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ANATOMY HANDBOOK

A Quick Reference for Gross Anatomy


S. Christopher Bennett, Ph.D. Version 3.2 November 4, 2006

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TABLE OF CONTENTS Introduction ............................................................... Terms of Orientation ....................................................... Terms of Movement .......................................................... Basic Principles ........................................................... HEAD AND NECK Osteology of the Head ...................................................... 5 Joints of the Skull ........................................................ 6 Muscles of the Posterior Triangle .......................................... 9 Prevertebral Muscles ...................................................... 11 Infrahyoid Muscles ........................................................ 13 Suprahyoid Muscles ........................................................ 15 Facial Muscles ............................................................ 17 Muscles of Mastication .................................................... 19 Muscles of the Tongue ..................................................... 21 Extrinsic Muscles of the Eye .............................................. 23 Cranial Nerves ............................................................ 24 Functions of Cranial Nerves ............................................... 25 Spinal Nerves of the Head and Neck ........................................ 27 Arteries of the Head and Neck ............................................. 29 Arteries and Veins of the Brain ........................................... 31 Veins of the Head and Neck ................................................ 33 Cross-section of the Neck ................................................. 34 BACK Osteology of the Postcranial Axial Skeleton ............................... Joints of the Postcranial Axial Skeleton .................................. Intermediate Muscles of the Back .......................................... Erector Spinae Muscles ................................................... Transversospinalis Muscles ................................................ Muscles of the Suboccipital Region ........................................ THORAX AND ABDOMEN Muscles of the Thoracic Wall .............................................. Muscles of the Abdominal Wall ............................................. Muscles of the Pelvis ..................................................... Muscles of the Perineum ................................................... Nerves of the Thorax ...................................................... Nerves of the Abdomen ..................................................... Arteries of the Thorax and Abdomen ........................................ Unpaired Visceral Branches of the Abdominal Aorta ......................... Veins of the Thorax and Abdomen ........................................... UPPER EXTREMITY Osteology of the Pectoral Girdle and Upper Extremity ...................... Joints of the Upper Extremity ............................................. Muscles attaching Upper Extremity to Trunk - Anterior Side ................ Muscles attaching Upper Extremity to Trunk - Posterior Side ............... 64 65 67 69 47 49 51 53 55 57 59 61 63 35 36 39 41 43 45 1 2 2 3

Muscles of the Shoulder Joint - Scapular Muscles .......................... Muscles of the Arm ........................................................ Superficial Extensors of the Forearm ...................................... Deep Extensors of the Forearm ............................................. Superficial Flexors of the Forearm ........................................ Deep Flexors of the Forearm ............................................... Other Muscles of the Forearm .............................................. Thenar and Hypothenar Muscles ............................................. Other Muscles of the Hand ................................................. Brachial Plexus ........................................................... Nerves of the Upper Extremity ............................................. Arteries of the Upper Extremity ........................................... Cutaneous Veins of the Upper Extremity .................................... Cross-section of the Arm .................................................. Cross-section of the Forearm .............................................. LOWER EXTREMITY

71 73 75 77 79 81 83 85 87 89 91 93 95 96 97

Osteology of the Pelvic Girdle and Lower Extremity ........................ 98 Joints of the Lower Extremity ............................................. 99 Muscles of the Anterior Thigh ............................................ 101 Muscles of the Medial Thigh .............................................. 102 Muscles of the Posterior Thigh ........................................... 103 Lateral Rotators of the Femur ............................................ 107 Gluteal Muscles .......................................................... 109 Muscles of the Anterior Crural Compartment - Dorsiflexors ................ 111 Muscles of the Posterior Crural Compartment - Superficial Plantarflexors . 113 Muscles of the Posterior Crural Compartment - Deep Plantarflexors ........ 115 Muscles of the Lateral Crural Compartment ................................ 117 Muscles of the Dorsum of the Foot ........................................ 119 Muscles of the Sole of the Foot - Layers 1-4 ............................. 121 Nerves of the Lower Extremity ............................................ 125 Nerves and Arteries of the Gluteal Region ................................ 127 Arteries of the Lower Extremity .......................................... 129 Cutaneous Veins of the Lower Extremity ................................... 130 Cross-section of the Thigh ............................................... 131 Cross-section of the Leg ................................................. 132

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INTRODUCTION This handbook contains much of the basic information about the bones, muscles, nerves, arteries, and veins of the body that is needed in a typical gross anatomy course. Such a course typically follows a regional approach, and so does the handbook. Within regions I have divided the material into small packets of information (a group of muscles; the pattern of arteries; etc.). I organize information visually, and so most packets consist of a drawing and some accompanying textual material, usually arranged on facing pages. I am often asked how one should study anatomy. I do not know how one should do it, I only know how I would study it. First I would divide up the material. In any particular region of the body the muscles can be divided into a number of groups, each containing a small number of muscles. Again I organize information visually so I usually have a drawing or an outline. I have already divided up the material for you. Then to study a group of muscles I would sketch them and label or note the origins, insertions, actions, and innervations. To study the pattern of arteries or nerves I would draw the pattern, name them, note the branching pattern, and where they go or what they do. All the drawings, in this handbook are simple enough that you can draw them. At first I might simply be copying my notes, but soon I would try to put the things down on paper from memory. If I could not remember some things, I would check my notes or look them up in the book, and try again until I had memorized the material and could put it down on a blank sheet of paper. If I can put it down on a blank piece of paper, I know I know it, and I know I can put it down on the test from memory. After having learned the muscles and the patterns of nerves and vessels, one other thing that I find helpful is to look over illustrations in anatomy texts and atlases and make sure you can understand them.

TERMS OF ORIENTATION Anterior - Toward the front, ventral. Posterior - Toward the back, dorsal. Dorsal - Pertaining to the back, therefore posterior. Ventral - Pertaining to the belly, therefore anterior. Superior - Higher than, situated above something else. Inferior - Lower than, situated below something else. Median - In the middle, referring to the midline of the body. Medial - Nearer to the midline of the body. Lateral - Farther to the side from midline of the body. Proximal - Nearest to the center of the body. Distal - Farthest from the center of the body. Superficial - At the surface. Deep - Below the surface. TERMS OF MOVEMENT Extension - Movement that straightens a joint. Flexion - Movement that bends a joint. ABduction - Movement of a limb or the head away from the midline of the body, or in the case of digits away from the axis of the limb. Adduction - Movement of a limb or the head toward the midline of the body, or in the case of digits toward the axis of the limb. Protraction - Movement (often sliding) of a body part forward. Retraction - Movement (often sliding) that pulls a body part backward. Elevation - Movement that lifts a body part up. Depression - Movement that pushes a body part down. Rotation - Movement of a limb about its axis. Medial and lateral rotation move the front of the limb medially and laterally, respectively. Circumduction - Movement that combines two other movements to move a body part in circles. For example, swinging the upper extremity in a circle combines flexion, extension, adduction, and aBduction. Note: To avoid confusion it is advisable to say "ad-duct" and "a-bee-duct".

BASIC PRINCIPLES OSTEOLOGY - Osteological features include: Head - articular end of bone Condyle - rounded knob for articulation Process - bony prominence Tubercle - a small rounded process Tuberosity - a large rounded process Trochanter - another name for a tuberosity on femur Epicondyle - process above condyle for attachment of muscles and/or ligaments Crest - a ridge Foramen - a hole through a bone Fossa - a depression Sulcus - a groove for a nerve, blood vessel, or tendon MUSCLES Muscles can only pull! Tense - apply force without length change Contract - shorten in length to move body parts Muscles are usually named by conventions: Action - e.g., Adductor longus Form - Size - e.g., Adductor magnus Length - e.g., Adductor longus Shape - e.g., Deltoideus Location - e.g., Tibialis posterior Attachment - e.g., Pectineus Muscles have: 1 - Origin - The attachment of a muscle on the bone that is fixed, generally the proximal end of the muscle. 2 - Insertion - The attachment of a muscle on the bone that is moved, generally the distal end of the muscle. 3 - Action - What happens when the muscle contracts. The action is usually described with a term of movement (e.g., flexion, extension, etc.) and the name of either the joint or the body part moved. Thus flex hip and flex thigh are equivalent. 4 - Innervation - Which nerve controls the muscle.

ARTERIES AND VEINS Arteries carry blood from the heart out to the body and veins return blood to the heart. The pattern of arteries and veins is described in the direction that blood flows. Large arteries branch into smaller arteries. Small veins join to become, or empty into, larger veins. Both are subject to topographic name changes, in which the name of a vessel changes after it has passed an anatomical landmark. Thus the External Iliac Artery becomes the Femoral Artery after passing under the Inguinal Ligament. Arteries and veins generally run together and have the same names. Therefore, if one learns the pattern of arteries one knows most veins as well. However, cutaneous veins do not accompany arteries. NERVES Nerves carry impulses from and to the brain. Nerves can be sensory, carrying impulses from receptors to the brain; motor, carrying impulses from the brain to muscles; or mixed, both sensory and motor. Nerves generally branch into smaller nerves, but small nerves can join to form a larger nerve. Nerves often run with arteries and veins, but the branching pattern of nerves usually differs from that of arteries and veins, and so the names of nerves usually differ from those of arteries and veins. VARIATIONS Variations on the pattern of structures presented in this handbook and most anatomy texts are common. Veins are particularly prone to variation, but nerves, arteries, and muscles also are variable. This will not be a problem in the lecture course because we will learn the "normal" pattern, but those in cadaver labs should be aware that variations occur and not be concerned by them. ABBREVIATIONS Terms of Orientation: Anterior Posterior Superior Inferior Medial Lateral Superficial External Internal Ant. Post. Sup. Inf. Med. Lat. Superf. Ext. Int.

Structures:

Muscle Artery Vein Nerve Ligament

SINGULAR PLURAL M. Mm. A. Aa. V. Vv. N. Nn. Lig. Ligg.

