Sobotta Atlas of Human Anatomy PDF

Sobotta Atlas of Human Anatomy Tables of Muscles, Joints, and Nerves 1st edition Edited by F. Paulsen and J. Waschke Translated by T. Klonisch and S. Hombach-Klonisch, Winnipeg, Canada München Sobotta Atlas of Human Anatomy Tables of Muscles, Joints, and Nerves 1st edition Edited by F. Paulsen and J. Waschke Translated by T. Klonisch and S. Hombach-Klonisch This booklet is a supplement to Sobotta, Atlas of Anatomy, volumes 1 to 3, 15th edition. The cross-references refer to the figure numbers in the Atlas. Apart from this, the tables are also useful for an independent systematic learning and revision of subject matter. Abbreviations: O = Origin; I = Insertion; F = Function All business correspondence should be made with: Elsevier GmbH, Urban & Fischer Verlag, Hackerbrücke 6, 80335 Munich, Germany, mail to: [email protected] Addresses of the editors: Professor Dr. med. Friedrich Paulsen Institut für Anatomie II (Chairman) Universität Erlangen-Nürnberg Universitätsstraße 19 91054 Erlangen Germany Professor Dr. med. Jens Waschke Institut für Anatomie I (Chairman) Ludwig-Maximilians-Universität Pettenkoferstraße 11 80333 München Germany Addresses of the translators: Professor Dr. med. Sabine Hombach-Klonisch Professor Dr. med. Thomas Klonisch Faculty of Medicine Department of Human Anatomy and Cell Science University of Manitoba 745 Bannatyne Avenue Winnipeg Manitoba R3E 0J9 Canada Bibliographic information published by the Deutsche Nationalbibliothek The Deutsche Nationalbibliothek lists this publication in the Deutsche Nationalbibliograﬁe; detailed bibliographic data are available in the Internet at http://www.d-nb.de. All rights reserved 15th Edition 2013 © Elsevier GmbH, Munich Urban & Fischer Verlag is an imprint of Elsevier GmbH. 13 14 15 16 17 5 4 3 2 1 All rights, including translation, are reserved. 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Acquisition editor: Alexandra Frntic, Munich, Dr. Katja Weimann, Munich Development editor: Dr. Andrea Beilmann, Munich Editing: Ulrike Kriegel, buchundmehr, Munich Production manager: Sibylle Hartl, Munich; Renate Hausdorf, buchundmehr, Gräfelﬁng Composed by: abavo GmbH, Buchloe Printed and bound by: Firmengruppe appl, Wemding Cover illustration: Nicola Neubauer, Puchheim Cover design: SpieszDesign, Neu-Ulm Printed on 80g LuxoArt Silk ISBN 978-0-7020-5254-5 Current information by www.elsevier.de and www.elsevier.com Table of contents Tables of muscles, joints, and nerves 1 Facial muscles...................................................................... 1 a Forehead, vertex, temple b Auricle c Palpebral fissure d Nose e Mouth f Neck 2 Muscles of the tongue............................................................... 6 a Intrinsic muscles of the tongue b Extrinsic muscles of the tongue 3 Muscles of the palate................................................................ 8 4 Masticatory muscles................................................................ 9 5 Muscles of the pharynx.............................................................. 10 a Pharyngeal constrictor muscles b Pharyngeal levator muscles 6 Muscles of the larynx................................................................ 12 7 Branches and innervation areas of the cervical plexus.................................... 14 8 Lateral muscles of the neck........................................................... 14 9 Suprahyoid muscles................................................................. 15 10 Infrahyoid muscles................................................................. 16 11 Scalene muscles.................................................................... 17 12 Prevertebral muscles................................................................ 18 13 Muscles of the thoracic wall.......................................................... 19 14 Ventral muscles of the abdominal wall................................................. 20 15 Lateral muscles of the abdominal wall................................................. 20 16 Dorsal muscles of the abdominal wall.................................................. 21 17 Spinocostal muscles................................................................ 21 18 Autochthonous muscles of the back................................................... 22 I Lateral tract...................................................................... 22 a Sacrospinal system b Intertransversal system c Spinotransversal system d Levatores costarum II Medial tract...................................................................... 26 a Spinal system b Transversospinal system III Autochthonous deep muscles of the neck............................................... 29 19 Diaphragm........................................................................ 31 20 Muscles of the pelvic floor and perineal muscles......................................... 32 a Diaphragma pelvis b Perineal muscles 21 Joints of the upper extremity......................................................... 34 a Joints of the shoulder girdle b Joints of the upper extremity c Planes and axes of the joints of the upper extremity 22 Branches and innervation areas of the brachial plexus.................................... 36 23 Segmental innervation of the muscles of the arm, diagnostically relevant indicator muscles.... 37 24 Ventral muscles of the shoulder girdle................................................. 37 25 Ventral muscles of the shoulder....................................................... 38 26 Lateral muscles of the shoulder....................................................... 38 27 Dorsal muscles of the shoulder girdle.................................................. 39 28 Dorsal muscles of the shoulder....................................................... 40 29 Ventral muscles of the upper arm..................................................... 41 30 Dorsal muscles of the upper arm...................................................... 42 31 Ventral superficial muscles of the forearm.............................................. 43 32 Ventral deep muscles of the forearm................................................... 44 33 Lateral (radial) muscles of the forearm................................................. 45 34 Dorsal superficial muscles of the forearm............................................... 46 35 Dorsal deep muscles of the forearm.................................................... 47 36 Thenar muscles.................................................................... 48 37 Palmar muscles.................................................................... 49 38 Hypothenar muscles................................................................ 50 39 Joints of the lower extremity......................................................... 51 a Bony connections of the pelvic girdle b Joints of the free lower extremity c Planes and axes of movements of the joints of the lower extremity 40 Branches and innervation areas of the lumbosacral plexus................................. 