Anatomy summary 2020/2021 Melanie Kolassovits

Anatomy summary

Inhalt
Anatomy summary ..................................................................................................................... 1
General terms ............................................................................................................................. 5
Cartilages and skeleton .............................................................................................................. 8
Vertebrae + osteology .............................................................................................................. 12
Vertebrae .............................................................................................................................. 14
Layers of the back ................................................................................................................. 16
Upper limb ................................................................................................................................ 17
Bones .................................................................................................................................... 17
Myotendinous cuff (rotator cuff) ...................................................................................... 17
Clavicle .............................................................................................................................. 17
Scapula .............................................................................................................................. 19
Humerus ............................................................................................................................ 22
Ulna ................................................................................................................................... 25
Radius ................................................................................................................................ 28
Bones of the hand ............................................................................................................. 30
Compartments of the upper limb ......................................................................................... 32
Deep fascia ........................................................................................................................ 32
Anterior compartment of the arm .................................................................................... 32
Posterior compartment of the arm .................................................................................. 33
Anterior compartment of forearm ................................................................................... 33
Posterior compartment of forearm .................................................................................. 35
Intrinsic muscles of hand .................................................................................................. 35
Sensory innervation of the upper limb ................................................................................. 36
Cubital fossa.......................................................................................................................... 38
Vascularisation of upper limb ............................................................................................... 39
Arterial supply ................................................................................................................... 39
Venous supply ................................................................................................................... 42
Axilla...................................................................................................................................... 43
Regions .............................................................................................................................. 43
Contents of axilla .............................................................................................................. 45
Thorax ....................................................................................................................................... 54
Anatomy summary 2020/2021 Melanie Kolassovits

Bones .................................................................................................................................... 54
Sternum:............................................................................................................................ 54
Ribs .................................................................................................................................... 54
Regional anatomy of thorax ................................................................................................. 56
Muscles of thorax ................................................................................................................. 60
Diaphragm ............................................................................................................................ 61
Vascularisation of thorax ...................................................................................................... 62
Nerve supply of thorax ......................................................................................................... 66
Mediastinum ......................................................................................................................... 69
Superior Mediastinum ...................................................................................................... 70
Inferior mediastinum ........................................................................................................ 73
Lungs ..................................................................................................................................... 76
Pleura ................................................................................................................................ 76
Lungs ................................................................................................................................. 77
Divisions ............................................................................................................................ 78
Pulmonary hilum ............................................................................................................... 80
Impressions on lung surface ............................................................................................. 81
Vascular supply ................................................................................................................. 82
lymphatic drainage ........................................................................................................... 82
Nerve supply ..................................................................................................................... 82
Tracheobronchial tree....................................................................................................... 83
Heart ..................................................................................................................................... 85
Pericardium ....................................................................................................................... 87
Pathway of blood .............................................................................................................. 88
External features of the heart ........................................................................................... 88
Structures .......................................................................................................................... 89
Chambers of heart ............................................................................................................ 90
Valves ................................................................................................................................ 93
Electrical conduction system ............................................................................................ 94
External heart major vessels ............................................................................................. 95
Abdominal wall ......................................................................................................................... 97
Abdominal regions ................................................................................................................ 97
Layers of abdominal wall ...................................................................................................... 98
Nervous supply ..................................................................................................................... 99
Anatomy summary 2020/2021 Melanie Kolassovits

vascular supply ................................................................................................................... 100

muscles ............................................................................................................................... 103
Inguinal structures .............................................................................................................. 106
Lower limb .............................................................................................................................. 108
Bones .................................................................................................................................. 108
Hip bone, Coxal bone, Pelvic bone ................................................................................. 108
Femur .............................................................................................................................. 114
Tibia ................................................................................................................................. 116
Fibula ............................................................................................................................... 118
Patella.............................................................................................................................. 119
Bones of the foot ............................................................................................................ 119
Compartments of lower limb ............................................................................................. 120
Gluteal region (2 posterior) ............................................................................................ 120
Thigh (3) .......................................................................................................................... 121
Knee (4) ........................................................................................................................... 123
Leg (5) .............................................................................................................................. 124
Ankle (6) .......................................................................................................................... 125
Foot (7) ............................................................................................................................ 126
Toes/digits (8) ................................................................................................................. 127
Superficial structures .......................................................................................................... 128
Superficial inguinal lymph nodes .................................................................................... 128
Deep fascia of thigh ........................................................................................................ 128
Saphenous hiatus/opening ............................................................................................. 128
Iliotibial tract ................................................................................................................... 128
Muscles ............................................................................................................................... 129
Muscles of thigh .............................................................................................................. 129
Muscles of leg ................................................................................................................. 133
Muscles of foot ............................................................................................................... 136
Arterial supply of lower limb .............................................................................................. 138
Veins of lower limb ............................................................................................................. 142
Important Regions in thigh ................................................................................................. 143
Muscular lacuna .............................................................................................................. 143
Vascular lacuna ............................................................................................................... 143
Femoral/Scarpa’s triangle ............................................................................................... 144
Anatomy summary 2020/2021 Melanie Kolassovits

Adductor canal/hunter canal .......................................................................................... 144

Adductor hiatus............................................................................................................... 144
Innervation of lower limb ................................................................................................... 145
Lumbar plexus ................................................................................................................. 145
Sacral plexus.................................................................................................................... 150
popliteal fossa..................................................................................................................... 154
Anatomy summary 2020/2021 Melanie Kolassovits

General terms
Anatomical planes:

Anatomical axes:
Anatomy summary 2020/2021 Melanie Kolassovits

Movements
In sagittal plane:
- Flexion
o Decreasing angles between 2 segments
- Extension
o Increasing angles between 2 segments
- Hyperextension
o Increasing angles more than 180°
- Dorsiflex
o Flexion at ankle joint
- Plantarflexion
o Bends foot + toes towards the ground
- Protrusion
o Movement anteriorly (e.g. protruding mandible)
- Retrusion
o Movement posteriorly (e.g. retruding mandible)
In frontal plane:
- Abduction
o Moving away from median plane
- Adduction
o Moving towards median plane
- Radial/ulnar deviation
o Moving toward radial/ulnar part
- Inversion
o Moving sole of the foot towards the median plane, rotating the foot medial
- Eversion
o Moving sole of the foot away from the median plane, rotating the foot lateral
- Elevation/depression
o Raises/lowers part superior/inferior
- Upward/downward rotation
o Raises/lowers limb by a lateral rotation movement
In transverse plane
- External/internal rotation
o Twisting the entire limb lateral/medial around its longitudinal axis
- Pronation
o Rotates radius medially
- Supination
o Rotates ulna laterally
- Protraction
o Anterolateral movements of the scapula on the thoracic wall
- Retraction
o posteromedial movements of the scapula on the thoracic wall
- circumduction
o circular movement that involves sequential flexion, abduction, extension,
adduction
Anatomy summary 2020/2021 Melanie Kolassovits

Body cavities
Dorsal cavity
- cranial cavity (brain)
- spinal/vertebral cavity (spinal cord)

ventral cavity
- thoracic cavity (thoracic viscera + lungs, heart, trachea, esophagus)
- abdominal cavity (abdominal viscera + adjacent structures)
- pelvic cavity (pelvic viscery + adjacent structures)
- (abdominopelvic cavity contains peritoneal and extraperitoneal cavity)
Anatomy summary 2020/2021 Melanie Kolassovits

Cartilages and skeleton

Cartilage
- Many bones were developed from it (fetal precursor tissue from bones)
- In adult skeleton: persists at almost all joints between bones and in structures that
must be deformate + strong (e.g. respiratory tract)
- Types:
o Hyaline cartilage
o Fibrocartilage
o Elastic cartilage

Hyaline cartilage
- May become calcified after adolescence (become bony structure)
- Poor regenerative capacity after injury
- Cartilaginous growth plates are composed of hyaline cartilage
- Articular cartilage – specialized hyaline cartilage
o Covers articular surfaces of synovial joints
o Increases contact area between bones -> reduces contact stress
o Delivers nutrients by diffusion from vessels of synovial membrane,
synovial fluid, hypochondrial vessels of an adjacent medullary cavity

Fibrocartilage
- Intervertebral discs of spine
- menisci of knee
- glenoid + acetabular labra (labrum = fibral cartilage covers remaining parts if 2 bones
don’t fit together perfectly)
- lining of bony grooves for tendons

elastic cartilage
- external ear
- corniculate cartilages
- epiglottis
- apices of arytenoids
Skeleton
Axial skeleton
- skull, laryngeal skeleton, auditory ossicles, hyoid bone (sup. to laryngeal skeleton),
vertebral column, thoracic cage
appendicular skeleton
- shoulder girdle (scapula + clavicle)
- upper limb (humerus, ulna, radius, hand bones)
- pelvic girdle (hip bone)
- lower limb (femur, tibia, fibula, foot bones)
Anatomy summary 2020/2021 Melanie Kolassovits

features of the bones

- elevations
- depressions (fossae)
o some are articular surfaces
- notch = incisura
- grooves/sula = lengthy depression
- hiatus = gap, entrance
- spine/crest
- hamulus/cornu/horn
- tuberosity (smaller in size), tubercle (bigger in size), trochanter (biggest) – rounded
projection
- crests/lines = long elevations, boundary edges
- epicondyle – for attachment, close to a condyle – for articulation
- protuberance/proeminence/eminence/torus
- head/caput – expanded proximal ends of many long bones
- foramen – hole in bone
- apertures – large holes (usually covered by connective tissue)
- fissures – clefts in/between bones
- surface markings: facets, ridges, nodules, rough areas
- articular surfaces (usually smooth area): facets/fovea, condyles, throchlea

Joints
- regions of skeleton where 2 or more bones meet + articulate
- prime functions: facilitate growth, allow movement between bones
- types:
o synovial joints
o fibrous joints
o cartilaginous joints

fibrous joints
- sutures (usually occur at level of skull bones)
- gomphosis (usually at level of teeth)
- syndesmosis (inbetween 2 bones, e.g. radius and ulna)

cartilaginous joints
- synchondrosis (rib attachment to sternum)
- symphesis (2 bones joined by fibrocartilage, all symphesis occur in midline)
Anatomy summary 2020/2021 Melanie Kolassovits

synovial joints
- freely moving joints
- the articulating surfaces are covered in hyaline articular cartilage and separated by a
film of viscous synovial fluid
- fibrous capsule encloses joint cavity
- absorbs shock, guides bone movements, distributes forces
- tendon attached muscle to bone
- types:
o 1. Planar
 Movement: sliding between bones
 E.g. intermetatarsal, some intercarpal
o 2. Hinge
 Uniaxial joints
 E.g. interphalangeal, humero ulnar, femur tibia
o 3. Pivot
 uniaxial
 E.g. atlantoaxial joint (dens + atlas), proximal radioulnar joint
o 4. Condyloid/ellipsoid
 Oval convex surface on one bone fits into elliptical cavity, biaxial
 E.g. radiocarpal joint of wrist, metacarpophalangeal
o 5. Saddle
 Articular surfaces have both concave + convex regions, biaxial
 E.g. carpometacarpal joint of thumb, ankle, calcaneocuboid
o 6. ball + socket
 multiaxial
 E.g. head of humerus into glenoid cavity of scapula, head of femur into
acetabulum of hip bone
Anatomy summary 2020/2021 Melanie Kolassovits

Muscles
Types of muscle
- Depending on function
o Skeletal muscle (striated, voluntary)
o Cardiac muscle
o Smooth muscle (nonstriated, involuntary) (found mainly in walls of hollow
organs)
- Depending on striations
o Striated muscle
o Non-striated muscle
- Depending on control
o Voluntary muscle
o Involuntary muscle
Skeletal muscles:
- Made of body + extremities
- Origin: attachment of stationary part of muscle when connecting
- Insertion: attached to a movable part of muscle when contracting

Type of action
- Agonist
o Prime mover
o Secondary mover
- Antagonist
o Opposes/reversed prime mover
- Synergist
o Aids prime mover, helps prevent undesired movement
Anatomy summary 2020/2021 Melanie Kolassovits

Vertebrae + osteology
Osteology
- Long bones
- Flat bones (e.g. skull bones)
- Short bones (e.g. vertebrae)
- Pneumatic bones – content a cavity full of air (e.g. maxilla – Oberkiefer)
Muscle names
Shape
- Deltoid
- Quadratus
- Rhomboid (diamond shaped)
- Teres (round)
- Gracilis (slender)
- Rectus (straight)
- Lumbrical (worm-like)
Size
- Major
- Minor
- Longus
- Brevis (short)
- Latissimus (broadest)
- Longissimus (longest)
Number of heads/bellies
- Biceps
- Triceps
- Quadriceps
- Digastric (2 bellies)
Depth
- Superficialis
- Profundus
- Externus
- Internus
Attachment
Position
- Anterior, posterior, medial, lateral, superior, inferior, supra/intra
- Interosseus (between 2 bones)
- Dorsi (of the back)
- Abdominis
- Pectoralis (of the chest)
- Brachii (of the arm)
- Femoris
- Oris (mouth)
- Ocule (eye)
Anatomy summary 2020/2021 Melanie Kolassovits

Action: Extensor/flexor, abductor/adductor, levator/depressor, supinator/pronator,

constrictor/dilator
Anatomy summary 2020/2021 Melanie Kolassovits

Vertebrae
Cervical region (first 7 vertebrae: C1-C7)
Thoracic region (12 vertebrae: T1-T12)
Lumbar region (5 vertebrae: L1-L5)
Sacral region (5 fused vertebrae – sacrum)
Coccygeal region (3-4 coccygeal vertebrae – coccyx)

Atlas: C1

Axis: C2

(Dens articulates with anterior articular cavity of axis)

General cervical vertebrae:

General thoracic vertebrae:

General lumbar vertebrae:

Anatomy summary 2020/2021 Melanie Kolassovits

Sacrum + Coccyx:

C7:

C1, C2, C7 have special features

Anatomy summary 2020/2021 Melanie Kolassovits

Layers of the back

Superficial layer
- Trapezius m. (inserted on spinous process of cervical + thoracic vertebrae
- Latissimus dorsi m. (insertion on medial lip of bicipital groove)
- Thoracolumbar fascia (inserted on spinous process of lumbar region + sacrum)
- Rhomboid minor + major m.
- Splenis capitis m. (insertion on transverse process of cervical vertebrae)
- Levator scapuli m.
- Spine of scapula
- External lip of iliac
crest

Intermediate layer
- Serratus posterior superior m. (insertion on posterior angle of ribs + thoracic spinous
processes)
- Serratus posterior inferior m.
- Erector spine m. (tendon of insertion at post. Aspect of sacrum)
- Erector spinae m.:
o Iliocostalis m.
o Longissimus m.
o Spinalis m.
Deep layer
- Attaching transverse processed of vertebrae with spinous processes
Anatomy summary 2020/2021 Melanie Kolassovits

Upper limb
Bones
Regions:
- Shoulder region (junction between upper limb + trunk)
- Axilla (armpit)
- Arm (between shoulder joint + elbow joint)
- Elbow joint + cubital fossa (between arm + forearm)
- Forearm (between elbow joint + wrist joint)
- Wrist joint (between forearm + hand)
- Hand (distal to wrist joint)

Myotendinous cuff (rotator cuff)

- At level of deltoid region
- Tendons of
o Subscapularis m. (anteriorly)
o Infraspinatus m. (posterior)
o Supraspinatus m. (posterior)
o Teres minor m. (posterior)
- Are fused to capsule of shoulder joint
- Insertion on greater tubercle of humerus
- Important in stabilizing shoulder joint

Clavicle
- Long bone, paired bone
- Between sternum + scapula
- Orientation:
o Laterally flat extremity
o Anterior the concave extremity
o Caudally/inferior the surface with a sulcus
- 2 faces, 2 borders, 2 extremities
- Superior face
o Can be palpated under skin
o Provides muscular insertions:
 Medially: sternocleidomastoid m.
 Laterally: deltoid + trapezius m.
- Inferior face
o Corresponding to 1st rib
o In the middle is a sulcus + a nutritive
foramen
o At sulcus: insertion of subclavicular m.
o Medially from sulcus: impression given by
costoclavicular ligament
o Laterally: conoid tubercle + trapezoid line
Anatomy summary 2020/2021 Melanie Kolassovits

- Anterior border
o Lateral third: insertion of deltoid m., concave
o Medial third: insertion of pectoralis major m., convex

- Posterior border
o Laterally convex
o Insertion of trapezius m.
o In the middle is origin of omohyoid
m., scalene m., subclavian a. + v.
- Medial extremity
o Sternal face
- Lateral extremity
o Acromial face
Anatomy summary 2020/2021 Melanie Kolassovits

Scapula
- Flat bone
- Triangular shape
- Located in posterior-
superior part of thorax
- Part of shoulder
- 2 faces, 3 borders, 3 angles

- Has superior and inferior surface, anterior border through spine

- Acromial angle – junction of inferior part of spine
- Acromion: articular face for lateral extremity of clavicle
- Supraspinous fossa – insertion of supraspinous m.
- Infraspinous fossa – subspinous m., teres major + minor m.

