Muscle

Biceps brachii

Origin
(SH) coracoid process of scapula (LH) supraglenoind tubercle of scapula Coracoid process of scapula $nterior distal humerus (LH) infraglenoid tubercle of scapula (MeH) posterior humerus! superior to radial groove (LaH) posterior humerus! inferior to radial groove

Insertion
Radial tuberosity

Action
Flexion of the forearm Supination of the forearm

Innervation
Musculocutaneous nerve (C ! C")

Coracobrachialis Brachialis Triceps

Middle! medial surface of humerus Coronoid process and ulnar tuberosity %lecranon of ulna and fascia of forearm

Flexes and adducts the arm Flexes forearm &xtends the forearm and long arm resists dislocation of forearm

Musculocutaneous nerve (C ! C"! C#) Musculocutaneous nerve (C ! C") Radial nerve (C"! C#! C')

Ligament Sacroiliac: Anterior Posterior Interosseous Sacrospinous Sacrotuberous

&xtends from $nterior surface of sacrum (osterior sacral tubercle Sacral tuberosities Lateral margin of sacrum and coccyx Lateral margin of sacrum and coccyx Venous drainage %varian veins (right drains into )+C and left into left renal vein) *terine veins )schial

&xtends to $nterior surface of ilium (osterior superior iliac spine )lium spine

)schial tuberosity

Structure Ovaries

Arterial supply %varian artery (branch of abdominal artery) *terine artery (branch of internal iliac) *terine artery (branch of internal iliac) %varian artery *terine artery (branch of internal iliac! branches into arcuate arteries as it goes alongside the uterus in the myometrium) +aginal artery Middle rectal artery )liolumbar artery

Ly phatic drainage %varian lymphatic vessels drain via para,aortic lymph nodes into the lumbar trun-s )nternal iliac lymph nodes

Innervation $utonomic via aortic plexus +isceral afferent enter spinal cord segments at ./0 1 .// Hypogastric plexus (symp and parasymp nerves turn on fe2 hours before ovulation) Sensory info reaches dorsal root at .// 3 ./4 Symp via Hypogastric plexus (arasymp via sacral segments S5 3S6

!terine tubes

!terus

*terine veins

Lymphatic vessels

Vagina

+aginal veins (begins at the greater sciatic foramen and into internal iliac veins)

)nternal iliac lymph nodes Superficial inguinal lymph nodes

Pelvic "all Piri#or is Origin $nterior surface of sacrum! superior margin of greater sciatic notch and sacrotuberous ligament Insertion 7reater trochanter of femur Action Lateral rotation of the thigh! assists in holding head of femur in acetabulum Innervation $nterior rami of S/ and S4

Obturat or e$ternus Obturat or internus

Origin &xternal surface of obturator membrane! anterior bony margins of obturator foramen (elvic surfaces of ilium and ischium8 obturator membrane

Insertion 7reater trochanter of femur 7reater trochanter of femur

Action Lateral rotation of the thigh! adducts the thigh Lateral rotation of the thigh! assists in holding head of femur in acetabulum

Innervation %bturator nerve (L5! L6) 9erve to obturator internus (L ! S/! S4)

Pelvic #loor Origin Lavator ani: Pubococcyge us Puborectalis Iliococcygeus :ody of pubis :ody of pubic )schial spin Insertion Coccyx Rectum! anal canal Coccyx Action Supports 3 maintains pelvic viscera and resists increases n abdominal pressure (coughs! snee;es) Forms part of the pelvic diaphragm so supports pelvic viscera! flexes coccyx during childbirth Innervation Coccygeal plexus! 9erve to lavator ani (branch of S6)! )nferior rectal nerve :ranches of S6 and S

Coccygeus %ischiococcygeus&

)schial spine

)nferior end of sacrum 3 coccyx

!rogenital triangle o# ale and #e ale %rigin )nsertion Super#icial (erineal body transverse perineus )nternal surface of 'eep transverse ischiopubic ramus (erineal body and and )schial perineus external anal tuberosity sphincter

Ischiocavernosis

)nternal surface of ischiopubic ramus and )schial tuberosity Male= Median raphe on ventral surface of bulb of penis8 perineal body

Bulbospongiosis

&mbraces crus of penis or clitoris! and perineal membrane medial to crus Male= perineal membrane! dorsal aspect of corpora spongiosum and cavernosa and fascia of bulb of penis

$ction Supports and fixes perineal body< pelvic floor to support abdominopelvic viscera and resist increased intra, abdominal pressure Maintains erection of penis or clitoris

)nnervation (erineal branch of pudendal nerve (S4,S6)

(erineal branch of pudendal nerve (S4,S6) (erineal branch of pudendal nerve (S4,S6)

Male= supports and fixes perineal body<pelvic floor! compresses bulb of penis to expel last drops of urine<semem8 assists erection by pushing blood

