Clinical Anatomy Grant’s Dissector Notes (Summer 2009 and Summer 2010)
Melissa McDole
Clinical Anatomy Lab Notes Unit #1
THE BACK/SHOULDER/CHEST
Week 1
Day 1
Surface Anatomy: N—152
The superficial, intermediate, and deep muscles of the back attach to the vertebral column.
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External occipital protuberance
Superior border of the trapezius muscle
Spinous process of the seventh cervical vertebra (vertebra prominens)
Spine of the scapula (at vertebral level T3)
Acromion of the scapula
Medial (vertebral) border of the scapula
Inferior angle of the scapula (at vertebral level T7)
Spinous processes of thoracic vertebrae
Erector spinae muscle (most noticeable in the lumbar region)
Median furrow
Lateral border of the latissimus dorsi muscle (posterior axillary fold)
Iliac crest (at vertebral level L4)
Posterior superior iliac spine
Skeleton of the Back
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Scapula: (N421)
o Acromion
o Spine
o Superior angle
o Medial (vertebral) border
o Inferior angle
Ilium: (N159)
o Iliac crest
Clinical Anatomy Grant’s Dissector Notes (Summer 2009 and Summer 2010)
Melissa McDole
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o Posterior superior iliac spine
Occipital bone
o External occipital protuberance (inion)
o Superior nuchal line
Temporal bone
o Mastoid process
Vertebral column
o 33 vertebrae
 7 cervical: allow flexibility and movement of vertebral column
 12 thoracic: allow flexibility and movement of vertebral column
 5 lumbar: allow flexibility and movement of vertebral column
 5 sacral: fused and provide rigid support of pelvic girdle
 4 coccygeal
Thoracic vertebra (N154)
o Body
o Vertebral arch: formed from combination of pedicles and laminae
o Pedicle (2)
o Lamina (2)
o Vertebral foramen
o Transverse process (2)
o Transverse costal facet
o Spinous process: long and slender
o Articular process—superior and inferior
o Vertebral notches—superior and inferior
o Costal facets—superior and inferior
Intervertebral disc (IV disc) and articular processes unite adjacent vertebrae
Intervertebral foramen—where spinal nerves pass through
Cervical vertebrae
o Differences from thoracic vertebrae include:
 Smaller bodies
 Larger vertebral foramen
 Shorter spinous processes (have bifurcated tip)
 Have transverse processes that have a foramen transversarium
o Transverse process
o Foramen transversarium
Clinical Anatomy Grant’s Dissector Notes (Summer 2009 and Summer 2010)
Melissa McDole
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o Spinous process
o Atlas (C1): has NO body
o Axis (C2): has the dens which is the body of C1 that fuses with C2 during development
o Vertebra prominens (C7): has the most prominent spinous process
Lumbar vertebrae differ from thoracic vertebrae according to the following:
o Larger bodies
o Broad spinous processes that project posteriorly
o Have NO transverse costal facets for ribs
o Spinous processes do NOT overlap
Sacrum: fused vertebrae (N157)
o Have NO spines or transverse processes
o Median sacral crest
o Posterior (dorsal) sacral foramina
o Sacral hiatus
Coccyx: 4 bones fused together
Superficial Muscles of the Back
Superficial muscles of the back include: Trapezius, Latissimus dorsi, Rhomboid major, Rhomboid minor, Levator scapulae
Trapezius muscle (N174)
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Proximal attachment: external occipital protuberance, nuchal ligament, spinous process of C7 to T12
Superior part: attaches to lateral 1/3 of clavicle; elevates scapula
Middle part: attaches to acromion and spine of scapula; retracts scapula
Inferior part: attaches to medial end of spine of scapula; depresses scapula
Innervation: accessory nerve (CN XI)(motor innervation); branches of ventral rami of spinal nerves C3 and C4
(sensory/proprioception innervation)
Arterial supply: transverse cervical artery
Latissimus Dorsi muscle (N174)- “widest”
 Proximal attachment: spines of vertebrae T7 to T12, iliac crest, thoracolumbar fascia, ribs 9 to 12, lateral to their angles
 Distal attachment: humerus (intertubercular sulcus)
 Innervation: thoracodorsal nerve
Clinical Anatomy Grant’s Dissector Notes (Summer 2009 and Summer 2010)
Melissa McDole
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Arterial supply: thoracodorsal artery
Function: extends, adducts, rotates humerus medially
Rhomboid major and rhomboid minor muscles (N177)
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Rhomboid minor:
o Proximal attachment: nuchal ligament, spinous process of C7 and T1
o Distal attachment: medial border of scapula
Rhomboid major:
o Proximal attachment: spinous process of T2 to T5
o Distal attachment: medial border of the scapula
Function of both muscles: retract scapula, rotate scapula to depress glenoid cavity, hold scapula close to thoracic wall
Innervation: dorsal scapular nerve
Arterial supply: dorsal scapular artery (may branch from subclavian artery or come from transverse cervical artery—“deep branch of
transverse cervical artery”)
Levator Scapulae Muscle (N174)
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Distal attachment: superior angle of scapula
Proximal attachment: transverse processes of upper four cervical vertebrae
Function: elevates scapula and rotates scapula to depress glenoid cavity
Innervation: dorsal scapular nerve
Arterial supply: dorsal scapular artery (may branch from subclavian artery or come from transverse cervical artery—“deep branch of
transverse cervical artery”)
Triangle of auscultation: bound by latissimus dorsi, trapezius, and rhomboid major muscle; area good for listening to sounds from thoracic
organs—lungs
Lumbar triangle: bound by latissimus dorsi, external oblique, and iliac crest; can be site of lumbar hernia
INTERMEDIATE MUSCLES OF THE BACK
N174
Clinical Anatomy Grant’s Dissector Notes (Summer 2009 and Summer 2010)
Melissa McDole
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Intermediate muscles of the back include: serratus posterior superior, serratus posterior inferior
Serratus posterior superior
o Thin muscles beneath rhomboids
o Proximal attachment: nuchal ligament and spinous process of C7 to T3
o Distal attachment: ribs 2 to 5, lateral to their angles
o Function: respiratory muscles
o Innervation: intercostal nerves
o Artery: intercostal arteries
Serratus posterior inferior
o Proximal attachment: spinous processes of T11 to L2
o Distal attachment: ribs 9 to 12 lateral to their angles
o Function: respiratory muscles
o Innervation: intercostal nerves
o Artery: intercostal arteries
DEEP MUSCLES OF THE BACK
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Splenius muscle (N174)
o Deep to trapezius muscle
o Proximal attachment: nuchal ligament and spinous process of C7 to T6
o Splenius capitis muscle: attached to mastoid process of temporal bone and superior nuchal line of occipital bone
o Splenius cervicis muscle: attached to transverse process of vertebrae C1 to C4
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Erector Spinae (N175)—made of 3 muscles
o Deep to serratus posterior muscles
o Spinalis muscle
 Medial column of erector spinae m.
 Inferior attachment: spinous processes
 Superior attachment: spinous processes
 Present at lumbar, thoracic and cervical vertebral levels
o Longissimus muscle
 “longest” muscle
 Intermediate column of erector spinae m.
 Inferior attachment: sacrum
 Superior attachment: transverse processes of thoracic and cervical vertebrae
Clinical Anatomy Grant’s Dissector Notes (Summer 2009 and Summer 2010)
Melissa McDole
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Iliocostalis muscle
 Lateral column of erector spinae m.