OSTEOLOGY OF THE HEAD SKULL - consists of two distinct parts: BRAINCASE - Bones: Frontal Parietals (2) Temporals (2) Occipital Sphenoid Sagittal - between parietals Coronal - between frontal and parietals Lambdoidal - between parietals and occipital Zygomatics (2) Nasals (2) Lacrimals (2) Maxillae (2) Palatines (2) Sphenoid Ethmoid Vomer Braincase and Face

Sutures:

FACE -

Bones:

FEATURES OF THE SKULL Orbits - sockets for eyeballs Optic Canal - for Optic N. and Ophthalmic A. Superior orbital fissure - between wings of sphenoid for CN III, IV, VI and ophthalmic division of Trigeminal N. Nasal aperture - external opening of nasal passages Nasal septum - separates nasal passages Infraorbital foramen - for Infraorbital NAV to supply nasal region Zygomatic arch External auditory meatus - opening of auditory canal Greater and lesser wings of sphenoid Sella turcica [=Turkish saddle] - depression for pituitary gland Cribriform plate of ethmoid - for Olfactory N. Hard palate - formed of palatine and maxillae Pterygoid plates - origin of pterygoid Mm., wall of pharynx Mandibular fossa - articulates with condyloid process of mandible Styloid process of temporal - origin of Stylohyoid, Styloglossus, and Stylopharyngeus Mastoid process of temporal - origin of Digastric, insertion of Sternocleidomastoid and Splenius capitus Occipital condyles - articulate with atlas Foramen ovale - for CN V2 Foramen rotundum - for CN V3 Foramen spinosum - for Middle meningeal A. Foramen lacerum - closed by cartilage Carotid canal - for Internal carotid A. Jugular foramen - for Internal jugular V. and CN IX-XI Stylomastoid foramen - for CN VII Foramen magnum - for spinal cord

MANDIBLE Body Ramus Angle - insertion of Masseter and Medial pterygoid Condyloid process - articulates with skull Coronoid process - insertion of Temporalis Mandibular foramen - for Inferior alveolar A+N Mental foramen - for Mental A+N to supply chin Mylohyoid Line - insertion of Mylohyoid Mental Spines - origin of Geniohyoid TEETH - on each side, top and bottom 2 1 2 3 Incisors Canine Premolars ("bicuspids") Molars - not preceded by deciduous teeth

HYOID BONE JOINTS OF THE SKULL Movement of Temporo-mandibular joint - rotation to elevate and depress mandible - lateral displacement - protraction and retraction Movements of Atlanto-occipital joint Skull-atlas - flexion and extension

NOTES

MUSCLES OF THE POSTERIOR TRIANGLE MUSCLE ORIGIN INSERTION ACTION/(NERVE) Splenius capitus Lower Ligamentum nuchae and spines of upper thoracic vertebrae Back of mastoid process, and superior nuchal line Extends, rotates, and laterally flexes head and neck (Dorsal rami of cervical Nn.) Elevates scapula (Ventral rami of C3-5)

Levator scapulae

Transverse processes of cervicals 1-4 Transverse processes of cervical vertebrae 3-6 Transverse processes of all cervical vertebrae Transverse processes of cervical vertebrae 4-6 By two heads from anterior surface of manubrium, and upper surface of clavicle

Upper border of the scapula

Scalenus anterior

Scalene tubercle of 1st rib

Scalenus medius

1st rib behind groove for Subclavius Outer side of 2nd rib

Elevate ribs, and laterally flex neck (Ventral rami of cervical Nn.)

Scalenus posterior

Sternocleidomastoid

Short tendon to outer surface of mastoid process and lateral 1/3 of superior nuchal line

Flexes, rotates, and laterally flexes head and neck; elevates sternum and ribs (Spinal Accessory N.) Tenses skin of neck (Facial N.)

Platysma

Skin and fascia of pectoral and anterior deltoid regions

Lower border of mandible

Note: The posterior triangle is bounded by Trapezius posteriorly, Sternocleidomastoid anteriorly, and the clavicle inferiorly. It contains Semispinalis capitus, Splenius capitus, Levator scapulae, the scalenes, and Omohyoideus.

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PREVERTEBRAL MUSCLES MUSCLE ORIGIN INSERTION ACTION/(NERVE) Longus capitus Transverse processes of middle 4 cervical vertebrae Bodies of upper thoracic and lower cervical vertebrae Occipital bone

Longus colli

Transverse processes and bodies of upper cervical vertebrae

Flexes head and neck (Ventral rami of cervical Nn.)

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INFRAHYOID MUSCLES MUSCLE ORIGIN INSERTION ACTION/(NERVE) Sternohyoid Back of manubrium Hyoid bone Depresses hyoid (Ansa cervicalis) Depresses thyroid cartilage (Ansa cervicalis) Depresses hyoid (Hypoglossal N.) Depresses hyoid (Ansa cervicalis)

Sternothyroid

Back of manubrium

Thyroid cartilage

Thyrohyoid

Thyroid cartilage

Hyoid bone

Omohyoid

Upper border of scapula and suprascapular ligament

2 bellies with an intermediate tendon passing through a ligamentous pulley - inserts on hyoid bone

Note: The Ansa cervicalis is a LOOP formed by branches of the Hypoglossal N. and C2,3 anterior to the Carotid sheath, and lying on top of the Internal Jugular V. Branches run from the bottom of the loop to innervate Sternohyoid, Sternothyroid, and Omohyoid.

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SUPRAHYOID MUSCLES MUSCLE ORIGIN INSERTION ACTION/(NERVE) Stylohyoid Styloid process Passes around Digastric and inserts on greater horn of hyoid bone Body of hyoid bone Elevate and retract hyoid (Facial N.)

Mylohyoid

Mylohyoid line of mandible

Elevate hyoid (Inferior alveolar N.) Protracts hyoid (Hypoglossal N.)

Geniohyoid

Mental spines of mandible below Genioglossus Posterior belly from mastoid notch of temporal bone

Body of hyoid bone

Digastric

Passes by intermediate tendon through Stylohyoid; anterior belly inserts on inferior surface of mandible near symphysis

Elevates hyoid; depresses and retracts mandible (Facial and Inferior alveolar Nn.)

Note: Mylohyoid forms the floor of the mouth and supports Geniohyoid, the muscles of the tongue, salivary glands, etc.

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FACIAL MUSCLES MUSCLE ORIGIN INSERTION ACTION/(NERVE) Frontalis Procerus Anterior skull Upper part of lateral nasal cartilages Skin over forehead and eyebrows Skin over lower forehead Elevates eyebrows Depresses medial part of eyebrows Closes eye Flares nostrils

Orbicularis oculi Nasalis

Ring of muscles encircling eyes Maxilla above canine Lateral nasal cartilage; part passes across bridge of nose Orbicularis oris

Levator labii superioris Levator anguli oris Zygomaticus minor Zygomaticus major Orbicularis oris Buccinator

Maxilla over the infraorbital foramen Maxilla below infraorbital foramen Outer part of zygomatic arch Zygomatic arch

Elevates and everts upper lip Elevates and everts upper lip Elevates and everts upper lip Elevates upper lip Closes mouth Compresses cheeks

Corners of orbicularis oris Skin and muscle of upper lip Corners of orbicularis oris

Ring of muscles encircling mouth Outer part of posterior maxilla and mandible Outer surface of mandible Outer surface of mandible Mandible below incisors Orbicularis oris

Depressor anguli oris Depressor labii inferioris Mentalis

Corners of orbicularis oris Skin over medial lower lip and orbicularis oris Skin over chin

Depresses angles of mouth Depresses lower lip Elevates skin over chin and protrudes lower lip

Note: All muscles of the face are innervated by the Facial N.

Note: In the drawing, superficial muscles inserting into Orbicularis oris are oriented inferomedially, whereas deep muscles are oriented inferolaterally.

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MUSCLES OF MASTICATION MUSCLE ORIGIN INSERTION ACTION/(NERVE) Masseter Zygomatic arch Outer surface of ramus of mandible Elevates and protrudes mandible (Trigeminal N.) Elevates and retracts mandible (Trigeminal N.) Elevates and laterally displaces mandible (Trigeminal N.) Protrudes mandible (Trigeminal N.)

Temporalis

Fan-shaped area on side of skull

Coronoid process of mandible

Medial pterygoid

Medial surface of lateral pterygoid plate

Ramus of mandible near angle

Lateral pterygoid

Lateral surface of lateral pterygoid plate

Neck of mandible near articulation

Note: N. All muscles of mastication are innervated by branches of the Trigeminal

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MUSCLES OF THE TONGUE MUSCLE ORIGIN INSERTION ACTION/(NERVE) Styloglossus Styloid process Into side of tongue Retracts and elevates tongue (Hypoglossal N.) Retracts and depress tongue; deflects tongue to side (Hypoglossal N.) Retracts, protrudes, and depresses tongue (Hypoglossal N.) Changes shape of tongue (Hypoglossal N.)

Hyoglossus

Hyoid bone

Into side of tongue

Genioglossus

Mental spines of mandible

Fan out beneath body of tongue

Lingualis

Muscular body of tongue that lies on top of Genioglossus

Note: All muscles of the tongue are innervated by the Hypoglossal N.

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EXTRINSIC MUSCLES OF THE EYE MUSCLE ORIGIN INSERTION ACTION/(NERVE) Superior rectus Top of eyeball Turns eyeball up (Oculomotor N.) Turns eyeball down (Oculomotor N.) Turns eyeball in (Oculomotor N.) Turns eyeball out (Abducens N.) Turns eyeball down and out (Trochlear N.)

Inferior rectus

Botton of eyeball

Medial rectus

Lateral rectus

Common tendinous ring around Optic N. at back of orbit

Medial side of eyeball Lateral side of eyeball Passes through trochlea, then laterally under Superior rectus, and inserts on upper lateral side of eyeball Passes laterally under Inferior rectus, and inserts on upper lateral side of eyeball Into upper eyelid

Superior oblique

Inferior oblique

Lower medial anterior corner of orbit

Turns eyeball up and out (Oculomotor N.)

Levator palpebra superioris

Posterior roof of orbit

Elevates upper eyelid (Oculomotor N.)

Note: The obliques pass backward to the eyeball from the anterior medial corners of the orbit so they can turn the eyeball up and down.

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CRANIAL NERVES I - Olfactory N. - beneath the frontal lobe, it sends branches through cribriform plate into nasal cavity. II - Optic N. - large nerve passing through optic canal and into eyeball. III - Oculomotor N. - found in orbit, it innervates Superior, Inferior, and Medial rectus Mm., Levator palpebra, and Inferior oblique. IV - Trochlear N. - found in orbit, it innervates Superior oblique. V - Trigeminal N. - main nerve of deep face, divides into three divisions: 1 - Ophthalmic division - passes up into orbit through sup. orb. fissure. A - Frontal N. - passes through top of orbit above eye, it exits supraorbital notch and becomes Supraorbital N., which passes up onto forehead. 2 - Maxillary division - deep in maxillary bone. A - Infraorbital N. - exits infraorbital foramen with Infraobital A. to supply central part of face. 3 - Mandibular division - passes down to mandible. A - Inferior alveolar N. - enters mandibular foramen and passes through mandible with Inferior alveolar A. It becomes Mental N. as it exits mental foramen to innervate chin. B - Lingual N. - passes between tongue and mandible to supply tongue VI - Abducens N. - found in orbit, it innervates Lateral rectus. VII - Facial N. - emerges deep to parotid gland and divides into many branches which spread out over face and innervate facial muscles. VIII - Vestibulocochlear N. - to inner ear deep in temporal bone. IX - Glossopharyngeal N. - descends medial to styloid process, supplies Stylopharyngeus and back of pharynx and tongue. X - Vagus N. - runs down neck with Internal jugular V. and Common carotid A. XI - Accessory N. - pierces back of Sternocleidomastoid and crosses posterior triangle of neck to supply deep side of Trapezius. XII - Hypoglossal N. - found near posterior belly of Digastricus, passes down and around External carotid A., then forward below tongue between Mylohyoid and Hyoglossus. Note: Mnemonic - O, O, O, to touch and feel virgin girls' vagina and hymen!

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FUNCTIONS OF CRANIAL NERVES CN # NAME SPECIAL SENSE SENSORY MOTOR PARASYMPATHETIC I II III IV V Olfactory Optic Oculomotor Trochlear Trigeminal Smell Sight -------Face, mouth, and 2/3 of tongue ---1/3 of tongue, pharynx, middle ear Pharynx, larynx, and viscera ----Most eye muscles Superior oblique Muscles of mastication Lateral rectus Facial muscles -Stylopharyngeus --Muscles of lens and iris ---

VI VII VIII IX

Abducens Facial Vestibulocochlear Glossopharyngeal

-Taste 2/3 tongue Hearing and equilibrium Taste 1/3 tongue

-Salivary and lacrimal glands -Parotid gland

X XI XII

Vagus Accessory Hypoglossal

----

Mm. of pharynx and larynx Sternomastoid and trapezius Mm. of tongue

Viscera ---

Note: Mnemonic Some say marry money, but my brother says big breasts matter most.

