Gray's Anatomy for Students

Front Cover
1 The Body
ADDITIONAL LEARNING RESOURCES for Chapter 1, The Body, on STUDENT CONSULT (www.studentconsult.com)
What is anatomy?
How can gross anatomy be studied?
Important anatomical terms
The anatomical position
Anatomical planes
Terms to describe location
Anterior (ventral) and posterior (dorsal), medial and lateral, superior and inferior
Proximal and distal, cranial and caudal, and rostral
Superficial and deep
Imaging
Diagnostic imaging techniques
Plain radiography
Contrast agents
Subtraction angiography
Ultrasound
Doppler ultrasound
Computed tomography
Magnetic resonance imaging
Diffusion-weighted imaging
Nuclear medicine imaging
Positron emission tomography
Single photon emission computed tomography
Image interpretation
Plain radiography
Chest radiograph
Abdominal radiograph
Gastrointestinal contrast examinations
Urological contrast studies
Computed tomography
Magnetic resonance imaging
Nuclear medicine imaging
Safety in imaging
Body systems
Skeletal system
Cartilage
Bone
Joints
Synovial joints
Descriptions of synovial joints based on shape and movement
Specific types of synovial joints (Fig. 1.20)
Solid joints
Skin and fascias
Skin
Fascia
Muscular system
Cardiovascular system
Lymphatic system
Lymphatic vessels
Lymph nodes
Lymphatic trunks and ducts
Nervous system
Central nervous system
Brain
Spinal cord
Meninges
Functional subdivisions of the CNS
Somatic part of the nervous system
Dermatomes
Myotomes
Visceral part of the nervous system
Terminology
Sympathetic system
1. Peripheral sympathetic innervation at the level of origin of the preganglionic fiber
2. Peripheral sympathetic innervation above or below the level of origin of the preganglionic fiber
3. Sympathetic innervation of thoracic and cervical viscera
4. Sympathetic innervation of the abdomen and pelvic regions and the adrenals
Parasympathetic system
Sacral preganglionic parasympathetic fibers
Cranial nerve preganglionic parasympathetic fibers
Visceral sensory innervation (visceral afferents)
Visceral sensory fibers accompany sympathetic fibers
Visceral sensory fibers accompany parasympathetic fibers
The enteric system
Nerve plexuses
Somatic plexuses
Visceral plexuses
Other systems
Clinical cases
2 Back
ADDITIONAL LEARNING RESOURCES for Chapter 2, Back, on STUDENT CONSULT (www.studentconsult.com):
Conceptual overview
General description
Functions
Support
Movement
Protection of the nervous system
Component parts
Bones
Typical vertebra
Muscles
Vertebral canal
Spinal nerves
Relationship to other regions
Head
Thorax, abdomen, and pelvis
Limbs
Key features
Long vertebral column and short spinal cord
Intervertebral foramina and spinal nerves
Innervation of the back
Regional anatomy
Skeletal framework
Vertebrae
Typical vertebra
Cervical vertebrae
Atlas and axis
Thoracic vertebrae
Lumbar vertebrae
Sacrum
Coccyx
Intervertebral foramina
Posterior spaces between vertebral arches
Joints
Joints between vertebrae in the back
Symphyses between vertebral bodies (intervertebral discs)
Joints between vertebral arches (zygapophysial joints)
“Uncovertebral” joints
Ligaments
Anterior and posterior longitudinal ligaments
Ligamenta flava
Supraspinous ligament and ligamentum nuchae
Interspinous ligaments
Back musculature
Superficial group of back muscles
Trapezius
Latissimus dorsi
Levator scapulae
Rhomboid minor and rhomboid major
Intermediate group of back muscles
Deep group of back muscles
Thoracolumbar fascia
Spinotransversales muscles
Erector spinae muscles
Transversospinales muscles
Segmental muscles
Suboccipital muscles
Spinal cord
Vasculature
Arteries
Veins
Meninges
Spinal dura mater
Arachnoid mater
Subarachnoid space
Pia mater
Arrangement of structures in the vertebral canal
Spinal nerves
Nomenclature of spinal nerves
Surface anatomy
Back surface anatomy
Absence of lateral curvatures
Primary and secondary curvatures in the sagittal plane
Useful nonvertebral skeletal landmarks
How to identify specific vertebral spinous processes
Visualizing the inferior ends of the spinal cord and subarachnoid space
Identifying major muscles
Clinical cases
3 Thorax
ADDITIONAL LEARNING RESOURCES for Chapter 3, Thorax, on STUDENT CONSULT (www.studentconsult.com):
Conceptual overview
General description
Functions
Breathing
Protection of vital organs
Conduit
Component parts
Thoracic wall
Superior thoracic aperture
Inferior thoracic aperture
Diaphragm
Mediastinum
Pleural cavities
Relationship to other regions
Neck
Upper limb
Abdomen
Breast
Key features
Vertebral level TIV/V
Venous shunts from left to right
Segmental neurovascular supply of thoracic wall
Sympathetic system
Flexible wall and inferior thoracic aperture
Innervation of the diaphragm
Regional anatomy
Pectoral region
Breast
Arterial supply
Venous drainage
Innervation
Lymphatic drainage
Breast in men
Muscles of the pectoral region
Pectoralis major
Subclavius and pectoralis minor muscles
Thoracic wall
Skeletal framework
Thoracic vertebrae
Typical thoracic vertebra
Articulation with ribs
Ribs
Distinct features of upper and lower ribs
Rib I
Rib II
Rib X
Ribs XI and XII
Sternum
Manubrium of the sternum
Body of the sternum
Xiphoid process
Joints
Costovertebral joints
Joint with head of rib
Costotransverse joints
Sternocostal joints
Interchondral joints
Manubriosternal and xiphisternal joints
Intercostal spaces
Muscles
Intercostal muscles
External intercostal muscles
Internal intercostal muscles
Innermost intercostal muscles
Subcostales
Transversus thoracis muscles
Arterial supply
Posterior intercostal arteries
Anterior intercostal arteries
Venous drainage
Lymphatic drainage
Innervation
Intercostal nerves
Diaphragm
Arterial supply
Venous drainage
Innervation
Movements of the thoracic wall and diaphragm during breathing
Pleural cavities
Pleura
Parietal pleura
Peripheral reflections
Visceral pleura
Pleural recesses
Costomediastinal recesses
Costodiaphragmatic recesses
Lungs
Root and hilum
Right lung
Left lung
Bronchial tree
Bronchopulmonary segments
Pulmonary arteries
Right pulmonary artery
Left pulmonary artery
Pulmonary veins
Bronchial arteries and veins
Innervation
Lymphatic drainage
Mediastinum
Anterior mediastinum
Middle mediastinum
Pericardium
Fibrous pericardium
Serous pericardium
Vessels and nerves
Heart
Cardiac orientation
Base (posterior surface) and apex
Surfaces of the heart
Margins and borders
External sulci
Cardiac chambers
Right atrium
Right ventricle
Tricuspid valve
Pulmonary valve
Left atrium
Left ventricle
Mitral valve
Aortic valve
Cardiac skeleton
Coronary vasculature
Coronary arteries
Right coronary artery.
