The middle ear

Membranous Labyrinth The Ear

The middle ear, or tympanic cavity, is the narrow slit-like cavity in the petrous part of the temporal bone containing the three auditory ossicles (Fig. 268). The walls of the cavity and its important relations are as follows. The lateral wall is formed mainly by the tympanic membrane, which divides it from the external auditory meatus, and above this by the squa-mous part of the temporal bone the part of the cavity above the tympanic membrane is known as the epitympanic recess or attic this...

The corpus striatum

Thalamocortical Tract

The caudate nucleus is a large homogeneous mass of grey matter consisting of a head, anterior to the interventricular foramen and forming the lateral wall of the anterior horn of the lateral ventricle a body, forming the lateral wall of the body of the ventricle and an elongated tail, which forms the roof of the inferior (temporal) horn of the ventricle. It is largely separated from the putamen by the internal capsule, but the two structures are connected anteriorly. The putamen is a roughly...

The sympathetic trunk

Clinical Sympathetic Trunk

The sympathetic trunk on each side is a ganglionated nerve chain which extends from the base of the skull to the coccyx in close relationship to the vertebral column, maintaining a distance of about 1 inch 2.5 cm from the midline throughout its course. Commencing in the superior cervical ganglion beneath the skull base, the chain descends closely behind the posterior wall of the carotid sheath, enters the thorax anterior to the neck of the first rib, descends over the heads of the upper ribs...

Internal structure

Internal Features Midbrain

The internal structure of the midbrain is again best described by reference to cross-sectional diagrams at representative levels viz. at the level of the inferior and the superior colliculi Figs 244, 245 . Observe that these sections pass through the midbrain at the level of the decussation of the superior cerebellar peduncle and the nucleus of the 4th nerve, on the one hand, and through the red nucleus and the nucleus of III on the other. The three subdivisions of the midbrain are also clearly...

The scalp

Features Mandible Mental Protuberance

The soft tissues of the scalp are arranged in five layers Fig. 221 , which may be remembered thus S skin C connective tissue A aponeurosis L loose connective tissue P periosteum. Each of these layers has features of practical importance. The skin of the scalp is richly supplied with sebaceous glands and is the commonest site in the body for sebaceous cysts. The subcutaneous connective tissue consists of lobules of fat bound in tough fibrous septa, very much like the connective tissue of the...

The auditory vestibulocochlear nerve VIII

Cochlear Nucleus Pons

The 8th nerve consists of two sets of fibres cochlear and vestibular. The cochlear fibres concerned with hearing represent the central processes of the bipolar spiral ganglion cells of the cochlea which traverse the internal auditory meatus to reach the lateral aspect of the medulla, at the cerebello-pontine angle together with VII , where they terminate in the dorsal and ventral cochlear nuclei. The majority of the projection fibres from these nuclei cross to the opposite side, those from the...

The eyelids and conjunctiva

Lacrimal Gland Conjunctiva

Of the two eyelids, the upper is the larger and more mobile, but apart from the presence of the levator palpebrae superioris in this lid, the structure of the eyelids is essentially the same. Each consists of the following layers, from without inwards skin, loose connective tissue, fibres of the orbicularis oculi muscle, the tarsal plates, of very dense fibrous tissue, tarsal glands and conjunctiva. The eyelashes arise along the mucocutaneous junction and immediately behind the lashes there are...

The cervical vertebrae

Axis Anterior Articular Facet

These are readily identified by the foramen transversarium perforating the transverse processes. This foramen transmits the vertebral artery, the vein, and sympathetic nerve fibres. The spines are small and bifid except C1 and C7 which are single and the articular facets are relatively horizontal Fig. 229 . The atlas C1 Fig. 230 has no body. Its upper surface bears a superior articular facet on a thick lateral mass on each side which articulates with the occipital condyles of the skull. Fig....

