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Gray's Anatomy for Students E-Book

Gray's Anatomy for Students E-Book

Richard Drake | A. Wayne Vogl | Adam W. M. Mitchell

(2009)

Additional Information

Book Details

Abstract

It didn’t take long for students around the world to realize that anatomy texts just don’t get any better than Gray’s Anatomy for Students. Only in its 2nd edition, this already popular, clinically focused reference has moved far ahead of the competition and is highly recommended by anyone who uses it. A team of authors with a wealth of diverse teaching and clinical experience has updated and revised this new edition to efficiently cover what you’re learning in contemporary anatomy classes. An improved format, updated clinical material, and remarkable artwork by renowned illustrators Richard Tibbitts and Paul Richardson make anatomy easier than ever for you to master. Unique coverage of surface anatomy, correlative diagnostic images, and clinical case studies demonstrate practical applications of anatomical concepts. And, an international advisory board, comprised of more than 100 instructors, ensures that the material is accurate, up to date, and easy to use.

  • Uses more than 1,000 innovative original illustrations— by renowned illustrators Richard Tibbitts and Paul Richardson—to capture anatomical features with unrivalled clarity, and makes body structures easy to locate and remember from one illustration to another through consistent use of color.
  • Includes over 300 clinical photographs, including radiological images depicting surface anatomy and common clinical applications of anatomic knowledge.
  • Presents an organization by body region that parallels the approach used in most of today’s anatomy courses.
  • Features conceptual overviews summarizing each body region's component parts, functions, and relationship to other bodily organs.
  • Uses clinical cases to underscore the real-life relevance of the material.
  • Features a rewritten abdomen section for greater clarity.
  • Provides updates and revisions to clinical material to provide you with the absolute latest knowledge in the field.
  • Includes expanded discussions of cranial nerves for added clinical relevancy.
  • Uses a new internal design and presents an improved index for easier retrieval of information.
  • Provides more information on the general aspects of anatomy via introduction chapter.

Table of Contents

Section Title Page Action Price
Front cover cover
Ad page 1
Gray’s Anatomy for Students i
Copyright iv
Editorial review board v
Acknowledgments ix
Preface x
Preface xi
About the book xiii
The idea xiii
The book xiii
Organization xiii
Content xiii
What the book does not contain xiv
Terminology xiv
Anatomical use of adverbs xv
Index of clinical content xvi
Table of Contents xxi
1 The Body Sec1:3
What is anatomy? Sec1:4
How can gross anatomy be studied? Sec1:4
Important anatomical terms Sec1:4
The anatomical position Sec1:4
Anatomical planes Sec1:6
Terms to describe location Sec1:6
Anterior (ventral) and posterior (dorsal), medial and lateral, superior and inferior Sec1:6
Proximal and distal, cranial and caudal, and rostral Sec1:6
Superficial and deep Sec1:6
Imaging Sec1:7
Diagnostic imaging techniques Sec1:7
Plain radiography Sec1:7
Contrast agents Sec1:7
Subtraction angiography Sec1:8
Ultrasound Sec1:8
Doppler ultrasound Sec1:9
Computed tomography Sec1:9
Magnetic resonance imaging Sec1:9
Nuclear medicine imaging Sec1:10
Positron emission tomography Sec1:11
IMAGE INTERPRETATION Sec1:11
Plain radiography Sec1:12
Chest radiograph Sec1:12
Abdominal radiograph Sec1:12
Gastrointestinal contrast examinations Sec1:12
Urological contrast studies Sec1:12
Computed tomography Sec1:12
Magnetic resonance imaging Sec1:13
Nuclear medicine imaging Sec1:13
SAFETY IN IMAGING Sec1:13
Body systems Sec1:14
SKELETAL SYSTEM Sec1:14
Cartilage Sec1:14
Bone Sec1:15
Joints Sec1:20
Synovial joints Sec1:20
Descriptions of synovial joints based on shape and movement Sec1:21
Specific types of synovial joints (Fig. 1.21) Sec1:21
Solid joints Sec1:21
SKIN AND FASCIAS Sec1:26
Skin Sec1:26
Fascia Sec1:26
MUSCULAR SYSTEM Sec1:27
CARDIOVASCULAR SYSTEM Sec1:29
LYMPHATIC SYSTEM Sec1:31
Lymphatic vessels Sec1:31
Lymph nodes Sec1:32
Lymphatic trunks and ducts Sec1:32
NERVOUS SYSTEM Sec1:34
