Atlas of Human Anatomy 4e (Netter Basic Science)

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Atlas of

Human Anatomy

Consulting Editors

Jennifer K. Brueckner, PhD

Noelle A. Granger, PhD

Assistant Professor

Professor

Department of Anatomy and Neurobiology

Department of Cell and Developmental Biology

University of Kentucky College of Medicine

University of North Carolina School of Medicine

Lexington, Kentucky

Chapel Hill, North Carolina

Stephen W. Carmichael, PhD, DSc

John T. Hansen, PhD

Professor

Professor of Neurobiology and Anatomy

Departments of Anatomy and Orthopedic Surgery

Associate Dean for Admissions

Mayo Clinic

University of Rochester School of Medicine and Dentistry

Rochester, Minnesota

Rochester, New York

Thomas R. Gest, PhD

Anil H. Walji, MD, PhD

Associate Professor

Professor and Director, Division of Anatomy

Division of Anatomical Sciences and Department

Professor of Radiology and Diagnostic Imaging

of Medical Education

Professor of Surgery

University of Michigan Medical School

Faculty of Medicine and Dentistry

Ann Arbor, Michigan

University of Alberta Edmonton, Alberta, Canada

j.

*

F o u r t h

E d i t i o n

Frank H. Netter, MD

SAUNDERS

SAUNDERS ELSEVIER

1600 John F. Kennedy Boulevard -Suite 1800 Philadelphia, Pennsylvania 19103-2899

Atlas of Human Anatomy Fourth Edition

Edition with Student Consult Access: Professional Edition: International Edition: Enhanced International Edition with Student Consult Access:

ISBN-13: ISBN-10: ISBN-13: ISBN-10: ISBN-13: ISBN-10:

978-1-4160-3385-1 1 -4160-3385-8 978-1-4160-3699-9 1-4160-3699-7 978-0-8089-2384-8 0-8089-2384-6

ISBN-13: 978-0-8089-2379-4 ISBN-10: 0-8089-2379-X

Copyright © 2006, 2003, 1997, 1989 by Saunders, an imprint of Elsevier Inc. All rights reserved. No part of this book may be produced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publishers. Permissions for Netter Art figures may be sought directly from Elsevier's Health Science Licensing Department in Philadelphia, Pennsylvania, USA: phone 1-800-523-1649, ext. 3276, or 215-239-3276; email: [email protected].

NOTICE Neither the Publisher nor the Editors assume any responsibility for any loss or injury and/or damage to persons or property arising out of or related to any use of the material contained in this book. It is the responsibility of the treating practitioner, relying on independent expertise and knowledge of the patient, to determine the best treatment and method of application for the patient. Previous editions copyrighted 2003, 1997, 1989.

Library of Congress Cataloging-in-Publication Data Netter, Frank H. (Frank Henry), 1906-1991. Atlas of human anatomy / Frank H. Netter.—4th ed. p. ; cm. Includes bibliographical references and index. ISBN-13: 978-1 -4160-3385-1 ISBN-10: 1 -4160-3385-8 1. Human anatomy—Atlases. I. Title. [DNLM: 1. Anatomy—Atlases. QS 17 N474a 2006] QM25.N46 2006 611.0022'12—dc22

Acquisitions

Developmental

2006047497

Editor: Anne Lenehan

Editor: Marybeth Thiel

Publishing Services Manager: Frank Polizzano Senior Project Manager: Cecelia B a y r u n s Design Direction: Louis Forgione Illustration Manager: Cecilia Nuyianes Cover Design Concept: M a d e l e n e H y d e Marketing Manager: Megan Poles

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Printed in the United States of America. Last digit is the print number:

9

8

7

6

5

4

3

ELSEVIER

Intern^ional

S a b r e

Foundation

To my dear wife, Vera

T

by

the uncovertebral joints of the cervical vertebrae, the vertebral

Frank H. Netter, MD, has been updated by our

veins, and the intricate vasculature of the eye, to mention a few,

Consulting Editor team of Jennifer K. Brueckner,

with artistic brilliance, anatomical precision, and visual appeal

Stephen W. Carmichael, Thomas R. Gest, Noelle A. Granger,

that is unsurpassed. The section includes a concise treatment of

John T. Hansen, and Anil H. Walji. We have each reviewed, mod-

the central nervous system, including the cranial nerves and im-

ified, and updated a section of the Atlas. Throughout the book,

portant central pathways.

he Fourth Edition of Atlas

of Human

Anatomy

new radiographs, c o m p u t e d tomographic (CT) images, CT an-

In the Back section, a new plate illustrates the proper

giograms, and magnetic resonance (MR) images have been

placement of a lumbar epidural anesthetic agent, as well as the

added, which reflects the importance of diagnostic imaging in

location for lumbar puncture or "spinal tap." Autonomics are tra-

clinical anatomy and medicine. In this edition, 45 plates have

ditionally the bane of many students, and excellent new draw-

been revised to show corrected anatomical relationships, 290

ings of the autonomic nervous system by Dr. Machado will serve

plates have been relabeled, and there are 17 completely new

as a new educational resource for these difficult concepts.

plates. Wonderful new artwork for this edition has been created

The Thorax section underwent minor editorial corrections

by Carlos A. G. Machado, MD, w h o has contributed to the

of terminology and subtle artwork modifications to more accu-

Netter illustrations for over ten years. Anatomical nomenclature

rately reflect the most c o m m o n anatomical patterns. For in-

has been brought up to date, and clinical terms and eponyms in

stance, the representation of the azygos venous system pat-

c o m m o n usage have been included parenthetically. The genius

tern was altered to reflect the most c o m m o n arrangement of

of Dr. Netter's paintings is that the anatomy is portrayed clearly,

these highly variable veins. The inclusion of the thoracic cross-

realistically, and in a clinically relatable fashion while maintaining

sectional images at the end of the section, rather than in the

the balance between complexity and oversimplification. We

later section, reinforces the importance of knowledge of cross-

have tried to adhere to these principles in the creation of the

sectional anatomy in the interpretation of cross-sectional MR

new plates for this edition. Finally, some of the plates were re-

and CT images.

arranged as page-pairs, where appropriate, to facilitate side-by-

The A b d o m e n section has had the most extensive revision

side comparisons of commonly illustrated elements. This fourth

for label changes and positioning of leader lines. By popular re-

edition owes much to the consulting editors of the earlier edi-

quest, the plate showing the c o m m o n variations in the branches

tions, Drs. Sharon Colacino (Oberg) (first edition), Arthur F. Dalley

of the celiac artery, which appeared in the first edition A b d o m e n

II (second edition), and John T. Hansen (third edition), who shep-

section, has been reinstated.

herded their editions with great skill and uncompromising professionalism, making our task significantly easier.

The anatomy of the pelvis is a particularly difficult area to teach and, because of the depth and tight organization of the in-

The head and neck is a particularly challenging area for stu-

ternal structures, difficult to illustrate. The Netter illustrations of

dents, residents and faculty to master, due not only to the sheer

pelvic anatomy are outstanding because of the clarity of their

number of structures packed in this relatively small region of the

presentation and their scope of coverage. A very small number

human body, but also the complexity of their three-dimensional

of plates were eliminated to permit the inclusion of the illustra-

anatomical organization. The age-old aphorism that "there is

tion of pelvic fascia, a parasagittal view of the broad ligament,

more anatomy above the hyoid bone than below it" presents a

and

unique challenge to anyone trying to portray the anatomy of this

tourethrograms, and a hysterosalpingogram). Comparative im-

region in a simple, visually appealing, and clinically relevant

ages of male and female pelvic anatomy were reorganized to al-

manner. More than ten new plates have been added to this sec-

low their side-by-side comparison.

normal

imaging

(male and female

radiographs,

cys-

tion. For the first time, spectacular original paintings created by

New CT angiograms have been included in the Upper Limb

Carlos Machado illustrate clinically important structures such as

and Lower Limb sections. This new technology not only clearly

F@rew®rdl

demonstrates blood vessels, but vividly shows bony landmarks

help you better understand anatomy and its application to the

to which the blood vessels are related. The ligaments of the

practice of clinical medicine. More information about the web-

wrist have been illustrated in more detail to reflect their in-

site, including the PIN code for access, can be found on the in-

creased importance in arthroscopic procedures and other appli-

side front cover of the Atlas.

cations of new technology to this joint.

Jennifer K. Brueckner, PhD

We hope you enjoy this new edition of the Atlas of Human

Stephen W. Carmichael, PhD, DSc

Anatomy and that you find it useful for learning and for your ca-

Thomas R. Gest, PhD

reer. For the standard edition and enhanced international edition

Noelle A. Granger, PhD

of the Atlas,

we have included access to the website www.

John T. Hansen, PhD

netteranatomy.com. By registering on this website, you will be

Anil H. Walji, MD, PhD

able to access supplemental material that has been organized to

Acknowledgments

It has been my pleasure to work with the other members of the

I would like to thank Marybeth Thiel, Developmental Editor, our a

editorial board, Carlos Machado, MD, and the Elsevier staff.

superb medical illustrator Dr. Carlos Machado, and the entire

Special thanks go to John Hansen, PhD, for the opportunity to

Editorial, Production, Design, Illustration, and Marketing staff at

work on this editorial team. I am indebted to my family for the

Elsevier for shepherding this edition to completion. For all our

support and encouragement that they have provided.

students, past, present and future, this Atlas is for you. Finally, to my wife, Paula, thank you for your love and encouragement

—Jennifer

K. Brueckner,

PhD

throughout the years. —John

T. Hansen,

PhD

I would like to thank the specialists at the Mayo Clinic who helped review the art, especially Richard A. Berger, MD, PhD, Shawn W. O'Driscoll, MD, PhD, Enrique A. Sabater, MD, and

I would like to thank my wife, Parviz, and my daughters, Amreen

Robert J. Spinner, MD.

and Farah, for their patience and constant support and encouragement during my involvement with this project. My special —Stephen

W.: Carmichael,

PhD,

DSc

thanks go to Dr. Carlos Machado, w h o has my utmost admiration for his brilliant artwork and who was an absolute delight to work with. I would also like to express my sincere appreciation

I must thank my family and especially my daughter, Madison,

to all the wonderful staff at Elsevier, in particular Linda Belfus for

and son, Taylor, for their support and understanding of my ef-

her exemplary leadership, and Anne Lenehan, Marybeth Thiel,

forts on this editorial task. It was a pleasure to work with my col-

and Cecelia Bayruns for all of their hard work, patience, and

leagues on the editorial board and with the staff of Elsevier. It

dedication, without which this atlas would not have been possi-

has been my sincere pleasure to work with Dr. Carlos Machado

ble. Finally, I would like to thank my fellow coeditors and all of

on the artwork changes for the 4th edition.

my colleagues who helped with reviewing the plates, in particular Pierre Lemelin, PhD, and Daniel Livy, PhD, whose meticulous

—Thomas

ft

Gest,

PhD

examination of the artwork has helped greatly in ensuring the accuracy of the head and neck section in this edition.

I am deeply grateful to my colleagues at University of North Carolina School of Medicine: James Scatliff, MD, former Chair of the Department of Radiology, for his help with the imaging, and O.W. Henson, PhD, Professor Emeritus of Anatomy, for his input. I especially thank Carlos Machado, the exceptional artist whose talent made any change required in the original plates both seamless and beautiful.

—Noelle

A. Granger;

PhD

—Anil

H. Walji, MD,

PhD

Imaging Acknowledgements

Plate 151

Som, P., & Curtin, H. (2003). Head and Neck Imaging (4th ed). St. Louis, MO: Mosby.

Plates 355, 368, and 373

James Scatliff, MD Former Chair of the Department of Radiology University of North Carolina

Plates 484 and 547

Enrique A. Sabater, M.D. Department of Radiology Mayo Clinic

Preface to the First Edition

I

have often said that my career as a medical artist for al-

and even revision of a number of them in order to make them

most 50 years has been a sort of " c o m m a n d performance"

more pertinent to today's ever-expanding scope of medical and

in the sense that it has grown in response to the desires

surgical practice. In addition, I found that there were gaps in the

and requests of the medical profession. Over these many years,

portrayal of medical knowledge as pictorialized in the illustra-

I have produced almost 4,000 illustrations, mostly for The CIBA

tions I had previously done, and this necessitated my making a

(now Netter)

number of new pictures that are included in this volume.

Collection

of Medical

Illustrations

b u t also

for

Clinical Symposia. These pictures have been concerned with the varied subdivisions

of medical

knowledge

such as

In creating an atlas such as this, it is important to achieve a

gross

happy medium between complexity and simplification. If the

anatomy, histology, embryology, physiology, pathology, diag-

pictures are too complex, they may be difficult and confusing to

nostic modalities, surgical and therapeutic techniques and clin-

read; if oversimplified, they may not be adequately definitive or

ical manifestations of a multitude of diseases. As the years went

may even be misleading. I have therefore striven for a middle

by, however, there were more and more requests from physi-

course of realism without the clutter of confusing minutiae. I

cians and students for me to produce an atlas purely of gross

hope that the students and members of the medical and allied

anatomy. Thus, this atlas has c o m e about, not through any in-

professions will find the illustrations readily understandable, yet

spiration on my part but rather, like most of my previous works,

instructive and useful.

as a fulfillment of the desires of the medical profession. It involved going back over all the illustrations I had made

At one point, the publisher and I thought it might be nice to include a foreword

by a truly outstanding

and

renowned

over so many years, selecting those pertinent to gross anatomy,

anatomist, but there are so many in that category that we could

classifying them and organizing them by system and region,

not make a choice. We did think of men like Vesalius, Leonardo

adapting them to page size and space and arranging them in

da Vinci, William Hunter and Henry Gray, who of course are un-

logical sequence. Anatomy of course does not change, but our

fortunately unavailable, but I do wonder what their c o m m e n t s

understanding of anatomy and its clinical significance does

might have been about this atlas.

change, as do anatomical terminology and nomenclature. This therefore required much updating of many of the older pictures

Frank H. Netter, MD (1906-1991)

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•

—

mm-

mm

Frank H. Netter, MD

F

rank H. Netter was born in New York City in 1906. He

studied art at the Art Students

League and the

National Academy of Design before entering medical

Dr. Netter's works are among the finest examples of the use of illustration in the teaching of medical concepts. The 13-book

Netter

Collection

of Medical

Illustrations,

which includes the

school at New York University, where he received his Doctor of

greater part of the more than 20,000 paintings created by Dr.

Medicine degree in 1931. During his student years, Dr. Netter's

Netter, became and remains one of the most famous medical

notebook sketches attracted the attention of the medical faculty

works ever published. The Netter Atlas of Human Anatomy,

and other physicians, allowing him to augment his income by il-

published in 1989, presents the anatomic paintings from the

lustrating articles and textbooks. He continued illustrating as a

Netter Collection. Now translated into 16 languages, it is the

sideline after establishing a surgical practice in 1933, but he ulti-

anatomy atlas of choice among medical and health professions

mately opted to give up his practice in favor of a full-time c o m -

students the world over.

first

mitment to art. After service in the United States Army during

The Netter illustrations are appreciated not only for their

World War II, Dr. Netter began his long collaboration with the

aesthetic qualities, but, more importantly, for their intellectual

CIBA Pharmaceutical Company {now Novartis Pharmaceuticals).

content. As Dr. Netter wrote in 1949 "clarification of a subject is

This 45-year partnership resulted in the production of the extra-

the aim and goal of illustration. No matter how

ordinary collection of medical art so familiar to physicians and

painted, how delicately and subtly rendered a subject may be, it

other medical professionals worldwide.

is of little value as a medical

illustration

beautifully

if it does not serve to

Icon Learning Systems acquired the Netter Collection in

make clear some medical point." Dr. Netter's planning, concep-

July 2000 and continued to update Dr. Netter's original paintings

tion, point of view, and approach are what inform his paintings

and to add newly commissioned paintings by artists trained in

and what make them so intellectually valuable.

the style of Dr. Netter. In 2005, Elsevier Inc. purchased the Netter Collection and all publications from Icon Learning Systems. There are now over 50 publications featuring the art of Dr. Netter available through Elsevier Inc.

Frank H. Netter, MD, physician and artist, died in 1991.

Contents

Head and Neck 1

Topographic Anatomy

Plate

Bones and Ligaments

Plates

2-22

Superficial Face

Plates

23-26

Neck

Plates

27-35

Nasal Region

Plates

36-50

Oral Region

Plates

51-62

Pharynx

Plates

63-73

Thyroid Gland and Larynx

Plates

74-80

Orbit and Contents

Plates

81-91

Ear

Plates

92-98

Meninges and Brain

Plates

99-115

Cranial and Cervical Nerves

Plates

116-135

Cerebral Vasculature

Plates

136-148

Regional Scans

Plates

149-151

Back and Spinal Cord 152

Topographic Anatomy

Plate

Bones and Ligaments

Plates

153--159

Spinal Cord

Plates

160--173

Muscles and Nerves

Plates

174--180

Thorax 181

Topographic Anatomy

Plate

Mammary Gland

Plates

182--184

Body Wall

Plates

185--195

Lungs

Plates

196--210

Heart

Plates

211--229

Mediastinum

Plates

230--241

Regional Scans

Plate

Cross-Sectional Anatomy

Plates

242 243--246

Abdomen 247

Topographic Anatomy

Plate

Body Wall

Plates

248--267

Peritoneal Cavity

Plates

268--274

Viscera (Gut)

Plates

275--285

Viscera (Accessory Organs)

Plates

286--299

Visceral Vasculature

Plates

300--317

Innervation

Plates

318--328

Kidneys and Suprarenal Glands

Plates

329--347

Abdominal Sections

Plates

348--349

Regional Scans

Plate

350

Section 5

Pelvis and Perineum Topographic Anatomy

Plate

Bones and Ligaments

Plates

352-355

Pelvic Floor and Contents

Plates

356-364

Plates

365-368

Uterus, Vagina, and Supporting Structures

Plates

369-375

Regional Transverse Section

Plate

Perineum and External Genitalia: Female

Plates

377-379

Perineum and External Genitalia: Male

Plates

380-387

Homologues of Genitalia

Plates

388-389

Testis, Epididymis, and Ductus Deferens

Plate

Rectum

Plates

Regional Scans

Plate

Vasculature

Plates

398-408

Innervation

Plates

409-417

Urinary Bladder

Section 8

Section 7

Section 8

'

351

376

390 391-396 397

Upper Limb Topographic Anatomy

Plate

Shoulder and Axilla

Plates

419-430

Arm

Plates

431-435

Elbow and Forearm

Plates

436-451

Wrist and Hand

Plates

452-471

Neurovasculature

Plates

472-483

Regional Scans

Plate

484

Topographic Anatomy

Plate

485

Hip and Thigh

Plates

486-505

Knee

Plates

506-512

Leg

Plates

513-522

Ankle and Foot

Plates

523-537

Neurovasculature

Plates

538-546

Regional Scans

Plate

547

Plate

548

418

Lower Limb

Cross-Sectional Anatomy Key Figure for Cross Sections References Index

a

Head and Neck Topographic Anatomy Plate 1

1

Head and Neck

Bones and Ligaments Plates 2 - 2 2 rnm^^mm^^^mm^mm^mmmmmmmmmmmmmmmmmmmmsm 2

Skull: Anterior View

3

Skull: Anteroposterior Radiograph

4

Skull: Lateral View

5

Skull: Lateral Radiograph

6

Skull: Midsagittal Section

7

Calvaria

8

Cranial Base: Inferior View

9

Bones of Cranial Base: Superior View

10

Foramina of Cranial Base: Inferior View

11

Foramina of Cranial Base: Superior View

12

Skull of Newborn

13

Bony Framework of Head and Neck

14

Cranial Base: Pterygoid Fossae

15

Mandible

16

Temporomandibular Joint

17

Cervical Vertebrae: Atlas and Axis

18

Cervical Vertebrae (continued)

19

Cervical Vertebrae: Uncovertebral Joints

20

Degenerative Changes in the Cervical Vertebrae

21

External Craniocervicai Ligaments

22

Internal Craniocervicai Ligaments

Superficial Face

Oral Region

Plates 23-26

Plates 51-62

23

Superficial Arteries and Veins of Face and Scalp

51

Inspection of Oral Cavity

24

Cutaneous Nerves of Head and Neck

52

Roof of Mouth

25

Facial Nerve Branches and Parotid Gland

53

Floor of Mouth

26

Muscles of Facial Expresssion: Lateral View

54

Muscles Involved in Mastication

55

Muscles Involved in Mastication (continued)

56

Teeth

Plates 27-35

57

Teeth (continued)

27

Muscles of Neck: Lateral View

58

Tongue

28

Muscles of Neck: Anterior View

59

Tongue (continued)

29

Infrahyoid and Suprahyoid Muscles

60

Tongue and Salivary Glands: Sections

30

Scalene and Prevertebral Muscles

61

Salivary Glands

31

Superficial Veins and Cutaneous Nerves of Neck

62

Afferent Innervation of Mouth and Pharynx

32

Cervical Plexus in Situ

33

Subclavian Artery

Pharynx

34

Carotid Arteries

Plates 63-73

35

Fascial Layers of Neck

63

Pharynx: Median Section

64

Fauces

65

Muscles of Pharynx: Median (Sagittal) Section

66

Pharynx: Opened Posterior View

Heck

Nasal Region Plates 36-50 36

Nose

67

Muscles of Pharynx: Partially Opened Posterior View

37

Lateral Wall of Nasal Cavity

68

Muscles of Pharynx: Lateral View

38

Lateral Wall of Nasal Cavity (continued)

69

Arteries of Oral and Pharyngeal Regions

39

Medial Wall of Nasal Cavity (Nasal Septum)

70

Veins of Oral and Pharyngeal Regions

40

Maxillary Artery

71

Nerves of Oral and Pharyngeal Regions

41

Arteries of Nasal Cavity: Nasal Septum Turned Up

72

Lymph Vessels and Nodes of Head and Neck

42

Nerves of Nasal Cavity: Nasal Septum Turned Up

73

Lymph Vessels and Nodes of Pharynx and Tongue

43

Nerves of Nasal Cavity (continued)

44

Autonomic Innervation of Nasal Cavity

45

Ophthalmic (V,) and Maxillary (V2) Nerves

46

Mandibular Nerve (V3)

47

Nose and Paranasal Sinuses: Cross Section

48

Paranasal Sinuses

49

Paransal Sinsues (continued)

50

Paranasal Sinuses: Changes with Age

Thyroid Gland and Larynx

Meninges and Brain

Plates 74-80

Plates 9 9 - 1 1 5

74

Thyroid Gland: Anterior View

99

75

Thyroid Gland and Pharynx: Posterior View

100 Meningeal Arteries

76

Parathyroid Glands

101 Epidural Hematoma

77

Cartilages of Larynx

102 Meninges and Superficial Cerebral Veins

78

Intrinsic Muscles of Larynx

103 Dural Venous Sinuses

79

Actions of Intrinsic Muslces of Larynx

104 Dural Venous Sinuses (continued)

so

Nerves of Larynx

105 Cerebrum: Lateral Views

Orbit and Contents

Meninges and Diploic Veins

106 Cerebrum: Medial Views 107 Cerebrum: Inferior View

Plates 81-91

108 Ventricles of Brain

si

Eyelids

109 Circulation of Cerebrospinal Fluid

82

Lacrimal Apparatus

110 Basal Nuclei (Ganglia)

83

Fascia of Orbit and Eyeball

111 Thalamus

84

Extrinsic Eye Muscles

112 Hippocampus and Fornix

85

Arteries and Veins of Orbit and Eyelids

113 Cerebellum

86

Nerves of Orbit

114 Brainstem

87

Eyeball

115 Fourth Ventricle and Cerebellum

88

Anterior and Posterior Chambers of Eye

89

Lens and Supporting Structures

Cranial and Cervical Nerves

90

Intrinsic Arteries and Veins of Eye

Plates 116-135

91

Vascular Supply of Eye

116 Cranial Nerve Nuclei in Brainstem: Schema

Ear Plates 92-98

117 Cranial Nerve Nuclei in Brainstem: Schema (continued) 118 Cranial Nerves (Motor and Sensory Distribution): Schema 119 Olfactory Nerve (I): Schema

92

Pathway of Sound Reception

120 Optic Nerve (II) (Visual Pathway): Schema

93

External Ear and Tympanic Cavity

121 Oculomotor (III), Trochlear (IV), and Abducent (VI) Nerves:

94

Tympanic Cavity

95

Bony and Membranous Labyrinths

122 Trigeminal Nerve (V): Schema

96

Bony and Membranous Labyrinths (continued)

123 Facial Nerve (VII): Schema

97

Orientation of Labyrinth in Skull

124 Vestibulocochlear Nerve (VIII): Schema

98

Auditory (Pharyngotympanic, Eustachian) Tube

125 Glossopharyngeal Nerve (IX): Schema

Schema

126 Vagus Nerve (X): Schema 127 Accessory nerve (XI): Schema 128 Hypoglossal Nerve (XII): Schema 129 Cervical Plexus: Schema 130 Autonomic Nerves in Neck 131 Autonomic Nerves in Head

132 Ciliary Ganglion: Schema

142

133 Pterygopalatine and Submandibular Ganglia: Schema

143 Arteries of Posterior Cranial Fossa

134 Otic Ganglion: Schema

144 Veins of Posterior Cranial Fossa

135 Taste Pathways: Schema

145 Deep Veins of Brain

Cerebral Vasculature Plates 136-148

146

Arteries of Brain: Lateral and Medial Views

Subependymal Veins of Brain

147 Hypothalamus and Hypophysis 148 Arteries and Veins of Hypothalamus and Hypophysis

136 Arteries to Brain and Meninges 137 Veins of the Vertebral Column—Vertebral Veins

Regional Scans

138 Arteries to Brain: Schema

Plates 149-151

139 Arteries of Brain: Inferior Views

149 Head Scans: Sagittal MR Images

140 Cerebral Arterial Circle (of Willis)

150 Head Scans: Axial CT Images

141 Arteries of Brain: Frontal View and Section

151 Head Scans: Coronal CT Images

Frontal bone

Infraorbital margin Zygomatic bone

Supraorbital notch Superciliary arch

Helix Glabella

Tragus Antihelix

Nasal bone

Antitragus Ala of nose

Anterior nares (nostril)

Lobule Commissure of lips

Philtrum

Angle of jaw (mandible)

Nasolabial sulcus

Submandibular gland

Tubercle of superior lip

External jugular vein

Mental protuberance

Inferior belly of omohyoid muscle Brachial plexus

Thyroid cartilage

Trapezius muscle Clavicle

jugular notch

Clavicular head of sternocleidomastoid muscle Sternal head of sternocleidomastoid muscle

Skull: Anterior View •MflnHHHHHMMHBMHHHM

Frontal bone Glabella

Parietal bone

Supraorbital notch (foramen)

Sphenoid bone

Orbital surface

Lesser wing Greater wing

Nasal bone

Temporal bone Lacrimal bone Ethmoid bone Orbital plate

Zygomatic bone Frontal process

Perpendicular plate

Orbital surface

Middle nasal concha

Temporal process

Inferior nasal concha

Zygomaticofacial foramen

Vomer

Maxilla

Mandible

Zygomatic process

Ramus

Orbital surface

Body

Infraorbital foramen

Mental foramen

Frontal process

Mental tubercle

Alveolar process —

Mental protuberance

Anterior nasal spine

Right orbit: frontal and slightly lateral view Orbital surface of frontal Orbital surface of lesser wing of sphenoid bone Superior orbital fissu Optic canal (foramen)

Posterior and Anterior ethmoidal foramina Orbital plate of ethmoid bone Lacrimal bone

Orbital surface of greater wing of sphenoid bone

Fossa for lacrimal sac

Orbital surface of zygomatic bone

Orbital process of palatine bone

Inferior orbital fissure Infraorbital groove

Orbital surface of maxilla

Skull: Anteroposterior Radiograph HWBHMBHWBHIwWHBBBB^

See also P l a t e 2

m

A A n g l e of m a n d i b l e C Crista galli E Ethmoid air cells (sinuses) F Frontal sinus G Greater w i n g of sphenoid L

Lesser w i n g of s p h e n o i d

M Maxillary sinus R Ramus of mandible

Skull: Lateral View

Sphenoid bone

Parietal bone

Greater wing Frontal bone Supraorbital notch (foramen)

Temporal bone

Temporal fossa

Squamous part

Superior temporal line

Zygomatic process

Inferior temporal li Coronal suture

Articular tubercle

Pterion

Groove for posterior deep temporal artery

Glabella

External acoustic meatus

Ethmoid bone Orbital plate

Mastoid process

Lacrimal bone Lambdoid suture

Fossa for lacrimal sac

Occipital bone

Nasal bone

Sutural (wormian) bone

Maxilla

External occipital protuberance

Frontal process Infraorbital foramen Anterior nasal spine Alveolar process

Mandible Head of condylar process

Zygomatic bone Zygomaticofacial foramen Temporal process Zygomatic arch

Mandibular notch Coronoid process Ramus Oblique line Body Mental foramen Sphenoid bone Greater wing

Infratemporal fossa exposed by removal of zygomatic arch and mandible

Infratemporal crest

Pterygomaxillary fissure

Lateral plate of pterygoid process

Inferior orbital fissure

Pterygoid hamulus (of medial plate of pterygoid process)

Infratemporal surface of maxilla Temporal bone

Alveolar foramina

External acoustic meatus

Tuberosity of maxilla

Mandibular fossa Articular tubercle Styloid process Sphenopalatine foramen

Superficially, mastoid process forms posterior boundary

Skull: Lateral Radiograph jffWfflffllMfflHMWBMffl

See also P l a t e 4

A

Anterior arch of atlas (CI vertebra)

G

Greater wing of sphenoid

C

Condyle of mandible

H

Hypophyseal fossa (sella turcica)

CP Coronoid process of mandible

L

Lambdoid suture

M

Maxillary sinus

CS Coronal suture D

Dens of axis (C2 vertebra)

F

Frontal sinus

MS Mastoid air ceils P

Palatine process of maxilla

S

Sphenoid sinus

Skull: Midsagittal Section

Sphenoid bone

Temporal bone

Parietal bone

Greater wing

Coronal suture

Lesser wing Anterior clinoid process

Squamous part

Grooves for branches of middle meningeal vessels

Petrous part Internal acoustic meatus Groove for superior petrosal sinus

Optic canal Sella turcica Sphenoidal sinus

External opening of vestibular aqueduct

Body Medial and lateral plates of pterygoid process

Groove for sigmoid sinus

Lambdoid suture

Frontal bone Frontal sinus

Occipital bone

Ethmoid bone Crista galli

Groove for transverse sinus

Cribriform plate Perpendicular plate (bony nasal septum)

External occipital protuberance Jugular foramen

Nasal bone

Groove for inferior petrosal sinus

Inferior nasal concha

Hypoglossal canal Maxilla

Foramen magnum

Anterior nasal spine Nasal surface Incisive canal Palatine process Alveolar process

Occipital condyle

Palatine bone Vomer (bony nasal septum)

Basilar part

Frontal bone

Opening of sphenoidal sinus

Nasal bone Ethmoid bone

Sphenopalatine foramen

Cribriform plate Superior nasal concha Middle nasal concha

Sphenoid bone

Lacrimal bone

Body Inferior nasal concha

Medial \ Lateral \

Maxilla Nasal surfa Palatine process Alveolar process

Plates of pterygoid process

Pterygoid hamulus Perpendicular plate J Horizontal plate

View of lateral nasal wall with nasal septum removed

j

Palatine bone

Superior view Frontal bone Coronal suture Bregma Parietal bone Sagittal suture Parietal foramen (for emissary vein) Lambda Lambdoid suture Sutural (wormian) bone Occipital bone