Costal/anterior face of scapula:

- Concave
- Superior border: contains scapular notch, omohyoid m.
- Medial border. Rhomboid major + minor m.
- Lateral border: looks at axilla
- Superior angle: insertion of elevator scapula m.
- Inferior angle: accessible to palpate
- Lateral angle:
o biggest angle
o glenoid cavity - 2 extremities
 Inferior – rough, infraglenoidian tubercle, insertion of triceps m.
 Superior – supraglenoidian tubercle, biceps brachialis m.
o Coracoid process
Anatomy summary 2020/2021 Melanie Kolassovits

Insertions:
- Medial border:
o Serratus anterior m.
o Levator scapulae m.
o Rhomboideus minor + major m.
- Anterior face:
o Pectoralis minor m. (on coracoid process)
- Posterior face
o Trapezius m. (on scapular spine + acromion process)
Origins:
- Lateral border:
o Long head of triceps brachii m.
o Teres minor
o Teres major
- Inferior angle:
o Latissimus dorsi
- Anterior face:
o Subscapularis m.
- Posterior face:
o Supraspinatus m.
o Infraspinatus m.
o Deltoid m. (on scapular spine)
Anatomy summary 2020/2021 Melanie Kolassovits

Acromioclavicular joint
Articulating surfaces:
- Acromial end of clavicle
- Medial acromial margin

- Fibrous capsula completely surrounds margins, lined by synovial membrane

- Ligaments (2 sets)
o Extrinsic ligament – coracoclavicular ligament
 Connects clavicle + coracoid process of scapula
o Intrinsic ligament – acromioclavicular ligament
 Quadrilateral
 Extends between upper aspects pf lateral end pf clavicle + adjacent
acromion
Anatomy summary 2020/2021 Melanie Kolassovits

Humerus
- Long, paired bone
- Formed by 1 diaphysis + 2 epiphysis
Anatomical position:
- Superior: extremity with spheric head
- Medial: articular surface of extremity with
spherical head
- Anterior: profound sulcus

Diaphysis (=body, shaft): body with 3 faces + 3 borders

Epiphysis: extremities superior + inferior

- Longest bone in upper limb

Articulations:
- Proximal: scapula (glenohumeral joint)
- Distal: with radius + ulna (elbow joint)

Proximal end (proximal epiphysis):

- Head
o Hemispherical shape
o Smooth articular surface (covered with hyaline cartilage)
o Articulates with glenoid cavity of scapula
- Neck
o Border between head + rest of humerus
o Capsule of shoulder will be attached here
- Greater tubercle/tuberosity
o Most lateral element of humerus
o Its medial part forms lateral lip of intertubercular sulcus
o Covered by deltoid m.
o Many vascular/nutrient foramina (holes in bone surface)
- Lesser tubercle
o Located more anterior + medial than greater tubercle
o Forms medial margin of intertubercular sulcus
o Insertion of subscapularis m.
- Intertubercular sulcus
o Also called bicipital groove, because tendons of biceps m. are located there
- Surgical neck
o Represented by narrow area located inferior to 2 tubercles
o Place where proximal extremity will join shaft
o Common area for fractures!
o Posteriocircumflex a. + axilary n. lie here
Anatomy summary 2020/2021 Melanie Kolassovits

Diaphysis:
Shaft
- Has 3 surfaces: antero-lateral, antero-medial, posterior
- 3 borders: anterior, lateral, medial

- Anterior border
o Begins at interior part of greater tubercle
o Descends almost to most inferior part of bone
o Continues lateral lip of intertubercular sulcus
- Lateral border
o Begins distally of greater tubercle
o Forms lateral supracondylar ridge
- Medial border
o Forms medial supracondylar ridge
- Deltoid tuberosity
o Place where deltoid m. will insert
- Anterolateral surface
o Between anterior + lateral border
o Has smooth proximal surface
o Largely covered by deltoid m.
o Lateral part of brachialis m. will originate at distal part
o Contains deltoid tuberosity
- Anteromedial surface
o Between anterior + medial border
o Provides attachment for coracobrachialis m. at mid segment
o Distal part is covered by brachialis m.
o Nutritive hole
- Posterior surface
o Between medial + lateral border
o Covered by medial head of triceps brachii m.
o Radial groove for radial n. + deep brachial a.
o Ridge on proximal part for attachment of triceps brachii m.
Anatomy summary 2020/2021 Melanie Kolassovits

Distal end (distal epiphysis):

- Coronoid fossa
o Superior to trochlea on anterior part
o Coronoid process of ulna will rest here during flexion of arm
- Radial fossa
o Lateral to coronoid fossa, superior to capitulum
o Radial head will rest here during flexion of arm
- Capitulum
o Covers anterior + inferior surface
o Articulates with head of radius
- Epicondyle
o Medial/internal epicondyle
 Origin of pronator teres m.
 ulnar n. passes posterior to it
o Lateral/external epicondyle
 Origin of supinator m. and extensor m.
- Trochlea
o Covers anterior, posterior, inferior surface
o Articulates with ulna at trochlear notch
- Olecranon fossa
o In posterior surface, superior to trochlea
o Olecranon process of ulna will rest into it during extension

Posterior surface anterior surface

Anatomy summary 2020/2021 Melanie Kolassovits

Ulna
- Long, paired bone
- 1 shaft, 2 extremities
- At level of forearm, medial

Anatomical position:
- Superior: largest extremity
- Anterior: depression of this
extremity
- Lateral: sharpest border

Upper extremity:
- Olecranon
o Large, thick, curved forward eminence
o Positioned at upper back of ulna
- Coronoid process
o Triangular eminence
o Projects horizontally forward, its base is continuous with shaft
o Upper surface is smooth + concave
- Ulnar tuberosity
o Concave surface with rough impression
o Attachment of brachialis muscle
- Trochlear notch
o = incisura trochlearis
o Articular surface between olecranon + coronoid process
- Radial notch
o Articular surface for radius
o Laterally located
Anatomy summary 2020/2021 Melanie Kolassovits

Shaft
- Concave forward, 3 borders, 3 surfaces
- Anterior surface
o Broader above, than below
o Has a nutrient groove
o Concave in upper 3/4, attachment flexor digitorum profundus m. (origin)
o Concave in lower 1/4, attachment of pronator quadratus m. (origin)
- Posterior surface
o Directed backward + outward
o Broad + concave above, narrow + convex in middle, narrow + smooth +
rounded below
o Oblique ridge from superior lateral to inferior medial, above ridge: triangular
surface – attachment for anconeus m. (insertion)
o Inferior part split by line
 medial attachment for carpi ulnaris
 lateral attachment for upper part supinator, lower part abductor
policis longus, extensor policis longus + brevis, extensor indicis
- Medial surface
o Broad + concave above, narrow + convex below
o Upper 3/4 – attachment for flexor digitorum profundus
o Lower 1/4 – subcutaneously placed
- Anterior border
o well marked
o From base of coronoid process until the styloid process
- Posterior border
o Well marked, s-shaped
o Proeminent under skin
o Form triangular surface of posterior aspect of olecranon, until neck of styloid
process
- Lateral border
o Insertion of interosseous membrane
o Upward: bifurcates, forming
triangular space for attachment of
supinator brevis, incisura radialis
o Downwards: ends at level of head
of ulna
Anatomy summary 2020/2021 Melanie Kolassovits

Lower extremity
- 2 eminences: head + styloid process
- Head:
o Outer eminence, larger, round
o Lateral: articular facet for
radius (ulnar notch of radius)
- Styloid process:
o Inner eminence, narrower,
projects more inferiorly
o Non-articular eminence
o Medially placed
- Groove in between head + styloid process – passage for tendon of extensor carpi
ulnaris
Anatomy summary 2020/2021 Melanie Kolassovits

Radius
- Long bone, paired bone
- 1 shaft, 2 extremities

Anatomical position
- Inferior: largest extremity
- Lateral: descending process of inferior extremity
- Posterior: surface with grooves

Upper extremity
- Head:
o Cylindrical form
o Depressed superiorly (place for articulation
with capitulum of humerus)
- Neck – smooth, constricted under head
- Radial tuberosity (bicipital tuberosity)
o Round shape, beneath neck
o Placed at inner + frontal aspect
o Insertion of biceps brachialis

Shaft
- Triangular shaped – 3 surfaces, 3 margins
- Inferior 1/3 subcutaneous placed – palpable under skin

- Anterior surface
o Concave upper 3/4, attachment for long flexor policis
o Broad, flat lower 1/4, attachment for pronator quadratus
o Nutrient groove placed superior
- Posterior surface
o Upper 1/3 rounded, convex, attachment for supinator
o Middle 1/3, broad, slightly concave, attachment for short extensor policis
o Lower 1/3 broad, convex
- Lateral surface
o Medial placed – pronatorium tuberosity (insertion for pronator teres m.)
o Above insertion of pronator teres: close contact with radial n.
- Anterior border
o More visible in its superior aspect, disappears in inferior 1/3
- Posterior border
o Exists only in the middle part
- Medial border
o Place for insertion of interosseous membrane
o Sharp downward, will bifurcate forming triangular space
o Inferior to it: ulnar incisura/notch of radius
Anatomy summary 2020/2021 Melanie Kolassovits

Lower extremity
- Pyramidal shape – 4 surfaces, a base
- Medial surface
o Ulnar notch (articular surface with ulna)
- Lateral surface
o Has groove for passing tendons of abductor longus m., extensor policis brevis
m.
o Will continue itself with the styloid process
- Posterior surface
o Has crests on it, between them are grooves
o For tendons of extensor m. and hand + digits
o Median placed: vertical crest (dorsal tubercle
- Anterior surface
o Concave from superior to inferior
o Attachment for pronator quadratus m.
- Base
o Carpal articulated surface
o Triangular shape, tip is elongated laterally to form styloid process
o Divided into 2 by a crest, triangular shape articulates with scaphoid bone
o Medial – quadrangular shape articulates
with lunate bone
Anatomy summary 2020/2021 Melanie Kolassovits

Bones of the hand

Carpal bones
- Bones of the wrist
- 8 bones, arranged in 2 rows
- Mnemonic formula:
o “Some Lovers Try Positions That They Can’t Handle”

Distal carpal row

Proximal carpal row

- Proximal row:
o Lateral – medial: scaphoid – lunate –
triquetrum – pisiforum
o Scaphoid + lunate bones articulate with distal end of radius
- Distal row:
o Lateral – medial: trapezium – trapezoid – capitate – harnate
o Articulates with metacarpal bones of hand
o Scaphoid: located in the floor of the anatomical snuff box
o Capitate: largest carpal bone
Metacarpal bones
- Bones located between carpal bones + phalanges of hand
- 5 metacarpal bones
- Structure:
o Base – proximal end, articulates with distal row of carpal bones
o Body – slender shaft
o Head – rounded distal end, articulates with proximal phalanx of the
corresponding finger
Anatomy summary 2020/2021 Melanie Kolassovits

Phalanges
- Distal 2 or 3 bones in fingers of hand
- 14 phalanges in hand, thumb has 2 phalanges (proximal + distal)
- Structure:
o Base
 Proximal end
 Articulates with head of corresponding metacarpal bone
 Base of middle/distal phalanx articulates with head of next most
proximal phalanx
o Body
 slender shaft, very short
o Head
 Rounded distal end, proximal, middle, distal phalanges have it
 Head of proximal/middle phalanx articulates with base of next phalanx
Anatomy summary 2020/2021 Melanie Kolassovits

Compartments of the upper limb

Deep fascia
- Connective tissue
- Envelopes muscle like a membrane

Anterior compartment of the arm

Muscles: (superficial – deep)
- Biceps brachii m.
o Short head of biceps brachii – coracoid process
o Long head of biceps brachii – tubercle above glenoid cavity
o Radial tuberosity
o Flexion (forearm)
o Performs biceps curls, allows palm of hand to point toward body while flexing
- Coracobrachialis m.
o Coracoid process of scapula
o Anteromedial surface of humeral shaft
o Flexion + adduction (shoulder joint)
- Brachialis m.
o Front of distal humerus
o Coronoid process of ulna
o Flexion (forearm)

Blood supply:
- Brachial artery

Nerve supply to muscles:

- Musculocutaneous n.

Structures passing through

compartment:
- Musculocutaneous n.
- Median n.
- Ulnar n.
- Brachial a.
- Medial antebrachial
cutaneous n.
Anatomy summary 2020/2021 Melanie Kolassovits

Posterior compartment of the arm

Muscles:
- Triceps brachii m.
o Infraglenoid tubercle of scapula
o Posterior shaft of humerus
o Posterior humeral shaft, distal to radial groove
o Olecranon process of ulna
o Extension (forearm)
o Extends forearm as during punch
- Anconaeus m.
o Lateral epicondyle of humerus
o Lateral aspect of olecranon process
o Pronation (forearm)
o Assists in extending forearm, allows forearm to extend away from body
- Supinator m.
o Lateral epicondyle of humerus
o Proximal ulna
o Proximal end of radius
o Supination (forearm)
o Turns hand palm-up

Blood supply:
- Profunda brachii a.

Nerve supply to muscles:

- Radial n.

Anterior compartment of forearm

Flexors – more medially located, go to palm of hand (anterior compartment)

Names:
Carpi – wrist
Digit – finger
Pollix – thumb

blood supply:
- Ulnar + radial artery

Nerve supply:
- Median + ulnar nerve
Anatomy summary 2020/2021 Melanie Kolassovits

Superficial layer (of flexors)

- Pronator teres m.
o Medial epicondyle of humerus
o Coronoid process of ulna
o Lateral radius
o Pronation (forearm)
o Turns hand palm-down
- Flexor carpi radialis m.
o Medial epicondyle of humerus
o 1st + 2nd metacarpal bone
- Palmaris longus m.
o Medial epicondyle of humerus
o Flexor retinaculum
o Palmar aponeurosis
o Crosses superficially to flexor retinaculum
- Flexor carpi ulnaris
o Medial epicondyle of humerus
o Olecranon
o Posterior border of ulna
o Pisiform, hamate, 5th metacarpal bone
- Brachio radialis m.
o Lateral supracondylar ridge at distal end of humerus
o Base of styloid process of radius
o Flexion (forearm)
o Assists + stabilizes elbow during biceps curl motion
Intermediate/2nd layer
- Flexor digitorum superficialis m.
o Medial epicondyle of humerus
o Medial margin of coronoid process of ulna
o Sides of middle phalanges of digits 2-5
rd
Deep/3 layer
- Flexor digitorum profundus m.
o Superior 3/4 of anterior surface of ulna
o Interosseous membrane
o Coronoid process of ulna
o Aponeurosis of flexor carpi ulnaris m.
o Palmar surface of distal phalanges of digits 2-5
- Flexor pollicis longus m.
o Anterior surface of radius
o Interosseous membrane
o Palmar surface of distal phalanx of thumb
- Pronator quadratus m.
o Distal portion of anterior ulnar shaft
o Distal surface of anterior radius
o Pronation (forearm)
Anatomy summary 2020/2021 Melanie Kolassovits

o Assists in turning hand palm-down

Posterior compartment of forearm
Extensors – more lateral, go to back of hand (posterior compartment)

- Extensor carpi radialis longus m.

o Lateral intermuscular septum of arm
o Lateral supracondylar ridge of humerus (distal third)
o Posterior aspect pf base of metacarpal bone 2
- Extensor carpi radialis brevis m.
o Lateral epicondyle of humerus
o Posterior aspect pf base of metacarpal bone 3
- Abductor pollicis longus m.
o Posterior surface of proximal half of radius, ulna + interosseous membrane
o Base of metacarpal bone 1
- Extensor pollicis brevis m.
o Posterior surface of distal 1/3 of radius + interosseous membrane
o Posterior aspect of base of proximal phalanx of thumb
- Extensor pollicis longus m.
o Posterior surface of middle 1/3 of ulna + interosseous membrane
o Posterior aspect of base of distal phalanx of thumb
- Extensor indicis m.
o Posterior surface of distal 1/3 of ulna + interosseous membrane
o Extensor expansion of index finger
- Extensor digiti minimi m.
o Lateral epicondyle of humerus
o Extensor expansion of digit 5
- Extensor digitorum m.
o Lateral epicondyle of humerus
o Extensor expansion of digits 2-5
- Extensor carpi ulnaris m.
o Lateral epicondyle of humerus
o Posterior border of ulna
o Base of metacarpal bone 5

Intrinsic muscles of hand

- Thenar muscles
o On radial/lateral side of arm
- Hypothenar m.
o Ulnar/medial aspect
- Palmar aponeurosis
- Lumbricals (deep)
- Interossei
o Palmar + dorsal set
Anatomy summary 2020/2021 Melanie Kolassovits

Sensory innervation of the upper limb

Musculocutaneous nerve
- Motor innervation of anterior compartments of arm
- > Distributes to biceps brachii m., brachialis m., coracobrachialis m.
- Originates from lateral cord of brachial plexus
- Pierces coracobrachialis m.
- Course:
o At lateral margin of biceps tendon: pierces deep fascia above elbow
o runs down lateral aspect of forearm as lateral antebrachial cutaneous n.
o Supplies skin on anterior + lateral aspect of forearm

Median nerve
- Originates from lateral + medial cord of brachial plexus
- Course:
o Travels with brachial a.: 2/3 lateral to it, then crosses anterior, 1/3 medial
from a.
o Passes between 2 head of origin of pronator teres, continues downward
behind flexor digitorum superficialis at wrist, enters palm by passing behind
flexor retinaculum
- Distributes flexors of forearm (except brachioradialis, flexor carpi ulnaris, ulnar half
of flexor digitorum profundus)

Ulnar nerve
- Originates from medial cord of brachial plexus
- Course:
o Travels along middle of arm, pierces medial intermuscular septum (between 2
heads of flexor carpi ulnaris) to enter anterior part of forearm
o passes down behind medial epicondyle of humerus
o distal 2/3 of forearm: ulnar a. lies on lateral side of ulnar nerve
o enters palm of hand by passing anterior of flexor retinaculum, lateral to
pisiform bone
- Innervates muscles at forearm (no innervations in arm)
o Flexor carpi ulnaris
o Ulnar half of flexor digitorum profundus

Superficial branch of radial nerve

- Course:
o Runs down on lateral side of radial a.
o In distal part of forearm: leaves artery, passes backwards, reaches posterior
surface of wrist and hand
- Distributes: brachioradialis m. (also innervates triceps m. at arm, extensors of
forearm)
Anatomy summary 2020/2021 Melanie Kolassovits
Anatomy summary 2020/2021 Melanie Kolassovits

Cubital fossa
Boundaries:
- Base (superior): line drawn through epicondyles of humerus
- Laterally: medial border of brachioradialis m.
- Medially: lateral border of pronator teres m.
- Roof (superficially): skin, superficial fascia, deep fascia, aponeurosis of biceps
- Floor (deep): brachialis m., supinator m., capsule of elbow joint

Contents:
- Medial compartment (medial to biceps brachii tendon)
o Brachial a. (divides into radial + ulnar a. at apex of fossa)
o Median n.
o Cephalic v.
- Lateral compartment (lateral to biceps brachii tendon)
o Radial n.
o Lateral antebrachial cutaneous n.
o Median cubital v.

Vascularisation of elbow:
- Branches (of arteries) coming from
superior arteries: collateral
- Branches coming from inferior arteries:
recurrent
Deep brachial a.: “Backup” vascularisation in case
of trauma/arteriosclerosis
Anatomy summary 2020/2021 Melanie Kolassovits

Vascularisation of upper limb

Arterial
supply

Brachial artery
- Course:
o Runs medial to median n. in proximal part of arm
o Runs lateral to median n. in distal part of arm
o Passes deep to bicipital aponeurosis, lateral to median n. and medial to
bicipital tendon
- Branches:
o Deep brachial a. (profunda brachii):
 Wraps around post. Surface of humerus
 Runs in radial groove with radial n.
 Supplies post. Compartment of brachium
o Nutrient humeral a.
o Superior ulnar collateral
 Runs with ulnar nerve
 Passes posterior to medial epicondyle
 Anastomoses with posterior ulnar recurrent a.
o Radial a.
o Ulnar a.
Anatomy summary 2020/2021 Melanie Kolassovits

radial artery
- Begins in cubital fossa, at neck of radius, medial to insertion of biceps brachii tendon
- Course:
o Passes downward + laterally
o Enters wrist + hand to form deep palmar arch
o Passes with radial n.
- Branches:
o Radial recurrent a.
o Superficial palmar branch
o Principal a. of thumb

Ulnar artery
- Begins in cubital fossa at neck of radius
- Is a branch of brachial a.
- Course:
o Passes downward + medially
o Runs through antebrachium, with ulnar n. (inbetween 2nd + 3rd layer of m.)
o Enters wrist + hand to form superficial palmar arch
- Branches:
o Ulnar recurrent a.
o Common interosseous a.
o Anterior + posterior interousseous a.
o Deep palmar branch

Superficial palmar arch

- Formed by ulnar a. + superficial palmar branch of radial a.
- Curve of arch lies across palm, level with distal border of extended thumb
- Gives rise to 3 common palmar digital a.

Deep palmar arch

- Formed by radial a. + deep palmar branch of ulnar a.
- Curve of arch lies across upper part of palmar, at level with proximal border of
extended thumb
- Gives rise to 3 palmar metacarpal arteries
Anatomy summary 2020/2021 Melanie Kolassovits
Anatomy summary 2020/2021 Melanie Kolassovits

Venous supply
Venous drainage – superficial veins
- Begins with dorsal venous arch (receives blood from digits)

Cephalic vein
- Drains lateral side of dorsal venous arch on dorsal part of hand
- Runs along lateral side of antebrachium in superficial fascia
- Ascends into cubital fossa
- Tributaries: median v.
- Drains into: axillary v.

