Title:
Semester, Year:
Instructors:
BIO 339/639 – Human Gross Anatomy
Summer 2016
Dr. Mary Hurley - ALT 225 - hurleymi@dyc.edu - 829-8109
Course Coordinator; Lecturer
Mr. Todd Stevens - ALT 028 - stevenst@dyc.edu - 829-7549
Mr. Russ Gullekson - ALT 533 - gulleksonr@dyc.edu - 829-8326
Level:
BIO 339 – undergraduate
BIO 639 – graduate
Credits:
6 (2 lecture, 4 lab)
Prerequisites:
BIO 107 & L, BIO 108 & L, or BIO 317
Students are expected to have successfully completed a
two semester Human Anatomy and Physiology sequence
with lab or a Comparative Anatomy course with lab
Course Description:
This course serves as a key foundational clinical science course for health professionals.
Through laboratory dissections, lectures linking anatomy to clinical practice and use of
text-graphics, students will achieve a thorough working knowledge of the human body
including all muscles with their specific attachments and nerve supplies, bones and bony
features, nerves and spinal levels of the nerves, vessels and their sources, and organs,
so as to confidently apply this knowledge in a clinical setting. Many clinical applications
are incorporated with the lecture and the labs, and includes a survey of Langman’s
embryology. The course uses a regional approach that emphasizes relationships
between various structures including bones, muscles, neurologic systems, and internal
organs. Students will apply anatomical knowledge to clinical cases. Laboratory sessions
consist of cadaver dissection and use of other materials such as diagnostic imaging,
models, case studies to learn anatomy and its correlation to examination and diagnosis.
Course Objectives:
Upon completion of this course, the students will be able to:
Cognitive:
1. describe the anatomy and movements of skeletal muscles, including bony
attachments, arrangements of muscle fibers, and specific actions of the muscles,
nerve and blood supply
2. describe articulation of the skeletal systems in terms of joint classification,
planes, degrees and types of motion, limitations or restrictions to motion
3. identify and describe the supporting connective tissue structures of the body
as well as blood vessels
4. identify, describe, and compare the components of the nervous system and
their relationship to sensoria, muscle function, and clinical relevance
5. identify and describe the anatomical and functional significance of the visceral
systems and their clinical relevance
6. describe and discuss the embryological development of the organ systems
7. demonstrate gross topographical features of the body and discuss importance
of these features
8. give examples of how common pathologic disorders may affect the body as it
relates to the regions and systems covered
9. apply relevant anatomical knowledge including vocabulary as it relates to
clinical application and practice.
Affective:
1. relate to the cadaver as the ‘first patient’ and treat the cadaver in an
appropriate respectful manner at all times
2. appreciate importance of anatomy as a foundational science for clinical
practice
Psychomotor:
1. demonstrate basic competency in performing dissection skills
2. demonstrate clinical skills in human bony landmark and organ palpation
Course Rationale:
Robust knowledge of anatomy is imperative to clinical competence and skill. This course
provides the first immersion of the health profession student into an inductive-deductivereason learning environment. This course forms the basis for understanding how
anatomy relates to patient examination, diagnosis and treatment.
Full Couse Format:
a. Format: lecture, class discussion, demonstrations, reading assignments,
clinical laboratory demonstration and performance of cadaver dissection
BIO339 and Bio639: 2 one hour lectures and 2 four hour labs per week
BIO639LF: an additional three hour Friday lab consisting of faculty or guest
speaker presentation of anatomical perspective of clinical applications and
dissection of topic-related joints and organs.
b. Course Requirements: class participation, laboratory participation. Students
are responsible for attending the prosection for their assigned dissections,
completing the assigned dissections, and presenting the material to their peer
learners - 10 point grade deduction for each non-participation. Students are
responsible for taking every lecture exam and lab practical. Students are required
to supply their own dissection kits, including double-pointed scissors, forceps, a
blunt probe, scalpel, blades, and gloves. Students are responsible for
downloading notes at campus.dyc.edu or moodle. Respect must be paid at all
times to the cadaver and cadaver tissues, no photographs are allowed in the
lab of cadaver materials. Any student found taking photographs of cadaver
material will be removed from the course.
c. Assessment of Students: lecture exams and laboratory practical exams
Exams: Each exam is worth 100 points and consists of:
1. 50 question multiple choice lecture exam taken in a lecture hall; constructed from the
lecture notes, 20% of the questions consist of clinical application of anatomy,
2. 50 question laboratory practical; consisting of identification and knowledge in the
laboratory.
Final Exam: A cumulative final will be administered during finals week, consisting of
questions from the semester lecture exams.
For students registered for Bio 639FL:
1. Additional lecture exam questions and lab checklist points given for every exam block,
consisting of material that was covered in the Friday lab sessions, for a total of 100
additional points in the semester. Twenty percent of the points (20 points) will come from
and additional 5 questions/lecture exam, 80% (80 points) from weekly lab checkouts that
consist of X-rays, palpations, movements, and dissection features from the previous
Friday labs.
In summary: 5 points from additional exam questions,15 point checkout per exam block
2. Mandatory attendance to every LF lab session, unexcused absence for presentation,
dissection, or checklist will result in a grade of ‘U’ for 639LF.
To calculate the final grade, students that are not registered for 639FL will be graded
from 400 points total, divided by 4; students registered for 639FL will be graded from 500
points total, divided by 5.
Grades: assigned according to DYC college catalog guidelines:
Rubric:
A- to A+ (100-90
points)
Ability to identify
90-100% of
structures in the
details of the
lecture notes and
laboratory
dissections and
demonstrations
(muscles, bony
landmarks,
vessels, nerves,
organs),
functions of
muscles,
knowledge of
blood supply and
source, specific
bony
attachments,
nerves and their
spinal levels,
knowledge of
embryology,
ability to apply
knowledge
clinically to all
structures.
B- to B+ (89-80
points)
Ability to identify
80-90% of
structures in the
details of the
lecture notes and
laboratory
dissections and
demonstrations
(muscles, bony
landmarks,
vessels, nerves,
organs),
functions of
muscles,
knowledge of
blood supply and
source, specific
bony
attachments,
nerves and their
spinal levels,
knowledge of
embryology,
ability to apply
knowledge
clinically to all
structures
C- to C+ (70-79
points)
Ability to identify
70-80% of
structures in the
details of the
lecture notes and
laboratory
dissections and
demonstrations
(muscles, bony
landmarks,
vessels, nerves,
organs),
functions of
muscles,
knowledge of
blood supply and
source, specific
bony
attachments,
nerves and their
spinal levels,
knowledge of
embryology,
ability to apply
knowledge
clinically to all
structures
D- to D+ (60-69
points)
Ability to identify
60-70% of
structures in the
details of the
lecture notes and
laboratory
dissections and
demonstrations
(muscles, bony
landmarks,
vessels, nerves,
organs),
functions of
muscles,
knowledge of
blood supply and
source, specific
bony
attachments,
nerves and their
spinal levels,
knowledge of
embryology,
ability to apply
knowledge
clinically to all
structures
F (< 60
points)
No
knowledge
of
anything,
pure
guessing
Laboratory Format: Extensive laboratory sessions will comprise of prosection of the
dissection of the day, demonstrations and student dissection, review of correlated
diagnostic imaging, models, basic palpation skills and movements.
SUGGESTED TEXTS & LEARNING RESOURCES:
Textbook: Clinically Oriented Anatomy, Moore and Dalley; Lippincott, Williams, Wilkins;
lecture notes are based on this source and are posted on moodle and campus.dyc.edu
under the headings courses and biology.
Atlas: Grant’s Atlas of Anatomy; Lippincott, Williams, Wilkins; Netter’s Atlas of Human
Anatomy; Elsevier; Atlas of Anatomy; Theime
Dissector: Grant’s Dissector; Lippincott, Williams, Wilkins; dissection notes are based
on this source and posted on campus.dyc.edu
Learning Center: Only students that have the proper paperwork filed at the learning
center to receive special considerations for testing will be allowed to take the lecture
exam in that way. Because of the nature of the lab practical and clinical practice of every
health profession discipline, ALL students MUST take the lab practical exam at the
same time.
Cheating policy:
Cheating will not be tolerated, a ‘0’ grade will be assigned. There will be cell-phone video
documentation by proctor.
Outcome Assessment:
A pretest before the course and a post-test during the final exam will be administered
wherein student performance will be statistically assessed and a report will be available
with the results and a plan that addresses any deficiencies.
LECTURE AND LAB SCHEDULE
Monday
5/23
Intro, memorial
service, remove
skin
5/30
Memorial Day
Holiday
6/6
anterior/lateral
leg
6/13
exam 2
6/20
hand
6/27
head
Tuesday
5/24
back
laminectomy
Wednesday
5/25
suboccipital
Thursday
5/26
scapulodeltoid
shoulder joint
Friday
5/27
gluteal
5/31
posterior
thigh/leg
6/7
anterior/medial
thigh
knee
6/14
posterior
cervical triangle
6/21
thorax
heart & lung
(in a.m.)
6/28
head orbit &
facial n. (a.m.)
6/1
foot
6/2
study day
6/3
exam 1
6/8
anterior
abdominal
wall
6/15
axilla
6/9
posterior
abdominal wall
6/10
pelvis
6/17
posterior UE
6/22
study day
6/16
anterior UE
elbow & wrist
6/23
exam 3
6/29
head
6/30
study day
Lecture 1
THE BACK: VERTEBRAL COLUMN
SURFACE ANATOMY:
6/24
anterior
cervical
triangle
7/1
final
1.
posterior median furrow: when the back is not being flexed or the scapulae are not
retracted the tips of the spinous processes lie deep to it. It ends as flattened triangle
over the sacrum.
2. intergluteal cleft: inferior continuation of posterior median furrow; created by left and
right gluteal muscles and fat.
3. nuchal groove: superior continuation of median furrow in the neck, overlies nuchal
ligament (nuchal ligament).
4. vertebral prominens: visible at the base of the neck, inferior to nuchal groove. It is the
spinous process of the C7 vertebra.
5. erector spinae: prominent vertical bulges, help to form borders of posterior median
furrow caudally, laterally end at angles of ribs in thoracic region.
6. trapezius, latissimus dorsi, teres major: superficial muscles of the back and scapuladeltoid region that can be seen especially in muscular individuals
7. vertebral border, inferior angle and spine of scapula: features of the scapula that can
be seen especially in lean individuals.
8. supraspinous ligament: ligament that overlies spinous processes of vertebrae. Can be
palpated in median longitudinal furrow.
9. spinous processes of lumbar vertebrae: palpated in posterior median furrow
10. posterior superior iliac spines: create dimples (in some individuals) superior and
lateral to gluteal cleft. A line connecting them overlies S2 vertebra.
BONY FEATURES:
Vertebral Column:
 24 individual vertebrae: 7 cervical, 12 thoracic, 5 lumbar
 segmentation: 33 vertebrae of early development reduce to 26 bones
 5 sacral vertebrae fuse producing the sacrum
 4 coccygeal vertebrae fuse producing the coccyx
1. Curvatures:
 Primary: Develop during the fetal period and are concaved anteriorly (flexed).
Persists in the thoracic and sacral regions of the spine in the adult, known as
kyphotic curvature
 Secondary: There are two, which develop as an individual learns to hold head
erect (cervical curvature) and assumes erect posture (lumbar curvature), known
as lordosis. Concaved posteriorly (extension). Persists in the cervical and lumbar
regions of the spine.
 Abnormal curvatures:
 hyperkyphosis: exaggerated primary curvature; example "dowager's
hunch", exaggerated thoracic curvature
 hyperlordosis: exaggerated secondary curvature; example "swayback",
exaggerated lumbar curvature
 scoliosis: lateral distortion - rib/vertebrae angle > 30, then brace
2.
Features of Typical Vertebrae:
 body: chunky anterior portion (support) - compact bone surrounding spongy
bone; gives strength to the vertebral column and supports body weight.
 vertebral pedicles: rounded bars forming anterior sides of vertebral arch
(protection), have notches that join to form the intervertebral foramen through
which the spinal nerves exit the vertebral canal.
 laminas: flat, thin plates forming posterior portion of vertebral arch (protection)