Central nervous system Sec1:34
Brain Sec1:34
Spinal cord Sec1:34
Meninges Sec1:35
Functional subdivisions of the cns Sec1:35
Somatic part of the nervous system Sec1:35
Dermatomes Sec1:38
Myotomes Sec1:39
Visceral part of the nervous system Sec1:41
Sympathetic system Sec1:43
Peripheral sympathetic innervation at the level of origin of the preganglionic fiber Sec1:44
Peripheral sympathetic innervation above or below the level of origin of the preganglionic fiber Sec1:44
Sympathetic innervation of thoracic and cervical viscera Sec1:45
Sympathetic innervation of the abdomen and pelvic regions and the adrenals Sec1:46
Parasympathetic system Sec1:48
Sacral preganglionic parasympathetic fibers Sec1:49
Cranial nerve preganglionic parasympathetic fibers Sec1:49
Visceral sensory innervation (visceral afferents) Sec1:49
Visceral sensory fibers accompany sympathetic fibers Sec1:49
Visceral sensory fibers accompany parasympathetic fibers Sec1:49
The enteric system Sec1:49
Nerve plexuses Sec1:50
Somatic plexuses Sec1:50
Visceral plexuses Sec1:51
OTHER SYSTEMS Sec1:52
Clinical cases Sec1:53
2 Back 55
Conceptual overview 56
GENERAL DESCRIPTION 56
FUNCTIONS 57
Support 57
Movement 57
Protection of the nervous system 58
COMPONENT PARTS 58
Bones 58
A typical vertebra 60
Muscles 60
Vertebral canal 62
Spinal nerves 63
RELATIONSHIP TO OTHER REGIONS 64
Head 64
Thorax, abdomen, and pelvis 65
Limbs 65
KEY FEATURES 65
Long vertebral column and short spinal cord 65
Intervertebral foramina and spinal nerves 66
Innervation of the back 66
Regional anatomy 67
SKELETAL FRAMEWORK 67
Vertebrae 67
Typical vertebra 71
Cervical vertebrae 72
Atlas and axis 72
Thoracic vertebrae 74
Lumbar vertebrae 74
Sacrum 74
Coccyx 75
Intervertebral foramina 75
Posterior spaces between vertebral arches 75
JOINTS 79
Joints between vertebrae in the back 79
Symphyses between vertebral bodies (intervertebral discs) 80
Joints between vertebral arches (zygapophysial joints) 80
“Uncovertebral” joints 80
LIGAMENTS 82
Anterior and posterior longitudinal ligaments 82
Ligamenta flava 82
Supraspinous ligament and ligamentum nuchae 83
Interspinous ligaments 84
BACK MUSCULATURE 86
Superficial group of back muscles 86
Trapezius 89
Latissimus dorsi 90
Levator scapulae 90
Rhomboid minor and rhomboid major 91
Intermediate group of back muscles 92
Deep group of back muscles 93
Thoracolumbar fascia 94
Spinotransversales muscles 94
Erector spinae muscles 95
Transversospinales muscles 97
Segmental muscles 99
Suboccipital muscles 99
SPINAL CORD 101
Vasculature 102
Arteries 102
Veins 104
Meninges 104
Spinal dura mater 104
Arachnoid mater 104
Subarachnoid space 104
Pia mater 105
Arrangement of structures in the vertebral canal 106
Spinal nerves 107
Nomenclature of spinal nerves 108
Surface anatomy 112
Back surface anatomy 112
Absence of lateral curvatures 112
Primary and secondary curvatures in the sagittal plane 112
Useful nonvertebral skeletal landmarks 112
How to identify specific vertebral spinous processes 114
Visualizing the inferior ends of the spinal cord and subarachnoid space 115
Identifying major muscles 116
Clinical cases 118
3 Thorax 123
Conceptual overview 124
GENERAL DESCRIPTION 124
FUNCTIONS 125
Breathing 125
Protection of vital organs 125
Conduit 125
COMPONENT PARTS 125
Thoracic wall 125
Superior thoracic aperture 126
Inferior thoracic aperture 126
Diaphragm 127
Mediastinum 128
Pleural cavities 128
RELATIONSHIP TO OTHER REGIONS 129
Neck 129
Upper limb 130
Abdomen 130
Breast 130
KEY FEATURES 130
Vertebral level TIV/V 130
Venous shunts from left to right 132
Segmental neurovascular supply of thoracic wall 132
Sympathetic system 134
Flexible wall and inferior thoracic aperture 134
Innervation of the diaphragm 134
Regional anatomy 137
PECTORAL REGION 137
Breast 137
Arterial supply 137
Venous drainage 137
Innervation 137
Lymphatic drainage 138
Breast in men 138
Muscles of the pectoral region 139
Pectoralis major 139
Subclavius and pectoralis minor 139
THORACIC WALL 141
Skeletal framework 141
Thoracic vertebrae 141
A typical thoracic vertebra 141
Articulation with ribs 141
Ribs 142
Distinct features of upper and lower ribs 143
Rib I 143
Rib II 144
Rib X 144
Ribs XI and XII 144
Sternum 144
Manubrium of sternum 144
Body of the sternum 144
Xiphoid process 144
Joints 145
Costovertebral joints 145
Joint with head of rib 145
Costotransverse joints 145