Female= (erineal body

Female= (ubic arch and fascia of corpora cavernosa of clitoris

($ternal urethral sphincter

)nternal surface of ischiopubic ramus and )schial tuberosity

Surrounds urethra

from bulb into body of penis Female= supports and fixes perineal body<pelvic floor8 sphincter of vagina8 assists erection of clitoris< compresses greater vestibular gland Compresses urethra to maintain urinary continence8 in females urethrovaginal sphincter portion also compresses vagina Ly phatic drainage Lymphatic vessels to superficial inguinal lymph nodes Lumbar lymph nodes

>orsal nerve of penis or clitoris! branch of pudendal nerve (S4,S6)

Structure Scrotu

Arterial Supply $nterior and posterior scrotal artery

Venous 'rainage $nterior and posterior scrotal veins

Innervation $nterior scrotal nerve from lumbar plexus and posterior scrotal nerves sacral plexus 7enitofemoral nerve! both divisions of $9S

Testis (pididy us

.esticular artery from abdominal aorta

.esticular veins from pampiniform plexus (ampiniform plexus Venous drainage )nferior vesicle vein Middle rectal vein +eins ?oin the prostatic venous plexus )nternal iliac veins >eep dorsal vein of the penis (from prostatic venous plexus) Superficial dorsal vein (from superficial external pudendal vein)

Structure Se inal vesicles

Arterial Supply )nferior vesicle artery (from internal iliac artery) Middle rectal artery (from internal iliac artery) (rostatic artery (from internal iliac artery) )nternal pudendal artery Middle rectal artery >orsal arteries of the penis (from internal iliac) bet2een the corpora cavernosa >eep arteries of the penis run centrally through the corpora cavernosa $rteries of the bulb of penis Location

Ly phatic drainage &xternal iliac nodes )nternal iliac lymph nodes

Innervation

Prostate

)nternal iliac lymph nodes Some drain into sacral nodes S-in 1 superficial inguinal lymph nodes 7lans 3 Spongy urethra 1 deep inguinal 3 external iliac and internal iliac lymph nodes

)nferior Hypogastric plexus

Penis

>orsal nerve of the penis (terminal branch of pudendal nerve)

)land

)eneral

Blood supply

*unction

Pituitary

$nterio, inferior to the hypothalamu s (osterior to hypothalamu s )nferior to the thyroid cartilage on anterior side of trachea (osterior surfaces of thyroid lobes Superior to the -idneys

structure :i,lobed gland made up of adenohypophysis and neurohypophysis (ine,cone shaped! found in the diencephalon 4 lobes! lin-ed by a thinner connection 1 the isthmus 4 pairs on each thyroid lobe .riangular

Pineal Thyroid

Superior and inferior hypophyseal arteries from the internal carotid arteries Superior cerebellar artery in the brain Superior and inferior thyroid arteries (from common carotid artery) Superior and inferior thyroid arteries Superior! middle and inferior suprarenal arteries

$nterior releases $C.H! .SH! 7)H! (RL! FSH! LH! MSH (osterior releases $>H and oxytocin Releases melatonin (effects 2a-e<sleep patterns) .5 and .6 from follicular epithelium of the gland! stimulates gro2th and development! C cells release C. to decrease Ca ion concentrations Monitor concentration of circulating Ca ions! too lo2 (.H released leads to increased Ca ion levels $drenaline and noradrenalin release in response to sympathetic 9S! Cortex releases mineralocorticoids and corticosteroids Most cells aid maturation of sperm and develop secondary sexual characteristics (roduces thymosines and targets lymphocytes and other cells of immune system to coordinate immune response Releases glucagon and insulin to control blood sugar levels Corpus luteum secretes progesterone to prepare uterus for implantation! oestrogen released by follicle

Parathyroid

Suprarenal corte$ + edulla

Testis , interstitial cells Thy us

)n the scrotum

.2o oval lobes

.esticular artery from abdominal aorta Superior and inferior thyroid arteries

>eep to the sternum! anterior to the trachea (ancreas! inferior border of stomach Lateral to the uterus

Consists of t2o lobes consisting of septa that separate individual lobules Lumpy clusters on the pancrease .2o oval lobes

Pancrease , islets o# Langerhans Ovary , theca interna cells and corpus luteu

Superior and inferior pancreaticoduoden al arteries %varian artery (branch of abdominal artery) *terine artery (branch of internal iliac)

Brachial ple$us Spinal roots A$illary Musculocutaneo us (osterior cord (C ,./) Lateral cord (C ! C" only) $rises from brachial plexus C ! C"! C#! C'! ./ C ! C" Motor distribution >eltoid! .eres minor! 7lenohumeral (shoulder) ?oint Coracobrachialis! biceps brachii! and brachilais! continues as lateral cutaneous nerve of forearm Flexor muscles in Sensory distribution S-in of upper lateral arm S-in of lateral side of forearm

Media

Lateral cord

C ! C"! C#!