 Inferior attachment: ilium (iliac crest)
 Superior attachment: ribs
Function: bends vertebral column laterally toward the side that is active
Innervation: dorsal rami
Artery: intercostal arteries
VERTEBRAL CANAL, SPINAL CORD, AND MENINGES pp 15 to 18
Overview:
Vertebral canal: encloses the spinal cord, spinal meninges (membranes), and blood vessels
Vertebral foramina
Cervical, thoracic, lumbar vertebrae
Sacral canal
Spinal cord: begins at foramen magnum of occipital bone and ends at L2 (in adult)
Spinal meninges
Spinal cord is shorter than the vertebral canal so the spinal cord is found at higher vertebral levels
Cervical enlargement: C4 to T1
Lumbar enlargement: L2 to S3
Spinal nerves: 31 pairs: 8 cervical, 12 thoracic, 5 lumbar, 5 sacral, 1 coccygeal; spinal nerves are numbered according to the vertebra above
them; spinal nerves pass under the vertebra (thoracic, lumbar, sacral only); cervical spinal nerves pass above vertebra; C8 has no vertebra
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Ligamenta flava: connect the laminae of the adjacent vertebrae
Spinal meninges
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Epidural (extradural) space
Epidural fat
Posterior internal vertebral venous plexus—N 170
o These veins have no valves allowing blood to flow superiorly or inferiorly depending on blood pressure gradients
o Can be routes for metastasis of cancer from the pelvis to the vertebrae, vertebral canal, and cranial cavity
Clinical Anatomy Grant’s Dissector Notes (Summer 2009 and Summer 2010)
Melissa McDole
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Dural sac: ends at S2
Dura mater
Arachnoid mater
Subarachnoid space: contains CSF (N169)
Spinal cord—N160
o Lumbar enlargement: L2 to S3; gives nerves to lower limbs
o Conus medullaris (medullary cone): end of spinal cord between L1 and L2
o Cauda equina: (horse tail) collection of ventral and dorsal roots in the lower vertebral canal
o Filum terminale internum: filament continuous with the pia mater; arises from tip of conus medullaris and ends at
S2
Pia mater: covers spinal cord
o Forms 2 denticulate ligaments: one on each side of the spinal cord—N 169
Dorsal roots
Ventral roots
Intervertebral foramen
Blood vessels: branches of the posterior intercostal, lumbar, or vertebral arteries depending on vertebral level; pass into vertebral canal
via intervertebral foramen (N172)
Spinal nerve
Spinal ganglion (dorsal root ganglion)
Dorsal ramus
Ventral ramus
Clinical correlation:
Lumbar puncture: used to obtain CSF from subarachnoid space; CSF is taken from space inferior to conus medullaris; at this level, there is no
danger of penetrating the spinal cord with the needle
SCAPULAR REGION—PP. 22 TO 24
Overview
6 shoulder muscles: deltoid, supraspinatus, infraspinatus, teres minor, teres major, subscapularis
Clinical Anatomy Grant’s Dissector Notes (Summer 2009 and Summer 2010)
Melissa McDole
Skeleton of the Scapular Region N 421
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Scapula:
o Acromion
o Suprascapular notch
o Supraspinous fossa
o Spine
o Infraspinous fossa
o Supraglenoid tubercle
o Glenoid cavity
o Infraglenoid tubercle
o Coracoid process
Humerus
o Head
o Anatomical neck
o Greater tubercle
o Lesser tubercle
o Intertubercular sulcus (bicipital groove)
o Surgical neck
o Deltoid tuberosity
o Radial groove
Deltoid muscle
o Proximal attachment: spine of scapula, acromion of scapula, lateral 1/3 of clavicle
o Distal attachment: deltoid tuberosity of humerus
o Function: abducts humerus N424
o Innervation: Axillary nerve
o Artery: posterior circumflex humeral artery
Axillary nerve
Posterior circumflex humeral artery and vein—N426
Teres minor muscle
o Proximal attachment: lateral border of scapula
o Distal attachment: inferior facet of greater tubercle of humerus
o Function: rotates humerus
o Innervation: axillary nerve
o Artery: circumflex scapular artery; posterior circumflex humeral a.
Clinical Anatomy Grant’s Dissector Notes (Summer 2009 and Summer 2010)
Melissa McDole
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Quadrangular space:
o Superior border: teres minor m. (inferior border)
o Lateral border: humerus
o Medial border: long head of triceps brachii m.
o Inferior border: teres major m. (superior border)
Long head of triceps brachii m.
Teres major muscle
o Proximal attachment: inferior angle of scapula
o Distal attachment: medial lip of intertubercular sulcus of humerus
o Function: adducts; medially rotates the humerus
o Innervation: lower subscapularis n.
o Artery: circumflex scapular a.
Triangular space
o Superior border: inferior border of teres minor m.
o Lateral border: tendon of long head of triceps brachii m.
o Inferior border: superior border of teres major m.
o Circumflex scapular artery comes through triangular space
Supraspinatus m.
o Proximal attachment: supraspinous fossa of scapula
o Distal attachment: highest facet of greater tubercle of humerus
o Function: initiates abduction of humerus
o Innervation: suprascapular nerve
o Artery: suprascapular artery
Infraspinatus m.
o Proximal attachment: infraspinous fossa of the scapula
o Distal attachment: middle facet of greater tubercle of humerus
o Function: laterally rotates humerus
o Innervation: suprascapular nerve (N 426)
o Artery: suprascapular artery
Superior transverse scapular ligament (“save the sea lions”)
o Suprascapular artery goes above the ligament
o Suprascapular nerve goes below the ligament
Scapular anastomosis (N427)
Rotator cuff: (4 muscles)—“SITS”
o Supraspinatus
Clinical Anatomy Grant’s Dissector Notes (Summer 2009 and Summer 2010)
Melissa McDole
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Infraspinatus
Teres minor
Subscapularis
SUPERFICIAL VEINS AND CUTANEOUS NERVES (pp 20-21)
Overview: superficial veins, cutaneous nerves, superficial fascia (N479)
Superficial veins (N 479)
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Basilic vein—“beside”
Cephalic vein
o The cephalic and basilic vein join across the cubital fossa at the median cubital vein
o Passes through deltopectoral groove between deltoid muscle and pectoralis major muscle
o Passes through deltopectoral triangle to join the axillary vein
Perforating veins: connect superficial veins to deep veins
Cutaneous nerves (N 479)
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Cutaneous nerves of the arm and forearm
o Superior lateral cutaneous nerve of the arm
o Inferior lateral cutaneous nerve of the arm
o Posterior cutaneous nerve of the arm
o Intercostobrachial nerve
o Medial cutaneous nerve of the arm
o Posterior cutaneous nerve of the forearm
o Lateral cutaneous nerve of the forearm (dissect only)
 Located at level of elbow in the superficial fascia lateral to the biceps brachii tendon
 Close to cephalic vein and median cubital vein
o Medial cutaneous nerve of the forearm (dissect only)
 On medial side of biceps brachii tendon
 Close to basilic vein
o Superficial branch of the radial nerve (dissect only)
 In superficial fascia near the styloid process of the radius
o Dorsal branch of the ulnar nerve (dissect only)
Clinical Anatomy Grant’s Dissector Notes (Summer 2009 and Summer 2010)
Melissa McDole
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 In superficial fascia near styloid process of the ulna
Deep fascia
o Extends from shoulder to fingertips
o Attaches to bones of upper limb and forms compartments that contain group muscles
o Aka brachial fascia in arm and antebrachial fascia in forearm, and palmar fascia in hand
o Dorsal fascia of the hand
PECTORAL REGION p 24 – 25
Overview:
Pectoral region (“chest”): covers anterior thoracic wall and part of lateral thoracic wall
Breast (N 182)
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Breast:
o Extends from lateral border of sternum to midaxillary line, and from rib 2 to rib 6
o Mammary gland = modified sweat gland
o Pectoral fascia: attached to skin by suspensory ligaments of the breast that pass between lobes of the mammary gland
o Areola
o Nipple
o Lactiferous ducts: 15 to 20 present; converge on nipple
o Lactiferous sinus: expanded part of lactiferous duct
o Areola  nipple  lactiferous ducts  lactiferous sinus
o Lymphatic drainage of mammary gland ** (N184)
o Retromammary space
Superficial fascia
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Platysma muscle: muscle of facial expression; extends inferior to clavicle into superficial fascia of superior thorax
o Thin, broad muscle
MUSCLES OF THE PECTORAL REGION PP 25 – 28
Overview:
Clinical Anatomy Grant’s Dissector Notes (Summer 2009 and Summer 2010)
Melissa McDole
Muscles of pectoral region include: pectoralis major and minor, subclavius muscles; muscles of pectoral region attach the upper limb to the
thoracic skeleton
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Pectoralis major m.
