Gray's Atlas of anatomy

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GRAY’S. ATL AS. OF ANATOMY. SECOND EDITION. G R. 9 9. V -. r i h. r i . s. ta. & ns a i s r e p. . p vi. tahir99-VRG & vip.persianss.ir.

Richard L. Drake, PhD, FAAA Director of Anatomy Professor of Surgery Cleveland Clinic Lerner College of Medicine Case Western Reserve University Cleveland, Ohio, USA. G R. 9 9. V -. A. Wayne Vogl, PhD, FAAA. r i h. Professor of Anatomy and Cell Biology Department of Cellular and Physiological Sciences Faculty of Medicine University of British Columbia Vancouver, British Columbia, Canada. r i . s. ta. & ns a i s r e p. Adam W. M. Mitchell, MBBS, FRCS, FRCR. Consultant Radiologist and Senior Lecturer Imperial College Chelsea and Westminster Hospital London, UK Illustrated by. Richard M. Tibbitts. . p vi. Saffron Walden, UK. Paul E. Richardson Cambridge, UK Photographs by. Ansell Horn. tahir99-VRG & vip.persianss.ir.

GRAY’S. ATLAS OF ANAT OMY. SECOND EDITION. G R. 9 9. V -. r i h. r i . s. ta. & ns a i s r e p. . p vi. Richard L. Drake Richard M. Tibbitts. A. Wayne Vogl. Adam W. M. Mitchell. Paul E. Richardson. tahir99-VRG & vip.persianss.ir.

1600 John F. Kennedy Blvd. Ste 1800 Philadelphia, PA 19103-2899. GRAY’S ATLAS OF ANATOMY, SECOND EDITION INTERNATIONAL EDITION. ISBN: 978-1-4557-4802-0 ISBN: 978-0-7020-5237-8. Copyright © 2015, 2008 by Churchill Livingstone, an imprint of Elsevier Inc. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Details on how to seek permission, further information about the Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions.. G R. Notices. V -. Knowledge and best practice in this field are constantly changing. As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary. Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein. In using such information or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility. With respect to any drug or pharmaceutical products identified, readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications. It is the responsibility of practitioners, relying on their own experience and knowledge of their patients, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions. To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any liability for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein.. The Publisher. 9 9. r i h. & ns a i s r e p. ta. ISBN: 978-1-4557-4802-0. r i . s. . p vi. VP Global Medical Education Content: Madelene Hyde Senior Manager, Content Development: Rebecca Gruliow Publishing Services Manager: Patricia Tannian Senior Project Manager: John Casey Design and Art Direction: Antbits Ltd.. Working together to grow libraries in developing countries www.elsevier.com | www.bookaid.org | www.sabre.org. Printed in Canada Last digit is the print number: 9 8 7 6 5 4 3 2 1. tahir99-VRG & vip.persianss.ir.

To my wife who supports me and to my parents who are always with me. Richard L. Drake To my family, to my professional colleagues and role models, and to my students. Wayne Vogl Thanks, to Cathy, Max and Elsa Adam W. M. Mitchell To my family – my inspiration, Evi, Zoë, and Nicholas x Richard M. Tibbitts To Lesley and in memory of AMR and JER Paul Richardson. tahir99-VRG & vip.persianss.ir.

ACKNOWLEDGMENTS The following reviewers helped enormously with their detailed critiques and suggestions for every chapter. Their assistance was invaluable. Mark Hankin, PhD, University of Toledo College of Medicine, Toledo, Ohio Marios Loukas, MD, PhD, St. George’s University School of Medicine, Grenada James J. Rechtien, DO, PhD, Michigan State University School of Medicine, East Lansing, Michigan William A. Roy, PT, PhD, Touro University, Henderson, Nevada Susan Standring, PhD, DSc, Professor of Experimental Neurobiology and Head, Division of Anatomy, Cell and Human Biology, Guy’s, King’s and St Thomas’ School of Biomedical Sciences, King’s College London, London William Swartz, PhD, Louisiana State University Health Sciences Center, Baton Rouge, Louisiana Mark F. Teaford, PhD, Johns Hopkins University School of Medicine, Baltimore, Maryland We want to thank Dr. Bruce Crawford for a radiograph of the head and neck and Dr. Murray Morrison for laryngoscopic images of the larynx; Dr. Jerry Healy for three images in the Abdomen section: the celiac artery, the bile duct system, and a three-dimensional view of abdominal vessels; and Siemens Medical Solutions USA and the following individuals with that company: Mollie Beaver, Director, CT Clinical Solutions, and Dr. Louise McKenna, Global Clinical Marketing Manager, CT Oncology, who supplied a syngo Multi-modality Workplace, which was used to acquire the majority of the clinical images. Stuart Morrison, MD, helped with all aspects of coordinating the collection of the radiographic material. Radiological assistance and images were contributed in each of the following areas:. Back. Thorax. Abdomen. Pelvis. Extremities. Head and Neck. Mark Kayanja, MD, PhD Jeffrey S. Ross, MD Mario Garcia, MD A. Michael Lincoff, MD Namita Gandhi, MD Michelle Inkster, MD, PhD Brian R. Lane, MD Anand Rao, MD James S. Wu, MD Matthew Barber, MD, MHS Tommaso Falcone, MD J. Stephen Jones, MD Eunice Moon, MD James S. Newman, MD, PhD Hakan Ilaslan, MD Bradford J. Richmond, MD Joshua Polster, MD Todd W. Stultz, DDS, MD J. Martin Paloma, DDS, MSD Cindy McConnaughy Ronald Lemmo, DDS. vi tahir99-VRG & vip.persianss.ir.

FOREWORD A working knowledge of anatomy is not an “optional extra” for health care professionals – it is fundamental. Acquiring that knowledge has always challenged even the most motivated students. Over many generations, learning materials that aid the process effectively have been warmly welcomed by students and their teachers (and by patients, who are the ultimate beneficiaries of that knowledge). I remember my own students’ response when I first included illustrations from Gray’s Anatomy for Students in a lecture—afterward, I was asked repeatedly for the source of the marvelous pictures. Looking beyond the “wow” factor that leapt from the pages of the book, it was clear that an enormous amount of thought and skill had gone into producing the artwork. This atlas contains a series of additional outstanding pieces of anatomical art from the illustrative team of Richard Tibbitts and Paul Richardson that will complement those in Gray’s Anatomy for Students, combined with relevant clinical pictures, surface anatomy, and images from a range of. modern imaging procedures. Of course, anatomy cannot be learned from books and interactive DVDs alone, no matter how excellent they may be. Anatomy is a practical subject, best learned by gaining hands-on experience of the body. Students should spend as much time as they can examining cadaveric dissections (if they do not have the opportunity to dissect themselves) and should always read from screen or page with the appropriate bones in front of them. They need to combine and correlate information from a wide variety of sources in order to gain the working knowledge mentioned earlier. This atlas will provide a valuable companion to their studies, and I am confident that it will remain in their libraries long after they have completed the early stages of their training. Susan Standring, PhD, DSc, FKC, Hon FRCS Emeritus Professor of Anatomy King’s College, London. vii tahir99-VRG & vip.persianss.ir. 1.

FOREWORD We began working on Gray’s Atlas of Anatomy in 2005 following the publication of our textbook, Gray’s Anatomy for Students. We wanted to produce an atlas that would build on themes and concepts established in the textbook and that would couple artistic renderings of “internal” gross anatomy with actual “living” anatomy, as visualized with modern imaging techniques and with surface anatomy. We believe that the final atlas presents a fresh and integrated approach to anatomy that is accessible to entry-level students in anatomy, as well as to students at more advanced levels. Because an atlas is used in a much different way than a textbook, we could not simply repackage figures used in Gray’s Anatomy for Students and put them in the atlas. Consequently, most of the figures in the atlas are new and were designed to present structures in a more complete context than in the textbook, even though the color palette and overall look of the figures in both the atlas and textbook are similar. Also, figures in the atlas provide additional detail not included in the textbook and directly correlate artistic representations of anatomy with computed tomography (CT) and magnetic. resonance imaging (MRI). Where appropriate, we have included endoscopic, laryngoscopic, and laparoscopic views of the anatomy and have included examples of ultrasound images. In a number of regions, we also have reconstructed the internal anatomy of patients by abstracting specific information from multiple MR or CT images, and we present these reconstructions together with artwork of the same anatomy. Although the artwork was done independently of the reconstructed images, the two types of representations are strikingly similar. Each page of this atlas was planned prior to beginning work on the figures, and all of the artwork was generated digitally. Most of the figures were created from an extensive digital database created for the textbook. Each figure was reviewed for accuracy and revised accordingly. We hope that the textbook and atlas used together will provide new and powerful learning tools for students of human gross anatomy. The Authors. viii tahir99-VRG & vip.persianss.ir.

PREFACE The 2nd edition of Gray’s Atlas of Anatomy continues in the tradition of the 1st edition, coupling artistic rendering with actual living anatomy as visualized with modern imaging techniques and surface anatomy. The combination of modern illustrations, imaging, and surface anatomy is unique among atlases available today. We have also added additional study aids that should enhance the learning experience. At the end of every chapter tables and schematic drawings have been added for quick review of subject matter. These include major nerves plexuses. throughout the body, branching patterns of major arteries, summaries of muscles organized into compartments or regions, and other helpful information. This material is designed to provide the reader quick access to information. It’s our hope that the 2nd edition of Gray’s Atlas of Anatomy will become a valuable learning aid for students encountering anatomy for the first time or for the individual seeking to review information critical to their daily experiences. The Authors. ix tahir99-VRG & vip.persianss.ir. 1.