54 41 Segmental innervation of muscles of the lower extremity, diagnostically relevant indicator muscles............................................... 56 42 Ventral muscles of the hip............................................................ 56 43 Dorsolateral muscles of the hip....................................................... 57 44 Pelvitrochanteric muscles of the hip................................................... 58 45 Ventral muscles of the thigh.......................................................... 59 46 Medial muscles of the thigh (adductors)................................................ 60 47 Dorsal muscles of the thigh (ischiocrural muscles)....................................... 61 48 Ventral muscles of the leg............................................................ 62 49 Lateral (fibular) muscles of the leg..................................................... 63 50 Dorsal superficial muscles of the leg................................................... 63 51 Dorsal deep muscles of the leg........................................................ 64 52 Muscles of the dorsum of the foot..................................................... 65 53 Medial muscles of the sole of the foot.................................................. 65 54 Muscles in the midregion of the sole of the foot......................................... 66 55 Lateral muscles of the sole of the foot.................................................. 67 56 Cranial nerves, overview............................................................. 68 57 Cranial nerves, functions (fiber qualities)............................................... 68 58 Cranial nerves...................................................................... 69 a Olfactory nerve [I] b Optic nerve [II] c Oculomotor nerve [III] d Trochlear nerve [IV] e Trigeminal nerve [V] – Ophthalmic nerve [V/1] – Maxillary nerve [V/2] – Mandibular nerve [V/3] f Abducent nerve [VI] g Facial nerve [VII] h Vestibulocochlear nerve [VIII] i Glossopharyngeal nerve [IX] j Vagus nerve [X] k Accessory nerve [XI] l Hypoglossal nerve [XII] 59 Functional organization of the isocortex: primary and secondary cortical areas................ 73 60 Nuclei of the thalamus (selection)..................................................... 73 Head Neck Trunk Upper extremity Lower extremity Cranial nerves Table 1 1 Facial muscles ( Figs. 8.63–8.65, 11.2, 11.13) The mimic muscles only partially originate from deﬁned bony structures but all insert in the skin. a Forehead, vertex, temple Occipitofrontalis Facial nerve [VII] Occipitofrontalis and temporoparietalis are collectively named epicranius. O: frontal belly: skin of the fore- I: epicranial aponeurosis F: forehead head frontal belly: wrinkling of the fore- occipital belly: highest nuchal line head (expression of surprise) occipital belly: smoothens wrinkles of the forehead Temporoparietalis Facial nerve [VII] O: skin of the temple, I: epicranial aponeurosis F: moves the skin of the head down- temporal fascia wards b Auricle Auricularis anterior Facial nerve [VII] O: temporal fascia I: anterior to the auricle F: moves the auricle in a superior and anterior direction Auricularis superior Facial nerve [VII] O: epicranial aponeurosis I: superior to the auricle F: moves the auricle in a superior and posterior direction Auricularis posterior Facial nerve [VII] O: mastoid process I: posterior to the auricle F: moves the auricle in a posterior direction 1 Table 1 Head Neck Trunk 1 Facial muscles (continued) c Palpebral ﬁssure Orbicularis oculi (surrounds the orbital opening like a sphincter) Facial nerve [VII] O: orbital part: nasal part of the I: orbital part: lateral palpebral F: closes the eyelids, compresses the frontal bone, ligament lacrimal sac frontal process of the maxilla, palpebral part: lateral palpebral lacrimal bone, ligament medial palpebral ligament lacrimal part: lacrimal duct, palpebral part: medial palpebral palpebral ﬁssure ligament, lacrimal sac lacrimal part: posterior lacrimal crest of the lacrimal bone, lacrimal sac Depressor supercilii (separation of the orbital part of the orbicularis oculi) Facial nerve [VII] O: nasal part of the frontal bone, I: medial third of the skin of the F: depresses the skin of the eyebrow dorsum of the nose eyebrow Corrugator supercilii Facial nerve [VII] O: nasal part of the frontal bone I: middle third of the skin of the F: pulls the skin of the forehead and eyebrow eyebrows towards the root of the nose, creates a vertical fold above the root of the nose (anger, thinking) Procerus Facial nerve [VII] O: nasal bone I: skin of the glabella F: horizontal folds on the dorsum of the nose (wrinkling of the nose) 2 Upper extremity Lower extremity Cranial nerves Table 1 1 Facial muscles (continued) d Nose Nasalis Facial nerve [VII] O: alar part: maxilla at the level of I: alar part: nasal wing, rim of the F: moves the nasal wings and the the lateral incisor nasal opening nose transverse part: maxilla at the level transverse part: tendinous plate of alar part: dilates the nasal opening of the canine the dorsum of the nose transverse part: narrows the nasal opening Depressor septi nasi Facial nerve [VII] O: maxilla at the level of the medial I: septal nasal cartilage F: moves the nose downwards incisor e Mouth Orbicularis oris Facial nerve [VII] O: marginal part and labial part: I: skin of the lip F: closes lips, pursing lips lateral of the angle of mouth Buccinator Facial nerve [VII] O: maxilla, pterygomandibular raphe, I: angle of mouth F: puts tension on the lips, increases mandible pressure within the mouth cavity, e.g. during blowing and chewing Levator labii superioris Facial nerve [VII] O: maxilla superior to the infra- I: upper lip F: pulls the upper lip sideways and orbital foramen upwards 3 Table 1 Head Neck Trunk 1 Facial muscles (continued) Depressor labii inferioris Facial nerve [VII] O: mandible inferior to the mental I: lower lip F: pulls the lower lip sideways and foramen downwards Mentalis Facial nerve [VII] O: mandible, at the level of the I: skin of the chin F: creates the groove of the chin, lower lateral incisor everts and protrudes the lower lip (together with the orbicularis oris; to pout or pull a face) Transversus menti Facial nerve [VII] O: transverse separation from the I: skin of the mental protuberance F: moves the skin of the chin mentalis Depressor anguli oris Facial nerve [VII] O: lower margin of the mandible I: angle of mouth F: moves the angle of the mouth downwards Risorius Facial nerve [VII] O: parotid fascia, masseteric fascia I: angle of mouth F: broadens the mouth (grin), creates dimples 4 Upper extremity Lower extremity Cranial nerves Table 1 1 Facial muscles (continued) Levator anguli oris Facial nerve [VII] O: canine fossa of the maxilla I: angle of mouth F: pulls the angle of the mouth to the medial side and upwards