ANATOMY RECALL RECALL SERIES EDITOR AND SENIOR EDITOR LORNE H. BLACKBOURNE, M.D. General Surgeon Fayetteville, North Carolina EDITORS JARED ANTEVIL, M.D. United States Marine Corps ‘Camp Pendleton, California CHRISTOPHER MOORE, M.D. Resident in Emergency Medicine Carolinas Medical Center Charlotte, North Carolina Me LIPPINCOTT WILLIAMS & WILKINS ‘A Wolters Kluwer Company Philadelphia » Baltimore + New York + London Buenos Aires + Hong Kong + Sydney + TokyoAcquisitions E ltors Blzabeth A. Nieginski Exlitorial Director: Julie P. Martine Development Editor: Melanie Car Managing Ealvor: Amy Dinkel Marketing Manager: Aimee: Sir Copyright © 2000 by Lippincott Willams & Wilkins. All rights reserved, This book is protected by copyright. No part of t may be nsmitted, in any form or by’ any eans—electronic, mechanical, photocopy, recording, or otherwise—without produced, stored in a retrieval system, oF t the prior written permission of the publisher, exept for brief quot boxed in enitical articles, reviews, and testing and evaluation materials pro- vided by the publisher to schools that have adopted its accompanying textbook Printed in the United States of America, For information, write Lippineote Williams & Wilkins, 530 Walnut Street, Philadelphia, PA 19106, ‘Materials appearing in this book prepared by individuals as part oftheir offical dutiesas U.S. Government emplayees are not covered by the above-mentioned copyright 987654929 Care has been taken to confirm the aconracy ofthe information presented to describe generally accepted practices. However, the authors, editors, publisher are not responsible for errors or omissions or for any consequences from application ofthe information in this book and make no warranty, express ‘or implied, with respect tothe contents ofthe publication “The authors, editors, andl publisher have exerted every effort to ensure that dng selection and dosage set forth inthis text are in accordance with enrent recommendations and practice atthe time of publication. Howeser, in view of ongoing research, changes in government regulations, and the constant flow of formation relating to crag therapy and drug reactions, the reader is urged to chek the package insert for each drug for any change in dications and dosage ‘and for added warnings and precautions. This is particularly important when the recommended agent isa new or infrequently employed drug, ‘Some drugsand medial devices presented inthis publication have Food and Drug Administration (FDA) elearance for limited use in restricted! research settings, Iti the esponsibility of the health care previder to ascertain the FDA, status of each drug or device planned for use in their clinical practice,ASSOCIATE EDITORS James Boyer Fousth-Year Medical Student School Charlottoslle, Virginia “Anikar Chhabra, M.D. Resident in Orthopedic Surgery University of Virginia Charlottesslle, Virginia Hiwot Desta, M.D. in Internal Medicine Ohio State University Columbus, Ohio Kimberly Estler, M.D. in Obstetrics and Gynecology University of Rochester Rochester, New York Barry Hinton, Ph.D. Professor of Anatomy andl Cell Biology University of Virginia School ‘of Medicine Charlotteslle, Virginia Mike Iwanik, Ph.D. Professor of Anatomy and Cell Biology University of Virginia School ‘of Medicine ottesvlle, Virginia Brian Kaplan, M.D. Resident in Otolaryngology University of Virginia Charlottesville, Virginia Clinton Nichols, M.D. Resident in Radiology University of California, San Diego Ravi Rao, M.D. Resident in Nenrost Brigham and Women's Hospital Boston, Massichusetts Jeffrey Rentz, M.D. Resident in General Surgery University of Utah Salt Lake City, Utah Peter Robinson, M.D. Resident in Internal Medicine University of Colorado Boulder, Colorado John Schreiber, M.D. Resident in Radiology Stanford University Stanford, CaliforniaCONTRIBUTORS Wang Cheung, MD. Jamal Hairston, M.D. Meredith LeMasters, M.D. Steven Lin, M.D. Bruce Lo, M.D. Ana Meura, M.D. Suzanne Perks, M.D. Andrew Wang, M.D, Thomas Wang, M.D. Philip Zapata, M.D.Dedication “This book is dedicated to the medical students at the University of Virginia,Contents Preface . = x Acknowledgments mhstwasnaisensinn =) 1 Overview occ coree ve I 2 TheHead occ eececceeserseee Siesrettnssres 2 3 The Central Nervous System — co 6 4 The Cranial Nerves ‘ ae 5 The Neck tot 6 The Back .... Ep : svueene 128) 7. The Upper Extremicy a 3 The Thorax mete 195, 9 The Abdomen .. a 214 10 The Pelvis and Perineum : 253 I The Lower Extremity os 285 Index 2319Preface Anatomy Recall was written by medical students, physicians, and anatomists specifically for use during a fist-year gross anatomy course and as a review for the United States Medical Licensing Examination (USMLE) Step 1. While there are certainly a wealth of gross anatomy texts available, most are better suited for reference than for mastery of the basic anatomy required to be a suc- ‘cessful medical student and physician, Its our intention that Anatomy Recall and an atlas are all you will ned for a comprehonsive study of basic anatomy’ ‘Anatomy Recalls arranged in the extremely successful question-and-answer Format that defines the entiee Recall series—a format that emphasizes active acquisition of knowledge, rather than passive absorption of it. Where appro- priate simple figures have been included to supplement the text material. Fach Chapter concludes with a “power review” that covers the most important and Frequently tested facts in each subject area. These power roviews are ideal for 4 quick review prior to an anatomy examination, a board examination, oF a surgery clerkship, ‘Anatomy is an exciting yet demanding course. It is important to have a text that is comprehensive yet readable and emphasizes (and reemphasizes) key points. A thorough initial study of anatomy wil continue to reward you through ‘outa lifetime of clinial practice. It is our hope that Anatomy Recall will prove to be an invaluable tool for mastering the subject of anatomy. Good luck! ‘The EditorsAcknowledgments. “The editors would like to acknowledge Melanie Cann, Amy Dinkel, Julie Mar- tine, and Elizabeth Nieginski at Lippincott Williams & Wilkins for their help and vision in bringing this book to fruition, xOverview Itis important to adhere toa certain formalism when describing the location or jovement of one body part relative to another, therefore, a significant portion 1 course (like many introductory courses in medicine) is devoted -ating with other healtheare pro ofthe toteac fessionals. language necessary for comm ANATOMIC POSITION What standard position is That of a human standing facing forward, assumed when deseribing feet pointing forward " the human body? outward (the “anatoraie position”) ANATOMIC PLANES. Deseribe the three basic 1. Transverse (horizontal): \ anatomic planes. horizontal plane aeross the body anatomic position; the most commo ‘cut used in computed tomography (CT) and magnetic resonance imaging (MRI) 2. Sagittal A plane formed by a vertical midline cut that divides the body into aeutacross the body in anatomic position from side to side and top to bottom ANATOMIC DESCRIPTORS Define the following terms: Ventral “Tawar the anterior (oF front) ofthe body Dorsal “Toward the posterior (or back of the bry Medial Closer to the midline Lateral Fusther from the miWith the palms facing up, the thumbs are lateral tothe other fingers, Tateral to the forefinger? What is the position of the The great toc is medal ‘great toe (first toe) relative ta the other toes? Define the following terms: Proximal Closcr to the center ofthe body (often ‘considered the heart) Distal Further from the center ofthe body Where is the radial artery The radial arteny (inthe forearm) i distal in relation to the subelavian tothe subclavian artery (under the artery? asic Which is more distal, the The tibia femur or tibia? ANATOMIC MOVEMENTS. What are the three major Simoth, cardia, and skoletal (striated) types of musele? Describe the innervation _ Skeletal musele is gonerally innervated by and characteristics of somatic nerves (i.e,, movement is skeletal muscle. voluntary, and is located etween two stable points (ie, bones). Contraction results in movement of a structure. What four parameters are Origin: Usually the more proximal, more used to describe skeletal medial, and more stable structure that muscles? the muscle is attached to Insertion: Usually the more distal, more Tateral structure that the muscle is attached fo, and the one that is moved by contraction Tnnervation: The nerve that eases the nsele to contract Action: The result ofthe muscle ‘contracting Define the following muscle actions: Flexion Decreasing the bending the joint ng ofa joint, oFChapter | Overview 3 Extension Inereasing the angle ofthe joint, oF straightening the joint Abduction Moving one structure away from another Taterally (ie, away from anatomic position) Adduetion Moving one structure toward another medially (.c. toward the anatomie position)—think add = together Deseribe the action that ‘occurs with each of the following movements: Kicking a soccer ball Extension ofthe leg atthe knee Spreading the fingers Abduction ofthe fingers at the metacarpephalangeal joints Bringing an arm that is Adiduction ofthe arm at the shoulder ‘extended straight out and to the side laterally, toward the body What is the difference ‘Tendons attach the muscle tothe bone, between ligaments and while ligaments attach bone to bone tendons? What isa strain? partial or incomplete tear of a muscle orligament What isa sprain? A partial or incomplete tear ofa tendon2 THE SKULL The Head ‘What is the skull? What are the two regions ‘of the skull? What is the ealvaria? What is diploe? Identify the structures on the following lateral view of the skull: xo7mo 0 1 skeleton of the head, incl mandible ngthe ‘The neuroeranium (i, the portion of the skull that encloses the brain) and the facial cranium “The skull cap (i.e. the vault of the neuro cranium, oF the portion of the skull that is Teft when the facial bones are removed) “The spongy bone layer between the dense ‘outer and inner bone layers of the calvaviaChapter 2/ The Head 5 A= Inferior and superior temporal lines B= Parictal hone C= Lambdoid suture D= Sphenoid bone, greater wing E = Temporal bone F = Zygomatic arch G= Occipital bone H= External occipital protuberance T= Mastoid process J. = Ramus of the mandible K= Angle of the mandible = Mental foramen M= Frontal bone coronal suture *erion (the “p” is silent) acrimal bone sternal auditory (acoustic) meatus terior nasl spine tyloid process Iveolar process What are the superior and ‘The attachment points for the temporal, inferior temporal lines? What region lies below the The temporal fossa superior and inferior temporal lines? What is the clinical signifi- Severe mide ear infections may spread ‘cance of the proximity of the tothe mastoid process ofthe temporal external auditory meatus and bon the mastoid process? NEUROCRANIUM Bones and sutures Which eight bones make ‘The frontal bone, the two parietal boues, up the neurocraniam? the two temporal hones, the ocipital bone, the sphenotd bone, and the ethinokd bone What are the immobile Sutures junetions between the hones of the neuroeranium called?6 Anatomy Recall Which hones articulate at the: Coronal suture? Sagittal suture? Lambdoid suture? sutures called! What is the intersection of the sagittal and coronal sutures called? What is a metopie suture? What is erantorynastosis? What is Scaphocephaly? Acrocephaly? Plagiocephaly? Identify the labeled points fon the neuroeraninm on the following posterior and superior views: “The frontal and patietal bones ‘The parictal hones of ether side The parietal and oceipital bones The lamba The bagi A persistent frontal suture, present in approximately 24 of the population Premature closure of the sutures ure closure ofthe sagittal suture ure closure ofthe coronal suture ure closure ofthe coronal and lambdoid sutures on one side onlyWhat are fontanelles? What are the largest fontanelles, and where are they located? Which sutures form the borders of the posterior fontanelle? How can the anterior and posterior fontanelles be ‘identified on an infant? In adults, what is the name of the remnant of th Posterior fontanelle? What isthe location of the anterolateral (sphenoidal) fontanelle called in adults? Why is the pterion Chepeor 2/ The Head 7 agit suture Lamba hoi suture stemal occipital protuber astoid process Decipital condyle = Bregia ‘ronal sutre agital suture Lambda aambdod suture Large fibrous areas where several sutures ‘meet; often called “soft spots” on an infant's head ‘The anterior and posterior fontanelles, on the superior surface of the neuroe ‘The sagital and lambdoid sutures ‘The anterior fontanelle is diamond. shaped and palpable in children younger than approximately 18 months. The posterior fontanelle is triangular and is not palpable past I year of age. The bregm ‘The asterion ‘The ptevion (brain surgery using an anterolateral incision is ealled a “pterional spproach") ‘The thinnest part of the lateral skull, the plerion is vulnerable to fractures that ean damage the middle meningeal artery, ‘which lies on the internal ska inthis region surface8 Anatomy Recal Internal surface features Label the following view of the floor of the neure- 90 o> superior orbital sure B= Foramen rotundum ramen ovale ypoglossal canal ‘raion magn ‘ramon lacerum nternal auditory meatus = Jugular fora Anterior cranial fossa In addition to the ethmoid The frontal bone bone, which bone eo utes to the floor of the anterior fossa? What is the name of the The enbriform plate flat part of the ethmoid bone that lies anteriorly in the midline? Cranial nerve (CN) I (the olfactory nerve) through the eribriform plate?What is the name of the sharp upward projection of the ethmoid bone in the midline? What is the function of the crista gall? Which structures pass through the anterior and posterior ethmoidal Foran Middle cranial fossa Which part of the brain ‘occupies the middle ‘cranial fossa? What are the borders of the middle cranial fossa: Anteriorly? Posteriorly? Laterally? Ventrally? Which three structures pass from the middle ‘cranial fossa into the orbit, via the optic canal? Which opening between the greater and lesser ‘wings of the sphenoid one conneets the middle ‘eranial fossa with the orbit? (Chapear 21 Tae Head The crista gal It provides the anterior site for the fal cerebri Ge Fold that Hes i the longitud between the two cerebral h spheres) ‘The anterior and posterior ethmoidal nerves and vessels, respectively ‘The temporal lobes of the cerebral The lesser wings of the sphenoid bones ‘The petrous part of the temporal hone 9 ‘The squamous part of the temporal bone, the greater wings of the sphenoid bones, and the parietal bones The temporal bones and the greater wings ofthe sphenoid bones 1. EN IH (the optic nerve) 2 The ophthalmic artery (a branch of tho internal earotid artery) 3, The central vein ofthe retina ‘The superior orbital fissure10 Anatomy Reel Which six structures pass from the middle eranial fossa to the orbit through the superior orbital fissure? The foramen rotundum transmits structures between which two spaces? Which structure passes through the foramen rotundum? ‘The foramen ovale trans- mits structures hetween which two spaces? Which two structures pass through the foramen ovale? ‘The foramen spinosum connects the middle ers fossa with whieh space? Which structure passes through the foramen spinosum? ‘The foramen lacerum lies at the junction of which ‘cranial bones? Grooves on the anterior part of the petrous tem- poral bone transmit which structures? What is the name of the thin plate of bone located at the junction of the petrous and squamous parts of the temporal bon L 3 4 6 (the oculomotor nerve) IV (the trochlear nerve) CNV; (the ophthalinie division of the a c The superior ophthalmie vein The inferior opthalmie vein ‘The middle cranial fossa and the perygopalatine fossa V5 (the mavilary division of the trigeminal nerve) ‘The middle eranial fossa and the infratemporal fossa EX Y; (the mandibular division of the tal nerve) andl the accessory meningeal atery “The infratemporal fossa (ike the foramen ovale) ‘The middle meningeal artery ‘The sphencid bone and the petrous part ‘of the temporal bone "The greater and lesser petrosal nerves “The tegmen tympani‘What is the clinical signi ficance of this thin bone? What is the name of the elevation of the sphenoid bone between the two optic canals? What is the name of the depression posterior to the tuberculum sellae? What is the name of the bony ridge that defines the posterior limit of the sella turelea? What are the boundaries of the sella turciea: Anteriorly? Posteriorly? Which structure lies in the hypophyseal fossa of the sella tureica? Which space is located directly inferior to the sella tureica? Which structure forms the roof of the sella tureiea? Which processes project from the lateral aspects of the dorsum sellac? ‘What structures attach to, the posterior clinoid processes? Posterior cranial fossa Which part of the brain lies in the posterior eranial fossa? Chapter 2/ The Head 11 This bone, which soparates the tympanic cavity from the middle cranial fossa, isso thin that infections ofthe middle ear can spread to the meninges and brain, The tubercubam sellae ‘The sella tureiea (“Turkish sad") The dorsum selle ‘The tuberculum sellae The dorsum sellae ‘The pity ary el The sphenoid sinus (surgery on the pituitary gland uses a “trans-sphenoidal” approich) ‘The diaphragma sellae(1¢., one of the dural folds) “The posterior elinold processes ‘The tentorinm cerebelli (Le, the dural {old between the occipital lobes and the cerebellum) ‘The corebelliun and brain stem12 Anacomy Recall What are the borders of the posterior cranial Fossa Anteriorly? Posteriorly? Ventrally (Le, the floor)? Dorsally (i.e. the roo)? Which three structures pass through the internal audi- tory meatus (ie. the open- 1g in the posterior aspect of the petrous part of the temporal bone)? Which cranial foramen lies the junetion of the pe- trous part of the temporal bone and the occipital bone? Which six structures pass through the jugular foramen? Where is the hypoglossal © relation to the {jugular foramen? Which nerve passes through the hypoglossal canal? Which large opening lies in the posterior midline floor of the posterior fossa? “The petrons part ofthe temporal bone The occipital bone "The occipital bone and the mastoid processes ofthe temporal b The tentorium corebell LGN VI (the abducens nerve) 2 CN VIII (the vestihulocachlear nerve) 3. The labyrinthine artery Tho jugular forasnon 1. GN IX (the glossopharyngeal nerve) 2 CNX the vagus nerve) 3. CN XE (the accessory ner 4. The intemal jugular vein (superior bulb) 5. The sigmoid sinus 6. The inferior petrosal sinus ‘The hypoglossal canal lies just medial to ‘he jugular foramen, CN XII (the hypoglossal nerve) ‘The foramen magnumWhich structures pass through the foramen smmagnum? What is the name of the bony “ramp” just anterior to the foramen magnum? ‘Which small opening may be present lateral to the foramen magnum? Which structure passes through the condyloid foramen? Which structures pass through the mastoid foramen? ‘What is the name of the midline crest on the in- side of the occipital bone? Which structure attaches to this crest? ‘What is the posterior term- ination of the internal ‘occipital crest? ‘Which structures are trans- ‘mitted in the grooves that project laterally from the internal occipital protuber- ance along the occipital bone? Chapter 2/The Head 13 1. The medulla oblongata (1, the lower aspect ofthe brain stem) 2 CN XI (the spinal accessory nerve 3. The vertebral arteries 4, ‘The venous plesus ofthe vertebral canal 5. ‘The anterior aud posterior spinal esters The clivus ‘The condyloid foran “The condyloid emissary vein ‘The mastoid emissary vein and a branch ‘of the ocepital artery The internal occipital rest ‘The fals cercbeli (Ke, the dural fold that separates the cerebellar hemispheres) “The internal occipital protuberance The transverse sinuses14 Aratomy Recall FACIAL CRANIUM, Label the structures sh on the following anterior view of the skull ken Eo Supraorbita noteh Superior orbital fissure C= Inferior orbital sure D= Inferior nasal concha E = Infraorbital foramen Alveolar process G= Ghabella Optie canal Midale nasal concha ‘Zygomaticofacial foramen K = Nasal septum = Angle ofthe manchible AM= Mental foramen What is the smooth median The glabella prominence of the frontal hone called? Which bone located be- The tween the orbits contains the eribriform plate and a perpendicular plate?Which structures pass through th Infraorbital foramen? ‘Zygomaticofacial foramen? Mental foramen? Orbie Which bones form the margins of the orbit: Superiorly! Laterally? Which twa fissures form a communication between the the orbit? Which structures pass into the orbit from the infratem- poral fossa via the inferior orbital fissure? Which structures pass through the supraorbital notch? Paranasal (air) sinuses What are paranasal sinuses? Chapter 2/The Head 15 ‘The infraorbital nerve (a contimation of EN Vp) the infraorbital artery, and the infraorital vein ‘The zygomaticofacial nerve The frontal bone (orbital plate) ‘The zygomatic bone and zyyomatic process of the frontal bone The maxilla and 7ygomatic hones The ethmoid, lacrimal, sphenoid, and frontal bones "The superior orbital fissure (comnicates with the middle cranial fxs) and the inferior orbital fissure (o ‘municates with the infratemporal fossa ‘The rygomatic branch of C nally division ofthe trig and the infiaorbital artery Va the vninal nerve) ENV; (the opthaliie division ofthe trigeminal nerve, or the supraosbital nerve) and the supraorbital vessels ‘The paranssal shnises are ai spaces within the bones ofthe ski that communicate with the nasal cavity. Don't confuse the pparanasal sinuses with the venous (éural) sinuses, which convey venous blood in the16 Anatomy Recall List the four skull bones that have paranasal sinuses. What is the funet these sinuses? Which sinus, because of its location, ean often lead to the spread of infection into the orbit? Which sinus is susceptible to the spread of infeetion from a tooth? ‘Which sinuses may be present at birth? Nasal caviey Which four bones form the roof of the nasal cavity? Which bones form the floor of the nasal eavity (and the hard palate, or the anterior portion of the roof of the mouth) Which eight bones form the lateral wall of the nasal cavity? Which opening forms a communication between the nasal cavity and the nasopharynx? Which structure divides the nasal cavity into left and right parts? 1. Frontal bone 2 Masia 3 I 4. Sphenoid home wid bone Ther fetion stash alone are thought to lighten the skull and aid in resontion of the voice ‘The maxillary sinus—roots ofthe posterior maxillary teeth often project up into this sinus, ‘The masilary and sphenoid sinuses The nasal bone, the frontal bone, the cribriform plate ofthe ethinoid bone, and the body of the spend bone The palatine process ofthe masilla and the liorizontal plate of the palatine bone “The ethmoid bone ‘The medial pterygoid plate ‘The perpendicular plate ofthe palatine hone ‘The masila “The nasal bone “The frontal bone ‘The herimal bone “The inferior concha The choanae, a large opening at the back of the nasal cavity The nasal septumWhich two bones contribute to the nasal septum? What are the three bony projections from the lateral ‘nasal wall called? What are the spaces below each of the nasal conchae called? ‘The inferior meatus con- tains the opening to which space above the super ‘concha? ‘What is the rounded prom- inence on the wall of the middle meatus? ‘What is the hiatus semi- Iumaris? ‘What isthe infundibulum? Deseribe the drainage of each of the following para- nasal sinuses: ‘The anterior ethmoid "The midalle ethmoid sinus ‘The posterior ethmoid sinus ‘The frontal sinus ‘The sphenoid sinus (Chapter 21 The Head 17 The vomer ancl the perpendicular plate of the ethmoid bone “The nasal conchae—the superior and middle conchae are part ofthe ethimotd bone, while the inferior nasal concha isan independent bone Meatus (eg, the superior meatus isthe space between the superior and middle conchae: the mide bets eatus isthe space 1 the aide and inferior conchae inferior meatus is the space below the inferior conch) an th “The nasolacrimal chct “The sphenoethmoid recess The ethmoid bulla The enrved eleft below the ethmoid bulla atthe: The chs wats semilomaris terior aspect of the "The biatus seminars (ia the infiand bulum), located inthe middle nasal meatus “The ethimoid bulla, located in the middle nasal meats The superior nasal meatus ‘The middle nasal meatus (via the Front nasal duet, which opens into the infuncibuluen) The sphenocthmoidal recess1 Anatomy Recall iMlary sinus Which three arteries supply branches to the nasal cavity? What are the two primary branches of the ophthalmic artery that supply the nasal cavity? ‘What are the two branches of the masillary artery that supply the nasal cavity? Which branch of the facial artery supplies the nasal cavity? Mandible Where does the body of the ible meet each of the rami? Name the two processes on top of each of the ram What is the name of the notch located between the coronoid and eondyloid processes? What is the name of the ‘opening on the medial surface of the mandible? What structure does the ar foramen lead What structures lie in the sand ilar canal? “The hiatus semi The masilary and facial arteries (branches of the extemal carotid artery) and the ophthalnie artery (a branch ofthe intemal ‘carotid artery) ‘The anterior and posterior ethrnoidal arteries, which supply the lateral wall and rasal septum ‘The sphenopalatine artery (which meatus, and nasal supplies the conchae, septum) and the descending palatine artery (which also supplies the nasal septum) ‘The superior labial artery ‘The coronoid process (anterior) and the condyloid process (posterior) ‘The mandibular noteh The mandibular foramen The mandibular canal ‘The inferior aleolar nerves and vessels,Infratemporal fossa Which structures pass though the: Petrotympanie fissure? ‘The stylomastoid foramen? ‘The greater palatine foramen? ‘The lesser palatine foramen? Chapter 2 The Hed 19 ‘The chorda tympani (a branch of the facial nerve within the temporal bone) ‘The facial nerwe ‘The greater palatine nerve and vessels ‘The lessor palatine nerve and vessels ‘THE SCALP AND SUPERFICIAL AND DEEP FACE SCALP What is the sealp: What are the five layers of the sealp? Branches of which artery constitute the major blood ‘supply of the sealp? What are these branches of the external caro that supply the sealp? Which branches of the internal carotid artery supply the sealp? What is unique about the veins of the seulp? “The skin and faseia that covers the Aponeuresis (gale aponeurotiea) Loose connective tis Pericraninm ‘The external carotid artery ‘The superficial temporal, posterior ‘auricular, and oceipital arteries “The supratrochlear and supraorbital arteries (vla the ophthalnic artery) ‘They have no valves.20. Anatomy Recal What connects the veins of Ennissury wins the scalp with the veins of the skull bones and the ‘veins within the cranium? NOSE What isthe medical term Nares for nostrils? What is the name of the The ala nasi (*wing of the nose cartilaginous part of the external nose that sur rounds each naris? What i the dilated part of The vestibule the nostel called? What three effects does the Warmin nose have on inspired ait? sing, and filtering MUSCLES OF FACIAL EXPRESSION Label the masse of Gc ° eune soz esChapeer 2/ The Hesd 24 A= Orbiculars ocul B= Nasalis C= Lesutor anguli ori D= Buccinstor B= Masseter F = Depressor angull oris G= Depressorlabitinferioris mporalis aerugator (supercili) = Levator lai superions = Zygomaticus major and minor ‘The mesodern ofthe second pharyngeal arch (ic. e hyoid arch) Dysfunction of whi muscle results in difficulty with blinking? ‘The orbicularis ocul (closes eyes) Which musele is primarily The froutalis muscle responsible for raising the eyebrows? Which nerve innervates the museles of facial GN VHT (the facial nerve) expression? ‘TEMPOROMANDIBULAR JOINT (TM) AND MUSCLES OF MASTICATION ‘Temporomandibular joint (TMJ) What type of joint isthe synovial joint TM? Jhtwo types of move. Hinge movement and sliding movement ments are provided by the Tp What are the articular sur- The articular tubercle and mandibular faces of the TMJ? fossa ofthe temporal bone andthe condsloid process of the mandible22 Anatomy Recall Name the three liga of the TMJ. Which ligament reinforces the TMJ by stretehing from the tubercle on the zygoma to the neck of the mandible? Which ligament reinforces the TM] by stretching from the spine of the sphenoid bone to the kingula of the ‘mandible? Dislocation of the TMJ ‘usually occurs in which Describe the origin and insertion for each of the following: Masseter muscle ‘Temporalis muscle (superior head) Lateral pterygoi (inferior head) 1. The lateral temporomandibular Figament 2, The sphenomandibular ligament 3, The stylomandibubar ligament “Tho lateral temporomandibular ligament ‘The sphenomanudbular ligament Anteriorly 1. The masseter nse 2, The temporalis muscle 3. The medial pterygoid muscle 4. The lateral plenyyoid muscle Origins The lower border and medial surface ofthe zygomatic arch Ansertion: The lateral surface of the ‘conoid process, rans, al angle of the mandible Origin: The Hoor ofthe temporal fossa Insertion: The coronoid process ancl ramus of the mandible Origin: The infratemporal surface of the spheroid bon Insertion: The neck ofthe mandible Origin The lateral surface ofthe lateral id pheChapeor2/The Head 23 Insertion: The articular disk and capsule of the TMJ he tuber of the maxi, the dial surface of the lateral pterygoid plate, and the pyramidal process of the palatine bone Inyertion: The medial surface of the angle and the ramus ofthe mandible Medial pterygoid muscle ‘Which muscle is responsible for: Closing the jaw and pro- The medial pterygoid! muscle tending the mandible? ‘Opening the jaw and pro- ‘The lateral pterygoid muscle truding the mandible? Which musele is the primary actor in: Depressing the mandible The lateral pterygoid muscle sat the TMJ? Ketracting the mandible? The temporals musele Which three muscles act to ‘The temporals, masseter, and mesial clevate the mandible at the pterygoid muscles TM? Which two muscles uct to The masseter muscle and the temporalis close the jaw and retract snusele the mandible? Which arteries supply the muscles of mastication? (sometimes called the pterygoid branches) PAROTID GLAND What is the name of the ‘The parotid gland largest of the three sets of salivary glands? What are the boundaries Of the space containing the parotid gland: Anteriorly? es of mastication24 Anatomy Recal Posteriorly? Medi ly? Superiorly? Which structure divides the parotid gland into super and deep parts? Which part of the parotid gland extends upward behind the TMJ? Which part of the parotid sland extends anteriorly superficial to the masseter muscle? What is the name of the extension of the parotid gland between the medial pterygoid muscle and the ‘mandible? What is the name of the ‘major duct of the parotid land? Where does the parotid duct begin? ‘The parotid duct pierces which muscle on its course Which three major structures traverse the parotid gland? The extemal auditory meatus and mastoid proves The styloid process The zygomatic arch CN VII (the facial nemve ‘The glenoid process ‘The facial process The pterygoid process ‘The parotid duct (Stensen's duct At the facial process ofthe parotid gland The buceinator Opposite the second upper molar tooth 1, EN VI (the facial nerve) 2. The retromandibular vein 3, The extemal carotid arteryFrom which ganglion do the parasympathetic fibers that supply the parotid land originate? What is the source of para: sympathetic fibers to the otie ganglion? Which nerve transmits post ganglionic parasympathetic fibers to the parotid gland? Sympathetic innervation to narotid gland! Folloss which structure? SUBMANDIBULAR REGION Name the two sets of sali- vary glands that lie in the submandibular region OF the three sets of salivary glands, which is the smallest? Where do the ducts of the sublingual salivary glands ‘open into the mouth? Which structure separates the parotid gland and the submandibular glands? Which duct drains the sub- ‘manlibular gland? Wharton's duct lies between which two structures? Where does Wharton's duct, Which major blood vessels ‘run in the submandibular region? CChapeer2/The Hed 25 ‘The otic ganglion Parasymmpathetic fibers originate in the Inferior salivary nucleus of CN IX (th elossopharyn tympani branch, and then travel to the ‘otic ganglion via the lesser petrosal nerve passing through the otic ganglion, e postganglionic parasyn are transmitted to the parotid gland via the auriculotemporal nerve ‘The external carotid artory ibaa gh 2. Sublingual glands ds ‘The sublingual glands Wharton's duet ‘The sublingual glands and the genioglossus suscle Alongside the frenulum of the tongue “The facial branches ud Kinga arteries (bo ofthe external carotid artery)26 Anatomy Recall What is the source of para- CN VII (the ficial nerve), via the chorda sympathetic innervation to tympani and lingual nerve the submandibular and sublingual salivary glands? INNERVATION OF THE FACE Which cranial nerve pro- VI (the facial nerve) vides motor innervation to the face? Identify the five terminal branches of CN VII on the following figure: A= Temporal branch B = Zygomatie branch (© = Buccal branch D= Mandibular branch E = Cervical branch thin which structure does The parotid gland CN VII divide i branches? Which eranial nerve pro. CNV the triger vides sensory innervation to the face?Identify the nerves that provide sensory innervation to the face on the following figure: (Chapeer2/The Head 27 ‘The supraorbital and supra trochlear nerves are branches of which nerve? What structures are inner- vated by the supraorbital and supratrochlear nerves? Which nerve provides sen- sory innervation to the eye and the septum, lateral walls, and tip of the nose? ster occipital nerve Auriculotemporal nerve = Lesser occipital nerve D= Zygomaticotemporal nerve ‘Zygomaticofacial nerve fraorbital nerve worbital nerve Supratrochlear nerve 1 = Lacrimal nerve J. = Infratrochlear nerve External nasal nerve L = Buccal nerve Mental nerve ‘The frontal nerve28 Anatomy Recall Deseribe the branches termination of the nasociliary nerve. Which branch of the naso- ciliary nerve provides sen- sory innervation to the sept tip of the nose? fateral walls, and Which branches of CN V, (the maxillary division of the trigeminal nerve) pro- vide sensory innervation to the nasal cavity? Which cranial nerve pro vides special sensory inner- vation to the nose? Describe the sensory innervation of the: Roof of the mouth Floor of the mouth, Cheek VASCULATURE OF THE FACE Arteries What is the source of arterial blood to the face? After giving off the posterior ethmoidal nerve the ciliary nerves to the irs, and a ‘communicating branch to the ciliary zzglion, the nasoeiiary nowve endl in the anterior ethmoidal nerve ancl the infaorbital nerve. ‘The anterior ethmoidal 1. Posterior inferior lateral nasal nerve 2 Posterior superior lateral nasal nerve 3. Nasopalatine nerve 4. Anterior superior alveolar nore EN 1 the olfactory nerve) —CN I passes ‘Hough the opening of the eribriform plate ofthe ethmoid bone on the way to the olfactory bulbs “The greater palatine and nasopalatine nienves (branches of CN V,, the msllary division of the trigeminal ner “The lingual nerve (a branch of CN Vy, the mandibular division ofthe trigeminal The bneeal nerve (also a branch af cNY) The external carotid arteryName the eight branches of the external carotid artery, from proximal to distal. Facial artery Describe the course of the facial artery in the sub- mandibular region. Where can the pulse of the facial artery be easily palpated? Name three branches of the facial artery. Maxillary arcery Where does the ‘maxillary artery branch from the external earotid artery? ‘The maxillary artery is divided into three parts by which muscle? Where does the pterygo- palatine part of the ‘maxillary artery run in rela- tion to the lateral pterygoid muscle? Chapter 2/ The Head 29 1. Superior thyroid artery 2 Ascending pharyngeal artery 3. Lingual artery 4. Facial art 5. Occipital artery 6. Posterior auricular artery 7. Superficial temporal artery 8. Masillary artery ‘The facial artery arses from the external carotid artery above the hyoid bone ascends deep to the digastric and stylohyoid muscles and then behind the submandibular gland, hooks around the inferior border ofthe mandibular body and then enters the anterior margin of the masseter muscle. 1. Inferior labial artery 2. Superior labial artery 3. Lateral nasal artery At the posterior border of the ramus of the mandible, within the parotid gland “The lateral pterygoid Between the two heads30 Anatomy Recall Identify the branches of the ‘maxillary artery on the following figure: Supartca enpera arery Mastin arery Name the five branches of the masillary artery within the infratemporal fossa. Which branch of the max- illary artery supplies the: External auditory meatus? ‘Tympanic membrane? B = Middle meningeal artery Anterior tympanic artery D= Deep auricular artery E = Masseter artery F = Sphenopalatine artery orbital artery Posterior superior alveolar artery Descending palatine artery Buccal artery Inferior alveolar artery 1, Deep auricular artery 2. Anterior tyimpanie artery 3. Middle meningeal artery 44 Accessory meningeal artery 5 Inferior alveolar artery ‘The deep auricular artery “The anterior tympanic arteryDamage to which artery resulls in an epidural hematoma? How does the middle men- ingeal artery enter the skull? wi maxillary artery supplies the chin and lower teeth? h branch of the Name the six major artery in the pterygo- palatine foss Describe the course of the sphenopalatine artery and the structures it supplies. Superficial emporal artery Where can the superficial temporal arterial pulse be nerve accompanies the superficial temporal artery? ‘The superficial temporal artery gives rise to the transverse facial artery. Between which two structures does the trans- verse facial artery pass? Veins Deseribe three pathways for venous drainage in the face and sealp. (Chapter 2/ The Head 31 “The middle meningeal artery (most often damaged in fractunes ofthe temporal bone) "Through the foramen spinostan The inferior alveolar artery 1. Posterior superior alwolar artery 2. Infraorbital artery 3, Descending palatine artery 4. Artery of the pterygoid canal 5. Pharyngeal artery 6. Sphenopala ‘The sphenop perygopalatine fossa, passes through the latine artery leaves the plerygopalatine foramen, and enters the nasal cavity, where it supplies the sal sept, interior to the auricle ofthe external The aurieulotemporal nerve ‘The zygomatic arch above and the parotid duct below 1, Facial vein to the retromandibular vein tothe external jugular vein 2, Plesnses within the face tothe external jugar vein 8. Vennns (dural) sinuses to the internal jugular vein32 Anscomy Recall Describe the origin of the The retrom retromandibular vein. the superficial temporal and masilary veins unite, The supraorbital al supratrochlear veins facial vein. join to form the angular vein, whieh becomes the facial vein at the lower margin ofthe orbit The retromandibular vein which structure to form the internal jugular vein? What are the (wo major The masilary vein and the pterygoid avenues of venous drainage venous plesis from the infratemporal fossa? How does the ptorygotd Via the deep facial vein “Tho wsterior, lateral, and occipital 2 Where does the anterior To the subnanulibular and submental Iymphatie chain drain? nodes, then tothe deep cervical nodes Where does the lateral To the superficial parotid andl deep Iymphatie chain drain? parotid nodes, and then to the deep ‘cervical nodes Where does the occipital To the occipital and retroaucicular nodes Iymphatic chain drain? sau then to the deep cervied! nodes ‘THE ORAL CAVITY PALATE What roof of the ‘The hard palate (anteriorly) ‘mout palate (posteriorly) Which bones comprise the The palatine processes of the masila ancl hard palate? the horizontal plates ofthe palatine bones ‘Where is the incisive Posterior to the central incisor teeth foramen located?Which structures pass through the incisive foramen? ‘TEETH What is the normal number ‘of adult tooth? Which nerves provide inner vation to the maxillary teeth? ve innervates the Which. mandibular tect What mechanism is respons- ible when a patient ‘experiences: Ear pain as a result of « ower jaw infection? Symptoms of sinusitis as a result of a tooth infection? TONGUE the midline undersurface of the tongue? What is ankyloglossia? What nerve provides for taste sensation on the anterior two thirds of the tongue, in addition to pro- viding parasympathetic innervation to the subman- dibular and sublingual salivary glands and the lacrimal glands? Which nerve provides for taste sensation on the pos: terior third of the tongue? Chapter 2/ The Head 33 The gre lorael tor and lesser pal of the sphiewopalatin ssopalatine nerve ine arteries 3218 12 molars) isos, 4 can 8 premolars, and “The anterior, middle, ancl posterior superior alwcolar branches of CN V5 (the rnulary division of the trigeminal nerve ‘The inferior alveolar branch ofthe Irritation of the mandibular nerve Irritation ofthe masilary nerve The fren An abnormally short frenulumy (can lead tospeech impediment) “The chorda tympani, a branch of CN VIL (the facial nerve) EN 1X (the glossopharyngeal nerve)34 Anatomy Recall Which nerve provides sensory innervation to the tongue? Musculature of the tongue What is the function of the vinsie tongue museles? Which four museles com Hyoglossus muscle? Styloglossus muscle? Palatoglossus muscle? Which one of the extrinsic muscles of the tongue is not innervated by ON XII (the hypoglossal nerve)? Lesions of CN XII cause the tongue to deviate toward which side? EN Y, the mandiblar division of the ‘They help the tongue maintain its shape © 1. Gonioglossus 2. Hyoalossus 3. Styloglossus 4. Palatoglossus Origin: The gonial tubercle ofthe snancible Insertion: The inferior aspect of the tongue and the body of the hyoid bone Action: Protrudes and depresses the ton Origin: The body of the greater hom of the hyoid bone Insertion: The side ‘and inferior aspect ofthe tongue Aetion: Depresses and retracts the tongue Origin: The styloid process Insertion: The side and inferior aspect of the tong Action: Retracts and elevates tongue Origin: Aponcuroses of the soft palate Insertion: The dorsolateral sie ofthe tongue Action: evates the tongue “The palatoglossus [this muscle is innewvated by CN X (the vagus nerve) via the pharyngeal plevus] ‘Toward the side ofthe lesion (this i own asthe “wheelbarrow effet.” think of what happens when you push a ‘wheelbarrow with one hand—to which side does it tend to deviate?)Vasculature of the tongue What is the arterial supply to the tongue? What is the lymphatic drainage from the: Anterior third (tip) of the tongue? Posterior two thirds of the tongue? ‘What are the lymph nodules located under the posterior tongue called? ‘THE PHARYNX Chapter 2/ The Head 38 ‘The lingual branch of the externa carotid artery, the ascending pharyngeal artery and branches ofthe fail artery submental nodes The submental nodes andl the submandibular nodes (to the deep ‘cervical lymphatic chain) “The lingual tonsils ‘What is the pharynx? What are the superior and inferior borders of the pharynx? PHARYNGEAL MUSCLES ‘What two groups of muscles ‘comprise the pharynx? Pharyngeal constrictor (external) muscles Name the three constrictor muscles, from interior to exterior. What is the action of the constrictors? ‘A museulr tube through which food and ‘water pass tothe esophagus and air passes to the laryns, trachea, andl hangs The pharyns extends from the base ofthe skull to vertebra C 1. Estemal circular layer the constrictors) Internal longitudinal ayer Superior constletor Middle constrictor Inferior constrictor By constricting in a coortinated fashion, these muscles push food into the esophagus. Constriction is under autonomie control36 Anatomy Reel Overlapping of the pharyngeal constrictors creates four gaps that allow: structures to acess the pharynx. Where are these aps located? What is the origin of the: Superior constrictor? Middle constrictor? Inferior constrictor? Longitudinal (internal) muscles Name the three longitudinal internal) museles of the pharynx. What is the action of the Jongitudinal museles? What is the origin ofthe: Palatopharyngeus musele? Salpingopharyngeus muscle? Stylopharyngeus muscle? What is the common in- sertion of the longitudinal muscles? 1. Superior ta the superior constrictor 2. Between the superior snd middle constrictors 3. Betwcen the middle and inferior 4. Inferior tothe inferior constrictor ‘The pterygoid hamulus, pterygo mandibular raphe, and posterior imloivoid line of the nade The stylohyoid ligament anel hyoid bone The thyroid and ericoid cartilages of the The median raphe ofthe pharyis (ie, the smline in the posterior ofthe pharyns The pharyngeal and superior laryngeal branches of CN X (the vagus nerve), via the pharyngeal plexus 1. Palatopharyngens muse 2, Salpingopharyngens muscle 3, Stylopharyngeus muscle These niscles ras the phanyn and nis curing swallowing snd spea ‘The hard palate (palaro-) The eartilaginons enstachian tube (saipine means tube" in Latin) The styoidl process (stylon "The posterior and superior border of the Uyroid cartilageWhat is the innervation of the longitudinal muscles? PHARYNGEAL REGIONS What are the three divisions of the pharyns? Hdentify the labeled. structures on the following posterior view of the pharyngeal region: ronmoo oo (Chapeer2/The Head 37 “The palatopharyngens muscle and the salpingopharyngens muse re innervation from CN X (the vagus nerve) via the pharyngeal plesus. The ilopharyngens muscle is innervated by IN IX (the glossopharyngeal nerve! “The nasopharyns, oropharyns, and laryngopharynx Nasal septum Nasal eavity Eustachian (auditory) tube Uvula38 Acstomy Recall Nasopharynx What structure forms the boundary between the nasal cavity and the nasopharyns? Which Iymphoid tissue collection protrudes from the posterior roof of the nasopharynx? Which structure connects) the tympanic cavity with the nasopharynx? Where in the nasopharynx is the opening of the ‘eustachian tube? Which muscle attaches to the eustachi Oropharynx What forms the border between the oral eavity and the oropharynx? What are the superior and inferior borders of the oropharynx? Which two folds bound the orophirymy katerally? What lies between these two folds? What is the name of the inferior projection from the ‘midline of the soft palate? F = Toye G= Middle constrictor musele piglotis 1 = Arytenoid musele Piriform recess K= Inferior constrictor nmasele The choanac, a hinge pent posterior extent of the nasal eaity The pharyngeal tonsils ‘The cuastachian tube Inthe later all The Ipingopharyngeus wnsce The palatoglossl arch (Formed by underlying muscle of the same name The soft palate (superiorly) and the superior border of the epiglttis The palatoglossal arches 1 palatophanyngeal ‘The palatine tonsils (within the tonsil The vata (als kono as “that litle thing atthe back of your throat‘What is the sensory inner- vation of the oropharynx? List the five muscles of the soft palate. Which musele is responsible for elevating and retracting the soft palat Laryngopharynx What isthe laryngopharyne Posteriorly, the laryngo- ppharyns is related to which vertebra What are the superior and inferior margins of the laryngopharyns? ‘THE EYE AND ADNEXA CChopter2/TheHesd 39 ENIX (the glossopharyngeal nerve 1. Tensor vli palatni muscle 2. Levator vel palatin’ usc 3, Palatoglexsus muscle 4. Palatopharyngeus muscle 5. Muscuhis wwulae anisele The levator vel palatin The portion of the pharynx that lies posterior tothe lays Vertebrae C106 Superior: The upper border ofthe ‘pilots Inferior: The lower border ofthe ericoid cartilage (Le, the beginning ofthe trachea) EYEBALL Identify the structures on the following figure of the vom»40 Aratomy Recall Chambers of the eye ‘The lens lies between which two structures? “The irs divides the space hetween the Tens and cornea into which chambers? What fills these chambers? ‘Trace the flow of aqueous humor. Obstruction of the canal of Schlemm can lead to which clinical condition? What are the con of glaucoma? equences ‘Ocular tunics What are the three ocular tunis? Fibrous tunic What two structures form the fibrous tunie of the eyeball? A= Comea B= Ins C= Ciliary body D> Lateral rectus mu E=Sclera acuta (a part ofthe retina) Aqueous humor = Ciliary processes Suspensory ligament (zonular fibers) reas bevy hood Dptic dise ON IL (the eptic nerve) “The irs (anteriorly) and the vitreous body (posteriorly) “The anterior and posterior chambers Aqueous humor Made by the ciliary processes, the acjueons humor enters the posterior chamber lows into the anterior chamber (via the pupil), and is drained from the: anterior chamber via the canal of Seblemm, Glaucoma The resultant increase in intraocular pressure can ease retinal damage and blindness The fibrons tunic, the vasenlar tun, and the retina The sclera (covers the posterior five sisths of the eyeball) and the comea (covers the anterior one sith of the eyeball)Chapeer 2/ The Head 41 Which structures pierce the 1, ON IT (the optienerve) sclera? 2. The central artery of the retina, a branch of the ophthalmic artery encased within the dural sheath of cnn) 3, The ciliary nerve, artery, and vein What is the function of the Refraction of ight What is the name of the site The limbus where the cornea and the sclera meet? Vascular tune Which three structures ‘The choroid the ciliary body (i. the comprise the middle vay- ciliary muscle and the eiliary processes), cular tunie of the eyeball? nthe iris Which structure is respons: The choroid ile for nourishing the retina? Contraction of the eiiary muscle convexity of the lens? When the lens is focusing Ie flattens. Fattening of th con distant objects, which achieved by relaxation of the ciliary change occurs within it? muscle, which leads to contraction of the suspensory ligament lens is atis the nerve supply to Parasympathetic bers from CN II (the the ciliary musele? ‘ciilomotor nerve, via the short ellary nerves (which in turn, are sent from the ciliary ganglion) What is the name of the “The iris (ie, the colored part of the eye} central pigmented dia- phragm in the middle eye layer? What isthe central aperture The pupil of the iris called? Which type of fibers innervate: ‘The sphincter pupillae __Parasymmpathetie fibers from GN HT (the Ge. the eireular musele —_ocilomotor nerve), via the short elliary fibers of the iis)? nenves from the ciliary gangho42 Anatomy Recall ‘The dilator pupil the radial musele fibers of the iris)? Retina What are the two layers of the retina?’ Where are the photo- receptors (ie., rods and Which structures are specialized for vision in dim Tight? Which structures are specialized for visual 1 and color vision? ‘The greatest visual acuity is found on which portion of the retina? ‘What is the name of the central depression in the macula? Axons from ganglion cells of the retina converge to form which structure? ‘What is the name of the origin of CN Hon the retina? What is the center of the optic dise called? Innervation of the eye What is the name of the parasympathetic ganglion in the posterior orbit, lateral to the optic nerve? Sympathetic Bbers, via the long ciliary ‘The pigmented retina and the neural retina In the neural retina Rods Cones The macula (near the center) ‘The fovea centrals (contains only cones) Tr the optie nerve) ‘The optiedise ‘The optic cup ‘The ciliary ganglion‘The ciliary ganglion trans: mits parasympathetic fibers to which structures via the short iliary Which nerve provides the sense of sight? Why is CN 11 unusual? ‘Where does the optic nerve from one eye join the optic nerve from the opposite eye? Vasculature of the eye ‘The optic dise is pierced hy which blood vessel? What ean result from ‘occlusion of the central artery of the retina? Which feature of the central artery of the retina makes its occlusion such an emer gency? ‘What is the venous drainage from the orbit? Chapeor 2/ The Head 43 ‘The sphincter papillae and eiiary muscles CN IH (the optic nerve) Itis invested by all thrce layers of ‘meninges (Le. the pia mater, the oid mater, and the dura mater) out its course, Therefore, ial pressure (as may increased intracr ‘occur with tumnors or bleeding) is transmitted to the back of the orbit via the subarachnoid space, which contains cerebrospinal fluid (CSE), This characteristic retinal abnormalities that may be noted! on ophthalmoscople At the opti ebiasm ‘The central artery of the Instant blindness Itisanend artery [ic the area supplied by the central artery ofthe retina has no collateral (alternative) circulation) “The superior and inferior ophthalmic veins, draining into the cavernous [ene ofthe venons (dural)44 ostomy Recall Musculature of the eye Define the action of each of the following museles: olation: Moves the eyeball superiorly and laterally In conjunction with the inferior oblique muscl Moves the eyeball superiorly Superior rectus muscle In Inferior rectus muscle In isolation: Moves the eyeball inferiorly ‘andl medially In conjunction with the superior “oblique muscle: Moves the vycball inferiorly Medial rectus muscle Adducts the eyeball Lateral rectus muscle Alducts the eyeball Superior oblique muscle In isolation: Moves te eychall inferiorly nd laterally In conjunction with the inferior reetus muscle: Maes the eyeball inferiorly Inferior oblique muscle In isolation: Moves the eyeball superiorly andl medially Tn conjunetion with the superior rectus muscle: Moves the eyeball superiorly How do the oblique muscles Medllly as well asin the vert move the eyeball? plane woe the eye straight up or down, the How do they move the eye To «sroernit the reeti muscles—the straight up and down? obi inferior ablique works with the rectus, and the superior oblique works sith the inferior rectus ‘Turning the eye medially The superior and inferior obliques and looking up and dow: tests which muscles? ‘Turning the eye laterally The superior and inferior reeth and looking up and doswn tests which muscles?‘What is the origin, course, and insertion of the superior “oblique muscle? What is the origin and in- sertion of the inferior “oblique muscle? EYELIDS What is the name of the longitudinal opening be- tween the upper and lower ‘eyelids? What is the name of the mucous membrane lining the inner eyelids an anterior surface of the eyeball? Which muscle closes the eyelid? Which muscle opens the eyelid? What is the origin and in- sertion of the levator pal. pebrae superioris muscle? wi yervates the levator palpebrae superioris muscle? LACRIMAL APPARATUS Tears are produced by which gland? ‘Trace the flow of tears from the lacrimal gland to the Chapter 21 The Head 45 From the body ofthe sphenoid ame, the ‘muscle forms tendon that rns anteriorly tu reach the trades, where turns posteriorly and courses laterally to insert fon the sclera honeath the superior reetns Origin: The floor ofthe oxbit Insertion: Tho selera, beneath the lateral rectus “The palpebral fissure ‘The conjunctiva The orbieularis oeul The levator palpebrae superiors (assisted by the superior tarsal muscle) ‘Origin: The lesser wing ofthe sphenoid bone Insertion: The skin of the upper eyelid “The superior division of CN 11 (the ‘oculomotor nerve) “The lacrimal gland ‘Tears from the lacrimal gland enter the ‘eye at the upper orbit, eireulate across the ‘comea, gather inthe lacus Iaerimalis, and center the lacrimal canaliculi, which open the lacrimal sae. The nasolacrimal o the inferior neatus of the nose46 Aestomy Recall is the name of the ‘opening into the lacrim located medial eye? Which structure passes through the nasolacrimal What is the innervation of the lacrimal gland? In addition to the lacrimal land, what other structures fare innervated by the lacrimal THE EAR The prmetun Incrimalis ‘The nasolucrimal duct Parasympathetie fibers from CN VIL (the facial nerve) travel from the lari nucleus tothe plerygopalatine ganglion and thew to CN Vy (the maailhay division of the trigeminal nerve). From CN Vy, the fibers travel to the lerimal gland via the lacrimal nerve. Note: Fibers travel with CN Vy but originate with NVI. ‘The conjunctiva and the skin ofthe eyelid ipper What are the three general parts of the ear? ‘The sensory organs for hearing and balance lie within which part? EXTERNAL EAR Which two structures ‘make up the external What is the function of the auricle? The external ear, the middle ear (tympanic cavity), and the inner ear (Uabyrinth) The inner ear The antiele and external auditory meatus Iecalleets sound vibrationsChapeer 2/ The Head 47 Adentify the labeled structures on the fallow- is 3 ( ; \) )/ c ent | — So) : x ‘The greater auricular and lesser bceipital nerves (beanches from the cervical plexus 3. The auriculotemporal nerve, a branch of EN V, (the mandibular branch of the trigeminal nerve) Which portion of the exter ‘Theesternal third nal auditory meatus is formed from cartilage? Which nerves innervate the The wuriculotemporal and auricular external auditory meatus? nerves48 Anatomy Recall Which three arteries suppl the auricle and external auditory meatus? What are the two means of venous drainage from the auricle and external audi tory meatus? Which structure lies at the end of the external auditory meatus, marking the medial boundary of the external ear? How many layers make up the tympanic membrane? Label the structures on the following figure of the tympanic membrane: Which nerves innervate the: Outer surface of the tympanic membrane? le posterior auricular artery ( branch of the external earotid artery) “The deep auricular artery (a branch of the maxillary artery) 3, The auricular branch of the superficial tetuporal artery ‘The extemal jogular and maxillary veins, and the pterygoid plexus ‘The tympanic membrane “Thive (two epithelial layers and an intermediate flbrous layer) A= Flaceid part B= Anterior mallear fold Lateral process of the malleus Lande of the malleus Umbo Posterior maller Fld “The anneulotemporal and auricularChapter 2/ The Head 49 Inner (medial) surface of The tympanic branch of CN IX (the the tympanic membrane? glossopharyngeal nerve) MIDDLE EAR (TYMPANIC CAVITY) ‘The middle ear is a space The pe within which bone? fous part of the temporal bone What are the boundaries of the middle ear: Superiorly (i.e. the roof}? The tegmien tympani (a thin plate of hone that & part ofthe petrous temporal bone) Inferiorly (Le., the floor)? The jugular fost and a thin plate of bone Anterior? The carotid canal Posteriorly? Masto air cells and the masts antruin Laterally ‘The tympanic membrane Medially? “The tera wall of the ner ear An opening in the anterior The eustachian tube wall of the middle ear exists for which structure? ‘The eustachian tube con. ‘The nasopharynx ncets the middle ear with which space? Contraction of which two The tensor wel palatink and muscles opens the eusta- —_salpingopharyngeus muses chian tube? Which three nerves inner- 1. ‘The auriculotemporal nerve vate the middle ear? 2 The tympanic brunch of CN IX (the lossopharyngeal nerve) 3. The auricular nerve Which three bones The mall the middle ear? ‘ossicles, sometimes referred to as “the hammer, anvil, and stirrup,” respectively, snes nel stapes (the three became of their shapes) Which ossiele attaches to The malleus the tympanic membrane? Name the two openings on The oval window and the round window the lateral wall of the inner50 Anatomy Recall Upon which opening does the foot plate of the stapes rest? Name the two muscles of the inner: What is the origin and in- sertion of the: Stapedius muscle? ‘Tensor tympani muscle? What is the smallest skeletal the human body? muscle Contraction of which muscle prevents loud noises from injuring the inner eat? ‘What is the function of the tensor tympani muscle’ Which nerve innervates the stapedins muscle? tensor tympani muscle? three arteries supply the middle ear? The oval window ‘The stapedius and tensor tympani nuscles Origin: The posterior wall of the ‘ymnpanna Insertion: The neck of the stapes Origin: The cartilaginous portion of the ‘eustachian tube Insertion: The handle ofthe malleus Tho stapedtins muscle The stapedtius muscle It dampens vibrations of the malleus. ‘The chorda tyimpani, a branch of CN VIL (the facial nerve) ENV; (the masillary division ofthe trigeminal nerve) 1. The posterior auricular artery terior tympanic artery 8. ‘The caroticotympanie artery INNER EAR (LABYRINTH) Which bone houses the “The petrous portion of the temporal boneCChopeer 2/ The Head $1 Which three structures L. The vestibule make up the bony labyrinth? 