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CONTENTS. 1. THE BODY. Anatomical position, terms, and planes Anatomical planes and imaging Surface anatomy: anterior view Surface anatomy: posterior view Skeleton: anterior Skeleton: posterior Muscles: anterior Muscles: posterior Vascular system: arteries Vascular system: veins Lymphatic system Nervous system Sympathetics Parasympathetics Dermatomes Cutaneous nerves. 2. 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17. BACK. Surface anatomy  Vertebral column Regional vertebrae Cervical vertebrae Thoracic vertebrae Lumbar vertebrae Sacrum Intervertebral foramina and discs Intervertebral disc problems Joints and ligaments Back musculature: surface anatomy Superficial musculature Intermediate musculature Deep musculature Back musculature: transverse section Suboccipital region Spinal nerves Spinal cord Spinal cord vasculature Venous drainage of spinal cord. 20 21 22 23 26 28 31 32 33 35 36 37 39 40 42 43 44 45 46 47. Meninges Spinal cord: imaging Transverse section: thoracic region Dermatomes and cutaneous nerves Tables. 3. 48 50 52 53 54. THORAX. Surface anatomy with bones Bony framework Ribs Articulations Breast Pectoral region Thoracic wall muscles Diaphragm Arteries of the thoracic wall Veins of the thoracic wall Nerves of the thoracic wall Lymphatics of the thoracic wall Intercostal nerves and arteries Pleural cavities and mediastinum Parietal pleura Surface projections of pleural recesses Right lung Left lung Lung lobes: surface relationship Lung lobes: imaging Bronchial tree Bronchopulmonary segments Pulmonary vessels and plexus Pulmonary vessels: imaging Mediastinum Pericardium Pericardial layers Anterior surface of heart Base and diaphragmatic surface of heart Right atrium Right ventricle Left atrium Left ventricle. 62 63 65 66 68 70 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 91 92 93 94 95 96 97 98 99. xi tahir99-VRG & vip.persianss.ir. 1.

CONTENTS Aortic valve and cardiac skeleton Cardiac chambers and heart valves Coronary vessels Coronary arteries and variations Cardiac conduction system Auscultation points and heart sounds Cardiac innervation Superior mediastinum: thymus Superior mediastinum: veins and arteries Superior mediastinum: arteries and nerves Superior mediastinum: imaging Superior mediastinum: veins and trachea Mediastinum: imaging Mediastinum: view from right Mediastinum: imaging – view from right Mediastinum: view from left Mediastinum: imaging – view from left Posterior mediastinum Mediastinum: imaging Transverse section: TVIII level Dermatomes and cutaneous nerves Visceral efferent (motor) innervation of the heart Visceral afferents Tables. 4. 100 101 102 103 105 106 107 108 109 110 111 112 113 114 115 116 117 118 120 124 125 126 127 128. ABDOMEN. Surface anatomy Quadrants and regions Abdominal wall Muscles Muscles: rectus sheath Vessels of the abdominal wall Arteries and lymphatics of the abdominal wall Nerves of the abdominal wall Dermatomes and cutaneous nerves Inguinal region Inguinal canal Inguinal hernias Anterior abdominal wall  Greater omentum. 134 135 136 138 141 142 143 144 145 146 148 150 151 152. Abdominal viscera Peritoneal cavity Abdominal sagittal section Abdominal coronal section Arterial supply of viscera Stomach Spleen Arteries of stomach and spleen Duodenum Small intestine Large intestine Ileocecal junction Gastrointestinal tract: imaging Mesenteric arteries Liver Vessels of the liver Segments of the liver Pancreas and gallbladder Vasculature of pancreas and duodenum Venous drainage of viscera Portosystemic anastomoses Posterior wall Vessels of the posterior wall Diaphragm Kidneys Gross structure of kidneys Kidneys: imaging Renal vasculature Branches of the abdominal aorta Inferior vena cava Abdominal aorta and inferior vena cava: imaging Lumbar plexus Lumbar plexus: cutaneous distribution Lymphatics Abdominal innervation Splanchnic nerves Visceral efferent (motor) innervation diagram Visceral afferent (sensory) innervation and   referred pain diagram Kidney and ureter visceral afferent   (sensory) diagram Tables. 153 154 155 156 157 158 159 160 162 164 166 168 169 170 172 174 175 176 179 180 182 183 184 185 186 188 189 190 192 193 194 196 197 198 199 200 201 202 204 206. xii tahir99-VRG & vip.persianss.ir.

CONTENTS. 5. PELVIS AND PERINEUM. Surface anatomy and articulated pelvis in men Surface anatomy and articulated pelvis in women Pelvic girdle Pelvic girdle: imaging Lumbosacral joint Sacro-iliac joint Pelvic inlet and outlet Orientation of pelvic girdle and pelvic brim Pelvic viscera and perineum in men Pelvic viscera and perineum in men: imaging Pelvic viscera and perineum in women Pelvic viscera and perineum in women: imaging Lateral wall of pelvic cavity Floor of pelvic cavity: pelvic diaphragm Rectum and bladder in situ Rectum Bladder in men Bladder in women Reproductive system in men Prostate Prostate and seminal vesicles Scrotum Testes Penis Reproductive system in women Uterus and ovaries Uterus Uterus: imaging Pelvic fascia Arterial supply of pelvis Venous drainage of pelvis Vasculature of the pelvic viscera Vasculature of uterus Venous drainage of prostate and penis Venous drainage of rectum Sacral and coccygeal nerve plexuses Pelvic nerve plexus Hypogastric plexus Surface anatomy of the perineum Borders and ceiling of the perineum. 212 214 216 217 218 219 220 221 222 223 224 225 226 227 230 231 232 233 234 235 237 238 239 240 241 242 243 244 245 246 247 248 249 250 251 252 253 254 255 258. Deep pouch and perineal membrane Muscles and erectile tissues in men Erectile tissue in men: imaging Muscles and erectile tissues in women Erectile tissue in women: imaging Internal pudendal artery and vein Pudendal nerve Vasculature of perineum Nerves of perineum Lymphatics of pelvis and perineum in men Lymphatics of pelvis and perineum in women Lymphatics Dermatomes Innervation of reproductive system in men Innervation of reproductive system in women Innervation of bladder Pelvic cavity imaging in men Pelvic cavity imaging in women Tables. 6. 259 260 261 262 263 264 265 266 267 268 269 270 271 272 273 274 275 278 284. LOWER LIMB. Surface anatomy Bones of the lower limb Pelvic bones and sacrum Articulated pelvis Proximal femur Hip joint Hip joint: structure and arterial supply Gluteal region: attachments and superficial  musculature Gluteal region: superficial and deep muscles Gluteal region: arteries and nerves Distal femur and proximal tibia and fibula Thigh: muscle attachments Thigh: anterior superficial musculature Thigh: posterior superficial musculature Thigh: anterior compartment muscles Thigh: medial compartment muscles Femoral triangle. 292 293 294 295 296 297 299 300 301 302 304 305 306 307 308 309 310. xiii. 1.

CONTENTS Anterior thigh: arteries and nerves Anterior thigh: arteries Thigh: posterior compartment muscles Posterior thigh: arteries and nerves Transverse sections: thigh Knee joint Ligaments of the knee Menisci and cruciate ligaments Knee: bursa and capsule Knee surface: muscles, capsule, and arteries Popliteal fossa Tibia and fibula Bones of the foot Bones and joints of the foot Talus and calcaneus Ankle joint Ligaments of the ankle joint Leg: muscle attachments Posterior leg: superficial muscles Posterior compartment: deep muscles Posterior leg: arteries and nerves Lateral compartment: muscles Anterior leg: superficial muscles Anterior compartment: muscles Anterior leg: arteries and nerves Leg: cutaneous nerves Transverse sections: leg Foot: muscle attachments Foot: ligaments Dorsum of foot Dorsum of foot: arteries and nerves Plantar aponeurosis Plantar region (sole) musculature: first layer Plantar region (sole) musculature: second layer Plantar region (sole) musculature: third layer  Plantar region (sole) musculature: fourth layer Plantar region (sole): arteries and nerves Dorsal hood and tarsal tunnel Superficial veins of the lower limb Lymphatics of the lower limb Anterior cutaneous nerves and dermatomes of   the lower limb. xiv. 311 312 313 314 316 318 320 322 326 327 328 329 330 333 334 335 336 339 340 341 342 343 344 345 346 347 348 350 351 353 354 356 357 358 359 360 361 363 364 365 366. Posterior cutaneous nerves and dermatomes of   the lower limb Tables. 7. 367 368. UPPER LIMB. Surface anatomy Bones of the upper limb Bony framework of shoulder Scapula Clavicle: joints and ligaments Proximal humerus Glenohumeral joint Muscle attachments Pectoral region Deep pectoral region Walls of the axilla The four rotator cuff muscles Deep vessels and nerves of the shoulder Axillary artery Brachial artery Brachial plexus Medial and lateral cords Posterior cord Distal end of humerus and proximal end   of radius and ulna Muscle attachments Anterior compartment: muscles Anterior compartment: arteries and nerves Veins of the arm Posterior compartment: muscles Posterior compartment: arteries and nerves Lymphatics of the arm Transverse sections: arm Anterior cutaneous nerves of the arm Posterior cutaneous nerves of the arm Elbow joint Elbow joint: capsule and ligaments Cubital fossa Radius and ulna Bones of the hand and wrist joint. 384 385 386 387 388 389 390 392 394 395 396 398 400 401 402 403 404 405 406 407 408 410 411 412 414 415 416 418 419 420 422 424 425 426.

