Vol I - Oase, Articulatii, Ligamente Si Muschi PDF

R.D.
SINELNIKOV
ATLAS
OF
HUMAN
ANATOMY
IN THREE VOLUMES
Volume I
The Science of Bones,
Joints, Ligaments
·
.
and Muscles
Translated from the Russian
by
.
Ludm1la Aksenova, M.D.
MIR PUBLISHERS
MOSCOW
First published 1988
Revised from the 1978 Russian edition
Printed in the German Democratic Republic
Ha aHrJIHHCKOM ll3bIKe
ISBN 5-03-000323-1 © I--fa11aTeJibCTBO «Me11nJ!HHa», 1978

5-03-000322-3 © English translation, Mir Publishers, 1988
PREFACE
This edition of Professor R.D. Sinelnikov's Atlas of Human The material is presented in line with the dialectical principles
Anatomy is a translation of the 5th Russian edition. The Atlas was of studying the body as an organic whole with consideration of all
first published in 1952-1958 and has for more than 30 years served the links binding its systems. Special attention is focused on the
in training several generations of medical students and physicians data of macro-microscopic anatomy.
working in various branches of medicine. Adherence to the princi The material in this edition is arranged in the following man
ples on which the book is based, as well as the continuing need for ner. The first volume consists of sections on osteology, arthrology,
it, explain why five editions of it in Russian, four in Spanish, and and myology. The second volume is devoted to splanchnology and
two in Czech have been published. A translation of the Atlas into ;rngiology. The third volume provides descriptions of the nervous
Arabic is currently being prepared for publication. In preparing system, the sense organs, and the endocrine glands.
every new edition extensive research was carried out to supplement The sections on the science of the muscles and viscera point
and improve the material of the book and to update it on the basis out the connection of every skeletal muscle and each internal or
of the achievements of modern anatomical science. Up till 1981 gan with its nerves and vessels. Moreover, the description of the
work on the Atlas was conducted by R.D. Sinelnikov with the col bony canals, grooves, and foramina is supplemented by informa
laboration of Ya.R. Sinelnikov and in recent years only by tion about the nerves and vessels which they transmit, thus making
Ya.R. Sinelnikov. it easier to understand the interrelations of the body's different sys
Several new drawings have been added to this edition and new tems. The Atlas contains illustrations of complex preparations al
sections introduced pertaining to age features, particularly to those lowing simultaneous study of several parts of the body, which en
of children. To bring the fundamental theoretical discipline, which sures a deeper knowledge of the links binding the different parts
is what human anatomy is, closer to clinical practice, much space into a single whole.
among the illustrations has been allotted to radiographs. Some of the illustrations in the Atlas demonstrate not only the
The illustrations and the terminology in the text conform with features of normal anatomy, but the existing topographo-anatomi
the Paris Nomina Anatomica (PNA)1. However, some Latin names cal correlations so as to bring anatomical concepts close to the re
on the illustrations are given according to the Basie Nomina Anat quirements of medical practice.
omica (BNA). Many drawings have been redrawn to show the ana The illustrations to this edition were made by different artists
tomical structures included in the new nomenclature, the text has over a span of more than thirty years. Foremost among these illus
been supplemented accordingly, and the subject index has been trators were A.A. Alekseev and F.K. Kovbasa, who made the grea
updated. ter number of original drawings. With the addition of new illustra
tions which was necessary as the systematic revision of the Atlas
English equivalents to the Latin terms are given according to progressed, the old ones of the former editions were corrected and
the Birmingham Revision (BR) of the Paris Anatomical Nomen updated.
clature (PNA) (Butterworths Medical Dictionary, 1978, second edition,
Editor-in-Chief MacDonald Critchley). Prof Ya.R. Sinelnikov
ABBREVIATIONS AND SYMBOLS
A., a., Aa., aa.-arteria, arteriae.
V., v., VV., vv.-vena, venae.
M., m., Mm., mm.-musculus, musculi.
Lig., Jig., Ligg., ligg.-ligamentum, ligamenta.
GI., gl., Gil., gll.-glandula, glandulae.
N., n., Nn., nn.-nervus, nervi.
R., r., Rr., rr.-ramus, rami.
S., seu, sive-or.
C i , C2, C3 -first, second, third cervical nerve.
Th i , Th2, Th3 -first, second, third thoracic nerve.
L i , 4, L3-first, second, third lumbar nerve.
S i , S2, S3 -first, second, third sacral nerve.
Constantly present nerve segments are put in round brackets, e.g. (C i , C2), (Th i , Th2).
Inconstantly present nerve segments are put in round brackets which are enclosed within square brackets,
e.g. [C 1 (C2)-C1 (Cs)].
(½), (½) etc. in the captions show the proportion of the size of the drawings to the natural size.
CONTENTS
Preface 5 Articulations of the Trunk Bones . 183
Articulations of the Vertebral Column 183
THE SCIENCE OF THE BONES 9 Articulations of the Ribs . 195
Articulations of the Bones of the Skull 199
The Bones of the Trunk 21
Articulations of the Shoulder Girdle and F�ee u;pe; L�mb
The Vertebrae 21
(Ya.R. Sinelnikov) . . . . . . . . . . . . 203
The Ribs . 37
Articulations of the Upper Limb 203
The Sternum 39
Articulations of the Shoulder Girdle 203
The Thoracic Cage . . . . . 41
Joints of the Free Upper Limb . . . . . 205
Development of Bones and Age Features of the Trunk Ske
Articulations of the Pelvic Girdle and Free Lower Limb 223
leton (Ya.R. Sinelnikov) 46
Joints of the Free Lower Limb 227
The Bones of the Head . 50
Development and Age Features of Bone Articulations
The Bones of the Cranium 56
(Ya.R. Sinelnikov) . 251
The Bones of the Face 80
The Skull as a Whole . 92
The Skull Cap 96 THE SCIENCE OF THE MUSCLES 255
The Base of the Skull . . . . 98
Muscles of the Trunk and Head 265
Development and Age Features of the Bones of the Head
Muscles and Fasciae of the Trunk 265
(Ya.R. Sinelnikov) . 110
Muscles and Fasciae of the Back 265
The Bones of the Upper Limb (Ya.R. Sinelnikov) 113
Superficial Muscles of the Back 268
The Bones of the Shoulder Girdle 113
Deep Muscles of the Back 272
The Skeleton of the Free Upper Limb 119
Fasciae of the Back 279
The Humerus 119
Muscles and Fasciae of the Head (Ya.R. Sinelnikov) 282
The Bones of the Forearm 123
Muscles of Facial Expression 286
The Bones of the Hand . . . . . 129
Muscles of Mastication 290
Development and Age Features of the Bones of the Upper
Fasciae of the Head 295
Limb (Ya.R. Sinelnikov) 137
Muscles and Fasciae of the Neck (Ya.R. Sinelnikov) 296
The Bones of the Lower Limb (Ya.R. Sinelnikov) 139
Superficial Muscles of the Neck 296
The Bones of the Pelvic Girdle 139
Deep Muscles of the Neck 301
The Skeleton of the Free Lower Limb 153
Triangles of the Neck . 305
The Femur 153
Fasciae of the Neck 307
The Patella 153
Muscles and Fasciae of the Chest 308
The Bones of the Leg 157
Superficial Muscles of the Chest 308
The Bones of the Foot . . . . 161
Deep (Proper) Muscles of the Chest 316
Development and Age Features of the Bones of the Lower
Fasciae of the Chest 317
Limb (Ya.R. Sinelnikov) . 172
The Diaphragm . 317
Muscles and Fasciae of the Abdomen 319
Muscles of the Lateral Abdominal Wall 319
THE SCIENCE OF THE ARTICULATION OF
175
Muscles of the Anterior Abdominal Wall 320
BONES
Articulations of the Bones of the Trunk and the Head 183 Muscles of the Posterior Abdominal Wall 323
8 CONTENTS
Aponeuroses and Fasciae of the Abdomen 323 Muscles of the Hip Joint 394
The Inguinal Canal 329 Muscles of the Free Lower Limb 401
Muscles of the Upper Limb (Ya.R. Sinelnikov) 341 Muscles of the Thigh 401
Muscles of the Shoulder Girdle 341 Muscles of the Leg 413
Muscles of the Free Upper Limb 349 Muscles of the Foot 422
Muscles of the Upper Arm 349 The Subsartorial Canal 435
Muscles of the Forearm 354 The Popliteal Fossa 435
Muscles of the Hand 376 The Cruropopliteal Canal 435
Fasciae of the Upper Limb 381 Fasciae of the Lower Limb 435
Synovial Sheaths of Muscle Tendons on the Hand 390 The Femoral Canal . 444
The Axillary Fossa 390 Synovial Sheaths of Muscle Tendons on the Foot 450
The Cubital Fossa 390 Age Features of Muscles (Ya.R. Sinelnikov) 451
Muscles of the Lower Limb (Ya.R. Sinelnikov) 391 Subject Index 453
THE
SCIENCE
OF
THE BONES
Osteologia
The skeleton formed by bones and joints is the supporting The long bones (humerus, clavicle, femur, phalanges, etc.)
structure of the human body. have a middle part, the diaphysis, and two end parts, the epiph
The bones (ossa) give rigid support to the soft tissues of the yses. The epiphysis located closer to the axial skeleton is called the
body and form levers which move due to muscle contraction. proximal epiphysis (epiphysis proximalis), the epiphysis of the same
In the whole body the bones form the skeletal system (systema bone but situated further from the axial skeleton is called the dis
skeletale) (Figs 1, 2, and 3b) which is made up of the axial skeleton tal epiphysis (epiphysis distalis) (Fig. 5). The wider parts of long
(skeleton axiale) and the appendicular skeleton (skeleton appendicu bones between the diaphysis and the epiphysis are known as meta
lare). The skull (cranium), the spinal column (columna vertebra/is), physes. Their boundaries are visible only in the bones of children
and the chest bones (ossa thoracis) form the axial skeleton. The ap and adolescents when a cartilaginous layer, the epiphyseal carti
pendicular skeleton consists of the bones of the upper limbs (ossa lage (cartilago epiphysialis) (Figs 5, 7), still remains between the di
membri superioris) and the bones of the lower limbs (ossa membri infe aphysis and epiphyses. The bone grows intensely in length at the
rioris). expense of this cartilage, which is later replaced by bony tissue
The skeletal system includes over 200 bones, 85 of which are forming the epiphyseal line (linea epiphysialis), which can hardly be
paired. detected with age.
Each bone is a complex organ composed of various types of In a cross-section of a long bone (Fig. 6) one can distinguish
connective tissue; it contains bone marrow which is supplied with the compact substance (substantia compacta) forming the outer lay
vessels and nerves. ers of the bone and the spongy (cancellous) substance (substantia
Most bones of a human adult consist of a bony and cartilagi spongiosa) found deeper than the compact substance, mainly in the
nous framework, as a result of which a bony part (pars ossea) and a epiphyses and metaphyses. In the diaphyses of long tubular bones
cartilaginous part (pars cartilaginosa) are distinguished in the skele the compact substance surrounds the medullary canal (cavitas me
tal system. The bony part makes up most of the bone. The articu dullaris) shaped like a tube.
lar cartilages (cartilagines articulares), the epiphyseal cartilages (car A cross-section of short bones (Fig. 3a) (vertebrae, carpal
tilagines epiphysiales) (Figs 5, 6, and 7), and the costal cartilages bones, tarsal bones, etc.) reveals on the surface a thinner layer of
(cartilagines costales) form the cartilaginous part of the skeletal sys compact substance surrounding the trabeculae of the spongy sub
tem. stance which forms the greater part of the bone. The trabeculae of
On the outside the bone is covered with a fine connective-tis the spongy substance form a complex meshwork but are arranged
sue membrane, the periosteum (Fig. 4), in which a fibrous and an in each bone of the skeletal system strictly in accordance with the
osteogenic layer are distinguished. The superficially situated functional loads.
fibrous layer is connected to the bone by fibres penetrating the In the flat bones (Fig. 3a) (the bones of the skull cap, shoulder
bone and contains blood and lymph vessels and nerves. From this blade, pelvic bone, etc.) the spongy substance, in contrast, usually
layer the vessels and nerves pass into the bone through nutrient forms a thinner layer and is surrounded on both sides by plates of
foramina (foramina nutricia) and thence into the nutrient canal the compact substance. In the bones of the skull cap, however, the
(canalis nutricius). The inner osteogenic layer contains osteogenic spongy substance is sufficiently developed. It is known as diploe
cells (osteoblasts) which take part in the processes of development (Fig. 8) and is sandwiched between the outer and inner plates of
and reorganization of bony tissue under normal conditions and af the compact substance (lamina externa and lamina interna). Diplo
ter injuries and fractures. At the junction with the articular carti etic canals (canales diploici) providing for the passage of venous ves
lage covering the ends of the bone, the periosteum is continuous sels extend through the spongy substance of the skull-cap bones.
with the perichondrium. As a result the bone as an organ is The meshes of the spongy substance and the medullary canal
covered with a continuous connective-tissue membrane. This contain the bone marrow (medulla ossium). Red marrow (medulla os
membrane covers the surface of the bone and all the structures sium rubra) and yellow marrow (medulla ossium jlava) are distin
situated on it: processes, spines, cristae, tubers, tubercles, rough guished.
ened lines (lineae asperae), pits and depressions (fovea, fossae), etc. The red marrow possesses high functional activity and is ca
The bone is lined on the inside by a finer membrane, the en pable of forming blood cells of the myeloid series. With the devel
dosteum. opment and growth of the organism, the red marrow is gradually
According to shape, long bones (ossa longa), short bones (ossa replaced by the yellow marrow. The yellow marrow is less active
brevia), and flat bones (ossa plana) are distinguished (Fig. 3a). Some and plays a reserve role, but under certain conditions it may be ac
bones contain cavities filled with air and are called pneumatic (ossa tivated.
pneumatica).
12 THE SKELETON
1. Skeleton, anterior aspect (½ 0).

THE SKELETON 13
2. Skeleton, posterior aspect (½ 0).

lJ'
I
JJ
IB
IA
3a. Bones of different shape.

1-long bones (ossa longi) (I A-humerus; 1 8-metacarpal bone and phalanges); 2-short
bones (ossa breves) (2 A-carpal bones; 2B-vertebra); 3-flat bone (os planum) (pelvic bone,
os coxae).
THE SKELETON OF THE FOETUS 15
Os temporale (squama) Os sphenoidale (ale major)
manus
Vertebra sacralis I
Os ilium -�,.::..._____ Funiculus

umbilicalis
Os ischii
Tibia
Metatarsus
Ossa digitorum ----=::--Wr.lilfD,
pedis
3b. Four-month-oldfoetus (drawing made from a

radiograph).
(Brown-bony tissue; blue-cartilaginous tissue; grey-connective tis
sue between the bones of the skull.)
16 THE PERIOSTEUM, DIAPHYSIS, EPIPHYSES
- Proximal epiphysis
External layer of periosteum
Internal layer of periosteum
'J
I
I
I
4. Periosteum (½). 5. Diaphysis and epiphyses (½).

(Right tibia, front aspect. The periosteum is cut (Right tibia, front aspect. The epiphyses are not
and drawn aside in the middle parts of the fused with the diaphysis.)
bone.)
THE COMPACT AND SPONGY SUBSTANCE OF THE BONE 17
Line of epiphyseal cartilage
Substantia spongiosa
Substantia compacta
Cavum medullare
Line of epiphyseal cartilage
6. Compact substance of bone (substantia compacta);

spongy substance of bone (substantia spongiosa); mar
row cavity, or medullary canal (cavum medullare) (½).
(Right tibia, frontal section.)
18 THE DIAPHYSIS, EPIPHYSES
7. Epiphyseal cartilages (radiograph).

(Right knee joint of a 12-year-old child.)
1-femoral diaphysis
2-patella
3-zone of epiphyseal cartilage
4-distal femoral epiphysis
5-proximal tibial epiphysis
6-zone of epiphyseal cartilage
7 -tibial diaphysis
8-proximal fibular epiphysis
9-fibular diaphysis
THE SPONGY SUBSTANCE 19
Lamina externa
Lamina interna
Cavum cranii
Canales diploici
8. Spongy substance of skull cap (diploe) (¾).

(Skull, from the right side, with the lower jaw removed. The outer table, lam
ina externa, of the skull bones is removed.)
THEBONESOFTHETRUNK
Ossa trunci
The vertebrae, ribs, and the sternum are the bones of the trunk.
THE VERTEBRAE
The vertebrae, 33 or 34 in number, are rings placed one above in the sagittal plane: cervical, thoracic, lumbar (abdominal), and
another which form a single column, the vertebral or spinal sacral (pelvic). The cervical and lumbar curvatures are concave an
column (columna vertebra/is) (Fig. 9). teriorly, the condition being known as lordosis (Gk); the thoracic
The vertebral column has the following parts: the cervical part and pelvic curvatures are convex anteriorly and are called kyphosis
(pars cervicalis), the thoracic part (pars thoracica), the lumbar part (Gk).
(pars Zumba/is), the sacral part (pars sacra/is), and the coccygeal part In addition, all vertebrae are separated into two groups-true
(pars coccygea). In accordance with this, five groups of vertebrae are and false vertebrae; the cervical, thoracic, and lumbar vertebrae
distinguished: cerebral (vertebrae cervicae) (7), thoracic (vertebrae make up the first group, while the sacral vertebrae fused to form
thoracicae) (12), lumbar (vertebrae lumbales) (5), sacral (vertebrae sac the sacrum (os sacrum) and the coccygeal vertebrae fused to form
ra/es) (5), and coccygeal (vertebrae coccygeae) (4 or 5). the coccyx (os coccygis) belong to the second group.
The vertebral column of a human adult forms four curvatures
THE VERTEBRA
The vertebra (see Figs 22 and 23) has a body, an arch, and pro The vertebral arch (arcus vertebrae) forms the posterior and lat
cesses. eral boundaries of the vertebral foramen (foramen vertebrale). The
The vertebral body (corpus vertebrae) is the anterior, thickened foramina are placed one above the other to form the vertebral
part of the vertebra and is bounded superiorly and inferiorly by canal (canalis vertebra/is) which lodges the spinal cord. The arch
surfaces facing, respectively, the adjacent proximal and distal arises from the posterolateral edges of the vertebral body as a nar
vertebrae, anteriorly and laterally by a slightly concave surface, row segment, the pedicle of the vertebral arch (pediculus arcus verte
and posteriorly by a flat surface. The body of the vertebra, its pos brae). The superior and inferior surfaces of the pedicle bear the su
terior surface in particular, has very many nutrient foramina (for perior vertebral notch (incisura vertebra/is superior) and the inferior
amina nutricia), which serve for the passage of vessels and nerves vertebral notch (incisura vertebra/is inferior). The superior notch of
into the bone substance. The bodies of the vertebrae are joined by one vertebra adjoins the inferior notch of the proximally situated
means of intervertebral discs (cartilages), as a result of which a vertebra to form the intervertebral foramen (foramen intervertebrale),
very flexible column, the vertebral column, is formed. which transmits the spinal nerves and vessels.
22 THE VERTEBRAL COLUMN
-----+--- Axis---+---
Pars cervicalis
columnae
vertebralis
Vertebra
prominens
/4}
Pars thoracica
columnae
vertebralis
Pars lumbalis
columnae
vertebralis
Foramina
sacralia
dorsalia
Pars sacralis
columnae
vertebralis
Pars coccygea
columnae
vertebralis
A B C
9. Vertebral column (columna vertebralis) (¼).

A-from the right side; B-anterior aspect;
C-posterior aspect.
THE CERVICAL VERTEBRAE 23
The vertebral processes (processus vertebra/es), seven in number, /ares inferiores) project from the inferior surface of the arch; the
project from the vertebral arch. One of them, unpaired, extends third pair, the transverse processes (processus transversi), extend from
from the middle of the arch and to the back and is called the spine the lateral surfaces of the arch (see Figs 24-27).
of the vertebra or spinous process (processus spinosus). The other The superior articular processes have superior articular facets
processes are paired. One pair, the superior articular processes (facies articulares superiores); the inferior processes bear similar infe
(processus articulares superiores) arise from the superior surface of the rior articular facets (facies articulares inferiores). Each vertebra articu
arch; the other pair, the inferior articular processes (processus articulates with the adjacent distal vertebra by means of these facets.
CERVICAL VERTEBRAE
The cervical vertebrae (vertebrae cervicales) (Figs 9-21), seven in The sixth vertebra has a particularly developed anterior tuber
number, are characterized by small low bodies (with the exception cle. The common carotid artery (arteria carotis communis) stretches
of the first two vertebrae) which gradually become wider in the di in front of and close to the tubercle and can be pressed to it when
rection of the last, seventh vertebra. The superior surface of the haemorrhage occurs. Hence the name carotid tubercle (tuberculum
body is slightly concave from right to left, while the inferior sur caroticum).
face is concave from front to back. The transverse process of the cervical vertebrae is formed of
The vertebral foramen (foramen vertebrale) is wide and almost two processes. The anterior one is the costal process (processus cos
triangular in shape. tarius), which is a rib rudiment; the posterior one is the true trans
The articular processes (processus articulares) are relatively short, verse process (processus transversus). Together they form the border
extend obliquely, and their articular facets are smooth or slightly of the foramen transversarium transmitting the vertebral artery,
convex. veins, and the attendant sympathetic nerve plexus.
The spines or spinous processes (processus spinosus) increase in In the cervical spine, the first vertebra, the atlas, the second,
length gradually from the second to the seventh vertebra. Except the axis, and the seventh, the vertebra prominens, differ from the
in the case of the first and seventh vertebrae the spinous process is common type of cervical vertebrae.
bifid and slightly inclined downward. The first cervical vertebra, the atlas (Figs 10, 11, and 14) has
The transverse processes (processus transversus) are short and neither a body nor a spine but is a ring formed of two arches, ante
project laterally. The superior surface of each process carries a rior and posterior (arcus anterior et arcus posterior), joined to one an
deep groove for the spinal nerve (sulcus nervi spinalis) (Fig. 13). It other by two more developed lateral masses {massae laterales). Each
separates an anterior tubercle from a posterior tubercle (tuberculum of these masses carries an oval concave superior articular facet (fo
anterius et tuberculum posterius) situated on the end of the transverse vea articularis superior), on the superior surface for articulation with
process. the occipital bone, and an almost flat inferior articular facet (fovea
Foramen vertebrale
Fovea arttculans Processus transversus

superior Foramen processus
transversarium
Processus transversus
Fovea articularis inferior
Tuberculum anterius
10. First cervical vertebra (atlas); superior 11. First cervical vertebra (atlas); inferior
aspect (½). aspect (½).
24 THE CERVICAL VERTEBRAE
articularis inferior), on the inferior surface for articulation with the facet (facies articularis anterior) for articulation with fovea dentis of
second servical vertebra. the atlas. The posterior surface has a posterior articular facet (facies
The anterior arch (arcus anterior) bears an anterior tubercle (tu articularis posterior), which the transverse ligament of the atlas (liga
berculum anterius) on the anterior surface and a small facet for the mentum transversum atlantis) adjoins. There are neither anterior and
odontoid process (fovea dentis) on the posterior surface which ar posterior tubercles nor a groove for the spinal nerve on the trans
ticulates with the dens of the axis. verse processes.
The posterior arch (arcus posterior) has a posterior tubercle (tu The seventh cervical vertebra, vertebra prominens (Fig. 19), is
berculum posterius) representing the spine. On the superior surface distinguished by its long and non-bifid spinous process which is
of the arch is a groove for the vertebral artery (sulcus arteriae verte easily palpated under the skin, thus the name. Furthermore, its
bra/is); the groove is sometimes converted into a canal. transverse processes are long, the foramen transversarium is very
The second cervical vertebra, the axis (Figs 12-14), carries an small (it provides passage for the vertebral vein) and is even absent
odontoid process (the dens) projecting upward from the body. The in some cases.
atlas together with the skull rotates about the dens like about an A costal facet (fovea costalis), a mark left by articulation with the
axis. head of the first rib, is often present on the lower edge of the
The anterior aspect of the dens carries an anterior articular lateral surface of the body.
Facies articularis anterior

Dens
Facies articularis posterior
Facies articularis
anterior
1
spinosus
transversus
Corpus vertebrae Processus articularis inferior
Corpus
vertebrae Processus
transversus
12. Second cervical vertebra (axis); anterior 13. Second cervical vertebra (axis);
aspect (½). from the left side (½).
THE CERVICAL VERTEBRAE 25
Dens
Arcus anterior atlantis
Fovea articula{is superior
Processus
Processus articularis
superior
Tuberculum anterius Processus costarius
axis
inferior axis Processus articularis inferior
14. First and second cervical vertebrae; from the 15. Sixth cervical vertebra (ver
back and right side (½). tebra cervicalis VI); anterior
aspect(½).
Processus spinosus
Processus spinosus
Incisura vertebralis
Facies articularis superior
Processus
transversus
Processus costarius
Corpus vertebrae Corpus vertebrae
Foramen processHs transversarium Tuberculum anterius

Tuberculum anterius Tuberculum posterius
16. Sixth cervical vertebra (ver 17. Fourth cervical vertebra (ver
tebra cervicalis VI); superior tebra cervicalis IV); inferior
aspect(½). aspect(½).
26 THE CERVICAL VERTEBRAE
Tuberculum posterius
Corpus vertebrae
Processus articularis inferior
Incisura vertebralis inferior
Foramen transversarium
Processus
Corpus vertebrae transversus
18. Sixth cervical vertebra (vertebra 19. Seventh cervical vertebra (ver
cervicalis VI); from the right side tebra r,rominens); from the right
(½). side (½).
20. Cervical part of vertebral column 21. Cervical part of vertebral column; lateral
(radiograph). aspect (radiograph).
I -body of fifth cervical vertebra }-first cervical vertebra
2-articular process 2-second cervical vertebra
3-spinous process 3-transverse process
4-spinous process
5-articular process
THE THORACIC VERTEBRAE 27
THORACIC VERTEBRAE
The thoracic vertebrae (vertebrae thoracicae) (Figs 9, 22-25), 12 The arches of the thoracic vertebrae form nearly circular verte
in number, are much higher and thicker than the cervical verte bral foramina which are, however, relatively smaller than those of
brae; their bodies gradually increase in size downwards toward the the cervical vertebrae.
lumbar vertebrae. The transverse process extends laterally and a little to the back
The posterolateral surface of the body carries two facets, the and carries a small costal facet (fovea costalis transversalis) for articu
superior costal facet (fovea costalis superior), and the inferior costal lation with the tubercle of the rib.
facet (fovea costalis inferior). The inferior facet of one vertebra joins The articular surface of the articular processes lies in the fron
the superior facet of the adjacent distal vertebra to form a com tal plane and faces backwards on the superior process but forwards
plete articular facet, the site of articulation with the head of the on the inferior process.
rib. The body of the first thoracic vertebra is an exception; it has a The spinous processes are long, three-sided, pointed, and slope
complete costal facet for articulation with the head of the first rib downwards. Those of the middle thoracic vertebrae fit one over the
on the superior part of the posterolateral surface and a semifacet other like tiles.
for articulation with the head of the second rib on the inferior The lower thoracic vertebrae are shaped more like the lumbar
part. The tenth vertebra has one semifacet on the superior edge of vertebrae. The transverse processes of the twelfth thoracic vertebra
the body. The bodies of the eleventh and twelfth vertebrae each have on their posterior surface an accessory process (processus acces
bear only one complete costal facet in the middle of each lateral sorius) and a mamillary process (processus mamillaris).
surface.
Processus transversus
superior
Corpus vertebrae
22. Eighth thoracic vertebra (vertebra thoracica VIII);

superior aspect (½).
28 THE THORACIC VERTEBRAE
Processus articularis superior
Fovea costalis inferior

Incisura vertebralis inferior
Processus spinosus
23. Eighth thoracic vertebra (ver

tebra thoracica VIII); from the
right side (½).

Incisura vertebralis superior
Processus Fovea costalis
mamillaris
Corpus vertebrae
t)
Process�s \ ,
spinosus
. I ans
'processus art,cu ..m f.
enor
Facies articularis inferior
24. Twelfth thoracic vertebra (vertebra 25. Thoracic part of vertebral column
thoracica XII); from the right side (radiograph).
(½). I-first rib
2-costal facet
4-transverse process
5-body of first thoracic vertebra
3-spinous process
THE LUMBAR VERTEBRAE 29
LUMBAR VERTEBRAE
The lumbar vertebrae (vertebrae Zumba/is) (Figs 9, 26-29), five The spinous process is short and wide, thickened and rounded
in number, are distinguished from other vertebrae by their large at the end. The articular processes arise from the arch, project to
size. The body of these vertebrae is bean-shaped, the arches are the back of the transverse process almost vertically. The articular
strongly developed, and the vertebral foramen is larger than in the surfaces lie in the sagittal plane; the superior facet is concave and
thoracic segment and is shaped like an irregular triangle. faces medially, while the inferior surface is convex and faces later
Each transverse process is in front of the articular process; it is ally.
compressed from front to back, and projects laterally and a little to Upon articulation of two adjacent vertebrae, the superior ar
the back. Its greater part is a rudiment of the rib and is therefore ticular processes of one vertebra embrace the sides of the inferior
called the costal process (processus costarius). On the posterior sur articular processes of the other. The superior articular process
face of the base of the costal surface is a slightly detectable acces bears a small mamillary process (processus mamillaris) on its postero
sory process (processus accessorius), which is a rudiment of the trans lateral edge, the site of insertion of muscles.
verse process.
26. Third lumbar vertebra (vertebra lumbalis III); supenor

aspect(½).
30 THE LUMBAR VERTEBRAE
Processus costarius
27. Third lumbar vertebra (vertebra lumbalis III); from the

right side (½).
I
Facies articularis superior
Processus mamillaris
Probe in
foramen vertebrale ---.ii;..
28. Third lumbar vertebra (vertebra lumbalis III); posterior

aspect (½).
THE LUMBAR VERTEBRAE 31
29. Lumbar segment of vertebral column (radio

graph);
} -twelfth thoracic vertebra 4 and 6-articular process
2-twelfth rib 5-spinous process
3-costal process 7 -first lumbar vertebra
32 THE SACRUM
THE SACRUM
In an adult the sacral vertebrae (vertebrae sacrales) five in num dially into the cavity of the sacral canal (they transmit the anterior
ber, are fused to form a single bone, the sacrum. rami of the sacral spinal nerves and the attendant vessels).
The sacrum (os sacrum) (Figs 9 and 30-35) is wedge-shaped; it The dorsal sacral surface (facies dorsalis) (Fig. 31) is convex lon
is located below the last lumbar vertebra and contributes to the gitudinally, narrower than the pelvic surface, and rough. It carries
formation of the posterior wall of the true pelvis. The anterior and five bony tubercles descending one after another. They are formed
posterior surfaces, two lateral borders, a base (with the wide part from fusion of the spinous, transverse, and articular processes of
directed upwards), and an apex (with the narrow part directed the sacral vertebrae.
downwards) are distinguished in the sacrum. A curved sacral canal The spinous tubercles of the sacrum (crista sacralis mediana) are
(canalis sacralis) runs through the bone from base to apex formed as the result of fusion of the spinous processes of the sacral
(Figs 33-35). vertebrae and are represented by four tubercles one above the
The anterior surface of the sacrum is smooth and concave and other, sometimes fused to form a single rough crest.
faces the pelvic cavity, thus it is called the pelvic surface (facies pel On both sides and lateral to the crista mediana and almost par
vina). It has traces of fusion of the bodies of the five sacral verte allel to it stretches a weakly pronounced articular tubercle of sac
brae in the form of four parallel transverse ridges (lineae transver rum (crista sacralis intermedia); it is formed by fusion of the superior
sae). Laterally to these ridges on each side are four anterior sacral and inferior articular processes. Still laterally on each side is a well
foramina (foramina sacra/is pelvina), which lead posteriorly and me- pronounced series of transverse tubercles (crista sacra/is lateralis),
I
Basis ossis sacri rocessus articularis
\ supenor
· Pars lateralis
-,-- _):-
j
/ 1
Foramina sacralia
pelvina
•
30. Sacrum (os sacrum); anterior aspect (¾).
(Pelvic surface.)
THE SACRUM 33
Foramina sacralia dorsalia Canalis sacralis
Processus
articularis Processus articularis
superior superior
Tuberositas sacralis
Facies
Crista sacralis
intermedia
Crista sacralis mediana
31. Sacrum (os sacrum); posterior aspect (¾).

(Dorsal surface.)
which are formed from fusion of the transverse processes. On each rior articular processes (processus articulares superiores) of the first
side between the articular and transverse tubercles there are four sacral vertebra project upward from the posterior part of the sacral
dorsal sacral foramina (foramina sacralis dorsalia). They are some base. Their superior articular facets (facies articulares superiores) face
what smaller than the corresponding pelvic sacral foramina and backwards and medially and articulate with the inferior articular
transmit the posterior rami of the sacral nerves. processes of the fifth lumbar vertebra. The entry into the sacral
The sacral canal (canalis sacralis) runs along the entire length of canal is bounded by the posterior border of the base (arch) of the
the sacrum; it curves and is wider on top and narrower downwards. sacrum with the superior articular processes projecting from it.
It is a direct downward continuation of the spinal canal. The sacral The apex of the sacrum (apex ossis sacri) is narrow, blunt, and
canal communicates with the sacral foramina anteriorly and poste has a small oval surface for articulation with the superior surface
riorly via intervertebral foramina (foramina intervertebralia) lying in of the coccyx. Here is the sacrococcygeal joint (junctura sacrococc:y
the bone. gea) (symphysis) (see Fig. 9).
The base of the sacrum (basis ossis sacri) (Figs 30 and 35) carries Behind the apex, on the posterior surface of the sacrum, the ar
a transverse-oval depression for articulation with the inferior sur ticular tubercles terminate as two small downward projections, the
face of the body of the fifth lumbar vertebra. At the site of the ar sacral cornua (cornua sacralia). The posterior surface of the apex
ticulation the anterior border of the base projects markedly into and the sacral cornua form the borders of the opening of the sacral
the pelvic cavity to form the promontory (promontorium). The supe- canal, the sacral hiatus (hiatus sacra/is).
34 THE SACRUM
Tuberositas
sacralis
Crista sacralis
mediana
Facies auricularis
superior
Crista sacralis lateralis
Crista sacralis intermedia
Crista sacralis
mediana
32. Sacrum (os sacrum); from the Foramina intervertebralia

right side (¾).
The superolateral part of the sacrum, lateral mass (pars latera

lis), is formed by fusion of the transverse processes of the sacral
vertebrae.
The lateral surface of these parts (Fig. 32) has an articular au
ricular surface (facies auricularis), which articulates with the auricu 33. Sacrum (os sacrum); from the
lar surface of the ilium (see The Bones of the Peluic Girdle).
To the back and medially of the auricular surface is a well pro
right side (¾).
nounced sacral tuberosity (tuberositas sacralis), the site of attach (Median longitudinal section.)
ment of the interosseous sacro-iliac ligaments.
The sacrum of a male is longer, narrower, and more curved
than that of a female.
THE SACRUM 35
Canalis sacralis
I "
34. Sacrum (os sacrum); superior aspect (¾).
Crista sacralis intermedia
Foramina sacralia pelvina Lineae transversae
Apex ossis sacri
35. Sacrum (os sacrum) (¾).

(Horizontal section through the second sacral vertebra.)
36 THE COCCYX
THE COCCYX
The coccygeal vertebrae (vertebrae coccygeae), four or five and articular processes in the form of small projections, coccygeal
less frequently three or six in number, fuse in the adult to form the cornua (cornua coccygea), extending upwards and articulating with
coccyx. the sacral cornua.
The coccyx (os coccygis) (Figs 9, 36 and 37) has the shape of a The superior surface of the coccyx has a slightly concave area
curved pyramid the base of which faces upwards and the apex which articulates with the apex of the sacrum by means of the sac
downwards. The vertebrae forming it possess only bodies. On each rococcygeal joint (junctura sacrococcygea).
side of the first coccygeal vertebra are the remnants of the superior
Corn ua coccygea
A B
36. Coccyx (os coccygis) (½).

A-anterior aspect;
B-posterior aspect.
37. Sacral and coccygeal parts of I -fifth lumbar vertebra

2-sacrum
4-pubic bone
5-pubic arch
vertebral column (radiograph). 3-coccyx 6-ischial bone
THE RIBS 37
THE RIBS
The ribs (costae) (Figs 38-41) are narrow, curved strips of bone (collum costae) carries a crest (crista colli costae) on its superior border
differing in length. There are twelve pairs of them arranged sym (it is absent on the first and twelfth ribs).
metrically on both sides of the thoracic segment of the vertebral At the junction with the shaft, the neck of the upper ten ribs
column. has a small tubercle of the rib (tuberculum costae), which has an ar
Each rib has a long bony part (os costale), a short cartilaginous ticular facet of tubercle of the rib (facies articularis tuberculi costae)
part, the costal cartilage (cartilago costalis), and two ends, an ante articulating with the transverse costal facet of the corresponding
rior or sternal, and a posterior or vertebral. vertebra.
The bony part of the rib has a head, neck, and a body, or shaft. The shaft of the rib (corpus costae) stretching from the tubercle
The head of the rib (caput costae) is at the vertebral end of the rib of the rib to the sternal end, is the longest segment of the bony
and is a thickened part carrying the articular facet of the head of part of the rib. At some distance from the tubercle the shaft curves
the rib (facies articularis capitis costae). From the second to tenth rib considerably to form the angle of the rib (angulus costae). The angle
this facet is separated by a horizontal crest of the head of the rib coincides only with the tubercle of the first rib, but on the other
(crista capitis costae) into a smaller, superior, and a larger, inferior, ribs the distance between these structures increases (down to the
part, each articulating correspondingly with the costal facets of the eleventh rib); the shaft of the twelfth rib does not form an angle.
two adjacent vertebrae. The shaft of the rib is flattened along its entire distance and there
The narrowest and rounded part of the rib, the neck of the rib fore two surfaces can be distinguished: an internal concave and an
Tuberculum costae II----
I
Tuberculum m. scaleni
anterioris
38. Right ribs (costae); superior aspect (¾).

A-first rib; B-second rib.
38 THE RIBS
Crista capitis costae
Facies articularis capitis

costae
39. Right eighth rib (costa VIII); inner aspect

(½).
Facies articularis
tuberculi costae
40. Right eighth rib (costa VIII); outer and posterior

aspect (½).
THE RIBS 39
Facies articularis capitis

costae
41. Right twelfth rib (costa XII); mner aspect (¾).
external convex surface; and two borders: a rounded upper and a The first two and last two ribs possess some specific features.
sharp lower border. A costal groove (sulcus costae) (Fig. 39) lodging The first rib (costa I) (Fig. 38) is shorter but wider than the other
the intercostal artery, vein, and nerve stretches on the internal sur ribs and its superior and inferior surfaces lie almost horizontally
face along the lower border. like the external and internal surfaces of the remaining ribs. The
The shape and position of a rib are as follows: the internal sur anterior part of the superior surface carries a tubercle for the at
face is concave, the external surface is convex; the upper and lower tachment of the scalenus anterior muscle called the scalene tuber
borders have the shape of a spiral; the rib itself twists about its cle (tuberculum musculi scaleni anterioris). Laterally and posteriorly of
long axis. the tubercle is a shallow groove for the subclavian artery (sulcus ar
The anterior end of the bony part of the rib bears a facet with teriae subclaviae) to the back of which is a small roughened surface
a slightly rough surface which is attached to the costal cartilage. for insertion of the scalenus medius muscle (musculus scalenus me
The costal cartilages (cartilagines costales) are a continuation of dius). To the front and medially of the tubercle is a less distinct
the bony parts of the ribs. There are twelve pairs of them also. groove for the subclavian vein (sulcus venae subclaviae). The articular
They become longer gradually from the first to the seventh rib and facet on the head of the first rib has no separating crest; the neck is
articulate directly with the sternum. The upper seven pairs of ribs long and thin; the angle of the rib coincides with the tubercle.
are referred to as true ribs (costae verae). The lower five pairs of ribs On its external surface the second rib (costa II) (Fig. 38) has a
are called false ribs (costae spuriae); the eleventh and twelfth ribs roughened area, the tubercle for the serratus anterior muscle (tu
are known as floating ribs (costae jluctuantes). The cartilages of the berositas musculi serrati anterioris) from which this muscle arises.
eighth, ninth, and tenth ribs do not reach the sternum directly, but The eleventh and twelfth ribs (costa XI et costa XII) (Fig. 41)
each joins the cartilage of the rib directly above it. The cartilages have articular facets which are not separ�ted by a crest. The angle
of the eleventh and twelfth (and sometimes the tenth) ribs do not of the rib, neck, tubercle, and costal groove are poorly marked on
reach the sternum and their ends lie freely in the muscles of the the eleventh and absent on the twelfth rib.
abdominal wall.
THE STERNUM
The breast-bone, or sternum (Figs 42-44), is an elongated un The manubrium sterni is the widest part of the sternum, thick
paired bone with a slightly convex anterior surface and a corre in its upper part and thinner and narrower below. It bears on the
spondingly concave posterior surface. It occupies part of the ante upper border the jugular notch (incisura jugularis) which is easily
rior wall of the thorax. The manubrium, body, and xiphoid process palpated through the skin. Lateral to it on each side is the clavicu
are distinguished on it. All these parts are joined to one another by lar notch (incisura clavicularis), the place of articulation of the ster
layers of cartilage which ossify with age. num with the sternal end of the clavicle.
40 THE STERNUM
42. Sternum; anterior aspect (¾).
Incisurae costales,,-______
III, IV, V
Incisurae costales..._:---�
,VI, VII
Corpus sterni
Incisurae costales III, IV, V
43. Sternum; from the right side (½).
Processus xiphoideus -
THE THORACIC CAGE 41
A little lower on the lateral border is the costal notch for the tales) are distinguished on the lateral border of the body. They
first rib (incisura costalis I) providing for articulation with the carti serve for articulation of the sternum with the cartilages of the sec
lage of the first rib. Still lower is a small depression, the upper part ond to seventh ribs. One of the incomplete notches is on the top of
of the notch for the second rib. The lower part of this notch is on the lateral border and corresponds to the cartilage of the second
the body of the sternum. rib, while the other is at the bottom of the lateral border and corre
The body of the sternum (corpus sterni), though narrower, is al sponds to the cartilage of the seventh rib. The four complete
most three times longer than the manubrium. It is shorter in fe notches are arranged between them and correspond to the third to
males than in males. sixth ribs.
The anterior surface of the sternum bears poorly marked trans The areas of the lateral borders between two adjacent costal
verse lines which are traces of fusion during embryonal develop notches are shaped like crescentic depressions.
ment. The xiphoid process (processus xiphoideus) is the shortest part of
The cartilaginous union of the upper border of the body with the sternum and varies in size and shape. Its pointed or blunt apex
the lower border of the manubrium is called the manubriosternal faces either forwards or backwards and has a bifid end or is perfo
joint (synchondrosis manubriosternalis) (see Fig. 195). The body and rated in the middle. A half-notch for articulation with the cartilage
the manubrium meet at an obtuse open to the back angle of the of the seventh rib is located in the superolateral part of the pro
sternum (angulus sterni). This projection is on a level with the ar cess.
ticulation of the second rib with the sternum and is easily palpated By old age the xiphoid process undergoes ossification and be
through the skin. comes fused with the body of the sternum.
Four complete and two incomplete costal notches (incisurae cos-
THE THORACIC CAGE

The thoracic cage (thorax) (Figs 44-47, a and b) is formed by talia). They are filled by ligaments, intercostal muscles, and mem
the thoracic segment of the spine, the ribs, and the sternum. branes.
The thorax has the shape of a truncated cone with the wide The thoracic cavity (cavum thoracis) is bounded by the thoracic
base facing downwards and the truncated apex upwards. An ante walls and has two apertures (inlet and outlet).
rior, posterior, and lateral walls and an upper (inlet) and lower The inlet of the thorax (apertura thoracis superior) is smaller than
(outlet) apertures are distinguished in the thorax. the outlet and is bounded by the upper border of the manubrium
The anterior wall is shorter than the other walls and is formed anteriorly, by the first ribs laterally, and by the body of the first
by the sternum and the costal cartilages. It slopes and therefore its thoracic vertebra posteriorly. It is transversely-oval in shape and
lower parts project forwards more than the upper parts. The poste lies in a plane sloping from back to front and downwards. The up
rior wall, which is almost vertical, is longer than the anterior one per border of the manubrium sterni is on a level with the space be
and is formed by the thoracic vertebrae and the parts of the ribs tween the second and third thoracic vertebrae.
from the heads to the angles. The outlet of the thorax (apertura thoracis inferior) is bounded by
On both sides of the external surface of the posterior wall, be the xiphoid process and the costal arch formed by the ends of the
tween the vertebral spines and the angles of the ribs, there is a false ribs anteriorly, by the free ends of the eleventh and twelfth
groove, the dorsal sulcus, accommodating the deep dorsal muscles. ribs laterally, and by the lower borders of the twelfth ribs and the
On the internal surface of the wall, between the projecting verte body of the twelfth vertebra posteriorly.
bral bodies and the angles of the ribs, there are grooves, the pul At the xiphoid process the costal arch (arcus costalis) forms the
monary sulci (sulci pulmonale) (Fig. 46). The posterior borders of infrasternal angle (angulus infrasternalis) which is open downwards.
the lungs adjoin these sulci. The thorax of different individuals varies in shape (it may be
The lateral walls are longer than either the anterior or poste flat, cylindrical or conical). A narrow thoracic cage is longer than a
rior wall. They are formed by the shafts of the ribs and are more or wide one, its infrasternal angle is more acute, and the intercostal
less convex, depending on the individual features. spaces are wider. The thorax of males is longer, wider, and more
The spaces bounded by two adjacent ribs superiorly and inferi conical than that of females. Furthermore the shape of the thorax
orly, by the lateral border of the sternum anteriorly, and by the depends on the individual's age.
vertebrae posteriorly, are called intercostal spaces (spatia intercos-
42 THE THORACIC CAGE
Apertura thoracis superior
Spatia intercostalia
Costae
spuriae
Arcus costalis
44. Thorax; anterior aspect (¾).

45. Thorax; posterior aspect (¾).

44 THE THORACIC CAGE
Processus spinosus
Fovea costalis Processus
Corpus vertebrae thoracicae \
\
I \.
/j
1/
�
46. Skeleton of thoracic segment (½).

(Relation of ribs to vertebra [fourth] and sternum.)
47. Chest (radiograph).

1-left clavicle 9-ascending aorta
2-descending aorta 10-apex of right lung_
3-hilum of lung 11-arch of aorta
4-pulmonary trunk 12-ribs
5-heart 13-right clavicle
6-left lung 14-right scapula
7-diaphragm (left dome) 15-left scapula
8-diaphragm (right dome)
DEVELOPMENT OF BONES AND AGE
FEATURES OF THE TRUNK SKELETON 1
The skeleton develops from the mesenchyme which is poorly called primary prevails in the skeleton of a newborn (Fig. 47a).
differentiated embryonic connective tissue. The bones of the cal Secondary ossification nuclei appear later. The primary, like the
varia and those of the face develop in connective tissue (endesmal secondary nuclei, appear earlier in girls than in boys. In tubular
or intramembranous ossification), others develop in cartilage, peri bones, the ossification nuclei first appear in the central parts of the
chondrally (later, with the appearance of the periosteum, perios diaphysis and then in the epiphyses.
teally) or endochondrally. All these processes begin at the end of At the end of the second month of the embryonic period the
the second month of the intrauterine period, when all other types vertebrae (except for the coccygeal vertebrae) have two nuclei in
of tissues are already present in the body of the embryo. their arch, which form from the fusion of several nuclei, and one
The bones forming in connective tissue are known as primary main nucleus in the body. In the first year of life, the nuclei of the
bones and pass through two developmental stages: membranous arch develop dorsally and unite. This process occurs more rapidly
and bony. Bones developing in cartilage are called secondary and in the cervical than in the coccygeal vertebrae. The arches usually
go through three stages: connective-tissue, cartilaginous, and bony. fuse by the age of 7 years. An exception is the first sacral vertebra
In intramembranous ossification, islets of ossification appear at (sometimes the sacral segment does not close until the age of
the site of the foture bones as condensations of mesenchymal cells 15-18 years). At the age of 3-6 years, bony union of the nuclei in
(which take part in the formation of fibrous fibres) and a great the arch with the nucleus in the body occurs, first in the thoracic
number of blood vessels. Osteoblasts differentiate from the mesen vertebrae.
chymal cells and produce intercellular substance consisting of os Epiphyseal rings appear on the borders of the vertebral body at
sein and calcium salts. The fibrous fibres are impregnated with this the age of 8 years in girls and at the age of 10 in boys. The verte
substance and the osteoblasts are embedded in them. After that bral spines and transverse processes which have additional secon
the osteoblasts develop into mature cells of bony tissue, the osteo dary ossification nuclei on the apices are completely ossified in the
cytes. Perichondral (periosteal) ossification occurs in a similar pubertal period or a little later.
manner at the expense of the cells of the perichondrium (perios The atlas and axis develop in a different manner. The anterior
teum). Endochondral ossification takes place through growth of and posterior arches of the atlas fuse to form a single bone at the
blood vessels from the surrounding mesenchyme into the cartilagi age of 5-6 years. Before the anterior bony arch forms, an area with
nous germs of the bones. Mesenchyme adjoining the forming bone its own paired ossification nucleus appears in the cartilaginous
develops into the periosteum. The external layer of the dura mater germ of the arch and fuses with the axis to form the den� at the age
serves as the periosteum for the internal surface of the skull bones. of 4-5 years. The dens articulates with the internal surface of the
The process of osteogenesis. continues with the formation of anterior arch of the atlas by means of the atlanto-axial articulation.
osteoclasts (bone destroyers) from mesenchymal cells surrounding The five sacral vertebrae fuse to form the sacrum quite late, in
the vessels. the IS-25th year of life. The three lower vertebrae begin to fuse
Cartilaginous tissue with a great number of ossification nuclei from the age of 15, the two upper vertebrae fuse by the age of 25.
The rudimentary coccygeal vertebrae are distinguished by the
In view of the fact that students will study the age features af extremely irregular appearance of the ossification nuclei: in the
ter they are acquainted in detail with the anatomy of a human 2nd-3rd week after birth in the first vertebra, at the age of 4-8
adult, in this section as well as in other similar sections we dwell years in the second, at 9-13 years of age in the third, and, finally,
only on some age peculiarities. For details of development we refer at the age of 15 in the fourth vertebra. Their fusion, first the lower
the reader to a textbook of embryology. and then the upper vertebrae, continues after the age of 30 years.
BONES OF THE TRUNK OF A NEWBORN 47
'
I_
v.
5
47a. Bones of trunk (of a newborn).

I-second cervical vertebra 4-sacrum
2-third thoracic vertebra 5-sternum
3-second lumbar vertebra 6-thorax
48 THE LUMBAR SEGMENT OF THE VERTEBRAL COLUMN
4 7b. Sagittal section through lumbar segment of verte

bral column of a child (photograph).
DEVELOPMENT OF THE TRUNK SKELETON 49
With age the vertebral column as a whole goes through differ the sternum. This process takes place in the 3rd-4th month of in
ent stages of changes in size and shape. It grows particularly inten trauterine life. The sternum contains primary ossification nuclei
sively during the first two years of life, it almost doubles in length; for the manubrium and body and secondary nuclei for the clavicu
until the age of 16 growth in length is slower, after which the spi lar notches and the xiphoid process. Ossification occurs irregularly
nal column grows again actively and in an adult its length is more in the different parts of the sternum. In the manubrium, for in
than three times the length of a newborn's spinal column. It is be stance, the primary ossification nucleus appears in the 6th intra
lieved that until the age of 2 years the vertebrae grow just as inten uterine month, the parts of the body fuse by the 10th year of life
sively as the intervertebral discs, but after the age of 7 the relative and unite finally by the age of 18. The xiphoid process often re
size of the disc diminishes markedly. The nucleus pulposus con mains cartilaginous even though a secondary ossification nucleus
tains a lot of water and is much larger in a child than in an adult. appears in it by the age of 6 years. The sternum as a whole ossifies
The vertebral column of a newborn is straight in the anteroposte at the age of 30 to 35 years, sometimes still later or even not at all.
rior direction. Later, as the result of a number of factors (the effect The thorax, formed by twelve pairs of ribs, twelve thoracic
of the work of muscles, independently maintained sitting posture, vertebrae, and the sternum together with the articular-ligamentous
the weight of the head, etc.), curvatures form in it. The cervical apparatus, goes through a series of developmental stages. The de
curvature (cervical lordosis) forms in the first 3 months of life. The velopment of the lungs, heart, and liver, and the position of the
thoracic curvature (thoracic kyphosis) appears by the age of body (lying down, sitting, walking) alter in respect to age and func
6-7 months, the lumbar curvature (lumbar lordosis) is expressed tion and thus cause changes in the thorax. The main parts of the
sufficiently by the end of the first year of life. thorax (the dorsal sulci, lateral walls, upper and lower apertures,
The ribs are laid down as mesenchyme which lies between the costal arch, and infrasternal angle) alter during the various periods
muscle segments and is then replaced by cartilage. Perichondral of development acquiring each time more and more features of the
ossification of the ribs begins from the second month of the intrau thorax of an adult. It is believed that the development of the tho
terine period, endochondral ossification occurs some time later. rax occurs in four main periods: from birth to the age of 2 years it
The bone tissue in the shaft of the rib grows anteriorly, the ossifi develops very intensively; in the second stage, between the ages of
cation nuclei appear in the region of the angle and head at the age 3 and 7, its development is quite rapid, though slower than in the
of 15-20 years. first period; the third stage, from 8 to 12 years of age, is character
The anterior ends of the upper nine ribs are joined on both ized by rather slow development; the fourth stage, the pubertal pe
sides by cartilaginous sternal bands which, approaching one an riod, is also marked sometimes by intensive development. After
other first in the upper and then in the lower parts, unite to form this, slow growth continues to the age of 20-25 and then stops.
THE BONES OF THE HEAD
Ossa capitis
The skull (cranium) (Figs 48-53) is the skeleton of the head. The facial bones form the framework of the face and the initial
The bones of the cranium (ossa cranii) and the bones of the face parts of the alimentary tube and respiratory tract.
(ossa faciei) are distinguished in it. The skull is the receptacle for Both parts of the skull are composed of individual bones
the brain and organs of sense (visual, acoustic, and olfactory or joined to one another by means of sutures (suturae) and cartilagi-
gans).
48. Skull (cranium); anterior aspect (½).

THE SKULL 51
nous articulations, or joints (synchondroses), which allow no move (ossa cranii) in terms of its development: unpaired bones: occipital
ment. The lower jaw is an exception, its joint is movable. (as occipitale), sphenoid (as sphenoidale), frontal (as frontale), ethmoid
The occipital, parietal, frontal, sphenoid, temporal, and eth (as ethmoidale), vomer; paired bones: temporal (as temporale), parie
moid bones are topographically referred to the bones of the cra tal (as parietale), inferior nasal concha (concha nasalis inferior), lacri
nium; the bones of the face are the inferior nasal conchae, the lac mal (as lacrimale), nasal (as nasale).
rimal and nasal bones, the vomer, the maxilla, the palatine and The bones of the face (ossa faciei) are the paired maxilla, pala
zygomatic bones, the mandible, and the hyoid bone. tine (as palatinum), and zygomatic (as zygomaticum) bones and the
The following bones are related to the bones of the cranium unpaired mandible (mandibula) and hyoid bone (as hyoideum).
Tuber frontale
Os nasale
Sutura coronalis
Canalis opticus
Sutura sphenofrontalis
Facies orbitalis
Processus zygomaticus ossis frontalis
ossis frontalis
Squama temporalis
Sutura frontozygomatica
Facies orbitalis alae

Lamina orbitalis major ossis sphenoidalis
ossis ethmoidalis
Os lacrimale Sutura sphenozygomatica
Fissura orbitalis inferior
Facies orbitalis maxillae

Sutura zygomaticomaxillaris
Lamina perpendicularis
ossis ethmoidalis
Concha nasalis inferior
Sutura intermaxillaris
49. Skull (cranium); anterior aspect (semischematical representation) (½).

52 THE SKULL
50. Skull (cranium); from the right side (¾).

THE SKULL 53
Squama temporalis Sutura squamosa
Sutura coronalis
Sutura sphenoparietalis
Margo parietalis ossis temporalis

(pars squamosa)
Tuber frontale
Linea temporalis
Os lacrimale
w-,-..-sutura
nasomaxillaris
Spina nasalis
anterior
Sutura occipitomastoidea
Sutura temporozygomatica
51. Skull (cranium); from the right side (semischematical representa

tion); (½).
54 THE SKULL
52. Skull (posteroanterior view radiograph).

1-parietal bone 9-tooth (upper lateral incisor)
2-frontal bone JO-mandible
3-temporal bone (petrous part) I I-inferior nasal concha
4-zygomatic bone 12-osseous nasal septum
5-condyloid process of mandible 13-middle nasal concha
6-coronoid process of mandible 14-temporal bone
7 -maxillary sinus 15-orbit
8-maxilla 16-frontal sinus
THE SKULL 55
53. Skull (lateral view radiograph).

I -parietal bone 13-maxillary incisors
2-sella turcica 14-maxilla
3-dorsum sellae 15-maxillary sinus
4-clivus 16-anterior nasal spine
5-occipital bone 17-coronoid process of mandible
6-temporal bone (petrous part) IS-infra-orbital margin
7-second cervical vertebra 19-orbit
8-transverse process 20-sphenoidal sinus
9-spinous process (spine) 21-anterior clinoid process
10-condyloid process of mandible 22-nasal bone
11-mandible 23-frontal sinus
12-mandibular incisors 24-frontal bone
56 THE OCCIPITAL BONE
THE BONES OF THE CRANIUM
THE OCCIPITAL BONE

The occipital bone (os occipitale) (Figs 54-56) is an unpaired lar in shape. Its posterior border is free, smooth, and slightly ta•
bone forming the posteroinferior part of the skull. Its external sur pered, and forms the anterior border of the foramen magnum. Its
face is convex, the internal (cerebral) surface is concave. Its antero anterior border is thick and rough and articulates with the body of
inferior part contains the foral)len magnum (foramen occipitale mag the sphenoid bone by means of cartilage to form the spheno-occip
num) by means of which the cranial cavity communicates with the ital joint (synchondrosis sphenooccipitalis).
vertebral canal. On the basis of development, the following four In adolescence the cartilage is replaced by bone tissue and
parts surrounding foramen magnum are distinguished in the oc both bones fuse to form a single bone. The superior surface of the
cipital bone: the basilar part (pars basilaris) situated in front of the basilar part facing the cranial cavity is smooth and slightly con
foramen magnum, paired condylar parts (partes laterales), and the cave. Together with the part of the sphenoid bone situated in front
squamous part (squama occipitalis) situated to the back of the for of it, the basilar part forms the clivus facing the foramen magnum
amen. (it lodges the medulla oblongata, the pons, and the basilar artery
The basilar part (pars basilaris) is short, thick, and quadrangu- and its branches). On the middle of the inferior external, slightly
Protuberantia occipitalis externa
superior
Crista occipitalis-r-...,---:::..__._ ______;._-4,-

externa
Linea nuchae
inferior
Tuberculum pharyngeum
54. Occipital bone (os occipitale); outer aspect (¼).

THE OCCIPITAL BONE 57
Eminentia
transversi
��.:,__________..;.__,._-+- Cristaintern
occipitalis
a
Canalis condylaris
55. Occipital bone (os occipitale); mner aspect (¼).
convex, surface of the basilar part are a small pharyngeal tubercle amen magnum and fuse anteriorly with the basilar part and poste
(tuberculum pharyngeum)-the site of attachment of the anterior lon riorly with the squamous part.
gitudinal ligament and the fibrous membrane of the pharynx On the external border of the internal (cerebral) surface
called pharyngobasilar fascia (fascia pharyngobasilaris) , and rough (Fig. 55) is a narrow groove for the inferior petrosal sinus (sulcus si
lines marking the insertion of the rectus capitis anterior and lon nus petrosi inferioris) which meets the inferior border of the petrous
gus capitis muscles. part of the temporal bone and joins the similarly named groove on
The external slightly uneven border of the basilar part and the temporal bone to form a sort of canal in which the venous infe
condylar parts of the occipital bone adjoin the posterior margin of rior petrosal sinus (sinus petrosus inferior) lies.
the petrous part of the temporal bone. Between them is the petro On the inferior, external, surface of either condylar part is an
occipital fissure (fissura petrooccipitalis), which in an unmacerated elongated oval in shape and convex articular process, the occipital
skull is filled with cartilage forming the petro-occipital joint (syn condyle (condylus occipitalis); both condyles with the articular sur
chondrosis petrooccipitalis) that as a remnant of the cartilaginous ske face converge anteriorly but diverge posteriorly; they articulate
leton ossifies with age. with the superior facets of the atlas. To the back of the occipital
The condylar parts (par/es laterales) of the occipital bone are condyle is a condylar fossa (fossa condylaris) lodging the posterior
slightly elongated, thickened in the posterior parts and narrowed a condylar emissary vein (vena emissaria condylaris).
little in the anterior parts. They form the lateral borders of the for- The external border of the condylar part bears a large jugular
58 THE OCCIPITAL BONE
Sulcus sinus
petrosi inferioris
Canalis n. hypoglossi
Condylus occipitalis
56. Occipital bone (os occipitale); from the right side (¼).
notch {incisura jugularis) with smooth edges. A small intrajugular tween the jugular process and the occipital condyle the hypoglos
process (processus intrajugularis) projects on the notch. sal canal (canalis nervi hypoglossi) passes through the bone; it trans
The jugular notch of the occipital bone and the jugular notch mits the hypoglossal nerve.
of the petrous part of the temporal bone form the jugular foramen The squamous part of the occipital bone (squama occipitalis)
{foramen jugulare). forms the posterior border of the foramen magnum and makes up
The intrajugular processes of both bones separate this foramen the greater part of the occipital bone. This is a wide triangular
into two parts: a larger posterior part lodging the upper bulb of the curved plate with a concave internal (cerebral) surface and a con
internal jugular vein (bulbus superior vena jugularis internae), and a vex external surface.
smaller anterior part transmitting the glossopharyngeal, vagus, and The edge of the squamous part is separated into two parts: a
accessory nerves {nervi glossopharyngeus, vagus et accessorius). larger strongly serrated superior part called the lambdoid border
The jugular notch is bounded by the jugular process (processus (margo lambdoideus) which articulates with the occipital border of
jugularis) posteriorly and laterally. On the external surface of its the parietal bones to form the lambdoid suture (sutura lambdoidea);
base is a small paramastoid process (processus paramastoideus) into a smaller less serrated inferior part called the mastoid border
which the rectus capitis lateralis muscle is inserted. (margo mastoideus) which unites with the edge of the mastoid pro
A wide sigmoid groove (sulcus sinus sigmoidei) stretches behind cess of the temporal bone by means of the occipitomastoid suture
the jugular process on the internal surface of the skull; it is a con (sutura occipitomastoidea).
tinuation of the sigmoid groove of the temporal bone. A smooth The external occipital protuberance (protuberantia occipitalis ex
jugular tubercle (tuberculum jugulare) is located anteriorly and me terna) (Fig. 54) is in the middle of the external surface of the
dially. squama where it is most convex. The protuberance is easily pal
To the back of and downwards from the jugular tubercle, be- pated through the skin. Laterally from it diverge paired raised su-
THE PARIETAL BONE 59
perior nuchal lines (linea nuchae superiores), above and parallel to bears the eminentia cruciata (eminentia cruciformis) in the middle of
which are encountered accessory highest nuchal lines (linea nuchae which is the internal occipital protuberance (protuberantia occipitalis
supremae). interna) (Fig. 55). It corresponds to the external occipital protube�
The external occipital crest (crista occipitalis externa) descends ance on the external surface.
from the external occipital protuberance to the foramen magnum. The cruciate eminence gives rise to a groove for the transverse
In the middle of the distance between the foramen magnum sinus (sulcus sinus transversi) passing laterally on either side, an as
and the external occipital protuberance, the crest gives rise to the ce�ding superior groove for the sagittal sinus (sulcus sinus sagittalis
inferior nuchal lines (linea nuchae inferiores), which diverge 'laterally superioris), and an internal occipital crest (eris/a occipitalis interna)
and pass to the edges of the squamous part parallel to the superior descending to the posterior semicircumference of the foramen
lines. All these lines mark the insertion of muscles. The surface of magnum.
the squamous part below the superior nuchal lines is the site of at Processes of the dura mater with the venous sinuses embedded
tachment of muscles terminating on the occipital bone. in them are attached to the borders of the transverse and sagittal
The cerebral surface (facies cerebra/is) of the squamous part grooves and the internal occipital crest.
THE PARIETAL BONE

The parietal bone (os parietale) (Figs 50, 51, 57, 58) is a paired sion of the venous sigmoid sinus of the dura mater, is found on the
bone forming the superior and lateral parts of the skull cap (cal cerebral surface at the posteroinferior angle. It is continuous with
varia). It is a quadrangular plate convex on the outer surface. Two the sigmoid groove on the temporal bone anteriorly and with the
surfaces, external and internal, and four borders, superior, inferior, groove for the transverse sinus on the occipital bone posteriorly.
anterior, and posterior, are distinguished in it. The superior, sagittal border (margo sagittalis) runs straight and
The external surface (facies externa) is even and convex. The is strongly serrated. It is longer than the other borders and articu
most convex part is called the parietal eminence, or tuber (tuber lates with the sagittal border of the contralateral parietal bone by
parietale). Below the tuber is a rough horizontal arched superior means of the sagittal suture (sutura sagittalis).
temporal line (linea temporalis superior) which arises from the ante The inferior, squamous border (margo squamosa) is tapered and
rior border of the bone and, being a continuation of the superior arched and its anterior area is covered by the posterior part of the
temporal line of the frontal bone, stretches along the entire surface upper border of the greater wing of the sphenoid bone. Further to
of the parietal bone to its posteroinferior angle. Below this line and the back, the parietal border of the squamous part of the temporal
parallel to the inferior border of the parietal bone stretches an bone is superimposed on it; the extreme posterior area articulates
other, more defined line, the inferior temporal line (linea temporalis by means of notches with the mastoid process of the temporal
inferior). The superior line gives attachment to the temporal fascia, bone. According to these three areas, the following three sutures
the inferior line is the site of insertion of the temporal muscle. form: the squamous suture (sutura squamosa), the parietomastoid
The internal surface (facies interna) is concave and bears poorly suture (sutura parietomastoidea), and the sphenoparietal suture (su
defined depressions corresponding to the gyri of the brain which tura sphenoparietalis ).
are called impressions for the cerebral gyri (impressiones digitatae), The anterior, frontal border (margo frontalis) is serrated. It ar
cerebral ridges and dendriform branching arterial sulci (sulci arteri ticulates with the parietal border of the squama of the frontal bone
osi) which are marks of the branches of the middle meningeal ar to form the coronal suture (sutura corona/is).
tery. The posterior, occipital border (margo occipitalis) is serrated and
On the superior border of the cerebral surface of the bone articulates with the lambdoid border of the occipital bone to form
passes an inco,nplete sagittal groove (sulcus sinus sagittalis superioris) the lambdoid suture (sutura lambdoidea).
and, together with the groove on the contralateral parietal bone, In accordance with the four borders, the parietal bone has four
forms a complete groove (the sickle-shaped process of the dura angles.
mater, falx cerebri, is attached to the margins of the groove). The anterosuperior, frontal angle (angulus frontalis) is almost
In the posterior part of the superior border of the bone is a straight (it is bounded by the coronal and sagittal sutures).
small parietal foramen (foramen parietale) which is an emissary The anteroinferior, sphenoidal angle (angulus sphenoidalis) is
(emissarium) transmitting a branch of the occipital artery to the acute (it is bounded by the coronal and sphenoparietal sutures).
dura mater and the parietal emissary vein. Deep in the sagittal The posterosuperior, occipital angle (angulus occipitalis) is ob
groove and next to it (particularly on the parietal bones at an el tuse (it is bounded by the lambdoid and sagittal sutures).
derly age) can be seen most of the small granular pits (foveolae The posteroinferior, mastoid angle (angulus mastoideus) is more
granulares) (granulations of the arachnoid mater of the brain pro obtuse than the posterosuperior angle (it is bounded by the lamb
ject here). doid and parietomastoid sutures). Its anterior part fits into the par
A small deep sigmoid groove (sulcus sinus sigmoidei), an impres- ietal notch (incisura parietalis) of the temporal bone.
60 THE PARIETAL BONE
Margo sagittalis
Angulus occi
� ",.
Linea temporalis
supenor
Linea temporalis
inferior
Margo
occipitalis
Margo fronralis
_____,,,\
Margo squamosus Angulus sphenoidalis
57. Right parietal bone (os parietale); outer aspect (¼).

THE PARIETAL BONE 61
Sulcus sinus sagittalis superioris
Margo occipitalis
Margo frontalis
Angulus sphenoidalis Angulus mastoideus

Margo squamosus
58. Right parietal bone (os parietale); mner aspect (¼).

62 THE FRONTAL BONE
THE FRONTAL BONE

The frontal bone (osfrontale) (Figs 48-53, 59-61) of a human supraorbital notch (incisura supraorbitalis) in its medial third. This
adult forms the anterior part and partly the base of the skull cap. notch varies greatly and may be present as a supraorbital foramen
It consists of four parts: frontal squama (squama frontalis), two orbi (foramen supraorbitale). Nearer to the median line, i.e. medially, is
tal plates (partes orbitales), and the nasal part (pars nasalis). located a no less defined frontal notch (incisura Jrontalis). The su
The frontal squama (squama frontalis) is convex to the front praorbital notch transmits the lateral branch of the supraorbital
and has the following surfaces: an external (frontal), two lateral nerve and vessels, the frontal notch transmits the medial branch of
(temporal) surfaces, and an internal (cerebral surface). this nerve and vessels. A frontal foramen (foramenfrontale) may be
The frontal surface (facies externa) is smooth, convex anteriorly found in place of the notch.
and has an eminence on the median line. This eminence is not de The supraorbital margin is continuous laterally with a blunt
tectable in some cases. This is the line of the frontal suture (sutura triangular zygomatic process (processus zygomaticus), whose serrated
metopica) marking the union of the halves of the frontal bone in edge unites with the frontal process of the zygomatic bone by
early childhood. In the anterior parts, the frontal surface of the means of the frontozygomatic suture (sutura frontozygomatica).
squama is continuous with the orbital surface (facies orbitalis) and An arched temporal line (Linea temporalis) ascends posteriorly
forms the supraorbital margin (margo supraorbitalis) on both sides. from the zygomatic process. It separates the frontal surface of the
Above and parallel to this margin is a more or less defined arched squama from its temporal surface (facies temporalis) which is the an
eminence, the superciliary arch (arcus superciliaris). Above each terosuperior area of the temporal fossa where part of the temporal
arch is a rounded frontal eminence (tuber frontale). Between and muscle arises.
slightly above the superciliary arches the surface of the squama has The cerebral surface (facies interna) of the frontal squama
a depressed area, the glabella. The supraorbital margin has a small (Fig. 60) is concave. It has poorly defined impressions for the gyri
Tuber
frontale
Linea ---i---
temporalis
Foramen
supraorbitale
Process us
zygomaticus
Sutura frontalis
59. Frontal bone (os frontale); outer aspect (¼).

THE FRONTAL BONE 63
(impressiones girorum), cerebral ridges (juga cerebralia), and incon stretches posteriorly and horizontally from the supraorbital margin
stantly present and indistinct arterial sulci (sulci arteriosi) which are of the squama. Inferior (orbital) and superior (cerebral) surfaces
markings for the brain and vessels lodged here. are distinguished in it.
The sagittal groove (sulcus sinus sagittalis superioris) runs in the The orbital surface (facies orbitalis) faces the cavity of the orbit
middle of the superior parts of the internal surface. Both its edges and is smooth and concave. In its lateral part at the base of the zy
pass upwards and to the back to unite with the sagittal groove of gomatic process it has a small shallow fossa for the lacrimal gland
the parietal bone, while downwards they join to form a single (Iossa glandulae lacrimalis).
sharp frontal crest (cristafrontalis) (to which the process of the dura The medial part of the orbital surface bears a poorly defined
mater, falx cerebri, is attached). At its lowest part the crest to trochlear fossa (fovea trochlearis), near to which a cartilaginous
gether with the ala of the crista galli (ala cristae galli ossis ethmoida trochlear spine (spina trochlearis) is often found (it serves for attach
lis} form the foramen caecum (foramen cecum), a blind opening ment of a cartilaginous ring which is a pulley, the trochlea, for the
occupied by a process of the dura mater. tendon of the superior oblique muscle of the eyeball).
The superior, or posterior, thickened border of the frontal The cerebral surface (facies interna) of the orbital part has
squama is called the parietal margin (margo parietalis). Its serrated clearly defined markings for the frontal lobes of the brain in the
border unites with the frontal border of the parietal bone to form form of impressions for the gyri (impressiones girorum) and cerebral
the coronal suture (sutura corona/is). The inferior triangular areas of ridges of the cranium (juga cerebralia).
the squama unite with the frontal border of the greater wings of The orbital plates are separated from one another by the eth
the sphenoid bone. moidal notch (incisura ethmoidalis) into which fits the cribriform
Each orbital plate (pars orbitalis) (Fig. 61) of the frontal bone plate (lamina cribrosa) of the ethmoid bone. The notch is bounded
contributes to the formation of the superior wall of the orbit. It on the sides by a border lateral of which are a series of small pits
--------------- Sulcus sinus

sagittalis
superioris
Sulci arteriosi
Impressiones
digitatae
Impressiones digitatae
60. Frontal bone (os frontale); mner aspect (¾).

64 THE FRONTAL BONE
Fossa glandulae
lacrimalis
Pars orbitalis
61. Frontal bone (osfrontale); inferior aspect(¾).
(Fig. 61 ). They roof in the open ethmoidal cells of the superior end and flattened sides and is surrounded in front and on the sides
part of the ethmoid bone to form their superior wall. Two eth by a serrated nasal margin (margo nasalis). The anterior parts of the
moidal grooves, anterior and posterior, stretch transversely be margin unite with the superior border of the nasal bone to form
tween the ethmoidal cells and together with the ethmoidal grooves the frontonasal suture (sutura frontonasalis), the posterior parts join
of the labyrinth of the ethmoid bone form small canals which have the frontal process of the maxilla (processus frontalis) by means of
small openings on the medial wall of the orbit: the anterior eth the frontomaxillary suture (sutura Jrontomaxillaris). Posteriorly, the
moidal foramen (foramen ethmoidale anterius) (see Figs 106 and 109) inferior surface of the nasal part bears shallow ethmoidal pits
which transmits the anterior ethmoidal vessels and nerve, and the which, as pointed out above, roof in the cells of the ethmoidal lab
posterior ethmoidal foramen (foramen ethmoidale posterius) which yrinths.
transmits the nerves and posterior ethmoidal vessels. The margin On either side of the nasal spine is the aperture of the frontal
of the ethmoidal notch articulates with the superior margin of the sinus (apertura sinus frontalis). It stretches upwards and forwards
orbital plate (lamina orbitalis) of the ethmoid bone to form the and leads into the cavity of the respective frontal sinus.
frontoethmoid suture (suturafrontoethmoidalis). Anteriorly the notch The frontal sinus (sinus frontalis) (see Figs 94 and 103) is a
unites with the lacrimal bone by means of the frontolacrimal su paired cavity lodged between both plates of the frontal bone in its
ture (sutura Jrontolacrimalis). anteroinferior parts. It is an air paranasal sinus (sinus paranasalis).
The posterior border of the orbital plate is thin and serrated, The right and left sinuses are separated by a vertical septum of the
and articulates with the lesser wing of the sphenoid bone to form frontal sinuses (septum sinuum frontalium). The septum deviates to
the internal part of the sphenofrontal suture (sutura sphenofrontalis). one or the other side as a result of which the sinuses differ in size.
The lateral border of the orbital plate is rough, triangular, and The borders of the sinuses vary considerably. Sometimes they
articulates with the frontal border of the greater wing of the sphe reach upwards to the frontal eminence, downwards to the su
noid bone to form the external part of the sphenofrontal suture. praorbital margin, backwards to the lesser wings of the sphenoid
Still laterally the border terminates at the zygomatic process. bone, and laterally to the zygomatic processes. By means of its ap
The nasal part (pars nasalis) of the frontal bone closes the eth erture the frontal sinus communicates with the middle meatus of
moidal notch anteriorly in an arch-like fashion. In the middle of the nose (meatus nasi medius). The cavity of the sinus is lined with a
its anterior part, the nasal spine (spina nasalis) (sometimes a double mucous membrane.
one) projects obliquely downwards and forwards. It has a tapering
THE SPHENOID BONE 65
THE SPHENOID BONE

The sphenoid bone (os sphenoidale) (Figs 62-64, 94, 96, 102) is riforrn plate (lamina cribrosa) of the ethmoid bone to form the
unpaired and forms the central part of the base of the skull. sphenoethmoidal suture (sutura sphenoethmoidalis). The sella turcica
The body (corpus ossis sphenoidalis) is the middle part of the is bounded posteriorly by the dorsum sellae terminating on both
sphenoid bone, it is cuboid in shape and has six surfaces. sides by a small posterior clinoid process (processus clinoideus poste
In its middle part the superior surface facing the cranial cavity rior).
has a depression, the sella turcica, in the centre of which is the hy The carotid groove (sulcus caroticus) stretches laterally from
pophyseal fossa (Iossa hypophysialis) (Fig. 62) in which the hypophy front to back of the sella (it is an impression of the internal carotid
sis is lodged. The size of the fossa is determined by the size of the artery and the attendant nerve plexus which are lodged here). A
hypophysis. The sella turcica is bounded by the tuberculum sellae sharp process called the lingula of the sphenoid bone (lingula sphe
anteriorly. To the back of it, on the lateral surface of the sella is an noidalis) projects at the posterior edge of the groove on its lateral
inconstantly present middle clinoid process (processus clinoideus me side.
dius). The posterior surface of the dorsum sellae is continuous with
A shallow transverse optic groove (sulcus chiasmatis) passes to the superior surface of the basilar part of the occipital bone to
the front of the sella and lodges the optic chiasma (chiasma opti form the clivus (on which the pons, the medulla oblongata, the
cum). On both sides the groove is continuous with the optic fo basilar artery and its branches are lodged). The posterior surface
ramen (canalis opticus). In front of the groove is a smooth surface, of the body is rough. It is joined to the anterior surface of the basi
jugum sphenoidale, that connects the lesser wings of the sphenoid lar part of the occipital bone by means of a cartilaginous layer to
bone. The anterosuperior border of the body is serrated, projects form the spheno-occipital joint (synchondrosis sphenooccipitalis). The
forwards slightly, and unites with the posterior border of the crib- cartilage is replaced by bony tissue with age and both bones fuse.
Fossa hypophysialis
Dorsum sellae
Foramen spinosum
62. Sphenoid bone (os sphenoidale) and occipital bone (os occipi
tale); superior aspect (¾).
66 THE SPHENOID BONE
Margo parietalis
Corpus ossis sphenoidalis

(Site of articulation with os occipitale)
Processus clinoideus posterior
Canalis
opticus Processus clinoideus
superior
'1111_.__ Margo
squamosus
Lingula sphenoidalis ....;;;.;;.,�:'i!,::,-"""".--�r--:#:��,.
Sulcus tubae
auditivae
Fossa scaphoidea
Processus pterygospinosus
Processus Fossa pterygoidea
Processus Lamina lateralis
vaginalis
pterygoideus { '7
Lamina medialis
� Incisura pterygoidea
Sulcus hamuli pterygoidei
63. Sphenoid bone (os sphenoidale); posterior aspect (½).
Concha
sphenoidalis
Processus vaginalis
Crista sphenoidalis
64. Sphenoid bone (os sphenoidale); anterior aspect (½).