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SPINAL NERVES OF THE HEAD AND NECK I - Dorsal rami of Spinal Nn. A - Suboccipital N. (C1) - found in suboccipital triangle with Vertebral A. Innervates rectus capitus posterior muscles and Obliquus capitus superior. B - Greater occipital N. (C2) - pierces Semispinalis capitus near midline, then pierces Trapezius and runs up onto back of skull. II - Ventral rami of Spinal Nn. (=Cervical Plexus). A - Lesser occipital N. (C2,3) - found in posterior triangle between Levator scapulae and Scalenus medius, it passes up onto skull between external ear and Greater occipital N. B - Great auricular N. (C2,3) - found in posterior triangle between Levator scapulae and Scalenus medius, it passes up over Sternocleidomastoid toward external ear. C - Supraclavicular Nn. (C3,4) - found in posterior triangle between Levator scapulae and Scalenus medius, they passes down over clavicle. D - Phrenic N. (C3-5) - descends neck on Scalenus anterior behind Internal jugular V., then passes into thorax behind first rib. In thorax it passes down to supply diaphragm. III - Sympathetic trunk - deep to Carotid sheath lying on prevertebral muscles, it has a large cigar-shaped ganglion high in neck, a smaller ganglion at base of neck, and passes down into thorax.

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ARTERIES OF THE HEAD AND NECK

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ARTERIES OF THE HEAD AND NECK I - Common carotid A. - large branch off Brachiocephalic trunk (right) or Aortic arch (left), passes up Carotid sheath with Internal jugular V., and divides into External and Internal carotid Aa. A - External carotid A. - passes up side of neck and skull to temple. 1 - Superior thyroid A. - passes down to Thyroid gland. 2 - Lingual A. - passes anteriorly to tongue, then between Hyoglossus and Genioglossus. 3 - Facial A. - passes through Submandibular gland, then up onto face, and follows a sinuous path toward corner of mouth. 4 - Occipital A. - passes up posteriorly to back of skull, then accompanies Greater occipital N. 5 - Posterior auricular A. - passes up behind ear. 6 - Maxillary A. - large branch medial to mandible. It passes forward, sends a branch down to mandible, and continues into maxilla. a - Inferior alveolar A. - branches off Maxillary A. near its beginning, and passes down into mandibular foramen, passes through mandible, exits mental foramen, and becomes Mental A. to supply chin. b - Infraorbital A. - terminal branch of Maxillary A., it exits Infraorbital foramen with Infraorbital N. 7 - Superficial temporal A. - terminal branch of External carotid A. It passes up onto scalp. a - Transverse facial A. - small branch, passes forward across Masseter below zygomatic arch. B - Internal carotid A. - passes up into skull to supply brain. 1 - Ophthalmic A. - passes through Optic canal into orbit, supplies eye, and sends a branch through supraorbital foramen to become Supraorbital A. a - Supraorbital A. - passes onto forehead with Supraorbital N. Note: A mnemonic for the branches of the External carotid A. from inferior to superior is: Some like fast, others prefer much slower.

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ARTERIES AND VEINS OF THE BRAIN

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ARTERIES AND VEINS OF THE BRAIN ARTERIES I - Internal carotid A. - passes through Carotid canal and splits into: A - Anterior cerebral A. - passes forward to supply medial surface and frontal pole of cerebral hemisphere. 1 - Anterior communicating A. - short transverse anastomosis between Anterior cerebral Aa. B - Middle cerebral A. - passes laterally into lateral sulcus to supply superior and lateral surfaces and temporal pole of cerebral hemisphere. II - Vertebral A. - passes through Foramen magnum, send off various cerebellar Aa. and joins opposite Vertebral A. to form Basilar A. A - Cerebellar Aa. - pass laterally around cerebellum to supply it. III - Basilar A. - unpaired median A. formed by union of Vertebral Aa. A - Posterior cerebral A. - passes posteriorly and laterally to supply inferior surface and occipital pole of cerebral hemisphere. B - Posterior communicating A. - small anastomosis passing anteriorly to Internal carotid A.

VEINS I - Transverse sinuses - drain confluence of sinuses, pass laterally and forward through tentorium cerebri to Jugular foramina, and pass through to become Internal jugular Vv. A - Superior sagittal sinus - drains veins along superior midline of brain and passes posteriorly and down to confluence of sinuses. B - Straight sinus - drains veins along lower midline of brain and passes posteriorly to confluence of sinuses. 1 - Inferior sagittal sinus - drains veins along inferior border of falx cerebri, and empties into straight sinus. 2- Great cerebral V. - drains veins from midbrain and cerebellum. Note: The Anterior and Posterior cerebral Aa. and Anterior and Posterior communicating Aa. form a Cerebral arterial circle (=Circle of Willis) around the hypophysis.

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VEINS OF THE HEAD AND NECK

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VEINS OF THE HEAD AND NECK I - External jugular V. - formed by union of Posterior auricular V. and posterior division of Retromandibular V. It passes down neck over Sternocleidomastoid and empties into Subclavian V. A - Posterior auricular V. - drains scalp behind ear. B - Posterior division of Retromandibular V. - joins with Posterior auricular V. to form External jugular V. 1 - Retromandibular V. - formed by union of Maxillary V. and Superficial temporal V., passes through Parotid gland and bifurcates. II - Internal jugular V. - continuation of Transverse sinus draining blood from brain. It receives blood from Common facial V. and passes down neck in Carotid sheath with Common carotid A. It empties into Subclavian V. A - Common facial V. - formed by union of Facial V. and anterior division of Retromandibular V., it passes deep and dumps into Internal jugular V. 1 - Facial V. - drains face. 2 - Anterior division of Retromandibular V. - joins with Facial V. to form Common facial V. a - Retromandibular V. - formed by union of Maxillary V. and Superficial temporal V., passes through Parotid gland and bifurcates. Note: The back of the skull is drained by the Occipital V., that empties into the Deep cervical V. running down the back of the neck deep to Semispinalis capitus. At the base of the neck the Deep cervical V. empties into the Vertebral V.

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CROSS-SECTION OF THE NECK

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OSTEOLOGY OF THE POSTCRANIAL AXIAL SKELETON VERTEBRAL COLUMN - consists of 5 regions 7 cervical vertebrae 12 thoracic vertebrae - bearing ribs 5 lumbar vertebrae 5 sacral vertebrae - fused to form Sacrum 4 coccygeal vertebrae - fused to form Coccyx - said to resemble Cuckoo's beak PARTS OF VERTEBRAE Body or centrum - bears weight; articulates with adjacent vertebrae Arch - encloses vertebral foramen, supports spinous and transverse processes and superior and inferior articular surfaces Vertebral foramen - for spinal cord Superior and inferior articular processes and surfaces - articulate with adjacent vertebrae Spinous process - for origin and insertion of muscles Transverse process - for origin and insertion of muscles; carry ribs in thoracic region Intervertebral disc - fibrous joint between vertebral centra CERVICAL VERTEBRAE All have transverse foramina (Foramina transversaria) for Vertebral A+V. C1 (=atlas) - articulates with occipital condyles C2 (=axis) - has odontoid process that permits atlas to rotate on axis C3-C5 have bifid spinous processes for Ligamentum nuchae THORACIC VERTEBRAE Costotransverse articulations - on transverse processes for tubercle of rib Superior and inferior costal articulations - on centrum for head of rib LUMBAR VERTEBRAE More robust than thoracic vertebrae. Do not carry ribs, but with large transverse process and mammillary processes for attachment of muscles. SACRAL VERTEBRAE - Fused together to form sacrum Body - fused bodies of centra of sacral vertebrae Alae - fused transverse processes of sacral vertebrae Auricular surface - articulates with pelvic bone Median Crest - fused spinous processes of sacral vertebrae Sacral Foramina - between transverse processes, for sacral spinal nerves

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RIBS:

True Ribs (pairs 1-7) False Ribs (pairs 8-12) Floating Ribs (pairs 11-12)

Head Superior and Inferior Articular Facets - articulate with vertebral centra Neck Tubercle - articulates with transverse process of vertebra Angle - lateral margin of erector spinae muscles Body Chondral (=sternal) end Costal cartilages - cartilaginous joint between rib and sternum STERNUM Manubrium Clavicular Notch - articulates with clavicle Body Xiphoid Process JOINTS OF THE AXIAL SKELETON Movements of Vertebral Column Skull-atlas - flexion and extension Atlas-axis - rotation, slight flexion and extension All others - flexion and extension in sagittal plane - lateral flexion (in coronal plane) - rotation Movements of Ribs - swing out, up, and forward like bucket handle to elevate sternum and increase volume of ribcage

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NOTES

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INTERMEDIATE MUSCLES OF THE BACK MUSCLE ORIGIN INSERTION ACTION/(NERVE) Serratus posterior superior Spines of lower cervical and upper thoracic vertebrae Spines of lower thoracic and upper lumbar vertebrae Lateral sides of upper 3 or 4 ribs Elevates ribs (2nd - 4th intercostal Nn.) Depresses ribs (9th - 11th intercostal Nn.)

Serratus posterior inferior

Lateral sides of lower 3 or 4 ribs

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ERECTOR SPINAE MUSCLES MUSCLE ORIGIN INSERTION ACTION/(NERVE) Spinalis Spines of lower thoracic and upper lumbar vertebrae With entire Erector spinae group from spines of sacral and lumbar vertebrae and iliac crest Continuation of longissimus - from transverse processes of upper thoracic and lower 4 cervical vertebrae With entire Erector spinae group from spines of sacral and lumbar vertebrae and iliac crest Spines of upper thoracic vertebrae By slips - medial to transverse processes of all 12 thoracic vertebrae; and lateral to all 12 ribs Tendon between Splenius capitus and Semispinalis capitus, onto back of mastoid process By slips to back of all 12 ribs

Longissimus thoracis

Longissimus capitus

Extend, rotate, and laterally flex vertebral column (Dorsal rami of Spinal Nn.)

Iliocostalis

Note: The three columns of muscle usually cannot be differentiated in the lumbar region and are best considered to be simply Erector spinae. Note: The main function of these muscles is to maintain the curvatures of the spine and keep the trunk erect.

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TRANSVERSOSPINALIS MUSCLES MUSCLE ORIGIN INSERTION ACTION/(NERVE) Semispinalis capitus Transverse processes of lower 4 cervical and upper 6 thoracic vertebrae Articular processes of lower cervical vertebrae and transverse processes of upper thoracic vertebrae Transverse processes of vertebrae Between superior and inferior nuchal lines on skull; just deep to Trapezius Spans 3 to 6 vertebrae and inserts of spines of cervical vertebrae

Semispinalis cervicis

Multifidus

Spans 2 to 3 vertebrae and inserts on spines of vertebrae Spans from one vertebra to next above, inserts on spine of vertebra

Extend, rotate, and laterally flex vertebral column (Dorsal rami of Spinal Nn.)

Rotatores

Transverse processes of vertebrae

-----------------------------------------------------------------------------Levator costae Transverse processes of last cervical to 11th thoracic vertebrae Passes laterally and down to back of next rib between angle and tubercle Elevate ribs (Dorsal ram Spinal Nn.)

Note: Levator costae is technically not a transversospinalis muscle, but was derived from them. Note: All transversospinalis muscles originate on a transverse process and insert on a spinous process, hence the name. The transversospinalis muscles are best seen in different parts of the back: Semispinalis is best seen in the cervical region, Multifidus is best seen in the lumbar region, and Rotatores are best seen in the thoracic region.