CONTENTS Imaging of the hand and wrist joint Bones of the hand Joints and ligaments of the hand Muscle attachments of forearm Anterior compartment of forearm: muscles Anterior compartment of forearm:   arteries and nerves Posterior compartment of forearm: muscles Posterior compartment of forearm:   arteries and nerves Transverse sections: forearm Carpal tunnel Muscle attachments of the hand Superficial palmar region (palm) of hand Tendon sheaths of hand Lumbrical muscles Intrinsic muscles of hand Palmar region (palm) of hand: arteries and nerves Arteries of the hand Innervation of the hand: median and ulnar nerves Dorsum of hand Dorsal hoods Dorsum of hand: arteries Dorsum of hand: nerves Anatomical snuffbox Superficial veins and lymphatics of forearm Anterior cutaneous nerves of forearm Posterior cutaneous nerves of upper limb Tables. 8. 427 428 429 430 431 434 435 437 438 440 442 443 444 445 446 448 450 451 452 453 454 455 456 457 458 459 460. HEAD AND NECK. Surface anatomy with bones Bones of the skull Skull: anterior view Skull: lateral view Skull: posterior view Skull: superior view and roof Skull: inferior view Skull: cranial cavity Ethmoid, lacrimal bone, inferior concha, and vomer. 476 477 478 480 482 483 484 485 486. Maxilla and palatine bone Skull: muscle attachments Scalp and meninges Dural partitions Dural arteries and nerves Dural venous sinuses Brain Brain: imaging Cranial nerves Arterial supply to brain Cutaneous distribution of trigeminal nerve [V] Facial muscles Vasculature, facial nerve [VII] and lymphatics Deep arteries and veins of parotid region Bony orbit Section through orbit and structures of eyelid Eyelids and lacrimal apparatus Innervation of the lacrimal gland Muscles of the eyeball Innervation of the orbit and eyeball Eye movements Vasculature of orbit Eyeball Eye imaging Ear surface and sensory innervation Ear Middle ear Internal ear Ear imaging Temporal and infratemporal fossae Bones of the temporal and infratemporal fossae Temporal and infratemporal fossae Temporomandibular joint Mandibular division of the trigeminal nerve [V] Parasympathetic innervation Arteries and veins of temporal and   infratemporal fossae Pterygopalatine fossa Neck surface anatomy Bones of the neck Compartments and fascia of the neck Superficial veins of the neck. 487 488 490 491 492 493 494 496 498 500 503 504 506 507 508 509 510 511 512 513 514 515 516 517 520 521 522 524 525 526 527 528 530 531 532 533 534 536 537 538 539. xv. 1.

CONTENTS Muscles of the neck Nerves in the neck  Cranial nerves in the neck Cervical plexus and sympathetic trunk Arteries of the neck Root of the neck: arteries Lymphatics of the neck Pharynx Muscles of the pharynx Innervation of the pharynx Vasculature of the pharynx Larynx Laryngeal cavity Muscles of the larynx Innervation of the larynx Thyroid gland Vasculature of the thyroid gland Nose and paranasal sinuses Nasal cavity: bones. xvi. 540 542 543 544 546 548 550 552 554 556 557 558 560 561 562 563 564 566 567. Nasal cavity: mucosal linings Vasculature and innervation of the nasal cavity Sinus imaging Oral cavity: bones Teeth Teeth: imaging Anatomy of teeth Vessels and nerves supplying teeth Innervation of teeth and gums Muscles and salivary glands of the oral cavity Vessels and nerves of the tongue Tongue Hard and soft palate Palate Innervation of oral cavity Cranial nerves Visceral motor pathways in the head. 568 569 570 572 573 574 575 576 577 578 579 580 581 582 583 584 586. Tables. 588. INDEX. 609.

1. THE BODY. CONTENTS Anatomical position, terms, and planes Anatomical planes and imaging Surface anatomy: anterior view Surface anatomy: posterior view Skeleton: anterior Skeleton: posterior Muscles: anterior Muscles: posterior Vascular system: arteries Vascular system: veins Lymphatic system Nervous system Sympathetics Parasympathetics Dermatomes Cutaneous nerves. 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17.

THE BODY • Anatomical position, terms, and planes. Sagittal plane Superior. Cranial. Caudal Medial. Vertical or longitudinal axis. Lateral. Proximal Transverse axis Posterior Sagittal axis Transverse, horizontal, or axial plane. Anterior. Distal. Dorsum of hand. Palmar surface of hand Proximal. Distal Dorsum of foot. Plantar surface of foot. 2. Inferior. Coronal plane.

1. Anatomical planes and imaging. Sacral promontory. Sacrum. Small intestine Uterus. Rectum. Bladder. Vagina. Pubic symphysis Urethra. Anal canal. T2-weighted MR image, in sagittal plane Heart Diaphragm Liver. Left colic flexure. Right colic flexure. Stomach. Gallbladder Transverse colon. Small intestine. Sigmoid colon. CT image, with contrast, in coronal plane. Manubrium of sternum. Pectoralis major. Left brachiocephalic vein. Right brachiocephalic vein. Brachiocephalic trunk Trachea Left common carotid artery Left subclavian artery Scapula. Esophagus. CT image, with contrast, in axial plane. 3.

THE BODY • Surface anatomy: anterior view. Sternocleidomastoid. Clavicle. Larynx. Acromion. Clavicle. Jugular notch. Jugular notch. Deltoid. Pectoralis major. Deltoid Areola Xiphoid process. Costal margin. Xiphoid process. Nipple Breast Cubital fossa. Cubital fossa Umbilicus Umbilicus Anterior superior iliac spine. Pubic symphysis. Pubic symphysis. Penis Scrotum Glans penis Head of fibula. Patella Tibial tuberosity. Patella. Tibia Tibia. Medial malleolus. Lateral malleolus. Dorsum of foot. 4.

1. Surface anatomy: posterior view. Vertebra prominens (spinous process of CVII) Acromion. Vertebra prominens (spinous process of CVII). Trapezius. Spinous process of TI. Spine of scapula. Deltoid Deltoid Inferior angle of scapula. Medial border of scapula. Latissimus dorsi. Olecranon Spinous process of TXII Iliac crest Iliac crest. Sacral dimple at posterior superior iliac spine Intergluteal cleft. Gluteal fold. Gluteal fold. Biceps femoris tendon Popliteal fossa. Popliteal fossa. Biceps femoris tendon. Gastrocnemius. Calcaneal (Achilles) tendon. Lateral malleolus. Medial malleolus. Calcaneal tuberosity. 5.

THE BODY • Skeleton: anterior. Frontal bone Orbit Zygomatic bone. Maxilla. CVII. Mandible. Rib I. Coracoid process Acromion. Clavicle. Lesser tubercle Manubrium of sternum. Greater tubercle. Scapula Body of sternum Humerus Xiphoid process of sternum Medial epicondyle. Trochlea. Lateral epicondyle. Capitulum. Ilium. Radius. Sacro-iliac joint Ulna. Sacrum Coccyx. Pubis. Carpal bones Pubic symphysis. Metacarpals. Greater trochanter. Ischium. Phalanges Lesser trochanter. Femur. Medial epicondyle Lateral epicondyle. Patella. Palpable bone (anterior view). Tibial tuberosity. Fibula Tibia. Medial malleolus Lateral malleolus Tarsal bones Metatarsals Phalanges. 6.

1. Skeleton: posterior. Parietal bone Occipital bone. External occipital protuberance. Mastoid process CII (axis). CI (atlas) Angle of mandible. Spine of scapula. Superior angle of scapula. Acromion. Clavicle. Greater tubercle. Shoulder joint. Scapula Inferior angle of scapula Humerus. Vertebral column. Medial epicondyle Olecranon. Lateral epicondyle Elbow joint. Head of radius. Iliac crest Posterior superior iliac spine. Radius Ulna. Sacrum. Hip joint. Coccyx. Greater trochanter Wrist joint Ischial tuberosity. Lesser trochanter. Ischial spine. Femur. Palpable bone (posterior view). Medial epicondyle. Medial condyle. Lateral epicondyle Knee joint. Lateral condyle. Fibula Tibia. Medial malleolus Ankle joint Tuberosity of fifth metatarsal. Lateral malleolus Calcaneus. 7.

