Anatomy Summary.pdf

Anatomy Summary By Jan Nawratil and Kevin Martens  Topic 1: Osteology – common study of the bones. Shape and internal structure of the bones. The bone as an organ. Osteology: - Bones produce white and red blood cells and store minerals -...

Anatomy Summary By Jan Nawratil and Kevin Martens  Topic 1: Osteology – common study of the bones. Shape and internal structure of the bones. The bone as an organ. Osteology: - Bones produce white and red blood cells and store minerals - Bone tissue=dense connective and supporting tissue - In bones, the matrix is hardened by the deposition of calcium phosphate and other minerals - In bones, there are osseous tissue, blood, bone marrow, cartilage, adipose, nervous and fibrous connective tissue - The human consists of between 208 and 212 bones. - Largest bone: femur; smallest bone: stapes Functions: - Haematopoiesis – the formation of blood cells from haematopoietic stem cells found in the bone marrow. - Lipid and mineral storage – bone is a reservoir holding adipose tissue within the bone marrow and calcium within the hydroxyapatite crystals. - Support – bones form the framework and shape of the body. - Protection – especially the axial skeleton which surrounds the major organs of the body. Internal structure – bone cells: - Osteoblasts – Synthesise uncalcified/unmineralised extracellular matrix called osteoid. This will later become calcified/mineralised to form bone. Arise from mesenchymal stem stells. - Osteocytes – As the osteoid mineralises, the osteoblasts become entombed between lamellae in lacunae where they mature into osteocytes. They then monitor the minerals and proteins to regulate bone mass. Control osteoblasts/osteoclasts. o Important functions:  Formation of bone  Calcium homeostasis  Matrix maintenance - Osteoclasts – Osteoclasts are polynuclear giant cells, which develop from monocytic stem cells. They are responsible for bone resorption and can be found in so-called resorption pits, which are referred to as Howship's lacunae. Present in the outer layer - Osteogenic cells are stem cells found in the endosteum, the inner layer of the periosteum and within the central canals  The majority of bone is made of the bone matrix. It is composed primarily of Collagen. Bone is formed by the hardening of this matrix around entrapped cells. When these cells become entrapped from osteoblasts they become osteocytes. Shape of the bones: - Ossa longa: contain Femur, Humerus, Ulna, Radius, Tibia, as well as metatarsal bone and metacarpal bones. They consist of two endings (epiphysis) and a shaft in between (diaphysis). - Ossa plana: Flat bones are generally constructed in a plane, laminar way, like the scapula,the sternum and the ribs. - Ossa brevia: The term "ossa brevia" describes short bones which are compact and cube or cylindric-shaped and can be found in wrist and ankle. - Ossa pneumatica: Hollow respectively pneumatized bones can be found in regions of the skull, e.g. maxilla, os frontale, os sphenoidale and os ethmoidale. - Ossa sesamoidea: Sesamoid bones are occurring variably as functional part of tendons, in which they are embedded. The largest sesamoid bone is the patella. - Ossa irregularia The extracellular matrix (ECM) refers to the molecules that provide biochemical and structural support to the cells. The ECM of bone is highly specialised. In addition to collagen and the associated proteins usually found in connective tissue, bone is impregnated with mineral salts, in particular calcium hydroxyapatite crystals. These crystals associate with the collagen fibres, making bone hard and strong. This matrix is organised into numerous thin layers, known as lamellae. Structure oft the bone: - Woven bone: consists of osteoid (unmineralised ECM), with the collagen fibres arranged randomly. It is a temporary structure, soon replaced by mature lamellar bone. - Lamellar bone (in adult): consists of highly organised sheets of mineralised osteoid o Compact bone is the outer shell: lamellae are organised into concentric circles, which surround a vertical Haversian canal o Spongy bone: consists of a 3D network of fine columns, which crosslink to form irregular trabeculae. This produces a light, porous bone, that is strong against multidirectional lines of force. The bone as an organ: Bones are surrounded by muscles and ligaments, are up of several tissues and cells and alll sever a common function (e.g. mobility)  Topic 2: Bone development and growth - formation of bone tissue: ossification - both methods, intramembranous and endochondreal ossification begin with mesenchymal. Intramembranous ossification (produces the flat bones of the skull and most of the clavicle): Endochondreal ossification: Bone growth: Ossification does not end at birth, but continues throughout life with the growth and remodelling of bones. Two directions: - Bone elongation: At the metaphysis, the cartilage thickens by cell division and enlargement and then undergoes replacement by bone o Zone of reserve cartilage (farthest from the marrow cavity) o Zone of cell proliferation (a little closer, chondrocytes multiply and arrange themselves in longitudinal lagunae) o Zone of cell hypertrophy (chondrocytes cease to multiply and begin to hypertrophy) o Zone of calcification (Minerals are deposited in the matrix between the columns of lacunae and calcify the cartilage o Zone of bone deposition (Within each column, the walls between the lacunae break down and the chondrocytes die) - Bone Widening and Thickening involves a process called appositional growth, the deposition of new tissue at the surface o Appositional growth occurs by intramembranous ossification at the bone surface o Osteoblasts in the inner layer of periosteum deposit osteoid tissue on the bone surface, calcify it, and become trapped in it as osteocytes o They lay down matrix in layers parallel to the surface  Topic 3: Cranial calvaria (skull Cap) - Upper part of the cranium - Dom-like shape - Made of the superior portions of the flat bones (ossa plana) of the cranium -> Os frontale, Os parietale, Os occipitale - Has numerous furrows for branches of A. Meningea media - At the middle line, on the interior of the skullcap is space for Sinus sagittalis and Falx cerebri - On each side of the middle line are small holes for Granulatio arachnoidales - Protects the brain Landmarks - Bregma: point at which Os frontale and the two Os parietale meet - Lambda: point at which the two Os parietale and Os occipital meet Bones: - Frontal Bone (unpaired) - Occipital Bone (unpaired) - Parietal Bone (paired) The bones are connected by sutures: - Coronal suture between frontal bone and the two parietal bones - Sagittal suture between the two parietal bones - Lambdoid suture between occipital bone and the two parietal bone Layers: - Lamina externa (hard cortical bone) - Diploe (soft spongy bone) - Lamina interna (hard cortical bone) Development: In the fetus, the formation of the Calvaria involves intramembranous ossification (see Topic 2) -> The base of the skull develops through endochondreal ossification (see Topic 2)  Topic 4: Internal surface of the cranial base (Basis cranii interna) The internal surface can be found by looking from the top, downwards to the floor of the brain - Hole where the brain is situated - Connected with the Basis cranii externa via numerous openings/channels - Is divided into three parts: 1. Fossa cranii anterior 2. Fossa cranii media 3. Fossa cranii posterior  They are arranged like stairs: highest-lowest 1. Fossa cranii anterior o Formed by:  Os frontale  Os ethmoidale  Os sphenoidale o Roff of the orbita and of the paranasal sinuses o In the middle line the crista galle is located, which looks like a comb of a rooster o The frontal lobe has its location in the anterior part of the internal cranial surface o Openings:  Lamina cribrosa  Foramen caecum  Foramen ethmoidale anterius/posterius 2. Fossa cranii media o Butterfly shape o Lies between Fossa cranii anterior and posterior o Formed by:  Os sphenoidale  Os temporale  Os parietale o Both temporal lobes are situated her o Openings:  Canalis opticus:  -> connection between Fossa cranii media and the orbita  -> A. ophtalmica + N. opticus  Fissura orbitalis superior  Foramen lacerum: N. petrosus major  Foramen ovale: N. mandibularis (V3), N. petrosus minor  Foramen rotundum: N. maxillaris (V2)  Foramen spinosum: A. meningea media forms the forehead and the superior orbital margin - Os parietale: ->forms part of the lateral wall of the skull - Os occipitale: ->forms the posterior wall of the skull - Os temporale: ->forms part of the lateral wall of the skull ->forms meatus acusticus externus - Os sphenoidale: ->forms parts of the lateral wall of the skull ->partly included in forming fossa temporalis - Os zygomaticus: ->forms the prominence of the cheecks ->forms the anterior wall of the fossa temporalis ->forms the inferior orbital margi - Maxilla: ->forms the upper jaw ->forms the medial margin of the orbita - Mandibula: ->forms the lower jaw Important structure: Incisura mandibulae: - Between Mandibulae and Arcus zygomaticus - Allows passage of N. massetericus (branch of N. mandibularis) and A. masseterica (branch of A. maxillaris Prominent Landmarks: - Nasion: Intersection of Os frontale with both Os nasale (suture between those two -> Sutura nasofrontalis - Glabella: point over the Nasion (the hairless spot between the eyebrows - Bregma (see Topic 3): point of intersection of the Sutura coronalis and Sutura sagittalis - Vertex: highest point of the skull, in the middle - Lambda (see Topic 3): point of intersection of the Sutura sagittalis and Sutura lambdoidea - Protuberantia occipitalis externa: middle elevation of Os occipital  Topic 7: Orbit/ Orbita Def.: the cavitiy of the skull in which the eye and its appendages are situated - 4-5cm deep - formed by 7 bones: o Os frontale Form the superior margin o Os lacrimale o Os ethmoidale Form the medial margin o Os sphenoidale Form the lateral margin o Os zygomaticum o Maxialla Form the inferior margin o Os palatinum