THE SPHENOID BONE 67
The anterior and part of the inferior surface of the body face situated medially and anteriorly; laterally and posteriorly of the fo
the nasal cavity. A vertical crest of the sphenoid (crista sphenoidalis) ramen rotundum is the foramen ovale transmitting the mandibu
projects into the middle of the anterior surface. Its anterior edge lar nerve and the vascular network of the foramen ovale; still more
adjoins the perpendicular plate (lamina perpendicularis) of the eth laterally and to the back of the foramen ovale is the foramen spin
moid bone. The lower segment of the crest is tapered and stretches osum transmitting the middle meningeal artery, vein, and nerve.
downwards to form the rostrum of the sphenoid (rostrum sphenoi The anterosuperior, orbital surface (facies orbitalis) is smooth,
dale) which is wedged in-between the alae of the vomer (alae vome rhomboid, and faces the orbital cavity. It forms the greater part of
ris). To both sides of the crest is a thin curved plate called the the lateral wall of the orbit. A gap is left between the inferior bor
sphenoidal concha (concha sphenoidalis) (Fig. 64) which forms the der of this surface and the posterior border of the orbital surface
anterior and partly the inferior walls of the sphenoidal sinus (sinus of the maxillary body to form the inferior orbital fissure (fissura
sphenoidalis) and has a small aperture of the sphenoidal sinus (aper orbitalis inferior) (Figs 48 and 49).
tura sinus sphenoidalis). Lateral to the aperture are small pits which The anterior, maxillary surface (facies maxillaris) is a small tri
roof in the cells of the posterior part of the ethmoid bone laby angular surface bounded by the orbital surface superiorly and by
rinth. The external margins of thes9 pits unite partially with the the root of the pterygoid process of the sphenoid bone laterally
orbital plate of the ethmoid bone to form the sphenoethmoidal su and inferiorly. It contributes to the formation of the posterior wall
ture (sutura sphenoethmoidalis), while t�e inferior margins unite with of the pterygopalatine fossa (fossa pterygopalatina) (see Figs 109 and
the orbital process (processus orbitalis) I of the palatine bone. 110) in which the foramen rotundum is located.
The sphenoidal sinus (sinus spheno[dalis) (see Fig. 94) is a paired The superolateral, temporal surface (facies temporalis) is slightly
cavity, occupies a large part of the body of the sphenoid bone, and concave and participates in the formation of the wall of the tem
is a paranasal air cavity. Both the right 1 and left cavities are sepa poral fossa (fossa temporalis) from which the temporal muscle arises.
rated by the septum of the sphenoid11 sinuses (septum sinuum sphe This surface is bounded inferiorly by the infratemporal crest (crista
noidalium) which is anteriorly contibuous with the crest of the infratemporalis) below which is an area with the foramen ovale and
sphenoid. Just like in the case of the frontal sinuses, the septum the foramen spinosum. This area forms the superior wall of the in
sometimes deviates to one side as a result of which the sinuses may fratemporal fossa (fossa infratemporalis) in which part of the lateral
differ in size. Each sinus communicates with the nasal cavity by pterygoid muscle originates. The superior, frontal border (margo
means of its aperture described above. The cavity of the sinus is frontalis) is widely serrated and articulates with the orbital plate of
lined with a mucous membrane. the frontal bone by means of the sphenofrontal suture (sutura
The lesser wings (alae minores) of the sphenoid bone arise from sphenofrontalis). The lateral parts of the frontal border terminate as
the anterosuperior angles of the body and project laterally as two a sharp parietal border (margo parietalis) which unites with the
horizontal plates at the base of which is a small round opening sphenoid angle of the parietal bone to form the sphenoparietal su
leading into a bony 5-6 mm long optic foramen (canalis opticus). It ture (sutura sphenoparietalis). The medial parts of the frontal border
transmits the optic nerve and the ophthalmic artery. The lesser are continuous with a thin free border which binds the superior
wings have a superior surface facing the cranial cavity and an infe orbital fissure (fissura orbitalis superior) inferiorly because of a gap
rior surface which faces the orbital cavity and forms the superior left between this border and the inferior surface of the lesser wing.
border of the superior orbital fissure (fissura orbitalis superior). The anterior, zygomatic border (margo zygomaticus) is serrated
The anterior border of the lesser wing is thick and serrated and and articulates with the frontal process of the zygomatic bone to
unites with the orbital plate of the frontal bone. The posterior con form the sphenozygomatic suture (sutura sphenozygomatica).
cave and smooth border projects into the cranial cavity freely and The posterior, squamous border (margo squamosus) unites with
is the border between the anterior and middle cranial fossae (fossae the sphenoidal border (margo sphenoidalis) of the temporal bone by
cranii anterior et media) (see Figs 101 and 102). The posterior bor means of the sphenosquamous suture (sutura sphenosquamosa). Pos
der terminates medially by a projecting well-defined anterior cli teriorly and laterally the squamous border terminates as the spine
noid process (processus clinoideus anterior) to which part of the dura of the sphenoid (spina ossis sphenoidalis) to which are attached the
mater is attached, forming the diaphragma sellae. sphenomandibular ligaments and a bunch of muscles tensing the
The greater wings (alae majores) arise from the lateral surfaces soft palate, the tensor palati muscle.
of the body of the sphenoid bone and stretch laterally. Medially of the spine of the sphenoid, the posterior border of
The greater wing has five surfaces and three borders. the greater wing stretches anteriorly of the petrous part (pars pe
The superior, cerebral surface (facies cerebralis) is concave and trosa) of the temporal bone and binds the sphenopetrosal fissure
faces the cranial cavity. It forms the anterior part of the middle (fissura sphenopetrosa) which is medially continuous with the for
cranial fossa and bears impressions for the gyri (impressiones digita amen lacerum (see Figs 96 and 102). In a nonmacerated skull this
tae), cerebral juga, or ridges (juga cerebralia), and arterial sulci (sulci fissure is filled with cartilaginous tissue to form the sphenopetrous
arteriosi) which are markings for the brain surface and middle joint (synchondrosis sphenopetrosa).
meningeal arteries lodged here. The pterygoid processes (processus pterygoidei) (Figs 63 and 64)
There are three openings at the base of the wing: the foramen spring downwards from the junction of the greater wings and the
rotundum (Figs 63 and 64) transmitting the maxillary nerve is body of the sphenoid bone. They are formed of two plates, lateral
68 THE TEMPORAL BONE
and medial. The lateral pterygoid plate (lamina lateralis processus which transmits vessels and nerves. The canal stretches sagittally
pterygoidei) is wider but thinner and shorter than the medial plate in the depth of the pterygoid process and opens on the maxillary
(the lateral pterygoid muscle originates from its lateral surface). surface of the greater wing on the posterior wall of the pterygopal
The medial pterygoid plate (lamina medialis processus pterygoidei) is atine fossa.
narrower, thicker and slightly longer than the lateral plate. Both Under the opening along the anterior edge of the fossa is the
plates fuse by means of their anterior borders and diverge to the pterygopalatine groove.
back to form the pterygoid fossa (fossa pterygoidea) in which the From the base of the medial plate a flat horizontal vaginal pro
medial pterygoid muscle arises. In the inferior parts, the plates do cess (processus vaginalis) projects medially, it is situated below the
not fuse but bind the pterygoid notch (incisura pterygoidea) into body of the sphenoid bone and covers the ala of the vomer (ala
which the pyramid process, or tubercle (processus pyramidalis) of the vomeris) from the lateral side. As a result the groove of the vaginal
palatine bone fits. The free end of the medial platP. terminates as process, the vomerovaginal sulcus (sulcus vomerovaginalis), which
the pterygoid hamulus (hamulus pterygoideus) which projects faces the wing is transformed into the vomerovaginal canal (canalis
downwards and laterally and has on its lateral surface the sulcus of vomerovaginalis).
the pterygoid hamulus (sulcus hamuli pterygoidei) (this sulcus lodges A small palatinovaginal sulcus (sulcus palatinovaginalis) some
the tendon of the tensor veli palatini muscle). times stretches sagittally lateral of the process, in which case the
The posterosuperior border of the medial plate becomes wider sphenoid process of the palatine bone lying directly below the sul
at the base to form an elongated scaphoid fossa (fossa scaphoidea) in cus closes it to form the palatinovaginal canal (canalis palatinovagi
which the tensor veli palatini muscle originates. nalis) (both canals transmit nerves arising from the pterygopalatine
Laterally of the scaphoid fossa is a shallow groove for the phar ganglion, while the palatinovaginal canal transmits in addition
yngotympanic tube (sulcus tubae auditivae) (Fig. 63) which passes branches of the sphenopalatine artery).
onto the greater wing laterally to reach the spine of the sphenoid The pterygospinous process (processus pterygospinosus) extends
(spina ossis sphenoidalis). This groove lodges the cartilaginous part of sometimes from the posterior border of the lateral plate towards
the auditory tube. Above and medially of the scaphoid fossa is an the spine of the sphenoid which it may reach to form an opening.
opening leading into the pterygoid canal (canalis pterygoideus)
THE TEMPORAL BONE

The temporal bone (os temporale) (Figs 51-53, 65-71, 102) is a and two margins, a longer superior and a shorter inferior margin.
paired bone which contributes to the formation of the base of the The anterior end of the zygomatic process is serrated and joins the
skull and the side of the skull. The organ of hearing and equilib temporal process of the zygomatic bone (processus temporalis) to
rium is lodged in it. The temporal bone articulates with the mandi form the zygomatic arch (arcus zygomaticus) (see Figs 50 and 51).
ble and is a support for the masticatory apparatus. On the inferior surface of the root is a transversely-oval articu
On the external surface of the bone is the lateral orifice of the lar fossa (fossa mandibularis) for articulation with the head of the
external auditory meatus (porus acusticus externus) around which the mandible. The fossa is bounded anteriorly by the eminentia articu
three parts of the temporal bone are arranged: the squamous part laris (tuberculum articulare) (Fig. 65).
(pars squamosa) superiorly, the petrous part (pyramid) (pars petrosa) The outer surface of the squamous part contributes to the for
medially and posteriorly, and the tympanic part (pars tympanica) mation of the temporal fossa (fossa temporalis) in which bundles of
anteriorly and inferiorly. the temporal muscle originate.
The squamous part (pars squamosa) has the shape of a plate sit The inner, cerebral surface of the squamous part (facies cerebra
uated almost sagittally. Its outer temporal surface (facies temporalis) /is) is slightly concave and carries impressions for the gyri (impres
is rather rough and slightly convex. In its posterior part it bears a siones digitatae), cerebral juga (juga cerebralia), and an arterial sulcus
vertical groove for the middle temporal artery (sulcus arteriae tem (sulcus arteriosus) lodging the middle meningeal artery.
poralis mediae), which is a mark of the artery of the same name. The squamous part of the temporal bone has two free borders,
In the posteroinferior portion of the squamous part is an sphenoidal and parietal.
arched line which is continuous with the inferior temporal line of The anteroinferior, sphenoidal border (margo sphenoidalis) is
the parietal bone. wide, serrated and articulates with the squamous border of the
Above and slightly in front of the external acoustic meatus, the greater wing of the sphenoid bone to form the sphenosquamous
squamous part gives rise to a horizontally projecting zygomatic suture (sutura sphenosquamosa). The superoposterior, parietal border
process (processus zygomaticus) which has a wide root but becomes (margo parietalis) is sharp and is longer than the sphenoidal border;
gradually narrower. The process has a medial and a lateral surfaces it articulates with the squamous border of the parietal bone.
THE TEMPORAL BONE 69
Pars squamosa
Margo parietalis
Sulcus arteriae
tern poralis mediae
Spina supra---1,---4,-------;,..,.-'"'11•
meatum
Fissura tympanomastoidea
t Meatus acusticus "
externus Processus styloideus
Processus masto1deus
65. Right temporal bone (os temporale); outer surface (½).

Hiatus canalis n. petrosi minoris
Sulcus n. petrosi
majoris
Sulcus n
Sulcus sinus
sigmoidei
ai;,:..�-i�l!!lir- Foramen
mastoideum
s_upenons
Impressio trigemini
66. Right temporal bone (os temporale); inner surface, superior aspect (½).
Eminentia arcuata
Porus acusticus internus
Processus
zygomaticus
Foramen
Pars petrosa--,�P,.•_"i!_..II mastoideum
Apex
partis petrosae
Sulcus sinus
petrosi inferioris
Processus Fossa subarcuata

styloideus
Vagina processus styloidei
67. Right temporal bone (os temporale); mner surface, posterior aspect (½).
The petrous part (pars petrosa), or pyramid, of the temporal with the groove for the transverse sinus of the occipital bone (it
bone consists of the posterolateral and anteromedial parts. lodges the transverse venous sinus of the dura mater). Downwards
The posterolateral part is the mastoid process (processus mastoi the sigmoid sinus is continuous with the similar sinus of the occipi
deus) situated to the back of the external acoustic meatus. Outer tal bone.
and inner surfaces are distinguished in it. The outer surface is con The mastoid process is bounded posteriorly by a serrated oc
vex, rough, and provides for muscle attachment. The mastoid pro cipital border {margo occipitalis) which articulates with the mastoid
cess is continuous downwards with a conical projection which is border of the occipital bone to form the occipitomastoid suture (su
easily palpated through the skin. tura occipitomastoidea). In this suture, in its middle part or occipital
On the inner surface, the process is bounded by a deep mas edge is the mastoid foramen (foramen mastoideum) (sometimes more
toid notch (incisura mastoidea) from which the posterior belly of the than one) which, as it is pointed out above, lodges the mastoid
digastric muscle (venter posterior musculi digastrici) arises. The occipi emissary veins (venae emissariae mastoideae) connecting the subcu
tal groove (sulcus arteriae occipitalis) for the occipital artery is paral taneous veins of the head with the sigmoid venous sinus and mas
lel to and slightly behind the notch. A mastoid foramen (foramen toid branch of the occipital artery.
mastoideum) is often found at the base of the mastoid process on its Superiorly the mastoid process is bounded by the parietal bor
lateral surface. Sometimes it is in the suture joining the mastoid der (margo parietalis) which at the junction with the parietal border
process and the occipital bone and is a venous emissarium. of the squamous part of the temporal bone forms the parietal
On the inner, cerebral surface of the mastoid process is a wide notch (incisura parietalis); the mastoid angle of the parietal bone is
S-shaped sigmoid groove (sulcus sinus sigmoidei) which is continuous wedged into it to form the parietomastoid suture (sutura parietomas
upwards with the sigmoid groove of the parietal bone and then toidea).
Fissura petrosquamosa
Fissura petrotympanica
Process us
zygomaticus
Canalis caroticus
Fossa mandibularis
.:..-.--Apertura externa
Processus styloideus canaliculi cochleae
Canaliculus mastoideus
extern us
Foramen
stylomastoideum
Processus mastoideus
68. Right temporal bone (os temporale); inferior aspect (½).
At the junction of the outer surface of the mastoid process and ders (superior, anterior, and posterior) are distinguished in the pe
the outer surface of the squamous part the remnants of the squa trous part.
momastoid suture (sutura squamosomastoidea) can be detected; it is The anterior surface (facies anterior partis petrosae) (Fig. 66) faces
well defined on a child's skull. the cranial cavity. It is smooth and wide and stretches obliquely
Bony air sinuses called the mastoid air cells (cellulae mastoideae) downwards and forwards and is continuous with the cerebral sur
(Fig. 69) located in the mastoid process and separated from one face of the squamous part from which it is sometimes separated by
another by bony walls are de{Ilonstrated on a cross-section of the the petrosquamous fissure (fissura petrosquamosa). Almost in the
process. The tympanic antrum (antrum mastoideum) is a cavity al middle of the anterior surface is an arcuate eminence (eminentia ar
ways found in the central part of the process; the mastoid cells cuata) formed by the underlying anterior semicircular canal of the
open into it and it communicates with the tympanic cavity. The labyrinth. A small area called the roof of tympanum, or tegmen
mastoid cells and the tympanic antrum are lined with a mucous tympani is situated between the eminence and the petrosquamous
membrane. fissure; under it is the tympanic cavity (cavum tympani). Close to
The anteromedial part of the pars petrosa is medial of the the apex of the petrous part the anterior surface bears a small tri
squamous part and the mastoid process. It has the shape of a trihe geminal impression (impressio trigemini) which is a mark for the tri
dral pyramid whose long axis runs medially and from back to geminal nerve ganglion.
front. The base of the petrous part faces laterally and to the back; Lateral of the impression is the hiatus for the greater super
the apex of the petrous part (apex partis petrosae) is directed medi ficial petrosal nerve (hiatus canalis nervi petrosi majoris) from which a
ally and forwards. narrow groove for the greater superficial petrosal nerve (sulcus nervi
Three surfaces (anterior, posterior, and inferior) and three bar- petrosi majoris) branches off medially. A small hiatus for the lesser
Prominentia canalis semicircularis lateralis
Probe in geniculum canalis facialis

Hiatus canalis n. petrosi majoris
Sinus tympani
Cellulae mastoideae
Probe in foramen
stylomastoideum Cellulae tympanicae
69. Right temporal bone (os temporale) (1/i).

(Vertical section made parallel to the axis of the petrous part.)
superficial petrosal nerve (hiatus canalis nervi petrosi minoris) is The inferior surface of the petrous part (facies inferior partis pet
found in front and a little laterally of the opening; it gives rise to rosae) (Fig. 68) is rough and uneven; it lies on the inferior aspect of
the groove for the lesser superficial petrosal nerve (sulcus nervi pe the cranial base. It carries a round or oval jugular fossa (fossa jugu
trosi minoris). laris) lodging the upper bulb of the internal jugular vein.
The posterior surface of the petrous part (facies posterior partis The floor of this fossa has a small groove for the auricular
petrosae) (Fig. 67), like the anterior surface, faces the cranial cavity branch of the vagus nerve. The groove leads into the orifice of the
but stretches upwards and backwards where it is continuous with mastoid canaliculus (canaliculus mastoideus) which opens into the
the mastoid process. Almost in the middle of this surface is a tympanomastoid fissure (fissura tympanomastoidea).
round porns acusticus intemus which leads into the internal audi The posterior margin of the jugular fossa is bounded by the
tory meatus (meatus acusticus internus). The porns transmits the fa jugular notch (incisura jugularis) which is divided into two parts, an
cial, intermediate, and vestibulocochlear nerves and the artery and anteromedial part and a posterolateral part, by a small intrajugu
vein of the labyrinth. A shallow subarcuate fossa (fossa subarcuata) lar process (processus intrajugularis). To the front of the jugular fossa
is present a little above and lateral to the porns acusticus internus. is a round orifice leading into the carotid canal (canalis caroticus)
It is well defined in the newborn; it lodges a process of the dura which has another orifice on the apex of the petrous part.
mater. A small petrosal fossa (fossula petrosa) lies between the anterior
Still laterally to porns acusticus internus is a slit-like external circumference of the jugular fossa and the external orifice of the
opening of the aqueduct of the vestibule (apertura externa aqueductus carotid canal; the inferior ganglion of the glosso-pharyngeal nerve
uestibuli) transmitting the endolymphatic duct from the cavity of is lodged in it. Deep in the fossa is an opening into the canaliculus
the internal ear. for the tympanic nerve (canaliculus tympanicus) in which the inferior
intern us
Sulcus tympanicus
Fenestra cochleae
70. Right temporal bone (os temporale) (1/i.).

(Vertical section made through external auditory meatus.)
Porus acusticus
internus '
Meatus acusticus
internus
externus
Porus acusticus
anterior externus
Canalis semicircularis
lateralis
Cellulae mastoideae
71. Right temporal bone (os temporale) (½).

(Horizontal section through external auditory meatus.)
tympanic artery also passes. The canaliculus opens into the middle sigmoid groove of the mastoid process of the temporal bone.
ear (auris media) or the tympanic cavity (cavum tympani). The posterior border of the petrous part (margo posterior partis
The styloid process (processus styloideus) projects downwards and petrosae) is the junction of its posterior and inferior surfaces. It car
slightly forwards lateral of the jugular fossa. It varies in length and ries on its cerebral surface the groove for the inferior petrosal si
is the site of origin of muscles and ligaments. nus (sulcus sinus petrosi inferioris) (a mark of the inferior petrosal ve
A bony projection of the tympanic part, called the sheath of nous sinus). A triangular funnel-like depression bearing the
the styloid process (vagina processus styloidei) descends in front of external opening of the cochlear canaliculus (apertura externi canali
and iateral to the root of the process. culi cochleae) is almost in the middle of the posterior border near
To the back of the root of the process is the stylomastoid fo the jugular notch.
ramen (foramen stylomastoideus) which is the external opening of the The anterior border of the petrous part (margo anterior partis
canal for the facial nerve (canalis facialis). petrosae) is on the lateral side of its anterior surface and is shorter
The superior border of the petrous part (margo superior partis than either the superior or posterior border. It is separated from
petrosae) separates the anterior surface from the posterior surface. the squamous part of the temporal bone by the petrosquamous
It carries the groove for the superior petrosal sinus (sulcus sinus pe fissure (fissura petrosquarnosa). Lateral of the internal opening of the
trosi superioris) (a mark of the superior petrosal venous sinus); the carotid canal the anterior border carries the orifice of the muscu
tentorium cerebelli which is a part of the dura mater is also at lotubal canal (canalis musculotubarius) which opens into the tym
tached to the groove. The groove is continuous posteriorly with the panic cavity (see The Musculotubal Canal).
CANALS AND CAVITIES OF THE PETROUS PART

OF THE TEMPORAL BONE
1. The carotid canal (canalis caroticus) (Figs 68 and 69) origi branch of the intermediate nerve called the chorda tympani which
nates in the middle of the inferior surface of pars petrosa as an ex leaves the tympanic cavity through the petrotympanic fissure.
ternal orifice. At first it ascends anteriorly of the cavity of the mid 5. The canaliculus for the tympanic nerve (canaliculus tympani
dle ear, then, curving, it passes forwards and medially and opens cus) originates on the inferior surface of the petrous part deep in
on the apex of the petrous part by means of an internal orifice. the petrosal fossa (fossula petrosa). It then passes to the inferior wall
The carotid canal transmits the internal carotid artery and the at of the tympanic cavity, perforates it, and enters the cavity. The
tendant veins and plexus of sympathetic nerve fibres. canaliculus stretches on the medial wall of the cavity in the groove
2. The caroticotympanic canaliculi (canaliculi caroticotympanici) of the promontory (sulcus promontorii) and then passes to the supe
are two small canaliculi branching off from the carotid canal and rior wall of the cavity where it opens by means of the hiatus for the
leading into the tympanic cavity. They transmit the caroticotym lesser petrosal superficial nerve (hiatus canalis nervi petrosi minoris).
panic nerves. 6. The musculotubal canal (canalis musculotubarius) (see Figs 68,
3. The canal for the facial nerve (canalisfacialis) (Fig. 69) origi 69 and 71) is a continuation of the anterosuperior part of the tym
nates on the floor of the internal auditory meatus (meatus acusticus panic cavity. Its external opening originates at the notch between
internus) in the facial nerve area (area nervi Jacialis); (see Vol. III. the petrous and squamous parts of the temporal bone at the ante
The Organ of Hearing). It stretches laterally almost at a right angle rior end of the petrosquamous fissure and reaches the superior
to the axis of the petrous part and passes to the anterior surface of part of the anterior wall of the tympanic cavity. It stretches later
this part to the hiatus for the greater superficial petrosal nerve (hi ally and slightly to the back of the horizontal part of the carotid
atus canalis nervi petrosi majoris). It bends here at a right angle to canal, almost on the axis of the petrous part. The horizontal sep
form the geniculum of the canal for the facial nerve (geniculum can tum of the musculotubal canal (septum canalis musculotubarii) sepa
alis facialis) and passes over to the posterior part of the medial wall rates the canal into a superior, smaller canal for the tensor tym
of the tympanic cavity which bears a corresponding prominence of pani (semicanalis musculi tensoris tympani) and an inferior, larger
the facial nerve canal (prominentia canalisJacialis). Further the canal canal of the pharyngotympanic tube (semicanalis tubae auditivae)
stretches posteriorly along the axis of the petrous part till it connecting the tympanic cavity with the pharyngeal cavity (see
reaches the pyramid of the tympanum (eminentia pyramidalis) and Vol. III. The Organ of Hearing).
then descends vertically to form the stylomastoid foramen (foramen 7. The mastoid canaliculus (canaliculus mastoideus) (see Fig. 68)
stylomastoideum). The canal transmits the facial and intermediate originates deep in the jugular fossa, crosses the inferior part of the
nerves, arteries, and veins. canal for the facial nerve, and opens into the tympanomastoid
4. The anterior canaliculus for the chorda tympani (canaliculus fissure. The canaliculus transmits the auricular branch of the va
chordae tympani) runs off the lateral wall of the canal for the facial gus nerve.
nerve a few millimetres above the stylomastoid foramen. It 8. The tympanic cavity (cavum tympani) (see Fig. 69) is elon
stretches forwards and upwards and enters the tympanic cavity by gated, compressed on the sides, and lined with a mucous mem
an opening on the posterior wall. The canaliculus transmits a brane. Inside it are ti'ree auditory ossicles: the malleus, incus, and
76 THE ETHMOID BONE
stapes which articulate with one another to form a chain. (The tympanica) which opens into the epitympanic recess (recessus epitym
structure of the canals listed and of the tympanic cavity, auditory panicus) (see Vol. III. The Organ of Hearing).
ossicles and labyrinth is described in detail in Vol. III. The Organ The inferior process of the tegmen tympani is wedged in be
of Hearing.) tween the medial portion of the tympanic and the squamous parts
The tympanic part (pars tympanica) (Figs 65 and 68) is the of the temporal bone. To both sides of the process stretch, respec
smallest part of the temporal bone. It is a slightly bent annular tively, the petrosquamous fissure (fissura petrosquamosa) and the
plate forming the anterior, inferior, and partly the posterior walls squamotympanic fissure (fissura petrotympanica) which transmits the
of the external auditory meatus (meatus acusticus externus). The lat chorda tympani and small vessels.
eral edge of the tympanic part is limited superiorly by the squama The lateral part of the pars tympanica is continuous with a
of the temporal bone and borders the porns acusticus externus. A bony crest whose elongated portion forms the sheath of the styloid
suprameatal spine (spina suprameatum) is found at the posterosupe process (vagina processus styloidei). The external auditory meatus is
rior lateral margin of the porns. The tympanic groove (sulcus tym absent in the newborn and the tympanic part is represented by the
panicus) is at the junction of the larger, medial and smaller, lateral tympanic ring (anulus tympanicus) (see Fig. 99).
parts of the external acoustic meatus. It gives attachment to the The medial surface of the greater tympanic spine carries a
tympanic membrane. Superiorly the tympanic groove terminates clearly defined spinous crest on the ends of which are an anterior
as two projections: the greater tympanic spine (spina tympanica ma and posterior tympanic processes; along the crest passes a groove
jor) in front and the lesser tympanic spine (spina tympanica minor) for the malleus.
at the back. Between these spines is the tympanic notch (incisura
THE ETHMOID BONE

The ethmoid bone (os ethmoidale) (Figs 72-74a, 74b, 103-106) tum. The whole perpendicular plate or only part of it often devi
is an unpaired bone. Its larger part is situated in the superior por ates to the side.
tions of the nasal cavity, the smaller part is in the anterior areas of The ethmoidal labyrinth (labyrinthus ethmoidalis) is a paired
the base of the skull. structure situated on each side of the perpendicular plate and ad
It is shaped like an irregular cube and is formed of air cells and joining the inferior surface of the cribriform plate. Each labyrinth
is therefore a pneumatic bone (ossa pneumatica). consists of a great number of air ethmoidal cells (cellulae ethmoi
A cribriform or horizontal plate, a perpendicular or vertical dales) (Fig. 72) communicating with one another as well as with the
plate, and two labyrinths, one on each side of the perpendicular nasal cavity through a series of openings. The cells are lined with a
plate, are distinguished. mucous membrane which is a continuation of the nasal mucosa.
The cribriform plate (lamina cribrosa) is the superior wall of the The cells are divided into anterior ethmoidal cells (cellulae eth
nasal cavity and fits horizontally into the ethmoidal notch of the moidales anteriores) opening into the middle meatus of the nose and
frontal bone to form the frontoethmoid suture (sutura Jrontoeth middle and posterior ethmoidal cells (cellulae ethmoidales mediae et
moidalis). It is pierced by 30-40 small openings transmitting nerves posteriores) communicating with the superior meatus of the nose.
(fibres of the olfactory nerves) and vessels. The lateral wall of the labyrinth· is a thin, smooth orbital plate
The perpendicular plate (lamina perpendicularis) (Figs 73 and (lamina orbitalis) (Figs 51, 72, 73, 109) forming the greater part of
74) is separated into two parts, a smaller, superior part above the the medial orbital wall. The plate joins the frontal bone superiorly
cribriform plate, and the other larger, inferior part below this to form the frontoethmoid suture (sutura frontoethmoidalis), the
plate. The superior part forms the crista galli and faces the cranial maxilla and orbital process of the palatine bone inferiorly to form,
cavity; the falx cerebri, a process of the dura mater, attaches to it. respectively, the ethmoidomaxillary suture (sutura ethmoideomaxilla
The anteroinferior margin of the crista galli is bounded on ris) and the palatoethmoidal suture (sutura palatoethmoidalis), with
each side by an inconstantly found projection, the ala of crista the lacrimal bone anteriorly to form the lacrimoethmoidal suture,
galli (ala cristae galli). Both projections border the foramen caecum and with the sphenoid bone posteriorly to form the sphenoeth
of the frontal bone posteriorly and superiorly. The lower part of moidal suture (sutura sphenoethmoidalis) (see Fig. 109). The superior
the perpendicular plate has an irregular quadrangular shape and border of the labyrinth carries two small ethmoidal grooves, ante
descends vertically into the nasal cavity to form the anterosuperior rior and posterior, which join similar grooves of the frontal bone to
part of the nasal septum. Superiorly it meets the nasal spine (spina form canals opening by means of the anterior and posterior eth
nasalis) of the frontal bone, anteriorly the bones of the nose, poste moidal foramina (foramina ethmoidalis anterius et posterius) which
riorly the crest of the sphenoid (crista sphenoidalis), inferiorly the transmit, respectively, the anterior and posterior ethmoidal nerves
vomer, and anteroinferiorly the cartilaginous part of the nasal sep- and vessels.
THE ETHMOID BONE 77
Labyrinthus ethmoidalis
(cellulae ethmoidales)
Lamina orbitalis
72. Ethmoid bone (os ethmoidale); superior aspect (½).
Crista galli
Ala cristae galli
Concha nasalis
media
73. Ethmoid bone (os ethmoidale); from the right side (½).
78 THE ETHMOID BONE
Cellulae ethmoidales
Lamina perpendicularis
Infundibulum ethmoidale
Bulla ethmoidalis
Concha nasalis
media
Concha nasalis
superior
Cellulae
ethmoidales
74a. Ethmoid bone (os ethmoidale); inferior aspect (½).
The medial wall of the labyrinth (Figs 74, 103, and 104) is a uncinatus) projects from the inferoanterior surface of each laby
rough grooved plate forming the greater part of the lateral wall of rinth in front of and below the middle nasal concha. On the intact
the nasal cavity. Its surface facing the perpendicular plate bears skull it joins the ethmoidal process (processus ethmoidalis) of the in
two thin laterally curled processes with slightly curved margins; ferior nasal concha.
the upper process is called the superior nasal concha (concha nasalis To the back of and above the uncinate process (Figs 73 and
superior) and the lower one is the middle nasal concha (concha nasa 74) is one of the largest cells which is bulged and called the eth
lis media). A rudimentary process is occasionally found above the moidal bulla (bu/la ethmoidalis).
superior concha; this is the highest nasal concha (concha nasalis su Between the uncinate process inferiorly and anteriorly and the
prema). A slit-like space called the superior meatus of the nose ethmoidal bulla superiorly is a passage known as the infundibu
(Tl!eatus nasi superior) is found in the superoposterior part of the me lum of the ethmoid (infundibulum ethmoidale) whose upper end
dial wall between the superior and middle nasal conchae. communicates with the aperture of the frontal sinus. The hiatus
The passage under the middle nasal concha is known as the semilunaris (see Fig. 104) forms between the posterior margin of
middle meatus of the nose (meatus nasi medius) (see Figs 103 and the uncinate process and inferior surface of the ethmoidal bulla,
105). by means of which the maxillary sinus communicates with the
A posteriorly and inferiorly curved uncinate process (processus middle meatus of the nose.
THE ETHMOID BONE 79
74b. Ethmoidal labyrinth (labyrinthus ethmoidalis).

(Plastic models of ethmoidal cells. N. Skripnikov's preparation.)
I. Ethmoidal cells, lift side: . II. Ethmoidal cells, right side: III. Ethmoidal cells, lift side: IV. Ethmoidal cells, right side:
I-anterior cells 4-sphenoidal sinus I-anterior cells 4-frontal sinus I-anterior cells 4-sphenoidal sinus I-anterior cells 4-sphenoidal sinus
2-middle cells 5-frontal sinus 2-middle cells 5-maxillary sinus 2-middle cells 5-maxillary sinus 2-middle cells 5-maxillary sinus
3-posterior cells 6-maxillary sinus 3-posterior cells 3-posterior cells 3-posterior cells 6-frontal sinus
THE BONES OF THE FACE
THE INFERIOR NASAL CONCHA

The inferior nasal concha (concha nasalis inferior) (Figs 75, 103 tion of the maxillary process and the body of the bone and projects
and 104) is a paired curved bony plate with three processes: maxil into the maxillary sinus. It is often fused with the uncinate process
lary, lacrimal, and ethmoidal. of the ethmoid bone.
The maxillary process (processus maxillaris) projects from the The anterior part of the superior border of the inferior concha
bone at an acute angle into which fits the inferior border of the hi articulates with the conchal crest of the maxilla, the posterior part
atus of the maxillary sinus. The process is seen distinctly from the of the concha articulates with the conchal crest of the perpendicu
opened maxillary sinus. lar plate of the palatine bone. The longitudinal slit-like space be
The lacrimal process (processus lacrimalis) joins the inferior con neath the inferior nasal concha is called the inferior meatus of the
cha to the lacrimal bone. nose (meatus nasi inferior).
The ethmoidal process (processus ethmoidalis) arises at the junc-
THE NASAL BONE

The nasal bone (os nasale) (Figs 76, 49-51) is paired, quadran rior surface is slightly concave and bears the ethmoidal groove (sul
gular, slightly elongated and slightly convex anteriorly. The supe cus ethmoidalis) lodging the anterior ethmoidal nerve. Both nasal
rior margin of each bone articulates with the nasal part of the fron bones articulate by mildly serrated medial borders to form the in
tal bone, the lateral margin articulates with the anterior margin of ternasal suture (sutura internasalis) which is grooved longitudinally.
the frontal process of the maxilla (processus frontalis maxillae). The inner surfaces of both bones adjoin the nasal spine (spina nasa
The anterior surface of the bone is smooth and perforated by lis) of the frontal bone and the perpendicular plate (lamina perpen
one or more openings transmitting vessels and nerves. The poste- dicularis) of the ethmoid bone.
THE LACRIMAL BONE

The lacrimal bone (os lacrimale) (Figs 77, 49-51) is a paired carries on its lateral surface the crest of the lacrimal bone (crista
elongated quadrangular plate situated in the anterior part of the lacrimalis posterior) which separates it into a larger posterior and a
medial orbital wall. Its superior border articulates with the orbital smaller anterior parts. The crest terminates as a projection called
part of the frontal bone to form the frontolacrimal suture (sutura the lacrimal hamulus (hamulus lacrimalis) which reaches the lacri
frontolacrimalis), the posterior border with the anterior border of mal groove on the frontal process of the maxilla. The anterior part
the orbital plate of the ethmoid bone; the inferior border meets the is flat, while the posterior part is concave to form the lacrimal
orbital surface of the maxilla posteriorly to form the lacrimomaxil groove (sulcus lacrimalis). Inferiorly the groove adjoins the lacrimal
lary suture (sutura lacrimomaxillaris) and the lacrimal process of the groove of the maxillary frontal process (sulcus lacrimalis processus
inferior concha anteriorly to form the lacrimoconchal suture (su Jrontalis maxillae) to form the fossa of the lacrimal sac (fossa sacci
tura lacrimoconchalis). Anteriorly the bone articulates with the fron lacrimalis). The fossa is continuous downwards with the nasolacri
tal process of the maxilla to form the lacrimomaxillary suture (su mal canal (canalis nasolacrimalis) which drains into the inferior mea
tura lacrimomaxillaris). tus of the nose.
The bone covers the anterior cells of the ethmoid bone and
THE VOMER
The vomer (Figs 78, 79, and 94) is an unpaired, elongated and is split into two everted processes called the alae of the vomer
rhomboid plate forming the posterior part of the nasal septum. (alae vomeris). They adjoin the inferior surface of the body of the
It is usually slightly curved (except for the posterior edge). sphenoid bone and embrace its rostrum.
The superior edge of the vomer is thicker than the other edges The posterior edge of the bone is free, slightly tapered, and
THE BONES OF THE FACE 81
Processus lacrimalis
r�
Processus ethmoidalis
I'
Processus lacrimalis
Processus maxillaris
A B
75. Right inferior nasal concha (concha nasalis inferior) (½).

A-inner aspect; B-outer aspect.
Fossa sacci
lacrimalis
Hamulus lacrimalis
A B A B
7 6. Right nasal bone 77. Right lacrimal bone

(os nasalis) (½). (os lacrimale) (½).
A-outer aspect; B-inner aspect. A-outer aspect; B-inner aspect.
78. Vomer; from the right side (1/i).

82 THE BONES OF THE FACE
79. Vomer; superior aspect (½).
separates the posterior apertures of the nose (choanae) one from the palatine bone, while the anterior edge is bevelled and articulates
other. with the perpendicular plate (lamina perpendicularis) of the ethmoid
The anterior and inferior edges are rough; the inferior one bone superiorly and with the cartilaginous nasal septum inferiorly.
articulates with the nasal crests (crista nasalis) of the maxilla and
THE MAXILIA
The maxilla (Figs 80-83, 49 and 51) is a paired bone situated with the lacrimal bone to form the lacrimomaxillary suture (sutura
in the superoanterior part of the visceral cranium. It is a pneu lacrimomaxillaris); posteriorly of the lacrimal bone it articulates
matic bone (ossa pneumatica) because it contains a large cavity, the with the orbital plate of the ethmoid bone to form the ethmoido
maxillary sinus (sinus maxillaris) which is lined by mucous mem maxillary suture (sutura ethmoidomaxillaris), and still further posteri
brane. orly, it joins the orbital process of the palatine bone to form the
A body and four processes are distinguished in the bone. palatomaxillary suture (sutura palatomaxillaris).
The body of the maxilla (corpus maxillae), in which the maxil The anterior border of the orbital surface is smooth and forms
lary sinus is lodged, has four surfaces: superior, or orbital; anterior; the free infraorhital margin (margo infraorbitalis). It is serrated la
medial, or nasal; posterior, or infratemporal. terally and is continuous with the zygomatic process (processus zygo
The processes of the bone are as follows: frontal, zygomatic, maticus). Medially the infraorbital margin curves upwards, tapers,
alveolar, and palatine. and is continuous with the frontal process on which stretches lon
The orbital surface (facies orbitalis) is smooth, triangular, and gitudinally the lacrimal crest (crista lacrimalis anterior).
slightly inclined forwards, laterally, and downwards. It forms the The posterior border of the superior (orbital) surface, together
inferior wall of the orbit (orbita). with the inferior border of the orbital surface of the greater wings
The medial border of the orbital surface articulates anteriorly of the sphenoid bone, which runs parallel with it, forms the infe-
Processus zygomaticus
Sulcus infraorbitalis l\ll •..,.....;.-'""'�- Cnsta lacnmahs

anterior
....i....111-.___.___ Sulcus lacrimalis
Tuber maxillae
Juga alveolaria
Arcus alveolaris
80. Right maxilla; anterolateral aspect (½).
Sulcus palatinus major
Processus alveolaris
Processus palatinus
81. Right maxilla; medial aspect (½).

rior orbital fissure (fissura orbitalis inferior). In the middle of its dis process articulates with the lacrimal bone to form the lacrimomax
tance the inferior wall of the fissure bears a small infraorbital illary suture (sutura lacrimomaxillaris). The ethmoidal crest (eris/a
groove (sulcus infraorbitalis) which stretches forwards and becomes ethmoidalis) stretches from front to back on the medial surface. The
deeper to be gradually continuous with the infraorbital canal (can superior border of the frontal process is serrated and articulates
alis infraorbitalis). The groove and the canal transmit the infraorbi with the nasal part of the frontal bone to form the frontomaxillary
tal nerve, arteries, and veins. The canal describes an arch and suture (sutura frontomaxillaris). The anterior border of the frontal
opens on the anterior surface of the body of the maxilla. The infe process unites with the nasal bone to form the nasomaxillary su
rior wall of the canal has small openings of the anterior dental can ture (sutura nasomaxillaris).
als which are called anterior dental foramina (Fig. 82); they trans The zygomatic process (processus zygomaticus) projects from the
mit nerves to the anterior maxillary teeth. laterosuperior angle of the body. Its rough end unites with the zy
The posterior surface (facies infratemporalis) faces the infratem gomatic bone (os zygomaticum) to form the zygomaticomaxillary su
poral and pterygopalatine fossae. It is uneven, often convex, and ture (sutura zygomaticomaxillaris).
forms the maxillary tuberosity (tuber maxillae). Two or three small The palatine process (processus palatinus) (Figs 81 and 83) is a
openings of the dental canals, the dental foramina (foramina alve horizontal bony plate extending medially from the inferior border
olaria) (Figs 80 and 82), can be seen on it; they transmit nerves to of the nasal surface of the body of the maxilla and together with
the posterior maxillary teeth. the horizontal plate of the palatine bone forms the bony septum
The anterior surface (facies anterior) is slightly curved. A rather between the nasal cavity and the cavity of the mouth. Both maxil
large infraorbital foramen (foramen infraorbitale) opens on it below lae unite by means of the rough medial borders of their palatine
the infraorbital margin and still further below is a small depression processes to form the median palatine suture (sutura palatina medi
called the canine fossa (Iossa canina) which is the site of origin of ana).
the levator anguli oris muscle. The palatine processes form a sharp marginal projection facing
The anterior surface is continuous downwards with the ante the nasal cavity; this is the nasal crest (eris/a nasalis) which adjoins
rior (buccal) surface of the alveolar process (processus alveolaris). the inferior border of the vomer and the cartilaginous nasal sep
The alveolar process has a series of depressions between ridges, tum. The posterior border of the palatine process meets the ante
which are called the alveolar juga (juga alveolaria). rior border of the horizontal part of the palatine bone to form the
Medially and forwards, towards the nose, the anterior surface transverse palatine suture (sutura palatina transversa). The superior
of the body of the maxilla continues as a sharp edge of the nasal surface of the palatine processes is smooth and slightly concave.
notch (incisura nasalis). The notch terminates below as the anterior The inferior surface is rough and carries two palatine grooves (sulci
nasal spine (spina nasalis anterior). The nasal notches of both maxil palatini) close to its posterior end; the sulci are separated from one
lae limit the anterior bony aperture of the nose (apertura piriformis) another by small palatine spines (spinae palatinae); both transmit
which leads into the nasal cavity. vessels and nerves. An incisive canal (canalis incisivus) forms be
The nasal surface (facies nasalis) of the maxilla (Fig. 81) has a tween the right and left palatine processes at the anterior border.
more complex structure. In its superoposterior angle is the hiatus The incisive foramen (foramen incisivum) may be found on one of
of the maxillary sinus (hiatus sinus maxillaris) leading into the sinus the processes, in which case an incisive groove is seen on the con
maxillaris. To the back of the hiatus the rough nasal surface artic tralateral process.
ulates with the perpendicular plate of the palatine bone by means The alveolar process (processus alveolaris) (Figs 80 and 83)
of a suture and carries a vertical greater palatine groove (sulcus pa whose development is associated with the development of the
latinus major) contributing to the formation of the walls of the teeth, projects downwards from the inferior border of the body of
greater palatine canal (canalis palatinus major). In front of the hia-, the bone and describes an arch which is convex anteriorly and la
tus of the maxillary sinus stretches the nasolacrimal groove (sulcus terally. The inferior surface of this region, the alveolar arch (arcus
lacrimalis) which is limited by the posterior border of the frontal alveolaris), has a row of tooth sockets (alveoli dentales) for the roots
process anteriorly. The groove closes to form the nasolacrimal of eight teeth on both sides. The sockets are separated from one
canal (canalis nasolacrimalis); the groove meets the lacrimal bone su another by interalveolar septa (septa interalveolaria). Some of the
periorly and the lacrimal process of the inferior concha inferiorly. sockets are in turn divided by interradicular septa (septa interradicu
Still further to the front the nasal surface carries a horizontal emi laria) into smaller sockets according to the number of roots which
nence called the conchal crest (crista conchalis) to which the inferior the tooth has.
nasal concha is attached. The anterior surface of the alveolar process bears longitudinal
From the superior border of the nasal surface at its junction ridges called alveolar juga (juga alveolaria) corresponding to the
with the anterior surface projects upwards the frontal process (pro five anterior sockets. In the foetus, part of the alveolar process with
cessus frontalis). It has a medial (nasal) and lateral (facial) surfaces. the sockets for the two anterior incisors is a separate incisive bone
The lateral surface is separated into an anterior and posterior parts (os incisivum) which fuses early with the rest of the maxillary alveo
by the lacrimal crest (crista lacrimalis anterior). The posterior part is lar process. Both alveolar processes meet in the middle to form the
continuous downwards with the nasolacrimal groove (sulcus lacri intermaxillary suture (sutura intermaxillaris).
malis). The inner, lacrimal border (margo lacrimalis) of the frontal
Probes in foraminaf
alveolaria
. \
Probes in canales -�-t-, Probes in canales

alveolares alveolares
82. Right maxilla;

anterolateral aspect (½).
(The dental canals are opened.)
Foramen incisivum
Process us
•-✓
,:-
· · ·· .
zygomat,cus --
I.
'
"""
i
Processus palatinus
83. Maxillae; inferior aspect (½).

THE PALATINE BONE

The palatine bone (os palatinum) (Figs 84-86; 108) is a paired palatine foramina (foramina palatina minora) (see Fig. 108). In front
bone. It is a curved plate situated in the back of the nasal cavity. of them, on the inferior surface of the lateral border of the hori
The bone forms part of the floor (the hard palate) and the lateral zontal plate is the greater palatine foramen (foramen palatinum ma
wall of the nasal cavity. A horizontal plate (lamina hori;;_ontalis) and jus) which is lodged in the suture between the palatine bone and
a perpendicular plate (lamina perpendicularis) are distinguished in the maxilla.
the palatine bone. The horizontal plates of both palatine bones The thin bony perpendicular plate of the palatine bone arises
meet on the midline of the hard palate to form the posterior part at a right angle and adjoins the anterior margin of the medial sur
of the median palatine suture (sutura palatina mediana) and articu face of the pterygoid process and the posterior part of the nasal
late with the two palatine processes of the maxillae, which are lo surface of the body of the maxilla. Its lateral surface carries the
cated in front of them, to form the transverse palatine suture (su greater palatine groove (sulcus palatinus major) which together with
tura palatina transversa). the palatine groove of the maxilla and the pterygoid process forms
The horizontal plate carries a posterior nasal spine (spina nasa the greater palatine canal (canalis palatinus major). The canal opens
lis posterior) on the posteromedial end and a nasal crest (crista nasa on the hard palate by the greater palatine foramen (foramen palati
lis) on the medial border. The superior surface of the horizontal num majus).
plate is slightly concave and smooth, the inferior surface is rough. The medial surface of the perpendicular plate bears the con
A thick tubercle (processus pyramidalis) projects backwards from chal cre�t (crista conchalis) which is a marking of fusion of the plate
the lateral part of the base of the perpendicular plate. It is wedged with the posterior part of the inferior nasal concha.
into the notch between the plates of the pterygoid process of the Slightly above it is the ethmoidal crest (crista ethmoidalis) for at
sphenoid bone and limits the pterygoid fossa (fossa pterygoidea) tachment of the middle nasal concha of the ethmoid bone.
from below. The superior border of the perpendicular plate terminates as
The inferior surface of the tubercle carries one or two lesser two processes: one is the orbital process (processus orbitalis) (Fig. 85)
Processus sphenoidalis
-�-
-.;;:_
Crista ethmoidalis
Crista conchalis
Surface contributing _..

to formation :;.,.:::�,:.
of fossa pterygoidea
Processus pterygoideus
Spina nasalis posterior Processus pyramidalis
84. Right palatine bone (os palatinum); 85. Right palatine bone (os palatinum);
medial and posterior aspect (¾). lateral aspect (¾).
Processus orbitalis
Incisura
----sphenopalatina
Sulcus
palatinus major
Crista conchalis
Surface contributing to formation

of fossa pterygoidea
t
Processus pyramidalis
86. Right palatine bone (os palatinum);

posterior aspect (½).
and the other is the sphenoidal process (processus sphenoidalis). The face of the maxilla; it often carries an air cell which is connected
processes are separated by the sphenopalatine notch (incisura with the posterior cells of the ethmoid bone.
sphenopalatina). The notch with the body of the sphenoid bone ad The sphenoidal process (processus sphenoidalis) reaches the infe
jacent to it forms the sphenopalatine foramen (foramen sphenopalati rior surface of the body of the sphenoid bone, its concha, and the
num). wings of the vomer.
The orbital process (processus orbitalis) adjoins the orbital sur-
THE ZYGOMATIC BONE

The zygomatic bone (os ;;ygomaticum) (Figs 49-52 and 87) is a tura fronto;;ygomatica) and with the greater wing of the sphenoid
paired bone and a component of the lateral parts of the visceral bone to form the sphenozygomatic suture (sutura spheno:;;ygomatica).
cranium. Three surfaces are distinguished on it. Its lateral surface The zygomatic bone unites with the maxilla to form the zygo
(facies lateralis) is shaped like an irregular quadrangle and is con maticomaxillary suture (sutura :;;ygomaticomaxillaris).
vex, particularly in the region of the protuberance. The orbital surface of the bone bears the zygomatico-orbital
The orbital surface (facies orbitalis) stretching medially and for foramen (foramen ;;ygomaticoorbitale) leading into a canal which bi
wards is concave. It forms part of the lateral and inferior walls of furcates in the bone. One branch of the canal opens on the ante
the orbit and meets the lateral surface by means of a sharp and rior surface of the bone as the zygomaticofacial foramen (foramen
curved margin which contributes inferiorly to the infraorbital mar :;;ygomaticefaciale), the other-on the temporal surface as the zygo
gin (margo infraorbitalis). maticotemporal foramen (foramen :;;ygomaticotemporale). These ca
The temporal surface (facies temporalis) faces the temporal nals transmit nerves.
fossa. The posterior angle of the bone gives rise to the temporal pro
The frontal process (processus frontalis) arises from the superior cess (processus temporalis) which meets the zygomatic process of the
angle of the body of the bone. It articulates with the zygomatic temporal bone to form the zygomatic arch (arcus :;;ygomaticus).
process of the frontal bone to form the frontozygomatic suture (su-
Processus frontalis
Foramen
zygomaticofaciale Processus frontalis
1\\ t
�
Foramen
zygomaticotemporale
Fac,es orbital is � I
fornmm,
,y�ms,eomb"•
\ j•
�
->
-/ I ,
Processus
temporalis
A B
87. Right zygomatic bone (os zygomaticum); (½).

A- lateral aspect; B- medial aspect.
THE MANDIBLE
The mandible (mandibula) (see Figs 48-53; 88-91) is an un series of ridges and depressions called alveolar juga (juga alveo
paired bone forming the lower part of the visceral skull. A body laria).
(corpus mandibulae) and two processes called rami (rami mandibulae) A solitary or double mental spine, or genial tubercle (spina men
projecting upwards from its posterior end are distinguished. talis) is located on the inner surface of the body of the mandible
The body (corpus) is formed from two halves of the bone which near the midline; the geniohyoideus and genioglossus muscles
fuse on the midline to form a single bone during the first year of originate here. On the lower margin is a depression called the di
life. The outer surface of each half is convex, and the height of the gastric fossa (Iossa digastrica) which serves for attachment of the di
body is greater than its width. A lower margin, or the base of the gastric muscle. A mylohyoid line (linea mylohyoidea) passes obli
mandible (basis mandibulae) and an upper margin formed by the quely on each side of the inner surface of the body towards the
alveolar part (pars alveolaris) are distinguished in the lower jaw. ramus; the mylohyoid muscle and part of the superior constrictor
On the outer surface of the middle part of the body is the men muscle of the pharynx arise here.
tal protuberance (protuberantia mentalis) directly lateral of which on Above this line in its anterior parts is the sublingual fossa (fo
each side is the mental tubercle (tuberculum mentale). The mental vea sublingualis) lodging the sublingual gland; under the posterior
foramen (foramen mentale) transmitting vessels and nerves is above part of the line is the submandibular fossa (fovea submandibularis)
and lateral of the tubercle. This foramen corresponds to the posi which is often poorly defined; it lodges the submandibular gland.
tion of the root of the second premolar. To the back of the mental Under the posterior part of the mylohyoid line also stretches the
foramen is the oblique line (Linea obliqua) which runs upwards and mylohyoid groove (sulcus mylohyoideus) which lodges the mylohyoid
is continuous with the anterior border of the ramus of the mandible. vessels and nerves.
The development of the alveolar part (pars alveolaris) is deter The ramus of the mandible (ramus mandibulae) (Figs 88 and 91)
mined by the teeth which it carries; it is bounded superiorly by the is a wide bony plate arising from the posterior end of the body ob
alveolar arch (arcus alveolaris). This border bears 16 (8 on each liquely and posteriorly to form the angle of the mandible (angulus
side) tooth sockets (alveoli dentales) (see Fig. 89) separated from one mandibulae) with the lower margin of the body.
another by interalveolar septa (septa interalveolaria). A multi-rooted A rough area called the masseteric tuberosity (tuberositas masse
socket lodging a tooth with two roots is divided by an inter-radicu terica) is located on the outer surface of the ramus in the region of
lar septum (septum interradicularia). the angle; it serves for attachment of the masseter muscle. In line
The superior margin of the outer surface of the body has a with this tuberosity but on the inner surface is a smaller, pterygoid
Incisura mandibulae
l i,
Caput mandibulae
I Processus coronoideus
Collum
mandibula
1/
Processus
condylaris
Juga
alveolaria
Angulus mandibulae
Corpus mandibulae Probe in canalis mandibulae

introduced through foramen mentale
88. The mandible (mandibula); outer aspect (¼).

(The external lamina of the compact bone substance is removed; a probe is intro
duced into the mandibular canal.)
Processus condylaris -
Fovea pterygoidea ---'•-._
Lingula mandibulae
Processus coronoideus _____ 1
Corpus mandibulae
Tuberculum mentale
Protuberantia mentalis
89. Mandible (mandibula); superior aspect (¼).

Sulcus mylohyoideus
Angulus mandibulae Tuberositas pterygoidea
90. Mandible (mandibula); mner aspect (¼).
Ramus mandibulae ---
Angulus mandibulae -
/··.
Basis mandibulae
Corpus mandibulae
91. Mandible (mandibula) of an old man (¼).

(The teeth and alveolar part of the mandible are absent.)
tuberosity (tuberositas pterygoidea) which is the site of origin of the On the superior end of the ramus are two processes which are
middle pterygoid muscle. separated by the mandibular notch (incisura mandibulae). The ante
The mandibular foramen (foramen mandibulae) is located in the rior process, called the coronoid process (processus coronoideus) often
middle of the inner surface of the ramus; it is bounded medially has a rough area giving attachment to the temporal muscle; the
and anteriorly by a small bony projection called the lingula of the posterior, condyloid process (processus condylaris) articulates with
mandible (lingula mandibulae). The foramen leads into the mandib the skull by means of the head of the mandible (caput mandibulae)
ular canal (canalis mandibulae) (Fig. 88) transmitting vessels and which is covered by cartilage.
nerves. The canal is lodged in the spongy substance of the bone; -it The head is continuous with the neck of the mandible (collum
curves downwards and to the front and reaches almost the middle mandibulae) on whose inner surface is seen a pterygoid pit (fovea
of the mandible and opens on the anterior surface of its body by pterygoidea) which gives attachment to the lateral pterygoid muscle.
means of the mental foramen (foramen mentale).
THE HYOID BONE

The hyoid bone (os hyoideum) (Fig. 92) is situated below the The greater horns project from the body to the back and later
tongue. It is shaped like a horse-shoe and can be felt through the ally. They are thinner and longer than the body and are slightly
skin in a lean person. It is attached to other bones by means of li thickened on the ends.
gaments. The hyoid bone consists of a body (corpus) and greater The lesser wings arise at the junction of the body and the
and lesser horns (cornua majora et minora). greater wings. In some cases they remain cartilaginous. They are
The body is a convex plate and carries a transverse and a verti joined to the body either by means of a joint with a weakly tight
cal crests. The superior border of the plate is sharp, the inferior ened capsule or by means of connective tissue. Their ends are em
border is thickened. The lateral borders of the body are joined to braced by the stylohyoid ligament (ligamentum stylohyoideum) which
the greater horns by means of articular surfaces or fibrous or hya sometimes contains one or more small bones.
line cartilage.
92. Hyoid bone (os hyoideum);

superior and outer aspect (¾).
92 THE SKULL AS A WHOLE
THE SKULL AS A WHOLE

The skull (cranium) (see Figs 48-53; 93-96) is separated into process; (4) superior margin of the porus acusticus externus;
two large parts which are continuous with one another. The upper (5) root of the zygomatic process of the temporal bone; (6) infra
part is the skull cap, or calvaria (fornix cranii), the lower part is temporal crest of the greater wing of the sphenoid bone;
called the base (basis). (7) sphenozygomatic suture; (8) zygomatic process of the frontal
The border separating these two large parts passes on a con bone; (9) supra-orbital margin, and (10) nasal margin of the fron
ventional line through the following structures: (1) external occipi tal bone. Above this line drawn through the structures named is
tal protuberance; (2) superior nuchal line; (3) base of the mastoid the calvaria, below the line is the base of the skull.
93. Skull (cranium); medial aspect of right half

(½).
(Sagittal section made to the left of the median plane.)
THE SKULL AS A WHOLE 93
Sutura coronalis
Sinus frontalis
Concha
nasalis inferior
trans versus
Sutura occipitomastoidea
Maxilla
(processus alveolaris)
Condylus occipitalis
Processus pterygoideus, lamina medialis
Lamina horizontalis ossis palatini
Linea mylohyoidea
Processus palatinus
94. Skull (cranium); medial aspect (represented semischemati

cally).
94 THE SKULL AS A WHOLE
95. Skull (cranium); inferior aspect (½).

(Lower surface of base of skull, basis cranii externa.)
THE SKULL AS A WHOLE 95
Sutura palatina transversa

Sutura palatina mediana
Processus palatinus
Lamina horizontalis ossis palatini
Crista infratemporalis
Arcus zygomaticus Lamina medialis processus

pterygoidei
Sutura sphenosquamosa
Lamina lateralis
processus pterygoidei
Tuberculum articulare
Foramen ovale
Fossa mandibularis
Foramen lacerum
Foramen spinosum
Canalis
Synchondrosis
caroticus
sphenooccipitalis
Foramen Tuberculum
pharyngeum
stylomastoideum
Processus mastoideus
Fissura
petrooccipitalis
lncisura mastoidea
Crista occipitalis
externa
Linea nuchae inferior
Sutura lambdoidea
Foramen occipitale magnum Protuberantia occipitalis externa
96. Skull (cranium); inferior aspect (semischematical represen

tation).
96 THE SKULL CAP
THE SKULL CAP

On examining the convex (external) surface of the skull cap, or The sutures formed between the bones are usually named after
calvaria (Figs 97 and 98) one can easily see that it is formed of the articulating bones.
bones joined by means of sutures (suturae). Some sutures of the calvaria are named according to direction
They articulate by means of connective tissue (syndesmosis). or shape: the coronal suture (sutura corona/is) is the union between
Sutures are one of the types of bone union. The bones contri the frontal and parietal bones; the sagittal suture (sutura sagittalis)
buting to the formation of the skull cap are joined by various types is that between the parietal bones; the lambdoid suture (sutura
of sutures, some forming a serrated line, others an even line. A su lambdoidea) is the junction between the occipital and parietal
ture with a serrated line is called a serrated suture (sutura serrata). bones.
One in which the bones unite to form an even line may be called On the lateral surface of the skull cap, below the inferior tem
either a squamous suture (sutura squamosa), when the edges of one poral line (linea temporalis inferior) is the temporal area which is
bone overlap the edge of the other bone (like the scales of fish), or continuous downwards with the temporal fossa (Iossa temporalis)
a flat suture (sutura plana) when the edges of the united bones are bounded laterally by the zygomatic process of the temporal bone
even and in simple apposition. (processus zygomaticus ossis temporalis).
Forarnen parietale --------------
Linea ternporalis
superior
Sutura parietornastoidea
Protuberantia occipitalis ---,
r,.._�r----:::=-'"'......:.....;llllll•
extern a
Processus rnastoideus
Linea nuchae superior
97. Skull (cranium); posterior aspect (½).

(Without the mandible.)
THE SKULL CAP 97
Foveolae granulares
Os parietale
. .....�
_1,1.____...;;.._.::;..=_.:.;...�-•-•-+- Sulcus sinus
I. t
sagittalis superioris
•
Ossa suturarum •
I
i
• '.('
Sutura lambdoidea
98. Skull cap or calvaria; internal aspect (½).
The anterior convexity of the calvaria is the forehead (frons). markings of vessels and grooves of the venous sinuses. The largest
The posterior part of the calvaria has three eminences: the two lat groove stretches on the midline of the calvaria and is called the
eral ones are called parietal eminences (tubera parietalia), the poste sagittal groove for the superior sagittal sinus (sulcus sinus sagittalis
rior eminence is the occiput. Between these three eminences is the superioris). On the margins of the groove are seen small but deep
utmost upwardly projecting point of the roof, the top or crown of granular pits (foveolae granulares) occupied by arachnoidal out
the skull (vertex). growths. In addition to these pits, two or three nutrient foramina
The cerebral surface of the skull cap bears grooves and ridges (foramina nutricia) are seen in the posterior parts of the sagittal
which reflect the relief of the brain and are its markings. groove, usually not in the groove itself but at some distance from
In addition, the cerebral surface of the calvaria carries the its edges.
98 THE BASE OF THE SKULL
THE FONTANELLES
One of the specific features of the skull of a newborn are fonta diamond-shaped and located at the junction of the sagittal, co
nelles (fonticuli cranii) (see Figs 3, 99 and 100). These are unossified ronal, and frontal sutures. It is normally ossified by the age of
areas of the membranous cranium (desmocranium) which are lo about two years.
cated in places of future sutures. The posterior fontanelle (fonticulus posterior) is triangular and is
It is general knowledge that the calvaria undergoes structural found at the junction of the sagittal and lambdoid sutures. It os
changes during intrauterine life, i.e. it is a membranous structure sifies at the beginning of the first year of life.
covering the top of the brain at first but is gradually replaced by The paired sphenoidal, or anterolateral fontanelle (fonticulus
bony tissue later without going through the stage of cartilage. This sphenoidalis) is situated on the anterolateral surface of the skull and
period is characterized by the appearance of bone nuclei (in the is bounded anteriorly and superiorly by the frontal and parietal
second or the beginning of the third intrauterine month) as islets bones and inferiorly by the greater wing of the sphenoid bone and
in this or that bone. These islets merge later to form large bony the squamous part of the temporal bone. It closes soon after birth,
plates which are the bony framework of the various bones of the sometimes by the end of the intrauterine period.
calvaria. The other paired fontanelle, the mastoid, or posterolateral fon
By the time of birth, however, areas of the membranous skull tanelle (fonticulus mastoideus), is to the back of the sphenoidal one at
remain between the bones as narrow bands and wider spaces called the articulation of the occipital squama with the mastoid process
fontanelles. Due to their elasticity they may retract or protrude de of the temporal bone. It ossifies in the same period as the sphe
pending on the intracranial pressure; hence their name (dim. of Fr. noidal fontanelle.
fontaine fountain). Six fontanelles are distinguished on the skull of The remnants of the membranous skull permit considerable
a newborn; among them two are paired and two unpaired. The un displacement of the cranial bones during delivery of the infant, as
paired are the anterior and posterior fontanelles, the paired-the a result of which passage of the head in the narrow parts of the
sphenoidal and mastoid fontanelles. birth canal is easier.
The anterior fontanelle (fonticulus anterior) (Fig. 100) is usually
THE BASE OF THE SKULL

The base of the skull (basis cranii) (Figs 95, 96, 99, 101, 102) is lis caroticus) opens on the inferior surface of the petrous part of the
the part of the skull located below the horizontal line which passes temporal bone. Lateral and to the back of the canal is the jugular
in front at the level of the supraorbital margin (margo supraorbita fossa (fossa jugularis) leading into the jugular foramen (foramen ju
lis) and at the back in the middle between the lambda and the ex gularis) which is formed from union of the jugular notches of the
ternal occipital protuberance (protuberantia occipitalis externa). petrous part of the temporal bone and the condylar part of the oc
The external and the internal base (surface) of the skull are cipital bone. Lateral of the jugular foramen is the styloid process
distinguished. (processus styloideus) and still further laterally the mastoid process
The external, or lower surface of the base of the skull (basis cra (processus mastoideus). Between these two processes is the stylomas
nii externa) (Figs 95, 96) together with the bony palate is covered by toid foramen (foramen stylomastoideum).
the facial bones. Here, to the back of the bony palate, project the The body of the sphenoid bone articulates with the basilar part
pterygoid processes (processus pterigoidei) whose medial plates to of the occipital bone by means of the spheno-occipital joint (syn
gether with the perpendicular plates of the palatine bones form the chondrosis sphenooccipitalis). Another two synchondroses are distin
outer borders of the choanae which are divided by the vomer. guished in the base of the skull. One is the sphenopetrous joint
Between the pterygoid processes, lateral and to the back of (synchondrosis sphenopetrosa) and the other the petro-occipital joint
them, the external surface of the base is formed by the body and (synchondrosis petrooccipitalis) which on a macerated skull are repre
greater wings of the sphenoid bone, the inferior surface of the pe sented, respectively, by the sphenopetrosal fissure (fissura sphenope
trous and tympanic parts and an area of the squamous part of the trosa) and the petro-occipital fissure (fissura petrooccipitalis)
temporal bone, and by the basilar part of the occipital bone and (Fig. 102).
anterior segment of its squama. To the back, in the centre of the base of the skull is the fora
The scaphoid fossa (fossa scaphoidea) is at the base of the medial men magnum, to the front of which on the basilar part of the oc
plate of the pterygoid process, to the back of which is the foramen cipital bone is the pharyngeal tubercle (tuberculum pharyngeum).
lacerum which has irregular edges and is filled by cartilaginous tis The foramen is embraced on both sides by the occipital condyles
sue Cln a non-macerated skull. The foramen ovale and the foramen (condyli occipitales). Posteriorly, almost on the midline, stretches the
spinosum open in the region of the greater wing of the sphenoid external occipital crest (crista occipitalis externa) and reaches the ex
bone. Lateral of them is the articular fossa (fossa mandibularis) with ternal occipital protuberance (protuberantia occipitalis externa). The
an articular surface (facies articularis) bounded anteriorly by the inferior and superior nuchal lines (linea nuchae inferior et linea nu
eminentia articularis (tuberculum articulare). The carotid canal (cana- chae superior) arise from the crest.
Fonticulus anterior
Fonticulus
posterior
Os nasale
•1----'-:+ Os lacrimale
Squama
occipitalis
Maxilla
tympanicus
Squama temporalis
99. Skull of a newborn; from the right side (½).

Tuber frontale
Fonticulus --#..;.______.!:!,",::----
anterior
Tuber
parietale
Fonticulus posterior
100. Skull of a newborn; superior aspect (½).

100 THE BASE OF THE SKULL
101. Upper suiface of base of skull (basis cranii interna);

superior aspect (¾).
The internal, or upper surface of the base of the skull (basis cra bears the hypophyseal fossa (fossa hypophysialis) in the centre. The
nii interna) (Figs 101 and 102) is a concave irregular surface re edge of the lesser wings of the sphenoid bone limits the middle
flecting the pattern of the brain lodged on it. It has three depres cranial fossa anteriorly, while the dorsum sellae and the superior
sions, called the anterior, middle, and posterior cranial fossae. border of the petrous part (margo superior partis petrosae) limit it
The anterior cranial fossa (fossa cranii anterior) is the most shal posteriorly. The floor of the middle fossa is formed by the body
low. Its floor is formed by the orbital plate (pars orbitalis) of the (corpus) and the greater wings (alae majores) of the sphenoid bone,
frontal bone, the lesser wings (alae minores) of the sphenoid bone, the anterior surfaces of the petrous part (facies anteriores partis petro
and the cribriform plate (lamina cribrosa) of the ethmoid bone. Pos sae) and the cerebral surface (facies cerebra/is) of the squamous part
teriorly it is bounded by the edge of the lesser wings and the tuber of the temporal bone. The carotid grooves (sulci carotici) are located
culum sellae. The region of the cribriform plate is the deepest part. on the floor of the fossae to both sides of the base of the sella tur
The crista galli projects here. In front of the crista galli is the fo cica; each groove runs backwards, downwards, and laterally to the
ramen caecum (foramen cecum). apex of the petrous part and leads into the carotid canal (canalis ca
The middle cranial fossa (fossa cranii media) is the deepest in roticus). The following structures open into the lateral parts of the
the lateral parts; in its central part projects the sella turcica which middle cranial fossa: optic foramen (canalis opticus), superior orbi-
THE BASE OF THE SKULL 101
Foramen caecum
Pars orbitalis ossis frontalis
Sulcus chiasmatis
Tuberculum sellae
Canalis opticus
Synchondrosis
sphenooccipitalis
Foramen ovale
Impressio trigemini
Foramen spinosum
Clivus
Fissura Porus acusticus

petrosquamosa internus
-�.;;.11.,-+--Sulcus sinus petrosi
Sulcus sinus petrosi inferioris
superioris
Sulcus sinus sigmoidei
Foramen occipitale magnum
Crista occipitalis interna
102. Upper suiface of base of skull (basis cranii interna);

superior aspect (semischematical representation).
ta! fissure (fissura orbitalis superior), foramen lacerum, foramen ro occipital angle of the parietal bone. In the centre of the fossa is the
tundum, foramen ovale, and foramen spinosum. The anterior sur foramen magnum in front of which is the clivus formed by the
face of the petrous part bears the trigeminal impression (impressio body of the sphenoid bone and the basilar part of the occipital
trigemina), tegmen tympani, arcuate eminence (eminentia arcuata), bone. The anterior condylar canal (canalis hypoglossi} opens at t:1e
and the grooves for the greater and lesser petrosal nerves. lateral semicircumference of the foramen magnum. The poster:or
The posterior cranial fossa (fossa cranii posterior) is limited ante condylar canal (canalis condylaris) lying lateral of the anterior con
riorly by the dorsum sellae and superior border of the petrous dylar canal and to the back of the jugular foramen {foramen jugula
part; the posterior border of the fossa passes along the groove for ris) is found occasionally. The internal occipital crest (crista occipita
the transverse sinus (sulcus sinus transversus) and the internal occipi lis interna) ascends on the midline from the posterior border of the
tal protuberance (Protuberantia occipitalis interna). The posterior cra foramen magnum to the internal occipital protuberance. A little
nial fossa is the deepest and its floor is formed by almost the whole above the crest, on both sides of the eminentia cruciata (eminentia
of the occipital bone (except for the upper part of the squama), by cruciformis) arise grooves for the transverse sinus (sulci sinus trans
part of the body of the sphenoid bone (a small area to the back of versi) and are continuous with the sigmoid groove (sulcus sinus sig
the dorsum sellae), posterior surface of the petrous part, and the moidei) which terminates at the jugular foramen.
102 THE CAVITY OF THE NOSE
THE CAVITY OF THE NOSE
The cavity of the nose (cavum nasi) (see Figs 93, 94, 103-107) is The piriform aperture (apertura piriformis) (see Figs 48 and 49)
located in the middle of the superior part of the visceral cranium. is bounded above by the free borders of the nasal bones, laterally
Its elements are the nasal cavity proper and the paranasal sinuses by the nasal notches (incisurae nasales) of the maxillae, and inferi
situated superiorly, laterally, and to the back of it. The frontal si orly by the anterior nasal spine (spina nasalis anterior).
nuses (sinus frontales) are above and in front of the cavity, the eth The choanae are openings almost oval in shape which are sepa
moidal cells (cellulae ethmoidales), or the ethmoidal labyrinths (labyr rated by the posterior border of the vomer. They are formed below
inthi ethmoidales) are situated on each side of the cavity, the by the posterior border of the horizontal plates of the palatine
maxillary sinuses (sinus maxillares) are slightly below, and the sphe bones, on both sides by the medial plates of the pterygoid pro
noidal sinuses (sinus sphenoidales) are situated to the back and cesses of the sphenoid bone, and above by the body of this bone,
above. the wings of the vomer, and the vaginal processes of the pterygoid
The cavity of the nose is divided by the osseous nasal septum processes of the sphenoid bone.
(septum nasi osseum) into the right and left halves. The paranasal si The osseous nasal septum (septum nasi osseum) (see Figs 93 and
nuses and the cells of the ethmoidal labyrinth open into each half. 94) is situated in the cavity of the nose and is usually curved to the
The cavity of the nose is located in the sagittal plane and its ante right or left side. It is formed by the perpendicular plate of the eth
rior opening is called the anterior (or piriform) bony aperture of moid bone above and by the vomer below and at the back; the in
the nose (apertura piriformis), the posterior openings are called the ferior border of the vomer unites with the nasal crests of the maxil
posterior apertures of the nose (choanae). lae and palatine bones.
Lamina cribosa
Concha nasalis superior
Openings of posterior ethmoidal cells
Openings of anterior
ethmoidal cells /
Infundibulum --�-+-wil,I•
Processus uncinatus ___:�-�..;;;;:--'(li"
ossis ethmoidalis -1...--,"C;:-"..,
Bulla ethmoidalis
Hiatus semilunaris _____ .J..- ...:!1•-;:":I
-"-
labyrinthi ethmoidalis �
Probe in canalis nasolacrimalis �- =--;.._._.,.
103. Right lateral wall of skeleton of the cavity of the nose (cavum nasi) (½).
(Sagittal section made to the right of osseous nasal septum.)
THE CAVITY OF THE NOSE 103
Processus sphenoidalis laminae

perpendicularis ossis palatini
Lamina medialis
processus pterygoidei
Os lacrimale
Meatus nasi inferior

104. Right lateral wall of skeleton of the cavity of the nose (½).
(Sagittal section made to the right of osseous nasal septum. The superior, middle, and infe
rior nasal conchae are partly removed.)
The' inferior wall of the nasal cavity is formed by the bony pal cha (concha nasalis media) and the inferior nasal concha (concha nasa
ate (palatum osseum) (see Fig. 107). lis inferior). Three longitudinal passages form between the conchae
The superior wall (or root) of the cavity of the nose is formed and the lateral wall of the nasal cavity (Figs 103 and 104). These
by the inner surface of the bones of the nose, the nasal parts of the are the superior meatus of the nose located under the superior con
frontal bones, and the cribriform plate of the ethmoid bone cha, the middle meatus of the nose under the middle concha, and
through which the cavity communicates with the anterior cranial the inferior meatus of the nose under the inferior concha.
fossa (fossa cranii anterior). The anterior surface of the body of the The superior meatus of the nose (meatus nasi superior) is shorter
sphenoid bone forms the posterior part of the superior wall. and narrower than the other two and occupies only the posterior
The lateral wall is formed by the surfaces of the frontal process parts of the nasal cavity. It is inclined slightly to the back and
and body of the maxilla facing the cavity of the nose, the lacrimal downwards and its posterior end reaches the sphenopalatine fo
bone, by the labyrinth of the ethmoid bone with its uncinate pro ramen (foramen sphenopalatinum). The posterior ethmoidal cells (cel
cess, the perpendicular plate of the palatine bone, and the medial lulae ethmoidales posteriores) open into the anterior part of the supe
plate of the pterygoid process of the sphenoid bone. Three nasal rior meatus. Above the superior nasal concha is the sphenoeth
conchae extend from the lateral wall towards the nasal septum: the moidal recess (recessus sphenoethmoidalis) in the region of which the
superior nasal concha (concha nasalis superior), the middle nasal con- sphenoidal sinus (sinus sphenoidalis) opens.
104 THE CAVITY OF THE NOSE
Lamina cribrosa
Cellulae
Lamina -1-----------;,1r--�- ethmoidales
perpendicularis
ossis ethmoidalis --;7-,,..'--
------ lL
iz-f- !IIJII ■
Concha nasalis -------------..
superior
Concha nasalis Sutura

media zygomaticomaxillaris
Processus uncinatus '-+-,-- Sinus maxillaris
labyrinthi
ethmoidalis
conchae nasalis
inferioris
inferioris
105. Skeleton of the cavity of the nose and orbits;

posterior aspect (½).
(Frontal section through base of temporal processes of zygomatic bones.)
The middle meatus of the nose (meatus nasi medius) runs paral ethmoid (infundibulum ethmoidale). The middle nasal meatus com
lel to the superior meatus on the whole, but is much longer and municates with the openings of the anterior ethmoidal cells by
wider. The maxillary sinus (sinus maxillaris) opens into it. On an in means of the hiatus and superiorly through the aperture of the
tact skull the opening of the sinus is markedly narrowed by the frontal sinus (apertura sinus frontalis), with the frontal sinus (sinus
neighbouring bones, namely, by the perpendicular plate of the pal frontalis).
atine bone posteriorly, and by the maxillary and ethmoidal pro The inferior meatus of the nose (meatus nasi inferior) is the long
cesses of the inferior nasal concha and the uncinate process of the est and widest. Near its anterior end is the inferior opening of the
ethmoid bone inferiorly. nasolacrimal canal (canalis nasolacrimalis) (Fig. 104). The inferior
The uncinate process (processus uncinatus) descending slightly to nasal concha is the superior wall of the inferior meatus, while the
the back divides the opening of the maxillary sinus into an antero inferior wall is formed by the palatine process of the maxilla and
inferior part and a posterosuperior part. The posterosuperior part the horizontal plate of the palatine bone. The space on both sides
is located between the large ethmoidal bulla (bu/la ethmoidalis) and of the nasal septum, between it and the conchae, is a narrow slit
the uncinate process. The opening into the maxillary cavity is seen called the common meatus of the nose. To the back of the conchae
on a non-macerated skull; it is called the hiatus semilunaris. The it is continuous with a very short posterior naris (meatus nasopharyn
superior, wider, part of the hiatus is called the infundihulum of the geus) opening by means of the choanae into the pharynx.
THE CAVITY OF THE NOSE 105
Cellulae ethmoidales
Lamina perpendicularis ossis ethmoidalis
I
'' Probe in apertura
sinus sphenoidalis
Sinus sphenoidalis
106. Skeleton of the cavity of the nose and orbits;

inferior aspect (¼).
(Horizontal section through median parts of orbital openings.)
Spina nasalis anterior

Foramen incisivum
,._,
Processus palatinus maxillae
Canalis palatinus major
Lamina lateralis processus

mmus } pterygoidei
Lamina medialis
107. Skeleton of the cavity of the nose;

superior aspect (½).
(Inferior wall of nasal cavity. Horizontal section through zygo
matic processes of maxillae.)
106 THE ORBIT
THE BONY PALATE
The bony palate (palatum osseum) (Fig. 108) is the floor of the dian palatine suture to the back of the incisor alveoli are the inci
cavity of the nose (cavum nasi) and the roof of the cavity of the sive foramina (foramina incisiva) transmitting nerves and vessels
mouth (cavum oris). and leading into the incisive canals (canales incisivi). Each incisive
The anterior two thirds of the skeleton of the bony palate are canal has two openings on- the superior (nasal) surface of the hard
formed by the palatine processes of the maxilla, the posterior part palate which are located to both sides of the nasal crest (eris/a nasa
by the horizontal plates of the palatine bones and their pyramidal lis). To each side of the incisive foramen the skull of a child, and
processes. sometimes that of an adult, carries a poorly defined incisive suture
Anteriorly and laterally the bony palate is bounded by the (sutura incisiva) (Fig. 108) which forms from articulation of the in
alveolar processes of the maxilla. The median palatine suture (su constantly found incisive bone (os incisivum) with the palatine pro
tura palatina mediana) stretches from front to back (sagittally) on cess of the maxilla. In the posterolateral parts of the bony palate,
the midline of the palate. It forms from the union of both palatine on each side, is a greater palatine foramen (foramen palatinum ma
processes of the maxilla and of both horizontal plates of the pala jus) to the back of which lies one or two lesser palatine foramina
tine bone. The posterior parts of this suture are crossed frontally (foramina palatina minora). Two palatine grooves (sulci palatini) are
by the transverse palatine suture (sutura palatina transversa) formed located on each side of the bone palate in front of the greater pala
from union of the palatine processes of the maxilla with the hori tine foramen; these are markings of vessels and nerves.
zontal plates of the palatine bones. On the anterior end of the me-
THE ORBIT
The eye socket, or orbit (orbita) (Figs 48, 49, and 109) is a cav posteriorly by the orbital surface of the greater wing of the sphe
ity whose four sides form an irregular pyramid. It lodges the eye noid bone and anteriorly by the orbital surface of the zygomatic
ball with its muscles, vessels and nerves, as well as the lacrimal bone. The sphenozygomatic suture (sutura spheno;;ygomatica) passes
gland and fatty tissue. It opens in front by a large orbital opening between these bones. The roof is separated from the lateral wall by
(aditus orbitae) which forms the base of the pyramid as it were. The the superior orbital fissure (fissura orbitalis superior) which is be
orbital cavity becomes slightly wider immediately at the aditus, but tween the greater and lesser wings of the sphenoid bone. The orbi
gradually narrows to the back. The longitudinal axes of both or tal surface of the zygomatic bone carries the zygomatico-orbital
bits, drawn from the middle of the aditus to the middle of the op foramen (foramen ;;ygomaticoorbitale).
tic canal, meet in the region of the sella turcica. The orbit borders The inferior wall, or floor of the orbit (paries inferior orbitae) is
upon the lateral wall of the nasal cavity medially, the correspond formed for the most part by the orbital surface of the maxilla. The
ing part of the anterior cranial fossa superiorly, the temporal fossa lateral part of the orbital surface of the zygomatic bone and, poste
laterally, and the superior wall of the maxillary sinus inferiorly. riorly, the orbital process of the palatine bone also contribute to
The orbital opening has a quadrangular contour with rounded the formation of the floor of the orbit. Between the inferior border
angles. The superior border is bounded by the supraorbital margin of the orbital surface of the greater wing and the posterior border
(margo supraorbitalis) and zygomatic process of the frontal bone. of the orbital surface of the maxilla is the inferior orbital fissure
On the medial side the aditus is limited by the nasal part of the (fissura orbitalis inferior) whose anterior end reaches the zygomatic
frontal bone and the frontal process of the maxilla. The inferior bone. Through this fissure the orbital cavity communicates with
border is formed by the infraorbital margin (margo infraorbitalis) of the pterygopalatine and infratemporal fossae. The infraorbital
the maxilla and the adjoining part of the zygomatic bone. groove (sulcus infraorbitalis) arises on the lateral border of the infe
The lateral border of the aditus is formed by the zygomatic rior surface of the maxilla and is continuous with the infraorbital
bone. All the orbital walls are smooth. The superior wall, or roof canal (canalis infraorbitalis) passing deep in the anterior parts of the
(paries superior orbitae) is formed by the orbital part of the frontal inferior orbital wall.
bone and, at the back, by the lesser wings of the sphenoid bone. The medial wall of the orbit (paries media/is orbitae) (Fig. 109) is
Between these two bones stretches the sphenofrontal suture (sutura formed (from front to back) by the lacrimal bone, the orbital plate
sphenofrontalis). The optic canal (canalis opticus) transmitting the op of the ethmoid bone, and lateral surface of the body of the sphe
tic nerve and ophthalmic artery is located at the root of each lesser noid bone. In the anterior part of the wall is the lacrimal groove
wing. At the anterior border of the superior wall, closer to the la (sulcus lacrimalis) which is continuous with the fossa of the lacrimal
teral angle, is the fossa for the lacrimal gland (Iossa glandulae lacri sac (Iossa sacci lacrimalis), which in turn is continuous downwards
malis) and in front of and medially to the border are the trochlear with the nasolacrimal canal (canalis nasolacrimalis).
fossa (fovea trochlearis) and the trochlear spine (spina trochlearis). The superior border of the medial wall of the orbit bears two
The lateral wall of the orbit (paries lateralis orbitae) is formed openings: the anterior ethmoidal foramen (foramen ethmoidale ante-
THE ORBIT 107
Foramen incisivum Os incisivum
Sulci
palatini
Lamina horizontalis Foramina palatina minora

Sutura palatina tran,;;versa
Spina nasalis posterior
108. Bony palate (palatum osseum); inferior aspect (¾).
Probe in canalis opticus
Lamina orbitalis -;..;�--�!:;..:.::::...__,:_.;__ Crista lacrimalis posterior

ossis ethmoidalis
Sutura
ethmoideomaxillaris --l.. ----•i--.....�:'""'---lf-
Processus orbitalis
laminae perpendicularis
OSSIS palatini
Canalis pterygoideus
(opened)
Foramen sphenopalatinum
109. Right orbit (orbita) and pterygopalatine fossa

(fossa pterygopalatina) (¾).
(Medial wall of right orbit. The lateral wall of maxillary sinus is removed by vertical section.)
108 THE TEMPORAL FOSSA
rius) which opens at the anterior end of the frontoethmoidal su the cavity of the orbit communicates with the cavity of the skull by
ture, and the posterior ethmoidal foramen (foramen ethmoidale poste means of it.
rior) found close to the posterior end of this suture. The optic The walls of the orbit are covered by a fine periosteum which is
canal (canalis opticus) is in the posterior angle of the medial wall; called the periorbit (periorbita).
THE TEMPORAL FOSSA
The temporal fossa (Iossa temporalis) (see Figs 50, 51, and 110) greater wing of the sphenoid bone. The anterior wall is formed by
is situated on each side on the outer lateral surface of the skull. Su the zygomatic bone and part of the frontal bone posterior to the
periorly and posteriorly it is separated from the other areas of the superior temporal line. Laterally the fossa is bounded by the zygo
calvaria by the superior temporal line (linea temporalis superior) of matic arch.
the parietal and frontal bones, which is in essence a conventional The inferior margin of the temporal fossa is bounded by the
boundary line. The medial wall of the temporal fossa is formed by infratemporal crest (crista infratemporalis) of the sphenoid bone.
the inferior part of the external surface of the parietal bone in the The zygomaticotemporal foramen (foramen zygomaticotemporale)
region of the sphenoidal angle, the temporal surface of the squa opens on the anterior wall of the temporal fossa. The fossa is oc
mous part of the temporal bone, and the external surface of the cupied by the temporal muscle, fascia, fat, vessels, and nerves.
983490 Int· Sinelnikow Bd. I (span.), - rh, 7 /7p, Tn/4., Z/7 - Bild 110,
Pars squamosa ossis ________

tcmporalis Sutura sphenosquamosa
Crista
infratemporalis
Lamina lateralis
processus pterygoideus
Processus pyramidalis
ossis palatini
110. Right temporal fossa (Iossa temporalis), infratemporal fossa

(Iossa infratemporalis), and pterygopalatine fossa
(Iossa pterygopalatina) (¾).
(The zygomatic arch is removed.)
THE INTRATEMPORAL AND PTERYGOPALATINE FOSSAE 109
THE INFRATEMPORAL FOSSA
The infratemporal fossa (fossa infratemporalis) (Fig. 110) is ited by the ramus of the mandible. At the junction of the anterior
shorter and narrower than the temporal fossa but its transverse di and medial walls the infratemporal fossa becomes deeper and is
mension is larger. Its superior wall is formed by part of the greater continuous with a funnel-like slit known as the pterygopalatine
wing of the sphenoid bone medial to the infratemporal crest. fossa (fossa pterygopalatina).
The anterior wall is formed by the posterior part of the maxil Anteriorly the infratemporal fossa communicates with the cav
lary tuberosity. The lateral plate of the pterygoid process of the ity of the orbit through the inferior orbital fissure. The fossa con
sphenoid bone is the medial wall of the infratemporal fossa. Exter tains the lower portion of-the temporal muscle, the lateral ptery
nally and downwards the fossa has no bony wall. Laterally it is lim- goid muscle, some vessels and nerves.
THE PTERYGOPALATINE FOSSA
The pterygopalatine fossa (fossa pterygopalatina) (see Figs 109 lower surface of the base of the skull through the pterygoid canal
and 110) is formed by parts of the maxilla, the sphenoid and pala (canalis pterygoideus). The pterygopalatine fossa is continuous later
tine bones. It is connected with the infratemporal fossa through ally with the infratemporal fossa.
the pterygomaxillary fissure (fissura pterygomaxillaris) which is wide On a non-macerated skull the sphenopalatine foramen (fo
upwards and narrow downwards. The pterygopalatine fossa is ramen sphenopalatinum) is closed by the mucous membrane of the
bounded anteriorly by the infratemporal surface of the maxilla (or, nasal cavity; it transmits nerves and arteries into the cavity of the
to be more precise, the maxillary tuberosity), posteriorly by the nose.
pterygoid process of the sphenoid bone, medially by the lateral In the lower part, the pterygopalatine fossa is continuous with
surface of the perpendicular plate of the palatine bone, and superi a narrow canal the superior part of which is formed by the maxilla,
orly by the maxillary surface of the greater wing of the sphenoid the sphenoid and palatine bones, and the inferior part by only the
bone. ll\axilla and the palatine bone. The canal is called the greater pala
In. its upper part the pterygopalatine fossa communicates in tine canal (canalis palatinus major) and opens on the hard palate by
front with the orbit through the inferior orbital fissure (fissura orbi means of the greater palatine foramen and lesser palatine foramen
talis inferior), medially with the cavity of the nose through the (foramen palatinum majus et foramina palatina minora); it transmits
sphenopalatine foramen (foramen sphenopalatinum), to the back with nerves and vessels.
the cranial cavity through the foramen rotundum and with the
DEVELOPMENT AND AGE FEATURES
OF THE BONES OF THE HEAD
Two parts are distinguished in the skull, the cerebral and the wings). It develops from enchondral nuclei which appear symmet
facial, or visceral (extracerebral). The cerebral part consists of the rically in the following order: in the region of the lesser wings, in
skull cap (calvaria) and base which are formed by several bones. the region of the greater wings, and in the body of the bone below
The bones of the calvaria develop in connective tissue and pass the hypophyseal fossa in the 3rd month of the intrauterine period;
through two stages, the membranous and osseous (primary bones), in the region of the carotid groove and the lingula in the beginning
by-passing the cartilaginous stage. The bones of the base also de of the 4th intrauterine month; in the region of the anterior part of
velop in connective tissue but go through three stages, the mem the body in the end of the 4th intrauterine month; two pairs of en
branous, cartilaginous (secondary bones), and osseous. The devel desmal nuclei give rise to the bone in the region· of the medial
opment of the bones of the visceral skull is associated with the plates of the pterygoid processes in the 3rd month and in the re
development of the branchial arches (first and second) which are gion of the superolateral areas of the greater wings in the end of
the foundation of the facial part of the head. Some of the bones the 3rd intrauterine month. The sphenoid bone ossifies completely
pass through three and the others through two (connective-tissue in the 10th year of life. The sinuses begin developing at the age of
and osseous) developmental stages (see Figs 3, 99, 100, and 110a). 3 years.
The occipital bone (except for the upper portion of the squa The temporal bone develops from the following points of os
mous part) is a secondary bone and has four enchondral ossifica sification: endesmal centres of the squama appear in the beginning
tion centres (points) which are all concentrated around the for of the 3rd month, those of the tympanic cavity at the end of the
amen magnum (one on each side, one in front and the other at the 3rd month of the intrauterine period; enchondral points appear in
back). The upper portion of the squamous part is a primary bone the 5th month of the intrauterine period for the petrous part and
and has two ossification points (one on each side of the median at the end of the first year of life for the styloid process. The tym
plane). Complete fusion of all parts occurs on the 4-6th year of panic part as such is absent in the newborn and is represented by a
life. ring whose ossification begins in the 3rd month of the intrauterine
The parietal bone is a primary bone. Its points of ossification period (see Fig. 99). As to the mastoid air cells, these are formed
appear in the region of the future parietal eminence in the end of completely by the age of 5-6 years. Complete ossification of the
the 10th intrauterine week. The bone tissue grows radially in rela temporal bone occurs by the age of 6 years.
tion to the eminence. The superior and inferior temporal lines The ethmoid is a secondary bone, it develops in cartilage and
start forming by the age of 12-15 years. its ossification begins in several points. The points of ossification
The frontal bone is a primary bone and develops from two appear earliest for the middle nasal concha (4th month of the in
points of ossification; each point appears in the region of the fu trauterine development) and the superior nasal concha (5th intra
ture supraorbital margin in the end of the 9th week of the intra uterine month). Two nuclei appear in the 9th month for the cribri
uterine period. The frontal bone of the newborn consists of two form plate. The ossification nucleus of the orbital plate forms in
halves whose fusion on the midplane begins in the 6th month after the 6th month after birth and the plate ossifies rapidly. At the age
birth and is completed by the end of the 3rd year to form the fron of 2 years an ossification nucleus appears on each side for the fu
tal (metopic) suture which disappears by the age of 8 years. The ture crista galli which forms from their fusion later. The perpendi
frontal sinuses begin appearing in the first year of life. cular plate ossifies at the age of 6-8 years, and the ethmoid cells of
The sphenoid is a secondary bone (except for the medial plate the labyrinth are completely formed by the age of 12-14 years.
of the pterygoid process and the superolateral areas of the greater The inferior nasal concha is a secondary bone; it has a single
THE SKULL OF A NEWBORN 111
6
5
110a. Bones of skull (ossa cranii) of a newborn.