Left coronary artery.
Variations in the distribution patterns of coronary arteries.
Cardiac veins
Great cardiac vein.
Middle cardiac vein.
Small cardiac vein.
Posterior cardiac vein.
Other cardiac veins.
Coronary lymphatics
Cardiac conduction system
Sinu-atrial node
Atrioventricular node
Atrioventricular bundle
Cardiac innervation
Parasympathetic innervation
Sympathetic innervation
Visceral afferents
Pulmonary trunk
Ascending aorta
Other vasculature
Superior mediastinum
Thymus
Right and left brachiocephalic veins
Left superior intercostal vein
Superior vena cava
Arch of aorta and its branches
The first branch
The second branch
The third branch
Ligamentum arteriosum
Trachea and esophagus
Nerves of the superior mediastinum
Vagus nerves
Right vagus nerve
Left vagus nerve
Phrenic nerves
Right phrenic nerve
Left phrenic nerve
Thoracic duct in the superior mediastinum
Posterior mediastinum
Esophagus
Relationships to important structures in the posterior mediastinum
Arterial supply and venous and lymphatic drainage
Innervation
Esophageal plexus
Thoracic aorta
Azygos system of veins
Azygos vein
Hemiazygos vein
Accessory hemiazygos vein
Thoracic duct in the posterior mediastinum
Sympathetic trunks
Branches from the ganglia
Surface anatomy
Thorax surface anatomy
How to count ribs
Surface anatomy of the breast in women
Visualizing structures at the TIV/V vertebral level
Visualizing structures in the superior mediastinum
Visualizing the margins of the heart
Where to listen for heart sounds
Visualizing the pleural cavities and lungs, pleural recesses, and lung lobes and fissures
Where to listen for lung sounds
Clinical cases
4 Abdomen
ADDITIONAL LEARNING RESOURCES for Chapter 4, Abdomen, on STUDENT CONSULT (www.studentconsult.com):
Conceptual overview
General description
Functions
Houses and protects major viscera
Breathing
Changes in intraabdominal pressure
Component parts
Wall
Abdominal cavity
Inferior thoracic aperture
Diaphragm
Pelvic inlet
Relationship to other regions
Thorax
Pelvis
Lower limb
Key features
Arrangement of abdominal viscera in the adult
Development of the foregut
Development of the midgut
Development of the hindgut
Skin and muscles of the anterior and lateral abdominal wall and thoracic intercostal nerves
The groin is a weak area in the anterior abdominal wall
Vertebral level LI
The gastrointestinal system and its derivatives are supplied by three major arteries
Venous shunts from left to right
All venous drainage from the gastrointestinal system passes through the liver
Portacaval anastomoses
Blockage of the hepatic portal vein or of vascular channels in the liver
Abdominal viscera are supplied by a large prevertebral plexus
Regional anatomy
Surface topography
Four-quadrant pattern
Nine-region pattern
Abdominal wall
Superficial fascia
Superficial layer
Deeper layer
Anterolateral muscles
Flat muscles
External oblique
Associated ligaments
Internal oblique
Transversus abdominis
Transversalis fascia
Vertical muscles
Rectus abdominis
Pyramidalis
Rectus sheath
Extraperitoneal fascia
Peritoneum
Innervation
Arterial supply and venous drainage
Lymphatic drainage
Groin
Inguinal canal
Deep inguinal ring
Superficial inguinal ring
Anterior wall
Posterior wall
Roof
Floor
Contents
Spermatic cord
Round ligament of the uterus
Inguinal hernias
Indirect inguinal hernias
Direct inguinal hernias
Abdominal viscera
Peritoneum
Innervation of the peritoneum
Peritoneal cavity
Omenta, mesenteries, and ligaments
Omenta
Greater omentum
Lesser omentum
Mesenteries
Mesentery
Transverse mesocolon
Sigmoid mesocolon
Ligaments
Organs
Abdominal esophagus
Stomach
Small intestine
Duodenum
Jejunum
Ileum
Large intestine
Cecum and appendix
Colon
Rectum and anal canal
Liver
Diaphragmatic surface
Visceral surface
Associated ligaments
Lobes
Gallbladder
Pancreas
Duct system for bile
Spleen
Arterial supply
Anterior branches of the abdominal aorta
Celiac trunk
Left gastric artery
Splenic artery
Common hepatic artery
Superior mesenteric artery
Inferior pancreaticoduodenal artery
Jejunal and ileal arteries
Middle colic artery
Right colic artery
Ileocolic artery