Branches

Popliteal Artery Post Exposure

The trunk of the sciatic nerve supplies the hamstring muscles biceps, semi-membranosus, semitendinosus and also the adductor magnus, the latter being innervated also by the obturator nerve. All the muscle branches apart from the one to the short head of biceps arise on the medial side of the nerve its lateral border is therefore the side of relative safety in its operative exposure. Fig. 184 Dissection of the sciatic nerve in the thigh and popliteal fossa. Note that gluteus medius has been...

The femoral sheath and femoral canal Fig 175

Femoral Sheath

The femoral artery and vein enter the femoral triangle from beneath the inguinal ligament within a fascial tube termed the femoral sheath. This is derived from the extraperitoneal intra-abdominal fascia, its anterior wall arising from the transversalis fascia and its posterior wall from the fascia covering the iliacus. Fig. 175 The femoral canal and its surrounds. Fig. 175 The femoral canal and its surrounds. The medial part of the femoral sheath contains a small, almost vertically placed gap,...

The subclavian arteries Fig 213

Thoracic Duct

The left subclavian artery arises from the arch of the aorta, immediately behind the commencement of the left common carotid artery. It ascends against the mediastinal surface of the left lung and pleura laterally and the trachea and oesophagus medially to lie behind the sternoclavicular joint. The right subclavian artery is formed behind the right sternoclavicular joint by the bifurcation of the brachiocephalic artery beyond this point, the course of the two arteries is much the same. The...

The venous sinuses of the dura Fig 214

Anterior Intercavernous Sinus

The venous sinuses lie between the layers of the dura. They receive the venous drainage of the brain and of the skull the diploic veins and disgorge ultimately into the internal jugular vein. They also communicate with the veins of the scalp, face and neck via emissary veins which pass through a number of the foramina in the skull. The superior sagittal sinus lies along the attached edge of the falx cerebri and ends posteriorly usually in the right transverse sinus. Connecting with it are a...

The kidneys

Renal Fascia

The kidneys lie retroperitoneally on the posterior abdominal wall the right kidney is 0.5 in 12 mm lower than the left, presumably because of its downward displacement by the bulk of the liver. Each measures approximately 4.5in 11 cm long, 2.5in 6 cm wide and 1.5in 4 cm thick. Posteriorly the diaphragm separating pleura , quadratus lumborum, psoas, transversus abdominis, the 12th rib and three nerves the subcostal T12 , iliohypogastric and ilio-inguinal L1 . Anteriorly the right kidney is...

Superficial veins

Thoracic Duct

The arrangement of the superficial veins of the head and neck are somewhat variable but the usual plan is as follows Fig. 216 The superficial temporal and maxillary veins join to form the retromandibular vein. This branches while traversing the parotid gland. Its posterior division, together with the posterior auricular vein, form the external jugular vein, whereas the anterior division joins the facial vein to form the common facial vein which opens into the internal jugular vein. The external...

Clinical features

Biceps Supinator

1 The pronator teres is inserted midway along the radial shaft. If the radius is fractured proximal to this, the proximal fragment is supinated by the action of the biceps and the distal fragment is pronated by pronator teres. The fracture must, therefore, be splinted with the forearm supinated so that the distal fragment is aligned with the supinated proximal end. If the fracture is distal to the midshaft, the actions of biceps and the pronator muscles more or less balance and the fracture is,...

Course and relations Cervical

Thoracic Trachea Relations

In the neck it commences in the median plane and deviates slightly to the left as it approaches the thoracic inlet. The trachea and the thyroid gland are its immediate anterior relations, the 6th and 7th cervical vertebrae and pre- Fig. 35 The oesophagus and its relations. Fig. 35 The oesophagus and its relations. vertebral fascia are behind it and on either side it is related to the common carotid arteries and the recurrent laryngeal nerves. On the left side it is also related to the...

The lymph nodes of the neck

Jugular Lymph Node

Although the lymph drainage of particular viscera is dealt with under appropriate headings tongue, larynx, etc. , it is convenient to summarize Fig. 219 Scheme of the lymph nodes of the head and neck. Superficial cervical along external jugular vein Deep cervical along internal jugular vein Superficial cervical along external jugular vein Deep cervical along internal jugular vein here the arrangements of the lymph nodes of the head and neck as a whole Fig. 219 . These can be grouped into...