I -occipital bone (os occipitale), external surface
2-occipital bone (os occipitale), internal surface
3-sphenoid bone (os sphenoidale)
4-temporal bone (os temporale)
5-maxilla
6-mandible (mandibula)
112 DEVELOPMENT OF THE BONES OF THE HEAD
ossification nucleus which appears at the beginning of the 3rd the mental ossicle while the proximal end gives rise to the auditory
month of the intrauterine period. ossicles. The osseous union of both halves begins in the 3rd month
The lacrimal bone is a primary bone. It develops from a single after birth and is completed at the age of 2 years.
point of ossification appearing on the 3rd intrauterine month. The hyoid bone is a secondary bone. It develops from five
The vomer is a primary bone developing from two endosteal points, one point giving rise to the body, one on each side for the
centres of ossification appearing in the 2nd month of the intrauter greater horns, and another on either side for the lesser horns. In
ine period. Each centre is situated parallel to the median plane. the body and greater horns the points of ossification appear at the
The right and left plates fuse later, while the cartilage of the nasal end of the intrauterine period or soon after birth; the lesser horns
septum located between them resorbs after birth. are ossified by the age of 13-15 years. The greater horns fuse with
The maxilla is a primary bone developing from five endesmal the body quite late, by 30-40 years of age and sometimes later; the
centres of ossification, namely superolateral, inferolateral, antero lesser horns fuse in old age.
median, posteromedian, and middle centre. The superolateral cen The age distinctions of the skull as a whole, of its topographic
tre forms the medial part of the orbital floor. The inferolateral cen areas and of the separate bones are expressed firstly by the differ
tre gives rise to the lateral part of the orbital floor, the zygomatic ent ratio of the cerebral to the visceral part. These differences, as
process, anterolateral part of the body, and the posterolateral wall well as the thickness of the bones, the size of the fossae and cavi
of the alveolar process. The middle nucleus develops into the fron ties of the skull, the presence of the fontanelles, the cranial synos
tal process and part of the body below it. The posterior two thirds toses, etc. are determined by the growth and development of the
of the palatine process and the internal wall of the alveolar process skull during five periods. The first period, from birth to the age of
corresponding to the canine tooth and molars arise from the pos 7 years, is characterized by active growth of the skull, particularly
teromedian nucleus. The anteromedian ossification point gives ori in size; the sutures become slightly narrower, the fontanelles grad
gin to the incisal part of the bone, i.e. part of the alveolar process ually reduce in size, the cavities of the nose and orbits grow and
corresponding to the incisors, and the anterior third of the pala acquire the proper shape; the relief of the mandible changes no
tine process. In the 5th month the nuclei fuse but the incisive su ticeably. In the second period, lasting to the age of 14 years, the
ture uniting the incisive bone with the other part of the maxilla size and shape of the skull and its parts change less actively than in
persists in the newborn. The maxillary sinuses appear in the 6th the first period, but the fossae, mastoid process and the cavities of
month of the intrauterine period and develop fully by the age of the orbits and nose grow noticeably larger. The third period lasts
12-14 years. from puberty to the age of 25 years. The frontal parts (forehead)
The palatine bone is a primary bone. It develops from a single are shaped in this period, the visceral skull becomes longer, the re
point of ossification which appears in the 2nd month of the intra gion of the zygomatic arches grows markedly, and the eminences
uterine life at the junction of the perpendicular and horizontal become more prominent. The fourth period, lasting to the age of
plates. 45 years, is firstly characterized by the ossification of sutures,
The zygomatic bone is a primary bone. It forms from a single which had started at the age of 20-30 years, being completed at its
point of ossification appearing at the end of the 2nd month of the end. It has been noted that premature ossification of the sagittal
intrauterine period. suture leads to the formation of a short skull, premature ossifica
The mandible develops as a paired bone and, according to its tion of the coronal suture results in the formation of a long skull.
development, is a mixed bone; its condylar and coronoid processes The fifth period lasts from the age of 45 to old age and is charac
which pass through the stage of cartilage are secondary bones, terized by atrophy first of the visceral and then of the cerebral
whereas the other part undergoes the stage of membranous ossifi skull and gradual loss of teeth, which has an effect on the shape of
cation and is a primary bone. Each half of the mandible grooves the jaws. Later, the alveolar processes are smoothed out and the
the cartilage of the first branchial arch; the cartilage resorbs by the whole skull becomes smaller.
5th month of the intrauterine period and its distal segment forms
THE BONES OF THE UPPER LIMB
Ossa membri superioris
The skeleton of the upper limb (skeleton membri superioris) is divided into the bones of the girdle of the
superior extremity, or shoulder girdle (ossa cinguli membri superioris) which includes the collar bone or clavi
cle (clavicula) and the scapula or shoulder blade, and the bones forming the skeleton of the free upper ex
tremity (skeleton membri superioris liberi); these include the humerus, bones of the forearm (ossa antebrachii),
and bones of the hand (ossa manus).
THE BONES
OF THE SHOULDER GIRDLE
THE SCAPULA
The shoulder blade (scapula) (Figs 111-114 and 119) is a flat ner than the upper border. It faces the vertebral column and is eas
bone. It is located between the muscles of the back over the second ily palpated through the skin.
to seventh ribs. It is triangular, in accordance with which three The lateral border (margo lateralis scapulae) is thick and faces
borders (upper, medial, and lateral) and three angles (superior, in the axillary region.
ferior, and lateral) are distinguished in it. The superior angle (angulus superior) is rounded and faces up
The upper border of the scapula (margo superior scapulae) is thin wards and medially.
and bears in its lateral part the suprascapular notch {incisura scapu The inferior angle (angulus inferior) is rough, thick, and faces
lae); on a non-macerated bone the notch is bridged by the superior downwards.
transverse ligament of the scapula or the suprascapular ligament The lateral angle (angulus lateralis) is thickened. Its lateral sur
(ligamentum transversum scapulae superius) as a result of which an face bears a thickened shallow articular glenoid cavity (cavitas gle
opening transmitting the suprascapular nerve is formed. noid.alis) for articulation with the articular surface of the head of
The lateral parts of the upper border of the scapula are contin the humerus.
uous with the coracoid process (processus coracoideus) which first pro The lateral angle is separated from the rest of the scapula by a
jects upwards but then curves at an angle and extends forwards small narrowed part called the neck of the scapula (collum scapulae).
and slightly laterally. In the region of the neck, above the superior margin of the gle
The medial border {margo medialis scapulae) is longer and thin- noid cavity is the supraglenoid tubercle (tuberculum supraglenoidale),
114 THE BONES OF THE UPPER LIMB
-----:--- Humerus
Ossa metacarpi
111. Bones of right upper limb (ossa membri superioris);

anterior aspect (¼).
THE SCAPULA 115
and below the glenoid cavity is the infraglenoid tubercle (tubercu spinata). They are the sites of origin of the supraspinat�s and infra
lum infraglenoidale). These are sites of the origin of muscles. spinatus muscles, respectively.
The anterior, costal surface (facies costalis) is concave. It is oc The spine of the scapula (spina scapulae) is a well developed
cupied by the subscapular muscle and is called the subscapular projection crossing the dorsal surface from the medial border to
fossa (fossa subscapularis). wards the lateral angle.
The posterior, dorsal surface (facies dorsalis) is divided by the The lateral part of the spine of the scapula is strongly devel
spine of the scapula (spina scapulae) into two parts. The smaller oped and is continuous with the acromion stretching laterally and
part is situated above the spine and is called the supraspinous slightly forwards and carrying on its anterior edge the articular
fossa (fossa supraspinata); the other, larger part occupies the rest of facet of the acromion (facies articularis acromii) for articulation with
the dorsal surface and is called the infraspinous fossa (fossa infra- the clavicle.
Facies articularis acromii
J
Processus coracoideus
Tuberculum infraglenoidale
Facies costalis
Margo lateralis -
l
Angulus infenor
112. Right scapula; anterior aspect (¾).

116 THE SCAPULA
Margo superior
Fossa Acromion
supraspinata Processus
coracoideus
/ 4" ��
Margo
medialis
I
Angulus inferior
113. Right scapula; posterior aspect (¼).

THE SCAPULA 117
Acromion
Tuberculum supraglenoidale
Tuberculum infraglenoidale
114. Right scapula; lateral aspect (¾).

118 THE CLAVICLE
THE CLAVICLE
The clavicle (clavicula) (Figs 111, 115, 116, 119) is a small tu lum conoideum) and the trapezoid line (Linea trapez.oidea); they give
bular S-shaped bone. It has a body and two ends, the sternal end attachment to the conoid and trapezoid oarts of the coracoclavicu
facing the manubrium sterni and the acromial end articulating lar ligament.
with the acromion of the scapula. The sternal end and the adjoin The superior surface of the clavicle is smooth. The sternal end
ing part of the body of the clavicle are convex forwards, the rest of (extremitas sternalis) is thick and carries on its internal surface the
the clavicle is concave forwards. sternal articular facet (facies articularis sternalis) for articulation with
The middle part of the clavicle located between its ends is the clavicular notch of the manubrium sterni.
somewhat compressed from top to bottom. On its inferior surface The acromial end (extremitas acromialis) is wider but slightly
it has a relatively large nutrient foramen. The sternal end bears an thinner than the sternal end. On its inferolateral surface is the ac
impression for the costoclavicular ligament (impressio ligamenti cos romial articular facet (Jacies articularis acromialis) for articulation
toclavicularis), the acromial end carries the conoid tubercle (tubercu- with the acromion of the scapula.
Facies articularis sternalis
Extremitas sternalis
115. Right clavicle (clavicula); superior aspect (½).
-
I
Facies articularis acromialis Foramen nutricium
I
Linea trapezoidea
lmpressio lig.
costoclavicularis
Extremitas acromialis
Tuberculum conoideum Extremitas sternalis
116. Right clavicle (clavicula); inferior aspect (½).

THE SKELETON OF THE
FREE UPPER LIMB
THE HUMERUS
The humerus (see Figs 111, 117-122) is a long tubular bone. A The lower periphery of each tuberosity is continuous with a
body, or shaft, and two ends, upper and lower, are distinguished in similarly named crest: the lateral lip of the bicipital groove or the
it. crest of the greater tuberosity (eris/a tuberculi majoris) and the me
The body, or shaft (corpus humeri) is rounded superiorly, while dial lip of the bicipital groove or the crest of the lesser tuberosity
the lower part is trihedral. A posterior and an anterior surfaces are (eris/a tuberculi minoris). Descending, both crests reach the upper
distinguished in the lower part of the shaft. The posterior surface parts of the shaft and together with the tuberosities form the bor
(facies posterior) is bounded by a lateral and medial borders (margo ders of the well defined bicipital or intertubercular groove (sulcus
lateralis et margo media/is). The anterior surface (facies anterior) is intertubercularis) lodging the tendon of the long head of the biceps
separated by a poorly defined border into an anteromedial surface brachii muscle (tendo capitis longi musculus bicipitis brachii).
(facies anterior media/is) and anterolateral surface (facies anterior later Below the tubercles at the junction of the upper end and body
alis). Slightly below the middle of its length the anteromedial sur of the bone is a small constriction called the surgical neck (collum
face bears a nutrient foramen (foramen nutricium) leading into a dis chirurgicum) corresponding to the zone of the epiphyseal cartilage.
tally running nutrient canal (canalis nutricius). The lower end, or the distal epiphysis (extremitas inferior s. epi
A little above this foramen, the anterolateral surface of the physis distalis) is flattened in the anteroposterior direction.
body carries the deltoid tuberosity (tuberositas deltoidea) for inser The distal segment of this part of the bone bears in its lateral
tion of the deltoid muscle. part a rounded eminence called the capitulum of the humerus
A spiral groove lodging the radial nerve (sulcus nervi radialis) is (capitulum humeri) for articulation with the head of the radius. Next
on the posterior surface of the shaft behind the deltoid tuberosity. to this eminence is the trochlea of the humerus (trochlea humeri)
It runs downwards and laterally. which articulates with the trochlear notch of the ulna.
The upper end, or the proximal epiphysis (extremitas superior s. The coronoid fossa (fossa coronoidea) is on the anterior surface
epiphysis proximalis) is thickened and carries a semispherical head of of the inferior end of the humerus above the trochlea, the radial
the humerus (caput humeri) whose surface faces medially, upwards, fossa (fossa radialis) is above the capitulum, and the olecranon
and slightly backwards. fossa (fossa olecrani) lies on the posterior surface.
The head is separated from the rest of the bone by a shallow The lower end of the humerus terminates distally as the lateral
annular constriction called the anatomical neck (collum anatomi and medial epicondyles (epicondylus lateralis et epicondylus media/is).
cum). On the anterolateral surface of the bone below the anatomi The medial epicondyle is more prominent. Its posterior surface
cal neck are the greater tuberosity (tuberculum majus) located later carries the groove for the ulnar nerve (sulcus nervi ulnaris). The
ally and the lesser tuberosity (tuberculum minus) situated medially groove and the epicondyles are easily palpated under the skin.
and a little to the front.
120 THE HUMERUS
Caput
Tubercul m humeri --,----
majus --,-
Tuberculum
'
anatomicum
Sulcus � • , Tuberculum majus
minus
'"'"""""""'"'''
\,
\. \
c,,,m ''"'""" � minoris
rn"ons
'
j
, '
Tuberositas :,
deltoidea --J-.'
Facies Sulcus nervi

radialis
Facies medialis
anterior
l
lateralis Foramen
anterior
nutricium
Facies I
Margo_ Margo posterio
lateralis medialis l
Margo
!�!�s-; lateralis
Fossa
radialis
Epicondylus Epicondylus
lateralis -1 Epicondylus Epicondylus __ lateralis
medialis medialis
humeri humeri
117. Right humerus; 118. Right humerus; posterior aspect

anterior aspect (¾). (¾).
THE HUMERUS 121
119. Right shoulder girdle (radiograph).

1-first rib 9-anatomical neck
2-rnedial border of scapula 10-acromion
3-intercostal space 11-coracoid process of scapula
4-lateral border of scapula 12-clavicle
5-scapula 13-spine of scapula
6-glenoid cavity of scapula 14-superior border of scapula
7-humerus 15-head of humerus
8-greater tuberosity of humerus 16-surgical neck
Caput humeri
Collum anatomicum
Capitulum
humeri Trochlea
humeri
Tuberculum
majus
Sulcus
intertubercularis
Fossa Epicondylus
Tuberculum minus olecrani medialis
120. Proximal end of right humerus; superior 121. Distal end of humerus; inferior
aspect(¾). aspect(¾).
122 THE HUMERUS
122. Distal segment of right humerus and proximal

part of right ulna and radius (radiograph).
)-humerus 8-tuberosity of radius
2-medial border of humerus 9-head of radius
3-medial epicondyle 10-capitulum of humerus
4-olecranon I I -lateral epicondyle
5-coronoid process of ulna 12-olecranon fossa
6-ulna 13-lateral border of humerus
7-radius
THE ULNA 123
THE BONES OF THE FOREARM

The bones of the forearm (ossa antebrachii) (Figs 123-131) are
the ulna and the radius. When the limb is hanging freely and in
supination (with the forearm and palm turned forward) the ulna is Olecranon
located medially and the radius laterally.
Processus
coronoideus----:�,-:,;..;,-:
THE ULNA Jncisura radialis
The ulna (see Figs 111, 123-125, 129-131) is a long tubular

bone. It has a shaft (body) and two ends, upper and lower. Tuberositas ulnae
The shaft of the ulna (corpus ulnae) is trihedral. It has three bor
ders: anterior (palmar), posterior (dorsal), and interosseous (lat
eral). Its three surfaces are the anterior (palmar), posterior (dorsal)
and medial surface.
The anterior border (margo anterior) is rounded, the posterior
border (margo posterior) faces to the back, and the interosseous bor
der (margo interosseus) is sharp and faces the radius.
The anterior surface (facies anterior) is slightly concave. It bears
a nutrient foramen (foramen nutricium) which is continuous proxi
mally with a nutrient canal (canalis nutricius). In the upper part of
the anterior surface of the junction of the shaft and the upper end Margo interosseus --.
Margo anterior
of the bone is the tuberosity of the ulna (tuberositas ulnae). The pos
terior surface (facies posterior) faces to the back, while the medial
surface (facies media/is) faces the medial border of the forearm.
The upper end, or proximal epiphysis (extremitas superior s. epi
physis proximalis) is thick and continuous upwards with the ole
cranon. The anterior surface of the olecranon bears the trochlear
notch (incisura trochlearis) which is bounded below by the coronoid
process (processus coronoideus). The lateral surface of the coronoid
process carries the radial notch (incisura radialis) for articulation of
the ulna with the articular circumference of the head of the radius.
The supinator crest (crista musculi supinatoris) arises behind the ra
dial notch and descends to the upper parts of the shaft.
The lower end, or distal epiphysis (extremitas inferior s. epiphysis
distalis) of the ulna is rounded. The head (caput ulnae) is distin
guished on it. The lower periphery of the head carries an articular
surface which faces the wrist and bears a fossa. The lateral peri
phery of the head carries for a considerable distance the articular
circumference of the ulna (circumferentia articularis ulnae) for articu
lation with the radius. The posteromedial surface of the head is
continuous with the medial styloid process (processus styloideus medi
a/is) which is easily felt through the skin.
Caput ulnae
Processus
styloideus medialis
123. Right ulna;

anterior surface (¾).
124 THE ULNA
Processus
coronoideus
Crista musculi -+--·.&••:;

supinatoris Tuberositas ulnae
Margo posterior -- f
Margo posterior-...--•
Fades medialis
Margo interosseus
Facies posterior ---
Fades posterior
Circumferentia
Caput ulnae articularis
Processus styloideus
medialis __....,._., medialis
124. Right ulna; 125. Right ulna;

posterior surface (½). surface facing the radius (¾).
THE RADIUS 125
THE RADIUS
The radius (see Figs 111, 126-131) is located laterally and a

Circumferentia articularis
little anteriorly to the ulna. It has a shaft (body) and two ends, up
per and lower.
The shaft of the radius (corpus radii) is triangular. It has three
borders (anterior, posterior, and interosseous, or medial) and three
surfaces (anterior, or palmar, posterior, or dorsal, and lateral, or
Tuberositas radii
outer).
The anterior border (margo anterior) and the posterior border
(margo posterior) are rounded.
The medial border of the bone is sharp, faces the ulna, and is
called the interosseous border (margo interosseus).
The anterior surface (facies anterior) is slightly concave. It bears
a nutrient foramen (foramen nutricium) which is continuous proxi
mally with a nutrient canal (canalis nutricius).
The posterior surface (facies posterior) faces to the back, the la
teral surface (facies lateralis) faces the lateral border of the forearm.
The upper end, or proximal epiphysis (extremitas superior s. epi Foramen nutricium
physis proximalis) carries at its junction with the shaft a well defined
tuberosity of the radius (tuberositas radii) facing medially. Superi Margo interosseus
orly to the tuberosity is an evenly constricted area of bone called
the neck of the radius (col/um radii). Above the neck is a cylindrical Margo anterior--
head of the radius (caput radii). The superior surface of the head is
Facies anterior
concave. The lateral part of the head carries a surface for articulat
ing with the radial notch of the ulna; it is called the articular cir
cumference of the radius (circumf erentia articularis radii) and can be
partly felt through the skin.
The lower end, or distal epiphysis (extremitas inferior s. epiphysis
distalis) is thick and wide in the frontal plane. The lateral peri
phery of the lower end is continuous with the lateral styloid pro
cess (processus styloideus lateralis) which is easily felt through the
skin. On the medial surface of the lower end is the ulnar notch (in
cisura ulnaris) which bears an articular surface for articulation with
the articular circumference of the ulna.
The anterior surface of the lower end of the radius is smooth,
the posterior surface carries small ridges separating small grooves
which lodge the tendons of muscles. The lower surface is concave
from side to side and from front to back. It serves for articulation
with the carpal bones and is called the carpal articular surface (fa
cies articularis carpea). It carries a small ridge which runs anteropos
teriorly and separates it into two parts corresponding to the two
carpal bones articulating with the radius. Processus styloideus
lateralis ----
126. Right radius;

anterior surface (¾).
126 THE RADIUS
---Caput radii
Caput radii
•'
f
Tuberositas radii __
I_.
Facies lateralis Margo interosseus
Facies anterior __
Facies posterior
Facies posterior ___
.,·i�
I ncisura ulnaris
Processus styloideus
lateralis
127. Right radius; 128. Right radius;

posterior surface (¾). surface facing the ulna (¾).
THE ULNA AND RADIUS 127
Olecranon
Circumferentia ---,-
articularis Processus coronoideus
129. Proximal ends of right ulna and radius;

palmar surface (½).
Processus styloideus radii
Facies anterior
Caput ulnae
l
Fades articularis
carpea
Fac,es postenor
130. Distal ends. of right ulna and radius;

inferior aspect (¾).
128 THE BONES OF THE FOREARM
8 5
7 8
131. Bones of right forearm

(radiograph).
)-humerus
2-medial epicondyle
3-olecranon
4-ulna
5-medial styloid process
6-lunate bone
7-scaphoid bone
8-lateral styloid process
9-radius
10-tuberosity of radius
11-neck of radius
12-head of radius
13-capitulum of humerus
14-olecranon fossa
THE BONES OF THE HAND 129
THE BONES OF THE HAND

The bones of the hand (ossa manus) (see Figs 111, and
132-142) are divided into the carpal bones (ossa carpi), the meta
carpal bones (ossa metacarpalia), and the bones of the fingers or
phalanges of digits of the hand (ossa digitorum manus), i.e. the pha
langes of the fingers (phalanges digitorum).
Tuberositas phalangis distalis
Corpus phalangis
-�
Phalanx distalis--
_
(�
Os trapezoideum
Os lunatum
Os capitatum Os scaphoideum
132. Bones ef right hand (ossa manus); palmar surface(¼).

130 THE BONES OF THE HAND
THE CARPAL BONES

The carpal bones (ossa carpi) (see Figs 111, 132-142) form two from the radial to the ulnar border of the hand): the scaphoid
rows, superior and inferior. The superior (or proximal) or first row bone (os scaphoideum), the lunate bone (os lunatum), the triquetral
adjoins the distal part of the forearm bones. The inferior row is bone (os triquetrum), and the pisiform bone (os pisiforme).
known as the distal, or second row. Some of the carpal bones face The distal row is made up of the trapezium bone (os trapezium
the metacarpus. s. os multangulum majus), the trapezoid bone (os trape;:_oideum), the
The proximal row is formed by the following bones (named capitate bone (os capita/um), and the hamate bone (os hamatum).
Phalanx distalis
Phalanx media
Spatia interossea
metacarpi
Os metacarpale V
Process us styloideus medius
Os multangulum Os capitatum
Os scaphoideum
Os lunatum
Os triquetrum
133. Bones ef right hand (ossa manus); dorsal surface (¼).

THE BONES OF THE HAND 131
134. Bones of right hand (radiograph).

}-radius 12-proximal phalanx of index finger
2-lateral styloid process 13-base of middle phalanx of index finger
3-lunate bone 14-distal phalanx of index finger
4-scaphoid bone 15-capitate bo11e
5-multangular (trapezium) bone 16-hook of hamate bone
6-trapezoid bone 17-hamate bone
7-first metacarpal bone 18-pisiform bone
8-sesamoid bone 19-triquetral bone
9-proximal phalanx of thumb 20-medial styloid process
IO-distal phalanx of thumb 21-head of ulna
11-second metacarpal bone
132 THE CARPAL BONES
Tuberculum ossis
scaphoidei ;;/ "•:,, ...
,:··
A B
135. Right scaphoid bone (os scaphoideum) (1/i).

A-palmar surface; B-dorsal surface.
Facies articularis
with os capitatum
A B C
136. Right lunate bone (os lunatum) (1/i).

A-palmar surface; B-dorsal surface; C-distal surface.
A B
137. Right triquetral bone (os triquetrum) (½).

THE CARPAL BONES 133
Mark of nervus ulnaris
A B
138. Right pisiform bone (os pisiforme) (1/i).

Tuberculum ossis
trapezii
A B
139. RJght trapezium bone (os multangulum s. trape

zium) (½).
A B
140. Right trapezoid bone (os trapezoideum) (½).

134 THE CARPAL BONES
THE SCAPHOID BONE

The scaphoid bone (os scaphoideum) (Fig. 135) occupies the ex pal articular surface of the radius. The inferomedial part of the
treme lateral ('radial') position in the proximal row of carpal bone carries a concave articular facet for articulation with the cap
bones. Its palmar surface is concave and continuous in the infero itate bone. Above it on the medial side of the bone is a facet for ar
lateral part with the tubercle of the scaphoid (tuberculum ossis sca ticulating with the lunate bone. The inferolateral periphery of the
phoidei). scaphoid bone bears an articular facet for articulation with the tra
The dors.al surface occupies a narrow strip which is continuous pezium and trapezoid bones.
proximally with a superiorly convex facet articulating with the car-
THE LUNATE BONE

The lunate bone (os lunatum) (Fig. 136) is medial to the scaph capitate bone and another facet on its medial part for articulation
oid bone. Its superior (proximal) surface is convex and articulates with the hamate bone.
with the carpal articular surface of the radius. The lateral surface of the bone has an articular facet for articu
The inferior (distal) surface of the lunate bone is concave and lation with the scaphoid bone. The medial surface of the lunate
bears an articular facet on its lateral part for articulation with the bone articulates with the triquetral bone.
THE TRIQUETRAL BONE

The triquetral bone (os triquetrum) (Fig. 137) occupies the ex The lateral part of the triquetral bone has a flat articular facet
treme medial ('ulnar') position in the proximal row of the carpal for articulation with the lunate bone; the inferior slightly concave
bones. Its superior surface is convex and carries an articular facet surface articulates with the hamate bone, the palmar surface unites
for articulation with the distal part of the forearm. with the pisiform bone.
THE PISIFORM BONE
The pisiform bone (os pisiforme) (Fig. 138) is ovoid. It is related the pisiform bone carries a small articular facet by means of which
to the sesamoid bones (ossa sesamoidea) and is situated within the it articulates with the triquetral bone.
tendon of the flexor carpi ulnaris muscle. On the dorsal surface
THE TRAPEZIUM BONE
The trapezium bone (os trape;:_ium s. multangulum) (Fig. 139) is concave articular facets: a superior, larger, and an inferior, smaller.
distal to the scaphoid bone and occupies the extreme lateral ('ra The first is for articulation with the trapezoid bone, and the second
dial') position in the distal row of the carpal bones. Its superior for union with the base of the second metacarpal bone.
surface bears an articular facet for articulation with the scaphoid On the anterior (palmar) surface of the trapezium, in the la
bone. The inferior surface of the trapezium bone has a saddle teral part, is a small ridge called the tubercle, or crest of the tra
shaped articular facet which articulates with the base of the first pezium bone (tuberculum ossis trape;:_ii s. multanguli). Medially to it is
metacarpal bone. The medial part of the trapezium carries two a groove lodging the tendon of the flexor carpi radialis muscle.
THE TRAPEZOID BONE

The trapezoid bone (os trape;:_oideum) (Fig. 140) is located next culates with the scaphoid bone; the lateral, slightly convex surface
to the trapezium. Its inferior saddle-shaped articular surface unites unites with the trapezium bone, and the medial, concave surface
with the second metacarpal bone. articulates with the capitate bone.
The superior surface of the trapezoid bone is concave and arti-
('_
THE CAPITATE BONE

The capitate bone (os capita/um) (Fig. 141) is the largest of the itate bone articulates with the base of the third metacarpal bone by
carpal bones and carries a spherical head in the proximal part. The means of a flat articular facet; the lateral surfaces bear small arti
remaining part of the bone is rather thick. Its medial surface arti cular facets for articulating with the bases of the second and fourth
culates with the hamate bone; the lateral, slightly convex surface metacarpal bones.
articulates with the trapezoid bone. The inferior surface of the cap-
THE CARPAL BONES 135
THE HAMATE BONE

The hamate bone (os hamatum) (Fig. 142) is located next to the (hamulus ossis hamati). The proximal surface of the hamate bone ar
capitate bone and occupies the extreme medial ('ulnar') position in ticulates with the lunate bone, the lateral surface with the capitate
the distal row of the carpal bones. On its anterior (palrriar) surface bone, and the medial, slightly convex surface articulates with the
is a well-developed projection which is slightly curved laterally (in triquetral bone. The distal surface of the bone carries two articular
the 'ulnar' direction); it is called the hook of the hamate bone facets for articulation with the fourth and fifth metacarpal bones.
A B
141. Right capitate bone (os capitatum) (½).

Hamulus ossis hamati
Hamulus
ossis hamati
Hamulus ossis hamati
A B C
142. Right hamate bone (os hamatum) (½).

A-palmar surface; B-dorsal surface;
C-distal surface.
136 THE CARPUS, METACARPUS, AND DIGITS OF THE HAND
THE CARPUS
The carpus is formed by the bones described above and the ar eminence consisting of the pisiform bone and the hook of the ha
ticulations and ligaments which join them. mate bone.
The superior, or proximal border of the carpus faces the fore Some of the carpal bones are easily felt through the skin. The
arm bones and is more convex transversely. scaphoid bone, for instance, is felt a little below and to the back of
The superior, or distal border is relatively flat. The posterior, the lateral styloid process; the lunate bone is felt next to the sca
or dorsal surface of the carpus is convex. phoid on the dorsal surface of the carpus; the pisiform bone can
The anterior (palmar) surface of the carpus is concave and is be palpated when the hand is partly flexed at the wrist joint; the
called the carpal sulcus (sulcus carpi). The sulcus is bounded later capitate bone is felt on the dorsal surface of the carpus, better in
ally by the radial carpal eminence formed by the tubercles of the flexion at the wrist.
scaphoid and trapezium bones and medially by the ulnar carpal
THE METACARPAL BONES

The metacarpal bones (ossa metacarpalia) (Figs 111, 132-134) means of which two adjacent bones articulate. The surface facing
are five small tubular bones. They are numbered in sequence from the carpal bones bears a facet for articulation with the carpal
the lateral (radial) to the medial (ulnar) border of the hand. bones forming the distal row. The articular surfaces of the first and
A shaft (body) and two ends, upper and lower, are distin fifth metacarpal bones are saddle-shaped.
guished in each bone. The base of the third metacarpal bone has in its posterolateral
The shaft (corpus) has three surfaces: posterior (dorsal), lateral part the styloid process of the third metacarpal bone (processus sty
(radial), and medial (ulnar). The lateral and medial surfaces are loideus medius s. processus styloideus ossis metacarpalis tertii).
separated by a small ridge bearing a nutrient foramen (foramen nu The lower (distal) end of a metacarpal bone is the rounded
tricium) which is continuous with a nutrient canal (canalis nutricius). head (caput). Its sides are rough.
The canal in the second to fifth metacarpal bones runs proximally, The shaft and head of the metacarpal bone are easily felt
while the canal in the first metacarpal extends distally. through the skin on the dorsal surface.
The shaft of the metacarpal bones has a palmar concavity. The spaces between the metacarpal bones are called interosse
The upper (proximal) end of a metacarpal bone is called the ous spaces of the metacarpus (spatia interossea metacarpi).
base (basis) and is thick. It carries on its sides articular facets by
THE BONES OF THE DIGITS OF THE HAND
The bones (phalanges) of the digits of the hand (ossa digitorum phalangis) is thick and carries an articular facet. The facets of the
manus) (Figs 132-134) are small and tubular. The thumb has two proximal phalanges articulate with the carpal bones, those of the
phalanges, proximal (phalanx proximalis) and distal (phalanx dista middle and distal phalanges are separated by a small ridge into
lis). In addition to the proximal and distal phalanges, all the other two parts for articulation of one phalanx with the other.
fingers have a middle phalanx (phalanx media). A shaft and two The lower (distal) end of the proximal and middle phalanges
ends, upper (proximal) and lower (distal), are distinguished in carries a head (caput phalangis).
each phalanx. The lower (distal) end of the distal phalanx bears on its dorsal
The shaft, or body (corpus) of a phalanx has a flat palmar sur surface a tuberosity (tuberositas phalangis distalis).
face which is bounded on the sides by small ridges and bears a nu Sesamoid bones are lodged in the muscle tendons on the pal
trient foramen {foramen nutricium) which is continuous distally with mar surface in the region of the metacarpophalangeal joints of the
a nutrient canal (canalis nutricius). thumb and index and little fingers and the interphalangeal joint of
The upper (proximal) end, or the base of the phalanx (basis the thumb.
OF THE BONES OF THE UPPER LIMB
The bones of the upper limbs, except for the clavicle, develop the other appears at 6 to 9 years and gives rise to the distal epiphy
as secondary bones (see Figs 3 and 142a). The scapula develops sis. All parts fuse with the shaft by the age of 18 to 22 years.
from one main or primary ossification nucleus and from 6 or The radius develops from four ossification centres, one is a pri
sometimes 8 secondary, or accessory nuclei. The main nucleus ap mary centre for the shaft, two are secondary centres for the proxi
pears in the centre of the future scapula at the end of the second mal and distal epiphyses, and the fourth is a secondary centre for
month of intrauterine development and gives rise to almost the the tuberosity of the radius. The fourth centre appears at the age
whole bone. The accessory nuclei appear at different periods be of 14 and fuses with the diaphysis by 18 years. The primary nu
tween the ages of 11 and 18 years and contribute to the formation cleus forms in the second month of intrauterine life, the proximal
of the processes, glenoid cavity, and the inferior angle and medial nucleus at the age of 5 or 6 years, and the distal nucleus appears at
border of the scapula. All parts of the scapula fuse completely at the age of 2 or 3. The proximal epiphysis joins the shaft between
the age of 20 to 24 years. the ages of 16 and 17, the distal epiphysis fuses with the shaft in
The clavicle is the first bone to begin ossification and the last the second year of life.
to be completely ossified. It forms from two ossification centres: The bones of the hand develop in the following manner. The
the main one gives rise to the greater part of the clavicle, the other eight carpal bones remain cartilaginous until birth. Each develops
gives origin to a small segment of the sternal end of the bone. The from its own ossification centre. Ossification of the separate bones
main ossification centres appear at the end of the first or the begin occurs in the following order: the capitate bone ossifies from an os
ning of the second month of the intrauterine period, the sternal sification centre in cartilage in the first year of life, the hamate
end of the bone develops later and its ossification begins at the age bone at the beginning of the second year, the triquetral bone at the
of 20-21 years. All parts of the clavicle fuse by the age of 23 or end of the second year, the lunate bone at the end of the fourth
24 years. year, the trapezium at the age of 5, the scaphoid in the middle of
The humerus develops from eight ossification centres, one the £if.th year, the trapezoid at the age of 6, and the pisiform bone
main, primary, and seven accessory, secondary centres. The pri ossifies between the ages of 8 and 10 years. All metacarpal bones
mary nucleus appears in the second month of the intrauterine pe develop in cartilage. Each bone has two ossification centres, one is
riod and gives origin to the whole shaft and the medial epicondyle. primary, diaphyseal, and the other is secondary, epiphyseal. The
All secondary nuclei appear after birth, three of them give rise to primary centres appear during the third month of intrauterine life
the proximal epiphysis, and the other four to the distal epiphysis. and give origin to the shaft and base (except for the first metacar
These secondary ossification nuclei appear in the first year of life pal bone whose shaft and head arise from the primary centre,
or much later (e.g. the nucleus of the lateral epiphysis appears by while the base forms from the secondary centre). The secondary
the age of 11 years), the proximal a little earlier than the distal ossification centres appear at the age of 3-4-5 years; the epiphyses
nuclei; secondary ossification nuclei appear earlier in girls than in join the shaft at 14-16 years of age.
boys. The time of complete ossification also differs. The proximal Each phalanx develops in cartilage from two ossification nu
epiphysis and the shaft fuse at 20-25 years of age, the distal epi clei: primary and secondary (accessory). The primary, diaphyseal
physis fuses with the shaft by the age of 20. nucleus, gives rise to the shaft and head of the phalanx, the epi
The ulna develops from three centres. One is the primary os physeal nucleus gives origin to the base. The diaphyseal nucleus
sification centre which appears in the second month of the intra appears· in all phalanges at the end of the second or beginning of
uterine period and gives rise to the shaft of the bone. The other the third month of intrauterine life, the epiphyseal nucleus forms
two (sometimes three) are secondary centres. One appears at the at the age of 2 or 3. The ossification nuclei fuse between the ages
age of 8 to 12 years and gives origin to the proximal epiphysis and of 16 and 20.
138 BONES OF THE UPPER LIMB OF THE NEWBORN
�- . .. 1 - - -!l
'�·--�
/ '
\- \'
I
I
4 5
142a. Bones of right upper limb

(ossa membri superioris) of the newborn.
1-clavicle 4-radius
2-scapula 5-ulna
3-humerus 6-bones of hand (ossa manus)
THE BONES OF THE LOWER LIMB
Ossa membri inferioris
The bones of the lower limb (ossa membri inferioris) (Fig. 143) are divided into bones forming the girdle
of the lower limb, or the pelvic girdle (cingulum membri inferioris) including the hip bones (ossa coxae), the ske
leton of the free lower limb (skeleton membri inferioris /ijeri) which is represented by the femur in the thigh,
the tibia and fibula in the leg, and by the tarsal bone (ossa tarsalia) and metatarsal bone (ossa metatarsalia),
and the phalanges of the digits of the foot (ossa digitorum pedis).
THE BONES OF THE PELVIC

GIRDLE
Both hip bones are joined anteriorly by means of a fibrous cartilage and posteriorly to the sacrum to
form a strong ring of bone, the pelvis. Hence the name pelvic girdle.
THE HIP BONE

The hip bone (os coxae) (Figs 143, 144-146) is a composite means of cartilage to the age of 16-17 years. The cartilage ossifies
bone consisting of three separate bones in early childhood; the il later and the lines of their junction are not seen.
ium (os ilium), the ischium (os ischii), and the pubis (os pubis). In the The acetabulum is bounded by a thick edge which 1s mter
adult these three bones fuse to form the single hip bone (os coxae). rupted in the anteroinferior part by the acetabular notch {incisura
The bodies of these bones unite to form the acetabulum on the acetabuli).
lateral surface of the hip bone. Medially to this edge the internal surface of the acetabulum
The ilium forms the superior part, the ischium the posteroinfe carries a smooth articular lunate surface (facies lunata) which
rior, and the pubis the anteroinferior part of the acetabulum. In bounds the acetabular fossa (Iossa acetabuli) located on the floor of
the process of development independent ossification points appear the acetabulum.
in each of these bones, as a result of which they are joined by
THE ILIUM
The ilium (os ilium) (Figs 144-149) is the largest hip bone. Its of the body bears the arcuate line (linea arcuata) above which is the
lower end is thick and is called the body of the ilium (corpus ossis wide flat part of the bone known as the ala of the ilium (ala ossis il
illi); it forms the upper part of the acetabulum. The medial surface lii).
140 THE BONES OF THE LOWER LIMB
Os sacrum
Ossa metatarsalia �:::,',,,f+-,jU::?-11

Ossa digitorum
pedis
143. Bones of right lower limb (ossa membri infe

rioris); anterior aspect (¼).
THE HIP BONE 141
Fossa iliaca
i
Os ilium
Ala ossis ilii
Crista iliaca
/
1/,
Spina iliaca Spina iliaca

anterior superio� posterior
superior
Spina iliaca
anterior inferior
Ramus superior Incisura ischiadica

ossis pubis minor
Tuberculum obturatorium
posterius
Facies symphysialis
Ramus inferior ossis pubis
144. Right hip bone (os coxae); medial aspect (½).

142 THE HIP BONE
Labium extern um cristae iliacae
t
s\ilii
. :s;
Os ;�
Linea glutaea posterior
Spina iliaca __..,...._""-

posterior superior
Linea glutaea mfenor

Facies lunata----j:----
Tuberculum obturatorium
anterius
Ramus ossis ischii
145. Right hip bone (os coxae); lateral aspect (½).

THE HIP BONE 143
Crista iliaca
Spina iliaca
anterior superior
Tuber ischiadicum
Ramus
Os ischii ossis ischii
146. Right hip bone (os coxae); anterior aspect(½).

144 THE HIP BONE
The lower part of the ala adjoining the body is narrow, the up The lateral surface of the ala ilii is called the gluteal surface
per part is wide. The border of the upper part is thick and carries (facies glutea) and bears marks of the origin of the gluteus muscles,
three rough lines, or lips: the outer lip (labium externum), the inner namely the posterior, anterior, and inferior gluteal lines.
lip (labium internum), and an intermediate area (Linea intermedia) be The posterior gluteal line (Linea glutea posterior) is in front of the
tween them; these lines give attachment to muscles. The upper pe posterior superior iliac spine and runs from the outer lip of the il
ripheral border of the ala is called the iliac crest (crista iliaca). It is iac crest to the base of the superior inferior iliac spine.
S-shaped and terminates anteriorly as a projection which is easily The middle gluteal line (Linea glutea anterior) arises from the an
felt through the skin and is called the anterior superior iliac spine terior superior iliac spine, stretches backwards and curves down
(spina iliaca anterior superior). Posteriorly the crest ends as the poste wards to reach the superior margin of the greater sciatic notch.
rior superior iliac spine (spina iliaca posterior superior). The ·inferior gluteal line (Linea glutea inferior) passes above the
Below the anterior superior spine the anterior end of the ala superior margin of the acetabulum.
has an iliac, or lunate notch which is limited below by the anterior The medial surface of the ala ilii is smooth and slightly con
inferior iliac spine (spina iliaca anterior inferior). Below the spine the cave in the anterior part and is called the iliac fossa (Iossa iliaca).
border of the bone curves to the front and reaches the iliopubic The inferior margin of the fossa is limited by the arcuate line.
eminence (eminentia iliopubica) which marks the junction of the In the posterior part of the medial surface of the ala, above the
body of the ilium and the pubis. Below the posterior superior iliac greater sciatic notch, is the auricular surface (facies auricularis)
spine the posterior border of the ala carries the posterior inferior bounded in front and below by the paraglenoid sulcus. To the
iliac spine (spina iliaca posterior inferior) where the greater sciatic back of and above the auricular surface is the iliac tuberosity (tu
notch (incisura ischiadica major) arises; the body of the ilium contri berositas iliaca).
butes to its formation.
THE ISCHIUM
The ischium (os ischii) (Figs 144-149) is made up of two parts: minor) is on the posterior surface of this part below the ischial
a body (corpus ossis ischii) and a ramus (ramus ossis ischii) which is spine. The anterior border of this portion of the ramus bears in its
curved at an angle. superior part the posterior obturator tubercle (tuberculum obturator
The body of the bone forms the posteroinferior part of the ace ium posterius). A thickened area with a rough surface is located on
tabulum. On the posterior surface of the body is a bony projection the posteroinferior aspect of the curved segment of the ramus; it is
called the ischial spine (spina ischiadica). Above and to the back of called the ischial tuberosity (tuber ischiadicum). The inferior part of
the spine is the greater sciatic notch (incisura ischiadica major). The the ramus fuses anteriorly with the inferior pubic ramus (ramus in
body of the bone is continuous downwards with the upper part of ferior ossis pubis).
the ramus of the ischium. The lesser sciatic notch (incisura ischiadica
THE PUBIS
The pubis (os pubis) (Figs 144-149) is made up of three parts: a terior part it carries the anterior obturator tubercle (tuberculum ob
body (corpus ossis pubis) and two rami: superior (ramus superior ossis turatorium anterius). The superior ramus is continuous anteriorly
pubis) and inferior (ramus inferior ossis pubis). with the inferior ramus at an angle.
The body of the pubis forms the anterior part of the acetabu On the medial surface of the pubis is a rough symphyseal sur
lum and is continuous directly with the superior ramus extending face (facies symphysialis).
forwards, downwards, and medially. The pubic rami together with the ischium limit the obturator
The superior edge of this ramus is sharp and is called the pecti foramen (foramen obturatum). The superior edge of this foramen is
neal line (pecten ossis pubis). Its anterior end is the pubic tubercle grooved from back to front and medially by a wide obturator
(tuberculum pubicum). The inferior edge of the superior ramus is groove (sulcus obturatorius) lodging the obturator vessels and nerve.
sharp and is called the obturator crest (crista obturatoria). In its an-
THE PELVIS 145
THE PELVIS
The pelvis (see Figs 147-149, 150-153) is formed by the two brae and the base of the sacrum. The arcuate line of tbe pelvis
hip bones, the sacrum, the coccyx, and the interpubic cartilage. (linea terminalis) is the inferior boundary of the false pelvis. It runs
They are joined by joints, ligaments, and two obturator mem on the crest of the pubis, then on the arcuate line of the ilium, and
branes to form a strong bony ring. A greater (or false) and a lesser passes on the promontorium to the contralateral side where it
(or true) pelvis are distinguished. stretches in a like manner.
The false (greater) pelvis (pelvis major) is bounded on the sides The true (lesser) pelvis (pelvis minor) is below the arcuate line.
by the alae of the ilium and posteriorly by the lower lumbar verte- Its lateral walls are formed by the lower part of the bodies of the
147. Male pelvis; anterior aspect (¾).

146 THE PELVIS
ilia and the ischia, the posterior wall by the sacrum and coccyx, ties, posteriorly by the coccyx, and anteriody by the pubic symphy
and the anterior wall by the two pubic bones. sis and the inferior pubic rami.
The inferior pubic rami meet to form the subpubic angle (an The pelvis contains the organs of the alimentary and urogeni
gulus subpubicus) in the male and the pubic arch (arcus pubis) in the tal systems, large vessels and nerves. Its shape and dimensions are
female. marked by individual features and sexual differences.
The junction of the false pelvis and the true pelvis, marked by The line connecting the middle points of the straight diameters
the arcuate line, is the superior aperture (inlet) of the pelvis (aper of the pelvic inlet and outlet is called the axis of the pelvis (axis pel
tura pelvis superior). The inferior aperture (outlet) of the pelvis vis) (Fig. 153). It forms an anterior concavity and runs parallel to
(apertura pelvis inferior) is limited laterally by the ischial tuberosi- the pelvic surface of the sacrum.
_______ Pelvis maior -----------
ACOcola"o �,rn,�ac• \
148. Female pelvis; anterior aspect (¾).

THE PELVIS 147
MEASUREMENTS OF THE PELVIS
FEMALE MALE
GREATER (FALSE) PELVIS

Interspinous diameter (distance between both anterior superior iliac spines) 23-25cm less by 2-3cm
Intercristal diameter (greatest distance between both iliac crests) 25-27cm
LESSER (TRUE) PELVIS
Inlet (apertura pelvis superior)
Anteroposterior diameter, or anatomic conjugate (diameter recta seu conjugata anatom
ica) (distance between promontorium and superior edge of symphysis) 11.5cm 10.8cm
Conjugate obstetric diameter (conjugata vera s . gynecologica) (distance between pro
montorium and most posteriorly prominent point of symphysis) 10.5-11cm
Conjugate diagonal diameter (conjugata diagonalis) (distance between promontorium
and inferior edge of symphysis) 12.5-13cm
Transverse diameter (diameter transversa) (greatest distance between both terminal
lines) 13.5cm 12.8cm
Oblique diameter (diameter obliqua) (distance between sacroiliac joint on one side and
iliopubic eminence on the other) 12-12.6cm 12-12.2cm
Pelvic cavity (cavum pelvis)
Anteroposterior diameter (diameter recta) (distance between articulation of second and
third sacral vertebrae and middle of symphysis) 12.2cm 10.8cm
Transverse diameter (diameter transversa) (distance between centres of acetabula) 11.5cm 10.8cm
Outlet (apertura pelvis inferior)
Diameter recta (distance between apex of coccyx and inferior edge of symphysis) 9.5cm 7.5cm
Diameter recta (distance between ischial tuberosities) 10.8cm 8.1cm
INCLINATION OF PELVIS (INCLINATIO PELVIS) IS MEASURED BY THE ANGLE
FORMED BY HORIZONTAL PLANE AND PLANE OF PELVIC INLET 55-60° 50-55°
COMPARATIVE SEX FEATURES OF PELVIS
FEMALE MALE
General appearance of pelvis Wider and shorter Narrower and higher

Position of alae of ilii More horizontal More vertical
Sacrum Shorter and wider Narrower and longer
Angle at junction of inferior pubic rami 90-100° 70-75°
(pubic arch) (subpubic angle)
Shape of cavity of true pelvis Cylindrical Conical
Shape of superior aperture, or inlet of true pelvis More rounded 'Card heart' due to marked projection of
(apertura pelvis superior) the promontory forwards
148 THE PELVIS
149. Female pelvis; anterior aspect (radiograph).

]-sacrum 11-ischial tuberosity
2-ala of ilium 12-lower part of ischial ramus
3-ilium 13-inferior ramus of pubis
4-acetabulum 14-pubic arch
5-head of femur 15-ischium
6-neck of femur 16-femur
7-greater trochanter 17 -·obturator foramen
8-coccyx 18-pubis
9-superior ramus of pubis 19-anterior sacral foramen
10-upper part of ischial ramus 20-anterior superior iliac spine
THE PELVIS 149
Articulatio
Fossa iliaca dextra sacroiliaca dextra
150. Male pelvis (pelvis masculinum); superior aspect (¾).

(Superior aperture, or inlet of pelvis.)
150 THE PELVIS
Fossa iliaca
Spina
ischiadica
Pecten
Tuberculum
pubicum
151. Female pelvis (pelvis femininum); superior aspect (¾).

(Superior aperture, or inlet of pelvis.)
THE PELVIS 151
152. Diameters of superior aperture (inlet) of pelvis (¾).

152 THE PELVIS
<;:onjugata anatomica
Diameter recta
(of pelvic cavity) / ',
I '
I
I
I
I
I
/. Inclinatio ·:,
'6ooY p�lvis � • . '·
L __j__________________ ..
153. Diameters of true (lesser) pelvis (¾).

THE SKELETON OF THE
FREE LOWER LIMB
THE FEMUR
The femur (see Figs 143; 154-157, 159) is the longest and face of the femur from the tip of the greater trochanter downwards
thickest tubular bone in the human skeleton. A body (shaft) and and medially and is continuous with the spiral line. The trochan
two ends, upper and lower, are distinguished in it. teric crest (crista intertrochanterica) runs in the same direction but on
The body (shaft) of the femur (corpus femoris) is cylindrical, the posterior surface of the proximal end and terminates at the
slightly twisted about the axis and cuived forwards. Its anterior lesser trochanter (trochanter minor) situated on the posteromedial
surface is smooth, the posterior surface carries a rough linea as surface of the proximal end of the bone. The rest of the proximal
pera which gives attachment to muscles. The line is divided into end of the femur projects upwards and medially and is called the
two lips, lateral and medial. The lateral lip (labium laterale) deviates neck of the femur (collumfemori.i); it terminates as a spherical head
laterally in the lower third of the bone and passes to the lateral of the femur (caput femoris). The neck is slightly flattened in the
condyle; in the upper third it is continuous with the gluteal tuber frontal plane. It meets the shaft of the bone at an angle of about
osity (tuberositas glutea). The medial lip (labium mediale) deviates in 90 ° in females and at a larger angle in males. The head carries on
the lower third of the femur towards the medial condyle and to its surface a small rough pit called the fossa of the head of the
gether with the lateral lip limits a triangular popliteal surface (fa femur (fovea capitis femoris) where the ligament of the head is at
cies poplitea). In the upper part the medial lip is continuous with tached; the rest of the surface is smooth.
the spiral line {Linea pectinea). Approximately in the middle part of The lower, or distal end of the femur (extremitas inferior s. epi
the shaft, to the side of the linea aspera is a nutrient foramen (for physis distalis femoris) is thick and wide and terminates as two con
amen nutricium) which leads into a proximally running nutrient dyles, medial and lateral (condylus media/is et condylus lateralis). The
canal (canalis nutricius). medial condyle is larger than the lateral one. The lateral surface of
The upper, or proximal end of the femur (extremitas superior, s. the lateral condyle and the medial surface of the medial condyle
epiphysis proximalis femoris) carries two rough prominences at the carry, respectively, the lateral epicondyle (epicondylus lateralis) and
junction with the shaft. These are the greater and lesser trochan the medial epicondyle (epicondylus medidlis). The surfaces of the two
ters. condyles facing each other are limited by the intercondylar notch
The greater trochanter (trochanter major) projects upwards and (Iossa intercondylaris) which is separated above from the popliteal
backwards and occupies the lateral part of the proximal end of the surface by the intercondylar line (Linea intercondylaris). The surfaces
bone. Its lateral surface can be easily felt through the sk.in, the me of both condyles are smooth and fuse to form the patellar surface
dial surface carries the trochanteric fossa (Iossa trochanterica). The (facies patellaris) for articulation of the patella with the femur.
trochanteric line {Linea intertrochanterica) runs on the anterior sur-
THE PATELLA
The patella knee cap (see Figs 143, 158, 159) is the largest ses base (basis patellae). The inferior border projects slightly to form
amoid bone of the skeleton. It is located in the tendon of the quad the apex of the patella (apex patellae).
riceps femoris muscle and can be easily felt through the skin. The anterior surface (facies anterior) of the bone is rough. The
When the limb is extended at the knee the patella is easily moved posterior, articular surface (facies articularis) is divided by a vertical
to the sides, upwards, and downwards. ridge into a smaller medial part and a larger lateral part. This sur
The superior border of the patella is rounded and is called the face articulates with the patellar surface of the femur.
154 THE FEMUR
Caput femoris --
'
major
Crista intertrochanterica
�
\' {:
Trochanter minor - /-:":..:f,
�-, .
Trochanter minor
-l•
Tuberositas
glutaea
' I ,
Linea pectinea -
II
1
Facies anterior
Corpus femoris-
Labium mediate ___ /
lineae asperae /
l Labium laterale
lineae asperae
1,
Linea intercondylaris
Fossa
intercondylaris
Epicondylus Epicondylus
lateralis medialis Condylus lateralis
Facies patellaris
154. Right femur; 155. Right femur;

anterior aspect (½). posterior aspect (½).
THE FEMUR 155
Fovea capitis -....1,..-,.r-,

femoris
Fossa
Collum femoris trochanterica
minor
Epicondylus lateralis Epicondylus medialis
Facies patellaris
Linea aspera
Condylus lateralis Condylus medialis
Condylus lateralis
Epicondylus Condylus
medialis medialis
156. �itht femur; medial 157. Distal end of right femur; inferior aspect
aspect(½). (½).
156 THE PATELLA, TIBIA AND FIBULA
Basis patellae
____.__ Facies
articularis
Apex patellae
Apex patellae
A B
158. Right patella (¾).

A-anterior aspect; B-posterior aspect.
159. Distal end of right femur and proximal

parts of right tibia and fibula (radiograph).
I-femur
2-medial epicondyle of femur
3-patella
4-medial condyle of femur
5-medial intercondylar tubercle
6-medial condyle of tibia
7 -intercondylar eminence
8-tibia
9-fibula
JO-head of fibula
11-lateral condyle of tibia
12-lateral intercondylar tubercle
13-intercondylar notch
14-lateral condyle of femur
15-lateral epicondyle of femur
THE TIBIA AND FIBULA 157
THE BONES OF THE LEG
l
The tibia, located medially, and the fibula, located laterally, are
the bones of the leg (Fig. 160).
Condylus lateralis
tibiae
Condylus medialis
Apex capitis - • •
fibulae ··
� 1,
THE TIBIA
Tuberositas tibiae
The tibia (see Figs 143, 159-163, 165) is a long tubular bone.
It has a body (shaft) and two ends, upper and lower.
The body (shaft) of the tibia (corpus tibia) is trihedral. It has
three borders: anterior, interosseous (lateral), and medial, and
three surfaces: medial, lateral, and posterior.
The anterior border (margo anterior) is tapered like a ridge and
in the upper part of the bone is continuous with the tubercle of the
tibia (tuberositas tibiae). The interosseous border (margo interosseus)
Facies lateralis -
is sharp and faces the interosseous border of the fibula. The me
dial border (margo media/is) is rounded. The medial, or anterome
dial surface of the bone (facies medialis) is slightly convex. Like the Margo anterior --
anterior border limiting it the medial surface can be easily felt
Fibula --
through the skin.
The lateral, or anterolateral surface of the bone (facies lateralis) Margo interosseus
is slightly concave. The posterior surface (facies posterior) is flat and
bears the soleal line (linea musculi solea) running from the lateral
condyle downwards and medially. Below it is the nutrient foramen
(foramen nutricium) leading into the distally stretching nutrient
canal (canalis nutricius).
The upper, or proximal end of the tibia (extremitas superior s.
epiphysis proximalis tibiae) is expanded. Its sides are called the me
dial condyle (condylus media/is) and the lateral condyle (condylus la
teralis). The lateral aspect of the lateral condyle carries a flat fibu
lar articular surface (facies articularis fibularis). In the middle of the
proximal surface of the upper end of the bone is the intercondylar
eminence (eminentia intercondylaris). Two tubercles are distin
guished in it, the medial intercondylar tubercle (tuberculum inter
condylare mediale) to the back of which is the posterior intercondy
lar area (area intercondylaris posterior) and the lateral intercondylar
tubercle (tuberculum intercondylaris laterale) in front of which is the
anterior intercondylar area (area intercondylaris anterior). Both areas
give attachment to the cruciate ligaments of the knee. To both
sides of the intercondylar eminence the superior articular surface
of the bone (facies articularis superior) carries two concave articular
surfaces, medial and lateral, corresponding to the condyles. These
surfaces are limited on the periphery by the infra-articular border
of the tibia. Malleolus lateralis
The lower, or distal end of the tibia (extremitas inferior s. epiphy
sis distalis tibiae) is quadrangular. On its lateral surface is the fibu
lar notch (incisura fibularis) which receives the lower end of the
fibula. The groove for the tibialis posterior muscle (sulcus malleola
ris) is situated on the posterior surface of the distal end of the 160. Right tibia and fibula;
bone. In front of the groove the medial border of the distal end of anterior aspect (¾).
158 THE TIBIA
Eminentia
intercondylaris
Facies
articularis Tuberositas tibiae
fibularis
Linea m.
Facies posterior __ l j Facies Iateralis
.
Margo mterosseus -
I
I '
I
\ Margo anterior
Margo medialis 1
Tncisura fibularis
Malleolus Malleolus medialis

medialis
161. Right tibia; 162. Right tibia;

posterior aspect (¾). lateral aspect (¾).
THE FIBULA 159
Area intercondylaris
posterior
Eminentia intercondylaris
superior
Tuberculum
Tuberculum
intercondylare__._______ ,-,-----�f- intercondylare
mediale
laterale
-----.11--Facies articularis
superior
Tuberositas tibiae
163. Proximal end of right tibia; superior aspect (¾).
the tibia is continuous downwards with the prominent medial facet (facies articularis malleoli) which extends to the inferior surface
malleolus (malleolus media/is) which is easily felt through the skin. of the bone where it is continuous with the concave inferior articu
The lateral surface of the malleolus is occupied by the articular lar surface (facies articularis inferior tibiae) (Fig. 165).
THE FIBULA
The fibula (see Figs 143, 159, 160, 164, 165) is a long and thin border (margo interosseus) is on the anterior surface of the bone.
tubular bone. It has a body and two ends, upper and lower. The upper, or proximal end of the fibula (extremitas superior s.
The body (shaft) (corpus.fibulae) is trihedral, prismatic in shape. epiphysis proximalisfibulae) forms the head (caputfibulae). The upper
It is twisted about the longitudinal axis and curved to the back. end of the head tapers and is called the styloid process of the
The three surfaces of the bone. the lateral (facies lateralis), anterior fibula or the apex of the head (apex capitis fibulae).
(fades medialis), and posterior (facies posterior), are separated one The lower, or distal end of the fibula (extremitas inferior s. epi
· from another by three borders, or crests. The anterior border physis distalisfibulae) forms the lateral malleolus (malleolus lateralis).
(margo anterior) is the sharpest and separates the lateral surface The lateral surface of the malleolus is easily felt through the skin.
from the medial one; the medial crest (crista media/is) is between The medial surface bears an articular facet of the lateral malleolus
the posterior and medial surfaces of the bone. The posterior sur (facies articularis malleoli) by means of which the fibula articulates
face carries a nutrient foramen (foramen nutricium) leading into a with the lateral surface of the talus, and above the facet is a rough
distally running nutrient canal (canalis nutricius). The interosseous area for articulation with the fibular notch of the tibia.
160 THE FIBULA
Apex capitis
Facies fibulae
�-.
articularis _____;;tl1'"
capitis fibulae
Caput fibulae Caput
fibulae
\l'f, ·.
I\
! \
·I Margo I J
interosseu_s __
Facies
medialis
Facies lateralis_
Crista �
medialis
Margo posterior
Facies medialis ii
· Margo interosseus
Facies posterior
Margo anterior-
Margo
posterior
Margo
Foramen nutricium anterior--,
Facies lateralis
'
I
+t tl�
• ,i,(
''It,
Malleolus
lateralis Facies
Malleolus articularis Malleolus
lateralis malleoli lateralis
A B C
164. Right fibula (¾).

A-anterior aspect; B-posterior aspect; C- medial aspect.
THE BONES OF THE FOOT 161
Tibia
Malleolus_ Malleolus
lateralis medialis
Facies articularis
malleoli
165. Distal ends of right tibia and fibula;

inferior aspect (¾).
THE BONES OF THE FOOT

The bones forming the tarsus of the foot (see Figs 143, lateral). The metatarsus is formed of five metatarsal bones. The
166-179) are as follows: the talus, calcaneum, navicular bone, cu phalanges of the digits are named like those of the hand.
boid, and the three cuneiform bones (medial, intermediate, and
THE TARSAL BONES
The tarsal bones (ossa tarsi) (see Figs 143, 166-170) are ar- cuneiform bones. The bones of the tarsus articulate with the leg
ranged in two groups: proximal, formed by the talus and calca- bones, the distal row articulates with the metatarsals.
neum, and distal, composed of the navicular, cuboid, and three
THE TALUS
The talus (Fig. 171) is the only bone of the foot that articulates The lateral and medial malleolar facets are flat. The lateral
with the leg bones. Its posterior part, the body (corpus tali), is con malleolar facet continues onto the superior surface of the lateral
tinuous forwards with a constricted part called the neck (collum tubercle of the talus (processus lateralis tali) located in the lower part
tali). The neck joins the body with the anteriorly directed head of of the lateral surface of the bone. On the posterior surface of the
the talus (caput tali). The bones of the leg embrace the talus from talus passes obliquely a groove for the flexor hallucis longus ten
above and on the sides like a fork. A joint forms between the leg don (sulcus tendinis musculi jlexoris hallucis longi). The groove divides
bones and the talus, for which purpose the upper surface of the the posterior border of the bone into two tubercles, a larger medial
body of the talus bears an articular pulley-shaped area called the tubercle (tuberculum mediale) and a smaller lateral tubercle (tubercu
trochlea (trochlea tali). On the sides of the body are the lateral and lum laterale). Both tubercles and the groove between them form the
medial malleolar facets-the malleolar facet of the lateral surface posterior tubercle of the talus (processus posterior tali). Sometimes
and the malleolar . facet of the medial surface of the talus (facies the lateral tubercle of the posterior process occurs as a separate os
malleolaris lateralis et facies malleolaris medialis). The surface of the trigonum.
trochlea is convex sagittally and concave transversely. In the posterolateral part the lower surface of the body carries
162 THE BONES OF THE FOOT
a concave posterior calcanean facet (facies articularis calcanea poste By means of the facets the lower part of the talus articulates
rior). The anteromedial parts of this surface are bounded by the with the calcaneum. The head of the talus (caput tali) is slightly
groove of the talus (sulcus tali) which stretches forwards and late compressed from top to bottom. Its anterior part carries a spheri
rally. In front and lateral of this groove is the middle calcanean cal navicular facet (facies articularis navicularis) for articulation with
facet (facies articularis calcanea media), in front of which is the ante the navicular bone.
rior calcanean facet (facies articularis calcanea anterior).
THE CALCANEUM
The heel bone, or calcaneum (calcaneus s. os calcis) (Figs a small peroneal tubercle (trochlea fibularis) to the back of which
172-174) is below and to the back of the talus. Its posteroinferior stretches the groove for the tendons of the peroneus muscles (sulcus
part is called the posterior surface of the calcaneum (tuber calcanei). tendinus musculi fibularium).
The inferior parts of this surface on the lateral and medial sides A large posterior facet for the talus (facies articularis talaris poste
are continuous, respectively, with the lateral tubercle of the calca rior) is located in the middle of the upper surface of the calca
neum (processus lateralis tuberis calcanei) and the medial tubercle of neum. To the front of it is a groove of the calcaneum (sulcus calca
the calcaneum (processus media/is tuberis calcanei). nei) running from back to front and laterally. Still more to the
The anterior surface of the calcaneum carries a saddle-shaped front, on the medial border of the bone, are two articular surfaces.
facet for the cuboid (facies articularis cuboidea) for articulation with One is the middle facet for the talus (facies articularis talaris media)
the cuboid bone. and the other, anterior to it, is the anterior facet for the talus (facies
In the anterior part of the medial surface of the calcaneum is a articularis talaris anterior), which fit into the respective facets on the
short and thick process called the sustentaculum tali. A groove for talus. When the talus is fitted to the calcaneum the anterior parts
the flexor hallucis longus tendon (sulcus tendinis musculijlexoris hallu of the groove of the talus and the groove of the calcaneum form a
cis longi) passes on its lower surface. pit called the sinus tarsi which is felt through the skin as a small
On the lateral surface of the calcaneum, in the anterior part, is depression.
THE NAVICULAR BONE
The navicular bone (os naviculare) (Fig. 175) is flat anteriorly On the lateral surface of the body is a small facet for articula
and posteriorly. On its posterior surface it carries a concave facet tion with the cuboid bone. The lower surface of the navicular bone
for articulation with the navicular facet of the head of the talus. is concave. In its medial part is the tuberosity of the navicular
The upper surface of the bone is concave. The anterior surface bone (tuberositas ossis navicularis) which can be easily felt through
bears three facets by means of which it articulates with the three the skin.
cuneiform bones. The facets are separated from one another by
small ridges.
THEBONESOF THEFOOT 163
:...._____ Calcaneus
Os metatarsale I (corpus)
Os metatarsale II
Phalanx proximalis-
Basis phalangis
Phalanx proximalis
Corpus phalangis
Caput phalangis
166. Bones of right foot (ossa pedis) (½).

(Dorsal surface.)
Sulcus tendinis
111. fibularis longi
Os cuneiforme laterale
Tuberositas ossis
metatarsalis V
Os cuneiforme mediale
Tuberositas ossis
metatarsalis I
Ossa sesamoidea
Phalanx distalis
167. Bones of right foot (ossa pedis) (¾).

(Plantar surface.)
168. Bones of right foot (radiograph).

I-tibia 9 and 10-sesamoid bone
2-talus 11-proximal phalanx of great toe
3-calcaneum 12-distal phalanx of great toe
4-tuberosity of navicular bone 13-fifth metatarsal bone
5-navicular bone 14-lateral cuneiform bone
6-medial cuneiform bone 15-tubercle of fifth metatarsal bone
7 -intermediate cuneiform bone 16-cuboid bone
8-first metatarsal bone 17-fibula
Trochlea tali
(facies superior trochleae)
Processus lateralis tali Sinus tarsi
Collum tali
Facies malleolaris lateralis Os naviculare
./ Os cuneiforme laterale
:I
Calcaneus
ossis cuboidei
Os cuboideum
Tuberositas ossis
Processus lateralis Trochlea fibularis metatarsalis V
tuberis calcanei
169. Bones of right foot (ossa pedis); lateral aspect (½).
Facies superior
trochlea tali
Facies malleolaris
medialis Processus posterior tali
Os naviculare
Os metatarsale I
ossis navicularis
Sustentaculum talis
Phalanx distalis Processus medialis

tuberis calcanei
170. Bones of right foot (ossa pedis); medial aspect (½).

Facies articularis navicularis
Trochlea tali
Facies malleolaris - Facies malleolaris

medialis lateralis
Collum tali
Processus lateralis
tali Processus lateralis
tali
Facies articularis
calcanea posterior
Facies articularis
calcanea posterior
A B
171. Right talus (¼).

A-inferior aspect; B-posterior aspect.
Facies articularis cuboidea
Facies articularis
talaris media
Facies articularis
----1.a- talaris posterior
Sulcus tendinis m. flexoris
hallucis longi
Corpus calcanei
Processus lateralis
tuberis calcanei
Tuber calcanei
172. Right calcaneum;

superior aspect (¼).
Corpus calcanei
Facies articularis talaris

'"T °'
Facies articularis
talaris media
FaciP. � articularis ______..,...::._.__

talaris anterior
Facies articularis --, -

cuboidea
Processus medialis tuberis calcanei

anteromedial aspect (¼).
Facies articularis talaris media
Facies articularis
talaris posterior Sulcus calcanei
Tuber calcanei
Trochlea peronaealis (fibularis)

Sulcus tendinum
mm. peronaeorum (mm. fibularium)
Corpus calcanei
Processus
tuberis calcanei

posterolateral aspect (¼).
THEBONESOF THEFOOT 169
THECUNEIFORM BONES
The cuneiform bones (ossa cuneiformia) (Figs 176-178) are The medial cuneiform bone (os cuneiforme mediale) has two fac
three in number and wedge-shaped. They are located in front of ets on its lateral concave surface for articulation with the interme
the navicular bone. The intermediate cuneiform bone is shorter diate cuneiform bone and the second metatarsal bone.
than the other bones as a result of which the anterior (distal) sur The intermediate cuneiform bone (os cuneiforme intermedium)
faces of these bones are at different levels. They have facets for ar has a facet on the medial surface for articulation with the medial
ticulation with the respective metatarsal bones. cuneiform bone and a facet on the lateral surface for union with
The base of the wedge (the wider part) of the medial cuneiform the lateral cuneiform bone.
bone faces downwards, the bases of the intermediate and lateral The lateral cuneiform bone (os cuneiforme laterale) carries facets
bones face upwards. on the medial surface for articulation with the intermediate cunei
The posterior surfaces of the bones have facets for articulation form bone and base of the second metatarsal bone, and a facet on
with the navicular bone. the lateral side for articulation with the cuboid bone.
THECUBO ID BONE
The cuboid bone (os cuboideum) (Fig. 179) is placed outwardly Fig. 167) which passes over to the lower surface of the bone and
to the lateral cuneiform bone, in front of the calcaneum, and to crosses it obliquely from the posterolateral to the anteromedial
the back of the bases of the fourth and fifth metatarsal bones. areas, according to the passage of this tendon.
The upper surface of the bone is rough, the medial surface has The posterior surface of the bone bears a facet for articulation
facets for articulation with the lateral cuneiform and the navicular with a similar facet on the calcaneum.
bones. The lateral edge of the bone bears the tuberosity of the cu The anterior surface of the cuboid bone has facets which are
boid bone (tuberositas ossis cuboidei) (see Fig. 169) which faces separated by a ridge. They serve for articulation with the fourth
downwards. In front of it arises the groove for the tendon of the and fifth metatarsal bones.
peroneus longus muscle (sulcus tendinis musculus peronei longi) (see
.:�,. .-,'<·
��-�
�Tuberos1tas oss1s nav1culans
A B
175. Right navicular bone (os naviculare) (¾).

A-posterior aspect; B-anterior aspect.
A B
176. Right medial cuneiform bone (os cuneiforme mediale) (¾).

A-medial aspect; B- lateral aspect.
A B A B
177. Right intermediate cuneiform bone 178. Right lateral cuneiform bone
(os cuneiforme intermedium) (¾). (os cuneiforme laterale) (¾).
A-medial aspect; B- lateral aspect. A-medial aspect; B-lateral aspect.
A B C
179. Right cuboid bone (os cuboideum) (¾).

A-lateral aspect; B-medial aspect; C-posterior aspect.
THE METATARSAL BONES

The metatarsal bones (ossa metatarsalia) (Figs 143, 166-170) The posterior surfaces of the bases have facets for union with
are five thin tubular bones located in front of the tarsus. Each the tarsal bones. On the inferior surface of the base of the first
metatarsal bone has a body or shaft (corpus), the posterior, proxi metatarsal bone is a tubercle of the first metatarsal bone (tuberositas
mal end called the base (basis), and an anterior, distal end called ossis metatarsalis I). The lateral surface of the base of the fifth meta
the head (caput). tarsal bone also has a tubercle (tuberositas ossis metatarsalis V) which
The bones are numbered from the medial side of the foot, can be easily felt through the skin. The anterior ends, or heads, of
from the big toe to the little toe. The first metatarsal bone is short the metatarsal bones are flattened on the sides. The peripheral
er but thicker than the others. The second metatarsal is the long parts of the heads bear spherical articular surfaces for articulation
est. The bodies of the metatarsals are trihedral. The dorsal surface with the phalanges of the toes. The inferior surface of the head of
of the shaft is slightly convex, the two inferior plantar surfaces the first metatarsal bone carries on each side a small smooth area
meet downwards to form a ridge. for the sesamoid bones (ossa sesamoidea) of the big toe. The head of
The base is the most massive part of a metatarsal. It is wedge the first metatarsal is easily felt through the skin.
shaped and the expanded part of the first to fourth metatarsals In addition to the sesamoid bones in the first metatarsophalan
faces upwards, while that of the little toe faces medially. The sides geal joint, one sesamoid bone is found in the interphalangeal joint
of the bases carry facets for articulation of the metatarsals with one of the big toe, and occasional sesamoid bones are found in the
another. peroneus longus tendon on the plantar surface of the cuboid bone.
THE BONES OF THE DIGITS OF THE FOOT

The bones (phalanges) of the digits of the foot (ossa digitorum The heads of the proximal and middle phalanges are pulley
pedis) (see Figs 143, 16C-170) are similar to those of the hand'in shaped.
shape, number, and interrelationship. Each phalanx has a body The distal end of each distal phalanx carries a tuberosity (tuber
(shaft) (corpus phalangis), a posterior (proximal) end, or base (basis ositas phalangis distalis).
phalangis), and an anterior (distal) end, or head (caput phalangis).
OF THE BONES OF THE LOWER LIMB
The bones of the lower limbs develop as secondary bones (see 13. All centres fuse with the shaft at different periods ranging from
Figs 3, 179a). The hip bone develops from three primary centres 16-18 to 20-24 years of age.
(or points) of ossification and several (up to eight) secondary (ac The' fibula develops from three ossification centres. The pri
cessory) centres. The primary centres give rise to the ilium (which mary (diaphyseal) centre appears in the middle of the second
appears on the third month of the intrauterine period), the month of intrauterine life and gives origin to the shaft and areas of
ischium (on the fourth month) and the pubis (on the fifth month the epiphysis. The other two are secondary, epiphyseal, centres;
of intrauterine life); the secondary centres give origin to emi the lower one arises in the first year of life and the upper centre, at
nences, depressions, and borders of individual bones. In the region the age of 3-5 years. The lower epiphyseal centre of ossification
of the acetabulum the three bones are at first joined to one another fuses with the shaft at 17-20 and the upper ossification centre at
by layers of cartilage in which secondary ossification centres 19-21 years of age.
appear later (by the age of 16-18 years). All centres fuse at The bones of the foot develop in the following manner. The ta
20-25 years of age. The pelvis as a whole undergoes changes lus arises from one ossification centre which appears in the last
in size and shape for the most part. However, sexual features months of intrauterine life; ossification continues to the age of
characteristic of male and female adults begin differentiation 8 years.
from the age of 8-10 years. The pelvis is higher in boys but The calcaneum forms from two ossification centres: the main,
wider in girls. primary, centre appears on the sixth month of intrauterine life and
The femur develops from five ossification centres one of which the secondary centre by the age of 9 years and gives rise to the tu
is primary (diaphyseal) and four are secondary. The primary cen ber calcanei. The centres fuse by 16-18 years of age.
tre (which appears at the beginning of the second intrauterine The navicular bone develops from a single ossification centre
month) gives rise to the shaft of the bone. The secondary centres which appears at the age of 3-5 years.
of ossification appear in different periods: the centre for the distal Each cuneiform bone develops from its own ossification centre.
femoral epiphysis appears at the end of the intrauterine period; an The lateral bone begins ossification by the end of the first year of
ossification centre appears in the cartilaginous femoral head at the life, the intermediate bone at the age of 3, and the medial cunei
end of the first or beginning of the second year; the third centre form bone at the age of 3-4 years.
arises in the cartilage of the greater trochanter at the age of 3, and The cuboid bone develops from one ossification centre which
the fourth appears in the cartilage of the lesser trochanter at the usually appears before birth, less frequently at 3-6 months of age.
age of 8 years. All these bone structures fuse with the shaft of the Each of the five metatarsal bones develops from tw� ossifica
bone between the ages of 16 and 20. tion centres: a main, primary, and an accessory (secondary) centre.
The patella forms in cartilage from a single ossification centre The main centre appears in the second to fifth metatarsals at the
in the second year in girls and in the fourth year in boys and ossifi beginning of the third month of intrauterine life and in the first
cation is completed by the age of 16-20. bone at the end of this month; the secondary centres form by the
The tibia develops from four ossification centres. One is dia age of 4 years and fuse by the age of 17 in females and by the age
physeal and appears in the second month of intrauterine life. of 20 in males.
Three ossification centres are secondary among which the upper Each phalanx develops from two ossification centres. The main
epiphyseal point arises in the ninth month of intrauterine life, the centre appears between the third and ninth months of intrautrrine
lower epiphyseal centre during the first year of life, and the ossifi life, the secondary centre arises by the age of 4. Fusion occurs be
cation centre for the tuberosity of the tibia appears at the age of tween the ages of 15 and 20.
BONES OF THE LOWER LIMB OF A NEWBORN 173
\.,
I
3
(-\ r-;
2 6
179a. Bones ef right lower limb

(ossa membri inferioris)
of a newborn.
1-hip bone (os coxae) 4-tibia
2-femur 5-patella
3-fibula 6-bones of foot (ossa pedis)
THE
SCIENCE
OF THE
ARTICULATION
OF BONES
Arthrologia
The articulations, or joints, of bones are separated into two groups: fibrous joints (articulationes s. junctu
rae fibrosae) and synovial joints (articulationes synoviales). These two types of joints differ in the degree of mo
bility which they provide for the bones in the skeletal system and in the capacity for bearing mechanical
loads.
FIBROUS JOINTS
Fibrous joints (articulationes s. juncturae fibrosae) (Fig. 180) pro sutures which provide accurate and even apposition. Still another
vide for contiguous (uninterrupted) union of bones by means of type of suture is schindylesis (Gk schindylesis splintering) in which
various types of connective tissue-dense connective tissue, carti a plate of one bone fits into a groove in the other bone, as in the
laginous tissue or bony tissue. articulation between the sphenoid bone and the vomer (sutura
The group of fibrous joints formed by dense connective tissue sphenovomeriana).
includes syndesmoses, sutures, and gomphoses. Gomphoses, or peg-and-socket joints (articulationes dentoalveo
Syndesmoses are articulations in which the uniting compact lares) form when the roots of a tooth, which are surrounded by the
connective tissue forms ligaments. For example, the pterygospi periodontium, fit into the alveolar bone. The bands of dense con
nous ligament (ligamentum pterygospinale) arises from the spine of nective tissue hold the teeth in the sockets. With age the hold
the sphenoid bone and is attached to the pterygospinous process grows weaker and the teeth get loose (this is discussed in detail in
on the lateral plate of the pterygoid process; the stylohyoid liga Vol. II. The Digestive System).
ment (ligamentum stylohyoideum), a thin and long ligament arises Cartilaginous joints (articulationes cartilaginae) are a variety of
from the styloid process, runs downwards and to the front, and is fibrous joints formed by cartilaginous tissue. These are synchon
attached to the lesser horn of the hyoid bone, etc. Some ligaments droses and symphyses.
are rich in elastic fibres, e.g. ligamenta Jlava located between the Synchondroses are formed by continuous plates of cartilage
vertebral arches, ligamentum nuchae, etc. Syndesmoses are also that join the edges of the bones and restrict movements. There are
formed by wide ligaments uniting bones for a considerable dis many of them in the skeletal system of children and adolescents in
tance; these are the interosseous membranes of the forearm and whom they join some of the bones (e.g. the diaphyses with the
leg (membrana interossea antebrachii et membrana interossea cruris). The epiphyses of the long bones, one sacral vertebra with another, etc.).
fontanelles of the skull (fonticuli cranii), formed of primary connec These are temporary synchondroses in which the cartilage is re
tive tissue, are also included in the group of syndesmoses. placed by bone with age. Cranial synchondroses (spheno-occipital,
Sutures (suturae) unite the bones of the skull cap and the bones sphenopetrous, petro-occipital, posterior and anterior intraoccipi
of the face. They are formed by short bands of dense connective tal) and synchondrosis of the sternum (the articulation between
tissue running between the borders of neighbouring bones and the manubrium and xiphoid process) are permanent synchon
penetrating them. The sutures ossify with age due to replacement droses maintained in the skeletal system of an adult.
of the compact connective tissue by bony tissue. Symphyses are formed by a plate of fibrous cartilage which
According to the outline of the sutures and the ways in which contains a cavity. Such joints exist between the vertebral bodies,
the opposed surfaces of the bones are fitted to each other, the fol namely the intervertebral symphysis, or intervertebral disc (sym
lowing types of sutures are distinguished: serrated suture (sutura physis intervertebralis) (Fig. 181), the manubriosternal svmphysis
serrata), squamous suture (sutura squamosa), and flat suture (sutura (symphysis manubriosternalis) (Figs 180, 195), and the pubic symphy
plana). The bones of the skull cap are joined by squamous and ser sis {symphysis pubica) (Figs 180, 218).
rated sutures. The facial bones mostly articulate by means of flat
A
180. Fibrous joints (articulationes fibrosae).