Inferior mesenteric artery
Left colic artery
Sigmoid arteries
Superior rectal artery
Venous drainage
Portal vein
Splenic vein
Superior mesenteric vein
Inferior mesenteric vein
Lymphatics
Innervation
Sympathetic trunks
Splanchnic nerves
Thoracic splanchnic nerves
Lumbar and sacral splanchnic nerves
Pelvic splanchnic nerves
Abdominal prevertebral plexus and ganglia
Parasympathetic innervation
Vagus nerves
Pelvic splanchnic nerves
Enteric system
Sympathetic innervation of the stomach
Posterior abdominal region
Posterior abdominal wall
Bones
Lumbar vertebrae and the sacrum
Pelvic bones
Ribs
Muscles
Psoas major and minor
Quadratus lumborum
Iliacus
Diaphragm
Structures passing through or around the diaphragm
Domes
Blood supply
Innervation
Viscera
Kidneys
Relationships to other structures
Renal fat and fascia
Kidney structure
Renal vasculature and lymphatics
Ureters
Ureteric vasculature and lymphatics
Ureteric innervation
Suprarenal glands
Suprarenal vasculature
Suprarenal innervation
Vasculature
Abdominal aorta
Visceral branches
Posterior branches
Inferior phrenic arteries
Lumbar arteries
Median sacral artery
Inferior vena cava
Lymphatic system
Pre-aortic and lateral aortic or lumbar nodes (para-aortic nodes)
Nervous system in the posterior abdominal region
Sympathetic trunks and splanchnic nerves
Abdominal prevertebral plexus and ganglia
Lumbar plexus
Iliohypogastric and ilio-inguinal nerves (L1)
Iliohypogastric nerve
Ilio-inguinal nerve
Genitofemoral nerve (L1 and L2)
Lateral cutaneous nerve of thigh (L2 and L3)
Obturator nerve (L2 to L4)
Femoral nerve (L2 to L4)
Surface anatomy
Abdomen surface anatomy
Defining the surface projection of the abdomen
How to find the superficial inguinal ring
How to determine lumbar vertebral levels
Visualizing structures at the LI vertebral level
Visualizing the position of major blood vessels
Using abdominal quadrants to locate major viscera
Defining surface regions to which pain from the gut is referred
Where to find the kidneys
Where to find the spleen
Clinical cases
5 Pelvis and Perineum
ADDITIONAL LEARNING RESOURCES for Chapter 5, Pelvis and Perineum, on STUDENT CONSULT (www.studentconsult.com):
Conceptual overview
General description
Functions
Contains and supports the bladder, rectum, anal canal, and reproductive tracts
Anchors the roots of the external genitalia
Component parts
Pelvic inlet
Pelvic walls
Pelvic outlet
Pelvic floor
Pelvic cavity
Perineum
Relationship to other regions
Abdomen
Lower limb
Key features
The pelvic cavity projects posteriorly
Important structures cross the ureters in the pelvic cavity
The prostate in men and the uterus in women are anterior to the rectum
The perineum is innervated by sacral spinal cord segments
Nerves are related to bone
Parasympathetic innervation from spinal cord levels S2 to S4 controls erection
Muscles and fascia of the pelvic floor and perineum intersect at the perineal body
The course of the urethra is different in men and women
Regional anatomy
Pelvis
Bones
Pelvic bone
Components of the pelvic bone
Ilium
Pubis
Ischium
Sacrum
Coccyx
Joints
Lumbosacral joints
Sacro-iliac joints
Pubic symphysis joint
Orientation
Differences between men and women
True pelvis
Pelvic inlet
Pelvic wall
Ligaments of the pelvic wall
Muscles of the pelvic wall
Obturator internus
Piriformis
Apertures in the pelvic wall
Obturator canal
Greater sciatic foramen
Lesser sciatic foramen
Pelvic outlet
Pelvic floor
The pelvic diaphragm
Levator ani
Coccygeus
The perineal membrane and deep perineal pouch
Perineal body
Viscera
Gastrointestinal system
Rectum
Anal canal
Urinary system
Ureters
Bladder
Neck of bladder
Urethra
In women
In men
Preprostatic part.
Prostatic part.
Membranous part.
Spongy urethra.
Reproductive system
In men
Testes
Epididymis
Ductus deferens
Seminal vesicle
Prostate
Bulbo-urethral glands
In women
Ovaries
Uterus
Uterine tubes
Cervix
Vagina
Fascia
In women
In men
Peritoneum
In women
Broad ligament
In men
Nerves
Somatic plexuses
Sacral and coccygeal plexuses
Sacral plexus
Sciatic nerve.
Pudendal nerve.
Other branches of the sacral plexus.