Zygomaticus major Facial nerve [VII] O: zygomatic bone I: angle of mouth F: pulls the angle of the mouth to the lateral side and upwards Zygomaticus minor Facial nerve [VII] O: zygomatic bone I: angle of mouth F: pulls the angle of the mouth to the lateral side and upwards Levator labii superioris alaeque nasi Facial nerve [VII] O: frontal process of the maxilla I: nasal wing, upper lip F: lifts the lips and the nasal wing (medial orbital wall) f Neck ( Fig. 11.2) Platysma Facial nerve [VII] O: base of mandible, parotid fascia I: skin below the clavicle, pectoral F: tenses the skin of the neck, fascia generates longitudinal folds 5 Table 2 Head Neck Trunk 2 Muscles of the tongue ( Figs. 8.139, 8.141, 8.147– 8.150) a Intrinsic muscles of the tongue Superior longitudinal muscle Hypoglossal nerve [XII] O: root of tongue I: apex of tongue F: shortens and broadens the tongue, elevates the tip of the tongue Inferior longitudinal muscle Hypoglossal nerve [XII] O: root of tongue I: apex of tongue F: shortens and broadens the tongue, depresses the tip of the tongue Transverse muscle Hypoglossal nerve [XII] O: lateral margin of the tongue, I: lateral margin of the tongue, F: narrows the tongue and, in associa- lingual septum lingual aponeurosis tion with the vertical muscle, extends the tongue Vertical muscle Hypoglossal nerve [XII] O: root of tongue I: lingual aponeurosis F: broadens the tongue 6 Upper extremity Lower extremity Cranial nerves Table 2 2 Muscles of the tongue (continued) b Extrinsic muscles of the tongue Genioglossus Hypoglossal nerve [XII] O: mental spine of the mandible I: lingual aponeurosis F: moves the tongue in an anterior and inferior direction Hyoglossus Hypoglossal nerve [XII] O: greater horn and body of hyoid I: lingual aponeurosis F: moves the tongue in a posterior and bone inferior direction Styloglossus Hypoglossal nerve [XII] O: styloid process of the temporal I: lingual aponeurosis F: moves the tongue in a posterior and bone superior direction 7 Table 3 Head Neck Trunk 3 Muscles of the palate ( Fig. 8.133) Levator veli palatini Pharyngeal branches of the glossopharyngeal nerve [IX] and the vagus nerve [X] (= pharyngeal plexus) O: inferior surface of the petrous I: palatine aponeurosis F: elevates the soft palate, widens the part of the temporal bone, cartilage lumen of the auditory tube of auditory tube Tensor veli palatini (is looped around the pterygoid hamulus which acts as a hypomochlion) Nerve to tensor veli palatini of the mandibular nerve [V/3] O: scaphoid fossa at the pterygoid I: palatine aponeurosis F: tenses the soft palate and widens process, membranous part and the lumen of the auditory tube cartilage of the auditory tube Palatoglossus Glossopharyngeal nerve [IX] O: palatine aponeurosis I: projects into the intrinsic muscles F: depresses the soft palate, simul- of the tongue taneously elevates the root of the tongue and thereby narrows the isthmus of fauces Musculus uvulae (unpaired muscle) Pharyngeal branches of the glossopharyngeal nerve [IX] and the vagus nerve [X] (= pharyngeal plexus) O: palatine aponeurosis I: stroma of the uvula F: shortens the uvula, thereby thick- ening it 8 Upper extremity Lower extremity Cranial nerves Table 4 4 Masticatory muscles ( Figs. 8.62, 8.64–8.67, 8.69) The masseter is easily palpated through the skin along its course from the mandibular angle to the zygomatic arch. When clenching the teeth the belly of the temporalis becomes noticeable at the temple. The medial pterygoid is located at the inside of the mandible. The lateral pterygoid projects from the temporomandibular joint anteriorly. Temporalis Deep temporal nerves (mandibular nerve [V/3]) O: temporal bone inferior to the I: coronoid process of the mandible F: closes the jaw (strongest mastica- inferior temporal line, deep lamina of tory muscle) the temporal fascia anterior portion: pulls the mandible forward (= protrusion) posterior portion: pulls the mandible backward (= retrusion) Masseter Masseteric nerve (mandibular nerve [V/3]) O: superﬁcial part: inferior margin I: superﬁcial part: angle of F: closes the jaw of the zygomatic arch mandible (masseteric tuberosity) superﬁcial part: pulls the mandible deep part: inner surface of the deep part: inferior margin of the forward (= protrusion) zygomatic arch mandible Medial pterygoid Nerve to medial pterygoid (mandibular nerve [V/3]) O: pterygoid fossa I: inferior margin of the mandible F: closes the jaw, pulls the mandible (pterygoid tuberosity) forward (= protrusion) Lateral pterygoid Nerve to lateral pterygoid (mandibular nerve [V/3]) O: upper head: infratemporal crest I: upper head: disc and capsule of F: upper head: initiates jaw opening of the sphenoid the temporomandibular joint by pulling the articular disc forward lower head: lateral plate of the lower head: condylar process of lower head: pulls the mandible pterygoid process mandible (pterygoid fovea) forward (= protrusion) unilateral action: contralateral excursion 9 Table 5 Head Neck Trunk 5 Muscles of the pharynx ( Figs. 8.150, 11.12, 11.13, 11.21) The pharyngeal muscles are divided into constrictor muscles (superior, middle, and inferior constrictor) and levator muscles (stylopharyngeus, salpingo- pharyngeus, and palatopharyngeus). a Pharyngeal constrictor muscles Superior constrictor Pharyngeal branches of the glossopharyngeal nerve [IX] (= pharyngeal plexus) O: pterygopharyngeal part: medial I: pharyngobasilar membrane, phar- F: narrows the pharyngeal space lamina of the pterygoid process, yngeal raphe (PASSAVANT’s ridge), separates the pterygoid hamulus epipharynx from the mesopharynx buccopharyngeal part: pterygo- mandibular raphe mylopharyngeal part: mylohyoid line of the mandible glossopharyngeal part: transverse muscle Middle constrictor Pharyngeal branches of the glossopharyngeal nerve [IX] and the vagus nerve [X] (= pharyngeal plexus) O: chondropharyngeal part: I: pharyngeal raphe F: narrows the pharyngeal space lesser horn of hyoid bone from behind, promotes wave-like ceratopharyngeal part: downward contractions to support greater horn of hyoid bone the transport of ingested food into the esophagus (peristalsis) Inferior constrictor Pharyngeal branches of the vagus nerve [X] (= pharyngeal plexus) O: thyropharyngeal part: thyroid I: pharyngeal raphe F: closes the laryngeal inlet by cartilage elevating the larynx, narrows the cricopharyngeal part: lateral side of pharyngeal space from behind, the cricoid cartilage promotes wave-like downward contractions to support the transport of ingested food into the esophagus (peristalsis) 10 Upper extremity Lower extremity Cranial nerves Table 5 5 Muscles of the pharynx (continued) b Pharyngeal levator muscles Palatopharyngeus (functionally also belonging to the palatine muscles) Pharyngeal branches of the glossopharyngeal nerve [IX] (= pharyngeal plexus) O: palatine aponeurosis I: thyroid cartilage, projects into F: narrows the isthmus of fauces, the lateral and posterior wall of the