o Has 2 heads
 Clavicular head
 Sternocostal head
 Both heads join at the sternoclavicular joint
o Distal attachment: humerus
o Function: flexes, adducts, medially rotates humerus
o Innervation: medial and lateral pectoral nerves
o Artery: pectoral branch of thoracoacromial artery
Deltopectoral triangle
Cephalic vein
Clavipectoral fascia
Pectoralis minor m. (N 428)
o Proximal attachment: ribs 3 – 5
o Distal attachment: coracoid process
o Function: draws glenoid cavity of scapula anteriorly and inferiorly
o Innervation: medial pectoral nerve
o Artery: pectoral branch of thoracoacromial artery
Subclavius m.
o Located inferior to the clavicle
o Attached to clavicle and first rib
o Function: depresses clavicle
o Artery: clavicular branch of thoracoacromial artery
Costocoracoid membrane
Thoracoacromial a. (CAP D)
o Clavicular branch
 Passes superiorly and medially to supply the subclavius m.
o Acromial branch
 Passes laterally across coracoid process toward acromion
o Pectoral branch
 Passes between the pectoralis major muscle and pectoralis minor muscle—supplies both
o Deltoid branch
Clinical Anatomy Grant’s Dissector Notes (Summer 2009 and Summer 2010)
Melissa McDole
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Courses laterally in the deltopectoral groove between deltoid muscle and pectoralis major muscle; deltoid branch
accompanies the cephalic vein
Lateral thoracic artery
Serratus anterior muscle
o Proximal attachment: upper 8 ribs
o Distal attachment: deep surface of scapula along length of medial border
AXILLA
Overview:
Axilla is region between pectoral muscles, scapula, arm, and thoracic wall; vessels and nerves pass through from root of neck and go to upper limb
Axilla contents include: axillary sheath, brachial plexus, axillary vessels and their branches, lymph nodes, lymphatic vessels, portions of 3
muscles, fat, connective tissue
 Axilla
o Boundaries:
 Apex of axilla: bounded by clavicle anteriorly, upper border of scapula posteriorly, and first rib medially
 Base of axilla: skin and fascia of armpit
 Anterior wall: pectoralis major muscle, pectoralis minor muscle, and clavipectoral fascia
 Posterior wall: posterior axillary fold (teres major and latissimus dorsi) and subscapularis muscle that covers anterior
surface of scapula
 Medial wall: upper portion of thoracic wall and serratus anterior muscle
 Lateral wall: intertubercular sulcus of humerus
 Axillary sheath: surrounds axillary vessels and brachial plexus; extends from lateral border of 1st rib to inferior border of teres major
muscle
 Axillary vein: passes superior to teres minor m. (N429)
Axillary Artery (N427)
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Axillary artery: begins at lateral border of 1st rib—a continuation of subclavian artery
o Ends at inferior border of teres minor muscle and becomes brachial artery
o Surrounded by brachial plexus
o 3 parts of axillary artery
 First part: goes from lateral border of 1st rib to medial border of pectoralis minor muscle
 Has one branch: superior (supreme) thoracic artery—supplies 1st and 2nd intercostal spaces
Clinical Anatomy Grant’s Dissector Notes (Summer 2009 and Summer 2010)
Melissa McDole
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Second part: posterior to pectoralis minor muscle
 Has 2 branches:
o thoracoacromial artery: from medial border of pectoralis minor and penetrates costocoracoid
membrane
 acromial branch: passes laterally across the coracoid process to acromion
 deltoid branch: passes laterally in deltopectoral groove---accompanied by cephalic vein
 pectoral branch: passes between pectoralis major and minor and supplies both
 clavicular branch: courses superiorly and medially to supply the subclavius muscle
o Lateral thoracic artery: from lateral border of pectoralis minor muscle (65%) and goes down along
lateral border of pectoralis minor muscle; may arise from subscapular artery or from thoracoacromial
artery
 Supplies pectoral muscles, serratus anterior muscle, axillary lymph notes, lateral thoracic wall in
females
Third part: from lateral border of pectoralis minor muscle to inferior border of teres major muscle
 has 3 branches
o subscapular artery
 largest branch of axillary artery
 divides into
 circumflex scapular artery: goes to muscles of on posterior surface of scapula
 thoracodorsal artery: goes to latissimus dorsi
o posterior circumflex humeral artery: supply deltoid
 larger of the 2 circumflex humeral arteries
 passes posterior to the surgical neck of the humerus with the axillary nerve
 pass via quadrangular space
o anterior circumflex humeral artery: supply deltoid
 Passes around the anterior surface of the humerus at the surgical neck; passes deep to the tendon
of the long head of the biceps brachii m.
Brachial Plexus—N 429
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brachial plexus begins at the root of the neck superior to the clavicle, passes distally toward the base of the axilla where terminal
branches arise
3 cords of brachial plexus:
o Lateral
 Lateral root of the median nerve
Clinical Anatomy Grant’s Dissector Notes (Summer 2009 and Summer 2010)
Melissa McDole
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Medial
 Medial root of median nerve
o Posterior
Musculocutaneous nerve:
o Most lateral terminal branch
o Enters coracobrachialis muscle
Median nerve
Ulnar nerve
3 terminal branches
o Musculocutaneous nerve
o Median nerve
o Ulnar nerve
Lateral pectoral nerve: branches from lateral cord
Medial pectoral nerve: branches from medial cord
Medial cutaneous nerve of the forearm: arise from medial cord
Medial cutaneous nerve of the arm: arise from medial cord
Posterior cord: branches include
o Axillary nerve: passes posterior to humerus through quadrangular space with posterior circumflex humeral artery
o Radial nerve: passes posterior to humerus; provides motor and sensory nerves to posterior arm
o Subscapular nerve (upper, middle, lower)
 Upper subscapular nerve: innervates subscapularis muscle
 Middle subscapular nerve (thoracodorsal nerve): innervates latissimus dorsi muscle
 Lower subscapular nerve: innervates subscapularis muscle and teres major muscle
Subscapularis muscle:
o Proximal attachment: subscapular fossa of scapula
o Distal attachment: lesser tubercle of humerus
o Member of rotator cuff muscle group
o Function: rotates the humerus
o Arterial supply: suprascapular artery
o Innervation: upper subscapular nerve, lower subscapular nerve
Serratus anterior muscle N 429
o Proximal attachment: external ribs 1 to 8
o Distal attachment: anterior surface of medial border of scapula
o Function: protracts the scapula, rotates the scapula, when arm is abducted above shoulders
o Arterial supply: lateral thoracic artery
Clinical Anatomy Grant’s Dissector Notes (Summer 2009 and Summer 2010)
Melissa McDole
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Innervation: long thoracic nerve
Clinical Correlation:
Long thoracic nerve:
 Injuries can occur via stab wounds and surgery during radical mastectomy
 Injuries affect serratus anterior muscle (paralysis)  causes winged scapula protrusion of scapula
Thoracodorsal nerve:
 Can be endure compression injuries and surgical trauma via mastectomy
 Injuries affect the latissimus dorsi muscle  weakened ability to extend, adduct, and medially rotate arm
Axillary Nerve:
 Goes around surgical neck of humerus and can be injured during fracture or during inferior dislocation of shoulder joint
 Injury affects deltoid muscle and teres minor muscle  weakened ability to abduct and laterally rotate the arm
ARM AND CUTITAL FOSSA
Overview
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Brachial fascia (deep fascia of the arm)
Antebrachial fascia (deep fascia of the forearm)
Anterior compartment (flexor)
o 3 muscles: biceps brachii, brachialis, coracobrachialis
o Musculocutaneous nerve innervation
Posterior compartment (extensor)
o 2 muscles: triceps brachii, anconeus
o Radial nerve
o Deep artery and vein of the arm
Skeleton of arm and cubital region (N436)
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Humerus
o Medial epicondyle
o Lateral epicondyle
Clinical Anatomy Grant’s Dissector Notes (Summer 2009 and Summer 2010)
Melissa McDole
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o Olecranon fossa
Radius
o Head
o Neck tuberosity
Ulna
o Olecranon