Coccygeal plexus
Visceral plexuses
Paravertebral sympathetic chain
Pelvic extensions of the prevertebral plexus
Sympathetic fibers
Parasympathetic fibers
Visceral afferent fibers
Blood vessels
Arteries
Internal iliac artery
Posterior trunk
Anterior trunk
Ovarian arteries
Median sacral artery
Veins
Lymphatics
Perineum
Borders and ceiling
Perineal membrane and deep perineal pouch
Ischio-anal fossae and their anterior recesses
Anal triangle
Urogenital triangle
Structures in the superficial perineal pouch
Erectile tissues
Clitoris
Penis
Erection
Greater vestibular glands
Muscles
Ischiocavernosus
Bulbospongiosus
Superficial transverse perineal muscles
Superficial features of the external genitalia
In women
In men
Superficial fascia of the urogenital triangle
Somatic nerves
Pudendal nerve
Other somatic nerves
Visceral nerves
Blood vessels
Arteries
Internal pudendal artery
Inferior rectal arteries
Perineal artery
Terminal part of the internal pudendal artery
External pudendal arteries
Testicular and cremasteric arteries
Veins
Lymphatics
Surface anatomy
Surface anatomy of the pelvis and perineum
Orientation of the pelvis and perineum in the anatomical position
How to define the margins of the perineum
Identification of structures in the anal triangle
Identification of structures in the urogenital triangle of women
Identification of structures in the urogenital triangle of men
Clinical cases
6 Lower Limb
ADDITIONAL LEARNING RESOURCES for Chapter 6, Lower Limb, on STUDENT CONSULT (www.studentconsult.com):
Conceptual overview
General introduction
Function
Support the body weight
Locomotion
Component parts
Bones and joints
Muscles
Relationship to other regions
Abdomen
Pelvis
Perineum
Key points
Innervation is by lumbar and sacral spinal nerves
Nerves related to bone
Superficial veins
Regional anatomy
Bony pelvis
Ilium
Ischial tuberosity
Ischiopubic ramus and pubic bone
Acetabulum
Proximal femur
Greater and lesser trochanters
Intertrochanteric line
Intertrochanteric crest
Shaft of the femur
Hip joint
Ligaments
Gateways to the lower limb
Obturator canal
Greater sciatic foramen
Lesser sciatic foramen
Gap between the inguinal ligament and pelvic bone
Nerves
Femoral nerve
Obturator nerve
Sciatic nerve
Gluteal nerves
Ilio-inguinal and genitofemoral nerves
Lateral cutaneous nerve of thigh
Nerve to quadratus femoris and nerve to obturator internus
Posterior cutaneous nerve of thigh
Perforating cutaneous nerve
Arteries
Femoral artery
Superior and inferior gluteal arteries and the obturator artery
Veins
Lymphatics
Superficial inguinal nodes
Deep inguinal nodes
Popliteal nodes
Deep fascia and the saphenous opening
Fascia lata
Iliotibial tract
Saphenous opening
Femoral triangle
Femoral sheath
Gluteal region
Muscles
Deep group
Piriformis
Obturator internus
Gemellus superior and inferior
Quadratus femoris
Superficial group
Gluteus minimus and medius
Gluteus maximus
Tensor fasciae latae
Nerves
Superior gluteal nerve
Sciatic nerve
Nerve to quadratus femoris
Nerve to obturator internus
Posterior cutaneous nerve of the thigh
Pudendal nerve
Inferior gluteal nerve
Perforating cutaneous nerve
Arteries
Inferior gluteal artery
Superior gluteal artery
Veins
Lymphatics
Thigh
Bones
Shaft and distal end of femur
Patella
Proximal end of tibia
Tibial condyles and intercondylar areas
Tibial tuberosity
Shaft of tibia
Proximal end of fibula
Muscles
Anterior compartment
Iliopsoas—psoas major and iliacus
Quadriceps femoris—vastus medialis, intermedius, and lateralis and rectus femoris
Vastus muscles
Rectus femoris
Patellar ligament
Sartorius
Medial compartment
Gracilis
Pectineus
Adductor longus
Adductor brevis
Adductor magnus
Obturator externus
Posterior compartment
Biceps femoris
Semitendinosus
Semimembranosus
Arteries
Femoral artery
Deep artery of thigh
Lateral circumflex femoral artery
Medial circumflex femoral artery
Perforating arteries
Obturator artery
Veins
Great saphenous vein
Nerves
Femoral nerve
Obturator nerve
Sciatic nerve
Tibial nerve
Common fibular nerve
Knee joint
Articular surfaces
Menisci
Synovial membrane
Fibrous membrane
Ligaments
Patellar ligament
Collateral ligaments
Cruciate ligaments
Locking mechanism
Vascular supply and innervation
Tibiofibular joint
Popliteal fossa
Contents
Tibial and common fibular nerves
Popliteal artery and vein
Roof of popliteal fossa
Leg
Bones
Shaft and distal end of tibia
Shaft and distal end of fibula
Joints
Interosseous membrane of leg
Posterior compartment of leg
Muscles
Superficial group
Gastrocnemius
Plantaris
Soleus
Deep group
Popliteus
Flexor hallucis longus
Flexor digitorum longus
Tibialis posterior
Arteries
Popliteal artery
Anterior tibial artery
Posterior tibial artery
Veins
Nerves
Tibial nerve
Sural nerve
Medial calcaneal nerve
Lateral compartment of leg
Muscles
Fibularis longus
Fibularis brevis
Arteries
Veins
Nerves
Superficial fibular nerve
Anterior compartment of leg
Muscles
Tibialis anterior
Extensor hallucis longus
Extensor digitorum longus
Fibularis tertius
Arteries
Anterior tibial artery
Veins
Nerves
Deep fibular nerve
Foot
Bones
Tarsal bones
Proximal group
Talus
Calcaneus
Intermediate tarsal bone
Distal group
Metatarsals
Phalanges
Joints
Ankle joint
Medial ligament (deltoid ligament)
Lateral ligament
Intertarsal joints
Subtalar joint
Talocalcaneonavicular joint
Ligaments
Calcaneocuboid joint
Ligaments
Tarsometatarsal joints
Metatarsophalangeal joints
Deep transverse metatarsal ligaments
Interphalangeal joints
Tarsal tunnel, retinacula, and arrangement of major structures at the ankle
Flexor retinaculum
Extensor retinacula
Fibular retinacula
Arches of the foot
Longitudinal arch
Transverse arch
Ligament and muscle support
Plantar aponeurosis
Fibrous sheaths of toes
Extensor hoods
Intrinsic muscles
On the dorsal aspect
Extensor digitorum brevis and extensor hallucis brevis
