral organ and largest gland, nutirents from the gut go to the portal/hepatic circulation first and are metabolically prepared by the liver for use by the body, moves with breathing, attaches to diaphragm,

falciform ligament, left triangular ligament, right triangular ligament, ligamentum teres hepatis (left umbilical vein), portal vein, hepatic artery, common bile duct, portal triad, round ligament, cystic duct, common hepatic duct,

hepatojugular reflex, enterohepatic circulation

 

gallbladder fossa

- shallow depression on inferior visceral surface of quadrate lobe

 

right lobe (anterior-superior area, posterior-superior area, medial-superior area, posterior-inferior area, anterior-inferior area, medial-inferior area), left lobe (lateral-superior area, lateral-inferior area),

ligamentum venosum, coronary ligament, inferior vena cava, quadrangular ligament, caudate ligament, porta hepatis, lesser omentum,

 

Gall Bladder:

-      Thin walled bluish-green pear shaped sac

-    stem represented by the cystic duct inferiorly

-    body and fundus represent the body of the pear

-      lies along right edge of quadrate lobe of the liver in the gallbladder fossa

-      covered by peritoneum on its inferior and posterior surfaces, occasionally completely invested with peritoneum

-      may be connected to liver by short mesentery

-      Fundus

-    rounded, wide, proximal end of gallbladder

-    projects from the inferior border of the liver

-    located at approximately the tip of the right 9th costal cartilage in the midclavivular line where the linea semilunaris of the rectus abdominus muscle meets the costal margin

-    passes inferiorly, anteriorly and laterally where it comes into contact with the posterior abdominal wall and descending part of duodenum

-      Body

-    passes superiorly, posteriorly and medial of the fundus

-    in contact with and attaches to the inferior visceral surface of the liver via loose connective tissue

-    in contact with the right transverse colon and superior part of the duodenum

-      Neck of the Gallbaldder

-    narrow, tapered and forms an “S” shaped bend

-    becomes continuous with the cystic duct

-    directed towards the porta hepatis of the liver (where the right hepatic duct and left hepatic duct join to form the common hepatic duct)

-    serves as a guide to the omental foramen (epiploic foramen) which lies immediately medial

-    Sprial Fold (Valve of Heister)

-        formed of muscosa from twisting of the neck of the gallbladder

-      Cystic Duct

-    ranges in length from 2cm to 4cm

-    runs between the layers of lesser omentum parallel to the common hepatic duct

-    passes initially superiorolateral from the gallbladder, then posteriorly then inferioirly to join the common hepatic duct

-    together with common hepatic duct from the liver forms the common bile duct immediately inferior to the porta hepatis

-    Spiral Fold of the cystic duct (Spiral Valve)

-        continuous with the spiral fold of the neck of the gallbladder

-        coils along the entire length of the cystic duct

-        maintains patencey of cystic duct to ensure

-      bile can pass into gallbladder when the common bile duct is closed by the choledochal sphincter and/or the hepatopancreatic sphincter

-      bile can pass into the duodenum when the gallbladder contracts

-      Functions

-      stores and concentrates bile from the liver

-      is able to hold 30ml to 60ml of bile

-      transitional epithelium

-      releases bile in response to hormones (cholecystokinin)

-      Arterial Supply

-      cystic artery branch of right hepatic artery between common hepatic duct and cystic duct, variations are common

-      Venous Drainage

-      fundus and body of gallbladder drain into anterior cystic vein and posterior cystic vein (right branch of portal vein)

-      biliary ducts and neck of gallbladder drain into the gastric vein, duodenal vein and pancreatic vein

-      Lymphatic Drainage

-      cystic lymph nodes near the neck of the gallbladder to hepatic lymph nodes (celiac lymph nodes)

-      Innervation

-      vagus nerve supplies parasympathetic fibers

-      celiac plexus supplies sympathetic fibers

-      right phrenic nerve supplies sensory fibers

-      hepatic plexus supplies part of the cystic artery

-      All these nerves pass alongside the cystic artery

 

SPLEEN

splenic artery, splenic vein, central artery, white pulp, red pulp, hilus, capsule, stores red blood cells, lymph node

 

URINARY SYSTEM

Micturition : act of urination

 