S-in of radial half

Medial cord (C ,./)

C'! ./

!lnar

Medial cord (C'! ./)

C'! ./

-adial

(osterior cord (C ,./)

C ! C"! C#! C'! ./

forearm (except flexor carpi ulnaris! ulnar half of flexor digitorum profundus! and five hand muscles Flexor carpi ulnaris and ulnar half of flexor digitorum profundus (forearm)8 most intrinsic muscles of hand .riceps brachii! anconeus! brachioradialis! and extensor muscles of forearm

of palm

S-in of medial side of 2rist! hand and some fingers

S-in of posterior arm! forearm and hand

Type o# /oint Articulating sur#aces

($tent o# capsule

Shoulder .oint %)lenohu eral /oint& :all,and,soc-et type of synovial ?oint (mobility ma-es the ?oint relatively unstable) Head of humerus 7lenoid cavity of the scapula ( 2hich is deepened slightly by the fibrocartilaginous 7lenoid labrum) Loose fibrous layer of the ?oint capsule surrounds the 7lenohumeral ?oint (?oint capsule attachments)8 Medially 1 the margin of the glenoid cavity Laterally 1 anatomical nec- of the humerus Superiorly 1 encroaches on the root of the coracoid process so the fibrous layer of the ?oint capsule encloses the proximal attachment of the long head of the biceps brachii to the supraglenoid tubercle of scapula 2ithin the ?oint@ Aoint capsule has t2o apertures8 an opening bet2een the tubercles of the humerus for passage of the tendon of the long head of the biceps brachii and an opening situated anteriorly! inferior to the coracoid process that allo2s communication bet2een the subscapular bursa and the synovial

Liga

ents

Move

ents

cavity of the ?oint@ )nferior part of the ?oint capsule is the only part not reinforced by the rotator cuff muscles so is the 2ea-est area@ 7lenohumeral ligament (superior! middle and inferior) Coracohumeral ligament Coracoacromial ligament More freedom than any other ?oin $llo2s movement around three axes Flexion,extension $bduction,adduction Rotation (medial and lateral) Circumduction@ (lbo" .oint Hinge ?oint type of synovial ?oint (4,5 cm inferior to the epicondyle of humerus .rochlea and capitulum of humerus .rochlea notch of ulna and head of radius .herefore there are humerulnar and humeroradial articulations Fibrous layer of the ?oint capsule surrounds the elbo2 ?oint= $ttached to humerus at the margins of the lateral and medial ends of the articular surfaces of the capitulum and trochlea@ $nteriorly and posteriorly it is carried superiorly! proximal to the coronoid and olecranon fossae@ Collateral ligaments of the elbo2 ?oint are medial and lateral thic-enings of the fibrous layer of the ?oint capsule8 Lateral 1 radial collateral ligament >istal 1 anular ligament of the radius Medial 1 ulnar collateral ligament Flexion and extension Long axis of the fully extended ulna ma-es an angle of approximately /#0 degrees 2ith the long axis of the humerus@ .his is called the carrying angle@

Type o# /oint Articulating sur#aces

($tent o# capsule

Liga

ents

Move ents Other

Pro$i Type o# /oint Articulating sur#aces ($tent o# capsule Liga ents

Move

ents

al -adioulnar .oint %diagra s are above& (ivot type of synovial ?oint that allo2s movement of the head of the radius on the ulna@ Head of the radius articulates 2ith the radial notch of the ulna@ .he radial head is held in position by the anular ligament of the radius@ Fibrous layer of the ?oint capsule encloses the ?oint and is continuous 2ith that of the elbo2@ $nnular ligament of radius 1 attached to the ulna anterior and posterior to its radial notch@ .he deep surface of the anular ligament is lined 2ith synovial membrane! 2hich continues distally as a sacciform recess of the proximal radioulnar ?oint@ >uring pronation and supination of the forearm! the head of the radius rotates 2ithin the collar formed by the anular ligament and radial notch of the ulna@ 'istal -adioulnar .oint (ivot type of synovial ?oint Round head of ulna articulates *lnar notch on the medial side of the

Type o# /oint Articulating sur#aces

($tent o# capsule

Liga Move

ents ents

distal end of the radius $ fibrocartilaginous articular disc of the distal radioulnar ?oint binds the ends of the ulna and radius together and is the main uniting structure of the ?oint Fibrous layer of the ?oint capsule encloses the distal radioulnar ?oint but is deficient superiorly@ .he synovial membrane extends superiorly bet2een the radius and the ulna to form the sacciform recess of the distal radioulnar ?oint@ (diagram belo2) $nterior and posterior ligaments extend from the radius to the ulna@ >uring pronation of the forearm and hand! the distal end of the radius moves (rotates) anteriorly and medially! crossing over the ulna anteriorly@ >uring supination! the radius uncrosses from the ulna! its distal end moving (rotating) laterally and posteriorly so the bones become parallel@ -adiocarpal .oint %"rist& &llipsoidal ?oint >istal end of the radius and the articular dis(diagram above) of the distal radioulnar ?oint articulate 2ith the proximal ro2 of carpal bones! except for the pisisform@ Fibrous layer of the ?oint capsule surrounds the 2rist ?oint and is attached to the distal ends of the radius and ulna and the proximal ro2 of carpals (scaphoid! lunate and triBuetrum)@ Pal er -adiocarpal liga ents (attached in such a 2ay so that hand follo2s the radius during supination of the forearm) 'orsal -adiocarpal liga ents (attached in such a 2ay so that hand follo2s the radius during pronation of the forearm) !lnar collateral liga ent (medial) -adial collateral liga ent (lateral) Flexion and extension $bduction and adduction Circumduction Type o# /oint Synovial ! plane Articulating sur#aces Aoints bet2een the carpal bones of the proximal ro2 Aoints bet2een the carpal bones of the distal ro2 .he idcarpal /oint 1 bet2een the proximal and distal ro2s of carpal bones .he pisotri0uetral /oint 1 formed from articulation of the pisiform 2ith the palmer surface of Move ent 7liding movement