Obstetrical pelvic measurements

Diagonal Conjugate

The figures for the measurements of the inlet, mid-cavity and outlet of the true pelvis are readily committed to memory in the form shown in Table 3. The transverse diameter of the outlet is assessed clinically by measuring the distance between the ischial tuberosities along a plane passing across the anus the anteroposterior outlet diameter is measured from the pubis to the sacrococcygeal joint. The most useful measurement clinically is, however, the diagonal conjugate from the lower border of...

Nerves

Ischial Tuberosity Sciatic Nerve

Only one nerve can be felt in the lower limb this is the common peroneal fibular nerve which can be rolled against the bone as it winds round the neck of the fibula Fig. 155 . Not unnaturally, it may be injured at this site in adduction injuries to the knee or compressed by a tight plaster cast or firm bandage, with a resultant foot drop. The femoral nerve emerges from under the inguinal ligament 0.5 in 12 mm lateral to the femoral pulse. After a course of only about 2 in 5 cm the nerve breaks...

The cervical sympathetic trunk

Sympathetic Chain Ganglia

The sympathetic chain continues upwards from the thorax by crossing the neck of the first rib, then ascends embedded in the posterior wall of the carotid sheath to the base of the skull Fig. 220 . It bears three ganglia 1 the superior cervical ganglion the largest lies opposite C2 and 3 vertebrae and sends grey rami communicantes to C1-4 spinal nerves 2 the middle ganglion lies level with C6 vertebra and sends grey rami to C5 and 6 nerves 3 the inferior ganglion lies level with C7 and is tucked...

The muscles of the anterior abdominal wall

Rectus Sheath

These are of considerable practical importance because their anatomy forms the basis of abdominal incisions. The rectus abdominis Fig. 43 arises on a 3 in 7.5 cm horizontal line from the 5th, 6th and 7th costal cartilages and is inserted for a length of 1in 2.5 cm into the crest of the pubis. At the tip of the xiphoid, at the umbilicus and half-way between, are three constant transverse tendinous intersections below the umbilicus there is sometimes a fourth. These intersections are seen only on...

The internal carotid artery

Blood Supply Cerebral Cortex

This artery commences at the bifurcation of the common carotid, and, at its origin, is dilated into the carotid sinus. This area receives a rich nerve supply from the glossopharyngeal nerve IX and acts as a pressor-receptor through this mechanism a rise of blood pressure brings about reflex slowing of the heart and peripheral vasodilatation. Tucked deep to the bifurcation is the small, yellowish carotid body which is also supplied by IX. This is a chemore-ceptor which produces a reflex increase...

The rectum

Prostate Rectum Fascia

It commences anterior to the third segment of the sacrum and ends at the level of the apex of the prostate or at the lower quarter of the vagina, where it leads into the anal canal. The rectum is straight in lower mammals hence its name but is curved in man to fit into the sacral hollow. Moreover, it presents a series of three lateral inflexions, capped by the valves of Houston, projecting left, right and left from above downwards. The main relations of the...

The ulnar and radial bursae and the synovial tendon sheaths of the fingers Fig 146

Mid Palmar Space Infection

The flexor tendons traverse a fibro-osseous tunnel in each digit. This tunnel is made up posteriorly by the metacarpal head, the phalanges and the fronts of the intervening joints. The anterior fibrous part consists of condensed deep fascia attached to the sharp anterolateral margin of each phalanx and termed the fibrous flexor sheath. This is particularly tough over the phalanges but loose over the front of each joint it therefore holds the flexor tendons in place without 'bow-stringing'...

The subphrenic spaces

Below the diaphragm are a number of potential spaces formed in relation to the attachments of the liver. One or more of these spaces may become filled with pus a subphrenic abscess walled off inferiorly by adhesions. There are five subdivisions of clinical importance. The right and left subphrenic spaces lie between the diaphragm and the liver, separated from each other by the falciform ligament. The right and left subhepatic spaces lie below the liver. The right is the pouch of Morison and is...