Sternocostal joints 146
Interchondral joints 146
Manubriosternal and xiphisternal joints 146
Intercostal spaces 147
Muscles 148
Intercostal muscles 149
External intercostal muscles 150
Internal intercostal muscles 150
Innermost intercostal muscles 151
Subcostales 151
Transversus thoracis muscles 151
Arterial supply 151
Posterior intercostal arteries 151
Anterior intercostal arteries 152
Venous drainage 153
Lymphatic drainage 154
Innervation 154
Intercostal nerves 154
DIAPHRAGM 156
Arterial supply 157
Venous drainage 158
Innervation 158
MOVEMENTS OF THE THORACIC WALL AND DIAPHRAGM DURING BREATHING 158
PLEURAL CAVITIES 159
Pleura 159
Parietal pleura 159
Peripheral reflections 160
Visceral pleura 161
Pleural recesses 162
Costomediastinal recesses 162
Costodiaphragmatic recesses 162
Lungs 163
Root and hilum 163
Right lung 164
Left lung 166
Bronchial tree 168
Bronchopulmonary segments 169
Pulmonary arteries 170
Right pulmonary artery 170
Left pulmonary artery 170
Pulmonary veins 170
Bronchial arteries and veins 170
Innervation 172
Lymphatic drainage 172
MEDIASTINUM 176
Middle mediastinum 177
Pericardium 177
Fibrous pericardium 177
Serous pericardium 178
Vessels and nerves 178
Heart 180
Cardiac orientation 180
Base (posterior surface) and apex 180
Surfaces of the heart 180
Margins and borders 182
External sulci 183
Cardiac chambers 185
Right atrium 186
Right ventricle 187
Tricuspid valve 187
Pulmonary valve 188
Left atrium 189
Left ventricle 190
Mitral valve 191
Aortic valve 191
Cardiac skeleton 192
Coronary vasculature 192
Coronary arteries 194
Right coronary artery. 194
Left coronary artery. 194
Variations in the distribution patterns of coronary arteries. 194
Cardiac veins 198
Great cardiac vein. 198
Middle cardiac vein. 198
Small cardiac vein. 198
Posterior cardiac vein. 198
Other cardiac veins. 198
Coronary lymphatics 200
Cardiac conduction system 200
Sinu-atrial node 200
Atrioventricular node 200
Atrioventricular bundle 200
Cardiac innervation 200
Parasympathetic innervation 203
Sympathetic innervation 203
Visceral afferents 203
Pulmonary trunk 203
Ascending aorta 204
Other vasculature 204
Superior mediastinum 204
Thymus 206
Right and left brachiocephalic veins 206
Left superior intercostal vein 207
Superior vena cava 207
Arch of aorta and its branches 209
The first branch 209
The second branch 210
The third branch 210
Ligamentum arteriosum 210
Trachea and esophagus 211
Nerves of the superior mediastinum 211
Vagus nerves 211
Right vagus nerve 212
Left vagus nerve 213
Phrenic nerves 214
Right phrenic nerve 214
Left phrenic nerve 214
Thoracic duct in the superior mediastinum 215
Posterior mediastinum 215
Esophagus 215
Relationships to important structures in the posterior mediastinum 215
Arterial supply and venous and lymphatic drainage 216
Innervation 216
Esophageal plexus 217
Thoracic aorta 217
Azygos system of veins 218
Azygos vein 218
Hemiazygos vein 220
Accessory hemiazygos vein 220
Thoracic duct in the posterior mediastinum 220
Sympathetic trunks 221
Branches from the ganglia 222
Anterior mediastinum 223
Surface anatomy 224
Thorax surface anatomy 224
How to count ribs 224
Surface anatomy of the breast in women 225
Visualizing structures at the TIV/V vertebral level 226
Visualizing structures in the superior mediastinum 227
Visualizing the margins of the heart 227
Where to listen for heart sounds 228
Visualizing the pleural cavities and lungs, pleural recesses, and lung lobes and fissures 228
Where to listen for lung sounds 229
Clinical cases 233
4 Abdomen 245
Conceptual overview 246
GENERAL DESCRIPTION 246
FUNCTIONS 247
Houses and protects major viscera 247
Breathing 249
Changes in intra-abdominal pressure 249
COMPONENT PARTS 250
Wall 250
Abdominal cavity 251
Inferior thoracic aperture 253
Diaphragm 253
Pelvic inlet 254
RELATIONSHIP TO OTHER REGIONS 254
Thorax 254
Pelvis 254
Lower limb 255
KEY FEATURES 256
Arrangement of abdominal viscera in the adult 256
Development of the foregut 256
Development of the midgut 256
Development of the hindgut 259
Skin and muscles of the anterior and lateral abdominal wall and thoracic intercostal nerves 259
The groin is a weak area in the anterior abdominal wall 260
Vertebral level LI 262
The gastrointestinal system and its derivatives are supplied by three major arteries 262
Venous shunts from left to right 264