Basilic vein
- Drains medial side of dorsal venous arch
- Runs along medial side of antebrachium
- Tributaries: median cubital v.
- Joins with venae canitantes to form axillary vein

Median cubital vein

- Links cephalic + basilic v. in cubital fossa
- Frequent site for venepuncture
Anatomy summary 2020/2021 Melanie Kolassovits

Axilla
- Located between superior part of lateral thoracic wall + arm
- Shape + size varies according to position of arm
- Transitional region – vessels + nerves pass from root of neck into upper limb

Regions
- Apex/cervicoaxillary margin
o Limited by:
 Medially: 1st rib
 Posteriorly: superior margin of scapula, medial face of coracoid
process
 Anteriorly: clavicle
o Arteries + nerves go through apex, from
neck to upper limb
o Veins + lymph vessels go through apex
from upper limb to neck

- Base
o Correlates with thick layer of fascia axillaris + skin
o Between:
 Anteriorly: inferior margins of pectoralis major m.
(ant. axillary fold)
 Posteriorly: latissimus dorsi m. (post. Axillary fold)

- Anterior wall
o Pectoralis major + minor m.
o Clavipectoral fascia (space between sup. Margin of
pectoralis minor + clavicle)
o Suspensory ligament of axilla (space between inf. Margin of
pectoralis minor m. + dermis at axillary base)
Anatomy summary 2020/2021 Melanie Kolassovits

- Posterior wall
o Formed by:
o Subscapularis m. (superiorly)
o Teres major m. + latissimus dorsi m. (inferiorly)

- Lateral wall
o Anterior + posterior walls converge laterally towards humerus
o Formed by:
 Bicipital sulcus + tendon of long biceps brachii m.
 Coracobrachialis m. (more medially)

- Medial wall
o Formed by:
o First 4 ribs + their intercostals m.
o Superior part of serratus anterior m.
Anatomy summary 2020/2021 Melanie Kolassovits

Contents of axilla
- Axillary a. (is a continuation of subclavian a. at 1st rib) (+its branches)
- Axillary v. (+ its tributaries)
- Nerves (from brachial plexus)
- Lymph vessels + axillares lymph nodes
These elements are surrounded by axillary sheath (elongation of prevertebral portion of
fascia cervicalis)
Between those elements: adipose tissue

Subclavian artery
- Left subclavian a.: direct branch from aortic arch
- Right subclavian a.: branch from arterial brachiocephalic trunk
- Passes between 1st rib + clavicle (runs inside subclavian groove of 1st rib, posteriorly
to anterior scalene m.)
- after passing inferior border of clavicle: becomes axillary artery
- branches:
o vertebral a.
 passes through transverse foramina C6-1
 passes through foramen magnum
 unites with opposite vertebral a. to form basilar a. (blood
supply of brain)
o thyrocervical trunk
 suprascapular a.
 passes between sternomastoid + ant. Scalene m.
 passes over suprascapular ligament to
supraspinous fossa, and through scapular notch to infraspinous
fossa
 transverse cervical a.
 passes anteriorly to ant. Scalene m.
 runs with CN IX (cranial n. 9)
 supplies rhomboids
 inferior thyroid a.
 variable, supplies thyroid gland
o internal thoracic a.
 parallel with sternum, behind ribs
 gives off:
 anterior intercostal branches
located in intercostal spaces (anastomoses with post.
Intercostal branches from aorta)
 Pericardiophrenic a. (between
pleura + pericardium, goes to diaphragm)
 Musculophrenic a. (goes to
diaphragm)
Anatomy summary 2020/2021 Melanie Kolassovits

 Superior epigastric a. (anastomoses with inferior epigastric a.

from external iliac a.)
 Perforating branches (goes to chest wall + breast)

Axillary artery
- Begins at inferior border of 1st rib (continuation of subclavian a.)
Imaginary divided into 3 parts by pectoralis minor m.:
- 1st part: superior to pectoralis minor m.
o 1 branch:
 superior thoracic a.
 supplies:
 pectoralis minor + major m.
 first intercostals m.
 superior part of serratus anterior
nd
- 2 part: deep to pectoralis minor m.
o 2 branches:
 thoracoacromial a. (trunk)
 pectoral branch
 deltoid branch
 acromial branch
 clavicular branch
 lateral thoracic a.
 extends along lateral side of pectoralis minor m.
 between pectoralis minor + major m.
 supplies:
o serratus ant.
o Axillary lymph nodes
o Subscapularis
o breast
rd
- 3 part: inferior to pectoralis minor m.
o 3 branches:
 ant. Humeral circumflex a.
 anastomoses with posterior humeral circumflex a.
 post. Humeral circumflex a.
 passes around post. Aspect
of surgical neck of humerus
 anastomoses with ant.
Humeral circumflex a.
 runs with axillary n.
 supplies deltoid + triceps m.
 part of contents of
quadrilateral space
 subscapularis a.
 branches: thoracodorsal a.
Anatomy summary 2020/2021 Melanie Kolassovits

 circumflex scapular a.
Anatomy summary 2020/2021 Melanie Kolassovits

Subclavian vein
- forms brachiocephalic v. along with jugular veins
- 2 brachiocephalic veins join to form superior vena cava
- 2 brachiocephalic veins, 1 brachiocephalic a.

Axillary vein
- Formed at inferior border of teres major m. (brachial veins +
basilic v. unite)
- Ascends (runs upward) on medial side of axillary a.
- Ends at lateral border of 1st rib -> becomes subclavian v.
- Corresponds to branches of axillary a.

Spaces created by muscle divertions:

Quardangular space
- Limited by: teres minor m., long head of triceps m., teres major m., humerus
- Contains: axillary n., post. Circumflex humeral a.
Triangular space
- Limited by: teres minor m., teres major m., long head of triceps m.
- Contains: circumflex scapular a.
Triangular interval:
- Limited by: Inferior border of teres major m., long heads of triceps m., lateral head of
triceps m.
- Contains: deep brachial a., radial n.
Anatomy summary 2020/2021 Melanie Kolassovits
Anatomy summary 2020/2021 Melanie Kolassovits

Lymphatics
- Lymphatic drainage is from palmar surface to dorsal surface of hand
- 5 principle groups:
o Pectoral
 Lie posterior to pectoralis minor m. with lateral thoracic a.
 Receive lymph mainly from anterior thoracic wall + most of the breast
 Drain mammary gland
o Subscapular
 Lie along inferior border of scapula + subscapularis vessels
 Receive lymph from posterior aspect of thoracic wall + scapular region
 Drain the back
o Humeral
 Lie medial to humerus near axillary a. + v.
 Receive nearly all lymph from upper limb (except that carried by
lymphatic vessels accompanying cephalic v.)
o Central
 In axillary fat, deep to pectoralis minor m.
 Receive lymph from all the above nodes
 Drain into: apical nodes
o Apical
 Lie posterior to clavicle
 Receive lymph from central nodes
- Groups are arranged reflecting pyramidal shape of axilla
- Laterally: lymphatics follow cephalic vein to chain of nodes in deltopectoral groove to
axillary nodes
- Medially: flow to epitrochlear nodes, to axillary
nodes

Mammary gland

- Superficial, on top of pectoralis major m.

- Gland lobules are connected with laciferous ducts
until it gets to nipple
- In female who hasn’t recently given birth: majority of mammary gland is fatty tissue
- After birth: alveola (creates breast milk) will increase in volume + start functioning,
the rest creates ducts that will lead milk to nipple
- Drained by pectoral nodes
Anatomy summary 2020/2021 Melanie Kolassovits

Brachial plexus
- Network of nerve fibres, supply skin + musculature of upper limb
- Formation:
o 5 roots
 Formed by anterior rami of C5-C8 + T1 spinal nerves
o 3 trunks
 Upper, middle, lower
o 6 divisions
 Each trunk is divided into 2 branches – anterior + posterior
o 3 cords
 Named by their position relative to axillary a. – lateral, medial,
posterior
Anatomy summary 2020/2021 Melanie Kolassovits

Terminal branches
- Musculocutaneous n.
o Controls contraction of anterior arm muscles – coracobrachialis m.(also
pierces it) biceps brachii m., brachialis m., some fibres for sensory innervation
o Comes from lateral cord, C5,6,7
- Axillary n.
o Controls deltoid m., teres minor m.
o Comes from posterior cord C5,6
- Radial n.
o Controls triceps brachii m., extensor + supinator m.
o Comes from posterior cord, C5,6,7,8, T1
- Median n.
o Controls flexor + pronator m. of forearm, thenar m., lateral 2 lumbricals
o Comes from medial + lateral cord, C5,6,7,8, T1
- Ulnar n.
o Controls flexor carpi ulnaris m., medial half of flexor digitorum profundus,
intrinsic m. of hand
o Comes from medial cord, C7,8, T1
Collateral branches
- Medial pectoral n.
o Controls greater + lesser pectoral m.
o Comes from medial cord, C8, T1
- Lateral pectoral n.
o Controls greater + lesser pectoral m.
o Comes from lateral cord C5,6,7
- Upper subscapular n.
o Controls superior part of subscapularis m.
o Comes from posterior cord C5,6
- Lower subscapular n.
o Controls inferior part of subscapularis m., teres major m.
o Comes from posterior cord, C5,6
- Thoracodorsal n. (in between subscapular nerves)
o Controls latissimus dorsi m.
o Comes from posterior cord C6,7,8
- Medial cutaneous n. of forearm
o Comes from medial cord C8, T1
- Medial cutaneous n. of arm
o Comes from medial cord T1
- Suprascapular n.
o Controls supraspinatus m., infraspinatus m.
o Comes from superior trunk, C5,6
- Long thoracic n.
o Innervates serratus anterior m.
o Comes from roots, C5,6,7
Anatomy summary 2020/2021 Melanie Kolassovits

Median n.
ulnar n.
Anatomy summary 2020/2021 Melanie Kolassovits
Anatomy summary 2020/2021 Melanie Kolassovits

Thorax
- Cavity formed by thoracic vertebrae, ribs, and sternum
- Contains: lungs, heart, great vessels of heart

Bones
Sternum:
- Median bone
- Located on anterior wall of thorax
- Articulated with the first 7 pairs of ribs + the clavicle on
each side
- 3 parts:
o Manubrium
 Joins to clavicle + 1st rib
 Contains jugular notch
o Body
 With sternal angle (with attachment of
2nd rib)
o Xyphoid process
- Convex anteriorly
- Concave posteriorly
- Junction of manubrium with body: sternal angle/ angle of Louis
- Xiphoid process is located in epigastrium

Ribs
- Shaft = body of ribs
- Medial: concave, lateral: convex
- 2 borders:
o Superior
o Inferior
 Shaft is crossed by costal sulcus
- Anterior extremity: costal cartilage (Knorpel)
- Posterior:
o Head – articulates with articular process of
vertebrae
o Tubercle – articulates with transverse process
of corresponding thoracic vertebrae
o Neck – between head + body
o Body/shaft

True ribs: 1-7 (join at sternum with cartilage end points)

False ribs: 8-12 (join at sternum with combined cartilage at 7th rib)
Floating ribs: 11-12 (no anterior attachment)
Anatomy summary 2020/2021 Melanie Kolassovits

- 1. Rib:
o more horizontal, shorter than the rest
o superior face is located at scalen-tubercle for insertion of scalen muscle
o this tubercle separates sulcus of subclavian vein (anterior) from sulcus of
subclavian artery (posterior)
- 12. Rib doesn’t articulate with the transverse process of T12
- 1., 10., 11., 12. Rib articulate with one single vertebra by a simple synovial joint
- Radiate ligaments connect anterior parts of each costal head to the bodies of 2
vertebrae
- Intra-articular ligament

Sternoclavicular joint
- Only skeletal
articulation between
upper limb and trunk
- Articulating surfaces: sternal end of clavicle + clavicular notch of the sternum
- Intrinsic ligaments: anterior + posterior sternoclavicular ligaments
- Extrinsic ligaments: midline interclavicular ligament + costoclavicular ligaments
- Anterior sternoclavicular ligament:
o Broad, attached above to the anterosuperior aspect of sternal end of clavicle
o Passes inferomedially to the upper anterior aspect of manubrium, spreading
to the posterior aspect of upper manubrium
- Posterior sternoclavicular ligament
o Weaker band, posterior to joint
o Descends inferomedially, from posterior aspect of sternal end of clavicle to
posterior aspect of upper manubrium
- Interclavicular ligament
- Costoclavicular ligament
Anatomy summary 2020/2021 Melanie Kolassovits

Regional anatomy of thorax

External surface has 4 faces

- Anterior face
o Sternum
o Sternocostal joints
o Costal cartilages
o Anterior extremity of ribs
o Intercostal spaces
- Posterior face
o Spinal crest
o Vertebral sulcus
o Transverse process of vertebrae
o Costotransverse joints
o Posterior extremity of ribs
- Lateral faces
o Convex form by the shaft of the ribs + intercostal space

Superior aperture:
- Oval
- Oblique from back to front
- Limited on each side by jugular notch
- Medial border of 1. Rib + vertebral body of T1
Inferior aperture:
- Formed by xyphoid process, costal arch, anterior extremity of 11. Rib, inferior border
of 12. Rib, vertebral body of T12
Anatomy summary 2020/2021 Melanie Kolassovits

Boundaries:
- Superior: Thoracic inlet
o Jugular notch
o Sternoclavicular joint
o Superior border of clavicle acromion
o Spinous process of C7
- Inferior: Thoracic outlet
o Xiphoid process
o Costal arch
o 12th + 11th rib
o T12
Regions:
- Thoracic wall
- Thoracic cavity
o Left + right pleural cavity
o mediastinum

Landmarks inside thorax:

- Jugular notch
o Corresponds with T2 in male, T3 in female
- Sternal angle
o Connects 2nd costal cartilage laterally
o Corresponds with
 Lower border of T4
 Bifurcation of trachea
 Beginning of aortic arch
 Oesophagus is crossed by left main bronchus
Thoracic wall:
- Skin
- Superficial fascia
o Thoracoepigastric veins
o Supraclavicular nerves
o Anterior + lateral cutaneous branches of
intercostal n.
- Deep fascia
o Surrounds muscles

Intercostal space:
Anatomy summary 2020/2021 Melanie Kolassovits

Limit between thoracic + abdominal cavity:

- Outer limit: costal cartilages
- Inner limit: dome of diaphragm

Topographical reference lines

Anterior chest posterior chest

Vertebral line unites spinous processes

Lateral chest
important surface anatomy
Anatomy summary 2020/2021 Melanie Kolassovits
Anatomy summary 2020/2021 Melanie Kolassovits

Muscles of thorax
Extrinsic muscles
- Pectoralis major m. (superficial)
- Pectoralis minor m.
- Serratus anterior m.
Intrinsic muscles (muscles in between ribs)
- Intercostales externi m. (intercostal bundle)
o Origin: lower/inferior border of rib
o Insertion: upper/superior border of rib below origin
o Action: elongate ribs, adding in forced inspiration -> inspirator m.
- Intercostales interni m.
o Upper/superior border of rib
o Lower/inferior border of rib below origin
o Depress ribs for forced expiration -> expirator m.
o Replaced posteriorly by intercostals membrane
- Intercostales intimi m. (are separated from interni by intercostal vessels + nerves)
- Transversus thoracis m. (covers internal thoracic a.)
o Superior attachment: internal surface of costal cartilage 2-6
o Inferior attachment: posterior surface of lower sternum
o Depress ribs + costal cartilages
- Subcostal m. – depress ribs
- Levatori costarum m. – elevates ribs
Inhaling
- Enlarges volume of thoracic cavity
- Antero-posterior diameter will be increased by lifting the ribs by:
o Sternocleidomastoid m. (lifts 2nd rib)
o Scalene m. (1st + 2nd rib)
o Pectoralis minor m. (3rd, 4th, 5th rib)
o Serratus anterior m. (all of the ribs)
o External intercostal m.
- Diaphragm contracts + goes lower in position
o Increases volume of thoracic cavity – inspiration
o Increases intra-abdominal pressure (assists in defecation, vomiting, child-
birth)
Exhaling
- Decreases volume of thoracic cavity
- Most work done by gravitation, most of exhaling is passive
- Depression of ribs done by
o Internal intercostal m.
o Rectus abdominis muscles
o Other abdominal muscles
- Diaphragm will relax/return to former position, be more concave
- Reduces volume to thoracic cage
- > longitudinal diameter of ribcage is diminished
Anatomy summary 2020/2021 Melanie Kolassovits

Diaphragm
- Shape: Dome-like, consists of peripheral muscular part + central tendon
- Position: between thorax + abdomen
- Origin:
o Sternal part: xyphoid process
o Costal part: lower 6 ribs + costal cartilages
o Lumbar part: arises by 2 crura/pillar from upper 2-3 lumbar vertebrae
- Insertion: central tendon
- Weak areas: Triangular spaces without muscular tissue (areas with possible sights of
hernia)
o Lumbocostal triangle: between costal + lumbar parts
o Sternocostal triangle: between costal + sternal parts
- Openings of diaphragm:
o Aortic hiatus
 Anterior to body of 12th thoracic vertebra, between crura
 Transmits aorta, thoracic duct
 In between 2 pleuras of diaphragm
o Oesophageal hiatus:
 transmits oesophagus + vagus nerves
 at level of T10
o vena cava foramen
 transmits inferior vena cava
 through central tendon at T8 level
 enters right atrium

vena cava
foramen
oesophagel hiatus
aorta

lumbar
vertebra

pillars/cruras
Anatomy summary 2020/2021 Melanie Kolassovits
Anatomy summary 2020/2021 Melanie Kolassovits

Vascularisation of thorax
Arteries
- pulmonary trunk
o arises from right ventricle
o runs supero-posterior + to left
o bifurcates inferior to aortic arch into right + left pulmonary
arteries (one for each lung)
- pulmonary arteries
o right pulmonary artery
 passes posterior to ascending aorta + superior vena cava
 goes to hilum of right lung
o left pulmonary artery
 passes anterior to descending aorta + left main bronchus
 goes to hilum of left lung
- ascending aorta
o runs supero-anterior + to right
o extends to level of second right sternocostal joint
o branches for the heart: right + left coronary arteries
- aortic arch
o continuation of ascending aorta
o Curves superior, to the left and posteriorly, then inferior, arching over left
principal bronchus and pulmonary trunk
o becomes descending aorta at lower border of T4 level
o branches: (from right to left)
 brachiocephalic trunk (becomes right subclavian a. + right common
carotid a.)
 left common carotid a.
 left subclavian a.
- thoracic aorta/descending aorta
o continuation of aortic arch at lower border of T4
o courses inferior on left side, then anterior of the vertebral column
o passes through aortic hiatus of diaphragm at level of T12
o main branches:
 parietal branches (vascularize parietal walls)
 9 pairs of posterior intercostals a.
 1 pair of subcostal a.
 For lower 9 intercostal spaces + upper part of
abdominal wall
 Superior phrenic a. supply the superior surface of
the diaphragm
 Visceral branches (vascularize organs)
 Bronchial branches: 1 or 2 for each lung
 Oesophageal branches
 Pericardial branches
Anatomy summary 2020/2021 Melanie Kolassovits

o Upper 1/2: left part of vertebral bodies, lower 1/2: ant. to vertebral bodies
Anatomy summary 2020/2021 Melanie Kolassovits

- Internal thoracic artery

o Branch of subclavian a.
o Origin: behing subclavian v., behind medial extremity of clavicle
o Descends into thorax 1,2cm lateral to lateral borders of sternum
o Posterior to costal cartilages of ribs, anterior to transversus thoracis m.
o Ends at 6th costal cartilage by dividing into musculophrenic + superior
epigastric arteries
o Branches:
 Perforating cutaneous branch
 Pericardiophrenic a.
 Anterior intercostal a.

- arterial ligament
o remnant of ductus arteriosus
o connects bifurcation of pulmonary trunk to inferior border of aortic
arch
- triangle of ductus arteriosus
o bounded by: phrenic n. left vagus n., left pulmonary a.
o contains: arterial ligament, left recurrent n., superficial cardiac
plexus
- intercostal arteries
o anterior intercostal a. (branches from internal thoracic a.)
o posterior intercostal a. (branches from thoracic aorta) anastomoses with ant.
Intercostal a.)
o for 1st + 2nd intercostal space: supreme intercostal a. (branch from subclavian
a.)
o right post intercostal a. are longer than left, because descending aorta is
located on the left
o elements are located in costal sulcus: vein – artery – nerve
Anatomy summary 2020/2021 Melanie Kolassovits

Veins
- brachiocephalic veins
o formed by internal jugular + subclavian veins posterior to sternoclavicular
joint
o angle of union is named venous angle!
- Superior vena cava
o Formed by union of right + left brachiocephalic v. posterior to right
sternocostal synchondrosis of first rib
o Course: Runs inferior, on the ride flank of the ascending aorta
o Joined by azygous vein at level of sternal angle
o Enters right atrium at level of lower border of 3rd right sternocostal joint
o Collects blood from veins of upper half of the body
- Azygous vein
o Continuation of right ascending lumbar vein
o Course: Ascends along right side of vertebral column
o Joins superior vena cava by arching above right lung root at T4-T5 level
o Receives right posterior intercostals + subcostals veins, some bronchial,
oesophageal, pericardial veins hemiazygos vein
o Tributaries: hemiazygos v. accessory hemiazygos v., receive most of the left
posterior intercostals veins + left bronchial veins
o Azygous v.: on right side
o Hemiazygous v.: on left side
- Intercostal veins
o Drain into azygous system
- Internal thoracic v. (receives blood from ant. Intercostal v., sup. Epigastric v.,
musculophrenic v.)