Inferior view

Frontal bone Frontal crest Groove for superior sagittal sinus Coronal suture Parietal bone Granular foveolae (for arachnoid granulations) Diploe Grooves for branches of middle meningeal vessels Groove for superior sagittal sinus Sagittal suture Lambdoid suture Occipital bone

Cranial Base: Inferior View

Maxilla incisive fossa Palatine process Intermaxillary suture Zygomatic process Zygomatic bone Frontal bone Sphenoid bone Pterygoid process Hamulus Medial plate Pterygoid fossa Lateral plate Scaphoid fossa Greater wing Foramen ovale Foramen spinosum Spine

Palatomaxillary suture

Palatine bone Fiorizontal plate Greater palatine foramen Pyramidal process Lesser palatine foramina Posterior nasal spine

Choanae Temporal bone Zygomatic process Articular tubercle Mandibular fossa Styloid process Petrotympanic fissure Carotid canal (external opening) Tympanic canaliculus External acoustic meatus Mastoid canaliculus Mastoid process Stylomastoid foramen Petrous part Mastoid notch (for digastric muscle) Occipital groove (for occipital artery) Jugular fossa (jugular foramen in its depth) Mastoid foramen Parietal bone Occipital bone Hypoglossal canal Occipital condyle Condylar canal and fossa Basilar part Pharyngeal tubercle Foramen magnum Inferior nuchal line External occipital crest Superior nuchal line External occipital protuberance

Vomer

Groove for auditory (pharyngotympanic, Eustachian) tube Foramen lacerum

Bones of Cranial Base: Superior View — •;•->• . •

• • . •. • •

m

Frontal bone Groove for superior sagittal sinus Frontal crest Groove for anterior meningeal vessels Foramen cecum Superior surface of orbital part

Ethmoid bone Crista gaili Cribriform plate

Sphenoid bone Lesser wing Anterior clinoid process Greater wing Groove for middle meningeal vessels (frontal branches) Body J u gum Prechiasmatic groove ( Tuberculum sellaeSella ) Hypophyseal fossa turcica j Dorsum sellae V Posterior clinoid process Carotid groove (for int. carotid a.) Clivus

Anterior cranial fossa

Middle cranial fossa

Temporal bone Squamous part Petrous part Groove for lesser petrosal n e r v e Groove for greater petrosal nerve Arcuate eminence Trigeminal impression Groove for superior petrosal sinus Groove for sigmoid sinus

Parietal bone Groove for middle meningeal vessels (parietal branches) — Mastoid angle

Occipital bone Clivus Groove for inferior petrosal sinus Basilar part Groove for posterior meningeal vessels Condyle Groove for transverse sinus Groove for occipital sinus Internal occipital crest Internal occipital protuberance — Groove for superior sagittal sinus

Posterior crania] fossa

Foramina of Cranial Base: Inferior View

Nasopalatine nerve) Sphenopalatine vessels! Greater palatine nerve and vessels Lesser palatine nerve and vessels Greater petrosal nerve Lesser petrosal nerve) Mandibular nerve (V3) > Accessory meningeal artery) Middle meningeal vessels) Meningeal branch of mandibular nerve (V$) j

Internal carotid artery) Carotid autonomic plexus) Chorda tympani of facial nerve (VII) Tympanic branch of glossopharyngeal nerve (IX) Auricular branch of vagus nerve (X) Facial nerve (VII)

Glossopharyngeal nerve (IX) \ Vagus nerve (X) / Spinal roots of accessory nerves (XI) \ Internal jugular vein ( Inferior petrosal sinus) Mastoid emissary vein) Posterior meningeal artery)

.. , Incisive tossa Greater palatine foramen Lesser palatine foramen Foramen lacerum Foramen ovale

Foramen spinosum

Carotid canal Petrotympanic fissure Tympanic canaliculus Mastoid canaliculus Stylomastoid foramen

Jugular fossa

- M a s t o i d foramen

Hypoglossal nerve (XII)-

- Hypoglossal canal

Medulla oblongata ) Vertebral arteries and venous plexus ? Spinal roots of accessory nerves (XI))

Foramen magnum

Foramen cecum Nasal slit Anterior ethmoidal foramen

Emissary vein to superior sagittal sinus I \ Anterior ethmoidal artery, vein, ) I and nerve

Foramina of cribriform plate

Olfactory nerve bundles

Posterior ethmoidal foramen

Posterior ethmoidal artery vein, and nerve Optic nerve (II) Ophthalmic artery

. , .. , Superior orbital fissure c

Oculomotor nerve Trochlear nerve (IV) ) Lacrimal, frontal, and nasociliary < b r a n c h e s 0 f ophthalmic nerve (Vi) Abducent nerve (VI) Superior ophthalmic vein

Foramen rotundum

Maxillary nerve (V2)

Foramen ovale

( Mandibular nerve (Vj) 1 Accessory meningeal artery ( Lesser petrosal nerve (occasionally)

r

( Middle meningeal artery and vein j M e n j n g e a , b r a 8 n c h o f mandibular nerve

Foramen sp.nosum

Sphenoid emissary foramen (of Vesalius) (inconstant) Foramen lacerum Carotid canal for

Internal carotid artery Internal carotid nerve plexus

Hiatus for

Lesser petrosal nerve

Hiatus for

Greater petrosal nerve

External opening of vestibular aqueduct

Facial nerve (VII) Vestibulocochlear nerve (VIII) Labyrinthine artery

!

Endolymphatic duct

Mastoid foramen (inconstant)

. , £ jugular foramen

Emissary vein (and occasional branch of occipital artery) Inferior petrosal sinus Glossopharyngeal nerve (IX) ) Vagus nerve (X) \ Accessory nerve (XI) Sigmoid sinus Posterior meningeal artery

Condylar canal (inconstant) — - j Hypoglossal canal

F.

.

c

^

(

E m i f a r > ' ve,in ancJ

meningeal branch ot ascending pharyngeal artery

Hypoglossal nerve (XII) Medulla oblongata Meninges , Vertebral arteries ) Meningeal branches of vertebral arteries Spinal roots of accessory nerves

Lateral view Sphenoidal fontanelle

Parietal bone

Anterior fontanelle

fuber (eminence)

Coronal suture

Squamous suture

Frontal bone Squamous part

/

Supraorbital notch (foramen)

. •'J&.V

Posterior fontanelle Lambdoid suture

Ethmoid bone Anterior ethmoidal foramen

Occipital bone

Orbital plate

Mastoid fontanelle

Lacrimal bone Nasal bone Temporal bone

Maxilla

Squamous part

Infraorbital foramen Zygomatic bone Zygomaticofacial foramen

Sphenoid bone Greater wing

Palatine bone

Petrosquamous fissure

\ \

Lateral plate of ^ pterygoid process

Pyramidal process

Hamulus of medial plate of pterygoid process

Superior view

Petrous part (mastoid process absent) Tympanic part (bony external acoustic meatus absent) Oval (vestibular) window Round (cochlear) w i n d o w Styloid process Mandibular fossa Zygomatic process

Frontal bone Anterior fontanelle

Coronal suture

Sagittal suture

Posterior fontanelle

Occipital bone

Lambdoid suture

Bony Framework of Head and Neck IJM1MJ

Temporal bone Sphenoid bone Temporal fossa Zygomatic arch Condylar process of mandible Mandibular notch Coronoid process of mandible Lateral pterygoid plate ( . b r o k e n line) Hamulus of medial pterygoid plate ( b r o k e n line) Pterygomandibular raphe {broken

Mastoid process External acoustic meatus Atlas (C1) Styloid process

line)

Ramus Mandible ^ Angle Body

Axis (C2)

Stylohyoid ligament

Stylomandibular ligament

Body Hyoid bone { Lesser horn Greater horn

C3 vertebra Epiglottis Thyroid cartilage Cricoid cartilage Trachea

C7 vertebra

-T'l vertebra 1st rib

2nd cervical to 1st thoracic vertebrae: right lateral view

Dens Superior articular facet Foramen transversarium Spinous processes

Articular pillar formed by articular processes and interarticular parts (pars interarticularis)

Spinous process of C (vertebra prominens)

Intervertebral foramina for spinal nerves

Groove for spinal nerve in transverse process Zygapophyseal (facet) joints

Costal facets (for I st rib)

Cervical vertebrae (spine): lateral radiograph S Spinous process (axis) T Transverse process VP Spinous process of C / (vertebra prominens) Z Zygapophyseal (facet) joint 1—7 Bodies of cervical vertebrae --- Cervical curvature i i Vertebral canal

Posterior view

External occipital protuberance

Superior nuchal line

External occipital crest

Nasal septum

Inferior nuchal line

Choana (posterior nasal aperture)

Foramen magnum Inferior orbital fissure

Mastoid foramen Occipitomastoid suture Occipital condyle

Mastoid process Lateral pterygoid plate Medial pterygoid plate

Styloid process Pterygoid fossa

Scaphoid fossa Pyramidal process of palatine bone

Zygomatic arch Horizontal plate of palatine bone Inferior concha

—Pterygoid hamulus

Tuberosity of maxilla

Alveolar process of maxilla

Palatine process of maxilla Incisive fossa

*

Inferolateral view

Af-7>.

Spine of sphenoid bone Foramen spinosum Foramen ovale

c

Sphenopalatine foramen Pterygopalatine fossa Choanae (posterior nares) Lateral plate Medial plate Hamulus Alveolar process of maxilla

of pterygoid process

Pyramidal process of palatine bone

Mandible SWi

Head

Attachments for major muscles of mastication

Lateral pterygoid

Condylar process Coronoid process

Attachments for accessory muscles of mastication

-Neck Mandibular notch

Temporalis

Lingula

Mylohyoid groove Oblique line Buccinator Submandibular fossa

Mandibular / T e m p o r a l i s foramen

Mylohyoid line Sublingual fossa Interalveolar septa

Masseter •

Alveolar part (crest) Mental foramen

'••

.

v

Ramus

::

Mental protuberance-— nfv^jjp.Y.V V - V., ,

Mental tubercle

(sssi

Base of mandible

^

— —

v Body

M a n d i b l e of adult: anterolateral superior view

Lateral pterygoid Coronoid process Head Neck

Condylar process / - Lingula

Mandibular notch

Mandibular foramen

Pterygoid f o v e a s Temporalis Mylohyoid line

/

/

Ramus

ligament

\

V

\

NAngle

Medial pterygoid Pterygomandibular raphe Mylohyloid Submandibular fossa 'Sublingual fossa Digastric fossa Digastric, anterior belly Mental spines (genial tubercles)

Mandible of adult: left posterior view

Mandible of aged person (edentulous)

Temporomandibular Joint HHHaRBmMH

Lateral view joint capsule Lateral (temporomandibular) ligament Sphenomanclibular ligament Sphenomandibular ligament (phantom) Styloid process Stylomandibular ligament Mandibular nerve and otic ganglion

W/;/

Joint capsule

||# W

— _ _ ^ I l l l

"'

Middle meningeal artery Auriculotemporal

%

n e r v e j | l

Maxillary artery-""-"""""""^

>11

Inferior alveolar n e r v e j & C tfff m

,

Lingual n e r v e ^

%s

N&C \ /vjk
of tongue

Vagus nerve (X) Superior cervical sympathetic ganglion Sympathetic trunk Carotid branch of glossopharyngeal nerve Internal carotid artery

Pharyngeal plexus

Carotid sinus

Pharyngeal, tonsillar, and lingual branches of glossopharyngeal nerve

Carotid body C o m m o n carotid artery

Pharyngeal branch of vagus nerve External carotid artery

Cranial and Cervical Nerves

Plate 125

Vagus Nerve (X): Schema I8fififiQfDSffln99BfiK&3fi3BS

See also

Plates 167, 168

/I*

Glossopharyngeal nerve (IX)

N

v i\

£v' Xt X/Posterior nucleus of vagus n e r v e (parasympathetic I \ \ ~ ' / \h„, / and visceral afferent) Solitary tract nucleus (visceral afferents including taste)

Meningeal branch of vagus nerv Auricular branch of vagus nerve

Spinal tract and spinal nucleus of trigeminal nerve (somatic afferent)

Auditory (pharyngotympanic, Eustachian) tube Levator veli palatini muscle

Nucleus ambiguus (motor to pharyngeal and laryngeal muscles)

Salpingopharyngeus muscle

Cranial root of accessory nerve* (see next plate)

Palatoglossus muscle Palatopharyngeus muscle

Vagus nerve (X) Jugular foramen

Superior pharyngeal constrictor muscle

Superior ganglion of vagus nerve

Stylopharyngeus muscle

Inferior ganglion of vagus nerve

Middle pharyngeal constrictor muscl Inferior pharyngeal constrictor muscle Cricothyroid muscle Trachea Esophagus Right subclavian a Right recurrent laryngeal nerve Heart Hepatic branch of anterior vagal trunk (in lesser omentum) Celiac branches from anterior and posterior vagal trunks to celiac plexus Celiac and superior mesenteric ganglia and celiac plexus Hepatic plexus Gallbladder and bile ducts Liver Pvloric branch

Pharyngeal branch of vagus nerve (motor to muscles of palate and pharynx; sensory to lower pharynx) Communicating branch of vagus nerve to carotid branch of glossopharyngeal nerve Pharyngeal plexus Superior laryngeal nerve: Internal branch (sensory and parasympathetic) External branch (motor to cricothyroid muscle) Superior cervical cardiac branch of vagus nerve Inferior cervical cardiac branch of vagus nerve A

Thoracic cardiac branch of vagus nerve Left recurrent laryngeal nerve (motor to muscles of larynx except cricothyroid; sensory and parasympathetic to larynx below vocal folds; parasympathetic, efferent, and afferent to upper esophagus and trachea) Pulmonary plexus Cardiac plexus Esophageal plexus Anterior vagal trunk Gaslric branches of anterior vagal trunk (branches from posterior trunk behind stomach)

/

from hepatic plexus Pancreas Duodenum Ascending colon Cecum Appendix

Plate 126

fibers (parasympathetic motor, secretomotor, and afferent fibers) accompany superior mesenteric artery and its branches usually as far as left colic (splenic) flexure Small intestine Efferent fibers Afferent fibers Parasympathetic fibers

Cranial and Cervical Nerves

mmrnm

A c c e s s o r y Merwe (XI): S c h e m a p i l i See also Nucleus ambiguus Vagus nerve (X)

Plate 32

Cranial root of accessory nerve (joins vagus nerve and via recurrent laryngeal nerve supplies muscles of larynx, except cricothyroid) Jugular foramen Superior ganglion of vagus nerve Accessory nerve (XI)*

Inferior ganglion of vagus nerve

CI spinal nerve C2 spinal nerve Accessory nerve (to sternocleidomastoid and trapezius muscles) Sternocleidomastoid muscle (cut) C3 spinal nerve C4 spinal nerve Trapezius muscle

Efferent fibers Proprioceptive fibers *Recent evidence suggests that the accessory nerve lacks a cranial root and has no connection to the vagus nerve. Verification of this finding awaits further investigation.

Cranial and Cervical Nerves

Plate 127

JHll

Hypoglossal Nerve (XII): Schema K&.vl-j,-:

See also

Plate 32

Hypoglossal nerve (XII) (in hypoglossal canal)

Hypoglossal nucleus

Superior longitudinal

Intrinsic muscles of tongue

Transverse and vertical Inferior longitudinal

Meningeal branch

Styloglossus muscle

Occipital condyle Inferior ganglion of vagus nerve Ventral rami of C1, 2 , 3 form ansa cervicalis of cervical plexus

Superior cervical sympathetic ganglion Superior root of ansa cervicalis

Genioglossus muscle Geniohyoid muscle (via CI)'

Internal carotid artery Inferior root of ansa cervicalis

Thyrohyoid muscle' (via C I ) Omohyoid muscle (superior belly)

Ansa cervicalis Internal jugular vein Common carotid artery

Efferent fibers Afferent fibers

Plate 128

See also

Sternocleidomastoid muscle (cut) Accessory nerve (XI) Hypoglossal nerve (XII) Geniohyoid muscle

Plate 32

Great auricular nerve Lesser occipital nerve Greater occipital nerve (from dorsal ramus of C2)

Nerves to anterior and lateral rectus capitis and longus capitis and colli muscles Nerves to longus capitis and colli and levator scapulae muscles Thyrohyoid muscle Superior root of ansa cervicalis Inferior root of ansa cervicalis Transverse cervical nerve

rapezius muscle Nerves to longus capitis and colli, levator scapulae, and middle scalene muscles Communication to brachial plexus Phrenic nerve

Omohyoid muscle (superior belly) Sternothyroid muscle

Sternohyoid muscle

Supraclavicular nerves (medial, intermediate, and lateral)

Ansa cervicalis Sternocleidomastoid muscle {cut) Omohyoid muscle (inferior belly)

Efferent fibers Afferent fibers Proprioceptive fibers

Plate 129

B V /

Q •.

Autonomic Nerves in Neck QBmUBXSi

See also

Plates 71, 125, 126, 165, 166, 209, 226, 240, 318

Internal carotid nerve

j

*

>

fi m 4

rV;JT

fe

w

V"

.»•

^A

Cervical vertebrae

Thoracic vertebrae

Lumbar

> vertebrae

Sacrum ( S I - 5 ) Sacrum (SI —5)

Coccyx

Plate 153

Coccyx

Bones and Ligaments

See also

Superior articular process and facet

Superior costal facet

Vertebral foramen

Plate 187

Pedicle Transverse costal facet

Superior vertebral notch (forms lower margin of intervertebral foramen)

Superior costal facet

nsverse process

Pedicle

Inferior articular process

sverse costal facet

Interior costal Inferior vertebral notch

Superior articular facet

Spinous process

spinous process

T6 vertebra: lateral view

T6 vertebra: superior view

Superior articular process and facet Vertebral cana 7th rib

Superior articular process and facet

sverse process

Costal facet Inferior articular process and Spinous process of T7 vertebra

T12 vertebra: lateral view

Transverse process of T9 vertebra Inferior articular process (T9)

Lamina

Spinous process (T9)

T7, T8 and 19 vertebrae: posterior view

Bones and Ligaments

PDafte 1S4

Anulus fibrosus

Vertebral body

Nucleus pulposus

Vertebral foramen

Pedicle me?.

Transverse process

Intervertebral disc

Superior articular process Mammillary process Lamina Superior articular process

Spinous process

Mammillary process

Pedicle

L2 vertebra: superior view

Transverse process Spinous process

Vertebral body

Vertebral canal Superior articular process Mammillary process Transverse process

\

Intervertebral disc \

\

Inferior articular process

\

Inferior vertebral notch

Vertebral body

Intervertebral (neural) foramen Superior vertebral notch

Pars interarticularis Accessory process—

Lamina

Spinous process of L3 vertebra - -

Lamina •Articular facet for sacrum

Inferior articular process

L3 and L4 vertebrae posterior view

PQate

USS

Lumbar vertebrae, assembled left lateral view

H o w e s

a m d

L i g a m e n t s

LyoirafeaB*

W e r S e f e r a e ^

Anteroposterior radiograph

f ^ a d o e g r a p B i s

Lateral radiograph

B

Body of L3 vertebra

D

Intervertebral disc space

IA

Inferior articular process of L1 vertebra

I

Intervertebral foramen

L

Lamina of L4 vertebra

IA

Inferior articular process of L3 vertebra

P

Pedicle of L3 vertebra

IN

Inferior vertebral notch of L2 vertebra

S

Spinous process of L4 vertebra

P

Pedicle of L3 vertebra

SA

Superior articular process of L1 vertebra

S

Spinous process of L3 vertebra

SF

Sacral foramen

SA

Superior articular process of L4 vertebra

T

Transverse process of L3 vertebra

SN

Superior vertebral notch of L3 vertebra

Note: The vertebral bodies are numbered B©iraes

and]

Ugameinr&s

P l a t ®

1S©

Sacrum and Coccyx See also

Plates 153, 159, 248, 352-354 Superior articular process

Base of sacrum Lumbosacral articular surface

Sacral canal Superior articular process —Ala (wing)

mm.

Promontory

Sacral part of pelvic brim (linea terminalis)

BK5

Anterior (pelvic) sacral foramina

Sacral hiatus

Transverse ridges

Median sagittal section

- — A p e x of sacrum Transverse process of coccyx Coccyx

Anterior inferior view

Facets of superior articular processes^

Pelvic surface

Auricular surface Sacral tuberosity Lateral sacral crest Median sacral crest

Median sacral crest

Intermediate sacral crest

Sacral canal

Posterior sacral foramen

Intervertebral foramen

Posterior sacral foramina

•Mi W y .

r

-Sacral cornu (horn)

^

Coccygeal cornu (horn)

Sacral hiatus Anterior (pelvic) sacral foramen

Dorsal surface

Transverse process of coccyx

Coronal section through S2 foramina

Posterior superior view

PiaSe

1 5 7

B@p©s

a n d

L i g a m e n t s

Vertebral Ligaments: Lumbar Region

Left lateral view (partially sectioned in median plane)

Inferior articular process Capsule of zygapophyseal joint (partially

Anterior longitudinal ligament

opened)

Superior articular process Transverse process

Lumbar vertebral body

Spinous process Ligamentum flavum

Intervertebral disc •

•

Interspinous ligament

:

a l l • • ^

Anterior longitudinal ligament••

Supraspinous ligament

^ ' . r - ' S v . ;

•Intervertebral foramen Posterior longitudinal ligament

TV

\ f

" .' • : . -

:

—

—

Posterior vertebral segments: anterior view Anterior vertebral segments: posterior view (pedicles sectioned)

Pedicle (cut

surface)

Pedicle (cut

surface)

Ligamentum flavum

Posterior surface of vertebral bod' Lamina Posterior longitudinal ligament

Superior articular process

Intervertebral disc

Bones and Ligaments

Plate 158

2

Superior articular process

Anterior longitudinal ligament

Transverse process Lamina Pedicle [cut)

Inferior articular process

Body of LI vertebra

Pedicle

Posterior longitudinal ligament

Intervertebral foramen

Intervertebral discs

Spinous process Interspinous ligament

L2 spinal nerve

Supraspinous ligament

Superior articular processes; facet tropism (difference in facet axis) on right side Spinous process Lamina Transverse process Body of L5 vertebra

Inferior articular process Ligamentum flavum Iliolumbar ligament

L5 spinal nerve

Iliac crest

Auricular surface of sacrum (for articulation with ilium)

Posterior superior iliac spine

Sacrum

Coccyx

Posterior inferior iliac spine

Left lateral view

Posterior sacroiliac ligaments Greater sciatic foramen Spine of ischium

Lateral, Posterior sacrococcygeal ligaments

Sacrospinous ligament Lesser sciatic foramen Sacrotuberous ligament

Plate 159

Posterior view

Bones and Ligaments

Spinal Cord and Ventral Rami in Situ

C I vertebra (atlas) C1 spinal nerve C2 vertebra (axis) C8 spinal nerve

Cervical plexus C7 vertebra T1 vertebra Brachial plexus

T1 spinal nerve 1 st rib

Spinal dura mater

Filaments of spinal nerve roots (T7 and T8) Intercostal nerves T12 vertebra

mat

T12 spinal nerve

LI vertebra 12th rib Iliohypogastric nerve Subcostal nerve L1 spinal nerve

Ilioinguinal nerve

Conus medullaris

Lumbar plexus Cauda equina

L5 vertebra

L5 spinal nerve

Femoral nerve

S1 spinal nerve Sacrum (cut

away)

Filum terminale internum Termination of dural sac Filum terminale externum (coccygeal ligament) S3 spinal nerve Coccygeal nerve

SporaaQ

ist

Sacral plexus Superior and inferior gluteal nerves Sciatic nerve Posterior femoral cutaneous nerve Pudendal nerve Coccyx

PGafe

.i

SOr.

X

v

7>fr

m.

major muscle v )

•v

V;

Lactiferous sinus Lung-

I AM ' .|

r / ; v i l l i . V-

6th rib •

Plate 182

v

M

V V,

m

;.

•;
.

Plate 195

Topography of Lungs: Anterior View

Thyroid gland

Trachea

Cervical (cupula, or dome, of) parietal pleura

Jugular (suprasternal) notch Apex of lung

Sternoclavicular joint

Arch of aorta

Clavicle 1st rib and costal cartilage

Cardiac notch of left lung

WS&l •

••:'

Left border of heart

Right border of heart

Horizontal fissure of right lung (often incomplete)

iA" yS8

."•

Costomediastinal recess of pleural cavity

Oblique fissure of right lung

Oblique fissure of left lung

Costodiaphragmatic recess of pleural cavity

Costodiaphragmatic recess of pleural cavity

Spleen Inferior border of left lung Left dome of diaphragm

Pleural reflection

Pleural reflection Stomach Right dome of diaphragm

Bare area of pericardium Liver

Xiphoid process

L m g s

Topography of Lungs: Posterior View

Cervical (cupula, or dome, of) parietal pleura Apex of left lung 1 st rib

1st rib Oblique fissure of right lung Clavicle

Oblique fissure of left lung

Horizontal fissure of right lung (often incomplete)

Spine of scapula Left border of costal parietal pleura

Right border of costal parietal pleura

Costodiaphragmatic recess of pleural cavity

Costodiaphragmatic recess of pleural cavity

Spleen

Liver

Pleural reflection

Pleural reflection Inferior border of right lung Left kidney

Right kidney Right dome of diaphragm

Left suprarenal gland

Lwngs

Right suprarenal gland

Plate 197

3

Lungs in Situs Anterior View

Thyroid gland

Trachea and inferior thyroid veins C o m m o n carotid artery

Omohyoid, sternothyroid and sternohyoid muscles

Internal jugular vein

Manubrium of sternum

Phrenic nerve

Sternocleidomastoid muscle

Anterior scalene muscle

External jugular vein

Thoracic duct

Costal part of parietal pleura (cutaway/)

Brachial plexus

Clavicle

Subclavian artery and vein

Pectoralis major muscle

Internal thoracic artery and vein

Pectoral is minor muscle

Axillary artery and vein

Intercostal muscles

Cardiac notch of left lung

-

; >

ivAi'JvX

Superior lobe, Middle lobe, Inferior lobe of right lung

Superior lobe, Inferior lobe of left lung Costomediastinal space

Oblique fissure Horizontal fissure of right lung

Oblique fissure

Costodiaphragmatic recess

Musculophrenic artery

Diaphragmatic part of parietal pleura

Lingula of superior lobe of left lung

Diaphragm 7th costal cartilage

/

Xiphoid process

Internal thoracic artery Mediastinal part of parietal pleura Fibrous pericardium

Plate 198

Lungs

Lungs: Medial Views

Right lung Groove for subclavian artery

Apex Area for trachea Area for esophagus

Groove for brachiocephalic vein

Groove for azygos vein

Groove for 1 st rib

Oblique fissure

Groove for superior vena cava

Pleura (cut edge) Right superior lobar (eparterial) bronchus

Area for thymus and fatty tissue of anterior mediastinum

Right pulmonary arteries Right bronchial artery

Anterior border

Right intermediate bronchus

Hilurm

Right superior pulmonary veins

Horizontal fissure

Bronchopulmonary (hilar) lymph nodes

Cardiac impression

Right inferior pulmonary veins

Oblique fissure

Inferior lobe

M i d d l e lobe

Groove for esophagus

Groove for inferior vena cava

Pulmonary ligament

Diaphragmatic surface

Inferior border

Apex Groove for subclavian artery Area for trachea and esophagus Oblique fissure Groove for arch of aorta Pleura (cut edge) Left pulmonary artery-

Groove for left brachiocephalic vein Groove for 1 st rib Anterior border Area for thymus and fatty tissue of anterior mediastinum

Left bronchial arteries Left main bronchus Left superior pulmonary veins Bronchopulmonary (hilar) lymph nodes Inferior lobe Left inferior pulmonary vein Groove for descending aorta Inferior border

Hilum Cardiac impression Pulmonary ligament Cardiac notch Oblique fissure Groove for esophagus Diaphragmatic surface Lingula

[Plate 1©®

Bronchopulmonary Segments

Right lung

Anterior view

Left l u n g

Superior lobe

Superior lobe

Apical (S1)

A pi coposterior

Anterior (S3)

Superior division (culmen)

(S 1 + 2)

Posterior (S2

Anterior (S3) Superior j lingular (S 4) Inferior lingular (S 5)

Middle lobe Lateral (S4)

Lingular division

Medial (S5)

Inferior lobe

Inferior lobe

Anterior basal (S8)

Antero medial basal (S 7+8 )

Medial basal (S7)

Posterior basal (S10)

Lateral basal (S9)

Lateral basal (S9)

Posterior basal (S10) Posterior view Left l u n g

S

Superior lobe /

Apicoposterior (S 1+2 ) Anterior

/

/

/

/

Right lung

s

Superior lobe Apical (S1) Posterior (S2)

v /

Anterior (S3)

(S3)

Lingular ( Superior division I lingular (S4) Middle lobe

•N S W ' \ Inferior lobe Superior (S{)) Lateral basal (S9)

•"V

\

I

f

1 \

it:

.

Inferior lobe Superior (S6) Lateral basal (S9)

Posterior basal (S10)

Posterior basal (S10)

Posterior (S2) Anterior (S3)

Superior division (culmen)

Anterior (S3) Superior lingular (S4) Inferior lingular (S5)

M i d d l e lobe Lateral (S4) Medial (S5)

Lingular division

Inferior lobe Superior (S6)

Inferior lobe

Anteromedial basal (S7+B)

Superior (S6) Anterior basal (S8)

Lateral basal (S9)

Lateral basal (S9)

Medial views Right lung Superior lobe Apical (S1)

Left lung Superior lobe

Posterior (S2)

Apicoposterior (S 1+2 )

Anterior (S3)

Anterior (S3)

Middle lobe Medial (S5)

Superior lingular (S4) Inferior lingular (S J)

Superior division (culmen)

Lingular division

Inferior lobe

Medial basal (S7) Anterior basal (S8) Lateral basal (S9) Posterior basal (S l0 ) —

Lungs

Inferior lobe Superior (S6) -Anteromedial basal (S 7+8 ) Lateral basal (S9) Posterior basal (S10)

Plate 201

3

Trachea and Major Bronchi

Connective tissue sheath (visceral layer of pretracheal fascia)

Thyroid cartilage Median cricothyroid ligament

Tracheal cartilage (ring) Elastic fibers

Cricoid cartilage

Gland Small artery

ill

Lymph vessels

Connective tissue sheath (visceral layer of pretracheal fascia) (cut away)

Nerve Epithelium

Annular (intercartilaginous) ligaments

interior wa//

Tracheal cartilages Cross section through trachea Mucosa of posterior tracheal wall shows longitudinal folds formed by dense collections of elastic fibers

Posterior wall

Superior lobar (eparterial) bronchus

Nerve | Small arteries Gland Elastic fibers Superior lobar bronchus

To superior ^ lobe

Trachealis (smooth) muscle Esophageal muscle Epithelium Lymph vessels

B3 — Superior division bronchus Lingular bronchus

Middle lobar bronchus

|F v

Right and left main bronchi

To lingula

^Intermediate bronchus

To middle lobe

Inferior lobar bronchus

Inferior lobar bronchus ^

(

To inferior < lobe

v Intrapulmonary

Plate 202

_

_

" Extrapulmonary

To inferior lobe

v Intrapulmonary

Lungs

Nomenclature of Bronchi; Schema i 'iWlfipnii ii

}t

ii

W ' MI'IPI li'-li'ii'llln Wi' ' ij i |

'i

•Trachea

1 +2c\

Superior lobar bronchus

B (apical) Sai

B

2 b

Superior lobar (eparterial) / bronchus , /

^

B 2 (poslerior)

B

^

^

/B4a

Right and l e f t ^ main bronchi

(anterior)

B* ( a n t e r i o r ) \ Lingular bronchus

B6

(superior, lower lobe)~

^—B

4

(superior lin

^ - B ^ (superior, lower lobe) (inferior lingular)

\

(medial) J

(apicoposterior)

Superior division bronchus

Intermediate bronchus Middle lobar bronchus g4 (lateral)

B

Inferior lobar bronchus

B

}

(anteromedial basal)

g7+8a

B (medial basal)

g7-'-8ai

B 8 (anterior basal)

„ .