2. The eochles 3, ‘The semicircular eanals| Which structures comprise 1. Tho ntriclo and saceule (housed in the the membranous labyrinth, vestibule) series of communicating 2. The cochlear duct sacs and duets that is sus- 3, The semicircular duets pended in the bony Tabyrinth? Which type of fluid is found Perlymmph within the bony labyrinth, surrounding the mem- Dranous labyrinth? Which type of fluid fills the ‘membranous labyrinth? wlolymph What is the arterial supply The labyrinthine (internal acoustic) to the inner ear? artery, branch of the busilar artery tration of the middle and amooe emir canal ancl duct alleus tapes = External anditory meatus eject52 Anitomy Recall F = Tympanie membrane G= Cochlew and cochlear duct 11> Tympanic ewity 1 = Eustachian tube Cochlear apparatus After vibrations from the Excitation ofthe tympanie membrane external ear cause the tym- causes the ossicles to move, The stapes panic membrane to vibrate, (.e.the final ossile) then transinits how are impulses conveyed vibrations tothe scala vestibuli via the to the cochlea (ie., the oval wins ‘organ of hearing)? Name the two compart- “The scala vestibuli (above) ancl the seala ments of the cochlea. tympani (below Which structure divides the ‘The spiral lamina cochles into the seala vest bli and the seala tympani ‘The cochlear duct, located ‘The spital ongan of Cort between the seala vestibuli and the seala tympani, con- tains which sensory organ? Where in the cochlea is the ‘organ of Corti stimulated by: Low-frequency sound Near the apex frequency sound ——_Near the base ‘The seala vest he The helicotrema scala tympani communicate at the tip of the cochlea through which structIdentify the labeled strac- tures on the following figure of the cochlear apparatus: Semicircular canals and ducts What is the function of the semicircular canals of the inner eax? Name the three semi- ‘circular eanals. Which sensory organs are within these canals? Vestibule What is the function of the utricle and the saccule? Chapear 2/ The Head 53 ‘ochlear ganglion Cochlear nerve oeliear dict Duter har cells H= Inner hair cell 1 = Buslar membrane J-= Scala tympani ‘They tense the angular acceleration of the head, Anterior (superior), posterior, and lateral Ample54 Anatomy Recall Which sensory organs are Macule found within the utriele and saccule? POWER REVIEW SKULL Name the four major 1. Coronal suture sutures of the skull. 2. Sagittal suture 3. Saami suture 4. Laambdoid suture The lambdoid and sagittal sutures intersect atthe lambda: the sagittal and coronal sutures intersect atthe bre gn What are the shapes of the Anterior: Piatnond-shaped two major fontanelles? Posterior: Te For each of the following cranial openings, name the bone where iti located, the structures it contains, and the structures it connects: Opti canal Location: Lesser wing ofthe sphenoid bone Structures contained: CN IL (the optic ‘nerve), the oplithaliie artery and the contra retinal win Structures connected: The orbit and the middle eranial fossa Superior orbital fissure Location: Betwoen the greater an lesser wings of the splienoidl bon Structures contained: CN IIL (the ‘eulomotor nerve), CN IV (the trochlear nerve), CN V) (the mic division of the trigeminal ‘EN VI (the abdueens nerve, and the superior ophthalmic vein Structures connected: The middle cranial fossa and the oxbit oramen rotundam Location: Greater wing ofthe sphenoid one Structures contained: CN V, (the mac lary division of the trigen Structures connected: The middle era: nial fossa and the pterygopalatine fossaForamen ovale Foramen spinosum Foramen lacerum Which structures pass through the earotid canal? Which structures pass through the foramen ‘magnum? Which structures pass through the internal audi- tory meatus? Which nerve passes through the cribriform plate ‘ofthe ethmoid bone? ‘What are the three bony projections from the lateral nasal wall called? (Chapter 2/The Head 55 Location: Greater wing of the sphenoid ‘bone Structures contained: CN V, (the ‘manibulae dission ofthe trigeminal nerve) and the accessory meningeal artery Structures connected: The middle the infratemporal cranial fossa fossa Location: Greater wing of the sphenoid bon Structures contained: The meningeal artery Structures connceted: The middle ildle 9: Between the sphienoid ‘petrous part of the temporal bone Structures contained: Intemal carotid artery, greater petrosal nerve, and deep petrosal nerve Structures connected: The middle and posterior cranial fossae and the neck ‘The internal carotid artery and sympathetic nerves ‘The medulla oblongata, CN X1 (the spi accessory nerve), the vertebral arteries, the venous plests, and the anterior and posterior spinal arteries GN VI the facial nerve) and GN VILL {the vestibulocochlear nerve) EN I (the olfactory ner) “The nasal conchae56 Anatomy Recall ‘The nasal cavity is divided to four passages by the nasal conchae. Name these passages and describe their location. ‘The inferior meatus con- tains the opening to wh structure? skull bones have Describe where each para- nasal sinus opens into the nasal cavity: Anterior ethmoid sinus, Posterior ethmoid sinus Frontal sinus Maxillary sinus Sphenoid sinus The three idle, and inferior) lie below the respective conch, -alus (superior, the sphenoetIuodl reeves lies above the superior concha, ‘The nasoluerimal duct “The frontal, masilary, ethmoid, and sphenoid bones Middle nasal meatus Midale nasal meats Superior nasal meatus Middle nasal meatus Mie nasal meatus Sphenocthmoidal recess SCALP AND SUPERFICIAL AND DEEP FACE What are the five layers, of the scalp? What nerve innervates the muscles of facial expression? Name the five terminal branches of the facial nerve Name the four muscles of ‘mastication, SCALP ski Connective tissue Aponesirosis Loose connective tise Peviostenn EN VU (the facial nemo) ‘Temporal, ygomatie, buccal, mandibular and cervical Masseter TemporalName the eight branches ‘of the external carotid ‘artery; from proximal to distal. ‘ORAL CAVITY Which four museles com- lature of the tongue? Which tongue muscle is NOT innervated by CN XII (the hypoglossal nerve)? Lesions of CN XII cause the tongue to deviate to which side? Describe the sensory innervation of the: Anterior tongue Chapter 2/ The Head 57 GN V, (the mandibular division of the trigeminal nerve) ENV (the trigeminal nerve) Smell: CN I the olfactory nerve) al sensation: CN V, and CN Vy (the ophthalinie and masilary divisions ofthe trigeminal newe Ge 1. Superior thyroid artery 2 Ascending pharyngeal artery 3. Lingual artery 4. Facial artery 5. Occipital artery 6, Posterior auricular artery 7. Masilary artery 8. Superficial temporal artery 1, Geniogloseus 2 Hyoglossus 3. Styloglossus 4. Palatoglossus The palatoglossus snuscle (inervated by EN X, the vagus nerve) ‘The side on which the lesion is located. Sensation: a branch Of CN Vy, the mandibular division of the trigeminal nerve ‘Taste: The chorda tympani, a branch of (EN VII (the facial nerve) igual werve58 Anatomy Recall Posterior tongue GN IX (the glossopharyngeal nerve) and EN X (the vagus nerve), for both sensation ane taste PHARYNX: What are the two major 1. The pharyngeal constrictor (external) ‘groups of pharyngeal rmuseles, consisting ofthe superior muscles? ‘constrictor, the middle constrictor, and the inferior constrictor 2. The longitudinal (intemal) muscles, consisting ofthe palatopharyngeus, salpingopharyngeus, and sylopharyngeus muscles What are the museles of L. Tensor vel palatini the soft palate? 2. Levator vei palatint 3. Palatoglossus 4, Palatophanngeus 5. Museu uvulae Which of these muscles is not innervated by CNX. (the vagus nerve) Which nerve provides Nasopharyns? GN Y; (the maxillary division of the trigeminal nerve) Oropharynx? CN IX (the glossopharyngeal nerve) Laryngopharyns? EN X (the vagus nerve) ‘The palatine tonsils lie “The palatine tonsils ae located between between which two arches the palatoglossal and palatopharyngeal (folds)? arches, which form the boundary ofthe oropharynx. Don't confuse the uvula with the palatine tonsils: the uvula bangs from the midline palate! Which structure connects ‘The eustachian the the tympanic cavity with the lateral wall of the nasopharynx?eve CN IIT (the oculomotor nerve) innervates which muscles? CNV (the trochlear nerve) innervates which muscles? EN VI (the abducens nerve) innervates which musele? Describe the innervation of the: Sphincter pupillac Dilator pupillae Which structures are specialized for: Vision in diem light? Color vision? FAR Which three bones are ‘contained in the middle ‘ear? CChapter2/ The Head 59 Superior division: The superior rectus ‘and levator palpebrae superiors muscles Inferior division: The medial and inferior reeti and the inferior oblique uscles: in addition, the inferior disision of CN IIT provides urasympathetie fibers to the ellary le and sphincter papillae ‘The superior and inferior oblique muscles The lateral rectus muscle Parasympatheti fibers (via CN II, ciliary ganglion, and the short eliary nerves) Sympathetic fibers via the long eliary 1. The malleus (attaches tothe tympanic ‘membrane, the link to the external 2 The ineus 8. The stapes (attaches to the oval ‘window of the cochlea, the link to the finer ear) Remember, the round window is the end of the cochlea,{60 Anatomy Recall, Name the two muscles of 1. ‘The stapedlis wnisele innervated by the inner ear and the the chorda tympani, Branch of nerves that innervate them, CN VII The tensor tympani (iaervated by eNYy) Which three structures The vestibule, the semnicireutareanals make up the bo of the inner ea labyrinth and the evelilea Which fluid fills the bony Perilymph labyrinth? Which sensory organs are Maculac (sense linear movements of the found within the utricle head) and saccule? What is the arterial supply The labyrinthine artery (a branch of the tothe inner ear? basilar artery)INTRODUCTION The Central Nervous System What are the three com ponents of a neuron? What is the difference between a ganglion and a What is the difference between grey matter and white matter Which structures comprise the CNS? Which bony structures pro- tect the CNS from injury List three basic functions of the CNS. How many spinal nerves and eranial nerves leave the C ‘THE BRAIN L. Cell body 2 Dendrites (carry impulses tothe cell body) 3, Axon (earres impulses away i cell body) Ganglion: A collection of ell bodies ‘outside of the CNS Nucleus: A collection of ell bodies ‘within the ONS. Grey tatter (cell bodes) is linated; white matter “The brain an the spinal cord The skull and the vertebral colum 1. Processing of 2. Coordination of vo involuntary behaviors 3. Higher-order cognition 31 spinal nerves and 12 er (Think, “Eat 31 flavors in 12 months") GROSS REGIONS OF THE BRAIN Grossly, what are the three recognizable parts of the brain? L. Cerebrum 2 Cerebellum 3. Brain stem “62 Anatomy Recall Cerebrum What is the cerebrum? Where in the cranium is the cerebrum located? How is the cerebrum divided? What separates the cerebral hemispheres from one another? What are gyri and sulei? Identify the four lobes of the brain on the following, figure: ‘The largest part of the brain, concerned mostly with higher-onder thinking ‘The anterior and middle eranal fess ‘Tho cerebrum i divided into right andl left hemispheres. Each hemisphere contains four lobes. Each lobe is divided unber of ye (olds). Each gyrus ‘contains organized collections of neurons. “The longittinal(interhemispheric) fissure are elevated folds on the surface of the cerebral hemispheres. Sill are the irooves that separate the gyri from cael other. This architecture inereases the surface area of the brain A= Frontal lobe B= Parietal lobe C= Temporal lobe D= Cecipital lobeWhat separates the: ‘rontal lobe from the parietal lobe? Parietal lobe from the ‘Temporal lobe from the frontal and parietal lobes? On the cerebral cortex, Motor signals? Where is the superior tem- poral gyrus located, and what is its role? Where is the visual cortex located? Which temporal lobe structure is involved with, What is the cerebrum composed of? What white matter structure ‘connects the hemispheres? What are the basal ganglia? Which five nuclei comprise the basal ganglia? Chapter 3 The Central Nervous Sytem 63 The central suleus “The parieto-occiptal suleus “The lateral suleus (.e., the span fissure) The posteentral gyrus (ic. the part of the parietal lobe immediately adjacent to the central sulcus) ‘The precentral gyrus (ie, the part of the frontal lobe immediately adjacent to the central suleus) ‘The superior temporal gyrus is located immediately below the Sylvian fissure and {s concerned with aueltory stm. In the occipital lobe The hippocampus Gray matter (superficial) and white matter The corpus callesunn Deep rey matter—specific nuclei pesitioned deep inthe base of the cerebral hemispheres that are involved in motor fimction 1. The caudate nucleus 2. The putamen 3. The globus pallidus64 Anatomy Recall arteries supply blood to the cbrum? Cerebellum, Where in the eranium is the cerebellum located? Wha is the main role of the ‘hellum’ ‘What clinical manifesta- patients with cerebellar lesions? characteris Which three arteries supply the cerebellum? Which major structures are part of the of the bra Which physiologic syste the hypothalamus involved with? What is the myclencepha- Jom (ic. the medulla oblongata)? What are the “pyramids?” ‘The substantia nigra ‘The subthalamic nucleus Auterior cerebral artery Middle covebral artery Posterior corer In the posterior cranial fossa Coordination ol adjustnent wennent and postural Unsteady gat. poor eoordination of movement, tremor ofthe hands 1, The posterior inferior cerebellar artery (abranch of the vertebral artery) “The anterior inferior eorebellar artery (abranch ofthe basikir artery) 3. The superior cerebellar artery Dranch ofthe basilar artery “The thalanias and hypothalamus ‘The thalamus The endoc Ihypothalannas is snvolvod in th fe system —the hormones to the pituitary gland “The portion of the brain stem that ‘connects the pons with the spinal eord The two swellings of the medulla oblongata where the descending fibers {rom the precentrl evrus eros tothe contralateral sideMENINGES OF THE BRAIN What are meninges What are the three meni geal layers, from superficial to deep? What separates the dura mater from the arachnoid mater? What causes a subdural hematoma? What isthe space between the arachnoid mater and the pia mater referred toas? How is the subarachnoid space different from the subdural space? Dura mater Deseribe the (wo layers of dura mater What artery provides the major blood supply to the dura mater, and what is ita branch of? | Describe the course of the middle meningeal artery. What elinieal entity results from rupture of the middle meningeal artery? CChapeer 31 The Central Nervous System 65 Protective coverings 'membeunes”) ever the surface ofthe brain 1. Dura mater 2. Anuchnoid mater 3. Pia mater The subdural space (a potential space) Rupture of the gerebral veins as they pass froin the brain surface into the venous chara) sinuses ‘The subi nai space Unlike the subdural space, the subarachnoid space is true space. Tt ‘contains cerebrospinal fluid (CSF), which ‘eushions the bra The outer dural layer is adherent to the bone. The inner dural layers the trae al component) The middle meningeal artery, branch of the malay artery It branches from the maillay artery in the infratemporal fossa, enters the cranium via the foramen spinosun, then runs ina grove on the inner aspect of the temporal bone Epidural hematoma66 Anatomy Recall What are the four dural folds? What is the function of the dural folds? Fale cerebri Where is the fals cerebri located? What structures does the fals corebri attach to anteriorly and posteriorly? Which structures are found in the inferior and superior margins of the falx cerebri? Tentorium cerebel Where is the What are the attachment points for the tentorium corebel Anteriorly? Laterally? Posteriorly? Which dural structure is continuous with the tentorium cerebelli? Fate cerebeli Where is the faly cerebelli located? 1. The fale coreb 2. The tentorium cerebelh 3. The fale cerebell 4 The diaphragina sella They separate the eranial eaity into compartnents Inthe longitudinal fissure (i. the fissure that separates the cerchral hemispheres {rom one another) ‘The erista gall of the ethmoid bone (anteriorly) and the internal oceipital prot nerance (posteriorly) The inferior and superior sgittal sinuses, respectively ‘The tentorium cemebelh separates the ccerebruin fron the bean stom and cerebellum, it es horizontally between the occipital lobes ofthe cerebral hemispheres and the cerebellum, Strictures below the membrane referred to as “infratentorial.” ‘The elinoid processes ‘The temporal and parietal bones “The occipital bone “The fale cerebri In the longitudinal fissure between the tsv0 cerebellar hemispheres (nt: the 160 {aly structures nim between hemispheres)Diaphragma sellac ‘What structure does the diaphragma sellac form a “rool” over? A small opening in the center of the diaphragm sella transmits which structure? Where does the diaphragma sella attach? What important structure lies on top of the diaphragma sellac? ARACHNOID MATER Chapter 3 The Central Nervous Sytem 67 The p ary gland The pituitary stalk infumelb To the clinoid processes “The optie chias What does the term “arachnoid” translate to? Pia mater What is contained in the pia mater? VASCULATURE OF THE BRAIN Arteries Which two sets of arteries constitute the blood supply of the brain? Incernal carotid arteries Describe the course of the internal earotid artery. Name the four parts of the internal earotid artery. Blood vessels, blood vessels, and blood vessels internal carotid arteries and the vertebral arteries ‘The internal carotid artery enters the shall through the carotid canal (located in the petrous portion ofthe temporal bone), passes thros nters the subarachnoid L 2 Petros part 3. Cavernous part 4 Cerebral part68 Anatomy Recall, Does the internal carotid artery give off any branches in the neck before enter the cranium? Which structure is the most perfused tissue in the body (per gram of tissue)? Which branch of the inter- nal carotid artery joins the posterior cerebral artery? Each internal carotid artery ‘ends by dividing into which two arteries? Which is larger—the middle cerebral artery or the anterior cerebral artery’ Deserihe the course of the anterior cerebral artery. What areas are supplied by the anterior eorebral artery? Vertebral arceries Describe the course of the vertebral arteries. What structures are sup plied by the vertebral 1. Superior hypophyseal artery 2. Inferior hypophyseal artery 3, Ophthalmic artery 4. Posterior communicating artery 5. Anterior chonoid artery The pituitary gland, which is supplied by the superior and inferior hypophyseal arteries, fs more perfused than the heart brain, or kidney (per gram of issue}! “The posterior communicating, ‘The anterior cerebral artery and th alle cerebral artery The middle cerebral artery It proceed tothe longitudinal Linterhemispheri) fissure, following a couryy path around the corpus callosum, "Tho medal surtices ofthe frontal and parietal lobes, including the area of the motor cortex that controls leg “They arse from the first part of the subclavian artery, ascend through the transverse foramina of vertebrae C 8, and then access the intracranial space via the foramen magn The neck muscles and the medal oblongataWhat are the clinical char- acteristics of a vertebral artery infarction? What are the three major branches of the vertebral artery? Which of these branches is the largest? ‘The vertebral arteries join ‘on the surface of the pons to form which structure? What structures are supplied by the basilar artery? What are the clinical char- acteristics of a basilar artery infarction? What are the four major branches of the basilar artery? (Chapter 3/ The Central Nervous Sytem 69 Lateral medullary syndrome of Wallenbergis the result of an infarction ofthe lateral part ofthe medulla ‘oblongata: ts many features are caused bby damage to the spinothalamic tract and cranial nerve origins: ontralateral loss of pain and tomperature sensation inthe trunk and extremities 2. Ipsilateral loss of pain and temperature sensation inthe face Dysphagia and dysarthria ertigo, nausea, and nystagns Ipsilateral Homer's synde wee Anterior spinal artery Posterior spinal artery Posterior inferior cerebellar artery ‘The posterior inferior cerebellar artery ‘The basilar artery Part ofthe cerebellum andl the pons ‘Signs and symptoms ofa basilar artery {infarction are related to injury to the ‘cerebellum and brain stem, notably the reticular activating system (which controls consciousness) and the corticospinal tracts (oshich are involved vith motor control) 1. Coma or death 2 Quadeiplegia 3, Impaired vision (asa result of visual cortex damage) 4, Disordered eye movement (as a result ‘of cranial nerve damage) 5. Cerebellar ataxia Pontine art Anterior inferior cerebellar artery Labyrinthine artery Superior cerebellar artery70 Anatomy Recall ‘The basilar artery ends by dividing into which vessels? What is the most common site for a berry aneurysm? What is « berry aneurysm? What isthe elinieal sign ficance of a herry aneurysm? Circle of Willis What is the circle of Wi Adentily the arteries on the following drawing of the circle of Willis: mo Oo > Mt ‘The left and right posterior cerebral arteries The biftreation of the basilar artery A congenital dilatation ofa blood vesse wvithin the bra tay rupture, leading to subarachnoid Jemorshage. or it nay eause symptoms by ccularging and impinging on other structures, “The circle of Willis, an arterial anastomosis network on the base of the brain, formed by the com the right and left internal carotid arteries and the right and left vertebral arteries ‘within the eran nication ofCerebral veins and venous (Gural) sinuses What is special about corebral veins? What great cerebral vei Galen)? the origin of the (of What are venous sinuses? ‘connecting the sealp and t ‘venous sinuses, form an anastomosis within the diplos? Which veins directly con- rect the venous sinuses with the sealp? What vein do the venous imately drain (Chapter 3 The Cental Nervous System 7H A = Anterior cerebral artery B= Anterior commun C= Ophthalmic artery = Internal carotid artery E = Middle cerebral artery ting artery F = Posterior communicating artery © H= Superior cerebellar artery T= Buslararte J. = Labyrinthine artery K = Anterior inferior cerebellar artery osterior inferior cerebellar artery jertebral artery terior spinal artery Posterior cerebral artery ey are valveless cd by the union ofthe two intemal cer ‘yal veins, Channels within the dura mater that pute venous blood and CSF from the brain tothe systemie venous circulation ‘The diploic veins ‘The internal jugular vein72 Anatomy Recall Which sinus lies within the convex (superior) border of the fals corebri? Which veins empty into the superior sagittal sinus? ‘The superior sagittal sinus ends by becoming contin- ‘uous with whieh other sinus? Where does this occur? Which sinus, loeated in the free (inferior) edge of the fale cerebri, is joined by the _great cerebral vein (of Galen)? Superior sagital sinus inferior sagittal sinus igmoid sinus “The superior sagittal sinus L. The diploie veins 2. The meningeal veins 3. The emistary veins At the torcular Herophil (also kno the “confluence of sinuses”, the p where five ofthe si sinuses meetin the ‘occipital “The inferior sagittal sinusWhat is the course of blood from the inferior sagittal sinus to the inferior jugular the junction of the inferior sagittal sinus and the great cerebral vein (of Galen)? In between which dural folds does the straight sinus run? Where is the transverse sinus located? After leaving the tentorium ccerebelli, what does the transverse sinus hecome? Describe the course of the Which sinus is found on cither side of the sella turciea? Which structures provide communication between the two sides of the eavern- Which four cranial nerves are found within the lateral wall of the cavernous sinus? (Chapter 3 The Central Nervous System 73 Tnlevior suit I sinus, straight sims transverse sinus, sigmoid sinus, intemal jugular vein ‘The straight sinus Inthe tine of attachment between the fax cerebr and the tentoriuim cerebelli The transverse sinus The transverse sinus occupies the attached! mangin ofthe tentorium cerebell ‘The sigmoid sinus ‘The sigmoid sinus mins through a groove: in the mastoid part ofthe temporal hone: it then runs snteriorly and inferiosly to reach the jugular foramen, where becomes continuons with the internal jugular vein ‘The eavernous sinus Intereavernous sinuses (anterior and posterio), located between the diaphragia sellae ane! the hypophyseal fossa 1. EN TIL (the oculomotor nerve) 2. CN IV (the trochlear nerve) 3. ENV, (the ophthalnie division ofthe trigeminal nerve) o masillary division of the74 Anatomy Recall Which nerve and which 1. EN VI (the abducens nerve) vessel run inside the 2. The oplthaliie artery, a branch of the ‘cavernous sinus? internal carotid artery What is an arteriovenous A ming of arterial andl venous blood that fistula? ‘occurs when trauma results in a tear of the internal carotid artery within the Which three veins drain The superior and inferior ophthalmic (othe eavernous sinus? eins, and the great cerebral vein (of Galen) Which small sinus, Iying in The superior petrosal sinus the margin of the tentorium ceorebelli ‘cavernous si transverse sinus? Which small sinus drains The inferior petrol sinus the cavernous sinus into the internal jugular vein? Describe the two courses 1, Cavemous sinus, superior petrosal venous blood may take Sinus, transverse sinus, sigmoid sims between