The nasopharynx

Eustachian Tube Sagittal

The nasopharynx lies above the soft palate, which cuts it off from the rest of the pharynx during deglutition and therefore prevents regurgitation of food through the nose. Two important structures lie in this compartment. The nasopharyngeal tonsil 'the adenoids' consists of a collection of lym-phoid tissue beneath the epithelium of the roof and posterior wall of this region. It helps to form a continuous lymphoid ring with the palatine tonsils and the lymphoid nodules on the dorsum of the...

The os innominatum

Ligamentum Teres

Fig. 158 The anterior aspect of the right femur. Fig. 158 The anterior aspect of the right femur. and forwards. It is covered with cartilage except for its central fovea where the ligamentum teres is attached. The neck is 2 in 5 cm long and is set at an angle of 125 to the shaft. In the female, with her wider pelvis, the angle is smaller. The junction between the neck and the shaft is marked anteriorly by the trochanteric line, laterally by the greater trochanter, medially and somewhat...

The wrist joint Fig 135

Radial Styloid

The articular disc of the inferior radio-ulnar joint covers the head of the ulna and is attached to the base of the ulnar styloid process. This disc, together with the distal end of the radius, form the proximal face of the wrist joint, the distal surface being the proximal articular surfaces of the scaphoid, lunate and triquetral. The wrist is a condyloid joint that is to say, it allows flexion, extension, abduction, adduction and circumduction, the last being a combination of the previous...

The development of the heart

Ostium Primum

The primitive heart is a single tube which soon shows grooves demarcating the sinus venosus, atrium, ventricle and bulbus cordis from behind forwards. As this tube enlarges it kinks so that its caudal end, receiving venous blood, comes to lie behind its cephalic end with its emerging arteries Fig. 29 . The sinus venosus later absorbs into the atrium and the bulbus becomes incorporated into the ventricle so that, in the fully developed heart, the atria and great veins come to lie posterior to...

The radial artery

Pronator Teres Brachial Artery

The radial artery Fig. 137 commences at the level of the radial neck by lying on the tendon of biceps. In its upper half it lies overlapped by brachio-radialis, the surface marking of the artery being the groove which can be seen on the medial side of this tensed muscle in the muscular subject. Distally in the forearm the artery lies superficially between brachioradialis and flexor carpi radialis, and it is between these two tendons that it is palpated at the wrist Fig. 116 . In the middle...

The sciatic nerve

The sciatic nerve L4, 5, S1-3 is the largest nerve in the body Fig. 184 . It is broad and flat at its origin, although peripherally it becomes rounded. The nerve emerges from the greater sciatic foramen distal to piriformis and under cover of gluteus maximus, crosses the posterior surface of the ischium, crosses obturator internus, with its gemelli, quadratus femoris and descends on adductor magnus Figs 183, 184 . Here it lies deep to the hamstrings and is crossed only by the long head of...

The larynx

Corniculate Cuneiform Arytenoid

The larynx has a triple function, that of an open valve in respiration, that of a partially closed valve whose orifice can be modulated in phonation, and that of a closed valve, protecting the trachea and bronchial tree during deglutition. Coughing is only possible when the larynx can be closed effectively. The structures which form its framework are the epiglottis, thyroid cartilage, cricoid and the arytenoids Fig. 205 . The larynx is slung from the U-shaped hyoid bone by the thyrohyoid...

Vaginal Structure

Vagina Rugous

A stratified squamous epithelium lines the vagina and the vaginal cervix it contains no glands and is lubricated partly by cervical mucus and partly by desquamated vaginal epithelial cells. In nulliparous women the vaginal wall is rugose, but it becomes smoother after childbirth. The rugae of the Fig. 102 Coronal section of the uterus and vagina. Note the important relationships of ureter and uterine artery. Fig. 102 Coronal section of the uterus and vagina. Note the important relationships of...