B8av

tf 0dn '

B8b-

B 9 (lateral basal) B 1 0 (posterior basal)

A

B 9 (lateral b a s a l ) ^ B 1 0 (posterior basal)

Nomenclature in common usage for bronchopulmonary segments (Plates 200 and 201) is that of Jackson and Huber, and segmental bronchi are named accordingly. Ikecla proposed nomenclature (as demonstrated here) for bronchial subdivisions as far as 6th generation. For simplification on this illustration, only some bronchial subdivisions are labeled as far as 5th or 6th generation. Segmental bronchi (B) are numbered from 1 to 10 in each lung, corresponding to pulmonary segments. In left lung,

Lptrags

B1 and B2 are combined as are B7 and B8. Subsegmental, or 4th order, bronchi are indicated by addition of lowercase letters a, b, or c when an additional branch is present. Fifth order bronchi are designated by Roman numerals i (anterior) or ii (posterior) and 6th order bronchi by Greek letters a or (3. Several texts use alternate numbers (as proposed by Boyclen) for segmental bronchi. Variations of standard bronchial pattern shown here are common, especially in peripheral airways.

P l a t ©

2 0 3

3

Intrapulmonary Airways? Schema

Terminal bronchiole

Smooth muscle Elastic fibers Alveolus

c c ^ - o c -Q 2 S

Cartilages

£ *

1st order

E 53

cc $ ^00

•

BH

u c o CD

2nd order

S i cu ^ DJD ^

3rd order

Respiratory bronchioles (alveoli appear at this level)

i _

1 -

o -D .

Cartilages become sparser (mostly at points of branching)

O

ro

(o i—

C

CD

— i

C Pulmonary { valve )

Conus arteriosus Supraventricular crest Septal papillary muscle Interventricular septum (muscular part)

Septal cusp Posterior cusp

Septomarginal trabecula (moderator band)

Chordae tendineae Posterior papillary muscle Anterior papillary muscle Trabeculae carneae

Plate 220

Opened right ventricle: anterior view

Heart

Left Atrium and Ventricle

Pericardial reflection

Transverse pericardial sinus Fold of left superior vena cava (ligament of Marshall)

Ligamentum arteriosum Left pulmonary artery

Left auricle (atrial appendage) Oblique vein of left atrium (of Marshall) ( Mitral )

Posterior cusp

valve

Anterior cusp

|

Arch of aorta

Right pulmonary arteryLeft pulmonary veins Left atrium

Anterior papillary muscle

Right pulmonary veins

Chordae tendineae

Coronary sinus

Posterior papillary muscle

Inferior vena cava

Flap opened in posterolateral wall of left ventricle

Left auricle (atrial appendage) Con us arteriosus

Left pulmonary arterv

Left semilunar cusp Aortic valve

/

Right pulmonary artery

Right semilunar cusp Posterior semilunar cusp

Membranous septum

Arch of aorta

Left superior pulmonary vein

Interventricular part

Valve of foramen ovale Right pulmonary veins

Muscular part of interventricular septum

Left atrium Coronary sinus

Mitral valve (cutaway)

Inferior vena cava

^ T

< ' '

^ llll I * I Ml -

^

Section through left atrium and ventricle w i t h mitral valve cut away

Heart

Plate 221

3

Valves of Fibrous Skeleton of Heart

Anterior semilunar cusp

Pulmonary valve

Right semilunar cus Left semilunar cusp

Conus arteriosus Left fibrous trigone Right coronary artery

Right (coronary) semilunar cusp Atrioventricular part of membranous septum Anterior cusp

Left (coronary) semilunar cu

Aortic valve

Posterior (noncoronary) semilunar cusp Circumflex branch • Anterior Mitral valve

Tricuspid valve

Septal cusp Posterior cusp

Commissural cusps

Right fibrous ring (of tricuspid valve)

Posterior cus

Right fibrous trigone Atrioventricular (AV) nodal branch1'

Left fibrous ring (of mitral valve

Posterior interventricular branch 1

Heart in diastole: viewed f r o m base w i t h atria removed

Anterior semilunar cusp

Pulmonary valve

Right semilunar cusp Left semilunar cu

Conus arteriosus Left fibrous trigone Right coronary artery

Right (coronary) semilunar cusp Aortic valve

Interventricular part

Left (coronary) semilunar cusp

Atrioventricular part

Posterior (noncoronary) semilunar cusp

Anterior cusp

Circumflex branch*

Mitral valve

cusp

Anterior cusp

Tricuspid valve

Posterior

Posterior cusp

Right fibrous ring (of tricuspid valve)

Left fibrous ring (of mitral valve) Posterior interventricular branch 1

Membranous septum

Right fibrous trigone

Heart in systole: viewed from base w i t h atria removed

Atrioventricular (AV) nodal branch1"

* O f left coronary artery 'Of right coronary artery

IHJeacrU:

Valves and Fibrous Skeleton of Heart (continued) HHHHMBMMNMKHiHM!

.

^ ... .

Commissure of semilunar valve cusps Opening of left coronary artery

Ascending aorta

Nodule of semilunar valve (body of Arantius)

Aortic sinuses (of Valsalva) Opening of right coronary artery ( Membranous septum

Lunula Left semilunar cusp

Interventricular

) Part J Atrioventricular V part

Posterior semilunar cusp

Aortic valve

Right semilunar cusp

Broken line indicating level of origin of tricuspid valve on opposite side of septum-"'

Anterior papillary muscle Anterior cusp of mitral valve

Muscular part of interventricular septum

Aortic valve oventricular Par*

Opening of inferior vena cava

(

Right atrium

Interventricular ( part (behind valve)

Opening of coronary sinus

Posterior cusp Anterior cusp

Chordae tendineae

Septal cusp

Septal papillary muscle

Membranous sePtum

V Tricuspid \ valve

Posterior papillary muscle (sectioned)

Posterior papillary muscle (sectioned)

Anterior papillary muscle

Tricuspid (right atrioventricular) valve Anterior cusp

Left atrium

Posterior cusp

\

Chordae tendineae

Mitral valve

Commissural cusps Anterior papillary muscle (sectioned)

Anterior papillary muscle (sectioned)

Posterior papillary muscle

Fibrous (Albini's) nodules

Mitral (left atrioventricular) valve

Heart

Plate 223

3

Atria, Ventricles, and Interventricular Septum y':

MMMIMHNMIMHIMWMNMMHM^

Mitral valve

Posterior cusp Anterior cusp

Right superior pulmonary vein

Pulmonarv trunk Anterior cusp of mitral valve

Openings of coronary arteries Ascending aorta Right auricle (atrial appendage)

Aortic sinus (of Valsalva)

Left semilunar cusp

Ascending aorta Left semilunar cusp Aortic valve

Right semilunar cusp

Posterior semilunar (noncoronary) cusp /

Superior vena cava

m . / ' " , . ^

Aortic valve

Supra ventricular crest

X

t

J monarv t r u n k

4

Con us arteriosus

Right anterior papillary muscle (cut) Right ventricle

Right atrium

CD

Septomarginal trabecula (moderator hand)

Anterior cusp {retracted)

Septal (medial) papillary muscle

Septal cusp— Posterior cusp Right ventricle Right anterior papillary muscle (cut) Right posterior papillary muscle Left ventricle Muscular part of interventricular septum

Plate 224

Plane of section

Heart

Ascending aorta Atrioventricular part ) v Membranous septum Interventricular part \

Superior vena cava Sinuatrial (SA) nodal artery

Pulmonary valve Atrioventricular (AV) node

Sinuatrial (SA) node

Atrioventricular (AV) bundle (of His)

Crista terminalis

Right bundle

Note: Specific internodal conduction pathways in the atria may exist based on strong physiological and some anatomical evidence

Purkinje fibers Septomarginal trabecula (moderator band) Anterior papillary muscle

Right fibrous ring (of tricuspid valve

Subendocardial branches (Purkinje fibers)

Inferior vena cava

Right side

(f Posterior semilunar Aortic valve

) . f. .. \ Lett semilunar cusp

Arch of aorta

Right semilunar

Membranous septum

Pulmonary trunk

Interventricular part

Superior vena cava

Atrioventricular part

Left auricle

Left bundle Anterior papillary muscle

Right pulmonary veins Mitral valve (cutaway)

Subendocardial branches (Purkinje fibers)

Muscular part of interventricular septum

Posterior papillary muscle Vi

Left s i d e

H e a r t

Plate 22S

3

Nerves of Heart See also P l a t e s 1 3 0 , 1 6 5 , 1 6 6 , 2 0 9

Superior cervical sympathetic ganglion Right vagus nerve (X) (Conjoined sympathetic and vagal) superior cervical cardiac nerves Middle cervical sympathetic ganglion Middle cervical (sympathetic) cardiac nerve Phrenic nerve Inferior cervical (vagal) cardiac branch Vertebral ganglion Inferior thyroid artery Vertebral artery Cervicothoracic (stellate) ganglion Ansa subclavia

Superior cervical sympathetic ganglion Left vagus nerve (X) Superior cervical (sympathetic) cardiac nerve Superior cervical (vagal) cardiac branch Middle cervical sympathetic ganglion Phrenic nerve Middle cervical (sympathetic) cardiac nerve Inferior cervical (vagal) cardiac branch Vertebral ganglion Cervicothoracic (stellate) ganglion Inferior cervical sympathetic cardiac nerves

Right recurrent laryngeal nerve

Inferior cervical (sympathetic) cardiac nerves Thoracic cardiac branch of vagus nerve 4th thoracic sympathetic ganglion Thoracic (sympathetic) cardiac branches Cardiac plexus

3rd thoracic sympathetic ganglion oracic (sympathetic) cardiac branches oracic cardiac branch of vagus nerve Left recurrent laryngeal nerve

Phrenic nerve (cut)

Plate 226

Heart

Innervation of Heart: Schema See also P l a t e s 126, 167, 168

Superior cervical sympathetic ganglion

Posterior nucleus of vagus nerve

Nucleus of

Superior cervical (sympathetic) cardiac nerve Middle cervical sympathetic ganglion Middle cervical (sympathetic) cardiac nerve Vertebral ganglion (variation Ansa subclavia Cervicothoracic (stellate) ganglion 1st intercosta nerve Inferior cervical (sympathetic) cardiac nerve Thoracic cardiac branch of vagus nerve 2nd thoracic sympathetic ganglion While ramus communicans Cray ramus communicans Thoracic (sympathetic) cardiac branches 4th thoracic sympathetic ganglion

—- —

Sympathetic preganglionic Sympathetic postganglionic

—

Parasympathetic preganglionic

— — - — — Parasympathetic postganglionic u — — V i s c e r a l afferent accompanying sympathetic fibers Visceral afferent accompanying parasympathetic fibers

Heart

Plate 227

Innervation of Blood Vessels: Schema See also P l a t e s 1 6 7 , 1 6 8

Cervical sympathetic trunk ganglia Spinal nerves Gray rami communicantes

i ':.•• •-

. ";

Spinal nerves

Spinal nerves Gray ramus communicans Lower lumbar sympathetic trunk ganglia

Sympathetic fibers

Postganglionic sympathetic fibers to lumbar and sacral plexuses and to nerves of lower limb

Preganglionic Postganglionic

Plate 228

Heart

Prenatal and Postnatal Circulation iwiMMMiwiiiiiii '!ijfjin;;w"WPirirrmr~T

n

r~n 111htr*w i wMrin 'i Brw i nmP i nri.

Pancreatic duct Sphincter of ampulla

Short common channel

Pancreatic duct Duodenal wall No common channel

Viscera (Accessory Organs)

Sphincter of ampulla

Long common channel

Plate 295

Variations in Cystic and Hepatic Ducts

Variations in cystic duct Low union with common hepatic duct

Adherent to common hepatic duct

Cystic duct absent or very short

Anterior spiral joining common hepatic duct on left side

High union with common hepatic duct

Posterior spiral joining common hepatic duct on left side

Accessory (aberrant) hepatic ducts Joining common hepatic duct

Joining (common) bile duct

Joining cystic duct-

Joining gallbladder Two accessory hepatic ducts

Plate 296

Viscera (Accessory Organs)

W o

o o

Transverse Section: Level of T12, Inferior to Xiphoid i ji

t

h—

T12

Plate 297

Pyloric canal

)

Stomach

1

Pylorus

Jejunum

W

(/)

0
.

Inferior vena cava

Celiac trunk

Splenic artery

Stomach {cut)

Hepatic portal vein Portal triad

Spleen

Proper hepatic artery (Common) bile duct

Right free margin of lesser omentum Suprarenal gland Duodenum Right kidney (retroperitoneal)

Pancreas Left colic (splenic) flexure

Attachment of transverse mesocolon

Right colic (hepatic) flexure

Transverse colon (cut) Left kidney (retroperitoneal)

Transverse colon (cut)

• Attachment of transverse mesocolon Inferior mesenteric vein (retroperitoneal) jejunum (cut)

Middle colic artery and vein

Duodenojejunal flexure

Superior mesenteric artery and vein

Root of mesentery (cut)

Uncinate process of pancreas

Low-power section of pancreas

Islets (of Langerhans)

Pancreatic notch Pancreatic duct (of Wirsung)

Interlobular duct Interlobular septum

Plate 298

Viscera (Accessory Organs)

Posterior extremity

Gastrosplenic ligament

Posterior extremitv

Superior bordei

Short gastric vessels

Gastric impression

Renal impression

Hilum

Inferior border Splenorenal (lienorenal) ligament Splenic artery Left gastro-omental (gastroepiploic) vessels

WBmm

mIUM

Splenic vei

siiiai M l

Colic impression

Diaphragmatic surface

Visceral surface

Short gastric vessels in gastrosplenic ligament

Inferior border

Anterior extremity

Diaphragm Spleen

Stomach (cut)

Serosa (visceral peritoneum)

9th rib

Fibrous capsule Splenic pulp Splenic trabeculae Splenic vein and artery — Hilum

Cross section

Suprarenal gland Left kidney Splenic artery and vein Transverse colon

Splenorenal (lienorenal) ligament Attachment of transverse mesocolon (cut)

"ail of pancreas

Spleen in situ

Viscera (Accessory Organs)

Plate 299

Arteries of Stomach, Liver, arid Spleen

Right and left inferior phrenic arteries

Left gastric artery

Abdominal aorta

Splenic artery

Celiac trunk

Esophageal branch of left gastric artery

Left hepatic artery

Recurrent branch of left inferior phrenic artery to esophagus

Right hepatic artery

Short gastric arteries

1 \

Proper hepatic arterv (Common) bile duct-""" Hepatic portal vein Right gastric artery-^ Supraduodenal artery '

\

Posterior superior, / Anterior superior ' pancreaticoduodenal arteries

Plate 300

Common hepatic artery Right gastro-omental (gastroepiploic) artery

/

/

Splenic branches of splenic artery

Left gastro-omental (gastroepiploic) artery

Visceral Vasculature

Arteries of Liver, Pancreas, Duodenum, and Spleen MPf Sasfjsf

Intermediate hepatic artery Proper hepatic artery Right hepatic artery Cystic artery

Right and left inferior phrenic arteries (shown here from common stem)

Hepatic portal vein

Celiac trunk

C o m m o n hepatic artery

Abdominal aorta

Left gastric artery

Gallbladder.

Short gastric arteries

'mmMm

mm

Cystohepatic triangle (of Calot) • —

wm

/ i

Cystic duct

^wmWk IA ••> ^fcfflPfc"^- J r m

Common hepatic duct (Common) bile duct Right gastric artery

Left gastro-omental (gastroepiploic) artery

Supraduodenal artery

Artery to tail of pancreas

Gastroduodenal artery

Greater pancreatic artery hM ' SS® it: 1W i l w •iSi\ ® Sv IS Itim » j H . Xf. > p i l l kV

Splenic artery

Pi

Dorsal pancreatic artery Inferior pancreatic artery Anastomotic branch Middle colic artery (cut)

Posterior superior pancreaticoduodenal artery {phantom)

z

Superior mesenteric artery

Inferior pancreaticoduodenal artery

Anterior superior pancreaticoduodenal artery Right gastro-omental (gastroepiploic) artery

Visceral Vasculature

Posterior inferior pancreaticoduodenal artery Anterior inferior pancreaticoduodenal artery

Plate 301

Variations in Celiac Trunk mmmm.:^——

Common origin of celiac trunk and superior mesenteric artery

Splenic and hepatic arteries take origin from superior mesenteric

Replaced right hepatic artery takes origin from superior mesenteric; inferior pancreaticoduodenal and I st jejunal arteries from replaced right hepatic

Accessory right hepatic artery takes origin from superior mesenteric; inferior pancreaticoduodenal arteries from accessory right hepatic; 1 st jejunal artery from anterior inferior pancreaticoduodenal

Plate 302

Celiacomesenteric trunk

Hepatolienomesenteric trunk

^ I n c o m p l e t e Y^ celiac trunk « Hepatomesenteric

Splenic artery takes origin from superior mesenteric (note replaced left hepatic artery from left gastric)

Replaced hepatic artery takes origin from superior mesenteric (note inferior pancreaticoduodenal artery from 1st jejunal)

Accessory right hepatic artery takes origin from superior mesenteric

Hepatogastric trunk /tf^ Lienomesenteric trunk

Lienogastric trunk Hepatomesenteric tru nl
left hepatic 6. Right < > left hepatic

Effects of hepatic artery obstruction

Capsular

A. Zone of relative safety B. Zone of questionable effects C. Zone of inevitable infarction

Plate 305

Arteries of Small Intestine >

'•'*

""•"

"

''''.

.

;'_-_*

'.

••:

•

-• •

Common hepatic artery

Supraduodenal artery Gastroduodenal artery Posterior superior pancreaticoduodenal artery

Splenic artery and vein

Dorsal pancreatic artery

Right gastro-omental (gastroepiploic) artery

Inferior pancreatic artery Superior mesenteric artery and vein

Anterior superior pancreaticoduodenala r te r y Inferior pancreaticoduodenal arteries

Celiac trunk

(Common portion) Posterior-^^ Anterior-^

J**^

Middle colic artery (cut)

Anastomosis (inferior pancreaticoduodenal to 1 st jejunal artery)

Right colic artery Ileocolic artery

Superior mesenteric artery Anterior cecal artery Posterior cecal artery Appendicular artery

Jejunal and ileal (intestinal) arteries Anastomotic loops (arcades) Straight arteries (arteriae rectae)

Plate 306

Visceral Vasculature

Arteries of Large Intestine For arteries of rectum see also Plate 398

Middle colic artery i Transverse mesocolon Straight arteries (arteriae rectae) (Common portion)

Inferior pancreaticoduodenal arteries

Posterior Anterior

Superior mesenteric artery Marginal artery Jejunal and ileal (intestinal) arteries Marginal arteryInferior mesenteric artery Left colic artery Ascending branch Descending branch

artery. Right colic artery

Marginal artery

Ileocolic artery Colic branch Ileal branch

Sigmoid arteries Sigmoid mesocolon

Marginal artery

Anterior cecal artery Posterior cecal artery Appendicular artery—

Internal iliac artery

Median sacral artery (from abdominal aorta)

Straight arteries (arteriae rectae) Superior rectal arterv

Middle rectal artery Branch of superior rectal artery

Visceral Vasculature

Inferior rectal artery

Plate 307

4

Variations in Colic Arteries

Middle colic artery

Superior mesenteric artery

Right colic artery

Middle colic artery

Right colic artery

Ileocolic artery Ileocolic artery

C o m m o n trunk for right colic and ileocolic arteries

C o m m o n trunk for right colic and middle colic arteries

Middle ic artery

Large branch from left colic artery

Middle colic artery absent

Right colic artery absent

Right colic artery Ileocolic artery

Ileocolic artery

Absence of middle colic artery replaced by large branch f r o m left colic artery

Absence of right colic artery

of Riolan Middle colic artery Right colic artery Ileocolic artery

Superior mesenteric artery Inferior mesenteric artery Left colic artery

Arc of Riolan between middle colic and left colic arteries

Plate 308

Visceral Vasculature

Veins of Stomach, Duodenum, Pancreas^ and Spleen HHMHHHMHHi

—M—

Hepatic veins

Hepatic portal vein

Inferior vena cava Left gastric vein and esophageal tributary M

Posterior superior pancreaticoduodenal vein

Short gastric veins

Right gastric vein Prepyloric vein Anterior superior pancreaticoduodenal vein Right gastro-omental (gastroepiploic) vein

Left gastroomental v. & (gastro. ; epiploic) -I vein

Posterior inferior pancreaticoduodenal vein

111

Anteriorinferior pancreaticoduodenal vein Left gastric vein vein

Splenic vein Short gastric veins

Hepatic portal vein Right gastric vein Posterior superior pancreaticoduodenal vein Superior mesenteric vein Right gastro-omental (gastroepiploic) vein Anterior superior pancreaticoduodenal vein

Left gastro-omental (gastroepiploic) vein (Great) pancreatic vein Inferior mesenteric vein

Visceral Vasculature

Plate 309

4

Veins of Small Intestine

Hepatic portal vein Left gastric vein Splenic vein Right gastric vein

Superior mesenteric: vein

Middle colic vein (cut)

Jejunal and ileal (intestinal) veins Anastomotic loops

Right colic vein

Straight veins (venae rectae)

Ileocolic vein

Superior mesenteric artery and vein

Jejunal and ileal (intestinal) vessels

Relations of superior mesenteric vein and artery in root of mesentery

Plate 310

Visceral Vasculature

Veins of Large Intestine For veins of rectum see also Plate 399

Hepatic portal vein

Left gastric vein

Splenic vein

Prepyloric vein Superior mesenteric vein Right gastroomental (gastroepiploic) vein Anterior superior pancreaticoduodenal vein Tributary from colon (cut) Posterior inferior pancreaticoduodenal vein Anterior inferior pancreaticoduodenal vein Middle colic vein (cut) Right colic vein Ileocolic vein Anterior cecal vein Posterior cecal vein Appendicular vein

(Dorsal or superior) pancreatic vein Inferior mesenteric vein Jejunal and ileal (intestinal) veins Left colic vein Left testicular (ovarian) vessels Inferior mesenteric vein Sigmoid veins Median sacral vein Superior rectal vein

Right testicular (ovarian) vessels FxternaJ iliac vessels Internal iliac vein Superior gluteal vein Obturator vein

Tributaries of left and right superior rectal veins Perimuscular rectal venous plexus Left middle rectal vein Left internal pudendal vein in pudendal canal (Alcock's) External rectal venous plexus

Right middle rectal vein Right inferior rectal vein (to internal pudendal vein)

Visceral Vasculature

Plate 311

4

Hepatic Portal Vein Tributaries: Portacaval Anastomoses

Falciform ligament and round ligament of liver Paraumbilical veins

Esophageal veins Blood f r o m superior mesenteric vein Blood f r o m splenic, gastric, and inferior mesenteric veins M i x t u r e of above t w o

Right gastric vein

Caval tributaries mm

Hepatic portal vein

Left gastric vein Short gastric veins

Posterior, Anterior superior pancreaticoduodenal veins

Left gastroomental (gastroepiploic) vein

Superior mesenteric vein Posterior, ^ Anterior inferior pancreaticoduodenal veins

Splenic vein

V \ —

*

Right gastroomental (gastroepiploic) vein Inferior mesenteric vein

4 Middle colic vein

Left colic vein

Right colic vein

Sigmoid veins

Ileocolic vein Left and right superior rectal veins

Anterior, Posterior cecal veins Appendicular vein

Middle rectal veins Levator ani muscle Portacaval anastomoses 1

Esophageal

3

Rectal

2

Paraumbilical

4

Retroperitoneal

Plate 312

Inferior rectal veins

Visceral Vasculature

Variations of Hepatic Portal Vein

Typical arrangement

Esophageal vein Right gastric vein

Cystic vein Hepatic portal vein

_ L

Left gastric vein Splenic vein

- j — 1.09 cm

Short gastric veins

V

Posterior superior pancreaticoduodenal vein Superior mesenteric vein

V — Pancreatic veins Left gastro-omental (gastroepiploic) vein

Right gastro-omental (gastroepiploic) vein

Inferior mesenteric vein

Inferior pancreaticoduodenal veins Middle colic vein Right colic vein

Left colic vein Jejunal and ileal (intestinal) veins

Ileocolic vein

Inferior mesenteric vein may enter j u n c t i o n of splenic and superior mesenteric veins Hepatic portal vein Superior mesenteric vein

Hepatic portal vein

Splenic vein

Inferior mesenteric vein

Left gastric vein may enter splenic vein (24% of cases) ight gastric vein plenic vein Left gastric vein

Inferior mesenteric vein may enter superior mesenteric vein Hepatic portal vein Superior mesenteric vein

High intestinal veins Splenic vein

Inferior mesenteric vein

Left gastric vein often enters junction of splenicand superior mesenteric veins Hepatic portal vein Superior mesenteric vein

Visceral Vasculature

Plate 313

Lymph Vessels and Nodes of Stomach

Celiac nodes

Nodes around cardia Left gastric nodes

Hepatic

Right superior pancreatic node

Suprapyloric nodes Splenic nodes

Subpyloric nodes

Left gastroomental (gastroepiploic) node

Right gastro-omental (gastroepiploic) nodes

Left gastric nodes Nodes around cardia Left gastroomental (gastroepiploic) node

Zones and pathways of gastric lymph drainage (zones not sharply demarcated)

Splenic nodes

Right gastro-omental (gastroepiploic) nodes

Suprapyloric., retropyloric, and subpyloric nodes

Left superior pancreatic nodes Celiac nodes

Right superior pancreatic node

Plate 314

Superior mesenteric nodes

Visceral Vasculature

Lymph Vessels and Nodes of Pancreas

mmmma

Anterior view

wmM

B ! 1 •j/.'W-'*.

Splenic nodes Superior pancreatic nodes Celiac nodes Superior mesenteric nodes (central superior group)

Cystic node (of Calot) Hepaticportal vein Celiac nodes

Posterior view

Superior pancreatic nodes Splenic vein

Hepatic nodes around bile duels and proper hepatic artery

Inferior mesenteric vein Superior mesenteric artery and vein

Pancreaticoduodenal nodes

Superior mesenteric nodes (central superior group)

Visceral Vasculature

Plate 315

4

Lymph Vessels and Nodes of Small Intestine

Right lymphatic trunk

Thoracic cluct

Thoracic duel

Cisterna chyli

Intestinal lymphatic trunk

Right and left lumbar lymphatic trunks

Superior mesenteric nodes (juxtaintestinal group)

> CAf&M&fr/— /i.j>.