vertebral arch: formed by the right and left pedicles and laminae
vertebral foramen: space for spinal cord; collective foramen form vertebral canal
spinous process: projects posteriorly from vertebral arch at the junction of the
laminae.
 provides attachment for various mm. (movement)
transverse process: laterally directed at junction of lamina and pedicle
 provide attachment for various mm.
articular processes: 2 superior and 2 inferior, also arise from junction of lamina
and pedicle. Superior of one vertebra articulate with inferior of next highest
vertebra forming zygapophysial (facet) joint, a plane type joint (limited
movement).
 orientations of facet joints vary depending on region of spinal column
 cervical - transverse plane
 thoracic - coronal plane
 lumbar - saggital plane
vertebral notches: superior of one vertebra joins inferior of next highest vertebra
to form intervertebral foramen thru which exit the spinal nerves
3. Features of Regional and Individual Vertebrae:
 Cervical Vertebrae: 7 total
 transverse foramen (foramina transversaria): foramen within the transverse
process that allow for passage of the vertebral artery and vein with the
exception of C7 thru which only the vertebral vein passes.
 bifid spinous process: found in C3 through C6
 anterior and posterior tubercles - located on transverse processes; anterior
tubercle of C6 is called the carotid tubercle because the common carotid
arteries may be compressed against them to control bleeding from the
vessel.
 uncinate processes- superior, lateral elevated margins of the bodies;
prevents posterior linear translocation of vertebral bodies and limits lateral
flexion.
 C1, C2 and C7 are atypical:
 Atlas (C1) - ring shaped bone, does not have a body or spinous
process. They are replaced by anterior and posterior
tubercles, respectively.
- kidney shaped concaved superior articular surfaces
for articulation with occipital condyles.
- enlarged vertebral foramen to accommodate dens and
brainstem
- large superior and inferior articular processes for
atlanto-occipital and atlantoaxial joints
 Axis (C2) - dens/odontoid process, the pivot around which C1
rotates.
 Vertebra prominens (C7) - larger spinous process is first easily
palpated of vertebrae, reduced foramina
transversaria carry only vertebral vein.
 Thoracic Vertebrae: 12 total
 costal facets for articulation with ribs  articulating facets on body and
transverse processes for head and tubercle of ribs, respectively.
 heart shaped vertebral body (when viewed from above).



 inferiorly directed spinous process overlaps arch of next lowest
 vertebral foramen is circular and smaller than those of cervical and lumbar
vertebrae
 vertebra (less pronounced in lower thoracic region)
Lumbar Vertebrae: 5 total
 heavy chunky bodies for support and kidney bean shaped (when viewed
from above).
 Due to orientation of the facets rotation movements are greatly reduces
 spinous processes are nearly rectangular
 posterior surface of base of transverse process has accessory process for
attachment of intertransversarii muscles
 posterior surface of superior articular process has mammillary process for
attachment of multifidis and intertransversarii muscles
 L5/S1 facet is in coronal plane
 L5 is significantly taller anteriorly and is largely responsible for lumbosacral
angle.
Sacrum: 5 fused vertebrae
 sturdy triangular bone wedges between pelvic bones to transmit weight from
vertebral column to lower limb.
 forms roof and posterosuperior wall of posterior half of pelvic cavity.
 anterior edge of the body is the sacral promontory
 lateral surface is auricular surface, for synovial sacroiliac joint
 auricular surfaces form slightly movable joint with iliac of pelvis
 fusion has resulted in:
1. spinous processes  median sacral crest
2. articular processes  intermediate sacral crests
3. transverse processes  two lateral sacral crests
4. intervertebral foramina  4 pair of sacral foramina
i. pelvic (for ventral primary rami)
ii. dorsal (for dorsal primary rami)
5. vertebral foramina  sacral canal with cauda equina
6. incomplete fusion of lowest laminas  sacral hiatus
Coccyx: 4 fused rudimentary coccygeal vertebrae (number can vary)
JOINTS OF VERTEBRAL COLUMN:
1. Intervertebral joints: symphysis type between vertebral bodies designed for
weight-bearing and strength.
 articulating surface of adjacent vertebral bodies are connected by
fibrocartilaginous disc (IV discs) and ligaments. Provide strong attachments
between the vertebral bodies. Each disc consists of:
 anulus fibrosis – form circumference of IV discs, fibers run obliquely
from disc to articular surface of vertebral body.
 nucleus pulposus – core of IV discs. Are responsible for much of the
flexibility and resilience of the IV discs and vertebral column. Serve as a
shock absorber. This is the portion of the IV disc which protrudes into the
vertebral canal when there is a herniation.
 intervertebral joints, collectively, are stabilized by:
 anterior longitudinal ligament – connects anterior side of bodies from
the pelvic surface of the sacrum to the occipital bone. It is the only
ligament that prevents hyperextension