All venous drainage from the gastrointestinal system passes through the liver 265
Portacaval anastomoses 266
Blockage of the hepatic portal vein or of vascular channels in the liver 266
Abdominal viscera are supplied by a large prevertebral plexus 266
Regional anatomy 268
SURFACE TOPOGRAPHY 268
Four-quadrant pattern 268
Nine-region pattern 269
ABDOMINAL WALL 270
Superficial fascia 270
Superficial layer 270
Deeper layer 271
Anterolateral muscles 272
Flat muscles 272
External oblique 272
Associated ligaments 273
Internal oblique 274
Transversus abdominis 274
Transversalis fascia 275
Vertical muscles 276
Rectus abdominis 276
Pyramidalis 277
Rectus sheath 277
Extraperitoneal fascia 278
Peritoneum 279
Innervation 279
Arterial supply and venous drainage 280
Lymphatic drainage 282
GROIN 282
Inguinal canal 284
Deep inguinal ring 284
Superficial inguinal ring 284
Anterior wall 285
Posterior wall 285
Roof 286
Floor 286
Contents 286
Spermatic cord 286
Round ligament of the uterus 288
ABDOMINAL VISCERA 292
Peritoneum 292
Innervation of the peritoneum 292
Peritoneal cavity 293
Omenta, mesenteries, and ligaments 295
Omenta 295
Greater omentum 295
Lesser omentum 295
Mesenteries 297
Mesentery 297
Transverse mesocolon 297
Sigmoid mesocolon 297
Ligaments 297
Organs 297
Abdominal esophagus 297
Stomach 298
Small intestine 300
Duodenum 300
Jejunum 301
Ileum 302
Large intestine 307
Cecum and appendix 308
Colon 310
Rectum and anal canal 312
Liver 316
Diaphragmatic surface 316
Visceral surface 317
Associated ligaments 317
Lobes 318
Gallbladder 319
Pancreas 320
Duct system for bile 323
Spleen 323
Arterial supply 327
Anterior branches of the abdominal aorta 327
Celiac trunk 329
Left gastric artery 329
Splenic artery 329
Common hepatic artery 331
Superior mesenteric artery 333
Inferior pancreaticoduodenal artery 333
Jejunal and ileal arteries 333
Middle colic artery 333
Right colic artery 333
Ileocolic artery 333
Inferior mesenteric artery 335
Left colic artery 335
Sigmoid arteries 335
Superior rectal artery 335
Venous drainage 337
Portal vein 337
Splenic vein 338
Superior mesenteric vein 338
Inferior mesenteric vein 339
Lymphatics 341
Innervation 341
Sympathetic trunks 342
Splanchnic nerves 342
Thoracic splanchnic nerves 342
Lumbar and sacral splanchnic nerves 343
Pelvic splanchnic nerves 344
Abdominal prevertebral plexus and ganglia 344
Parasympathetic innervation 345
Vagus nerves 345
Pelvic splanchnic nerves 345
Enteric system 345
Sympathetic innervation of the stomach 345
POSTERIOR ABDOMINAL REGION 348
Posterior abdominal wall 349
Bones 349
Lumbar vertebrae and the sacrum 349
Pelvic bones 349
Ribs 349
Muscles 349
Psoas major and minor 349
Quadratus lumborum 350
Iliacus 350
Diaphragm 351
Structures passing through or around the diaphragm 352
Domes 352
Blood supply 353
Innervation 353
Viscera 355
Kidneys 355
Relationships to other structures 356
Renal fat and fascia 356
Kidney structure 358
Renal vasculature and lymphatics 359
Ureters 359
Ureteric vasculature and lymphatics 361
Ureteric innervation 361
Suprarenal glands 365
Suprarenal vasculature 365
Vasculature 366
Abdominal aorta 366
Visceral branches 367
Posterior branches 368
Inferior phrenic arteries 368
Lumbar arteries 368
Median sacral artery 368
Inferior vena cava 370
Lymphatic system 372
Pre-aortic and lateral aortic or lumbar nodes (para-aortic nodes) 372
Nervous system in the posterior abdominal region 374
Sympathetic trunks and splanchnic nerves 374
Abdominal prevertebral plexus and ganglia 375
Lumbar plexus 378
Iliohypogastric and ilio-inguinal nerves (L1) 378
Iliohypogastric nerve 378
Ilio-inguinal nerve 379
Genitofemoral nerve (L1 and L2) 379
Lateral cutaneous nerve of thigh (L2 and L3) 381
Obturator nerve (L2 to L4) 381
Femoral nerve (L2 to L4) 381
Surface anatomy 382
Abdomen surface anatomy 382
Defining the surface projection of the abdomen 383
How to find the superficial inguinal ring 384
How to determine lumbar vertebral levels 385
Visualizing structures at the LI vertebral level 386
Visualizing the position of major blood vessels 387
Using abdominal quadrants to locate major viscera 388
Defining surface regions to which pain from the gut is referred 389
Where to find the kidneys 390
Where to find the spleen 390
Clinical cases 391
5 Pelvis and Perineum 405
Conceptual overview 406
GENERAL DESCRIPTION 406
FUNCTIONS 406