depresses the soft palate, elevates pharynx the pharyngeal wall towards the soft palate Salpingopharyngeus Pharyngeal branches of the glossopharyngeal nerve [IX] (= pharyngeal plexus) O: cartilage of tube I: projects into the lateral wall of the F: elevates the pharynx pharynx Stylopharyngeus Stylopharyngeal branch of the glossopharyngeal nerve [IX] O: styloid process of the temporal I: thyroid cartilage, projects into the F: elevates the pharynx bone lateral wall of the pharynx 11 Table 6 Head Neck Trunk 6 Muscles of the larynx ( Figs. 11.34, 11.36, 11.39) Cricothyroid (straight part: superficial, oblique part: deep) External branch of the superior laryngeal nerve of the vagus nerve [X] O: external surface of the arch of I: inferior rim of the lamina of the F: puts tension on the vocal liga- cricoid cartilage thyroid cartilage ments by tilting the cricoid cartilage (strongest tensor muscle of the vocal ligaments) Posterior crico-arytenoid Recurrent laryngeal nerve of the vagus nerve [X] O: posterior lamina of the cricoid I: muscular process of the arytenoid F: widens the glottis by lateral move- cartilage cartilage ment of the vocal process of the arytenoid cartilage and lateral tilt of the arytenoid cartilage Lateral crico-arytenoid Recurrent laryngeal nerve of the vagus nerve [X] O: lateral upper rim of the arch of I: muscular process of the arytenoid F: closes the intermembranous part the cricoid cartilage cartilage of the glottis by inward rotation of the arytenoid cartilage Transverse arytenoid Recurrent laryngeal nerve of the vagus nerve [X] O: lateral rim and posterior surface I: lateral rim and posterior surface of F: closes the intercartilaginous part of of the arytenoid cartilage the opposite arytenoid cartilage the glottis by converging both aryte- noid cartilages Oblique arytenoid Recurrent laryngeal nerve of the vagus nerve [X] O: base of the posterior surface of I: tip of the arytenoid cartilage F: pulls the arytenoid cartilage the arytenoid cartilage ary-epiglottic part: lateral rim of the medially and, thus, narrows the ary-epiglottic part: tip of the epiglottic cartilage intercartilaginous part of the glottis, arytenoid cartilage narrows the entrance to the larynx 12 Upper extremity Lower extremity Cranial nerves Table 6 6 Muscles of the larynx (continued) Vocalis Recurrent laryngeal nerve of the vagus nerve [X] O: inner side of the thyroid cartilage I: vocal process of the arytenoid F: closes the glottis completely, cartilage lateral of the vocal liga- responsible for the ﬁne-tuning of the ments tension in the vocal ligaments Thyroarytenoid Recurrent laryngeal nerve of the vagus nerve [X] O: inner surface of the lamina of the I: muscular process and anterior F: narrows the intermembraneous thyroid cartilage surface of the arytenoid cartilage part of the glottis thyro-epiglottic part: lateral rim of thyro-epiglottic part: narrows the the epiglottic cartilage entrance to the larynx 13 Tables 7–8 Head Neck Trunk 7 Branches and innervation areas of the cervical plexus ( Figs. 11.61, 11. 62, 11.65 –11.69) motor function sensory function (Deep) Ansa cervicalis superior root (= anterior root) infrahyoid muscles inferior root (= posterior root) Muscular branches longus colli, longus capitis, rectus capitis anterior and lateralis, intertransversarii anteriores cervicis, trapezius, levator scapulae, scalene muscles, geniohyoid Branches of the punctum nervosum (ERB’s point) great auricular nerve skin of the upper neck region, at the man- dibular angle, anterior and posterior to the auricle, the major part of the auricle transverse cervical nerve skin in the upper anterior neck region lesser occipital nerve skin in the occipital region medial, intermediate, and lateral supraclavicular skin in a stripe inferior to the clavicle nerves Phrenic nerve diaphragm parietal pleura, pericardium, peritoneum 8 Lateral muscles of the neck ( Figs. 11.3, 11.5) The sternocleidomastoid derives from the same primordium as the trapezius (same innervation). The sternocleidomastoid has its origin at the mastoid process and courses to the anteromedial side in an oblique downward direction. It is integrated in the superﬁcial lamina of the cervical fascia. Sternocleidomastoid Accessory nerve [XI]; cervical plexus O: sternal head: ventral aspect of I: mastoid process, lateral superior F: unilaterally active: turns the head to the sternum nuchal line the contralateral side and bends the clavicular head: sternal third of the head to the same side, clavicle bilaterally active: erects the head, bends the cervical vertebral column, auxiliary breathing muscle when the head is in a ﬁxed position 14 Upper extremity Lower extremity Cranial nerves Table 9 9 Suprahyoid muscles ( Figs. 8.145–8.148, 11.3, 11.5) The suprahyoid muscles create the ﬂoor of the oral cavity and are counteracting the infrahyoid muscles. The anterior belly of the digastric lies super- ﬁcially. Shaped as a broad muscular plate, the mylohyoid forms the ﬂoor of the oral cavity. On its inner aspect lies the round-shaped geniohyoid. The posterior belly of the digastric and the stylohyoid position dorsally. Mylohyoid (Together, the right and left parts of the muscle form a muscular plate that provides the caudal seal of the oral cavity.) Nerve to mylohyoid (mandibular nerve [V/3]) O: mylohyoid line of the mandible I: mylohyoid raphe, body of hyoid F: lifts the ﬂoor of the oral cavity bone (opens mouth), depresses the man- dible, lifts the hyoid bone during swallowing Digastric (Posterior belly and anterior belly are connected by an intermediate round tendon, which is fixed at the lesser horn of the hyoid bone.) Anterior belly: nerve to mylohyoid (mandibular nerve [V/3]) Posterior belly: digastric branch (facial nerve [VII]) O: mastoid notch of the temporal I: digastric fossa of the mandible F: supports the mylohyoid bone Stylohyoid Stylohyoid branch (facial nerve [VII]) O: styloid process of the temporal I: body of hyoid bone with two mus- F: lifts the hyoid bone during swal- bone cular bundles which encompass the lowing intermediate tendon of the digastric Geniohyoid (The right and left parts of the muscle lie close to each other – only separated by a thin septum of connective tissue.) Ventral branches of C1–C2 O: mental spine of the mandible I: body of hyoid bone F: supports the mylohyoid 15 Table 10 Head Neck Trunk 10 Infrahyoid muscles ( Figs. 11.3, 11.5) The infrahyoid muscles are counteracting the suprahyoid muscles. Located beneath the superﬁcial sternohyoid are the sternothyroid and the thyro- hyoid. The omohyoid is positioned farthest to the lateral side. Sternohyoid Ansa cervicalis (cervical plexus) O: inner surface of the manubrium I: body of hyoid bone F: pulls the hyoid bone caudally of sternum Sternothyroid Ansa cervicalis (cervical plexus) O: inner surface of the manubrium I: oblique line of the lamina of the F: pulls the larynx caudally of sternum thyroid cartilage Thyrohyoid Ansa cervicalis (cervical plexus) O: outer