Plate 316

Visceral Vasculature

Lymph Vessels and Nodes of Large Intestine

Epicolic nodes Paracolic nodes

Middle colic nodes Superior mesenteric nodes (central superior group)

Inferior mesenteric nodes

Left colic nodes

Right colic nodes

Preaortic nodes

Sigmoid nodes

Ileocolic nodes

Paracolic nodes Prececal nodes

Superior rectal nodes

y-Kwv

Appendicular nodes Inferior mesenteric nodes Left colic nodes Preaortic nodes

C o m m o n iliac nodes Internal iliac nodes External iliac nodes

Superior rectal nodes Middle rectal nodes

Middle rectal nodes Superficial inguinal nodes Perineal lymph vessels (drain largely to inguinal nodes)

Visceral Vasculature

Plate 317

Autonomic Nerves and Ganglia of Abdomen See also Plates 165, 166

Right sympathetic trunk Thoracic duct

Anterior, Posterior vagal trunks

Right greater and lesser thoracic splanchnic nerves

Left gastric artery and plexus

Right phrenic nerve

Left greater thoracic splanchnic nerve

Inferior phrenic arteries and plexuses Right greater and lesser thoracic splanchnic nerves Right suprarenal plexus Right aorticorenal ganglion

Celiac ganglia

Left lesser thoracic splanchnic nerve Splenic artery and plexus C o m m o n hepatic artery and plexus Superior mesenteric ganglion and plexus Left aorticorenal ganglion

Right least thoracic splanchnic nerve

Left sympathetic trunk

Right renal artery and plexus

Intermesenteric (aortic) plexus

Right sympathetic trunk

Inferior mesenteric ganglion

White and gray rami communicantes

Left colic artery and plexus

Cisterna chyli

Inferior mesenteric artery and plexus

Gray ramus communicans 3rd lumbar ganglion of sympathetic trunk 2nd and 3rd lumbar splanchnic nerves Right ureter and plexu Right testicular (ovarian) artery and plexus 4th lumbar splanchnic nerve 1 st sacral ganglion of sympathetic trunk Gray rami communicantes

Plate 318

Left common iliac artery and plexus Superior rectal artery and plexus Superior hypogastric plexus Internal and external iliac arteries and plexuses Right and left hypogastric nerves to inferior hypogastric (pelvic) plexus

Nerves of Stomach and Duodenum See also Plates 165, 166

Right and left inferior phrenic arteries and plexuses Anterior and posterior layers of lesser omentum

Hepatic branch of anterior vagal trunk Anterior vagal trunk Celiac branch of posterior vagal trunk

Right greater thoracic splanchnic nerve

Celiac branch of anterior vagal trunk Left gastric artery and plexus

Vagal branch from hepatic plexus to pyloric part of stomach Hepatic plexus Right gastric artery and plexus

Anterior gastric branch of anterior vagal trunk Left greater thoracic splanchnic nerve Left lesser thoracic splanchnic nerve Splenic artery and plexus Celiac ganglia and plexus Plexus on gastro-omental (gastroepiploic) arteries Superior mesenteric artery and plexus

Plexus on anterior superior and anterior inferior pancreaticoduodenal arteries (posterior pancreaticoduodenal arteries and plexuses not visible in this view)

Innervation

Plate 319

4

Nerves of Stomach and Duodenum (continued) See also Plates 165, 166

Posterior gastric branch of posterior vagal trunk

Plexus on gastro-omental (gastroepiploic) arteries

Hepatic branch of anterior vagal trunk via lesser omentum

Hepatic plexus

Branch from hepatic plexus to cardia via lesser omentum

Right gastric artery and plexus

Right inferior phrenic artery and plexus Posterior vagal trunk Celiac branch of posterior vagal trunk Celiac branch of anterior vagal trunk Left gastric artery and plexus Left inferior phrenic artery and plexus Celiac ganglia and plexus Greater, lesser, and least thoracic splanchnic nerves Aorticorenal ganglia Splenic artery and plexus

Phrenic ganglion

Greater, Lesser, Least thoracic splanchnic nerves

Branch from right inferior phrenic plexus to cardia of stomach Right and left inferior phrenic arteries and plexuses Anterior vagal trunk Posterior vagal trunk

View with stomach reflected cephalad

Plexus on anterior superior and anterior inferior pancreaticoduodenal arteries

Right greater, esser, and east thoracic splanchnic nerves

Plexus on gastroduodenal artery Plexus on posterior superior and posterior inferior pancreaticoduodenal arteries

Celiac ganglia

Superior mesenteric ganglion and plexus

Right aorticorenal ganglion

Superior mesenteric ganglion and plexus

Plate 320

Celiac branches of anterior and posterior vagal trunks Left gastric artery and plexus Left greater, lesser, and least thoracic splanchnic nerves Left aorticorenal ganglion

Innervation

Innervation of Stomach and Duodenum: Schema See also Plates 167, 168 Right 6th thoracic ganglion of sympathetic trunk

[rtnli

Esophageal plexus

Gray, White rami communicantes Spinal sensory (dorsal root) ganglion Anterior (ventral) root of spinal nerve Right greater thoracic splanchnic nerve Right lesser thoracic splanchnic nerve Celiac ganglia Least thoracic splanchnic nerve

Left greater thoracic splanchnic nerve Aortic plexus Left 9th thoracic ganglion of sympathetic trunk Posterior vagal trunk and celiac branch Anterior vagal trunk and celiac branch of vagus nerve (X) Left gastric artery Celiac trunk Splenic artery

Common hepatic artery

Short gastric arteries

Proper hepatic artery Superior mesenteric ganglion Aorticorenal ganglia Right gastric artery

mSBm

Right renal artery Gastroduodenal artery Posterior and anterior superior pancreatico- • duodenal arteries Superior mesenteric artery Posterior and anterior inferior pancreaticoduodenal arteries

f

Left, Right gastroomental (gastroepiploic) arteries

Sympathetic fibers Preganglionic Postganglionic

—— - - -

Parasympathetic fibers Preganglionic Postganglionic Afferent fibers

Innervation

Plate 321

4

Nerves of Small Intestine See also Plates 165, 166

Anterior vagal trunk Posterior vagal trunk

Celiac branches of anterior and posterior vagal trunks

Hepatic plexus Greater thoracic splanchnic nerves Celiac ganglia and plexus Gastroduodenal artery and plexus Lesser thoracic splanchnic nerves Least thoracic splanchnic nerves Aorticorenal ganglia Superior mesenteric ganglion Intermesenteric (aortic) plexus Inferior pancreaticoduodenal arteries and plexuses Superior mesenteric artery and plexus Middle colic artery and plexus (cut) Right colic artery and plexus Ileocolic artery and plexus Superior mesenteric artery and plexus Peritoneum (cut edge) Mesenteric branches Mesoappendix (contains appendicular artery and nerve plexus)

Plate 322

Innervation

Nerves of Large Intestine For nerves of rectum see Plates 165, 166, 410-413

Anterior vagal trunk and hepatic branch\ Posterior vagal trunks

^ V

Marginal artery and plexus Esophagus

Right greater thoracic splanchnic nerve

Left greater thoracic splanchnic nerve

Celiac ganglia and plexus Left suprarenal plexus Left lesser and least thoracic splanchnic nerves

Right aorticorenal ganglion Superior mesenteric ganglion Middle colic artery and plexus

Left aorticorenal ganglion Left renal artery and plexus I st left lumbar splanchnic nerve Left lumbar sympathetic trunk Intermesenteric (aortic) plexus

Right colicartery and plexus Ileocolic artery and plexus Cecal and appendicular arteries and plexuses

Sacral sympathetic trunk Right sacral plexus Pelvic splanchnic nerves Middle rectal artery and plexus

Left colic artery and plexus

gv H4

Inferior mesenteric ganglion, artery, and plexus Sigmoid arteries and plexuses Superior hypogastric plexus Superior rectal artery and plexus Right and left hypogastric nerves

Right inferior hypogastric (pelvic) plexus Nerves from inferior hypogastric (pelvic) plexuses to sigmoid colon, descending colon, and left colic (splenic) flexure

Innervation

Plate 323

4

Thalamus

Sympathetic efferents Parasympathetic efferents Somatic efferents Afferents and CNS connections Indefinite paths Posterior (dorsal) nucleus of vagus nerve

Myclencephalon (medulla oblongata)

K

Spinal sensory (dorsal root) ganglion

Thoracolumbar spinal cord

Sacral spinal cord Levator ani muscle External anal sphincter muscle "Abdominopelvic splanchnic nerves

Pudendal nerve

Chief segmental sources of sympathetic libers innervating different regions of intestinal tract are indicated. Numerous afferent libers are carried centripetally through approximately the same sympathetic splanchnic nerves that transmit preganglionic fibers.

"

Thalamus

A b d o m i n a l aorta

Posterior (dorsal) nucleus of vagus nerve

Celiac ganglia Myelencephalon (medulla oblongata)

Ccliac trunk

^

Spinal sensory (dorsal root) ganglion

Thoracolumbar spinal cord

Sacral spinal cord

Pudendal nerve * A b d o m i n o p e l v i c splanchnic nerves

Plate 324

Innervation

Innervation of Small and Large Intestines: Schema

Sympathetic efferents Parasympathetic efferents Somatic efferents Afferents and CNS connections Indefinite paths

V

T 1 0 - 12

Superior rectal artery and Rectal plexus

Inferior anal (rectal) nerve

Innervation

Levator ani muscle External anal sphincter muscle

Chief segmental sources of sympathetic fibers innervating different regions of intestinal tract are indicated. Numerous afferent fibers are carried centripetally through approximately the same sympathetic splanchnic nerves that transmit preganglionic fibers.

Plate 324

4

Autonomic Reflex Pathways: Schema

Spinal sensory (dorsal root) ganglion

Sympathetic trunk-

Dorsal (posterior) root

Thoracic part of spinal cord Intermediolateral cell column

Ganglion of sympathetic trunk

Spinal nerve to vessels and glands of skin

Ventral (anterior) root Meningeal branch to spinal meninges and spinal perivascular plexuses (usually arises from spinal nerve) n.

White ramus communicans Gray ramus communicans

/Abdominopelvic ^ f (greater, lesser, / and least) thoracic \| / splanchnic nerves

Ganglion of sympathetic trunk

Stretch (distention)

IJ til wftrj Vagus nerve (X)

VA : Celiac ganglion Ganglion of sympathetic trunk

\

•: v •.••• :

Enteric plexuses of gut —

I ;

V !

Superior mesenteric ganglion

Sympathetic

(

Preganglionic

^

f

Postganglionic

e r s

Plate 325

Parasympathetic J Preganglionic — fibers ) „ . . ( Postganglionic —

Afferent fibers

Innervation

Intrinsic Autonomic Plexuses of Intestine: Schema

Peritoneal layers of mesentery

Branch of straight artery (arteriae rectae) to intestine and accompanying nerves

Subserous plexus

Longitudinal intramuscular plexus

Myenteric (Auerbach's) plexus

Circular intramuscular plexus

Submucous (Meissner's) plexus

Periglandular plexus

Visceral peritoneum (serosa) Subserous connective tissue Longitudinal muscle Intermuscular stroma -Circular muscle Submucosa Submucosal glands

\0 y

Muscularis mucosae Mucosa and intestinal glands Lumen

Note: Intestinal wall is shown much thicker than in actuality.

Innervation

Plate 326

4

Innervation of Liver and Biliary Tract: Schema See also Plates 167, 168

Sympathetic trunk Common areas of referred pain in biliary disease

Dorsal root (spinal) ganglion Thoracic pari of spinal cord Right greater thoracic splanchnic nerve-

Left greater thoracic splanchnic nerve

Posterior vagal trunkRight phrenic nerve to diaphragmatic part of parietal (and visceral?) peritoneum

Anterior vagal trunk

Hepatic branch of anterior vagal trunk Diaphragm Phrenic ganglion Celiac ganglia Common hepatic artery Splenic artery Anterior hepatic plexus Posterior hepatic plexus

Aorta Gastroduodenal artery and plexus Sympathetic fibers Preganglionic Postganglionic

Sphincter of hepatopancreatic ampulla

Parasympathetic fibers Preganglionic ——• Postganglionic Afferent fibers

Plate 327

Ramification of nerve fibers around fine branch of hepatic artery

Innervation

I n n e r v a t i o n

o f

P a i W N f l s s

S c h e m a

See also Plates 167, 168

Dorsal root (spinal) ganglion

Right sympathetic trunk

Left sympathetic trunk Thoracic part of spinal cord

Right greater thoracic splanchnic nerve —

Left greater thoracic splanchnic nerve Anterior vagal trunk

Posterior vagal trunk Common areas of pancreatic pain

Celiac ganglia

Splenic artery Celiac trunk-

XV®

S u perio r mesenteric ganglion Superior mesenteric artery and plexus

Sympathetic fibers Preganglionic Postganglionic

Schema of intrinsic nerve supply

Parasympathetic fibers Preganglionic • Postganglionic - 0 """" Afferent fibers

Innervation

Plate 328

4

Kidneys in Situ: Anterior Views

Diaphragm Right suprarenal gland

Esophagus Left suprarenal gland iac trunk

Right kidney

Left kidney

Right renal artery and vein

Left renal artery and vein

Right subcostal nerve

Superior mesenteric artery (cut)

Transversus abdominis muscle

Subcostal nerve

Quadratus lumborum muscle Iliac crest Psoas major muscle lliacus muscle Right ureter Right common iliac Right external iliac arte Right internal iliac artery Urinary bladder

Esophagus Inferior vena cava Area for bare area of liver Right suprarenal gland Peritoneum (cut) Area for liver Duodenum Peritoneum (cut) Area for colon Area for small intestine

Plate 329

Abdominal aorta Iliohypogastric nerve Ilioinguinal nerve Lateral femoral cutaneous nerve Genitofemoral nerve Left testicular (ovarian) artery and vein Inferior mesenteric artery (cut) neum (cut) grnoid mesocolon (cut) Rectum

Gastrophrenic ligament Left suprarenal gland Splenorenal ligament Area for stomach Area for spleen Tail of pancreas Transverse mesocolon Area for small intestine Area for descending colon

Anterior relations of kidneys

Kidneys and Suprarenal Olands

Kidneys in Situ: Posterior Views

Pleura (costodiaphragmatic recess)

Latissimus clorsi muscle

Lumbocostal ligament

Serratus posterior inferior muscle

Quadratus lumborum muscle (cut)

External oblique muscle

Diaphragm

Aponeurosis of transversus abdominis muscle

Subcostal nerve

Internal oblique muscle

Ascending colon

Right kidney

Transversus abdominis muscle

Thoracolumbar fascia (posterior layer)

Iliohypogastric nerve Iliac crest

Ilioinguinal nerve Quadratus lumborum muscle (cut)

Gluteal aponeurosis (over gluteus medius muscle)

Psoas major muscle Iliolumbar ligament

Gluteus maximus muscle

Aorta Projection of 11th rib

Inferior vena cava

Posterior relations of kidneys

Area for diaphragm

Area for diaphragm

Projection of 12th ri

Projection of 12th rib

Area for aponeurosis of transversus abdominis muscle

Area for aponeurosis of transversus abdominis muscle

Area for quadratus lumborum muscle

for quadratus lumborum muscle

Area for psoas major muscle

Area for psoas major muscle

ICidneys and Suprarenal Glands

Plate 330

885 Wr •

Schematic Cross Section of Abdomen at T12 See also Plates 293, 297, 338, 339 Liver Falciform ligament Superior epigastric vessels

Linea alba Rectus abdominis muscle Lesser omentum

Transversalis fascia Parietal peritoneum Visceral peritoneum of liver

Left gastric artery and vein

Proper hepatic artery (bifurcation) Common hepatic duct. Gallbladder Cystic duct Hepatic portal vein Costodiaphragmatic recess of pleural cavity

7th coslal cartilage External oblique muscle Diaphragm Stomach Gastrosplenic ligament and short gastric vessels Spleen

i

•

>

Pleura ^

,7

mm

Intercostal vessels nerve Omental (epiploic) foramen (of Winslow) Common hepatic artery (retroperitoneal)

Intercostal muscles Splenorenal ligament with splenic vessels

Hepatorenal recess (Morison's pouch) Inferior vena cava Omental bursa (lesser sac) Right sympathetic trunk Right crus of diaphragm Azygos vein Thoracic duct Anterior longitudinal ligament Celiac ganglia Abdominal aorta Body of T'l 2 vertebra

Plate 331

Parietal peritoneum on posterior wall of omental bursa Left kidney Left suprarenal gland Latissimus dorsi muscle lliocostalis -Longissimus ? Erector spinae \ muscle Spinalis

Kidneys and Suprarenal Glands

Renal Artery and Vein in Situ

Inferior vena cava

Esophagus Left inferior phrenic vein

Right and left inferior phrenic arteries

Left superior suprarenal arteries

Celiac trunk

Left middle suprarenal artery

Right superior suprarenal arteries

Left suprarenal vein

Right middle suprarenal artery

Left inferior suprarenal artery

Right suprarenal vein Right inferior suprarenal artery

Sir

um

mm®

mm

Ureteric branch of left renal artery Left renal artery and vein Ureteric branch of right renal artery

Left testicular (ovarian) artery and vein

Right renal artery and vein Left 2nd lumbar vein and communication to ascending lumbar vein

Right testicular (ovarian) artery and vein Inferior vena cava Abdominal aorta

Kidneys and Suprarenal Glands

Inferior mesenteric artery Superior mesenteric artery (cut)

Plate 332

A

Variations in Renal Artery and Vein

Proximal subdivision of renal artery

A Low accessory right renal artery may pass anterior to inferior vena cava instead of posterior to it B Inferior phrenic artery with superior suprarenal arteries may arise from renal artery (middle suprarenal artery absent) Double left renal vein may form ring around abdominal aorta

Multiple renal veins Persistent left inferior vena cava may join left renal vein

Plate 333

Kidneys and Suprarenal Glands

Gross Structure of Kidney m

Superior pole

—

Anterior surface of right kidney

Fibrous capsule [cut and peeled back) Medial border Lateral border Hilum Renal artery Renal vein Renal pelvis Stellate veins visible through capsule

Medial border Ureter

Inferior pole

Suprarenal gland and lobulated kidney of infant

Fibrous capsule Cortex

Minor calices

Medulla (pyramids)

Blood vessels entering renal parenchyma

Renal papilla

Renal sinus

Major calices Renal column (of Bertin)

Renal pelvis Fat in renal sinus Minor calices

Base of pyramid Ureter

Right kidney sectioned in several planes, exposing parenchyma and renal pelvis

Kidneys and Suprarenal Glands

Plate 334

Superior (apical) segmental artery

Frontal section of left kidney: anterior view

Anterior superior segmental artery Capsular and perirenal branches

Interlobar arteries

Inferior suprarenal artery Anterior branch of renal artery

Arcuate arteries

Renal artery Posterior branch of renal artery (posterior segmental artery)

Cortical radiate (interlobular) arteries

Pelvic and ureteric branches Anterior inferior segmental artery

(Capsular) perforating radiate artery

Posterior segmental arteries Inferior segmental artery

Vascular renal segments Superior

Anterior superior Posterior Anterior inferior

Inferior—-wj

Anterior surface of left kidney

Plate 335

Posterior surface of left kidney

Kidneys and Suprarenal Glands

Nephron and Collecting Tubule: Schema

Fibrous capsule Proximal convoluted tubule 7

Subcapsular zone

Cortical"" corpuscle Juxtamedullary renal corpuscle

Renal cortex

Proximal convoluted tubu

y

Distal convoluted

convoluted tubule

Henle's loop Descending limb Ascending limb

Collecting tubule CD

•Z

o

CL>

CL

CD

£= o N

_^ """

CD -i—• =5

O

CD CD C L

Descending limb Renal ii. medulla ^ (pyramid)

Renal (malpighian) corpuscle; glomerular (Bowman's) capsule with glomerulus

Ascending

Afferent and efferent glomerular arterioles


) Urethra Paraurethral (Skene's) gland Greater vestibular (Bartholin's) gland Vestibule

Plate 388

5

Testis, E p i d i d y m i s , a n d D u c t u s D e f e r e n s .

.

.—--—- '

'

'••"""•""•••""V"':™"-"''''

",' ••..••••---—-—

.. ."

"''""Syv '

.....

. • • • M H M j vg .

A b d o m i n a l aorta Testicular vessels (part of spermatic cord) Ureter Inferior mesenteric artery C o m m o n iliac vessels Internal iliac vessels External iliac vessels Inferior vesical artery Inferior epigastric vessels Artery to ductus deferens Cremasteric vessels Testicular vessels in spermatic corcl Femoral vessels Superficial external pudendal vessels {cut—pass superficial to spermatic cord)

mm mm

Deep external pudendal vessels Pampiniform venous plexus Deep dorsal vein and dorsal arteries of penis under deep (Buck's) fascia of penis

i•

Vasculature

Plate 401

5

A r t e r i e s a n d V e i n s of Pelvis: F e m a l e

M e d i a n sacral artery

A b d o m i n a l aorta Right

Iliolumbar artery

} C o m m o n iliac arteries

Lateral sacral arteries

Internal iliac artery Posterior division Anterior division External iliac artery Umbilical artery (patent part) O b t u r a t o r artery

Superior gluteal artery

M i d d l e rectal artery Uterine artery

Piriformis muscle

Vaginal artery Inferior vesical artery

Inferior gluteal arterv

Superior vesical arteries

Internal pudendal artery—

/ / •

Medial umbilical ligament (occluded part of umbilical artery) Pubic symphysis Sagittal section

Coccygeus (ischiococcygeusj muscle

Right p a r a m e d i a n section: lateral view

Sacrotuberous ligament O b t u r a t o r fascia (of obturator internus muscle)

A b d o m i n a l aorta Inferior vena cava

Internal pudendal artery in pudendal canal (Alcock's)

Right c o m m o n iliac artery

Levator ani muscle (cut edge)

Left c o m m o n iliac artery Ureter? External iliac artery (cut)

Superior gluteal artery Umbilical artery (patent part) O b t u r a t o r artery

—Internal iliac artery Posterior division Anterior division

Piriformis muscle Internal pudendal artery Inferior gluteal artery Coccygeus (ischiococcygeus) muscle M i d d l e rectal artery Uterine artery Vaginal artery Inferior vesical artery Internal pudendal artery Inferior rectal artery Superior vesical arteries Medial umbilical ligament (occluded distal part of umbilical artery)

Plate 402

Obturator

canal Obturator internus muscle Levator ani muscle

Vasculature

A r t e r i e s a n d V e i n s of Pelvis: M a l e

Left p a r a m e d i a n section: lateral view

Inferior vena cava

Abdominal aorta

Right obturator vessels

C o m m o n iliac vessels

Right umbilical artery (patent part)

Median sacral vessels External iliac vessels (cut)

Superior vesical artery

Internal iliac vessels

Umbilical artery (occluded part)

Iliolumbar artery

Deep circumflex iliac vessels Inferior epigastric vessels

Lateral sacral artery Superior gluteal artery Obturator artery \

Umbilical artery Ureter (cut)

Ductus deferens and its artery

Inferior gluteal artery Inferior vesical artery

Medial umbilical ligament-

Middle rectal artery

Median umbilical ligament (urachus)

Internal pudendal artery Ductus deferens and its artery

Superior vesical artery

Prostatic branches of inferior vesical artery

Superficial dorsal vein of penis—

Inferior rectal artery Prostatic venous plexus

Deep dorsal vein and dorsal artery of penis

Sphincter urethrae muscle Perineal artery

Deep (Buck's) fascia of penis

Posterior scrotal arteries

Testicular artery

Internal pudendal artery on superior aspect of perineal membrane

Pampiniform (venous) plexus Artery to ductus deferens

Inferior vesical artery

Vesical (retropubic) venous plexus

Branch to Urethral branches Capsular branches Hyperplastic middle lobe W

0

W /

- « » " T -w — M .

Z>

Hyperplastic lateral lobe Sphincter urethrae mucle Arterial supply of prostate

(Frontal section, anterior view of specimen with benign hyperplasia)

Vasculature

Plate 403

I

,•;

, .'vl

;'•

A r t e r i e s a n d Veins of P e r i n e u m a n d U t e r u s w^q^s-wssM^.

• •

1

• i fH 1 1 H11 —

Posterior view

Plate 427

Shoulder and Axilla

Pectoral, Clavipectoral, arid Axillary Fasciae See also Plate 188 Thoracoacromial arte

Trapezius muscle muscle invested by fascia of infrahyoid muscles

C o r a c o i d process

Clavicle Fascia investing subclavius muscle*

Cephalic vein

C o s t o c o r a c o i d ligament*

Deltoid muscle

Costoclavicular ligament Costocoracoid membrane*

Pectoralis major muscle (cut)

Fascia investing pectoralis minor muscle* Suspensory ligament of axilla* Pectoralis major muscle and pectoral fascia (superficial and deep layers)

Biceps brachii muscle Short head Long head

Latissimus dorsi fascia Serratus anterior fascia Axillary fascia (anterior part)

Brachial fascia (cut edge) over coracobrachial and biceps brachii muscles

Anterior view

O m o h y o i d muscle

O b l i q u e parasagittal section of axilla Trapezius muscle ( Brachial plexus < (

Lateral cord Posterior cord Medial c o r d

Supraspinatus muscle

Scapula

|

Body

Infraspinatus muscle Subscapularis muscle Teres minor muscle Teres major muscle Latissimus dorsi muscle ( dllary l y m p h nodes ) (

Central

avicle Subclavius muscle and fascia* C o s t o c o r a c o i d ligament* Thoracoacromial artery and cephalic vein Costocoracoid membrane* Lateral pectoral nerve Axillary artery and vein Pectoralis major muscle and fascia Pectoralis minor muscle and fascia* M e d i a l pectoral nerve Suspensory ligament of axilla Axillary fascia ( f e n e s t r a t e d )

pectQra[

(anterior) ^ C o m p o n e n t s of clavipectoral fascia

Shoulder and Axilla

Plate 428

Axilla (Dissection): Anterior View

Trapezius muscle

Thoracoacromial artery A c r o m i a l branch

Pectoralis m i n o r t e n d o n (cut)

Suprascapular artery and nerve Dorsal scapular artery and nerve

D e l t o i d branch

C o r a c o i d process

Transverse cervical artery

Clavicular branch

Acromion Cephalic vein

Pectoral branch

M u s c u l o c u t a n e o u s nerve

Axillary artery

Anterior circumflex humeral artery

A n t e r i o r scalene muscle

Clavicle and subclavius muscle (cut)

Axillary nerve and posterior circumflex humeral artey Pectoralis major muscle (cut)

Sternocleidomastoid muscle

C o r a c o b r a c h i a l muscle Phrenic Deltoid muscle

n e r v e

Biceps brachii muscle

m

M

M

M

Omohyoid muscle

f

' IWJi

Musculocutaneous nerve

Brachialisi muscle

Ulnar nerve

/

Medial brachial cutaneous nerve

Profunda brachii (deep brachial) artery

\A wm-L : IwM}.

Intercostobrachial nerve /m Circumflex / 1 scapular artery I

Radial nerve Triceps brachii muscle Brachial veins

\ \

Lower sub- / scapular nerve Teres major muscle

Subscapular artery

Ulnar nerve

Latissimus dorsi muscle

X

1

Thoracodorsal artery and nerve U p p e r subscapular nerve

Medial antebrachial i cutaneous nerve f Basilic vein

Subclavian artery and vein

T ^ ^ w^ 1

M e d i a n nerve Brachial artery

I * •^ s

1 I

Serratus anterior muscle

Lateral thoracic artery and long thoracic nerve t Ansa pectoralis

1st rib Brachial plexus Superior thoracic artery Lateral pectoral nerve Medial pectoral nerve

Pectoralis minor (cut)

Plate 429

Shoulder and Axilla

Brachial Plexus: Schema

Note: Usual composition shown. Prefixed plexus has large C4 contribution but lacks T1. Postfixed plexus lacks C5 but has T2 contribution.

Contribution from C4 Dorsal ramus

Musculocutaneous nerve (C5, 6, 7

To longus colli and scalene muscles (C5, 6, 7t 8)

Axillary nerve (C5, 6) Radial nerve (C5, 6, 7r 8, T1 Median nerve (C5, 6, 7, 8 , 1 1 ) Ulnar nerve (C7, 8, T1)

1 st intercostal nerve Long thoracic nerve (C5, 6, 7) Medial pectoral nerve (C8, T1) Medial brachial cutaneous nerve (T1) Medial antebrachial cutaneous nerve (C8, T1)

Inconstant contribution

Upper subscapular nerve (C5, 6) Thoracodorsal (middle subscapular) nerve (C6, 7f 8) Lower subscapular nerve (C5, 6)

Shoulder and Axilla

PQafa 43©

Muscles of Arm: Anterior Views See also Plate 474

Acromion

Coracoacromial ligament

CoracoicJ process

Subdeltoid bursa

Pectoralis minor t e n d o n {cut) Greater tubercle, Lesser tubercle of humerus

muscle M u s c u l o c u t a n e o u s nerve (cut)

Intertubercular t e n d o n sheath

C o r a c o b r a c h i a l muscle Circumflex scapular artery (cut)

D e l t o i d muscle (.reflected)

Teres major muscle Latissimus dorsi muscle

Pectoralis major muscle ( r e f l e c t e d ) Anterior circumflex humeral artery Biceps brachii

( \

Long head

muscle

(

Short head Biceps brachii tendons (cut) Short head Long head

Brachial artery (cut) M e d i a n nerve [cut) Brachialis muscle

Coracobrachialis muscle

Lateral antebrachial cutaneous nerve

Musculocutaneous Branch to biceps brachii (cut)

Bicipital aponeurosis

D e l t o i d muscle (cu Biceps brachii t e n d o n Brachioradialis muscle Pronator teres muscle Flexor carpi radialis muscle Brachialis muscle

Superficial layer

Lateral intermuscular septum

Medial intermuscular septum

Lateral e p i c o n d y l e of humerus Lateral antebrachial cutaneous nerve Head of radiu

Medial epicondyle of humerus

Biceps brachii t e n d o n Radial tuberosity

Tuberosity of ulna

Deep layer

Arm

Muscles of Arm: Posterior Views See also Plate 477

Superficial layer

Acromion

Supraspinatus muscle Greater tubercle of humerus Infraspinatus muscle Teres m i n o r muscle Axillary nerve and posterior circumflex humeral artery D e l t o i d muscle (cut and

reflected)

Superior lateral brachial cutaneous nerve Long head Lateral head Tendon

) > ofTriceps brachii muscle \

Brachioradialis muscle ^ psule of shoulder joint Supraspinatus t e n d o n Teres major

Infraspinatus and eres minor tendons (cut)

Posterior brachial cutaneous nerve (from radial nerve

Axillary nerve

Medial intermuscular septum

Posterior circumflex humeral artery

Teres major muscle

Ulnar nerve Medial epicondyle of humerus

Superior lateral brachial cutaneous nerve

O l e c r a n o n of ulna

Profunda brachii (deep brachial) artery

Flexor carpi ulnaris muscle

Radial nerve

A n c o n e u s muscle

M i d d l e collateral artery

Extensor carpi radialis longus muscle

Radial collateral arterv

Extensor carpi ulnaris muscle

Inferior lateral brachial cutaneous nerve

/

Posterior antebrachial cutaneous nerve (fro radial nerve)

Long head of triceps brachii muscle

Extensor d i g i t o r u m muscl

Lateral head ot triceps brachii muscle (cut)

Extensor carpi radialis brevis m

Medial head of triceps brachii muscle Medial e p i c o n d y l e of humerus

Lateral intermuscular septum N e r v e to anconeus and medial head of triceps brachii muscle Posterior antebrachial cutaneous nerve

Ulnar nerve O l e c r a n o n of ulna

Deep layer

Lateral epicondyle of humerus

A n c o n e u s muscle

PQate 432

Brachial Artery in Situ

Coracoid process

Axillary artery

Deltoid muscle

Pectoralis minor muscle (cut)

Anterior circumflex humeral artery

Lateral cord, Medial cord of brachial plexus

Humerus

Musculocutaneous nerve

Pectoralis major muscle and tendon (cut)

Subscapularis muscle Biceps brachii muscle

Long head

Anterior and posterior circumflex humeral arteries

Short head

Teres major muscle

C o r a c o b r a c h i a l muscle

Latissimus dorsi muscle Profunda brachii (deep brachial) artery

Muscular branch

Medial brachial cutaneous nerve

Median nerve

Ulnar nerve Medial antebrachial cutaneous nerve

Muscular branch

Long head Medial head

Biceps brachii muscle

ofTriceps brachii muscle

Superior ulnar collateral artery Brachialis muscle Medial intermuscular septum Inferior ulnar collateral artery Medial epicondyle of humerus

Biceps brachii tendon

Bicipital aponeurosis Radial artery

Pronator teres muscle .tfctf;:

Ulnar artery Flexor carpi radialis muscle Brachioradialis muscle

Plate 433

Arm

Brachial Artery and Anastomoses around Elbow See also Plate 427

Clavicular branch A

Pectoral branch

Acromial branch Deltoid branch Thoracoacromial artery

Superior thoracic artery

Axillary artery

Lateral thoracic artery

Anterior circumflex humeral artery Posterior circumflex humeral artery

Subscapular artery Circumflex scapular artery

Brachial artery

Thoracodorsal artery Profunda brachii (deep brachial) artery of lower margin of teres major muscle is landmark for name change from axillary to brachial arterv Radial collateral artery

Middle collateral artery Superior ulnar collateral artery

Inferior ulnar collateral artery Radial recurrent artery

Posterior interosseous artery

Anterior ulnar recurrent artery Posterior ulnar recurrent artery

Radial artery

C o m m o n interosseous artery Anterior interosseous artery Ulnar artery

Plate 434

6

Arm: Serial Cross Sections

Musculocutaneous nerve

Pectoralis major muscle and tendon

Median nerve

Cephalic vein

Medial antebrachial cutaneous nerve

Biceps brachii muscle

Brachial artery and veins Coracobrachialis muscle

Basilic vein

Humerus

Profunda brachii (deep brachial) artery

Deltoid muscle of Triceps brachii muscle

Ulnar nerve Radial nerve

Lateral head Long head

Medial brachial cutaneous nerve

Biceps brachii muscle

Latissimus dorsi tendon Musculocutaneous nerve

Teres major muscle

Brachialis muscle

Brachial fascia

Cephalic vein

Median nerve Brachial artery and veins

Radial nerve Posterior antebrachial cutaneous nerve (from radial nerve)

Medial antebrachial cutaneous nerve Basilic vein

Radial collateral artery

Medial brachial cutaneous nerve

Middle collateral artery

Neurovascular compartment

Lateral intermuscular septum of Triceps ( brachii < muscle

(

Ulnar nerve

Medial head Lateral head

*

Superior ulnar collateral artery Medial intermuscular septum

Long head

Brachial fascia

Biceps brachii muscle

Lateral antebrachial cutaneous nerve (from musculocutaneous nerve)

Cephalic vein

Medial antebrachial cutaneous nerve

Brachialis muscle

Basilic vein Brachioradialis muscle

Median nerve

Radial nerve

Ulnar nerve

Extensor carpi radialis Iongus muscle Posterior antebrachial cutaneous nerve (from radial nerve)