Openings for nerves and vessels: - Canalis opticus o N. opticus and A. ophtalmica pass through it - Fissura orbitalis superior o Lying between the lesser and greater wing of Os sphenoidale o N. trochlearis, N. abducens - Fissura orbitalis inferior o V. ophtalmica, N. zygomatics and N. infraorbitales pass through it - Foramen ethmoidale o Has more than one opening o Nerves and vessels of the same name pass through them - Foramen infraorbitale o Opening in the maxilla o A., V. and N. infraorbitalis pass through - Foramen lacrimale o Carries tears from the lacrimal sac to the eyes via the Canalis lacrimalis Content: - Eyeball - Muscles of the eye: o M. levater palpebrae o M. obliquus superior/inferior o M. rectus lateralis/ medialis/ superior/ inferior - Cranial nerves:  o N. opticus (2) o N. occulomotorius (3) o N. trochlearis (4) o N. abducens (6) o N. trigeminus (5) - Eyelids - Septum orbitale - Ganglion ciliare - Conjunctiva o Lines the inside of the eylids and voers the sclera o Helps to lubricate the eye by producing mucous and tears  Topic 8: Bony nasal cavity/ Cavitas nasi The nose is an olfactory and respiratory organ. It consists of nasal skeleton, which houses the nasal cavity. Functions: Warms and humidifies the inspired air Removes and traps pathogens and particulate matter from the inspired air Responsible for sense of smell Drains and clears the paranasal sinuses and lacrimal ducts The nasal cavity is the most superior part of the respiratory tract. It extends from the vestibule to the nasopharynx. It can be generally divided into three regions: - the vestibule, refers to the area surrounding the external opening to the nasal cavity - the respiratory region is the largest, and is lined by ciliated psudeostratified epithelium. Within the epithelium are interspersed mucus-secreting goblet cells - the olfactory region is located at the apex of the nasal cavity. It is lined by olfactory cells with olfactory receptors Nasal Conchae - Projecting out of the lateral walls of the nasal cavity are curved shelves of bone. They are called conchae (or turbinates) - The are three conchae o Inferior o Middle o Superior - They project into the nasal cavity, creating four pathways for the air to flow. These pathways are called meatuses: o Inferior meatus: Lies between the inferior concha and floor of the nasal cavity. o Middle meatus: Lies between the inferior and middle concha. o Superior meatus: Lies between the middle and superior concha. o Spheno-ethmoidal recess: Lies superiorly and posteriorly to the superior concha. The function of the conchae is to increase the surface area of the nasal cavity – this increases the amount of inspired air that can come into contact with the cavity walls. They also disrupt the fast, laminar flow of the air, making it slow and turbulent. The air spends longer in the nasal cavity, so that it can be humidified. Openings into the Nasal Cavity: - One of the functions of the nose is to drain a variety of structures. Thus, there are many openings into the nasal cavity, by which drainage occurs. o The paranasal sinuses drain into the nasal cavity. o The frontal, maxillary and anterior ethmoidal sinuses open into the middle meatus. The location of this opening is marked by the semilunar hiatus, a crescent-shaped groove on the lateral walls of the nasal cavity. o The middle ethmoidal sinuses empty out onto a structure called the ethmoidal bulla. This is a bulge in the lateral wall formed by the middle ethmoidal sinus itself o The posterior ethmoidal sinuses open out at the level of the superior meatus. The only structure not to empty out onto the lateral walls of the nasal cavity is the sphenoid sinus. It drains onto the posterior roof. In addition to the paranasal sinuses, other structures open into the nasal cavity: - The nasolacrimal duct acts to drain tears from the eye – it opens into the inferior meatus - The auditory (or eustachian) tube opens into the nasopharynx at the level of the inferior meatus. The auditory tube allows the middle ear to equalise with the atmospheric air pressure. Innervation: The innervation of the nose can be functionally divided into: - Special sensory innervation refers to the ability of the nose to smell. This is carried out by the olfactory nerves. The olfactory bulb, part of the brain, lies on the superior surface of the cribriform plate, above the nasal cavity. Branches of the olfactory nerve run through the cribriform plate to provide special sensory innervation to the nose. - General sensory innervation to the septum and lateral walls is delivered by the nasopalatine nerve (branch of maxillary nerve) and the nasociliary nerve (branch of the ophthalmic nerve). Innervation to the external skin of the nose is supplied by the trigeminal nerve.  Topic 9: Types of joints – classification Can be made into structural and functional: Structural classification 1. Fibrous joints: a. Fixed/ immobile joint b. Have no joint cavity c. Connect via fibrous tissue (rich in collagen fibres) i. Sutures (e.g. skull bones) ii. Syndesmosomes: 1. Found between long bones 2. E.g. distal tibio-fibular joint 3. Allow small movement d. Sutures: Are immobile or only slightly mobile fibrous joints that closely bind the bones of the skull to each other i. Serrate suture is one in which the adjoining bones firmly interlock by their serrated margins ii. lap (squamous) suture is one in which the adjacent bones have overlapping beveled edges iii. plane (butt) suture is one in which the adjacent bones have straight non-overlapping edges 2. Cartilaginous joints a. Connected only by cartilgage (fibrocartilage, hyaline cartilage) b. Allow more movement than fibrous joint but less than synovial joint c. Forms the growth region of immature bones -> ossification centers (synchondroses) d. E-g- symphysis pubis 3. Synovial joints (Bony joints) a. Most common and most moveable joints b. Have instead of fibrous joints and cartilaginous joints a joint capsule around it and the joint cavity is filled with synovial fluid c. is an immobile joint formed when the gap between two bones ossifies and they become, in effect, a single bone Joint capsule: - is continuous with the periosteum of the articulating bones - has no blood vessels and lymph (avascular)  receives nutrition from the surrounding blood supply via diffusion - consists of two layers: o outer fibrous membrane -> contains ligaments o inner synovial membrane –> secretes the synovial fluid (functions of the fluid are lubrication, shock absorbing, joint nourishing Functional classification: - synathrosis o permits little or no mobility o most of them are fibrous joints - amphiathrosis o permits slight movement o most of them are cartilaginous joints (e.g. intervertebral discs) - diathrosis o freely moveable o all of them are synovial joints (e.g. shoulder joint)  Topic 10: Synovial joints (diarthrosis) Characterisation: - the facing surfaces of the two bones are covered with articular cartilage (2-3mm thick) - surfaces are separated by a narrow space, the joint (articular cavity), containing the synovial fluids - a connective tissue joint (articular capsule encloses the cavity and retains the fluid - has an outer fibrous capsule - has an inner cellular synovial membrane (consist of fibroblast-like cells that secrete the fluid Classes: - ball-and-socket joints o the shoulder and hip joint o one bone has a smoothe hemispherical head that fits into a cuplike socket on the other - condylar (ellipsoid) joints: o exhibit an oval convex surface on one bone that fits into the complementary depression on the other o for example: the readiocarpal joint of the wrist and metacarpophalangeal joints - saddle joints: o both bones have a saddle-shaped surface o concave in one direction and convex in the other o for example: trapeziometacarpal joint between the trapezium of the wrist and metacarpal 1 at the base of the thumb o are biaxial - Plan (gliding) joints: o Bone surfaces are flat or only slightly concave and convex o The adjacent bones slide over each other and have relatively limited movement o Are found between the carpal bones of the wrist o Usually biaxial - Hinge joints: o Essentially monoaxial joint, moving freely in one plane with very little movemtn in any other, like a door hinge o For example: elbow, knee and interphalangeal joints o One bone has a convex surface, the other one has a concave depression - Pivot joints: o Monoaxial joints in which a bone spins on its longitudinal axis o Two principal examples:  Radioulnar joint at the elbow  Atlantoaxial joint, the dens of the axis projects into the vertebral foamen of the atlas Movement of Synovial joints: - Flexion and extension o Flexion decreases a joint angle o Extension straightens a joint - Abduction and Adduction o Abduction is a movement of a body part in the frontal plane away from the midline of the body o Adduction is movement in the frontal plane back toward the midline - Elevation and Depression o Elevationo is a movement that raises a body party vertically in the frontal plane o Depression lowers a body party in the same plane - Protaction and Retraction o Protraction is the anterior movemtn of a body part in the transvers plane o Retraction is posterior movement - Circumdution o One end of and appendage remains fairly stationary while the other end maked a circular motion - Rotation o Rotation is a movement in which a bone spins on its longitudinal axis - Supination and pronation o Supination of the forearm is a movement that turn the palm to the face anteriorly or upward o Pronation is the opposite movement Biomechanical classification: - Simle joint: o Two articulation surfaces o E.g. shoulder/hip joint - Compound joint: o Three or more articulation surfaces o E.g. radiocarpal joint - Complex joint: o Two or more articulation surfaces  Has an articular disc or meniscus o E.g. knee joint  Topic 11: Joint of the vertebral column - Usually consist of 24 articulating vertebrae and 9 fused vertebrae in the sacrum and coccyx - Cervical = C1-C7 - Thoracic = Th1-Th12 - Lumbar = L1- L5 - Sacral + Coccy= 9 - Is a synovial joint between the superior articulate process of one vertebra and the inferior articulate process of the vertebra directly above it - The biomechanical function of each pair of facet joints is to guide and limit movement of the spinal motion segement  Protect the motion segement from anterior shear forces - Each vertebrae is separated by intervertebral discs: o We have 23 of them o Protects the spinal cords o Form fibrocartilaginous joints between two vertebrae for slight movement o Absorb shock Structure: - Consist of an outer fibrous ring (annulus fibrosis) (consist of several layers of fibrocartilage which surrounds an inner gel-like center (nucleus pulpsosus - There is no intervertebral disc between atlas and axis  Topic 12: Joints of the pectoral girdle Def: the set of bones which connects the upper limb to the axial skeleton - Because the upper limbs ar not usually involved in carrying weight (like the legs in our body), ist stability is less than the lower limbs, but has greater mobility Joints of the pectoral girdle: - Consists of three true joint and two false joints - Glenohumeral joint: o Articulation between caput humeri and caritas glenoidalis o Ball and socket type joint o Allowes: abduction, adduction, lateral/medial rotation, extension and flexion - Acromioclavicular joint o Articulation between acromion and the lateral end of the clavicula o Plane type joint - Sternoclavicular joint o Articulation between manubrium sterne and the first costal cartilage with the clavicula o Saddle type joint - Scapulocostal joint o Musculotendinous joint o Formed by: m. trapezius, M. rhomboideus, m. serratus anterior o Articulation of the anterior scapula and the posterior thoracic cage - Suprahumeral joint o Formed by the coracoacromial ligament and the capet humerus  The gap between those two structures is mostly filled by the subacromial bursa and the tendon of M. supraspinatus  Topic 13: The craniovertebral joint - Atlanto-occipital joint: o Joint between atlas and Os occipitale o Movements: flexion, extension oft he neck (-> nodding the head in „yes“ movement) - Atlanto-axial joint: o Joint between atlas and axis o Movements: lateral rotation of atlas and axis (-> shaking head in „no“ movement)  Topic 14: Joints of the skull bones - Skull bones articulate via sutures - Fibrous joints which only occur in the skull - Sutures = synathroses (->joints which permit very little or no movement under normal conditions) - Temporomoandibular joints o Only between the mandibula and the cranium Sutures: Sutures are a type of fibrous joint that are unique to the skull. They are immovable, and fuse completely around the age of 20. The major fontanelles and sutures of the skull Sutures are of clinical importance, as they can be points of potential weakness in both childhood and adulthood. The main sutures in adulthood are: Coronal suture which fuses the frontal bone with the two parietal bones. Sagittal suture which fuses both parietal bones to each other. Lambdoid suture which fuses the occipital bone to the two parietal bones.  Topic 15: Temporomandibular joint - is the articulation of the condyle of the mandible with the mandibular fossa of the temporal bone - is joint combines elements of condylar, hinge, and plane joints - It functions in a hingelike fashion when the mandible is elevated and depressed, - it glides from side to side to grind food between the molars - it glides slightly forward when the jaw is protracted to take a bite or when the mouth is opened widely - If you palpate the joint just anterior to your earlobe while opening the mouth, you can feel this forward glide of the condylar process. - Synovial joint - hingen and sliding joint - a capsule, made of dense fibrous membrane surrounds the joint - has and ariculation disc (meniscus) o thin oval plate of fibrocartilage present in joints which seperate synoval cavities o allows separate movements to occur in each space which is formed by the articulation disc - the synovial membrane lining the joint capsule produces the synovial fluid that fills these cavities - three important ligaments play a role by defining the borders of movement oft he jaw o stylomandibular ligament o sphenomandibular ligament o temporomandibular ligament (thickened lateral portion oft he capsule=  this ligament prevents the excessive retraction or moving backward of the mandibula - blood supply: A. carotis externa -> A. temporalis superficialis The mandibular is moved primary by the four muscles of mastication: - M. masseter - M. temporalis - M. pterygoideus medialis - M. pterygoideus lateralis  Topic 17: Glenohumeral joint - The shoulder joint is a ball and socket joint between the scapula and the humerus. It ist he major joint connecting the upper limb to the trunk - It is one of most mobile joints in the human body, at the cost of joint stability Structures of the shoulder joint: - Formed by the articulation oft he head of the humerus with the glenoid cavity of the scapula - Both the articulating surfaces are covered with hyaline cartilage (typical for a synovial joint - Head of the humerus is much larger than the glonid foss (3:1) - To reduce the disproportion in surfaces, the glonoid fossa is deepend by a fibrocartilage rim, called the glenoid labrum Ligaments: o Glenohumeral ligaments:  Consists of three bands, which runs with the joint capsule from the fossa tot he anatomical neck of the humerus o Coroacohumeral ligament  Attaches the base oft he coracoid process tot he greater tubercle oft he humerus o Transverse humeral ligament  Spans the distance between the two tubercles oft he humerus  Holds the tendon oft he long head of the biceps in the intertubercular groove Joint capsula and Bursae: - The joint capsule is a fibrous sheath which encloses the structures of the joint - extends from the anatomical neck of the humerus to the border of the glenoid fossa. - To reduce friction in the shoulder joint, several synovial bursae are present  - The bursae that are important clinically are: o Subacromial: supports the deltoid and supraspinatus muscles. Inflammation of this bursa is the cause of several shoulder problems. o Subscapular: reduces wear and tear on the tendon during movement at the shoulder joint. Innervation: - N. suprascapularis - N. axillaris - N. pectoralis lateralis Blood supply: - A. circumflexa humeri anterior - A. circumflexa humera posterior - A. circumflexa scapulae - A. suprascapularis Movements: - Extention and Flexion oft he should joint - Abduction and adduction of the shoulder - Medial and lateral rotation of the shoulder - Circumduction of the shoulder  Topic 18: Elbow joint and joints of the forearm Elbow: - The elbow is the joint connecting the proper arm to the forearm - It is marked on the upper limb by the medial and lateral epicondyles, and the olecranon process - Structurally, the joint is classed as a synovial joint, and functionally as a hinge joint. Articulating Surfaces: Trochlear notch of the ulna and the trochlea of the humerus Head of the radius and the capitulum of the humerus Movements of the Joint: The orientation of the bones forming the elbow joint produces a hinge type synovial joint, which allows for extension and flexion of the forearm: - Extension: Triceps brachii and anconeus - Flexion: Brachialis, biceps brachii, brachioradialis Stability of the Joint: - Like all synovial joints, the elbow joint has a capsule enclosing the joint. - This in itself is strong and fibrous, strengthening the joint. - The joint capsule is thickened medially and laterally to form collateral ligaments, which stabilise the flexing and extending motion of the arm. - The radial collateral ligament is found on the lateral side of the joint, extending from the lateral epicondyle, and blending with the annular ligament of the radius (a ligament from the proximal radioulnar joint). - The ulnar collateral ligament originates from the medial epicondyle, and attaches to the coronoid process and olecranon of the ulna. Bursae: - A bursa is a membranous sac filled with synovial fluid - It acts to cushion the moving parts of a joint, preventing degenerative damage - There are many bursae in the elbow, but only a few have clinical importance: o Intratendinous – located within the tendon of the triceps brachii. o Subtendinous – between the olecranon and the tendon of the triceps brachii, reducing friction between the two structures during extension and flexion of the arm. o Subcutaneous – between the olecranon and the overlying connective tissue. Elbow: - Humeroulnar joint: o Hinge joint which allow movement of flexion and extension o From trohclea notch to trochlea - Humeroradial joint o Between caput radii and capitulum humeri o Ball and socket joint - Proximal radioulnar articulation o Privot joint o Between radius and ulnar o Makes supination and pronation possible Joints of the Forearm: - Proximal radioulnar joint o Pivot joint between circumference of the head of radius and raial notch of the uln o Distal radioulnar joint  Pivot joint between  Head of ulnar and ulnar notch  They are connected by the following ligaments:  Palmar radioulnar ligament  Dorsal radioulnar ligament  Articulation disc  Topic 19: Wrist and midcarpal joints Wrist joints: - Articulatio mediocarpales - Articulatio ulnocarpae - Articulatio intercarpales: o Can be subdivided into three sets of articulations  Those of the proximal row  Those of the distal row  Those of the two rows with each other o Joints of the proximal and distal row are arthrodial joints - Articulationes carpometacarpales: o Five joints in the wrist that articulate the distal row of carpal bones with the proximal bases of the five metacarpal bones o Carpometacarpal joint of the thum is called: trapezioetacarpal joint o Second metacarpal articulates with the Os trapezoideum o Third metacarpal articulates with the Os capitatum o Fourth metacarpal articulates with the Os hamatum o Fifth metacarpal articulates with the Os hamatum Movements: - The wrist is an ellipsoid type synovial joint, allowing for movement along