1 -syndesmosis 2 -suture (sutura)
A-ligamentum flava A-serrate suture (sutura serrata)
B-interosseous membrane of leg (membrana B-squamous suture (sutura squamosa)
interossea cruris) C-plane suture (sutura plana)
FIBROUS JOINTS 179
3 -synchondrosis
A-of manubrium sterni (synchondrosis manubriosternalis)
B-of xiphoid process (synchondrosis xiphosternalis) 4-gomphosis
C-spheno-occipital (synchodrosis sphenooccipitalis) 5 -syrnphysis (syrnphysis pubica)
A
('
I D
F
G
180a. Types of synovial joints (½).

A-spheroid or ball-and-socket joint (articulatio spheroidea s. cotylica), shoulder joint (articulatio humeri);
B -variety of ball-and-socket joint, hip joint (articulatio coxae);
C-variety of hinge joint (ginglymus), talocrural joint (articulatio talocruralis);
D-ellipsoidal joint (articulatio ellipsoidea), radiocarpal joint (articulatio radiocarpea);
E -pivot joint (articulatio trochoidea), proximal radioulnar joint (articulatio radioulnaris proximalis);
F -hinge joint (ginglymus), interphalangeal joint (articulatio interphalangea);
G-saddle joint (articulatio sellares), carpometacarpal joint of thumb ( articulatio carpometacarpea pollicis).
SYNOVIAL JOINTS
Interrupted articulations of bones, or synovial joints (articula intracapsular ligaments are intra-articular in location but are
tiones synouiales) (Fig. 180a) are the most commonly encountered covered by the synovial membrane which separates them from the
type of articulations in the human body. They permit free move joint cavity.
ments. The joint is called simple (articulatio simplex), if it is formed The articular discs are pads of hyaline or fibrous cartilage
by two bones, and compound (articulatio composita) if it is formed wedged between the articular bone surfaces. They are attached to
by three or more bones. the articular capsule and divide the joint cavity into two compart
Each synovial joint has compulsory structural elements, in the ments. The discs increase the congruency of the articular surfaces
absence of which union of bones cannot be related to this group of and, consequently, the range and variety of movements. Besides,
joints, and accessory elements which determine the structural and they act as shock absorbers by reducing jolts and shaking during
functional distinctions of a synovial joint. movement. Such discs exist, for instance, in the sternoclavicular
The compulsory elements of a synovial joint are the articular and mandibular joints.
cartilages (cartilagines articulares) covering the articular surfaces (fa The articular menisci, or interarticular fibrocartilages (menisci
cies articulares), the articular capsule (capsula articularis), and the articulares), in contrast to the discs, are not complete cartilaginous
joint cavity (cauitas articularis). plates but crescent-shaped structures of fibrous cartilage. Each
The articular cartilage is usually hyaline (cartilago hyalina) or knee joint has two menisci, right and left, which are attached by
less frequently fibrous (cartilago fibrosa). It covers the articular sur their outer edges to the capsule nearer to the tibia, while their
faces on the opposed parts of the articulating bones. Therefore, sharp inner edge projects freely into the joint cavity. The menisci
one surface of the cartilage is fused with the bone surface which it provide various movements at the joint and are shock absorbers.
covers, while the other projects freely into the joint. An articular labrum (labra articularia) is formed of dense
The articular capsule (capsula articularis) encloses the articulat fibrous connective tissue. It is attached to the edge of the acetabu
ing ends of the bones without passing over to the articular surfaces lum or glenoid cavity, making them deeper and increasing the con
and is continuous with the periosteum of these bones. The capsule gruency of the surfaces. The lip faces the joint cavity (shoulder
is made up of fibrous connective tissue and consists of two layers, and hip joints).
or membranes. The outer capsular ligament (membrana fibrosa s. Joints differ in the shape of the articular surfaces and mobility
stratum fibrosum) is formed of dense fibrous connective tissue and of the articulating bones. According to the shape of the articular
serves as a mechanical factor. It is continuous with an inner syno surfaces, the following synovial joints are distinguished: spheroid
vial membrane (membrana synouialis s. stratum synouiale) which or ball-and-socket (articulationes spheroidea s. cotylicae), plane (articu
forms synovial folds (plica synouialis) penetrating between the ends lationes plana), ellipsoidal or condyloid (articulationes ellipsoideae s.
of the articulating bones at places and increasing the congruence condylares), saddle (articulationer• sellares), ovoid (articulationes ouoi
of the surfaces forming the joint. This membrane secretes a synov dales), pivot (articulationes trochoideae), hinge (articulationes ginglymi)
ial fluid (synouia) into the joint which lubricates the articular sur and bicondylar (articulationes bicondylaris).
faces of the bones, provides nourishment for the articular carti Movements at a joint are determined by the shape of the arti
lage, acts as a shock absorber, and changes mobility at the joint by cular surfaces. Ball-and-socket and plane joints, in which the gen
changing viscosity. The working surface of the membrane in eratrix is a segment of a circumference, allow movement about
creases not only due to the folds but also due to synovial villi (villi three mutually perpendicular axes: transverse, anteroposterior
synouiales) projecting into the joint cavity. (sagittal), and vertical. For instance, the following movements are
The joint cavity is a closed narrow space limited by the articu possible at the shoulder joint: flexion (flexio) and extension (exten
lating bone surfaces and the articular capsule and is filled with sio) about the transverse axis with the movement occurring in the
synovial fluid. The cavity is air-tight. sagittal plane; abduction (abductio) and adduction (adductio) about
The various accessory structures of the joints are ligaments (li the anteropos!erior axis, in which case the movement is made in
gamenta), articular discs (disci articulares), interarticular fibrocarti the frontal plane; and finally, rotation (rotatio) about the vertical
lages or articular menisci (menisci articulares), and articular labra axis including pronation (pronatio) (medial rotation) and supina
(labra articularia). tion (supinatio) (lateral rotation), with the movement occurring in
The ligaments are bands of dense fibrous connective tissue the horizontal plane. These movements are very limited in plane
which strengthen the articular capsule and limit or direct move joints (the flat articular surface in this case is regarded as a small
ments at the joint. In relation to the articular capsule, the liga segment of a large-diameter circumference). They occur at a large
ments may be extracapsular (ligamenta extracapsularia), intracapsu amplitude in ball-and-socket joints in which circular movement or
lar (ligamenta intracapsularia), or capsular (ligamenta capsularia), circumduction (circumductio) occurs in addition, with the apex of
located in the capsule between the fibrous and synovial mem the circumduction centre corresponding to the centre of the sphe
branes. Practically all joints possess ligaments. The extracapsular roidal joint, while the periphery of the limb describes the base of a
ligaments intertwine with the outer parts of the fibrous layer of the cone.
capsule; the capsular ligaments are thickenings of this layer; the Joints allowing movement about only two axes are called biax-
182 SYNOVIAL JOINTS
ial. Such are the ellipsoid (e.g. the wrist joint) and saddle joints The bicondylar joints are a variety of the ellipsoid joints. These
(e.g. the carpometacarpal joint of the thumb). are ellipsoid joints working in combination with one another (e.g.
Uniaxialjoints are those with a cylindrical or pulley-shaped ar the atlanto-occipital and the knee joints).
ticular surface. In a cylindrical (trochoid) joint the generatrix The ovoidjoints are a variety of plane joints with an ovoid arti
moves parallel to the rotation axis. Such is the median atlantoaxial cular surface. Basically, flat surfaces are saddle- or ovoid-shaped
joint in which the rotation axis passes vertically through the dens almost in all cases.
of the second cervical vertebra or the superior radioulnar joint. A At some joints of the skeletal system movements occur only in
variety of this type of joint is the hinge joint (ginglimus) in which conjunction with movements at the neighbouring joints, i.e. ana
the generatrix is inclined in relation to the rotation axis (as if bev tomically isolated joints are united by a common function. Such
elled). The humeroulnar and interphalangeal joints serve for illus functional combination of joints must be borne in mind in study
tration. ing their structure and analysing the character of movements.
ARTICULATIONS OF THE BONES
OF THE TRUNK AND THE HEAD
Juncturae trunci et capitis
ARTICULATIONS OF THE
TRUNK BONES
VERTEBRAL COLUMN
The separate vertebrae are joined to one another by means of ing adjacent vertebral bodies; (2) zygapophyseal joints umtmg
various articulations to form the vertebral column (columna verte arches and processes of adjacent vertebrae; (3) ligaments of the
bralis). vertebral column which stretch between the bodies, arches, and
These articulations are as follows: (1) intervertebral discs unit- processes of the vertebrae.
INTERVERTEBRAL DISCS
lntervertebral discs (cartilages) are located between the bodies tervertebral disc the nucleus pulposus, which is normally com
of two adjacent vertebrae in the cervical, thoracic, and lumbar seg pressed, protrudes above the level of the anulus fibrosus. The in
ments of the vertebral column. tervertebral disc fuses with the hyaline cartilage covering the
An intervertebral disc (discus intervertebralis) (Figs 181-183) is adjacent surfaces of the vertebral bodies and is similar in shape to
formed of fibrous cartilage. A peripheral part called the anulus these surfaces. There is no disc between the atlas and axis. The
fibrosus and a centrally located nucleus pulposus are distinguished thickness of the discs differs and increases gradually towards the
in it. lower segments of the vertebral column; the discs of the cervical
The collagen fibres forming the anulus fibrosus are arranged and lumbar segments are slightly thicker in front than at the back.
concentrically, obliquely (one across another), and spirally. Their The discs are much thinner in the middle part of the thoracic seg
ends merge with the periosteum of the vertebral bodies. The cen ment than in the proximally and distally located parts. The carti
tral part of the disc (nucleus pulposus) is very resilient and is a laginous discs account for a quarter of the length of the vertebral
peculiar elastic layer. In lateral movements of the vertebral column column.
it is displaced to the side of extension. On cross-section of the in-
THE ZYGAPOPHYSEAL JOINTS

The zygapophyseal joints {junctura zygapophysealis) (see Figs process (processus articularis inferior) of the next distal vertebra. The
182, 183, 184) form between the superior articular process (proces articular capsule (capsula articularis) is attached to the margins of
sus articularis superior) of one vertebra and the inferior articular the articular cartilage. The joint cavity (cavum articulare) is set in
Fibrae obliquae
Anulus fibrosus
181. Intervertebral discs (disci intervertebrales);

anterior aspect (¼).
Discus intervertebralis
181a. Intervertebral discs of the lumbar segment (photograph).

(Horizontal section through middle of disc.)
1-anulus fibrosus
2-nucleus pulposus
3-cavity of intervertebral disc in the articulation between lumbar and sacral vertebrae
ARTICULATIONS OF THE VERTEBRAL COLUMN 185
accordance with the position and direction of the articular surfaces They are related functionally to joints allowing only a slight
and is nearer to the horizontal plane in the cervical segment, to the range of movements.
frontal plane in the thoracic segment, and to the sagittal plane in The symmetric zygapophyseal joints are combined joints, i.e.
the lumbar segment. those in which movement at one joint inevitably causes movement
The zygapophyseal joints are of the plane type in the cervical at the other because both are formed by processes on the same
and thoracic segments and pivot in the lumbar segment. bone.
THE LIGAMENTS OF THE VERTEBRAL COLUMN

The ligaments of the vertebral column (ligamenta columnae vertebra/is) are divided into two groups, the
group of long and the group of short ligaments.
THE LONG LIGAMENTS OF THE VERTEBRAL COLUMN

The long ligaments of the vertebral column are as follows. deep layers of bunches of this ligament are shorter than the super
1. The anterior longitudinal ligament (ligamentum longitudinale ficial layers. As a result they join two adjacent vertebrae, whereas
anterius) (see Figs 182-187) runs on the anterior and partly on the the superficial, longer bunches stretch for the distance of four or
lateral surfaces of the vertebral bodies from the anterior tubercle five vertebrae. The anterior longitudinal ligament prevents ex
of the atlas to the sacrum where it merges with the periosteum of treme extension of the vertebral column.
the first and second sacral vertebrae. 2. The posterior longitudinal ligament (ligamentum longitudinale
In the lower parts of the vertebral column the anterior longi posterius) (see Figs 182-184, 187, 188) runs on the posterior sur
tudinal ligament is much wider and stronger; it is joined loosely to face of the vertebral bodies in the vertebral canal (canalis vertebra
the vertebral bodies and firmly with the intervertebral discs be /is). It arises on the posterior surface of the axis and is continuous
cause it intertwines with the perichondrium covering them; on the with the membrana tectoria at the level of the upper two cervical
sides of the vertebrae it is continuous with their periosteum. The vertebrae. Inferiorly this ligament stretches to the proximal part of
inferior vertebrae
lumbalis II Capsula articularis

vertebrae lumbalis III
Articulatio zygapophysealis (cut open)
(articulatio intervertebralis)
Lig. longitudinale
posterius
Anulus fibrosus
Lig. longitudinale anterius
182. ZJgapophyseal joint (junctura zygapophysealis); superior aspect (¼).

(Third lumbar vertebra. Articulation between second and third lumbar vertebrae; section.)
186 ARTICULATIONS OF THE VERTEBRAL COLUMN
____ Discus
L1g flavum intervertebralis
Nucleus pulposus
Anulus fibrosus
Lig. supraspinale
Processus articularis ..,..,...._!,l;�'J'!

superior
Processus ---�2
trans versus
Lig. longitudinale
anterius
183. Ligaments and joints of vertebral column

(ligamenta et juncturae columnae vertebralis);
right aspect (¼).
(Lumbar segment. The vertebral canal is partly opened.)
.. __
Lig. longitudinale posterius ___;.'H:,;:;

(deep bundles)
Lig. intertransversarium
,-----,t- Capsula articulationis

zygapophysealis
184. Ligaments and joints of vertebral column

(ligamenta et juncturae columnae vertebralis);
posterior aspect (¼).
(Lumbar segment. The arches and processes of twelfth thoracic and first and second lumbar
vertebrae are removed.)
Arcus vertebrae
�::---➔- Pedunculus arcus

vertebrae
�-
�) "'
185. Ligaments of vertebral column
ifl------Lig. longitudinale
anterius (ligamenta columnae vertebralis);
anterior aspect (¾).
(Lumbar segment. Bodies of first and second lumbar vertebrae re
moved by frontal section.)
the sacral canal. In contrast to the anterior longitudinal ligament, bodies. It is joined loosely to the bodies of the vertebrae from
the posterior ligament is wider in the upper than in the lower parts which it is separated by a layer of connective tissue lodging a ve
of the vertebral column. It is fused firmly with the intervertebral nous plexus. Like in the anterior longitudinal ligament, the super
discs and is slightly wider here than at the level of the vertebral ficial bundles are longer than the deep ones.
THE SHORT LIGAMENTS OF THE VERTEBRAL

COLUMN
The short ligaments of the vertebral column are as follows. whose anterior margin limits posteriorly the intervertebral fora
1. The yellow ligaments (ligamenta jlava) (see Figs 182, 183, men (foramen intervertebrale) transmitting the second cervical nerve.
185) fill the spaces between the vertebral arches from the axis to 2. The interspinous ligaments (ligamenta interspinalia) (see Figs
the sacrum. They stretch from the inner surface and lower border 183, 186, 187) are thin bands filling the spaces between the spi
of the vertebral arch to the external surface and upper border of nous processes of two adjacent vertebrae. They are strongest in the
the arch of the next lower vertebra, and their anterior edges limit lumbar segment of the vertebral column and least developed be
the intervertebral foramen from the back. tween the cervical vertebrae. They are joined to the ligamenta flava
The ligamenta flava are made up of vertically running elastic anteriorly and are continuous posteriorly with the supraspinous li
bands lending them a yellow colour. They are strongest in the lum gament at the apex of the spinous process.
bar segment. The ligamenta flava are very resilient and elastic as a 3. The supraspinous ligament (ligamentum supraspinale) (see
result of which they become shorter in extension of the trunk and Fig. 183) is a continuous band running over the tips of the spinous
act like muscles, holding the trunk in extension and relieving the processes in the lumbar and thoracic segments. It is lost down
tension of the muscles. In flexion they stretch and in this way also wards on the spinous processes of the sacral vertebrae; above it is
relieve the tension of the erector muscle of the spine (see Muscles ef continuous with the rudimentary ligamentum nuchae at the level of
the Back). There are no ligamenta flava between the atlas and the the prominent ( seventh cervical) vertebra.
axis; a connective-tissue atlantoaxial membrane is stretched here
Membrana atlantooccipitalis anterior
Membrana atlantooccipitalis ___..;..
posterior
Capsula articulationis
atlantoaxialis lateralis
Lig. nuchae
Articulatio zygapophysealis (opened)
Capsula articulationis zygapophysealis
Vertebrae prominens
Lig. interspinale
Lig. supraspinale -
Fovea costalis transversalis

186. Ligaments and joints ef vertebral column
(ligamenta, juncturae et articulationes
columnae vertebralis);
right side, lateral aspect (¾).
4. The ligamentum nuchae (see Fig. 186) is a thin triangular (see Fig. 184) are thin bands which are poorly developed in the
band of elastic and connective-tissue fibres. It ascends from the cervical and partly in the thoracic segments but are stronger in the
spinous process of the prominent vertebra along the spinous pro lumbar part. They are paired ligaments joining the apices of the
cesses of the cervical vertebrae and, expanding, is attached to the transverse processes of adjacent vertebrae and limiting Hexion of
external occipital crest and the external occipital protuberance. the spine to the contralateral side. In the cervical segment they
5. The intertransverse ligaments (ligamenta intertransversaria) may be bifid or may be absent completely.
THESACROCOCCYGEALJOINT
The sacrococcygeal joint (junctura sacrococcygea) forms between This synchondrosis is strengthened by the following ligaments
the bodies of the fifth sacral and first coccygeal vertebrae; the sac (see Figs 218-219).
rococcygeal synchondrosis contains a small cavity in the interverte 1. The lateral sacrococcygeal ligament (ligamentum sacrococcy
bral disc. geum laterale) stretches between the transverse processes of the last
Pars basilaris ossis occipitalis
Lig. cruciforme atlantis
t.
Membrana atlantooccipitalis posterior
Lig. flavum
187. Ligaments and joints ef cervical vertebrae and occipital

bone; inner aspect (½).
(Sagittal median section through occipital bone and first to fourth cervical verte
brae.)
sacral and first coccygeal vertebrae and is a continuation of the in rior surface of the coccyx and the lateral walls of the opening into
tertransverse ligament. the sacral canal and closes its fissure. It corresponds to the liga
2. The anterior sacrococcygeal ligament (ligamentum sacrococcy menta £lava and the supraspinous ligaments of the vertebral
geum ventrale) is a continuation of the anterior longitudinal liga column.
ment and consists of two bands located on the anterior surface of 4. The deep posterior sacrococcygeal ligament (ligamentum sac
the sacrococcygeal joint. The fibres of these bands intersect. rococcygeae dorsale profundum) is a continuation of the posterior lon
3. The superficial posterior sacrococcygeal ligament (ligamen gitudinal ligament.
tum sacrococcygeum dorsale superficiale) is stretched between the poste-
,.-,,.ra�- Articulatio zygapophysealis

(opened)
188. Ligaments and joints of cervical vertebrae and occipital

bone; inner aspect (¼).
(Posterior parts of occipital bone and arches of first to fifth cervical vertebrae re
moved by frontal section.)
ARTICULATIONS AND LIGAMENTS

BETWEEN THE OCCIPITAL BONE AND THE ATLAS
AND AXIS
The atlanto-occipital joint (articulatio atlantooccipitalis) (see Figs 1. The anterior atlanto-occipital membrane (membrana atlan
187, 188; 189-192) is paired. It is formed by the articular surfaces tooccipitalis anterior) (see Figs 186, 187) stretches for the whole dis
of the occipital condyles (condyli occipitalis) and the superior articu tance of the gap between the anterior border of the foramen mag
lar facet (fovea articularis superior) of the atlas. The longitudinal num and the superior margin of the anterior arch of the atlas; it
axes of the articular surfaces of the occipital bone and the atlas merges with the upper end of the anterior longitudinal ligament.
come a little closer to each other anteriorly. The articular surfaces 2. The posterior atlanto-occipital membrane (membrana atlan
of the occipital bone are shorter than those of the atlas. The articu tooccipitalis posterior) (see Figs 186, 187, 189) stretches between the
lar capsule is attached to the margins of the articular cartilages. posterior border of the foramen magnum and the superior margin
According to the shape of the articulating surfaces, this joint is in of the posterior arch of the atlas. In its anterior part is an opening
cluded in the group of ellipsoid joints (articulatio ellipsoidea). transmitting vessels and nerves. It is an altered ligamentum fla
At both joints, the right and the left, possessing separate articu vum.
lar capsules, movements occur simultaneously, i.e. the joints form The following three joints form in articulation of the atlas and
a single combined joint. Nodding (anterior and posterior flexion) axis; two are paired and one is unpaired.
and slight sidewards movements of the head are possible. 1. The lateral atlantoaxial joint (articulatio atlantoaxialis latera-
Os occipitale
Membrana
atlantooccipitalis
posterior
Lig. flavum
189. Ligaments of cervical vertebrae and occipital bone; posterior aspect (¾).
Os occipitale
Atlas
Lig. cruciform '-.

atlantis
J
Axis
190. Li aments and joints of cervical vertebrae and occipital bone; mner
aspect (½).
lf.
(Posterior parts of occipital bone and posterior arch of atlas are removed.)
Articulatio
atlantoaxialis -----....:.::::a..,-....··'.:
lateralis (opened)
191. Ligaments and joints of cervical vertebrae and occipital bone; m

ner aspect (½).
(Posterior parts of occipital bone and posterior arch of atlas are removed.)
Dens axis Articulatio atlantoaxialis mediana
Lig. longitudinale posterius
192. Ligaments and joints of atlas and axzs; superior aspect (¾).
(Anterior arch and lateral masses of atlas and dens of axis p.irtly removed by horizontal section.)
Articulatio zygapophysealis
(opened)
Processus articularis inferior vertebrae VII
Processus articularis superior vertebrae VIII Processus transversus
Lig:
Lig. costotransversarium costotransversarium
Jaterale laterale
Facies articularis capitis costae
Lig. capitis costae radiatun\
193. Ligaments and joints of ribs and vertebrae; superior

aspect(¼).
(Part of eighth thoracic vertebra and right seventh rib removed by horizontal sec
tion.)
lis) (see Figs 187; 190-192) is a paired combined joint formed by 1. The membrana tectoria (see Figs 190, 192) is a broad, rather
the superior articular facets of the axis and the inferior articular dense fibrous sheet stretched from the anterior border of the fora
facets of the atlas. It allows a po_or range of movements because the men magnum to the body of the axis. It is called so (L tectum roof)
articulating surfaces are flat and even. The articular facets of the because it covers posteriorly (from the aspect of the vertebral
atlas make gliding movement in all directions in relation to the canal) the dens, the transverse ligament of the atlas, and other
axis. structures of this joint. It is regarded as a part of the posterior lon
2. The median atlantoaxial joint (articulatio atlantoaxialis medi gitudinal ligament of the vertebral column.
ana) (see Figs 187, 191, 192) forms between the posterior surface 2. The cruciate ligament of the atlas (ligamentum cruciforme at
of the anterior arch of the atlas (fovea dentis) and the dens of the lantis) (see Fig. 190) consists of two bands (longitudinal and trans
axis. Besides, the posterior articular facet of the dens forms a joint verse). The stout connective-tissue transverse band stretches be
with the transverse ligament of the atlas. tween the inner parts of the lateral mass of the atlas. It adjoins the
The joints of the dens are related to the group of trochoid, or posterior articular surface of the dens of the axis and reinforces it.
pivot joints and allow rotation of the atlas together with the head This band is called the transverse ligament of the atlas (ligamentum
about the dens of the axis, i.e. turning the head to the right and to transversum atlantis) (see Figs 190, 192). The longitudinal band (fas
the left. ciculus longitudinalis) is made up of two, upper and lower, bands.
The ligaments of the two joints described are as follows. The upper band runs from the middle of the transverse ligament
ARTICULATIONS OF THE RIBS 195
of the atlas to the anterior surface of the foramen magnum. The and the middle of the anterior border of the foramen magnum. It
lower band, which also arises from the middle of the transverse lig is considered a rudiment of the chorda dorsalis.
ament, passes downwards to be attached to the posterior surface of 4. The alar ligaments of the odontoid process (ligamenta alaria)
the body of the axis. (see Figs 190, 191) are formed of bands of connective-tissue fibres
3. The apical ligament of the odontoid process (ligamentum api stretched between the lateral surfaces of the dens and medial sur
cis dentis) (Figs 187, 191) stretches between the apex of the dens faces of the occipital condyles.
ARTICULATIONS OF THE RIBS

The joints formed by the ribs allow movements. The posterior ends of the ribs unite with the bodies and
transverse processes of the thoracic vertebrae to form the costovertebral joints (articulationes costovertebrales),
the anterior ends unite with the sternum to form the sternocostal joints (articulationes sternocostales).
THE COSTOVERTEBRAL JOINTS

The posterior ends of the ribs articulate with the vertebrae by 2. The costotransverse joint (articulatio costotransversaria) (see
means of two joints. Figs 193, 194, 196) is formed by the articular facet of the tubercle
1. The joint of the head of a rib (articulatio capitis costae) (Figs of a rib (facies articularis tuberculis costae) and the costal facet (fovea
193-196) is formed by the articular facet of the head of the rib costalis transversalis) of one of the transverse processes of the thor
and the costal facets of the vertebral bodies. The heads of the sec acic vertebrae. Only the upper ten ribs have such joints. The arti
ond to tenth ribs are conical and come in contact with the corre cular facets are covered by hyaline cartilage. The thin articular
sponding articular facets of the bodies of two adjacent vertebrae. capsule is attached to the edges of the facets.
The facets of the vertebral bodies are usually formed by a The joint is strengthened by the following ligaments.
smaller superior costal facet (fovea costalis superior) located in the A. The superior costotransverse ligament (ligamentum costotrans
lower part of the body of the next vertebra above and a larger infe versarium superius) arises from the inferior surface of a transverse
rior costal facet (fovea costalis inferior) at the upper border of the process and is attached to the crest of the neck of the next rib be
next vertebra below. The first, eleventh, and twelfth ribs articulate low.
with the facet of only one vertebra. The articular facets of the B. The lateral costotransverse ligament (ligamentum costotrans
vertebrae and heads of the ribs are covered by fibrous cartilage. versarium laterale) is stretched between the bases of the transverse
The intra-articular ligament of the joint of the head of rib (lig and spinous processes and the posterior surface of the neck of the
amentum capitis costae intraarticulare) is lodged in the cavity of the next rib below.
joints of the second to tenth ribs. It runs from the crest of the head C. The inferior costotransverse ligament (ligamentum costotrans
to the intervertebral disc and divides the joint cavity into two com versarium) is lodged between the posterior surface of the neck of a
partments. The articular capsule is thin and strengthened by the rib and the anterior surface of the transverse process of the corre
radiant ligament of the joint of the head of the rib (ligamentum capi sponding vertebra.
tis costae radiatum) which arises from the anterior surface of the The articulations of the head and tubercle of the rib are com
head of the rib and is attached fan-wise to two adjacent vertebrae bined (cylindrical or pivot) joints because they are connected func
and the intervertebral disc. tionally: movements occur at both joints during respiration.
196 ARTICULATIONS OF THE RIBS
Lig. costotransversarium superius
M. intercostalis externus
(cut and reflected)
Lig. intertransversarium
Capsula articularis
194. Ligaments and joints of ribs and vertebrae; posterior aspect (¾).
ARTICULATIONS OF THE RIBS 197
Lig. sternoclaviculare anterius Synchondrosis sternalis superior
Membrana intercostalis
externa
Membrana sterni
Ligg. costoxiphoidea
195. Ligaments and joints of ribs and sternum; anterior aspect (¾).
(Anterior parts of ribs and sternum on left side partly removed by frontal section.)
198' ARTICULATIONS OF THE RIBS
Processus
costotransversaria.
(cut open)
I
Caput costae
Corpus cos·tae __\_
Membrana sterni
Corpus sterni
196. Ligaments and joints of ribs, vertebrae, and sternum; superior aspect (½).
(Union of fifth pair of ribs with fifth thoracic vertebra and corresponding sternal segment. Joint between head of left
rib and vertebra is represented semischematically.)
THE STERNOCOSTAL JOINTS

The anterior ends of the ribs terminate as costal cartilages. The the anterior and posterior surfaces of the sternum and intersect
costal cartilage of the first rib is fused with the sternum (synchon and interlace with those on the opposite side and with ligaments
drosis). Those of the second to seventh ribs articulate with the cos located above and below them. As a result a strong fibrous layer
tal notches of the sternum to form the sternocostal joints (articula covering the sternum forms. It is called the sternal membrane
tiones sternocostales) (Figs 195, 196). The cavity of these joints is a (membrana sterni).
narrow vertical slit. The cavity of the second sternocostal joint con The bands of fibres descending from the anterior surfaces of
tains the intra-articular sternocostal ligament (ligamentum sternocos the sixth and seventh costal cartilages obliquely and medially to
tale intraarticulare), which passes from the second costal cartilage to the xiphoid process form the costoxyphoid ligaments (ligamenta cos
the junction of the manubrium and body of the sternum. toxiphoidea).
In the cavities of the other sternocostal joints this ligament is The fifth to ninth costal cartilages are joined to one another by
either poorly pronounced or absent. means of dense fibrous tissue to form the interchondral joints (ar
The capsules of these joints are formed by the perichondrium ticulationes interchondrales).
of the costal cartilages and are strengthened by the sternocostal The tenth rib is joined to the cartilage of the ninth rib by
ligaments (ligamenta sternocostalis radiata) among which the anterior fibrous tissue, while the cartilages of the eleventh and twelfth ribs
ligaments are stronger than the posterior ones. end freely between the abdominal muscles.
These ligaments fan out from the end of the costal cartilage to
ARTICULATIONS OF THE SKULL BONES 199
Arcus zygomaticus
197. Right mandibular joint (articulatio temporomandibula

ris); lateral aspect (¾).
BONES OF THE SKULL
Except for the mandible, the bones of the skull articulate by The fontanelles (fonticuli) (see Figs 99, 100) deserve mention
means of contiguous joints. The bones of the skull cap are joined among the syndesmoses. They are described in details in the sec
to one another by fibrous connective tissue to form syndesmoses. tion The Skull as a Whole.
The bones of the base of the skull articulate by means of cartilagi
nous tissue to form synchondroses. Both are replaced with age by
bony tissue to form synostoses.
200 ARTICULATIONS OF THE SKULL BONES
Tuberculum articulare
Caput superius
Discus articularis m. pterygoidei lateralis
Squama temporalis Caput inferius
m. pterygoidei lateralis
Capsula articularis
Caput mandibulae
198. Right mandibular joint (articulatio temporomandibularis); lateral aspect

(¾).
(Joint opened by sagittal section.)
ARTICULATIONS OF THE SKULL BONES 201
Processus pterygoideus
(lamina lateralis)
Lig. pterygospinale
Spina ossis sphenoidalis
Lig. sphenomandibulare
Lig. stylomandibulare
Hamulus pterygoideus
199. Right mandibular joint (articulatio temporomandibula

ris); medial aspect (¼).
202 ARTICULATIONS OF THE SKULL BONES
THE MANDIBULAR JOINT

The mandibular joint (articulatio temporomandibularis) The ligaments of the mandibular joint can be divided into the
(Figs 197-199) is a paired joint formed by the head of the mandi following three groups.
ble (caput mandibulae) and the articular (mandibular) fossa (fossa I. Intracapsular ligaments (ligamenta intracapsularia). These are
mandibularis) and eminentia articularis (tuberculum articulare) of the the meniscotemporal ligaments (anterior and posterior) running
squamous part of the emporal bone. The heads of the mandible from the temporal bone to the posterior parts of the disc, and the
are ellipsoid-shaped and their long converging axes form an ob meniscomandibular ligaments (medial and lateral) stretching from
tuse angle at the anterior border of the foramen magnum. the neck of the mandible to the inferior circumference of the disc.
The articular fossa of the temporal bone is partly included in II. Extracapsular ligaments (ligamenta extracapsularia). This is
the cavity of the mandibular joint. Two parts are distinguished in the lateral ligament (ligamentum laterale) (Fig. 197). It arises from
the fossa: extracapsular, located behind the squamotympanic the base of the zygomatic process of the temporal bone and
fissure and intracapsular, which lies to the front of it. The intra stretches to the lateral and posterior surfaces of the neck of the
capsular part of the articular fossa is enclosed in a capsule which mandible. Some of its bands intertwine with the capsule of the
also extends to the anterior margin of the articular tubercle. The joint. Two parts are distinguished in the ligament, anterior (or lat
articular surfaces are covered by a connective-tissue cartilage. A eral) and posterior (or medial).
biconcave oval plate of fibrous cartilage is lodged in the joint cav III. Ligaments related to the mandibular joint but not con
ity. This is the articular disc (discus articularis) (Fig. 198); it lies hor nected with the articular capsule.
izontally adjoining the articular tubercle above and the head of the 1. The sphenomandibular ligament (ligamentum sphenomandibu
mandible below. It is fused on the periphery with the articular cap lare) (Fig. 199) extends from the spine of the sphenoid bone and is
sule and separates the joint cavity into two communicating com attached to the lingula of the mandible.
partments, superior and inferior. Some tendinous fibres of the 2. The stylomandibular ligament (ligamentum stylomandibulare)
lateral pterygoid muscle are attached to the medial edge of the (Figs 197-199) stretches from the styloid process of the temporal
disc. bone to the mandibular angle.
The articular capsule (capsula articularis) is attached along the The mandibular joint is a hinge joint, or ginglymus. The right
edge of the articular cartilage; on the temporal bone it is fastened and left joints form together a single combined articulation. Move
anteriorly to the anterior sloping surface of _the articular tubercle, ments at the joints lower and raise the mandible, displace it for
posteriorly to the anterior margin of the petrotympanic fissure, wards, backwards, and to the side (right or left). In movements to
and laterally to the base of the zygomatic process. Medially it the side slight rotation about the vertical axis occurs in one joint,
reaches the spine of the sphenoid bone. The capsule embraces the while in the other joint the articular disc is displaced in the direc
neck of the mandible and is attached on its posterior aspect some tion of the movement of the head of the mandible.
what lower than on the anterior aspect.
ARTICULATIONS OF THE SHOULDER
GIRDLE AND FREE UPPER LIMB
Juncturae cinguli membri superioris
et membri superioris liberi
UPPER LIMB
The articulations of the upper limb (juncturae membri superioris) are subdivided into the articulations of
the shoulder girdle (juncturae cinguli membri superioris) and the articulations of the free upper limb (juncturae
membri superioris liberi).
SHOULDER GIRDLE
The bones of the upper limb are joined to the skeleton of the trunk by means of one joint, the sterno
clavicular joint.
THE STERNOCLAVICULAR JOINT

The sternoclavicular JOmt (articulatio sternoclavicularis) 1. The anterior and posterior sternoclavicular ligaments (liga
(Fig. 200) is formed by the clavicular notch of the sternum and the menta sternoclaviculare anterius et posterius) run on the anterior, supe
sternal end of the clavicle. This is a simple joint (articulatio simplex). rior, and posterior surfaces of the articular capsule and strengthen
The articular surfaces are covered by a connective-tissue carti it.
lage, they are incongruent and saddle-shaped in most cases. The 2. The costoclavicular ligament (ligamentum costoclaviculare) is a
incongruency is corrected by the articular disc (discus articularis) strong ligament ascending from the superior border of the first rib
lodged in the joint. to the clavicle and limits its movement upwards.
The articular capsule (capsula articularis) is strong and is atta 3. The interclavicular ligament (ligamentum interclaviculare)
ched to the margins of the articular surfaces of the bones. The arti stretches between the sternal ends of the clavicles above the s{i
cular disc divides the joint cavity into two parts, inferomedial and prasternal notch. It limits movement of the clavicle downwards.
superolateral, which do not communicate. Sometimes the centre of According to the range of movements, the sternoclavicular
the disc is perforated and both cavities of the joint communicate. joint is closer to the type of ball-and-socket (spheroid) joints (ar
The ligamentous apparatus of the sternoclavicular joint is re ticulatio spheroidea s. cotylica).
presented by the following ligaments.
204 ARTICULATIONS OF THE SHOULDER GIRDLE
Clavicula
Lig. sternoclaviculare
anterius
interclaviculare
Lig. costoclaviculare
200. Sternoclavicular joints (articulationes

sternoclaviculares); anterior aspect (¾).
(Right sternoclavicular joint opened by frontal section.)
THE ACROMIOCLAVICULAR JOINT

The acromioclavicular joint (articulatio acromioclavicularis) (see 2. The coracoclavicular ligament (ligamentum coracoclaviculare)
Fig. 204) is formed by the articular facet of the acromial end of the (see Fig. 204) is stretched between the inferior surface of the ac
clavicle and the articular facet of the acromion of the scapula. This romial end of the clavicle and the coracoid process of the scapula.
is a simple joint. The articulating surfaces are flat. An articular Two parts are distinguished in the coracoclavicular ligament:
disc (discus articularis) is sometimes present in the joint cavity. the quadrangular trapezoid part (ligamentum trape;;,oideum) which
This is a multiaxial joint, but the range of movements is strictly occupies a lateral position and runs from the trapezoid line of the
limited in view of which it is related to plane joints (articulatio acromial end of the clavicle to the coracoid process of the scapula,
plana). and the triangular conoid part (ligamentum conoideum) stretching
The articular capsule (capsula articularis) is attached along the medial to the trapezoid part between the conoid tubercle of the ac
margin of the articular surfaces and is strengthened by the follow romial end of the clavicle and the coracoid process of the scapula.
ing ligaments. Both ligaments meet at the coracoid process at an angle and
I. The acromioclavicular ligament (ligamentum acromioclavicula limit a depression formed above by the clavicle and filled with are
ris) stretches between the acromial end of the clavicle and the ac olar tissue and sometimes occupied by a synovial bursa.
romion of the scapula
LIGAMENTS OF THE SCAPULA

The ligaments of the scapula are fibrous bands which join its (Figs 202, 203) bridges the scapular notch and together with it
separate structures. limits a foramen.
I. The coracoacromial ligament (ligamentum coracoacromiale) 3. The spinoglenoid ligament, or inferior transverse ligament of
(Figs 201, 204) is the strongest of the scapular ligaments. It is the scapula (ligamentum transversum scapulae inferius) (see Fig. 202)
stretched in the form of a quadrangular plate between the acro is the weakest scapular ligament. It stretches on the posterior surface
mion and the coracoid process of the scapula. of the scapula from the root of the acromion, over the neck of the
2. The suprascapular ligament, or superior transverse liga scapula, and to the lateral surface of the glenoid cavity; some of its
ment of the scapula (ligamentum transversum scapulae superius) bands intertwine with those of the capsule of the shoulder joint.
THE SHOULDER JOINT 205
JOINTS OF THE FREE UPPER LIMB
THE SHOULDER JOINT

The shoulder joint (articulatio humeri) (Figs 201-206) is formed parts the fibrous layer is strengthened by muscle tendons which
by the glenoid cavity of the scapula (cavitas glenoidalis scapulae) and are interlaced with it: by the supraspinatus, infraspinatus, and
the head of the humerus (caput humeri). The articular surfaces are teres minor muscles in the lateral parts and by the subscapularis
covered by hyaline cartilage and do not conform each other in muscle in the medial part. In movement at the shoulder joint these
shape. Their congruence is increased by the labrum glenoidale muscles draw out the capsule and prevent its strangulation be
(Fig. 204) attached to the edge of the glenoid cavity. tween the articulating surfaces of the bones.
The articular capsule (capsula articularis) is attached on the On the humerus, the articular capsule bridges the biciptal
scapula to the periphery of the articular cartilage, the glenoid cav groove and transmits the tendon of the long head of the biceps
ity, and external margin of the labrum glenoidale; on the humerus brachii muscle which arises from the supraglenoid tubercle and
the capsule is attached to the anatomical neck. It is spacious and the margin of the labrum glenoidale, passes through the cavity of
stretched weakly. Its inferomedial part is thin, but in the other the shoulder joint, and then occupies the bicipital groove. In the
Lig. coracohumerale
Acromion Lig. coracoacromiale
Tcndo m. bicipitis brachii

(caput longum)
Scapula
201. Right shoulder joint (articulatio humeri); anterior aspect

(¾).
206 THE SHOULDER JOINT
Lig. coracoacromiale
Lig. transversum scapulae
inferius
Lig.
_,
Scapula
202. Right shoulder joint (articulatio humeri) and ligaments of right

scapula; posterior aspect (¾).
(The spine of the scapula is removed.)
cavity of the joint the tendon is covered by a synovial membrane m the bicipital groove around the biceps brachii tendon. It is
which is attendant to it to a level 2-5 cm below the anatomical called the intertubercular synovial sheath (vagina synovialis intertu
neck. Then the synovial membrane curves upwards and passing on bercularis). The joint cavity often communicates with the subscapu
the tendon, is continuous with the synovial layer of the articular lar bursa (bursa musculus subscapularis) located at the root of the cri
capsule. coid process.
A double-wall protrusion of the synovial membrane thus forms The shoulder joint has only one ligament, the coracohumeral
Capsula
articularis
Cavum Scapula
articulare
203. Right shoulder joint (articulatio humeri) (¾).

(Joint opened by frontal section.)
ligament (ligamentum coracohumerale). This is a thickened fibrous the tautened articular capsule inhibits abduction and raising of the
layer of the capsule, which extends from the lateral edge of the cri arm above the shoulder level. Higher raising of the limb is accom
coid process to the greater tuberosity of the humerus. plished by concomitant movement of the scapula.
The coracoacromial ligament (ligamentum coracoacromiale) is lo According to shape, the shoulder joint is a ball-and-socket, or
cated above the shoulder joint and together with the acromion and spheroid joint (articulatio spheroidea) permitting a wide range of
coracoid process of the scapula forms the vault of the shoulder. movements.
The vault protects the shoulder joint from above and together with
Lig.coracoacromiale
Articulatio Li_g.trapezoideum
. } Lig. coracoclavicular
L1g.con01·cteum
Clavicula
Scapula (margo lateralis)
204. Right shoulder joint (articulatio humeri) and acromioclavicular joint (arti
culatio acromioclavicularis) (¾).
(Shoulder joint is opened and humerus removed.)
205. Right shoulder joint (radiograph).

1-acromion 7-scapula
2-coracoid process 8-lateral border of scapula
3-clavicle 9-glenoid cavity of scapula
4-first rib 10-head of humerus
5-spine of scapula 11-humerus
6-medial border of scapula 12-greater tubercle of humerus
206. Right shoulder joint. (Radiograph taken with the arm

raised.)
1-acromion 8-rnedial border of scapula
2-clavicle (acromial end) 9-lateral border of scapula
3-coracoid process 10-glenoid cavity of scapula
4-first rib 11-head of humerus
5-superior border of scapula 12-anatomical neck
6-spine of scapula 13-humerus
7-scapula
THE ELBOW JOINT 211
THE ELBOW JOINT

The elbow joint (articulatio cubiti) (Figs 207-212) is formed by ments at the sides. Its synovial membrane covers also those parts
the articular surface of the inferior humeral epiphysis (its trochlea of the bones which are in the joint cavity but are not covered by
and capitulum), the articular surfaces of the ulna (trochlear and cartilage (the neck of the radius, etc.).
radial notches), and the head and articular circumference of the Three joints are distinguished in the cavity of the elbow joint:
radius. This is a compound joint (articulatio composita). The articu the humeroulnar, the humeroradial, and the proximal (superior)
lar surfaces are covered by hyaline cartilage. radioulnar joints.
The articular capsule (capsula articularis) is fastened on the 1. The humeroulnar JOmt (articulatio humeroulnaris)
humerus above the margins of the coronoid and radial fossae in (Figs 209-212) is formed between the trochlea of the humerus and
front; on the periphery of the bases of the epicondyles (leaving the trochlear notch of the ulna; it is a variant of the hinge joint
them free) and almost at the margin of the articular surface of the and is related to the cochlear joints.
trochlea and head of the humerus on the sides; and a little below 2. The humeroradial joint (articulatio humeroradialis) (Fig. 209)
the superior margin of the olecranon fossa at the back. On the is formed by the head of the humerus and the facet on the head of
ulna the articular capsule is attached to the edges of the trochlear the radius. It is related to the ball-and-socket or spheroid joints
and radial notches; on the radius it is fastened to the neck, forming (articulatio spheroidea) (actually movements occur about not three
here a sac-like protrusion (Figs 207, 209). The capsule is thin and but only two axes, frontal and vertical).
poorly stretched in front and behind but is strengthened by liga- 3. The superior, or proximal radioulnar joint (articulatio radi-
Capsula articularis
Lig. collaterale
radiale Lig. collaterale ulnare
207. Right elbow joint (articulatio cubiti); anterior aspect

(¼).
212 THE ELBOW JOINT
l
Epicondylus lateralis
a) vertical
bands
b) horizontal Capsula
bands articularis
c) oblique
b.ands
Lig. collaterale ulnare --
208. Right elbow joint (articulatio cubiti); posterior aspect

(¼).
(Extreme Hexion at elbow joint.)
oulnaris proximalis) (Figs 209, 214) is formed by the radial notch of ale ulnare) (Figs 207, 208) runs downwards from the lateral hum
the ulna and the articular circumference of the head of the radius eral epicondyle, then expands fan-wise to be attached at the edge
and is a typical trochoid, or pivot joint. of the trochlear notch of the ulna
The humeroulnar joint permits Hexion (flexio) and extension 2. The radial collateral (lateral) ligament (ligamentum collaterale
(extensio) which occur with simultaneous movement of the radius at radiale) (Figs 207, 208) arises at the base of the lateral humeral epi
the radiohumeral joint. Rotation (rotatio) of the radius about the condyle, stretches downwards to the lateral surface of the head of
longitudinal axis is also possible in the humeroradial joint; medial the radius, and separates into two bands. These bands run horizon
rotation is called pronation (pronatio) and lateral rotation is known tally and then around the head of the radius in front and behind to
as supination (supinatio); mild adduction (adductio) and abduction be attached to the edges of the radial notch of the ulna. The super
(abductio) occur as well. In the superior radioulnar joint rotation of ficial layers of the ligament blend with the Hexor tendons, the deep
the radius occurs with simultaneous movement at the humerora layers are continuous with the annular ligament of the radius.
dial joint. 3. The annular ligament of the radius (ligamentum anulare ra-
The following ligaments are related to the elbow joint. dii) (Figs 207, 209) embraces the articular circumference of the ra
1. The ulnar collateral (medial) ligament (ligamentum co/later- dial head from the anterior, posterior, and lateral aspects and, be-
THE ELBOW JOINT 213
.;:....::ai..,__Capsula
articularis
_.....JLJIII/II-- Trochlea humeri
-...�1--Cavum
articulare
Caput radii
Articulatio
radioulnaris
distalis
210. Right elbow joint. (Radiograph

209. Right elbow joint (articulatio cubiti), taken with the forearm in prona
interosseous membrane of forearm (mem tion.)
brana interossea antebrachii), and distal ra
I-humerus 8-medial styloid process
2-cubital fossa 9-ulna
dioulnar joint (articulatio radioulnaris); 3-medial epicondyle
4-trochlea of humerus
IO-neck of radius
11-head of radius
anterior aspect (½). 5-coronoid process of ulna
6-radius
12-capitulum humeri
13-lateral epicondyle
(Cavity of elbow joint is opened.) 7 -lateral styloid process 14-olecranon
214 THE ELBOW JOINT
ing attached to the anterior and posterior edges of the radial notch sea antebrachii) (Fig. 209) fills the space between the radius and the
of the ulna, holds fast the radius to the ulna. ulna and is attached to their interosseous borders.
The strong collateral ligaments check side movements at the It is formed of strong fibrous bands descending obliquely from
elbow joint. On the whole, the elbow joint is a variety of hinge the radius to the ulna. One of the bands runs in the opposite direc
joints (ginglymus) and functions as a cochlear joint. tion, from the tuberosity of the ulna to the tuberosity of the radius
In addition to the annular ligament of the radius, the interosse and is called the oblique cord (chorda obliqua). The membrane has
ous membrane of the forearm contributes to bracing together the openings transmitting vessels and a nerve. Some forearm muscles
radius and the ulna. arise on its palmar and dorsal surfaces.
The interosseous membrane of the forearm (membrana interos-
M. brachialis Humerus
Integumentum
commune
M. flexor carpi
radialis
M. flexor digitorum
superficialis
M. flexor digitorum
profundus
(originfrom ulna)
Processus coronoideus
211. Right elbow joint (articulatio cubiti) (¼).

(Cavity of elbow joint opened by sagittal section.)
THE ELBOW JOINT 215
212. Right elbow joint. (Radiograph taken with the

elbow flexed.)
1-olecranon 5-radius
2-trochlea of humerus 6-coronoid process
3-head of radius 7 -capitulum humeri
4-ulna 8-humerus
THE DISTAL RADIOULNAR JOINT

The distal, or inferior radioulnar joint (articulatio radioulnaris The articular capsule (capsula articularis) is loose. It is attached
distalis) (Figs 209,210,213,216) is formed by the articular circum · along the margin of the articular surfaces of the bones to the disc
ference of the head of the ulna and the ulnar notch of the radius. and forms above between the ulna and radius a pouch called reces
Distal to the head of the ulna is the articular disc (discus articularis) sus sacciformis (Fig. 215).
(Fig. 215). It is a triangular fibrocartilaginous plate attached by its The distal radioulnar joint is a variant of the trochoid joint (ar
base to the ulnar notch of the radius and by its apex to the medial ticulatio trochoidea).
styloid process of the ulna. The disc separates the cavity of the dis Together with the proximal radioulnar joint it forms a com
tal radioulnar joint from the cavity of the radiocarpal joint. bined joint providing rotation of the radius in relation to the ulna.
JOINTS OF THE HAND
THE RADIOCARPALJOINT
The radiocarpal joint (articulatio radiocarpea), or wrist JOmt dorsale). It turns from the dorsal surface of the distal end of the ra
(Figs 213, 217), is formed by the carpal articular surface of the ra dius to the carpus where it is attached to the dorsal surfaces of the
dius and the distal surface of the articular disc (see The Distal Ra scaphoid, lunate, and the triquetrum bones. It checks flexion of
dioulnar Joint). They form a slightly concave articular surface the hand.
which unites with a convex proximal articular surface provided by 4. The anterior radiocarpal ligament (ligamentum radiocarpeum
the proximal row of the carpal bones (scaphoid, lunate, and trique palmare). It arises from the base of the lateral styloid process of the
trum). radius and the margin of the carpal articular surface of this bone
A thin articular capsule (capsula articularis) is attached to the and runs downwards and medially to be attached to the proximal
margins of the articular surfaces of the bones forming the joint. and distal rows of carpal bones (the scaphoid, lunate, triquetrum,
The joint is strengthened by the following ligaments. and capitate). The ligament checks extension of the hand.
1. The lateral ligament of the wrist (ligamentum collaterale carpi In addition to these ligaments, there are the interosseous inter
radiale) which is stretched between the latetal styloid process and carpal ligaments (ligamenta intercarpea interossea) which connect the
the scaphoid bone. Some of its bands reach the trapezium bone. proximal carpal bones to one another; some of the carpal bones ar
The ligament checks adduction of the hand. ticulate to form intercarpal joints (articulationes intercarpeae).
2. The medial ligament of the wrist (ligamentum collaterale carpi The radiocarpal joint is a variant of biaxial joints and is an el
ulnare), arises from the medial styloid process and is attached to lipsoid joint (articulatio ellipsoidea). It permits the following move
the triquetrum and partly to the pisiform bone. It checks abduc ments: flexion, extension, adduction, abduction, and circumduc
tion of the hand. tion (Figs 216 and 217).
3. The posterior radiocarpal ligament (ligamentum radiocarpeum
THE PISIFORM JOINT

The pisiform joint (articulatio ossis pisiformis) joins the pisiform 2. The pisometacarpal ligament (ligamentum pisometacarpeum)
to the triquetrum bone. The sesamoid pisiform bone carries an ar runs from the pisiform bone to the bases of the third to fifth meta
ticular facet only on the side touching the approximate articular carpal bones.
surface of the triquetrum bone. The ligaments are an extension of the flexor carpi ulnaris ten
The articular capsule (capsula articularis) is attached to the mar don within which the large sesamoid pisiform bone is lodged.
gins of the articular surfaces. The joint cavity may communicate Sesamoid bones are small rounded bony or fibrocartilaginous
with the cavity of the radiocarpal joint. The pisiform joint has the structures embedded in tendons. They are responsible for raising
following ligaments. the respective muscle tendon and creating a favourable angle of its
1. The pisohamate ligament (ligamentum pisohamatum) action on the bone.
stretches between the pisiform bone and the hook of the hamate
bone.
THE INTERCARPALJOINTS
The carpal bones articulate with one another by means of in joints formed between some of the carpal bones and communi
tercarpal joints (articulationes intercarpea), while the proximal and cates with the cavity of the carpometacarpal joint. The articular
distal rows are joined by the midcarpal joint (articulatio mediocar capsule is attached to the margins of the articular surfaces of the
pea) (Figs 213-217). The distal surface of the first row of carpal carpal bones.
bones forms a large and deep concave articular surface which re The midcarpal joint is strengthened by the following liga
ceives the spherical surface formed by the articular surfaces of the ments.
capitate and hamate bones. The lateral part of the first row of car 1. The dorsal intercarpal ligaments (ligamenta intercarpea dor
pal bones has a distally facing spherical surface of the scaphoid salia) stretch between some of the carpal bones on the dorsal sur
bone which is received by the corresponding concavity formed by face of the joint.
the bones of the second row. The joint cavity is S-shaped. The cav 2. The palmar intercarpal ligaments (ligamenta intercarpea pa/
ity of the midcarpal joint is continuous with the cavities of the maria) like the dorsal ligaments are stretched between the carpal
JOINTS OF THE HAND 217
Lig. radiocarpeum palmare _...,___ Articulatio radioulnaris

distalis
Lig. carpometacarpeum
palmare
Ligg. metacarpea palmaria.
Ligg. metacarpea
transversa profunda
Articulatio
metacarpophalangea
(opened)
-t79r---lF--:..-.-l-yagina fibrosa digiti

manus
Tendo m. flexoris Articulationes

digitorum superficialis interphalangeae
manus
� (opened)
213. Right radiocarpal joint (articulatio radiocarpea) and ligaments and joints of
the hand; palmar surface (¾).
218 JOINTS OF THE HAND
Lig. radiocarpeum
dorsale
Lig. collaterale
• ...,, _____ carpi radiale
Os scaphoideum
Articulatio carpometacarpea
pollicis
Ligg. metacarpea
dorsalia
Articulatio
metacarpophalangea
Ligg. collateralia
Articulatio interphalangea
(opened)
214. Right radiocarpal joint (articulatio radiocarpea) and ligaments and joints of
the hand; dorsal surface (½).
(Cavities of the metacarpophalangeal and interphalangeal joints of index finger opened by section made paral
lel to dorsal surface of hand.)
JOINTS OF THE HAND 219
Membrana interossea antebrachii
Ulna
Lig. intercarpeum interosseum
Recessus sacciformis
Articulatio radiocarpea
Articulatio radioulnaris distalis
Lig. collaterale carpi radiale
Lig. Ligg. intercarpea

interossea
Os trapezoideum
Os multangulum
Articulatio carpometacarpea
pollicis
215. Joints and ligaments of right hand (½).

(Joint cavities opened by section made parallel to dorsal surface of hand.)
bones but on the palmar surface. Some bands arise on the capitate of the carpal bones close to the radiocarpal and carpometacarpal
bone and fan out to the bones of the first and second carpal joints.
rows to form the radiate carpal ligament (ligamentum carpi radia According to the shape of the articulating surfaces, the midcar
tum). pal joint is related to the spheroid joints (articulatio spheroidea) with
There are also interosseous intercarpal ligaments (ligamenta in two spheroid heads. It permits a very small range of movements
tercarpea interossea) (see Fig. 215) which are located between some and is therefore a poorly mobile joint.
THE CARPOMETACARPAL JOINTS

The carpometacarpal joints (articulationes carpometacarpeae) trapezoid, capitate, and hamate bones and the contiguous proxi
(Figs 213-217) are formed by the distal surfaces of the carpal mal articulating surfaces of the bases of the medial four metacar
bones of the second row and the bases of the metacarpal bones. pals. The joint of the fifth metacarpal bone is related in shape to a
Two carpometacarpal joints are distinguished: one is formed by saddle joint (articulatio sellaris). The articular capsule is attached to
the trapezium bone and the first metacarpal bone and is related to the margins of the articular surfaces of the bones and is tightly
the thumb; the other is formed between the trapezium, trapezoid, stretched. The cavity of the carpometacarpal joint communicates
capitate, and hamate bones and the medial four metacarpals. with the cavities of the intercarpal, midcarpal, and intermetacarpal
The carpometacarpal joint of the thumb (articulatio carpometa joints. The palmar and dorsal carpometacarpal ligaments (liga
carpea pollicis) is formed by the distal saddle-shaped articular facet menta carpometacarpea pa/maria et dorsalia) stretching between the
of the trapezium bone and the saddle-shaped articular facet of the carpals and metacarpals on the respective surfaces are related to
base of the first metacarpal bone. the ligaments of the carpometacarpal joints.
The carpometacarpal joint of the thumb is a variety of biaxial The carpometacarpal joints form a unit which is from the me
joints and is a saddle joint (articulatio sellaris). chanical standpoint the firm framework of the hand.
The second to fifth carpometacarpal joints are formed by the These joints permit a very small range of movements and are
flat articulating facets on the distal surfaces of the trapezium, related to plane joints (articulationes planae).
THEINTERMETACARPALJOINTS
The intermetacarpal JOmts (articulationes intermetacarpeae) mar surfaces of the joints. These are the four dorsal metacarpal
(Figs 213-217) are formed between the flat facets on the conti ligaments (ligamenta metacarpea dorsalia) and the three palmar met
guous sides of the bases of the medial four metacarpals. The artic acarpal ligaments (ligamenta intercarpea pa/maria). Ligaments of the
ular capsule is attached to the margins of the articular facets. The other group are between the bases of the metacarpal bones. These
cavities of the joints communicate proximally with the carpometa are called the interosseous metacarpal ligaments (ligamenta metacar
carpal joints. pea interossea). The intermetacarpal joints are plane joints permit
Two groups of ligaments are related to the intermetacarpal ting a very limited range of movements.
joints. Ligaments of one group are located on the dorsal and pal-
THE METACARPOPHALANGEAL JOINTS

The metacarpophalangeal joints (articulationes metacarpophalan ments pass from the sides of the metacarpal heads to the palmar
geae) (Figs 213, 214, 216) are formed by the articular surfaces of surface of the bases of the proximal phalanges to intersect with
the heads of the metacarpal bones and the contiguous articular similar contralateral fibres. These are called palmar ligaments (li
facets on the bases of the proximal phalanges. The head of the first gamenta pa/maria).
metacarpal bone is compressed from front to back and is trochlear The deep transverse ligaments of the palm (ligamenta metacar
in shape; the heads of the other metacarpals are spherical. The ar pea transversa profunda) are stretched on the palmar surface of the
ticular capsules are loose. They are attached on the sides by the joints between the heads of the medial four metacarpals.
collateral ligaments (ligamenta collateralia) which arise from depres The metacarpophalangeal joint of the thumb is a hinge joint
sions on the ulnar and radial surfaces of the heads of the metacar (ginglymus), while those of the other fingers are ball-and-socket or
pals and are attached to the sides and partly to the palmar surface spheroid joints (articulationes spheroideae).
of the base of the proximal phalanx. Some fibres of these liga-
13
216. Joints of right hand. (Radiograph taken with the

hand in adduction, ulnar deviation.)
1 -radius 12-middle phalanx of index finger
2-lateral styloid process 13-distal phalanx of index finger
3-scaphoid bone 14-capitate bone
4-multangular, or trapezium bone 15-hook of hamate bone
6-first metacarpal bone 17-triquetral bone
7-sesamoid bone 18-pisiform bone
8-proxymal phalanx of thumb 19-lunate bone
9-distal phalanx of thumb 20-medial styloid process
10-second metacarpal bone 21-ulna
11-proximal phalanx of index finger
THE INTERPHALANGEAL JOINTS OF THE HAND

The interphalangeal joints of the hand (articulationes interphal lea, and are attached one to the side of the base of the phalanges
angeae manus) (Figs 213, 214, 216, 217) form between the approxi (collateral ligaments), and the others to their palmar surface.
mate phalanges of each finger. The articular surface on the head of The thumb has only one interphalangeal joint.
each phalanx is trochlear in shape and carries a guiding groove, The interphalangeal joints between the proximal and middle
while the base of the phalanx bears a flat facet with a guiding phalanges of the other fingers are called proximal interphalangeal
ridge. joints, those between the middle and distal ph�langes are the distal
The ligaments of the interphalangeal joints are the palmar lig interphalangeal joints. Interphalangeal joints are typical hinge
aments (ligamenta palmaria) which pass from the sides of the troch- joints (ginglymus).
217. Joints of right hand. (Radiograph taken with the

hand in abduction, radial deviation.)
1 -radius 12-middle phalanx of index finger
2-lateral styloid process 13-distal phalanx of index finger
3-scaphoid bone 14-capitate bone
4-multangular, or trapezium bone 15-hook of hamate bone
6-first metacarpal bone 17-triquetral bone
7-sesamoid bone 18-pisiform bone
8-proximal phalanx of thumb 19-lunate bone
9-distal phalanx of thumb 20-medial styloid process
10-second metacarpal bone 21-ulna
11-proximal phalanx of index finger
ARTICULATIONS OF THE PELVIC GIRDLE
AND FREE LOWER LIMB
Juncturae cinguli membri inferioris et membri inferioris liberi
JOINTS OF THE LOWER LIMB

The joints of the lower limb (juncturae membri inferioris) are subdivided into joints of the pelvic girdle
(juncturae cinguli membri inferioris) and joints of the free lower limb (juncturae membri inferioris liberi).
•
JOINTS OF THE PELVIC GIRDLE
The bones of the pelvic girdle articulate by means of two sacroiliac joints, the pubic symphysis, and
some ligaments.
THE SACROILIAC JOINT

The sacroiliac joint (articulatio sacroiliaca) (Figs 218-220) is a rior superior iliac spine, and are attached to the transverse tuber
paired joint formed between the iliac bone and sacrum. cles of the sacrum for the distance from the second to third sacral
The articulating auricular surfaces (facies auriculares) of the il foramina. The other bands of ligaments run from the posterior su
iac bones and sacrum are flat and covered by fibrous cartilage. The perior iliac spine downwards and slightly medially to be attached
articular capsule (capsula articularis) is attached to the margins of to the posterior surface of the sacrum in the region of the fourth
the articular surfaces and is taut. The ligaments of the joint are sacral vertebra.
strong fibrous bands tightly stretched on its anterior and superior The sacroiliac joint is related to the group of joints which per
surfaces. The anterior (ventral) sacroiliac ligaments (ligamenta sac mit a limited range of movements.
roiliaca ventralia) are short fibrous bands stretching •On the anterior The hip bone is also united with the vertebral column by
surface from the pelvic surface of the sacrum to the iliac bone. means of a series of strong ligaments; these are as follows.
The following ligaments are located on the posterior surface of 1. The sacrotuberous ligament (ligamentum sacrotuberale)
the joint. (Figs 218-220) arises from the medial surface of the ischial tuber
1. The interosseous sacroiliac ligaments (ligamenta sacroiliaca osity, passes upwards and medially spreading fan-wise, and is at
interossea) lie behind the sacroiliac joint in the space between the tached to the lateral border of the sacrum and coccyx. Some bands
bones forming it. They are attached to the iliac and sacral tuberos pass over to the inferior part of the ischium to form the falciform
ities. process (processus falciformis).
2. The posterior (dorsal) sacroiliac ligaments (ligamenta sacroil 2. The sacrospinous ligament (ligamentum sacrospinale)
iaca dorsalia). Some bands of these ligaments arise from the poste- (Figs 218-220) runs from the ischial spi�e medially and to the
224 PELVIC LIGAMENTS AND JOINTS
back and is attached in front of the sacrotuberous ligament to the (Figs 218-219) passes from the anterior surface of the transverse
lateral border of the sacrum and partly to the coccyx. processes of the fourth and fifth lumbar vertebrae laterally to the
Both ligaments together with the greater and lesser sciatic posterior parts of the iliac crest and medial surface of the ala of the
notches form the borders of the greater and lesser sciatic foramina ilium.
{foramen ischiadicum majus etforamen ischiadicum minus) which trans The sacrococcygeal joint (junctura sacrococrygea) (see Articula
mit muscles as well as vessels and nerves leaving the pelvis. tions of the Vertebral Column).
3. The iliolumbar ligament (ligamentum iliolumbale)
Lig. longitudinale anterius

Lig.
sacroiliaca interossea
Articulatio sacroiliaca
(cavum articulare)
Foramen ischiadicum minus Lig. sacrococcygeum

ventrale
Symphysis pubica
218. Pelvic ligaments and joints; seen from above (¾).

(Ligaments and joints of pelvic girdle [ligamenta et articulationes s. juncturae cinguli membri inferioris].
Part of left hip bone, left parts of sacrum and of third, fourth, and fifth lumbar vertebrae removed by hori
zontal and sagittal sections.)
PELVIC LIGAMENTS AND JOINTS 225
THE PUBIC SYMPHYSIS

The pubic symphysis (symphysis pubica) (Figs 218, 220) is I. The superior pubic ligament (ligamentum pubicum superius) is
formed by the articular symphyseal surfaces (facies symphysialis) of stretched between both pubic tubercles on the superior border of
the pubic bones, which are covered by hyaline cartilage, and the the symphysis.
fibrocartilaginous interpubic disc (discus interpubicus). The disc fuses 2. The inferior (arcuate) pubic ligament (ligamentum arcuatum
with the articular surfaces of the pubic bones and has a sagittal pubis) passes on the inferior border of the symphysis from one pu
slit-like cavity within it. The disc is shorter in females than in bic bone to the other.
males, but is thicker and has a relatively larger cavity.
The pubic symphysis is strengthened by the following liga
ments.
219. Pelvic ligaments and joints, hip joint (articulatio coxae); posterior view
(¾).
(Articular capsule of left hip joint is removed.)
226 PELVIC LIGAMENTS AND JOINTS
Lig. interspinale
Lig. supraspinale
Canalis sacralis
superius
Lig. sacrospinale
Lig. sacrotuberale
Foramen ischiadicum majus
Lig.
Processus falciformis
220. Ligaments and joints of pelvis, right side; mner aspect (½).
(Sagittal-medial section.)
THE OBTURATOR MEMBRANE

The obturator membrane (membrana obturatoria) membrane bears some small foramina. Together with the muscle
(Figs 219-221) is formed on predominantly transverse connective arising from it and the obturator groove it borders the obturator
tissue fibres which are attached to the borders of the obturator fo canal (canalis obturatorius) which transmits the obturator vessels
rarnen and close it except in the obturator groove. The obturator and nerves.
THE HIP JOINT 227
JOINTS OF THE FREE LOWER LIMB
THE HIP JOINT

The hip joint (articulatio coxae) (Figs 219, 221-224) is formed The articular capsule (capsula articularis) is attached to the hip
by the articular surface of the femoral head (which is covered by bone along the edge of the labrum acetabulare; on the femur it is
hyaline cartilage except for the fovea capitis) and by the acetabu attached to the trochanteric line and embraces posteriorly two
lum of the hip bone. The acetabulum is covered by cartilage only thirds of the femoral neck but does not reach the trochanteric
in the region of the articular surface (facies lunata), the rest of its crest.
surface is filled with fatty tissue and covered by a synovial mem The hip joint has the following ligaments.
brane. Above the acetabular notch stretches the transverse 1. The iliofemoral ligament (ligamentum iliofemorale) (Fig. 221)
ligament of the acetabulum (ligamentum transversum acetabuli). lies on the anterior surface of the hip joint. It stretches from the
On the free margin of the acetabulum and on this ligament is anterior inferior iliac spine and is attached to the trochanteric line.
attached the labrum acetabulare which makes the acetabulum It checks extension at the hip joint and contributes to holding the
deeper. trunk erect.
Spina iliaca anterior inferior --
Membrana obturatoria
Lig. pubofemorale
221. Right hip joint (articulatio coxae); anterior aspect

(½).
228 THE HIP JOINT
Linea epiphysialis
Labrum acetabulare
Cavum articulare
Capsula articularis
Tuber ischiadicum
222. Right hip joint (articulatio coxae) (½).

(Cavity of hip joint opened by frontal section.)
2. The pubofemoral ligament (ligamentum pubofemorale) lar capsule, loops the femoral neck, and is attached to the anterior
(Fig. 221) runs downwards from the superior pubic ramus and in inferior iliac spine.
tertwines with the capsule of the hip joint; some of its bands reach 5. The ligament of the head of the femur (ligamentum capitis
the medial part of the trochanteric line. femoris) (Figs 222, 223) is in the joint cavity. It arises from the
3. The ischiofemoral ligament (ligamentum ischiofemorale) transverse ligament of the acetabulum and is covered by a synovial
(Fig. 219) arises on the anterior surface of the body of the ischium, membrane; it is attached to the pit in the femoral head. Vessels
runs forewards and blends with the capsule of the hip joint; some pass to the head of the femur in the ligament.
of its bundles reach the trochanteric fossa. The hip joint is ,a variety of a ball-and-socket joint (articulatio
4. The zona orbicularis (Figs 219 and 222) runs in the articu- cotylica).
THE HIP JOINT 229
Fatty tissue in
fossa acetabuli
Facies lunata
M. rectus femoris (origin)
Lig. capitis femoris
Membrana
obturatoria
223. Right hip joint (articulatio coxae) (½).

(Articular capsule is cut and femoral head drawn out of acetabulum.)
230 THE HIP JOINT
224. Right hip joint. Radiograph.

1-ischial spine 9-lesser trochanter
2-acetabulum 10-femur
3-obturator foramen 11-intertrochanteric crest
4-superior ramus of pubis 12-greater trochanter
5-inferior ramus of pubis 13-neck of femur
6 and 8-ischium 14-head of femur
7 -ischial tuberosity 15-ilium
THE KNEE JOINT 231
THE KNEE JOINT

The knee joint (articulatio genu) (Figs 225-233) is formed by posterior surface (facies articularis) of the patella. The superior ar
three bones, namely, the lower end of the femur, the upper end of ticular surfaces (facies articulares superiores) of the tibial condyles are
the tibia, and the patella. The articular surfaces of the femoral slightly concave and are incongruent with the convex articular sur
condyles are ellipsoid. The medial condyle is more convex than the faces of the femoral condyles. This incongruence is corrected to
lateral condyle. On the anterior surface of the bone, between the some extent by the interarticular cartilages called the medial semi
condyles, is the patellar surface (facies patellaris) which is divided lunar cartilage and lateral semilunar cartilage (menisci medialis et
by a small groove into a medial (smaller) and lateral (larger) areas. lateralis) or menisci (Figs 231-233) which are located between the
These areas articulate with the respective articular facets on the femoral and tibial condyles. The menisci are cartilaginous trihe-
Tenda m. recti femoris

(cut off)
M. vastus medialis
(cut off)
Patella
Retinaculum patellae
mediate
Retinaculum patellae --:mtrc--
laterale Lig. collaterale tibiale
Lig. collaterale -- Lig. patellae

fibulare
Lig. capitis fibulae _..µ....,..:...:.,.:c.-
anterius
Caput fibulae
Membrana interossea ---!i!r-""

cruris
225. Right knee joint (articulatio genus); anterior aspect (¼).

232 THE KNEE JOINT
M. adductor magnus
Bursa subtendinea m. gastrocnemii

medialis (opened)
Caput laterale
m. gastrocnemii
M. semimembranosus
Lig. popliteum
obliquum
M. biceps
femoris
M. popliteus .._,-�-+-- Lig. capitis fibulae

(partly removed) posterius
226. Right knee joint (articulatio genus); posterior aspect (¼).
dral plates. Their peripheral edge is thick and fused with the artic nence of the tibia. The anterior parts of both menisci are joined by
ular capsule, the edge facing the joint cavity is sharpened and free. the transverse ligament of the knee (ligamentum transversum genus).
The superior surface of the meniscus is concave, the inferior sur The articular capsule (capsula articularis) is loosely stretched. Its
face is flat. The peripheral edges of the menisci almost copy the posterior part is thicker than the other parts and bears some
configuration of the superior border of the tibial condyles as the orifices which transmit vessels. In front it blends with the tendon
result of which the lateral meniscus resembles a part of a circum of the quadriceps femoris muscle and is attached to the borders of
ference, while the medial meniscus is crescent-shaped. The men the articular surface of the patella. On the femur the capsule is at
isci are attached in front and behind to the intercondylar emi- tached slightly above the articular cartilage in front, almost at the
THE KNEE JOINT 233
Tenda m. quadricipitis ----....\lllr

femoris
Bursa suprapatellaris
Facies articularis
patellae
Patella
Bursa praepatellaris
subcutanea
Condylus medialis
(fades patellaris)
-----::1-----,,-.�_Plica synovialis
infrapatellaris
--,-...-+--- Plicae alares
M. gastrocnemius -�--+,
(caput laterale)
227. Right knee joint (articulatio genus) (½).

(Cavity of knee joint opened by sagittal section)
234 THE KNEE JOINT
cartilage on the sides, and on its border behind. On the tibia the
capsule is attached to the borders of the articular surface. The ar
ticular capsule is lined with a synovial membrane which covers the
ligaments lodged in the joint cavity and forms synovial villi (villi
synovialis) and synovial folds (plicae synoviales). The stronger devel
oped folds are as follows: (a) the alar folds (plicae a/ares) (Fig. 227)
which run on the sides of the patella to its apex and contain fatty
tissue between their layers; the infrapatellar synovial fold (plica sy
novialis infrapatellaris) which is below the patella and is a continua
tion of the alar folds. It arises in the region of the apex of the pa
tella, enters the cavity of the knee joint, and is attached in the
region of the anterior edge of the intercondylar notch of the
femur.
The capsule of the knee joint forms a series of synovial ever
sions (eversiones synoviales) and synovial bursae (bursae synoviales)
which are situated along the distribution of muscles and tendons
but do not communicate with the joint cavity (see Muscles of the
Lower Limb). The largest pouch of the articular capsule is the su
prapatellar bursa (bursa suprapatellaris) situated above the patella
between the tendon of the quadriceps femoris muscle; in some in
dividuals it may be isolated.
Two groups of knee joint ligaments are distinguished, one ex
tra-articular and the other intra-articular. The following well de
veloped ligaments are situated on the sides of the joint.
1. The medial ligament of the knee or tibial collateral liga
ment (ligamentum collaterale tibiale) (Figs 225, 226, 231, 232). It
runs downwards from the medial femoral epicondyle, blends with
the articular capsule and medial meniscus, and reaches the upper
part of the tibia.
2. The lateral ligament of the knee or fibular collateral liga
ment (ligamentum collaterale Jibulare) (Figs 225, 230-232). It is nar
rower than the medial ligament; it arises from the lateral epicon
dyle of the femur and also stretches downwards, gives off some
bands to the articular capsule, and is attached to the lateral surface
of the head of the fibula.
The anterior parts of the articular capsule are reinforced by
ligaments related directly to the tendon of the quadriceps femoris
muscle. This muscle approaches the patella to be attached to its
base. Some of the bundles of the tendon are continued downwards 228. Right knee joint. Radio
to the tuberosity of the tibia to form below the apex of the patella graph.
the ligamentum patellae (Figs 225, 227, 230). Other bundles 1-femur 7-tibia
stretch vertically on the sides of the patella and its ligament and 2-intercondylar notch 8-tuberosity of tibia
3-medial condyle of tibia 9-lateral condyle of femur
form vertical ligaments called the lateral and medial retinaculi of 4-lateral condyle of tibia IO-medial condyle of femur
the patella (retinaculum patellae laterale et retinaculum patellae medi 5-head offibula I I-patella
ale). They run from the sides of the patella to the respective fem 6-fibula
oral condyle. Under these ligaments are tendon fibres stretching

horizontally from the sides of the patella to the femoral epicon
dyles. The posterior parts of the articular capsule are strengthened
by the oblique posterior ligament of the knee (ligamentum popliteum
obliquum) (Fig. 226) which is a part of the tendon of the semimem
branosus muscle. The ligament runs from the medial tibial con
dyle to the lateral femoral condyle and some of its fibres blend on
the way with the articular capsule.
In addition to the oblique ligament, another ligament called
THE KNEE JOINT 235
229. Right knee joint. Radiograph made with the knee

joint flexed.
I-femur 6-tibia
2-intercondylar notch 7-tuberosity of tibia
3-lateral condyle of tibia 8-medial condyle of femur
4-medial condyle of tibia 9-lateral condyle of femur
5-head of fibula IO-patella
the arcuate ligament of the knee (ligamentum popliteum arcuatum) dially and is attached to the tibia in the anterior intercondylar
(Fig. 226) is always found in this part of the articular capsule. It area.
stretches between the lateral femoral epicondyle and the middle 2. The posterior cruciate ligament (ligamentum cruciatum poste
part of the oblique ligament. rius) stretches from the medial surface of the medial femoral con
The following ligaments are in the cavity of the knee joint. dyle to the back and medially, crosses the anterior cruciate liga
1. The anterior cruciate ligament (ligamentum cruciatum ante ment, and is attached to the posterior intercondylar area of the
rius) runs from the lateral condyle of the femur forwards and me- tibia.
236 THE KNEE JOINT
Condylus medialis
Plica synovialis --fll'":'--�----
infrapatellaris
Lig. cruciatum posterius
Condylus lateralis Lig. cruciatum antcrius
Tendo m. bicipitis femoris •--
Lig. patellae
Facies articularis patellae
Tendo m. quadricipitis femoris
230. Right knee joint (articulatio genus); anterior aspect (¼).

(Articular capsule cut on lateral, anterior, and medial surfaces. Quadriceps femoris muscle
with patella are drawn away distally.)
THE KNEE JOINT 237
3. The transverse ligament of the knee (ligamentum transversum 5. The posterior meniscofemoral ligament (ligamentum menisco
genus) connects the anterior surface of both menisci. femoralis posterius) (Fig. 232) runs from the posterior part of the lat
4. The anterior meniscofemoral ligament (ligamentum menisco eral meniscus upwards and medially to the medial surface of the
femorale anterius) (Fig. 231) extends from the anterior part of the medial femoral condyle.
medial meniscus upwards and laterally to the medial surface of the The knee joint is a combination of a hinge (ginglymus) and pi
lateral femoral condyle. vot (trochoid) joints and is related to trochoginglymus.
Facies patellaris
Lig. cruciatum anterius
Lig. transversum genus
Lig. collaterale tibiale
Caput fibulae
231. Right knee joint (articulatio genus); anterior aspect (½).