Clinical importance:
Thoracosynthesis – needle should be
inserted on upper edge of rib, to avoid
intercostal bundle

Usually 7th/8th intercostal space on

posterior wall of thorax
Anatomy summary 2020/2021 Melanie Kolassovits

Lymphatic drainage
- Of thoracic wall:
o To axillary lymph nodes
o To parasternal lymph nodes (along internal thoracic vessels)
o To intercostals lymph nodes from deeper structures
- Of breast:
o Into pectora lymph node from lateral + central parts of the breast
o Into apical + supraclavicular lymph node from superior part of breast
o Into parasternal ln. from medial part of breast
o Into interpectoral ln. from deep part of breast
o Lymphatics of breast form anastomosing network which is continuous across
midline with that of other side + abdominal wall
- Of thoracic contents:
o Of trachea, bronchi, lungs
 Pulmonary lymph nodes (lie in angle of bifurcation of branching lobar
bronchi)
 Bronchopulmonary lymph hilar lymph nodes (lie in hilus of lung)
 Tracheobronchial lymph nodes (superior + inferior to bifurcation of
trachea)
 Paratracheal ln (along each side of trachea)
o Anterior mediastinal lymph node
 Lies anterior to large blood vessels of thoracic cavity + pericardium
 The efferents unite with those of paratracheal ln -> form left + right
bronchomediastinal trunks
 Left bronchomediastinal trunk terminates in thoracic duct, right in
lymphatic duct
o Posterior mediastinal ln
 Lie along oesophagus + thoracic aorta

(see more info about thoracic contents in

chapter of mediastinum)
Anatomy summary 2020/2021 Melanie Kolassovits

Nerve supply of thorax

Anterior branches of thoracic nerves

- Intercostal nerves (anterior rami of T1-T11)

o Runs inferiorly to intercostal vessels in costal groove of corresponding rib, in
between intercostals externi + interni m.
o First 6 are distributed within their intercostal space, lover 5 nerves leave
anterior ends of their intercostal spaces to enter abdominal wall
- Subcostal n. (anterior rami of T12)
o Follows inferior border of T12 rib + passes into abdominal wall
o Distributions: to intercostales m., anterolateral abdominal m., skin of thoracic
+ abdominal wall, parietal pleura, peritoneum
- Segmental innervation of anterior surface of trunk: nerves of vertebrae will innervate
the level of trunk on which they are lying
o T2 – sternal angle
o T4 – nipple
o T6 – xiphoid process
o T8 – costal arch
o T10 – umbilicus
- Phrenic nerve
o Course: descends over scalenus anterior to enter thorax
o Accompanied by pericardiophrenic vessels, passes anterior to lung
roots, between mediastinal pleura + pericardium
o Supplies motor + sensory innervation to peritoneum of diaphragm, pleurae,
pericardium (right phrenic n. also to liver, gallbladder, and biliary system)
Anatomy summary 2020/2021 Melanie Kolassovits

- Left vagus n.
o Course: enters thoracic inlet between left common carotid + left subclavian
a., posterior to left brachiocephalic v.
o Crosses aortic arch – left recurrent laryngeal n. branches off
o Passes posterior to left lung root
o Forms anterior oesophageal plexus, anterior vagal trunk at oesophageal
hiatus (then leaves thorax to pass into abdominal cavity, and divide into
anterior gastric + hepatic branches)
o Branches: left recurrent laryngeal n., anterior oesophageal plexus, anterior
vagal trunk, divides into anterior gastric + hepatic branches
- Right vagus n.
o Enters thoracic inlet on right side of trachea, anterior from r. subclavian a.,
travels inferior posterior to right brachiocephalic vein + superior vena cava,
passes posterior to right lung root, leaves thorax at oesophageal hiatus,
passes into abdominal cavity
o Forms: post. Oesophageal plexus, post. Vagal trunk (at oesophageal hiatus),
divides into posterior gastric + celiac branches (in abdominal cavity)
- Recurrent laryngeal nerves
o Right one: hooks around right subclavian a.
o Left one: hooks around aortic arch
o Both ascend into trachea-oesophageal groove
o Nerves enter larynx posterior to cricothyroid joint – inferior laryngeal n.
o Innervations: laryngeal mucosa below fissure of glottis, all laryngeal muscles
(except cricothyroid m.), vocal cords
o Branches: bronchial branch, oesophageal branch, inferior laryngeal n.
Anatomy summary 2020/2021 Melanie Kolassovits

- Thoracic sympathetic trunk – fight or flight

o External to spinal column, adjacent to vertebral bodies
o Comprised of paired, longitudinally arranged paravertebral
sympathetic ganglia linked together by myelinated axons
o Extend from upper neck to coccyx
o T2-T12 thoracic ganglia adjacent to their respective vertebral
bodies, located within posterior mediastinum
o Postganglionic fibres supply liver, spleen, kidney, alimentary tract,
left colic flexure
o superior, middle, inferior cardiac nerves (T1-4) arise from superior,
middle, inferior cervical ganglion
 form superior + deep cardiac plexus + pulmonary plexuses,
supplies heart + bronchi
o thoracic cardiac branches arise from T1-4, innervate cardiac plexus,
contribute to oesophageal + thoracic aortic plexus

- splachnic nerves
o conver visceral afferent + efferent fibres to + from viscera of body cavities
o Greater splachnic n. (visceral)
 Formed by preganglionic fibres from T5-T9 ganglia
 Relay in aorticorenal ganglion
 Terminates on ciliac ganglia
o Lesser splachnic n.
 Formed by preganglionic fibres of T10-T11 ganglia
 Relay in aorticorenal ganglion
o Least (lowest) splachnic n. (if present)
 Derives from T12
 Terminates on aorticorenal ganglia
o Ciliac ganglia redistributes nerves to: stomach, vessels of abdomen, liver,
pancreas, adrenal gland, small bowel, colen
Anatomy summary 2020/2021 Melanie Kolassovits

Mediastinum
- All the anatomical structures between left + right mediastinal pleurae
- Extends from sternum (anterior) to vertebral column (posterior), from thoracic inlet
(superior) to diaphragm (inferior), 2 mediastinal pleura (lateral)
- left side of mediastinum: arterial structures (most superior – pulmonary a.), right
side: venal structures

Subdivisions:
- Superior mediastinum (thoracic inlet)
- Inferior mediastinum
o Anterior mediastinum
o Middle mediastinum
o Posterior mediastinum

Transverse thoracic plan: imaginary line from sternal angle to lower

border of T4

Superior mediastinum
- Contains: Oesophagus, trachea, arch of aorta, big branches of aortic arch,
brachiocephalic veins, upper half of superior vena cava, phrenic n., vagi n., thoracic
duct
- Lies above transverse thoracic plan
Inferior mediastinum
- Below transverse thoracic plan
- Middle mediastinum
o Contains: pericardium, heart, pulmonary trunk, ascending aorta, lower half of
superior vena cava, upper part of inferior vena cava, bifurcation of trachea
- Posterior mediastinum
o Contains: oesophagus, descending thoracic aorta, azygous + hemiazygous v.,
vagi n.
- Anterior mediastinum
o Contains: thymus
Anatomy summary 2020/2021 Melanie Kolassovits

Superior Mediastinum

1st layer/superficial layer

- Thymus
o Plays a role in development of immune system
o Grows only until puberty, is gradually replaced by fat tissue
o Shape: 2 unequal lobes left + right, united in middle part, irregular shape
o Colour: red (new-born), yellow (child), grey (adult)
o Location:
 Posterior to: sternum, 4th-5th costal cartilage, internal thoracic a. + v.
 anterior to: pericardium, heart, cardiac nerves, pulmonary trunk,
ascending aorta
 lateral to: thymus, mediastinal pleura, phrenic nerves
o blood supply: superior thoracic a., lateral thymic arteries, left brachiocephalic
veins

2nd layer/superficial layer

- Brachiocephalic veins

- Phrenic nerves
o Branches of cervical plexus
o Main function: motor + sensory innervation of diaphragm
o R.+l. phrenic n. enter between subclavian a. + brachiocephalic v. into sup.
Mediastinum
 R. phrenic n. runs lateral from superior vena cava, past lateral wall of
right atrium and inferior vena cava to diaphragm
 L. phrenic n. crosses anterior to aortic arch, crosses left a. + v. to reach
diaphragm
- Superior vena cava
o Drains blood from all structures above diaphragm (except heart + lung)
o Located postero-lateral from ascending aorta on right side
- Anterior mediastinal lymph nodes
o Around thymus
o Drain parasternal lymphatic vessels
Anatomy summary 2020/2021 Melanie Kolassovits

3rd layer/middle layer

- Aortic arch
o Begins posterior from sternal manubrium
o Arches sup. + post. To left side, crosses left pulmonary pedicle, becomes
descending aorta at T4 level
o Right/postero-medial face
 In contact with trachea, oesophagus, thoracic duct, l. recurrent
laryngeal n.
o Left/antero-lateral face
 In contact with cardiac nerves, left recurrent laryngeal n., left phrenic
n., mediastinal pleura
o Superior face
 In contact with brachicephalic trunk, left common carotid a., left
subclavian a.
o Interior face
 In contact with left recurrent laryngeal n., branch of vagus

4th layer/posterior layer

- Thoracic part of trachea
o Begins at C6-T4
o 2 parts:
 Cervical
 Thoracic
o At level of T4: divides into main bronchi
o Located in mediosagital plan, in fron of oesophagus
o Posterior to it: oesophagus
o Anterior to it: aortic arch
o Lateral to it:
 left: mediastinal pleura of l. lung, left recurrent laryngeal n., aortic
arch, left common carotid a.
 right: mediastinal pleura of r. lung, superior vena cava, arch of azygous
v.
- Thoracic part of oesophagus
o Posterior to trachea, medial to mediastinal plaure of lungs, anterior to
vertebral column
o Starts at superior aperture of thorax at T4 level
o Between pleura + oesophagus is azygous arch (right) and aortic arch (left)
Anatomy summary 2020/2021 Melanie Kolassovits

- Thoracic duct
o largest lymphatic vessel in human body
o 75% of lymph is collected
o Also called Hoorne’s canal
o Starts in abdomen
o Enters thorax through abdominal hiatus
o 40cm long in adults, 5 mm wide in abdominal region
o Fluid drains at level of venous angle (pirgoff’s angle/cistern chyli)
between left subclavian v. + left internal jugular v.
o Bicuspid valve – to prevent blood from veins to go to lymphatic vessel
o Arch of thoracic duct: located on root of neck (post: ant. Scalene m.,
subclavian a.; ant.: internal jugular v., left common carotid a.)
o Tributaries:
 Drains lymph from: r.+l. descending thoracic lymph trunks (originating
from lower 6 intercostal spaces, 6-11)
 Intercostal spaces 1-5 via upper intercostal lymph trunks
 Mediastinal lymph trunks
 Left jugular trunk
 Bronchomediastinal trunk
 Left subclavian trunk
- Tracheobronchial lymph nodes
- Superior tracheal lymph nodes
o Situated in angle between trachea + main bronchus
o Drain lymph nodes from: lung, trachea, bronchea, oesophagus
- Vagus n.
o 10th pair of cranial n.
o Entering points to thorax:
 Right vagus n.: anterior from r. subclavian a.
 Left vagus n.: between left common carotid a. + left subclavian a.
o Right vagus n. surrounds right subclavian a. (with right recurrent laryngeal n.
branch)
o Left vagus n. surrounds aortic arch (with his branch)
Anatomy summary 2020/2021 Melanie Kolassovits

Inferior mediastinum
Anterior mediastinum
- Thin compartment, flattened antero-posterior
- Between posterior face of transvers thoracic m. + anterior face of pericardium
- Contents:
o Inferior extremity of thymus/fat tissue
o Sternopericardic ligaments
o Branches of internal thoracic aorta
o Superior phrenic lymph nodes
o Prepericardic lymph nodes
o Fat + conjunctive tissue

Middle mediastinum
- Occupied by pericardium + its contents
- Contents:
o Heart
o Ascending aorta
o Pulmonary trunk
o Pulmonary arteries
o Superior vena cava
o Azygous v.
o Pulmonary veins (4)
o Phrenic n.
o Deep cardiac plexus
o Lymph nodes
o Bifurcation of trachea
Anatomy summary 2020/2021 Melanie Kolassovits

Posterior mediastinum
Located between pretracheal plan + anterior face of vertebral column, between diaphragm +
pericardium + costal pleura, has 4 layers:
- Most anterior – 1st layer
o Elements of pulmonary pedicle
 Contain:
 Main stem bronchi
 2 pulmonary a.
 4 pulmonary v. (2 superior, 2 inferior)
 Bronchial vessels
 Lymphatic vessels
 Pulmonary plexus
 Conjunctive mediastinal tissue
 Extrapedicular boundaries: vagus nerves descend posterior from
pedicle, phrenic nerves descend anterior from pedicle
 Left pulmonary pedicle:
 Ascending aorta ascends anterior from it
 Aortic arch crosses it
 Thoracic aorta is posterior to it
 Right pulmonary pedicle
 Sup. Vena cava descends anterior from it
 Azygous v. ascend post. From it, then crosses it to drain into
sup. Vena cava
nd
- 2 layer
o Oesophagus
 Below T4 until T11 – infra brochus segment
 Boundary: pericardium (anterior); vertebral column, thoracic aorta,
azygous v., thoracic duct (posterior); mediastinal pleura of lung
(laterally)
 On each side of oesophagus vagus nerves descend
 Juxtaoesophagis lymph nodes, prevertebral lymph nodes
o vagi
- 3rd layer
o Thoracic aorta
o azygous v.
 continues right ascending lumbar v.
 connection between superior + inferior vena cava
 2 types of tributaries veins:
 Parietal veins
 Visceral veins (pericardic: oesophagian, mediastinal,
(accessory-) hemiazygous v.)
 Boundaries: oesophagus (anterior); VC, post. Intercostal a.,
sympathetic trunk (post.); thoracic duct (left), mediastinal pleura,
medial face of right lung (right)
Anatomy summary 2020/2021 Melanie Kolassovits

o thoracic duct
 (see superior mediastinum)
th
- 4 layer
o Hemiazygous v.
 Continues with left ascending lumbar v.
 Anastomoses with left renal v.
 Located on left side of VC, posterior from thoracic aorta, at T8-T9
passes over VC, drains into azygous v.
 Tributaries: pericardiac + mediastinal v.
o thoracic sympathetic nerves chain
 10-12 pairs of ganglions united by fibres, on each side of VC
 2 types of branches:
 Somatic (for muscles)
 Visceral
o for organs
o From splachnic nerves (greater, lesser, inferior)
 Right thoracic sympathetic trunk: lateral from (accessory-) hemiazygos
v.
 left thoracic sympathetic trunk: lateral from azygous v.
 anteriorly: endothoracic fascia
 posteriorly: head of ribs, costotransverse joints
Anatomy summary 2020/2021 Melanie Kolassovits

Lungs
Pleura
- serous membrane
- produces fluid: thin layer of fluid, acts as lubricant -> lungs can slip smoothly as they
expand + contract
- fluid is drained by lymphatic system
- attaches lung to inner surface of thoracic cage
- failure to function -> difficult, painful breathing
- parietal pleura:
o attaches to internal walls of thoracic cavity
o contains pain receptors
o covers diaphragm + mediastinum
- visceral pleura
o attaches to lungs external surface
o no pain receptors
o extends into interlobular fissures
o continues with parietal pleura at hilum of each lung (becomes parietal pleura)
- pleural space
o space between parietal + visceral pleura
o 10-20 mm wide
o Contains small volume of serous fluid with 2 major functions:
 Lubrification
 Surface tension
o Pulls 2 pleuras together when thorax expands -> lung also expands -> lung fills
with air
- Compartments:
o Cervical
o Costal
o Mediastinal
o diaphragmatic
Anatomy summary 2020/2021 Melanie Kolassovits

Lungs
- cone-shaped organs
- lie in thoracic cavity
- weigh about 800g -> 90% air, 10 % tissue
- left lung is narrower, right lung is shorter
- apices extend 1-2cm past clavicles
- during inspiration: ends at 6th rib midclavicular, 8th rib laterally
- inferior broder: rises + falls between 9th + 12th rib

structure:
- apex (apex pulmonis)
o lies above level of anterior end of 1st rib
o reaches 1-2cm above medial 1/3 of clavicle
o coverings:
 cervical pleura
 suprapleural membrane – connective tissue that covers apex of each
lung, extension of endothoracic fascia that exists between parietal
pleura + thoracic cage
o impressions:
 subclavian a.
 subclavian v.
- base (basis pulmonis)
o semilunar, concave
o rests on dome of diaphragm
o right sided dome is higher than left
(because of liver)
- 3 borders:
o Anterior (margo anterior)
 Formed by convergence of mediastinal + costal surface
 In left lung marked by deep notch (created by apex of heart) – cardiac
notch
 Extends vertically downwards to form lingula (projection of upper
lobe, might be remnant of middle lobe during evolution)
o Posterior (margo posterior)
 Smooth, rounded
 Formed by costal + medial surfaces (meeting posteriorly)
 Extends from C7 - T10
o Inferior (margo inferior)
 Thin + sharp
 Separates base of lunga from costal surface
 Extends into costodiaphragmatic recess
Anatomy summary 2020/2021 Melanie Kolassovits

- 2 surfaces:
o Costal (facies costalis)
 Smooth + convex
 Faces internal surface of chest wall
 Related to costal pleura, which separates it from ribs + intercostal m.
o Medial (facies medialis)
 Anterior (mediastinal)
 Posterior (vertebral)

Fissures
- Oblique fissure
o Begins posteriorly at level of 5th thoracic vertebra
o Passes antero-inferiorly in a spiral course
o Meets the inferior margin close to 6th costochondral junction
- Horizontal fissure
o Extends from anterior margin, at level of 4th costal cartilage
o Runs horizontally backwards, meets oblique fissure in mid-axillary line
o Only present in right lung

 Pulmonary pleura extends into fissures of lung -> lobes can move on each other
during respiration

Divisions
- Lobes: major divisions of lungs (divided by fissures)
- Segments: minor divisions of lungs
- Secondary lobules: minor divisions of segments

Lobes:
- Right lung: 3 lobes
o Superior (upper)
o Middle
o Inferior (lower)
- Left lung: 3 lobes
o Superior (upper)
o Inferior (lower)
Anatomy summary 2020/2021 Melanie Kolassovits

Segments:
- Associated with major branches of airway
Anatomy summary 2020/2021 Melanie Kolassovits

Pulmonary hilum
- Pulmonary root connects medial surface of lung to heart + trachea
- Formed by a group of structures that enter/leave the hilum
- Structures:
o Principle bronchus
o 1 pulmonary a.
o 2 pulmonary v.
 Superior
 Inferior
o Bronchial a.
 1 on right side
 2 on left side
o Bronchial veins
o Anterior + posterior pulmonary plexus of nerves
o Lymphatics bronchopulmonary
Right hilum:
- Situated behind superior vena cava + right atrium, inferior to terminal part of azygous
v.
- Superior -> inferior:
o Superior lobar bronchus
o Pulmonary a.
o Principle bronchus
o Inferior pulmonary v.