surface of the lamina of the I: body of hyoid bone F: approximates the hyoid bone and thyroid cartilage the larynx nearer to each other Omohyoid (Inferior belly and superior belly are connected by an intermediate tendon which is attached to the carotid sheath.) Ansa cervicalis (cervical plexus) O: inferior belly: superior border of I: superior belly: body of hyoid bone F: stretches the fascia of the neck the scapula since the intermediate tendon is at- tached to the carotid sheath, prevents the lumen of the internal jugular vein from collapsing, pulls the hyoid bone caudally 16 Upper extremity Lower extremity Cranial nerves Table 11 11 Scalene muscles ( Figs. 2.89, 11.3, 11.5, 11.6) The three scalene muscles, scalenus anterior, scalenus medius, and scalenus posterior course to the upper ribs and form a triangular muscular plate at the lateral aspect of the cervical vertebral column. The brachial plexus and the subclavian artery pass through the scalene triangle delineated by the scalenus anterior and scalenus medius. Scalenus anterior Direct branches of the cervical plexus and brachial plexus O: anterior tubercles of the transver- I: scalene tubercle of rib I F: vertebral column: bends the se processes of the 3rd–6th cervical cervical part of the vertebral column vertebrae sideways thorax: lifts rib I and thus the thorax (breathing muscle: inspiration) Scalenus medius Direct branches of the cervical plexus and brachial plexus O: tubercles of the transverse I: rib I posterior to the groove for F: vertebral column: bends the cervical processes of the 3rd–7th cervical subclavian artery vertebral column sideways vertebrae thorax: lifts rib I and thus the thorax (breathing muscle: inspiration) Scalenus posterior Direct branches of the cervical plexus and brachial plexus O: posterior tubercles of the I: rib II F: vertebral column: bends the transverse processes of the 5th–6th cervical part of the vertebral column cervical vertebrae sideways thorax: lifts rib II and thus the thorax (breathing muscle: inspiration) 17 Table 12 Head Neck Trunk 12 Prevertebral muscles ( Figs. 2.89, 11.6) The prevertebral muscles are located to the right and left sides of the vertebral bodies of the cervical and upper thoracic vertebral column and are covered by the prevertebral lamina of the cervical fascia. The rectus capitis anterior and rectus capitis lateralis connect the anterior and lateral parts of the atlas and axis. Rectus capitis anterior and rectus capitis lateralis Direct branches of the cervical plexus O: transverse process and lateral I: basilar part of the occipital bone F: bend the head to the ventrolateral mass of the atlas side, turn the head to the ipsilateral side Longus capitis Direct branches of the cervical plexus O: anterior tubercles of the trans- I: basilar part of the occipital bone F: bends the head ventrally, turns the verse processes of the 3rd–6th head to the ipsilateral side cervical vertebrae Longus colli Direct branches of the cervical plexus O: body of the 5th cervical to 3rd I: transverse processes of the 5th– F: bends the head ventrally, turns the thoracic vertebrae, anterior tubercles 6th cervical vertebrae, body of the head to the ipsilateral side of the transverse processes of the 2nd–4th cervical vertebrae, anterior 2nd–5th cervical vertebrae tubercle of the atlas 18 Upper extremity Lower extremity Cranial nerves Table 13 13 Muscles of the thoracic wall ( Figs. 2.87–2.93) The pectoralis major shapes the surface relief of the anterior upper thoracic wall. Beneath this muscle lies the pectoralis minor. These two muscles, together with the subclavius, belong to the group of ventral muscles of the shoulder girdle ( Table 24). The external intercostal muscle and internal intercostal muscle ﬁll the intercostal spaces. The subcostales and the transversus thoracis position on the inner side of the thoracic wall. External intercostal muscle Intercostal nerves (thoracic nerves) O: inferior costal rim from the I: superior rim of the next deeper rib F: lifts the ribs, inspiration tubercle to the bone-cartilage line of the ribs Internal intercostal muscle (The innermost intercostal muscle is delineated on its inner side by the posterior intercostal vessels and the intercostal nerve.) Intercostal nerves (thoracic nerves) O: superior costal rim ventral to the I: inferior rim of the next higher rib F: depresses the ribs, expiration costal angle Subcostales (inconsistent muscle) Intercostal nerves (thoracic nerves) O: superior rim of the lower ribs I: inferior rim of the lower ribs, F: depresses the ribs, expiration between tubercle and angle of rib skipping one rib Transversus thoracis Intercostal nerves (thoracic nerves) O: dorsally at the body of sternum I: costal cartilage of ribs II–VI F: braces the thoracic wall, expiration and xiphoid process 19 Tables 14–15 Head Neck Trunk 14 Ventral muscles of the abdominal wall ( Figs. 2.91–2.93, 2.98) The muscles of the anterior abdominal wall, the rectus abdominis and the pyramidalis, are located within the rectus sheath. Rectus abdominis Intercostal nerves (thoracic nerves) O: outer surface of the costal I: pubic symphysis F: bends the torso, abdominal press, cartilage of ribs V–VII, costoxiphoid expiration (diaphragmatic/abdominal ligaments breathing type) Pyramidalis (inconsistent muscle) Caudal intercostal nerves (thoracic nerves) O: pubic symphysis ventral to the I: linea alba F: ”tenses“ the linea alba rectus abdominis 15 Lateral muscles of the abdominal wall ( Figs. 2.85–2.87, 2.91–2.93, 2.96, 2.98, 2.99) The external oblique, the internal oblique, and the transversus abdominis are collectively named the lateral muscles of the abdominal wall. Their tendi- nous plates form the rectus sheath. In men and women, the cremaster separates from the internal oblique and the transversus. External oblique Caudal intercostal nerves (thoracic nerves) O: outer surface of ribs V–XII I: outer lip of the iliac crest, inguinal F: unilaterally active: rotates the ligament, participates in the forma- thorax to the contralateral side, bends tion of the anterior lamina of the the vertebral column to the ipsilateral rectus sheath side; bilaterally active: bends the torso, abdominal press, expiration (diaphrag- matic breathing type) Internal oblique Caudal intercostal nerves (thoracic nerves); iliohypogastric nerve; ilioinguinal nerve (lumbar plexus) O: thoracolumbar fascia (deep layer), I: inferior rim of the costal cartilage F: unilaterally active: rotates the intermediate zone of the iliac crest, of ribs IX–XII, contributes to the thorax to the ipsilateral side, bends inguinal ligament anterior and posterior laminae of the the vertebral column to the ipsilateral rectus sheath above the arcuate line, side; below thereof all tendinous ﬁbers bilaterally active: bends the torso, project into the anterior lamina abdominal press, expiration (diaphrag- matic breathing type) 20 Upper extremity Lower extremity Cranial nerves Tables 15–17 15 Lateral muscles