posterior longitudinal ligament – located on the floor of vertebral
canal. Narrow band attached primarily to the IV discs. Superiorly
becomes the tectorial membrane, attaching to occipital bone
2. Zygapophysial Joints: Synovial, plane gliding joints (also referred to as facet
joints).
 Between superior and inferior articular processes of adjacent vertebrae.
Permit gliding between the vertebrae. Enclosed in capsular ligaments.
 Accessory ligaments unite the laminae, transverse processes, and spinous
processes and help to stabilize the joints these include:
 supraspinous ligaments – connects the apices of the spinous process
form C7 to sacrum. Merges superiorly with nuchal ligament.
 interspinous ligaments – connect adjoining spinous processes,
attaching rom the root to the apex of each process.
 ligamenta flava – yellow ligaments, extend vertically connecting lamina.
Form part of posterior wall of the vertebral canal.
 nuchal ligament – Also referred to as nuchal ligament (nuchae means
nape of neck). A broad, strong median ligament of the posterior neck.
Extends from external occipital protuberance and posterior border of
foramen magnum to spinous processes of cervical vertebrae. Provides
site of attachment for some muscles (eg. trapezius)
3. Craniovertebral Joints: Synovial joints with no IV discs. Give a wider range of
movement
 atlanto-occipital joint : synovial condyloid joint between occipital
condyles and superior articular processes of atlas, stabilized by three
ligaments:
1. anterior atlanto-occipital membrane - continuation of
anterior longitudinal ligament
2. posterior atlanto-occipital membrane - from arch of atlas to
posterior margin of foramen magnum
3. tectorial membrane or membrana tectoria - continuation of
posterior longitudinal ligament into internal periosteum of
occipital bone

atlantoaxial joint : 3 articulations; synovial pivoting joint between dens
of axis and interior anterior surface of atlas, stabilized by:
1. cruciform ligament - consisting of transverse, superior and
inferior fibrous bands. Attaches axis to foramen magnum,
provides "socket" for dens
2. apical ligament – extends from the tip of the dens to the
anterior margin of foramen magnum
3. alar ligaments – extends from the sides of the dens to the
lateral margins of the foramen magnum. Prevents excessive
rotation. provide attachment from dens to foramen magnum
and secure dens within its "socket"
CLINICAL TERMS:
1. spondylolysis: degenerative condition in which there is defect in the vertebral
arch resulting in a fracture usually between superior and inferior articular
processes (pars inarticularis) that separates the vertebral arch from the body.
2. spondylolisthesis: can result from spondylolysis, when the fracture results in
anterior displacement of the body of the vertebrae.
3. spondylosis: bony arthritic growth of vertebral bodies referred to as osteophytes
REGIONAL ANATOMY OF THE BACK
BONY FEATURES:
1. Axial skeleton: skull, vertebral column and thoracic cage (ribs and sternum)
 vertebra: spinous and transverse processes
 skull
 occipital bone: superior nuchal line, inferior nuchal line and external
occipital protuberance (inion)
 temporal bone: mastoid process
2. Appendicular skeleton: limbs and attachment girdles
 pectoral girdle includes scapulas and clavicles
 Scapula: spine, acromion and vertebral border
 Clavicle: acromial end, clavicular end
 pelvic girdle includes 2 pelvic bones
 Os coxa: crest of ilium  attachment for latissimus dorsi m. and
some deep back mm.
 Humerus: intertubercular sulcus  attachment for latissimus dorsi m.
MUSCLES:
A. Extrinsic Back Muscles: muscles associated with upper limb or ribs. During
development they migrated to the back, so are supplied by anterior primary rami,
with the exception of trapezius which is supplied by CNXI. Not considered true back
muscles.
Superficial group, superficial layer:
1. Trapezius: diamond-shaped (trapezoid)
 attachments: from superior nuchal line, external occipital protuberance,
nuchal ligament, spinous processes of C7 through T12 to lateral third of
clavicle, acromion and spine of scapula.
 innervation: cranial nerve XI (spinal accessory) and anterior primary rami of
C3 and C4 (proprioception)
 actions: extension of head; elevates, rotates and retracts scapula;
descending fibers elevate, middle fibers retract and ascending fibers
depress scapula; ascending and descending fibers act together in rotates
glenoid cavity superiorly.
2. Latissimus dorsi: fan-shaped, covers lower back, widest (= latissimus) muscle of
back
 attachments: from spinous processes of T7-12 and thoracolumbar fascia,
crest of ilium, and lower ribs to floor of intertubercular sulcus of humerus
 innervation: thoracodorsal n. (C6 - C8) from posterior cord of brachial
plexus
 actions: medial rotation, extension and adduction of humerus
Superficial group, deep layer: (all supplied by dorsal scapular nerve C4-5)
3. Rhomboid minor: rhombus-shaped
 attachments: nuchal ligament and spinous processes of C7 and T1 to
vertebral border of scapula (at the root of scapular spine)
 innervation: dorsal scapular n.(C4 - C5) upper root Brachial Plexus
 actions: retraction and downward rotation of scapula; secure scapula to
thoracic wall (with serratus anterior)
4. Rhomboid major: rhombus-shaped
 attachments: spinous processes of T2 – T5 to vertebral border of scapula
from just below rhomboid minor to inferior angle
 innervation: dorsal scapular n.(C4 - C5) upper root Brachial Plexus
 actions: retraction and downward rotation of scapula; secure scapula to
thoracic wall (with serratus anterior)
5. Levator scapulae:
 attachments: from post. tubercles of transverse processes of upper 4
cervical vertebrae to vertebral border of scapula from superior angle to root
of spine
 innervation: dorsal scapular n. (C4-5) from upper root of brachial plexus
 actions: assist rhomboids and elevation of scapula
Intermediate group:
6. Serratus posterior mm.: very thin and supplied by intercostal n.,a.,v.’s
7. Serratus posterior superior: lies deep to rhomboids, fiber orientation parallel to
rhomboids
 attachments: spinous processes of upper thoracic vertebrae to superior
ribs;
 innervation: intercostal nerves
 actions: assists inspiration
8. Serratus posterior inferior: lies deep to rhomboids, fiber orientation parallel to
rhomboids
 attachments: spinous processes of lower thoracic vertebrae to inferior ribs;
 innervation: intercostal nerves
 actions: assists expiration
B.
Intrinsic back muscles: “true” back muscles, three deep layers
 fill in hollow between vertebral spinous processes and angles of ribs
 move the vertebral column and attach to vertebrae, ribs, pelvis and skull
 contained in a tube of deep fascia that attaches medially to the nuchal ligament,
tips of the spinous processes, supraspinous ligament and the medial sacral crest
and attaches laterally to the transverse process of cervical and lumbar fascia and
angles of the ribs.
 in the thorax and lumbar region it is called the thoracolumbar fascia of which the
lumbar aponeurosis is the thickened inferior portion with anterior and posterior
layers to enclose the muscles
 only muscles of the body innervated by posterior primary rami of spinal n.
deep 1: splenius capitis and cervicis (superolateral fiber orientation)
deep 2: erector spinae mm. (vertical-superolateral fiber orientation)
deep 3: transversospinalis mm. (superomedial fiber orientation)
DEEP 1: Splenius muscles arise from the midline and extend superiolaterally, covering
the deep muscles like a bandage  splenion = bandage
9. splenius capitis: caput = head
 attachments: nuchal ligament and spinous processes of C7 -T6 to superior
nuchal line and mastoid process
 innervation: posterior primary rami of middle and lower cervical nn.
 actions: extension of head (both sides); ipsilateral rotation of head and neck
10. splenius cervicis: cervix = neck
 attachments: nuchal ligament and spinous processes of C7 -T6 to post.
tubercles of transverse process of C1-C3(C4).
 innervation: posterior primary rami of middle and lower cervical nn.
 actions: extension of head (bilateral); ipsilateral rotation of head and neck
(unilateral)
DEEP 2: Erector spinae mm. (aka "sacrospinalis"):
 Three columns of massive muscle extending from sacrum to skull.
 They lie in a groove between the spinous process and the angle of the ribs
laterally.
 Encased in thoracolumbar fascia.
 Arise from a common inferior tendon that extends from the iliac crest to median
sacral crest.
 Each column is divided into 3 parts based on their superior attachment  capitis,
cervicis, thoracis or lumborum
11. iliocostalis: angles of lower ribs and transverse processes of cervical vertebrae
12. longissimus: longest, from sacrum to skull, attaches to ribs between tubercle
and angle, transverse processes and eventually mastoid process
13. spinalis: spanning spinous processes of vertebrae on each side
 innervation: posterior primary rami of spinal nerves.
 actions: extension of vertebral column (both sides), ipsilateral rotation (single
side)
DEEP 3: Transversospinalis:
 From lower transverse processes to higher spinous processes
 Occupy space between transverse process and spinous process
 Extension and contralateral rotation of vertebral column, head and neck
 Innervated by posterior primary rami of spinal nerves
 3 layers:
14. Semispinalis:
 divided into 3 parts based on superior attachment (captitis, cervicis, and
thoracic)
 arise from transverse processes of T12 and superior
 span 4-6 segments
 important in holding up head
15. Multifidus (= many cleavages)
 arise from posterior sacrum, posterior superior iliac spine, aponeurois of
erector spinae, sacro-iliac ligaments, mammillary process of lumbar vertebrae
and transverse processes. Most superior attachment is C2.
 spans 2-4 segments
 more prominent on lower spine
16. Rotatores
 span 1 (brevis) to 2 (longus) vertebrae;
 arise from transverse processes of vertebrae
 best developed in thoracic region
 mainly stabilize spine
Minor deep layer:
17. interspinales: run between spinous processes
18. intertransversarii: run between transverse processes
19. levatores costarum: transverse processes to ribs between tubercle and angle
VESSELS:
1. transverse cervical artery: from thyrocervical trunk of the subclavian, supplies
trapezius; typically the dorsal scapular a. is a branch of it
2. thoracodorsal a.: a branch of the subscapular a. that is from the axillary a.
NERVES:
1. spinal accessory nerve: cranial nerve XI (CNXI); exits through the jugular
foramen and supplied both trapezius and sternocleidomastoid muscles
2. dorsal scapular nerve: C4,5; supplies rhomboids and levator scapulae
3. thoracodorsal nerve: C6-8; supplies latissimus dorsi
CLINICAL APPLICATION:
1. Triangle of auscultation: small triangular gap in the musculature allowing for good
examination of posterior segments of the lungs by stethoscope. The border of the
triangle are
 superior horizontal border of latissimus
 medial border of the scapula
 inferior lateral border of trapezius
2. Whiplash: severe hyperextension of the neck during head butting in football or
rear-end collision causes severe stretching and sometimes tearing of the anterior
longitudinal ligament/ and or crushing or fracturing of posterior vertebral arch.
Severe hyperflexion can occur with rebound, head-on collision or head blocking
in football, can result in rupture of the IV disc (most common between C5/C6 and
C6/C7).
LECTURE 2: CONTENTS OF VERTEBRAL COLUMN
SPINAL CORD AND MENINGES AND SUBOCCIPITAL REGION
SPINAL CORD:
 Cylindrical structure slightly flattened anteriorly and posteriorly.
 Contains bundles of nerve tracts and central gray matter
 Begins as a continuation of the medulla oblongata and extends from
foramen magnum to between L1 and L2 vertebrae (can range from T12 to
L3)
 Conus medullaris: tapered inferior end of cord.
 Enlargments corresponding to innervations of limbs:
 cervical  C4-T1
 lumbar  T11-S1