Type o# /oint Articulating sur#aces

($tent o# capsule

Liga

ents

Move

ents

.oint Intercarpal %IC&

Carpo etacarpal %CMC&

Synovial! plane

the triBuetrum >istal surfaces of the carpals of the distal ro2 Carpal surfaces of the bases of the metacarpals

CMC o# the thu

Synovial! saddle

.rape;ium .he base of the /st metacarpal

Inter etacarpal %IMC&

Synovial! plane

$d?acent metacarpals articulate 2ith each other

$lmost no movement occurs at the CMC ?oints of the 4nd and 5rd fingers! that of the 6th finger is lightly mobile! and that of the th finger is moderately mobile! flexion and rotating slightly during a tight grasp@ (ermits angular movement in any plane 1 flexion,extension! abduction,adduction or Circumduction and restricted amount of axial rotation $s-=

Metacarpophalangea l %MCP& Knuckles

Synovial! condyloid (allo2 movement in t2o planes8 flexion, extension! adduction, abduction@

Metacarpals :ase of proximal phalanges

Pro$i al interphalangeal %PIP& 'istal interphalangeal %'IP&

Synovial! hinge Synovial! hinge

Middle phalanges (roximal phalanges >istal phalanges Middle phalanges

Flexion,extension! abduction, adduction! and Circumduction of the 4nd, th digits occur at the 4nd, th M( ?oint Movement at the M( ?oint of the thumb is limited to flexion, extension Flexion and extension Flexion and extension

Muscles o# the anterior %#le$or& co Origin Muscle *le$or carpi ulnaris Humeral head= medial epicondyle of humerus *lnar head= olecranon and

part ent o# the #orear Insertion Action Super#icial layer (isiform! hoo- of hamate! and th metacarpal Flexes 2rist and adducts hand

Innervation *lnar nerve (C#, C')

Pal

aris longus

posterior border of ulna Medial epicondyle of humerus

*le$or carpi radialis Pronator teres

Medial epicondyle of humerus Coronoid process of ulna Humeroulnar head= medial epicondyle of humerus! ulnar collateral ligament and coronoid process of ulna Radial head= superior half of anterior border of radius $nterior surface of radius $d?acent interosseous membrane (roximal three Buarters of medial and anterior surfaces of ulna and interosseous membrane >istal fourth of anterior surface of ulna

>istal half of flexor retinaculum and palmar aponeurosis :ase of 4nd and 5rd metacarpal Middle of lateral surface of radius (pronator tuberosity)

Flexes 2rist and tightens palmer aponeurosis Flexes 2rist and abducts hand (ronates forearm and flexes elbo2

Median nerve (C#, C') Median nerve (C", C#) Median nerve (C", C#)

*le$or digitoru super#icialis

Inter ediate layer :odies of middle Flexes ()(s of phalanges of medial four medial four digits digits Flexes MC(s and hand

Median nerve (C#!C' and ./)

*le$es pollicis longus

'eep layer :ase of distal phalanx of thumb

Flexes phalanges of /st digit (thumb)

Median branch of interosseous nerve (C',./)

*le$or digitoru pro#undus

:ases of distal phalanges of medial four digits

Flexes >)(s of medial four digits8 assists 2ith flexion of 2rist

Pronator 0uadratus

>istal fourth of anterior surface of radius

(ronates forearm8 deep fibres bind radius and ulna together

Medial part= ulnar nerve (C',./) Lateral part= median nerve (C',./) Medial part= ulnar nerve (C',./) Lateral part= median nerve (C',./)

Muscles o# the posterior %e$tensor& co part ent o# the #orear Muscle Origin Insertion Action Super#icial layer Brachioradialis (roximal t2o Lateral Flexes forearm

Innervation Radial nerve (C !