the cavernous Interna jugular vein sinus and the internal 2 Cavemous sinus, inferior petrosal jugular vein. sinus, internal jugular vein ‘What is infectious inflam- Cavernous sinus thromboplilebits mation of the cavernous sinus with secondary thrombus formation called? Which isthe smallest of the The oceipital sins ‘venous sinuses? Where is the occipital sinus In the attached margin ofthe fly located? cerebell Where does the occipital Into the “confluence of sinuses sinus drain? (CEREBROSPINAL FLUID (CSF) What is CSE? CSF isthe liquid that fils the subarach- noid space, surrounding and cushioning the brain and spinal cordWhere is CSF produced? ‘ame the four ventricles. What is the name of the thin wall that separates the right and left lateral ventricles? Which ventricle is con tained within the diencephalon? Which ventricle lies be- tween the pons and the cerebellum? Describe the course of CSF from the lateral ventricle to the fourth ventricle. Where is the cerebral aqueduct (of Sylvius) located? How does CSF travel from the fourth ventricle to the subarachnoid space? (Chapter 3 The Central Nervous System 75 In the vaseular choroid plexuses in the ventricles of the brain 1, Right lateral ventricle 2. Leit lateral ventricle 3. Third ventricle 4, Fourth ventride “The septum pelloeidum ‘The thind ventricle ‘The fonrth ventricle lc. interventricular foramen (of Monro), third ventricle, cerebral aquedluct (of Syivins), forth ventricle In the midbrain From the fourth ventridle, CSF passes through the foramen of Magendie (onediall) and the two foramina of Luschkx (laterally) into the eerebello- medtllay ester (4. the cisterna magna), large pool of CSF that widely separates the arachnoid mater and the pia ater76 Anatomy Recall Identify the subarachnoid cisterns on the following, figure: Which important blood vessel ies protected ‘within the pontine The posterior part of the circle of Willis is located within which cistern? How is CSF reabsorbed into the venous circulation? What are aggregations of arachnoid villi called? aterpedtinenlar cistern erebellomedullay eisters (i. the cisterna magna) D= Pontine cistem ‘The basilar artery (remeunber, the pons cand the basilar artery go together) The interpeduncuar cistern (betworn the cerebral peduncles) ‘Through the arachnoid vil, projections ‘of the arachnoid mn nto the venous (dural) sinuses Arachnoid granalationsWhere does most CSF pass into the venous blood? ‘THE SPINAL CORD (Chapter 3 The Conceal Nervous System 77 At the superior sagital sinus VERTEBRAL COLUMN, What structure supports tand protects the spinal cord? What is « vertebral foramen pine the vertebral coum What are the five regions of the vertebral column, and how many vertebrae com. prise each’ Where does the spinal cord ‘What is the tapered (cone- shaped) lower end of the spinal cord called? SPINAL NERVES What is the distribution of the 31 pairs of spinal nerves that leave the spinal cord via the intervertebral foramina? Where does spinal nerve C5 exit the vertebral col- ‘umn relative to vertebra C5? ‘The vertebral cokunn, comprised of vertebrae and intervertebral disks ‘The large central circular opening within ceach vertebra, bounded by la posteriorly, pedicles laterally, and the vertebral body anteriorly; ithe articulated vertebral column, the vertebral foramina form the vertebral canal, which houses the spinal cord and its associated structures y 24 are movable in Thoracic: 12 Coceygeal 4 (fused) Vertebral level L2 Vertebra level L3 ‘The conus medullaris Cervical: 8 Thoracic: 12 Lumbar: 5 Sacral 5 Coceygeak: 1 Above it78 Anatomy Recall Whe exit the yertebral column, relative to vertebra TS? c does spinal nerve TS Explain why spinal nerve GB exits above its associated vertebra, while spinal nerve TS exits below. What is the eauda equina (horse's tail”)? low are the spinal nerves formed? What type of information does the dorsal root of « spinal nerve trans in what direction? What type of information does the ventral root of spinal nerve transmit, and in what direction? Describe the loc: the snsory dermatome asso ited with each of the following dorsal roots: C6 Which muscles are supplied by ventral roots from: 3-052 Below it "This isa fimetion of the fact that there are 8 cerveal spinal nerves andl only 7 conical vertebra: spinal nerve C8 exits below vertebra C7 and above vertebra TI, forcing spin vertebra Tl, and 30 09, nerve TL to exit below ‘The splayed bundle of elongated spinal nerve roots canal to the termination of the spinal cord (ke, helow vertebra L2) FRoatlets from the dorsal and ventral surlaces ofthe spinal cord unite to Form the dorsal and ventral roots ofthe spinal ‘nerve. Upon exiting the vertebral cal the dorsal and ventral rots join together to form the spinal nerve. Sensory “alferent’) information, toward the spinal cord Motor (‘efferent”) inforn fron tion, away he spinal cord Radial forvarm and thumb (*is-shooter") Nipple Umbsticus Cenitoanal region The diaphragm (°C3, C4, and C5 keep the diaphragm alive)[Chapter 3/ The Cental Nervous System 79 ce Muscles ofthe hand suse? Ane phar flesors 83-85? Muscles ofthe bladder. anal sphincter. What structures does the The dor spinal nerve divide into, Imost immediately: upon wn ventral primary rami exiting the vertebral canal? Does the dorsal primary Rani convey both sensory and motor ramus transmit motor or information; rots convey one type or the sensory information? What cther about the ventral primary SPINAL TRACTS What is spinal tract? Able of asons (i, white matter) ceonnceting parts of the CNS ‘Through which spinal tracts The fasciculus gracilis and fascieulas are tactile, vibratory, and ———_cumeatus (ascending trcts ofthe dorsal proprioceptive (joint posi- column) and the dorsolateral tract of tion) sense transmitted from Lissaner the spinal cord to the brain? What type of sensory infor: Pain ane tempe mation docs the spinotha- amie tract transmit from the spinal cord to the thalamus? Where is the spinothalamic tract located? nateral aspect of the spinal The corticospinal tact (also known asthe pyramidal tact”) cerebral cortex to the spinal cord? VASCULATURE OF THE SPINAL CORD ‘What arteries constitute the sterial blood supply of the spinal cord? ‘The unpaired anterior spinal artery ‘Two posterior spinal ‘The radicular (“root”) branches af the series80 Anatomy Recall, vertebral, cervical, posterior intercostal, and lumbar arteries ‘The anterior spinal artery The two vertebral arteries (they combine isa branch of which artery? short branches to become the anterior spinal artery Which radicular artery pro- The arteriarudicularts magna, clinically vides the main blood supply known as the “artery of Adaamkiewie?” to the inferior two thirds of the spinal cord? MENINGES OF THE SPINAL CORD Name the meningeal layers The meninges that surround the spinal that surround the spinal cord are continuations of those that cord. round the brain (ke, the arachnoid mater, and dura mater) Which bony landmarks ean The ilae erests ate on a horizontal line he used to determine the with vertebrae LI-LA Tocation of vertebrae 13a? What isthe filum terminate? ex that attaches to the cocey, the most caudal extension of con tissue, POWER REVIEW What is the name of a collection of nerve cell bodies locates Within the CNS Neuron ‘Outside of the CNS? anglion BRAIN Which structure joins the The conus callosum cerebral hemispheres? What structures are separ- The lateral suleus separates the temporal lated from one another by lobe from the frontal an parietal lobes. the lateral suleus (Le. the sylvian fissure)?Which portion of the brain is concerned with: Voluntary motor ivity? Sensory data? What are the three men- Name the four dural folds that subdivide the brain. What are the two midline dural folds? Deseribe the fals cerebri. Describe the t cerebeli. What is the term “supra: tentorial” used to refer to? Each internal carotid artery ‘endls by dividing into which two arteries? ‘Through which intracranial artery does the majority of blood from the internal ‘carotid artery flow? The vertebral arteries join to form which structure? How does the basilar artery end? How does blood travel from the great cerebral vein (of Galen) back to the heart? Chapter 31 The Central Nervous System 81 The precentral gyrus “The postee rl gyrus ura mater, arachnoid mater, pla mater Fals cerebri,tentorinsn corebel cerebelli, diaphragma sllae The fabs cercbri and the falxcerebeh, “The falscercbri isthe dural fold locate! {nthe longitu ‘nwo cerebral hemispheres fissure between the ‘The tentoriun corebell i the horizontal dural fold that supports the occipital lobes andl ewers the cerebellum, ‘Strictutes lacated above the tentorium cerebell “The anterior cerebral artery and middle cerebral artery The middle cerebral artery ‘The basilar artery By dividing into the lef and right posterior cerebral arteries After Dlood passes tothe transverse s then to the sigmoid sinus, which drains {nto the internal jagular vein. The al jugular vein drains into the tering the straight sinus, the vs and inter82 Anatomy Recall Which spaces communicate through the: terventricular foramen (of Monroe)? Cerebral aqueduct (of Sylvins)? Foramen of Magendie (median aperture)? Foramina of Lusebka (lateral apertures)? What structure separates the lateral ventricles? SPINAL CORD What structure is housed in the: Vertebral canal? Intervertebral foramina? State where each of the following spinal nerves exits the vertebral ean Spinal nerve C1 Spinal nerve C8 Which artery that supplies the upper portion of the spinal cord is paired? Which artery constitutes the principal arterial supply of the inferior two thirds of the spinal cord? brachiocephalic vein, wich in turn ‘empties into the superior vena cava. The two lateral ventricles and the thi ventricle The third ventricle and the fourth, ventricle ‘The fourth ventricle and the cerebro- medullary cistern (i, the cisterna magna) ‘The fouth ventricle and the eerebro- meadllay cistern (.e, the cisterna maga) ‘The septum pellucidm The spinal cond Individual spinal nerves Above vertebra GI (ie. the atlas) Below vertebra C7 ‘The posterior artery (a branch of vertebral artery); the anterior artery is unpaired The artery of Ad4 What quality makes a nerve ‘aeranial nerve? How many pairs of eranial nerves are there? Give the names of the wv vl vin vu 1 x xt xu For each eranial nerve, state whether it earvies sensory fibers, motor fibers, or both: 1 (olfactory nerve) (optic nerve) The Cranial Nerves To be a eranial nerve, a nerve must pass through a foramen in the skull Twelve Olfactory nerve Optic nerve culomotor nerve Trochlear nerve Trigeminal nerve Abducens nerve Vestibulocochlear nerve Glossopharyngeal nerve Vagus nerve 5 Hypoglossal nerve Sensory Sensory 8#4 Aacomy Rect 1 (oculomotor nerve) IW (trochlear nerve) (trigeminal nerve) VE (abducens nerve) Vit Gfacal nerve) VIII (vestibulocochlear nerve) IX (glossopharyngeal werve) X (vagus nerve) [XT (spinal aceessory nerve) II (hypoglossal nerve) Which cranial nerves carry parasympathetic fibers? Are these parasympathetic fibers pre- or post- ‘ganglionic? Which eranial nerves earry preganglionic sympall be For each cranial nerve or group of cranial nerves, state where the nerve oF group of nerves enters or exits the brain: Motor Motor Both Motor Both Sensory Both Both Motor Motor Some Say Marry Money, But My Brother Says Big Brains Matter More 1. EN IM (oculomotor nerve) 2. EN VIE (facial nerve) 3. CN IX (glossopharyngeal nerve) 4. CNX (vagus nerve) Preyanglionic None Anterior forebrain Dienwcephalonand 1V VI,VI, and VIL IX, X, XT (cranial root), ‘and XI Where does the spinal root of CN XI (the spinal accessory nerve) originate? Cranial nerves exit which aspeet of the brain stem? What is the one exception? Which two cranial nerves are not peripheral nervous tissue? Which three cranial nerves do not originate on the brain stem? Identify each of the labeled structures on the following figure of the base of the Drain: CChagter41The Crna Nerves 85 Midbrin Pons Jometion ofthe pons and the meddlla Medulla the superior aspect of the spinal cord “The ventral (anterior) surface CN IV (the trochlear nerve) exits on the dorsal surface. ENT (the olfactory nerve} and GN I (the optic nerve) 1. EN I (the olfactory nerve) 2. CN IL ithe optic nerve) 3, CNT (the spinal accessory nerve) 1 the olfactory nerve} Dlfactory tract C= CN IL (the optic nerve) D= Optic chiase Optic tract F = CNT (the oculomotor nerve) = CNV (the trigeminal nerve) H= CN VIL (the facial nerve) 1 = CN XII (the hypoglossal nerve) J = CNXI (the spinal accessory nerve) K=CN IV (the trochlear nerve) 1.= GN Vi ithe abducens nerve) 'N VIII (the vestbulocochlear nerve) N= CN IX (the glossopharyngeal nerve) O= ENX ithe vagus nerve)86 Anatomy Recall Identify cael. of the labeled ceranial nerves on the follow- ing figure of the base of the ‘skull: a 8 c > igeminal nerve CN IX (the glossopharyngeal nerve), CNX (the vagus nerve), ad CN XP (the spinal accessory nerve) E= CN [the olfactory nerve) F = CNV, ithe opthalmic division of the Urigeminal nerve) G=EN VI ithe alxlucens n H= CN XII (the hypo CN I (OLFACTORY NERVE) What type of fibers are Special sensory fibers carried by CN 1? What is the function of Provides for the sense of smell oN Describe the origin and Approximately 20 neurosensory cells unite course of the olfactory nerve. in the superior nasal eaity to form nall neve bundles that comprise theWhat is the most common cause of anosmia inability to smell)? CN II (OPTIC NERVE) (Chapter 4 The Cranial Nerves 87 olfactory nerve, These bundles pass through foramina i the enbriform plate fof the ethmoid bone to enter the ‘olfactory bulbs in the anterior cranial Fossa, Fron the olfactory bulbs, impulses «are conveyed to cortical centers by the olfactory tracts “hronie rhinitis: other causes include Fracture ofthe eribriform plate and tumors or abscesses ofthe frontal lobe that compress the olfactory bull What type of fibers are carried by CN TI? What is the function of NIP How does CNT the orbit? Which structure ae panies the optie nerve in the optic canal? Which terms are used to describe the parts of CN I in the visual pathway? Where do the two optic nerves temporarily join together? The lateral retina becomes the optic tract on which side? why? The medial retina be- comes the optic tract on Special sensory fibers Vision Through the opti eanal ‘The ophthalie artery and optic tract Optic nenve, optic chia At the optic chiasin The ipsilateral side ‘These fibers do not erass at the optic chiasm, “The contralateral side ‘These fers do cross at the opti clasm.88 Anatomy Recall Which three sheaths enclose the optic nerve? ‘The majority ofthe optic tract terminates in which structure? ‘The optic radiations connect, sthich two structures? cN The optic nerve gers of cerebra enclosed by the three The lateral geniculate body ofthe thalamus thalarns (OCULOMOTOR NERVE) Which types of fibers are carried by CN What are the functions of CN? EN HL travels between which two arteries on the base of the brain? CN IIL passes through the lateral wall of which sinus? CN Il enters the orbit through which structure? List three other structures that also pass through the superior orbital fissure, What are some common ‘causes of CNH dysfunction? Somatic and visceral motor fers Somatic motor fibers: Innerate the ‘medial, nferior, and superior rect smus- ces, the inferior oblique rouscle, and the levator palpebrae superiors muscle Visceral motor fibers: Provide visceral ‘motor (parasympathetic) innervation to the sphineter pupillae and ciliary muscles “The posterior cerebral and superior cerebellar arteries The superior orbital fssu L. GNIV (the trochlear nerve) NV; (the opthaliie divisio trigeminal nerve) 3. CNVI (the abducens nerve) of the 1. Hemiation ofthe brain through the foramen imagem (uncal herniation) asa result of mereased intracranial pressure [eaused by an expanding intracranial mass lesion or obstruction of cerebrospinal fluid (CSE) outflow] + oF inflammatory processes involving the cavernous sinus Strokes Multiple selerosisChapter 4 The Cranial Nerves @9 cN (TROCHLEAR NERVE) otor fibers Which type of fibers are Sonnatic carried by ©N IV? What is the function Motor innervation of the superior oblique of CN IV? muscle, which moves the eyeball inferiorly ancl laterally (isolation) and inferiorly (in conjunction with the inferior What is the trochlea? A fbrocartilaginous structure attached to the frontal bone that serves asa pulley for the tendon ofthe superior oblique nusele TV exits the skull The superior orbital issure—remember ugh what opening? CN TIT (the oculomotor nerve), CN Vy, (the opthalie division of the trigeminal nenve), and CN VI (the abducens also pass theo features 1, Its the only cranial nerve to exit the Drain stem on the dorsal surfiee 2, Itis the smallest of the eranial nerves in diameter. 3, Its the only cranial peripheral Teaving the brainstem, fibers decussate before CN V (TRIGEMINAL NERVE) ENV has three main divi sions, Identify the territory of each on the following A = CNY; (the ophthalmic division B = CNVj (the masllary division 4 C= CNV) (the mandibular division)90 Anatomy Recall Which part of the face is ¢ angle ofthe mandible (innervated by not innervated by CN V? Which type of fibers are chial motor carried by the trigeminal nerve? Which division of CN V CNY, ‘carries all of the motor fibers? EN V, provides motor 1. ‘The muscles of mastication (Le, the innervation to which medial and lateral pterygoids, the muscles? masseter musele, and the temporal muscle) 2. The tensor tympani muscle 3. The tensor velipalatini musele 4. The mylohyoid muscle 5. The anterior belly ofthe digastric smusele Where does each division of CN V exit the middle cerunial fossa? foramen rotundum foramen ovale CN VI (ABDUCENS NERVE) EN Vi carries which type Somatic motor of fibers? What is the funtion “The abducens nerve provides motor of CN VP Innervation to the lateral rectus muscle (which abducts the eye). CN Vi exits the skull The superior orbital fissure (remember, through which opening? CN IIL,CN IV, and CN V, aso pass through this fssure) CN VI (FACIAL NERVE) Which types of fibers are Somatic sensory, visceral sensory, vscoral carried by the facial nerve? motor (parasympathetic) and branchial tor fibers Which muscles receive 1, The muscles of facial expressio ‘motor innervation from 2 The stapedtis muscle cx va? 3. The stylohyoid musele‘What are the sensory: functions of CN VID? ‘Which structures receive parasympathetic innervation from CN Vi What are the only two sets of glands in the head that EN VIT docs not innervate? ‘Trace the path of CN VIL from the brain stem to its ‘exit from the skull What is the greater petrosal nerve? Deseribe the course of the greater petrosal nerve. (Chapter 4/ The Cranial Nerves 91 4. The posterior belly ofthe digastric muscle (Note the symmetry with CN Vs, Which innervates the muscles of mastication, the tensor tympani nusele, the tensor vel palatini muscle the mylohyoid muscle, and the anterior belly ofthe digastric muscle.) ‘Visceral (special) sensory functions: ‘Taste (anterior two thirds of tongue) andl sensory innervation ofthe soft an Ihard palates Somatic sensory fametions: Sensory ‘innervation ofthe auricle and a sinall portion of skin behind the ear 1. The submandibular and sublingual salivary glands (via the chorda tympani branch) 2 The lacrimal glands (via the chorta ‘yimpani branch) 3. The sceretory’glands ofthe nasal and palatine mucosa (via the greater ppetrosal branch) 1. The parotid gland (note that although CN VII passes through the parotid land, it does not innervate it) 2. The integumentary glands (i.e, those of the scalp) CN VIL emerges from the eaudal pons, courses through the internal anditory ‘eats with through the facial canal in the petrous pportion ofthe temporal bone, ancl passes tough the stylomastoid foramen to ext the eranial fossa A branch of CN VII that cartes taste fibers tothe tongue andl parasyrnpa thet fibers to the nasal andl palatine After originating from the geniculate ganglion, the greater petrosal nerve92 Aratomy Recall passes throng the horizontal part ofthe facial eanal and over the foramen Teer Tt then joins the deep petrosal nerve to farm the none ofthe plerygoid canal, which passes through the pterygoid contributes to the ccaal and th plerygopalaine ga In the desconding part of the facial anal What is th 1. Provides taste to the anterior two branch? thirds of the tongue 2. Provides parasympathetic innervation to the submandibular ane! subling salivary gnds and the laerinnal glands ‘The chorda tympani exits the skull via which forame The peteoty mpanic fis Which nerve does the The lingual nerve, a branch wf GN Vy, chords tympani join after exiting the petrotympani fissure? Lesions ofthe ficial nerve 1, Unilateral facil paralysis (loss of cial proximal to the stylomastoid ———nuscle ianervation, also known as Foramen leadl to which, Bell's palsy) deficits? Why? Unilateral loss of taste inthe anterior two thirds ofthe tongue (los af ‘chorda tympani taste fibers) 8. Decreased saivation (loss of innervation to the submandibular sublingual glands) 4. Unilateral hyperacuss (loss of Jnnervation to the stapedins musele of the inner ear, sehieh normally dampens sounds Lesions of the facial nerve Unilateral facial paralysis omly. Taste distal to the stylomastoid salvation, and hearing ate spared because foramen lead to what the branches that innervate the tongue, deficits? salivary glands, and stapedlins musele arise proximal to this point CN Vill (VESTIBULOCOCHLEAR NERVE) CN VIM carries which type Special sensony fibers (ike GN Land of fibers? ex)What is the function of the vestibulocochlear nerve? Where does GN VIII exit the brain stem? Which organs are inner- vated by the vestibular branch? In addition to balance, what else does the vestibular branch of CN VII mediate? Which organ is innervated by the cochlear branch? Where does CN VIL exit the posterior eranial fossa? Which other structures teavel with ON V through the internal audi- tory meat cn (Chapter 4 The Cranal Nerves 93 Hearing (cochlear portion) and balance (vestibular portion) Branches representing the vestibular and cochlear portions emerge separately at a groove between the pons and medulla, ‘Tho utricl, saceule, and semnicieula canals (ie, the three organs responsible for maintaining equilibrium) Coordination of heal and eye movements The cochlea Through the internal the petrous portion ofthe temporal bone) EN VI (4 the facial nerve) and the labyrinthine (internal acoustic) artery, a branch from the basilar artery (GLOSSOPHARYNGEAL NERVE) Which types of fibers are ‘carried by CN IX? fanetions of CN What are the sensory fanetions of CN IX? ‘EN IX cartes all types of cranial nemve fibers: visceral and branchial motor bers, somatic fibers, visceral a special sensory fibers, and parasympathetic Branchial motor fbers: Inner stylopharyngeus musele, which sates the pharyns daring swallowing and specch Visceral motor fibers: Supply the otic ganglion, which provides scerctomotor fibers to the parotid gland ethe Somatic sensory fibers: Prosi sensation to er pharyny, tonsils, posterior third of the tongue, skin ofthe external ear, and the of the tympanic94 Anatomy Recall Which structure receives Where does CN IX exit the Which other eranial nerves cet the skull at the jugular foramen? What are the six major branches of CN IX? CN IX on a dissection? CN X (VAGUS NERVE) Special sensory fers: Provide the posterior tied ofthe tongue with taste sensation Visceral sensory fibers: Carry aflerent input from the carotid body and sis The parotid gland (remember—the parotid gland is traversed by CN VII but innervated by CN IX) At the jugular foramen (locate! atthe suture line between the inferior edges of the temporal and ocespital hones) EN X (the vagus nerve) and GN XT spinal accessory nerve) 1. ‘Tympanie branch 2. Carotid branch 3, Pharyngeal branch 4, Muscular branch 5. Tonsillar branch, 6. Lingual branch, Locate the stylopharyngeus muscle; CN TX emerges posteriorly and ri the lateral border of the muscle, Which types of fibers does CN X carry? What are the motor fanetions of CNX? What are the sensory functions of CN Branchial and visceral moter fibers somatic and visceral sensory fibers Branchial motor fibers: Innersate the striated muscles of the pharynx an lary (except for the sylopharyngens and tonsor vel paatin muscles) and the palstoglossus muscle of the Visceral motor fibers: innervate the smooth musele ofthe abdominal and thoracie viscera Somatic sensory fibers: Innervate the skin on the back of the ear, the external auditory m tympanic membrane, and the pharynx atus, the externalWhich structures receive parasympathetic innery tion via CNX? Deseribe the origin of CN X. List the seven major branches of CNX. (Chapter 4 The Cranial Nerves 95 Visceral sensory fibers: Innensate the esophagus; th thoraeie and abdominal viscera the stretch receptors in the aortic arch, ‘and the chemoreceptors inthe aortic bodies “The cardiae plewus (parasympathetic iimervation slows the heart and con- strits coronary arteries) 2. The pulmonary plesus (parasympathetic in ‘constrict the bro 8. The ablominal branches (parasympathetic innervation provides for gastrointestinal motility as Faras the lef cole Meare and stimula me gastrointestinal secretions) arises as $-10 rootlets fom the medulla 1. Meningeal branch (provides sensation tothe dura mater im the posterior cranial fossa) 2 Auricilar branch (provides sensation. tothe back of the ear and ccommanicates with te auricular branch of CN VIL) 3, Superior ryngeal branch (the internal laryngeal branch provides sensation inthe larynx above the vocal inferior constrictor and erico muscles) of the larynx except the exicathyroid smusele) Nerve tothe carotid body and. ‘Motor branch to the pharyngeal plexus Parasymmpathotie branches to the thoracic and abdorninal visee ‘Within the carotid sheath, posterior to th carotid artery and medial tothe intemal jugular vein96 Anatomy Recall What structure does the recurrent laryngeal nerve Joop around on the: Right side? Left side? ‘The vagus joins with which structure before lewvin the thorax? Which vagus nerve (right or left) forms the anterior vagal trunk? How ean the variation in the paths of the left and ight vagus nerves be explained? List the six structures supplied by the anterior vagal trunk Which structure is supplied by the posterior vagal trunk? ‘The contralateral vagus (forming the esophageal plexus and vagal trunks) The let (Remember LARP: Left Right Posterior) By recall development oft the embryolog e region; as the foregut rotates (clockwise from above, the vgs nerve (which is adherent to the esophagus) rotates with it ‘The ant 1 aspect of the st 2. Lesser omentum, 3, Liver 4 Pylonis 5. Head of the panereas 46. The frst two parts of the duodens ‘The posterior aspect of the stomach CN XI (SPINAL ACCESSORY NERVE) ON Xe: of fibers? ties which type What is the function of ON XI? Deseribe the course of the spinal root of GN XI. Somatie motor fibers Spinal root: Provides motor innervation ‘ tathe stermoeleidomastotd a traperins muscles Ceanial root: Provides somatic or innervation tothe larynx and pharynx via the pharyngeal and recurrent laryngeal branches of CN X After origi C1-C6, the spi tng from cervical sega I root of CN XI travels‘Chapter 4 The Cranial Nerves 97 superiorly into the exaniinn through the Joins the cranial root ets the skull through the: jugular foramen, CN Xil (HYPOGLOSSAL NERVE) EN XI carries which type of fibers? What is the function of NN? Where does CN XIL originate? Where does GN XI exit the skull? Does CN XH travel medial or lateral to CNs IX, X, and XI upon exiting the cranium? Which spinal nerve fibers travel with CN XI? POWER REVIEW rnatie motor fibers innervation to all ENXM provides of the i ind extrinsic muscles of the tongue, except forthe palatoglossus nusele (which is supplied by CN 0. EN XI emerges from the brain stem as 5-10 rootlets between the “olive” and the pyramid of the ventral medulla Through the hypoglossal canal (in the ‘occipital hone) Medial (think ofthe tongu middle) being in the ‘The descending branches of spinal nerve 1, which join with branches from spinal nerves C2 and C3 to form the ansa cenicalis For each cranial nerve, state the eranial foramen 1 (the olfactory nerve) 11 (the optie nerve) TI (the 0 ymotor nerve) IV (the trochlear nerve) V, (the opthalmie division of the trigeminal nerve) ‘The eribriform plate The optic “The superior orbital fissure ‘The superior orbital fissure ‘The superior orbital fissure98 Anatomy Recall Vs (the maxillary division of the trigeminal nerve) V, (the mandibular VI (the abducens nerve) VII (the facial nerve) AX (the glossopharyngeal nerve) X (the vagus nerve) XI (the spit nerve) XII (the hypoglossal nerve) Which four cranial nerves ‘carry parasympathetic Bers? Where do the two optic nerves temporarily join together? Between which two arteries does CN IH (the oculomotor nerve) emerge from the Drain? What isthe function of ENV (the trochlear nerve)? What are the three main CNV provides motor inner vation to which muscles? “The foramen ovale “The superior orbital ssurc “The tylomastoid foramen The intemal auditory meatus The jugular foramen ‘The jugular foramen ‘The jugular foramen ‘The hypoglossal canal EN TIT (the ocrlomotor nerve) EN VII (the facial nerve) EN IX (the glossopharyngeal nerve) EN X (the vagus nerve) 1 2, 3. ‘ At the optic chiasin EN IIL emerges from the br the superior cerebellar and posterior Motor innervation tothe superior oblique russe ophthalmie division sillary Avis andibular divisionWhat isthe funetion of CN VI (the abducens nerve)? CN VII (the facial nerve) provides motor innervation for which structures? Which nerve provides for taste om the: Anterior two thirds of the tongue? Posterior t tongue? of the What is the function of EN VIII (the vestibulo- cochlear nerve)? What are the symptoms and signs of vestibular nerve dysfuneti Where does CN X (the vagus nerve) travel in the neck? ‘The recurrent laryngeal nerve loops around which structure on the right? On the left? Which vagus nerve (i.e. the right or the left) forms the anterior vagal trunk? Which intrinsic musele of the larynx is not supplied by the recurrent laryngeal nerve? Chapter 4/ The Cranial Nerves 99 3. The tensor vel palatind muscle Johyoid muscle terior belly ofthe digastric 1. The muscles of facial expression 2. The stapedius muscle 3, The stylohyoid muscle o4 1 posterior belly of the digastric rusele “The chord tympani, branch of CN VIL EN 1X (the glossopharyngeal nerve) Provides for hearing and equilibrium Dizziness, impaired balance, nysta nausea oF vomiting Within the carotid sheath, posterior to the carotid artery and medial to the intemal “The subclavian artery and the Higumentum arteriosuin, respectively (remember, unilateral damage e hoarseness; bilateral damage causes airway obstruction Theleft (Remember LARP: Left Anterior, Right Posteri) ‘The ericothyroid muscle100 Anatomy Recall What is the funetion of EN XI (the spinal aceessory nerve)? What is the funetion of EN XU (the hypoglossal nerve)? The spinal root supplies motor root supplies motor Faryad pharyn Moves the tongue (HCN XI is damaged, the tongue will deviate toward the side of the lesion5 BONES OF THE NECK The Neck Which bones form the skeleton of the neck? What are the superior bony landmarks of the neck? What are the inferior bony landmarks of the neck? Which small, “U"-shaped bone, located at the level of the body of vertebra C3 and just below the mandible, ‘Serves as an attachment site for many of the muscles of the neck? Which two muscles origi nate on the hyoid bone? List the seven muscles of the neck that insert on the hyoid bone. “The seven cervical vertebrae (see Chapter 6, "The Back’) and the clavices(s Chapter 7, "The Upper Limb’) The inferior margin ofthe mandible, the mastoid process of tI and the external occipital protuber the occipital bone The superior borders ofthe clavcles and th umn (i.e, the ist bone of the “The hyoglossus (one of the extrinsic tongue muscles) and the midalle ‘constrictor muscle of the pharynx The mylohyoid musele 1 2. The geniohyoid muscle 3, 4 The stylohyoid muscle The digastric muscle omobyoid muscle e sternohyoid muscle e thyrohyoid muscle102 Anatomy Recall MUSCLES OF THE NECK SUPERFICIAL MUSCLES What are the two superficial muscles of the neck? As you make a transverse ‘cut across the neck to do a thyroid resection, what is the most superficial muscle you encounter? Platysma ‘What are the attachments of the platysma muscle? What is the innervation of | the platysma? What does the platysma do? Sternocleidomastoid muscle Origin? Insertions? Innervation? Actions? L. The stemodleidomastoid muscle 2 Theplatysma This thin, flat muscle extends from the ‘mandible to the fascia of the pectoralis and deltoid muscles of the upper cestromity.