two axes. - This means that flexion, extension, adduction and abduction can all occur at the wrist joint. All the movements of the wrist are performed by the muscles of the forearm. Innervation: is delivered by branches of three nerves: - Median nerve – Anterior interosseous branch - Radial nerve – Posterior interosseous branch - Ulnar nerve – deep and dorsal branches Midcarpal joint - allows augmentation of the movements at the wrist joint when it has reached its limit - These movements include flexion, extension, abduction and adduction of the wrist Articulations: - It is formed by the eight carpal bones that make up the carpus - From lateral to medial, the proximal row of carpal bones is made up of the scaphoid, lunate, triquetrum and pisiform bones. The distal row is made up of the trapezium, trapezoid, capitate and hamate bones Ligaments: - Intercarpal ligaments - link some adjacent carpals - Palmar intercarpal ligament o anteriorly, extends from the proximal row of the carpal bones to mainly the head of the capitate - Dorsal intercarpal ligament o Posteriorly o projects from the proximal to distal row of carpal bones - Radial collateral ligament o a strong ligament that is a continuation of the radial collateral carpal ligament from the wrist joint that extends from the scaphoid bone to the trapezium - Ulnar collateral ligament o Like the radial collateral ligament, the ulnar collateral ligament is an extension o It is a prolongation of the ulnar collateral carpal ligament o it connects the hamate bone to the triquetrum  Topic 20: Carpometacarpal joint. Joint of the digits of the hand Carpometacarpal joint: see point 19 Joints of the digits of the hand (metacarpophalangeal joints): - joints between the metacarpal bones and the phalanges of the fingers - except the thumb (hinge joint) all phalanges are connected to the metacarpal bones via condyloid joints - movement which occur in these joints are: o flexion o extension o adduction o abduction o circumduction - each joint of the hand has the same ligaments o collateral ligament of metacarpophalangeal articulations:  The collateral ligaments are strong, round cords which flank the joints  Each is attached to the posterior tubercle and adjacent pit on the side of its metacarpal head, and each passes distoanteriorly to the side of the anterior aspect of its phalangeal base. o palmar ligaments of metacarpophalangeal articulations:  They are thick, dense and fibrocartilaginous  They are placed between the collateral ligaments and are connected to them  The palmar ligaments are attached firmly to the base of proximal phalanx, but the attachment to the head of metacarpal is loose Blood supply of metacarpophalangeal joints: - These joints receive their blood supply form the dorsal and palmar metacarpal arteries, princeps pollicis artery and radialis indicis artery Nerve supply of metacarpophalangeal joints: - These joints recieve their nerve supply for the palmar digital branches of median nerve, the deep terminal branch of ulnar nerve and the posterior interosseous nerve.  Topic 21: Joints and ligaments of the pelvic girdle. The pelvis as a whole Pelvis is formed by: - Os sacrum - Os coccyx - Os ischium - Os ilium - Os pubis Also includes other structures: - Pelvic cavitiy - Pelvic floor - Perineum The joints of the hip are most important in retaining balance Male and female hips differentiate: - The woman has a bigger and wider pelvis - The foramen obduratum has a more triangular form than the male component - The pelvic exit is wider and the angle of the Angulus pubicus is bigger in the female Joints and ligaments: - Lumbosacral joint: o Joint between the last lumbar vertebra and the first sacral segment o Not a real joint like the definition says - Sacroiliac joint: o Between Os sacrum and Os ilium o Connected by a strong, weight bearing synovial joint o There are two sacroiliac joints -> one on each side of the body o Those two joints move together as a single unit (->bicondylar joint) o The sacral surface is covered by hyaline cartilage o The iliac surface has fibrocartilage  Ligaments of the sacroiliac joint: o Anterior sacroiliac ligament ->just a slight thickening of the anterior joint capsule o Interosseous sacroiliac ligament o Posterior sacroiliac ligament o Sacrotuberous ligament o Sacrospinous ligaments - Sacrococcygeal symphysis o Amphiarthrodial joint o Formed between the oval surface of the apex of the Os sacrum and Os coccyx  Have a disc between them o It is a slighty moveable joint o Surface of the sacrum -> convex o Surface on the coccyx -> concave Ligaments of the sacrococcygeal symphysis: o Anterior sacrococcygeal ligament  Extension of the anterior longitudinal ligament o Posterior sacrococcygeal ligament  Has a profound and superficial part o Lateral sacrococcygeal ligament  Runs from the lower lateral angles of the sacrum to the transerve processes of the first coccygeal vertebra o Intercornual sacrococcygeal ligaments  From the cornu of the sacrum to the cornu of coccyx - Acetabulofermol joint: o The hip joint o Joint between acetabulum and the femur  Both surfaces are covered with a strong lubricating layer of articular hyaline cartilage o Supports the weight of the body o Ligaments:  Extracapsular ligaments of the acetabulofemoral joint  Iliofemoral ligament  Ischiofemoral ligament  Pubofemoral ligament  Intracapsular ligaments of the acetabulofemoral joint  Ligamentum teres - Pelvis symphysis: o Cartilaginous joint (fibrocartilage) o Nonsynovial amphiathrodial joint o Ends of both pubic bones are coverd with hyaline cartilage  Topic 22: Hip Joint. X-ray anatomy. Age peculiarities. Hip Joint: - is a ball and socket synovial joint - formed by an articulation between the pelvic acetabulum and the head of the femur - It forms a connection from the lower limb to the pelvic girdle, and thus is designed for stability and weight-bearing Articulating Surfaces: - The hip joint consists of an articulation between the head of femur and acetabulum of the pelvis. - The acetabulum is a cup-like depression located on the inferolateral aspect of the pelvis - Its cavity is deepened by the presence of a fibrocartilaginous collar – the acetabular labrum - The head of femur is hemispherical, and fits completely into the concavity of the acetabulum. - Both the acetabulum and head of femur are covered in articular cartilage, which is thicker at the places of weight bearing Ligaments: - Intracapsular o It is a relatively small structure, which runs from the acetabular fossa to the fovea of the femur o It encloses a branch of the obturator artery (artery to head of femur), a minor source of arterial supply to the hip joint. - Extracapsular o Iliofemoral ligament – spans between the anterior inferior iliac spine and the intertrochanteric line of the femur  It has a ‘Y’ shaped appearance, and prevents hyperextension of the hip joint o Pubofemoral – spans between the superior pubic rami and the  intertrochanteric line of the femur  It has a triangular shape, and prevents excessive abduction and extension o Ischiofemoral – spans between the body of the ischium and the greater trochanter of the femur.  It has a spiral orientation, and prevents excessive extension Neurovascular Supply: - The arterial supply to the hip joint is largely via the medial and lateral circumflex femoral arteries - They anastomose at the base of the femoral neck to form a ring, from which smaller arteries arise to supply the hip joint itself - The medial circumflex femoral artery is responsible for the majority of the arterial supply - The artery to head of femur and the superior/inferior gluteal arteries provide some additional supply. - The hip joint is innervated by the femoral nerve, obturator nerve, superior gluteal nerve, and nerve to quadratus femoris. Movements and Muscles: - Flexion – iliopsoas, rectus femoris, Sartorius - Extension – gluteus maximus, semimembranosus, semitendinosus and biceps femoris - Abduction – gluteus medius, gluteus minimus and the deep gluteals (piriformis, gemelli etc.) - Adduction – adductors longus, brevis and magnus, pectineus and gracillis - Lateral rotation – biceps femoris, gluteus maximus, and the deep gluteals (piriformis, gemelli etc.) - Medial rotation – gluteus medius and minimus, semitendinosus and semimembranosus  Topic 23: Knee joint The knee is the articulated connection between the femur, tibia and patella. Structure of the joint: - The articulation of the femur and tibia is termed femoro-tibial joint (articulatio femorotibialis) - The connection between the femur and patella is called femoropatellar joint (articulatio femoropatellaris) - The cartilaginous articular surfaces of the femur and tibia are called condyles. - The femur additionally has an articular surface (facies patellaris) to the cartilage- covered facies articularis kneecap. Menisci: - Between the condyles of the thigh and leg bones are the fibrocartilaginous menisci fused in their growth to the joint capsule: o the meniscus medialis (medial meniscus) o lateral meniscus (lateral meniscus) Lateral ligaments: - The lateral ligaments are used to stabilise the knee against varus and valgus stress - Due to tension during extension they also prevent internal and external rotation, so that these actions are only possible in the bent knee position and with untensed ligaments - They include: o ligamentum collaterale mediale:  from epicondylus medialis to the condylus medialis  protects the medial side of the knee from being bent opne by a stress applied to the lateral side o ligamentum collaterale laterale:  from epicondylus lateralis to the condyles lateralis   protects the lateral side from an inside bending force Cruciate ligaments: - The ligamentum cruciatum anterius runs in the joint cavity from posterior, superior and lateral toward anterior, inferior and medial - The ligamentum cruciatum posteriorius from top medial to bottom lateral. - In internal rotation, the cruciate ligaments wrap around one another, in external rotation they yield from one another. Other ligaments: - The joint is