o Coronoid process
Anterior Compartment of the Arm
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Lateral intermuscular septum
Medial intermuscular septum
Coracobrachialis muscle:
o Proximal attachment: coracoid process
o Distal attachment: medial side of shaft of humerus
o Function: adducts and flexes humerus
o Artery
o Innervation: musculocutaneous nerve
Brachialis muscle
o Deep to biceps brachii muscle
o Proximal attachment: anterior surface of distal ½ of humerus
o Distal attachment: cornoid process of ulna
o Function: Flexes forearm
o Artery:
o Innervation: musculocutaneous nerve
Biceps brachii muscle
o Proximal attachments on scapula:
 Short head of biceps brachii muscle: coracoid process
 Long head of biceps brachii muscle: supraglenoid tubercle of scapula
o Distal attachment: tuberosity of the radius
o Function: supinates, flexes forearm
o Artery:
o Innervation: musculocutaneous nerve
Bicipital aponeurosis: broad extension of biceps tendon that attaches to antebrachial fascia; on medial side of biceps brachii tendon
o Protects the brachial artery and median nerve from injury during venipuncture
Clinical Anatomy Grant’s Dissector Notes (Summer 2009 and Summer 2010)
Melissa McDole
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Musculocutaneous nerve turns into or gives off a branch known as the lateral cutaneous nerve of the forearm
Medial cutaneous nerve of the forearm
Median nerve: courses distally within medial intermuscular septum
Ulnar nerve: passes posterior to the medial epicondyle of humerus
Brachial artery: continuation of axillary artery; begins at inferior border of teres major muscle and ends at level of elbow by branching
into ulnar artery and radial artery—N433
o Brachial artery courses with median nerve ; median nerve passes anterior surface of brachial artery
Deep artery of the arm (deep brachial artery, profunda brachii artery): arises from brachial artery; courses around posterior humerus
and runs with radial nerve in the radial groove
Superior ulnar collateral artery: arises from brachial artery near the middle of the arm; courses distally with ulnar nerve and passes
posterior to the medial epicondyle of the humerus
Inferior ulnar collateral artery: arises from brachial artery
Cubital fossa (N433)
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Cubital (elbow) fossa:
o Depression on anterior elbow
o Contains superficial veins for venipuncture
o Boundaries of cubital fossa
 Lateral boundary: brachioradialis muscle
 Medial boundary: pronator teres muscle
 Superior boundary: imaginary line connecting medial and lateral epicondyles of the humerus
 Superficial boundary (roof of the cubital fossa): antebrachial fascia reinforced by the bicipital aponeurosis
 Deep boundary (floor of the cubital fossa): brachialis and supinator muscles
Posterior compartment of the arm (N432)
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Triceps brachii muscle
o 3 proximal attachments
 Long head of triceps brachii muscle: attaches to infraglenoid tubercle of scapula
 Lateral head of triceps brachii muscle: posterior surface of humerus superior to radial groove
 Medial head of triceps brachii muscle: posterior surface of humerus inferior to radial groove
o Distal attachment: olecranon of ulna
o Function: extends forearm
o Artery:
Clinical Anatomy Grant’s Dissector Notes (Summer 2009 and Summer 2010)
Melissa McDole

o Innervation:
Anconeus muscle
o Proximal attachment: lateral epicondyle of the humerus
o Distal attachment: lateral surface of the olecranon and superior part of the posterior surface of the ulna
o Function: assists the triceps to extend forearm
WEEK 2
pp. 36 – 43
FLEXOR REGION OF THE FOREARM
Overview
The intermuscular septa, interosseus membrane, radius, and ulna combine to divide the forearm into anterior (flexor) compartment and a
posterior (extensor) compartment
Muscles in the anterior compartment of the forearm can be divided into superficial group of flexor muscles and a deep group of flexor muscles
Muscles of the superficial flexor group arise primarily from the medial epicondyle of the humerus and its supracondylar ridge.
Muscles of the deep flexor group arise from the anterior surfaces of the radius, ulna, and interosseus membrane.
The ulnar artery, ulnar nerve, and median nerve separate the superficial flexor group from the deep flexor group
Skeleton of the forearm (N436, 439)
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Humerus
o Medial epicondyle
o Medial supracondylar ridge
o Lateral epicondyle
o Lateral supracondylar ridge
o Capitulum
o Trochlea
o Olecranon fossa
Radius
o Head
o Neck
Clinical Anatomy Grant’s Dissector Notes (Summer 2009 and Summer 2010)
Melissa McDole
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o Tuberosity
o Anterior oblique line
o Ulnar notch
o Styloid process
o Interosseous border—attaches to the interosseous membrane
Ulna
o Olecranon
o Trochlear notch
o Radial notch
o Head
o Interosseous border—for attachment of interosseous membrane
Pisiform bone
Elbow joint: articulation between the trochlear notch of the ulna and the trochlea of the humerus and the articulation between the head of
the radius and the capitulum of the humerus—make up the hinge action of the elbow joint
Proximal radioulnar joint: between the head of the radius and the radial notch of the ulna
Distal radioulnar joint: between the head of the ulna and the ulnar notch of the radius
Superficial group of flexor muscles (N446)
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Superficial group of flexor muscles: (5)
o Pronator teres
 Distal attachment: middle of the lateral surface of the radius
 Function: pronates the hand and flexes the forearm
 Innervation: median nerve
o Flexor carpi radialis
 Flexor carpi radialis tendon: attaches to the base of the second metacarpal bone
 Function: flexes and abducts the hand
 Innervation: median nerve
o Palmaris longus
 Palmaris longus tendon: attaches to the palmar aponeurosis
 Function: flexes the hand
 Innervation: median nerve
o Flexor carpi ulnaris
 Flexor carpi ulnaris tendon: attaches to the pisiform bone, hamate bone, and base of the fifth metacarpal bone
 Function: flexes and adducts the hand
Clinical Anatomy Grant’s Dissector Notes (Summer 2009 and Summer 2010)
Melissa McDole
o
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Flexor digitorum superficialis: located deep to the four muscles in the group
 Flexor digitorum superficialis tendon: attaches to the middle phalanx of digits 2 to 5
 Function: flexes the middle phalanx of digits 2 to 5
 Innervation: median nerve
o Proximal attachment of the superficial group of flexor muses is common flexor tendon (attached to the medial epicondyle of the
humerus)
o Flexor carpi radialis tendon
o N446
Radial artery
Median nerve
Ulnar artery
Ulnar nerve
Vessels and Nerves (N447)
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Brachioradialis muscle
Superficial branch of the radial nerve
o Courses distally on the deep surface of the brachioradialis
o Can be traced to the distal 1/3 of the forearm and emerges on the dorsal side of the brachioradialis tendon to become a cutaneous
nerve
Brachial artery: located in cubital fossa
o Bifurcates into the radial artery and the ulnar artery
Radial artery gives rise to several unnamed muscular branches
o Radial recurrent artery: arises from the radial artery near its origin from the brachial artery
 Anastomoses with the radial collateral branch of the deep artery of the arm
 Anastomotic network around the elbow
Median nerve
o In cubital fossa
o Medial to the brachial artery
o Innervates most of the muscles of the flexor compartment of the forearm
o Passes deep to the flexor digitorum superficialis muscle
Ulnar artery
o In cubital fossa
o Passes posterior to the deep art of the pronator teres muscle
o Median nerve crosses anterior to the ulnar artery in the cubital fossa
Clinical Anatomy Grant’s Dissector Notes (Summer 2009 and Summer 2010)
Melissa McDole
o
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Passes between the flexor digitorum superficialis and the flexor digitorum profundus muscles to reach the ulnar (medial) side of
the forearm
Common interosseous artery
o Arises about 3 cm distal to the origin of the ulnar artery from the brachial artery
o Short branch