Left hilum:
- Lies inferior to aortic arch, anterior to descending thoracic aorta
- Superior -> inferior:
o Pulmonary a.
o Principle bronchus
o Inferior pulmonary v.
Anatomy summary 2020/2021 Melanie Kolassovits

Impressions on lung surface

- Indicate lungs relations with surrounding structures
- Right lung:
o Cardiac impression (related to part of right auricle, r. atrium, r. ventricle)
o Wide groove for superior vena cava + terminal portion of brachiocephalic v.
o Groove for azygous v.
o Right side of oesophagus (shallow, vertical groove behind hilum + pulmonary
ligament)
o Posteroinferiorly: cardiac impression hast short, wide groove -> inferior vena
cava

- Left lung:
o Cardiac impression (related to anterolateral surface of left ventricle + auricle)
o Aortic arch + descending aorta (groove arches over hilum, descends behind it
+ pulmonary ligament)
o Left subclavian a. (narrower groove ascends to apex)
o Thoracic duct + oesophagus (posterior to aortic groove)
o Left brachiocephalic v. (anterior to subclavian groove)
Anatomy summary 2020/2021 Melanie Kolassovits

Vascular supply
- Pulmonary trunk bifurcates into r. + l. pulmonary a., that approach hila of lungs
- Each artery divides into branches, that accompany the segmental + the subsegmental
bronchi
- R. pulmonary a. divides into 2 large branches as it emerges behind superior vena cava
- L. pulmonary a. emerges from within concavity of aortic arch, descends anterior to
descending aorta, enters oblique fissure
- Pulmonary veins
o Usually 4 (2 from each lung)
o Originate from capillary networks in alveolar walls
o Return oxygenated blood to left atrium
o Superior pulmonary v.: anteroinferior to pulmonary a.
o Inferior pulmonary v.: most inferior hilar structure, slightly posterior

lymphatic drainage
- Pulmonary lymphatics originate in superficial
+ deep plexuses
o Superficial plexus lies deep to visceral pleura (its efferents turn around the
margins of the lung + fissures, finally reaches bronchopulmonary nodes)
- Deep lymphatics originate at bronchiolar level (follow bronchovascular divisions to
hilum, ending in the same nodes)

Nerve supply
Pulmonary plexuses
- Lie anterior + posterior to other hilar structures of lung
- Plexus has sympathetic (sympathetic trunk) and parasympathetic (vagus) nerves
Anatomy summary 2020/2021 Melanie Kolassovits

Tracheobronchial tree
Formed by system of airways:
- Trachea
- Bronchi
- bronchioles

Trachea:
- 10-11cm long tube
- Formed by cartilage + fibromuscular membrane
- Lined internally by mucosa
- Descends from larynx at level of C6
- Travels inferiorly to superior mediastinum
- Bifurcates at level of sternal angle (forms l.+r. main bronchi)
- As it descends, it’s located anteriorly to oesophagus, inclines slightly to right
- Surrounded by rings of hyaline cartilage (c-shape)
- At top of trachea: cricoid cartilage attaches it to larynx (only complete tracheal ring)
- Cricoid cartilage: attachment site for muscles, cartilages, ligaments involved in
opening + closing airway, producing speech

Larynx:
- Tough, flexible segment of respiratory tract
- Connects pharynx to trachea
- Allows air to pass through, while keeping food + drinks from blocking airway
- Bodie’s “voice box” – contains vocal folds
- Composed of 3 large, unpaired cartilages
o Cricoid
o Thyroid
o Epiglottis
- 3 pairs of smaller cartilages: arytenoids, corniculate, cuneiform
Anatomy summary 2020/2021 Melanie Kolassovits

Neurovascular supply of tracheobronchial tree

- Trachea receives sensory innervation from recurrent laryngeal n.
- Arterial supply from tracheal branches of inferior thyroid a. (branch from
thyrocervical trunk, branch from subclavian a.)
- Venous drainage via brachiocephalic, azygous, accessory hemiazygos v.

Bronchi:
- At level of sternal angle, trachea bifurcates into r. + l. main bronchi
- Undergo further branching -> secondary bronchi
- Each secondary bronchi supplies a lobe of the lung, gives rise to several segmental
bronchi
- Left main bronchus passes inferiorly to aortic arch, anteriorly to thoracic aorta +
oesophagus to reach hilum of left lung
- Right main bronchus: wider, shorter, descends more vertically -> higher incidence of
foreign body inhalation!
- Right superior lobar bronchus arises before right main bronchus enters hilum

- Primary bronchi branch into secondary (lobar) bronchi

- Each secondary bronchus supplies a lobe of lung -> 3 r. lobar bronchi, 2 l. lobar
bronchi
- Lobar bronchi bifurcate into several segmental (tertiary) bronchi

Bronchioles:
- Branching from segmental bronchi
Conducting bronchioles – terminal bronchioles – respiratory bronchioles (have alveoli
extending from their lumens)

- Alveoli = tiny, air-filled pockets with thin walls, sites of gaseous exchange in lungs
(oxygen moves into blood, CO2 moves into alveoli
Anatomy summary 2020/2021 Melanie Kolassovits

Heart
- Cone-shaped muscle, size of fist
- Weighs 250-350g
- 4 chambers
o 2 atriums
o 2 ventricles – double pump
- 2 circulations
o Systemic circuit
 Blood vessels that transport blood to + from all body tissues
o Pulmonary circuit
 Blood vessels that carry blood to + from lungs
 Ends in left atrium
- Auricles – for when more blood is needed (e.g. during exercise)
Structure:
- Apex
o Inferolateral part of left ventricle
o Left 5th intercostal space (near midclavicular line)
o Oriented to left
- Base
o On posterior surface
o Faces posteriorly towards bodies of T5-T8, faces to right
o Formed mainly by left atrium (lesser part by right atrium)
o Extends superiorly to bifurcation of pulmonary trunk, inferiorly to coronary
sulcus/atrioventricular groove
o Separated to r. + l. by interatrial groove
o Cardiac crux (cross): meeting point of atrioventricular, interatrial and post.
Interventricular grooves
o Vessels which open into base:
 2 pulmonary v. on each side (4) (LA)

 Superior + inferior vena cava (RA)

Anatomy summary 2020/2021 Melanie Kolassovits

- 4 surfaces
o Anterior (sternocostal) surface – mainly formed by right ventricle
 2 main regions
 Atrial region (superior to atrioventricular groove) mainly RA
 Ventricular region (inferior to atrioventricular groove) 1/3 left,
2/3 right
 Separated by pericardium from body of sternum, sternocostal m., 3 rd-
6th costal cartilages
o Diaphragmatic (inferior) surface – mainly formed by LV (partly by RV)
 Formed by only ventricles
 Heart rests mainly on central tendom
 Separated from base by atrioventricular groove
 Transverse/crossed by posterior interventricular groove
o Right pulmonary surface – mainly formed by RA
 Rounded, formed by right atrial wall
 Separated by pericardium from mediastinal aspect of light lung
 Sulcus terminalis separates systemic atrial venous sinus from
appendage/auricle – corresponds with crista terminalis on inside
o Left pulmonary surface – mainly by LV (forms cardiac impression of left lung)
 Faces posterosuperior + to left
 Consists almost completely of obtuse margin of left ventricle
 Separated by pericardium from left phrenic neurovascular bundle
- 4 borders: right, left, inferior, superior
- Position: in mediastinum, behind sternum, pointing left, lying on diaphragm
Anatomy summary 2020/2021 Melanie Kolassovits

Pericardium
- Double walled sac around heart
- Function: protects + anchors
heart, prevents overfilling of
heart with blood
- Composed of:
o Superficial fibrous pericardium
o Deep 2-layer serous pericardium
 Inner (visceral) serosal layer (forms outer covering of heart) –
epicardium
 Outer (parietal) serosal layer (adheres to internal surface of fibrous
pericardium)
 (Those 2 are separated by pericardial cavity, filled with fluid for
freedom of movement)
- Pericardial reflexions of serous layer: 2 complex “tubes”
o Aorta + pulmonary trunk
o Vena cava + 4 pulmonary veins
- Oblique sinus – inverted J
- Transverse sinus – passage between pericardial tubes

Vascular supply + lymphatic drainage of pericardial sac

- 80% of vascular supply comes from r. + l. internal thoracic a. (pericardiophrenic
branches)
- Veins are tributaries of azygous system, internal thoracic, superior vena cava
- Most lymph drainage by thoracic + right lymphatic ducts
Nerve supply of pericardium:
- Pain from parietal pericardium: phrenic nerves
- Pain from serous pericardium:
o Sympathetic fibres (from cervical + upper thoracic + stellate ganglia) – fight or
flight, travel to aortic + cardiac plexuses
o Vagal fibres (via oesophageal plexus + l. recurrent laryngeal n.) –
parasympathetic

Layers of heart wall from out to in:

- Epicardium (visceral layer of serous pericardium)
- Myocardium (= muscle of heart)
- Endocardium (lining the chambers)
Anatomy summary 2020/2021 Melanie Kolassovits

Pathway of blood

External features of the heart

Borders of heart:
- Upper/superior (atrial) border
o Anterior to it: ascending aorta, pulmonary trunk
o Extremity goes to superior vena cava, enters RA
- Right border
o Stops at level of diaphragm
- Inferior border/acute margin
o Sharp, thin
o Formed mainly by RV
- Left border/obtuse margin
o Separates sternocostal surface from left surface
Grooves on cardiac surface:
- Interartrial groove (groove of waterston) – separates 2 atria
- Atrioventricular (coronary) groove
o Separates atria from ventricles
o Contains coronary a., circumflex a., coronary sinus
- Interventricular grooves
o Extend from atrioventricular groove to apical notch
o Incisura apices cordis (little to right from cardiac apex) – created by septum
contracting
- Septums (internal)
o interventricular septum - Separates ventricles internally, muscular septum
o interatrial septum - Separates atria internally, thin, has no muscles
o interatrioventricular septum - Separates atria + ventricals internally
Anatomy summary 2020/2021 Melanie Kolassovits

Structures

- Right auricle: at level of RA – for when more blood is needed (e.g. during exercise)
- Ascending aorta originates from LV
- Pulmonary trunk originates at RV (r. + l. pulmonary a.)
- 4 pulmonary v. originate at LA
- Coronary sinus opens in RA
- Posterior wall of LA has relationship with oesophagus
Anatomy summary 2020/2021 Melanie Kolassovits

Chambers of heart

Atria of the heart

- Receiving chambers
- Each atrium has a protruding auricle

Right atrium
- Cube form
- Receives unoxygenated blood from body from superior + inferior vena cava +
coronary sulcus
- Atrial wall is made out of pectinate m.
o Originates from crista terminalis on posterior wall of RA
o Descends on lateral wall
- Tendon of Todaro (subendocardial) inserts into central fibrous body, one of the
landmarks of Koch triangle (medial part)
- Right wall: right auricle
- Left (medial) wall: fossa ovalis (open in embryo), entrance of coronary sinus, AV-
node, thebesian valve, eustachian valve
- Anterior wall: tricuspid valve (opening to RV)
- Posterior wall: openings of superior + inferior vena cava
Anatomy summary 2020/2021 Melanie Kolassovits

Left atrium of heart

- Cylinder-like form
- Receives oxygenated blood through pulmonary veins
- Medial wall: interatrial septum
- Lateral wall: left auricle, left superior + inferior pulmonary veins
- Posterior wall: venous wall, right superior + inferior pulmonary veins
- Anterior wall: mitral valve/left
atrioventricular valve
Anatomy summary 2020/2021 Melanie Kolassovits

Ventricles of heart
- Discharging chambers of the heart
- Papillary + trabeculae carneae muscles mark ventricular walls

Right ventricle
- Cone shape
- Sends blood through pulmonary trunk to lungs
- Contains diaphragmatic surface
- Medial wall: interventricular septum
- Tricuspid valve, connected through tendinous cords to papillary muscles (anterior,
post., septal papillary muscles)
- Trabeculae carnea – network of fibres -> higher force of contraction
- At base: opening of pulmonary trunk, pulmonary valve (tricuspid)

Left ventricle
- Cone-shaped
- Thicker walls for greater force of contraction
- Sends oxygenated blood through aorta to body
- Mitral/biscupid valve – ant. + post. Papillary m.
- Aortic/tricuspid valve
Anatomy summary 2020/2021 Melanie Kolassovits

Valves
- Tricuspid valve
o RA – RV
o Anterior, posterior, septal cusps
- Pulmonary/pulmonic valve
o RV – pulmonary trunk
- Mitral valve (bicuspid valve)
o LA – LV
o Posterior, anterior cusps
- Aortic valve
o LV – Aorta
o Semilunar cusps

Diastola = relaxation of heart, atria are filled passively

Systole = contraction (of ventricles), ventricles fill
Anatomy summary 2020/2021 Melanie Kolassovits

Electrical conduction system

- Specialized cardiac muscles cells, that carry impulses throughout the heart
musculature, signalling chambers to contract in proper sequence
- At level of:
o Lateral wall of RA
o Walls of RV, LV
- Sinoatrial node (SA)
o In wall of RA
o Sets basic rate 70-80
o Normal pacemaker
o At opening of superior vena cava
o Connected to AV-nodes by continuous fibres
o Sends impulses to atria + atrioventricular nod (AV) via internodal pathway
- Atrioventricular node (AV)
o In interatrial septum
- Bundle of his (AV-bundle)
o In interventricular septum
o Divides into R + L bundle branches for each ventricle
o Become subendocardial branches (“Purkinje fibers”) (inside of ventricles)
 Innervate myocardium of the ventricles
- Contraction begins at apex
Autonomic innervation:
- Sympathetic – fight or flight
o Increases rate + force of contraction
- Parasympathetic (branches of vagus n.)
o Slows heart rate
- Those 2 are antagonistic – only 1 can act at the same time
Anatomy summary 2020/2021 Melanie Kolassovits

External heart major vessels

Anterior view
- Vessels returning blood to heart:
o Superior + inferior vena cava
o R. + l. pulmonary veins
- Vessels conveying blood away from heart
o Pulmonary trunk – r. + l. pulmonary a.
o Ascending aorta (3 branches)
 Brachiocephalic a.
 Left common carotid a.
 Subclavian arteries

Vessels that supply/drain the heart:

- Arteries
o R. + l. coronary a. (in atrioventricular groove) (for RA + RV)
 Left: very short, branches: ant. ventricular a., left coronary a., marginal
a.
o Marginal a. (for RV) (branch of right coronary a.)
o Circumflex a. (LV)
o Anterior interventricular arteries (supplies left half of RV + LV)
o Posterior interventricular a.
- Veins
o Small cardiac v.
o Anterior cardiac v.
o Great cardiac veins
o -> coronary sinus
- Few anastomosis -> ischemia happens fast when embolus happens
- Terminal branches mean that there is only this branch for a certain area
Anatomy summary 2020/2021 Melanie Kolassovits

Relative thickness of muscular walls

- LV thicker than RV, because if forces blood out against more resistance, systemic
circulation is much longer than pulmonary circulation
- Artia are thin, because ventricular filling is done by gravity – little atrial effort
required
Anatomy summary 2020/2021 Melanie Kolassovits

Abdominal wall
Abdominal regions

- R. + l. hypochondriac region
o Liver (right)
o Spleen, colon, stomach, … (left)
- Epigastric region
o Liver, stomach, pancreas
- R. + l. flanks
o Descending colon (left)
o Ascending colon (right)
- R. + l. lateral lumbar region
o Kidneys
- Umbilical region
o Small intestine, transverse colon
- R. + l. inguinal region
o Ileocecal junction, appendix (right)
o Sigmoid colon (left)
- Hypogastric region
o Bladder, small intestine, pregnant uterus
Anatomy summary 2020/2021 Melanie Kolassovits

Layers of abdominal wall

Abdominal wall can be divided into anterolateral + posterior sections
Anterolateral:
1. skin
2. fascia (camper’s fascia, scarpa’s fascia)
3. muscles
4. transversalis fascia
5. extraperitoneal fascia
6. peritoneum

Superficial fascia
- Below umbilicus divided into:
o Superficial fatty layer (camper’s fascia)
o Deep membranous layer (scarpa’s fascia)
rd
- 3 layer adipose tissue deep to membranous layer
- Within superficial layer: blood vessels, lymphatics, nerves; in region of groin: superior
inguinal lymph node
- Above umbilicus: single sheet of connective tissue

Adipose layer
- Superior adipose layer
o Above superficial fascia
- Deep adipose layer
o Below superficial fascia
o Thickness is more variable
o Thin/absent where membranous layer fuses with bony prominences + linea
alba
o Liposuction removes this layer

Deep fascia
- 3 layers:
o Superficial
o Intermediate
o Deep

Endoabdominal fascia
- deep to transversalis fascia

transversalis fascia
- Thin layer of connective tissue
- Lying between deep surface of transversus abdominis m. +
extraperitoneal fat
- Attached to posterior margin of inguinal ligament
- between anterior + superior iliac spine + femoral sheath
- inferior extension forms anterior part of femoral sheath
Anatomy summary 2020/2021 Melanie Kolassovits

- has a discrete thickening – iliopubic tract (deep crural arch) – important during open
+ laparoscopic inguinal hernia repair
- further thickening: interfoveolar ligament – runs inferior to inguinal ligament, may
contain m. fibres
- prolonged as internal spermatic fascia over structures that pass through deep
inguinal ring (e.g. intestinal vessels, ductus deferes, round ligament of uterus)

extraperitoneal tissue
- lies between peritoneum + fasciae lining abdominal + pelvic cavities
- contains variable amount of fat (especially abundant on posterior wall of abdomen
around kidneys)

Nervous supply
Segmental nerves
- Anterior abdominal wall is innervated by anterior ventral rami of 6 th-11th intercostal
nerves, subcostal n. (12th thoracic), 1st lumbar n. (ilioinguinal n., iliohypogastric n.)
o Supply muscles + skin of anterior abdominal wall
- 7 -12th thoracic ventral rami continue anteriorly from intercostal + subcostal spaces
th

into abdominal wall

- All these segmental nerves run anteriorly within a thin layer of fascia between
transversus abdominis + internal oblique m.
- Transversus abdominis plane (TAP) block – regional anaesthetic technique for
abdominal surgery – anaesthetic is injected into neurovascular plane between
internal oblique + transversus abdominis m.
Anatomy summary 2020/2021 Melanie Kolassovits

vascular supply
arterial supply
above umbilicus:
- superior epigastric a. + veins
o terminal branch of internal thoracic a.
o are entering rectus sheath, run inferiorly behind rectus abdominis
o anastomose with inferior epigastric arteries (above level of umbilicus)
o branches supply rectus abdominis + perforate anterior lamina of rectus
sheath, to supply abdominal skin
- posterior intercostal a. 10-11
- subcostal a.
- lumbar a. 1-4
- musculophrenic a.
below umbilicus:
- inferior epigastric a./deep inferior epigastric a.
o originates from external iliac a., proximal to inguinal ligament
o accompanying veins unite to form vein, that drains into external iliac v.
o curves into extraperitoneal tissue, ascends obliquely along medial margin of
deep inguinal ring
o lies posterior to spermatic cord, separated by transversalis fascia
o forms lateral umbilical fold
o disruption of a. by surgical incisions may result in hematoma
o branches of inferior epigastric a. anastomose with branches of superior
epigastric a. within rectus sheath, posterior to rectus abdominis at level above
umbilicus
o ascends along medial margin of deep inguinal ring
o vas deferens (in male)/round ligament (in female) passes medially after
hooking around the a. at the deep inguinal ring
o branches:
 cremastric a.
 pubic branch
 near femoral ring (medial border)
 posterior to pubis
 anastomoses with pubic branch of
obturator a.
 if larger than pubic branch of obturator a. –
supplies most of territory in thigh -> abberant obturator a.
 muscular branches
 supply abdominal m. + peritoneum
 anastomose with circumflex iliac + lumbar
a.
 cutaneous branches
 perforate most superior part of aponeurosis
of external oblique m.
Anatomy summary 2020/2021 Melanie Kolassovits

 supply skin
 especially important for plastic surgeons
- superficial epigastric a.
- superficial circumflex iliac a.
- external pudendal a.

anastomoses:
- femoral a. – superficial epigastric a., superior circumflex iliac a., superior external
pudendal a.
- external iliac a. – deep circumflex iliac a.
- posterior intercostal a., subcostal a., lumbar a.

vascular supply of abdominal wall through 3 main zones:

- zone 1
o represents epigastrium + central anterior abdominal wall withing rectus
abdominis m. region
o supplied by superior + inferior epigastric a.
- zone 2
o lower + anterior abdominal wall below zone 1
o supplied by superficial epigastric a., superficial external pudendal a.,
superficial circumflex iliac a.
- zone 3
o lateral to zone 1
o supplied by musculophrenic a., lower intercostal a., subcostal a., lumbar a.
Anatomy summary 2020/2021 Melanie Kolassovits

venous supply
- small tributaries of inferior epigastric v.
o drain skin around umbilicus
o anastomose with terminal branches of umbilical v.
o drains into umbilical region via falciform ligament -> portosystemic
anastomoses
o my open widely in portal hypertension when blood drains into systemic
circulation via inf. Epigastric v.
- above umbilicus: drains into azygous system
- below umbilicus: drains into femoral system via great saphenous v.
- caput medusae – dilated superficial veins radiating from umbilicus (has to do with
liver)

lymphatic drainage
above umbilicus:
- drain into axillary + sternal nodes
below umbilicus:
- drain into superficial inguinal nodes

Hesselbach’s inguinal triangle

important landmark in laparoscopic inguinal hernia repair
borders:
- lateral border – inferior epigastric a.
- inferior border – medial third of inguinal ligament
- medial border – lateral margin of rectus abdominis
Anatomy summary 2020/2021 Melanie Kolassovits

muscles
anterolateral muscles of abdomen:
- Vertical muscles (near midline)
o Rectus abdominis m.
o Pyramidalis m. (inferior to rectus abdominis m.)
- Flat muscles (situated laterally)
o External oblique m. (superficial)
o Internal oblique m. (underneath external oblique m.)
o Transversus m. (deep to internal + external oblique m.)