KIDNEYS

lies at the level between L1 and L4, ureter (right ureter lies behind duodenum), minor and major calyx, renal pelvis, sinus (inside hilus), suprarenal glands, renal capsule, renal pyramid, renal column (between pyramids), hilus, renin, coretex, medulla, medullary rays, lower and upper poles, renal fascia, renal papillae

 

renal vein anteriorly, ureter posteriorly, renal artery in middle

 

Nephrons : Bowman’s capsule, glomerulus (bunching of arterioles within Bowman’s capsule), urinary pole, vascular pole (where the afferent arteriole enters and efferent arteriole exits), proximal convoluted tubule, loop of Henle, distal convoluted tubule

vasa vecta (straight venule, straight arteriole)

 

Renal artery

n      Segmental arteries :

n      Interlobal arteries : passes between renal pyramids

n      Arcuate arteries : passes between medulla and coretex

n      Interlobular arteries : passes into coretex

n      Afferent arterioles : passes into glomerulus

n      Efferent arterioles : passes out of glomerulus

Renal vein is fed from

n      Segmental vein 

n      Interlobal vein : passes between renal pyramids

n      Arcuate vein : passes between medulla and coretex

n      Interlobular vein : passes medulla

n      Efferent venules : passes out of glomerulus  ????????

n      Afferent venules : passes into glomerulus ??????????

 

Ureters

-      thick walled, distensible muscular ducts

-      transmit urine from kidneys to the urinary bladder via peristalsis

-      continuous superiorly with the renal pelvis

-      narrow lumen

-      one bilaterally on each side, 2 in total

-      divided into two parts at the pelvic brim (abdominal ureter and pelvic ureter)

-      Abdominal Ureter

-      about 12cm long and 5mm wide

-      adheres closely to parietal peritoneum

-      lies retroperitoneal through its entirety

-      descends almost vertically anterior to the psoas major muscle

-      lie close to lumbar lymph nodes and the sympathetic trunk

-      right ureter lies close to the inferior vena cava

-      crosses the posterior brim of the pelvis and the external iliac artery just distal to the bifurcation of the common iliac artery on its anterior aspect

-      becomes the pelvic part of the ureter inferior to the pelvic brim

-      Pelvic Ureter

-      pass postereoinferiorly on the lateral wall of the pelvis external to parietal peritoneum and anterior to the internal iliac artery

-      curve atereomedially at around 1.5cm superior to the ischial spine (ischium) superior to levator ani muscle adhered to the peritoneum

-      Male

-      vas deferens passes between the ureter and the peritoneum

-      ureter lies lateral to vas deferens

-      ureter enters the postereosuperior angle of the urinary bladder immediately superior to the seminal vesicle

-      Female

-      descends on lateral wall of the pelvis minor forming the posterior border of the ovarian fossa

-      passes medial to the origin of the uterine artery

-      continues to the level of the ischial spine (ischium) where it is crossed superiorly by the uterine artery

-      passes close to the fornix of the vagina and enters the posteriosuperior angle of the urinary bladder

-      Arterial Supply

-      abdominal part

-      renal artery, gonadal artery (testicular artery or ovarian artery), abdominal aorta

-      pelvic part

-      external iliac artery, internal iliac artery, superior vesical artery and/or inferior vesical artery (male), uterine artery (female)

-      Venous Drainage

-      gonadal vein (testicular vein or ovarian vein)

-      Lymphatic Drainage

-      superior part of ureters join the kidney lymph vessels or pass directly into the lumbar lymph nodes (lareal aortic lymph nodes)

-      middle part of the ureters drain into the common iliac lymph nodes

-      inferior part of the ureters drain into the common iliac lymph nodes, external iliac lymph nodes or internal iliac lymph nodes

-      Innervation

-      All supply autonomic parasympathetic and sympathetic nerve fibers

-      renal plexus (lesser splanchnic nerve, lowest splanchnic nerve)

-      gonadal plexus (testicular plexus or ovarian plexus)

-      inferior hypogastric plexus

-      dorsal roots of T11, T12 and L1 supply sensory fibers

 

SUPRARENAL GLAND

endocrine gland, epinephrine (adrenaline), norepinephrine (noradrenaline), lies superior to kindeys, is attached to renal fascia

inferior suprarenal artery (renal artery), superior suprarenal artery (inferior phrenic artery), middle suprarenal artery (aorta),

 

BLADDER

urethra, trigone, ureters, transitional epithelium

 