(Articular capsule removed. Tendon of quadriceps femoris muscle together with patella are
drawn away distally.)
238 THE KNEE JOINT
232. Right knee joint (articulatio

genus); posterior aspect (¼).
(Articular capsule removed.)
Condylus lateralis
Condylus medialis
�-•-Tendo m. poplitei
·t
Lig. meniscofemorale --1e-'--

posterius
Meniscus medialis --1-1----
Meniscus lateralis
Condylus lateralis tibiae
Lig. collaterale fibulare
Lig. capitis fibulae

posterius
Caput fibulae
Tuberositas tibiae
Lig. transversum genus
Meniscus medialis Meniscus lateralis
Lig. meniscofemorale posterius

Lig. cruciatum anterius
233. Right knee joint (articulatio
genus) (¼).
Lig. cruciatum posterius (Distal surface of knee joint seen from above.
Cruciate ligaments of knee are cut.)
THE TIBIOFIBULAR JOINT 239
JOINTS OF THE LEG BONES
The proximal ends of the leg bones form the superior tibiofib
ular joint (articulatio tibiefibularis) (Figs 232, 234, 236, 238). The ar
ticulating surfaces are the flat articular facet of the head of the
fibula (facies articularis capitis fibulae) and the fibular articular sur
Lig. capitis
fibulae anterius
face of the lateral tibial condyle (facies articularis fibularis).
The articular capsule (capsula articularis) is attached to the
edges of the articulating surfaces; it is taut and strengthened by
the anterior and posterior ligaments of the superior tibiofibular
joint (ligamenta capitis fibulae anterius et posterius). The ligaments are
on the anterior and posterior surfaces of the joint and extend from
the tibia to the head of the fibula. The proximal tibiofibular joint
permits a small range of movements.
The space between the two leg bones is filled by the interosse
ous membrane of the leg (membrana interossea cruris).
The fibres of the membrane descend and run laterally from the
interosseous border of the tibia to that of the fibula. In the upper
part of the membrane is a large opening transmitting vessels and
Membrana interossea
cruris nerves; in the lower part is a smaller opening transmitting vessels.
The membrane is stronger in the lower part.
The distal ends of the leg bones form the inferior tibiofibular
syndesmosis (joint) (syndesmosis s. articulatio tibiofibularis).
On the anterior and posterior surfaces of this joint are short
but strong ligaments stretching from the anterior and posterior
edges of the fibular notch of the tibia to the lateral malleolus.
These are the anterior and posterior inferior tibiofibular ligaments
(ligamenta tibiefibularia anterius et posterius) (Figs 234-236). There
are also dense bands of connective-tissue fibres stretched for the
whole distance between the fibular notch of the tibia and the
rough surface of the lateral malleolus facing it.
234. Right tibiofibular joint (arti

culatio tibiofibularis), interosseous
Lig. tibiofibulare membrane of leg (membrana interos
anterius sea cruris), and tibiojibular syndes
mosis (syndesmosis tibiofibularis);
anterior aspect (¾).
240 LIGAMENTS AND JOINTS OF THE FOOT
JOINTS OF THE FOOT
THE ANKLE JOINT

The ankle, or talocrural joint (articulatio talocruralis) (Figs 235, articular surface (facies articularis inferior) and the malleolar facet
236, 238-240) is formed between the articular surfaces of the dis (facies articularis malleolaris). The fibula also bears an articular facet
tal ends of the tibia and fibula and the articular surface of the of the lateral malleolus (facies articularis malleoli).
trochlea of the talus. The tibia articulates by means of its inferior The articular surface of the talus is pulley-shaped (trochlear)
Membrana interossea.._, __..,._

cruris
Lig. tibiofibulare
anterius
Articulatio talocruralis (opened)

Malleolus Lig. mediale (deltoideum) (pars tibionavicularis)
lateralis
Lig. Lig. calcaneonaviculare

} Lig. bifurcatum
talocalcaneum;-....,,w,11; Lig. calcaneocuboideum
laterale
Ligg. cuneonavicularia dorsalia
Lig. cuneocuboideum
dorsale
Ligg. tarsometatarsea dorsalia
Ligg. metatarsea dorsalia
Articulatio metatarsophalangea IV
Ligg. collateralia
235. Ligaments and joints of right foot (½).

(Dorsal surface.)
LIGAMENTS AND JOINTS OF THE FOOT 241
Lig. tibiofibulare
posterius
Pars tibiotalaris posterior
(lig. mediale) (deltoideum)
Pars tibiocalcanea Facies superior tali
(lig. mediale) (deltoideum)
Lig. talofibulare posterius
Lig. calcaneo fibulare
Articulatio subtalaris
(cavum)
236. Ligaments and joints of right foot (¼).

(Articular capsules are removed.)
Articulatio
metatarsophalangea
(opened)
Ligg. collateralia
Ligg. plantaria
Ligg. metatarsea .....,,-----1"--!-----i---,.-,,

plantaria
�---....:;_;;....;:31-�-Tendo m. peronaei
longi
,'1..----id-n::lP... Ligg. cuneonavicularia plantaria
Tendo m. tibialis anterioris
��-_.l,,,--...:...,-.i;....u...-- Lig. cuboideonaviculare plantare
posterioris
Tendo m. peronaei __
brevis
Tendo m. peronaei
longi
Lig. calcaneonaviculare
plantare
237. Ligaments and joints of right foot (½).

(Plantar surface.)
Tibia
Articulatio talocruralis
(cavum)
Lig. talofibulare posterius
Lig. mediale
(deltoideum)
Lig. talocalcaneum interosseum
Lig. bifurcatum
Lig. Articulatio cuneonavicularis (cavum)

Lig. intercuneiforme interosseum
Os cuneiforme intermedium
Ltg cuneocubo1deum
interosseum Os cuneiforme laterale
Os cuboideum
Ligg. metatarsea Lig. cuneometatarseum

interossea interosseum
Ligg. collateralia
Articulationes interphalangeae
(cavum)
238. Joints and ligaments of right foot (½).

(Section through ankle joint and joints of foot.)
I ,.-�ri
_;-L--Tibia
Articulatio talocruralis Lig. talocalcaneum interosseum
Articulatio subtalaris
Calcaneus
Os metatarsale II
Articulatio talocalcaneonavicularis
238a. Joints and ligaments of right foot (½).

(Section through ankle joint and joints of foot.)
on top, while on the sides it carries flat malleolar facet of the lat tween the tip of the medial malleolus and the sustentaculum tali;
eral and malleolar facet of the medial surface of the talus (facies (d) the posterior talotibial part (Pars tibiotalaris posterior) run
malleolaris lateralis et media/is). The leg bones grasp the trochlea of ning from the posterior border of the medial malleolus downwards
the talus like a fork. and laterally to be attached to the posteromedial parts of the body
The articular capsule (capsula articularis) is attached for a great of the talus.
distance to the edge of the articular cartilage and only on the ante The following ligaments are on the lateral surface of the ankle
rior surface of the body of the talus it separates from the cartilage joint.
to be attached to the neck of the talus. The anterior and posterior 1. The anterior talofibular ligament (ligamentum talofibulare an
parts of the capsule are weak. terius). It passes from the anterior border of the lateral malleolus to
The ligaments of the ankle joint run on its sides. the lateral surface of the neck of the talus.
1. The medial (deltoid) ligament (ligamentum mediale [deltoi 2. The calcaneofibular ligament (ligamentum calcaneofibulare)
deum]) (Figs 235, 236, 238). It is subdivided into the following which arises on the lateral surface of the lateral malleolus, runs
parts: downwards and backwards, and is attached to the lateral surface of
(a) the anterior talotibial part (Pars tibiotalaris anterior) running the calcaneum.
downwards and forwards from the anterior border of the medial 3. The posterior talofibular ligament (ligamentum talefibulare
malleolus to be attached to the posteromedial surface of the talus; posterius). It stretches almost horizontally from the posterior border
(b) the tibionavicular part (pars tibionavicularis) stretching from of the lateral malleolus to the lateral tubercle of the posterior pro
the medial malleolus to the dorsal surface of the navicular bone; it cess of the talus.
is longer than the aforementioned part; The ankle joint is a variant of the hinge joint of the cochlear
(c) the calcaneotibial part (Pars tibiocalcanea) stretching be- type.
THE SUBTALAR JOINT

The subtalar (talocalcanean) JOmt (articulatio subtalaris) 1. The interosseous talocalcanean ligament (ligamentum talocal
(Figs 236, 238, 241) is formed by the posterior calcanean facet for caneum interosseum) lies in the sinus tarsi and its ends are attached
the talus (facies articularis posterior calcanei), and the posterior calca to the groove of the calcaneum and the groove of the talus.
nean facet of the talus (facies articularis calcanea posterior tali). 2. The lateral talocalcanean ligament (ligamentum talocalcaneum
The articular capsule (capsula articularis) is loose and is at laterale) is stretched between the superior surface of the neck of
tached for the most part to the edge of the articular cartilages and the talus and the superolateral surface of the calcaneum.
only in front (on the talus) and behind (on the calcaneum) it devi 3. The medial talocalcanean ligament (ligamentum talocalca
ates slightly from the margins of the articulating surfaces. neum mediale) runs from the posterior process of the talus to the
The joint is strengthened by the following ligaments. sustentaculum tali.
THE TALOCALCANEONAVICULAR JOINT

The talocalcaneonavicular joint (articulatio talocalcaneonavicula 2. The plantar calcaneonavicular ligament (ligamentum calca
ris) (Fig. 235) is formed by the articular surfaces of the talus, calca neonaviculare plantare). It passes from the sustentaculum tali to the
neum, and navicular bone. The talus forms the articular head, the plantar surface of the navicular bone. In the upper part it is con
calcaneum and navicular bone supply the articular socket. tinuous with the navicular fibrous cartilage which contributes to
The articular capsule (capsula articularis) is attached to the the formation of the articular socket of the joint.
edges of the articular cartilages. According to shape, the talocalcaneonavicular joint is a spher
The following ligaments reinforce the capsule. oid joint (articulatio spheroidea) but it permits movements only in
1. The talonavicular ligament (dorsal) (ligamentum talonavicu one plane, about the axis, approximately in the sagittal direction.
lare) stretches between the neck of the talus and the navicular
bone.
THE CALCANEOCUBOID JOINT

The calcaneocuboid joint (articulatio calcaneocuboidea) (Fig. 235) die-shaped. The medial part of the articular capsule (capsula articu
is formed by a facet on the posterior surface of the cuboid bone laris) is attached to the edge of the articular cartilage and is taut;
(facies articularis posterior ossis cuboidei) and a facet on the calcaneum the lateral part is attached at some distance from the edge of the
(facies articularis cuboidea calcanei). The articulating surfaces are sad- cartilage.
Ligaments, which are stronger on the plantar surface, reinforce 2. The short plantar ligament (ligamentum calcaneocuboideum
the joint. plan/are) is located deeper than the long plantar ligament.
I. The long plantar ligament (ligamentum plantare longum) is Its bundles are in direct contact with the articular capsule
the strongest. It arises on the inferior surface of the tuber calcanei, and connect the plantar surfaces of the calcaneum and cuboid
runs forwards, bridges the groove of the cuboid bone to form an bone.
osteofibrous canal, and reaches the bases of the four lateral meta The calcaneocuboid joint resembles a saddle joint (articulatio
tarsal bones. The deep bundles of this ligament are shorter and are sellaris) in shape but functions as a uniaxial joint.
attached to the tuberosity of the cuboid bone.
THE TRANSVERSE TARSAL JOINT

The transverse tarsal joint (articulatio tarsi transversa) (Figs 235, the medial calcaneocuboid ligament (ligamentum calcaneocuboideum);
238) unites two joints, the talocalcaneonavicular (articulatio talocal it runs to the dorsal surface of the cuboid bone. The other is me
caneonauicularis) and the calcaneocuboid (articulatio calcaneocuboidea) dial to it and is called the lateral calcaneonavicular ligament (liga
joints. The line of the joint is S-shaped with the medial part being mentum calcaneonauiculare); it passes to the navicular bone.
convex anteriorly and the lateral part convex posteriorly. The The bifurcated ligament is also known as 'the key' to the trans
joints are isolated anatomically but have a common bifurcated lig verse tarsal joint because with all the ligaments surrounding this
ament (ligamentum bifurcatum). This ligament arises on the dorsal joint being cut it holds the articulating bones in place and the foot
surface of the calcaneum at its anterior border and separates im can be exarticulated at this joint during operation. only when this
mediately into two ligaments. One is situated laterally and is called ligament is transected.
THE CUNEONAVICULAR JOINT

The cuneonavicular joint (articulatio cuneonauicularis) (Fig. 235) culare dorsale) lies laterally to the dorsal cuneonavicular ligament
is a complex articulation in the formation of which the navicular, and connects the dorsal surfaces of the cuboid and navicular
cuboid, and the three cuneiform bones take part. The following ar bones.
ticulations form here: joints between the anterior articular surfaces 3. The dorsal intercuneiform ligaments (ligamenta intercunei
of the navicular bone and the posterior articular surfaces of the formia dorsalia) are on the dorsal surface of the joint between the
medial, intermediate, and lateral cuneiform bones, and joints be medial, intermediate and lateral cuneiform bones.
tween the contiguous surfaces of the cuboid, navicular, and cunei 4. The plantar cubonavicular ligament (ligamentum cuboideo
form bones. nauiculare plan/are) (Fig. 241) lies on the plantar surface of the joint
The joint cavity between the navicular and cuneiform bones is between the cuboid and navicular bones.
in the frontal plane and from it branch out to the front another 5. The plantar cuneocuboid ligament (ligamentum cuneocuboi
three joint cavities, one between the medial and intermediate cu deum plantare) connects the plantar surfaces of the lateral cunei
neiform bones, another between the intermediate and lateral cun form and cuboid bones.
eiform bones, and the third between the lateral cuneiform and cu 6. The plantar cuneonavicular ligaments (ligamenta cuneonaui
boid bones; a cavity also extends to the back between the navicular cularia plantaria) are stretched between the plantar surface of the
and cuboid bones. navicular and the three cuneiform bones.
The articular capsule (capsula articularis) is attached along the 7. The plantar intercuneiform ligaments (ligamenta intercunei
edge of the articular cartilage. The joint cavity communicates with formia plantaria) are situated on the plantar surface between the
the cavity of the tarsometatarsal joint (articulatio tarsometatarsea) in cuneiform bones.
the region of the second metatarsal through the joint cavities be In addition to the ligaments described above, a series of short
tween the medial, intermediate and lateral cuneiform bones. strong ligaments are located between the adjacent bones in the
The following ligaments strengthen the cuneonavicular joint. joint cavities: the interosseous cuneocuboid ligament (ligamentum
I. The dorsal cuneonavicular ligaments (ligamenta cuneonauicu cuneocuboideum interosseum), interosseous intercuneiform ligaments
laria dorsalia) stretch on the dorsal surface of the joint between the (ligamenta intercuneiformia interossea). The cuneonavicular joint is an
navicular and the three cuneiform bones. articulation permitting a limited range of movements.
2. The dorsal cubonavicular ligament (ligamentum cuboideonaui-
239. Joints of right foot. Radiograph.

I-tibia 8-prnximal phalanx of great toe
2-talus 9-distal phalanx of great toe
3-navicular bone 11-tubercle of fifth metatarsal bone
4-medial cuneiform bone 12-cuboid bone
5-intermediate cuneiform bone 13-calcaneum
6-lateral cuneiform bone 14�fibula
7 and IO-metatarsal bone
240. Joints of right foot. Radiograph taken with the toes m dorsal
flexion.
1-tibia 8-proximal phalanx
2-talus 9-distal phalanx
3-navicular bone 11-tubercle of metatarsal bone
4-medial cuneiform bone 12-cuboid bone
5-intermediate cuneiform bone 13-calcaneum
6-lateral cuneiform bone 14-fibula
7 and IO-metatarsal bone
Tendo m.
Ligg. metatarsea
plantaria
Lig. tarsometatarseum
Ligg. plantare
tarsometatarsea
plantaria
Ligg. intercuneiformia
plantaria
Lig. cuboideo -
naviculare plantare
plantare
241. Ligaments and joints of right foot (%).

(Plantar surface.)
THE TARSO METATARSALJOINTS

The tarsometatarsal joints (articulationes tarsometatarseae) The articular capsule (capsula articularis) of each tarsometatar
(Figs 235, 238) join the bones of the tarsus to the bones of the me sal joint is attached along the edge of the articular cartilage and is
tatarsus. The following three tarsometatarsal joints are distin strengthened by the following ligaments.
guished: (1) between the medial cuneiform and the first metatarsal 1. The dorsal tarsometatarsal ligaments (ligamenta tarsometatar
bones; (2) between the intermediate and lateral cuneiform and the sea dorsalia) are situated on the dorsal surface of the joints.
second and third metatarsal bones; (3) between the cuboid and the 2. The plantar tarsometatarsal ligaments (ligamenta tarsometa
fourth and fifth metatarsal bones. The joint between the medial tarsea plan/aria) which are on the plantar surface.
cuneiform and first metatarsal bones is formed by articular sur 3. The interosseous metatarsal ligaments (ligamenta metatarsea
faces which are slightly saddle-shaped, the other bones articulate interossea) stretch between the bases of the metatarsal bones.
by means of flat surfaces. The line formed by the cavity of the tar 4. The interosseous tarsometatarsal ligaments (ligamenta cuneo
sometatarsal joints is irregular because the second metatarsal bone metatarsea interossea) join the cuneiform bones to the metatarsal
is longer than the other metatarsals, while the lateral cuneiform bones. The medial one joins the medial cuneiform bone to the
bone projects forwards a little as compared to the anterior part of base of the second metatarsal bone and is 'the key' to the tarsome
the cuboid bone. tatarsal joints. These joints permit a limited range of movements.
THE INTERMETATARSAL JOINTS

The intermetatarsal joints (articulationes intermetatarseae) form amen/a metatarsea interossea), the dorsal metatarsal ligaments (liga
between the bases of the metatarsal bones. The direction of liga menta metatarsea dorsalia), and the plantar metatarsal ligaments (lig
ments strengthening them is on the whole similar to that of the lig amenta metatarsea plan/aria).
aments of the hand. The gaps between the individual metatarsal bones are called
The articular capsules (capsulae articulares) are reinforced by interosseous spaces of the metatarsus (spatia interossea metatarsi).
the following ligaments: the interosseous metatarsal ligaments (lig-
THE METATARSO PHALANGEALJOINTS

The metatarsophalangeal joints (articulationes metatarsophalan in the dorsal part, but is strengthened by the plantar ligaments (li
geae) (see Figs 235, 237, 238) are formed by the articular surfaces gamenta plantaria) on the plantar surface and by the collateral liga
of the heads of the metatarsals and the bases of the proximal pha ments (ligamenta collateralia) on the sides. In addition, the deep
langes. The heads of the second and third metatarsal bones are of transverse ligament of the sole (ligamentum metatarsea transversa pro
an irregular spherical shape and their dorsal surface is rather nar Junda) stretches between the heads of the metatarsal bones.
row. The metatarsophalangeal joints are of the ball-and-socket type
The articular capsules (capsulae articulares) are attached along (articulatio spheroidea). .,..
the edge of the articular cartilage and are loose. The capsule is thin
THEINTERPHALANGEALJOINTS
The interphalangeal joints of the toes (articulationes interphalan ened by the collateral ligaments (ligamenta collateralia) on the sides
geae pedis) (Figs 235, 237, 239) join the proximal phalanges to the and by the plantar ligaments (ligamenta plan/aria) on the plantar
middle phalanges and the middle phalanges to the distal ones. surface.
Their articular capsules (capsulae articulares) are thin and strength- The interphalangeal joints are of the hinge type (ginglymus).
OF BONE ARTICULATIONS
The bones are laid down at the end of the second month of in Almost all of the elements of the joints of adults are also pres
trauterine life as thickenings of the mesenchyme between the carti ent in the joints of the newborn (Figs 241b and c). The most active
laginous ends of the future bones (Fig. 241a). The mesenchyme re factor determining the formation of a joint after birth are the mus
sorbs and a space, i.e. the cavity of the future joint, appears in it. cles which exert an action on the given joint, i.e. the work of the
Thus, at the site of the joint the bones come in contact with one joint.
another by means of cartilagionous articular surfaces, whereas the The specific features of some elements in certain joints can be
mesenchyme surrounding the formed joint cavity blends with the seen in Figs 241b and c. In the shoulder and hip joints, for in
perichondrium and gives rise to the articular capsule. When two stance, the articular labrum is poorly pronounced and the glenoid
spaces appear in the mesenchyme located between the articular cavity of the scapula and the acetabulum of the hip bone are not
surfaces, it separates these cavities to form later a disc which com deep enough. The articular capsule is relatively thick.
pletely separates one cavity from the other; a bilocular joint forms. Some age features can be found in the joints of the hand. In
A meniscus forms if the central part of the disc fails to develop. the newborn the articular disc in the distal radioulnar joint is still
241a. Development ofjoint (represented semischematically).

I-accumulation of mesenchymal cells (prechondral state) 6-articular capsule
2-site of cavity of future joint 7 -articular cartilage
3-perichondrium 8-articular disc
4-periosteum 9-meniscus
5-joint cavity
252 JOINTS OF A NEWBORN
241b. Shoulder joint (articulatio humeri), joints of hand (articula

tiones manus), and mandibular joint (articulatio temporomandibula
ris) of the newborn.
3
2
241c. Joints of right lower limb (juncturae membri inferioris) of the

newborn.
1-hipjoint 3-menisci of knee joint
2-knee joint 4-joints of foot
DEVELOPMENT OF BONE ARTICULATIONS 253
not formed, while the articular disc in the mandibular joint closely All elements encountered in the joints of an adult are demon
resembles that in an adult. This is determined by the functional strated in the joints of the newborn (Figs 241 b and c) but as if pro
differences between these two joints. totypes. Subsequently they continue their formation and acquire
The development of bone articulations is directly dependent the geometrical shapes of the articular surfaces characteristic of
on the formation of the bony and connective-tissue structures and each joint of an adult.
muscular tissue.
THE
SCIENCE
OF THE
MUSCLES
Myologia
"" )
,.
·•
MUSCLES OF THE HUMAN BODY 259
Venter occipitalis (m. occipitofrontalis)

- M. semispinalis capitis
/•lll./Jir-'1.1:r-
splenius capitis
sternocleidomastoideus
deltoideus
M. brachioradfalis
.··:,�-
M.
M.
111!-'-l--f'.f- M. flexor carpi radialis

M. palmaris longus
< M. gJ_utaeus medius
.,,.,,..--- M. f!e\or carpi ulnaris
. 1-,,i:' �l'ut_ aeus ,naximus:,,---,-,-,.�'-r,,- flexor digitorum
' ..
4 '' .... <,·· superficialis
(tendo)
·/.' ;..t
'
,. ,
✓
' "\
-·
✓
·,
·J
/
semimembranosus
biceps femoris . . .., • J
,,, ',....
1
semimembranosus
-;:
, '.
�-
M. peronaeus brevis
M. peronaeus longus
(tendo)
243. Muscles of the human body (posterior aspect).

260 TYPES OF MUSCLES
Tendo f
I
244. Spindle-shaped, or fusiform muscle (mus 245. Broad muscle.
culus fusiformis). (Obliquus externus abdominis muscle shown in
(Extensor carpi radialis brevis muscle shown in illustration.) illustration.)
nati) which have a complex tendinous framework while the muscle muscles (musculi articulares) which reinforce a joint and pass into it
fibres are attached to its numerous septa by bands. or are attached to the articular capsule, cutaneous muscles (musculi
The shape of the muscles is diverse (Fig. 271). Muscles can be cutanei) which are inserted into the skin and move it, pronators
quadrate (musculi quadrati), triangular (musculi triangulares), cruciate (musculi pronatores), supinators (musculi supinatores), tensors (musculi
(musculi cruciati), circular (musculi orbiculares), muscles with two tensores), and others.
heads (biceps) (Fig. 248) and more (triceps, quadriceps), muscles with Functionally muscles are united to form groups responsible for
two bellies (biventer) (Fig. 249); muscles which are attached by motor activity of one type. These are functional working groups.
means of several slips (serrate muscles) or by means of aponeurosis Each axis of rotation at a joint has its own pair of functional
(broad muscles), etc. working groups. Uniaxial joints have one pair (or two functional
According to function, the following muscles are distinguished: working groups), biaxial joints have two pairs (four groups of mus
flexors (musculi jlexores), extensors (musculi extensores), adductors cles), triaxial joints have three pairs (six groups of muscles).
(musculi adductores), abductors (musculi abductores), rotators (musculi Muscles which act in concert as components of one functional
rotatores), levators (musculi levatores), depressors (musculi depressores), working group, i.e. which accomplish a single-type action, are
erectors (musculi erectores), sphincters (musculi sphincteres), articular called synergists. Muscles which act in opposition to another
TYPES OF MUSCLES 261
Tendo
Venter ji
1J
Tendo
246. Unipennate muscle (muscu 247. Bipennate muscle (musculus 248. Biceps muscle.
lus unipennatus). bipennatus). (Biceps brachii muscle shown m il
(Flexor pollicis longus muscle shown m il (Flexor hallucis longus muscle shown in il lustration.)
lustration.) lustration.)
group of muscles and are a component of another functional work (2) osteofibrous canals;
ing pair are called antagonists. Such differentiation is conditional (3) interosseous septa;
because in some movements synergists may act as antagonists and (4) retinacula of tendons.
vice versa. Thus, the fasciae isolate groups of muscles and provide condi
The skeletal muscles have an auxiliary apparatus (Fig. 250a) tions for their free independent contraction.
which makes their functioning easier. It includes fasciae, synovial The supporting function lends fasciae particular significance,
bursae, sheaths of tendons, trochlea of muscles, tendinous arches, they are the site of origin and insertion of many muscles.
and sesamoid bones. In case of local inflammation the fasciae limit the focus of
The fasciae are fibrous membranes which form linings for affection and prevent its extension to the adjacent group of mus
body cavities and cover muscles (with the exception of the muscles cles. The interfascial spaces, in contrast, often serve as paths for
of the face) and organs. Superficial fasciae passing in the subcu the spread of the inflammatory process.
taneous fat and deep (proper) fasciae are distinguished. The deep The synovial bursae (bursae synoviales) are thin-walled isolated
fasciae form the following structures for the skeletal muscles: sacs which do not communicate with the joint cavity. They are
(1) fibrous canals; formed of a synovial membrane and contain synovial fluid. They
Intersectio
tendinea
249. Digastric (biventer) muscle (musculus digas 250. Multigastric muscle.

tricus). (Rectus abdominis muscle shown in illustra
(Omohyoid muscle shown in illustration.) tion.)
may be located under the skin (subcutaneous synovial bursa, bursa mation of which contributes the fascia forming the osteofibrous
synovialis subcutanea ), under fasciae (subfascial synovial bursa, bursa canal, and an internal synovial layer (stratum synovia,l,e), in view of
synovialis subfascialis), between or under the muscles (submuscular which they are called synovial sheaths of tendons (vaginae synoviales
synovial bursa, bursa synovialis submuscularis ), and under tendons tendinum).
(subtendinous synovial bursa, bursa synovialis subtendinea ). The bur The synovial layer forms a duplicature lining the tendon itself
sae reduce friction and protect the muscle from injury and, as a re and the inner surface of the fibrous layer. A synovial cavity (cavitas
sult, make the work of the muscles easier. synovialis) containing synovial fluid forms between the two synovial
The sheaths of tendons (vaginae tendines) are protective devices surfaces of the synovial layer. The site of junction of the synovial
for muscle tendons at the places of their closest contact with the surfaces is called the mesotendon (mesotendineum). The part of the
bone, mainly on the hand and foot. They reduce friction, make the synovial layer investing the tendon itself is known as the peritendi
work of the muscles easier, and reduce the risk of injury to that neum.
part of the tendon which borders upon the bone. The sheaths of Muscular pulleys (trochleae musculari) are encountered on the
tendons have an external fibrous layer (stratum fibrosum) to the for- bone in some parts of the skeleton. A tendinous arch (arcus tendi-
1-fasciae (forearm fasciae) 3-synovial bursae (A-in the region of the shoulder joint; B-the knee)
2-tendon sheaths (A-opened sheath of finger tendon; B-transverse section of sheath) 4-trochlea of muscles (of superior oblique muscle) 5-sesamoid bones (patella)
neus) forms here above the notch in a bone covered with a thin contractile apparatus of a skeletal muscle develops particularly in
layer of cartilage. Passing under the arch over the trochlea, the ten tensively from the age of 3-4 years, and by the age of 7-8 the mus
don is held fast in place and changes its direction. A synovial cles are almost similar in structure to those of adults. The physio
bursa reducing friction is lodged between the tendon and the logical properties of the muscles, however, begin to be established
trochlea. from the age of 12-14 years and the process is completed -only by
Sesamoid bones are present in the tendons of some muscles. the second decade of life. The development of muscles reaches its
One of the surfaces of such a bone is covered by cartilage and ar peak by the third decade of life when the diameter of the muscle
ticulates with the articular surface of the other bone. The sesamoid fibres is the greatest and the network of blood vessels, the nerve
bones are located close to the site of attachment of the tendon and apparatus, and the connective-tissue framework are developed
increase the angle of the attachment, thus contributing to the im well.
provement of the conditions for the work of the muscle and in Involution of the skeletal muscle begins at old age. The ratio of
creasing the lever of action of the muscular traction. The patella is its components is disturbed: the striated muscular tissue atrophies,
the largest sesamoid bone. some of the blood vessels become empty, the number of nerve ap
The structure of skeletal muscles characteristic of an adult paratus decreases. This is accompanied by growth of fibrous con
I
takes shape gradually. Thf muscles of a newborn possess all the nective and fatty tissue. Physical exertion delays the development
components, but still resemble the foetal muscles in structure. The of involutional changes in the skeletal muscle.
MUSCLES OF THE TRUNK AND HEAD
Musculi trunci et capitis
. MUSCLES AND FASCIAE

OF THE TRUNK
The human body except for the head and limbs is called the trunk (truncus).
The muscles of the trunk are grouped as follows: (I) the muscles of the back (musculi dorsi); (2) the mus
cles of the neck (musculi colli); (3) the muscles of the chest (musculi thoracis); (4) the muscles of the abdomen
(musculi abdominis).
MUSCLES AND FASCIAE

OF THE BACK
REGIONS OF THE BACK

The following regions of the back (regiones dorsi) (Fig. 252) are nens and of the vertebrae distal to it are palpated along the sulcus.
distinguished: To the sides of the sulcus the contours of the sacrospinalis muscle
(a) the nuchal region (regio colli posterior), an unpaired region are visible, in the upper part are also seen the contours of the scap
occupying the posterior (occipital) parts of the neck; ula and its spine (spina scapulae). The superior border of t�e scap
(b) the vertebral region (regio vertebralis), an unpaired region ula is on the level with the second rib, the inferior angle is on the
corresponding to the contours of the vertebral column; level with the seventh rib. On contraction of well-developed mus
(c) the scapular region (regio scapularis), corresponding to the culature a depression, a rhomboid area, is noticeable in the upper
contours of the scapula; part of the back, in the centre of which is located the spine of the
(d) the infrascapular region (regio infrascapularis), right and left, vertebra prominens.
located below the scapula; This depression corresponds to the expanded part of the ten
(e) the lumbar region (regio lumbalis), right and left, bounded don of the trapezius muscle. The iliac crests can be felt in the
by the twelfth rib above and by the iliac crest below; lower part of the back. Another rhomboid depression is outlined
(f) the sacral region (regio sacralis), an unpaired region corre here and bounded above by the spinous process of the fifth lumbar
sponding to the contours of the sacrum. vertebra, on the sides by the posterior superior iliac spine, and be
A longitudinal sulcus dorsi passing on the midline is seen on low by the coccyx.
inspection of the back; the spinous process of the vertebra promi-
M. biceps
brachii
Spina scapulae
Margo medialis_�--------
scapulae
M. triceps brachii
(caput laterale) __
M. triceps brachii ____

(caput mediate)
251. Outlines of trunk muscles (posterior

aspect).
Regio parietalis
Regio temporalis
Regio colli
posterior
Regio deltoidea
Regio brachii
posterior
Regio infrascapularis
Regio vertebralis
Regio lumbalis
Regio sacralis
Regio perinealis
Regio femoris posterior
252. Regions ef the trunk and lines ef skin incisions.

(Blue line-boundaries of regions; red line-skin incisions most suitable for exposure of
muscles which are being prepared.)
268 MUSCLES OF THE BACK
MUSCLES OF THE BACK

Superficial and deep muscles of the back (musculi dorsi) are dis II. Deep (proper) muscles of the back.
tinguished. A. Long muscles:
I. Superficial muscles of the back. 1. The splenius capitis muscle (musculus splenius capitis).
A. Muscles of the back related to the upper limb: 2. The splenius cervicis muscle (musculus splenius cervicis).
1. The trapezius muscle (musculus trape;:,ius). 3. The sacrospinalis muscle (musculus erector trunci spinae).
2. The latissimus dorsi muscle (musculus latissimus dorsi). 4. The transversospinalis muscle (musculus transversospinalis).
3. The rhomboid major and minor muscles (musculi rhom- B. Short muscles:
boidei major et minor). 1. The interspinales muscles (musculi interspinales).
4. The levator scapula muscle (musculus levator scapulae). 2. The intertransverse muscles (musculi intertransversarii).
B. Muscles of the ribs: 3. The levatores costarum muscles (musculi levatores
5. The serratus posterior superior muscle (musculus serratus costarum).
posterior superior). 4. The group of suboccipital muscles.
6. The serratus posterior inferior muscle (musculus serratus The deep muscles of the back are covered by the lumbar fascia
posterior superior). (fascia thoracolumbalis).
SUPERFICIAL MUSCLES OF THE BACK

1. The trapezius muscle (musculus trape;:,ius) (see Figs 243, 253) sacrospinalis muscle and laterally by the upper border of the inter
is a flat and broad muscle occupying a superficial position on the nal oblique muscles of the abdomen; the floor (anterior wall) of
back of the neck and upper part of the back. It is triangular with this area is formed by the aponeurosis of the transversus abdomi
the base facing the vertebral column and the apex directed to the nis muscle.
acromion of the scapula. The trapezius muscles of both sides meet The upper fibres of the latissimus dorsi muscle pass laterally
to form a trapezoid. The muscle takes origin from the external oc and the lower fibres ascend obliquely and laterally to cover the
cipital protuberance, the superior nuchal line, ligamentum nuchae posterior surface of the lower ribs. The muscle receives here acces
and supraspinous ligament of all thoracic vertebrae. The tendi sory fibres in the form of three or four slips and also covers the in
nous bundles of the muscle are short and only in the region of the ferior angle of the scapula and the inferior margin of the teres ma
lower cervical and upper thoracic vertebrae they are very long and jor muscle (musculus teres major) (sometimes receiving an additional
form a diamond-shaped tendinous area. fibre). Proximally the latissimus dorsi muscle forms the posterior
The muscular fibres pass radially to the scapula and are in wall of the axillary fossa, approaches the humerus and is inserted
serted into the spine of the scapula, the acromion, and the acrom in the crest of its lesser tubercle. The bursa of the latissimus dorsi
ial part of the clavicle. muscle (bursa subtendinea musculi latissimi dorsi) is located here.
Action: on contraction all the fibres draw the scapula to the Action: draws the arm to the trunk and pulls the upper limb
vertebral column; contraction of the upper fibres raises the sca backwards to the midline and at the same time rotates it medially
pula, contraction of the lower fibres lowers it. When the scapula is (pronation). When the arm is fixed the muscle pulls the trunk up
fixed, both trapezius muscles pull the head backwards; contraction on the arm or contributes to upward displacement of the lower
of one of the muscles tilts the head to the corresponding side. ribs in respiratory excursions and is thus an accessory muscle of
Innervation: branch of accessory nerve to sternomastoid mus respiration.
cle and cervical nerves (C 3 -C4 ). Innervation: nerve to the latissimus dorsi muscle (C 7 , C8 ).
Blood supply: transverse cervical, occipital, suprascapular, and Blood supply: the thoracodorsal, circumflex humeral, and in
intercostal arteries. tercostal arteries.
2. The latissimus dorsi muscle (see Figs 243, 253, 254) is a flat 3. The rhomboid major muscle (musculus rhomboideus major)
muscle located superficially in the lower part of the back, but its (Figs 254, 257) is a muscle of the second layer. It lies under the
superior fibres are covered in the initial part by the trapezius mus trapezius muscle between the scapulae and is shaped like a flat and
cle. It arises from the spinous processes of the lower five or six wide rhomboid plate. It arises from the spinous processes of the
thoracic vertebrae, the superficial (posterior) layer of the thoraco upper four thoracic vertebrae. Its fibres pass laterally and slightly
lumbar fascia, the posterior part of the outer lip of the iliac crest, downwards to be inserted into the medial border of the scapula.
and lower four ribs. The lateral border of the tendinous part of 3a. The rhomboid minor muscle (musculus rhomboideus minor)
this muscle, the posterior border of the external oblique muscle of arises from the spinous processes of the lower two cervical verte
the abdomen and the iliac crest below form the lumbar triangle brae and is inserted into the medial border of the scapula. Both
(trigonum lumbale), or Petit's triangle; the floor (anterior wall) of the rhomboid muscles are often separated by a small layer of connec
triangle is the internal oblique muscle of the abdomen. Above this tive tissue.
triangle is a small rhomboid area covered posteriorly by the latissi Action: draw the scapula closer to the vertebral column along
mus dorsi muscle and bounded above by the twelfth rib and lower an oblique line directed to the midline and upwards.
border of the serratus posterior inferior muscle, medially by the Innervation: nerve to the rhomboids (CcC 6 ).
Protuberantia occipitalis
externa
M. sternocleidomastoideus
M. trapezius
Processus spinosus vertebrae
cervicalis VII
deltoideus
Fascia
infraspinata
M. teres major
M. triceps
brachii
rhomboideus major
Processus spinosus
vertebrae thoracicae XII
M. obliquus abdominis Trigonum lumbale

externus obliquus abdominis internus)
M.
253. Supeificial muscles of the back (musculi

dorsi) (¼).
M. splenius capitis (pulled aside)
M. levator scapulae
M. rhomboideus minor
M. levator scapulae (pulled aside) M. rhomboideus major
M. supraspinatus
M. infraspinatus
(partly removed)
M. infraspinatus
M. teres minor
M. tri�eps brachii
(caput longum)
(clit off)
M. serratus anterior
M. serratus posterior
inferior M. erector spinae
(pulled)
M. obliquus abdominis
externus
Fascia thoracolumbalis externus
(deep layer)
Fascia thoracolumbalis ::::::::::::�'...J-!!+i-lfifur.;:��,..,�

(superficial layer)
M. glutaeus maximus
Lig. sacrotuberale
Tuber ischiadicum
M. glutaeus maximus
(cut and reflected)
254. Supeifi,cial muscles of the back and posterior re

gion of the neck (¼).
(First, second, and third layers. The trapezius muscles and left latissimus
dorsi muscle are removed.)
superior
M. splenius
�'!ll�l'lk-- cervicis
M. longissimus
Mm. intercostales --E:::::----'-;iL---;r thoracis.
externi
M. latissimus dorsi
'j/1.ff--:-\- (cut and reflected)
inferior
internus
----
M. obliquus abdominis externus
externus Fascia thoracolumbalis
(superficial layer)
255. Muscles of the back and posterior region of the

neck (¼).
(Third layer of superficial muscles. Firscand second layers of deep muscles. Mus
cles and bones of shoulder girdle are removed.)
Blood supply: the transverse cervical, suprascapular, and inter It arises from the lower part of the ligamentum nuchae and the
costal arteries. spinous processes of the lower two cervical and upper two thoracic
4. The levator scapulae muscle (musculus levator scapulae) (Figs vertebrae. It runs obliquely downwards and laterally and is in
254, 257) is a muscle of the second layer. It is elongated, thick and serted by means of four slips into the external surface of the sec
located in the posterolateral parts of the neck under the trapezius ond, third, fourth, and fifth ribs slightly laterally of their angles.
muscle. It originates as four separate slips from the posterior tu Action: raises the upper ribs, takes part in the act of inspira-
bercles of the transverse processes of the upper four cervical verte tion.
brae and runs downwards and slightly laterally to be inserted into Innervation: intercostal nerves (Th 1- Th4).
the upper part of the medial border of the scapula and its superior Blood supply: intercostal and deep cervical arteries.
angle. 6. The serratus posterior inferior muscle (musculus serratus poste
Action: raises the scapula, its upper angle in particular, caus rior inferior) (see Figs 254, 255, 257), like the posterior superior
ing rotation as a result of which the lower angle is displaced to muscle, is flat and thin and is located under the latissimus dorsi
wards the vertebral column; when the scapula is fixed the cervical muscle. It arises from the superficial layer of the lumbar fascia at
part of the vertebral column is inclined backwards and to the side the level of the lower two thoracic and upper two lumbar verte
of the contracting muscle. brae. Its fibres pass upwards obliquely and laterally and are in
Innervation: nerve to the rhomboids (C4, C5). serted as four slips into the external surface of the lower four ribs.
Blood supply: the transverse cervical, superficial cervical, and Action: lowers the lower ribs and thus takes part in the act of
ascending cervical arteries. respiration.
5. The serratus posterior superior muscle (musculus serratus pos Innervation: the intercostal nerves (Th9- Th 12).
terior superior) (Fig. 255) is thin and covered by the rhomboid mus Blood supply: the intercostal arteries.
cle.
DEEP MUSCLES OF THE BACK

The deep (proper) muscles of the back are classified as long and short muscles.
LONG MUSCLES OF THE BACK
I. The splenius capitis muscle (musculus splenius capitis) (see 1. The iliocostocervicalis muscle (musculus iliocostalis) (see Figs
Figs 254, 255, 257) arises from the ligamentum nuchae and the 255-257) is inserted by numerous muscular and tendinous slips
spinous processes of the lower five cervical and upper three thor into the angles of all the ribs and the transverse processes of the
acic vertebrae and is inserted into the lateral parts of the superior lower cervical vertebrae; it is divided topographically into the mus
nuchal line and the posterior border of the mastoid process. culi iliocostalis lumborum, thoracis, and cervicis:
II. The splenius cervicis muscle (musculus splenius cervicis) arises (a) the iliocostalis muscle (musculus iliocostalis lumborum) takes
from the spinous processes of the lower five cervical and upper five origin from the posterior part of the transverse tubercles of the
thoracic vertebrae and is inserted into the posterior tubercles of the sacrum and lumbar fascia, passes laterally and upwards, giving off
transverse processes of the upper two or three cervical vertebrae. eight or nine slips which are inserted into the angles of the lower
Action: bilateral contraction pulls the head and neck back eight or nine ribs by thin and narrow tendons;
wards. In unilateral contraction the head and neck are rotated to (b) the costalis muscle (musculus iliocostalis thoracis) arises near
the side of the acting muscle. the angles of the lower five or six ribs, ascends slightly obliquely
Innervation: the greater occipital nerve and third and fourth and laterally and is inserted by thin, narrow tendons into the
cervical nerves (CrC4 ). angles of the upper five or seven ribs;
III. The sacrospinalis muscle (musculus erector spinae) (see Figs (c) the costocervicalis muscle (musculus iliocostalis cervicis) takes
255-257) is the strongest and longest muscle of the back. It fills origin from the angles of the upper five or seven ribs, also ascends
completely the depression in the back formed to the sides of the obliquely and laterally, and is inserted by three slips into the pos
spinous processes and extending to the angles of the ribs. The terior tubercles of the transverse processes of the fourth, fifth, and
muscle takes origin from the posterior part of the iliac crest, the sixth cervical vertebrae.
dorsal surface of the sacrum, the spinous processes of the lower Innervation: the spinal nerves (C3 -C8; Th 1- Th 12; L1 ).
lumbar vertebrae, and partly from the superficial layer of the lum 2. The longissimus muscle (musculus longissimus) (see Figs
bar fascia. Ascending, the muscle separates in the lumbar region 255-257) is medial of the costocervicalis muscle and stretches
into the following three parts: (1) the laterally located iliocostocer from the sacrum to the base of the skull. The following three parts
vicalis muscle; (2) the medially situated spinalis muscle and (3) the are distinguished in it topographically:
longissimus muscle located between them. (a) the longissimus thoracis muscle (musculus longissimus thora-
MUSCLES OF THE BACK 273
cis) arises from the transverse processes of the lumbar and lower muscle whose fibres bridge two to four vertebrae and are covered
six or seven thoracic vertebrae and passes upwards to be inserted by the semispinalis muscle; (3) the rotatores muscles occupying
into the angles of the lower ten ribs and posterior parts of the the deepest position.
transverse processes of all thoracic vertebrae; 1. The semispinalis muscle (musculus semispinalis) (Figs
(b) the longissimus cervicis muscle (musculus longissimus cervicis) 258-260) is separated into three parts topographically:
originates from· the transverse processes of the upper four or five (a) the semispinalis thoracic muscle (musculus semispinalis thora
thoracic and lower cervical vertebrae, stretches upwards, and is in cis). Its fibres run between the transverse processes of the lower six
serted into the transverse processes of the second, third, fourth, and the spinous processes of the upper seven thoracic vertebrae,
and fifth cervical vertebrae; each bridging six or seven vertebrae;
(c) the longissimus capitis muscle (musculus longissimus capitis) (b) the semispinalis cervicis muscle (musculus semispinalis cervi
takes origin from the transverse processes of the upper three thor cis); its fibres are stretched between the transverse processes of the
acic and lower three or four cervical vertebrae, extends upwards, upper thoracic and the spinous processes of the lower seven cervi
and is inserted into the posterior border of the mastoid process. cal vertebrae and bridge five vertebrae;
Innervation: the spinal nerves (C 1 -Cs; Th 1 -Th 12 ; L 1 -L5; (c) the semispinalis
_ capitis muscle (musculus semispinalis capitis);
S 1 -S2 )- it is lodged between the transverse processes of the upper five thor
3. The spinalis muscle (musculus spinalis) (see Figs 255-257) acic and the lower three or four cervical vertebrae and extends to
runs along the spinous processes and is divided topographically the nuchal area of the occipital bone. A medial and lateral parts
into the following three parts: are distinguished in this muscle. The venter of the medial part is
(a) the spinalis thoracis muscle (musculus spinalis thoracis) takes interrupted by a tendinous intersection.
origin from the spinous processes of the upper two or three lumbar Action: contraction of all parts of the semispinalis muscle ex
and lower two or three thoracic vertebrae and extending upwards tends the upper segments of the vertebral column and pulls the
is i11serted into the spinous processes of the eighth to second thor head back or holds it in this position. Contraction of the muscle
acic vertebrae; on one side causes slight rotation.
(b) the spinalis cervicis muscle (musculus spinalis cervicis) arises Innervation: the spinal nerves (C2 -Cs; Th 1 -Th 12 ).
from the spinous processes of the upper two thoracic and lower 2. The multifidus muscle (musculus multifidus) (Figs 258-260) is
two cervical vertebrae, runs upwards, and is inserted into the spi covered by the semispinalis muscle and in the lumbar region by
nous processes of the fourth, third, and second cervical vertebrae; the longissimus muscle. Its fibres run for the whole distance of the
(c) the spinalis capitis muscle (musculus spinalis capitis) is a vertebral column between the transverse and spinous processes of
poorly developed part of the spinalis muscle and is often absent. It the vertebrae (up to the second cervical) and bridges two, three or
takes origin from the spinous processes of the upper thoracic and four vertebrae. It arises from the posterior surface of the sacrum,
lower lumbar vertebrae and extends upwards to be inserted near to the posterior part of the iliac crest, the mamillary processes of the
the external occipital protuberance. lumbar vertebrae, the transverse processes of the thoracic verte
Action: the whole erector spinae muscle acts as a strong exten brae, and the articular processes of the lower four cervical verte
sor of the vertebral column on bilateral contraction. It holds the brae and is inserted into the spinous processes of all vertebrae with
trunk erect. In contraction on one side the vertebral column bends the exception of the atlas.
to the same side. The upper fibres pull the head to the side of the 3. The rotatores muscles (musculi , otatores) (Figs 259, 260) are
contracting muscle. Some of the fibres (the costalis muscle) pull the deepest part of the transversospinalis muscle and are separated
the ribs downwards. into the following parts topographically:
Innervation: the spinal nerves (C 1 -Cs; Th 1 -Th 12 ; L 1 -L5; (a) the cervical rotatores muscles (musculi rota/ores cervicis);
S 1 -S2 )- (b) the thoracic rotatores muscles (musculi rota/ores thoracis);
4. The transversospinalis muscle (musculus transversospinalis) (c) the lumbar rotatores muscles (musculi rotatores lumborum).
(Figs 258-260) is covered by the erector spinae muscle and fills the They take origin from the transverse processes of all vertebrae
depression between the spinous and transverse processes for the (except the atlas) and the mamillary process of the lumbar verte
whole distance of the vertebral column. Its relatively short muscu· brae; overlapping one vertebra, they are inserted into the spinous
Jar fibres run obliquely from the transverse processes of one ver processes of the !],ext vertebrae above, the adjacent parts of their
tebra to the spinous processes of the contiguous vertebra above. arches, and the base of the arches of two contiguous vertebrae.
According to the length of the muscle fibres, i.e. the number of Action: contraction of the transversospinalis muscles on both
vertebrae that they bridge, the following three parts are distin sides extends the vertebral column; contraction of a muscle on one
guished in the transversospinalis muscle: (1) the semispinalis mus side rotates the column to the contralateral side.
cle whose fibres bridge five and more vertebrae; (2) the multifidus Innervation: the spinal nerves (C2 -Cs; Th 1 -Th 12 ; L 1 -Ls)-
M. rectus capitis
posterior minor
M. obliquu_s capitis ---:�-In M. semispinalis capitis
supenor
M. rectus capitis M. longissimus capitis
posterior major
M. obliquus capitis inferior
M. iliocostalis----'--WI"
thoracis
M. spinalis
Mm. intercostales .,....�---Ht.l\-1'�f/Jl'I thoracis
externi
longissimus
thoracis
M. iliocostalis
lumborum
intern us

neck (¼).
(Long deep muscles of the back; second superficial layer.)
MUSCLES OF THE BACK 275
M.
M. infra
spinatus
M. longissimus thoracis
et lumborum
posterior
inferior
M. multifidus
. glutaeus medius
M. quadratus
femoris
magnus
minimus
257. Sites ef origin and insertion ef muscles ef the back (schematical representa
tion).
M. semispinalis capitis
M. rectus capitis
posterior minor
M. obliquus capitis
superior
Mm. interspinales
(cut and reflected)
M. semispinalis
thoracis
Mm. levatores
costarum
Fascia thoracolumbalis
(deep layer)
M. transversus
abdominis
258. Muscles of the back and posterior region ef the

neck (¼).
(Deep muscles of the back; second deep layer.)
ORIGIN AND INSERTION OF MUSCLES OF THE TRUNK 277
M. semispinalis capitis M. trapezius
M. sternocleido
mastoideus
M. digastricus
splenius capitis
��. �l-JJ!:35�:-" �;__

(venter posterior)
'-"- M. longissimus
~ capitis
rectus capitis
posterior minor
M.
externus
M.
intern us
M. semispinalis
Mm. rotatores
thoracis
intertransversarii
lumborum
259. Sites of origin and insertion of muscles of the trunk (schematical representa
tion).
(Deep muscles of the back; second deep layer.)
M. multifidus
M. levator
costae brevis
Mm. rotatores
thoracis M. levator
costae longus
Mm. inter
transversarii
laterales
lumborum
Mm. rotatores M. quadratus
lumborum lumborum
M. transversus
abdominis
�-'-4-- Foramen ischiadicum

majus
.,....,-...,..-:#'---- Lig. sacrospinale

neck (¼).
(Deep muscles; second deep layer. Short muscles of the back and pos
terior region of the neck.)
FASCIAE OF THE BACK 279
SHORT MUSCLES OF THE BACK
1. The interspinales muscles (musculi interspinales) (Figs 257, costarum breves muscles (musculi levatores costarum breves) passing
258, 260) are short paired muscular fibres stretching between the to the rib next below.
spinous processes of two contiguous vertebrae. Action: raise the ribs.
The cervical interspinales muscles (musculi interspinales cervicis), Innervation: the spinal and intercostal nerves (C8; Th,-Th 11).
the thoracic interspinales muscles (musculi interspinales thoracis) 4. The group of suboccipital muscles (Figs 256, 258-260; 261,
(which are often absent), and the lumbar interspinales muscles 262) consists of short, weak muscles occupying the deepest posi
(musculi interspinales lumborum) are distinguished. tion. These are as follows:
Action: extend the vertebral column and hold it erect. (a) the rectus capitis posterior major muscle (musculus rec/us ca
Innervation: the spinal nerves (C3-L5 ). pitis posterior major) runs between the spinous process of the axis
2. The intertransverse muscles (musculi intertransversarii) (Figs and the lateral segment of the inferior nuchal line;
259, 260) are short and stretch between the transverse processes of (b) the rectus capitis posterior minor muscle (musculus rec/us ca
two contiguous vertebrae. The following parts are distin guished: pitis posterior minor) passes from the posterior tubercle of the atlas
the anterior and posterior intertransverse muscles (musculi inter to the medial segment of the inferior nuchal line;
transversarii anteriores et posteriores cervicis), the thoracic intertrans (c) the obliquus capitis inferior muscle (musculus obliquus capitis
verse muscles (musculi intertransversarii thoracis), and the lateral and inferior) stretches between the spinous process of the axis and the
medial intertransverse muscles (musculi intertransversarii laterales et transverse process of the atlas;
mediales lumborum). (d) the obliquus capitis superior muscle (musculus obliquus capitis
Action: hold the vertebral column erect; unilateral contraction superior) runs from the transverse process of the atlas to the lateral
of the muscles bends the column to the side. segments of the inferior nuchal line.
Innervation: the spinal nerves (C 1 -C6 ; L,-4). Action: contraction of muscles on both sides bends the head
3. The levatores costarum muscles (musculi levatores costarum) backwards; contraction of muscles on one side bends the head
(Figs 258-260) are present only in the thoracic segment of the backwards and to the side; at the same time the obliquus capitis
vertebral column. They are covered by the erector spinae muscle. inferior muscle and partly the rectus capitis posterior major mus
The muscular fibres arise from the transverse processes of the ver cle rotate the head.
tebra prominens and the upper eleven thoracic vertebrae and run Innervation: the first cervical (suboccipital) and second cervi
downwards obliquely and laterally, diverging fan-wise, to be in cal nerves.
serted to the angles of the ribs below. In the lower thoracic seg Blood supply: all the deep (proper) muscles of the back are
ment of the vertebral column there are muscular fibres which over supplied with blood by the intercostal, lumbar and sacral arteries
lap one rib. These are called the levatores costarum longi muscles while the muscles of the back of the neck are supplied by the oc
(musculi levatores cos/arum longi) in distinction from the levatores cipital, deep cervical, and vertebral arteries.
FASCIAE OF THE BACK

The following fasciae of the back are distinguished. with the exception of the cervical vertebrae. It is the thickest in the
1. The superficial fascia of the back is a thin connective-tissue lumbar region and much thinner in the upper parts. The super
layer (part of the general subcutaneous fascia) covering the super ficial layer fuses with the deep layer laterally on the lateral border
ficial muscles of the back. of the erector spinae muscle. As a result a fibrous sheath forms
2. The fascia nuchae is located on the dorsal surface of the which invests the lumbar part of this muscle whose upper parts are
neck between the superficial and deep layers of muscles. It fuses lodged in the osteofibrous sheath of the back.
with the ligamentum nuchae medially (Fig. 255) and is continuous The superficial layer gives rise to the latissimus dorsi and serra
with the superficial layer of the cervical fascia laterally; it is at tus posterior inferior muscles. The deep layer of the lumbar fascia
tached above to the superior nuchal line. stretches between the transverse processes of the lumbar vertebrae,
3. The lumbar fascia (fascia thoracolumbalis) (Figs 253-255; the iliac crest, and the twelfth rib; it fuses laterally with the super
258) forms a dense fibrous sheath in which the deep muscles of the ficial layer. The deep layer is present only in the lumbar region, in
back are lodged. This fascia consists of two layers; superficial (pos the space between the quadratus lumborum and the erector spinae
terior) and deep (anterior). The superficial layer is attached below muscles. The transversus abdominis muscle (musculus transversus ab
to the iliac crests, laterally it reaches the angles of the ribs, and is dominis) takes origin from the deep layer and from its junction with
attached medially to the spinous processes of all the vertebrae, the superficial layer.
280 MUSCLES OF THE POSTERIOR REGION OF THE BACK
M. rectus capitis posterior minor

M. rectuscapitis posterior
major (cut off) M. rectus capitis posterior major
M. obliquus capitis superior M. obliquus capitis superior
(cut off)
Tuberculum posterius atlantis M. obliquus capitis inferior
Capsula articulationis atlantoaxialis

lateralis
Processus spinosus
261. Short muscles ef posterior region ef the

neck (¼).
ORIGIN AND INSERTION OF MUSCLES OF THE BACK 281
Lig. nuchae
posterior minor
M. obliquus
capitis superior
Mm. rotatores �
...-JR!!tn
thoracis
M. multifidus
trunci
262. Sites of origin and insertion ef muscles ef the back (schematical representa
tion).
(Deep muscles of the back; second deep layer. Short muscles of the posterior region of the neck.)
MUSCLES AND FASCIAE
OF THE HEAD
The following regions of the head and face are distinguished (Fig. 264).
REGIONS OF THE HEAD

1. The frontal region (regio frontalis) is unpaired and reaches ated on the sides of the head below the parietal region. It corres
the nasofrontal suture (the root of the nose) and the supraorbital ponds to the contours of the squamous part of the temporal bone.
margins anteriorly, the parietal region posteriorly, and the tem 4. The occipital region (regio occipitalis) is unpaired and is situ
poral regions laterally. ated to the back of the parietal region. It stretches to the posterior
2. The parietal region (regio parietalis) is unpaired and corre region of the neck.
sponds to the contours of the parietal bones. 5. The infratemporal region (regio infratemporalis).
3. The temporal region (regio temporalis) is paired and is situ-
REGIONS OF THE FACE

1. The orbital region (regio orbitalis) is paired and corresponds from the nasal and oral region by the nasolabial groove (sulcus na
to the boundaries of the orbit. solabialis).
2. The nasal region (regio nasalis) is unpaired and corresponds 6. The parotideomasseteric region (regio parotideomasseterica) is
to the contours of the nose. paired and corresponds to the contours of the parotid gland and
3. The infraorbital region (regio infraorbitalis) is paired and is the masseter muscle. The posterior parts of this region are called
located lateral to the nasal region and below the orbital region. the retromandibular fossa.
4. The zygomatic region (regio zygomatica) corresponds to the 7. The oral region (regio oralis) is an unpaired region.
contours of the body of the zygomatic bone. 8. The mental region (regio mentalis) is unpaired and is sepa
5. The buccal region (regio buccalis) is paired and is separated rated from the oral region by the mentolabial groove (sulcus mento
labialis).
MUSCLES OF THE HEAD

The muscles of the head (musculi capitis) are divided into two 1. Mus-des of the scalp.
groups: the muscles of facial expression and the muscles of masti 2. Muscles surrounding the eyes.
cation. 3. Muscles surrounding the mouth.
The muscles of facial expression, or the facial muscles are lo 4. Muscles surrounding the nose.
cated under the skin and, in contrast to the other skeletal muscles, The muscles of mastication move the mandible on contraction
are devoid of fasciae. Most of them arise on the bones or fasciae of and thus cause the act of mastication. They have a mobile point, or
the head and are inserted into the skin. the point of insertion, on the mandible and a fixed point, the point
On contraction, the muscles of facial expression displace cer of origin, on the skull bones.
tain areas of the skin on the head and thus lend the face a variety The following four pairs of muscles of mastication are distin-
of expressions, hence their name. guished.
They are predominantly grouped around the natural orifices of 1. The masseter muscle (musculus masseter).
the face (the palpebral fissure, oral fissure, orifices of the nose and 2. The temporal muscle (musculus temporalis).
ear) which either become smaller and even closed completely by 3. The medial pterygoid muscle (musculus pterygoideus medialis).
the action of the muscles or become larger, i.e. dilate. In accord 4. The lateral pterygoid muscle (musculus pterygoideus lateralis).
ance with this, all muscles of facial expression are divided into the
following four groups.
MUSCLES OF THE HEAD 283
M. temporoparietalis
M. auricularis anterior
M_. auricularis superior
Venter frontalis musculi occipitofrontalis
Galea aponeurotica
,.-4 M. orbicularis oculi (pars orbitalis)
M. levator labii superioris

alaeque nasi
M. levator
labii superioris
mmor
., _____ M. nasalis
(pars transversa)
M. auricularis posterior
M. orbicularis oris
M. depressor labii inferioris

M. depressor anguli oris
M. zygomaticus major
263. Muscles of the head; right side (½).

(Muscles of facial expression.)
284 REGIONS OF THE HEAD AND NECK
Regio frontalis
Regio infraorbitalis
Regio
}oralis
Regio mentalis
---------'t-- Regio buccalis

---'�----"--;z:=:::::--t- Regio parotideomasseterica
Regio parietalis Trigonum submandibulare
Regio occipitalis
N/ Trigonum caroticum
Rcgio colli lateralis
f
,---
i Trigomun omoclaviculare
(Fossa supraclavicularis major)
Regio infraclavicularis
Fossa supraclavicularis minor
264. Regions of the head and neck.

LINES OF SKIN INCISIONS ON THE HEAD AND NECK 285
265. Lines of skin incisions on the head and neck.

(Most suitable for exposing the muscles which are being dissected.)
286 MUSCLES OF THE HEAD
MUSCLES OF FACIAL EXPRESSION
MUSCLES OF THE SCALP

1. A broad tendinous plate, called the epicraneal aponeurosis rower, and is inserted into the skin of the auricle above the tragus.
(galea aponeurotica s. aponeurosis epicranialis) (Figs 263, 266), lies un Action: pulls the auricle forwards and upwards.
der the skin of the scalp between the frontal and occipital bones Blood supply: the superficial temporal artery.
and is fused tightly with the skin of the scalp and loosely with the 3. The auricularis superior muscle (musculus auricularis superior)
periosteum of its bones. (Fig. 263) is next to the auricularis anterior muscle. It arises above
The anterior parts of the aponeurosis include the frontal belly, the auricle from the epicranial aponeurosis, extends downwards,
the posterior parts include the occipital belly. The two bellies form and is inserted into the upper part of the auricular cartilage.
the occipitofrontalis muscle (musculus occipitofrontalis). A bundle of fibres of this muscle is interlaced into the epicra
(a) The frontal belly (venter frontalis) (Figs 263, 266) is under nial aponeurosis and is called the temporoparietal muscle (musculus
the skin of the forehead. It is formed of vertical fibres originating temporoparietalis).
from the epicranial aponeurosis slightly above the frontal tubers Action: pulls the auricle upwards and tenses the epicranial
and passing downwards to be intertwined with the skin of the fore aponeurosis.
head at the level of the superciliary arches. Blood supply: the superficial temporal, posterior auricular, and
(b) The occipital belly (venter occipitalis) (Figs 263, 266, 270) is occipital arteries.
made up of relatively short muscle fibres which originate in the re 4. The auricularis posterior muscle (musculus auricularis poste
gion of the highest nuchal line, stretch upwards, and intertwine rior) (Fig. 263) is poorly developed. It originates dorsally from the
with the posterior parts of the epicranial aponeurosis. fascia nuchae and, passing forwards, reaches the base of the auri
The epicranial aponeurosis and the muscular parts connected cle.
with it form the epicranius muscle (musculus epicranius). Action: pulls the auricle backwards.
Action: contraction of the occipital belly displaces to the back Blood supply: the posterior auricular artery.
the epicranial aponeurosis and, together with it, the skin of the 5. The transversus nuchae muscle (musculus transversus nuchae)
scalp; contraction of the frontal belly displaces forwards the epi is an inconstant muscle. It arises from the external occipital protu
cranial aponeurosis and the part of the skin of the scalp connected berance, extends laterally to the point of insertion of the sterno
with it; with the aponeurosis fixed, the muscle raises the eyebrows cleidomastoid muscle and reaches the mastoid process. It is in
and widens the palpebral fissure. serted here into the tendon of the sternocleidomastoid muscle and
Blood supply: frontal belly-the superficial temporal, su sometimes gives off some fibres to the occipital fascia and the pla
praorbital, lacrimal, and angular arteries; occipital belly-the oc tysma muscle.
cipital and posterior auricular arteries. Action: tenses the fascia and, with it, the skin of the occipital
2. The auricularis anterior muscle (musculus auricularis anterior) region.
(Fig. 263) originates from the temporal fascia and epicranial apo Blood supply: the occipital artery.
neurosis, runs to the back and downwards, becomes slightly nar-
MUSCLES SURROUNDING THE EYES

1. The corrugator muscle of the eyebrow (musculus corrugator su 3. The orbicularis oculi muscle (musculus orbicularis oculi) (Figs
percilii) (Fig. 266) arises from the frontal bone above the lacrimal 263, 266) lies under the skin overlying the anterior parts of the or
bone, passes upwards in line with the superciliary arch, and is in bit. Three parts are distinguished in the muscle: orbicular, palpe
serted into the skin of the eyebrow, in which its bundles are inter bral, and lacrimal which arise in the region of the medial angle of
laced with the muscle fibres of the frontal belly of the occipitofron the eye:
tal muscle. (a) the orbital part (pars orbitalis) takes origin from the medial
Action: draws the skin of the eyebrows towards the midline to palpebral ligament, the frontal process of the maxilla, and the na
form vertical folds in the region of the bridge of the nose. sal part of the frontal bone and stretches along the superior and
Blood supply: the angular, supraorbital, and superficial tem inferior margins of the orbit to form a muscular ring.
poral arteries. In the region of the lateral palpebral ligament, the inner fibres
2. The procerus muscle (musculus procerus) arises on the ridge of of the muscle form the lateral palpebral raphe (raphe palpebralis la
the nose by elongated flat fibres from the nasal bone or the apo /era/is);
neurosis of the nasal muscle and is inserted into the skin. (b) the palpebral part (pars palpebralis) is a direct continuation
Action: contraction of the muscle on both sides produces of the orbital part of the muscle and is found right under the skin
transverse folds at the root of the nose. of the eyelid. It has two parts, superior and inferior (pars palpebralis
Blood supply: the angular and ethmoidal arteries. superior et inferior). They take origin from the upper and lower
MUSCLES OF THE HEAD 287
Fascia temporalis (lamina superficialis)

Fascia temporalis (lamina profunda)
M. temporalis
Venter frontalis musculi occipitofrontalis
Venter
occipitalis
M. zygomaticus
major M. nasalis (pars alaris)
Corpus
adiposum buccae
Ductus parotideus
266. Muscles of the head; right side (½).

(Muscles of facial expression and muscles of mastication).
288 MUSCLES SURROUNDING THE MOUTH
M. depressor septi nasi
M.
M.
M. levator
anguli oris
M. mentalis M. depressor anguli oris

M. transversus menti
267. Muscles surrounding the mouth; inner aspect (½).

(The skin with the muscles surrounding the mouth is separated from the bones of the face. The
mucous membrane of the cheeks and lips is removed.)
edges of the medial palpebral ligament, respectively, and pass to Action: the palpebral part narrows the palpebral fissure and
the lateral angle of the eye to be inserted into the lateral palpebral smoothes out the transverse folds in the skin of the forehead; the
ligament; palpebral part closes the palpebral fissure; the lacrimal part dilates
(c) the lacrimal part (pars lacrimalis) arises from the posterior the lacrimal sac.
crest of the lacrimal bone and separates into two parts which em Blood supply: the facial, superficial temporal, infraorbital, and
brace the lacrimal sac (sacrus lacrimalis) anteriorly and posteriorly supraorbital arteries.
and are lost between the muscle fibres of the palpebral part.
MUSCLES SURROUNDING THE MOUTH

The muscles surrounding the oral fissure are divided into two Action: narrows the oral fissure and pulls the lips forward.
groups: one is represented by the orbicularis oris muscle whose Blood supply: the labial, mental, and infraorbital arteries.
contraction narrows the oral fissure, while the other group is made 2. The zygomaticus major muscle (musculus z;ygomatirus major)
up of muscles stretching radially in relation to the oral fissure; (Figs 263, 266, 267) takes origin from the lateral surface of the zy
their contraction widens it. gomatic bone. Some of the muscle fibres are a continuation of the
1. The orbicularis oris muscle (musculus orbicularis oris) (Figs orbicularis oris muscle. Stretching downwards and medially, the
263, 266, 267) is formed of circular muscle fibres lying in the zygomaticus major muscle is inserted into the orbicularis muscle
thickness of the lips. The muscle fibres are fused closely with the and the skin of the angle of the mouth.
skin. The superficial layers of this muscle receive the fibres of mus Action: pulls the angle of the mouth upwards and laterally.
cles approaching the oral fissure. A marginal part (pars marginalis) Blood supply: the infraorbital and buccal arteries.
and a labial part (pars labialis) are distinguished in the muscle. 3. The zygomaticus minor muscle (musrulus z;ygomaticus minor)
MUSCLES SURROUNDING THE NOSE 289
:;(Figs 263, 266, 267) takes origin from the anterior surface of the Blood supply: the buccal artery.
zygomatic bone. Its medial fibres intertwine with the fibres of the 8. The risorius muscle (musculus rzsorius) (Figs 263, 267) is an
orbicularis oris muscle. inconstant muscle and partly a continuation of the platysma fibres.
4. The levator labii superioris muscle (musculus levator labii supe Some fibres of the muscle arise from the masseteric fascia and the
rioris) arises from the infraorbital margin above the infraorbital skin in the region of the nasolabial fold. It stretches medially to be
foramen. inserted into the skin of the angle of the mouth.
5. The levator labii superioris alaeque nasi muscle (musculus lev Action: pulls the angle of the mouth laterally.
ator labii superioris alaeque nasi) is next to the levator labii superioris Blood supply: the facial, transverse facial, buccal, and infraor
muscle; it takes origin from the base of the frontal process of the bital arteries.
maxilla. 9. The depressor anguli oris muscle (musculus depressor anguli
The three last muscles stretch downwards, converge a little, oris) (Fig. 263) takes origin as a wide base from the anterior surface
and form a quadrangular muscular plate whose bundles are in of the mandible inferior to the mental foramen. On extending up
serted into the skin of the upper lip, partly into the orbicularis oris wards it narrows and reaches the angle of the mouth; some of its
muscle and into the skin of the ala nasi. fibres are inserted into the skin here, others are inserted into the
Action: the levator labii superioris alaeque nasi muscle raises upper lip and the levator anguli oris muscle.
the upper lip and pulls upwards the ala of the nose. Action: pulls the angle of the mouth downwards and laterally.
Blood supply: the infraorbital, superior labial, and angular ar Blood supply: the inferior labial, mental, and submental arter
teries. ies.
. 6. The levator anguli oris muscle (musculus levator anguli oris) 10. The depressor labii inferioris muscle (musculus depressor labii
(Figs 266, 267) lies deeper than the last named muscle. It takes ori inferioris) (Figs 263, 266, 267) is partly covered by the depressor
gin below the infraorbital foramen from the canine fossa and, ex anguli oris muscle. It arises from the anterior surface of the mandi
tending downwards, is inserted into the skin at the angle of the ble above the origin of the depressor anguli oris anteriorly of the
mouth and into the orbicularis oris muscle. mental foramen, passes upwards, and is inserted into the skin of
Action: pulls the angle of the mouth upwards and laterally. the lower lip and chin.
Blood supply: the infraorbital and buccal arteries. The medial fibres of the muscle intertwine with those of the
7. The buccinator muscle (musculus buccinator) (Figs 266, 267, contralateral muscle at the lower lip.
273) takes origin from the buccinator crest of the mandible, the Action: pulls the lower lip downwards.
pterygomandibular ligament, and the external surfaces of the max Blood supply: the inferior labial, mental, and submental arter
illa and mandible in the region of the sockets of the second molars. ies.
Passing forwards, the fibres of the buccinator muscle are continu 11. The mentalis muscle (musculus mentalis) (Figs 266, 267)
ous with the upper and lower lips and are inserted into the skin of arises next to the depressor labii inferioris muscle from the alveo
the lips and the angle of the mouth, and the mucous membrane of lar juga of the mandibular incisors, passes downwards, and is in
the vestibule of the mouth. serted into the skin of the chin.
A buccal pad of fat (corpus adiposum buccae) lies external to the Action: pulls the skin of the chin upwards and pulls out the
muscle, the mucous membrane of the vestibule of the mouth ad lower lip.
joins the inner surface of the muscle. The parotid duct (ductus pa Blood supply: the inferior labial and mental arteries.
rotideus) pierces the middle parts of the buccinator muscle at the 12. The transversus menti muscle (musculus transversus menti) is
level of the anterior border of the masseter muscle. a small inconstant muscle which crosses the midline directly under
Action: pulls the angle of the mouth laterally; in bilateral con the chin. It is often a continuation of the depressor anguli oris
traction the oral fissure is stretched and the inner surface of the muscle.
cheek is pressed to the teeth.
MUSCLES SURROUNDING THE NOSE
1. The nasal muscle (musculus nasalis) (Figs 263, 266) takes ori Action: narrows the nostrils.
gin from the maxilla above the alveoli of the canine and lateral in Blood supply: the superior labial and angular arteries.
cisor teeth, stretches upwards, and separates into two parts, medial 2. The depressor septi nasi muscle (musculus depressor septi nasi)
and lateral: (Fig. 266) arises from the alveolar juga of the maxillary medial in
(a) the lateral, or transverse part (pars transversus) curves cisor and partly includes fibres of the orbicularis oris. It is inserted
around the ala nasi, becomes slightly wider, and is continuous with into the inferior surface of the cartilage of the nasal septum.
a tendon in the midline. The tendon joins that of the contralateral Action: pulls the nasal septum downwards.
muscle; Blood supply: the superior labial artery.
(b) the medial, or alar part (pars alaris) is inserted into the pos Innervation: all the muscles of facial expression are innervated
terior end of the cartilage of the ala nasi. by branches of the facial nerve.
290 MUSCLES OF MASTICATION
MUSCLES OF MASTICATION
1. The masseter muscle (musculus masseter) (Figs 266, 268-270) of the superficial part pass obliquely, downwards and to the back;
takes origin from the inferior border of the zygomatic arch by su those of the deep part stretch downwards and to the front. Both
perficial and deep parts. parts of the masseter muscle unite to be inserted into the external
The superficial part (pars superficialis) arises as tendinous fibres surface of the ramus of the mandible and its angle in the region of
from the anterior and middle parts of the zygomatic arch; the deep the masseteric tuberosity.
part (Pars prefunda) takes origin as a muscle from the middle and Action: raises the lowered mandible; the superficial part of the
posterior areas of the zygomatic arch. The bands of muscle fibres muscle contributes to forward protrusion of the mandible.
Fascia temporalis
(lamina superficialis)
Fatty tissue
Fascia temporalis (lamina profunda)
M. masseter (pars superficialis)
268. Muscles of mastication; right side (½).

(The superficial layer of temporal fascia partly cut and drawn aside.)
MUSCLES OF MASTICATION 291
Blood supply: the facial, masseteric, and transverse facial arter don which passes medially of the zygomatic arch and is inserted
ies. into the coronary process of the mandible.
Innervation: nerve to the masseter (trigeminal nerve). Action: contraction of all fibres raises the lowered mandible;
2. The temporal muscle (musculus temporalis) (Figs 266, the posterior fibres pull backwards the anteriorly protruded mand
269-271) occupies the temporal fossa (Iossa temporalis). It takes ori ible.
gin from the temporal surface of the greater wing of the sphenoid Blood supply: the deep temporal and superficial arteries.
bone and the squamous part of the temporal bone. Passing Innervation: the deep temporal nerves (trigeminal nerve).
downwards, the fibres of the muscle converge to form a strong ten- 3. The lateral pterygoid muscle (musculus pterygoideus lateralis)

(The zygomatic arch is divided and turned aside together with the masseter mus
cle.)
292 ORIGIN AND INSERTION OF MUSCLES OF THE HEAD
(Figs 269-271; 272-274) arises by two parts, or heads, upper and goid process of the sphenoid bone and passes backwards to be in
lower. serted into the pterygoid pit of the mandible. A small slit transmit
The upper head of the muscle takes origin from the inferior ting the buccal nerve is left between the upper and lower heads of
surface and infratemporal crest of the greater wing of the sphenoid the muscle.
bone and is inserted into the medial surface of the articular cap Action: displaces the mandible to the contralateral side. Bila
sule of the mandibular joint and into the articular disc. The lower teral contraction of the muscle causes the mandible to protrude
head arises from the lateral surface of the lateral plate of the ptery- forwards.
M. temporalis
M. pterygoideus lateralis
__.J..-\\-----..---�
M. corrugator supercilii
M.

·�, alaeq ue nasi
M. obliquus capitis superior M. depressor septi
M. rectus capitis post. minor
M.
M.
depressor labii inferioris

Platysma
M. depressor anguli oris
270. Sites of origin and insertion of the muscles of the head (schematical re
presentation).
MUSCLES OF MASTICATION 293
Blood supply: the maxillary artery. Action: displaces the mandible to the contralateral side. Bila
Innervation: the lateral pterygoid (trigeminal) nerve. teral contraction causes forward protrusion and raises the lowered
4. The medial pterygoid muscle (musculus pterygoideus medialis) mandible.
(Figs 271-274). Takes origin from the walls of the pterygoid fossa Blood supply: the alveolar, buccal, and facial arteries.
of the sphenoid bone, stretches backwards and downwards, and is Innervation: nerve to the medial pterygoid muscle (trigeminal
inserted into the pterygoid tuberosity of the mandible. nerve).
M. temporalis
(cut and reflected)
M. pterygoideus medialis

(The cavity of the mandibular joint is opened by sagittal section; part of mandib
ular ramus is removed.)
294 MUSCLES OF MASTICATION
M. mylohyoideus (cut off)
272. Muscles of mastication; posterior aspect (¾).
M. ·temporalis
M. buccinator
Lig. sphenomandibulare
M. genioglossus
M. constrictor pharyngis
superior
M. digastricus
273. Sites of origin and insertion of the muscles of mastication (schematical represen
tation).
FASCIAE OF THE HEAD 295
M.
M.
M. tensor veli palatini
M. levator veli palatini
Lig. apicis dentis
M. digastricus
Lig. cruciforme atlantis (venter posterior)
Membrana tectoria
Membrana atlantooccipitalis
posterior
M. rectus capitis posterior major

obliquus capitis superior
rectus capitis posterior minor
M.
M. trapezius
274. Sitesof origin and insertion of muscles and ligaments on base of skull
(schematical representation).
FASCIAE OF THE HEAD

The fasciae of the head (Figs 263, 266, 268) are as follows: the downwards. Posteriorly it is attached to the cartilage of the exter
temporal, masseteric, parotid, and buccopharyngeal. nal acoustic meatus and passes over to the mastoid process. Inferi
I. The temporal fascia (fascia temporalis) extends from the peri orly it is continuous with the cervical fascia; anteriorly it covers the
osteum of the skull bones in the region of the temporal line and masseter muscle after which it is continuous with the buccophar
epicranial aponeurosis, covers the temporal muscle and separates yngeal fascia.
into two layers close to the zygomatic arch. One is the superficial 3. The parotid fascia (fascia parotidea) is connected posteriorly
layer (lamina superficialis) which is attached to the superior margin. with the masseteric fascia and separates into two layers which in
and outer surface of the zygomatic arch, the other is the deep layer vest on both sides the parotid gland.
(lamina profunda) which passes over to the inner surface of the zy 4. The buccopharyngeal fascia (fascia buccopharyngea) covers
gomatic arch. Vessels and fatty tissue are lodged between these two the buccinator muscle and at the anterior border of the masseter
layers. muscle passes over to the medial surface of the mandibular ramus
2. The masseteric fascia (fascia masseterica) is continuous with where it covers the medial pterygoid muscle and then stretches
the temporal fascia on the zygomatic arch, and it then passes over to the pharyngeal wall.
MUSCLES AND FASCIAE
OF THE NECK
REGIONS OF THE NECK

The following regions of the neck (regiones colli) (Fig. 264) are 3. The paired lateral cervical region (regio colli lateralis) is
distinguished. bounded by the posterior border of the sternocleidomastoid mus
1. The anterior cervical region (regio colli anterior) includes: cle anteriorly, by the border of the trapezius muscle posteriorly,
(a) the submaxillary triangle (trigonum submandibulare); and by the border of the clavicle inferiorly. This region includes
(b) the carotid triangle (trigonum caroticum). the omoclavicular triangle (trigonum omoclaviculare) in which the
2. The paired sternocleidomastoid region (regio sternocleidomas greater supraclavicular fossa (Iossa supraclavicularis major) is situ
toideae) corresponds to the contours of the sternocleidomastoid ated.
muscle. 4. The posterior cervical region (regio colli posterior) is bounded
The paired lesser supraclavicular fossa (Iossa supraclavicularis by the lateral borders of the trapezius muscle.
minor) is bounded by the heads (slips) of the sternocleidomastoid
muscle and the corresponding border of the clavicle.
MUSCLES OF THE NECK

The cervical muscles (musculus colli) cover one another to form oid (musculus sternohyoideus), the sternothyroid (musculus sternothyroi
three groups-superficial, middle, and deep. deus), the thyrohyoid (musculus thyrohyoideus), and the omohyoid
The deep muscles may be divided into a lateral and preverte (musculus omohyoideus) muscles.
bral groups. III. The deep muscles of the neck:
I. The superficial muscles of the neck: the platysma and the 1. The lateral group: the scalenus anterior (musculus scalenus an
sternocleidomastoid muscles (musculus sternocleidomastoideus). terior), medius (musculus scalenus medius), and posterior (musculus
IL The middle group: scalenus posterior) muscles.
1. The suprahyoid muscles (musculi suprahyoidei): the digastric 2. The prevertebral group: the longus capitis (musculus longus
muscle (musculus digastricus), the stylohyoid muscle (musculus stylohy capitis), the longus cervicis (musculus longus colli), the rectus capitis
oideus), the mylohyoid muscle (musculus mylohyoideus), and the geni anterior (musculus rectus capitis anterior), and the rectus capitis latera
ohyoid muscle (musculus geniohyoideus). lis (musculus rectus capitis lateralis) muscles.
2. The infrahyoid muscles (musculi infrahyoidei): the sternohy-
SUPERFICIAL MUSCLES OF THE NECK

1. The platysma (platysma) (Figs 275, 280, 281) is a thin mus from the sternal end of the clavicle, and the other medial arising
cular sheet lying under the skin with which it is closely fused. The from the anterior surface of the manubrium sterni.
muscle fibres arise on the chest on the level of the second rib and Both heads join at a right angle in such a manner that fibres of
pass upwards and medially. On reaching the border of the mandi the medial head lie closer to the surface. The formed muscular
ble the medial fibres intertwine with those of the contralateral belly stretches upwards and to the back to be inserted into the
muscle and are inserted into the border of the mandible; the la mastoid process of the temporal bone and the superior nuchal line.
teral fibres of the muscle extend to the face on which they interlace Between the lateral and medial heads of the muscle is a small
with the parotid and masseteric fasciae and reach the angle of the depression called the lesser supraclavicular fossa (Iossa supraclavicu
mouth. laris minor), while between the medial heads of the right and left
Action: tenses the skin of the neck and partly of the chest, low sternocleidomastoid muscles above the jugular notch of the ma
ers the mandible, and pulls the angle of the mouth laterally and nubrium sterni is the jugular fossa (Iossa jugularis).
downwards. Action: when the chest is fixed contraction of one muscle in
Blood supply: the superficial cervical and facial arteries. clines the head to the same side but turns the face to the opposite
Innervation: cer Y ical branch of the facial nerve. side; contraction of both muscles draws the head to the back and
moves it slightly forward; with the head fixed the muscle pulls the
2. The sternocleidomastoid muscle (musculus sternocleidomastoi clavicle and sternum upwards.
deus) (Figs 275,276,280,281) is behind (under) the platysma. It is Blood supply: the occipital, sternocleidomastoid, and superior
a rather thick, slightly flattened muscular band which crosses the thyroid arteries.
neck obliquely and spiral-like from the mastoid process to the ster Innervation: branch of accessory nerve to the sternomastoid
noclavicular joint. It arises by two heads, one lateral taking origin muscle and second pair of cervical nerves (C 2 -C 4).
MUSCLES OF THE NECK 297
Tendinous loop -...,;i:.14,l..,..,:...ai...-'----"--+----�>,

Os hyoideum --4��-;-,---7�
M. omohyoideus (venter superior)
M. sternocleidomastoideus (caput claviculare)

Fascia colli
(lamina superficialis et lamina praetrachealis) M. sternocleidomastoideus (caput sternale)
275. Superficial muscles of the neck; anterior aspect (¾).