Rectus abdominis m.
- Vertical muscle, paired, long, strap-like muscle
- Origin: connects with contralateral m., covers pubic symphysis (medial tendon), pubic
crest (lateral tendon), pubic tubercle (2 tendons of origin)
- Insertion: xiphoid process + 5th-7th costal cartilages (superiorly attached to 3 slips of
muscles)
- Nerve supply: thoracoabdominal n. (T7-T12) ilioinguinal n. branch, ventral rami of
lower 6/7 spinal nerves
- Action: flexes trunk, stabilizes pelvis, compress abdominal cavities
- Muscle fibres are partially interrupted by 3 fibrous bands -> tendinous intersections
- Medial border: linea alba
- Lateral border: linea semilunaris
- Additional fibres arise from lower part of linea alba
- Vascularisation
o Supplied by superior + inferior epigastric a. (inferior is dominant supply)
o Contributions: lower 3 posterior intercostal a., subcostal a., lumbar a., deep
circumflex iliac a.

rectus sheath
rectus abdominis m. is on each side enclosed by fibrous sheath
- posterior part: completely behind upper 2/3 of m. (absent below umbilicus)
- arcuate line (line of douglas) – line of termination of posterior rectus sheath
- below arcuate line: rectus abdominis lies on transversalis fascia + extraperitoneal
connective tissue
- formed from aponeurosis of all 3 lateral abdominal muscles (external, internal
oblique m., transversus abdominis m.) (each has anterior + posterior fibrous layers)
- contents within rectus sheath: rectus abdominis m., pyramidalis m., sup. + inf.
Epigastric vessels, intercostal n. T7-T11
Anatomy summary 2020/2021 Melanie Kolassovits

pyramidalis m.
- triangular muscle, vertical m.
- origin: pubic crest (anterosuperior margin of pubis), (ligamentous fibres in front of)
pubic symphesis
- insertion: linea alba
- action: tenses linea alba
- nerve supply: terminal branches of subcostal n (T12), also possible by fibres of L1
- base on pubis bone, apex attached to linea alba
- lies in front of lower part of rectus abdominis, within rectus sheath
- may be larger on one side, is sometimes absent on one or both sides
- vascular supply: branches of inferior epigastric a.
external oblique m.
- flat m.
- origin: external surfaces of 5th-12th ribs
- insertion: linea alba, pubic tubercle, anterior half of iliac crest (outer lip), anterior
external oblique m., abdominal aponeurosis
- nerve supply: thoracoabdominal nerves (T7-T11), subcostal n.
- action: compresses abdomen, support for abdominal regions, lateral flexion of trunk,
maintains abdominal tone
- largest, most superficial m. out of the 3 anterolateral muscles
- curves around lateral + anterior parts of abdomen
- inguinal ligament: thick lower border of aponeurosis between anterior superior iliac
spine + pubis tubercle
- medial half forms gutter-like floor of inguinal canal
- lacunar ligament – some fibres of inguinal ligament extend posterior + lateral
- vascular supply:
o mainly by branches from lower posterior intercostal + subcostal a. above
deep circumflex iliac a. below
Anatomy summary 2020/2021 Melanie Kolassovits

internal oblique m.
- Flat m.
- Deep to external oblique m.
- Origin: thoracolumbar fascia, anterior 2/3 of iliac crest (between origin of external +
transversus m.), lateral 2/3 of inguinal ligament
- Insertion: inferior borders of 10th-12th ribs + their cartilages, linea alba, pecten pubis,
conjoint tendon, pubic crest, pectineal line
- Nerve supply: thoracoabdominal n. (T7-T12), L1 n., subcostal n., small contribution:
iliohypogastric + ilioinguinal n.
- Action: compresses + supports abdominal viscera, flex trunk against resistance
- Conjoint tendon – fibres originating next to inguinal ligament: fuse with aponeurosis
of transversus abdominis m.
- Vascularisation: by branches from lower posterior intercostal + subcostal a., inferior
epigastric a., deep circumflex iliac a.

Transversus abdominis m.
- Flat m.
- Deepest of the anterolateral abdominal muscles
- Origin: thoracolumbar fascia, medial lip of iliac crest, lateral third of inguinal
ligament, internal aspects of costal cartilages lower 6 rib (7-12) – interdigitate with
those of diaphragm, thoracolumbar fascia
- Insertion: linea alba, pubic crest, pectineal line
- Nerve supply: anterior rami of lower 6 thoracic spinal nerves (T7-T12), L1
- Action: compress abdominal organs
- Muscle ends anteriorly in aponeurosis
- Lower fibres of aponeurosis insert into pubic crest + pectineal line with aponeurosis
of internal oblique m. -> conjoint tendon
Anatomy summary 2020/2021 Melanie Kolassovits

Inguinal structures
Inguinal canal
- Passageway between muscle layers of anterior abdominal wall in groin region
- Better developed in males
- Oblique tunnel with deep (internal) + superficial (external) openings/rings
- Passageway for external genital organs:
o Spermatic cord (males)
 Coverings:
 Internal spermatic fascia (from fascia transversalis)
 Cremasteric fascia (from internal oblique)
 External spermatic fascia (from external oblique)
 Contents:
 Testicular a. + v. + lymphatics + n.
 Vas deferens
o Round ligament of uterus (females)
o Ilioinguinal n. (both)
- Common place for hernias (inguinal hernia)
- MALT (2M, 2A, 2L, 2T)
o Superior wall (roof) – 2 muscles
 Internal oblique m.
 Transverse abdominus m.
o Anterior wall – 2 aponeuroses
 Aponeurosis of external oblique m.
 Aponeurosis of internal oblique m.
o Lower wall (floor) – 2 ligaments
 Inguinal ligament
 Lacunar ligament
o Posterior wall – 2 T
 Transversalis fascia
 Conjoint tendon
- Parallel to + above medial part of inguinal ligament
Anatomy summary 2020/2021 Melanie Kolassovits

superficial inguinal ring (medial boundary of inguinal canal)

- Hiatus in aponeurosis of external oblique m. above + lateral to pubic crest
- Triangular, apex points laterally towards anterior superior iliac spine, base = pubic
crest
- Lateral crus (pl. crura) stronger, attached to pubic tubercle
- Medial crus thinner, attached to pubic symphysis
- Intercrural fibres arch above apex

Deep inguinal ring (lateral boundary of inguinal canal)

- Opening in transversalis fascia
- Situated between anterior superior iliac spine + pubic symphysis 1 cm above inguinal
ligament, 1-2cm wide
- Inferior epigastric vessels run in medial border of deep inguinal ring
Anatomy summary 2020/2021 Melanie Kolassovits

Lower limb
Bones
Hip bone, Coxal bone, Pelvic bone
- Large, flat, paired bone
- Anatomical position:
o Posterior: margin with a big notch
o Lateral: surface with a hemispheric cavity (acetabulum)
o Inferior: notch of acetabulum
- Each hip bone has 3 parts
o Ilium
o Ischium
o Pubis
- 2 surfaces: lateral + medial
- 4 margins: anterior, posterior, superior, inferior
- 4 angles:
o Anterosuperior (iliac spine)
o Posterosuperior (iliac spine)
o Anteroinferior (pubis)
o Posteroinferior (ischial tuberosity)

Lateral surface:
- acetabulum (cotyloid cavity)
o hemispherical depression – cup-shaped
o formed by bodies of 3 bones (ilium, ischium, pubis)
o superior rim: attachment of cotyloid ligament/acetabular labrum
o cotyloid notch: inferior, transverse acetabular ligament
o circular depression (fossa acetabuli): ligamentum teres
o curved articular surface (facies lunata/lunate surface): head of femur will lie
here
- obturator foramen
o between ischium + pubis
o bount by thin, uneven margin – attachment of obturatory membrane
o deep groove superiorly: converted into foramen by obturator membrane
o obturator vessels + nerves are passing through
- gluteal surface
o superior curved line = posterior gluteal line, superior to it gluteus maximus m.
inserts
o middle curved line = anterior gluteal line, superior to it: gluteus medius m.
inserts
o inferior curved line = inferior gluteal line, superior to it: gluteus minimus m.
inserts, inferior to it: reflected tendon of rectus femoris m.
Anatomy summary 2020/2021 Melanie Kolassovits

medial surface:
- arcuate line – 2 parts
o superior: iliac fossa, attachment of iliacus m., nutrient canal
o inferior: sacropelvic surface – 2 parts
 auricular surface (articulation with sacrum)
 iliac tuberosity (insertion of sacroiliac ligaments)
- plane surface – acetabul (back of acetabulum)
- obturator foramen
Anatomy summary 2020/2021 Melanie Kolassovits

Anterior margin
- anterior superior iliac spine
o tensor fasciae latae m. inserts
o sartorius m. inserts
o inguinal ligament inserts (directly at lower corner of spine, goes until pubis)
st
- 1 notch
o lateral cutaneous femoral n.
- anterior inferior iliac spine
o rectus femoris m. insertion + origin
o ilio-femoral ligament (goes to femur)
nd
- 2 notch
o Passes iliopsoas m.
- Iliopubic eminence
- Pectineal surface
o Pectineus m.
o Anterior obturatory crest
o Posterior pectineal line
- Pubic tubercle (spine)
o Inguinal ligament
- Pubic crest
o Rectus abdominis m. origin
o Pyramidalis m. origin

Posterior margin
- Posterior superior iliac spine
- Posterior inferior iliac spine
o Insertion of sacroiliac ligaments
- Greater sciatic notch
o Passing of piriform m.
o Sciatic n. (biggest n. in body)
o Superior gluteal n.
o Inferior gluteal n.
o Internal pudendal vessels passing
- Ischial spine
o Insertion of superior gemellus m.
- Lesser sciatic notch
o Passing of obturator internus m.
o Passing of pudendal nerves + vessels
- Ischial tuberosity
o Our body weight falls on it when sitting
Anatomy summary 2020/2021 Melanie Kolassovits

Superior margin = iliac crest

- Inner lip:
o transversalis abdominis m.
o quadratus lumborum m.
o erector spinae m.
o iliacus m.
- intermediate zone:
o internal oblique m.
- external lip:
o tensor fascia lata m.
o external oblique m.
o latissimus dorsi m.
o gluteus maximus m.

inferior margin
muscle attachments:
- adductor brevis m.
- gracilis m.
- abductor magnus m.
anterior articular border of pubis
Anatomy summary 2020/2021 Melanie Kolassovits

Pelvic girdle
- ring-like bony structure, located in lower part of the trunk
- connects the axial skeleton to the lower limbs
- bony pelvis consists of 2 hip bones
- 4 articulations within pelvis:
o 2 sacroiliac joints (between ilium of hip bone + sacrum)
o Sacrococcygeal symphysis (between sacrum + coccyx)
o Pubis symphysis (between pubic bodies of 2 hip bones)
- Functions:
o Transfer of weight from upper axial skeleton to lower appendicular skeleton
o Provides attachment for a lot of muscles
o Contains + protects abdominopelvic + pelvic viscera
- Pelvic region is divided into 2 parts:
o Greater pelvis (false pelvis)
 Located superiorly
 Supports lower abdominal viscera (ilium, sigmoid column)
 Little obstetric relevance
o Lesser pelvis (true pelvis)
 Located inferiorly
 Within it reside pelvic cavity, pelvic viscera
o Pelvic inlet:
 junction between greater + lesser pelvis
 border: bony edges of pelvic inlet -> pelvic brim
Anatomy summary 2020/2021 Melanie Kolassovits

Pelvic inlet
- Size is determined by pelvic brim
- Borders:
o Posterior: sacral promontory (superior portion of sacrum) + sacral wings (ala)
o Lateral: arcuate line on inner surface of ilium + pectineal line on superior
pubic ramus
o Anterior: pubic symphesis
- Determines structure + size of birth canal, prominent ridges are a key site for
attachment of muscles + ligaments

Pelvic outlet
- Located at end of lesser pelvis + beginning of pelvic wall
- Borders:
o Posterior: tip of coccyx
o Lateral: ischial tuberosities + inferior margin of sacrotuberous ligament
o Anterior: pubic arch (inferior border of ischiopubic rami)
- Angle beneath pubic arch: sub-pubic angle (greater in women)

pelvis joints
posterior -> anterior
- Lumbosacral joint
o Allows flexion, extension, lateral flexion, minimal rotation of torso with
respect to pelvis + lower limb
- Sacroiliac joint
o Allows very little mobility through slight gliding + rotation movements
o In women the ligaments of this joints soften during pregnancy -> increase of
pelvic diameter during childbirth
- Sacrococcygeal
o Allows flexion + extension of coccyx
o Passive movements during childbirth + defecation
- hip
- pubic symphysis
o usually no movements on this joint, except in pregnancy when ligaments
soften -> increase of pelvic diameters
Anatomy summary 2020/2021 Melanie Kolassovits

Femur
- longest + strongest bone, paired + long bone
- 2 extremities, 1 shaft
- Anatomical position:
o Superior: extremity with an angle
o Medial: hemispherical articular surface of superior extremity
o Posterior: rough surface of the bone
Shaft: 3 surfaces, 3 margins
- Anterior surface:
o Smooth, gently convex
o Covered by vastus intermedius m.
- Lateral surface:
o Insertion of vastus intermedius m.
- Medial surface:
o Smooth, no particularity
- Medial + lateral margin: slightly marked
- Posterior margin:
o Rough ridge – linea aspera
o Medial lip: vastus medialis + adductor m.
o Lateral lip: vastus lateralis + short head of
biceps femori m.
- Linea aspera:
o Proximally: medial lip becomes pectineal line
 Insertion of pectineus m.
o Lateral lip becomes gluteal tuberosity
o Insertion of gluteus maximus m.
o Distally: bifurcation: medial + lateral supracondylar line, between them:
popliteal fossa
Anatomy summary 2020/2021 Melanie Kolassovits

Proximal extremity
- head
o Faces anterosuperomedially
o Articulates with acetabulum
o Medial: fovea – attachment of ligamentum teres
- Neck
o Superior medial direction
o Connects head with body
- Anterior surface: lateral – intertrochanteric line
- Posterior surface: lateral – intertrochanteric crest
- Greater trochanter
o Lateral to neck
o Medial: trochanteric fossa: insertion of obturator externus m.
o Attachment site for:
 Gluteus medius m.
 Gluteus minimus m.
 Piriform m.
 Obturator internus m.
- Lesser trochanter
o Posteromedial, inferior to neck-shaft junction
o Insertion for iliopsoas m.
o At intertrochanteric line: attachment of ilio-femoral ligament
o At intertrochanteric crest: on sup. Half of quadrate tubercle: attachment of
quadratus femoris m.
Distal extremity
- Medial + lateral: condyles (articulation with tibia + patella)
- Anteriorly: patellar surface (articulation with patella)
- Posteriorly: separated by intercondylar fossa
- Lateral condyle:
o Larger anteroposterior than medially
o Most prominent point – attachment of fibular
collateral ligament
o Insertion of gastrocnemius m. (in post. Side) +
anterior view
popliteus m.
- Medial condyle:
o Superiorly: adductor condyle
o Insertion of magnus adductor m., medial head of gastrocnemius m.
o Tibial collateral ligament insertion posterior view

- Intercondylar fossa:
o On posterior surface of femur, separates 2
condyles
o Contains 2 facets for attachment for internal knee
ligaments
o Medial wall: posterior cruciate ligament
Anatomy summary 2020/2021 Melanie Kolassovits

o Lateral wall: anterior cruciate ligament

Tibia
- Paired, long bone, medial to fibula
- Anatomical position:
o Inferior: smaller epiphysis/extremity
o Medial: smaller epiphysis process (medial
malleolus)
o Anterior: sharp crest of shaft
- 1 shaft, 2 extremities

Shaft
- 3 surfaces, 3 margins
- Medial surface:
o Smooth, underneath skin
o Nothing special
o Superior: insertion of pes anserinus (group of tendons) = “goose foot”
 Conjoined tendons of 3 muscles: sartorius m., gracilis m.,
semitendinosus m.
- Lateral surface:
o Broad + smooth, visible only in its superior part
o Superior: insertion of tibialis anterior m.
- Posterior surface:
o Nutrient foramen
o Superior: oblique line going downward + medially: soleal line – insertion of
soleus m.
o Above soleal line: insertion of popliteus m.
o Below soleal line: insertion of flexor digitorum longus m. (medial)
- Anterior border:
o Sharp, palpable underneath skin
o Superior: tibial tuberosity – attachment patella ligament
- Medial border:
o Pronounced only in its inferior part (nothing special)
- Lateral border = interosseus border:
o Attachment of interosseus membrane
o Lateral: fibular notch

Proximal extremity
- Connected with femur to form knee joint
- Widened by medial + lateral condyle
- Superior surface = tibial plateau (articulation with femoral condyles)
- Intercondylar eminence
o 2 tubercles
o 2 rough areas anterior + posterior for insertion of ant. + post. Cruciate
ligament
Anatomy summary 2020/2021 Melanie Kolassovits

- Lateral: articular facet – head of fibula

Distal extremity
- Cuboidal shape
- Involved in forming ankle joint
- Superior + inferior face articular with tarsal bone -> ankle joint
- Anterior face:
o Passage of tendons of extensor digitorum longus m. + tibialis anterior m.
- Posterior face:
o Passage of tendons of flexor hallucis longus m.
o Lateral face: fibular notch
o Medial face: continuous with medial malleolus
o Posterior groove: tendon of tibialis posterior + flexor digitorum longus m.
Anatomy summary 2020/2021 Melanie Kolassovits

Fibula
- Long, paired bone, lateral to tibia
- Anatomical position:
o Inferior: flatten epiphysis
o Medial: articular surface of inferior epiphysis
o Posterior: fossa of inferior epiphysis
- 1 shaft, 2 extremities

Shaft
- Lateral surface – insertion of peroneus (longus, brevis, tertius) m.
- Medial surface
o Extensor digitorum longus m.
o Extensor hallucis longus m.
- Lateral surface
o Tibialis posterior m.
o Flexor hallucis longus m.
o Soleus m.
- 3 borders
o Medial border = interosseus border
 Attachment of interosseus membrane
o Anterior + posterior borders – no specific features

Proximal extremity
- Head – articular face for lateral condyle of tibia
- Apex of head – insertion of biceps femoris m.
- Neck – lateral + posterior – common fibular n.