(Plat- means “at.”) ‘The platysma is innervated by the cervical branch of CN VIL (the facial nerve) Assists in facial expressions, especially frowning layicular (cleido-) head, which inserts on the clavicle, “The spinal branches of CN XU (th accessory spinal nerve) and spinal nerves Cand C3 Acting singly, the sternocleidomastoid ‘musele pulls on the mastoid process, tilting the head to the ipsilateral side, laterally bending the neck, and rotating the face so that i looks superiorly to the other side. Acting together, the stomocleidomastoid muscles flex the neckDEEP MUSCLES Which three major exte- gories are used to classify the deep muscles of the neck? ‘Suprahyoid muscles Which four muscles com- prise the suprahyoid group? Mylohyoid muscle Origin? Insertion? Innervation? Action? Geniohyoid muscle Origin? Insertion? Innervation? Action? Digastric muscle What is the origin of the digastric muscle’s name? Chapter 5 /The Neck 103 Suprahyoid group Infrahyoid group (strap muscles) Muscles ofthe posterior triangle floor The mylohyoid “The geniokiyoid The sylohyoid The digastric The mylohyoid line of the mandible ‘The median raphe of the hyoid bone ‘The mylohyoid nerve, a branch of CNV, (the mandibular branch ofthe trigeminal nerve) Elevates the hyoid bone and tongue and depresses the mandible ‘The genial tubercle ofthe mandible "The body of the hyoid bone ‘Spinal nerve C1, wia CN VH (the hypoglossal nerve) Elevates the hyoid bone and t ‘The styloid process ofthe temporal bone “The body of the hyoid bone EN VII (the facial nerve) Elevates the hyoid bone ‘The digastric musele has an anterior belly and a posterior belly. “Digastrie” means “two bellies.104 Anatomy Recall Deseribe the course of the digastric muscle, Which two nerves innervate he digastric muscle? Infrahyoid (strap) muscles Which four muscles com- prise the infrabyoid group? What is the action of the strap muscles? What nerve innervates all of the infrahyoid muscles bbut one? ‘not innervated by the ansa corvicalis? Which strap muscle crosses perpendicular and just deep to the sternocleidomastoid muscle? Which musele has both superior and an inferior belly? Omohyoid muscle Origin? Th terior belly arises from the sndible and the posterior belly arses from the temporal bone, just deep to the ‘mastoid process, The two bellies are ‘connected by a tendon held in a fascial sling attached to the hyoid bone Anterior belly: The mylohyoid nerve, a ranch of the inferior alveolar nerve (from CNV) Posterior belly: C VI (the facial ‘The 1 pobyoid 2. The sternohyoid ‘The sternothyroid 4. The thyrohyoid ‘These museles lower the hyo and larynx during phonation. ‘The ansa cerviealis ‘The thyrohyoid muscle—this muse is innervated by spinal nerve! XIII (the hypoglossal nerve) The omohyoid muscle ‘The omohyoid muscle. Ater originating atthe hyoid bone, the omohyoid muscle passes throw fascial sting (connected tothe clavicle) and under the sterno- leidomastoid muscle to insert on the superior border of the scapula. Therefore, it has both a superior and an inferior belly Hyoid bow Seapala (om-means “shoulder” iChapter The Neck 105 Sternohyoid muscle Origin? Manubriam ofthe steruum Insertion? Hyoid bone Sternothyroid muscle Origin? ‘Manubriun ofthe steraan Insertion? “The hyoid bone Thyrohyoid muscle Origin? “The thyroid cartilage Insertion? “The hyoid bone Muscles of the posterior triangle floor Which four deep muscles. 1. Splenius capitis muscle form the floor of the 2 Levator s posterior tiangle? 3. Posterior sa 4. Mid Which other muscle may The anterior seaene muscle contribute to the infero= medial part of the posterior tviangle? Where does the anterior ‘The first ib scalene musele insert? Identify the muscles of the neck on the following figure: 8 8 L 5 E M N s o H P 1 4 o «106 Anatomy Recall Splenius capitis muscle Origin? Action? Levator seapulae muscle Origin? Insertion? Innervation? Action? Posterior sealene muscle Origin? A= Digastric muscle, posterior belly Stylohyoid muscle yoglossus muscle ylohyoid muscle Digastric muscle, anterior belly hhyrohyoid muscle = Omoliyoid muscle, superior belly ‘The inferior half ofthe nuchal Higa and the spinous processes of vertebrae cLc6 “The mastoid process and the lateral superior nuchal line Unilateral contraction: Fleses and rotates the head and neck ipsilaterally Bilateral contraction: Extends the head andl neck ‘The transverse processes of vertebrae cles ‘The superomedial border of the seapula ‘The dorsal scapular nerves and spinal nerves C3 and Co Elevates and rotates the seapula (counterclockwise from the back) ‘The transverse processes of vertebrae cosInsertion? Innervation? Action? Middle sealene muscle (Chapter S/The Neck 107 ‘The second rib Spinal nerves C7 and C8 Flexes the neck laterally and elevates the second rib during inspiration Origin? “The transverse processes of vertebrae cc Insertion’ ‘The first nb Innervation? Spinal nerves C3-C8 ‘Action? Flexes the neck laterally nd elevates fist nib during inspiration FASCIAE OF THE NECK SUPERFICIAL FASCIA ‘What is the superficial fascia The investing fascia ‘of the neck called? ‘What does the investing The investing fascia is Found on both fascia invest? sides of i, it"invests" the stemoeleidomastoid muscle. It mms inferior to the platysma and surrounds all of the deeper structures ofthe neck DEEP FASCIAE What are the three deep fasciae of the neck? 3B. Fascia of the carotid sheath What does the pretracheal Located deep to the infrahyoid muscles, fascia enclose? the trachea, thyroid phagus What does the inferior bor- The fibrous pericardium of the der of the pretrucheal fascia mediastinum ‘merge with? What does the prevertebral Located posterior to the esophagus and fascia cover? pretracheal fascia, this fascia ies against108 Anatomy Recall the cervical vertebral bodies and surrounds the prevertebral museles What isthe retropharyngeal ‘The retropharyngeal space is « potential space? space betwen the prevertebral fascia a the posterior portion ofthe pretracheal fascia, ‘TRIANGLES OF THE NECK Which structures delineate Anterior boundary: Medan line of the the anterior triangle of the neck neck? Posterior houndat ror border of the stemocleidomastoid muscle Base: Inferior mandible Jugular notch (ie. the space between the clavicles and above the smanubrin) Which two muscles i the anterior triangle int four smaller triangles? digastric and omobyoid What are the four sub- The subinental twiangle divisions of the anterior The digastric (submandibular) triangle? triangle 3. The carotid triangle 4. The muscular triangle 1 Which structures delineate Anterior boundary: Th the posterior triangle of the border ofthe ste neck? ssl Posterior boundary: The border of the trapezius inscle Base: The middle third of the clavicle Apes: Point where the stomnocleidonstoid and trapesius sles ect, on the occipital Which structure divides the ‘The inferior belly of the omohyoid posterior triangle into two inuscle divides the pesterior triangle into smaller triangles, and what he occipital and supraclavicular are the resultant spaces triangles, called?Identify the labeled structures and triangles on the foll 20m > ANTERIOR TRIANGLE ‘Submental triangle What is unique about the submental triangle? What are its boundaries? What forms the floor of the submental triangle? CChapeer 5 /The Neck 109 A = Parotid region B = Digastsc (submandibular) e D = Carotid triangle Jbmental triangle E = Muscular triangle F = Mastoid process Apes ofthe posterior triangle Sternocleidomastoid muscle Occipital triangle J = €NXI (the spinal accessory nerve) K = Supraclaicular triangle is the anterior te ‘unpaired tsiangle within the nae. Th submental triangle (mental, chin’) is bounded by the hyaid bone and the anterior belies ofthe let and right digastric muscles, which form the apex of the triangle at the mandible. ‘The mylokyoid muscle110 Anatomy Recall Which structures of interest The submental mph nodes, which drain are found in the submental the tip ofthe tongue, the lower incisors, triangle? and the lower lip and chin Digastric (submandibular) triangle What bounds the digastric The inferior ma triangle? the superior margins of both the anterior ‘and posterior bellies of the digastric sce n of the mandible and What structure nearly fills Th the digastric triangle? suibmanll land Which major nerve passes CN'XII (the hypoglossal nerve) through the digastric triangle? Carotid triangle What are the boundaries of ‘The anterior border ofthe the carotid triangle? Which important structures ‘The common internal artery the pass through the carotid jugular vein, and the vagus nerve (CD triangle? housed in the carotid sheath (occasion ally, the superior part of the ansa cereals descends within the sheath as well) Identify the following structures in the carotid triangle: ear onmMuscular triangle What are the boundaries of the muscular triangle? What divides the muscular triangle into right and left halves? What are the prineiple contents of the muscular twiangle? CChapeer $/The Neck 111 igatric muscle, posterior belly IN XI (spinal accessory werve) Internal jugular vein wot sheath remal carotid artery External carotid artery Facial artery Hyoglossus muscle T = Mylohyoid musele gual ate CN XI (hypoglossal nerve) Sommon carotid artery EN X (vagus nerve) A B c L E F c HW ‘The anterior border of the wscle andl the stor border ofthe superior belly of stemocleidomastoid» hyo muscles, the thyroid iland, and the parathyroid glands VASCULATURE OF THE NECK ARTERIES Where do the arteries of the neck arise from? What are the arteries of the neck: On the left side? ‘Om the right side? divide into? ‘The arch of the aorta 1. The left common carotid artery 2. The left subclavian artery ‘The brachiocephalic trunk (i artery) 2. The right subclavian artery112 Anatomy Recall ‘Subclavian artery How does the subclavian artery pass out of the thorax and into the neck? Which nerve loops under the right subclavian artery? What are the five major branches off the subelavian artery? With one exception, which part of the subclavian artery sends off all of the branches? What is the exception? What do the vertebral arteries become? What are the three branches of the thyro- cervical trunk? ‘What does the costocervical trunk divide into? ‘What does the subclavian artery bee ome as it leaves the neck and travels distally? When does this occur? Over the first ib, between the anterior and middle sealenus muscles, and under the clavicle “The subclavian artery is divided into three parts as it passes behind the anter sealenus niscle. The Bist partis medial the second pat is pesterior the third parts lateral toi ‘The right recurrent laryngeal nerve, a 1. The internal thoracic (internal smammary) artery ‘The vertebral artery ‘The thyrocervial trunk ‘The costocervical tru ‘The dorsal seapula All branches arise from the first part of| the subelavian artery, except forthe costocervical trunk on the right, which usally arises from the second part The vertebral arteries trivel in the vertebral foramina of the cervical vertebrae and join posterior to the pons to form the basilar artery (Recall that the vertebrobasilar system, along with the internal eartid system, provides blood to the brain.) 1. The inferior thyroid artery 2. The transverse cervical artery 3. The suprascapular artery ‘The superior intercostal and deep cervical ‘The subclavian artery becomes the axillary artery as it passes the lateral border of the frst nib.‘Common carotid artery How does the common carotid artery terminate? Where does the common carotid bifurcate? What isthe difference be- tween the carotid body and the carotid sinus, in terms of structure, function, and location? Which nerve innervates the carotid sinus? What are the branches of the internal carotid artery ‘within the neck? What are the two terminal branches of the external carotid arter What are the six branches of the external carotid artery before this bifureation ‘occurs, in ascending order? Of these six branches, which are: Anterior? Posterior? Medial? CChapeer §/The Neck 113 By diving into the intemal and external carotid arteries Within the carotid triangle, t the superior border of the thyroid cartilage ‘The carotid body isa small, ovoid mass of tissue located at the bifurcation of th ‘common carotid artery into the internal and external earoti arteries. The carotid body contains chemoreceptors that detect changes in oxygen and carbon dioxide tensions. The carotid sin ‘of the internal carotid artery just distal to the bit that contains pressure receptors. ‘GN IX (the glossopharyngeal nerve) ‘There are none! (The first branch of the internal carotid artery isthe ophthalmic artery, which arises intracranial ‘The masillay artery and the superficial temporal artery Superior thyroid artery Ascending pharyngeal artery Lingual artery Facial artery Occipital artery Posterior auricular artery ae: 5 6 portant three) 1. The occipital artery 2. The posterior auricular artery ‘The ascend pharyngeal artery114 Anatomy Recall Identify the arteries of the ‘ncek on the following figure: Common carotid artery ‘VEINS Internal jugular vein ‘What areas are drained by the internal jugular vein? Where does the internal jugular vein originate? Which fascia covers the internal jugular vein? Posterior auricular artery B = Occipital artery Ascending pharyngeal artery Internal carotid artery sternal carotid artery = Superficial temporal artery Mallar artery Facial artery Lingual artery J = Superior thyroid artery retures in the cranium and the Face A direct continuation of the signoid sinus, the internal jugular vein exits the skull through the jugular foramen. The carotid sheath (which also invests the ‘carotid artery and CN X)tween the three structures within the carotid sheath? External jugular vein Which veins join to form the external jugular vein? external jugular vein drain? Chapter 5 /The Neck 115 The vein i Iateral, the artery i medi and the nerve is posterior ‘The retromnandibular and posterior ‘The extemal jugular vein travels behind the steruocleidnnastoid m te subclavian vein, INNERVATION OF THE NECK Is the sympathetic trunk in the carotid sheath? ‘causes which syndrome? What is Horner's syndrome? Which Tung tumor ean cause 4 Horner's syndrome? Where do the parasympa- tuavels with (and is part of) CNX? “The sympathetic tink contains posteanslionic bers which originate in the three cervieal ganglia (ie, the und superior ganglia). These postennglioniesytupatheti fibers travel up the neck along the carat sheath, inferior, idle No, the syimpathetic teak travels longs (outside ane posterior to) the ‘carotid sheath, Homer's syndrome losis: Drooping of the eyelid occurs ‘when innervation of the levator palpelirae is disrupted, Miosi ‘unopposed parasympathetic action, he pupil is constricted owing to Anhydrasis: Perspiring is a sympathetic Fimtion, A superior suleus tumor (Pancoast tamor) “The carotid sheath—CN X (the vagus nerve) represents the parasympathetic fibers in the neck Th recurrent laryngeal nerve116 Anatomy Recall Deserihe the path of the right recurrent laryngeal Deseribe the path of the left recurrent laryngeal nerve. ‘The cervical plexus orig nates from whieh nerves? Which motor branches originate from the cervical plexus? Which nerve innervates the strap muscles? What is the origin and ‘course of this nerve? Which nerve innervates the diaphragm? What is its origin? What is the path of the phrenic nerve in the neck? What are the four major sensory branches of the cervical plexus? After traveling down th IN X. the right recurrent hoods around the subclavian travel hack up toward the tracheoesophageal groove, while CN X passes anterior to the subclavian neck as part of ryngeal nerve nt layngeal nerve takes similar path, except it hooks around the ligamentum arteriosum while GN X passes anterior to the arch of the wort ‘The ventral primary ra ces of spinal ner ‘The ansa cere ‘The phrenic nerve Twigs to the longus capitis muscles, the sternocleidomastoid snusele, the trapezius muscle, the levator caput musele, and the scalene museles ud cervicis ‘The ansa cervicalis This “U~-shaped nerve (ansa means Toop”) originates from spinal nerves C1 C3 and nuns just anterior to the carotid sheath. This position makes the ansa conicalis vulnerable to injury during surgery on the earotid artery ‘The phrenic nerve, which aries from spinal nerves €3-€3 ("C3, C4, and C5 keep the diaphragm alive") “The phrenie nerve erosses the anterior of the anterior scalenus muscle to enter the thorace inlet 1. The lesser ocipital nerve 2 The great auricular nerve 3. The transverse cervical nerve 4. The supraclavicular nerveIdentify the labeled structures on the following figure: CChapeor §/The Neck 117 Between which muscles does the brachial plexus emerge from the deep part of the neck? VISCERA OF THE NECK ‘THYROID GLAND What conneets the left and right lobes of the thyroid gland? ‘What is the isthmus anterior to? A= Great auricular nerve cervical nerve Stemnocleidomastoid muse Lesser occipital nerw XI (spinal accessory nerve) Traperiue muscle Supraclavicnlar nerve ‘The anterior and medial scales The isthmus “The second and third tracheal rings118 Anatomy Recall Describe the origin ofthe dual blood supply of the thyroid. Which third thyroid artery ‘exists in 10% of people? Describe the venous drainage of the thyroid. What is the venous drainage of the thyroid? Which important nerve runs with the inferior thyroid artery? PARATHYROID GLANDS The superior thyroid artery originates from the external carotid artery. The rior thyroid artery isa branch of the tlyrocersical trunk (a branch oft subclavian artery) Inv a stall percentage of the population, the thyroid ina artery—an unpaired branch directly fromthe aorta, bruchio- or left common carotid rior to the thyroid ‘and supplies the isthmus. This third artery ean be a source of serious bleeding in patients undergoing thyroid surgery Superior ancl middle thyroid veins d to the internal jugular vein; inferior tothe brachiocephalic ‘The superior and middle thyroid drain to the internal jugular vein, The inferior thyroid vein crains tothe brachiocephalic veins ‘The recurrent laryngeal nerve—it is Important to avoid this nerve during How many parathyroid glands are normally present? Where do the parathyro arteries originate? Loss of the parathyroid. in what Four (ie. left and right superior and inferior) They are usually branches from the inferior thyroid arteries, Hypocaleetnia, which can lead to tet (onscle spa The “voioe baxAt what vertebral level is the laryns located? What two structures does the larynx connect? Laryngeal cartilages What tissue comprises the laryngeal skeleton? How many cartilages are there in the larynx? ‘Name the three unpaired cartilages. ‘What is the anatomic term for the “Adam's apple?” What is the derivation of the word thyroid? Which cartilage is palpable inferior to the thyroid cartilage? Describe the attachments of the epiglottis: The front of the epiglottis attaches to? ‘The stalk attaches to? ‘The sides attach to? ‘The upper edge attaches to? Which ligaments anchor the cricoid cartilage? (Chapter 5/The Neck 119 At the level of vertebrae C3-C6 erior pharyns and the trachea Cartilage three paired and three unpaired ‘The thyroid cartilage ‘The ericoid cartilage ‘The epiglotic cartilage The laryngeal prominence (Le,, where the Janina ofthe thyroid cartilage meetin the ‘median plane) Greek thyros ("shield") ‘The cricoid cartilage ‘The body of The thyroid cartilage ‘The aryepiglottic folds Nothing Superiorly: The crioothyroid ligaments Inferiorly: The cricotracheal ligaments120 Anatomy Recall Identify the labeled structures on the following figure of the larynx: Which two structures pieree the thyrohyoid membrane on either side? Name the three paired cartilages of the larynx. Which of these pairs is most important in phonation, and how do they work? Where are the corniculate and cuneiform cartilages located? Laryngeal inlet What are the aryepiglottic folds? What are the piriform recesses? A= Epiglottic eartilage (Le. epigltts) Hoxly of the hyoid bone Thyrohyoid membrane i Higaan riod cartilage ‘The internal kiyngeal nerve superior laryngeal vessels 1. Arytenoid cartilages 2 Comiculate cartilages 3, Cuneiform cartilages ‘The vocal cords atach to the py shaped arytenoid cartilages, which articulate with the ericoid curtilage. These articulations allow the arytenoid cartilages tostide, rotate, and tlt, thus modifying the position of (and the tension on) the vocal cords Near the posterior aspects of the arytenoid cartilages cartilage that for the inlet to the larynx (the epiglotis forms the anterior border) Named for their pear-ike shape, the piriform recesses are recesses on each,What are the valleculae? Vocal cords Vocal folds What are the “true vocal cords?” What is the conus elasticus? Where do the vocal ligaments attach? What is the sensory inner- vation of the lary: [Above the vocal folds? Below the vocal folds? Vestibular folds What are the “false vocal cords?” Where are the vestibular folds located in relation to the vocal folds? What comprises the vestibule folds? ‘Where do the vestibular ligaments attach? (Chapter 5/The Neck 121 side ofthe inlet to the layns. They are separated rom the inlet by the avepisottic folds ‘Two small (peanut-sized) depressions between the epiglotis and the anterior lary; clinically significant because they are a frequent lodging place for food Vocal folds, consisting of the vocal Figaments andl the cous elastiens An elastic membrane between the vocal cricoid cartilage (in ‘other words, the vocal ligam free clge ofthe conus elation Between the voeal processes of arytenoid cartilages andl the posterior aspect of the thyroid cartilage “The internal branch ofthe superior laryngeal nerve, a branch of CN X (the vagus nerve) ‘The recurrent laryngeal branch of CNX Vestibular folds; these structures do not participate in sound production but Appear similar to the true vocal cords They are superior to the vocal folds Vestibular ligaments enclosed in a ‘mucous membrane Between the arytenoid cartilages and the point where the epiglottic cartlage meets the thyroid cartilage122 Anatomy Recall, The vestibular ligaments form the free edge of which ‘membrane? Musculature of the larynx Which two groups of muscles comprise the laryngeal musculature? Extrinsic muscles What are the three muscles of the inlet of the larynx and what do they do? Inerinsic muscles ‘The quadrangular membran membrane between the arytenoid cartilages and the epiglttic eartilage 1. Extrinsic muscles (move the entire larynx) 2. Intrinsic muscles (move the s cartilages and vocal cords) 1. ‘The transverse arytenoid muscle: Joins the arytenoid cartilages (this muscle is the only unpaired musele ofthe larynx) 2. The oblique arytenoid museles: Narrow the inlet 3. The thyroepiglottic muscles: Widen the inlet Which museles are the principal: Adductors of the vocal ‘cords? Abductors of the vocal cords? ‘Tensors of the vocal cords? Relaxers of the vocal cords? Which nerve innervates all but one of the intrinsic Inryngeal muscles? Which muscle is the ex- ception, and which nerve innervates i? What is the path of the re- current laryngeal nerves in the neck? ‘The lateral cricoarytenoid muscles ‘The posterior ericoarytenoid muscles “The ericothyroid muscles ‘The thyroarytenold museles ‘The recurrent laryngeal nerve ‘The cricothyroid muscle is innervated by the external branch of the superior laryngeal nerve ‘They travel down as part of CNX (the vagus nerve) within the carotid sheath, and then branch around the great vessels(Chapter §/The Neck 123 (ic. the brachiocephalic artery onthe right and the arch ofthe aorta on the left) to travel up the tracheoesophageal groove. They then picree the cricothyroid rmusele and enter the larynx. POWER REVIEW MUSCLES AND FASCIAE OF THE NECK What are the two insertions The sternum and the clavicle of the sternocleidomastoid muscle? ‘What is the most superficial The plalysma, innervated by CN VII (the ‘muscle of the neck, and facial nerve) which nerve innervates it? How are the anterior As suprahyoid or infrahyoid ‘muscles of the neck classified? Which four muscles com- 1. Mylohyoid prise the suprahyoid group? 2 Geniolyoid 3. Stylohyoid 4. Digastric ‘What isthe origin, insertion, Origin: The temporal bone, deep to the and innervation of the ‘mastoid process digastric muscle? Insertion: Mandible Innervation: CN VIL (posterior bell): ‘ON V (anterior belly) Which four muscles com- 1, Omohyoid prise the infrahyoid group? 2. Thyroliyoid 3. Stemohyoid 4, Sternothyroid What is the other name for ‘The "strap" muscles this group of muscles? Which nerve innervates “The ansa cervicalis all of the strap muscles but one?124 Anatomy Recall Which musele is the The thyrohyoid, which is innervated by exception, and which nerve spinal nerve CI via CN VI (the innervates this musele? Iypoglossal nerve) What four deep muscles 1. Spl form the floor of the 2. Lawator seapul posterior triangle? 