298 MUSCLES OF THE NECK
Glandula parotis
M. masseter
Tendo m. digastrici
M. mylohyoideus
Venter occipitalis -
(m. occipitofrontalis)
M. digastricus --�_:.------,,-,.,---..,.;�c,..::�...._
(venter posterior)

M. scalenus anterior
M. scalenus medius
M. scalenus posterior
M. omohyoideus (venter inferior)
M. deltoideus
276. Muscles of the neck; right side (½).

(Superficial muscles and the middle group.)
M. hyoglossus
M. masseter
M. levator scapulae
M. scalenus medius
277. Muscles of the neck; right side (½).

(Middle group and deep muscles, lateral group.)
THE MIDDLE GROUP OF MUSCLES OF THE NECK
THE SUPRAHYOID MUSCLES
1. The digastric muscle (musculus digastricus) (Figs 275-278) Blood supply: the occipital, facial arteries and the suprahyoid
has two bellies, anterior and posterior, which are connected by a branch of the lingual artery.
tendon. Innervation: the facial nerve.
The anterior belly (venter anterior) arises from the mandibular
3. The mylohyoid muscle (musculus mylohyoideus) (Figs
digastric fossa and passes downwards and backwards to be contin
275-278) is flat and of an irregular triangular shape. It arises from
uous with the tendon which is fastened to the body of the hyoid
the mylohyoid line on the mandible. Its fibres pass downwards and
bone by a process of the cervical fascia. This tendon, curving back
slightly to the front and meet the fibres of the contralateral muscle
wards and upwards, is continuous with the posterior belly (venter
to form the raphe of the mylohyoid muscle.
posterior) which is inserted into the mastoid notch of the temporal
The posterior fibres of the muscle are inserted into the anterior
bone. Between the two bellies and the border of the mandible is
surface of the body bf the hyoid bone. Both mylohyoid muscles
the submandibular fossa (Iossa submandibularis) lodging the sub
contribute to the formation of the floor of the oral cavity and are
mandibular gland.
called the diaphragm of the mouth.
Action: when the hyoid bone is fixed the muscle lowers the
Action: when the mandible is fixed the muscle pulls the hyoid
mandible; with the mandible fixed the muscle pulls the hyoid bone
bone upwards and forwards; when the hyoid bone is fixed the mus
upwards.
cle helps to lower the mandible.
Blood supply: anterior belly-the submental artery; posterior
Blood supply: the sublingual and submental arteries.
belly-the occipital and posterior auricular arteries.
Innervation: the mylohyoid nerve from the trigeminal nerve.
Innervation: anterior belly-the trigeminal nerve (nervus trigem
inus) (third division); posterior belly-the facial nerve (nervusfacia 4. The geniohyoid muscle (musculus geniohyoideus) (see
lis). Fig. 278) arises from the spina mentalis of the mandible, passes
2. The stylohyoid muscle (musculus stylohyoideus) (Figs downwards and slightly to the back above the mylohyoid muscle,
275-278) has a thin flat belly which takes origin from the styloid and is inserted into the anterior surface of the body of the hyoid
process of.the temporal bone, stretches forwards and downwards, bone.
and lies on the anterior surface of the posterior belly of the digas Action: pulls the hyoid bone forwards and upwards; when the
tric muscle. The distal end of the muscle separates into two slips hyoid bone is fixed the muscle takes part in lowering the mandible.
embracing the tendon of the digastric muscle and is inserted into Blood supply: the sublingual and submental arteries.
the body and greater horn of the hyoid bone. Innervation: the hypoglossal nerve and first and second pairs
Action: pulls the hyoid bone backwards, upwards, and later of cervical nerves (C 1 -C2).
ally.
THE INFRAHYOID MUSCLES
1. The sternohyoid muscle (musculus sternohyoideus) Innervation: superior branch of ansa cervicalis [C 1 -C 3 (C4)].
(Figs 275-278, 281) is thin and flat and arises from the posterior 3. The thyrohyoid muscle (musculus thyrohyoideus) (Figs
surface of the clavicle, the capsule of the sternoclavicular joint, 276-278) seems to be a continuation of the sternothyroid muscle.
and the manubrium sterni. Stretching upwards it reaches the body It arises from the oblique line of the thyroid cartilage, passes up
of the hyoid bone into which it is inserted below the mylohyoid wards, and is inserted into the edge of the greater horns of the hy
muscle. Between the muscle and the bone are located here the re oid bone.
trohyoid bursa (bursa retrohyoidea) and the infrahyoid bursa (bursa Action: pulls the hyoid bone closer to the larynx; raises the lar
infrahyoidea). Sometimes the muscle is crossed by one or two tendi ynx when the hyoid bone is fixed.
nous intersections (intersectiones tendineae). Innervation: thyrohyoid branch of the ansa cervicalis (C 1 -C2).
Action: pulls the hyoid bone downwards. 4. The levator glandulae thyroideae muscle (musculus levator
Innervation: superior branch of the ansa cervicalis glandulae thyroideae) is a thin muscular slip stretching on the me
[C1-Cs(C4)]. dial border of the thyrohyoid muscle from the body of the hyoid
2. The sternothyroid muscle {musculus sternothyroideus) bone or the thyroid cartilage to the capsule of the thyroid gland (in
(Figs 277, 281) is flat and lies behind the sternohyoid muscle. It the region of its isthmus or the lateral or the pyramidal lobe).
takes origin from the posterior surface of the first costal cartilage This muscular slip can separate from the thyrohyoid or cri
and manubrium sterni, and is directed upwards to be inserted into cothyroid muscle or from the inferior constrictor muscle of the
the oblique line of the thyroid cartilage. pharynx.
Action: pulls the larynx downwards. Action: pulls the capsule together with the thyroid upwards.
5. The omohyoid muscle (musculus omohyoideus) (Figs 257-278, tendon, comes out from under the lateral border of the sternoclei
281) is long and flat. It has two bellies, superior and inferior, domastoid muscle, stretches backwards and slightly downwards,
which are joined by an intermediate tendon approximately in the and reaches the suprascapular notch to be inserted into the supe
middle of the length of the muscle. rior border of the scapula and the suprascapular ligament.
The superior belly (venter superior) arises from the lower border Action: when the scapula is fixed the muscle pulls the hyoid
of the body of the hyoid bone lateral to the insertion of the sterno bone downwards and laterally and also pulls at the sheath of the
hyoid muscle and passes downwards along the lateral border of cervical neurovascular bundle thus dilating the lumen of the inter
this muscle. It then deviates to the back, lies behind the sternoclei nal jugular vein.
domastoid muscle and is continuous here with the intermediate Blood supply: all muscles which are situated below the hyoid
tendon which fuses with the fascia! sheath of the cervical neurovas bone are supplied with blood by the inferior thyroid, superficial
cular bundle. cervical, and transverse cervical arteries.
The inferior belly (venter inferior) arises from the intermediate Innervation: superior branch of the ansa cervicalis (C 1 -C3).
DEEP MUSCLES OF THE NECK
THE LATERAL GROUP

1. The scalenus anterior muscle (musculus scalenus anterior) (Figs 276, 277, 279) takes origin from the anterior tubercles of the
(Figs 276, 277, 279) arises from the anterior tubercles of the third, upper six cervical vertebrae, passes downwards behind the scale
fourth, fifth, and sixth cervical vertebrae and stretches downwards nus anterior muscle, and is inserted into the superior surface of the
and to the front to be inserted into the scalene tubercle of the first first rib behind the groove for the subclavian artery. Above this
rib. groove, between the scalenus anterior and medius muscles, is a tri
Action: when the vertebral column is fixed the muscle pulls the angular interscalenus space (spatium interscalenum) lodging the sub
first rib upwards; with the chest fixed contraction of the muscle on clavian artery and the nerves of the branchial plexus.
one side flexes the cervical spine to the same side, bilateral con Action: with the vertebral column fixed the muscle raises the
traction flexes it forward. first rib; when the chest is fixed it flexes the cervical spine for
Blood supply: the ascending cervical and inferior thyroid arter wards.
ies. Blood supply: the vertebral and deep cervical arteries.
Innervation: the cervical nerves (C5-C7). Innervation: the cervical nerves (C5-C8).
2. The scalenus medius muscle (musculus scalenus medius) 3. The scalenus posterior muscle (musculus scalenus posterior)
Lig. stylohyoideum
Cornu minus
ossis hyoidei
M. thyreohyoideus
M. stylohyoideus
M. digastricus
(fibrous plate)
M. omohyoideus M. sternohyoideus
278. Sites of origin and insertion of muscles on the hyoid

bone (schematical representation).
Pars basilaris
(ossis occipitalis)
M. levator scapulae (cut off)
Tuberculum
m. scaleni anterioris
279. Deep muscles of the neck; anterior aspect (½).

FASCIAE OF THE NECK 303
Fascia cervicalis
280. Fasciae of the neck; right side (½).

304 MUSCLES AND FASCIAE OF THE NECK
Spatium suprasternale
Spatium previscerale
M. sternohyoideus Glandula thyreoidea
M.
Lamina superficialis
fasciae cervicalis
Lamina pretrachealis,
fasciae cervicalis
carotis communis
V. jugularis interna
M. sternocleido N. vagus
mastoideus
M. longus
colli
M.
et m. scalenus
posterior
M. semi�p_inalis
+-II----,-- cerv1c1s
M. levator
scapulae -----r,6-1
Processus
spinosus __;.;..._-+
M. splenius capitis
et m. splenius
l/
i
cervicis
I
I
Lig. nuchae
281. Muscles and fasciae of the neck (¾).

(Horizontal section of the neck through the seventh cervical vertebra.)
TRIANGLES OF THE NECK 305
(Figs 276, 277, 279) takes origin from the posterior tubercles of the fixed; when the chest is fixed contraction of the muscle on both
fifth and sixth (sometimes from the prominens) cervical vertebrae, sides flexes forward the cervical spine.
stretches downwards behind the scalenus medius muscle, and is in Blood supply: the deep and transverse cervical arteries, first in
serted into the external surface of the second rib. tercostal artery.
Action: raises the second rib when the vertebral column is Innervation: the cervical nerves (C 7 -C8).
THE PREVERTEBRAL GROUP
1. The longus capitis muscle (musculus longus capitis) (Fig. 279) Action: flexes the cervical spine forwards and to the side of the
arises from the anterior tubercles of the third, fourth, fifth, and contracting muscle.
sixth cervical vertebrae and runs upwards to be inserted into the Blood supply of both muscles: the vertebral and the ascending
inferior surface of the basilar part of the occipital bone slightly be and deep cervical arteries.
hind the pharyngeal tubercle. Innervation: the cervical nerves (C2 -C6).
Action: flexes forward the head and cervical spine.
3. The rectus capitis anterior muscle (musculus rec/us capitis an
Innervation: the cervical nerves (C 1 -C8).
terior) (Fig. 279) is short and takes origin from the anterior surface
2. The longus cervicis muscle (musculus longus colli) (Figs 279,
of the transverse process and lateral mass of the atlas, passes up
281) occupies the anterolateral surface of all the cervical and the
wards, and is inserted into the inferior surface of the basilar part of
first, second, third, and fourth thoracic vertebrae. The middle
the occipital bone in front of the foramen magnum.
parts of the muscle are slightly wider. The muscle fibres differ in
Action: flexes the head to the side of the contracting muscle;
length in view of which three parts are distinguished in the muscle:
bilateral contraction flexes the head forwards.
(a) the mediovertical part takes origin from the bodies of the
Blood supply: the vertebral and ascending pharyngeal arteries.
fifth, sixth, seventh cervical and first, second, and third thoracic
Innervation: the cervical nerves (C 1 -C2 ).
vertebrae and stretches upwards and medially to be inserted into
the anterior surface of the bodies of the third and second cervical 4. The rectus capitis lateralis muscle (musculus rec/us capitis la
vertebrae and the anterior tubercle of the atlas; teralis) (Fig. 279) is square in shape. It arises from the anterior pe
(b) the superior oblique part extends from the anterior tuber riphery of the transverse process of the atlas and is directed up
cles of the transverse processes of the second, third, fourth, and wards and laterally to be inserted into the jugular process of the
fifth cervical vertebrae to the body of the second cervical vertebra occipital bone.
and the anterior tubercle of the atlas; Action: flexion of the head to the side of the contracting mus
(c) the inferior oblique part arises from the bodies of the up cle; contraction of both rnuscles flexes the head forwards.
per three thoracic vertebrae and is directed upwards and laterally to Blood supply: the vertebral and occipital arteries.
be inserted into the anterior tubercles of the transverse processes Innervation: the cervical nerves (C 1 -C2).
of the lower three cervical vertebrae (fifth, sixth, and seventh).
TRIANGLES OF THE NECK

The two sternocleidomastoid muscles divide the anterior re 1. The submaxillary (submandibular) triangle (trigonum sub
gion of the neck (regi.o colli anterior) into three triangles, one ante mandibulare) is bounded by the anterior and posterior bellies of the
rior and two lateral (Fig. 282). digastric muscle and the inferior border of the mandible. A small
To the side of the midline each half of the neck is divided by trigonum linguale or Pirogoff's triangle (trigonum Pirogowi) is
the sternocleidomastoid into two triangles, medial and lateral. marked out in it by the posterior border of the myohyoid muscle,
The medial triangle is bounded by the inferior border of the the posterior belly of the digastric muscle, and the hypoglossal
mandible, the midline of the neck, and the anterior border of the nerve.
sternocleidomastoid muscle. In this manner the right and left me 2. The carotid triangle (trigonum caroticum) is limited by the
dial triangles form together one anterior triangle of the neck. posterior belly of the digastric muscle, the superior belly of the
The lateral triangle of the neck is bounded by the posterior omohyoid muscle, and the anterior border of the sternocleidomas
border of the sternocleidomastoid muscle, the clavicle, and the toid muscle.
border of the trapezius muscle. The lateral triangle includes the omoclavicular triangle.
Each of these triangles is divided by the muscles of the neck 3. The omoclavicular triangle (trigonum omoclaviculare) is
into some smaller triangles. bounded by the posterior border of the sternocleidomastoid mus
The digastric muscle and the superior belly of the omohyoid cle, the clavicle, and the inferior belly of the omohyoid muscle; it
muscle divide the medial triangle into the submaxillary and ca corresponds to the greater supraclavicular fossa.
rotid triangles.
306 TRIANGLES OF THE NECK
Glandula parotis
(covers fossa
retromandibularis)
Trigonum
submandibulare
M. omohyoideus, venter superior
Regio colli anterior
Regio colli lateralis
282. Triangles ef the neck (semischematical representation).

Arrows indicate the triangles. The triangles are outlined brown and yellow; the relation of the trunks of the main nerves and blood vessels
to the triangles is shown.
1-Pirogoffs triangle
2-omotracheal triangle
3-omotrapezium triangle
FASCIAE OF THE NECK 307
FASCIAE OF THE NECK

The cervical fascia (fascia cervicalis) is composed of the follow rynx, oesophagus) and also form a sheath for the neurovascular
ing three layers: the superficial layer (lamina superficialis) investing, bundle of the neck (for the internal jugular vein, the common ca
like a sock, all the cervical muscles and the submandibular gland; rotid artery, and the vagus nerve), which is called the carotid
the pretracheal fascia (lamina pretrachealis) forming a sheath for the sheath. The pretracheal fascia blends with the superficial layer at
infrahyoid group of muscles and investing the neurovascular bun the posterior border of the sternocleidomastoid muscle. An area of
dles and some of the organs of the neck; the prevertebral fascia the pretracheal fascia between the two omohyoid muscles which is
(lamina prevertebralis) forming a sheath for the prevertebral group limited above by the hyoid bone and below by the clavicles and
of muscles. manubrium sterni is dense and forms the omoclavicular aponeuro
1. The anterior part of the superficial layer of the cervical fas sis.
cia (lamina supeificialis) is a continuation of the fascia proper of the 3. The prevertebral fascia (lamina prevertebralis) arises from the
chest and neck. The lower part of the fascia is attached to the ante base of the skull and descends to cover the group of prevertebral
rior border of the clavicle and the manubrium sterni. Ascending, it muscles. Its lateral parts blend with the costal processes of the cer
splits to form a sheath for the sternocleidomastoid muscles and on vical vertebrae. As a result the prevertebral fascia with the cervical
reaching the hyoid bone it is attached here and then invests the vertebrae form an osteofibrous sheath for the prevertebral muscles.
suprahyoid group of the cervical muscles. Having formed the Approximately at the level of the third thoracic vertebra the lower
sheath for these muscles and for the submandibular gland, the su parts of the fascia are continuous with the endothoracic fascia (fas
perficial layer passes over to the face where it is continuous with cia endothoracica). On the periphery the fascia passes over to the
the masseteric and parotid fasciae (fascia masseterica et fascia paroti scalenus muscles.
dea). Spaces filled with loose fatty tissue form between the fasciae of
At the back of the neck the superficial layer is continuous with the neck and between the fasciae and the viscera.
the fascia proper of the shoulder and back. It splits at the lateral 1. The suprastemal interaponeurotic space (spatium interapo
margin of the trapezius muscle to invest this muscle, and is at neuroticum suprasternale) is above the jugular notch of the manub
tached to the ligamentum nuchae and reaches the superior nuchal rium sterni, between the superficial layer and pretracheal fascia.
line and the external occipital protuberance. This space is continuous with the right and left lateral recesses
2. The pretracheal fascia (lamina pretrachealis) arises from the behind the sternocleidomastoid muscle.
posterior surface of the clavicles and the manubrium sterni and as 2. The previsceral space (spatium previscerale) is between the
cends to form a sheath for the thyroid gland and the group. of in pretracheal fascia and the viscera of the neck.
frahyoid muscles. The upper parts of this fascia blend with the su 3. The retrovisceral space (spatium retroviscerale) forms between
perficial layer at the level of the hyoid bone, the lateral parts give the prevertebral fascia and the viscera of the neck.
off processes to the organs of the neck (the larynx, trachea, pha-
MUSCLES AND FASCIAE
OF THE CHEST
REGIONS OF THE CHEST

The anterolateral thoracic wall is composed of the following re 4. The medioclavicular line (linea mamillaris s. medioclavicula
gions (regiones pectorales) (Fig. 285). ris) runs through the middle of the clavicle. It is also called the
1. The pectoral region (regio pectoralis) (the region of the mam mamillary line (linea mamillaris) but the variable position of the
mary gland, or regio mammaria) is limited by the inferior border of mammary gland makes the name inaccurate.
the pectoralis major muscle, superiorly it borders on the infraclavi 5. The anterior axillary line (linea axillaris anterior) corre
cular fossa. This region is also called the anterosuperior region of sponds to the anterior axillary fold (plica axillaris anterior) which is
the chest. projected along the superolateral border of the pectoralis major
2. The presternal region (regio presternalis) occupies an extreme and pectoralis minor muscles.
medial position stretching from the anterior median line to the 6. The posterior axillary line (linea axillaris posterior) corre
parasternal line. It is also called the anterior median region of the sponds to the posterior axillary fold (plica axillaris posterior) formed
chest. by the anterior borders of the teres major and latissimus dorsi
3. The axillary region (regio axillaris) includes the axillary muscles.
fossa (fossa axillaris) (see Muscles of the Upper Limb. The Axillary 7. The middle axillary line (linea axillaris media) passes be
fossa). tween the anterior and posterior axillary lines.
4, The inframammary region (regio inframammaria) occupies 8. The scapular line (linea scapularis) passes vertically through
the lower part of the pectoral region and borders upon hypochon the inferior angle of the scapula
driac region (regio hypochondriaca). It is also the inferior part of the 9. The paravertebral line (linea paravertebralis) is projected
pectoral region. along the transverse vertebral processes.
The following vertical lines are marked on the thoracic wall I 0. The posterior median line (linea mediana posterior) runs on
(see Vol. II. Respiratory Apparatus). the midline of the back along the vertebral spinous processes.
1. The anterior median line (linea mediana anterior) runs on the Inspection and palpation of the chest determine the regions of
middle of the sternum. the clavicles on the superior border and the right and left costal
2. The sternal line (linea sternalis) corresponds to the lateral arches and the infrasternal angle on the inferior border. The angle
border of the sternum. of the scapula is also well palpated, it corresponds to the articula
3. The parasternal line (linea parasternalis) runs midway be tion of the second costal cartilage with the sternum. The nipple in
tween the sternum and the medioclavicular line. males is usually in line with the fourth rib.
MUSCLES OF THE CHEST

The muscles of the chest (musculi thoracis) are separated into 1. The external intercostal muscles (musculi intercostales externi).
two groups, one is composed of superficial muscles (those related 2. The internal intercostal muscles (musculi intercostalis interni).
to the shoulder girdle) and the other is formed by deep muscles 3. The intercostales intimi muscles (musculi intercostales intimi).
(muscles of the chest proper). 4. The subcostal muscles (musculi subcostales).
The superficial muscles are as follows. 5. The transversus thoracis muscle (musculus transversus thora-
1. The pectoralis major muscle (musculus pectoralis major). cis).
2. The pectoralis minor muscle (musculus pectoralis minor). The musculotendinous sheet separating the thoracic and ab
3. The subclavius muscle (musculus subclavius). dominal cavities and which is called the diaphragm (diaphragma) is
4. The serratus anterior muscle (musculus serratus anterior). also related to the chest muscles.
The following are the deep muscles.
SUPERFICIAL MUSCLES OF THE CHEST

1. The pectoralis major muscle (musculus pectoralis major) which is continuous upwards with the infraclavicular fossa. The in
(Figs 283, 285-287, 290, 292) is a wide paired muscle located in ferolateral border of the pectoralis major muscle is sometimes
the anterosuperior parts of the thoracic wall. clearly outlined under the skin. The muscle arises on the medial
The superolateral border of the muscle meets the anterior bor half of the clavicle (the clavicular part, or pars clavicularis), the an
der of the deltoid muscle to form the deltoideopectoral groove terior surface of the sternum and second to seventh costal carti-
Epicondylus
medialis
trapezius
deltoideus
J
M. Iatissimus dorsi
pectoralis major
M. �n,rn, ,mo,irn �
M. rcctus abdominis
Linea alba
Spina iliaca anterior superior
M. tensor fasciae Iatae �
283. Outlines of trunk muscles (anterior aspect).

Regio deltoidea
284. Regions of the trunk and lines of skin incisions.

(Blue line-boundaries of regions; red line-skin incisions most suitable for exposing
muscles in dissection.)
ORIGIN AND INSERTION OF TRUNK MUSCLES 315
scalenus anterior
externus
inferior
M. rectus abdominis
�......,V--__,l'---'tl--1--- M. obliquus abdominis

internus
M. glutaeus maximus M. tensor fasciae latae
M. glutaeus medius
M. glutaeus minimus
M. semitendinosus obturatorius externus
289. Sites ef origin and insertion ef the trunk muscles (schematical representation).
316 MUSCLES OF THE CHEST
!ages (the sternocostal part, or pars sternocostalis), and the anterior small and elongated and lies below and almost parallel to the clavi
wall of the sheath of the rectus abdominis muscle (the abdominal cle. It is covered by the pectoralis major muscle. The subclavius
part, or pars abdominalis). muscle takes origin from the bony and cartilaginous parts of the
Passing laterally and upwards, the fibres of the muscles con first rib and is directed laterally and upwards to be inserted into
verge in such a manner that those of the lower part of the muscle the inferior surface of the acromial part of the clavicle.
lie behind the fibres of the upper part as a result of which the mus Action: pulls the clavicle downwards and medially and in this
cle is much thicker here. This narrowed, but thicker part of the manner holds it fast in the sternoclavicular joint; when the shoul
muscle passes over to the humerus and thus forms the anterior der girdle is fixed the muscle raises the first rib and thus acts as an
wall of the axillary fossa, and is continuous with a tendon which is auxiliary muscle of respiration.
inserted into the lateral lip of the bicipital groove, the lower fibres Blood supply: the transverse scapular (suprascapular) and ac
being attached at a higher and the upper fibres at a lower level. romiothoracic arteries.
Action: draws the arm to the trunk and rotates it medially (pro Innervation: the subclavian nerve (C5 ).
nation); when the limb is held horizontally the muscle pulls it to a f The serratus anterior muscle (musculus serratus anterior)
sagittal position (anteversion); when the arm is fixed the sternocos (Figs 285, 287-291) is flat and wide and situated on the anterolat
tal part of the muscle assists in expanding the thoracic cage during eral part of the thoracic wall. Its upper part is under the pectoralis
respiration. major muscle, while the lower part lies superficially and is covered
Blood supply: the acromiothoracic, lateral and superior tho by the pectoral fascia. The muscle arises by eight or nine slips
racic, and intercostal arteries. from the external surface of the upper eight or nine ribs and from
Innervation: medial and lateral pectoral nerves (C5 -Th 1). the tendinous arch between the first and second ribs. Passing up
2. The pectoralis minor muscle (musculus pectoralis minor) wards and backwards it covers the outer surface of the ribs and
(Figs 291, 292) is flat, triangular, and located in the second layer runs under the scapula to be inserted into its medial border and
being covered by the pectoralis major muscle. It arises from the inferior angle. Fibres which are inserted into the inferior angle of
second, third, fourth and fifth ribs near to the junction of their the scapula are developed best.
cartilaginous and bony parts. Running upwards and laterally the Action: pulls the scapula away from the vertebral column; the
fibres of the muscle converge to be inserted by a short tendon into inferior fibres, in addition, displace the inferior angle of the scap
the coracoid process of the scapula. ula laterally and cause its rotation about the sagittal axis. Together
Action: pulls the scapula forwards and downwards; when the with the rhomboid muscle the serratus anterior muscle presses the
scapula is fixed raises the ribs being thus an auxiliary muscle of re scapula to the thoracic wall. When the shoulder girdle is fixed the
spiration. serratus anterior muscle also acts as an auxiliary muscle of respira
Blood supply: the acromiothoracic, intercostal and superior tion (during inspiration).
thoracic arteries. Blood supply: the thoracodorsal, lateral thoracic, and intercos
Innervation: the medial and lateral pectoral nerves (C7 -Th1). tal arteries.
3. The subclavius muscle (musculus subclavius) (Figs 291, 294) is Innervation: nerve to the serratus anterior muscle (C5 -C7).
DEEP (PROPER) MUSCLES OF THE CHEST

The intercostal muscles are short and flat and fill the intercos 2. The internal intercostal muscles (musculi intercostales interni)
tal spaces. External, internal, and intimi (innermost) intercostal (see Figs 259, 260, 295) take origin from the upper border of the
muscles are distinguished. rib, pass obliquely upwards and forwards, and are inserted into the
1. The external intercostal muscles (musculi intercostales externi} lower border of the rib next above medially of the costal groove.
(see Figs 258-260, 291) arise from the lower border of the rib lat They are absent in the posterior part of the intercostal space to the
eral of the costal groove, run obliquely downwards and forewards, back of the angle of the rib. This part is filled by the internaJ pos
and are inserted into the upper border of the rib next below. The terior intercostal membrane (membrana intercostalis interna).
external intercostal muscles are absent in the region of the costal The sources of blood supply and innervation are the same as
cartilages which is filled by the external anterior intercostal mem those for the external intercostal muscles.
brane (membrana intercostalis externa). In the posterior parts of the 3. The intercostalis intimi muscles (musculi intercostales intimi)
thoracic wall they adjoin the levatores costarum muscles (see Mus are on the inner surface of the internal intercostal muscles and
cles of the Back). their fibres pass in the same direction and are inserted into the in
Action: participate in the act of respiration (inspiration). ternal surface of adjacent ribs. These muscles fill half of the inter
Blood supply: the intercostal, internal mammary, and muscu costal space and their posterior border touches the subcostal mus
lophrenic arteries. cles.
Innervation: intercostal nerves (Th 1 -Thll)- Blood supply: the same as for the external intercostal muscles.
THE DIAPHRAGM 317
Innervation: intercostal nerves (Th1 -Th11). 5. The transversus thoracis muscle (musculus transversus thoracis)
4. The subcostal muscles (musculi subcostales) (Fig. 298) lie on (Fig. 259) is flat, thin, fan-shaped, and lies on the internal surface
the internal surface of the lower ribs in the region of their poste of the anterior thoracic wall. It takes origin from the inner surface
rior ends. They have the same sites of origin and direction of fibres of the xiphoid process and the lower part of the body of the ster
as the internal intercostal muscles, but their fibres, in contrast, num. Its fibres radiate obliquely upwards and laterally to be in
pass over one rib to the next above. serted into the internal surfaces of the third and fourth ribs.
Action: the internal intercostal and subcostal muscles take part Action: takes part in the respiratory act (expiration).
in the act of respiration (expiration). Blood supply: the intercostal arteries.
Blood supply: the intercostal arteries. Innervation: intercostal nerves (Th2-Th6).
Innervation: intercostal nerves (Th1-Th11 ).
FASCIAE OF THE CHEST

1. The pectoral fascia (fascia pectoralis) (Figs 285, 290). The su ture from the low�r border of the pectoralis major muscle over to
perficial layer (lamina superficialis) of this fascia covers the external the lower border of the latissimus dorsi muscle to form the axillary
surface of the pectoralis major muscle. It fuses with the clavicle su fascia (fascia axillaris). In the infraclavicular region part of the pec
periorly and with the sternum medially, and is continuous laterally toral fascia forms a thick area called the clavipectoral fascia (fascia
with the fascia covering the serratus anterior muscle and inferiorly clavipectoralis) which fuses with the vessels passing under it (the
with the fascia of the abdominal wall. In the infraclavicular region subclavian artery and vein).
it sinks and as the deep layer invests the pectoralis minor and sub 2. The endothoracic fascia (fascia endothoracica) covers the in
clavius muscles and then fuses with the clavicle and the coracoid ternal surface of the thoracic wall.
process of the scapula. In the axillary fossa it runs as a dense struc-
THE DIAPHRAGM
The diaphragm (diaphragma) (Figs 295-297) is an unpaired The median arcuate ligament (ligamentum arcuatum medianum)
broad muscle closing the outlet of the thorax like a dome. is in front of the aortic opening.
The fibres of the muscular part of the diaphragm arise from The medial muscle fibres of the diaphragmatic crura pass up
the inner border of the outlet of the thorax, according to which the wards and converge to form the aortic opening (hiatus aorticus)
sternal, costal, and lumbar parts are distinguished in it. (Fig. 297) transmitting the aorta and thoracic duct. A little higher
The sternal part of the diaphragm (pars sternalis diaphragmatis) the medial muscular bundles of both crura split again to form the
is the smallest. It arises from the posterior surface of the xiphoid oesophageal opening (hiatus esophageus) (Figs 296, 297) transmit
process and is continuous with the central tendon. ting the oesophagus and vagus nerves, and then pass to the centre.
The costal part of the diaphragm (pars costalis diaphragmatis) Besides, two paired slits form in the crura of the vertebral part
is also small and originates by slips from the inner surface of the diaphragm. One pair transmits the greater and lesser
of the bony and cartilaginous parts of the lower six ribs. Its fibres splanchnic nerves and the azygos (on the right side) and hemiazy
run upwards and inwards an<:a are continuous with the central gos (on the left side) veins. The other paired slit transmits the sym
tendon. pathetic trunk.
The vertebral part of the diaphragm (pars Zumba/is diaphragma More or less clearly outlined triangular slits form between the
tis) arises from the lumbar vertebrae and consists of two, right and sternal and costal and between the costal and vertebral parts of the
left, crura (crus dextrum et crus sinistrum). diaphragm; diaphragmatic hernias often occur here.
Each crus arises from the anterolateral surface of the bodies of The muscular fibres of the diaphragm which are directed to the
the first three (on the right side the first four) lumbar vertebrae centre continue as tendons to form the central tendon (centrum
and from the medial and lateral arcuate ligaments. tendineum). This area of the diaphragm is trifoliate in shape, with
The medial arcuate ligament (ligamentum arcuatum mediate) one leaf directed forwards (on which the heart lies) and the other
stretches arch-like as a thick connective-tissue band over the ante two directed to the sides (the lungs are located on them). In the
rior surface of the psoas major muscle from the body to the trans posterior part of the central tendon to the right of the midline is
verse process of the first lumbar vertebra. the vena-caval opening (foramen venae cavae inferioris) (Figs 296,
The lateral arcuate ligament (ligamentum arcuatum laterale) runs 297) which transmits the inferior vena cava.
over the quadratus lumborum muscle from the transverse process The thoracic and abdominal surfaces of the diaphragm are
of the first lumbar vertebra to the twelfth rib. covered by fasciae which in turn are covered by connective tissue,
318 THE DIAPHRAGM
the subpleural and subperitoneal fatty tissue, respectively. This is lar line to the level of the fourth intercostal space on the right side,
the foundation for the serous membrane, namely, the parietal peri and to the level of the fifth intercostal space on the left side. When
toneum in the abdominal cavity and the parietal layer of the the diaphragm contracts its domes flatten out as a result of which
pleura and pericardium in the thoracic cavity. The lungs and heart the capacity of the thoracic cavity increases.
lie on the thoracic surface of the diaphragm; the liver, stomach, Action: the diaphragm is the main muscle of respiration which
and spleen are in contact with the abdominal surface; and the pan on contraction becomes flat and thus promotes inspiration but be
creas, duodenum, kidneys, and adrenals touch areas of the abdom comes spherically convex during expiration.
inal surface of the diaphragm which are not covered by the parie Blood supply: the pericardiacophrenic artery, phrenic branches
tal peritoneum. of the descending thoracic aorta, inferior phrenic, and musculo
A relaxed diaphragm has the shape of a bevelled spherical con phrenic arteries.
vexity facing the thoracic cavity with two domes, right and left, dis Innervation: phrenic nerves (C 3 -C5 ).
tinguished in it. The apex of the tlomes rises on the medioclavicu-
MUSCLES AND FASCIAE OF
THE ABDOMEN
REGIONS OF THE ABDOMEN

The following regions of the abdomen (regiones abdominis) are The inguinal folds corresponding to the position of the inguinal li
distinguished (see Fig. 284). The upper part of the abdomen (ep gaments are distinctly seen in the lower part of the abdominal wall.
igastrium) has an epigastric region (regio epigastrica) and two la When the abdominal muscles are tensed a groove forms on the
teral, right and left hypochondriac regions (regio hypochondriaca midline which corresponds to the linea alba abdominis. The um
dextra et sinistra). In the middle part of the abdomen (mesogas bilicus is on the linea alba on the level of the articulation between
trium) are distinguished two lateral abdominal (right and left) re the third and fourth lumbar vertebrae.
gions (regio lateralis dextra et sinistra) and a middle, umbilical re The rectus abdominis muscles are outlined to both sides of the
gion (regio umbilicalis). The lower part of the abdomen midline; the tendinous intersections (intersectiones tendineae) of these
(hypogastrium) has two lateral regions called the inguinal (right muscles are defined clearly as three or four transverse constric
and left) regions (regio inguinalis dextra et sinistra) and a middle, tions.
pubic region (regio pubica). The slips of the external oblique muscle alternating with slips
Right and left costal arches (arcus costalis dexter et sinister) are of the serratus anterior muscle and longissimus dorsi muscle are
clearly outlined when the abdominal wall is pulled in. The xiphoid outlined on the upper part of the anterolateral portion of the thor
process is felt in the angle formed by the cartilaginous costal acic wall.
arches, which is called the infrastemal angle (angulus infrasternalis).
MUSCLES OF THE ABDOMEN

The muscles of the abdomen (musculi abdominis) may be sepa ternus); (3) the transversus abdominis muscle (musculus transversus
rated topographically into muscles of the lateral, anterior, and pos abdominis). The muscles of the anterior abdominal wall are: (1) the
terior abdominal wall. rectus abdominis muscle (musculus rectus abdominis); (2) the pyram
The muscles of the lateral abdominal wall are as follows: idalis muscle (musculus pyramidalis).
(1) the external oblique muscle (musculus obliquus abdominis exter The quadratus lumborum muscle (musculus quadratus lumbo
nus); (2) the internal oblique muscle (musculus obliquus abdominis in- rum) is related to the muscles of the posterior abdominal wall.
MUSCLES OF THE LATERAL ABDOMINAL WALL

The muscles of the lateral abdominal wall are arranged in neuroses of the contralateral muscle and thus help to form the
three layers. The external oblique muscle lies superficially, the in linea alba.
ternal oblique muscle lies deeper, and the transversus abdominis The lower slips of the external oblique muscle are inserted into
muscle occupies the deepest position. the anterior part of the outer lip of the iliac crest. The middle
All these muscles are related to the broad muscles of the abdo fibres of the aponeurosis bridge the anterior notch of the hip bone
men. On the anterior ·abdominal wall they are continuous with and are stretched between the anterior superior iliac spine and the
aponeuroses. pubis; the lower border of the aponeurosis folds back on itself (it is
1. The external oblique muscle of the abdomen (musculus obli reflected) to form a groove. This thick lower border of the aponeu
quus abdominis externus) (Figs 285, 287, 289, 299) is flat and broad rosis stretching between the anterior superior iliac spine and the
and arises from the lateral surface of the lower eight ribs by eight pubic tubercle and symphysis is called the inguinal ligament (liga
slips. On the anterolateral surface of the thorax the upper five slips mentum inguinale). The fibres of this ligament separate at the pubic
are wedged between the lower slips of the serratus anterior muscle, bone to form two crura. One is the medial, or superior crus (crus
while the lower three slips are between those of the longissimus mediale) which is attached to the symphysis with some of the fibres
dorsi muscle. The fibres of the external oblique muscle are di passing over to the contralateral side, the other is the lateral, or in
rected obliquely downwards and forwards to be continuous with ferior crus (crus laterale) and is attached to the pubic tubercle on
the aponeurosis. The upper part of the aponeurosis extends to the the same side. A triangular cleft forms between the crura; the su
midline and contributes to the formation of the anterior wall of perolateral angle of the cleft is rounded by curving intercrural
the sheath of the rectus abdominis muscle. The bundles of the fibres (fibrae intercrurales). Fibres separate from the inner part of the
aponeurosis of the external oblique muscle, like those of all the inferior crus and pass inwardly and medially to the anterior layer
broad abdominal muscles, interlace with the bundles of the apo- of the sheath of the rectus abdominis muscle; this is the reflected
320 MUSCLES OF THE ABDOMEN
part of the inguinal ligament (ligamentum reflexum). The oval open rosis of the internal oblique muscle contributes to the formation of
ing formed in the aponeurosis of the external oblique muscle by the posterior wall of the rectus abdominis sheath only in the upper
the two crura of the inguinal ligament, the intercrural fibres, and two thirds, to the level of the arcuate line (linea arcuata). On the
the reflected part is the superficial inguinal ring (anulus inguinalis midline the bands of the anterior and posterior layers intertwine
supe-r:ficialis). It transmits the spermatic cord (funiculus spermaticus) with those of the fellow layers on the contralateral side to form the
in males (Fig. 301) and the round ligament of the uterus (ligamen linea alba (see Sheath of the Redus Abdominis Muscle).
tum teres uteri) in females (Fig. 302). (In pathological cases organs Action: the internal oblique muscle is part of the prelum ab
may protrude from this opening and inguinal hernia forms.) A dominale; contraction of one muscle rotates the trunk to the same
bundle separates from the medial end of the lateral crus and runs side.
backwards and laterally on the border of the superior pubic ramus. Blood supply: the intercostal, inferior and superior epigastric,
It rounds off the sharp angle between the inguinal ligament and and musculophrenic arteries.
the pubic bone and is called the lacunar ligament (ligamentum lacu Innervation: intercostal nerves (eighth to twelfth), iliohypogas
nare), or pectineal part of the inguinal ligament. tric and ilioinguinal nerves.
A triangular area forms in the wall of the trunk to the back of 3. The transversus abdominis muscle (musculus transversus ab
the posterior border of the external oblique muscle above the iliac dominis) (Figs 290-292, 295, 299, 305) is flat and broad and occu
crest; it is called the lumbar triangle (trigonum lumbale) (see Muscles pies the deepest position in the anterolateral part of the abdominal
of the Back). wall. It arises from the inner surfaces of the lower six costal carti
Action: the external oblique muscle is a muscle of the prelum lages (where its slips are wedged between the slips of the costal
abdominale; contraction of one muscle rotates the trunk to the part of the diaphragm), the lumbar fascia, the inner lip of the iliac
other side; with the pelvis fixed contraction of both muscles pulls crest, and the lateral two thirds of the inguinal ligament. Its fibres
the chest and flexes the vertebral column. run horizontally forwards and end in an aponeurosis before they
Blood supply: the intercostal, lateral thoracic, and the super reach the lateral border of the rectus abdominis muscle. Above the
ficial circumflex iliac arteries. arcuate line the aponeurosis lies behind the rectus abdominis, be
Innervation: intercostal nerves (fifth to twelfth), the lumbar low the line it extends over the anterior surface of the muscle. On
nerve (Th5 -Th 1 2, L 1 ), the midline the fibres of the aponeurosis contribute to the forma
2. The internal oblique muscle (musculus obliquus abdominis in tion of the linea alba. A few fibres separate from the lower parts of
ternus) (Figs 288-290, 299, 304) is broad and flat and located me the transversus muscle and meet similar fibres of the internal ob
dially of the external oblique muscle in the anterolateral part of lique muscle to form the cremaster muscle.
the abdominal wall. It arises from the lateral two thirds of the A laterally convex line forms at the junction of the muscular
inguinal ligament, intermediate area of the iliac crest, and the lum fibres with the aponeurosis; it is called the linea semilunaris
bar fascia (at the junction of its two layers). Its fibres spread fan (Fig. 291). It is behind the rectus abdominis muscle in the upper
like, mainly obliquely, upwards and forwards; the lower fibres run part and lateral to the lateral border of the muscle for the remain
almost horizontally and obliquely downwards and forwards. They ing distance.
give off fine fibres which descend along the spermatic cord and Action: the transversus abdominis muscle is part of the prelum
form part of the cremaster muscle (see Fig. 304) which elevates the abdominale; it flattens the abdominal wall and brings the lower
testis. The posterior fibres of the internal oblique muscle run al parts of the chest closer to each other.
most vertically to be inserted into the external surface of the lower Blood supply: the superior and inferior epigastric and muscu
three or four ribs. The remaining fibres end as an aponeurosis lophrenic arteries.
which extends to the lateral border of the rectus abdominis muscle Innervation: intercostal (seventh to twelfth), iliohypogastric,
and separates into two layers investing the muscle anteriorly and and ilioinguinal nerves.
posteriorly to take part in the formation of its sheath. The aponeu-
MUSCLES OF THE ANTERIOR ABDOMINAL WALL

1. The rectus abdominis muscle (musculus rectus abdominis) (Figs tiones tendineae), two of which are above the umbilicus, one is on
290-292, 295, 306, 307) is paired, flat and related to the long mus the level with it, while the poorly developed fourth intersection is
cles of the abdomen. It is in the anterior part of the abdominal sometimes below the umbilicus.
wall to both sides of the linea alba which stretches on the midline 2. The pyramidalis muscle (musculus pyramidalis)
from the xiphoid process to the pubic symphysis. The rectus ab (Figs 290-292, 300, 304, 306) is paired, triangular, and varies in
dominis muscle arises from the fifth, sixth, and seventh costal car size. It arises from the pubic bone in front of the insertion of the
tilages and the xiphoid process; running downwards it becomes rectus abdominis muscle. Its fibres converge and run upwards to
narrower and is inserted into the pubic bone in the space between be inserted into the lower parts of the linea alba at various levels.
the pubic symphysis and tubercle. The muscle fibres are inter Both muscles, the rectus and the pyramidalis, are enclosed in
rupted by three or four transverse tendinous intersections (intersec- the sheath of the rectus abdominis muscle (vagina musculi recti ab-
MUSCLES OF THE TRUNK 321
M. stemocleidomastoideus
Fascia pectoralis
(lamina profunda)
M. pectoralis major
Mm. intercostales---.--.:.
interni
Vagina m. recti ----+..-f:!lr":----t'!i:::--'---- Tendo

(anterior layer) m. bicipitis brachii
Aponeurosis m.
bicipitis brachii
M. brachioradialis
M. obliquus abdominis internus
290. Muscles of the trunk; anterior aspect (¼).

(The external oblique muscle and part of the pectoralis major muscle are removed on the right; the ex
ternal and internal oblique muscles and part of the pectoralis major muscle are removed on the left; the
greater part of the anterior layer of the sheath of the rectus abdominis muscles is also removed.)
322 MUSCLES OF THE TRUNK
V. jugularis interna
externi
M. pectoralis
major
Vagina m. recti abdominis

(posterior layer)
Aponeurosis Linea semilunari
m. bicipitis brachii
Vagina m. recti
abdominis
(anterior layer)
M. transversus
---- abdominis
Hiatus saphenus
M. pyramidalis
291. Muscles of the trunk; anterior aspect (¼).

(The pectoralis major, external and internal oblique, and rectus abdominis muscles are
removed on the right; the superficial muscles of the chest, the external and internal ob
lique muscles, and part of the rectus abdominis muscle are removed on the left.)
APONEUROSES AND FASCIAE OF THE ABDOMEN 323
dominis) (Figs 285, 290, 291, 295, 300, 306) which is formed by the one side flexes the vertebral column laterally. Unilateral contrac
aponeuroses of the broad abdominal muscles. tion of the external oblique muscle rotates the vertebral column to
Action: they are part of the prelum abdominale; flex the trunk the contralateral side; contraction of the internal oblique muscle
forwards; the pyramidalis muscle, in addition, tenses the linea rotates it to the side of the contracting muscle. The muscles of the
alba. abdominal wall and the diaphragm maintain the intra-abdominal
Blood supply: rectus abdominis muscle-the superior and infe pressure at a certain level by their tonus, which is important for
rior epigastric arteries; pyramidalis muscle-the cremasteric and holding the abdominal organs in a definite position. When the to
inferior epigastric arteries. nus of the muscles of the abdominal wall reduces (atony) intra-ab
Innervation: intercostal and lumbar nerves (Th5-Th 12; L 1 ). dominal pressure drops as a result of which the organs are dis
The broad and long muscles of the abdominal wall are the placed downwards (ptosis) by their own weight and their function
muscles of the trunk and cause the following movements: by lower is disturbed as a consequence. Contraction of the muscles of the
ing the ribs they take part in the act of respiration; they change the abdominal wall reduces the capacity of the abdominal cavity and
position of the vertebral column; contraction of all muscles (except the organs are compressed, which helps in their evacuation (defae
for the transversus abdominis) pulls the chest downwards and cation, urination, childbirth). In view of this the muscles of the ab
flexes the vertebral column forwards; contraction of muscles on dominal wall are called prelum abdominale.
MUSCLES OF THE POSTERIOR ABDOMINAL WALL
The quadratus lumborum muscle (musculus quadratus lumbo gament. The posterior part extends from the iliac crest and ilio
rum) (Figs 292, 297, 298, 299) is flat and fills the space between the lumbar ligament to the transverse processes of the upper four lum
twelfth rib and the iliac crest; it lies on the posterior abdominal bar vertebrae.
wall and is separated from the deep muscles of the back by the Action: pulls the ilium upwards and the twelfth rib downwards;
deep layer of the lumbar fascia. The muscle is made up of two contributes to lateral flexion of the lumbar vertebral column; con
parts, anterior and posterior. The anterior part stretches from the traction of both muscles pulls the lumbar spine backwards.
internal lip of the iliac crest and iliolumbar ligament to the twelfth Blood supply: the subcostal, lumbar, and iliolumbar arteries.
rib and twelfth thoracic vertebra and also to the medial arcuate Ii- Innervation: intercostal and lumbar nerves (Th 12, L 1 -L3).
APONEUROSES AND FASCIAE

OF THE ABDOMEN
THE SHEATH OF THE RECTUS ABDOMINIS MUSCLE
Each of the two rectus abdominis muscles is invested in its Above the arcuate line the anterior wall of the sheath is formed
sheath (vagina musculi recti abdominis) (Figs 285, 290, 291, 295, 300, by fibres of the aponeurosis of the external oblique muscle and the
306, 307) formed by the aponeuroses of the three broad muscles of anterior layer of the aponeurosis of the internal oblique muscle;
the abdominal wall. The sheath has an anterior and a posterior the posterior wall is formed by the posterior layer of the aponeuro
lamina (laminae anterior et posterior); the posterior lamina exists sis of the internal oblique muscle, the aponeurosis of the transver
only in the upper two thirds of the muscle but is absent in the sus abdominis muscle and uppermost by muscle fibres of this mus
lower part below the arcuate line (Figs 291, 295, 300, 307) so that cle. Below the arcuate line the aponeuroses of the three muscles
the posterior surface of the rectus abdominis muscles rests here on form a thicker anterior wall of the sheath, but there is no posterior
the fascia transversalis (Figs 295, 306). The arcuate line is convex layer below this line and only the fascia transversalis is found here.
upwards and is 4-5 cm below the umbilicus.
THE LINEA ALBA

The linea alba (Figs 285, 300, 302, 303) has the appearance of and wider, more or less defined slits are left between the interlac
a tendinous band stretching from the xiphoid process to the pubic ing fibres, through which herniations may occur. Approximately
symphysis. It is 1-2 cm wide in the upper part of the abdominal on the middle of the linea alba is the umbilical ring (anulus umbili
wall and considerably narrows in the lower parts but is thicker calis) which is filled by loose cicatricial tissue called the navel (um
here being reinforced on the inner surface by a connective-tissue bilicus s. umbo). In the intrauterine developmental period in place
structure called the adminiculum lineae albae. The linea alba is of the navel was a round opening transmitting the umbilical vein
formed by interlacing fibres of the aponeuroses of the three pairs and arteries. A hernia often occurs here.
of broad abdominal muscles. In the upper part, where it is thinner
324 ORIGIN AND INSERTION OF TRUNK MUSCLES
M. pectoralis minor
M.
M. subscapulari
M. pectoralis
major
obliquus abdominis
intern us
externus
intern us
externus
M. obturatorius externus
M. semitendinosus
M. adductor longus
M. adductor magnus
292. Sites of origin and insertion of the trunk muscles (schematical representation).
ORIGIN AND ATTACHMENT OF MUSCLES ON THE CLAVICLE 325
M. trapezius M. sternohyoideus
Lamina pretrachealis fasciae cervicalis
Lamina superficialis
fasciae cervicalis
Capsula
art. acromioclavicularis
M. pectoralis major
M. deltoideus
(caput claviculare)
Capsula
art. sternoclavicularis
293. Sites of origin and attachment of muscles, fasciae, and articular capsule
on the clavicle; superior aspect (schematical representation).

Capsula
art. acromioclavicularis M. pectoralis major
Lig. conoideum
. Lig. coracoclaviculare
L1g. trapezoideum
294. Origin and attachment of muscles, fasciae, and articular capsule on the
clavicle; inferior aspect (schematical representation).
326 MUSCLES AND FASCIAE OF THE TRUNK
M. sternothyreoideus
M. sternothyreoideus
(reflected)
M. transversus thoracis
Diaphragma
(pars sternalis)

(lamina posterior)
M. transversus abdominis
M. obliquus abdominis -
internus.
M. obliquus abdominis -
externus
M. transversus
abdominis
M. rectus abdominis
Lig. inguinale
Lacuna musculorum A. iliaca externa
V. iliaca externa
Arcus iliopectineum "
Lacuna vasorum
Membrana obturatoria
295. Muscles and fasciae of the trunk (¼).

(Anterior thoracic and abdominal wall; inner aspect.)
THE DIAPHRAGM 327
Oesophagus (in hiatus oesophageus) Aorta (in hiatus aorticus)

M. trapezius
V. cava inferior (in foramen venae cavae)
Pars lumbalis diaphragmatis
Pars sternalis diaphragmatis
296. Diaphragm; superior aspect (½).

328 THE POSTERIOR ABDOMINAL WALL
Pars sternalis diaphragmatis
Pars lumbalis
diaphragmatis
Lig. arcuatum
mediale
Lig. arcuatum
medianum
Lig. arcuatum
laterale
M. quadratus
Crus dextrum lumborum
diaphragmatis
M. iliacus
Hiatus
saphenus
externus
297. Diaphragm and muscles of posterior abdominal wall; inner

aspect (½).
(The quadratus lumborum muscle and part of the pectoralis major and minor muscles are removed on
the right.)
THE INGUINAL CANAL 329
FASCIAE OF THE ABDOMEN

The following fasciae are developed best in the abdominal wall vesting the spermatic cord and testis this protrusion of the
(Figs 285, 295, 299). transversalis fascia is called the internal spermatic fascia (fascia
1. The superficial fascia of the abdomen is thin in the upper spermatica interna). The dilated oval depression on the surface of
part of the abdominal wall but much thicker in the lower parts and the transversalis fascia is the deep inguinal ring (opening of the
is distinguished by the presence of elastic fibres. It fuses with the inguinal canal) (anulus inguinalis profundus). The medial border of
linea alba on the midline and with the inguinal ligament inferiorly. this ring, which is most pronounced due to thickening of the fas
Two thick bands form in the lower part above the symphysis, these cia, is called the interfoveolar ligament (ligamentum interfoveolare).
are called the ligaments of the penis. There are two of them: On the inner surface of the subperitoneal fascia lies the perito
(a) the fundiform ligament of the penis (ligamentum fundiforme pe neum. A series of folds (Fig. 307) are seen on the peritoneum of
nis) arising from the pubic symphysis and giving off two crura the anterior abdominal wall along the distribution of the ligaments
which pass on the sides of the penis, and (b) the suspensory liga and vessels in the preperitoneal fatty tissue. An unpaired median
ment of the penis (the suspensory ligament of the clitoris in fe umbilical fold (plica umbilicalis mediana) passes on the midline from
males) (ligamentum suspensorium penis et ligamentum suspensorium cli the apex of the urinary bladder to the umbilicus; it forms along the
toridis) stretching from the pubic symphysis to the dorsal surface of course ef the obliterated embryonal urachus. To each side of the
the penis (clitor). The fascia! bands in the region of these liga median folds is a medial umbilical fold (plica umbilicalis media/is)
ments are reinforced partly by tendinous bands of the rectus ab which runs from the lateral surface of the bladder to the umbili
dominis and external oblique muscles. cus; it forms along the course of the obliterated embryonal umbili
2. The fascia iliaca (see Fasciae of the Pelvis and Inigh ). cal artery. Still further laterally is the paired lateral umbilical fold
3. The transversalis fascia (fascia transversalis) covers the inner (plica umbilicalis lateralis) stretching along the distribution of the in
surface of the transversus abdominis muscle and the inner surface ferior epigastric artery and veins.
of the posterior lamina of the rectus abdominis sheath; below the Depressions called fossae are seen between the folds in the
arcuate line it covers the inner, posterior, surface of the rectus ab lower part of the inner surface of the anterior abdominal wall. La
dominis. Inferiorly it fuses with the borders of the inguinal liga teral to the lateral umbilical fold is the lateral inguinal fossa (fossa
ment which is reflected to the back and upwards. The transversalis inguinalis lateralis) which corresponds to the deep inguinal ring. Be
fascia is thicker in the region of the umbilicus and is called here tween the medial and lateral folds is the middle inguinal fossa
the umbilical fascia. Concentrated longitudinal bands in the lower (fossa inguinalis media/is) corresponding to the superficial inguinal
part of the linea alba form the adminiculum lineae albae for its ring. The supravesical fossa (fossa supravesicalis) is between the me
support. In the inguinal region the transversalis fascia forms a fun dial and median umbilical folds. Viscera may protrude (hernias)
nel-li_ke protrusion lodging the processus vaginalis of the perito through these fossae and after passing through the abdominal wall the
neum which passes along the spermatic cord into the scrotum; in- herniation emerges through the external (superficial) inguinal ring.
THE INGUINAL CANAL

The inguinal canal (canalis inguinalis) (Figs 301-307) is a pas The opening transmits the spermatic cord in males and the
sage on the lower part of the abdominal wall. It contains the sper round ligament of the uterus in females. The opening can be ex
matic cord in the male and the round ligament of the uterus in the amined: the entrance into the inguinal canal can be felt by push
female. The canal runs obliquely. From the superficial inguinal ing the skin on the scrotum upwards and laterally with the little
ring above the anterior part of the superior ramus of the pubic finger. Normally only the tip of the little finger passes through the
bone it passes laterally, upwards and slightly backwards to the opening; a larger opening is interpreted as dilation of the super
deep inguinal ring located 1-1.5 cm above the medial part of the ficial inguinal ring.
inguinal ligament. The canal is 4-5 cm long. The deep (internal) inguinal ring (anulus inguinalis profundus) is
The walls of the inguinal canal are as follows: (a) the anterior a funnel-like depression of the transversalis fascia bounded medi
wall formed by the aponeurosis of the external oblique muscle; ally by the interfoveolar ligament (ligamentum interfoveolare)
(b) the posterior wall formed by the transversalis fascia; (c) the in (Fig. 305). Medially of this ligament the posterior wall of the ingui
ferior wall formed by the reflected part of the inguinal ligament; nal canal is reinforced by the fibres of the inferior border of the
(d) the superior wall formed by the lower borders of the internal aponeurosis of the transversus abdominis muscle which, curving
oblique and transversus abdominis muscles. downwards are attached to the pubic tubercle and crest to form
The superficial (external) inguinal ring (anulus inguinalis super the conjoint tendon (falx inguinalis s. tendo conjunctivus) (Figs 305,
ficialis) is an oval opening (2.5-3 X 1-2.5 cm) above the pubic 307). Vessels (inferior epigastric artery and veins), to which the lat
bone. It is bounded anteriorly and inferiorly, respectively, by the eral umbilical fold corresponds, run medially of the deep inguinal
superior and inferior crura of the inguinal ligament (crus mediale et ring; this circumstance must be borne in mind when the deep
crus laterale), laterally by the intercrural fibres (fibrae intercrurales), inguinal ring has to be cut in incarcerated hernia.
and medially and downwards by the reflected part of the inguinal
ligament (ligamentum reflexum) (Figs 303, 304).
330 THE DIAPHRAGM. THE POSTERIOR ABDOMINAL WALL
M. intercostalis
Mm. intercostales A., v. et. n. intercostalis
298. Muscles ofposterior thoracic and abdominal wall; inner aspect(¾).

MUSCLES OF THE BACK AND ABDOMEN 331
M. erector trunci
(lamina profunda)
M. latissimus dorsi

299. Muscles of the back and abdomen (½).

(Horizontal section through second lumbar vertebra.)
332 SHEATHS OF THE RECTUS ABDOMIS MUSCLES
Cartilago costalis
extern us
A M. intercostalis
internus
Vagina m. recti abdominis (lamina anterior)

Linea alba
Fascia transversalis
M. pyramidalis
D
Lig. umbilicale medianum
Peritonaeum parietale
300. Sheaths of rectus abdominis muscles at different levels.

(Horizontal sections through anterior abdominal wall.)
A-on the level of the xiphoid process
B -above the arcuate line
C-below the arcuate line
D-above the pubic symphysis
Aponeurosis m.
obliqui externi
abdominis
externi
Fascia spermatica
interna
(cut)
Crus laterale
,..i:.;,.---Lig. suspensorium
Fascia cribrosa penis
Funiculus
spermaticus
V. saphena _..a,:...:..---'�-'\-',,----\-i-+tt.,_,,.
magna
301. Inguinal canal (canalis inguinalis) of a male; anterior

aspect(½).
334 THE INGUINAL CANAL
Spina iliaca anterior

superior
Fibrae
Airnlus inguinalis
---- sur.erficialis
b'---=r----- Lig. teres uteri
Hiatus saphenus
Fascia lata�...,11��-'��:----
(lamina
superficialis)
---- V. saphena magna
302. Inguinal canal (canalis inguinalis) of a female; anterior

aspect(½).
THE SUPERFICIAL INGUINAL RING 335
'''\
\
\'
Lig. inguinale
Lig. lacunare
Crus laterale
(pulled aside)
Fascia lata _;�-�-,-\c---

(lamina Funiculus spennaticus
superficialis) (partly removed)
magna
303. Su{;erficial inguinal ring (anulus inguinalis superficialis); anterior

aspect (½).
M.obliquus
abdominis externus
(cut)
Vagina m.recti abdominis

(lamina anterior)
(cut and reflected)
M.obliquus
abdominis internus
Aponeurosis m.
obliqui abdominis externi
(cut and reflected)
Lig.inguinale
reflexum --•I-"---------' Crus laterale
M.cremaster
304. Inguinal canal (canalis inguinalis); anterior aspect (½).

(On the right the lower parts of the external oblique muscle are cut and reflected; on the left the an
terior wall of the rectus abdominis sheath is opened and drawn aside.)
M. rectus abdominis
M.obliquus
abdominis externus
(cut and reflected)
Vagina m.recti abdominis
,115...---- (lamina anterior)
(reflected)
M.obliquus Anulus inguinalis

abdominis internus profundus
(cut and reflected)
Funiculus
Aponeurosis m.
obliqui abdominis externi
(cut and reflected)
M. cremaster
Crus mediale
Funiculus Crus mediale

spermaticus (cut and reflected)
305. Inguinal canal (canalis inguinalis); anterior aspect

(½).
(On the right the external and internal oblique muscles are cut and reflected; the
walls of the deep inguinal ring are exposed. On the left the spermatic cord is re
moved; the superficial inguinal ring is exposed.)
I
Fascia transversalis Vagina m. recti abdominis (lamina posterior)

(lamina anterior)
(cut and reflected)
Linea arcuata
(cut and reflected) A. et vv. epigastricae
inferiores
M. rectus abdominis
(cut off)
M. obliquus
abdominis internus
(cut and reflected)
Aponeurosis m. obliqui
abdominis externi
(cut and reflected)
Anulus inguinalis Faix inguinalis

profundus IJl.,..,4'�--.-,('t;tendo conjunctivus)
reflexum
��;�--::=--T- Lig.
Crus laterale
M. cremaster Anulus inguinalis
superficialis
306. Inguinal canal (canalis inguinalis); ante

rior aspect (½).
(The transversalis fascia and the deep inguinal ring are exposed on
the right.)
THE ANTERIOR ABDOMINAL AND PELVIC WALL 339
A. et vv. epigastricae inferiores

Anulus inguinalis
profundus
Fascia iliaca
Vasa spermatica
V. iliaca externa
Lig. interfoveolare
Faix inguinalis (tendo conjunctivus)
Ductus deferens
Vesica urinaria
Vesicula seminalis
307. Anterior abdominal and pelvic wall; mner aspect

(½).
(The fossae and folds of the inner surface of the anterior abdominal wall are
seen on the right. On the left the peritoneum and fascia transversalis are re
moved, the deep inguinal ring is exposed.)
'
MUSCLES OF THE UPPER LIMB
Musculi membri superioris
REGIONS OF THE UPPER LIMB

The following regions of the upper limb (regiones membri superi anterior) and a posterior antebrachial region (regio antebrachii poste
oris) (Figs 309, 310, 319) are distinguished. rior).
1. The deltoid region (regio deltoidea) corresponds to the posi 5. The wrist (carpus) in which an anterior carpal region (regio
tion of the deltoid muscle. carpalis anterior) and a posterior carpal region (regio carpalis poste
2. The upper arm (brachium) has an anterior brachia! region rior) are distinguished.
(regio brachii anterior) corresponding to the outlines of the biceps 6. The hand (manus) which has a palm (palma manus), on whose
brachii muscle and a posterior brachia! region (regio brachii poste medial side is the thenar eminence (thenar) and on the lateral side
rior) corresponding to the outlines of the triceps brachii muscle the hypothenar eminence (hypothenar), and a back (dorsum manus s.
(Figs 330, 331, 340). regio dorsi manus) which corresponds to the dorsal surface of the
3. The elbow (cubitus) in which are distinguished an anterior carpus and metacarpus.
cubital region (regio cubiti anterior) with the cubital fossa (fossa cubi 7. The fingers (digiti manus) in which are distinguished palmar
talis) and a posterior cubital region (regio cubiti posterior). surfaces (facies digitales uentrales palmares) and dorsal surfaces (facies
4. The forearm (antebrachium) with an anterior (regio antebrachii digitales dorsales).
MUSCLES OF THE UPPER LIMB

The muscles of the upper limb (musculi membri superioris) are di rioris). The muscles of the last-named group are divided in turn
vided into two groups according to their topographic and ana into the muscles of the upper arm (musculi brachii), the muscles of
tomic features. One group consists of the muscles of the shoulder the forearm (musculi antebrachii), and the muscles of the hand (mus
girdle (musculi cinguli membri superioris) and the other is made up of culi manus).
the muscles of the free upper limb (musculi partis liberae membri supe-
MUSCLES OF THE SHOULDER GIRDLE

The following are the muscles of the shoulder girdle (see also (5) the teres major muscle (musculus teres major);
Muscles ef the Back and Muscles ef the Chest): (6) the subscapularis muscle (musculus subscapularis).
(1) the deltoid muscle (musculus deltoideus); 1. The deltoid muscle (musculus deltoideus) (Fig. 313) covers the
(2) the supraspinatus muscle (musculus supraspinatus); shoulder joint. It is thick and triangular with the base facing up
(3) the infraspinatus muscle (musculus infraspinatus); wards and the apex downwards. The muscle is made up of large
(4) the teres minor muscle (musculus teres minor); muscle fibres converging fan-wise at the apex. It arises from the
342 OUTLINES OF MUSCLES OF THE UPPER LIMB
Fossa infraclavicularis
M. deltoideus ----
Sulcus deltoideopectoralis--------:-
M.
V. mediana cubiti
308. Outlines of the muscles on the anterior surface of right upper limb.
REGIONS OF THE UPPER LIMB 343
Regio deltoidea ---f---
Regio antebrachii anterior
309. Regions of upper limb; anterior aspect.

344 REGIONS OF THE UPPER LIMB
Regio antebrachii anterior
Regio deltoidea
Regio brachii anterior
Regio cubiti posterior

Fossa axillaris
Regio brachii posterior
310. Regions of upper limb.
clavicle and scapula and is inserted into the deltoid tuberosity of the posterior surface of the shoulder joint capsule and on contrac
the humerus. A large subdeltoid bursa (bursa subdeltoidea) is lodged tion of the muscle pulls the capsule away thus preventing its incar
between the inferior surface of the muscle and the greater tuberos ceration.
ity of the humerus. Action: abducts the arm.
Action: pulls the upper arm forwards and pronates it slightly, Blood supply: the suprascapular and circumflex scapular arter
abducts the arm to the horizontal level, pulls the limb back, supi ies.
nating it slightly. Innervation: the suprascapular nerve (C5 -C 6).
Blood supply: the posterior circumflex humeral, acromiothor 3. The infraspinatus muscle (musculus infraspinatus) (see
acic, and profunda brachii arteries. Fig. 322) is triangular, flat, and fills the infraspinatus fossa com
Innervation: the circumflex nerve (C 5 -C 6). pletely. Its lateral part is covered by the deltoid muscle, medial
2. The supraspinatus muscle (musculus supraspinatus) (see part by the trapezius muscle, and inferior parts by the latissimus
Fig. 322) is trihedral and occupies the whole supraspinous fossa dorsi and the teres major muscles. In the middle it is covered by its
from whose walls it arises. The muscular fibres converge to form a own fascia. The infraspinatus muscle arises from the entire surface
narrower part of the muscle, stretch laterally, pass under the ac of the infraspinatus fossa and the posterior surface of the scapula,
romion, and are inserted into the facet on top of the greater tuber leaving the external border and inferior angle free.
osity of the humerus. The end tendon of the muscle is fused with The muscle is directed laterally and its fibres converge to form
THE UPPER LIMB. LINES OF SKIN INCISIONS 345
a small short tendon which is inserted into the middle facet of the Blood supply: the circumflex scapular and suprascapular arter
greater tuberosity of the humerus. At the insertion is the bursa of ies.
the infraspinatus muscle (bursa subtendinea musculi infraspinati). Innervation: the suprascapular nerve (C5 -C6).
Action: pulls the raised limb to the back and rotates the arm 4. The teres minor muscle (musculus teres minor) (see Fig. 322) is
laterally. elongated, slightly rounded (on cross section) and its fibres are ar
ranged parallel to one another.
The superior border of the muscle is in contact with the infra
spinatus muscle; the posterior part is covered by the teres major
and the anterior by the deltoid muscles. The teres minor muscle
arises from the lateral border of the scapula and occupies a narrow
area on it extending from below the infraglenoid tubercle to the
inferior angle of the scapula. Passing laterally, the muscle is con
tinuous with a short and rather strong tendon which is fused with
the posterior surface of the shoulder joint capsule and inserted
into the inferior facet of the greater tuberosity of the humerus.
Action: supinates the upper arm and pulls it slightly to the
back; draws out the capsule of the shoulder joint.
Blood supply: the circumflex scapular artery.
Innervation: the circumflex nerve (C5 ).
5. The teres major muscle (musculus teres major) (see Fig. 322) is
flat and elongated with the fibres running first downwards and
then parallel to its length. Its posterior part is covered by the latis
simus dorsi muscle, the lateral part by the long head of the triceps
brachii muscle and the deltoid muscle, and the middle part by a
fine fascia connected to the fascia of the latissimus dorsi muscle.
The teres major muscle arises from the lateral border of the in
ferior angle of the scapula and fascia of the infraspinatus muscle
and runs laterally to be inserted into the crest of the lesser tuberos
ity of the humerus. The bursa of the teres major muscle (bursa sub
tendinea musculi teretis majoris) is lodged at the insertion.
Action: pronates and pulls the upper arm back thus drawing it
to the trunk.
Blood supply: the subscapular artery.
Innervation: the subscapular nerve (C5 -C7 ).
6. The subscapularis muscle (musculus subscapularis) (Fig. 314)
fills the subscapular fossa completely. It is flat, triangular and
made up of muscle fibres which are separated by fascia! layers.
The base of the triangle is parallel to the medial scapular border,
while the apex is formed by the converging muscle fibres and faces
laterally towards the humerus. Two layers are distinguished in the
muscle, superficial and deep. The superficial fibres arise from the
costal surface of the scapula, the deep fibres originate from the
subscapular fascia which is attached to the borders of the subscap
ular fossa. Running laterally the muscle is continuous with a small
tendon which is fused with the anterior surface of the shoulder
joint capsule (which the contracting muscle draws out) and is in
serted into the lesser tuberosity of the humerus and its crest. At
the insertion of the tendon is a small subscapular bursa (bursa sub
tendinea musculi subscapularis) which communicates with the cavity
of the shoulder joint.
311. Lines of skin incisions on upper limb

Action: pronates the arm and helps in its adduction to the
trunk.
(most suitable for exposure of muscles Blood supply: the subscapular artery.
during dissection). Innervation: the subscapular nerve (C5 -C 7 ).
M.
Sulcus
deltoideopectoralis
Epicondylus medialis
Aponeurosis
M. flexor carpi --+-------··'

radialis
M. flexor digitorum
superficialis
�~Of-- Tendo m. palmaris longi
312. Muscles and fasciae of right upper limb; anterior aspect

(¼).
(The skin and subcutaneous fat are removed.)
MUSCLES OF THE UPPER LIMB 347
M. teres major
Caput longum
m. tricipitis brachii
M. latissimus dorsi
Caput laterale
M. brachialis ---'ila----;:-'-:it7"i'i'\
Tendo
Septum intermusculare
brachii laterale -'------,=--· l1
Caput mediale ---:--t'l■
M. anconeus
M. extensor carpi radialis
longus
M, extensor carpi radialis
brevis
M. abductor pollicis longus
M. extensor digitorum
Tendo
m, extensoris pollicis longi
313. Muscles of right upper limb; lateral aspect (¼).

348 MUSCLES OF THE SHOULDER GIRDLE AND ARM
M. pectoralis minor
(cut off)
M. deltoideus (pulled aside)

(cut off)
Caput longum
major
(cut off)
Caput breve
M. latissimus
dorsi
Caput mediale
M. pronator teres
Tendo m. bicipitis brachii
314. Muscles of right shoulder girdle and arm; anterior aspect (¾).
MUSCLES OF THE FREE UPPER LIMB
MUSCLES OF THE UPPER ARM

The muscles of the upper arm are separated into the anterior extensors (the triceps brachii and anconeus muscle) to the second
and posterior groups. Flexors (the biceps brachii, coracobrachialis, group.
and brachialis muscles) are mainly related to the first group, and
THE ANTERIOR GROUP OF MUSCLES

OF THE UPPER ARM
1. The biceps brachii muscle (musculus biceps brachii) (Figs Innervation: the musculocutaneous nerve (C5 -C6).
312-314) has two heads and is rounded and spindle-shaped. It oc 2. The coracobrachialis muscle (musculus coracobrachialis)
cupies the anterior region of the upper arm and the bend of the el (Fig. 315) is flat and covered entirely by the short head of the bi
bow and lies directly under the skin. ceps brachii muscle. It takes origin from the apex of the coracoid
The long head (caput longum) is located lateraly. It arises by a process and is inserted below the middle of the medial surface of
long tendon from the supraglenoid tubercle of the scapula, runs the humerus on the medial lip of the bicipital groove. Some of its
over the head of the humerus through the cavity of the shoulder fibres are also inserted into the medial intermuscular septum of
joint, lies in the intertubercular groove where it is invested by the the arm. At the origin of the muscle lies the bursa of the coraco
intertubercular synovial sheath (vagina synovialis intertubercularis) brachialis muscle (bursa musculi coracobrachialis).
and is then continuous with a muscular belly. Action: raises and adducts the arm.
The short head (caput breve) occupies a medial position. It takes Blood supply: anterior and posterior circumflex humeral arter
origin by a wide tendon from the apex of the coracoid process of ies.
the scapula, passes downwards and is also continuous as a muscu Innervation: the musculocutaneous nerve (C6-C7 ).
lar belly. 3. The brachialis muscle (musculus brachia/is) (Fig. 315) is quite
The two heads are united to form a long fleshy belly which, on broad, fleshy, and spindle-shaped and lies under the biceps brachii
reaching the cubital fossa, becomes narrower and continues as a muscle on the anterior surface of the lower half of the upper
strong tendon which is inserted into the tuberosity on the radius. arm. It arises from the lateral and anterior surfaces of the distal
Some of the fibres separate from the proximal end of the ten half of the humerus, embracing in a horseshoe manner the in
don as a thin sheet; this is the bicipital aponeurosis (aponeurosis sertion of the deltoid muscle, and also from the lateral and me
musculi bicipitis brachii s. lacertus fibrosus). To each side of the biceps dial intermuscular septa of the arm. It then bridges the elbow
brachii muscle on the upper arm run vertically and almost sym joint, fuses with its capsule, and is inserted into the tuberosity of
metrically two grooves called the medial and lateral bicipital the ulna.
grooves (sulcus bicipitalis media/is et sulcus bicipitalis lateralis). Action: flexes the forearm and stretches the capsule of the el
Action: flexes the limb at the elbow joint and supinates the bow joint.
forearm; the long head helps in abduction and the short head in Blood supply: the ulnar collateral arteries and the muscular
adduction of the limb. branches of the brachia! and radial recurrent arteries.
Blood supply: muscular branches of the axillary artery and bra Innervation: the musculocutaneous nerve (C5-C6).
chia! artery.
THE POSTERIOR GROUP OF MUSCLES

OF THE UPPER ARM
1. The triceps brachii muscle (musculus triceps brachii) (Fig. 322) dial and lateral intermuscular septa and is directed medially and
is large and long and stretches for the whole distance of the poste downwards.
rior surface of the arm from the scapula to the olecranon. It has The medial head (caput mediale) is covered by the lateral and
three heads, a long, a lateral, and a medial head. At the origin they partly by the long heads. It arises from the posterior surface of the
are covered by the deltoid muscle. humerus below the spiral groove and from the medial and lateral
The long head (caput longum) arises by a wide tendon from the intermuscular septa.
infraglenoid tubercle of the scapula, passes downwards in the The three heads meet to form a strong spindle-shaped belly
space between the teres minor and major muscles, and is next and which is continuous downwards with a strong tendon inserted into
medial to the lateral head. the olecranon. Some of the deep fibres of the medial head inter
The lateral head (caput laterale) takes origin from the posterior twine with the capsule of the elbow joint.
surface of the humerus above the spiral groove and from the me- Action: contraction of the long head moves the arm backwards
Fossa subscapularis
M. deltoideus
M. rhomboideus major
Caput breve (cut off)
(cut off)
Caput longum
(cut off)
Caput mediale
M. brachialis
Tendo m. bicipitis brachii
315. Muscles of right shoulder girdle and arm; anterior aspect (¾).
(The subscapularis and biceps brachii muscles are partly removed.)
ORIGIN AND INSERTION OF MUSCLES ON THE SCAPULA 351
M. deltoideus Capsula
art. acromioclavicularis
M. subscapularis
316. Sites of origin and insertion of muscles on right sca

pula; anterior aspect (schematical representation).
352 ORIGIN AND INSERTION OF MUSCLES ON THE HUMERUS
M. supraspinatus
M. subscapularis
M. latissimus dorsi
M. pectoralis major
M. teres major
• I
:�'i i
4 ; < ! ;,
M. deltoideus ;r,_ ·; 1/l
I 1'1//1
' /I
/ M. coracobrachialis
1
M. brachialis
M. brachioradialis
M. extensor carpi
radialis brevis M. flexor carpi radialis,
m. flexor digitorum superficialis,
m. palmaris longus
317. Sites of origin and insertion of muscles on right hu

merus; anterior aspect (schematical representation).
OUTLINES OF MUSCLES OF THE UPPER LIMB 353
Spina scapulae
M. triceps brachii
(caput longum)
M. triceps brachii
(caput laterale)
M. triceps brachii
____,____
(tendo)
M. triceps brachii
(caput mediale)
M. infraspinatus
M. anconeus
M. flexor carpi ulnaris
318. Outlines ef muscles ef right upper limb; posterior aspect.

354 REGIONS OF THE UPPER LIMB
and adducts it; the whole muscle helps in extension of the forearm
at the elbow.
Blood supply: the posterior circumflex humeral, profunda bra
chii, and ulnar collateral arteries.
Innervation: radial nerve (C 7 -C 8).
2. The anconeus muscle (musculus anconeus) (Fig. 321) is small
and pyramidal in shape. It is as if a continuation of the medial
head of the triceps brachii muscle. Its apex takes origin from the
lateral epicondyle of the humerus and the lateral ligament of the
elbow, while the base, which consists of fibres radiating fan-wise
from the apex, is inserted into the posterior surface of the olec
ranon and fuses with the capsule of the elbow joint.
Action: extends the forearm at the elbow joint and at the same Regio deltoidea
time draws away its capsule.
Blood supply: the interosseous recurrent artery.
Innervation: the radial nerve (C 7 -C 8).
MUSCLES OF THE FOREARM

Regio brachii posterior
The muscles of the forearm (musculi antebrachii) are divided
into three groups according to their position: anterior, lateral (ra
dial), and posterior. The muscles of the anterior and posterior
groups are arranged in layers.
There are four layers in the anterior group. Regio cubiti posterior
First (Superficial) Layer
1. The pronator teres muscle (musculus pronator teres).

2. The flexor carpi radialis muscle {musculus jlexor carpi radia
lis).
3. The palmaris longus muscle (musculus palmaris longus).
4. The flexor carpi ulnaris muscle (musculusflexor carpi ulnaris).
Second Layer Regio antebrachii posterior

The flexor digitorum superficialis muscle (musculus flexor digito
rum supeijicialis).
Third Layer
1. The flexor digitorum profundus muscle {musculus flexor dig

itorum profundus).
2. The flexor pollicis longus muscle (musculus jlexor pollicis lon
gus).
Fourth Layer
The pronator quadratus muscle {musculus pronator quadratus).

The lateral (radial) group includes the following muscles.
1. The brachioradialis muscle (musculus brachioradialis).
2. The extensor carpi radialis longus muscle (musculus extensor
carpi radialis longus).
3. The extensor carpi radialis brevis muscle (musculus extensor
carpi radialis brevis). The muscles of the posterior group lie in two 319. Regions of upper limb; posterior
layers. aspect.
THE UPPER LIMB. LINES OF SKIN INCISIONS 355
Superficial Layer
1. The extensor carpi ulnaris muscle (musculus extensor carpi ul

naris).
2. The extensor digitorum muscle (musculus extensor digitorum).
3. The extensor digiti minimi muscle (musculus extensor digiti
minimi).
',--,' '
Deep Layer ,' ',
/ '-
............. , ...._ .... ---
1. The supinator muscle (musculus supinator). ,'.______
-_,,.,... ------.. ;...>----
,,,.
,/' t
2. The abductor pollicis longus muscle (musculus abductor polli II,,.. .. -
cis longus).
,//_)
3. The extensor pollicis hrevis muscle (musculus extensor pollicis
brevis).
4. The extensor pollicis longus muscle (musculus extensor pollicis
longus).
5. The extensor indicis muscle (musculus extensor indicis).
THE ANTERIOR GROUP OF MUSCLES

OF THE FOREARM
First (Superficial) Layer
1. The pronator teres muscle (musculus pronator teres) (Fig. 333)

is thick and the shortest in this layer. It arises by two heads. The
larger, humeral head (caput humerale) arises from the medial epi
condyle of the humerus, medial intermuscular septum, and ante
brachial fascia; the smaller, ulnar head (caput ulnare) takes origin
from the medial edge of the tuberosity of the ulna. The two heads
form a belly which is slightly flattened from front to back and is
continuous with a narrow tendon. The muscle stretches obliquely
and laterally to be inserted into the middle third of the lateral sur
face of the radius.
Action: pronates the forearm and helps in its flexion at the el
bow joint.
Blood supply: muscular branches of the brachia!, ulnar and ra
dial arteries.
Innervation: the median nerve (C6 -C 7 ).
2. The flexor carpi radialis muscle (musculus jlexor carpi radialis)
is bipennate, flat, and long. It lies laterally to all the forearm flex
ors. Proximally it is covered by the aponeurosis of the biceps bra
chii muscle and the palmaris longus muscle; the remaining, larger,
part is covered only by fascia and skin. The muscle arises from the
medial humeral epicondyle, the intermuscular septa, and the an
tebrachial fascia, runs downwards, passes under the flexor retinac
ulum, and is inserted into the base of the palmar surface of the
second (third) metacarpal bone.
Action: flexes the hand at the wrist and pronates it.
Blood supply: muscular branches of the radial artery.
Innervation: the median nerve [C6 -C7 (C8) ].
320. Lines of skin incisions on upper limb

3. The palmar longus muscle (musculus palmaris longus)
(Fig. 330) has a short spindle-shaped belly and a very long tendon.
It lies directly under the skin medial to the flexor carpi radialis (most suitable for exposure of muscles
muscle. It takes origin from the medial humeral epicondyle, the in- in dissection).
356 MUSCLES OF THE FOREARM
termuscular septum, and the antebrachial fascia, passes to the itorum profundus) (Fig. 332) is a strongly developed flat and wide
palm and continues as the wide palmar aponeurosis. belly which springs from the proximal half of the anterior ulnar
Action: tenses the palmar aponeurosis and helps in flexion of surface and the interosseous membrane. It passes downwards and
the hand. gives place to four tendons which run under the flexor retinaculum
Blood supply: muscular branches of the radial artery. and into the carpal tunnel with the tendons of the flexor digitorum
Innervation: the median nerve [(C7 ) C8]. profundus muscle lying above them. Then each tendon of the
4. The flexor carpi ulnaris muscle (musculus jlexor carpi ulnaris) flexor digitorum profundus muscle passes between the slips of the
(Fig. 331) occupies the medial border of the forearm. It has a long flexor digitorum sublimis tendons to be inserted into the bases of
fleshy belly and a rather thick tendon. It arises by two heads, by the distal phalanges of all fingers except for the thumb. The ten
the humeral head (caput humerale) from the medial epicondyle of dons of the flexor digitorum sublimis and profundus are enclosed
the humerus and the intermuscular septum, and by the ulnar head in a common synovial sheath (vagina synovialis communis musculijlex
(caput ulnare) from the olecranon, the two upper thirds of the dor orum digitorum manus). The sheaths for the tendons of the index,
sal surface and fascia of the forearm. Running downwards, the ten middle, and ring fingers originate at the level of the metacarpal
don passes under the flexor retinaculum to be inserted into the pis heads and pass to the distal phalanges separately from the com
iform bone. Some of the fibres are continuous with the mon sheath. Only the sheath for the tendon of the little finger is
pisometacarpal and pisohamate ligaments which are inserted into connected with the common sheath.
the hamate and fifth metacarpal bones. Action: flexes the distal phalanges of al1 fingers except for the
Action: flexes the hand and helps to adduct it. thumb.
Blood supply: the superior ulnar collateral, supratrochlear bra Blood supply: muscular branches of the ulnar artery.
chia!, and ulnar arteries. Innervation: ulnar and median nerves (C6-C8, Th,).
Innervation: the ulnar nerve (C8 , Th,). 2. The flexor pollicis longus muscle (musculus jlexor pollicis lon
gus} (Fig. 332) is long, unipennate, and lies on the lateral border of
Second Layer the forearm. It arises from the upper two thirds of the anterior ra
dial surface and the interosseous membrane and from the medial
1. The flexor digitorum sublimis muscle (musculus jlexor digito
epicondyle of the humerus. The muscle is continuous with a long
rum superficialis) (Fig. 331) is covered in front by the palmaris lon
tendon which, passing downwards, lies in the carpal tunnel; it is
gus and flexor carpi radialis muscles which leave grooves on it. The
then invested by the synovial sheath of the flexor pollicis longus
muscle itself takes origin by two heads. One is called the humero
tendon (vagina tendinis musculi jlexoris pollicis longi} and is inserted
ulnar head (caput humeroulnare); it is long and narrow and arises
into the base of the distal phalanx of the thumb.
from the medial epicondyle of the humerus and the coronoid pro
Action: flexes the distal phalanx of the thumb.
cess of the ulna. The other is the radial head (caput radiate) which
Blood supply: muscular branches of the radial, ulnar, and ante
is wide and short and arises from the proximal palmar surface of
rior interosseous arteries.
the radius. The two heads join to form a common belly which sep
Innervation: the median nerve (C6 -C8).
arates into four long tendons. These tendons pass over to the hand
and run in the carpal tunnel to be inserted into the bases of the
middle phalanges of the fingers. At the level of the proximal pha Fourth Layer
langes each tendon splits into two and therefore has two points of
The pronator quadratus muscle (musculus pronator quadratus)
insertion on the edges of the base of the middle phalanges.
(Fig. 333) is a thin quadrangular plate formed of transverse muscle
Action: flexes the middle phalanges of the index, middle, ring,
fibres stretching directly on the interosseous membrane. It takes
and little fingers.
origin from the distal part of the palmar surface of the ulna and is
Blood supply: the radial and ulnar arteries.
inserted into the palmar surface of the radius on the same level.
Innervation: the median nerve (C,-C8 , Th 1 ).
Action: pronates the forearm.
Third Layer Blood supply: the anterior interosseous artery.
Innervation: the median nerve (C6-C8 ).
1. The flexor digitorum profundus muscle (musculus jlexor dig-
THE LATERAL (RADIAL) GROUP OF MUSCLES OF THE FOREARM
1. The brachioradialis muscle (musculus brachioradialis) into the lateral surface of the radius proximal to the styloid pro
(Fig. 336) is spindle-shaped and occupies the extreme lateral posi cess.
tion. Slightly below its middle the muscle gives place to a long ten0 Action: flexes the limb at the elbow joint and helps both to
don. The muscle arises from the lateral border of the humerus pronate and to supinate the radius.
slightly above the lateral epicondyle and from the lateral intermus Blood supply: the anterior descending branch of the profunda
cular septum of the upper arm and runs downwards to be inserted brachii artery and radial recurrent arteries.
MUSCLES OF THE SHOULDER GIRDLE AND ARM 357
Clavicula
M. deltoideus
Caput laterale
�
Tenda __
Caput mediale
I ,
\\ I i I I�
M. extensor carpi
Olecranon -1 radialis longus
M. anconeus Fascia antebrachii
321. Muscles of right shoulder girdle and arm; lateral

view.
358 MUSCLES OF THE SHOULDER GIRDLE AND ARM
� M. levator scapulae
1
M. rhomboideus minor ilJJf//
� _____ Fascia supraspinata
Fascia infraspinata l� f/'
supraspinatus
M. rhomboideus l \�
majo•;•''
Foramen quadrilaterum
1
Tuberculum majus
humeri
I\"��
Angulus
inferior ,
scapulae
M.
M. teres major
M. extensor carpi
radialis longus
322. Muscles of right shoulder girdle and arm; posterior

aspect (¾).
(The deltoid muscle is partly removed.)
MUSCLES OF THE SHOULDER GIRDLE AND ARM 359
(cut off) . supraspinatus (partly removed)
Spina scapulae �,...__,_____.