Dorsal and ventral medial sulci: run longitudinally
Due to differential growth of cord and vertebral column in utero, cord
segments are higher than corresponding bony segments caudally,
resulting in the cord occupying approximately 2/3 length of vertebral canal.
Spinal roots become progressively oblique inferiorly to reach appropriate
exit point. Forming cauda equine (horse’s tail) inferior to conus medularis.
SPINAL NERVES: 31 pairs, mostly arising segmentally:





cervical (8): C1-C8; exit vertebral column via intervertebral foramina
ABOVE corresponding bony segment, except C8 exits below bony C7
thoracic (12): T1-T12; exit BELOW corresponding bony level
lumbar (5): L1-L5; exit BELOW corresponding bony level
sacral (5): S1-S5; branch into anterior and posterior rami within sacrum,
respective rami pass through dorsal (posterior) and pelvic (anterior) sacral
foramina.
coccygeal (1): Co1; exits sacral hiatus with S5
 Nerves arise from cord as anterior or ventral (motor) and posterior or
dorsal (sensory) rootlets.
 dorsal rootlet is associated with dorsal root ganglion
 Rootlets join together to form a spinal nerves which exit spinal canal
via intervertebral foramen
 The spinal nerve then splits into:
 a small posterior or dorsal primary ramus to supply the
intrinsic back muscles and skin of the back
 and a much larger anterior or ventral primary ramus that
supplies the rest of the body.
 spinal nerves supply limbs via nerve plexuses:
 brachial plexus - upper extremity;
 lumbar and lumbosacral plexuses - lower extremity
MENINGES:




dura mater "tough mother": the pachymenix: a dense fibrous, outer
membrane of the spinal cord. Forms the dural root sheaths continuous
with epineurium.
spinal dural sac: A tubular sheath within the vertebral canal. Attaches to
the margin of the foramen magnum where it is continuous with the cranial
dura mater. Terminates at the level of S2 vertebrae.
epidural space: separates dura mater from vertebrae, contains fat and
venous plexus
leptomeninges:
o arachnoid mater ("spidery mother"): delicate web-like membrane
enclosing subarachnoid space containing spinal cord and filled


with cerebrospinal fluid (CSF). It is not attached to dura mater but
held against it by pressure of CSF.
o pia mater ("delicate mother"): thin membrane intimately associated
with spinal cord directly covers the roots of spinal nerves and spinal
blood vessels.
 inferior to conus medularis continues as filum terminale.
 lateral extensions denticulate ligaments attach cord to dural
sac suspending it in cerebrospinal fluid.
filum terminale: anchors dural sac to coccyx. Has an internal part, which
is a fibrous strand covered by pia mater. It pierces the dural sac continuing
through the sacral hiatus to attach to dorsum of coccyx.
lumbar cistern: An enlargement of the subarachnoid space in the dural
sac, caudal to the conus medullaris and containing the cauda equina.
 this is the site of spinal taps between L3 and L4 vertebrae.
INTERNAL ANATOMY OF SPINAL CORD:
The cord is made up of gray matter and white matter- in the gray matter are cell
bodies and synapses and in the white matter are ascending and descending
neural pathways.
BLOOD SUPPLY:
 The arteries supplying the spinal cord are branches of the:
 vertebral
 ascending and deep cervical
 intercostal
 lumbar
 sacral arteries.
 3 longitudinal arteries:
1. Anterior spinal artery (1): formed by the union of branches of the
vertebral arteries. Runs inferiorly in the anterior median fissure.
2. Posterior spinal arteries (2): is a branch of vertebral arteries or
posteroinferior cerebellar artery.
Dermatome: the region of skin associated with a specific nerve (sensory). Based
on what we just learned does C1 have a dermatome?
SUBOCCIPITAL REGION
SURFACE ANATOMY:
1. spinous process of C2: palpated inferior to external occipital protuberance
2. transverse processes of CI: palpated deeply behind mastoid processes
3. Borders:
 from inferior nuchal line of occipital bone to spinous process of axis to
transverse process of atlas
 roof is the deep surface of semispinalis capitis m.
 floor is the posterior atlanto-occipital membrane
 Bounded by rectus capitis posterior major, superior and inferior oblique
muscles
BONY FEATURES:
 atlas: posterior tubercle, transverse process, posterior arch
 axis: spinous process of C2
 occipital bone
MUSCLES:
 Muscles superficial to this region are trapezius, levator scapulae, splenius
and semispinalis capitis (from superficial to deep)
 All of the muscles of the suboccipital region are innervated by the
posterior primary rami of C1 (aka suboccipital nerve).
* indicates muscles which make up the boundaries of the triangle
1. rectus capitis posterior minor:
 attachments: below medial end of inferior nuchal line to posterior
tubercle of atlas deep to rectus capitis posterior major and outside of
triangle
 innervation: suboccipital (C1)
 actions: stabilizes atlanto-occipital joint
2. rectus capitis posterior major*:
 attachments: below inferior nuchal line, lateral to rectus capitis
posterior minor to spine of axis
 innervation: suboccipital (C1)
 actions: extends head, rotates atlas and head to same side
3. obliquus capitis superior*:
 attachments: transverse process of atlas to inferior nuchal line, lateral
to rectus capitis posterior major
 innervation: suboccipital (C1)
 actions: extends head
4. obliquus capitis inferior*:
 attachments: spinous process of axis to transverse process of atlas,
 innervation: suboccipital (C1)
 actions: rotates atlas and head to same side
NERVES:
1. Suboccipital nerve: posterior primary rami of C1.
 This nerve is motor only and usually has no sensory roots,
sensory to this region is supplied by posterior primary rami of C2 (aka
greater occipital nerve).
 Passes superior to the posterior arch of C1 and inferior to the
vertebral artery to emerge from center of suboccipital triangle.
2. Greater occipital nerve: post. primary ramus C2.
 Emerges inferior to oliquus capitis inferior muscles, passes medially to
pierce semispinalis capitis muscles; it then passes superolaterally to
posterior scalp.
 Provides sensory to posterior neck and scalp.
VESSELS:
1. Occipital artery: branch of external carotid artery.
 Enters region laterally from beneath the mastoid process, passes
across superolateral margin en route to posterior scalp.
2. Vertebral artery: branch of subclavian a.
 Ascends in the neck via transverse foramina of cervical vertebrae 1 –
6 and passes over posterior arch of atlas to enter foramen magnum of
skull
 lies deep to suboccipital muscles
 after entering foramen magnum, each vertebral a. joins the other to
form the basilar artery.
3. Basilar artery: forms the vertebrobasilar system, an important circulatory
supplier of the cerebrum
 obstruction can cause dizziness
CLINICAL TERMS:
1. fracture of the dens: at the junction with the body of C2, account for 40% of
fractures of the axis.
2. Burst (Jefferson) fracture: fracture of anterior or posterior arches of C1
3. Hangman's fracture: with hyperextension injury, fracture of the arch of C2
between superior and inferior articular processes (pars interarticularis)
EMBRYOLOGY:
Approximately 15 days after the beginning of menstruation ovulation occurs
If the egg is fertilized within 24 hours in the oviduct then cellular divisions known
as cleavages begins in which cell number increase without an increase in overall
size of the embryo.
DAY
3
4
6
7
8
EVENT
morula formed, a solid ball of 32 cells enters the uterus.
blastocyst formed, a hollow ball of cells forms which contains an inner
cell mass and blastocytic cavity surrounded by trophoblast.
 inner cell mass gives rise to the embryo, amniotic sac and
yolk sac
 trophobast gives rise to other extraembryonic structures
trophoblast layer begins implanting into the endometrium
inner cell mass organizes into epiblast (ectoderm) and hypoblast
amnion sac and yolk sac appear
9
extraembryonic mesoderm is present and the embryo becomes fully
implanted into the endometrium
15
mesoderm, primitive streak, notochord form from ectoderm:
17
neural plate appears
27
neural tube closes
Day 1 is the day of fertilization
CLINICAL APPLICATION:
Spina bifida: incomplete closure of the neural tube. There are three types:
1. occulta – Mildest form; the outer part of some of the vertebrae do not
close. The split is so small that the spinal cord does not protrude.
2. meningocele – Rarest form; vertebrae develop normally but the meninges
are forced out between the vertebrae and fill with fluid creating a cyst on
the back.
3. myelomeningocele – Most severe; the unfused portion of the spinal
column allow the meninges and part of the spinal cord exit through the
gap.
LECTURE 3 - SCAPULAR AND DELTOID REGION
SURFACE ANATOMY:
1. posterior axillary fold: consists of skin, latissimus dorsi and teres major
2. spine of scapula: root is located medially opposite tip of T3 spinous process
3. inferior angle of scapula: opposite tip of T7 spinous process, over rib 7
2. triangle of auscultation: a relative thinning of the musculature of the back
which allows respiratory sounds to be heard more clearly. It is located
medially to the inferior angle of scapula. Created by gap between latissimus
dorsi, rhomboid major, lateral border of trapezius.
IMPORTANT MUSCULAR ATTACHMENTS:
 pectoral girdle to axial skeleton: levator scapulae, rhomboids, trapezius,
(serratus anterior, pectoralis minor, subclavius covered with upper
extremity)
 humerus to pectoral girdle: deltoid, supraspinatus, infraspinatus, teres
major and minor, subscapularis, (triceps and biceps, coracobrachialis
covered with upper extremity)
 humerus to axial skeleton: latissimus dorsi, (pectoralis major covered with
upper extremity)
1. Humerus:
 head: articulates with the shallow glenoid fossa of scapula in the
ball-and-socket glenohumeral joint
 anatomical neck: ligamentous attachment of shoulder joint, site of the
epiphyseal plate