Plate 435

Brachial artery and veins Medial intermuscular septum

p

Humerus Triceps brachii muscle and tendon Lateral intermuscular septum

Arm

H e m e s ©f EDfe@w

Right elbow Medial

Condyle

Humerus

Humerus

Lateral

Medial supracondylar ridge

Lateral supracondylar ridge

Olecranon fossa^

Coronoid fossa

Radial fossa

Lateral epicondyle Lateral epicondyle

Medial epicondyle

Capitulum

Olecranon

Trochlea Groove for ulnar nerve

Coronoid process

Tuberosity

Radial notch of ulna Tuberosity

Tuberosity

Radius

Radius

In extension: anterior view

In extension: posterior view Sublime tubercle Humerus

Radius

Humerus

In extension: lateral view

!n extension: medial view Humerus Medial epicondyl Capitulum Trochlea Head Neck Tuberosity Radius

Ulna Coronoid process ( r , . . . > of ulna Trochlear notch Olecranon

In 90° flexion: lateral view

E!fe@w and Forearm

Coronoid process Trochlear notch Olecranon

In 90° flexion: medial view

Plate 436

Jwj Elbow: Radiographs See also

Plate 436

Lateral radiograph

Anteroposterior radiograph

Plate 437

C

Capitulum

CP

Coronoid process of ulna

H

Humerus

HR

Head of radius

L

Lateral epicondyle

M

Medial of epicondyle

NR

Neck of radius

O

Olecranon

OF

Olecranon fossa

R

Radius

T

Trochlea of humerus

RT

Radial tuberosity

U

Ulna

c

Capitulum

CP

Coronoid process of ulna

H

Humerus

HR

Head of radius

L

Lateral epicondyle

O

Olecranon

R

Radius

T

Trochlear notch

U

Ulna

•mSS^m^n H s a i wMtfi f»

W-1 i

H 81 i ill

lift:

i f s i y

Elbow and Forearm

Right elbow Anterior view

Humerus

Joint capsule Medial epicondyle

Lateral epicondyle Radial collateral ligament

Ulnar collateral ligament

Insertion of brachialis muscle Biceps brachii tendon Oblique cord Radius

Humerus

Joint capsule

Joint capsule

Ulnar collateral ligament

Radial collateral ligament

Annular ligament of radius

Annular ligament of radius

Triceps brachii tendon

Humerus

Biceps brachii tendon

Triceps brachii tendon

Biceps brachii tendon Oblique cord Radius

Subcutaneous olecranon bursa

In 90° flexion: medial view

In 90° flexion: lateral view

Humerus

Subcutaneous olecranon bursa

Joint capsule (cut edge)

Humerus

Fat pads

Opened j o i n t : anterior view

Synovial membrane

Opened j o i n t : posterior view

Articular cartilage

Radius

Elbow and Forearm

Radius

Plate 438

Bones of Forearm

— Olecranon

Right radius and ulna in supination: anterior view

Right radius and ulna in pronation: anterior view

Trochlear notch Coronoid process

Head

Radial notch of ulna Ulnar tuberosity

Neck

Oblique cord Ulnar tuberosity

Oblique cord

Radial tuberosity

Radius

Ulna

Radius

Ulna

Anterior surface

Anterior su

Lateral surface Posterior border

Anterior border Anterior border

Posterior surface Interosseous membrane

Interosseous border Interosseous border

Interosseous membrane

Dorsal tubercle Groove for extensor pollicis longus muscl

Groove for extensor carpi radialis longus and brevis muscles

Groove for extensor digitorum and extensor indicis muscles

Area for extensor pollicis brevis and abductor pollicis longus muscles

Styloid process of ulna Styloid process

Styloid process

Radius Ulnar notch of radius Styloid process

Styloid process ted)

Area for scaphoid bone

Area for lunate bone

Carpal articular suface

Plate 439

Coronal section of radius demonstrates how thickness of cortical bone of shaft diminishes to thin layer over cancellous bone at distal end

Eib@w and Forearm

Individual Muscles of Forearm: Rotators of Radius iff §

Right f o r e a r m : anterior view Supinated position

Pronated position

Medial epicondyle

Medial epicondyle

Lateral epicondyle

Supinator

Pronator teres

Radius Radius

Pronator quadratus

Elbow and Forearm

POat© 44®

Individual Muscles of Forearm: Extensors of Wrist and Digits

(Note: Anconeus muscle not shown because it is extensor of elbow

Medial epicondyle Olecranon Lateral epicondyle

Extensors of wrist Olecranon Lateral epicondyle

Extensor carpi radialis longus

mmon extensor tendon

Extensor carpi radialis brevisExtensor carpi ulnaris

Common extensor tendon

Extensors of digits (except t h u m b ) Extensor d i g i t o r u m

Extensor digitorum and extensor digiti minimi (cutaway)

Interosseous membrane Radius

Extensor digiti m i n i m i Extensor indicis

Extensors of t h u m b A b d u c t o r pollicis longus Extensor pollicis brevis Extensor pollicis longus

Extensor indicis tendon

Extensor digitorum and extensor digiti minimi tendons

Right forearm: posterior (dorsal) views

Plate 441

Elbow and Forearm

Individual Muscles of Forearm: Flexors of Wrist Wimivm

Note: Brachioradialis muscle not shown because it is flexor of elbow Medial epicondyle

Lateral epicondyle

C o m m o n flexor tendon

Flexor carpi radialis

Palmaris longus

Radius

Pisiform H o o k of hamate Palmar aponeurosis (cut)

Right forearm: anterior (palmar) view

Elbow and Forearm

Plate 442

Individual Muscles of Forearm: Flexors of Digits

Medial epicondyle

Medial epicondyle

Lateral epicondyle

Lateral epicondyle

Coronoid process Coronoid process Interosseous membrane Interosseous membrane Radius

Radius

Flexor d i g i t o r u m superficialis

Flexor d i g i t o r u m profundus

Flexor pollicis longus

Radius

. Ulna

Radius

Flexor digitorum superficialis tendons (cut a

Right forearm: anterior ( p a l m a r ) views

Plate 443

E!b@w and Forearm

Muscles of Forearm (Superficial Layer): Posterior View See also Plates 470, 478

Superior ulnar collateral artery (anastomoses distally with posterior ulnar recurrent artery)

Triceps brachii muscle

Brachioradialis muscle Ulnar nerve Extensor carpi radialis longus muscle Medial epicondyle of humerus C o m m o n extensor tendon Olecranon of ulna

Anconeus muscle

Extensor carpi radialis brevis muscle

Extensor digitorum muscle

Extensor digiti minimi muscle

Extensor pollicis brevis muscle

Extensor pollicis longus t e n d o n Extensor retinaculum (compartments numbered)

Dorsal branch of ulnar nerve

Extensor carpi radialis brevis tendon Extensor carpi radialis longus tendon

Superficial branch of radial nerve

A b d u c t o r pollicis longus tendon Extensor carpi ulnaris tendon

Extensor pollicis brevis tendon

Extensor digiti minimi tendon

Extensor pollicis longus tendon

Extensor digitorum tendons Extensor indicis tendon

5th metacarpal bone

EIb©w and F@rearnn

Plate 444

Muscles of Forearm (Deep Layer): Posterior View See also Plates 470, 479

, ( Superior ulnar collateral f branches oi ) inferior ulnar collateral brachial artery ) , . . . ( (posterior branch) P

Medial intermuscular septum

Ulnar nerve

Posterior ulnar recurrent artery

Medial epicondyle of humerus

Triceps brachii tendon [cut)

O l e c r a n o n of ulna

Anconeus muse

Flexor carpi ulnaris muscl

Recurrent interosseous artery

Posterior interosseous artery

M i d d l e collateral branch of deep brachial artery

Lateral intermuscular septum

Brachioradialis muscle

Extensor carpi radialis longus muscle

Lateral epicondyle of humerus

C o m m o n extensor t e n d o n ( p a r t i a l l y cut)

Extensor carpi radialis brevis muscle

Supinator muscle

Posterior interosseous nerve

Pronator teres muscle (slip of insertion)

Radius

-

interosseous nerve Extensor pollicis longus muscle

Extensor indicis muscle

Anterior interosseous artery (termination)

uctor pollicis longus muscle

Extensor pollicis brevis muscle

Extensor carpi radialis brevis t e n d o n Extensor carpi radialis longus t e n d o n

Extensor carpi ulnaris t e n d o n (cut) Extensor digiti minimi tendon (cut) Extensor d i g i t o r u m tendons (cut)

Extensor retinaculum (co m part m e n ts n u m bered)

oth metacarpal bone

Plate 445

Radial artery

1 st metacarpal b o n e 2nd metacarpal bone 1 st dorsal interosseous muscle

Elfoow and Forearm

Muscles of Forearm (Superficial Layer): Anterior View mmmmmmmmmmmmmmmmmsm

wmrnmrnm

See also Plates 475, 476

Medial antebrachial cutaneous nerve

Biceps brachii muscle

Ulnar nerve

Brachial artery and median nerve

Triceps brachii muscle Lateral antebrachial cutaneous nerve (terminal musculocutaneous nerve)

M e d i a l intermuscular septum

Brachialis muscle

Ulnar artery

Medial e p i c o n d y l e of humerus

Biceps brachii t e n d o n

C o m m o n flexor t e n d o n

Radial artery

Pronator teres muscle Bicipital aponeurosis Flexor carpi radialis muscle

Brachioradialis muscle

Palmaris longus muscle

Extensor carpi radialis longus m u

Superficial flexor muscles

Flexor carpi ulnaris muscle

Extensor carpi radialis brevis muscle

Flexor digitorum superficialis muscle Flexor pollicis longus muscle a n d t e n d o n Palmaris longus tendon

Dorsal branch of ulnar nerve

M e d i a n nerve

Palmar carpal ligament (continuous w i t h extensor retinaculum)

Thenar muscles

Palmar aponeurosis

EIb@w and Forearm

Ulnar artery and nerve

Pisiform

Palmar branch of median nerve

H y p o t h e n a r muscles

Plate 446

6

Muscles of Forearm (Intermediate Layer): Anterior View See also Plates 475, 476

Ulnar nerve

Biceps brachii muscle

M e d i a n nerve

Brachialis muscle

Brachial artery Lateral antebrachial cutaneous nerve (cut) (from musculocutaneous nerve)

Medial intermuscular septum Pronator teres muscle (humeral head) (cut and reflected)

Radial nerve Deep branch Superficial branch

Medial epicondyle Flexor carpi radialis and palmaris longus tendons (cut)

Biceps brachii t e n d o n

Anterior ulnar recurrent artery

Radial recurrent artery

Flexor d i g i t o r u m superficialis muscle (humeroulnar head)

Radial artery

Ulnar artery Supinator muscle

C o m m o n interosseous artery Pronator teres muscle (ulnar head) (cut)

Brachioradialis muscle

rior interosseous artery Pronator teres muscle (

Flexor carpi ulnaris muscle exor d i g i t o r u m superficialis muscle

Flexor d i g i t o r u m superficialis muscle (radial head)

Ulnar artery Flexor pollicis longus muscle

Palmar carpal ligament (continuous w i t h extensor retinaculum) w i t h palmaris longus t e n d o n (cut and reflected)

Flexor carpi radialis t e n d o n (cut)

Ulnar nerve and dorsal branch M e d i a n nerve Palmar branches of median and ulnar nerves (cut) Pisiform D e e p palmar branch of ulnar artery and deep branch of ulnar nerve Superficial branch of ulnar nerve

Superficial palmar branch of radial artery

Flexor retinaculum (transverse carpal ligament)

Elbow and Forearm

Muscles of Forearm (Deep Layer): Anterior View See also Plates 475, 476

Brachialis muscle

Ulnar nerve

M u s c u l o c u t a n e o u s nerve (becomes) Lateral antebrachial cutaneous nerve

M e d i a n nerve Brachial artery

Lateral intermuscular septum

Medial intermuscular septum

Radial nerve

Pronator teres muscle (humeral head cut and

Lateral e p i c o n d y l e

or ulnar recurrent artery

Biceps brachii t e n d o n (cut)

Medial epicondyle of humerus

Radial recurrent artery Radial artery

Flexor carpi radialis, palmaris longus, flexor d i g i t o r u m superficialis (humeroulnar head), and flexor carpi ulnaris muscles (cut)

Supinator muscle V

Posterior and anterior interosseous

Posterior ulnar recurrent artery

Flexor d i g i t o r u m superficialis muscle (radial head) {cut)

reflected)

—

Ulnar artery

0

Pronator teres muscle (cut and reflected)

n interosseous artery

Radial artery Flexor pollicis longus muscle and t e n d o n (cut) Radius Pronator quadratus muscle Brachioradialis t e n d o n (cut) Radial artery and superficial palmar branch

Pronator teres muscle (ulnar head) (cut) M e d i a n nerve (cut) Flexor d i g i t o r u m profundus muscle terior interosseous artery and nerve Ulnar nerve and dorsal branch Palmar carpal branches of radial and ulnar arteries Flexor carpi ulnaris tendon (cut)

Flexor pollicis longus t e n d o n Pisiform Flexor carpi radialis tendon (cut) A b d u c t o r pollicis longus t e n d o n

Deep palmar branch of ulnar artery and deep branch of ulnar nerve

Extensor pollicis brevis tendon

H o o k of hamate

1 st metacarpal b o n e

Elb@w and Forearm

*

5th metacarpal b o n e

Plate 448

Forearm: Serial Cross Sections

Median antebrachial vein

Flexor digitorum superficialis muscle (radial head)

Pronator teres muscle

Anterior branch of medial antebrachial cutaneous nerve

Radial artery and superficial branch of radial nerve

Flexor pollicis longus muscle

Radius

I nterosseous m em brane

Brachioradialis muscle

Flexor carpi radialis muscle

Cephalic vein and lateral antebrachial cutaneous nerve (from musculocutaneous nerve)

Ulnar artery and median nerve Palmaris longus muscle Flexor digitorum superficialis muscle (humeroulnar head)

Supinator muscle D e e p branch of radial nerve

C o m m o n interosseous artery

Extensor carpi radialis longus muscle

Ulnar nerve

Extensor carpi radialis brevis muscle

Flexor carpi ulnaris muscle Basilic vein

Extensor digitorum muscle

Flexor digitorum profundus muscle

Extensor digiti minimi muscle

Ulna and antebrachial fascia

Extensor carpi ulnaris muscle

Anconeus muscle

Flexor carpi radialis muscle

Posterior antebrachial cutaneous nerve (from radial nerve)

Brachioradialis muscle Radial artery and superficial branch of radial nerve

Palmaris longus muscle Flexor digitorum superficialis muscle

Flexor pollicis longus muscle

Median nerve

Extensor carpi radialis longus muscle and tendon

Ulnar artery and nerve Flexor carpi ulnaris muscle

Radius

Anterior interosseous artery and nerve (from median nerve)

Extensor carpi radialis brevis muscle and tendon

Flexor digitorum profundus muscle Ulna and antebrachial fascia

Abductor pollicis longus muscle

Interosseous membrane and extensor pollicis longus muscle

Extensor digitorum muscle Extensor digiti minimi muscle

Posterior interosseous artery and nerve (continuation of deep branch of radial nerve)

Extensor carpi ulnaris muscle

Palmaris longus tendon

Flexor carpi radialis tendon

Median nerve

Radial artery

Flexor digitorum superficialis muscle and tendons Flexor carpi ulnaris muscle and tendon

Brachioradialis tendon

Ulnar artery and nerve

A b d u c t o r pollicis longus tendon

Dorsal branch of ulnar nerve

Superficial branch of radial nerve

Flexor digitorum profundus muscle and tendons

Extensor pollicis brevis t e n d o n ^

Antebrachial fascia

Extensor carpi radialis longus tendon

Ulna Extensor carpi ulnaris t e n d o n

Extensor carpi radialis brevis tendon

Pronator quadratus muscle and interosseous membrane

Flexor pollicis longus muscle

Extensor indicis muscle and tendon

Extensor pollicis longus t e n d o n

Extensor digiti minimi tendon Radius

Plate 449

Extensor digitorum tendons ( c o m m o n tendon to digits 4 and 5 at this level)

Elbow and Forearm

Attachments of Muscles of Forearm: Anterior View mmmmamm* mss*

Brachioradialis muscle Extensor carpi radialis longus muscle

Brachialis muscle Pronator teres muscle (humeral head)

Supinator Extensor carpi radialis brevis, extensor digitorum, extensor digiti minimi, extensor carpi ulnaris muscles

Common extensor tendon

Brachialis muscle Biceps brachii muscle

Common flexor tendon

Pronator teres, flexor carpi radialis, palmaris longus, flexor carpi ulnaris, flexor digitorum superficialis (humeroulnar head) muscles

Flexor digitorum superficialis muscle (humeroulnar head) Pronator teres muscle (ulnar head)

Supinator muscle Flexor digitorum superficialis muscle (radial head)

Flexor digitorum profundus muscle

Pronator teres muscle Flexor pollicis longus muscle

Radius Pronator quadratus muscle Pronator quadratus muscle Brachioradialis muscle

Note: Attachments of intrinsic muscles of hand not shown

Abductor pollicis longus muscle — Flexor carpi ulnaris muscle Extensor carpi ulnaris muscle Flexor carpi radialis muscle

Flexor pollicis longus muscle

4

Flexor digitorum superficialis muscle

Flexor digitorum profundus muscle

Origins

Elbow and Forearm

Insertions

Plate 450

Attachments of Muscles of Forearm: Posterior View

Triceps brachii muscle (medial head)

Note: Attachments of intrinsic muscles of hand not shown

riceps brachii tendon Supinator

Flexor carpi ulnaris muscle (humeral origin via c o m m o n flexor tendon

Anconeus muscle

Biceps brachii muscle

Flexor carpi ulnaris muscle (ulnar origin)

Supinator muscle

Flexor digitorum profundus muscle

Abductor pollicis longus muscle Extensor carpi ulnaris muscle (ulnar origin) Pronator teres muscle Extensor pollicis longus Extensor pollicis brevis muscle Extensor indicis muscle-

Ulna

Radius

Extensor carpi radialis longus muscle

Brachioradialis muscle

Extensor carpi radialis brevis muscl Abductor pollicis longus muscle Extensor carpi ulnaris muscle

Extensor digitorum muscle (central bands)

Extensor cligiti minimi

Extensor pollicis brevis muscle

Extensor pollicis longus muscle

Extensor indicis muscle Extensor digitorum muscle (lateral bands) r

I

Plate 451

i Origins

j M i

Insertions

C a r p a i SS@mes

Anterior (palmar) view

Radius

Ulna

Radial styloid

Ulnar styloid process

Scaphoid

Lunate

Tubercle of scaphoid

Triquetrum

Trapezium

Pisiform

Tubercle of trapeziu

Hamate

Trapezoi

H o o k of hamate Capitate

Metacarpal bones

Posterior (dorsal) view Radius Dorsal tubercle of radius (Lister's)

Ulnar styloid process

Scaphoid Radial styloid process pezium Triquetrum

Trapezoid

Hamate Capitate

Metacarpal bones

Wrist and Hand

Plate 452

Movements of Wrist m

Ulna

Radius

Ulna

Radius

Lunate

Scaphoid

net rum

Capitate Trapezoid

Lunate

Tra

Pisiform Capitate Hamate Trapezoid

Sesamoid bo Pisiform

Trapezium

Hamate

Metacarpal bones

Metacarpal bones Sesamoid bones

Position of carpal bones w i t h hand in abduction: anterior (palmar) view

Position of carpal bones w i t h hand in adduction: anterior (palmar) view Wrist (radiocarpal) joint

Radius

Radius

Midcarpal joint Carpometacarpal joint

Wrist (radiocarpal) nt

. Palm

Articular disc of wrist joint Lunate Midcarpal oint

H a n d in flexion

Capitate Carpometacarpal joint

Wrist (radiocarpal) joint

3rd metacarpal bone

Midcarpal joint Carpometacarpal joint

Dorsum Hand in anatomical position

Sagittal sections through wrist and middle finger

Plate 453

Hand in extension

Carpal tunnel: palmar view

Ulna Interosseous m e m b r a n e

Palmaris longus t e n d o n Palmar carpal ligament (thickening of deep antebrachial fascia) [cut and reflected)

Ulnar artery and nerve Flexor carpi ulnaris t e n d o n

Radial artery and superficial palmar branch

Flexor digitorum profundus tendons

Flexor carpi radialis t e n d o n

Flexor d i g i t o r u m superficialis tendons

Flexor pollicis longus t e n d o n

Pisiform

M e d i a n nerve

Deep palmar branch of ulnar artery and deep branch of ulnar nerve

Palmar aponeurosis Tubercle of scaphoid

H o o k of hamate

Tubercle of trapezium Flexor retinaculum (transverse carpal ligament)

Metacarpal bones

Flexor retinaculum removed: palmar view

Short radiolunate ligamentPalmar radiolunate ligament

Long radiolunate ligament

Ulnolunate ligament

Radioscaphocapitate ligament

Ulnocapitate ligament Scaphotrapeziotrapezoid ligament

Ulnotriquetral ligament

Scaphocapitate ligment

Lunotriquetral ligament

Trapeziotrapezoid ligament

Triquetrohamate ligament Triquetrocapitate ligament

Capitohamate ligament Trapeziocapitate ligament

1

Metacarpal bones

Wrist asrad Hainsd

Plate 454

Ligaments of Wrist (continued)

Posterior (dorsal) view Dorsal radial metaphyseal arcuate ligament Dorsal radiocarpal ligament Dorsal radioulnar ligament Ulnotriquetral ligament (dorsal view)

Scapholunate ligament

Triquetrohamate ligament

Trapeziotrapezoid ligament

Dorsal intercarpal ligament Trapeziocapitate ligament

Capitohamate ligament

Metacarpal bones

Coronal section: dorsal view Ulna

Radius «

Distal radioulnar joint

Lunate

Articular disc of wrist joint

Wrist (radiocarpal) joint

Meniscus

Scaphoid Midcarpal joint

Interosseous intercarpal ligaments

Trapezoid

Triquetrum

Trapezium

Hamate

Carpometacarpal joint

Capitate

Intermetacarpal joints

Metacarpal bones

Plate 455

Wrist aind Hand

Bones of Wrist and Hand

Carpal bones

Scaphoid and Tubercle

Lunate Triquetrum Pisiform

Trapezium and Tubercle

L

itate

Carpal bones

7

Hamate and Hook

Trapezoid

Base Shafts Head

Sesamoid bones

Base Shafts Head Base | Shafts V Head J

Metacarpal bones y '

Right hand: anterior (palmar) view

Proximal phalanges

M i d d l e phalanges

Base Shafts Tuberosity Head

L [

Distal phalanges

Lunate

Carpal bones

Scaphoid Capitate Trapezoid Carpal bones

Metacarpal bones

Proximal phalanges Right hand: posterior (dorsal) view M i d d l e phalanges

Distal phalanges

WsrSsf audi Haoid]


.

Midpalmar space Palmar aponeurosis

forming canals Profundus and superficialis flexor tendons to 3rd digit Septum b e t w e e n midpalmar and thenar spaces

Thenar space

C o m m o n palmar digita. artery and nerve

Flexor pollicis longus t e n d o n in t e n d o n sheath (radial bursa)

Lumbrical muscle in its fascial sheath

Extensor pollicis longus tendon

Flexor tendons to 5th digit in c o m m o n flexoi sheath (ulnar bursa H y p o t h e n a r muscles Dorsal interosseous fascia Dorsal subaponeurotic space Dorsal fascia of hand Dorsal subcutaneous space

Wrist and Hand

A d d u c t o r pollicis muscle Palmar interosseous fascia Palmar interosseous muscles Dorsal interosseous muscles Extensor tendons

Plate 462

Lumbrical Muscles and Bursae, Spaces, and Sheaths: Schema Usual arrangement

C o m m o n variation

Tendinous sheath of flexor pollicis longus (radial bursa) Intermediate bursa (communication between c o m m o n flexor sheath [ulnar bursa] and tendinous sheath of flexor pollicis longus [radial bursa])

C o m m o n flexor sheath (ulnar bursa) Thenar space Midpalmar space

Lumbrical muscles (in fascial sheaths) (Synovial) tendon sheaths of fingers

Lumbrical muscles: schema

Flexor digitorum profundus tendons

1st and 2nd lumbrical muscles (unipennate)

Camper chiasm

3rd and 4th lumbrical muscles (bipennate)

Flexor digitorum superficialis tendons (cut)

Note: Flexor digitorum superficialis and profundus tendons encased in synovial sheaths are b o u n d to phalanges by fibrous digital sheaths made up of alternating strong annular (A) and weaker cruciform (C) parts (pulleys). Tendons of flexor digitorum superficialis and profu muscles

(Synovial) tendon sheath

Plate 463

Wrist and Hand

Flexor and Extensor Tendons in Fingers

Insertion of central band of extensor t e n d o n t o base of middle phalanx Slips of long extensor t e n d o n t o lateral bands

Triangular aponeurosis

Posterior (dorsal) view

Extensor expansion (hood)

Interosseous muscles

Long extensor tendon

Metacarpal b o n e

BBS!

Insertion on extensor tendon to base of distal phalanx Lateral bands

Interosseous t e n d o n slip to lateral band Lumbrical muscle

Extensor expansion (hood)

Lateral band

Insertion of extensor t e n d o n to base of middle phalanx

Part of interosseous t e n d o n passes to base of proximal phalanx and joint capsule

Long extensor t e n d o n

Central band

Insertion of extensor t e n d o n to base of distal phalanx

Metacarpal b o n e

Finger in extension: lateral view Collateral ligaments'

Vinculum breve

Vincula longa

Flexor d i g i t o r u m profundus t e n d o n Flexor digitorum superficialis t e n d o n

Interosseous muscles Lumbrical muscle

Collateral ligament Insertion of small deep slip of extensor tendon to proximal phalanx and j o i n t capsule

Extensor t e n d o n

A t t a c h m e n t of interosseous muscle to base of proximal phalanx and j o i n t capsule

Interosseous muscles Insertion of lumbrical muscle to extensor t e n d o n

m superficialis t e n d o n (cut)

Lumbrical muscle

Collateral ligaments

Finger in flexion: lateral view

Flexor d i g i t o r u m profundus t e n d o n (cut) Palmar ligament (plate)

C/feit/tadL / Af.p.

Wrist and Hand

Note: Black arrows indicate pull of long extensor tendon; red arrows indicate pull of interosseous and lumbrical muscles; dots indicate axis of rotation of joints

Plate 464

Radial artery and palmar carpal branch

Pronator quadratus muscle

Radius

Ulnar nerve Ulnar artery and palmar carpal branch

Superficial palmar branch of radial

Flexor carpi ulnaris t e n d o n

Flexor retinaculum (transverse carpal ligament) ( r e f l e c t e d )

Palmar carpal arterial arch Pisiform

O p p o n e n s pollicis muscle

M e d i a n nerve

Branches of median nerve to thenar muscles and to 1st and 2 n d lumbrical muscles

A b d u c t o r digiti minimi muscle (cut) Deep palmar branch of ulnar artery and deep branch of ulnar nerve

A b d u c t o r pollicis brevis muscle {cut)

Flexor digiti m i n i m i brevis muscle (cut)

Flexor pollicis brevis muscle

O p p o n e n s digiti m i n i m i muscle D e e p palmar (arterial) arch

A d d u c t o r pollicis muscle

Palmar metacarpal arteries C o m m o n palmar digital arteries

1 st dorsal interosseous muscle

D e e p transverse metacarpal ligaments

Branches from deep branch of ulnar nerve lo 3rd and 4th lumbrical muscles and to all interosseous muscles Lumbrical muscles

(reflected)

Anterior (palmar) view

Radius

Palmar interosseous muscles (unipennate)

Radius

Deep transverse metacarpal ligaments

Radial artery

A b d u c t o r digiti minimi muscle

A b d u c t o r pollicis brevis muscle

Dorsal interosseous muscles (bipennate)

Posterior (dorsal) view

Anterior (palmar) view

Tendinous slips to extensor expansions (hoods)

*.—w.

Note: A r r o w s indicate action of muscles.