Urogenital Diaphragm

-        Thin sheet of striated skeletal muscle stretching between the two sides of the pubic arch

-        Covers the anterior part of inferior pelvic aperture (pelvic outlet)

-        Anterior and posterior fibers run transversely (deep transverse perineal muscles)

-        Middle fibers surround membranous urethra (sphincter urethrae muscle)

 

Perineal Body

-        tendinous centre of the perineum

-        small and wedge shaped mass of connective tissue

-        landmark of perineum

-        attachment site of: deep transverse perineal muscle, bulbospongiosus muscle, levator ani muscle, external anal sphincter

 

REPRODUCTIVE SYSTEM

 

MALE REPRODUCTIVE ORGANS

prostrate gland, bulbourethral glands, ejaculatory duct, seminal vesicle

vas deferens

ductus deferens

genitofemoral nerve, superficial posterior scrotal nerve, dorsal nerve of the penis

testicular artery, deep artery of the penis, dorsal artery of the penis

 

PENIS

Penis is erectile tissue, homologous with the female clitoris, contains corpus spongiosum and paired corpus cavernosa

Corpus Spongiosum contains the urethra and is the inferior muscle of the penis, it is covered superiorly by the paired Corpus Cavernosum each of which contain a deep artery of the penis

Tunica Albunigea is fibrous connective tissue which covers the corpus cavernosum and corpus spongiosum

Tunica Vaginalis is a peritoneal sac that covers the front and sides of the testis and epididymis

Septum of the penis is the part of the tunica albunigea which separates the two corpus cavernosa

Bulbospongios muscle inserts into the corpus spongiosum

Ischocavernosus muscle inserts into the corpus cavernosum

Glans Penis is the continuation of the corpus spongiosum

Prepuce is a free fold of skin which covers the glans penis

Fenulum is the median ventral fold of the glans penis

 

TESTICLES

Scrotum are sacs of skin which contain pubic hair and sweat glands, outer most layer of the testicles, is homologous to the female labia majora

Epididymis

Seminiferous Tubules

Spermatic Cord

 

FEMALE REPRODUCTIVE ORGANS

ovaries, uterus, fallopian tubes, cervix, mammary glands, lactifierous ducts, vulva, internal cervical os, external cervical os, agnesa, genitofemoral nerve, ovarian artery

Labia Majora are large skin folds which contain pubic hair and sweat glands, are homologus to the male scrotum

Labia Minora are hairless and contain no fat, lateral parts form the prepuce of the clitoris and the medial parts form the frenulum of the clitoris

Vestibule is the space between the labia minora, contains the urethra, vagina and ducts of the greater vestibular glands

Cilioris is erectile tissue, homologous with the male penis, contains paired corpus cavernosa

Glans Clitoris is derived from the corpus cavernosa

Bulbospongiosus muscle forms a ring around the vaginal orifice

Ischiocavernosus muscle inserts into the corpus cavernosum

 

 


 

Viscerotomes of Thorax & Abdomen

 


 

Arterial Supply of the Thorax & Abdomen

 

Ascending Aorta

Aortic Arch

n      Right Brachiocephalic artery

n      Right Common Carotid artery

n      Right Subclavian artery (see Upper and Lower Limb for more branches)

n      Internal Thoracic artery

n      Anterior Cutaneous artery

n      Anterior Intercostal artery two per each of the upper six intercostal spaces, supply these spaces, external intercostal muscle, internal intercostal muscle, innermost intercostal muscle, serratus anterior muscle, pectoralis major muscle, pectoralis monir muscle

n      Upper branch anastomoses with posterior intercostal artery

n      Lower branch anastomoses with collateral branch of the posterior intercostal artery

n      Pericardiophrenic artery accompanies phrenic nerve, supplies the pericardium, pleura and upper surface of diaphragm muscle

n      Perforating branch perforate the internal intercostal muscle and accompany the anterior cutaneous branches of the intercostal nerve, supplies pectoralis major muscle

n      Medial Mammary branches from the 2nd to 4th perforating branches

The internal thoracic artery terminates at the sixth intercostal space as it divides into :

n      Musclophrenic artery laterally, supplies diaphragm muscle, pericardium and muscle of the abdominal wall, anastomoses with the deep circumflex iliac artery at the 10th intercostal space

n      Anterior branches two per each of the costal spaces from the 7th to 9th 

n      Superior Epigastric artery medially, descends on deep surface of rectuc abdominus muscle within rectus sheath, anastomoses with the inferior epigastric artery, supplies rectus abdominus muscle, diapgragm muscle, peritoneum and anterior abdominal wall

n      Left Common Carotid artery (see Head and Neck for branches)

n      Left Subclavian artery

n      Internal Thoracic artery identical branches to internal thoracic artery of right subclavian artery