of the abdominal wall (continued) Transversus abdominis Caudal intercostal nerves (thoracic nerves); iliohypogastric nerve; ilioinguinal nerve (lumbar plexus); genitofemoral nerve O: inner surface of the costal carti- I: contributes to the posterior lamina F: abdominal press, expiration lage of ribs VII–XII, thoracolumbar of the rectus sheath above the arcu- (diaphragmatic breathing type) fascia (deep layer), inner lip of the ate line, below thereof it contributes iliac crest, inguinal ligament to the formation of the anterior lamina Cremaster Genitofemoral nerve O: separation of the internal oblique I: surrounds the spermatic cord, in F: lifts the testis and the transversus abdominis women the round ligament of uterus 16 Dorsal muscles of the abdominal wall ( Figs. 2.96, 2.99) The quadratus lumborum forms the muscular basis of the posterior abdominal wall. Medially thereof follows the psoas major. Quadratus lumborum Caudal intercostal nerves; muscular branches (lumbar plexus) O: inner lip of the iliac crest I: rib XII, costal process of the 4th–1st F: bends the vertebral column to the lumbar vertebrae ipsilateral side 17 Spinocostal muscles ( Fig. 2.75) The spinocostal muscles, serratus posterior superior, and serratus posterior inferior, are thin muscles of minor functional relevance and are located on top of the autochthonous muscles of the back. Serratus posterior superior Cranial intercostal nerves (thoracic nerves) O: spinous process of the 6th, 7th I: ribs II–V lateral to the angle of rib F: elevates the ribs, inspiration cervical vertebrae and the 1st, 2nd thoracic vertebrae Serratus posterior inferior Caudal intercostal nerves (thoracic nerves) O: spinous process of the 11th, 12th I: caudal margin of ribs IX–XII F: depresses ribs IX–XII, as an thoracic vertebrae and the 1st, 2nd antagonist to the diaphragm also lumbar vertebrae active during forced inspiration 21 Table 18 Head Neck Trunk 18 Autochthonous muscles of the back ( Figs. 2.76–2.79, 2.81–2.84, 2.96) I Lateral tract The lateral tract of the autochthonous muscles of the back covers the medial tract in the cervical and lumbar regions. Hence, it is also referred to as the superﬁcial part of the autochthonous muscles of the back. The iliocostalis, the longissimus, and the intertransversarii constitute the group of straight muscles. Diverging cranially in an oblique angle (spinotransversal) are the splenius muscles. The levatores costarum course in an oblique laterocaudal direction to the ribs. a) Sacrospinal system Iliocostalis lumborum Posterior branches of the lumbar nerves O: together with the longissimus I: angle of ribs XII–V F: unilaterally active: lateroﬂexion; thoracis from: bilaterally active: extension spinous processes of the lumbar vertebrae, dorsal surface of the sacrum, dorsal third of the iliac crest, thoracolumbar fascia Iliocostalis thoracis Posterior branches of the thoracic nerves O: ribs XII–VII medial to the costal I: angle of ribs (VI) VII–I F: unilaterally active: lateroﬂexion; angle bilaterally active: extension Iliocostalis cervicis Posterior branches of the cervical nerves O: ribs VII–(IV) III medial to the I: posterior tubercle of the trans- F: unilaterally active: lateroﬂexion; costal angle verse process of the 6th–(4th) 3rd bilaterally active: extension cervical vertebrae 22 Upper extremity Lower extremity Cranial nerves Table 18 18 Autochthonous muscles of the back (continued) Longissimus thoracis Posterior branches of the spinal nerves O: spinous processes of the lumbar A: medial part: mamillary process of F: unilaterally active: lateroﬂexion; vertebrae, the 5th lumbar vertebra, bilaterally active: extension dorsal surface of the sacrum, accessory process of the 4th–1st frequently from the mamillary lumbar vertebrae, process of the 2nd and 1st lumbar transverse processes of the thoracic vertebrae and from the transverse vertebrae; process of the 12th–6th thoracic lateral part: costal process of the vertebrae 4th–1st lumbar vertebrae, deep lamina of the thoracolumbar fascia, ribs XII–II medial to the costal angle Longissimus cervicis Posterior branches of the spinal nerves O: transverse process of the 6th–1st I: posterior tubercle of the trans- F: unilaterally active: lateroﬂexion; thoracic and 7th–3rd cervical verte- verse process of the 5th–2nd cervical bilaterally active: extension brae vertebrae Longissimus capitis Posterior branches of the spinal nerves O: transverse process of the I: posterior margin of the mastoid F: unilaterally active: lateroﬂexion; 3rd thoracic to the 3rd cervical process bilaterally active: extension vertebrae 23 Table 18 Head Neck Trunk 18 Autochthonous muscles of the back (continued) b) Intertransversal system Intertransversarii laterales lumborum (These are not autochthonous muscles in the true sense but they are of ventral origin.) Anterior branches of the spinal nerves O: iliac tuberosity, costal process I: costal process of the 5th–1st F: unilaterally active: lateroﬂexion; and accessory processs of the lumbar vertebrae, bilaterally active: extension 5th–1st lumbar vertebrae, iliac tuberosity transverse process of the 12th thoracic vertebra Intertransversarii mediales lumborum Posterior branches of the spinal nerves O: accessory process of the I: mamillary process of the F: unilaterally active: lateroﬂexion; 4th–1st lumbar vertebrae 5th–2nd lumbar vertebrae bilaterally active: extension Intertransversarii thoracis Posterior branches of the spinal nerves O: transverse process of the I: accessory process and mamillary F: unilaterally active: lateroﬂexion; 12th–10th thoracic vertebrae process of the 1st lumbar vertebra bilaterally active: extension up to the transverse process of the 11th thoracic vertebra Intertransversarii posteriores cervicis Posterior branches of the spinal nerves O: posterior tubercle of the trans- I: posterior tubercle of the trans- F: unilaterally active: lateroﬂexion; verse process of the 6th–1st cervical verse process of the 7th–2nd cervical bilaterally active: extension vertebrae vertebrae Intertransversarii anteriores cervicis (These are not autochthonous muscles in the true sense but they are of ventral origin.) Anterior branches of the spinal nerves O: anterior tubercle of the trans- I: anterior tubercle of the trans- F: unilaterally active: lateroﬂexion; verse process of the 6th–1st cervical verse process of the 7th–2nd cervical bilaterally active: extension vertebrae vertebrae 24 Upper extremity Lower extremity Cranial nerves Table 18 18 Autochthonous muscles of the back (continued) c) Spinotransversal system Splenius cervicis Posterior branches of the cervical nerves O: spinous process of the 3rd tho- I: posterior tubercle of the trans- F: unilaterally active: lateroﬂexion, racic to the 6th cervical vertebrae, verse process of the (3rd) 2nd–1st rotation of the cervical part of the supraspinal ligament cervical vertebrae vertebral column and of the head to the ipsilateral side; bilaterally active: extension of the