THE BODY • Muscles: anterior. Temporalis. Frontalis. Orbicularis oculi. Masseter. Buccinator Orbicularis oris. Sternocleidomastoid Trapezius. Scalenes. Long head of biceps brachii (cut). Deltoid. Pectoralis minor Short head of biceps brachii (cut). Pectoralis major. Coracobrachialis External intercostal Serratus anterior. Internal intercostal. Biceps brachii. Brachialis. Rectus abdominis. Posterior wall of rectus sheath Biceps brachii tendon (cut) Supinator (superficial head) Internal oblique (cut). Pronator teres Brachioradialis. Transversus abdominis. External oblique. Flexor digitorum profundus. Flexor carpi radialis Palmaris longus Flexor carpi ulnaris. Flexor pollicis longus Iliopsoas. Tensor fasciae latae. Pronator quadratus Obturator externus. Thenar muscles Hypothenar muscles. Adductor brevis. Sartorius Rectus femoris Iliotibial tract Vastus lateralis. Pectineus Adductor magnus Adductor longus Gracilis. Vastus medialis. Fibularis longus Soleus Tibialis anterior Extensor hallucis longus Extensor digitorum longus. 8. Gastrocnemius Extensor digitorum longus. Extensor hallucis longus.

1. Muscles: posterior. Occipitalis Sternocleidomastoid. Trapezius. Semispinalis capitis. Splenius capitis Splenius cervicis Rhomboid minor Rhomboid major Levator scapulae Supraspinatus Infraspinatus. Deltoid. Teres minor Lateral head of triceps brachii (cut) Teres major Latissimus dorsi (cut) Long head of triceps brachii. Infraspinatus Latissimus dorsi. External intercostal Medial head of triceps brachii Erector spinae. Triceps brachii External oblique. Internal oblique. Extensor carpi radialis longus Supinator (deep head) Flexor carpi ulnaris. Gluteus medius Abductor pollicis longus. Extensor digitorum. Extensor pollicis longus Extensor pollicis brevis. Gluteus maximus. Extensor indicis Piriformis Gemellus superior Obturator internus. Iliotibial tract. Gemellus inferior Quadratus femoris Long head of biceps femoris Semitendinosus Semimembranosus Gracilis Plantaris. Adductor magnus Short head of biceps femoris Semimembranosus Long head of biceps femoris (cut) Plantaris (cut) Popliteus. Gastrocnemius. Fibularis longus Soleus. Soleus (cut). Flexor digitorum longus. Flexor hallucis longus Calcaneal tendon Fibularis brevis (tendon). 9.

THE BODY • Vascular system: arteries. Superficial temporal artery Facial artery Vertebral artery Right subclavian artery Brachiocephalic trunk Axillary artery Internal thoracic artery Ascending aorta Profunda brachii artery. Left internal carotid artery Left external carotid artery Left common carotid artery Left subclavian artery Arch of aorta Anterior circumflex humeral artery Posterior circumflex humeral artery Thoracic aorta Celiac trunk. Common hepatic artery Brachial artery. Splenic artery Left renal artery. Radial artery. Superior mesenteric artery. Ulnar artery. Inferior mesenteric artery Left common iliac artery. Testicular/ovarian artery. Left internal iliac artery Deep palmar arch. Left external iliac artery. Superficial palmar arch. Transverse branch of lateral circumflex femoral artery Descending branch of lateral circumflex femoral artery Popliteal artery. Anterior tibial artery Posterior tibial artery. Fibular artery. Dorsalis pedis artery. 10. Femoral artery Deep artery of thigh.

Vascular system: veins. Superficial temporal vein Facial vein Anterior jugular vein Right subclavian vein. Left external jugular vein Left internal jugular vein Left subclavian vein. Right brachiocephalic vein Axillary vein. Left brachiocephalic vein. Cephalic vein. Superior vena cava. Azygos vein Basilic vein. Inferior vena cava. Brachial veins Hepatic vein. Splenic vein Portal vein. Median cubital vein Testicular/ovarian vein. Inferior mesenteric vein Superior mesenteric vein. Cephalic vein. Left common iliac vein. Basilic vein Radial vein. Left external iliac vein. Ulnar vein. Left internal iliac vein. Deep vein of thigh. Femoral vein. Great saphenous vein. Popliteal vein Small saphenous vein. Anterior tibial vein Posterior tibial vein Great saphenous vein Posterior fibular vein. Small saphenous vein Superficial veins Deep veins. Dorsal venous arch. 11. 1.

THE BODY • Lymphatic system. Pharyngeal tonsil Submandibular nodes. Palatine tonsil Lingual tonsil Thoracic duct. Cervical lymph nodes. Left subclavian vein. Right lymphatic duct Right subclavian vein Efferent lymphatic vessel Axillary lymph nodes. Thymus gland. Cortex (containing lymphocytes and macrophages). Tracheal lymph nodes Lymphatic vessels of the upper limb Thoracic duct Cubital nodes. Spleen. Reticular fiber. Trabecula Valve. Cisterna chyli Small intestine Intestinal lymph nodes. Lymph nodules in small intestine (Peyer’s patch). Large intestine Appendix. Medullary sinus. Iliac lymph nodes Deep lymph nodes Capsule Lymph. Afferent lymphatic vessels. Structure of a lymph node Femoral lymph nodes. Inguinal lymph nodes. Bone marrow Popliteal lymph nodes. Lymphatic vessels of the lower limb. Drainage of the right lymphatic duct Drainage of the thoracic duct. Principal components of the lymphatic system. 12.

Nervous system. Trigeminal nerve [V]. Cervical plexus Brachial plexus. Phrenic nerve. Axillary nerve Musculocutaneous nerve Radial nerve. Intercostal nerves. Median nerve Ulnar nerve Conus medullaris Cauda equina Lumbar plexus. Superficial branch of radial nerve Deep branch of radial nerve. Femoral nerve Sacral plexus. Median nerve. Lateral femoral cutaneous nerve. Ulnar nerve. Sciatic nerve. Lateral femoral cutaneous nerve Peripheral nervous system (PNS) Cranial nerves. Central nervous system (CNS). Obturator nerve Posterior cutaneous nerve. Brain Tibial nerve. Spinal cord Spinal nerves. Common fibular nerve Sural nerve Saphenous nerve Superficial fibular nerve. Deep fibular nerve. Tibial nerve. Sural nerve. 13. 1.

THE BODY • Sympathetics. Peripheral. Organs. Thoracic visceral plexuses. T1. Preganglionic sympathetic nerves follow somatic nerves to periphery (glands, smooth muscle). Heart. Prevertebral plexus. L2. Abdominal viscera. Sympathetic ganglion. Sympathetic trunk. Pelvic viscera. Preganglionic sympathetic Postganglionic sympathetic. Ganglion impar. All sympathetic visceral efferent (motor) nerves originate from spinal levels T1–L2 and pass into the associated spinal nerves. 14.

Parasympathetics [III]. Pupillary constriction Ciliary ganglion Lacrimal gland Pterygopalatine ganglion. [VII]. Parotid gland. [IX] Sublingual gland. Otic ganglion. [X]. Thoracic visceral plexuses. Cranial parasympathetic outflow via cranial nerves. Sumandibular gland. Submandibular ganglion. Heart. Sacral parasympathetic outflow via pelvic splanchnic nerves. Prevertebral plexus. Transition from supply by [X] to pelvic splanchnic nerves. Synapse with nerve cells of enteric system Abdominal viscera. S2–S4. Erectile tissues of penis (or clitoris in women). Preganglionic parasympathetic Postganglionic parasympathetic. Pelvic viscera. All paraympathetic visceral efferent (motor) nerves emerge from the brain in cranial nerves III, VII, IX, and X and from spinal levels S2–S4. 15. 1.

THE BODY • Dermatomes. [V1] C2. Cranial nerve [V] (Trigeminal nerve). [V2] [V3]. C3 C2. C4. C3 C4. T2 T3. T2. T4. T3. C5. T5 T6 T7 T8 T9 T10 T11 T12 L1 L2 L3 L4. C5. T4 T5 T6 T2. C5. T2. T7 T8 T9 T10. T1. T1. T1. T1. L5. T11 T12. C6. C5. C6. C6. C6. S3. L1 S4. C8 C8. C8 C7. L2. C8. C7. C7 C7. L2. S2 L3. S2. L3 L3 L3. Trigeminal L4 L5. L4. Cervical L5 Thoracic Lumbar. L5. L5 L4 L4. Sacral. S1. S1. S1. Dermatome map (cutaneous distribution of nerves). 16. S1.

Cutaneous nerves. Greater occipital nerve C2 Supraclavicular nerves (from cervical plexus) C3,4 Lateral cutaneous nerves T3–T5. Third occipital nerve C3 Posterior cutaneous branches C4–T6. Superior lateral cutaneous nerve of arm C5,6. Supraclavicular nerve (from cervical plexus) C3,4 Superior lateral cutaneous nerve of arm (from axillary nerve) C5,6 Posterior cutaneous nerve of arm C5,6,7,8. Medial cutaneous nerve of arm C8,T1. Medial cutaneous nerve of arm C8,T1. Anterior cutaneous branches of intercostal nerves T2–T11. Intercostobrachial nerve T2. Intercostobrachial nerve T2 Inferior lateral cutaneous nerve of arm C5,6. Inferior lateral cutaneous nerve of arm C5,6 Posterior cutaneous branches T7–T12. Medial cutaneous nerve of forearm C8,T1 Lateral cutaneous nerves T6–T11. Posterior cutaneous nerve of forearm C5,6,7,8 Medial cutaneous nerve of forearm C8,T1. Superior cluneal nerves L1–L3 Medial cluneal nerves S1–S3 Anterior cutaneous branch of subcostal nerve (T12). Lateral cutaneous nerve of forearm C5,6 Lateral cutaneous branch of subcostal nerve (T12). Lateral cutaneous nerve of forearm C5,6 Iliohypogastric nerve L1. Iliohypogastric nerve L1. Subcostal T12. Superficial branch of radial C6,7,8. Femoral branch of genitofemoral L1,2 Inferior cluneal nerves Inguinal nerve L1 S1–S3. Palmar branch of median Palmar branch of ulnar Superficial branch of radial C7,8. Dorsal branch of ulnar C8,T1. Lateral cutaneous of thigh L2,3. Median C6,7,8. Median C6,7,8. Obturator L2,3,4. Ulnar C8, T1 Medial and intermediate cutaneous of thigh L2,3. Medial cutaneous of thigh L2,3. Lateral cutaneous of thigh L2,3 Posterior cutaneous of thigh L2,3. Infrapatellar branch of saphenous Lateral cutaneous of calf L5, S1,2. Saphenous L3,4. Saphenous L3,4 Lateral sural cutaneous nerve L5, S1,2. Sural communicating branch of common fibular. Superficial fibular L4,5, S1. Sural L5, S1,2. Deep fibular Sural S1,2. 17. 1.