Descending Aorta

n      Thoracic Aorta

n      Posterior Intercostal artery which the upper six anastomoses with anterior intercostal artery (internal thoracic artery) and the others continue on with the corresponding intercostal nerve

n      Collateral branch

n      Dorsal branch

n      Spinal branch

n      Lateral Cutaneous branch

n      Brachial artery

n      Abdominal Aorta which passes into abdomen through left and right crurae of the diaphragm muscle at level of T12

4 branches anteriorly

      - Coeliac Trunk

      - Superior Mesenteric

      - Inferior Mesenteric

      - Median Sacral

4 Branches laterally

      - Inferior Phrenic

      - Suprarenal

      - Renal

      - Gonadal

+ lumbar arteries

-        1 for each vertebrae

-        4 from abdominal aorta

-        1 from internal iliac

n      Inferior Phrenic artery

n      Superior Suprarenal artery

n      Celiac Trunk

n      Common Hepatic artery

n      Right Gastric artery

n      Hepatic A. Proper

n      Left Hepatic artery

n      Right Hepatic artery

n      Cystic artery

n      Gastroduodenal artery

n      Right Gastroepiploic artery

n      Splenic artery

n      Short Gastric artery

n      Left Gastroepiploic artery

n      Pancreatic branch

n      Left Gastric artery

n      Middle Suprarenal artery

n      Superior Messenteric artery which arises from aorta below celiac trunk

n      Middle Colic artery which anastomoses with the left colic artery via the marginal artery

n      Right Colic artery

n      Intestinal arteries

n      Ileocolic artery

n      Anterior Cecal artery

n      Posterior Cecal artery

n      Ileocecal artery

n      Appendicular artery

n      Renal artery comes of the aorta at L1

n      Inferior Suprarenal artery

n      Segmental artery which passes into the hilum of the kidney

n      Interlobal artery which passes between renal pyramids

n      Arcuate artery which passes between medulla and coretex

n      Interlobular artery which passes into coretex

n      Afferent arteriole which enters the glomerulus

n      Efferent arteriole which exits the glomerulus

n      Inferior Messenteric artery

n      Left Colic artery

n      Descending branch

n      Ascending branch which anastomoses with the middle colic atery via the marginal artery

n      Sigmoid artery

n      Superior Rectal artery

n      Testicular artery

Descending Aorta then terminates as it bifurcates at …

n      Common Illiac artery

n      External Illiac artery

n      Internal Illiac artery

 

(Obliterated) Umbilical artery

costocervical artery

thyrocervical artery

right coronary artery

left coronary artery

ovarian artery

inferior pancreaticoduodenal artery

jujenal artery

ileal artery

anterior superior pancreaticoduodenal artery

right gastroepiploic artery

posterior superior pancreaticoduodenal artery

 


 

Venous Drainage of the Thorax & Abdomen

 

Supeior Vena Cava

n      Azygous vein

n      Right Posterior Intercostal vein (5th to 11th)

n      Right Subcostal vein

n      Transverse Connecting vein joins the hemiazygous vein and/or accessory hemiazygous vein

n      Right Bronchial vein

n      Right Ascending Lumbar vein

n      Right Superior Intercostal vein

n      Hemiazygous vein joins the accessory hemiazygous vein inferiorly

n      Left Posterior Intercostal vein

n      Left Subcostal vein

n      Left Bronchial vein

n      Left Ascending Lumbar vein

n      Accessory Hemiazygous vein joins the hemiazygous vein superiorly

n      Left Superior Intercostal vein

 

internal vertebral venous plexus

 

Brachiocephalic vein

n      Internal Thoracic vein

n      Anterior Intercostal vein

n      Superior Epigastric vein

 