In the sole
First layer
Abductor hallucis
Flexor digitorum brevis
Abductor digiti minimi
Second layer
Quadratus plantae
Lumbricals
Third layer
Flexor hallucis brevis
Adductor hallucis
Flexor digiti minimi brevis
Fourth layer
Dorsal interossei
Plantar interossei
Arteries
Posterior tibial artery and plantar arch
Lateral plantar artery
Medial plantar artery
Dorsalis pedis artery
Veins
Nerves
Tibial nerve
Medial plantar nerve
Lateral plantar nerve
Deep fibular nerve
Superficial fibular nerve
Sural nerve
Saphenous nerve
Surface anatomy
Lower limb surface anatomy
Avoiding the sciatic nerve
Finding the femoral artery in the femoral triangle
Identifying structures around the knee
Visualizing the contents of the popliteal fossa
Finding the tarsal tunnel—the gateway to the foot
Identifying tendons around the ankle and in the foot
Finding the dorsalis pedis artery
Approximating the position of the plantar arterial arch
Major superficial veins
Pulse points
Clinical cases
7 Upper Limb
ADDITIONAL LEARNING RESOURCES for Chapter 7, Upper Limb, on STUDENT CONSULT (www.studentconsult.com):
Conceptual overview
General description
Functions
Positioning the hand
The hand as a mechanical tool
The hand as a sensory tool
Component parts
Bones and joints
Muscles
Relationship to other regions
Neck
Back and thoracic wall
Key points
Innervation by cervical and upper thoracic nerves
Nerves related to bone
Superficial veins
Orientation of the thumb
Regional anatomy
Shoulder
Bones
Clavicle
Scapula
Proximal humerus
Greater and lesser tubercles
Surgical neck
Joints
Sternoclavicular joint
Acromioclavicular joint
Glenohumeral joint
Muscles
Trapezius
Deltoid
Levator scapulae
Rhomboid minor and major
Posterior scapular region
Muscles
Supraspinatus and infraspinatus
Teres minor and teres major
Long head of triceps brachii
Gateways to the posterior scapular region
Suprascapular foramen
Quadrangular space (from posterior)
Triangular space
Triangular interval
Nerves
Suprascapular nerve
Axillary nerve
Arteries and veins
Suprascapular artery
Posterior circumflex humeral artery
Circumflex scapular artery
Veins
Axilla
Axillary inlet
Anterior wall
Pectoralis major
Subclavius
Pectoralis minor
Clavipectoral fascia
Medial wall
Serratus anterior
Intercostobrachial nerve
Lateral wall
Posterior wall
Subscapularis
Teres major and latissimus dorsi
Long head of the triceps brachii
Gateways in the posterior wall
Quadrangular space
Triangular space
Triangular interval
Floor
Contents of the axilla
Biceps brachii
Coracobrachialis
Axillary artery
Superior thoracic artery
Thoraco-acromial artery
Lateral thoracic artery
Subscapular artery
Anterior circumflex humeral artery
Posterior circumflex humeral artery
Axillary vein
Brachial plexus
Roots
Trunks
Divisions
Cords
Branches (Table 7.7)
Branches of the roots
Branches of the trunks
Branches of the lateral cord
Branches of the medial cord
Median nerve.
Branches of the posterior cord
Lymphatics
Axillary process of the mammary gland
Arm
Bones
Shaft and distal end of the humerus
The condyle
The two epicondyles
The three fossae
Proximal end of the radius
Proximal end of the ulna
Muscles
Coracobrachialis
Biceps brachii
Brachialis
Posterior compartment
Arteries and veins
Brachial artery
Profunda brachii artery
Veins
Nerves
Musculocutaneous nerve
Median nerve
Ulnar nerve
Radial nerve
Elbow joint
Cubital fossa
Forearm
Bones
Shaft and distal end of radius
Shaft and distal end of ulna
Joints
Distal radio-ulnar joint
Interosseous membrane
Pronation and supination
Muscles involved in pronation and supination
Biceps brachii.
Supinator.
Pronator teres and pronator quadratus.
Anconeus.
Anterior compartment of the forearm
Muscles
Superficial layer
Flexor carpi ulnaris
Palmaris longus
Flexor carpi radialis
Pronator teres
Intermediate layer
Flexor digitorum superficialis
Deep layer
Flexor digitorum profundus
Flexor pollicis longus
Pronator quadratus
Arteries and veins
Radial artery
Ulnar artery
Veins
Nerves
Median nerve
Ulnar nerve
Radial nerve
Posterior compartment of the forearm
Muscles
Superficial layer
Brachioradialis
Extensor carpi radialis longus
Extensor carpi radialis brevis
Extensor digitorum
Extensor digiti minimi
Extensor carpi ulnaris
Anconeus
Deep layer
Supinator
Abductor pollicis longus
Extensor pollicis brevis
Extensor pollicis longus
Extensor indicis
Arteries and veins
Posterior interosseous artery
Anterior interosseous artery
Radial artery
Veins
Nerves
Radial nerve
Hand
Bones
Carpal bones
Proximal row
Distal row
Articular surfaces
Carpal arch
Metacarpals
Phalanges
Joints
Wrist joint
Carpal joints
Carpometacarpal joints
Metacarpophalangeal joints
Deep transverse metacarpal ligaments
Interphalangeal joints of hand
Carpal tunnel and structures at the wrist
Palmar aponeurosis
Palmaris brevis
Anatomical snuffbox
Fibrous digital sheaths
Extensor hoods
Muscles
Dorsal interossei
Palmar interossei
Adductor pollicis
Thenar muscles
Opponens pollicis
Abductor pollicis brevis
Flexor pollicis brevis
Hypothenar muscles
Opponens digiti minimi
Abductor digiti minimi
Flexor digiti minimi brevis
Lumbrical muscles
Arteries and veins
Ulnar artery and superficial palmar arch
Radial artery and deep palmar arch
Veins
Nerves
Ulnar nerve
Median nerve
Superficial branch of the radial nerve
Surface anatomy
Upper limb surface anatomy
Bony landmarks and muscles of the posterior scapular region
Visualizing the axilla and locating contents and related structures
Locating the brachial artery in the arm
The triceps brachii tendon and position of the radial nerve
Cubital fossa (anterior view)
Identifying tendons and locating major vessels and nerves in the distal forearm
Normal appearance of the hand
Position of the flexor retinaculum and the recurrent branch of the median nerve