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2. BACK. CONTENTS Surface anatomy  Vertebral column Regional vertebrae Cervical vertebrae Thoracic vertebrae Lumbar vertebrae Sacrum Intervertebral foramina and discs Intervertebral disc problems Joints and ligaments Back musculature: surface anatomy Superficial musculature Intermediate musculature Deep musculature Back musculature: transverse section Suboccipital region Spinal nerves Spinal cord Spinal cord vasculature Venous drainage of spinal cord Meninges Spinal cord: imaging Transverse section: thoracic region Dermatomes and cutaneous nerves Tables. 20 21 22 23 26 28 31 32 33 35 36 37 39 40 42 43 44 45 46 47 48 50 52 53 54.

BACK • Surface anatomy. Ligamentum nuchae. Vertebra prominens (spinous process of CVII) Acromion of scapula. Spine of scapula. Inferior angle of scapula. Spinous process of TXII. Iliac crest Sacral dimple at posterior superior iliac spine. Intergluteal cleft. Surface anatomy of the back. 20.

Vertebral column. Anterior view. Posterior view. Lateral view. CI (atlas). CI (atlas). CI (atlas). CII (axis). CII (axis). CII (axis) Cervical vertebrae. Cervical curvature. CVII. CVII. CVII. TI. TI. TI. Intervertebral disc Thoracic vertebrae. Thoracic curvature Intervertebral disc. TXII. TXII TXII LI. LI LI. Lumbar curvature. LV. LV. Lumbar vertebrae. LV. Promontory Sacrum. Sacrum. Coccyx. Coccyx. Sacral/coccygeal curvature. 21. 2.

BACK • Regional vertebrae. Vertebral foramen Superior articular process Spinous process 7 cervical vertebrae (CI–CVII). Inferior articular process Vertebral body. Foramen transversarium Transverse process. CV vertebra. Superior articular process Transverse process. Facet for articulation with tubercle of rib V. Vertebral foramen. Inferior articular process Spinous process. 12 thoracic vertebrae (TI–TXII). Demifacet for articulation with head of rib V. Vertebral body. Demifacet for articulation with head of rib VI. TV vertebra Vertebral foramen Superior articular process Spinous process. Pedicle. 5 lumbar vertebrae (LI–LV). Transverse process Vertebral body Inferior articular process. Sacrum (5 fused sacral vertebrae I–V). Coccyx (3–4 fused coccygeal vertebrae I–IV). LIII vertebra. 22.

Cervical vertebrae. Anterior tubercle of CI (atlas). Posterior tubercle of CI (atlas). CI (atlas). Anterior tubercle of CI (atlas). Lateral atlanto-axial joint. Dens of CII (axis). Posterior tubercle of CI (atlas). Body of CII (axis). CII (axis) Intervertebral disc. Spinous process of CII (axis). Zygapophysial joint. CIII. Spinal cord. Column of articular processes. CIV Intervertebral foramen. Vertebra prominens (spinous process of CVII). Vertebral body of CVII. CV Anterior tubercle of CVI (carotid tubercle). Spinous processes. CVI. Cervical region of vertebral column. T1-weighted MR image in the sagittal plane. Foramen transversarium CVII. Vertebra prominens (spinous process of CVII). Cervical vertebrae (lateral view). Posterior tubercle of CI (atlas). Anterior tubercle of CI (atlas) Spinous process of CIII. Spinous process of CII (axis). Vertebral body of CII (axis). Intervertebral disc space Vertebra prominens (spinous process of CVII) Rib I Vertebra prominens (spinous process of CVII)). Vertebral body of CVII. Cervical region of vertebral column. Radiograph, AP view. Cervical region of vertebral column. Radiograph, lateral view. 23. 2.

BACK • Cervical vertebrae Anterior tubercle Anterior arch. Articular facet for dens Tubercles for attachment of transverse ligament of atlas Lateral mass. Foramen transversarium. Anterior arch. Superior articular facet. Superior articular facet Groove for vertebral artery. Transverse process Lateral mass. Vertebral foramen. Anterior tubercle. Posterior arch Posterior tubercle. CI vertebra (atlas; superior view). CI vertebra (atlas; anterior view). Anterior articular facet Dens. Dens (odontoid process) Groove on posterior surface of dens for transverse ligament of atlas. Superior articular facet. Anterior articular facet Superior articular facet. Transverse process. Facets for attachment of alar ligaments. Interarticular part. Vertebral foramen Spinous process. Inferior articular facet Body. CII vertebra (axis; superior view) Body. CII vertebra (axis; anterior view). Pedicle. Body. Uncinate process. Anterior tubercle. Foramen transversarium. Posterior tubercle Groove for spinal nerve Superior articular facet Inferior articular process. Lamina. Vertebral foramen. Inferior articular facet Spinous process (bifid). Spinous process (bifid). CV vertebra (superior view). CV vertebra (anterior view) Uncinate process Zygapophysial joint. Body of vertebra Joint capsule. CIV. Uncovertebral joint. Uncinate process. Intervertebral disc CV. Uncovertebral joint Inferior articular facet. CIV/CV vertebrae (anterior view). 24.

Cervical vertebrae Anterior. Anterior tubercle of CI (atlas) Median atlanto-axial joint. Transverse process of CI (atlas). Dens of CII (axis) Transverse ligament of atlas. Foramen transversarium. Posterior arch of CI (atlas) Posterior tubercle of CI (atlas). First cervical vertebra (atlas). CT image in axial plane Posterior. Anterior arch of CI (atlas). Dens of CII (axis). Posterior arch of CI (atlas). Spinous process of CII (axis) Vertebral body of CII (axis). Intervertebral disc space. Cervical vertebrae CI–CIII. Radiograph, lateral view. Anterior. Vertebral body. Anterior tubercle Foramen transversarium. Posterior tubercle. Vertebral foramen. Spinous process. Lamina. Typical cervical vertebra. CT image in axial plane Posterior. 25. 2.

BACK • Thoracic vertebrae. TI Vertebral body of TI. TII. Zygapophysial joint. TIII. TIV. Intervertebral foramen. Intervertebral disc TV. TVI Cerebrospinal fluid in subarachnoid space. Intervertebral disc. TVII. TVIII. Spinal cord Spinous process. TIX. Vertebral body of TIX (with compression fracture). TX. TXI. TXII Vertebral body of TXII. Thoracic region of vertebral column.. Thoracic vertebrae (lateral view). T2-weighted MR image in sagittal plane (compression fracture TIX). Body. Superior articular process. Vertebral foramen. Superior vertebral notch. Superior articular facet. Demifacet for articulation with head of rib III Demifacet for articulation with head of rib III. Facet for articulation with tubercle of rib III. Body Pedicle. Superior articular facet. Spinous process Demifacet for articulation with head of rib IV Lamina. Transverse process Spinous process. TIII vertebra (superior view). 26. Facet for articulation with tubercle of rib III. Inferior vertebral notch Inferior articular facet Inferior articular process. TIII vertebra (lateral view).

Thoracic vertebrae. Superior articular facet. Vertebral body of TI. Transverse process. Lamina. Vertebral body of TV. Inferior articular process. Spinous process. TIII vertebra (posterior view) Rib Thoracic aorta. Spinous process. Vertebral body. Head of rib. Transverse process Intervertebral disc space. Pedicle. Vertebral body of TXII. Thoracic region of vertebral column. Radiograph, AP view. Transverse process. Tubercle of rib. Spinous process. Thoracic vertebra with rib articulations. CT image in axial plane Superior articular process Superior vertebral notch. Body. Costal facet. Superior articular facet Transverse process. Spinous process Body. Vertebral foramen Pedicle Superior articular facet. Inferior vertebral notch. Transverse process Spinous process. TXII vertebra (superior view). Inferior articular facet Inferior articular process. TXII vertebra (lateral view). 27. 2.