3. Posterior scalenus 4. Middle scale seapitis What travels in the carotid ‘The common sheath? jugular vein, and C J artery, the internal WX (the vagus What travels just outside The sympathetic trunk the carotid sheath? Disruption of this trunk Prosis, miosis, and anhycleoss (i, ‘causes what triad of Homer's syndrome symptoms? What to struct Th ial plewus and the subclavian between the anterior artery and middle sealenus muscles? Vasculature of the neck What are the branches of ‘These are none; the ophthalmic artery (in the internal earotid artery the eranjumn) isthe first branch in the neck? What are the six major 1. Superior thyroid artery branches of the external 2 Ascendling pharyngeal artery carotid artery. from 3, Lingual artery proximal to distal? 4. Facial artery 5. Occipital arte 6. Posterior auricular artery How does the external By dividing into the maxillary and carotid artery terminate? erficial temporal What are the three major Inferior thyroid artery branches of the thyro- 2. Transverse cervical artery ‘cervical trunk? 3. Suprascapular arteryINNERVATION OF THE NECK What are the four major sensory branches of the cervical plexus? What is the origin and ‘course of the phrenic nerve? \VISCERA OF THE NECK What is the arterial supply and venous drainage of the thyroid gland? Where does the arterial supply of the parathyroid ‘glands originate? ‘What is the anatomic term for the “true” yoeal cords and where do they attach? ‘What is the anatomic term for the “false” vocal cords? laryngeal muscles? What muscle is the ex- ception, and which nerve innervates it? (Chapter 5/The Neck 125 1, Lesser occipital nerve 2. Great auricular nerve 3. Transverse cervical nerve 4. Supraclavicular nerve After originating from spinal nerves C3 (65, the phrenic nerve travels on the anterior surface of the anterior scalenus rmusele to enter the thoracic inet Arterial supply: Inferior and superior thyroid arteries (branches ofthe ‘thyrocerscal trunk and the external carotid arteries, respectively) ‘Venous drainage: Superior and middle thyroid veins drain to the internal eri thyroid vein brachiocephalic vein Usually from the inferior thyroid arteries The vocal folds stretch between the vocal processes ofthe arytenoid cartilages and the posterior thyroid cartilage. Vestibular folds ‘The recurrent laryngeal nerve “The cricothyroid muscle, which is innervated by the superior laryngeal6 VERTEBRAE The Back How many vertebrae are in cach region of the back Which two curves of the vertebral column are: Concave posteriorly? Which two curves are known as the primary curvatures? why? Which two curves are ki as the seconclary curvatures? ‘When does the cervical ‘curvature form? When does the lumbar curvature form? n6 Cervieal region: 7 ‘Thoracic region: 12 Lumbar region: 5 Sacral region: 5 (fused) Coceygeal region: 4 (fused) The thoracie an sucral curves The cervical and lumbar curves, ‘The thoracic and sueral curves ‘The thoracie and sacral curves develop in the fetal period. (Recall that the fetus i Chi When the infant holds its head erect (at 3-4 months) ‘When the infant begins to walk (a the cend of the frst year)Identify the labeled structures on the following views of a “typical” vertebra: (Chapter 6 /The Back 127 Which structures form the vertebral arch? What is the function of the vertebral arch? How many processes arise from the vertebral arch of « typical vertebra? ‘What does the vertebral arch form, along with the vertebral body? A= Spinons process Inferior articular process and facet C= Transverse process D= Lami E= Superior articular facet Pedic Vertebral foramen Vertebral body Superior vertebral notch, iperior articular process Pedicle ‘Transverse process stebral body QF Inferior articular fucet ‘The pedicles (laterally) and the fused Protection ofthe spinal cord, and meninges Seven (two transverse processes, one spinows process, and four articular processes) ‘The vertebral foramen128 Anatomy Recall What is the vertebral canal? Which structures pass through the intervertebral foramen? Which cervical vertebra does not have a spinous process? Describe the appearance of the spinous processes of vertebrae C2-C6, Why is vertebra C7 some- Limes called the vertebra prominens? What are the unique char- acteristics of vertebra CL the atlas)? What is the odontoid pro- ‘cess (dens)? What is the colloquial name for an odontoid fracture? What structure is unique to the cervical vertebrae? Which structures pass through the transverse foramina? Which cervical vertebra does not transmit vertebral arteries through its trans- verse foramina? Which structures are unique to the thoracie vertebrae? What is unique about the Jambar vertebrae? The eanal formed by the articulated 1H foramina of successive vert: bac and the intervening intervertebral disks ‘The spinal nerve and artery and the intervertebral vein Vertebra C1 Short andl bifid thas the longest spinous process stebra Cl lacks a body and a spinous process. The anterior and posterior arches form the “top” and “bottom” of the \ertebra, connecting the lateral masses that form its sides ‘The portion of vertebra C2 (the axis) that projects superiorly and acts as a pivot point for the alas Ahan an's fracture “The paired transverse foramina ‘The vertebral artery, as wel as the vertebral vein and autononsie nerves Vertebra C7 “The costal facets (where the thoracic vertebrae articulate with the ribs) 1. They have the largest bodies and pedicles, 2 A mamillary process is located on the posterior surface of each superior articular process. (Note: vertebra T12 also has mamillary processes.)What is the sacral pro- montory? JOINTS AND LIGAMENTS CChaptar 6 /The Back 129 ‘The anterior edge of vertebra SI (fr the posterior boundary of the true pels) CRANIOVERTEBRAL JOINTS ‘What is the joint between the skull and vertebra CL (the atlas) called? Which motion occurs at the atlanto-occipital joint? Which ligaments attach vertebra CL to the skull? What is the joint between the atlas and the axis called? What does the atlanto-asial Joint consist of? Which motion occurs at the atlanto-axial joint? Where does the transverse ligament attach? What is its purpose? What are the points of inser tion of the eruciform ligament? Where do the alar ligaments attach? Which movement is pre- vented by the alar igaments? The a to-occipital Flexion and extension of the head (nodding “The anterior and posterior al ‘cipital membranes ‘The atlanto-asial joint Two facet (plane) joints and one pivot joint between the dens and the anterior arch of the atlas Rot by remembering“ (atlas, then no (asi Te mins between the tubercles on the lateral masses of vertebra C1, arching. cover the dens of vertebra C2 Tho transverse ligament holds the dens against the anterior arch of vertebra cl Horizontally: The lateral masses of vertebra CL Superiorly: The occipital bone Inferiorly: The body of vertebra C2 ‘They run from the sides of the dens to the lateral margins ofthe foramen. ‘magnum, ‘The alar ligaments cheek the rotation and side-to-side movement of the head.130. Anatomy Recall JOINTS OF THE VERTEBRAL BODIES Between the badies of adjacent vertebrae At what level is the mast Between vertebrae C2 and C3 (there is ‘superior intervertebral disk no intervertebral disk between the atlas Foun and the uss) At what level is the most Between vertebrae 15 and SI inferior intervertebral disk found? What is the external cover: ‘The anus filvoss ing of the i disk called? tervertebral ternal matrix The nucleus palposus “The anterior hi «posterior longitudinal ments stabilizing the vertebral bodies? Where does the anterior Along the anterior aspect ofthe vertebral longitudinal ligament ran? boxlies and intervertebral diss, frou the ‘ocipital bone to the sacrum Where does the posterior Along the posterior aspect of the longitudinal ligament ran? ral bodies, within the vertel Which membrane is the The tectorial membrane posterior longitudinal liga- ‘ment continuous with? ‘The surface of the dens and th lar, and cruciform ligaments INTERVERTEBRAL JOINTS Which two structures form ‘The superior snd inferior articular the Facet joints? processes of adjacent vertebrae ‘What is the fumetion of the The facet joints alle lesion, extension, facet joints? nd rotation ofthe spine, They also iit to bearWhich ligament connects the lamina of adjacent vertebrae? What does the ligamentum flavum do? Which ligaments connect the spinous processes? What is the ligamentum rnuchae? Which ligaments connect the transverse processes? Identify the labeled liga ments and associated structures of the vertebral column on the following views: Chapter 6 /The Back 131 ‘weight and prevent anterior movement of ‘the superior vertebra onto the inferior one ‘The figarmentums Alas It-eomtnbutes to the posterior houndaries of the intervertebral foramina and helps tostraighton the vertebral column after Alexion. “The interspinous and supraspinous Tigaments A median fibrous septum between the posterior neck mnuscles; it is attached to the alas and the cerviea spinous processes and is the upward extension of ‘the supraspinous Tigament ‘The intertranscerse ligaments (these are ‘most substantial inthe lumbar region)132. Anatomy Recal Superior articular process ipenior vertebral notch tervortebral disk tervertebral foramen Ligunentan flava Articular capsule ofthe Facet erior vertebral notch Merior articular process Pedicle Ligamentum flavann Lamina Posterior longitudinal liam Anterior longitudinal i Intervertebral disk oint When performing a lumbar A lumbar puncture is usually performed puncture (spinal tap), which at the level of vertebrae L3-LA or ligaments are pierced? LA-LS. in the midline between the ihae crests, After piercing the skin and superficial fascia, the necile passes through the supeaspinous ligament, the interspinous ligament, and th ligamentuin flavusn before piercing the dura mater and the arachnoid mater to reach the cerebrospinal fluid (CSF).MUSCLES What are the three ana- tomie classifications used to ‘categorize the muscles of the back? What are the two funetional classifications used to categorize the muscles of the buck? How do these groups overlap? dentify the superficial and intermediate muscles of the back and the related 9 oa> Chapter 6/The Bick 133 Superficial intermediate, or deep Extrinsic or intrinsic Extrinsic = superficial and intermediate Intrinsic = deep134 Anatomy Recall SUPERFICIAL BACK MUSCLES Latissimus dorsi muscle Origin? Insertion? Innervation? Action? Trapezius muscle Origin? Insertion? Innervation? Action? Levator scapulae muscle Origin? Accessory nerve B= Traperins muscle (reflected) 1 cervical artery C= Trans (superficial bravich) D= Levator seapulae wnscle E = Latissinus dors! avusele F = External abdominal oblique muse G= Sternocleidomastoid muscle H= Rhomboid minor n ‘muscle raped ‘Thoracolumbar fascia ‘The floor of the bicipital yroove ofthe Imes ‘The thoracodorsal nerve (fro brachial pleas: receives bran the C6, C7, and CS ventral rami) Adduets, extends, and rotates the jv at the shonlder joint ‘The extemal occipital protuberance, the superior nuchal line, the ligame ana the spinous pracesses of 712 vertebrae C The spine ofthe scapula, the aeromion, and the lateral thin ofthe clavicle “The spinal accessory nerve (CN NI) and branches of spinal nerves C3 and Co sates, and depresses ‘The transverse processes of vertebra c1csChapter 6 The Back 135 Inyertion? The medial border ofthe se ‘opposite the supraspinons fossa Innervation? ‘The dorsal scapular nerve (from the brachial plexus; receives branches from the C5 ventral ramus) Action? Elevates the seapula Rhomboid minor muscle Origin? “The spinous processes of vertebra Tnsertion? “The root of the spine of the scapula Innervation? The dorsal scapular nerve Action? Adducts the sapula Rhomboid major muscle Origin? “The spinous processes of vertebrae 1215 Insertion? “The medal border ofthe seapula Innervation? ‘The dorsal scapular nerve Acti Adds the scapula INTERMEDIATE BACK MUSCLES. Serratus posterior superior muscle Origin? ‘The ligamentum mucha. the supraspinous ligament, and the spinous processes of vertebrae C73 Insertion? The upper border of ibs 2-5 Innervation? Intercostal nerves T174 (ie, the TL74 ventral primary rani) Action? Elevates the ribs ‘Serratus posterior inferior muscle Origin? ‘The supraspinous ligament and the spinous processes of vertebrae THALS136 Anatomy Recall Invert “The lower border of ribs 9-12 Innervation? Intercostal nerves TTI (ie, the T-T12 venteal primary ra Action? Depresses the ribs DEEP BACK MUSCLES Name the three layers of 1. Spinotransverse group (superficial) deep museles within the 2 Sacrospinalis group (intermediate) back 3. Transversospinals group (deep) Which muscles comprise 1. Spinotransverse groups Splenins cach group? capitis and splenius cervicis muscles 2. Sacrospinalis groups Ercetor spinae (formed by the thocostali, Tonggssinuis, and spinalis muscles) 3, Transversospinals groups Semispinalis, multifdis, and rotatores Splenius capitis muscle Origin? ‘The inferior half of the ligamentum nuchae and the spinons processes of vertebrae C7 and T1-T3 Insertions? ‘Temporal bone: At the mastoid process Occipital bone: Along the lateral third ‘of the superior nuchal line Innervation? “The dorsal rami of the Actions? Unilaterally and rotation of the head and neck Bilaterally: Extension ofthe bead and neck Splenius cervicis muscle Origin? ‘The spinous processes of vertebrae 316 Insertion? ‘The transverse processes of vertebrae cetInnervation? Actions? Erector spinae Is the ereetor spinae palpable? How are the iliocostalis, longissimus, and spinalis muscles subdivided? Which fascial compartment encloses the erector spinae? What is the common origin ‘of the erector spinae? What is the insertion for the: Hiocostalis muscle? Longissimus muscle? Spinalis muscle? What is the action of the cerector spinae: Unilaterally? Chapter 6/The Back 137 The dorsal rani of the inferior vervical nerves (the same asthe splenius eapits rmusele) Unilaterally: Ipsilateral lateral lesion ‘and rotation of the head and neck Bilaterally: Estension of the head and neck Yes. The three vertical columns (i, the iiocostals, longissimus, and spinalis muscles) form the prominent bulge that is palpable along each side of the vertebral column. Into three parts each, aceording tothe superior attachments (¢,,spinalis thoracs,spinals eervies,spinalis capitis) “The erector spinae lies between the posterior and anterior layers of the thoracolumbar fascia, Most ofthe divisions ofthe columns attach throngh a broad tendon to: 1. The posterior part ofthe iliac crest 2. The posterior part ofthe sacrum 8. The sacroilia ligaments 4. The sacral and lumbar spinous provesses The ribs and vervical transverse processes The ribs, transws and mastoid process c pracesses ‘The spinous processes (note thatthe spinals also arises from the spinous processes) Lateral flexion ofthe head or vertebral column138 Anatomy Recall Bilaterally? ‘The semispinalis musele is the largest musele in whieh region? How many vertebral seg- ments do fibers of this muscle sp What are the three divisions of the semispinalis muscle? What is the origin of the: ‘Semispinalis thoracis? Semispinalis cervicis? Semispinalis capitis? What is 1e insertion of the: Semispinalis thoracis? Somispinalis corvicis? Semispinalis capitis? Which nerves innervate the semispinalis muscle? What is the bilateral aetion of the semispinalis muscle? What isthe unilateral action of the semispinalis muscle? 1. Extension ofthe vertebral column and the head 2. Control of move nt during lesion “The posterior neck spinalisthoracis, the is cervicis, and the semispinalis capitis ‘The thoracie vertebrae ‘The cervical vertebrae The occipital bone between the inferior al ines 1s processes of vertebrae The spinous processes of vertebrae 2.63 ‘The planum nuchale (occipital bone) ‘The dorsal rami ofthe spinal nerves Extension of the head and upper vertebral column Contralateral rotation ofthe headMultifidus muscle In which region is the multi- fidus muscle most prominent? Describe the origin and Innervation? Actions? Rotatores muscles Deseribe the origin and insertion of the rotatores, Innervation? Action? SUBOCCIPITAL REGION What are the four major muscles of the suboceipital region? What is the rectus capitis posterior major musele’s: Origin? Insertion? What is the rectus capitis posterior minor muscle’s: Origin? ‘Chapter 6 (The Back 139 “The lumnbar region "The mulifidus muscle rans superomediall from the vertebral arches tothe spinous processes, covering the laminae and spanning 3-4 vertebrae, ‘The dorsal rami ofthe spinal nerves Unilateral action: Ipsilateral flexion and ‘contralateral rotation of the vertebral ‘column Bilateral action: Extension and stabilization ofthe spine “The rotatores arise fron process of one vertebrae and insert o spinous process of th vertebra the transverse at (ie, superior) The oral rai of the spinal nerves Contralateral rotation and stabilization of the vertebral colun 1. Rectus capitis posterior major 2. Rectus capitis posterior minor 3. Obliquus capitis superior 4. Obliquus expitis inferior The spinous process of vertebra C2 (the The lateral portion ofthe inferior nuchal line The posterior tubercle of vertebra C2 (the axis)140 Anatomy Recall Insertion? The medial part ofthe inferior nuchal ine ‘The transverse process of vertebra C1 (the atlas Insertion? “The occipital bone, above the inferior ‘mucha line What is the obliquus capitis inferior musele’s: The spinous process of vertebra C2 (the Insertion? ‘The transverse process of vertebra C1 (the atlas) Which nerve innervates all ‘The subocepital nerve of the suboceipital muscles? Where does the suboceipital ‘The suboceipital nerve originates from nerve originate? the dorsal ramus of vertebra Cl (the atlas) and emerges between the vertebral artery (above) and the posterior ach of | the atlas (below) What actions do the 1. Extension ofthe head (all four suboccipital muscles scles) perform as a unit? 2, Rotation ofthe head (all scles ‘except for the obliqus capitis superior) 3. Flexion ofthe head laterally (all a pt for the obliquns spits inferior) es, ex POWER REVIEW What is the first easily C7 (the long spinous process is palpable palpated vertebr atthe base ofthe neck Which feature is unique to ‘The paired transverse foramina the cervical vertebrae?Do all of the transverse foramina transmit a vertebral art process (dens)? Which action occurs at the: Atlanto-occipital joint? Atlanto-axial joint? What does the eruciform ligament connect? most inferior? What is the name of the external covering of the intervertebral disk? The soft internal part? What are the five superficial muscles of the back? Which two muscles com- prise the spinotransverse (superficial) group of the deep back museles? What comprises the sacro- spinalis (intermediate) group of the deep back ‘muscles? (Chapter 6/The Back 141 No; only sinall accessory vertebral veins pas the vertebra C7 the transverse foramina of “The part of vertebra C2 (the asi) that projects superiorly from the vertebral hovly and articulates with vertebra C1 the atlas) Flesion and extension ofthe head (nodding) Lateral movement of the head (Le, from side to side) The vertical pat eonncets vertebra C2 (the axis) to the Forarnen magnum, The horizontal portion spans vertebra C2 across the dens Most superior: Between vertebrae C2 aud C3 Most inferior: Between vertebrie L5 ‘and SI “The anulis fibrosis (Sbrous cartilage) and the nucleus pulposus (elastic cartilage), respectively Trapezius Latissinmns dors Rhombold major with the upper limb) ‘The splenius rnuseles ts and splenins cerviis “The erector spinae (three parts)142 Anatory Recall Which three muscle groups 1. The semispinalis muscles (ie. the comprise the deep group semispinais capitis, the semispinals of the deep back muscles? ceric, and the semispinals thoracis rmuseles) “The nltiidus ranscle 3, The rotatores musclesThe Upper Extremity ve regia 1. Pectoral ginle; Clavie and seapula of the upper Eimb, and 2. nm (brachu); Hamers tshich bones are found in 3. Forearm (antebrachinn) Uh each region? radius Wrist (carps): Carpal bones 5. Hand (manus): Metaearpal bones and phalanges Tdenify the labeled bo ‘on the Following f the upper extremity sarpal bones etacarpal bones Phalanges144 Anatomy Recall PECTORAL GIRDLE What is the fanetion of the ‘girdle? Which bone isthe first to hexin ossification during fetal development, but the last to complete What are the two articula- tions of the elaviele? Describe the surface anatomy of the elaviel. Where is the weakest point of the clavicle? What is the name of the anterior surface of the scapula? Deseribe the coracoid process. “The pectoral gil connects the upper limb to the asia skeleton, (The axial ists ofthe shy the tthe eis au then skeleton co vertebral col cartilages, andthe storm.) ‘The clavicle (ossification begins a weeks’ gestation and ends 21 years after Diath) ‘The medial end of the ckvicle articulates with the manubrium of the sternum at the sternoclavicular joint. The lateral end of the clavicle articulates with the aacromion ofthe seapula at the ‘acromioelavicar joint. 1. The jugular (suprasteral) notch Hes between the medial elevations ofthe clavicle. 2. The mexlal two thirds ofthe elle is convex anteriorly: the large vessels an nerves that supply the upper lib pass posterior tothe bone in this region, 8. The acromioclaviculr joint ean he palpated 2-3 centimeters medal to the acromion (ie, the lateral ‘extension of the spine ofthe seapula that forms the palpable “point” ofthe shoulder) “The point where the medial two thirds of the clavicle meet the lateral thied ‘The subscapular fossa “This bony process arises from t superior border of the scapula; itis often, described as having a “bird's beak” appearance‘The coracoid process pro- vides for which three muscular attachments? Which bony landmark lies midway along the superior order of the seapula? Which ligament runs across the supraseapular notch? Which two structures traverse the superior trans- verse seapular ligament? Which structure divides the posterior surface of the scapula into two Fossae? Which of these fossue is the largest? Which muscle originates from the: Spine of the seapul Supraspinous fossa? Infraspinows fossa? What are the articulations of the seapula? (Chapter 7/ The Upper Extemicy 145 origin of the coracobrachilis sele The origin ofthe short head of the ps bre wele insertion ofthe pectoris minor sele ‘The suprascapular notch ‘The sperior transverse scapular Hgament “The suprascapular artery rans over te ligament, and the suprascapular nerve rns under the ligament. Think, “The Army goes over the bridge and the Navy goes under it divides the The spine ofthe seupul posterior surface ofthe seapmla int the supmaspinous fossa and the ifraspinous fossa ‘The infraspinous fossa (Le, the one below the spine ofthe scapula) Te deltoid muscle “The supraspinatus muscle “The infragpinats muscle “Te spine of the scapula continues Iara asthe acronon, which articulates anteriorly with the clavicle to for the acromioclavicular joint The lateral surface ofthe seapula fornis the glenoid fossa, which articulates with the head of | the humeris to form the glenobummeral joint.146 Anatomy Recall What structure deepens the slenoid fossa? Which muscles originate just above and below the iglenoid fossa? Identify the labeled structures on the following diagram of the seapula (posterior view Deseribe the surface anatomy of the seapula as it relates to the vertebral column. ‘The glenoid labrum, a fibrocartilaginous lip that extends over the glenoid fossa, thereby deepening it ‘The long heael of the biceps brachii and the long head ofthe triceps rachis respectively zon C= Root of the spine of the seapula nfraspinous Fossa ferior angle = Concoid process uprascapular notch, 1. The root of the spine of the (ce, the medial end) i opposite the spinous process of vertebra T3. The superior angle ofthe seapula les atthe level of ver(Chapter 7/ The Upper Extremity 147 3. The inferior angle ofthe seapal lies at the level of vertebra T7. ‘ARM (BRACHIUM) Identify the labeled structures on the following figure of the humerus (anterior view): Lesser tubercle wrtubercle ercular groove Surgical neck eltoid tuberosity Tuner shaft (body) Lateral supracondylar ridge | Ii cee 1 = Medial supracondylar ridge Medial epicondyle Which three muscles insert The supraspinatus, infraspinatus, and on the greater tuberele of teres minor muscles (ie. all he rotator the humerus? cles except for the subseapularis Which muscle inserts on the is muscle (Le, the fourth lesser tubercle of the rotator cuff muscle) humerus?148 Anatomy Recall Which three muscles insert ‘on the intertubercular groove? Where is the anatomical neck of the humerus? Where is the surgical neck ‘of the humerus? Where is the radial (spiral) ‘groove and why is it clini- cally important [Name the two articular sur- faces of the distal humerus. Where are the coronoid fossa and the olecran fossa? ‘What structures do these fossne accommodate? 