Contain and support bladder, rectum, anal canal, and reproductive tracts 406
Anchors the roots of the external genitalia 408
COMPONENT PARTS 408
Pelvic inlet 408
Pelvic walls 409
Pelvic outlet 409
Pelvic floor 411
Pelvic cavity 411
Perineum 412
RELATIONSHIP TO OTHER REGIONS 414
Abdomen 414
Lower limb 414
KEY FEATURES 415
The pelvic cavity projects posteriorly 415
Important structures cross the ureters in the pelvic cavity 415
The prostate is anterior to rectum 417
The perineum is innervated by sacral spinal cord segments 417
Nerves are related to bone 418
Parasympathetic innervation from spinal cord levels S2 to S4 controls erection 418
Muscles and fascia of the pelvic floor and perineum intersect at the perineal body 419
Gender determines the course of the urethra 419
Regional anatomy 421
PELVIS 421
Bones 421
Pelvic bone 421
Components of the pelvic bone 423
Ilium 423
Pubis 424
Ischium 425
Sacrum 425
Coccyx 426
Joints 426
Lumbosacral joints 426
Sacro-iliac joints 426
Pubic symphysis joint 428
Orientation 428
Gender differences 428
True pelvis 429
Pelvic inlet 429
Pelvic wall 429
Ligaments of the pelvic wall 429
Muscles of the pelvic wall 430
Obturator internus 430
Piriformis 430
Apertures in the pelvic wall 431
Obturator canal 431
Greater sciatic foramen 431
Lesser sciatic foramen 432
Pelvic outlet 432
Pelvic floor 432
The pelvic diaphragm 432
Levator ani 435
Coccygeus 436
The perineal membrane and deep perineal pouch 436
Perineal body 438
Viscera 438
Gastrointestinal system 439
Rectum 439
Anal canal 439
Urinary system 441
Ureters 441
Bladder 441
Neck of bladder 442
Urethra 444
In women 444
In men 444
Preprostatic part. 444
Prostatic part. 445
Membranous part. 445
Spongy urethra. 446
Reproductive system 448
In men 448
Testes 448
Epididymis 448
Ductus deferens 450
Seminal vesicle 451
Prostate 451
Bulbourethral glands 452
In women 453
Ovaries 454
Uterus 455
Uterine tubes 455
Cervix 457
Vagina 458
Fascia 458
In women 458
In men 458
Peritoneum 460
In women 460
Broad ligament 460
In men 462
Nerves 462
Somatic plexuses 462
Sacral and coccygeal plexuses 462
Sacral plexus 463
Sciatic nerve. 465
Pudendal nerve. 465
Other branches of the sacral plexus. 466
Coccygeal plexus 466
Visceral plexuses 469
Paravertebral sympathetic chain 469
Pelvic extensions of the prevertebral plexus 469
Sympathetic fibers 471
Parasympathetic fibers 471
Visceral afferent fibers 471
Blood vessels 471
Arteries 471
Internal iliac artery 471
Posterior trunk 472
Anterior trunk 473
Ovarian arteries 474
Median sacral artery 475
Veins 477
Lymphatics 477
PERINEUM 478
Borders and ceiling 478
Perineal membrane and deep perineal pouch 480
Ischio-anal fossae and their anterior recesses 480
Anal triangle 480
Urogenital triangle 483
Structures in the superficial perineal pouch 483
Erectile tissues 483
Clitoris 483
Penis 484
Erection 485
Greater vestibular glands 485
Muscles 485
Ischiocavernosus 485
Bulbospongiosus 485
Superficial transverse perineal muscles 487
Superficial features of the external genitalia 487
In women 487
In men 488
Superficial fascia of the urogenital triangle 489
Somatic nerves 490
Pudendal nerve 490
Other somatic nerves 490
Visceral nerves 492
Blood vessels 492
Arteries 492
Internal pudendal artery 492
Inferior rectal arteries 492
Perineal artery 493
Terminal part of the internal pudendal artery 494
External pudendal arteries 494
Testicular and cremasteric arteries 494
Veins 494
Lymphatics 496
Surface anatomy 497
Surface anatomy of the pelvis and perineum 497
Orientation of the pelvis and perineum in the anatomical position 497
How to define the margins of the perineum 497
Identification of structures in the anal triangle 499
Identification of structures in the urogenital triangle of women 500
Identification of structures in the urogenital triangle of men 501
Clinical cases 504
6 Lower Limb 511
Conceptual overview 512
GENERAL INTRODUCTION 512
FUNCTION 513
Support the body weight 513
Locomotion 515
COMPONENT PARTS 517
Bones and joints 517
Muscles 518
RELATIONSHIP TO OTHER REGIONS 520
Abdomen 520
Pelvis 521
Perineum 521
KEY POINTS 521
Innervation is by lumbar and sacral spinal nerves 521
Nerves related to bone 525
Superficial veins 525
Regional anatomy 526
Bony pelvis 526
Ilium 526
Ischial tuberosity 527
Ischiopubic ramus and pubic bone 528
Acetabulum 528
Proximal femur 529
Greater and lesser trochanters 529