Inferior Vena Cava passes through central tendon of diaphragm muscle

n      Left Hepatic vein

n      Middle Hepatic vein

n      Right Hepatic vein

Alll three drain the

n      Hepatic Sinusoids of the liver

n      The Liver receives the Portal vein through the Porta Hepatis. The portal vein receives blood from the digestive tract and Spleen. It drains:

n      Pyloric vein

n      Cystic vein

n      Splenic vein

n      Short Gastric vein

n      Left Gastroepiploic vein

n      Pancreatic vein

n      Inferior Messenteric vein

n      Superior Rectal vein

n      Sigmoid vein

n      Left Colic vein

n      Superior Messenteric vein

n      Right Gastroepiploic vein

n      Right Colic vein

n      Omental vein

n      Iliocolic vein

n      Intestinal vein

n      Left Gastric vein

n      Inferior Phrenic vein

n      Lumbar veins

n      Right Suprarenal vein

n      Right Gonadal vein (Right Testicular vein or Right Ovarian vein)

n      Right Renal vein

n      Right Segmental vein 

n      Right Interlobal vein

n      Right Arcuate vein

n      Right Interlobular vein

n      Right Efferent venule ???

n      Right Afferent venule ???

n      Left Renal vein which has identical branches to right renal vein and is also joined by

n      Left Segmental vein 

n      LeftInterlobal vein

n      Left Arcuate vein

n      Left Interlobular vein

n      Left Efferent venule ???

n      Left Afferent venule ???

n      Left Suprarenal vein

n      Left Gonadal vein (Left Testicular vein or Left Ovarian vein)

n      Common Illiac vein

n      Ascending Lumbar vein

n      Internal Illiac vein

n      External Illiac vein

n      Median Sacral vein

 

 

thoracoepigastric vein joins the lateral thoracic vein and the superficial epigastric vein

subcostal vein

pulmonary vein

 


 

Lymphatic Drainage of the Thorax & Abdomen

 

Spleen, Gonads

 

Lumbar lymph nodes lie bilateral to abdominal aorta and inferior vena cava. Receives lymph from posterior abdominal wall, kidneys, ureters, testes, ovaries, uterus and uterine tubes and also receives lymph from the inferior mesenteric lymph nodes and common iliac lymph nodes (descending colon, pelvis and lower limbs).

 

Cisterna Chyli is an inferior expansion of the thoracic duct. Absent in some people. Located between the origin of the abdominal aorta and the azygos vein on the right side of the bodies of L1 and L2, posterior to the right crus of the diaphragm muscle.

 

Thoracic Duct is the main lymphatic duct which begins at the cisterna chyli and ascends through the aortic hiatus (diaphragm muscle) into the thorax. It empties lymph from the entire body except for the left half of the head and neck, the right upper limb and the right upper thorax into the vascular system at the lateral side of the junction of the left subclavian vien and left internal jugular vein.


 

Innervation of the Thorax & Abdomen

 

N.

Spinal nerves (31 pairs): are formed by junction of dorsal root (dorsal root ganglion) and ventral root of spinal cord, divides into dorsal ramus and ventral ramus (anterior cutaneous branch and lateral cutaneous branch), sympathetic ganglion, posterior border of spinal nerve is postvertebral muscle, dorsal rami in the lower parts of both secondary curvatures have little, if any, cutaneous distribution, dorsal rami of all spinal nerve except C1 are mixed (sensory and motor), dorsal roots are sensory

n      8 Cervical nerves : medial branches are cutaneous

C1:

C2:

C3:

C4:

C5:

C6:

C7:

C8:

n      12 Thoracic nerves: upper thoracic middle branches are mostly cutaneous, middle thoracic lateral branches are mostly cutaneous

T1 - T11 (Intercostal nerve) have branches lateral cutaneous nerve, anterior cutaneous nerve, are branches of the anterior primary ramus

T1 - T6 supply thorax and pass between internal intercostal muscle and innermost intercostal muscle

T1: in part joins brachial plexus

T2: sometimes contributes to brachial plexus

T3:

T4:

T5:

T6:

T7 - T12 supply thorax and abdomen and pass between internal oblique muscle and transverse abdominus muscle outside of costal margin

T7:

T8:

T9:

T10:

T11:

T12 (Subcostal nerve):

n      5 Lumbar nerves:

L1:

L2:

L3:

L4: lateral branch is a mixed nerve supplying both muscle and deep structures.