BACK • Lumbar vertebrae Spinous process. Vertebral body LI. Vertebral body of LI. LII. Spinous process. Intervertebral disc Transverse process. LIII. Intervertebral foramen. LIV Zygapophysial joint Intervertebral disc. Vertebral body of LV. LV. Lumbar vertebrae (lateral view). Lumbar region of vertebral column. T1-weighted MR image in sagittal plane. Vertebral body of LI Spinal nerve Vertebral body of LI Pedicle Intervertebral foramen Intervertebral disc space Intervertebral foramen Inferior articular process Superior articular process Intervertebral disc Vertebral body of LV. Vertebral body of LV. Intervertebral foramina of lumbar region of vertebral column. T1-weighted MR image in sagittal plane. Lumbar region of vertebral column. Radiograph, lateral view. 28.

Lumbar vertebrae. Body. Vertebral foramen. Pedicle. Mammillary process. Superior articular facet. Lamina. Transverse process. Spinous process. LIV vertebra (superior view) Superior articular process Superior articular facet Mammillary process. Transverse process. Inferior articular process Spinous process. LIV vertebra (posterior view). Vertebral body Psoas major Superior articular process Zygapophysial joint. Inferior articular process. Lamina. Spinous process. Articulation of lumbar vertebrae. T1-weighted MR image in axial plane. 29. 2.

BACK • Lumbar vertebrae Superior vertebral notch. Superior articular process. Pedicle Mammillary process Transverse process. Body. Spinous process. Inferior vertebral notch Inferior articular facet. LIV vertebra (lateral view) Superior articular process Superior articular facet. Mammillary process Transverse process. Body. Lamina. Accessory process Pars interarticularis. Inferior articular process. Spinous process. LIV vertebra (oblique view) Superior articular process. Lamina. Transverse process. Pedicle. Spinous process. Pars interarticularis. Lumbar region of vertebral column (“Scottie dog”). Radiograph, oblique view. 30. Inferior articular process.

Sacrum. Sacral canal. Superior articular process. Articular facet for pelvic bone (sacro-iliac joint). Superior articular facet. Promontory Ala. Anterior sacral foramina. Lateral sacral crest Median sacral crest Intermediate sacral crest. Posterior sacral foramina. Sacral cornua. Sacral hiatus Cornua. Cornua Transverse process. Transverse process Coccyx. Sacrum and coccyx (anterior view). Sacrum and coccyx (posterior view). Superior articular process. Vertebral body of LV. Spinous process Promontory Articular facet for pelvic bone (sacro-iliac joint). Sacrum Sacral cornua Cornua. Intervertebral disc. SI. Sacral region of vertebral column.. Sacrum and coccyx (lateral view). T2-weighted MR image in sagittal plane. 31. 2.

BACK • Intervertebral foramina and discs Intervertebral disc. Nucleus pulposus. Superior articular process Anulus fibrosus Transverse process. Vertebral body Spinous process. Spinal cord Spinal nerve Posterior ramus Intervertebral disc Superior articular facet Anterior ramus Transverse costal facet Intervertebral disc Hyaline cartilage Anulus fibrosus. Nucleus pulposus Intervertebral foramen Inferior costal facet Intervertebral disc. Superior costotransverse ligament. Superior costal facet. Radiate ligament of costovertebral joint. Lateral costotransverse ligament. Sympathetic trunk and ganglia Vertebral body of LV. Sacrum. Intervertebral disc in lower lumbar region of vertebral column.. Gray and white rami communicantes. Rib. Intercostal nerve. Intervertebral foramina and discs in the thoracic region. T2-weighted MR image in sagittal plane. 32 tahir99-VRG & vip.persianss.ir.

Intervertebral disc problems. Spinal cord. Cauda equina. Vertebral canal containing cerebrospinal fluid and cauda equina. LIV. Herniation of nucleus pulposus LV. LIV vertebra. Disc protrusion. Intervertebral disc protrusion in lower lumbar region of vertebral column. T2-weighted MR image in sagittal plane Vertebral canal containing cerebrospinal fluid and cauda equina. Intervertebral disc protrusion (midsagittal section). Nucleus pulposus. Anulus fibrosus Defect in anulus fibrosus. Herniation of nucleus pulposus. Compression of spinal nerve roots Dura. Cauda equina. Disc protrusion. Intervertebral disc protrusion in lower lumbar region of vertebral column.. Intervertebral disc protrusion (superior view). T2-weighted MR image in axial plane. 33 tahir99-VRG & vip.persianss.ir. 2.

BACK • Intervertebral disc problems. Cauda equina LIV L4 Herniation of nucleus pulposus of L4/L5 disc not affecting LIV spinal nerve but compressing LV and other nerves passing to lower levels. LV L5. Sacrum S1 S2. S3 S4 S5. Co. Intervertebral disc protrusion (posterior view). Nerve root. Main weakness. Reflex decreased. Area of sensory decrease. Disc involved. C5. Deltoid (biceps). (biceps, pectoralis). Shoulder, upper lateral arm. C4–C5. C6. Wrist extension. (biceps, brachioradialis). 1st and 2nd digits (lateral forearm). C5–C6. C7. Triceps. Triceps. Third finger. C6–C7. C8. Intrinsic hand muscles. 4th and 5th digits (medial forearm). C7–T1. C5. C5–C6 C7. C6. Clinically important nerve roots in the upper limb. Nerve root. Main weakness. Reflex decreased. Area of sensory decrease. Disc involved. L4. Iliopsoas and quadriceps. Patellar tendon (knee jerk). Knee, medial lower leg. L3–L4. L5. Dorsiflexion of foot at ankle (big toe extension, foot eversion and inversion). Dorsum of foot, big toe. L4–L5. S1. Plantar flexion of foot at ankle. Lateral foot, small toe, sole. L5–S1. Achilles tendon (ankle jerk). L4. L5 S1. Clinically important nerve roots in the lower limb. 34 tahir99-VRG & vip.persianss.ir.

Joints and ligaments. Anterior longitudinal ligament External occipital protuberance Lumbar vertebral body Ligamentum nuchae. Superior articular process Superior articular facet. Vertebra prominens (spinous process of CVII) Supraspinous ligament Interspinous ligament. Intervertebral disc Posterior longitudinal ligament. Ligamenta flava. Spinous process. Capsule of zygapophysial joint. Transverse process. Supraspinous ligament. Ligamentum nuchae and supraspinous ligament (lateral view) Anterior longitudinal ligament Superior articular process. Interspinous ligament. Inferior articular facet. Ligamenta flava. Interspinous ligament. Inferior articular process. Vertebral ligaments of the lumbar region (posterior oblique view). Supraspinous ligament. Intervertebral disc Posterior longitudinal ligament. Inferior articular process. Ligamenta flava. 35 tahir99-VRG & vip.persianss.ir. 2.

BACK • Back musculature: surface anatomy. Ligamentum nuchae Splenius capitis Trapezius Levator scapulae Superior angle of scapula Acromion of scapula Rhomboid minor Spine of scapula. Rhomboid major Triangle of auscultation Humerus. Inferior angle of scapula. Latissimus dorsi. Erector spinae Iliac crest. Posterior view of male showing surface projections of back muscles. 36 tahir99-VRG & vip.persianss.ir.

Superficial musculature. Superior nuchal line. External occipital protuberance. Splenius capitis. Dorsal scapular nerve Superficial branch of transverse cervical artery. Trapezius. Levator scapulae Spine of scapula. Accessory nerve [XI] Rhomboid minor. Deltoid. Deep branch of transverse cervical artery (dorsal scapular artery). Infraspinatus. Rhomboid major Teres major. Triangle of auscultation. Inferior angle of scapula. Humerus Latissimus dorsi. Thoracolumbar fascia. External oblique. Lumbar triangle. Superficial musculature – trapezius and latissimus dorsi. 37 tahir99-VRG & vip.persianss.ir. 2.

BACK • Superficial musculature. Splenius capitis. Dorsal scapular nerve Levator scapulae. Superficial branch of transverse cervical artery. Supraspinatus Spine of scapula. Levator scapulae Rhomboid minor. Rhomboid minor (cut) Deep branch of transverse cervical artery (dorsal scapular artery). Teres minor Infraspinatus Rhomboid major. Rhomboid major (cut). Teres major Levator scapulae Rhomboid minor Supraspinatus. Latissimus dorsi. Teres minor Infraspinatus External oblique. Teres major Serratus anterior. Rhomboid major. Superficial musculature – levator scapulae and rhomboid major and minor. 38.

Intermediate musculature. Semispinalis capitis Splenius capitis. Ligamentum nuchae Levator scapulae Supraspinatus Acromion of scapula. Serratus posterior superior. Teres minor. Splenius cervicis. Infraspinatus Teres major Posterior layer of thoracolumbar fascia Serratus anterior. Serratus posterior inferior. External oblique Iliac crest. Intermediate musculature. 39. 2.

BACK • Deep musculature. Occipital bone Superior nuchal line Ligamentum nuchae. Splenius capitis. Vertebra prominens (spinous process of CVII). Semispinalis capitis Spinous process of CII (axis) Longissimus capitis. Iliocostalis cervicis Longissimus cervicis. Splenius cervicis. Longissimus. Spinalis thoracis Longissimus thoracis. Spinalis. Iliocostalis thoracis. Iliocostalis. Iliocostalis lumborum. Transversus abdominis Iliac crest. Posterior superior iliac spine. Deep group of back muscles – erector spinae muscles. 40.