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MUSCLES OF SUBOCCIPITAL REGION MUSCLE ORIGIN INSERTION ACTION/(NERVE) Obliquus capitis superior Obliquus capitis inferior Rectus capitus posterior major Rectus capitus posterior minor Transverse process of atlas Spine of axis Occipital bone Transverse process of atlas Occipital bone deep to Semispinalis Occipital bone deep to Rectus major

Spine of axis

Extend and rotate head (Suboccipital N.)

Posterior tubercle of atlas

Note: There are similar short muscles (Rectus capitus anterior and Rectus capitus lateralis) between the atlas and occipital bone on the anterior side. All of these muscles are primarily postural. Note: The Greater occipital N. passes over these muscles and pierces Semispinalis capitus and trapezius. When Semispinalis capitus is reflected, the Greater occipital N. lies transversely on its deep surface. Also visible are the 3rd occipital N. and the Deep cervical V.

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MUSCLES OF THE THORACIC WALL MUSCLE ORIGIN INSERTION ACTION/(NERVE) External intercostals Lower border of ribs Passes down and medially to next lower rib Passes down and laterally to next lower rib

Internal intercostals

Lower border of ribs

Innermost intercostals

Same origin and insertion as internal intercostals; variable layer lying over Intercostal NAV, may be difficult to differentiate from Internal intercostals Back of sternum Inner surface of costal cartilages

Move ribcage during active respiration (Intercostal Nn.)

Transversus thoracis

Note: The ribcage is also moved directly by Serratus posterior superior and inferior, Levator costae, and the scalenes. Other muscles can also move the ribs during powerful respiration, e.g., Sternocleidomastoid, Rectus abdominus, etc.

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MUSCLES OF THE ABDOMINAL WALL MUSCLE ORIGIN INSERTION ACTION/(NERVE) External oblique Outer surface of lower 8 ribs Passes down and medially to iliac crest and linea alba Passes up and medially to lower 3 ribs and linea alba (splits around Rectus abdominus) Aponeurosis of internal intercostal

Internal oblique

Thoracolumbar fascia, iliac crest, and inguinal ligament

Transversus abdominus

Deep on costal cartilages, iliac crest, and inguinal ligament Pubic symphysis and pubic crest

Flex and laterally flex lumbar vertebrae; compress abdomen to expel contents; obliques are main rotators of lumbar spine (Ventral rami of lower thoracic and first lumbar Nn.)

Rectus abdominus

Sternum and lower costal cartilages

Flex lumbar spine, compress abdomen (Ventral rami of lower thoracic Nn.)

Note: A important function of the muscles of the abdominal wall is support the viscera against the pull of gravity.

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MUSCLES OF THE PELVIS

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MUSCLES OF THE PELVIS MUSCLE ORIGIN INSERTION ACTION/(NERVE) Iliacus Iliac fossa Passes down to insert on lesser trochanter of femur with Psoas major Passes beneath inguinal ligament to insert on lesser trochanter of femur with Iliacus Iliopubic eminence near acetabulum Flexes hip (Femoral N.)

Psoas major

Bodies of the lumbar vertebrae

Flexes hip (2nd and 3rd lumbar Nn.)

Psoas minor

Bodies of the last thoracic and first lumbar vertebrae Iliac crest and transverse processes of lower lumbar vertebrae

Flexes lumbar vertebrae (Ventral ramus of L1) Flexes lumbar vertebrae laterally (Ventral rami of Subcostal N. and L1-3 or 4)

Quadratus lumborum

Transverse processes of upper lumbar vertebrae and last rib

Note: Note: Psoas minor is small, and is absent in 40% of individuals. Iliacus and Psoas major are discussed on p. 103 as Iliopsoas.

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MUSCLES OF THE PERINEUM

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MUSCLES OF THE PERINEUM - MALE MUSCLE ORIGIN INSERTION ACTION/(NERVE) Bulbospongiosus Central tendon of perineum and median raphe with opposite Bulbospongiosus Pubic arch, urogenital diaphragm, and dorsum of penis Compresses bulb of corpus spongiosum during micturation and ejaculation; compresses Dorsal V. of penis (Pudendal N.) Compresses crus of penis to erect (Pudendal N.) Stabilizes central tendon of perineum (Pudendal N.)

Ischiocavernosus

Medial side of ischial tuberosity

Pubic arch on side of crus of penis Central tendon of perineum near anus

Transversus perinei

Medial side of ischial tuberosity

MUSCLES OF THE PERINEUM - FEMALE MUSCLE ORIGIN INSERTION ACTION/(NERVE) Bulbospongiosus Central tendon of perineum Pubic arch, and root and dorsum of clitoris Sphincter of vagina; compresses Dorsal V. of clitoris (Pudendal N.) Compresses crus of clitoris to erect (Pudendal N.) Stabilizes central tendon of perineum (Pudendal N.)

Ischiocavernosus

Medial side of ischial tuberosity

Pubic arch on side of crus of clitoris Central tendon of perineum

Transversus perinei

Medial side of ischial tuberosity

Note: The central tendon of the perineum is a muscular/fibrous band extending anteriorly on the midline from the anus to the urogenital diaphragm.

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NOTES

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NERVES OF THE THORAX I - Cranial Nerves A - Vagus N. - passes down neck into mediastinum, in front of Aortic arch and sends off Recurrent laryngeal N., then continues behind heart to form plexus around the esophagus. 1 - Recurrent laryngeal N. - passes behind Brachiocephalic trunk on right and Aortic arch on left, then up neck. Note they begin at a different level on each side. II - Cervical Plexus A - Phrenic N. - passes down neck, on side of fibrous pericardium, in front of root of lung, pierces diaphragm and supplies its ventral surface. III - Spinal Nerves A - Intercostal Nn. - ventral rami of Spinal Nn. T1-T11. They run laterally between ribs to supply thoracic wall. IV - Sympathetic Trunk - continuation of trunk from neck, descends thorax on either side of vertebral column. Has 11 ganglia in thorax which give it a lumpy appearance. A - Greater splanchnic N. - main visceral branch of Sympathetic trunk. It passes anteriorly and inferiorly on side of vertebral column, pierces the diaphragm, and ends in large Celiac ganglion, which in turn sends branches to the abdominal viscera.

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NERVES OF THE THORAX AND ABDOMEN

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NERVES OF THE ABDOMEN I - Lumbar Plexus - ventral rami of L1-L4 A - Subcostal N. (T12) - runs laterally below 12th rib. B - Iliohypogastric N. (L1) - runs laterally from behind Psoas major to innervate lateral gluteal region. C - Ilioinguinal N. (L1) - runs laterally from behind Psoas major and inferior to Iliohypogastric N., and innervates pubic region. D - Lateral cutaneous N. of thigh (L2,3) - passes laterally over Iliacus below Ilioinguinal N. to innervate skin of anterolateral thigh. E - Femoral N. (L2-4) - large; passes over Iliacus and under inguinal ligament to innervate anterior thigh. F - Genitofemoral N. (L1,2) - pierces Psoas major and passes down on top of it. Innervates scrotum/labium majus and skin of anteromedial thigh. G - Obturator N. (L2-4) - medial to Psoas major, deep in pelvis, passes into thigh under inguinal ligament and innervates adductors. H - Lumbosacral Trunk (L4,5) - contributes to Sciatic N. II - Sacral Plexus - ventral rami of L4-S4 A - Superior gluteal N. (L4-S1)- passes back to innervate Gluteus minimus and medius and Tensor fasciae latae. B - Inferior gluteal N. (L5-S2) - passes back to innervate Gluteus maximus. C - Pudendal N. (S2-4) - passes back to innervate perineal muscles and skin of perineal region. D - Sciatic N. (L4-S4) - formed by the union of the Lumbosacral Trunk (L4,5) with S1-4, passes down into thigh and innervates posterior thigh and leg and foot. III - Sympathetic Trunk - continues down on either side of vertebral column from thorax through lumbar region. May be difficult to find behind Abdominal Aorta and Inferior Vena Cava. Note: Iliohypogastric and Ilioinguinal Nn. may run together for some distance.

Note: Mnemonics for branches of lumbar plexus are: "Some India inks last for generations or longer" and "Should I initiate long fornication given only lust?", the latter thanks to a former student.

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ARTERIES OF THE THORAX AND ABDOMEN

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ARTERIES OF THE THORAX AND ABDOMEN Ia - Ascending Aorta, Aortic Arch, and Descending Aorta in thorax. A - Subclavian A. 1 - Internal thoracic A. - descends inside thoracic wall behind Transversus thoracis. Divides at 6th rib into: a - Superior epigastric A. - pierces diaphragm and runs down Rectus sheath, anastomose with Inferior epigastric A. b - Musculophrenic A. - runs laterally on diaphragm. B - Intercostal Aa. - pass laterally from Aorta between ribs. Ib - Abdominal Aorta - continuation of Descending Aorta in abdomen. A - CELIAC TRUNK - unpaired visceral branch supplying liver, spleen, and stomach. See p. 61 for branches. B - SUPERIOR MESENTERIC A. - unpaired visceral branch supplying small intestine and part of colon. See p. 61 for branches. C - Suprarenal Aa. - small, pass to suprarenal glands. D - Renal Aa. - large; pass laterally to kidneys. E - Testicular/Ovarian Aa. - pass down over Psoas major to gonads. F - Lumbar Aa. - pass laterally to abdominal wall. G - INFERIOR MESENTERIC A. - unpaired visceral branch supplying part of colon and rectum. See p. 61 for branches. H - Median sacral A. - passes down over sacrum between Common iliac Aa. I - Common iliac Aa. - terminal branches, pass inferolaterally to supplu lower extremilty. 1 - External iliac A. - passes down to thigh and becomes Femoral A. a - Inferior epigastric A. - branches off just above inguinal ligament, passes medially, then up rectus sheath. 2 - Internal iliac A. - passes down into pelvis. a - Superior gluteal A. - passes back to gluteal region between Lumbosacral trunk and 1st sacral ramus. b - Inferior gluteal A. - passes back to gluteal region between 1st and 3rd sacral rami. c - Obliterated umbilical A. - fetal terminal branch, in adults a fibrous cord passing up abdominal wall to umbilicus.

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UNPAIRED VISCERAL BRANCHES OF THE ABDOMINAL AORTA

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UNPAIRED VISCERAL BRANCHES OF THE ABDOMINAL AORTA A - CELIAC TRUNK - unpaired visceral branch supplying liver, spleen, and stomach. 1 - Common hepatic A. - passes toward liver and gives off: a - Gastroduodenal A. - passes to end of stomach and sends off: i - Right Gastroepiploic A. - passes along greater curvature of stomach and anastomoses with Left gastroepiploic A. b - Hepatic (Proper) A. - passes up to liver and splits into: i - Right hepatic A. - enters Porta hepatis to supply liver. ii - Left hepatic A - enters Porta hepatis to supply liver. iii - Cystic A. - passes to gall bladder. c - Right gastric A. - passes down to stomach and then along lesser curvature of stomach; anastomoses with Left gastric A. 2 - Splenic A. - passes left over to spleen; sends off: a 3 Left gastroepiploic A. - passes along greater curvature of stomach and anastomoses with Right gastroepiploic A.

Left gastric A. - passes along lesser curvature of stomach and anastomoses with Right gastric A.

B - SUPERIOR MESENTERIC A. - unpaired visceral branch supplying small intestine and part of colon. 1 - Intestinal Aa. - 10-16 branches pass into mesentery to supply jejunum and ileum. Interconnected by anastomosing arcades. a - Vasa recta - small straight vessels passing from ends of anastomosing Intestinal Aa. to small intestine. 2 - Ileocolic A. - passes down to junction of ileum and colon. 3 - Right colic A. - passes right to ascending colon. 4 - Middle colic A. - passes up to transverse colon. G - INFERIOR MESENTERIC A. - unpaired visceral branch supplying part of colon and rectum. 1 - Left colic A. - passes left to descending colon. 2 - Sigmoid Aa. - usually 2 or 3, pass down to sigmoid colon. 3 - Superior rectal A. - passes down to rectum.