secured anteriorly: o by the so called ligamentum patellae tendo continuation of the quadriceps femoris o by the retinaculum patellae Joint capsule: - The capsula articularis encompasses all joint surfaces of the knee, including the patella - It consists of two layers: o membrana fibrosa: the stabilising fibre layer o membrana synovialis:  which inwardly lines the knee joint synovia in horizontal section  it has joint space enclosed by the two membranes, whereby the posterior cruciate ligament lies outside the joint capsule. Bursa: - The knee joint is surrounded by numerous bursae (bursae), which can increase in size in the instance of inflammation - can change the appearance of the leg surface - It partly communicates with the joint capsule, and is partially independent of it. o Bursa suprapatellaris: This is located above the patella between femur and the quadriceps tendon and is connected with the joint cavity o Bursa prepatellaris: This is located ventrally to the knee between the patella and the skin and has no connection to the joint cavity. o bursa intrapatellaris: This lies below the patella between the ligamentum patellae and the tibia. Arterial supply: - arteria genus descendens - arteria genus media - arteria superior lateralis genus - arteria superior medialis genus - arteria inferior lateralis genus - arteria inferior medial genus  Topic 24: Joints of the leg and the ankle joint Joints of the leg: see topic 21-23 Ankle joint: - bones of the ankle: o tibia o fibula o talus - includes 3 joints o talocrural joint:  synovial hinge joint  connects te distal end of the tibia and the fibula with the proximal end of the talus  movements: dorsiflexion, plantarflexion o subtalar joint  also know as talocalcaneal joint  formed at the articulation point of the talus and calcaneus  movements: inversion, eversion  plane synovial joint  main ligament: interosseous talocalcaneal ligament  the joint is wrapped in a capsule lined by synovial membrane o inferior tibiofibular joint  formed by the convex medial side of the distal end of the fibula and the concave surface on the lateral side of the tibia  ligaments: anterior and posterior ligament of the lateral malleolus - ligaments of the ankle: o deltoid ligament:  from malleolus medialis to the calcaneus, Os naviculare and talus  inhibits abduction of the foot to the lateral side  consists of 4 parts  tibionavicularis  tibiocalcanea  tibiotalaris anterior  tibiotalaris posterior o anterior talofibular ligament:  passes from the anterior margin of the malleolus fibularis to the talus  prevents the foot from sliding forward o posterior talofibular ligament:  runs horizontally between the neck of the talus and the medial side of the lateral malleolus o calcaneofibular ligament:  running from the apex of the fibular malleolus donwards to a tubercle on the lateral surface of the calcaneus  Topic 25: Joints of the foot - Ankle joint: see topic 24 - Calcaneocuboidal joint: o Formed between calcaneus and Os cuboideum o Ligaments:  Dorsal calcaneocuboid ligament  Long plantar ligament  Plantar calcaneocuboid ligament o Movements:  Inversion  Eversion - Talonaviclar joint: o Formed between talus and Os naviculare - Cuneonavicular articulation: o Formed between Os naviculare and the three cuneiform bones o They are connected via dorsal and plantar ligaments:  Dorsal: three small bundles, one attached to each of the cuneiform bones  Plantar: similar arrangement like the dorsal ligaments  Strenghtend by the tendon of M. tibialis posterior o Movement: only gliding  Topic 26: Tarsomoetatarsal, metatarsophalangeal and interphalangeal joints - Tarsometatarsal joints: o Arthrodial joints o Formed between the three cuneiform bones and the cuboid bone, which articulate with the bases of the metatarsal bones o Connected via dorsal and plantar ligaments  Plantar ligaments for the first and second metatarsal bone are the strongest in this joint o Movemtn: only gliding is permitted - Metatarsophalangeal joint: o Formed between the metatarsal bones of the foot and the proximal phalanges of the toes o Condyloid joints o The joint has a plantar and two collateral ligaments o Movements: flexion, extension, abduction, adduction, circumduction - Interphalangeal joints: o Formed between the proximal and distal phalanges of the toes o Hinge joints  Each of these joint has a plantar and two collateral ligaments o Movements: flexion, extension (limited by the ligaments)  Topic 27: General principles of the imaging anatomy - Radiography: o Uses electromagnetic radiation o Generates, unlike CT, plain-film tomography o An X-Ray is produced by an X-Ray generator and is projected toward and object  A certain amount of this X-Ray is absorbed and gets visible o The X-Rays that pass through the object are captured behind by a detectpr - Computed tomography (CT) o Uses, like radiography X-Rays o Allows a 3D image of the interior of the human body  Gets created by series of two dimensional radiographic images take around a single axis of rotation o CT produces a volume of data that can be manipulated in order to demonstrate various bodily structures base on their ability to block the X-Ray beam o Advantages over radiography:  CT completely eliminates the superimposition of images of structures outside the area of interest  Because of the inherent high-contrast resolution of CT, differences between tissues that differ in physical density by less than 1% can be distinguished  Data from a single CT imaging procedure consisting of either multiple contiguous or one helical scan can be viewed as images in the axial, coronal, or sagittal planes - Sonography o Ultrasound-based diagnostic imaging of interal body structures o Ultrasound images are made by sending a pulse of ultrasound into tissue using and ultrasound transducter  The sound reflects and echos off parts of the tissue  This reflected echo is recorded and displaced on a monitor o Ultrasound can also be used therapeutically o Obstetric sonography = sonography of pregnant woman - Positron emission tomography o Produces 3D-images of functional processes of the body o The system detect pairs of gamma rays emitted indirectly by a positron- emitting radionuclide, which is introduced into the body on a biologically active molecule o A short-lived radioactive tracer isotope is injected into the patient  As a radioisotope undergoes positron emission decay, it emits a positron which can be detected - Magnetic resonance imaging (MRI) o Use strong magnetic fields and radiowaves to form images of the body o There are some controindicators, but still MRI is considered to be safer than the other imaging methods o Functioning:  The patient is postioned within an MRI-scanner which forms a strong magnetic filed  Most medical applications rely on detecting a radio frequency singal emitted by excited hydrogen atom body  Orientation of the image is controlled by varying the main magnetic field using gradient coils  Topic 28: Myology - Three kinds of muscular tissue o Skeletal o Cardiac o Smooth - All types have one funcamental purpose: to convert the chemical energy of ATP into the mechanical energy of motion Types of muscles: - Skeletal: o A voluntary striated muscle that is attached to one or more bones o Voluntary because it is usuall subject to conscious control o Striated because it exhibits a microscopic pattern of alternating light and dark bands, or striations o A typical skeletal muscle cell is about 100 micrometer in diameter and 3cm long o Different types:  Slow twitch fibers (type 1)  Contract slowly but can contract repeatedly over long periods  Have a good blood supply, hence they are red fibres  Are suited to endurance activity using the aerobic energy system, which relies on oxygen  Fast twitch fibres (Type 2a)  Have a fast contraction speed and can use aerobic and anaerobic energy sources  Are white fibres  Fatigue faster than slow twitch fibres, because of the less reliance on oxygen  Fast twitch fibres (Type 2b)  Contract extremely rapidly, create very forceful muscle contractions  Fatigue quickly  Are white fibres, but unlike type 2a fibres they can only use anaerobic energy sources - Cardiac: o Also striated, but it is involuntary o Its cells are not fibrous in shype, but relatively short and stumpy o They are called cariocytes or myocytes o Are commonly about 80 micrometer long and 15 micrometer wide - Smooth: o Also involuntary, but it lacks striations o Contains the same contractile proteins as the other muscle types, but they are not arranged in a regularly overlapping way o They are fusiform in shape o In average about 200 micrometer long and 5 micrometer wide Functions of muscle: - Movement: o Enable us to move from place to place o Move body contenets in the course of breathing, blood circulation, feeding and digestion, defecation, urination and childbirth - Stability: o Maintain posture by preventing unwanted movements o Are called antigravitiy muscles, because they resist the pull of gravitiy and prevent us from falling or slumping over - Control of body openings and passages - Heat production: o Skeletal muscles produces 20-30% of our body heat and up to 40 times as much during exercise o Glycemic control:  Regulation of blood glucose within normal limits  Skeletal muscles absorb, store and use a large share of glucose Universal properties of muscle: - Excitability (responsiveness): o When stimulated by chemical signals, stretch, and other stimuli, muscle cells exhibit electrical and mechanical responses - Conductivity: o The local electrical excitation is conducted throughout the entire plasma membrane - Contractility: o Muscle cells are unique in their ability to short substantially when stimulated - Extensibilty: o Muscle cells can stretch to as mch as three times their contracted length without harm - Elasticity: o When a muscle cell is stretched and then the tension is released, it recoils to a short original length Topic 29: Connective tissue formations of skeletal muscles and tendons. Internal and exteral mechanics of skeletal muscles - Skeletal muscle