o Passes posterolaterally toward the interosseous membrane before dividing into the anterior interosseous artery and the posterior
interosseous artery
o Anterior interosseous artery: supplies the deep group of flexor muscles
o Posterior interosseous artery: supplies the extensor group of forearm muscles
Anterior ulnar recurrent and posterior ulnar recurrent: arise from the ulnar artery in the proximal forearm
o these arteries anastomose with the inferior and superior ulnar collateral branches of the brachial artery
Ulnar nerve
o Passes between the 2 heads of the flexor carpi ulnaris muscle and medial ½ of the flexor digitorum profundus muscle
Deep group of flexor muscles (N448)
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deep group of flexor muscles include (3):
o flexor digitorum profundus
 proximal attachment: anterior surface of ulna and interosseous membrane
 4 tendons lie deep to the 4 tendons of the flexor digitorum superficialis muscle
 Distal attachment: distal phalanx of digits 2 to 5
 Function: flexes the distal phalanx of digits 2 to 5
 Innervation: lateral ½ = median nerve; medial ½ = ulnar nerve
o flexor pollicis longus
 proximal attachment: anterior surface of the radius and interosseous membrane
 distal attachment: distal phalanx of digit 1 (thumb)
 Function: flexes the thumb
o pronator quadratus
 deep to the tendons of the superficial and deep flexor muscles
 Function: pronates the hand
Anterior interosseous artery and nerve pass deep to the pronator quadratus muscle
All muscles of the anterior compartment of the forearm are innervated by the MEDIAN nerve EXCEPT for the FLEXOR CARPI
ULNARIS MUSCLE and the medial ½ of the FLEXOR DIGITORUM PROFUNDUS MUSCLE, which are innervated by the ULNAR
NERVE
Clinical Anatomy Grant’s Dissector Notes (Summer 2009 and Summer 2010)
Melissa McDole
PALM OF THE HAND
Intrinsic hand muscles: have proximal and distal attachments in the hand
Thenar group of muscles forms the thenar eminence; hypothenar group of muscles forms the hypothenar eminence
Palm is supplied by 2 arterial arches: superficial palmar arch derived mainly from the ulnar artery and the deep palmar arch derived from the
radial artery
Nerve supply to the palm derived from median and ulnar nerves
Skeleton of the hand (N456)
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Eight carpal bones
5 metacarpal bones
14 phalanges
Pisiform bone
Hook of the hamate: on medial side of wrist
Tubercle of the scaphoid: on lateral side of wrist
Tubercle of the trapezium
Flexor retinaculum
Carpal tunnel: space between the carpal bones and the flexor retinaculum—allows passage of the flexor tendons and the median nerve of
the hand
Superficial palm N459, 460
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Palmar aponeurosis: has 4 bands of longitudinal fibers—1 band to each of digits 2 to 5
Thenar muscles
Palmaris brevis muscle: superficial to the hypothenar muscles
o Thin, fragile muscle
o Proximal attachment: medial aspect of the palmar aponeurosis
o Distal attachment: skin over the hypothenar eminence
Palmaris longus muscle
Flexor digital sheath
Ulnar artery passes lateral to the pisiform bone and the ulnar nerve, then divides into a superficial branch and a deep palmar branch;
the superficial branch crosses the palm to form the superficial palmar arch; superficial palmar branch of the radial nerve (N460)
3 common palmar digital arteries
Clinical Anatomy Grant’s Dissector Notes (Summer 2009 and Summer 2010)
Melissa McDole
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Proper palmar digital arteries
Ulnar nerve  superficial branch of the ulnar nerve supplies cutaneous innervation to digit 5 and the medial side of digit 4
Deep branch of the ulnar nerve: disappears into hypothenar muscles
Carpal Tunnel
N461
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Flexor retinaculum: between the thenar and hypothenar eminences
Carpal tunnel contains the following:
o Median nerve
o 4 tendons of the flexor digitorum superficialis muscle
o 4 tendons of the flexor digitorum profundus muscle
o Tendon of the flexor pollicis longus muscle
Recurrent branch of the median nerve: innervates the 3 thenar muscles
Median nerve innervates lumbrical 1 and 2
Common palmar digital branches: come off median nerve and innervate lateral 3 ½ digits(thumb to middle finger); divide to give rise
to 2 proper palmar digital nerves (N 472)
Fibrous digital sheath: flexor tendons of carpal tunnel pass through palm of hand posterior to the superficial palmar arch and digital
nerves; flexor tendons enter fibrous digital sheaths on anterior surfaces of digits
2 sets of synovial sheaths that are deep to the flexor retinaculum and extend to the palm
o Common flexor synovial sheath (ulnar bursa)
o 3 digital synovial sheaths
Radial bursa: sheath that contains the tendon of the flexor pollicis longus (N462)
Carpal tunnel syndrome
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Swelling of common flexor synovial sheath; results in median nerve compression; symptoms: pain and paresthesia
(tingling/numbness of skin) of the thumb, index, and middle fingers, and weakness of the thenar muscles
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4 lumbrical muscles: attached to the 4 tendons of the flexor digitorum profundus m.
o Distal attachment: radial side of the extensor expansions of digits 2 to 5
o Function: flex metacarpophalangeal joints (MCP) and extend the interphalangeal joints(IP)
Clinical Anatomy Grant’s Dissector Notes (Summer 2009 and Summer 2010)
Melissa McDole
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Side note: relationship of the tendons of the flexor digitorum superficialis and flexor digitorum profundus mm. FLEXOR DIGITORUM
PROFUNDUS TENDON PASSES THROUGH FLEXOR DIGITORUM SUPERFICIALIS TENDON; the flexor digitorum superficialis
tendon attaches to the middle phalanx and the flexor digitorum profundus tendon attaches to the distal phalanx (applies for digits 2 – 5)
Side note: flexor pollicis longus muscle tendon attaches to the distal phalanx of the thumb
Thenar Muscles N 465
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Thenar group muscles contain: (3)
o Abductor pollicis brevis: attaches to the lateral side of the proximal phalanx of the thumb
 Function: abducts the thumb
o Flexor pollicis brevis: attaches to the lateral side of the proximal phalanx of the thumb
 Function: flexes the thumb
o Opponens pollicis: attaches to the lateral side of the shaft of the first metacarpal bone; deep to the abductor pollicis brevis
muscle
 Function: opposes the thumb
o Proximal attachments of all three are the scaphoid, trapezium, flexor retinaculum
Side note: Recurrent branch of the median nerve crosses the superficial surface of the flexor pollicis brevis muscle, then disappears
deep to the abductor pollicis brevis muscle
Recurrent branch of the Median Nerve
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This nerve is superficial and can be easily severed by minor cuts over the thenar eminence; if the recurrent branch of the median
nerve is injured, the thenar muscles are paralyzed and the thumb cannot oppose
Hypothenar muscles (N465)
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Muscles include:
o Abductor digiti minimi:
 Attaches to the medial side of the base of the proximal phalanx of digit 5
 Function: abducts digit 5
o Flexor digiti minimi brevis
 Attaches to the medial side of the base of the proximal phalanx of digit 5
 Function: flexes digit 5
o Opponens digiti minimi
 Attaches to the medial border of the 5th metacarpal bone
Clinical Anatomy Grant’s Dissector Notes (Summer 2009 and Summer 2010)
Melissa McDole
o
 Function: opposes digit 5
Proximal attachments for all 3 are the pisiform, hamate and flexor retinaculum
Deep Palm (N465, 466)
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Side note: the ulnar nerve and artery pass on the lateral side of the pisiform bone
Deep branch of the ulnar nerve & deep palmar branch of the ulnar artery: pass between the proximal attachments of the flexor
digitorum minimi brevis and abductor digiti minimi muscles
o Deep branch of the ulnar nerve is on anterior surface of interosseous muscles
Deep palmar arch: runs with the deep branch of the ulnar nerve; arch arises from the RADIAL ARTERY and is completed by the
DEEP BRANCH OF THE ULNAR ARTERY
Adductor pollicis m.