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VEINS OF THE THORAX AND ABDOMEN

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VEINS OF THE THORAX AND ABDOMEN I - Superior Vena Cava - drains head, arms, and thorax and passes down to heart. A - Brachiocephalic Vv. - drain blood from Subclavian V. and Jugular V. 1 - Left superior intercostal V. - union of 2nd and 3rd intercostal Vv., drains into Left Brachiocephalic V. B - Azygos V. - on right side of spinal column, it drains Right intercostal Vv., Hemiazygos V. and Accessory hemiazygos V. passes up and dumps into Superior Vena Cava from behind. 1 - Hemiazygos V. - drains lower Intercostal Vv. on left side. 2 - Accessory hemiazygos V. - drains upper Intercostal Vv. on left side. 3 - Intercostal Vv. - on right side they drain into Azygos V.; on left they drain into Hemiazygos and Accessory hemiazygos Vv. II - Inferior Vena Cava - drains abdomen and legs, and passes up to heart. A - Hepatic Vv. - three or so short veins from back of liver. III - Hepatic Portal V. - large vein entering Porta hepatis. blood from organs to liver. A - Splenic V. - drains blood from spleen. B - Superior mesenteric V. - large; drains blood from Ascending and Transverse colon and small intestine. C - Inferior mesenteric V. - drains blood from descending and sigmoid colon. D - Gastric V. - drains blood from stomach; may empty into Splenic or Hepatic portal V. It drains venous It

Note: The Left testicular/ovarian V. usually empties into the Left renal V. rather than the Inferior Vena Cava. Note: The Thoracic Duct lies between the Descending Aorta and Azygos V. and drains lymph and chyle from the Cisterna chyli up to dump into the union of the L. Internal jugular V. and the L. Subclavian V.

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OSTEOLOGY OF THE PECTORAL GIRDLE AND UPPER EXTREMITY CLAVICLE Sternal Articular Surface - articulates with sternum Acromial Articular Surface - articulates with acromion process Conoid Tubercle - attachment for conoid part of Coracoclavicular Ligament SCAPULA Supraspinous Fossa - origin of Supraspinatus Infraspinous Fossa - origin of Infraspinatus, Teres major, and Teres minor Subscapular Fossa - origin of Subscapularis Spine - insertion of Trapezius Vertebral border - insertion of Rhomboideus major and minor, and Serratus anterior Coracoid Process - origin of Coracobrachialis, and Biceps brachii short head; insertion of Pectoralis minor, and attachment for trapezoid part of Coracoclavicular Ligament Acromion Process - roofs over shoulder joint and articulates with clavicle Glenoid fossa - articulates with humerus Supraglenoid Tubercle - origin of Biceps brachii long head Infraglenoid Tubercle - origin of Triceps brachii long head HUMERUS Head - articulates with scapula Anatomical Neck - margin of articular surface of head Surgical Neck - where humerus often breaks Greater Tubercle - insertion of Supraspinatus, Infraspinatus, and Teres minor Lesser Tubercle - insertion of Subscapularis Intertubercular Sulcus (=Bicipital Groove) - groove for tendon of Biceps brachii long head; Latissimus dorsi, Teres major, and Pectoralis major insert on its sides Deltoid Tuberosity - insertion of Deltoideus Radial (=Spiral) Groove - for Radial N. between medial and lateral heads of Triceps brachii Capitulum - articulates with radius Trochlea - articulates with ulna Medial Epicondyle - origin of flexors of forearm Lateral Epicondyle - origin of extensors of forearm Olecranon Fossa - receives olecranon process on extension of elbow Coronoid Fossa - receives coronoid process on flexion of elbow ULNA Olecranon Process - insertion of Triceps brachii Trochlear Notch - articulates with trochlea of humerus Coronoid Process - forms inferior margin of trochlear notch Radial Notch - articulates with proximal end of radius Ulnar Tuberosity - insertion of Brachialis Styloid Process - attachment of ligaments

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RADIUS Head - articulates with humerus and ulna Fovea capitis - depression for capitulum of humerus Radial Tuberosity - insertion of Biceps brachii Styloid Process - attachment of ligaments Ulnar Notch - articulates with distal end of ulna Lower Articular Facet - articulates with scaphoid and lunate CARPUS Scaphoid Lunate Triquetrum Pisiform Trapezium Trapezoid Capitate Hamate Mnemonics for these, proximal thumbside to digit V side, then distal thumbside to digit V side are: Sally Lowers Tom's Pants Then Things Can Happen Some Lovers Try Positions That They Can't Handle

METACARPALS I-V AND PHALANGES Digit I (=Pollex) has: Proximal and Distal Phalanges Digits II-V have: Proximal, Middle, and Distal Phalanges JOINTS OF THE UPPER EXTREMITY Movements of scapula - upward and downward rotation - elevation and depression - protraction and retraction Movements of shoulder joint - flexion and extension - aBduction and adduction - medial and lateral rotation Movements of forearm - flexion and extension - Pronation and supination Movements of wrist and hand adduction and abduction at radio-carpal joint extension at radio-carpal joint flexion at intercarpal joint flexion and extension of carpo-metacarpal joints opposition of pollex by rotation flexion and extension of metacarpo-phalangeal joints

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MUSCLES ATTACHING UPPER EXTREMITY TO TRUNK - ANTERIOR SIDE MUSCLE ORIGIN INSERTION ACTION/(NERVE) Serratus anterior Slips from outer surface of upper eight ribs Passes between ribs and scapula to vertebral border of scapula Protracts and rotates scapula upward, elevates ribs (Long thoracic N.) Depresses scapula (Medial pectoral N.) Adducts and medially rotates shoulder (Lateral and Medial pectoral Nn.)

Pectoralis minor

Outer surface of ribs 3-5

Coracoid procces of scapula

Pectoralis major

Clavicular head medial 1/2 of clavicle Sternal head sternum and upper 6 cartilages

Bicipital groove of humerus

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MUSCLES ATTACHING UPPER EXTREMITY TO TRUNK - POSTERIOR SIDE MUSCLE ORIGIN INSERTION ACTION/(NERVE) Trapezius Skull, and all cervical and thoracic vertebrae Lateral 1/3 of clavicle, spine of scapula Elevates, depresses, retracts, and rotates scapula up and down (Spinal accessory N.) Elevates and rotates scapula downward (Dorsal scapular N.) Elevates, retracts and rotates scapula downward (Dorsal scapular N.) Elevates, retracts and rotates scapula downward (Dorsal scapular N.) Adducts, extends, and medially rotates shoulder (Thoracodorsal N.)

Levator scapulae

Transverse processes of C1-4

Upper angle of scapula

Rhomboideus minor

Spines of C7-T1 and lower part of Ligamentum nuchae

Upper part of vertebral border of scapula

Rhomboideus major

Spines of T1-4

Lower part of vertebral border of scapula

Latissimus dorsi

Aponeurosis from lower 6 thoracic vertebrae, lumbosacral fascia, iliac crest and lower 3 or 4 ribs

Passes under axilla, inserts in bicipital groove

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MUSCLES OF THE SHOULDER JOINT - SCAPULAR MUSCLES MUSCLE ORIGIN INSERTION ACTION/(NERVE) Subscapularis Subscapular fossa Passes in front of joint to lesser tubercle of humerus Passes above joint to greater tubercle of humerus Passes behind joint to greater tubercle of humerus Passes behind joint to greater tubercle of humerus Medial lip of bicipital groove near Latissimus dorsi Medially rotates shoulder (Upper subscapular N.) ABducts shoulder (Suprascapular N.)

Supraspinatus

Supraspinous fossa

Infraspinatus

Infraspinous fossa

Laterally rotates shoulder (Suprascapular N.)

Teres minor

Upper 2/3 of lateral border of scapula

Laterally rotates shoulder (Axillary N.)

Teres major

Inferior angle of scapula

Adducts and medially rotates shoulder (Lower subscapular N.) Flexes, aBducts, and extends shoulder (Axillary N.)

Deltoideus

Lateral 1/3 of clavicle, upper surface of acromion, spine of scapula

Deltoid tuberosity of humerus

Note: Subscapularis, Supraspinatus, Infraspinatus, and Teres minor together form the "Rotator Cuff", and share the common function of holding the head of the humerus in the glenoid fossa. Note: can. Deltoideus cannot initiate aBduction of the shoulder, but Supraspinatus

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MUSCLES OF THE ARM MUSCLE ORIGIN INSERTION ACTION/(NERVE) Biceps brachii Short head coracoid process of scapula (w/ Coracobrachialis) Long head supraglenoid tubercle of scapula Coracobrachialis Coracoid process of scapula (w/ Biceps brachii - short) Lower 2/3 of anterior humerus By tendon on back of tuberosity of radius; tendon of long head runs in bicipital groove Flexes elbow and supinates forearm (Musculocutaneous N.)

Middle of medial border of humerus

Flexes and adducts shoulder (Musculocutaneous N.) Flexes elbow (Musculocutaneous N.) Extends elbow (Radial N.)

Brachialis

By tendon to tuberosity of ulna

Triceps brachii

Long head infraglenoid tubercle of scapula Medial head posterior surface of humerus below spiral groove Lateral head posterior and lateral surface of humerus above spiral groove

Upper surface of olecranon

Anconeus

Lateral epicondyle of humerus

Lateral surface of olecranon and ulna

Extends elbow (Radial N.)

Note: Biceps brachii also inserts by way of the bicipital aponeurosis into the deep fascia over the origin of the flexors of the wrist and hand. The aponeurosis can be palpated easily in the living. Note: Anconeus can be considered a detached part of Triceps brachii.

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SUPERFICIAL EXTENSORS OF THE FOREARM MUSCLE ORIGIN INSERTION ACTION/(NERVE) Extensor carpi radialis longus Extensor carpi radialis brevis Extensor digitorum communis Lateral supracondylar ridge of humerus Lateral epicondyle of humerus Base of metacarpal II Extends and aBducts wrist (Radial N.) Extends and aBducts wrist (Deep radial N.) Extends digits II-V (Deep radial N.)

Base of metacarpal III

Lateral epicondyle of humerus

By four tendons to extensor expansions of digits II-V Extensor expansion of digit V Base of metacarpal V

Extensor digiti minimi Extensor carpi ulnaris

Lateral epicondyle of humerus Lateral epicondyle of humerus, and posterior border of ulna

Extends digit V (Deep radial N.) Extends and adducts wrist (Deep radial N.)

Note: Extensor carpi radialis, Extensor digitorum communis, and Extensor digiti minimi originate by a common tendon from the lateral epicondyle. Note: All extensors except Extensor carpi radialis longus are innervated by the Deep Radial N.

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DEEP EXTENSORS OF THE FOREARM MUSCLE ORIGIN INSERTION ACTION/(NERVE) ABductor pollicis longus Middle 1/3 of back of ulna, radius, and interosseus membrane Back of radius and interosseus membrane Middle 1/3 of back of ulna and interosseus membrane Back of ulna and interosseus membrane near distal end Base of metacarpal I ABducts pollex and wrist (Deep radial N.)

Extensor pollicis brevis

Base of proximal phalanx of digit I

Extends pollex (Deep radial N.)

Extensor pollicis longus

Base of distal phalanx of digit I

Extends pollex (Deep radial N.)

