Superficial & Intermediate Back – Critical Structures
trapezius – transverse cervical artery vasculature supply and cranial nerve XI innervation
latissimus dorsi –
rhomboideus major
rhomboideus minor
levator scapulae
transverse cervical artery
spinal accessory nerve (CN XI)
humerus
humeral head
greater & lesser tubercles
intertubercular groove
scapula
coracoid process
scapular spine
acromion
gleniod fossa
clavicle
sternum
manubrium
Posterior Shoulder, Deep Back, and Spinal Cord – Critical Structures
deltoid
teres minor
teres major
long head of triceps brachii
supraspinatus
infraspinatus
axillary nerve –
suprascapular artery – the army goes over the bridge, so the suprascapular artery goes over the transverse
scapular ligament
suprascapular nerve – the navy goes under the bridge, so the suprascapular nerve goes under the transverse
scapular ligament
quadrangular space – bounded by the teres minor superiorly, teres major inferiorly, triceps brachii long head
medially, and the humerus (triceps lateral head) laterally
erector spinae
iliocostalis – most lateral, goes from the iliac crest to the costals (ribs)
longissimus- the middle and longest erector spinae muscle
spinalis – most medial, right next to the spinous processes of the vertebrae
spinal cord
denticulate ligaments
ventral roots
dorsal roots
dorsal root ganglion
conus medullaris
cauda equina
filum terminale
arachnoid mater
subarachnoid space
pia mater
dura mater
vertebra
vertebral body (thoracic, lumbar)
pedicle
lamina
spinous process
transverse process
costal facets
sacrum
sacral foramena
spinal canal
Pectoral Region – Critical Structures
pectoralis major – innervated by the lateral and medial pectoral nerves
pectoralis minor – innervated by the medial pectoral nerve only
subclavius
serratus anterior
deltopectoral triangle
cephalic vein
lateral pectoral nerve
medial pectoral nerve
thoracoacromial artery
clavicular branch
pectoral branch
deltoid branch
acromial branch
breast
nipple
areola
lactiferous sinuses and ducts
Axilla – Critical Structures
subscapularis muscle
coracobrachialis muscle
long head of biceps brachii
superior thoracic artery
lateral thoracic artery
subscapular artery
scapular circumflex artery
thoracodorsal artery
anterior humeral circumflex artery
posterior humeral circumflex
lateral cord
medial cord
posterior cord
musculocutaneous nerve
lateral contribution to median nerve
medial contribution to median nerve
median nerve
ulnar nerve
axillary nerve
radial nerve
long thoracic nerve
upper subscapular nerve
lower subscapular nerve
thoracodorsal (middle subscapular) nerve
medial cutaneous nerve of the arm
medial cutaneous nerve of the forearm
ansa pectoralis – ansa means “handle”, this nerve bridges the medial and lateral pectoral nerves near the cords
Upper Extremity – Critical Structures
Coracobrachialis
biceps brachii
long head
short heads
brachialis
triceps brachii
long head
lateral head
medial head
All Flexor Muscles (anterior group) of the forearm have at least partial origin on the MEDIAL EPICONDYLE
of the humerus as the common flexor tendon
pronator teres
flexor carpi radialis
palmaris longus
flexor carpi ulnaris
flexor digitorum superficialis
flexor pollicis longus
flexor digitorum profundus
pronator quadrates
All Extensor Muscles (posterior group) of the forearm have at least partial origin on the LATERAL
EPICONDYLE, and supracondylar ridge of the humerus
brachioradialis
extensor carpi radialis longus & brevis
extensor digitorum
extensor digiti minimi
extensor carpi ulnaris
abductor pollicis longus
extensor pollicis longus & brevis
extensor indicis
supinator
palmar aponeurosis
thenar mass
hypothenar mass
adductor pollicis
lumbricals
interosseus muscles
musculocutaneous nerve – The musculocutaneous nerve supplies all three flexor muscles in the arm. It is a
terminal branch of the lateral cord of the brachial plexus. It pierces the coracobrachialis
as it leaves the axilla and runs between bicep and brachialis, and becomes cutaneous
in lateral forearm.