surgical neck: site of fractures which may involve the axillary n. and
post. humeral circumflex a. in quadrangular space
greater and lesser tubercles: next to anatomical neck; attachment
site for rotator cuff mm.(SIT and SS)
greater creates the round countour of the shoulder; loss of the contour
is sign of dislocated shoulder joint.
intertubercular sulcus (bicipital groove for tendon of long head of
biceps)
pectoralis major attaches to lateral edge
latissimus dorsi attaches to floor
teres major attaches to medial edge
deltoid tuberosity: insertion for deltoid m.
spiral groove: sulcus for radial n. and profunda brachii a.; between
lateral and medial heads of triceps on back of humerus
2. Scapula: mobile bone encased in muscle
 vertebral (medial) border: attachment for rhomboids, levator
scapulae, serratus anterior; runs from rib 2-7, used as imaging
landmark
 inferior angle: teres major attachment; at the level of T7
 axillary (lateral) border: attachment for teres major, teres minor and
long head of triceps (infraglenoid tubercle)
 spine: deltoid and trapezius attach; bends laterally to form acromion
 acromion: deltoid and trapezius attach; acromioclavicular joint
 coracoid process: (corax = crow); palpable 1" below clavicle;
pectoralis minor, coracobrachialis, short head of biceps brachii attach;
coracoacromial and coracoclavicular ligaments stabilize
acromioclavicular joint
 glenoid fossa: forms ball-and-socket joint with head of humerus;
features supraglenoid and infraglenoid tubercles (for attachment of
long heads of biceps
and triceps, respectively); faces ant. and lat.
so that humerus looks like it is in
medial rotation
 supraspinous fossa: supraspinatus attaches
 Infraspinous fossa: infraspinatus and teres minor attach
 subscapular fossa: subscapularis attaches
 greater scapular notch (spinoglenoid notch): deep to acromion;
provides passage for suprascapular n. and a. to infraspinous fossa
 suprascapular notch: scapular ligament closes superior border;
suprascapular n. (under) and suprascapular a. (above) ligament
3. Clavicle: acromial extremity: attaches deltoid, trapezius, pectoralis major,
subclavius, and sternocleidomastoid; acromioclavicular joint; first bone of
body to ossify; most frequently fractured bone in body.
 conoid tubercle & trapezoid tubercle
MUSCLES:
Review trapezius (spinal accessory n.), rhomboids and levator scapulae
(dorsal scapular n. C 4-5), latissimus dorsi (thoracodorsal n. C 6 - 8)
1. Deltoid (delta = triangle):
 attachments: clavicle, scapular spine and acromion to deltoid
tuberosity innervation: axillary n. (C5-6) from post. cord of BP
 actions: most important function: abduction of arm w/supraspinatus;
 anterior part flexion and medial rotation of humerus;
 middle partmajor abductor of humerus;
 posterior partextension and lateral rotation of humerus
 innervation: axillary n. (C5-6) from post. cord of BP
ROTATOR CUFF MUSCLES: supraspinatus, infraspinatus, teres minor,
subscapularis (SITSS). Also function as dynamic ligaments, which means not
only do they move the humerus but they stabilize the glenohumeral joint.
 secure humerus at shoulder, tendons form rotator cuff
 responsible for the strength and stability of the glenohumeral joint
2. Supraspinatus:
 attachments: supraspinous fossa to greater tubercle of humerus
 actions: abducts humerus
 innervation): suprascapular n. (C4-6) from upper trunk of BP
3. Infraspinatus:
 attachments: from infraspinous fossa to greater tubercle of humerus
 actions: laterally rotates humerus
 innervation: suprascapular n. (C4-6) from upper trunk of BP
4. Teres Minor:
 attachments: axillary border of scapula to greater tubercle
 innervation: axillary n. (C5-6) from post. cord of BP
 actions: laterally rotates humerus
5. Subscapularis:
 attachments: subscapular fossa to lesser tubercle of humerus
 innervation: upper and lower subscapular nn. (C5-7) post. cord BP
 actions: adducts and medially rotates humerus
Other muscle:
6. Teres Major:
 attachments: axillary border of scapula to medial edge of
intertubercular sulcus
 innervation: lower subscapular n. (C5 - 7) from posterior cord BP
 actions: secures humerus at shoulder; adducts and medially rotates
humerus
ARTERIES:
 Arteries of scapular and deltoid region contribute to arterial anastomosis of
posterior shoulder:
1. Transverse cervical artery: branch of thyrocervical trunk of subclavian a.
2. Suprascapular artery: branch of thyrocervical trunk crosses over
suprascapular ligament and accompanies suprascapular n. through
spinoglenoid notch; supplies posterior mm. of rotator cuff
3. Dorsal scapular artery: frequently a deep branch of transverse cervical
a.; supplies mm. of medial border of scapula
4. Circumflex scapular artery: branch of subscapular a. (from axillary a.);
passes around axillary border to supply teres major and minor mm.
 Other arteries:
5. Posterior circumflex humeral artery: branch of axillary a., passes
behind surgical neck of humerus, (quadrangular space) to supply deltoid
and teres major mm.
6. Profunda Brachii artery (deep brachial a.): branch of brachial a.; passes
deeply within triangular interval, accompanied by radial n., following spiral
groove on back of humerus
NERVES:
1. Spinal accessory nerve: CN XI- trapezius
2. Dorsal scapular nerve: C4-5 - rhomboids
3. Suprascapular nerve: C4-6; from upper trunk of BP; passes posteriorly
through suprascapular and spinoglenoid notches; supplies supraspinatus
and infraspinatus
4. Axillary nerve: C5-6; terminal branch of posterior cord BP, passes
posteriorly (quadrangular space) to supply deltoid and teres minor mm.
5. Radial nerve: C5-T1; terminal branch of posterior cord BP, passes along
back of humerus, (triangular interval) along radial groove; nerve supply to
posterior compartments of upper limb
ANATOMICAL SPACES:
 Triangular space: bounded by teres minor (medially), teres major
(inferiorly) and long head of triceps brachii (laterally); contains circumflex
scapular a.
 Quadrangular (quadrilateral) space: bounded by teres major (inferiorly),
teres minor (superiorly), long head of triceps brachii (medially) and medial
aspect of surgical neck of humerus (lateral); transmits posterior circumflex
humeral a. and axillary n. to posterior shoulder region
 Triangular interval: bounded by lateral and long heads of triceps brachii
(laterally and medially, respectively) and teres major (superiorly); contains
profunda brachii a. and radial n.
JOINTS:
1. Glenohumeral: ball-and-socket joint between head of humerus and
glenoid fossa of scapula; more freely mobile than hip, but less stable
(easily dislocated)