Extensor indicis

Extensor expansion of digit II

Extends index finger (Deep radial N.)

Note: The tendons of Extensor pollicis longus and brevis bound the Anatomical Snuffbox. Note: All extensors except Extensor carpi radialis longus are innervated by the Deep Radial N.

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SUPERFICIAL FLEXORS OF THE FOREARM MUSCLE ORIGIN INSERTION ACTION/(NERVE) Flexor carpi radialis Palmaris longus Medial epicondyle of humerus Medial epicondyle of humerus Medial epicondyle of humerus Bases of metacarpals II-III Palmar aponeurosis Flexes wrist (Median N.) Flexes wrist (Median N.) Flexes and adducts wrist (Ulnar N.)

Flexor carpi ulnaris

Pisiform, hamate, and base of metacarpal V

Note: Palmaris longus is absent in 10% of individuals. The trait is genetically controlled, and absence of the muscle is dominant.

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DEEP FLEXORS OF THE FOREARM MUSCLE ORIGIN INSERTION ACTION/(NERVE) Flexor digitorum superficialis Medial epicondyle of humerus, coronoid process of ulna, and oblique line of radius By four tendons to 2nd phalanges of digits II-V (Tendons split near insertion to allow Flexor digitorum profundus to pass through) By four tendons to distal phalanges of digits II-V Base of distal phalanx of thumb Flex digits II-V (Median N.)

Flexor digitorum profundus

Middle 2/3 of ulna and interosseus membrane Middle 2/3 of radius and interosseus membrane

Flex digits II-V (Median and Ulnar Nn.)

Flexor pollicis longus

Flexes pollex (Median N.)

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OTHER MUSCLES OF THE FOREARM MUSCLE ORIGIN INSERTION ACTION/(NERVE) Brachioradialis Lateral supracondylar ridge of humerus By 2 heads, from lateral epicondyle of humerus and supinator crest of ulna Medial epicondyle of humerus, and coronoid process of ulna Distal 1/4 of front of ulna Styloid process of radius Flexes elbow (Radial N.)

Supinator

Anterior and lateral surface of radius

Supinates forearm (Deep radial N.)

Pronator teres

Middle of lateral surface of radius

Pronates forearm (Median N.)

Pronator quadratus

Distal 1/4 of lateral surface of radius

Pronates forearm (Median N.)

Note: Brachioradialis can assist in supination of a pronated forearm, and used to be called "supinator longus".

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THENAR MUSCLES MUSCLE ORIGIN INSERTION ACTION/(NERVE) ABductor pollicis brevis Flexor retinaculum and adjacent carpals Flexor retinaculum and adjacent carpals. Found deep to ABductor pollicis brevis Flexor retinaculum and adjacent carpals Radial side of base of 1st phalanx of digit I Radial side of metacarpal I ABducts pollex (Median N.)

Opponens pollicis

Flexes metacarpal I; rotates metacarpal to oppose (Median N.) Flexes pollex (Median N.)

Flexor pollicis brevis

Base of 1st phalanx of digit I

HYPOTHENAR MUSCLES MUSCLE ORIGIN INSERTION ACTION/(NERVE) ABductor digiti minimi Pisiform and adjacent ligaments Ulnar side of base of 1st phalanx of digit V Ulnar side of metacarpal V ABducts digit V (Ulnar N.)

Opponens digiti minimi

Flexor retinaculum and hook of hamate

Rotates metacarpal V (Ulnar N.) Flexes digit V (Ulnar N.)

Flexor digiti minimi

Flexor retinaculum and hook of hamate

Base of 1st phalanx of digit V

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OTHER MUSCLES OF THE HAND MUSCLE ORIGIN INSERTION ACTION/(NERVE) Lumbricales (4) From sides of four tendons of Flexor digitorum profundus Tendon into extensor expansions of digits II-V Flex digits II-V at metacarpophalangeal joints and extend at interphalangeal joints (Usually 1st and 2nd by Median N.; 3rd and 4th by Ulnar N.) Wrinkles skin of medial side of palm to deepen hollow of hand (Ulnar N.) Adducts pollex (Ulnar N.)

Palmaris brevis

Ulnar border of palmar aponeurosis and front of flexor retinaculum

Skin of medial (=ulnar) side of hand

Adductor pollicis

Metacarpal III and adjacent carpals

Ulnar side of base of 1st phalanx of digit I Into bases of 1st phalanges; on medial side of digit II, and lateral sides of digits IV-V Into bases of 1st phalanges; on lateral sides of digits II-III and medial sides of digits IV and V

Palmar interossei (3)

By 1 head from side of metacarpal they act on

Adduct digits II, IV, and V toward axis of digit III (Ulnar N.)

Dorsal interossei (4)

Each by 2 heads, from sides of adjacent metacarpals I-V

ABduct digits II-IV from axis of digit III (Ulnar N.)

Note: PAD (Palmar ADduct) and DAB (Dorsal ABduct) are words.

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BRACHIAL PLEXUS

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BRACHIAL PLEXUS I - ROOTS - Ventral rami of Spinal Nn. C5-T1 A - Long thoracic N. - branches off roots C5-C7 of brachial plexus, and passes down to Serratus anterior deep to Pectoralis major. II - TRUNKS - Upper, Middle, and Lower Trunks formed from roots. A - Suprascapular N. - arises from upper trunk; can be found deep near Omohyoideus, it passes under suprascapular ligament into supraspinous fossa where it is found with Suprascapular A. III - DIVISIONS - Anterior and Posterior Divisions of each trunk. IV - CORDS A - Lateral Cord - from anterior division of upper and middle trunks. B - Posterior Cord - from posterior divisions of each trunk. C - Medial Cord - anterior division of lower cord. V - BRANCHES A - Musculocutaneous N. B - Median N. (formed from medial and lateral roots) C - Axillary N. D - Radial N. E - Ulnar N. Note: The mnemonic for the arrangement of the brachial plexus is: Robert Taylor Drinks Cold Beer

Roots Trunks Divisions Cords Branches

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NERVES OF THE UPPER EXTREMITY

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NERVES OF THE UPPER EXTREMITY Ia - Lateral cord A - Lateral pectoral N. - passes medial to Pectoralis minor and ends in Pectoralis major. B - Lateral root of Median N. - joins medial root to form Median N. Ib - Musculocutaneous N. - continuation of Lateral Cord, pierces Coracobrachialis and descends arm between Biceps brachii and Brachialis. At elbow becomes Lateral cutaneous N. of forearm. IIa - Medial cord A - Medial pectoral N. - pierces Pectoralis minor and ends in Pectoralis major. B - Medial root of Median N. - joins lateral root to form Median N. IIb - Ulnar N. - continuation of Medial Cord. Passes down arm with Brachial A., then behind medial epicondyle, and down forearm with Ulnar A. A - Palmar digital branches of Ulnar N. - pass across palm to digits IV-V. IIIa - Posterior cord - lies behind Axillary A. A - Upper subscapular N. - arises in axilla, passes to Subscapularis. B - Thoracodorsal N. - arises between Upper and Lower subscapular Nn. and passes with Thoracodorsal A+V to Latissimus dorsi. C - Lower subscapular N. - arises near Axillary N., passes to Teres maj. D - Axillary N. - large branch, passes behind humerus and through quadrangular space with Posterior humeral circumflex A+V. IIIb - Radial N. - continuation of Posterior Cord. Passes behind humerus with Profunda brachii A., then anterior to lateral epicondyle, and splits into Superficial and Deep Radial Nn. A - Superficial radial N. - passes down forearm deep to Brachioradialis. At wrist it passes onto dorsum of hand. 1 - [Dorsal] digital Nn. - small branches passing along digits. B - Deep radial N. - Pierces Supinator and passes down extensor side of forearm deep to Extensor digitorum communis. IV - Median N. - Descends arm with Brachial A., and passes down forearm deep to Flexor digitorum superficialis. A - Palmar digital branches of Median N. - cross palm to digits I-IV. B - Recurrent branch of median N. - passes laterally to thenar muscles. Note: Long thoracic N. off roots C5-C7 and Suprascapular N. off Upper Trunk were described on p. 89.

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ARTERIES OF THE UPPER EXTREMITY

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ARTERIES OF THE UPPER EXTREMITY - SHOULDER REGION Ia - Subclavian A. - passes laterally from Brachiocephalic trunk or Aortic arch to supply arm. At lateral border of 1st rib becomes Axillary A. A - Vertebral A. - passes up through Foramina transversaria of cervical vertebrae, through Suboccipital triangle, and into skull. B - Thyrocervical trunk - short branch from top of Subclavian A. 1 - Inferior thyroid A. - passes up neck behind Carotid sheath to Thyroid gland. 2 - Suprascapular A. - passes over Suprascapular Ligament and into supraspinous fossa, a branch then passes laterally into infraspinous fossa. 3 - Transverse cervical A. - passes down to vertebral border of scapula, and anastomoses with Suprascapular and Circumflex scapular Aa. C - Internal thoracic A. - branches off opposite Thyrocervical trunk and passes down into thorax. D Costocervical trunk - branches off back of Subclavian A. and sends branches up neck and down into thorax.

Ib - Axillary A. - continuation of Subclavian A. after first rib. After passing inferior border of Teres major it becomes Brachial A. A - Thoracoacromial A. - branches off Axillary A. medial to Pectoralis minor and branches on deep surface of Pectoralis major. B - Lateral thoracic A. arises deep to Pectoralis minor and passes down lateral border of Pectoralis minor to supply muscles and mammary gland. C - Subscapular A. - short medial branch opposite Humeral circumflex Aa. It divides into Circumflex scapular A. and Thoracodorsal A. 1 - Circumflex scapular A. - passes backward into triangular space, enters infraspinous fossa and anastomoses with Transverse cervical A. and Suprascapular A. 2 - Thoracodorsal A. - passes down thoracic wall with Thoracodorsal N. to Latissimus dorsi. D - Anterior humeral circumflex A. - small branch opposite Subscapular A., passes laterally around humerus. E - Posterior humeral circumflex A. - large branch opposite Subscapular A., passes laterally behind humerus with Axillary N. through quadrangular space.

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ARTERIES OF THE UPPER EXTREMITY - ARM, FOREARM, AND HAND I - Brachial A. - continuation of Axillary A. after distal border of Teres major. Passes down in front of humerus. In cubital fossa it splits into Ulnar and Radial Aa. A - Profunda brachii A. - passes down upper arm deep behind humerus with Radial N. B - Superior ulnar collateral A. - passes down with Ulnar N. behind medial epicondyle, and anastomoses with Posterior ulnar recurrent A. C - Inferior ulnar collateral A. - branches off Brachial A. about 5 cm above elbow, passes down to medial epicondyle and anastomoses with Anterior ulnar recurrent A. D - Radial A. - passes down anterior to radius with Superficial radial N. Passes behind metacarpal I through "Anatomical Snuffbox", and goes deep to form Deep palmar arterial arch. 1 - Radial recurrent A. - arises in cubital fossa and passes up arm to anastomose with Profunda brachii A. 2 - Deep palmar arterial arch - runs deep across palm to Ulnar A. and sends off branches to Palmar metacarpal Aa. E - Ulnar A. - passes down anterior to ulna with Ulnar N. Superficial palmar arterial arch. On palm forms

1 - Anterior and posterior ulnar recurrent Aa. - arise in cubital fossa and pass up to anastomose with Inferior and Superior ulnar collateral Aa., respectively. 2 - Common interosseus A. - short branch arising below cubital fossa. a - Anterior interosseus A. - descends forearm between radius and ulna anterior to interosseus membrane. b - Posterior interosseus A. - descends forearm between radius and ulna posterior to interosseus membrane. c - Interosseus recurrent A. - passes up arm and anastomoses with Profunda brachii A. 3 - Superficial palmar arterial arch - passes across palm to connect with Radial A. a - Palmar metacarpal Aa. - branch off Deep and Superficial palmar arterial arches and pass down palm over metacarpals, then divide into Palmar digital Aa. i - Palmar digital Aa. - pass along each side of digits. Note: Suppose infant is a mnemonic for the collaterals and recurrents of the elbow.