lateral cutaneous nerve of forearm
radial nerve – The radial nerve innervates all the muscles in the extensor compartments of the arm and
forearm. It does not innervate any muscles of the hand. The radial nerve is sensory to the dorsal surface
of the hand over the thumb first 2 1/2 fingers.
deep branch
superficial branch
median nerve – The median nerve is the primary innervation for the muscles of the flexor forearm. It
innervates all the flexor muscles except flexor carpi ulnaris and the ulnar half of flexor digitorum
profundus. It forms from the union of branches from medial and lateral cords of brachial plexus. It runs
through the medial arm with the brachial a. and then deep in the flexor compartment of the forearm. It
passes through the carpal tunnel into the hand. In the hand the median nerve innervates only the thenar
muscles and the radial two lumbricals. The median nerve is sensor to the thumb, index, middle and 1/2
of the ring fingers.
recurrent branch
ulnar nerve – The ulnar nerve is the primary innervation of the hand. It innervates all the hand muscles except
those innervated by the median nerve. In the forearm it only innervates the flexor carpi ulnaris and the
ulnar half of the flexor digitorum profundus. The ulnar nerve runs in the medial arm, passing behind the
medial epicondyle of humerus, to run under the flexor carpi ulnaris and into hand. It is a terminal branch
of the medial cord of the brachial plexus. The ulnar nerve is sensory over the little finger and half the
ring finger.
superficial branch
brachial artery – The axillary a. changes name to brachial at the inferior border of teres major. It passes
medial to humerus with median n. It gives off a deep branch (profunda brachii) which
runs with the radial n. At the elbow (cubital fossa) the brachial a. bifurcates into radial
and ulnar arteries.
profunda (deep) brachii artery
radial artery – The radial artery runs under the brachioradialis m in the forearm and passes around
the distal radius to the dorsum of the hand where it dives between the thumb and first
finger. It ends as the major blood supply of the deep palmar arterial arch.
ulnar artery – The ulnar artery runs deep in the forearm, passing under pronator teres and flexor
digitorum superficialis in flexor compartment. It gives off the common interosseus
artery, which in turn gives off the anterior and posterior interosseus arteries which
are the blood supply to the deep aspects of the forearm. The ulnar artery ends as the
major blood supply to the superficial palmar arterial arch.
interosseus
common
anterior
posterior
superficial palmar arch – The superficial and deep palmar arches are anastomotic connections between the
ulnar and radial arteries. They give off branches supplying the fingers.
humerus
medial & lateral epicondyles
capitulum
trochlea
olecranon fossa
coronoid fossa
ulna
olecranon
trochlear notch
coronoid process
ulnar tuberosity
styloid process
radius
head
neck
radial tuberosity
styloid process
interosseus membrane
transverse carpal ligament (flexor retinaculum) – This thickened fascia passes superficial to the tendons of the
superficial and deep flexor digitorum muscles and the flexor pollicis longus, commonly known as the
carpal tunnel. The median nerve passes through the carpal tunnel and is the nerve involved in carpal
tunnel syndrome.
There is also an extensor retinaculum which functions in the same way on the posterior side of the wrist
metacarpals
phalanges
Thoracic Wall, Pleura & Lungs – Critical Structures
* = structures that can be found on RADIOGRAPHS
internal thoracic artery*
anterior intercostal arteries
external intercostal m.
internal intercostals m.
innermost intercostals m.
transversus thoracis m.
intercostal vein
intercostal artery
intercostal nerve
cupola (lung apex) *
costodiaphragmatic recess*
root of lung
lung*
upper lobes
lower lobes
major (oblique) fissure
minor (horizontal) fissure
right middle lobe
lingual
cardiac notch
trachea*
main bronchi*
carina*
sternum*
retrosternal space*
ribs
brachiocephalic veins (left & right) *
azygos vein & arch*
arch of aorta*
brachiocephalic trunk*
left common carotid artery*
right common carotid artery*
left subclavian artery*
right subclavian artery*
superior vena cava
ascending, descending and arch of
aorta
pulmonary trunk
ligamentum arteriosum
left vagus nerve
left recurrent laryngeal nerve
phrenic nerve
Q1. The intercostal nerves and vessels run in the space between which muscles?