The parotid gland

Facial Nerve Retromandibular Vein

This is the largest of the salivary glands, lying wedged between the Internal jugular vein, vagu and sympathetic chair Internal jugular vein, vagu and sympathetic chair Fig. 208 The parotid and its surrounds in a schematic horizontal section the facial nerve is the most superficial of the structures traversing the gland. The line of section is shown in the inset head. external carotid artery and retromandibular vein Fig. 208 The parotid and its surrounds in a schematic horizontal section the...

The ulnar nerve

Pectoralis Major Nerve

The ulnar nerve C 7 , 8, T1 Fig. 142 is formed from the medial cord of the plexus. It lies medial to the axillary and brachial artery as far as the middle of the humerus, then pierces the medial intermuscular septum in company with the superior ulnar collateral artery to descend on the anterior face of triceps. It passes behind the medial epicondyle where it can readily be rolled against the bone , to enter the forearm Fig. 122 . Here it descends beneath flexor carpi ulnaris until this muscle...

Segmental anatomy

Segmental Fissures Caudate Lobe

The gross anatomical division of the liver into a right and left lobe, demarcated by a line passing from the attachment of the falciform ligament on the anterior surface to the fissures for the ligamentum teres and ligamentum venosum on its posterior surface, is simply a gross anatomical descriptive term with no morphological significance. Studies of the distribution of the hepatic blood vessels and ducts have indicated that the true morphological and physiological division of the liver is into...

Developmental abnormalities

Aberrant Renal Artery

1 It is common for one or more distally placed arteries to persist aberrant renal arteries and one may even run to the kidney from the common iliac artery. 2 Occasionally the kidney will fail to migrate cranially, resulting in a persistent pelvic kidney. 3 The two metanephric masses may fuse in development, forming a horseshoe kidney linked across the midline. 4 In 1 in 2400 births there is complete failure of development of one kidney congenital absence of the kidney . 5 Congenital polycystic...

Arterial supply of the intestine

Inferior Mesenteric Artery Anatomy

The alimentary tract develops from the fore-, mid- and hind-gut the arterial supply to each is discrete, although anastomosing with its neighbour. The fore-gut comprises stomach and duodenum as far as the entry of the bile duct and is supplied by branches of the coeliac axis which arises from the aorta at T12 vertebral level see Fig. 53 . The mid-gut extends from mid-duodenum to the distal transverse colon and is supplied by the superior mesenteric artery Fig. 66 arising from the aorta at L1....

The radial nerve

Posterior Cutaneous Nerve Triceps

Fig. 140 The segmental cutaneous innervation of the body. The radial nerve C5, 6, 7, 8, T1 is the main branch of the posterior cord. Fig. 141 The distribution of the radial nerve. Fig. 141 The distribution of the radial nerve. Lying first behind the axillary artery, it then passes backwards between the long and medial heads of the triceps to lie in the spiral groove on the back of the humerus between the medial and lateral heads of triceps Fig. 141 . The profunda branch of the brachial artery...

Lymph drainage Fig 198

Tongue Lymphatic Drainage

The drainage zones of the mucosa of the tongue can be grouped into three 1 the tip drains to the submental nodes 2 the anterior two-thirds drains to the submental and submandibular nodes and thence to the lower nodes of the deep cervical chain along the carotid sheath 3 the posterior one-third drains to the upper nodes of the deep cervical chain. There is a rich anastomosis across the midline between the lymphatics of the posterior one-third of the tongue so that a tumour on one side readily...

Relations of the stomach

Gastric Artery

Anteriorly the abdominal wall, the left costal margin, the diaphragm and the left lobe of the liver. Posteriorly the lesser sac, which separates the stomach from the pancreas, transverse mesocolon, left kidney, left suprarenal, the spleen and the splenic artery. Superiorly the left dome of the diaphragm. The lesser omentum is attached along the lesser curvature of the stomach, the greater omentum along the greater curvature. These omenta contain the vascular and lymphatic supply of the...