Distal extremity
- Laterally continues with lateral malleolus
- Articular face for tibia + talus
- Posterior – groove for tendons of peroneus m.
Anatomy summary 2020/2021 Melanie Kolassovits

Patella
- Located at front of knee joint, within patellar surface of femur
- Superior aspect attached to quadriceps tendon
- Inferior aspect attached to patellar ligament
- Has triangular shape with anterior + posterior surfaces
- Apex: inferiorly, connected to tibial tuberosity by patellar ligament
- Base: superior aspect, attachment area for quadriceps tendon
- Posterior surface:
o Articulates with femur
o 2 facets:
 Medial facet: articulates with medial condyle of femur
 Lateral facet: articulates with lateral condyle of femur

Bones of the foot

- Posterior row:
o Talus – ankle joint together with tibia + fibula
o Calcaneus (heel bone) – posterior: calcaneal tuberosity – attachment for
achilles tendon
- Anterior row:
o Navicular (navi – looks like boat)
o Cuboid
o Cuneiform (lateral, intermediate, medial)
- Metatarsals – 5, one for each digit
- Phalanges – bones of the toes – each toe has
3 phalanges (proximal, middle, distal) (big
toe only 2 phalanges)
Anatomy summary 2020/2021 Melanie Kolassovits

Compartments of lower limb

Gluteal region (2 posterior)
Limits:
- Circular line – pubis tubercle
- Inguinal fold
- Iliac crest
- Gluteal cleft
- Coccyx
- Genitofemoral sulcus
- Pubic tubercle

1. Skin – thick
2. Subcutaneous layer
a. Femoral posterior cutaneous n.
b. Superficial veins
3. Gluteal fascia
4. Deep layer
a. Superficial muscular layer – gluteus maximus m.
b. Intermedius muscular layer:
i. Gluteus medius m.
ii. Piriformis m.
iii. Gemellus superior m.
iv. Obturator internus m.
v. Gemellus inferior m.
vi. Quadratus femoris m.
vii. Biceps m. + semitendinosus m. (common tendon – ischiatic tuberosity)
c. Suprapiriform foramen -> superior gluteal neurovascular bundle
d. Infrapiriform foramen -> inferior gluteal neurovascular bundle, sciatic n.,
posterior cutaneous femoral n., internal pudendal neurovascular bundle
e. Deep muscular layer
i. Gluteus minimus m.
ii. Obturator externus m.
iii. Semimembranosus m.
iv. Adductor magnus m.
f. Osteo-articular layer
i. Hip bone
ii. Femur – proximal epiphysis
iii. Hip joint
Anatomy summary 2020/2021 Melanie Kolassovits

Thigh (3)
Limits:
- Proximal – circular line, from pubic tubercle to inguinal fold, ant. sup. Iliac spine,
gluteal cleft, pubic tubercle
- Distal – circular line 2 cm superior to patella
- 2 regions:
o Anterior region
 Medial compartment
 Anterior compartment
o Posterior region

Anterior region:
Contains obturator region, Scarpa femoral triangle
1. Skin
2. Subcutaneous layer
a. Artery: superficial epigastric; superficial circumflex iliac; external pudendal
b. Veins:
i. Great saphenous -> femoral v.
ii. Accessory saphenous -> great saphenous
c. Nerve:
i. Lateral cutaneous femoral n., genitofemoral n.
ii. Obturator n.
d. Superficial inguinal lymph nodes (scarpa triangle)
3. Fascia lata – cylindric
a. 2 septums: medial, lateral -> 2 muscular compartments
b. Iliotibial tract (lateral)
c. Fascia cribrosa – creates greater saphenous vein arch
d. Femoral vessels sheets
4. Deep layer – 3 muscular layers
a. Superficial
i. Tensor fascia lata m., sartorius m., adductor longus m., gracilis m.
ii. Scarpa triangle fascia
b. Intermediate
i. Vastus lateralis m., rectus femoralis m., vastus medialis m., iliopsoas
m., pectineus m., adductor brevis m., adductor magnus m.
ii. Muscular + vascular lacuna
iii. Femoral vessels sheets – extend until hunter canal
iv. Femoral a. + deep branch
v. Femoral n. (+ saphenous n.)
vi. Obturator n.
c. Deep
i. Vastus intermediate m.
ii. Obturator externus m.
Anatomy summary 2020/2021 Melanie Kolassovits

Posterior region
1. Skin
2. Subcutaneous layer – posterior cutaneous femoral
3. Fascial layer – fascia lata
4. Deep layer
a. Superficial
i. Biceps femoral m. – long head (lat.)
ii. Semitendinosus m. (med.)
b. Deep
i. Biceps femoral – short head (lat.)
ii. Semimembranosus m. (med.)
c. Arterial network – inferior gluteal a.; circumflex femoral a. (med., lat.);
perforating branches (deep femoral)
d. Sciatic n. (most important aspect of this compartment)
Anatomy summary 2020/2021 Melanie Kolassovits

Knee (4)
Limits:
- Proximal: circular line 2cm superior to patella
- Distal: horizontal plane – imaginary cut through tibial tubercle

Anterior region
1. Skin
2. Subcutaneous layer
a. Subpatellar serous bursa
i. Saphenous n.
ii. Fascia lata -> crural fascia
3. Deep layer
a. Quadricipital layer -> patellar ligament
b. Goose feet (sartorius, gracilis, semitendinosus m.)
c. Patellar arterial network
i. Anastomoses between sup. + inf. Knee a. (popliteal a.)
ii. Descending knee a. (femoral a.)
iii. Recurrent ant. tibial a. (ant. tibial a.)

Posterior region = popliteal fossa

1. Skin
2. Subcutaneous layer
a. Lesser saphenous v.
b. Saphenous n.
c. Posterior cutaneous femoral n.
d. Sural cutaneous n. med. + lat.
3. Knee fascia
4. Deep layer -> popliteal fossa with the neurovascular bundle:
a. Sciatic n. –> tibial + common peroneal n.
b. Popliteal a. -> 5 articular branches
c. Popliteal v.
5. Bony skeleton
a. Distal femoral epiphysis
b. Patella
c. Proximal tibial epiphysis
d. Knee joint
Anatomy summary 2020/2021 Melanie Kolassovits

Leg (5)
Limits:
- Superior: Transverse plane through tibial tubercle
- Inferior: transverse plane through malleolus

Anterior region
1. Skin
2. Subcutaneous layer
3. Fascial layer
a. Crural fascia, becomes superior extensor retinaculum
i. Sends septa to divide ant. post. Lat. Compartment
4. Deep layer
a. Medial compartment
i. Tibial ant. m., extensor hallucis longus m., extensor digitorum longus
m., peroneus tertius (fibular) m.
ii. Tibialis anterior neurovascular bundle (ant. tibial a. + v. + deep
peroneal n.)
b. Lateral compartment
i. Peroneus longus m.
ii. Peroneus brevis m.
iii. Superficial peroneal n.

Posterior region
1. Skin
2. Subcutaneous layer
a. Great saphenous v., saphenous n.
b. Lesser saphenous v. (-> popliteal v.)
c. Medial sural cutaneous n. (tibial n.) + lat. Sural cutaneous n. (common
peroneal n.) -> sural n.
3. Crural fascia
4. Deep layer
a. Superficial
i. Triceps sural m. (gastrocnemius + soleus m.)
ii. Plantar m.
b. Deep
i. Popliteus m., long flexor of digits m., posterior tibial m.
ii. Neurovascular bundle (post. Tibial a. + v. + tibial n.)
iii. Peroneal a.
5. Bony skeleton: tibia, fibula
Anatomy summary 2020/2021 Melanie Kolassovits

Ankle (6)
- Proximal: transvers plane through base of malleolus
- Distal:
o Ant. -> 3cm inferior to talocrural flexion fold
o Post. -> calcaneous tubercle
o Med.-lat. -> 1 cm inferior to malleolus

Anterior region
1. Skin (2-3 folds)
2. Subcutaneous layer
a. Greater saphenous v. + saphenous n.
b. Superficial peroneal n. -> medial dorsal cutaneous + intermediate dorsal
cutaneous n.
3. Fascial layer – crural fascia -> inferior extensor retinaculum
4. Deep layer
a. Ant. tibial tendon, long extensor of hallucis, long extensor of digits, peroneus
tertius
b. Ant. tibial neurovascular bundle – malleolar network (med. + lat.)

Posterior region
1. Skin
2. Subcutaneous layer
a. Lesser saphenous v., sural n.
3. Fascial layer
a. Flexor retinaculum (med.), peroneal retinaculum (lat.)
4. Deep layer
a. Medial compartment
i. Post. Tibial tendon, long flexor of hallucis + digits
ii. Post. Tibial neurovascular bundle
5. Bony skeleton
a. Distal epiphysis of tibia + fibula
b. Talus, calcaneus
c. Tibiofibular joint
d. Talocrural joint
Anatomy summary 2020/2021 Melanie Kolassovits

Foot (7)
Limits:
- Anterior: curved line, proximal to digits
- Posterior: plane, 3 cm inf. To talocrural flexion line
- Lateral-medial: 1 cm inf. To the malleolus
- Inferior: calcaneal tuberosity
Posterior region
1. Skin: thin
2. Subcutaneous layer: lax tissue
a. Superficial venous arch: greater + lesser saphenous v.
b. Superficial lymph nodes
c. Saphenous n. (medial)
d. Medial + intermediate dorsal cutaneous n.
e. Sural n. (lat.)
3. Dorsal fascia of foot -> inferior peroneal retinaculum
4. Deep layer
a. Tendinous layer
i. Tendon of: anterior tibial, long extensor of hallucis + digits, short
peroneal m.
b. Extensor fascia
c. Muscular layer
i. Short extensor of hallucis + digits
ii. Dorsal a. of foot -> arched a. -> 4 dorsal metatarsal a. -> dorsal a. of
the digits + perforating a.
iii. Deep peroneal n.
d. Dorsal interosseous fascia
Plantar region
1. Skin – thick at the level where foot presses to ground
2. Subcutaneous layer
a. Plantar venous network -> lesser saphenous v.
b. Branches of superficial med. + lat. Plantar n.
3. Superficial plantar fascia
4. Deep layer
a. Medial compartment (halluces)
i. Abductor m., adductor m., short flexor m., tendon of long flexor,
tendon of long peroneal m.
ii. medial plantar neurovascular bundle
b. Lateral compartment (small digit)
i. Abductor m., short flexor m., opponent m., tendon long peroneal
ii. Lateral plantar NVB
c. Intermediate compartment
i. Short flexor of the digits 2-5, quadratus plantae m., lumbricals 2-5,
adductor m., tendon of long peroneal, medial interosseous m.
ii. Medial plantar n. -> common plantar digital n. -> proper digital n.
iii. Lateral plantar a. + n.
Anatomy summary 2020/2021 Melanie Kolassovits

Toes/digits (8)
Limits posterior:
- Dorsal surface: curved line through interdigital commissures
- Plantar surface: sulcus through digito-plantar folds

Posterior region
1. Skin
2. Subcutaneous layer
a. 2 dorsal digital a.
b. 2 dorsal digital v.
c. 2 dorsal digital n. (7 <- superficial peroneal n.; 3 <- sural n.)
3. Tendinous layer
a. Tendon of long + short extensor of digits

Plantar region
1. Skin
2. Subcutaneous layer
a. 2 plantar digital a.
b. 2 plantar digital v.
c. 2 plantar digital n.
3. Fibrous layer – fibrous shields -> tunnels for the flexor tendons
4. Tendinous layer
a. Tendon of long flexor of hallucis
b. 2 tendons of long + short flexor of digits
Anatomy summary 2020/2021 Melanie Kolassovits

Superficial structures

Superficial inguinal lymph nodes

- Superior group
o Lies distal to inguinal ligament
o Receive lymph vessels from anterior abdominal wall below umbilicus, gluteal
region, perineal region, external genital organs
- Inferior group
o Lies vertical along the terminal great saphenous v.
o Receives all superficial lymph from posterolateral part of calf

Deep fascia of thigh

Fascia lata
- Encloses the thigh like a trouser leg
- Begins most proximally around the iliac crest + inguinal ligament
- Ends most distally to the bony proeminences of the tibia, where it continues to
become deep fascia of the leg (crural fascia)
- Sends
intermuscular
septa to linea
aspera of femur
- Separates thigh
into 3
compartments
(anterior,
medial,
posterior)

Saphenous hiatus/opening
- Gap, that serves as entry point for efferent lymphatic vessels + great
saphenous v., draining into superficial inguinal lymph nodes +
femoral v.
- Membranous tissue (cribriform fascia) covers hiatus
- hiatus develops inferomedially a sharp margin of the gap (falciform
margin), which lies anterior to femoral vessels

Iliotibial tract
- laterally deep fascia forms a thick band
Anatomy summary 2020/2021 Melanie Kolassovits

- goes from iliac tubercle to lateral condyle of tibia

Muscles
Muscles of thigh
- Gluteals extend, abduct, rotate thigh
- Anterior compartment of thigh – flexes thigh at hip, extends leg at knee
- Medial (adductor) compartment – adducts + medially rotates thigh
- Posterior compartment – extends thigh, flexes leg

Gluteals
Gluteus maximus m.
- Origin: dorsal ilium; sacrum; coccyx
- Insertion: gluteal tuberosity of femur; iliotibial tract
- Action: extends thigh

Gluteus medius m.
- Origin: lateral surface of ilium
- Insertion: greater trochanter of femur
- Action: abduction of femur

Gluteus minimus m.
- Origin: external surface of ilium
- Insertion: greater trochanter of femur
- Action: abduction of femur

Tensor fascia lata m.

- Origin: anterior aspect of iliac crest; anterior superior iliac spine
- Insertion: iliotibial tract
- Action: flexion + abduction of femur
- Innervation by: superior gluteal n.

Posterior pelvis (group of small muscles inferior to gluteals) – lateral rotators

Piriformis m.
- Origin: anterolateral surface of sacrum
- Insertion: greater trochanter of femur
- Action: lateral rotation of femur

Obturator internus m.
- Origin: inner surface of obturator membrane;
greater sciatic notch; margins of obturator
foramen
- Insertion: greater trochanter, in front of piriformis
- Action: lateral rotation of femur
Anatomy summary 2020/2021 Melanie Kolassovits

Obturator externus m.
- Origin: outer surfaces of obturator
membrane, pubic and ischium; margins
of obturator foramen
- Insertion: trochanteric fossa of posterior
femur
- Action: lateral rotation of femur

Superior gemellus m.
- Origin: ischial spine
- Insertion: greater trochanter of femur
- Action: lateral rotation of femur

Inferior gemellus m.
- Origin: ischial tuberosity
- Insertion: greater trochanter of femur
- Action: lateral rotation of femur

Quadratus femoris m.
- Origin: ischial tuberosity
- Insertion: trochanteric crest of femur
- Action: lateral rotation of femur

Anterior compartment of thigh

Iliopsoas m.
- Psoas major m.
o Origin: lumbar vertebrae (L1-L5), thoracic vertebrae (T12)
o Insertion: lesser trochanter of femur
o Action: flexion + lateral rotation of thigh; flexion of torso
o Innervation: femoral n.
- Iliacus m.
o Origin: iliac fossa, iliac crest, lateral sacrum
o Insertion: lesser trochanter of femur
o Action: flexion + lateral rotation of thigh; flexion of torso
o Innervation: femoral n.

Sartorius m.
- Forms Pes anserinus with gracilis + semitendinosus m.
- Origin: anterior superior iliac spine
- Insertion: medial aspect of proximal tibia
- Action: flexion of tibia; flexion, abduction, lateral rotation of thigh
- Innervation: femoral n.
Anatomy summary 2020/2021 Melanie Kolassovits

Quadriceps femoris m.
- Rectus femoris m.
o Origin: anterior inferior iliac spine; superior margin of acetabulum
o Insertion: patella; tibial tuberosity
o Action: extension of tibia + fibula; flexion of thigh
o Innervation: femoral n.
- Vastus lateralis m. (lateral of rectus femoris m.)
o Origin: greater trochanter; intertrochanteric line; linea aspera
o Insertion: patella; tibial tuberosity
o Action: extension of tibia + fibula
o Innervation: femoral n.
- Vastus medialis m. (medial of rectus femoris)
o Origin: linea aspera; intertrochanteric line
o Insertion: patella; tibial tuberosity
o Action: extension of tibia + fibula
o Innervation: femoral n.
- Vastus intermedius m. (deep to rectus femoris)
o Origin: proximal femur shaft
o Insertion: patella; tibial tuberosity
o Action: extension of tibia/fibula
o Innervation: femoral n.

Medial/adductor compartment
Pectineus m.
- Origin: pectineal line of pubis
- Insertion: lesser trochanter to linea aspera of posterior aspect of femur
- Action: adduction, flexion, medial rotation of femur
- Vascularisation: Obturator a.
Adductor magnus m.
- Origin: ischial rami; pubic rami; ischial tuberosity
- Insertion: linea aspera; adductor tubercle of femur
- Action: adduction, flexion, extension of femur
- Vascularisation: perforating branch of femoral a.
Adductor brevis m.
- Origin: body of pubis; inferior ramus of pubis
- Insertion: linea aspera above adductor longus m.
- Action: adduction, flexion of femur
- Vascularisation: Obturator a.
Adductor longus m.
- Origin: pubis near pubic symphesis
- Insertion: linea aspera
- Action: adduction, flexion of femur
- Vascularisation: Obturator a.
Gracilis m.
Anatomy summary 2020/2021 Melanie Kolassovits
Anatomy summary 2020/2021 Melanie Kolassovits

Posterior compartment – hamstring muscles

Biceps femoris m. (on lateral side of post. Compartment)
- Long head
- Short head
- Innervation: sciatic n.

Semitendinous m.
- Innervation: sciatic n.

Semimembranosus m.
- Innervation: sciatic n.
Anatomy summary 2020/2021 Melanie Kolassovits

Muscles of leg
Anterior compartment
Tibialis anterior m.
- Origin: lateral condyle + upper tibial shaft; interosseous membrane
- Insertion: inferior surface of medial cuneiform; 1st metatarsal bone
- Action: dorsiflexion, inversion of foot
- Innervation: deep fibular n.

Extensor hallucis longus m.

- Origin: anteromedial fibula shaft; interosseous membrane
- Insertion: distal phalanx of big toe
- Action: dorsiflexion of foot; extension of big toe
- Innervation: deep fibular n.

Extensor digitorum longus m.

- Origin: lateral condyle of tibia; proximal portion of fibula; interosseous membrane
- Insertion: middle + distal phalanges of toes 2-5
- Action: dorsiflexion of foot; extension of toes
- Innervation: deep fibular n.

Lateral compartment
Fibularis/peroneus longus m. (superficial)
- Origin: upper portion of lateral fibula
- Insertion: 1st metatarsal; medial cuneiform
- Action: plantar flexion + eversion of foot
- Innervation: superficial fibular n.

Fibularis/peroneus brevis m. (deep to longus m.)