Intertrochanteric line 529
Intertrochanteric crest 531
Shaft of the femur 531
Hip joint 532
Ligaments 534
Gateways to the lower limb 535
Obturator canal 535
Greater sciatic foramen 535
Lesser sciatic foramen 536
Gap between the inguinal ligament and pelvic bone 536
Nerves 537
Femoral nerve 537
Obturator nerve 538
Sciatic nerve 538
Gluteal nerves 539
Ilio-inguinal and genitofemoral nerves 540
Lateral cutaneous nerve of thigh 540
Nerve to quadratus femoris and nerve to obturator internus 540
Posterior cutaneous nerve of thigh 540
Perforating cutaneous nerve 540
Arteries 540
Femoral artery 540
Superior and inferior gluteal arteries and the obturator artery 540
Veins 542
Lymphatics 542
Superficial inguinal nodes 542
Deep inguinal nodes 542
Popliteal nodes 543
Deep fascia and the saphenous opening 544
Fascia lata 544
Iliotibial tract 545
Saphenous opening 545
Femoral triangle 545
Femoral sheath 547
GLUTEAL REGION 547
Muscles 548
Deep group 549
Piriformis 549
Obturator internus 549
Gemellus superior and inferior 550
Quadratus femoris 550
Superficial group 550
Gluteus minimus and medius 550
Gluteus maximus 550
Tensor fasciae latae 551
Nerves 551
Superior gluteal nerve 551
Sciatic nerve 552
Nerve to quadratus femoris 552
Nerve to obturator internus 552
Posterior cutaneous nerve of the thigh 553
Pudendal nerve 553
Inferior gluteal nerve 553
Perforating cutaneous nerve 554
Arteries 554
Inferior gluteal artery 554
Superior gluteal artery 554
Veins 554
Lymphatics 554
THIGH 555
Bones 555
Shaft and distal end of femur 556
Patella 558
Proximal end of tibia 558
Tibial condyles and intercondylar areas 558
Tibial tuberosity 560
Shaft of tibia 560
Proximal end of fibula 560
Muscles 561
Anterior compartment 561
Iliopsoas—psoas major and iliacus 562
Quadriceps femoris—vastus medialis, intermedius, and lateralis, and rectus femoris 562
Vastus muscles 562
Rectus femoris 563
Patellar ligament 564
Sartorius 564
Medial compartment 564
Gracilis 565
Pectineus 566
Adductor longus 566
Adductor brevis 567
Adductor magnus 567
Obturator externus 567
Posterior compartment 568
Biceps femoris 568
Semitendinosus 569
Semimembranosus 569
Arteries 569
Femoral artery 569
Deep artery of thigh 569
Lateral circumflex femoral artery 570
Medial circumflex femoral artery 570
Perforating arteries 570
Obturator artery 571
Veins 573
Great saphenous vein 573
Nerves 573
Femoral nerve 573
Obturator nerve 574
Sciatic nerve 574
Tibial nerve 574
Common fibular nerve 575
Knee joint 575
Articular surfaces 576
Menisci 576
Synovial membrane 577
Fibrous membrane 578
Ligaments 578
Patellar ligament 578
Collateral ligaments 579
Cruciate ligaments 579
Locking mechanism 581
Vascular supply and innervation 581
Tibiofibular joint 584
Popliteal fossa 584
Contents 585
Tibial and common fibular nerves 585
Popliteal artery and vein 585
Roof of popliteal fossa 585
LEG 585
Bones 586
Shaft and distal end of tibia 586
Shaft and distal end of fibula 587
Joints 588
Interosseous membrane of leg 588
Posterior compartment of leg 588
Muscles 588
Superficial group 588
Gastrocnemius 589
Plantaris 589
Soleus 589
Deep group 591
Popliteus 591
Flexor hallucis longus 591
Flexor digitorum longus 592
Tibialis posterior 592
Arteries 593
Popliteal artery 593
Anterior tibial artery 593
Posterior tibial artery 593
Veins 594
Nerves 594
Tibial nerve 594
Sural nerve 595
Medial calcaneal nerve 595
Lateral compartment of leg 595
Muscles 595
Fibularis longus 595
Fibularis brevis 596
Arteries 596
Veins 596
Nerves 596
Superficial fibular nerve 596
Anterior compartment of leg 596
Muscles 596
Tibialis anterior 596
Extensor hallucis longus 598
Extensor digitorum longus 598
Fibularis tertius 598
Arteries 598
Anterior tibial artery 598
Veins 599
Nerves 599
Deep fibular nerve 599
FOOT 600
Bones 600
Tarsal bones 600
Proximal group 601
Talus 602
Calcaneus 603
Intermediate tarsal bone 604
Distal group 604
Metatarsals 604
Phalanges 604
Joints 605
Ankle joint 605
Medial ligament (deltoid ligament) 606
Lateral ligament 607
Intertarsal joints 607
Subtalar joint 608
Talocalcaneonavicular joint 608
Ligaments 608
Calcaneocuboid joint 610
Ligaments 610
Tarsometatarsal joints 610
Metatarsophalangeal joints 611
Deep transverse metatarsal ligaments 611
Interphalangeal joints 612
Tarsal tunnel, retinacula, and arrangement of major structures at the ankle 612
Flexor retinaculum 612