The structure of the alimentary canal

Ileocolic Artery

The alimentary canal is made up of mucosa demarcated by the muscularis mucosae from the submucosa, the muscle coat and the serosa the last being absent where the gut is extraperitoneal. Middle colic artery Superior mesenteric artery Middle colic artery Superior mesenteric artery Fig. 68 Lymph nodes of the large intestine. Fig. 68 Lymph nodes of the large intestine. The oesophageal mucosa and that of the lower anal canal is stratified squamous elsewhere it is columnar. At the cardio-oesophageal...

The prostatic capsules

Colliculus Seminalis

These are normally two, pathologically three, in number. 1 The true capsule a thin fibrous sheath which surrounds the gland. 2 The false capsule condensed extraperitoneal fascia which continues into the fascia surrounding the bladder and with the fascia of Denonvilliers posteriorly. Between layers 1 and 2 lies the prostatic venous plexus. 3 The pathological capsule when benign 'adenomatous' hypertrophy of the prostate takes place, the normal peripheral part of the gland becomes compressed into...

Testicular Artery

Blood Supply Testis Testicular Artery

The testicular artery arises from the aorta at the level of the renal vessels. It anastomoses with the artery to the vas, supplying the vas deferens and epi-didymis, which arises from the inferior vesical branch of the internal iliac Fig. 90 Transverse section of the testis. Fig. 90 Transverse section of the testis. artery. This cross-connection means that ligation of the testicular artery is not necessarily followed by testicular atrophy. The pampiniform plexus of veins becomes a single...

The mediastinum

Sternopericardial Ligament

The mediastinum is defined as 'the space which is sandwiched between the two pleural sacs'. For descriptive purposes the mediastinum is divided by a line drawn horizontally from the sternal angle to the lower border of T4 angle of Louis into superior and inferior mediastinum. The inferior mediastinum is further subdivided into the anterior in front of the pericardium, a middle mediastinum containing the pericardium itself with the heart and great vessels, and posterior mediastinum between the...

Lymphatic drainage

Axila Lymphatic Drainage

This is of considerable importance in the spread of breast tumours. The lymph drainage of the breast, as with any other organ, follows the pathway of its blood supply and therefore travels 1 along tributaries of the axillary vessels to axillary lymph nodes 2 along the tributaries of the internal thoracic vessels, piercing pectoralis major to traverse each intercostal space to lymph nodes along the internal mammary chain these also receive lymphatics penetrating along the lateral perforating...

The muscles of the pelvic floor and perineum

Levator Prostatae Sphincter Vaginae

The canal of the bony and ligamentous pelvis is closed by a diaphragm of muscles and fasciae which the rectum, urethra and, in the female, the vagina, must pierce to reach the exterior. The muscles are divided into a the pelvic diaphragm, formed by the levator ani and the coccygeus and b the superficial muscles of the a anterior urogenital perineum and the b posterior anal perineum. Levator ani Fig. 97 is the largest and most important muscle of the pelvic floor. It arises from the posterior...

The axillary nerve

Axillary Nerve

The axillary circumflex nerve C5, 6 arises from the posterior cord of the Fig. 140 The segmental cutaneous innervation of the body. plexus and winds round the surgical neck of the humerus in company with the posterior circumflex humeral vessels Figs 122, 141 . Its branches are muscular to deltoid and teres minor cutaneous to a palm-sized area of skin over the deltoid. The axillary nerve may be injured in fractures of the humeral neck or in dislocations of the shoulder. This will be followed by...

Surface anatomy and surface markings

Surface Marking Nipple Line Infant

Be able to identify these landmarks on yourself or the patient Fig. 42 . The xiphoid. The costal margin extends from the 7th costal cartilage at the xiphoid to the tip of the 12 th rib although the latter is often difficult to feel this margin bears a distinct step, which is the tip of the 9 th costal cartilage. The iliac crest ends in front at the anterior superior spine from which the inguinal ligament Poupart's ligament passes downwards and medially to the pubic tubercle. Identify this...