Q2. What artery is running with the phrenic nerve?
Q3. Imagine that during a tooth extraction, the tooth was accidentally dropped down the trachea.
Into which main bronchus would it be most likely to lodge?
Q4. Which bronchus is also called the "eparterial bronchus"?
Q5. What is a cardiac tamponade?
Q6. What is pericardiocentesis?
ANS. 1. internal & innermost; 2. pericardicophrenic artery; 3. Rt.; 4. Rt. upper/superior, it is usually
located superior to the pulmonary artery; 5. may result from bleeding into the pericardial sac & leads to
compression of the encased heart; 6. withdrawing fluid from the pericardial sac.
Middle Mediastinum and Heart – Critical Structures
* = structures that can be found on RADIOGRAPHS
outer fibrous layer of pericardium – outermost and toughest pericardium layer, most visible in chest cavity
oblique sinus – area of the pericardium where the heart sits (posterior to the L atrium) in the chest cavity
transverse sinus – behind the aorta and pulmonary trunk, separates inflow and outflow vessels
superior vena cava* - largest vein running into the superior right edge of the right atrium
inferior vena cava* - largest vein running into the inferior right edge of the right atrium
pulmonary trunk* - large artery emanating from the superior portion of the right ventricle
L & R pulmonary arteries* - 2 on each side (L and R anatomically) split from pulmonary trunk
pulmonary veins – bring blood back from the lungs to the heart into the
ascending aorta* - the section between the heart and the arch of aorta
descending aorta* - the section from the arch of aorta to the point where it divides into the
common iliac arteries
right coronary artery – off of the aorta, runs between the R ventricle and R atrium
atrial branch and nodal artery – branch running to R atrium, and splits to SA Node
marginal artery – branch running on R margin of R ventricle, w/small cardiac vein
posterior interventricular artery – branch running on post. between the ventricles with
the middle cardiac vein
left coronary artery – off of the aorta, runs between the L atrium and pulmonary trunk
anterior interventricular artery – branch running on ant. Between the bentricles with
the great cardiac vein
circumflex branch – runs between L atrium and L ventricle to posterior
coronary sinus – large vein on post. between L atrium and L ventricle, sm mid great drain into
great cardiac vein – runs with the L ant. interventricular artery, becomes the coronary sinus
middle cardiac vein – runs with the R post. interventricular artery, into the coronary sinus
small cardiac vein – runs with R marginal artery, into the coronary sinus
anterior cardiac veins – feed directly into R atrium (only visible veins not going to coronary
sinus, the only others are the microscopic smallest or “thebesian” veins)
left auricle* - “ear” or left atrial appendage, on the perimeter of L atrium towards L ventricle
right auricle – “ear” or right atrial appendage, on the perimeter of R atrium towards R ventricle
pectinate muscles – “comb-like”, on the inner anterior wall of the R atrium
crista terminalis – separates pectinate muscle from smooth muscle ant./post. in the R atrium
tricuspid valve – AV valve, three cusps, between R atrium and R ventricle
fossa ovalis – thin tissue remnant of foramen ovale between the R and L atriums
valve (Eustachian) of IVC – remnant in adult heart, in fetal heart directed blood from Inferior
Vena Cava into the L atrium from the R atrium via the foramen ovale
mitral valve – AV valve, bicuspid valve, two cusps, between L atrium and L ventricle
aortic semilunar valve – three cusps, no chordae tendinae, between the L ventricle and aorta
chordae tendinae – connect leaflets of AV valves to papillary muscles on the ventricular floor
papillary muscles* - secure chordae tendinae of AV valves to ventricular floor, & moderates tension
trabeculae carneae* - “beams of meat” on interior ventricular walls, rounded irregular muscular projections
moderator band – runs in the R ventricle from the base of the ant. papillary muscle to the interventricular
septum, as part of the electrical transmission system of the heart
infundibulum (of R ventricle)* - aka – conus arteriosis, cone shaped smooth muscle outflow from R ventricle
to the pulmonary trunk, just inferior to the pulmonary semilunar valve
pulmonary semilunar valve – three cusps, no chordae tendinae, between the R ventricle and pulmonary trunk
interventriclular septum* - the wall between the R and L ventricle
Q1. Which veins do NOT drain into the right atrium via the coronary sinus?