consists of connective tissue and muscle tissue - Layers of connective tissue serve their function in protecting and coverin muscles fibers, tendons and the entire muscles - Three layers of connective tissue are known and can be distinguished o Epimysium  Surrounds the whole skeletal muscle  Dense layer of connective tissue  Fascia o Perimysium  Encompasses the muscle fascicles (contains a group of muscle fibers)  Contains nerves and blood vessels for the muscle o Endomysium  Surrounds each single muscle fiber  Seperates the muscle fibers from the fascicles - Tendons also have three layers: o Paratenon o Epitenon o Endotenon Muscle mechanisms: - First step o Action potential propagates by activating voltage-gated sodium channels along the axon o When it reaches the neuromuscular junction, it causes a calcium ion influx - Second step o The calcium influx causes vesicles to fuse with the plasma membrane, releasing acetylcholine out into the ECS between the motor neuon terminal and junction - Third step o Acetylcholine diffuses across the synapse and bins to it and activates nicotinic acetylcholine receptors on the junction o Activation of nicotinic receptor opens its intrinsic sodium/potassium channel. Causing sodium to rush in and potassium to trickle out o Because the channel is more permeable to sodium, the charge difference becomes less negative - Fourth step o Action potential spreads through the muscle fibers network of T-tubules, depolarizing the inner portion of the muscle fiber - Fith step o The depolarization actives L-Type voltage-dependent calcium channels in the t-tubule membrane - Sixth step o Activated voltage gated calcium channels interact with calcium release  channels to active them, and release by the sarcoplasmic reticulum - Seventh step o Calcium binds to the troponin C present on the actin-containing thin filaments of the myofibrils o Troponin ten allosterically modulates the tropomyosin o Once calcium binds to the troponin C and causes and allosteric change in the troponin protein, troponin T allows tropomyosin to move - Eight step o Myosin binds to the newly uncovered binding sites on the filament o The release of ADP (bound to myosin to its nucleotide binding pocket) and inorganic phosphate are tightly coupled to the power stroke o This will pull the Z-bands toward each other - Ninth step: o ATP binds to myosin, allowing it to release actin and be in the weak binding state o Myosin then hydrolyzes ATP and uses the nergy to move into the conformation o Myosin heads move 10-12nm - Tenth step: o Steps 9 and 10 repeat as long as ATP is available and calcium is freely bound within the thin filaments - Eleventh step: o During those steps, calcium is actively pumped back into the sarcoplasmic reticulum  Topic 30: Muscles of the facial expression - Innervated by N. facialis - The facial muscles are subcutaneous - Generally originate from the surface of the skull bone and insert on the skin of the face - When they contract, the skin moves Muscles: - M. Buccinator o Origin: from the alveolar process of the maxilla and mandibula, temporomandibular joint o Insertion: in the fibres of the orbicularis oris o Artery: A. buccinator o Nerve: N. buccinator from N. facialis - M. Mentalist o Origin: Fossa incisiva o Insertin: chin o Artery: A. mentalis o Nerve: N. mandibularis from N. facialis - M. risorius: o Origin: Fascia of M. Masseter o Insertion: modiolus o Artery: A. facialis o Nerve: R. zygomatici and R. buccales from N. facialis - M. Zygomaticus major o Origin: Arcus zygomaticus o Insertion: modiolus o Artery: A. facialis o Nerve: N. zygomaticus from N. facialis - M. zygomaticus minor o Origin: Os zygomaticus o Insertion: skin of the upper lip o Artery: A. facialis o Nerve: N. facialis - Lavatory labii superioris o Origin: medial- infraoorbital margin o Insertion: upper lip o Artery: A. facialis o Nerve: N. facialis  Topic 31: Muscles of chewing All muscles are innvervated by N. trigemnus -> N. mandibularis Only the mandibula moves during mastication and talkin Muscles: - M. temporalis o Origin: Fossa temporalis, fascia temporalis o Insertion: Processus coronoideus o Artery: A. temporalis profundus o Nerve: N. temporalis profundus (from N. mandibularis) - M. masseter o Origin: Pars superficialis, arcus zygomaticus o Insertion: Pars superficialis, angulus mandibulae (Tuberositas masseterica); pars profunda o Artery: A. masseterica o Nerve: N. mandibularis - M. pterygoideus medialis o Origin: Fossa pterygoidea o Insertion: Tuberositas pterygoidea o Artery: A. maxillaris o Nerve: N. mandibularis (N. pterygoideus medialis) - M. pterygoideus lateralis: o Origin: caput superius: crista infratemporalis of Os sphenoidale; Caput inferius o Insertion: Caput superius: discus of articulatio temporomandibularis; processus mandibulae o Artery: A. maxillaris o Nerve: N. mandibularis (N. pterygoideus medialis)  Topic 32: Superficial muscles of the back - M. trapezius: o Origin: Protuberantia occipitalis externa o Insertion: acromion, spina scapulae o Artery: A. cervicalis superficialis o Nerve: N. accessorius - M. sternocleidomastoideus o Origin: manubrium sterni o Insertion: Processus mastoideus o Artery: A. occipitalis; A. thyroidea superior o Nerve: N. accessorius - M. splenius capitis: o Origin: Processus spinosi (C7-Th3) o Insertion: Processus mastoideus (Os occipitale, Os temporale) o Artery: Branches of the Aorta o Nerve: Nn. Spinales – R. posterior - M. teres major o Origin: Angulus inferior (Scapula) o Insertion: Sulcus intertuberculuaris (Humerus) o Artery: A. circumflexa scapulae o Nerve: N. suprascapularis - M. rhomboideus major o Origin: Processus spinosus (Th2- Th5) o Insertion: Margo medialis (Scapula) o Artery: A. dorsalis scapulae o Nerve: N. dorsalis scapulae - M. latissimus dorsi: o Origin: Processus spinosi (Th7-Th12) o Insertion: Crista tuberculi minoris (Humerus) o Artery: A. thoracodorsalis o Nerve: N. thoracodorsalis - M. levater scapulae o Origin: Processus transervus (C1- C4) o Insertion: Angulus superior scapulae) o Artery: A. dorsalis scapulae o Nerve: N. dorsalis scapulae - M. rhomboideus minor: o Origin: Processus spinosus (C7-Th1) o Insertion: Margo medialis (Scapula) o Artery: A. dorsalis scapulae o Nerve: N. dorsalis scapulae - M. splenius cervicis: o Origin: Processus spinosus (Th3-Th6) o Insertion: Processus transversus (C1-C3) o Artery: A. occipitalis, A. cervicalis transversus o Nerve: Posterior branch of the cervical nerves - M. obliquus externus abdominis o Origin: Rib 5-12 o Insertion: Linea alba, ligamentum inguinale o Artery: A. circumflexa ilium profunda o Nerve: N. subcostalis - M. serratus posterior superior: o Origin: L. nuchae o Insertion: the uper borders of the 2nd till the 5th rib o Artery: Aa. intercostales o Nerve: 2nd-5th intercostal nerves  Topic 33: Deep muscles of the back - M. erector spinae o Origin: Processus spinosus (Th9-Th12) o Insertion: Processus spinosus (Th1-Th2) o Artery: A. sacralis lateralis o Nerve: Posterior branch of spinal nerves - M. serratus posterior inferior o Origin: vertebrae Th11-L2 o Insertion: inferior borders of the ribs (Th9-Th12) o Artery: Aa. intercostalis o Nerve: Nn. intercostalis - M. longissimus thoracis o Origin: Os sacrum, Crista iliaca o Insertion: 2-12 Rib (processus transversus) o Artery: Dorsal branches of the posterior intercostal arteries from the throacic aorta o Nerve: dorsal rami of thoracic and lumbar spinal nerves (T7-L5) - M. iliocostalis thoracis o Origin: sacrum/ illiac crest/ processus spinosus of lower lumbar/thoracic vertebrae o Insertion: ribs o Artery: intercostal and lumbar arteries o Nerve: posterior branch of spinal nerve - M. scalenus posterior o Origin: Processus transversus (C4-C6) o Insertion: second rib o Artery: A. cervicalis ascendens/ descendens o Nerve: C6/C7/C8 - M. semispinalis capitis o Origin: Processi spinosi et transversi of the neck and breast vertebrae o Insertion: Processi spinosi o Artery: o Nerve: nervi spinales - M. longissimus capitis o Origin: o Insertion: o Artery: A. sacralis lateralis o Nerve: - M. longissimus cervicis o Origin: o Insertion: o Artery: A. saacralis lateralis o Nerve: Rami dorsalis of the nervi spinales - M. spinalis thoracis o Origin: Processus spinosus o Insertion: Processus spinosus  o Artery: A. sacralis lateralis o Nerve: Rami dorsales of the nervi spinales - M. iliocostalis lumborum o Origin: o Insertion: o Artery: Aa. Intercostales; Aa. lumbales o Nerve: Nn. spinales - M. obliquus internus abdominis o Origin: Ligamentum inguinale, crista iliaca o Insertion: Linea alba o Artery: A. subcostalis o Nerve: N. ilioinguinalis, N. iliohypogastricus  Topic 34: Muscles of the neck. Superficial, deep and hyoid muscles. - Platysma o Origin: Inferior clavicula o Insertion: mandibula o Artery: A. suprascapularis, A. mentalis o Nerve: N. facialis - M. sternocleidomastoideus o Origin: Manubrium sterni o Insertion: Processus mastoideus o Artery: A. occipitalis; A. thyroidea superior o Nerve: N. accesorius - M. digastricus o Origin: Venter anterior; corpus mandibulae; venter posteroir: medial from proc. mastoideus o Insertion: M. stylohyoideus o Artery: o Nerve: N. trigeminus; N. facialis - M. stylohyoideus o Origin: Proc. Styloideus (Os temporale) o Insertion: Cornu majus o Artery: A. alveolaris inferior o Nerve: N. mandibularis - M. Mylohyoideus o Origin: linea mylohyoideus o Insertion: median raphe o Artery: A. alveolaris inferior o Nerve: N. mandibularis - M. geniohyoideus o Origin: Symphysis menti o Insertion: Os hyoideum o Artery: o Nerve: Ansa cervicalis - M. sternohyoideus o Origin: Manubrium sterni o Insertion: Os. hyoideum o Artery: o Nerve: Ansa cervicalis - M. sternothyroideus o Origin: Manubrium sterni o Insertion: Thyroid cartilage o Artery: o Nerve: Ansa cervicalis - M. thyrohyoideus o Origin: Manubrium sterni o Insertion: Os hyoideum o Artery:  o Nerve: C1 - M. Omohyoideus o Origin: Angulus superior scapulae o Insertion: Os hyoideum o Artery: o Nerve: Ansa cervicalis Topic 35 = Topic 34 Topic 36: Thoracic muscles: muscles of the pectoral girdle, muscles of the thoracic