Motor function of the median and ulnar nerves in the hand
Visualizing the positions of the superficial and deep palmar arches
Pulse points
Clinical cases
8 Head and Neck
ADDITIONAL LEARNING RESOURCES for Chapter 8, Head and Neck, on STUDENT CONSULT (www.studentconsult.com):
Conceptual overview
General description
Head
Major compartments
Other anatomically defined regions
Neck
Compartments
Larynx and pharynx
Functions
Protection
Contains upper parts of respiratory and digestive tracts
Communication
Positioning the head
Connects the upper and lower respiratory and digestive tracts
Component parts
Skull
Cervical vertebrae
Hyoid bone
Soft palate
Muscles
In the head
In the neck
Relationship to other regions
Thorax
Upper limbs
Key features
Vertebral levels CIII/IV and CV/VI
Airway in the neck
Cranial nerves
Cervical nerves
Functional separation of the digestive and respiratory passages
Triangles of the neck
Regional anatomy
Skull
Anterior view
Frontal bone
Zygomatic and nasal bones
Maxillae
Mandible
Lateral view
Lateral portion of the calvaria
Temporal bone
Visible part of the facial skeleton
Mandible
Posterior view
Occipital bone
Temporal bones
Superior view
Inferior view
Anterior part
Middle part
Anterior half
Vomer
Sphenoid
Body
Pterygoid processes
Greater wing
Posterior half
Occipital bone
Temporal bone
Posterior part
Occipital bone
Temporal bone
Cranial cavity
Roof
Floor
Anterior cranial fossa
Lesser wings of the sphenoid
Middle cranial fossa
Sphenoid
Sella turcica
Fissures and foramina
Temporal bone
Posterior cranial fossa
Boundaries
Foramen magnum
Grooves and foramina
Squamous part of the occipital bone
Foramina and fissures through which major structures enter and leave the cranial cavity
Meninges
Cranial dura mater
Dural partitions
Falx cerebri
Tentorium cerebelli
Falx cerebelli
Diaphragma sellae
Arterial supply
Innervation
Arachnoid mater
Pia mater
Arrangement of meninges and spaces
Extradural space
Subdural space
Subarachnoid space
Brain and its blood supply
Brain
Blood supply
Vertebral arteries
Internal carotid arteries
Cerebral arterial circle
Venous drainage
Dural venous sinuses
Superior sagittal sinus
Inferior sagittal and straight sinuses
Confluence of sinuses, transverse and sigmoid sinuses
Cavernous sinuses
Superior and inferior petrosal sinuses
Cranial nerves
Olfactory nerve [I]
Optic nerve [II]
Oculomotor nerve [III]
Trochlear nerve [IV]
Trigeminal nerve [V]
Ophthalmic nerve [V1]
Maxillary nerve [V2]
Mandibular nerve [V3]
Abducent nerve [VI]
Facial nerve [VII]
Vestibulocochlear nerve [VIII]
Glossopharyngeal nerve [IX]
Tympanic nerve
Vagus nerve [X]
Accessory nerve [XI]
Cranial root of the accessory nerve
Hypoglossal nerve [XII]
Face
Muscles
Orbital group
Orbicularis oculi
Corrugator supercilii
Nasal group
Nasalis
Procerus
Depressor septi nasi
Oral group
Orbicularis oris
Buccinator
Lower group of oral muscles
Upper group of oral muscles
Other muscles or muscle groups
Platysma
Auricular muscles
Occipitofrontalis
Parotid gland
Important relationships
Facial nerve
External carotid artery and its branches
Retromandibular vein and its tributaries
Arterial supply
Innervation
Innervation
Sensory innervation
Ophthalmic nerve [V1]
Maxillary nerve [V2]
Mandibular nerve [V3]
Motor innervation
Vessels
Arteries
Facial artery
Transverse facial artery
Branches of the maxillary artery
Branches of the ophthalmic artery
Veins
Facial vein
Transverse facial vein
Intracranial venous connections
Lymphatic drainage
Scalp
Layers
Skin
Connective tissue (dense)
Aponeurotic layer
Loose connective tissue
Pericranium
Innervation
Anterior to the ears and the vertex
Posterior to the ears and the vertex
Vessels
Arteries
Branches from the ophthalmic artery
Branches from the external carotid artery
Veins
Lymphatic drainage
Orbit
Bony orbit
Roof
Medial wall
Floor
Lateral wall
Eyelids
Skin and subcutaneous tissue
Orbicularis oculi
Orbital septum
Tarsus and levator palpebrae superioris
Conjunctiva
Glands
Vessels
Innervation
Lacrimal apparatus
Innervation
Sensory innervation
Secretomotor (parasympathetic) innervation
Sympathetic innervation
Vessels
Fissures and foramina
Optic canal
Superior orbital fissure
Inferior orbital fissure
Infra-orbital foramen
Other openings
Fascial specializations
Periorbita
Fascial sheath of the eyeball
Check ligaments of the medial and lateral rectus muscles
Muscles
Extrinsic muscles
Levator palpebrae superioris
Rectus muscles
Superior and inferior rectus muscles
Medial and lateral rectus muscles
Oblique muscles
Superior oblique
Inferior oblique
Extrinsic muscles and eyeball movements
Vessels
Arteries
Veins
Innervation
Optic nerve
Oculomotor nerve
Trochlear nerve
Abducent nerve
Postganglionic sympathetic fibers
Ophthalmic nerve [V1]
Lacrimal nerve
Frontal nerve
Nasociliary nerve
Ciliary ganglion
Parasympathetic root
Sensory root
Sympathetic root
Eyeball
Anterior and posterior chambers
Lens and vitreous humor
Walls of the eyeball
Vessels
Arterial supply
Venous drainage
Fibrous layer of the eyeball
Sclera
Cornea
Vascular layer of the eyeball
Choroid
Ciliary body
Iris
Inner layer of the eyeball
Optic part of the retina
Ear
External ear
Auricle
Muscles
Innervation
Vessels
External acoustic meatus
Innervation
Tympanic membrane
Innervation
Middle ear
Boundaries
Tegmental wall
Jugular wall
Membranous wall
Mastoid wall
Anterior wall
Labyrinthine wall
Mastoid area
Pharyngotympanic tube
Vessels
Innervation
Auditory ossicles
Malleus
Incus
Stapes
Muscles associated with the ossicles
Tensor tympani
Stapedius
Vessels
Innervation
Internal ear
Bony labyrinth
Semicircular canals
Cochlea
Membranous labyrinth
Organs of balance
Utricle, saccule, and endolymphatic duct
Sensory receptors
Organ of hearing
Cochlear duct
Vessels
Innervation
Facial nerve [VII] in the temporal bone
Branches
Greater petrosal nerve.