o Has 2 heads:
 Oblique: proximal attachment: bases of metacarpal bones 2 & 3 and adjacent carpal bones
 Transverse: proximal attachment: anterior surface of the shaft of metacarpal bone 3
 Both heads attach to the medial side of the base of the proximal phalanx of the thumb
 Function: draws thumb toward digit 3 (adducts thumb)
Palmar interosseous muscles (3)
o Attach to the metacarpal bones of digits 2, 4, 5 (index, ring, little fingers)
o Distally, each muscle attaches to the base of the proximal phalanx and the extensor expansion of the same digit on which it
originates (N465)
o Unipennate (fibers on one side of the tendon)
o Function: PAD—adduct digits 2, 4, 5
o Innervation: deep branch of ulnar nerve
Dorsal interosseous muscles (4)
o Attach to metacarpal bones 1 – 5
o Distally, each muscle attaches to the bases of the proximal phalanges and the extensor expansion of digits 2 to 4 (index, middle,
ring)
o Function: DAB—abduct digits 2 to 4; move digits away from imaginary axial line
o Innervation: deep branch of ulnar nerve
Side Note: ALL INTRINSIC HAND MUSCLES ARE INNERVATED BY ULNAR NERVE EXCEPT THE MUSCLES OF THE
THENAR GROUP AND THE FIRST 2 LUMBRICALS WHICH ARE INNERVATED BY THE MEDIAN NERVE (N472)
EXTENSOR REGION OF THE FOREARM AND DORSUM OF THE HAND
Clinical Anatomy Grant’s Dissector Notes (Summer 2009 and Summer 2010)
Melissa McDole
Overview:
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2 groups of muscles
o Superficial: extend the wrist and proximal phalanges
o deep group: abduct and extend the thumb; supinate hand, extend digit 2 (index finger)
o deep branch of radial nerve innervates extensor muscles of forearm
o nerves and vessels divide superficial group from deep group
No intrinsic muscles in the dorsum of the hand so no motor innervation is required
Radial, ulnar and median nerves share cutaneous innervation of the dorsum of the hand
Superficial group of extensor muscles (N444)
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Extensor retinaculum
Superficial extensor group contains 6 muscles:
o Brachioradialis
 Attaches to lateral surface of distal radius
o Extensor carpi radialis longus:
 Attaches to base of metacarpal bone 2
o Extensor carpi radialis brevis: attaches to lateral epicondyle via common extensor tendon
 Attaches to base of metacarpal bone 3
o Extensor digitorum: attaches to lateral epicondyle via common extensor tendon
 Attach to extensor expansions of digits 2 to 5
 Intertendinous connections (N470)
o Extensor digiti minimi: attaches to lateral epicondyle via common extensor tendon
 Attaches to extensor expansion of digit 5
o Extensor carpi ulnaris: attaches to lateral epicondyle via common extensor tendon
 Attaches to base of metacarpal bone 5
Deep group of extensor muscles (N445)
 5 muscles comprise the deep extensor group:
o Abductor pollicis longus
 Distal attachment: base of metacarpal bone 1
o Extensor pollicis brevis
Clinical Anatomy Grant’s Dissector Notes (Summer 2009 and Summer 2010)
Melissa McDole
 Distal attachment: base of proximal phalanx of digit 1
Extensor pollicis longus
 Distal attachment: base of distal phalanx of digit 1
o Extensor indicis
 Distal attachment: extensor expansion of digit 2
o Supinator
o Proximal attachments 4 (abductor pollicis longus, extensor pollicis brevis, extensor pollicis longus, extensor indicis) are posterior
surfaces of the radius, ulna, and interosseous membrane
Anatomical snuffbox
o Depression on posterior surface of the wrist
o Boundaries:
 Anterior: abductor pollicis longus tendon, extensor pollicis brevis tendon
 Posterior: extensor pollicis longus tendon (N469)
o Contains radial artery –dorsal carpal arch is a branch of the radial artery and arises in anatomical snuff box and supplies blood to
dorsum of the hand
Supinator muscle
o Proximal attachments: lateral epicondyle of humerus, radial collateral and anular ligaments of elbow, and lateral surface of ulna
o Distal attachment: proximal 1/3 of radius
o Function: supinates the hand
Side note: the radial nerve divides into superficial branch and a deep branch; deep branch of the radial nerve enters supinator muscle
(distal border); when deep branch of radial nerve emerges from supinator, its name changes to posterior interosseous nerve—provides
motor branches to the extensor muscle—posterior interosseous nerve runs with posterior interosseous artery (branch of common
interosseous artery)
Side note: The radial nerve innervates all of the muscles in the posterior compartment of the forearm!! There are NO intrinsic
muscles in the dorsum of the hand; so there are no muscles in the hand that are innervated by the radial nerve!!