L5:

n      5 Saccral nerves:

S1:

S2:

S3:

S4:

S5:

n      1 Coccygeal nerve:

 

Spinal Cord

three meninges

n      Pia mater : delicate, closely invested in spinal cord and nerve

n      Arachnoid mater (“spider like”): delicate

n      Dura mater (“tough mother”): outermost, tough

n      Most superficial and toughest of the leptomeninges covering the CNS. The meningeal layer of the cranial dura is continuous with the spinal dura at the formaen magnum (occipital)

 

Dura, pia and arachnoid known as leptomeninges

dural sac (thecal) is composed of dura and arachnoid and forms sheath around neural structures

epidural space seperates dural sac from walls of vertebral canal

subdural space is a potential space between dura and arachnoid

subarachnoid space is between arachnoid and pia and contains cerebrospinal fluid (CSF)

spinal medulla ends at the level of the first lumbar vertebrae (L1)

 

chorda equinae

conus medallaris

filum tenrminallae

ligamenta denticulata

 

Pudendal nerve

n      Inferior Rectal nerve

n      Perineal nerve

n      Deep branch

n      Superficial Posterior Scrotal nerve (males)

n      Superficial Labial nerve (females)

n      Dorsal Nerve of the Penis (males)

n      Dorsal Nerve of the Clitoris (females)

 

Phrenic nerve (innervates a. costal and b. crural portions)

Vagus nerve

Recurrent Laryngeal nerve

greater splanchic nerve

lesser splanchic nerve

least splanchic nerve

illiohypogastric nerve

illioinguinal nerve

sympathetic trunk

pelvic splanchnic nerve

sinoatrial node

atrioventricular node

purkinje fibers

atrioventricular bundle

cardiac plexus

thoracic splanchnic nerve

thoracoabdominal nerve

 

PARASYMPATHETIC NERVOUS SYSTEM

SYMPATHETIC NERVOUS SYSTEM

 

AUTONOMIC NERVOUS SYSTEM

SOMATIC NERVOUS SYSTEM

Neuroanatomy (Thorax & Abdomen)

 

SPINAL COLUMN

Dura Mater : cerebrospinal fluid (CSF)

Arachnoid Mater :

Pia Mater (“Tough Mother”) : denticulate ligament, linea splendens, filum terminale

Spinal Medulla (Cord) : cauda equinae, cervical/brachial (upper limb) enlargement, lumbar (lower limb) enlargement,

 

dural sheath, posterior longitudinal ligament, spinal ganglion,


 

Cutaneous Innervation of the Thorax & Abdomen

 


 

Dermatomes of the Thorax & Abdomen

 

C5 - T12 all have thin strips of dermatome innervation corresponding to the location of the respective vertebrae. The dermoatomes pass forward and down similar to the ribs and intercostal nerve.


 

Reflexes of the Thorax & Abdomen

 


 

Regional Anatomy of the Thorax & Abdomen

 

MEDIASTINUM

 

Superior Mediastinum

BORDERS

n      Lateral : pleural cavity

n      Medial :

n      Inferior : plane from sternal angle to intervertebral disc between T4 and T5

n      Superior : oblique plane of 1st rib

n      Posterior :

n      Anterior : manubrium

CONTENTS

n      trachea

n      oesaphagus

n      thymus

n      phrenic nerve

n      vagus nerve

n      cardiac plexus

n      cardiac nerve

n      left recurrent laryngeal nerve (vagus nerve)

n      arch of aorta (brachiocephalic artery, left common carotid artery, left subclavian artery)

n      superior vena cava (both brachiocephalic veins)

n      terminal thoracic duct

n      lymph nodes

 

Anterior Mediastinum

BORDERS

n      Lateral : pleural cavity

n      Medial :

n      Inferior : diaphragm muscle

n      Superior : superior mediastinum

n      Posterior : pericardium, middle mediastinum

n      Anterior : sternum

CONTENTS

n      lymph nodes

n      mainly fat and connective tissue

 

Middle Mediastinum

lies between right and left pleural cavities

BORDERS

n      Lateral : pleural cavity

n      Medial :

n      Inferior : diaphragm muscle

n      Superior : superior mediastinum

n      Posterior : posterior mediastinum

n      Anterior : anterior mediastinum

CONTENTS

n      heart

n      pericardium

n      main bronchi

n      phrenic nerve

 