Extensor retinacula 613
Fibular retinacula 613
Arches of the foot 614
Longitudinal arch 614
Transverse arch 614
Ligament and muscle support 614
Plantar aponeurosis 615
Fibrous sheaths of toes 615
Extensor hoods 616
Intrinsic muscles 616
On the dorsal aspect 617
Extensor digitorum brevis (and extensor hallucis brevis) 617
In the sole 617
First layer 617
Abductor hallucis 618
Flexor digitorum brevis 618
Abductor digiti minimi 618
Second layer 619
Quadratus plantae 619
Lumbricals 620
Third layer 620
Flexor hallucis brevis 620
Adductor hallucis 621
Flexor digiti minimi brevis 621
Fourth layer 621
Dorsal interossei 622
Plantar interossei 622
Arteries 622
Posterior tibial artery and plantar arch 622
Lateral plantar artery 622
Medial plantar artery 623
Dorsalis pedis artery 623
Veins 624
Nerves 624
Tibial nerve 625
Medial plantar nerve 625
Lateral plantar nerve 625
Deep fibular nerve 627
Superficial fibular nerve 627
Sural nerve 627
Saphenous nerve 627
Surface anatomy 628
Lower limb surface anatomy 628
Avoiding the sciatic nerve 628
Finding the femoral artery in the femoral triangle 630
Identifying structures around the knee 630
Visualizing the contents of the popliteal fossa 632
Finding the tarsal tunnel—the gateway to the foot 633
Identifying tendons around the ankle and in the foot 634
Finding the dorsalis pedis artery 635
Approximating the position of the plantar arterial arch 635
Major superficial veins 636
Pulse points 637
Clinical cases 638
7 Upper Limb 649
Conceptual overview 650
GENERAL DESCRIPTION 650
FUNCTIONS 651
Positioning the hand 651
The hand as a mechanical tool 651
The hand as a sensory tool 654
COMPONENT PARTS 654
Bones and joints 654
Muscles 655
RELATIONSHIP TO OTHER REGIONS 657
Neck 657
Back and thoracic wall 658
KEY POINTS 659
Innervation by cervical and upper thoracic nerves 659
Nerves related to bone 663
Superficial veins 663
Orientation of the thumb 664
Regional anatomy 665
SHOULDER 665
Bones 665
Clavicle 665
Scapula 665
Proximal humerus 667
Greater and lesser tubercles 667
Surgical neck 668
Joints 668
Sternoclavicular joint 668
Acromioclavicular joint 669
Glenohumeral joint 670
Muscles 675
Trapezius 676
Deltoid 676
Levator scapulae 676
Rhomboid minor and major 677
POSTERIOR SCAPULAR REGION 678
Muscles 678
Supraspinatus and infraspinatus 678
Teres minor and teres major 679
Long head of triceps brachii 680
Gateways to the posterior scapular region 680
Suprascapular foramen 680
Quadrangular space (from posterior) 681
Triangular space 682
Triangular interval 682
Nerves 682
Suprascapular nerve 682
Axillary nerve 682
Arteries and veins 682
Suprascapular artery 682
Posterior circumflex humeral artery 683
Circumflex scapular artery 683
Veins 684
AXILLA 684
Axillary inlet 685
Anterior wall 686
Pectoralis major 686
Subclavius 687
Pectoralis minor 688
Clavipectoral fascia 688
Medial wall 688
Serratus anterior 688
Intercostobrachial nerve 689
Lateral wall 690
Posterior wall 691
Subscapularis 691
Teres major and latissimus dorsi 692
Long head of the triceps brachii 692
Gateways in the posterior wall 692
Quadrangular space 692
Triangular space 692
Triangular interval 693
Floor 693
Contents of the axilla 693
Biceps brachii 694
Coracobrachialis 694
Axillary artery 695
Superior thoracic artery 696
Thoraco-acromial artery 696
Lateral thoracic artery 697
Subscapular artery 697
Anterior circumflex humeral artery 697
Posterior circumflex humeral artery 697
Axillary vein 697
Brachial plexus 700
Roots 701
Trunks 701
Divisions 701
Cords 701
Branches (Table 7.7) 701
Branches of the roots 701
Branches of the trunks 705
Branches of the lateral cord 706
Branches of the medial cord 706
Median nerve. 706
Branches of the posterior cord 708
Lymphatics 709
Axillary process of the mammary gland 709
ARM 710
Bones 712
Shaft and distal end of the humerus 712
The condyle 712
The two epicondyles 713
The three fossae 713
Proximal end of the radius 713
Proximal end of the ulna 713
Muscles 715
Coracobrachialis 715
Biceps brachii 715
Brachialis 716
Posterior compartment 716
Arteries and veins 717
Brachial artery 717
Profunda brachii artery 718
Veins 720
Nerves 720
Musculocutaneous nerve 720
Median nerve 720
Ulnar nerve 720
Radial nerve 722
ELBOW JOINT 724
CUBITAL FOSSA 729
FOREARM 731
Bones 732
Shaft and distal end of radius 732
Shaft and distal end of ulna 733
Joints 734
Distal radio-ulnar joint 734