ANS. 1. anterior cardiac and smallest (thebesian - microscopic) veins
The RIGHT side of the body comes in threes and the LEFT in twos
R Atrium to R Ventricle = Tricuspid Valve
L Atrium = Mitral Valve (bicuspid)
R Lung = three Lobes
L Lung = two Lobes
R Coronary Artery = three Branches (we need to know)
LCA = two Branches (we need to know)
Posterior Mediastinum & Autonomics – Critical Structures
* = structures that can be found on RADIOGRAPHS
esophagus*
ligamentum arteriosum
left vagus nerve
left recurrent laryngeal nerve
anterior vagal trunk
right vagus nerve
posterior vagal trunk
esophageal plexus
descending (thoracic) aorta*
posterior intercostal arteries
azygos vein*
hemiazygos vein*
accessory hemiazygos vein
posterior intercostal veins
superior intercostal vein
thoracic duct
sympathetic trunk
greater splanchnic nerve
lesser splanchnic nerve
rami communicans
Q1. From what regions do parasympathetic fibers emanate?
Q2. An aneurysm of the arch of the aorta stretches the area of the ligamentum arteriosum; what
may be a clinical sign of damage to nerves in the area?
Q3. What structure does the right recurrent laryngeal nerve loop around and pass posterior to on
its course to the larynx?
Q4. Where does the left superior intercostal vein drain?
Q5. Where does the descending aorta begin?
Q6. Does the descending aorta pierce the diaphragm?
Q7. At what level does the thoracic duct usually cross from the right side to the left?
Q8. What areas does the thoracic duct normally drain?
Q9. Which rami communicans carries preganglionic fibers?
Q10. Which rami may be found over the entire length of the sympathetic trunk?
Q.11 The greater, lesser and least splanchnic nerves supply what area?
ANS. 1. Cranial-sacral; 2. May cause the patients voice to be hoarse (see clinical note in MD
176); 3. right subclavian artery; 4. left brachiocephalic vein; 5. At the sternal angle, 2nd rib, 4-5th
thoracic vertebra; 6. NO, passes behind the crus of the diaphragm at thoracic level 12; 7. Sternal
angle; 8. lower extremities, pelvic & abdominal cavities, left sides of the thorax, head & upper
limb; 9. White; 10. Gray; 11. sympathetics to most of the abdominal viscera
Abdominal Wall & Supramesocolic Organs – Critical Structures
umbilicus
Camper’s fascia
Scarpa’s fascia
Bony structures:
anterior superior iliac spine
pubic tubercle
pubic ramus
symphysis pubis
external abdominal oblique muscle
internal abdominal oblique muscle
transversus abdominis muscle
Inner anterior abdominal wall:
median umbilical fold
medial umbilical fold
lateral umbilical fold
greater omentum – hangs from the greater curvature of the stomach inferiorly over the intestines
lesser omentum – attached to the lesser curvature of the stomach and the liver
hepatogastric ligament –
hepatoduodenal ligament –
greater peritoneal sac – the general cavity of the abdomen
lesser peritoneal sac – made up of the lesser and greater omentum
omental foramen - the small opening at the right end of the lesser omentum connecting the greater and
lesser peritoneal sacs together
greater and lesser curvature of stomach
pyloris
gastrosplenic ligament
duodenum
duodenojejunal flexure
jejunum
lobes of liver: right, left, caudate and quadrate
falciform ligament
round ligament of liver
gallbladder
cystic duct
common bile duct
hepatic ducts
common hepatic duct
celiac trunk
left gastric artery
esophageal branch of left gastric artery
splenic artery
left gastro-omental artery
dorsal pancreatic artery
greater pancreatic artery
short gastric arteries
common hepatic artery
proper hepatic artery
right and left hepatic arteries
cystic artery
right gastric artery
gastroduodenal artery
right gastro-omental artery
anterior superior pancreaticoduodenal artery
posterior superior pancreaticoduodenal artery
hepatic portal vein