- Origin: distal fibular shaft
- Insertion: proximal end of 5th metatarsal
- Action: plantar flexion + eversion of foot
- Innervation: superficial fibular n.
Anatomy summary 2020/2021 Melanie Kolassovits

Posterior compartment
Superficial posterior compartment:
Triceps surae m.
- Gastrocnemius m. (2 heads)
o Origin: medial + lateral condyles of femur
o Insertion: posterior calcaneus
o Action: plantar flexion of foot; flexion of tibia + fibula
o innervation: tibial n.
- Soleus m.
o Origin: superior tibia; fibula; interosseous membrane
o Insertion: posterior calcaneus
o Action: plantar flexion of foot
o innervation: tibial n.

Plantaris m.
- origin: posterior femur above lateral condyle
- insertion: calcaneus/calcaneus tendon
- action: plantar flexion of foot; flexion of tibia + fibula
- innervation: tibial n.

tibialis posterior m.
- origin: superior tibia + fibula; interosseous membrane
- insertion: several tarsal + metatarsals 2-4
- action: plantar flexion of foot
- innervation: tibial n.

deep posterior compartment

popliteus m.
- origin: lateral condyle of femur; lateral meniscus
- insertion: proximal tibia
- action: flexion of tibia + fibula; medial + lateral rotation of
thigh + lower leg
- Innervation: tibial n.
flexor digitorum longus m.
- Origin: posterior tibia
- Insertion: distal phalanges of toes 2-5
- Action: plantar flexion + inversion of foot; flexion of toes
- Innervation: tibial n.
flexor hallucis longus m.
- Origin: midshaft of fibula; interosseous membrane
- Insertion: distal phalanx of big toe
- Action: flexion of big toe, plantar flexion of foot
- Innervation: tibial n.
Anatomy summary 2020/2021 Melanie Kolassovits

tibialis posterior m.
Anatomy summary 2020/2021 Melanie Kolassovits

Muscles of foot
Dorsal aspect
Extensor digitorum brevis m.
- Origin: calcaneus; extensor retinaculum
- Insertion: base of proximal phalanx of big toe;
extensor expansions on toes 2-5
- Action: extension of toes 2-5
Extensor hallucis brevis m.

Plantar aspect
1st layer
- Abductor hallucis m.
o Origin: calcaneal tuberosity; flexor retinaculum
o Insertion: proximal phalanx of big toe
o Action: adduction, flexion of big toe
- Flexor digitorum brevis m.
o Origin: calcaneal tuberosity
o Insertion: middle phalanx of toes 2-4
o Action: flexion of middle toes
- Abductor digiti minimi m.
o Origin: calcaneal tuberosity
o Insertion: proximal phalanx of little toe
o Action: abduction, flexion of toe 5
nd
2 layer
- Quadratus plantae m.
o Origin: medial + lateral sides of calcaneus
o Insertion: tendon of flexor digitorum longus
o Action: flexion of toes 2-5
- Lumbricals m.
o Origin: tendons of flexor digitorum longus m.
o Insertion: medial side of proximal phalanx of toes 2-5
o Action: extensions, flexion of toes 2-5
Anatomy summary 2020/2021 Melanie Kolassovits

3rd layer
- Flexor hallucis brevis m.
o Origin: lateral cuneiform; cuboid bones
o Insertion: base of proximal phalanx of big toe
o Action: flexion of big toe
- Adductor hallucis m.
o Origin: bases of metatarsals 2-5; fibularis longus tendon sheath; ligament
across metatarsophalangeal joints
o Insertion: base of proximal phalanx of big toe
o Action: adduction, flexion of big toe
- Flexor digiti minimi brevis m.
o Origin: base of metatarsal 5; tendon sheath of fibularis longus
o Insertion: base of proximal phalanx of little toe
o Action: flexion of little toe
th
4 layer
- Plantar interossei m.
o Origin: side of each metatarsal that faces metatarsal 2 (absent from
metatarsal 2)
o Insertion: extensor expansion on 1st phalanx of each toe (except 2) on side
facing 2
o Action: abduction, flexion, extension of small toes
- Dorsal interossei m.
o Origin: sides of metatarsals
o Insertion: both sides of toe 2 for each other toe, extensor expansion over first
phalanx on side opposite toe 2
o Action: abduction, flexion, extension of middle toes
Anatomy summary 2020/2021 Melanie Kolassovits

Arterial supply of lower limb

From heart:
Descending aorta -> abdominal aorta -> 2 common iliac a. -> external + internal iliac a.

Internal iliac artery – branches:

- Cranial/superior gluteal a.
o Course: leaves pelvis through greater sciatic foramen superiorly to piriformis
m.
o Origin: continuation of posterior division of internal iliac a.
o Divides into:
 Superficial division – supplies deep surface of gluteus maximus m.
 Deep division – divides into:
 Superior branch – distributed to gluteus medius m.
 Inferior branch – distributed to gluteus minimus m.
- Caudal/inferior gluteal a.
o Course: leaves pelvis through greater sciatic foramen inferior to piriformis m.,
distributes muscular branches
o Origin: one of 2 terminal branches of anterior division of internal iliac a.
- Internal pudendal a.
o For perineum + external genitalia
- Obturator a.
o For adductor muscles
o Course: leaves pelvis through obturator canal, accompanied by ant./post.
Obturator n. branches
o Origin: from internal iliac a. in pelvis
o Branches:
 Anterior + posterior branches
 Acetabular a. (goes to head of femur via ligamentum teres)

External iliac a. – branches:

Inferior epigastric a.
- Ascends to anastomose with superior epigastric a. (branch of internal thoracic a.)

Deep circumflex iliac a.

- Runs laterally travelling along
iliac crest of pelvic bone

Deep femoral a.
- For adductors, hamstrings,
quadriceps m.
Anatomy summary 2020/2021 Melanie Kolassovits

Femoral a.
- Terminal branch of external iliac a., after passing posterior to inguinal ligament
- Length: from inguinal ligament until greater adductor hiatus
- Course:
o On anterior surface of thigh, goes through adductor canal
o Exits through adductor hiatus – now on posterior compartment of thigh
o Passes into popliteal region, where it continues as popliteal a.
- Enters femoral triangle (scarpa’s triangle), where deep femoral a. arises,
posterolateral to femoral a.
- Branches:
o Perforating branches – adductor magnus m.
o Lateral femoral circumflex a.
o Medial femoral circumflex a.
- In vascular lacuna:
o Anterior to it: inguinal ligament
o Posterior: pectineal ligament
o Lateral: iliopectineal arch/muscular lacuna
o Medial: femoral v., lymphatic ganglia, lacunar ligament

- Femoral (scarpa’s) triangle

o Anterior: fascia cribrose, superior circumflex iliac v., genitofemoral n.
o Posteromedially: pectineus m. fascia
o Posterolateral: iliopsoas m. fascia
o Lateral: sartorius m., femoral n.
o Medial: femoral v.

Lateral -> medial

Femoral n. -> a. -> v.
Anatomy summary 2020/2021 Melanie Kolassovits

- As descending along middle thigh:

o Anterior (to femoral a.): sartorius m.
o Posteromedial: fascia of adductor longus m.
o Posterolateral: fascia of vastus medialis m.
o Posterior: femoral v.
o Lateral: saphenous n. (continuation of femoral n.)
- Inferior thigh (adductors/hunters canal):
o Posteromedial: fascia of adductor magnus m.
o Posterolateral: fascia of vastus medialis m.
o Anterior: arched fibres of adductor magnus m./vastus medialis; sartorius m.
o Lateral: femoral v.
o Medial: saphenous n.

Popliteal a. (continuation of femoral a.)

- Branches:
o Muscular branches: supply surrounding muscles
o Articular (genicular) branches – for knee
 Lateral + medial superior genicular a.
 Middle genicular a.
 Lateral + medial inferior genicular a.
o Terminal branches:
 Anterior tibial a.
 Origin: Arises at level of lower border of popliteus m.
 Course:
o Passes anterior into anterior
compartment of leg, through opening in upper parts of
interosseus membrane
o Descends on anterior surface of
interosseous membrane, accompanied by deep
peroneal/fibular nn
 Branches:
o Post. Tibial recurrent a.
o Ant. tibial recurrent a.
o Muscular branches
o Ant. medial malleolar a.
o Ant. to ankle joint, a. becomes
dorsalis pedis a.
 Posterior tibial a.
 Is one of the terminal branches of popliteal
a.
 Origin: lower border of popliteus m.
 Course:
o Descends deep to gastrocnemius +
soleus m. + to deep transverse fascia of leg
Anatomy summary 2020/2021 Melanie Kolassovits

o Lies on post. Surface of tibia

o Passes post. To medial
malleolus
o Deep to flexor
retinaculum
o Terminates by dividing
into medial + lateral plantar a.
 Branches:
o peroneal a.
 Large a., arises
close to origin of post. Tibial a.
 Gives off
muscular branches + nutrient a. to fibula
 Ends by taking
part
in
the

anastomoses around ankle

o Lateral plantar a.
 Larger one of the terminal branches
 On reaching base of 5th metatarsal bone, a.
curves medially to form plantar arch
 At proximal end of first intermetatarsal space,
joins dorsalis pedis a.
 Gives off plantar digital arteries to toes
Anatomy summary 2020/2021 Melanie Kolassovits
Anatomy summary 2020/2021 Melanie Kolassovits

Veins of lower limb

Superficial veins:
- Great (long) saphenous v.
o Often harvested for coronary a. bypass surgery
o Becomes medial malleolus
- Small (short) saphenous v.

Deep veins:
- Common femoral v.
- Femoral v.
- Deep femoral v.
- Popliteal v. peroneal v.
- Anterior tibial v.
- Posterior tibial v.
Anatomy summary 2020/2021 Melanie Kolassovits

Important Regions in thigh

Muscular lacuna
Boundaries:
- Anteriorly: lateral portion of inguinal ligament
- Posterolaterally: ilium
- Medially: iliopectineal arch
Contents:
- Iliopsoas m.
- Femoral n.
- Lateral femoral
cutaneous n.

Vascular lacuna
Boundaries:
- Anteriorly: medial portion of inguinal ligament
- Posteriorly: fascia of pectineus, pectineal ligament
- Medially: lacunar ligament
- Laterally: iliopectineal arch
Contents: !!!!
- Femoral sheath
- Femoral a. + v.
- Genital branch of genitofemoral n.
- Lymphatic vessels
Anatomy summary 2020/2021 Melanie Kolassovits

Femoral/Scarpa’s triangle
- Musculofascial ring on the anterior surface of thigh
- Boundaries
o Superior – inguinal ligament
o Lateral – sartorius m.
o Medial – lateral edge of adductor longus m.
- Contains femoral a., v., n. (know the arrangement!)

Adductor canal/hunter canal

- Musculofascial canal that contains large neurovascular bundle (femoral a., v,
saphenous n.) of anterior thigh
- Begins proximally at inferior angle of femoral triangle, ends distally at adductor
hiatus
Adductor hiatus
- Opening in the tendon of insertion of adductor magnus m.
- Boundaries:
o Medial – portion of tendon of adductor magnus that attaches to adductor
tubercle
o Lateral – insertion of adductor magnus into linea aspera
o Inferior – femur
Anatomy summary 2020/2021 Melanie Kolassovits

Innervation of lower limb

Lumbar plexus
- Located in lumbar region, within substance of psoas major m., anterior to transverse
processes of lumbar vertebrae
- Formed by anterior rami (divisions) of lumbar spinal nerves L1, L2, L3, L4
(contributions from T1-T12)
- Roots divide into several cords -> combine together to form 6 major peripheral
nerves of lumbar plexus
Anatomy summary 2020/2021 Melanie Kolassovits

1. Iliohypogastric n.
- 1st major branch of lumbar plexus
- Course:
o runs to iliac crest, across quadratus lumborum m. of posterior abdominal wall
o perforates transversus abdominis m.
o divides into its terminal branches
- roots: L1 (with contributions of T12)
- motor functions: innervates internal oblique + transversus abdominis m.
- sensory functions: innervates posterolateral gluteal skin in pubic region

2. ilioinguinal n.
- course: same as iliohypogastric n., after innervating muscles of anterior abdominal
wall, passes through superficial inguinal ring, to innervate skin of genitalia + middle
thigh
- roots: L1
- motor functions: innervates internal oblique + transversus abdominis m.
- sensory function: innervates skin on upper middle thigh
o in males: also skin over the root of penis + anterior scrotum
o in females: skin over mons pubis + labia majora

3. genitofemoral n.
- course: After leaving psoas major m. – quickly divides into a genital branch + femoral
branch
- Roots: L1+2
- Motor functions: genital branch innervates cremasteric m.
- Sensory functions:
o genital branch innervates skin of the ant scrotum in males, skin over mons
pubis + labia majora in females
o Femoral branch innervates skin on upper ant thigh

4. lateral cutaneous n. of thigh

- Course: Enters thigh at lateral aspect of inguinal ligament, where it provides
cutaneous innervation to skin
- Roots: L2+3
- motor functions: none
- Sensory functions: innervates anterior + lateral thigh down to lever of knee
Anatomy summary 2020/2021 Melanie Kolassovits

5. obturator n.
- Major peripheral n. of lower limb
- Course: Descends through fibres of psoas major m., emerges from its medial border –
runs posteriorly to common iliac arteries + laterally along pelvic wall to the obturator
canal, splits into anterior + posterior divisions
- Roots: L2,3,4
- Anterior division:
o Descends between adductor longus + adductor brevis towards femoral a.
o Gives off branches to adductor longus, adductor brevis, gracilis m.
o Pierces fascia Lata to become cutaneous branch of obturator n.
- Posterior division:
o Descends through obturator externus m. before passing anteriorly to
adductor magnus
o Gives off branches to apply adductor magnus
- Motor functions: innervates all the muscles in medial compartment of thigh
o Adductor longus
o Adductor brevis
o Adductor magnus
o Gracilis
o Obturator externus
- Sensory function: cutaneous branch supplies skin of the middle part of medial thigh
Anatomy summary 2020/2021 Melanie Kolassovits

6. femoral n.
- Largest branch from lumbar plexus
- Course:
o Descends from lumbar plexus in the abdomen, travelling down through fibres
of psoas major
o exits psoas major at lower part of its lateral border, passing behind iliac fascia
to midpoint of inguinal ligament
o traverses behind inguinal ligament into thigh + splits into anterior + posterior
division
o Passes through femoral triangle lateral to the femoral vessels (enclosed in
femoral sheath) + gives off articular branches to hip + knee joints
o Terminal cutaneous branch of femoral n. is saphenous n., which continues,
with the femoral a.+ v. through the adductor canal
- Roots: L2-4
- Motor functions:
o hip flexors
 Pectineus
 Iliacus
 Sartorius
o Knee extensors
 Quadriceps femoris (rectus femoris, vastus lateralis, vastus medialis,
vastus intermedius)
- Sensory functions:
o First cutaneous branches of femoral n. are anterior cutaneous branches (arise
in femoral triangle) supply skin on anteromedial thigh
o Last cutaneous branch of femoral n. is saphenous n. which supplies skin on
medial side of leg + foot
- Branches
o Anterior group
 Intermediate cutaneous n. of thigh
 Medial cutaneous n. of thigh
 Branch to sartorius
o Posterior group
 Saphenous n.
 Runs on lateral side of femoral a. until it enters adductor canal
 Crosses anterior to femoral a. from lateral to medial
 Gives infra patellar branch to join the patellar plexus, then
supplies the medial side of leg + foot
 Branches to quadriceps femoris m.
 Articular branches to knee joint
Anatomy summary 2020/2021 Melanie Kolassovits
Anatomy summary 2020/2021 Melanie Kolassovits

Sacral plexus
- Formed by anterior rami of sacral spinal nerves S1, S2, S3, S4
- Receives contributions from L4+5
- They divide into spinal roots (and the lumbosacral trunk) + divide into several cords –
then combine together to form the 5 major peripheral nerves of sacral plexus
- These nerves descend down the posterior pelvic wall
- 2 main destinations:
o Leave pelvis via greater sciatic foramen – they enter gluteal region + innervate
those structures
o Remain in pelvis – innervate pelvic muscles, organs + perineum
Anatomy summary 2020/2021 Melanie Kolassovits

1. superior gluteal n.
- Course: Leaves pelvis via greater sciatic foramen, enters gluteal region superiorly to
piriformis m., accompanied by superior gluteal a. + v. for much of its course
- Roots: L4,5 S1
- Motor functions: innervates gluteus minimus, Medius, tensor fascia Lata m.
- sensory function: none

2. inferior gluteal n.
- course: Leaves pelvis via greater sciatic foramen, enters gluteal region inferiorly to
piriformis m., accompanied by inferior gluteal a. + v. for much of its course
- Roots: L5, S1+2
- Motor functions: innervates gluteus maximus
- sensory function: none

3. sciatic n.
- Major nerve of lower limb
- Thick, flat band, approximately 2 cm wide, largest n. in body
- Derives from lumbosacral plexus
- Course:
o Leaves pelvis via greater sciatic foramen, enters gluteal region, emerges
inferiorly from piriformis m., descends in inferolateral direction
o As it moves through gluteal region, it crosses post surface of sup gemellus,
obturator internus, inferior gemellus, quadratus femoris m., then enters
posterior thigh by passing deep to the long head of biceps femoris
o Within posterior thigh it gives rise to branches to the hamstring muscles +
adductor magnus
o When reaching apex of popliteal fossa, it terminates bifurcating into tibial +
common fibular/peroneal nerves
- Motor function: muscles of posterior thigh
o Biceps m.
o Semitendinosus m.
o Semimembranosus m.
o Adductor magnus m.
Anatomy summary 2020/2021 Melanie Kolassovits

Tibial n. (medial popliteal)

- Largest terminal branch of sciatic n.
- Origin at level of middle posterior thigh
- Becomes posterior tibial nerve in popliteal fossa (descends in posterior region of leg)
- Branches:
o Cutaneous branch (sural n.)
o Muscular branch – innervates grastrocnemius, soleus, popliteus, plantaris m
(muscles of post compartment)
o Articular branch – knee joint
Anatomy summary 2020/2021 Melanie Kolassovits

Sural n.
- Descends over posterior part of the calf
- Joined with sural communicating branch of lateral popliteal n.
- Course:
o Descends posterior + inferior of the lateral malleolus (with the short
saphenous v.)
o Runs anterior to lateral border of foot
o Ends by supplying lateral side of little toe

Posterior tibial n.
- Continuation of tibial n. (medial popliteal)
- Begins at inferior border of popliteus m.
- Course: Descends + ends inferior to flexor retinaculum
- Divides into medial + lateral plantar n.
- Gives up muscular + cutaneous branches
- Innervates:
o Muscular branch: soleus, tibialis posterior, flexor digitorum longus, flexor
hallucis longus m.
o Medial calcaneal branch: skin of heel + medial side of the sole of the foot
o Articular branch: ankle joint

Anterior tibial n. (deep peroneal)

- Terminal deep branch of lateral popliteal n.
- Begins on lateral side of neck of fibula
- Course:
o Descends in anterior compartment of leg
o Passes anterior to ankle joint
o Passes posterior to inferior extensor retinaculum into dorsum of foot
- Innervates intertarsal + tarsometatarsal joints
- Motor innervation: all muscles in anterior compartment of leg,
- sensory innervation: small area of skin in the cleft between 1 st+2nd toes + ankle joint
Anatomy summary 2020/2021 Melanie Kolassovits

popliteal fossa
- Shallow depression on post surface of knee
- Boundaries:
o Superomedial - tendons of semimembranosus + semitendinosus muscles
o Superolateral – tendon of biceps femoris m
o Inferior – medial + lateral heads of gastrocnemius muscles
- Contains (nerve – vein – artery; lateral – medial)
o Popliteal a. (deepest + most medial structure) + v. + their branches
o Tibial n.
o Common fibular n
o Popliteus m