cervical part of the vertebral column Splenius capitis Posterior branches of the cervical nerves O: spinous process of the I: mastoid process, (superior nuchal F: unilaterally active: lateroﬂexion, 3rd–7th cervical vertebrae, line) rotation of the cervical part of the ligamentum nuchae vertebral column and of the head to the ipsilateral side; bilaterally active: extension of the cervical part of the vertebral column d) Levatores costarum Levatores costarum (The levatores costarum longi skip a rib at a time, the levatores costarum breves course to the next caudal rib.) Posterior branches of the cervical nerve [C8] and of the thoracic nerves [T1–T10] O: transverse process of the I: ribs XII–I each lateral of the costal F: lift the ribs, lateroﬂexion and 11th thoracic to 7th cervical angle rotation of the vertebral column vertebrae 25 Table 18 Head Neck Trunk 18 Autochthonous muscles of the back (continued) II Medial tract The medial tract of the autochthonous muscles of the back is located beneath the lateral tract in the cervical and lumbar regions. Hence, it is also referred to as the deep part of the autochthonous muscles of the back. The interspinales and the spinalis constitute the group of straight muscles. The rotatores, the multiﬁdi, and the semispinalis converge in a craniomedial direction (transversospinal). a) Spinal system Interspinales lumborum Posterior branches of the spinal nerves O: spinous process of the 5th–1st I: superior rim of the median sacral F: segmental extension lumbar vertebrae crest, spinous process of the 5th–2nd lumbar vertebrae Interspinales thoracis Posterior branches of the spinal nerves O: spinous process of the I: spinous process of the (1st lumbar) F: segmental extension (12th) 11th–2nd (1st) thoracic 12th–3rd (2nd) thoracic vertebrae vertebrae Interspinales cervicis Posterior branches of the spinal nerves O: spinous process of the I: spinous process of the 1st thoracic F: segmental extension 7th–2nd cervical vertebrae to 3rd cervical vertebrae 26 Upper extremity Lower extremity Cranial nerves Table 18 18 Autochthonous muscles of the back (continued) Spinalis thoracis (At its origin and insertion, this muscle has close connections with the longissimus thoracis and the multifidi, respectively.) Posterior branches of the spinal nerves O: spinous process of the I: spinous process of the F: unilaterally active: lateroﬂexion; (3rd) 2nd, 1st lumbar and (10th) 9th–2nd thoracic vertebrae bilaterally active: extension 12th–10th thoracic vertebrae Spinalis cervicis Posterior branches of the spinal nerves O: spinous process of the I: spinous process of the F: unilaterally active: lateroﬂexion; (4th) 3rd–1st thoracic and (6th) 5th–2nd cervical vertebrae bilaterally active: extension 7th–6th cervical vertebrae Spinalis capitis (Inconsistent muscle, which, at its insertion point, is closely associated with the semispinalis capitis.) Posterior branches of the spinal nerves O: spinous process of the I: squamous part of occipital bone F: unilaterally active: lateroﬂexion; 3rd–1st thoracic and between highest nuchal line and bilaterally active: extension 7th–6th cervical vertebrae superior nuchal line near the external occipital protuberance 27 Table 18 Head Neck Trunk 18 Autochthonous muscles of the back (continued) b) Transversospinal system Rotatores (They are subdivided into the rotatores cervicis, rotatores thoracis, and the inconsistent rotatores lumborum. The rotatores breves course to the adjacent upper vertebra, whereas the rotatores longi skip one vertebra at a time.) Posterior branches of the spinal nerves O: mamillary processes of the lum- I: base of the spinous process of the F: unilaterally active: segmental latero- bar vertebrae, 3rd–1st lumbar, 12th–1st thoracic, and ﬂexion, rotation; transverse processes of the thoracic 7th–2nd cervical vertebrae bilaterally active: segmental extension vertebrae, inferior articular processes of the cervical vertebrae Multiﬁdi (They are particularly strong in the lumbar region and skip two to four vertebrae at a time.) Posterior branches of the spinal nerves O: dorsal surface of the sacrum, I: spinous process of the 5th–1st F: unilaterally active: segmental latero- posterior sacro-iliac ligament, lumbar, 12th–1st thoracic, and 7th–2nd ﬂexion, rotation; dorsal part of the iliac crest, cervical vertebrae bilaterally active: segmental extension mamillary processes of the lumbar vertebrae, transverse processes of the thoracic vertebrae, inferior articular process of the 7th–4th cervical vertebrae Semispinalis thoracis (Its muscle fibers skip five to seven vertebrae at a time.) Posterior branches of the spinal nerves O: transverse process of the (12th) I: spinous process of the F: unilaterally active: rotation of the 11th–7th (6th) thoracic vertebrae (4th) 3rd thoracic to the 6th cervical vertebral column and head to the vertebrae contralateral side; bilaterally active: extension 28 Upper extremity Lower extremity Cranial nerves Table 18 18 Autochthonous muscles of the back (continued) Semispinalis cervicis Posterior branches of the spinal nerves O: transverse process of the I: spinous process of the 6th–3rd F: unilaterally active: rotation of the (7th) 6th thoracic to 7th cervical cervical vertebrae vertebral column and head to the vertebrae contralateral side, sidebending; bilaterally active: extension Semispinalis capitis Posterior branches of the spinal nerves O: transverse process of the I: squamous part of occipital bone F: unilaterally active: rotation of the (8th) 7th thoracic to 3rd cervical between highest nuchal line and vertebral column and head to the vertebrae superior nuchal line, medial part contralateral side, sidebending; bilaterally active: extension III Autochthonous deep muscles of the neck ( Figs. 2.77, 2.78, 2.81–2.83) Rectus capitis posterior major Suboccipital nerve (dorsal branch of the cervical nerve [C1]) O: spinous process of the axis I: middle third of the inferior nuchal F: unilaterally active: rotates and line bends the head to the ipsilateral side; bilaterally active: involved in the ﬁne- tuned positioning and kinematics of the head joints, extension Rectus capitis posterior minor Suboccipital nerve (dorsal branch of the cervical nerve [C1]) O: posterior tubercle of the posterior I: inferomedial to the inferior nuchal F: unilaterally active: rotates and arch of atlas line bends the head to the ipsilateral side; bilaterally active: involved in the ﬁne- tuned positioning and kinematics of the head joints, extension 29 Table 18 Head Neck Trunk 18 Autochthonous muscles of the back (continued) Obliquus capitis superior Suboccipital nerve (dorsal branch of the cervical nerve [C1]) O: transverse process of the atlas I: lateral third of the inferior nuchal F: unilaterally active: bends the head line to the ipsilateral side; bilaterally active: involved in the ﬁne- tuned positioning and kinematics of the head joints, extension Obliquus capitis inferior Suboccipital nerve (dorsal branch of the