Inframesocolic Organs & Posterior Wall – Critical Structures
superior mesenteric artery
mesenteric arterial cascades (jejunum vs ileum)
ileocolic artery
appendicular artery
right colic artery
middle colic artery
marginal artery
inferior mesenteric artery
left colic artery
sigmoid arteries
superior rectal artery
superior mesenteric vein
inferior mesenteric vein
pancreas (and its regions)
gonadal arteries
left gonadal vein
right gonadal vein
renal arteries
renal veins
abdominal aorta
inferior vena cava
accessory renal arteries
renal cortex & columns
renal medulla (pyramid)
renal papillae
major calyces
minor calyces
renal pelvis
ureter (right & left)
suprarenal glands
suprarenal arteries
suprarenal veins
psoas major
iliacus
quadratus lumborum
right and left crus of diaphragm
median arcuate ligament
medial arcuate ligament
lateral arcuate ligament
subcostal nerve
iliohypogastric herve
ilioinguinal nerve
lateral femoral cutaneous nerve
genitofemoral nerve
Pelvis & Perineum – Critical Structures
Female
vagina
uterus (body & fundus)
cervix
posterior vaginal fornix
uterine artery & vein
vesicouterine pouch
rectouterine pouch (of Douglas)
broad ligament
mesosalpinx
mesovarium
mesometrium
round ligament
ovarian ligament
suspensory ligament of ovary
uterine tube
infundibulum
fimbriae
ampulla
isthmus
ovaries
bulb of vestibule
urethra
Male
seminal vesicle
prostate
prostatic urethra
ejaculatory ducts
bulb of penis
penile urethra
testis
tunica albuginea of testis
epididymis
vas deferens
ampulla of vas
Both – Female and Male
obturator internus
piriformis
levator ani
coccygeus
tendinous arch
external anal sphincter
common iliac artery/veins
external iliac arteries/veins
internal iliac arteries/veins
internal pudendal artery/vein
umbilical artery
superior vesicle artery
obturator artery/vein
bladder
detrusor muscle
trigone
ureter (left & right)
rectum
retropubic space
perineum
anal triangle
urogenital triangle
anus
pudendal nerve
sacrospinous ligament
sacrotuberous ligament
ischiorectal (ischoianal fossa)
crura (of clitoris and penis)
corpus cavernosus (of clitoris and penis)
glans (of clitoris and penis)
ischiocavernosus muscle
bulbospongiosus muscle
dorsal nerves (of clitoris and penis)
Lower Extremity – Critical Structures
femur
femoral head
trochanters – greator & lesser – like the tubercles of the humerus
condyles – medial & lateral – articulating surface with the
epicondyles – medial & lateral
anterior superior iliac spine
acetabulum – “vinegar cup” – the fossa in which the head of the femur articulates
acetabular fossa – depressed area in the floor of the acetabulum, superior to the acetabular notch
tibia – medial and larger bone of the lower leg
condyles – medial & lateral medial malleolus
fibula
lateral malleolus
talus
calcaneous
iliotibial tract
femoral nerve, artery & vein
great saphenous vein
profunda femoris artery
medial femoral circumflex artery
tensor fascia lata
sartorius
quadratus femoris
gracilis
pectineus
iliopsoas
adductor group
obturator artery & vein
patella
patellar ligament
tibial (medial) collateral ligament
fibular (lateral) collateral ligament
anterior cruciate ligament
posterior cruciate ligament
medial meniscus
lateral meniscus
gluteus maximus
gluteus medius
gluteus minimus
piriformis
superior gluteal nerve
inferior gluteal nerve
sciatic nerve
superior gluteal vessels
inferior gluteal vessels
biceps femoris
common peroneal nerve
popliteal artery
soleus
gastrocnemius
plantaris
tibialis posterior
flexor digitorum longus
flexor hallucis longus
tibial nerve
fibular nerve
posterior tibial artery
anterior tibial artery
fibular artery
flexor hallucis longus tendon
tibialis anterior
extensor hallucis longus
extensor digitorum longus
fibularis tertius
dorsalis pedis artery
arcuate artery
fibularis longus
fibularis brevis
deep fibular nerve
superficial fibular nerve