1. Pectoralis major: Literal ip of the groove: Teres maj 2 Medial ip of the imus dorsi: Floor of the grove smber, three “major” muscles Lat Res the peetorals major, the teres major tnd the largest muscle of the back, the Fatissins dors the intertubercular groove: Distal to the head ofthe humeras unl proximal to the greater and lesser tubercles Distal to the greater and lesser tubercles, where the humeral shat begins The radial groove runs obliquely along the posterior humerus and houses the radial nerve. Therefore, fractures affecting the shaft ofthe humerus may lead to radial nerve damage L. The eapitulum (i, the literal articular surface) articulates with the head of the radi, 2 The trochlea (ic. the medial articular surface) articulates with the irnoteh ofthe ulna trochl The coronoidl fossa fs superior tothe trochlea on the distal end of the humeras anteriorly: The oleeranon fossa hes in the same position posteriorly The coronoid process and the olee of the ulna, respectivelyFOREARM (ANTEBRACHIUM) Identify the labeled structures on the following figure of the bones of the Which styloid process is more distal, the radial styloid process or the ulnar styloid process? Which muscle inserts on the styloid process of the radius? Which musele inserts on the: Radial tuberosity? Ulnar tuberosity? CChapear 7 The Upper Extremity 149 A = Troehlear notch Coronoid process Ulnar tuberosity D= Oleeranon E= Head of the radins Radial tuberosity Interosseus borders Styloid processes “The radial styloid process fs normally approximately centimeter distal to the tna stloid process. The brachioradiais muscle ‘The biceps brachii see The brachial muscle150 Anatomy Recall, Describe the articulations ofthe: Proximal radius Distal radius Where are the heads of the radius and ulna located? What attaches the lateral aspect of the shaft of the ulna and the medial aspect of the shaft of the radius? What other function does the interosseous membrane WRIST (CARPUS) Identify the labeled bones on the following figure of the wrist (posterior view): “The capitulum of the humerus and the The proximal row of earpal bones (except for the pisiform bone) ‘The head ofthe radius is Located at the proximal end of the bone, articulating ‘with the eapitafura ofthe lumerss and the radial note ofthe ulna. The head of the ulna iat the distal end of the bone articulating with the artieslar disk of the raioulnar joint, To remennber the location of the radial and ulnar heals, think RPUD: Racial Proximal, Ula Distal. ‘The interosseous membrane Itisthe att, deep fo nt site for se i rousces,What is a mnemonic to remember the earpal bones? Which of the four earpal bones in the prosimal row does not articulate with the radius and articular disk? Which of the four carpal bones in the proximal row articulates with the ulna? Which carpal bone is com- monly fractured when one falls on the palm with the hand abducted? Which carpal bone isthe most commonly fractured? (Chapter 7! The Upper Extremity 151 A= Hamate B= Capitate (C= Trapezoid D= Trapezium = Triquetrun F = Lunate G = Seaphoid Note thatthe pisiform, whi anterior to the triquetrum, {na posterior view lies just A viable rom lateral to medial, proximal ow followed by distal row Some Lovers Try Positions That They Can't Seaphoid tants Triquetrum Pisiforn Trapeziuan Trapezoid Capitare Hamat To remember thatthe trapezium comes before the trapezoid, tink “trapeciunn vvith th ‘The pisiform [None of the carpal bones articulates with the ulna The seaphoid The scaphoid152 Anatomy Recall HAND (MANUS) Identify the labeled bones ‘on the following figure of the wrist and hand. Distal phalans Head of the middle phalans Head of the proximal phalans Head ofthe fifth metacarpal bone Hook of the lamate -apitate = Pisiforin Triqqetran = Trapezoid J = Tubercle ofthe trapezium K= Lamate 1. = Tubercle ofthe seaphoic Name the three parts of a The base is prosimal, the esd i distal, metacarpal bone and the d the shalt (bods) i in the middle location of each, How many phalanges are in: Each finger? ‘Three (proximal, middle, and distal) ‘The thumb? Two (proximal, distal)Chapter 7/ The Upper Extremity 153 PECTORAL GIRDLE AND SHOULDER PECTORAL MUSCLES Name the four pectoral muscles. Pectoralis major mmsce Pectoralis minor muscle Serratus anterior umscle Subslavins musele Pectoralis major muscle Origin? Clavicular head: The anterior sieface of the medial clavicle Stemmocostal head: The anterior surtiee of the sternum and the superior si costal catia The lateral lip ofthe intertuber groove of the humerus The (lranches of the brachial plesus receiving, fibers from the CS and TT ventral rami and the C5, C6, and C7 ventral rani respectively) Action? Adducts and medially rotates the lu eras tthe glenouneral (shoulder) joint The superior border of th The deltopectoral triangle (the ether pectoralis major musele sides are formed by the deltoid, one of contributes to which ana-—— the scapnlar muscles, andthe clavicle tomie triangle? What vascular structure lies in the deltopectoral triangle? Pectoralis minor muscle Origin? Ribs 2-5 Insertion? “The coracoid process ofthe seapuak, Innervation? The medial pectoral nerve Action? Stabilzes the scapula by draveing it anteriorly154 Anatomy Recall ‘The pectoralis minor muscle divides which important axillary structure into three arts? Serratus anterior muscle Origin? Innervation? Action? What happens when the long thoracie nerve is injured? What is the blood supply of the serratus anterior Subelavius muscle Origin? Insertion? Action? SCAPULAR MUSCLES Which six muscles pass from the seapula to the humerus and act on the shoulder joint? ‘The ilar artery ‘The extemal surfaces of ibs 1-8 (the usele is nanied forthe saw-toothed appearance ofits proximal attachments) The nedial border of the scapula ‘The long thoracie nerve (a branch of the brachial plemus receiving fibers from the C5, 06, and C7 ventral Holds the seapula against the thoracic wall Denervation of the long thoracie nerve, Teacling to Toss of serratus anterior finetion, characteristiclly results ia a phenomenon known as "winging ofthe scapula” ‘The dorsal seapular artery (a branch of the subelavian artery) Rib 1, at the costal cartilage ‘The inferior surface of the claviele The nerve to subelavins (a branch of the brachial plesus receiving fibers frou the (C5 and C6 ventral rami) Stubilizes the elaviele 1, Deltoid muscle 2 Teres major muscle 3, Supraspinatus musele 4. Infraspinatus museleWhich of these muscles comprise the “rotator cull” muscles? Why are these four muscles known as the “rotator cuff” muscles? Action? ‘Teres major muscle Origin? Insertion? Innervation? (Chapter 7/ The Upper Extremity 155, aii 6. Subseapularis muscle minor muscle sis Supraspinatus Intraspinatus ‘Teres minor Siabscapmlaris Along with thelr corresponding tendons, these four muscles surround the glenohumeral joint, forming a rmusculotendinous “eufl that protects stabilizes the joint by holding the head ofthe humerus inthe glenotd fossa, ‘The lateral third of the clavicle, the ‘acromion ofthe scapula, and the spine of| the seapula, “The deltoid tuberosity of the humerus ‘The aillary nerve (a terminal branch of the brachial plewus receiving fibers from the C5 and C6 ventral rami) Anterior part: Flesion and medial rotation of the humerus at the ¢lenohumeral joint Middle part: Abduction ofthe humneras atthe glenohumeral joint Posterior part: Extension and lateral rotation of the umerus at the glenohuneral joint "The dorsal surface of the inferior angle of the seapala ‘The medial ip ofthe intertuboreular sgroove of the humerus The lower subscapular nerve (a branch of the brachial plexus receiving fibers from the OB and C7 ventral rami)Action? Adduction andl mba rotation of the Tnumerus at the glenolumeral joint The posterior asillary fold Supraspinatus muscle Origin? The supraspinous fossa ofthe seapla rene (a branch of the brachial plesis receiving fibers from the C4, C5, an O6 ventral rami) Action? Assists the deltoid seth abduction of the nerus.at the glenohumeral joint: ats in concert with the other rotator cu Jes to old the head of th inthe glenoid fossa Infraspinatus muscle Origin? “The infraspinous fossa ofthe scapula Insertion? “The middle facot on the greater tubercle of the hunne nas Innervation? ‘The suprascapmlar nenve Action? Lateral rotation of the hunerus at the elenohueral joint also assists in holding the head of the humerus in the leno fxs Teres minor muscle Origin? ‘Tho superior part of the lateral border of the scapula Insertion? The inferior facet on the greater tubercle of the humens ‘The axillary nerve Lateral rotation ofthe humerus atthe leniobmmeral joint: also assists in holdingSubscapularis muscle Origin? Insertion Innervation? FASCIAE ‘The pectoral fascia is con- ‘inuous with which structure inferiorly? Laterally, the pectoral fascia becomes what? Which two muscles are en veloped by the clavipectoral fascia? ‘What isthe portion of the clavipectoral fascia between the first rib and the coracoid proces of the scapula called? Which artery, vein, and nerve pierce the costocora- ccoid membrane? Chapter 7/The Upper Exaremky 157 the head of the humerus in the glenoid fossa (note thatthe action ofthe teres ‘minor muscle i identical to that ofthe infaspinatus muscle) “The subscapular fossa on the anterior surface of the seapala ‘The lesser tubercle ofthe humerus “The upper and lower subscapular nerves (branches of the brachial plesus receiving, fibers from the C5, C6, and al Meetial rotation and adduction of the humerus atthe glenohumeral joint also assists in holding the head of the humors Inthe glenoid fossa “The fase ofthe abelominal wall “The asilay fascia ‘The subelasius and pectoralis minor “The costoconicoid membrane The thoracoacromnial artery (a branch of the auilary artery), the cephalic vein, and the lateral pectoral nerve JOINTS AND LIGAMENTS OF THE PECTORAL GIRDLE What are the three joints of the pectoral girdle? 1. Stemoclavicular joint 2 Acromioclavicular joint 3. Glenohumeral (shoulder) joint158 Anatomy Recall Deseribe the sterno- clavicular joint. Name the four ligaments of the sternoclavicular joint and describe their functions. Which arteries supply the sternoclavicular joint? Deseribe the aeromio- clavicular joint. Name the to ligaments of the aeromioclavicular joint. Which arteries supply the acromioclavicular joint? Describe the glenohumeral joint. ‘Name the sis ligaments of the glenohumeral joint. ‘The glenohumeral joint allows for which types of movements? The stemoclavicular joint isa synenial joi ‘of the elavicle and the ma “The synovial mevibs cular capsule between the sternal end brit ofthe Anterior sternoclavicular Tigamer anteriorly Posterior sternoclavicular ligament: Reinforces the capsule posteriorly Interelavicular ligames the medial ends ofthe claveles ligament: Attaches Reinforees the capsule stabilizes “The internal thoracie and supraseaplar arteris (branches of the subclavian artery and the thyrocervial trunk, respectively) “The aeromioclavicular joint i a synovial joint that joins the lateral end of the clavicle with the aeromion ofthe seapula, 1 ‘Acromiochiieular ligament Conacoelavicular ligament (Fo i trapezoid ligaments) wed by the conoid ‘The suprascapuilar and thoracoaeromial ‘The glenolumeral joint is balland- socket joint between the gh Flesion and extensi i fossa of| ul the heal ofthe humerus, al liga Middle glenohumeral igam Inferior glenohusneraligarent “Transverse humeral ligament Coracobumeralligasnent ‘Coracoacromial ligament abduction and adduction, medial and lateral rotation, tnd eireumdetionChapter 7 / The Upper Extrmity, 159 1. Axillary nerve 2 Suprascapular nerve Lateral pectoral nerve Name the four arteries that 1. Anterior cireumflex humeral artory supply the glenohumeral 2 Posterior cicumfles humoral artery joint. 3, Suprascapular artery 1. Scapular circumle Name the three burs 1. Subseromial bursa the glenohumeral joint. 2. Subdeltoid bursa 3, Subscapular bursa What is the function of ‘To reduce friction between the rotator these bursae? ‘calf and the coniconeromial arch during ent ofthe glenohumeral jo ‘Name the muscles involved in the following movements at the glenohumeral joint Adduction ectoralis major, latssinus dorsi, teres ajo, triceps, and subscapularis Abduction Deltoid and supraspinatus Flex Peetorals major, anterior part of the deltoid, coraco Drachi rachialis, and biceps Estensio Latssimus dorsi, posterior part ofthe deltoid, triceps. and teres major Medial rotation Subscapullaris, pectoralis major, anterior ppart ofthe deltoid, latissimus dorsi, and teres major Lateral rotation Infraspinatus, teres minor, and posterior part ofthe deltosd AXILLA What is the asilla? ‘The pyramidal area atthe junction ofthe ‘upper extremity and the trunk tinderarsn) ‘What are the boundaries of the axilla: Medially? Ribs 1-4, the intercostal muscles, and the serratus anterior muscle160 Anatomy Recs Laterally? The hmors (specifically the flor of the intertubc tena groove Anteriorly? The pe anuscles Posteriorly? The scapula and the subscapularis, teres ‘major, and latins dorsi muscles What forms the base of The asl. sand skin Th scapula, and first rib interval between the clavicle Axillary artery Asillary sein Aaillary Impl nodes Branches ofthe brachial plexus Biceps brachii muscle the long an short heads) -oracobrachi What is the asillary sheath? A continuation of the cervical fascia into the axilla that encloses the allay artery the asillary vein, and the brach plesus VASCULATURE Axillary artery Deseribe the origin and fate The sibelavian artery becomes the of the axillary artery. zillary artery at the lateral border ‘of the fest ib, The axillary artery becomes the brachial artery at the inferior border ofthe teres mjor He Delineate the three parts of the axillary artery, and name the branches from each. (Note that the first part has one branch, the second part two, and the extenals from the lateral border of the: first rb to the superior border of the pectoris minor muscle, giving off the superior thoraci arterySecond part? ‘Third part? What are the two branches of the subscapular artery? Which two branches of the axillary artery anastomose swith one another on the ‘surgical neck of the humerus? Ide on the following figure: ammo fy the labeled arteries CChupcer 7/ The Upper Extremity 161 Extends deep tothe peetorals minor muscle, giving off the thoracoaero- taal artery and the lateral thoraeie Extends from the inferior border of the pectoralis minor muscle to the inferior border of the teres major muscle, giving ‘off the subscapular, anterior circumflex ind posterior circumflex arteries 1, Gireumflex seapular artery 2. Thoracodorsal artery The anterior and posterior dreumnflex Inumeral arteries162 Anatomy Recall Axillary vein Deseribe the origin and fate of the axillary vein. Within the axilla, what is the relationship between the axillary vein and artery? Axillary lymph nodes Name the five groups of axillary lymph nodes. ‘What is the course of lym- phatic drainage in the axillary region? ‘BRACHIAL PLEXUS What is the brachial plexus? sillary artery Thoracoaeromial artery ral thoracie artery Subscapnlar artery F = Postesiorcircutnlex humeral artery G= Anterior circumflex humeral artery H1= Brachial artery Note that the superior thoracie artery branches off the first part of the asllary posteriorly and therefore is not visi this view The axillary vein originates atthe inferior border of the teres major muscle as a mn ofthe basiie vein, and becomes the subclavian vein atthe lateral border ofthe frst rib, Note that the borders ofthe allay vein parallel those ‘of the asilary artery ‘The vein lies superficial to the artery 1. Central 2 Lateral 3. Subscapular (posterior) 4. Pectoral 5. Apical ‘The lateral, pectoral, and subscapular (posterior) nodes drain into the central woes, whic 1 drain into the apical nodes drain into the large network of nerves that originates in the neck and extends into the alla, siving rise to most ofthe nerves that supply the upper extremityWhat are the five segmental branchings of the brachial plexus? ‘The ventral primary rami of sshich spinal cord segments contribute to the brachial plexus? ‘The rami leading to the brachial plesus run between which to muscles? Which two nerves branch off from the rami of the brachial plexus before the rami become trunks? Which two nerves branch off the superior trunk of the brachial plexus? What do the trunks divide low are the cords formed from the anterior and posterior divisions of the trunks? (Chapter 7/ The Upper Excremity 163 Rani Trunks Disisions Cords Branches (ter (,C5,C7, C8, and T1 ar nerve: From the supplies the rhomboid minor nl rhomboid major muscles Tong thoracie nerve: From the C5, C6, ane C7 rami, supplies the se rior muscle (een winging?) the rami Superior trunk: Formed fr ‘of C5 and C6 Middle trunk: Continuation of the ramus of CT Inferior trunk: Formed from the rami of CS and TT and CB anni, supplies the supraspinatus ‘and infraspinatis mseles and the lenolnaneral oi, rns under the supedior transverse seapular ligament islike the Navy!) ‘vmomber, the 2. Thenene to subclavins: From the CB, ramus, supplies the subclavius muscle Each trank splits into an anterior division and a posterior division, Lateral cord: Formed from the anterior divisions of the superior and midalle trunks164 Anatomy Recall ‘The lateral cord gives rise to which branch? What are the two terminal branches of the lateral cord? ‘The medial cord gives rise to which three branches? to the lateral pectoral nerve? ‘What are the two terminal branches of the medial cord? Which terminal nerve branch of the brachial plexus receives contribu. tions from both the medial and lateral cords? ‘The posterior cord gives rise to which three branches? Medial cord: Continnation ofthe anterior division ofthe inferior th “The lateral pctoral nerve: From the ¢ 8, and C jor muscle and contributes to the ration of the pector ‘ami, supplies the pectoral 1. The museulocutancous nerve: From the C5, O6, and C7 rami, supplies d corscobrachilis, biceps brachii, and Drachialis nuseles 2. The lateral oot of the median nerve 1. The medial pectoral nerve: From the and TI rami, supplies the pectoral minor and pectoralis major muscles 2, The medial brachial cutaneous nerve: From the C8 and TI rami, supplies the skin on the medal side of th 3, The medial antebrachial entancous nerve: From the G8 and TH rami supplies the skin on the medial side of | the forearm Lateral tot! The medial pectoral nerve is eal “meatal” bocanse It arises From the eda cord ofthe brachial plexus, not because ofits position relative to the lateral pectoral nerve. Similarly, the lateral pectoral nerve is designated “lateral bbeeanise it arises from the lateral cord; t lies medial to the medial pectoral nerve 1. The! 2 The redial rot of the median nerve ‘The media 8, and TL sve: From the C5, C6, C7, pper subscapular nerve: From vervates the “upper portion of the subscapularis eleWhat are the two terminal branches of the posterior cord? ‘Which nerve is the largest ranch of the brachial plexus? Which muscles are inner- vated by the radial nerve? Identify the labeled nerves ‘on the following diagram of the brachial plexus: (Come on! You can do it!) (Chapter 7 "The Upper Extremity 165 ‘The thoracodorsal nerve: From the CT ‘and CS rami, innervates the lations dorsi nmscle 3, The lower subscapular nerve: From the C3 and C6 rai, innervates the lower portion ofthe subscapularis musele as well as the tores major 1, The axillary nerve: From the C5 and C6 rami, innervates the deltoid and teres minor museles, eventually Ipecomics the lateral brachial eutancous nerve, which supplies the skin on the lateral arm 2. The radial nerve: From the 5, C6, C7, €8, and TH rami ‘The radial nerve ‘The extensors ofthe upp vozerxe*166 Ansomy Recall ARM (BRACHIUM) Dorsal spar neve = Suprascapmlar nerve Nome to subelavins Long thoracic nerve Meal pectoral nerve Meslial brachial eutancous ner Mei ante brachial entancons nerve Later peetoral eve Muscufacutaneons nerve Asillry nerve Radial new Laxser subeapnkir nerve Thoracodrsal nerve N= Upper subscapular nerve 0 P= Uhnarnerve Note: The brachial plesns is key anatomiestracture that yall cone app Median nerve agai anel again during your anatomy course and beyond: yor would be well served to memorize it so thal son ea reproduce a diagram oft on com mane, MUSCLES OF THE ARM What divides the ar anterior fascial (lexor) and posterior faseial (extensor) compartments? Which muscles of the brachium lie in the: Anterior fascial (flexor) Posterior fascial (extensor) compartment? Brachialis muscle The medial and lateral intermuscular septa and the humerus BBC Brachialis muscle Biceps brachii muscle Goracobrachialis muscle Treeps brachii muscle ‘The distal half ofthe the humerus terior surfice ofBiceps brachii muscle Origin? rmervation? Action? Describe the course of the tendon of the long head of the biceps brachit muscle. Coracobrachialis muscle Origin? Insertion? Innervation? Action? ‘Triceps brachii muscle Origin? Chapter 7 The Upper Excromicy 167 ‘Thew process of the ul ar tuberosity ane the coronoid ‘The museulocutancous nerve Main flexor ofthe forearm at the hhumeroulnar (elbow) joint Long head: The sup of the scapula Short head: The coracoid process 0 scapula ‘The radial tuberosity and the fascia of the ‘medial forearm via the biciptal aponcurosis reulocutancous nerve ulnar joints ant of the humeroulnar joint from a supine position ‘The tendon of the long head of the biceps brachii muscle crosses the head of the h losed in a fbrons capsule) and descends in the intertubercular ‘groove to the radial tuberosity The tip of the coracoid process of the seapuila ‘The medial surface ofthe humerus, about halfivay denn ‘The musenlocutancous nerve Assists in flexion andl ackluction ofthe arm at the glenohumeral joint Long head: The infiaglenoidl tubercle of the seapula Lateral head: The posterior surface of the humerus, proximal (superior) to the radial groove168 Anatomy Rees Innervation? Action? Which small muscle sists the triceps brachit usele in extending the forearm? Medial head: The posterior surface of Tamers, distal inferior) to the radial groove ‘The oleeranow of the uaa “The radial nerve (remember, the radial none innervates all of the extensors in the upper ib) ‘The triceps brachil i the ehieFextensor of the forearm at the humeroksar join, i addition, the long head ofthe triceps brachi steadies the head of the ablucted Inamerus, ‘The anconeus musele, located in the forearm VASCULATURE OF THE ARM Arteries Which artery represents the principal arterial supply to the upper limb? Deseribe the course of the brachial artery. ‘The superior ulnar colls eral artery pierces which, fascial membran The superior ulnar collat- eral artery travels with which nerve behind the medial epicondyle? ‘Tho brachial artery The brachial artery originates at the inferior border ofthe teres major musele asa continuation ofthe axillary artery and ‘courses distally in the “beipital groove’ anterior tothe medial ntormuscular septum before ending én the cubital fossa by diving into the ular andl ral “The medial inte lar septa The ulnar nerveIdentify the labeled arteries ‘on the following figure of the arm and forearm: rom Veins Name the two main super ficial veins of the arm. Where do the cephalic and basilie veins originate Which superficial vein runs through the deltopectoral triangle? Which vein forms « com- munication between the basilie and cephalic veins in the cubital fossa? Chapter 7 The Upper Excremity 169 terior and posterior cireunflex Inumera arteries Brachial artery Deep brachial artery D= Superior Inferior ulnar collateral artery Radial artery G= Ulnar artery ieror interossens artery nar collateral artery ‘The cephalic vein and the basic vein The dorsal venous arch of the hand "The cephalic vin ‘The cephalic vein The median eubital vein170. Anatomy Recall Identify the labeled super ficial veins on the following figure of the arm and forearm: INNERVATION OF THE ARM Which four major nerves trun through the arm? Which of these do not branch in the arm? ‘The median nerve lies close proximity to which artery? Deseribe the course of the radial nerve in the arm. A= Alla vein B= Cephalie win Basile vein Median eubital vein E=Cephualie vin Basie vei L. Median nerve 2. Ulnarnenve 3. Radha nerve 4. Musculocutancous nerve ‘The median and ulnar nerves ‘The brachial artery (the median nerve is located just anterior to it) ‘The radial nerve enters the arm posterior tothe brachial artery and medial tothe humerus. It passes inferolaterally along, the humerus inthe radial groove (accompanied by the deep brachial artery), and pierees the lateral intermuscular septum to run between the brachialis and brachioradilis muscles. At the lateral epicondyle of the humerus, theDescribe the course of the museuloeutaneous nerve. ELBOW REC CChapter 7 The Upper Extremigy 171 radial nerve divides into deep and superficial branches, ‘The museulocutaneous nerve pierces the between th 1 eachials snuseles. E contaneous nerve becomes the lateral tebrachial cutaneous nerve. (Recall that the medial antebrach ‘sa branch from the brachial plexus.) CCUBITAL FOSSA What is the cubital fossa? What are the boundaries of the cubital fossa: Laterally? Medially? Superiorly? What forms the floor of the ‘cubital fossa? ‘The roof? List four key structures found in the cubital fossa. Where does the media ‘cubital vein lie in relation to the bieipital aponeurosi ‘The hollow area on the anterior surface of the elbow ‘The pronator teres muscle (a superficial anterior muscle in the forearm) Imagine a line between the medial and lateral epicondles of the humerus ‘The brachialis and supinator muscles “The superficial faseia, skin, and biciptal aponeurosis 1. The brachial artery 2 The median nerve 3. The radial artery 4. The tery Superficial toi; the veins in the region of the eubital fossa are a favorite target for phlebotomists because oftheir superficial position172 Anatomy Recall HUMEROULNAR (ELBOW) JOINT Describe the humeroulnar The hnuneroniae joint i synovial joint fn which the trocliea of the humerus articilates with the trochl the ulna, and the expit Iumerus articulates with the head of the rads Name the museles involved in Flexion of the humero- The brachials, biceps brachii, brachio- ulnar joint? radials and pronator teres muscles Estension of the humero- The trieops brachii and anconens muscles ulnar joint? Name the three ligaments 1. Anniar ligament that reinforce the humero- 2. Radial collateral ligament ‘ulnar joint. Ulnar collateral ligament Deseribe the annular ‘The annular ligament travels around most of the head of the radius, preventing withdrawal of the head from is socket The annular ligament then fuses with the collatera FOREARM (ANTEBRACHIUM) MUSCLES OF THE FOREARM, What are the two groups of 1. The flewor pronator (anterior forears forearm muscles! group 2. The extensor-supinator (posterior Forearm) group Anterior forearm muscles Which flexor-pronator muscles: Pronate the forearm and 1 hand? tor quadeatus muscle Flex the hand at the 3. Flexor carpi radials muscle ‘radiocarpal joint? 4. Flexor exp ulmaris muscle 5. Palmaris longus muscleFlex the interphalangeal joints of the digits? ‘What is the only muscle that ‘ean flex the distal inter phalangeal joints? Which muscle is most important in flexing the digits slowly? Which muscle is most important in flexing the digits quickly or against Which flexor-pronator ‘muscles form the: Superficial layer of anterior forearm muscles? Intermediate layer of anterior forearm muscles? Deep layer of anterior forearm muscles? ‘What is the common origin of the flexor-pronator ‘muscle group? Which three flexor-pronator muscles do not share this ‘common origin? (Chapeer 7/ The Upper Extremity 173 6, Flexor digitorum superficial musele 7. Flexor digitorum profundus muscle 8. Flesor pollicis longus muscle ‘The flexor digitorum profiandas muse (this muscle also assists in lesion at the metacarpophalangeal and wrist Joints) ‘The flexor digitorum superficialis muscle ‘The flexor digitorum profundus musele From lateral to medial 1. The pronator teres muse 2 The flexor carpi radials musele 3. The palmars longus muscle 4. The flexor carpi alnaris muscle ‘The flexor digitorum superticialis muscle 1. The flexor digitorum profundus usele ‘The flexor pollicis longus muse 3. The pronator quadratus musel ‘The common flexor tendon, from the medial humeral epicondyle (the "funny ene") ‘The deep Hexor-pronator muscles (Le the flexor digitorum profundus, the flexor pollicis longus, and the pronator ‘quadratus muscles) do not arise from the ‘common flexor tendon.174 Anatomy Recall Identify the superficial Hlexor-pronator museles on, the following figure:(Chapter 7/ The Upper Exeremicy 175 Identify the deep flexor- ppronator museles on the follwing figure: Flexo cligitorann profimds ynscle exor polis longus misc C= Pronator quadratus musele Pronator teres muscle Origin? “The medial epicondyle of the Insertion? The alway down, tonal surface ofthe ruins, about The median nerve Promtes the land nel forearm Flexor carpi radials muscle Origin? ‘The medial epicondyle of the humerus Insertion? “The bases ofthe second and third metacarpal bones Innervation? “The median nenwe176 Anatomy Recall, Action? ‘The tendon of the flexor carpi radialis muscle runs through a vertical groove in which carpal bone? Palmaris longus muscle Origin’ Inserti Innervation? Action? Flexor carpi ulnaris muscle Origin? Inserti Innervation? Action? Fleses the forearm and flexes and abducts the hand “The traperium (i, the fist bone in the second row of exmpal bones) ‘The medial epicondyle ofthe humerus “The fleror retinaculum (ie. thickened portion of the antebrachial fascia) and the palmar aponeurosis (ie. thickened portion of the palmar fascia) Flexes the hand and forearm ‘The medial epicondyle ofthe bumers, the medial olecranon of the ulna, and the posterior border ofthe ulna ‘The pisiform bone, the hook ofthe hhamate, and the base ofthe fifth metacarpal bone The w exes ancl adducts the hand anel flexes the forear Flexor digitorum superfcialis muscle Origin? Insertion? Innervation? ‘The medial epicondyle of the humenns, the coronoid process ofthe ulna, andthe oblique line ofthe radius ‘The middle phalanges ofthe digits Tw edian nerve(Chapter 7/ The Upper Extremity, 177 Action? Fleses the proximal interphalangeal joints of the medial four digits, Hewes the hand, and Hewes the forearm: Flexor digitorum profundus muscle Ovigi ‘The anteromerdial surface of the ulna and the Insertion? ‘Tho bases ofthe distal phalanges of digits Innervation? ‘The ulnar and median nerves Action? lexes the distal interphalangeal joints and assists in flexing the metaearpoph- langeal joints and radioearpal (ist) joint Flexor pollicis longus muscle Origin? “The anterior surface ofthe radius, the interosseous membrane, and the coronoid process ofthe ulna Insertion? “The base of the distal phalans ofthe thas Innervation? ‘The median nerve Action? lexes the interphalangeal joint of the shuinb Pronator quadratus muscle Origin? ‘The anterior surface ofthe ulna Insertion? ‘The anterior surfuce of the radius Innervation? ‘The median nerve Action? Pronation ofthe forearn at the proximal and distal radioulnar joints Posterior forearm muscles Classify the nine extensor- supinator museles by action. Which extensor-supinator muscles: Extend the radiocarpal 1. The extensor carps radials longus Joint? muscle 2 nsor carpi radials brevis usor curpl ulnaris museleExt 4 phalangeal joints of the 5, digits? 6 Extend the thamb? 