%1& ($tensor carpi radialis longus %3& ($tensor carpi radialis brevis %4& ($tensor digitoru %6&

thirds of lateral supraepicondylar ridge of humerus Lateral supraepicondylar ridge of humerus Lateral epicondyle of humerus Lateral epicondyle of humerus

surface of distal end of radius :ase of second metacarpal bone :ase of third metacarpal bone &xtensor expansions of medial four digits

C2! and C#) &xtend and abduct hand at 2rist ?oint &xtend and abduct hand at 2rist ?oint &xtends medial four digits at metacarpophalangea l ?oints &xtends hand at 2rist ?oint &xtends fifth digit at metacarpophalangeal and interphalangeal ?oints &xtends and adducts hand at 2rist ?oint Radial nerve (C" and C#) >eep branch of radial nerve (C5 and C') (osterior interosseous nerve (C# and C')! a branch of the radial nerve

($tensor digit ini i %7& ($tensor carpi ulnaris %2&

Lateral epicondyle of humerus Lateral epicondyle of humerus (osterior border of ulna Lateral epicondyle of humerus

&xtensor expansion of fifth digit :ase of fifth metacarpal bone

(osterior interosseous nerve (C# and C')! a branch of the radial nerve

Anconeus %5&

Supinator %8&

($tensor indicis %9&

Abductor pollicis longus %1:& ($tensor pollicis longus %11&

($tensor pollicis brevis %13&

Lateral epicondyle of humerus Radial collateral and anular ligaments Supinator fossa Crest of ulna (osterior surface of ulna )nterosseous membrane (osterior surface of ulna! radius! and interosseous membrane (osterior surface of middle third of ulna )nterosseous membrane (osterior surface of radius

'eep Layer Lateral $ssists triceps in surface of extending elbo2 olecranon ?oint Superior Stabili;es elbo2 ?oint part of $bducts ulna during posterior pronation surface of ulna Lateral! Supinates forearm posterior! and anterior surfaces of proximal third of radius

Radial nerve (C#! C'! and ./)

>eep branch of radial nerve (C and C2)

&xtensor expansion of second digit :ase of first metacarpal bone :ase of distal phalanx of thumb

&xtends second digit Helps to extend hand

$bducts thumb and extends it at carpometacarpal ?oint &xtends distal phalanx of thumb at metacarpophalangeal and interphalangeal ?oints &xtends proximal phalanx of thumb at metacarpophalangeal

(osterior interosseous nerve (C# and C8)

:ase of proximal phalanx of

 )nterosseous membrane

thumb

/oint

Muscles that act on the thu b Muscle Origin *le$or Flexor retinaculum pollicis (transverse carpal brevis ligament) %Medial ; .ubercle of trape;ium deep uscle o# thenar& Abductor Flexor retinaculum pollicis .ubercles of scaphoid brevis and trape;ium %lateral super#icial ; lateral uscle o# thenar Opponens Flexor retinaculum pollicis (transverse carpal %opposition& ligament) %deep to .ubercle of trape;ium abductor pollicis brevis& Adductor %bliBue head= base of pollicis second and third metacarpals! capitate and ad?acent carpal bones .ransverse head= anterior surface of body of third metacarpal Muscles that act on the little #inger Muscle Origin *le$or digiti Hoo- of hamate ini i brevis Flexor retinaculum (transverse carpal ligament) Abductor digit (isiform ini i Opponens digiti ini i Hoo- of hamate Flexor retinaculum (transverse carpal ligament)

Insertion Lateral side of base of proximal phalanx of thumb Lateral side of base of proximal phalanx of thumb

Action Flexes thumb

Innervation

$bducts thumb and helps oppose it

Recurrent branch of median nerve (C' and ./)

Lateral side of first metacarpal

%pposes thumb to2ards centre of palm and rotates it medially

Medial side of base of proximal phalanx of thumb

$dducts thumb to2ards middle digit

>eep branch of ulnar nerve (C' and ./)

Insertion Medial border of fifth metacarpal

Action Flexes proximal phalanx of digit

Innervation

Medial side of base of proximal phalanx of digit Medial border of fifth metacarpal

$dducts digit >ra2s fifth metacarpal anteriorly and rotates it! bringing digit into opposition 2ith thumb

>eep branch of ulnar nerve (C' and ./)

Short uscles o# the hand Muscle Origin Lu bricals %6 Lateral side of uscles& each tendon of flexor digitorum profundus in the palm

Insertion Lateral sides of extensor expansions of digit 4,

Action Flexes digits at metacarpophala ngeal ?oints &xtends interphalangeal

Innervation Median nerve (C',./) >eep branch of ulnar nerve (C' and ./)

'orsal interossei %6 uscles& Pal er interossei %6 uscles&

$d?acent side of t2o metacarpals

(almar surface second! fourth and fifth metacarpals

&xtensor expansions and bases of proximal phalanges of digit 4,6 &xtensor expansion of digits and bases of proximal phalanges of digit 4! 6! and

?oints $bducts digit 4, $ssists lumbricals $dducts digit 4! 6! and

>eep branch of ulnar nerve (C' and ./) >eep branch of ulnar nerve (C' and ./)