cervical nerve [C1]) O: spinous process of the axis I: transverse process of the atlas F: unilaterally active: bends the head to the ipsilateral side; bilaterally active: involved in the ﬁne- tuned positioning and kinematics of the head joints, extension 30 Upper extremity Lower extremity Cranial nerves Table 19 19 Diaphragm ( Figs. 2.98–2.101) The diaphragm separates the thoracic cavity from the abdominal cavity. Its cupulas form the ﬂoor of the right and left pleural cavity, respectively. The lumbar part delineates the retroperitoneal space dorsally and is part of the posterior abdominal wall. Diaphragma Phrenic nerve (cervical plexus) O: sternal part: inner surface of the I: all parts unite in the central tendon F: diaphragmatic (abdominal) breath- xiphoid process, ing (inspiration), abdominal press rectus sheath costal part: inner surface of the costal cartilage of ribs XII–VI lumbar part: – medial part: body of the 3rd–1st lumbar vertebrae – lateral part: with medial arcuate ligament (psoas arcade) and lateral arcuate ligament (quadratus arcade) at the costal process of ribs I and XII Passageways and weak spots in the diaphragm Name Position Structure Aortic hiatus lumbar part, aorta; between right crus, left crus and vertebral column thoracic duct Esophageal hiatus lumbar part (medial part, left side) esophagus; vagus nerves; left phrenic nerve: left phrenico-abdominal branch Caval opening central tendon inferior vena cava; right phrenic nerve: right phrenico-abdominal branch Sternocostal triangle [LARREY’s triangle] between costal part and lumbar part superior epigastric artery/vein Lumbocostal triangle between sternal part and costal part Not labeled lumbar part, greater and lesser splanchnic nerves; (medial part) azygos vein; hemi-azygos vein Not labeled lumbar part, sympathetic trunk between medial part and lateral part Not labeled central tendon left phrenic nerve: left phrenico-abdominal branch 31 Table 20 Head Neck Trunk 20 Muscles of the pelvic ﬂoor and perineal muscles ( Figs. 7.63–7.65, 7.87–7.89, 7.99, 7.115) The pelvic diaphragm is formed by the levator ani and the ischiococcygeus. Beneath it lie the perineal muscles. a) Pelvic diaphragm Levator ani (It consists of the pubococcygeus and the iliococcygeus. Beginning at the pubococcygeus, the puborectalis forms a loop around the rectum.) Branches of the sacral nerve [S3 and S4] O: pubococcygeus: inner surface I: central tendon of perineum, F: stabilizes pelvic organs, hence facili- of the pubis adjacent to the pubic coccyx, sacrum, tates urinary and fecal continence, symphysis loop formation with ﬁbers of the encompasses the rectum from iliococcygeus: tendinous arch of opposite side behind the anus behind, hence distal rectal occlusion levator ani (puborectalis) (puborectalis) Ischiococcygeus Branches of the sacral nerve [S3 and S4] O: ischiadic spine, I: sacrum, coccyx F: similar to levator ani sacrospinal ligament External anal sphincter Pudendal nerve (sacral plexus) O: subcutaneous part: dermis and I: dermis and subcutis around the F: occlusion of the anus subcutis around the anus anus, superﬁcial and deep part: anococcygeal ligament central tendon of perineum 32 Upper extremity Lower extremity Cranial nerves Table 20 20 Muscles of the pelvic ﬂoor and perineal muscles (continued) b) Perineal muscles Deep transverse perineal muscle Pudendal nerve (sacral plexus) O: inferior pubic ramus I: central tendon of perineum F: secures the levator gap External urethral sphincter (part of the deep transverse perineal muscle) Pudendal nerve (sacral plexus) U: circular muscle, A: connective tissue surrounding the F: occlusion of the urethra, muscle ﬁbers from the deep trans- urethra (membranous part), occlusion of the urinary bladder during verse perineal muscle vaginal wall (sphincter urethrovagi- ejaculation nalis) Superﬁcial transverse perineal muscle (inconsistent muscle) Pudendal nerve (sacral plexus) O: ramus of ischium I: central tendon of perineum F: supports the deep transverse peri- neal muscle Ischiocavernosus Pudendal nerve (sacral plexus) O: ramus of ischium I: crus of penis/clitoris F: stabilizes the cavernous bodies of penis/clitoris, ejaculation Bulbospongiosus (surrounds the bulb of penis in men and the bulb of vestibule in women) Pudendal nerve (sacral plexus) O: central tendon of perineum, in I: surrounds the bulb of penis/bulb of F: stabilizes the cavernous bodies of men also at the raphe of penis vestibule penis/clitoris, ejaculation 33 Table 21 Head Neck Trunk 21 Joints of the upper extremity ( Fig. 3.8) a) Joints of the shoulder girdle Name of joint Type of joint Range of movement Medial clavicular joint uneven articular surfaces, rotation in the sagittal axis (when lifting the shoulder), sternoclavicular joint irregular joint rotation in the longitudinal axis of the arm (during ante- functionally: spheroidal joint version and retroversion of the shoulder), rotation in the (characteristic: articular disc) longitudinal axis of the clavicle (when swinging the arm) Lateral clavicular joint plane joint, rotation in the sagittal axis (when lifting the shoulder), acromioclavicular joint functionally: spheroidal joint rotation in the transverse axis (when swinging the arm), (characteristic: variable, mostly incomplete rotation in the longitudinal axis (during anteversion and articular disc) retroversion of the shoulder) b) Joints of the upper extremity Name of joint Type of joint Range of movement Shoulder joint spheroidal joint anteversion (ﬂexion) retroversion (extension) abduction adduction medial rotation lateral rotation (arm rotation, circumduction: combined movement with anteversion, abduction, retroversion, adduction) Elbow joint a) humero-ulnar joint hinge joint ﬂexion extension b) humeroradial joint spheroidal joint (functionally restricted: no ﬂexion abduction) extension rotation c) proximal radio-ulnar joint pivot joint pronation supination Distal radio-ulnar joint pivot joint pronation supination Carpal joints lateral movements of the hand: a) proximal carpal joint, ellipsoid joint ulnar abduction radiocarpal joint radial abduction b) distal carpal joint, hinge joint palmar ﬂexion mediocarpal joint dorsal extension Thumb joint saddle joint abduction carpometacarpal joint of thumb adduction opposition reposition Carpometacarpal joints II–V plane joints variable degree of sliding movements Metacarpophalangeal joints spheroidal joints ﬂexion (functionally restricted) extension abduction* adduction* (* in relation to the middle ﬁnger) Finger joints hinge joints ﬂexion extension 34 Upper extremity Lower extremity Cranial nerves Table 21 21 Joints of the upper extremity (continued) c) Planes and axes of the joints of the upper extremity Sagittal axis Longitudinal axis Retroversion (Extension) External (lateral) Transverse rotation axis Adduction Abduction Internal (medial) rotation Anteversion (Flexion) Fig. 1 Shoulder joint; Fig. 2 Should

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