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CUTANEOUS VEINS OF THE UPPER EXTREMITY I - Basilic V. - passes from dorsum of hand, up medial side of arm to elbow, there it is connected to Cephalic V. by Median cubital V. It continues up arm,and halfway up arm it goes deep and runs with Brachial A. It becomes Axillary V. at distal border of Teres major. A - Median cubital V. - runs transversly in cubital fossa and connects Basilic and Cephalic Vv. 1 - Median V. of forearm variable, passes up forearm from palm and dumps into Median cubital V. in cubital fossa. B - Dorsal venous arch variable, on dorsum of hand, it drains blood from digital veins and in turn drains into Basilic and Cephalic Vv. II - Cephalic V. - passes up from Dorsal venous arch along lateral (radial) side of forearm. At elbow it connects with Median cubital V. It continues up arm cutaneously, goes deep below Deltoideus. Near clavicle it dumps into Axillary V.

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CROSS-SECTION OF THE ARM

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CROSS-SECTION OF THE FOREARM

Note: Pronator teres is shown near its insertion on the radius, but originates on the medial epicondyle and passes diagonally across the flexor side of the forearm.

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OSTEOLOGY OF THE PELVIC GIRDLE AND LOWER EXTREMITY PELVIC BONES (=Os coxa) consisting of 3 fused bones: Ilium, Ischium, & Pubis

Acetabulum - articulates with head of femur Obturator foramen - covered by fascia, origin of Obturator internus and externus Pubic Symphysis - median joint of two pelvic bones ILIUM Auricular Surface - articulates with sacrum Iliac Crest Iliac Fossa - origin of Iliacus Anterior Superior Iliac Spine - origin of Sartorius Anterior Inferior Iliac Spine - origin of Rectus femoris Greater Sciatic Notch - Piriformis, Sciatic N., etc. pass through Gluteal Lines - margins of origins of gluteal Mm. ISCHIUM Body Ramus Ischial Spine - attachment of Sacrospinous Ligament Ischial Tuberosity - origin of hamstrings Lesser Sciatic Notch - Obturator internus passes through PUBIS Body Superior and Inferior Rami Symphyseal Surface - articulates with opposite pubis FEMUR Head - articulates with pelvic bone Neck Shaft Greater Trochanter - insertion of lateral rotators and gluteal Mm. Lesser Trochanter - insertion of Iliopsoas Intertrochanteric line Intertrochanteric crest Gluteal Tuberosity - insertion of deep part of Gluteus maximus Linea Aspera - insertion of adductors, origin of vasti, Biceps femoris short head Medial & Lateral Supracondylar Lines Medial & Lateral Epicondyles - attachment for collateral ligaments Adductor Tubercle - insertion of part of Adductor magnus Medial & Lateral Condyles - articulate with tibia Patellar Surface - articulates with patella Intercondylar Notch (or Fossa) - space for cruciate ligaments

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TIBIA Medial and Lateral Condyles - articulate with femur Intercondyloid Eminence (or Tubercles) - attachment for cruciate ligaments Tibial Tuberosity - insertion of Ligamentum patellae Popliteal (or Soleal) Line - superior margin of origin of Soleus Anterior Border (or Crest) Superior and Inferior Fibular Articular Facets - articulate with fibula Medial Malleolus - attachment of ligaments and pulley for plantarflexors Inferior Articular Surface - articulates with talus FIBULA Head - insertion of Biceps femoris, ligaments Lateral Malleolus - attachment for ligaments and pulley for fibular Mm. TARSUS Talus Calcaneus Calcaneal Tuberosity - heel; insertion of superficial plantarflexors, origin of some plantar Mm. Sustentaculum Tali - pulley for Flexor hallucis longus Navicular Cuboid Cuneiforms (3): First (or Med.)/Second (or Intermediate)/Third (or Lat.) METATARSALS I-V AND PHALANGES Each metatarsal has: Base (or Proximal end) and Head (or Distal end) Metatarsal V has a Tuberosity Digit I (=Hallux) has: Proximal and Distal Phalanges Digits II-V have: Proximal, Middle, and Distal Phalanges JOINTS OF LOWER EXTREMITY Movements of Hip joint - extension and flexion - aBduction and adduction - medial and lateral rotation Movements of Knee joint - flexion and extension - slight medial and lateral rotation of tibia Movement of Ankle (=Tibiotalar) joint - dorsiflexion and plantarflexion Movement of Subtalar and Calcaneotalonavicular joints - inversion and eversion

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MUSCLES OF THE ANTERIOR THIGH MUSCLE ORIGIN INSERTION ACTION/(NERVE) Vastus lateralis Linea aspera and lateral side of femur Anterior and lateral femur Linea aspera and medial side of femur Anterior inferior iliac spine and upper margin of acetabulum Anterior superior iliac spine Patella and Lig. patellae to tibia Extends knee (Femoral N.)

Vastus intermedius

Patella and Lig. patellae to tibia Patella and Lig. patellae to tibia

Extends knee (Femoral N.) Extends knee (Femoral N.)

Vastus medialis

Rectus femoris

Patella and Lig. patellae to tibia

Flexes hip, extends knee (Femoral N.)

Sartorius

Upper part of medial surface of tibia

Flexes hip, flexes knee (Femoral N.)

Note: All muscles of the anterior thigh are innervated by the Femoral N.

Note: Tensor fasciae latae may be included in drawings of the muscles of the anterior thigh because of its position, but it should be considered a gluteal muscle. Note: Articularis genu is a small deep slip of Vastus intermedius that inserts on the synovial capsule of the knee and pulls the capsule up when the knee is extended.

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MUSCLES OF THE MEDIAL THIGH MUSCLE ORIGIN INSERTION ACTION/(NERVE) Iliopsoas Iliacus - iliac fossa Psoas major lumbar vertebrae Pectineus Superior ramus of pubis Line from lesser trochanter to linea aspera Lesser trochanter of femur Flexes hip (Femoral N.) (Upper 3 or 4 lumbar Nn.) Adducts, flexes, and laterally rotates hip (Femoral N.) Adducts hip (Obturator N.) Adducts hip (Obturator N.) Adducts hip (Obturator N.)

Adductor brevis

Anterior surface of inferior ramus of pubis Anterior surface of body of pubis Inferior ramus of pubis and ischial tuberosity

Linea aspera

Adductor longus

Linea aspera

Adductor magnus

Linea aspera and medial supracondylar line to adductor tubercle Upper part of medial surface of tibia

Gracilis

Body and inferior ramus of pubis near the symphysis

Adducts hip; flexes and medially rotates knee (Obturator N.)

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MUSCLES OF THE POSTERIOR THIGH MUSCLE ORIGIN INSERTION ACTION/(NERVE) Semimembranosus Ischial tuberosity Posterior surface of medial condyle of tibia Upper part of medial surface of tibia Head of fibula Extends hip, flexes knee (Sciatic N.) Extends hip, flexes knee (Sciatic N.) Extends hip, flexes knee (Sciatic N.) Flexes knee (Sciatic N.)

Semitendinosus

Ischial tuberosity

Biceps femoris

Long head ischial tuberosity Short head - linea aspera and lateral supracondylar line

Note: All muscles of the posterior thigh are innervated by the tibial division of the Sciatic N., and some books state that Semimembranosus and Semitendinosus are innervated by the Tibial N.

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LATERAL ROTATORS OF THE FEMUR MUSCLE ORIGIN INSERTION ACTION/(NERVE) Piriformis Anterior surface of sacrum - passes through greater sciatic foramen Ischial spine Greater trochanter of femur Rotates hip laterally (L5-S2)

Gemmellus superior

Tendon of Obturator internus

Rotates hip laterally (N. to Obturator internus) Rotates hip laterally (N. to Obturator internus; L5-S2)

Obturator internus

Internal (=post.) surface of obturator fascia

Tendon passes through lesser sciatic foramen to medial surface of greater trochanter Tendon of Obturator internus

Gemmellus inferior

Upper part of ischial tuberosity

Rotates hip laterally (N. to Quadratus femoris) Adducts and laterally rotates hip (Obturator N.) Adducts and laterally rotates hip (N. to Quadratus femoris; L4-S1)

Obturator externus

External (=ant.) surface of obturator fascia

Trochanteric fossa of femur

Quadratus femoris

Ischial tuberosity

Quadrate tubercle of femur

Note: Obturator externus can be seen between Gemmellus inferior and Quadratus femoris in the gluteal region. Its origin can be seen in the medial thigh if Adductor longus and brevis and Pectineus are reflected; it is then superior (and deep) to the upper margin of Adductor magnus.

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GLUTEAL MUSCLES MUSCLE ORIGIN INSERTION ACTION/(NERVE) Gluteus minimus Outer surface of ilium between anterior and inferior gluteal lines Upper part of the outer surface of ilium Anterior border of greater trochanter with Gluteus medius ABducts and medially rotates hip (Sup. gluteal N.)

Gluteus medius

Lateral surface of greater trochanter

ABducts and medially rotates hip (Sup. gluteal N.) Extends, adducts, and laterally rotates hip (Inf. gluteal N.)

Gluteus maximus

Posterior gluteal line of ilium and posterior surface of sacrum and coccyx Outer surface of ilium behind anterior superior iliac spine

Posterior femur and iliotibial tract

Tensor fasciae latae

Iliotibial tract

ABducts and medially rotates hip (Sup. gluteal N.)

Note: The main function of Tensor fasciae latae and Gluteus minimus and medius is to brace the hip during walking to keep the pelvis level when the opposite foot is off the ground.

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MUSCLES OF THE ANTERIOR CRURAL COMPARTMENT - DORSIFLEXORS MUSCLE ORIGIN INSERTION ACTION/(NERVE) Tibialis anterior Upper 2/3 of lateral tibia and interosseus membrane Middle 1/2 of fibula Tendon to medial surface of metatarsal I and medial cuneiform Tendon to base of distal phalanx of hallux Tendon divides into 4 and each inserts on distal phalanges of digits II-V Base of metatarsal V Dorsiflexes ankle, inverts foot (Deep fibular N.)

Extensor hallucis longus

Extends hallux, dorsiflexes ankle (Deep fibular N.) Extends digits II-V, dorsiflexes ankle (Deep fibular N.)

Extensor digitorum longus

Upper 3/4 of fibula and interosseus membrane

Fibularis tertius

Small slip of extensor digitorum longus

Everts foot (Deep fibular N.)

Note: All muscles of the anterior crural compartment are innervated by the Deep fibular N.

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MUSCLES OF THE POSTERIOR CRURAL COMPARTMENT - SUPERFICIAL PLANTARFLEXORS MUSCLE ORIGIN INSERTION ACTION/(NERVE) Soleus Upper 1/3 of posterior fibula, middle 1/3 of posterior tibia Lateral femoral condyle with Gastrocnemius Calcaneus by Tendo calcaneus Plantarflexes ankle (Tibial N.)

Plantaris

Long tendon to medial side of posterior calcaneus Posterior tibia above soleal line

Plantarflexes ankle (Tibial N.)