glenoid labrum: ring of cartilage which deepens fossa, blends
with tendon of long head of biceps superiorly

supra- and infraglenoid tubercles: attachments for long
heads of biceps and triceps, respectively; tendon for long head
of biceps passes thru the joint outside of the synovial
membrane

capsule is open for entrance of tendon of long head of biceps
and under coracoid process

subscapular bursa - between subscapularis tendon and neck
of scapula communicates with the shoulder joint; weakest
inferiorly

subacromial/subdeltoid bursa between deltoid and
supraspinatus tendon - no communication with shoulder joint

glenohumeral ligaments: anterior reinforcement of joint
capsule

transverse humeral ligament - between tubercles, straps
tendon

rotator cuff: SIT SS mm. ("dynamic ligaments")

coracoacromial arch: acromion, coracoid process and
coracoacromial lig., opposes upward displacement of humeral
head, supraspinatus passes under it, with overlying
subacromial/deltoid bursa
 anterior displacement (dislocation) – if arm is extended and laterally
rotated and a posterior force is applied head of humerus will
translocate anteriorly
 inferior displacement (dislocation) – if arm is abducted and a superior
force is applied head of humerus will translocate inferiorly.
2. Acromioclavicular Joint: weak plane or gliding joint between acromion of
scapula and lateral extremity of clavicle; dislocates frequently
 coracoclavicular ligament (strongest - trapezoid lateral, conoid
medial)
 acromioclavicular ligaments
 articular cartilage intrudes from above into joint cavity
 lateral sliding of clavicle over acromion = "shoulder separation",
 shoulder falls away from the clavicle
3. Sternoclavicular Joint: saddle-type joint between medial extremity of
clavicle and manubrium of sternum - manubrium side is like a socket; only
bony connection of pectoral girdle with axial skeleton
 fibrocartilagenous disk inside joint attaching to sternoclavicular lig.,
prevents medial displacement of clavicle


stabilized by sternoclavicular, interclavicular and costoclavicular
ligaments
supported by subclavius muscle; rarely dislocates
CLINICAL TERMS:
Shoulder impingement: pressure on rotator cuff tendons passing under the
acromion and coracoacromial arch.
LECTURE 4 - GLUTEAL REGION
The gluteal region is formed by the gluteal muscles and runs from the iliac crest
to the gluteal fold.
SKELETAL FEATURES:

Bony pelvis – consists of 2 os coxae, sacrum and coccyx

os coxae consists of 3 separate bones, ilium, ishium, pubis, which fuse by
age 17:

Ilium: fan shaped, contributes to the upper 2/3's of the
acetabulum
1. iliac crest: is palpated when you put your hands on
your hips. Highest portion is at level of L4 and is the
superior border of the gluteal region
2. anterior superior iliac spine (ASIS): attachment for
sartorius and tensor fasciae latae origins
3. posterior superior iliac spine (PSIS): subcutaneous,
creating skin "dimples" at level of bony S2
4. greater sciatic notch: becomes the greater sciatic
foramen with the attachments of the sacrotuberous
and sacrospinous ligaments. Provides passage for
sciatic n., superior and inferior gluteal nerves and
arteries, pudendal n. and internal pudendal arteries
and piriformis m. from pelvic cavity to gluteal region
and posterior thigh
5. posterior, anterior and inferior gluteal lines:
markings on lateral surface bounding areas for origins
of gluteal mm.
 Ischium:
1. ischial tuberosity - supports body weight (seated);
covered by gluteus maximus muscle when thigh is
extended. Attachment for hamstring muscles, adductor
magnus muscle. and sacrotuberous ligament.
2. ischial spine - beak-like prominence separating
greater and lesser sciatic notches. Attachment for
sacrospinous ligament.
3. lesser sciatic notch - becomes the lesser sciatic
foramen with attachment of the sacrotuberous
ligament and sacrospinous ligament. Conveys
obturator internus muscle and internal pudendal a. and
pudendal n. to perineum.
 Pubis:
1. pubic tubercle: inferior attachment for inguinal
ligament;
2. pubic crest: medial to pubic tubercle
3. pecten pubis: ridge on superior ramus of pubis,
lateral to pubic tubercle; attachment for pectineus m.
4. pubic arch: formed by two inferior ishiopubic rami;
attachments for adductors
5. body of pubis: adjacent to the pubic symphysis
6. superior and inferior rami:
 Obturator foramen: bounded by ischium and pubis, superior to the
ischial tuberosity and mostly covered by obturator membrane and
obturator internus and externus mm. Conveys obturator nn. and
vessels to medial thigh.
 Sacrum & coccyx: posterolateral surface provides attachment for
sacrotuberous and sacrospinous ligaments and gluteus maximus m.;
anterior surface provides attachment for piriformis m.
 Femur: the thigh bone; the superior part consists of a head, neck, greater
and lesser trochanters.
1. greater trochanter: attachment for gluteus medius
and minimus mm. and lateral rotators of femur, vastus
lateralis
2. lesser trochanter: attachment for iliopsoas m.
3. intertrochanteric crest: extends posteriorly between
greater and lesser trochanters, featuring quadrate
tubercle.
4. intertrochanteric line: anterior between greater and
lesser trochanters
5. gluteal tuberosity: for glut. maximus (superior and
lateral part of linea aspera)
JOINTS OF THE PELVIC GIRDLE:
1. Lumbosacral joints: intervertebral (symphysis type) and zygapophysial
(synovial type) articulations between L5 and S1
 L5 is secured to pelvis via lumbosacral and iliolumbar ligaments.
2. Sacrococcygeal joint: symphysis type
 Supported by sacrococcygeal ligaments
3. Sacroiliac joints: synovial articulation between sacrum and ilium
 Strongly supported by:
 anterior, posterior and interosseous sacroiliac
ligaments
 reinforced by iliolumbar, sacrospinous and
sacrotuberous ligaments
 and extensively supported by erector spinae &
gluteus maximus
 Movements limited, mainly weight-bearing
4. Symphysis Pubis: symphysis type articulation with fibrocartilaginous disc
(usually larger in females), reinforced by pubic ligaments.
5. Hip Joint: ball and socket between head of femur and acetabulum
 Stronger (weight-bearing), less mobile than shoulder
 Supported by three major ligaments that limit extension:
 iliofemoral ligament: fans out (Y-shaped) from AIIS to
intertrochanteric line of femur
 pubofemoral ligament: from pubis (inferior to
acetabulum) to anterior part of neck of femur; also
limits abduction
 ischiofemoral ligament: from body of ischium, passes
superolaterally over neck of femur to medial side of
greater trochanter; fibers merge with iliofemoral
ligament
 Fovea capitis - articular cartilage on femoral head pitted at center
receives blood supply and ligamentum teres femoris which
secures head in acetabulum.
 Acetabular labrum - rim of fibrocartilage deepens socket
o lunate surface - articular cartilage is
horseshoe-shaped
o inferiorly interrupted by acetabular notch which is
closed by transverse acetabular ligament to provide
attachment for labrum
o zona orbicularis: fibers of the joint capsule pass in a
circular orientation around the neck of femur; holds
head in acetabulum
 Blood supply: lateral and medial circumflex femoral; superior and
inferior gluteal aa.
MUSCLES OF GLUTEAL REGION:
SUPERFICIAL GROUP:
1. Gluteus maximus: largest, heaviest, coarsest muscle in the body, covers
ischial tuberosity when femur is extended.