:reast region Superior lateral 0uadrant

In#erior lateral 0uadrant Superior edial 0uadrant

Lymph nodes $nterior axillary nodes $pical axillary nodes Medial axillary nodes $nterior axillary nodes )nternal thoracic nodes $pical axillary nodes Medial axillary nodes Cutaneous nodes )nternal thoracic nodes Cutaneous nodes

&fferent drainage Superior trun-

Cutaneous lymphatics into superior trunSubaveolar plexus to axilla

In#erior

edial 0uadrant

Cutaneous lymphatics

($trinsic uscles o# the shoulder Muscle Origin Pectoralis a/or Clavicular head= sternal head of clavicle Sternocostal head= anterior surface of sternum and superior six costal cartilages $bdominal part= aponeurosis of external obliBue muscle $nterior surfaces of ribs 4, Ribs /,'

Insertion $nterior muscles )ntertubercular groove of humerus

Action $dducts and medially rotates humerus $cting alone= Clavicular head flexes humerus and Sternocostal head extends it from the flexed position >ra2s scapula inferiorly and anteriorly Rotates scapula so its inferior angle moves laterally and up2ards $bducts and raises the arm $nchors and depresses clavicle

Innervation Lateral and medial pectoral nerves

Pectoralis Serratus anterior

inor

Coracoid process of scapula $nterior surface of medial border of scapula

Medial pectoral nerve (C'! ./) Long thoracic nerve (C ! C"! C#)

Subclavius

Costal cartilage of /st rib

)nferior surface of middle third of clavicle Posterior uscles

9erve to subclavius (C ! C")

Latissi

us dorsi

Trape<ius

Levator scapulae

Spinous processes of inferior six thoracic vertebrae )liac crest )nferior 5 or 6 ribs %ccipital bone Spinous processes of .#, ./4 9uchal ligament (osterior tubercle of transverse processes of C/, C6 Minor= 9uchal ligament and spinous processes of C# and ./ Ma?or= spinous processes of .4, .

)ntertubercular sulcus of humerus

&xtends! adducts and medially rotates humerus &levates! retracts! and rotates scapula

.horacodorsal nerve (C",C')

$cromion Spine of scapula

Superior medial border of scapula

-ho and

boid inor

a/or

Medial border of scapula

&levates scapula and tilts its glenoid cavity inferiorly by rotating scapula Retracts scapula and rotates it to depress glenoid cavity8 fixes scapula to thoracic 2all

Spinal accessory nerve Cervical nerve (C5,C6) >orsal scapular (C ) Cervical nerves (C5,C6) >orsal scapular nerve (C6,C )

Intrinsic uscles o# the shoulder Muscle Origin 'eltoid Clavicular part= lateral third of clavicle $cromial part= acromion Spinal part= spine of scapula

Insertion >eltoid tuberosity of humerus

Teres

inor

Superior lateral border of scapula

)nferior facet on greater tubercle of humerus Crest of lesser tubercle Superior facet on greater tubercle of humerus Middle facet on greater tubercle of humerus Lesser tubercle of humerus

Teres

a/or

Supraspinatus

(osterior surface of inferior angle of scapula Supraspinous fossa of scapula )nfraspinous fossa of scapula

In#raspinatus

Subscapularis

Subscapular fossa

Action Clavicular (anterior) part= flexes and medially rotates arm $cromial (middle) part= abducts arm Spinal (posterior) part= extends and laterally rotates arm Laterally rotates arm8 helps to hold humeral head in glenoid cavity of scapula $dducts and medially rotates the arm Helps deltoid to abduct arm and acts 2ith rotator cuff muscles Laterally rotates arm8 helps to hold humeral head in glenoid cavity of scapula Medially rotates arm and adducts it8 helps to hold humeral head in glenoid cavity

Innervation $xillary nerve (C , C")

$xillary nerve (C and C")

Lo2er subscapular nerve (C" and C# Suprascapular nerve (C6! C ! and C") Suprascapular nerve (C and C")

*pper and lo2er subscapular nerves (C ! C"! and C#)

Type o# /oint

=ip .oint :all C Soc-et

Articulating sur#aces ($tent o# capsule

Liga

ents

Move

ents

Round head of femur $cetabulum (roximally , Forms external fibrous layer and internal synovial membrane@ Fibrous layer attaches to the acetabulum and the transverse acetabular ligament@ >istally , Fibrous layer attaches to femoral necand the root of the greater trochanter@ (osteriorly , Fibrous layer crosses the necproximal to the intertrochanteric crest@ $nteriorly and superiorly , iliofemoral ligament 2hich attaches to the anterior inferior iliac spine and the acetabular rim proximally and the intertrochanteric line distally@ :odies strongest ligament and prevents hyperextension of the hip ?oint during standing@ $nteriorly and inferiorly , pubofemoral ligament 2hich arises from the obturator crest of the pubic bones and merges 2ith the fibrous layer of the ?oint capsule@ :lends 2ith medial part of the iliofemoral ligament and prevents overabduction of the hip ?oint@ (osteriorly , ischiofemoral ligament 2hich arises from the ischial part of the acetabular rim and attaches to femoral nec-@ .ransverse ligament of acetabulum 1 attaches to acetabular fossa and converts the notch into a foramen Ligament of the head of femur (teres) 1 attaches to femoral fovea and to acetabular fossa! margins of acetabular notch and the transverse acetabular ligament Flexion<extension $bduction<adduction Medial,lateral rotation Circumduction