Posterior Mediastinum

BORDERS

n      Lateral : pleural cavity

n      Medial : pleural sacs

n      Inferior : diaphragm muscle

n      Superior : superior mediastinum

n      Posterior : vertebral column

n      Anterior : pericardium

CONTENTS

n      oesophagus

n      oesophageal plexus (vagus nerve)

n      sympathetic trunk

n      splanchnic nerve

n      descending aorta

n      azygous vein

n      hemiazygous vein

n      thoracic duct

n      lymph nodes

 

PLEURA

Parietal Pleura : lines the wall of the pleural cavity in the thorax, very sensitive to pain

n      Costal Pleura lines the thoracic wall, forms anterior, lateral and posterior walls of pleural cavity

intercostal nerve

internal thoracic artery, superior phrenic artery, posterior intercostal arteries, superior intercostal

arteries

n      Cervical Pleura (Cupula of the Pleura) is the superior continuation of the costal pleura, rises above level of 1st rib

n      Diaphragmatic Pleura is the inferior continuation of the costal pleura, forms the floor of the pleural and thoracic cavity, costal portion supplied by intercostal nerve, central portion supplied by phrenic nerve

n      Mediastinal Pleura is continuous anteriorly and posteriorly with the costal pleura, and inferiorly with the diaphragmatic pleura, surrounds the root of the lung, supplied by phrenic nerve

Visceral (Pulmonary) Pleura : covers the outside of the lungs and enters into fissures, insensitive to pain

vagus nerve

bronchial arteries

pulmonary vein

 

PLEURAL CAVITY

Pleural Cavity : is a potential space between the parietal pleura and the visceral pleura, contains fluid

n      Costodiaphragmatic Recess exists where costal pleura rises up to the superior surface of the diaphragm

n      Sternocostal Recess exists where costal pleura double backs on itself to become mediastinal pleura

n      Retroesophageal Recess exists where mediastinal pleura continues posteriorly with costal pleura

 

PERITONEUM

* = peritoneal ligament, not the same as a bone to bone ligament, contain blood vessels and and lymph

 

Retroperitoneal Organs : lie posterior to the peritoneum

n      kidneys

n      duodenum

n      pancreas

n      ascending colon (25-50% is covered)

n      descending colon (25-50% is covered)

n      sigmoid colon

n      rectum

n      abdominal aorta

n      celiac trunk

n      superior mesenteric artery

n      inferior mesenteric artery

n      inferior vena cava

n      superior mesenteric artery

n      inferior mesenteric artery

gastrointestinal regions alternate from retroperitoneal to peritoneal to stop twisting and tangling of gut

 

Intraperitoneal Organs: completely or mostly covered in peritoneum

n      stomach

n      liver

n      gall bladder

n      transverse colon

n      jejunum

n      ileum

n      cecum

 

Parietal Peritoneum: lines the wall of the peritoneal cavity

Visceral Peritoneum : covers the visceral organs of the abdomen

 

Gastrocolic Ligament* : duodenum and adjacent 2/3rds of stomach to transverse colon

Gastrolineal (Gastrosplenic) Ligament* : continuation of the gastrocolic ligament which joins the stomach to the spleen

Lineorenal Ligament* : continuation of the gastrolineal ligament which joins the spleen to the posterior abdominal wall, contains splenic vessels and tail of pancreas

Gastrophrenic (Phrenicosplenic) Ligament* : connects the fundus of the stomach and lower oesophagus to the diaphragm muscle, located above the spleen

Hepatogastric Ligament* : part of lesser omentum connecting the liver to the stomach

Hepatoduodenal Ligament* : is a continuation of the hepatogstric ligament which connects the liver to the duodenum, contains bile duct, hepatic artery, portal vein

 

Greater Omentum : connects to greater curve of stomach, fuses with messentery of transverse colon, contains lots of fat

Lesser Omentum : connects lesser curve of stomach, lower oesophagus and the first part of the duodenum to the inferior surface of the liver

 

Transverse Mesocolon : part of the greater omentum which connects to the transverse colon

Sigmoid Mesocolon : part of the greater omentum which connects to the sigmoid colon

The Mesentry : part of the greater omentum which connects to the small intestine

 

Epiploic Foramen : communication between the lesser sac and the hepatorenal recess of the greater sac

Greater Sac : anterior region created by greater omentum

Lesser Sac (Omental Bursa) : region posterior to stomach, created by lesser omentum

 