attachments: inferior to posterior gluteal line of ilium, sacrum and
sacrotuberous ligament to gluteal tuberosity (femur) and iliotibial
tract
 innervation: inferior gluteal n. L5-S2
 actions: extension of thigh or of pelvis; assists lateral rotators
2. Tensor fascia lata: located between layers of fascia lata laterally
 attachments: iliac crest and ASIS to iliotibial tract to lateral tibial
condyle
 innervation: superior gluteal n. (L4-S1)
 action: tenses the iliotibial band to allow gluteus max to act on thigh;
stabilizes extended knee and abducts thigh; stabilizes trunk on hip
joint
INTERMEDIATE GROUP:
3. Gluteus medius:
 attachments: ilium between anterior & posterior gluteal lines to lateral
surface of greater trochanter
 innervation: superior gluteal n. L4-S1
 actions: abduction and medial rotation of thigh; supports the
contralateral pelvis during the swing phase of walking;
 failure produces a positive Trendelenburg sign - dropping
of pelvis on unsupported side.
4. Piriformis: "pear-shaped" regional landmark:
 n. to piriformis (S1,2) superior gluteal artery and nerve
emerge from greater sciatic foramen superior to piriformis;
 sciatic nerve, inferior gluteal artery and nerve emerge from
greater sciatic foramen inferior to piriformis
 attachments: from anterior surface of sacrum and sacrotuberous
ligament to
superior border of greater trochanter
 innervation: n. to piriformis S1,S2
 actions: abduction of flexed femur; lateral rotation of extended femur
DEEP GROUP:
5. Gluteus minimus:
 attachments: from ilium between anterior and inferior gluteal lines to
anterior surface of greater trochanter
 innervation: superior gluteal n. L4-S1
 actions: abduction and medial rotation of thigh
6. Obturator internus:
 attachments: from internal surface of obturator membrane and
borders of obturator foramen to medial surface of greater trochanter
 innervation: n. to obturator internus L5-S2
 actions: abduction of flexed femur; lateral rotation of extended femur
7. Superior gemellus:
 attachments: spine of ishium to tendon of oburator internus muscle
 innervation: n. to obturator internus L5-S2
 actions: abduction of flexed femur; lateral rotation of extended femur
8. Inferior gemellus:
 attachments: tuberosity of ishium to tendon of oburator internus m.
 innervation: n. to quadratus femoris L4-S1
 actions: abduction of flexed femur; lateral rotation of extended femur
9. Quadratus femoris:
 attachments: lateral border of ischial tuberosity to quadrate tubercle
 innervation: n. to quadratus femoris L4-S1
 action: lateral rotation of thigh
NERVES: from lumbosacral plexus L4-S4
1. Sciatic: L4-S3; largest nerve in the body, goes thru the greater sciatic
foramen, usually below piriformis, to supply hamstring mm. and all crural
and foot mm. via tibial n. and common fibular n.
2. Posterior femoral cutaneous: S1 - S3; passes through greater sciatic
foramen below piriformis to supply skin of inferior gluteal region &
posterior thigh
3. Superior gluteal: L4-S1; via greater sciatic foramen above piriformis to
supply gluteus medius, gluetues minimus and tensor fascia latae
4. Inferior gluteal: L5-S2; via greater sciatic foramen below piriformis to
supply gluteus maximus
5. Pudendal: S2 -S4; via greater sciatic foramen below piriformis, around
sacrospinous ligament and through lesser sciatic foramen to perineum to
supply skin of perineum
6. Nerve to quadratus femoris: L4-S1 supplies inferior gemellus and
quadratus femoris.
7. Nerve to obturator internus: L5-S2 supplies superior gemellus and
obturator internus.
ARTERIES: are branches of the internal iliac artery:
1. Superior gluteal: through greater sciatic foramen above piriformis;
supplies piriformis and all three glutei mm; contributes to hip joint
anastomosis
2. Inferior gluteal: through greater sciatic foramen below piriformis; supplies
piriformis and mm. below piriformis, part of gluteus maximus, hamstrings
3. Internal pudendal: accompanies pudendal n. in its course to perineum;
supplies perineal structures
LECTURE 5 – POSTERIOR THIGH AND LEG
POPLITEAL FOSSA AND KNEE
SKELETAL FEATURES:
 Ischial tuberosity: attachment for hamstring mm.
 Femur:
o linea aspera: vertical, roughened line on midposterior surface,
attachment for (medial to lateral): vastus medialis, pectineus,
adductor longus, adductor brevis, and adductor magnus, gluteus
maximus, biceps femoris (short head) and vastus lateralis, diverges
inferiorly as medial and lateral supracondylar lines
o adductor tubercle: superior aspect of medial epicondyle, attaches
part of adductor magnus forming medial aspect of adductor hiatus
 Tibia: shaft is triangular in cross section with medial, lateral, and posterior
surface
o soleal line: oblique ridge on upper posterior surface, running
inferomedially, attachment for soleus m.
o condyles: articulate with the condyles of the femur
o gerdy’s tubercle: located on lateral condyle attachment for tensor
fascia latae
 Fibula: non weight bearing,
o head: attaches biceps femoris m. and fibular collateral ligament
o neck: associated with common fibular n. to anterior leg
 Calcaneus:
o tuber calcanei: (aka calcaneal tuberosity) attaches tendo calcaneus
(Achilles tendon)
MUSCLES:
POSTERIOR THIGH:
 a group of 3 muscles that cross two joints: hip and knee
 hip extensors and knee flexors
 all L5 - S2
1. Biceps femoris: lateral muscle of posterior thigh that has 2 heads, long
and short. Short head is technically not a hamstring because it has a
different nerve supply (fibular division of sciatic).
 attachments: from ischial tuberosity (long head) and lateral
lip of linea aspera of femur (short head) to head of fibula
 innervation: tibial division of sciatic n. (L5-S2) (long head);
common fibular division of sciatic n.(L5-S2) (short head)
 actions: extension of thigh; knee flexion; lateral rotation of
leg
2. Semimembranosus: (half membrane)
 attachments: from ischial tuberosity to the posterior medial
condyle of tibia
 innervation: tibial division of sciatic n. (L5-S2)
 actions: extension of thigh; knee flexion; medially rotation of
leg
3. Semitendinosus: (is half tendon)
 attachments: from ischial tuberosity to the medial surface to
superior part of tibia inferior to gracilis
 form what is known as pes anserine with sartorius and
gracilis
 innervation: tibial division of sciatic n.
 actions: extension of thigh; knee flexion; medial rotation of
leg
POPLITEAL FOSSA: Diamond-shaped depression posterior to the knee;
bounded by:
superior lateral border  biceps femoris
superior medial border  semimembraneous and semitendinosus
inferior  heads of gastrocnemius
Roof  skin, superficial and deep fascia
Floor  popliteal surface of femur, oblique popliteal ligament and fascia of
popliteus m.
MUSCLES:
DEEP POPLITEAL FOSSA: All of the muscles of the deep popliteal fossa are
innervated by tibial nerve.
4. Plantaris: sometimes missing
attachments: from supracondylar line of femur to tuber
calcanei (via long narrow tendon = "freshman's nerve"),
medial to Achilles tendon
innervation: tibial n. S1, S2
actions: flex knee and plantar flexion of foot at ankle
(because it is so small it’s contribution to these movements
is minor).
5. Popliteus:
 attachments: from lateral condyle of femur inferior to
attachment of fibular collateral ligament, to tibia superior to
soleal line
 innervation: tibial n. L4 - S1
 actions: flexion of leg at knee (minor); lateral rotation of
femur
Popliteus unlocks the knee joint by rotating the tibia
medially on the femur, to initiate flexion
extension of the leg at the knee causes the
converse (lateral rotation of tibia) to "lock" the knee
joint, the so-called "screw home" mechanism
SUPERFICIAL CRURAL COMPARTMENT: All of the muscles of the crural
compartment are innervated by tibial nerve.
6. Gastrocnemius: (the prominent calf muscle)
 attachments: 2 heads of origin: lateral condyle (lateral head)
and popliteal surface (medial head) of femur to tendo
calcaneus (Achilles' tendon)
 innervation: tibial n., S1, S2
 actions: flexion of leg at knee; plantar flexion of foot at ankle;
raises heel during walking
7. Soleus: (= flatfish) deep to the gastrocnemius
 attachments: soleal line of tibia and posterior upper surface
of fibula to tendo calcaneus
 innervation: tibial n.,S1, S2
 actions: plantar flexion of foot at ankle
CONTENTS OF POPLITEAL FOSSA:
 Popliteal a.: continuation of femoral a. from anterior thigh through
adductor hiatus
o genicular branches (anastomosis around knee joint)
o terminates as anterior & posterior tibial aa.
 posterior tibial a. has lateral branch in posterior crural
compartment called fibular (peroneal) a.
 Popliteal v.: from venae comitantes of anterior and posterior tibial aa.,
receives small saphenous (superficial drainage from lateral leg)
 becomes femoral v. after passing through adductor hiatus