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JOINTS OF THE UPPER ARM
Acromioclavicular joint (N423)
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Acromioclavicular joint
o Acromion
o Coracoid process of the scapula
o Lateral end of the clavicle
Coracoclavicular ligament (between coracoid process and clavicle)
Clinical Anatomy Grant’s Dissector Notes (Summer 2009 and Summer 2010)
Melissa McDole
o
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Supports acromioclavicular joint
2 parts: prevent the acromion from moving inferiorly relative to the clavicle, strengthening the joint
 Conoid ligament
 Trapezoid ligament
Glenohumeral joint (N423)
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Glenohumeral joint (shoulder joint)
o Ball-and-socket synovial joint with a wide range of motion
o Shoulder joint has greater degree of movement than any other joint in the body due to small area of contact between the head of
the humerus and the glenoid fossa of the scapula and loose joint capsule; stability of the shoulder joint depends on the function of
the rotator cuff muscles
o Glenoid fossa of the scapula
o Head of the humerus
o Anatomical neck of the humerus
o Capsule of the glenohumeral joint
o Glenoid cavity
 Glenoid labrum
 Glenohumeral ligaments (3)
 Superior, middle, inferior
 Tendon of the long head of the biceps brachii muscle: passes through the glenoid cavity and attaches to the
supraglenoid tubercle
o Coracoacromial ligament
 Goes from coracoid process to acromion—coracoid process prevents superior displacement of head of the humerus
Elbow Joint and Proximal radioulnar joint (N436, 438)
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Elbow joint has:
o Hinge joint: between trochlea of humerus and trochlear notch of the ulna
o Gliding joint: between the capitulum of the humerus and the head of the radius
Ulnar collateral ligament: on the medial side of the elbow joint (has strong anterior cord and fanlike posterior portion)
Radial collateral ligament: fans out from the lateral epicondyle of the humerus to the radius and anular ligament
Proximal radioulnar joint
o Pivot joint that occurs between the head of the radius and the radial notch of the ulna
Annular ligament and radial notch of ulna encircle head of the radius; radius can rotate anular ligament
Clinical Anatomy Grant’s Dissector Notes (Summer 2009 and Summer 2010)
Melissa McDole
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Synovial cavity
Intermediate Radioulnar Joint (N439)
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Radius and ulna are joint by interosseous membrane (fibrous joint)
Distal Radioulnar joint (N455)
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Distal radioulnar joint is the pivot joint that is between the head of the ulna and the ulnar notch of the radius
Radiocarpal ligaments: reinforce anterior and posterior surfaces of the wrist
Articular disc
Wrist Joint (N454, 455)
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Wrist joint (radiocarpal joint): articulation between the distal end of the radius and the proximal carpal bones; distal endo the radius
articulates with only 2 carpal bones: scaphoid and lunate
Metacarpophalangeal joints (N458)
Interphalangeal joints (N458)
CHAPTER 6: THE LOWER LIMB
Functions of lower limb include: weight bearing, locomotion, and maintenance of equilibrium
Lower limb is divided into 4 parts: hip, thigh, leg, foot
SURFACE ANATOMY (N485)
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Iliac crest
Anterior superior iliac spine
Pubic tubercle
Patella
Medial femoral epicondyle
Lateral femoral epicondyle
Medial malleolus
Clinical Anatomy Grant’s Dissector Notes (Summer 2009 and Summer 2010)
Melissa McDole
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Lateral malleolus
SURACE VEINS AND CUTANEIOUS NERVES
Superficial fascial of the posterior lower limb (N545)
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Small saphenous vein: passes posterior to lateral malleolus at the ankle; arises from the lateral end of the dorsal venous arch; drains
into the popliteal vein
Sural nerve: (calf of the leg)—runs with small saphenous vein; innervates the skin of the lateral aspect of the ankle and foot
Cutaneous nerves:
o Cluneal nerves: innervate skin of gluteal region
 Superior cluneal nerves: branches of dorsal rami of L1 to L3—innervates upper buttock
 Middle cluneal nerves: branches of dorsal rami of S1 to S3—innervates the middle part of buttock
 Inferior cluneal nerves: branches of posterior cutaneous nerve of thigh wrap around the inferior border of the gluteus
maximus muscle and innervate the skin over the lower part of the buttock
o Posterior cutaneous nerve of the thigh: lies deep to the deep fascia: innervate skin on posterior side of thigh and popliteal fossa
Superficial fascia
Superficial fascia of the anterior lower limb (N544)
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Great Saphenous (“saphenous , manifest, obvious”) vein: arises from medial end of dorsal venous arch of the foot
o At ankle, great saphenous vein passes anterior to the medial malleolus
o At knee, it passes over posterior border of medial epicondyle of the femur
o At level of knee the great saph vein courses anterolaterally to eventually lie on the anterior surface of the proximal thigh
o Perforating veins: connect great saph vein to deep venous system
o Many superficial veins join the great saph vein and some are large and not named
o Accessory saphenous vein: drains superficial fascia and skin of medial side of thigh
o 3 small superficial veins (superficial external pudendal, superficial epigastric, and superficial circumflex iliac) join the great
saph vein near its proximal end
o Saphenous opening: about 4 cm inferior to inguinal ligament; drains into the femoral vein
Great Saphenous Vein
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When valves of superficial veins and perforating veins fail to prevent backflow of blood, veins become incompetent and become
distended—varicose veins
Clinical Anatomy Grant’s Dissector Notes (Summer 2009 and Summer 2010)
Melissa McDole
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Portions of the great saph vein may be removed and used as graft vessels in coronary bypass surgery; distal end of vein is attached
to aorta so that valves won’t interfere with blood flow
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Cutaneous innervation of the anterior surface of the lower limb:
o Lateral femoral cutaneous nerve: passes deep to the lateral end of the inguinal ligament and innervates the skin of lateral thigh
o Anterior cutaneous branches of femoral thigh: innervate skin of anterior thigh; branches enter superficial fascia lateral to the
great saph vein
o Cutaneous branches of obturator nerve: innervate skin of the medial thigh
o Saphenous nerve: branch of femoral nerve and pierces deep fascia on medial aspect of knee and runs with great saph vein into
the leg; innervates skin of anterior and medial aspects of leg and medial side of ankle and foot
Superficial fibular nerve: pierces the deep fascia proximal to the lateral malleolus; innervates dorsum of foot and sends dorsal digital
nerves to skin of the toes
Dorsal digital branches of deep fibular nerve: innervate skin between 1st toe and 2nd toe; used to test deep fibular nerve function
Superficial inguinal lymph nodes (2 subgroups)
o Horizontal group: about 2 cm below inguinal ligament
o Vertical group: around proximal end of the great saph vein
o Collect lymph from the lower lymph, inferior part of anterior abdominal wall, gluteal region, perineum, and external genitalia
o Drain into deep inguinal lymph nodes
Deep fascia of lower limb
o Fascia lata (“broad”)
o Crural fascia: in leg
o Pedal fascia: in foot
o Iliotibial tract: on lateral leg
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ANTERIOR COMPARTMENT OF THE THIGH
Overview:
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Fascial compartments include: anterior (extensor), medial (adductor), posterior (flexor)
Anterior compartment (5 muscles): sartorius, rectus femoris, vastus lateralis, vastus intermedius, vastus medialis
Blood supply to the lower limb = femoral artery and deep femoral artery
Skeleton of the thigh (N468)
o Anterior superior iliac spine
o Anterior inferior iliac spine
o Pecten pubis
Clinical Anatomy Grant’s Dissector Notes (Summer 2009 and Summer 2010)
Melissa McDole
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o Pubic tubercle
Femur (N489)
o Greater trochanter
o Lesser trochanter
o Lateral condyle and lateral epicondyle
o Medial condyle and medial epicondyle
o Medial supracondylar line
o Adductor tubercle
o Linea aspera
o Pectineal line
Tibia (N513)
o Tuberosity
Patella
o Anterior surface
o Articular surface
Saphenous opening (N544)
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Saphenous opening: great saph. Vein drains into femoral vein
Femoral triangle (N500)
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Femoral triangle
o Boundaries:
 Superior: inguinal ligament
 Lateral: Sartorious muscle
 Medial: adductor longus muscle
o Contents:
 Femoral nerve and branches