Muscles that act on the hip Muscles o# the gluteal region Muscle Origin )luteus a$i us (osterior sacrum and coccyx Sacrotuberous ligament ilium edius &xternal surface of ilium &xternal surface of ilium $nterior surface of sacrum Sacrotuberous ligament (elvic surface of obturator membrane and

Insertion Super#icial layer Lateral condyle of tibia 7luteal tuberosity

Action &xtension $ssists in lateral rotation $ssists in rising from sitting position Steadies thigh $dducts thigh Medially rotates thigh

Innervation )nferior gluteal nerve (L ! S/! S4)

)luteus )luteus ini us Piri#or is

Lateral surface of greater trochanter of femur $nterior surface of greater trochanter of femur Superior border of greater trochanter of femur Medial surface of greater trochanter of femur

Superior gluteal nerve (L7> S/) Superior gluteal nerve (L7> S/) :ranches of anterior rami of S1> S4 9erve to obturator internus (L ! S1)

Obturator internus

Laterally rotates extended thigh $bducts flexed

Superior ge ellus In#erior ge ellus ?uadratus #e oris

surrounding bones )schial spine )schial tuberosity Lateral border of ischial tuberosity

Medial surface of greater trochanter

thigh Steadies femoral head in acetabulum Laterally rotates thigh Steadies femoral head in acetabulum

Duadrate tubercle on intertrochanteric crest of femur

9erve to obturator internus (L ! S1) 9erve to Buadratus femoris (L ! S/) 9erve to Buadratus femoris (L ! S/)

Muscles o# the posterior co Muscle Biceps #e oris

part

ent o# the thigh %collectively @no"n as ha Insertion Lateral side of head of fibula Action Flexes leg Rotates leg laterally &xtends thigh

strings

Origin Long head= ischial tuberosity Short head= linea aspera and lateral supracondylar line of femur )schial tuberosity

Innervation Long head= tibial division of sciatic nerve (L ! S/! S4) Short head= common fibular division of sciatic nerve (L .ibial division of sciatic nerve (L ! S/! and S4)

Se iA ebranous Se itendonosus

(osterior part of medial condyle to tibia Lateral side of head of fibula

&xtend thigh Flexes and rotates leg medially 2hen the thigh is flexed

Muscles o# the anterior co part Muscle Origin Pectineus Superior pubic ramus

ent o# the thigh Insertion (ectineal line of femur

Psoas

a/or

Psoas Iliacus

inor

Lateral aspects of ./4,L vertebrae .ransverse processes of all lumbar vertebrae

Lesser trochanter of femur

Tensor #ascia lata

)liac crest )liac fossa $la of sacrum $nterior sacro, iliac ligaments $nterior superior iliac spine )liac crest

(ectineal line and iliopectineal eminence .endon of psoas ma?or Lesser trochanter )liotibial tract that attaches to lateral condyle of tibia

Action $dducts and flexes thigh $ssists 2ith medial rotation of thigh Flexes thigh at hip ?oint Stabilises hip ?oint Flexes thigh Flexes thigh at hip ?oint Stabilises hip ?oint $dducts thigh Medially rotates thigh Flexes thigh Helps -eep -nee extended

Innervation Femoral nerve (L4! L5)

$nterior rami of lumbar nerve (L/! L4! L5) $nterior rami of lumbar nerve (L/! L4! L5) Femoral nerve (L4 and L5)

Superior gluteal nerve (L6! L )

Sartorius

$nterior superior iliac spine

Superior medial surface of tibia

Flexes thigh at hip ?oint $dducts thigh at hip ?oint Laterally rotates thigh at hip ?oint Flexes leg at -nee ?oint

Femoral nerve (L4! L5)

-ectus #e oris %0uadriceps #e oris& Vastus lateralis %0uadriceps #e oris&

Vastus edialis %0uadriceps #e oris&

Vastus inter edius %0uadriceps #e oris&

$nterior superior iliac spine )lium superior to acetabulum 7reater trochanter of femur Lateral lip of linea aspera of femur )ntertrochanteric line of femur Medial lip of linea aspera of femur $nterior and lateral surfaces of body of femur

:ase of patella .ibial tuberosity

&xtends leg at -nee ?oint Rectus femoris steadies hip ?oint and helps iliopsoas to flex thigh

Femoral nerve (L4! L5! L6)

Muscles o# the edial co part Muscle Origin Adductor :ody of pubis longus Adductor brevis Adductor agnus :ody of pubs )nferior pubic ramus )schial tuberosity )schial ramus (adductor art)

ent o# the thigh Insertion Middle third of linea aspera of femur (ectineal line (roximal part of linea aspera of femur 7luteal tuberosity Linea aspera Medial supracondylar line (adductor part) $dductor tubercle of femur (hamstring part) Superior medial surface of tibia