 Tibial n.: division of sciatic n. (L4 - S3) serving posterior crural
compartment & sole of foot
 produces medial sural cutaneous n. (passing out of popliteal
fossa) which becomes sural n. (when joined by
communicating branch from common fibular)
 Common fibular (common peroneal) n.: division of sciatic n. (L4 - S2)
serving anterior and lateral crural compartments and dorsum of foot
 produces lateral sural cutaneous n. and contributes to sural
n. (via communicating branch)
 Plantaris and Popliteus mm. lie deep within fossa
LECTURE 6: DEEP POSTERIOR LEG AND SOLE OF FOOT
SKELETAL FEATURES:
1. Tibia: medial malleolus: tendons of deep mm. of posterior crural
compartment pass behind on way to sole
2. Calcaneus: forms the prominence of the heel
 tuberosity (tuber calcanei): several mm. attach
 sustentaculum tali: medial shelf supporting talus; inferior groove
for flexor hallucis longus tendon
3. Navicular: tuberosity of insertion of tibialis posterior m
4. Flexor Retinaculum: from medial malleolus to calcaneus; prevents
bowstringing of deep flexors (Tom, Dick & Harry)
5. Plantar Aponeurosis: thick central portion of deep fascia of sole, from
tuber calcanei via five digital bands to tendons of digits, provides
attachment for mm., supports medial longitudinal arch, partitions sole
into lateral, medial & central compartments
MUSCLES:
 All of the muscles of the posterior crural compartment are innervated by
tibial nerve.
DEEP CRURAL COMPARTMENT:
1. Tibialis posterior:
 attachments: from posterior surfaces of tibia, fibula and interosseous
membrane to tuberosity of navicular, plantar surfaces of cuneiforms
and bases of metatarsals II through IV;
 innervation: tibial n., L4-L5
 action: inversion of foot; plantar flexion of foot at ankle
2. Flexor Digitorum Longus:
 attachments: from posterior surface of tibia to plantar surfaces of
distal phalanges of digits II-IV;
 innervation: tibial n., S2.S3
 action: flexes toes; plantar flexion of foot at ankle
3. Flexor Hallucis Longus:
 attachments: posterior surface of fibula and interosseous membrane
to plantar surface of great toe distal phalanx. Tendon runs between 2
small sesamoid bones in the tendon of flexor halluces brevis.
 innervation: tibial n., S2,S3
 action: flexion of great toe (important in "pushing off")
4. Popliteus: see posterior thigh and leg (Lecture 17)
Note: proximal attachment of flexor digitorum longus and flexor hallucis
longus are "reversed" from their distal attachment, necessitating a crossover
of their tendons en route to their insertions.
 the order of deep muscle tendons passing behind the medial
malleolus is represented as Tom, Dick and Harry
SOLE OF FOOT:
1. muscles contribute to support of plantar arches but only during movement
of the foot
2. promote coarse movements only -little fine motor capability
3. described as four layers:
4. all: S2,S3
FIRST LAYER:
1. Abductor Hallucis:
 attachments: from medial surface of calcaneus to medial surface of
proximal phalanx of great toe
 innervation: medial plantar n. S2,S3
 actions: abduction and assistance in flexion of great toe; maintenance
of medial longitudinal arch
2. Flexor Digitorum Brevis
 attachments: from anteromedial part of tuber calcanei to sides of
proximal phalanges of toes II - IV or V. Tendons split to permit those
of flexor digitorum longus to reach distal phalanges
 innervation: medial plantar n. S2,S3
 actions: flexion of digits II-IV or V; maintenance of longitudinal arches
3. Abductor Digiti Minimi:
 attachments: from lateral and anterior surfaces of tuber calcanei to
lateral surface of proximal phalanx of digit V
 innervation: lateral plantar n. S2,S3
 actions: abduction and assistance in flexion of fifth toe; maintenance
of lateral longitudinal arch
SECOND LAYER:
4. Quadratus Plantae: (flexor accessorius)
 attachments: from lateral and medial surfaces of calcaneus to tendons
of flexor digitorum longus
 innervation: lateral plantar n. S2,S3
 actions: adjustment of pull by flexor digitorum longus tendons to
conform more closely to axes of toes
5. Lumbrical mm. (lumbricus = earthworm):
 attachments: tendons of flexor digitorum longus to extensor
expansions of lateral four digits
 innervation: I -medial plantar n S2,S3; II-IV -lateral plantar n. S2,S3
 actions: extension of PIP and DIP joints; flexion of MTP joints of digits
II-V
THIRD LAYER:
6. Flexor Hallucis Brevis:
 attachments: from cuboid and lateral cuneiform and tendon of tibialis
posterior m. to tendons of abductor hallucis (medial head) and
adductor hallucis (lateral head).
 Each tendon carries a small sesamoid bone
 innervation: medial plantar n. S2,S3
 actions: flexion of great toe
7. Adductor Hallucis:
 attachments: from bases of metatarsals II - IV (oblique head) and from
plantar ligaments of lateral four MTP joints (transverse head) to lateral
surface of proximal phalanx of great toe
 innervation: lateral plantar n. S2,S3
 actions: adduction and assistance in flexion of MTP joint of great toe;
maintenance of transverse plantar arch
8. Flexor Digiti Minimi Brevis:
 attachments: from base of metatarsal V to base of 5th proximal
phalanx
 innervation: lateral plantar n. S2,S3
 actions: flexion of fifth toe
FOURTH LAYER: reference axis for abduction/adduction is digit II
9. Plantar Interosseous Muscles –3 PAd
 attachments: from medial surfaces of metatarsals III - V to medial
surface of proximal phalanges of toes III – V
 innervation: lateral plantar n.
 action: adduct digits III – V
10. Dorsal Interosseous Muscles – 4 DAb
 attachments: from adjacent surfaces of neighboring metatarsals to
medial surface of proximal phalanx of second toe and lateral surfaces
of proximal phalanges of toes II- IV
 innervation: lateral plantar n.
 action: abduct digits II - IV
ARTERIES: Branches of posterior tibial a.
 Medial Plantar: passes deep to abductor hallucis m. and supplies great
toe
 Lateral Plantar: crosses from medial malleolus laterally (superficial to
quadratus plantae belly), curves medially again at base of fifth metatarsal
to form plantar arterial arch, supplies most of sole and lateral four toes
NERVES:
1. Medial Plantar: branch of tibial n., passes with medial plantar a.
o supplies abductor hallucis, flexor hallucis brevis, flexor digitorum
brevis & first lumbrical m.
o skin of medial three and one-half digits and of medial sole L4,L5
2. Lateral Plantar : branch of tibial n., passes with lateral plantar a.
 supplies all other mm. of sole and skin of lateral one and one-half
digits and of lateral sole S1,S2
3. Sural: S1, S2; from posterolateral aspect of calf to posterolateral sole
4. Saphenous: L3,L4; posteromedial aspect of calf to posteromedial sole
5. Tibial: supplies cutaneous branches to heel S1,S2
DERMATOMES:
DIGIT I: L4
DIGIT II-IV: L5
DIGIT V: S1
ARCHES OF THE FOOT:
 distribute loads and act as shock absorbers provide energy in stepping
forth
 lateral arch is typically lower than medial arch accounting for familiar
pattern of footprints displaying full impression of lateral sole
 medial longitudinal arch: consists of calcaneus, talus, navicular, three
cuneiforms and medial three metatarsals
o supported by spring ligament, plantar aponeurosis and muscles
 lateral longitudinal arch: consists of calcaneus, cuboid, metatarsals IV
& V;
o lower than medial arch- supported by long and short plantar
ligaments
LIGAMENTS OF THE FOOT:
 spring ligament: extends from sustentaculum tali of calcaneus to
plantar surface of navicular, forming a sling for head of talus; "keystone"
of medial longitudinal arch
 long plantar ligament: extends from calcaneus to cuboid and bases of
second through fifth metatarsals, supporting lateral arch; forms a
"retinaculum" for tendon of fibularis (peroneus) longus
 short plantar ligament: (calcaneocuboid ligament) lies deep to long
plantar ligament; provides strong support for lateral arch
JOINTS:
Permitting Inversion/Eversion of Foot:
 subtalar joint: a plane joint between body of talus and superior
articular surface of calcaneus
 talocalcaneonavicular joint: between head of talus and posterior
surface of navicular and anteromedial surface of calcaneus and the
intervening plantar calcaneonavicular "spring" ligament
 talonavicular part is a ball & socket type
 calcaneocuboid joint: a plane joint; this, with talonavicular part of
previous joint is frequently called the transverse tarsal joint
Tarsometatarsal Joints:
 medial tarsometatarsal joint: medial cuneiform and first metatarsal,
greatest freedom of movement
 intermediate tarsometatarsal joint: all cuneiforms and bases of
metatarsals II and III
recall vulnerability of second metatarsal to "march fractures"
 lateral tarsometatarsal joint: cuboid and bases of metatarsals 4 and 5
Joints of digits:
 metatarsophalangeal joints (MTP): condyloid type
 interphalangeal joints (PIP & DIP): hinge type