The superficial pulp space of the fingers

Superficial Pulp Space Finger

The tips of the fingers and thumb are composed entirely of subcutaneous fat broken up and packed between fibrous septa, which pass from the skin down to the periosteum of the terminal phalanx. The tight packing of this compartment is responsible for the severe pain of a 'septic finger' there is little room for the expansion of inflamed and oedematous tissues. The blood vessels to the shaft of the distal phalanx must traverse this space and may become thrombosed in a severe pulp infection with...

The endopelvic fascia and the pelvic ligaments Fig 107

Cardinal Ligament

Pelvic fascia is the term applied to the connective tissue floor of the pelvis covering levator ani and obturator internus. The endopelvic fascia is the extraperitoneal cellular tissue of the uterus the parametrium , vagina, bladder and rectum. Within this endopelvic fascia are three important condensations of connective tissue which sling the pelvic viscera from the pelvic walls. 1 The cardinal ligaments transverse cervical, or Mackenrodt's ligaments , which pass laterally from the cervix and...

The popliteal fossa Fig 178

Pics Floor The Popliteal Fossa

The popliteal fossa is the distal continuation of the adductor canal. This 'fossa' is, in fact, a closely packed compartment which only becomes the Fig. 178 The popliteal fossa. a Superficial dissection. b Deep dissection. c Floor. Fig. 178 The popliteal fossa. a Superficial dissection. b Deep dissection. c Floor. rhomboid-shaped space of anatomical diagrams when opened up at operation or by dissection. Its boundaries are superolaterally biceps tendon reinforced by semitendinosus inferomedially...

The posterior anal perineum Figs 99 100

Posterior Perineal Triangle

This is the triangle lying between the ischial tuberosities on each side and the coccyx. It comprises, in essentials, the anus with its superficial sphincters, levator ani and, at each side, the ischiorectal fossa. Fig. 99 a The female perineum on the right side the muscles of the anterior perineum have been dissected away. b Distribution of the pudendal nerve to the female perineum. Fig. 99 a The female perineum on the right side the muscles of the anterior perineum have been dissected away. b...

The intercostal spaces

Intercostal Nerve Diagram

There are slight variations between the different intercostal spaces, but typically each space contains three muscles, comparable to those of the abdominal wall, and an associated neurovascular bundle Fig. 8 . The muscles are Fig. 8 The relationship of an intercostal space. Note that a needle passed into the chest immediately above a rib will avoid the neurovascular bundle. 1 the external intercostal, the fibres of which pass downwards and forwards from the rib above to the rib below and reach...

Movements of the shoulder girdle

Shoulder Girdle With Acromion

The movements of the shoulder joint itself cannot be divorced from those of the whole shoulder girdle. Even if the shoulder joint is fused, a wide range of movement is still possible by elevation, depression, rotation and protraction of the scapula, leverage occurring at the sternoclavicular joint, the pivot being the costoclavicular ligament. Abduction of the shoulder is initiated by the supraspinatus the deltoid can then abduct to 90 . Further movement to 180 elevation is brought about by...

Vessels

Mid Inguinal Point

The femoral artery Fig. 153 can be felt pulsating at the mid-inguinal point, half-way between the anterior superior iliac spine and the pubic symph-ysis. The upper two-thirds of a line joining this point to the adductor tubercle, with the hip somewhat flexed and externally rotated, accurately defines the surface markings of this vessel. A finger on the femoral pulse lies directly over the head of the femur, immediately lateral to the femoral vein structures passing over the dorsum of the ankle....

Femoral hernia

Femoral Hernia Borders

The great importance of the femoral canal is, of course, that it is a potential point of weakness in the abdominal wall through which may develop a femoral hernia. Unlike the indirect inguinal hernia, this is never due to a Fig. 176 The relationship of an indirect inguinal and a femoral hernia to the pubic tubercle the inguinal hernia emerges above and medial to the tubercle, the femoral hernia lies below and lateral to it. Fig. 176 The relationship of an indirect inguinal and a femoral hernia...