Plate 465

Arteries and Nerves of Hand: Palmar Views mm

Radial artery

Ulnar artery and nerve

Median nerve and palmar branch Superficial palmar branch of radial artery

Palmar carpal ligament (continuous with extensor retinaculum) Flexor retinaculum (transverse carpal ligament)

A b d u c t o r pollicis brevis muscle (cut)

Deep palmar branch of ulnar artery and deep branch of ulnar nerve

O p p o n e n s pollicis muscle

Superficial branch of ulnar nerve

Flexor pollicis brevis muscle

C o m m o n flexor sheath (ulnar bursa)

Recurrent (motor) branch of median nerve to thenar muscles-"""

Superficial palmar (arterial) arch

Proper digital nerves and arteries to t h u m b

C o m m o n palmar digital nerves and arteries C o m m u n i c a t i n g branch of median nerve with ulnar nerve

A d d u c t o r pollicis muscle

Proper palmar digital nerves and arteries

Branches of median nerve to 1st and 2nd lumbrical muscles Flexor tendons, synovial and fibrous sheaths

Branches of proper palmar digital nerves and arteries to dorsum of middle and distal phalanges

Ulnar artery and nerve Radial artery

Palmar carpal branches of radial and ulnar arteries

Median nerve

Pisiform

Superficial palmar branch of radial Deep palmar (arterial) arch and deep branch of ulnar nerve Princeps pollicis artery

Deep palmar branch of ulnar artery and deep branch of ulnar nerve Branches to hypothenar muscles Superficial branch of ulnar nerve

Proper digital arteries and nerves of thumb

H o o k of hamate Distal limit of superficial palmar arch Radialis indicis a Palmar metacarpal arteries C o m m o n palmar digital arteri Proper palmar digital arteri Proper palmar digital nerves f r o m median nerve-

Wrist arad HawcO

Deep palmar branch of ulnar nerve to 3rd and 4lh lumbrical, all interosseous, adductor pollicis, and deep head of flexor pollicis brevis muscles mmunicating branch of median nerve with ulnar nerve Proper palmar digital nerves from ulnar nerve

Wrist and Hand: Superficial Radial Dissection

Lateral (radial) view Superficial branch of radial nerve Medial branch

Extensor retinaculum

Lateral branch Dorsal digital branches of radial nerve

Dorsal carpal branch of radial artery

Scaphoid Radial artery in anatomical snuffbox

Extensor carpi radialis brevis tendon

ium

Extensor carpi radialis longus tendon

Insertion of abductor pollicis longus t e n d o n

1 st metacarpal bone Radial artery 1st dorsal interosseous muscle

Insertion of extensor pollicis brevis tendon

Insertion of extensor pollicis longus tendon Deep fascia (cut)

Fracture of middle third (waist) of scaphoid (most common)

Plate 467

Wrist and Hand

Wrist and Hand: Superficial Dorsal Dissection

Posterior (dorsal) view Posterior antebrachial cutaneous nerve (from radial nerve) Cephalic vein Superficial branch of radial nerve Extensor retinaculum (thickening of posterior antebrachial fascia) C o m m u n i c a t i n g branches of radial and ulnar nerves Basilic vein Dorsal branch of ulnar nerve Dorsal venous network of hand Dorsal metacarpal veins

Probe in dorsal subaponeurotic space (between opened dorsal fascia of hand and dorsal interosseous fascia) Intercapitular veins

Dorsal digital nerves and veins

Dorsal branches of proper palmar digital nerves

Note: Lymphatic pathways shown in black; arrows indicate direction of drainage

Wrist amdl Hand

6

Wrist and Hand: Deep Dorsal Dissection MMMM

m

Medial antebrachial cutaneous nerve

Lateral antebrachial cutaneous nerve (terminal part of musculocutaneous nerve)

Posterior antebrachial cutaneous nerve (branch of radial nerve)

Superficial branch of radial nerve Extensor digitorum, extensor digiti minimi, and extensor indicis tendons (cut)

Extensor retinaculum Radial artery in anatomical snuffbox Dorsal branch of ulnar nerve A b d u c t o r pollicis longus tendon Dorsal carpal branch of ulnar artery Extensor carpi ulnaris tendon

Extensor pollicis brevis tendon Extensor pollicis longus tendon Extensor carpi radialis longus tendon Extensor carpi radialis brevis tendon

Dorsal carpal (arterial) arch Dorsal metacarpal arteries

Dorsal digital arteries

Dorsal digital branches of dorsal branch of ulnar nerve

Dorsal digital branches of superficial branch of radial nerve to 1st, 2nd, 3rd, and radial half of 4lh fingers Dorsal branches of proper palmar digital branches of ulnar nerve and of proper palmar digital arteries to dorsum of middle and distal phalanges of 5th and ulnar half of 4th fingers

Dorsal branches of proper palmar digital branches of median nerve and of proper palmar digital arteries to dorsum of middle and distal phalanges of 2nd, 3rd, and radial half of 5th fingers

Wrist and Hand

Posterior (dorsal) view Extensor carpi ulnaris - C o m p a r t m e n t 6

Extensor digitorum Extensor indicis

I ) \

^ Compartment 4

Extensor pollicis longus - C o m p a r t m e n t 3 Extensor carpi radialis brevis ) . . . . . . ( Compartment 2 Extensor carpi radialis longus ) Abductor pollicis longus )

Plane of cross section shown below

Extensor pollicis brevis

)

^ Compartment 1

Extensor retinaculum

Radial artery in anatomical snuffbox

Abductor digiti minimi muscle

Dorsal interosseous muscles

I n terte n d i n o us co n necti o n s

Transverse fibers of extensor expansions (hoods)

Cross section of most distal portion of forearm Extensor retinaculum Extensor pollicis longus - C o m p a r t m e n t 3 C o m p a r t m e n t 4 \ Extensor digitorum and 1 / extensor mdici

Extensor carpi radialis brevis

\ Extensor Compartment 5 ^ digiti minimi

Extensor carpi radialis longus

Compartment 2

Extensor pollicis brevis

Extensor C o m p a r t m e n t 6 ^ carpi ulnaris

Abductor pollicis longus

Compartment 1

Radius

Wrist and Hand

Plate 47©

Epiphysis Nail matrix

Synovial membrane Articular cartilage

Lateral band / Extensor Central tendon \ mechanism

Middle phalanx

Nail root Eponychium (c uti cle)

Sagittal section

un ule Na

bed

Flexor digitorum superficialis tendon

Bodv of nail

Distal phalanx Fibrous tendon sheath of finger Synovial (flexor tendon) sheath of finger Nerves

Flexor digitorum profundus tendon

Arteries

Palmar ligament (plate) Distal anterior closed space (pulp)

Articular cavitv Body of nail

Cross section through distal phalanx

Subungual space

Nail bed

M i n u t e arteries -

Distal phalanx

Fine nerves

Fibrous septa and areolar tissue in anterior closed space (pulp)

Dorsal digital artery and nerve

Dorsal branches of proper palmar digital arteries and nerves to dorsum of middle and terminal phala

Arteries and nerves

Nutrient branches to metaphysis

Plate 471

Proper palmar digital artery to neighboring digit Proper palmar digital artery and nerve

Cutaneous Innervation of Wrist and Hand

Anterior (palmar) view Lateral antebrachial cutaneous nerve

Musculocutaneous nerve

Radial nerve

J |

M e d i a l antebrachial cutaneous nerve

Superficial branch

Palmar branch

Ulnar nerve

Palmar digital branches

Median nerve

/

Palmar branch

Posterior (dorsal) view

Palmar digital branches

V I '

M e d i a l antebrachia cutaneous nerve ^ Division between ulnar and radial nerve innervation on dorsum of hand is variable.

Lateral antebrachial cutaneous nerve

i

f

v.

>

Musculocutaneous nerve

Posterior antebrachial cutaneous nerve

aiiiliiii:! Radial nerve

Slllsli Dorsal branch and dorsal digital branches Ulnar nerve

Superficial branch and dorsal digital branches




Talus

Neck Head

Cuboid Tuberosity of 5th metatarsal bone

Posterior process

Navicular Tuberosity Lateral Intermediate Medial

C u n e i f o r m bones

Tarsometatarsal joint Base

Plantar view

Shaft (body)

Lateral tubercle

Phalanges Proximal

Head

Middle Distal

Medial tubercle

Talus

Base

Posterior process

Shaft (body)

Head

Head

Transverse tarsal joint

Base

Navicular Tuberosity

.uberosity C u n e i f o r m bones

Lateral Intermediate Medial

Calcaneus Tuberosity Medial process Lateral process Sustentaculum tali Groove for tendon of flexor hallucis longus Fibular (peroneal) trochlea Cuboid Tuberosity Groove for fibularis (peroneus) longus tendon Tuberosity of 5 th metatarsal bone

Tarsometatarsal joint Shaft (body) Metatarsal bones .,. f Medial Sesamoid bones j ^ ^

c

Proximal Phalanges -


Calcaneus

Sustentaculum tali

Plate 524

Ankle and Foot

Calcaneus

Right f o o t

Posterior talar articular surface

Articular surface for cuboid bone

Anterior talar articular surface

Middle talar articular surface Anterior talar articular surface

Middle talar articular surface Articular surface for cuboid bone /

f" 1 1

Tuberosity Lateral process of tuberosity

^Fibular (peroneal) trochlea

Fibular (peroneal) trochlea

Sustentaculum tali

Groove for fibularis (peroneus) longus tendon Lateral view

Anterior talar articular surface

1

Posterior talar articular surface

Calcaneal sulcus

M i d d l e talar articular surface

Tuberosity

Posterior talar articular surface

Superior view

M i d d l e talar articular surface

Articular surface for c u b o i d bone

Tuberosity

Posterior talar articular surface

Sustentaculum tali

Sustentaculum tali

Groove for tendon of flexor hallucis longus

Medial process of tuberositv

M e d i a l view

Fibula Interosseous membrane Posterior tibiofibular ligament

Medial (deltoid) ligament of ankle-

Posterior talocalcaneal ligament

Groove for tendon of flexor hallucis l o n g u s Medial process of tuberosity

Fibular (peroneal) trochlea j' r

Lateral process of tuberosity

Tuberosity Posterior view

Posterior talofibular ligament Calcaneofibular ligament Fibular (peroneal) tendons in inferior fibular (peroneal) retinaculum Critical Posterior view with ligaments

angle

^^-Ji

Functional relations of calcaneus

7

Ankle: Radiographs

Lateral view

c CB F HT LC N PT ST T TC TM TT

Anterior view F LM MM T TA

Fibula Lateral malleolus Medial malleolus Tibia Talus

Calcaneus Cuboid Fibula Head of talus Lateral cuneiform Navicular Posterior process of talus Sustentaculum tali of calcaneus Tibia Tuberosity of calcaneus Tuberosity of 5th metatarsal Trochlea of talus

Ligaments and Tendons of Ankle

Right foot: lateral view

i Posterior talofibular ligament ) Components of lateral Calcaneofibular ligament > (collateral) ligament Anterior talofibular ligament \ of ankle

Fibula Anterior and Posterior tibiofibular ligaments

Interosseous talocalcaneal ligament Dorsal talonavicular ligament Calcaneonavicular ligament

(

caneocuboid ligament

J

__ Blfurcate

h

^ament

Dorsal cuboideonavicular ligament

Superior fibular (peroneal) retinaculum

Dorsal cuneonavicular ligaments Dorsal intercuneiform ligaments Dorsal tarsometatarsal ligaments

Calcaneal (Achilles) tendon (cut)

Inferior fibular (peroneal) retinaculum

Dorsal metatarsal ligaments

Lateral talocalcaneal ligament

Dorsal c u n e o c u b o i d ligament

Long plantar ligament

Cuboid bone

Fibularis (peroneus) longus

Dorsal calcaneocuboid ligament

Fibularis (peroneus) brevis Right foot: medial view

Posterior tibiotalar part Medial (deltoid) ligament of ankle )

Medial talocalcaneal ligament

Tibiocalcaneal part Tibionavicular part Anterior tibiotalar part

Posterior process of talus

Dorsal talonavicular ligament Posterior talocalcaneal igament

Navicular bone Dorsal cuneonavicular ligaments Medial cuneiform bone

Calcaneal (Achilles) tendon (cut)

Dorsal intercuneiform ligament Dorsal tarsometatarsal ligaments

u ...

1st metatarsal bone Tuberosity

ii i

^

J

j ,

•;

^y^i

Tibialis anterior tendon Tibialis posterior tendon

„

Short plantar ligament Plantar calcaneonavicular (spring) ligament

Sustentaculum tali ^ L o n g plantar ligament

7

7

Ligaments and Tendons of Foot: Plantar View

Flexor digitorum longus tendon to 2nd toe [cut)

Distal phalanx of great toe

Flexor digitorum brevis tendon to 2nd toe (cut)

nterphalangeal (IP) joint

4th distal phalanx

Flexor hallucis longus tendon (cut)

4th middle phalanx

Proximal phalanx of great toe

Deep transverse metatarsal ligaments Metatarsophalangeal (MP) joint

5th proximal phalanx

Sesamoid bones

4th lumbrical tendon (cut)

A b d u c t o r hallucis and medial head of flexor hallucis brevis tendons (cut)

A b d u c t o r digiti minimi and flexor digiti minimi brevis tendons (cut)

Adductor hallucis and lateral head of flexor hallucis brevis tendons (cut)

Plantar ligaments (plates) Interosseous muscles (cut)

1 st metatarsal bone

5th metatarsal bone

Plantar tarsometatarsal ligaments

Plantar metatarsal ligaments

Medial cuneiform bone

Tuberosity of 5th metatarsal bone

Tibialis anterior tendon (cut)

Fibularis (peroneus) brevis tendon

Plantar cuneonavicular ligament

Cuboid bone

Plantar cuboideonavicular ligament

Fibularis (peroneus) longus t e n d o n

Tuberosity of navicular bone Plantar calcaneonavicular (spring) ligament

Tuberosity of cuboid bone Long plantar ligament

Tibialis posterior tendon

Plantar calcaneocuboid (short plantar) ligament

Flexor digitorum longus tendon (cut) Sustentaculum tali

Calcaneus

Flexor hallucis longus tendon (cut)

Medial process and Lateral process of Tuberosity of calcaneus

Posterior process of talus (medial and lateral tubercles)

Phalanges A

Joint capsule Metatarsal bone

Distal Capsules and ligaments of metatarsophalangeal a n d interphalangeal joints: lateral view

Collateral ligaments

Plantar ligament (plate)

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Lateral view

Soleus muscle

Extensor digitorum longus muscle

Fibularis (peroneus) longus muscle

Superior extensor retinaculum /Tendinous sheath of tibialis anterior

Fibularis (peroneus) brevis muscle

Lateral malleolus and subcutaneous bursa

Calcaneal (Achilles) tendon

Inferior extensor retinaculum

C o m m o n tendinous sheath of fibularis (peroneus) longus and brevis

Tendinous sheath of extensor digitorum longus and fibularis (peroneal) tertius Tendinous sheath of extensor hallucis longus

Subcutaneous calcaneal bursa (Subtendinous) bursa of calcaneal tendon Superior and Inferior fibular (peroneal) retinacula Calcaneus Extensor digitorum brevis muscle

Fibularis (peroneus) longus tendon

A b d u c t o r digiti minimi muscle

M e d i a l view

Tibialis anterior tendon and sheath Tibia Sheath of tibialis posterior tendon Superior extensor retinaculum Medial malleolus and subcutaneous bursa Inferior extensor retinaculum Tibialis posterior tendon and sheath Tibialis anterior t e n d o n and sheath

Fibularis (peroneus) brevis tendon

Fibularis (peroneus) tertius tendon Tuberosity of 5th metatarsal bone

Calcaneal (Achilles) tendon Tendinous sheath of flexor digitorum longus Posterior tibial artery and tibial nerve Tendinous sheath of flexor hallucis longus Subcutaneous calcaneal bursa

Tendinous sheath of extensor hallucis longus

(Subtendinous) bursa of calcaneal tendon Flexor retinaculum Calcaneus Lateral plantar nerve Medial plantar nerve Tendinous sheath of flexor digitorum longus

A b d u c t o r hallucis muscle {cut) Plantar aponeurosis (cut) Flexor digitorum brevis muscle (cut)

7

Muscles of Dorsum of Foot: Superficial Dissection

Superficial fibular (peroneal) nerve (cut) Fibularis (peroneus) brevis muscle Fibularis (peroneus) longus tendo Extensor digitorum longus muscle and tendon Superior extensor retinaculum Fibula Perforating branch of fibular (peroneal) artery Lateral malleolus and anterior lateral malleolar artery Inferior extensor retinaculum Lateral tarsal artery and lateral branch of deep peroneal nerve (to muscles of dorsum of foot)

bialis anterior tendon Anterior tibial artery and deep fibular (peroneal) nerve Tibia Extensor hallucis longus tendon Tendinous sheath of extensor digitorum longus Medial malleolus Tendinous sheath of tibialis anterior Tendinous sheath of extensor hallucis longus terior medial malleolar artery Dorsalis pedis artery and medial branch of deep fibular (peroneal) nerve Medial tarsal artery

Fibularis (peroneus) brevis tendon Arcuate artery Tuberosity of 5th metatarsal bone Fibularis (peroneus) tertius tend Extensor digitorum brevis and extensor hallucis brevis muscles Extensor digitorum longus tend Lateral dorsal cutaneous nerve (continuation of sural nerve) (cut) Dorsal metatarsal arteries Dorsal digital arteries Dorsal branches of proper plantar digital arteries and nerves —

Deep plantar artery passing between heads of 1 st dorsal interosseous muscle to join deep plantar arch Extensor hallucis longus tendon Extensor expansions

Dorsal digital branches of deep fibular (peroneal) nerve

Dorsal digital branches of superficial fibular (peroneal) nerve

Dorsum of Foot: Deep Dissection

Superficial fibular (peroneal) nerve (cut) Fibularis (peroneus) longus tendon Fibularis (peroneus) brevis muscle and tendon Extensor digitorum longus muscle and t e n d o n Fibula Perforating branch of fibular (peroneal) artery Anterior lateral malleolar artery Lateral malleol Lateral branch of deep peroneal nerve (to muscles of dorsum of foot) and lateral tarsal artery Fibularis (peroneus) longus tendon (cut)

Soleus muscle Tibialis anterior muscle and tendon bia nterior tibial artery and deep fibular (peroneal) nerve Extensor hallucis longus muscle and tendon terior medial malleolar artery Medial malleolus Dorsalis pedis artery Medial branch of deep fibular (peroneal) nerve Medial tarsal arteries Tuberosity of navicular bone /

Extensor digitorum brevis and extensor hallucis brevis muscles (cut) Fibularis (peroneus) brevis tendon (cu Fibularis (peroneus) tertius tendon (cut) A b d u c t o r digiti minimi muscle Dorsal metatarsal arteries

Arcuate artery Posterior perforating branches deep plantar arch Deep plantar artery to deep plantar arch uctor hallucis muscle Extensor hallucis longus tendon

Metatarsal bones Dorsal interosseous muscles Lateral dorsal cutaneous nerve (continuation of sural nerve) (cut) Anterior perforating branches from plantar metatarsal arteries Dorsal digital arteries — Dorsal branches of proper plantar digital arteries and nerves

Extensor hallucis brevis tendon (cut) Extensor digitorum brevis tendons (cut) Extensor digitorum longus tendons (cut) Extensor expansions Dorsal digital branches of deep fibular (peroneal) nerve Dorsal digital branches of superficial fibular (peroneal) nerve

7

7

Sole of Foot: Superficial Dissection

Superficial transverse metatarsal ligaments-

Proper plantar digital arteries and nerves

Superficial branch of medial plantar artery

Transverse fasciculi

Digital slips of plantar aponeurosis

Lateral plantar fascia

Medial plantar fascia

Cutaneous branches of lateral plantar artery and nerve Cutaneous branches of medial plantar artery and nerve

Lateral band of plantar aponeurosis (calcaneometatarsal ligament)

Plantar aponeurosis

Medial calcaneal branches of tibial nerve and posterior tibial artery Tuberosity of calcaneus w i t h overlying fat pad (partially cut away)

Muscles of Sole of Foot: First Layer

Proper plantar digital branches of medial plantar nerve

Proper plantar digital branches of lateral plantar nerve Proper plantar digital arteries

C o m m o n plantar digital arteries from plantar metatarsal arteries

Lumbrical muscles Fibrous sheaths of flexor tendons

Flexor digitorum brevis overlying Flexor digitorum longus tendons

Superficial branch of medial plantar artery

Lateral head and Medial head of flexor hallucis brevis muscle

Flexor hallucis longus tendon Plantar metatarsal branch of lateral plantar artery

Abductor hallucis muscle and tendon

Flexor digitorum brevis muscle

Abductor digiti minimi muscle (deep to lateral plantar fascia)

Plantar aponeurosis (cut) Medial process and Lateral process of Tuberosity of calcaneus

Medial calcaneal branches of tibial nerve and posterior tibial artery

7

7

Muscles of Sole of Foot: Second Layer

Proper plantar digital branches of medial plantar nerve

Flexor digitorum longus tendons Proper plantar digital branches of lateral plantar nerve

Flexor digitorum brevis tendons Fibrous sheaths (opened) Sesamoid bones C o m m o n plantar digital nerves and arteries Lumbrical muscles

Flexor digiti minimi brevis muscle

Lateral head and Medial head of flexor hallucis brevis muscle Flexor hallucis longus tendon

Superficial branch and Deep branch of lateral plantar nerve

Lateral plantar nerve and artery

uctor hallucis tendon and muscle {cut) Flexor digitorum longus tendon

Superficial and deep branches of medial plantar artery Medial plantar artery and nerve

Quadratus plantae muscle

Tibialis posterior tendon Flexor hallucis longus tendon

Nerve to abductor digiti minimi mu (from lateral plantar nerve)

Posterior tibial artery and tibial nerve (dividing) Flexor retinaculum

Flexor digitorum brevis muscle and plantar aponeurosis (cut)

Lateral calcaneal nerve and artery (from sural nerve and fibular [peroneal] artery

A b d u c t o r hallucis muscle (cut) Medial calcaneal artery and nerve Tuberosity of calcaneus

Muscles of Sole of Fool: Third Layer

Proper plantar digital branches of medial plantar nerve

Proper plantar digital branches of lateral plantar nerve Proper plantar digital branch of superficial branch of medial plantar artery Anterior perforating arteries to dorsal metatarsal arteries Tendons of lumbrical muscles (cut) Sesamoid bones Flexor digitorum longus tendons

Transverse head and Oblique head of adductor hallucis muscle

Flexor d i g i t o r u m brevis tendons {cut)

Medial head and Lateral head of flexor hallucis brevis muscle

Flexor digiti minimi brevis muscle

Plantar metatarsal arteries

Superficial branches of medial plantar artery and nerve

Plantar interosseous muscles

Flexor hallucis longus t e n d o n (cut)

Superficial branch of lateral plantar nerve

A b d u c t o r hallucis muscle (cut)

Deep plantar arterial arch and deep branches of lateral plantar nerve

Deep branches of medial plantar artery and nerve

Tuberosity of 5th metatarsal b o n e

Flexor d i g i t o r u m longus t e n d o n (cut) Tibialis posterior t e n d o n

Peroneus brevis t e n d o n

Medial plantar artery and nerve

Peroneus longus t e n d o n and fibrous sheath

Flexor hallucis longus t e n d o n Quadratus plantae muscle (cut and slightly retracted)

Flexor retinaculum A b d u c t o r hallucis muscle (cut)

Lateral plantar artery and nerve A b d u c t o r digiti minimi muscle (cut) Lateral calcaneal artery and nerve Tuberosity of calcaneus

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Flexor digitorum brevis muscle and plantar aponeurosis (cut) M e d i a l calcaneal artery and nerve

7

Interosseous Muscles and Deep Arteries of Foot

Dorsal view

Fibularis (peroneus) longus tendon (cut) Fibularis (peroneus) brevis tendon (cut) Cuboid bone Lateral tarsal artery Tuberosity of 5th metatarsal bone Fibularis (peroneus) tertius tendon (cut) Posterior perforating branches (from deep plantar arterial arch) Dorsal metatarsal arteries Extensor digitorum longus tendons (cu

Navicular bone Dorsalis pedis artery Medial tarsal artery Lateral ) Intermediate / Cuneiform bones Medial ) Dorsal tarsometatarsal ligaments Dorsal metatarsal ligaments artery Deep plantar artery passes to contribute to deep plantar arch interosseous muscles

Metatarsal bones

Extensor expansions Anterior perforating branches (from plantar metatarsal arteries)

Extensor hallucis longus tendon (cut) Extensor digitorum brevis and extensor hallucis brevis tendons (cut)

Dorsal digital arteries

Plantar view

Proper plantar digital arteries C o m m o n plantar digital arteries Lumbrical muscles (cut) Deep transverse metatarsal ligament and plantar ligaments (plates) Interosseous muscles

Plantar Dorsal

A b d u c t o r digiti minimi muscles Plantar metatarsal arteries Flexor digiti minimi brevis muscle Deep plantar arch Lateral plantar artery (cut) Tuberosity of 5th metatarsal bone Fibularis (peroneus) longus tendon Fibularis (peroneus) brevis tendon Tuberosity of cuboid bone Long plantar li Calcaneocuboid (short plantar) ligament

Flexor hallucis longus tendon (cut) Anterior perforating branches (to dorsal metatarsal arteries) Sesamoid bones Insertion of adductor hallucis and lateral head of flexor hallucis brevis muscles (cut) Insertion of abductor hallucis and medial head of flexor hallucis brevis muscles (cut) Medial origin of flexor hallucis brevis muscle (cut) Deep plantar artery (from dorsalis pedis artery) Posterior perforating branches (to dorsal metatarsal arteries) Plantar metatarsal ligaments (between bases of metatarsal bones) Medial cuneiform bone bialis anterior tendon (cut) Lateral origin of flexor hallucis brevis tendon (cut) berosity of navicular bone Tibialis posterior tendon (cut) Plantar calcaneonavicular (spring) ligament

Interosseous Muscles of Foot

Dorsal view

Cuboid Tuberosity of 5th metatarsal b o n e

Navicular

Lateral Intermediate > C u n e i f o r m bones Medial

Dorsal interosseous muscles (bipennate)

5th metatarsal b o n e

I Proximal phalanx Little \ (5th) < M i d d l e phalanx toe / ( Distal phalanx

1 st metatarsal b o n e

Proximal phalanx of great toe

Distal phalanx of great toe

Plantar view

Distal phalanx of great toe

Proximal phalanx of great toe Distal phalanx

Sesamoid bones

M i d d l e phalanx Proximal phalanx

1 st metatarsal b o n e Plantar interosseous muscles (unipennate)

5th metatarsal bo

Lateral / Intermediate / Medial \

Tuberosity of 5th metatarsal b o n e Cuboid

Navicular

C u n e i f o r m bones

7

Femoral Nerve and Lateral Femoral Cutaneous Nerve

Lateral femoral cutaneous nerve (L2, 3) Femoral nerve (12, 3, 4)

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Lumbar plexus

O b t u r a t o r nerve Lumbosacral trunk lliacus muscle Psoas major muscle (lower pa Articular branch Sartorius muscle (cut and reflected) Pectineus muscle

Rectus femoris muscle (cut and reflected) Quadriceps femoris -< muscle

Vastus intermedius muscle

Lateral femoral cutaneous nerve

Anterior cutaneous branches of femoral nerve Sartorius muscle (cut and reflected)

Vastus meclialis muscle Vastus lateralis muscle

Saphenous nerve

Articularis genus muscle

Infrapatellar branch of saphenous nerve

Note: O n l y muscles innervated by femoral nerve shown

Medial crural cutaneous nerves (branches of saphenous nerve)

Cutaneous innervation

7

Obturator Nerve

Iliohypogastric nerve >• Lumbar plexus Ilioinguinal nerve

Genitofemoral nerve

Lumbosacral trunk

Lateral femoral cutaneous nerve

Femoral nerve Obturator externus muscle

Obturator nerve (L2, 3, 4)

Posterior branch

Articular branch A d d u c t o r brevis muscle Anterior branch

A d d u c t o r longus muscle (cut) \

A d d u c t o r magnus muscle (ischiocondylar, or hamstrings/' part supplied by sciatic [tibial! nerve)

Posterior branch

Cutaneous branch

V

I

Gracilis muscle

A

Articular branch to knee joint

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A d d u c t o r hiatus

Note: Only muscles innervated by obturator nerve shown Cutaneous innervation

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7

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Posterior femoral cutaneous nerve (SI, 2 , 3 )

Greater sciatic foramen Inferior clunial nerves Sciatic nerve (L4, 5, SI, 2, 3)

Perineal branches

C o m m o n fibular (peroneal) division of sciatic nerve

Tibial division of sciatic nerve

Long head (cut) of biceps femoris muscle

Short head of biceps femoris muscle

Adductor magnus muscle (also partially supplied by obturator nerve)

^ , • Cutaneous innervation

Long head (cut) of biceps femoris muscle

Semitendinosus muscle

Semimembranosus muscle

Tibial nerve

Common fibular (peroneal) nerve

Articular branch

Posterior femoral cutaneous nerve

Articular branch

Plantaris muscle

Medial sural cutaneous nerve

Lateral sural cutaneous nerve

Sural communicating branch

Gastrocnemius muscle

Sural nerve

Soleus muscle

Medial sural cutaneous nerve From sciatic nerve

Tibial nerve

Medial calcaneal branches

Medial and lateral plantar nerves

C o m m o n fibular (peroneal) nerve via lateral sural cutaneous nerve

Superficial fibular (peroneal) nerve Sural nerve

Lateral calcaneal branches

Lateral dorsal cutaneous nerve

Tibial nerve via medial calcaneal branches

Tibial Nerve

C o m m o n fibular (peroneal) nerve

Tibial nerve (L4, 5, SI, 2, 3)

Articular branch Lateral sural cutaneous nerve (cut)

Medial sural cutaneous nerve (cut)

Medial calcaneal branches (SI, 2)

Articular branches

Medial plantar nerve (L4, 5)

From tibial nerve

Plantaris muscle

Lateral plantar nerve (SI, 2)

Gastrocnemius muscle (cut)

Saphenous nerve (L3, 4) Sural nerve (SI, 2) via lateral calcaneal and lateral dorsal cutaneous branches

Nerve to popliteus muscle

Popliteus muscle

Interosseous nerve of leg

Cutaneous innervation of sole

Flexor retinaculum (cut)

Soleus muscle (cut partly retracted)

Flexor cli longus muscle

Tibialis posterior m

Flexor hallucis longus muscle

Sural nerve

Lateral calcaneal branch

Medial calcaneal branch

Flexor retinaculum (cut)

Lateral dorsal cutaneous nerve

Tibial nerve

Medial calcaneal branch Medial plantar nerve

Flexor d i g i t o r u m brevis muscle and nerve A b d u c t o r hallucis muscle and nerve Flexor hallucis brevis muscle and nerve 1st lumbrical muscle and nerve Common plantar digital nerves Proper plantar digital nerves

Lateral calcaneal branch of sural nerve Lateral plantar nerve

N e r v e to abductor digiti minimi muscle Quadratus plantae muscle and nerve A b d u c t o r digiti minimi muscle Deep branch to interosseous muscles, 2nd, 3rd, and 4th lumbrical muscles and A d d u c t o r hallucis muscle uperficial branch t o 4th interosseous muscle and Flexor digiti minimi brevis muscle

C o m m o n and Proper plantar digital nerves

Note: Articular branches not s h o w n

7

Common Fibular (Peroneal) Nerve W S V f i K y . ' - i W • sr.*

See also Plates 520, 521

C o m m o n fibular (peroneal) nerve (phantom)

Lateral sural cutaneous nerve

(phantom)

Articular branches Biceps femoris t e n d o n Recurrent articular nerve Common fibular nerve (L4, 5, SI, 2)

Extensor d i g i t o r u m longus muscle (cut)

Head of fibula Deep fibular (peroneal) nerve

Fibularis (peroneus) longus muscle (cu

bialis anterior muscle

Cutaneous innervation

Superficial fibular (peroneal) nerve

Branches of lateral sural cutaneous nerve

Fibularis (peroneus) longus muscle

Extensor d i g i t o r u m longus muscle

Extensor hallucis longus muscle

Fibularis (peroneus) brevis muscle Lateral sural cutaneous nerve

Medial dorsal cutaneous nerve

Intermediate dorsal cutaneous nerve

Inferior extensor retinaculum (partially

cut)

Lateral dorsal cutaneous nerve (branch of sural nerve)

Superficial fibular (peroneal) nerve Lateral branch of deep fibular (peroneal) nerve to Extensor hallucis brevis and Extensor d i g i t o r u m brevis muscles Medial branch of deep fibular (peroneal) nerve

Deep fibular (peroneal) nerve

Sural nerve via lateral dorsal cutaneous branch

Dermatomes of Lower Limb

Schematic demarcation of dermatomes (according to Keegan and Garrett) shown as distinct segments. There is actually considerable overlap between any t w o adjacent dermatomes. An alternative dermatome map is that provided by Foerster (see References).

Autonomous sensory zones A

SI

Anterior

Posterior view

Segmental innervation of lower limb m o v e m e n t s

Knee

Extension

Dorsiflexion

Flexion

Foot

14, 5

Ankle Flexion

Extension

Plantar flexion

7

Superficial Nerves and Veins of Lower Limb: Anterior View

Lateral cutaneous branch of subcostal nerve Superficial epigastric vein Inguinal ligament (Poupart's) Superficial circumflex iliac vein Femoral branches of genitofemoral Lateral femoral cutaneous Saphenous opening (fossa ovalis) Fascia lata

Ilioinguinal nerve (scrotal branch) (usually passes through superficial inguinal ring) Genital branch of genitofemoral nerve Femoral vein uperficial external pudendal vein Accessory saphenous vein Great saphenous vein

Anterior cutaneous branches of femoral nerve Cutaneous branches of obturator nerve

Patellar nerve plexus

Branches of lateral sural cutaneous nerve (from c o m m o n fibular [peroneal] nerve Deep fascia of leg (crural fascia)

Infrapatellar branch of saphenous nerve

Saphenous nerve (terminal branch of femoral nerve)

Great saphenous vein

Superficial fibular (peroneal) nerve Medial dorsal cutaneous branch Intermediate dorsal cutaneous branch

Small saphenous vein and lateral dorsal cutaneous nerve (from sural nerve) Lateral dorsal digital nerve and vein of 5th

Dorsal digital nerves

Dorsal venous arch

Dorsal digital nerve and vein of medial side of great toe Dorsal metatarsal veins Dorsal digital branch of deep fibular (peroneal) nerve Dorsal digital nerves and veins

Superficial Nerves and Veins of Lower Limb: Posterior View

Lateral cutaneous branch of iliohypogastric nerve Iliac crest Medial clunial nerves (from dorsal rami of S1, 2, 3)

Superior clunial nerves (from dorsal rami of LI, 2, 3) Inferior clunial nerves (from posterior femoral cutaneous nerve)

Perforating cutaneous nerve (from dorsal rami of SI, 2, 3)

Branches of posterior femoral cutaneous nerve

Branches of lateral femoral cutaneous nerve

Accessory saphenous vein

Branch of femoral cutaneous nerve Branch of cutaneous branch of femoral nerve

Terminal branches of posterior femoral cutaneous nerve

Great saphenous vein

Lateral sural cutaneous nerve (from c o m m o n fibular [peroneal] nerve)

Small saphenous vein Sural c o m m u n i c a t i n g nerve Branches of saphenous nerve — Medial sural cutaneous nerve (from tibial nerve)

Sural nerve

Lateral calcaneal branches of sural nerve

Lateral dorsal cutaneous nerve (continuation of sural nerve)

Medial calcaneal branches of tibial nerve

Plantar cutaneous branches of medial plantar nerve

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Plantar cutaneous branches of lateral plantar nerve

7

Lymph Vessels and Nodes of Lower Limb See also Plates 407, 408

Popliteal vein Popliteal lymph nodes

Cribriform fascia within saphenous opening

Horizontal group: Superolateral nodes Superomedial ^ nodes Vertical group: Inferior nodes

Superficial inguinal nodes

Fascia lata Great saphenous vein

Small saphenous vein

Superficial lymph vessels

External iliac lymph nodes

Deep fascia of leg (crural fascia) Femoral nerve

Femoral ring Great saphenous vein

Inguinal ligament (Poupart's)

Lacunar ligament (Gimbernat's)

Ductus (vas) deferens Femoral sheath Femoral canal (opened) Femoral artery and vein

Great saphenous vein

Deep inguinal lymph nodes

CT Angiograms of Arteries of the Lower Limb

8

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References

Plate 58

Plates 291, 2 9 2

Braus H. A n a t o m i e des M e n s c h e n . Berlin, Verlag von Julius

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tebrates. A c t Hepat 1955;3:1.