Popliteus

Lateral femoral condyle

Rotates leg medially (Tibial N.) Plantarflexes ankle, flexes knee (Tibial N.)

Gastrocnemius

Medial and lateral heads from medial and lateral femoral condyles, respectively

Calcaneus by Tendo calcaneus

Note: Popliteus does not insert on the foot and so is not a plantarflexor. Its main function is to rotate the tibia medially on the femur to unlock the knee joint and permit it to be flexed. Note: All muscles of the posterior crural compartment are innervated by the Tibial N.

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MUSCLES OF THE POSTERIOR CRURAL COMPARTMENT - DEEP PLANTARFLEXORS MUSCLE ORIGIN INSERTION ACTION/(NERVE) Flexor digitorum longus Middle of posterior tibia Tendon passes medial malleolus, divides into four tendons and each inserts on 3rd phalanx of digits II-V Tendon passes medial malleolus, and inserts on the tuberosity of navicular and plantar surface of cuneiforms, etc. Tendon passes beneath sustentaculum tali, inserts on 2nd phalanx of hallux Flexes digits II-V, plantarflexes ankle (Tibial N.)

Tibialis posterior

Upper 2/3 of medial fibula, interosseus membrane, and lateral tibia

Plantarflexes ankle, inverts foot (Tibial N.)

Flexor hallucis longus

Lower 2/3 of posterior fibula

Flexes hallux, plantarflexes ankle (Tibial N.)

Note: All muscles of the posterior crural compartment are innervated by the Tibial N.

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MUSCLES OF THE LATERAL CRURAL COMPARTMENT MUSCLE ORIGIN INSERTION ACTION/(NERVE) Fibularis longus Upper 2/3 of anterior fibula Tendon passes behind lateral malleolus, inserts on lateral side of metatarsal I Tendon passes behind lateral malleolus, inserts on base of metatarsal V Plantarflexes ankle, everts foot (Superficial fibular N.)

Fibularis brevis

Lower 2/3 of anterior fibula

Plantarflexes ankle, everts foot (Superficial fibular N.)

Note: Both muscles in the lateral crural compartment are innervated by the Superficial fibular N.

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MUSCLES OF THE DORSUM OF THE FOOT MUSCLE ORIGIN INSERTION ACTION/(NERVE) Extensor digitorum brevis Upper anterior surface of the calcaneus By four tendons to digits I-IV; 1st on base of 1st phalanx of digit I; 2nd-4th on lateral sides of tendons of Extensor digitorum longus Tendon to base of 1st phalanx of digit I Extends digits I-IV (Deep fibular N.)

Extensor hallucis brevis

Upper anterior surface of the calcaneus

Extends hallux (Deep fibular N.)

Note: Both muscles are innervated by the Deep fibular N. that also innervates the muscles of the anterior crural compartment. Note: Extensor hallucis brevis is considered to be a part of Extensor digitorum brevis.

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MUSCLES OF THE SOLE OF THE FOOT - 1ST LAYER MUSCLE ORIGIN INSERTION ACTION/(NERVE) ABductor hallucis Calcaneal tuber Medial side of base of 1st phalanx of digit I 2nd phalanx of digits II-V Lateral side of base of 1st phalanx of digit V ABducts hallux (Med. plantar N.)

Flexor digitorum brevis ABductor digiti minimi

Calcaneal tuber

Flexes digits II-V (Med. plantar N.) ABducts digit V (Lat. plantar N.)

Calcaneal tuber

MUSCLES OF THE SOLE OF THE FOOT - 2ND LAYER MUSCLE ORIGIN INSERTION ACTION/(NERVE) Quadratus plantae By 2 heads from calcaneal tuber and plantar ligaments Tendon of Flexor digitorum longus Straightens pull of Flexor digitorum longus, flexes digits II-V (Lat. plantar N.) Flex digits II-V at metatarsophalangeal joints, extend digits II-V at interphalangeal joints (Med. and Lat. plantar Nn.)

Lumbricales (4)

Sides of tendons of M. flexor digitorum longus

With tendons of Extensor digitorum longus and into medial sides of bases of the 1st phalanges of digits II-V

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MUSCLES OF THE SOLE OF THE FOOT - 3RD LAYER MUSCLE ORIGIN INSERTION ACTION/(NERVE) Flexor hallucis brevis Cuboid, lateral cuneiform, and ligaments at base of metatarsal I By 2 bellies on medial and lateral sides of base of 1st phalanx of digit I Lateral side of base of 1st phalanx of digit I Flexes hallux (Med. plantar N.)

Adductor hallucis

Two heads: oblique head from bases of metatarsals II-IV; transverse head from metatarsophalangeal joint capsules of digits II-V Base of metatarsal V

Adducts hallux, assists in flexing (Lat. plantar N.)

Flexor digiti minimi

Lateral side of 1st phalanx of digit V

Flexes digit V (Lat. plantar N.)

MUSCLES OF THE SOLE OF THE FOOT - 4TH LAYER MUSCLE ORIGIN INSERTION ACTION/(NERVE) Plantar interossei (3) Bases and medial sides of metatarsals III-V Medial sides of 1st phalanges of digits III-V Adduct digits III-V toward axis of digit II (Lat. plantar N.) ABduct digits II-IV from axis of digit II (Lat. plantar N.)

Dorsal interossei (4)

By two heads from the sides of adjacent metatarsals I-V

Into bases of 1st phalanges; on medial side of digit II, and on lateral sides of digits II-IV

Note: PAD (Plantar ADduct) and DAB (Dorsal ABduct) are words.

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NERVES OF THE LOWER EXTREMITY

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NERVES OF THE LOWER EXTREMITY I - Femoral N. - passes under Inguinal ligament into Femoral Triangle lateral to Femoral A+V. It divides into muscular branches and Saphenous N. A - Nn. to Vasti - branches of Femoral N. that supply the vasti. B - Saphenous N. - passes down adductor canal with Femoral A+V. It does not pass through adductor hiatus, but continues with Saphenous A. and becomes cutaneous after passing knee. II - Obturator N. - passes through obturator foramen, divides into 2 branches found between Adductor longus and magnus. III - Sciatic N. - arises from sacral plexus, passes between Piriformis and Obturator internus. Then passes down thigh deep to Gluteus maximus and hamstrings. A short distance above knee it divides into Tibial and Common fibular Nn. A - Tibial N. - passes down popliteal fossa and posterior crural compartment with Popliteal A+V and Posterior tibial A+V. Behind knee it sends off Medial sural cutaneous N. Behind medial malleolus it divides into Medial and Lateral plantar Nn. 1 - Medial sural cutaneous N. - descends leg between heads of Gastrocnemius. May join with Lateral sural cutaneous N. to form Sural N. 2 - Medial plantar N. - passes anteriorly toward base of metatarsal I with Medial plantar A. 3 - Lateral plantar N. - passes anteriorly toward base of metatarsal V with Lateral plantar A. B - Common fibular N. - passes through popliteal fossa with Biceps femoris tendon, sends off Lateral sural cutaneous N., curls around head of fibula, and splits into Superficial and Deep fibular Nn. 1 - Lateral sural cutaneous N. - passes down lateral side of leg. 2 - Deep fibular N. - passes between tibia and fibula, into and down anterior crural compartment with Anterior tibial A+V. Terminal branches continue onto dorsum of foot. 3 - Superficial fibular N. - passes down lateral crural compartment between Fibularis longus and brevis and Extensor digitorum longus. Terminal branches continue onto dorsum of foot as a cutaneous nerve.

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NERVES AND ARTERIES IN THE GLUTEAL REGION

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NERVES AND ARTERIES IN THE GLUTEAL REGION NERVES I - Branches of sacral plexus in gluteal region A - Superior gluteal N. - found with Superior gluteal A+V superior to Piriformis, then passes laterally with deep branches of Superior gluteal A+V between Gluteus minimus and medius. B - Inferior gluteal N. - found with Inferior gluteal A+V between Piriformis and Obturator internus, and medial to Sciatic N. C - Pudendal N. - found with Inferior pudendal A+V between Piriformis and Obturator internus, medial to Superior gluteal NAV, and passing deep to perineal region. D - Sciatic N. - arises from sacral plexus, passes between Piriformis and Obturator internus. Then passes down thigh deep to Gluteus maximus and hamstrings.

ARTERIES I - Branches of Internal Iliac A. in gluteal region A - Superior gluteal A. - found with Superior gluteal N. superior to Piriformis. Deep branches pass laterally between Gluteus minimus and medius, and superficial branches pass laterally between Gluteus medius and maximus. B - Inferior gluteal A. - found with Inferior gluteal N. between Piriformis and Obturator internus and medial to Sciatic N. C - Internal pudendal A. - found with Pudendal N. between Piriformis and Obturator internus and medial to Sciatic N. It goes deep to inguinal region.

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ARTERIES OF THE LOWER EXTREMITY

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ARTERIES OF THE LOWER EXTREMITY Ia - Femoral A. - continuation of External iliac A. after passing under Inguinal ligament. Passes down femoral triangle, adductor canal, through adductor hiatus, and becomes Popliteal A. A - Profunda femoris A. - branches off in Femoral triangle, goes deep toward femur, and passes down thigh deep alongside femur. 1 - Medial femoral circumflex A. - branches off about 2 cm from origin of Profunda femoris A., passes medially between Iliopsoas and Pectineus, around back of femur, and anastomoses with Lateral femoral circumflex A. 2 - Lateral femoral circumflex A. - branches off about 2 cm from origin of Profunda femoris A., splits into three branches; one branch passes laterally around femur, and anastomoses with Medial femoral circumflex A. Ib - Popliteal A. - continuation of Femoral A. on posterior thigh. It passes through popliteal fossa, and divides into Anterior and Posterior tibial Aa. shortly below knee. A - Superior Superior Inferior Inferior medial genicular A. lateral genicular A. medial genicular A. lateral genicular A. Pass around knee from posterior to anterior and anastomose together. Superiors branch off above heads of Gastrocnemius, inferiors below.

Bi - Anterior tibial A. - passes between tibia and fibula into and down anterior crural compartment on interosseus membrane. As it crosses ankle it becomes Dorsalis pedis A. Bii - Dorsalis Pedis A. - continuation of Anterior tibial A. Passes under extensor retinacula toward base of metatarsal I. 1 - Arcuate A. - runs laterally along bases of metatarsals. a - Dorsal metatarsal Aa. - four; each passes distally between metatarsals and divides into dorsal digital Aa. i - Dorsal digital Aa. - pass distally along digits. C - Posterior tibial A. - passes down posterior crural compartment deep to Soleus, passes behind medial malleolus, and splits into Medial and Lateral plantar Aa. 1 - Fibular A. - branches off Posterior tibial A. about 6 cm below knee, and passes deep along fibula. 2 - Medial plantar A. - passes anteriorly toward base of metatarsal I with Medial plantar N. 3 - Lateral plantar A. - passes anteriorly toward base of metatarsal V with Lateral plantar N.

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CUTANEOUS VEINS OF THE LOWER EXTREMITY I - Great saphenous V. - drains Dorsal venous arch and runs in front of medial malleolus, up medial side of lower extremity, and ends in Femoral V. in femoral triangle. A - Dorsal venous arch - runs across top of foot at base of toes, drains at each end into Great and Small saphenous Vv. respectively. II - Small saphenous V. - drains Dorsal venous arch and runs behind lateral malleolus, up back of leg, and ends in Popliteal V.

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CROSS-SECTION OF THE THIGH

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CROSS-SECTION OF THE LEG

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