(cut off)
M. teres minor
(partly removed)
Foramen
quadrilaterum
Foramen trilaterum
M. deltoideus
(cut away)
Caput longum
Caput laterale
m. tricipitis brachii .----,r
(cut and reflected)
Caput mediale
m. tricipitis brachii 'r---=-illt!ITT�lff
-:-
Epicondylus medialis --:

M. anconeus
323. Muscles of right shoulder girdle and arm; posterior

aspect (¾).
360 ORIGIN AND ATTACHMENT OF MUSCLES ON THE SCAPULA
Capsula art. acromioclavicularis
M. omohyoideus
M. triceps brachii
(caput longum)
M. rhomboideus
minor
major
324. Sites of origin and attachment of muscles and joint cap

sules on the right scapula; posterior aspect (schematical
representation).
ORIGIN AND ATTACHMENT OF MUSCLES ON THE SCAPULA 361
Innervation: the radial nerve [C5 -C6 (C 1 ) ]. 3. The extensor carpi radialis brevis muscle (musculus extensor
2. The extensor carpi radialis longus muscle (musculus extensor carpi radialis brevis) (Fig. 337) is slightly covered by the extensor
carpi radialis longus) (Fig. 336) is spindle-shaped with a narrow ten carpi radialis longus muscle proximally; distally it is crossed by the
don which is much longer than its belly. A small portion of the up abductor pollicis longus and extensor pollicis brevis muscles. The
per part of the muscle is covered by the brachioradialis muscle; in extensor carpi radialis brevis muscle arises from the lateral hum
the distal part its tendon is crossed by the abductor pollicis longus eral epicondyle and the collateral and annular radial ligaments. It
and extensor pollicis brevis muscles which run downwards and obc runs downwards and is continuous with a tendon which passes
liquely. The muscle takes origin from the lateral epicondyle and next to the extensor carpi radialis longus tendon in the synovial
the lateral intermuscular septum of the upper arm, passes down sheath of the tendons of the radial extensors of the wrist (vagina
wards and gives place to a tendon which runs under the extensor tendinum musculorum extensorum carpi radialium) and is inserted into
retinaculum and is inserted into the base of the dorsal surface of the base of the third metacarpal bone.
the second metacarpal bone. Action: extends the hand at the wrist joint and abducts it a
Action: flexes the limb at the elbow joint, extends the hand at little.
the wrist joint and helps in its abduction. Blood supply: the branches of the profunda brachii artery and
Blood supply: the radial collateral (profunda brachii) and re the recurrent radial artery.
current arteries. Innervation: the radial nerve [ (C5 ) C6 -C 1 ].
Innervation: the radial nerve (C5 -C 7 ).
THE POSTERIOR GROUP OF MUSCLES

OF THE FOREARM
The Superficial Layer
the lateral epicondyle of the humerus, posterior border of the ulna,
1. The extensor carpi ulnaris muscle (musculus extensor carpi ul and the capsule of the elbow joint and is inserted into the base of
naris) (Fig. 337) has a long spindle-shaped belly and lies on the the dorsal surface of the fifth metacarpal bone by a short but
medial border of the dorsal surface of the forearm. It arises from strong tendon which is invested by a synovial sheath of the exten-
M. coracobrachialis
M. pectoralis minor M. biceps brachii

(caput breve)
�,._a.,;;...;,,;;f'l\W-- Capsula art.

acromioclavicularis
M. rhomboideus
minor
M. supraspinatus
M. deltoideus
325. Sites ef origin and attachment ef muscles, ligaments, and joint capsules on
right scapula; superior aspect (schematical representation).
362 ORIGIN AND ATTACHMENT MUSCLES ON THE HUMERUS
M. supraspinatus
Capsula M. subscapularis
art. humeri�-+------,. M. infraspinatus
M. triceps brachii
(caput laterale)
M. pectoralis major
: ii
. \11(1•----M. deltoideus
'\
1/i... l
Ii,
M. brachialis
M. triceps brachii
(caput mediale) M. triceps brachii
(caput mediale) M. brachialis
M. brachioradialis
M. extensor carpi
radialis brevis
M. supinator
Lig. collaterale
carpi ulnaris radiale
M. anconeus
326. Sites of origin and attachment of muscles, ligaments, and joint capsules on
right humerus; posterior and lateral aspects (schematical representation).
sor carpi ulnaris tendon (vagina tendinis musculi extensoris carpi ulna the skin nearer to the lateral border of the dorsal surface of the
ris). forearm and borders upon the extensor carpi ulnaris and the ex
Action: abducts the hand to the ulnar side and extends it at the tensor digiti minimi muscles on the ulnar side and upon the exten
wrist joint. sor carpi radialis longus and brevis muscles on the radial side.
Blood supply: the posterior interosseous artery. The muscle takes origin from the lateral epicondyle of the
Innervation: the radial nerve [ (C 6) C 7 -C 8]. humerus, the capsule of the elbow joint, and the antebrachial fas
2. The extensor digitorum muscle (musculus extensor digitorum) cia. At the middle of its length the belly separates into four ten
(Fig. 337) has a spindle-shaped belly and, according to the direc dons which, after passing under the extensor retinaculum, are en
tion of the muscular bundles, it is bipennate. It is directly under closed together with the extensor indicis tendon into a common
MUSCLES AND FASCIAE OF THE UPPER ARM 363
synovial sheath of the extensor digitorum and extensor indicis ten tebrachial fascia, and the lateral ligament of the elbow, runs
dons (vagina tendinum musculorum extensoris digitorum et extensoris indicis) downwards, and gives place to a tendon which is lodged in the sy
stretching approximately to the middle of the metacarpal bones. novial sheath of the extensor digiti minimi tendon (vagina tendinis
On the hand the tendons are joined together by fine inconstant musculi extensoris digiti minimi). On leaving the sheath the tendon
intertendinous connections (connexus intertendinei); at the base of joins the extensor digitorum tendon passing to the little finger and
the proximal phalanges of the index, middle, ring, and little fingers both are inserted into the base of the distal phalanx.
each tendon ends in a tendinous expansion which fuses with the Action: extends the little finger.
capsule of the metacarpophalangeal joint. The tendinous expan Blood supply: the posterior interosseous artery.
sions separate into three slips, the lateral two are inserted into the Innervation: the radial nerve (C6 -C8 ).
base of the distal phalanx and the middle one into the base of the
middle phalanx.
The Deep Layer
Action: extends the fingers and assists in extension of the hand
at the wrist. 1. The supinator muscle (musculus supinator) (Fig. 338) is a thin
Blood supply: the posterior interosseous artery. rhomboid sheet lying on the lateroposterior surface of the proxi
Innervation: the radial nerve (C6 -C8 ). mal end of the forearm. It arises from the lateral epicondyle of the
3. The extensor digiti minimi muscle (musculus extensor digiti humerus, the supinator crest of the ulna, and the capsule of the el
minimi) (Fig. 33 7) is a small spindle-shaped belly lying directly un bow joint, extends obliquely downwards and laterally embracing
der the skin in the lower half of the dorsal surface of the forearm the upper end of the radius, and is inserted into it for a distance
between the extensor carpi ulnaris and extensor digitorum mus from the tuberosity of the radius to the insertion of the pronator
cles. It takes origin from the lateral epicondyle of the humerus, an- teres muscle.
V.
M. biceps brachii
M. brachialis
N. radialis
Sulcus bicipitalis
lateralis - Septum
intermusculare
brachii medialc
Septum Humerus
intermusculare
brachii laterale· M. triceps brachii
(caput mediale)
M. triceps brachii
(caput longum)
327. Muscles and fasciae of right upper arm (½ 0).

(Transverse section through middle of upper arm.)
364 MUSCLES OF THE SHOULDER GIRDLE AND UPPER ARM
Costa I
M. infraspinatus
Sternum
M. subscapularis
M. pectoralis
major
M. teres minor
Humerus
328. Sites of origin and insertion of muscles on the bones of right shoulder gir
dle and upper arm; lateral aspect (schematical representation).
MUSCLES AND FASCIAE OF THE FOREARM 365
,��➔�- M. pronator teres

(outline)
Tendo m. bicipitis -'IA!MH
brachii Aponeurosis
-":,.;i:,:-l'll!r-- m. bicipitis
brachii
Fascia antebrachii
M. flexor
carpi radialis
M. flexor digitorum
-.a-1-1111----- superficialis
329. Muscles and fasciae of the right forearm; ante

rior aspect (¾).
(Fasci al sheaths of muscles are opened.)
Tendo m. bicipitis
brachii
Aponeurosis
M.
M. flexor
carpi ulnaris
M. flexor carpi flexor digitorum

radialis superficialis
M. flexor digitorum
superficialis
(caput radiale)
M. flexor pollicis --.+-11,.C:.\1•

longus
1
Tendo m. abductoris \�·
pollicis longi \\
�
�
·t f;
330. Muscles of right forearm; anterior

aspect (¾).
(First [superficial] layer.)
MUSCLES OF THE FOREARM 367
M. brachialis
Mm. pronator teres,

�---"��Ir:--- flexor carpi radialis,
palmaris longus
(cut off)
M. flexor digitorum
M. extensor superficialis
carpi radialis (caput humeroulnare)
longus
•,.._"""•-M. opponens digiti minimi

M. abductor digiti minimi
•��.-,-- M. flexor digiti minimi
brevis

aspect(¾).
(Second layer.)
Bursa
bicipitoradialis
Tendo
m.bicipitis
brachii
M.extensor carpi
radialis longus M.flexor
pollicis
longus
M.flexor
carpi ulnaris
M.opponens
digiti minimi
Tendo m.flexoris -:--""lil�IIIII' Tendines m.flexoris
pollicis longi digitorum profundi
M. flexor digitorum
superficialis
(cut off)

aspect (¾).
(Third layer.)
Action: causes lateral rotation (supination) of the forearm and lateral surface of the forearm and is covered at its origin by the ex
helps in extension of the limb at the elbow joint. tensor carpi radialis brevis and extensor digitorum muscles, while
Blood supply: the radial recurrent and interosseous recurrent its lower part is directly under the antebrachial fascia and skin.
arteries. The muscle takes origin from the posterior surface of the ra
Innervation: the radial nerve [ (C5 ) C 6 -C 7 (C 8 )]. dius and ulna and from the interosseous membrane, runs obli
2. The abductor pollicis longus muscle (musculus abductor pollicis quely downwards, with the tendon curving around the radius, and
longus) (Fig. 338) has a flattened bipennate belly which is continu after passing under the extensor retinaculum it is inserted into the
ous with a thin long tendon. It lies in the distal half of the dorso- base of the first metacarpal bone.
Epicondylu
medi alis
Tendo
m . bicipitis
brachii
M. supinator
��--...--- Membrana
interossea antebrachii
Ra dius
333. Muscles of right forearm; anterior aspect (½).

(Fourth layer consisting of the pronator quadratus muscle.)
370 ORIGIN AND ATTACHMENT OF MUSCLES OF THE FOREARM
Capsula art. cubiti

M. flexor digitorum
superficialis
(caput humeroulnare)
M. flexor pollicis
longus (caput ulnare)
M. brachialis
M. flexor digitorum
superficialis ____,..H
(caput radiale)
M. pronator teres flexor digitorum

profundus
M. brachioradialis
Capsula
art. radiocarpalis
334. Sites of origin and attachment of muscles and joint capsules on the
bones of the right forearm; anterior aspect (schematical representa
tion).
(The interosseous membrane is intact.)
Action: abducts the thumb and assists in abducting the hand. sal surface of the radius, and the ulnar crest (interosseous border)
Blood supply: the posterior and anterior interosseous arteries. and runs obliquely downwards next to the abductor pollicis longus
Innervation: the radial nerve [C 6 -C 7 (C 8)]. tendon.
3. The extensor pollicis brevis muscle (musculus extensor pollicis The tendons of the two muscles are invested in the synovial
brevis) (Fig. 338) is on the lateral border of the lower dorsal surface sheath of the tendons of the abductor pollicis longus and extensor
of the forearm. It arises from the interosseous membrane, the dor- pollicis brevis muscles (vagina tendinum musculorum abductoris longi
Fascia brachii --- J
Bursa subcutanea M. extensor carpi

olecrani _____ radialis longus
M. anconeus
M. flexor
carpi ulnaris - M. extensor carpi
radialis brevis
M. extensor ____._::::_-_
carpi ulnaris
Fascia antebrachii
abductor pollicis
longus
M. extensor pollicis
brevis
M. extensor carpi
radialis brevis
Tendines mm.
extensorum digitorum
Connexus
intertendineus
335. Muscles and fasciae of right forearm; posterior

aspect (½).
(The skin and subcutaneous fat are removed.)
M tnceps brach11 --- r/J

�,
·/ 1/
Septum mtermusculare._1'-----,�,/l\
brachii laterale
M. anconeus
Tendines m. extensoris
digitorum
Connexus ..,:::::.1....-
intertendineus
336. Muscles of right forearm; lateral aspect (¾).

M. extensor carpi
radialis longus
M anconeus
M. extensor carpi
radi alis brevis
M. flexor carpi
ulnaris
M. extensor
_ _ digiti
mm1m1
M. extensor carpi abductor pollicis

ulnaris longus
extensor pollicis
brevis
Retinaculum extensorum
extensor pollicis
longus
Tenda m. extensoris::......._+-+H--+i-tt-f.r
:.::
indicis
Tenda m. extenso..:.r.:..:
is'---
digiti minimi
Connexus
intertendineus
337. Muscles ef right forearm; posterior aspect (¾).

(Superficial layer.)
• Epicondylus lateralis
M. flexor carpi �-4-lllf-'-'f.11[

ulnaris (cut off)
M. flexor digitorum
profundus
Tendo m. extensoris
carpi radialis brevis
M. abductor pollicis
longus
brevis
longus
\\il�\Rj;.,,.-Retinaculum extensorum
(the canals are opened)
digitorum (cut off)
338. Muscles ef right forearm; posterior aspect (¾).

(Deep layer.)
ORIGIN AND ATTACHMENT OF MUSCLES OF THE FOREARM 375
et extensoris brevis pollicis). After passing under the extensor retinac 4. The extensor pollicis longus muscle (musculus extensor pollicis
ulum the muscle is inserted into the base of the dorsal surface of longus) (Fig. 338) has a spindle-shaped belly and a long tendon. It
the proximal phalanx of the thumb. lies next to the extensor pollicis brevis muscle and arises from the
Action: extends and slightly abducts the proximal phalanx of interosseous membrane and the interosseous border and posterior
the thumb. surface of the ulna, runs downwards, and gives place to a tendon
Blood supply: the posterior and anterior interosseous arteries. which is invested in the synovial sheath of the extensor pollicis
Innervation: the radial nerve [C6 -C 7 (C8)]. longus tendon (vagina tendinis musculi extensoris pollicis longi). The
M. triceps brachii
Capsula art. cubiti
M. anconeus
M. flexor digitorum profundus
M. flexor carpi ulnaris
M. pronator teres
M. extensor pollicis longus
M. extensor pollicis brevis
M. extensor indicis
M. pronator quadratus
M. brachioradialis
339. Sites of origin and attachment of muscles and joint capsules on bones
of right forearm; posterior aspect (schematical representation).
(The interosseous membrane is intact.)
376 MUSCLES AND FASCIAE OF THE FOREARM
M. flexor digitorum superficialis

N. medianus M. palmaris longus
A. et vv. ulnares
M. flexor carpi radialis N. ulnaris
Fascia antebrachii
��r-- M. flexor digitorum

profundus
M. extensor carpi radialis --4'---'lll' -;- lntegumentum commune

longus
Ulna
M. extensor pollicis longus,

m. abductor pollicis longus,
m. extensor indicis
Vasa et nn. interossei M. extensor digitorum
340. Muscles and fasciae of right forearm (½ 0).

(Transverse section through middle of forearm.)
tendon curves around the first metacarpal bone, emerges onto its tensor digitorum muscle. Sometimes it is absent. The muscle arises
dorsal surface, and extends to the base of the distal phalanx to be from the lower third of the dorsal surface of the ulna, and ends as
inserted into it. a tendon which passes under the extensor retinacillum and to
Action: extends the thumb and abducts it partly. gether with the extensor digitorum tendon runs through the syno
Blood supply: the posterior and anterior interosseous arterie_s. vial sheath and extends to the dorsal surface of the index finger to
Innervation: the radial nerve [ (C6 ) C,-C 8 ]. be inserted into its tendinous expansion.
5. The extensor indicis muscle (musculus extensor indicis) Action: extends the index finger.
(Fig. 338) has a narrow, long, and spindle-shaped belly lying on Blood supply: the posterior and anterior interosseous arteries.
the lower dorsal surface of the forearm and is covered by the ex- Innervation: the radial nerve [ (C 6 ) C,-C 8 ].
MUSCLES OF THE HAND

The muscles of the hand are subdivided according to their lo The muscles of the thenar eminence, muscles of the hypothenar
cation into two groups, one formed of the muscles of the palmar eminence, and muscles of the middle group are distinguished in
surface and the other consisting of muscles of the dorsal surface. the group on the palmar surface.
MUSCLES OF THE HAND 377
Muscles of the Thenar Muscles of the Hypothenar
1. The abductor pollicis brevis muscle (musculus abductor pollicis 1. The palmaris brevis muscle (musculus palmaris brevis).
brevis). 2. The abductor digiti minimi muscle (musculus abductor digiti
2. The flexor pollicis brevis muscle (musculus flexor pollicis bre minimi).
vis). 3. The flexor digiti minimi brevis muscle (musculus flexor digiti
3. The opponens pollicis muscle (musculus opponens pollicis). minimi brevis).
4. The adductor pollicis muscle (musculus adductor pollicis). 4. The opponens digiti minimi muscle (musculus opponens digiti
minimi).
Muscles of the Middle Group
1. The lumbrical muscles (musculi lumbricales).

2. The palmar interossei muscles (musculi interossei palmares).
MUSCLES OF THE PALMAR SURFACE
Muscles of the Thenar (Fig. 343) is the deepest in the thenar group. It arises by two heads
whose fibres are directed one towards the other at an angle. The
1. The abductor pollicis brevis muscle (musculus abductor pollicis
oblique head (caput obliquum) takes origin from the radiate carpal
brevis) (Fig. 341) is on the radial (lateral) surface of the thenar di
ligament, the capitate bone, and the palmar surface of the second
rectly under the skin. It arises from the tendon of the abductor
and third metacarpal bones; the transverse head (caput transversum)
pollicis longus muscle, antebrachial fascia, tubercle of the scaph
arises from the palmar surface of the third metacarpal and the
oid, and flexor retinaculum and is inserted into the radial surface
heads of the second and third metacarpal bones. The muscle bun
of the base of the proximal phalanx of the thumb. Its tendon
dles converge at an angle to be inserted into the base of the proxi
usually lodges a sesamoid bone.
mal phalanx of the thumb, the ulnar sesamoid bone, and the cap
Action: abducts the thumb and sets it in mild opposition, helps
sule of the metacarpophalangeal joint.
in flexion of the proximal phalanx. Action: adducts the thumb and assists in flexing the proximal
Blood supply: superficial palmar branch of radial artery.
phalanx.
Innervation: the median nerve (C6 -C7 ).
Blood supply: superficial and deep palmar arches.
2. The flexor pollicis brevis muscle (musculus jlexor pollicis brevis) Innervation: the ulnar nerve (Cs).
(Fig. 341) lies medially of the abductor pollicis brevis muscle and
also directly under the skin. It arises from the flexor retinaculum,
the trapezium, trapezoid, and capitate bones, and the base of the Muscles of the Hypothenar
first metacarpal bone. The muscle fibres run distally and are in 1. The palmaris brevis muscle (musculus palmaris brevis) (see
serted radially: the superficial fibres (caput superjiciale) are inserted Fig. 330) is a thin plate of parallel fibres. It takes origin from the
into the radial sesamoid bone, the deep fibres (caput profundum) are ulnar border of the palmar aponeurosis and the flexor retinaculum
inserted into both sesamoid bones of the metacarpophalangeal and is inserted into the skin of the hypothenar.
joint of the thumb. Action: tenses the palmar aponeurosis thus forming folds on
Action: flexes the proximal phalanx of the thumb. the skin of the hypothenar.
Biood supply: superficial palmar branch of radial artery, deep Blood supply: the ulnar artery.
palmar arch. Innervation: the ulnar nerve [ (C7 ), Cs, Th i ].
Innervation: the superficial fibres-the median nerve (C6 -C1), 2. The abductor digiti minimi muscle (musculus abductor digiti
deep-the ulnar nerve (Cs-Th 1 ). minimi) (Fig. 341) occupies the extreme medial position in this
3. The opponens pollicis muscle (musculus opponens pollicis) group of muscles and lies directly under the skin and partly under
(Fig. 342) is shaped like a thin triangular sheet and lies under the the palmaris brevis muscle. It arises from the pisiform bone, the
abductor pollicis brevis muscle. It arises from the crest of the tra tendon of the flexor carpi ulnaris muscle, and the flexor retinacu
pezium and the flexor retinaculum and is inserted into the radial lum and is inserted into the ulnar side of the base of the proximal
border of the first metacarpal bone. phalanx of the little finger.
Action: opposes the thumb in relation to the little finger. Action: abducts the little finger and assists in flexion of its
Blood supply: superficial palmar branch of radial artery, deep proximal phalanx.
palmar arch. Blood supply; deep branch of the ulnar artery.
Innervation: the median nerve (C6 -C7 ). Innervation: the ulnar nerve [ (C7 ), Cs, Th i ].
4. The adductor pollicis muscle (musculus adductor pollicis) 3. The flexor digiti minimi brevis muscle (musculus jlexor digiti
378 MUSCLES OF THE HAND
M. palmaris longus
M. flexor digitorum super'ficialis
M.
M.
Fascia antebrachii
Retinaculum flexorum
M. flexor M. flexor digiti minimi

pollicis brevis brevis
Mm. lumbricales
M. interosseus----::-::=:.I!-----½ Pars anularis vaginae fibrosae

dorsalis I
Tendines m. flexoris
digitorum profundi
�----=
341. Muscles of right hand; palmar surface (¾).

(Fasciae are partly removed.)
M. flexor digitorum
profundus
M. opponens pollicis
(cut off)
M. flexor
pollicis brevis
M. abductor pollicis M. opponens digiti minimi

brevis (cut)
_,,..l--- Tendo m. flexoris

digitorum superficialis
Mm. lumbricales
342. Muscles of right hand; palmar surface (¼).

(The proximal and part of the middle phalanx of the middle finger are removed; the ex
tensor digitorum tendon is exposed.)
M. abductor
pollicis brevis -;=..i...�
(cut) M. opponens digiti minimi
M. lumbricalis
(cut off)
M. adductor pollicis
Tendo m. flexoris
digitorum
profundi
Chiasma tendinum
343. Muscles of right hand; palmar surface (½).

FASCIAE OF THE UPPER LIMB 3'81
minimi brevis) (see Fig. 341) is small and flattened; it lies lateral to and is inserted into the dorsal surface of the base of the proximal
the abductor digiti minimi muscle and its upper part is covered by phalanx of the index, middle, ring, and little fingers to in
the palmaris brevis muscle and skin. The muscle arises from the tertwine with the dorsal aponeurosis on the radial side of these
hook of the hamate bone and the flexor retinaculum, runs distally, fingers.
and is inserted into the base of the proximal phalanx of the little Action: flex the proximal phalanx and extend the middle and
finger. distal phalanges of the four fingers.
Action: flexes the proximal phalanx of the little finger and Blood supply: superficial palmar arch.
helps in its adduction. Innervation: first and second muscles-the median nerve, third
Blood supply: deep branch of the ulnar artery. and fourth muscles-the ulnar nerve (Cs, Th 1 ).
Innervation: the ulnar nerve (C7 -Cs)- 2. The palmar interossei muscles (musculi interossei pa/mares)
4. The opponens digiti minimi muscle (musculus opponens digiti (Fig. 344) are three spindle-shaped muscle fibres lodged in the in
minimi) (Fig. 341) is medial to the flexor digiti minimi brevis mus terosseous spaces between the metacarpal bones. The first muscle
cle which covers its lateral border. The muscle takes origin from lies on the radial part of the palm; it arises from the ulnar side of
the hook of the hamate bone and the flexor retinaculum and is in the second metacarpal bone and is inserted into the ulnar side of
serted into the ulnar side of the fifth metacarpal bone. the metacarpophalangeal joint of the index finger and into its dor
Action: draws the little finger to oppose the thumb (opposi sal aponeurosis. The second and third interossei muscles are on
tion). the ulnar half of the palm; arising on the radial side of the fourth
Blood supply: deep branch of the ulnar artery. and fifth metacarpal bones they are inserted into the radial side of
Innervation: the ulnar nerve (C 7 -Cs)- the capsules of the metacarpophalangeal joints of the ring and
little fingers.
Action: flex the proximal and extend the middle and distal
The Middle Group
phalanges of the index, ring, and little fingers; adduct these fingers
1. The lumbrical muscles (musculi lumbricales) (Fig. 341), four in to the middle finger.
number, are small and spindle-shaped. Each arises from the radial Blood supply: deep palmar arch.
border of the corresponding flexor digitorum profundus tendon Innervation: the ulnar nerve (Cs, Th i ).
MUSCLES OF THE DORSAL SURFACE
The dorsal interossei muscles (musculi interossei dorsales) Action: the two muscles on the radial side pull the proximal
(Fig. 349), four in number, are spindle-shaped and bipennate and phalanges of the index and middle fingers towards the thumb; the
lie in the interosseous spaces on the dorsal surface of the hand. two muscles on the ulnar side pull the middle and ring fingers to
Each arises by two heads from the adjacent sides of the bases of wards the little finger. In addition, all four muscles assist in flexing
two adjacent metacarpal bones; the first and second muscles are the proximal and extending the middle and distal phalanges of the
inserted into the radial side of the index and middle fingers, while index, middle, ring, and little fingers.
the third and fourth muscles are inserted into the ulnar side of the Blood supply: deep palmar arch.
middle and ring fingers. Innervation: the ulnar nerve (Cs, Th 1 ).
FASCIAE OF THE UPPER LIMB

The fasciae covering the upper limb differ characteristically in thickness along their distance. In some
places the fascia! layers form clearly defined sheaths and line fossa, canals, and other structures of various
size.
FASCIAE OF THE SHOULDER GIRDLE

The following fasciae are distinguished in the region of the tus and teres minor) and the capsule of the shoulder joint, and is
shoulder girdle (see Figs 285, 312, 321, 327): (a) the deltoid fascia continuous with the fascia covering the triceps brachii muscle;
consisting of a weaker superficial layer and a stronger deep layer. (b) the supraspinous fascia which is rather thick and stretches on
The superficial layer covers the outer surface of the deltoid muscle the edges of the supraspinous fossa to cover the supraspinatus
and at the anterior border of the muscle is continuous with the muscle; (c) the infraspinous fascia which is attached to the edges
pectoral fascia. The deep layer invests the deltoid muscle, which it of the infraspinous fossa and blends with the deep layer of the del
separates from the muscles of the shoulder girdle (the infraspina- toid muscle fascia to form a sheath for the infraspinatus and teres
minor muscles; (d) the subscapular fascia which is thin and hardly transmitting the nerves and blood and lymph vessels. It is unno
detectable and is attached to the edges of the subscapular fossa to ticeably continuous superio ly with the fascia of the deltoid mus
cover the subscapularis muscle. cle, inferiorly with the brae fial fascia and posteriorly with the fas
The axillary fascia (fascia axillaris) is a relatively thick sheet cia covering the latissimus orsi and teres major muscles.
covering the axillary fossa inferiorly; it has a series of openings
FASCIAE OF THE ARM

The brachia! fascia (fascia brachii) is clearly defined and is and medial, are present be ween the flexors and extensors in the
thickest in the middle third of the upper arm and below the del lower half of the arm; they prm fascia! sheaths for these groups of
toid muscle. Two frontally arranged intermuscular septa, lateral muscles and serve for insertion of some parts of the arm and fore-
Tendo m. brachioradialis
Tendo m. abductoris
pollicis longi _____,..
Tendo m. flexoris --+-.P.'-"lli-:
carpi radialis
(cut off)
M. flexor pollicis brevis
(caput profundum)
M. abductor pollicis brevis
(cut off)
M. adductor pollicis Mm. interossei palmares

(cut off)
Tendo m. flexoris
pollicis longi
(cut off)
Vaginae fibrosae digitorum manus

mm. flexorum digitorum --==±-➔
superficialis et profundi
I
344. Muscles of right hand; palmar surface (�).
(Interossei muscles.)
I
TENDONS OF MUSCLES OF THE HAND 383
arm muscles. The lateral intermuscular septum of the upper arm stronger; it arises from the brachia! fascia and is on the medial sur
(septum intermusculare brachii laterale) arises from the brachia! fascia face of the upper arm where it is attached to the medial border of
covering the lateral surface of the upper arm and passes deeper to the humerus for the distance between the distal end of the cora
be attached to the lateral border of the humerus for a distance cobrachialis muscle and the medial epicondyle. The medial sep
from the deltoid tuberosity to the lateral epicondyle; it separates tum separates the medial head of the triceps muscle from the bra
the lateral and medial heads of the triceps muscle from the brachi chialis and pronator teres muscles. In some parts the brachia!
alis and brachioradialis muscles. The medial intermuscular sep fascia is pierced by nerves and blood vessels.
tum of the upper arm (septum intermusculare brachii mediale) is
M. extensor carpi radialis longus

M. extensor pollicis longus
Aponeurosis dorsalis M. interosseus dorsalis II

digiti II
Capsula articularis
M. lumbricalis I
M. interosseus dorsalis I
Chiasma tendinum (m. flexor digitorum M. abductor pollicis longus

superficialis with m. flexor digitorum profundus)
345. Tendons offlexors and extensor of index finger.

384 TENDONS OF MUSCLES OF THE HAND
M. pronator quadratus
Vagina synovialis tendinis

m.. flexoris carpi radialis
+fiflll-,JF----M. flexor digitorum

profundus
M. flexor digitorum superficialis

{pulled aside)
�c'-\\'t,c;;&--...,,..- Retinaculum flexorum

{cut)
Vagina synovialis
digiti ininimi
Vaginae synoviales tendinum

digitorum manus
346. Synovial sheaths of tendons (vaginae synoviales tendinum) of right hand;

palmar surface (¾).
(Staining material is injected into the sheath.)
ORIGIN AND INSERTION OF MUSCLES OF THE HAND 385
FASCIAE OF THE FOREARM

The antebrachial fascia (fascia antebrachii) (see Figs 329, 335) is the brachioradialis and extensor carpi radialis muscles; the poste
a continuation of the brachia! fascia. It is thickest in the region of rior (extensor) seat is occupied by the extensor digitorum, extensor
the elbow joint from where arise some of the muscles of the fore digiti minimi, extensor carpi ulnaris, anconeus, and supinator
arm. For its whole distance the fascia gives off many septa pene muscles. The anterior seat, which is separated into a superficial
trating between separate groups of muscles and forming fascia! and deep parts by a fascia! sheet, lodges the group of the anterior
sheaths for them. Over the whole circumference of the forearm the forearm muscles with the flexor digitorum profundus and flexor
antebrachial fascia is closely fused with the superficial muscles. Su pollicis longus muscles lying in the deep part and the pronator
periorly it blends with a fibrous sheet, the bicipital aponeurosis; in teres, flexor carpi radialis, flexor digitorum superficialis, palmaris
feriorly it forms well defined transversely running bands embrac longus, and flexor carpi ulnaris muscles in the superficial part. In
ing the wrist joint (Fig. 341 ). the lower half of the forearm the fascia! seats are the same in num
The fascia! septa and bones of the forearm and the interosse ber but are smaller because they surround tendons extending from
ous membrane form three seats for muscles in the upper half of the muscles and not the muscles themselves.
the forearm: lateral, posterior, and anterior. The lateral seat lodges
M. flexor pollicis brevis
M. abductor pollicis brevis
M. flexor carpi radialis
M.
M. opponens digiti minimi

M.
Mm. interossei palmares
M. flexor digiti minimi brevis

M. flexor pollicis longus
M. flexor digitorum
superficialis
34 7. Sites of origin and insertion of muscles on bones of right hand; palmar

surface ( schematical repre sentation).
Tcndo rn.
Tenda m. extensoris carpi radialis brevis
Tendo rn. extensoris carpi radialis lomgi

Tendo m. extensoris pollicis longi
extensoris
extensoris
Tendo rn. flexoris

pollicis longi
348. Muscles of right hand; dorsal surface (¾).


Tendines m. extensoris digitorum
(cut off) M. abductor pollicis longus
M. extensor carpi ulnaris L Tendo m. extensoris carpi radialis longi
Tendo m. extensoris pollicis longi
M. interosseus dorsalis I
Tendo m. extensoris digiti

minimi (cut off)
digitorum (cut off)
349. Muscles of right hand; dorsal surface (¾).

[The extensor tendons of digits ( except for the thumb) are removed, the canals are
opened.]
388 TENDONS OF MUSCLES OF THE HAND
Retinaculum extensorum Vag. tendinum rilm. abductoris longi

et extensoris brevis pollicis
Vagina tendinis m. extensoris pollicis longi
Vagina tendinis m. extensoris

carpi ulnaris
Vagina tendinum mm. extensoris

digitorum et extensoris
,. indicis
Vagina tendinis m. extensoris

digiti minimi
Connexus intertendineus
350. Synovial sheaths of tendons (vaginae synoviales

tendinum) on right hand; dorsal surface (¾).
ORIGIN AND INSERTION OF MUSCLES OF THE HAND 389
FASCIAE OF THE HAND

The fasciae of the hand (fasciae manus) (see Figs 330, 335) are The palmar aponeurosis contains besides the longitudinal
direct continuations of the antebrachial fascia. bands also superficial transverse ligaments (fasciculi transversi), par
Two fasciae, superficial and deep, are distinguished on the pal ticularly clearly defined at the base of the interdigital spaces
mar surface of the hand. The superficial fascia is a thin sheet (Fig. 343).
covering the muscles of the thenar and hypothenar. In the central The deep fascia of the hand, which is called the palmar inter
parts of the palm it thickens markedly and is continuous with the osseous fascia, is a relatively thin sheet of loose alveolar tissue
palmar aponeurosis (aponeurosis palmaris). The aponeurosis is trian covering the palmar interossei muscles. The tendons of the flexor
gular, its base faces the fingers and the apex faces the forearm and digitorum muscles, vessels, and nerves lie between the deep fascia
blends with the flexor retinaculum. In the region of the apex the and the palmar aponeurosis.
tendon of the palmaris longus muscle is inserted into the aponeu The superficial and the deep fascia blend on the sides to form
rosis in which its fibres diverge fan-wise to reach the bases of the a space in which the flexor tendons and the lumbrical muscles
fingers where they are grouped into larger bands. pass.
M. extensor carpi radialis brevis

extensor carpi radialis longus
M. extensor carpi ulnaris
Mm. interossei dorsales
longus
351. Sites of origin and insertion of muscles on bones of right hand; dorsal
aspect (schematical representation).
390 ORIGIN AND INSERTION OF MUSCLES OF THE HAND
The palmar fascia of the fingers forms fibrous flexor sheaths of developed among these sheaths is the annular part of the fibrous
the fingers (vaginae fibrosae digitorum manus) in which the digitorum flexor sheath (pars anularis vaginae fibrosae). Collateral ligaments (li
flexor tendons stretch. These sheaths are lined with a synovial gamenta collateralia) are also present here.
membrane and their walls are strengthened by ligaments. The best
SYNOVIAL SHEATHS OF MUSCLE TENDONS

OF THE HAND
On the palmar surface are five synovial sheaths of the flexor flexor tendons and runs to the thumb to be inserted into base of
tendons of fingers (vaginae synoviales digitorum manus) (Figs 346, the distal phalanx.
350) which are isolated from one another. The largest, the com On the dorsal surface of the hand the dorsal fascia of the hand
mon synovial sheath of the flexor tendons (vagina synovialis commu (fascia dorsalis manus) covering the dorsal interossei muscles contri
nis musculorum jlexorum digitorum manus) is lodged in the carpal tun butes to the formation of the synovial sheaths.
nel and contains the tendons of the flexor digitorum sublimis and Six synovial sheaths are located on the dorsal surface of the
profundus muscles emerging onto the hand. This sheath is also hand (Fig. 350). Each contains tendons of certain muscles stretch
connected with the sheath of the little finger which contains the ing on the dorsal surface of the forearm. The sheaths are located
flexor tendons extending to this finger. under the extensor retinaculum where the tendons pass from the
Three sheaths of an identical type are on the palmar surface of forearm to the hand. Counting from the radial side, the first sheath
the index, middle, and ring fingers. They arise on the level of the contains the tendons of the abductor pollicis longus and the exten
metacarpophalangeal joints and reach the base of the distal pha sor pollicis brevis muscles; the second sheath lodges the tendons of
langes. the extensor carpi radialis muscles; the third invests the tendon of
The sheaths contain the tendons of the flexor digitorum subli the extensor pollicis longus muscle; the fourth contains the tendon
mis and flexor digitorum profundus muscles. of the extensor digitorum and extensor incidis muscles; the fifth
There is a separate synovial sheath of the flexor pollicis longus lodges the tendon of the extensor digiti minimi muscle, and the
tendon (vagina tendinis musculi jlexoris pollicis longi). It is lodged in sixth sheath contains the tendon of the extensor carpi ulnaris mus
the carpal tunnel lateral to the common synovial sheath of the cle.
THE AXILLARY FOSSA

The axillary fossa, or armpit (Iossa axillaris) (see Fig. 312) is a terior wall is formed by the subscapularis, teres major, and latissi
depression between the lateral surface of the thoracic wall and the mus dorsi muscles.
medial surface of the upper arm. It is clearly defined in maximum When the arm is abducted another two openings are seen in
abduction of the upper arm. the axillary Fossa which are formed by the passage of the long head
With removal of the skin covering the fossa, the underlying of the triceps brachii muscle between the teres major and teres mi
fascia and the loose fatty tissue, a large axillary cavity (cavum axil nor muscles. A three-sided opening (foramen trilaterum) is bounded
/are) is exposed which rather resembles in shape a four-sided pyr by the medial border of the long head laterally, by the teres minor
amid whose apex faces upwards and the base downwards. The base muscle superiorly, and by the teres major muscle inferiorly. Later
of the pyramid is also the lower aperture of the axillary cavity. The ally of the long head of the triceps brachii muscle is a four-sided
upper aperture of the axillary cavity forms in the region of the opening (foramen quadrilaterum) whose medial side is the lateral
apex. surface of the long head of the triceps brachii muscle, the upper
Four walls limiting the axillary Fossa are distinguished: medial, side is the teres minor muscle (from the posterior aspect) or the
lateral, anterior, and posterior. The medial wall is formed by the subscapularis muscle (from the anterior aspect), the lower side is
serratus anterior muscle; the lateral by the coracobrachialis muscle the teres major muscle, and the lateral side is the humerus. The ax
and the short head of the biceps brachii muscle; the anterior wall illary Fossa is filled with loose fatty tissue containing many vessels,
is formed by the pectoralis major and minor muscles, and the pos- lymph nodes, and nerves.
THE CUBITAL FOSSA

The cubital fossa (Iossa cubitalis) (see Fig. 314) is in the anterior orly, by the pronator teres muscle medially, and by the brachiora
cubital region (regio cubiti anterior). The Fossa proper is seen only dialis muscle laterally. Superficial and deep vessels and nerves pass
when the skin and the fatty tissue filling the Fossa are removed. in it.
The cubital Fossa is bounded by the brachialis muscle superi-
MUSCLES OF THE LOWER LIMB
Musculi membri inferioris
REGIONS OF THE LOWER LIMB

The following are the regions of the lower limb (regiones membri (b) the posterior region of the knee (regio genus posterior) is on
inferioris) (Figs 353, 365). the posterior surface of the knee. It includes the popliteal fossa
1. The gluteal region (regio glutea) is continuous with the pos (fossa poplitea).
terior femoral region. Its upper boundary is formed by the iliac 4. The crural regions:
crest, the lower boundary is the fold of the buttock (sulcus gluteus s. (a) the anterior crural region (regio crurus anterior) extends
plica glutea). from the tibial tuberosity to the level of the base of the malleoli
2. The femoral regions: and occupies the anterior surface of the leg;
(a) the anterior femoral region (regio femoris anterior) corre (b) the posterior crural region (regio cruris posterior) including
sponds to the location of the quadriceps femoris and sartorius the calf which is the most protruding upper part of this region.
muscles. The lower boundary line passes 4 cm above the patella; 5. The regions of the foot:
(b) the posterior femoral region (regio femoris posterior) corre (a) the dorsum of the foot (dorsum pedis) is on the dorsal and
sponds to the space bounded superiorly by the fold of the buttock lateral and medial surfaces of the foot and extends from the bend
and ,nferiorly by a transverse line drawn 3-4 cm above the base of of the ankle joint to the proximal phalanges of the toes;
the patella. (b) the region of the sole of the foot (plan/a pedis) is on the
3. The regions of the knee: plantar surface of the foot and stretches from the distal areas of
(a) the anterior region of the knee (regio genus anterior) is on the posterior surface of the calcaneum to the proximal phalanges
the anterior, lateral, and medial surfaces of the knee. It includes of the toes;
the patellar region which corresponds to the contours of the pa (c) the calcanean region (regio calcanea) corresponds to the pos
tella and the femoral condyles; terior surface of the calcaneum.
MUSCLES OF THE LOWER LIMB

The muscles of the lower limbs (musculi membri inferioris) are di the free lower limb. The muscles of the last-named group are in
vided into two groups according to their topographo-anatomical turn subdivided into the muscles of the thigh, the muscles of the
features, namely the muscles of the hip joint and the muscles of leg, and the muscles of the foot (Figs 352-401).
Spina iliaca
anterior superior
M. tensor
fasciae latae--
M. vastus lateralis
Tendo m. bicipitis
femoris
Lig. patellae
M. gastrocnemius
M. extensor (caput mediale)
digitorum longus
M. tibialis anterior
Malleolus lateralis
352. Outlines of muscles of right lower limb; anterior aspect.

REGIONS OF THE LOWER LIMB. LINES OF SKIN INCISIONS 393
___,_----,,- Regio femoris anterior
---,1-- Regio genus anterior
Regio cruris anterior
Regio calcanea
353. Regions and lines of skin incisions on lower limb.

(Blue line-area boundaries; red line-skin incisions most suitable for exposure of muscles in dissection.)
394 MUSCLES OF THE LOWER LIMB
MUSCLES OF THE HIP JOINT

The muscles of the hip joint are grouped into internal and ex The External Group of Muscles of the Hip Joint
ternal muscles.
1. The gluteus maximus muscle (musculus gluteus maximus).
The Internal Group of Muscles of the Hip Joint 2. The gluteus medius muscle (musculus gluteus medius).
1. The psoas major muscle (musculus psoas major). 3. The gluteus minimus muscle (musculus gluteus minimus).
2. The psoas minor muscle (musculus psoas minor). 4. The quadratus femoris muscle (musculus guadratus Jemoris).
3. The iliacus muscle (musculus iliacus) 5. The gemellus superior muscle (musculus gemellus superior).
4. The iliopsoas muscle (musculus iliopsoas). 6. The gemellus inferior muscle (musculus gemellus inferior).
5. The obturator internus muscle (musculus obturatorius interna). 7. The obturator externus muscle (musculus obturatorius exter
6. The piriformis muscle (musculus piriformis). nus).
7. The coccygeus muscle (musculus cocrygeus). 8. The tensor fasciae latae muscle (musculus tensor fasciae latae).
THE INTERNAL GROUP OF MUSCLES OF THE HIP JOINT
1. The psoas major muscle (musculus psoas major) (see Fig. 297) 5. The obturator internus muscle (musculus obturatorius internus)
is long and spindle-shaped. It takes origin by five slips from the (Fig. 360) is flattened and its-muscular fibres are directed slightly
lateral surface of the bodies of the twelfth thoracic and upper four fan-wise. It takes origin by a wide part from the inner surface of
lumbar vertebrae and the respective intervertebral cartilages. Slips the hip bone around the obturator membrane and from its inner
which are located deeper arise from the transverse processes of all surface. A small cleft between the bands of the muscle and the ob
lumbar vertebrae. Becoming slightly narrower, the muscle runs turator groove of the pubic bone is transformed into the obturator
downwards and a little laterally and fuses with the fibres of the ilia canal (canalis obturatorius) transmitting vessels and nerves. Con
cus muscle to form a common iliopsoas muscle. verging, the muscle fibres are directed laterally, pass over the
2. The psoas minor muscle (musculus psoas minor) (see Fig. 297) lesser sciatic notch almost at a right angle, leave the pelvic cavity
is inconstant, thin, and spindle-shaped. It lies on the anterior sur through the lesser sciatic foramen, and are inserted by a short
face of the psoas major muscle. It arises from the lateral surface of strong tendon into the trochanteric fossa. Where the bands pass
the bodies of the twelfth thoracic and first lumbar vertebrae and over the lesser sciatic notch lies the bursa of the obturator internus
stretches downwards; its tendon is continuous with the fascia iliaca muscle (bursa ischiadica musculi obturatorii interni).
and is inserted together with it into the pectineal line and the ilia The obturator internus muscle is divided topographically into
pubic eminence. two parts, one larger, extending to the exit from the pelvic cavity
Action: tenses the fascia iliaca. and called the intrapelvic part, and the other, smaller, tendinous
Blood supply: the lumbar arteries. part stretching under the gluteus maximus muscle and called the
Innervation: muscular branches of the lumbar plexus (L 1 -L,i). extrapelvic part.
3. The iliacus muscle (musculus iliacus) (see Fig. 297) fills the il- Action: supinates the thigh.
iac fossa completely and arises from its walls. It resembles a tri Blood supply: the inferior gluteal, obturator, and internal pu
angle in shape with the apex facing downwards. denda! arteries.
The fibres forming the muscle converge fan-wise towards the Innervation: muscular branches of the sacral plexus [Li-L5;
arcuate line and blend with those of the psoas major to form the S 1 -S2 (Ss)].
iliopsoas muscle. 6. The piriformis muscle (musculus piriformis) (Fig. 357) is
4. The iliopsoas muscle (musculus iliopsoas) (see Fig. 297) forms shaped like a flat isosceles triangle whose base arises from the ante
from fusion of the distal muscle fibres of the iliacus muscle and rior surface of the sacrum lateral to the anterior sacral foramina,
the psoas major muscle. It emerges from the pelvic cavity through between the second and fourth foramina. Converging, the muscle
the lacuna musculorum and runs downwards on the anterior sur fibres are directed laterally and emerge from the cavity of the true
face of the hip joint to be inserted by a thin short tendon into the pelvis through the greater sciatic foramen; the muscle then gives
lesser trochanter of the femur; the bursa of the psoas major tendon place to a narrow and short tendon which is inserted into the apex
(bursa ileopectinea) is lodged between the capsule of the hip joint of the greater trochanter. At the place of the insertion is the synov
and the tendon and often communicates with the cavity of the hip ial bursa of the piriformis muscle (bursa musculi piriformis). When
joint. passing through the greater sciatic foramen the muscle fails to fill
Action: flexes the hip joint and rotates the thigh medially. it completely but leaves small slits along the upper and lower bor
When the thigh is fixed the muscle flexes the trunk forwards. ders which transmit vessels and nerves. The slit formed along the
Blood supply: the iliolumbar and the deep circumflex iliac ar upper border of the piriformis muscle is called the suprapiriformis
teries. foramen and that formed along the lower border is the infrapir
Innervation: the muscular branches of the lumbar plexus iformis foramen.
(Li -Li). Action: supinates the thigh and assists in its abduction.
M. tensor fasciae latae
Funiculus spermaticus
(cut off)
V. saphena magna
lntegumentum commune
M. vastus lateralis
Bursa subcutanea
praepatellaris
354. Muscles and fasciae ef right thigh; anterior aspect (¼).

(Skin and subcutaneous layer are removed.)
Blood supply: the superior and inferior gluteal arteries. Action: in man the muscle is rudimentary; on contraction it
Innervation: muscular branches of the sacral plexus contributes to strengthening the pelvic walls.
[S 1 -S2 (Ss)]. Blood supply: muscular branches of the internal pudenda! ar
7. The coccygeus muscle (musculus coccygeus) (Figs 360, 361) is tery.
a thin sheet with a relatively small number of muscle fibres. Innervation: muscular branches of the pudenda! nerve.
Arising from the ischial spine, it passes on the medial side of the
sacrospinous ligament and is inserted into the lateral surface of the
lower two sacral and upper two or three coccygeal vertebrae.
396 MUSCLES OF THE HIP JOINT AND THIGH
Lig. inguinale
Arcus iliopectineus
Lacuna vasorum
Trigonum femorale
M. gracilis
Tendo m.
Retinaculum patellae mediale
355. Muscles of right hip joint and thigh; anterior

aspect(¼).
MUSCLES OF THE HIP JOINT AND THIGH 397
M. glutaeus medius
Bursa iliopectinea
M. vastus intermedius
endo m. semitendinosi
Tendo m. gracilis
(cut off)

aspect (¼).
(The rectus femoris and sartorius muscles and part of the iliopsoas muscle are
removed.)
M. glutaeus medius
M. rectus femoris
(cut off)
. M. obturatorius externus
M. pectineus
M. adductor longus
M. vastus (cut off)
intermedius
Canalis adductorius
M. semimembranosus
Lig. patellae

aspect (¼).
M. glutaeus minimus
M. obturatorius
externus
M. quadratus femoris
Tenda m. semimembranosi
Lig. collaterale fibulare -

aspect (¼).
400 ORIGIN AND ATTACHMENT OF MUSCLES OF THE THIGH
THE EXTERNAL GROUP OF MUSCLES

OF THE HIP JOINT
Capsula art. coxae 1. The gluteus maximus muscle (musculus gluteus maximus) re
sembles a rhombus in shape. It is formed of large fibres and is
strong, flat, and 2-3 cm thick. It covers the greater trochanter and
the other muscles of this group. The muscle arises from the poste
rior part of the external surface of the iliac bone to the back of the
posterior gluteal line, from the lateral borders of the sacrum and
coccyx, and from the sacrotuberous ligament. The muscle fibres
M. vastus lateralis stretch obliquely downwards and laterally and the upper ones are
inserted into the fascia lata which is continuous with the iliotibial
tract, while the lower fibres are inserted into the gluteal tuberosity
of the femur. The trochanteric bursa of the gluteus maximus mus
cle (bursa trochanterica musculi glutei maximi) is lodged here between
the greater trochanter and the muscle.
Action: brings the trunk to an erect position when it is bent
forwards, extends the thigh, and tenses the fascia lata of the thigh.
Blood supply: the superior and inferior gluteal, medial circum
flex, and profunda femoris (perforating artery prima) arteries.
Innervation: inferior gluteal nerve (plexus sacralis) (Ls, S 1 -S2).
2. The gluteus medius muscle (musculus gluteus medius)
(Fig. 369) is under the gluteus maximus. It resembles a triangle in
shape. The muscle is thick and consists of two layers, superficial
and deep. The muscle fibres run fan-wise; they arise widely from
the external surface of the ala of the ilium between the anterior
gluteal line in front, the iliac crest above, and the posterior gluteal
line below. Then all the muscle fibres converge to form a strong
common tendon which is inserted into the apex of the greater tro
chanter; the trochanteric bursa of the gluteus medius muscle (bursa
trochanterica musculi glutei medii) is lodged here.
Action: abducts the thigh, with the anterior fibres rotating it
medially and the posterior fibres rotating it laterally; assists in
bringing erect the trunk when it is bent forwards.
Blood supply: the superior gluteal and lateral circumflex arter
ies.
Innervation: the superior gluteal nerve (sacral plexus) (L 1 - Ls,
Si)-
3. The gluteus minimus muscle (musculus gluteus minimus)
(Fig. 369) resembles the gluteus medius in shape but is much thin
M. adductor
M. gastrocnemius magnus ner across, and is completely covered by it. The muscle arises from
(caput Iaterale) the external surface of the ilium between the anterior and inferior
gluteal lines. The muscle fibres then converge to be continuous
with a tendon which is inserted into the anterior border of the
greater trochanter. The trochanteric bursa of the gluteus minimus
muscle (bursa trochanterica musculi glutei minimi) lies here.
Capsula art. genus
Action: similar to that of the gluteus medius muscle, it abducts
the limb and contributes to bringing the trunk to an erect position
when it is bent.
Blood supply: the superior gluteal and lateral circumflex arter
359. Sites of origin and attachment ef ies.
Innervation: the superior gluteal nerve (plexus sacralis) (L 1 -Ls,
muscles and articular capsules on right Si)-
thigh; anterior aspect (schematical 4. The quadratus femoris muscle (musculus quadratus femoris)
representation). (Fig. 370) has the appearance of a relatively thick rectangle which
MUSCLES OF THE FREE LOWER LIMB 401
is covered by the gluteus maximus muscle posteriorly. It takes ori 7. The obturator externus muscle (musculus obturatorius exter
gin from the lateral surface of the ischial tuberosity and is inserted nus) (see Fig. 297) is shaped like an irregular triangle. It arises by
into the trochanteric crest and reaches the greater trochanter. its widest part from the obturator membrane and the bony edge of
Action: rotates the thigh laterally. the obturator foramen, after which the muscle fibres converge
Blood supply: the inferior gluteal, medial circumflex, and obtu fan-wise and are continuous with a tendon lying on the posterior
rator arteries. surface of the capsule of the hip joint. The muscle is inserted into
Innervation: the sciatic nerve (sacral plexus) (Li-L5, S,). the trochanteric fossa next to the obturator internus muscle.
5. The gemellus superior muscle (musculus gemellus superior) Action: rotates the thigh laterally.
(Fig. 371) is a small slip arising from the ischial spine; it is inserted Blood supply: the obturator and lateral circumflex arteries.
into the trochanteric fossa. The muscle adjoins the superior border Innervation: the obturator nerve (lumbar plexus) [(4),
of the obturator internus tendon after it emerges from the pelvic L3-Li)]:
cavity. 8. The tensor fasciae latae muscle (musculus tensor fasciae lataiJ
Action: rotates the thigh laterally. (Fig. 355) is flat and slightly elongated. It lies on the anterolateral
Blood supply: the inferior gluteal and internal pudenda! arter surface of the pelvis and its distal end blends with the fascia lata
ies. femoris. The muscle arises from the outer lip of the iliac crest
Innervation: branches of the sacral plexus (Li-L5, S,). closer to the anterior superior iliac spine. The muscle fibres are di
6. The gemellus inferior muscle (musculus gemellus inferior) rected vertically downwards to be continuous with the iliotibial
(Fig. 371) resembles the gemellus superior muscle in shape and tract.
lies below the tendon of the obturator internus muscle. It arises Action: tenses the fascia lata and helps in flexion of the thigh.
from the ischial tuberosity and is inserted into the trochanteric Blood supply: the superior gluteal and lateral circumflex arter
fossa. ies.
Action: rotates the thigh laterally. Innervation: the superior gluteal nerve (sacral plexus) (Li-L5,
Blood supply and innervation are the same as in the case of the S,).
gemellus superior muscle.
MUSCLES OF THE FREE LOWER LIMB

The muscles of the free lower limb are divided into the muscles of the thigh, the muscles of the leg, and the muscles of the foot.
MUSCLES OF THE THIGH

The muscles of the thigh (musculi femoris) form an anterior, me The Medial Group
dial, and lateral groups. Extensors are predominantly related to
1. The gracilis muscle (musculus gracilis).
the first, adductors to the second, and flexors to the third group.
2. The adductor longus muscle (musculus adductor longus).
3. The adductor brevis muscle (musculus adductor brevis).
4. The adductor magnus muscle (musculus adductor magnus).
5. The pectineus muscle (musculus pectineus).
The Anterior Group The Posterior Group
1. The sartorius muscle (musculus sartorius). 1. The semitendinosus muscle (musculus semitendinosus).
2. The quadriceps femoris muscle (musculus quadriceps femoris). 2. The semimembranosus muscle (musculus semimembranosus).
3. The articularis genus muscle (musculus articularis genus). 3. The biceps femoris muscle (musculus biceps femoris).
THE ANTERIOR GROUP OF MUSCLES OF THE THIGH
1. The sartorius muscle (musculus sartorius) (Fig. 355) is a strap bercle of the tibia; some fibres blend with the fascia of the upper
like and longest muscle in the human body. Lying on the anterior part of the leg.
surface of the thigh, it descends spirally, passing to the medial sur Action: flexes the thigh and leg, rotating the thigh laterally and
face, and then curving around the back of the medial epicondyle the leg medially thus assisting in crossing the legs.
passes over to the anteromedial surface of the leg. The muscle Blood supply: the lateral circumflex and superior genicular ar
arises from the anterior superior iliac spine, passes obliquely teries and muscular branches of the femoral artery.
downwards, and ends as a flat tendon which is inserted into the tu- Innervation: the femoral nerve (lumbar plexus) (4-L3).
M. obturatorius
internus
Lig. sacrospinalc et 111. coccygeus
Lig. sacrotubcrale
M. rectus fcmoris
M. gastrocnemius (caput medialc)
360. Muscles of right hip joint and thigh (¼).

(The internal muscles of the hip joint, the anterior and medial groups of thigh
muscles.)
Lig. sacrospinale et m.
coccygeus
M.glutaeus
maximus
M. adductor brevis
M. adductor longus
361. Muscles of right hip joint and thigh; medial aspect

(¼).
404 ORIGIN AND INSERTION OF MUSCLES ON THE HIP BONE
2. The quadriceps femoris muscle (musculus quadriceps femoris) A. The rectus femoris muscle (musculus rectus femoris) is the
(Figs 355-359) occupies the anterolateral surface of the thigh and longest head and occupies the anterior surface of the thigh. It
its lower parts extend to the lateral surface. Each of its four heads takes origin by a fine tendon from the anterior inferior iliac spine
arises independently, but on reaching the knee they form a com and superior border of the acetabulum and then passes downwards
mon tendon which passes on the anterior surface of the patella and to be continuous with a narrow tendon which fuses with the base
is inserted into the tubercle of the tibia. and anterior surface of the patella. On reaching the tibia the ten-
M. iliacus
M.
internus
erector trunci
Ligg. sacroiliaca
interossea
Spina
anterior superior
Spina iliaca
posterior superior
Fascies auricularis
Spina iliaca
anterior inferior
M. obturatorius internus
M. transversus perinei profundus
362. Sites of origin and attachment of muscles and articular

capsule on right hip bone; inner aspect (schematical re
presentation).
ORIGIN AND INSERTION OF MUSCLES ON THE FEMUR 405
don of the muscle is inserted into the tibial tubercle. Below the pa vastus medialis muscle arises from the medial lip of the linea as
tella the tendon is called the ligamentum patellae. pera and runs downwards to be continuous with a wide tendon
B. The vastus medialis muscle (musculus vastus media/is) occu which partly blends with the common tendon together with the
pies the anteromedial surface of the lower half nf the thigh. The rectus femoris muscle and is partly inserted into the medial border
muscle fibres forming it are directed obliquely downwards and of the patella to form the medial retinaculum of the patella.
anteriorly. In front it is partly covered by the rectus muscle. The C. The vastus lateralis muscle (musculus vastus lateralis) occu-
M. glutaeus medius
M.
M. adductor longus
M. biceps femoris
(caput breve)
M. adductor magnus
M. gastrocnemius
(caput laterale)
M. gastrocnemius
(caput mediale)
Lig. collaterale tibiale Ligg. cruciata genus
Capsula art. genus
363. Sites of origin and attachment of muscles, ligaments, and articular

capsules on right femur; posterior aspect (schematical representa
tion).
406 OUTLINES OF MUSCLES OF THE LOWER LIMB
Plica glutealis
M. �mOmemO,a"°'"' (
M. gastrocncmius
M. gastrocnemius __ (caput laterale)
(caput mediale)
M. soleus --.
Tendo
calcaneus (Achillis) --
Malleolus medialis
364. Outlines of muscles of right lower limb; posterior aspect.

REGIONS OF THE LOWER LIMB. SKIN INCISIONS 407
Regio perinealis
Regio femoris
posterior ---+-+--
Regio genus posterior
Regio cruris posterior
365. Regions and skin incisions on lower limb.

(Blue line-area boundaries; red line-skin incisions most suitable for exposure of muscles in dissection.)
408 MUSCLES AND FASCIAE OF THE THIGH
M. glutaeus maximus
M. adductor magnus
Fascia lata
Tractus iliotibialis
M. gastrocnemius -- M. gastrocnemius

(caput mediale) (caput laterale)
366. Muscles and fasciae ef right hip joint and thigh; posterior
aspect(¼).
MUSCLES AND FASCIA£ OF THE THIGH 409
M. glutaeus maximus
M. adductor magnus
Intersectio Tractus iliotibialis

tendinea ----li-lltt-<t,-,;
M. semimembranosus
--....llil!--- Fossa poplitea and

neurovascular bundle
367. Muscles and fasciae of right hip joint and thigh;

posterior aspect (¼).
M. latissimus dorsi ---,1,-----1/

externus
M. biceps femoris
(caput longum)
M. semimembranosus
M. gastrocnemius
(caput laterale)
368. Muscles and fasciae of right hip joint and thigh; la
teral aspect (¼).
MUSCLES OF THE HIP JOINT 411
M. glutaeus medius (cutoff)
M. glutaeus minimus
Lig. sacrospinale
M. glutaeus medius
(cutoff)
•,;.;.+.--',llll----Trochanter major
(cutoff)
369. Muscles ef hip joint; posterior aspect (½).
pies almost the entire anterolateral surface of the thigh. It is partly D. The vastus intermedius muscle (musculus vastus intermedius)
covered by the tensor fasciae latae muscle in the upper part and by is on the anterior surface of the thigh between the vastus medialis
the rectus femoris muscle in front. The muscle fibres forming it and vastus lateralis muscles and directly under the rectus femoris
are directed downwards and forwards. muscle. It is the weakest among all the other heads. The vastus in
The muscle arises from the greater trochanter, the intertro termedius muscle takes origin from the anterior surface of
chanteric line, and the lateral lip of the linea aspera. It runs the femur, starting from the intertrochanteric line, runs down
downwards and ends as a wide tendon part of which fuses with the wards and gives place (almost in the middle of its length) to a
rectus femoris tendon to form a common tendon and the other wide tendon which fuses distally with the tendon of the rectus fe
part is inserted into the lateral border of the patella to form the moris muscle to form the common tendon of the quadriceps
lateral retinaculum of the patella. muscle.
412 MUSCLES OF THE THIGH
The four heads forming the quadriceps femoris muscle are in muscle extends the leg at the knee joint; the rectus femoris muscle
serted into various areas of the patella and the following bursae are flexes the hip joint.
found at the sites of insertion (see Fig. 227): (a) the subcutaneous Blood supply: lateral circumflex and profunda femoris arteries.
prepatellar bursa (bursa subcutanea prepatellaris) lying in the subcu Innervation: femoral nerve (lumbar plexus) (½-L.).
taneous fat in front of the patella; (b) the suprapatellar bursa 3. The articularis genus muscle (musculus articularis genus) (see
(bursa suprapatellaris) lodged under the quadriceps femoris tendon Figs 225, 359) is a flat sheet of several clearly defined muscle
above the patella; (c) the subcutaneous infrapatellar bursa (bursa fibres. It is on the anterior surface of the thigh under the vastus in
subcutanea infrapatellaris) lying in front of the ligamentum patellae; termedius muscle. It takes origin from the anterior surface of the
(d) the deep infrapatellar bursa (bursa infrapatellaris profunda) lower third of the femur and runs downwards to be inserted into
lodged at the insertion of the ligamentum patellae into the tuber the anterior surface and sides of the capsule of the knee joint.
cle of the tibia, and some other bursae. Action: tenses the capsule of the knee joint.
Some of these bursae may communicate with the cavity of the Blood supply: lateral circumflex artery and perforating
knee joint. branches of the profunda femoris artery.
Action: contraction of all the heads of the quadriceps femoris Innervation: the femoral nerve.
THE MEDIAL GROUP OF MUSCLES OF THE THIGH
1. The gracilis muscle (musculus gracilis) (Fig. 360) is long and Blood supply: the obturator and perforating arteries.
slightly flattened. It lies under the skin and occupies the extreme Innervation: anterior branch of the obturator nerve (½-L.).
medial position in this group of muscles. It arises from the anterior
surface of the pubic bone, passes downwards, and gives place to a 4. The adductor magnus muscle (musculus adductor magnus)
thin tendon which curves behind the medial epicondyle of the (Fig. 358) is broad, thick, and the largest in this group. It lies un
femur and is inserted into the tubercle of the tibia. Before reach der the adductor longus and adductor brevis muscles lateral of the
ing the site of its insertion the gracilis tendon blel)-ds with the ten gracilis muscle. The adductor magnus arises by a strong short ten
dons of the sartorius and semitendinosus muscles and the crural don from the inferior ramus of the pubis and the ramus of the
fascia to form a superficial 'goose's foot' (pes anserinus superficialis). ischium for a distance to the ischial tuberosity; the muscle fibres
Here is also the anserine bursa (bursa anserina cruris). then diverge fan-wise downwards and laterally and are inserted by
Action: adducts the thigh and also helps in flexing the leg at a broad tendon into the medial lip of the linea aspera on the femur
the knee joint while rotating the limb laterally. for its whole length. Some of the distal muscle fibres end in a thin
Blood supply: external pudenda!, obturator, and profunda tendon which is inserted into the medial epicondyle of the femur.
femoris arteries. Action: adducts the thigh, rotating it slightly laterally.
Innervation: anterior branch of the obturator nerve (½-L.). Blood supply: the obturator and perforating arteries.
2. The adductor longus muscle (musculus adductor longus} Innervation: posterior branch of the obturator nerve (½-L3)
(Fig. 356) is flat and resembles a triangle in shape. It lies on the and branches of the sciatic nerve (L.-L5).
anteromedial surface of the thigh. 5. The adductor minimus muscle (musculus adductor minimus)
The muscle arises by a short strong tendon from the pubic (Figs 370, 371) is as if part of the upper fibres of the adductor
bone below the pubic tubercle lateral of the gracilis muscle. Then magnus muscle. It takes origin from the anterior surface of the in
gradually expanding it runs downwards and is inserted into the ferior ramus of the pubis and the ramus of the ischium and is in
middle third of the medial lip of the linea aspera. serted into the medial lip of the linea aspera on the femur. It is tri
Action: adducts the thigh, assists in its flexion at the hip joint angular and lies to the front of the adductor brevis muscle; it
and lateral rotation. borders upon the obturatorius externus and quadratus femoris
Blood supply: external pudenda!, obturator, and profunda muscles above and the adductor magnus muscle below.
femoris arteries. Action: flexes the thigh at the hip joint, adducts and rotates it
Innervation: anterior branch of obturator nerve (Lr L3 ). laterally.
3. The adductor brevis muscle (musculus adductor brevis) Blood supply: obturator and perforating arteries.
(Fig. 357) is triangular and lies under the adductor longus muscle. Innervation: posterior branch of the obturator nerve (L3- L,).
It arises on the anterior surface of the inferior ramus of the pubis
lateral of the gracilis muscle. Running downwards and laterally, it 6. The pectineus muscle (musculus pectineus) (Fig. 356) is flat
expands slightly and is inserted into the upper third of the medial and almost quadrangular. It borders upon the iliopsoas muscle la
lip of the linea aspera. terally and the adductor longus muscle medially. A small depres
Action: adducts the thigh and assists in its flexion at the hip sion forms between the iliopsoas and the pectineus.
joint and lateral rotation. The muscle arises from the superior ramus and pecten of the
MUSCLES OF THE LEG 413
pubis, extends downwards and slightly laterally, and is inserted Blood supply: the obturator, external pudenda!, and profunda
into the spiral line. femoris arteries.
Action: flexes and adducts the thigh, rotating it slightly later Innervation: branches of the femoral nerves and inconstantly
ally. branches of the obturator nerve (Le L3).
THE POSTERIOR GROUP OF MUSCLES OF THE THIGH
I. The semitendinosus muscle (musculus semitendinosus) band reaches the capsule of the knee joint and is continuous with
(Fig. 367) is long and thin and lies closer to the medial border of the oblique posterior ligament of the knee.
the posterior surface of the thigh. Its lateral margin borders upon The bursa of the semimembranosus tendon (bursa musculi semi
the biceps femoris muscle, the medial upon the semimembranosus membranosus) forms where the tendon separates into bands.
muscle. The proximal end is covered by the gluteus maximus mus Action: extends the thigh at the hip joint, flexes the leg at the
cle. Often the muscle is interrupted in the middle by a tendinous knee joint and rotates it medially.
intersection {intersectio tendinea). The muscle arises from the ischial Blood supply: medial circumflex, perforating, and popliteal ar
tuberosity, runs downwards, and is continuous with a long tendon teries.
which bends around the medial femoral epicondyle and stretches Innervation: the tibial nerve (4-L5; S 1).
on the anteromedial surface of the tibia to be inserted into its tu 3. The biceps femoris muscle {musculus biceps femoris) (Fig. 368)
bercle. Some of the end fibres of the tendon blend with the fascia stretches on the lateral border of the posterior surface of the thigh.
of the leg and thus contribute to the formation of the superficial It has two heads, long and short, which fuse to form a single com
'goose's foot' (Fig. 360). mon belly. The long head (caput longum) arises from the ischial tu
Action: extends the thigh at the hip joint, flexes the leg at the berosity by a small flat tendon; the short head (caput breve) takes
knee joint and slightly rotates it medially, assists in bringing the origin from the lateral lip of the linea aspera for the length of the
trunk to an erect position. distal half of the femur. At the origin of the long head is the upper
Blood supply: the perforating arteries. bursa of the biceps femoris muscle (bursa musculi bicipitis femoris su
Innervation: branches of the tibial nerve (4-L5; S 1 (S2)]. perior). On fusion, both heads form a strong belly which passes
2. The semimembranosus muscle (musculus semimembranosus) downwards and gives place to a long narrow tendon: after curving
(Fig. 367) lies on the medial border of the posterior surface of the around the back of the lateral epicondyle the tendon is inserted
thigh. Its lateral margin is covered by the semitendinosus muscle into the head of the fibula. Some bands pass horizontally to be in
which leaves a mark here in the form of a wide longitudinal serted into the edge of the superior articular surface of the tibia,
groove. The medial margin of the muscle is free. The muscle arises others run downwards and blend with the crural fascia. Between
by a flat strong tendon from the ischial tuberosity. It passes the tendon of the muscle and the lateral ligament of the knee is
downwards and is continuous with a flat tendon which gradually lodged the lower bursa of the biceps femoris muscle (bursa subtendi
narrows, becomes rounded and after curving around the medial nea musculi bicipitis femoris inferior).
epicondyle runs to the anteromedial surface of the tibia. Here the Action: extends the thigh at the hip joint, flexes the leg at the
tendon becomes wider, separating into three bands to form the knee joint rotating it laterally.
deep 'goose's foot' (pes anserinus prefundus) (Fig. 382). The medial Blood supply: medial circumflex, perforating, and popliteal ar
band lies horizontally and ends on the medial condyle of the tibia; teries.
the middle band also stretches to the medial condyle and is contin Innervation: the long head-tibial and sciatic nerves (S 1 -S2),
uous with the fascia covering the popliteus muscle; the lateral the short head-common peroneal nerve (4-L5; S 1).
MUSCLES OF THE LEG

The muscles of the leg (musculi cruris) form three groups: la 2. The peroneus brevis muscle (musculus peroneus [fibularis] bre-
teral, anterior, and posterior; the posterior group has two layers, vis).
superficial and deep. The lateral group is composed predominantly
of flexors and pronators of the foot and the anterior group-of ex
The Anterior Group
tensors of the foot; the posterior group is mostly formed of flexors
and supinators of the foot. I. The tibialis anterior muscle (musculus tibia/is anterior).
2. The extensor digitorum longus muscle (musculus extensor dig
The Lateral Group
itorum longus).
I. The peroneus longus muscle (musculus peroneus [fibularis} lon 3. The extensor hallucis longus muscle (musculus extensor hallu
gus). cis longus).
M. glutaeus maximus _._-,c;..;.::i-..·

(cut off)
M. piriformis
M.obturatorius internus
Mm.gemelli
Lig.sacrotuberale
M. glutaeus maximus
(cut off)
M. semitendinosus et caput
longum m.bicipitis
femoris (cut off)
femoris laterale
_,.LL....._,....__ M.biceps femoris

(caput breve)
M.biceps femoris
(caput longum) (cut off)
M. gastrocnemius --,----;{ajlfflff
(caput mediale) (cut off)
M.soleus
370. Muscles of right hip joint and thigh; posterior

aspect (¼).
'
I
M. glutaeus maximus ______
(cut off)
Foramen ischiadicum
majus
Tendo m. piriformis
Lig. sacrospinale (cut off)
M. obturatorius internus ��:::r'�"""'�_:-=,....

(cut)
-1-�=-M. glutaeus maximus

(cut off)
M. adductor magnus
femoris laterale
M. vastus lateralis
371. Muscles of right hip joint and thigh; posterior

aspect (¼).
The Posterior Group Deep Layer
1. The popliteus muscle (musculus popliteus).

2. The flexor digitorum longus muscle (musculusflexor digitorum
Superficial Layer longus).
3. The flexor hallucis longus muscle (musculusJlexor hallucis lon
1. The triceps surae muscle (musculus triceps surae). gus).
2. The plantaris muscle (musculus plantaris). 4. The tibialis posterior muscle (musculus tibialis posterior).
THE LATERAL GROUP OF MUSCLES OF THE LEG

1. The peroneus longus muscle (musculus peroneus [fibularis] lon dyle of the tibia, and the fascia cruris, and a posterior head arising
gus) (Fig. 379) is on the lateral surface of the leg. Its upper part lies from the upper parts of the lateral surface of the fibula. Between
directly on the fibula, while the lower part covers the peroneus bre the two heads is the superior musculo-fibular canal. Stretching
vis muscle. The peroneus longus muscle arises by two heads: an downwards, the muscle is continuous with a long tendon which
anterior head arising from the head of the fibula, the lateral con- curves around the lateral malleolus posteriorly, passes on the la-
M. rectus femoris
M. M. vastus medialis
Lamina vastoadductoria
A. et v. femorales
Femur
femoris mediale
M. gracilis
M. biceps femoris (caput breve)

Septum intermusculare femoris posterius
M. biceps femoris (caput longum)
M. semitendinosus
N. ischiadicus
372. Muscles and fasciae of right thigh (½).