wall. Thoracic fasciae. - M. pectoralis major o Origin: Clavicula; sternum o Insertion: Crista tuberculi majoris o Artery: A. pectoralis o Nerve: Nn. Pectoralis medialis/ lateralis (C5-Th1) - M. pectoralis minor o Origin: Ribs 3-5 o Insertion: Processus coracoideus scapulae o Artery: A. pectoralis o Nerve: Nn. Pectoralis medialis/ lateralis (C6-Th1) - Diaphragma o Origin: Processus xiphoideus; corpori vertebrae L1-L3 o Insertion: Central tendon of the diaphragma o Artery: A. thoracica interna -> A. pericardiophrenica o Nerve: N. phrenicus (C3-C5) - Mm. Intercostalis internus o Origin: Rib, superior border o Insertion: Rib, inferior border o Artery: Aa. intercostales o Nerve: Nn. intercostales - Mm. Intercostalis externus o Origin: Lower border oft he ribs o Insertion: upper border of the ribs below the origin o Artery: Aa. intercostales o Nerve: Nn. intercostales - M. serratus anterior o Origin: Ribs 8-9 o Insertion: Margo medialis, angulus inferior/ superior (scapula) o Artery: A. thoracica lateralis; A. thoracodorsalis o Nerve: N. thoracicus longus  Topic 37: Diaphragm - Is a dobule-domed sheet of skeletal muscle - Located at the inferior-most aspect of the rib cage - Two main functions: o Seperates the throacic cavity from the abdominal cavity o Undergoes contraction and relaxation, altering the volume of the thoracic cavity and the lungs, producing inspiration and expiration Anatomical position and attachments: - Three peripheral attachments: o Lumbar vertebrae and acuate ligaments o Costal cartilages of ribs 7-12 o Xiphoid process of the sternum - The parts that arise from the vertebrae are tendinous in structure: o Right crus: arises from L1-L3 and their intervertebral discs o Left crus: arises from L1-L2 and their intervertebral discs - The muscle fibres of the diaphragm combine to form a central tendon, whcih ascends to fuse with the inferior surface of the fibrous pericardium Pathways through the diaphragm: - Apertura oesophagealis: transmits the oesophagus, vagus nerves and oesophageal branches of the left gastric vessels - Aperture aortica: transmits the aorta, thoracic duct and azygous vein - Apertura cavalis: transmits the inferior vena cava Actions: - Diaphragm is the primary muscle of respiration - During inspiration, it contracts and flattens, incrasing the vertical diameter of the thoracic cavity - This producses lung expansion and air is drawn in - During expiration, the diaphragm passiveyl relaxes and returns to ist original dome shape - This reduces the volujme of the thoracic cavity Innervation and vasculature: - The halves of the diaphragm receives motor innervation from a phrenic nerve - The left half is innervated by the left phrenic nerve and vice versa - Each phrenic nerve is formed in the neck within the cervical plexus and contains fibres from spinal root C3-C5 - The majority of the arterial supply is deliverd via the inferior phrenic arteries, which arises directly from the abdominal aorta  Topic 38: Muscles of the anterior abdominal wall. Fasciae of the abdominal wall. Function of abdominal muscles - M. obliquus externus abdomins: o Origin: Ribs 5-12 o Insertion: Labium externum (Crista iliaca) o Artery: A.iliolumbalis, A. circumflexa ilium profunda, Aa. intercostales o Nerve: Nn. Intercostales (Th5-Th12) - M. obliquus internus abdomins o Origin: Fascia thoracolumbalis, ribs 8-9 o Insertion: Linea alba, pecten pubis o Artery: Aa. subcostales o Nerve: Nn. Intercostales (Th8-Th12), N. ilioinguinales, N. iliohypogastricus - M. transversus abdomins o Origin: Crista iliaca, ligamentum inguinale; cartilago costalis of the 7th till 12th rib o Insertion: on top of linea arcuata o Artery: A. epigastrica inferior o Nerve: Nn. Intercostales (Th5-Th12); N. ilioinguinales, N. iliohypogastricus - M. rectus abdominis o Origin: Processus xiphoideus, cartilage of the ribs 5-7 o Insertion: between tuberculum pubicum and symphysis pubis (Os pubis) o Artery: A. epigastrica inferior o Nerve: Nn. Intercostales (Th5-Th12) - M. Pyramidalis o Origin: Os pubis (ventral to the insertion of M. rectus abdominis) o Insertion: Linea alba o Artery: A. epigastrica inferior o Nerve: N. subcostalis - M. quadratus lumborum o Origin: Labium internum of crista iliaca o Insertion: 12th rib, L1-L4 o Artery: Lumbar branches of A. iliolumbalis o Nerve: N. subcostalis - M. iliacus o Origin: Fossa iliaca, spina iliaca anterior superior o Insertion: Fascia iliaca (Trochanter minor) o Artery: A. iliolumbalis, A. circrumflexa femoris medialis o Nerve: N. femoralis Function of abdominal muscles: - Assist in the breathing process - These muscles serve as protection for the inner organs - Together with the back muscles they provide postural support and are importan in defining the form - When the glottis is closed and the thorax and pelvis are fixed, they are integral in the  cough, urination, defecation childbirth, vomit, and singing functions - When the pelvis is fixed, they can initiate the movement oft he trunk in a forward motion - They also prevent hyperextension Fasciae of the abdominal wall: - Composed oft wo layers: o The fatty outer layer, Camper’s fascia o The more membranous inner layer, Scarpa’s fascia o Campars fascia is continous inferiorly with the superficial fascia of the thigh and it is composed of elastic and smooth muscle fibers o Scarpas fascia ende inferior to the inguinal ligament fusing with the fascia lata of the thigh  Topic 39: Inguinal canal - The inguinal canal is a short passage that extends inferiorly and medially, through the inferior part of the abdominal wall - It is superior and parallel to the inguinal ligament - It acts as a pathway by which structures can pass from the abdominal wall to the external genitalia - The inguinal canal also has clinical importance. It is a potential weakness in the abdominal wall, and therefore a common site of herniation Mid-inguinal point and midpoint of the inguinal ligament: - The mid-inguinal point is halfway between the pubic symphysis and the anterior superior iliac spine. The femoral artery crosses into the lower limb at this anatomical landmark. - The midpoint of the inguinal ligament is exactly as the name suggests. The inguinal ligament runs from the pubic tubercle to the anterior superior iliac spine, so the midpoint is halfway between these structures. The opening to the inguinal canal is located just above this point. Boundaries: - The anterior wall is formed by the aponeurosis of the external oblique, and reinforced by the internal oblique muscle laterally. - The posterior wall is formed by the transversalis fascia. - The roof is formed by the transversalis fascia, internal oblique and transversus abdominis. - The floor is formed by the inguinal ligament (a ‘rolled up’ portion of the external oblique aponeurosis) and thickened medially by the lacunar ligament. - During periods of increased intra-abdominal pressure, the abdominal viscera are pushed into the inguinal canal. To prevent herniation, the muscles of the anterior and posterior wall contract, and ‘clamp down’ on the canal. - The two openings to the inguinal canal are known as rings o The deep (internal) ring  is found above the midpoint of the inguinal ligament. which is lateral to the epigastric vessels  The ring is created by the transversalis fascia, which invaginates to form a covering of the contents of the inguinal canal. o The superficial (external) ring  marks the end of the inguinal canal, and lies just superior to the pubic tubercle  It is a triangle shaped opening, formed by the evagination of the external oblique, which forms another covering of the inguinal canal contents  This opening contains intercrural fibres, which run perpendicular to the aponeurosis of the external oblique and prevent the ring from widening.  Topic 40: Proper muscles of the pectoral girdle (muscles of the shoulder) - M. serratus anterior o Origin:  Pars superior: 1st and 2nd rib  Pars divergens: 2nd and 3rd rib  Pars convergens: 4th and 9th rib o Insertion:  Pars superior: Angulus superior  Pars divergens: margo medialis of the scapula  Pars convergens: angulus inferior of the scapula o Artery: A. thoracica lateralis, A. thoracodorsalis o Nerve: N. thoracicus longus - M. pectoralis major o Origin: Clavicula; sternum o Insertion: Crista tuberculi majoris o Artery: A. pectoralis o Nerve: Nn. Pectoralis medialis/ lateralis (C5-Th1) - M. pectoralis minor o Origin: Ribs 3-5 o Insertion: Processus coracoideus scapulae o Artery: A. pectoralis o Nerve: Nn. Pectoralis medialis/ lateralis (C6-Th1) - M. subclavius o Origin: 1st rib o Insertion: Lower part of the Clavicula o Artery: A. thoracoacromialis o Nerve: N. subclavius (C5-C7 - M. levator scapulae o Origin: Processi transervi from 1st to 4th cervical vertebrae o Insertion: Angulus superior (Scapula) o Artery: A. dorsalis scapulae o Nerve: N. dorsalis scapulae (C4-C5) - M. rhomboideus major o Origin: Processus spinosus (Th1- Th4) o Insertion: Margo medialis (Scapula) o Artery: A. dorsalis scapulae o Nerve: N. dorsalis scapulae - M. rhomboideus minor: o Origin: Processus spinosus (C6-C7) o Insertion: Margo medialis (Scapula) o Artery: A. dorsalis scapulae o Nerve: N. dorsalis scapulae - M. supraspinatus o Origin: Fossa supraspinata (scapula) o Insertion: Tuberculum majus (Humerus) o Artery: A. suprascapularis  o Nerve: N. suprascapularis (C4-C6) - M. infraspinatus o Origin: Fossa infraspinata (scapula) o Insertion: Tuberculum majus (humerus) o Artery: A. supraspinatus, A. circumflexa scapulae o Nerve: N. suprascapularis (C4-C6) - M. subscapularis o Origin: fossa subscapularis (scapula) o Insertion: tuberculum minus (humerus) o Artery: A. subscapularis o Nerve: N. subscapularis - M. teres minor o Origin: margo lateralis o Insertion: tuberculum majus (humerus) o Artery: A. circumflexa humeri posterior, A. circumflexa scapulae o Nerve: N. axillaris (C5-C6) - M. teres major o Origin: Angulus inferior (scapula) o Insertion: crista tuberculi minoris (humerus) o Artery: A. suprascapularis, A. circumflexa scapulae o Nerve: N. subscapularis (C5-C8) - M. deltoideus o Origin:  Pars