Nerve to stapedius and chorda tympani.
Transmission of sound
Temporal and infratemporal fossae
Bony framework
Temporal bone
Sphenoid bone
Maxilla
Zygomatic bone
Ramus of mandible
Temporomandibular joints
Joint capsule
Extracapsular ligaments
Movements of the mandible
Masseter muscle
Temporal fossa
Contents
Temporalis muscle
Deep temporal nerves
Zygomaticotemporal nerve
Deep temporal arteries
Middle temporal artery
Infratemporal fossa
Contents
Sphenomandibular ligament
Medial pterygoid
Lateral pterygoid
Mandibular nerve [V3]
Branches
Meningeal branch
Nerve to medial pterygoid
Buccal nerve
Masseteric nerve
Deep temporal nerves
Nerve to lateral pterygoid
Auriculotemporal nerve
Lingual nerve
Inferior alveolar nerve
Chorda tympani and the lesser petrosal nerve
Chorda tympani
Lesser petrosal nerve
Maxillary artery
Branches
Middle meningeal artery
Inferior alveolar artery
Deep auricular, anterior tympanic, and accessory meningeal arteries
Branches from the second part
Pterygoid plexus
Pterygopalatine fossa
Skeletal framework
Sphenoid bone
Pterygoid canal
Gateways
Contents
Maxillary nerve [V2]
Branches
Orbital branches.
Greater and lesser palatine nerves.
Nasal nerves.
Pharyngeal nerve.
Zygomatic nerve.
Posterior superior alveolar nerve.
Infra-orbital nerve.
Nerve of the pterygoid canal and the pterygopalatine ganglion
Greater petrosal nerve
Deep petrosal nerve
Pterygopalatine ganglion
Innervation of the lacrimal gland
Maxillary artery
Branches
Posterior superior alveolar artery.
Infra-orbital artery.
Greater palatine artery.
Pharyngeal branch.
Sphenopalatine artery.
Artery of pterygoid canal.
Veins
Neck
Fascia
Investing layer
Prevertebral layer
Pretracheal layer
Carotid sheath
Fascial compartments
Fascial spaces
Superficial venous drainage
External jugular veins
Anterior jugular veins
Anterior triangle of the neck
Muscles
Suprahyoid muscles
Stylohyoid
Digastric
Mylohyoid
Geniohyoid
Infrahyoid muscles
Sternohyoid
Omohyoid
Thyrohyoid
Sternothyroid
Vessels
Carotid system
Common carotid arteries
Internal carotid arteries
External carotid arteries
Veins
Nerves
Facial nerve [VII]
Glossopharyngeal nerve [IX]
Vagus nerve [X]
Accessory nerve [XI]
Hypoglossal nerve [XII]
Transverse cervical nerve
Ansa cervicalis
Elements of the gastrointestinal and respiratory systems
Esophagus
Trachea
Pharynx and larynx
Thyroid and parathyroid glands
Thyroid gland
Arterial supply
Superior thyroid artery.
Inferior thyroid artery.
Venous and lymphatic drainage
Recurrent laryngeal nerves
Parathyroid glands
Location of structures in different regions of the anterior triangle of the neck
Posterior triangle of the neck
Muscles
Vessels
External jugular vein
Subclavian artery and its branches
Transverse cervical and suprascapular arteries
Veins
Nerves
Accessory nerve
Cervical plexus
Muscular branches
Cutaneous branches
Brachial plexus
Root of the neck
Vessels
Subclavian arteries
Vertebral artery
Thyrocervical trunk
Inferior thyroid artery.
Transverse cervical artery.
Suprascapular artery.
Internal thoracic artery
Costocervical trunk
Veins
Nerves
Phrenic nerves
Vagus nerves [X]
Recurrent laryngeal nerves
Sympathetic nervous system
Cervical part of the sympathetic trunk
Ganglia
Superior cervical ganglion.
Middle cervical ganglion.
Inferior cervical ganglion.