The radius and ulna Fig 123

Ulna With Features

The radius consists of the head, neck, shaft with its radial tuberosity and expanded distal end. The ulna comprises olecranon, trochlear fossa, coronoid process with its radial notch for articulation with the radial head , shaft and small distal head, which articulates with the medial side of the distal end of the radius at the inferior radio-ulnar joint. In pronation and supination, the head of the radius rotates against the radial notch of the ulna, the shaft of the radius swings round the...

The fascial compartments of the neck Fig 188

Carotid Sheath

The fascial planes of the neck are of considerable importance to the surgeon they form convenient lines of cleavage through which he may separate the tissues in operative dissections and they delimit the spread of pus in neck infections. The superficial fascia is a thin fatty membrane enclosing the platysma. Pretracheal fascia containing thyroid, trachea, oesophagus and recurrent nerve Pretracheal fascia containing thyroid, trachea, oesophagus and recurrent nerve Carotid sheath containing...

The development of the intestine and its congenital abnormalities

Vitello Intestinal Fistula

The primitive endodermal tube of the gut is divided into 1 the fore-gut supplied by the coeliac axis extending as far as the entry of the bile duct into the duodenum 2 the mid-gut supplied by the superior mesenteric artery continuing as far as the distal transverse colon 3 the hind-gut supplied by the inferior mesenteric artery extending thence to the ectodermal part of the anal canal. Fig. 69 Stages in rotation of the bowel. a The prolapsed mid-gut loop, seen in lateral view. b The mid-gut...

Lymph drainage Fig 105

Lymph Drainage Inguinal

1 The fundus together with the ovary and Fallopian tube drains along the ovarian vessels to the aortic nodes, apart from some lymphatics which pass along the round ligament to the inguinal nodes. 2 The body drains via the broad ligament to nodes lying alongside the external iliac vessels. Fig. 105 Lymph drainage of the uterus and vagina. 3 The cervix drains in three directions laterally, in the broad ligament, to the external iliac nodes posterolaterally along the uterine vessels to the...

Abdominal aorta Fig 110

Abdominal Arteries Paired Unpaired

The aorta enters the abdomen via the aortic hiatus in the diaphragm at the level of the 12th thoracic vertebra and ends at L4 in the transcristal plane Fig. 42 . It lies throughout this course against the vertebral bodies and is easily palpable in the midline. Anteriorly, from above down, it is related to the pancreas separating it from the stomach , the third part of the duodenum and coils of small intestine. It is crossed by the left renal vein. A large tumour of pancreas or stomach, a mass...

The development of the diaphragm and the anatomy of diaphragmatic herniae

Pleuroperitoneal Membrane

The diaphragm is formed Fig. 12 by fusion in the embryo of 1 the septum transversum forming the central tendon 2 the dorsal oesophageal mesentery 3 a peripheral rim derived from the body wall 4 the pleuroperitoneal membranes, which close the fetal communication between the pleural and peritoneal cavities. The septum transversum is the mesoderm which, in early development, lies in front of the head end of the embryo. With the folding off of the head, this mesodermal mass is carried ventrally and...

The bronchopulmonary segments of the lungs

Bronchopulmonary Segments

A knowledge of the finer arrangement of the bronchial tree is an essential Table 1 The named divisions of the main bronchi. Apicoposterior Anterior Superior Inferior Medial cardiac Anterior Lateral Posterior 7 Medial basal cardiac bronchus 9 Lateral basal bronchus 10 Posterior basal bronchus Fig. 20 The named divisions of the main bronchi. prerequisite to intelligent appreciation of lung radiology, to interpretation of bronchoscopy and to the surgical resection of lung segments. Each lobe of...

Mensuration in the lower limb

Nelaton Line Test

Measurement is an important part of the clinical examination of the lower limb. Unfortunately, students find difficulty in carrying this out accurately and still greater difficulty in explaining the results they obtain, yet this is nothing more or less than a simple exercise in applied anatomy. First note the differences between real and apparent shortening of the lower limbs. Real shortening is due to actual loss of bone length for example, where a femoral fracture has united with a good deal...