Action $dducts thigh $dducts thigh Flexes thigh $dducts thigh (adductor part flexes thigh and hamstring part extends it)

Innervation $nterior branch of obturator nerve (L4! L5 and L6) %bturator nerve (L4! L5 and L6) $dductor part= obturator nerve (L4! L5! and L6) Hamstring part= tibial part of sacral nerve (L6) %bturator nerve (L4 and L5)

)racilis

:ody of pubis

Obturator e$ternus

Margins of obturator foramen and obturator membrane

.rochanteric fossa of femur

$dducts thigh Flexes leg Helps rotate leg medially Laterally rotates thigh Steadies head of femur in acetabulum

%bturator nerve (L5 and L6)

Muscles involved in ventilation %pectoralis a/or and are not included in this table& Muscle Origin Insertion Sternocleido as Medial half of Mastoid process

inor as "ell as serratus anterior Action Raises sternum Berve $ccessory nerve

toid

clavicle Manubrium

to allo2 forced inspiration .ilts head Rotates head /st rib /st rib 4nd rib &levates /st rib &levates /st rib &levates 4nd rib C5,C' nerves C5,C' nerves C",C' nerves

Scalenes Anterior Middle Posterior Intercostal Muscle &xternal intercostals )nternal intercostals )nnermost intercostals (covered by endothoracic fascia)

C5,C" vertebrae C4,C" vertebrae C6,C" vertebrae

uscles %rigin )nferior margin of top rib Lateral margin of costal groove of top rib Medial margin of costal groove of top rib

)nsertion Superior surface of rib under it Superior surface of rib belo2 Superior surface of rib belo2

Fibre direction Medially and inferiorly Laterally and inferiorly Starts at about mid,clavicular line going laterally and inferiorly

$ction )nspiration Moves ribs up &xpiration Moves ribs do2n $cts 2ith internal intercostals

Intercostal arteries Artery (osterior intercostals

$nterior intercostals

Origin Superior intercostal artery (intercostal spaces / and 4) and thoracic aorta (remaining intercostal spaces) )nternal thoracic (intercostal spaces /,") and musculophrenic arteries (intercostal spaces #,E)

Course

'istribution

(ass bet2een internal and innermost intercostal muscles

)ntercostal muscles! overlying s-in! and parietal pleura

Superior Mediastinu %diagra belo"C super#icial and deep& Boundaries= .he superior mediastinum extends inferiorly from the superior thoracic aperture to the hori;ontal plane that includes the sternal angle anteriorly and passes approximately through the ?unction ()+ disc) of .6 and . vertebrae posteriorly! often referred to as the transverse thoracic plane@ Contents= From anterior to posterior! the contents of the superior mediastinum are8 thymus great vessels air2ay alimentary tract lymphatic trun-s Posterior Mediastinu Boundaries= inferior to the transverse thoracic plane! anterior to the . ,./4 vertebrae! posterior to the pericardium and diaphragm! and bet2een the parietal pleura of the t2o lungs Contents= .horacic aorta Middle Mediastinu Boundaries= >iaphragm! anterior and posterior mediastinum! and the left and right lungs Contents= Heart (enclosed in pericardium) $scending aorta Lo2er half of S+C Anterior Mediastinu Boundaries= smallest subdivision of mediastinum! lies bet2een the body of the sternum and transverse thoracic muscles anteriorly and the pericardium posteriorly@ Contents= )nferior part of the thymus

.horacic duct lymphatic trun-s (osterior Mediastinal lymph nodes $;ygous and hemia;ygous veins &sophagus &sophageal nerve plexus

$;ygous vein (ulmonary artery and veins (hrenic nerve

Left coronary artery Left ventricle Left atrium )nterventricular septum Right coronary artery (arts of both ventricles Right atrium (arts of S$9 and $+9

Circumflex artery Left atrium (osterior 2all of left ventricle Marginal artery Myocardium of lateral RHS of the heart

$nterior interventricular artery )nterventricular septum $nterior 2alls of both ventricles (osterior interventricular artery )nterventricular septum $d?acent (posterior) portions of both ventricles

SA node AV node AV bundle -ight and le#t bundle branches Pur@in/e #ibres Cardiac Innervation Arise Sy patheti ./,. <" c

Location .op right of right atrium Aunction bet2een atria and ventricles :et2een $+9 and bundle branches in the interventricular septum )nterventricular septum Fithin the ventricle 2alls

Ter inate Fithin the cardiac plexus to end in the S$ and $+ nodes

Parasy hetic

pat

+agus nerve

$trial 2all! along coronary arteries and )+ septum near $+ and S$ node

(##ects Sympathetic stimulation causes increased= Heart rate )mpulse conduction Force of contraction )ncrease blood flo2 through the coronary vessels to support the increased activity@ (arasympathetic stimulation slo2s= Heart rate Force of contraction Constriction of coronary arteries