Deep musculature. Rectus capitis posterior minor. Semispinalis capitis. Obliquus capitis superior Transverse process of CI (atlas). Spinous process of CII (axis) Rectus capitis posterior major Obliquus capitis inferior. Vertebra prominens (spinous process of CVII). Semispinalis thoracis Rotatores thoracis (long, short). Levatores costarum (short, long). Multifidus. Intertransversarius Quadratus lumborum Iliac crest. Erector spinae (cut). Deep group of back muscles – transversospinales and segmental muscles. 41. 2.

BACK • Back musculature: transverse section. Transversalis fascia Psoas major. Transversus abdominis. Skin. Internal oblique. Superficial fascia. External oblique. Quadratus lumborum Anterior layer Middle layer. Latissimus dorsi. Posterior layer Erector spinae. Thoracolumbar fascia. Transversospinales. Thoracolumbar fascia and the deep back muscles (transverse section – lumbar region). Transversus abdominis Internal oblique Psoas major External oblique. Quadratus lumborum. Latissimus dorsi Transverse process. Erector spinae Spinous process Transversospinales. Lumbar region (LIII) showing back musculature. CT image in axial plane. 42.

Suboccipital region. Third occipital nerve (posterior ramus of C3) Superior branch of the occipital artery. Semispinalis capitis (cut) Greater occipital nerve (posterior ramus of C2). Rectus capitis posterior minor Rectus capitis posterior major Obliquus capitis superior. Splenius capitis (cut). Occipital artery. Posterior ramus of C1. Mastoid process of temporal bone. Inferior branch of the occipital artery. Transverse process of CI (atlas) Vertebral artery. Posterior ramus of C2. Obliquus capitis inferior Transverse process of CII (axis). Longissimus capitis. Spinous process of CII (axis) Interspinalis cervicis Multifidus. Posterior ramus of C3. Spinalis cervicis. Semispinalis capitis (cut). Sternocleidomastoid (cut). Splenius capitis (cut) Trapezius (cut). Semispinalis cervicis. Suboccipital region. 43. 2.

BACK • Spinal nerves. C1. Relation of spinal nerve roots to vertebrae. CI. C2. Subarachnoid space. CII. C3. CIII. C4. Cervical nerves. Cervical enlargement (of spinal cord). CIV. C5. C1. CV. C1 emerges between skull and CI vertebra. CI (atlas). C6. CVI. C7. C2. CVII. CII (axis). C3. C8. CIII. TI. C4. T1. CIV. TII. T2. C5. TIII. T3. CV. C6. TIV. CVI. C7. T4. C8. TVI. T6. TI. T1 TVII. Thoracic nerves. C8 emerges inferior to pedicle of CVII vertebra. CVII. TV. T5. C2–C7 emerge superior to pedicles. T1–Co emerge inferior to pedicles of their respective vertebrae. TII. T7. T2 TVIII. T8. Nomenclature of spinal nerves (posterior view). TIX. T9 TX. T10 LIV. TXI. Pedicle of vertebra. T11 Lumbosacral enlargement L4 (of spinal cord). TXII. T12. LV LI. L5. L1. Conus medullaris LII. L2 Lumbar nerves. Cauda equina. S1. LIII. L3. S2. Sacrum. LIV. Filum terminale (pial part). L4. S3 S4. LV. S5. L5 SI. End of dural/arachnoid sac. Filum terminale. SII. S1. Sacral and coccygeal nerves. Coccyx. SIV. S2 S3. SV. S4. 44. Co. SIII. S5 Co. Filum terminale (dural part) Coccyx. Sacral and coccygeal nerves (posterior view – vertebral arches removed).

Spinal cord. Spinal cord and spinal nerves in vertebral canal C1. Central canal Anterior median fissure. Cervical enlargement (of spinal cord). Anterior horn Gray matter White matter. Anterior rootlets Posterior horn C8. Pedicles of vertebrae. Posterior rootlets. T1. Anterior root Posterior root Spinal nerve Sympathetic trunk Anterior ramus Spinal ganglion Posterior ramus Sympathetic ganglion. Posterior median sulcus. White ramus communicans. Posterior intermediate sulcus Posterolateral sulcus Recurrent meningeal branches of spinal nerve. Lumbosacral enlargement (of spinal cord). Gray ramus communicans. Features of the spinal cord (thoracic region) and basic organization of a spinal nerve (posterior view) Conus medullaris Cauda equina. T12 L1 Vertebral body. Sympathetic ganglion Gray and white rami communicantes. Anterior root L5. Spinal nerve. Spinal ganglion. Anterior ramus. S1. Posterior ramus Posterior root S5 Filum terminale. Co. Intervertebral foramen. Spinous process. Spinal nerves (transverse section). 45. 2.

BACK • Spinal cord vasculature. Segmental supply of spinal cord (posterior view). Anterior spinal artery. Posterior spinal artery Anterior spinal artery. Anterior radicular artery. Anterior radicular artery Right posterior intercostal artery. Segmental medullary arteries Vertebral artery Ascending cervical artery Deep cervical artery Costocervical trunk Segmental spinal artery. Posterior radicular artery. Thyrocervical trunk. Segmental spinal artery Right posterior spinal artery. Subclavian artery. Left posterior spinal artery Posterior radicular artery Segmental medullary artery Left posterior intercostal artery Segmental spinal artery. Segmental supply of spinal cord (anterior view). Right posterior spinal artery. Left posterior spinal artery Segmental medullary arteries (branch from segmental spinal artery) Sulcal (central) branches to spinal cord. Posterior intercostal artery Posterior radicular artery Segmental spinal artery. Anterior spinal artery. Artery of Adamkiewicz (branch from segmental spinal artery). Posterior radicular artery Anterior radicular artery. Anterior radicular artery Segmental spinal artery Anastomotic loops to posterior spinal arteries. Segmental spinal artery. Pia arterial plexus Segmental spinal artery. Segmental medullary artery. Lateral sacral artery. Segmental medullary artery. Anterior spinal artery. Right posterior intercostal arteries. Arteries that supply the spinal cord (anterior view). 46. Left posterior intercostal arteries Segmental spinal artery.

Venous drainage of spinal cord Anterior internal vertebral plexus. Anterior external vertebral plexus. Dura mater Posterior internal vertebral plexus. Basivertebral vein. Spinal nerve. Vertebral venous plexus (left posterolateral view) Accessory hemi-azygos vein. Intervertebral vein. Posterior intercostal vein. Posterior ramus Anterior ramus. Vein connecting to posterior external venous plexus (not shown) Basivertebral vein. Anterior spinal vein. Posterior longitudinal ligament. Anterior internal vertebral plexus. Dura mater Intervertebral vein. Anterior radicular vein Posterior radicular vein. Extradural fat. Posterior sulcal (central) vein Posterior internal vertebral plexus. Posterior spinal vein. Veins that drain the spinal cord (transverse section). 47. 2.

BACK • Meninges. Subarachnoid space. Pia mater. Arachnoid mater Dura mater. Subarachnoid space. Intervertebral foramen. Cord and meninges at thoracic level. Arachnoid mater Dura mater. Pia mater Arachnoid mater Dura mater. End of spinal cord at vertebrae LI–LII Cauda equina. Filum terminale (pial part). Cauda equina and meninges at lumbar level Anterior sacral foramen. Anterior ramus. Sacral spinal nerve. End of subarachnoid space–sacral vertebra II Posterior ramus Posterior sacral foramen Dura mater. Nerve root Filum terminale (dural part). Nerve roots and meninges at sacral level. 48.

Meninges. Anterior spinal artery. Subarachnoid space. Arachnoid trabeculae. Pia mater. Posterior spinal arteries. Denticulate ligament. Anterior root. Posterior root Spinal ganglion. Arachnoid mater. Dura mater. Spinal nerve. Recurrent meningeal branches of spinal nerve. Meninges covering parts of the thoracic region of the spinal cord (posterior view). 49. 2.

BACK • Spinal cord: imaging. Cerebellum. Vertebral body of CII (axis) Spinous process of CII (axis) Cerebrospinal fluid in subarachnoid space. Spinal cord. Cervical enlargement of spinal cord. Vertebra prominens (spinous process of CVII). Vertebral body of CVII. Intervertebral disc. Cervical and upper thoracic vertebral column showing upper and middle portions of spinal cord. T2-weighted MR image in sagittal plane. 50.

Spinal cord: imaging. Spinous process of thoracic vertebra Vertebral body of thoracic vertebra Spinal cord. Cerebrospinal fluid. Intervertebral disc. Vertebral body of LI. Lumbosacral enlargement Conus medullaris. Thoracic and upper lumbar vertebral column showing middle and lower portions of spinal cord and its termination.. Cauda equina. T2-weighted MR image in sagittal plane. Spinal cord. Conus medullaris Vertebral body of LI. Cerebrospinal fluid in lumbar cistern. Intervertebral disc. SI. Cauda equina. Spinous process of lumbar vertebra. End of dural/arachnoid sac. Lumbar and sacral vertebral column showing termination of spinal cord and continuation and termination of dural/arachnoid sac. T2-weighted MR image in sagittal plane. 51. 2.

BACK • Transverse section: thoracic region. Posterior intercostal artery. Latissimus dorsi. Thoracic aorta. Vertebral body. Accessory hemi-azygos vein. External intercostal. Left lung Azygos vein. Internal intercostal Innermost intercostal. Sympathetic ganglion White and gray rami communicantes. Serratus anterior. Spinal nerve. Right lung Visceral Parietal. Anterior ramus Pleura. Posterior ramus. Teres major Subscapularis. Spinous process. Scapula. Posterior cutaneous branch of posterior ramus of spinal nerve. Infraspinatus Trapezius. Erector spinae Rhomboid major. Transverse section through thoracic region of vertebral column. Right lung. Thoracic aorta. Left lung. Scapula. Rhomboid. Transversospinales Erector spinae. Trapezius. Thoracic region of back. CT image in axial plane. 52.