Lymphatics
Thoracic duct
Lymphatics of the neck
Superficial lymph nodes
Superficial cervical lymph nodes
Deep cervical lymph nodes
Pharynx
Skeletal framework
Anterior vertical line of attachment for the lateral pharyngeal walls
First part
Second part
Third part
Pharyngeal wall
Muscles
Constrictor muscles
Superior constrictors
Middle constrictors
Inferior constrictors
Longitudinal muscles
Stylopharyngeus
Salpingopharyngeus
Palatopharyngeus
Fascia
Gaps in the pharyngeal wall and structures passing through them
Nasopharynx
Oropharynx
Laryngopharynx
Tonsils
Vessels
Arteries
Veins
Lymphatics
Nerves
Glossopharyngeal nerve [IX]
Larynx
Laryngeal cartilages
Cricoid cartilage
Thyroid cartilage
Epiglottis
Arytenoid cartilages
Corniculate
Cuneiform
Extrinsic ligaments
Thyrohyoid membrane
Hyo-epiglottic ligament
Cricotracheal ligament
Intrinsic ligaments
Fibro-elastic membrane of the larynx
Conus elasticus (cricovocal membrane)
Quadrangular membrane
Laryngeal joints
Cricothyroid joints
Crico-arytenoid joints
Cavity of the larynx
Division into three major regions
Laryngeal ventricles and saccules
Rima vestibuli and rima glottidis
Intrinsic muscles
Cricothyroid muscles
Posterior crico-arytenoid muscles
Lateral crico-arytenoid muscles
Transverse arytenoid muscle
Oblique arytenoid muscles
Vocalis
Thyro-arytenoid muscles
Function of the larynx
Respiration
Phonation
Effort closure
Swallowing
Vessels
Arteries
Veins
Lymphatics
Nerves
Superior laryngeal nerves
Recurrent laryngeal nerves
Nasal cavities
Lateral wall
Regions
Innervation and blood supply
Skeletal framework
Ethmoid bone
External nose
Paranasal sinuses
Frontal sinuses
Ethmoidal cells
Maxillary sinuses
Sphenoidal sinuses
Walls, floor, and roof
Medial wall
Floor
Roof
Lateral wall
Nares
Choanae
Gateways
Cribriform plate
Sphenopalatine foramen
Incisive canal
Small foramina in the lateral wall
Vessels
Arteries
Sphenopalatine artery
Greater palatine artery
Superior labial and lateral nasal arteries
Anterior and posterior ethmoidal arteries
Veins
Innervation
Olfactory nerve [I]
Branches from the ophthalmic nerve [V1]
Anterior and posterior ethmoidal nerves
Branches from the maxillary nerve [V2]
Parasympathetic innervation
Sympathetic innervation
Lymphatics
Oral cavity
Multiple nerves innervate the oral cavity
Skeletal framework
Maxillae
Palatine bones
Sphenoid bone
Temporal bone
Cartilaginous part of the pharyngotympanic tube
Mandible
Hyoid bone
Walls: the cheeks
Buccinator
Floor
Mylohyoid muscles
Geniohyoid muscles
Gateway into the floor of the oral cavity
Tongue
Papillae
Inferior surface of tongue
Pharyngeal surface
Muscles
Intrinsic muscles
Extrinsic muscles
Genioglossus
Hyoglossus
An important landmark.
Styloglossus
Palatoglossus
Vessels
Arteries
Veins
Innervation
Glossopharyngeal nerve [IX]
Lingual nerve
Facial nerve [VII]
Hypoglossal nerve [XII]
Lymphatics
Salivary glands
Parotid gland
Submandibular glands
Sublingual glands
Vessels
Innervation
Parasympathetic
Greater petrosal nerve
Chorda tympani
Sympathetic
Roof—palate
Hard palate
Soft palate
Muscles of the soft palate
Tensor veli palatini and the palatine aponeurosis
Levator veli palatini
Palatopharyngeus
Palatoglossus
Musculus uvulae
Vessels
Arteries
Ascending palatine artery and palatine branch
Greater palatine artery
Veins
Lymphatics
Innervation
Greater and lesser palatine nerves
Nasopalatine nerve
Oral fissure and lips
Oropharyngeal isthmus
Teeth and gingivae
Vessels
Arteries
Inferior alveolar artery
Anterior and posterior superior alveolar arteries
Gingival supply
Veins
Lymphatics
Innervation
Inferior alveolar nerve
Anterior, middle, and posterior superior alveolar nerves
Innervation of gingivae
Surface anatomy
Head and neck surface anatomy
Anatomical position of the head and major landmarks
Visualizing structures at the CIII/CIV and CVI vertebral levels
How to outline the anterior and posterior triangles of the neck
How to locate the cricothyroid ligament
How to find the thyroid gland
Estimating the position of the middle meningeal artery
Major features of the face
The eye and lacrimal apparatus
External ear
Pulse points
Clinical cases
9 Neuroanatomy
Introduction
Part I: Nervous system overview
Development
Terms of orientation
Cellular components
Nervous system functional organization
Part II: Brain
Cerebral hemispheres
Ventricular system
Meninges
Cerebral vasculature
Venous drainage
Part III: Thalamus
Part IV: Brainstem
Overview
External midbrain
External pons
External medulla oblongata
Brainstem internal features
Internal midbrain
Internal pons
Internal medulla oblongata
Vascular supply to the brainstem
Part V: Spinal cord
Overview
Spinal meninges
External features
Internal features
Ascending tracts in the spinal cord
Anterolateral pathways
Posterior column–medial lemniscal pathway
Descending tracts in the spinal cord
Lateral motor systems
Medial motor systems
Vascular supply to the spinal cord
Part VI: Basal nuclei
Corpus striatum
Connections of the basal nuclei
Part VII: Cerebellum
Structures of the cerebellum
Afferent cerebellar pathways
Efferent cerebellar pathways
Vascular supply
Part VIII: Visual System
Central visual pathway
Part IX: Auditory and vestibular system
Auditory pathways
Cochlea
Central auditory pathways
Vestibular pathways
Central vestibular pathways
Part X: Hypothalamus
Borders of the hypothalamus
Connections to the pituitary
Functional divisions of the hypothalamus
Lateral zone
Medial zone
Periventricular zone
Summary of connections
Part XI: Olfactory and limbic system
Olfactory system
Limbic system
Amygdala
Nucleus accumbens
Septal nuclei
Hippocampal formation
Acknowledgments
Inside Back Cover
Copyright
Title Page
Dedication
Contents
Chapter 1: ‘I’m thinking’ – Oh, but are you?
Chapter 2: Renegade perception
Chapter 3: The Pushbacker sting
Chapter 4: ‘Covid’: The calculated catastrophe
Chapter 5: There is no ‘virus’
Chapter 6: Sequence of deceit
Chapter 7: War on your mind
Chapter 8: ‘Reframing’ insanity
Chapter 9: We must have it? So what is it?
Chapter 10: Human 2.0
Chapter 11: Who controls the Cult?
Chapter 12: Escaping Wetiko
Postscript
Appendix: Cowan-Kaufman-Morell Statement on Virus Isolation
Bibliography
Index