Interosseous membrane 734
Pronation and supination 735
Muscles involved in pronation and supination 735
Biceps brachii. 735
Supinator. 736
Pronator teres and pronator quadratus. 736
Anconeus. 736
ANTERIOR COMPARTMENT OF THE FOREARM 736
Muscles 736
Superficial layer 737
Flexor carpi ulnaris 737
Palmaris longus 739
Flexor carpi radialis 739
Pronator teres 739
Intermediate layer 739
Flexor digitorum superficialis 739
Deep layer 741
Flexor digitorum profundus 741
Flexor pollicis longus 742
Pronator quadratus 742
Arteries and veins 742
Radial artery 742
Ulnar artery 743
Veins 743
Nerves 743
Median nerve 743
Ulnar nerve 744
Radial nerve 744
POSTERIOR COMPARTMENT OF THE FOREARM 745
Muscles 745
Superficial layer 745
Brachioradialis 745
Extensor carpi radialis longus 747
Extensor carpi radialis brevis 747
Extensor digitorum 747
Extensor digiti minimi 747
Extensor carpi ulnaris 747
Anconeus 747
Deep layer 747
Supinator 747
Abductor pollicis longus 749
Extensor pollicis brevis 749
Extensor pollicis longus 749
Extensor indicis 750
Arteries and veins 750
Posterior interosseous artery 751
Anterior interosseous artery 751
Radial artery 751
Veins 751
Nerves 751
Radial nerve 751
HAND 751
Bones 752
Carpal bones 752
Proximal row 752
Distal row 752
Articular surfaces 752
Carpal arch 752
Metacarpals 752
Phalanges 754
Joints 754
Wrist joint 754
Carpal joints 755
Carpometacarpal joints 755
Metacarpophalangeal joints 755
Deep transverse metacarpal ligaments 755
Interphalangeal joints of hand 755
Carpal tunnel and structures at the wrist 756
Palmar aponeurosis 758
Palmaris brevis 759
Anatomical snuffbox 759
Fibrous digital sheaths 759
Extensor hoods 760
Muscles 762
Dorsal interossei 762
Palmar interossei 763
Adductor pollicis 764
Thenar muscles 765
Opponens pollicis 765
Abductor pollicis brevis 766
Flexor pollicis brevis 766
Hypothenar muscles 766
Opponens digiti minimi 766
Abductor digiti minimi 766
Flexor digiti minimi brevis 766
Lumbrical muscles 766
Arteries and veins 767
Ulnar artery and superficial palmar arch 767
Radial artery and deep palmar arch 769
Veins 770
Nerves 770
Ulnar nerve 771
Median nerve 772
Superficial branch of the radial nerve 772
Surface anatomy 775
Upper limb surface anatomy 775
Bony landmarks and muscles of the posterior scapular region 775
Visualizing the axilla and locating contents and related structures 777
Locating the brachial artery in the arm 779
The triceps brachii tendon and position of the radial nerve 779
Cubital fossa (anterior view) 779
Identifying tendons and locating major vessels and nerves in the distal forearm 781
Normal appearance of the hand 782
Position of the flexor retinaculum and the recurrent branch of the median nerve 783
Motor function of the median and ulnar nerves in the hand 783
Visualizing the positions of the superficial and deep palmar arches 784
Pulse points 784
Clinical cases 786
8 Head and Neck 795
Conceptual overview 796
GENERAL DESCRIPTION 796
Head 796
Major compartments 796
Other anatomically defined regions 797
Neck 798
Compartments 798
Larynx and pharynx 799
FUNCTIONS 799
Protection 799
Contains upper parts of respiratory and digestive tracts 799
Communication 800
Positioning the head 800
Connects the upper and lower respiratory and digestive tracts 800
COMPONENT PARTS 800
Skull 800
Cervical vertebrae 802
Hyoid bone 803
Soft palate 804
Muscles 804
In the head 804
In the neck 804
RELATIONSHIP TO OTHER REGIONS 805
Thorax 805
Upper limbs 805
KEY FEATURES 806
Vertebral levels CIII/IV and CV/VI 806
Airway in the neck 806
Cranial nerves 807
Cervical nerves 808
Functional separation of the digestive and respiratory passages 808
Triangles of the neck 811
Regional anatomy 812
SKULL 812
Anterior view 812
Frontal bone 812
Zygomatic and nasal bones 813
Maxillae 814
Mandible 814
Lateral view 814
Lateral portion of the calvaria 814
Temporal bone 816
Visible part of the facial skeleton 816
Mandible 816
Posterior view 816
Occipital bone 816
Temporal bones 817
Superior view 818
Inferior view 819
Anterior part 819
Middle part 819
Anterior half 819
Vomer 819
Sphenoid 819
Body 819
Pterygoid processes 819
Greater wing 820
Posterior half 820
Occipital bone 820
Index 1081
A 1081
B 1082
C 1083
D 1085
E 1086
F 1086
G 1087
H 1088
I 1089
J 1090
K 1090
L 1090
M 1092
N 1093
O 1094
P 1094
Q 1097
R 1097
S 1098
T 1100
U 1101
V 1102
W 1103
X 1103
Y 1103
Z 1103