Nishida S. The Structure of t h e Eye. New York, Elsevier NorthHolland, 1982.

L a c h m a n N, A c l a n d RD, Rosse C. Anatomical evidence for t h e absence of morphologically distinct cranial root of t h e a c c e s sory nerve in man. Clin Anat 2002; 15:4.

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parenchymal architecture. A m J Anat 1949; 84:311.

Foerster O. The d e r m a t o m e s in man. Brain 1933; 56:1. Garrett FD. The segmental distribution of t h e c u t a n e o u s nerves in the limbs of man. Anat Rec 1948; 102:409.

Plates 305, 3 0 8 Michels

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A b d o m i n a l Organs, With a Descriptive Atlas. Philadelphia, J B

Keegan JJ. D e r m a t o m e hypalgesia with posterolateral herniation of lower cervical intervertebral disc. J Neurosurg

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Lippincott, 1955. Plate 3 2 6 T h o m a s MD. In The Ciba Collection of Medical Illustrations, Vol

Plate 172

3, Part II. Summit, NJ, CIBA, p 78.

Turnball IM. B l o o d y s u p p l y of t h e spinal cord. In Vinken PJ, GW

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A m s t e r d a m , North-Holland, 1972, p p 4 7 8 - 4 9 1 .

J a c k s o n CL, Huber JF. Correlated applied a n a t o m y of t h e bronchial tree and lungs with a system of nomenclature. Dis Chest 1943; 9:319.

Ikeda S, O n o Y, Miyazawa S, et al. Flexible b r o n c h o - f i b e r s c o p e . Otolaryngology (Tokyo) 1970; 42:855.

Plates 3 5 6 , 360, 365, 370, 378, 3 7 9 Oelrich T M . The striated urogenital sphincter muscle in the female. Anat Rec 1983; 205:223.

J a m e s TN. The internodal pathways of t h e human heart. Prog Cardiovas Dis 2001; 43:495.

ated urethral sphincter a n d radical prostatectomy: the apical

Plates 359, 361, 3 8 3 , 384 Oelrich T M . The urethral sphincter muscle in the male. A m J Anat 1980; 158:229.

Plates 253, 3 6 6 , 370, 3 8 3 Myers RP, King BF, Cahill DR. Deep perineal " s p a c e " as defined by magnetic resonance imaging. Presented at 14th Annual Session

Myers RP, Goellner JR, Cahill DR. Prostate shape, external stridissection. J Urol 1987; 138:543.

Plate 2 2 5

of t h e A m e r i c a n

Association

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Clinical

Anatomists, Honolulu, HI, 1997. [Abstract: Clin Anat 1998;11].

Plate 4 0 3 Flocks RH, Kerr HD, Elkins HB, et al. Treatment of c a r c i n o m a of the prostate by interstitial radiation with radio-active gold (Au 198): a preliminary report. J Urol 1952; 68(2):510. Plate 4 8 2

Plate 282 DiDio LJA. Anatomo-Fisiologia d o Piloro ileo-ceco-colica Actas

S t o r m o n t TJ, Cahill DR, King BF, Myers RP. Fascias of the male

Plates 359, 361

Plate 2 0 3

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Plates 348, 361, 384, 396, 4 1 4 external genitalia and perineum. Clin Anat 1994; 7:115.

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homen.

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Plates 116, 117, 127

Bruyn

. Morphology

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Primeiras

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ileo-ceco-colico.

(Com observacao direta in vivo de "papila" ileo-ceco-colico.) [English summary]. Thesis, Fac M e d , Univ de Sao Paulo, 1952. Plate 290 Healey JE Jr, Schroy PC. A n a t o m y of t h e biliary d u c t within the human liver: analysis of the prevailing pattern of branchings a n d the major variations of t h e biliary ducts. Arch Surg 1953; 66:599. Healey JE Jr, Schroy PC, Sorensen RJ. The intrahepatic distribution of the hepatic artery in man. J Int Coll Surg 1953; 20:133.

Keegan JJ, Garrett FD. The segmental distribution of the cutaneous nerves in the limbs of man. Anat Rec 1948; 102:409. Plate 5 4 3 Keegan JJ. Neurological interpretation of d e r m a t o m e hypalgesia with herniation of the lumbar intervertebral disc. J Bone Joint Surg 1944; 26:238. Last RJ. Innervation of the limbs. J Bone Joint Surg 1949; 31(B):452.

Index

References are to plate numbers. In most cases, structures are listed under singular nouns.

A Abdomen, 268 autonomic nerves and ganglia of, 318 axial CT images of, 350 bony framework of, 248 cross sections of at L3, 349 at L3, 4, 349 at L1-L2, 339 at T10, 293 at T12, 297, 331, 338 innervation of, 318 left lower quadrant of, 268 left upper quadrant of, 268 regions and planes of, 268 right lower quadrant of, 268 right upper quadrant of, 268 subcutaneous tissue of, 249 surface anatomy of, 247 viscera of, 269 Abdominal aortic plexus. See Intermesenteric plexus Abdominalis muscle, transversus, 362 Abdominal muscles, transversus, 363 aponeurosis of, 252 Abdominal wall anterior, 249, 265 arteries of, 255 deep dissection of, 251 intermediate dissection of, 250 internal view of, 253 nerves of, 257 superficial dissection of, 249 veins of, 255 arteries of, 263 internal view of, 263 lymph vessels and nodes of, 266 nerves of, 267 peritoneum of, 274 veins of, 265 median (sagittal) section of, 348 posterior arteries of, 264 internal view of, 263 lymph vessels and nodes of, 266 nerves of, 267 peritoneum of, 274 veins of, 265 posterolateral, 254 Abdominis aponeurosis, transversus, 252, 330, 349 Abdominis muscle aponeurosis of, 255, 330 rectus, 181, 188, 189, 192, 247, 250, 251, 258, 259, 293, 349, 351, 378 axial CT image of, 350 capsular branch of, 335 cross section of, 252 pelvic branch of, 335

Abdominis muscle (Continued) sheath of, 189 transversus, 25, 94, 96, 179, 189, 255, 257, 258, 263, 267, 329, 498 aponeurosis of, 252, 330, 349 tendon of origin of, 175, 176, 179 Abducent nerve (VI), 83, 84, 86, 114, 117, 118, 121 distribution of, 118 schema of, 118 Abducent nucleus, 116, 117, 121 Abductor digiti minimi muscle, 465, 470, 476, 533, 534, 536, 541 nerve to, 534 tendon of, 533 Abductor hallucis muscle, 533, 534, 535, 541 insertion of, 534, 536 Abductor hallucis nerve, 541 Abductor pollicis brevis muscle, 461, 465 Abductor pollicis longus muscle, 441, 444, 449, 451 area for, 439 Abductor pollicis longus tendon, 444, 469, 470 Aberrant ductule, 390 Accessory muscle bundle, 67 Accessory nerve (XI), 34, 114, 116, 117, 129, 177 cranial root of, 126, 127 schema of, 118, 127 spinal nucleus of, 116, 117 spinal roots of, 10, 118, 127 Accessory oculomotor nucleus, 116, 117, 121, 132 Acetabular fossa, 376, 487 fat in, 487 transverse section of, 376 Acetabular labrum, 352, 487 Acetabular ligament, transverse, 352, 487 Acetabular notch, 352, 486 Acetabulum, 352, 486 anteroposterior radiograph of, 488 articular surface of, 376 lunate surface of, 486 margin of, 352, 353, 486 radiograph of, 355 Achilles tendon. See Calcaneal (Achilles) tendon Acinus, 204 Acoustic artery, internal. See Labyrinthine artery Acoustic meatus external, 8, 13, 92, 93 auricular branch of vagus nerve to, 24 axial CT images of, 150 axial MR image of, 150 cartilaginous and osseous, 93 coronal oblique section of, 93 internal, 92, 97, 123 Acoustic opening, internal, 97 Acromial anastomosis, 427 Acromial angle, 420, 421 Acromial plexus, 427

Acromioclavicular joint, 423, 425 capsule of, 423 Acromioclavicular ligament, 423 Acromion, 27, 33, 185, 287, 418, 420, 421, 422, 423, 424, 425, 427, 429, 431, 432 anteroposterior radiograph of, 422 Adamkiewicz, artery of, 171 Adductor brevis muscle, 489, 493, 539 attachments of, 489, 491 Adductor canal, 500 Adductor hallucis muscle, 541 deep tibial nerve branch to, 541 insertion of, 536 oblique head of, 535 transverse head of, 535 Adductor hiatus, 539 femoral artery passing through, 512 Adductor longus muscle, 376, 489, 492, 493, 500, 505, 539 attachments of, 489, 491 innervation of, 540 transverse section of, 521 Adductor magnus muscle, 485, 489, 495, 500, 502, 505, 540 adductor minimus part of, 493 attachments of, 489, 491 hiatus of, 493 innervation of, 540 tendon of, 493 Adductor magnus tendon, 501, 506, 510, 511 Adductor muscles, thigh, 496 Adductor pollicis muscle, 462, 465, 476, 535 fascia over, 460, 462 Adductor tubercle, 489 Adenohypophysis, 140, 147, 148 cleft of, 147 Adnexa, 371 Afferent fibers, olfactory bulb, 119 Afferent nerves of mouth and pharynx, 62 of nose and sinuses, 210 of stomach and duodenum, 321 Agger nasi, 37, 38 Air, in colon, radiograph of, 355 Air cells, mastoid, axial MR image of, 150 Airway intrapulmonary, 204 to nasopharynx, 37 Airway reflexes, nerves initiating, 210 Ala, 8 lateral part of, 157 wing of, 157 Alar fibrofatty tissue, 36, 38 Alar fold, 507 Alar ligament, 22 Albini's nodules. See Fibrous (Albini's) nodule Alcock's canal. See Pudendal canal (Alcock's)

Alveolar artery anterior superior, 40 inferior, 40, 53, 60 lingual branch of, 69 mental branch of, 40, 69 middle superior, 40 posterior superior 40, 69 Alveolar duct, 204 opening of, 204 Alveolar nerve, 53, 55, 122, 131, 134 anterior superior, 45 nasal branch of, 42 inferior, 16, 40, 53, 55, 60, 131, 134 branch of, 40 entering mandibular foramen, 46 middle superior, 45 posterior superior, 44, 45 superior, 62, 71 Alveolar sac, 204 Alveolar vein inferior, 60, 70 posterior superior, 60, 70 Alveolus, 204 capillary bed in, 205 Amacrine cells, 120 Ampulla ear, 95, 96 semicircular, 92 of uterine tube, 372 Amygdaloid body, 110, 112, 119 thalamus and, 110 Anal canal, 393 anatomical, 393 arteries of, 398 beginning of, 376 beginning of, transverse section of, 357, 521 longitudinal muscle of, 356, 357 muscularis mucosae of, 393, 394 sagittal MR images of, 397 surgical, 393 veins of, 399 Anal columns, 393 Anal glands, 393 Anal nerve, inferior, 410, 411, 414, 496, 503 AnaS pit, 388 Anal sinus, 393 Anal sphincter muscle external, 356, 358, 360, 365 deep part of, 394, 395, 396 peripheral view of, 395 subcutaneous of, 391, 393, 395, 396 superficial part of, 391, 393, 394, 395 internal, 393, 394 Anal triangle, 380 Anal tubercle, 388 Anal valve, 393 Anal verge, 393 Anastomosis around elbow, 434 around scapula, 427 carotid-vertebral, 138 gastro-omental arterial, 272 in incisive canal, 40 obturator-pubic arterial, 259 paravertebral, 172 patellar, 500, 512 portacaval, 312 right-left, 138

Anastomosis (Continued) between septal sphenopalatine artery and greater palatine artery, 41, 138 subclavian-carotid, 138 subclavian-vertebral, 138 Anastomotic branch, 301 Anastomotic loop of ileal arteries, 280 of jejunal arteries, 280 of posterior spinal arteries, 171 of small intestinal veins, 310 of small intestine, 306 Anastomotic vein inferior, 102, 145 superior, 102 Anatomical snuffbox, 444 radial artery to, 469, 470 Anconeus muscle, 432, 444, 445, 477 nerve to, 432 origin of, 421 Angular artery, 23, 36, 68, 85, 138 Angular gyrus, 105 cerebral artery to, 141 cerebral branches to, 141, 142 Angular vein, 23, 70, 85 Ankle dorsiflexion and plantar flexion of, 543 lateral ligament of, 514 ligaments and tendons of, 514 ligaments of, 527 medial ligament of, 514 radiograph of, 526 tendons of, 527 Annular ligament of radius, 438 of trachea, 202 Anococcygeal body, 357, 378, 379, 395, 396 Anococcygeal nerve, 411, 412, 499 Anocufaneous line, 392, 393, 394 Anoderm, 393 Anorectal hiatus, 358 Anorectal junction, circular muscle layer of, 359 Anorectal line, 393 Anorectal musculature, 394 Ansa cervicalis, 31, 32, 128, 129 inferior root of, 32, 34, 71, 74, 128, 129 superior root of, 32, 34, 71, 74, 128, 129 ventral rami of, 128 Ansa of Galen, 80 Ansa subclavia, 130, 209, 226, 240 Anserine bursa, 506, 507 Antebrachial vein intermediate, 418, 479 median, 449 Anterior chamber, 81, 87, 88, 89, 90 endothelium of, 88 Anterolateral central arteries, 140, 141 Anteromedial central arteries, 140 Antihelix, 1, 93 crura of, 1, 93 Antitragus, 1, 93 Anulus fibrosus, 19, 155 Anum, fibrous septum of, 394 Anus, 360, 377, 380, 382, 388, 395 fetal, 388 transverse fibrous septum of, 393

Aorta, 207, 263, 324, 330, 342 abdominal, 27, 179, 195, 207, 225, 232, 270, 273, 274, 278, 298, 300, 301, 324, 327, 329, 330, 331, 332, 339, 341, 342, 363, 369, 398, 400, 401, 403, 412 cross section of, 338 arch of, 237, 244 ascending, 138, 215, 220, 223, 224, 225, 242, 245 axial CT images of, 242, 350 descending, 237, 242, 245, 246 thoracic, 194, 242 prenatal, 229 thoracic, 172, 297 cross section of, 297 descending, 172, 231, 241 esophageal branches of, 237 ureteric branch from, 341 Aortic arch. See Arch of aorta Aortic hiatus, 195 Aortic lymph node, lateral, 266, 343, 406 Aortic lymph nodes, 266 Aortic nerve, 228 Aorticorenal ganglion, 165, 167, 267, 318, 320, 321, 322, 324, 344, 345, 346, 409 celiac, 267 left, 318, 320, 323, 410, 415 right, 318, 320, 323 superior mesenteric, 267 Aortic plexus, 321, 322, 412 Aortic sinus, 223, 224 Aortic valve anatomy of, 223 semilunar cusps of, 221, 222, 223, 224, 225 left, 224 Apical foramen, 57 Apical ligament, of dens, 63, 65 Appendicular artery, 281, 306, 307, 322,323 Appendicular nodes, 317 Appendicular plexus, 322, 323 Appendicular vein, 311, 312 Appendix, 126 fibrous, 287 vermiform, 271, 281, 283, 284, 362, 363 aggregate lymphoid nodules of, 283 barium radiograph of, 283 circular muscle of, 283 fixed retrocecal, 283 orifice of, 282 serosa of, 283 submucosa of, 283 variations in position of, 283 Arachnoid, 102, 109 cerebral veins penetrating, 102 Arachnoid-dura interface, 102 Arachnoid granulation, 100, 102, 109 granular foveola for, 99 skull indentation for, 99 Arachnoid mater, 169 lumbar, 170 thoracic, 170 Arantius, body of, 223

Arch of aorta, 74, 75, 80, 138, 206, 210, 211,212,213,214,215,221,232, 233 groove for, 199 radiograph of, 213 Arcuate artery, 335, 337, 530, 531, 536 afferent glomerular arteriole from, 337 lymph vessels along, 343 Arcuate eminence, 9 Arcuate ligament dorsal radial metaphyseal, 455 lateral, 195, 263 medial, 195, 263 median, 195, 263 Arcuate line, 248, 251, 255, 259, 279, 348, 352, 353, 356, 486 section above, 252 section below, 252 Arcuate nucleus, 147 Arcuate popliteal ligament, 508, 511 Arcuate vein, 337 Arcus tendineous fasciae pelvis, 372 Areola, 182 Areolar gland, 182 Areolar tissue, 179, 251, 361, 471 in anterior closed space of finger, 471 Areolar venous plexus, 256 Arm. See also Forearm arteries of, 484 cutaneous nerves of, 479, 481 inferior lateral, 432, 477, 479, 481 medial, 257, 429, 432, 435, 473, 474, 479 ~ ' posterior, 432, 477, 479, 481 superior lateral, 432, 477, 478, 479, 481 deep artery of, 429, 432, 433, 434, 435 middle collateral branch of, 445 muscles of, 432 anterior views of, 430 deep layer of, 430, 432 posterior, 432 posterior view of, 432 superficial layer of, 430, 432 superior lateral, 432 neurovascular compartment of, 435 radial nerve in, 477 serial cross section of, 435 superficial veins of, 480 Arrector muscle, hair follicle, 167 Arteriae rectae, 307 Arteriogram, celiac, 303 Arteriole intralobular, 291 periportal, 291 portal, 291 Artery(ies). See also specific arteries of anterior abdominal wall, 255 of arm, 484 to brain, 136-137, 138, 141, 142 frontal view of, 141 lateral and medial views of, 142 colic, 308 of duodenum and head of pancreas, 301, 304 of esophagus, 237 of face, 23 of female pelvic organs, 400 of female pelvis, 403 of female perineum and uterus, 405 of femoral head, 504

Artery(ies) (Continued) of femoral head and neck, 504 of fingers, 471 of foot, 536 of foot, deep, 536 of hand, palmar view of, 466 of head, 23 of hip and thigh, 500-502 of hypothalamus and hypophysis, 148 intrarenal, 335 intrinsic distribution of, in spinal cord, 172 of large intestine, 307 of liver, 301 of liver, pancreas, duodenum, and spleen, 301, 305 of liver and gallbladder, variations in, 305 of male pelvis, 403 of male perineum, 405 of mammary gland, 183 to meninges, 136 of nasal cavity, 41 of neck, 504 of oral and pharyngeal regions, 69 of oral region, 69 of pancreas, 301 of posterior abdominal wall, 264 of posterior cranial fossa, 142, 143 of rectum and anal canal, 398 renal, 335 of scalp, 23 of spinal cord, 171 of spleen, 301 of stomach, liver, and spleen, 300 of testis, 401 of thigh anterior view of, 501 posterior view of, 502 of upper limb, 473 computed tomography of, 484 at wrist, 461 Articular cavity, 471 of finger, 471 Articular disc, 16, 243 Articularis genus muscle, 505, 507, 511, 538 attachment of, 489 Articular nerve great, 32 recurrent, 542 Articular process inferior, lumbar, 155 superior, lumbar, 155 Articular tubercle, 55 Aryepiglottic fold, 66, 67, 78 Aryepiglottic muscle, 78, 80 Arytenoid muscle oblique, 67, 78, 79, 80, 235 transverse, 63, 78, 79, 80, 235 action of, 79 Atlantoaxial joint, 19 lateral, 19 capsule of, 21 median, superior view of, 22 radiograph of, 17 Atlantooccipital joint capsule, 21, 22 Atlas (C1 j, 13, 17, 19, 22, 153, 160 anterior, 21 anterior arch of, 5, 17, 19, 37, 62, 137 anterior tubercle of, 19 dens of, articular facet for, 17 inferior view of, 17

Atlas (C1) (Continued) lateral mass of, 17 occipital condyle of, 17 posterior, 21 posterior arch of, 17, 18, 178 posterior tubercle of, 17, 175, 176 spinous process of, 18 superior articular facet for, 17 superior view of, 17 transverse foramen of, 17 transverse process of, 17, 21, 30, 39, 176 Atrioventricular bundle, 225 Atrioventricular node, 22, 218, 225 Atrioventricular valve left. See Mitral valve right. See Tricuspid valve Atrium, 224 internodal conduction pathways of, 225 left, 214, 215, 220, 221, 224, 246 auricle of, 212 oblique vein of, 214, 215, 216 section through, 221 right, 212, 213, 214, 215, 220, 223, 224, 241,246 opened, 220 radiograph of, 213 Auditory ossicles, 93 Auditory (pharyngotympanic, Eustachian) tube, 92, 93, 96, 125, 126 cartilage of, 47 cartilaginous part of, 52, 55, 64, 65, 67 groove for, 8 opening of, 37 pharyngeal opening of, 63, 64, 66, 125 Auerbach's plexus. See Myenteric (Auerbach's) plexus Auricle, 92, 97 concha of, 93 left, 212, 213, 215, 216, 224, 225 lobule of, 93 posteromedial surface of, 24 right, 93, 212, 214, 219, 220, 224 Auricular artery anterior, 23 deep, 40 posterior, 23, 34, 40, 100, 136, 138, 178 Auricularis anterior muscle, 26 Auricularis posterior muscle, 26 Auricularis superior muscle, 26 Auricular muscle, facial nerve branches to, 123 Auricular nerve, 122 anterior, 122 articular branch of, 122 great, 21, 22, 24, 32, 129, 177, 178 greater, 31 posterior, 25, 123 occipital branch of, 123 Auricular tubercle (of Darwin), 93 Auricular vein, posterior, 23, 70 Auriculotemporal nerve, 16, 24, 40, 55, 71, 122, 125, 134 Auscultation, triangle of, 152, 246, 424 precordial area of, 213 Autonomic ganglion, abdominal, 318 Autonomic nerves of abdomen, 318 in head, 131

Autonomic nerves (Continued) of nasal cavity. 44 to neck, 24 in thorax, 209 Autonomic nervous system schema of, 167 topography of, 167 Autonomic plexus, intrinsic, 326 Autonomic reflex pathways, 325 Axilla dissection of, 181 anterior view of, 429 dissection of, anterior view, 429 muscles of, 424 oblique parasagittal section of, 428 oblique parasagittal section of, 428 suspensory ligament of, 428 Axillary artery, 183, 189, 198, 200, 255, 427, 428, 429, 433, 434 acromial branch of, 434 anterior view of, 434 clavicular branch of, 434 computed tomography of, 484 deltoid branch of, 434 pectoral branch of, 434 posterior view of, 434 Axillary fold, 181 anterior, 181 posterior, 181 Axillary fossa, 243, 244, 245 Axillary lymph nodes, 428 along axillary vein, 484 apical, 184 brachial, 184 central, 184, 428 lateral, 483 along axillary vein, 483 parasagittal section of, 428 pectoral, 184, 428 subscapular, 184 Axillary nerve, 177, 425, 427, 429, 432, 476, 477, 481 superior lateral cutaneous nerve of arm from, 479 Axillary recess, 423 Axillary tail (of Spence), 182, 183 Axillary vein, 189, 198, 256, 428 intercostal tributaries to, 256 lymph nodes along, 483 Axis (02), 13, 17, 19, 22, 153 anterior view of, 153 body of, 17, 21 dens of, 5, 17, 37, 63 inferior articular process of, 17 interarticular part of, 17 left lateral view of, 153 pedicle of, 17 posterosuperior view of, 17 posterior articular facet of, 17 posterior lateral view of, 153 posterior tubercle of transverse process of, 30 spinous process of, 17, 174, 176 transverse process of, 30 Azygos vein, 17, 21, 153, 194, 206,.207, 209, 230, 241, 245, 246, 293, 331, 349 arch of, 230, 232, 244 axial CT images of, 242 groove for, 199

B Babinski's sign, 101 Back bones and ligaments of, 153-157 lumbar region, cross section of, 179 muscles of deep layer of, 176 axial CT images of, 350 intermediate layer of, 175 superficial layers of, 174 nerves of, 177. 179 surface anatomy of, 152 Bartholin's gland. See Vestibular gland, greater Basal nucleus, organization of, 110 Basal vein, 144, 145, 146 Basilar artery, 140, 141, 143, 171 axial MR image of, 150 Basilar membrane, 96 Basilar venous plexus, 103 Basilic vein, 418, 429, 449, 468, 480, 483, 484 intermediate, 480 Basivertebral vein, 137, 173 Biceps brachii muscle, 181, 418, 420, 429, 433, 435, 446, 447, 451 fascia over, 428 insertion of, 420 long head of, 424, 426, 428, 433, 435, 474 origin of, 420 tendon of, 243, 244, 245 short head of, 424, 428, 430, 433, 434, 435, 474 combined, 244 origin of, 420 tendon of, 425, 432, 433, 438, 446, 447 long head of, 423, 425, 430 short head of, 430 Biceps femoris muscle, 485, 489, 495, 503, 515 attachments of, 489, 515 long head of, 485, 494, 495, 540 attachments of, 491 short head of, 488, 494, 495, 540 attachments of, 491 tendon of, 506, 511, 514, 517, 520, 542 bursa of, 511 inferior subtendinous, 506, 507 long head of, 353 Bicipital aponeurosis, 430, 433. 446, 480 Bifurcate ligament, 527 Bigelow, Y ligament of, 487, 496 Bile canaliculus, 292 Bile duct, 126, 290, 291, 292 common, 167, 273, 274, 278, 279, 288, 294, 295, 297, 298, 300, 301, 304 cross section of, 338 hepatic ducts joining, 290 junction with duodenum, 295 extrahepatic, 294 union of pancreatic ducts and, 295 Bile ductule, 290 intralobular, 290 periportal, 290, 291, 292 Biliary tract innervation of, 327 intrahepatic, 292 Bipolar cells, 120

Bladder-prostate junction, 376 Blood circulation intrapulmonary, 205 postnatal, 229 prenatal, 229 Blood vessels, innervation of, 228 Bone(s) See also specific bones of abdomen, 248 of cranial base, 9 of elbow, 436 of foot, 523, 524 of forearm, 439 of hand, 474 of head, 2-16 of lower limb, 513, 524 of nasal cavity and paranasal cavity, at birth, 50 pelvic, 352-353 of right leg, 513 of thorax, 185 of wrist, 453, 456 Bowel loop, entering hernial sac, 261 Bowman's capsule, 336 Brachial anastomosis, around elbow, 433 Brachial artery, 27, 30, 31, 183, 193, 198, 206, 211, 230, 427, 429, 447 branches of, 433, 434 muscular branch, 433, 434 cords of, lateral, 428, 433 deep, 429 computed tomography of, 484 in situ, 433, 434 medial, 428, 433 posterior, 428 Brachial cutaneous nerve, superior Bateral, 177 Brachialis muscle, 420, 429, 430, 433, 435, 446, 447, 448 insertion of, 420, 438 origin of, 420, 421 Brachial plexus, 27, 30, 31, 32, 129, 160, 183, 189, 193, 198, 206, 211, 228, 230, 231, 232, 428, 429 anterior and posterior divisions of, 430 communication to, 129 cords of lateral, 428, 433 medial, 428 posterior, 428 medial, 428, 433 posterior, 428 roots of, 430 schema of, 430 terminal branches of, 430 trunks of, 430 Brachial vein, 429, 435 Brachiocephalic trunk, 33, 74, 75, 76, 136, 193, 206, 211, 212, 214, 232, 237, 243, 420 Brachiocephalic vein, 74, 208 groove for, 199 left, 70, 75, 137, 206, 211, 212, 230, 231, 243 right, 75, 137, 206, 210, 211, 212, 230, 243 Brachioradialis muscle, 418, 433, 444, 446, AA7 origin of, 420 Brachioradialis tendon, 448, 449

Brain, 48 arteries to, 136, 141, 142 frontal views of, 141 inferior views of, 139 lateral and medial views of, 142 schema of, 138 coronal section of, 108 deep veins of, 145 sagittal section of, in situ, 106 subependymal veins of, 146 ventricles of, 108 Brainstem anterior view of, 114 cranial nerve nuclei in, 116, 117 medial dissection of, 117 posterior phantom view of, 116 schema of, 117 sectioned, 107 Bregma, 7 Broad ligament, 389 anterior lamina of, 372 of female ureter, 340 mesometrium of, 371 mesosalpinx of, 369 posterior lamina of, 372 subdivisions and contents of, 372 uterine, 360, 362 Bronchial artery, 204, 205, 207 esophageal branch of, 207 inferior left, 207 left, 199, 231 esophageal branch of, 237 inferior, 237 superior, 237 right, 199, 207, 230, 237 superior left, 207 variations in, 207 Bronchial vein left, 207 right, 207 Bronchiole respiratory, 204, 205 terminal, 204, 205 Bronchomediastinal lymphatic trunk, 208 left, 266 right, 266 Bronchopulmonary lymph nodes, 199, 208, 230, 231 Bronchopulmonary segments, 200, 201 anterior view of, 200 lateral view of, 201 medial view of, 201 nomenclature for, 203 posterior view of, 200 Bronchus, 167, 202, 204, 234 anterior basal, 203 anteromedial basal, 203 apicoposterior, 203 elastic fibers of, 204 extrapulmonary, 202 inferior lobar, 202 intermediate, 202 intrapulmonary, 202, 204 lateral basal, 203 left, 203 axial CT images of, 242 left main branches of, 199, 206, 232, 233, 241 lingular, 202