clavicularis: acromial part of the clavicle  Pars acromialis: acromion  Pars spinalis: spina scapulae o Insertion: tuberositas deltoidea (humerus) o Artery: A. circumflexa humeri posterior and anterior o Nerve: N. axillaris (C5-C6) - M. trapezius o Origin:  Pars descendens: Os occipitale between linea nuchalis suprema and superior  Pars transvers: processi spinosi  Pars ascendens: processi spinosi processi spinosi of the mid- and downwards-located corpore thoraci o Insertion:  Pars desendens: acromial part of the clavicle  Pars transversa: acromion  Pars ascendens: spina scapulae  Topic 41: Brachial muscles. Brachial fascia Brachial fascia: - Forms a thin, loose, membranous sheath fort he muscles of the arm and forms septa (walls) between them - Thin over M. biceps brachii - Thick over M. triceps brachii - Strenghtened by fibrous aponeuroses, derived from the M. latissimus dorsi and M. pectoralis major Muscles: - M. biceps brachii o Origin:  Caput longum: Tuberculum spraglenoidale  Caput breve: Processus coracoideus o Insertion: tuberositas radii o Artery: A. brachialis o Nerve: N. musculocutaneous (C5-C7) - M. brachialis o Origin: Facies anterior of the humerus o Insertion: tuberositas ulnae o Artery: A. radialis recurrens o Nerve: N. musculocutaneous (C5-C7), N. radialis (C5-C6) - M. triceps brachii o Origin:  Caput longum: tuberculum infraglenoidale  Caput mediale: Facies posterior of the huerus medial distal of the sulcus nervi radialis o Insertion: olecranon o A. profunda brachii o Nerve: N. radialis, N. axillaris - M. Anconeus o Origin: epicondylus lateralis humeri o Insertion: Facies posterior of the ulna, olecranon o Artery: A. profunda brachii o Nerve: N. radialis (C6-C8) - M. coracobrachialis o Origin: processus coracoideus o Insertion: Facies anterior of the humerus medial distal of the crista tuberculi minoris o Artery: A. brachialis o Nerve: N. musculocutaneous  Topic 42: Muscles of the forearm: anterior group - M. pronator teres o Origin:  Caput humerale: epicondylus medialis of the humerus  Caput ulnare: processus coronoideus o Insertion: mid third of the facies lateralis of the radius o Artery: A. radialis, A.ulnaris o Nerve: N. medianus - M. flexor digitorum superficialis o Origin:  Caput humeroulnare: epicondylus medialis of the humerus, processus coronoideus  Caput radiale: facies anterior of the radius o Insertion: bases of the middle part of the second till the fith fingers o Artery: A. ulnaris o Nerve: N. medianus - M. flexor carpi radialis o Origin: epicondylus medialis of the humerus, fascia anterbrachii o Insertion: facies palmaris of the basis of the Os metacarpi 2 o Artery: A. ulnaris o Nerve: N. medianus - M. flexor carpi ulnaris o Origin:  Caput humerale: Epicondylus medialis of the humerus  Caput ulnare: olecranon o Insertion: Os pisiforme, Os hamatum, Os metacarpale o Artery: A. ulnaris o Nerve: N. ulnaris - M. palmaris longus o Origin: Humerus o Insertion: Aponeurosis o Artery: A. ulnaris o Nerve: N. medianus - M. Flexor digitorum profundus o Origin: membrana interossea, ulna o Insertion: base of the distal ends of the 2nd till 5th carpi o Artery: A. interossea anterior o Nerve: N. medianus - M. flexor pollicis longus o Origin: facies anterior of the radius o Insertion: distal phalanx of the thumb o Artery: A. interossea anterior o Nerve: N. medianus - M. pronator quadratus: o Origin: distal to the facies anterior of the ulna o Insertion: facies anterior of the radius  Topic 43: Muscles of the forearm: lateral and posterior group - M. brachioradialis o Origin: margo lateralis of the humerus o Insertion: Proximal of the Processus styloideus of the radiu o Artery: A. radialis recurrens o Nerve: N. radialis - M. extensor carpi radialis lungus o Origin: Crista supraepicondylaris lateralis to the epicondylus lateralis o Insertion: dorsal facies of the basis of the Os metacarpi 2 o Artery: A.radialis o Nerve: N. radialis - M. extensor carpi radialis brevis o Origin: Epicondylus lateralis of the humerus o Insertion: dorsal facies of the basis of the Os metacarpi 3 o Artery: A. radialis o Nerve: N. radialis - M. extensor digitorum o Origin: epicondylus lateralis of the humerus, fascia antebrachii o Insertion: dorsal side of the 2.-5. finger o Artery: A. interossea posterior o Nerve: N. radialis - M. extensor digiti minimi o Origin: epicondylus lateralis of the humerus, fascia antebrachii o Insertion: dorsal side of the 5th finger o Artery: A. interossea posterio o Nerve: N. radialis - M. extensor carpi ulnaris o Origin:  Caput humerale: epicondylus lateralis of the humerus  Caput ulnare: olecranon, fascia antebrachii o Insertion: dorsal side of the Os metacarpi 5 o Artery: A. ulnaris o Nerve: N. ulnaris - M. supinator o Origin: Epicondylus lateralis humeri, crista musculi supinatoris der ulna o Insertion: facies anterior of the radius o Artery: A. radialis recurrens o Nerve: N. radialis - M. abductor pollicis longus o Origin: fascies posterior of the ulna, membrana interossea o Insertion: Basis of the Os metacarpi 5 o Artery: A. interossea posterior o Nerve: N. radialis - M. extensor pollicis brevis o Origin: Facies posterior of the radius o Insertion: basis of the phalanx proximalis of the thumb  o Artery: A. interossea posterior o Nerve: N. radialis - M. extensor pollicis longus o Origin: facies posterior of the ulna, membrana interossea o Insertion: Basis of the Os metacarpi 1 o Artery: A. interossea posterior o Nerve: N. radialis - M. extensor indicis: o Origin: membrana interossea o Insertion: Dorsal part of the forefinger o Artery: A. interossea posterior o Nerve: N. radialis  Topic 44: Muscles of the hand - M. abductor pollicis brevis: o Origin: retinaculum musculorum flexorum, eminentia carpi radialis o Insertion: radial of the basal connection of the thumb o Artery: Arcus palmaris superficialis o Nerve: N. medianus - M. adductor pollicis o Origin:  Caput obliquum: Os hamatum, Ossa metacarpi 2-5  Caput transversum: Os metacarpi 3 o Insertion: ulnar of the basal connection of the thumb o Artery: Arcus palmaris profundus o Nerve: N. ulnaris - M. flexor pollicis brevis: o Origin:  Caput superficialis: retinaculum musculorum flexorum  Caput profundum: Os capitatum, Os trapezium o Insertion: radial of the basal connection of the thumb o Artery: Arcus palmaris superficialis o Nerve: N. ulnaris, N. medianus - M. opponens pollicis o Origin: retinaculum muscolurm flexorum, hamulus ossis hamati o Insertion: Os metacarpi 5 o Artery: Arcus palmaris superficialis o Nerve: N. medianus - M. abductor digiti minimi o Origin: Os pisiforme, retinaculum musculorum flexorum o Insertion: Basal phalanx o Artery: A. ulnaris o Nerve: N. ulnaris - M. flexor digiti minimi o Origin: Retinaculum musculorum flexorum, hamulus ossis hamati o Insertion: phalanx proximalis of the 5th finger o Artery: A. ulnaris o Nerve: N. ulnaris - M. Opponens digiti minimi o Origin: retinaculum musculorum flexorum, hamulus ossis hamati o Insertion: Os metacarpi 5 o Artery: A. ulnaris o Nerve: N. ulnaris - Mm lumbricales o Origin: tendons of the musculus flexor digitorum profundu o Insertion: radial side of each finger in the area of the dorsalaponeurosis o Artery: Arcus palmaris superficialis o Nerve: N. medianus, N. ulnaris - Mm interossei palmaris  o Origin: ulnar side of the of metacarpi 2, radial side of the ossa metcarpi 4 and 5 o Insertion: phalanx proximalis and dorsalaponeuronis of the finger 2,4 and 5 o Artery: Arcus palmaris superficialis o Nerve: N. ulnaris - Mm. Interossei dorsales o Origin: sides of the ossa metacarpalis o Insertion: entrance of the dorsalaponeurosis o Artery: Arcus palmaris superficialis o Nerve: N. ulnaris  Topic 45: Muscles of the hip A) Gluteal muscles: - M. gluteus maximus o Origin:  Facies glutea of the ala ossis ilium, dorsal to the linea glutea posterior,  Facies posterior of the os sacrum,  Fascia thoracolumbalis, lig. sacrotuberale o Insertion:  cranial part: tractus iliotibialis  caudal part: tuberositas glutea o Artery: A. glutea inferior/ superior o Nerve: N. gluteus inferior - M. gluteus medius o Origin: Facies glutea of the Ala ossis ilium between lineae gluteae anterior and posterior o Insertion: apex of the trochanter major o Artery: A. glutea superior o Nerve: N. gluteus superior - M. gluteus minimus o Origin: facies glutea of the Ala ossis ilium between lineae gluteae anterior and inferior o Insertion: apex of the trochanter major o Artery: A. glutea superior o Nerve: N. gluteus superior B) Adductor muscles: - M. pectineus: o Origin: Pecten ossis pubis o Insertion: Trochanterminor and linea pectinea of the femur o Artery: A. obturatoria o Nerve: N. femoralis, N. obturatorius - M. adductor longus o Origin: Os pubis till te symphysis o Insertion: Middle third of the labium mediale of the linea aspera o Artery: A. profunda femoris o Nerve: N. obturatorius - M. adductor brevis o Origin: Ramus inferior ossis pubis o Insertion: Proximal third of the labium mediale of the linea aspera o Artery: A. profunda femoris o Nerve: N. obturatorius - M. adductor magnus o Origin:  Main part: ramus inferior ossis pubis, ramus ossis ischii  Dorsal part: tuber ossis ischii o Insertion:  proximal two thirds of the labium mediale of the linea aspera  epicondylus medialis of the femur, septum intermusculare vastoadductorium o Artery: A. profunda femoris o Nerve: N. obturatorius, N. tibialis - M. gracilis o Origin: Corpus ossis pubis, ramus inferior ossis pubis o Insertion: superficial on the condylus medialis of the tibia o Artery: A. circumflexa femoris medialis o Nerve: N. obturatorius C) Lateral rotator group - M. tensor fasciae latae o Origin: spina iliaca anterior superior o Insertion: superior to the tractus iliotibialis, tibia inferior to the condylus lateralis o Artery: A. circumflexa femoris lateralis o Nerve: N. gluteus superior - M. quadratus femoris o Origin: Tuber ischiadicum o Insertion: Crista intertrochanterica o Artery: A. glutea inferior o Nerve: N. musculi quadrati fermoris - M. obturatorius externus o Origin:  boneous margin of the foramen obturatum,  lateral facies of the membrana obturatoria