(Transverse section through the middle of the thigh.)
ORIGIN AND ATTACHMENT OF MUSCLES OF THE THIGH 417
teral surface of the calcaneum, over to the sole under the peroneal septa of the leg and extends downwards next to the peroneus lon
tubercle, fits into the groove for the tendons of the peroneus mus gus tendon. After curving around the lateral malleolus posteriorly
cles, and crosses the sole obliquely to be inserted into the tubercle it passes forwards on the lateral surface of the calcaneum and is in
of the first metatarsal bone, the base of the second metatarsal bone serted into the tubercle of the fifth metatarsal bone.
and the medial cuneiform bone. Action: causes plantar flexion of the foot and raises its lateral
Action: accomplishes plantar flexion of the foot and lowers its border.
medial border. Blood supply: peroneal and anterior tibial arteries.
Blood supply: the lateral inferior genicular, peroneal, and ante Innervation: superficial peroneal nerve (musculocutaneous
rior tibial arteries. nerve of lower limb) [(Li) L5; S i ].
Innervation: superficial peroneal nerve (musculocutaneous On passing behind the lateral malleolus, the tendons of both
nerve of lower limb) [(Li) L5; Si]. peroneal muscles are invested in a common synovial sheath of the
2. The peroneus brevis muscle (musculus peroneus [fibularis] bre peroneal tendons (vagina synovialis musculorum peroneorum [fibular
vis) (Fig. 379) is long, thin, and lies directly on the lateral surface ium] communis). Distally this sheath separates to form a separate
of the fibula under the peroneus longus muscle. It arises from the sheath for each tendon.
lower half of the lateral surface of the fibula and the intermuscular
M. glutaeus medius
M.
373. Sites of origin and attachment of muscles and ligaments on right pel
vic bones and femur; superior aspect (schematical representation).
418 ORIGIN AND ATTACHMENT OF MUSCLES ON THE HIP BONE
M.
Lig. inguinale
rectus femoris
Lig. sacrotuberale
M. gemellus superior
Lig. pubicum superius
M.
adductor magnus
374. Sites ef origin and attachment ef muscles, ligaments, and articular capsules
on right hip bone; outer aspect (schematical representation).
MUSCLES OF THE LEG 419
THE ANTERIOR GROUP OF MUSCLES OF THE LEG
1. The tibialis anterior muscle (musculus tibia/is anterior) sor retinaculum. Before entering the canal it separates into five
(Figs 376, 379) is long and narrow and lies superficially occupying thin tendons which pass to the dorsal surface of the foot; four of
the extreme medial position in relation to the other muscles of this them are inserted into the phalanges of the ,lateral four toes. At the
group. Its medial border adjoins the anterior border of the tibia, site of insertion each tendon separates into three slips, the middle
while its lateral border adjoins the extensor digitorum longus mus one terminating on the base of the middle phalanx and the two
cle proximally and the extensor hallucis longus muscle distally. collateral slips are inserted into the base of the distal phalanx. The
The tibialis anterior muscle arises by its broadest part from the la fifth small tendon is inserted into the base of the fifth metatarsal
teral tibial surface (beginning from the lateral condyle) and the in bone. This tendon is often fused with an inconstant peroneus ter
terosseous membrane. In the lower third of the leg it is continuous tius muscle (musculus peroneus tertius, s. fibularis tertius) which arises
with a long flat tendon which is lodged in a canal under the infe from the lower third of the fibula and the interosseous membrane
rior extensor retinaculum and extends first to the medial border of and is also inserted into the base of the fifth metatarsal bone.
the foot and then to the plantar surface on which it is inserted into Action: extends the lateral four toes, accomplishes dorsal flex
the medial cuneiform bone and the base of the first metatarsal ion of the foot, and together with the peroneus tertius muscle
bone. The small bursa of the tibialis anterior tendon (bursa subtend raises (pronates) its lateral border.
inea musculi tibia/is anterioris) can be found at the site of the inser Blood supply: anterior tibial artery.
tion. Innervation: deep peroneal (anterior tibial) nerve.
Action: accomplishes dorsal flexion of the foot and raises its 3. The extensor hallucis longus muscle (musculus extensor hallu
medial border. cis longus) (Fig. 377) lies between the tibialis anterior and the ex
Blood supply: anterior tibial artery. tensor digitorum longus muscles which cover its upper two thirds.
Innervation: deep peroneal (anterior tibial) nerve (Li-Ls; S 1 ). The muscle arises from the medial surface of the middle and lower
2. The extensor digitorum longus muscle (musculus extensor dig- thirds of the fibula and the interosseous membrane and passes
itorum longus) (Fig. 376) lies lateral of the tibialis anterior muscle. downwards to be continuous with a narrow long tendon which fits
The extensor hallucis longus tendon passes between these two into the middle canal and passes under the inferior extensor reti
muscles in the lower third of the leg. The extensor digitorum mus naculum to the great toe to be inserted into its distal phalanx.
cle arises from the upper third of the tibia, the head and anterior Some of the fibres fuse with the base of the proximal phalanx.
border of the fibula, the interosseous membrane, the anterior inter Action: extends the great toe, assists in dorsal flexion of the
muscular septum, and the crural fascia. It is then directed down foot, raising (supinating) its medial border.
wards, narrows gradually, and gives place to a narrow and long Blood supply: the anterior tibial artery.
tendon which passes in the lateral canal under the inferior exten- Innervation: the deep peroneal (anterior tibial) nerve.
THE POSTERIOR GROUP OF MUSCLES OF THE LEG
Superficial Layer form a strong tendo calcaneus (Achillis) in the lower third of the leg;
the tendon is inserted into the posterior surface of the calcaneum.
1. The triceps surae muscle {musculus triceps surae) (Figs 380, The bursa of the tendo calcaneus (bursa tendinis calcanei s. Achillis)
381) is made up of the gastrocnemius muscle lying superficially is found at the insertion.
and the soleus muscle located in front of it closer to the leg bones. Action: the triceps surae muscle flexes the leg at the knee joint,
A. The gastrocnemius muscle (musculus gastrocnemius) accomplishes plantar flexion of the foot, raises the heel. When the
(Fig. 380) consists of two strong fleshy heads, medial (caput medi foot is steadied the muscle pulls the leg and thigh to the back.
ale) and lateral (caput laterale). Blood supply: the posterior tibial and peroneal arteries.
The stronger medial head arises from the popliteal surface of Innervation: the tibial (medial popliteal) nerve (L4-Ls; S 1 -S2).
the femur above the medial condyle, the lateral head arises sym 2. The plantaris muscle (musculus plantaris) (Fig. 381) is rudi-
metrically but at a slightly lower level above the lateral condyle. mentary and often absent. Its mu.scular belly is spindle-shaped,
Both heads at their origin form the inferior border of the popliteal short, and arises from the lateral femoral condyle and the posterior
fossa. Extending downwards, they unite approximately in the mid wall of the knee joint capsule. It extends downwards and slightly
dle of the leg and are then continuous with a tendon. medially and ends in a long, narrow tendon lying between the gas
B. The soleus muscle {musculus soleus) (Fig. 381) is flat and trocnemius and soleus muscles. In the lower third of the leg it
covered by the gastrocnemius muscle. It arises from the head and usually fuses with the tendo calcaneus, but in ·Borne cases it is in
upper third of the shaft of the fibula as well as from the soleal line serted into the calcaneum independently and its fibres intertwine
and middle third of the shaft of the tibia. Some of the muscle with those of the plantar aponeurosis.
fibres arise from the tendinous arch of the soleus muscle (stretched Action: tenses the capsule of the knee joint.
between the leg bones). Passing downwards, the muscle is contin Blood supply: the popliteal artery.
uous with a tendon which fuses with the gastrocnemius tendon to Innervation: the tibial (medial popliteal) nerve (Li -Ls; S 1 ).
420 MUSCLES AND FASCIAE OF THE LEG AND FOOT
Bursa
subcutanea prepatellaris ....!l,&,::..µ,___,,,.:,;.:t...
Lig. patellae
commune
Fascia cruris
M. triceps surae
M. extensor digitorum -�....:::;:;,_

longus
Retinaculum
extensorum superius
Malleolus lateralis
Retinaculum
mm.
Fascia dorsalis pedis
Tendines 111. extensoris Tendo m. extensoris

digitorum longi
hallucis longi
375. Muscles and fasciae of right leg and foot; anterior aspect
(¼).
MUSCLES AND FASCIA£ OF THE LEG AND FOOT 421
M. quadriceps femoris
genus
M. peronaeus
longus
M. gastrocnemius
(caput mediale)
M. peronaeus brevis
(m. fibularis brevis)
\'Ml,\-\-�--Tendo m. extensoris
hallucis longi
376. Muscles of right leg and foot; anterior aspect

(¼).
422 MUSCLES OF THE FOOT
Deep Layer gus) (Fig. 382) occupies the extreme lateral position on the poste
rior surface and covers partly the tibialis posterior muscle.
1. The popliteus muscle (musculus popliteus) (Fig. 383) is flat, It arises from the lower two thirds of the fibula, the interosse
short, and lies directly on the posterior surface of the capsule of _ous membrane, and the posterior intermuscular septum of the leg.
the knee joint. It arises from the lateral femoral condyle and the The muscle is directed downwards to be continuous with a long
arcuate ligament of the knee. It is directed downwards, becomes tendon which passes under the flexor retinaculum and onto the
slightly wider, and is inserted into the posterior surface of the tibia sole in the groove between the talus and calcaneum.
above the soleal line. Here the tendon stretches under the flexor digitorum longus
Action: flexes the knee and rotates the leg medially at the same tendon and sends it some of the fibrous bands. After that it runs
time, pulling at the capsule of the· knee joint. fotwards and is inserted into the base of the distal phalanx of the
Blood supply: the popliteal artery. great toe.
Innervation: the tibial (medial popliteal) nerve (L s; S 1 -S2 ). Action: flexes the great toe and also assists in flexion of the lat
ter four toes through the fibrous bands added to the flexor digito
2. The flexor digitorum longus muscle (musculusflexor digitorum
rum longus tendon; accomplishes plantar flexion and lateral rota
longus) (Fig. 382) occupies the extreme medial position in this
tion of the foot.
group of muscles; it lies on the posterior surface of the tibia. The
Blood supply: the peroneal artery.
muscle arises from the middle third of the posterior surface of the
Innervation: the tibial (medial popliteal) nerve (Ls; S 1 -S2 ).
tibia and from the deep layer of the crural fascia. It stretches
4. The tibialis posterior muscle (musculus tibia/is posterior)
downwards and ends in a long tendon which curves around the
(Fig. 383) lies between the flexor digitorum longus and flexor hal
back of the medial malleolus under the flexor retinaculum. It then
lucis longus muscles directly on the interosseous membrane.
passes to the sole in which it is directed obliquely and laterally and
It arises from the interosseous membrane and from the adjoin
separates into four tendons passing to the lateral four toes to be in
ing borders of the tibia and fibula. The muscle runs downwards
serted into the bases of the distal phalanges. Before insertion each
and ends in a long tendon which, on passing in a separate canal
tendon perforates the tendon of the flexor digitorum brevis mus
under the flexor retinaculum, curves around the back of the me
cle.
dial malleolus and passes over to the sole to be inserted into the tu
Action: flexes the distal phalanges· of the lateral four toes, as
berosity of the navicular and into the medial, intermediate, and la
sists in plantar flexion of the foot by raising (supinating) its medial
teral cuneiform bones.
border.
Action: accomplishes plantar flexion of the foot and rotates it
Blood supply: the posterior tibial artery.
laterally (supinates) at the same time.
Innervation: the tibial (medial popliteal) nerve (Ls; S 1 -S2 ).
Blood supply: the posterior tibial and peroneal arteries.
3. The flexor hallucis longus muscle (musculusjlexor hallucis Ion- Innervation: the tibial (medial popliteal) nerve (Ls; S 1 -S2).
MUSCLES OF THE FOOT
The muscles of the foot (musculi pedis) are separated into the plantar muscles proper, or the muscles of the median plantar emi-
muscles of the dorsal surface of the foot and those of the plantar nence.
surface of the foot.
The muscles of the dorsum of the foot are mainly extensors,
the muscles of the sole are mainly flexors. Muscles of the Eminence of the Great Toe
1. The abductor hallucis muscle (musculus abductor hallucis).

Muscles of the Dorsal Surface 2. The flexor hallucis brevis muscle (musculus jlexor hallucis bre
1. The extensor digitorum brevis muscle (musculus extensor dig vis).
3. The adductor hallucis muscle (musculus adductor hallucis).
itorum brevis).
'1. The extensor hallucis brevis muscle (musculus extensor hallucis
brevis).
Muscles of the Eminence of the Little Toe
Muscles of the Plantar Surface 1. The abductor digiti minimi muscle (musculus abductor digiti
minimi).
The muscles of the sole form the following three groups: 2. The flexor digiti minimi brevis muscle (musculus jlexor digiti
(a) the muscles of the eminence of the great toe, or the muscles of minimi brevis).
the medial plantar eminence; (b) the muscles of the eminence of 3. The opponens digiti minimi muscle (musculus opponens digiti
the little toe, or the muscles of the lateral plantar eminence; (c) the minimi).
Membrana interossea
cruris
...-it----r M. extensor hallucis

longus
Canal m. extensoris -.-+-,:!;.,:..i..-

digitorum longi (cut off)
M. extensor---.1---'r-'l�,.,.._
hallucis brevis
M. extensor·
digitorum brevis
377. Muscles of right leg and foot; anterior aspect

(¼).
424 ORIGIN AND ATTACHMENT OF MUSCLES OF THE LEG
Tractus iliotibialis <c:apsula art. genus
Capsula art. tibiofibularis
Lig. collaterale fibulare M. quadriceps femoris

M. biceps femoris
M. sartorius
M. extensor digitorum -->f!-.\-1,f�,
longus
M. peronaeus longus
(m. fibularis longus)
tt.ffirtlfr.--iftrlcf- M. extensor digitorum

longus
4--#li'-I-- M. extensor hallucis

longus
378. Sites of origin and attachment of muscles, ligaments, and articular capsules
on bones of right leg; anterior aspect (schematical representation).
(The interosseous membrane is left intact.)
MUSCLES OF THE LEG AND FOOT 425
Lig. collaterale fibulare --/:....='4-'."'-1.-

M. biceps femoris --,�,f,-4\\\111
M. gastrocnemius ____ ,
(caput laterale)
M. extensor digitorum longus
M. soleus
M. peronaeus brevis --l-+�+"-t""t

M. extensor hallucis longus
Retinaculum mm. extensorum superius

Retinaculum mm. Retinaculum mm. extensorum inferius
peronaeorum superius M. extensor digitorum brevis
Tendo calcaneus
(Achillis)
Retinaculum mm.
peronaeorum inferius
M. abductor
digiti minimi --it.=�---,�::,..-
379. Muscles of right leg and foot; lateral aspect

(¼).
Epicondylus
lateralis femoris
M. biceps femoris
(cut off)
Caput fibulae
M. gastrocnemius
M. gastrocnemius (caput laterale)
(caput mediale)
Tendo m. peronei longi
Malleolus medialis
Tendo m. flexoris
digitorum longi
380. Muscles of right leg; posterior aspect (¼).

Tendo m. adductoris
magni
M. vastus medialis
M. semimembranosus Tendo m. bicipitis femoris

(cut off) (cut off)
Canalis cruropopliteus (BNA)

Arcus tendineus m. solei
M. gastrocnemius
(caput laterale) (cut off)
M. gastrocnemius
(caput mediale) (cut off)
,,.,fl---Tendo m. peronaei longi


428 MUSCLES OF THE LEG
M. gastrocnemius
(caput laterale)
Bursa subtendinea m.
gastrocnemii medialis
Tendo m. bicipitis
femoris
Caput fibulae
Tendo calcaneus
(cut off)
Retinaculum
mm. peronaeorum {fibularium)
superius

(Deep layer.)
MUSCLES OF THE LEG AND FOOT 429
Tendo m. bicipitis
femoris (cut off)
Caput fibulae
Fibula
M. peronaeus brevis
Tendo m. flexoris digitorum

longi (cut off) ---+-11-
M. abductor digiti minimi Tendo m. peronaei longi
(cut off) (m. fibularis longi)
Aponeurosis plantaris (cut off) (cut off)
M. flexor digitorum
brevis (cut off)
M. flexor hallucis brevis
digitorum longi
383. Muscles of right leg and foot; posterior aspect (¼).

(Deep layer.)
430 MUSCLES AND FASCIA£ OF THE LEG
Muscles of the Median Eminence quadratus plantae [musculus jlexor accessorius]).

3. The lumbrical muscles (musculi lumbricales).
1. The flexor digitorum brevis muscle (musculus jlexor digitorum
4. The plantar interossei muscles (musculi interossei plantares).
brevis).
5. The dorsal interossei muscles (musculi interossei dorsales).
2. The quadratus plantae (flexor accessorius) muscle (musculus
MUSCLES OF THE DORSAL SURFACE
1. The extensor digitorum brevis muscle (musculus extensor dig Innervation: the deep peroneal (anterior tibial) nerve (LvL5;
itorum brevis) (Fig. 389) is flat and lies directly on the dorsal surface S i )-
of the foot. It arises from the upper and lateral surfaces of the an 2. The extensor hallucis brevis muscle (musculus extensor hallucis
terior part of the calcaneus and runs forwards to end in four nar brevis) (Fig. 389) lies medially of the extensor digitorum brevis
row tendons. The distal ends of these tendons fuse with the exten muscle. It arises from the upper surface of the anterior part of the
sor digitorum longus tendons and are inserted into the base of the calcaneus, runs forwards and medially, and ends in a tendon which
proximal phalanges of the lateral four toes and take part in the for is inserted into the base of the proximal phalanx of the great toe.
mation of the dorsal tendinous expansion. A tendon to the little The distal end of the tendon fuses with the extensor hallucis lon
toe is sometimes absent. gus tendon and contributes to the formation of the dorsal tendi
Action: extends the lateral four toes and at the same time pulls nous expansion.
them laterally. Action: extends the great toe.
Blood supply: the tarsal artery and the perforating branch of Blood supply: the tarsal artery and the perforating branch of
the peroneal artery. the peroneal artery.
Innervation: the deep peroneal (anterior tibial) nerve (L;-L5;
A. etvv.
cruris
M. extensor
digitorum longus
Septum intermusculare ___,_....,

anterius (cruris)
M. peronaeus longus
Fibula
A. etvv.
tibiales posteri.ores
M. gastrocnemius
(caput mediale)
M. tibialis posterior
M.
M. gastrocnemius
(caput laterale) V. saphena parv a
384. Muscles and fasciae of right leg (½).

(Transverse section through middle of leg.)
ORIGIN AND ATTACHMENT OF MUSCLES OF THE LEG 431

Capsula art. genus
M. semimembranosus
Lig. collaterale
Lig. collaterale tibiale fibula re
M. soleus
M. flexor digitorum .,_......__ M. flexor hallucis

longus longus
Membrana _ ___,,-+
interossea cruris
Capsula art, talocruralis
on bones of right leg; posterior aspect (schematical representation).
(The interosseous membrane is left intact.)
432 ORIGIN AND ATTACHMENT OF MUSCLES ON THE TIBIA
Tuberculum intercondylare
mediale
M. semimembranosus
Capsula art. genus
Lig. collaterale tibiale
Margo medialis
I
Margo anterior� M. soleus
M. flexor digitorum longus

Facies medialis
Malleolus medialis
Capsula art. talocruralis
Lig. mediale (deltoideum)
on the right tibia; medial surface (schematical representation).
MUSCLES OF THE FOOT 433
MUSCLES OF THE PLANTAR SURFACE
Muscles of the Eminence of the Great Toe this group directly under the plantar aponeurosis. It arises from
1. The abductor hallucis muscle (musculus abductor hallucis) the lateral and medial tubercles of the calcaneum and from the
(Fig. 387) lies superficially and occupies the extreme medial posi plantar aponeurosis. Extending forwards, it is continuous with a
tion in this group of muscles. It arises from the flexor retinaculum, short tendon which is inserted into the lateral side of the base of
the medial tubercle of the calcaneum, and the plantar surface of the proximal phalanx of the little toe.
the navicular bone. It is directed forwards and ends in a tendon Action: abducts and flexes the proximal phalanx of the little
which fuses with the flexor hallucis brevis tendon and is inserted toe.
into the medial sesamoid bone and base of the proximal phalanx Blood supply: the lateral plantar artery.
of the great toe. Innervation: the lateral plantar nerve (S 1 -S2 ).
2. The flexor digiti minimi brevis muscle (musculusjlexor digiti
Action: flexes and abducts the great toe and strengthens the
minimi brevis) (see Fig. 395) is medial to the abductor digiti minimi
medial part of the arch of the foot.
muscle of the foot and partly covered by it. It arises from the fifth
Blood supply: the medial plantar artery.
metatarsal bone, the long plantar ligament, and the plantar sheath
Innervation: the medial plantar nerve (Ls; S 1).
of the peroneus longus muscle, runs forwards, and ends in a ten
2. The flexor hallucis brevis muscle (musculus flexor hallucis bre
don which fuses with the tendon of the abductor digiti minimi
vis) (Fig. 395) lies directly on the first metatarsal bone and is
muscle to be inserted into the base of the proximal phalanx of the
slightly shorter than the abductor hallucis muscle which covers it
little toe.
partly. It arises from the medial cuneiform bone, the plantar sur
Action: flexes the proximal phalanx of the little toe.
face of the navicular bone, the tibialis posterior tendon, and the
Blood supply: the lateral plantar artery.
long plantar ligament. The tendon of the muscle together with the
Innervation: the lateral plantar nerve (S 1 -S2 ).
adductor hallucis tendon is inserted into the lateral and medial
3. The opponens digiti minimi muscle (musculus opponens digiti
sesamoid bones and the base of the proximal phalanx of the great
minimi) (Figs 395, 396) is very often absent. It arises together with
toe, separating thus into two distal tendons, each being related re
the flexor digiti minimi brevis muscle from the long plantar liga
spectively to the lateral and medial heads of the muscle.
ment and from the sheath of the peroneus longus muscle and is in
Action: flexes the great toe.
serted into the lateral border of the fifth metatarsal bone.
Blood supply: the medial plantar artery and the plantar arch.
Action: adducts and opposes the fifth metatarsal bone; to
Innervation: lateral head-the lateral plantar nerve (S 1 -S2 ),
gether with the flexor digiti minimi brevis muscle strengthens the
medial head-the medial plantar nerve (Ls-S2 ).
lateral part of the arch of the foot.
3. The adductor hallucis muscle (musculus adductor hallucis)
Blood supply: the lateral plantar artery.
(Fig. 365) lies deeply, directly on the metatarsal bones, and is
Innervation: the lateral plantar nerve (S 1 -S2).
covered by the flexor digitorum longus and flexor digitorum brevis
muscles. It arises by two heads, transverse and oblique.
The transverse head (caput transversum) arises from the plantar
Muscles of the Median Eminence
surface of the capsules of the third, fourth, and fifth metatarso
phalangeal joints, the distal ends of the lateral four metatarsal 1. The flexor digitorum brevis muscle (musculus flexor digitorum
bones, the plantar aponeurosis (septum laterale), and from the brevis) (Fig. 393) occupies the medial position on the foot under
transverse ligaments of the heads of the metatarsal bones. The ob the plantar aponeurosis. It arises by a short strong tendon from the
lique head (caput obliquum) is stronger and arises from the plantar medial tubercle of the calcaneum and the plantar aponeurosis.
surface of the cuboid and lateral cuneiform bones, the base of the Running forwards, the muscular belly ends in four tendons which
four lateral metatarsal bones, the long plantar ligament, and from are lodged in the synovial canals with the flexor digitorum longus
the plantar sheath of the peroneus longus muscle. Both heads a;e tendons. In the region of the proximal phalanges of the lateral four
continuous with a common tendon which is inserted into the la toes each of the four flexor digitorum brevis tendons separates into
teral sesamoid bone and the base of the proximal phalanx of the two slips to be inserted into the base of the middle phalanges of
great toe. these toes. The flexor digitorum longus tendon passes between the
Action: adducts and flexes the great toe. slips.
Blood supply: the plantar and dorsal metatarsal arteries; the Action: flexes the middle phalanges of the lateral four toes.
perforating branch of the arcuate artery. Blood supply: the posterior tibial and lateral and medial plan
Innervation: the lateral plantar nerve (S 1 -S2). tar arteries.
Innervation: the medial plantar nerve (Ls; S 1).
2. The flexor digitorum accessorius muscle (musculus quadratus
Muscles of the Eminence of the Little Toe
plantae s. musculusjlexor accessorius) (Fig. 394) is almost quadrangu
l. The abductor digiti minimi muscle of the foot (musculus ab lar and lies under the flexor digitorum brevis muscle. It arises from
ductor digiti minimi) (see Fig. 393) lies laterally of all the muscles of the inferior and medial surfaces of the posterior part of the calca-
434 MUSCLES AND FASCIAE OF THE FOOT
neum by two separate heads which fuse to form a common belly. the lumbrical muscles are lodged between these muscles and the
Running forwards, the muscle narrows slightly and is inserted into deep transverse ligament of the sole.
the lateral border of the flexor digitorum longus tendon at the Action: flex the proximal phalanges of the lateral four toes ex-
point of its division into separate tendons. tending at the same time their middle and distal phalanges.
Action: together with the flexor digitorum longus muscle flexes Blood supply: the lateral and medial plantar arteries.
the distal phalanges and lends the traction of this muscle a straight Innervation: the medial and lateral plantar nerves (L5 ; S,-S2).
direction. 4. The plantar interossei muscles (musculi interossei plan/ares)
Blood supply: the lateral plantar artery. (Fig. 396) are narrow, short, and three in number. They lie in the
Innervation: the lateral plantar nerve (S,-S2). spaces between the second and third, the third and fourth, and the
3. The lumbrical muscles (musculi lumbricales) (Fig. 394) are fourth and fifth toes. Each muscle arises from the medial surfaces
thin, short, and four in number. They lie between the flexor digito of the third, fourth, and fifth metatarsal bones and are inserted
rum longus tendons, are covered by the flexor digitorum brevis into the base of the proximal phalanx and are partly continuous
muscle, and come in contact with the interossei muscles in the with the dorsal tendinous expansion.
depth of the sole. Each lumbrical muscle arises from the respective Action: flex the proximal phalanges and extend the middle and
flexor digitorum longus tendon, the lateral three arising by two distal phalanges of the third, fourth, and fifth toes and also adduct
heads and the first muscle by a single head. They run forwards and these toes towards the second toe.
in the region of the metatarsophalangeal joints curve around the Blood supply: the plantar arch and the plantar metatarsal ar
medial surface of the lateral four toes, and pass over to their dorsal teries.
surface to be inserted into their dorsal tendinous expansion. In Innervation: the lateral plantar nerve (S 1 -S2).
some cases the lumbrical muscles are inserted into the joint cap 5. The dorsal interossei muscles (musculi interossei dorsales)
sules and even stretch to the distal phalanges. Synovial bursae of (Fig. 390) resemble the plantar muscles in shape. They are four in
Retinaculum mm. extensorum superius -----
M. abductor halluc,s
Tenda m. extensoris hallucis longi

\
Panniculus adiposus plantae
38 7. Muscles and fasciae of right foot; medial aspect (½).

FASCIA£ OF THE LOWER LIMB 435
number and fill all the interosseous spaces on the dorsal surface. third, and fourth toes laterally. The four muscles also flex the prox
Each muscle arises from the opposing surfaces of two adjacent imal phalanges and extend the middle and distal phalanges of
metatarsal bones. They pass forwards, and are inserted into the these toes.
base of the proximal phalanges of the second, third, and fourth Blood supply: the plantar arch and the plantar metatarsal ar
toes and into the dorsal tendinous expansion. teries.
Action: the first interossei muscle pulls the second toes medi Innervation: the lateral plantar nerve (S 1 -S2).
ally; the second, third, and fourth muscles displace the second,
THE SUBSARTORIAL CANAL

The adductor magnus muscle has openings which transmit lamina is a space triangular in cross-section. It is called the subsar
blood vessels. The lowest and largest opening is called the opening torial canal (canalis adductorius) and lodges the femoral artery and
in the adductor magnus (hiatus tendineus [adductorius]). A little vein and the saphenous nerve. The vessels pass from the canal into
higher is a thick intermuscular layer of fascia bridging the vastus the popliteal fossa, while the nerve pierces the fascia! lamina to ap
medialis and the adductor magnus muscles, which is called the pear on the medial surface of the thigh.
lamina vastoadductoria. Between these muscles and the fascia!
THE POPLITEAL FOSSA

The popliteal fossa (Iossa poplitea) (see Figs 364, 366, 367) is in both heads of the gastrocnemius muscle and the plantaris muscle
the region of the posterior surface of the knee and is rhomboid. It inferiorly; the floor of the fossa is formed by the popliteal surface
is bounded by the biceps femoris muscle superiorly and laterally, of the femur and the posterior surface of the knee joint capsule.
by the semimembranosus muscle superiorly and medially, and by
THE CRUROPOPLITEAL CANAL

The cruropopliteal canal (canalis cruropopliteus) (it is described from the popliteal fossa. Its opening is bounded anteriorly by the
in detail in manuals of topographical anatomy) passes between the popliteus muscle and posteriorly by the tendinous arch of the so
anterior surface of the soleus muscle and the deep muscles of the leus muscle. The canal lodges nerves and vessels entering it from
posterior group on the leg. The proximal end of the canal arises the popliteal fossa.
FASCIAE OF THE LOWER LIMB
FASCIA£ OF THE PELVIS AND THIGH

The external surface of the pelvis is covered by a fascia which iliaca fuses with it closely; medially it is separated from the ingui
is a continuation of the lumbar fascia (fascia thoracolumbalis) (see nal ligament and covers here the iliopsoas muscle, passes over to
Fig. 253). Below the outer lip of the iliac crest and the dorsal sacral the pectineus muscle and forms a lining for the iliopectineal fur
surface the fascia covers the group of gluteus muscles and is con row. Bands of the fascia iliac.a, which are called the iliopectineal
tinuous downwards with the fascia lata of the thigh. arch (arcus iliopectineus), arise from the inferior surface of the ingui
The fascia covering the gluteus maximus muscle thickens no nal ligament and reach the iliopubic eminence as a result of which
ticeably in the region of the femoro-gluteal fold (see Fig. 366). The lateral and medial spaces form under the ligament. The lateral,
layer of fascia lining the inner surface of the gluteus maximum larger, space is called the lacuna musculorum and lodges the ilio
muscle covers the gluteus medius, piriformis, obturatorius inter psoas muscle and the femoral nerve. The medial space is known as
nus, and quadratus femoris muscles. the lacuna vasorum and transmits the femoral artery laterally and
The fascia of the internal surface of the pelvis is called the fas the femoral vein medially with a lymphatic gland (in some cases)
cia iliaca (see Fig. 297). It arises on the inner lip of the iliac crest or fatty tissue lodged between them. From the direction of the ab
and the lateral surfaces of the bodies of the lumbar vertebrae and dominal cavity this place is covered by the fascia transversalis and
covers the iliacus and the psoas major and minor muscles. the peritoneum and corresponds to the deep femoral ring.
On reaching the lateral end of the inguinal ligament, the fascia The fascia lata (see Figs 354, 366) is a thick sheet investing the
Rctmaculum mm extensorum --+---:--

supenus
Tendo m. tibialis antcrioris
M.
M.
Retinaculum mm extensorum
mfe11us
extensor hallucis
brevis
Tenda m. extensoris
M. abductor digiti hallucis longi
minimi �
Tendincs m. extensoris
digitorum brevis
Tcndines m. extensoris
digitorum longi
Mm. interossei
dorsales
388. Muscles of right foot; dorsal surface (¾).

Canal of m. extensoris Retinaculum mm. extensorum

digitorum longi superius
-,....j�
-,
Canal of m. tibialis
anterioris
Retinaculum mm.
Canal of m. extensoris
hallucis longi ----------".All■■
Canal of m. extensoris
digitorum longi ---,'.;..;,i',--�
M. extensor digitorum Tenda m. tibialis

brevis anterioris (cut off)
,E-,-�11\<'c------,,\iWl,--M. extensor hallucis

brevis
Mm. interossei
dorsales
Tenda m. extensoris
hallucis longi
(cut off)
digitorum longi {cut off)

(The extensor digitorum longus and tibialis anterior tendons are removed.)
muscles of the thigh. It is fused with the inguinal ligament in front small oval depression of fascia. It is called the saphenous opening
and above and with the gluteus fascia in back, and is continuous (hiatus saphenus) (see Fig. 303). The lateral margin of the depres
downwards with the crural fascia. On the lateral surface of the sion is thick and called the falciform margin (margo falciformis).
thigh the fascia lata is thickest and forms a band called the iliotib The upper part of the margin is attached to the inguinal ligament
ial tract (tractus iliotibialis) which arises in the region of the anterior and is called the superior cornu (cornu superius), the lower part is
superior iliac spine and stretches to the region of the lateral con called the inferior cornu (cornu inferius). The depression, or the oval
dyle of the tibia. The proximal part of the tract receives the tensor fossa, itself is covered by a lamina which has many openings and is
fasciae latae muscle and some fibres of the gluteus maximus mus called the cribriform fascia (fascia cribrosa) (see Fig. 301).
cle. On the anterior surface of the proximal part of the thigh is a
M. peronaeus longus
( tendon cut off)
M. peronaeus brevis
( tendon cut off)
Lig. talocalcaneum laterale
Lig. talocalcaneum
interosseum
Facies articularis posterior

_...,..,,_.___ ossis navicularis
Tendo m. tibialis anterioris

Tendines m. extensoris digitorum
brevis (cut off)
Tendo m. extensoris hallucis

brevis ( cut off)

ORIGIN AND INSERTION OF MUSCLES OF THE FOOT 439
Tendo cafcaneus (Achillis)
M. extensor digitorum brevis
M. peronaeus brevis
M. peronaeus tertius
(m. fibularis tertius)
M. abductor digiti
m1mm1
brevis
brevis
M. extensor hallucis
longus
M.
391. Sites of origin and insertion of muscles on bones of right foot; dorsal
surface (schematical representation).
440 THE PLANTAR APONEUROSIS
Panniculus adiposus
plantae
'':'i'!�M- Eminentia plantaris

Sulcus plantaris ----=---........-ll'l lateralis
medialis
Eminentia plantaris -----.--

intermedia
Aponeurosis
plantaris
Fasciculi transversi --..,-+--r----'-=--'-'-_,__

aponeurosis plantaris
392. Plantar aponeurosis (aponeu

rosis plantaris) (½).
Aponeurosis plantaris -+----H.- M. abductor digiti

(cut off) minimi
M. flexor digitorum --'--'-�

brevis
Mm. interossei
plantares
M. flexor digiti
minimi brevis
M. flexor hallucis Tendines m. flexoris
brevis digitorum longi
Lig. metatarseum
transversum
profundum
..&-.='---
Vagina fibrosa digitorum brevis
digitorum pedis
393. Muscles of right foot; plantar surface (½).

The fascia lata gives off septa penetrating deeply between the culare femoris mediale) is attached to the medial lip of the linea as
muscles; a lateral, medial, and posterior septa are distinguished. pera of the femur. It is the boundary between the medial and ante
The lateral intermuscular septum of the thigh (septum intermus rior groups of the thigh muscles.
culare femoris laterale) is attached to the lateral lip of the linea as The posterior intermuscular septum is defined less clearly. It is
pera of the femur. It separates the anterior group of thigh muscles attached, like the medial septum, to the medial lip of the linea as
from the posterior group. pera. It separates the medial group of muscles from the posterior
The medial intermuscular septum of the thigh (septum intermus- group.
posterioris
M. abductor digiti
minimi
M. quadratus plantae
M. abductor hallucis (m. flexor accessorius)
(partly removed)
M. flexor hallucis brevis
�1-'-lM--ttill:;a., Tendines m. flexoris

digitorum longi
Tendo m. flexoris
hallucis longi

In the upper third of the anterior surface of the femur, in the fused with the pectineal line in the region of the iliopubic emi
region of the femoral triangle (trigonumfemorale) which is bounded nence. On the lateral side of the femoral triangle the deep layer is
by the inguinal ligament and the sartorius and the adductor longus continuous with the fascia iliaca covering the iliopsoas muscle,
muscles, the fascia lata separates into two layers, superficial and while on the medial side both layers of the fascia lata fuse. The
deep, the space between which is filled with a large amount of floor of the triangle is formed by the iliopsoas and the pectineus
loose fatty tissue with vessels passing and lymphatic glands lodged muscles.
in it. In the upper part of the femoral triangle the deep layer is
Retinaculum mm. flexorum Tuber calcanei
Tendo m. flexoris digitorum -Y-'rl--i,r

longi (cut off)
M. quadratus plantae
Tendo m. tibialis posterioris (m. flexor accessorius)
(cut off)
Lig. plantare longum

M. peronaeus longus
Vagina tendinis m. peronaei
(fibularis) longi plantaris
M. opponeus digiti minimi

M. adductor hallucis
(caput obliquum) Mm. interossei plantares
M. flexor digiti minimi brevis
M. adductor hallucis -=:::::--nl�-..g--',�f/7. digitorum longi (cut off)
(caput transversum)
Tendo m. flexoris ---IHI.I

hallucis longi
digitorum brevis (cut off)

THE FEMORAL CANAL

The femoral canal (canalis femoralis) (see Figs 301-307) does vein laterally, by the inguinal ligament superiorly and anteriorly,
not exist under normal conditions. It forms only with the occur and by the pectineal ligament inferiorly and posteriorly.
rence of a femoral hernia, i.e. in protrusion of the abdominal or The deep femoral ring itself is filled by loose fatty tissue or a
gans (an intestinal loop, omentum, etc.) under the inguinal liga large lymph gland.
ment in the lacuna vasorum. Thus, there is only the deep femoral When a femoral hernia forms, the femoral septum bulges out,
ring (anulus femoralis profundus) normally. It is closed by an area of pushes the lymph gland aside, thus forming a space which the pro
the transversalis fascia in the form of the femoral septum (septum truding viscera enter and then descend between the superficial and
femorale) whose surface facing the abdominal cavity is lined with deep layers of the fascia lata. This space produced between the fas
the parietal peritoneum. The deep femoral ring is bounded by the cia! layers is actually the cavity of the femoral canal whose anterior
pectineal part of the inguinal ligament medially, by the femoral wall is the inguinal ligament and the superior cornu of the falci-
'I
Vagina synovialis tendinis m. flexoris

hallucis longi (cut open)
I
Tenda m. tibialis _
anterioris
Mm. interossei
dorsales
��===:::., M. opponens digiti minimi
M. abductor hallucis
(cut off)

ORIGIN AND ATTACHMENT OF MUSCLES OF THE FOOT 445
M. flexor digitorum brevis
M. tibialis posterior
hilii---1\----: Lig. calcaneocuboideum

plantare
plantare
M. peronaeus longus (caput obliquum)
M. tibialis anterior
M. abductor hallucis
(caput transversum)
M. flexor hallucis -./l,o.�

longus
397. Sites of origin and attachment of muscles and ligaments on bones of right
foot; plantar surface (schematical representation).
446 TENDONS OF MUSCLES OF THE FOOT
Retinaculum mm. extensorum

superius
Vagina tendinis
Vagina synovialis m. tibialis anterioris
mm. peronaeorum (fibularium)
communis
Retinaculum mm. extensorum '--r-7::::------::::::::;��]i

inferius
398. Synovial sheaths of tendons (vaginae synoviales

� tendinum) on right foot; dor-
sal surface (½).
(A coloured mass is administered into the sheath.)
TENDONS OF MUSCLES OF THE FOOT 447
form margin of the fascia lata, the posterior wall is the deep layer saphenus, the hernial sac distends the cribriform fascia and pro
of the fascia lata, and the lateral wall is the femoral vein. trudes under the skin through the hiatus which is as if the external
On reaching the weakest place in the fascia lata, the hiatus opening of the femoral canal.
FASCIAE OF THE LEG

The fascia of the leg, which is called the crural fascia (fascia cru In the lower third of the anterior surface of the leg the crural
ris) (see Figs 375, 384), is a direct continuation of the fascia lata fascia is poorly developed, as the result of which transverse bands
but is much less conspicuous. It gives off two intermuscular septa, are clearly distinguishable. They form the superior extensor retin
anterior and posterior, which penetrate deeply into the leg to form aculum (retinaculum musculorum extensorum superius) which is
the fascia! beds for the anterior, posterior, and lateral groups of stretched between the anterior border of the tibia and the lateral
muscles. It should be pointed out that the posterior fascia! bed is surface of the fibula.
subdivided by a frontal septum into a superficial and a deep seat. In the lower third in the region of the malleolus the crural fas
The anterior interrnuscular septum (septum intermusculare anterius) cia forms a thickening called the inferior extensor retinaculum
separates the anterior group of muscles from the lateral group. (retinaculum musculorum extensorum inferius) in which one lateral and
The posterior interrnuscular septum (septum intermusculare posterius) two medial (superior and inferior) bands are distinguished.
passes between the lateral and the posterior groups of muscles. On the lateral surface of the leg the fascia thickens slightly to
M. peronaeus longus
(m. fibularis Jongus) M. peronaeus brevis (m. fibularis brevis)
I Tendo calcaneus (Achillis)
Vagina synovialis mm. peronaeorum (fibularium) communis
Retinaculum mm. peronaeorum (fibularium) superius
Retinaculum mm. extensorum inferius

Vagina tendinum m. extensoris digitorum pedis longi
Retinaculum mm. peronaeorum (fibularium) inferius
Vagina tendinis m. extensoris hallucis longi

/ M. peronaeus tertius (m. fibularis tertius)
Tendines m. extensoris digitorum longi
�\'
\\·.�J-,J
-J_,
Integumentum commune
minimi Tendines m. extensoris digitorum brevis
399. Synovial sheaths of tendons (vaginae synoviales tendinum) on right foot; dor
solateral surface (½).
Vagina tendinum m. flexoris digitorum pedis longi
Vagina synovialis tendinis m. tibialis anterioris
M. abductor hallucis (cut off) mm. flexorum
400. Synovial sheaths of tendons (vaginae synoviales tendinum) on right foot; me
dial aspect (½).
form the superior and inferior peroneal retinacula (retinacula mus In the region of the medial malleolus the crural fascia thickens
culorum peroneorum [fibularium] superius et inferius). Together with to form the flexor retinaculum (retinaculum musculorum flexorum)
the bones of the leg and foot these ligaments hold the peroneus which stretches between the medial malleolus and the calcaneus. It
longus and brevis muscles in place. The superior retinaculum is assists in the formation of four separate fibrous canals.
stretched between the lateral malleolus and the calcaneus. Some of Three of these canals transmit tendons: the medial canal trans
the bands of the retinaculum are interlaced into the deep layer of mits the tibialis posterior tendon, the lateral canal the flexor hallu
the crural fascia. The inferior retinaculum is located on the lateral cis longus tendon, and the canal located between these two trans
surface of the calcaneus and forms osteofibrous canals lodging the mits the flexor digitorum longus tendon. The fourth canal lodges
tendons of the peroneus muscles. the posterior tibial artery and vein and the tibial nerve.
FASCIAE OF THE FOOT

The fasciae of the foot (fasciae pedis) (see Figs 375, 392) are a The superficial fascia is thicker on the plantar than on the dor
direct continuation of the crural fascia. The fascia on the dorsal sal surface. The middle part of the plantar fascia is very thick and
surface of the foot is thin and attached to some points of the is made up of longitudinal fibrous bands; it is called the plantar
bones. Where there are muscles, the fascia separates into two lay aponeurosis (aponeurosis plantaris). In the distal part the fibrous
ers to form sheaths for the superficial muscles of the dorsal surface bands forming the aponeurosis are directed transversely and are
of the foot. The deep layer of the fascia separates the interossei called the superficial transverse ligaments (fasciculi transversi). Most
muscles from the extensors of the toes. of the fibres of the plantar aponeurosis arise from the posterior
TENDONS OF MUSCLES OF THE FOOT 449
Tuber calcanei
Retinaculum
peronaeorum (fibularium)
inferius
Vagina synovialis tendinis

m. tibialis posterioris
Vagina tendinis
m. peronaei (fibularis)
longi plantaris
Vaginae tendinum
digitorum pedis
Vagina fibrosa
digitorum pedis Bursae
synoviales
Pars cruciformis
vaginae fibrosae
401. Synovial sheaths of tendons (vaginae synoviales tendinum) on right foot;

plantar surface (½).
surface of the calcaneum, run forwards, and separate into five slips metatarsals to form together with the dorsal fascia of the foot
according to the number of toes. On the way, the inner surface of (fused with the dorsal surface of the metatarsals) four intermeta
the aponeurosis fuses with the flexor digitorum brevis muscle pass tarsal spaces containing the interossei muscles.
ing here. On the posterior surface of the calcaneum some bands of The plantar aponeurosis and the deep fascia of the sole are
the aponeurosis are a continuation of the triceps surae tendon. joined by means of two longitudinal septa to form three fascia!
The outer surface of the plantar aponeurosis is fused with the skin sheaths: medial, lateral, and intermediate. Each sheath contains
by means of separate connective-tissue bands. The spaces between the respective group of muscles of the plantar surface of the foot.
the bands are filled with fatty tissue. The medial and lateral plantar grooves (sulcus plantaris medialis
The deep plantar fascia fuses with the plantar surfaces of the et lateralis) lie on both sides of the middle sheath (Fig. 392).
SYNOVIAL SHEATHS OF MUSCLE TENDONS

ON THE FOOT
Synovial sheaths (Figs 398-401) containing the long tendons sheath of the tibialis posterior tendon (vagina synouialis tendinis mus
of the leg muscles are located in the distal part of the leg and on culi tibialis posterioris) lies directly behind the medial malleolus,
the foot. Three anterior sheaths lying under the inferior extensor slightly to the back is the synovial sheath of the flexor digitorum
retinaculum are distinguished. The tendon of the tibialis anterior longus tendon (vagina tendinis musculi Jlexorum digitorum pedis longi),
muscle lies in the medial sheath, the tendons of the extensor dig and still further to the back is the synovial sheath of the flexor hal
itorum longus and peroneus tertius muscles are in the lateral lucis longus tendon (vagina synovialis tendinis musculi Jlexoris hallucis
sheath, and the tendon of the extensor hallucis longus muscle oc longi).
cupies the intermediate sheath. On the plantar surface of the foot the digital synovial sheaths
The common synovial sheath of the peroneal tendons (vagina of the tendons of the foot (vaginae tendinum digitales pedis) are fused
synovialis musculorum peroneum [fibulariumj communis) is located on with the walls of the osteofibrous canals stretching on the plantar
the lateral surface of the ankle joint under the superior peroneal surface of the phalanges of the toes. The flexor digitorum tendons
retinaculum. are lodged in these canals. The synovial sheath of the extensor hal
Three separate synovial sheaths are situated on the medial sur lucis longus tendon (vagina tendinis musculi extensoris hallucis longus)
face of the ankle joint under the flexor retinaculum. The synovial is the longest.
AGE FEATURES OF MUSCLES
The number of muscles in the newborn is the same as that in adult and for 20 to 22 per cent of the total body mass of a new
an adult; there are more than 650 of them. But macroscopic and born. This index considerably reduces at the age of 6-8 months
microscopic differences exist which are relative to the mass and (the beginning of the period of eruption of the teeth) and amounts
size of the muscles, their connection to the bones and skin, and the to 16.6 per cent of the total mass, but again increases to 22 per
character of the intermuscular connective tissue. The muscles ac cent by the age of 6 years.
count for up to 40-45 per cent of the total body mass of a human The internal perimysium in the newborn is a fine-fibrillar con-
401 a. Temporal and masseter muscles (musculus tem

poralis et musculus masseter) on right side (in the new
born).
452 THE DIAPHRAGM OF THE NEWBORN
401h. Diaphragm (diaphragma); superior

aspect (in the newborn).
nective tissue. The external perimysium, which lies in contact with pographo-anatomical features. In the newborn it is attached to the
the subcutaneous fat, is loose and thus affords the skin a good edge of the squama of the temporal bone, whereas in an adult it
range of mobility. occupies the temporal fossa completely and its upper fibres reach
The organization of the tendinous part of a skeletal muscle is a the inferior temporal line of the parietal bone (see Fig. 401a).
very important feature with regard to age. Beginning from the ne Certain changes occur in the position of the diaphragm: under
onatal period, the tendinous component forming the tendon of the the effect of respiratory movements its height changes in the first
muscle grows intensely with age; the existence of this component place beginning from birth and this process continues with age be
determines the definite relation of the muscle to the site of its in cause it is not only associated with inspiration and expiration but
sertion into the bone. This is one of the main factors affecting the depends on the position of the liver, the extent to which the sto
function of the muscle. mach is filled, and the individual features of the structure of the
Microscopically, the muscle fibres are slightly thinner in the trunk.
newborn than in an adult, the nuclei are more spherical, and the The connective-tissue bands in the region of the central ten
transverse striations are less defined. don, nearer to the sternal part of the diaphragm, have a semicircu
The muscles of some regions of the body have some specific lar position with the curvature directed towards the vertebral co
features. For instance, the superficial fibres of the masseter muscle lumn (Fig. 4016). After birth the curvature is lost and the bands
spread fan-wise in the adult but are almost parallel in the new gradually take a sagittal direction.
born. The masseter muscle forms actively beginning from the pe In general, the skeletal muscles of an infant possess all the
riod of eruption of the deciduous teeth. The tendon of this muscle properties of these muscles of an adult, but the transverse stria
is also marked by a certain difference: it is very short in the new tions are less defined, the fibres are rather thin, the nuclei are
born, but is almost half the length of the muscle in an adult slightly spherical, the tendinous part is less pronounced, the area
(Fig. 401a). of muscle insertion is smaller, and there is a difference in the di
The attachment of the temporal muscle is distinguished by to- rection of the muscular bands.
SUBJECT
INDEX
Index terminorum
A armpit, 390
articular circumference, of radius, 125
bone(s)
sesamoid, 134, 136, 153, 171, 216
of ulna, 123 short, 11
Abduction, 181, 212 articulation(s), see joint(s) of skull, 50, 110
acetabulum, 139, 144, 172 atlas, 23, 46, 183 sphenoid, 51, 65, 110
acromion, 115 axis, 24, 46, 183 wings, greater, 67
adduction, 181, 212 lesser, 67
air cells, ethmoidal, 76, 102 spongy substance, 11
mastoid, 71, 110
ala(e), of crista galli, 63, 76 B temporal, 51, 68, 110
petrous part, 68
of ilium, 139 canals, 75
of vomer, 67, 68, 80 Band, longitudinal, 194 pyramid, 68
angle(s), infrasternal, 41, 319 bone(s), 11 squamous part, 68
of parietal bone, frontal, 59 calcification, 46 tympanic part, 68, 76
mastoid, 59 carpal, 130, 137 triquetral, 130, 137
occipital, 59 of chest, 11 of trunk, 21
sphenoidal, 59 compact substance, 11 of upper limb, 113, 137
of rib, 37 development, 46, 110, 111 zygomatic, 51, 87, 112
subpubic, 146 ethmoid, 51, 110 bulla, ethmoidal, 78
ankle, 240 flat, 11 bursa(e), anserine, 412
antrum, tympanic, 71 frontal, 62, 110 of biceps femoris muscle, lower, 413
anulus fibrosus, 183 heel, see calcaneum upper, 413
aperture, of frontal sinus, 64 hyoid, 51, 91, 112 of coracobrachialis muscle, 349
of nose, bony, anterior, 84, 102 incisive, 84, 106 infrapatellar, deep, 412
posterior, 82, 102 lacrimal, 51, 112 superficial, 412
of pelvis, inferior, 146 long, 11 of infraspinatus muscle, 344
superior, 146 of lower limb, 139, 171 of latissimus dorsi muscle, 344
piriform, 102 lunate, 134, 136, 137 of obturator internus muscle, 394
of sphenoidal sinus, 67 marrow, 11 of piriformis muscle, 394
aponeuroses, 257 nasal, 51, 80 prepatellar, subcutaneous, 412
bicipital, 349, 385 occipital, 56, 110 of psoas major tendon, 394
epicranial, 286 basilar part, 56 of semimembranosus tendon, 413
palmar, 356, 389 condylar part, 57 subcutaneous, 262
plantar, 448 squamous part, 58 subdeltoid, 344
arch(es), alveolar, 84, 88 palatine, 51 subfascial, 262
costal, 41, 319 parietal, 51, 59, 110 submuscular, 262
iliopectineal, 435 angles, 59 subscapular, 206, 345
pubic, 146 border, frontal, 59 subtendinous, 262
superciliary, 62 occipital, 59 suprapatellar, 234, 412
tendinous, 262 sagittal, 59 synovial, 234, 261
vertebral, 21 squamous, 59 of teres major muscle, 345
pedicle, 21 pisiform, 134, 136, 137 of tibialis anterior tendon, 419
zygomatic, 87 pneumatic, 11, 76, 82 trochanteric, of gluteus maximus muscle,
area, intercondylar, anterior, 157 primary, 46 400
posterior, 157 scaphoid, 134, 136, 137 of gluteus medius muscle, 400
intermediate, 144 secondary, 46 of gluteus minimus muscle, 400
456 INDEX
C concha
middle, 78, 110
eminence
ulnar, 136
superior, 78, 110 cruciate, 59
Calcaneum, 162, 172 sphenoidal, 67 frontal, 62
calvaria, 92, 96 condyle(s), occipital, 98, 191 hypothenar, 341
canal, carotid, 72, 75, 98, 100 of femur, lateral, I 53 iliopubic, 144
condylar, anterior, 101 medial, 153 intercondylar, 157
posterior, 101 of tibia, lateral, 157 parietal, 59, 97
cruropopliteal, 412 medial, 157 thenar, 341
diploic, 11 connections, intertendinous, 363 eminentia, articularis, 68, 98, 202
for facial nerve, 75 cord, oblique, 214 cruciata, 59, 101
femoral, 444 spinal, 21 emissary, 59
hypoglossal, 58 cornu(a), coccygeal, 36 endomysium, 257
incisive, 84, 106 of falciform margin, inferior, 438 endosteum, 11
infraorbital, 84, 106 superior, 438 epicondyle, of femur, lateral, 153
inguinal, 329 sacral, 33 medial, 153
mandibular, 91 crest, conchal, 84, 86 of humerus, lateral, 119
medullary, 11 ethmoidal, 84, 86 medial, 119
musculo-fibular, superior, 416 frontal, 63 epiphyses, 11
musculotubal, 75 of greater tuberosity, 119 eversions synovial, 234
nasolacrimal, 80, 84, 106 of head of rib, 37 expansion tendinous, dorsal, 430
nutrient, 11 iliac, 144 extension, 181, 212
obturator, 226, 394 infratemporal, 67, 108
optic, 106 lacrimal, 82, 84
palatine, greater, 84, 86, 109
palatovaginal, 68
of lacrimal bone, 80
of lesser tuberosity, 119 F
of pharyngotympanic tube, 75 medial, 159
pterygoid, 68, 109 nasal, 82, 84, 86, I 06 Facet, articular, 23
sacral, 32, 33 of neck of rib, 37 calcanean, 162
subsartorial, 435 obturator, 144 costal, 24, 27, 195
for tensor tympani, 75 occipital, external, 59, 98 malleolar, 240
vertebral, 21 internal, 59, 10 I navicular, 195
vomerovaginal, 68 of sphenoid, 67, 76 of tubercle of rib, 195
canaliculus, caroticotympanic, 7 5 oftrapezium bone, 134 falx, cerebri, 59, 63
for chorda tympani, anterior, 75 trochanteric, 153 fascia(e), 26 I
mastoid, 72, 75 crista galli, 76, 100 of abdomen, 329
for tympanic nerve, 72, 75 crus, of diaphragm, 3 I 7 antebrachial, 385
capitulum of humerus, 119 of inguinal ligament, inferior, 329 axillary, 317, 382
capsule, articular, 181 superior, 329 of back, superficial, 279
of elbow joint, 211 brachia!, 382
of hip joint, 227 buccopharyngeal, 295
of knee joint, 234
of mandibular joint, 202 D cervical, 307
of chest, 3 I 7
of shoulder joint, 205 clavipectoral, 317
carpus, 136 Dens, 24 cribriform, 438
cartilage(s), articular, 11, 181 desmocranium, 98 crural, 447
costal, 11, 39 diaphragm, 3 I 7 deltoid, 381
epiphyseal, 11 changes with age, 452 endothoracic, 307, 317
fibrous, 181 costal part, 317 of foot, 448
hyaline, 181 sternal part, 317 of hand, 389, 390
semilunar, 231 vertebral part, 317 of head, 295
cavity, axillary, 390 diaphragma sellae, 67 iliaca, 329, 435
glenoid, 113, 204 diaphysis, 11 infraspinous, 381
joint, 181 diploe, 11 interosseous palmar, 389
of nose, 102 duct, parotid, 289 lata, 435
synovial, 262 disc(s), articular, 181, 202 lumbar, 257, 435
thoracic, 41 interpubic, 225 masseteric, 295, 307
tympanic, 71, 75 intervertebral, 21, 49, 177, 183 of neck, 307
choanae, I 02 dorsum sellae, 65, 100, IO I nuchae, 279
chorda tympani, 75 parotid, 295, 307
circumduction, 181 pectoral, 305
clavicle, 11, 118, 137
clivus, 56 E pharyngobasilaris, 57
pretracheal, 307
coccyx, 21 prevertebral, 307
column, vertebral, 11, 21, 49 Ear, middle, 75 spermatic internal, 329
curvatures, 21, 49 elbow, 341 supraspinous, 381
concha, nasal, highest, 78, 110 eminence, arcuate, 71, 101 temporal, 295
inferior, 51, 78, 110 carpal, radial, 136 thoracolumbalis, 435
INDEX 457
fascia(e) foramen groove(s), bicipital, lateral, 349

transversalis, 329 sphenopalatine, I09 medial, 349
umbilical, 329 spinosum, 67, 98, IOI of calcaneum, 162
fasciculi, 257 stylomastoid, 75, 98 carotid, 65, I00
femur, 11, 153 supraorbital, 62 costal, 39
body, 153 suprapiriformis, 394 ethmoidal, 80
head, 153 transversarium, 23 for llexor hallucis longus tendon, 162
neck, 153 vertebral, 23 for inferior petrosal sinus, 57, 75
fibres, intercrural, 319, 329 zygomaticofacial, 87 infraorbital, 84, 106
fibula, 159 zygomatico-orbital, 87, 106 intertubercular, 119
body, 159 zygomaticotemporal, 87, 108 lacrimal, 80, 106
head, 159 foramina, ethmoidal, anterior, 76 of maxillary frontal process, 80
fingers, 341 posterior, 76 for lesser superficial petrosal nerve, 71
fissure(s), orbital, inferior, 67, 84, 106, 109 intervertebral, 33 for middle temporal artery, 68
superior, 67, IOI, 106 nutrient, 11, 21 mylohyoid, 88
petro-occipital, 57, 98 palatine, greater, 86 nasolacrimal, 84
petrosquamous, 71, 75, 76 lesser, 86, I06 obturator, 144
pterygomaxillary, 109 sacral, anterior, 33 occipital, 70
sphenopetrosal, 67, 98 dorsal, 33 optic, 65
squamotympanic, 76 fossa(e), acetabular, 139 palatine, 84, I06
tympanomastoid, 72 articular of temporal bone, 98, 202 greater, 84, 86
llexion, 181, 212 extracarsular, 202 for pharyngotympanic tube, 68
fluid synovial, 181, 261 intracapsular, 202 plantar, lateral, 450
fold(s), axillary, anterior, 308 axillary, 316, 390 medial, 450
posterior, 308 canine, 84 of promontory, 75
synovial, 18I, 234 condylar, 57 sigmoid, 58, 59, 70, 101
alar, 234 coronoid, 119 spiral, 119
infrapatellar, 234 cranial, anterior, 67, 100 for spiral nerve, 23
umbilical, lateral, 329 middle, 67, 100 for subclavian artery, 39
medial, 329 posterior, 10I for superior petrosal sinus, 7 5
median, 329 cubital, 341, 390 for superior sagittal sinus, 59, 97
fontanelle(s), 98, 177, 199 digastric, 88 for tibialis posterior muscle, 157
anterior, 98 of head of femur, 153 for transverse sinus, 59, 70, IOI
anterolateral, 98 hypophyseal, 65, 100 tympanic, 76
mastoid, 98 iliac, 144 for ulnar nerve, 119
posterior, 98 infraspinous, 115
H
posterolateral, 98 infratemporal, 67, 109
sphenoidal, 98 inguinal, lateral, 329
forearm, 341 middle, 329
forehead, 97 jugular, 72, 98, 296 Hamulus, lacrimal, 80
foot, 391 for lacrimal gland, 63, 106 pterygoid, 68
"goose's", deep, 413 of lacrimal sac, 80 hand, 341
superficial, 412, 413 olecranon, 119 hiatus, for greater superficial petrosal nerve,
foramen, caecum, 63, 76, I00 petrosal, 72, 75 71, 75
dental, 84 popliteal, 391, 435 for lesser superficial petrosal nerve, 72,
ethmoidal, anterior, 64, 106 pterygoid, 68, 86 75
posterior, 74, 108 pterygopalatine, 67, I09 of maxillary sinus, 78, 84
frontal, 62 radial, 119 sacral, 33
incisive, 84, I06 scaphoid, 98 semilunaris, 78
infraorbital, 84 subarcuate, 72 _ hook of hamate bone, I35
infrapiriformis, 394 sublingual, 88 horn(s) of hyoid bone, greater, 91
intervertebral, 21 submandibular, 88, 300 lesser, 91
jugular, 58, 98 subscapular, 115 humerus, 11, 119, 137
lacerum, 101, 67 supraclavicular, greater, 296 body, 119
magnum, 56, 98, IOI lesser, 296 neck, anatomical, 119
mandibular, 91 supraspinous, 115 su-rgical 119
mastoid, 70 supravesical, 329
mental, 88, 91 temporal, 67, 68, 108, 291
nutrient, 11
obturator, 144
trochanteric, 153
trochlear, 63, 106 I
optic, 67, 100
ovale, 67, 98, 10I Ilium, 139, 172
palatine, greater, 86, I06, I09
lesser, 86, I06, 109 G impression(s), for cerebral gyri, 59, 62, 67
for costoclavicular ligament, 118
parietal, 59 trigeminal, IOI
rotundum, 67, 101, 109 Ginglimus, 182, 202, 214 infundibulum of ethmoid, 78
sciatic, greater, 224 glabella, 62 intersection(s) tendinous, 257, 319, 413
lesser, 224 gomphoses, 177 ischium, 139, 144, 172
458 INDEX
J joint(s)
tarsometatarsal, 246, 250
tibiofibular, inferior, 239
ligament, cruciate
of knee, 234
anterior, 234
Joint(s), 177 superior, 239 posterior, 235
acromioclavicular, 204 transverse tarsal, 246 cubonavicular, dorsal, 246
age features, 251 triaxial, 260 plantar, 246
atlantoaxial, lateral, 191 trochoid, 182, 215 cuneocuboid, interosseous, 246
median, 182, 194 uniaxial, 182, 260 plantar, 246
atlanto-occipital, 182 of vertebrae, 183 cuneonavicular, dorsal, 246
ball-and-socket, 181, 203, 228, 250 wrist, 216 plantar, 246
biaxial, 181, 216, 220, 260 zygapophyseal, 183 extracapsular, 181
bicondylar, 182 juga, alveolar, 84 fundiform of penis, 329
calcaneocuboid, 245, 246 cerebral, see also ridge(s), cerebral, 67 of head of femur, 228
carpometacarpal, 220 iliofemoral, 227
of thumb, 220 iliolumbar, 224
cartilaginous, 50, 177
cochlear, 214 K inguinal, 319
reflected parts, 320, 329
compound, 181, 211 intercarpal, dorsal, 216
condyloid, 181 Key, to tarsometatarsal joints, 250 palmar, 216
costotransverse, 195 to transverse tarsal joint, 246 interclavicular, 203
costovertebral, 195 knee cap, 153 intercuneiform, dorsal, 246
cuneonavicular, 246 kyphosis, 21, 49 plantar, 246
cylindrical, 182 interfoveolar, 329
development, 251 intermetacarpal, 220
elbow, 211
ellipsoid, 181, 191, 216 L interosseous, intercarpal, 220
intercuneiform, 246
fibrous, 177 metacarpal, 220
of head of rib, 195 Labra, articular, 181 metatarsal, 250
hinge, 182, 202, 214, 220, 237 labrum, acetabulare, 227 sacroiliac, 223
hip, 227 glenoidale, 205 interspinous, 188
humeroradial, 211 labyrinth ethmoidal, 76, 102 intertransverse, 190
humeroulnar, 182, 211 lacuna vasorum, 435 intracapsular, 181, 202
intercarpal, 216 lamina vastoadductoria, 435 ischiofemoral, 228
interchondral, 198 ligament(s), 181 of joint of head of rib, intra-articular, 195
intermetacarpal, 220 acromiodavicular, 204 radiant, 195
interphalangeal, 182 alar of odontoid process, 195 lacunar, 320
of hand, 221 annular of radius, 212 pectineal part, 320
of toes, 250 apical of odontoid process, 195 lateral, of knee, 234
knee, 231 arcuate, of diaphragm, lateral, 317 of mandible, 202
mandibular, 202 medial, 317 of wrist, 216
manubriosternal, 41 median, 317 longitudinal, anterior, 185
metacarpophalangeal, 220 of knee, 235 posterior, 185, 194
metatarsophalangeal, 250 bifurcated, 246 medial (deltoid), 245
midcarpal, 216 calcaneocuboid, lateral, 246 calcaneotibial part, 245
ovoid, 182 medial, 246 talotibial part, 245
peg-and-socket, 177 calcaneofibular, 245 tibionavicular part, 245
petro-occipital, 57, 98 calcaneonavicular, plantar, 245 of wrist, 216
pivot, 181 capsular, 181 meniscofemoral, anterior, 237
pisiform, 216 carpal radiate, 220 posterior, 237
plane, 181, 204, 220 carpometacarpal, dorsal, 220 meniscomandibular, 202
radiocarpal, 216 palmar, 220 meniscotemporal, 202
radioulnar, distal, 215 collateral, fibular, 234 metacarpal, dorsal, 220
proximal, 211 of fingers, 220, 390 palmar, 220
sacrococcygeal, 33, 36, 189, 224 of interphalangeal joints, 250 palmar, 220
sacroiliac, 223 of metatarsophalangeal joints, 250 pisohamate, 216, 356
saddle, 181, 220 radial (lateral), 212 pisometacarpal, 216, 356
shoulder, 181, 204 ulnar (medial), 212 plantar, long, 246
simple, 177, 203 tibial, 234 short, 246
spheno-occipital, 56, 65, 98 coracoacromial, 204 pterygospinous, I 77
sphenopetrous, 67, 98 coracoclavicular, 204 pubic, inferior, 225
spheroid, 181, 207, 220 conoid part, 204 superior, 225
sternoclavicular, 181, 203 trapezoid part, 204 pubofemoral, 228
sternocostal, 198 coracohumeral, 206 radiocarpal, anterior, 216
subtalar, 245 costoclavicular, 203 posterior, 216
synovial, 181 costotransvfrse, inferior, 195 sacrococcygeal, anterior, 190
talocalcaneal, 245 lateral, 195 lateral, 189
talocalcaneonavicular, 245, 246 superior, 195 posterior, deep, 190
talocrural, 240 cruciate, of atlas, 194 superficial, 190
INDEX 459
ligament(s) linea muscle, adductor

sacroiliac, anterior (ventral), 223 aspera of femur, 153 magnus, 412
posterior (dorsal), 223 asperae, 11 minimus, 412
sacrospinous, 223 semilunaris, 320 pollicis, 377
sacrotuberous, 223 umbilicus, 319 age features, 45 I
sphenomandibular, 202 lingula, of mandible, 9 I anconeus, 354
spinoglenoid, 204 of sphenoid bone, 65 antagonists, 261
sternoclavicular, 203 lip, of bicipital groove, lateral, 119 articularis genus, 401, 412
sternocostal, 198 medial, I 19 auricularis, anterior, 286
intra-articular, 198 of iliac crest, inner, 144 posterior, 286
stylohyoid, 91, 177 outer, 144 superior, 286
stylomandibular, 202 of linea aspera, lateral, 153 auxiliary apparatus, 261
of superior tibiofibular joint, anterior, 239 medial, 153 of back, 268
posterior, 239 lordosis, 21, 49 deep, 268
suprascapular, 113, 204 cervical, 49 superficial, 268
supraspinous, 188 lumbar, 49 belly, 257
suspensory, of clitoris, 329 biceps brachii, 349
of penis, 329 caput breve, 349
talocalcanean, interosseous, 245
lateral, 245 M caput longum, 349
femoris, 401, 413
medial, 245 bipennate, 257
talofibular, anterior, 245 Malleolus, lateral, 159 biventer, 260
posterior, 245 medial, 159 blood vessels, 257
talonavicular, 245 mandible, 51, 88 brachialis, 349
tibiofibular inferior, anterior, 239 alveolar part, 88 brachioradialis, 354, 356
posterior, 239 angle, 88 buccinator, 289
transverse, of acetabulum, 227 development, 112 cervical, 296
of atlas, 24, I 94 head, 91 of chest, 308
of foot, superficial, 448 ramus, 88 deep, 316
of scapula, inferior, 204 manubrium sterni, 39 superficial, 308
superior, 204 margin, falciform, 438 coccygeus, 394, 395
of vertebral column, long, 188 infraorbital, 82, 87, 106 coracobrachialis, 349
short, 188 supraorbital, 62, 98, 106 corrugator of eyebrow, 286
yellow, 188 masses lateral, of cervical vertebrae, 23 costalis, 272
ligamentum, nuchae, 189 of sacrum, 34 costocervicalis, 272
patellae, 234, 405 maxilla, 51, 82, 112 cremaster, 320
line(s), arcuate, 139, 144 body, 82 deltoid, 341
axillary, anterior, 308 meatus, of nose, inferior, 80 depressor, anguli oris, 289
middle, 308 middle, 64, 78 labii inferioris, 289
posterior, 308 superior, 78 septi nasi, 289
epiphyseal, 11 auditory, external, 68, 72, 76 digastric, 296, 300
gluteal, inferior, 144 internal, 72, 75 of eminence, of great toe, 422, 433
middle, 144 membrana tectoria, 185, 194 of little toe, 422
posterior, 144 membrane(s), atlanto-occipital, anterior, 191 median, 430
intercondylar, 153 posterior, 191 epicranium, 286
intertrochanteric, 153 intercostal, anterior, 316 erector spinae, 268, 272
mamillary, 308 posterior, 316 extensor, carpi radialis, brevis, 354, 361
median, anterior, 308 interosseous, of forearm, I 77, 214 longus, 354, 361
posterior, 308 of leg, 177, 239 carpi ulnaris, 355, 361
medioclavicular, 308 obturator, 226 digiti minimi, 355, 363
mylohyoid, 88 sternal, 198 digitorum, 355, 362
nuchal, inferior, 59, 98 synovial, 181, 261 brevis, 430
highest, 59 menisci, articular, 181, 231 longus, 413, 419
superior, 59, 98 mesotendon, 262 hallucis, brevis, 422, 430
oblique, 88 metaphyses, 11 longus, 413, 419
parasternal, 308 metatarsus, 161 indicis, 355, 376
paravertebral, 308 muscle(s), 257 pollicis, brevis, 355, 370
pectineal, 144 of abdomen, 319 longus, 355, 375
scapular, 308 abductor, digiti minimi, of foot, 433 of facial expression, 282, 289
soleal, 157 of hand, 377 fibre, 257
spiral, 153 hallucis, 433 of foot, 422
sternal, 308 pollicis, brevis, 377 flexor, carpi radialis, 354, 355
temporal, of frontal bone, 62 longus, 355, 369 carpi ulnaris, 354, 356
of parietal bone, inferior, 59 adductor, brevis, 401, 412 digiti minimi brevis, of foot, 433
superior, 59 hallucis, 422, 433 of hand, 377
trapezoid, 118 oblique head, 433 digitorum, accessorius, 433
linea, alba, 319, 320, 323 transverse head, 433 brevis, 433
adminiculum, 323, 329 longus, 401, 412 longus, 416, 422
460 INDEX
muscle, flexor digitorum muscles, of neck muscle, semispinalis

profundus, 354, 356 deep, 301 thoracic, 273
sublimis (superficialis), 354, 356 lateral group, 301 semitendinosus, 401, 413
hallucis, brevis, 422, 433 prevertebral group, 305 serratus, anterior, 308, 316
longus, 416, 422 superficial, 296 posterior, inferior, 268, 272
pollicis, brevis, 377 nerve apparatus, 257 superior, 268, 272
longus, 354, 356 oblique, external, 319 skeletal, 257
of forearm, 349 internal, 320 soleus, 419
functional groups, 260 obliquus capitis, inferior, 279 spinalis, 273
fusiform, 257 superior, 279 capitis, 273
gastrocnemius, 419 obturator, externus, 394, 401 cervicis, 273
gemellus, inferior, 394, 401 internus, 394 thoracic, 273
superior, 394, 401 occipitofrontalis, 286 spindle-shaped, 257
geniohyoid, 296, 300 omohyoid, 296, 300 splenius, capitis, 268, 272
gluteus, maximus, 394, 400 opponens, digiti minimi, of foot, 4:}3 cervicis, 268, 272
medius, 394, 400 of hand, 381 stemocleidomastoid, 296, 305
minimus, 394, 400 pollicis, 377 stemohyoid, 296, 300
gracilis, 401, 412 orbicularis, oculi, 286 striated, 257
head, 257 lacrimal part, 288 stylohyoid, 296, 300
of hypothenar, 377 orbital part, 286 subclavius, 308
iliacus, 394 palpebral part, 286 subcostal, 308, 316
iliocostalis, 272 oris, 288 suboccipital, 279
iliocostocervicalis, 272 palmaris, brevis, 377 subscapularis, 345
iliopsoas, 394 longus, 354, 355 supinator, 355, 363
infrahyoid, 296 pectineus, 401, 412 suprahyoid, 296
infraspinatus, 344 pectoralis, major, 308 supraspinatus, 341
intercostal, external, 316 minor, 308 synergists, 260
internal, 316 penniform, 257 temporal, 282, 291
intercostalis intimi, 316 peroneus, brevis, 413, 417 temporoparietal, 286
interossei, dorsal, of foot, 434 longus, 413, 416 tendon, 257
of hand, 381 piriformis, 394 tensor fasciae latae, 394, 401
palmar, 381 plantaris, 416, 419 teres, major, 341
plantar, 434 popliteus, 416, 422 minor, 341
interpsinales, 268, 279 procerus, 286 of thenar, 377
cervical, 279 pronator, quadratus, 354, 356 of thigh, 401
lumbar, 279 tcres, 354, 355 thyrohyoid, 296, 300
thoracic, 279 psoas, major, 394 tibialis, anterior, 413, 419
intertransverse, 268, 279 minor, 394 posterior, 416, 422
anterior, 279 pterygoid, lateral, 282, 291 transversospinalis, 268, 273
lateral, 279 medial, 282, 293 transversus, abdominis, 319, 320
medial, 279 pyramidalis, 320 menti, 289
posterior, 279 quadratus, femoris, 394, 400 nuchae, 286
thoracic, 279 lumborum, 323 thoracis, 308
latissimus dorsi, 268, 272 plantae, 430 trapezius, 268
levator, anguli oris, 289 quadriceps femoris, 401, 404 triceps, brachii, 349
glandulae thyroidea, 300 rectus, abdominis, 320 lateral head, 349
labii superioris, 289 capitis anterior, 296, 305 long head, 349
alaeque nasi, 289 capitis lateralis, 296, 305 medial head, 349
scapulae, 268, 272 capitis posterior, major, 279 surae, 416, 419
levatores costarum, 268, 279 minor, 279 unipennate, 257
breves, 279 femoris, 404 vastus, intermedius, 411
longi, 279 rhomboid, major, 268 lateralis, 405
longissimus, 272 minor, 268 medialis, 405
capitis, 273 risorius, 289 zygomaticus, major, 288
cervicis, 273 rotatores, 273 minor, 288
thoracis, 272 cervical, 273 myofibrils, 257
longus, capitis, 296, 305 lumbar, 273 myofilaments, 257
cervicis, 296, 305 thoracic, 273
lumbrical, of foot, 434 sacrospinalis, 268, 272
of hand, 377, 381
masseter, 282, 290
sartorius, 401
scalenus, anterior, 296, 301 N
of mastication, 282, 290 medius, 296, 301
mentalis, 281 posterior, 296, 301 Navel, 323
multifidus, 273 of scalp, 282 notch, acetabular, 110
multipennate, 257 semimembranosus, 401, 413 clavicular, 39
mylohyoid, 296, 300 semispinalis, 273 costal, 41
nasal, 289 capitis, 273 ethmoidal, 63
of neck, 296 cervicis, 273 fibular, 157
INDEX 461
notch periosteum, 11 region(s)

frontal, 62 peritendineum, 262 buccal, 282
intercondylar, 153 phalanges, of foot, 171, 172 calcaneal, 391
jugular of hand, 136, 137 carpal, 341
of occipital bone, 57 pit(s), granular, 59, 97 cervical, 296
of sternum, 39 pterygoid, 91 of chest, 308
of temporal bone, 72 plate(s), cribriform, 63, 65, 75· crural, 391
mandibular, 91 horizontal, 86 cubital, 341
mastoid, 70 orbital, 63, 64 deltoid, 341
nasal, 84, 102 perpendicular, of ethmoid bone, 67, 76, epigastric, 319
parietal, 59 80 of face, 282
pterygoid, 68 of palatine bone, 86 femoral, 391
radial, 123 pterygoid, 68 frontal, 282
sciatic, greater, 144 porus acusticus, externus, 76 of head, 282
lesser, 144 internus, 72 hypochondriac, 308, 319
supraorbital, 62 prelum abdominale, 320 inguinal, 319
suprascapular, 113 process(es), alveolar, 84 inframammary, 308
trochlear, 123 condyloid, 91 infraorbital, 282
tympanic, 76 coracoid, 113 infrascapular, 265
ulnar, 125 coronoid, of mandible, 91 infratemporal, 282
vertebral, inferior, 21 of ulna, 123 of knee, 391
superior, 21 ethmoidal, 80 lumbar, 265
nucleus pulposus, 49, 183 falciform, 223 mental, 282
frontal, of maxilla, 80 nasal, 282
of palatine bone, 84 of neck, 296
0
of zygomatic bone, 87 nuchal, 265
intrajugular, 72 occipital, 282
lacrimal, 80 oral, 282
mastoid, 70, 98 orbital, 282
Olecranon, 123
maxillary, 80 parietal, 282
opening, in adductor magnus, 435
orbital, 87 parotideomasseteric, 282
aortic, 317
palatine, 84 pectoral, 308
of aqueduct of vestibule external, 72
pterygoid, 67 presternal, 308
for cochlear canaliculus, external, 75
pterygospinous, 68 pubic, 329
oesophageal, 317
sphenoidal, 87 sacral, 265
orbital, 106
styloid, of fibula, 159 scapular, 265
saphenous, 438
lateral, 125 sternocleidomastoid, 296
vena-caval, 317
medial, 123 submaxillary, 296
optic chiasma, 65
of temporal bone, 75, 98 umbilical, 319
orbit, 82, 106
of third metacarpal bone, 136 temporal, 282
floor, 106
temporal, 68, 87 of upper limb, 341
roof, 106
uncinate, 7 8 vertebral, 265
ossification, centres, 110
xiphoid, 319 zygomatic, 282
endochondral, 46
zygomatic, of maxilla, 84 retinacula peroneal, 448
intramembranous, 46
of temporal bone, 68, 82, 96 retinaculum, extensor, 361, 362, 369, 376, 390
nuclei, 46
promontory, 33 inferior, 419, 447
perichondral, 46
pronation, 181, 212 superior, 447
periosteal, 46
protuberance, mental, 88 flexor, 355, 356, 377
osteoblasts, 46
occipital, external, 59, 98 of patella, lateral, 234, 411
osteoclasts, 46
internal, 59, 101 medial, 234, 405
pubis, 139, 144, 172 rib(s), 37, 49
pulleys, muscular, 262 angle, 37
p pyramid of tympanum, 75 false, 39

floating, 39
head, 37
Palate, bony, 106
palm, 341 R neck, 37
shaft, 37
patella, 153 true, 39
pelvis, 145 Radius, 125, 137 ridge(s), cerebral, 59, 63, 67
age changes, 172 raphe palpebral lateral, 286 transverse, 32
axis, 146 recess epitympanic, 76 ring, femoral deep, 435, 444
false, 145, 147 recessus sacciformis, 215 inguinal, deep, 329
inlet, 146, 147 region(s), of abdomen, 319 superficial, 320, 329
measurements, 147 abdominal, 319 tympanic, 76
outlet, 146, 147 antebrachial, 341 umbilical, 323
sex features, 147, 172 axillary, 308 rostrum of sphenoid, 67
true, 145, 147 of back, 265 rotation, 181, 212
perimysium, 257 brachia!, 341
462 INDEX
s space(s)
interscalenus, 301
previsceral, 307
suture(s)
sphenosquamous, 67, 68
sphenozygomatic, 67, 87, 106
Sacrum, 21, 32, 33 retrovisceral, 307 squamomastoid, 71
apex, 33 suprasterual interaponeurotic, squamous, 59, 96, 177
base, 33 307 zygomaticomaxillary, 84, 87
lateral mass, 34 spine(s), iliac, anterior, inferior, 144 symphysis, I 77
sarcolemma, 257 superior, 144 intervertebral, 177
scapula, I I 3 posterior, inferior, 144 manubriosternal, 177
angles, 113 superior, 144 pubic, 177, 225
ligaments, 204 ischial, 144 synchondroses, I 77, 199
spine, 115 nasal anterior, 64, 76, 80, 84, permanent, 177
schindylesis, I 77 102 temporary, 177
sella turcica, 65, I 00 palatine, 84 syndesmosis, 96, I 77, I 99
septa, interalveolar, 84, 88 of scapula, 115 tibiofibular inferior, 239
interradicular, 84, 88 of sphenoid, 67, 68 synostoses, 199
septum, frontal, 444 supramental, 76
of frontal sinuses, 64 trochlear, 63, 106
intermuscular, of leg, anterior, 447
posterior, 447
tympanic, greater, 76
lesser, 76 T
of thigh, lateral, 442 of vertebra, 23
medial, 442 squama frontal, 62 Tarsus, 161
posterior, 442 sternum, 39, 49 tegmen tympani, 71, IOI
of upper arm, lateral, 383 angle, 41 tendo calcaneus, 419
medial, 383 body, 41 tendon(s), 257
of musculotubal canal, 75 sulci, arterial, 59, 63, 67 central, 317
nasal, osseous, 102 pulmonary, 41 changes with age, 452
of sphenoidal sinuses, 67 sulcus, carpal, I 36 conjoint, 329
sheath(s), fibrous, of flexor of fingers, 390 dorsi, 265 thorax, 41, 49
of rectus abdominis muscle, 320, 323 palatinovaginal, 68 inlet, 41
of styloid process, 76 of pterygoid hamulus, 68 outlet, 41
synovial, of tendons, 262 vomerovaginal, 68 tibia, I 57
common of peroneal tendons, 417 supination, 181, 212 body, 157
of extensor hallucis longus tendon, 450 surface, articular, 181 triangle(s), carotid, 296, 305
of extensor pollicis longus tendon, 375 auricular, of sacrum, 34 femoral, 443
of flexor digitorum longus tendon, 450 of ilium, 144 lumbar, 268, 320
of flexor hallucis longus tendon, 450 of calcaneum, posterior, 162 of neck, 305
of flexor pollicis longus tendon, 356 sustenaculum tali, I 62 omoclavicular, 296, 305
intertubercular, 349 suture(s), 50, 96, 177 Pirogoff's, 305
of radial, extensors, of wrist, 361 coronal, 59, 63, 96 submaxillary, 296, 305
of tibialis posterior tendon, 450 ethmoidomaxillary, 76, 82 trochanter, greater, I 53
shoulder blade, see scapula flat, 96, 177 lesser, 153
sinus(es), frontal, 64, 102, 110 frontal, 62, 110 tuber parietal, 59
maxillary, 82, 102, I I 2 frontoethmoid, 64, 76 tubercle(s), articular of sacrum, 32
paranasal, 64 frontolacrimal, 64, 80 of calcaneum, lateral, 162
petrous inferior, 57 frontomaxillary, 64, 84 medial, 162
sphenoidal, 67, 102 frontonasal, 64 of cervical vertebra, anterior, 23
tarsi, 162 frontozygomatic, 62, 87 posterior, 23
skeletal system, bony part, 11 incisive, I 06, 112 carotid, 23
cartilaginous part, 11 intermaxillary, 84 conoid, 118
skeleton, 11 internasal, 80 genial, 88
appendicular, 11 lacrimoconchal, 80 infraglenoid, 115
axial, 11 lacrimomaxillary, 80, 82, 84 intercondylar medial, 157
skull, 11, 50, 92, 112 lambdoid, 58, 96 mental, 88
age distinctions, 112 metopic, 110 of metatarsal bones, I 71
base, 98 nasomaxillary, 84 obturator, anterior, 144
external surface, 98 occipitomastoid, 58, 70 posterior, 144
internal surface, 100 palatine, medial, 86 of palatine bone, 68, 86
bones, 199 median, 84, I 06 peroneal, I 62
cap, 92, 96, 199 transverse, 84, I 06 pharyngeal, 57, 98
cerebral, I 10 palatoethmoidal, 76 pubic, 144
crown, 97 palatomaxillary, 82 of rib, 37
joints, 199 parietomastoid, 59, 70 scalene, 39
visceral, 110 sagittal, 59, 96 of scaphoid, 134
socket(s), eye, I 06 serrated, 96, 177 for serratus anterior muscle, 39
tooth, 84, 88 sphenoethmoidal, 65, 67, 76 spinous of sacrum, 32
space(s), intercostal, 41 sphenofrontal, 64, 67, 106 supraglenoid, 113
interosseous, of metacarpus, 136 sphenoparietal, 59, 67 of talus, lateral, 161

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R.D.

Printed in the German Democratic Republic

ISBN 5-03-000323-1 © I--fa11aTeJibCTBO «Me11nJ!HHa», 1978

1. Skeleton, anterior aspect (½ 0).

2. Skeleton, posterior aspect (½ 0).

3a. Bones of different shape.

Os temporale (squama) Os sphenoidale (ale major)

Os ilium -�,.::..._____ Funiculus

3b. Four-month-oldfoetus (drawing made from a

External layer of periosteum

Internal layer of periosteum

4. Periosteum (½). 5. Diaphysis and epiphyses (½).

Line of epiphyseal cartilage

Line of epiphyseal cartilage

6. Compact substance of bone (substantia compacta);

7. Epiphyseal cartilages (radiograph).

8. Spongy substance of skull cap (diploe) (¾).

9. Vertebral column (columna vertebralis) (¼).

Fovea arttculans Processus transversus

Facies articularis anterior

Fovea articula{is superior

Foramen processHs transversarium Tuberculum anterius

22. Eighth thoracic vertebra (vertebra thoracica VIII);

Processus articularis superior

Fovea costalis inferior

23. Eighth thoracic vertebra (ver­

Processus articularis superior

26. Third lumbar vertebra (vertebra lumbalis III); supenor

Processus articularis superior

Facies articularis inferior

27. Third lumbar vertebra (vertebra lumbalis III); from the

Processus articularis inferior

28. Third lumbar vertebra (vertebra lumbalis III); posterior

29. Lumbar segment of vertebral column (radio­

Foramina sacralia dorsalia Canalis sacralis

Crista sacralis mediana

31. Sacrum (os sacrum); posterior aspect (¾).

Crista sacralis intermedia

32. Sacrum (os sacrum); from the Foramina intervertebralia

The superolateral part of the sacrum, lateral mass (pars latera­

34. Sacrum (os sacrum); superior aspect (¾).

Crista sacralis intermedia

Foramina sacralia pelvina Lineae transversae

Apex ossis sacri

35. Sacrum (os sacrum) (¾).

36. Coccyx (os coccygis) (½).

37. Sacral and coccygeal parts of I -fifth lumbar vertebra

Tuberculum costae II----

38. Right ribs (costae); superior aspect (¾).

Crista capitis costae

Facies articularis capitis

39. Right eighth rib (costa VIII); inner aspect

40. Right eighth rib (costa VIII); outer and posterior

Facies articularis capitis

41. Right twelfth rib (costa XII); mner aspect (¾).

42. Sternum; anterior aspect (¾).

Incisurae costales III, IV, V

43. Sternum; from the right side (½).

THE THORACIC CAGE

23. Eighth thoracic vertebra (ver

29. Lumbar segment of vertebral column (radio

The superolateral part of the sacrum, lateral mass (pars latera

4 7b. Sagittal section through lumbar segment of verte

51. Skull (cranium); from the right side (semischematical representa