7 ‘ 9, The extensor digitorann mise The este Tho extensor digit miniunéyonscle The abductor polliis longus sinscle The extensor pollicis brevis mmsele The extensor pollicis longus mussel The extensor retinaclan (he. thickening of the deep Fascha of the fw when the hand is hype ‘extended at the earpal What are the extensor Located on the distal ends of the met ‘expansions? ‘earpal hones and on the phalanges, the festensor expansion extensor tendons laton ont over te bon are Formed shen the What structure anchors the ‘The pulsar ligament extensor expansions to the yetacarpal bones? Identify the labeled muscles ‘on the following diagram of the superficial muscles of the posterior forearm:Identify the labeled muscles on the following diagram of the deep muscles of the What is the origin of the deep muscles of the posterior forearm? Which nerve innervates all the muscles of the posterior forearm? CChopeor 7/"The Upper Extremity 179 A= Brachioradialis muscle B = Anconens muscle = Extensor carpi radials longus musele Extensor digitorum musele Alxluctor pollicis longus musele Extensor pollicis brevis mus 11 = Flexor carpi nlnaris mnsele Extensor carpi ulnaris muscle Anconeus inuscle Supinator muscle Abeluctor pollicis lon Extensor pollicis longus muscle Extensor indicis muscle F = Extensor pollicis brevis musele “The interosseous membrane and th pesterior surfaces ofthe ulna and radius he radial nerve, which has superficial and deep branches180 Anatomy Recall Anconeus muscle Origin? The lateral epicondye of the humerus Insertion? “The hateral surface of the olecranon and the superior part ofthe posterior surface oF the ulna Innervati inesteuding the t Assists the triceps brs Forearm at the hnumetoulnar jo Brachioradials muscle Origin? ‘The prosimal two thirds of the ondvlar ridge of the humeras Insertion? “The lateral surface of the distal end ofthe dius Innervation? ‘The radial nerve Action? Fleyes the forearm atthe humeroulnar Ihow) joint Extensor carpi radials brevis muscle Origin? The lateral epicondse ofthe humerus Insertion? ‘The base ofthe thi! metacapal bone Innervation? The radial nerve Action? wend the fingers and abducts the band at the radioearpal joint xcensor carpi radials longus muscle Origin? The lateral supracondylar ridge ofthe Iumerus ‘The base of the second metacarpal bone The radial nerveAction? Extensor carpi ulnar muscle Origin? Inyertion? Innervation? Action? Excensor digit minimi muscle Origin? Insertion? Innervation? Extensor digitorum muscle Innervation? Action? ‘Abductor pollicis longus muscle Origin? ‘Chapter 7/ The Upper Extremicy 181 Extends and abducts the lanl atthe rudioespl joint The lateral epicondyle and posterior surfuee of the uln The base ofthe fifth metacarpal bone ‘The radial nerve Extend and adducts the hand at the rudioearpal joint ‘The common extensor tendon and the interosseus membs The extensor expansions und the bases of the middle and distal phalanges “The radial nerve Extends the fifth digit (i.e. the “te” Finger “The lateral epicondye of the humerus ‘The extensor expansions and the bases of the middle and distal phalanges “The radial nerve Extends the fingers at the metacarpopha- langeal joints and the hand a the radiocarpal joint The interosseus membrane ancl the posterior surfaces ofthe radius and wna “The base ofthe frst metacarpal bon182 Anatomy Recall Innervation? Action? Extensor pollicis brevis muscle Ovigi Insertion? Innervation? Action Extensor policis longus muscle Origin? Insertion? Innervation? Action? Extensor indies muscle Origin? Insertion? Innervation? Action? Supinator muscle Origin? The radial nerve Abslucts the thin at the ‘earpometacarpal joint and the hand atthe radioearpal joint ‘The interosseuis membrane and posterior surface of the rads “The base of the proximal phalans of the Haas Extends the proximal phalans of the tub anelabdincts the hand atthe radioearpal joint ‘The interosseus membrane and the posterior surface ofthe ulna “The base ofthe distal plalans of the thumb The radial nerve tas of the thumb lioctpal Extend the distal pha andl abnets the hand at the joint ‘The interosseus membrane une the posterior surface of the hia ‘The extensor expansion af the second dligit (the inde finger) ‘The radial nerve Extends the second digit The lateral epicondye of the humerus, the radial collateral and annularCChapeer 7/ The Upper Exeremity 183 ligament, the supinator fossa, and the crest of the Insertion? ‘The lateral, posterior, andl anterior surfaces ofthe prosinal third ofthe radius Innervation? “The radial newe Action? Supination ofthe forearm and hand atthe radioulnar joint VASCULATURE OF THE FOREARM Which artery in the forearm is often used to palpate an arterial pulse? ‘The ulnar artery accom panies which nerve on its course between the two heads of the flexor digitorum superficialis muscle? ‘The ulnar artery lies be- tween which two muscles? ‘The common interosseous artery (a branch of the ulnar artery) divides into whieh two arteries? Before anastomosing with the posterior interosseous artery, whieh fascial mem- brane does the anterior interosseous artery pieree? “Tho radial artery, which lies lateral to the tendon ofthe fleror earpi radials muscle The median Ina arte subsequent ris medially to join the ulnar nerve) sve (note the ‘The tlexor digitorum superficiais and the exor digitora The ante posterior interosseous artery terosseous artery The interosseous membrane INNERVATION OF THE FOREARM Describe the course of the ulnar nerve at the elbow. ‘The ulnar nerve passes between the medial epicondyle oft “funny bone") and the olecranon of the ina to enter the forearm,184 Anatomy Real ‘The heads of which flexor- pronator musele are split by the: Median nerve? ‘The pronator teres umscle Ulnar nerve? “The flexor carpi ulnaris muscle JOINTS AND LIGAMENTS OF THE FOREARM Describe the proximal The proximal radioulnar joint isa pivot- radioulnar joint. ‘ype synovial joint in which the head of the radius articulates with the radial note ofthe nln Deseribe the distal radio- ‘The distal ralionfnar joint isa pivot-type ulnar joint synovial joint in which the head ofthe ‘ln articulates with the uluar notch of the radius, ‘The proximal and distal Pronation and supination radioulnar joints allow for which movements of the forearm? Which muscles are involved i Pronation of the forearm The proniator quadlratus and pronator teres masles ‘The supinator and biceps brachit muscles WRIST (CARPUS) Describe the radioearpal The radiocarpal joint is « condyloid joint (ovrist) joint where the radius and articular disk articulate with the seaphoid, lanate, and triquetral bones, Which movements are Flesion and extension, abduction and possible at the radiocarpal —_alduction, snd eireumduetion joint? Name the four ligaments 1. Anterior ligament associated with the radio- 2. Posterior lizament carpal joint. 3, Radial collateral Kigament 4, Ulnar collateral ligament Deseribe the interearpal Te interearpal joint i the synovial joi Joint. ‘between the proximal and distal rows of ‘carpal bones.Which movements are allowed by the interearpal joint? Which structure converts the carpal groove into a “tunnel?” How is the flexor retina cculum formed? Deseribe the attachments of the flexor retinaculum, [Name the structures that center the palm superficial to the lexor retinaculum, What are the anterior and posterior boundaries of the carpal tunnel?” What structures pass through the carpal tunnel? What structure, deep to the flexor retinaculum, encloses the flexor digitorum pro- fundus and flexor digitalis superficialis tendons? How is the extensor retina- cculum formed? Describe the attachments of the extensor retinaculum. Which nerve erosses the ‘extensor retinaculum? ‘Chapter 7/ The Upper Exremicy 185 Flexion and abvluetion of the hand ‘The flexor retinaculun The deep fascia of the forearm thickens anteriorly atthe wrist ‘The scaphoidl and trapezis the lateral-most carpal bones) laterally andl the pisiform and hamate (the medial most carpal bones) medially UP UP above the flexor retinaculum ‘Ulnar neve Palmatis longus Palmar cutaneous branch of the median, “The flexor retinacy dth sm anteriorly pal bones posteriorly 1. Median nerve 2. Flesor pollicis longus t 3. Flexor digitorum profundus tendons (four) 4. Flewor digitorum superficalis tendons (four) The common flexor synovial sheath The deep fascia ofthe forearm thickens posteriorly at the wrist, The styloid process ofthe and the triquetrum aa pisfon laterally Ina dally, ones The superficial ranch of the radial nerve‘Anatomy Recall HAND (MANUS) ANATOMIC SNUFF BOX: What are the boundaries of the anatomie snuff box: Posteriorly? ‘The tendon of the extensor pollicis longus muscle Anteriorly? ‘The tendons of the extensor pollicis Devs and abductor pollicis longus muscles Proximally? ‘The styloid process ofthe radius What forms the floor of the The seaphold and trapezium bones ‘anatomic snufT box? Which artery lies in the The radial artery anatomic snuff box? ‘Tenderness over the “The seaphoid bone anatomic snuff box suggests fracture of which bone? JOINTS AND LIGAMENTS OF THE HAND Which ligaments support Each joint is supported by one palmar the metacarpophalangeal ligament and evo collateral ligaments, joints? ‘What is the clinical name for enlargement of the: Proximal interphalangeal Bouchard’s nodes (characteristic joints? sheumatoid arthritis) Distal interphalangeal Heberden’s nodes (characteristic in joints? osteoarthritis) FASCIAE AND MUSCLES OF THE HAND Name the four fascial com- 1, Thenar compartment partments in the hand. 2. Adductor compartment 3. Hypothenar compartment 4. Central compartment What is the fibrous structure ‘The palmar aponcurosis that overlays the tendons in the palm?Palmaris brevis muscle Origin? Insertion? Innervation? Action? Intrinsic hand muscles Name the four groups of trinsic muscles of the hand. ‘Thenar muscles ‘Name the three thenar muscles. What is the major action of the thenar muscles? Abductor pollicis brevis muscle Origin? Insertion? Action? Flexor pollicis brevis muscle Ovi Insertion? Action? (Chapter 7/ The Upper Extemiy 187 ‘The flexor retinaculum and palmar aponcurosis ‘The skin of the medial palm The ulnar nerve Wrinkles the skin of the medial palm 1 2, Adductor pollicis muscle 3, Hypothenar muscles 4. Short anusles (Le, the lumbr interossei) 1. Abductor pollicis brevis muscle 2. Flexor pollicis brevis muscle 3. Opponens polis muscle Abduction, flexion, and opposition ofthe ‘earpometacarpal joint of the thumb "The median nerve ‘The flexor retinaculum, the seaphoid bone, and the trapezium bone ‘The base of the proximal phalans of the fam Abduets the thumb ‘The flexor retinaculum and the trapezius bone ‘The base ofthe proximal phalans of the b Fleses the thumb188 Anatomy Recall ‘Opponens polis muscle Origin’ Insertion? Action? Adductor pollicis muscle Origin? Insertion? Innervation? Action? What structure separates the two heads of the adductor pollicis muscle? Hypothenar muscles Name the three hypothenar muscles. Which nerve innervates the hypothenar muscles? ‘Abductor digit minim! muscle Flexor digi minimi brevis muscle Origin? Insertion? ‘The flexor retinaculuan and the trapezius bone ‘The first metacarpal Opposes the thumb tothe: her digits ‘The eapitate bone, the bases of the second and third metacarpal, and the palmar surface of the third meta The prosimal pha was ofthe thom The w Adds the ‘carpometacarpal joint an at the ‘The radial artery (as it form palmar arch) ‘muscle 1. Abductor digi mini 2 Flexor digit min ‘The pisiform bone and the tendon of the flexor carpi ulnaris muscle ‘The prosimal phalanx ofthe 6th digit Abduets the fifth digit ‘The flexor retinaculum and the hook of the hamate ‘The proximal phalans ofthe fifth digitAction? COpponens digi minim’ muscle Origin? Insertion? Action? ‘Short muscles What are the short muscles ‘of the hand? Lumbricals Origin? Insertion? Innervation? Insertion? Innervation? Chapter 7/ The Upper Excremity 189 Flexes the proximal phalans of the fifth digit ‘The flexor retinaculum and the hook of the hamate ‘The fifth metacarpal Opposes the filth digit L. The humbricals 2. The interossei (dorsal and pa “The lateral ses ofthe tendons ofthe flexor digtorum profundus muscle ‘The lateral sides ofthe extensor expansions ervates the two lateral lumbricals, and the ulnar nerve innervates the two medal iubrieals, ‘The median Flexion ofthe metacarpophalangeal joints nd extension ofthe prosimal and distal interphalangeal joints Dorsal interossei: The sides of the metacarpal Palmar interossel: The medial side of the second metacarpal and the lateral sides of the fourth and fifth netacarpals Dorsal interossei: The lateral sides of the bases ofthe proximal phalanges and the extensor expansions Palmar interossel: The bases ofthe proximal phalanges and the extensor ‘expansions The ulnar nerve190 Aratomy Recall What are the actions of the: Dorsal interossei museles? 1. Abduction of the digits from the axial Tine (ie the third digit) DAB (Dorsal Abslucis) Flexion of the metacarpophalan joints 3. Extension of the interphalangeal joints snber al Palmar interossei muscles? 1. Adduction ofthe digits to the ail line; remember PAD Aut) 2, Flexion ofthe mnetacarpophalangeal joints 8, Extension ofthe interphalangeal joints VASCULATURE AND INNERVATION OF THE HAND In the hand, the radial The princeps pollicis artery and the deep artery divides into which palmar arch vessels? ‘The princeps pollicis artery ‘Two proper digital arteries divides into which vessels? Identify each region on the following figure by the nerve that innervates itOWER REVIEW Chapter 7/ The Upper Extremicy 191 A ~ Radial nerve B= Median nerve © D= Ulnar nerve E= Radial nerve F = Median nerve PECTORAL GIRDLE AND SHOULDER Which six muscles pass from the seapula to the humerus and act on the shoulder joint? Which four muscles aid in the medial rotation of the humerus? Which two muscles rotate the humerus laterally? What are the four “rotator ceuff™ muscles? ‘Which muscles insert on the: Greater tubercle of the humerus? Lesser tuberele of the humerus? Of the four rotator cuff muscles, which does not rotate the humerus? 1 2 us muscle 3. Teres minor musele 4 5. Subseapularis musele Deltoid muscle 6, Teres major muscles Deltoid muscle msele Teros major Latissimus dorsi musele Infraspinatus nuscle 2. Teres minor muscle siTs. Supraspinatus muscle Tofraspinatus muscle ‘Teres minor muscle Subscap The supraspinatus,infraspinats, teres minor muscles (4, the pos rotator cuff muscles) ‘Tho subscapularis musele (ie. the anterior rotator cuff muscle) The supraspinatus ruse (the infraspinatus and teres rotate the humerus laterally, whi subscapularis muscle is involved rotation)192 Anatomy Recall Identify the labeled mus- cular attachments on the following figure, showing the posterior surfaces of the clavicle, scapula, and proximal humerus: mooo > om AXILLA ‘The axillary artery extends from where to where? Which muscle divides the axillary artery into three parts? Drigin of the deltoid muscle 1B = Insertion ofthe supraspinatas rmusele C= Insertion of the infraspinatus muscle Insertion ofthe teres minor musele Origin of the triceps muscle, lo head Drigin of the teres minor 1 Insertion ofthe deltoid muscle 11 = Origin of the supraspinatus muscle T = Origin of the infraspinatns muscle J ~ Origin ofthe teres major muscle cle ‘Tho lateral border ofthe fist rb tothe inferior border of the teres major muscle “The pectoralis minor museleARM Which nerve and vessel run in the spiral groove on the bback of the humerus, and tare therefore susceptible to damage following fracture of the humeral shaft? Describe the four muscles of the arm in terms of their fascial compartments. Which nerve innervates the: Flexors of the upper limb? Extensors of the upper limb? Which musele is the main flexor of the humeroulnar joint? Which muscle is the main extensor of the humero- ‘ulnar joknt? Weakened flexion of the humeroulnar joint and supination of the forearm suggests damage to which, (Chapter 7/ The Upper Extremicy 193 Te radial nerve artery the deep brachial Anterior fascial compartment: Biceps bach, brachialis, and coraeo- Drachilis muscles flexors) Posterior fascial compartment: ‘Triceps brachii muscle (extensor) The cnlocutanicous nen The radial nerve “The triceps brachii muscle “The musculocutancous nerve ELBOW REGION AND FOREARM Which nerve passes behind the medial humeral epi ‘condyle (“funny bone”)? The ulnar nerve194 Anatomy Recall All ofthe flexor muscle the forearm are innervated by the median o ulnar nerves except for which ome? nerve innervates all of the posterior muscles of the forearm? WRIST AND HAND What carpal bone is the most commonly fractured? Which structures pass through the carpal tunnel? Which artery lies in the anatomic snuff box? In the hand, which nerve innervates th ‘Thenar museles? Hypothenar muscles? The brachioracalis uscle—despite being safleor, the brachioradialis wscleis supplied by the radial nerves this micas that tis the one exception tothe rue that the radial nerve isthe “nerve ofthe extensors The radial nerve ‘The seaphoidl bone; fracture causes tenderness in the anatomic smufl box ‘The medlian nerve (this is the nerve that, {compressed in carpe tunnel syndrome), the flexor pollicis longus tendon, the four fleyor digitoru profundus tendons, and the Four flexor digitorum superficialis tendons The radial artery Medial nerve Ulnar nerveTHORACIC WALL The Thorax Which bones form the skel ton of the thoracie wall? "The sternum is composed of which three segments? Which bones form the bor- ders of the superior thoracic aperture? ‘The sternal angle (ma briosternal joint) marks the location of which three ‘What is contained in the costal grooves, immediately inferior to each rib? How many spaces are ther do they con tercostal sand what Name the three i muscle layers. 1. Vertebrae T1712 2 Ribs 1-12 andl their associated costal cartilages 8. The stern “The manubriam, the body, and the xiphoid process Vertebra TL, nb 1, and the manubeiuin of the stern 1, The beginning and aortic arch "The carina of the hangs (i.e, the bifurcation of the trachea into the left and right main stem bronchi) 3. The separation ofthe superior and inferior mediastinum [draw a horizontal line from the sternal (anteriorly) to the vertebrae TTS, swertebral disk (posteriorly) ding of the Nevrowaseular bundles (VAN: Ve Artery, Nerve] ach contains « neurovascular bundle and three musele ayers 1. Estom 2 Internal 3. Tnnermost intercostal 19s,Superiorly? Inferiorly? ‘The superior and inferior mediastinum are separated by a plane passing between which structures? ‘Superior mediastinum ‘What structures are con- tained within the superior mediastinum? What are the first branches off of the aorta? What is the first branch off the arch of the aorta? ‘The brachiocephalic artery gives off which two major branches? What is the second branch off the arch of the norta? What is the third branch off the arch of the aorta? Which structure hooks around the aortic arch just lateral to the ligamentum arteriosum? Which two veins join to form the superior vena cava? Which two veins join to form the brachiocephalic vein? Where does the thoracic duct empty? Chapter 8/ The Thorax 197 ‘Tho superior thoracie aperture ‘The diaphragan ‘The sternal angle and the TTS intervertebral disk ‘The hyn gland ‘The trachea rd of the evophagus duct ‘The vagi and phrenic nerves and the recurrent lannigedl nerve 6. The great vessels “The right and left coronary arteries ‘The brachiocephalic artery ‘The right common carotid artery and the right subclavian artery “The left common carotid attery “The left subclavian artery ‘The loft recurrent laryngeal nerve “The let and right brachiocephalic veins The internal jugular vein and the subelavian vein Into the left internal jugular or left subclavian vein, just before these veins join each otherInferior mediastinum ‘The inferior mediasti divided into which three ‘compartments? What is located in the anterior mediastinum? List seven structures con- tained in the posterior mediastinum. Which artes supplies th Upper third of the esophagus? Middle third of the esophagus? Lower third of the esophagus? What structure is contained within the middle ‘mediastinum? HEART Chapter 8/ The Thorax 199 Anterior, middle, and posterior ‘compartinents A portion ofthe thymus gland 1. The lower two thinds ofthe esophagus 2. The anterior and posterior esophageal plesuses 8, The descending aorta 4. The thoracie duct 5. Sphanchnic nerves 6 The aygos vein 7. Theh wygos vein ‘The inferior thyroid artery ‘The bronchial and esophageal arteries, branches ofthe descending worta ‘The left gastric and let inferior phrenic arteries ‘The heart What are the three layers of ‘cardiac tissue? What isthe apex of the heart? What is the base of the heart? What is the margin betw the atria and ventricles called? 1. Epicardiun 2. Myocardi 8, Endocardiam “The pointed portion of the heart formed by the projection ofthe left ventricle downward, forward, and tothe left ‘The posterosuperior portion of the heart formed primaaily by the left atria ‘The coronary sulensOutilow valves of the ventricles? Deseribe the flow of blood through the heart. What are the valves formed from? How many leaflets does the mitral valve have? ‘What is the orientation of the two leaflets of the mitral valve? How many leaflets does the tricuspid valve have? What is the orientation of the three leaflets of the tricuspid valve? Each mitral and tricuspid valve leaflet is attached to hhow many papillary muscles? What structures connect the smitral and tricuspid valve leaflets to the papillary muscles? What is the function of the papillary muscles? Chapter 8 The Thorax 201 1. The pulmonic vabe 2 The aortic va Blood flows from the right atrium to the right ventricle through the tricuspid valve, From the right ventriele, blood flows tothe pulmonary artery through the palmonic valve and throngh the lungs {nto the let atrium. From the left atrium, blood passes tothe left ventricle through the mitral valve, and then to the aorta through the aortic valve Thin sheets of fibrous tissue called cusps (leaflets) Anterior and posterior Three Anterior, posterior, nl septal (medial) Two Chordae tendineae ‘They help hol ty valves elosed darn ventricular iflons ventricular ejection (contraction)Identify the structures that form the heart’s conducting system on the following figure: Chapter 8/ The Thorax 203 ‘What is the path of electrical stimulation in the normally functioning heart? ular node ular bundle (of His) Purkinje fibers “The impulse arises spontaneoushy in the sinoatrial node ancl travels across the atria, causing them to contract. The ‘mpase stimulates the atrioventricular rnode, which distributes the impulse through the atrioventricular bundle (of His). The atrioventricular bundle (of His) has right and lft branches consisting of collections of specialized conducting vocytes called Purkinje fibers. From the Purkinje fibers, the impulse passes to the ventricular myoeytes, resulting in ventricular contraction.(Chapter 1 The Thorax 205 Where do the right and left From the sinuses of Valsalva, which arc main coronary arteries arise? located within the right and lft leaflets of the aortiovale ‘The right coronary artery 1. The marginal artery generally gives rise to which 2. The posterior interventeicular two major branches? (posterior descending) artery ‘The anterior right atrial ‘The sinoatrial nodal artery branch of the right coronary artery gives rise to which small, yet very important, branch? ‘The left main coronary 1. The circunalle artery artery gives rise to which 2. The anterior interventricular (lef two major branches? rior descending) artery What are the two major ‘The diag types of branches of the left perforating b anterior descending artery? Which structure is supplied ‘The anterior two thinds ofthe by the diagonal branches interventricnar septum aand the perforating. branches? |dentify the shaded struc- tures corresponding to the venous drainage of the heart, as well as the other labeled structures, on the following sternocostal view of the heart: branches and theLUNGS Chapter 8/The Thorax 207 Name the two fissures of the right lung. What is the fissure of the left lung? Name the three lobes of the right lung. Name the two lobes of the left lang. ‘What is the lingula? Name six components of the root of the lung. Which of these structures is posterior? Which of these structures is anterior and inferior? How does the location of the pulmonary artery differ from the right to the left? Describe the ten terms used to describe the airways as the got progremivly Oblique (inajor) and hori ‘The oblique (major) fissure 1. Right upper lobe 2 Right middle lobe 3. Right lawer lobe 1. Left upper lobe 2. Left lower lobe ‘The lingula (from Latin dingwa, meanin tongue) is a smal extension of the left upper lobe; you can think of it as being the left-sided equivalent of a middle lobe. Primary (main stem) bronchus nomary artery Superior and inferior pulmonary veins Bronchial artery and vein The pulmonary nerve plexus Lymphaties "The primary (ma ‘The pulmonary veins On the lef, the pulmonary artery is superior to the primary (main stem) bronchus and the pulmonary vein, whereas on the right, the pul artery is between the primary (main stem) bronchus and the pulmonary vein Trachea Primary (main stem) bronchus Secondary (lobar) bronchus Tertiary (segmental) bronchus Respiratory bronchioleDeseribe the three main ‘components of the azygos venous system, ‘What isthe name of the Iymph nodes found: ‘Within the pulmonary parenchyma? At the hilum? At the carina? ‘Tracheobronchial nodes on the right side drain to which structure? On the left side? DIAPHRAGM What is the inferior bound- ary of the thoracie eavity? What three arteries supply Which nerve innervates the diaphragm? Where does the phrenic nerve travel through the thorax? Chapter 8/The Thorax 209 the hikum of the hhemiazyos nginto the azygos and. 1, The azygos vein proper forms a Dridge between the superior vena cava and the inferior vena cava and accepts flow from the intercostal vein. Like the vena eavae, the azygos vein runs ‘on the right side, 2. The hemiazygos vein drains the inferior lft side and empties into the azygos ve 3. The accessory hemiazygos vei drains the superior left side before ‘emptying into the azygos vein, ‘Tracheobronchial nodes ‘The right thoracic duet ‘The left thoracic duct ‘The diaphragm 1. Inferior phrenic artery 2. Musculophrenie artery 3. Pericardiacophrenie artery ‘The phrenic nerve Just on the outside ofthe perieardinmWhat are the ligaments within the breast called? What are the three major arteries that supply blood to the breast? Which arteries make minor ‘contributions to the blood supply of the breast? What percentage of breast Iymph node drainage lateral? Where do the lateral Iymph nodes of the breast drain to? POWER REVIEW. Chapeer 8/The Thorax 2 Cooper's ligaments ort 1, Perforating branches of the internal 2. Lateral mammary branches of th lateral thoracie artery 3, Pectoral branches ofthe thoracoaeromial artery ‘The subscapular artery and intercostal perforating arteries Approximately ‘Most drain to the aia lymph nodes, first to the pectoral group (deep to the pectoris major muscle along the inferioe horer of the pectoralis minor muscle), and then tothe superficial apial group, “The parasternal Iymph nodes, which run svith the intemal thorace How do the neurovaseula bundles run along the thoracic cage What are the first branches of the aorta? What are the branches of the wortie arch? Which is the most anterior of the great vessels in the midline? What are the two major arteries of the heart, and which parts of the heart do they supply? In the costal grooves beneath the nbs The right andl left coronary arteries The brachiocephahi artery, the let ‘common carotid artery, an the left tery subelav The left brachiocephalic ve to join the ri bbrachiacephalie vein anal for the superioe vena ewa 1. The left main coronary artery gives off two branches. The anterior interventricala (loft anterior descending) artery supplies the(Chapter 8/ The Thorax 213 ‘The esophageal hiatus is The right eras formed by which portion of the diaphragm? Innervation of the diaphragm — C3, C4, and C5 keep the diaphragm alive’ is by which spinal nerves?Chapter 91 The Abdomen 215 Identify the nine abdominal regions on the following figare: i —---42 81 \ es t- hz Left hypochondrie region H= Left lumbar region 1 = Left inguinal region Note that in practice, often refer to the abdomen in terms of four quadrants, delineated by horizr ‘and vertical planes through the wName the strapslike vertical ‘muscle of the anterolateral abdominal wal What structure encloses ‘most of the rectus abdominis muscle? What forms the reetus sheath? In addition to the rectus abdominis muscle, what structures are enclosed by the rectus sheath? Which vessel gives rise to the: Superior epigastric artery? Inferior epigastric artery? Identify the lettered strue- tures on the following figure of the anterior abdominal wall: Chapter 9/The Abdomen 217 The rectus abdominis muscle ‘The rectus sheath ‘The aponeuroses of the external oblique, oblique, and transversus 1. ‘The pyramidalis muscle (in 80% of people) 2. The superior and inferior epigastric arteries and veins 3. Lymphatic vessels 4. The T7112 ventral primary r Internal thoracie artery External iliac artery Xiphoid process Linea semilunaris UmbilicusIdentify the borders of the inguinal triangle (Hlesselbach’s triangle) on the following figure: Chapter 9/ The Abdomen 219 ‘The intercostal nerves run hetween which layers of the abdominal wall? What are the major nerves of the anterior abdominal wall? Which muscles are inner: vated by the subcostal nerve? Deseribe the lymphatic drainage of the anterior abdominal wall, A= Inferior epigastric artery and vein B= Lateral horder ofthe rectus abdominis muscle (Le. the linea sabdomins muscles, “neurovascular plane, “The inferior six thoracic nerves (T7-TH) and the subcostal nerve (T12) ‘The external oblique, internal oblique, transverss abdominis, rectus abdon sand pyramidalis muscles Above the umbilicus, drainage isto the auillary nodes. Below the urn drainage is to the superficial ‘external iliac, and aortic (lumbar) nodes.