Dermatomes and cutaneous nerves. Greater occipital nerve C2 Third occipital nerve C3. C3 C4 T2. Trapezius Posterior cutaneous branches C4–T6. T3 T4 T5 T6 T7 T8 T9 T10 T11 T12. Latissimus dorsi Posterior cutaneous branches T7–T12. L1 L2 L3 L4. Superior cluneal nerves L1–L3. L5 Iliohypogastric nerve L1 S3. Medial cluneal nerves S1–S3. S4 Inferior cluneal nerves S1–S3. Dermatomes and cutaneous nerves of the back. 53. 2.

BACK • Tables Superficial (appendicular) group of back muscles Muscle. Origin. Insertion. Innervation. Function. Trapezius. 1. Superior nuchal line, external occipital protuberance, ligamentum nuchae, spinous processes of CVII to TXII. Lateral one third of clavicle, acromion, spine of scapula. Motor—accessory nerve [XI]; proprioception— C3 and C4. Assists in rotating the scapula during abduction of humerus above horizontal; upper fibers elevate, middle fibers adduct, and lower fibers depress scapula. Latissimus dorsi. 2. Spinous processes of TVII to LV and sacrum, iliac crest, ribs X to XII. Floor of intertubercular sulcus of humerus. Thoracodorsal nerve (C6 to C8). Extends, adducts, and medially rotates humerus. Levator scapulae. 3. Transverse processes of CI to CIV. Upper portion of medial border of scapula. C3 to C4 and dorsal scapular nerve (C4, C5). Elevates scapula. Rhomboid major. 4. Spinous processes of TII to TV. Medial border of scapula between spine and inferior angle. Dorsal scapular nerve (C4, C5). Retracts (adducts) and elevates scapula. Rhomboid minor. 5. Lower portion of ligamentum nuchae, spinous processes of CVII and TI. Medial border of scapula at the spine of scapula. Dorsal scapular nerve (C4, C5). Retracts (adducts) and elevates scapula. Intermediate (respiratory) group of back muscles Serratus posterior superior. 6. Lower portion of ligamentum nuchae, spinous processes of CVII to TIII and supraspinous ligaments. Mastoid process, skull below lateral one third of superior nuchal line. Anterior rami of upper thoracic nerves (T2 to T5). Elevates ribs II to V. Serratus posterior inferior. 7. Spinous processes of TXI to LIII and supraspinous ligaments. Lower border of ribs IX to XII just lateral to their angles. Anterior rami of lower thoracic nerves (T9 to T12). Depresses ribs IX to XII and may prevent lower ribs from being elevated when the diaphragm contracts. Spinotransversales muscles Splenius capitis. 8. Lower half of ligamentum nuchae, spinous processes of CVII to TIV. Mastoid process, skull below lateral one third of superior nuchal line. Posterior rami middle cervical nerves. Together—draw head backward, extending neck; individually—draw and rotate head to one side (turn face to same side). Splenius cervicis. 9. Spinous processes of TIII to TVI. Transverse processes of CI to CIII. Posterior rami lower cervical nerves. Together—extend neck; individually—draw and rotate head to one side (turn face to same side). 54.

Tables. 3 1. 6. 5 4. 2 7. 8. 9. 55. 2.

BACK • Tables Erector spinae group of back muscles Muscle. Origin. Insertion. Iliocostalis lumborum. 1. Sacrum, spinous processes of lumbar and lower two thoracic vertebrae and their supraspinous ligaments, and the iliac crest. Angles of the lower six or seven ribs. Iliocostalis thoracis. 2. Angles of the lower six ribs. Angles of the upper six ribs and the transverse process of CVII. Iliocostalis cervicis. 3. Angles of ribs III to VI. Transverse processes of CIV to CVI. Longissimus thoracis. 4. Blends with iliocostalis in lumbar region and is attached to transverse processes of lumbar vertebrae. Transverse processes of all thoracic vertebrae and just lateral to the tubercles of the lower nine or ten ribs. Longissimus cervicis. 5. Transverse processes of upper four or five thoracic vertebrae. Transverse processes of CII to CVI. Longissimus capitis. 6. Blends with iliocostalis in lumbar region and is attached to transverse processes of lumbar vertebrae. Transverse processes of all thoracic vertebrae and just lateral to the tubercles of the lower nine or ten ribs. Spinalis thoracis. 7. Spinous processes of TX or TXI to LII. Spinous processes of TI to TVIII (varies). Spinalis cervicis. 8. Lower part of ligamentum nuchae and spinous process of CVII (sometimes TI to TII). Spinous process of CII (axis). Spinalis capitis. 9. Usually blends with semispinalis capitis. With semispinalis capitis. Transversospinales group of back muscles Semispinalis thoracis. 10. Transverse processes of TVI to TX. Spinous processes of upper four thoracic and lower two cervical vertebrae. Semispinalis cervicis. 11. Transverse processes of upper five or six thoracic vertebrae. Spinous processes of CII (axis) to CV. Semispinalis capitis. 12. Transverse processes of TI to TVI (or TVII) and CVII and articular processes of CIV to CVI. Medial area between the superior and inferior nuchal lines of occipital bone. Multifidus. 13. Sacrum, origin of erector spinae, posterior superior iliac spine, mammillary processes of lumbar vertebrae, transverse processes of thoracic vertebrae, and articular processes of lower four cervical vertebrae. Base of spinous processes of all vertebrae from LV to CII (axis). Rotatores lumborum. 14. Mammillary processes of lumbar vertebrae. Spinous processes of lumbar vertebrae. Rotatores thoracis. 15. Transverse processes of thoracic vertebrae. Spinous processes of thoracic vertebrae. Rotatores cervicis. 16. Articular processes of cervical vertebrae. Spinous processes of cervical vertebrae. 56.

Tables. 6. 8. 12. 9. 11. 3 5 10 2 4 7. 1. 16. 15 13. 14. 57. 2.

BACK • Tables. Segmental back muscles Muscle. Origin. Insertion. Function. The rib below vertebra of origin near tubercle. Contraction elevates rib. Levatores costarum. 1. Short paired muscles arising from transverse processes of CVII to TXI. Interspinales. 2. Short paired muscles attached to the spinous processes of contiguous vertebrae, one on each side of the interspinous ligament. Postural muscles that stabilize adjoining vertebra during movements of vertebral column. Intertransversarii. 3. Small muscles between the transverse processes of contiguous vertebrae. Postural muscles that stabilize adjoining vertebra during movements of vertebral column. 2. 1. 3 2. 58.

Tables. Suboccipital group of back muscles Muscle. Origin. Insertion. Innervation. Function. Rectus capitis posterior major. 1. Spinous process of axis (CII). Lateral portion of occipital bone below inferior nuchal line. Posterior ramus of C1. Extension of head; rotation of face to same side as muscle. Rectus capitis posterior minor. 2. Posterior tubercle of atlas (CI). Medial portion of occipital bone below inferior nuchal line. Posterior ramus of C1. Extension of head. Obliquus capitis superior. 3. Transverse process of atlas (CI). Occipital bone between superior and inferior nuchal lines. Posterior ramus of C1. Extension of head and bends it to same side. Obliquus capitis inferior. 4. Spinous process of axis (CII). Transverse process of atlas (CI). Posterior ramus of C1. Rotation of face to same side. 3. 2. 4. 1. 59. 2.

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3. THORAX. CONTENTS Surface anatomy with bones Bony framework Ribs Articulations Breast Pectoral region Thoracic wall muscles Diaphragm Arteries of the thoracic wall Veins of the thoracic wall Nerves of the thoracic wall Lymphatics of the thoracic wall Intercostal nerves and arteries Pleural cavities and mediastinum Parietal pleura Surface projections of pleural recesses Right lung Left lung Lung lobes: surface relationship Lung lobes: imaging Bronchial tree Bronchopulmonary segments Pulmonary vessels and plexus Pulmonary vessels: imaging Mediastinum Pericardium Pericardial layers Anterior surface of heart Base and diaphragmatic surface of heart Right atrium Right ventricle Left atrium. 62 63 65 66 68 70 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 91 92 93 94 95 96 97 98. Left ventricle Aortic valve and cardiac skeleton Cardiac chambers and heart valves Coronary vessels Coronary arteries and variations Cardiac conduction system Auscultation points and heart sounds Cardiac innervation Superior mediastinum: thymus Superior mediastinum: veins and arteries Superior mediastinum: arteries and nerves Superior mediastinum: imaging Superior mediastinum: veins and trachea Mediastinum: imaging Mediastinum: view from right Mediastinum: imaging – view from right Mediastinum: view from left Mediastinum: imaging – view from left Posterior mediastinum Mediastinum: imaging Transverse section: TVIII level Dermatomes and cutaneous nerves Visceral efferent (motor) innervation of the heart Visceral afferents Tables. 99 100 101 102 103 105 106 107 108 109 110 111 112 113 114 115 116 117 118 120 124 125 126 127 128.