PERINEUM

Parietal Perineum :

Visceral Perineum :

 

ABDOMINAL REGIONS

 

Four Quadrants

Divided by

-      Midsagital plane: which passes through the midline vertically

-      Transumbilical plane: which passes through the umbilicas transversely

Creates four quadrants

-      Right Upper Quadrant (RUQ)

·      Contains

o      

-      Right Lower Quadrant (RLQ)

·      Contains

o      

-      Left Upper Quadrant (LUQ)

·      Contains

o      

-      Left Lower Quadrant (LLQ)

·      Contains

o      

 

Nine Regions

Divided by

-      Left and right Midclavicular lines: passes vertically through the midclavicular and midinguinal

-      Transpyloric Plane: passes transversely through the midpoint of the jugular notch (manubrium) and the pubic symphysis

·     Passes through the level of L1

·     Many important structures are located at this level

·         gall bladder

·         liver

·         pylorus (stomach)

·         duodenal bulb

·         pancreas body and tail

·         kidneys

·         spleen

Remembered by Grandparetns Like Paediatric Doctors Preventing Kids Sickness

-      Subcostal Plane: passes transversely through the inferior most margin of the ribs

-      Transtubercular Plane: passes transversely through the pubic tubercule

Creastes nine regions

-      Upper

·     Right Hypochondriac

·     Epigastric

·     Left Hypochondriac

-      Middle

·     Right Lumbar

·     Umbilical

·     Left Lumbar

-      Lower

·     Right Inguinal

·     Hypogastric (Suprapubic)

·     Left Inguinal

 

 

 

 


 

Surface Anatomy of the Thorax & Abdomen

 


 

Acupuncture of the Thorax & Abdomen

 

 


 

 

Umbilicus

In normal, physically fit individuals lies between L3 and L4

 

 

CLINICAL CONSIDERATIONS

INGUINAL HERNIA

A portion of the intestines (usually ilium???) get pushed under the inguinal ligament. More common in males ???

 

HIATUS HERNIA

The stomach gets pushed through the oesophageal hitaus of the diaphragm into the thoracic cavity

n      Sliding Hiatus Hernia

n      Rolling Hiatus Hernia

 

TRANSITIONAL VERTEBRAE

Skeletal congenital abnormalities occurring over the transitional regions of the spine : atlanto-occipital, cervicothoracic, thoarcolumbar and lumbosacral. Predisposes to other skeletal congenital abnormalities such as spina bifida etc.

n      Occipitalisation of cervical vertebrae

n      Cervical ribs (thoracic outlet syndrome)

-        joins 1st rib anterio-laterally

-        normally only C7

n      Lumbar ribs

n      Lumborisation of sacral or thoracic (rare) vertebrae

n      Sacralisation of lumbar vertebrae

 

GYNAECOLOGY

Salpingiogram, Histosalpingiogram (HSG) used to investigate the

Laproscopy

Papanicolou Smear

Human Choriononic Gonadotropin (HCG) released by placenta to stop degeneration of corpus luteum in pregnancy. Can be detected by unrinanalysis.

Menstrual Cycle (ovulatory phase, luteal phase, follicular phase),

Endometriosis, Ectopic Pregnancy, Histeromyoma, Infertility, Pelvic Inflammatory Disease (PID), Urinary Tract Infection (UTI)

 

DEATH

Section of the spinal cord above C3 will result in death without artificial respiration as the phrenic nerve and intercostal nerve originate from C3-C5. Both the diaphragm muscle (phrenic nerve) and external intercostal muscles (intercostal nerve) are capable of maintaining respiration by themselves.


 

Upper Limb

 

 

 

 

Bones

 

Joints

 

Movements & ROM

 

Muscles

 

Fascia

 

Trigger Points

 

Arterial Supply

 

Venous Drainage

 

Lymphatic Drainage

 

Innervation

 

Cutaneous Innervation

 

Dermatomes

 

Reflexes

 

Regional Anatomy

 

Surface Anatomy

 

Acupuncture

 


 

 

Bones of the Upper Limb

 

 

 

Clavicle

 

Scapula

 

Humerus

 

Ulna

 

Radius

 

Carpals

Scaphoid

Lunate

Triquetral

Pisiform

Trapezium

Trapezoid

Capitate

Hamate

 

Metacarpals

 

Phalanges

Proximal

Middle

Distal