Bronchus (Continued) major, 202 medial basal, 203 middle lobar, 202, 203 nomenclature of, 203 posterior basal, 203 right axial CT images of, 242 intermediate, 206 right main branches of, 207, 230, 245 smooth muscle of, 204 superior lobar, 202, 203, 206 Brunner's gland. See Duodenal glands Buccal artery, 40, 69 Buccal nerve, 24, 40, 46, 62, 71, 122 branches of, 25 Buccinator crest, 68 Buccinator lymph node, 72 Buccinator muscle, 15, 26, 48, 52, 54, 55, 60, 65, 68, 123 Buccopharyngeal fascia, 60, 63, 65 Buck's fascia. See Deep (Buck's) fascia Bulbar conjunctiva, 81, 87 Bulbospongiosus muscle, 358, 366, 370, 380, 381, 383, 404, 405, 417 bulb of vestibule of, 366 Bulbourethral (Cowper's) gland, 253, 361, 366, 383, 384, 389, 417 duct of, 383 opening of, 384, 385 perineal membrane and, 348 primordium of, 389 Bulging septum, 37 Bursa anserine, 506, 507 fibular collateral, 507 of hand, 462 iliopectineal, 496 infrapatellar, 511 patellar, 508 radial, 460 subdeltoid, 423 ulnar, 460 Buttock, nerves of, 503 c C1 spinal nerve, 127 dorsal ramus of, 178 dorsal roots of, 114 exit of, 161 ventral ramus of, 71 ventral roots of, 114 C2 spinal nerve, 127 dorsal ramus of, 177, 178 ventral ramus of, 32, 71, 177 C3 spinal nerve, 19 dorsal ramus of, 177 ventral ramus of, 32, 71, 177 C4 spinal nerve, 127 C5 spinal nerve, ventral ramus of, 32 C8 spinal nerve, 160 exit of, 161 C6 transverse process, 136 C1 vertebra. See Atlas (C1) C2 vertebra. See Axis (C2) C3 vertebra, 13 inferior articular facet for, 19

C3 vertebra (Continued) tubercles of transverse process of anterior, 26 posterior, 26 C4 vertebra anterior tubercle of, 18 body of, 18 lamina of, 18 posterior tubercle of, 18 posterosuperior view of, 17 C7 vertebra, 13, 153, 160 posterior tubercle of transverse process of, 30 spinous process of, 18, 152, 174, 175, 176, 424 superior view of, 18 Calcaneal artery lateral, 534, 535 medial, 534, 535 Calcaneal nerve lateral, 534, 535 medial, 534, 535 Calcaneal (Achilles) tendon, 485, 515, 516, 517, 518, 521, 527 soleus muscle insertion in, 515, 517 Calcaneocuboid ligament, 527, 536 dorsal, 527 plantar, 528 Calcaneofibular ligament, 514, 525, 527 Calcaneometatarsal ligament, 532 Calcaneonavicular ligament, 527 plantar, 527, 528, 536 Calcaneus, 524, 527, 528 anterior talar articular surface of, 525 body of, 523, 524, 525 dorsal view of, 523 fibular, 524 fibular trochlea of, 523 functional relations of, 525 groove for tendon of flexor hallucis longus, 523 lateral process, 523, 533 lateral view of, 525 medial process, 523 medial view of, 525 middle talar articular surface of, 525 plantar view of, 523 posterior talar articular surface of, 525 posterior view of, 525 radiograph of, 54 superior view of, 525 sustentaculum tali of, 523 trochlea of, 524 tuberosity of, 485, 488, 516, 517, 523, 533, 534, 535 radiograph of, 54 Calcar, 489 Calcar avis, 111, 112 Calcarine artery, 142, 143 Calcarine sulcus, 105, 106, 107, 111, 120 Callosomarginal artery, 141, 142 Calot, cystic node of, 315 Calot, triangle of, 301 Calvaria, 102 inferior view of, 7 superior view of, 7 Calyx, major, 339 Camper chiasm, 461 Camper's fascia, 348

Camper's (fatty) layer of subcutaneous tissue, 249, 361, 348, 378, 380 Canal of Schlemm. See Scleral venous sinus (canal of Schlemm) Canine teeth, 57 Capillary plexus, 148, 205 cortical, 337 medullary, 337 Capitate, 452, 453, 455, 456, 461 anterior (palmar) view of, 452 coronal section of, 455 posterior (dorsal) view of, 452 radiograph of, 457 Capitis muscle, rectus anterior, 32, 47, 73 anterior and lateral, nerves to, 129 lateral, nerves to, 129 lateralis, 30, 32 posterior major, 175, 176, 178 posterior minor, 175, 176, 178 Capitohamate ligament, 454, 455 Capitulym, 420, 436, 437 Capsular artery, 335 Capsular ligament, 423 of shoulder, 423 Capsular vein, 337 Capsule, internal, 141 Cardia, nodes around, 314 Cardiac nerve, cervical, 165 Cardiac notch, 236, 275 Cardiac orifice, 276 Cardiac plexus, 126, 165, 209, 226, 227, 240 Cardiac vein anterior, 216 of diaphragmatic surface, 216 great, 216 middle, 216 small, 216 of sternocostal surface, 216 Cardinal ligament, 360, 364, 370, 371, 372, 373 Caroticotympanic nerve, 123, 125 Carotid arterial arch, dorsal, 469 Carotid artery common, 23, 29, 31, 32, 33, 34, 71, 74, 75, 76, 100, 125, 128, 130, 133, 134, 136, 137, 198, 210, 232, 237 external, 28, 32, 34, 40, 59, 75, 76, 85, 86, 121, 123, 128, 130, 131 schema of, 34 internal, 10, 23, 28, 33, 34, 44, 47, 69, 71, 75, 76, 85, 86, 100, 123, 125, 130, 131, 132, 134, 138, 139, 140, 141, 142 caroticotympanic branch of, 138 groove for, 9 left common, 74, 80, 137, 193, 211, 214, 243 left internal, 142, 143 right common, 30, 80, 137, 193 right internal, 142 right lateral dissection of, 34 Carotid autonomic plexus, 10 Carotid body, 34, 125, 130, 210 Carotid canal, 10 external opening of, 8 for internal carotid artery, 11 for internal carotid nerve plexus, 9 Carotid groove, 9

Carotid nerve ( I X ) , 71 external, 165, 167 internal, 130, 131, 133, 165, 167 Carotid plexus, 86, 121, 131, 209, 226 common, 130, 131 external, 130, 133, 167 internal, 86, 123, 132, 165, 167 Carotid sheath, 28, 32 cranial nerves in, 60 Carotid sinus, 125, 130, 131, 210 Carotid vein, common, 70 Carpal arterial arch, dorsal, 469 Carpal articular surface, 439 Carpal bones, 452 in abduction, 453 in adduction, 453 anterior (palmar) view of, 452 posterior (dorsal) view of, 452 Carpal ligament palmar, 454, 460 transverse. See Flexor retinaculum Carpal tunnel, 461 palmar view of, 454 transverse cross section of, 461 Carpometacarpal joint, 455 articular capsule of, 454 capsule of first, 455 Carpometacarpal ligament dorsal, 455 palmar, 454 Carpotriquetral ligament, 454 Cartilage accessory nasal, 36 alar lateral and medial crus of, 36 major, 36, 38, 39 minor, 36 articular of elbow, 438 of finger, 471 of hip joint, 487 of knee, 511 arytenoid, 77, 78 muscular process of, 78 vocal process of, 78 auricular, 47 bronchial, 204 corniculate, 77 costal, 186, 248, 293, 419 cross section of, 196 eighth, -115 fifth, 194 fifth left, 241 of first rib, 243 second, 245 seventh, 198, 331 sixth, 424 cricoid, 20, 28, 29, 74, 77, 78, 196, 233, 234 arch of, 77 lamina of, 77, 78 longitudinal muscle bundle attached to, 234 posterolateral surface of, 234 prominence over lamina of, 66 of larynx, 77 septal, 39 septal nasal, 36 lateral process of, 38. 39

Cartilage (Continued) thyroid, 28, 29, 31, 74, 196, 202, 206, 233, 234, 235 lamina of, 77, 78 oblique line of, 29 superior horn of, 77 tracheal, 28, 202 Cartilage lamina, thyroid, 77 posterior border of, 67 Cauda equina, 160, 161, 170, 179, 339 in lumbar puncture, 162 Cauda equina artery, 171 Caudal mesonephric duct, residua off, 389 Caudate nucleus, 141 anterior vein of, 145, 146 body of, 108, 110 head of, 110, 111, 112, 145 posterior vein of, 145 terminal, 146 tail of, 108, 110, 112 thalamus and, 110 transverse veins of, 145, 146 Cavernous nerve, 166, 410, 412 Cavernous plexus, 121 Cavernous sinus, 85, 100, 104, 136, 140 coronal section through, 104 efferent hypophyseal vein to, 148 emissary vein communicating with, 70 superior view of, 104 Cecal artery, 323 anterior, 281, 306, 307 posterior, 281, 307 Cecal fold, 281, 362, 363 Cecal plexus, 323 Cecal vein anterior, 311, 312 posterior, 311, 312 Cecum,. 126, 269, 272, 281, 284, 362, 363 variations in posterior peritoneal attachment of, 281 vascular fold of, 281 Celiac ganglion, 44, 126, 165, 167, 168, 219, 267, 318, 320, 321, 323, 324, 325, 327, 328, 331, 345, 346, 409 Celiac lymph node, 266, 314, 315 Celiac plexus, 126, 165, 166, 240, 319, 320, 322, 323, 344, 345, 346, 410, 415 posterior vagal trunk to, 240 vagal branch to, 240 Celiac trunk, 165, 195, 206, 278, 298, 300, 305, 321, 324, 328, 329, 333 arteriogram of, 303 bifurcation of, 297 common origin of, 302 cross section of, 338 prenatal, 229 variations in, 302 Ceneus, apex of, 107 Central artery anterolateral, 141 anteromedial, 140 central, anterolateral, 143 posteromedial, 140 precentral, 141 Centra!! sulcus, 106

Central vein, 290, 291 of liver, 290, 291 Cephalic vein, 181, 188, 189, 256, 418, 424, 428, 429, 449, 468, 479, 480, 483, 484 accessory, 479, 480 intermediate, 480 Cerebellar artery anterior, 140 anterior inferior, 136, 138, 139, 140, 141, 143, 171 posterior, 141, 143 inferior, 143 posterior inferior, 141, 171 superior, 136, 138, 139, 140, 141, 143, 171 Cerebellar hemispheric vein, inferior, 144 Cerebellar notch anterior, 97 posterior, 97, 113 Cerebellar nucleus, 113 dentate, 113 emboliform, 113 fastigial, 113 globose, 113 Cerebellar peduncle inferior, 113, 144 inferior, superior, middle, 144 middle, 113, 114, 144 superior, 113, 114, 115,144 decussation of, 113 superior plane of, 113 Cerebellar tonsil, herniation of, 101 Cerebellar tonsillar artery, 143 Cerebellar vein hemispheric inferior, 151 precentral, 144 superior, 144 Cerebellomedullary cistern posterior, 109 vein of, 144 Cerebellum, 106, 111, 115, 146 anterior lobe of, 113 axial MR image of, 150 biventer lobe of, 113 dentate nucleus of, 115 flocculonodular lobe of, 113 flocculus of, 114 horizontal fissure of, 113 inferior fovea of, 115 inferior surface of, 113 lateral recess of, 115 lateral views of, 105 medial eminence of, 115 median sagittal section of, 115 parts of, 144 posterior lobe of, 113 posterior view of, 115 posterolateral fissure of, 107 sagittal MR image of, 149 secondary fissure of, 107 superior fovea of, 115 superior surface of, 113 tonsil of, 107, 115 Cerebral aqueduct, 106, 107, 108, 109, 146 Cerebral arterial circle (of Willis), 139,140

Cerebral artery anterior, 136, 138, 140, 141, 143 branches of, 141 left, 142 right, 142 terminal branches of, 142 communicating, 140 left anterior, 142 left middle, 142 middle, 136, 138, 140, 141, 143 branches of, 141 left, 142 temporal branches of, 141 posterior, 136, 138, 140, 141, 143, 171 branches to, 136, 138 right, 142, 143 temporal branches of, 143 terminal branches of, 142 right anterior, 142 temporal branches of, 143 posterior and anterior, 142 terminal branches of, 142 Cerebral crus, 107, 113, 114, 139, 145 Cerebral falx, 48 Cerebral fissure anterior, 143 longitudinal, 107, 143, 145 Cerebral hemisphere axial CT images of, 150 axial MR image of, 150 medial surface of, 106 Cerebral peduncle, 106, 115 Cerebral sulcus, lateral, 141 Cerebral vasculature, 136-138, 139-141, 143-144, 145-146 Cerebral veins anterior, 144, 145, 146 deep, 99 middle, 144, 145 great, 103, 104, 106, 115, 144, 145, 146 quadrigeminal cistern of, 109 inferior, 102, 104, 145 internal, 99, 108, 111, 144, 145, 146 lateral direct, 146 middle deep, 144, 145, 146 superficial, 145 penetrating subdural space, 99 superficial, 99, 102 middle, 99, 102, 104 superior, 102 opening of. 101 Cerebrospinal fluid, circulation of, 109 Cerebrum, 113 anterior lobe of, 113 biventer lobule of, 113 external capsule of, 110 flocculonodular lobe, 113 frontal pole of, 107 gyri of, 107 horizontal fissure of, 113 horizontal sections through, 110 inferior surface of, 113 inferior view of, 107 internal capsule of, 110 lateral views of, 105 medial view of, 106 medial views of, 106

occipital pole of, 107 posterior lobe of, 113

Cerebrum (Continued) posterolateral fissure of, 113 sulci of, 107 superior surface of, 113 superior vermis of, 113 temporal pole of, 107 tonsil of, 113 Cervical artery ascending, 33, 69, 71, 74, 75, 76, 136, 138, 171, 427 deep, 33, 136, 138, 171 superficial, 74, 75 transverse, 32, 69, 74, 75, 76, 138, 177, 427, 429 Cervical canal, 371 CervicaB cardiac nerve, 166, 209 inferior, 165, 226 middle, 165, 226 superior, 69, 71, 165, 226 sympathetic and vagal, 226 Cervical! curvature, 18, 153 Cervical enlargement, 161 Cervical ganglion middle, 165 superior, 165, 167 CervicaB nerve, 130-133, 134-135, 161 branches of, 25 superficial, 177 transverse, 24, 31, 71, 129 vertebrae and, 127, 161 Cervical plexus, 160, 177, 178, 481 ansa cervicalis of, 32, 128 branches from, 24 in situ, 32 schema of, 32, 129 supraclavicular nerves from, 479 Cervical spinal nerves, 160 C1, 160 exit of, 161 C2, dorsal ramus of, 177 C3, dorsal ramus of, 177 C4, dorsal ramus of, 177 C8, 160 exit of, 160 dorsal rami of, 24, 32, 177 medial branches of, 24 posterior cutaneous branches of, 178 Cervical sympathetic cardiac nerve inferior, 130, 226, 227 middle, 33, 130, 165, 226, 227 superior, 32, 60, 128, 130, 132, 133, 134, 165, 226, 227, 240 Cervical sympathetic ganglion, middle, 32, 60, 130, 131, 132, 133, 134, 167 Cervical sympathetic trunk, 131, 240 vertebral ganglion of, 240 Cervical vagal cardiac nerve inferior, 227 superior, 227 CervicaB vein deep, 137 left, 137 right, 137 right, deep, 137 superficial, 177 transverse, 70, 177

Cervical vertebrae. See also Atlas (C1); Axis (C2); specific vertebrae anterior view of, 17, 171 arteries of, 171 articular pillar of, 21 costal facets of, 21 external craniocervical ligaments of, 21 inferior aspect of, 18 lateral radiograph of, 21 number of, 161 right lateral view of, 21 superior aspect of, 18 superior view of, 18 upper, 17 Cervicis muscle, interspinals, 176 Cervicofacial nerve, 25 Cervicothoracic (stellate) ganglion, 13, 130, 165, 209, 226, 227, 240 esophageal and recurrent nerve branches from, 240 Cervix, 360, 364, 369, 370, 371, 372 external os of, 371 sagittal MR images of, 397 C5 spinal nerve, ventral ramus of, 32 C4 spinal nerve, 127 Cheek ligament, 83 Chest axial CT images of, 242 radiograph of, 213 Chest drainage tubes, placement of, 190 Chiasmatic cistern, 109 Chief cell, 276 Choana, 8, 13, 14, 37, 38, 39, 52, 55, 66, 67 Cholangiole, 292 Chordae tendineae, 220, 221, 223 Chorda tympani nerve, 62, 71, 93, 94, 122, 123, 124, 131, 133, 134, 135, 165 Choroid, 87, 89, 90 vascular arrangements within, 91 Choroidal artery anterior, 139, 140, 141, 143 posterior lateral, 139, 143 posterior medial, 139, 143 Choroid plexus, 111, 112, 145 of fourth ventricle, 106, 108, 109, 114, 115 of lateral ventricle, 108, 109, 110, 143, 145 of third ventricle, 106, 108, 109 Choroid vein, 91 bulb of, 91 Choroid vein, superior, 99, 145, 146 Ciliary artery anterior, 90, 91 recurrent branch of, 91 long posterior, 90, 91 posterior, 85 short, 91 short posterior, 90, 91 Ciliary body, 87, 90 blood vessels of, 90 fibers of, 88 orbicularis ciliaris of, 89 Ciliary ganglion, 45, 86, 121, 122, 131, 132, 165, 166, 168 nasociliary root of, 86, 131, 132 oculomotor root of, 132 parasympathetic root of, 86, 121

Ciliary ganglion (Continued) roots of, 131 schema of, 132 sensory root of, 86, 121, 122, 131 sympathetic root of, 86, 121, 132 Ciliary muscle, 87, 118, 121, 132 circular fibers of, 88 meridional fibers of, 88 Ciliary nerve long, 86, 121, 122, 131, 132 short, 86, 121, 122, 131, 132 Ciliary process, 87, 88, 89 Ciliary vein, anterior, 88, 90, 91 Cingular artery, 142 Cingulate gyrus, 106 isthmus of, 106, 107 Cingulate sulcus, 106 Circle of Willis. See Cerebral arterial circle (of Willis) Circular muscle, 326 Cisterna chyli, 266, 314, 318 lumbar lymph trunk to, 343 Claustrum, 110 Clavicle, 1, 26, 27, 28, 29, 31, 181, 182, 184, 186, 188, 189, 196, 197, 198, 213, 230, 231, 243, 418, 420, 421, 422, 423, 424, 425, 427, 428, 429 acromial end of, 419 acromial facet of, 419 anteroposterior radiograph of, 422 conoid tubercle of, 419 costoclavicular ligament impression on, 419 inferior surface of, 419 radiograph of, 422 right, 419 shaft body of, 419 sternal end of, 419 sternal facet of, 419 subclavian groove of, 419 superior surface of, 419 trapezoid line of, 419 Clavipectoral fascia, 428 pectoralis minor muscle invested by, 188 subclavius muscle invested by, 188 Clavipectoral fossa, 428 Clinoid process anterior, 9 coronal CT images of, 151 posterior, 9 Clitoris body of, 388 crus of, 360, 366, 370 deep artery of, 404 deep dorsal vein of, 356, 357, 360, 364, 365 dorsal artery of, 404 dorsal nerve of, 267, 413, 414 frenulum of, 377 glans of, 377, 388 prepuce of, 377 suspensory ligament of, 378, 379, 380 Clivus, 9 surface of, 22 Cloquet, node of, 266, 408 Clunial nerve inferior, 177, 411, 413, 503, 540, 545 medial, 177, 502, 545 superior, 177, 254, 502, 545 Coccygeal cornu, 157 Coccygeal ligament, 160, 161

Coccygeal nerve, 160, 161, 499 vertebrae and, 161 Coccygeal plexus, 499 schema of, 499 Coccygeus (ischiococcygeus) muscle, 263, 358, 359, 398, 402, 410, 411, 412 Coccyx, 153, 157, 160, 161, 248, 352, 353, 357, 376, 379, 391 anterior inferior view of, 157 posterior superior view of, 157 spinal nerves and, 161 tip of, 354, 357, 359, 376, 380, 382, 395 transverse process of, 157 Cochlea, 92, 95, 97 helicotrema of, 92, 96 osseous, 92, 96 section through, 92, 96 Cochlear aqueduct, 96 Cochlear cupula, 95 Cochlear ganglion, 124 Cochlear nerve, 92, 95, 96, 97 distribution of, 118 posteromedial view of, 95 Cochlear nucleus, anterior and posterior, 116, 117, 124 Cochlear recess, 95 Cochlear window. See Round window (cochlear) Cochleus, modiolus of, 96 Colic artery arc of Riolan between middle and left, 308 ascending branch of, 307, 398 descending branch of, 307, 398 left, 264, 307, 318, 323, 324, 340, 398 middle, 290, 298, 301, 306, 307, 318, 322, 323, 340, 348 absence of, 308 right, 306, 307, 308, 322, 323, 340 absence of, 308 variations of, 308 Colic flexure . left, 126, 269, 270, 271, 272, 275, 278, 284, 288, 298, 347 right, 269, 288, 297 Colic impression, 287 Colic lymph nodes left, 317 middle, 317 right, 317 Colic plexus left, 278, 284, 318, 323 middle, 322, 323 right, 275, 322, 323 Colic vein left, 311,312,313 middle, 298, 303, 311, 312 right, 311, 312, 313 Collateral artery middle, 432, 434, 435 radial, 434, 435 Collateral eminence, 111 Collateral ligament, 509 fibular, 493, 499 radial, 438 tibial, 493, 514 ulnar, 438 Collateral sulcus, 106 Collateral trigone, 111

Collecting tubule, 336, 337 schema of, 337 Colles' fascia. See Superficial perineal (Colles') fascia Colliculus brachia of, 114 inferior, 106, 111 brachium of, 111 left, 144 superior, 106, 107, 111, 114, 115, 116, 132, 143, 144 brachium of, 111 left, 144 Colli muscle, nerves to, 129 Colon air in, radiograph of, 355 area for, 329 ascending, 126, 269, 272, 278, 284, 339, 349 axial CT images of, 350 cross section of, 338 site of, 274 circular muscle of, 282 descending, 167, 271, 278, 339, 342 area for, 329 cross section of, 338, 349 descending from left colic flexure, 297 from left colic flexure, 297 site of, 274 mucosa and musculature of, 284 nerve to, 410 right colic flexure of, 297 cross section of, 297 , sigmoid, 167, 168, 269, 271, 284, 391, 392, 393, 394, 412 looping to right side, 284 nerve to, 410 reflected, 271 variations in position of, 285 transverse, 269, 270, 273, 278, 284, 291, 294, 298, 299, 339 ascending to left colic flexure, 297 axial CT images of, 350 cross section of, 338 tributary from, 309 tributary from, 311 Commissure anterior, 106, 115, 146, 147 of fornix, 112 habenular, 106, 111 posterior, 106, 111, 388 Communicating artery anterior, 136, 138, 139, 140, 141, 142 posterior, 104, 136, 139, 140, 141, 142, 143 Communicating vein, 31, 137 Compressor urethra, female, 356 Compressor urethrae muscle, 367, 404 Compressor urethralis muscle, 370 Computed tomography (CT) abdominal, 350 of arteries of the arm, 484 of chest, 242 of head, 150 coronal images of, 151 of upper limb arteries, 484 Concha inferior, 14 nasal. See Nasal concha Conducting system, 225

Condylar canal, 11 Condylar emissary vein, 137 Condyle lateral, 489 medial, 489 Coneus, 106 C1 spinal nerve, 133 dorsal ramus of, 178 dorsal roots of, 114 exit of, 161 ventral ramus of, 71 ventral roots of, 114 C1 vertebra. See Atlas (C1) Conjunctiva, 91 bulbar, 81, 83, 88, 90 inferior palpebral, 81 palpebral, 83 superior palpebral, 81 Conjunctival artery, posterior, 91 Conjunctival fornix inferior, 81 superior, 81 Conjunctival vein, posterior, 91 Conjunctival vessels, 90, 91 Connective tissue of liver, 291 subserous, 326 Connective tissue sheath, 202 Conoid ligament, 425, 423 attachment of, 419 Conus arteriosus, 212, 218, 220, 222, 224 Conus elasticus, 78 Conus medullars, 160, 161, 170, 339 Convoluted tubule distal, 336 proximal, 336 Cooper's ligament. See Pectineal ligament (Cooper's) Coracoacromial ligament, 423, 425, 426, 430 Coracobrachialis muscle, 244, 245, 429, 430, 433, 435, 474 fascia over, 428 insertion of, 420 origin of. 420 Coracoclavicular ligament, 423 Coracohumeral ligament, 423 Coracoid process, 185, 189, 420, 421, 423, 425, 427, 428, 429, 433 anteroposterior radiograph of, 422 Cornea, 81, 83, 87, 88, 90, 91 Corneal limbus, 81 Corneoscleral junction, 81 Corniculate tubercle, 77 Coronal sulcus, 246, 385, 388 Coronal suture, 2, 5 Coronary artery anterior interventricular branch of, 219 diagonal branches of, 219 arteriographic views of, 218, 219 arterioventricular nodal branch of, 218 circumflex branch of, 219 atrioventricular branch of, 219 conus branch of, 218 of diaphragmatic surface, 216 interventricular septal branches of, 216, 217

Coronary artery (Continued) left, 216, 217, 219 anterior interventricular branch of, 216, 217, 219 circumflex branch of, 216, 217, 219 marginal branch of, 216, 217, 218 opening of, 224 posterior interventricular branch of, 218 posterior left ventricular branch of, 217 posterolateral branches of, 218, 219 right, 217, 218 atrial branch of, 216, 217 marginal branch of, 216, 217 opening of, 223 posterior interventricular branch of, 216, 217 posterolateral branches of, 216 sinuatrial nodal branch of, 216, 218 of sternocostal surface, 217 variations in, 217 Coronary ligament enclosing bare area of liver, 348 hepatorenal portion of, 287 of liver, 287 Coronary sinus, 214, 215, 216, 221, 233, 241 opening of, 220, 223 valve of, 220 Coronary sulcus, 214 Coronary vein, variations in, 217 Coronoid fossa, 420 Coronoid process, 15, 436, 443 radiograph of, 422 Corpora cavernosa, 382 Corpora quadrigemia, 107 Corpus albicans, 371 Corpus callosum, 106, 107, 108, 111, 141, 143 anterior, 145 cistern of, 109 dorsal vein of, 144, 146 genu of, 106, 107, 110, 112, 146 right dorsal branch to, 143 rostrum of, 106, 141 sagittal MR image of, 149 splenium of, 106, 107, 110, 112, 143, 144, 145, 146 sulcus of, 106 trunk of, 106, 141 Corpus cavernosum, 361, 382, 383, 385 sagittal MR images of, 371, 397 Corpus luteum, 371 Corpus spongiosum, 361, 366, 381, 382, 383 sagittal MR images of, 397 Corpus striatum, 110, 141 Corrugator cutis ani muscle, 393 Corrugator supercilii muscle, 25, 36, 123 Corti, organ of. See Spiral organ (of Corti) Cortical radiate artery, 335, 337 lymph vessels along, 343 Cortical radiate vein, 337 Costal facet inferior, 187 superior, 187 Costal groove, 186 Costal impression, 287

Costal pleural, 231, 232 Costocervical trunk, 33, 69, 136, 137, 138 Costochondral joint, 186 Costoclavicular ligament, 186, 419 attachment of, 419 Costocoracoid ligament, 188, 428 Costocoracoid membrane, 428 Costodiaphragmatic recess, 198, 230, 231, 293, 330, 332, 342, 349 right, 206 Cosfomediastinal space, 331 lateral, 198 superior, 198 Costovertebral joint, 243 left lateral view of, 187 right posterolateral view of, 187 transverse section of, 187 Cough receptor, 210 Cowper's gland. See Bulbourethral (Cowper's) gland Coxal bone. See Hip bone Cranial base bones of, 9 foramina of, 10, 11 inferior view of, 10 inferior view of, 8 Cranial fossa anterior, 9 middle, 9 posterior, 9 arteries of, 142, 143 veins of, 144 posterior veins of, 144 Cranial mesonephric (Gartner's) duct, 389 Cranial mesonephric tubule, 389 Cranial nerve, 116, 130-133, 134-135 in carotid sheath, 60 communicating branch of, 45 motor and sensory distribution of, 118 nuclei of medial dissection of, 117 posterior phantom view of, 116 schema of, 116 palsy of, 101 Cranial nuclei, in brainstem, schema of, 117 Craniocervical ligaments external anterior view of, 21 posterior view of, 21 right lateral view of, 21 internal, 22 Cremaster fascia, 250 Cremasteric artery, 255 Cremasteric muscle, 250, 251, 259, 261, 390 lateral origin of, 259 medial origin of, 259 Cremasteric vessels, 260, 401 Cribriform fascia, 546 Cribriform plate, 6, 9, 37, 39, 119 foramina of, 11 Cricoarytenoid muscle lateral, 78, 80 action of, 78, 79 posterior, 78, 80, 235 action of, 79

Cricopharyngeus muscle, 75, 76, 80, 233, 234, 235 Cricothyroid artery, 69 Cricothyroid joint, 77 pivot point of, 79 Cricothyroid ligament lateral, 77 median, 74, 77, 202 Cricothyroid muscle, 29, 68, 74, 78, 80, 126

action of, 79 oblique part of, 79 straight part of, 79 Crista galli, 3, 6, 9, 39 coronal CT images of, 151 Crista terminalis, 220, 225 Cross section of abdomen at L1-2, 339, 349 at L3, 349 at L3, 4, 349 at T10, 293 at T12, 297, 331, 338 of descending duodenum, 179 forearm, serial, 449 of gallbladder, 297 of scrotum, 390 of testis, 390 Cruciate ligament, 22, 507, 509 anterior, 508, 509, 514 attachment of, 508 origin of, 514 inferior longitudinal band of, 22 posterior, 514 attachment of, 514 superior longitudinal band of, 22 transverse, 22 C3 spinal nerve, 19, 127 dorsal ramus of, 178 ventral ramus of, 32, 71, 178 C2 spinal nerve, 133 dorsal ramus of, 177, 178 ventral ramus of, 32, 71, 177 Cubital fossa, 418 Cubital lymph nodes, 483, 484 Cubital node, 483 Cubital vein intermediate, 480 median, 418, 479, 483, 484 Cuboid bone, 523, 524, 527, 536, 537 articular surface for, 525 base of, 523 dorsal view of, 523 groove for fibularis longus tendon insertion, 523 plantar view of, 523 radiograph of, 54 shaft of, 523 tuberosity of, 523, 524, 528, 536 Cuboideonavicular ligament, plantar, 528 Culrnen, 113, 115, 144 Cuneate fasciculus, 114 Cuneate tubercle, 114 Cuneiform bone intermediate, 523, 536 lateral, 523, 536 radiograph of, 54 medial, 523, 524, 527, 536 plantar view of, 523

Cuneiform tubercle, 66, 67, 78 Cuneocuboid ligament, dorsal, 527 Cuneonavicular ligament dorsal, 527 plantar, 528 Cuneus, 106 apex of, 107 Cuspid teeth. See Teeth, canine Cutaneous nerve(s) antebrachial lateral, 469 dorsal, lower limb intermediate, 540, 541, 542 lateral, 542, 545 medial, 541, 542 femoral lateral, 409 posterior, 411 of forearm, medial, 469 of head, 24 lateral antebrachial, 447 lateral dorsal, 544 lateral femoral, 329, 499, 538, 539 medial antebrachial, 429, 432, 469 of neck, 24, 31 perforating, 411, 499 posterior antebrachial, 469 superior lateral brachial, 177 Cuticle, 471 C1 vertebra. See Atlas (C1) C2 vertebra. See Axis (C2) C3 vertebra, 13 inferior articular facet for, 19 tubercles of transverse process of anterior, 30 posterior, 30 C4 vertebra anterior tubercle of, 18 body of, 18 lamina of, 18 „