 Femoral artery and some branches
 3 branches arise from femoral artery distal to inguinal ligament
o Superficial external pudendal artery
o Superficial epigastric artery
o Superficial circumflex artery
Clinical Anatomy Grant’s Dissector Notes (Summer 2009 and Summer 2010)
Melissa McDole
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Respectively, arteries pass medially, superiorly, laterally, from their origin and supply the superficial
fascia of the abdominal wall, proximal thigh, and part of perineum
 Courses distally between the sartorius muscle and the adductor longus muscle
Femoral vein and some tributaries (great saph vein)
Femoral sheath
Femoral Triangle
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Can feel pulse of femoral artery about 3 cm inferior to midpoint of inguinal ligament
A catheter can be inserted into femoral artery and pushed up to the aorta and its branches
A catheter inserted into the femoral vein can be pushed up to the IVC into the right atrium of the heart
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Femoral sheath (3 compartments)
 Lateral: contains femoral artery
 Intermediate: contains femoral vein
 Medial (femoral canal): contains lymphatics; proximal opening into abdominal cavity is called the femoral ring
 NAVL
Femoral Hernia
 Femoral ring is site for herniation (protrusion of abdominal organs through ring to femoral canal)
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Three arteries arise from femoral triangle
o Deep artery of the thigh (deep femoral artery, profunda femoris artery): courses parallel to femoral artery but posterior to
adductor longus muscle; supplies medial and posterior compartments of the thigh
o Lateral circumflex femoral artery: arises from deep artery of the thigh; passes laterally deep to the proximal end of the rectus
femoris muscle ans supplies the muscles and soft tissues of the lateral part of the thigh; has 3 branches
 Ascending branch: anastomoses with the superior gluteal arty
 Transverse branch: anastomoses with the medial circumflex femoral artery
 Descending branch: courses inferiorly on the anterior surface of the vastus intermedius muscle and anastomoses with
the genicular arteries at the knee
o Medial circumflex artery: passes posteriorly between the pectineus and iliopsoas muscles; important blood supply to the neck of
the femur
Floor of the femoral triangle is formed by the iliacus and psoas muscle (iliopsoas muscle)
o Proximal attachment: iliac fossa (iliacus), transverse processes and bodies of vertebrae of T12 to L5
o Distal attachment: iliopsoas tendon—lesser trochanter of femur
Clinical Anatomy Grant’s Dissector Notes (Summer 2009 and Summer 2010)
Melissa McDole
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o Function: strong flexor of the thigh
Pectineus muscle
o Proximal attachment: pecten pubis and superior ramus of pubis
o Distal attachment: pectineal line of femur
o Function: adducts thigh; flexes thigh
o Innervation: femoral nerve
Femoral nerve
o lies on the floor of the femoral triangle on the lateral side of the femoral artery
o innervates anterior thigh muscles and the skin of the anterior thigh
o anterior cutaneous branches of the femoral nerve
Adductor Canal and Sartorius muscle (N500)
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Adductor canal: fascial compartment deep to sartorius muscle and conducts femoral artery and vein through inferior part of thigh
o Begins at apex of femoral triangle and ends at adductor hiatus (above knee)
o Femoral vessels pass through adductor hiatus to reach popliteal fossa
Sartorius muscle:
o Proximal attachment: anterior superior iliac spine
o Distal attachment: medial surface of the proximal tibia
o Crosses the hip joint and knee joint
o Function: flexes and laterally rotates the thigh; flexes the leg
o Innervation: femoral nerve
Femoral artery runs through the adductor hiatus and becomes the popliteal artery
Nerve to the vastus medialis and saphenous nerve accompany femoral vessels in the adductor canal
o Nerve to the vastus medialis = motor to vastus medialis muscle
o Saphenous nerve = cutaneous nerve; innervates skin of medial side of leg, ankle, and foot
Quadriceps Femoris Muscle (N501)
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Lateral intermuscular septum: attaches to the linea aspera on posterior surface of femur
Quadriceps femoris muscle: occupies most of anterior compartment of the thigh
o 4 parts
 Rectus femoris
 Proximal attachment: anterior inferior iliac spine
 Distal attachment: tibial tuberosity
Clinical Anatomy Grant’s Dissector Notes (Summer 2009 and Summer 2010)
Melissa McDole
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 Crosses hip joint and knee joint
 Function: flexes thigh; extends the leg
 Innervation: femoral nerve
 Vastus lateralis
 On lateral side
 Proximal attachment: lateral lip of linea aspera and greater trochanter of femur
 Distal attachment: tibial tuberosity
 Function: extends the leg
 Innervation: femoral nerve
 Vastus intermedius
 Between lateralis and medius
 Proximal attachment: anterior and lateral surfaces of the femur
 Distal attachment: tibial tuberosity
 Function: extends the leg
 Innervation: femoral nerve
 Vastus medialis
 On medial side
 Proximal attachment: medial lip of linea aspera of femur and intertrochanteric line
 Distal attachment: tibial tuberosity
 Function: extends the leg
 Innervation: femoral nerve
Tendons of al 4 muscles unite to form the quadriceps femoris tendon (attaches to patella); patellar ligament attaches patella to
tibial tuberosity (attachment of quadriceps femoris muscle)
Descending branch of the lateral circumflex femoral artery: can view on anterior surface of vastus intermedius muscle, deep
to rectus femoris muscle
Motor branches of the femoral nerve
 Located between rectus femoris muscle and the 3 vastus muscles
Patellar Tendon (Quadriceps) Reflex
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Patellar tendon reflex tests the function of the femoral nerve and spinal cord segments L2 to L4
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Side note: ALL MUSCLES OF THE ANTERIOR COMPARTMENT OF THE THIGH ARE INNERVATED BY THE FEMORAL
NERVE
Clinical Anatomy Grant’s Dissector Notes (Summer 2009 and Summer 2010)
Melissa McDole
MEDIAL COMPARTMENT OF THE THIGH (N501)
Overview:
Medial compartment contains 6 muscles (gracilis, adductor longus, adductor brevis, pectineus, adductor magnus, obturator externus); function—
adduction of thigh aka adductor group of muscles
 Gracilis muscle
o Proximal attachment: pubic bone
o Distal attachment: medial condyle of the tibia
o Crosses the hip and knee joints
o Function: adducts the thigh; assists with flexion of leg
 Pectineus muscle: adduct thigh
 Adductor longus muscle: adduct thigh
 Deep artery of the thigh
o Passes between the pectineus and adductor longus muscles then courses inferiorly between adductor longus and brevis muscles
o Have perforating arteries that penetrate the adductor brevis and adductor magnus muscles; encircle the femur and supply
muscles of the posterior compartment of thigh
 Adductor brevis muscle
o Proximal attachment: body and inferior ramus of pubis
o Distal attachment: pectineal line and linea aspera of femur
o Function: adducts thigh
 Anterior branch of obturator nerve: crosses anterior surface of adductor brevis muscle
 Posterior branch of obturator nerve: crosses its posterior surface; lies between adductor brevis and adductor magnus muscle
 Adductor magnus muscle
o proximal attachment: ischiopubic ramus and ischial tuberosity
o distal attachment: gluteal tuberosity, linea aspera, medial supracondylar line, adductor tubercle of femur
o has ischiocondylar portion innervated by tibial division of sciatic nerve rather than obturator nerve
 obturator externus muscle: deep to pectineus muscle and iliopsoas tendon
o proximal attachment: superior pubic ramus, ischiopubic ramus, external surface of obturator membrane
o distal attachment: trochanteric fossa on medial side of greater trochanter of femur
o Function: lateral rotator of thigh (N501)
 Side Note:
o Innervation of medial thigh
 Obturator nerve innervates muscles of medial compartment of thigh EXCEPT:
Clinical Anatomy Grant’s Dissector Notes (Summer 2009 and Summer 2010)
Melissa McDole
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Pectineus muscle (motor innervation- femoral nerve and obturator nerve)
Ischiocondylar portion of adductor magnus muscle (innervation by tibial division of sciatic nerve)
GLUTEAL REGION
Overview
Muscles in this region adduct and laterally rotate the thigh
Key landmark: piriformis muscle
Skeleton of Gluteal region:
(N486)
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Pelvis
o Gluteal lines (anterior, posterior, inferior)
o Greater sciatic foramen
o Greater sciatic notch
o Ischial spine
o Lesser sciatic notch
o Lesser sciatic foramen
o Ischial tuberosity
o Sacrotuberous ligament (between sacrum and ischial tuberosity)
o Sacrospinous ligament (between scrum and ischial spine)
Femur (N489)
o Greater trochanter
o Intertochanteric crest
o Trochanteric fossa
o Quadrate tubercle
o Gluteal tuberosity